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“What makes soldiers and doctors good at their jobs are also the very things that make it hard to leave work at work. My former husband was, and is, very good at his job, especially when it comes to compassion and care for his patients. At work, he gives his all. He sits with grieving families, helping them understand what’s happening with their loved ones and even crying with them as they die. To ask one more thing of him when he’d given every ounce of his soul all day seemed selfish and childish. So I tried to be civilized and grown-up, swallowing my need for love, to be seen and cared for the way his patients were. By the end of the day, he was so drained; he must have felt that no story he could tell me could bridge the huge divide between the battlefield of the hospital and the home we shared. This is what many doctors do: go back and forth between the battlefield and whatever “home” they’ve created. They are soldiers in everyday life.”
Susan Hart Gaines is an executive coach specializing in physician wellbeing.
She shares her story and discusses her KevinMD article, “The difficulty in coming home: What doctors and soldiers have in common.”
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Hosted by Kevin Pho, MD, The Podcast by KevinMD shares the stories of the many who intersect with our health care system but are rarely heard from.
Transcript
Kevin Pho: Hi, and welcome to the show, where we share the stories of the many who intersect with our health care system but are rarely heard from. My name is Kevin Pho, founder and editor of KevinMD. Today on the show we have Susan Hart Gaines. She is an executive coach specializing in physician well-being, and she wrote the KevinMD article “The difficulty in coming home: What doctors and soldiers have in common.” Susan, welcome to the show.
Susan Hart Gaines: Thank you so much for having me.
Kevin Pho: So we’ll get into your article in a little bit, but first off, can you share your story and journey to where you are today?
Susan Hart Gaines: Yeah. I was married to a physician for 24 years, and I have a lot of firsthand experience, as the spouse of a physician, of what the unique struggles are for doctors with their families, and in particular with the difficulty in coming home, both literally and existentially.
I have a background in journalism from Northwestern University, so I’ve always been about communicating and connecting to people through words and writing. Recently, well, not that recently, I started focusing specifically on doctors, realizing that I had so much wisdom and so much firsthand knowledge of what doctors deal with. So I then went on to get some coaching certifications from Positive Intelligence and Co-Active coaching, and I’m just loving it.
Kevin Pho: So in your coaching practice, when you see physicians, what are some of the common issues that they come to you with?
Susan Hart Gaines: Well, interestingly, it’s not to try to fix the workplace. I think we’re all well aware of the issues that physicians and other medical personnel are facing today. It’s really about what’s going on at home and how to connect, how to connect even to their patients; it’s not that different. But a lot of physicians who are either facing burnout, or fear they will be facing burnout, are really dealing with a sort of crisis of: Who am I, what really matters to me, and how can I reconnect to my family, but ultimately to the self? It starts there.
Kevin Pho: So talk more about what you mean by that, when you say that physicians have problems reconnecting with their family, their patients, and themselves. What are some stories or examples that you could share that illustrate that issue?
Susan Hart Gaines: Yeah. I think that a lot of doctors are supposed to be compassionate, and yet a lot of the training disconnects them from the essence of compassion, right? I mean, if you’re really following your calling as a physician, you are entering another person’s suffering. That’s what it takes. And yet so much of the messaging in med school and after is: Don’t feel, disconnect from that if you want to survive. Don’t actually take that home with you, don’t actually let that in, or it’ll kill you. But I’m finding that if you do that too much, you disconnect from the essence of what you’re doing, and from yourself.
And then you come home. Not everyone comes home to a family, and there are other things about people who are not partnered, without children. But let’s say you’re coming home to a family, and you’ve been doing that all day, dealing with life and death, entering other people’s suffering, and yet somehow having to disconnect. And then we’re expecting them to connect again on some emotional level to these other humans that are waiting for them at home, or to themselves, and they’re just done. Usually by the end of the day, they’re done. And they practice this disconnection for so long that they may not even realize it. I find out soon there’s a lot of messiness under numb. It’s really self-protective, if you will, and a disconnection from: What am I feeling, and what am I supposed to do with all this?
Kevin Pho: All right, let’s transition into the KevinMD article that you wrote. It’s titled “The difficulty in coming home: What doctors and soldiers have in common.” Now, for those who didn’t get a chance to read your article, can you just walk my audience through it and share the story of why you decided to write it?
Susan Hart Gaines: Yeah. I was actually coaching a soldier, and I coached doctors, of course, and I started hearing some reverberations that were similar. It was this idea of: Who am I when I get home, and how do I connect? It manifests in different ways, but it was essentially this sort of inertia: “I don’t know what to do. I just sit on the couch and watch TV.” And then other people were just feeling like they couldn’t reconnect to their people at home.
I started thinking about my own life being married to a physician, and this was a long time ago, but just that frustration of, “Come on, tell me what’s going on. What happened? Where are you?” And I realized what we’re asking doctors to do, and soldiers, and I think it’s almost been better documented with soldiers: They’re entering into this life-and-death stuff every day, not all specialties, but some of them, and then we’re expecting them to what, just leave all that with their coat? They take off the white coat, and they come home, and they’re what, another person?
I learn a lot through writing, and so in the writing of this, this is what I discovered beyond the cliche of the battlefield, and that’s been written about a lot. It’s: What’s the real essence of what both groups of people struggle with? And it’s this coming home. How do you come home, both every day, literally, and existentially and metaphorically? But really, it’s coming home to the self.
And yeah, I think that doctors have for so long been training to do this thing, and nobody was training them, nobody was talking about the importance of self-care. And I want to call self-care something much deeper than a bubble bath and a massage: self-care of who am I, what really matters to me in the world, and how do I nurture that every day? How do I refill my cup? That’s not generally part of the training. I think that’s changing in med school, but that’s not what med school teaches you. They don’t teach you how to fill your cup, how to figure out who you are. You’re just supposed to be, at all costs, for the patient.
Kevin Pho: So you talk about those dual realities that physicians face, the realities at work and the realities at home, and it’s very difficult to disconnect one from the other. They’re not expected to go home and, like you said, hang their coat up and then suddenly disconnect from whatever work reality they had to face. So what are some tips and advice that you could share with these physicians to help manage that transition better?
Susan Hart Gaines: Yeah, I’ve been thinking a lot about the threshold, the literal passage from the hospital or clinic to home. And I’ve been getting some good information from physicians who have been working on this: How do you transition, and even, for that matter, transition from patient room to patient room? How do you not carry with you all the stuff from the last one, and be fully present for the next one?
One physician I just spoke with yesterday said he just has a little ritual of how he knocks on the patient door. He takes a breath and uses that knock to sort of be almost like the bell in meditation practice: This is when we start again, this is when I get present. It’s that motion, that knock-knock and the breath, that helps him move into that next room. And I would say that something like that could be developed for coming home. How do you step across that threshold? Maybe it’s a workout, maybe it’s a yoga class, maybe it’s sitting in your car and listening to an app-led short mindfulness meditation to just help you clear out and get centered.
But I also think something’s really important, and that is: Why are physicians feeling they have to leave everything at work? I mean, if I knew then what I know now, I think I would have understood that there needs to be a bridge between the hospital, and what physicians are dealing with, and home. And what is that bridge? That bridge is stories. Tell me a story about your day, a real story, a story of how it was boring, or it was frustrating, or maybe there really was life and death. But share with your heart what actually happened.
And I think a lot of physicians, and I don’t know if this is more males than females, I think both, I happen to have more male clients, but there’s this idea that you’re supposed to leave work at work. But for physicians, this is not just a job. So perhaps that’s part of the problem: They think they’re supposed to leave it all there. Bring it home. What does it look like to bring it home? How can you use your stories to transition into this other life and help your partner and your children understand where you’re coming from every day?
Kevin Pho: I’ve had several physician coaches on the show, and they’ve written on my site, and I’m always interested in asking: What are the triggers that cause a physician to seek out coaching? Because I think what you’re describing is actually quite common in terms of what happens in a lot of clinicians’ houses, but only a minority of them actually take that next step and try to help themselves by seeking coaching. So among your clients, is there a specific trigger or something that takes them to that next level to seek a coach like yourself?
Susan Hart Gaines: Yeah, I love that question. I would say that recently, this article, “The difficulty in coming home: What doctors and soldiers have in common,” touched a lot of physicians, I think because they felt really seen, and they felt like, “She knows what’s happening when I leave work, somehow.” I think it’s a matter of trust, I think it’s a matter of timing, and I think they often read something that just makes them think, “Yeah, that’s me, that’s me, and maybe this could help me.”
I think there are a lot of physicians, and people in general, but physicians in particular, who think, “I got this. I’m not supposed to need help. I’m not. And what’s a coach anyway?” I mean, we don’t have a PhD, we don’t. What is this? And in my case, I’m not even an MD, which I would say is often an advantage, and my clients like that, because I have a different view of the world they’re in. I have an intimate view, but I have a different view.
But I really think they read something that says, “OK, I think I can trust her. I think she might know something about this living thing that I don’t.” And I think that takes a lot for doctors, first of all, just to admit they might not be an expert in this area of something called life. They are experts, top of the game, in medicine. But while they’ve been studying medicine, coaches, hopefully the coaches they seek out, have been really studying what it means to live, and the messiness of it. Why is it so messy? It doesn’t have the rules that medicine has. There are no rules. And so I think they end up, just, something clicks.
Often, I will also say, it might be a marriage that they’re really struggling in. They want to save their marriage. Even though I don’t put myself out there as a relationship coach, relationships are always there. Nobody wants to lose their marriage, nobody wants to have bad relationships with their children, and nobody wants to hate their job either. But I’m finding, even if they come to me saying, “I hate my job, I’m burned out,” the stuff we start working on first is at home, is inside of them. And then the work, and changing the work environment, or boundaries, and all of that become much more clear.
Kevin Pho: We’re talking to Susan Hart Gaines. She is an executive coach specializing in physician well-being, and she wrote the KevinMD article “The difficulty in coming home: What doctors and soldiers have in common.” Susan, what are some of your tips, wisdom, and take-home messages that you want to leave with the KevinMD audience?
Susan Hart Gaines: To really take a new look at what self-care means. It’s been thrown around a lot. I think people’s eyes glaze over, even mine do, to a certain extent. Self-care can mean very superficial things, and I think it often almost disrespects what physicians are really dealing with and what they think it would take to fix their problems. But self-care is this deep knowledge of who you are, what matters to you, and what your life purpose is, and really attending to that, right? It’s attending to your deepest heart, and discovering it, maybe for the first time. And that’s a kind of self-care that is life-giving and lifelong, and can help people really reconnect to their work, to their home, and to themselves.
It can’t fix a messy work environment and all the pressures that physicians are under, but it has to start from the inside out. Otherwise, you don’t even know what you want. And happiness is not going to be from fixing your job. It’s got to be from the inside out.
Kevin Pho: Susan, thank you so much for sharing your time and insight, and thanks again for being on the show.
Susan Hart Gaines: Thank you so much for having me.
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