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Physician Jessie Mahoney discusses her article “Learning to trust your body again: Healing the hidden wounds of medical training,” exploring how the culture of medicine conditions physicians to ignore their basic bodily needs in the pursuit of excellence. Jessie explains how this disconnection erodes trust in self, contributes to burnout, and undermines both personal well-being and professional leadership. She shares how rebuilding trust through mindfulness, acceptance, and compassion allows physicians to heal, lead sustainably, and model healthier practices for patients and teams. Listeners will walk away with practical strategies for honoring their bodies, shifting perspective with small changes, and embracing presence over performance.

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Transcript

Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast. Today we welcome back Jessie Mahoney, pediatrician and coach. Today’s KevinMD article is “Learning to trust your body again: healing the hidden wounds of medical training.” Jessie, welcome back to the show.

Jessie Mahoney: Thanks. I am happy to be here.

Kevin Pho: All right, what is this latest article about?

Jessie Mahoney: This article is about learning to trust your body again. And the backstory is that recently in the last year, twenty years after having been in the ICU a couple of times as a pediatrician mom with two young kids, I went back to work with a personal trainer to try to do the physical therapy that I never did.

I was too busy. And what I have learned from this experience is literally that so many of those ways that I approach things, like just sacrificing myself and not listening to my body, have actually become literally a part of my cells and a part of the way that I move. And as I have worked with this amazing person, I have started to realize that it is also like a body untraining.

And so while I showed up because I was going to get stronger (I am in my mid-fifties, when you are in menopause, you are supposed to build that muscle and eat your protein), I thought, “Well, I need to do this so I do not break down.” And it ended up being this totally different experience than I expected.

And I think for so many of us in medicine, we do not listen to our bodies. We do not even know how. And it made me really start to think about all of this hidden curriculum of medicine and what we have learned, and that these wounds from way, way, way back are still here thirty years later. And what happens if we do not tend to them?

Kevin Pho: So I definitely hear you, and I am sure a lot of physicians listening to you now can relate with that because medicine is rooted in self-sacrifice. Right. And when they say self-care, self-care often comes last. Now I think that you, I am sure, talk to so many different physician clients. Just give us a sense of what kind of examples have you heard? What kind of stories have you heard about physicians sacrificing themselves physically and having them come to regret that later on?

Jessie Mahoney: Really, I will just say awful stories. And so many physicians, I used to think it was uncommon to be a physician who ended up in the ICU in their thirties. It is actually not that uncommon. And I think a huge part of my story was that I just did not take the time to go in, and I waited and waited and waited and waited because there was no time. And I see this where people defer preventive care; they get cancer. There was that recent article about how women live longer than men except in medicine.

And you just see so much autoimmune disease and also just catastrophic, life-changing medical issues from one, neglect and two, from the system itself. So from the lack of sleep and from not being able to use the restroom and from the intense ongoing levels of stress and fight or flight.

So interesting because we tell our patients, right. We would never tell them to do things like that. We know they are harmful and yet we do them to ourselves and almost glorify them when people do not take time off. I actually scheduled somewhat emergent surgery at the end of a day, and I worked all day and did not eat because I was like, “Well, I need to be NPO, so I will just go at 5:00 p.m.” and that makes no sense at all. Right, it was not an elective surgery. But this thought that I just thought that was normal. And then you start to recognize that it is not normal when you see other people do it.

Kevin Pho: So what might seem not normal is incredibly normal in the lived physician experience. And why is it that medicine is a culture? Why do we normalize things that in pretty much any other field would be considered extreme?

Jessie Mahoney: Well, such a good question. So this is my personal opinion. I actually do not know why. It is our culture. Right. So it is just essentially been carried on from a time when medicine was very different. And so I think to me it is a carryover, and then we have become very attached to it. It is all we know. And so we have this fear that if we do not do it, that something bad will happen. I often liken it a bit to a cult, and I say that somewhat facetiously and also true that the idea is if we step out of line, we will get in trouble or something bad will happen; we will be kicked out.

And so we all sort of line up and keep doing it, and then it is actually what we know. And even if we are uncomfortable with it, we expect it for ourselves and we expect it for our colleagues. So even if you change, your colleagues expect it. Yeah. I remember actually being in a car accident on the way to work and my boss said, “Well, could you come this afternoon?”

And I ended up actually having quite a few injuries, and I could not go back to work for three months, but that was the first response was, “Can you, OK, well reschedule your morning because obviously you cannot get here, but could you show up this afternoon?” And it is not that anyone has an intent to harm; it is just the culture we have set up. It is a little bit like we do not know any different.

I think about work hours. And same story, right? Those of us who did it, which I was in the era of before work hours, we thought it was normal. And so then we are like, “Well, what happens if the next generation does not have all that learning? Something terrible will happen,” but it is really just a matter of what we do not know and perpetuating a culture. I think that culture also works really well for systems, and so we would have to redesign our systems.

Kevin Pho: Yeah. And that is a big project. Yeah, of course. Like, a lot of systems rely on people who self-sacrifice and kind of work until they literally die, right? So, it is no wonder that systems would want to prefer the status quo.

Jessie Mahoney: Yes. I think it also, I am just thinking we are trained in this way to not listen to our bodies, so we also do not even know how. Yeah. And part of it is that by the time we start having these issues, we do not even see them. We do not notice them. We just think pain is normal. We just are not attuned to listening. And so we think once you start listening or something hits you over the head, then things really shift. And that is what I see happening a lot in medicine these days. And this work that I have started to do, I had no idea how impactful this was on my body and the way that I carry my body and all of these old injuries and things that are layered upon layers.

And I think that I was never taught how to listen. In fact, I was taught to not listen. The exact opposite. I was a competitive athlete as a child, which I think many people who go into medicine were. And so we are also taught there not to listen. And so it becomes this very familiar echo. And when you start to listen, it is pretty phenomenal what you realize you have done to yourself. And I think what we expect others to do to themselves. And that is where we can change what we expect of ourselves. We can change what we expect of others as well.

Kevin Pho: So you have been on the show multiple times. You have written a lot of articles on KevinMD talking about balance and burnout. Have you noticed any changes over the last few years? Has it gotten better from your experience and the clients that you are seeing?

Jessie Mahoney: I think it has gotten better on a personal level. So physicians themselves and people working in medicine themselves are beginning to set boundaries and recognize the harm they are doing to themselves, right? We took an oath to do no harm.

What has not gotten better is the systems matching. Yeah. And I think that is beginning to follow with so many people leaving medicine and it being so hard to replace. But I do not think that the tide has shifted yet because there is still many a physician who says, “Well, I cannot let down my colleagues, so I will work double time, triple time, because we do not have this staff.” And that is the crisis that we are in right now. And the story of right now, not enough money in medicine and all the political and economic changes. And so it is still going back to this way of, we have to do this in order to keep the system afloat or in order to take care of our patients. And so it is shifting but incredibly slowly.

Kevin Pho: And when you say the system, it is not just like the hospital system and our medical systems, but we are talking about medical education as well, because the culture of medicine gets ingrained from the very beginning, right? So the medical education system has to change as well.

Jessie Mahoney: And I think that we are taught, I mean, very beginning of medical school, right? When you can sleep, when you can, if you do not get any sleep, that is actually you are learning more. And you cannot take time off practically even for a death in the family. And so that becomes the norm. And when you are in training, you are very susceptible to cultural patterns and what people tell you, and you feel very vulnerable. And so that becomes just sealed in, in this time of trauma and then we carry it forth. So yes, it has to change the whole way and the systems have to change, but we also have to change what we expect of ourselves and what we expect of others.

And I think it is to me, it is really with compassion. Because when I get angry at like, “Oh, why did I do that?” or, “Why did not I do this physical therapy for twenty years?” and, “Why have not I learned to trust myself and the cues?” And that does not help you change, and it does not help you have compassion for yourself or others. And yet, generally in medicine, we are terrible at self-compassion. So getting ourselves out of this is also a dilemma because of the ways that we were trained.

Kevin Pho: So what kind of advice do you have for physicians to push back against the system that prefers the status quo? How do you have physicians listen to their bodies, and sometimes that is in tension, like you mentioned in your story, with administrators who expect them to persevere through bodily injury?

Jessie Mahoney: I think as you ask that question, it has to start with you because if you do not feel strong within yourself and you do not trust yourself, it is really hard to advocate effectively. And so that is what I think the message of this whole personal training journey for me was, is that while I thought I was pretty strong at it, because I have been working at this a long time. If you recognize that the wounds are not just in your brain and the way you think, but they are really somatic as well, and really working on all of those. So taking care of your nervous system so that when you advocate, you are standing tall and the tone and energy you bring to the conversation is very steady and grounded.

Because when we advocate from a place of fear, like physiologic fear, which I think many of us, when we try to negotiate or we try to be persuasive about why this is unreasonable, we are in a more reactive pattern. And so I think it actually does have to start with you, and it has to start with working on your own body and making your own changes and standing tall and using also just legal tools behind you. I remember being on a California Medical Association Wellness Committee, and they wanted us to decide whether it was OK for residents to take six weeks leave after having a baby, and legally in California, you are disabled for six weeks. And so when you, I think sometimes using those kinds of laws to sort of say, “Well, this is not really a choice.” You are actually disabled. So we should not be asking people who are disabled to be at work, and we should not say that this human is exempt from that, but all other humans are not. So sometimes leaning into those things, but if you do not feel safe yourself, it is very hard to advocate.

That is why it is so hard for residents in particular, right? Because they are not actually safe. They are vulnerable to the whole system, and they need promotions and they need passing and they need all of these things. So we really do have to start with ourselves and then with yourself, if you feel safe and whole, it is much easier to advocate for others. So for example, if you were a leader and you took care of yourself first, you can model changing the system. I think it is a lot to ask for people to just go advocate and yell and fight back, which actually we have seen has not worked honestly.

Kevin Pho: So this should be an obvious question, but I suspect it is not for a lot of physicians. Yeah. Tell us the type of signs and symptoms they should observe in their own bodies to make them realize that, hey, I may be doing some irreparable harm physically to myself.

Jessie Mahoney: Yeah. You know, I would actually start with checking in with your body on a regular basis so you actually know what it feels like. Because what I have found is so many people who are trained in medicine have no idea how they feel. Yeah. Whether they feel good, happy, sad, like they are completely numb to the feelings. And in fact, when I was trained, you were not supposed to feel things, right. You were not supposed to feel sad. You were. Empathy, OK. But you were not supposed to have grief reactions to things, and so just this practicing in more neutral moments about how you feel so that you actually are once again in tune with your body.

I also think mindfulness helps you have a sense of if, just like you can do things like a body scan where you begin to get to know your body again because then you will notice the cues that things are off. And then the other thing I will say, which I see a lot, and this was me with that whole ICU experience, if you are asking your colleagues, “What do you think this is? What do you think I should do?” You should go see a doctor and be in an exam room and allow yourself to be a patient.

I think we think that that is weak, but if anything does not feel right, I think as a physician you should trust it. We do not. We are like, “Well, maybe it is fine. Maybe I do not want to know.” And I think we know the system so integrally that we really do not want to know. And so just to honor that, if you are picking up anything, it is actually very likely something and that you should have a much lower bar of entry into the medical system than anybody else because our level of sensitivity and judgment is literally off when it comes to our own health and our own signs and symptoms.

And I think often people I hear today, especially labeling it as burnout when it is not burnout, it is actually a physical issue. And people, physicians will come to coaching, and very often it is a mental health issue. And so it is like, “Wait a minute. Make sure that you are not just judging yourself and thinking this is something you can mindset your way out of.” I always say, “Get the physical checked out first to make sure you are not missing something really significant.” And get your own health care. I think we tell people about health care all the time. And one of the tools I think is so helpful is hearing what you say to patients and applying it to yourself.

So if you are telling people they should get their screenings fifty times a day, just take a moment and say, “Oh, am I due for anything?” And treating yourself as well and taking as good care of yourself as well is critically important because we are acting like professional athletes in medicine these days. We actually need more care and we need to prevent injury and prevent illness and prevent these long-term issues if we can.

Kevin Pho: We are talking to Jessie Mahoney, pediatrician and coach. Today’s KevinMD article is “Learning to trust her body again, healing the hidden wounds of medical training.” Jessie, let us end with some take home messages that you want to leave with the KevinMD audience.

Jessie Mahoney: The first one is to show up with compassion. Do not be mean to yourself about whatever you have not done or deferred maintenance and honor that it is hard to take care of yourself. And the next one is just to listen, so if there is anything, remember your Richter scale is completely different than everyone else’s and get to the help and support that you would want for your patients.

Kevin Pho: Jessie, as always, thank you so much for sharing your perspective and insight and thanks again for coming back on the show.

Jessie Mahoney: My pleasure.