So welcome to Our Voices Our Future, the podcast
where we amplify the voices driving change and
equity within medicine and beyond. Brought to
you by the Gender Equity Task Force, a committee
of the American Medical Women's Association.
We're here to challenge norms, break barriers
and ignite conversations that matter. I'm Rhea
Manohar and each episode will bring you candid
discussions with leaders, change makers and advocates
working to create a more inclusive and just world.
No more silence, no more waiting. you're listening
to Our Voices, Our Future. Let's get into it.
Today, we have Dr. Jatoo Sinesi. Dr. Sinesi is
a board certified obstetrician and gynecologist,
current transformational success coach, and passionate
advocate for sustainable living. A native of
Washington, D .C. metro area, she graduated magnum
cum laude from the University of Maryland Baltimore
County with a degree in biological sciences before
obtaining her medical degree and completing her
residency in obstetrics and gynecology at Emory
University School of Medicine in Atlanta, Georgia.
After a successful career in private practice,
Dr. Snesi made the bold decision to retire from
clinical medicine at age 35, embarking on a mission
to help others harmonize high achievement with
personal fulfillment. As a certified success
coach, she focuses on supporting early career
professionals, especially in service -oriented
fields who face overwhelming and burnout. Passionate
about assisting, recovering, pathological altruists.
Dr. Sinesse empowers her clients with the tools,
mindset shifts, and systems necessary to achieve
success aligned with their wellbeing through
personalized coaching, engaging workshops, and
inspiring speaking engagements. Well, thank you
so much for being here today. Thank you so much
for having me. Thank you. So with that, I just
kind of want to get us started. Can you share
your journey into medicine and how you first
became interested in coaching? Absolutely. I
will do my best to be brave. I decided I wanted
to be an OBGYN at 12 years old. And because in
the typical overachiever fashion, I laid out
a plan and I stuck with the plan. So I was fortunate
enough to apply to a STEM high school. go to
us and get admitted into that. I applied for
a STEM scholarship in college and was unfortunate
enough to participate in that. So I got not only
scholarship money, but support in undergrad and
support with getting into medical school. Then
once I got into medical school and got into medical
specific training, interestingly enough, it was
the experience of of it wasn't what I had hoped
it would be. I always did fine. I didn't like
it as much as I thought I would at any given
stage. However, at every stage, everyone says
the next step will be better. When you're in
classes, it was like, oh, when you get on the
wards, it's going to be better. You're going
to enjoy it. And when you're on the wards, like,
oh, well, you want to be an OBGYN. So once you
get away from all the heart disease and rotavirus,
it's going to be great. And the thing is, every
step, it did get better. It just never really
felt good. And even getting through residency,
everyone's like, okay, well, when you're in attending,
you can control your schedule, you have more
autonomy, you have more agency, it's gonna be
better. And again, better. Still was like, this
was not what I envisioned when I was 12 years
old. Loved taking care of patients. Loved, the
reason I decided I wanted to do OB -GYN is because
I liked the intellectual stimulation. of medicine
and of maternal fetal physiology and all those
kinds of things. I liked the connection that
I was able to make with my patients. I was able
to take care of them. Even when I was going through
that kind of taking care of your patient from
like the beginning to delivery, that model was
kind of going away, but you still got to see
most of my patients during prenatal care and
got to deliver some of them. So I enjoyed the
patient care part. It was a lot of the other
stuff. administrative things, and just OB -GYN
is a very physically and mentally challenging
specialty. So it just never was quite what I
had hoped it would be. And so when I finally
finished with all of the testing, which for me
was my oral boards two years out of residency,
I was like, OK, I've done all the things. I've
hit all the benchmarks. I've been blessed to
have followed the path and not really hit obstacles
in the path. Why don't I like this more? And
so that was my first existential crisis. That's
when I actually ended up working with a therapist.
I was like, there must be something wrong with
me because clearly other people have gone this
path and they seem to be doing fine. So what's
wrong with me? You know, the self -flagellating
began. And I ended up taking some time off during
my third year out of residency. It took a randomly
designated 100 -day sabbatical. Why 100 days?
No real reason, just picked it. Took some time
off, came back, made some changes to how I was
practicing, was like, okay, this is gonna make
it work. And again, better, still wasn't quite
what I wanted it to be. And at that time, I thought
I had exhausted all the different options to
make clinical medicine work for me. With the
beauty of 2020 hindsight, I realized I did not,
but. The combination of youth with its naivete
and hubris made me think, I'll go do something
else. So I left clinical medicine without a plan.
Don't recommend that. And so a lot of people
think that I left clinical medicine to become
a coach. No, I left clinical medicine and three
years later hired a coach. And when I was working
with the coach at that time, I was like, oh,
as much as... values I got from working with
my therapist is like a lot of this coaching tools
and mindset would have been helpful to me back
when I was a clinician, even thinking of different
ways to make clinical medicine work for me. And
that's when I was like, oh, I think that that's
what I want to do. I think that I would like
to help others, whether they decide they want
to stay in medicine or leave medicine, but just
be more intentional about how they design their
lives after this long time. all this time and
all this money invested in being a physician.
So that's the circuitous route of how I went
from being a practicing clinician to being a
coach. That was super interesting. I kind of
want to break that down a little bit. For a lot
of people in your situation or even throughout
medicine, I know I've encountered several people
who've kind of had the same kind of self -doubts,
whether it be do I want to still be in medicine
or I planned my entire future around this specific
specialty. And now I realized that once I got
into clinicals that I just don't like it. So
what kind of advice or how would you approach
it for students that are in that experience?
I'll start broad and then I'll come a little
more specific. Broadly, what I've learned from,
you know, there was a learn from your mistakes.
So what I've learned from what I did not the
best in my past is it's good to have a plan.
It is also good to allow for the opportunity
to pivot within that plan. When you're super,
super rigid, you may have heard the term have
a plan and hold it loosely. So allowing for the
pivot can sometimes help you realize, well, maybe
I can do this in a different way. Similarly,
when I left with no plan, I'm like, if you're
going to pivot, the semblance of a plan, have
the beginning of something, even if you're going
to grow from it. And more specifically, let's
say, like I said, I decided I don't want to be
an OBGYN when I was 12. And thankfully, that
actually is the... element of medicine, even
when I was thinking about leaving, people were
like, oh, what do you want to do? I'm not going
to besmirch any other specialty, but people would
say specialty. I was like, absolutely not. So
one of the things that if you think I do want
to do something different, speak to people that
you, if you have access to them, hopefully you
can have access to folks who are in that specialty.
Number one, when you are in training, As much
as your attendings and the people who are training
you want to help you, a lot of times they have
a pretty narrow experience of even practicing.
I trained in an academic center. They know academic
medicine. They know some private practice, but
they don't know the expanse of different ways
that people practice obstetrics and gynecology.
So if you can reach out to different people in
the specialty that you're like, oh, I thought
I liked this. Maybe I don't. Maybe see how different
people are practicing. And similarly, if there
are other specialties that you are considering,
talk to people in academics. Talk to people who
are in private practice. Talk to folks who are
doing locum tenens. If you're internal medicine,
talk to people who are hospitalists. See the
different ways that you can practice the specialty.
I think sometimes we think that there are former
limits in the ways that we can practice than
there actually are. Yeah, I think even as a student
we could run into those challenges so often because
your main exposure to a lot of these things are
specifically in your rotations where you do get
a breadth of what you're learning, but not necessarily
how you could be applying it. So I appreciate
you sharing that with all of us. Now I kind of
want to talk a little bit about pathological
altruism. This is a newer term that a lot of
people might not be familiar with. So could you
first define what that means? Absolutely. So
I do want to say I am definitely a proponent
of altruism, healthy altruism, being of service
to other people and in some ways being selfless
in that service. That is not the problem. Where
I come at it and consider it. When I think it's
become pathological is when that is your default
mechanism. You are constantly, always considering
other people's well -being and values above your
own. When anytime there is an option, it is always
your first thought is to be in sacrifice mode.
That does not serve you long term because that
can't serve you long term. You do. It's not even
saying, think of yourself above other people.
Let's at least just have them all in the same
line. So you're considering all the different
people who are affected by a decision. When someone
asks you to do something, and I consider myself
a recovering pathological altruist, because when
people ask me to do things, the first thing that
goes in my brain is, how can I say yes? Like
my brain defaults to, how do I get to a yes for
someone else? And it's nice to know that. However,
sometimes you have to take a step back and be
like, does a yes to this person make sense for
my core values, my priorities, what's going on
in my life in this situation right now? So that's
where, and people who go into service professions,
we tend to be altruistic and it's really, it's.
quick trip over into pathological altruism because,
especially as physicians, part of our training
is always be available, always put the patient
first. And that is necessary. You do have to
consider your patient. However, there are situations
where, whether it's inside or outside of work,
you do need to know when a no is appropriate
and recognizing that the flip side of every yes
is a no. And I think a lot of times we think
the yes and the no for this situation. Like you
say, give me a ride to the airport. And I say,
OK, well, if I say yes to Rhea, I can take her
to the airport. And if I say no, she has to find
someone else. And that's the only yes and no
dichotomy we often consider. However, I invite
you to also consider, I say yes to Rhea. And
then that means I say no to, let's say, going
to my nephew's play. So you have to consider
all the nos and yeses that are in play when you
are deciding what's the most appropriate yes
and most appropriate no. So with that I kind
of want to talk about how do you recognize this
in yourself or for others specifically like what
are the common signs that physicians or even
physicians in training might be experiencing
pathological altruism? So similar what I was
saying before like literally if your brain always
says How do I say yes? If your first thought
is yes. That's not a bad thing in and of itself
if that's in your brain. However, catching yourself
and taking that moment, whether it's in the moment
to take a breath, to take a thought, or even
just to say, I'll get back to you with that answer,
whether it's later today or tomorrow or let me
check my calendar. But if you always think every
single time I say yes, end it. Especially if
those yeses start having a resentment attached
to them, that's a sign. That's a sign that you're
doing it out of a sense of duty. And some things
you do have to do out of a sense of duty. But
if you feel resentful every time you're saying
yes to something, it could be that there's a
lack of alignment with what's really important
to you and or you don't get to do enough things
that actually aligned with your core values and
priorities. Thank you for sharing all that. With
that I kind of want to dive a little bit deeper
specifically into challenges faced by women physicians
who are facing altruism but even the expectations
placed upon them in the medical field. Obviously,
with the American Medical Women's Association,
we work a lot with women physicians and women
trainees. And we've heard resounding feelings
about unrealistic expectations or overburdening
in some capacity. Absolutely. Yeah. So as I was
saying, just as physicians in general, we tend
to inherent nature in our training tend to put
us down this pathological altruism track, then
when you add on top of that fact that women in
this society are just naturally considered caregivers,
whether they do believe oftentimes is not conscious,
people will ask you, you will be the first person
who's asked to do something extra. They say,
oh, we need to squeeze in another patient. in
the schedule, everyone's double booked, but they're
like, ah, she's most likely to say yes, so they'll
come to you. I need someone to switch a call.
I need someone to take an extra call. You tend
to be the person that gets picked. If you happen
to be a woman who is unpartnered with no children,
you're on the top of the list of women who gets
asked. And so these are the things that tend
to come up for women. And this is, again, where
that knowing when to say no having those boundaries
is really important. And it really it's, it's
not comfortable at first, especially if you're
not used to doing that. And this is just something
we don't have a lot of practice honoring our
own priorities and making decisions that honor
ourselves. And so I really do encourage you to
practice even on low stakes things. So what just
getting the reps in anything that you get good
at all the other things in medicine, you're like,
okay, do another H &P, do this, you get good
at it by practicing it. And because we don't
have practice, we don't have the practical practice.
And then there's just this subtle mindset that
makes you think that that's wrong. So part of
changing that mindset is actually getting those
reps in and starting with low stakes things.
And it could be literally something little. Sometimes
it could just be. I don't actually want to do
a thing. And maybe it's not at work. Maybe it's
at home. Maybe it's outside of work. Somebody
invites you to do a thing. You're like, oh, I
feel like I should go. Oh, that's another sign.
Should. If you are saying should a lot, that
can be a sign that you are falling into pathological
altruism. If you can replace should with I want
to, I need to, that is more aligned with something
that that tends to be more aligned with like
your priorities and your values. If it's, if
should is just should, because somebody else
thinks I should do it, that can sometimes be
a red flag that I'm doing this out of a sense
of duty that doesn't really make sense for me.
Those are some helpful strategies. I do kind
of want to talk a little bit about, we've discussed
strategies that we can internally do. But as
you noted, there are these environmental and
societal expectations, how do we kind of break
out of those moles as institutions or greater
society, almost deprogramming how we place these
burdens on? Oh, 100%. I think that a lot of the
issue is, might sound lame, but the individuals
within the institution, I think that I know people
who are in leadership situations and they're
just like, okay, I understand the importance.
My general feeling is that intentional wellbeing
is the antidote to the pathological altruism.
So if you are intentional and not kind of incidental
about incorporating wellbeing into your life,
if you think, before I do this thing, let's figure
out how... I can have the experience that aligns
with me feeling well. I have the sense of peace.
I have the sense of joy. I feel intellectually
stimulated going into it. A lot of times we get
caught up in something and once we start to feel
poorly, then we're like, well, how do I feel
well on the back end? If you start with the intention
of I'm going to have these benevolent acts of
doing, and I'm also going to have a sense of
well -being. as I have these benevolent acts
of doing, you're much more likely to be well
and avoid that sense of burnout. And I say that
to say, the more people who you have in your
organization, particularly people who are in
leadership, who recognize the importance of intentional
well -being, the more likely those systems and
those institutions are to change because you
have people who support their direct reports,
making decisions that align with their sense
of well -being. And then you also have people
who are modeling that. Because I have friends
who are in leadership who they know, like mentally
they know, but actually practically being like,
oh, this person needs to take time off for the
death of a family member. It's like they know
they'd only make sense for this person to take
time off, but then they're just like, I have
to change the schedule and all these things.
And the more again, the more reps you get in
and the more you realize you actually can't allow
people to honor their sense of wellbeing and
keep the system, keep the practice and keep things
running in the way that they need to. And sometimes
you might have to reschedule a patient. You don't
love to do that. Sometimes that may actually
have to happen. So that's kind of on a institutional
level. And then again, the individuals within
an organization. I really think on the personal
side, many times we underutilize the resource
of our schedule and our calendar. Part of it
I do think is because at work, sometimes we can
feel so over scheduled and like somebody else
has control of our schedule. And so every second
of our day is monopolized by something that we
feel reluctant to put something on our personal
calendar because it feels too rigid. Again, I
invite you to practice. Just test it out. Even
if you're just setting aside, this is my decompression
time. This is my reflection time. Just putting
those things in your calendar, it also will make
you. So when somebody asks you to do something,
you're like, let me check my calendar and you
say, oh, I had said that I'm just going to sit
down and watch Netflix for an hour. You put it
on your calendar because, again, that is aligned
with your sense of well -being. And you can decide
to do whatever for the other person at that time.
However, you see that you have been intentional
about setting aside that time to take care of
yourself. So just doing those kind of things.
And really, a lot of it just starts with reflection,
which, again, we don't do a lot of in health
care and as health care professionals, reflecting
on What does well -being actually, how does it
feel for me? It's very interesting. I will do
workshops with rooms full of physicians and ask
them like, what qualities do you associate with
a sense of well -being? People cannot think of
anything. If I say, what are the, what words
do you associate with like having a bad day?
Oh, just all sorts of things. I'm frustrated.
I'm this and that we have a very broad lexicon
for negativity. And we tend to not spend a lot
of time thinking about what do I associate with
feeling well? Oh, I'm joyful. Oh, I'm curious.
Oh, I'm excited because we're just on the grind.
And so just even taking time to reflect what
does feeling good for me feel like for me? And
then taking the next step, what actually elicits
those positive feelings in me? And a lot of times
it's much less grandiose than you think. It doesn't
take a trip to Dubai. Sometimes it just takes
a walk around the neighborhood and you actually
can get that little dopamine hit that'll get
you a little bit further in your day. I love
these little and practical strategies that you've
shared with us thus far. And I think we've kind
of danced around this topic a little bit. But
obviously a lot of the strategies that you've
provided for us are to help avoid burnout. But
if we implemented these on a larger scale, how
do you think this would affect burnout specifically
for women physicians who are thinking about leaving
the practice altogether due to these expectations?
I will. So I've talked about small things you
can do. I will say for some people, those small
kind of low key strategies can be helpful. I
will say if you are kind of deep in the depths
of burnout, sometimes taking Some time off actually
is somewhat necessary. I'm not saying put it
all together. But I will say, again, from my
own personal experience, I will say when I took
my sabbatical and came back to work, one element
that I think hindered that change from being
as successful as it could have been is I decided
I made the plan for the change at the beginning
of my break. So I was still in the depths of
burnout when I was just figuring out, when I
was deciding what changes needed to happen to
make it better. So it was better, but it still
wasn't ideal. I think that sometimes truly your
nervous system needs some time to recover. Some
folks depending on on the reality of your life,
your financial situation, your job situation,
your FMLA. If you can take some time off just
to kind of reset and reassess. I mean, I'll do
a little bit of a plug. Sometimes working with
a coach can be helpful to help you be really
clear and identify what do I actually want my
life to look like inside and outside of work?
And what are the strategies that I think will
help me get to that vision and to that goal.
So if the things that you were doing, the smaller
things you're doing aren't working for you, sometimes
you maybe do need to take a step back so that
you can figure out what works for you. If you
aren't to that point yet, again, the knowledge
that I borrowed this from a coach friend of mine,
a strategy that she shares with folks is come
up with a list of seven activities that you know
bring you joy. Things you can do on a daily basis.
Ideally, small things. So you have this list
of seven. And then at the start of your day,
identify three things that you're going to do
that day. So you know that you have the power
to bring joy to your life. And you know that
there are at least three different moments in
the day where you're going to bring yourself
a sense of joy. So that's one thing. I'm also
a fan of affirmations, because that's, again,
just starting your day in a positive mindset,
thinking of the things. And again, your brain
automatically goes negative. So if you can put
your brain on a positive thought process at the
beginning of the day, and again, the reflection
and the paying attention and seeing what are
the things that you can do every single day,
that help you maintain a baseline sense of wellbeing.
I have a system that I call the five essential
strengths for success with satisfaction. And
the number five step is sustain personal policies
for self -care. So what are the things that you
do? And not, you know, people think many petty
spa, that's lovely for self -care, but what are
the just baseline fundamental things you do?
I generally say, eat nutritiously. Drink enough
water. Get enough sleep. Move your body. Those
four things alone, like most of us don't do even
three of the four regularly. So you can do four
of those. And then outsource. This is especially
for women physicians. Outsource as much as makes
sense and is possible. If you don't really want
to do it and you can get someone else to do it
for free or for money that you can pay, for the
love of God, outsource. And particularly for
if you were people think that if you were don't
have kids and don't have a partner, it doesn't
make sense for you to hire someone to clean your
house. If you don't want to clean your house
and you want your house to be clean and you can
afford it, hire someone to clean your house.
I'm a big believer in outsourcing whatever is
possible. It's life changing. So with that, you've
shared so many interesting strategies with us
at really all levels of the medical career. So
do you have any final advice or thoughts to give
to our listeners who are maybe struggling with
satisfaction and balance? My basic fundamental
recommendation is reflect more and do less. So,
reflect on what's working for you, what's not
working for you, and do less. Sometimes that
involves outsourcing, sometimes that involves
resigning from a thing. Going back to the things
that women physicians get pulled into often and
be like, don't you want to be on this committee?
Which it looks like it's a good idea. but it's
maybe something that isn't particularly influential
in terms of policy change or they don't resource
you that much. And you might just be like, I
remember having a client once who was on like
17 committees. This was somebody who was in education
and not in a position. And I was like, maybe
we can get done at like 11. So maybe some of
those you don't need to be on. So reflect more
and do less. Well, thank you so much for sharing
with us and spending time with us. That's a wrap
on this episode of Our View of Voices, Our Future.
We hope today's conversation inspired you, challenged
you, and reminded you of the power of raising
your voice. The fight for equity doesn't stop
here. Join us in the movement. Subscribe wherever
you get your podcasts. And if you loved this
episode, share it with someone who needs to hear
it. Until next time, stay bold, stay vocal and
keep the conversation going. This is our voices,
our future.