“What exactly is my obligation to medicine? Am I supposed to practice medicine forever? Is it my duty? Do I have to continue serving my patients, the hospital, and society because of these expectations?

The answer is simple: You get to decide. Most physicians I know love practicing medicine. It is and has always been a calling. The problem lies only in the thought that you should practice medicine. When used in this way, the word should is a cognitive distortion. A cognitive distortion is a pattern of thinking that is generally false or inaccurate and carries the potential to cause psychological harm. When you use the word should, there is often an accompanying shift in focus from what you want to what others might think.”

Michael Hersh is a gastroenterologist.

He shares his story and discusses his KevinMD article, “Stop ‘shoulding’ all over yourself.”

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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. Rate and review the show at KevinMD.com/rate. Subscribe at KevinMD.com/follow.

Today on the show we have Michael Hersh. He’s a gastroenterologist and a physician coach. He wrote the KevinMD article “Stop ‘shoulding’ all over yourself.” “Shoulding” is S-H-O-U-L-D-I-N-G, in quotes. Michael, welcome to the show.

Michael Hersh: Oh my gosh, Kevin, thank you so much for having me. I just want to start out by saying that you have really created such an incredible platform for physicians, and I want to thank you for doing that, for highlighting all of the amazing things that all of my colleagues are doing. It’s great to learn new things and see what everybody is out there doing. So thank you for doing this.

Kevin Pho: Well, thank you so much for the kind words, and obviously I wouldn’t be able to do what I do without physician contributors like yourself really just sharing your story and insight. Now, we’ll get into your article in a little bit, but for those who don’t know you, just please share your story and journey to where you are today.

Michael Hersh: Yeah, so I had a very traditional path through my medical training. I went straight through and finished my training in gastroenterology 13 years ago. I started in a small multi-specialty group. I was the second gastroenterologist in a smaller group that subsequently got bought out by our local community hospital and then taken over by a larger health care system. So my career has spanned a number of different changes and progressions.

In addition, I am married, and I’ve got two young children, an eight-year-old and a five-year-old. And then on top of all of that, I had an experience in the medical-legal jungle, as I like to refer to it. I probably was starting to experience some burnout just through the typical growing pains of building a practice, and then successfully building the practice, getting super busy, and having so many expectations about when I can see patients and when I can get them in. And then going through the medical-legal stuff, the burnout was there, but it was like an accelerant on the burnout itself, on the flame.

I got through all of that, and then I started feeling like everything was fine, right? I should be happy, right? Everything I’ve always wanted has come to fruition. I’m a doctor, I’ve got a busy practice, I’ve got the wife and the kids, and the house is great. And then something just didn’t seem right, and I couldn’t quite figure out what it was. So the burnout was there, and I think I just didn’t recognize it.

Kevin Pho: Yeah, so you mentioned the medical-legal jungle. Tell me how that specifically contributed to your burnout.

Michael Hersh: Yeah, I think that all comes down to expectations, too: that we are perfect at all times, that we just do everything correctly. And even if we have done everything exactly the way that it’s supposed to be done, the perception of others really weighs heavy on us, right? So we have this idea that not only should we be perfect, but everybody else should also think that we are perfect. And I think that’s where it comes into play, where you can do everything well and everything perfectly, and other people may or may not see it that way.

Kevin Pho: So we’re going to talk a little bit more about that topic and journey in your KevinMD article. It’s titled “Stop ‘shoulding’ all over yourself,” and that’s S-H-O-U-L-D-I-N-G, in quotes. 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?

Michael Hersh: Absolutely. Yeah, so again, getting back to the issue of burnout, as I was making my way through my own journey in physician burnout, what I noticed was that there was one overriding theme, and that was expectation, right? There were the expectations I was placing on myself, and expectations being placed on me by my patients and by administration. And when I dug into what was underlying this, the innocuous word that was always there was “should,” right? So what I found was that each time there was an expectation, “should” was just so steeped in what was going on behind the scenes for me.

So in the article, I list out some of the common “should” statements that we as physicians hear all the time. You should see a certain number of patients every day. Your charts should be closed within a certain amount of time. Your clinic should be between these hours. And then there’s how that translates to our personal lives as well. You should spend so much time with your children. You should be present for all of the things. And all of those shoulds start to loom large, right? They start to feel very heavy. So that’s where this article was born out of.

Kevin Pho: So tell me about the weight of all those expectations. You go to work, and you say that you should have these certain patient satisfaction scores, you should see this many patients per day, or do this many procedures per week. And then you go home, and you should spend this much time with your family. Give us a picture of how the weight of all those expectations played on you.

Michael Hersh: Yeah, so this gets into a little bit of the idea of balance, right? We hear people talking all the time about work-life balance. I wouldn’t say this was my idea before coaching, but what coaching has taught me is the idea of life balance, because we separate all of these things. Most of us spend our entire 20s in our medical training, right? It is our life. And then we get into our 30s, and we start building the other aspects of our life. We get married, we have children, and then we want to quarter off this work part as if it’s not part of our life.

So what I have come to learn is that we need to treat our jobs as part of our life, because we’ve created our lives in that way. But we’re so hard on ourselves, because we try to say, “Oh, work is here now, right? That’s this part, and now I have to balance all of the life stuff.” And I think that is exactly how it was weighing on me. I was like, “Oh, work is taking up such a big part. I don’t have time for all of these other things that are super important to me.”

So when I took the pressure off of “work is not my life” by admitting, “Well, yeah, I mean, in many ways it is. I created that. This is what I always wanted, and it actually, in a lot of ways, still is,” just by recognizing how much of my life is my work, it took off the expectation and the pressure that I wasn’t doing things right, if you will.

Kevin Pho: Right. So tell me the steps you took to recognize that, because there are a lot of physicians who are in the exact same position that you described, with the weight of expectations, and you just keep working harder, right? But you made a U-turn. You made a change in your life and recognized, “Hey, this isn’t right for me. I want to make a change.” So was there a specific event that made you change? Was there someone that you talked to that just made you realize this new perspective?

Michael Hersh: Yeah, so it was definitely a process, right? But I’ll tell you what the pivotal moment was. I had seen a lot of the physician coaching stuff popping up. I’ll tell you that there are a lot more opportunities for physician coaching, at least as I have found, for women, right? There are a lot of physician coaches that specialize in coaching female physicians, but there wasn’t a ton, at least at the time that I found it, that was focused on, or even allowed for, men to be involved in coaching.

And we didn’t touch on the fact that I am originally from New York, so I’m steeped with a healthy sense of skepticism and cynicism. So when I heard about coaching, I spoke to a prospective coach, and I was not at all convinced, right? This was not an immediate sell. I wasn’t all in from go. And in my process of saying no to the experience, I was asked one pivotal question, and that was, “If you don’t do this, then what will change?” Right? And it hit me like a ton of bricks that in order to get to where I wanted to be, I had to do something different.

That was the beginning of what turned out to be the transformation that I never wanted, right? This was an experience and a transformation that I never wanted but I needed, and I never looked back.

Kevin Pho: So paint us a picture of before and after. Give us a scenario of what you were like before this pivotal moment, and give us a scenario of what you are like now.

Michael Hersh: Yeah, well, at the end of the day, I’m the same person, right? But I think it is how I perceive different situations, right? Frustrations are normal, right? We all experience them in our day-to-day lives. And this is not to say that coaching got me to a point where I never get frustrated or I never get overwhelmed, but it’s given me a new perspective, right?

If I’ve been away on vacation, and it’s that first Monday back where you’re just dreading coming back and what’s there, I can tell myself, “Yeah, that’s completely normal, number one. And number two, you’ve done this before, and you’ve gotten through it before, and you’re going to get through it today.” Right? So there’s that.

And it’s also how I deal with it when I don’t do things the way that I would want to, right? So if I am frustrated and I don’t respond in the way that I wish I had, I ask myself a couple of questions: What did I do well? What could I have done better? And what will I do differently next time? And then I don’t beat myself up about it, right? I try to learn from it, and I try to move on. I think all of this comes from being curious about why I am doing things the way that I’m doing them, with the goal of doing things better next time.

Kevin Pho: We’re talking to Michael Hersh. He’s a gastroenterologist and a physician coach. Michael, what kind of advice do you have for physicians who were in your before state and really suffering under the weight of all these shoulds and expectations?

Michael Hersh: Yeah, I think it’s just knowing that you have a choice, right? I think suffering under “should” is very disempowering, right? You feel like you’ve given away all of your power to the expectations. Knowing that you have choices, and that you can choose to do things any way that you want, I think is it. And knowing that there is power in that choice is one of the most important takeaways.

Kevin Pho: And my final question: What are some of your take-home messages that you want to leave with the KevinMD audience?

Michael Hersh: Yeah, we are all only here for a limited time, right? This is not a never-ending journey. And so, figuring out what you want in life, creating that for yourself, and never living in the land of expectations and what you think other people will think, because at the end of the day, you’re the one who’s going to look back on your life and wonder, “Did I live my life to the fullest extent? Did I do things my way?” Right? And you don’t want that answer to be no. So now is the time to figure that out.

Kevin Pho: Michael, thank you so much for sharing your story, time, and insight, and thanks again for being on the show.

Michael Hersh: Thank you so much for having me. I really appreciate it.