Disconnecting from your clinical identity - reclaiming your whole self

0:00 Welcome to the Clinician Researcher podcast, where academic clinicians learn the skills to build their own research program, whether or not they have a mentor. As clinicians, we spend a decade or more as trainees learning to take care of patients. When we finally start our careers, we want to build research programs, but then we find that our years of clinical training did not adequately prepare us to lead our research program. Through no fault of our own, we struggle to find mentors, and when we can't, we quit. However, clinicians hold the keys to the greatest research breakthroughs.

0:40 For this reason, the Clinician Researcher podcast exists to give academic clinicians the tools to build their own research program, whether or not they have a mentor. Now introducing your host, Tiosi Onwemona. So I'm talking today about disconnecting from your clinical identity, and I'm talking about it because of what Morgana brought up, and it's all of our stories. It's not just her story, it's all of our stories. So if you recall, there was this thing where you probably finished all of four years of college. Most people have a short track program where they can combine college and medical school, but most of us did the four years of college, and then we did four years of medical school, and then we did three years of residency training, and maybe we've gone on to do three or more years of fellowship training.

1:34 But it's been a long time, first of all, trying to get into medical school, almost like the whole idea of scratching at the door, let me in, I want to be a doctor, I want to save lives, let me in. And then you finally get in. So there's all the years that you built up just trying to get in, just trying to be the doctor. And then you get into medical school, and there's all that time trying to learn what a doctor is supposed to learn. And then you graduate, and there's all this time spent learning how to be the doctor that you've been preparing to be or learning about being all these years. And so even though when you do the math, maybe the period of training might be about 10 years, give or take a few, depending on what your specialty is, it's really been a couple of extra years in terms of all the work you had to do just to get to the place of even doing the whole medical school thing anyway.

2:23 So let's just say, by the time you get to where you are done with your training, first of all, you're just tired of training because you're just like, get me out of here. Can I just be an adult? Can I just be my own person? Please let me be my own doctor. But there's also the whole of your identity that's now wrapped inside this thing that's medicine. And I don't know about you, but for me, when I started, actually, it wasn't even when I started, it was in the middle of medical school. I just felt like, holy cow, this is such a soul sucking identity problem. Everything is wrapped around medicine. I'm always studying. I'm always going to see patients coming from seeing patients. It just felt like it was just sucking all of me up. And I don't know about your experience, but it really did feel soul sucking to me, even in medical school, where I was like, I can't do this.

3:09 This is just, I used to be a whole person before I came into medical school. Why is it now taking over my whole life? I don't see people. I'm sleeping all the time. When I'm not sleeping, I'm studying. When I'm not studying, I'm in the hospital. It really did feel all consuming. And it almost felt like a vice or like, what's the word? It was like something closing in on me, trying to take over my life. Anyway, so fast forward to being an attending. And it actually never went away. And I always really felt like I was choking. And it took me a long time to get to the place where I realized that if I was ever going to take my life back, whatever taking the life back meant, I would have to be the one to step in, right?

3:51 Because we exist in a culture where people overwork. We exist in a culture where people feel like sacrifice is the only way forward. We exist in a culture where it's the patient's welfare or nobody's welfare. And so many times we are kind of trained, especially for women or underrepresented in the academy, to sacrifice our lives on somebody else's altar. It may be the altar of the patient, which feels very noble and good and right. It may be the altar of the academic environment. The institution needs you. You don't show up, nothing will happen. Or it may be sacrificing our lives on the altar of, oh, this is what it takes to succeed academically. Therefore, you must XYZ.

4:31 That will always be something that's trying to claim us. And the challenge is that we are very entrenched in this identity of the physician is giver, the physician is sacrificer, the physician is hard worker, the physician is non-complainer, the physician is do everything. And it's hard. It's like we've been training for so long to have this identity that swallows us up. It's hard to think of life outside of this identity. However, we must. I read this thing somewhere that it was like somebody's epitaph, like the thing they put on the grave when you die. And it was like, he was born a man, died a doctor.

5:12 The identity is sometimes unshakable from your personal identity. Everywhere you go, you are the doctor. But I want to say that we were whole people, whole people before we came into medicine. And medicine will end for us. It will end for all of us in some way. Some of us will, I don't know, continue to keep the identity burning and seeing patients until we die. Some of us will be forced to retire even when we don't want to. We're like, no, if I'm not doctoring, who am I? What can I do? I mean, people really do have crises when they have to give up doctoring. So it's a big deal. It's a big deal. But what do I want to invite you to think about?

5:53 I want to invite you to think about the identity you had before you came into medicine. Now you can never be the same again, right? There's no going back to who you used to be. It's too late. It's like you passed through the fire, that you've been burned beyond recognition. And there's a new you, and there's no going back and getting the old person. But it is important to recognize that you used to be somebody different. Before you came into medicine, you were capable, you were strong. And if you didn't go into medicine, you would have been okay. You would have found your way. You would have had a great career. The same drive and energy that you bring to medicine is the same drive and energy that you would have brought to another sphere of life. And so you are a whole and capable person.

6:34 And it's important to say that because sometimes there is a stripping of our identity by medicine where it's like, if you're not a doctor, who could you be? And it's a lie, right? It's the whole scarcity mindset. In reality, you could be many things. Your physician training empowers you to be many things. And yes, it may involve going back to the beginning, to the beginning, and learning something new or retraining in a different way, but you are... It's toti potential, right? It's the multipotent stem cell. There's nothing you cannot become. And I think to some extent, like military training, you pass through, you can handle a lot of things relative to many people in the general population who have not had as much stress as part of their evolution as a person.

7:21 So I think the first thing I want to share is that you can do anything. And that's important. You know that. Like fundamentally, you know that, but there's also the sense of like, am I going to give away the four years of med school and the thousands of dollars I paid in tuition? I'm not... Like, there's a sense that we've sunk so much into medicine that we're afraid that if we lose it, we've lost so much of an investment. But again, I want to say you can do anything. Every investment you've ever made in medicine is an investment that you always have. Like you never lose it. Everything you've invested into becoming the person you are as a physician, someone who's really like, you know, operates at a high level, is able to work hard, is able to push through challenges, is persevering, able to advocate for people, all of that, you still keep that and you can apply it to anything you want in life.

8:09 And so your investment in medicine, even if you're counting the costs or maybe you haven't even paid off your student loans. At the end of the day, you still own it. You still have it. You're not losing anything. You can be anything you want to be. Okay. The second thing is that whether you want to be anything you want to be or not, your time in medicine is going to come to an end. It just is, right? Now, I'm not trying to be morbid and say you're going to die. I mean, we all are and that's okay. But the reality is at some point you might retire. Some people have been disabled and left medicine. Some people have been forced to leave whether through job cuts or some other unforeseeable challenge. But at the end of the day, whether we leave after a long and happy career of planned retirement or we leave abruptly or we leave because just something else has pulled us in a different direction, our medical careers are going to end.

9:01 And then the question is, are we ready? Are we ready for life beyond? Now I'm not trying to push everybody into the future to say, let's forget about today and just go into the future. But it is important to be future thinking, right? That's why we talk about, oh, are you ready for retirement? How much have you saved up in your 401k? All of that stuff that frankly, we're just too busy to even think about like, no, I just need to get through today. Don't tell me about 30 years from now. I just need to survive today. But the reality is that tomorrow is coming. But what does that mean? What does that matter? Well, it's relevant because it means if you're not going to be a physician forever and ever, amen. You're going today to be ready for that eventuality, right?

9:44 For that certainty of the day medicine is not like all of your life. And I'm specifically talking about like, just how do you disconnect your identity such that it doesn't have to be a painful separation whenever the time comes. And I'm not even talking so much about disconnecting your identity as much as how do you grow? How do you grow all the other parts of you that actually frankly have withered away and almost died because you've been so focused in medicine? How do you grow your financial wisdom? How do you grow your business acumen? How do you grow your ability to learn new things or to have new hobbies? How do you do that? How do you become a whole person again?

10:24 Because honestly, our training kind of leaves us, I mean, very strong, very strong as physicians, very strong, very cool people, but lopsided. There are many things that we're not as good at. For example, we're not very good at negotiating because negotiating is just not part of our training. It's just not what we do. And so if we're going to learn to negotiate life, negotiate and grow and not just negotiating money, but just negotiating in general, it's a skill you haven't developed. If you're going to grow as an entrepreneur, it's not a skill. Even though many physicians own their own practices, entrepreneurship is not a skill you develop as part of your training. And so it's how do you, in the midst of your busy, super busy schedule where you barely can think about life, how do you create space to be more of who you already are?

11:14 This is not go and try to become someone else. How do you create space for expanding all of you? And what does that look like for you? What does that look like for you? So I think this is the point at which I want to pause and I just want to invite you all to just speak about what are some of the ways that you take time for you to think about you outside of who you are as a physician. It took a long time to get here, a long time. And so the idea that you're just going to like, you know, switch off like, oh, I finished residency today, I got my life back is not really real, right?

11:58 Because you know, there have been some, what is it called, neural networks that have been rewired. And if you're going to unwire them, it's going to take a long time to do that. And so really this is a journey. It's a journey. So I think it's not so much like, oh, if you haven't started thinking outside of the box of being a clinician, something's wrong with you. It's not that. It's just recognizing that it's taking you a long time to get here. You're wrapped up in an identity that sometimes lies to you and tells you this is all there is and there's more to you. And I think it's an encouragement to say, how do you create space to remember who you once were and who you want to be, right?

12:41 Who else you could be and what you need to do, invest today to create the opportunities for tomorrow. And I think one of the conversations we had earlier before you all came on with Margana was that sometimes you're just burned at the end of the day. You're just tired. You don't want to talk to anybody. You don't want to be anywhere. You don't want to do any. You just want to recover. And it's real. Like the work we do is hard and you literally have to come back home and recover from your work. So there isn't even a chance to say, well, what do I want to do today? How do I want to refresh? You're just like, save me somebody, please. I have to do this again tomorrow. And so I think that the struggle is real.

13:22 The struggle is real. And so I think the whole goal, the whole point of this is not necessarily to offer any solutions because I don't necessarily have any. It's just to recognize that it's a journey. It'll take time. And what may be more important than doing anything right now is thinking big, is thinking beyond who you are right now, is remembering that there's so much more to your universe than just your clinical medicine. And even if this is the thing that you are so good at right now that it seems like nothing else really is available to you, just to remember that, hey, the universe is huge. Your space, your role in it is big. And to begin to just think, think outside of the box because it's thinking first that allows you to take steps that you may not take otherwise.

14:11 But it's allowing yourself to think. Not like when you think, oh, what if I didn't do medicine? Sometimes there are alarm bells. I don't know about you. They go off in my head saying, what do you mean? What if you didn't do medicine? $100,000 of debt are still remaining. Stop thinking that. It's just a thought. What if I didn't do medicine at all? What if I retired and became an accountant? What if? And I think the thought experiment is just to allow you to expand your mind and think about what else could be and to help you start to think about, well, what needs to be different today to allow me to be who I want to be tomorrow? But again, it's a work in progress. It takes time.

14:52 And it's thinking. It's also connecting with people who are not where you are, connecting with people outside of medicine in different ways. It's connecting with people who are not in your specialty because even within medicine, we think differently depending on how we practice, is connecting with networks of people who are you used to hang out with, maybe not your high school buddies because you're so disconnected now, but the people who nourish you, the people who love you, the people who remember you before you became the big time doctor that you don't even think that you are. Making those connections so that you expand your community. But it's also thinking about, well, how do I become independent financially so that I'm not always tethered to this role where I feel like unless I'm working clinically, I may not even make any income.

15:46 And that may be a longer term thought, but still important to start to think about. What might I listen to or what opportunities may I make available just so I can think differently? Anyway, so I think these are things to think about. I do think, and maybe this is something I can solicit your comments on too, I do think we have a different experience as women in medicine compared to men for sure. I think that our challenges are somewhat different and our burdens are different too. And for that reason where I think, and again, this may just be a broad generalization that you can just take and throw in the trash, there may be more space for men to the extent that there might not be as much for women, but maybe that's just my thought.

16:31 Anyway, I'll tell you how I think about it now. I definitely feel like I work hard. And some days I think I'm like, what am I doing here again? Why am I here? But I realized that I've made an investment in medicine that I intend to cash in on and whatever that means. I'm not just talking financially. I really am not talking financially. So I recognize sometimes when I'm working hard, when there are hard days, I think, wait a minute, why am I working hard again? I'm like, ah, this is my goal. Ah, I have a goal. Okay. I have a short-term goal. And this short-term goal, once I get to it, that I don't necessarily have to do all these things. But I also think about it, how do I thrive now today? Well, how do I thrive today so I don't have to wait? In seven months when I finish being called junior faculty, then life will be good.

17:17 When you find yourself saying, if, then, if whenever I, then I will, then you know that you're kind of like in this cycle, this vicious cycle, because there's never an arrival point when you graduate. And then you graduate. It's like, well, okay, when I start my first job and then you start your first job, it's like, okay, no, no, no. When I get my first house, so when I get the second, it just keeps going. When you find yourself in that cycle of deferring happiness until, deferring peace until, it's a sign that maybe you should stop and say, well, how do I make life better for me right this moment? How do I make it work in spite of all the challenges that are going on?

18:01 How do I make it work? So I'll end with an example of a way I feel like, you know, it feels like a hybrid way that I'm doing it. I don't necessarily recommend this for anybody else, but hey, it worked for me. It's working, at least it's working. So last week I went and gave a talk at NMA, the National Medical Association. It was in New York this year. And I was supposed to give a talk on Sunday morning at 7.30 AM. And I agreed to this talk months ago. So when I finally get this email from family members saying, we're doing this family reunion, surprise birthday party Saturday night. I'm like, I've already committed to this Sunday talk and I want to honor my commitment. So I was like, okay, how about I'm not going for the party?

18:44 And then everyone was RSVPing and my siblings were coming. And I mean, there was family coming in from all over. I'm like, this is like an opportunity. It's an opportunity to get together. So I say, I'm going to go to this party and then I'm going to fly out at night to go to give my talk. And if you fly a lot, you know that you should never like take the last flight of the day because you just never know what will happen to that last flight of the day. So I skipped the last flight of the day and I took the second to the last flight of the day, which was the 9 PM flight. So the party goes on for an hour. I get the notification that the flight is delayed. I spend 30 more minutes with family. That's so cool. Great time. And then I go to the airport, flight is canceled.

19:24 I buy another ticket to go to Philly because I'm like, if I just get to Philly, I can take the 5 AM train and I can still make it at 7 30. And then we're on the tarmac for two hours and then that flight is canceled too. And so now it's Sunday morning. I missed most of the party because I was at the airport. I'm not where I'm supposed to be to give my talk and I have no idea what to do. Anyway, so I record the talk and I send it to them, which they watch and it worked out, was well received and all of that. Finally found a flight to go to New York the next day, which it was like, what's the point of going? My talk is over. But another thing I had planned during that time was to meet with family in New York so that we could, we could actually was another reunion in New York.

20:04 So actually if I didn't make it to the talk, I would have missed that. So anyways, I did make it to New York. We did do the family reunion and somehow in the middle of like, like at the end of breakfast, I was like, Hey, I have this session I'm going to. I'll see you all later. And I go to the session and then I leave the session and I come back. And so how did it work? At least I thought back on it and I was like, wow, you know, like, you know, usually people would say just separate work from family and work when you end work and then do family when you do family. And sometimes it works to just kind of like mix and match. Just to say that there is not one way that works well. There's just the way that works for you. How do you make it work?

20:46 Right? How do you make it work? And, and sometimes it's being creative and thinking outside the box, you know, like there's this whole idea. My daughter has this idea that families are supposed to sit at the table and have dinner every evening at 6pm, which I laugh at. Like, where did you get this from? Like, what TV show are you watching? Like, who does this all the time? And maybe you guys do not, not saying anything against that, but just to say that for every person is something different that works. And it's important to just recognize that your life is unique. Nobody has your life. Nobody has your challenges. Nobody has, you know, your ambitions, your hopes, your dreams, your goals, and whatever it is, just embrace who you are and where you are. And don't let anybody judge you. Don't let anybody tell you there's a way to be, or there's a way to do things.

21:28 It's really just, hey, is this where you want to be right now? Is this what you want to be doing? And if that's the fact, if that's it, then just embrace it and go with it. Thanks for listening to this episode of the Clinician Researcher Podcast, where academic clinicians learn the skills to build their own research program, whether or not they have a mentor. If you found the information in this episode to be helpful, don't keep it all to yourself. No one else needs to hear it. So take a minute right now and share it.

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