Latest / The Hidden Load: For the educators and leaders in medicine who hold everyone up. / Moral Injury and Hidden Squeezes with Dr. Gita Balakumar
Transcript
- Santina Wheat: Welcome to the hidden load for the educators and leaders in medicine who hold everyone up. We will tackle the hard topics and help you conquer your chaos and get to calm all by starting to acknowledge and remove that hidden load. This podcast is a space for us to name the things that are common, but not normal. Each week, we'll look at the invisible weight you're carrying and explore practical coaching-based tools to help you find more calm, better boundaries, and a sense of purpose that doesn't require you to run on empty. I'm so glad that you've carved time out for yourself today. Let's get into the episode. Dr Santina Wheat: Welcome back to The Hidden Load. I am your host, Dr. Santina or Tina Wheat. If you are a mid-career clinician or leader, then you know the landscape of medicine shifted right underneath our feet. Many of us entered this profession when it felt like a calling, and it was built on relationships and mutual respect. But over the last two decades, healthcare transformed into a system governed by rigid metrics, RVUs, and contracts that just treat human beings like cogs in a wheel. When the system demands absolute perfection, but offers zero grace when you are hurting, clinicians experience something much deeper than burnout. They experience moral injury. Our guest today is Dr. Gita Balakumar. Gita is a pediatrician with 20 years of diverse clinical experience spanning private practice, military basis, urgent care, and outpatient facilities. Today, she's a master certified physician development coach And the founder of Dragonfly Coaching MD. She is here to talk about what happens when a dedicated clinician Hits the institutional wall, the shame that follows, and why coaching needs to become a baseline survival tool, not just for late career pivots, but starting on day one of medical school. Gita, welcome to the show. I'm so happy to have you. You've had a rich and varied 20-year career. Looking back, how did the shifting institutional expectations in medicine turn the worlds that you loved into a heavy, unmanageable load? Gita Balakumar: Yeah, thank you so much for inviting me, Dr. Wheat, and I'm glad to share my story and the experiences I have. for me, entering medicine was exciting. there was meaning and there was intellectual challenges and there was, you know, this excitement to work with other healthcare professionals that so we could take care of our patients. And through the course of time, There were so many pivots, not just with clinical medicine, but also with EHR documentation and the volume and I'm gonna and doing more in front of the computer. So ultimately what happened through the course of my career didn't happen overnight. And I felt like it was like a slow burial of expectations that kept moving. And ultimately it had nothing to do with medicine. And this is where it became. Something of a load that was unmanageable for me. Dr Santina Wheat: So right now it seems that there's this common corporate trend in healthcare where our leadership tells the staff we are all a family here. And they encourage the socialization, they encourage the deep emotional buy-in, they encourage us to be vulnerable. But that's not always the reality. you've seen what happens when that illusion of family actually runs into a contract. So what happens to the individual physician psyche when they realize that the institution's love only really extends to those productivity metrics? Gita Balakumar: I think the word family is not neutral. it's a it implies an emotional contract to your employer or your workspace, but it has conditions. So the answer to the question is more of like the psychological impact that this idealized relationship. is actually transactional. and and then actually you kind of end up realizing there's a form of betrayal involved. I think it also disrupts the loyalty to an organization or an employer, which is part of a physician or healthcare's professional identity because We feel like the main purpose here is to give care to the patient. But when something like the worker doesn't align properly with the priorities of the organization, they will fall back on your contract. And it makes you realize that you Or you get to a point you may feel like you're just another cog in the wheel for the institution. Dr Santina Wheat: Absolutely. And I think that you shared with me that you have a personal example of this. when you experienced injury and had an Achilles rupture, you you still had the exact same contract, right? You were still expected to be that same cog in the wheel. Can you tell us a little bit about that period in your life and what it felt like to carry Gita Balakumar: Yeah. Dr Santina Wheat: that physical pain while also realizing that even though your institution may have said that they were a family, that they really didn't have any room for your humanity. Gita Balakumar: Yeah, I mean, I as I think back on it, I mean I'm a bit far removed from it, but even thinking about it, I have more of like a objective stance on it because it was a collision of a few different things. it was a story of here's a healthcare provider, a physician, who has a visible vulnerable physical injury and I still had to have a full schedule. I was on a scooter. I had crutches. I had a basket for the computer. I had my stethoscope. I had my pen. So I'm still functioning and expected to do this at full capacity. And I'm also a physician that understands what the recovery time of my injury is. But the rest of my Body was having to compensate for the physical demand of my job, and there was no adjustments made on my behalf. the response of the employer left me with a feeling of basically I'm treated as a productivity robot and not a person. And it goes back to the sense of betrayal as well. And it's almost cruel. It because when you know the recovery time and being asked to do this full capacity schedule was not medically reasonable. I was a physician patient. And one thing always sits in my head of the memory of that is I had to Get letters from an orthopedic, and I was talking with the medical assistant, his medical assistant, and getting the letters back and forth. And she said one day to me, This tells you a lot about your employer. Cause they were providing letters to show a ramped up schedule, like she can do two patients an hour at this week, then three patients. And she got to a point where she even recognized that my employer was not, you know, trying to protect me as a individual in a vulnerable space. And that resonated with me quite a bit. And so I felt at the end of this that I'm not here for but productivity. And they are viewing me just as a robot and not a body that also deserves care. And per the contract, these are the hours I need to work, regardless of my own health. Santina Wheat: That's that's so frustrating. so I would consider this to to feel like a betrayal from your employer and like you just have hit this institutional wall. when this happens, it can be real to have this feeling of shame and frustration and disgrace. and many of us don't actually talk about that. How did you untangle the challenges that you experienced with us? Gita Balakumar: Yeah. I mean, the shame is always the last thing to go because you have to go through your internal processes first to kind of rid it out your system. But I could intellectually understand burnout, moral injury, you know, the dysfunction in our system. But I still would like wake up in the middle of the night. thinking, why can't I be stronger? Like I can get through this. And what finally changed or shifted for me was seeing the same thing in other physicians that I worked with. Like different specialties, different decades of practice, different systems. So I realized that this is a universal response, but The way medical culture is is to convince ourselves to be stoic and to provide service and to be competent, and you know, you could keep pushing. But if everyone is exposed to these same conditions and they develop these symptoms, the problem is the conditions that we're working under. So I got to the point where my distress wasn't a character flaw. I got to the point that this was just part of the values I still had intact. The system who doesn't want to afford me some grace during a physical vulnerability, but I'm still showing up the work and I'm still giving to my patients. The system still asked me to, you know, be productive regardless of what I may go into. And I think that resonated with me because this was an injury that was visible. It wasn't even a responsibility or a burden that was internal that other people are carrying as well that aren't as obvious. Santina Wheat: I feel like it's so hard what you're describing, but then also there's some people, particularly in that mere care mid-career space, that they're responsible for being the leaders that are the ones that have to enforce these contracts that don't always make sense. what do you what do you say to those leaders who are tasked with that, enforcing these contracts that we know are unyielding? having to tell their junior team members to keep pushing through because that's what it says if they they want to have that income or want to maintain their position. Gita Balakumar: I mean, I think that's that's a very tricky answer because that leader also has their responsibilities, but I also feel that you have to take each individual as a human being and it's a case-by-case basis, and you have to provide a space for support and encouragement and be reasonable and discussions about this human being in front of you as opposed to this is somebody that needs to see twenty five patients a day and this is what the contract says. So you we have to get back to the human element. And this is exactly why we're here is to take care of other human beings. But the people that are doing that work need that grace as well. Santina Wheat: Absolutely. I do want to pivot a little bit here to a topic that you has have brought up as a deeply personal hidden load, one that is almost completely separate, it feels like, of what's happening in in our work days is often ignored in medicine. And that's the emotional and cognitive weight of caring for an elderly patient. we often talk about the barriers and the challenges of raising children and childcare, but elder care is a completely different landscape that seems to have fewer conversations. Why is navigating the care of an aging adult a unique kind of invisible exhausting labor for physicians? Gita Balakumar: Yeah, and you know, I speak upon this because there is mixed generational homes and there's a cohort of individuals that are managing, aging adults in their family or parents and children. So if you have an aging an adult or parent that you're caring for, it's a it's a responsibility that's not recognized. Santina Wheat: Okay. Gita Balakumar: So when my parent needed care, I became the medical translator, the care coordinator, the decision maker, and on top of a full clinical load. So the hardest part like wasn't the logistics per se, it was that I could also see what was happening medically to my parent at an earlier time. because I have that clinical knowledge. And I'm also witnessing the system falling short in ways I recognize and have experienced personally and intimately. And so you kind of feel even more powerless the change, the outcome, because you've existed in the healthcare space and you know, well, that's kind of just the way it is, you know, but you're Fighting for your parent, and then being a doctor and sort of the de facto medical decision maker, there's really no permission or time to also be the child of the parent. Like you have to compartmentalize, but you're not allowed to be fully the child because you're also the decision maker. I think this really weighs with me too, because it's specifically for physicians that carry this weight, you also understand what you're seeing. a non-physician child may see their parent slowing down, but you know what all the medicines are and what the side effects are and You are never allowed the mercy of not knowing. that clinical knowledge is sort of a double-edged sword. And so there's rarely any space to grieve, and you tend to carry it alone because you can't burden like another parent or sibling in what you see. Santina Wheat: Mm-hmm. Gita Balakumar: So I think there's a lot of nuance in Santina Wheat: I did lose both of my parents at a fairly young but adult age. and my mom I lost while I was a a fairly young attending. Gita Balakumar: lack of a better word, burden in this type of responsibility, if you're a physician with like an aging family member. Santina Wheat: And it was interesting because my peers did not know how to relate to me in it. They didn't understand that. They could understand the challenges of the childcare that I also was facing, but they they really couldn't understand the additional challenges of if my mom wasn't just aging, she was sick, of so like going to the hospital and having to advocate for those things, knowing how the system worked. I felt it it be to be especially hard as an educator myself because she was in settings where she was being treated by residents. And it was just there were times that I was like, what are your faculty teaching you? Or I would never let my residents do what you're doing. Or I can't imagine that they think you're you're treating someone this way. And it was just a different feeling because I understood all of the nuances not only of the medicine, but of the system and the education in a way that the typical daughter doesn't necessarily as they're going through these challenges. And I think for many, when they're in that mid-career time, there's this interesting squeeze because you're often at the peak of your clinical leadership responsibilities, perhaps your own children, also the decline of your parents. And going back to what you said before, you walk in that into the day and your clinical schedule doesn't care. It still expects you to function in the exact same way and have the same productivity and the same outcomes. Gita Balakumar: Right. And I you know, I I think it's also it's less mm less relational. Like I don't think a lot of people relate to it. I think more p because you might be the only person in the office going through it. Because a lot of the other roles that people have in the office or the healthcare s they might be younger or, you know, like you mentioned, people have a lot more latitude if like you if the children are sick. People really understand the importance of that. But to see the decline of a parent and have the clinical knowledge, it's trying to like Santina Wheat: Mm-hmm. Gita Balakumar: You're not trying to be the physician for your parent, but you are the medical decision maker with all knowledge. So it's definitely a lot of mental weight and emotional weight. Santina Wheat: Absolutely. I want to transition to you being a coach. When you transitioned into being a master's certified physician development coach, it wasn't about leading medicine behind as I understand it. It was a pivot to protect your colleagues. for a physician who feels trapped because they think that clinical care is their is the only thing that their degree allows them to do, what possibilities does coaching open up for? Gita Balakumar: Okay. So here's the honest role of what coaching does. There is peer support and there's like wellness programs, but they're not designed to do what coaching does because it it doesn't support them in the way that coaching provides a safe space. like a psychologically safe space and you're talking with an individual that has gone through, you know, very similar environments, if not, you know, the same residency medical school. And it's not necessarily for just physicians, it's anyone in healthcare, a dentist, a a nurse, like, you know, there's that relatability. And so it's genuinely valuable because it lets that person feel less alone. It's not a punishment. And versus peer support where it's just like witnessing. This is something that it allows them to be empowered as they're speaking. And it may take time and it allows them a space to untangle. any thought process they have, and it gives them again that safe psychological space to kind of rummage through their own head because they themselves have the answer. It's more of asking a during coaching, asking the right questions to help guide them, but it's not as stigma as having therapy, it's not mentoring, it's not yoga at lunchtime. Like those things are helpful. But I think if you have a coach that really understands, you know, what they're going through and 80% of the elements that they go through, it provides them empowerment down the line. and a little bit more of a foundation to be who they are. Santina Wheat: And you've said that if you had access to coaching yourself earlier in your career, that it might have changed your trajectory and how you navigated your institutional challenges. why why is that? What is it? can you speak more to what it is that you think that this type of coaching can provide that the standard institutional wellness programs is just unable to? Gita Balakumar: Think the institutional programs, they're sort of designed to help you cope better with the existing conditions. So, like mindfulness and you know, resilience training, and they're asking that person to be more adaptive to a system that's not adapting to the people that are providing care. So I think. Santina Wheat: Mm-hmm. Gita Balakumar: That is contradictory to how we need to care for our healthcare providers and our physicians. giving them that safe space to let them know that what they're going through is not, they don't need to feel isolated. It's not a character flaw. It's a more subtle approach, but Santina Wheat: Okay. Gita Balakumar: Institutions and organizations may not recognize it because they may feel that it's harder to measure and it might be more expensive, but it it it will provide adequate support, but it doesn't really pinpoint how it's done because the work is upon the individual. So for me, It's it would have been such a benefit early on in my career because you I would have felt safe in verbalizing what I was going through as opposed to having a three minute conversation around the corner with an attending or you know seeking out therapy or you know just swallowing it and hiding it and just keep moving forward. So I think the evolution of how healthcare workers function in their practices now is changing. And one of the paths to being you know, a healthy individual going through all this is coaching. And it's not that wellness programs they that's one lane. This is just another lane. that is opening up and that is available to physicians. And, you know, I I would suggest if there is a coaching, you know, department or practice in their organization, seek it out. And it doesn't have to be this day, you know, weekly thing. It could just be like, you know, you're having trouble going through a project and communication style with this individual. It can be as minor and as big as they want, but at the end of the day, the goal with coaching is to have this person transform to a higher expectation for themselves that they're comfortable with. Santina Wheat: And you you really believe that it's not just a benefit to attending physicians or other practicing healthcare clinicians. you're passionate about bringing coaching principals into medical schools and training programs early rather than waiting until doctors are 20 years in and already experiencing the challenges of burnout. if we taught these tools earlier. How would medical students and other health professional students be able to navigate their career transitions early on? How might that rewrite the future of medicine? Gita Balakumar: Think that there would be more confidence in themselves because we we've all kind of heard of imposter syndrome and they have the medical knowledge. We all know you have it. It's just that 20 years in, I'm having to relearn things and correct things. I don't want these the future of our medical doctors to be 20 years in and trying to turn the tide. I want them to have like established guidance in the beginning and how they can kind of even untangle and work through things themselves in a safe space where, you know, that's the time when you're younger to be able to build a foundation of you know, h how you can unravel some of the complexities that we encounter. Santina Wheat: Absolutely. So if you have somebody that's listening today, say they're a mid-career physician that is facing institutional challenges, what is the one thing that you feel like they need to hear today to help them start navigating this challenge? Gita Balakumar: Yeah. I think is whatever that person is feeling right now, it's not a weakness, it's not a character flaw. You know, you didn't choose the wrong career. It's just that what physicians experience is not just ordinary, it's extraordinary. And the loads that we carry, there you're allowed to need support. And right now you are exactly as you are, you know, you're sitting there and you're thinking about this, but in no way are you not deserving to have the support you need and to be able to be vocal about someone to struggles that you have because at the end of the day we're human too. Santina Wheat: Absolutely. If any of my listeners would like to find you, how do they reach out and find you? Gita Balakumar: Yeah, so dragon flycoaching md dot com. you know, please check it out and if you have any queries, you know, please leave a note there. and then there's information to, you know, guide you if you wanted to find a coach in your time zone. I have other connections, but you know, I'm hoping that you'll reach out and you know we can kind of see how I can help you and I'm excited to have this lane open up to make our, you know, healthcare workers healthier in through it all. Santina Wheat: Thank you so much, Keita. We'll make sure that we have that contact information in the show notes. Thank you for pulling back the curtain on some of these institutional challenges and sharing some of your experiences and reminding us that our humanity is important and should not be a disqualification for all that we're doing as clinicians and leaders. of course. Gita Balakumar: Yeah. Santina Wheat: To my fellows educators and leaders, your contract might be rigid, but your community does not have to be. Stop doing that heavy lifting alone and see where you can get your support. Maybe it's with a coach like Etho or myself. I am Dr. Santina or Tina Wheat, and this has been The Hidden Load, and I look forward to seeing you next week. Gita Balakumar: Thank you. Santina Wheat: Thank you for listening to The Hidden Load. If today's conversation spoke to you, I would love for you to share it with a colleague who might need to hear it too. It's one of the simplest ways we can start shifting the culture of medicine together. Thank you for listening to The Hidden Load. If today's conversation spoke to you, I would love for you to share it with a colleague who might need to hear it too. It's one of the simplest ways we can start shifting the culture of medicine together. And remember, your time spent reflecting here matters. You can earn free CME or CE credits for listening to today's episode through the Pinnacle app. You'll find that link in the show notes. If you are looking for one-on-one coaching support or want to dive deeper into the resources we discussed today, let's connect. You can find information on how to reach me in the show notes. don't forget to hit subscribe so that you never miss an episode and leave me a rating so that others can find me too. and take care of yourself because you deserve to be held up to. And I'll see you next time. And remember, your time spent reflecting here matters. You can earn free CME or CE credits for listening to today's episode through the Pinnacle app. You'll find that link in the show notes. If you are looking for one-on-one coaching support or want to dive deeper into the resources we discussed today, let's connect. You can find information on how to reach me in the show notes. don't forget to hit subscribe so that you never miss an episode and leave me a rating so that others can find me too. and take care of yourself because you deserve to be held up to. And I'll see you next time.