Jessi Gold | How Do You Feel?: One Doctor's Search for Humanity in Medicine | Talks at Google

Hi.

Welcome to Talks at Google. I'm Carolyn, and I'm really excited to chat today with our guest psychiatrist, author, and mental health advocate, Dr. Jesse Gold. Dr. Gold is the Chief Wellness Officer for the entire University of Tennessee system, encompassing over 80,000 students, faculty, and staff. She's also a writer and author and is about to publish her first book, how how do youo Feel? One Doctor's Search for Humanity in Medicine. In her book, Dr. Gold tells the story of her own experiences as a practicing psychiatrist transitioning to telehealth during the early days of the pandemic and the hidden physical and mental toll of caring for others and what to do about it. And I want to welcome Dr. Gold to toxic Google.

Thank you so much for having me. You can call me Jesse.

Hi. Hi. Thank you. Hi, Jesse. How's it going?

It's all right. I'm doing all right. Yeah.

Thank you so much for joining us today. I'm just gonna. I'm just gonna get right into it. So how do you feel? Opens with an anecdote about having a telehealth therapy session with a patient and not realizing that you had already met with him before. You describe this experience in the book as essentially a breaking point for you. Can you expand on that? Can you kind of give us the background context of what happened and. And why this was such an aha moment?

Yeah, I think that if you asked other kinds of doctors, they might not feel as bad for getting someone's name and reintroducing themselves, but psychiatry is so much about the relationship and so much about being a safe place and a trusted place for people. And if you were in a situation where you just told someone everything and you never told anyone that before, and then you come back the next week and somebody doesn't remember you, that's a pretty bad thing, I think. And for me, I'd never done it before because I'm pretty good about that stuff. I care a lot about my patients. I care a lot about what I'm doing. And so, for me, it felt like one of the worst things I could possibly do. I think the patient's reaction was very much like, I met you already, Dr. Gold. And I felt really horrible and was basically fighting, like, physical and mental reactions while trying to recover and sort of fix the relationship in real time, knowing that it wasn't a good person to have done that to, especially based on their history and really trying to show that. I also felt bad because I knew it wasn't a good thing. I think it was in the context of not being completely there mentally and being burnt out. And usually before patients, even if I'm really rushed, I have time to look and go, I have a new patient, let's see what their deal is. Or, oh, this person's coming back, let's remind myself. And I just didn't have time. So I went like, it's a one hour block. That person is new. Go. And that was wrong. So, you know, I think for me it just shows like how something can feel really bad to someone that might not feel bad to everyone, but in the context, for me, it was probably one of the bigger errors that I could make that affected me and a patient.

And what was that a signal for you? I mean, you talk about how this was, this was really kind of eye opening and represented to you that something need to. Needed to change. Like, can you explain a little bit for people who haven't had a chance to read your book yet? Because it's not out yet, but it's coming out in a week. Can you explain a little bit about what led up to that point?

Yeah, for me, it was a lot of what is now called burnout. I didn't know that despite being a person who studies burnout, talks to patients about burnout all day, gives talks about burnout all the time, and could rattle off symptoms very easily. You know, for me, burnout has like a constellation of three things. One's emotional exhaustion. For me, that looked a lot like physical exhaustion. So like, at the end of the day, I would fall asleep and not realize I went to sleep. So I'd go, like, try to watch a silly show and be awake four hours later and have no idea how that happened. And then obviously it messed up my nighttime sleep. So it became like a pretty bad cycle. The second one is either cynicism or depersonalization, depending on who you ask. Depersonalization is like, you kind of just are really disconnected and like, a patient in this circumstance would be like an object as opposed to a human. And I don't think I got that bad. But that like forgetting part is, is more of that than I would have liked. There's also the cynicism aspect, which is anger. And so for me, anger is actually an early warning sign that I tend to blow past but get pretty mad at like emails and people asking me to do things. Because emails are never like, hey, Jesse, it's really great to talk to you. How are you? They're like, hey, Jesse, want to do a talk? Want to come here? What? You know, and it's always more stuff to do, so that can feel pretty bad. And then the last one is a reduced sense of personal accomplishment. So either you feel like you're not getting stuff done, or someone pointed out that you're not getting stuff done. And for me, I was behind in a lot of things, and that's very unlike me. And then this patient thing kind of compounded all of that and made me go, oh, something's wrong. As you'll see in the book, I was not very quick to identify what that thing was, despite, again, being someone who specializes in that. But I think that just kind of shows that it's a really hard thing to identify in our kind of common workplaces because a lot of those symptoms feel like you're just supposed to feel like that. Like, work, hard work, if you're good at work, is just going to be tiring and it's just going to make you feel disconnected sometimes. And you might not get everything done sometimes. And you can very easily blow off a lot of that just as like. I'm pretty sure this is what work is, and I think especially in healthcare, and I. And I definitely did that until I couldn't and then I had to do something about it.

I think one of the very interesting threads throughout the book is you, as a doctor in the healthcare profession, treat a number of other healthcare workers as. As your patients. And it was kind of through your interactions with these other healthcare workers that you. You kind of learn some things about your own. Your own experiences. What did your experiences treating other healthcare workers teach you about medicine or clarify for you about. About your experience as a doctor?

I love that population. I think it's a really unique population that I kind of stumbled on taking care of because I really cared about our workplace and how we were burning out from it and my clinical population too, especially in the pandemic. And for me, getting to see people who are like me but not like me will trigger some stuff from like, you know, we use a word in psychiatry or therapy called countertransference, which is like, if something a patient experiences is similar to something you experience, you might have an emotional reaction to it. I tend to go into my head, which you see a lot in the book, with connections to, like, my own life experiences and my own memories and things that are triggers. But I went into medicine because I liked patient stories. That was further emphasized by going into psychiatry. So I've always been fascinated by what brings people to me, what their life experiences are, how that's showing up, and when you Talk to so many people who are working in the same system that you are at the same time, you can notice similarities and differences. So a big difference for me was I was a frontline worker behind a computer for the entirety of the pandemic. And I had a lot of guilt about that. That's in part why I did. You know, I was surprised by how much guilt I had around that. And I think the guilt made me overworked. Like, I saw more patients, I did more talks, I did more writing. It was like, how can I make up for the fact that I'm a doctor, but I'm behind a screen and not at risk at all? And that might be kind of strange for people to hear, but it was strange for me to notice. But at the same time, I think, you know, I could hear a story and relate in some way to the things that they're experiencing. Especially in the culture of medicine. I've always struggled in hierarchy. I've always struggled with test taking. And a lot of those things are mentioned in the book as, like, things that I had in common. And I think for our job, we're not always supposed to bring up that stuff. Like, we're not always supposed to say, like, oh, that happened to me too, for a lot of reasons. One being doctors are supposed to be stoic and have, like, no interaction in that way to, like, sort of not making it about you is like, a big thing that comes up. You're supposed to make it about them. And so, you know, you see over time, sort of my evolution and my thoughts on self disclosure, too. But I think along the way, I keep just kind of putting that away, going, oh, that's something I had to, or, that's something I had to, and being like, how do I bring that up in a way that's helpful. But it definitely made me realize that, like, the challenges I had in health care and in training were very common and things that needed to change and we needed to be talking about where I've been. Totally.

I mean, that. That brings me to. Throughout the book, you mentioned the hidden curriculum in medicine and its impact on how doctors view and express emotions. Can you explain what that hidden curriculum is and how it shows up in training and in practice?

Yeah, that's a good question. So often when people talk about the hidden curriculum, they're talking about things like role modeling, what you see, people experience. So in medicine, there's a lot of hierarchy. So you see residents when you're in med school, but you also see the attendings of people who are done, and you see them and the way that they interact with patients, and you learn from that, and that's what they mean by hitting curriculum. But what I felt like I was learning wasn't just like, okay, that's a good skill to interact with the patient, or that works in trying to get someone to talk to you. I learned I'm not supposed to have feelings, and that feelings were kind of looked down upon. And in talking to a lot of health care workers, I've heard a lot of stories about when people experience codes. Like someone, you know, their heart stops and people have to pump it, and they either live or don't like that. That's the experience that kind of defines their understanding of emotions in medicine. Because as a med student, if it's the first one you ever see, people just don't say anything or react. It's almost like that just happens, and you go right on to the next patient or sometimes like lunch. And that kind of culture is what you see is, like, someone can die and nobody talks about it and nobody reacts. And so you don't want to be the person who reacts. So the other thing that kind of intersects here is, like, perfectionism and wanting to be good at these things. And so when you're in a situation where it looks like you're going to get a bad evaluation or like they're going to look down on you for having feelings, you. So you sort of go, well, it seems like everyone else isn't doing this to be good at this. I should not do this either. And it really kind of makes you want, like, want to change yourself in a lot of ways to fit the mold, because it feels like an expectation. And also sometimes you hear them criticize people who are more openly emotional, and that, you know, leads you to kind of be like, oh, I don't want to be that person either. And so you want good evaluations, you want to get into residency, whatever it is, and so you learn, don't do it.

Yeah, I mean, it's. That sounds very intense. One of the very interesting things to me, there's so much in this book that I found interesting, but the fact you went into psychiatry and your. Your dad was a psychiatrist, and. And this is still something that kind of took you by surprise or that it took you a while to kind of figure out how, like, even. Are you saying that even for psychiatrists, they feel. Psychiatrists are receiving this hidden curriculum and getting the message that they shouldn't have feelings or. Or express their feelings.

So I think that Med school, way worse for me than residency and psychiatry. And in psychiatry, residency was the first time that anyone ever said to me, like, how did that make you feel like a patient, you know, and actually realize that something a patient said or, you know, if it was hard, something that I experienced might affect me, but it didn't happen all the time, and you still don't see people react. And so, like, when we learned psychotherapy, we. We, like, learn it like a football player. Like, we have a recording. We go back and watch it with friends, like with our kind of peer group and our supervisors, and, you know, they give you feedback there. And if you're too expressive or you're too. You're talking too much about yourself or anything like that, you would get that as negative feedback. Because psychiatry was founded on, like, Freudian principles of psychotherapy, which is very much like, he uses this word, kind of being a mirror, blank slate. And so you're supposed to be a person who just reflects back the other person. I already fail at that because I have a social media presence. I write. There are all these things that make that not great for me to begin with. But we are modeled. I'd never seen a supervisor cry or I've never seen a supervisor really show emotion. And so while they bring it up and they have more awareness that patients can affect us or that then can affect our patient doctor relationship, I don't feel like it actually was emphasized for us very much. Psychiatry also, as a field, values going to psychotherapy along the way much more than the other fields. If you're in a mental health profession kind of across the board, they'll tell you to start going to therapy and learn about yourself so you could be better with others. And that's very much valued. And so that felt true as well. Which if I was in surgical residency, there's no way that I would have felt comfortable in the same way just going to therapy every week.

You mentioned that when you went into medical school, you were determined not to become a psychiatrist. You were like, I am not going to be a psychiatrist. I'm going to be a neurologist. What changed your mind? Why did you change your mind?

You know, that is like something about not wanting to do what your dad does. I'm sure people listening can relate. And, you know, I think even going to med school in the first place, sometimes I'd be like, did I do this for me or did I do this? Because this is what I learned smart people do, and that's what I'm supposed to do. Because I'm a smart person, right? And I think that inherently learned that from being in the household. And so I tried to fight against it some, just to make sure that I was making decisions for me, because I was a little afraid I didn't make the med school one for me. And when I went into med school, I was like, I like the brain, so I'm going to do something else, which is neurology, because I could never see myself being a surgeon. And. And then I started doing psych, and I was like, oh, I fit this much better. And so for me, that was because we still have time with patients. Like, we're allowed to talk to them. Their stories really matter. So I mentioned really liking storytelling. But, you know, in psych, you could see a hundred patients with depression, and you might end up with the same treatment at the end. But, like, why they're there matters, and how they got there matters, and what's going on in their life matters. And so that was really nice. And. And then psychiatry was like, also, you know, one of the only fields where I saw people doing other things besides clinic all the time. And I. And I knew I wanted to keep writing. I knew that I wanted to keep doing some other things, like, externally. And I felt like that balance existed in psych. And then, last of all, I felt, like, humanized more on my rotations in psych than any other rotation. So in a lot of rotations, they say stuff like, hey, med student, like, you know, they don't even learn your name. Or they do, but they don't call you. It's like. And then you don't usually have a computer you can use. You kind of are fighting for space to be able to write notes. Like, a resident probably has one desk, and then you're kind of waiting for them to finish or waiting for a nurse or something. And on my first day of psych rotation, like, we had it labeled desk. And it seems very simple, but I felt very like my part matters, and they care about me as a person, and this is really important. And I don't even know if that person who is the attending, realized what they were doing by doing that. But in the context of all the other times of sort of just being like a cog in the wheel who's there to help when they can, it felt much more me. And I ended up fighting not being able to win in the fight against not doing what my dad does, I suppose, and going to psychiatry.

I want to touch on the pandemic of it all a little bit because the book is set in the primarily at the onset of the pandemic. So. And you mentioned that this a large part of why you were experiencing, what you were experiencing is because you were over committing, because you felt a guilt when your colleagues were going into the hospitals every day and you were able to do your work from home. Reading the book brought me back and brought back a lot of intense memories about those first early months of the pandemic. I wanted to know, did writing it, what was the process of writing it like? What was that experience like, having to relive that?

Thanks for asking. So first I hope that people won't feel like the book is triggering. I think there'll be some parts of it where they'll feel like it brings up stuff they've tried to put down. But I hope in doing that they recognize they just were kind of pushing it down and should process it. It's not a pandemic book. It's a book that takes place during the pandemic and very much is like this compounder of existing problems or makes you realize the cracks in already broken systems. And yes, something else could have done that, but the pandemic did it much more obviously. And so that's why it' still took place during the pandemic. And even this many years later, it still seemed relevant to make it that time period. You know, for me, I am a person who goes to psychotherapy every week and I process along the way. And so I was processed in a lot of ways when I started writing it. And so when I would write stories, I'd feel less emotionally like affected by them. But I did have a lot more like, oh, this actually is a reflection that I didn't realize about myself and I didn't actually realize I felt like that at the time. So I it late, it let me like remove myself enough to like actually get in touch with the real feelings where if you would have asked me in the middle, I'd be like, I'm overwhelmed. I don't, you know, I don't know, like, I can't tell you how I feel. And feelings, words are really hard even for me. And so I think that actually pausing and writing it and spending all the time with the stories and my patience and realizing how that affects me me give me a much better like, like a time capsule of the experience and being able to say like, this is how I felt. You can keep processing that if you want. You know, I still see my same therapist. She's a character in the book. If you want to call her a character. And because of that, there's like an. A whole nother layer of processing, which is she's read the book. And she. Her first question to me was like, how would you like me to read the book? And I was like, what does that mean? And I guess in theory, she was wondering if she should read it. Like, it was a therapeutic narrative, and she needed to go, like, one by one through it. Like, she would, if she had assigned that to someone or if she just wanted me, like, to have those conversations with her. And so she was just gonna read it and get over it and be done with it. And I. And I was kind of like, I'm open to whatever, but I didn't really think of it as part of the process, but I think very much it. It is. And it was.

That's really interesting, you know, so we've spent a lot of time talking about medicine, but the book discusses not just. It's not just for healthcare workers. It's not just about healthcare workers. It's also about the complexity. I mean, it. I found that there were takeaways in the book that were applicable to people who consider themselves perfectionists or type A individuals or. One of the things that really stood out to me, the complexities of caring for others in general. That, I think, is something that a tremendous number of people can identify with, whether they have children or aging parents or relatives or loved ones who they have to care for. What takeaways do you have for people who aren't in the medical field but are still doing that care work?

Yeah, I mean, I think all of us are caregivers in some way. It might just not be defined. Like, we might not have a kid or we might not have a parent who needs us yet, and we don't know where we're caregiving. But people who are advocates are advocating, and that is its own version of care. Like, you might think it helps your mental health, but it's also quite hard. You're. Anything you're doing where you're kind of putting others before yourself in the work that you're doing, I think is part of that. I think medicine is this weird subculture that is like, the extreme of it, but in the only extremes, you can apply the common things to you too, even if you don't necessarily relate to the extreme. So for me, it's like, how do you identify your own feelings in the context of being so aware of other people's? So it's very easy for me to never ask myself How I'm doing. Part of the reason that the title is how do you feel? Is like the you part is what's important. And for me, I spend so much time asking a question like that to my patients, to my friends, to my family, and never really had asked myself. And my therapist asked me if I had and I said no. What do you mean I'm supposed to ask myself that? That seems silly. And it actually is really helpful because if you do, you can recognize the subtle signs of these things before it becomes like a 10 out of 10. You need to skip work or you need a vacation to feel better. And a lot of us don't tend to notice till then because we're so focused on the work or on the other people. I think it's also important as a caregiver to know that, like, you're allowed to take care of yourself and it actually makes you better at the caregiving. So I think it's very hard and it can feel selfish almost to be like, I need a break or I need to go get a massage or I need to go do something for me when you have so much going on or you are caring for other people. But if you go take that break or you go take that hour, it actually will make you much better when you go back into the caregiving situation. And we tend to not frame it like that. And I think in doing it like that, it helps you realize that you're part of the equation too, and caregiving does affect you. And I think we don't say that enough either. Like, we kind of are like, this is what we do. We take care of our kids and we take care of our parents and we're fine. But this doesn't make any sense. So I kind of approach things now like, of course my work is going to affect me. Of course I might burn out now. I need to plan to do better and like, recognize it and be able to take steps earlier to kind of divert it. And I think that mindset is so much better than if I burn out, I failed at this, or if I somehow can't balance all of these things. I'm not a good doctor, not a good human, whatever you want to tell yourself in those settings. I think also self compassion is a really important tool for folks who are caregivers. So, you know, it's very easy to blame yourself for a lot of things and be really mean to yourself. But if you actually heard that out loud, you would never tell someone else. Like, if you came to me and you're like, I'm having a hard day. I did this and it was a mistake. I feel really dumb or something. I wouldn't be like, yeah, that's because you're an idiot and you're really bad at your job. Right? Like, I would never say that to you, like as a friend. And you know, it just doesn't make any sense. You couldn't say that to someone as a friend. And so when you hear that out loud, you're like, why did I just say that to myself? I wouldn't be my own friend. And so being able to have more balanced thoughts in those settings. The world is hard enough. You can't control caregiving, you can't control what's going on with others, but you can control the way you talk to yourself. And so reframing, that's like, you know, I'm human. Humans make mistakes or it's okay, like, let's think about what I learned from this situation or whatever it is for you that helps you kind of reframe it. You might not catch it every single time because it's really hard to catch every single time. But even once every week will help you feel better, to be honest.

That self compassion. Are you speaking kindly to yourself? Are you speaking to yourself the way you would a friend? I definitely see that as it can be difficult, especially for, I think perfectionists, a lot of high performing type A type of people. You talk about this a lot for high achieving individuals, for people who like yourself, identify as type A. You've mentioned that high functioning individuals often delay seeking help for mental health struggles or when they're, when they're facing challenges like this. Why do you think that is and what advice would you give to someone who, who might be hesitant to ask for help?

I think we see it as a failure or a weakness like and something someone else can beat us because of. So like if we're in a competitive profession like most of us are and we want to advance and whatever, you know, comes with that, I think we see if we're even, if we have something mentally wrong with us, we're no longer even and they can win. I think that's part of it. I know that sounds horrible, but I do think it's part of it. And in that sense we also kind of identify something that makes us vulnerable, which doesn't feel good to us because we were taught to like not be vulnerable because leaders aren't vulnerable, which is not true by any means. But for some reason that's like the way we view things. And the way it was modeled for us, I think, in so many ways. And so we view it as a weakness, though, really push our own feelings and really push it down and push it down until we can't anymore. And that's why it tends to be so much later, is because we're like, I. Like, I can do my work anyways. And I think we can a lot of times too, because we're so good at work and school that we can do that when we have no capacity and like, almost robotically still be good at work. But the rest of our life looks like a disaster. We just didn't spend the time looking at that. And so, you know, what I would say to people is like, that mentality is unrealistic, that our work is obviously going to affect us in the same sense. It's not a weakness if it does, it should. And identifying that is good for you and will make you better in your job, just like being a better caregiver. I think that, you know, stigma sometimes comes into play too, and we're working on that in a lot of ways. But know that at least my story, I take meds, I go to therapy. It was hard for me to say all that out loud, but it's important that I say it out loud. And I think hopefully you'll be able to see yourself in my story and the stories and the patients in the book, and be able to say like, it isn't a bad thing for this to be the case. It's a strength to do this. It'll make me better. And that you won't hesitate to get help if you need it.

What other advice do you have for people who may be struggling to balance the demands of. To balance the various demands of life, whether they're work, whether it's caregiving, whether it's, you know, taking care of others in their community, whatever. What some. A lot of people have a lot on their plate and. And that can become overwhelming. What advice do you have to people that you have found has worked in your life?

Yeah, I mean, we can't do everything. I think that's important. Like, we really try to do absolutely everything that we can and not say no to things. Because either we think that people are going to judge us for saying no, or we think that we can't say no for whatever reason in our sort of work structure. And I think it's really important that we realize we can, and that is an important thing to do. I think we also tend to lose the reason that we do stuff when we do so many things. So like one of the biggest preventers of burnout is meaning or purpose. It sounds very like woo, woo, philosophical, like find meaning and purpose. Right. But in a lot of ways we lose it. Like, there's a reason you do what you do, why you're passionate about what you do, and sometimes you lose that in the context of just doing and doing and doing and doing and so trying to find ways to reground yourself in that. So for me, I keep a little box of like, nice things that patients tell me and go to that when I'm having a hard day. But I do think there are ways to do that in the workplace. Otherwise that can remind you. Like, I went into the profession for this reason. I care about it for this reason. And then when you're thinking about saying no to stuff, valuing your emotional capacity in that equation, but also valuing, like, is this in line with my meaning and purpose? Right? Because like, I think we often say no to things that we like, just can't take on, but actually would give us back emotional energy because we like doing it. So one of the first things to go is probably like your social life. And it's probably like mentoring because you're like, oh, people, I can't no more. I have to do the Excel spreadsheet, but I don't have to see people. Right. And you will actually get energy back being with people or mentoring, if that's something you like. And so be mindful too that in saying no, you don't want to just say no to the things that actually will fulfill you and paying attention to what gives you energy and what does it is really important when you're thinking about balancing all of this stuff.

So really being honest with yourself about what your priorities are, you know, what you can say no to, what you, what you maybe shouldn't say no to, what you should prioritize, that sort of thing. That's really helpful. We're almost out of time. Normally these wrap by saying like, what's next for you? But in the spirit of, in the spirit of like embracing saying no and prioritizing, I. I'm curious, what is something that you have said no to recently?

I think I just said no to doing another talk this morning. You know, I think I, it's, it's weird because I'm like doing a talk and then saying I'm saying no to a talk. It's kind of meta, but in a lot of ways I put my talks on, on the notes in my phone instead of in my calendar, so I can see how many I said yes to as opposed to just when. And that really helps me go, like, no, your January looks really bad. So you don't get to the point where you're like, who made your schedule like this? And then you realize you did it. So I think it's really important to say no. And I'm working on it. And. And again, in saying all of this stuff to people, like, I'm a human. I'm a work in progress. There are still really bad months for me. And I know I did that to myself. And so I have to kind of re ground myself in the things I write about. And I'm not like, perfect by any means. And. And I think that that's important for people to know because it's like a constant thing. Like, it's not like you solve burnout and you're good. It's just you figure out some of these things and you might have to remind yourself of them along the way.

Well, thank you so much, Jesse. And it was so great talking to you. And I just want to hold up the book. It's coming out October 6th. Is that right? October 8th. I'm so sorry. So it's coming out October 8th, but you can pre order it now.

And I think. I mean, I'm not like, I don't know when this is exactly coming out, so it might be out by the time this is actually in the world. And if that's true, you can get it wherever you get books.

Right. Thank you so much.