Breaking free from a toxic relationship with medicine [PODCAST]

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Today’s show discusses the telltale signs of a toxic relationship between physicians and their job, with guest Elizabeth Hughes, a dermatologist. In this episode, we delve into the similarity between an emotionally manipulative marriage and a career that starts with passion and purpose but morphs into a job that feels like a trap.

Elizabeth shares her experience of being in a psychologically and emotionally manipulative marriage for over twenty years and draws parallels between her ex’s behavior and the behavior of Medicine The Job. She points out the telltale signs of a toxic relationship, such as a lack of trust, unrealistic expectations, and making physicians feel unworthy or unvalued.

Through her own experience, Elizabeth offers tough love to physicians who may be feeling trapped in their jobs, encouraging them to break free from abusive behavior and rediscover the passion and purpose that initially drew them to medicine.

So tune in to this eye-opening episode, where we discuss the importance of recognizing toxic relationships with our careers and reclaiming our sense of self-worth.

Elizabeth Hughes is a dermatologist.

She shares her story and discusses her KevinMD article, “The dark side of medicine: How the profession can become an emotionally and psychologically manipulative relationship.”

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Transcript

Kevin Pho: Hi and welcome to the show. Rate and review at KevinMD.com/rate. Subscribe at KevinMD.com/podcast. Today we welcome back Elizabeth Hughes. She’s a dermatologist. Her most recent KevinMD article is “The dark side of medicine: How the profession can become an emotionally and psychologically manipulative relationship.” Elizabeth, welcome to the show.

Elizabeth Hughes: Thank you so much for having me back.

Kevin Pho: Now, for those who didn’t listen to our first episode together, which was almost a year and a half ago, just briefly share your story and journey to where you are today.

Elizabeth Hughes: The story behind this article is that I left clinical medicine at the end of 2020, and I found the process to be very similar to going through a divorce from my ex-husband, who had antisocial personality disorder. It’s embarrassing to admit, but I was in this psychologically and emotionally manipulative relationship for well more than 20 years, and I didn’t realize how much it had affected me. So as I was moving into the next chapter of my life, I realized that I was going through the same process as I left medicine, so to speak. Not that I will ever stop being a dermatologist in some way, and a lot of my pursuits have to do with skin health now, but leaving that clinical relationship was a lot like leaving my ex.

Kevin Pho: All right. You talk more about that in your KevinMD article, “The dark side of medicine: How the profession can become an emotionally and psychologically manipulative relationship.” Now, how did this come together, and how similar were those two experiences?

Elizabeth Hughes: Remarkably similar. So part of what I do now is I work with physicians who are struggling. They don’t have professional satisfaction. They love the idea of medicine, they love their mission and calling, but they don’t love the day-to-day. And I realized that many of us fall in love with medicine almost like medicine is our professional soulmate, the way you fall in love with a person early on. But we don’t have a healthy relationship with Medicine The Profession.

And it turns out that in many ways, there’s a dark side of medicine, which is what I talked about: Medicine The Job, which dictates what you’re going to do and controls your financial impact. It controls how much control you have over your staff, your schedule, and your own clinical standards. You have to sometimes sacrifice in order to stay with the system and do what you love. So it’s this funny Dr. Jekyll and Mr. Hyde situation. There’s the shining example of being a caring physician, and then there’s everything that you have to go through in order to be one. And that was the same thing in my marriage as well. There was this idea of marriage, and then there was being married to someone who took advantage of me time and time again.

Kevin Pho: So give us some examples of what Medicine The Job can place on these physicians who maybe romanticize Medicine The Profession.

Elizabeth Hughes: Yes. So one of the big ones is all of the things that doctors do to make up for the shortcomings of Medicine The Profession, or Medicine The Job, as I call it. It will deny patients care. It requires prior authorizations and going above and beyond and arguing your way to get a scan or a medication or a surgery. That’s Medicine The Job denying patients those things. But we as doctors call patients, we apologize, we stay up late, we work on our own time to try to make up for this sort of shortcoming. And it’s none of our fault, but we take the blame. That’s really it. It’s none of our fault, but we doctors take the blame, because we’re hyperfunctional.

Kevin Pho: And when physicians take the blame for going that extra mile for patients that Medicine The Job demands of them, how does that make you feel? How does that make some of your clients feel when you talk to other physicians?

Elizabeth Hughes: Well, they feel upset that there isn’t an equal commitment from their job. Like, “You know, I’m 150 percent in as a doctor. I want the best for my patient. Why is it that I have to fight the other half of my profession in order to get that? Why isn’t there an equal meeting of enthusiasm and commitment?”

Kevin Pho: Now, some would say that other jobs also place their employees under some of the same conditions that you just mentioned. But what about medicine makes it especially more painful?

Elizabeth Hughes: Right. So there’s no doubt other jobs do exactly the same sort of thing, but what’s painful is that people’s lives are at stake. And we doctors are very, very connected to our patients. Their physical outcome and their well-being, their health, weighs on us at night. And it’s completely different if you’re punching in code. I mean, there’s not that human connection, and it’s really not life or death, or health or illness.

Kevin Pho: So when you were breaking away from Medicine The Job, was there a tipping point? Was there a breaking point, a specific event that made you say, “This is enough”? What was that one point, or was it something of a more gradual process?

Elizabeth Hughes: Well, it was obviously more gradual, but there was one tipping point, where I walked in in the morning one day, and I had two non-physician administrators who greeted me even as I was having patients put into my exam rooms. They said, “You’re not seeing enough patients.” And I was like, “Have you looked at my schedule? I am 110 percent booked for the next three months. How do you want me to see more patients? I can’t move faster.” What did they want me to do?

Kevin Pho: Like, how many more patients did they want you to see?

Elizabeth Hughes: They wanted me to squeeze two more patients in every day, one before lunch and one after lunch. And the idea wasn’t good for patients either. This was a real tipping point. They wanted patients to just be able to drop in, and I would need to guarantee to see them. They would have drop-in spots, thinking, “Well, if somebody no-shows, you can squeeze them in.” But I would have to guarantee to have them cared for by the end of the day, and it wasn’t fair to any patient: the patients who were scheduled, the patient who’s sitting in the lobby hoping that sometime in the next three hours I’ll see them. It didn’t make any sense at all.

Kevin Pho: Now, there are some physicians who may not be aware or may not recognize what the symptoms of being in a toxic relationship are. So for those physicians who may not be aware, what are some signs that they are in a toxic relationship with medicine?

Elizabeth Hughes: A refrain of, “I’m doing everything I can. Why isn’t this working? What’s wrong?” Usually, because doctors are self-critical, “What’s wrong with me? What can I do better?” And so you scurry around, you fix that, and it doesn’t get better. That’s the key thing: that you can’t change yourself enough to change the relationship. That means the relationship is toxic.

Kevin Pho: So what can they do? What are some options that they have? Because I’m sure the scenario you described applies to many millions of physicians who are out there. They’re listening to you now, and they recognize, “Hey, I’m in that situation. What do I do next?”

Elizabeth Hughes: What do I do next? OK, so the first thing not to do is run away and find another job. Believe it or not, the answer is to stop and take stock of where you really are. Don’t run away from something bad. Figure out what you do want and go toward that, because it might not be leaving clinical medicine. It might be a shift in the way you practice. But don’t react. Don’t do what I did, which is reach that tipping point and walk out the door. Do some work on what you want first.

Kevin Pho: So what would be an example that would illustrate that?

Elizabeth Hughes: Well, many people, and I did this, move from job to job, and you realize that you’re dealing with different people but the same situation. And it wasn’t until I got some coaching, honestly, got some coaching to sort out what it was I wanted to do. And for me, it was that I wanted to found a skincare company. I wanted to talk about burnout and unleashing doctors’ creativity, and that’s what I really wanted to do, helping people in just a different way. And there’s also moving past the identity of “I’m a doctor,” which is a hard thing as well, but you’ve got to do that. No, you don’t have to do anything, but it’s best for you, and most successful, if you don’t run and scurry to do the next thing. Stop, take stock.

Kevin Pho: Now let me flip the question. Give us an example of what a healthy relationship would look like between a physician and a health care entity. What would that look like?

Elizabeth Hughes: A healthy relationship. So it would look like a partnership where, you know, I as a doctor do my part of the job, and the rest of the system, whether it’s the nurses or the colleagues that I work with immediately in my office, or a third-party payer, they all work together. Everybody says, “What we want is the patient’s best outcome,” and everybody does everything they can to get to that point. That’s what it would look like. And that’s what I think doctors want. They want to feel like they’re an equal partner in this process, and not that they have to carry the burden themselves.

Kevin Pho: And from your perch, from your experience, how common is that scenario?

Elizabeth Hughes: Not very, unfortunately. There’s a degree of grumbling everywhere. And some people find it by working it out so that they do locums, let’s say, so that they can, you know, have some time in clinical medicine, out of clinical medicine, in clinical medicine, out of clinical medicine, to retake stock. Unfortunately, in our current system, it’s not very common to have this really good, mutually supportive relationship where everybody’s on the same page about what the end result is.

Kevin Pho: Is there anything that physicians individually can do to take small steps toward that goal of a partnership?

Elizabeth Hughes: Well, honestly, realize that that’s the goal. A lot of us have been stuck in these toxic relationships basically since medical school. And when you really look at it and just realize that you want something different, and what you want isn’t crazy, you’re not bad for wanting it. And I genuinely believe these little steps taken by individuals, internally first, are the thing that’s going to shift medicine: “No, I think there can be something better. I want something different, and I’m going to keep looking until I find it or make it better.” That’s how real change happens.

Kevin Pho: So how do you coach physicians to just take those initial steps and open those conversations with their administrators to be more of a partnership? Because, like you said, these physicians have probably been in a toxic relationship since medical school, and it’s not easy to shift that mindset. So when you talk to other physicians, how do you tell them to open up those lines of communication to be more of a partnership?

Elizabeth Hughes: Oh, that’s a great question. So most of the time, when people address their administration, they come from this place of being a supplicant: “May I please have this change? Will you grant this to me?” And the internal shift is to, “I’m not a supplicant. I’m not a peon. I’m not an indentured servant. I am a professional, a highly trained professional, asking for something completely reasonable for a good reason.” That’s the first shift. Again, it’s an internal shift. And when I started to do that for myself, that totally worked. You know, it totally worked.

Kevin Pho: We’re talking to Elizabeth Hughes. She’s a dermatologist, and her KevinMD article is titled “The dark side of medicine: How the profession can become an emotionally and psychologically manipulative relationship.” Now, as we talk about the scenario where physicians don’t break away from Medicine The Job, if they’re perpetually in that toxic relationship for the long term and can’t break away, talk about the effect that has on physicians.

Elizabeth Hughes: It saps away their creativity, actually. And I know our time is limited, but there are actual changes to the brain. And this is from rodent models, but parts of the brain that go into judgment, decision-making, creativity, and long-term planning are all negatively affected. All of that really higher executive function that we doctors make our living on is actually damaged. There are brain changes, physiologic brain changes.

Kevin Pho: And my final question, Elizabeth: Tell us some of your take-home messages that you want to leave with the KevinMD audience.

Elizabeth Hughes: So, you’re not crazy to feel like something’s wrong. That’s the big thing. You are not crazy. And don’t run away to something else. Stop, take stock, figure out what you love, and go toward it, and everybody, you, your patients, everybody will be better.

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

Elizabeth Hughes: You’re welcome. Thank you so much for having me.

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