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Physician Jessie Mahoney discusses her article “Why physicians struggle with caregiving and how to cope with grace,” reflecting on the unique challenges doctors face when caring for aging parents and ill family members. Jessie explains how medical training, far from easing the role, can intensify stress through hyperawareness, overresponsibility, and self-judgment. She shares how mindfulness and coaching provide physicians with tools to manage guilt, perfectionism, and anticipatory grief, while fostering presence, perspective, and resilience. Listeners will gain practical strategies to approach caregiving with compassion, balance, and grace—caring for themselves as well as their loved ones.

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Transcript

Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast. Today we welcome back Jessie Mahoney, a pediatrician and coach. Today’s KevinMD article is “Why physicians struggle with caregiving and how to cope with grace.” Jessie, welcome back to the show.

Jessie Mahoney: Thanks so much for having me.

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

Jessie Mahoney: So this article is about caring for aging parents as physicians, and I wrote it because I am caring for my own aging parents and I notice very often that a lot of my physician tendencies make it harder. My best friend from medical school is a geriatrician, so she is always advising me about the medical part, and what I realized was that so much of the mindset part is also the problem.

If I look back at all the things that make me a good physician, they do not necessarily make me a good daughter caring for my parents. A lot of these tendencies, like over-responsibility, taking things on that are not mine, and maybe over-personalizing whether they take my advice or not, actually make the situation much more challenging than it needs to be. I hear from so many others the same thing, and so I thought it was worthwhile having a conversation about this idea that being doctors actually makes it harder to care for our parents, and yet we are the ones who are generally tasked in families with caring for our parents.

I am the only child who is a physician, and also the daughter who is a physician, so you generally then land in that role by default. My brothers are perfectly happy to let me take on that role, and yet it brings all these other layers that get in the way.

Kevin Pho: So talk to me about some of the challenges that you are facing, perhaps because you are a physician caring for your parents.

Jessie Mahoney: Yeah. I think one, I feel like it is my job, and it is not actually my job. It is sort of a self-appointed job or appointed by others in the family. But one, it takes a ton of time, and most people who are practicing medicine do not have a ton of time. The over-personalization is a big one. Maybe we make a suggestion and our parents do not agree with the suggestion or do not like the suggestion. I used to take it personally. I do not anymore.

I have decided, and this is one of the thoughts that has helped me the most, that when I am in my eighties, I am not going to want anyone telling me what I should or should not do. I should not take it personally if they are doing that. But I think when you make a medical recommendation, and maybe you know it is the best thing as a physician and your parents do not want to do it, we do take it as, “Do they not trust me? Do they not think I am a good doctor?” when it usually has nothing to do with that.

I think also we often know what is best practice, and it is not really our job to teach them or educate them; it is really their own doctor’s job. But I think we, especially with the chaos in the medical system, end up being the navigators or care navigators, and that adds this whole other layer that is really, really complex. We tend to also over-function. I would be one of those. So trying to do all the things and take care of that, and potentially taking care of the things that are not medical, and we do not necessarily delegate those to other siblings or other people who might be able to help. It feels like this sense of, again, over-responsibility.

The other layer that I find is just the guilt about things that we can and cannot do anything about, and maybe the limitations of the medical system. I would say with the limitations of the medical system today, it is really hard to get appointments. It is really hard for elderly people to get in to be seen, to use the technology, to write emails, and even to understand how to email your doctor and how to be an effective advocate for yourself. So I find myself very often being the translator, which, when you are also dealing with this emotional overlay of maybe grief about things your parents cannot do or obvious declines in the way things are going, it is really a complex situation.

Kevin Pho: And I think that is only compounded for those physicians where their parents may not be in the same city or even another country.

Jessie Mahoney: Yes, absolutely. I see culturally there is a sense that it is our job. As a way of respecting our elders, we should be saving them and doing all of these things. I see people hop on planes to go to India tomorrow and try to navigate everything, and it is really a challenge to do that, especially if you are practicing as a physician. So how can we separate out what is actually our job? Because really, we are children and they are parents, and so where is the line between the love and the caring? We do not feel the same way about our patients, and yet I think we jump in. Many of us want to be the ultimate physician in that role, and that is sort of how we judge our ability or our value as a daughter or a son or whatever it might be.

It is really challenging is what I will say. My article is not to say it is not challenging, but I think even that recognition relieves some of the burden of it. To understand that, “Wow, this is really complex. No wonder I am exhausted. No wonder I am depleted.” And to recognize that you are not alone, I think is really helpful.

The other things that I think help, for me, have been mindfulness, just the awareness and showing up with a very specific intention about how I want to show up. I want to be caring and loving, and that does not mean that I am going to be able to fix everything. I want to be in the advisor role or the consultant role, and they are not necessarily going to do everything that I recommend. So seeing what the intention is and what energy I want to bring to the relationship, rather than this reactive, “Here is a red flag, what are we going to do about it? Let me call all my expert friends and figure it out.” It is about being very clear about what my role is and how I want to show up.

For me in particular, I think it is staying out of urgency. We always want to fix; we are fixers in medicine. Most of the things that are coming up are not urgent. They do not have to be decided today. This one has been really helpful: my urgency is not necessarily their urgency. My urgency is certainly not my brother’s urgency. Sometimes their urgency is not my urgency. They may think that something is really important. My mom was really wanting to get glasses, and that is the least of the things going on right now, but to her, it is the most important. So again, just letting there be space between what I know medically and what would feel good to her.

Really, I like to ask the question for me, “What would peace do?” Because peace is going to lead me to show up but not over-give and not feel guilty and not burn myself out. I hope it is a marathon and not a sprint. That would be the good outcome. Therefore, I am figuring out how to manage my energy and make sure that I am not interfering with our child-parent relationship. I am not their parent. I think sometimes when we are the physician, we flip into that role. It is really about being very intentional, I think, and strategic, knowing the way we show up and what parts of that are going to be helpful and what parts are not.

Kevin Pho: You mentioned drawing the line to prevent you from over-giving and over-caring. So for you, where is that line, and how can one determine where that line should be?

Jessie Mahoney: Well, number one, it is really hard because most of us were trained by medicine to be over-giving and over-caring and to sacrifice ourselves. But you really do not want to be burnt out on your parental caregiving. That is even more of a challenge than being burnt out in your other physician roles. So I really ask and I keep asking myself this question, and maybe it sounds a little morbid, but when all is said and done, I will want to feel proud and at peace with how I showed up.

I usually say, “My future self, when all is said and done, will she wish I had gone over today? Will she wish I had dropped everything, or will she wish I had taken my mom to an appointment, or will she wish I had asked my brothers to do it?” You cannot always get the right answer because you do not know what is going to happen. But I consult my future self all the time because I find that that is the most reliable way for me to have a compass about how to show up. Then sometimes I do consult my physician colleagues, but not for their medical advice, but more like, “Do you think it is OK? What seems reasonable?” Because I think our sense of what is reasonable is a little bit warped.

It is really what we would be able to sleep at night with when all is said and done, or asking myself the question, “What would peace do?” or “What would caring do?” This sort of self-sacrifice is not the be-all and end-all. Being a martyr child is going to really interfere with your relationship.

Kevin Pho: Now some of the things that you mentioned go into the category of self-compassion: do not take things too personally and do not self-blame. How easy or difficult is it, or what are some things that physicians can do to give themselves more self-compassion when they are in that caregiving role for their parents?

Jessie Mahoney: For me, it is that we are exceptional at showing compassion to other people but need to make sure we show ourselves as much compassion. The easiest way for me is actually similar to how I use it in medicine, which is to understand that when I practice self-compassion, you release oxytocin, you have access to your higher, wiser brain. And boy, is that needed now. I do not need access to my reactive, unthoughtful brain. If you know the physiology of it, that helps, and it actually allows you to be a better caregiver for longer if you practice self-compassion, both in caregiving and in the medical field.

Ideally, I want to be in this for the marathon, and self-compassion is actually the tool that is going to help you be able to do that. We rarely want to give ourselves grace and compassion; we feel like it is a pass. One of my favorite authors talks about self-compassion as a life raft for turbulent times, and I remember that phrase a lot because medicine is full of turbulent times and caring for aging parents is by definition a turbulent time. It is something that we were never taught in medical school, how to care for loved ones, and it is becoming more and more of an issue as people are living longer and longer. It almost feels to me like it needs to be some course for people who hit fifty. How do we train them?

We did used to have something in our wellness program about it, which I think my brain has filed away. I did not have aging parents at the time, but now I do. You can just really see how it is a very complex, nuanced situation where these default thought patterns and ways of approaching things as physicians make it much more challenging.

Kevin Pho: And it is also a commentary on our health care system, in fact, that physician children have so much responsibility because parents themselves do not have access to their own physicians. Like you said, they cannot communicate with their physician and cannot get the answers, and it is so much easier just to lay that responsibility on their physician children.

Jessie Mahoney: Well, and if you come at it from a place of compassion for them, you understand they are terrified. They do not know what else to do. My sense is I used to think that they sort of understood the burden, but they do not understand how the system works. They do not even understand how asking for your help might interplay with other complexities. I also see this: they want your help, but they do not want your help. They are sort of torn in that, and you want to help and you also do not want to help. You want to really leave it to their physicians, and I think it is a challenge.

I find also when you are navigating, it is about how you relate to the physician caring for them. It is like a third piece of the triangle. Being respectful of your colleagues while you watch your parents approaching it their way and not understanding the system. Then also we tend to feel guilty about the person on the other end receiving all their messages. I think that if we are aware and mindful and show up with grace and compassion, that that is first of all what we can do. It is what is in our control. But it is kind to all of our fellow physicians who are caring for our parents, kind to ourselves, and kind to our parents at the same time.

We also bring, I did not mention this, but we bring our perfectionism and our unreasonable expectations, and we want everything to be done just right. Yet we know in our current medical system today, that is just not possible.

Kevin Pho: Are there any support services for caregivers other than your own immediate family?

Jessie Mahoney: I think mindfulness and compassion are probably the best support services that you can find. My dearest friend, who is a geriatrician, has actually done a lot of training on mindfulness for caregivers. Getting some kind of training and having a mindfulness practice is one of the most helpful things that caregivers can do. In fact, it is something I used to teach moms as a pediatrician. They would say, “What can I do to help care for my two-month-old? Or how can I stimulate their development?” And I would say, “Practice mindfulness.”

I think that this is the same thing because it allows you that space to respond rather than react. I do not know of organizations that have patient navigators or things like that. I think it is an area where somebody could really make a huge difference in helping us figure out how to navigate and utilize support systems out there. It is definitely an entrepreneurship opportunity for someone who is really interested or for whom it is their passion. But for now, and it strikes me a bit as the same for now as how we work in the health care system, it is leaning into being the best version of you and not taking it personally and making sure that you are not depleted. Because when you are depleted and drained is when we do not show up as our best, and this is something that in the end I want to have shown up my best for.

Kevin Pho: We are talking to Jessie Mahoney. She is a pediatrician and coach. Today’s KevinMD article is “Why physicians struggle with caregiving and how to cope with grace.” Jessie, let us end with some take-home messages that you want to leave with the KevinMD audience.

Jessie Mahoney: I think the message is being aware that it is a really challenging, complex, and nuanced situation. So if you are overwhelmed and if you are feeling burnt out, you are absolutely in good company. Then, focus on what you can do and what is in your control, which the primary thing is to take care of yourself. I know we often say put your own oxygen mask on first; I would say here, at least put yours on as well. We really want to put our parents’ on and really show up for that situation.

But recognizing that our doctor tendencies may not be as helpful, that awareness is really going to change that entire situation. Check in with your future self so that you will feel at peace when all is said and done. For me, that has been the most important. I will say, not all is said and done yet, but that is helping guide me along the journey.

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

Jessie Mahoney: Thanks for having me.