Child Mental Health for Pediatric Clinicians

46. What do you do about Burnout with Dr. Jessi Gold

• Elise Fallucco • Season 3 • Episode 46

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If you think you may be experiencing burnout, what can you do? To answer this question, Dr. Fallucco discusses strategies to combat healthcare burnout with Dr. Jessi Gold, Chief Wellness Officer at the University of Tennessee Health System. 

 WE discuss:
*  That systemic changes in Healthcare are urgently needed to reduce burnout.
*  Individual strategies to address burnout in the current healthcare system including:
----- practicing self-reflection -  and asking, "How Do *I* feel?" and "How is my job affecting my health?"  
-----practicing self-compassion and gratitude, which can help counterbalance the natural tendency for our brain to focus on negative things and threats, 
---  We discuss the “Three Good Things” exercise which  can help reduce burnout and increase well-being. Three Good Things and other free tools are available at the Duke Center for Healthcare Safety and Quality online at: https://hsq.dukehealth.org/tools/ 

Dr. Jessi Gold is an Associate Professor of Psychiatry at UT Health Science Center. Dr. Gold is not only a psychiatrist, but she is a mental health advocate and fantastic writer whose work has appeared in the New York Times, The Atlantic, InStyle, Slate, and Self. 

https://www.drjessigold.com/
@drjessigold

Dr. Gold's new memoir is called
 How Do You Feel? One Doctor's Search for Humanity in Medicine available on Amazon at
https://www.amazon.com/exec/obidos/ASIN/1982199776?tag=simonsayscom

Check out our website PsychEd4Peds.com for more resources.
Follow us on Instagram @psyched4peds

Dr. Elise Fallucco:

welcome back to Psyched4Peds, the child mental health podcast for pediatric clinicians, helping you help kids. I'm your host, Dr. Elise Fallucco, child psychiatrist and mom. So we're continuing our conversation about burnout in healthcare with Dr. Jessi gold, chief wellness officer at the university of Tennessee health system, psychiatrist and author of the book. How do you feel? One doctor's search for humanity in medicine. In our last episode with Dr. Gold, we talked about how to recognize signs of burnout. And now the real question for this episode is what do we do when we recognize that we or someone we love is burned out. I'm looking for solutions. Life hacks pro tips to help us deal and survive in healthcare. Dr. Jessi gold. What would you recommend?

Dr. Jessi Gold:

So disclaimer, whenever I talk about individual solutions, people want to punch me in the face because The system is a big problem. And I think they think when I'm talking about an individual solution that I'm not acknowledging that the system is a big problem. I chose the career and the career path I have to attempt to fix the system. But in the meantime, most of the people listening can't fix the system. It's not their job. It involves the government. It involves insurance companies. These are big,, big monolithic industries that, we're fighting for these things to change medicine. but inherently, if you don't want to quit, which is an option by the way, but if you don't want to quit, you have to figure out how to fit in an existing mold, which is the existing culture and the existing sort of system problems you have to have faith and hope that someone's taking your feedback and listening, that someone like me is working on that stuff in parallel, but that stuff takes time. And so in the meantime, should you want to stay in the field, you do have to do individual things. So the individual things that I've seen be helpful, One is actually paying attention to how you feel. It is cheesy, it's the title of my book for a reason, but really, we spend so much time on other people that we don't even pause to do a self check in, and if we did, we would notice stuff earlier. Whatever those symptoms are for you, or whatever those things that might be changed for you. So sometimes I'm like, how did I sleep? How am I interacting with my peers and colleagues? How mad am I at my emails? Whatever that is, right? I'm not saying do that every two minutes. I'm saying like once a week would be nice just to make sure that you actually are checking in with yourself and acknowledging your humanity in this situation. Another thing that can be really helpful is our brains evolutionarily are designed to remember the bad thing and to pick out the bad thing, right? So we learned if we ate a poisonous berry and it made us sick not to eat that berry again. And so our brain was like poisonous berry today, poisonous berry today. All I did was eat a poisonous berry today. And so our brains are like, basically supposed to tell us all the things we do wrong over and over, but in the way that it, manifests in somebody who's a perfectionist is not good. And so there's two ways to combat that one is self compassion, which is probably the most important thing for anybody in medicine, I have to be gentle and kind to myself and say nicer things to myself. Not, if I burn out, I'm a horrible doctor. If I burn out, this week was really hard. I totally get it. Be nicer to yourself and the other thing in that same vein is like Trying to pick out the good stuff in your day. There's a thing called Three Good Things you can get that from Duke online they have a program for it that's a text program.. But if you don't go that way, you can literally just write down the three good things of your day. What it does is force you to remember that even though that you had the poisonous berry, maybe, That like someone said something nice to you or a patient complimented you or you help someone today or whatever that is. And so you're like, you're left with more of a balance. And I think we really need the balance so that we don't just go, I'm a failure. I'm a failure. I'm a failure. Nobody wants. And then on top of that, I'm not sleeping. I'm not functioning. I'm going to work sick. I'm going to burn out. There's just no way. And so those are a couple things that I think are. Easy life hacks that have worked for me have worked for patients and I will say sometimes people Don't like a woo woo thing and think that like the three good things or Things like that might feel a little like there's no way there's tons of evidence on that You can see it in my book But you can also see all of the stuff by Brian Sexton who made the program they've studied this.

Dr. Elise Fallucco:

The first thing that you can do to survive in this culture or continue navigating in this culture is pay attention to how you're feeling. How's your sleep? How's your mood? How's your energy? How are you responding to your inbox? Or for me, I think the tipping point was like, how do I feel at the end of the day? How, of course we're tired, but can I deal with bedtime? I get for me, it got to the point where my sweet little guy who was probably, six or seven years Old at the time was like, mommy, it's time for our minute. It's time for you to tuck me in and we talk. And I was so tired and just done talking that I wanted to avoid it. I'm like, maybe if I fall asleep on the couch down here, he won't notice and he'll forget. And And I feel so bad about it in hindsight, and I again, in hindsight, I realized yeah, that was a symptom, that something was not great, that, these things that are supposed to be life giving and the priorities of my life, like family, were taking a back seat. So number one, ask yourself how you're feeling, be honest about it. And if you can have some real life people in, who can reflect and ask you those questions and who you can be honest with, whether it's your therapist or your friends or your family or somebody. Number two was fight our natural tendency to focus on the negative things by practicing self compassion, like giving ourselves some grace, being nicer to yourself. And then finally three, try to consciously get your brain to pay attention to the positive things in your day. One of the things that my family does when we try to have dinner together on the few times that we don't have 8, 000 activities and are actually able to sit at a table and eat a meal. We do this thing called rosebud and thorn, and it's not exactly three good things, but it's where you talk about, the rose, the good, the best thing in your day, the bud. We interpret that as something else that's pretty good in your day, but not quite a rose. And then finally the thorn. Something that's challenging that you're dealing with. And we go around the table and each of the kids and I and my husband talk about that. And it's a nice way to reconnect and also to try to remember again, like the easiest thing that comes to my mind every single day is the thorn. I'm like, Oh, I can go on and on about that thorn. Let me tell you who annoyed me today. But anyway, to the point that our minds tend to focus on the negative.

Dr. Jessi Gold:

And we like have a culture of that too, right? I think there's camaraderie in, for lack of a better word, bitching about some stuff in the workplace, like we like that. It's just when that takes over and you can't do anything else, like it's really hard to go into work knowing that your only sort of solace is to complain to a friend, right? I think you need the friend, but it'd be nice if you talked about something completely not related to work as well.

Dr. Elise Fallucco:

Exactly. The other solace in going to work, it makes me think of, we had a drawer full of chocolate at one of the clinics that I worked at,

Dr. Jessi Gold:

that

Dr. Elise Fallucco:

one of my colleagues brought, and I was like, I can do it today because of that drawer full of chocolate.

Dr. Jessi Gold:

My admin has like a bunch of candy, and I'm always like, are you trying to kill me inadvertently? Because every time I walk by, it's really hard not to eat the candy, but, oh my gosh.

Dr. Elise Fallucco:

It's like such a stress reliever. We're not that we're endorsing that by any means. Okay. You've done such a good job about de stigmatizing mental health and being really open about your own personal journey and mental health journey. You have written a memoir about your own experience and struggles helping more people feel comfortable about having emotions and having struggles. And so I just want to thank you for that. That's, it's incredible.

Dr. Jessi Gold:

Thank you. Someone asked me what I feel like when I talk about this stuff and, sometimes I feel bad that I even have to be thanked for doing it. And I know that's a weird thing to say, but I just, I get it, because I know what role models exist for people who have talked about some of this stuff openly, and it's part of why I've consciously made the decision to do it. But sometimes I'm just I wish it was boring. I wish that me having said I'm on meds, or that I've been depressed, or that I've been burned out I'm the thousandth person who's done that in medicine, instead of I don't know, top 20 or something, and I think that It would be nice. I'm hoping we get there where enough of us feel okay talking about it, that I don't have to be thanked for it. But I, in the meantime, I'm happy to be a trailblazer of sorts in this conversation, because I've done enough of the processing to be able to share my story, like not everybody can, not everybody will ever want to, but we do need some people just like we do athletes, just like we do. Celebrities just like we do whatever other extra group you want to include like we all need the people who like break it down and say Oh, turns out we have this too. And I'm happy to be one of them. I just sometimes like when people say thanks, I'm like, I get it. And I wish I didn't have to be thanked for it.

Dr. Elise Fallucco:

Yeah, no, and it's such a good point. It's funny, because I think as Doctors, as people in health care were one of the last people to open up and to be vulnerable. And, just with the Olympics having recently happened, I think about Coco Gauff. I think about Michael Phelps and, other incredible athletes performing at a high level. Simone Biles, like who are open about their own mental health struggle and how empowering that is for other people. And yet, as you point out, we don't have a lot of us in medicine. Who talk about this. So another reason to thank you for for pushing our field forward. So before we close, do you have any final pieces of advice about either recognizing burnout or what to do when you see burnout in yourself?

Dr. Jessi Gold:

Yeah, first of all I let me thank the audience for what they do because I don't think that we get thanked enough in the workplace like it's why we need to remind ourselves because like I'm a psychiatrist. My patients don't thank me very much. I think because they don't think they're supposed to. I don't know, but it doesn't happen very often because of boundaries or something. And so we Get in this place where we can't we don't realize we're helping people, even the tiny places that we're helping people. And so I hope that the people listening know that their jobs are really hard. We wouldn't exist in a lot of spaces without them. And I'm grateful for what they do. And that at the same time, if the work that they do is impacting their life, it should. There's a quote that I like that I'm going to totally butcher, but maybe you have it written down because your face looks like you do. Yes.

Dr. Elise Fallucco:

This is this the Rachel Remmer one? Yeah, yes. Oh, or Remen. So Dr. Rachel Naomi Remen says the expectation that we can be immersed in suffering and loss daily and not be touched by it is as unrealistic as expecting to be able to walk through water without getting wet.

Dr. Jessi Gold:

It's in so many ways, it's like the air that we breathe is challenging. Of course, we're going to have trouble breathing. we don't view it like that. We view it like somebody made a mistake doing that, or somebody is not like living up to expectations by Having their job affect them but like the stuff that we do should affect us it should not be commonplace to see a kid struggle or see a kid be hurt or See a kid who has trauma or listen to a parent who's really worried about their child Like whatever you want to say insert challenge here shove a mental health visit into ten minutes that's not easy. That's hard. It's going to affect you and do not beat yourself up for that You Take care of yourself for that.

Dr. Elise Fallucco:

Thank you. I just like to the people in the back, what you're doing is hard. It's legitimately hard and challenging. And it's like walking through water, of course, is going to make you wet. Get help when you need to get support. You deserve it just as much as everybody around us. So give yourself permission to take time and to get out. And you had said something really nice in your book. you talk about these really interesting patient vignettes of other healthcare workers who are struggling and their experiences of coming to see you and how hard that is in one scene, you're talking to a character who's a PGY three resident who's on medical leave to take care of mental health problems. And is feeling bad, like who's covering for me and while I'm out, what are people thinking about me and how is this going to affect my career and, all the anxiety thoughts just spinning and you in the book write, you know, right now you're taking care of yourself and, quote, instead of failing in your job, you're focused on getting better and which over time will make you better able to do your job and make you a better, more empathetic doctor and leader. And I've loved that so much and it's, there's so much truth in it. Thank you for that. Thank you for all of this. Yeah, I

Dr. Jessi Gold:

wish we framed getting help like that. I think about therapy like that. I go every week. Am I, Am I? In a 10 out of 10 crisis right now? No, but does it make me better at my job? Yes. And therapy training and psychiatry training tends to think a little bit more like that than other fields in medicine. And we all can benefit from learning more about ourselves. We all could benefit from taking time to take care of ourselves. Cause if we can't take care of ourselves, how are we supposed to take care of other people? When we talk about culture change, that's what we mean. That this is part of being a good leader, that this is part of being a good doctor, that this is part of being a good mom, friend, sister, whatever you want to put in there. It's all part of it. Yes,

Dr. Elise Fallucco:

absolutely. Thank you. And for those of us who are listening again, Dr. Jessi Gold's book, coming out in October, 2024 is called, How Do You Feel? One Doctor's Search for Humanity in Medicine And I hope you guys will all check it out. It is a fantastic read. I've read through it twice now and I'm still laughing and at other times crying and then highlighting and underlining like somebody who's a little obsessed about reading, which I am. It's beautifully written in addition to being a really important topic. So thank you so much for your time, for your expertise, and for all the work you are doing, Dr. Jessi Gold, to change the culture of healthcare for the better.

Dr. Jessi Gold:

Thanks for having me, and I hope people pick up the book and feel the same that you do, and I would love to hear if they do on my socials or wherever.

Dr. Elise Fallucco:

And you're available at Dr. Jessi Gold on all of the platforms and all of the all the platforms. Everybody just check out our show notes and we'll have some more detailed information about how to access the book and access Dr. Jessi Gold.

And as a brief

Dr. Elise Fallucco:

recap of the highlights from our episode. We talked about the importance of checking in with yourself and really asking yourself, how do you feel. And Dr. Gold also shared recommendations about how to counter our natural tendency to focus on the negative by practicing two things. One self-compassion. And to gratitude. And I want to thank all of our psyched for paeds listeners who have reached out. And shared personal stories and questions related to burnout. And this is inspired us to do a nother episode next week, where we talk about specific exercises and tools. That might help you recognize signs of burnout and more importantly, take steps to try to correct things if needed. Thank you so much for listening. And we'll see you next week.