DTD 164
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[00:00:00] This is the Drive Time debrief, episode 164.
Hey guys. Welcome back to the podcast. I'm Amanda. I'm Laura. And I'm Kendra. And today we've got a favorite topic of Kendra's. How about you introduce it? Okay, today we're gonna talk about vulnerability in medicine, and we do touch on this quite a bit, so stay with me, right?
[00:01:00] I feel like medicine has misconstrued vulnerability or even we've told ourselves that vulnerability is a weakness. It's actually a superpower because it keeps you in the posture to not go down the shame spiral or not to experience, you know, fear not to get defensive.
It just really protects us against some of the underlying reasons why you know, maybe a certain patient interaction, a conversation with a consultant. You know, day in, day out we are asked to step into the arena. And why I love this is because, you know, we've talked several of Brené Brown's books, and she talks about this speech from 1910.
It was a Theodore Roosevelt speech called The Man in the Arena. And she talks about it in the way as like, you know, going through life. I mean, he was basically saying, the people that mean the most, the opinions I listened to. The things that I consider of integrity and that I would want to be a part of are those people [00:02:00] that are actually down in the arena.
It's not the Monday morning armchair quarterback, some people call it, or the people standing on the sidelines interrogating you or telling you maybe you should do this or maybe you should feel this way, or whatever they're saying, they're on the sidelines doing it, or they're in the crowd.
They're not actually getting bloodied with you, getting battered with you. They're not getting dirty, they're not faced down in the dirt. You know that you might feel like you've just been through the fight of your life or you've just had a week during work where you have battled every single day. So it's the people that are in the arena that are the ones that can, you know, share their opinion or they can share their perspective because they're the ones getting bruised and battered and dirty with you. And so this is kind of introducing this anecdotal kind of correlation to what is it like to be a physician in the arena? What is it like to show up, be vulnerable, stay curious, not defensive, stay curious, and [00:03:00] how it can be our strongest ally.
And so, if anyone's read Rising Strong the introduction to the book makes it very clear what we're talking about. But basically, as physicians, we often step into the arena where we risk failure, criticism, and emotional exposure. So how can we continually show up courageously when the stakes are high, or when we're constantly being asked to extend ourselves and maybe even beyond, what we're, you know, physically and mentally able to be.
How do we continue to show up like this? Yeah, Brené is inspirational when you see her talking about this. It's like I no longer have any interest in people's criticism who are not in the arena, getting absolutely pummeled along with me. And a lot of people will say it's hardly ever the person above you who's criticizing you.
It's almost always somebody who's an internet warrior who is just ready to comment and Right. As a physician and free to do so. Yeah. Or they feel free [00:04:00] to do so. Yeah. I feel like as physicians, we do the same, where we like to comment on how another specialty is handling something we don't know. We don't know what it's like in their office.
You know what I mean? They for sure don't know what it's like in my scenario, so I'm doing the best I can. I promise you. I did find Roosevelt's little speech. It's not too long, so, he says: "It is not the critic who counts, not the man who points out how the strong man stumbles or where the doer of deeds could have done them better. The credit belongs to the man who is actually in the arena, whose face is marred by dust and sweat and blood. Who strives valiantly, who errs, who comes short again and again because there is no effort without error and shortcoming. Amen. But who does actually strive to do the deeds?
Who knows great enthusiasms, the great devotions who spends himself in a worthy cause, who at the best knows in the end, the triumph of high achievement. And who at the worst, if he [00:05:00] fails, at least fails while daring greatly so that his place shall never be with those cold and timid souls who neither know victory nor defeat."
It's pretty. Yeah. And that's, that was her Daring Greatly book. Yeah. Talks a lot about it. So she has stripped this thing down and written several books about it. But I think what's most intriguing about it is like, this speech is a hundred and almost 130 years old. Yeah, yeah. And just amazing how even a hundred years ago the resiliency of the time or the men who stood up as mighty men of valor really could give a rat's about who was standing on the sideline or who, who wasn't in their close circle actually making valiant decisions. And I mean, just that perspective alone make you think, it sounds like there were internet trolls before even the internet.
Did they live in their mother's basement though? That's my question. It's possible. It's possible. I don't know. So just to point out that we all step into the arena when we have to make tough [00:06:00] calls, when we take on leadership positions or have to have difficult conversations with patients and colleagues, the fear of judgment from peers, patients, or even ourselves, often leads us to shut down rather than staying open.
And that's what we're just trying to point out is that you are the hero in this story. You don't have to worry about what others are thinking because they're not there in the arena with you. It's unfortunate that our medical training many, many times pushes us over into maladaptive perfectionism and Laura, I think we're gonna have to trademark your narcissistic system of abuse, applying to medicine.
The whole system, the whole hierarchy discourages vulnerability. God forbid, you are overwhelmed with 80 different decisions that have to be made at once, and one of them gets botched because you're gonna be set up in front of all of your peers and basically publicly humiliated. And so it makes a lot of sense why that happens, but it disconnects with the best version of ourselves.
Because of that, we tend to be defensive. [00:07:00] We tend to shame ourselves and others. We also tend to emotionally detach, and the goal I think of this podcast is to be courageous enough to reconnect with the best parts of ourselves, which are vulnerable. So a key question just to think about as you're driving home or driving into work, but think about the last time that you felt exposed or uncertain in your practice.
What was your initial reaction and did you lean into curiosity or pull away? For me, this comes up a lot with like, I have just become very comfortable with having no idea what's going on in the ER. I don't feel like that's a bad thing for me to know when I don't know and to reach out.
And I loved when we talked to Dr. Palmer you know about her husband who died by suicide, but she was saying in her practice, I just loved it. She's like, I never go down alone. We were taught that do not go down alone, reach out. We're all here. And man, that is. I [00:08:00] don't feel like that is very well taught.
Maybe I'm wrong about that, but I feel like the opposite is taught, like, why don't you know this? Mm-hmm. Right. And I would say it's probably not the standard, at least like, 'cause when you said that, I was like, yeah, I don't think I was ever told that in residency. Much less told like even lean into your like senior residents that were on service, or even like an attending, don't ask questions, you're just supposed to know.
Mm-hmm. Like you, I never even felt like I could even be like, Hey, this patient doesn't look too good. I'm not really sure what's going on. Right. And like patient's crumpy, you know, but you were even afraid to go to the attending and be like something ain't right here. What if I'm wrong? Yeah, yeah.
Right. Yeah. What if you're wrong? I mean, that's the thing. Like, okay, great. You know, patient's fine, but God, we get really conditioned to not not reach out. Yeah, yeah. No. That we're like thrown in the arena, like the gladiators. Just one person in there to either no. Sort [00:09:00] survive or get killed. Yeah. That's what it feels like.
Yeah, it definitely does. Yeah. And if we don't know something we're, nobody tells us this explicitly, but definitely the vibe is you better hide that. So nobody thinks you're incompetent or an idiot or you know, our imposter syndrome flares up. And so sometimes when we're out in that arena, we freak out if we don't know something or we feel somehow if we feel that imposter syndrome or we're having something difficult happen to us.
We can kind of get like that deer in the headlights situation where we're actually freaking out, either panicking or super stressing, or many of you are doing this shaming yourselves and beating up on yourselves. Like, why don't I know this or, and I want to offer this to you. We have had podcasts on self-criticism before, and I don't know if we said this specifically.
But I'm gonna say it now, [00:10:00] so that maybe you can be a little more dedicated to letting go of that self critic. It's actually emotionally immature to beat yourself up. It's not the best version of you. It's the less evolved lower brain that is doing that, and there's no virtue in it. And so, you know, it's a default.
When we are triggered into a fight or flight or freeze or fawn situation, sometimes that voice comes up and what do you do? What do you do? So knowing how to ground yourself, and we talk about grounding. We're talking about helping ourselves notice when we are in a limbic. Emotionally immature, lower brain state, and pulling ourselves back up into our thinking brain, and here is a great tool for that curiosity.
So now if we're not practiced in learning [00:11:00] to pay attention to what our brain is doing. Sometimes it just feels like that's just the way it is and the world is ending and you're the worst doctor ever, and you might as well just go home and sit on the couch and eat Cheetos. If we start practicing and noticing the thoughts that we have that are driving us into a sympathetic state and noticing that we can actually change our physiology by doing deep breathing, by paying attention to our surroundings, putting our feet flat on the floor, touching something, smelling something, hearing something, and being curious, curiosity comes from our cerebral cortex. And so instead of judging ourselves and shaming ourselves, we think what exactly is going on here. What triggered me? And then what can I learn from this experience? What is the opportunity here for me to learn? And as we're curious, we are [00:12:00] open to solutions and not just survival, which we are in a thinking profession. We've got to be able to think straight. And when we're in our limbic system, we can't.
So if we're freaking out because we think we don't know how to do something, or somebody's yelling at us, or any number of things that go on on a day-to-day basis at work, in a medical profession. That's our opportunity to just be curious, okay, what is it that's going on? What triggered me and why do I feel unsafe right now?
And what, what can I learn here? So here's some real world applications. So if you think about, say if you're an emergency physician or a hospitalist and you have a code either that comes in through the ambulance bay or that happens on the floor, and you go in the room and people are shouting and your brain tries to dive down into the limbic system [00:13:00] and you feel like you're freaking out.
It's not gonna be helpful there to be like, oh, you're such an idiot. Like you should know all this stuff. Like why is why after doing this for so many years does this still rile you up? It riles just about everybody up. It's life and death, and it's normal for that to rile you up. However, our emotionally mature selves are able to regulate ourselves, get ourselves calm enough to be able to think straight.
And, get the job done. So some other examples would be we can get pretty upset sometimes, either at other doctors, at patients, patients', family members, and sometimes that happens without us even realizing what's going on. This actually happened to me not too long ago. It's pretty rare at this point, but I had a full amygdala hijack a couple of months ago when, you know, it's the middle of winter.
I'm working in a pediatric ER. The wait times are crazy because [00:14:00] everyone is coming in with all the nine different respiratory viruses that are going around and this dad start, like I had just seen them. I explain what workup we're gonna do and he, you know, they had probably waited an hour and a half at that point, so not even that long, or, you know, in ER terms.
And I leave the room probably five, 10 minutes later, the nurse comes down and tells me that this dad is just berating her, that they have been there so long. My therapist tells me I have very strong protectors and one came out and I went in there and I was like, what is wrong with you? Like, can't you see that this nurse is trying to take care of your child?
That we are all doing the best we can anyway? And it was so interesting 'cause in years past, I might have come back to the desk and just been like, rah, that dad. And while that is [00:15:00] in there too, I was able to come back and say, wow, what happened to me? Like I kind of lost it with that guy and I don't do that often.
And so it was an opportunity for me to be curious and being curious helped me calm myself down. Think about how I really wanna be in the face of those situations. And hopefully next time that happens, I'll be able to go in, in a more regulated state and not be taken aback and not be taken over by my amygdala.
Who knows? No, no guarantees. But so here's the invitation to you listener. The next time you feel defensive or exposed or embarrassed or shamed or, oh, really protective. Like I was just take a moment and say, what else might be true here? Is there another way to see this situation? How can I stay open and make sure I'm getting [00:16:00] all the information I need rather than shutting down and losing the opportunity to connect and to grow myself.
I think that's a good point. I think, you know, one of the things that I've kind of learned how to do is sometimes I can't think of all of that right away. So one of the things I really related to, Brené Brown in, I think it was Daring Greatly. She's like, you know, before I freak out, I just pause one second and be like, do I have enough information to freak out right now?
Like, like, should I pull the trigger? And so that's what I think of in my brain. Mm-hmm. I'm just quick to be like, I, I mean, I know what it feels like when I'm going, getting ready to go to level 20. And so as soon as I feel it, I'm like, is this a good time to pull the trigger or something to that effect?
Like, do I have all the information I need to really go full throttle here, or should I maybe get a little more information? And I'll tell you like, since I've been more aware of that. Just even asking that like, should I [00:17:00] go, you know, full psycho here, or should I get some more information? And typically I can ask maybe one or two questions or go to that nurse or that patient or that whatever, and just ask one or two more clarifying questions and kind of get the information I need.
Yeah, because like it's amazing when we're hearing something from somebody, if they're telling you the story and they're at level 10, or you feel like, especially I think women do this a lot, we're kind of feelers, we feel the angst or the intensity of a story that someone's telling us, even though they're just giving us information. If it's a very intense situation or they have felt something, it's very easy for us to pick up on that and can easily like supercharge us as well. And so I have to be very intentional about not joining in the intensity at first, but just considering that it's information giving at the moment.
And then maybe before I pull the trigger or go full psycho, I should go get some more information. And most of the [00:18:00] time going in with a level head and just trying to seek information. Usually I would say not all the time, but usually, you know, that I don't pull the throttle in. Go well, yeah. And I still have a job.
Yeah. The other thing too is you could turn the curiosity outward and be like, you know, maybe he was under the impression that there was no wait today, or his doctor said that he would be seen right away, because that's, sometimes it seems like, you know, actually, as I recall, it was one of those situations where they came in and in triage the kid, like the complaint was abdominal pain and kid was completely non-tender. Mm-hmm. And I, you know, but he was saying, you know, they were worried about appendicitis. So I ordered an ultrasound and he was mad that the ultrasound had not been ordered as soon as they got there.
That was what he was mad about. I was like, you have gotta be kidding. Yeah. Always makes me think that he, he [00:19:00] or she or whoever, probably like thinks their kid's dying. You know? They just don't know. Even though he's like rolling on the floor, jumping around. Yes. Yeah, you're right. But I mean, I don't know.
Yes, the react that way. Or maybe they just have, maybe they have always just had a really easy time. Yeah, right. There's definitely a different story than what my story is. Or maybe not, but maybe we don't know until we get more information. Yeah, it's always helpful. Get more information, ask more questions rather than a me because maybe full psycho is warranted.
Full psycho is sometimes warranted, but sometimes our brains will allow some assumptions and instead of like just assuming everything or going to level 10, you know, maybe getting more information is helpful. I find this helpful too, that turning outward is like, you know, if you get on the phone and you're just like expecting to have a slam dunk admin, you're just like, blah, blah, blah.
You say like three sentences. That's all really they need, like it's going to be admitted and they come back full psycho and you're like, oh wow, that's [00:20:00] interesting. Are you okay? Like, you know, it's really easy to ask more questions like what else is going on in your life right now? Yeah, yeah. Can I, do you wanna call me back?
Is this a bad time? Like, I just find, I ask the same like three or four questions and usually there's a pause and then there's like, oh, okay. Yeah. Maybe a little self-reflection. I don't know what goes on on the other end. I can't see that. But you, you hope that maybe just saying, are you okay? Or is this a bad time?
Is all the questions you need to ask?
So, yeah. So anyways, hopefully this has kind of given you some reassurance that being vulnerable in medicine, meaning staying open, staying curious, we've given you a few actionable tips, but also just some things to think about that it absolutely is a part of medicine. If you recall, especially those that work in acute care critical care, you know, this is sometimes the worst day of a patient's life, and most, I would say most of the time, their defensiveness or anger or anything that they [00:21:00] may be coming at you with is really the fear is undermining all that.
They've never been to the hospital before, or they've never experienced something like this. Or they call a friend before they decide to pull the trigger and come to the hospital and the friend's like, oh yeah, my mom had that and she died, or something like that. Right, right. Yeah. So we don't know where they're getting their information.
Dr. Google. Right. Everything is accessible and so they may get pieces of information that only feeds their fear, and so when they come in they are also resisting being vulnerable. And so it can really lead to a very detached communication, a very detached experience because now both of you, you know, me as a physician and the patient are detaching because we're self preserving and we're like not wanting to engage in the full psycho.
I love in Daring Greatly, Brené Brown, you know, she uses that a lot talking in leadership styles and it's very easy as a leader to really, I don't know, take [00:22:00] on a little bit more about whatever situation you lead. So whether it's an ER or a private physician group or whatever, you really wanna take on the problems as like your problems.
And actually it's, you know, it's just the way that shop is run or whatever. I think it's also easy to be like, yeah, we can fix everything, but asking a few more questions and really getting to the bottom of whatever your team is bringing to the table. Sometimes, you know, it's not really a fix, but maybe someone just needs to be heard, and so just staying curious, not trying to take it on as something that, as a leader, that you need to necessarily be responsible.
But once you ask more questions, you stay curious and get more information. Usually, sometimes it works itself out. And Brené talks about, she gives several examples in Daring Greatly how leaders did this. And just also being aware that sometimes if you are not able to show up your best self to the workday, to a shift, or to wherever you [00:23:00] work, that can also influence how you're gonna receive information and take care of patients.
So we always talk about how do you prepare yourself every day to come to work and be able to even stay curious, a curious mindset, but also a courageous mindset and be able to be courage. So what do you need? Right? And so we talk about that a lot and making sure that you're getting everything that you need to show up your best self.
So curiosity is the antidote to fear. It helps us learn rather than shut down. And so next time when you're in what we have described as a quote, arena moment, pause for a minute. Pause to see what the situation is bringing about. Is it making you feel a certain way? Is it making some thoughts come about?
Are you jumping to conclusions? Are you assuming some situation? And what information do you need? What questions do you need to ask, maybe to get some more information? Or do you just need to take a minute? Do you need to do what Laura said and just breathe to get [00:24:00] out of the amygdala hijack in your limbic system and get back into your thinking brain so that you can make some, real some educated decisions and also talk about these things, right? Talk about it with a friend, a fellow colleague that you trust your, you know, plus minus on the spouse. 'cause they may or may not be medical and may not, may not be able to understand, but understand that when these experiences come up, there's something under there.
And just stay curious about it. Ask more questions, ask more questions of yourself, and be able to know that yes, while medical culture has traditionally sent us all into the fear and shame cycle because of some sort of expectation, know that being more and more curious about how you can show up better just may give you the encouragement that you need.
One closing thought is, medicine will always demand courage. Vulnerability is a part of that courage, so let's choose curiosity to keep us engaged, learning and growing, both for ourselves and for our patients. So if [00:25:00] anything that you enjoyed in this podcast that has helped you, we are always requesting for you to write and review us.
Leave a comment email us, send us a note at [email protected]. We love to hear from you, we love to engage with you. And we also wanna tell you about a free video called How to Crush Physician Burnout for Good without Cutting back Hours, quitting Medicine, or sucking it up in silence.
Just scroll down in the show notes and click the link today. So, until next time, you are whole. You are a gift to medicine and the work you do matters.
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