Mind Dive

Episode 63: Burnout and Balance in Psychiatry with Dr. Jessi Gold

• The Menninger Clinic

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Burnout in health care settings is an all-too-common struggle for healthcare professionals. This month Dr. Jessi Gold explores the toll of the pandemic on health care workers and how these workers can overcome the emotional and psychological exhaustion that accompanies such a demanding field. The dangers of allowing burnout to fester can be catastrophic, not just for the individual, but for health systems as a whole, as the silent suffering of their workers can lead to inefficiencies in care and loss of public trust.  She discusses her framework for confronting burnout and shares her approach of being vulnerable as a therapist with these patients to help encourage them to open up since they are so used to hiding their suffering.

 Dr. Jessi Gold, M.D., serves as the inaugural Chief Wellness Officer for the University of Tennessee System and as an associate professor of psychiatry at the University of Tennessee Health Science Center. Dr. Gold graduated from the Yale School of Medicine and has received numerous awards and accolades for her contributions in mental health and psychiatry, especially during the COVID-19 pandemic. Her first book, “HOW DO YOU FEEL?: One Doctor’s Search for Humanity in Medicine,” is available now and explores the personal tolls of a career spent healing others. 

 “We’ve long believed that somehow if we just tried harder, this really hard thing that we do, where we listen to people’s traumas and problems, that if we just became numb to it, that it won’t affect us,” notes  Dr. Gold. “Thinking like that never made sense to me. Of course, it affects us and, while it’s not a weakness, it is something that we have to prepare for and factor into our approach.” 

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Dr. Bob Boland: 0:02

Welcome to the Mind Dive podcast brought to you by the Menninger Clinic, a national leader in mental health care. We're your hosts, Dr. Bob Boland and Dr. Kerry Horrell.

Dr. Kerry Horrell: 0:11

Monthly we explore intriguing topics from across the mental health field and dive into hidden realities of patient treatment.

Dr. Bob Boland: 0:18

We also discuss the latest research and perspectives from the minds of distinguished colleagues near and far.

Dr. Kerry Horrell: 0:23

So, thanks for joining us.

Dr. Bob Boland: 0:34

Let's dive in.  Welcome! So, we are delighted today to have Dr Jessie Gold. Dr Gold is the Chief Wellness Officer for the University of Tennessee System, and she is an associate professor in the Department of Psychiatry in the UT Health Science Center. She's a fierce mental health advocate and she's highly sought after expert in the media, so we're very lucky to have her and she yeah, we are, and she's from everything on burnout to celebrity self-disclosure, something that we'll be discussing about both of those things, really today. In her practice she sees healthcare workers, trainees, and college students. Dr Gold is a graduate of the University of Pennsylvania, the Yale School of Medicine and Stanford Medicine.

Dr. Kerry Horrell: 1:12

Do you want to say the title of her book?

Dr. Bob Boland: 1:15

Right, and we'll be talking about her recent book. How Do You Feel?

Dr. Jessie Gold: 1:19

Thanks for having me.

Dr. Bob Boland: 1:22

Great, so how?

Dr. Jessie Gold: 1:24

Today, I feel like I'm okay.  You know I feel like it's rainy and that maybe sometimes, when you wake up in the morning and it's rainy in Tennessee, you want to go back to bed, but other than that I'm awake and ready to talk to you guys.

Dr. Bob Boland: 1:39

You want to go back to bed?

Dr. Kerry Horrell: 1:41

Well, also on rainy days it's impossible.

Dr. Bob Boland: 1:42

Yeah, it's a lovely day here, though I have to be clear.

Dr. Kerry Horrell: 1:44

Here's a question. I should probably know this, but University of Tennessee is in which city in Tennessee?

Dr. Jessie Gold: 1:50

So good question. So, my job is over the whole system which is all five schools in the University of Tennessee system. So, University of Tennessee, Knoxville, Chattanooga, martin, southern and the Southern Health Science Center and the Health Science Center. Because I see patients, I'm based at the Health Science Center which is in Memphis. If I didn't see patients, the rest of the folks who work for the system live in Knoxville, Tennessee, but I live in Memphis. 

Dr. Kerry Horrell: 2:14

How far away is Memphis from Knoxville?

Dr. Jessie Gold: 2:16

Very far. So, something that I've learned in this gig is that Tennessee is very long in a very surprising way, because I think when we learn geography it's just sort of there and touching a lot of states and it doesn't mean anything. But it actually feels like you. It probably takes about six and a half hours to drive from one to the other and that's like honestly Florida down, for you know, I grew up there, so surprisingly long I'm.

Dr. Kerry Horrell: 2:41

I'm from California and really the only other place I've lived in for a long amount of time is Texas. So, I'm surprisingly long. I'm from California and really the only other place I've lived in for a long amount of time is Texas, so I'm from two states that take a long time.

Dr. Jessie Gold: 2:49

That's still. That's pretty big.

Dr. Bob Boland: 2:51

So, I'm from Rhode Island. So yeah, you don't know anything about that.

Like I can get from one side to the other quite quickly.

Dr. Kerry Horrell: 2:58

One other thing I want to say from your bio, or I don't think we said in your bio is you're also the inaugural chief wellness physician, correct at University of Tennessee.

Dr. Jessie Gold: 3:07

Yeah, I'm the first person in the role here. I mean, I think it's an interesting job because I think in a lot of ways the chief wellness officer role has rolled out in health systems and hospital systems, but maybe less so in this sort of academia, undergrad, grad education bit, and so it's a fun job that way.

Dr. Bob Boland: 3:27

Yeah, Wow. So, I mean we usually start not by talking about geography but by asking people about their careers. But you know your book is a memoir, so we'll be talking about your career a lot today, so I don't want to spill all the beans at once but maybe tell us just a little bit about your background, how you got into medicine and psychiatry. You do mention there that your dad's a psychiatrist and I think I know who it is. But I think I know. Go ahead, Donna, but just tell us a little bit, yeah.

Dr. Jessie Gold: 3:57

Yeah, I mean, I'm one of those kids who always wanted to be a doctor. I think it was like in the water that if you were good at school you went into something like medicine and that's what I always thought. I think I didn't really start to question that at all until I like college, but I had always thought I would be a doctor. You know, in college I didn't like pre-med classes and struggled there like probably so many people who are listening and so many people who are doctors and not doctors there are like probably so many people who are listening and so many people who are doctors and not doctors and that led me to anthropology. So, I was an anthropology major and also got a master's in anthropology and really looked at medical anthropology. So, I was always pretty fascinated by, like how we thought about health care, the culture of health care, how we train people. You know, when I went to med school, I really didn't want to be a psychiatrist, because my dad's a psychiatrist. Most kids who are psychiatrists start out intending not to be psychiatrists.

Dr. Bob Boland: 4:51

yeah, I think that's probably true. At least that seems to be a trope right here.

Dr. Kerry Horrell: 4:53

I'm not a psychiatrist, I'm a psychologist, so I so I'm, I'm an outsider looking in, but that's my sense was that well, just following in because yeah, right, yeah no, we've. We've interviewed enough psychiatrists that asked this question how did you get there? So many are like I happened upon it, yeah, yeah.

Dr. Jessie Gold: 5:09

Yeah, I would say it was like a magnetic pull for me. So, as you know, the only reason I didn't want to do it is my dad is I mean you said you probably know who my dad's Mark Gold? My dad is a former chairman of psychiatry.

Dr. Bob Boland: 5:22

That was really mysterious. But you don't mention the name in the book.

Dr. Jessie Gold: 5:25

I don't my dad's a former chairman of psychiatry. He's very well known in addiction. He's very bright and very good at his job and I think following that felt overwhelming to me. I think, you know, not because of anything, like I didn't feel like I'd measure up, but it just felt like there's this conversation about nepo babies. I didn't feel like I'd measure up, but it just felt like there's this conversation about nepo babies. I think I'm a psychiatry nepo baby, right? So I think that you know, I want to seem as if I've earned what I am doing, and so I think when I was younger, like that part felt really confusing to me, Like I don't want to follow in his footsteps and either not measure up or measure up. And then people think I got there because of him.

Dr. Bob Boland: 6:05

And so, all these benefits you get from being I can't imagine. I'm sure what they are, but who knows.

Dr. Jessie Gold: 6:09

I mean, we all. You know, everything is who you know. Sometimes you know, and so for me, though, it was like every rotation. I would be like I just want to pull up a chair and talk to someone, or I just want to know about their background, or I just care about their story, and I would be fighting it so hard, like I tried to do neurology forever, because I was like I like the brain, I can do that, but I just didn't like that, like we didn't get as much time with people. I thought it was really depressing. I thought about if I could see like 100 people with depression or 100 people with a stroke, because if that's like the most common thing we see, what would I rather see? And I was much more drawn to depression because of, you know, even if we give them all the same med at the end, like why they're there and who they are is a part of the treatment, and I think that part was always like the draw for me.

Dr. Jessie Gold: 6:57

Psychiatry also had a lot of people doing weird stuff, so people weren't just clinicians like. People were writing and advocating and, you know, finding ways where mental health intersect with policy, or you know all these different spaces for psychiatry and because the field, like you have the flexibility hours wise, and because you're not like I need to be in an operating room for 80 hours a week to still be good at my job, like there were a lot of people modeling sort of these hodgepodge careers of lots of things and I never thought I could just do like clinical practice my whole life. I always knew I wanted to do other things. I started writing in med school. So, you know, having like looking ahead and kind of seeing people not just doing clinical practice or you know, just this one particular model of a field also was a big draw for me in psychiatry.

Dr. Kerry Horrell: 7:48

I resonate with that a lot. That was, you know, in a different way but a similar way. That was why psychology was such a draw to me is there's so many aspects to it. You know, as we kind of get into and talk about your book, maybe a first question I want to ask is what inspired you to write this book? Like, where did it get its first roots and ideas?

Dr. Jessie Gold: 8:07

from.

Dr. Jessie Gold: 8:08

Yeah, I wish I could say that I was like a person who was like I've always wanted to write a book and there are definitely people like that I really turned to writing, initially as a way to process and then really started writing these like 1200 1500 word pieces for traditionally women's magazines that like either looked at an aspect of mental health in like popular culture and talked about it in more depth, or talked about something a lot of my patients were bringing up and talked about it in more depth and sort of like a psycho ed kind of way.

Dr. Jessie Gold: 8:36

And this really came about because, you know, I was a psychiatrist in the middle of the pandemic, seeing healthcare workers and all my patients were talking about a lot of the same stuff, but a lot of it, you know, not together, like they didn't ever talk about it out loud, it was just stuff they were telling me and I was feeling like you know, we are doing this group in particular a disservice, like not having these conversations in a way that made them feel seen and understood and also sort of broke down the this is just a wellness checkbox lecture thing.

Dr. Jessie Gold: 9:06

You know, I mean as a person who is one of those people who gives those lectures. You know, I think that's one way of giving people information but, like the, you know, healthcare workers in particular are turned off by that way of giving, getting that information. And so, you know, was there a better way to help them? You know, get some of that without forcing it in a lecture, you know, with my own experience and really burning out and not identifying it, and yet swimming in the content so often like why would anybody else be able to identify it? And I felt like that was an important conversation that also normalized, like how hard it is to know when something's wrong and how complicated it is to ask for help in all, all fields where you prioritize others before yourself, but in particular in healthcare.

Dr. Kerry Horrell: 10:06

Well, and I'm thinking about too, I think, one of the I don't think it's unique to the pandemic, but one of the, I think, important qualities of the pandemic was everyone was going through it. And I think there is sort of this idea of, well, everybody's struggling, everyone has to deal with this. So, my unique suffering and struggles I just need to suck it up and deal with it. We're all in this. But in my experience, it made people really hesitant or not wanting to get into it in a deep way. They were like, yeah, we're all in this, we're all doing it, the whole world is feeling this. So why do my particular experiences matter? So, yeah, I'm so glad that you were talking about this. So why do my particular experiences matter? So, I'm yeah, I'm so glad that you were talking about this.

Dr. Bob Boland: 10:47

Now, were you in this position during the beginning of the pandemic, or were you?

Dr. Jessie Gold: 10:51

no. So I was at Wash U in St Louis and really like was actually the psychiatrist on the college campus and then March 2020 came and they furloughed a bunch of us but I was a faculty position and so I wasn't like you can't, what do you do? That basically just meant someone had to see me. I had to find another clinical role, right? And so, in that context I said, well, it seems as if this is going to really affect, like our people a lot. What are we doing there? Can I open my clinic and really try to focus on seeing faculty and staff and their dependence on dependence? And so I started that and then, in the context, like that really grew to HR funding part of my position, hr. funding, some therapy positions, me having a leadership role in this, like within the psychiatry department, we're really like in the whole system looking at faculty and staff wellness and doing outreach and education and really building our clinic.

Dr. Jessie Gold: 11:44

And I stumbled on that in part by being furloughed, but also by being a person who had already done research in and like looked at these topics before and, you know, noticing that, like as psychiatrists, we had the ability to step into that role and really support the system in that way and like I had a lot of guilt myself, like being behind a screen and not being a frontline worker, which I talk about a lot in the book, but you know the way that I sort of compensated for that was probably overwork but also like what is our duty as psychiatrists to be in this role, where our people are suffering and we have the skills to help them with that suffering, like is our job to step up and help?

Dr. Jessie Gold: 12:26

And I really felt like it was, and so you know, I pushed our department to do that and like helped with planning around that and really like that grew into a leadership role for me throughout that time period though who would have known? Because I mean, I really just thought it was going to be a couple of months and then it turned into what my job looked like.

Dr. Bob Boland: 12:45

So you know, yeah right, well, that's, that's great, because you saw a need essentially to fill a list that a lot of places did not fill during the time, and, yeah, how important I was just going to sort of go back to like your book begins, though, like where you give a vignette Now you're careful to say that your patients are amalgams, I think, and not necessarily individuals and obviously de-identified and all that. But I think it's something actually that, even though you describe it as this, you know very sort of emblematic thing for you. I don't think it's that unusual for people to go through and you want to say a little bit about that.

Dr. Jessie Gold: 13:19

Sure, and yeah, I use composites. I think anyone who listens would understand the desire for that. I think it was weird for me to write a nonfiction book where you're really like compiling a bunch of stories to one story because it starts to border on fiction almost because you're putting so many people together but that's what it is in order to protect them and also sort of you know, a lot of these things are what we talk about all the time with similar people. We just happen to make people feel like that's the only time we've ever heard that story because that's part of our job. But, you know, heard that story because that's part of our job.

Dr. Jessie Gold: 13:53

But you know this book starts with me having an experience where, like, I reintroduce myself to a patient. You know, for me I either look at a chart or remember the person before I see them and would have looked to see that I had seen them before but with, in the context of pretty heavy burnout and sort of like, really like showing up later and not having time and all the things that come with that. I didn't do that, and I just looked very much at my schedule. The person was scheduled for an hour and assumed it was a new patient and started talking to them again. You know I tell this story, and I've had conversations with non-psychiatric providers who say, like duh, I never remember anybody.

Dr. Jessie Gold: 14:36

But I felt like for me, you know it was. I don't like to do that Like to me. You know, if someone just told me their trauma and I just reintroduced myself it sort of signals that that wasn't something that stood out to me or resonated with me or mattered to me. And I really know how much our patients connect in that way and expect things in a certain way. And, yes, sure, I might not remember every single person, but I will have looked at their chart enough to pretend. So, I think that for me it was just not like me and I, the way that the person reacted and the way that the person liked it made me also feel kind of compounded that. And you know, I think I felt comfortable being able to share it because I didn't cut someone's leg off right Like.

Dr. Jessie Gold: 15:23

I think if, like if I did a mistake that I would get sued for or I didn't have the ability to repair and really help the patient kind of like reconnect with me, it might have been harder for me to write about or maybe never would have written about it, but people still seem surprised. I even wrote about this, but you know, for me it was a. It was like a big flashing warning sign that was like hey, this isn't how you want to do this, this isn't the person you like to show up as at work and you don't want people to feel like this and something's wrong with you because it's definitely getting into your work it's that I just can really resonate with that, because I do feel like I've had times where you know something's happened, where it's like it's fine, but I'm like this isn't me, this isn't how I do my clinical usually you check the chart beforehand, but, but sometimes you're in a hurry and yeah, right, yeah.

Dr. Kerry Horrell: 16:11

But just those feelings where you're like, even if this is not, even if, like you know, yeah, there's repairs when you make sense of it. I know that feeling like this isn't who I am as a clinician and it's such a sign of like what's going on. And so I'm so glad that you speak about that and I think, think ultimately, you know your book is really personally revealing and you know you even talk about and acknowledge that, like doctors are not super encouraged to do that, maybe especially psychiatrists. I know, in psychology, and especially you know I'm I tend to learn psychodynamic, psychoanalytic. I know there's a lot of theories and ideas about self-disclosure and how we talk about our own, our own work, and so I wonder if you can tell us a little bit about how to make that.

Dr. Kerry Horrell: 16:52

Actually, I do, yeah, and before I even say that question, though, I do want to say the way that I am, so in support of it and I, because I mean, you know, I think one of the things I really try to champion in my own work with my patients, as someone who really focuses on shame and shame resilience, is vulnerability, and in my work I try to be, where possible and where it's appropriate, as vulnerable and open as I can. I'm like, I am a human being first and foremost with you all, and before you're going to ask the question, I just want to say I adore this about you and I adore this about your writing, but I wonder how, how that was for you, like how you made the decision and how it felt to kind of put yourself out there in this way.

Dr. Jessie Gold: 17:34

Yeah, I mean. Thank you for that. That's very kind. I'm a big proponent of vulnerability too, like a human, but I also wish we learned more in training, just because I do think it has. It's actually a skill that we could use with patients if we chose to learn it in that way, as opposed to just saying we should never do it ever.

Dr. Jessie Gold: 17:53

You know, I dabbled in it for a while, like with using social media and writing and talking about being a person who goes to therapy, but I had not like ever written as much as in the book, and I think probably the intermediate step for me was disclosing that I take medication. And I wrote a piece on that after a lot of reflection, because I didn't realize I stigmatized myself for being in the media, even though I spend all day telling other people it's totally normal. But I realized I was not sharing that without even realizing it in some kind of unconscious way. And when I went to like therapy and talked about it, I realized I had a lot of like well, someone's going to think I'm a less good doctor, or someone's going to think if I'm emotional, I'm going to crack at any moment, and you know I'm a boring case of someone who had depression. I went to Wellbutrin in college, and I've been on the same dose ever since. I probably could get off of it. I just decided not to. And you know it is what it is and it's very boring, but I still didn't feel like I could share that, and trying to understand the reasons behind that really probably propelled my ability to continue to be vulnerable and like be more vulnerable in this book, because you know it took a while to understand that. But to be a person who does this field and can still stigmatize myself, I think is a relevant conversation for everybody, because our culture, our upbringing, the sort of like ethos of mental health and society like gets into all of our brains in ways we don't even realize and I think it's important to break down. I also think that you know the response I got to that, how I felt doing that was helpful at kind of propelling me forward and doing it more.

Dr. Jessie Gold: 19:34

Being a psychiatrist who takes care of people like her is also part of my decision. It felt like modeling in some way because my patients are me in some capacity, and so it felt like if I could show that it was possible to be vulnerable, maybe they could be vulnerable with me just a little. Like I don't expect my patients to feel like all of them can say like hi, I'm Jesse, I see a therapist every week and I take antidepressants. But I would love them to say like that[CM1] code affected me emotionally or work-life balance is hard or some of these things that we pretend we can't say out loud, that you know, if you see kind of an extreme version of vulnerability modeled, maybe you can feel like you can tiptoe into it a little bit more. You know, I think that you guys would find this particularly interesting.

Dr. Jessie Gold: 20:20

Like I don't overly disclose in a patient setting, like there's like public Jesse and there's like Dr Jesse, and if a patient brings it up, I will talk about it. But I actually just assume they don't know this about me unless they talk about it. Like if they want to talk about it, like everything I write I know my patients can see, I think about my life through that lens and make sure that anything I put out there is not like going to isolate a certain patient population, is not going to make people feel uncomfortable seeing me. But I also don't assume that they've read it or that they want to talk about it or that they know I've said any of that and so I'm not.

Dr. Jessie Gold: 20:56

I'm treating the one on one patient setting like anybody else would, with the understanding that they could know that that I might see a point where saying something about myself or saying something about myself as like a I've heard people say things like this in like a more general sense, where it actually is about me, but I don't say it's about me can be useful as a way to like help move things along in a patient encounter. But I do view one-on-one patient encounters very differently than like a public disclosure, because I do think that like choosing to say in a patient setting like oh, I take that medicine too, or something would need a purpose, like it wouldn't like just happen for no reason. It would feel extraneous and distracting and maybe some people don't need to know that stuff for boundary purposes. But I think using self-disclosure in this setting, where it makes sense and like where I've thought about it, is still something I do with patients. But it's just like I don't walk into a patient setting when I prescribe Wellbutrin and like high-five them.

Dr. Bob Boland: 21:58

Yeah, really, I try this.

Dr. Kerry Horrell: 22:00

Again. I'm just really resonating A couple of thoughts I was just having was this is a silly way to say this, but it's so in my mind to think about it it's very vulnerable to be vulnerable in this line of work, just the feeling of. I typically have a trainee or two in my shame. Resilience groups and this year particularly my two trainees there are both really interested. They're like you. You share about yourself in a way that feels appropriate and it's self-disclosing. And how do you know when to do that and how to do that?

Dr. Bob Boland: 22:34

well, and I'm always like you know, you feel it out, you catch the vibe, you get the sense of what the group needs I think the, of course, the good way we think we learn it and it makes some sense is are we doing it to help ourselves or to help the patient? And we shouldn't be doing it to help the patient. But then really, how do you tell which is the difference?

Dr. Kerry Horrell: 22:54

I mean, that's a little subtle, I mean even in my clinical work I've had so many patients say like it was so helpful to see that you knew something about this, want to say I've, I've stolen this joke a bit from Brene Brown. It's like a riff off of one of her jokes, but I was like you know, I feel like if I had a superlative in high school, it would have been least likely to get into shame and self-compassion research. Um, like, and then I share, like I totally was a recovering perfectionist. I, you know I talk about this and I feel like it helps patients to feel okay, especially because I think these topics, especially self-compassion, patients can be like okay this is like the light, this was really important in my life and my growth.

Dr. Kerry Horrell: 23:38

I think it's just been really helpful, but I thought I was having. I just wanted to say that I thought this was this interesting. I work inpatient, right, so my patients could come and go about a month, six weeks, sometimes longer, and I've had a few colleagues I'm pregnant right now say you just don't need to tell them at any point, you're pregnant, you don't need to bring that into it. And I was like guys at some point.

Dr. Bob Boland: 24:00

Yeah, yeah, soon, they'll let a patient figure it out.

Dr. Kerry Horrell: 24:02

Pregnancy is not the easiest thing to hide in the world at a certain point, but definitely I feel like the discouragement or the ethos of like, I don't know, are you distracting your patients by at all bringing in your own life, Especially if you don't need to, if these patients are going to be gone before you go on maternity leave? And I just had the thought that I was like that's just not who I am as a clinician either, that I wouldn't talk about some of this with my patients.

Dr. Jessie Gold: 24:32

Anyways, I just I'm resonating a lot with you. Yeah, I mean, I've seen my therapist model, it really well and I think that also helped me recognize, like, what a strong skill it is. Like, when I was thinking about whether I should talk about being in the media, like she was like I'm going to tell you something I've never told anybody. Like I take the same medicine that you take, like does that change your opinion of me? And like my gut reaction was, oh my gosh, no, I love her.

Dr. Jessie Gold: 24:52

Like why would that change my opinion of her? And like to like in that moment, had like such a light bulb of like well then, why would my patients feel any different? Right, and like that use of it was like simple and subtle and also very impactful to me, like sort of clicking all of these things and having a realization that, like I'm not judging her, why would someone judge me? That isn't really giving my patients credit, and it was really helpful. So, I've seen, you know, one of the cool things about being a psychiatrist in therapy is sometimes you can actually learn skills that you can then apply when you're talking to patients. But you know, that was really helpful for me to see, because I do think that it really did help in that setting, like I wasn't like, oh, why did she talk about her? Like leave that out of here, you know.

Dr. Bob Boland: 25:34

I mean, a lot of your disclosures are about burnout and that's what you are an expert about, and you know. First of all, I mean, you know people are as all as all kinds of words like that People are using to describe everything. Now, do you want to first like uh, we've had, we've talked about some and, I think, some of our podcasts, but you want to say a bit about how you see, like, what is burnout? Sure, you know we're in mental health mental health.

Dr. Jessie Gold: 25:56

Words are fun for people to use, wrong, you know like all of our words are used not like we think about the words.

Dr. Jessie Gold: 26:02

So, burnout I can't help it yeah right like burnout's been, like work is hard, I'm tired, I'm burnt out, right, like that's what it's been used as. Like the definition I use is the definition people who are researchers use, which is this sort of three like constellation of three things. So, burnout is directly related to work, which is an important thing for people to understand. So, like the ICD defines it as a workplace condition, it's not in the diagnostic manual because of it being a workplace condition. You could make an argument about whether that should be changed, and we should just allow it anyway because we see it enough. But psychiatry has kind of like kept it on the outskirts because it is a workplace associated condition. If you're a stay-at-home mom, your workplace is home. If you're in school, your workplace is school, just like a caveat.

Dr. Jessie Gold: 26:51

And the three sorts of constellation of symptoms are like well, first one's emotional exhaustion. I describe that as sort of being like really just spent at the end of the day, like you don't have anything left in me. That looks like a lot of physical exhaustion and so that was kind of confusing. But I think emotion can drain you in a lot of ways. The second one depends on which researcher you ask. It is either cynicism or depersonalization. Cynicism being like anger as your primary sort of view of the world and sort of with colleagues, with your work, with your productivity, just sort of the way you're feeling angry. Depersonalization being more like that removed. Feeling like we learn it in medicine and in therapy as a kind of coping mechanism to not get overly attached or affected by what patients are telling us. But it's as if you were removed, like to an extreme all the time, and not just as a protective mechanism, like in your interactions with other people and all of your patients. People say they treat patients like objects. I just kind of feel it's like going through the motions and like being less connected to your work and less connected to the people around you. And the last one is a reduced sense of personal accomplishment, and that one is the one that everyone shows up in your office for. So that one's the one where someone told you you're not doing your work. You feel like you're not doing your work. You actually aren't doing your work and so you say, hey, something's wrong, because we care about productivity, and we care about getting work done.

Dr. Jessie Gold: 28:13

The first two I think we are the first two, two and a half, depending on you know who you ask. Really, we blow off as like we work. Hard work should make you tired, hard work should sometimes be frustrating, hard work should sometimes lead you to be like disconnected or whatever. We like very much to pass it off like that's what work is. But the minute it causes problems and like we notice that we're not doing something, then we're like, oh wait, like maybe that's not what work is, and so it becomes a big issue.

Dr. Jessie Gold: 28:37

Health care workers were at like 50 percent for burnout, even pre-pandemic, which is higher than other fields and like even the equivalent sort of educational paths and things like that. So, you know we have not been good at this for a long time. I think that you know the pandemic, like you were kind of saying,  drew people's eyes to the conversation that maybe weren't there before or maybe had avoided it before, but we were not in a good place before that whole time period, especially with burnout so hospitals were like, really only starting to acknowledge burnout and be open about solving it.

Dr. Bob Boland: 29:11

I think it's only in the years before the pandemic that, like our, the hospital where I worked was even kind of tracking it and starting to get surveys, and then that was in the days of like, well, I guess we need more yoga classes that is always the solution.

Dr. Jessie Gold: 29:25

Uh, pizza parties and yoga I heard that that makes everybody really like wellness exactly right, right yeah, the point is like we need more than that.

Dr. Kerry Horrell: 29:33

Now you think I can say like I think the field is growing in that way and still, I don't know you're, you're the expert.

Dr. Bob Boland: 29:38

Uh, how are we doing with that?

Dr. Jessie Gold: 29:40

I would say it's complicated. So I would say there's also like part of the reason I'm glad this book is coming out now is, I do think there's like a desire to just kind of like return to pre-pandemic conversation and ignore it again, because we must be fine now, because the pandemic's over it's over.

Dr. Bob Boland: 29:56

Everything's good yeah.

Dr. Jessie Gold: 29:57

Like instead of recognizing that obviously that would compound an existing problem and then have lasting effects. It's sort of like, but like it's good now, right, like we can go back to other stuff, and so, like, having this conversation now I feel like it is important for that reason. I think you know, you still see, like people trying to put into place, like doing something, and I think that's because the things that actually make a difference are butting up against a lot of administrative and systemic kind of barriers to change, and so people sort of get frustrated with that and try to show that they care and like buy a program, buy a like app, buy whatever, because if you show someone you did something, it feels like you're not just ignoring that this is a problem. But a lot of this work is slow, like really, really slow, and a lot of this work might not be fixed anytime soon because we don't have redundancy in the workplace. We do have bad models of care that are based on, like just billing. We do have insurance companies that dictate our lives. We do have Epic and all these other sorts of like EMRs that people don't like right, even though they did make you know things better in some places and harder in others. I think that those big things are where a lot of our stress and strain come from and a lot of where burnout's coming from. But like the idea of being able to possibly like fix that is daunting and also hard to show, like day-to-day workers, that you're doing, and so I think that part's hard. I lay my hat a lot on culture for that reason, because you know I can work on systems.

Dr. Jessie Gold: 31:33

But like people day-to-day, like actually can't fix the system that they're working in, and if they just are mad at it and frustrated at it, it's very like serenity prayer, like you know, bad, like to be like all right, like here's, here's, all these things I can't change, I'm just going to be pissed about it all the time, right, and so you know I, I, I like try to focus on how we treat ourselves and how we treat each other. But it's a framing thing. So, like for a long time, when we talked about how we treat ourselves, people used the resiliency word and you know, didn't admit that the system was also a problem. So, for me it's always been like oh no, no, no, like the system's a problem.

Dr. Jessie Gold: 32:10

My job is to help fix the system. Your job is not. You can tell me what you see, you can give me feedback, I can be transparent, but your job is to, like, help you survive this broken system, because I don't want you to quit and I don't think we do want all these people to quit and I do think we need to recruit people into this field. And so, as you know, acknowledging the limitations of the workplace that we have, like, every workplace has limitations. Ours might have some more than others, but you know, being able to say, like, transparently, going in, these are the problems in these workplaces, but how do you cope, how do you deal, how do you support each other through them? Like is the place where I try to spend a lot of my energy in these conversations and where I, like, spent most of it in the book. For that reason, because I feel like I can help there, like I don't know that I can fix insurance companies, I'd love to try but I don't know how logical.

Dr. Bob Boland: 32:59

God bless, really stop wasting time with us.

Dr. Kerry Horrell: 33:06

I'm thinking about how one of the things that I often do, which I like, and I feel complicated about this too is I go on the news, or I talk about things A lot of times. Here's the kind of question what are three ways you can deal with burnout, holiday stress? So, it's like five things to cope with holiday stress, and I do think it's important to get things out into the public space about mindfulness, meditation, taking care of yourself, giving yourself some compassion, taking a step away. I think those are important things and I almost always sit there and think you can't boil these down to three things and a lot of times, the kind of thing we're talking about how to deal with election anxiety.

Dr. Kerry Horrell: 33:42

I'm like that is not necessarily all individual Same with burnout. It's like to just be like you as an individual, are just responsible for coping with this. In some ways, of course, that's true, we are responsible for our own coping, but it also just makes me like this is a larger issue and I think to continue to put the message as I'm appreciating what you're saying is what I'm trying to make Like it is not always up to just the individual. Like to cope with it and be like you know, bob, do better at not burning yourself when it's like well, that's not always a totally fair way to look at it. So, I just appreciate that perspective a lot.

Dr. Bob Boland: 34:17

That's not always a totally fair way to look at it. So, I just appreciate that perspective a lot, gosh I mean. So, you know, your patients read this, your colleagues, yeah, how do people react to all, to all this?

Dr. Jessie Gold: 34:26

I mean most people have been nice, you're very positive.

Dr. Jessie Gold: 34:30

That's why I asked yeah, I mean I, you know, I think even with my family this is different than my family members are, with sharing openly, and I think even with my family this is different than my family members are with sharing openly.

Dr. Jessie Gold: 34:39

And I think, like me, my family has jokingly just said that's just you and we're getting used to it and maybe that's how the field feels about me too and I'm just the touchy, feely memoir person who talks about their own stuff. But maybe that's what Kay Redfield Jameson did too and that's OK and some of us have to have roles like that. But you know, people have been generally like nice about it and when they actually read the book feel like it's a good way to like get into the information and not feel like I'm like lecturing to them about something that you know or dismissing their feelings or anything like that. I mean, I think the hard thing about releasing a book in the election year is the hard thing that's releasing a book in an election year just like kind of competing for press and you're not exactly.

Dr. Bob Boland: 35:24

It's not about the election.

Dr. Jessie Gold: 35:25

Yeah, so you know, I think that that's been hard, but overall, people have I love getting like messages from people who've read it or listened to it and felt like it helps them through something they're going through or something they didn't name or identify in their own life, but was what they were going through or, you know, made them feel like people are thinking about these issues in a way that isn't just like within our own community. Like part of why I wanted to write like a non-academic popular press book on this is, like, sure, like we're a subpopulation, but everybody who's a caregiver deals with a lot of these things, and also everybody sees a healthcare worker for something somewhere and should understand, like, what we're dealing with and where that's coming from and how we're not supported in these ways because, like we need other people to care about us just as much as we care about ourselves, because we don't have the capacity to be our perpetual advocates either.

Dr. Bob Boland: 36:20

Yeah, I would imagine. I mean my reaction was it's very reaffirming. I mean these are things that we all went through. We were all in the pandemic. We all had that kind of feeling of that fear, like, for instance, you described the first time you have to, like, go into the hospital, or if they ask you to come see a patient, like all these things are kind of things that we all kind of experience.

Dr. Jessie Gold: 36:38

So absolutely, yeah, I mean, I think the like is this a pandemic book was also an issue right, like, if you read the back, you'll notice I don't say COVID once, and I think it's just. You know, there's this like, I mean COVID fatigue, but also COVID avoidance of like certain groups, just like hating all things, covid, covid, and so we tried not to center it on that. But you know, I think to me it was this time that brought out a lot of already big problems in our system and I, you know, I could say, well, could this have been set at a different point in my life or other times and like maybe, but I don't know, because I think it was like just a confluence of like issues that, like you, they maybe we pushed it like as much as we could down and couldn't anymore, and it just cracked a lot of things, especially in health care, and so I think, you know, I didn't, it didn't seem like another place that it could be taking place.

Dr. Kerry Horrell: 37:28

Really, well, and I'm thinking about even tons of like my favorite musicians were like, yeah, this album, this beautiful, creative work of art, came out of a pandemic, and so I am so grateful for your work, dr gold, and for this coming out of your experience in pandemic and I think also again, just again, pandemic or not just well puts a lens on just the way we always feel, yeah, and so I want to remind our listeners again, especially because most of our listeners are mental health professionals, if they're interested in reading your book it is called how Do you Feel?

Dr. Kerry Horrell: 37:57

Any particular places that you tend to say? You can purchase it here or find it here.

Dr. Jessie Gold: 38:02

It depends on who you are. I think you can get it most places If you're a local bookstore person. I always like saying that, but I also understand it's in hardcover and not paperback and that is like an excessive thing for some people. So, there is a company that makes books cheaper, and you know where to find books cheaper and that is where you can get them to. There's an audio Like I think a lot of I've recognized that a lot of people in health care like audibles, audible versions. So, it's not my voice, which is going to be weird to people, but it is really well done. I think the person who read it did a really great job and so you know you can get it that way too, if that's an easier way for you to digest information or you do that stuff on your commute or anything like that. I think, like a lot of people in healthcare seem to do that, based on what I've been seeing online and sort of reactions from people being excited that there is an audible version.

Dr. Bob Boland: 38:55

Yeah, good, and I, I so. But back to your point. A lot of clinicians live through this and they're experiencing it. What advice do you have for them? It's kind of like words here.

Dr. Jessie Gold: 39:08

I mean, my parting words are always like, for some reason, someone told us we weren't allowed to have feelings, and we weren't allowed to be human, and I don't think that was the right thing. I think you can be yourself and do this job well. I think you can have feelings and give yourself space for feelings and do this job well. You might not be able to do all that in the moment, like you might not be a person who feels comfortable crying with a patient. You might always think that's bad; you might always think that it needs to be at a different time, but you can't have nowhere and never be the answer because it'll come back to you. So, giving yourself transition times, giving yourself time at the end of the day, but just really recognizing, like that you are a person doing this job, not a robot doing this job, and, of course, this job is going to affect you.

Dr. Jessie Gold: 39:49

I think, for some reason, we've long believed that somehow, if we just tried harder, this really hard thing that we do, where we listen to people's like problems and traumas, won't affect us, if we just kept working, if we just saw more patients, if we just became more numb to it, and that just like doesn't make any sense to me. I think we should be looking at it like the stuff we hear is hard, the stuff we do is hard. Of course it affects us. It's not our problem that it affects us, it's not a weakness that it affects us, but like it is something we have to prepare for and think about and kind of factor into how we approach our workday and that's the healthier way to do it.

Dr. Kerry Horrell: 40:24

We so appreciate your wisdom, your vulnerability, your work, Dr Gold, and thank you for coming and sharing.

Dr. Jessie Gold: 40:29

Yes, thank you. Thanks for having me.

Dr. Kerry Horrell: 40:31

And you've been listening to Dr Jesse Gold on the Mind Dive podcast. I'm your host, Dr Kerry Horrell.

Dr. Bob Boland: 40:37

And I'm Bob Boland.

Dr. Kerry Horrell: 40:40

Thanks for diving in. The Mind Dive podcast is presented by the Menninger Clinic. If you're curious about the professional experiences of mental health clinicians, make sure to subscribe wherever you listen.

Dr. Bob Boland: 40:51

For more episodes like this, visit www.menningerclinic.org.

Dr. Kerry Horrell: 40:56

To submit a topic for discussion, send us an email at podcast@menninger.edu.

 


 [CM1]Here is Dr. Gold discussing being vulnerable to connect with patients who are healthcare workers.