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“Work dread. Even if you didn’t know it had a name, you know the feeling. It is that sensation in the pit of your stomach when you realize that the start of your workday or workweek is fast approaching, and you don’t want it to come. Sometimes it begins on Sunday afternoon when you want to be enjoying time with your family. Other times, you might find yourself sitting in the hospital or clinic parking lot, resisting the beginning of another busy day. Maybe you sit in your car for an extra 10 minutes and allow yourself to finish a podcast episode. Or perhaps you doomscroll on Facebook for a few minutes before taking a deep breath, getting out of your car, and starting your day.”

Michael Hersh is a gastroenterologist.

He shares his story and discusses his KevinMD article, “The epidemic of work dread.”

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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 to the show Michael Hersh. He’s a gastroenterologist and a physician coach. His latest KevinMD article is titled “The epidemic of work dread.” Michael, welcome back to the show.

Michael Hersh: Hi, Kevin. Thank you so much for having me back on the podcast. I’m very excited to be here.

Kevin Pho: So for those who didn’t get a chance to listen to our first episode together, just briefly share your story and journey to where you are today.

Michael Hersh: Of course. So I am a hospital-employed gastroenterologist and a physician coach. I’m also a husband and a dad to two elementary school-aged kids. And I’ve really spent the last couple of years trying to figure out how to wear all of these many hats and really how to balance all of my different roles. As far as my medical practice goes, I’ve been in my current role for the last 13 years. What I joined was this very small medical group that over time has blossomed into this much larger, multispecialty, multi-hospital organization. And with those changes, there have come a lot of opportunities for my career, but also a number of challenges.

And so, as my roles at work and at home expanded, and as the challenges grew, so did the stress and the overwhelm and the burnout. And as a result, I started trying to explore ways to escape medicine. In my mind, I was almost vilifying medicine and idealizing retirement. And so I found the financial independence, retire early movement and started working harder to try to escape medicine, and all that ended up happening was I increased my stress and my overwhelm and my burnout, and I was reducing the time that I had for my greatest priority, which was my family. And that is when I found physician coaching, which really helped me to examine some of these issues and the priorities and the stress and the overwhelm, and it really changed the trajectory of my life.

Kevin Pho: So what did that look like before you found physician coaching, when you felt overwhelmed and you felt like you wanted to villainize medicine? Tell us a couple of stories that would really paint a picture for us.

Michael Hersh: There were just always ideas that I had of ways that I could make my day more effective, right? So I would have an idea that I wanted to change the way that I was receiving messages, or how I was getting calls from patients. And I would get these looks from administrators, head nods or things, kind of a sense of acknowledgment that they were listening, but nothing ever really changed. And I think that that was a huge source of frustration, that every time I kind of had an idea about how we could move forward, to make the practice of medicine more effective, more streamlined, and better for myself and for the patients, nothing was changing. And I think that that just increased the frustration and the stress and the overwhelm.

Kevin Pho: So when you brought these ideas to the hospital leaders and administrators in general, you said nothing would get done, but what exactly were their responses?

Michael Hersh: Things along the lines of “We’ll look into it” and “That’s an interesting idea.” All of the things that, you know, are ways of kind of recognizing what you’re saying, but also brushing it off.

Kevin Pho: And you talk more about that in your KevinMD article, titled “The epidemic of work dread.” So you’re feeling these emotions, and you said you were villainizing medicine, and then you found physician coaching. So tell us what happened next.

Michael Hersh: Yeah, so what I would say is I would have all of these ideas about how I thought my day should go, and it wasn’t going that way. And so what ended up happening is I started dreading work altogether. And it was impacting not only my time at work but my time when I wasn’t at work. So I found my Sundays were filled with dread. I was already thinking about how my week was going to go, and I was kind of frittering away the precious free time that I had dreading my impending doom, if you will, when I went back to work on Monday. And then I would get to work, and I would find myself sitting in the parking lot, doing everything I could to avoid getting out of my car. I would finish listening to my KevinMD podcast or finish listening to music or doomscroll on social media. And I was just delaying the inevitable of getting out of my car and stepping foot inside to do the job that I was there to do.

And so I brought that frustration to a coaching session, and I was asked this question. It’s not the most eloquent question, but it really was eye-opening for me. And the question was, “If somebody came to you and they complained that they were in pain, and when you looked at that person, you saw that the reason that they were in pain was because they were punching themselves in the face, would you tell them? Would you tell them that the source of their pain was because they were punching themselves in the face?” Of course, of course I would tell them that that was clearly the reason that they were in pain. And the coach looked at me and said, “Michael, you are punching yourself in the face.”

And it was kind of a mic-drop moment, because I hadn’t really thought about how I was thinking about my day, and how that was the underlying source of all of the dread that I was feeling. And so, of course, I realized that I was focusing on all of the most negative aspects of my day, and that I was dreading the day. And when you think that it’s impossible to be happy as a physician in the current health care climate, of course you’re going to dread going. Of course you’re going to be looking for ways to escape medicine.

And so the article was really about learning how to reframe the challenging aspects of our day, right? So when I think about peer-to-peers and patient satisfaction scores and quality metrics, I actually have to resist an eye roll, right? I think of those things, and then I want to roll my eyes. But when you remember that when you get to work, you get to change lives, you get to provide care for a lot of patients that are truly grateful to have you, then you stop trying to run away from the things that inspire you. And you get to enjoy work again, and you get to stop dreading it.

Kevin Pho: So tell us a little bit more about that process. So you went to that physician coach, and after that coach gave you that mic-drop moment, you decided to reframe it and focus more on the positive. So that sounds great, but tell us exactly how you did that. Take us into the nuts and bolts of what exactly you did.

Michael Hersh: Of course, yeah. And I want to pause and say that it’s not only about focusing on the positives, right? So I think the key here is, number one, having to recognize what the underlying issues were. What was I dreading, right? Because I don’t even think I knew. I had this overriding sense of dread, but I don’t think I had ever taken a moment to examine why. What was it about the day that I was dreading? And then once you can know what it is about the day that you’re not looking forward to, you can dig into it and discover why. OK, so why am I dreading this thing? Why am I dreading this peer-to-peer that I have this afternoon? What is it about that, right? And once you can learn to recognize those things and dig into them, you reclaim your power, right? And you get to think about the peer-to-peer in a slightly different way.

And then the other aspect of that is the frustration, right? So I find some of these things to be very frustrating. But I also think we have a sense that frustration is bad, right? That we’ve already struggled enough to become physicians, so I shouldn’t have to feel frustrated anymore. But the truth is, you get to feel frustrated, and that’s OK. Being frustrated does not mean that you’re not a good doctor or that you are any less of a person. Leaning into the frustration and remembering that frustration can be a tool that helps you to effect change makes all the difference in the world.

Kevin Pho: So tell us how you wear those hats now. You introduced yourself as a physician and as a father, and you wore so many hats. So now, after this mindset change, tell us about your life now.

Michael Hersh: Yeah, so I think that this is an ongoing journey, as it is for all of us, right? Because as your roles develop over time, you get to choose how you spend your time and how you see yourself. And so I think the most important thing for me was learning to recognize the choices that I’m making, right? And so I get to choose to go to my job every day, right? That is a choice that I make every single day, and I get to choose to focus on my patient satisfaction scores or quality metrics, or I get to choose to just be a dad. And I get to choose to take a day off and spend it with my kids and not log in to the EMR to see what’s there.

And so I think that’s how my life is different: It’s coming from a more empowered place of recognizing the areas of my life where I have choices, and then also remembering that each thing I’m doing is a choice. And at any point in time, I can change my decision.

Kevin Pho: We’re talking to Michael Hersh. He’s a gastroenterologist. We’re talking about his latest KevinMD article, titled “The epidemic of work dread.” So, Michael, we have a lot of clinicians, of course, who were in your position, as you described before: burned out doing prior authorizations, struggling with the electronic health records, struggling with work-life balance, and not quite knowing where to go next. So in terms of immediate next steps, what kind of advice can you share with these clinicians?

Michael Hersh: Yeah. I think, first and foremost, our time is way too limited and too precious to waste on dread, right? So recognizing that it’s there is the first and foremost, most important thing. And then you want to take a moment to remind yourself, “My work matters.” Focus on the fulfilling aspects of your work. Stop trying to escape this moment, hoping that the next one is going to be better, right? Learn to enjoy this particular moment.

And for some people, for me, that involved slowing down a little bit, right? I was racing towards something, and it took slowing down to realize that the person I was in a race with was myself. I was creating my own struggle. And all of that starts with just recognition, with understanding that this is what’s going on. I think so many of us are in such a rush that we forget to stop and examine how we are in control, right? And then the key thing here is also frustration. It’s OK to feel frustrated. You can feel frustrated and still make an incredible impact. So just take a moment, slow down, and examine what’s going on.

Kevin Pho: Wonderful advice. And sometimes, when I get frustrated dealing with all the things that you describe, we just have to realize that, as physicians, there are really very few professions that can make as big an impact on someone else as we do in exam rooms today.

Michael Hersh: 100 percent. Absolutely. And even when you say that, it puts a smile on my face, because it’s so true, right? I will say one other aspect here is that I am the kind of person that, when a grateful patient says, “Oh, thank you. You’ve done such a great job. You’ve been such an important person for me,” I would say there was a point in my life where I was still just rushing out of the room while the patient was mid-compliment, right? Where I was just like, “Thanks so much,” and then moving on to the next thing.

And I think, if you can, stay in that moment to actually experience the gratitude. Here is a person who is putting themselves out there. They’re being vulnerable with you, and they’re thanking you for the work that you have done. Take a moment to really hear them, because I think so many of us are in such a rush to just get through our day that we miss that important moment. It’s important for the patient who’s taken a moment to share that with you, but it’s important for you too. And it will help you to kind of overcome some of the other challenges throughout your day.

Kevin Pho: And my final question, Michael: Any take-home messages that you want to leave with the KevinMD audience?

Michael Hersh: Yeah, I would just say be curious with yourself. When you’re experiencing work dread, take a moment to explore why. What is it that you’re dreading, and why are you dreading it? And is there some aspect of that dread that could actually be a gift? Is there some part of that thing? Maybe you don’t enjoy the whole thing, but maybe there’s some part of it that you enjoy. What is that thing? And then always recognize that you are making these choices, and at any point in time, you can choose something different, and you get to decide. It’s so important to just stay in your power and not in victim mode.

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

Michael Hersh: Oh my gosh, thank you so much, Kevin. I really appreciate everything.