Latest / The Hidden Load: For the educators and leaders in medicine who hold everyone up. / The Posture of Steady: High Performance vs. True Wellness with Dr. Devina Wadhwa
Transcript
- Santina Wheat: Welcome to the hidden load for the educators and leaders in medicine who hold everyone up. If you're listening to this episode in the month of August, I am running a birthday special. Send me an email and I will give you the code so that you can get a discount on any of my coaching packages. I would love to help you. I am Dr. Santina Wheat and I will see you next week. 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. 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. Welcome back to The Hidden Load. I am your host, Dr. Santina or Tina Wheat. If you are an educator, a clinician, or a leader in healthcare, you know that the system measures you by one primary metric, and that is your capacity to function. Can you finish those charts? Can you run the clinic? Can you see one more patient? Can you hold the teaching rounds? In our culture, as long as you are still performing, achieving, and outwardly managing your responsibilities, then the system assumes that you are perfectly fine. But there is a devastating hidden load carried by the highest achieving professionals among us. The difference between functioning and truly being well. In medicine, we have normalized chronic stress, emotional flattening, and subtle self-abandonment, because they are the baseline requirements for keeping up with modern medicine. Our guest today is Dr. Davina Wadwa. She's a psychiatrist, an assistant professor at NOSM University in Northern Ontario, a writer, and a mindfulness practitioner. Working in rural and remote medicine, she has lived and studied the quieter, hidden emotional realities of caring for others, including the weight of what she calls the posture of steady. And after losing her father, her entire understanding of grief, suffering, and what it actually means to remain a human being within healthcare was completely reshaped. Davina, welcome to the show. You have written so beautifully about the version of ourselves that medicine rewards. Why does it Dr. Devina Wadhwa: Thank you so much for having me on the show. Santina Wheat: I'm so happy to have you. Can you tell us why does our training actively encourage us to confuse high performance with actual wellness? Dr. Devina Wadhwa: You know, I have reflected on this over the last few years, and it's quite interesting being close to a decade practicing as an independent psychiatrist. It took me seven years to realize that medicine has trained us in terms of performance and really forgetting the humanism behind it. And I think, you know, there's no on purpose reason why medicine has trained us this way. I think it's just The way that it's been done for generations and generations of physicians coming down the road. And we haven't stopped to think about and question: is this way serving us any longer? And is this the right way? Because we've become too busy and continue to follow the way that we were trained to do and continue to teach the same way. And so I think change comes from individuals that have experiences that. determined that this is maybe not the way it's supposed to be. And there is an inertia and momentum, but it takes time. And I think it's having conversations like this that are vulnerable, transparent and open. And teaching these conversations is what is going to help us change this trajectory that we have followed in medicine for so many years. Santina Wheat: Thank you for sharing that. I really want to talk about what you call the posture of steady. You use this phrase to describe the hidden load of psychiatric and clinical care as the unspoken expectation that we can sit with other people's trauma, panic, and pain all day long while remaining entirely untouched by it ourselves. What is the actual cost of maintaining that rigid posture day in and day out? Dr. Devina Wadhwa: That cost shows up in our nervous systems at one point or another. And I think we often think there have an invincibility in medicine, which I definitely, you know, had this concept of go, go, go, do not sleep. You don't need to eat. that that bathroom break can wait. And there comes a breaking point. And I hope, you know, it's not dramatic for many of us. Mine felt like it was a dramatic waking point where My life fractured in terms of purpose and meaning. And my nervous system definitely showed me what I had been carrying for years of sitting with emotional pain of my patients, staying composed, holding their trauma within me. And when time came for it, my nervous system couldn't do it anymore. And it really showed me whether it was in the way I processed grief of losing my dad in the depression that followed that. In my inability to stay composed anymore, in needing to share my vulnerability and take time, right? It did show up eventually. And I think as we're all human beings, it it it sleeps in parts and corners of us and it shows up in tiny ways, a bit of irritability, a little bit harder time falling asleep once in a while. And it cumulates. And if we think about the cumulation that can occur over decades, it It has an impact on us. so yes, it hides in our nervous system, but it does manifest itself one way or another at some point or another. Santina Wheat: What are the ways that you have seen this manifest in yourself or in others? Dr. Devina Wadhwa: So you know, speaking personally, and I I've seen it in my colleagues around me, and you know, I'm sure many of us have, whether it's that feeling of dread before walking into a room to see a patient that you've been looking after, you know, for weeks on an inpatient unit, for example, or that feeling of numbness where you're hearing so much trauma and pain, and there's absolutely no emotional. reaction. There is no element of compassion, empathy, or pain that you're feeling in terms of the transference and counter-transference with your patient, whether it's driving home and thinking about a patient and worrying, whether you made the right decision, whether it's over checking, over-analyzing, not being able to shut out your work. And so I think it shows up in different ways for different people. for me, definitely My biggest red flag was that emotional flatlining where I went into medicine because I loved, loved, im important I said loved. Now I've sort of reframed that looking after people, that compassion of knowing that I'm making a difference. And when that started to erode, that was a a big red flag for me because it made me question my purpose in medicine. Santina Wheat: Absolutely. That's such a horrible feeling when that happens. but I want to talk a little bit about the specifics of your practice because you practice in rural and remote communities in Canada. And in those settings, and in other settings, of course, it's really difficult to leave the stories at the clinic door. it's harder to have those boundaries, they're thinner. The patient encounters are emotionally intimate, and you can be acutely aware of the gaps where the system just does not offer anyone enough. How does that environment in which you're practicing amplify the feeling that you can never do enough, no matter how hard you work? Dr. Devina Wadhwa: That's such a wonderful question. And it's it's such a raw and true question because oftentimes, you know, we are using the word moral distress a lot, sort of that mismatch between what we know as clinicians our patients need and knowing that we're working in a system that has so many barriers, one of which is lack of access to care. And fueled by that is attrition because physicians Are in these isolated communities where it just becomes too much. And sometimes the only option is scaling back or leaving all together. And I think talking about it, you know, for me, finding a voice through writing, being on platforms like this is so wonderful because the isolation in medicine is real. It's quite starkly sort of surprising to me how many of us are going through very similar experiences, if not often the same. And we're quietly suffering because there's this idea that vulnerability, you know, shows weakness, that vulnerability shows you're not cut out for this profession or job or even community. And I think for me, where it's come down to is I walk through those doors telling myself, it's a sort of a a mantra for for lack of a better word, that I'm doing the best I can today, and I'm going to do the best I can today for the patients that I'm serving. Knowing that the wait lists are going to be long, I can't change that. But the interaction that I have with my patient, if I'm truly authentic, caring, compassionate, I think that goes a really long way. And when that fundamentally starts to degrade, we we lose that sense of belonging in medicine. so I think finding our hearts again is sort of this journey has brought me back to, you know. why I started doing this work in the first place and it's really connecting to heart in medicine. Santina Wheat: Absolutely. you briefly mentioned already that losing your father deepened your understanding of human suffering in a way that medicine alone never really could. I think that many of us are trained to not show our grief because if we do, then we show that vulnerability and we're not supposed to be vulnerable, that that would mean that we're less effective at our jobs. How did navigating your personal loss change the way that you actually sit with and listen to the patients who you are caring for? Dr. Devina Wadhwa: You know, it's compassion times two, three, four, five. Really having this profound experience of loss for me in in the tragic way that it happened to me really truly allowed me to understand what emotional pain looks like, what depression feels like, what this ki idea of losing purpose in your life can feel like. And all of those sensations are so equal to. What our patients walk through our doors terrified, vulnerable, scared. And it doesn't matter if it's a patient coming to you for psychiatric help or they're coming to you because they're suffering from diabetes. I think the pain is so equivalent. It's it's the pain of human suffering, the pain of not knowing, the pain of questioning our purpose. And having had this loss and integrating it within myself as a a human being and as a clinician. As difficult and painful as it as it was, I now, you know, a few years down the road express gratitude for allowing, you know, the experience to have made me a better doc and a doctor who listens better, who is more in tune with my learners. I'm a more effective teacher. I have a lot more compassion for my students. and so I think you know, it's easy to sort of describe. depression or grief by reading it in the DSM or prescribing an antidepressant and having you know, going through the motions of walking through all of that yourself really allows you to know what it's like potentially to be in somebody else's shoes. and oftentimes what it's like to be in your patient's shoes. And I think there's no there's not a bigger connection or a more humanistic connection than that. Santina Wheat: well I'll share with you, I had a very similar experience when my mother passed. she sort of bounced from academic hospital to academic hospital as they were trying to escalate her care. and at the time I was a core faculty member and so I was very deeply involved in education. And watching other trainees care for my mom and not see her as a person really changed how I thought about academic medicine. It really changed how I talk to my residents about how they interact with their patients. Just the little things that you mentioned, I'll add as a family physician, I spend a lot of time doing the paperwork for FMLA, for when families need to be off to care for their loved ones, or figuring out where it is that their loved one is going to live and get the care that they need. or having those hard end of life conversations and being on the receiving end of it in a not always ideal way. broke my love of medicine for a period of time, if I'm being totally transparent. And I've really had to come around and and change how I think about that. And how I interact with my residents about it. Because I think all of this, I think that when we are told to not show that vulnerability, when we're told to be stone faced all of the time, it's a trap. And when we aren't Dr. Devina Wadhwa: And Santina Wheat: able to show that grief, when we're not able to show that we have exhaustion or that things hurt us or that we care about what our patient is experiencing, our learners learn that same thing. and it just sort of repeats the cycle. So when we can teach our learners to to to sit in that humanity, I think it makes us all better. It makes it better for us as colleagues, it makes it better for them to experience, and then of course it makes it better for our patients. Dr. Devina Wadhwa: I I absolutely love that. And it it all comes back to just we're human beings and it brings the humanity back into medicine, which is sort of a striking thing to think that medicine lost its humanity for a bit. and I have hope though, because we're, you know, when I was a resident training over seven years ago, there they were these conversations did not happen. You know, you quietly yawned in a corner or just held it together. And we're having these amazing conversations. So I have so much hope for the the future of our profession. Santina Wheat: Absolutely. So, as physicians, we are trained to use our intellect to solve absolutely every problem. And when we feel overwhelmed, we're told to rationalize it, to optimize our schedule, to just tough it out or to grid it out. but you've mentioned our nervous systems and that our nervous systems will keep score, even when outwardly we're acting capably. So, what does it look like when a highly functional leader is actually in a state of that somatic nervous system bankruptcy. Dr. Devina Wadhwa: So I you know, I always think as physicians, as you mentioned, it's actually we're sort of trained to be, I like to think of it neck up, right? Everything is so cerebral, and we're trained to be in this cerebral space all day long, 24 hours. And so we get disconnected from what is happening in our body really. And that's where my love for you know, as a yoga teacher and somebody who practices mindfulness or meditation. and I teach this very openly with my learners and my peers around reconnecting. And these are micro-regulation sort of practices, tiny practices of remembering to step out of this head up and come back to whether it's breathing, whether it's relaxing your shoulders, whether it's unclenching your jaws, whether it's taking that doorway pause, which we've all learned about, you know, between one patient curtain or doorway to the next and doing that quick 10 second longer exhale to activate the parasympathetic system. It allows our nervous system to reset and say, hey, I'm safe and I can move into whatever the next thing is with a reset. And I think forgetting to reset between our encounters or in our day from one meeting to another, from one teaching session to another our nervous system just carries all of this. And you know, for all of us, it's different how it manifests, whether it's those tight shoulders crunched to the neck. I know that's what I do, or the jaw that's really clenched. and just a constant reminder to say, yes, it's beautiful that we're neck up, but we also have to remember to come back to our body and sort of the present, because our body is doing its thing, it's breathing every day, and if we just came back to the awareness of it, our parasympathetic system is so grateful to us. And that's why I love these tiny micro practices that you don't we just have to be human to remember to practice them. Santina Wheat: I love you talking about micropractices. I always feel like people think that they have to make massive life changes and don't realize that it's sometimes those tiny things in your day that can make you feel like you've had a massive change. But but Dr. Devina Wadhwa: Yes. Santina Wheat: absolutely the 30 seconds to do deep breaths and get some water, or the actually taking time to go to the restroom in between patients, whatever it might be that you need to reset yourself and feel well walking into that next day. encounter can be absolutely transformational, honestly. Dr. Devina Wadhwa: And for our patients too, because you know, as a psychiatrist, I often think I have patients who have waited months for that 60-minute appointment and have driven, you know, in northern Ontario three and a half, four hours for that appointment. And I have to be in a place to receive them with that much, you know, intention because that interaction could be transformative for them, their their access to healthcare, their trust in mental health care. And you know, it could be life changing. And I like to think of it as a very powerful interaction that can mean a lot. Santina Wheat: Absolutely. Similarly to the the microhabits that I think are important, I think that people also think of burnout sometimes as a massive dramatic thing, but that's not often the case. we think of burnout often as the person who quits their job or makes a massive error. but you like to talk about it being something that can start much quieter. it's showing up as irritability, a loss of joy. or just moving through life in a survival mode. So how can a busy clinician catch these quiet warning signs before they completely lose their sense of self and move into that traumatic burnout? Dr. Devina Wadhwa: So the the technique that I love and and you know when we define burnout like on Google it's a dramatic collapse of of spirit or the the burnout inventory makes it seem like you mentioned this complete collapse. And you know, most clinicians have a a a tiny diagnosis, whether it's one symptom or two or three of you know elements of burnout. And I I love the technique notice, name, and integrate. And it's it's very well known in the in therapy world and in life, you know, and it's we have to stop to we have to stop for a moment and really kind of notice what's going on. And correctly naming it. You know, am I really tired and I need a week off work? Or am I completely emotionally feeling numbed out? Or is the system really aggravating me because I can't get my patients the follow-up they need? or am I having an acute stress reaction to some really traumatic events that I've witnessed at work, right? So I think the naming is as important as the noticing because once we name it, we get the quote diagnosis correct. And then it's always about finding a way to integrate because we cannot, if we're in medicine, we're not gonna remove the trauma, we're not gonna remove the fatigue, we're not gonna remove the system barriers. But it's like, how can I digest and metabolize this in a more meaningful way so that yes, I'm still gonna be tired, I'm still working in a system that's got a lot of disparity, but how can I be healthy, metabolize it and integrate it into my work and be happy about that? It's back to awareness practices of figuring out what's going on with me right now? Like, why can I not sleep? Or why am I thinking about this patient on my drive home? And sort of just noticing that allows us to name it correctly and then it allows us to sort of digest it properly. Santina Wheat: I really love that. When I talk about burnout, I really like thinking about the variety of stages. So you can be in an early stage where there's smaller things that you can do to pull yourself back, or you can be in much further and potentially need medication because you've actually reached more depression or anxiety that's associated with it and it's not just the burnout, right? and I think that there's strategies that you can do, as you were mentioning. as as you start to notice yourself floating in that direction, I I try to have little cues in my life that show me that I'm starting to float back towards burnout that allow me to pull myself back. Like when I stop being interested in reading a book is one of my cues. Dr. Devina Wadhwa: Number. Santina Wheat: and it doesn't always be picking up a book. Sometimes it's listening to one. But when I'm stop, when I stop having that urge, it's a sign to me that joy is missing somewhere because that's one of those things. That just brings me joy. Or when I stop wanting to interact with my kids in a specific way, when I I just find myself just getting irritated and not wanting to have them have those deep questions with me, it's a sign that I start need to start doing those things. And when I can catch it in those moments, it's my hope that I will never go all the way back to the bad burnout that I had been in, which also like like your experience came shortly after. after my mom passed and was just sort of compounded. But if I can identify those things early on, it allows me to not get there. And then also I try to name them out loud. I think that's one of the most important things I like to talk about on this podcast is demonstrating that because I want my learners and my other faculty to see that. I want them to have those same moments so that they can catch themselves when they're starting to not be their best self, so that they can identify those moments and bring them back to themselves. Dr. Devina Wadhwa: And it's and these are all, you know, again, micro micro tools. And it's it's they're so they seem so small, but they're so important. because the micro tools allow us to essentially, you know, they're preventative. We talk to our patients about exercising and eating well. And for us, these micro tools of you know, catching these important elements in our life prevent that sort of dramatic collapse. Santina Wheat: Absolutely. And so we've been talking a little bit about practices that really have nothing to do with achievement. We've been talking about mindfulness and yoga. I was talking about reading, but there's also travel and photography or going for walks. All of those things are actually really wonderful for your nervous system, but for a high-achieving doctor or other clinician whose entire self-worth has been built up by being productive, why is it that this can feel so uncomfortable? But why is it also really necessary for our survival? Dr. Devina Wadhwa: It's it it's this beautiful concept of it's foreign. you know, in residency training, you're literally the name resident means that you are a resident of the hospital. And so when you have trained for a decade to be a resident of the hospital, prior to that a medical student, how are you supposed to have those tools and skills to know how to do anything else? and that is one of the biggest struggles that I had when I finished my residency training in terms of, okay, what do I do now? What do I do after work? It was this complete new concept of I don't have to study. I don't have a royal exam a college exam to prepare for. And it's so fundamental and it's so foreign that, you know, it's it's it's shocking. And I think we have to re-infuse it back into our training programs where yes, we have to we have to learn how to become physicians. And I'm not saying that we need to take, you know, every Friday off and not do call. But I think we have to figure out that pendulum in terms of where is that middle ground of the pendulum for learning how to become a doctor, making sure we know how to work in the can in the confines and the constraints of the system we work in with the pressures we work in, but also know how to find joy and shut down and tell your nervous system, hey, it's time to shut down, I'm safe and reset. And I think it really comes from our training and changing that concept of our training and seeing mentors figuring out how to do that in their life, adding, you know, whatever those joyful things are back into their lives, no matter what stage of medicine we're in. Because then when you retire, right, that's a whole nother sort of a life in in medicine, what do you do with your time? And so having that throughout your life is so important. It's sort of a grounding force. Santina Wheat: Absolutely. Now, Davina, from my understanding, you're incredibly passionate about creating spaces where healthcare professionals can stop performing resilience in isolation. I love that because resilience in isolation does not work. If a clinical chief or a program director or other leader wants to bring real, unpolished emotional honesty into their department or their institution. How do they start that conversation, but do it in a way that doesn't feel performative and doesn't feel like a forced wellness exercise? Dr. Devina Wadhwa: R right. And you know, it's always this concept of and that's why again I go back to the micro tools and the micro practices. and sometimes there's these micro-peer connections where I find the there's so much effectiveness in having raw, vulnerable, open conversations in non-formalized micro ways. And it sounds again s like such a foreign concept because you know, in residency training we used to have this weekly wonderful sort of Luncheon, where people would just drop in, they'd be food, and you would share the struggles that you are having, or patients that you're navigating and managing. And somehow we graduate as staff and we we lose that, you know, this concept of peer support and everything feels a lot more formalized, and we have to behave a certain way because now we have residents working with us. And I think we need to reintroduce or go back to that. You know, in in school we have friends and we talk about our struggles and we go into high school and university and we carry that peer support mentality and it gets lost somewhere. And I think we need to go back to that sort of honest, raw, authentic conversations. Santina Wheat: Absolutely. So Davina, as we're getting close to wrapping up, if there is a clinician who is listening to us right now who is outwardly succeeding, maybe they have that perfect CV, their department is running smoothly, but internally they completely feel disconnected, lonely, and depleted. What is the first step that they need to take today to start remaining human within their career? Dr. Devina Wadhwa: kind to yourself. I think self-compassion is that first step for noticing, you know, you, we, you're human. And just extend the love and kindness you do to the people around you and your patients to yourself. Because if you're not okay, you can't be okay for others. And you know, the second piece I always say is, and that's why I think you and I are on having this conversation on a platform like this, is You know, sharing vulnerability is hard. It can seem, you know, difficult at times, but it's it's so healing. And share, find somebody that you can talk to because again, you will notice that you're not alone. You know, we're we're never alone. and we know that, we tell that to our patients all the time. So extend that grace and compassion to yourself. Santina Wheat: Absolutely. I always feel like the hardest part about this journey is this feeling of isolation, this feeling of, I'm the only person that must be feeling this way. I'm the only person that must be experiencing imposter syndrome. I'm the only person that must not must not know how to handle that tragedy. but when we can talk about it together, when we know we're not the only one, that this is a normal part of the process and that other people can give us advice or can just sit there with us in empathy. And solidarity, it can really be helpful. Davina, thank you so much for coming on today and reminding us that being functional is not the same thing as being well, and for giving us permission to put the armor down. I hope that everyone will go and look for her beautiful essays across Healthy Debate and Kevin MD. But where else can people find you? Dr. Devina Wadhwa: So I do now write for SOME Docs as well. And that's one of the platforms I do use. And I do actually have a upcoming book that's gonna be launched in about a month on grief and moving through life after loss. so look out for that. It's called What Lives Through Loss. Santina Wheat: Amazing. And so this actually will probably be airing right around the time that book is coming out. So you should look for that book right around now. To my fellow leaders and educators, stop overriding your own biology to keep a broken system looking steady. The room doesn't need your perfect performance. It just needs your presence. I'm Dr. Santina Wheat and this has been The Hidden Load. I hope that this has been helpful and I hope that you will share it with someone else who needs it. And I will see you next week. If you're listening to this episode in the month of August, I am running a birthday special. Send me an email and I will give you the code so that you can get a discount on any of my coaching packages. I would love to help you. I am Dr. Santina Wheat and I will see you next week. 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.