What I learned from stepping away from medicine for a year [PODCAST]

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“Before COVID-19, I left the practice of medicine for what would turn out to become an entire year. While away, I found a new way of seeing our hearts and bodies as humans in the medical profession, allowing me to return.

Here are five lessons I learned in the hope they might help others.”

Jennifer Lycette is a hematology-oncology physician and can be reached on Twitter @jl_lycette.

She shares her story and discusses her KevinMD article, “What I learned from stepping away from medicine for a year.”

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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 Jennifer Lycette. She’s a hematologist-oncologist, and she wrote the KevinMD article “What I learned from stepping away from medicine for a year.” Jennifer, welcome to the show.

Jennifer Lycette: Thank you for having me, Kevin. I’m excited to be here.

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

Jennifer Lycette: Sure. So I’m a community hematologist-oncologist, and I’ve been in post-fellowship practice for about 15 years, the latter half of that in a rural community practice in northern Oregon. A few years ago, I found myself among the 50-plus percent of our profession suffering from burnout, and it culminated in me actually leaving the practice of medicine altogether.

Looking back, I actually didn’t know what was wrong at the time. I didn’t recognize at first that I was suffering from burnout, and unfortunately, I don’t think anyone around me did either. I just remember feeling so broken personally, and part of a system so broken that it felt unsustainable. I was able to recognize on some level that I needed to leave. I needed to leave to figure out what was wrong and to hopefully find my way back.

When I left, I didn’t really have a plan. I didn’t know how long I would be out. I thought maybe six months, but six months after I left, the pandemic hit, and it was a very surreal time to be not in practice. I graduated medical school in 2000. So to be a physician of 20 years, and my whole lifelong dream had been to be a physician since I was 12 years old, for me it was a very deep calling, as it is for most of us, and to then not be in practice during this medical crisis of our lifetimes was a very strange experience.

With the help of a life coach, I just started figuring out how I could return. Even though I’m not an ER doc or a pulmonologist or an intensivist, so I knew I wouldn’t necessarily be treating people with COVID, I wanted to be there for my patients. And so I’m happy to say I did find my way back, and I’ve been back in practice part-time now for about eight months.

Kevin Pho: Before you took that break, was there any specific event that caused you to temporarily leave medicine, or was it just a culmination of things that caused you to leave?

Jennifer Lycette: That’s such a great question, and I’ve been thinking about that. It wasn’t any one event; it was the culmination. But there are a few things that really stick out in my mind from that time. I feel like to someone not in medicine, these all might sound like not so big a deal, but it was really the culmination of 20 years of these events. But a couple I recall.

So in terms of the system, I just had this most ridiculous and frustrating prior authorization denial ever. I had a patient who had been on a chemotherapy that was showing a good response, and we had to pause it so the patient could undergo a surgical procedure. Then six weeks later, we resumed it because it was working. We didn’t stop it for toxicity or for progression, and the insurance company denied it. I was on the phone with the so-called peer-to-peer, and they continued to insist on denying it. I mean, I found myself literally begging, begging for this patient’s life, that this was a treatment that was working. And thankfully, they eventually, I mean, I was not going to get off the phone without that approval, and I got it. And we all do so many of those calls, but that one just really kind of crushed my soul.

And then from the personal standpoint, I remember there was a time a colleague dropped by and just asked me, “How is your joy in practice?” And I realized in the moment I didn’t feel any joy at all. I remember it was just this horrifying feeling inside, but I didn’t want to admit to it, so I did what we all do, right? I said, “Fine. I’m fine. Everything’s fine.”

And then from the personal front, with my family, I remember there was an evening when we were home, the family sitting around, and I asked my husband a question, and he said, “Oh, I was just going to email you something.” And I said, “What?” I said, “We’re sitting in the same room.” And he said, “Well, you just have that look on your face.” And I knew the look he meant. It was the look of just not being there, not being present.

And so those are just three things to maybe help illustrate. I know that every physician listening to this will get it. Maybe non-physicians won’t get it, but those were things that just really opened my eyes to the fact that something was really wrong, and I didn’t want to keep living this way. And that’s kind of what happened.

Kevin Pho: So you talk more about your story in your KevinMD article, and it’s titled “What I learned from stepping away from medicine for a year.” Now, for those who didn’t get a chance to read that article, can you just walk my audience through it and just share the story of why you decided to write it?

Jennifer Lycette: Yeah, absolutely. And I just want to say thank you again for publishing it and for inviting me to talk about it. I want to first just explain the story of how I found my life coach, because I know this is a new thing that many people are doing, but for me, it was something I actually didn’t seek out.

For several years, I have been doing writing, and it’s sort of my self-care, and it’s really helped me in my recovery from burnout. I was invited to read a piece at a narrative medicine event in Portland, Oregon, with the Northwest Narrative Medicine Collaborative, and one of the other women there was reading her piece. We started chatting afterwards and got to talking, and she told me she was a life coach. I didn’t really even know what that meant or believe it was really a real thing, to be honest. And so she gave me her card, and then it was months later, after I left practice, that I thought of her. I went to her website and started looking at some of the resources she had, and they all really resonated with me. And I thought, “Well, I have to do something. I have to do something to figure out what’s going on with myself.” And it was starting to enter my mind, like, “Oh, I think I’m burned out.” And so I contacted her.

I mentioned that whole story because the introduction to my article is about basically things I learned when I stepped away, and working with a life coach. And of course, in a thousand words, it’s not comprehensive, but I chose to focus on five things. The first three things I’ve come to call my theory of the triad of burnout with physicians. These are things that I recognized in myself that I actually didn’t before, and it’s this triad of perfectionism, a lack of self-compassion, and maybe a subconscious need for external validation. These were all things that I had to do a lot of inner work to recognize in myself, and to be honest, it wasn’t easy to have to admit them to myself. But since I’ve done so, it’s made such a huge difference in my life.

And a part of that is really learning to allow vulnerability, which as physicians is really difficult to do, because we’re really trained to believe that we are superhuman. We don’t need to eat, we don’t need sleep, we don’t need to acknowledge our emotions. We just need to suppress it all down and keep going. And I learned after 20 years that that has a cost, and that cost for me was burnout. And so even though writing a piece so vulnerable, and even speaking with you right now, is something way out of my norm, I’m trying to put myself out there and share my story in hopes that it can help others.

The two other points I make out of the five points in the article: I read a book by an author called Dave Markowitz, and he has this expression in there: “The heart has a back door.” And for me, as an oncologist, this was huge, because I realized that it’s OK to hold things and let them go, let them go out the back door. And I know for some people this is going to sound kind of out there and different and not what we usually talk about as physicians, but that’s just been a visualization that has really helped me in my practice. And with my life coach, I’ve learned, I think, that in our training, we train ourselves to suppress these emotions because we’re afraid of the burden, but it’s actually better to feel them and then let them go.

And that leads to the last point, which is something, again, that was so eye-opening to me and that I wasn’t ready to accept at first, but it’s that emotions live in our bodies. And of course, we see this in our patients all the time with stress-related illnesses and things where we do all the medical workup and find nothing’s wrong, and try to talk to them about the other things in their lives that might be affecting them. But guess what? That affects us as physicians too, because we are also human beings.

And this was a big piece for me in terms of self-compassion. I realized I was missing this part of self-compassion, which is our common humanity, and I learned this by taking a quiz on a website. There’s a woman, her name is Kristin Neff. She’s a PhD, and she’s written kind of the leading book on self-compassion. She has a wonderful website, and you can go and take this self-assessment. I can still remember the moment when I saw my results, and I scored low across the board for everything, for both self-compassion for myself and common humanity.

And it all circles back to perfectionism, because I think in medicine we confuse perfectionism and striving for excellence, and they’re actually two very separate things. Perfectionism is actually a maladaptive coping mechanism that we all, I shouldn’t say we all, that many of us turn to in order to kind of protect ourselves. And so these were things that I only discovered because I took the time away from medicine, and I was fortunate to be in a position in my career that I could do that. And so I decided to write about it because I know many people aren’t in that situation, and if these resources can help them, and I’m someone who loves reading and exploration and learning these things on my own, and if other people can find that helpful, I wanted to share it.

Kevin Pho: We’re talking to Jennifer Lycette. She is a hematologist-oncologist, and she wrote the KevinMD article “What I learned from stepping away from medicine for a year.” Jennifer, I’m interested in hearing about that moment where you decided to go back into medicine again. Tell me what that moment was like.

Jennifer Lycette: So I’m not sure it was a single moment, but as I mentioned, being away from the workforce during the pandemic, it was a very hard feeling to be watching all this happen from the outside. I was, of course, calling and texting my friends and colleagues, checking in on everyone and wanting to figure out a way that I could get back and help. And I had several sessions and conversations with my life coach, because I also, I will be honest, had a fear of going back, both the fear of things returning to the way they’d been before and also this unknown with the pandemic. When I went back to practice, the pandemic had already been occurring for six months, so it was very different for me to go back to work with all the PPE precautions and everything going on.

And ultimately, I actually did find a different practice, and that was part of my exploration, realizing that in order to go back, I did need to make a change. And I did go back part-time. I think the thing that’s been so interesting with the pandemic is I felt like for the first time ever in my career, it was completely acceptable to go back part-time, because everyone was already doing all their administrative meetings, and virtual remote visits were already happening. And so I was very nervous about approaching the place I was interviewing, but one of the things I did is I just made my goals and availability very clear. I said, “This is what I can offer,” and they said, “Great.”

And so it’s been very interesting when I talk with my patients. I think so many patients and people outside of medicine don’t understand what we really do as physicians. I remember one patient asked me, because I, of course, explained to all my patients my hours and the days I’m not in clinic. I do still work from home. I answer my chart messages, I check my Epic, I review chemo orders, and I actually love it, because I’m not pressured. I’m not doing those things in between clinic. And this patient asked me, he’s like, “What do you mean you work part-time? What do you do when you’re not here?” I used to answer that by saying, “Well, I have kids, and I’m with my family.” But I did something different this time. I said, “Well, I work from home,” because it’s true. That’s what I do.

And so I started having those conversations more with my patients, and I think, hopefully, more and more of us can be able to do this in practice, and there will be more recognition that all the things that we do can’t be compressed into a clinic day, which is, of course, what also builds up and leads to burnout.

Kevin Pho: Let me ask you that question that your colleague had asked you years ago. Are you now finding joy in medicine?

Jennifer Lycette: I am, very much. It’s been so rewarding to be back in practice in my community. We care for a very vulnerable rural population, and I feel like I have value to my organization again, which is another piece of burnout we didn’t touch on. And I am happy to be able to answer that question yes.

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

Jennifer Lycette: I think if I could distill it down to one message, I would say the only way to win at this game is to own your own truth, to be authentic to yourself. And it might mean you have to make some big changes, but I think it’s worth it. And thank you for letting me share my story.

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

Jennifer Lycette: Thank you, Kevin.

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