What to Do When Medicine Isn't What You Thought It Would Be with Dr. Taylor Nichols

You're doing all the right things but still feeling that disconnect between your values and the reality of medical practice?

Do you sense a gap between what you envision medicine to be and what it truly is in its current state?

In this episode, I interview Dr. Taylor Nichols, EM and addiction medicine physician to talk about some of the existential questions facing medical professionals today.

Namely- how to navigate when your expectations and your idealistic desires to help people- don’t match up to the day-to-day reality we face in the system.

You’ll learn why at the age of 7 Taylor decided he wanted to dedicate his life to saving other people

and what happened when he hit a wall after working frontline during the COVID-19 pandemic.

If you are wondering whether you should stick it out in the current system or find your own path forward this episode will empower you to make the choice that is best for you.

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Transcript

Chelsea Turgeon: 0:17

We all knew that going into medicine would be hard. Nobody They decided to go into the medical field because they just wanted an easy career path, or they're just trying to phone it in, we knew it would be hard, that it would be long hours, that there would be insane responsibility, stress, life or death decisions, but that didn't deter us. For many of us, hardness and all those sacrifices seemed worth it. Because it was in the name of helping people, saving lives, making a difference. There's this innate human drive towards contribution. We want to feel useful and helpful, like us existing on this planet matters. And for some of us, we want to contribute so much that sometimes we are willing to sacrifice our health and well being for it. And in the medical field, more often than not, That's expected. It's indoctrinated into us to sacrifice ourselves to help others. But what happens when we no longer feel like we're making a difference? When the systemic barriers and the lack of internal support make it impossible to have the positive impact that we want? All that sacrifice no longer feels worth it. And that's when we start to experience symptoms of burnout. Or, as my guest today refers to it, healthcare associated trauma. In this episode, I interview Dr. Taylor Nichols, emergency medicine and addiction medicine physician, to talk about some of the existential questions facing medical professionals today. Namely, how to navigate when your expectations and your idealistic desire to help people Don't match up to the day to day reality that we face. When we were having this conversation, I honestly felt this bubble of warmth coming between our Zoom screens. It felt like we were so tuned in, connected to each other, and I think that comes from how just genuine and relatable and authentic Taylor is. Through this conversation, you'll learn why, at the age of seven, he decided he wanted to dedicate his life to saving other people, and then his career long struggle of trying to live out that moral vision of his seven year old self while dealing with the realities of the healthcare system, and how with a little flexibility, the right connections, and a little bit of dumb luck, he's been able to find a way to save others. stay in medicine and honor his values. Plus, he's got a side gig where he's basically living out the job I always said I wanted when I was in medical school. And if you want a chance to talk with Taylor and ask him any of your burning questions, at the end of this episode, I'll let you know what to do. But for now, Let's get to the show.

3:22

You're listening to Life After Medicine, the podcast for health professionals who want to make a difference, make a living, and still have the freedom to enjoy their life. My name is Chelsea Turgeon, and my mission is to help you, the lost health professional, find your authentic path to helping others and generating stable income without having to sacrifice your own health and happiness in the process.

Chelsea Turgeon: 3:48

Hello, my loves. Welcome back to another episode of Life After Medicine. Thank you for pressing play today. We are here with Dr. Taylor Nichols. He's host of Recovery Reform podcast and together we're going to explore making a difference within the current healthcare system. And I want to just jump right into the good stuff. So to begin with, Taylor, can you tell me like what happened when you were seven years old that inspired you

Taylor Nichols: 4:14

to go into medicine? When I was seven years old, I had a brain tumor. I had the brain tumor removed it was likely growing in my brain for much longer, and I had, headaches and all the classic symptoms until I ended up going unconscious and needing to be resuscitated in my home, my parents called 9 1 1, did rescue breaths, the whole thing, and, I was rushed to the emergency department, had significant, increased intracranial pressure, which was the cause of all, you know, me, Going unconscious and I developed the whole Cushing's triad I had the Abnormal breathing and I had become really sick that day Because of it and I ended up having four operations to you know, relieve the pressure with an emergency ventriculostomy and then Remove the tumor and put in a VP shunt and while I was in the hospital. I truly felt that my life had been saved by these people who had dedicated their life to saving other people. I thought that was the greatest gift you could give someone. I wanted to pay it forward and I wanted to be someone who, stood for that, who was there to save other people. So I decided at seven when I was in the hospital, it was like, that was it. I was going to go train to become a doctor and there was no question about it. So that's how I ended up landing in medicine.

Chelsea Turgeon: 5:35

What a deep and profound experience to have. Yeah, as a 7-year-old, and I can just see how much that impacted you and how that created this drive to want to save people's lives and like you said, to pay it forward. And I think that's incredible.

Taylor Nichols: 5:47

And it, and it does, you know, one of the things that, I think we relate on is the sort of like ethic and, moral drive of why we wanted to pursue this in the first place. and that really. At the groundwork for me of of that strong, ethical framework of what I believe medicine can and should be and what I wanted to pursue for a career, but within medicine in Yeah. And

Chelsea Turgeon: 6:10

if you could articulate that, like, what was that ethical framework of like what medicine could or should be or like, what was that sort of like, I want to be a doctor so that I can

Taylor Nichols: 6:19

what? Simply put, like, I wanted to be there to save lives, and that's how I ended up landing in emergency medicine. It's to be there To do everything you can to save someone's life When in the setting of whether it's acute injury or illness, or just simply inability to access resources, you are there for somebody at their, potentially lowest. And I, love that. I still love that about emergency medicine and the ethos of what emergency medicine is. And I think, I think we can live up to that, but the healthcare landscape currently makes. Makes that more challenging. And it makes practicing emergency with the like moral vision that we went into it with, with that sort of clarity becomes really challenging, when the system doesn't really allow you to pursue it in that same way.

Chelsea Turgeon: 7:09

And so it's like you have this beautiful moral vision. Like it's there. The heart is there. The desire, the intent to help people is, is so strong. And then you get into the day to day practice. And what is that like for you?

Taylor Nichols: 7:24

So I trained at UCSF, right? I felt really lucky to do emergency medicine residency at the hospital where I was hospitalized as a kid. in emergency medicine residency, we rotate through the pediatric ICU. and so I got to rotate through the ICU that I spent two weeks in, that was an incredibly special experience. I mean, all of it was, was special to me, On the whole residency was fantastic, I really enjoyed it. I learned I thrived doing what I felt like I always wanted to do in the way that I wanted to do it, which was to be there for everyone, no matter who comes through the door, right? Like the ethos of emergency medicine is anyone, anything, anytime. And, and we did that and we did it well, and you were doing it with best friends and with great attendings and, people who really supported you. And it felt like the hospital supported you, particularly like, like San Francisco General is a perfect example of a very like mission driven hospital. And that meant a lot. And I didn't really realize then that wasn't. How the rest of the world worked, and that aligned with me, right? All of those things aligned with my personal sort of mission and what I went into medicine for. And then I graduated from residency and went out and I started working in the community. And it was kind of an abrupt lesson in the realities of medicine, of corporatization of medicine, of what that looked like. In practice outside of this community hospital outside of this or this county hospital this of mission driven setting. And that was a hard transition for me.

Chelsea Turgeon: 9:16

Do you have an example of like a, a moment where you had this abrupt wake up call or this abrupt realization?

Taylor Nichols: 9:23

Yeah. I trained in a place that was very It's a research heavy institution, they're very much on the forefront of the most recent data, and practicing by that. I mean, you have the people who literally wrote the papers, and so, when you're, you're very, like, heavily point of care ultrasound based, and we had a bunch of people who were publishing on, Utilizing point of care ultrasound, for example. And then I went to a community group that I was literally told that they didn't believe in ultrasound. and I was told that I was wasting my time doing them. And then was asked to essentially change my practice. And mind you, like, I had just gotten out of residency. And I thought, if I change my practice now, it's gonna be unsafe. But their belief structure of like how medicine worked was different than mine, and it was the confrontation of what an academic sort of evidence driven, current evidence based practice look like versus what the realities of contract management and like needing to practice the way say the hospital wanted us to, or the specialist, subspecialists us to sort of follow like a more protocol driven approach. So I ended up leaving that group because I felt like there's got to be a better way than this. then feeling like I was constantly struggling, fighting between the way I trained and what I believed and the way the corporate aspect wanted me to practice. and I left and I went and I worked, in a few different settings. I started sort of working part time in academia, which I did. Enjoyed and I worked in a rural setting, which was great. and you felt a lot of value in what you were doing for that community. And so that spoke to sort of that moral framework that you're talking about of like wanting to be there to help people in the best way I knew how. But then again, all of this still is, is in the like framework of being before COVID.

Chelsea Turgeon: 11:16

Yeah. So then what happened during COVID in the wake of COVID

Taylor Nichols: 11:20

The places that were hit the hardest were emergency medicine and critical care. The emergency department has always been sort of this, the safety net, the like the true net where all the other social safety nets fail. The emergency department still exists and is the last bastion of care. And instead, it became the front door of healthcare for everything. People just couldn't get access anymore. And we already faced physician, nursing shortages, and that was only exacerbated by what happened to all of us like literally watching people suffer and die from COVID, but also from the delayed presentations of other things because people didn't want to get COVID. And so we were seeing delayed presentations of strokes and heart attacks and things that we could then no longer do anything about, and it was really hard to want to go to work every day and then have people telling you that you're lying to them to then be told that that's not real, is really hard. and part of this sort of systems based trauma, like I already have this framework in my mind sort of developed during residency that that like burnout wasn't the problem, right? And started looking up like what was burnout and what did that mean? And it didn't really fit with like what I had experienced and I felt kind of like burned out or what we call burned out during residency at a point. And, This wasn't burnout and that it was a systems based problem and we were experiencing systems based trauma. And then COVID happened in that systems based trauma was wildly exacerbated. And that's why so many people have wanted to leave. And so you have this problem of, you already have a physician workforce shortage, you have a nursing workforce shortage, and then people are leaving, which exacerbates the shortage, which creates this like downward spiral of part of the problem, not to mention all of the policy factors built this system that is fragmented and opaque, that we can't hold all the pieces together. And so then what happens is everything starts collapsing around us, and the emergency department Becomes the only place that's accessible. Now it's become hallway medicine and waiting room medicine. There just simply aren't the beds available, nurses available, the staff, the beds, the things aren't there that we need to do the job the way we trained to do it. And so you can't, it doesn't feel Good to be practicing waiting room medicine, to not be able to do a proper exam because you can't get a patient in a bed or get them undressed to actually examine them. It doesn't feel good to have to tell people in the lobby that they might have cancer. none of that feels good and none of that feels okay. And so when you wonder why emergency medicine is breaking, it's because the rest of the system is collapsing around us and we're having to do things that we weren't like, This isn't what we signed up for. so that becomes really challenging. And that's why this downward spiral more and more of them want to leave. Or they want to, like, at least not work full time. so if they're working less, you have less physician hours, and you have fewer nurses, and none of them, like, people think, like, oh, they'll come back. No, they're not coming back. They don't want to exist in a system that's harming them. That's the problem that we're failing to recognize and we're unwilling to accept is that like the problem is that the system is harming them and they've just decided I'm not going to do that anymore. I'm not going to accept being traumatized by a healthcare system that is not supporting us. Yeah.

Chelsea Turgeon: 14:57

They have a right to not experience that anymore and to leave, right. They have right. But then also there's the like, but then how does the system ever get fixed? And like, how do we reconcile? Just like the drive to want to make it better, but also our own individual drive for like, having a good life.

Taylor Nichols: 15:14

that's the existential question for all of us in medicine. And I've managed to find my balance still in medicine, but I left a lot of emergency medicine behind. And instead of working 12 to 15 shifts a month, I work four. I kind of have a hard limit on that, and I've shifted a lot of my focus to addiction medicine, and I work in sort of the full spectrum of addiction medicine from inpatient consult service, residential and addiction medicine clinic, all of that was stemmed from, fortunately, Having, one of my best friends from med school was, or is still an emergency medicine physician who worked in this addiction medicine clinic. And basically when I was talking to him about this point of sort of hitting a wall of being burned out, he's like, just come in the clinic with me, like, trust me, you'll like it. And I went and it was. Exactly what I had been looking for. you felt a sort of usefulness that you didn't necessarily always feel in the emergency department. Patients were super grateful. and you developed a relationship over time to get the followup that you don't get an emergency medicine. I think that's one of the weaknesses of medicine and part of the burnout. what we collectively call burnout that I don't really believe is burnout, systems based trauma. you don't get to see the good outcomes. You don't get to have people thank you for saving their life or whatever, or just making them feel less alone when they're scared in the emergency department, right? Like that in and of itself is a win. And yet, I went into clinic, and it was like, you know, here's my friend, he's their addiction medicine physician, and they're coming in, he's gotten them stable on medication, and they like, get up to hug him, and be like, you saved my life. It's like, how much we want to be able to be there, and do that. And, and like at that feedback in emergency medicine, here it is like in clinic and people were really just like endlessly positive and you're talking about people who have like some of them been at the lowest of low, right? you had the whole spectrum of folks coming through the door. And I love that, right? Those are like, those are my people. That's who I signed up to take care of in emergency medicine. And here it was, but you're doing something and you're getting that positive feedback and it made you want to be there more. I was like, all right, I'll do this. And he, and he basically, fortunately for me, like gave me his job. And that has snowballed into a separate aspect of my career, and I'm, I'm forever grateful to him for that, because it did allow me to find a way to stay in medicine. And balance my life in a way that worked for me and managed that trauma. and I'll do what I love. I can still be in emergency medicine, but just not full time and that's okay. And I think a lot of us have a really hard time accepting that. I know I have personally had a really hard time accepting that, like, I am no longer the person who works 12 to 15 shifts in the emergency department, who's like constantly there, who's working in a trauma center and all. I think we do at some point have to, Stop with the mindset that we absorbed through medical school and residency of like, that you have to sacrifice and sacrifice and sacrifice to the system. You have to look out for yourself

Chelsea Turgeon: 18:34

yeah, I think that's so huge because it's like one thing that you're kind of doing by reducing your shifts And then also finding another avenue to practice medicine in a way that's more fulfilling is you're taking the reins You're taking control a part of trauma is this helplessness that you feel so then by Getting out of that helplessness and into this sense of autonomy You I think there's just a lot of healing and power that comes from that.

Taylor Nichols: 18:57

Absolutely. you know, to, to that point, the autonomy, part of that's been removed from medicine by the like sort of corporatization of medicine itself from like a systems level. We're talking about hospital systems, corporations, private equity, taking over a lot of the system, a lot of healthcare. It is a reduction in autonomy for health care professionals at large, and that loss of autonomy is a huge factor in the trauma that is, a health care associated trauma The idea of burnout leaves the blame to the individual. But the trauma doesn't come from the individual part. You aren't causing yourself trauma. The system is harming you. The system is traumatizing you, and that is the part that you need to escape. And if you're able to find a way to take back some level of autonomy, I still work in health care, but I have more autonomy over my life, and that has helped relieve some of that trauma that I was experiencing.

Chelsea Turgeon: 19:59

And so I want to also cover some of the other parts of your, your story and your expertise, because that was one of the things that made me reach out to you initially, as I, I look on your LinkedIn profile and I was like, Netflix medical consultant. What is he like writing grace anatomy? he doing? What is that?

Taylor Nichols: 20:15

I just lucked into that, right. That was like truly dumb luck. Met with, you know, having a certain level of experience and expertise. I just happened to have a very good friend from medical school, whose sister is then, the film industry, who, has worked with a bunch of people in Hollywood. And her best friend was a writer who was writing, previously for a few shows and had asked me some questions about, emergency medicine related things just by virtue of knowing, his friend's sister. and then she at one point told me that she wanted to write, a pilot that it was going to be based around a female emergency medicine protagonist, emergency medicine resident specifically. And asked me if I could put her in touch with people, asked me what my experience was like, what the sort of medical system at large looks like and the training system and all that. know, and she and I had talked a number of times over the years on different things and, you know, she said, if this gets picked up, I want you to be a consultant if you're okay with doing that. And fortunately it got picked up by Netflix, and we're still working through a few episodes, and they're already getting ready to, to film it and produce it. so it will, at least what I know of the working title is it's called Pulse. and hopefully it'll be exceptional and I encourage all of you to watch it when it comes out.

Chelsea Turgeon: 21:38

I love that. well, one thing I heard, it's like, yes, there's an element of luck and all of that, but it's also like the people that, you know, in your life, people you connect with. And there really is your

Taylor Nichols: 21:46

network. It's the network. And it's also like being willing to say yes to opportunities like that, right? Like it, part of it started with, Hey, can I ask you a question? And I can't pay you at all, but like, I just want to get some feedback on like, if this seems realistic, And I was like, that seems cool. I like talking about this stuff. I'm happy to help. or one episode of a show previously and spent a bunch of time on it. And it turned out great. and then I became sort of a trusted go to for her to be like, Hey, does this make sense? What about this? what if this happened and be like, you know, there were times where I was like, that doesn't make sense. Here's how I would reframe it. Maybe like once or twice a year, get a call just out of the blue. Like, Hey, I have a question. Okay, great. And maintaining those connections is where the like dumb luck ends up coming in where it's like, Hey, I've liked working with you. I want you to be the consultant. I get to use my brain in a totally different way. And it, it is a relief. It's sort of an off flat valve for me to enjoy the experience and reflect on the fact that like, oh yeah, like I, I do really like, love this stuff. I just had to get out of the system and ex eminent in a different way. Yeah, I

Chelsea Turgeon: 23:00

love that. And I know initially you said it was unpaid, but now that it's been picked up, is it a paid thing now?

Taylor Nichols: 23:05

Yeah, I am officially have a contract with, Netflix. That's so cool. Which is, so funny to me. Like, it's not a thing that was ever on my radar. you know, the health tech thing I grew up in the Bay Area, that's sort of all around me. My brother has been in the startup space, not specifically health tech, but just in, in startup world and so I have made some of my connections in that world, partly through him and then partly just through like growing up in and being trained in an environment That is ever present so, keeping those connections too. And sometimes it's doing the unpaid work, but like working with a friend of mine who is working on developing AI tools for charting, like for EHRs. it gives you some leverage to if if you're able to take on some of these different positions or different roles, you can become a paid clinical consultant, and that's absolutely needed in the, in the health tech space. So there are lots of opportunities for that out there to find ways to like balance your life and maintain your autonomy while still leveraging your sort of healthcare skill set.

Chelsea Turgeon: 24:14

That's another huge reason I started this podcast in general is to just bring people on who like are doing some outside of the box things with their degree. and just to get this sense of like, there is this abundance of opportunities, like you having a medical degree does not limit you in any way. that doesn't even make sense how having additional experience and additional Education would decrease the opportunities available to you.

Taylor Nichols: 24:38

I think we devalue that, but we're also, we're just raised in a system where we feel like that's never going to be enough. That's never adequate. We're never the expert in the room, but you are, you are the expert in the room, literally having any clinical experience with people who are creating clinical tools, but have zero clinical experience. You are now the expert in the room. And you can be helpful on so many different platforms across so many different spaces, whether it's in tech, whether it's investing, whether it's, film and TV, like All of those things, they need expertise and you will find that becoming the expert in the room that people turn to you're like, Oh yeah, I actually did all of those things and I have all of that experience and it does matter. It does make a difference. Like you said, we just don't think that we just, hold this sort of so deeply inside us that like we just feel inadequate, but you are, and you should take advantage of that because it is so needed.

Chelsea Turgeon: 25:36

amen to all of that. For someone who is sort of at that wall of burnout, that place of disillusionment with the system, feeling trapped, feeling not enough. Like what is just one little nugget of advice that you would give someone like that?

Taylor Nichols: 25:49

First, the first step is just like push, pause, step back. And examine what you wanted when you went into medicine and what you are getting and what is like hurting you. And if there are ways that you can reframe that. And for me it was addiction medicine. For me it was needing more control of my time and more autonomy. And for other people it may be totally different things. And for other people, like I said, it may be leaving medicine entirely. It may be going into a non clinical job. I've been really fascinated with some of my friends who have left medicine entirely, and I've talked to them about what their experience is like, and everybody has different reasons, and everybody has different experiences, but just know there are a lot of opportunities out there, and your expertise is needed in so many spaces, and so take a step back, push pause, and re examine your value set, and what it is that is hurting you, And it may be that there will never be an alignment in your current job in the current place that you work, you know, and maybe there are other places to do the same job in the same role within health care that align better with that value set, depends on how you approach it and whether how willing you are to make those changes. but I think that's the first step. And if it is, There will never be a role in medicine that I feel aligns with my values anymore, then leave. shouldn't be shame in that, because if you can't continue to do the thing that you signed up to do, in a way that feels morally right to you, then don't do it. Because you are only hurting yourself and sacrificing your life for what? You deserve to be able to be happy in pursuing your, and that can be pursuing completely different things. It doesn't have to be medicine at all. and so I think that's step one. like you said at the beginning, like, what are your values? What did you want to get out of this? And is what you're doing aligned with that? And if you can't find that a lot anywhere, then look elsewhere. And that's okay. it seems super scary, but really like there are so many different ways to pursue being in a clinical or even nonclinical field that could even relate to medicine. It doesn't even have to relate to medicine at all. That's the experience and expertise that we have. And there are so many also non clinical jobs that leverage that expertise. You don't need to do any other training or get another degree or any of that. There are already a significant number of possibilities out there. And so I would say, look for them and feel free to reach out

Chelsea Turgeon: 28:22

yeah. People need to hear that, especially the, you deserve to be happy in your career. Thank you so much again for coming on, for sharing your journey so openly, so, so beautifully.

Taylor Nichols: 28:33

Thank you so much. I really appreciate it.

Chelsea Turgeon: 28:36

So how do we navigate it? When our expectations and our idealistic desires to help people don't match up to the day to day reality that we face, what do we do when we don't feel like we're making a difference anymore? Just like you heard in Taylor's story, first, we have to know it's not a you problem. It's a systems problem. No one is thriving in this system, and so you really have to stop blaming yourself. Along with that, we have to stop believing that indoctrination, that we must sacrifice ourselves for the system, because when we continually sacrifice ourselves, nobody's winning here. One of the biggest pieces that helped Taylor in his journey was self love. Autonomy, taking some of his power this reduces the feeling of helplessness that can be associated with trauma and burnout. So taking some autonomy is key. Maybe for you, that looks like reducing your shifts, going part time, just doing something to remind yourself that you are in charge and that you're not helpless. Everyone's journey towards a fulfilling career is going to look different, but at the end of the day, you have to remember you deserve to be happy in your career. And you being happy is not selfish. I really believe that the world is a better place when we're all doing work that we love. So if you want a chance to ask Dr. Taylor Nichols any of your burning questions about how he's managed to create a fulfilling and meaningful career within the medical system and a little bit outside too. Come join us in the Life After Medicine Facebook group for a Q& A. We'll be collecting and answering your questions on the Q& A thread pinned to the top with Taylor's name on it. The link is in the show notes to join the group and can't wait to see you there.