Andrew N. Wilner, MD: Welcome to Medscape. I’m your host, Dr Andrew Wilner. Today, I have the privilege of speaking with Dr Jessi Gold. Dr Gold is an associate professor of psychiatry at the University of Tennessee Health Science Center and the author of How Do You Feel?
Today, we’re going to talk about her book and her role as chief wellness officer at the University of Tennessee. Welcome, Dr Gold.
Jessica A. Gold, MD, MS: Thank you so much for having me.
Wilner: Dr Gold, let’s start with your book. Why did you write it?
Tiptoeing Into Self Disclosure
Gold: It’s not like there was an “aha” moment precisely, but I’ve been being a clinician who takes care of healthcare workers as a psychiatrist since the pandemic, if not before, and for the most part, I’ve been hearing the same stories over and over again. They always end with “I’ve never told anyone that before,” “No one else feels this way,” or “I feel alone in this.”
For me, many of the stories have the same themes and we shouldn’t feel alone in it. To be able to tell stories of my patients and tell my own story in a way that might make this information accessible and might make people feel seen was the ultimate goal there.
Wilner: I read your book and I found it very interesting. Also, it was quite intimate. There was a large amount of self-reveal. How did you feel about that?
Gold: I’ve tiptoed into self-disclosure for a while, and I’ve been on social media for a while, talking about my own therapy. I wrote a piece a bit ago about my own meds and noticed that the response wasn’t that I combusted or that people thought I was a horrible person or judged me for it.
As I’ve tiptoed into it, I’ve felt more comfortable and recognized the need for it. I also realized in being an expert in an article on burnout that, when they asked me how I was feeling and I said the real answer and then the article changed to me being the lead story, clearly we weren’t talking about this enough.
Being a person, again, who’s like the clinician of healthcare workers, I wanted to model that and also thought if I could start the conversation, maybe other people would feel more comfortable being vulnerable. I took the leap to do that.
Wilner: In your book, you talk about how COVID-19 affected you. Also, I believe you had four patients and their stories with the different mental health issues that they struggle with. COVID-19 is a little bit behind us, so has anything changed, do you think, in the mental health world?
Gold: I think in many ways people want to believe that COVID-19 came down from the clouds, made us sad, went back to the clouds, and we’re fine again. It just never was going to be that way.
As healthcare workers, we had high rates of burnout and mental health conditions long before COVID-19. It just gave us new stressors. COVID-19 also really exposed many of the issues in healthcare, including access and who gets access to things, people dying, ventilators, and protective equipment. All of these things were maybe new stressors or cracks in existing stressors, so it only compounded our bad baseline mental health.
In my experience, just because it’s been better and those stressors are different doesn’t mean we’re okay now. I think there’s a desire to pretend that we’re okay now, but for me, it’s important that this conversation is still happening and that we’re not only talking about people who are caregivers or who work in frontline work in the height of a pandemic, but we also recognize that their jobs are always hard, that their jobs are going to be impacted by those years of their life, and that it should be a conversation we continue to have.
Reducing Stigma
Wilner: I’m going to read a line from your book: “People who ask for help are the subject of gossip and are judged.” What you’re talking about there is stigma. Particularly for physicians, it’s very difficult for them to ask for help. As a wellness officer, what’s going on there?
Gold: There are some data about that. Basically, medical students, when they’re going into medical school, are asked if getting mental health help is a weakness. A very small percentage of them say yes to that. Then they say, well, what about all this other noise in the culture? What about your supervisors? What about your colleagues? What about residency applications? What about patients?
Over 50% of them — closer to 60% in many of those cases — are saying my patients would judge me, my colleagues would judge me, my supervisors would judge me, and my next level of applications, residency programs, would judge me. It ends on this question that’s like, well then if you get help, would you talk about it? It’s a tiny number.
Basically, just because we come in with our own beliefs — and maybe they aren’t even stigmatizing — maybe we actually think mental health is health, once we get into this culture of healthcare to what we’re seeing around us, to what we’re seeing modeled, that changes. Maybe we still get help but we’re not talking about it, or maybe we don’t get help, which is obviously the worst outcome. We have high rates of suicide in our profession, and the people who show up at my door tend to be quite sick by the time that they show up.
It’s a little skewed because I am a psychiatrist and not a therapist, but in so many ways, it’s like, oh, it’s not interfering with my work yet. Many of my patients also say, “I haven’t hurt anyone yet,” which has never been my favorite response because I don’t think we should measure our own well-being by whether we made an error or whether we’re in a position where patients are going to notice.
I think we should care about ourselves. People come pretty late. I think that is a product of stigma. It’s what we see. I think the stigma comes from what you see modeled. Nobody else is talking about it.
I think it comes from even those little jokes that they make about psychiatry or mental health patients. If you see somebody who is in the emergency department for a mental health thing and the people around you make dark-humor jokes about it, then you say, well, I have that same thing. Like, I’m not going to disclose it.
We also have a culture of showing up no matter what and using that as a badge of honor. If we wouldn’t show up if we were actively hemorrhaging, why wouldn’t we skip for mental health? It just doesn’t meet the criteria for not showing up.
All of those things combined lead to us thinking I just have to deal with it myself, or My job is to serve other people, not to serve myself. Therefore, I just have to ignore what’s going on with me.
Wilner: I know I would feel differently telling my residents, “Hey, I have to leave early today. I have a dentist appointment at 4 PM” vs “I have to leave early today. I have to see my therapist.”
Gold: Do you think you feel at all better than when you started your medical career, or do you think that it has been the same for you the whole time?
Wilner: I think I would be more open today, but I think that probably is related to the gray hair and wrinkles I’ve accumulated.
Gold: I think when you have more power and flexibility, you care less about what all these other noises are. But I also think that as a culture, we’ve evolved to being more comfortable with mental health in general. I think people have become more comfortable talking about it out loud, but in our profession, much less than others.
I feel like it’s also hard with therapy because you’re probably going every week or every other week. There are only a few things you would need to do that for, so even if you didn’t say, “I’m leaving at 4 PMbecause I have therapy,” if you left at 4 PM every week for an appointment, it’s either physical therapy or mental therapy.
You don’t have many options, and residents, medical students, trainees, and other health professions don’t have the ability to take that much time off, but if they did and they had to ask for it, it would be much harder.
What Does a Wellness Officer Do?
Wilner: I don’t remember wellness officers when I was in medical school. Is that a new thing?
Gold: It’s a newer thing. It’s developed under the concept that having somebody overseeing all of this stuff and valuing it at a higher level is important to making sure things actually get done.
Places like Stanford are among the first that had chief wellness officers in the hospital system. Many hospitals have grown to have them. I’m in a different role in that I’m the University of Tennessee system, which includes the undergraduate schools, so it’s a bit different from the people who are just in health.
The point is to have somebody whose goals, values, and things that they’re thinking about are always about the well-being of the people that are in the institution — students, faculty, and staff. That’s not always what the bottom line is for everybody else in administrative positions. It makes sure some stuff gets done and that you’re in the right rooms to make it happen.
Wilner: Give me an example of one of those things that qualify as stuff.
Gold: Much of what the chief wellness officers who work in hospitals are working on includes, how do we think about the role of the electronic medical record? How do we think about staffing? How do we think about control in your workplace, and what does that look like? Is our well-being matching up to what our productivity measures are? Are we actually measuring the right thing?
You see much of the system focus from the chief wellness officers that are in the healthcare system. I have a little bit of a different bent just because I’m not exclusively in the healthcare system, so much of what I’m looking at is why we focus so much on the intervention side and are there enough things that we could be looking at, and what kind of options would we have for prevention on our campuses?
It’s always going to be stopping the bleeding that’s going to take your attention, right? If there’s a crisis, you have to address the crisis, but we don’t all need to get to the crisis. When you have a little bit of breathing room and time to step back and actually look at what’s going on, how do we make sure that we have preventive options and that we have things for folks to try to do along the way that aren’t just like, oh, they got to crisis again. That’s what I’m looking at.
What does that look like? Is that a peer support program? Is that a coaching program? Is that just making sure that they know of all the resources and where to access them when they need them? Is it regular screening tools for themselves that they can monitor?
There are many things that people have implemented, but across the spectrum and across our whole state, we’re looking at what makes sense and what programs are working or not.
Advice for Improving Wellness
Wilner: We’re just about out of time. I have one more question. Apart from seeing you, do you have any advice for physicians and other healthcare workers trying to improve their own wellness?
Gold: We’re people that do this job, not robots that do this job, so pretending that our job doesn’t affect us doesn’t help. It should. It’s a hard job. We listen to hard stuff; we see hard stuff. Pretending that somehow, you can see all that stuff and hear all that and be fine, doesn’t make sense.
Instead, you should think about how you can deal with that and approach it that way. I’m not saying that the healthcare system is great because there are so many problems in the system, but if you’d like to stay in it for as long as you have, or you’d like to stay in it at least for a while, you do have to figure out what it looks like for you to do that.
For me, it’s been things like checking in on myself and my feelings, making sure I take my vacation days, working on self-compassion and that mean voice in my head when I do things wrong or when I think I did things wrong, looking at how email takes over your life, and making really strict boundaries around certain things like talks or all those extra asks that come up in academics.
There are ways that we can manage it, and this isn’t to say this is somehow a resiliency problem, because our resilience is higher than any other field. It is to say that we can do something, and I think that’s more important than doing nothing.
Wilner: Dr Gold, thanks for joining me for this Medscape interview.
Gold: Thanks for having me.
Note: This article originally appeared on Medscape.
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