Why work shouldn’t define your self-worth [PODCAST]

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In this episode, we are joined by Tracey O’Connell, a radiologist and physician coach, to discuss the pitfalls of “do what you love” as career advice, particularly for college graduates. We explore the role of love in our career choices, whether it be a love for intellectual content, patients, being needed, feeling useful, the paycheck, or social capital. We also dive into the challenges of prioritizing productivity over personal well-being in the medical field, where burnout and The Great Resignation have become prevalent. Tracey shares the struggles of finding self-worth outside of work. We also touch on the importance of sustainable well-being and developing emotional tools to support oneself. Join us as we explore the complex relationship between love, work, and self-worth, and ask the question: Did you choose your career because you loved it or because you couldn’t love yourself if you didn’t?

Tracey O’Connell is a radiologist and physician coach. She can be reached at her self-titled site, Tracey O’Connell, M.D.

She shares her story and discusses her KevinMD article, “Who do we become when we love work more than we love ourselves?”

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Transcript

Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast and get CME for this episode by clicking on the CME link in the show notes. Today we welcome back Tracey O’Connell. She’s a radiologist and a physician coach. Her KevinMD article is titled “Who do we become when we love work more than we love ourselves?” Tracey, welcome back to the show.

Tracey O’Connell: Thanks so much, Kevin.

Kevin Pho: Well, we were talking offline about how it was almost two years ago since you were last on. Now, for those who didn’t listen to our first few episodes together, just briefly share your story and journey to where you are today.

Tracey O’Connell: Right. So I’m trained as a radiologist, a musculoskeletal imager, and I still do teleradiology a few hours a day. But I left a toxic private practice situation almost six years ago now, and since then I have really done a lot of reflecting on what worked and what didn’t work in that career. Now I really work with others to foster sustainable well-being in health care, whether they’re radiologists or even teenagers, just helping people to create lives that are more sustainable from the inside, and in how we show up at work.

Kevin Pho: Now, we last spoke, like I said, about two years ago. From a coaching standpoint, have you noticed any trends that have emerged over the last two years since we last spoke?

Tracey O’Connell: Definitely. Definitely more and more people are seeking coaching and seeking consultation, and being much more willing to talk about what’s missing. I think, thanks to you and your show and the contributors and the articles, your space has really been one of the only, shall we say, psychologically safe spaces to really share what’s true on the front lines and in people’s personal lives. The Great Resignation, the great alignment, people figuring out what they will and will not tolerate anymore, learning from each other, and recognizing what used to be in secrecy. And I mean, certainly the pandemic brought out a lot of this, but much of it was already there; it just became more than people could tolerate. And so avenues like your programming have definitely given people the skills and the confidence and safety to go ahead and seek something else, and to talk about what’s really happening for them in their lives.

Kevin Pho: Now, when you encounter health care workers who come to you for coaching services, what would you say is the most common reason that propels them to seek you out? Is there normally a singular event? Has it been something that’s been built up? What would you say is the most common story that you hear from people who engage you for coaching?

Tracey O’Connell: Well, I’ve really narrowed it down into broad categories. The things that people almost always present to coaching for have to do with their self-worth and setting boundaries: recognizing that there’s something that doesn’t feel right inside of themselves in how they’re showing up every day, or that the way they’ve previously been getting self-worth is not working anymore. And then figuring out, “Wow, what do I do about this? I recognize that something is not OK, and I want to do something about it, but I don’t know what to do about it.” And how to speak out comfortably, or have the confidence, security, and self-worth to talk about and set what’s OK and not OK for them, and kind of face the consequences of what that might bring.

Kevin Pho: And you talk more about that in your KevinMD article titled “Who do we become when we love work more than we love ourselves?” Now, for those who didn’t get a chance to read that article, how did it come together?

Tracey O’Connell: Well, I was gardening. This was almost a year ago, and it was around graduation, and someone sent me an article from CNN.com. I have the title here. It was an opinion piece written by Carolyn Chen, and it was entitled “Why ‘do what you love’ is the worst graduation advice.” It was targeted toward college graduates, and so it was already selected for folks who have had the opportunity to go to college. I opened the article thinking this was going to be something that says it’s impractical to do what you love, or asks how we can follow passion when we don’t know what our passion is.

But it was interesting, because the article was talking more about, you know, I thought it was going to be about wages. And certainly, I want everyone here on this podcast to know that I understand that most of us work because we need to make an income. So when we’re going to be talking about whether we love what we do, that’s always a caveat for people, like, “Well, if I won the lottery, maybe I wouldn’t work.” Some people say, “I would work anyway.” But I think what was interesting is that the author ended the article with this: “I certainly don’t want you to hate your job. Work is an important source of dignity and meaning for all of us. But to love smart in our work-obsessed world, we need to ask ourselves instead, who do we become when we love work too much?”

And this got me really thinking, because my kids are now 23, 21, and 17. So at that time I had a son who was graduating from college, and now, a year later, I have a daughter who’s about to graduate from high school. That article, and my own career experience, and my kids being those ages, and the roles that we play in helping to guide others not to make the same mistakes we’ve made, really got me thinking about how much love plays a role in what we choose to do in medicine. Are we doctors out of altruism, or is it egoism? Are we doing this to make others feel better, or because it makes us feel better about ourselves? And then, how is doing good for others sustainable?

We all know about compassion fatigue, we know about imposter syndrome, and we know about burnout. But then, when people do leave these positions, or when they come and we talk about setting boundaries, or leaving their work, or pursuing something different, then there’s this kind of identity crisis: Who am I if I’m not a doctor? And what am I worth? I’ve invested so much of myself, not just time, hours, energy, resources, and money, but social capital. There’s identity. And so I really got to thinking: If work defines you, who are you without it? And did you choose medicine because you loved it, or because you couldn’t love yourself if you didn’t?

Kevin Pho: So when you talk to all these physicians in your coaching, I’m sure there’s a spectrum, right? There are going to be physicians who see medicine, of course, as a calling, and that’s all they’re going to do. And then you’re going to see physicians, certainly on the other side of the spectrum, who see medicine more as a way to make a living. So what kind of conclusions have you come to when you’re talking to the spectrum of physicians during your coaching, and how they answer the questions that you just brought up?

Tracey O’Connell: Well, I think I see a biased group, right? Because the people that actually show up for coaching have already decided that they’re willing to take some kind of a step forward. I think that, you know, we’ve all sacrificed for what we believe is more important than our well-being to get where we are. And you can do that. You can sacrifice your well-being for a really long time, for decades even. But eventually, you know, something happens. It’s either a confrontation with self, or a confrontation with a work partner, or a health issue, or a relationship that’s falling apart. I think what most people are finding is that, at least the way that the system is set up now, our brains haven’t evolved, and our physiology and bodies have not evolved, as fast as technology and all the demands on us.

And so I think that the underlying issue is this self-worth issue. You can do all the things and juggle all the stuff to feel like you’re enough, but at the end of the day, you’re still confronted with this: Who am I? What am I worth? Who am I if I’m not a doctor? Who am I if I’m not good at everything? I saw this great meme the other day that said, “Worry about your character, not about your reputation, because your character is who you are, and your reputation is what others think of you.” I’d never thought about it quite that way before. Character is the mental or moral qualities that are unique or distinctive to an individual. And then we get into reputation, which is what other people think of us, or what’s earned, or shaping our behavior to evoke a specific action from others and play a role.

And it’s interesting, because my daughter is into theater, and so I was thinking about that. You say this person or that character had these qualities, or you say, “The role I’m playing in the show,” or, “What character are you playing in the show?” I get really into words and language, and I was looking up the difference between character and role, and then also authenticity, right? Because if you play a role really well, it looks as if you are the person that you’re playing. And so self-worth is that character, those values, those qualities that underlie who you really are, and that, I think, gets skipped in medical culture.

And this is also the conclusion I came to by raising my kids at this age. Having a child who’s 23 and another child who’s 21, I think about myself being 22 when I started medical school. You think you know everything, right? But we all know, through the retrospective scope, we didn’t. And then I see their own struggles with self-worth right now, in choosing careers or choosing relationships, and I feel sad for my younger self, because at 22 I was dealing with all those same struggles that they’re dealing with, but they just kind of got put on the back burner for 30 years, or at least 25 years, while I felt that everything else I was doing was more important than maybe the things that are my character.

And we talk about moral injury here in your programming, and that idea really comes down to: What am I doing that’s not in my character, that I don’t believe in? Whether it’s a procedure that I don’t believe is necessary, or whether it’s “I really value my family, but I’m showing up every day for strangers.”

Kevin Pho: Tell us about the long-term consequences for physicians who subjugate their self-worth, perhaps because of their career. From what you’ve seen, what are the long-term effects of that?

Tracey O’Connell: Well, lots of health consequences, personal health consequences, right? People not going to the doctor until it’s too late. I really do believe in Gabor Maté’s research, or books, or what he’s learned as a physician, as a family doctor and then as a palliative care doctor. His observations are that denying the self, denying compassion for the self, really leads to illness on a cellular level. And even though we can’t say, “Oh, your cancer was caused by that traumatic event in your life,” he has said that he has yet to see cancer in someone who doesn’t have a history of trauma. And so I think that the trauma of physicianhood, as my friend Melissa Hankins talks about, takes a really huge toll.

The way that it usually shows up is people thinking that they’re juggling everything just fine, but then they have that Jenga tower, where that one thing goes, and then everything goes. But then there’s a huge fear component, because when we’re feeling amazing, and when we’re feeling altruistic or egoistic, and everything’s going well, that feels sustainable, and it feels rewarding, and it feels like you’re master of the universe. But then what happens when the tower collapses is that we don’t have the skills to pick ourselves up again. When we’re not the good doctor, or not able to juggle all the things we’ve previously juggled, we feel there’s a deficit inside of us, as opposed to the external stressors being too much. But then there’s also this huge fear of “I don’t know how to cope with this. I’ve never encountered this before.”

Kevin Pho: So how can physicians do that? How can they reclaim their self-worth? What are some tips that you can share with us to do that?

Tracey O’Connell: Well, I think the biggest thing, I mean, it takes as much effort as it did to become a doctor, really. And it’s so weird, because, you know, you meet young people who sort of have that quality. A lot of the coaching I do with the LGBTQ community is kind of them teaching me, because they’ve already done this inner work on getting comfortable with who they are, no matter what other people think, right? Getting comfortable with their own authenticity and character, regardless of the reputation that they have. And so I like working with that group, because it gives me more inspiration to deal with people who have always done the thing, who followed the paved path, but ironically end up really lost.

I heard this other quote by Joseph Campbell recently, which is that if the path you’re on is clear, you’re probably on someone else’s. And so I feel like there’s a real reluctance, when people do come to me, to deal with the blurry path, because we’ve always known in medicine what comes next in our training. And, you know, once we’re in practice, then, as a radiologist, it was like: How many cases am I going to read? Am I going to be the highest RVU achiever? Am I going to be the chair of the department? Am I going to be medical staff, whatever?

And so I think it’s kind of almost like the first step is giving permission to people to even question a lot of these very basic things, and exploring who they are without wearing their doc name tag. And people cry. They don’t know who they are without that. And once we get just that ability to express that, and say, “Hey, that’s nothing to be ashamed of. It’s completely understandable,” we talk a lot about the things that we’ve developed shame around, and how to have more compassion for self, and not just in a sitting-in-lotus sort of way, but a fierce protection, a healthy anger, to stand up for ourselves and our one wild and precious life.

Kevin Pho: And my final question, Tracey. Tell us some of your take-home messages that you want to leave with the KevinMD audience.

Tracey O’Connell: Self-worth needs to be cultivated. It needs to be taught. If you’re looking for sustainable well-being, you can only do you, and that requires attention, intention, time, permission, and connection, company with others. And I will tell everyone who’s listening that you are so not alone. When I had my own struggles with my own self-worth, I thought that I was seriously the only person in my workplace, or on the planet, that felt this way, and I now know that that’s universal. I mean, Taylor Swift’s new album is all about her own self-loathing, and revenge, and what it would have been, and, you know, falling in love, falling out of love, and recovery. I mean, it’s human. It’s human to have these struggles, and it’s really, really liberating to share them and talk about them and value them as you move forward.

Kevin Pho: Thank you so much for sharing your time and insight. Thanks again for coming back on the show.

Tracey O’Connell: So appreciate your time, too, Kevin.

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