‘Self-disclosure reciprocity’ key in changing culture of medicine
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Key takeaways:
- “Pushing our feelings down” has consequences.
- We can do better by telling our stories, because telling our stories changes our stories.
CHICAGO — The way that clinicians are taught to deal with feelings in medicine is complex, according to Jessi Gold, MD, MS.
“This is something that I think about all the time as a psychiatrist and as a clinician in the clinic,” Gold, chief wellness officer at University of Tennessee System and associate professor of psychiatry at University of Tennessee Health Science Center, said during a Women in Medicine Summit keynote address. “We get asked the same question all the time: ‘How are you?’ Most of the time, we say it to show that we want to engage with people and be empathetic, but we don’t actually wait for the answer — and at the same time, we don’t want to give the answer.”
Source: Jennifer R. Southall
Gold said the response given is normally: “I’m fine. I’m OK,” but those are not actual feelings.
“In psychiatry, we call ‘fine,’ Feelings I'm Not Expressing. We say ‘fine’ because we were told in medicine that we’re not supposed to have feelings. Patients have feelings. If we have feelings, it’s now all about us and that’s not the point of being a health care worker. Our job is to take care of others,” Gold said.
Perfectionism
Perfectionism is also common among physicians, according to Gold.
“We’re all perfectionists, and in a competition of perfect, if we have feelings or a weakness, we ‘lose,’” she said. “We’re also taught that good doctors are stoic and if we’re a good doctor, we can do our job without emotion. This is only compounded by being female, because we are taught as women that if we show emotion, people will call us emotional, and that has a lot of repercussions. If I’m emotional and a leader, everyone will think that I am going to lose it at any point, and that I shouldn’t be a leader — because ‘feelings.’ We are taught to bury it all down and to just keep going. Just keep doing our job and we shouldn’t be talking about it. Someone’s going to judge us for talking about it. Push it all down.”
However, pushing it all down has consequences, Gold continued.
“I am a psychiatrist who primarily sees health care workers, and in my experience, pushing down our emotions delays how bad we are,” she said. “We push it all down until we are quite bad and our measure is, ‘Did I hurt someone today? And if I hurt someone today, then I should go talk to Dr. Gold, because that’s a problem.’ We push it down until we’re quite bad, or we never seek care, which is why we have such high rates of suicide, particularly among women physicians.”
Where it starts
Even for those of us who enter med school believing mental health is health, everyone else believes it isn’t, according to Gold.
“The data show that many people in health care say that if they get to the point where they need help, they wouldn’t talk about it and so we become a culture of silence, where even the people who don’t stigmatize it don’t talk about it,” she said. “We also become a culture of normalizing horrible conditions. Somewhere along the way, we decided that being in medicine is a field in which we are supposed to not eat, malfunction, mostly be burnt out and be a little depressed. But that does not actually mean that’s good. What it does mean is we have no idea that we are not OK. We think feeling bad is just a part of being a doctor.
“It also means that if we don’t want to feel bad, that we don’t like feeling bad, that we think something is wrong with us for feeling that way,” Gold continued.
She said the medical culture is unfair because everyone else is just sucking it up and not talking about it.
“That helps us struggle alone — feel alone and feel like we are the problem,” she said. “As a psychiatrist, I spend all day talking about burnout and prescribing medicine to health care workers. Also as a psychiatrist, I go to therapy and take medicine, but I don’t say that I am on medicine. I believe that our stories are our stories to tell. But I am an authentic human who cares about [mental well-being] and believes modeling it as a person who sees health care workers is important. But somewhere in my head, I have purposely decided to not tell others that I, too, am on medicine. I believe that antidepressants are the same as blood pressure medication, but does the truth mean something different for me because it’s my life?”
Ask for help
Paying attention to the ways in which barriers to seeking help gets into our heads is important because it will allow us to ask for help and realize the things that are preventing us from seeking it, according to Gold.
“Inherently at my core, I believe that we can do better, and how we can do better is by telling our stories because telling our stories changes them,” she said. “I believe me telling you about my story will then make it so someone else will tell their story to someone else, and we will no longer have this culture where we pretend that we don’t need help.”
Gold said she is a massive fan of “vulnerability.”
“Vulnerability is scary for a lot of reasons,” she said. “It would be great if you talked about yourself, but you will not know how people will react. You may receive feedback that is negative and it will feel bad — but I am going to tell you to do it anyway because it makes a difference. It creates a culture where we are open about it and can support each other through it.”
Self-disclosure reciprocity — when you are open about something, then others feel that they, too, can be open about things — is so important and is how we should all be, according to Gold.
“[Self-disclosure reciprocity] shows that we are courageous and empathetic, which are important characteristics of leadership,” she said. “None of us are ‘fine.’ The baseline of what we should be saying is: ‘Of course we are not fine.’ It doesn’t matter what you do in medicine, what role you have — stuff affects us. Pretending that it doesn’t is a joke and we cannot do that anymore. It isn’t helping any of us. What it is doing is delaying us receiving care, delaying creating a culture where those who are coming after us feel unsafe and will not want to join medicine. Inherently, when someone asks you, ‘How are you?’ they truly want to know the answer.”
For more information:
Jessi Gold, MD, MS, can be reached on X @drjessigold.
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Gold J, et al. Self-disclosure reciprocity: How sharing our stories changes culture. Presented at: Women in Medicine Summit; Sept. 13-14, 2024; Chicago.
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