# DTD 200
[00:00:00] This is the Drive Time Debrief, episode 200.
Hey guys, welcome to the podcast. I'm Amanda. I'm Laura. And I'm Kendra. And I cannot believe I'm saying this, but this is our 200th episode. This is crazy. Every time somebody comes up to us and is like, "Oh, I heard you, you know, on the podcast," I'm like, really? So amazing.
Way back [00:01:00] a few years ago, we weren't sure anybody was gonna be paying attention, but I do want to tell you, if this is your first episode and it's number 200, there's a lot of us that are Type A, I don't know, and maybe a little OCD-ish. We got you. We have created something where you can skip 199 episodes and go straight to our Podcast Fast Track. That is a compilation of like the 10 or so episodes that we think are probably the more important ones to start with, so you don't have to feel bogged down by 199 episodes catching up. To get that, you go to www.thewholephysician.com/fasttrack or just go to our website, thewholephysician.com and scroll down. You can get it there.
But with that, on our 200th episode, we are gonna talk about some of the most important things, most impactful things that we think a young physician should know. Even an older physician should know. If you are really invested in having career longevity, these are some really important things to [00:02:00] start visiting early. And so Kendra's gonna start us out.
Yeah, y'all. Some of my favorites are understanding that burnout is often a boundaries problem, not a resilience problem. I was actually talking to another EM physician earlier today and we were discussing how incredibly resilient specifically EM physicians are because of not only the type of work we do day in and day out, but when you're kind of a jack of all trades, which we love to be, or acute care, there is nothing that we don't bounce back from, and it's every angle too. It's the different patients, the type of patient expectation, managing this, managing that, managing consults, managing problems that we didn't spend a whole residency learning. We got to see what we got to see during residency in the shop that we trained. Boom, end of story. So the rest of it we're learning on the fly, and [00:03:00] so we couldn't be a more resilient specialty. So taking a step back and understanding that boundaries play a huge role in this. It's not a resilience problem. You don't need to be any tougher. You just need clear edges. And we talk a lot about boundaries. There's several podcast episodes, and so I invite you to check those out.
I would offer, like I'm just imagining being a family practitioner this day and age, I would imagine being a pediatrician, surgeons—it's not just specialty specific. I think doctors in general are wildly resilient and need a round of applause for our resilience. It's not a resiliency problem. We're the canary in the coal mine. During training we do get a lot of programming. You're the first one there. You're the last one to leave. If you can, you should. Patients come first. You come last. And that includes everything in your life, right? So then when you transition to attendinghood, the self-sacrifice is well ingrained. It is in our DNA, I mean, not to [00:04:00] mention, holler back at me, all you people pleasers, like just add that to the mix and that's a different level.
But what is most important, and I will say this is probably right up there with boundaries being number one, is deciding what you won't sacrifice. If it's sleep, then decide today what you're gonna do about protecting your sleep. And these aren't easy things in our world of medicine, but they are worth protecting. Movement, exercise. How do you get out all your stress? How do you cope with, you know, that crazy day or maybe three crazy days in a row, right? Movement. When are you gonna do that? What about that special someone, your partner, your spouse, that person that has been with you, maybe through training or maybe not, but is your safe place? How do you protect time inside your marriage or inside your partnership? And what about your kids? If your kids bring you joy day in and day out, how are you gonna protect that time with them? And all of this together is [00:05:00] really about showing up for yourself and protecting your mental health. And so decide what's most important. And those are the things—doesn't have to be all of those things I just listed, but the most important to you.
And then normalizing your emotional processing. We witness some crazy stuff every day, and I'm not just talking about in the ER. All of us as physicians who care for chronically ill patients, acutely traumatic patients, patients that come from a rough neighborhood or rough scenario or you know, don't have access to care. There is a lot of suffering and not just like, you know, sick suffering. It's mental illness. It's poverty. It is discrimination. It is all these things. And to normalize this means that we're metabolizing it, not suppressing it. We're not supposed to shove all this down. We have to be able to have [00:06:00] conversations where we're like, "Yeah, what I just saw really sucked," or "What that family is going through right now really sucked," or whatever it is. It's talking about it, it's processing through. It's recognizing also why is this bothering you so much. Like what is it triggering? What is some unprocessed stuff? And being able to get that out and processing it, man that really moves the needle and keeps you moving forward and really, really beats back that stuckness that a lot of us feel.
And then the final thing I would say is, investing in these deeply connected, safe relationships, whatever that looks like for you. Quantity is not what matters. Quality matters. I cannot tell you what it means to have a few of your people. It is, you know, your three or your two, or even your one, however many. It really is about that quality relationship and investing in that, because then that's your safe place. That becomes your emotional [00:07:00] stability. That becomes your place where you can like just show up and just be yourself. Whether that's like, "I need to cry something out right now because this sucked," or "I just had a week," or whatever and they're like, "Yep, do it. Let's go. Let's get it and let's go."
I love how Brené Brown talks about this specific thing, when you are just deep in that shame spiral, she says, it is important that you get it out with your safe place because shame does not thrive when it is spoken about, it thrives in silence in that dark place of isolation. And as soon as we get it out, as soon as we stand up and say, "I feel bad, and this is what it is," and that person comes along and says, "Let's do this right? Let's walk this out, let's do this." That really becomes that place of healthy processing and those people are priceless.
Yeah. So, so important and so easy for us to have a busy life, a busy career, and get to the end of [00:08:00] it and realize that we haven't maintained our friendships and that's not a good idea—to maintain those safe relationships. So I think we're on number five and here's what I would have to offer is that we need to accept that medicine will take everything we allow it to take, and it is very much like a narcissistic family system, in that it does not take into account the needs of all members. It's the house of medicine. It expects all the people participating in it to pour themselves in, and it's not typically going to be giving back equally. And so it's really important for us to realize that just like in those narcissistic family systems, these systems do not regulate themselves. They often get worse and worse over time.
And so the more we over-function to prop up a system that is not functioning in a sustainable way—I'll give you an example. I know an ER doctor who was [00:09:00] amazing and she over-functions to the detriment of her health. She is a medical director and she was working one morning and then there was a shift that was not covered that evening, and so she was gonna go home, take a nap, and then come back and work that shift. That's what I'm talking about. That is not sustainable. It's not okay for us to work ourselves to death, literally to death to fill holes in a schedule that hasn't been addressed by the people who really should address it. So just know medicine will take everything we allow it to take. Super important for us to recognize what kind of life we want, how we want to feel, and to take responsibility for that.
Number six, and you might push back on this with me. We need to learn to tolerate disappointing people. This really is a core physician skill that no one teaches and we all need. Most likely, we did not have this skill coming into medical training. And [00:10:00] we have to understand that if we are trying to please everyone, it's just impossible. We can't be like Elastigirl and try to be flexible for everyone. That is a recipe for disaster. When we do that, we're gonna make someone else miserable. When we spend extra amounts of time with a patient that is frustrated and angry with us, we're making somebody else wait longer. So just be aware. We have to learn to be okay with disappointing people.
Number seven, get coaching or therapy before you're in crisis. We talk about coaching as kind of like going to the gym for your mind. All physicians need some mental health support. There's tools, skills, concepts that we never learned. We certainly did not learn them in training. Research shows that doctors lose emotional intelligence over the course of their training and even career. [00:11:00] We might have started out more emotionally intelligent, but over time that goes down and emotional intelligence is what is gonna help us have better relationships and really be more successful in life. Unfortunately, we have heard many stories of people who delayed or didn't get the support that they needed, got overtired and a crisis really turned into a catastrophe. And we don't want that for you. We want you to be able to have the support you need as you go along. You're a trainee. Go ahead. Start now. You need that person in your back pocket. So please, please, please get that coaching or therapy or both. Many of our clients have both and I personally had many, many times in my life where I've had both and always have somebody, whether it be a therapist or coach—we all need it.
Number eight, be willing to pivot. This goes along with your identity. As a human being, you are a person, your [00:12:00] beloved daughter or son, brother, sister, spouse, mother, father, you are not just a doctor, and if practicing medicine is not serving you any longer, you can pivot or your current practice is not serving you. Be ready to pivot. I've told you guys lots of times, I actually quit for three years to get my head back on straight. I pivoted from general emergency medicine to pediatric emergency medicine, pivoted from full-time to part-time. And all these things have benefited me and helped me practice in a more sustainable, joyful, and happy way.
Maybe your specialty isn't what you thought. I was talking to a doc earlier today where she was like, "If I had done anesthesia earlier in my training, I probably would've applied to anesthesia residencies instead of what I did." It's never too late to make changes. A lot of times the pivoting is actually in mindset. [00:13:00] So what is it about your current job that feels terrible? The reality is that we can affect a lot of our own suffering by just examining the thoughts that we have about different situations. And so if there's a particular patient population that you see that drives you nuts and you find that they drain your energy, what is it that you're thinking about them that's causing that? And is that thought optional? Is it a thought that you want to keep or would you be willing to pivot that thought into something that might generate less negative emotion?
So lots of different ways to pivot and practice in a different way or choose a completely different career that is also available to you. There are plenty of docs who go on to do other things. They might go into research, they might go into consulting. I feel like I've heard of a few of them who've gone into real estate. There are so many things that [00:14:00] this skillset that we have can prepare us for and help us to do well. It's never failure to want to change and grow. That is wisdom. So that's what I would just offer to you is that pivoting is part of life. And just because you chose one path does not mean you stay on that path for your entire life. It's so important to choose what actually gives you joy and energy and vitality and not stay stuck in things that you feel are draining to you.
I love that. I don't know where that gets ingrained in us, but that was a big obstacle for me before I pivoted was this idea of like, "I need to do this till I drop dead." Or like, I don't know what, but why aren't we allowed to have a phase two or phase three or phase four in our career? Now, looking back, it makes a lot of sense to me.
Okay, so next, this was originally gonna be a top 10 list, but we threw in some bonuses. I think we're at number nine now. It's drop the [00:15:00] fantasy of "later." It will get better. If there is a group of people who are experts at delayed gratification, it's doctors, but sometimes we overinvest in that and we think "when we get to the goal, everything will get better." Except for you've done this a bazillion times, you got accepted to med school, you thought "it's gonna be great from here on out," only to think, "Oh shoot. Maybe it's when I get in the residency I want. Oh shoot. Maybe it's when I become an attending. Oh, crap. It's not that. Maybe it's when I retire" or whatever it is. Right? If you are constantly waiting to get to a goal to be happy, it's just like the top of a mountain. The vast majority of the time going up and coming back down, you're waiting to be happy. That's not what we want for you. The other thing, you know this about yourself. You get to your goal, you just move your goalpost, right? So then it's the next thing. So you're just in this perpetual waiting to be happy. Do not do that. That's called arrival fallacy.
There is a sweet spot where you do consider your future. We're also [00:16:00] not advocating hedonism. That is pleasure in the moment at the expense of your future. There is a sweet spot where you both have your future in mind, but you're enjoying the present moment also.
Number 10, leave work at work mentally, not just physically. This was my prior life. I think that this drove a lot of my previous burnout was I was both stuck in work dread all the time, stuck up in my head thinking about the future of work, but then also when something happened, I would ruminate about the past incessantly also. So basically I was never in the moment. I was always at work. Even when I wasn't at work, I was mentally at work and no wonder I never felt recovered. No wonder I had all of this dread and angst because I never left work at work, at least not mentally. I brought it home with me to just sit there and stew in it. Whether it be about the future shift or about something that happened in the past. I would offer you do not get paid for that. That is completely unpaid [00:17:00] labor and you can't even blame work for that because it can't force you to be caught in perpetual dread or rumination. That is something that I just didn't know that I had control over. No one had ever discussed that. I just thought, "This is what everyone did." Not everyone does. You can learn to shut that rumination cycle off or shut off the work dread and be in this present moment. And that is such a gift whenever you can start to live your life that way.
And so first bonus is build recovery into your week, not just vacations. There is a quote, let me find it from Brianna Wiest, that is one of my favorites. "True self-care is not salt baths and chocolate cake. It is making the choice to build a life you do not need to regularly escape from." And if that is something that I could gift to you would be that you don't have to take a vacation from your life. That's fantastic. If it feels like you constantly need to run away from your own life, then that's probably a signal it might be useful to go listen to one of our [00:18:00] boundaries episodes, right, or to really get clear on your priorities because we've mentioned it before. This is a kind of career that will take everything from you. Just like Laura said, there is no shut-off valve, so that is gonna be up to you. So think about that.
And I think that we get stuck in—well, perfectionist. I also happen to be a recovering ruminator and a recovering perfectionist. But we tend to be all or nothing about it. "Well, I need to build three hours of rest into my week." Completely upend your life to switch your life completely. How about this though? It's much more sustainable to be like, how could I make this next month 1% better than it was this month? Over time, you will get there. If you go to the grocery store and you hit a stoplight, you're not worried that you're not gonna get to the grocery store. There's no hurry. It's just you hit a stoplight. It's the same with your own wellness, and making a better life for yourself. Just do a little bit at a time. You will get there, and as long as you get there, then there's no [00:19:00] stress in it. It doesn't have to be a complete upending of your entire life.
And then lastly, second bonus. Stop outsourcing your internal compass. When you were a little kid, you knew what made you happy, you knew what mattered to you. You did things just for fun. And then all of us became really excellent at getting gold stars and A pluses. And somewhere along the way, for many of us, we turn to external validation at some point rather than staying in line with our own internal compass. And that's a hard thing to realize, but not always are you and your work in alignment. Attendings have things that attendings need to accomplish. Admin has things that admin needs to accomplish. Guidelines have outcomes that they need to accomplish, especially if you work for a private equity group. You probably don't have the same goals in mind. And so it does take some time to figure out what are the priorities of your life, what are the goals of your life? It will mean, and we mentioned this earlier, that sometimes you will [00:20:00] disappoint some people because you can't be everything to everybody when you are doing that. You aren't being what you want to be. And I would offer that maybe that's the most important thing is to be happy with who you are, more than being happy with anything that anybody else has to say about you. That's like a deep knowing, a deep groundedness that in my opinion, is a much better place to be.
Yeah, I think all of these really are definite pearls of wisdom. It can be a little overwhelming. So just take each one with a grain of salt, but also put this one on repeat because I think the more times that you can hear us just become that still small voice in there, that little whisper that says "It's okay, we see you, you are inherently worthy of everything you will do, have done, and everything in between." And you know, really, physician wellness is not about finding the perfect job or mastering stress management or becoming, you know, boundaries 101 expert. It's really about learning to live inside a system without letting the system live inside of you.
So that's it for today's episode. Friends, if you found this conversation helpful, the best way to support us is by leaving a review. It helps other physicians find this podcast and it moves us up on the list, and we'd love to hear from you. If one of these resonated with you or if you're gonna make one of these your mantra for the new year, email us at [email protected]. We love to share stuff like this on air. And don't forget to follow us on the socials @TheWholePhysician, wherever you are on your socials. We're there. So check us out. And if you want some weekly bits of encouragement straight to your inbox, then sign up on our website to get our weekly Well Check, which is lots of bits of goodness every week to your inbox, and that's where we also tell you about our next masterclass and what we have coming up.
So click the link in the show [00:22:00] notes to sign up. And thanks for spending time with us today. Until next time, you are whole. You are a gift to medicine and the work you do matters.
