How to survive the modern health care system without losing yourself [PODCAST]

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We sit down with Rebecca Arnold, an author and certified executive leadership coach, to explore the emotional challenges faced by physicians experiencing disillusionment in the health care system. Rebecca shares insights on how to reconnect with your values, manage internal stressors like perfectionism and burnout, and find support among colleagues who share your commitment to high-quality, patient-first care.

Rebecca Arnold is an author, certified executive leadership coach, and founder of Root Coaching & Consulting, LLC, a holistic leadership coaching firm for ambitious professionals in high-pressure careers.

She discusses the KevinMD article, “Ways to overcome the grief of disillusionment about medicine.”

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Transcript

Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast. Today we welcome Rebecca Arnold. She’s an author, a certified executive leadership coach, and founder of Root Coaching and Consulting. Today’s KevinMD article is “Ways to overcome the grief of disillusionment about medicine.” Rebecca, welcome to the show.

Rebecca Arnold: Thanks. I’m delighted to be here.

Kevin Pho: So let’s start by briefly sharing your story and journey.

Rebecca Arnold: Sure. So as you mentioned, I’m an executive coach for leaders in high-pressure careers like medicine, law, and academia, and I burned out. I’m trained as an attorney, and I burned out from a policy job I was so committed to, and I completely did not prioritize my well-being. Things were not aligned with my values in terms of how I was operating. After I burned out from what I thought was my dream job, I realized that I wanted to become a coach to support people, to be the coach I wish I had had when I was navigating that experience. That was what brought me to the work.

I have tremendous respect for the work of physicians, and as a person who has a chronic illness, I have a lot of interactions with the health care system. So I love working with physicians because I see how much support you all need as you go through your day-to-day work. I consider you all like elite athletes, and when we think about elite athletes, they have a whole team of support. That is my dream for what physicians would have too.

Kevin Pho: So you mentioned that you’re an executive leadership coach, and not just for physicians, of course, but for a variety of individuals in high-pressure fields. When physicians specifically come to you with questions, what are some commonalities in the things that are leading them to burnout with the other high-pressure fields that you deal with?

Rebecca Arnold: Yeah, that’s a great question. Lots of folks who come to coaching who are grappling with these questions in high-pressure fields are trying to figure out how to balance their work with their family and their lives, and how to operate within a system that may not be fully aligned with how they might operate things if they had a magic wand, or even with how they envisioned the system would be when they entered it. For an attorney, that might be, “This is how I thought the law was, and this is how it is in the day-to-day.” For a physician, there’s a vision that folks hold in mind through the decades of training and schooling, and when that vision doesn’t match with reality, it causes a great deal of pain, suffering, frustration, all kinds of things.

So when I see people in my coaching practice, they are battling with overwhelm, trying to figure out how to make an impact in a very large system, trying to figure out how to de-stress, and, for physicians, ways to metabolize the grief that many are carrying and don’t have a lot of space for. Lots of the people drawn to high-pressure careers are perfectionists who are extremely hard on themselves, and over time that causes a tremendous amount of internal stress. So some of our work is figuring out other strategies for maintaining motivation without beating oneself up on the inside.

Kevin Pho: Your KevinMD article is titled “Ways to overcome the grief of disillusionment about medicine.” Now, for those of you who get a chance to read your article, just tell us what it’s about.

Rebecca Arnold: Yeah, so it’s about this idea that through your training, you hold on to a vision of how medicine is going to be, and when the reality doesn’t match with that, it’s almost a shock to the system. The things that my physician clients talk about are the pace of seeing patients, where they don’t feel like they can really forge the connections they thought they could, or they’re spending an inordinate amount of time on administrative tasks like billing and trying to convince insurance companies to cover procedures, instead of making diagnoses and doing procedures and all the work that really lights them up about their job.

So in the article, I go through normalizing this experience for folks who really care about patient care. It’s a real tectonic shift they experience internally. Part of us is just saying that sometimes physicians operate as islands and don’t have really honest conversations with each other about the frustration and disappointment. So the article covers that normalization and also a relatively simple process for starting to make some shifts, both to metabolize that grief about the system and also to recognize where there’s a small shift, about something within your system that you deeply care about, that you have some control over. You can start to make very small moves in it, and that sense of success can build over time.

Maybe that’s the flow of patient care. Maybe it’s the way that labs come in through your online system, from your electronic medical records, that isn’t as seamless as it could be. Maybe it’s a questionnaire that you would like to shift: something that feels relatively small and manageable, so you can regain a sense of agency about your own role in the system.

The other part I cover in the article is how important it is to focus on your wins. Even in the most dysfunctional system, your audience is having daily wins: diagnoses they made, an amazing connection with a patient, a procedure that went exceptionally well that was unexpected. What I see in folks who have a lot of perfectionism and are high achievers is that they breeze past the wins and focus on the things that fell short. So one of the practices to gain some of that inner strength to overcome some of these systemic challenges is to start paying attention to those small wins, and build confidence and build pride about the work that you’re doing.

Kevin Pho: So one of the things that you mentioned right off the bat was the mismatch of expectations versus reality when it comes to practicing medicine. For the majority of physicians that you talk to, during training, are they shielded from some of the realities of medicine, whether it’s the time pressures, the administrative hassles, and the bureaucracy, so that when they start practicing and see what it really is, they’re completely unprepared for it?

Rebecca Arnold: No, so I think they see it throughout their training, but there’s this mindset that is, “Well, when I become an X, it will be like Y.” And Y is different from the realities as a resident. So, “When I’m fully trained, in my own practice, it’s going to be so much smoother because I’ll be able to control my own systems,” or, “When I have more autonomy, I’ll be able to change how things function.” So there’s a promise they’re holding on to, and at the end of residency, when they step into their position, it’s this “Oh” kind of deflation of, “I thought it would be different, and it’s not.”

Kevin Pho: You mentioned perfectionistic tendencies. I think that a lot of the characteristics and traits that make one become a physician and get accepted to medical school and residency in the first place kind of work against them as they come out and help them, and really are a detriment to helping them deal with some of the issues that you’re talking about. So talk about that shift in mindset, that shift away from perfectionism.

Rebecca Arnold: Yeah, that’s a great question. One of the practices that I do with all my clients, physicians or not physicians, is to build a practice of self-compassion. People who are wired as perfectionists hate this because they think, “If I let up on myself, I’m going to be messing up all over the place. I’m going to bomb out of whatever program I’m in, or my patients will suffer.” So we do a little bit of mindset work around what the actual cost of perfectionism is.

Yes, it does drive higher standards, of course, and there are lots of other ways to drive high standards without beating yourself up. The costs of perfectionism are so much internal pressure. Folks in your audience know that when we’re under stress and pressure and anxiety, our IQ drops. It’s just proven. We have to work really hard to overcome that internal stress to feel more balanced, to be able to do a procedure, or have an engaging conversation, or make a diagnosis.

So some of what we do together is think about some substitutes and ways to talk to myself or think about my work that are a little gentler, to give myself some space and not stress myself out so much. There’s plenty in the circumstances to cause stress, but on top of that, our own internal stress is unhelpful. So my clients might practice something like, “This is really hard work, and I’m doing my best,” or, “As I make mistakes, there are people who have my back, and I’m learning,” or, “I am so much more skilled than I was five years ago, but perfection is an unrealistic standard.”

When we zoom out, right, the system often demands perfection, which is an unrealistic standard for human beings. So a lot of it is how we settle our nervous system and speak to ourselves a little more gently and still hold the bar high, which none of my clients struggle with. The high bar is not going to go away.

Kevin Pho: So take us into one of your coaching sessions. Do you have an example of a case study of a physician who came to you with some of the problems that you talked about? Talk about how you coached that person through it and had a measurable impact in terms of how they moved forward.

Rebecca Arnold: Yeah, so I was working with a client who was a physician who did procedures as well as seeing folks in clinics, and they were really wrestling with impostor syndrome. This is super common for folks early in their careers, but also if there’s a new type of procedure, or new technology, or new innovation in the field, people who like to perform at high levels will combat, oftentimes, impostor syndrome at lots of different phases of their careers, based on not feeling equipped.

So what was happening with my client is they would walk into a procedure, and instead of focusing on, “Here’s the protocol, here’s what I need to focus on, this is what I need to look out for,” it was also, “I can’t do this. I’ve only seen this procedure X number of times. Am I the right person to be doing this?” So we worked on some of the thoughts, some of the mindset shifts that we just talked about, around, “I’ve done this a number of times. Here are the outcomes I’ve had. I’m going to take a deep breath and connect with the confidence I feel when I walk out of a procedure that’s gone really well, and use that to bring my system down so that I can focus on what needs to happen in the OR and take command in the way that I need to.”

If you’re so distracted by all that other stuff, you’re really not doing the best medicine that you could, and you’re probably not taking control in the OR the way that you need to. This client was doing all kinds of physically suboptimal shifts to accommodate other people in the OR, instead of themselves, who was the surgeon. So gaining more confidence and reducing the negative self-talk helped them be more comfortable operating, owning the OR in the way that they needed to, in a heart-centered, open, kind, but confident way, and feel better about their outcomes and what they were generating for patients. So overall, if you think about it times X number of procedures a week, if it goes even incrementally better internally, that’s a huge drop in stress over time. So that’s just one example.

Kevin Pho: So I want to talk more about the process, because I want physicians who may be listening to this to realize that this isn’t an overnight thing in terms of the shift in mindset and taking small wins and the things that we’re talking about here. Because, as you know, physicians, or any other high achievers, to get to where they are today, have had to do things a certain way for such a long time, and sometimes small shifts in that mindset can take a long time. So talk a little bit about the process: how difficult it may or may not be, and how much time it would take to notice an appreciable difference.

Rebecca Arnold: Yeah, so when I work with clients, it’s a minimum of six months because of that shift. We work on a small mindset shift, and then my client experiments with it, and then we look at how it went and what some other opportunities to shift are. I don’t work with people for less than that time because I know that that’s the minimum amount of time change needs to happen.

So what we’ll start to do in the process is someone will talk through their thought process or what’s happening for them, and I’ll notice, “Here’s a generalization or a mindset that the person doesn’t even realize is causing them distress.” So I’ll point it out, and we’ll talk about other ways to look at it, or the impact of that, like how much pain that belief is causing them. Then we’ll look at different tweaks that actually land. What I mean by that is I’ll see a reaction in their body that seems like they’re settling, and then they’ll go out into their practice and try it out and say, “The first couple days it went really well. After that, I fell back off the cliff and was back to beating myself up more.” So we’ll look at what the trigger of that was and what was going on that led to that, and then how we look at ways to shift that habit or shift that trigger, so that you substitute a different behavior and can feel more settled. That’s an example of how the process works over time.

So it often isn’t an overnight shift, but then, when I think about six months, most of my clients have massive shifts over six months. So when I think about six months, it’s not a huge investment of time when you think about these dynamics that have been in place probably since middle school for most folks. I see my clients’ lives get incrementally better, and then it just grows. They’ll say, “The old me,” which was them of three months ago, “would never have thought X, Y, and Z.” So often it just takes someone being vulnerable with somebody and exposing these thoughts, feelings, body sensations, and the impact of them to help make some of those shifts.

Kevin Pho: Now, for those who may not be ready to take that next step into coaching, and who may find themselves in a scenario that you mentioned earlier, where there’s a mismatch between expectations and the reality of medicine, are there any high-yield things that they can do if they’re not ready to go into a formal coaching program?

Rebecca Arnold: Yeah, so I would start looking at where you have agency, because what I often see is that people miss where they actually can have an impact. What I would encourage people to do, if they’re not ready and are feeling like the circumstance is a big mismatch, is start looking at where your own values are, and where you are seeing those values either reflected or not reflected in your system. If there are areas where there is that mismatch, what is one small action you can take to start to regain some of your agency? Maybe it’s a conversation with someone in your hospital system or in your practice. Maybe it’s, again, some of those tweaks that we talked about. It feels really horrible to not have a sense of agency, and so for many folks, just getting a little bit of a sense of agency is really helpful.

The other thing I would point to, which is not that hard of a practice, is just to notice your self-talk. You don’t have to change anything; just notice. Oftentimes, when people start a practice where they notice their self-talk, they see how often it is negative. I mean, we talk to ourselves more often than anybody else, and so just bringing awareness to it can start a different type of dialog in terms of your inner self-talk.

My book, The Rooted Renegade, has over fifty different practices that you can do on your own if you’re not ready to dive into coaching, or a different kind of relationship to dive into this with another person. There are bite-sized practices that you can take on to start to shift things.

Kevin Pho: We’re talking to Rebecca Arnold. She’s an author, certified executive leadership coach, and founder of Root Coaching and Consulting. Today’s KevinMD article is “Ways to overcome the grief of disillusionment about medicine.” Rebecca, we’ll end with some take-home messages for the KevinMD audience.

Rebecca Arnold: Yeah, so I would say, first, change can feel really hard, but small tweaks make a big impact. That’s one. The other thing I would say is you’re not alone. There are so many people in health care systems who don’t feel good about the direction things are going in, and very small changes can cascade into big systemic impact. So find your allies who are also frustrated about the way things are going. There are plenty of people out there. And look at what the low-hanging fruits are, to start to get more of a sense of agency.

Kevin Pho: Rebecca, thank you so much for sharing your perspective and insight. Thanks again for coming on the show.

Rebecca Arnold: Thanks for having me.

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