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It took me 23 years to figure out that I was so disconnected from my own feelings that I couldn't even name them. And this was in the name of good medicine. Somewhere between medical school and residency, I'd been taught that not feeling my feelings was the way to be a good doctor.
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It was not long ago I was struggling to be known for my area of expertise, feeling like my contributions were lost in the shuffle and unsure how to advance my career. I spent a lot of time juggling tasks that didn't quite align with my goals, and I missed out on a lot of precious moments with my family. But I've had my aha moment, and now I'm all about channeling my energy into activities that truly propel me forward and bring me happiness.
I'm Stacey Ishman, and I'm the host of the Medical Mentor Coaching Podcast. I became a full professor in 2016, and I've built clinical, research, and administrative programs while mentoring and coaching young academic physicians from medical school through their first 10 years of practice. Join me as we dive into all things career advancement, finding your niche, and working towards that elusive work-life integration.
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Hello, and welcome back to the Medical Mentor Coaching Podcast. Today I'm talking about something really personal and something I'm a little embarrassed about. I'm talking about how I'm not very good at feeling my feelings, and I didn't even realize it for 23 years.
Now, if you're a physician, you've probably been taught that you need to be cool and calm in most situations in order to take care of your patients. And there's some validity to this. I think it's important to make sure that we can support others.
You can't ignore your emotions in the process of that. And really, for most of my career, I think that's what I was doing. Now, I used to have a wide range of emotions.
I got really upset when I was a kid. I would do that crying thing where you're like, like forever. And so I know I got really upset, and I know I got really happy.
And somewhere along the way, some kind of emotional detachment became what I thought was what made me a good doctor. I really felt like I was being told that this is what you had to do. And so I was determined to be a good doctor.
This is what I did. And when I think back to some of my most profound memories in the middle of my medical career, they're ones where I struggled to hold back my emotions. I remember the day that I got a needle stick, and I was maybe two months pregnant, maybe less than that.
I worked so hard to get pregnant. I mean, I did IUI, I did IVF, I did everything. And I had to go to employee health because I had a needle stick.
And the first person that I had to tell that I was pregnant, other than my spouse at the time, was the head of employee health, who happened to be taking care of me that day, and who happened to sit on a committee with me, ironically, about needle sticks. And I had to tell them I was pregnant. And I hated that.
It felt terrible. I felt like I got robbed of a chance to tell my family as the next person. I know it didn't take anything from my family, but it felt bad.
And his congratulations were lovely, but they felt hollow as I sat in this situation that seemed profoundly unfair. But I never talked about it. I think this is the first time I've talked about it.
I don't think I told my mom about it. It wasn't until a few years ago that I realized I was so disconnected from my own feelings that I couldn't even name them. I learned this through a program called Empowering Women Physicians.
It's run by Sunny Smith. And in eight weeks, I learned so much about myself. It was really powerful.
And Sunny would ask us oftentimes, and honestly, she wasn't really asking me. This was a group coaching program. I often wasn't the one who raised my hand.
And she would ask someone to talk about their feelings. How did that make you feel? And I often found that I could not name the feeling that I was having. I might be thinking through my own situation.
I might be listening to someone else's scenario. I couldn't figure out what I felt. I had like a kindergartner's evaluation of what my feelings were.
I was sad. I was mad. I was happy.
Like, this is pathetic in terms of the range of emotions. You know, it's good, I guess, compared to nothing or neutral. But I didn't have any nuance to the way I was feeling.
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And I can tell you my wife is a social worker. And she is nuanced out the yin-yang. Like, you know, I'll give her a happy or sad.
And she's like, but about what? And how do you feel? And is that a little bit or a lot? Or, you know, the depth? And is it, you know, this kind of sad? And I'm not good at it. And so it was really eye-opening for me to realize that the reason I'm not good at it is I've been trained not to be good at it. That I've worked not to be good at it.
And so I want to share three things today. And the first of these is the tips that are helping me regain the ability to feel and process my emotions. The second is some of the data behind why it's important for us to feel our own emotions.
And the last is just a reminder to be compassionate with yourself as you unlearn emotional detachment because it's not an easy process. So the first step is really to acknowledge emotional detachment. Awareness is the first step.
And some of the ways that you can do this is by learning to label your emotions. Now, it sounds easy, but because I didn't have the vocabulary, some of the suggestions I got were great. One of them is to do something called Word Hippo, or it could be any real thesaurus kind of app or dictionary if you're old school.
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But this is a way that you can go in and you can put in a broad emotion like mad or happy, and it can come up with a wide range of emotions, which I found really useful to think, gosh, which one resonates with me, which one describes how I'm feeling right now to expand my vocabulary. And really simply naming your emotions reduces their intensity and helps you manage them better. The second is to think about something called an emotion journal.
And this felt way too woo-woo for me, like me writing down every day if I felt happy or sad or, you know, at 11, 11, what was my emotion? And so, you know, not to make fun of it, but it just felt like too much. And honestly, one of the things that's been really useful is an app called How We Feel. And it reminds me at whatever interval in a day, you know, to just record how I feel.
And quite honestly, I ignore it a lot. You know, if I'm in the middle of something busy, I don't say, okay, app, right now I'm going to tell you that I feel hesitant. But it does make me think about how I feel, even if I don't record it.
And I think that's really the key. And so daily check-ins are really, really useful. Take a moment, ask yourself how you're feeling, use an app, write it in your notes app, write it in your diary, whatever works for you.
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And if you're really not good at it, one of the things I like about that app is it starts off with two key questions. One is, am I high or low energy? I can usually answer this one. And then is it a positive or negative emotion? Also not hard to answer.
And then within those, you begin to see sort of the whole quadrants of emotion. There are also emotion wheels out there, which are divided more like into eight quadrants. And those have been useful too.
Honestly, I used more with therapy, but those are useful. And so if you want to look at an emotion wheel, or you want to try an app, I highly recommend it. And then the last of the points here is to find and create a supportive environment.
So find other people who are willing to help you with this, who are going through this whole thing, or who really got great emotional intelligence, and open this kind of communication with your team. Allow them to give a little bit of their feelings to you instead of making everybody feel like we have to kind of squash that. And then don't hesitate to seek help from a mental health professional if it's something you think could be useful, because therapy can be a safe place to process those kinds of emotions.
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Now I want to talk a little bit about the data behind emotional detachment. It was really eye-opening to me. And the first of these is the way it impacts patient care and colleague interactions.
And so there's a study in JAMA from 2011, where they looked at the validity of a single item measure of emotional exhaustion and depersonalization and burnout assessments. But what they found is that if you have a high level of depersonalization, you're more likely to report patient outcome or patient practices are not as good as they could be. And this means more errors and less empathy.
Sort of funny to make an error on error, but anyway. And it also notes that team collaboration was actually more strained in people who had depersonalization, especially with their colleagues. And I can absolutely attest to this.
At times in which I didn't realize that this was at its maximum. And for me, it was during COVID when everything was crazy and stress was the highest. I really had a hard time connecting.
And quite honestly, the guidance that I was given was terrible, that I shouldn't try and connect, that I shouldn't try and talk to others. And so we shouldn't do that to each other. And then the next is that depersonalization reduces professional satisfaction.
This is not surprising, right? We know burnout decreases satisfaction. And we know that burnout is actually characterized by emotional exhaustion and depersonalization. And so more than 50% of physicians are affected by this in some way.
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And those in academic medicine are particularly at high risk due to high demands and stress. And this has been documented in the Mayo Clinic Proceedings in 2017. In addition, academic medicine in 2006 showed that depersonalization correlates with lower job satisfaction and 45% of physicians with high depersonalization had some dissatisfaction with their job.
So if you're not feeling good, think about whether this may, in fact, be part of what's contributing. But what's fascinating to me, there's also some cognitive function pieces. And there's a journal called Medical Teacher that found that depersonalization can impair clinical decision-making and that 34% of physicians reported cognitive function negatively impacted when they were highly depersonalized.
So you're not even thinking as well in those times. And academic medicine in 2003 discussed the fact that burnout and depersonalization reduced research productivity and dropped publication rates by as much as 20%. So if you're not getting everything done, if you're not connecting with your colleagues, this could absolutely be contributing.
Now, the fourth point I want to talk about is the impact on personal well-being. And you can imagine it's significant. So depersonalization is closely linked to mental health issues.
And in the Journal of Occupational Health Psychology, they found that 40% of physicians who experienced this phenomenon also found that they had depression and anxiety, incredibly high numbers. And the AMA has reported that 60% of physicians with depersonalization found that there was negative impact on their personal relationships and their work-life balance. So not surprisingly, just like burnout, which is sort of the bigger, broader impact, depersonalization by itself can have a significant impact.
And the last of these points, which I think is also super interesting, is that it lowers professional reputation. In a study published in the Journal of General Internal Medicine, 28% of physicians who had high levels of depersonalization were perceived by their colleagues as being less competent or less committed to their work. In addition, teaching and mentorship are affected.
And the Medical Education Journal found 35% of academic physicians with this phenomenon had a decrease in their effectiveness in mentoring and negatively impacted medical education and training development. Now, all of these stories, numbers are good. I'm a data dork.
I love this stuff. But one of the stories really hits home for me was when I was young attending at the time, and I was with a great resident. And we went to the ICU because the family was withdrawing, you know, big care.
They were going into palliative care with a child who'd gone through a lot and who I'd helped take care of. And they asked me if I would come by. And I was happy to come by.
But it was a sad time. This child was not going to make it very long. The family was incredibly sad.
And as I walked out of the room, I held it together in the room. And I worked hard to hold it together in the room. And I'm not sure that that actually gave the family the idea of the empathy I was really feeling.
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And I cried softly as we kind of walked out of the NICU. And my resident who was lovely, didn't really know how to react. I mean, I didn't have any idea how to tell him how to react.
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He didn't know what to do with it. And I feel really bad at this point that I didn't give him the tools to say it's okay for me to feel sad, it would be okay for him to feel sad. It was okay for him to feel uncomfortable, it'd be okay to comfort me.
And so I'm hoping that our medical education has really evolved beyond where I was at that time. And that I would do a much better job if I was doing this today. Now the most significant story for me is one when I was an intern.
And there was a patient who'd had a carotid blowout. And if you don't know what that is, that somebody usually has had had neck cancer, and often they've had a radiation, and the vessel gets really weak, and sometimes it gives way. And so they start bleeding from their carotid.
And you can imagine, it doesn't last that long if you don't stop it. And so this family had had more than one blowout in the past. This patient was really not in good shape.
And he decided he wasn't going to do anything. He was really kind of palliative care in the ER. And my job was to stand there with him and suction the blood while he slowly bled to death.
And his family cried all around him. And I was devastated. And I had no idea what to do with it.
I really sat there until I couldn't take it anymore. And I actually asked my senior if I could hand it off to him. And we found another resident to come.
And he walked with me to the ambulance bay. And he was supportive and reassured me, but didn't shed a tear. And I just remember that feeling.
It was just the worst. And I couldn't figure out what to do with it. And it seemed clear to me, nobody else was reacting.
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Nobody else was giving emotional empathy to the family. They were lovely people. They met well.
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I know they were given great care. I just think back and think, is that really the best way that we could have done this? So thank you very much for listening to this today. I know it was a little bit heavier than some of these, but I really think that we need to move away from this habit of suppressing our emotions and recognize and connect with them.
And it allows us to be better physicians. It allows us to be better family members. It allows us to be better colleagues.
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It's allowed us to do better research or more research. And depersonalization is not a healthy way to manage emotions. We need to create supportive environments where people feel like they can express them, whether it's in front of a patient or not.
And I want you to know that reclaiming our emotions isn't just possible. It's crucial for our long-term wellbeing. Thank you much for joining me today on the Medical Mentor Coaching Podcast.
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I hope you have a great week.
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