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When Dr. Mark Greenawald received that letter in the mail – the one from the State Board of Medicine – it was like a punch in the gut. How does one recover? The inclination is to roll yourself up in a ball and hide in the corner…but not for Mark. He shares ideas and insights on how to recover from such a professional blow.
And, if you find yourself having trouble overcoming a similar issue – we are here to help. Visit us at https://www.mymdcoaches.com
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From fractional CFO services to accounting, bookkeeping, and payroll, Eagle financial group is your partner to ensure that your practice keeps on serving your patients, and gives you more time to spend with your family and friends.
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Mark Greenawald, MD is Professor and Vice Chair of Family Medicine and Community Medicine at the Virginia Tech Carilion School of Medicine (VTC) and presently serves as the Vice Chair for Academic Affairs, Well-being and Professional Development and as residency program faculty for the Carilion Clinic Department of Family and Community Medicine. He also serves as the Medical Director for the Carilion Clinic Institute for Leadership Effectiveness (ILE). He is a former President of the Virginia Academy of Family Physicians and in 2016 was named the Virginia Family Physician of the Year.
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Access the Show Transcript Here
LCM 29: Avoiding Isolation: Dr. Mark Greenawald
Summary: The conversation emphasizes the importance of seeking support and sharing stories in a supportive community. Personal experiences are shared, resources are provided, and the “Life-Changing Moments” podcast is introduced.
2023, Dr. Dael Waxman
Life Changing Moments
Produced by Clawson Solutions Group (www.csolgroup.com)
Chapters0:00:00 Relearning the Power of Asking for Help
0:00:45 Physicians facing scrutiny and emotional isolation in their careers.
0:04:01 Dr. Greenewald’s profound story of a Board of Medicine complaint.
0:11:51 The Decision to Settle Out of Court
0:14:25 Fear of Losing License and Internal Struggle
0:19:35 Acknowledging and Normalizing Our Shortcomings and Mistakes
0:20:54 Rx for Success: Empowering Medical Professionals
0:21:56 Introduction to Physician Outlook and its Unique Features
0:24:01 Importance of Response and Reaction to Challenging Situations
0:28:02 Creating a Safe Space for Sharing and Processing Experiences
0:34:01 Shifting medical culture to be present for each other
0:36:15 Don’t try to face challenges alone, reach out for support
0:43:55 The Power of Sharing Our Stories
Long SummaryIn this part of the conversation, the speaker reflects on their own experience of reaching out for help and emphasizes the importance of seeking support from colleagues. They introduce the companion podcast, “Life-Changing Moments,” where they will explore transformative experiences and learn from them. The focus of this episode is the significant challenge many physicians face when their care of patients comes under scrutiny. The speaker emphasizes the isolating and emotionally intense nature of this experience, as well as the lack of space to process it within the medical culture. They highlight the need for physicians to share their stories and create a supportive community.
The guest for the episode is introduced as Dr. Mark Greenewald, who shares his own life-changing moment involving the scrutiny of his care. He discusses receiving a complaint from the State Board of Medicine regarding the death of a patient who had been abusing medication. Dr. Greenewald reflects on the challenges of navigating this experience and the feelings of guilt and self-doubt that arose.
The speaker also shares their own experience of facing a malpractice claim and the isolating and stigmatizing nature of this experience in the medical field. They discuss the importance of recognizing and accepting what has happened and allowing oneself to experience a range of emotions. They emphasize the value of having a safe space to process these emotions, even if it’s not with someone who knows the details of the case. The speaker found support from colleagues they trusted and established relationships with, and they emphasize the importance of reaching out for support and sharing one’s journey.
The conversation also touches on the importance of creating a culture within the medical profession that allows for open discussions about challenges and the seeking of help. The speaker encourages colleagues to cultivate relationships and offer support to one another, both professionally and personally. They discuss the importance of not minimizing others’ emotions and offering compassion and assistance when someone reaches out for support.
The episode concludes with the speaker thanking the audience for tuning in and offering resources for those who may be struggling and in need of support. They encourage listeners to rate and review the podcast and join the MD Coaches community to continue the discussion and support each other through life-changing moments.
Brief SummaryIn this conversation, I reflect on the importance of seeking support from colleagues, and introduce our new podcast “Life-Changing Moments.” We discuss the challenges physicians face when their care comes under scrutiny, emphasizing the need for physicians to share their stories and create a supportive community.
Our guest, Dr. Mark Greenewald, shares his own experience of scrutiny and navigating a complaint. I share my experience of facing a malpractice claim and the importance of finding support. We discuss creating a culture that allows for open discussions about challenges and offering compassion and assistance to colleagues.
We thank the audience, provide resources for support, and invite listeners to join the MD Coaches community.
Tagsseeking support, colleagues, podcast, Life-Changing Moments, challenges, physicians, care, scrutiny, stories, supportive community, guest, Dr. Mark Greenewald, experience, navigating complaint, malpractice claim, finding support, culture, open discussions, compassion, assistance, audience, resources, MD Coaches community
Relearning the Power of Asking for Help
[0:00] So I had already had that experience behind me. How quickly we forget, though, in terms of the power of reaching out and asking for help. So I had to, in some ways, relearn that.
And in this case, started reaching out more to colleagues.
There are times in our lives that change the way we see the world.
Navigating these challenges can take insight, trusted confidants, or even a coach.
Let’s explore those moments.
In this companion podcast to Rx for Success, we will discover ways to learn and write our own success stories together.
I’m Dr. Dale Waxman, a physician coach with MD Coaches, and this is Life-Changing Moments.
Physicians facing scrutiny and emotional isolation in their careers.
[0:45] At some point in our careers, many, if not most physicians go through the significant challenge of having our care of patients scrutinized.
This can range from having a case come before a hospital quality committee, to a malpractice, suit, and all the way up to a review by a state medical board.
While the clinical scenarios that bring these forward range from an undesired outcome, to a medical error, or to uncommonly negligence, the common denominator for all of them for the healthcare professional involved is an intensely emotional, isolating, and self-examining experience like no other in their career.
In the medical culture, we do not have spaces to process these experiences.
Our cultural perfectionism has evolved such that we don’t feel safe discussing these with peers and we’re left then to experience the ultimate shame, fear, and vulnerability that arises alone.
We need to reverse this lack of presence for one another. One way to do that is for us to share our stories.
It takes strength and vulnerability to do so, especially on a podcast.
[2:04] So I am grateful to our guest today for coming on to discuss a profound, life-changing moment that occurred in this space to him.
My guest is Dr. Mark Greenewald.
[2:16] Dr. Greenewald is a professor and vice chair of family and community medicine at the Virginia Tech Carilion School of Medicine, and presently serves as the Vice Chair for Academic Affairs, Wellbeing, and Professional Development. He also serves as the Medical Director for the Carilion Clinic Institute for Leadership Effectiveness. He’s also the former President of the Virginia Academy of Family Physicians, and in 2016 was named the Virginia Family Physician of the Year. Mark has also long been a national leader in efforts to to improve the well-being of physicians.
And I might add, that was long before burnout was a dinner table conversation.
He’s been at this a lot longer than most.
He has developed innovative programming to improve the daily professional lives of all healthcare professionals.
Mark was also instrumental in my matriculation into coaching training and has had a strong influence in how I think and how I coach.
I have the privilege of teaching alongside him a coaching school, and we have had many philosophical discussions about contemporary medicine and how individuals are managing themselves within it.
Dr. Greenewald’s path into medicine story is chronicled in the Rx for Success podcast number 137.
I really encourage you to listen to both his riveting story as well as much of the wisdom that he imparts there.
[3:46] So, Mark, with that, I really can’t thank you enough for coming back to the MD Coaches Family Podcast, and so welcome to Life-Changing Moments.
Thank you, Dale. It’s an honor and privilege to be here. I want to meet that guy who you just introduced.
Dr. Greenewald’s profound story of a Board of Medicine complaint.
[4:01] He sounds like somebody I’d want to get to know. Sometimes we don’t know the impact that we have on the world, right?
A lot of times. Yeah. So, you know, it was a pretty lengthy introduction.
It’s a longer introduction than I usually do, and I just, you know, you and I talked a little bit before recording.
This topic has a lot of gravity, and we don’t share these kind of stories easily.
[4:28] We just don’t share them very much at all. So again, I’m grateful for your willingness to put that out there, because we all heal from that.
And there’s a lot of listeners I know who’ll be able to identify with what you’re about to share with us and what I’d like to do if it’s okay with you, can we just have you tell the story that you’ve shared with me, it was not on the earlier podcast, about one of your significant life-changing moments where some of your care was scrutinized? Sure Dale, so in probably it was about 2007 is when this particular circumstance happened where I received a note one day in the mail from our State Board of Medicine basically said that a complaint has been filed against you, provided some details of that complaint and said that we will be…
Investigating this and you will be contacted by an investigator to go through the process. Though I had been in leadership positions up to that point I had never been exposed to a Board of Medicine complaint before I was quite aware of our Board of Medicine. We at that point had something called the board briefs that every month put out kind of board determinations against colleagues and often those were things that were in my view often quite egregious in terms of things that had happened, improprieties that had happened and things like that, but never really thought.
[5:52] About the board process, had never known at that point in time or was aware of any of my own personal colleagues who had been, through that process, so receiving this letter was a gut punch for me on many levels, and reading what it was about, even more so, the case involved was a very tragic one where a patient had died.
This was in the times when controlled substances were not tracked as much as they are now.
This was in the days where we were right in the middle of the opioid production epidemic or the promotion epidemic and this was a patient who actually was on not something that we would normally consider in the context of opiates.
She was on tramadol which at that point in time was a newer medication that was not really mainstream considered an opioid nor necessarily yet really described as a drug of abuse at least within the realm of primary care.
Out that she had been abusing it as well as some other medications, receiving it from both me, myself, and some other colleagues both in and out of the state.
So she was well-versed in the process of moving through the system.
[7:00] And we didn’t have at that point PMPs to track those things.
And she overdosed and she died tragically from that.
And even during that time that I cared for this patient, Dale, which was over many years, there were many times when my instincts told me there’s something just not quite right here.
But I couldn’t put my finger on it and she as well as other family members, direct family members who were involved with her care always had explanations and stories for things and And so I, in retrospect, overlooked some of those gut feelings that I had about what was going on and that things were not quite right.
[7:40] Regardless, this ultimately tragically ended in her death and actually had reached out to her husband expressing my sorrow for what had happened.
We actually had exchanged some communication about that and they had actually moved at that point in time.
So at the time of her death, they weren’t even living here in my community anymore.
Part of the gut punch for this was that there was never any litigation that came up around this particular case, thankfully.
But the complaint came from a family member who I’d never met who was not involved at all in her care.
I was never aware of this particular individual. And so the first part of that journey, for those of us who have been on it, and I think There are likely many listeners who have their stories, and I have others as well, in terms of getting involved in the system that you described, whether it be around malpractice claims or just local concerns, peer reviews.
And the vulnerability that one experiences when they realize that anybody, for any reason, can file a complaint.
[8:46] With the board of medicine and though the board has a due process that they follow from the very start of that process there’s always the sense of guilty until proven innocent that because the complaint happened it’s a legitimate complaint and therefore we will do everything we can to investigate.
[9:06] It. The other thing that I realized early on as I started to seek counsel about this is that when a complaint comes in like this, in many ways, the board has carte blanche in terms of how they go about looking into this.
So it doesn’t necessarily become just this particular case that they can ask for other examples of patient care that you’re doing and you talk about that feeling of totally being out of control that none of us, I think, in healthcare embrace readily.
It’s not our normal MO in terms of how we operate.
And so I was just distraught and really didn’t know what to do, reached out to my chair at that time and was guided to reach out to our legal team, which would have been something that I wouldn’t have really even known about.
One of the things that happens often with these cases is that both for this and malpractice cases, the first thing the legal team says is don’t discuss this with anybody.
And for many of us, myself included, that was horrifying because I needed some place to process this.
And so then there’s now that moral dilemma of I need to process this with somebody and, I’ve been told not to.
And so initially, really process it with a very inner circle, including my own wife.
[10:29] Didn’t really have, know how to go about reaching out beyond that.
As the process continues, the other thing that you learn about these processes while the reviews take time and I had to then go back and review the case because I had to write a report basically explaining my behavior and making sure that that was meticulous in terms of how I went about that and using the right terminology and making sure our legal team had a chance to review that.
You turn that in and it can take months if not years before that process kind of works its way through to a hearing and the hearings then becomes its own process.
Again, in my case with a board of hearing, with others it would be a trial or something like that or a settlement.
All of the angst that goes on around that, do you appear at the hearing, do you not appear at the hearing, what is the strategy around all those things?
And ultimately, what we were able to do working with the board in this particular case was to have a, this would be almost like a settlement if you will, I’m not using the right terminology, but to be able to say I accept the complaint but I don’t admit that I did anything wrong.
So I accept what the board’s decision was and I also at the same time contend that I.
The Decision to Settle Out of Court
[11:51] Did nothing wrong in this process and what my legal team guided me is that that was the wisest approach because if it went to a hearing you never know what would happen kind of like a jury trial. You would be then very much out of control and again we see very much parallels in the legal system in terms.
[12:09] Of making a settlement prior to a trial so that you don’t take that risk of what would happen. Well even that as you can imagine you know the admission of Culpability without guilt was not something that I embraced readily because I really did not believe that I had done anything Outside the standard of practice certainly not had done had not done anything illegal and didn’t feel like I had done anything.
[12:33] Wrong though as we all can can understand in retrospect We would certainly knowing what we know now do things differently so that that was all happening and once that decision is made you know that’s going to show up in the board briefs. So it’s coming and it’s going to be out there then for everyone. Well what happened in my particular case went beyond that because at that point in time when the decision came out this is now two and a half years, three years almost after the initial event happened.
[13:03] Was that we were in the process of forming our new medical school here the Virginia Tech Carilion School of Medicine and I was serving as the Dean of students and there was some community uproar around the medical school and some things going on and for some reason our local newspaper at that time decided that they were going to do a story on some of the recent board decisions and particularly taking a stab at the medical school because I was a leader in the dean’s office who had now been cited by the board.
So there I was, just literally Dale, as our first class of our new medical school.
So the first 40 students of our new medical school were going through orientation.
That week, the headlines in the paper, front page of the paper, was about these Board of Medicine decisions.
So there was no hiding. It was just right out there.
And there was really no way at that point to defend myself.
You know, it was like, there it is. This is the facts because it was published there, the board, these are the facts.
For me during that time, I received a lot of support from both my organization, Kirlian Clinic, as well as the medical school, Virginia Tech Kirlian School of Medicine, including the dean, including at that point our CEO of the healthcare system, some of our other physician leadership.
Fear of Losing License and Internal Struggle
[14:25] And yet at the same time, it felt like I was, I kind of, if you will, had the scarlet letter.
It was like many people have described that when they’ve had a malpractice claim against them that it’s almost like others want to make sure that you’re not contagious so they’re going to kind of steer clear of you just in case whatever karma you had, they didn’t catch on to it.
And so, very, very isolating and one of the determinations of this particular case, my fear of course was initially that I could lose my license. Fortunately that did not happen.
My license could also have been suspended. Fortunately that did not happen.
One of the criteria of my being able to retain my license was to have to go through a CME training around prescribing of medications, which.
Very interesting Sammy, but again very much feeling ashamed of that I had to do this, that I had done something wrong when you know that it was it was it could have been any of my colleagues, it could have been any of us who could have.
[15:29] Been in this situation. And so went through a lot of internal struggle around that time of how do I go forward with this. You and I have known each other for a little while and you know that disappearing, which is what I wanted to do.
[15:45] Is not in my nature.
It was one of those you just like to kind of ride off into the sunset and just save the embarrassment and the shame, but that was not going to be the case.
I was in a leadership position. I was very visible at that time and continue to be.
And so really kind of addressed it head on and started telling my story to others, not the story of the case, but the story of the journey, the story of how do we, when we have these kinds of circumstances that happen to us, and they will in some form, whether it just be a patient who we feel like we may have made a decision that caused harm to them or perhaps made an error that did or did not cause harm to them, that how do we navigate that in a healthy way, in a constructive way, and in a way that doesn’t, that perhaps will leave a scar but doesn’t leave a wound, an open wound, which I think sadly often happens and I’ve seen that happen since. So fortunately I was able to do that and As I have shared in the other podcast that you referenced with Randy, I had had a situation previously where I had had a patient who had died during a delivery, an obstetrical delivery, and tragic, very tragic time for me.
[17:06] There was no involvement of the legal or Board of Medicine process then, but there was that journey once again of guilt and of shame and of fear and of vulnerability and of grief.
And fortunately for me during that time, one of the things that I had done finally after a year was sought out help, formal professional help, in this case with a therapist.
So I had already had that experience behind me.
How quickly we forget though in terms of the power of reaching out and asking for help.
So I had to, in some ways, relearn that, and in this case, started reaching out more to colleagues.
[17:44] And as I told my story, I started having colleagues coming to me, sharing their stories, many, of which had never shared their stories before because they’d been told not to.
And so, you know, and often in the cases of litigation, and there were open wounds that were still there.
As you and I had talked about this, it had been many years now that since I’ve processed this and I’m realizing that during that time probably the most important thing that came out of that that lives today was that was really the seeds of the PRX med program which I started three years ago were really planted then in terms of how do we create a structure so that we don’t have to wait till we crash to look around and ask for help.
[18:36] At which time, there may not be anybody who we know and trust enough or who knows us enough, that we feel able to share some of our deepest emotions that are going on around this.
And I was able to start that process. I had an inner circle of people who I was able to start sharing that story with and sharing the journey with, and they were able to start sharing theirs with me, such that.
[19:03] Has become normalized for us in terms of the daily struggles that we deal with in health care.
And we all do. And to be able to have partners, colleagues who we can process those things with, has been freeing in many ways for me.
The connection has been so important.
And the ability to be with others who we can begin to accept.
Acknowledging and Normalizing Our Shortcomings and Mistakes
[19:35] In many ways our shortcomings, in many ways our flaws, and in many ways our mistakes.
Again, we all carry with us, and not to normalize those as it’s okay, but to normalize those as it happens to all of us.
What do we do with it once it happens?
And so even in knowing that you and I were going to be talking about this, lots of both insights from then have come back to me again, in realizing even more so the importance in 2023, as we have gone through COVID, as we have had a lot of very tragic things happen to us, as we know our burnout and distress as a profession is at such a high level, as many people are really rethinking why they do this, what they want to do into the future, do they want to continue this?
The importance even more of being able to process this journey has in many ways, just it has fanned the flame that I already carry with me of the importance of this.
And as you pointed out, the work that I’ve done really for the last two decades around trying to help support our colleagues on this journey.
Rx for Success: Empowering Medical Professionals
[20:54] Hi, I’m Rhonda Crowe, founder and CEO for MD Coaches. Here on Rx for Success, we interview a lot of great medical professionals on how they grew their careers, how they overcame challenges, and how they handle day-to-day work.
I really hope you’re getting a lot of great information, but if you’re looking for an answer to a specific problem, management or administration challenge, or if you’re feeling just a bit burnt out, like maybe you chose the wrong career? Well, then there’s a faster way to get the help you need. No, it’s not counseling, it’s coaching. Rx for Success is produced by MD Coaches, a team of physicians who have been where you are. I know you’re used to going it alone, but you don’t have to. Get the support you need today. Visit Visit us at MyMDCoaches.com to schedule your complimentary consultation.
Again, that’s MyMDCoaches.com because you’re not in this alone.
Introduction to Physician Outlook and its Unique Features
[21:56] We’ll get back to our interview in just a moment, but right now, I want to tell you a little bit about Physician Outlook.
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[22:27] It’s really unique among physician lifestyle magazines. And like the Prescription for Success podcast, Physician Outlook amplifies the voice of any physician who has something to say.
It also engages patients who still believe in physician-led, team-based care.
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That’s a really great deal on this stunning publication. Today’s episode is brought to you by Eagle Financial Group.
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Eagle Financial Group is your partner to ensure that your practice keeps on serving your patients and gives you more time to spend with your family and friends.
It’s time that you overcome your obstacles and get control of your financial life today.
Give Eagle Financial Group a call at 719-755-0043, drop us an email at clientservicesateaglefsg.com or visit us online at eaglefsg.com.
[23:54] We are a proud sponsor of the MD Coaches family of podcasts.
Importance of Response and Reaction to Challenging Situations
[24:01] You know, as you were telling the story of the clinical scenario, I was in my mind, I was thinking listeners are going to listen to this and they’re going to say, they’re going to have all their own opinions about how that was handled and all that. And I want to say here, we’re not going to be talking about the case anymore because that’s not what’s important. What’s important is your.
[24:24] Response and reaction and what you did with what you had to go through with respect to the board.
You very well articulated the emotions, fear, vulnerability, the shame that went with that, and the gut punch and distraught. You know, one of the things that you said is you’re not, you’re an extrovert. And you’re also a resilient fellow who has this experience, I’ve experienced you as experiencing, I just need to lean into this in one way or the other.
And I know that that’s what I need to do to help me get through this.
The reason I’m pointing all that out is you, I know, work with a lot of physicians also, as you just said.
Not everybody has the toolbox to lean in. What I want people to take away from this is, okay, I’ve also been told by my lawyers not to talk about this with anybody.
And I’m not somebody that already has a circle around me of people to turn to, even though the lawyers say not to talk to anybody.
What was helpful for you that allowed you to continue to emerge, allowed you to heal, allowed you to form a scar?
Dale, I think a few things were essential in that process.
One was the ability to accept that.
[25:52] Had and was happening. I didn’t go into denial mode or at least stay there long if I did.
[25:59] Around becoming a victim, which I think was was important because I think if I had taken on a victim mode I would have been stuck there, and I would have been spent my time trying to justify, something that at the end of the day wasn’t going to be able to ever come to a conclusion that would have been satisfying or made me whole again.
And so, the ability to accept that it was happening, and I think to a certain degree to be able to allow myself to experience the many emotions that I had.
Many of them are very classic in terms of what we’ve described as the grieving process.
You know, I mentioned denial earlier, you know, anger was quite real.
And both anger at the situation, anger at the board process, even though, again, I think the board handled themselves in the way that they did. I don’t think I was treated any differently than anybody else.
And anger at myself for the fact that if I began to judge myself and my care, how could you have done this even though, again, as I looked back, yes, I would have done things differently and I don’t think that anything was done wrong.
The other thing that was two things that were helpful for me, one was that while I did not discuss the case with anybody.
[27:19] I did find myself sharing how I was processing the case. I think that nuance is an important one and I’ve worked with a lot of colleagues since that said, I don’t need to know anything about the details of the case because that’s not my role and it doesn’t matter. That’s what lawyers are for, that’s what expert witnesses are for, that’s what others are for. My expertise is going to be to just give you the space to just feel what you’re feeling and create a safe space to just say, yeah, if you’re angry, let’s, talk about that.
You know, if you’re sad, let’s talk about that. If you’re ashamed, let’s talk about that.
If you’re feeling unworthy, let’s talk about that.
You know, if you’re afraid, let’s talk about that.
Creating a Safe Space for Sharing and Processing Experiences
[28:02] And it didn’t have to be me.
It just happened to be that these were colleagues who we had established enough of a relationship with that they trusted me.
I think they respected me, and I was able to just be that sounding board for them, because they almost didn’t want to talk to somebody who hadn’t experienced it because they were afraid they wouldn’t really get it.
[28:25] For example, I could share some of my emotions with my wife back at that time, who happens to be a physician, but she’s not in the same special day I am.
She’s not, she doesn’t do those things. And so, for somebody to say, you know, I’ve not experienced anything exactly like this, I get it, like I get what you’re going through.
Yeah, so what you mentioned was that you yourself didn’t share the details of the case but you shared your process and then later on you’re now this person that you could provide a space for people to do that.
Going back to you at that time, where did you, who did you turn to to talk about the process?
Few colleagues who I was close to, some locally, but some who I’d known from time ago, and just people who along the way we had established a relationship with. In many cases, we had talked about things that we struggled with within healthcare, so we had at some point allowed ourselves to show a little bit of our vulnerability enough that we gained some.
[29:33] Respect for each other. We gained some trust for each other. So these weren’t people who I just kind of pulled as a curbside and said, hey, can I talk to you for a minute? These were folks who I’d already established some kind of relationship with, though not in many of the cases, not to this level. This really took me being able to say, I need your help, and not I need your advice, I need your help. I’m really grappling with how to go about and in some cases I did ask them their opinion, not about the case, but about how do you view me differently.
[30:09] Like, just knowing that my name showed up in the board briefs, like, how does that land for you?
And having some very loving colleagues who said, look, you know, this is something that happened, and there was nothing illegal or immoral about what happened, and none of them felt in the need to judge.
[30:28] And they were able to express that. And so that acceptance, which was different than me just trying to go back to business as usual, because these are times that you’re never going to just go back and say, okay, let’s go back to 2006, Mark Greenwald, and then just kind of pick up where you left off before all this happened.
We know that doesn’t happen. This becomes part of the fabric of your life, and how do you then allow it to change you in a way that is constructive for you and others rather than destructive for you and others?
Because it can go that way, and we know it does.
I know that some colleagues, because they can’t reach out, turn inward and they find themselves abusing substances, or they find themselves starting to lash out within relationships and causing those relationships to become dysfunctional, or they just shut down and don’t talk about it at all, which can also cause problems with all of their circles of relationships.
And because of the lessons I had learned from my previous journey, I wasn’t willing to do that because I did do that the first time for a year.
[31:35] And felt the being alone in the midst of a crowd feeling was still palpable to me today.
How with my patient who had died back in the early 2000s, how alone I felt during that time, even in the midst of putting on my happy face and going about and doing my work was something that has scarred me.
You know, the ability to hide for that long is not something I’m proud of.
[32:02] And it did happen. And I was determined to not let that happen again. Because it was scary.
It was very scary. To be sure, this is what I meant by leaning in. You know, you from that first experience, you said, I don’t want to be scarred from putting on the happy face and moving through and not sharing the story. But to be sure, calling up a colleague and saying, what do you think about me when you see my name? That isn’t an easy thing to do either. I mean, this is not easy to call up these colleagues and yet do it anyway is what I’m hearing you say.
Yeah and in my case and maybe this was a blessing though it didn’t feel like it at the time, I almost had to do that because again after this appeared in the newspaper I had to go to the dean and say you know without taking my head on a platter and saying you know if this is bad for the medical school and you feel it’s better for me to step down from my position you know I’ll do that. Like I don’t, you know, I don’t, I don’t want to become that guy, you know, that, that either harmed the medical school or that everybody’s talking about behind my back. And so you had to say, look, this has happened. How are you feeling about this? This is somebody, the Dean I knew, gotten to know well, had great respect for and she said, we’re standing by you. And that, that was a gift. You know, I don’t think that that always happens. I don’t know. You know.
[33:26] When I hear about people who say they were isolated, I often don’t know if it’s because that was their choice or literally they did reach out and were rejected, when they reached out in that need of help and they were really pushed away, almost repelled in some ways.
But that was the case for me, Dale. So I really felt like, at least in those circumstances, because of my leadership role, I had to do that.
And I was glad that I did. I was glad that I was the one that initiated that conversation rather than waiting for them to talk about the proverbial elephant in the room.
This has happened. Now let’s talk about it. Yeah.
Shifting medical culture to be present for each other
[34:01] You know, I started this by, you know, how do we, how do we shift and change our medical culture to be more present for each other like you are from what you’ve learned?
Before we get to that is what other lessons do you want to impart?
To listeners that you gleaned from this experience? Some I think I’ve already articulated, but summarizing, first of all, it’s much wiser to respond than react.
So the ability to just step back in the moment and take a breath and say, okay, let’s just think through this in terms of even the practical things that needed to happen.
[34:40] Like early on, I need to contact my legal department. We’ve had some colleagues who have had instances like this happen and not, if they’re employed within a system, not contacted a legal department because of the shame, because of the fear in particular, and yet that’s exactly what they need to do because that’s a world, Dale, that certainly for me, even though in my leadership role I’m involved with that, the nuances of that and the details of that are way too big for us to try to navigate alone as physicians.
And so making sure you reach out to those people who know how to travel this journey and know the rules of the journey, which I did not at all.
And I was glad I did because there was part of me that wanted it to go away so fast.
It would be like, just do whatever you need to do. Just I’ll take my punishment and then move on.
And that would have been very, very unwise.
The second thing is really don’t isolate. as tempting as that is, resist that temptation, and be discerning about who one reaches out to and yet do not not do it.
[35:52] And that may for some colleagues who haven’t formed as close bonds, that may be somebody who they just know superficially, but who in that superficial relationship feel that there’s enough there that they could trust them.
They feel like there’s something about that person’s character that they would be able to open up a little bit more with.
So be discerning about who you open up with and don’t not open up.
Don’t try to face challenges alone, reach out for support
[36:15] I think that’s vitally, vitally important.
And the third for me, which came out of that was, don’t try to do this journey alone.
Like just don’t, and so be proactive. Don’t wait until something like this happens, but to be able to say, I describe it often as, who are those 2 a.m. colleagues?
Who are the people in your life who, if you had a tragedy happening at 2 a.m., which again, assuming unless they’re on call, they’re asleep, that you could call them and they wouldn’t say, what the heck are you calling me for?
They would be there. You know that they would say, I’m coming right over, or let’s talk about it, or let’s meet in the morning.
That you foster those relationships now so that when that time comes, there’s not a question in your mind or a temptation to say, yeah, I could call them, but I don’t wanna bother them.
So making sure that each of you have invited each other into your lives to say, you better bother me.
[37:10] Do never, never try to travel this and deal with these things alone.
And that goes, that goes beyond our professional lives. I think that goes into all of our lives to be able to say we will all have tragedies happen to us, whether in our professional or personal lives.
And, and knowing that you have, for lack of a better word, a safety net, a group who you know will be there for you, just like you would be there for them, becomes just so vital.
And by investing on the front end, you don’t have to wonder about that if those things happen to you.
And it provides them, it’s a gift to them as well, because I’m not gonna assume that it’s any easier for them to be vulnerable than it is for me. And so the ability for me to say, look, I’m gonna be there for you, just call.
[37:55] Yeah, so those are, so great summary of great suggestions for people who are in that situation.
And so that’s a nice segue to, what are your suggestions for those of us that want to be there for our colleagues, how do we hold space?
What are some one to three things to pull out of your back pocket to remember when somebody is really hurting and vulnerable in front of us?
Yeah, so for all of our colleagues, I would say looking at whatever situation you’re in in terms of your work status, if you’re in a small group practice, if you’re in part of an employed health system, whatever that is, ask yourself what mechanisms are in place for you and your colleagues right now within that system.
And making sure that everybody knows about that, whether that be something like an employee.
[38:44] Assistance program or whether that be therapists in town who like to see physicians or coaches, but really making sure that everybody knows what resources are available and creating a culture where we talk about those things.
And so making it known, okay, if you have this happen to you, if you receive a letter from an attorney saying we want all your files on this patient or if you get a board of medicine letter requesting information on a patient that you as a group, you as a team know what to do in that situation.
So that you don’t panic, you don’t do things that will come back later to potentially haunt you because you didn’t reach out. So I think something as simple as that, so that’s more on the technical side.
But then also saying as a group, how do we begin to talk about these things?
[39:37] So, as we have challenges with patients, again, it doesn’t have to get to this level.
How do we reach out to each other and not posture, you know, and not create a culture which is the medical culture that I think you and I probably grew up in, which was much more about posturing, was much more about not showing signs of quote weakness, not showing any indecision or any uncertainty in terms of our medical knowledge or our decision making process around patient care.
How do we begin to change that conversation?
That which I believe is a toxic culture in many ways isn’t what is inherited by the next generation of physicians who are being taught by us now.
And that becomes so essential that how do we start to change that conversation so that there’s not kind of that generational passing down of what we carry with us often in terms of our wounds and scars.
And then the third thing, DL, that I think is so essential is really on an individual basis asking ourselves, who are those people for us?
And being able to reach out for them, as I shared earlier, the impetus for a program that I started that really in many ways came out of this, a program called PeerRxMed.
And PeerRxMed is just, it’s kind of my mission to the world in many ways of the premise that no one should care alone.
[41:03] And so, it’s basically just a platform for encouraging colleagues to connect with each other and providing some catalysts to help them with that conversation, with that relationship building.
And there’s no reason that colleagues couldn’t do that on their own and it happens every day.
And one of the reasons that I started PRX is because many of my colleagues said, I intend to do that.
I want to check in regularly with my colleagues and it doesn’t happen.
Happen. And if I had just a nudge to help me remember, oh that’s right, in the busyness of my life and all of the things going on, I’m going to send Dale a text today just to say, hey.
[41:43] Dale, if your week’s anything like mine, it’s been pretty crazy, hope you’re doing okay.
In less than 30 seconds, regular touches like that over time become in many ways the energy that can keep us going, and knowing that we’re not alone, because we’re not, we’re only alone by choice.
But it’s a choice often that we made by default rather than intentionally.
And the investment in that relationship, you’re cultivating the relationship.
If you call me at two in the morning sometime, what are some things I should not do?
First of all, don’t try to problem solve anything, which would be our initial temptation.
Really the ability to just be there and listen. So I should say the first thing you should not do is hang up.
[42:31] Okay, so don’t hang up, which may be the temptation too in the morning, like what the heck are you calling me for?
But once you’ve gotten past that, to really just to be able to listen, to be able to be compassionate in terms of just saying, sounds like this is hard for you.
And to not problem solve, not try to get into the details of what’s going on necessarily.
And then to be able to offer help by asking either what do you need right now or if that person is so distraught that they can’t even think about that to be able to lay out a plan for them. So here’s what’s going to happen.
I’d like to meet you for coffee tomorrow at 7 o’clock or 7.30 and help guide you through this or who’s checking in on them as well in terms of safety depending on what the circumstance is. Who’s with you right now?
You know, who knows that you’re really struggling right now, who can really be watching you and who, can help to be there for you if you’re distraught. So I think all those things are important things to do, but the biggest thing to not do is don’t hang up and don’t try to problem solve it.
Yeah, thank you, Mark. That’s well said. It’s difficult for those of us who spend most of our waking hours, problem solving, to not step into that. And also not to minimize.
The Power of Sharing Our Stories
[43:55] That’s the other one I was thinking of is, oh, that doesn’t sound like much of a case at all.
That’s not what’s going through that person’s mind. It’s not about the case. It’s about, it’s now in this public eye. Or even about to, I appreciate you saying that, Dale, not to minimize the emotion. Right.
You know, it sounds like you might be overreacting to this right now.
Okay, well, 2 a.m. is never the time to say that. But to be able to say, it sounds like this is really has you distraught right now.
And I’d like to hear more about that and talk about that and hear about that.
And a lot of times in telling our story, we’re able to ratchet it down and start to gain perspective because in many cases, what we’ve done is allowed that story to run around in our minds for days or weeks.
And it has taken on a life of its own, and the ability to tell our story and have somebody else serve as a caring listener, and just to be able to reflect back to us can in many ways allow us to gain that perspective that we may have lost.
[44:56] And then I would say, Dale, this is the courageous part, I think, for many of our colleagues, that if you’re really helping someone who you really believe needs professional help, to say that to them, to be able to have the courage say, you know what, this is bigger than you or I. I’d really like to help you get to somebody who I think can serve you better right now. And that’s hard because then we’re risking being rejected.
[45:19] We’re risking having some of that anger be targeted on us in terms of that person reacting.
And yet, if we ultimately care about them, that’s what we will do is to be able to share our truth about where we’re concerned and how we’d like to help.
Yeah. Well, Mark, I feel like we could go all day because there’s a lot to talk about in this space.
And I also want to conclude with that, that courage.
You’ve given us a lot of yourself today by sharing your story.
And I know you because you do this not for your own healing as much as to be of service to others.
And that’s the point of this podcast, is also to be of service to others.
So very much a person, this is not an easy place to be. It’s vulnerable.
And as you said, it brought, I mean, this is a while ago, and it still brought, it brought all that stuff back up.
And that’s also still part of the healing as well. And you’ve given us some great tips about self-management, as well as others’ management for those of us who are supporting one another who are going through these things.
There’s some fantastic tips. So Mark, thank you for your courage.
[46:32] For being willing to be vulnerable, for leaning in, and for, once again, being a guest with us today.
Very much appreciated. So, thank you.
Dale, thank you. I appreciate what you’re doing to begin to highlight and really disseminate a lot of these things to colleagues around the country and around the world.
Really a great service that you’re providing as well. I am most appreciative of Mark Greenewald’s generosity and willingness to reflect on the lessons he learned to impart to others.
I think you’ll agree that it takes a tremendous amount of courage to tell a story that puts one in a vulnerable spotlight.
It’s one thing to do so with a trusted colleague and quite another to put it into the universe as this podcast has done.
It speaks not only to Mark’s investment into his own healing, but also his heartfelt intention to improve our professional culture by being of service to all of us through his story.
There is so much to take away from this conversation, I’m going to try to organize it in three parts, naming emotions, self-management, and others management.
[47:45] So, number one, naming emotions when challenging events occur.
Mark described the feeling he had after receiving a letter from the medical board as a gut punch.
This was followed by a flood of emotions, fear, anger, shame, guilt, feeling alone, and out of control.
We know from emotional intelligence work that pausing, reflecting, and actually naming the emotions we’re experiencing is the first step in self-management.
Unawareness of our emotions, or not naming them, is the first step in self-management.
Can lead to maladaptive responses including mental and physical illness.
[48:25] So at least internally, name what’s going on with you in the moment.
Then, number two, self-management. Once those emotions are named, allow yourself to feel them and choose a response rather than an automatic reaction. In other words, pause and choose the the response. Then reach out and connect with a trusted colleague. It’s not easy to do, but do it anyway. You don’t need to discuss the details of what’s happened.
The conversation is about processing what you’re experiencing. And finally in self-management, don’t isolate. Number three, others management. Find yourself creating a safe space for your colleagues or your group or your or healthcare system to process what’s happening without judgment or advice.
When with them individually, just listen and offer support. Ask them what they need right now.
And if you think they need some professional help, have the willingness to say that and.
[49:30] Offer to help them identify someone to help.
Well, one of the professionals to consider referring them or yourself to is a physician coach. MD Coaches, in addition to other coaching services, we assist our clients through life challenges like those discussed in this podcast.
You can find us at MyMDCoaches.com.
As always, thank you for listening and be well. Thank you for tuning in to Life Changing Moments.
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