Feeling guilty for not being on the frontlines of the pandemic [PODCAST]

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“Do all physicians and scientists not on the frontlines of this pandemic feel this, or is it unique to women? Women in medicine and science have long struggled with the sense of never having ‘done enough’ and have pushed themselves even harder to get the same recognition accorded our male colleagues. Does that make us more vulnerable to guilt, or are we holding ourselves to unreasonable expectations? We arranged to meet for a ‘wellness session,’ and as we shared our experiences, we realized one thing was common: We all felt guilt.”

Theresa Rohr-Kirchgraber is an internal medicine-pediatrics physician.

She shares her story and discusses her KevinMD article that she co-authored, “The guilt of not being on the frontlines of the pandemic.”

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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 Theresa Rohr-Kirchgraber. She is a professor of clinical internal medicine and pediatrics at the Indiana University School of Medicine, and she’s a co-author of a recent KevinMD article, “The guilt of not being on the frontlines of the pandemic.” Theresa, welcome to the show. So we’re going to get into your article in a little bit, but first off, can you share your story and your journey to where you are today?

Theresa Rohr-Kirchgraber: Sure. I’m originally from Los Angeles and went to medical school in New York City and residency in Cleveland. I am an internal medicine and adolescent medicine boarded physician, currently living and working in Indianapolis. Clinically, I spend 60 percent of my time seeing primary care patients, as well as some of my time doing eating disorders, especially in adults, and then I spend approximately 40 percent of my time as the executive director of the IU National Center of Excellence for Women’s Health, a program through the IU School of Medicine to increase care for women across the state, but also to increase physician leadership from the women in medicine group.

Kevin Pho: Wonderful. So I want to get into the article that you co-wrote, “The guilt of not being on the frontlines of the pandemic,” and I want to start with reading an excerpt. The article starts, “Do all physicians and scientists not on the frontlines of this pandemic feel this, or is it unique to women? Women in medicine and science have long struggled with a sense of never having ‘done enough’ and have pushed themselves even harder to get the same recognition accorded our male colleagues. Does that make us more vulnerable to guilt, or are we holding ourselves to unreasonable expectations?” Theresa, can you share the story behind the article and why you and your group decided to write it?

Theresa Rohr-Kirchgraber: Oh, yes. So it was a virtual wellness group that was set up by one of the members of our department for the women physicians to get together. We have had meetings in the past, but with the pandemic and social distancing, we weren’t getting together and having this meeting, which really was meant to have time to share. Some women had glasses of wine, some had coffee, and some had kids running in the background, but it was just a time for us to share. There were division chiefs as well as young new faculty. There’s a little bit of everything; some are MDs, and some are PhDs. But one of the common things that came out was how we were feeling.

Here it was four o’clock in the middle of a workday, and we were on this call. We had been getting all of the comments, all of the sightings, and all the stories, reading things on our Facebook and Twitter feeds, and we were feeling pretty bad for all of those that are out there. And we started to talk among ourselves about what we were really doing and the guilt that we felt from not being on the front lines. Even some of the folks that were on the call, I mean, they’re hospitalists, but they weren’t in the ICU. And so we started to talk about what the expectation was, what it is that we should be doing, and why we have this sense of guilt.

When one of my neighbors did this beautiful chalk drawing at the end of our driveway, they said, “Two superheroes live here.” And as much as I really appreciated that, I also felt a little guilty that they were doing it for me, and I wasn’t really that much of a hero. And as we spoke about it, we realized, too, that this is such a common feeling for most of the women that I knew. No matter what you do, it never seems to be quite enough.

Kevin Pho: I think this article really resonated with me as well, because I’m in primary care internal medicine. My hours had been cut, the clinical medicine I was doing was all virtual medicine or telemedicine, and I’m spending a lot of time at home with kids. The guilt that you described was something that I was feeling as well. Now, what came up from this conference? What are some tips that you gave to people who were feeling this type of guilt?

Theresa Rohr-Kirchgraber: So, a number of things. But the biggest thing that came out of it is that we got together and rewrote this together. There were a number of us who went back and forth. We said, “You know, there’s probably a lot more people than just us feeling this way.” And by putting this article together, by being able to have it placed on your website, I mean, in the blog, it was great, because it reached so many more folks. I got numerous phone calls and emails and things back saying, “Thanks for saying this. I didn’t know. I felt so alone.” And just by knowing that other people had that similar kind of feeling, it gave some comfort.

So from that perspective, we actually did a very fair amount. We technically got a publication out of it, we got information, and we were able to share things with others. Some of our faculty actually got onto a new show about it. It got put into Women4Change, which is a bipartisan organization for women to make changes in politics. And so it was hopeful, I think, because it allowed us to reach a larger audience, so that not just physicians were in the same boat, not just the scientists were feeling these same feelings, but everybody felt in some way that they needed to do more.

So it was incredibly impactful, I think, for folks like yourself to say, “I’m not the only one,” and also to recognize that what you are doing is important. You’ve probably had situations with patients who were wondering, “Gosh, I’m not doing enough. What else can I do? I’m making masks.” And for you to be able to tell them, “No, by the fact that you are isolating and social distancing, that is impactful. You don’t have to be out there intubating people and putting them on the front lines. Those little things that you’re doing, reaching out to your neighbor, writing letters, making phone calls to those that might be shut in, all of those things have impact.”

Kevin Pho: So we are now talking in the first week of June, and you wrote that article at the end of April. So is there anything that you know now that you wish you knew back before the pandemic, to those people who may not be on the front lines?

Theresa Rohr-Kirchgraber: I think that even then, we have to be very cognizant of how we do negative talk to ourselves or to others. I think since this whole episode, I’ve become more aware of when I’m doing negative self-talk, and we’ve been talking to others as well about taking out certain words. For example, take out the word “just” or “but.” They’re so diminutive: “I’m just a medical student. I’m just a mom. I’m just,” you know.

And in fact, I had that conversation with one of my medical students this morning. She said, “Oh, sorry,” but I’m like, “OK, look, that one goes out, too. You’re not sorry. It doesn’t, you just say, ‘Oh, let me have a minute. Let me get this.’ So ‘Oh, I’m so sorry, let me,’ no, no.” Because it sets up kind of a negative connotation in the listener’s mind.

So I think probably even at the beginning, I would have been more proactive about getting rid of that negative self-talk. And since that time, I’ve been more proactive in my own life about giving myself credit. I used to drive home thinking of all the things I didn’t do: “Did I check that enough? Did I check that number? Oh, maybe I should have given this medicine instead of that.” By the end of the day, I was so frustrated with all the things I should have done that day. So now I’ve decided, forget that. Now when I drive home, I’m thinking of the two good things that I did today, even if it’s just that somebody smiled when we made a joke, or we commented on this great piece of jewelry that the patient was wearing. It doesn’t have to be something phenomenal, but we have to feel better about what we’ve been doing and give ourselves credit.

So I’m also trying to work with others, my patients, my staff, my other colleagues, so that whenever they start this kind of negative self-talk, we can redirect them, because we’re all here for a purpose. We all have goals and aspirations, and we’re all doing good in some way, shape, or form. You just have to recognize it.

Kevin Pho: I think that’s wonderful advice. I want to take a step back now and ask you about something that you’ve been curious about or something that you’ve been passionate about over the last few months.

Theresa Rohr-Kirchgraber: Oh, goodness. I think that my passion has only increased significantly around issues of diversity. This pandemic has shown so much how many people are impacted, and not just because of the virus, but because of other things that they don’t have as much control over. I’ve been very concerned about diversity for many, many years, but this pandemic, and the differences it has shown in health care disparities, made me even more enthusiastic about making some changes, even small changes.

So for example, we did a study last summer called Diversity on the Walls, where we actually walked around the walls of the School of Medicine here in Indianapolis, and we only looked at those walls that you can easily see, so, in fact, we didn’t go behind closed doors or locked things that needed special permission. All we did was look. We looked at what’s on the wall. We graduated our first African American physician in 1908. His picture is not in the class picture. There is not, now, one picture of an African American physician or scientist on the walls of one of the largest medical schools in the country. It’s 2020. We have one picture of a woman, Marion Couch, who was our chair of ENT a couple years ago. She’s the only woman physician or scientist that we have on the walls.

So even though we did this study last year, and we had done some documentation and some presentations about it, I think this pandemic and the health disparities that we’ve recognized with it made us even more emphatic about the fact that we’re going to change this. We’re going to change it in October. We’re getting funding to put together at least four portraits or pictures along with the stories. It’s going to have two African American physicians and two women physicians, and we’re going to, by God, get them on the wall, so that we won’t have another medical student walking around saying, “You know, nobody here looks like me,” so we don’t have another faculty member saying, “You know, I’m new here, but gosh, I don’t see a lot of female representation.”

We’re just going to change it, come hell or high water. We’re just going to do it, and we’re not going to wait around and look for a million different people to tell us how. We’re just going to do it. We’re going to do it ourselves and get it done, and do it, even though it was probably kind of a byproduct. It’s just, over these last few months, you really recognize the differences in what people have. You know, my patients who now no longer can come see me because they lost their insurance, because they lost their job, I mean, those kinds of things, it tears at you. And we have to make a difference from that perspective.

Kevin Pho: Well, thank you so much for sharing that. I have one last question for you, and that’s, what’s your take-home message for the KevinMD audience?

Theresa Rohr-Kirchgraber: Oh, keep listening and keep sharing. You never realize the impact that you have. You write something or you read something, and you think it’s just that one person that’s looking at it. No, no. I think having this ability to discuss, to put your feelings out there, you do not know what an impact it can make on somebody who is far away, who never knew you before, just like this kind of an interaction. It’s phenomenal, it really is.

And Kevin, I thank you for having this ability to gather people together in very unusual situations, then they can go and look at it at nights, weekends, or whatever, just to be able to have that ability to share. So I would encourage everybody not only to read your blog but to share it and to get others to listen in, because we’re all in this together, no matter where you’re from, no matter how big you are, and we have to have each other in order to move forward.

Kevin Pho: Well, thank you so much for sharing your insight, wisdom, and inspiration. On the show, we have Theresa Rohr-Kirchgraber. She is a professor of clinical internal medicine-pediatrics at the Indiana School of Medicine, and she is the co-author of the KevinMD article “The guilt of not being on the frontlines of the pandemic.” Theresa, thank you so much for being on the show.

Theresa Rohr-Kirchgraber: I appreciate it, Kevin.

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