Episode 277 - When “Yes” Becomes Too Much: Confronting Physician Burnout

Chadi sits down with Dan Golden, MD, MHPE, Associate Professor of Radiation Oncology at Rush University, to discuss his deeply personal and recently published account of physician burnout. He shares the mental and physical toll of burnout, clarifies how it differs from depression and anxiety, and reflects on the pressures of academic medicine’s “say yes to everything” culture that leaves little room for setting boundaries. From masking symptoms and navigating a job change that added stress, to ultimately taking leaves of absence and undergoing intensive therapy, Dr. Golden offers an unfiltered look at how dire things became—and why speaking out may help others facing the same struggle.

Read his article on burnout.
https://www.redjournal.org/article/S0360-3016(25)06438-7/fulltext

Check out Chadi’s website for all Healthcare Unfiltered episodes and other content. https://www.chadinabhan.com/

Watch all Healthcare Unfiltered episodes on YouTube. https://www.youtube.com/channel/UCjiJPTpIJdIiukcq0UaMFsA

Transcript

SPEAKER_00 0:12

It's Healthcare Unfiltered, and it's your host, Shadi Nabhan. I'm a hematologist and a medical oncologist with interest in all aspects of healthcare delivery, treatment, leadership, mentorship, and policy. Thank you for tuning in to this special episode of Healthcare Unfiltered, where I host Dr. Dan Golden, who is a radiation oncologist at Rush University Medical Center here in Chicago. He was previously at the University of Chicago where we interacted and intersected when I was a faculty there. Dan recently wrote an article in a major radiation oncology journal, we call it the Red Journal, about his own experience with burnout. And what led him really to have bad thoughts almost and suicidal ideation because of the burnout and how he actually went through a quote-unquote rehabilitation program to overcome the challenges of burnout. Folks, burnout is real. Physicians and folks in the healthcare ecosystem do encounter burnout. The environment, though, the culture of medicine is to always show perseverance, tenacity, and the fact that you're strong. You're stronger than any of the tasks that you are being assigned to. And if you admit you have burnout, that is a sign of weakness, and we do not really endorse weakness. Because he believes, appropriately so, that many other physicians probably are facing the same situation. They're just too shy to admit it. They're probably too embarrassed to even mention that they have burnout, because the culture and the environment may not embrace that. And they may not help in finding solutions to this problem. I reached out to Dan and I asked him to come on the show, and he generously accepted. I wanted to know what went through his mind before he decided to write the article. What were the receptions of the article after it got published? How difficult it was to publish this article, how challenging it was to share with the entire world the mental and physical issues that a physician would face as they are battling burnout. So I hope you share this podcast episode with many others. And I hope that if you are encountering burnout and if you're having any issues, to seek help and to ask someone for help and reach out to Dr. Golden and to other people who might have encountered the same issue, and they're able to provide you with advice that could take you over the hump of the problems that you are facing. So burnout is real, and I hope this episode sheds some light on burnout and helps overcome the challenges that we face as we face burnout in the medical profession. Folks, check out my website, chattinabhan.com, my books, Toxic Exposure and the Cancer Journey, my two new books coming out in 2026. One is called AI and Cancer Care, When Machines Meet Modern Medicine, and a medical terror fiction, Deception in the Ivory Tower, coming in late 2026. Here it is, my conversation with Dr. Dan Golden on burnout in medicine. Well, it's a pleasure to have uh a dear friend, Dr. Dan Golden. Uh, welcome to Healthcare Unfiltered. Yeah, thank you so much for having me, Charlie. And we were together at the University of Chicago back in the day, but now you have moved on to Rush. How long have you been at Rush now?

SPEAKER_01 4:03

Uh it's getting close to three years.

SPEAKER_00 4:05

Okay. So well, Dan, we're gonna do some uh intro and get uh listeners and viewers get to know you a little bit. Um, and um obviously we are gonna talk about a provocative uh paper editorial commentary reflection that you wrote in the Red Journal uh about burnout, and you actually share a lot of personal experience with everyone, with the entire world. So I'd love to dig deep uh into that a little bit. But first of all, just tell us a bit about you and what you do, and um what got you into medicine?

SPEAKER_01 4:38

Sure. So uh I work now, like you mentioned, at Rush University Medical Center in Chicago, grew up in California from Oakland, went to Berkeley, and then came to Chicago for medical school. I went to UIC. Um and did my residency here, met my wife and woke up this morning. I've been in Chicago 23 years now. Uh, always thought I'd move back out west, but um here I am and it's a great city and uh I got three kids now. Um, what are they, seventh, sixth, and fourth grade, and uh love to ski and play golf. And um yeah, what got me into radiation oncology? Uh it's kind of an interesting story. I I was actually one of those guys that went to med school planning to be an orthopedic surgeon. Um, so I was kind of angling towards that the whole time and had always told myself if I found something better or found a reason not to do orthopedic surgery, I'd switch. And at the end of my third year of medical school, I had a back injury on a trampoline. I was a gymnast and hurt myself at the gym and did my orthopedic rotations, my back was really killing me. And I did a lot of pondering my fourth year and thought this is probably not a good career move when I'm 26 and I'm having back pain. Uh and uh that was kind of a reason not to do orthopedic surgery for me. And around the same time, a close friend in medical school came in one day, and she was one of those people that had no idea what she was going to do. And she walked in one day and said, I found the best specialty in medicine. I said, What do you what is it? She said, Radiation oncology. And I had no idea what it was. I I said, I was like, What is that? And she said, It's invisible surgery. And this light bulb went off in my head, and I said, I said, wait a minute. So I could kind of be like a surgeon, but not actually have to be in an operating room because I loved anatomy. Um, you know, I knew whatever specially I did, I wanted it to have some anatomic focus. Uh, you know, not nothing against medical oncology, but that was the reason I wasn't as interested in medical oncology as the therapy itself systemic. So um, you know, I kind of when I started looking into radiation oncology, I went, okay, you know, I get to use my anatomy knowledge. Uh, I was a molecular biology major and undergrad, and you know, really loved the uh radiation biology and the the science behind what we do. I enjoyed physics and um did a couple rotations at the end of medical school and uh applied as an intern. And here I am now as a radiation oncologist. Yeah. Yeah.

SPEAKER_00 7:19

Well, we are not gonna talk about medicine, radiation oncology or precision oncology today, actually. Uh, we are going to talk about um an article that you wrote that addressed your own personal journey with burnout and what you did and what you encountered. Uh let me start by asking you, first of all, Dan, is uh how would you define burnout to people who are listening or viewing this? I ask this not because there's no definition. The definition exists in textbooks and people write about it all the time, and you can obviously Google it and ask. But take all of that aside, because you experienced it, and I think a lot of people experience it as well. In your own words, what is burnout?

SPEAKER_01 8:10

Yeah, I guess um I mean at the start of my essay, and my my junior high school English teacher told us define a word and then write your essay. So that's what I did. I have the dictionary definition of burnout, but to answer your question, I I guess it it was kind of this constant sense of wariness and overwhelm uh that I couldn't escape. Um just feeling like I had too much on my plate, not enough time. Um and and that became uh you know pathologic to the point that I became depressed and severely anxious. And um yeah, I do think that there's a distinction between burnout and clinical anxiety and depression. I think one can be burned out and not be clinically depressed and anxious, but I think there's probably a big overlap in people who are experiencing burnout that they may also be experiencing depression or anxiety triggered by the burnout. Um, but but for me, it really manifested as a constant sense of overwhelm and and just wariness that you know I had to get up each day, and there was always more to do than I had time for, and and it just felt like I could never get my head above the water.

SPEAKER_00 9:36

When did you first notice that?

SPEAKER_01 9:40

Um, yeah, I thought about that a lot. It it wasn't like one day it went from being great to suddenly I was really burned out. Uh I do remember pre-pandemic, you know, maybe 2018, 2019, uh driving home from work, and I had a commute at my old job, about 40, 45-minute commute, and I would often call my family just to chat and catch up. And I remember driving home one day, talking to my parents and kind of venting about that sense that I had so much on my plate and not enough time or support or or uh just personal energy to do it all. Um but I continued to do it, and I think it gradually got worse. I I do think the pandemic contributed in ways that I talk about in the article with um uh uh the move to virtual, kind of some of the loss of human connection, um just the stress of the pandemic itself, you know, wearing masks and worrying about getting COVID and spreading COVID. I mean, that that certainly contributed, but I I don't think the pandemic was the primary trigger. I do think it was my overall workload, and and by workload, I I include personal workload, you know, family commitments, um, childcare, household duties. Uh, it wasn't just work, you know, professional work that was grinding on me.

SPEAKER_00 11:19

Is it that we do this to ourselves? Is it that we we are the problem by taking on too many tasks that we cannot actually find time for? How much of this is self-inflicted?

SPEAKER_01 11:35

Um that that's a good question. I I I do think that I I need to take primary responsibility. I'm an adult and I probably could have done a better job monitoring my own effort and where I was putting it. And uh a lot of commitments that I had accumulated or professional commitments I had accumulated over the years were voluntary. Um, you know, they weren't core to my job description. Um you know, there's certainly a lot of external pressure though to take on more, to do more. You know, there's uh kind of an old saying that in your first three years in academics, say yes to everything. Um, I was very good at that, but I think I never learned how to say no. And um, you know, I look back and a lot of the things I said yes to were successful, different projects that I started up, um an organization I founded, uh boards review website that I started, it you know, they all were successful, but over the years they each kind of grew and required more time and energy on top of a busy clinical load that um, you know, after I'd been at my prior position for 10 years, was humming and going really well, but it was quite busy, you know, constant consults, follow-ups, contours. Uh you know, it was quite busy. And that by itself maybe should have been enough. Um, but I had taken on a lot of other commitments. Um and uh you know, one uh kind of metaphor that I use to visualize this is I I've talked to mentees about what I went through, and this is how I would explain it to them is I felt kind of like a fish tank. And I had different balloons that were slowly inflating that were different commitments, whether it was my my clinical responsibilities, my family life, my, you know, I when I started my job, I had one six-month-old, and by the time I left my old position, I had three children and three dogs. Um, it felt like these balloons were getting bigger and bigger. I had a grant that I was doing, I had the sports review website, but there was only so much space in that fish tank. And as the balloons kept inflating, I felt like that felt like a fish tank that was about to explode. Um I I didn't see, I think one problem I had was I didn't see how I could deflate those balloons um without without causing serious disruptions, you know, walking away from a grant or somehow scaling back my clinic, or I mean, you know, family life is is what it is, you can't really just walk away from childcare.

SPEAKER_00 14:33

Yeah.

SPEAKER_01 14:34

Um yeah, go ahead.

SPEAKER_00 14:36

Yes, we do certain things and we bring so much uh on our plate, but how much of this is also the culture of medicine, possibly academic medicine, I don't know, where you actually, if you don't add much, if you don't say the yes and so on, you kind of frowned upon your chair, your whoever your boss is, but it's like, uh, this Dan guy is a bit on the lazy side. Every time I ask him to do something, he says, like, no, yeah, it's not in a job description, but but the other guy is always saying yes. I mean, how much of this the culture?

SPEAKER_01 15:11

Yeah, I mean, uh certainly in academics, there's uh, you know, if you are an academic physician, you want to get promoted, there's a lot that needs to be on your CV beyond just staffing a clinic for the most part. And it varies from institution to institution, but um, you know, there's service to, you know, if you look at a CV, there's all these categories: publications, service to organizations, grants, media, you know, all these different uh categories that you need to fill up in theory to get promoted. And so um there is certainly a culture of take on more, do more. Um, and I um admire people that seem to do that very uh uh easily and seem to remain well balanced. I I think I maybe got carried away uh with what I took on and should have been more careful about committing myself to certain endeavors. Um and uh but it is what it is. I I did it and you know kind of followed the path and it led me to here. And um, I don't really regret anything that I took on. I just uh um wish maybe in hindsight I had been more careful about taking on so many different commitments. Uh but you're right, there is there is a culture um of you know taking on these extra responsibilities that um aren't necessarily in the job description.

SPEAKER_00 16:50

What made you decide to share what you went through as a burnt-out physician with the entire world?

SPEAKER_01 17:01

Um you know, I I thought a lot about it before I shared it publicly. Um I started writing the essay when I was a couple months into my initial stint in an intensive outpatient therapy program. Um, I think I I I I've written a fair number of papers over the years, but the dirty secret I tell people is I actually really don't like writing. I find it to be a somewhat painful process. I uh you know, I'm to get myself to write, I have to, I'm like a dog getting ready for bed. I have to like circle my chair five times, get my cup of coffee, like check my email, settle in, and then you know, eventually I can start writing. And I remember writing it on a plane flight. Um I think I started writing it really to help myself just see a linear arc to what I was dealing with, because in the moment it felt very overwhelming and and uh I didn't really see where I was coming from and necessarily where I was going. And so putting it down on paper helped me understand that. Um, as far as the question about going public with it, uh, you know, I talk about in the essay that I was pretty severely depressed and was having suicidal ideations, um, which really scared me and I think finally jolted me to make some significant changes to my uh professional commitments um and just to stop and hit pause and seek help. And I felt like if I shared this, that somebody else out there that might be dealing with uh similar struggles might be able to follow the proverbial breadcrumbs to get help. Um I cite some examples in the essay of physicians who have died of suicide. Um I also cite some great examples of physicians that have also shared their mental health challenges publicly. Um, but uh I'm aware of many other physicians that aren't public knowledge or at least haven't been covered in the media who've died by suicide. Um, and so you know, I think that by sharing it, if it can help somebody else, it's worth it, you know. And uh I also talk in the essay about common humanity and kind of feeling uh like maybe I I'm not alone. And by sharing it, maybe it engenders some common humanity for other physicians out there that might be dealing with similar challenges.

SPEAKER_00 19:39

So take us through these challenges, take us through, take us back to that night when you started the essay by you laying in your bed in Washington, D.C. at one of the major conferences that you normally would network with colleagues, you would go out and see friends and so on. And you were completely despondent just in your in your in your hotel room, not really wanting to do anything. Um this may be cathartic, but I think it will help us to understand what you were going through. And it seems to me that this was like the catalyst event, at least from reading the article, that really um affected you.

SPEAKER_01 20:17

Yeah. Uh you know, I think from about 20, well, I moved jobs in 2023. There were multiple reasons for it. Um, I I loved teaching. In my prior position, I was at a network site for the University of Chicago, which I I loved. I love the patients, I love the staff and my colleagues that I worked with there, um, but I wasn't directly working with residents. And it's not that common that another academic position pops up in the same city that you live in, and you have the opportunity to move jobs and not have to move your family. So um I was excited to move to Rush to be more in the educational milieu, work directly with residents and medical students. Um, but I think I wasn't necessarily uh vocal about this, but I was also looking to hit reset, gave me an opportunity to step away from some uh non-clinical activities that I had accumulated over the years at my prior position, some grants and other um commitments that, like I mentioned earlier, I didn't feel like I had a good way to deflate those balloons. And by moving jobs, it kind of hit the reset button. Um, what it what I didn't anticipate was moving jobs was quite stressful. Uh, you know, it was a new professional environment, new colleagues. I was at tumor boards now, and you know, with a whole new slew of medical oncologists and surgeons and radiologists and pathologists that I didn't know. And um there was a lot of stress associated with that. So it um and and then I, you know, just doing what I had always done, I took on new responsibilities. I got a grant, I um was program director for the residency program, and all of a sudden there I was, I had moved jobs and I had too many commitments again. And by the time I got to Washington, DC, I think I had just been functioning for several months in that kind of constant state of feeling overwhelmed, stressed, anxious, and it kind of triggered this uh depression. Um, you know, and I I do want to mention that part of the story when I was in DC is I went to a cousin's house, um, had dinner with her and her family, and um, they'd always seemed like distant relatives because I grew up on the West Coast, they were on the East Coast. Um, but I've gotten to know her and her family more over the years. Uh and her father, my great uncle, actually had died by suicide. Um, and it really hit me when I was eating dinner with them that uh you know I was having these thoughts and was so stressed. And that that was, I think, the catalyst to say, I don't know what I'm gonna do, but I need to hit pause and figure out how to get better. Um, I didn't know about the uh intensive outpatient therapy program that I did. I just flew home and told my wife I'm taking a medical leave. And uh then through Rush actually has a great, it's called the Wellness Center, which is uh there's I don't know how many um therapists, psychotherapists that work there, but it's completely internal for staff, faculty, and students. They don't do any patient care, it's purely set up for uh Rush employees and students who are struggling with the challenges of life to come and meet. And one of the therapists there who I'd already been meeting with periodically suggested that I look at one of these uh intensive outpatient programs. Um and so I I enrolled in that, and then uh yeah, at the time I didn't know if I was going to return to medicine. I knew that I could be happy and much less stressed if I didn't do medicine, but I didn't know if I was ready or wanted to give it up, and that was something I had to deal with and really ponder during my time out of work or off work.

SPEAKER_00 24:44

When you say suicidal ideation, um were these did they ever progress to more than just thoughts? Did you ever get close?

SPEAKER_01 24:57

No, I mean I I think in the essay I talk about probably the you know, it was so my one of my uh you know, one of my many therapists, and I'm just kidding, uh therapist that I've now known for two or three years, um, who I was connected to through the wellness center. Um he said that uh you know, suicide is a maladaptive response to feeling trapped. Uh and that really gave me a uh a framework to look at it and say, all right, what's making me feel trapped that I'm having these escape fantasies? Uh, you know, I would also have fantasies about I was a ski instructor before medical school, and I would be driving to work on Interstate 80, and I would be fantasizing I could just keep driving another 20 hours or so and be back in Lake Tahoe, um, maybe 30 hours. Uh, though my wife would find me and I probably have the sheriff come pick me up and bring me back to Chicago. But um yeah, I had other escape fantasies. I think, I think, yeah, you know, like this therapist said, suicide is I think any intelligent person, if you're considering what are the ways that I can escape this sense of uh feeling trapped or overwhelmed, it is not an unreasonable thought to say, well, you know, uh not not to be morbid, but you know, if I ended my life, I wouldn't have to deal with this anymore. Um to your question though, I think the closest I ever came to any sort of action, and that this is what really spooked me and triggered me to take a leave from work was after that dinner in DC with my my cousin the next morning. I was walking to do something at the meeting, some commitment that I had to go to. And I just remember looking at a balcony and thinking, you know, it was like an eighth-floor balcony in a hotel, like, oh, I could jump off that. And that immediately I that was when I moved my flight up, flew home, met with my psychiatrist, therapist, and also my chair, and said, you know, I've been struggling for a long time now. I need to take a leave of absence. And uh he he, my my chair here at Rush was extremely supportive, uh, I think very uh empathetic and and understanding, and basically said, take the time you need, we want you back healthy, and you know, you're we we appreciate you here and you know do what you need to do. And um, you know, for that I'm eternally eternally grateful to him and all of my colleagues here, really, because when I went out, it meant that I had other colleagues who had to pick up the slack. I treat head and neck and lung cancer, and there's two of us for head and neck and two of us for lung. And so suddenly there was only one for each, and um, they stepped in and for four months, and then another two months later on, just saw all the patients and took care of everything and really gave me the space I needed.

SPEAKER_00 28:04

So you could imagine this could have gone differently, though, where maybe you did not have a very supportive environment. To you, could you envision a scenario where other physicians may not get the support of the department where they really may not seek that because they are afraid of losing the job?

SPEAKER_01 28:22

Yeah, certainly. Um I think that's again one reason I wrote the article is I do say in the article that uh you know, physicians shouldn't be scared to take advantage of the benefits that are afforded to them. Um, you don't have to, and this is something we talked a lot about in this program that I participated in is um, you know, how much do you share about your personal struggles, challenges? You know, you do you disclose everything? Do you disclose nothing? Um, and you do have a right to take a medical leave of absence without disclosing specific details. Um, I think, you know, I always believe honesty is the best policy. And for me, being honest with, and I I at the time did not share specific details with my chair, but I did tell him I was having some mental health struggles. And it I I said if if it continues, it will, it hadn't impacted my patient care up until that point. But I could see on the horizon if I didn't stop and get myself into a better place, it could impact patient care because I wouldn't be able to maintain my clinical responsibilities. Um, but there's many levels of disclosure, and you can choose to not disclose and take a leave of absence. And um, you know, I mean, for medical reasons, you I would assume need some sort of doctor's uh no, but uh that was one thing with this uh outpatient program. They were very good. I mean, they they deal with this all the time. Every person that comes there brings an FMLA paperwork or something similar, and they filled it out right away.

SPEAKER_00 30:08

And boom, everything was what was their program like? What did you actually do in the program? You signed up for this outpatient almost like a rehab from burnout, like is that what it was?

SPEAKER_01 30:18

Yeah, yeah. Um, and and interestingly, um, some of the people that were participating were in uh drug or alcohol rehab. Um, they had a track for that. Um, so I started in what was called a partial hospitalization program, but I wasn't hospitalized. Uh I think it's probably more like everything in medicine, a billing thing, but um uh it was five days a week, um, three group therapy sessions a day. So we started at 9:30, had two sessions in the morning, lunch break, and then another session in the afternoon. Um, and then in addition to that, you I was assigned an individual psychiatrist and an individual therapist and a family therapist. Um, and I would meet with them twice a week uh individually. Um and it really kind of came at it from all angles. There was a lot of opportunity for introspection about life, there was a lot of uh uh discussion about different tools to manage stress and burnout and um anxiety and um depression. Uh there was, like I said, discussions about disclosure. You know, they have a curriculum essentially that they work through. Um and uh I as far as I know, I was the only physician in the group. And there were, I mean, gosh, probably eight or 10 of these groups running at any given time, with probably 15 people per group. So we're talking 100, 150 people that I was kind of in this milieu with. Uh, you know, it was all encompassing. So the psychiatrist, uh, and I'm open about this in my essay, you know, I had started taking antidepressants many years ago, but they managed that and made adjustments. Um, the therapist works with you on uh, you know, kind of trying to drill down on what's causing the stress or the anxiety or the depression, and what are tools and what ways you can uh respond to that. Uh after three or four weeks, you transition to what they call intensive outpatient psychotherapy or IOP. Um, and that was two group sessions. So I was done at lunch and I met once a week with the psychiatrist and the therapist. Um, but the program is kind of uh starts very intense and then over about it's kind of set up for a 12-week program, but some people are there shorter. I ended up stretching it out a little bit longer. Um, but by the end, I was only going three days a week, you know, and they kind of try to get you on a on-ramp back into uh society, so to speak, to uh kind of return to work, return to family life and be successful.

SPEAKER_00 33:03

Um tell me, tell me how did your wife and kids, well, kids probably were too young probably to understand the impact of this, but at least how did your wife take it when maybe I mean how was the conversation between you and your wife when you said, you know what, I'm taking medical leave, I'm gonna go into this program, or or or did she notice that you needed that program, right? Sometimes it's either she knew or she didn't know.

SPEAKER_01 33:30

Yeah, I I I talk in the essay about masking, and I was very good at masking my symptoms. Uh you know, I had a close friend from medical school and another friend from high school who I'd been a little bit more open with, but I really hid it from everybody. I think in part I was hiding it from myself. If I admitted to other people how stressed and anxious and depressed I was feeling, it would mean I had to admit it to myself. So um when I initially told my wife, who's uh not in medicine, um, she's in the finance world that I was gonna, and I it wasn't really a discussion so much of like, should I do this? It was I I said, I'm I'm taking time off. I I I need this. It wasn't really a should I do this. And um, she was pretty shocked. Uh she initially, I think, was scared about financial implications if I took time off, which um you know turned out was not an issue because if you're on FMLA, you can at least at my institution, I'm fortunate I maintained my salary while I was off, um, at least on my initial uh stint. Um I think that she had always envisioned me working till I was old and gray and you know, 65 or 70 and sailing off into the sunset. So for me, it, you know, 44 to suddenly say, I don't know if I'm gonna go back to medicine. Um she was pretty shocked and taken aback initially. And I think it took her some time to process it. Uh, but she came around to it and I think understood it. I think, you know, you asked me earlier why did I write the essay? I think it was a way for me to communicate with her and with some of my other family and friends also about uh what I was dealing with, um, so that they could support me. Uh but yeah, uh she came around to it and has was quite supportive in the end. But it it was, I'd say a month or two of kind of some stress between us about what are you doing? Why are you doing this? What you know, what are the implications here? Um, yes, about my kids. I I didn't uh didn't really talk to them about it. I told them, you know, they noticed I wasn't going to work that I was sleeping in and walking them to school. And I said, I'm taking a class to be less stressed, was kind of how I framed it for them. They were, I guess, 12, 11, and 10 or so. Um and they so I'd come home and they'd say, How was class today, Daddy? It's you know, um, it'll be interesting. I obviously, well, maybe not obviously, but I haven't shared the essay with them. But at some point when they're older, I'll certainly let them read it. And it'll be interesting to hear them reflect on this time and how they perceived what I was doing, what I was going through.

SPEAKER_00 36:33

In the essay, you talk about you got better, but then it seemed like you quote unquote either relapse or things got worse and you had to go back. I mean, I like there was like you know, back and forth. Take us through this.

SPEAKER_01 36:49

Yeah. Uh well, uh, when I initially took uh about a 12 or 14-week leave, uh enrolled in this IOP program. I guess in my head I thought, you know, I'll do this program, I'll feel better, I'll come back, I'll just jump back in and continue to do what I was doing. Um, I came back uh after about three and a half months off and went back full steam ahead, full-time clinic, program director, grant, you know, everything. And after about a month and a half, I was feeling overwhelmed, stressed, uh not as bad as I had been the prior fall, but um I could see I was backsliding a lot, and um I decided to take another two months off. Um at that point, I did go on uh short-term disability. Um at that point, also my chair kind of and I met and he said, We want you back, but when you come back this time, you need to be ready. It needs to be in a way where you'll be successful. Um and uh I actually owe uh Sue Yam a big thank you. She is the editor-in-chief of the Red Journal.

SPEAKER_00 38:11

She she's coming on my podcast.

SPEAKER_01 38:13

Oh, great, yeah, she's wonderful. I I had written uh uh this essay, and it kind of ended with me going back to work and I had submitted it to a couple of more general medical journals. You know, I if you read the essay, I never really, other than saying I'm a radiation oncologist, I never talked about anything specific to my specialty. Um, you know, I intentionally wrote it in a way that it isn't specialty specific. Uh, but it got rejected, as you know, many academic manuscripts are, and I was okay with that.

SPEAKER_00 38:46

Take me through like, did you get some reasons for the rejection in some of the other uh well?

SPEAKER_01 38:50

I submitted it to the New England Journal of Medicine and they sent it back and said, Thank you, no. That was about all. Uh I didn't get any response from them. I then uh JAMA had recently published a somewhat uh an essay in a similar vein that I cited my article. Um it came out after I had started writing it, but uh I didn't submit it there because they this other essay, uh it's called um redefining resilience. Um I just figured it was too similar. Wouldn't they and then I submitted it to JCO, Art of Oncology, and they they said they had published prior essays on the same topic. Uh, I'm not sure I'm aware of any essays that are quite the same as what I published. Um I've kind of come to view what I wrote as a case report on physician burnout. Uh, you know, rather than a survey that shows lots of physicians are burned out, it's a kind of case study of one physician who's burned out. Um and at that point, I went for the easy win, so to speak, because I I knew Dr. Yam and I had already discussed some of what it was going on with her, and she'd been quite supportive. And I thought, you know what, I I bet I bet they'll go for this at the Red Journal. And uh so I had submitted it, and um they kind of preliminarily accepted it with, but they wanted some revisions, and this was right around the time I was realizing I needed to take more time off. So I hit the pause button and said, uh, you know, I don't want to publish it right now. And they were okay with that. Uh, but I had a phone call with Dr. Yam, and it happened to be right before I was going to meet with my chair about returning to work. And I told her about all my clinical commitments and everything, and she said, she said, Dan, if you go back to full-time clinical care, you're gonna burn out again. At least what I told her was considered full-time for me. She said, Can you go to 80%? And I said, you know, I'm fortunate that financially with my wife and my jobs, I could make that, I could swing that. And uh, you know, I know that's maybe not an option for everybody, but uh, I literally 10 minutes later walked across the hall to my chair's office and said, Hey, how about? Because I had two academic days, one for just general academic administrative, and one because I had been PD. I gave up being program director and I said, How about instead of adding clinical time, you just give me that day as an off day, and I go to 80%. My chair said, Well, let me think about it. And he got back to me a few days later and said, Sure, we can do that. You know, I'm essentially working the same clinical volume I was before all this happened. Um, so it didn't change the clinical coverage in the department. Um, and I have so now I have Wednesdays off and I use it to I sleep in or I'll get up early and go play golf with a friend, walk the kids to school. Uh I go to pottery class now almost every Wednesday, uh, which is something I had done growing up in high school and had uh uh kind of lost but it rediscovered very therapeutic.

SPEAKER_00 42:07

Um tell me then, how has been the reception to the article that you wrote? Um well, obviously I I was very touched by it. I reached out to you, and I'm sure uh what uh have you gotten any reception? Have you gotten people that reached out to you? What what uh give me some feedback into what you received?

SPEAKER_01 42:29

Yeah, um I mean the the feedback has been, you know, I was a little bit worried. I talked with friends and family about publishing this, you know, would I have trolls troll it on Twitter or um you know, somebody write a commentary? But um, you know, it's been uniformly supportive, uh empathetic, many sympathetic emails, people telling me they've had similar struggles, uh people telling me that it has like, I mean, again, my my goal of writing it and or at least going public with it, I think was to try to demystify the recovery process and what some of the resources are out there. Uh, like I said, when I initially said I'm taking time off work, I was not aware of the IOP program. I was loosely aware these things existed, but I was not aware of what the nuts and bolts were of this of one of these programs. And so um I've received emails from people saying, oh, you know, I wasn't aware that this is what it was, or I've shared this with colleagues. Um I've had department chairs tell me that they shared it with all of their faculty and residents as required reading. Um I actually was very honored to receive an email from the chief medical officer last week of the Lorna Breen Heroes Foundation. She's the uh New York City emergency room doctor that died of suicide. Early in the COVID pandemic. It was national news, New York Times covered it. I cited in my article, but the essay trickled somehow to her. And she reached out to me to thank me for writing it. I've had colleagues from around the country just reach out to say hi, I think, and offer their support, but also just to connect more. I talk in the article about needing more human connection in today's world and not letting everything be subsumed by virtual meetings.

SPEAKER_00 45:07

I think if there's a way to share it more broadly with people who don't subscribe to the Red Journal, or people who are probably, if there's a way that uh and I know it's open access, so any way that you can really share that more ubiquitously and publicly, it would help a lot of people. How are you doing now? How are we doing now? We're taping this in 2026. So how is your mental health, physical health? I see you're wearing a bow tie. I mean, that's must be good. Yeah.

SPEAKER_01 45:36

Uh mental health is is good. Um, you know, it one one thing I learned in this program is you know uh it can be similar to recovering from drug or substance use. Uh, you know, you have to be aware of relapses and um, you know, backsliding. So it's something I try to monitor closely. I still meet with a therapist regularly and have a psychiatrist. I talk in the article about how I'm comfortable with the fact that I'll probably have a psychiatrist and therapist as part of my healthcare team in perpetuity, and I'm okay with that. I think it's good just uh, you know, good to have the support network there when I don't need it. So if I do need it in the future, um, it's there rather than scrambling to try to set something up. I've actually gone back up to technically 100% effort, but I still uh without getting a nitty-gritty, still maintain my Wednesdays um as uh kind of personal days to just rest, recharge, relax a little bit. Um physical health is good. I was skiing last week in Wyoming and did some backcountry skiing, which is kind of my zen, my uh happy place, you know, just climbing a mountain, just me and a guide and skis and trees and snow. Um, so well, I'm glad you're fortunate for that. Yeah.

SPEAKER_00 47:07

I'm glad that you're doing well. And I also appreciate the fact that you are open about this, honest about this. I think you are helping a lot of people in the medical profession by spreading the word. And uh I I can only imagine how difficult it was to make a decision to even share that publicly. Because, you know, it's you know, you're sharing a vulnerability that you experienced, and sharing a vulnerability in a world that usually embodies, you know, perseverance and resilience, and you're strong and you're not breakable is no easy feat. So congrats, and I thank you from the bottom of my heart.

SPEAKER_01 47:47

Yeah, there's a a quote I'm pretty sure I have in the essay that I learned in this this program, but they say shame thrives in the dark and dies in the light. Yeah. Um, you know, I think, yeah, you're right. There's uh especially now with social media, you know, there's a lot of posturing and um, you know, trying to show that you're living your best life. And um many of us, if not all of us, aren't always having the best day of our life, even though it might look like that on Instagram or Facebook or or Twitter. And uh I think going public with it was a way to kind of put it out in the light and maybe be a little less ashamed about it and own it and say this is who I am. And I think also uh to maybe peel back that that facade and show people what I dealt with so that others who might struggle might say, Oh, okay, this is not completely out of the ordinary. Maybe, maybe I'm not the only one dealing with this, and there's ways to navigate through it. So Dr.

SPEAKER_00 48:51

Dan Golden, thank you so much for coming on Healthcare Unfiltered.

SPEAKER_01 48:55

Yeah, thank you so much for having me. It's been a pleasure.

SPEAKER_00 49:05

Thank you, everyone, for tuning in and thank you for listening to my podcast with Dr. Dan Golden. Thank you, Dan, for being honest, for sharing your vulnerability with the entire world, because I know that this is going to help other people. And if it helps one person, it suffices. If it helps one person, it suffices. Folks, please subscribe to the show. You can find it everywhere. And um, and let me know what you think about this podcast, other podcast episodes. Join the conversation, have a comment, and discuss all of these topics because they're very important to discuss and to highlight. And before I let you go, I'm gonna leave you with a saying by Nelson Mandela. It always seems impossible until it's done. Until next time. Take care.