Medical school, residency and working in medicine can be tough — or even traumatic. The exhaustion and burnout can be worse for those from underrepresented groups in medicine (like women and people of color) or those working in certain specialties (like cancer care). Dr. Anthony Chin-Quee’s memoir “I Can’t Save You” explores these themes. In this episode, he and Mayo Clinic’s Dr. Alyx Porter talk about personal strategies and systemic changes to help medical professionals beat burnout.
We talked with:
- Anthony Chin-Quee, M.D., is a board-certified otolaryngologist with degrees from Harvard University and Emory University School of Medicine. An award-winning storyteller with The Moth, he has been on the writing staff of Fox’s “The Resident” and a medical adviser for ABC’s “Grey’s Anatomy.” He is the author of the memoir “I Can’t Save You.”
- Alyx B. Porter, M.D., is a neurologist who subspecializes in neuro-oncology. Her clinical focuses include tumors of the brain and spinal cord; neurological complications of cancer and cancer treatment including brain metastases. Dr. Porter is the most senior Black female adult neuro-oncologist in the country. She is passionate about physician workforce diversity. She is a noted philanthropist, having endowed a scholarship at her alma mater, Spellman College, and created ElevateMeD, a nonprofit to support the next generation of diverse physician leaders.
We talked about:
In this episode, Dr. Millstine and her guests discuss:
- Numbing yourself is not the answer. Dr. Chin-Quee’s book talks about how drugs, alcohol or sex are used to numb the stress and strain of medical training and work. Another coping strategy is to emotionally disassociate from your patients. But Dr. Porter argues she’s a better doctor when she cares — and patients can tell when you don’t. The challenge is to care without letting these feelings consume you.
- Dealing with medical fatigue. Sometimes you don’t know you’re about to burn out until it happens. Dr. Porter starts look for any shift in pattern among learners — are they starting to come in later? Are they getting a little more irritable with patients or colleagues? It’s important to really ask, “How are you doing?” and if necessary, ask them multiple times.
- Create spaces for underrepresented groups in medicine. Despite all the progress (and lip service) paid to diversity, equity and inclusion in medicine, it’s still essentially a “club for white guys,” Dr. Chin-Quee says. It’s important to admit the medical world wasn’t made for you, Dr. Chin-Quee says, so you can carve out your own place in it. Dr. Porter talks about systemic changes needed to better support women and people of color in medicine — including scholarships, mentorships and leadership development — which is why she founded ElevateMeD.
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Read the transcript:
Dr. Denise Millstine: Welcome to the “Read. Talk. Grow.” Podcast, inspired by conversations with my own patients about what they are reading. On “Read. Talk. Grow.,” we discuss health by talking about books, especially fiction, memoir and creative nonfiction that portray or explore health topics. We use reading to better understand how it is to live with or navigate these conditions. In the same way that books can transport us to a different historical time or into a less familiar culture, they can draw readers into various health experiences. On the show we connect authors and experts to talk about health issues, including those often considered hard to discuss.
I’m Dr. Denise Millstine. I’m an assistant professor of medicine at Mayo Clinic, where I practice women’s health, internal medicine and direct the section of Integrative Medicine and Health in Arizona. I’m the host of “Read. Talk. Grow.,” and the medical director for the women’s health blog through Mayo Clinic Press.I am always reading and love discussing books, so let’s get started.
Our book today is “I Can’t Save You: A Memoir” by Anthony Chin-Quee. While most episodes of “Read. Talk. Grow.,” are directed to a general audience, today’s will focus on healthcare professionals. Of course, anyone can listen, but our topic today is navigating medical training, particularly understanding well-being and recognizing wellness when it’s present.
The issue of physician wellness has received focus in the last 10 to 15 years. Burnout rates were astronomical prior to the COVID pandemic and have certainly not decreased since then. Burnout, fatigue and untreated mental health among medical professionals has real impacts on all of us in terms of patient satisfaction and injury through mistakes. We are hoping to shine light on this topic and continue these important conversations.
I have two guests to welcome today. Dr. Anthony Chin-Quee is a board-certified otolaryngologist with degrees from Harvard University and Emory University School of Medicine. An award-winning storyteller with the Moth, he has been on the writing staff of Fox’s “The Resident” and a medical advisor for ABC’s “Grey’s Anatomy.” He is the author of today’s book, “I Can’t Save You: A Memoir,” released in 2023. Tony, welcome to the show.
Dr. Anthony Chin-Quee: Thank you so much, Denise. It’s such a pleasure to be here.
Dr. Denise Millstine: Our second guest is Dr. Alyx Porter, who’s a neurologist who sub-specializes in neuro-oncology. Her clinical focuses include tumors of the brain and spinal cord, neurological complications of cancer, and cancer treatment, including brain metastases. Dr. Porter is the most senior Black female, adult neuro-oncologist in the country. She’s passionate about physician workforce diversity. She’s a noted philanthropist, having endowed a scholarship at her alma mater, Spelman College, and the creator of ElevateMeD, a nonprofit to support the next generation of diverse physician leaders. Alyx, welcome to the show.
Dr. Alyx Porter: Thank you so much, Denise, for having me. What a pleasure.
Dr. Denise Millstine: Our book today is “I Can’t Save You: A Memoir” by Dr. Anthony Chin-Quee. The book begins in the late stages of medical school and goes through Tony’s experience as an otolaryngologist, also known as ENT, resident, including some difficult conversations he has with voices in his own head, as well as creative formats like screenplay, poetry and even rap.
My experience with this book: I found it at an independent bookstore in Providence, Rhode Island, called Symposium Books while I was on spring break, and I thought: “Why have I never heard of this book?” I got it from the Livy app at Mayo Clinic Library, and actually Tony is the reader for the audio book. So, you don’t know this, but we’ve actually hung out for about five or six hours, Tony, which was a delight.
Dr. Anthony Chin-Quee: I’m glad I could be there for you. I’ve gotten a lot of great feedback about the audiobook. When you read the book, you learn that Tony’s actually a very artsy person, and I hadn’t been able to do any acting or performing in a very long time. Getting in the booth to do the audiobook was as close as I could get, so I tried my best to give you the goods, I guess.
Dr. Denise Millstine: Well, you did it so well, but honestly, this is a really vulnerable book and a really vulnerable topic that I think all medical learners should be exposed to, because we all navigate some struggles with the difficult journey that we go through. Tell us about the responses you’re getting to the book, particularly from the medical community.
Dr. Anthony Chin-Quee: Going back, I mean, I can tell you this briefly, why I wrote the book and when I started. It’s actually during the timeline of the story that you read or listen to. The idea came to me when I was in the middle of a massive major depressive episode, and I had been asked to leave my job for a little while because I failed a big test I shouldn’t have failed, and I was on this beach in Mexico. And I was trying to figure out a reason to go on, in addition to go on just living, how to go on going to this job in residency training that just seemed like it was trying to kill me every day. And I just remembered how much I always loved to tell stories, and that I was always really good at it, even as a little kid. Writing them, or reading them, or acting, or singing, or dancing. All that sort of stuff that kind of got stomped out of me in my medical journey.
I decided at the end of training, my goal with finishing training, was going to be to tell my story in a way that I felt was honest, in a way that I hadn’t really seen in physician memoirs to that point. I’d read a lot of them over the course of my life. We’re generally pretty intent upon looking good at the end of the day, when we write our stories, and we want people to keep looking up to us.
Also, despite any issues or problems or hardships we go through, in the books it’s always medicine that saves you. It’s always your patients that save you, the magic you’re able to do with them. That wasn’t my experience and it wasn’t the experience of most of the people I’d been going through it with.
I wanted to tell a little bit of that experience, and I hope that some folks would feel seen by that experience and by that honesty. A lot of people who I went through training with have reached out to me. They’ve all known I’ve been writing the book for a long time. I told them back in residency, I was like: “This is coming. Just look out.” Many of them have reached out so thankful to have had an account like this that they can look to and reflect on and talk with their friends and colleagues about, because they’ve gone through some shade of the experiences that I know I experienced.
That was really a goal of mine, was to make it universal for both healthcare professionals, non-professionals alike. So, the reception thus far from my colleagues has been really good. Funny thing is, I haven’t heard much from my old bosses. They’re conspicuously silent because I was pretty tough on a lot of them. That’s part of the game. It’s all good.
Dr. Denise Millstine: Hopefully it will have changed them for the better, even if you never know that it was the impetus for that. But one of the premises of “Read. Talk. Grow.” is that we can use books to move us into a place that’s uncomfortable, and if we are hesitant to show our own cards or experience. Say you’re a resident who is using alcohol or other substances during their program, it’s a difficult line to work with because we do have this complex to always be doing it well and always be the best. But they might be able to say, “I read this guy Tony’s book and this is what was going on with him,” and you can open the topic to see what sort of reception you get even before you necessarily show your own hand to make sure that you’re in a safe space. I’m hoping that some residents who are navigating that were some trainees, or anybody actually, who are navigating that can use your story to open a bridge.
Dr. Anthony Chin-Quee: That’s one of my dreams with sharing the story, and thinking back on the time and why I wrote about it in the way that I did, I just remember feeling and knowing that the experience of residency training — I know I can only speak to the surgeon bit of it, but I think there’s some common ground with everybody who goes through it — it seems that it is structured in a way that’s meant to just strip away all of your defenses.
Anything you’ve built up to kind of tamp down the parts of you that you haven’t quite figured out yet, or you’re not sure about, or you’re scared of, or you’re angry about. It strips away your ability to navigate in the way that you’ve learned your entire life because you can’t sleep, you can’t eat.
You’re always expected to be excellent, just nonstop, and it just never stops. You’re around death and dying and sickness. People on the worst days of their life, all day, every day, for years. What do you do when you’re a young person and you definitely haven’t figured your life out? You haven’t figured out who you are and how to navigate whatever pain or trauma you’ve come from before you started this journey.
Then you take away any mechanisms that you’ve learned to cope in maybe a healthy way. You start to turn to whatever is around you to just get you through. That means different things for everybody. It’s not just alcohol, it’s not just drug use. It’s the relationships you have with people. It’s who you choose to bring close and who you keep at a distance. It’s locking yourself away from folks, or maybe it’s being around folks so much that you don’t have time to hear yourself think because that’s the safest thing. There’s so much that’s taken away from you, and we’re not given a space or healthy ways to address those things, and so we struggle often. It’s important for us to be able to talk openly about that.
Dr. Denise Millstine: Alyx, your work reaches across so many different fields. You’re a neurologist, you manage brain cancers, so you’re working with medical oncologists, radiation oncologists, brain surgeons, a lot of egos in the care of the patients that you navigate. I’m sure you’ve come face to face with how to manage wellbeing or how to help people that you’re educating with well-being. What have been some of the strategies that have worked for you?
Dr. Alyx Porter: I do get to work with a multitude of personalities and egos and I love it. I feel like it’s the best way to take care of a patient, when you have a bunch of people coming from diverse perspectives, who are looking through their lens at this patient in front of us, trying to figure out the best course of action.
I fully believe that cancer care is done best in a team. That means as a team, we share the wins; as a team, we share the losses. That’s been one of the tools that I’ve used as I have tried to cope over the years with a specialty that has significant hardship, significant outcomes that aren’t what we hope for our patients and their families.
Knowing that reality, yet, and still, trying to hold space for enough hope for that next patient to try, or to believe, or to do, and that’s a hard balance to have. The conversations that I have with patients, that I have with myself, that I have with trainees are a little bit different now, 15 years into the game than when I first left fellowship, because I recognize the toll that it starts to take.
I remember some years ago someone shared with me, when you’re in a specialty where you’re dealing with a lot of difficult things, when you’re dealing with death, you have to live and you have to live well. That’s the best way to try to balance it. Living well looks very different for all of us. For some of us, it’s making sure that we’re getting fresh air and that we’re putting healthy food into our bodies and that we’re going on walks and surrounding ourselves, doing the things that we love and the people that we love.
For others of us, sometimes that means that you’re going to splurge for a first-class ticket to a wonderful vacation. But whatever it looks like for each of us, that’s one of the things I try to instill in our fellows, our residents. One of the things I love so much, Tony, in your book, you talked about stripping all of these emotions away and turning into sort of a cyborg. In order to do what we do well, you have to care. If you don’t care, patients see right through it. In order to be the best that I know how to be, that means I have to feel it. Figuring out that balance of feeling it, but not letting it consume continues to be a work in progress. I still have patients and families that I carry with me that I met as a resident or fellow.
Yet and still, I believe most days I’m better for having met them. I’m better for having walked the journey with them, for having hopefully reduced a bit of suffering by providing some education and some empowerment. But it’s a team sport. Just like Tony in his book took the resident and they had a soda to try to shake off a really tough situation.
There’s times where I’ve taken the resident and we’ve gone for a walk outside or we’ve gone down and grabbed some water because this isn’t normal. This isn’t normal life that we’re trying to navigate, and we can’t pretend like these terrible things aren’t happening, or that we just didn’t ruin someone’s day. Similar to what Tony says, oftentimes I’m seeing people and they equate me with the worst day of their life when I have to share with them what the diagnosis is or what’s in front of them, or what we might expect, and you have to recover from that.
Learning how to take that time and make space for that recovery. There was one time that I really called on a social worker to help bail me out because I just couldn’t go back in the room. That’s where the team comes in. We share some of the wins together, but we also share those burdens together. That’s what I think has allowed me to continue to have energy for this kind of work these years later.
Dr. Denise Millstine: There is such a poignant story about loss and in the book, and for those listeners who maybe aren’t trained in medicine, what Dr. Porter is referencing is that a lot of patients with aggressive brain tumors will be treated and will pass away. Often these stories are those of thriving young people who have a diagnosis that comes seemingly out of the blue and can be really dramatic and traumatic stories.
Tony, you tell such a beautiful story of one of your most impactful early losses with a patient you name Ludes, who is a young patient with asthma. Talk a bit about that because here’s an early case where you didn’t get the support that you needed, or knew would help you and basically just said, let’s go on to the next consult, but talk about rewriting that story. Clearly, she’s one of those patients like Alyx mentioned that you carry with you and that has changed you.
Dr. Anthony Chin-Quee: Every time I think about that story I go back to that moment. That story, just to give the overview, I won’t spoil the whole thing, but there was a teenage patient who lived with asthma and tracheal stenosis. There are two diagnoses that can imitate each other very often, and if you’re treating asthma and you don’t know that tracheal stenosis is there, you could have a patient who gets very close to death very quickly.
We were called in for a patient who was having both an asthma attack and her trachea was getting to pinpoint diameter. We had to figure out what to do in an emergency situation at her bedside. There were multiple doctors in the room. Everyone had an opinion about what to do, including my boss, who I was there with.
The patient ended up passing away. She passed away, and I think what was one of the more devastating ways that a patient and a family can experience a death like that. I was still reasonably young, I mean we’re all young in residency, but I was in the early years and I knew the technician side of what I was supposed to do, but it was just so devastating to be in the middle of a family’s nightmare in that visceral sense.
I knew that her family members, when they thought of their daughter dying, would see my face among the faces that they remembered. I was also confused, and I was angry. I didn’t think that we did it correctly. I thought that certain doctors weren’t acting correctly, or making the wrong decisions. But there’s nothing you can do. As a trainee you just do as you’re told.
So I had to sit with that, on top of whatever else I was going through in my personal life. It was just such a lonely moment. I know that my boss at the time had an opportunity to recognize that, and to debrief in a compassionate way, even if I resisted it. Sometimes as a teacher and as a mentor, you got to see through the outer shell. You got to see through the hubris that you’re teaching everybody to adopt, and stop someone, and get into how they’re doing. When they just went through someone that would traumatize a non-medical person for their entire lives. But we just go on to see the next person, and we do it every day.
That’s one story, but many stories like that over the course of my training kind of made it so important to me when I got older and was myself in a teaching and sort of mentoring position to always take that time when I saw my fellow residents trying to just endure. I used to always tell them in an emergency there’s always time to think. You never need to panic. You can always stop and think about what the next step is.
Afterwards, there’s always time for you that you have to take. You just have to. Let the pager ring for a few minutes. You have to find a way to process it and find a way to take what you need from that experience and find a way to let go of the rest.
It’s not something we are taught to do, either in medicine or in real life. It’s a skill that we have to practice and we have to learn. It makes me so happy to hear Dr. Porter takes that responsibility so seriously and is very intentional about it, because that’s what we need to take care of each other.
Dr. Denise Millstine: You comment in the book, I think it’s around the same time, that you were learning from your seniors, your supervising physicians, the type of physician you wanted to become, but also the type of physician you did not want to become, and when you have an experience like this that’s painful, there is a gift in having it shape you so that the next time you are in a different position, perhaps a more advanced position or a more senior position, and then you have the option to know not to leave the learner hanging when they’ve just been through something that, like Alyx said, is not normal.You’re not supposed to see these things and then say, “Okay, I’m going to the fifth floor to pull a Lego out of some kid’s nose.” But that is the reality.
Dr. Anthony Chin-Quee: Absolutely. I think that whenever we as physicians or medical professionals have these experiences, we know at that moment that these are important. You don’t necessarily know that they’re going to be formative, but you know “this is one of those that I’m going to remember,” and I really encourage folks to take note of it. Write it down.
Find a way to memorialize it for yourself because the lessons that you hope to gain from these, you’re not going to gain that day. You have to grieve, you have to mourn, you have to deal with all this stuff. But when you look back on it later on, that’s when you can really find the important things that can help you shape who you want to be as a physician and healer. So that’s the advice I can offer.
Dr. Alyx Porter: Tony, you put it so beautifully in the book. Part of the role of being a physician and choosing medicine as a career is you take on the responsibility of committing yourself to being a lifelong learner. When you take that responsibility on, everyone becomes your teacher. I was talking to a medical student earlier today who was excited. He was just starting his rotations and I was thrilled for him because the rotations are such a wonderful opportunity to see sort of where your people are; who thinks about disease in the way that you do? Where do sorts of senses of humor align? But also you have that opportunity to see so many different personalities and observe so many different interactions.
From those interactions you can start to become, or figure out who you’ll become as a physician, taking what you love, remembering what you don’t love, and never doing that, ever. Watching patients’ reactions, all of those brief moments really do and have the opportunity to shape who we want to be in our careers.
I think that opportunity to constantly be in a position of learning is one of the best gifts of having this sort of career, especially in academic medicine, where you’re constantly being challenged and made better by the learners that we encounter. You put it so beautifully in the book, and I have lived that experience on a regular basis.
Dr. Anthony Chin-Quee: Thank you so much. I appreciate that.
Dr. Denise Millstine: I want to actually jump back to the very beginning of the book. You are late in medical school and you are taking the first of the board exams called Step One Exams. You have some personal relationship issues going on at the time and lots of different things happening. You didn’t get the score you were hoping for. That’s for sure.
First of all, you make the point that this is not a score people share publicly, but you did. You wrote it down in a book, which is, again, I think, really wonderful to normalize it because it turns out 100% of the people don’t score in the 90th percentile. You’re not alone in getting that score. But I think there is something about learning from these moments of opportunity or sometimes called learning from failure.
Not that you failed, but again, taking that and spinning it so that it’s what prompts you to be better as opposed to letting it be the thing that derails you and keeps you from making further progress. Can you turn to can you talk about learning from failure or learning from things, not turning out the way you had hoped?
Dr. Anthony Chin-Quee: I feel like I had a lot of those moments over the course of my career. I didn’t learn from the failures as they happened. I definitely felt those and felt the defeat. A lot of times when I think about failure, I can only speak for myself and my experience, but the way that failures would happen to me had so much more to do with me and less to do with the difficulty of the material and all that sort of stuff.
I was in a place where I was sabotaging myself. When I failed at things I would make excuses that didn’t really take myself to task. It took a long time and a lot of failures to get to the point where I had to look myself in the eye and just be like, “Listen, you have a lot of things to figure out. You have a lot of growing up to do. What’s really stopping you? What’s actually behind all this failure? You’re smart enough to do all this stuff, you know that. So is everybody who gets into med school. So what is stopping you?”
That’s a major question. That’s one of the central questions of the book and why I wrote it the way I did. It’s less about my journey through medicine. It’s more about finding a way to grow up and figure out who I am, forgive myself for the things that I had been holding on to for so long and embrace where I was at as far as my mental and emotional health, and be proactive in that regard.
But I would say, if we’re going to just talk, the big answer about how I dealt with failure was that I used it as an opportunity to explore myself and all the pieces that I was too scared to face over the course of a lifetime. Only one side was able to do that.
Could I finally put all the exams and all that, all the work I had to do really in the proper perspective and kind of take the weight off of myself so that when it came time to do these sorts of evaluations in the future and deal with these high pressure situations, I could come at it from a place of feeling more complete in myself. That’s a really long winded answer for you, but I hope that suffices.
Dr. Alyx Porter: Denise, can I add an “and” to everything that Tony just said? “And” we need a better way to figure out who is going to be an exceptional physician besides these standardized tests. Tony mentions it. We need a test that’s going to help us understand who has the EQ, who has the resiliency. Yes, who can learn material, memorize it, pull it out under duress, who can lead a team? We don’t test that well. Just because you get a 90th percentile score doesn’t mean you’re going to be an exceptional physician. But that’s the way that we choose. Who even gets the opportunity to play in the game? I hope that while test scores end up being important to allow us to get to the next steps and beyond, it’s such a challenge.
When we talk about broadly looking at the physician workforce and who is getting into medical schools these days and how they’re being judged and graded, there’s a lot of inherent bias that goes within a lot of those processes, and I’m not sure that we’re always getting it right.
Dr. Denise Millstine: In fact, you’re sure we’re not always getting it, if we’re honest about it. But I imagine there are people in training listening to the show and may have just received news that they didn’t score as well or they got a bad evaluation or an evaluation that they thought was unfair, and what I think is important for me to have that listener here is these are inflection points.
These are not the point at which everything that you’ve worked for has fallen apart. In fact, it can be the point at which you get to tap into yourself and understand who your authentic self is and use that to direct your career and your energies to the places that are most meaningful to you.
Dr. Anthony Chin-Quee: I think that’s super well-said.
Dr. Denise Millstine: Thank you. I want to talk a little bit about fatigue. Alyx, this is such a huge topic in medical training and I think often the person who is exhausted doesn’t recognize, is just pushing through. We see in the book some really difficult examples of what this is. Can you talk a little bit about fatigue with the people that you’re training and how you recognize it and how people can deal with that?
Dr. Alyx Porter: It’s one of those insidious symptoms, if you will, because for many of us, we manage, manage, manage, and then we crash. Sometimes there’s not much of a warning before the crash comes. For some of us it can look like showing up later and later and later to work. For others it can be a lack of attention to detail.
Sometimes it’s being slightly short tempered or irritable with the patient or with the rooming staff, or with our coworkers, coresidents, other learners and the team. So it can look different for each of us. The main thing that I try to look out for and our fellows and our residents is just a shift in their typical pattern and just asking very honestly, away from everybody else: “How are you doing?”
Usually I ask a couple of times because it’s very easy, once we’re in that fatigue mode, it’s much easier to say fine than it is to say what actually is happening at that moment. Some of us are the type that go inward when we’re under stress or strain. Others of us go outward, and so it can be hard to ask that question even of one another as we’re passing friends in the hallway and notice that they’re maybe not making the same level of eye contact as they had previously or something like that.
It’s one of those things that I think we have to constantly talk about. It’s extra challenging for those of us that are hitting that mid — there’s fatigue that happens when you’re in training and that’s purely because you’re working a ton. Once you hit that mid-career, you’re still working a lot, but you’re also raising young children.
You might be taking care of aging ill parents, and so the fatigue comes from different directions because now your energy is dispersed, and that is a challenge also. One of the things that I continue to think about is how we continue to support that mid-career physician who has strain, who still is carrying a heavy clinical load, who’s trying to get their academic promotion.
All of those things still carry a bit of mounting fatigue that feels a little different than when I was a resident working 80 hours a week, but yet and still has the same impact. So it’s something that continues to need to be addressed for sure.
Dr. Denise Millstine: It’s physiologic. It’s not weakness to be tired when you’ve worked hard and haven’t slept enough. Tony, you tell a story of a physician. I don’t think you knew, but you knew the singing physician, and their tragic end because of being in a car with somebody who was overtired. So I just wanted to make sure that that was highlighted in our conversation.
All right, Tony, this is a tough one. Medicine is very tribal, and what I mean by that is, particularly in training, you sink in with a group of people who are at a similar stage as you, and here’s a quote from your book: “We were the future lifesavers of America. We were brilliant, dedicated and talented and in the precious moments we owned outside of work, all of our social activities centered around or were adorned by liquor, drugs and sex. Self-preservation by way of self-medication.”
We talked about this a little bit earlier, but can you talk about the impact of that culture? Not just the individual’s decision, but what happens when you’re in this group and that behavior is normalized or seems like the easiest way to get through these difficult months and years?
Dr. Anthony Chin-Quee: You think you’re taking care of each other. It’s not like you’re searching out people who are just as dysfunctional as you. You’re just searching out people who seem to be coping in the same way as you know how to cope. You hang out with each other and you do all these things to numb yourselves.
Everyone has the same sort of mechanisms, and you’re able to be there for each other in this way that is vulnerable, but not. No one ever talks about the deep, painful things that are driving us to meet each other at the bar all the time, but we can get drunk around each other and be vulnerable in that way. We make those decisions and all that sort of stuff.
I forget where I read this or someone told me, but you always bring around yourself the people and behaviors that you think you deserve. For me it was that culture. It was those sorts of relationships where we could feign vulnerability because that’s what I was always best at, and there are a lot of people in medicine for whom that’s just been a way to get through their entire lives.
We were kindred spirits and in a certain sense, and we played it so safe in retrospect because we didn’t demand better of each other. We didn’t demand that we grow, or that we really be there to support each other. It’s a tough lesson to take from those times and something that’s so difficult to see as you’re going through it.
For the trainees that are listening and are going through something similar and you feel that, not only are you tired, but you’re just drained just to your soul and the things you do for fun aren’t restorative, take a look at what it is you’re doing and who you’re doing it with because that could give you a clue to where you need to push yourself to and pull yourself away from.
Dr. Denise Millstine: Words of wisdom right there. Thank you. I hope they fall on open ears. Before we wrap up, and I had about eight more questions that I wanted to ask you all, I want to talk about race. We talked about racism in healthcare with Linda Villarosa on episode three of “Read. Talk. Grow.” with her book, “Under the Skin” really focused on racism and healthcare as it pertains to patients.
But in your book, we’re seeing racism in medical education, and we have such a long way to go in diversity and in true inclusion and among healthcare professionals. Many of our listeners are definitely finding themselves as the first, the one of the few, or the only entering into their training programs or positions, which comes with so many layers, challenges, opportunities. I want you both to please comment on this.
Dr. Anthony Chin-Quee: Being underrepresented in medicine is still and has always been just really a very, very difficult road. Despite all the lip service, despite all of the proclamations of allyship and all of the positions opened up for diversity, equity and inclusion, this profession is still predominantly a club for white guys and basically we’re just trying to figure out how we can make it our own.
It’s a fight. It’s a fight every day for your whole career, for a lot of us, just our entire lives, it’s the same sort of fight. Whenever I think about my experience, I think about what I would say to trainees who are underrepresented and also to trainees who are overrepresented, and what I would say to trainees and folks not just trainees, but folks in medicine who are underrepresented in the field.
The main thing I would say is that even though you’re made to feel like you’re the crazy person, you’re not. You’re smart enough to know that if you’re being made to feel crazy, it’s because something crazy is going on around you. It’s not in your head. People will try to convince you that it is in your head. Take that to heart and try to remember it. Also that the world, this medical world, wasn’t built with you in mind. It still isn’t. It’s not built for you. You’re an intruder and it’s tough to hear and tough to accept, but if you can recognize that, then you can start to figure out how you can start making a home for yourself in this world, because no one’s going to do that for you.
You have to make a place that you can call home in this profession, whether it’s with the work that you do, whether it’s with the colleagues that you work with or keep around, it’s a home you have to build that is not just there for you.
For those who don’t quite understand how all this feels, I would say — this is what I said to one of my colleagues who I kind of outline in the book a little bit in, who I’m actually very good friends with. We have come a long way since training. But part of that was me letting him know that you know what, being white and talking about racism, it’s funny because when you’re a white guy, you don’t have to think about it really, ever. If you don’t feel like it.
It’s the same thing with sexism and misogyny. Men don’t have to think about how women feel because the world is built for men and women are thinking about how they navigate the world as women all the time. Just like people of color are thinking about what it means to be black in every space that I’ve ever gone into.
But if you’re a white guy, especially a straight white guy, you don’t have to, and so if you’re in that population, you have to make it your work, your active work, your intentional work to think about these things and live in the discomfort of this world that you benefit from. But your partner sitting next to you does not, and ask yourself these difficult questions all the time.
It takes consistent work to really become someone who is allied with folks who don’t have the power that you have. With the power that you have there’s so much you can do to lift other people up. One of those things is giving up some of that power to other people, which is a thing not a lot of people are ready to do, and that’s a really tough concept to wrap your head around.
That’s where we get a lot of pushback. Recognizing the power is one thing, but really creating an equitable world requires that you give it up, and are you ready to do that, and how will you do that? That’s the conversation I had with Peyton several years after we graduated, when he confessed that he knew all the things that I was going through weren’t just in my head in medicine and in training. He really just wanted to get it off his chest and he wanted forgiveness. I knew he did.
He didn’t fancy himself a bad person and this had been weighing on him for so long. I didn’t forgive him. I was like, “I’m glad that you told me. So now I don’t feel like I’m a nut. But what’s the work you’re going to do? Let’s talk about it. What’s the work that you’re going to do personally in this position where you’re now an attending in specialized surgery with residents coming up behind you, with what are you going to do in your community? What are you going to do with your two young boys who are white men in training? What are you going to teach them? How are you going to do it? That’s the work I’m happy to talk with you about, but I’m not here to make you feel better about coming clean.” That’s what I would say to folks that are listening. There’s work and reckoning to be done no matter who you are in medicine, and we can only move forward if we’re willing to do it.
Dr. Alyx Porter: Tony said so beautifully that this is an institution — medicine — that wasn’t built with people of color or women necessarily in mind, and so my husband, who’s also a black male physician, we can talk a whole hour about the lack of representation of black men in medicine. That’s the reason why my husband and I founded ElevateMeD.
There is a gap that we experienced in our medical school education and the matriculation into our careers. We created what we wished we’d had. Number one, we wish we had scholarships. The debt burden that folks that are underrepresented experience, not just coming out of undergrad, but also coming out of medical school, is much higher than their white counterparts.
Cost is the number one thing that’s keeping Black and brown students from even pursuing a career in medicine. So how can we start to lower that power differential? How can we start to make medical education much more equitable? We have to be able to provide scholarships. The second thing is we have to have mentorship.
You can’t be what you can’t see, and so any student who is part of our program has a mentor that looks like them in the role in the career that they aspire to go into so they can start to learn to navigate some of those pitfalls. Because most of us who are first in our families were first in all kinds of ways, and we don’t have that uncle or parent or someone to immediately reach out to say, “Am I crazy, or is this really happening?”
The third thing is financial literacy, both personal financial literacy and also healthcare financial literacy. So not only do we have higher indebtedness, when we’re coming out of undergrad and medical school, we usually end up having credit problems because we’re also looking to try to help our family members. Or maybe we have family members who might have taken advantage of the different credit card applications that were being sent home and we went into medical school or undergrad. That’s not uncommon because the family goes together.
Now that you’re in medical school, it’s part of your responsibility to help beyond your immediate household, and that’s something that often is unique for underrepresented folks, and so it’s important that we understand how best to navigate that and also have some understanding of healthcare financial literacy because there’s a whole lot of language out there that being used that we don’t often get taught in medical school.
That’s something that we want our ElevateMeD students to have a very clear understanding of. Finally, leadership development. Physicians end up being leaders in whatever spaces they hold, whether they end up one day, hopefully they all become senior residents, maybe they’ll even be chief resident. Maybe you’ll have a practice of your own one day, or you’ll have a care team to help manage.
Understanding that leadership is a skill that is taught and that can be cultivated, and just because you have an M.D. or D.O. behind your name doesn’t immediately entitle you to being one that has the privilege of leading others, so really teaching those skills because there’s so much of an unwritten curriculum that happens within medicine, and that’s how we continue to get to be othered.
Really with our program, which we launched in 2019, I’m just thrilled we’ve been able to award over a million dollars in tuition-based scholarships and support to over 50 medical students from across the country, and we’re continuing to grow. It’s programs like that that are helping build up this next generation of diverse physicians who we hope will become leaders in healthcare.
But as Tony mentioned, you really have to put your money where your mouth is in a lot of ways. The folks that, in 2020, said that they wanted to help and be all about it, yeah, we saw some grants. We saw some donations then, but now we’re being told, “We don’t have the budget for that anymore.”
That hasn’t been too much time that’s past when everybody had their position statements on race and racism in America and healthcare and what their role would be, but that’s the first thing to get cut when there’s times of financial strain. So it’s really something that’s not just an issue that folks that are coming from diverse communities need to deal with. This is something that everyone needs to really lean in to help make better.
Dr. Anthony Chin-Quee: I’m just appreciating all of that, especially with your organization. I always get frustrated with singular talk of pipeline programs. We just need to find a way to give Black and brown kids access and get them into med school and then just let them go.But it’s so much more. There’s so much personally, culturally that we have to do and that we can do to take care of each other throughout the journey, especially later on when it gets super hard. Financial literacy. That is so real. I didn’t know anything about that stuff. It got me in so much trouble with money because I just didn’t have anyone in my family who had been in the position like this before. It can be devastating to so many folks. So I just want to say I thank you for the work that you’re doing. I think you’re doing it well.
Dr. Alyx Porter: Thank you.
Dr. Denise Millstine: Well, I want to thank you both for the work that you’re doing. The book, “I Can’t Save You” really highlights a lot of aspects of being in medicine, in medical training, and Alyx, ElevateMed is something I am definitely glad we can highlight on “Read. Talk. Grow.” Hope more people will take a look at this and see how they can use their lifestyle, their privilege, their positions to really make the world a more inclusive place. We’ve been talking about “I Can’t Save You,” written by Dr. Anthony Chin-Quee. Thank you both for being on the show.
Dr. Alyx Porter: Thank you so much.
Dr. Anthony Chin-Quee: Thank you.
Dr. Denise Millstine: Thank you for joining us to talk books and health today on “Read. Talk. Grow.” To continue the conversation and send comments, visit the show notes or email us at readtalkgrow@mayo.edu.
“Read. Talk. Grow.” is a production of Mayo Clinic Press. Our producer is Lisa Speckhard Pasque and our recording engineer is Rick Andresen.
The podcast is for informational purposes only and is not designed to replace the physician’s medical assessment in judgment.Information presented is not intended as medical advice. Please contact a healthcare professional for medical assistance with specific questions pertaining to your own health if needed. Keep reading everyone.
