SafeTEA Podcast with Nicola and Deborah

S1E2: The Real Cost of Healthcare: Dr. Martinek on Saviorism and Mental Health

• Nicola and Deb • Season 1 • Episode 2

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Navigating the murky waters of professional relationships can be daunting, especially in high-stakes environments like healthcare. Dr. Nathalie Martinek joins us to unveil her powerful insights on assertiveness and communication, tackling the challenges faced in toxic work settings head-on. Her book, "The Little Book of Assertiveness," emerges as a beacon for those seeking to maintain personal integrity without resorting to confrontation. Through candid discussions, we uncover the pervasive issues of burnout, moral distress, and the often ignored emotional well-being of those on the front lines of patient care.

The conversation takes a sobering turn as we expose the underbelly of the medical and academic worlds, where neglect and a cutthroat 'publish or perish' culture can erode team unity and individuals’ mental health. Her own harrowing experiences serve as a reminder of the personal toll these environments can take, from depression to suicidal ideation. We shine a spotlight on the necessity for emotional support within these settings and the vital role of self-care practices to safeguard those tasked with healing others.

As we wrap up our heart-to-heart, we address the elephant in the room: saviorism and the insidious nature of assimilation trauma in the healthcare sector. It's a complex landscape where gender and racial minority professionals often bear the brunt, and where maintaining one's sense of self is an act of defiance. We extend a hand to those grappling with these realities, offering practical advice, empathy, and resources. Dr. Martinek's work lights the path to resilience and self-preservation, reminding us of the strength found in solidarity and the collective pursuit of wellness.

Check out Nathalie's book here: https://amzn.to/3u4pW5L
And you can find her on her website here: https://www.drnathaliemartinek.com/ 

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Nicola:

So welcome to another empowering episode of Safety, the Podcast with Safety. Leadership and Experiences of Inspiring Woman Take center stage and where, of course, a bit of tea is always spilt. So I'm your host and I'm joined by my co-host, deborah, and today we're absolutely delighted to introduce our guest, dr Natalie Martinick.

Nathalie:

Hello, thanks for having me.

Nicola:

Now, before we dive into today's inspiring episode, we have got a fascinating insight to share. We have been taking a sneak peek behind our podcast analytics and guess what? A whopping 75% of our regular listeners have not yet hit that subscribe button, where we would absolutely be thrilled to have such a dedicated audience tuning in. We would also love this dedicated audience to click, subscribe and support our safety tea community officially. Subscribing is a small action that makes a huge difference, and it helps us bring more incredible guests, enhance our production quality and grow our safety family. So if you have been enjoying our conversations and if today's episode resonates with you, please consider hitting that subscribe button. It's a simple way to show your support Deborah.

Deb:

Absolutely. In return, we promise to keep delivering content that's not only informs and inspires, but also empowers you in the world of safety leadership. So, again, we're not exclusive and we welcome anyone who wants to make a difference in the world in terms of safety and how can we learn from one another? Safety is a powerful platform for women and their voices and safety, and we want to see more women in those leadership roles, right? So please support us. Thank you so much for your support for those who have already clicked on and subscribed to us, but it would be great, as Nicholas is, to continue that process. So, just thinking about Natalie, do you want to just describe to us about your career and how you got into where you are today?

Nathalie:

Yeah, I haven't had what anyone would call conventional, although it started that way. I trained as a scientist in developmental and systems biology in Canada, then I moved to Australia to begin my post-doctoral research in cancer research, and during that time I ended up deciding I needed to leave that entire institution and professional lineage, I guess and pursue other things, and so I became more interested, as a result of my experiences up to that point, in human behavior and the things that cause toxic behaviors to metastasize within an institution, and learning about what are the key qualities that enable healthy relationships between parent and child, but also among each other as colleagues, friends, family members, etc. And then, yeah, also became very intrigued by power dynamics, again as a result of my past experiences, having been bullied as a child multiple times, being excluded, and so they're seeing repeated patterns that you can't unsee everywhere. So I wanted to understand how does this happen? How do we go from being normal humans who want to get along to humans who can't get along? But we pretend that we get along because that's what's required of us to be seen as good people or whatever is required to succeed in any workplace context or community context.

Nathalie:

So what I'm doing now? Again, I do some work around relationships, healthy relationships within a practitioner environment, as well as consulting work with mostly women, some men around toxic workplace situations, bullying and how to extract themselves slowly out of situations that are causing them strife and suffering, without the perpetrators knowing what's going on, because once and I'm sure you know this once you get into a situation, it's hard to come out of it without disturbing and ruffling some feathers. So we do some stealth, subtle extraction work, as well as dealing with narcissistic behaviors in our relationships, our own, how we're contributing to the conflict but pointing fingers at everyone else, and, again, how to change the game so that you're not at the mercy of someone who's trying to control and dominate you. So that's the suite of things that I do now.

Deb:

Yeah, and on top of that, a book, you've got a book called the Little Book of Assertiveness. Tell us a little bit about what that entails in terms of your book.

Nathalie:

Yeah. So one of the things that I noticed around the women and the men that I work with is a tendency to people please conform and submit to someone who's more dominant, more clear about a decisive, about a direction, a path in a relationship or in the work. So I wanted to offer something to readers of how to understand the barriers to us being able to speak up for ourselves, as well as the ability to speak up, but without being confrontational by you know, which we tend to do. When we're trying to push back, we're trying to override or overcome something with an equal force. That doesn't work, especially if there's a precedent set in a relationship where the other person is dominating you. It's just going to be mayhem. So I wanted to introduce assertiveness in the context of power dynamics and power and balances in the relationship and trying to equalize it in the moment without while still preserving your integrity.

Deb:

That sounds amazing. Before we dive into it, Nicola, do you want to just give us an idea of what we're going to talk about today?

Nicola:

Yep, for sure we can. So I was really excited to chat to Natalie today because it's, you know, she's kind of spilling some tea on her journey and expertise, navigating these toxic professional relationships and mental health and more being, and specifically, you know, in the safety sector. And I think one of the things that really stood out for me, natalie, was that, you know, there was some research published in the Journal of Nursing Management that found, you know, just kind of tying back to your book is assertiveness. Training for nurses led to improved communication skills, reduced conflict, enhanced team cooperation, and you offer a variety of strategies for dealing with those dominating behaviors. What was some of the main inspiration behind writing the book and how do these kind of strategies apply to these high pressure environments?

Nathalie:

Yeah, it's a great question because one of the things I didn't mention my sort of side interest hustle over for over a decade has been in burnout and mental distress and suicide within the medical community. So that has been so observing and I'm not a physician, but I've been closely working with doctors, nurses and many allied health professionals over the years and so say, hearing about the experiences over the years and the barriers to them just being able to do their job and the level of toxicity within the medical culture as part of their own training environment and practice environment just seeps in and infests the relationships and infects patients. You know patient care. So that was the main inspiration behind us assertiveness book.

Nathalie:

Because you know, you hear and I've experienced this as well receiving feedback when you're training and learning and the feedback is supposedly helpful, but it's not because it's critical without offering any solutions or insights of what you could be doing better or differently.

Nathalie:

It's just a way to dominate, diminish, put you down and let you know that you're a surf within this hierarchy and don't try to. You know, don't try to climb the ranks until someone annoyance you and if you don't conform then you're not going to get anywhere. So I was seeing this in the impact, and that was what led to just this simple understanding of if we are able to communicate better or respond to criticism, sexist comments, misogynistic comments in a way that mocks the other person a little bit but also raises awareness of like you know what they're saying and that you're not having any of it or you're not playing into this drama they're trying to pull you into so that they can continue to dominate you. I thought that's a win. That's a win People having scripts and being able to identify strategies as well as scenarios that they experience often.

Deb:

Wow, I love that thinking. I've had the opportunity to visit some EAs and emergency departments and kind of think about you know what doctors and our nurses go through, and just by asking simple questions it's amazing how people will just spill the beans and help to work together to they're so keen to collaborate. Just exactly what you're saying. This sounds really, really interesting and I'm sure some of our listeners are quite curious about what prompted you to shift your career choice.

Nathalie:

Here we go. Let's get to the juicy next.

Nathalie:

There was a number of things. So when we talk about toxic workplace environment, we tend to focus on things like gas lighting or criticism, high pressure, communication styles, territoriality, power dynamics. One of the things that I don't think is talked about a lot is neglect. So it's the form of abuse that is neglect or negligence, much like a parent not being emotionally attuned to a child, although translated into a workplace context where obviously it's not parent, child, but you tend to be treated like a child and the authority is this parent figure.

Nathalie:

And so you come in with an expectation that you're going to have a certain experience, because that's what's been explicitly promised and that was the conditions that you agreed to take on the role. And then the reality is quite different, where you're only paid attention to when that other person, that senior person, has something to gain from you and when they no longer need what you have to offer, they kind of forget about you. You become sort of invisible and you could see that the new favorite person gets anointed and all the attention, and it creates a dynamic within the team that some people feel more confident or better than you or superior to you because of the attention they've been getting. But it's just fake, because it's just the authority playing everyone against each other, while all they're interested is extracting what they need from each of us's resources for their own gain and benefit, to maintain their position and their status, but they're not necessarily producing anything on their own. So that's the kind of thing I've experienced the neglect or negligence because they don't need me.

Deb:

Yeah.

Nicola:

Yeah, what sparked your passion specifically for healthcare? Was there a particular moment or experience that really drew you into that space?

Nathalie:

Yeah. So my postdoctoral work was in a cancer hospital, and so you're seeing patients and the work that we're doing as researchers is medical research and under the guise that things that you're doing, even if you may not be using human tissues or cells or organisms, or even if you're using animal organisms that somehow what you're doing is going to translate to the human experience in order to alleviate suffering or cure, treat and cure diseases. So that's the promise behind anyone involved in medical research. But a lot of it is a lie and I started to feel like I was violating my ethical, my morals, because it was a huge leap from seeing what I was doing to the promises that we're making, that we're writing in our grant applications, that we're writing up in our research papers, that we're presenting in front of audiences of our peers and colleagues and collaborators. And so I started to feel pretty icky with myself what we call moral distress because I didn't feel like what I was doing is realistically translating to this outcome.

Nathalie:

And I wasn't necessarily doing the work because I wanted to cure anything. I was curious about what's going on biological processes so that we get a better understanding. It's knowledge acquisition that maybe we could draw parallels to what's happening in humans, but humans are complex. We're not studying the role of trauma when we're looking at cells in a culture dish or what's going on in mice and trying to translate to humans. So I was feeling like there was this marketing, this gaslighting, this lie. So that's just me. Others will have different ideas about that. And part of that is you have to publish or you perish.

Deb:

So there's, this pressure.

Nathalie:

It's a pressure to continually produce because there's all these competitors out there. You see people poaching ideas. So it led to some sort of under, lots of underhanded tactics knowledge theft, ideas theft yeah, not only in your own team but all over. And then there was the other parts of the social relating. So there's the power dynamics that I talked about. In a group that could happen. But I was also seeing quite a bit of sexism and the impact of this sort of environment on the women versus the men, and I had to see a lot of men cheating on their wives and hooking up with some of their students or technicians or their staff, their employees. And I was like and it's not just a one-off, it's kind of widespread and accepted norm and the things that you hear about that happen on conferences and conferences and that sort of thing. And I'm like sure you do you. But it was pervasive and it just said a lot about the entitlement. You see a lot more. You saw how certain people were being elevated, not necessarily because their research was crash hot, but because they play a game well, and so I'm like we're here looking for the truth. This is, you know, it's bullshit. So after a while I just felt so morally injured and burnt out and depressed and suicidal that I was like I need to get out of here. And then, when I left over time that started to lift. So it told me there's something poisonous in the environment. Not me, it's not me. I'm not the debt, you know, I'm not the problem. My problem was that I wasn't able to assimilate into that environment and had to leave.

Nathalie:

So, because I was in a cancer hospital and you're seeing patients, I became intrigued with what's going on for the doctors who are treating patients, because they're exposed to a great degree of suffering. What's it like for them? And this was before there was all this conversation about burnout in healthcare. And so I was. I convinced someone. I cornered him in an elevator once and he couldn't leave until I finished talking and asked him if I could, you know, learn from him, shadow him. And so he allowed me to shadow his appointments with patients who were children and adolescents and survivors of cancer.

Nathalie:

And I was noticing those interactions and the meetings among all the doctors before and after, and it was the unsaid that really caught my attention. They weren't talking about the impact on them, their wellbeing. You know the impact of knowing that a patient is gonna have a lower quality of life because of the treatments that they've had, that saved their lives but has created all these secondary effects. So that was the beginning of my journey my intrigue of what's going on in this medical culture that is causing so many doctors to feel distressed. That goes beyond the suffering they you know they encounter with patients. There's so much more. So that was the beginning.

Deb:

Yeah, I think it's great that you had the opportunity to shadow someone, because I think you can find amazing information and things about different how people are feeling on the ground. Just thinking about your typical work day what does that look like for you? Are there any projects or topics you're currently working on or excited about that you can tell us? Just talk us through what that looks like for you.

Nathalie:

Yeah, so I do a range of things. I work in an institution some of the time and I do my own consulting work some of the time. So I'll focus on my own consulting work, because the work is still around burnout prevention. But when I talk about burnout I see it as trauma and abuse. It's not, oh, because you're, you know you don't have enough skills and you can't keep up with the work and you know someone's cracking the whip at you and you're just like, oh, I just can't do it, I'm burned out. There's a lot more to it. So it's understanding the and. So, yeah, I'll describe what I call saviorism. So saviorism is very much embedded in the healthcare world. I think it's also embedded in the human resources world. It's embedded in everywhere that you're trying to save or protect the institution, a manager, a leadership team, patients, a system and what that does. It means that you're sacrificing yourself in order to do something that might be outside of your job. So, for example, you have a workplace that are trying to, you know, improve employee morale and well-being, so they take on, you know they wanna implement these well-being initiatives and strategies, so they hire someone, which I'll call the savior, to try to fix the things that are problematic in the institution, but without actually addressing the underlying causes, which is, you know, a corrupt hierarchy, bullying. You know people not having the competencies or the skills are being supported to build their skills in order to do their jobs lots of different things. So this one person is appointed to have to fix these things. So we call that the workplace savior.

Nathalie:

It's the same with a doctor or nurse, anyone in healthcare profession. You come in and you have to work with limited resources, including limited time, to try to find out enough about a patient's situation, and then you know, diagnose them and provide them with a treatment, but you're not given enough time to actually find out the whole story of the patient and multiple contributing factors. You're trained in a deficit model to see everything as a problem and only pay attention to the problem and not see what's actually working well, that the patient is leveraging to stay alive. So your mind is going into problem-solving mode all the time, not into listening and learning and appreciating what the patient is able to leverage and looking at what are the resources in their life that they could draw on. So that, among all these other things, causes you to leap into rescuer mode because you see the patient is disempowered to the you know disease or illness or the symptoms. Which is the perpetrator? So you're just playing out this Cartman's dreaded drama triangle where there's a perfect, you know persecutor, the victim and the rescuer, and anyone who's any of those roles is disempowering. You're not able to solve problems, you're not able to transform a situation because you're constantly just rescuing, rescuing, fixing, fixing and not considering how can I facilitate a change, working with what we have, because we all have the ability to do that together.

Nathalie:

So the saviorism is very much embedded across every industry.

Nathalie:

You're there to do what the institution needs of you, under the guise that you know there's some sort of fair exchange, but there's also it's often an extractive or exploitative situation, because if you don't live up to what's required, you'll either want to leave or you'll be forced to leave, and you know it's.

Nathalie:

You don't feel like you're, you know really seen, except in situations where there's a nice culture, is psychologically safe, everyone feels valued, everyone feels like they're contributing meaningfully, you're supported in your professional development, there's actually directions or pathways that you can go, or something that's created for you, where you feel cared for.

Nathalie:

So people will tend to stay in those roles and not experience the burnout, or at least be able to catch the early signs of burnout, because maybe they're doing too much, because they've entered into saviorism mode because of their loyalty to the manager of the institution. So I've said a lot and hopefully that made sense, but that's what I'm focusing on helping people identify the underlying causes of their form of burnout and really noticing the saviorism what's happening between two people or between themselves and the relationship with the team or the institution, because it's so subtle and it's so deeply entrenched in all of us, because that's how we're often brought up to be able to fix and be these heroes. Yeah, so programs and just one-on-one coaching on identifying and how to create a change, a habit change that will take time to do if it's gonna be done well.

Nicola:

Come on, that's so true, I think. I work for an organization that is almost 98% women in the organization and most of those women are healthcare professionals. They're nurses and they deal with community nursing. And you're so right. There's this savior thing right when you put the needs of the patient and the clients as far above any of the needs that you will ever have. If you are on the edge of burnout, it doesn't matter. The client comes first and you're putting yourself at risk all the time. There was a study I was reading from the Harvard Business Review that estimated turnover and reduced productivity associated with burnout could cost healthcare facilities in the US up to $17 billion annually. So I'm kind of keen to dive into. You wrote an article that discussed the need for balance for healthcare professionals. What are some practical steps that healthcare workers can take to maintain their balance? What are some of the practical things they can do?

Nathalie:

Ah, yes. So I'm gonna be pretty upfront here. That number one is you cannot trust any institution to actually care about you. Don't trust them, don't trust any of it, because even if they your manager, if you're in a position where you have a manager and they say these things like we're a team or family, we can look after you, don't believe it because there's so many pressures and constraints that will make that hard to happen. So I don't trust any institution and I don't think many should trust the institutions as well. So because of that, you're clear that, okay, it's on me to create either an environment where we support each other we all kind of feel the same way and we've all verbalized this to each other and that we have each other's back, and so that's number one, being quite open and telling the truth about the reality of healthcare, that it's not an environment that is going to be necessarily uplifting and energizing.

Nathalie:

There'll be times where that happens, but there's a lot of drain, there's a lot of pressure and you're exposed to suffering and trauma all the time. So you're actually vulnerable to vicarious trauma. Again, if you go into saviorism mode and you're trying to save and I don't mean like life and death. Emergency situations just go above and beyond for a patient because you're assuming they don't have a capacity, because you don't know enough about them, and so you put your needs last. So don't trust. Be clear about your role and responsibilities and be quite boundaryed around that. So if you're done at five, you're supposed to clock at five, you're ready, planning to leave at five and of course things come up.

Nathalie:

But what the healthcare setting relies on is these do-gooder types who, if they're asked to, oh, can you just do X? That will end up taking more of your time. You can't leave at five and they rely on that. So you'd have to be clear upfront when you, before you start or as you start, like this is my hard, this is my boundary. I need to leave right away because I've things to do and you're modeling what's possible within your environment so others can try that out as well. And that takes a lot of courage because the pressure to sacrifice and submit to this healthcare Institute authority and the guilt tripping that happens because you're dealing with sick patients and overworked people and if you can't do it, then that means someone else will have to spend more time doing that, staying over time Again, it's like that's not my problem, that's a system problem.

Nathalie:

They need to rectify it. I'm not here to save it or excuse it. So, having the clear boundaries which, again, you have to be honest with your personality type am I someone who can do that? Or am I a typical healthcare nurse or healthcare worker where I'm the nurturer and I'm always there to care for and save everyone? It's gonna be hard for me to do so. It requires, again, some coaching or some sort of assistance from peer group to support you, to be okay, to be boundary. So those are the two main things that stand out to me that don't trust, don't expect anyone to look after you. That way you won't be disappointed or have these unrealistic expectations of what you can expect from your institution. It shouldn't be quite suspicious to some of the things that they've implemented as well-being, like mindfulness and yoga and drawing time. Those are all nice and all, but they're not gonna help you deal with the trauma that you're exposed to all the time or the interpersonal aggression that is prevalent within nursing as well as often in medical professionals. So yeah, those two things.

Deb:

Yeah, just talking about that and thinking about deloits. They put out a report and 77% of employees have experienced burnout. Right, so thinking about when COVID came around and people have now invested quite a lot of money and time in their own mental health. So I think there is that responsibility from a personal perspective that you do need to think about your mental health and think about that balance, being bold enough to be able to speak out and say, right, it doesn't matter what industry you're in, this is my hard stuff. I'm not looking at my phone at five o'clock.

Deb:

Look, in health and safety, it's quite difficult for us because we can never tell when there's gonna be an incident or an accident. But again, it's setting those boundaries as to who's gonna be responsible for that time and share the load right, share it around. So just thinking about the environment that I work in and I can see that people are taking the time to think about their mental wellbeing and doing those hard stops. You've also done some research on strategies for managing burnout and PTSD. Now we're starting to see that you've done it in the healthcare industry and we're starting to see some cases in health and safety come through the courts around PTSD and being awarded money as compensation because they were not given the right support at work. So what is your research kind of telling you in that space?

Nathalie:

Well, my research is not necessarily in PTSD. It's again burnout as trauma and un-gaslighting the current discourse around burnout, because I believe we've all been gaslit. So one of the traumas that I talk about is assimilation trauma so as burnout, which again in healthcare. So I co-authored a paper that came out.

Nicola:

What is assimilation trauma? Four of the elite sausages in the back.

Nathalie:

Yeah. So when we think about assimilation, I'm going to use a Star Trek reference here. Are any of you Trek-ies? Who isn't Okay? So next generation, the Borg. What do the Borg do?

Nathalie:

They're that cube of aliens. So they kind of kidnap you know humanoid species from all over the universe and they assimilate them into the collective and they lose their identity. They become one of you know nine, one of 12. And they no longer have a name. They don't remember who they were in the past. Their sole purpose is to serve the existence of the collective and of course, there's a puppet master behind all of it, but they don't know that. They just are surfs to do their job and they're quite brutal. So they go around as well and attacking other you know planets and again kidnapping and absorbing them into the collective.

Nathalie:

So that's assimilation. So this is what happens throughout our lives. We are assimilating into a culture, a practice, a community in order to conform, in order to survive and succeed within it. And there's some people who are very good at assimilating and there's some people, like myself, who are pretty shit at it, because I'm a disruptor in my nature and so I see the things that don't seem to be working well and I challenge. And so those who are assimilated are very good at accepting status quo and are comforted by it, and those of us who see it as problems and potentially harmful, or are harmful, will speak up and challenge it and we're not very liked as a result.

Nathalie:

So, as an assimilated person, if we think about medicine, so you take, you know, 18 or 22 year olds generally, or 18, 19 year olds or 20 year olds who have been wanting to go and be doctors and for all the reasons that they're told is, you know, going to make their lives better or great, or they want to help people, whatever the reason, or they'll make a lot of money and they have these high scores. They get into, you know, medical training and so they're the cream of the crop and then, shortly after entering, you know, they start to experience this imposter syndrome because they're learning a lot, there's a lot of intensity and very smart people all around them. So they start feeling like they're not good enough not everyone, but a good number. So they go from being like high up on a pedestal you know the super pets to these like, or these golden children, to like, oh, I'm not good enough here. And so they start to want to embody certain traits that will keep them successful. And so, yeah, and in medical school, one of the first things, the first kind of patient experience they have, is with a dead body, with a cadaver.

Nathalie:

So the ready learning things and practices and mannerisms and ways of thinking subtly like indoctrinated into a cult, that make them see themselves as different to the patients that they're going to be seeing, and so that division is already dehumanizing and studies show that empathy, you know, reduces sharply in first year medical students. So you're dehumid, it's a dehumanizing process, and so that's part of the assimilation I'm. You know, if I'm one of those students, I have to adopt ways of thinking and being and seeing the world and other people that will enable me to survive in this environment. And it's not a, you know, chill act environment, it's quite intense. There's a lot of requirements for your grades, for knowledge acquisition, for performing in a certain way, and so you're kind of you know what's the word I'm looking for yeah, you're pushed to have to conform, to assimilate.

Nathalie:

So in order to assimilate, you have to suppress the aspects of yourself that are not desired by the culture, and again, this is what's known as the hidden curriculum. So self-sacrifice is a major part of it. You won't be good if you can't sacrifice yourself for the authority, for the patient, for the institute, basically. So there's a perfectionism Can't do anything wrong. There's a right or wrong answer about everything. There's one way of seeing things, you know, and that makes sense in some ways. Like if you're going to perform surgery, there's certain things that you have to do in a certain sequence.

Nathalie:

But when it comes to human-on-human interaction, there's no script. It's just you need to put people at ease, you need to see them as whole humans who are capable of, you know, dealing with their life situations, and you're not there to fix them. But that's not part of the conversation. So you suppress these things enough. You become kind of splintered from yourself, fragmented from yourself, and you construct this ideal medical persona and over time you still don't get over the imposter syndrome.

Nathalie:

Even though you're highly competent, confident and this is common among women, because it's also the foundation of medicine is male and it, you know, very manly, brain-focused, intellectually focused. No emotion, emotion are seen as weaknesses. They're, you know, inconveniences. We need to have good medical judgment, all that stuff, and even though there's, you know, more teaching about emotional intelligence and that sort of thing. It's still not embodied in the people who are training these doctors enough so that they don't adopt this hidden curriculum. So that's what happens.

Nathalie:

So over time you're slowly assimilating to become in this medical ideal, medical professional ideal, and you're subduing the parts of yourself or you're rejecting those parts of yourself that are not seen as valuable. That is traumatizing, because you are a splintered identity, you're a shell of yourself and you've lost connection to the things, the people that you've connected with. Often people in medicine disconnect from their families because they're like you don't understand what I'm going through, but these people do. So it is very culty in that sense and the practices can also be seen as abusive in the way that some of the training techniques that are used, which pimping, high criticism but no insight on how to do things differently you should just know and many other things.

Nathalie:

So that's what I termed as assimilation trauma and that's the one of the, I think, the key underlying distressors that contribute to suicide and the mental distress because if you've ever been in a narcissistic relationship, you just lose yourself to that dominant person. You become what they require you to be for your own survival and well-being, and it happens progressively. You don't even see it happening, but people around you see the change. They try to warn you, but you shut them out because you need to protect that person. You need to protect this life that you're cultivating for yourself, because you've invested money, time, energy, your fantasies, your dreams into this thing being providing you with what you want. So you're prepared to kind of ignore everyone in order to achieve that goal, but you lose yourself in the process.

Deb:

This is the best, it's coming from the source, right? So if we don't teach empathy and we don't continue to be ourselves and be allowed to be ourselves from that beginning, you kind of molded into that space of what people want you to be, right? So really, really interesting in terms of that, in saying that, thinking about the pandemic, thinking about healthcare as a whole, globally, what do you think would be some of the things to better support our workers who are experiencing this kind of, I would say, moral injury and trauma that you talk about? We have a shortage in New Zealand, we all over the world is the same. So how do you kind of think that this could work if we change something, or what are you going to?

Nicola:

do yeah.

Nathalie:

So you're going to get the pessimist here. It's not really up to us, right? If you're working for an institution, you don't, unless you're like the CEO or someone very high up who is influenced in decision making power. You really can't do anything because it's so entrenched. It's just how we operate. And hospitals, healthcare is business, and they need to get whatever support from the government by achieving certain metrics and milestones, which don't always center excellence or patient experience or even practitioner experience. So it's not really up to us. Being realistic, you're entering into a system that will try to bleed you dry unless you have things in place that prevent that from happening and that you, as a collective of colleagues, look after each other, like what we've talked about before. Yeah, yeah, that's how I see things, and I think if people are leaving, good for them, that takes a lot of courage. I also think we're coming through a time.

Nathalie:

Covid exposed a lot, wouldn't you say, and the mandates and the forced immunization of healthcare professionals. Some were all for it and some were not for it, and they lost their jobs. So that already destroyed the trust that they had, and now they're. You know, many of them have come back. They've been asked to come back after all that. But I think they'll be different, because this has exposed the sort of corruption and, again, this kind of authoritarian regime in these free countries that we live in. I think people, there will be establishment of alternative approaches, or not necessarily alternative medicines, but different types of clinical situations that can better meet the needs of society, and it just takes courageous people and, of course, financial backing, and government won't necessarily like it, but I think that's the point we're getting at. We have all these amazingly skilled and trained people who are leaving and refusing to work, and so there'll be other ways of helping communities that don't need to go through the mainstream healthcare system, which becomes a little more like the American approach with concierge medicine or the traveling doctors and nurses where they're their own solo practitioners and there's no insurance companies or third parties that mediate the relationship between the doctor and patient, and doctors and nurses feel free if they can do that and they feel fulfilled and they feel like they're finally practicing what they were promised they were going to experience. So I see hope in that like think about other ways of doing what you need to do that doesn't require you to have to go through the conventional, institutional way. I mean, you know, we are all co-creating this kind of situation that we're in, unfortunately, and relying on an authority to see this and want to change it. It's going to be a slow process. There's something that I think we have power to do, but it does require a collective effort. So that's the other. You know, that's the one thing.

Nathalie:

How do you prevent assimilation? Trauma, again, being aware that it is something that happens to everyone if you're not aware of it. Being able to compartmentalize if you have to kind of perform a certain way in the work context, be that, but don't believe that that's you. When you come out of that environment, come back into yourself. So you need to do practices like meditation or you know, fitness things or whatever that helps you reground in back into yourself, like you're putting on, kind of you know, an outfit, like your cosplaying the doctor or the nurse and you're being what you need to be in that context. But it's not you if the context doesn't allow you to be your. You know true self. So compartmentalization could be helpful to be able to withstand that environment, but you return to yourself at the end of, you know, after the work environment.

Nicola:

Do you think there's any kind of gender specific challenges that come? That comes with this assimilation, trauma and burnout? What are your?

Nathalie:

thoughts on that. Yeah, it's more common in women. But I think there's pressure for men to be this masculine you know, this hyper masculine doctor knows all kind of personality or character. So the ones who are more attuned or sensitive aren't allowed to be like that unless they're in high up position. So they're the ones at the top, then it's okay. Then they're modeling to everyone that it's okay to be vulnerable and sensitive and this is a superpower. But unless that, that modeling is there high up, those men are going to have a hard time as well to fit in and have to adopt, you know, assimilate.

Nathalie:

So I think women because women, you know people are more comfortable with women as the nurture, as the giver, as the sacrificer, and not the steely, you know, decisive more, you know exhibiting more of those traits that we associate with men, and so women can't win, because if you're too, if you're not nurturing enough, you're seen as bossy. If you're too nurturing, then you get exploited. So you know it's tough. Women are juggling, so of course they assimilate, of course, and that the distress that is associated with that comes out in these narcissistic behaviors, and so that's, you know, contributes all this kind of conflict or animosity among a team or within colleagues that can spill out into patients, because this is what this is what the environment is kind of promoting unintentionally, but yeah, so I do see that it does hurt women more.

Nathalie:

They are more criticized. They are more mistreated by their patients. They're not always seen, like you know. You hear a lot about women who are doctors not being their thought of as a nurse or not. The doctor or the surgeon or the male med student is called doctor. This is common. It still happens, which is wild.

Nicola:

Yeah, that is. I'm curious and this might actually be quite a contentious question as well. Bring it. I'm just trying to word it up in my head because I'm really curious about the assimilation trauma and you know coming. We live in a country where we had a strong level of colonization in this country. Does that assimilation trauma affect races as well?

Nathalie:

Yes, so we have plafill thoughts for this area. Again, if you think about the foundation of medicine, and what we published was focused on US medicine, but it applies to New Zealand, australia, canada, all the kind of English-speaking Commonwealth countries that, if you think about who started medical school, who started medicine? Men, white men, affluent white men, and in the US it was a lot of the early experimentation to learn about anatomy and surgical techniques were done on slaves, black slaves and mistreatment of black corpses, and it's horrendous, but that's the legacy and that is still the skeleton of healthcare. So we never got rid of it. It's the unspoken, it's still there.

Nathalie:

So you do have, there are experiences of people who come from an immigrant background or minority within a population of a dominant ethnicity or race having a hard time fitting in and so they have to assimilate and they would have already started their assimilation journey before they entered medical school, potentially because they've had to learn how to get in there. So you have even affluent families, regardless of ethnicity and race, who have gone to like elite schools growing up, and so they've assimilated, they've had insight into. Well, they've just been assimilating in order to be part of it's just they don't even know they're assimilating. They're assimilated so they're more likely to be able to fit in in, say, the medical school culture. So it becomes a shock when any of those people become mistreated or diminished after having not experiencing not necessarily experiencing that throughout their education journey. So that's when they sort of start to wake up. To wait a minute. I'm being picked on because I look different or too different, or seen as different, but the rest of the time others are still trying to keep assimilating or go to the next level of assimilation. And so, yeah, definitely, gender, race, ethnicity has a key part. And so what ends up happening to those who are already quite assimilated because again of their education and their family background and their experiences, that they haven't had to deal with the level of strife because they've had it easy, they fit in, they know what's required of them, they know the rules, they know the game, they thrive. But as soon as things don't start going right, they have no resilience, they have no internal resources to manage it.

Nathalie:

And these are the kind of people who are amazing to everyone. They're smiling, they're friendly, they're always there to lend a hand, they never ask for help, they never complain about everything, anything, but they're there for people who, when they are, they're like talk to me when you need something, but they don't go to anyone else. So the moment something doesn't work or the experience like their first patient death, it hits them hard. They don't necessarily know why, but they don't talk about it. They kind of stiff upper lip suck it up and over time you hear about the suicides and everyone's like we didn't see that one coming. They were so amazing in every way. We had no idea that they were so distressed, because they probably didn't know that they were distressed or they did. They didn't feel like they could talk to anyone about it because they had to maintain their assimilated identity and that's who they are. So we have it on both sides. Nobody's winning here.

Deb:

Yeah, thinking about our next generation coming through into healthcare. Specifically, woman, what would be your message that you would want to give to those people coming into the industry or thinking about coming into that space?

Nathalie:

So for women coming into into healthcare, one, do everything in your power to preserve your empathy, to be aware of the hidden curriculum and don't assimilate to it, but also just observe and look at where you have the power to do what you need to do. And if what you need to do contradicts the culture, expect backlash, but just keep going. Keep going. Don't let them convince you that there's something wrong with you or that you're going to fail out because you're not doing things according to an expectation and an expectation that is there to diminish you. At times You'll get backlash, but just expect it. So expect all the things and don't buy into it really, because your existence challenges status quo to begin with, not all women, but women who are good at challenging status quo. Now you can have a great career, but you might have to be quite innovative in how you express that.

Nathalie:

So do what you need to do to get through the system, but don't buy into the lies that you're hearing about yourself. Just stay true to yourself. Stay rooted in your culture. Stay rooted in practices that help you. Stay grounded. Stay connected to your friends that are outside of medicine. Do not lose connection, because everything will try to convince you that they don't understand you, and only certain people understand you. The more you stay connected, the more you're reminded of who you are. So don't lose yourself to the cult.

Deb:

Well, I love that and I think it applies to a lot of other industries as well, specifically health and safety. But any industry, stay true to yourself, be bold, be curious and challenge that status quo. To have your say at the table. Love that, nicola. Did you have any questions? Before we kind of get into the fun question?

Nicola:

I also just wanted to mention, you know we've spoken quite a bit about suicide and completed suicide, so it just, you know, has a strap line for everyone. Then can't really speak for Australia, but for New Zealand. We have the New Zealand National Suicide Prevention Helpline and it's available 24 seven. You can also text them on one seven, three seven, or just text or call and there will be a trained counsellor on the other end of the telephone at any time. And I think that's quite important because you know one, I'm unfortunately a child of a lost parent to mental health and you know so, really important, just you know, if something like that happens, just reach out, reach out to anyone. Absolutely, I'd say probably my last, like nitty gritty question, I guess have there been moments in your career specifically where being a woman has impacted your research or professional interactions?

Nathalie:

Yeah, it's a good question. I've thought about that in the past. I think where I've struggled the most is when I've been in situations where I've had some one who's in a supervision or manager position who is a woman. I've never had issues with men. In fact, I've had the most support and thoughtfulness and care with the male supervisors or managers that I've had. So that's what led to my interest in women on women aggression as well, like why does this happen? So, yeah, I haven't had.

Nathalie:

Yeah, so it's more about women either feeling threatened by me, or me feeling threatened by them and not being able to communicate and being able to be supported to do what I need to do, or them being caring about a level of distress I was experiencing and just kind of like get on with it or it's not happening. It's not happening, yeah. So I don't know if I answered the question, but it's a tough one to say because I don't have direct evidence of being totally squashed down because of a person I've just had. There's just been barriers that I've had to overcome, either by my own ingenuity or getting the hell out.

Nicola:

What was your biggest barrier, do you think?

Nathalie:

The biggest barrier was realizing that I was in the wrong profession. You're shy or not. The wrong profession, the wrong, I guess the wrong manifestation of that profession. I still am a scientist. I'm still doing research. I'm still theorizing, testing those theories. I'm still quite scientific, maybe even more diligent than I was back in the sloppy biology In a medical research environment because, published in Paris, you got to get things done. You got that sort of thing. So it's just I had to say that you can't, you don't only need to be a scientist in that context. You could still be yourself, but more in a more liberated way, in a different way.

Nicola:

Makes sense, makes sense. All right, dave, do you want to?

Deb:

get into our final questions. Yes, we always like to ask our guests fun questions and we get some interesting answers. So, thinking about what's in your game, so it's kind of for your question it's like describe the items that are in your purse without naming it and we'll try and guess it.

Nathalie:

Okay, anything that lets me hear or listen better.

Nicola:

Yeah, pause.

Nathalie:

Yeah, an object that conceals blemishes and things I don't want other people to see.

Deb:

Concealer yeah.

Nathalie:

Oh, I didn't mean to Cover up. Oh, it wasn't, brian, it's still early. What else do I have? An object that enables me to write my thoughts, record my thoughts, talk to people, get hate mail, good mail, podcast invitations. That's in my purse.

Nicola:

Your phone.

Deb:

The most important one. Yeah, I guess, is it anything?

Nicola:

else in the same bag yeah.

Nathalie:

Yeah, in the same handbag.

Deb:

Well, thank you so much, Dr Natalie Martinick. It's been an awesome podcast, very insightful. You've given us a lot to think about and, I guess, our listeners a lot to think about. But what I picked up is you know, stay true to yourself, don't be afraid to challenge and always, always be bold and curious. It's amazing what you can find out there. So thank you for sharing your incredible knowledge and experiences, and it's been an absolute pleasure to have you on the podcast.

Nicola:

Well for sure, I feel like your work. You know your perspectives on workplace dynamics and mental health, and you know assimilation trauma. These contributions are not just thought provoking, they're really transformative as well. I'm definitely going to go away and do a little bit more reading into assimilation trauma. I'm now very curious, very interested to know a little bit more.

Deb:

Yeah, for sure. And where can one get hold of your book, because that sounds like an interesting read. Yeah, thanks.

Nathalie:

So the book is called A Little Book of Assertiveness and it's on all online retailers like Amazon and Bookstores. You can also access it on my website, hackingnarcissismcom. And yeah, I think that's yeah, and it's global.

Nicola:

Nice one. Thank you, and to our listeners, we hope today's conversation has given you some valuable insights and inspired you to think about safety and wellbeing in new and empowering ways. It's not just about policies and procedures. It's about people, their experiences and the environments we create. We would love to hear your thoughts about today's episode, so please head over to LinkedIn and comment on the post. We would love to hear your thoughts and your comments and listen next time for some Canada conversations with remarkable women reshaping the landscape of safety and wellbeing. And until then, stay safe, stay empowered and keep making a difference, one story at a time.

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