Vulnerability is challenging but necessary for health care professionals [PODCAST]

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“In the world of medicine, inordinate stress is instead accepted as just part of the job. If you can’t handle the heat, get out of the kitchen — or see a therapist on your own time and dime. I strongly believe that traditional therapy and psychiatry are vital and valuable disciplines- I might not be here without them. But not everyone who needs help living through this crisis (or pre-coronavirus life) is mentally ill or needs a diagnosis in order to qualify for guidance and support. No one should have to go through this pandemic, or life itself, alone. Literally or metaphorically. Not even doctors.

As we wait for scientists to develop a vaccine and improve the reliability of testing, it is a good time to confront the obvious: in order to come out intact, healthy and whole on the other side of this pandemic, we are going to have to build our emotional intelligence and learn how to be vulnerable again.

The only way to heal is to feel.”

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, “Vulnerability is challenging but necessary for health care professionals.”

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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. Today on the show, we have Tracey O’Connell. She is a radiologist and a physician coach, and she wrote the KevinMD article “Vulnerability is challenging but necessary for health care professionals.” Tracey, welcome to the show.

Tracey O’Connell: Thank you so much, Kevin.

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

Tracey O’Connell: I started off going to medical school to be a psychiatrist, and I had a weird six-week rotation in psychiatry, as well as a couple of other instances in my medical school training, that made me believe that I wouldn’t feel safe there, and maybe it wasn’t the best place for me, because I was having my own emotional struggles at the time. I decided, “Oh, I’ll go into radiology, because that will protect me from my feelings, and I’ll be able to compartmentalize and look at the world in black and white and be a consultant,” right? I thought, “I’m social. I can be the contact person for other physicians to come to, to be a part of the patient care process.”

And what happened was, you can take the emotional person out of an emotional circumstance, but you can’t take the emotions out of the person. And so, ironically, I was putting myself in the dark nine hours a day. And, you know, radiology changed a lot in the past 20 years as I was going through training, and then all the computer evolutions of PACS, being able to do computer-assisted technology and detection techniques, and PowerScribe, and the demand of keeping up the rapid pace at which CT scans and MRIs can be generated. All of that software sort of evolved faster than I believe humans can evolve, and certainly than I could evolve, and it was very, very stressful.

And the competition I felt in radiology kind of never ended either. It was not a particularly touchy-feely division to be in, and my division in particular, which was musculoskeletal imaging, is a mostly male-dominated field, with male referrers as orthopedists. That’s not globally true anymore, but it just ended up being probably the exact wrong place for my type of personality to be in.

About four years ago, the group went through some massive changes, and I had never become a partner. I’m glad that I had my eyes open the whole time at these junctures in my career, where I could sort of see, “I don’t want to get trapped.” So I never became a partner. I worked part-time. I had a family, three kids, all of whom I was able, and I’m still married after 27 years. So, you know, I feel like I made a lot of really wise decisions with the information I had at the time, and that allowed me, when some big shifts were made, to make my exit and switch to teleradiology, where I could really rediscover myself and a lot of parts of myself that I felt like I’d lost or buried or sacrificed in my career.

And so that was a great way to do that seamlessly, and then kind of pivot into this new realm of learning about myself and learning about coaching, and really walking into this notion of boldly and authentically living my life, and now wanting to help others do that. So now I help teens and adults show up more boldly and authentically in everything they do. I did some training as an integrative health coach, and then with Brené Brown’s curriculum centered on helping professionals.

Kevin Pho: So you started off as a traditional radiologist, and you pivoted to teleradiology and now coaching. What are some of the challenges that you had overcome in making that transition?

Tracey O’Connell: Well, I think the obvious ones, of just sort of, medicine really gives you a path that’s very much laid out, and I got very good at doing that. I’m very much a rule follower, doing what I’m told to do, and so I stayed on the path, and at each fork in the road, you know, you make your next decision. And so the biggest challenge was for me to sort of take that leap of faith, not knowing exactly what I’d be doing next, but knowing that it just had to be better than where I was.

I was in a very toxic practice for about 16 years, and the whole time I sort of thought there was something wrong with me. And maybe the truth is that maybe it wasn’t the right career for me, but I’ve since worked in teleradiology and other practices, more community practices, where there’s less competition, less keeping up with the other practice across town and trying to compete for referrers, and really being able to just do good medicine and have relationships with my peers and with the patients. So I’m glad that I’ve had that experience, where now I’ve been able to create my own path and seek out alternative ways to still practice medicine and have it meet, and be able to meet, my own personal needs for healing and well-being.

Kevin Pho: All right, so let’s transition now into the KevinMD article that you wrote. This was back last May, and it was titled “Vulnerability is challenging but necessary for health care professionals.” Now, for those who didn’t read the article, can you just walk my audience through it and share the story of why you decided to write it?

Tracey O’Connell: Yeah. Well, first I want to thank you, Kevin, for the forum that you provide with KevinMD, because if I had not had that forum, I don’t know that I would have ever started sharing my own experiences and this belief that I have about why vulnerability is needed in medicine. So thanks to your blog forum. It provided me an avenue where I could think, “Well, I want to write something. How do I share it with everyone?” And so you provided that for me.

And it really got my mind thinking, because all along in medicine, I never felt that I could be vulnerable, that I could really be myself. I’ve heard lots of physicians talk about this since then, and the term of, you know, armoring up. We armor up when we go to work. We armored up, at least for me. I armored up as I prepared to take the MCAT. I armored up immediately, sort of without realizing that I was going to be losing a good portion of my identity in kind of pretending and wearing a persona of what was expected of me, and how I needed to show up and behave, and what was OK and what was not OK. And the boundaries were not set by me. They were set by medical culture.

And as we all know, it’s changed a lot. I will say I grew up around physicians. My parents had friends who were physicians. I saw physicians as just people, not as anything special or elevated in society. And, you know, I think with the expectation put on doctors to be perfect, and my own struggles with failure, I think in that article I wrote about getting my first B-minus on a test in the first month of medical school, and that sent me into this spiral of sort of panic, like, “I’m just average here.”

And I think that by having to keep up with that, and look to the left, look to the right, get that threat of “Not all of you will be here” in however many years in the future, it ended up making me just very paranoid and pretty fragile inside, because I couldn’t keep up that veneer.

And so I think what incited me to write that first article was really my own learning, in the past four years since leaving that private practice, to really dig deep into myself and think, “Why did I want to be a doctor to begin with?” And really wanting to be a healer and not feeling like I was doing that, and feeling frustrated, and all that, you’re thinking there’s something wrong with me, and pathologizing that, rather than seeing that I had a lot of gifts that I wanted to offer, and I had good intentions. And I think most people go into medicine for that reason and then lose parts of themselves, their human side, and lose their compassion, certainly now with the pandemic more than ever.

And I think that maybe the reason so many physicians are now turning to physician coaching, whether they’re seeking it out or doing it themselves, is because they want that human connection with other people. They want to make an impact. They want to feel fulfilled in what they’re doing, rather than exhausted by what they’re doing.

Kevin Pho: Now, when it comes to vulnerability, as you know, in medicine we’re taught not to be vulnerable. We’re taught not to show weakness through our training and residency. Now, can you give a story or an anecdote of why it’s important for physicians to feel vulnerable or show vulnerability, and how can that help them?

Tracey O’Connell: Well, I mean, here’s the reality: We are all human, and human vulnerability is part of being alive. We know that everything we do comes with uncertainty, risk, and emotional exposure. And I use the analogy, and I’ve done it before, that it can almost be like having another habit, maybe like with alcohol, where you can pull off the bender until you’re in your 40s, and then your body will rebel. When we stockpile our emotional selves, they don’t just go away. Unexpressed emotion, repressed emotion, doesn’t go away. It just comes out in other ways. It comes out in physical maladies or disease or emotional turmoil, and certainly depression. And I experienced all of those things, and I thought that it was just me, because everyone around me was putting on that veneer as well.

And I’ll be honest: When I left that job, I didn’t want to have anything to do with doctors at all. In fact, I didn’t want to even introduce myself as a physician. I didn’t want to put MD behind my name. I wanted to just start over and have this whole new identity going through the world. And I really spent a lot of time writing, and to myself, and learning to trust myself again, because I felt that I’d betrayed a big part of myself going into medicine and didn’t know that I could trust myself to make the right decisions moving forward. So, back to that whole idea of creating your own path again.

And so the other articles I’ve written for KevinMD have been about my own inappropriate responses to being overwhelmed at work, you know, having a newborn and trying to be breastfeeding and pumping at work, and then going to do a pancreas biopsy, and then being told I’d made a mistake, and just kind of losing it, and then how that was received by my peers. Some people are so uncomfortable with vulnerability they can’t even witness it in someone else.

It’s sort of like people have learned so much in medicine to keep a distance between the patient and themselves that anything that breaks through that barrier, whether they feel themselves as not being seen how they want to be seen, or not being able to control the outcome of how they’re being seen, makes people so uncomfortable that they can’t really cope with it. And then what happens is it manifests in other ways that may seem not obvious at the beginning. But once you talk to people, you realize everyone’s struggling with the same things, and they’re coming out. Either people feel comfortable sharing their hard times or they don’t, but either way, that energy, that need to express and connect with others and belong, doesn’t go away.

Kevin Pho: We’re talking to Tracey O’Connell. She’s a radiologist and a coach, and she wrote the KevinMD article “Vulnerability is challenging but necessary for health care professionals.” Tracey, some of the things that you describe, a lot of physicians are going through, whether it’s balancing work life and home life, or balancing the stress that they have at work. Now, what are some actionable ways physicians can show vulnerability? And to take a step back, can vulnerability be coached? Can it be taught?

Tracey O’Connell: It’s a multi-pronged fork that you’re asking me about, Kevin, because I think that absolutely, vulnerability can be taught, and there’s curriculum that I have available that I’ve learned through Brené Brown’s program, and also just all my own self-help that I’ve done to educate myself over the years, to really keep myself going. I have a library of 25 years of books of how does one sustain well-being.

And I think that the issue and the real challenge in medicine is that once people do take their armor off, they may be willing to do that, but then what happens? And that’s where I’ve kind of taken a little bit of a pivot to a global, I mean, yes, the answer is absolutely coaching, and absolutely connecting with others on these issues, and really changing medical culture from the top down.

And that kind of leads to my most recent article, which is really talking about what would happen if we dismantled the hierarchy in medicine, because we know that power structures, we have vertical power structures in all aspects of our society. And, you know, with the caste system in America, with all the racial divisions, with any kind of top-down or vertical power structures in business, we know now that these don’t work. And I think what’s so glaringly obvious is that we have this dynamic in medicine, and whether the power structure is seen within medicine or outside of it, in the form of insurance companies or big pharma, what’s happening is it’s not a sustainable plan. This is not a program for sustainable well-being.

And it’s almost as if we have to set up a new manifesto or a new oath, and it has to come from, maybe this, maybe the silver lining of this pandemic has been to level the playing field and set up massive new paradigm shifts, where what is needed and essential, since you’ve got this exodus of physicians leaving medicine, burning out, high suicide rates. Clearly, what we’ve set up and historically worked no longer works. So it’s sort of like you can either pretend that massive change doesn’t need to happen, or acknowledge and embrace that it absolutely does.

And I’ve been reading this book, “The Infinite Game” by Simon Sinek, and we’re playing that game in our lives and in medicine in general, where we as human beings have to be able to sustain our own well-being. That doesn’t mean be euphoric all the time, but it means to be able to continue on, to be able to vacillate, and not be at a constant level of cortisol and isolation and frustration and powerlessness, and instead shift to a much more sustainable model.

And that has to be something, you know, there’s this undercurrent that nobody talks about in medicine, which is money, and that’s how big medicine became corporatized. And to recognize medicine as the business that it is, and if that’s the way it’s going to be, and re-establish what makes, following the same model that businesses use, what makes businesses thrive for the long term, not just in the short term. And so if we don’t want to have a shortage of physicians, and we don’t want to have the current status of the medical realm, it’s time for massive upheaval. I’m a visionary, and I’m an idealist, and I’m a reformer, but I also need a lot of help from others out there who have more tactical ways of executing that. But I do believe it’s wholeheartedly possible.

Kevin Pho: Now, what are some of the things that we physicians can do on an individual basis to bring about some of the change that you’re talking about?

Tracey O’Connell: Well, one thing I heard recently, and I’m always a big proponent of self-compassion, which some people construe as, you know, sitting in lotus and just meditating, but it’s so much more than that. We talk about self-care. I heard this great analogy by Kristin Neff, who’s done a lot of work on self-compassion, which is that self-care is what we show to ourselves before we get on the plane and when we get off of the plane, but when we’re on the plane, that phrase of putting on your own oxygen mask first really is when we show ourselves self-compassion. And that has to do with recognizing the situation we’re in is difficult, that it is common humanity that everyone would feel overwhelmed in the circumstance, that there’s nothing unique or wrong with the way that you’re feeling, that those feelings are universal. And also just practicing really deep self-kindness in a fierce sort of way, not just in the tender, nurturing sort of way, but in a fiercely loyal way, to take care of ourselves.

And while it may be unpopular, I feel like there’s definitely a need for individuals to start setting up boundaries for themselves. We get brainwashed in medicine, and we jump into the cult mentality, and we lose our sense of even what’s right or wrong. I have friends who have had newborn babies: a pediatric radiologist with a newborn who gets an intussusception, who then knows that there’s a high recurrence rate of intussusception, but still goes to work the next day and hopes that the nanny will know when the baby might be having a recurrence, because she feels more loyal to her job than to her newborn. And that’s just not natural. That’s not a natural response. That’s a product of our conditioning.

And so we have to condition ourselves in a new way that says, “Hey, if I’m in this for the long game, for the infinite game,” like any relationship, we have to invest in being proactive and recognizing, “Hey, this is where I draw the line,” and knowing that we are not indispensable. We are essential. And confronting some of those invisible boundaries, or even, you know, even taking the risk of, if someone is going to fire me because I need to take care of my own infant, then that’s something that’s good to know as soon as possible, to find a different place to work.

Kevin Pho: And my final question: What is your take-home message that you want to leave with the KevinMD audience?

Tracey O’Connell: The single most important thing I would say is to look out for yourself. The medical system will never tell you to do so. No one at work is going to tell you, “Hey, you know, it looks like you could use a day off. It looks like you’ve got a lot going on, a lot on your plate.” We have to start relating to each other on a human level and recognize that someone who’s not accepting of that reality for you is dealing with their own version and their own struggle, and that you have to stand up for yourself. That may mean confronting the discomfort of the hierarchy. It may mean trusting your own self and what you know to be OK and not OK more than you trust the system that will dispose of you as they need to, should they need to.

And so it’s really about developing, I think we all enter medicine at a very young age, when we’re not fully formed, so it may require some deep digging and working with another and really spending time with yourself to decide at what point, where will you draw the line, and what is going to constitute a life of well-being for you. And what will help you sustain that well-being in the long term is absolutely where you need to be investing your energy. And hopefully we’ll be creating a movement toward this massive paradigm shift for the infinite game.

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

Tracey O’Connell: Thank you so much, Kevin.

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