Dr. Elizabeth Hughes MD and "Doctors Emotionally Abusive Relationship With Our Careers"
Are YOU at Risk?
Learn six parallels between classic abusive romantic relationships and employee physician's often dysfunctional relationship with their career.
This is Episode 60 of our Physicians On Purpose [ POP ] Podcast - with 19,564 downloads to date.
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Keys to recognizing an abusive relationship
- I teach people how to treat me.
- You don't get what you want in life, you get what you tolerate.
- Einstein’s Insanity Trap: If you always do what you've always done, you'll always get what you've always got.
Physician’s On Purpose Podcast 60. Elizabeth Hughes MD: Doctors Emotionally Abusive Relationship With Our Careers
Dike Drummond 00:06
Hello again, Dr. dike Drummond here with the latest edition of the Physicians On Purpose Podcast coming to you from beautiful Seattle, Washington in our home on the web at TheHappyMD.com.
I'm super excited because I have Dr. Elizabeth Hughes here, Dr. Hughes is a dermatologist, coach, speaker even has her own line of skincare products. And I was turned on to her work when I saw an article on LinkedIn just recently, that was comparing a doctor's relationship with their career, to the dysfunctional romantic relationships some people get in, in their marriage or non-married relationships, the kind of stuff that people write movie scripts about. And I was fascinated. Because we've talked about this a lot in my coaching communities. I was fascinated. I wanted to bring Dr. Hughes on and ask her a little bit more about her history, and how she learned this and how she explains it to her clients. So Dr. Hughes, welcome.
Elizabeth Hughes MD 01:36
Thank you so much. Call me Elizabeth plaase. Okay.
Dike Drummond 01:39
So tell us a little bit about how you learned when it must have been some sort of eureka aha moment. “Oh, my gosh, this relationship with my career mirrors a relationship that I had someplace else.” I learned a lot from that original relationship that applies here, too. Oh, my gosh, that kind of a thing. Right?
Elizabeth Hughes MD 01:59
Right. I wasn't as much of a eureka moment. More, there had been long term dissatisfaction with medicine, if you want to call it burnout, but it just wasn't professional to fulfillment that I felt like my profession, or as I call it, in the article, medicine, the job was’nt carrying an equal weight of that relationship toward the patient. I was the one giving I was the one cleaning up messes. The doctor was the person making sure the patient was okay. While the medical system or medicine, the job or whatever you want to call it was making it as hard as possible.
It felt like nearly impossible for me to do the right thing. And I had been feeling that for a while. And then I was like, when I got to the point where I wanted to separate myself from doing clinical medicine. And like you move to a situation where I have very specific, you know, patient population of physicians, as well as start to invent things. I realized that my separation process, all of that grief, all of that I can't, what will I do with myself, my world might crumble, I'm going to lose my house, my livelihood, my identity, all of those things. I had been churning all that through my head as I thought about leaving medicine.
And then I was like, Oh, I've done this before.
Elizabeth Hughes MD 03:35
It's funny. It took a long time for me to get that awareness. And you think, Oh, I'm smart, smartness should be able to see things clearly. Because I've made a living being the smartest person in the room, like we all have, we doctors are the smartest person in the room. Right? And yet, that's not protection. And it's not something that guarantees your success in this area.
Dike Drummond 04:02
Right? It guarantees your success scholastically it guarantees your success during the academic portions of our training. But once you get out into practice, it's not nearly as much use as emotional intelligence and all sorts of other things that we skip along the way.
Elizabeth Hughes MD 04:18
Exactly especially applied towards yourself. I mean, we get I at least got some emotional intelligence and some patient centered interviewing and all of those things, but that was all for someone else. It's turning it back and turning that that lens that we have for our patients back on ourselves and say, Wait, here's my real current reality without all of my needs, wants, desires, expectations, training, like here's where I really am, I'm in a situation which is not healthy for me. And I'm staying. I'm choosing to stay in this space and I you know, when I've Finally, when I finally recognize that, then I was able to say, okay, I can drop this now. Let's go. Well, it's
Dike Drummond 05:09
Interesting you use the word choosing. What I think you did was come to the point where you realized you were at choice. Yeah. And there was another choice you could make. Now, one of the things that you did in your article is you went point by point through these facets of the relationship that were both true for the romantic relationship. And then is there a way that you could go maybe back through some of those talking points?
Elizabeth Hughes MD 05:30
Absolutely. Actually, so the the article, it was like, I had 1000 word limit, and it was like double the size. So I like compressed things out.
The first thing is that the abuser or victimized or whatever you want to call it medicine, the job expects me or the doctor to carry the weight of the relationship, all of the caring comes from the doctor, medicine, the job doesn't have to take care of that. If medicine, the job is delaying, you're delaying patient care, because of a prior authorization or a mix up or overly expensive medicine that's necessary. It is falls on the doctors to scramble in some way to make up for that defect in medicine, that job. That's where it is. And that's totally true. What I found with my relationship, and I think this was another point is that my ex, would not only have me basically scrambled to keep things on an even keel, you know, keep his public face looking good. But he would do some outrageous for ridiculous stuff. And I was just supposed to roll with the punches. And that's another thing. You know, the hospital decides that it's just not going to replace a doctor who's retired. Right? And everybody else would just absorb that work, right? That's ridiculous. That's another one. I mean, these these outrageous things that medicine that profession does, that's an that's another one.
Dike Drummond 07:10
Well, and let me just interject in there. When you lose somebody due to attrition, and they're not replaced, and you keep seeing the patients, you've just increased the profit margin for the operation. And the CFO will never replace that person. You may think yourself, oh, Cheryl left, it's going to be great when we get a person back to her place for it's not going to happen if you keep seeing the patients because the huge financial disincentive, so that's just an outtake. Okay, ready? Point number two.
Elizabeth Hughes MD 07:44
You find yourself in one of these toxic relationships, tolerating things that intellectually you'd say, I would never put up with this. For instance, I will never see, for instance, dermatology is a fast paced, quick specialty. So we see people very quickly. But I never want to have less than 15 minutes for a patient visit. And all of a sudden, you've got 10 minutes, and then you're like, No fifth 10 minutes is not long enough to do a full skin check and do a biopsy and explain what you're doing and all of that. And suddenly you find yourself doing what you said you wouldn't do just sort of letting your standard slide. That sort of thing happens. And it's it's subtle, because it's just a couple extra squeezed in patience. And then well, we're just changing your template for everybody and welcome. This is your new template. And this happened to me in corporate medicine. Absolutely. Can you just see a couple others cute frog in the pot? Yes, Frog in the pot.
Dike Drummond 08:53
The other way to say it is don't let that camel put his nose under the tent. It's pretty soon you have the whole camel in the tent. And I also want to add in just a little side note. It's a little known fact, but the research that showed the frog in the pot, meaning if you put a frog in a pot of boiling water, he'll jump out. But if you put a frog in a cool pot and you heat the pot up the frog pretty soon will be dead in the pot. By the way, all of the frogs in that experiment. Were pithed. They were decorticated. Just so you know. So if you're thinking maybe you would recognize that. Maybe you'd get out quicker, but it doesn't work that way.
Elizabeth Hughes MD 09:36
Oh my gosh, I didn't know that. Yeah, so they just didn't have what little reptilian brain there was.
Dike Drummond 09:42
Right? Right. So so we got number one we got number two, keep going because I know you had three or four more.
Elizabeth Hughes MD 09:48
Well, here's another one. So my ex was a serial. I hate this word, but serial philanderer. There were lots and lots and lots of other people. And he would always say what you're selling important to me. And it really made me think, well, if I'm so important, why aren't you investing your resources and your time and your energy in me? Right? I'm important just because I'm like some steady base that you can like, you know, show around, but all reliable, Old Reliable, dammit. But what about all of the physician substitutes that are suddenly being elevated to this idea of being equivalent to a doctor and doctors becoming providers, we were these old reliables. But newer nurse practitioners or even physician's assistants with little to no expertise are suddenly coming in and taking our jobs. And one of my things that I did in my corporate medicine world was a ton of consults. And most of them for from people who were physician equivalents. Who just if they had been a doctor and had the 10,000 plus hours that we all have, by the time we're done with training, they would know that was dandruff. That was easy. That's not you know, that's something that requires a dermatologist intervention. But it's it's funny that that corporate medicine is enamored with these physician substitutes and expect us doctors just to say okay, yeah, bring them on. Bring bring you bring your mistress. Oh, work with they're all trainer.
Dike Drummond 11:34
Oh, my, bring your mistress in here. I love it. Again, I'm gonna do a little outtake here, realize that if you're able to actually substitute a mid-level for a practicing physician, again, you've affected the financial returns of that service for the better. And again, don't let that camel put his nose under the tent right now, but now what will happen in the years in the near future, as we start to see the baby boomer retirement cliff, is people like you who are board certified dermatologists are going to need to work with teams of mid level providers because you won't have an option. There aren't going to be enough doctors, we're all going to have to become better leaders.
Elizabeth Hughes MD 12:17
Right? Oh, without a doubt. And I think that there is a real place for that. I will say I spent the first part of my career in academic medicine overseeing residents and medical students, and particularly residents, there is a way to do this and do it well. But it has to be structured in a very specific way.
Dike Drummond 12:36
Well, and I would say to that the physician, not the business, but the physician needs to be at the center of the choice to bring on a mid-level provider, the choice of person who is the mid-level provider you bring on and how to organize the team. A lot of times it's forced on you from the outside, like you said, like your partner. Oh, but but, but I love you, you're I count on you for who will wash my laundry. I mean,
Elizabeth Hughes MD 13:03
right? Is it right? Exactly, exactly. Well, and that's actually I want to bring up on the next point, which is that your abuser never actually trusts you. And so it's a funny thing the abuser doesn't trust you to be, here's what I found. When I with my ex, if I did something like put on lipstick or pluck a stray eyebrow, are you having an affair? No, I'm not having grooming This is normal female behavior. Like he was he was the one cheating and constantly thought I was the person who was cheating. So I've looked at all of the ways that doctors are overseen to make sure that we're providing quality care, all of these coders and malpractice insurance and all of those layers, most of it isn't really necessary. Or I wouldn't say that it's not necessary. But let's say the baseline of that is medicine doesn't trust me the doctor to do the right thing does not trust my skills, my experience or anything like that. There's there is this culture in medicine that the doctors are somehow a problem. We need you. We trust you to be reliable, but we don't you know, but we watched you.
Dike Drummond 14:30
So and I would say to just a quick outtake This is where emotions and relationships and and business principles keep clashing. I keep stepping in here to make business observations. In America, there's a way to make more money if you can prove to a particular payer that you have a higher score on some sort of quality indicator or something like that. So a lot of those things are going to send a message to you that we don't trust you. But what's actually happening is that the business has gone for more cash, and they need a couple of boxes checked a couple of mouse clicks a couple of keystrokes by somebody on your team in order to get the metric to be what they need it to be to get a few extra bucks. It's all about cash. But it does send that signal of you know, we got to measure your quality, we got to measure your patient satisfaction, all that kind of stuff.
Elizabeth Hughes MD 15:21
Right? Yeah, definitely. You feel like Big Brother's watching you as a doctor. A lot of times somebody's watching, of course you're doing all the time, even when they don't need to.
Dike Drummond 15:33
Right? They're watching you from a statistical viewpoint, and from all the metrics and all the mid-level managers, but you'll never see your boss unless you're in trouble. They'll never come and shadow you.
Elizabeth Hughes MD 15:42
Oh, yeah. Or they will never ever.
Dike Drummond 15:44
Elizabeth Hughes MD 15:47
Okay, so here's another point is, an abuser expects you the victim, what to support all of his freeloader friends. So my you know, my ex was constantly entertaining women, sending them on vacations going interesting places, buying, you know, anything from Home Depot runs with these people to jewelry stores out on my money, basically, I mean, he made money. But it was like, we don't have enough money and money was leaving and leaving out the door. It made me really think about the pharmacy benefit managers, and all of the coders and all of those people, there is a financial incentive for them. But my work as a doctor is supporting all those people that are making my job harder, right? Why? Why should I be paying for all of these people? Right in medicine, and it's the way medicine is set up now. But I truly believe that if more doctors recognized how toxic that relationship is, there could be a groundswell of people who lead medicine differently and find something that's truly more functional.
Dike Drummond 17:05
Yep. And it's part and parcel of what it takes these days in America with multiple payers and all the pressures that the business is under, you have to build a business that has that level of complexity, you have to play that game. And in order to win from a business perspective, and the overhead is so high in these big hospital systems that have a medical group attached to them, overheads up around 60 70%. In many cases, they have to have the doctors working at 100% capacity all the time all the time.
Elizabeth Hughes MD 17:39
Yeah. All the time. They have to have somebody making sure that you do.
Dike Drummond 17:43
And in your case, it's I need you to work harder for my Mr. Says.
Dike Drummond 17:52
Hang on a second. There's lipstick on your collar. Pharmacy Benefits.
Elizabeth Hughes MD 17:56
Allow me to go watch that for you.
Dike Drummond 17:58
Yes, yes, I take that shirt off. It's got lipstick on it.
Elizabeth Hughes MD 18:02
Wow, oh, oh, I can laugh now.
Dike Drummond 18:06
Yeah, I bet that wasn't easy for a very long time. Really what she's our she made it out. And as you go marching as you go driving by the institution these days, they've all pointed at you from the windows of the ivory tower, and they say she got away.
Elizabeth Hughes MD 18:24
Exactly, exactly. So I think the last point I want to make is that abusers make their victims feel wholly dependent on them. And that's one of the biggest, I'm sure in your practice. In my practice, that's one of the biggest things that people forget that we're smart, creative, people who have probably been working and hustling and making things happen outside the medical world before we got into it. And then but once you're in, this is the, you know, if I'm not a doctor, I'm not going to eat, I'm not going to make my mortgage, I won't be able to, you know, take care of my kids and all of that little cluster of worries, I was there, that if I leave medicine, my world is going to fall apart. And I felt the same way in my in my job, or in my marriage was if I leave, it's all gonna fall apart. You know, I'll lose my house. I won't be able to pay my mortgage. i A dermatologist thought I was not going to be able to pay mine or, I mean it was it was reversed. But I was convinced that all of that was going to go when I left my ex and I won't be married anymore. I won't have that. That societally approved label of who I am. Wife. Same thing. I won't have that societally approved label, doctor.
Dike Drummond 19:51
And were you told that by your ex.
Elizabeth Hughes MD 19:54
Oh, that I will
Dike Drummond 19:55
Don't leave me to lose everything. Oh, yeah.
Elizabeth Hughes MD 19:59
Okay, yeah, he got actually kind of cleared me out too. But I rebuilt it was fine.
Dike Drummond 20:03
Right? Well, I'm just thinking about how when a doctor suggests that they might leave the practice if there aren't some changes made how managers talk to you at that point in time. Right.
Elizabeth Hughes MD 20:14
Right. Well, one of the sad things I've found, I'll talk about me and other people that I've worked with is sometimes you just have to say, I'm leaving, there's really nothing that you can negotiate. But you know, because you're stuck in your negotiation world and your corporate world, there's nothing you can negotiate. So I have to leave because there's no, there's no acceptable level of wiggle room here. That can make it so it works for me.
Dike Drummond 20:41
Right. So I think you're looking at your phone while you're talking to me, do you have the ability to list those five points? Just a sentence at a time? Yeah,
Elizabeth Hughes MD 20:49
let me do that. Because I had to pull it up quite good. You remember, okay, so I had, I kind of put two into one. So the first one is an abuser never admits to being wrong. Instead, you clean up the abusers, messes. Okay, so you're shuffling around to make the patients feel better. And abuser. Never trust you. Number two,
Dike Drummond 21:10
always monitoring you. Yeah.
Elizabeth Hughes MD 21:13
Monitoring and abuser does whatever he wants and expects you to roll with the punches. Yep, yep. Yep. And abuser will tell you you're special but sees other people on the side. And abuser expects you to support his free sleazy freeloader, friends, and the abusers make their victims feel wholly dependent upon them.
Dike Drummond 21:34
Ain't that all just the truth? Ain't that all just the truth? Well, let me let me put my spin on the way I've taught it up until this point in time, here's the way I see it.
What ends up happening is when you make the decision to go to medical school, when you're at the lightworkers fork in the road, and you choose to be a light worker, a helper, a healer, to fight the forces of darkness, illness, suffering, death, dying, and family members crazed attempts to deal with those, those things, the first thing you do for seven to 16 years is drop yourself into your transit through the bowels of the medical education system. And that is so all consuming. That you jettison your friendships and your hobbies, and you become 100% focused on your career as your identity.
Elizabeth Hughes MD 22:22
Dike Drummond 22:23
I AM a doctor.
And what ends up happening is that you, you spend all your time in your practice, you get all of your money from your practice, you look for all of your satisfaction and fulfillment from your practice, you don't ever have an off switch. And what that does is put you in a place where it's very easy to be dominated. Yes, I'm taken advantage of.
So one of the things that we teach is that burnout will wake you up by making it physically impossible for you to go further in this relationship with it under these circumstances. So there's several different layers of separation from your career, it's a conscious choice of what relationship I'm going to have just like your conscious choice of leaving the relationship that you were in, and you're now consciously creating your relationship with your what you consider to be your job, right, and all sorts of new skills and things right.
But here's the progression that I usually see stage one is “terrarium” where you put a lid on your practice. You see your patients, you do your documentation, you don't do anything else at work, you have a nice boundary ritual when you get home to shut the doctor off.
Then comes a bridge position where you escaped this job and take another job knowing it's not where you're going to finally end up it's a spacer, where I'm going to pay the bills and practice my craft, but I'm moving to a different location.
Then there is side gig, try something new to spice it up. Right? Usually you have to train your regular practice to put a side gig in place, and then there's transition out of medicine. Because one of the things I know is that when you graduate from your last fellowship or residency program, you are truly 100% free to do anything you want. But we're so well trained to be residents, we just look for another set of tracks in the form of a job description.
Elizabeth Hughes MD 24:13
Absolutely. And you've and I'll speak for myself, you feel kind of lost when those tracks aren't there for a little while you go like, I make the rules. Now, I'm not used to that. Productivity, right, exactly. It's just tell me
Dike Drummond 24:29
what to feel
Elizabeth Hughes MD 24:30
totally disorienting. Unless you have someone who's going to help you along and help you see that this is you're in a normal place. This is a good place to be you're gonna end and somewhere else.
Dike Drummond 24:41
And the challenge too is that if you think about your job description, and anybody who's listening right now, think about your current job description. Did you play a role in designing that job? The answer is no. What did define the boundaries of that job description? It's the revenue model of your employer. I just gonna be really clear that that's all it's meant to satisfy. So that's why burnout is inevitable. For an employee physician, there will come a time where you say, I can't take it anymore. And that's when burnout puts you on a path with more purpose. Just like the day you realize I can't go on in this relationship anymore,
Elizabeth Hughes MD 25:20
right. And the day that I did that was when I realized I was was harming my kids basically, had staying in that bad relationship was not doing the right thing for my children. And so for medicine, it was staying in medicine, as I was practicing was actually not doing the right thing for my patients. They were suffering in their own way. As much as I was, it was time for me to make a change, not just for the people, I you know, the the few people I mean, dermatology, I don't see that many people. It's not 1000s and 1000s. But well, how can I make a bigger impact that will really change things for a large number of people, that's, that became my driving force. And it got me a little closer back to why I went into medicine in the first place. You know, I fell in love with medicine, like a little doc at age 13, five days after my 13th birthday, I broke my arm and had this amazing orthopedic surgeon who fixed my arm and I fell in love and I was like, Oh, I wouldn't do what he does.
Dike Drummond 26:27
Well, I was thinking you were gonna tell me you got a rash from contact dermatitis from this? Yes.
Elizabeth Hughes MD 26:33
No, but I I grew up with atopic dermatitis and chronic hives as a little kid. Okay, so I know itchy skin, that's part of it. But this this one, this one surgeon basically walked into the ER and said, You're gonna feel okay.
Dike Drummond 26:52
I feel okay.
Elizabeth Hughes MD 26:56
And then I realized that I had gotten off track from actually making people feel okay, I was making a financial system, which isn't, you know, have questionable ethics in the first place. I was making it feel okay. Right?
Dike Drummond 27:12
Well, I'm going to end our time today. And we need to do this again, sometime, I'm certain of that, I want to end our time today with two sayings and a law that all apply here that I keep them close in my heart, because they sting, they always wake me back up again. So it goes like this.
I teach people how to treat me.
You don't get what you want in life, you get what you tolerate.
And I'm going to give you the inverse of Einstein's insanity. If you always do what you've always done, you'll always get what you've always got.
So one of the keys to making these kinds of changes is to stop tolerating anything less than what's ideal for you. Remember, everything that you do with other people in relationships, teaches them how to treat you. And in order for anything to change, you have to take new actions. And it's ideal if your new actions are not done in anger, or in reaction to something it's ideal if you can step out of your whirlwind, I'll just show my whirlwind drawing step out of your whirlwind, and think about, you know, what is my current satisfaction with my job? What would I like more of what would I like less of and actually plan to take some baby steps in a direction that feels right for you? That's, that's how you can make some change, significant change over a very short period of time without having to go through the crisis of burnout to get there. Right. Wow. So toxic relationship abusive, really, what are we going to call this relationship with your career?
Elizabeth Hughes MD 28:49
I would call it a toxic relationship.
Dike Drummond 28:52
So this has been dike Drummond, Dr. Elizabeth Hughes, on are you in fact, in a toxic relationship with your career? Now, Dr. Hughes? Where can people find you on the web?
Elizabeth Hughes MD 29:05
My name is my my website. ElizabethHughesMD.com
Dike Drummond 29:10Okay, great. So ElizabethHughesMD.com . And we'll put that in the show notes as well. Thank you so very much.
Elizabeth Hughes MD 29:18
This is wonderful. Pleasure. Thank you so much.
Dike Drummond 29:20
You bet and that's the end of today's physicians on purpose podcast till I see you in another podcast either on YouTube or on our podcast, audio platform, keep breathing and have a great rest of your day.
Dr. Hughes’ original Kevin MD article is here
- I teach people how to treat me.
- You don't get what you want in life, you get what you tolerate.
- Einstein’s Insanity Trap: If you always do what you've always done, you'll always get what you've always got.
PLEASE LEAVE A COMMENT:
What - if any - aspects of your relationship with your career seem abusive to you?