The guilt of physician-moms [PODCAST]

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“As women physicians, especially physician moms and women physicians of color, we have handled and achieved more than the vast majority of the population, in order to reach our current status of physician.

We do because we can.

We are Superwomen. Until we’re not.

Without thought, we take on others’ responsibilities, because we can.

In addition to our own personal responsibility to ourselves and to our loved ones, we take on the responsibilities of our patients’ well-being, the failures of dysfunctional medical and political systems, and even the disastrous effects of diseases, such as COVID-19.

Our patients hand over their poor health to us, and we accept it.

Our dysfunctional medical systems hand over their inadequacies to us, and we accept them.

We carry the weight of the world on our shoulders. Because we can.

Until we cannot.”

Rebecca Elia is an obstetrics-gynecology physician and physician coach. She can be reached at her self-titled site, Rebecca Elia, MD.

She shares her story and discusses her KevinMD article, “What does it mean to be responsible during the COVID-19 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 Rebecca Elia. She’s a trained obstetrics and gynecology physician, but now she’s a full-time physician coach. She wrote the KevinMD articles “What does it mean to be responsible during the COVID-19 pandemic?” and “How the COVID-19 pandemic is traumatizing health care professionals.” We’ll get to those articles in a bit, but first, Rebecca, welcome to the show.

Rebecca Elia: Thank you so much. It’s a pleasure to be here.

Kevin Pho: So I wonder if you could share your story and your journey to where you are today.

Rebecca Elia: OK, I’ll try to make it brief. I wrote a book once, like, composed of 25 chapters about this. But I think the important thing is that it’s really what’s behind my story that’s consistent, that’s most important, and not the story itself. And that is that my entire life, I’ve held a real belief that we need to really support and empower women and children, especially in our culture and in our world. And so all of my choices have been centered around that.

So I chose to go into medicine at a time when integrative care didn’t really exist and functional medicine wasn’t really well known. I really wanted to be able to assist women in creating lives that were meaningful and fulfilling for them, and I was really interested in all the factors that affect a person’s well-being and wellness rather than actually curing disease. So I was a stranger in a strange land at that time.

And I chose obstetrics and gynecology even though I had a background in psych. I was accepted into UCSF’s psychiatry program. I chose OB/GYN because I really felt like I would have the most opportunities to work with predominantly healthy women and to be able to share my gifts and my expertise in areas of wellness in that particular group or aspect. So that’s why I chose OB/GYN.

But like two months after making partner, passing my board exams, and paying back all of my student loans, I left my practice, and I went to work with the only integrative gynecologist I knew at the time in the country, Dr. Christiane Northrup, who has since left medicine and has written many books. And then after that, I actually moved to Greece for two years and didn’t practice. And then I was sort of left with, “OK, how do I fit my desires, my calling, into this conventional medical world? How do I continue to travel to Greece every year? How do I do things on my terms, on my own schedule?” And for that reason, I mostly just worked part-time in per diem positions in clinic-only practices in order to be able to create the life that I wanted.

And then about 10 years ago, I left medicine altogether, and that’s another story, how that came to be. It was not a pleasant one, by the way, which is often the case. But it was great because it helped me really reevaluate, like, where do I want to go from here? And that was the point at which I became certified as a co-active coach. And then four years ago, I began to work predominantly with women physicians who are mothers, and many who are leaders. And I left the practice of medicine about four years ago in order to really work full-time with these moms, really physician moms.

And it’s been really exciting, because now not only do I get to assist them to do the same thing in their lives that I did, but also I’m just seeing the tremendous impact they have and the power they hold to change our world in a much more positive way. And a lot of them are women of color. A lot of them are really concerned about creating more equity for other women and also creating just more equitable health care systems. And so, I mean, what’s happening right now is very timely. It’s a tremendous opportunity, and I just really feel so, so blessed to be able to be a part of their impact on the world.

Kevin Pho: And that transitions nicely into the first article that I want to talk about, “What does it mean to be responsible during the COVID-19 pandemic?” I want to read you a short excerpt. You write, “As women physicians, especially physician moms and women physicians of color, we have handled and achieved more than the vast majority of the population in order to reach our current status of physician. We do because we can. We are Superwomen. Until we’re not. Without thought, we take on others’ responsibilities because we can.” Now tell me the story behind that article and why you decided to write it.

Rebecca Elia: Wow. You know, all of the articles that I’ve written and submitted to you, Kevin, have come just out of me, right? But they’re not really coming out of me. They’re coming out of all of us, all of the women that I work with and all the women I have worked with over my lifetime. I think that underneath it all, there are several challenges that are really predominant that physician moms face. And I would say the biggest internal challenge that they face has to do with this. It has to do with their just, without thought, sacrificing themselves for others.

And before this pandemic, they might have been able to get away with it simply because, you know, it’s a no-brainer to sacrifice yourself for your children. You’re going to do anything for them. As a matter of fact, when women become pregnant, they make incredible changes in their lives, like quitting smoking, or, you know, they get healthy, things they would never do for themselves. So up to this point, they haven’t really had to sacrifice their kids or their livelihood or well-being. But with this pandemic hitting, they’re in this very difficult position of, “How do I be there for my patients without putting myself and my children, my family, at risk?” And so it’s an enormous dilemma.

And you know, most of the time, for most people, what gets in the way of our really going for what we want is fear. For physician moms, it’s guilt, right? So they’re just faced with a tremendous amount of guilt if they’re not able to show up completely in both of these aspects of their lives. And now what’s happening is they’re paying the price for all of these problems that they didn’t create in the first place: political decisions, medical systems that are dysfunctional, you know, not enough PPE, all of that. They’re paying the price of that when in fact this was not a disaster that they caused. And so that’s where it came from. It came from them.

Kevin Pho: And what you’re saying definitely resonates, because over the past few months, I’ve been getting so many stories from physician moms who really articulate exactly what you’re saying. Now, what kind of advice or what kind of tips do you normally share with these physician moms who are undergoing so much stress during this pandemic?

Rebecca Elia: I think that, you know, this is such an insane situation we’re all in right now. Everybody’s under a tremendous amount of stress. And for a lot of people, and this ties in with the other article you mentioned, for a lot of us it’s bringing up places in ourselves that are calling for healing that we didn’t even know were present, because it almost takes an extreme situation for those things to surface. And so most of us who are in this situation have gone into survivor mode. And when you’re in survivor mode, you can’t even attend to what you value, or what you want, or what your vision is, or what your future is, or what your calling is. You have to really focus on getting yourself out of survivor mode.

So step one is to really take incredibly good care of yourself, with all of the things that that means. Look at all of the numerous needs you have that are not being met, and place yourself at least equal to everyone else. If we lose you, you can’t be here for anyone else. So it’s really a matter of doing everything you possibly can. Get all the support that you can. Make requests, and set up really effective boundaries so that you can take care of you first and really address whatever healing needs to happen. And that includes inequities and injustices. All of those things need to be addressed before, again, we can talk about, you know, what you value, what you want, and what your vision is. You know, you’ve got to take care of you first.

Kevin Pho: That certainly will be part of the solution, right? The system itself needs to change. And for those hospital administrators or people who work for academic institutions who may be listening to this podcast, what needs to change within a system to better treat these physician moms who are going through these situations?

Rebecca Elia: Really good question. Unfortunately, I think what we’re going to be seeing, and I really think, honestly, it’s going to be over the next decade, I don’t think that this is just going to go away with the end of this pandemic. This is the beginning of massive change. And what we’re seeing on every level is deconstruction, or even destruction. I really believe that many of these systems, you can’t salvage them. You cannot salvage them. You can’t use those same building blocks that created the problem in the first place to fix it. And so I think what’s going to happen, regardless of anyone’s intention, is that a lot of these systems are going to dissolve. They’re just not going to work anymore. We’re already seeing that.

And so what I would say to people in those positions is, recognize that what is dissolving needs to go away, and that the rebuilding needs to be by people who know better. So in other words, it’s not enough just to create more diversity. You need to give people of color positions of power, and you need to give that kind of power to people who know better, people who have the experience and the expertise. And this ties into one of my other articles, which is respect. But you need to acknowledge that, for example, physician moms have a wealth of experience and expertise that no one else has. So let them make the decisions. They know what needs to be done. They know what doesn’t work, you know?

And for so long, the people who’ve been making decisions in our medical structures have been people who don’t know any of this. They don’t have experience in any of this. Let the people who do make those decisions, and let them participate in the restructuring and rebuilding. Because honestly, I believe that as physicians, for many of us, our purpose is not to fall on our swords and die. You know, we’re not military personnel. Our purpose is to heal, to help with healing, and to rebuild. This is part of our purpose, that we need to be around to do this, and we need to be empowered to do that. They don’t give us the power, no problem. I think that we’ll end up taking it.

Kevin Pho: Well said, well said. So let’s take a step back. Tell me something that you’ve been curious about or something that you’ve been passionate about over the last few months.

Rebecca Elia: You know, I mean, it has to be what’s coming up for everybody, which is justice and equity. I mean, how can it not be, you know, for all of the parts of our population who have been, I don’t even know what word to use, OK, worse than neglect, have been destroyed, you know, whose health and lives and livelihood have been destroyed? And, you know, it’s really upsetting to me, and I’m much older than you, Kevin, it’s really upsetting to me that it’s taken this long and this much, and this death and destruction, for us to get to the point where we’re finally ready to move, I believe.

And so, you know, yes, it’s people of color, it’s the underserved, it’s our elderly. I’ve been caring for two very elderly parents, and this has been terrifying for me. It’s all of the darkest shadows that are now rebuilt in our nation that need to be addressed, and the fact that they need to be addressed within our structures, not just certain medical structures, but our educational structure, our political systems, all of it, right? Our economic structures, all of it. So I guess, you know, I know it’s a huge umbrella, but that’s what’s been foremost in my mind, like it has been, I think, in most people’s minds right now.

Kevin Pho: We’re talking to Rebecca Elia. She’s a physician coach. She wrote the KevinMD article “What does it mean to be responsible during the COVID-19 pandemic?” Rebecca, my final question: What is your take-home message for the KevinMD audience?

Rebecca Elia: OK, so it’s twofold. I mentioned it a little bit earlier. For those of you in survival mode, you really, really need to look at what you need and get your needs met in any way you can. You need to stand up for yourself. If trauma’s coming up, you need to get help with that. You need to look at places in yourself that are calling for help and healing and support, and just focus on that right now.

Once you’ve done that, this is an ideal time, if you haven’t already, to really gain clarity about what you value, what you truly want, what’s the most important in your life, what stays, what goes, and what is essential, because everything that’s nonessential will fall away. And then you make every single decision from this day forward based on who you are, what your calling is, what you value, and what you want.

Kevin Pho: Well, thank you so much for sharing your wisdom and advice. Rebecca, how can people get a hold of you?

Rebecca Elia: They can get a hold of me through my website. I have a contact form there. It’s just my name, rebeccaelia.com, and I look forward to talking with you all. Thank you so much, Kevin.

Kevin Pho: All right. Thank you for joining us on the show.

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