Burnout, and the Human Cost of Healthcare with Dr. Jessi Gold

You wrote an essay that was like, I want to be a doctor because it has steady pay. I'm not going to have a problem when they get rid of all the jobs. You'll still need my job. And it's interesting academically.

Hi, everybody, and welcome to the podcast. This is Generations md. My name is Stephanie and I'm joined here by my colleague, Dr. Sarah Davis, who is also my mother. And today we have a very special guest, Dr. Jesse Gold.

She is the chief Wellness Officer at the University of Tennessee. She's a board certified psychiatrist and she's the author of a recent book called how do you feel? So welcome, Dr. Jesse Goal.

Thank you so much for having me.

Thanks so much for being here. My mom is a huge fan of the book, so she is extra excited to have you here. Before we kind of dive into the book and specific questions about that, can you kind of just give a background about like, how you got into medicine and how you got into psychiatry and how you got to where you are today?

Sure. I'll do my best to summarize my life for you. You know, I think for me, I grew up in medicine like you. So my dad's a psychiatrist. He'll say he's not a typical psychiatrist in that he's really never seen patients. Most of my life was like a researcher and an academic and a businessman. And that's what I saw. But I also was like always around people who are doctor folks. And so I think at a young age, very much thought, like, if you're smart and you like science, you should be a doctor. And so I always thought I was going to be a doctor. Went to college, didn't like pre med, found anthropology. That helped me survive in med school. Tried very hard not to be a psychiatrist because I didn't really want to follow my father. So mostly because he's actually pretty well known in his field, but also like, there's like some kind of weird Nepo baby thing that I was trying not to, like, go through. And so I was like, oh, I don't. I'm going to avoid this. And so like, I did neurology rotations and tried really hard to be like, I like neurology, but I do not like neurology. It was too depressing for me. But also everything I was doing, I'd be like, drawn to the person and the story and how they got there and all of that stuff. And it just like, as much as I tried to fight it, like, it always came back to psychiatry. Psychiatry was also the field where like, people did the most like, hodgepodge mix of stuff. So it wasn't like they were just clinicians. They were like clinicians who wrote, who did advocacy, who did, you know. And so that was also important to me because, like, even in med school I had started writing, but I also kind of knew that like, I couldn't be a full time clinician, that it just like didn't suit my personality and it didn't suit like sort of the, like my brain's needs to do 45 things at the same time. And so, you know, seeing that there was more flexibility in psychiatry was also part of that. I've always been interested in college students and healthcare workers, I think in sort of a weird self reflection kind of way where, like I'd be in college and say, oh, they could have done this better. And then be in med school and say, oh, they could have done this better. And then I figured, like, I might as well help, like fix it. And so I see those patients clinically and have since really, like, I could make a decision about that. So I even did like a whole extra rotation and residency at the student health center. And then my first job, I was the psychiatrist on a college campus. And then with the health care worker stuff really probably threw myself into leadership around it during the pandemic in part because of need. Like, I asked a question and I got nominated for running it mostly just because I had had a background healthcare worker, mental health, had done some research in it, kind of understood the landscape. It just wasn't what I was doing at that job in particular at that exact time. And so I sort of approached my chairman like, well, what is our department doing to support the mental health of the folks that work here? And he said, well, yeah, that's great. What are we doing? And so I wrote like our plan. I helped develop a faculty and staff clinic. I did a lot of outreach and education and like built a better program for faculty staff in that hospital system. And so that's how I ended up doing more on the wellness side of things. Just sort of timing and need and interest. And that has led me more or less to where I am now, which combines the college student stuff and the healthcare workers, like, wellness stuff. And I'm doing wellness for five campuses of the University of Tennessee system, which includes the Health Science center, but it's students across the campuses, so UT, Knoxville, Chattanooga, Southern Martin and Health Sciences. And that's about 63,000 students. And that's like the really short version of my life that's good.

Yeah, that's awesome. Summary. Yeah. Well, so your book is called how do you feel? And I've been following your Instagram. You've been kind of on this book tour. So my first question to you is right now, how do you feel?

Tired. I mean, that's not even a feeling, but my first answer is going to be that I think sometimes I get tired and I can't actually tell you what my feelings are because I'm like just kind of chugging ahead and haven't paused at all. And so, I mean, I think that I've been mostly proud, somewhat anxious and just very exhausted. But I think I'm not inherently a person who likes self promotion and you have to do a lot of that with this and your publisher doesn't do as much, as much as you'd like. And so, you know, I like podcasts and conversations and I like, you know, doing book conversations because I wrote it to have conversations. But it's more like even the Instagram posting more or less feels more like, buy this, I told you to buy it. And so when I started, it was like really important to me to be a lot more authentic about how I was posting and be more honest about how much I hate doing it. And I think I felt good about like what I've been able to put out and not make people want to mute me or block me or something because I'm in like self promo mode and not really like destroy my psyche as a result. But I don't love that stuff. But it's necessary, obviously.

Well, you do. You have to get the word out. I mean, you have a fantastic book, but people need to know about it so that they read it. So, so along the lines of your book, how do you, I mean, I, I, you know, like I said, I read it, I loved it. But how, how do you describe your book to people?

Yeah, so it's part memoir, part patient narrative. All of the patients are healthcare workers or healthcare worker, adjacen, pre med student. And it really follows me and them while we struggle with the challenges, caring for ourselves while we care for other people. You know, I think a lot of the themes are relevant outside of healthcare, like burnout, overwork, perfectionism, stigma. I mean, I could keep going. I mean like presenteeism, these like kind of big overarching themes that all of us deal with in the workplace where with mental health and wellness more broadly. And it's just that I happen to be a psychiatrist who takes care of healthcare workers who took care of them during the pandemic. And that was where I decided to like kind of start the conversation. But I also feel like, at least from the healthcare side, there isn't really a book on our mental health in a way that's not academic, that feels approachable, that makes people feel understood and seen, and that was like really important to me. So I didn't really want to write something that was too academic, that turned people off. I didn't want it to feel like the wellness lectures that they all hate. Like, I really wanted it to feel like I tricked them into the information almost and then they recognize themselves in it or they were like, oh, this is good. It's another one of those like doctor stories about being a doctor and oh, oh no trick. She's a doctor who sees doctor. You know, like, I kind of wanted to get into it that way. And so like, you know, that's the best way I think I could describe it.

Yeah, that's a great description. And part of the book is, you know, it's these different stories and then it's your personal journey through all this, through the pandemic. And you talk in the book about, in medicine we kind of learn not to do self disclosure. Right? That's kind of supposed to be this. No, no, you can relate to them. But you're not supposed to say, oh yeah, I had this. I catch myself all the time doing self disclosure. I always tell myself, oh, you're not supposed to do this. But in, in your book you talk about using self disclos disclosure and you know, and you certainly do a lot of self disclosure in the book. So can you just talk about that a little bit?

Yeah, I mean, for better or worse, there's a belief that if we talk about ourselves, we're not caring for the other people, that we're somehow making it about us and distracting as if like our story can actually heal them or support them in any way. I think there's also supposed to be such a significant barrier between us, the human and us, the practitioner. And so like we try really hard not to bring in our lives and we try really hard like to keep them separate again, as if that's humanly possible and really only bring it up when we have to. Like you're visibly pregnant and they're going to all ask you or you know, these things that you just have no idea how else to have that conversation. You have to take time off because someone in your family died. You'll probably tell them why. You know, I think those are acceptable self disclosures. Mental Health is very far from that. Talking about how the work impacts us, but also just our own. Mental health in general is pretty taboo. I think mental health is pretty stigmatized in medicine. I think even psychiatry as a field is stigmatized in medicine. But I think that a lot of that just comes from this belief that, like, if we. We aren't supposed to have feelings either. And so we like pushed that down and all of it down, so why would it affect us, we're fine kind of thing. I guess I tiptoed into self disclosure by being someone who is on social media and like, I was a Twitter use early on and really was, you know, spending time kind of saying like, oh, I go to therapy and I get reactions and people found that positive. And I was like, oh, maybe it's helpful to do this and. Or I'd write a piece and it would be about my experience in med school or something, and it would be helpful to people in training in some capacity. And I realized I had like, an ability to be useful, like, with my story in a way that I didn't realize in my own personal experience, in a way I didn't realize and kind of carried that with me as I tiptoed more and more into talking about stuff. And I, I guess nose dived a bit when I talked about being on meds when I was like. Then I did that mid, like, early pandemic because I had an experience where like, a lot of other people on social were talking about it and I realized I wasn't. And I'd been on meds since college and they hadn't changed. In fact, like, my mental health history is super boring. And I was like, I don't understand what that's about. And I, like, took that with me to therapy and realized that, like, deep in there somewhere, I had this belief that, like, if someone knew I was on meds, like, they'd think I wouldn't be as good of a doctor. And once I kind of realized that, despite the fact that I am a psychiatrist who takes care of people and tells them all day that mental health meds are the same as other meds and they shouldn't be ashamed of it, and I really believe that, I didn't really apply it to myself and like, that self reflection followed by subsequent burnout over the pandemic and sort of seeing how alone a lot of my patients felt in their experiences, even though their experiences were the same, it made me realize that we should be talking about it more. I have felt that I was more and more able to do the self disclosure bit and I didn't like burst and combust into flames or lose my career. And the book is the most I've ever really self disclosed. But I do think some of us have to do it. Like, I don't think all of us have to do it to the extent that I do it. Like, I'd like people to just talk about like some of the common stressors in medicine, like out loud and not pretend that they're like, oh no, you burnt out. Like, well of course you burnt out. We all are burnt out. Right? Like, so to me, like, I wish that some of the boring things were said more regularly, but like some of us still had the space to be like examples of like, oh yeah, well you can have mental health challenges and still be a good clinician, still be a good mentor, still be a good teacher or whatever else. I also wish we learned self disclosure more like a skill instead of something not to do. Because I think most of the time when we want to do it, if we say like, is this for me or is it for them? Like, you can get a pretty good answer. And sometimes it is for them. Like there is a, there is a place and a time where you saying something about you will make people like you more as a doctor and will help them more too. And we learn it like even in psychiatry and in like sort of mental health training that it's like a never thing. And I don't, I don't personally feel like that is very helpful because if you learn it that way, then you feel like, if you do feel like sharing or it comes out in some way that you like broke a rule and you get punished for it or like you somehow have bad boundaries. Right. I think that that comes up a.

Lot just talking about mental health specifically like talking about mental health amongst healthcare workers. How do you feel like that conversation has changed from when you were in medical training versus now? And do you think kind of maybe helped pave the way to have the space for you to be able to write a book like this?

I would like to say that I wish it was better because I think that that would be really nice that we had evolved and it's so, so much better. But I think part of the problem is every generation has like a I did it, so you should too. And medicine is a really like pretty hierarchical model. And then on top of that, like we do a lot of hidden curriculum teaching where you model what you see and if what you're seeing is not self disclosing is not talking about mental health, is being told you shouldn't because you could lose your license. Whatever it is that lore keeps getting passed down. So it doesn't matter if you come in one way, you still leave the other way. And so there's even evidence, like, you know, a study of med students where they said getting mental health help isn't a weakness. But then they said, like, my peers would think so, my supervisors would think so, residency applications would think so, my patients would think so. And as a result, when they asked them, like, if you got help, would you talk about it? All of them said no. So even if you come in going like, this is the same. It is totally normal. Like, our culture messes you up and like, all of these external sort of noise and influence. And so I think that that is still the case. But I, you know, there was just a Wall Street Journal article pretty recently that was kind of like, we did it, so so should you, right? And I think that still becomes the ethos of medicine. But the pandemic helped at least show us it's not hidden, right? That, like, we were all pushed to a limit where we had emotions to the point that we're like. Some healthcare workers cried on tv. Like, you could see it very visibly. You can see it in your peers. You could see it in your supervisors. There wasn't really a not affected person. And I think that helped at least say, this isn't like some hidden thing that was just like, magically a problem. It's always been a problem. We're just now, like, recognizing that we're all the same and dealing with it just like, sort of mental health was in the general population too. I think people were like, oh, look, we're all depressed at home when we can't leave the house, right? So I think it had that effect. I will say, post pandemic, there is a sort of like, can we just go back to normal thing. And we're. We know we're not affected by it. So, like, let's put it back in the box like, and. And pretend that this didn't change anything. But I do think your generation and younger talk about work life balance a lot more. Expect work life balance a lot more. Come in. Having used a lot of the verbiage and gotten help in college or seen their friends get help in college, and I think come in and push the system in a way that they don't know what to do with it. I get a lot of, like, what's wrong with these kids? Like, what did we do to them. And I get that in college too, like what they're saying about them from the professor level. And I think to me it's not sensitivity as much as it's just like, awareness. You guys talk about it, you understand it, and you don't think it's acceptable, so you'd like it to change. It doesn't mean it will and it won't quickly. But I think that kind of force of conversation and that like, force that's pulling it to change is going to make medicine change or, or, you know, fail. Because, like, why would people go into it? And I say that all the time in meetings. I'm like, I just really don't think as it stands, it's sustainable for us to recruit Gen Z and Alpha, like into our career. We have to figure out how to make it more transparent, more amenable to work, life balance, more supportive, more mental health aware in some capacity or it will not survive. Because I don't think people care about the stuff that they cared about before, like prestige.

That's true. There is a story in your book and I had to kind of address all of those feelings that are in me. I feel like, oh, I'm very into, you know, mental health and all of this stuff. But then you realize you carry with you these biases. There's a story about an internal medicine resident who has OCD and he's terrified of getting Covid. He's washing his hands like, you know, 30 or 40 times, taking an hour to put on his PPE and all this. And he eventually has to kind of take a break from his residency program for his mental health. And I found myself really at this kind of crossroads where part of me felt very empathetic for him and said, you know, I feel terrible that he's going through this, but part of me was like, suck it up, dude, and get to work. You know, everybody else is going to work. You've got all your residents, and if you're not there, oh my gosh, all of your workload is distributed on your completely overtaxed other residents. And so I really, I just struggled with, with hearing that story. And I know that those stories weren't like actual patients. It was more kind of a, you know, conglomeration of multiple different patients. But I guess I just kind of wanted you to comment, like, did, did anybody else say that or am I just mean or what?

I mean, I mean, about that. I think that's just like such a common thing. I mean, even he says it right, like I have. You know, he's very much like, I don't want to take time off. You can't make me take time off. Like, it's going to hurt everybody. They're going to wonder what's wrong with me. It's not going to be acceptable. Right. Like, a lot of what you're saying is what he imagined people would say, right? And it's not wrong that people would say it. And I think that, you know, if you miss more than one day when you're sick, even if you miss one day when you're sick, people, like, just rag on you. In residency, I mean, I remember making the schedule at as chief, and a bunch of people were pregnant, and I remember being like, well, that's not fair. Like, my brain was like, that's not fair. Like, look at all these pregnant people. Like, and yet that's the age of life in which a lot of people have babies. It's great that we could be accommodating as much as possible, which is still not accommodating. Right. Like, they miss, like, two weeks, but really, like, your brain's like, well, I didn't have a baby. You know, like, and these other people are making up, you know, picking up for you while you have a right. And you're. You hear yourself, and you're like, oh, gosh. Like, I'm a female who's a very, like, feminist, and I should not be saying these things.

So, like.

But it comes from this sort of, like, it's enculturated, you know, in so many ways. Like, we're. We're trained to. To be like that. Like, how dare you not show up? How dare you put this on me? Like, you should be doing your work because that's your job. Like, you come. You do your hard stuff. I do my hard stuff. We all do hard stuff, but we don't pick up each other's hard stuff because there's too much of that to go around. And the way residency is set up, like, if you're sick, like, you're calling in somebody who's, like, literally on some kind of fun rotation, like an elective, a research block, vacation even. And you're like, hey, can you come do consults for. You know? And they are, like, not going to be happy. Like, I've never made a call for someone as a chief where that was a fun phone conversation. And they catch. You know, they hear it, and they're like, I'm so. Like, they kind of are like, I get it. I get it. I get you know, I'm like, I shouldn't be. Like, I shouldn't be mad. Good for them. I hope they're, you know, like, they start to sort of be like, I'm not a bad person. I'm not a bad person. I'm not a bad person. But, like, your initial reaction is like, I want to go to my elective. Like, that person needs to get out of bed and do that work. Because I want to be on my elective. And I have never had. There's a couple people in my residency class who would always take shifts or people who are just too nice. And probably I would say, like, maybe a little pushover in that sense where they could. They would do it because they're kind, and they're just kind people. But they would do it all the time because of that. And they'd be like, oh, okay, I'll help. You know, and the rest of us are like, no, thank you. I think that reaction is like, you know, what makes it so hard, right? Because even if. I mean, I'm sure you have stories of, like, your peers and stuff, but, I mean, so many people tell me stories of, like, miscarrying on the job or, like, hemorrhaging until they pass out and then they go to the hospital, or, like, these just extreme cases of how they still worked through it, and it's almost like a badge of honor. And then on top of it, it's also like, but that's the bar. So, like, if that's the bar, germs don't make that. Like, like, especially with, like, a kind of gross misunderstanding of OCD as it exists. Right? I think, like, we know what it means. We learned it in school. But to understand, like, what that does to someone when it's like a global pandemic is probably really hard for everybody to understand to the same extent that I might, because it's my job. Like, the patient could. Based on his experience, right? Because he was also like, this is different than I thought. Right? And I think that's what happens a lot of times with people with that. But I think we minimize that stuff so much that, oh, you're anxious. You can't come here. Anxious, I'm anxious.

Everybody's anxious.

Get out of bed. Oh, you didn't sleep well. Like, none of us sleep. We're miserable. Like, you know, oh, you have pneumonia. Put on a mask. Like, I mean, you know, in so many ways, like, if that's, like, the physical health stuff, you have to be so, so sick. Like, mental health. You can't even see. Like, how do I, like, I mean, I've heard, like, how do I not know that they're lying? You know, like, I don't know what their brain is saying. Like, are you sure that that's really what, like, they really can't go in that room? Can you prove that they can't go in that room? No, I can just tell you what I'm being told and trust people, you know, and like, I don't think we're really set up for that very well.

You know, people want some objective evidence. It's like, okay, is your white count 30,000 okay? You can miss work. Like, you know, we want something like that. But you know, if it's just like, okay, you're telling me that you are washing your hands a zillion times, like, ah, come on, just, just get in there and do the work.

Yeah, just wash your hands. We're fine with that. We'll take an extra two minutes to wash your hands and we'll go, you know, like, it just doesn't fit.

One of the things that has started to like, kind of rub me the wrong way is when, when I hear people say, like, well, healthcare, being a doctor is a calling because I feel like it's, it, it ends up being sort of used against us. It's a way to underpay us and undervalue us because, well, it's a calling. We just, we didn't have any choice. Like, we were, we were called to be doctors. And so now you can kind of treat us like crap because, you know, this is, this is the only thing that we had to be. But I felt like kind of with the pandemic there was a lot of that and this sort of the, the healthcare heroes. So I kind of wanted to hear your perspective on, on that. Like, what do you, what's your reaction when you hear those words?

I mean, a lot of my patients like really struggled with that, you know, I mean, I think our career in general is like so much about self sacrifice. Like, but I think that there's so much self sacrifice you can do to not exist anymore as a person or, you know, in a lot of ways. And it's expected that we will really like run towards the fire, keep running, even if we are going to get burned like, badly. Right. And I think in the pandemic it was nice that people said thank you for a while until they didn't. But I do think that that also put pressure towards, like, you're going to go to whatever division of the hospital, we say we need you and you're going to do that work. And like, even if you haven't done it in 30 years or you never liked it to begin with because we all can do ICU work as if. But you know, I, I, and like, that belief, I think put more pressure on people, sort of like bucking that or saying it's, you know, like, we don't actually. Protective gear. You told us these things can only be used once. Now you're saying we can put them in a bag and they can be used for two weeks. Like, I'm confused. If that was just BS to begin with, cool, but could you explain that? But also, like, so you're saying I don't need to be protected, so it doesn't matter how I, how I am if I get sick. We had colleagues getting sick and dying, right? And so I think in the context of the narrative of like, oh, thank you, but also we aren't giving you proper protective equipment. And also you're dying at really high rates in the context of this, in, in ways that you haven't before because you never actually were risk. But we're not going to talk about that out loud much either. Like, that parallel was, is very hard for me to stomach and I think was really hard for my patients to stomach. I also think if you're a hero, beyond like not saying anything bad about the system because you don't really see like Superman, like complaining, you don't also see them having feelings. Like, they're just like stoic people who do the job and step in and help and that's what they do. Right? But like, we could do that and still not like it, or we could do that and still have repercussions as a result. Right? And I think that like, sort of nuance or like duality of existence is not allowed with that word.

I think I see it a lot from like just starting this journey. Like, you have to do this whole personal statement of like, why you were called towards medicine. And like, this is the only thing that makes sense and there's so many steps to get in, into medical school. And then again another personal statement for residency. And just like you are kind of just put into this box and I can see how like, your identity can be stripped and like you're just going towards this one thing of medicine being your quote unquote calling. And that can lead to unhealthy behaviors and stuff.

And if you wrote, I'm just doing this because it's a good job, no you would like it. Like, people will be like, what kind of essay is this? But, you know, in so many ways, like, I don't need another essay that tells me that you just want to help people. And you've always wanted to help people since that time you were little and you got a boo boo and your doctor was really nice to you. Like, I've read every single one of those essays. They aren't. They don't stand out. I would almost prefer the realistic essay. But we, like, someone else would cynically say, like, well, we can't take that person. Like, they actually are a jerk, right? If you wrote an essay that was like, I want to be a doctor because it has steady pay and, like, I'm not going to have a problem when they get rid of all the jobs. You'll still need my job, so I should have a job no matter what. So there's job security. And it's interesting academically, right? Like, which is probably deep down, a good majority of the reasons people are picking these fields. Like, I get it. I wanted to help people, too, right? Like, there is a part of that that is true. I'm not dismissing that. But I do think that, like, there's also a part that was for me, like, I'm a smart kid. Smart kids go to med school. This is what I do. The end. And if I wrote an essay like, smart kids go to med school, they'd be like, like, who was wrong with this person? Right? But that's really the truth. Like, if you polled your classmates, they would all lie, sort of. Like, there's a chapter in the book where we, like, they're going around the room saying what specialties they want to go into. And like, I mean, I went to Yale Med, so it's also skewed. But I mean, my class was like, neurosurgery and dermatology, like, whatever. And like, it wasn't acceptable to say anything besides that stuff. Like, you're sitting there listening. Half those people are going to go into internal medicine and peds, but they're not. Like, I'd like to be a pediatrician. I'd like, they're all like, I think, like, hand surgery, you know, and you're just like, like, maybe there's like, just be honest about this stuff some. And like, I think the. That is part of the issue too, when medicine isn't like, you think it should be, or you actually don't spend as much time with patients as you'd like, or you're not actually curing everybody or you're not actually magic. Like that is where burnout comes from. Expectation versus reality. And we come in with enormous expectations even when people tell us not to. So I'm sure your mom has told you things she doesn't like about medicine as much as she's told you stuff she likes about medicine. Like I had people doing that all of my life. I had a, I had like a meeting. It was like we didn't have, we had managed care as like a big thing in, in medicine. Not necessarily like investment banks buying stuff out as it is now. But you know, they're like, oh, insurance companies are ruining medicine, blah, blah, you don't want to do it, it's not. And I was like, I, I, I don't know, like, what is this? Like, I think that you're mistaken. Like I know better than you. Like this is useless information. I'm not gonna listen to it. The end. Right. And they were trying to warn me really. But like I was so in this bubble of like, this is what I'm doing, this is my job, this is why if I can get in good for me that like I couldn't hear that stuff. And I think that that's stuff would help us actually like go into this field. Bit more open minded and not like constantly shocked by the things that are wrong with it, you know?

Yeah, I really like this conversation a lot. And it's really just touching on burnout going into medicine. And again, it's your quote unquote calling you write this personal statement. It's the only thing you can do. And I really like this how open you're being about like, yeah, like, you know, I think a lot of people that are in my med school class and stuff would be good at a lot of other jobs. And yes, everyone is like really smart and is interested in medicine, is interested in helping people and like are probably going to be great doctors and like, but they'd also probably be other like good at other things too and probably would enjoy other things too. It's not like this is the one thing and like this is it and your whole identity is this. And I feel like just that starts getting curated early on and when that's your everything, I can see how that can then lead to burnout. So can you like just talk a little bit about burnout and like kind of exactly like what that means?

Yeah, yeah. I mean, so burnout is one of these mental health words that people use wrong all the time and I think they need, they think it means work makes me Tired, just like, I'm depressed means I'm sad. But it's not. When we talk about burnout, I mean, like this constellation of three things that's based in the workplace. So it's workplace associated. It's not in a psychiatric diagnostic manual. In the other coding manuals, it's a workplace associated condition classified by the WHO that way. But it is like, there's like, kind of three clusters of symptoms. The first one is emotional exhaustion, which looks a lot like physical exhaustion. Sort of like at the end of the day, you're just over it, you got nothing left, you're spent. The second one depends on who's surveying. But it can be cynicism, meaning, like, you're really angry and pissed off. Or it can be depersonalization, which is really, like, disconnected is the best way I can describe that. Like they say treating patients like objects. But I kind of see it like in medicine. And a lot like they teach us to be removed to survive. But it's like if you were removed all the time or you were removed so much so that you, like, lose the thing that makes you really good at what you do, but you might not even know because you don't even know that you do that thing. And it takes some time. And the last one is a reduced sense of personal accomplishment. So you're either getting less done and you've been told you're getting less done, or you notice you're getting less done, or you just feel like you're getting less done. That's the one where everyone shows up because they're like, the other things I think we blow off as, like, work consequences. Like, of course I'm emotionally exhausted. Of course I sometimes feel disconnected and angry. But if we're actually not doing our jobs, that really bothers us. So that tends to be where people notice it or have them come in my office sometimes. The definition is also like, that expectation reality thing, like what you think work is going to be and what work actually is. And that difference is where burnout originates. In medicine, the argument is, usually you write an essay that says, I just want to help people, but you spend all day documenting. And nobody wrote a I just want to document essay. And that difference is where burnout comes from. You know, I think in the context of sort of like, never questioning things and always constantly achieving, then you can be burnt out because you never stop to go, why am I doing this in the first place? And I sure I really want to. You know, someone asked me why I thought med students were so Depressed. And I was like, I actually don't think anyone asked them why they wanted to be med students, you know, because I just think there's so much that's like, momentum. Like, you started in college, you got past that first hurdle, you keep going through that hurdle, you go through another one, you got in. Then they're like. And all the messages are like, if you can get past this, like, great, nobody can. If you can get into there, great. Nobody can. And so it's like constant reinforcement of, like, just making it, and you don't actually know why you want to. It just like, feeds into this, like, perfectionist, overachiever sense of like, like, well, if I am questioning it, it must mean I'm not like, either, like, understanding that I can do this and I'm good at this, and it's like a challenge. Or you're like, I'm not cut out for it. There's no either. There's no in between. That's like, I'm questioning it. And questioning is healthy. And if I question it, I can make sure that I'm actually going into this with open eyes and open arms, right? Like, you're, you're questioning it, which is, like, sacrilegious. And so all along you don't. Until, you know, if you pick a residency with your one month rotation and you don't like it from your one month rotation, like, it is very hard to switch residency programs. Like, it, it happens. I've seen lots of people do it, but it's very hard. And most of the time they're switching into, like, psychiatry because there's space and will take you. Right? Like, and we want people who, like, figure themselves out. Right? But it's very hard to, like, halfway through psychiatry be like, oh, no, just kidding. I want to be a neurosurgeon. Like, maybe you're qualified. And it's just like a very, very different thing. You're gonna have to go through the whole thing again. You have to repeat residency and the match, right? Like, we don't have a process that is at all set up to let you have an informed decision. And so what, what the driver behind that is, is like, oh, they said I deserved it. Like, oh, they said I, I earned it. Oh. And like, it's, it's just constant reinforcement for winning a competition. And like, that makes it really hard when it is actually not fun when you're doing the work and you actually don't like the job. Because there can always be more competition. Like, I'm in academic medicine. There's always more competition, but it's not the same. Like, it's not the same as, like, getting into a school or getting into a residency. Like, jobs are, like, you got a job and then you, like, got a publication, and then, like, they're just, like, a lot of things you're constantly expected to achieve, like, all the time, but it doesn't feel, like, as rewarding in that sense. Like, and you kind of look around and go, huh, I actually hate this. And it doesn't happen until you get the time to do that. And then what? Like, our jobs don't really prepare us for very much else.

The system is kind of. Is kind of rigged for all of this. But I don't know. Is there anything that med students can do, do to try to minimize their chances of being burned out later?

Yeah, I mean, I wish I learned how to take care of my mental health, like, in college, not just, like. I mean, I went to therapy and, like, got meds, but I didn't really know. Like, this is a warning sign that you're not going down the right path. Like, this is what it looks like in me when I'm struggling. This is what it looks like when I need to do something as a coping skill. These are the coping skills I like. Like, those kind of things would have been better incorporated when I was taking classes and not in residency and then not in clinical practice. And if I would have learned that earlier, I think I would have identified signs and symptoms in myself earlier, would have been able to make life changes earlier, would have been able to, like, actually take care of myself and prioritize myself earlier. So I'm a big fan of that, like, figuring out you as early as possible. Maybe that means in college and in med school, you're doing a lot of therapy because you have the time. But maybe it also means that, like, there are certain things you pay attention to, like your sleep or your feelings, and you actually stop and notice them and say, like, what is a warning sign for me? When do I know things are off? When do I know I need to make an adjustment? When do I know I need to call a friend or go do something to make myself feel better and start to pay attention to that. I also wish I learned boundaries earlier. You know, I think in the same way that we can constantly be achieving because there is always something to achieve. There's always also always something that. That seems like a fun yes. But, you know, I learned maybe in residency that everyone was asking me to do papers because I wrote fast and I was a good writer and it took me until residency, like, probably halfway through to be like, I don't like that topic. Why did I, like, why am I saying yes to doing this? Like, I don't care that I can get another publication. Like, they heard I write fast. They're done with the work. They just want me to write it. Like, oh, good for me. I can get on this publication. But, like, I actually hate the information. I actually hate doing this. Like, why am I saying yes to this? And like, it took me, I wish I learned that earlier, like, to be able to say, like, do I like this? Why am I saying yes to this? Do I have emotional capacity to say yes to this and also learn to value saying no? Like, I wish I learned that in college. Like, because as much as you can constant, you can constantly be doing stuff if you don't. And I think boundaries and like, sort of understanding yourself, your feelings and your coping skills are big things that I would have started much earlier if I had a chance. I also think it's really healthy to, like, question things. Like, I think when I was in college and I was like, I don't want to do this, people were like, either, like, oh, no, but you've always wanted to. And then I was like, something's wrong with me, you know? Or I was like, oh, challenge accepted, you know? And I think I wish that it was just like, why are we questioning this? Like, what about it feels wrong? Like, where's the disconnect coming from? And like, I was in therapy in junior and senior year of college, but, like, and she was good, but I didn't do a good job with it. Like, I. You know, she asked me once to write down every career that I could think of and then tell her why I didn't want to do them. And I would be like, it's not healthcare. Like, it's not, you know, like, it wasn't like, I. I was like, well, you know, my personality doesn't really, like, like, being around people in this way. I wouldn't like that. Oh, I don't really like math, so I couldn't be income. Like, it wasn't really, like, things about me. It was like, it's not that. Like, in that same calling way. Right? And so I think, like, as much as possible, like, actually reflecting on that and like, understanding what about you fits. Fits the field. What how it aligns with their values out, aligns with the things you want to be doing will, like, keep you centered. Because once you figure that out, like, you can keep going back to it. So, like, I know that now, but I had to go to like, a lot of therapy and like, really, like, learn a lot about myself and, you know, really understand, like, how I fit within this, like, career that I had already picked. And I think, you know, being able to sit and understand that and, and, and take the time with that will like, give you something as like an inspiration throughout. Because really the things that prevent against burnout across the studies are meaning and purpose and then the other one being social support and like a supportive supervisor. So, you know, you can't always control supportive supervisor. Like, but you can control, like, how you're incorporating peers and peer support into your life and like, how you continue that moving forward and you can fix and learn to manage. Like, why am I doing this? What brought me to this? Am I doing things in line with this? Am I just doing things because I have to do them, or am I actually saying yes to the things that align with things I want to be doing? Right? So that stuff earlier, I think can make a difference. Like, I also think there's a realism in our field that doesn't exist, which is like, of course you're burnt out. Like, you're doing a field where you see really hard stuff and you work really long hours and often thankless. Right? Of course you're burnt out. Instead of how dare you burn out. Like, I think for a long time I thought, like, if I worked more or said yes to more things, somehow I would just keep going and I would never burn out. And that's what a successful person did. But I don't think that that's fair. And I think that most of the people I see as patients like, that I also see as college students. Like, I feel like the expectation that you will not succeed perfectly or that the work that we do affects us makes it a much more realistic way of approaching life. Because then when it happens, you don't take that personally, you don't blame yourself for it. And when it happens, you're prepared for it to happen. Because you said, turns out, all of us fail. Turns out all of us burn out. That's just the way it is. Maybe not everybody's clinically burning out, right? We're at about 50%, but half of us are, which means we should probably just approach it like, this is the outcome of our profession. And how do I manage that potential outcome of the profession? Just like I'm learning to manage that patients die. Just like I'm learning to manage that, that I have long Hours and I have to be on my feet just like, you know, And I don't think we learn it like that. And I wish we did because pretending it's not going to happen or it's somehow magically like happening is like, silly. Our systems are all broken. That what we're working in is hard and what we're doing is hard. Of course it affects us, you know.

Yeah. In regards to just talking about all this stuff and talking about the way that things are shifting and stuff. And I, I do see a difference in like discussions in my peers. Like people in our big 240 class group chat, text and like, ask about, hey, does anyone have a good therapist around? Like, does anyone have, like, these are conversations that we have. We talk about burnout, we talk about like these things. We talk about boundaries. Like, these are like words that we know. I think social media is a huge part of that and people like you, like, come on here and talk about this. So I do think that that is something that is shifting a little bit.

You know, I hear that in students and I, and I. My biggest concern is that it gets. Get stomped out of you or that like, you get a lot of pushback in a way that's frustrating, you know, Like, I think that there are a lot of faculty not my age, like, you know, but I think that there are a lot of faculty who like, wouldn't understand why you're talking about all of it openly and like, would judge you for it. And like, I've given a lot of talks and like, like lots of people are like, what did we do to them and why are they so sensitive at the end? And so like, my biggest concern in that is like, just to know that, like, I hope you guys support each other through it and I hope you recognize that, like, those people are just those people and that's what they grew up with and you don't have to become them. Like, you might have to change a little bit to deal with it. Like, you might have to like, not talk about it as openly for the one rotation because that person was a lot. And there's just no point. Right. Like sometimes there's no point and you can find the ways to balance and survive it and still come out yourself. But notice that like, the environment is not perfect for people who are like, open and honest about mental health yet. And it won't be tomorrow either. And so there might be things that in order to kind of protect yourself and to feel like, able to deal with the things that are coming at you that you kind of have to like, hide a little. Not in a way that feels inauthentic, but in a way that you chose to do that as a protective mechanism, that you chose to do that because that person will be that person and I can't change that person. I can only control myself kind of way. And so just know that. And like, that would be advice, like, from me to peers as a emotional person who went through training, who changed themselves along the way to fit in a bit and had to refine myself. It would be a lot nicer if I didn't have to find myself and that I valued that along the way as what made me unique and good and special. And I think it just wasn't encouraged with evaluations and stuff like that. And so, you know, just know that those people haven't gone anywhere. So, like, some of the feedback you get isn't very nice. And like, some of the feedback you get is going to be like, what's. They're talking about themselves too much or they're talking about their mental health too much, or they're talking, you know, they care about this stuff and nobody cares about this stuff. And. And it doesn't mean they're right, but they do have some control, which is complicated.

Well, I think that's a great segue to kind of the. One of the last stories you tell in your book is about. Oh, it's. It's basically like a. You know, you kind of get like rejected from some sort of thing. And I just, I love your reaction to that rejection that. I don't know. Can you just briefly tell that story?

Yeah, I mean, I like, I give these talks all the time. Like, I'm a. Well, I'm like a Mental health and healthcare. Taking care of yourself while you take care of others. Expert. And in the pandemic, I probably gave the same talk to like 50 to 100 departments in my healthcare system. One of the departments basically asked me to audition, like, give the talk to them ahead of time and see how they think. The people who listen, like, no facial reaction, like, nothing. Which I need to know. Like, all of us do. Like, it's not bombing right afterwards. They're sort of like, okay, we'll talk to you later. They had their admin call me and their admin was like, oh, like, basically sort of tries to just go, we're gonna pass. And. And I said, like, what was what? Like, why? Like, just out of curiosity. And he's like, I'm not supposed to say this, but they think you're not serious enough. And I started laughing, like, uncontrollable. Like, uncontrollably laughing, like, yes, proving their point. But also just, like, I don't know. Like, I was like, what am I doing? And he was like. Like, that wasn't the reaction I was expecting in telling you that. And I was like, yeah, you know what? I just don't care anymore. Like, I. Like, the thing that they don't like about me is the thing that other people do and the thing that has made me go a lot further, how young I am, and I don't care. Like, I don't need to give that lecture. They need me to give the lecture, right? Like, that's their problem, not mine. And it was, like, the first time that I recognized, like, just how much those kind of comments, like, did affect me before. Like, and, like, you know, made me cry in med school or, like, made me go, I don't know. Why don't they understand me? Why? Why can't they understand me? Like, I don't think I did anything wrong. Like. Like, I got evals. Like, she doesn't know her place or something. And. And I, you know, they. They take some of that out of your dean's letter when you're applying to residency because it's not appropriate that they put it in the first place, but it doesn't mean that you didn't read it right. And I would cry and be like, I don't know that I fit. And I don't think they get me. And I don't know that I can be this person that they want me to be. And that was not how I felt when they said that. You know, I was like, that's their problem, not mine. And I was like, wow, I've, like, really grown about this issue. And I think sometimes you have to have some of that happen for that to happen. But I did very much just kind of go, like, okay, I'm definitely not serious enough. But I talk about serious stuff all the time. Like, what do you want from me? If I talked about this stuff without a sense of humor, you guys would be bored out of your. You guys would be depressed. Like, half of the stuff I just told you, I said, medicine's depressing. You're gonna burn out. You're like, half the episode, you're gonna be like, oh, gosh, what's wrong with this person? But if I did it like, without facial expressions and super serious and all that stuff, Like, I mean, there are people who do. Like, that's their Jam. It's not my jam. Like, it's just not working. Like you need the break. Like you need to go. Yes. And like, there can be a stupid meme. And like, yes. And like, sometimes we can laugh about how ridiculous our field is. And like, sometimes we can laugh about how stupid hierarchy is. Right. And so I don't know, I think that the balance is, like, something I figured out over time, but it did take a while.

Yeah.

Yeah.

Well, I really appreciate this conversation and the transparency and it's so empowering. Just we have so many listeners that are med students or pre meds. This conversation was really impactful to me and made me feel seen and made me feel like I have more power even in the place that I am right now. So thank you so much. As we're kind of like wrapping up now, do you want to plug all of your socials and your book and all of those things I know you said you don't like.

Sure, sure, sure. I'm at Dr. Jessegold on most platforms. Jesse spelled like Jessica without the ca because that's my real name. I mostly, I guess, now use, like Instagram. I still have a Twitter ex account and I do have a Tick tock and I do have a LinkedIn and I do have a threads because I thought maybe it would replace Twitter and I don't really know how I feel about that. And then all my stuff, like, you can contact me, all that stuff through my website, which is, I think, how you guys found me, which is Dr. Jessegold.com. you know, I wrote this book which is called how do you feel you can get it? Most places that you buy books, if they don't have it, you can ask them to get it. They should be able to. It's a publisher that will print it so they can find it where you get books. It's cheaper. And those. Some of those online places that you get books, but you don't need to get them from there. You can get it from local bookstores too. But I wrote this book is like a conversation starter really. And so to me, like, I want you to read it to, like, be easier able to have these conversations, to feel less alone in the things you're dealing with, to start conversations with your peers and your attendings and your mentors to. To know that, like, this is like, totally common and it's across the board common and it's something we should all be talking about out loud. And so if the book does that or you read it and inspires you to want me to like, come over there and talk more about it somewhere. Like, that's what I'm trying to do, is, like, have these conversations. Conversations and stories can change this culture, and that's the only way to do it. So I'm happy to be sort of a person running around doing that as much as possible.

You guys know where to find us @Generations MD on Instagram, Generations MD on Tikt and AskGenerations MD@gmail.com. and we will see you next week.

Bye, guys. Bye.