EP187: Embracing Emotions: Dr. Annia Raja on Burnout, Grief, and Healing

Exploring Physician Grief and Burnout with Dr. Annia Raja

In this episode of The Girl Doc Survival Guide, Christine chats with Dr. Annia Raja, a licensed clinical psychologist specializing in therapy for high achievers, including physicians. Dr. Raja shares insights from her own experiences as a physician's spouse and dives deep into the many facets of grief that physicians encounter, including personal losses, changes in identity, and professional sacrifices. The discussion also touches on the interconnected nature of grief and burnout, the importance of emotional intelligence, and the need for social support in the grieving process. Dr. Raja emphasizes the idea that acknowledging and naming grief are essential steps to finding purpose and meaning beyond the medical profession. Dr. Raja offers therapy for physicians, link here.

00:00 Introduction to Dr. Annia Raja

01:04 Personal Anecdote: Grief in the Medical Profession

02:23 Understanding Physician Grief

07:51 The Link Between Grief and Burnout

10:20 Emotional Intelligence and Grief

13:35 Final Thoughts on Grief and Connection

Transcript

Christine Ko: [00:00:00] Welcome back to The Girl Doc Survival Guide. Today I'm happy to be with Dr. Annia Raja. Dr. Annia Raja, PhD is a licensed clinical psychologist who specializes in providing therapy to physicians and other high achievers struggling with burnout and looking to find meaning and purpose in life and beyond work. She earned her PhD at the UT Southwestern Medical Center in Dallas, and she now runs an online therapy practice serving clients in California, Texas, and many other states. As the spouse of a physician, Dr. Raja brings both personal and professional insight into the unique challenges of being a doctor. Dr. Raja recently wrote on the many faces of physician grief and why naming grief matters. She also regularly writes on other themes central to physician wellbeing, such as burnout, identity outside the white coat, and the hidden emotional costs of practicing medicine; all topics that I'm very interested in.

[00:01:00] Welcome to Annia.

Annia Raja: Thank you so much, Christine. I'm honored to be here with you. 

 Christine Ko: Can you first share a personal anecdote? 

Annia Raja: My husband is a physician in a demanding specialty. He and I have been together since college. In our own respective professional journeys, there's been a lot of intersections of grief from the literal of both witnessing and directly experiencing death, that's the most kind of acute example, the most obvious one; all the way to the more subtle ones. When I think about grief, what doesn't get talked about is the grief that comes with changes in life and the sense of self. With the arc of both of us moving through our respective careers, there has been grief in terms of aspects of ourselves that may have shifted or have been lost along the way. We have had to contend with, what does it mean for us to be good stewards of each other's emotions? Grief included, as well as how [00:02:00] can he and I be good, safe harbors for a sense of respite and reprieve from painful emotions. Grief is inescapable, professionally and personally. Grieving is essential to what it means to be alive and to experience life. There's a much broader umbrella to the theme of grief beyond just death and dying.

 Christine Ko: It's interesting what you said, that there's a fair amount of grief associated with the self, like losing a part of yourself. One of the reasons I was interested in your recent article is because I was talking to a friend of mine named Tony Subtil. He brought that up, that he realized through grieving recently with his mother's passing that there was grief also when he moved from the US; he's now in Canada. All the times he moved during training, those kinds of losses, you would grieve for them as well, but he didn't really, at the time. Can you talk a little bit more about that, [00:03:00] about grieving a part of yourself? 

Annia Raja: Yeah, absolutely. I think this is something that physicians uniquely experience, given the nature of training, the grueling nature of training and the arc of becoming a physician. Physicians broadly are in training the formative years of your life. This is your early to mid twenties, into your thirties, sometimes even into your late thirties. And then there's also the physicians where they might have come to medicine later in life. That's an example that my husband contends with too. He had a career prior to entering into medicine, completely unrelated to medicine. When we look at the life stages that we're navigating, the one thing that is finite in life is time. We can't get time back. And so grieving the loss of time itself, grieving there may be milestones that you've had to miss out on or maybe perhaps have felt like you have [00:04:00] to miss out on, whether it's particular events like a family wedding or gap years, even, taking breaks from medicine, all the way to some of the tougher moments of whether it's losing a family member during the course of medical training, losing aspects of yourself, even hobbies. Physicians often come to me in a state of burnout, and I would say, grief. They have lost a sense of themselves along the way. Often a sense of, I don't even know who I am outside of my doctor identity. And so naming that there's a sense of loss and grief about who one is, I think that's an essential step to starting to cultivate what could I be or how could I have a sense of myself again, or have a sense of myself at all in the first place.

 Christine Ko: Yes. I will put a link to your recent Kevin MD article in the show notes. You name some examples. You call them the many [00:05:00] faces of physician grief, and of course you say patient loss, but you talk about lost ideals and personal sacrifices and medical errors and near misses, transitions and endings, and systemic injustice, and moral injury, and career detours. And even the body's toll, like injuries from standing long hours or chronic back pain or stress related illness. So you name all that.

I'm close with my sister. My sister, she said to me relatively early on when I was in training, she was like, you've changed since you've been in medical school, and you're an intern now and you are just different. And she meant that I used to be more happy go lucky, somewhat structureless. She definitely felt that I had lost that happier being, self.

Annia Raja: When we're cultivating one aspect, there's always a sense of loss that comes with the opposite. The sense of structure and the imposition of that that can often come for [00:06:00] doctors not only in training, but just over the arc of their careers. It necessitates that sense of loss with, what does it mean to have a sense of freedom, a sense of spontaneity, a sense of looseness, of uninhibitedness? The opposite is true too; when we're in a experience of feeling unmoored or feeling a sense of openness and expansiveness, there can be this yearning for structure, right? For physicians, the impulse can be so laser focused and have our heads down and be like, I'm doing it. There's gonna be some payoff on the other side. Once I get done with training, it's gonna all be worth it. This sense of punting gratification, punting living life. And when you're on the other side, wherever you go, there you are, life is gonna feel better. When that fantasy inevitably shatters, that itself can bring grief to it too. I've noticed in my therapy practice of having doctors reach out to me within three to [00:07:00] five years post training. They're not reaching out immediately once they're done with residency or fellowship. It's a couple of years after. Enough time has passed post training where that illusion of, I'm finally gonna start living. It's finally settled in, Oh wait, life doesn't quite work that way. And that can be really unsettling and really, sometimes even destabilizing for people where, It's wait a second, all these years have passed. What did I give up all this in my life for? Making both sense and meaning and emotionally processing that arc, that's often really necessary for people to grieve the past in order to make more meaning and purpose about how they want to live in the present, what future they wanna be working towards. Those are fundamentally interconnected. 

 Christine Ko: That's interesting. A little earlier you said that grief often is related to burnout. Can you talk about that? 

Annia Raja: Yeah. I won't [00:08:00] even attempt to ascribe cause and effect with that. Burnout, to define this phenomenon, it's a state of chronic exhaustion, of cynicism, of detachment, of depersonalization. To colloquially speak to it, it's being in zombie mode. You're moving through life but not actually living. Does burnout cause grief? Does grief cause burnout? I think they're in an enmeshed relationship together. Grief is in fundamental relationship to burnout because it's often the lack of experiencing the human emotion of grief among others that is reinforcing the experience of burnout.

So much of what is rewarded for doctors is the ability to numb and to just get through and get the job done without demonstrating any emotion. It does necessitate numbing actual emotional experience. We as [00:09:00] human beings are not capable of selective emotional numbing. That's not possible. When we tell ourselves, I'm gonna numb the unpleasant. I'm gonna numb the painful, I'm gonna numb the "bad". We can't selectively do that. What ends up happening is we numb ourselves to the full spectrum of human emotion. So we numb ourselves to the capacity to feel joy, to feel pleasure, to feel meaning, to feel fulfillment, contentment and happiness, to use that kind of catchall term. I say that a little flippantly because there's such a western fixation on happiness, as if that's always the goal, but happiness is in relationship to sadness, to pain, et cetera. And that's also to say nothing of other meaningful ways of moving through life that are more rooted in fulfillment, purpose, meaning, which doesn't necessarily mean that we're happy all the time.

We have to cultivate the ability to [00:10:00] feel. We can't selectively numb. So if we wanna feel those meaningful, pleasurable emotions, it will necessitate that we increase our capacity and our tolerance and our willingness to be able to feel the painful.

 Christine Ko: The things you're saying are in parallel to what I was talking about with my friend Tony. One thing he said was, you have to feel the feels. Naming grief and not selectively numbing goes to emotional intelligence, which is defined in various ways, but being emotionally intelligent means that you can name your feelings, manage them, and act on them, and use them as data. So really just name it, just like you were saying earlier, name grief, but also, be able to name this emotion, whether it's grief or something else. I've been learning how to be emotionally intelligent. It's really hard for me to feel my feelings. I would rather numb.

Annia Raja: It's a human impulse, right? A lot of emotional intelligence, to use that phrase, or emotional experience, is a [00:11:00] skill that can be cultivated. The ability to cultivate this ability is a growth edge that we all can have. Have a kind of curious child's mind about our feelings, suspending judgment, suspending criticism, suspending any urge to try to assess or to solve. Just having more of a curiosity of, what am I feeling? That can even be a language gap where we don't even have the adequate vocabulary and the specificity to be able to name our feelings. That is a skill that can be cultivated. As that is cultivated, also inviting a curiosity of, what might my emotions be telling me? Emotions can be data. There's something that my feelings are trying to tell me. Every emotion serves some function. There is no "bad" emotion. It's all a source of information. One common example is anger. One of the [00:12:00] functions of anger is that it's a response to a perceived injustice. Response, perception, and injustice. So when you notice anger, what type of injustice might you be perceiving? And I've found that that question really opens up a lot of things for people.

To bring it back to grief, the topic that we're discussing today, it's very similar. A function of grief. Grief is a sign that you are alive and you are living. If you think about the opposite, if you didn't feel grief to loss, if you didn't feel grief about losing a loved one, or if you didn't feel grief about systemic injustices, if you didn't feel grief about a loss of a sense of self. I think there's a deeper problem then, right?

We, we really have a lot of work to do on cultivating a sense of enlivenesss. And so thank goodness that grief is there to tell you that you're still [00:13:00] living.

 Christine Ko: Great. You've mentioned name it, figure out what that's telling you, whether it's grief or anger. And you also mentioned a little earlier too, and it's in your Kevin MD article as well, to be compassionate to yourself. You were touching on it earlier with saying, be curious, and be like a child, and just think about it. Don't judge yourself. And all of that is part of being compassionate to yourself about what you're feeling. Is that the case? 

Annia Raja: Oh, absolutely. You stated it beautifully. 

 Christine Ko: Okay. This has been great. Do you have any final thoughts? 

Annia Raja: The last thing I'll share is humans are fundamentally social beings. We are meant to be in relationship and in connection with each other. And when it comes to grief, especially grief, I think it needs to be meaningfully moved [00:14:00] through in connection with other people, with friends, with family, with colleagues, in therapy, which is something that I encourage everyone to consider at some point in their life. These types of feelings are meant to be felt and moved through in connection with someone else. It's not meant to be done in silo. The urge with emotions like grief can often be to isolate, to suppress, and to numb. Too often shame has a similar impulse. When we experience shame, the impulse is to hide, to isolate, to be secretive. And the antidote to shame is to be in connection, to share. That's very aptly related to grief. The antidote to grief is to connect with others about it and to share the experience of that. I don't say that from a solution perspective, like you're [00:15:00] gonna solve your grief. Having someone bear witness to that grief with you is something I would love to encourage your listeners to consider. The last note that I would leave your listeners with is to share. 

 Christine Ko: Great. It's been a pleasure to talk to you. Thank you for all your insights, your article, and your time.

Annia Raja: You're so welcome. Thank you for having me. It's been a pleasure as well.