Doctors are humans, not heroes [PODCAST]

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“The truth is, we were all drowning, alone, and hiding behind the image of perfection. Clearly, each of us secretly thought that the others had it all figured out. We were so afraid of admitting weakness or asking for help, so we kept it to ourselves and muddled through, burnt out and miserable, terrified of being judged for our vulnerability.

When we negatively judge ourselves for needing help, we end up judging others who need our help too.

Our patients feel this undercurrent of judgment when they ask for our help. They don’t want to face that vulnerability because they too feel judged.

Asking for help and facing our struggles with honesty is a sign of courage and compassion. It is human nature to need each other and to feel connection.

Maybe if we’d all been a little less armored, more vulnerable, and shared our struggles with each other, our cohort of future doctors could have leaned on each other to cope better back during our intern year too.”

Jordana Rothschild is a preventive medicine physician.

She shares her story and discusses her KevinMD article, “Doctors are humans, not heroes.”

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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 Jordana Rothschild. She is a preventive medicine physician, and she wrote the KevinMD article “Doctors are humans, not heroes.” Jordana, welcome to the show.

Jordana Rothschild: Thank you so, so much for having me here. I’m really excited.

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

Jordana Rothschild: Yeah. I am a preventive medicine physician, and I actually started out in a different field. I started out in med-peds and ended up really being miserable in residency and changing halfway through, because I was so burned out, and I just thought there had to be a better way. So that was kind of where I started my journey. I ended up moving through that into a lot of mind-body medicine, prevention, and lifestyle medicine, really because I realized, through managing my own health, my own personal issues, as well as the health of my patients, and seeing what my colleagues went through, that I just couldn’t compartmentalize. For me, health is not just diagnosis, medication, diagnosis, treatment, etc. For me, it’s really the whole human, the whole picture, and I just needed to be in an environment where I could integrate all of that.

Kevin Pho: So talk about preventive medicine itself as a specialty. How is that different from primary care?

Jordana Rothschild: So there are a lot of different hats that preventive medicine physicians wear. A lot of us end up going into public health and working on policy, community initiatives, population health, things like that. And with preventive medicine and lifestyle medicine, the clinical side of things, which is where I am, it’s a lot more of a focus on prevention, really, whereas in primary care, it’s much more focused on each individual diagnosis, and you’re kind of troubleshooting. You don’t have the time to really look at a day in the life of a human being. You’re really just kind of in and out, troubleshooting: “This is wrong, let’s fix it,” as opposed to kind of taking a step back and making sure that they don’t end up coming in for that acute visit in the first place.

Kevin Pho: So give us a sense: What are some of the common patients and scenarios that you see on a daily basis?

Jordana Rothschild: So what I tend to see are people who have kind of run-of-the-mill, common diagnoses: high blood pressure, migraines, high cholesterol, insomnia, anxiety, a lot of the things that you can’t really treat quickly and easily. You can kind of get their numbers looking good, but then they go home, and maybe they look good on paper, but they still don’t feel good, and there’s nothing, like, super wrong with them, but they just want to feel better than they do right now.

And so those are the kind of things where we really can take a deep dive into how their life looks: What are they eating, not just how many calories they’re eating, but the quality of the food that’s going into their bodies, the type of physical activity they’re getting, the quality of sleep, their relationships? You know, the social connectedness is a big deal, especially right now, we’re seeing with the pandemic that’s impacting health. So we can kind of take a deeper dive into what does it really take to get somebody feeling amazing and not just having the absence of a disease.

Kevin Pho: All right, let’s transition now into the KevinMD article that you wrote, titled “Doctors are humans, not heroes.” Now, for those who didn’t get a chance to read your article, can you just walk my audience through it and share the story of why you decided to write it?

Jordana Rothschild: This is something that had been on my mind for a long time, but the pandemic kind of crystallized it for me, and that was that, as doctors, sometimes we can put these really hard standards on ourselves and really make ourselves feel isolated. We’re very self-critical, and it’s hard for us to reach out for help. It’s hard for us to admit weakness, to say we don’t know something, and then that can be very isolating. And it’s not only that it’s hard on us, and that it wears us down and makes us feel stressed and alone and isolated, but it’s also, I believe, hard on our patients, because we’ve created this system where we see ourselves as superheroes, and we want to come in, know the diagnosis right away, and save the day, right? And that’s what happens on all the medical TV shows. There’s this problem, there’s this complicated patient, who always has a solution at the end. But you and I both know that that’s not reality, right? Reality is, medicine’s not an exact science, and we don’t always know the answers.

And when we put pressure on ourselves to definitively know the answers, and we create the expectations where the patients think that we’re going to quickly come to a conclusion and know the answer, we’re setting ourselves up for failure. And I saw that more than ever during the pandemic, where, especially at the beginning, this was happening so fast, and we didn’t have the answers, and we were frustrated that we felt helpless and we didn’t have the answers. And our patients felt frustrated and afraid, and they lost trust in us, because they expected us to have the answers, and we just didn’t. Science just doesn’t move that quickly, unfortunately.

And so I wrote about how maybe the solution is to say, maybe we can be honest, maybe we can be human, maybe we can admit to ourselves, to our colleagues, and to our patients that “I don’t know what’s wrong with you right now. I don’t know the exact cure for you right now. But I know a lot. I know a lot of science, and we’re going to do the best we can together, and this is going to be a journey that we go on together.” And that’s OK, maybe.

Kevin Pho: Now, you talked about the expectations some patients have of their clinicians. What’s your experience with patients whenever a clinician simply says, “I don’t know. I’m not sure what’s causing your pain. I’m not sure what the diagnosis is”? What’s your experience with the patient response to that?

Jordana Rothschild: You know, it’s interesting, because it can go either way, and it depends on your relationship with the patient, right? We’ve been in some places where you think you know what’s wrong with them, and so you don’t admit that you don’t know. You have a hypothesis, and you want to act with confidence, so you tell them, “This is what it is,” but then you turn out to be wrong, and then they lose faith in you. Or you go to the other situation, where you say, “I’m not sure if this is what’s wrong with you. I think it might be this. Let’s try this,” and then they go home and say, “Oh, they don’t know what they’re talking about.” Or you bring in another specialist, and you say, “You know what, I’m not exactly sure. Let’s do this in a team approach. Let’s get a couple of specialists. Let’s create a team for you so that we can all figure this out together.” And look, there’s no perfect answer, because we’re all human, and our patients are human too, so they’re all going to react in different ways.

But it is my personal experience that honesty always works better. I have had multiple patients, as I’m sure you have too, most of us have, where they’ve already seen several different physicians, and they’re frustrated, and they’re saying, “You know, nobody can help me. Nobody knows what’s wrong with me. Can you fix me?” And when those patients come to me, I usually say to them, “I don’t know if I can fix you. This is what I know, this is what I don’t know, and this is what I’m willing to try. Is that something that you want to do with me?” And you know what? They appreciate it. They said, “You know what, thank you for being honest with me.” Not everybody has a straight-up label. Medicine can be really complicated and messy. And so when I’m at least honest, and I say, “I don’t know. I’m not positive. This is my best working hypothesis. I have no problem looking things up. I have no problem asking other specialists for help. Let’s figure this out together,” they respond really well.

Kevin Pho: One of the things you mentioned is that physicians are trained in a system where they are always taught to show strength, to show a projection of strength, no matter how bad that situation is and no matter how they’re feeling. How did you learn to become more vulnerable in the exam room?

Jordana Rothschild: Oh, that’s a great question. I’m not really sure when I learned that. I think it was a more recent thing, just because the other way wasn’t working for me. It took me a long time. It’s a huge risk, and it’s a very scary thing to be that open and vulnerable with a patient, but the other way just wasn’t working for me. And it was certainly what was modeled for me.

I mean, I think back, when I was a resident, I think back to the attendings that were my role models and how I watched some of them clearly in physical pain. There were some times where they were physically sick and still rounding in the hospital, and that was the lesson I learned: that you only call out sick if you’re on death’s door, right? And that’s a lesson that many of us learned. And so I kind of ended up burning myself out with that mentality, and I realized it wasn’t going to work for me. And so I need to be me. I need to be human. And there are some patients that aren’t going to like that, and there are lots of doctors out there, and that’s OK. They don’t have to see me if that’s not the kind of doctor they want to be seeing.

Kevin Pho: When you said that wasn’t working for you, and it was potentially leading to your burnout, what exactly were you feeling and going through during that time?

Jordana Rothschild: There were so many ups and downs. You know, there were times that I was better, times that I was in more difficulty. But I mean, I think back, there was a time, even back to my intern year, where I was juggling. I had an infant at home, I had family responsibilities, and I was an intern, and I was on a difficult rotation, and I completely neglected myself. I didn’t eat, I didn’t sleep, I was completely dehydrated, and I ended up fainting in the hospital. It doesn’t get more physical than that, than your body just saying, “You’re done.” I dropped in the middle of rounds. There was nothing left. My body completely gave out on me.

So that didn’t seem to stop me. It wasn’t enough to hammer that message home, because I went right back to what I was doing. But then, a couple years later, I was in residency, and I was pregnant with my second child, and I ended up, again, overworked, under-sleeping, undernourished, dehydrated, and I went into preterm labor. And that still didn’t stop me. And I don’t really know exactly where it was, but there were so many clues along the way where my body was saying, “You can’t do this.”

Kevin Pho: We’re talking to Jordana Rothschild. She’s a preventive medicine physician, and she wrote the KevinMD article “Doctors are humans, not heroes.” The scenario where doctors are being burned out is becoming more frequent, especially with the pandemic, and you have made that turnaround and realized that approach of projecting strength all the time isn’t necessarily healthy. What kind of advice do you have for clinicians who may be burned out and want to appear more vulnerable to patients and perhaps get their way out of burnout? What’s your advice to them?

Jordana Rothschild: Don’t be afraid to set boundaries. Don’t be afraid to take care of you. It’s OK. And if somebody else doesn’t like it, there’s somewhere else for them to go. But you only get one chance to be you.

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

Jordana Rothschild: I think that there’s a lot of love out there. We love each other as physicians. We are caring, loving, giving people with huge hearts, and if we let each other in, we are all willing to be there for each other. So turn to your neighbor, turn to your colleague, and just be there. If you open yourself up to them, they will receive you with love.

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

Jordana Rothschild: Thank you.

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