Welcome to the Clinician Researcher podcast, where academic clinicians learn the skills
to build their own research program, whether or not they have a mentor.
As clinicians, we spend a decade or more as trainees learning to take care of patients.
When we finally start our careers, we want to build research programs, but then we find
that our years of clinical training did not adequately prepare us to lead our research
program.
Through no fault of our own, we struggle to find mentors, and when we can't, we quit.
However, clinicians hold the keys to the greatest research breakthroughs.
For this reason, the Clinician Researcher podcast exists to give academic clinicians
the tools to build their own research program, whether or not they have a mentor.
Now introducing your host, Toyosi Onwuemene.
Welcome to the Clinician Researcher podcast.
I'm your host, Toyosi Onwuemene, and it is such a pleasure to be here talking with you
today because I have a special guest, an absolutely super awesome physician coach who specializes
in how people-pleasing perfectionism, lack of boundaries intersects with burnout.
It is none other than Dr. Megan Melo.
Megan, welcome to the show.
Thank you so much for having me.
I'm really pleased to be here and chat with you because that's always a good time for
us.
Absolutely.
Okay.
So, Megan, clearly you're a physician and you're a coach.
Tell me about that journey.
Yeah.
How much time do we have?
So I'm a family and obesity medicine physician in Seattle, Washington, and was in practice
for about 10 years before I started really sort of jumping into sort of more coaching
frameworks.
Initially, I became certified in Brene Brown's work through the Certified Daring Way program,
being able to facilitate some of her programs, and then also added on a life coaching certification
when I was trying to do more work with my patients struggling with obesity.
So I wanted to add coaching tools and be able to blend sort of both coaching and medical
care.
But what that led me to was becoming familiar with the literature on coaching and physician
burnout.
We had statistically significant benefits to using coaching tools to help relieve physician
burnout.
I had been involved in physician wellness for a long time without having a lot of tools
or skills.
It's just something that I was passionate about.
But being able to get trained as a coach and use these tools now with physicians has just
made a tremendous difference for my life and the people that I serve.
It's about relieving the stress.
That same thing applies to my obesity medicine patients, right?
We're relieving distress and bias and all the things that people struggle with.
So it's really been quite a gift to the work that I already do.
That is really beautiful.
And your work is a gift to my audience.
And so I have clinicians who are trying to make this transition to becoming researchers
and a lot of people pleasing, a lot of perfectionism, and definitely a struggle with boundaries.
And so I feel like you're the perfect person to come on the show.
Let's start with people pleasing.
How do you help us with people pleasing?
I feel like it's just in our DNA.
What are we going to do about it?
How can we win?
Yeah.
And it really kind of is in our DNA because for so many of us who have been on the path
to becoming physicians, clinicians, we have been high achievers for a very long time.
And the road to high achieving is filled with external validation.
We have been seeking prizes.
We have been trying to be the tops in our class.
We have been trying to be amenable and polite.
And if you think about medical school and the rotations that we go through, yes, you
needed to know medical information, right?
You needed to be able to do sort of medical skills and do that.
But you also had to be the good one, the nice one, the smart one.
And you had to restart that every four to six weeks, depending on how long your rotation
was, right?
And so, we've always got very good at being able to show up and be polite and pleasant
and do whatever was necessary of us, right?
We've built that habit over many, many years.
And when we transition into our attending roles or if we're trying to do anything else
professionally, no one tells us that we could turn that off.
No one tells us that we no longer have to go seeking the gold stars.
We still want to do high quality work, but the higher achiever we are, right, the higher
we are on the ladder, the less of the little stuff that we have bandwidth for, right?
We need to be much more focused.
And so, when I'm working with someone, it's really about recognizing the discomfort that
happens when you consider saying no, right?
When you consider setting boundaries, when you are trying to advocate for what you need
and want and getting all this pushback, because that's very real.
So how do we turn it off?
Because when you start to talk about not being that person anymore, are you saying we should
no longer be team players?
That is often the language that is used against us and often the language that keeps us stuck.
So me saying to someone in a kind of polite way, I'm not going to be able to help you
with that, or being able to say, well, you know, if I'm going to take on that project,
then what is coming off my plate, right?
Being able to sort of negotiate and advocate for yourself, making it clear that you're
not trying to be mean or rude, but there's only so much bandwidth we have, right?
We have to wrestle, though, with our own discomfort of saying no, because we have been trained,
right?
Being a team player means you always say yes, but you're not going to be effective in any
place that you are, really, if you're always saying yes, right?
Even if you are working at, I don't know, a clothing store, right?
If you're always saying yes and always being interrupted, you're never going to complete
any projects, right?
We have to be somewhat focused.
And in order to do that, we have to, you know, kind of tolerate that discomfort of saying
no.
We have to sit with it.
We have to practice it.
It's as silly as that sounds.
Yeah, I'm, as you're speaking, already feeling uncomfortable sitting with that discomfort.
So tell me, how do you help physicians to sit with the discomfort?
I mean, okay, so from my audience, your mentor tells you to do something.
You're depending on your mentor to be, you know, to sign your letters of recommendation,
to support you in your projects.
And when you say, hey, sit with the discomfort of saying no, I'm thinking my career is about
to be over.
I'm about to say no to my mentor.
So help me talk to my audience about how do they handle this with mentors who have actual
hierarchy over them in this journey?
Yeah.
How do we feel now when we're being asked to do too much?
Frustration, resentment, overwhelm.
How am I ever going to get this done?
Right?
We have a lot of negative emotions and they aren't pleasant to feel, right?
Obviously we don't like feeling them, but they are familiar.
They're sort of comfortable in their own way, right?
This is just the way it is, right?
Everybody has to go through this.
You know, this is the cost of having this career, right?
We have all these ideas that we just have to suck it up and deal with it.
If we want to move forward though, we're going to need to tolerate the discomfort of a different
feeling, the discomfort of saying no, the discomfort of being able to advocate for yourself,
you know, in order to be successful with the other thing.
So in the instance of a mentor or a boss of some kind coming to you and wanting you to
take on a project, if you know that you're already too busy, you probably already have
too many things on your plate, you might need to ask for their help to decide which is the
most important.
Because sometimes they are simply looking for another human to take over whatever that
task is that they probably don't want to do, right?
Because they're probably also overburdened with things to do.
But that doesn't mean that it's a good fit for you.
It doesn't mean that it's in alignment with your interests.
We're going to have to say no to things.
And again, you know, kind of the higher on the ladder we climb, the more skills and expertise
that we have, the more opportunities we get offered.
But again, to do good work, there's only 24 hours in a day.
We're going to have to be focused on what's important to us, what helps us move forward.
You know, where can we use our gifts and talents, but do that in a bounded way.
I love it.
I love two things that came out of what you said.
One is that, wow, this is a skill.
And that means you can practice it, you can develop it and get strong in it.
And that is real.
It's like you may not be good at it now, but you're going to practice and get better.
The second thing is I love the way you talk about sharing with your mentor.
Oh, great.
This is a great opportunity.
And what of these other things on my plate do you recommend I take to take on this work?
Which is awesome, because what you're doing is putting yourself on the same side of the
table and saying, I know you care about me and I know you want me to succeed.
And how can we move forward together?
And so I think it's a really great way to do it without being confrontational or feeling
like you're being mean or being rude in some way.
And when we're feeling overwhelmed and taxed and burned out, we often fall into black and
white thinking.
So we think either I say yes and just go along with it, or I slam my hands down on the table
and say, hell no, and I leave.
There is in between.
There is a lot of middle ground there.
And practicing and learning the skills of being able to say sort of no, but or yes and
I'm going to need some help in deciding which of these things are priorities.
Using those tools really helps us to be able to keep it collaborative.
Yeah, to sit on the same side of the table, as you say.
I love it.
Okay.
You also touched on boundaries.
I think this is a good segue into boundaries.
Okay.
Tell me about boundaries and should clinicians who are trying to succeed as researchers have
any boundaries?
I mean, maybe when they get to the top, they can have boundaries, but why are boundaries
important and how?
How do we enforce them?
Yeah.
And enforcing them tends to be kind of the biggest challenge, right?
Because it's much easier to say, oh, I need help.
I need to say no.
But when you get that pushback, right?
When you're sitting in that discomfort, when you feel it in a sort of coming on, being
able to hold true to yourself, right?
In that moment, you know, it doesn't all happen at once.
When I think about boundaries, I really love Brene Brown's sort of guidance on that.
She talks about living big, boundaries, integrity, and generosity.
What boundaries do I need to have in place for me to stay within my integrity, making
the most generous assumptions of other people?
So if we think about that in the clinician research or space, right, the integrity piece
is about producing high quality scientific progress, you know, clinical research.
The generosity is assuming that everybody is doing the best that they can and trying
to say with what I've got, with where I am, what am I able to accomplish and what do I
need to say no to, right?
If I've got some kind of a big project that I'm working on, then I'm probably not going
to be able to, you know, take on other little tasks, especially ones that don't require
my expertise.
Maybe when I'm not working on a big project, I would pitch in, but, you know, during that
time, I'm just going to have to say no, right?
And that might be, that might be social engagements, right?
That might be, yeah, I don't bring cupcakes to the birthday party, you know, or I don't
bake, you know, my own, you know, something like, you know, it can be that life stuff
too, that I let myself off the hook with thinking I have to do things in the same way that I
always do them in order to, you know, kind of complete this project the way that I want
to.
Wow, you make it sound so easy.
I don't think it's easy.
Let me, let me, let me just say that I don't think it's easy.
I don't think that I think that's, you know, why a lot of us run into trouble, right?
We might try to set a boundary somewhere.
We might say no to somebody.
And we might feel really good for a moment, right?
After we sort of wrestled with the discoverer, that somebody is going to come and ping again
against that boundary, right?
It's not just going to happen one time.
It's that maintenance, right?
That ability to hold your own values, to know what's important for you and to be able to
kind of keep that, keep that fence around and say, no, I'm protecting my time or my
energy in this way.
And because of that, I'm going to need to say no, or I'm going to need to, you know,
kind of ask for more help.
You know, it can look a lot of different ways.
And it speaks to what you said earlier about black and white thinking, especially when
you are burned out.
And the reality is that there are many ways to present your boundaries and to enforce
them without feeling like you're fighting all the time.
Yeah.
All right.
Well, let's talk about perfectionism.
Okay.
So, sometimes members of my audience will say, well, perfectionism is necessary.
If you're trying to submit a grant, it better be perfect.
I mean, honestly, you've got to be really good.
And so how do you let go of perfectionism when you absolutely need it?
Yeah.
I mean, I don't know.
What do you say?
That's another, that's another big topic.
And again, I sort of lean into Brittany Brown's work on this is that there's a difference
between perfectionism and excellence or healthy striving, right?
Of course we want to provide, you know, high quality work, right?
We want to produce things that matter and, you know, are well done.
But perfectionism is really about a fear of shame, right?
A fear of failure.
So if, if I'm in this mindset where, you know, I can't have a typo or, you know, can't be
wrong about something, I'm going to struggle to put anything out into the world, right?
I'm going to be stopped because it's never going to seem good enough because I'm always
going to be worried that someone's going to find a flaw, right?
We know that, you know, kind of in the medical literature and research world, right, that
we will find answers in some studies and then other studies are going to come along and
they're going to debunk whatever we've seen, right?
We know that, right?
We know that, you know, half of what we learned in medical school is obsolete within five,
you know, five years or something like that, right?
We know that things are always changing and that includes the work that we're, you know,
doing all the time.
We want to produce high quality work and we want to get it out there.
And so we're going to have to let go of this idea that if I don't have it all perfectly
perfect, maybe I'll just add on this little extra piece.
Maybe I'll just revise it again or maybe I'll just do this.
We're never going to get it out there.
Okay, but the struggle is real.
The struggle is real with when you go present your work at a conference and people kind
of are not very nice sometimes.
They tear it down.
And so when you go to publish the manuscript, you are afraid to put it out into the world
because sometimes the criticism is harsh.
How do you deal with that?
Yeah.
And I think that's true elsewhere in medicine, right?
I don't have a perfect answer for that because I don't control, you know, what people will
say.
But even if I produce something that's high quality that, you know, I absolutely stand
behind, somebody may come along and tear it down, right?
That's also true.
I might provide great care to my patient and they're upset about something, right?
And they think it was a terrible visit.
I don't control what other people think.
So what I need to do is to stand behind my own work to know that, you know, I control
how I think about it, that I'm a fallible human, but I work hard and I produce high
quality work.
And I'm going to need to push forward with that, knowing that none of us is infallible.
None of us actually is perfect.
And the people who are being so harsh and so mean have probably been treated that way
themselves and probably would love for it to be different.
But until we start practicing doing things differently, right, if we bring a different
tack to academic medicine, right, to clinical research, until we do that, until we push
for that, the culture won't change, right?
I'm sure that you don't want to be that person who's sitting there tearing down somebody
else's work.
You may need to give them feedback.
You might want to point out if there's a problem, but we don't need to attack the person in
order to do that.
We can be kind, we can be clear, we can be direct and create a different environment.
Yeah, the environment we wish to see.
Yeah.
You know, one of the things that I feel like you allude to is the need for radical self-compassion,
which I think is a prelude to being able to have compassion on others.
And some of that tearing down that we see is people who are struggling with their self-compassion.
And so of course, how can they treat others with gentleness?
Can you speak a little bit to how can our clinicians and our scientists develop more
self-compassion?
Yeah.
And I think often it's very easy for us to have compassion for others, right?
We love our friends, our family, our pets, you know, perhaps our colleagues.
You know, we have a lot of compassion for what other people are going through.
If your friend called you and they told you they were just diagnosed with cancer or they
were really behind on a major project or had a bad outcome, we wouldn't sit there and shame
and blame them, right?
We wouldn't do that.
And yet we might do it to ourselves quite by default, right?
We might, you know, say I missed a deadline, right?
Or made a mistake or had a bad patient outcome.
And I sit there in the energy of I'm a terrible person.
I'm a terrible doctor.
I shouldn't be doing this even though I keep doing it probably, right?
Because now I feel obligated to make up for it.
That doesn't help any of us.
It doesn't help me.
It doesn't help our patients, right?
It's a terrible place to live.
And you would never do that to your friend or your child or even your pet.
So when we're thinking about self-compassion, you know, when we hear those voices in our
head, when we have that energy going on, you know, taking a pause and saying, would I ever
say that out loud to another human?
No, I am a human.
I am, you know, I do make mistakes because we all do.
You know, it's normal for me to feel this way.
It's normal for me to feel bad about something if something bad has happened.
And I can be here with myself.
I can be here with my feelings, right?
So much of the, you know, kind of the major problems with medical culture is we've been
taught that push our feelings down.
Pretend we don't have them, you know, to be just these wonderful, caring, compassionate
human beings who don't have feelings of our own, right?
But so many of us were sitting on top of like years and years of frustration and resentment
and we're just kind of squashing it down.
That is not benign.
And that includes when we think about sort of our compassion for ourselves.
We need to be able to believe that we are valuable human beings, that, you know, that
we will make mistakes, that we can have our own back, even if we're in kind of toxic cultures.
Wow.
Thank you.
Thank you for sharing that.
And I think that's just a perfect segue into my next question, which is that, well, what
you're describing is countercultural, right?
If this is not the prevailing culture of medicine, even though we're compassionate physicians
with our patients, we're not compassionate with ourselves, and to a great extent, not
with each other.
And so for a faculty member who wants to practice radical self-compassion, who wants to start
to change the culture by changing themselves, how can they connect with you?
How can they connect to do this work?
Yeah.
Thank you so much for asking.
I currently work one-on-one and in groups with physicians, and we do this kind of work
exactly.
So we are looking at our situations and trying to untangle and unpack all the layers of things.
People can find me at my website, which is www.healthierforgood.com.
And I am a fellow podcaster, and my podcast is all about these topics.
So that is Ending Physician Overwhelm.
And so for anybody who's out there listening to us on their favorite podcast player, they
can certainly find my podcast there as well.
Awesome.
Okay.
And I will put that information in the show notes as well.
Megan, it's been a pleasure to talk with you, and you shared so many incredible insights
and I know I can be helpful to so many.
I wonder if you have any closing comments, anything that we haven't talked about that
is important for you to mention?
Yeah.
I think I'd just like to circle back to that counterculture because that really comes up
a lot.
And I think that, you know, I especially see that in the women physicians that I coach
who are working so hard to often fit into these sort of patriarchal, hierarchical systems.
And there's an extra layer there, right, of trying to be countercultural when you are
already others.
Finding safe spaces for you to feel cared for and nurtured, whether that's in a coaching,
a therapy, a group, your family, your friends, right, having safe spaces where you can feel
really nurtured and taken care of is really important.
That isn't weakness.
We as humans need compassion and connection for ourselves.
And so even if the dominant culture where you are is not supportive and not, you know,
kind of conducive to that, please find your space, find your safe space, get the help
that you need.
We all deserve that.
That is beautiful.
And thank you.
I feel like that's a perfect way to end today's show.
Everyone you heard Dr. Megan Mello.
Wow, it is countercultural.
And especially if you are underrepresented in the academy in any way, it becomes even
more challenging.
Definitely seek help, seek community that will support you and reach out to Dr. Mello
if you are struggling with perfectionism, burnout and people pleasing, which I think
is most of us.
So definitely check her out.
Megan, thanks again for being on the show.
Thank you so much for having me.
It's been a pleasure.
All right, everyone, we'll see you again on the next episode of the clinician researcher
podcast.
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