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“We are in an epidemic of gaslighting in medicine. The best definition I heard of gaslighting is transferring your authority on yourself from you to someone else. We give up our authority on ourselves to everyone else but ourselves. We leave our feelings of work ethic to our current culture: we are lazy if we don’t step in line and do everything asked of us. We are told we aren’t worth our salaries as physicians are replaced with less expensive nurse practitioners and physician assistants. We are told our education is not important as the public ignores our expertise, and the judicial and legislative system tells us they know better for our patients. And it is somehow our fault, or at least we are left to deal with it. Show up and work hard to pay outrageous student loans gathered in pursuit of the cause. I don’t know the right answer for all of this. But I do know where we need to start.”

Amy Vertrees is a general surgeon and founder, BOSS Business of Surgery Series.

She shares her story and discusses her KevinMD article, “A call to stop overworking.”

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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 we welcome back on the show Amy Vertrees. She’s a general surgeon. Her KevinMD article is titled “A call to stop overworking.” Amy, welcome back to the show.

Amy Vertrees: Thanks, Dr. Pho. I really appreciate you having me back. You know, I’m a huge fan of your mission of letting all these stories that we see every day be shared, so we can kind of all learn from each other.

Kevin Pho: Perfect, and thank you so much for continuing to come on. I think this is our third episode together, and if you want to read more or hear more from Amy, just search back to her prior episodes.

Amy, so we’re going to go right into your latest KevinMD article. It’s titled “A call to stop overworking,” and that is sure to resonate with a lot of physicians. So walk my audience through that article and tell us why you decided to write it.

Amy Vertrees: Great. Yeah, it’s so interesting. I’ve been a coach for two years, and the one thing that’s been consistent is that everyone is just burned out and overwhelmed and not exactly sure what happened, where to start, or where to stop, actually. And I’ve been really tracing it back to why everyone is overworking.

For one thing, we feel like we just have to. Especially in these strange times of COVID, there’s a lot of short staffing, so there’s certainly the pandemic issue. But I think there’s also this general culture of overworking, especially with surgeons. Through my training, we were always taught to own the patient, that you were weak if you weren’t following everything. You had to know everything about the folks, and the handoffs were something that we just didn’t do as much.

Now we’ve transitioned into the 80-hour work week, which was a challenge in itself. I think our handoffs got a little bit better. There were still issues, obviously, that came up, but I think in that generation we got a little bit better about handing off and letting go of someone. But that creates, I think, other issues too. So now we are able to hand off, but then there’s guilt with it too: Maybe I shouldn’t. What are they going to think of me if I hand this person off?

So there’s a culture of never being able to let go, because we think that it means something about us. And we also think that the patients need that from us, that we have to be there all the time, that our presence is necessary, otherwise they won’t think that we care, and that we feel responsible. It’s all these thought errors over time that have led us to this culture where we’re just not looking at it from a perspective that’s a little bit different.

I think the millennials have a little bit better perspective, some freedom from this, but there’s still that underlying idea that you’re lazy if you don’t do all the work, you’re irresponsible if you don’t manage everything, and if you’re going to help someone, you’re going to be dumping on them. All these things are in the back of our mind, maybe not even consciously.

I’m even discovering this with people who are mid-career who are working on something, and they’re saying, “Maybe I want to do something outside of surgery.” So they’re finding some of these things. I’m working with someone who’s working at an ergonomics company, and she’s like, “I just feel like I’m doing it wrong because it’s fun.” This idea that work has to be hard, that it has to be overwhelming, and that it has to be just a general hustle culture is something that seems to be just pervasive in our culture.

Kevin Pho: So through your coaching practice, or even through your experiences as a surgeon, give us a story or an example that really illustrates that culture of overwork.

Amy Vertrees: Oh, I think a lot of it is the idea of going on vacation and stressing about it too. We all need to go. Especially if you have a complex patient, and this could be a surgical patient, but you can see it with any medical patient too, when you have these relationships with someone, you operate on them, and especially if there’s a complication, or it doesn’t go as well, or the underlying medical problems are just overwhelming, you know, of course, it happens like an hour before you’re supposed to go. And so now it’s, “Should I go? My partner’s going to think I’m dumping on them.” All the thoughts that come up lead to a ton of stress.

When I work with folks, we look at that and say, “Look at it from your colleague’s perspective. How do you feel when something comes up last minute?” “Well, of course I would help them. Of course I would want them to go on vacation. It’s important.” So we’re very good at looking at other people’s perspective and not good at looking at ours.

So it’s usually the partner worry, but then there’s also the patient worry. And that’s actually really helpful in taking time off, but also with complications too, when we ask ourselves, “What do the patients really want from us?” We think that we should be at the bedside doing everything for them, but really, what they want is to know that they’re taken care of, they want to know what’s going on, and they want to know that we care. And that actually does not have to be in physical proximity.

When I work with folks, we consider those two things. The first is, what is your concern, or what do you think their concern is, and how could you address it, especially ahead of time? If you’re worried that your partner is going to think you’re dumping on them, then you call them and say, “This came up, and I really need to go. I don’t want you to think that I’m dumping on you. What are your thoughts?” And we will almost always get reassured, with them saying, “Oh, no, don’t worry about it. I’ve got it.” We worry far more than we should.

And for the patients too, a lot of times, if we’re worried what they’re going to think of us, we may avoid it. We may just kind of go and let someone come in, and try to avoid that interaction that we think is going to be uncomfortable, saying, “Look, I’m not going to be here tomorrow.” But I think that if we are certain that it’s OK, then we can convey that as well, and also remember what they want. So if you’re going out of town, say to a patient, “Everything went fine. Here’s the current situation that we have. I just want you to know I’m going out of town. This was always planned, but I have complete faith in my partner.” You transfer your trust onto the partner, and that is going to be fair for your partner, it’s going to be fair for your patient, and it’s really working with the underlying current of what they really want, which is just to be taken care of and know what’s going on.

Kevin Pho: So to travel the path to become an attending, as you know, is a very rigorous path. You have to do rigorous premedical training, medical school, residency, and fellowship, and I think that sometimes self-selects people who are more prone to overwork. Now, from your experience in coaching, how difficult is it for your clients to really let go of that mentality?

Amy Vertrees: I’m talking from personal experience, especially when you overwork. I mentioned this in the growth days article: We let go of a lot of things that we don’t want to do. We may not want to socialize with other people, or we may not want to do some of the other daily activities or housework, and so work sometimes is a bit of an escape for us too. So one is, we think that we have to do it, and then the other thing is, it allows us to do things that we don’t want to do, typically. And it just becomes a bit of a habit, and we get this feeling that we’re going to be lazy if we don’t do something. So there are certainly a lot of incentives for working: to avoid criticism, but also to avoid other things that we don’t want to do.

And I know when I have had days off, sometimes those are really stressful if I have not planned ahead. I mean, if you’re so used to going and you pause and stop for a minute, there’s all the negative chatter that happens in our mind about what we should be doing. Especially if you’re high-achieving by nature and you have a ton of things going on, you likely have a lot of things that are unfinished, and so these little vacuums of space can be ways for us to worry about all those things that we’re not doing.

Kevin Pho: So let’s talk about a path forward. If I’m a physician who is more prone to overwork, with difficulty letting go and difficulty handing patients off, what are some paths forward? What are some solutions that you can offer?

Amy Vertrees: I think a great thing is to practice with some days off, just in general, you know, during the week. That’s the growth days article I wrote back in February 2021, which is just a practice of saying, “I’m going to take this day off just for catching up.” So catching up is one thing, and giving yourself some space, because a lot of times we’re not giving ourselves space to plan ahead and do these things, and so to create systems that allow us to be more efficient in work.

The next part is just to understand what we really want and why we aren’t doing it. If I really want to go on vacation and I really hate that I feel terrible about it, it’s asking myself why. What are my concerns? It’s really sitting down and asking what my concerns are, and working with a coach too, because a lot of times we don’t even know what our thoughts are that are holding us back.

I’ve had several light bulb moments recently with some folks I’ve been working with, where I say, “Well, I can’t do this. It’s not hard.” Like, so work has to be hard. I told someone that my goal in life right now is to never work anymore. So I’m not going to work anymore, meaning that I’m going to enjoy everything that I do, and recognize the fact that it doesn’t have to be hard to be worthy. And that’s something I think our culture has really, we don’t even realize how ingrained it is.

Kevin Pho: How hard is it to change that culture? Because I think that a lot of medical culture still embraces overwork, and when people schedule growth days or set boundaries, there’s a little bit of pushback from the medical establishment. So just from the clients that you coach, do you feel like there’s pushback when they implement some of the suggestions that you articulate?

Amy Vertrees: Yeah, I think the vast majority of the discomfort is internal, but there are certainly going to be people who say, “You know, I had to overwork. Why can’t you overwork?” And forming boundaries is just uncomfortable, you know? But I think if we communicate why, then it’s not so difficult. Like we said, “I’m leaving on vacation, and you’re covering,” you know, that is going to lead to some unspoken things or some assumptions, and I think if you consider the other person and explain that.

I think the most important way to change the culture is that we give permission to each other. Because if I say, “I really appreciate you covering for the vacation, and I’m looking forward to covering for you too, because I know, I’m sure there’ll be a time when you’re going to worry, and I don’t want you to worry,” it’s giving permission to ourselves. But I think that we need to start communicating. We need to be telling everyone ahead of time that they could do that and giving permission, because we don’t even realize that that’s what we’re looking for: permission to do it.

Kevin Pho: So when you say giving permission, how long does that process take? Because a lot of physicians still have that ingrained memory, like you said before, that we have to care for patients 24/7, that we have to be available 24/7. How long is that transition to this new mindset? Is it something that takes a course of months, years? From your experience, how long does it take to kind of make that subtle shift?

Amy Vertrees: I would imagine a couple of months as you learn your internal dialogue. Someone who’s been coaching for a while or working on it, who is familiar with listening to the thoughts that come up, probably would catch on a little bit quicker. A lot of people have never even thought about this idea that our thoughts lead to an emotion, and our emotion leads to an action, or actually gives us the results. You know, we don’t even think that we’re being driven by these internal dialogues. So I think it takes a couple of months to start tuning in to some of this negative chatter, because we don’t realize that’s what’s driving us, and so it depends on where you are in that mindset journey.

The other aspect is, I think everyone wants to help, and when you do communicate, it’s a great idea. But so many times I’ve seen, like, “Oh, you really need to take some time off, but before you go, if you can, make sure to call these people and follow up with all these results.” And so in some ways, you know, we’re like, “I know I need a break, but I know I can’t take it right now.”

There was a period of time of about two weeks where I was completely overwhelmed. Call happens. Some calls are easy, and some, you just have a terrible, awful stretch. In that particular time, if you don’t have a backup, if you don’t have anyone to give that to, some things have to give, and it’s getting better about asking people for stuff.

And if you find yourself really, I called it, crispy around the edges, it’s to really hyperfocus on the task, because you can spin yourself into overwhelm. So I think if you find yourself completely overwhelmed, just really hyperfocus on the task and say, “All I have to do is write the orders right now, and then I can take a deep breath. And all I have to do is this.” And then after the fact, if you have to just push through for a short period of time, look back and say, “How can I fix this? Can I spread the call schedule out more? Can I ask to take less?”

And we have to deal with all that internal drama, you know, the scarcity of less money available, and, you know, “What if people think I’m lazy?” Those things are going to come up, and someone may actually feel that way, and that, with boundaries and dealing with the culture, is a little bit uncomfortable.

But I think the more that we pause, ironically, the more that we take some time off, and I’ve seen this myself, when I take off, I can come up with protocols that I couldn’t if I’m drowning. I’ve paused, and I’ve met with my office staff, and I’ve created a checklist. Atul Gawande had a great book called Checklist, talking about the airline industry, where the more organized you are, then you don’t have to have things drop.

And I think this is where the danger comes in: When we’re in hustle culture and when we’re working, then we make mistakes, which cost us more time. And we also use these as evidence to tell us how terrible we are. Once you kind of start spinning into that cycle of “I feel terrible, and now I’m making mistakes,” and now you have proof that you’re terrible, it’s a cycle that is even worse. And this is what is hard to recover from, when you truly make mistakes based on not having any time to breathe.

Kevin Pho: Now, do you have a case study or a success story, maybe a before-and-after scenario, where a physician was guilty of overwork and you made some changes, and now their professional life has changed? What is the success story that you can really tell my audience to illustrate that point?

Amy Vertrees: Oh, I can tell you my own. Yeah. I started a private practice two years ago, and the benefit was I could choose all the people around me. I was able to work with them because they report to me, rather than being employed, which was a little bit frustrating. In this particular instance, I was able to put systems in place.

I was just joking with someone yesterday: I watched an entire season of Schitt’s Creek finishing notes one day, I had that many to do. And I don’t watch TV anymore, because I actually finish my notes ahead of time. So there’s the amount of free time that I’m able to have by delegating tasks to other people. And the people that are there to help us really want to help us.

When we get so busy, if we don’t take these little times to be kind of the CEO of our practice, then what happens? What happened to me is I was feeling like I had to do everything myself. I felt like I had to call all the patients, and then I would make a mistake, and it would be worse. They weren’t sure who they called, and they thought I called, so they didn’t. And then a patient didn’t get notified, and then I mixed up two patients, and I called them with the wrong results. That was a real wake-up call for me, because it’s like I’m actually causing harm by trying to do everything myself, and people are here to help.

And, you know, making those mistakes made me feel terrible, made me not want to do this anymore, and made me feel terrible about myself, because now not only could I do the job that I really loved and was good at, but now I don’t want to do anything else, because I didn’t trust myself.

And taking that journey, and, I think, being really present with how I felt each step of the way, like when I was overwhelmed with work and when I was really, you know, low, feeling that I was making mistakes, and being present with those and realizing that there’s nothing wrong with me, that I had a way out. And that’s how I work with folks. I usually share my story so they can kind of see themselves in that, and then help them with whatever their specific underlying thoughts are. I have several success stories, but mine I know most readily because I lived it.

Kevin Pho: We’re talking to Amy Vertrees. She’s a general surgeon and physician coach. She wrote the KevinMD article “A call to stop overworking.” Amy, what are some of your take-home messages that you want to leave with the KevinMD audience?

Amy Vertrees: It’s to pay attention to what you’re listening to in your mind. Why are you not doing what you want? Why are you working when you know that you don’t want to? And you have permission to stop. Everyone needs you to stop. Your patients do, your family does, the people around you do, and you do. And it’s OK. Nothing’s going to happen. In fact, you’re going to be better off. And this life is short, so really take the time to get help if you need it, from a coach or a trusted colleague, and find ways to do less. You’ll actually be much better off.

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

Amy Vertrees: Thank you so much.