Amid powerlessness, reclaim your personal power [PODCAST]

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“You have more power than you realize.

It’s no secret that medical providers feel structurally powerless in our chaotic health care system. Control over the volume, pace, and elements of our work often rests squarely in the hands of others. But know this: Your own personal power over your work remains formidable and fully intact.

If you’re stressed out, burning out, and dreading Mondays, you have the power to make quality decisions about your work and life — decisions that honor who you are and what you want. Imagine waking up excited to do work that gives you joy, not despair. Imagine work that promotes happiness and wellbeing, not stress and impairment. As a health expert, surely you deserve healthy work.”

Cathy Woodhouse is an internal medicine physician.

She shares her story and discusses her KevinMD article, “Amid powerlessness, reclaim your personal power.”

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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 Catherine Woodhouse. She is an internal medicine pediatrics physician, and she wrote the KevinMD article “Amid powerlessness, reclaim your personal power.” Catherine, welcome to the show.

Cathy Woodhouse: Thank you, Kevin, for having me. This is fantastic.

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?

Cathy Woodhouse: I am a med-peds-trained physician in clinical practice for over 20 years, and I’m also a certified coach, an author, inventor, entrepreneur, and speaker. Kevin, I’ve had kind of an atypical career. I didn’t have money for medical school, so I enlisted. I became a commissioned corps officer in the Public Health Service. After residency, I traveled all around the country for eight years providing care to medically underserved populations. It was meaningful work, great work, but at the end of my obligation, I burned out from overwork. I couldn’t work, and it was so bad that I had to move back home at 38 years old to live with my mom and dad.

It took me a couple of months to recover, and when I did, I decided to do part-time locums work at one of the large area hospitals as an internist, exclusively. Working part-time, something happened which was wonderful: I found myself again. I had time to think and rediscover the person who I was before the burnout started. I lost 40 pounds, I wrote a book, I co-invented a device for medical wheelchair users, and I got a third board certification in obesity medicine. Kevin, when physicians and clinicians have time and space, we can do stuff.

I discovered that when I was traveling around as a locums doc, I would visit the same offices again and again, and I noticed that my brilliant, fantastic women colleagues were suffering from burnout too. So I started training to become a speaker, because I was going to get on the stage and encourage them and strengthen them.

Then COVID hit, which is probably a through line for a lot of the people that you interview, I’m sure. But I covered for seven colleagues, 87 percent of whom were African American women just like me. Out of those seven colleagues that I covered for while they were sick with COVID, six got very sick, and one, the seventh, ended up on a ventilator and died. That’s when I made the decision not to be patient-facing during COVID, and I decided to launch my business. So now I help stressed-out, burning-out women physicians get the clarity and power they need to make the work that they want. I cannot wait to speak to you about power.

Kevin Pho: You mentioned that you felt burned out, and then you switched and made a little bit of a transition in your career. What specifically were you feeling that made you realize that, hey, you were burned out?

Cathy Woodhouse: Kevin, I didn’t know I was burned out. I’ve been listening to your podcast, and that seems to be not an uncommon phenomenon. We’re working so hard, and we think that the solution when we’re tired is to work harder, right? Because there’s obviously something wrong with me, so if I just work harder, it’ll fix it. We get ourselves into this spiral, and we’re not aware. A lot of times our colleagues are struggling too, so they don’t know to help us, you know?

So I did not know I was burned out until one day I could not get out of bed. I was that exhausted. I happened to be doing call work in addition to my clinic work at my last assignment, and as a med-peds doctor, I was taking all the inpatient call, all the pediatric call, and all the newborn nursery call for both services. I was doing the work of two people every month, and I just didn’t know. I didn’t know until it was over, until I was crying in the staff bathroom every day, until I had chest pain and headaches every day as a previously healthy person. I didn’t know.

Kevin Pho: And when you were making that transition and cut back on your clinical work, you said that you found yourself. What are some of the things that you specifically did to come to that sense of enlightenment?

Cathy Woodhouse: I did a lot of inner work. I read a lot of personal development books. I remember when I was burning out from doing too much call, my medical director told me, “Real doctors do call.” That hurt, because we’re real doctors. We don’t come to work to fail, Kevin. We just don’t. So I had to really work on my thoughts, and so, you know, just a lot of personal development stuff, and prayer. That’s what I needed to do, and it took me 10 years. It took me 10 years, and so that’s part of my mission. I don’t want other burned-out people to take 10 years to get themselves reconnected with who they are.

Kevin Pho: All right, let’s transition now to the KevinMD article, where you’ll be talking more about that. It’s titled “Amid powerlessness, reclaim your personal power.” 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?

Cathy Woodhouse: The reason that I wrote it was specifically because, as I shared with you, here are these fabulous people, physicians, clinicians, fabulous people. I mean, they save lives, right? We save lives. We’re doing amazing things. We did amazing things to get here. But when it comes to making changes in our stressful work, if we’re stressed out, if we’re burning out, our courage evaporates, and it was illogical. We have these powerful people doing amazing things every single freaking day, but when you say, “Hey, why don’t you make a change in your work? Take one less patient a day so that you have more time to go to the bathroom.” “I can’t do that. I’m too scared. What if my admin fires me? What if I’m labeled a troublemaker, you know? What if I don’t meet my overhead?” So there’s that incongruence: The structural powerlessness that physicians and clinicians feel every day doesn’t jibe with the personal power that each of us carries.

So in the article, I talk about a physician that I cover who literally had been telling her admin for years and years that she was overbooked and overstressed. Great doc, fantastic doc. No response, no responsiveness. About two years in, after letting them know what was needed, she put her purse on her shoulder and walked out. Drastic, yes, but it’s an example of personal power that she exercised.

Personal power requires three things. The article talks about reclaiming your personal power: rediscovering that amazing person that was on your medical school or other program application, right? We’ve done all these things, you know? Rediscover that person by asking yourself questions. OK, get clear on what you want for your work. What do you want, you know? And then create a plan. Make a decision, and then make a plan for your work. You can do it. We have all the arsenal, right? We’re leaders. We know how to create something out of nothing. Why can’t we do that for ourselves? So that’s what the article talks about.

One thing I did not put in the article that I wish I had was remembering. Remembering. So you’re reconnecting, but really sit down and remember all that you’ve done. You can use that.

Kevin Pho: I think that scenario that you described really describes millions of physicians across the country, about the burdens that administration places on them: that they have to see more patients, that we have to do this, despite the support staff being short-staffed, especially during the pandemic. So can you apply some of your thoughts to a real-life situation? What do you advise physicians to do, short of just putting their purse on their shoulder and walking out? What are some things that they could do perhaps before then to reclaim some of their personal power?

Cathy Woodhouse: Absolutely. So again, the first step is remembering, and in realizing, assessment. We don’t do assessment well. Remember, we talked about how a lot of doctors don’t even know they’re burned out. So you’ve got to know where you are with your work. That’s the first step. There’s a bunch of assessment tools on the internet. I have my own tool that I developed so that you can see how your job is affecting you and where you are. Where are you, honestly? Because if you’re stressed out and burning out, you only have a certain amount of time before things continue to get worse and worse and worse, and if you change nothing, at year three you’re going to be worse off than you were.

So the first part is assessment. If you can’t see yourself, ask a peer, “How do you think I’m doing?” Simple stuff. “How do you think I’m doing? I can’t see myself. How do you think I’m doing?” Mistakes, errors, omissions: huge clue. I made them. I did. I made things that, hopefully, fortunately never harmed a person, a patient, but it was like, “Huh, I did that.” Look at your notes, the quality of your notes, right? So get the objective measurement.

I also teach something called the SOAP method. You SOAP on yourself. Take 30 minutes, just like you would take 30 minutes for a special patient, right? You book that time for a complicated patient. You SOAP on yourself. Subjective: How are you feeling? Objective: Look in the mirror. What do you see? You know how to examine people, you know? Is your hair falling out? Are your shoulders slumped, a sad expression cast on your face? You know, assessment: Where are you? How are you doing? And then plan: Do one thing. So that’s something that can help. Assessment is huge, and then getting help.

Kevin Pho: So you make that assessment, and let’s say that physician determines that he or she is burned out.

Cathy Woodhouse: Yep.

Kevin Pho: What’s the next step after that?

Cathy Woodhouse: The next step after that is to get help. Again, some of us know what we want to do. Some of us know that we wanted to start something different or have a different clinical practice environment yesterday. But that’s not my experience with most of the doctors that I’ve associated with over the last 13 years and covered for when they were sick or too stressed to work. There’s a lot of lack of clarity.

And again, I have been coached. I believe in coaching. It’s a wonderful way to gather yourself, to make incremental changes, and to get the courage to make those changes, because a lot of people don’t even know what they want. A lot of people don’t even know what they need. They’re too tired. They’re too stressed out. Sometimes they need a break before they get a coach, you know? So having someone come alongside you is critical, and I don’t think I would have burned out as badly if I’d had someone in my corner, an ally.

We don’t share, Kevin. We’re siloed. Some offices are literally structured so that you have one provider per pod. I covered for a practice where the providers were all together. They were happy, but they didn’t like the fact that we were laughing and having a good time, so they moved us to a building where every doctor had his or her own silo. Morale plummeted. So I hope I’m answering your question. It’s these little things, the little things. It’s far beyond, “We’ll do this with your schedule, do that with your schedule.” It is clarity before planning, and understanding what you need.

Kevin Pho: One of the things that you said earlier really struck me, when you talked about your administrator who said real doctors take call. That certainly can be extrapolated to real doctors see 30 patients a day, real doctors work full time, real doctors don’t take days off. Now, how do you coach physicians to fight against that guilt the administration places on them?

Cathy Woodhouse: Yes, we battle so much. We’re not only battling, I mean, the barriers to change, right? We’ve got the financial things, right? We’ve got debt. We’ve got financial responsibilities. “How am I ever going to get out of this?” We’ve got all these things, and then we have the mindset. We have the institutionalized conditioning that we go through, both at our work level but also during our training, right? We put on that white coat, you know, fake it till you make it. You have a persona that you enter into before you are able to get mastery. So you grow up saying, “OK, I am this.” And so years later, when you’re out in the workforce, they say you are this, and there’s incongruence growing, because you can’t be that anymore. It’s very difficult.

So what I do is I talk to physicians. When we talk about power, we talk about their selves. What you deserve is a very good, logical place, right? Because we fight logicalness, if that’s a word, with truth. We fight it with truth, and the truth is that you are a health care expert. You deserve healthy work. We’ve got to start with that foundation. If we don’t start, without the foundation, we can’t battle that.

And then I talk about saboteur thinking. I talk about sage perspective, a learner perspective versus a judge perspective. So there are those voices in our heads, right? “Who do you think you are, throwing away your training?” Those aren’t our voices. So recognizing that there are these voices that are not for our best good is a very good way to start that foundation, to lay that foundation. You are worth X. What are you worth? Once you build that and realize that these are voices external to you, that they sound like you but they’re not you, then you can build.

Kevin Pho: Now, when you coach physicians to change their mindset, how difficult is that for some physicians?

Cathy Woodhouse: Extremely, extremely. But the good news, the excellent news, is that health care workers, clinicians, physicians, we’re brilliant people. So once you insert that nugget of truth, that process of inquiry starts, and that little kernel can’t be taken away, and it can grow. That’s why peer coaching has been so effective, right? You’ll see these programs, right, at Mayo and Stanford. They have peer coaching. You’re creating a normalcy. You’re normalizing things. You can’t get your footing when you’re caught up in all that institutionalized thinking. You have to be around people who will resonate that truth that you are worth X, you know what I mean?

Kevin Pho: We’re talking with Catherine Woodhouse. She’s an internal medicine pediatrics physician, and she wrote the KevinMD article “Amid powerlessness, reclaim your personal power.” Catherine, what are some of your take-home messages that you want to leave with the KevinMD audience?

Cathy Woodhouse: Absolutely. Do something. If you are stressed out and you are burning out, do something. Get clarity. Get power. If you need help doing that, get help. Get support. Don’t walk through this alone. You don’t have to walk this alone, but no one’s coming to rescue you. I don’t mean to blame the victim, because I’m not trying to do that, but the reality is if you do nothing, things are going to get worse. Do something, one small thing today, in the direction of healthy work, whatever that looks like for you. It doesn’t necessarily mean leaving medicine. Just one thing. What can you do? Can you pick up the phone and call someone for an appointment, or to talk, you know? Can you take one patient off of your schedule, and pee, and eat? One thing.

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

Cathy Woodhouse: Thank you.

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