Psychiatry & Psychotherapy Podcast - Physicians Receiving Treatment, with Dr. Trenkle

Episode Date: February 28, 2018

This week I had a discussion with Dr. Darcy Trenkle on the difficulty of providers to get psychiatric treatment, using ourselves as the examples.  In a recent article nearly 40% of physicians surveyed said they would be reluctant to seek formal medical care for treatment of a mental health problem because of concern that this may put their medical license in jeopardy.  Physicians have three times the national average for suicide and have unique stressors and often a culture not conducive to seeking help.  We discussed difficulties we had in contemplating getting care for different issues we faced.  Hopefully, this will open a discussion regarding the conflicts providers have in engaging needed help.  Dr. Trenkle is a psychiatrist in Southern California and is affiliated with Loma Linda University Health.  She received her Medical Degree from Loma Linda University School of Medicine. She completed her residency training at Loma Linda University in 2015. She is the Medical Director for Electroconvulsive Therapy as well as Program Development for the Behavioral Medical Center at Loma Linda University.  If you are a Medical Student, Resident or Attending listening to this and need help, please reach out to a local provider.  We are open to receive emails if you are local, our names are searchable in the Loma Linda email system.   By listening to this episode, you can earn 0.75 Psychiatry CME Credits. Link to blog. Link to YouTube video. Join David on Instagram: dr.davidpuder Twitter: @DavidPuder Facebook: DrDavidPuder

Welcome to the Psychiatry and Psychotherapy Podcast, the podcast to help you in your journey towards becoming a wise, empathic, genuine, and connected mental health professional. I'm your host, Dr. David Puter, a psychiatrist who splits his time practicing psychopharmacology, individual and group psychotherapy, medical director of a day treatment program, medical education research, and teaching, residents, and medical students. Welcome to the podcast. I am sitting here with Dr. Trankel. And she's a colleague of mine. She is, I think, three doors down from where I see patients.

And we have been in the same residency program together. We graduated around the same time. And her role here at our institution is really twofold. One is to do some of the ECT and some of the teaching and working with residents. But also it's kind of her unique passion to see a lot of medical students, residents, and attendings. And so today, I thought it would be really an interesting conversation to one, hear some of her journey in sort of her mental health and to talk about some of the

nuance of treating the populations of people like ourselves. And so one way we thought about to do that would be to reduce the stigma and just kind of talk about some of our own maybe journey. and mental health, and then to kind of talk about maybe some of the barriers of treatment, maybe some of the things that make it more difficult for us as physicians, as providers of care, to seek our own treatment. So Darcy, welcome to the podcast. Thanks for having me, David. So tell us a little bit about yourself, like where you grew up maybe, your favorite pastimes,

All right. Well, I grew up in Redlands. I was born at Loma Linda University. I grew up in Redlands, went to Academy here, went to college out in Riverside, and then I swung right back around for medical school residency and then attending ship. All right. So you have been a part of the Loma Linda family for a while. You were born here. You went to medical school residency and now you're in attending here. and yeah I'm I'm curious like when you decided you wanted to go into psychiatry that was an interesting choice for me I came from a background of a family of doctors my mom and my dad and my brother and cousin aunts and uncles were all physicians and so being a physician was sort of just the thing that I was going to do I started a medical school thinking that I wanted to do pathology like my father or maybe even ER because that sounded interesting. As I progressed through first, second, and then into clinical third year, realizing that I didn't want to actually

do any of those things, had actually no idea what I wanted to do because everything seemed a little bit interesting until I got to psychiatry. Once I was here interacting with the people, it was something I had never experienced before. People were happy. People were kind. There was a lot less pressure to do pretty much anything. I can remember rounding as a third year with one of our older attendings. And we were supposed to be seeing adolescent patients, but instead we were watching YouTube videos for like an hour. There was no good reason for us to be doing that we should have been seeing patients. And then our attending came in and we were like, oh no, but there was this new patient we forgot to see.

And then she was just like, oh, that's cool. We'll just see them together. And I was just like stunned because we literally were watching YouTube videos instead of seeing patience. And she was like, that's cool. We'll just figure it out. Wow. Very different than maybe some of your other rotations. It was extremely different.

And I was like just struck like, man, this is a place I want to be. These are people I want to be with. Yeah. Yeah. Did you find that the people, the residents had similar sort of personality characteristics as you? or like did you find like some of the attendings you kind of wanted to be like or anything like that? The residents and the attendings in this program tend to have actually like pretty different personality types than I did. I'm an extraordinary Jay.

Which means she's very organized. Something like that. And so I didn't necessarily see. see that there was a lot of like my characteristics in the people, but at the same time, this place was just, it was like a family. People cared for each other. They knew each other and they interacted really well in a way that that I was really looking for in a program, in a residency, and in occupation. I'm curious, like, as a medical student, as a resident, if you felt stigma towards yourself as a practicing mental health provider?

I never really thought about it that way. I never thought about psychiatry at all until I started psychiatry rotation. Like it wasn't even on my radar as something that I was possibly going to do. Once I started engaging in it and saying that this was actually a field that I was going to pursue, it became a lot more obvious. So being a fourth year and being on rotation and asking you, like, what are you going into, like, oh, psychiatry. They're like, okay, never mind.

You can just go home. It's like, well, all right. I mean, I would probably go home because I was a fourth year. Right. But I think that it became very apparent that if you were going to psychiatry, that it was potentially sort of this like you're not really going to be doing medicine anymore. And even within my family, there weren't any psychiatrist in my family at all. And it was this very like sort of foreign, like, really?

Psychiatry? My mom's a dermatologist, dad's a pathologist, my brother's a surgeon, aunt's a surgeon, OBGYN. Psych is on no one's radar. Yeah, I remember one guy when he found that I was going to become a psychiatrist, he immediately said, oh, I'm sorry. And I was like, oh, really, tell me more. And then he didn't have any words. And there was another person who said to me, why don't you be a real doctor? And I was like, hmm, yeah, okay.

Like, that's offensive. Yes. Yeah, I have gotten that quite a bit. People don't, you know, and the distinction between psychiatrists or psychologist and not really having a clear understanding of like what we go through and the foothold that we have to have in medicine in order to do our jobs well. Yeah.

Yeah. So when you think about stigma for kind of being the position of a psychiatrist, do you ever feel you've had stigma against yourself about maybe receiving mental health care when you've needed it? That's been an interesting journey for me because, you know, you spend your years in residency. And as you progressively learn more and more about mental illness and the disease process, and the sort of biological underpinnings of the disease, it becomes more and more apparent that this is something that is difficult to fight and is on the same level as diabetes and high blood pressure and cancer. The invasion into our biology is extreme. and so I can distinctly remember learning that and seeing that as a first, second, third, fourth year psychiatry resident and, you know, looking at the rest of the world and thinking, man, like,

our patients are so, there's so much stigma out there against mental illness and, like, this is horrible, and we've got to change the world and we want to do whatever marches or anything that we can to look at, you know, decreasing stigma. And one of the most interesting things that happened to me in the transition from being a fourth year resident to being a first year attending was for the first time in my life, like, identifying that I actually was suffering from anxiety. I thought it was just this sort of like drive, this drive to like to complete things, to do things. I was a perfectionist. I was a good student. I assumed that it was part of being normal. and that that was just who I was and that was how I had to exist.

I didn't realize for a very, very long time that this was like a disease state. Now, can you differentiate for me or help me understand, like, how the anxiety felt for you, maybe how it was different than just kind of a drive to do well, like, or how you got those things mixed up? like when was the awareness sort of kind of it all of a sudden made sense or yeah tell me a little bit about that um the it probably started when um as as fourth year residents we get to um observe some group therapy in our partial day hospital programs and i was observing um and participating in our dialectical behavioral therapy track for um for our women downstairs and

And for the first time in my life, somehow four years into residency, I actually learned what a healthy coping skill was. And I looked at this thing, these different things that they're teaching. And I'm just like, oh, my goodness. Like, if I started engaging in these, like, my life can be better. And at that point, I'm like realizing, well, like, why does your life need to be that much better? I'm like, oh my goodness, you worry about things all the time. You think about this stuff constantly.

You're constantly worried about what other people are thinking of you. You're constantly thinking about situations. And, you know, the one sentence you said to this random person 15 years ago and how it might like still affect your relationship today, you're, I couldn't take feedback as a resident at all. Good, bad feedback. It didn't matter. I couldn't take feedback. I did everything in my power as a resident to make sure that nobody that was ahead of me ever had to say words to me. Because if they were going to say words to me, there was a risk that they were going to say something bad about me, what I perceived to be bad about me.

And so more or less, I just did all of the things, all of the work, made sure that nobody ever had to say anything to me. And it became very apparent in sitting in these like group therapy sessions that that was a problem. So because of just the weight of people's negative feedback or the potential for negative feedback, you really sort of would go the extra mile in every way possible. And one thing that comes to my mind is that in medicine, that's almost impossible to always perform at that level. or sooner or later you're going to come up against like, you know, it's just really hard to perform at that level. I don't know.

Was there certain times that it was harder to meet that sort of mark that you put for yourself? Or, you know, and then what would happen in those times? You know, I was always extremely good at doing things, checking off tasks, getting stuff done. and that was something that was actually valued within our program and was something that, you know, was able to put me sort of above maybe other, or, you know, above another people's eyes as far as what they value. And I can distinctly remember getting feedback at one point that basically it was good feedback. It was an attending doing a really good job. and they told me that you're a solid worker. You do everything that we ask.

Your patients are well taken care of. And your clinical knowledge is lacking. And in that moment, I can remember just, like, sneaking to the bottom of the floor. Everything inside of me, like, just broke. And all I could think was that they think I'm a horrible doctor. They think I'm a terrible person. They think I'm stupid.

They're never going to want to work with me. And I avoided this person for like all of residency. I couldn't say words to them for three years. Okay. Wow. Yeah, that seems like, that seems very hard feedback to receive for anyone. You know, I mean, it would be hard to hear that. Wow.

Do you have any other sort of examples of maybe how the anxiety manifested or, you know, you know, in this sort of process when you were in the group therapy, learning the stuff, was there anything that you learned that maybe helped you reduce that anxiety? One of the things that I also noticed is that I was always afraid to speak up or say anything that was sort of on my mind. Like the idea of me doing a podcast like this three years ago would have just been like never, ever, ever, will I ever say the words and have words come out my mouth in front of people. I can remember starting out as an attending and we have these these weekly med directors meetings with lots of people and I would have opinions about something

but just being absolutely terrified and like I cannot say the words and if I did say words I was just I was physically like sweating shaking. I could feel my heart beating inside of my chest if I just said words in front of people and looking at that as far as I just didn't I never thought that the words that I had to say were valuable enough for anybody to hear. And so in learning about these different coping skills and taking a different perspective on what's going on there, like, well, maybe that's a disease process. Maybe that's not actually who you are. Maybe you actually have something that's worth saying. Yeah.

One thing that comes to my mind is medicine, in particular, kind of attracts people with this sort of heightened perfectionism because I think you have to cross off a lot of boxes to get into medical school. Like you have to be very diligent to do this and this and this and this and this. Do you see other people, colleagues, medical students with the same sort of cluster of conflicts and anxiety? I think there's a similar trend. I think there's a similar trend. I I work with a lot of our residents in this program and supervise them. And this is a distinctive trend in a lot of students or residents that I've encountered with just sort of that like imposter syndrome sort of thing where there just aren't. There's nothing inside of me that's good enough for anybody else.

And so the counter to that is we'll just work as hard as humanly possible. so that people don't look at you all that closely and realize that there's nothing there. Yeah, I can relate to this sort of imposter syndrome. When I was, I would have even dreams about that, I remember. You know, when you're kind of a new resident, when you're new, you're asked to, you know, make big decisions, decisions that, you know, could influence a person's like mind, which is, it's, it's scary and you're asked to make these decisions without, you know, years of experience. And so I would often feel like one of the dreams I had was I was running naked in a, in a football game and I had no pads.

And I had the knowledge that I didn't have any pads, but I was pretending that I did have the pads, you know? So it's that kind of picture of like you're trying to fake it, but you also realize, like, that you don't quite have everything, like, as you should. Yeah. I don't know if any other pictures come near. Oh, dear. You don't really want to go into my dreams, David.

Okay. We'll save that for another session. Sounds good. So what about like, okay, so do you feel open to share about your treatment at all or anything that helped you kind of overcome this? Because obviously you're on a podcast three years later. You're in a different space. I'm on a podcast, so I'm in a different space too.

Yeah, but what helped you? We're also both closed. Overcome this, yes. So I, my journey to seeking help for my anxiety was very random and scattered and probably not ideal. I had a difficult time accepting that this was a thing. or even if I, in the moments where I could accept that, okay, well, maybe you do have anxiety. Maybe there is something slightly pathologic about the way you think about yourself in regards to other people. That could probably just be fixed with like some exercise or sleeping more or reading as many self-help books as you possibly can get your hands on.

And then it'll probably go away and you'll be fine. Wait, that doesn't fix everything? No. I wish it did. But it doesn't. And that was an unfortunate realization that I actually already knew because I had spent four years in residency. Yeah. Finding and treating patients where they tried that. They had tried it and it didn't work. So I knew that part of it, but there was a piece of me like, no, this is going to work for me. They were all different than me. I can totally manage this and handle this. Like I've handled everything. else in life. Right. So, okay, you have a problem and you're like, I can take care of this myself. Yes. I read a bunch of self-help books and I'm like a hair better. Like there are some things I can do better. There are some, I start to see this idea of a person without anxiety and I read all these books and like, yeah, you can get to this place and it's like, wow, I'd love to be there. Oh,

I'm not there. I tried all your techniques and I'm still not there. Maybe you just need to double the amount of time you're trying them. Maybe I should double down. So we get more books and more books and you're like, wait, well, maybe this is the other one. And it just, it just wasn't effective. And it wasn't until like having a random conversation with another friend of mine who, who was suffering from depression and anxiety at the time. And in sort of a similar boat, like I've tried these other things and nothing seems to be working and they were a physician as well. And, you know, at some point, we kind of like came to this weird conclusion of like what like what if we tried us as our eyes and we kind of just had this like well I'll do it if you do it uh which again

not the most ideal way of seeking help finding help and engaging in treatment um but it was a way for me to do it a challenge and some you know friendship sort of bonding experience at the same time it was definitely that and if you want to get me to do anything honestly challenging me and making it like a, like a game, something I have to win is a really great way to get me engaged. So we kind of started down this path where it was, well, I'll do it if you do it. So I can distinctly remember getting the medications, having them at home, and just like staring at them. And you have this bottle of pills and you're like, man, am I really going to have to take this? This is really a thing I have to do. I have to swallow this pill and just looking at it.

honestly being terrified that it was going to change who I was. I was so scared that if I started taking this medication, that it was going to change fundamentally the choices that I made. And I was absolutely terrified of that. Yeah. And I think it's terrifying for a lot of people. A lot of my patients have a lot of anxiety, especially anxious people, have a lot of anxiety about.

taking medications for anxiety. Yes. Did you read all the side effects, or you already knew all the side effects? No. Yeah, I mean, I knew the side effects of the medication. I knew what it was capable of doing. I knew more or less what dosages you should be working with and how to titrate and all of those things.

And, you know, cognitively, I understood that. And like this sort of cognitive process, I've told, like, hundreds of patients that this will not change who you are because that's one of the questions I always get, is Is this going to change me? Will I be different? And I've told them over and over and over again, like, no, that's not actually what's going to happen here. And then I'm sitting here, like, holding these pills and like, man, this is going to change who I am. You can't do this.

Don't do this. This is a bad idea. And finally, at some point, I realized, like, man, you are a huge hypocrite. You literally, like, this is when I was, I had already been attending for, like, six months. And it was like, you. literally seen like 80 medical students. Oh, wow. And you're talking to them about medications and telling them that they need to take

this medication in the midst of trying to go through medical school. And if you're going to tell them when, like for me, like finally it was, well, look, if it does change who you are, then you should know that. If it fundamentally like changes something about me, I should know that because I'm giving this medication to a lot of people. I'm recommending that lots of people take these types of medications. And if it legitimately changes you, like, I should really, really have that information. And that was kind of what allowed me to, like, to kind of step into that zone.

I'm like, okay, well, I knew it wasn't going to kill me, so I can do anything for four to six weeks and see what happens. Yeah. Yeah, that, I remember having a similar sort of. debate in my mind over getting a therapist. And I knew I wanted to get a particular therapist. I had her phone number. I had it in my phone. I had called it before. I had put her name in my phone. I had stopped, you know, I'd called and then just kind of hung up after one ring or two. Probably about for three to four weeks I had been thinking about it. And then finally I pulled the trigger. and it was just like so much anxiety to just get in to the first appointment.

Yeah. But that kind of experience really helped me understand what patients go through and sort of all the mind games that patients play with like receiving help. So, okay, take us to where what happened next? So what happens next are side effects for two weeks. For two weeks. But by four weeks. it was a really good experience for me because there's there really isn't any way to understand what it feels like until you walk through that.

Okay. And walking through that was a very interesting process because on the other side, like, it turns out I wasn't actually lying about these things. Oh. On the other side, there was relief. I can remember walking, like going back into that our medical director's meeting and sitting there and somebody had a question about ECT and they're like, Darcy, blah, blah, blah, blah. And usually I would just freeze and again, my heart would pound and I'd be sweating and I'd just say a word and hope that they moved on past me. But I can remember sitting there and like giving a thoughtful answer about what needed to be said and giving.

and giving my opinion on something. And my heart wasn't racing. And I didn't like analyze every single word that I said as soon as it came out of my mouth to determine whether or not it was a stupid word. It was just me talking in a room with other humans. Wow. So the anxiety really kind of went away in large part. After about four weeks, you said?

Okay. It was an interesting feeling because I didn't realize how heavy the anxiety was. And I didn't realize all of the areas in my life that were being governed by this worry of what other people would think. As small as like what parking spot I chose when my husband's in the car, like things that shouldn't matter. But like in my head, I'm like really worried about making the right decision. so that people don't question me. Because if they question me, that means I've done something wrong. And if I've done something wrong, then that means I'm bad.

That means I'm a terrible person. That means I'm an idiot. And then like all the way down the wormhole. Yeah, I could see why that would be as you took the pill, all of a sudden you realized that all that sort of overthinking was not normal. Because if you've lived in that space for so long, then maybe you think, well, this is just how everyone thinks. Yeah, that was my general assumption.

I had a lot of very similar friends to me when I was in medical school. We were all just type A, like get all of the things done. And so that was sort of my general perception of this is what it's like to be a medical student. This is what it's like to be a resident. This is what it's like to be in attending that you have to, like, you should be concerned about all of those things to make sure that you're taking care of all of your business. And when it was gone, or not gone, when it was decreased significantly, and I had like time and space in my own brain, I was able to realize that those were not things that had to

be there, that that was actually like this continued suffering that I had. had for so many years that was unnecessary. Because I'm still as capable. I am probably more capable. I'm doing all of the things that I was doing previously. And I'm not worrying as much. So kind of thinking through, if someone was listening to this, and let's say they were a medical student or a resident or a physician,

or maybe even a therapist. And they felt like, you know, I know I need to get help in some way or fashion. Would it be therapy or medications, but I don't really know how to get to that point to actually pull the trigger to get help. Maybe pull the trigger is the wrong analogy here. Maybe just make the first steps. Let's say it that way. What are some of your thoughts on how to overcome that barrier if you were that person? For me, it was finding the right motivation.

And when I have worked with students and residents in this context, that's usually the avenue that I try to go down as far. As looking at, are you the person today that you want to be? Are there like incongruencies? What are the differences there? And then a lot of times, especially like what I found with myself was that I had a really difficult time valuing me. So I had a really difficult time getting better or engaging in treatment. if the only thing that would improve was me.

And so what it took was looking at my children. And I have two boys. And having this knowledge that I have a biological illness, that I have genetics that have been passed down to them, and that there is a potential for them to suffer from, something along this line. And when they are teenagers or when they're in their 20s and they go off to college and they suddenly realize that they have crippling social anxiety, what is the message that I would have wanted to send to them? That you should just work it out. Here's all of the 50

self-help books that I read that didn't actually help. Or do I want to show them what it's like to ask for help, to seek treatment, to get better. And I didn't want them to have to live in a world where they couldn't come talk to me about that

or we couldn't talk about if they needed medication. I wanted that to be a dialogue that was easy and I couldn't do that if I hadn't engaged in my own treatment. And I wasn't capable

of helping them specifically if I wasn't better. And so it's you know everybody else's motivation is is different but what are the things looking at why why do you even want to be better why do you even want to change there's something driving you and there's something getting in the way yeah I think about this for myself um and I think that when I went into therapy I did it sort of with some narcissistic defenses of um

I'm doing this to become a better psychiatrist, a better therapist. It's been recommended by good therapists who I value as like an important step in training. And it probably wasn't until my third therapist and maybe halfway through when I was in the psychoanalytic Institute that I realized, actually, you know what? I probably really needed to be in therapy. and this is probably going to really change every relationship I have subsequently. Because I needed to work through some stuff. And yeah, so I don't know if that's helpful for anyone. But I sometimes say that to people who are in training as a way of sort of decreasing the internal stigma.

Yeah, I can remember there's a sort of idea that all the psychiatry residents should be or should have gone to therapy or be in therapy. And because I need to check all the boxes, I'm like, okay, I'm a psychiatry resident. I should go to therapy. And I can distinctly remember going to therapy and checking off the box. I say words. I think I talk about my mom and dad a little bit. And then, like, I talk about my work a little bit. And then I go home.

And then eventually, like, I guess I'll be better or something. Not really sure. I even remember taking notes during my first therapy. Actually, my second therapist, she would say things, and I would, like, write it down. And then never read it again. Yes. But it was that, like, very, like, I have to be very studious, you know, I have to, like, do this perfectly. And that, you know, it was a difficult dynamic that I somehow wasn't paying attention to at the time, you know,

looking at, well, I'm in this room with this, you know, LMFT or with this sidey and like, you know, I'm, I'm this doctor and like, and just having that element in the room with me and like, they're going to see right through me and see that I'm not, like, I'm not a good doctor, that I'm not a good doctor, that I'm not a good human being and they're going to realize all this stuff about me. And then all they're going to think all day is, man, what a terrible doctor, Darcy is. And like somehow that's just what they were going to do. So I had to like really keep it all together to make sure they didn't see that part. And I see that as well in a lot of the professionals I know.

It's like we have learned over so many years how to present a very professional image of ourselves that we forget that that's not like who we really are. Yeah. And we as a group, I think, have a really hard time kind of being congruent with our emotional sort of experience because it's so sort of trained in us through many thousands, hundreds of thousands of interactions with people that we need to behave a certain way and present ourselves a certain way. And so I think there are. I think that makes it really, really hard for people in mental health to know that they're even at a place where they need help. Yeah. Talk to me a little bit about like when you see someone who has, let's say, suicidal thoughts, do they often just think that they're burned out? Or do they think that they're depressed?

Or do they think they even have a problem? What are your sort of thoughts on that? Um, suicidality is, is a really like, interesting subject in that I didn't realize like, because I'm around, because we're around it so much, we ask about it so much. It's, it's just like, you know, we ask family history and we ask suicidality. These are not, these are questions that are inherent in our, in our field and in our job. And it's such a challenging topic. for many people to engage in. And it gets to the point where they don't even know, like, they don't know how severe it is. Most of, or a lot of the people that I talk to when we're talking about suicidality, they feel that it's a normal experience.

And the statement that I've heard more times than I can count is, well, everybody thinks about this once in a while. And hearing that is always incredibly heartbreaking to me because suicidality isn't something that everybody thinks about. It's a symptom of severe depression. And people don't see it that way. So I was thinking what you said was really important. You said as a psychiatrist,

which we talk about suicidality a lot with our patients. So it kind of becomes more normalized than other doctors, per se. But even within other doctors, even if they have suicidal thoughts, once they have the thought, they may like intellectualize or rationalize the thought, thinking like, oh, but everyone has these thoughts, or it's not that big of a deal. Or I don't know, maybe I'll, what I hear is sometimes I'll be able to get through it. or, you know, it'll pass or I just need to go, you know, make these slight changes and that'll be okay.

Yeah. Yeah, do you hear any other sort of, it's almost like the resistance towards realizing that I need help, you know? Yeah. Any more thoughts on that in particular, the resistance of sort of the knowledge of needing help? Yeah. Or getting help. Or whatever, whatever's coming to your mind. You know, I look at like that space of asking for help and getting help.

And it's all a very similar thing. I think you touched on a little bit before that. You know, as physicians, you know, we're team leaders. You have to be at the top. You have to be functioning. And somewhere along the line we get this idea in our head that we don't need help. We don't need it from anybody. and we have to always be perfect, always perform well.

And so the notion of needing help in anything is challenging. And let alone, like if I can't ask for help on how to manage a patient because I'm too scared that I'm going to look stupid in front of my colleagues, like, how can I even have an ability to say like my mind is broken? because this is the challenging part is that when you look at suicidality, when you look at anxiety, when you look at depression, you start to get these incredibly intrusive, negative thoughts about yourself, about the world, about dying, that aren't a product of you.

They're a product of a disease. But if you don't understand that, you can't separate them out. What do you think about, I know burnout is thrown around us? a lot. And in some of my research, I use the burnout scale. And, you know, we're kind of looking at how this relates to other things like connection and between attendance and attendance. Do you have any thoughts about the word burnout or the use of it in medicine? Is it helpful? Is it not helpful? Yeah, anything there? I think it's, it's a helpful term. I mean, we're faced with this issue.

of physicians are struggling and we're struggling and I'm struggling and I don't know what that means and I don't have a word for it. And so we gravitate towards this idea of, okay, well, well, burnout sounds like, sounds like the word. And you describe burnout and it definitely describes what I'm going through. Like I am suffering from all of those things and all of those things are me. And at the same time, like a piece that I see missing sometimes is that a lot of those symptoms, a lot of those categories are actually very similar to depression. And so if you're meeting some of the criteria for burnout, you can also at the same time be meeting the criteria for depression. Depression is a much harder word. It's a much harder disease. It's a much,

it has so much attached to it, whereas burnout can kind of be like, well, we can do resilience projects and they can be helpful and they certainly are. And at the same time, we might be missing people with legitimate depression who are kind of hanging out in the burnout zone because that's an easier place to be than actually acknowledging that I have depression. Yeah, I think certain words are easier to acknowledge. I treat a lot of patients with medical issues, and I use the word stress a lot, because people will acknowledge, yeah, I'm in a lot of stress,

you know, but they don't want to use the words that are more mental health-oriented. Or, you know, people use frustration. They won't use anger. People use concern rather than fear. And sometimes, you know, whatever we're going to call it, you know, sometimes calling it lesser things, though, I think leads to people not getting help or a kind of a false normalization. Like, oh, everyone's burned out. Like, just pick up your boots.

Pick yourself up and keep going. Um, yeah, any other sort of thoughts coming to your head about that or? I think it's, it's normal. I mean, we don't, none of us want. to be sick. None of us want to be broken. And unfortunately, the reality is that we are broken. I'm broken. And it took me a very, very long time to understand that. And to understand that that is a normal thing,

that it's actually average to be broken. And that's all right. And we, engaging in that, accepting that for ourselves is so incredibly hard and incredibly difficult as physicians. And so if you give us an ability to say, am I depressed or am I burnt out, like we're going to all go towards burnout because depression is a thing that nobody wants.

Yeah, so, you know, I think medical school, residency, attendinghood, being a physician, there's unique stressors and kind of, you know, there's unique things that are make burnout and make depression and make even suicidality higher rates and I know it's not the sort of the general sort of topic of what we're going in today

and I think later maybe in other sessions we're going to discuss some of our thoughts about those things any sort of anything you want to share about sort of the link of these things at this point or shall we save that for another episode. Got to keep them on their toes, David.

We'll save it for another episode. Save it for another episode, okay. Well, this I think has been really meaningful. And I think that our hope in sharing some of our stories is that if you're listening to this and maybe, you know, you want to, you know, consider what are your options for help? You know, there are people like ourselves who are trained. and interested in helping and kind of thinking through these things with other people. And sometimes I think it can be helpful to get evaluated by a professional just to kind of consider

like, hey, are there other things that I haven't thought about? You know, I saw a person recently, and it was very obvious to me that they had obstructive sleep apnea. And once they got that treated, they felt so much better, you know? But it's not like it's not on everyone's radar, like what all the thousands of things that could be going on. on that are contributing. So I think that could be one good reason to kind of consider, you know, like, hey, have I thought through all the different things that might have led to this place, you know? Can I get an outside opinion?

Can I get something outside of me that can give me sort of some thoughts and some input? So if you're a Lomelinda physician and you're listening to this, you know, me and Darcy are available and you can always shoot us an email. And, you know, if you're someone who's listening in, you know, Australia or England, you know, consider getting someone in that location, you know, maybe asking around who's a trusted individual, who's a person that other people recommend, other people would send their family members to, and, you know, checking in with that person. So any final thoughts, Dr. Trankel? Thoughtless currently, David. Good. Good. Good. Well, I really, appreciate it Darcy. I appreciate your vulnerability and I think that takes a lot of courage.

And I really think that having a discussion about this can reduce stigma and reduce our own sort of internal bias against getting help. So thank you. Thank you.