Jessica: There has to be something that we can do differently. We need to figure out what that is. We need to figure out how to, to change the way we function within the work and how the system needs to change.
Chrissie: I love when authenticity arrives 'cause I feel settled in my body when I know that somebody is truly inhabiting theirs and not just giving facade and like the ghost version of themselves, the part that can do the job, but not really offer self.
Jessica: to me that, that is the embodiment of how I would view joy is having that alignment of who I am and being able to express it in the outside world without fear or concern.
Chrissie: You're listening to Solving for Joy. I'm your host, Dr. Chrissie Ott.
Hello friends, and welcome to this week's episode of the solving for joy podcast. I am thrilled to introduce my guest today. Dr. Jessica Ching. Dr. Ching is a powerhouse in the world of plastic and craniofacial surgery. She's not only a highly skilled surgeon, but also a very compassionate leader, dedicated educator, and advocate for authenticity in medicine. Her incredible journey includes being a summa cum laude graduate from Baylor University, uh, AOA in med school, UTMB, and advanced training in both plastic and craniofacial surgery. She is currently shaping the future of care at Baylor College of Medicine and Texas Children's Hospital, my alma mater. But her impact does not stop there. She has held leadership roles and delivered keynote speeches around the world and earned a reputation as a teacher who truly inspires her students. She's passionate about transforming how we think about wellbeing, music to my ears, as well as patient care, bringing authenticity and heart into every room she steps into. I cannot wait for you to hear her wisdom and hear about her research today. Let's dive in. Welcome Jessica. Thanks for being here.
Jessica: Oh, thank you so much for having me.
Chrissie: My pleasure. We met, uh, about six weeks ago at the international conference on physician health in Halifax, Nova Scotia. And it was exciting for me to walk into a room and find somebody with a Baylor College of Medicine email address. And I just couldn't wait to get to know more about you. And, um, you were presenting in that conference on your published research on authenticity, and I would love for you to have the opportunity to share with our audience a little bit about what brought you into this space and what you found when you and your collaborators looked into authenticity as a measurable variable in trainees and faculty.
Jessica: So, um, you know, going through my education and training I was exposed to a lot of, um, mental health struggles around me and personally. And I remember not having the words to articulate it and the people around me also not being able to articulate how they were feeling or what they needed. I remember feeling really helpless, like watching people suffer and being able to do nothing, which is so counterintuitive when you think about why you want to be a doctor, right? Yeah.
Chrissie: Yeah, we're trained to run towards the suffering, right? And have something to offer to it.
Jessica: Exactly, and so having nothing to offer because it wasn't even something people talked about or was okay to talk about. Um, and then when I became a faculty, I had worked at, um, for a couple of years and one of the anesthesiologists that I had grown to work with and as a close work colleague. She, um, committed suicide, um, and I just work with her the day before. And, uh, you know, there weren't any signs. There wasn't anything that she specifically said that, uh, I would have known was any different from anything else. Um, any other time I worked with her, but I remember feeling, you know, heartbroken over it, thinking like she was hurting that much and nobody knew anything and she didn't say anything. And, you know, you watch everything, you know, the candlelight vigils, the scholarship foundation, you know funding and the you know, all of the grieving. And, memorializing of her and then within two weeks, everything kind of stopped. Um, and everything went back to how it was before. Nothing ultimately changed. And I think that was when I, that was what struck me more than even the grieving process was just thinking like, are we really going to go back to how it was? Somebody died. Like somebody was suffering so much in the middle of all this. That they committed suicide and we're not going to change anything. We're just going to pretend that we're just going to pretend it didn't happen. And that's what it felt like. It felt like people were kind of just going back to what they knew and what they'd always done.
Chrissie: What year was that? Jessica, were you in the midst of the pandemic then or?
Jessica: It was right in the beginning of it. It was April of 2020. So, um, so we were, you know, there was a lot of isolation going on because we weren't fully up and running. We were in that kind of shut down or, um, time. And so, there wasn't a lot of social, um, outreach or anything like that, like not, not like normal, So, you know, that's what I really, I started thinking. I was like, there has to be something that we can do differently. We need to figure out what that is. We need to figure out how to, to change the way we function within the work and how the system needs to change. And so I did a deep dive for a long time, looking into that. And I, um, one of the tools I used to try to sort through what was important was a qualitative, survey or tool I made on, and I put it online. It's called the Authentic Doctor Survey.
Chrissie: The Authentic Doctor Survey. Okay, where can people find it?
Jessica: Uh, authentic doctor survey.com.
Chrissie: Authenticdoctorsurvey. com. like, two things are coming up before, before we head into the survey information. One is how important it is to highlight that we don't have a behavioral or communication template to share our darkest feelings. We have behavioral and communication templates, especially in our workspace to share very surface feelings. Uh, I heard, on a, Podcast where Dr. Jessi Gold was being interviewed recently. The, um, the abbreviation, fine feelings I'm not expressing. Right. So you may have even asked that colleague that day, Hey, how are you doing? And she may have said fine. Right? But the truth is underneath there was deep suffering and we don't have a quick way to say, Hey, I'm really suffering. I'm here. Right? Um, I've shared on previous, um, you know, communications about this red light, yellow light, green light thing that I used to give to adolescents and their families when I would admit them for suicidal ideation to the hospital as a hospitalist, because we don't have the words, right? So if everybody just knew yellow light means I'm not exactly great and red light means I'm actively ideating, it would be really helpful to spread that language. And I am so, um, struck by your intrinsic motivation and instinct of something has to change. How can I help? How can I be of service to this? So thank you for hearing that call and responding to it with your own creative wisdom and creating a survey, a qualitative study that can't wait to hear more about it.
Jessica: yeah, I think, you know, you bring up some really good points about just not having words and, and when I made this qualitative tool, that's exactly what I was trying to do was capture the words. I realized and, um, was advised that storytelling would be, would be really powerful and trying to generate, you know, information and give like a reality check to people, especially that weren't in medicine about what was going on. And so I, that survey tool is designed, you know, has three questions and they're free text response. And it's, uh, you know, it's basically allowing people to say what authenticity means to them how they struggle and what we could do to help and you know some people didn't answer very much. Um, I send it out pretty broadly I did a couple of different like social media postings about in different groups and send it out across my institution and you know after about 350 responses. I started looking at it to look at, um, the do qualitative thematic analysis from it.
Chrissie: I'm sorry to interrupt you, but I just want to like, that is staggering that you got 350 responses to a free text survey that people were not compelled to reply to. Um, again, timeline. This sounds like it might've been in the heart of our pandemic.
Jessica: It was like when we were coming out of it, it took me a while to formulate this and get it running. So it was like 22, um, like during 22.
Chrissie: I just, I, I'm, so struck by that. response number. So very, very helpful. And then you began to look at it and what did you find?
Jessica: There were so many people that were really afraid to be themselves because they felt like that there was going to be repercussions. They would be ostracized. They wouldn't be liked by their boss. Um, and one of the other questions was, Your gender, how old you were, and then what level of training you were. So, if you were a student, resident, fellow, or faculty, and then how senior or junior were in your faculty, so I could kind of see on the spectrum where the, uh, respondent was. And, um, when they were either in residency or, or early faculty career, they really struggled. Uh, there were a lot of, uh, verbalization about struggling, being themselves, or ways they'd felt judged when they had been themselves. And then, you know, when they were more senior, um, faculty, the ones that were applied, they kind of had more of a mentality like, I'm fine. This is how it is. I'm okay. I made it. Um, And then the, the students and the like intern, I would say, younger, they were really in a search for identity. And when asked about authenticity, they would often describe the dichotomy they saw before them, where they were either going to choose to be themselves or choose to be a doctor. and be professional. And so you could almost see like through these respondents and where they were the journey that probably each one of us felt, um, where we really felt like we couldn't be ourselves and we're going to make a decision to be the profession or to be ourselves. And then, um, the struggle with that early on. And then, you know, the more senior people just coming to terms with that's how it is.
Chrissie: That's so profound. I mean, it's really like when you're looking at that dichotomy and I will, I will say I think that we should maybe think of it as a false dichotomy, but a really compelling false dichotomy where you're basically legitimately opting for either a split from yourself or a split from the secret society you've been privileged to be inducted into.
Jessica: Right, and I agree with you. It's not a it's not a dichotomy. I would want to propagate or to like to proclaim is true, but so on the authentic doctor survey it was anonymous, um, it's up and accruing but you know, I analyzed 300 and a little over 350 responses with qualitative thematic analysis. And it basically, you know, it really showed that, um, students and, early trainees feel like they're faced with a dichotomy, whether or not it's real, um, they feel pressured to either choose between being themselves or being a doctor or part of the profession that they want to be, um, privileged to enter, especially if they're a student applying to residency, you could really see the pressure and the struggle. And then when you're in the residency, um, group and in the early faculty group, they felt that struggle, they had made the choice to enter a profession and felt like they had kind of needed to put their authenticity aside in order to not be judged, in order to be accepted as part of the group. Um, and there was a distinct overtone of feeling like that the group didn't want to know who they really were anyways. And, it wasn't invited for them to be that way.
Chrissie: It's so profound that the profession tends to give this subliminal message that who you are is actually not welcome here. Right. And, and even if we don't mean to, that is such a common experience in trainees and early career physicians. Um. I feel quite relieved when someone shows up in their professional role as a physician with their entire self intact that they bring their qua, their spice into the room, their humor. Mm-Hmm. or you know, their nerdiness or their self-awareness or you know, to some extent some healthy self deprecation. Right. I love when authenticity arrives 'cause I feel settled in my body when I know that somebody is truly inhabiting theirs and not just giving facade and like the ghost version of themselves, the part that can do the job, but not really offer self. It's, it's a very deep thing, I think, to contemplate when we evacuate ourselves in order to perform a task, even a task as important as Practicing medicine and performing surgery.
Jessica: One of the words that they used to describe kind of the feeling that you're talking about or to go hand in hand with it is professionalism. There was a lot of, in the responses, professionalism came up quite a bit as a theme that, they felt like they were choosing to be professional over to be themselves and the two couldn't co exist. And so, um, you know, that is a term that has been weaponized over time. And I think it started out probably honorable, but now the way that that is used is almost like, you know, like you said, vacate and just be the professional.
Chrissie: Yes. The weaponization of that term is something so important for us to keep an eye on. Because that is, in fact, one of the ways that gatekeepers, you know, isolate people from the herd, and it's how physicians sometimes lose careers. And I also hear, like, in the early part of a career, there's maybe not quite as much nuance at integrating what is felt to be the personal self with the professional self, it's almost like there's an oscillation where we have to choose, you know, zero value or one value and eventually with more and more practice of this profession, the end goal is more of an integrated self that is similar in different spaces, right? Even some of our leaders like Dr. Tait Shanafelt in the wellbeing world, talk about eschewing the term life work balance in favor of life work integration.
Jessica: I, I like that. I, I wish it would be even further than just feeling like, I wish it was just all life. Right? Like, I, you know, I wish we could go even further than just having to have even two terms. Right? That like, this is life and this is work. Why isn't it all just life?
Chrissie: We can. Let's do it. We'll start today. That's right.
Jessica: I'm in. Like,
Chrissie: it's true. Um, yes, I'm sorry, uh, if I got you off track. That's so, yes, they're, they were saying it was hard to have professionalism or to feel like they were embodying professionalism if they brought more of a sense of self to work.
Jessica: Exactly. Exactly. And, you know, all of this research is qualitative research. It gave a lot of stories. Um, it gave me like, it. It, it validated the themes that I personally felt and made it not just my story, but a collective story. And through that I moved into the quantitative research, which is what, um, I had presented at the International Conference on Physician Health, looking at the quantitative anonymous survey data of, um, authenticity, depression, burnout, and suicide.
Chrissie: Could you tell us a little bit about the, um, the domains that you measured and where you found significance in, in the study?
Jessica: Yes. So looking at the quantitative, uh, metrics, one of the tools we use was called the authenticity scale, abbreviated authenticity scale. And it had three domains, um, authentic living, accepting external influence and then the last one was self alienation and accepting external influence and self alienation were negative domains. Authentic living was a positive domain and what that meant was, um, authentic living meant how well you're living out your values in accordance with who you are. Um, I know who I am and I'm not afraid to be it. The accepting external influence is how much am I impacted by the opinions of others? How much do they inhibit me? Do I, am I afraid of them? And the last one, the self alienation is how detached I am from who I am. I don't really know who I am, um, I don't know what my values are.
And so, I looked at those three domains across the metrics for burnout, suicide, and depression. For burnout, we use the Copenhagen, uh, the work section inventory. For depression, we use the PHQ 9, and then for suicide, we use the ASQ suicide screener questionnaire. And through that I show across the across all the physician specialties that we surveyed, which included internal medicine, family medicine, pediatrics, emergency medicine, OBGen. and surgery that, um, 1200 physicians we surveyed with 783 responses, I think. And it showed that authentic living was protective across the board with, it was correlated with an, uh, decrease in burnout, depression, and suicide versus self alienation and accepting external influence correlated with an increase on all the domains.
Chrissie: That is so exciting. I mean, I just want to like highlight that and circle it and put exclamation marks in the margin here because authentic living, like knowing what your values are and then living according to them is, you know, it's a path to living a life well lived, right? It's actually making the inner and outer congruent, having internal and external consistency, it's fidelity to a vision of self and values expressed in the world, which is one of the most important things that we address in the space of coaching and coaching physicians, it's actually bringing that into metacognitive awareness. And all of this also ties in so beautifully to me with ways we solve for joy, right? Like getting deeper into who we are and then bringing that back out as an offering to the world through our professional existence and through our integrated existence period.
Jessica: I think for me, you know, talking about solving for joy, when I think about the description of authentic living and the way you articulated it just now, to me that, that is the embodiment of what I, how I would view joy is having that alignment of who I am and being able to express it in the outside world without fear or concern. Um, And knowing like, I, I, I feel like validated in doing that too, I think is also a huge part, you know, that the internal validation of, of living out who I am. I think I don't know anything greater like day to day than to be able to do that.
Chrissie: Absolutely. And the fact that you have given us some numerical quantitative proof that in these particular things correlate to better mental health outcomes. Absolutely. is so powerful.
Jessica: You know, I, I think that, um, that was a huge hope in doing it was to be able to quantitatively provide it. So right on the cusp of, of moving into the quantitative research, I was trying to articulate the qualitative research and I was met with resistance about where's the statistics. And so then I thought, well, I guess I have to get those now. And so that's, that's partly why the shift occurred was because the statistics didn't exist to be able to say things that we inherently as people who have done work on ourselves and to advocate for others, we know intuitively no, but there's no statistics for those that need that.
Chrissie: Yes, our, left brained world view does not, um, offer a lot of space for different ways of knowing, but yes, I agree that you've proven the obvious in some beautiful way, right? Of course we knew it would be true. So, and it turns out that life confirmed it, you know, that we did actually count it and it was true. Um, I'm excited to hear about your vision for operationalizing this insight. Where do you see the ripple happening and how do you want to invite people to use this, um, information, this insight, this beautiful proving of what maybe should be obvious and, um, and moving forward with it so that it can be of great service.
Jessica: You know, I think there's so many ways to operationalize it. Part of the next segments of research that I I'm starting now, look at ways to operationalize it and how the effects may be greater if we optimize it. And so some of that is to be determined, but I think, I think what we can take away personally and then thinking about education and training in the system. There's so many different levels to operationalize it. So personally I would say for me, I look at the way that I interact with colleagues or as an educator, how I interact with trainees and toward my patients and families. And I think, am I promoting you to live authentically? Am I giving you any reason to be concerned with the opinions of others, or my opinion? And am I helping you to be connected and know what your values are? So I will have discussions with them about, I feel like I'm hearing from you that this is a value, that you, that I can sense that this is something that is really important to you. And they may or may not be that aware that that's what they're saying, but hopefully the way that I'm speaking with them is drawing them in to be able to be closer to the values or to be more knowledgeable in their own values.
Chrissie: I love that It's a very consistent with a coach approach,
Jessica: yeah. And
you know, and then looking at as an educator and thinking about how we train people in the system in which we put them through medical school and residency, I think about You know, the, what we talked about with the word professionalism and just wanting to have those conversations with them that they maybe don't know how to articulate about not having to make a choice between themselves and the profession, and that we want them to be authentic because that is actually what's gonna give them a longevity in their career and in life.
Chrissie: Yes. Yes. Absolutely. If they betray themselves early on, that is going to be amplified over the course of their career. That's not going to be diminished. It's going to get worse because the more time goes by, the more that trajectory departs from one of an integrated self that happens to be a physician.
Jessica: Mm hmm. The, you know, in the last, you know, kind of group I think about is with, um, You know, with the system, whether it be local or, you know, regional or national, I think that there is a way in which the system is set up, which sends a message that there's not room for being who you are or that you are just a number and you're filling a job and we don't need to know more about you because we'll replace you. Um, and that's, that's a bigger problem.
Chrissie: Yeah. Your dispensable cog in a very complex machine. Yeah.
Jessica: Yeah. And, and that's a, that's a, so, uh, you know, that one, I, I think we'll take more time and more data to really sort through. That one is pretty multifactorial, but hopefully, um, we'll get there.
Chrissie: I am hopeful that the more people are aware of this research and the tool that you developed that we may, you know, it adds to the weight that will help to change attitudes over time. The old guard saying, well, I had to stuff my true self and therefore it's not a problem that you are also stuffing your true self. You know, instead it's like, let us give better than we got. Let us make It better as my, um, my friend, Becca Clarren said on, the podcast recently, let us be better ancestors, you know, to our, our professional progeny, let us hold this door open instead of pulling it closed from the inside saying you have to give up your soul in order to enter here. We do not want that. You want intact humans practicing medicine and working in health care.
Jessica: I mean, that's who I would want taking care of my family is a whole human.
Chrissie: That ia who I want taking care. Absolutely, and they give better care. They have more discretionary effort. They're more available for relating and regarding. Um, I see this as just a really important piece and it, it makes me have lots of ideas about collaborative research and interventions, Jessica. We, we can talk and play offline about that sometime, but I think it's a really exciting area of focus in addition to your incredibly complex clinical work.
Jessica: You know, I, I, um, I love all the hats that I wear. Otherwise I wouldn't wear them. But I, you know, I really find so, so much value in the advocacy work through the research and being able to tell the story of those that maybe can't articulate and also help get them what they might not even realize they need. And then to think about how we can prevent others from going down that road.
Chrissie: Absolutely. Ascending and using your access and influence to benefit those who don't have access or influence yet. Mm hmm. And are really still in the throes of, you know, trying to make it through the gauntlet of training. They're not in the place where they can finally relax and say the words, I made it. Right. They need voices like yours. How are you solving for joy these days?
Jessica: Oh my goodness. Well, I, I think for me, um, I really, um. strive to be authentic every day. I'm looking to do that. Um, and some days I feel like I do a really good job or some moments I even feel like I do a really good job. And then other moments I feel like, why did I say that? Why did I do that? And, you know, and those are learning moments for me of thinking like that didn't feel good, you know, like that wasn't what I meant or that wasn't really in alignment with who I am. So I think I think working on that is a is a constant process for me and solving for joy and I think I feel just there's a huge weight lifted for me when I am really all in alignment, you know, thoughts, words, and actions, core values all together and, um, operating in unison. I think for me, I just feel like it's like in the zone and that is my happiest place too. So
Chrissie: That is awesome.
Jessica: Other than that, I love spending time with my husband and daughter. So, um, quality family time is huge in forming those really substantial relationships that I found over time i, I can't get, unless I really am authentic. Right? You don't get the depth. You don't get the, um, the buy in. So I think that, you know, for me, um, it all ties together.
Chrissie: One of my teachers, James Olivia Chu Hillman will often write and say, you know, I can't know you without you, and I can't be known without me. More you is better. More you is always better. So more authenticity is always better, and, um, that's an exciting place for us to, to end today. Um, you know, I think of Solving for Joy oftentimes in terms of what variables in our little mental math equation, did we take for constants that turn out to be variables? And from our conversation today, I'm taking away that in our approach to living more authentically, especially in medicine and healthcare, that constant that we may have believed at some point that, that we thought was a constant about needing to not show our, our authentic selves is actually variable and when we change that variable, we end up solving for more joy. Right?
Jessica: Absolutely.
Chrissie: Jessica, thank you so much for all of this today. We started off our recording jamming to Pink Pony Club, and here's to Chappel Roan who is a fantastic model of authenticity. And here's to authenticity at any cost. Here's,
we are going to have links in the show notes to Dr. Jessica Ching's, authenticity questionnaire and, uh, relevant websites for her research. If anyone here is listening and would like to join in, uh, by taking the survey or getting in touch with her, we will have contact information there as well.
I'm so honored to have this conversation with you. And I want to say to, you know, many of our listeners, are in healthcare, many are not, but we have special resources for those of us struggling. If you are listening to this podcast and having even passive suicidal ideation, that's not a green light. That is a yellow light, my friend. So please hook up with somebody who you can talk to about it. And let them know what yellow light means, um, call nine eight eight if you need immediate care and know that there is also a physician suicide hotline specifically. So we will add that to the show notes as well. Um, it is 24 seven, picked up by human, so there is no need for you to suffer without help. There are too many people who care. You mean too much to too many people. So please get the medical help that you need. Um, and we will keep taking care of one another taking care of ourselves and solving for joy. We'll see you next week friends. Thank you for being with us.
I want to take a quick moment to acknowledge our incredible team. This podcast is produced by the amazing Kelsey Vaughn, post production and more handled by Alyssa Wilkes, and my steadfast friend and director of operations, Denise Crain. Our theme music is by Denys Kyshchuk cover photography by the talented Shelby Brakken and a special appreciation to my loyal champion and number one fan, Suzanne Sanchez. Thanks again for tuning in everyone. May we continue caring for ourselves, caring for others, and may we continue solving for joy. Take care. We'll see you next time.
