Healing the healer: How physicians can overcome the struggle of caring [PODCAST]

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Join us in this insightful podcast episode as we welcome Karen Leitner, an internal medicine-pediatrics physician and life coach, to discuss the unique challenges physicians face when their loved ones need medical care. Karen shares her personal experiences and sheds light on the logistical, internal, and resistance-related obstacles that can make it difficult for doctors to help their family members in the same way they do for their patients. Learn how embracing self-compassion can ease the emotional burden and navigate the complexities of being both a physician and a loved one. Tune in for a heartfelt conversation on finding balance, building understanding, and fostering self-compassion in the face of these difficult situations.

Karen Leitner is an internal medicine-pediatrics physician and life coach.

She shares her story and discusses her KevinMD article, “When a loved one is a patient: Navigating the emotional burden for physicians.”

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Transcript

Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast and get CME for this episode by clicking on the CME link in the show notes. Today on the show we welcome Karen Leitner. She’s an internal medicine-pediatrics physician and a life coach. Her KevinMD article is titled “When a loved one is a patient: Navigating the emotional burden for physicians.” Karen, welcome to the show.

Karen Leitner: Thank you for having me.

Kevin Pho: So we’ll get into your article in a little bit, but first off, just briefly share your story and journey to where you are today.

Karen Leitner: Sure. I trained in internal medicine and pediatrics, and I started working in primary care. It was my dream to take care of families. About seven years in, I experienced a relatively profound burnout, and I left my practice and transitioned into non-clinical telehealth, specifically medical patient advocacy.

Somewhere along the way, I subscribed to a podcast on life coaching ideas, and they were really, really helpful to me. When the pandemic hit, I was at another career crossroads, and again I reached out and hired a coach to help me figure out what I wanted to do. I found the tools so useful that I decided to use them myself to help other women doctors, and now that’s what I do full time.

Kevin Pho: So you’re a primary care physician, and you mentioned that you experienced a pretty severe case of burnout that led you to course-correct your career. So what exactly were you feeling during that time?

Karen Leitner: Yeah, so I don’t think I realized I was burned out at the time. I basically describe it as feeling like I was failing on all fronts. There was my patient panel, and I had reduced my practice to part time to accommodate my growing family. I had two kids, and I had a third I wanted to bring into the world, and I just felt like I couldn’t handle it all. I was really stressed and overwhelmed and exhausted, and I didn’t know what was happening or why. I just knew it didn’t feel sustainable and I needed to get myself out of there, and so I left.

Kevin Pho: So tell me about that journey. How difficult was it for you?

Karen Leitner: It was difficult. I think one of the most surprising things about it was that leaving my practice wasn’t really the solution for me. For a lot of us, there certainly are things in the health care system that contribute to burnout, and I’m not saying that it didn’t help to not be in that environment. But there were a lot of things about the way I was thinking that were compounding the distress I was feeling.

That’s what I have brought into my work now, and it’s why coaching has been so helpful, because there are certain things about the system we can’t change, but we can change a lot. And I want to be careful not to act like it wasn’t my fault. I’m not blaming myself, but it was very empowering to realize, “Oh, even when these things stay the same, I still have the ability to get myself to a better-feeling place.”

Kevin Pho: All right, so let’s talk now about your KevinMD article, titled “When a loved one is a patient: Navigating the emotional burden for physicians.” Now tell us, how did this article come together?

Karen Leitner: I spend a lot of time speaking to women physicians, and I started to notice a pattern. It also sort of applied to my own life as a human, as a mom, as a wife, and as a patient. I just noticed an aspect of suffering around when a loved one is going through something that felt different to me than what a layperson experiences. I had never thought about it exactly that way, but I had a client, for example, who had a family member pass away, and I realized she felt a lot of responsibility for that having happened, because of our medical knowledge. Sometimes we feel like we put a special burden on ourselves to try to heal everybody and fix everybody.

And then I also realized, but we literally can’t, because you can’t have the same perspective or objectivity for your child. I mean, you might think you do, but I think it’s challenging to maintain that. And then within the system, there are all these obstacles to helping us take care of the people we care about. I mentioned that in the article: We don’t have access to the chart, and we don’t have the ability to order labs.

And there’s also this, and I would be really interested if you ever experience this, but there’s this kind of narrative, like, “I don’t want to seem like this. I don’t want to be that patient. I don’t want to seem entitled. But I want to advocate for what I need.” It’s like we’re walking on a tightrope. So I sort of compare it to when you go to the doctor, you’re also juggling six oranges, because you want to say enough, but you don’t want to say too much, and you want to contribute, but you don’t want to be too pushy. So it’s a unique difficulty, and I had never heard anyone really, really talk about it before, and I thought it would be worthwhile to share, since I know other people probably feel the same way.

Kevin Pho: So tell us, how does one try to manage all those conflicting feelings and intentions?

Karen Leitner: I mean, I think the first place to always start is to have self-compassion and just realize, “It’s OK that I feel this way. It’s normal. It doesn’t mean something’s wrong with me.” It’s not like every other doctor out there in the world is perfectly able to be a patient without feeling discomfort. I think one of the aspects of self-compassion is this idea of common humanity: It’s not just me going through this. This is a kind of suffering that all humans experience, and it’s OK to feel that way, even if you don’t do anything to change it. You’re just acknowledging it, because what we tend to do as physicians is judge ourselves really harshly. And so there’s an opportunity to not do that.

Kevin Pho: So as a coach, take us into one of your sessions. If someone came to you in this situation, how would you guide them through this? What exactly could they do to help implement some of the things you just suggested?

Karen Leitner: I think the first step is always to notice. Notice the thoughts you’re having; notice the feelings you’re having. Say you’re feeling super anxious or angry; let’s say even anger. I noticed, for me and my family situation, when I think I know what’s right or what is going to help a family member and they don’t listen, I start to feel angry. And it’s just interesting: Why would you feel angry? It’s like, “Well, they’re not listening, and I could help them.” Usually underneath the anger, there’s a difficult emotion, like frustration, fear, failure, or sadness.

So we start with noticing what you’re feeling, noticing what’s creating it, which is always going to be how you’re thinking about it, and then just deciding: Is there a different way I might want to think about this that maybe takes the other person’s feelings into account? So I can give you an example, if that’s OK.

Kevin Pho: Of course.

Karen Leitner: You know, it used to drive me bonkers when my mom would ask me medical questions about her friends, but she’d give me, I’d say, a thimbleful of information. She’d be like, “So-and-so is getting this surgery. Is that OK?” And I’d be like, “Why is she asking me this?” I would get annoyed, like, “She always does this, and then I don’t know the answer.”

And I was able to reframe it to realize she really wants to help her friend, and she thinks by asking me that question, it’s helpful. I know it’s actually not, and I feel like she’s setting me up to fail, because I can’t really speak to that or answer. But what she’s doing in asking me is being helpful to the friend. So if I just allow her, if I just give that to her, like, “Oh, yes, I can actually help,” while understanding why she’s asking, that this is how she thinks she’s helping, I don’t feel as angry anymore.

So it’s just a reframe, taking it out of only your experience and thinking about: What is the other person thinking? What is the expectation? And what do I think I’m supposed to be able to do? A lot of this is that we hold ourselves to a high standard. We want to be able to help people, and when we’re not able to, it brings up feelings in us.

It’s sort of like when you’re on call, and people keep calling and people keep calling, and you’re like, “Why does it keep calling?” It’s like, no, people are going to keep calling. It’s OK. I just have to help as many as I can as quickly as I can, and I’m still doing my job well even if lots of people are calling. I don’t have to feel angry about it.

Kevin Pho: You brought up the term self-compassion, and when I talk to a lot of physician coaches, that term often comes up. What does that mean to you, and why are physicians generally so lacking in self-compassion?

Karen Leitner: Well, officially, if you ask Kristin Neff, who’s a self-compassion expert, she says it’s mindfulness, so being aware of what’s going on in the moment; self-kindness; and the common humanity, like I referenced already. To me, the biggest one that physicians lack is self-kindness. I can’t prove this, but I think a lot of it comes from our training, where we had to push ourselves so hard, just to deny our own body physiology: to not eat, to not sleep, to not go to the bathroom, to just power up and show up no matter how we’re feeling.

So I think we had to be like, “Come on, let’s go, get in there.” I think of this inner drill sergeant. And maybe it helps up to a point, but we take that to the extreme, and we carry it with us throughout the rest of our lives. We talk to ourselves in ways that we would never talk to someone else. We can be so kind and caring toward our best friend, but to ourselves, we’re like, “That was so stupid. Everyone’s going to think you’re, why do you think you should even get that promotion?”

So that’s what self-compassion is: realizing I don’t have to talk to myself that way, and actually, I’m more successful when I don’t. Because I think there’s this belief that if I don’t whip myself, I’m not going to achieve, and so many of us are into overachieving. But the evidence shows that the kinder and more encouraging you can be, the more successful you’re going to be. And I think that’s where a lot of us need some help.

Kevin Pho: Talk about the support systems that physicians should have when coping with some of the emotional and mental challenges of caring for a loved one. We talked about the conflicting thoughts that you mentioned earlier. Talk now about the support systems physicians should have around them to help them through these times.

Karen Leitner: Well, I think having another physician who’s a friend, who’s someone you trust and you can confide in, so you can be like, “Gosh, it’s so hard for me with my dad in the ICU, because I don’t feel like they listen to me,” or, “I’m not sure what I should say.” I think just normalizing that can be really helpful. So a friend, a colleague.

I think you can be a really good support to yourself, and I think that goes back to self-compassion. I think most of us don’t realize that we could be supporting ourselves with that self-kindness that I’m talking about. I think you only need one person. You don’t have to have 50 friends to talk about these things with, but especially when there are things that we feel shame about or we feel conflict about, having one person that you can connect to and open up to is wonderful. And having a coach or having a group of other women physicians who can validate your experience, like we do in my coaching program, is also really, really helpful.

Kevin Pho: So I want to talk about burnout. I think that a lot of physicians today, as you know, are where you were years ago. They may be toiling in either a primary care job or a specialty job and questioning what direction they’re going in professionally. Now, for those physicians who are on the precipice, so to say, what kind of advice do you have for them?

Karen Leitner: Well, the first thing I would want them to know is that burnout is not necessarily a personal failing on the part of the physician. I think it’s the system and all the moral injury we experience; burnout is an end result of moral injury. OK, so big picture, it’s not you, it’s the system. But sometimes we use that as an excuse to avoid taking better care of ourselves. We’re like, “It’s not me. It’s the health care system. It’s my job. It’s my call schedule.” And in truth, if all those things have to change, you’re not going to feel better. So what can you control? What can you change in and of yourself? And how can you take better care of yourself within the system? That, I think, is where I spend a lot of time and energy with the physicians that I coach.

For me, part of why I was under so much distress and why I experienced burnout was, like I said, I was a perfectionist. I had a lot of imposter syndrome. I did not have self-compassion. I don’t think I really valued myself. And that comes from our socialization as women and lots of other things. But when you work on looking at those things and you can help yourself think in a better way, it’s amazing how much more empowered you can be to then show up differently within that environment.

Some of us, I think, adopt this learned helplessness from training. I don’t know if you’re familiar with that phrase.

Kevin Pho: For those who aren’t familiar, what is learned helplessness?

Karen Leitner: Yeah, learned helplessness. And I’m not even sure, it sounds a little judgy; I’d like to make it more neutral. But it’s this idea that when we’re in training, we have very little agency. We don’t determine our call schedule. We don’t determine the order of our rotations or how many patients we’re able to care for. People just tell us what to do and how much we get paid, and we accept it, and we’re like, “I guess I just have to do this.”

But then sometimes, even after we leave our training, we have that same mentality. I’ve had people say to me, “Well, I don’t know. If I leave this job, it’s going to be the same everywhere.” No, it’s not going to be the same everywhere. You have the ability to go find a place where it feels better for you, or switch careers, or negotiate for more money, or ask if you can go part time. So I think there’s this mindset of, “There’s nothing I can do. This is just how it is.” And I’m not saying we can change everything, but there’s always something you can do. What else could I do? What’s one thing I could do to empower myself to feel better in this environment?

Kevin Pho: If you were to replay your whole professional career and start from the beginning, is there anything that you would do differently?

Karen Leitner: I would have self-compassion, and I would just realize it’s a choice. How you talk to yourself is a choice. And I would acknowledge how hard it was and how hard I was working, and not make it mean anything about me that I found things challenging. And I would speak out more about how I was feeling, because I think so much of the time, this shame keeps us quiet, because we think everyone else is doing it perfectly and we’re the only ones having a hard time. Now that I do this all the time, I realize that it’s so untrue, and there’s so much power in connection and in sharing these experiences with others.

Kevin Pho: How can physicians speak out more? Because that is something that I completely agree with as well. So if someone were to speak about some of those feelings and emotions and stories that you mentioned, how can you do that?

Karen Leitner: Yeah, well, I mean, there are lots of different ways. Like, how would you do it? How can you think of a way that you would? I mean, for sure, you can write pieces, articles, if you want that anonymity. We can start podcasts, and we can just start sharing our experiences. I think we can advocate at our institutions for peer support and for better, like calling our institutions out on the blame culture we have. M&M is supposed to be a way for us to learn and do better the next time, but so much of the time, it can be very blamey and scary and shamey.

So I think it’s a really good question, because some of it is about safety. You don’t want to speak up and then worry about retribution. But what I always come back to is that there’s so much strength in numbers. So it’s one person speaking up versus 100 people all saying, “Hey, we’re having a hard time with this, and we want someone to listen, and we want our needs to be heard.” I would just try to find like-minded people.

Kevin Pho: I agree. So I think we certainly both agree that it doesn’t really matter which way we speak out and share the stories, as long as we do, right? Because it destigmatizes, and, I don’t want to say normalizes, but really, by bringing out burnout and the issues physicians face, the more we bring it out, I think the more it destigmatizes it. And the more it becomes destigmatized, then we can start talking about solutions.

Karen Leitner: Yeah, exactly.

Kevin Pho: We’re talking to Karen Leitner. She’s an internal medicine-pediatrics physician and a life coach. Her KevinMD article is titled “When a loved one is a patient: Navigating the emotional burden for physicians.” Karen, tell us some of the take-home messages that you want to leave with the KevinMD audience.

Karen Leitner: The take-home message is, if you’re a physician, you are extremely valuable. I don’t care if it’s your first day out of training or if you’ve been working for 40 years. And there’s so much opportunity for you out there in the world. If you’re not happy where you are, find someone to talk to about it. Get help. Take care of yourself. Don’t be afraid to seek mental health care. You’re really, really important. You’re one of the most valuable resources we have in health care, and we need you, and we need you to be healthy and take care of yourself.

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

Karen Leitner: Thank you.

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