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Episode: How do you feel? A conversation with Dr Jessi Gold

Author: Michelle Chestovich MD
Duration: 00:42:07

Episode Shownotes

Physican coach Michelle Chestovich MD had a conversation with psyschiatrist, wellness officer and author Jessi Gold MD. Her book is part memoir and part patient stories about how we deal with burnout and the stressors of our job. Incredible book and I highly suggest for you and everyone you love!Grab

How do you Feel? here: https://www.simonandschuster.com/books/How-Do-You-Feel/Jessi-Gold/9781982199777I'll be hosting a virtual bookclub on this book in 2025, sign up here if you'd like an invitation:https://mamadoclifecoaching.myflodesk.com/bookclub

Full Transcript

00:00:00 Speaker_01
You are listening to Episode 198 of the Remind Yourself Podcast. Welcome to the Remind Yourself Podcast, the podcast for physician moms just like you who want to ditch mom guilt, stop yelling, and start enjoying their lives today.

00:00:21 Speaker_01
I'm your host, Rachelle Chestevich, certified life coach, family physician, and mom of four. If you want to overcome overwhelm for once and for all, this is the place for you. Hello, Mama Docs, and welcome back.

00:00:39 Speaker_01
Today, I have a most amazing human who is going to share information that is going to benefit all of you. I learned about her because she wrote an awesome book.

00:00:50 Speaker_01
So not only is she an esteemed wellness officer at the University of Tennessee and a psychiatrist and associate professor, she is the author of How Do You Feel? One Doctor's Search for Humanity in Medicine.

00:01:04 Speaker_01
Folks, I listened, I read this book, rather, and it so resonated with me that I went and reached out and said, Dr. Jessie Gold, please come and be on my podcast. And she so graciously said yes. So welcome, Dr. Jessie Gold. Thank you for having me.

00:01:20 Speaker_01
I'm so excited to have you here. So before we delve into your amazing book that seriously, every human should really read because it affects all of us the way our brains work. particularly those of us in health care, it really affects us.

00:01:35 Speaker_01
So before we get into that, tell us just a little bit about yourself. Where are you at? What are all the amazing things that you're doing?

00:01:41 Speaker_00
Sure. I live in Memphis, Tennessee. I've been here since February of this year, so almost the end of the year, so almost a full year when we're recording this. I grew up the youngest of four. My dad is also a psychiatrist.

00:01:58 Speaker_00
I don't have kids, but I have a dog. Her name is Winnie. I am a psychiatrist who sees health care workers and college students in my other hat. I'm the chief wellness officer of a five school university system that also started in February.

00:02:13 Speaker_00
Busy in that hat, obviously. I started writing as a way of processing and coping, and that has evolved into part of my job as well, as you mentioned the book. But I do a lot of freelance writing, too, for the same reasons. I like Taylor Swift.

00:02:29 Speaker_00
I like stupid television. Oh, what's your favorite stupid television? Depends on my mood. I liked that show. Nobody wants this recently.

00:02:39 Speaker_00
And then I liked I just watched some show with Keir Knightley, and that was pretty decent on Netflix called Black Doves or something like that. But I mostly just like get sucked into random Netflix shows and

00:02:53 Speaker_00
like Bravo and also like around this time of year, like I didn't even realize Netflix was starting to make so many holiday movies, but turns out they went right into that market.

00:03:04 Speaker_00
And now I can just watch dumb holiday movies for hours, which I'm not going to complain about.

00:03:09 Speaker_01
Oh, my gosh, I love that. So my teenage daughters, they've been studying hard. They've got finals coming up, but they study. And then at eight o'clock, they're like, what show are we going to watch tonight?

00:03:18 Speaker_01
And they've been just snuggling in and watching holiday shows. And it just makes my heart happy because it's a nice diversion, a nice break. So I want to learn more about this wellness work before I jump into the book. Tell me about that.

00:03:29 Speaker_01
Is it just the medical system or is it all of the colleges, all of the schools?

00:03:35 Speaker_00
Yeah, so I, before this job, worked at Washington University in St. Louis, and through the Department of Psychiatry, did outreach, education, and engagement, basically, with wellness, starting from the Department of Psychiatry.

00:03:48 Speaker_00
And then I built our faculty and staff clinic and did a lot of outreach that way. And that was really focused on the hospital system, but also the people who are faculty and staff at the university.

00:03:58 Speaker_00
This job is a new job and it's over all five schools of the University of Tennessee.

00:04:03 Speaker_00
So that includes like UT Knoxville, which you've probably seen from sports, UT Chattanooga, UT Southern, UT Martin, and where I'm based physically, which is the Health Science Center.

00:04:14 Speaker_00
So the Health Science Center is like one batch of students, but I have undergrads and graduate students across the system. And my job is basically to say like, What are we doing? And how can we do that together?

00:04:25 Speaker_00
And how do we support each other in a common mission, which is making people feel safe at school, well at school, wanting to stay in school, wanting to finish school, wanting to come back for other schools, all of the above, but as it relates to wellness and, you know, sort of looking

00:04:41 Speaker_00
Who is doing what well? Who's having issues? Are they common issues? How do you break down silos to support people in addressing issues that are common across campuses? I think we reinvent the wheel a lot.

00:04:52 Speaker_00
I think we have a lot of silos in academics that don't need to be there. And it lets us have conversations and feel supported in ways that maybe we wouldn't otherwise.

00:05:00 Speaker_00
And so I often say my job isn't to like come and tell people what to do, but to bring people together to figure out what to do. And it's been a really cool experience. I've never worked in a big school system like that before.

00:05:11 Speaker_00
It's a unique sort of chief wellness officer role because it encompasses health care, but also the other parts of higher ed, which I haven't been doing outside of clinical work before. So it's kind of cool.

00:05:22 Speaker_01
I love that. And I think it's so important, right?

00:05:24 Speaker_01
I mean, I focus all about like how we can help health care workers feel better and remember, oh, by the way, we're human and we need to take care of ourselves, whether we're sick physically or our brain is needing a little bit of help.

00:05:36 Speaker_01
I love bringing that up. But also all the humans need help and support. And I think that work to make it just like this is part of it and it's just normal is so good and de-stigmatizing.

00:05:47 Speaker_00
Wouldn't you agree? Yeah, I mean, I think that healthcare workers start in college, right? Yes, that's right. If we learn a lot of these things earlier, the better we'll be when we get to school, the better we'll get at residency.

00:06:01 Speaker_00
You know, I just think that it's just not part of what we're focusing on when you're trying to be perfect or you're trying to get all good grades or when grades are your sole focus.

00:06:10 Speaker_00
And so sort of having that be a value that you learn early on, I think matters. Like, you know, they do it in elementary school for some folks now, and there's positives to that as well.

00:06:20 Speaker_00
But I do think that college in particular is a skill learning environment. You're learning how to develop as an adult, you're learning how to take care of yourself as an adult, you're learning all sorts of things on your own.

00:06:32 Speaker_00
And so I think in that context, it should be how do you balance work and life and how do you find like

00:06:38 Speaker_00
feelings overwhelm you and what do you do about that and where do you get help and how do you know and all that stuff that I think is important for work moving forward and life moving forward.

00:06:48 Speaker_00
And if you don't learn it when you're young, when you get to a more stressful environment with not as much flexibility, you're going to have a harder time.

00:06:56 Speaker_01
That's so good. I just, it warms my heart because I believe so much in this work and I'm also a primary care doc. So I also believe in prevention. So I'm like, okay, yeah, let's help the people who are out in medicine, but let's back it up.

00:07:08 Speaker_01
Residency, medical school. No, no, no. Listen, I love that you're like, no, we do it way before. I'm like, that's. Brilliant.

00:07:13 Speaker_01
You know, I have a first year in college and she's doing chemistry, maybe thinking the pre-med route, and it's a lot of stress, but we talk a lot about like, how do you relieve your stress? That's great that you can talk about it.

00:07:22 Speaker_01
Oh, you're seeing your therapist? Awesome. And you're doing your little color sheets? Are you moving your body, sleeping, right? All those things. But I'm just, I'm just her mom, right? But it's so lovely that you're doing that on a bigger scale.

00:07:34 Speaker_00
Yeah, I mean, it was really important, like in the book, one of the characters is a pre-med for that reason, because I wanted to make sure that we kind of thought about the path to getting here and not just assuming that med school was the entire problem or nursing school was the whole problem or whatever, because sure, like that's part of it, but we're humans before we get there.

00:07:51 Speaker_00
We're fully grown adults. And we've already had a lot of life experiences and we're bringing those with us. And if you ignore that part, you are missing a big part of I think our like development as humans and our development emotionally.

00:08:04 Speaker_00
And I think it's really important to kind of like shift that back. And I think You know, healthcare in so many ways is about putting out fires and not about prevention.

00:08:13 Speaker_00
I think mental health is very similar because if you're dealing with crises and you're overwhelmed with crises, you can't work on prevention. And I think at least in my job, I've had the privilege of being able to step back a bit because I'm not

00:08:26 Speaker_00
actively on any of the campuses putting out the fires, like that's not my job. I can support them where it makes sense, but I'm not the person that's putting out the fire.

00:08:35 Speaker_00
I'm the person who can kind of take a bird's eye view and like, while we're dealing with things, also think about what it looks like more broadly.

00:08:41 Speaker_00
And I think it gives us the ability to look like preventatively in a different way that like you wouldn't otherwise, because you're so focused on what you have to do and what is necessary in the moment, which is how our healthcare system is set up, unfortunately.

00:08:55 Speaker_01
Oh my gosh, I love that. It's so brilliant. And I love that... What was I thinking? You mentioned that, yes, it starts earlier. And the other thing I was going to say, we start to get some bad habits in place, right?

00:09:06 Speaker_01
You know, these perfectionist tendencies don't just start in medical school. They start earlier. And how can we learn to deal and cope and

00:09:15 Speaker_01
Just so so it's just like there when we when we, God forbid, make a mistake, we don't get the A plus on our tests. Like, how do we deal with it? I love, love, love that you're doing that. That's thank you for that work. It's so amazing.

00:09:27 Speaker_01
And I hope all the universities across the nation like I'm not I didn't understand that that's. that it was all of the schools. I think it's amazing. I'm like, all the schools around the nation.

00:09:35 Speaker_00
Yeah, most people don't because like the role of chief wellness officer really originated in homes. And I, and I have such a background in that, that most people just assume that it like, even when people read my title, they add health system a lot.

00:09:47 Speaker_00
And I'm like, no, no, no, no.

00:09:48 Speaker_01
The whole system more, I was admiring it before, but I think it's even, I'm more enamored with it. And I think it's even more amazing now that we've talked about it for a little bit. So that's awesome.

00:09:58 Speaker_01
To segue to this book, it starts during the good old pandemic. Tell us a little bit about it. I mean, I love that you so personally share your story. So, you know, it's not a spoiler alert, people.

00:10:09 Speaker_01
You're going to get the book and you're going to read it. It's so good. Dr. Jessie Gold shares her own story with her own brain and dealing with the pandemic. And too, she shares these vignettes from patients. And it's phenomenal.

00:10:22 Speaker_01
And I think there's so many pieces that resonate. Where do you want to start with talking about this amazing book?

00:10:28 Speaker_00
Yeah, I mean, the two-line explanation for anyone who's like, should I, what is it about, is it's part memoir, part patient narrative and follows me and four patients forward as we deal with the challenges caring for ourself when we care for other people for our jobs.

00:10:42 Speaker_00
You know, all of my patients in this book are healthcare workers or healthcare worker adjacent, but it doesn't mean that like anybody who's a caregiver, anybody who struggles at work with feelings, and anybody who's dealt with burnout won't relate.

00:10:54 Speaker_00
It's just a specific industry to highlight in the moment. I think sometimes people get worried when it centers in the pandemic. And I think a lot of what I tried to do was

00:11:05 Speaker_00
use the pandemic as a stressor, as a novel thing that sort of cracked the surface of a problematic system, but not as the like only thing. And it's not a pandemic book that you are going to go, oh, pandemic. Oh, my gosh.

00:11:21 Speaker_00
But it might be reminding of that time for you because it's about that time for me. And I thought in a lot of ways, could I shift it forward? I started writing it in 2021.

00:11:31 Speaker_00
And I don't think that while I went through the long, long writing process that I thought the pandemic would still be going on for so much of it. I was like, oh, well, I'll just write about that and it'll be in an interesting time capsule of time.

00:11:43 Speaker_00
But we talked about whether we wanted to shift it forward and not do the beginning. And I was like, Like, we could, but I don't know that the same things would have happened.

00:11:53 Speaker_00
Like, for sure not to me, but that some of the things that my patients dealt with were also unique to this situation.

00:11:59 Speaker_00
Like, it doesn't mean that we wouldn't have had burnout and stuff to the extent that we did, or I wouldn't have to the extent that I did. But, for example, switching entirely to telehealth when I've never done it before,

00:12:11 Speaker_00
I wasn't going to have that any other way. If I started that in 2022, then I'm just like, and I've been doing telehealth for two years and that's my job, you know?

00:12:20 Speaker_00
And so I think it takes place during the pandemic is not a pandemic book, but really looks at all of the things that cracked a pretty broken system that doesn't prioritize us as humans in it.

00:12:33 Speaker_01
Yeah, I would agree. It's not a pandemic book, but it's sort of like that almost explosion of like you talk about the cracking. And that's exactly right, because most of us know, looking back, we've been treading water for a very long time.

00:12:44 Speaker_01
How long are we just like paddling, paddling, paddling, keeping our little noses above water? And then the pandemic hit and then all of a sudden there's this like This is not a joke anymore. OK, I'm going to work. We don't even have masks.

00:12:56 Speaker_01
And people are telling me to tie a bandana around my face. I'm like, are you effing kidding me about this? Right. Like I was stressed before and now. Yeah. Right. It really did just unleash a torrent of pent up because we're really good.

00:13:11 Speaker_01
Once you say it, pushing down emotion. Tell us a little bit about that.

00:13:14 Speaker_00
Yeah, I think a lot about it as a beach ball. That's how I describe it. And it eventually slaps you in the face more aggressively, right?

00:13:24 Speaker_00
We like to think that pushing our emotions down is like a rock that you bury and that the rock goes away and you never think about it again, but it just doesn't work like that.

00:13:33 Speaker_00
But I explore in the book and I think a lot about how we developed our awareness of emotions in work.

00:13:41 Speaker_00
you know, I specifically obviously do focus on healthcare, but I actually think that emotions in the workplace have their own roles depending on what field you're in and what that looks like.

00:13:49 Speaker_00
And healthcare just, I know better because I'm in it and my patients are in it. And for me, you know, we get a lot of messaging about emotions and, you know, feedback about emotions and boundaries and what it means to be a good caregiver.

00:14:02 Speaker_00
And most of what we get is like that being stoic is perfect and being stoic is a good caregiver. And so we, Even if we come in as people who are more emotional and more empathetic, we learn to protect ourselves. We have to not.

00:14:17 Speaker_00
And to be a good doctor, we have to not. And to fit in the culture where everyone dresses the same and looks the same, we have to not. And so we really push it all away and try to pretend that our job doesn't affect us.

00:14:30 Speaker_00
And I think it sort of becomes like you act it until it's true. And it becomes like a play that you're in until you don't even realize you still do that, that you're doing that at all.

00:14:41 Speaker_00
You know, and for the most part, like we're probably practicing pretty unhealthy coping mechanisms, like actually removing ourselves from the situation and like somewhat dissociating in a way that's not healthy, but we do it to protect ourselves.

00:14:57 Speaker_00
And I know that I do it to protect myself and being aware of that is important, but also being aware that like our job affects us and there's no way that you can just like go pretending like it doesn't is, you know, like I think for some reason we're taught not to.

00:15:15 Speaker_00
So then we approach like our job as if it's not going to affect us. And if we have reactions, that's on us and we're the problem. And it just doesn't make any sense that that's the way it is, but it is the way it is.

00:15:28 Speaker_00
And I think we learn emotions in that context. I interviewed a bunch of people for the book when I was first starting and thinking about it. And without a doubt, and I almost wish I studied this, but I didn't.

00:15:38 Speaker_00
Every single person said codes were how they learned about feelings in medicine that like they went, they saw a code, nobody reacted or worse people went to go eat lunch.

00:15:49 Speaker_00
And so they learned like, yes, we don't care when people die, you know, and like that's an extreme example. So then if somebody is like a little sick or something, like you can't cry then, right? So

00:15:59 Speaker_00
I think that sort of culture is pervasive and I don't even know that we know we do it.

00:16:05 Speaker_00
I often point to the example of like DeMar Hamlin needing CPR on the field for the Buffalo Bills because there was like a time period where when that happened, a bunch of people who had watched it on TV were like, oh my goodness, like CPR is so scary and like traumatic.

00:16:23 Speaker_00
And the healthcare workers on social were like, Oh, my God, is CPR traumatic? You know, like, is that like, should I be affected by that? I see that every day.

00:16:32 Speaker_00
And I think sometimes it takes like a little bit of bursting of that bubble in reality to show us how weird our job is because we get so used to it.

00:16:40 Speaker_00
And I think to me, that was like a perfect example of this intersection of like what actually is true about how our job should and could affect us and what we think is true because we're so desensitized.

00:16:53 Speaker_01
Yeah, I remember that. And I remember everyone saying like, I mean, it was it was a very traumatic, emotional thing to witness. And people are like, oh, my gosh, everyone has to take a break. And how are people ever going to get back to work?

00:17:04 Speaker_01
And it's like, this is what we do in health care all the time. Yeah, you just move on to the next thing. And people do when because, again, as a coach, I talk to people about these things that they're shoving down, right? Like you deliver

00:17:17 Speaker_01
a child that has like a triple nuchal cord and is no longer living, right? That's devastating for you to be in the room, for the family.

00:17:25 Speaker_01
And then you have to just go right next door because the person is precipitously delivering and it's like the most joyous day. It's like, when do we get time to process this crap?

00:17:33 Speaker_01
And that's just such a small example of, as you well know, the things that we deal with day to day. And I believe it's dangerous when we shove it all down because people become, as you well know, one of the tenets of burnout is emotional exhaustion.

00:17:47 Speaker_01
And people come home and they're just like depleted. They're like, I can't do anything. I don't want to think. I don't even want to see the people that I love. I just want to lay on the couch and maybe, oh, by the way, pour me a huge glass of wine.

00:17:58 Speaker_01
and another one, right, to numb that bad feeling. So knowing that this is where many of us are, I think it's just great. I love that you wrote the book so candidly and so beautifully. It was so beautifully written. Your voice is certainly not my voice.

00:18:12 Speaker_01
It's very eloquent. And yet it felt like, I'm like, oh my God, this is the same crap my brain has done. And the same thing that I've talked to other women physicians about.

00:18:22 Speaker_01
I'm like, this just is so familiar, of course, because we all have human brains and many of us go into medicine because we're very compassionate. So what happens?

00:18:30 Speaker_01
You tell us as the expert what happens when we're very compassionate, we really want to help people, and then we have to just like shove down the feelings. It doesn't usually end well. doesn't usually end well.

00:18:41 Speaker_00
I mean, you know, there's studies of like our empathy decreasing over over med school or, you know, what that looks like. And I think that what happens is we try until we can. And in some people, it might work fine.

00:18:54 Speaker_00
You know, they might they might not ever get to the point of burnout. But before pandemic, our numbers were 50 percent. So like that means you definitely know a burnt out physician because you go to more than one probably.

00:19:06 Speaker_00
or a burnout nurse or whatever. And what that does is people leave their jobs and then you don't have access to them.

00:19:11 Speaker_00
And what that does is it makes people stay in hospital longer, makes people not like their care as much, makes errors more common, so that affects patients. But an individual burnout is a risk factor for depression.

00:19:25 Speaker_00
It's a risk factor for suicidal thoughts. We have really high rates of suicide in physicians and nurses. And a lot of that comes from if you push it down and push it down and it's sort of normalized because half of the group has it.

00:19:38 Speaker_00
then by the time you want to deal with it, you're pretty bad. And I would say most of the people that show up in my office are like a nine or 10 instead of like a four or five.

00:19:50 Speaker_00
Like I'm a psychiatrist, so it's going to be skewed anyway, because you're probably at the point that you think you need meds. But that's not great.

00:19:57 Speaker_00
And we're and like speaking of this sort of like intervention prevention thing, like if you think that everybody looks depressed,

00:20:06 Speaker_00
and you're just supposed to be depressed to be in medicine, then when you actually are like, I don't actually want to feel this way. I need it to stop. Like I need help.

00:20:14 Speaker_00
Like you blame yourself for one, but also you wait a lot longer because you're kind of like, I'm pretty sure we're all just dealing with this and I just need to suck it up and deal with it. And then there's a point at which you can't do that anymore.

00:20:25 Speaker_00
And that's the point that people show up, but, or they don't. And that's why we have also high rates of other outcomes. But I think, you know, waiting and waiting until it's interfering with work is not great.

00:20:38 Speaker_00
But, you know, what I hear so much from my patients is like, well, I haven't heard anyone yet, as if like our sort of barometer on our on whether we're okay is like, did we hurt a patient?

00:20:51 Speaker_00
If you're a patient listening, I'm sure you're like, that sounds horrible. I wouldn't want that on my family members either. It's not good, but we feel irreplaceable. There's no redundancy in our jobs.

00:21:04 Speaker_00
People don't take off when they're actually sick, so why would they take off for mental health? The bar is Are you hemorrhaging? And so, where does burnout fit? It doesn't.

00:21:15 Speaker_00
And so, again, in the context of our workplace, it just doesn't measure up until it does. And when it does, it's pretty bad. And so, that's what I end up seeing a lot in folks.

00:21:26 Speaker_00
And when you talk about how does something like that manifest, that's what I see is this delay. And then it's pretty bad because you can blow past some of the early symptoms and blame it on work and blame it on

00:21:38 Speaker_00
everything that we do, and then it's not good after that.

00:21:42 Speaker_01
Yeah. Okay, I'm going to just double down and say, listeners, this is so important. We go way too long before we get help. And I get it that there's stigma. That's why we're talking about it.

00:21:55 Speaker_01
We're just, you know, if you had chest pain, I'd be like, yo, you got to get that checked out. If you are having dire thoughts, if you are thinking, I'd be better off not here, that's already well beyond a time that you need to see somebody.

00:22:04 Speaker_01
But again, I hear from many of you that you're like, oh, life is hard. Maybe I just need to try a little harder, get up a little earlier. And that kind of stick-to-itiveness doesn't serve us well when we need care.

00:22:17 Speaker_01
And so I will just keep saying it again and again. We, too, are human. And we have brains. And we deal with a lot of stress and trauma. And if you don't already have a therapist, please get one. And what would be a good warning sign earlier?

00:22:29 Speaker_01
So people come to you at a nine out of 10, which is great. I'm glad any time help seeking behavior is good. And yet how would people know, like, oh, maybe now would be the time. How could we get people?

00:22:41 Speaker_00
Yeah, I mean, here's the thing is like I'm this wellness person. And if you're in medicine listening, you probably hate that word because the person probably shows up when you're like having a bad day to give a lecture.

00:22:51 Speaker_00
And I'm that person a lot of times.

00:22:53 Speaker_00
The reason it bothers you is because being told to do things for yourself makes you feel like nobody's acknowledging the system's broken, but it also makes you feel like, I'm like a 10 out of 10 and you want me to deep breathe, like seriously, go screw yourself in whatever words you want to insert there, right?

00:23:10 Speaker_00
And so, In a lot of ways, the way that I kind of conceptualize this is like we need to do some stuff for ourselves in the context of a broken system if we would like to stay working in this system.

00:23:29 Speaker_01
And stay alive. I mean, again, my listeners hear me talk again and again about how we're at such high risk for suicide and like, yeah, it sucks to be told, oh, breathe, when we're short-staffed.

00:23:40 Speaker_01
And you can feel better despite the God-blessed broken system.

00:23:44 Speaker_00
Yeah.

00:23:44 Speaker_01
Right? And gain back that control of, wait a minute, this is my life. I need some blessed sleep or my brain goes bonkers.

00:23:51 Speaker_00
Yeah. Right. Yep. And the reason I like even mentioned that is like, you know, there are things you can do, but it feels like there are no things you can do because usually you're so sick.

00:24:00 Speaker_00
So this again gets back to the reason why we need to notice stuff earlier, because if you notice stuff earlier, maybe yoga won't feel like the worst thing someone's ever told you. It'll feel like a nice little break.

00:24:10 Speaker_00
And so when I think about that, you know, my earliest warning sign is that email pisses me off. Not like email is like, thanks for the email. It's like, I want to take my computer and I want to throw it across the room.

00:24:23 Speaker_00
And I didn't ever make much of it and didn't really think about it at all. But I recognize now or like on reflection that nobody's writing you an email to be like, hey, what's up? I love you. It's all an ask.

00:24:37 Speaker_00
Like in some form or another, the ask might just be that you need to reply to that email, but it's more to do.

00:24:42 Speaker_00
And in the context of emotional exhaustion and no capacity, email's the devil because it's like asking you for stuff you don't have to give. And so the reaction of anger is not even about the email or the person.

00:24:55 Speaker_00
It's about capacity and feeling over, over, overblown, you know? And so I think that's an early warning sign for me. I've heard that from other people. I think that other people sometimes it's just like a slight change in your schedule.

00:25:08 Speaker_00
Like you were a person who loved cooking and you come home and you don't have like the energy to cook. It's not that you had a hard day and you're just kind of like, well, we'll get takeout. It'll be fun. It's like you like cooking.

00:25:20 Speaker_00
It gives you back energy. And the idea of possibly doing it sounds like the worst possible thing anyone could suggest. It's not because you're depressed. It's not because it has to do with your mood.

00:25:29 Speaker_00
It's just like a capacity that you don't have the capacity. And I think we blow past that again because we're like, well, what's a takeout for a day or two? And it's fine until it's not, you know.

00:25:39 Speaker_01
Yeah, I think of that as like running on empty, like so many of us are running on freaking fumes. But then I hear from so many women, they're berating themselves like, oh, what am I doing wrong? I should be able to do more.

00:25:49 Speaker_01
I love the email piece because that used to be me for sure. I don't know how many times I've been in and out of burnout, but I used to like freak the heck out. And I hear that commonly from people. So that's fascinating. But again, like.

00:26:00 Speaker_01
Okay, so yes, we can be annoyed, but is it getting worse? And if so, maybe some help would be beneficial for you, right? Because there's a whole spectrum of whether it's burnout or anxiety.

00:26:14 Speaker_01
I tend to think, you talked a bit about anxiety in the book, and I am someone who runs high on the anxious scale. I think a lot of us in medicine do. It made us do our shit and study, right? But when it gets too far,

00:26:29 Speaker_00
that can be dangerous, too, right? Yeah. I mean, I think that we like anxiety is motivating until it's not just like that.

00:26:39 Speaker_01
It's crippling. I mean, it can become crippling.

00:26:42 Speaker_00
And I think like sometimes people worry worry about getting meds for anxiety for that reason because they feel like anxiety has motivated them. And if you get meds, then somehow I'm going to take away your motivation.

00:26:53 Speaker_00
But in my experience, you're not motivated at a 9 out of 10. You're motivated at a 3. So if I could just get you back to a 3, you'd be much better functioning. Anxiety is an evolutionary benefit. It's not going to go away.

00:27:06 Speaker_00
The point of it is to tell you where there's threat and if there could be threat. And the problem with anxiety that is not treated is that you see threats everywhere. And that's why you feel miserable. And so

00:27:18 Speaker_00
If you think there's threats everywhere, you're not going to sleep because you're going to be awake to attack the threat or ready to run to run away from the threat.

00:27:24 Speaker_00
You're going to constantly ruminate because you're going to make sure you didn't miss something that showed you the threat, right? Like all of the symptoms of anxiety make a ton of sense in an evolutionary context.

00:27:33 Speaker_00
But if they happen all the time, you can't actually do well or function. And so, you know, just like burnout, like maybe in a way, it's a way to kind of give you a sign that your body, like your work affects you and it can affect you.

00:27:46 Speaker_00
But if it gets to a certain point, it's like saying, like, you can't do this anymore and it makes you really not like your job. And maybe before it was just a warning that you needed to try, like, figure out how to make your job fit you more.

00:27:59 Speaker_01
I love that. That's such a beautiful explanation. And I love that you mentioned like medication. We don't have to go into all that. And I've talked about it on the podcast before.

00:28:05 Speaker_01
Like, I think there's even just a lot of stigma, like what's going to happen if I'm seeing a doctor, if I'm seeing a therapist, if I'm on medication, how is that going to affect my ability to work? And my thought is like,

00:28:15 Speaker_01
What if you're on a blood pressure medicine? It's the same. And I get it that there has been stigma over the years with our credentialing and things like that. That's been changing over time.

00:28:22 Speaker_01
Most of our states, not all, don't ask those questions anymore if we've ever had a history of anxiety or depression, that sort of thing.

00:28:29 Speaker_01
But I love, there was one example in the book, there were a few examples, where you talk to your patients, you're so, you have such these beautiful patient, physician relationships that I'm seeing in these little nuggets.

00:28:38 Speaker_01
But, you know, you start with like, okay, what, feels good to you, and you talk about therapy with patients, and then you also talk about medications.

00:28:46 Speaker_01
And I thought that was so beautiful, the way you, of course, honored the fact that, of course, they have concerns.

00:28:52 Speaker_01
Of course, I don't need to push them, which I thought was really beautiful, because sometimes, like, no, seriously, everyone needs an SSRI.

00:28:58 Speaker_01
I would joke with my patients, it should be in the water like fluoride, but you just seemed calmer about it all, right? Tell me about that.

00:29:05 Speaker_00
You know, it's so interesting. When I was an intern, And I don't even know that he would know that this affected me. But when I was an intern on the inpatient psych unit, a bunch of the patients had the same doctor.

00:29:19 Speaker_00
And I called that doctor to tell that doctor that a bunch of their patients were there. And I naively sort of as an intern was like, what are you not doing? Like, you know, I was like, why is everybody here? What is going on?

00:29:31 Speaker_00
And, you know, I'd said it nicer than that because of reverence and hierarchy. But, you know, he said, You know, Jessie, like these patients are young and they're having first break psychosis.

00:29:43 Speaker_00
And my job as their clinician is to see them and get them to come back and maybe take meds eventually. Most of them are not on meds right now because they haven't gotten to the point where they understand why they need them.

00:29:55 Speaker_00
And I can't force them on them because that's not how it works. You know, and I had like a realization that

00:30:03 Speaker_00
Like sometimes there's help in not just like always doing the thing you know is right, you know, because you can't force it on people and you can do your best to get a teammate and get on board and it doesn't always work.

00:30:18 Speaker_00
You know, but I do think that I've had more success with people coming earlier and not waiting to the point of needing to be hospitalized because they know I'm there and that I would listen.

00:30:28 Speaker_00
And we always kind of agree on things like, OK, well, if you don't want a daily anxiety medicine and you want an as needed one, can we look at it as like, OK, well, how often do you use it?

00:30:39 Speaker_00
Because if you use it as like all the time, then why are you taking an as needed medicine? And usually when they like understand it that way, then they are better able to understand like when they need one. That's every day.

00:30:52 Speaker_00
I think they feel more on board with that decision making. I think, you know, sometimes. I have to document a lot about conversations and hope that that's okay. And it doesn't always, you know, when it's more severe, it does make me more anxious.

00:31:07 Speaker_00
I think one of the harder things as an outpatient psychiatrist is like, there's very strict criteria for where somebody could go to a hospital and not a lot of use for it in a lot of ways.

00:31:17 Speaker_00
And so you're often taking care of pretty sick people who don't meet that criteria and hoping that they get okay and that eventually they'll listen.

00:31:24 Speaker_00
I have the privilege of seeing a specific kind of population that doesn't always get to that point, which is nice, but I do think that understanding resistance and working with resistance is what we need to be doing.

00:31:39 Speaker_00
I'm in a field with a lot of stigma in the first place. I'm in a field with a bad history. If I don't understand that and approach my job like people are mostly scared of me, I don't think it really helps people.

00:31:53 Speaker_00
The very first time I asked for help, I was told I wasn't sick enough to get care. And that experience really shaped how I do clinical medicine because I don't even know that they would know it affected me at all.

00:32:09 Speaker_00
But I know that I was lying and that I was minimizing because I didn't know that person and I didn't trust that person. So why did they get to decide what counts? But for me, I've learned people need more than one visit.

00:32:23 Speaker_00
People need to trust you to come back for that. You need to be a safe space for people. You might not get there on the first try, but you want people on your team and understanding. I can't even tell you how many people have come back for meds later.

00:32:35 Speaker_00
And I think that that's because they'll say, you didn't push that on me and you let me figure out I needed it. You know, like they eventually do.

00:32:46 Speaker_00
I mean, sometimes not, but if you give them the information and they have that and they approach life with that in their pocket, they have the information and that's what they needed and they needed to be armed with that, you know?

00:32:59 Speaker_01
No, I love it. It was it. It was very poignant. There were several episodes, episodes. Is that right? Several situations in the book where it was like that. And I thought it was so Beautiful. And you're right. It does give the patient the agency.

00:33:09 Speaker_01
I mean, of course, we talked about we all as physicians, we think about working together with our patients and things like that. But yeah, I think that's beautiful. And just like that agency and that control, which would be really, really helpful.

00:33:21 Speaker_01
So I just want to be mindful of our time. But again, I am just going to say that this book is amazing because it is such a good conversation starter for all of us to talk about. How are we doing? Right. I mean, the title of the book. How do you feel?

00:33:35 Speaker_01
I think I had mentioned to you that my sister died by suicide in 2021. And we've been very open about sharing her story. And I would tell people, please check in on your friends and family and ask them how they're really doing.

00:33:50 Speaker_01
How are people really doing? And so I think your book helps bring to light these conversations that we need to be having. And it also just normalizes like, yeah, we're in health care and to

00:34:00 Speaker_01
It's totally cool to see a therapist and see a psychiatrist and get the help that you need. And you also showed stories of how you started feeling better and how, like, your patients were doing better. What are other thoughts that you have about that?

00:34:12 Speaker_01
Because I just think that, seriously, this should be, of course, I love mandating, required curriculum for, you know, all medical students and before, actually, in the University of Tennessee, hopefully, as the wellness officer, I would know somebody who could get it in, right?

00:34:27 Speaker_00
Yeah, I mean, I feel like for me, The book was intended to spark conversations that you might be turned off from or scared by in other ways. I mentioned lectures. Usually I can get them on my side by the end.

00:34:41 Speaker_00
I've been doing this long enough that I have a way of talking to people who don't want to hear what I'm talking about.

00:34:48 Speaker_00
I think stories are a different way in, and being able to see yourself in stories and feeling like that gives you ammunition to have a conversation you haven't been able to have in the workplace is the goal, really.

00:35:00 Speaker_00
I think so much of this stuff we're scared to talk about, and I'm glad when you sent me an email and stuff and how open you are about your family. Not everybody is. And I understand that.

00:35:12 Speaker_00
And it's really hard for people to talk about because it's a very different kind of death and it's a very different kind of experience as a family member.

00:35:20 Speaker_00
It's also just a different experience to talk about publicly because people don't know how to act. And I think it normalizes it a lot to just kind of talk about it like it is a thing that happens to people.

00:35:34 Speaker_01
And it is a thing. And It's unfortunate across our whole nation, but we as health care professionals are at higher risk. And women physicians, we're at two and a half times the risk as our standard peers.

00:35:46 Speaker_01
So I'm like, I'm going to keep talking about this and normalizing that, hey, we're an at-risk profession. Now, we don't need to all run around freaking out, but like, OK, well, what are we going to do to protect ourselves?

00:35:55 Speaker_01
Perhaps we should be seeing somebody regularly, right? I always say you wouldn't go rafting down the Grand Canyon without a life jacket and a guide and a oar.

00:36:05 Speaker_01
So, too, in medicine, what are you going to do to take care of yourself, given that we're at higher risk? So I think your book definitely is just that spark. And I'm so excited. I am going to, in this next year, host a virtual book club.

00:36:15 Speaker_01
So listeners, get ready. It's going to be amazing. Yeah, we're going to come on Zoom and talk about this book. And then I'm hoping that's going to be the ripple effect.

00:36:22 Speaker_01
That's like, again, one of my missions is to not only normalize and talk about this, but then for everyone to go back to their organization and be that ripple effect to say, hey, let's talk about this book.

00:36:30 Speaker_01
Let's let's do these things to start to make change. Before we leave, what other little nuggets of wisdom or something that we didn't talk about that you want to make sure my listeners hear, if anything?

00:36:42 Speaker_00
I mean, I think my big thing is just that sometimes there are lots of things in our workplace that are messy and like you can't control them, but you can control what you do and how you talk to other people and how you feel.

00:36:55 Speaker_00
And I think it feels sometimes like lame and like we're saying it's on you. But to me, it's like it's something you can do. Like, not everybody is in a role like mine and can change systems.

00:37:07 Speaker_00
And if you think about systems all the time, you'll beat yourself up and it'll feel miserable, like really hopeless.

00:37:12 Speaker_00
But finding places for hope and finding places for meaning and finding places where you can make change, you can change the way that you talk to other people.

00:37:21 Speaker_00
Like, the main things to prevent against burnout are meaning, purpose, and a supportive work culture. Those are not that has nothing to do with the electronic medical record or insurance companies or any of this stuff like that.

00:37:32 Speaker_00
Those are the things that cause a lot of it. But we can actually prevent it by some of these things that are individual or team based, and we can do that together.

00:37:41 Speaker_00
And so, you know, part of the reason to have these conversations is to start that and spark that and make people motivated to want to do that. So I'm honored that you want to have a book club. I'll try to stop by if it's.

00:37:53 Speaker_01
Yeah, we'll see. You're you're a busy woman. I don't want to put that on you, but I'll certainly send you an invite.

00:37:59 Speaker_00
But I'd like to come if I'm in town. At least you guys can then you have an open conversation without me and say what you need to say. And then I'll come at the end or something, you know, to be a surprise.

00:38:09 Speaker_01
Or maybe I could get a little video of you ahead of time, be like, hey, there she is. Because it's amazing. And again, I know you've been going around the nation and sharing your amazing book. Speaking of which, where can people find this?

00:38:20 Speaker_01
I know where I got it. Where would you send people to get this book? How do you feel? You guys, it's seriously so good. And with the holidays coming up, get it instantly.

00:38:28 Speaker_00
You know, most places that you can get books, you can find it. Some people like the place that delivers that's faster and cheaper. Some people do not.

00:38:36 Speaker_00
It can be found at the ones you do not and the ones that you do, your local bookstores have them, but also if you can't afford the extra money because it is a hardcover and I get it. So I think keeping all that in mind, support local where you can.

00:38:50 Speaker_00
If you can't, you can find it anywhere. It's called How Do You Feel? I do think it's that, you know, people have asked me, like, would you give it to a health care worker for the holidays or should I give it to my therapist?

00:38:59 Speaker_00
I think that it actually is a good present, even though it feels like a silly one. But I think it is like saying, I know that you're a human and I want you to know that I see you and I value that about you. And it's not like you look depressed.

00:39:12 Speaker_00
Here's a book about it. Right. Like, I think that

00:39:15 Speaker_01
You guys, it's not depressing at all. Like I laughed. I may have got choked up a few times, but you are funny. You're a lot of funny. And so the book was very entertaining. I found it was very entertaining and helpful and it gave such hope.

00:39:27 Speaker_01
So that was like my biggest takeaway. And I agree. I interrupted you. I apologize. I think it would be a beautiful gift for anybody that you know and love.

00:39:36 Speaker_01
It's just a beautiful gift because when we can be, show up in the world as the beautiful, full humans we are with our big, huge hearts and emotion, we do a better job as physicians. But more importantly than that, we just, we feel better.

00:39:52 Speaker_00
Yeah, we have to show up as ourselves and be okay with that, and not blame ourselves for being human, and not blame ourselves for being affected by our jobs, and not blame ourselves for not being this perfect person who fits in a box that's like everybody else, because that's boring.

00:40:06 Speaker_00
And I'm happy to be the person that I am, but it took me a long time to recognize that that person was a good doctor too. And I think that's unfair, and I wish I knew it earlier, but now I can say it from my perch of whatever, that

00:40:19 Speaker_00
I think the things that make me who I am make me much better at my job. And I wish that that was honored along the training process. And it wasn't, but I'm here now and I'm going to hopefully make it better for other people eventually.

00:40:31 Speaker_00
And maybe somehow that was why I became a doctor, like to blow it up and make it better for people.

00:40:37 Speaker_01
I love it. Well, I'll blow it up right with you, because seriously, I see the ripple effect of what you're doing. And I'm having a little like I'm throwing a little pebbles and creating a little ripple effect. That's what we need to do.

00:40:47 Speaker_01
Yes, the system needs to change, but it starts from within. We need to empower ourself, feel whole and good and be like, this is B.S. I am not staying up all night and working all day the next day in clinic. Nope, that's not for me.

00:40:57 Speaker_01
Like, again, I get a little feisty, but it is OK. I know, right? But it starts with just remembering we're human and a lot of us struggle. And again, your book so beautifully with stories. And again, I'm like, are you in my brain? What is happening here?

00:41:13 Speaker_01
And I think I mentioned that to you. You're like, yeah, I hear that a lot because You just say so beautifully what many of us are feeling inside that my words don't come out that way.

00:41:22 Speaker_01
So thank you for the amazing work that you're doing, not only in Tennessee, but just around the nation and for writing this book for all humans to realize that they're not alone in these struggles and that help is available.

00:41:35 Speaker_01
So thank you so much for taking time to be with us today. Absolutely. Thanks for having me and wanting to have this conversation. Absolutely. Bye. Are you ready to take control of your life and put these tools into action? I'm here to help.

00:41:50 Speaker_01
I offer free consultations for physician moms to see if my one-on-one coaching package is right for you. You can sign up for a free consult at www.MamaDocLifeCoach.com.