We know that healthcare workers are burned out and exhausted. Provider mental health is a huge issue… but are the institutions listening?
This week on It’s OK, burnout expert Dr. Jessi Gold talks to us about (obviously) burnout, but also ways HCW* can start to change the workplace culture into one that actually values the human workforce. Sound unlikely? Listen in for Dr. Gold’s ideas for a grassroots movement - using the language of capitalism to get the c-suite to listen.
*We talk a bunch about HCW in this episode, but the topics involved are relevant to everyone who feels even a little bit exhausted by the pressures of the world.
Dr. Gold’s new book, How Do You Feel?: One Doctor's Search for Humanity in Medicine, is out on October 8, 2024. For more info visit drjessigold.com
In this episode we cover:
- Can you be emotionless and still practice good medicine?
- How medical training seeks out perfectionists, and then uses that perfectionism as a way to wring out even more work
- Why you can’t self-care your way out of burnout, but you can support yourself inside the catastrophe
- Ways to get the administration to start valuing their workforce (spoiler: it involves speaking the language of capitalism!)
We're re-releasing some of our favorite episodes from the first 3 seasons. This episode was originally recorded in 2022.
Looking for a creative exploration of grief? Check out the best selling Writing Your Grief course here.
About our guest:
Dr. Jessi Gold is an Assistant Professor in the Department of Psychiatry at Washington University School of Medicine in St Louis. She’s a nationally recognized expert on healthcare worker mental health and burnout (particularly during the pandemic). Her work can be found in major publications like The New York Times, The Atlantic, The Washington Post, and TIME. Find the “burned out burnout expert” at drjessigold.com and on social media @drjessigold
Pre-order Dr. Gold’s book - How Do You Feel?: One Doctor's Search for Humanity in Medicine
About Megan:
Psychotherapist Megan Devine is one of today’s leading experts on grief, from life-altering losses to the everyday grief that we don’t call grief. Get the best-selling book on grief in over a decade, It’s Ok that You’re Not OK, wherever you get books. Find Megan @refugeingrief
Additional Resources:
Physician Support Line on social @shrink.rapping
American Foundation for Suicide Prevention on social @afspnational
Clinician Well-Being Knowledge Hub developed by @theNAMedicine
Want to talk with Megan directly? Join our patreon community for live monthly Q&A grief clinics: your questions, answered. Want to speak to her privately? .css-j9qmi7{display:-webkit-box;display:-webkit-flex;display:-ms-flexbox;display:flex;-webkit-flex-direction:row;-ms-flex-direction:row;flex-direction:row;font-weight:700;margin-bottom:1rem;margin-top:2.8rem;width:100%;-webkit-box-pack:start;-ms-flex-pack:start;-webkit-justify-content:start;justify-content:start;padding-left:5rem;}@media only screen and (max-width: 599px){.css-j9qmi7{padding-left:0;-webkit-box-pack:center;-ms-flex-pack:center;-webkit-justify-content:center;justify-content:center;}}.css-j9qmi7 svg{fill:#27292D;}.css-j9qmi7 .eagfbvw0{-webkit-align-items:center;-webkit-box-align:center;-ms-flex-align:center;align-items:center;color:#27292D;}Mark as PlayedTranscript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:00):
This is it's okay that you're not okay, and I'm
your host, Megan Divine. This week, if you are a
burned out healthcare worker or you know someone who is,
you need to listen to this episode. If you're a
therapist or another healthcare worker, like, how do you keep
showing up to do the work when the work itself
is breaking you into a million little pieces? This is
(00:22):
such a big issue, and it's honestly something we don't
talk about enough. This is another episode friends where we
speak directly into the abyss. This week special guest and
burnout tour guide doctor Jesse Gold. And since that long
time ago when Jesse and I first recorded this conversation,
I want to make sure that I note she's released
(00:43):
a new book. It is called how Do You Feel?
We will link to that book in the show notes,
but be sure to check it out. Stay tuned, everybody,
We're going to be right back after this first break
before we get started. Two quick notes. One, this episode
(01:04):
is an encore performance. I am on break working on
a giant new project, so we're releasing a mix of
our favorite episodes from the first three seasons of the show.
This episode is from season one in which I answered
listener questions, sometimes on my own, sometimes with a guest.
So if you want more of these Q and A
style episodes, you can find the entire collection from season
(01:25):
one wherever you get your podcasts. Second note, while we
cover a lot of emotional relational territory in our time
here together, this show is not a substitute for skilled
support for the license mental health provider, or for professional
supervision related to your work. I really want you to
take what you learn here, take your thoughts and your
reflections out into your own world, and talk about it all. Hey, friends,
(01:52):
So one of the main goals of this show is
to give voice to what's really going on inside the
healthcare field. We're always talking about the importance of mental
health and reaching out for help, but the helpers are
human too. In an industry that prizes stoic detachment as
a form of high achievement, being a real human being
with feelings and limitations is seen as a liability a
(02:13):
lot of the time. That's especially true in the hospital setting,
where the fast paced and demanding workload can make even
the most committed helper feel like they have to sacrifice
themselves on the altar of the bottom line. Doctor Jesse
Gold is an assistant professor in the Department of Psychiatry
at Washington University School of Medicine in Saint Louis. She's
(02:33):
a nationally recognized expert on health care worker mental health,
and burnout, particularly during the pandemic. She writes regularly for
the popular press about mental health, stigma, and medical training.
That is a giant mouthful of professional street cred, all
of which to say that doctor Gold knows her stuff
when it comes to mental health challenges facing the health
care industry itself. Doctor Gold isn't afraid to speak into
(02:57):
that complex, messy, very very human sea of being called
to care for people while at the same time feeling
like you're falling apart. JESSI, my friends, welcome to the show.
Speaker 2 (03:07):
Thanks for having me.
Speaker 1 (03:08):
So I want to open with something that you wrote
in Forbes magazine last year. You wrote, quote, here's something
we don't say out loud as healthcare professionals enough. We
have reactions, feelings and emotional responses. We feel angry and
depressed and anxious. We have worries about what's going on
in the world right now and how it affects our patients.
We also have feelings about what we see and experience
(03:29):
on a shift, and those feelings often catch us off guard.
Our emotions are suppressed and held inside because we are
supposed to be stoic caregivers. So that mouthful just as
the starting point. What do you see as one of
the main issues unfolding for healthcare workers right now?
Speaker 2 (03:47):
I mean that whole mouthful is mostly a way to
say that we're told and taught not to feel.
Speaker 3 (03:53):
Really, it's the way to survive, it's the way to
deal with what we see day to day, and it
ends up being away that we then get burnt out
and said in a bigger way because we push down
a lot of feelings and we push down our reactions
and it just becomes not a space we feel safe
being in. And then it's kind of all compounds until
it's much worse. And I think that's a big problem
(04:15):
with healthcare in general. But right now, with everything that's
been going on in the pandemic and everything that people
have been exposed to, and how different the workspace has been.
You know, it depends on what phase of the pandemic,
but certainly like more risk to yourself or your family,
different lacks of resources in different ways because of staffing
or even just simply like resources like beds. I think,
(04:38):
much more death than usual on a day to day
in what you're seeing, and so you have this additional
compounded hard workplace on a baseline mental health situation that's
not ever really been great for healthcare workers. And so
it's kind of a perfect storm in a lot of ways.
And the feelings part is a big part of it,
because we just don't have a culture that talks about
(05:00):
any of it, and so you feel really alone and
that makes it a lot worse.
Speaker 1 (05:03):
Yeah, I think it's just it's such a hot mess,
right It was a hot mess before the pandemic. Like
the none of these things we see erupting right now,
they're not new. It's like we had a system that
was already broken, was already fractured in part because of
what you were just mentioning, like this culture of stoicism,
(05:25):
this idea that having human emotions is somehow unprofessional.
Speaker 3 (05:29):
Yeah, I mean, I think in a lot of ways,
a hot mess is a decent way of describing it.
And it's like an extra hot mess now, I suppose,
But I think, you know, I've heard someone say that
the fault lines are what you see through COVID, which
is like these things that have been brewing under the
surface but just get much more exposed with all of
the additional stressors of COVID, And I think this is
(05:50):
definitely one of them.
Speaker 2 (05:52):
And our culture and healthcare is horrible.
Speaker 3 (05:55):
I mean, we've lived in a group where you know,
you're prioritizing sleeping, not eating, like really prioritizing the other person,
you know, the patient over yourself. There's a lot of
conversation around like if you show emotion in a patient room,
like are you taking away from what that patient is experiencing?
(06:15):
So you spend a lot of time trying to learn
not to react to things or that it's normal to
go from a person dying in one room to a
conversation about like eating or something kind of just generic
in another.
Speaker 2 (06:27):
And that's just what you do.
Speaker 3 (06:28):
And it's a weird culture and not a culture we
talk enough about how weird it is either, and that
makes it hard.
Speaker 1 (06:35):
Yeah, I think that's a really interesting point you bring
up about, Like even if there wasn't this sort of
professional training cultural model of the stoic attending, right, like
you don't want to take away from the person in
the room by showing your humanity because then it's like,
oh crap, like now we're talking about me. We don't
want to hijack the situation in the room. But I
think one of the things that's really happened is we've
(06:57):
made that an either or situation and stuf of a continuum.
You are completely impenetrable, which doesn't do so great for
your clients and patients anyway. Or to use hot mess again,
you're a hot mess and you're taking away from what's
in the room at the time. And I think having
these conversations is how we create that middle ground of
how do we be full humans showing up to do
(07:18):
this work with the boundaries and the ethics that are
in place for us, but also not at the cost
of our own humanity and our own relationships and our own.
Speaker 2 (07:26):
Lives for sure.
Speaker 3 (07:28):
And I think in a lot of ways, if you
ask patients like they would be okay if you showed emotion.
It's different to show emotion over something that requires emotion
and would be an empathetic gesture to show emotion than
it is to just be emotional all the time and
not make it like a space that feels safe for
patients to talk at all. Right, that's very different, and
I think we worry that once you like tip over,
(07:51):
you're all the way over, and it's just really not
like that. And I think a lot of times I've
heard from people where their doctor has like actually cried
with them or sat with them through something that it's
been a really meaningful experience. But if you take that
from the doctor side, they'd be like, why would I
ever do that? That's horrible, Like nobody would like that.
That's not something I'm allowed to do. So it's a
(08:11):
very different perspective on what we want or what we
think we're supposed to be doing.
Speaker 1 (08:16):
It's interesting that you brought up that, like basically the
if I start crying, I'll never be able to stop
thing in the medical world as well. I mean, I
hear this a lot with people who are having a
really hard time navigating super challenging life things. They're like,
I can't start crying because I'll never be able to stop.
And that is such a product of our emotion a
verse culture as a wider social culture, and also again
(08:39):
in the medical industry. So this actually sets us up
really well. For the first listener question that I wanted
to get into, if you're ready, sure, I actually asked
my audience for questions. I told them all you were
coming on the show. I wanted to get a lot
of questions from people really working on the front lines,
and I can tell you that, like, question after question
after question after question was basically asking the same thing,
(09:01):
how do I handle my own grief, knowing how I
have to show up day after day and take care
of other people. For some of the people who sent
in their questions are actually working in the same hospital
where somebody close to them died, so the sensory awareness
is just on tilt for them. I'm going to preface
this question by saying we are not going to have
a neat and tidy solution for this, but I wonder
(09:22):
if we can use one of those questions as a
starting point.
Speaker 3 (09:25):
There's no neat and tidy solution to most things, especially grief,
but feelings are messy, and I think part of the
desire for a neat and tidy answer is part of
the problem, because we want it to be perfect so
then we can do it. But really, in a lot
of ways, you just need to be and see where
you go from there.
Speaker 1 (09:43):
Yeah, this is why I love your work so much,
in your presence in the world, because you're like, well,
this shit's missed. It's messy, Like we can't make it
anything but messy. Okay. So here is the question, dear
doctor Golden Meghan. I'm an inpatient PA trying to balance
the grief of the traumatic loss of my father, followed
by that of my relationship, as well as the grief
and loss and hardship brought on by the pandemic in
(10:05):
my daily work life. I'm so tired from carrying this
weight twenty four to seven. I have a counselor, but
I feel I could do more to compartmentalize or otherwise
find some relief. Is there a way to honor my
deep feelings but also find reprieve? How do I care
for myself in a world that requires so much of
my energy? I chose this question on purpose because it
(10:29):
has so much jammed into it, right, so many layers
and layers and layers, and I feel like it's really
indicative of what's happening in medical facilities all around the country.
So where do we start.
Speaker 3 (10:41):
It's interesting because you could say, oh, This feels like
a complex story, but in a lot of ways, it's
everybody's story, right. I think people forget that healthcare workers
have the life experiences that everybody else has gone through
that have been challenging over the pandemic, like being a mother,
being a partner, being a caregiver, having family members get
sick and die, and then on top of it, I
(11:02):
have to go to work every day on the front
lines and help everybody else. Right, So there's like that
added stressor which seems like enough to people, but we
have all the other stuff.
Speaker 2 (11:11):
Too, right.
Speaker 3 (11:12):
But I'm guessing that you know, in a lot of ways,
it's really good that she goes to counseling already, because
I think that's a big thing that's hard for people
in general in healthcare to ask for help, to admit
they need help, and they really hate talking about things.
So having a place for that that's just for you
is really important. I think in a lot of ways,
we try really hard not to have feelings in the
(11:35):
workplace and to pretend that somehow there's this big difference
between work and home and everything like that, but it's
all together, and you're the same person going into work
it's just you have to deal with the things at work,
and so, you know, I think it's important to give
yourself space and time to acknowledge what you're feeling as
much in the moment as you can. I think it's
really hard in healthcare because that's a privileged time and
(12:00):
able to pause at all. But honestly, like reflecting on
what you feel in your body, reflecting on what feelings
are actually having and being okay with also having feelings
while you do the job, I think is a really
important thing. So obviously it's great to have a space
to talk about with the therapist and process and all
of that, but the time before your next appointment is
important too, which is like, how do I deal day
(12:22):
to day without just like pushing my emotions down until
that one hour once a week, And you really need
to give yourself space and be okay like having a
full range of feelings. So I think a lot of
healthcare workers have struggled with things like anger and not
knowing whether like being angry makes you a bad doctor
or PA or nurse or any other person on the
(12:44):
health care spectrum. And you know, I think you can
be angry, and that feeling can be valid and you
can still do your job well. And I think it's
important that we get used to holding both things and
knowing when we have time to do whatever we need
to do, to let our selves acknowledge that we are
a human being with feelings and have to do our
job at the same time.
Speaker 1 (13:05):
Yeah, I love that, and it reminds me of something
earlier we had on the co founders of the New
York's end Center for Contemplative Care on and they work
with physicians, they work with people in healthcare, and they said, like,
I don't believe it when you say I don't have
time to acknowledge my own feelings, sit in my own humanity.
They're like, yes, you're busy, but you have thirty seconds, right,
(13:29):
And sometimes I mean it seems like it's not enough.
But what they pointed out was like thirty seconds many
times a day becomes fifteen minutes, and fifteen minutes of
allowing your own humanity to yourself will make a dent
in that pressure. It's not going to solve anything, like
none of this is like a super easy solution here.
But what I hear you really saying, Jesse, is like
(13:51):
there is power in acknowledging your humanity, even if it
is a split second as you're moving from one room
to the next, to be able to say I have
feelings about this. You have feelings about this, and I
don't have time for them right now, but I want
to notice for myself that I see them for sure.
Speaker 3 (14:06):
I think that we spend too much time assuming that
all things coping take hours. Like if I'm going to
tell you to have feelings or cope with something, you
need to whip out a yoga mat and do like
a forty minute class. Right, that's impossible for most people
most of the time. There are different things you can
do that take less time that are really helpful. Healthcare
workers really like things like deep breathing because you walk
(14:27):
the stairs between patients. You have the time gelling in
and out of a room before you have to see
the next person to take the second and like actually
change your breathing patterns to calm yourself or acknowledge how
you're feeling, or give gratitude for what you just experienced,
if that's helpful for you. I think we don't stop
enough to think about the good things in our day
(14:48):
or the privilege of our job. We often get really
caught up in the hard thing of our job, and
so trying to just do that in the quick amount
of time that you have.
Speaker 2 (14:56):
You're right, it sort of just.
Speaker 3 (14:57):
All adds up to being less than you know, maybe
ideal in the world, but much better than nothing, and
much better than only having that once a week time
in counseling, which most people don't even have, because that's
a privilege to be able to fit into your schedule,
and also to not feel scared to do that in
the first place in healthcare. So I think you're right,
(15:18):
just kind of all kind of comes together as much
as you can.
Speaker 1 (15:21):
Yeah, it really doesn't. And I just want to pull
out that one little bit that you said, not only
is it a privileged to find the time to go
to therapy, but because we're working against that idea that
having emotions on the job makes you less professional, less
skilled at your work, like that is a big thing
that we want to name here too. That can feel
really scary to even acknowledge that you're wrestling with this
(15:41):
stuff because of that culture of perfectionism that we see
so much. So I love that you're like, you can't
just whip out a yoga mat and I think we
often use all of those things that you just mentioned.
We often like they're often positioned as these cure alls,
like if you would only practice gratitude and journal for
fifteen minutes about all the things that you love about
your life, that everything would up sucking so much. And
(16:01):
that's like, that is not what those tools are for.
Those tools are not to remove suckage. They're to help
you navigate, manage, and support yourself inside this really really
difficult situation. And for me, like the language that I
use around that is like, this is helping you acknowledge
the reality of the situation, and acknowledgment is very powerful medicine.
Speaker 3 (16:21):
Yeah, I mean, I think that's a problem with a
lot of framing around coping skills or especially like resilience,
is this feeling that it's somehow your fault that you're
not surviving in a broken system, And when people suggest
doing things that can help you, it feels like they're saying,
come on, like fix yourself, like yeah, wornything else is fine,
work harder, figure it out, like you should be fine. Yeah,
(16:43):
But really what we should be saying is the system,
specifically in healthcare, but in a lot of ways, is
very very broken, and culture change takes time, policy change
takes time. Any other sort of systematic change is going
to take time. And if you want to survive in
a truly broken system, even as it attempts to heal,
you have to figure out how to do that yourself,
(17:06):
and it requires some individual coping to do that. It
doesn't mean something's wrong with you. It means that you're
reacting normally to a really bad situation. And if you
want to still be in healthcare, you have to figure
out how to deal. And you know, I'm not exempt
from that by any means. Like I think it's important
for people to realize, like just because I preach like
(17:29):
things around coping skills and burnout and things like that
doesn't mean I'm really great at all the stuff myself.
Like I've really spent a lot of time over the
pandemic trying to figure out what coping skills actually work
for me and don't feel like that, like I'm just
doing something to do it, And like I spend a
lot of my energy like coping with others and having
(17:50):
the support of other people, And when that got taken
away in the pandemic, it was a lot of like, oh,
what do I actually like to do myself that actually
still feels good in this way that going to dinner
with a friend might. And it's been a lot of
work and I'm still working on it, and you could
ask way therapist and she'd probably tell you I'm okay sometimes.
Speaker 2 (18:08):
And struggle a lot.
Speaker 3 (18:10):
But I think it's important that people realize that even
though I know these things, it doesn't mean that I
do them all the time. And we spend a lot
of time in medicine assuming like, well, I can, I
should be able to take care of that myself, like
I understand disease or I understand mental health, I should
be able to figure out how to deal with this,
And honestly, you shouldn't because I actually am an expert
(18:31):
in this particular area and I can't. Right, So it
doesn't matter what you know. It matters how it gets
applied and how other people point out things to you
that you might not even realize are going on.
Speaker 1 (18:42):
Yeah, I love this. There's actually a Twitter thread of
yours where you I think you started it, where were like, okay, physicians,
let's talk about the things that we would tell our
patients to do, but we don't do ourselves. And there's
this whole long thread of like I don't I never
drink water, I drink only diet soda, I don't get
enough sleep, like I never moved from my like all
of these things like remembering your humanity in there and
(19:03):
this is not I think there's so much perfectionism baked
into the healthcare industry, right like, I must do this
correctly or I won't. Like, oh, come on, like you
are still human and you are still a catastrophe in progress,
just like all of us.
Speaker 2 (19:18):
I mean, medicine like recruits those people. Yeah, in a
lot of ways.
Speaker 3 (19:21):
So it's like it's a process that is like let's
start out with the people who are most likely to
be perfectionists and then make it harder for them by
judging them for having anything that's outside of perfection or
making them feel judged for having anything outside of perfection.
And achievement and perfection become this thing that carries throughout
but probably did and most people who went into healthcare's
(19:43):
life before that, because you have to go into a
process of applications where not everybody gets in, and there's
all this competition up front, and the competition makes you
feel like you have to be perfect, and that just
continues on and on and on, especially if you stay
at academics.
Speaker 1 (19:59):
Yeah, yeah, I love that perspective there, that through that
whole rigorous process of getting into the field, because we
have that culture of stoicism and perfectionism that we are
actually like selecting for that. And then you put these
people who are selected to run that way, to hold
themselves to really high standards, to suppress their feelings because
of multiple reasons, and we put them into a highly
(20:22):
emotionally charged situation over and over and over again. And
then I just don't think we can be surprised when people.
Speaker 3 (20:28):
Break, especially not people who mostly wrote application essays about
how they want to help people, right Like, the people
that are the best at what we do care a
whole lot, and that's really hard to keep doing and
not break. And you don't want to find ways to
only keep the people in healthcare that are fine with
no feelings and don't break, right like, you want to
(20:51):
keep those people.
Speaker 2 (20:52):
So we have to do better.
Speaker 1 (21:01):
Welcome back to friends. We have been talking with doctor
Jesse Gould on the reality of being a healthcare professional
with real human feelings inside a profession that doesn't actually
value human feeling. Let's get back to our conversation. I
think this sort of brings us around to the big
picture environment that a second listener question ushers us into.
(21:22):
Debbie wrote in how do we change things in healthcare?
As a frontline worker, we need our managers to understand
that we are not machines. We are human and need
to be heard and understood and rewarded. I get it
that managers have numbers and goals to meet, and we
have patients, but it's the frontline clinicians who do the work.
We're the ones who face the trauma of treating COVID
(21:43):
patients head on, seeing the horror unfold. We can't just
keep going as if nothing has changed. We've changed. How
do we change the system so more value is placed
on our well being? I think a shift has begun.
Workers want more. I see that, but I guess for
now we just have to say stand up for ourselves.
So I love that line in there in this question,
(22:04):
how do we change the system so that more value
is placed on our well being? And you touched onto
this a little bit, but if we widen that lens out,
how do we start forcing a change in a system
that was broken before the pandemic. Those fault lines are
really glaring and exposed. Now how do we even start?
Speaker 3 (22:26):
Yeah, I mean I've thought somewhat about this, in part
because in one of my roles in the hospital, I've
had to interface a lot with like administration and try
to argue for the need to invest in these things.
And I think it's very frustrating because we ultimately have
different goals, right, Like, I think when you're a frontline clinician,
your goal is to help the patient as best as
(22:48):
you can, and you're really focused on them. Once you
get higher and higher up in mezine, you're dealing with
people who are really concerned about the bottom line and
really concern and about money, and ultimately you realize just
how much our healthcare system is actually a system that's
built on financing instead of the people that it's taken
(23:10):
care of, and that itself can be pretty disheartening. But
I do think there are ways where you can make
arguments acknowledging those values that maybe not your values, but
are the values of the system to get what you want.
Speaker 2 (23:25):
Right.
Speaker 3 (23:25):
So, for example, depression is the number one cause of
disability worldwide, which means it costs the system a lot
of money to have a lot of depressed doctors because
you don't go to work, or nurses or whatever. You
don't go to work, you can't be as productive, you
might have errors. All of these things are true, and
there's data that backs it up, and I think hospital
(23:48):
systems are becoming more aware of it because of COVID
and how many people have been speaking out about their
mental health in COVID and realizing that they can't just
give you a pizza party or like a lecture on
wellness until you like, we're done, that's all we're doing,
that's all we care about the end, or just give
you access to an employee access program and realize that's
(24:09):
not enough either. And so I do think there is
a way to advocate for what you need or what
you're missing while still appealing to a value that might
not be your value, but is the value that might
get things done. Unfortunately, you have to do that sometimes.
So I think that's really important. And at the same time,
I do think you can make small changes, like in
(24:30):
your teams, in the people that you're supervising, in the
way you interact with other people, that can make a
big difference. So, you know, I talked a bit about
how we don't talk about feelings, but we don't even
say like it's okay to make mistakes, or that was
hard or that was challenging, or of course you don't
have an answer to that and you don't know, we
don't know, right, and modeling that for people having conversations
(24:52):
about why it's hard to say that stuff you don't
even have to talk about, like mental health conditions. Right,
we just need to start changing the conversations around struggle
and why it might be hard to do this job.
And some of that can happen on a team level
or a supervisor level, and then it can get to
(25:12):
higher and higher levels, sort of as a bottom up
approach to changing how we talk about this stuff.
Speaker 2 (25:18):
And once you do that.
Speaker 3 (25:19):
At the same time, hopefully they hear your advocacy and
they hear the things you want and they start making changes.
But I do think you can make some changes just
by having real conversations.
Speaker 1 (25:30):
Yeah, absolutely. I mean, we started out this the first
half of the show talking about telling yourself the truth
in these moments, letting yourself be human, letting yourself having
these feelings. And I love what you just brought in
there about like we can start having these conversations in
our teams at the nurses station, you know, in supervision,
to just start normalizing what's actually happening, Like we're not
(25:51):
talking about anything like earth shatteringly new, We're talking about
let's name what's actually in the room, and start claiming
our humanity as normal and healthy and challenging in these situations.
This is really a grassroots movement of the people who
are in the front lines doing the work starting to
tell the truth to themselves and to the people around them.
(26:11):
And I also love that you brought in like let's
borrow from the c suite. Let's borrow from higher up admins.
They do have a balance sheet at the end of
the day, and there is economic benefit to valuing people's
humanity and their limits. And I think you know, whether
you take on that role or not, Like if you
pick up that flag and you decide to go after
(26:33):
that or not. I think that's something that we want
to start really talking about, is the economic reality of
denying people their humanity, not just in the medical world
but all around the entire globe. But that we do
have to speak the language of finances, and how do
we start understanding that denying people their humanity costs us.
(26:53):
It costs us financially, it costs us in community building,
it costs us in all of the public health crises
that we have currently unfolding. Interruptive. You know, I started
this our conversation out by like saying, we're never going
to have a solution for the hot mess of all
of this. And I still believe that. I still believe
we're not talking about a solution here, but I do
think we're talking about a way forward from here without
(27:16):
collapsing into the despair of the hot mess. But how
do we really start to change the culture. One of
the things that I picked up from your work, there's
this great quote from you that says, the mental health
system is broken. You can't fix it by breaking yourself.
And I think that's a really interesting sort of closing
(27:37):
point for us in all of these things that we've
talked about. So tell me a little bit about that statement,
and if there's a message you want to dictate to
the world in this in this moment about I don't
know everything we just talked about.
Speaker 3 (27:50):
I mean, I think in a lot of ways we
neglect mental health in all conversations. So the reason why
it's not in the financial conversation is people forget it
and don't put it there or think it's not relevant.
Or we're seeing all these people leave jobs and they
don't talk about the fact that it's because of burnout
or mental health. It's just like, oh, staffing or these
(28:10):
like procedural things. And that's very true. But at the
same time, you have to call it what it is
and say people are choosing themselves over a job that
takes it out of them. Right, we have to have
mental health in these conversations or we're really missing out
and we're not advocating enough for ourselves. We're just going
to keep jumping jobs until we find a place that
maybe is a little bit better with it, right, And
(28:32):
I think you know when I said that we can't
fix it by breaking ourselves, I meant over the pandemic,
I've seen therapists really try to just take every single
patient that they possibly can to make up for the need.
And there's a huge need, and there's always going to
be a huge need, and the need keeps increasing and
(28:53):
will after the pandemic. But you talk to therapists and
they're like, well, I started working in the evenings. I
took back all my you ask to come back from before.
I am working on weekends now, and now I'm sad. Like,
turns out that has a big effect on me too,
because I don't have free time anymore, and I'm holding
all this stuff for other people. And as much as
(29:14):
you want to try to help in every single way
you can, which is what we do in our jobs,
in so many ways, there's only so much as a
human in a broken system that you can do without
realizing that you really need to step back and put
yourself first. Like, you can do what you can do,
but there are limits to what you can do because
you're a human being, And so as much as you
(29:36):
are an advocate or a caring person about how broken
these things are and how much you want to change them,
there's a space for that. But in the same breath,
there's also boundaries and a way to have space for you.
And we neglect the second part because we really want
to do the first part right, But you don't do
the first part right unless you do the second part.
Speaker 1 (29:56):
Yeah, I think that's a really beautiful end note for
our time together in a life lot of ways, this
is a lifelong pursuit we're talking about, right, like this
exploration of how do we do the work we're called
to do without losing ourselves in the process. So ordinarily
at the close of the show, I ask you where
people can find you when we are absolutely going to
do that, But first I would also love some ideas
(30:16):
where physicians and other healthcare workers can go for support.
What are your like maybe top two or three places
that you would recommend right now.
Speaker 3 (30:24):
So you know, in a world of misinformation, it's always
helpful to go to places that you know are consistently
good and putting out good information. So I always go
to like big organizations when that's the case. So often
that means going to like the American Foundation for Suicide Prevention,
who has website on healthcare worker mental health thrive By.
The Huffington Post also has a huge website it's called
(30:45):
like all In for Heroes, I think, and they have
all these resources collected.
Speaker 2 (30:50):
Most of them.
Speaker 3 (30:51):
Medical organizations also have that too, So you could go
to the AMA, you can go to the Double AMC
and they all have these kind of like wellness hubs
and they're probably the kind of thing where you're listening
to me, you're rolling your eyes and saying like, did
you just give me more stuff.
Speaker 2 (31:04):
To read and do?
Speaker 3 (31:04):
But at least it's there, you know. And I think
the people who started things like the Physician Support Line,
which is staffed and it's all psychiatrists and staffed voluntarily,
they made that over COVID.
Speaker 2 (31:16):
They're wonderful humans. You can use that.
Speaker 3 (31:18):
I know that that's limiting to then only physicians, and
I know nurses who are trying to start the same
thing for nurses. I think there are some places that
still offer free therapy if you're in healthcare, and those
places like Emotional PPE or Therapy AID are also quite
good because it's national and you can find some people
who are willing to give you some free sessions, particularly
(31:39):
you know, in the situation where your workplace is and
doing that too. And I think all those people really
care and are trying their best to give you access
to what they know exists. And obviously we could do better,
and obviously we need more things, but those are the
best that we have right now.
Speaker 1 (31:55):
I think, yeah, they're sort of the starting places for
what we mentioned earlier in the show. About starting to
link up with others and find places where you can
tell the truth. Right, It is a little bit overwhelming
to be like, oh, now I need to go to
the AMA site and search through all of this like
I have fourteen seconds. But again, like even just starting
that practice of telling the truth to yourself and maybe
finding one or two other places. I actually love your
(32:17):
Twitter feed for this, so let people know where they
can find you online.
Speaker 2 (32:21):
I'm at doctor Jesse Gould.
Speaker 3 (32:23):
I spelled JESSEJSSI because I was a high maintenance child
that didn't say there was an I in Jessica, so
that's why it's spelled that way. I also have that
same as an Instagram handle, and then anything I write
is on my website, which is just like doctor jessegold
dot com.
Speaker 2 (32:38):
But I think that can be helpful for people because
I've written a.
Speaker 3 (32:40):
Lot on this particular topic, including from my own experience
and being a burned out for an out expert.
Speaker 1 (32:47):
Yes, I think that's the powerful thing here is that
you know what you're talking about. You're not just some
talking head from the C suite telling people to do
things for their mental well being so that they can
be even more productive on the job, but this is
actually something you live, and I am so glad to
have had this time with you, my friend. People. We
will link to everything that Jesse just recommended and a
(33:07):
couple of extras in the show notes coming up next
your weekly questions to carry with you and how you
can send in your question for us to use on
the show. Don't miss that part, friends, we will be
right back each week. I leave you with some questions
(33:29):
to carry with you until we meet again. It's part
of that whole. This awkward stuff gets a lot easier
with practice thing, and I definitely want you to practice now.
This week, doctor Jesse Golden, I talked a lot about
telling yourself the truth and then telling other people the truth.
I mean, honestly, this is not anything that has to
do only with the healthcare industry. This is something that
(33:52):
I feel like I spend all of my time talking
about the importance of telling yourself the truth and finding
somebody else to share that truth with. It's important to
find connection inside the catastrophe. So this week, for your
questions to carry with you, your homework assignment is to
tell yourself the truth about one thing. I don't care
(34:15):
what it is. I don't care how you tell yourself
the truth, whether that is in the thirty seconds between
clients or patients or two year old tantrums like I
don't care what it is, but find one thing and
tell yourself the truth about it, and then just see
what happens. I want you to be a good observer
of what happens when I tell myself the truth. Yeah,
(34:37):
and then extra credit.
Speaker 2 (34:39):
I don't know.
Speaker 1 (34:39):
I don't know that I want to use extra credit
because I don't want to tap into your perfectionist achiever
thing here when we're talking about burnout. But if you
want to do an additional thing, find one other person
to tell the truth too. It doesn't have to be
a big life altering thing that you share. It could
be just like you know, I really don't like Kale.
(35:01):
Find one other person to share the truth with and
see what happens. This is also a good time for
me to remind you that I really do want to
hear if you don't like Kale or whatever you need
to spell the truth about. But this is also a
Q and a show, and I want your questions. You
can ask me anything you'd like. You can bring me
(35:21):
your clinical questions I'm trying hard to be a good friend.
Frustrations you are, I'm overwhelmed with the pain of the world. Questions.
We got a lot of those. Let's talk it all out, friends,
Call us at three two three six four three three
seven six eight and leave a voicemail. If you missed it,
you can find the number in the show notes or
visit Megandivine dot co. If you'd rather send an email,
(35:44):
you can do that too, right on the website Megandivine
dot Co. We want to hear from you. I want
to hear from you. This show, this world needs your
questions Nowather. We can make things better even when we
can't make them right. You know how most people are
(36:08):
going to scan through their podcast app looking for a
new thing to listen to, and then they're going to
see the show description for here after and think, I
want to talk about that stuff. Things are hard enough.
This is where you come in your reviews. Let people
know it really isn't all that bad.
Speaker 2 (36:21):
In here.
Speaker 1 (36:23):
We talk about heavy stuff, but it's in the service
of making things better for everyone. So everyone needs to listen.
Spread the word in your workplaces, in your social world
on social media, and click through to leave a review,
Subscribe to the show, download episodes, send in your questions,
want more Hereafter. Grief education doesn't just belong to end
(36:44):
of life issues. Life is full of losses, from everyday
disappointments to events that clearly divide life into before and after.
Learning how to talk about all that without cliches or
platitudes or simplistic think positive posters is important skill for everyone.
Find trainings, workshops, books and resources for every human trying
(37:05):
to make their way in the world after something goes
horribly wrong at Megandivine dot Co. Hereafter with Megan Divine
is written and produced by me Megan Divine. Executive producer
is Amy Brown and Elizabeth Fozzio, Edited by Houston Tilley.
Music provided by Wave Crush,
This is it's okay that you're not okay, and I'm
your host, Megan Divine. This week, if you are a
burned out healthcare worker or you know someone who is,
you need to listen to this episode. If you're a
therapist or another healthcare worker, like, how do you keep
showing up to do the work when the work itself
is breaking you into a million little pieces? This is
(00:22):
such a big issue, and it's honestly something we don't
talk about enough. This is another episode friends where we
speak directly into the abyss. This week special guest and
burnout tour guide doctor Jesse Gold. And since that long
time ago when Jesse and I first recorded this conversation,
I want to make sure that I note she's released
(00:43):
a new book. It is called how Do You Feel?
We will link to that book in the show notes,
but be sure to check it out. Stay tuned, everybody,
We're going to be right back after this first break
before we get started. Two quick notes. One, this episode
(01:04):
is an encore performance. I am on break working on
a giant new project, so we're releasing a mix of
our favorite episodes from the first three seasons of the show.
This episode is from season one in which I answered
listener questions, sometimes on my own, sometimes with a guest.
So if you want more of these Q and A
style episodes, you can find the entire collection from season
(01:25):
one wherever you get your podcasts. Second note, while we
cover a lot of emotional relational territory in our time
here together, this show is not a substitute for skilled
support for the license mental health provider, or for professional
supervision related to your work. I really want you to
take what you learn here, take your thoughts and your
reflections out into your own world, and talk about it all. Hey, friends,
(01:52):
So one of the main goals of this show is
to give voice to what's really going on inside the
healthcare field. We're always talking about the importance of mental
health and reaching out for help, but the helpers are
human too. In an industry that prizes stoic detachment as
a form of high achievement, being a real human being
with feelings and limitations is seen as a liability a
(02:13):
lot of the time. That's especially true in the hospital setting,
where the fast paced and demanding workload can make even
the most committed helper feel like they have to sacrifice
themselves on the altar of the bottom line. Doctor Jesse
Gold is an assistant professor in the Department of Psychiatry
at Washington University School of Medicine in Saint Louis. She's
(02:33):
a nationally recognized expert on health care worker mental health,
and burnout, particularly during the pandemic. She writes regularly for
the popular press about mental health, stigma, and medical training.
That is a giant mouthful of professional street cred, all
of which to say that doctor Gold knows her stuff
when it comes to mental health challenges facing the health
care industry itself. Doctor Gold isn't afraid to speak into
(02:57):
that complex, messy, very very human sea of being called
to care for people while at the same time feeling
like you're falling apart. JESSI, my friends, welcome to the show.
Speaker 2 (03:07):
Thanks for having me.
Speaker 1 (03:08):
So I want to open with something that you wrote
in Forbes magazine last year. You wrote, quote, here's something
we don't say out loud as healthcare professionals enough. We
have reactions, feelings and emotional responses. We feel angry and
depressed and anxious. We have worries about what's going on
in the world right now and how it affects our patients.
We also have feelings about what we see and experience
(03:29):
on a shift, and those feelings often catch us off guard.
Our emotions are suppressed and held inside because we are
supposed to be stoic caregivers. So that mouthful just as
the starting point. What do you see as one of
the main issues unfolding for healthcare workers right now?
Speaker 2 (03:47):
I mean that whole mouthful is mostly a way to
say that we're told and taught not to feel.
Speaker 3 (03:53):
Really, it's the way to survive, it's the way to
deal with what we see day to day, and it
ends up being away that we then get burnt out
and said in a bigger way because we push down
a lot of feelings and we push down our reactions
and it just becomes not a space we feel safe
being in. And then it's kind of all compounds until
it's much worse. And I think that's a big problem
(04:15):
with healthcare in general. But right now, with everything that's
been going on in the pandemic and everything that people
have been exposed to, and how different the workspace has been.
You know, it depends on what phase of the pandemic,
but certainly like more risk to yourself or your family,
different lacks of resources in different ways because of staffing
or even just simply like resources like beds. I think,
(04:38):
much more death than usual on a day to day
in what you're seeing, and so you have this additional
compounded hard workplace on a baseline mental health situation that's
not ever really been great for healthcare workers. And so
it's kind of a perfect storm in a lot of ways.
And the feelings part is a big part of it,
because we just don't have a culture that talks about
(05:00):
any of it, and so you feel really alone and
that makes it a lot worse.
Speaker 1 (05:03):
Yeah, I think it's just it's such a hot mess,
right It was a hot mess before the pandemic. Like
the none of these things we see erupting right now,
they're not new. It's like we had a system that
was already broken, was already fractured in part because of
what you were just mentioning, like this culture of stoicism,
(05:25):
this idea that having human emotions is somehow unprofessional.
Speaker 3 (05:29):
Yeah, I mean, I think in a lot of ways,
a hot mess is a decent way of describing it.
And it's like an extra hot mess now, I suppose,
But I think, you know, I've heard someone say that
the fault lines are what you see through COVID, which
is like these things that have been brewing under the
surface but just get much more exposed with all of
the additional stressors of COVID, And I think this is
(05:50):
definitely one of them.
Speaker 2 (05:52):
And our culture and healthcare is horrible.
Speaker 3 (05:55):
I mean, we've lived in a group where you know,
you're prioritizing sleeping, not eating, like really prioritizing the other person,
you know, the patient over yourself. There's a lot of
conversation around like if you show emotion in a patient room,
like are you taking away from what that patient is experiencing?
(06:15):
So you spend a lot of time trying to learn
not to react to things or that it's normal to
go from a person dying in one room to a
conversation about like eating or something kind of just generic
in another.
Speaker 2 (06:27):
And that's just what you do.
Speaker 3 (06:28):
And it's a weird culture and not a culture we
talk enough about how weird it is either, and that
makes it hard.
Speaker 1 (06:35):
Yeah, I think that's a really interesting point you bring
up about, Like even if there wasn't this sort of
professional training cultural model of the stoic attending, right, like
you don't want to take away from the person in
the room by showing your humanity because then it's like,
oh crap, like now we're talking about me. We don't
want to hijack the situation in the room. But I
think one of the things that's really happened is we've
(06:57):
made that an either or situation and stuf of a continuum.
You are completely impenetrable, which doesn't do so great for
your clients and patients anyway. Or to use hot mess again,
you're a hot mess and you're taking away from what's
in the room at the time. And I think having
these conversations is how we create that middle ground of
how do we be full humans showing up to do
(07:18):
this work with the boundaries and the ethics that are
in place for us, but also not at the cost
of our own humanity and our own relationships and our own.
Speaker 2 (07:26):
Lives for sure.
Speaker 3 (07:28):
And I think in a lot of ways, if you
ask patients like they would be okay if you showed emotion.
It's different to show emotion over something that requires emotion
and would be an empathetic gesture to show emotion than
it is to just be emotional all the time and
not make it like a space that feels safe for
patients to talk at all. Right, that's very different, and
I think we worry that once you like tip over,
(07:51):
you're all the way over, and it's just really not
like that. And I think a lot of times I've
heard from people where their doctor has like actually cried
with them or sat with them through something that it's
been a really meaningful experience. But if you take that
from the doctor side, they'd be like, why would I
ever do that? That's horrible, Like nobody would like that.
That's not something I'm allowed to do. So it's a
(08:11):
very different perspective on what we want or what we
think we're supposed to be doing.
Speaker 1 (08:16):
It's interesting that you brought up that, like basically the
if I start crying, I'll never be able to stop
thing in the medical world as well. I mean, I
hear this a lot with people who are having a
really hard time navigating super challenging life things. They're like,
I can't start crying because I'll never be able to stop.
And that is such a product of our emotion a
verse culture as a wider social culture, and also again
(08:39):
in the medical industry. So this actually sets us up
really well. For the first listener question that I wanted
to get into, if you're ready, sure, I actually asked
my audience for questions. I told them all you were
coming on the show. I wanted to get a lot
of questions from people really working on the front lines,
and I can tell you that, like, question after question
after question after question was basically asking the same thing,
(09:01):
how do I handle my own grief, knowing how I
have to show up day after day and take care
of other people. For some of the people who sent
in their questions are actually working in the same hospital
where somebody close to them died, so the sensory awareness
is just on tilt for them. I'm going to preface
this question by saying we are not going to have
a neat and tidy solution for this, but I wonder
(09:22):
if we can use one of those questions as a
starting point.
Speaker 3 (09:25):
There's no neat and tidy solution to most things, especially grief,
but feelings are messy, and I think part of the
desire for a neat and tidy answer is part of
the problem, because we want it to be perfect so
then we can do it. But really, in a lot
of ways, you just need to be and see where
you go from there.
Speaker 1 (09:43):
Yeah, this is why I love your work so much,
in your presence in the world, because you're like, well,
this shit's missed. It's messy, Like we can't make it
anything but messy. Okay. So here is the question, dear
doctor Golden Meghan. I'm an inpatient PA trying to balance
the grief of the traumatic loss of my father, followed
by that of my relationship, as well as the grief
and loss and hardship brought on by the pandemic in
(10:05):
my daily work life. I'm so tired from carrying this
weight twenty four to seven. I have a counselor, but
I feel I could do more to compartmentalize or otherwise
find some relief. Is there a way to honor my
deep feelings but also find reprieve? How do I care
for myself in a world that requires so much of
my energy? I chose this question on purpose because it
(10:29):
has so much jammed into it, right, so many layers
and layers and layers, and I feel like it's really
indicative of what's happening in medical facilities all around the country.
So where do we start.
Speaker 3 (10:41):
It's interesting because you could say, oh, This feels like
a complex story, but in a lot of ways, it's
everybody's story, right. I think people forget that healthcare workers
have the life experiences that everybody else has gone through
that have been challenging over the pandemic, like being a mother,
being a partner, being a caregiver, having family members get
sick and die, and then on top of it, I
(11:02):
have to go to work every day on the front
lines and help everybody else. Right, So there's like that
added stressor which seems like enough to people, but we
have all the other stuff.
Speaker 2 (11:11):
Too, right.
Speaker 3 (11:12):
But I'm guessing that you know, in a lot of ways,
it's really good that she goes to counseling already, because
I think that's a big thing that's hard for people
in general in healthcare to ask for help, to admit
they need help, and they really hate talking about things.
So having a place for that that's just for you
is really important. I think in a lot of ways,
we try really hard not to have feelings in the
(11:35):
workplace and to pretend that somehow there's this big difference
between work and home and everything like that, but it's
all together, and you're the same person going into work
it's just you have to deal with the things at work,
and so, you know, I think it's important to give
yourself space and time to acknowledge what you're feeling as
much in the moment as you can. I think it's
really hard in healthcare because that's a privileged time and
(12:00):
able to pause at all. But honestly, like reflecting on
what you feel in your body, reflecting on what feelings
are actually having and being okay with also having feelings
while you do the job, I think is a really
important thing. So obviously it's great to have a space
to talk about with the therapist and process and all
of that, but the time before your next appointment is
important too, which is like, how do I deal day
(12:22):
to day without just like pushing my emotions down until
that one hour once a week, And you really need
to give yourself space and be okay like having a
full range of feelings. So I think a lot of
healthcare workers have struggled with things like anger and not
knowing whether like being angry makes you a bad doctor
or PA or nurse or any other person on the
(12:44):
health care spectrum. And you know, I think you can
be angry, and that feeling can be valid and you
can still do your job well. And I think it's
important that we get used to holding both things and
knowing when we have time to do whatever we need
to do, to let our selves acknowledge that we are
a human being with feelings and have to do our
job at the same time.
Speaker 1 (13:05):
Yeah, I love that, and it reminds me of something
earlier we had on the co founders of the New
York's end Center for Contemplative Care on and they work
with physicians, they work with people in healthcare, and they said, like,
I don't believe it when you say I don't have
time to acknowledge my own feelings, sit in my own humanity.
They're like, yes, you're busy, but you have thirty seconds, right,
(13:29):
And sometimes I mean it seems like it's not enough.
But what they pointed out was like thirty seconds many
times a day becomes fifteen minutes, and fifteen minutes of
allowing your own humanity to yourself will make a dent
in that pressure. It's not going to solve anything, like
none of this is like a super easy solution here.
But what I hear you really saying, Jesse, is like
(13:51):
there is power in acknowledging your humanity, even if it
is a split second as you're moving from one room
to the next, to be able to say I have
feelings about this. You have feelings about this, and I
don't have time for them right now, but I want
to notice for myself that I see them for sure.
Speaker 3 (14:06):
I think that we spend too much time assuming that
all things coping take hours. Like if I'm going to
tell you to have feelings or cope with something, you
need to whip out a yoga mat and do like
a forty minute class. Right, that's impossible for most people
most of the time. There are different things you can
do that take less time that are really helpful. Healthcare
workers really like things like deep breathing because you walk
(14:27):
the stairs between patients. You have the time gelling in
and out of a room before you have to see
the next person to take the second and like actually
change your breathing patterns to calm yourself or acknowledge how
you're feeling, or give gratitude for what you just experienced,
if that's helpful for you. I think we don't stop
enough to think about the good things in our day
(14:48):
or the privilege of our job. We often get really
caught up in the hard thing of our job, and
so trying to just do that in the quick amount
of time that you have.
Speaker 2 (14:56):
You're right, it sort of just.
Speaker 3 (14:57):
All adds up to being less than you know, maybe
ideal in the world, but much better than nothing, and
much better than only having that once a week time
in counseling, which most people don't even have, because that's
a privilege to be able to fit into your schedule,
and also to not feel scared to do that in
the first place in healthcare. So I think you're right,
(15:18):
just kind of all kind of comes together as much
as you can.
Speaker 1 (15:21):
Yeah, it really doesn't. And I just want to pull
out that one little bit that you said, not only
is it a privileged to find the time to go
to therapy, but because we're working against that idea that
having emotions on the job makes you less professional, less
skilled at your work, like that is a big thing
that we want to name here too. That can feel
really scary to even acknowledge that you're wrestling with this
(15:41):
stuff because of that culture of perfectionism that we see
so much. So I love that you're like, you can't
just whip out a yoga mat and I think we
often use all of those things that you just mentioned.
We often like they're often positioned as these cure alls,
like if you would only practice gratitude and journal for
fifteen minutes about all the things that you love about
your life, that everything would up sucking so much. And
(16:01):
that's like, that is not what those tools are for.
Those tools are not to remove suckage. They're to help
you navigate, manage, and support yourself inside this really really
difficult situation. And for me, like the language that I
use around that is like, this is helping you acknowledge
the reality of the situation, and acknowledgment is very powerful medicine.
Speaker 3 (16:21):
Yeah, I mean, I think that's a problem with a
lot of framing around coping skills or especially like resilience,
is this feeling that it's somehow your fault that you're
not surviving in a broken system, And when people suggest
doing things that can help you, it feels like they're saying,
come on, like fix yourself, like yeah, wornything else is fine,
work harder, figure it out, like you should be fine. Yeah,
(16:43):
But really what we should be saying is the system,
specifically in healthcare, but in a lot of ways, is
very very broken, and culture change takes time, policy change
takes time. Any other sort of systematic change is going
to take time. And if you want to survive in
a truly broken system, even as it attempts to heal,
you have to figure out how to do that yourself,
(17:06):
and it requires some individual coping to do that. It
doesn't mean something's wrong with you. It means that you're
reacting normally to a really bad situation. And if you
want to still be in healthcare, you have to figure
out how to deal. And you know, I'm not exempt
from that by any means. Like I think it's important
for people to realize, like just because I preach like
(17:29):
things around coping skills and burnout and things like that
doesn't mean I'm really great at all the stuff myself.
Like I've really spent a lot of time over the
pandemic trying to figure out what coping skills actually work
for me and don't feel like that, like I'm just
doing something to do it, And like I spend a
lot of my energy like coping with others and having
(17:50):
the support of other people, And when that got taken
away in the pandemic, it was a lot of like, oh,
what do I actually like to do myself that actually
still feels good in this way that going to dinner
with a friend might. And it's been a lot of
work and I'm still working on it, and you could
ask way therapist and she'd probably tell you I'm okay sometimes.
Speaker 2 (18:08):
And struggle a lot.
Speaker 3 (18:10):
But I think it's important that people realize that even
though I know these things, it doesn't mean that I
do them all the time. And we spend a lot
of time in medicine assuming like, well, I can, I
should be able to take care of that myself, like
I understand disease or I understand mental health, I should
be able to figure out how to deal with this,
And honestly, you shouldn't because I actually am an expert
(18:31):
in this particular area and I can't. Right, So it
doesn't matter what you know. It matters how it gets
applied and how other people point out things to you
that you might not even realize are going on.
Speaker 1 (18:42):
Yeah, I love this. There's actually a Twitter thread of
yours where you I think you started it, where were like, okay, physicians,
let's talk about the things that we would tell our
patients to do, but we don't do ourselves. And there's
this whole long thread of like I don't I never
drink water, I drink only diet soda, I don't get
enough sleep, like I never moved from my like all
of these things like remembering your humanity in there and
(19:03):
this is not I think there's so much perfectionism baked
into the healthcare industry, right like, I must do this
correctly or I won't. Like, oh, come on, like you
are still human and you are still a catastrophe in progress,
just like all of us.
Speaker 2 (19:18):
I mean, medicine like recruits those people. Yeah, in a
lot of ways.
Speaker 3 (19:21):
So it's like it's a process that is like let's
start out with the people who are most likely to
be perfectionists and then make it harder for them by
judging them for having anything that's outside of perfection or
making them feel judged for having anything outside of perfection.
And achievement and perfection become this thing that carries throughout
but probably did and most people who went into healthcare's
(19:43):
life before that, because you have to go into a
process of applications where not everybody gets in, and there's
all this competition up front, and the competition makes you
feel like you have to be perfect, and that just
continues on and on and on, especially if you stay
at academics.
Speaker 1 (19:59):
Yeah, yeah, I love that perspective there, that through that
whole rigorous process of getting into the field, because we
have that culture of stoicism and perfectionism that we are
actually like selecting for that. And then you put these
people who are selected to run that way, to hold
themselves to really high standards, to suppress their feelings because
of multiple reasons, and we put them into a highly
(20:22):
emotionally charged situation over and over and over again. And
then I just don't think we can be surprised when people.
Speaker 3 (20:28):
Break, especially not people who mostly wrote application essays about
how they want to help people, right Like, the people
that are the best at what we do care a
whole lot, and that's really hard to keep doing and
not break. And you don't want to find ways to
only keep the people in healthcare that are fine with
no feelings and don't break, right like, you want to
(20:51):
keep those people.
Speaker 2 (20:52):
So we have to do better.
Speaker 1 (21:01):
Welcome back to friends. We have been talking with doctor
Jesse Gould on the reality of being a healthcare professional
with real human feelings inside a profession that doesn't actually
value human feeling. Let's get back to our conversation. I
think this sort of brings us around to the big
picture environment that a second listener question ushers us into.
(21:22):
Debbie wrote in how do we change things in healthcare?
As a frontline worker, we need our managers to understand
that we are not machines. We are human and need
to be heard and understood and rewarded. I get it
that managers have numbers and goals to meet, and we
have patients, but it's the frontline clinicians who do the work.
We're the ones who face the trauma of treating COVID
(21:43):
patients head on, seeing the horror unfold. We can't just
keep going as if nothing has changed. We've changed. How
do we change the system so more value is placed
on our well being? I think a shift has begun.
Workers want more. I see that, but I guess for
now we just have to say stand up for ourselves.
So I love that line in there in this question,
(22:04):
how do we change the system so that more value
is placed on our well being? And you touched onto
this a little bit, but if we widen that lens out,
how do we start forcing a change in a system
that was broken before the pandemic. Those fault lines are
really glaring and exposed. Now how do we even start?
Speaker 3 (22:26):
Yeah, I mean I've thought somewhat about this, in part
because in one of my roles in the hospital, I've
had to interface a lot with like administration and try
to argue for the need to invest in these things.
And I think it's very frustrating because we ultimately have
different goals, right, Like, I think when you're a frontline clinician,
your goal is to help the patient as best as
(22:48):
you can, and you're really focused on them. Once you
get higher and higher up in mezine, you're dealing with
people who are really concerned about the bottom line and
really concern and about money, and ultimately you realize just
how much our healthcare system is actually a system that's
built on financing instead of the people that it's taken
(23:10):
care of, and that itself can be pretty disheartening. But
I do think there are ways where you can make
arguments acknowledging those values that maybe not your values, but
are the values of the system to get what you want.
Speaker 2 (23:25):
Right.
Speaker 3 (23:25):
So, for example, depression is the number one cause of
disability worldwide, which means it costs the system a lot
of money to have a lot of depressed doctors because
you don't go to work, or nurses or whatever. You
don't go to work, you can't be as productive, you
might have errors. All of these things are true, and
there's data that backs it up, and I think hospital
(23:48):
systems are becoming more aware of it because of COVID
and how many people have been speaking out about their
mental health in COVID and realizing that they can't just
give you a pizza party or like a lecture on
wellness until you like, we're done, that's all we're doing,
that's all we care about the end, or just give
you access to an employee access program and realize that's
(24:09):
not enough either. And so I do think there is
a way to advocate for what you need or what
you're missing while still appealing to a value that might
not be your value, but is the value that might
get things done. Unfortunately, you have to do that sometimes.
So I think that's really important. And at the same time,
I do think you can make small changes, like in
(24:30):
your teams, in the people that you're supervising, in the
way you interact with other people, that can make a
big difference. So, you know, I talked a bit about
how we don't talk about feelings, but we don't even
say like it's okay to make mistakes, or that was
hard or that was challenging, or of course you don't
have an answer to that and you don't know, we
don't know, right, and modeling that for people having conversations
(24:52):
about why it's hard to say that stuff you don't
even have to talk about, like mental health conditions. Right,
we just need to start changing the conversations around struggle
and why it might be hard to do this job.
And some of that can happen on a team level
or a supervisor level, and then it can get to
(25:12):
higher and higher levels, sort of as a bottom up
approach to changing how we talk about this stuff.
Speaker 2 (25:18):
And once you do that.
Speaker 3 (25:19):
At the same time, hopefully they hear your advocacy and
they hear the things you want and they start making changes.
But I do think you can make some changes just
by having real conversations.
Speaker 1 (25:30):
Yeah, absolutely. I mean, we started out this the first
half of the show talking about telling yourself the truth
in these moments, letting yourself be human, letting yourself having
these feelings. And I love what you just brought in
there about like we can start having these conversations in
our teams at the nurses station, you know, in supervision,
to just start normalizing what's actually happening, Like we're not
(25:51):
talking about anything like earth shatteringly new, We're talking about
let's name what's actually in the room, and start claiming
our humanity as normal and healthy and challenging in these situations.
This is really a grassroots movement of the people who
are in the front lines doing the work starting to
tell the truth to themselves and to the people around them.
(26:11):
And I also love that you brought in like let's
borrow from the c suite. Let's borrow from higher up admins.
They do have a balance sheet at the end of
the day, and there is economic benefit to valuing people's
humanity and their limits. And I think you know, whether
you take on that role or not, Like if you
pick up that flag and you decide to go after
(26:33):
that or not. I think that's something that we want
to start really talking about, is the economic reality of
denying people their humanity, not just in the medical world
but all around the entire globe. But that we do
have to speak the language of finances, and how do
we start understanding that denying people their humanity costs us.
(26:53):
It costs us financially, it costs us in community building,
it costs us in all of the public health crises
that we have currently unfolding. Interruptive. You know, I started
this our conversation out by like saying, we're never going
to have a solution for the hot mess of all
of this. And I still believe that. I still believe
we're not talking about a solution here, but I do
think we're talking about a way forward from here without
(27:16):
collapsing into the despair of the hot mess. But how
do we really start to change the culture. One of
the things that I picked up from your work, there's
this great quote from you that says, the mental health
system is broken. You can't fix it by breaking yourself.
And I think that's a really interesting sort of closing
(27:37):
point for us in all of these things that we've
talked about. So tell me a little bit about that statement,
and if there's a message you want to dictate to
the world in this in this moment about I don't
know everything we just talked about.
Speaker 3 (27:50):
I mean, I think in a lot of ways we
neglect mental health in all conversations. So the reason why
it's not in the financial conversation is people forget it
and don't put it there or think it's not relevant.
Or we're seeing all these people leave jobs and they
don't talk about the fact that it's because of burnout
or mental health. It's just like, oh, staffing or these
(28:10):
like procedural things. And that's very true. But at the
same time, you have to call it what it is
and say people are choosing themselves over a job that
takes it out of them. Right, we have to have
mental health in these conversations or we're really missing out
and we're not advocating enough for ourselves. We're just going
to keep jumping jobs until we find a place that
maybe is a little bit better with it, right, And
(28:32):
I think you know when I said that we can't
fix it by breaking ourselves, I meant over the pandemic,
I've seen therapists really try to just take every single
patient that they possibly can to make up for the need.
And there's a huge need, and there's always going to
be a huge need, and the need keeps increasing and
(28:53):
will after the pandemic. But you talk to therapists and
they're like, well, I started working in the evenings. I
took back all my you ask to come back from before.
I am working on weekends now, and now I'm sad. Like,
turns out that has a big effect on me too,
because I don't have free time anymore, and I'm holding
all this stuff for other people. And as much as
(29:14):
you want to try to help in every single way
you can, which is what we do in our jobs,
in so many ways, there's only so much as a
human in a broken system that you can do without
realizing that you really need to step back and put
yourself first. Like, you can do what you can do,
but there are limits to what you can do because
you're a human being, And so as much as you
(29:36):
are an advocate or a caring person about how broken
these things are and how much you want to change them,
there's a space for that. But in the same breath,
there's also boundaries and a way to have space for you.
And we neglect the second part because we really want
to do the first part right, But you don't do
the first part right unless you do the second part.
Speaker 1 (29:56):
Yeah, I think that's a really beautiful end note for
our time together in a life lot of ways, this
is a lifelong pursuit we're talking about, right, like this
exploration of how do we do the work we're called
to do without losing ourselves in the process. So ordinarily
at the close of the show, I ask you where
people can find you when we are absolutely going to
do that, But first I would also love some ideas
(30:16):
where physicians and other healthcare workers can go for support.
What are your like maybe top two or three places
that you would recommend right now.
Speaker 3 (30:24):
So you know, in a world of misinformation, it's always
helpful to go to places that you know are consistently
good and putting out good information. So I always go
to like big organizations when that's the case. So often
that means going to like the American Foundation for Suicide Prevention,
who has website on healthcare worker mental health thrive By.
The Huffington Post also has a huge website it's called
(30:45):
like all In for Heroes, I think, and they have
all these resources collected.
Speaker 2 (30:50):
Most of them.
Speaker 3 (30:51):
Medical organizations also have that too, So you could go
to the AMA, you can go to the Double AMC
and they all have these kind of like wellness hubs
and they're probably the kind of thing where you're listening
to me, you're rolling your eyes and saying like, did
you just give me more stuff.
Speaker 2 (31:04):
To read and do?
Speaker 3 (31:04):
But at least it's there, you know. And I think
the people who started things like the Physician Support Line,
which is staffed and it's all psychiatrists and staffed voluntarily,
they made that over COVID.
Speaker 2 (31:16):
They're wonderful humans. You can use that.
Speaker 3 (31:18):
I know that that's limiting to then only physicians, and
I know nurses who are trying to start the same
thing for nurses. I think there are some places that
still offer free therapy if you're in healthcare, and those
places like Emotional PPE or Therapy AID are also quite
good because it's national and you can find some people
who are willing to give you some free sessions, particularly
(31:39):
you know, in the situation where your workplace is and
doing that too. And I think all those people really
care and are trying their best to give you access
to what they know exists. And obviously we could do better,
and obviously we need more things, but those are the
best that we have right now.
Speaker 1 (31:55):
I think, yeah, they're sort of the starting places for
what we mentioned earlier in the show. About starting to
link up with others and find places where you can
tell the truth. Right, It is a little bit overwhelming
to be like, oh, now I need to go to
the AMA site and search through all of this like
I have fourteen seconds. But again, like even just starting
that practice of telling the truth to yourself and maybe
finding one or two other places. I actually love your
(32:17):
Twitter feed for this, so let people know where they
can find you online.
Speaker 2 (32:21):
I'm at doctor Jesse Gould.
Speaker 3 (32:23):
I spelled JESSEJSSI because I was a high maintenance child
that didn't say there was an I in Jessica, so
that's why it's spelled that way. I also have that
same as an Instagram handle, and then anything I write
is on my website, which is just like doctor jessegold
dot com.
Speaker 2 (32:38):
But I think that can be helpful for people because
I've written a.
Speaker 3 (32:40):
Lot on this particular topic, including from my own experience
and being a burned out for an out expert.
Speaker 1 (32:47):
Yes, I think that's the powerful thing here is that
you know what you're talking about. You're not just some
talking head from the C suite telling people to do
things for their mental well being so that they can
be even more productive on the job, but this is
actually something you live, and I am so glad to
have had this time with you, my friend. People. We
will link to everything that Jesse just recommended and a
(33:07):
couple of extras in the show notes coming up next
your weekly questions to carry with you and how you
can send in your question for us to use on
the show. Don't miss that part, friends, we will be
right back each week. I leave you with some questions
(33:29):
to carry with you until we meet again. It's part
of that whole. This awkward stuff gets a lot easier
with practice thing, and I definitely want you to practice now.
This week, doctor Jesse Golden, I talked a lot about
telling yourself the truth and then telling other people the truth.
I mean, honestly, this is not anything that has to
do only with the healthcare industry. This is something that
(33:52):
I feel like I spend all of my time talking
about the importance of telling yourself the truth and finding
somebody else to share that truth with. It's important to
find connection inside the catastrophe. So this week, for your
questions to carry with you, your homework assignment is to
tell yourself the truth about one thing. I don't care
(34:15):
what it is. I don't care how you tell yourself
the truth, whether that is in the thirty seconds between
clients or patients or two year old tantrums like I
don't care what it is, but find one thing and
tell yourself the truth about it, and then just see
what happens. I want you to be a good observer
of what happens when I tell myself the truth. Yeah,
(34:37):
and then extra credit.
Speaker 2 (34:39):
I don't know.
Speaker 1 (34:39):
I don't know that I want to use extra credit
because I don't want to tap into your perfectionist achiever
thing here when we're talking about burnout. But if you
want to do an additional thing, find one other person
to tell the truth too. It doesn't have to be
a big life altering thing that you share. It could
be just like you know, I really don't like Kale.
(35:01):
Find one other person to share the truth with and
see what happens. This is also a good time for
me to remind you that I really do want to
hear if you don't like Kale or whatever you need
to spell the truth about. But this is also a
Q and a show, and I want your questions. You
can ask me anything you'd like. You can bring me
(35:21):
your clinical questions I'm trying hard to be a good friend.
Frustrations you are, I'm overwhelmed with the pain of the world. Questions.
We got a lot of those. Let's talk it all out, friends,
Call us at three two three six four three three
seven six eight and leave a voicemail. If you missed it,
you can find the number in the show notes or
visit Megandivine dot co. If you'd rather send an email,
(35:44):
you can do that too, right on the website Megandivine
dot Co. We want to hear from you. I want
to hear from you. This show, this world needs your
questions Nowather. We can make things better even when we
can't make them right. You know how most people are
(36:08):
going to scan through their podcast app looking for a
new thing to listen to, and then they're going to
see the show description for here after and think, I
want to talk about that stuff. Things are hard enough.
This is where you come in your reviews. Let people
know it really isn't all that bad.
Speaker 2 (36:21):
In here.
Speaker 1 (36:23):
We talk about heavy stuff, but it's in the service
of making things better for everyone. So everyone needs to listen.
Spread the word in your workplaces, in your social world
on social media, and click through to leave a review,
Subscribe to the show, download episodes, send in your questions,
want more Hereafter. Grief education doesn't just belong to end
(36:44):
of life issues. Life is full of losses, from everyday
disappointments to events that clearly divide life into before and after.
Learning how to talk about all that without cliches or
platitudes or simplistic think positive posters is important skill for everyone.
Find trainings, workshops, books and resources for every human trying
(37:05):
to make their way in the world after something goes
horribly wrong at Megandivine dot Co. Hereafter with Megan Divine
is written and produced by me Megan Divine. Executive producer
is Amy Brown and Elizabeth Fozzio, Edited by Houston Tilley.
Music provided by Wave Crush,
Host
Megan Devine
Popular Podcasts
On Purpose with Jay Shetty
I’m Jay Shetty host of On Purpose the worlds #1 Mental Health podcast and I’m so grateful you found us. I started this podcast 5 years ago to invite you into conversations and workshops that are designed to help make you happier, healthier and more healed. I believe that when you (yes you) feel seen, heard and understood you’re able to deal with relationship struggles, work challenges and life’s ups and downs with more ease and grace. I interview experts, celebrities, thought leaders and athletes so that we can grow our mindset, build better habits and uncover a side of them we’ve never seen before. New episodes every Monday and Friday. Your support means the world to me and I don’t take it for granted — click the follow button and leave a review to help us spread the love with On Purpose. I can’t wait for you to listen to your first or 500th episode!
Stuff You Should Know
If you've ever wanted to know about champagne, satanism, the Stonewall Uprising, chaos theory, LSD, El Nino, true crime and Rosa Parks, then look no further. Josh and Chuck have you covered.
Dateline NBC
Current and classic episodes, featuring compelling true-crime mysteries, powerful documentaries and in-depth investigations. Follow now to get the latest episodes of Dateline NBC completely free, or subscribe to Dateline Premium for ad-free listening and exclusive bonus content: DatelinePremium.com