Authors: Laura Uricoechea, Meghan Etsey, Dr. Jessi Gold – on behalf of AMWA Gender Equity Task Force
“Our Voices, Our Future” is a podcast by the Gender Equity Task Force of the American Medical Women’s Association that explores the challenges, stories, and successes of those working to advance gender equity in medicine. Through candid conversations with changemakers, advocates, and leaders, each episode dives into issues like pay gaps, leadership disparities, and inclusive workplace culture. Tune in to be inspired, informed, and empowered to take action. Full episode listening links are available below the transcription.
Laura: Welcome to Our Voices, Our Future, a podcast where we amplify the voices driving change in equity within medicine and beyond. Brought to you by the Gender Equity Task Force, a committee of the American Medical Women’s Association. We’re here to challenge norms, break barriers, and ignite conversations that matter.
Laura: I’m your host, Laura Uricoechea, and in each episode, we bring you candid conversations with leaders, change makers, and advocates, working to create a more inclusive and just world. No more silence, no more waiting. It’s time to get Our Voices, Our Future Today. We’ll be talking about burnout in medicine, focusing on burnout among women in medicine. Burnout is a widespread experience in our field, from pre-meds and medical students to residents and attending physicians. Why is that? What is it about the culture of medicine that makes burnout feel almost inevitable? To explore these questions, we’re joined by Dr. Jessi Gold. Dr. Gold is the Chief Wellness Officer for the University of Tennessee System. Overseeing wellness initiatives across five campuses that serve over 62,000 students and 19,000 faculty and staff. She’s also an associate professor at the University of Tennessee Health Science Center Department of Psychiatry. Dr. Gold is recognized as “a fierce mental health advocate and highly sought-after expert in the media on everything from burnout to celebrity self-disclosure.” Dr. Gold has written for The New York Times, The Atlantic, InStyle, Slate, and Self. In October 2024, she published her book, How Do You Feel? One Doctor’s Search for Humanity in Medicine. Clinically, she works as an outpatient psychiatrist, treating students, faculty, and healthcare workers. Dr. Gold, welcome! We’re so excited to have you here with us.
Dr. Gold: Thank you so much for having me.
Laura: So let’s get started. Could you tell us about what drew you to psychiatry and your interest in mental health and wellness, particularly among students and healthcare workers?
Dr. Gold: Yeah, it’s a good question. When I went to med school, I wasn’t, oh my goodness, I’m gonna do psychiatry. I actually was the opposite, because my dad’s a psychiatrist, so I was like, could I not do psychiatry? That would be great. So I tried really, really hard to do anything but psychiatry. I was really excited by and interested in people’s stories. Whenever I was on a rotation, I wanted to pull up a chair and talk to someone about their life, not just their symptoms and disorder. I was like, Oh, I don’t think I’m gonna get away from this, and so you know, it was the thing that I kept trying not to do that ended up being what I did. Then you know, I think my interest in the populations that I’ve chosen to see stems from some experiences in my own life. So, not in a narcissistic way, but in an attempt to do better for others. When I was in college, that was the first time I asked for my own mental health help. When I asked for help, you know, I was pretty guarded, and it was hard to ask for help even though my dad was a psychiatrist. I didn’t answer the questions with a lot of enthusiasm or detail. By the end of my talk with the therapist, they were like, “you’re not sick enough to get care on campus.” I was like, I don’t know what that means. I’m both invalidated and validated at the same time. I didn’t wanna be here, so obviously I was right and invalidated in that I finally got here, what do you mean? I think that experience always stands in the back of my head, as it’s a time when many people seek care for the first time. It’s really important that when you seek care, it feels safe and that it feels like even if I don’t give you meds, you might want them later. So I’ve always just wanted to make that experience better for folks. Then, as I was in med school and residency and saw how much we struggle with our mental health and also don’t talk about it, I couldn’t get away from that either. I started doing research on it. My medical school thesis was “Med Student Mental Health and Access to Care.” It became the combination of both that I’m doing now, which is awesome.
Laura: That’s really cool. I’m sorry that you had such a bad experience during undergrad.
Dr.Gold: It’s okay. I wish I could say it’s uncommon, but I think it’s common. That experience, when I say it, people are, like “oh that sucks” and it feels sad, but also, I’m glad that someone’s talking about it, because the same thing happened to me too, kind of thing.
Laura: I feel like you’re in a vulnerable spot when you go. When you finally decide you’re gonna talk to somebody about what you’re feeling, what you’re going through, for them to tell you, this is bad, but not bad enough for you to be here.
Dr.Gold: Then you’re like, do I need to make something up? It makes you wanna go, What do I have to do to be sick enough? Then you’re like, that’s not healthy either.
Laura: You’ve spoken and written a lot about burnout, not just from a clinical perspective, but also a personal one. Can you share what burnout has looked like for you?
Dr.Gold: Burnout is one of these interesting terms that we use wrong all the time. Mental health words in general tend to be co-opted, and we use them incorrectly. People are like, “Ugh, I’m so depressed”, but they just mean they’re sad. Burnout’s very similar, in that the way we use it colloquially makes it seem less serious than it actually is. People use it like “work was hard, I’m burnt out,” and that’s not really what it is.
Burnout is a workplace-associated condition, not a psychiatric condition, meaning that the systems we work in create the symptoms of burnout, and they come in three clusters. The first is emotional exhaustion, which can look like physical exhaustion, but you’ve got nothing left at the end of the day. Depending on who you ask, the second cluster is either cynicism or depersonalization, so it’s either anger or numbness/disconnection. Depersonalization in clinicians looks a lot like you lack empathy, and you’re just going through the motions. The patient is not a human, but more like an object, is how they describe that part. Then, the last one is a reduced sense of personal accomplishment, so you’re doing less, and you feel like you’re doing less, and someone pointed out that you’re doing less. That’s the one we don’t like, because we mostly base everything on work. So if we’re not getting our work done, we start to notice it.
When I look back at my symptoms of burnout, I see I missed a lot of things. So I didn’t really notice I was burnt out until I would fall asleep every day after work and wake up four hours later with this heavy sort of fatigue that I couldn’t fight. I can best describe that as what it actually felt like for me to have COVID, where you’re achy and don’t know why you’re going to sleep, but you appear to be asleep. I would wake up four hours later and say, “Oh, I guess I’m tired”. That was not great. In the same sense, it started to show in what I was doing work-wise. For me, it was primarily over the pandemic. I was doing Telehealth, and a patient pointed it out to me. The thing I write about in my book, in the introduction, is sort of my breaking point, so to speak. It was when a patient that I’d already seen before, I reintroduced myself to in a very first-visit conversation. I said, “Hi, I’m Dr. Gold, this is psychiatry”. You know, this whole thing. Then the patient stated, “I know, I met you three weeks ago”. Many doctors who read that story have told me, “Oh, I do that all the time,” or “That’s not such a big deal”. In psychiatry, it is, because if I just told you this trauma I’ve never told anyone. Then that person doesn’t remember; that’s terrible. It’s not to say that I remember everyone I’ve ever seen, right? Usually, I can look at the chart before and make sure that I remember what they came in for. I was just so tired and disorganized and behind that I kind of was just like: patient, patient, patient, patient, patient, patient. I couldn’t do the other stuff; that was a big thing for me. It started to affect work and not just me, which is a big thing for me, but you know, looking back, what I blew through were things like my emails made me really mad, and my inbox made me really mad. I’d be like, “how dare somebody send me another email?” or, “why is this patient still writing to me? This is so annoying.” It was really out of proportion to the ask or the email. It was just that, you know, an email or a message were more things to do and I couldn’t do it. When that happens, my baseline emotion in situations like that is getting frustrated and angry, putting it out there, and getting it away from me. I used to go, I guess emails make me mad, right? Now I’m more aware that when I start to feel like that, it is something to pay attention to and that might be a sign that something’s getting off that I need to deal with. If I had noticed that, maybe I wouldn’t have gotten to the point that I’m so burnt out to the point I’m sleeping every day, or it’s interfering with work. We don’t all have to get there, but many of us do because we don’t notice until it gets that bad.
Laura: I think the problem, especially in a field like medicine, is that it’s so easy to overlook those signs. It’s kind of normalized that you just have to push through with no sleep and just try to do your best until the point that you can’t do anything because you don’t have the energy for it.
Dr. Gold: Yeah. If 50% of us are burnt out, that means you’re looking at someone who’s burnt out when trying to compare yourself. Which means I go, “well, I sleep more than Jim,” or “I cry equivalently to Jane.” So, our normalization of it makes it very hard to know that something’s wrong. Our normalization of it makes it so if we start to go, wait, like, I don’t like this feeling, I’d really like this to stop, then we start to blame ourselves. How come I can’t cut it? How did I get here in the first place? How dare I? It seems like everyone else is tolerating this massive discomfort that comes with our job. You know, the actual symptoms of burnout are really symptoms of our workplace, too. Just in general, of course, you’re emotionally exhausted, you listened to patients’ trauma or saw patients’ trauma all day. Of course, you are depersonalized, because if you were super connected all the time, you would sponge. It would be impossible to do our jobs if we were really connected at every minute of every hour of every day. So many of these things are just things we learned to do to cope, or things that we learn or have as side effects of our job, but we blow them off in that setting, too. Just because it feels like I’m emotionally exhausted, why wouldn’t I be, right?
Laura: From your perspective, what are the biggest drivers of burnout in medicine today? Are they different than what they were five or ten years ago?
Dr. Gold: I think the drivers change over time as things change, but there are many core clusters. So you could say: “What is the system in medicine contributing to burnout?” Some of that is paperwork, and maybe 20 years ago, that paperwork was written, and now that paperwork is electronic, and there’s more of it. Maybe insurance companies were problematic at one point, but maybe now they have more prior authorizations, calls, work, denials, and things that we’re doing. Maybe the lack of redundancy and not having enough staff or positions in healthcare was always a problem at certain times along the way. Maybe it’s worse now, you know? I think that systems and medicine intersect in a way that causes a lot of this for people. There’s a lot of evidence that our documentation burden has contributed to burnout, or that women document more into the evenings and have more complex patients. So that contributes even more to their burnout. Also, having supportive workplaces is not just the people and the situation, but also staff support and the right people in place to do things that you need, obviously, is gonna contribute to burnout. So those things are true, the system part is true.
Then I think the cultural part of medicine also contributes to burnout. We don’t talk enough about that piece. I like that piece because I was an anthropology major. I have a master’s in anthropology, and so I’m always observing that part of it. I understand why people hate the electronic medical record. I wish we would also talk more about the fact that we don’t talk about this enough, and that we are expected to work like this and be fine, or that hierarchy is so bad, or that we still mistreat and bully people, or that people are harassed in the workplace, or that patients harass people. Those parts of it are really relevant too. So it’s more tangible sometimes to focus on the system things and to blame the system things. Those are totally valid, but they need to be worked on and talked about. The culture stuff is just as important, in my opinion. We sometimes ignore that and assume it’s never gonna change, and I don’t think that’s very helpful.
Laura: I agree. I think the culture in medicine is normalized. It’s just, Oh, that’s just how it is. I talked to my mom about it the other day, telling her some stories I saw in the hospital with some residents and attending physicians. She was like, “Why don’t they complain?” I was trying to explain to her that that’s just kind of how it is.
Dr. Gold: I think sometimes people think that’s how it was 10 years ago. Speaking of change, right? Sometimes you tell these stories, and they’re like, oh, that was your mom, right? That was your grandma, right? But no. That stuff still happens in medicine. We haven’t evolved past many things that you probably don’t think still happen in medicine, ’cause they sound completely unhealthy and ridiculous, but that’s how it still is, you know.
Laura: What role do you think gender plays in how burnout is experienced in medicine?
Dr. Gold: All the studies would say women are more burnt out. That shouldn’t shock people. If you’re wondering why, my favorite study of this looked at dual physician households, meaning the husband and the wife. That’s just how it was set up to have both genders. The husband and the wife are both physicians, and then COVID happens. They ask, “Who took on more household responsibilities, cut back their hours, and had the burden of also teaching the kids?” I don’t have to tell anyone listening that this is true, but the women cut back their hours more.
The women were teaching more. The women were taking on this extra burden at home more. Yet we had started from the same place. We’re both doing the same job. It’s not like we’re doing different levels of jobs. They’re doing the same job. As a result of that, the women physicians were more burnt out and more depressed, which I don’t think should be surprising because it’s sort of like two jobs. I think putting all of that together, you know, you can look at the other stuff that I’m sure you’re talking about on this podcast too: pay, lack of flexibility for the kinds of stuff that we need to be doing for having a family, and all of that kind of stuff. Having to delay having a family, if that’s part of what you want in your life, and harassment in the workplace, not having clear paths to promotion, or a sort of leaky pipeline. All of those things clearly contribute too, but if you look at all of us in the same workplace and situation, if we’re still taking on this much more, of course, we’re gonna burn out this much more.
Laura: In your experience, how has the conversation around burnout in medicine changed since you started your career?
Dr. Gold: I mean, we talk about it a lot more. I’m not that old. If you were to talk to somebody probably 10 years older than me, they’d say, “Oh my God, all they talk about is burnout now.” I don’t think it was even a term regularly discussed in the ethos of medicine. I did a very basic study for my thesis, which I was doing in med school, about med student mental health and access to care. Do they have access, and is there stigma? That was novel, right? The fact that it was a novel is silly at this point. It definitely has changed in that we talk about it more. It doesn’t mean that we’re doing all of the things we should be doing, or that we’ve fixed it all. We have definitely invested more time, programming, and energy in it. The pandemic, in particular, forced that issue because everyone was sad. Everybody was burnt out, and we had this new novel and a really hard stressor. It forced some of the systems to reckon with some stuff that they hadn’t before. It’s still a thing where I deal with conversations like, well, the pandemic’s over, they should be fine, right? You’re like, well, we weren’t fine before, so how is it possible that we’re fine after? So I think a lot of that requires conversation that I wish I didn’t have to have, that it was obvious to people that this was a problem. If you look at some of the difficulties in getting money for positions like mine, or getting money for real, sustainable change in healthcare. Some of that stuff shouldn’t have to be an argument daily, but it is. I think many people do jobs like mine without a percent of time dedicated to it, and that’s a lot of work for that, you know?
Laura: I think from a medical student perspective, I would say that I don’t know if it’s me, but I do think there’s still a stigma around mental health. I was filling out some applications for some sub-internships for my fourth year. I remember I came across one of the medical forms. It asked if I had a diagnosis of a mental health disorder. I’ve had anxiety for many, many years, and I was so scared to list that, because in my head it was, like, if I put this down, are they gonna reject me just because I have that?
Dr. Gold: Yeah, they aren’t supposed to ask those questions because it’s illegal. The Americans with Disabilities Act says you are really only supposed to ask something that interferes with current impairment, meaning, like right now, today, at this very hour, is your anxiety so bad that you’re gonna cut a patient’s leg. It’s gonna be the wrong one. You know? Like, that’s what matters, really. Much of the wording is outdated if you look at licensure and credentialing. This is something that the Dr. Lorna Breen Heroes Foundation has worked really hard to advocate for, state by state. The Federation of State Medical Boards stated long ago that these questions shouldn’t be asked. They just don’t have the power to make every state agree. So they have to advocate state by state to change it, and we’re lucky that that’s been a big focus of the Dr. Lorna Breen Heroes Foundation’s advocacy because that change does matter. When people see that change, they feel safer getting help and don’t worry that getting help will blow up their entire life and identity.
There’s still a stigma even without that. Licensure is a component, but if you are on a rotation and a person has a mental health condition, and the attending rolls their eyes or judges them or says, call psychiatry, I don’t wanna deal with that, or ugh, not that person again. If you’re at home, trying to deal with something, and you go into work, and that’s what they say about someone experiencing something similar to you, it will stick. If psychiatry is still a stigmatized profession, and people say, “Why’d you go to med school for that?” That’s gonna impact how we think about it. The kind of hidden curriculum around mental health is that patients could judge you for it, your supervisors could judge you for it, your colleagues will judge you for it, it really doesn’t matter that you are okay that you have anxiety, because you think no one else is gonna be okay that you have anxiety, so you’re not gonna talk about it. Then, if you don’t talk about it, no one else knows anyone has anxiety in med school. So it’s a perpetuating problem.
Even if you’re okay with it, I’m okay with it. I’ve had depression, I take meds, and I’m okay with that. I had fears about talking about it, too, even though I’m a psychiatrist who prescribes medications to healthcare workers. I was afraid that someone might think I was sicker at one point, or that if I had feelings, I was gonna crack, or that a patient would not like to see someone who has had depression. That’s a big, true thing that we must reckon with, talk about, deal with, recognize, and understand. Much of that comes from the culture and the hidden curriculum, and it’s part of it. The hidden curriculum is not just about empathizing with patients, but what we think about those kinds of patients.
Laura: There is a lot of talk about resilience in medical training, but sometimes that feels like a way of putting the burden on the individual. How do you think we can reframe conversations about burnout to include more focus on systems and institutions?
Dr.Gold: So the resilience word makes more people cringe than most words in medicine. I think it has a bad reputation, and I think that it was just used wrong. I don’t actually think resiliency is bad. We have more resilience than any field. Even the most resilient people are burnt out. That is all true. What happened was we were trying not to have to fix systems and instead to teach individuals some skills, and in teaching individual skills, we said, we’re helping you with your resiliency. So people took that as the system’s fine, you’re the problem. So resiliency sort of became this symbol of, I’m the problem. You think I’m the problem. Resiliency really should be: The system is really messy and broken, but it takes a really long time to fix, and I would like you not to quit tomorrow. So you do need to learn some stuff to recognize your own signs and symptoms, to be able to talk about it, to know how to deal with it, to know coping skills, because you don’t wanna quit tomorrow. Maybe you will quit, and that’s also okay. That’s a part we should talk about. It’s not that the system is not the problem, or that skills are the problem; it’s that we need to talk about all of it together. We need to focus on system change and think about how to change a system, but no system has changed overnight.
So, how do we help our teams, and how do we help each other through the existing problem? Some of that is even acknowledging out loud, and not in this fight club way, that our system is broken, right? Even when we see patients and we’re running behind, we take the burden ourselves and we’re like “oh my gosh, I’m so sorry, it’s just one of those days”. Instead of going “you know what? I get 10 minutes to see patients. I’m 50 minutes behind because I have patients that are more complicated than 10 minutes”. If a patient heard that, they’d be like “oh, that’s terrible, you’re set up to fail,” and in so many ways, we are. I think that saying some of that out loud takes a little bit of the weight and is a sort of punishment for it. It’s our fault, no, it’s the ethos’s fault. We’re doing the best we can within it. I think we have to have those conversations out loud and not just blame ourselves and put it in our brains and ignore it, and that’s part of how we blend the two.
Laura: I agree. I think you have to be resilient in medicine because things don’t always go smoothly, but the way we talk about resilience in medicine places so much burden on the individual that it can make it worse for them and their mental health.
Dr.Gold: I wish we used a different word. Also, there are some components of this that we need to figure out ourselves. If we don’t care about ourselves, no one else will. So, it is important that I know that when I’m about to burn out, I hate my emails, because no one else knows that about me. No one else is gonna pay attention to that. The only thing someone else will pay attention to is my performance evaluations and what patients say about me. So, if I don’t get that bad, it’s gonna take a long time before anyone else cares about me. I think it is important, even though it can feel like an extra burden, that we do some things there.
Laura: In your view, what responsibility do institutions have when it comes to supporting the mental health of their trainees and healthcare employees?
Dr.Gold: A lot. I mean, so there’s a level of this that, luckily, is supported by things like the credentialing of hospitals and schools. So, to keep your accreditation, you must have access to mental health care for medical students. You need to be able to let them get treatment if they need it, and you have to have programming that teaches some of this stuff, that’s part of the accreditation process. Due to that being true in medicine, nursing, pharmacy, and dentistry, there’s something they can’t get away with. They have to do some of that stuff, but the problem is we do many things just to check the box. What does it mean to have access to care? Oh, you gave them a list of people? Or does it mean you actually pay for a therapist who has after-hours and is available on weekends? Who knows? That’s important. There’s a difference between checking the box, not getting in trouble, not losing your accreditation, and really caring about these topics. I also worry that we don’t care about them until somebody gets really hurt, right? So, a lot of the schools that have the best programming around wellness and mental health in general are the schools that have had very prominent physician suicides or resident suicides. It was in the news, and then they were like Uhh, oh, gotta have an answer for this, gotta fix this. We shouldn’t be waiting for the problem to fix it. We shouldn’t have to backtrack like that. We should value this, value us as people, all along, and not only in a time of crisis. It’s much easier to do this before you’re in a crisis. I would hope that, you know, if anything, scrambling during COVID to create some of these resources showed people that it wasn’t very helpful, but if they’re wondering if they can stop caring, the answer is no.
Laura: You’re now in a role that’s all about shaping wellness across an entire university system. Did you ever envision yourself in a position like that?
Dr.Gold: They didn’t exist. Chief Wellness officers are newer in general. They were started in academic health centers and hospital systems. Then my role is kind of weird in that one of my five campuses is a health science center. I do have medical students, pharmacy students, nursing students, etc. However, I also have four other campuses with undergraduate and graduate populations, and that’s very different from a health science center. A position like mine didn’t exist when I would’ve said, What do I wanna be in 10 years? I feel the same way. What will you do 10 years from now? I have no idea, it’s like an uncharted path in some way, which is kind of fun. I think I would’ve told you in residency that I liked college mental health, writing, and trying to find ways to help healthcare workers. Even if that was what I was doing, teaching-wise, or if it was what I was doing sort of administratively. Then this sort of confluence of things, including the pandemic, made this more of what I was doing in all aspects of my life. That’s just been kind of interesting and kind of the right place at the right time, and you know, a way that aligns a lot of my interests and, I think, gives me a lot of meaning, which is burnout prevention. That’s been nice for me, but it wasn’t anything I could have predicted.
Laura: I think answering those questions about where you see yourself in 10 years is hard because sometimes things happen in life that take you on a different path than you could’ve ever imagined.
Dr.Gold: Yeah, and the best stuff for me has always been, I wouldn’t have thought about it. I’m randomly in a room, and the person does this. I ask a question, and I get connected to them. I started doing something, and that was really fun, and I get to keep doing different things. That’s always been the best stuff for me, not this tomorrow, I will do this with this person, and this will be the answer. It just does not work that way.
Laura: What challenges have you faced as you’ve led wellness initiatives across the University of Tennessee System?
Dr.Gold: I’ve been there a year and a half. I’m in a new position. New positions always have challenges, because you have to teach about your role and create your role at the same time. Like, why does your role matter? Also, what are you hoping to do with it? It’s a lot of politics in that sense. I think, you know, in new roles too, value matters. Just hiring me is not enough; you have to hire teams, you have to put money behind it, and you have to do stuff. I think my institution understands that, but I wouldn’t say that everybody in every place, in every institution that is a part of the system, understands that. I would also say, I’m in a weird role, so system work is parallel to campus work, so none of the people on the campuses report to me. So the only way for them to, you know, get on board or wanna do anything is that they decide they wanna be on board and do it, and they agree that it’s of value. So it’s a lot of socializing concepts and trying to get them to understand that that’s something they want, and working with them to make it feel like we’re doing it together, which we are. Still, it doesn’t always feel like that. So, how do you do things that don’t feel like you’re doing them to someone, but instead with someone is really important in my role, and that’s been something that I’ve worked really hard to be doing, but is also a challenge of it, because if they decide they don’t like the thing, they can just say nah and that’s hard.
Laura: I feel like if I were in your position, I’d be disappointed and wondering if I could have done more to change their minds.
Dr.Gold: Yeah, try to meet more people and go up a different way, or get at it from a different route or person, look for different levers and stuff like that. Some of that is doable, right? I was just conversing with someone about hope as a process and organizational skillset. I think in hope, you’re saying “well, that didn’t work, but is there another way at it?” or “are there other ways at it that don’t feel like that’s just the end?”. I think that matters in a lot of ways.
Laura: There is a question that I wanted to ask you. It’s a little bit of a different topic than what we’ve been discussing right now, but I noticed in a lot of the reading that I did about you prior to this interview, that you talk a lot about the power of vulnerability and self-disclosure reciprocity in medicine. Can you talk a bit more about that and how it might help shift the culture that contributes to burnout?
Dr.Gold: I mean, the definition of vulnerability feels really bad. It’s like risk and emotional exposure, and these things that nobody wants. Nobody wants risks or wants to be emotionally exposed, but when you’re vulnerable, a lot of good things happen. People who are vulnerable leaders are seen as more empathetic and courageous. If I tell a story, you’re more likely to tell a story, which is what self-disclosure reciprocity is. If I disclose, you’re more likely to disclose. If I’m kind of buttoned up, you won’t talk to me about anything. So you know, what vulnerability in some capacity does is start to create a culture that’s not silent.
When I say vulnerability, I don’t mean that everyone who’s an attending listening has to be or a student; we know that on both sides of the coin have to say, “Oh, like I need to just tell my entire mental health history.” So, being vulnerable is not word vomiting your trauma. If you’re ready to word vomit your trauma, you’ve processed it. You know who you’re telling, what you’re telling, and why you’re telling it. All of that is fair, but your story is your story. Tell your story to whom you want, when, and how you want, all of the above. I’m pretty open and haven’t told my whole story, okay? So that’s important, but what I mean for most people to do is, like: This system in medicine is kind of messy, and I don’t like it. It’s kind of weird that we go from code to eating lunch. It’s pretty messed up that this happens, or whatever. I’m really tired today. It’s really hard to balance work and life. My kids are sick at home, I’m gonna leave early. Whatever that is, these ways of modeling humanity, you don’t have to do the extreme version, which is that you do what I do and write an entire memoir about your mental health. Some of us have to do that because it moves the needle and is important. Most of the needle moving will come in these little spaces, such that if you say, “I’m tired today,” maybe the next day someone else will tell you they’re tired too. Maybe, when that fatigue is actually someone feeling like they might be depressed, you’ll be able to catch it. They talk to you about it, and you can say, “Hey, how can I help? How can I listen? How can I be supportive?”. That’s a very different culture from what we have now.
Laura: I think it’s kind of like opening the door for a new conversation. It’s funny that you mentioned, “How do we go from a code to eating lunch afterward?” I remember on the third day of my first clerkship during my third year. I was at a community hospital, and we had a code, and there was no code team, so the med students lined up to do the compressions. The patient did not make it, and we walked out of the room and carried on with our day like nothing had happened. I feel I wasn’t the only one who wanted to talk about it, but nobody did. So I kind of just followed along.
Dr.Gold: In those positions, it’s the leader’s responsibility to say, “Have you ever seen somebody die before? What was that like? Can we take like five minutes to talk about it?” or “If you need to go outside and take a break, it’s okay. I’m not judging you. It doesn’t matter. I’ve seen too many of these. I’m numb, but I recognize why you’re not, and let’s have a conversation about that.”
Laura: Now, circling back to burnout, you’ve mentioned that by the time burnout gets severe enough, something like a yoga class isn’t going to solve the problem, and yet many institutions still approach wellness by assigning modules or requiring trainees to attend wellness lectures. In your opinion, what kinds of approaches actually make a meaningful difference in preventing or addressing burnout?
Dr.Gold: It’s not that yoga is the problem; it’s when yoga is offered. If I’m 10 out of 10 burnout and you tell me to do yoga, I will want to punch you in the face. If I’m 2 out of 10 burnt out, I might go, “That’s a good idea, what’s yoga?” A lot of the problem is that we are not addressing this early enough. So, the interventions that are being suggested and applied are helpful. They just make us more frustrated. We need scaled interventions where we could get something if we’re a two, something if we’re a 5, something if we’re a 7. We need different things we could do depending on when we notice and ask for help. That’s one thing to know as an individual, that at a 10 out of 10, you might need to: take time off, go to therapy, get a psychiatrist, or whatever. That needs to be available, but so does the yoga class, if that’s what you wanna do, at a 2 out of 10. More systematically, we must think about the things causing it upstream to help downstream. We can’t just fix the 10 out of 10 burnout with a pizza party and not say that we’re also having to think about electronic medical records or paperwork burden or staffing, or whatever it is, safety in the workplace. All of that needs to be thought about upstream to prevent downstream effects.
I think that many things that prevent burnout are Meaning, Purpose, and Social Support. Social Support is a supportive workplace. Do you feel valued at work? Most of us know we’re gonna work hard, don’t ask it. Nobody went to med school thinking they weren’t gonna work hard, but if you work hard and you’re treated terribly, no one tells you good job, no one tells you you matter, it starts to not be fun. I can work hard if people care that I work really hard, and that’s important. I think that’s a thing we can fix in how we talk about each other and do stuff like that. Meaning and Purpose are vague. It sounds woo-woo and sort of philosophical, but it’s why we do what we do, and how do we remind ourselves of that in the context of a workplace with many things that tell us not to? Is that reminding ourselves of the good things in our day, even though we want to only remember the bad? Is that, every time a patient says something nice, you put it somewhere and look at it when you’re having a bad day? Is that, you know, when you wake up in the morning, going, I do this because I care about helping people, or, you know, whatever it is? A lot of us do different things to kind of reground in that. It matters because if you don’t have that, you say, “Why am I here? This is stupid. I’m not doing anything helpful. I’m not helping anyone. I hate this. The system’s terrible. The system’s broken.” It’s really easy to get stuck in being mad at the system, and you have a right to be mad at the system, but again, it’s not changing tomorrow
So I often find that in my job, I get really mad at the system just like a person because my brain works in sort of a Where’s Waldo of system problems, and it’s really unfortunate and doesn’t shut off. I find things like the Serenity Prayer really helpful for that, God or no God. The point of the Serenity Prayer is really like there are things you can change and things you can’t, and it really matters to know which ones those are. There are a lot of us who have no way of changing the system. I’m in a role where I can now, but I wasn’t for years. If I had just been mad at the system, which I was all the time as a resident or a med student, that takes a toll. If I could say I have no way of controlling the system, I can control how I feel. I can control how I show up for my patients. I can control how I show up for my colleagues. I can take a vacation day. I can take someone else’s shift when they need to go on vacation. Those kinds of things we can control, and if you focus on that, sometimes it takes the just terribleness away from this heavy problem, which is the system.
Laura: Kinda gives you a little different focus, so you’re not focusing entirely on how bad the system is.
Dr.Gold: A hundred percent.
Laura: What keeps you hopeful about the future of medicine when it comes to wellness and mental health?
Dr.Gold: The people in it. I mean, as bad as our system is and has been for a long time, really good people still wanna do it. I don’t know why, but it’s true. I like the people who do medicine; people still care about other people. People still have hopes that they can change the system. People haven’t stopped going into it because there’s the risk of that too, right? Which is, that’s terrible, who wants to work in an environment like that? I’m not gonna do that. I can’t tell you that that won’t happen in generations to come if we don’t change stuff. It should be something we’re thinking about, because they value work-life balance and flexibility more than anybody, and we need to be thinking about that. I have hope that we talk about this more and that we have good people who care about it. While some things might take a long time to change or might never change, I do think we could get to a better place.
Laura: My last question is: is there anything you wish more medical students, trainees, or healthcare professionals knew about burnout, especially when recognizing the early signs?
Dr.Gold: I would just say that it’s not just being tired. It’s not just like a product or a side effect of our job. It is something you have to manage. Some of the reasons we think when we show up at work, we’re helping our patients and colleagues, is because if we’re not at work, we’re burdening people. If we are at work and we’re burnt out, patients are more likely to stay in the hospital longer, have more errors, and have lower satisfaction. If we are burnt out and at work, our colleagues are more likely to get burnt out, right? So we’re not actually helping anyone. We’re also not helping ourselves. If you’re burnt out, not only is burnout its own problem, but it’s a risk factor for car accidents, depression, and suicidal thoughts, independently of depression. It is a stepping stone to suicidal thoughts, being burnt out alone. That’s important and something that we should be talking about. If you’re not gonna show up just to show up for you, the idea that we’re showing up because we have to.
I used to say to my therapist, “My 80% is better than a lot of people’s 100%, I have to be here. There’s no one else. Then a patient’s not gonna be seen for a month?” Things like that, that I get. However, if you look at the data, we’re rationalizing and intellectualizing this stuff and putting a lot of burden on us that just doesn’t make sense. The day off does make a difference. The desire to step back and take a vacation. All of those things do make a difference. We have to value that, and we have to value ourselves in the equation. It’s not something we can ignore. We are better caregivers if we care for ourselves.
Dr.Gold: I agree with you. I think you just covered some very important points. I especially liked what you said last: we are better caregivers if we also take care of ourselves. I think it helps us do a better job. It helps us keep our empathy and humanity. The very thing that brought many of us to medicine.
Laura: I want to thank you again for being with us today. I was very excited about our conversation. I was really looking forward to it. Thank you so much for sharing everything that you shared with us today. Before we go, is there anything else that you would like to share with our audience?
Dr.Gold: Of course. Thank you so much for having me. If people want to talk more, I respond to my DMs on things like Instagram (@drjessigold). You can contact me through my website, which is also just drjessigold.com. I did spend some time writing that book, which, if anybody’s interested, is about my experience and patients’ experiences. It has patient narratives, looks at all of this data, and puts it all in one place. Hopefully, it won’t feel like one of those boring wellness lectures, because I’ve learned how to tell this information in a way that isn’t boring, is a little bit silly, is a little bit funny, but also personal. The book is “How Do You Feel? One Doctor’s Search for Humanity in Medicine”. If you’re interested, you’re the target population for whom it was written. So I hope that you consider reading it too.
Laura: Your book is now on my list as I am in my fourth year, so hopefully, there will be more time for me to do things like reading books. I’m really looking forward to reading it. Thank you again, Dr. Gold, for joining us today.
Laura: So that’s a wrap on this episode of Our Voices Our Future. We hope today’s conversation inspired, challenged, and reminded you of the power of raising your voice. The fight for equity doesn’t stop here. Join us in the movement. Subscribe wherever you get your podcast. If you love this episode, share it with someone who needs to hear it. Until next time, stay bold, vocal, and keep the conversation going. This is Our Voices, Our Future.
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About the Authors
Meghan Etsey, MS4
Meghan Etsey is a fourth year medical student from St. George’s University. She has a Bachelors of Arts in Biology and a Bachelors of Arts in Nutrition and Dietetics from Bluffton University in Bluffton, Ohio. She served as the President of the St. George’s University’s Women in Medicine chapter in St. George, Grenada where she expanded relationships with the community and worked towards educating women and helping the youth. She is also a member of the Gender Equity Task Force and Sex and Gender Health Collaborative Committees within the American Medical Women’s Association. When she is not pursuing medicine, you can find her with her friends and family on different road trips and adventures exploring the world.
Laura Uricoechea, MS4
Laura Uricoechea is a fourth-year medical student at the Philadelphia College of Osteopathic Medicine. She is currently completing a Master of Public Health at Thomas Jefferson University between her third and fourth years of medical school. Laura is applying to OB/GYN residency and is passionate about women’s health, particularly reproductive healthcare. She is an active member of the Gender Equity Task Force within the American Medical Women’s Association. Outside of medicine, Laura enjoys spending time outdoors—she loves hiking, paddleboarding, swimming, and playing tennis.