Episode 1: The First Domino to Fall

In this episode, Rebecca introduces herself and talks a bit about her journey from burnout to flourishing.  She talks about her passion for helping other women physicians change the culture of medicine by first liberating themselves from unhealthy patterns and conditioning.  She lays a foundation of concepts for proceeding through a curriculum for flourishing for women physicians which includes some surprising, yet evidence-based research findings that can be liberating and life-changing. 

You can find Dr. Lauderdale on instagram, or email her at rebecca@rebeccalauderdalemd.com

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Resources and References:

Organizational Factors Affecting Physician Well-Being. Tawfik, D.S., Profit, J., Webber, S. et al. https://doi.org/10.1007/s40746-019-00147-6

Impact of Organizational Leadership on Physician Burnout and Satisfaction. Shanafelt, T., Gorringe, G., et al.

The Gifts of Imperfection, by Brene Brown

Brene Brown TED Talks 

Flourish by Martin Seligman

The Body Project by Joan Jacobs Brumberg

The Meaning of Human Existence by Edward O. Wilson

Immunity to change, by Robert Kegan and Lisa Lahey

Passive Income MD - Peter Kim

Dr Una’s EntreMD Podcast and Business School

Sunny Smith, MD - Empowering Women Physicians Podcast and coaching program

In the Sanctuary of Women by Jan Richardson

Music used with permission:

Intro “Death Dance” by Luftmensch

Outro “ Gold among the sand” by Trevor Kowalski

Transcript

Hi there! Thanks so much for joining me for my very first Women Physicians Flourish podcast episode - whoever you are you are welcome here and I hope you find something that is truly of value to you.  I'm going to start by telling you briefly about myself so that you have some Idea as to why I’m here and why I’m doing this.  I’m a primary care internist. I've been a practicing physician for a decade and a half, and I am producing this podcast to create more conversation around the topic of flourishing and wellbeing for physicians, particularly women physicians.  I’ve been on an 8 year journey from severe burnout to now living a completely different life than I imagined was possible for me when I was at my lowest point. 

There are, thankfully, a growing number of voices in this space, which I am so grateful for, much more than there were back in 2013 or so, when I was suffering a great deal and didn't really have anyone to mentor me through the process, so I cobbled together my own curriculum for healing burnout, which Martin Seligman calls “getting to zero” instead of being in the negative on the wellness scale,  and then I got interested finding out a way to get above zero - to flourish, which is a different set of skills. This hard-won curriculum I developed for myself, which includes lots of real science, but also stories and friendship and courage and vulnerability, is the topic of this podcast.  The title, women physicians flourish, has a period at the end, on purpose, because its a declarative - it may be aspirational, but it is the purpose of this podcast to help that statement be true. 

One thing that has spurred me on to create a podcast, is that during the pandemic, while living physically in a smaller radius, I’ve expanded my virtual world to include a whole international community of physicians doing amazing things in their lives and for other physicians, their families and patients, people like Peter Kim with his Passive Income MD site and the Leverage and Growth Summit. That summit  is where I found Dr. Una with EntreMD and Sunny Smith and her amazing Empowering Women Physicians coaching program and facebook group where there are literally thousands of physicians working on the problems of burnout and finding ways to flourish instead. I am so grateful to them and all the other physicians in those groups who have graciously shared their time and skills and knowledge and friendship - I wouldn't be recording this podcast right now if it weren't for them. 

So, I stated a focus on women physicians, not with the intention of excluding anyone - if you aren't a physician or don’t identify as a woman, I welcome you with open arms.  But for me, as a woman and a physician, having gone through that long period of severe burnout 7-8 years ago that included depression and suicidal ideation, I know through the process of healing from that, that many of the factors that predisposed me to that experience are related to the fact that I’m a woman, with the conditioning and expectations of women in America. and the things that happen when you’re struggling to abide by gender norms that don’t serve you, so you try to change them, and strange things happen.  Shame and guilt and fear and backlash. Those things made it harder for me to make changes that eventually led to much more freedom in my life.  I do want to make it clear up front that the last thing I will be doing is victim blaming here.  The organizations and systems we work within are the largest causes of physician burnout, regardless of gender. It’s not our fault. The estimate from published studies is that around 80% of the factors contributing to burnout are related to local systems, organizational factors and regulatory requirements, not our personal characteristics. So, if you are experiencing burnout, You are not broken, it’s the system you work within. 

But despite this, in my particular case, and I suspect this is true for some of you as well, I needed some pretty significant personal transformation before I was even able to consider changing my work environment  - it was only after getting some of this transformation underway, that was ready to make the career change I did - i went from being an adult hospitalist to practicing outpatient medicine for medically complex patients, which i love, and experienced a great deal of growth and did things that I never thought I would or could do.  I ran for election to the board of directors of my 300 physician group and they elected me! I’m now in my second term, and I started a program of physician peer groups;  along with some of the friends I’ll talk about in later episodes I have given talks at a national festival about how to form groups for the purpose of transformation, I’ve played and sung with a band, I’ve written a short book, written a blog for KevinMD, and I am happier than I thought I could ever be if you had asked me back in 2013. My life is not perfect and I still have plenty of struggles and make lots of mistakes, but despite that I have a very rewarding life that is worlds different than it was 7-8 years ago.   

So, though the system we work in is definitely the major root cause of the high rate of burnout in physicians, many of us have internal work we need to do first before we have the strength and the skills to go on to change our lives and ultimately change the culture of medicine in America.  This is a dream many of us share and that I want to propagate and grow the vision for - something we all need - not just women and not just physicians - all of us benefit when the providers of healthcare are well and flourishing.  That’s not just a positive sentiment that feels warm and fuzzy.  When doctors flourish, they are more productive, stay in their jobs longer, have better patient outcomes, less substance abuse, less divorce, patients are happier, it spills over to the whole world. I get tears in my eyes thinking about it - there’s been a lot of suffering but there’s also the potential for immense transformation here, so much potential, and I want us to be ready to be part of that.  I can sense a tide turning through these years since I had my big breakdown/epiphany/transformation whatever you want to call it - there were very few people talking about physician burnout, much less the causes and evidence for relieving it, and certainly not about physicians actually flourishing. But now we know so much more and there’s so much more awareness. It's an incredible opportunity and responsibility to be part of this profession at this time in history, and I just can’t wait to do this with y’all and play my little part in it. 

That’s the reason for this podcast - to share with you information and skills that are evidence based and not just an N=1 bunch of anecdotes that leave you wondering whether it even makes sense to listen to what I have to say.  You have my commitment that I will bring you things that have real evidence behind them. 

So, today, the first major point I want to evangelize, and that this episode is really about is that taking time and energy, and investing resources on learning to care for yourself is NOT SELFISH. It is actually an imperative. It’s interesting that we work to conform to standards of beauty and behavior, which society teaches us determines our worth, and we don’t think twice about the time and the money we spend on that- the never-ending litany of self-improvement projects focused on what others want, and keeping us from ever getting down into the real substance of what we want for our lives, our real fulfillment, however we define that for ourselves.  But we have hesitation in spending any meaningful amount of time or other resources on loving ourselves and meeting our own desires. 

I was INCREDIBLY stubborn about this. I spent the better part of my adult life on  self-improvement projects, trying to perfect myself in various ways, and allowing it to cover up the fact that I was not happy - my relationships weren’t what I wanted them to be, my work wasn’t fulfilling, I had no outlets for creative expression - And somehow I thought that the best thing to do was to take on different “projects” for making myself “better.” Things like losing weight, cosmetics, wardrobe - and these things arent bad in and of themselves, but for me they were grasping, grasping at some way of meeting expectations. And I was never happy with the results, they were never enough. I had been on a diet almost continuously since I was a teenager, and when I think back or see photos of myself,  I just feel so sad that I couldn't see that I was totally normal and beautiful and just really wish I had been able to feel happy and be ok with who I was and love the people I was with.  

One of the other things I would do was get preoccupied with feeling like I was a terrible parent and would set out to immerse myself in some new parenting method. or I’d take on some new project at work or with my social group (all focused on what I thought would make other people happy with me, to meet expectations) but would end up just feeling like crap, because what I was looking for was for my worth to come from perfection, which does not exist. It wouldn't matter what I did, what method I used, the result was the same because that’s what perfectionism does to you.  So, because I couldn’t be perfect I would start eating more to buffer from the negative feelings, gain back weight, and then go on a diet again. And the cycle continued, all the while being completely oblivious to the truth, the deeper issue that I didn't feel like I was worthy of the happiness and fulfillment I wanted. I thought my purpose was to meet the expectations of others and that would make me happy.  this was far below my level of conscious thought (though probably obvious to any astute observer from miles away), so it took experiencing a great deal of existential pain to accept that I needed to do work on self-love and acceptance and eliminating perfectionism. 

I really felt averse to that term in the beginning.  Self-love. It conjured images of people who are self-involved, or just totally disconnected from reality. I thought it was a cop-out term for people who wanted to justify self-indulgence. But I could not have been more wrong. 

I remember the specific setting I was in when the first of the dominoes fell.  I had been on yet another diet program and was frustrated by my lack of success.  I found a book called Immunity to Change that was written by two Harvard Psychologists and it’s about how to figure out the invisible reasons that keep people or organizations from succeeding when they want to change. great book,  highly recommend it.  But when I was working through the exercises in the book trying to figure out why I was having so much trouble eating healthy and not losing my excess weight, it just kept coming up that the reasons I wasn't successful had nothing to do with knowledge or skill about nutrition or exercise, it had to do with the fact that I quite literally hated myself. I was never happy with my appearance, no matter what I weighed, and the truth was that most of the time it was within a healthy range (i hated seeing photos of myself), I thought I was a terrible parent because I wasn't at home but then when I was at home I was tired and irritable because I was exhausted, and I thought I was a terrible doctor because I had a family to take care of, I thought I was terrible wife, I didn't have the kind of friendships I  wanted, because I thought I had to be a perfect person to be able to have those kinds of relationships. 

As I became consciously aware of how much I disliked myself, a little voice in my head quietly suggested that maybe the topic I needed to work on wasn’t my weight or appearance. I was resistant to that idea, but I browsed the Immunity to Change authors’ suggested resource page, which had a listing of books on all sorts of topics people might be targeting for their change efforts.  And one of the topic headings was self acceptance.  And it just rung true to this little part of me that that’s what I needed.  I didn't WANT to need that. But that little voice just suggested, again, that maybe it wouldn't hurt to just see what this was about.  I don’t have to do anything about it, just look.  The first item on the resource page was Brene Brown’s book The Gifts of Imperfection, and they listed her TED talks.  So, I read the description of the book on Amazon and then I watched the first TED talk and I was struck speechless.  

For those of you who don’t know her work, or this part of her work, Dr. Brene Brown is a social scientist, a PhD in social work at the University of Houston, who started her career researching shame  - what shame is, what causes it, and how it affects the behavior of humans.  And as her body of research grew she noticed this small percentage of people in her studies who were what she called “wholehearted” - they lived their lives with this openness, this willingness to put themselves out there and be their authentic selves and take risks and love and live in this free, big way that was so different than the vast majority of people she studied.  So she becomes so intrigued that she decides to study those people - what’s different about them? What do they do, what do they not do, what is different about their life experience, their childhoods, education, etc., that could maybe give a playbook so to speak of how to be a wholehearted person.  

In her book, The Gifts of Imperfection, she writes about that moment while she was analyzing her data when she realized what was different about the wholehearted people.  they did not have different rates of experiencing trauma, or socioeconomic status, or education or race or ethnicity or things like that.  It wasn't some special kind of childhood or social status or anything, though she does say that about 10% seem to have been taught how to be this way in their families, but the vast majority were not, and learned it themselves, they fought for it.

Here’s a direct quote from Gifts of Imperfection:

“I thought I’d find that Wholehearted people were just like me and doing all of the same things I was doing: working hard, following the rules, doing it until I got it right, always trying to know myself better, raising my kids exactly by the books…

  After studying tough topics like shame for a decade, I truly believed that I deserved confirmation that I was “living right.”

  But here’s the tough lesson that I learned that day (and every day since):

  How much we know and understand ourselves is critically important, but there is something that is even more essential to living a Wholehearted life: loving ourselves

  Knowledge is important, but only if we’re being kind and gentle with ourselves as we work to discover who we are. Wholeheartedness is as much about embracing our tenderness and vulnerability as it is about developing knowledge and claiming power. 

  And perhaps the most painful lesson of that day hit me so hard that it took my breath away: it was clear from the data that we cannot give our children what we don’t have. Where we are on our journey of living and loving with our whole hearts is a much stronger indicator of parenting success than anything we can learn from how-to books.”

She then goes on to talk about the fact that analyzing that data and making those findings led to a huge spiritual transformation for her, because she realized that she was living almost exactly the opposite way from the wholehearted people.  She had very little self love in her life. So, she spent a year with a therapist working through all of it before she even started writing up her findings and sharing what she had found with others. 

Another quote:

“As it turned out, the work I had to do was messy and deep. I slogged through it until one day, exhausted and with mud still wet and dripping off my traveling shoes, I realized “Oh, my God. I feel different. I feel joyful and real. I’m still afraid, but I also feel really brave. Something has changed - I can feel it in my bones.” I was healthier, more joyful, and more grateful than I had ever felt. I felt calmer and grounded, and significantly less anxious. I had rekindled my creative life, reconnected with my family and friends in a new way, and most important, felt truly comfortable in my own skin for the first time in my life.” 

I can personally attest that this is a reproducible result.  A year or two in and I felt exactly the same way.  When I first read her work I was speechless and then I just said “oh no” like a million times.  I realized, like she had, that I was living the complete opposite way of wholeheartedness. And that it was going to be really messy but her story and the stories of others along the way convinced me that it was worth it. Wholeheartedness was what I wanted, deep down in my soul, and always had been.  So I set about developing my own curriculum, cobbled together from dozens, probably hundreds of sources in the years since I found her work in 2014, and it changed my life.  

One of the reasons that Dr. Brown’s work spoke so clearly to me, and convinced me to get started, was that she had EVIDENCE, not just anecdotes. This was actual data.  And that is what I want to bring to you through this podcast.  Today, again, the point I’m hoping to drive home is that your ability to love and care for yourself determines the ability you have to love and care for anyone else in your life.  And that is actually in the evidence.  It’s not just Dr. Brown’s evidence. You can find this in other social sciences, psychiatry and psychology, and even evolutionary biology. 

Our survival as happy, whole, flourishing beings and not people who are just barely surviving is predicated on the fact that we participate in our own wellbeing. Natural selection did not give us happiness, at least not the lasting type, it gave us survival, but it did have a hand in determining the things that contribute to our flourishing, as have group selection and cultural evolution, which I’ll talk about in later podcasts because I find it so fascinating and helpful in understanding and then implementing that knowledge for change.  Many of the things that lead us to flourish are done in relationships with other people - one on one or in groups of various sizes.  Knowing about those things can make the way forward clearer, and our neocortex will help us if we use it to that end - this is who we are as humans.

For now, I hope I've been able to convince you, and if not convince, maybe put a little crack in the shell, tip the domino, that if you’re like I was back in 2014 trying to figure out why I was so unhappy, that you are closer to your own big transformation than you were before listening to this podcast today. 

Thank you so much for your ear and your attention.  If you liked this episode, it means a whole lot to the success of this podcast if you’ll share it with others, and consider giving me a review on apple podcasts - 5 star ratings give the podcast more visibility so that I can keep doing this and help more people. 

If you want to stay in touch and hear about other things I’m up to, you can go to www.rebeccalauderdalemd.com and sign up for my email list - in return I’ll send you a couple exercises you can do that can help with that inner critic we talked about earlier.  You can also find me on instagram at dr.lauderdale, and in my bio there are links to my website and other things I've done. And, don't forget to take a look in the show notes for links to other resources mentioned in this episode. 

Thank you again and here’s a little benediction for you, written by Jan Richardson:

“That you will know your vision

and live into it.

That you will withstand

the onslaught that comes.

That places of necessity

and places of horror

will give way to 

wonders and possibilities.

That you will see.

That your seeing will change you.

That your seeing

will change the world. “

Much love, my friends