EP144: Navigating High-Pressure Careers: Tips for Healthcare Providers

Navigating Perfectionism and Burnout in High-Stress Professions with Dr. Chrissy Cammarata

In this episode, Dr. Chrissy Cammarata, a licensed psychologist specializing in obsessive-compulsive disorder, anxiety, and related disorders, shares her insights on managing stress, finding balance, and overcoming perfectionism and burnout in high-stress fields like healthcare. Through evidence-based treatments such as CBT and ACT, Dr. Cammarata provides practical strategies for healthcare providers to set boundaries, improve emotional resilience, and maintain a growth mindset. The conversation also touches upon the unique challenges women face in medicine, the systemic issues contributing to burnout, and the importance of seeking support from mentors, colleagues, and therapy.

00:00 Introduction and Guest Welcome

00:51 Understanding Perfectionism in High-Performing Professionals

02:56 Perfectionism's Impact on Women in Medicine

05:44 Recognizing and Addressing Thinking Traps

07:53 Strategies for Managing Perfectionism and Burnout

11:03 Practical Tips for Healthcare Providers

19:22 Balancing Career and Personal Life

22:47 Final Thoughts and Advice

Transcript

Christine Ko: [00:00:00] Welcome to today's episode. I'm excited to have Dr. Chrissy Cammarata with us. Dr. Cammarata is a licensed psychologist with over 15 years of experience working with obsessive compulsive disorder, anxiety, and related disorders. She's helped children, teens, and adults find relief through evidence based treatments like cognitive behavioral therapy, or CBT,  and ACT, which is Acceptance and Commitment Therapy. Dr. Cammarata is also an expert in perfectionism and burnout, particularly in high pressure fields like medicine, where these issues are all too common. She's here today to share some of her insights on how health care providers can manage stress, find balance, and take care of themselves while delivering the best possible care to others. Welcome to Chrissy. 

Chrissy Cammarata: Thanks so much for having me. 

Christine Ko: Thank you for being here. My first question to you is why perfectionism often feels like a badge of honor to [00:01:00] high performing individuals like doctors or psychologists or lawyers. And what would it take to change that mindset? 

Chrissy Cammarata: Yeah, great question. If you think of a very basic scenario of, who do you want operating on your mother for heart surgery, you want someone that is a perfectionist. who's going to make sure that they focus on every single detail and not miss a thing. That's going to help you feel most comforted. As professionals, we feel like we need to have that level of higher standards compared to everybody else in every situation. In some cases, being very detail oriented and having those high standards is helpful, but we need to find a difference between what is good enough and something that is going to push us to the level that we can't sustain.

Christine Ko: I like that. The balance between what is good enough and a level you can't sustain. The good enough doctor or the good enough mother. Not to say that means that you're a bad mother or a bad doctor, but you're truly good enough. Tagging on to what you [00:02:00] said, when I have colleagues who are really detail oriented, I am always thinking the patient is probably really lucky to have a doctor like that.

Chrissy Cammarata: Some folks are very detail oriented. They see the trees as opposed to the forest. They're able to obsess about things in a way that is very natural to them. That can be something that's very productive. And there are certain times in our lives where that can shift and become destructive. One of the things we see in kids is during puberty especially in adolescence, when there's so much hormone and so much stress, so much social pressures happening, that it can shift the brain from being able to have those traits being useful to turning them around on themselves. So for example, that's a time when we see a lot of eating disorders take over. And part of that is because those kids are very good at counting calories and creating these mental routines and rituals in their minds that make them good at having things like anorexia. Thinking about women in medicine specifically, women are [00:03:00] more at risk for things like burnout and having perfectionism be turned on them because many of them feel like they have to prove themselves in male dominated fields. They may lack mentorship. They may also have inequitable balances between their work and home lives. Thinking of during the COVID 19 stress where they had to care for families at home while also being expected to be performing at a high level at work. And so perfectionism can go from something that they're just naturally trending toward to they might be finding themselves obsessing and becoming very upset over mistakes or procrastinating because they know that they have to check their work so many times to feel like they are being successful that they can't manage it, and so they just avoid doing their work, which then obviously their performance will suffer. 

Christine Ko: That's interesting. I've never really thought of it that way. That being obsessive about something, for example, is in a way a skill. It can actually help you a lot of times, but it can turn on you as well. For a woman, maybe for much of her life, [00:04:00] the perfectionism has served her well, but now it's just really more of a detrimental thing. What can they do?

Chrissy Cammarata: Burnout is a systemic issue, right? Especially for women. We need to be figuring out how to better support women and minoritized people in these settings because they need more mentors that look like them and have the similar identities. As a society, we need to do a better job.

For women who are struggling with this, Can you find other women who are in similar situations to yourself? Being able to talk with them and being able to share your experience and how you're dealing and coping and hearing how they are managing some of their difficulties. Thinking about, how do we make things more equal at home? Part of that is having partners who are able to and willing to step up and share the load in a way that's a better division of labor than what we typically have had in our lifetimes. But the other piece to that is being willing to ask for that support. Some of us who are [00:05:00] perfectionists don't want to delegate our work. We don't feel like other people can do it as well. And the other side to that is if we delegate things like, say, child care, Does that mean we're not a good mom because our husband is the one that the school is calling or the one that's going to the parent teacher conferences? For myself, I've got a partner; we share things very 50 50. I had a role as an administrative person at a children's hospital, and so my job was very demanding, and he was the one who did daycare drop off. And I struggled with that so much because it was like, Oh, I'm not involved enough. We have to know that there's limits to what we can manage as human beings.

Christine Ko: Thank you for sharing that. I think that's well put that we have to be able to ask for help. Being able to ask for help also relates to boundaries. To have a boundary on how much I think is reasonable for me to be taking on. I think sometimes the boundaries for me can be difficult because it's just as you touched on just now, wouldn't a good mother or a good doctor [00:06:00] do XYZ?

Chrissy Cammarata: Absolutely. We have these automatic thoughts or cognitive distortions that all of us engage in at one point or another. Thinking patterns or thinking traps. One of them is shoulds. Like, I should be the one who is available to my kids at all time. I should be the one getting up with my children in the middle of the night, even if I'm an ER doctor who has to work 12 hour shifts, three days a week in a row. Being able to recognize when you have those thinking traps, the catastrophic thinking, black and white thinking, all or nothing. Being able to recognize that the way we think about things can impact how we feel about things and how we feel about things also influence our thinking. And being able to recognize some of that and having some mindfulness around, what am I telling myself? And, what am I telling the people around me as well?  

Christine Ko: How I think does affect how I feel and how I feel definitely does affect how I think. What do you recommend doing about the thinking traps? 

Chrissy Cammarata: Yeah, part of [00:07:00] it is thinking about looking at the facts. So if I'm thinking that I'm a terrible mother, where are the facts for that? What would I tell a friend who is also telling me something similar? As humans, we extend a lot more courtesy and grace to other people, but we don't do that as much for ourselves. So if a friend would say Oh, my husband is the one who does pick up and drop off. And I feel really bad because I feel like I'm neglecting my kids. Probably you would say, that's ridiculous. You spend so much time with your kids and your kids are wonderful and they love you. What would we say to someone else? 

Christine Ko: Yeah, and at the risk of sounding not very sympathetic, I'd be like, I think you're really lucky that you have a husband that does that.

Chrissy Cammarata: Yeah, yes. Yes, exactly. Hey, let's have a little reality check here of, you have a wonderful support system, and that is a great privilege. 

Christine Ko: So looking at facts and, What I would tell a friend? I think that is useful. Can you give some more tips on how a doctor or healthcare provider can avoid letting [00:08:00] perfectionism affect their relationships with patients, colleagues, family members, or loved ones?

Chrissy Cammarata: The first step is the awareness and being mindful of, What's going on for you? And there's some clues that things are getting out of hand. That would be: chronic feelings of stress that might be physical headaches, GI distress, racing heart, things like that. And emotional ones like chronic irritability, feeling short tempered a lot, depersonalization. Feeling like you're not having the same compassion for your colleagues or your patients. Just feeling very depleted, and having less sense of accomplishment than you used to have. If those things are happening, it's a clue that something is going on and you need to prioritize some sort of self care. But again, going back to an earlier point, it really is a systemic issue. We really need to do a better job of supporting our healthcare workers. But with that said, when this is happening, reaching out to the people that are important to you in your life and discussing how they can help you, and then, seeking [00:09:00] therapy if that's something that is necessary. And that might look like doing something like CBT. It might be learning some relaxation strategies. It might sometimes be taking a break from work. I've worked with folks who had big jobs and decided that it was contributing to health problems , and they decided to step into different fields. Sometimes that's what is necessary to really meet your life needs. 

Christine Ko: I like how you put that. That all sounds quite useful. Reach out to the important people in your life, maybe get therapy. And you actually put it in that order. To reach out to your existing circle. And then also maybe have therapy. I don't know if you deliberately put it in that order. But something I have asked others on this podcast or just like people around me, if I had better friends, would I still need therapy?

Chrissy Cammarata: That's a really good point, and I think sometimes, yes. For folks who have clinically significant symptoms, symptoms that are causing so [00:10:00] much distress that it's hard to sleep, it's hard to work, it's hard to have a good time with your friends or get the things done that you need to get done. People who have diagnoses like OCD, generalized anxiety disorder, major depression, et cetera. I think that those folks really would benefit from someone who is trained to do an evidence based treatment like cognitive behavioral therapy or interpersonal therapy for depression. I think that friends are wonderful, and the reason I put that first is because it is important to have strong mentors who can guide you around what is reasonable for a physician, or someone who is the chief of a department, what should they be expecting in terms of stress, and what kind of pressure is reasonable to be placing upon themselves?Is the stress you're feeling more than maybe your peers or counterparts? Probably it's going to be more than the average person, but are you placing much more pressure on yourselves than is expected? And as a woman, how do you get the support you need? Somebody who is able to guide you through how to recognize when you're [00:11:00] engaging in problematic thinking patterns, significant avoidance, and procrastination. 

One of the most important treatments for anxiety disorders is something called exposure and response prevention. And what that entails is essentially facing your fears. We might think of something like contamination OCD, where someone is very fearful of germs and they may avoid touching doorknobs or they may wash their hands excessively. One of the ways we treat that is helping them to come up with a plan so that they don't engage in those rituals, but then we also gradually expose them to the germs. That's very concrete. Let's now think about the executive or the physician who's afraid of killing a patient because they miss a detail in the medical record and so they spend hours poring over and re reading details so that they can feel certain that they got all of the details. That's gonna look a little bit different because what we're gonna need to do is help them resist that urge to check and check, but also help them feel okay that as a [00:12:00] human, you might miss some things, but that you are a good enough doctor, and you're able to keep your patients safe. You don't have to remember every single piece of information. 

Christine Ko: Yes. Okay. I love your analogy, and I love what you're saying. So exposure and, what was it?

Chrissy Cammarata: Response prevention or ritual prevention is another way. 

Christine Ko: Exposure and response or ritual prevention. Obviously, you wouldn't want to practice with having a really adverse outcome for your patient. With the germs, you can be exposed to germs and then learn not to wash your hands like right away. How would you do that with someone who is afraid of making a mistake? 

Chrissy Cammarata: We might start with something very simple, like sending an email to a friend that is poorly written and seeing how that feels. That's very low risk. When I work with kids who have perfectionism around their homework, we also sometimes will get the teachers involved, and we'll have them practice writing a paper or something with one typo or something like that. With [00:13:00] a physician, for example, it might be just gradually pulling back on some of those rituals and realizing that it's okay. You don't have to read that record 17 times before making a decision. What if we just read it 10 times and see if that's okay? Also thinking about challenging some thoughts and maybe even gathering a poll from their peers of, What do you do to prep for a situation? What is reasonable? And then setting some boundaries around that. Most of the time, we're engaging in exposures. We're not trying to create the adverse outcome. You're expecting a really negative outcome. We're trying to help you around learning that outcome does not occur.

Christine Ko: Yes. Okay. Being detail oriented, of course, that is a plus oftentimes. But then the skill that often benefits you can really turn on you. When you gave the example just now of like poring over a chart and just reading something 17 times, I don't know how much it's correlated with stress for me or maybe burnout or just... but, a lot of what I [00:14:00] do is look at microscopic slides, patient samples, tissue samples of the skin and make a diagnosis. Sometimes I really have to try to prevent myself from doing this, but I have this almost compulsion where I look at the slide and I'm like, this is the diagnosis. And then I look at it again. And I'm like, is it? And I'm like, yes, it is. And then I put it down, but then I'm like, but wait, is it? I'll pick it up and I'll look at it again. And I'm like, you need to stop this. It's not changing. It's not any different, and sometimes what happens when I'm like looking at it obsessively in a negative way, my mind actually gets a little bored at the same time, and so my mind wanders. And so then I'll be like, wait, I'm not even looking at this anymore, so did I ever really look at it? It's this horrible cycle in a way... so I have this rule where I'm like, no, you really cannot look more than three times. I break it a lot, but I've never gone up to 17. A lot of what you're saying put some of my responses, [00:15:00] I guess, my rituals into a certain light. I'll have to think about them. 

Chrissy Cammarata: That's such a good example. The fact that you set yourself some boundaries there has probably helped you stay fairly sane. Think about kids with type one diabetes. As young people they're at risk for developing eating disorders because we're essentially prescribing them to do some ritualized calorie counting and carb counting and awareness that for some kids can then take over. Sometimes just engaging in these behaviors can lead us down this path of compulsion. Not to say that you can get someone who wasn't predisposed to something like an eating disorder or OCD to develop a diagnosis. But some of these behaviors can certainly take on a life of their own.

Christine Ko: I think I always thought, oh, I'm not actually really an obsessive compulsive type of personality or person. I don't mean that to put that down. I'm actually just loose, like my sister will call me a hippie. I find it especially odd when I'll do something obsessive, like with the slides, for example. It's been just puzzling to me. Like, [00:16:00] why? Cause I feel like in the past, like 10 years plus, I did not do stuff like that. 

Chrissy Cammarata: Ah, interesting.

Christine Ko: Yeah, when I've tried to self analyze myself, I'm more stressed now, I think, than earlier on in my career, even though it was stressful. Especially when I didn't have kids, for example, working was stressful, but it was just me going home and then, it's just me. I think parents getting older, and me getting older, there can be health problems for me or parents, much less the kids, like, life.

Chrissy Cammarata: Yeah, we're in this time where we're sandwiched between taking care of young people and taking care of parents. Time is such a commodity right now. And women, as we get into mid and late career, menopause, that's another period that's similar to adolescence where hormones are changing. Stress and hormones and things like that can exacerbate predispositions to things like anxiety disorders and OCD and eating disorders. All of that is something that women are vulnerable to as they get later on into their careers. 

Christine Ko: Oh, yeah. You said that at puberty, teens: [00:17:00] something that sort of helped them can turn on them. That makes sense that with perimenopause or menopause for women, what might've been helpful, essentially a positive trait, can then be more detrimental to them. 

Chrissy Cammarata: Yeah, absolutely.

Christine Ko: Do you have other practical strategies for overcoming perfectionism and building a healthier mindset? 

Chrissy Cammarata: Yeah. Another strategy is shifting to a growth mindset. Thinking about mistakes as opportunities. Seeing setbacks and barriers as challenges, things that you can learn from, and leaning into that sort of attitude. That really is something that we can change by being first aware of it and then practicing, trying to look at those thoughts and challenging them when appropriate. The other thing that can be useful to do is stepping back from thoughts and looking at them as opposed to looking through them. Think about if you have this bowl of soup and if you're like swimming in that bowl of soup, it's really hard to see, beyond what is right in front of you and all of the soup around you. But you can [00:18:00] practice strategies to take yourself out of that bowl of soup and sort of look at what's in the bowl. By doing that you can notice thinking patterns that are unhelpful, and sometimes helpful, and be able to choose which ones you're going to use and which ones you're just going to throw away. And so, say things like, I'm having the thought that I should look at that slide more times. I would say then, thank you, mind. That's a very helpful strategy. I'm going to go off and do this other thing now instead. And so you can treat your mind like a tool that it is and not necessarily the thing that drives all things. 

Christine Ko: Yeah. You had mentioned earlier that when your partner was dropping the kids off at daycare and stuff, you had these sort of thoughts in your head of, Oh, I should be doing that. How did you get over those thoughts? Or did you ever? 

Chrissy Cammarata: Yeah, I don't always get over them. Some of them are very sticky at times and I find that I'm looking through them. I can have some panic driven urges to change things about my life so that I can do these things that [00:19:00] my mind is telling me I should be doing. Other times I'm better at practicing what I preach, mindfulness and challenging thoughts. I talked to my partner a lot and use him as a support system. He's able to share a perspective that you can't always have when you're in the throes of some panic and anxiety. But really the more you're practicing these mindfulness and thought separation strategies, it is easier. 

Christine Ko: Related to that, is there a waythat I could, or someone could, improve emotional resilience while staying committed to their job? 

Chrissy Cammarata: You mentioned something earlier, which was boundary setting, and that's such an important component. The distinction folks need to think about when they're setting boundaries is that boundaries don't mean that you're telling other people what to do. It's more of like how you're willing to respond. And so doing some work to decide, what are you expecting from yourself? And what are you willing to do to meet the needs of your organization or your family or whatever? One of the things I think about is, am I willing to [00:20:00] work past 7 o'clock every single night? Or to 11 o'clock every single night? Or stay at my clinic till whatever hours? And deciding, what is my boundary there? Obviously you want to have some flexible boundaries. Sometimes you can't be rigid. Being able to say, okay, how often will I flex my boundary, and how often am I okay? Thinking about what you're willing to do to get wherever it is that you want to go. Thinking about your values. In terms of your career, why do you love that job? What about it drives you and brings you joy? Not always happiness. Cause a lot of times, like with kids and work, it's not always happy, but it's something that brings you deep feelings of connection to something. What is that? And then trying to figure out, how do you meet those needs? For me, personally, I enjoy working with clients and patients. And the farther I get from that, the less joy I feel in my job. I was on this career track towards more administrative roles. I realized I needed to get back to doing more clinical work. That felt different than what I was expecting, and it [00:21:00] felt like a big shift to change my role, but it was something I needed to do. 

Christine Ko: Yeah, I love it. Yes. I think I agree with you. So much of my life, I really wanted to be a doctor, but no one in my family is a doctor. I didn't actually know what it meant. I had a sort of naive, idealized version in my head of what a doctor would be. It's very proscribed, in the U S and many other countries, of how you become a doctor. I went along with that. I wanted to be a doctor. And so I just, I was just like, well, this is what I do to be a doctor. But then I think, once you're done with training, I think for the first time you can really be like, what do I want my work life to look like? I had never really thought about that, what do I want my boundaries to be in terms of how late do I work? How much can my boss or multiple bosses send me emails at all hours of the night? Can they just give me a whole 'nother clinic or say you see X number of patients per hour, and I have no choice about it? [00:22:00] I don't think anyone ever really sat down with me and said you should think about how you would want your life to be. What are my boundaries about things like that? It's taken me a long time even to think about stuff like that. 

Chrissy Cammarata: Yeah. That's not something we get a lot of mentorship around. It's really important to step back and instead of just getting on the achievement train where you just bump along from promotion to promotion and take on as much as you can to see where it gets you.... Thinking about, where exactly do you want to go? There might be costs to setting boundaries. In some cases, it might mean that you don't go into an administrative role or whatever. And for many of us, that's okay. We don't spend enough time thinking about what it is that we want. We just think about what it is that we can get. 

Christine Ko: What is we can get. Oh, this has been really illuminating to me. I'm going to ask you something else. If there's one piece of advice you'd give to someone feeling overwhelmed by perfectionism and burnout, what would that be?

Chrissy Cammarata: It's okay to step back. It's okay to quit. A mentor that I had was going into a [00:23:00] different career direction. There's such an identity wrapped up in being in certain roles. It can feel like you're losing a part of yourself to step back from something or step into a different role. In many cases, we as humans, we don't quit enough. You need to know when to quit your losses and move into something else. 

We spend a lot of time standing in the hallway with a lot of doors in front of us. We can choose all of these different doors. People tend to be happier when they walk through a door, regardless of what door it is. We feel really stuck and struggle a lot when we stand in that hallway. If you're struggling with burnout, making a decision, whatever that is, as long as it feels connected to your values and feels like helpful for you, is probably going to move you along and get you out of that stupor. 

Christine Ko: I like it. It's okay to step back. Do you have any final thoughts?

Chrissy Cammarata: As a woman who's worked in healthcare, I've worked with physicians, I've worked with psychologists. I see so many people who get to this midpoint in their lives and their careers, and they're struggling [00:24:00] so much. It's so important to take a moment and take stock of where you are and what your life is at this moment and try to decide what it is that you need and who you need around you to be able to help you get there. 

Christine Ko: Yeah. I really appreciate all of your insights. Even starting from, you said first of all, have the awareness. Just have a minute, even, really think, like, is where I am really where I want to be? And if it is, but you're still feeling overwhelmed, maybe just, what would make it a little better? And if it's not, what do I need to do to change that? I like how you said to first reach out to the important people around you. And then also maybe consider therapy, especially if you have a true functional impairment of how you're able to accomplish the things that you need to get done in a given day. All of that's really helpful. I really enjoyed speaking with you. Thank you so much for taking the time. 

Chrissy Cammarata: Yeah. Thank you so much.