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In this episode, we speak with Elizabeth LaRusso, a psychiatrist who shares her experiences and insights on the importance of cultivating meaningful connections and holding space for others. She discusses the challenges of learning to hold space for oneself in the face of suffering and offers advice for fellow doctors on how to honor vulnerability, empathize with emotions, and support each other through shared acceptance. Join us as we explore the power of authentic connection in healing and growth.

Elizabeth LaRusso is a psychiatrist.

She shares her story and discusses her KevinMD article, “Leaving The House of God.”

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Transcript

Kevin Pho: Hi, and welcome to the show. Rate and review at KevinMD.com/rate. Subscribe at KevinMD.com/podcast. Today on the show, we have Beth LaRusso. She’s a psychiatrist, and her KevinMD article is titled “Leaving the House of God.” Beth, welcome to the show.

Elizabeth LaRusso: Thanks so much. I’m happy to be here.

Kevin Pho: So we’ll get into the article in a little bit, but first off, briefly share your story and journey to where you are today.

Elizabeth LaRusso: I struggle with brevity, but I’m working on it. I grew up in Minnesota, in Rochester, so that’s kind of the mothership of medical centers, if you believe the Mayo hype. Growing up there, and my dad is a physician, there aren’t that many other career options that one considers, although I really wanted to be a journalist. But I decided for a variety of reasons that medicine was a better bet.

So I went away to college in Vermont. I stayed on the East Coast. I was a history major; I really was not great at science, and so I wanted to study other things. I went back to school after graduating from Middlebury and did a post-bac premed program, and then I ended up going to medical school in Boston.

I’ve always taken a bit of a circuitous path, so I took time off in the middle of med school, not sure that I had what it took to become a doctor, but then realized, once I discovered psychiatry, that I really did. I did my residency in Boston, and it took a little time. I was very fortunate to have my fourth year of residency be able to be completed over two years, so I could also parent my first child during residency. That was a wonderful gift that I wish for more residents. It was very unheard of at the time to have that opportunity.

Then I went to your neck of the woods. I was on faculty at Dartmouth for a few years, and then I was called back to the Midwest, to where my family is. So I’m here, and I have been in Minneapolis now for about a decade.

Kevin Pho: All right. So you are a psychiatrist. Tell me about a typical day in the life, the typical things that you would see on a daily basis.

Elizabeth LaRusso: Oh boy. I mean, my career has been so different than the typical psychiatrist’s, so it’s hard for me to think about how to answer that. I ended up developing a specialization and expertise in perinatal and reproductive psychiatry, while always doing consult-liaison psychiatry, so patients who are admitted to the medical-surgical units who have delirium.

Kevin Pho: What is perinatal and reproductive psychiatry?

Elizabeth LaRusso: It’s a specialization, basically, in women’s mental health: women who are seeking to become pregnant, who are pregnant, or who are postpartum and have psychiatric issues, anything ranging from run-of-the-mill anxiety to postpartum psychosis or bipolar disorder, things like that. There’s a lot of misunderstanding, by psychiatrists and by the world at large, about how to treat women with psychiatric issues during and after pregnancy. There are a lot of misconceptions about medication. A lot of physicians don’t want to work with patients and don’t want to give them the medical care they deserve in terms of psychiatric medication because of misperceptions about it.

Kevin Pho: Right. What are some examples of those misperceptions?

Elizabeth LaRusso: The major misconceptions are, one, that psychiatric illness during pregnancy is somehow a moral failing, or something you can white-knuckle through, and isn’t as deserving of treatment as something like diabetes is. So I would say that’s the primary misconception. The secondary misconception is that psychiatric medications are much more harmful than other categories of medications in pregnancy and really should be avoided.

If you take those two and put them together, that leads to women feeling caught between a rock and a hard place in terms of experiencing their symptoms and getting treatment. It leads to a lot of guilt and shame for a lot of women in making a decision to accept the treatment that is absolutely indicated for significant conditions.

Kevin Pho: All right. And then you said that your career then took a turn, and in doing that, you got into medical leadership.

Elizabeth LaRusso: I always practiced medicine, because I strongly believe that physicians who are leading other physicians need to also be practicing clinical medicine. I ended up becoming the medical director of our department and staying on longer than planned because of COVID, and then really getting, I think burnout is a shorthand term that we use, because people know what we mean when we say burnout, but I would say for me a more apt descriptor would be disillusioned. I became very disillusioned with the American health care system and my ability to impact it in the way that I had hoped.

So I made big changes. I cut back my FTE, I took a bunch of time off, and I went to Peru. I decided that medical leadership was not something that I wanted to devote more time to. I did a writing fellowship, and here I am.

Kevin Pho: All right. So you talk more about that in your KevinMD article, “Leaving the House of God.” How did the article come together?

Elizabeth LaRusso: Well, I had been fortunate enough to do an Op-Med writing fellowship with Doximity, and over the course of a year, you produce six articles. I started out, really, and they were pretty lighthearted and used a lot of humor. Then, as I sort of worked through each essay, I realized how there were things that I needed to process about my experience that I thought would actually be helpful to other physicians too, because I think that there’s a lot that we go through that we don’t talk about. So I started to increasingly write about more personal and difficult topics, like what it’s like to be a leader in medicine and then decide that that’s no longer the path you’re going to follow.

I think one of the things that became so apparent, and I’m not on social media, so I’m on LinkedIn and Doximity, but I’ve never had a Facebook account, and that whole part of the world has really not been something I’ve been involved in, but the beauty of the Doximity experience was that people would post their comments. I would get so many comments from other physicians saying, “Thank you for sharing your vulnerability. Thank you for expressing in words what so many of us feel.” There would be dialogue between docs, and not all the feedback was positive, of course, but I recognized the power of vulnerability when it’s coming from a credible source. That led me to want to summarize my year of articles with the “Leaving the House of God” piece.

Kevin Pho: Now, what part, or what example of vulnerability, did you share that resonated with those doctors on Doximity?

Elizabeth LaRusso: The piece that I had, if you’re interested in it as well, I had titled “The passion paradox,” and they changed the title to “Why I considered taking Depakote Sprinkles.” It was initially a lighthearted piece about how, if you bring too much passion to your work, that is experienced. It was about my experience of the mold for physician leaders in corporate medicine being quite narrow: how you’re asked to show up, how you’re asked to present yourself, and how you’re asked to interact. It was about my struggles to try and really have that be how I brought myself to my work, only to recognize that in doing that, I had lost all the joy and all of the things that made me feel like I actually had something valuable to contribute. So recognizing that organizational leadership was too confining as a way of trying to contribute to the profession that I love deeply, that resonated with so many people.

Kevin Pho: So one of the goals that you had mentioned in your writing was to really share some lessons from your professional story. What other lessons can physicians learn from reading your story?

Elizabeth LaRusso: Well, I think one of the things that I’m reflecting on now is a quote by Rumi: “Yesterday I was clever, so I wanted to change the world. Today I am wise, so I am changing myself.” I wouldn’t go so far as to say I’m wise. I would say that I have gained wisdom over the course of my practice and my personal exploration. I think that medicine is broken. My hope would be that the health care system is not broken beyond repair.

What I’ve recognized, and what I’m trying to learn more of, is how one can develop a healthy detachment from outcomes, such that you choose where you can have the greatest impact and don’t exceed your own limits and give more of yourself than you have to give. So one of the lessons that I would want my colleagues to consider, and it’s been really helpful to me, is really just the Serenity Prayer: “Grant me the serenity to accept the things I cannot change, the courage to change the things I can, and the wisdom to know the difference.” I think too many of us physicians see it as our obligation to solve every problem, or try to solve every problem. I think we need to learn which problems deserve our focus and where we should put our attention.

Kevin Pho: How can we go about doing that? How do we prioritize the problems in health care and choose which one to fix? When you say that health care is broken, that could be taken in so many different ways. There are so many things wrong with our health care system. So when physicians are confronted with that issue, how can they go about picking and choosing which approach to take, what problem to fix, and how best to spend their energy?

Elizabeth LaRusso: If I had that answer, I would probably not have to practice psychiatry anymore, because I’m sure it would be a lucrative kind of bullet. But I would say I can’t answer that for anyone else. What I can say, as a psychiatrist and as someone who believes that we have not only an opportunity but an obligation to know ourselves, is that it starts with each individual deciding to direct their attention internally: knowing themselves, learning truly what gifts they have, what they want to offer, and where they can make the most impact, and asking themselves what cost it’s taking from them. That is really how each person goes about starting to answer that question for themselves.

I think we are so good, as doctors, at diagnosing other people’s problems and telling other people what to do, and I think many of us are extraordinarily disconnected from our own experience and our own needs. So I would say that each individual should consider starting there.

Kevin Pho: As you were sharing your story, you mentioned it was a circuitous route. If you were to replay your entire professional career again, is there anything that you would do differently?

Elizabeth LaRusso: You know, I guess I would frame it a little bit differently. I can’t say a specific thing, because all of our experiences combined to make us who we are, right? What we choose to learn and take away from them is ours to choose. So I can’t say I would change anything. I would say I wish that I had learned earlier to respect my own limits before I had exceeded them. I wish that I had learned that working hard isn’t the only path to having a contribution or creating meaning. And yeah, I wish I had sort of had that insight and wisdom a little bit earlier in the game.

Kevin Pho: Now, for those early-career physicians who do believe that working hard is perhaps the only way to make that difference, what kind of wisdom can you impart to them to let them know that there are other ways to make a difference in our health care system?

Elizabeth LaRusso: I would never want to suggest that, as a physician, one shouldn’t work hard. That is, you know, the warp and weft of our vocation and the oath that we take, etc. I think that for a lot of physicians, and I don’t know how this plays out for early-career physicians, honestly, because I think early-career physicians are a different generation, and they’re coming with a different understanding, perhaps, of their role and the exchange that they enter into when they’re becoming a doctor.

But I think a lot about a surgeon that I had in my clinic who was thinking about leaving medicine, was very much struggling, and said, “You know, our family’s motto has always been that the hardest path is the right one.” I talked to a friend of mine who’s a therapist, and we were talking about this, and she was like, “Wow, time to get a different motto.” I was like, “Well, I guess I would look at it differently.” I would look at it as, for many physicians, not working as hard is the hardest thing, and learning that there are different ways of contributing. It may not always be taking the next patient, or taking another shift, or deciding that everything’s your responsibility. It may actually require backing off a little bit and putting your time and attention elsewhere. I think for many of us, that’s a harder lesson than the working hard that we’ve been trained to do.

Kevin Pho: We’re talking about Beth LaRusso. She’s a psychiatrist. Her KevinMD article is titled “Leaving the House of God.” Beth, what are some of your take-home messages that you want to leave with the KevinMD audience?

Elizabeth LaRusso: My take-home message is that connection heals. I believe that this is true in the doctor-patient relationship. I believe that this is true in our relationships with each other. And, most importantly, the primary source of connection, I think, is connection with ourselves. If we do not have an authentic connection with ourselves and our internal experience, we can’t really show up in an authentic way for others, and we’re limiting what we can contribute to the collective.

So I would encourage my colleagues to look at the opportunity that they have to cultivate awareness of themselves, their relationships, and where they can expand their connection, because in my view, this is something that each of us can do that ultimately, even if it’s not quantifiable, will lead to some improvements in what otherwise is a broken health care system.

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

Elizabeth LaRusso: Thank you so much. It was a pleasure.