Cognitive Distortions & Career Resilience with Dr. Brittany Buss

Overcoming Setbacks: Dr. Brittany Busse’s Journey

This week, we discuss common cognitive distortions and how they can affect thought patterns

Dr. Frances Mei Hardin: Welcome to this week’s episode of Promising Young Surgeon. This week, we will discuss common cognitive distortions and how they can surreptitiously affect our thought patterns. Then Doctor Brittany Busse joins us to discuss overcoming career setbacks and her extraordinary journey after being forced out of a surgical residency program. Before we even get to the cognitive distortions, I do want to share a little bit of an update. I know that on this show we do talk a little bit about the literature that highlights differences between female and male physicians, their practices, the amount of time that they spend with patients, and even some surgical outcomes, because those have all been published in the past couple of years. But I had the most interesting thing come through clinic several weeks ago, and it has been haunting me a little bit. But I had this wonderful patient, nice, this lady, she was, like, in her sixties, and she came in for these persistent, chronic neck symptoms. She was having globus sensation, which is where it feels like something stuck in your throat, even though nothing’s there, and tightness of her neck, things like that. And it was even affecting her swallow a little bit, making it feel like things were getting stuck or, you know, again, the swallow did not feel normal to her, and so she was just sent to me to kind of get that all checked out. Okay, well, that’s easy. This has been going on for years and years, so that is an automatic laryngoscopy. In clinic, we put a very small camera through the nose, down the back of the nose, and then can look down at the voice box that way. And it’s really. It’s easy. It’s under a minute. People do well with that in general. So we go ahead and we do it. And she had this, you know, she had this very significant fungal laryngitis. She had supraglottic squeeze. You know, we’re not going to get into all those technical terms today because it’s not pertinent to the point that I want to make. But very real anatomic, physiologic, very literal disease was present on, multiple levels. And here’s what was so interesting. I went over everything with the patient, and she was, like, moved to tears. And she told me she’d been having this going on for over ten years, had seen multiple physicians for this, and her whole experience had been that she was told, without ever having a scope exam at any point, that she had a diagnosis of hysterical laryngitis. that is. That is not really a modern diagnosis. I had personally never run across that before. And of course, you know, it just sounds like kind of a scientific way for someone to say you’re just hysterical and you don’t have laryngitis, you know, or maybe some strain related to psychosomatic disease or something like that. But I really do. I think that that case like that does haunt me. I hate that she went so many years with a diagnosis of hysterical laryngitis when she has, like, multiple physical treatable conditions. And I just think that it helps highlight these areas where we can do better in medicine, listening to properly working up and getting patients down these treatment pathways.

Learning to recognize your thought distortions can help improve your work at work

Alrighty, so let’s jump into a few common cognitive distortions today. Here’s why it matters. Because recognizing your thought distortions is the first step to changing them and making your mind a better place to live, more inhabitable and perhaps less hostile. They can also get in the way of us acting skillfully at work. And so, for instance, even if you are in a position where you know the interpersonal effectiveness skills, you want to use them at work, you’re trying to, you know, build positive, reciprocal relationships with people that you work with. Well, guess what? Thought distortions can get in the way. They can make it more difficult to implement those. And. And so we’ll go through some of these today. The first, you know, many people will at least be able to relate to this or find it familiar, but the first is catastrophizing. That’s jumping to conclusions where you predict a severely negative outcome even without evidence that it’s the most likely one. For example, I’m definitely going to fail this test. Mind reading. This one is particularly common in high stress work environments, and it’s where you interpret an event or a situation negatively without evidence to support that conclusion. So, for instance, let’s say that somebody at the hospital snaps at you. Your mind starts to race about what you could have done wrong. In reality, most of the time, people are not thinking about you. And the behavior of snapping at you in passing is more about the person who does it and how their day is going than

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it is about you. And for example, an example of mind reading in that situation would be if you just think, you walk away from that saying, okay, my attending thinks I’m incompetent. That doctor thinks I’m incompetent. Overgeneralizing is where a blanket negative conclusion is made that goes far beyond the current situation, often includes words such as always, never, or nothing. For example, since the first week of MS, three rotations has gone so poorly, this whole year will suck should statements I do want to take a little extra time to highlight the should statements because, yes, they’re insidious, they’re hard to get rid of. But I think that once you really start paying attention, you’ll see how often you do it. So again, they’re hard to challenge. But what the should statements do is create a rigid idea of how you or others should behave. Begin by noticing how many times a day you think or say, I should or he she. They should try to change should to a preference, to a choice. You can learn to relate to your values differently so that when they’re not reflected in the world, it’s not perceived as an existential threat. Because here’s the thing is, if you believe truly that something, quote unquote, should be and then it’s not, it doesn’t match up with reality, then that can be extraordinarily painful. So an example I like this comes up a lot, is just saying, instead of I should stay late to help out with this late admission, it’s, I choose to stay late to help out the team. Taking ownership of your decisions really does help you feel better about them. And we do all have agency. And, you know, it’s not like, oh, this team member, or like, my program is forcing me to cover this case late. It’s like you are choosing to be there because you could always, you know, you could always say, no, I’m not going to do that. You know, we’re all adults with agency. And so this is an important point to remember. Fallacy of fairness. This is where you measure every behavior and situation on a spectrum of fairness. The reality is that everyone’s definition of what’s fair is different. And also in reality, the world can often be unfair. For example, even though your performance may be commensurate with another student on a rotation, in medical school, you guys get the same exam score, you perform the same duties, but they received honors and you don’t, based on a subjective call. Right. It can be really easy to make yourself miserable perceiving some slight, whether it’s in class or in the hospital. And you know, another example that I really like that comes up in residency is the distribution and assignment of surgical cases. Because, of course, there’s a variety of different cases rolling to the or every day. We have an admin chief who assigns the cases. Okay, it would be nearly impossible to assign cases in a 100% equitably distributed fashion, right? And it’s easy to make yourself miserable by saying, well, how come that person got that case? And, you know, now I’m covering this kind of a case. We tend to think about what we deserve. Here’s what’s really important to remember. There are a lot of things that have broken in our favor to get to this point, and we tend not to focus on those. Try not to get hung up on the breaks that are not in your favor. Kind of try that on for size. I think that that was, you know, this kind of pep talk was one of the things that really did help me start to begin the long journey of shifting my thinking. Blaming. Blaming is where you make others responsible for how you feel. For instance, if an attending makes a negative comment towards you on morning rounds, then you feel upset for the rest of the day. You think, you made me feel bad about myself. M instead of just assigning blame externally or thinking, you know, I’m stuck here. I have no choice but to stay. I’m already on this path again. This goes back to our agency and taking ownership of our decisions. It’s. I’m choosing to stay on this path to becoming a physician, so I’ll square up and stay here. Finally, we have the fallacy of change. This is a fallacy where you expect other people to change or meet your expectations or needs, especially if you pressure them enough. For example, let’s say that you ask a colleague to discontinue berating staff on one of the units. You expect them to hear and understand what you’re saying and to change their behavior accordingly. At the end of the day, the only person whose actions and words you have control over are your own. And that’s really important to remember because you can kind of

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prioritize accordingly. That is to say, one of the best ways to start a different conversation or change the culture is to be a different kind of leader and kind of demonstrate an alternative behavior yourself. Right. People do learn by. By watching you. That’s true at all levels and stages of our medical training on the path to becoming a physician and a surgeon. Like, even when we’re in medical school, like, there are a lot of pre meds who are going to look up to you, you know, there’s high schoolers who may look up to you and maybe shadowing and things like that. So at all levels, like, we are being watched and our behavior may be replicated someday. So I just think that that’s also worth remembering and having a little bit of perspective on. Alrighty. So now that we’ve gone through some of these common cognitive distortions, that certainly can impact our day and our work as healthcare workers, we’re going to jump into our discussion with our guest, Doctor Busse.

Doctor Brittany Busse is a physician digital health expert

Doctor Brittany Busse is a physician digital health expert and she is the co founder, president and chief medical officer of Vitel Health. Vital Health was founded in 2020, enabling whole person preventative care via telehealth services. In addition to her work as a physician leader, she enjoys practicing and teaching yoga and meditation, spending time with her partner and son, and exploring northern California. Thank you so much for joining me today, doctor Busse.

Dr. Brittany Busse: Thanks. Thanks for having me. I’m, excited to talk to you and your, group here.

Dr. Frances Mei Hardin: Well, I would love to open with hearing more about your journey into medicine, like, what made you want to become a doctor and then what led you to want to pursue surgical residency?

Dr. Brittany Busse: Sure. so I grew up in a family where my mom was a nurse. Actually, no, other doctors in the family. But I was really interested in taking care of other people, helping other people. And my mom was kind of funny because she was like, well, honey, you are so smart. She’s like, you need to be a doctor. Like, don’t be a nurse like me. Cause really smart people go to medical school. And I was like, okay, mom. And, like, nothing against nurses. I love nurses. That was just kind of her point of view on the situation. so I kind of toyed around with different things growing up. Like, I thought the heart was really interesting. So I thought at first maybe I would like to be a heart surgeon. but then I realized it was really kind of bloody and scary, at least for a kid. And then I thought maybe brain surgery would be a lot cleaner. At least it looked cleaner on tv. and found out that wasn’t really the case either. And, the funny part was, as I was going through all of these things, and discovering, like, I was really interested in the brain and how the brain works and reading. My mom was a psychiatric nurse, so she had a bunch of, like, really crazy old psychiatric books from, like, the seventies. Really interesting what people did in psychiatric care back then. and I thought, well, maybe I would be interested in that. So when I went to medical school, actually, before medical school, as an undergrad, I actually majored in psychology and in physiology, also like a double major. And then I went to the University of Wisconsin Madison, thinking I would probably go into psychiatry. We all started our rotations, as we know, in our third year of medical school, and I did psychiatry first. I was like, I just can’t wait to, like, do psychiatry and practice. And it was so disappointing. Like, I have never been so disappointed in my life. I felt like nobody seemed like they were asking interesting questions. Like, it just was a bunch of, like, did you take your pills today? How did they make you feel? Well, you’ve been taking this one pill for two weeks and doesn’t seem to be working, so let’s try this other pill. And I was like, wow, this is just the opposite of what I want to do with my life.

Dr. Frances Mei Hardin: Probably not as interesting as what they were doing in the seventies for it.

Dr. Brittany Busse: Even in, like, the eighties and early nineties. I mean, we think of things like Doctor Fraser Crane, and, like, he would actually talk to the patients and be like, I’m listening. And, like, nobody was listening. There was no talking, no listening, no, like, real, like, connection. I felt like happening in that short period, and I kind of had the same experience going through internal medicine and family medicine and Ob GYN and all of those things. I just. It didn’t resonate with me. Like, I don’t really take medications myself, and I just couldn’t see myself pills to people for the rest of my life. So when I got to my surgical rotation, I was like, this might not be good because I’ve been known to pass out when I see blood. And I, remember I avoided going to the or for, like, almost the entire first week of, like, an eight week rotation. And I would just follow the intern around everywhere because she just had a bunch of paperwork to do and, like, bother her. And then all of a sudden, she gets a page, she gets to go to the or, and she’s so excited, she’s going to drag me along with her. And I just practically panicked. so I get pulled

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Dr. Brittany Busse: into this hernia repair surgery, gowned up, like, totally afraid to touch anything. Like, oh, my God, I’m gonna break something. And they have the patient all covered up, and there are blue drapes anywhere. Obviously, all of these surgical residents totally are, picturing this right now. You know, you have your blue drapes and you have a clean square of skin for this hernia repair. And it was so, like, beautiful and perfect. And although, you know, there’s a person there, like, with the blood and everything being detached from a person, it didn’t cause me the same, like, vasovagal reaction that I had had. Like, even seeing dialysis, like, when the blood was out of the person and then going through the machine and going back in, I just. My whole body just shut down. But there was just this sense of calm control that came with the atmosphere of the room and the person came in with a problem and they left without a problem. And I learned of the surgeon motto, a chance to cut is a chance to cure. And I was just like, that is it for me, like, I can do this all day. Like, this is what I want to do. and I just went to, like, every surgery I could find after that and went through all different kinds of rotations, and ended up doing like, some orthopedic shadowing and really interested in plastics. And, I had really high scores, so it wasn’t really, like, an issue for me, like, choosing a more competitive specialty at that point. I guess I kind of lucked out in that sense that, like, I was. I was well positioned, from a standardized testing standpoint to choose any specialty I wanted. So, I chose plastics knowing that it was really competitive. And I think the issue there for me ended up being really, like, because it was such a small specialty, especially at the time that I attempted to match. I think there were 90 spots in the entire country, and it was like the height of, like, plastic surgery interest, like the prostitute tv shows, and everybody wanted to be a plastic surgeon. so there was, I think, close to 800 applicants for those 90 spots.

Dr. Frances Mei Hardin: Oh, my gosh.

Dr. Brittany Busse: Yeah. like, basically, if you didn’t know someone, you weren’t going to get a spot. And our program had two spots, and then that one went to one of our internal candidates who had known the program for, like, forever. Like, she was like, I am plastics, and she had just, like, ingratiated herself to everybody there. And then the other spot was basically like kind of a trade, like an internal thing where, like, one of our other applicants went to this other program and we got one of their applicants that they really liked. So I ended up unmatched. And, that was kind of like my first, like, oh, my m. God, what are you going to do now? Moment. And I was like, okay, well, I’m just going to research all of the programs that have, prelim spots that also have plastic surgery programs, that are known for taking prelim residence, like, after their third year, or even have like, a fellowship plastic surgery program so that maybe I could transition into the fellowship. so I ended up matching in the scramble, here in Sacramento.

Dr. Frances Mei Hardin: Okay, perfect for a prelim surgery year.

Correct. Plastics fellowship, yes. And if I still wanted to do fellowship in plastics, yes

Correct.

Dr. Brittany Busse: But with PGY one surgery year, with, like, the spoken contract that I would continue, you know, so long as I wanted to continue with the program. And maybe after my third year, I would transition into their plastics because they did have a transitional program or I would complete all of my general surgery. And if I still wanted to do fellowship in plastics, yes.

Dr. Frances Mei Hardin: Then. Plastics fellowship, yes. And I’ve definitely. I’ve heard of all those different routes, you know, to getting to, really, the same place.

I would love to share my first vasovagal reaction

I do want to take a second, though, to highlight, like, I really appreciate you sharing that story and going into the or for the first time, you know, having had vasovagal reactions, like, with dialysis and stuff. And I would love to share my first vasovagal reaction, which, you know, I think it surprises people. Like, they feel like they are maybe more limited when they’re premed or looking at medicine, because they’re like, well, what if I. What if I faint? It’s like, honestly, most surgeons I know have fainted for one reason or another. But, my first vasovagal came when I was an undergrad. I was a biochem major at Notre Dame, and I was shadowing a hemonk guy in town. And he was awesome. He was such a good. He was like an old school doctor. He. He was just great. And, of course, a lot of hemonk, a lot of it was just very critical, you know, conversations with families. It was. It was very interpersonal, a lot of pharmacology type of stuff. But then occasionally, and I happened to be there one time when he had to do a bone marrow biopsy. This was on, like, a, you know, a girl in

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her twenties. And the bone marrow biopsy, it, honestly, to this day, may still be the biggest needle I’ve ever seen in my life. Like, of course it’s a large bore needle. It’s larger than anything that I use in my regular daily life now. Haven’t seen anything like that big in years, and it’s pretty famous for being painful. So, like, watching this awake person in pain, plus seeing that huge, I mean, super needle, like, it was unreal. That device is still scary to me. I just immediately passed out and, you know, like, nurses are ready for that. Everyone was nice to me about it. They just carted my body. You know, they just kind of put it up against a wall, and then they gave me some orange juice, and it was like, no problem. You know, I do think that, like, destigmatizing that for younger people or people who are interested, it’s good for them to hear, and I. Yeah, so I just think that that’s. That’s great for people to know. It’s, like, not typically a big deal. I mean, I hope that it’s, like, pretty rare that someone would be a jerk to you about it, especially if it’s, like, early on and you’re not decent.

Dr. Brittany Busse: I think, like, the first time I ever passed out like that, I was actually. Yeah, I was in high school, and I was shadowing an ER doctor because I was like, I want to be a doctor. And they’re like, okay, come shadow us in the ER. And, like, there was just a kid came in to get stitches, and I’m like, ooh, this is so cool. And, like, I remember being, like, very genuinely interested in what was happening. And the surgeon’s there, or the. Your doctor’s putting in the stitches. And, like, I just remember he’s talking to me, and then he looks over and he goes, oh, we have a fainter. And, like, I just. He was, like, could see that all the color had, like, drained from my body. And I remember feeling weak but still interested in what was happening. And, like, a, chair just getting, like, shoved under me and, like, wheeled out of the.

Dr. Frances Mei Hardin: Yes.

Dr. Brittany Busse: And everyone was so nice, and it was like, it was funny. Like, it was mortifying. Obviously, to me, I was a high schooler, and they’re, never gonna let me back in the ER again. And everybody was like, oh, don’t worry. Like, people faint all the time. Like, not the first time we’ve seen that, so totally.

Dr. Frances Mei Hardin: That’s like, welcome to the Er. Yeah, welcome to the team. Like, you’re one of us now. I think if you’ve fainted, you know, in, like, a patient bay.

This story is so hilarious. It brings a little levity to surgery

and this is the last one, but really quick. This story is so hilarious. And it’s another example of what you’re describing where, like, the trainee, the resident position, they were hype. Like, they were very pumped to be there. but what happened was, this is lore from my training program, but this resident was pumped to do their first case. Like, they were opening the neck. This was a younger resident, so this was very new for them. So they have the scalpel in their hand, and they’re going to cut their neck. Well, guess what?

Dr. Brittany Busse: They’re.

Dr. Frances Mei Hardin: They’re way too excited. They end up cutting themselves. So they cut their other hand. So they. Now they’ve cut themselves. Now they have a little laceration on their, their hand. And they were, like, so upset. They were like, okay, okay, just stitch it up, like, really quick. They’re begging me, attending. They’re like, just please stitch it up really quick. And then I could just scrub back in and. And then maybe I could still do the case. Like, I’m really ready. Like, I really really want this. And so the attending who tells this story, he was like, okay, you know, obviously a little setback. This is going to add some time. But he’s like, fine, you know, whatever. And it was a clean scalpel that hit him. So he just, like, cleans it out. And he’s like, okay, I’m just going to stitch it. He puts the first stitch in, resident immediately passes out. And so again, yeah, they just kind of finished stitching it. They kind of cart his body off to the side. And he’s like, coming to when they’re already well underway with surgery. And he’s like, no, you guys left without me. Like, you did it. And they’re like, yeah, like, you passed all, you totally lost consciousness. Like, you’re out. Like, you’re not going to get to do this case. But it is, it’s nice. It brings a little levity when stuff like that happens because. Pretty benign scenario.

Dr. Brittany Busse: Yeah, nobody got hurt, so that’s always good.

Dr. Frances Mei Hardin: No.

You were a prelim surgery resident in Sacramento, California

And so going back to your experience, so you’re in Sacramento, you were a prelim surgery resident, and what was your experience from that point?

Dr. Brittany Busse: you know, it’s, it was interesting, I would say. You know, they, I didn’t know too much about programs as a whole or really. I mean, I’ve, I guess most people would say, like, I’m not just naive. I’m kind of stubborn in a way. Like, I have this belief that work shouldn’t be hard, right. And it shouldn’t make your life miserable. And, like, maybe that is a wrong belief in surgery, but I was going to stick to that belief, and I did not care what anyone else was going to say or do about it. Like, I was there to do my work, be really good at my job, and take really good care of patients. Like, I loved patients. Patients loved me. Like, there were no issues there. But when it came down to it, like, when work was done, I was going to go home and I was not going to want to take that work home with me. Like, if I’m on, call, yes, I will answer my

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Dr. Brittany Busse: pager, but it doesn’t mean I’m, like, sitting at home in a locked room alone, waiting for my pager to go off. You know, at one point, I remember I had a partner and he had two kids. And I got paged and I immediately answered and I started talking to the attending and he’s like, what is that noise in the background? And I was like, that’s two four year olds, you know, because they were twins. And he’s like, why are they making so much noise? And I’m like, because they’re four. Like, I don’t understand. And he’s like, well, it’s like, I can’t. I can’t think straight. I can’t talk to you right now because, like, there’s just too much noise in the background. And he’s like, you’re gonna have to go somewhere else, and I’m gonna have to call you back.

Dr. Frances Mei Hardin: Sounds like a cartoon villain.

Dr. Brittany Busse: Yeah, but that. I mean, I won’t say everyone in the program was a villain. Like, there were some amazing people. however, a lot of those people have since left the program, because it turned out to be incredibly toxic and incredibly malignant. And I said, like I said, some of that is probably due to my own attitude. They felt it needed adjusting, and it was a very hierarchical program. It’s attached to, also military operations. So there were times that we had to be working at the air force base, which sucked. I had no idea that was going to happen. Like, they’d cart you off, like, over an hour away from home, and you’d have to live in this gross hotel the entire time you were there. And residents got ringworm, and there were bedbugs. It was horrible. And, since we weren’t military, we had no access to any services while we were on base. We couldn’t use the gym. We couldn’t buy gas. They would give us such a hard time, and I was like, but we’re here. Like, we’re serving in the hospital, essentially, and they would just give us all such a hard time. So I really came to, like, despise most of the people in the program, but I kept showing up, right? Like, I kept working hard. I kept doing my best, you know, to prove that I deserve to be there, honestly, like, and I don’t know if part of that is, like, being a prelim or anything, but I very easily. I had my second year given to me. My. And after that, it was like, you were. You were a resident. Like, it wasn’t a year to year contract. After that, it was like, okay, once you made it through intern year, I did. I scored the highest of all of the interns on the in service exam. Like, there was really no reason to cut me from the program at that point. So I continued into my second year and then through my third year, and then I did, research after that. I went into the lab and started working with, mesenchymal stem cells for, like, reconstructive purposes. So yeah.

Dr. Frances Mei Hardin: And I already can hear, you know, in your voice, like, and I. I would say that I’m like minded in that. I do also think that, you know, I want there to be a world where being good at your job and treating people, you know, respectfully and with kindness at your job and showing up in day, every day and doing your duty, that that’s good. Like, if you meet those x, y, and z, like, I. You, know, I also, like, I kind of believe, okay, if you check all those boxes, then you should be good. Although this gets a little bit into the, you know, cognitive distortions that we kind of talked about at the beginning, just, which is that there’s, like, this fallacy of fairness, because I do think that that would be, like, a fair world. And I. I want to live in that world, although the world we live in is, like, really unfair. So I can just already kind of hear, you know, maybe where this is going, especially in a super hierarchical system.

Dr. Brittany Busse: And I think it’s hard, you know, just, like, for me, it’s also hard a little bit to talk about because, honestly, I can only tell what happened from my perspective. And, they can only say what happened from their perspective. So I could never tell you, like, you know, from their point of view, maybe I was the worst president ever. Like, I have no idea, you know, at this point, what caused the massive rift between myself and my, residency program? Because things seem like at least, you know, an intern year and everything, things seem like they started off great. Like, I was like, oh, yeah, everyone likes me. I have a lot of friends. And when I. I think it was during my second year that I moved a bit further away. Like, I moved out of downtown Sacramento kind of to the suburbs. I moved in with this partner who had a couple kids. And, like, I had a life, like, outside. And most of the attendings, like, yes, technically, they had lives outside of surgery, but they didn’t act like they had lives outside of surgery. And it became kind of, like, obnoxious, I think, to them. To think that I had a life outside of surgery, at least like I said, that’s my perception, was like, you know, the minute I kind of set these boundaries with them, they were like, oh, no, she cannot, like, survive in this system. And, like, started making my life, like, really, really difficult.

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Dr. Brittany Busse: I mean, even my other residents made my life difficult. Like, I had residents who would sexually harass me while I was working. Like, they thought that for some reason, they were allowed to do that because they heard other people saying, things about me. And so it got to the point where, like, I didn’t. I didn’t even want to go to work, but, like, I still wanted so badly to succeed and to, like, be a plastic surgeon. But it became so apparent to me that that was not going to happen there. Right. Like, even the plastic surgery program was very clicky. Like, they all went to the same church, and I don’t go to church. And, like, they were actually mostly guys. There was one female resident. She was the chief resident when I came on as an intern, and then she graduated, and all the rest of their residents were all males. like, all very pretty, pretty males. And, I just. And they all went to the same church, and they all talked about the same things, and they all got together all the time. And I was just like, this is. I am not going to fit in with this group, no matter how hard I try, at least as a woman, in my opinion. We do that.

When I was a junior resident, one attendings told me about ganging up

I know I will just be this, and if I’m this, then everyone will like me, and I will fit in. And I was, like, a master at, like, changing myself. Yeah, but only up until a point, right? Like, if it came to impeding on, like, my lifestyle and my boundaries, and in that, it started to make me, like, uncomfortable, and I was like, no. Like, yeah, I’m not giving you guys my free time to, like, you get all of my work time. You can’t have my free time, too.

Dr. Frances Mei Hardin: But I agree with you. I think, especially in some surgical cultures, there is this agreement. Like, you don’t have a life outside the hospital. And certainly, even if you do, on paper, it is not more important than the hospital, and there’s nothing more important than being here. And I do think that what’s also tough is I’ve seen kind of a dozen different versions of, like, if one person doesn’t fit in, they’re gonna. They’re gonna know it, they’re gonna feel it, because they. I’ve seen them ganged up on. When I was a junior resident, one of the attendings told me, and this was, like, under. This was, like, a very pleasant conversation, kind of like small talk on a very sunny day. Like, this is just working in clinic. And in between patients, this attending said to me, oh, yeah, every year, the department picks the resident that they don’t like, and they make it very unpleasant for that resident. And I was like, oh. And, you know, I didn’t say anything like I was junior. I was afraid. I was kind of, like, afraid to hear that news. Obviously, I’ve had many years to think about it since. And, you know, my question would be, why? Like, why is that? You know, why is that necessary? Why isn’t it like, hey, there’s only two residents every year, and then we had three every other year. But I’d be like, you know, why not? If both those residents win, we all win. And, like, the department excels and things like that. But no, it really played out that way. and I just think there’s, you know, it’s antiquated. It’s horrible. It’s just like, kind of. It comes off very animalistic to me. And so I’m sorry that you experienced that because it’s tough, and I can just already imagine a lot of those types of scenarios. And so, you know, I guess just kind of jumping ahead in time.

I would just ask what your experience was like when you were led to quit

I would just ask what your experience was like when you were led to quit and then kind of those next steps, because you’ve talked a little bit publicly about your em applications and things like that, if you could just walk us through.

Dr. Brittany Busse: So I think. So around that time, so I became a research, ah, resident again. I just went and I worked with one of the plastic surgeons, actually. He was a really super nice guy. he was a junior associate professor. Just joined the group, and he got his own lab. Really wanted to do, adipose derived stem cell, work. So I was like, oh, can I help? Like, that sounds really cool. So we get fat pads out of rats and, like, break them down and grow the stem cells, and it was really fun and interesting. and then right at the end of that year, I was like, you would sometimes rotate back onto service just to, like, cover for people who are on vacation or, like, for a week here and there. So I was rotating back on to service, and I had, like, a really bad, like, pain in my eye, and I had slept with my contacts in, so I was like, it’s just a corneal abrasion. Like, I get them all the time because I had really dry eyes. so I went to, like, my stash of these, like, prednisone eye drops, basically, that I would put on my eyes so that the inflammation would calm down and then I could put my contacts back in, but I was out, so. Well, that sucks. So I’m like, I got to find myself, ophthalmology resident, and I probably have some prednisone drops that they could get me. And so

00:35:00

Dr. Brittany Busse: I got the ophthalmology resident, and, like, we went to their little station up on, like, the 8th floor of the hospital. And she looks in my eyes. I don’t know. I don’t see any corneal abrasions. She’s like, but your eyes are really dry, like, really bad. And so I think you should go see the corneal specialist. And, like, we, all the residents, we get these little plugs put in our eyes that, like, keep the moisture on your eyes longer. And she’s like, so you should just go get that done and then be fine. I’m like, okay. So I go over to the. I was like, off to shift for the day, and I was like, I might as well just pop by. And they were able to see me. And so I come in and there’s this medical student there. He’s like, can I dilate your eyes? And I was like, no. Like, please, like, go away. Like, I don’t need my eyes dilated. I just want to get my plugs and go home. Like, I don’t have want to do this. And I felt kind of bad because, well, I don’t really have anything better to do today. And he looks kind of sad. I was like, well, knock yourself out. Like, enjoy your beautiful view of my 29 year old pristine retinas, you know? And he looks in there and gets really quiet, and then the resident, looks and also gets really quiet, and then they leave, and the attending comes back and says, yeah, we can definitely put the plugs in your eyes, and we’ll take care of that right away. She’s like, but something else we should probably talk about. I don’t know, because I’m just a corneal specialist, but it looks like both of your retinas are detached. And I was m like, what are you talking about?

Dr. Frances Mei Hardin: No, yeah.

Dr. Brittany Busse: Ah, yeah, I think they might be. So you should probably see a retinal specialist about that. And I was like, okay, when am I going to do that? She’s like, no, like, now, like, immediately, like, I just told you, both of your retinas are detached. I was like, okay. So from there, you know, I shuttled off, and I totally just. I mean, this was kind of like a long string of, like, health issues that I started having. Like, my pancreas kind of felt like it was shutting down where I was, like, constantly hypoglycemic or, like, I guess overreacting in that way. And I actually started carrying around, like, pez tablets to, like, every surgery. And I would have the nurses, like, pop them in my mouth while I was operating so that I didn’t pass out and like, I had seen an endocrinologist, and, like, I was in the middle of getting all of this worked up, and now all of a sudden, like, my retinas are detaching. I was like, what in the world is happening? so I just kind of started having a meltdown. And then my partner was like, remember what you always say? And I was like, a chance to cut is a chance to cure. He’s like, so they told you. Did you have a surgical problem or a non surgical problem? I’m like, a surgical problem? He’s like, so great. Like, let him fix it and go on with your life. And I was like, yeah, okay. Like, that sounds fine. So I went and had surgery done, like, two days later, pretty much like, they just, like, this has now. It was so, close to, like, my retinal artery, and it was just, like, a massive issue. So, from there, I started to have some issues as far as, like, double vision. And, I couldn’t see very clearly, especially out of my right eye. And I wasn’t sure how I could return to the lab at this point. I couldn’t drive. Like, I couldn’t do anything because of the double vision. And my. I had filed disability paperwork, like, before I went out on leave, which happened to be the end of June. End of May. Beginning of June, right. So we all know what happens in June. New residents come in. So somehow I was told, and, like, people said that this also sounds kind of sketchy, because, like, you were saying, like, sometimes people are trying to push a resident out of the program, but I was told that my disability paperwork was lost because it somehow got filed away with all of this new resident paperwork. And the lady who was in charge of HR also retired, apparently at the exact same time that my disability paperwork was filed. And they said, oh, we can’t find it anywhere. So you either return to work tomorrow, or you’re going to need to quit, or we’re going to fire you. And I was like, what? I’m talking about, like, at this point, I had been out for three months, I think, like, recovering and still not fully recovered from the surgery. And I was like, this is crazy. Like, I don’t understand. Like, I’ve been getting a paycheck. I thought everything was fine. They were like, nope, nope. Like, you need to do this right away. So I remember I talked to the head of the surgery department. She actually also had her lab in the same stem cell lab that I was working in.

Not being board certified puts a damper on your prospects as a doctor

So I knew her from that. and she was like, oh, like, it’s okay. Like, it sounds like you’re gonna need to resign, and we’ll be happy to, you know, continue your medical insurance until you can find a job, and we’ll even continue your paychecks for, like, another two months. And, And then it was like, I think it was, like, august or September at that point. So she was like, you can even apply, you know, to the match, and, like, we’ll make sure, like, you could match maybe into a new specialty that’s better suited, you know, for your current

00:40:00

condition and all of this stuff. And I was like, yeah, sure. Like, as a trauma resident, I often work with emergency medicine colleagues, and I thought, well, I think emergency medicine might be okay. And, like, I come to, like, find out later from, like, another attending colleague who had since left the program. And, like, we met up for coffee one time, and he said, I just wanted to see how you’re doing, because, like, kind of. It was, like, your situation where, like, everyone knows who the resident is that everyone has decided to, like, pin a target on the back of, except the resident who kind of senses it but doesn’t really know. So, like, everybody else goes, well, yeah, it’s terrible that nobody does anything about it.

Dr. Frances Mei Hardin: Yeah.

Dr. Brittany Busse: You know? And, he’s like, yeah, you wouldn’t. He’s like, you think she was being nice to you? He was like, nothing happens without her sign off. Like, so, like, it seemed nice at the time. And you were like, oh, thank you so much for helping me quietly and nicely separate from this program, who has made my life a living hell for the past three years. And I did that. I went and I applied for the match, and I was, like, an excellent candidate, right. For em at this point. Like, I had three years of surgical training, excellent scores, even all the way back to medical school. The one thing I didn’t have that I didn’t realize that I didn’t have were excellent letters of recommendation.

Dr. Frances Mei Hardin: How did you find out?

Dr. Brittany Busse: I found out five years later, since, as an applicant, you sign away your rights to ever read said letters of recommendation. I found out from the person who had been the chief resident at the time in the EM program, and he was trying to help me get a job. This was, like, years later, after I’m not board certified in anything, it’s really hard to get a job. he was trying to help me get a job in basically the fast track of an ER department, department that he worked at. And, he’s like, do you know why you didn’t match into emergency medicine. Because, you know, on paper, you are, like, the top candidate for this position. And I was like, no, I just, you know, kind of assumed it just wasn’t a good fit and my life was going to go in a different direction. I kind of didn’t think about it after that. He was. No, he was like, your residency program director wrote a letter about you so terrible that any program would have had to have been crazy to hire you. I, was like, really? That person went out of their way to destroy my future as a doctor because, like, for anyone who’s not aware, like, at the time, it seemed like not being board certified, it does put a huge damper on your, prospects as a doctor. Like, you can’t contract with insurance companies. You can’t get a job in a hospital system. Like, it kind of seems like the only place you can get a job is an urgent care, which is not a super awesome place to work. Having worked in one for, like, four years, I can tell you that firsthand. but it’s something that’s very important in the medical world, but it turns out it’s less important, I think, to patients than we think it is. But that really hit me hard, and I didn’t really know what to do with that information, honestly. I kind of just was like, I’m just going to put that back here where, like, I’m like, but my life still worked out fine. You know, everything’s fine. And, you know, like, even up to last year, one of the doctors I had worked with reached out to me, and, like, you could tell he’d just been carrying around a guilty conscience. Like, hey, like, how are you doing? Like, is your life okay? Are you okay? And I was like, my life is awesome. Like, are you okay? He’s like, well, I’ve just. I’ve always thought about, and this is, mind you, ten years after the incident. He’s like, I just always thought about, like, what happened to you and how it was so terrible and, like, unfair, and I just. I just want to make sure you’re okay. And, like, I recently quit my job there, and I’m moving down to southern California, so I thought now would be a good time to talk to you.

Dr. Frances Mei Hardin: Oh, my gosh. I mean, I’m so sorry that that happened to you. I mean, it sounds like you’re in an even better spot now, and I’m glad that you got out of a surgical residency experience where you describe it as your life was living hell. And. And, you know, I can certainly relate to aspects of that. And so I’m glad that you didn’t have additional years in that kind of a traumatic, difficult situation. But, you know, and it really is crazy. I mean, certainly when you’ve written about the topic, it, it did grab my attention. Like, the fact that maybe one program director or one experience like that does have the ability, whether that’s right or wrong, I’m not convinced that it’s right that they could then just end somebody’s medical career. And like, especially, what if that resident is like, good at their job, they’re respectful towards people, you know, no safety issues whatsoever, but yet maybe at somebody’s subjective call, that can still, that can be the end of it. And even more so, I think that the literature

00:45:00

Dr. Frances Mei Hardin: even really does support, like, for women and underrepresented minorities in medicine, things like that. Just if you’re a person who does not fit in, you are definitely a candidate for being that person who gets singled out or gets a target on their back. You know, like they’re going to pick from that lot, typically.

Dr. Brittany Busse: Yeah. There was actually, I think it was an article that was published in JAMA that said there was just an alarmingly high rate of what they called unattended attrition from residency programs by women and people of color. And it’s. But why? Like, where are all the women and, minorities going? It’s like, well, we’re being told either to our faces or, you know, not so subtly in, the actions of other people that we don’t belong, that, like, we don’t fit in and we’re not welcome there. And the programs know how to get us out. Like, they have figured out the system, like you said, like, for targeting them and for just making life really unpleasant. Like, like I said to the point, it’s like, how much do you value your life? Like, for me, it was a lot. Like, I value my life. And I feel really sorry for the residents who feel like their life’s not worth living because this happens to them. Right. And I have talked to these residents, like, I have talked to people who approached me for like, any number of reasons. Most of them have been targeted by residency programs. And it’s heartbreaking. Like, it’s hard for me on the days that I, like, hear their stories. Like, I have to spend a lot of time, reprocessing. I think what happened to me, in addition to, like, feeling their pain, like, I’m a very empathic person in that way. and it’s really hard to hear like that. And this toxic culture and residency, you know, not only still exists, like, in this year, 2024, but it’s, like, perpetuating and there’s no recourse and there’s no consequence, right? Like, I mean, because people are like, well, why didn’t you call a lawyer, and why didn’t you do this? I was like, I did. They were like, yeah, but since you signed away your heiress rights and the program could just as easily have destroyed all the evidence.

You spoke about feeling isolated after leaving residency program

Like, it’s really your word against theirs or maybe these other people. And. And if you talk to those people again, they’re like, oh, I didn’t say that. Don’t ask me to testify against this program. So it’s hard for me to talk about. Cause I’m like, oh, my God, if somebody hears this, they’re gonna say something. Cause they know who I am and where I went and who the program director is and all that stuff. So it’s like, well, now is that person gonna come after me?

Dr. Frances Mei Hardin: Well, and even, like you said, people didn’t even feel comfortable to reach out to you until they left that program. And I’ve heard multiple, you know, similarly, where residency programs and people who are still in the department are told not to contact them, you know, and so then they feel even more isolated. Like, it’s just, it. My heart goes out to you because it seems like, of, course, incredibly distressing to have to go through that.

Telehealth: What advice would you give to people facing career setbacks

But I do want to make sure that, you know, we spend time on, really, the good part. And, like, I’d love to. Basically, you’ve already alluded to it, but you are an expert at this based on your experience, you know, based on the things that you’ve learned, the wisdom you have from your unique journey. And so your advice on career setbacks, you know, something this major, this unexpected, but, of course, coming out much stronger on the other side, you know, the incredible life and career that you have now, like, we’d love to hear all about.

Dr. Brittany Busse: I think it’s important, like, too, that we talk about this stuff just because, like I said, still happening. And despite, like, you know, the wonderful things that can, you can still become with your life. Like, I would definitely not advocate for anyone ending their life ever for this reason, especially. but it’s just like, we don’t want to skim over the bad that happened just because it turned out for the best. And I think I spent most of my life doing that. Like, well, I was able to be resilient because, right, we are physicians, and we are very resilient. People, most of us. And, it’s how we define ourselves. We shouldn’t have to define ourselves that way and constantly face, like, this surreal amount of abuse and trauma that a lot of us have to go through, even if it’s not at the level of being targeted. I think many programs just excel at ripping your humanity away from you and making you feel like that’s the only way to survive and to become a good doctor who’s very dedicated to your profession is just to become dehumanized. And, like, that definitely needs to change. I don’t want to skim

00:50:00

Dr. Brittany Busse: over that portion of it. but just coming back to, it’s like, yeah, at first I was like, what am I going to do? I was supposed to be a surgeon. A surgeon is amazing. It’s the best job ever. And I went to work in an urgent care, and it was like being demoted from, like, the sommelier at, the fanciest restaurant you can think of to, like, behind the counter at a McDonald’s. Like, people would say really rude things to me all the time, and, like, when you were used to just, like, walking into a room and saying, like, I’m gonna take your organs out. Sign here, you know? And people like, yes, please. Thank you. I’m in so much pain. I can’t wait to be rid of this appendix. and, you’re just like, hey, you have a cold. What do you know? Where are you from? Are you from another country? And it’s like, no, I’m, like, literally from Wisconsin. It’s just a few states over the other direction. so that part can be hard, right? Like, you. So you’re. You feel like you’re being completely, like, stripped of your prowess and everything that you earned, right? And so I think that goes back to some of those, like, cognitive fallacies that you were talking about. It’s just like, I earned this. I should be treated, differently. Like, I need this in order to, like, be recognized. And,

Dr. Frances Mei Hardin: And it’s an identity death.

Dr. Brittany Busse: It is. It’s a huge identity death. Like, you’re just like, I don’t know what to do at this point. But again, it’s like you start to look around you and you start to see that, like, this is just one facet of who you are. And I would be very fortunate to think about these words that were said to me when I was an undergrad. And I had this mentor, and he had said that you’re a tree, and all of these other things are just birds. So if you see yourself as, ah, a surgeon, as a doctor, as a mother, as, you know, anything. The birds can come and go, but it doesn’t change the nature of the tree. Like, a tree still exists and it still provides so much value to the world. So why would you identify just with the flightiness of birds? And so that was something that was really true for me. Like, yes, I could still be a doctor. I worked at the urgent care. Eventually I, transitioned from urgent care to telehealth back in 2016. So it was like a super new field at the time. And because I had this ability to create great relationships with people and relationships with patients, I was chosen to be a medical director of this startup, telehealth company, who was trying to figure out how they could create continuity of care within telemedicine. Because, like, so many telehealth companies at the time, and even to this day, they’re one off platforms, right? Like, you get a doctor to talk to you about your cold, and it’s just like that urgent care experience. Like, but if you come back the next day, that doctor isn’t there. Now there’s some other doctor who you have to tell your whole life story to all over again. But we really wanted to create a touchless care platform for injured workers where they would start with you as their doctor from the time of injury all the way until discharge, and you would just manage all of the care remotely without ever having to, like, lay hands on them. So there was this whole new opportunity at the time to define what would eventually, like, I think coined by, like, maybe Amwell or Pella Doc or something they called it, started calling it website manner, you know, and I was just like, it’s just treating people like humans. I was like, so only tool really at, your disposal in telehealth is your ability to connect with somebody remotely. And I read in an old medical textbook that said, like, 85% of diagnosis is actually good history taking. And I was like, true. Then obviously, I could diagnose more people via telehealth than I could in a clinic setting, even, because I have way more time on my hands to just talk to them and listen. Like, this is my main tool is listening. And so we developed this whole, like, you know, website manner protocol where we could teach doctors to be human again and listen to people and hear what they had to say and also kind of look around their environment, like, do you see, are there other people in there? Does there something that maybe looks hazardous to them as they have this back injury or something, that you could talk to them about. So we just became, like, really good observers, and that really just helped change the trajectory of how I saw myself and made me a leader in the space, because it was such a new space, and there was a lot of opportunity to kind of step forward and to say, like, this is the way we think that other human beings should be treated in the realm of telemedicine. And this is why telemedicine is important and to really, like, defend it as, a tool and as a care, a place of care, rather than most people were just like, oh, what’s that? Like, telemedicine? That sounds weird. It wasn’t until

00:55:00

Dr. Brittany Busse: Covid that people really saw the utility of it. but I started doing that in 2016.

Dr. Frances Mei Hardin: Yeah, but that’s awesome that you were on the front. Yeah, exactly. Like, you had already been in that space. So I would imagine that was really, like, a gift to be at the right place at the right time in terms of the whole telemedicine movement and things like that. And I do want to say that I completely agree with, you know, what you mentioned about, like, we shouldn’t glaze over the bad parts. Like, some of this stuff that happens in graduate medical education, it. Unfortunately, some of it is life ending. For some physicians we know physician suicide is a real issue. And so I absolutely agree with you. We don’t glaze over the ugly bits. You know, certainly in this podcast on my site, rethinking residency. Like, I actually do believe in talking about the. The ugly bits in part, because then we can prepare others for them or, like, think about ways we could improve or do them better, or think about ways that the culture can change.

Agreed that authenticity is key to marketing and attracting patients

Like, what you’ve alluded to, then what I think is also awesome, and I really appreciate you sharing, is the other side where, yes, you very much lived and created, you know, and then you happen to be. I don’t mean happen to be like, I’m not belittling this. This is incredible. You happen to be at an incredible position. A very. You know, you really advanced your position. And then when Covid happened, I would imagine being a leader in the telemedicine space. It’s just incredible, you know?

Dr. Brittany Busse: Yeah, it’s been fun. And honestly, it’s. It’s going back to, like, that part of me that. That says that, it’s not okay to keep impeding on other people’s boundaries. Right. Like I said, it’s not okay for me. And, like, I don’t tell other people what to do because I don’t like being told what to do. Like, that is just the number one thing that people should know about me is that I’m out here trying to create a better system and a better paradigm for doctors, because the way that we’ve been treated and trained is wrong. And it only entrains us to continue to participate in the broken healthcare system that is run completely on our backs and tears at this point. And some cases, like you said, blood doctors have fed this system for too long. And, the doctors who were abused have become the bullies. And it’s this perpetuating cycle of victims and abusers that just can go on and on and on indefinitely. And the only people winning in this scenario are huge healthcare organizations and hospitals and insurance companies. Like, no doctor is winning in this. So you can be a bully all you want and be self righteous in that, but it doesn’t benefit you, it doesn’t benefit anyone else, and it definitely doesn’t benefit patients, like, we’re finding. So sticking to my authenticity and what I believed was right for me and, like, knowing that I deserved to have a life, that I was worthy of living my life and having a family and being a multifaceted person and that that didn’t make me a bad doctor. Like, knowing that and carrying that forward helps me continue to, you know, push other doctors just a little bit harder to envision their life as a practicing physician outside of this paradigm that we’ve all been trained into. And, like, you know, you’re living like, you know, private practice allows you to be who you want to be, to treat your patients how you want to treat them, and to still live your life as yourself, to be authentic, to be human. But I think the hardest and first step in that for most doctors is, like, regrasping their own identity and their own sense of authenticity. Because to survive in this program for so long and as long as they have, it’s amazing that they have made it this far, but they’ve been stripped of something so vital to themselves, and they need help recovering that part of themselves and to know that that part of them is good, that that part of them is beautiful, and that part of them is actually, like, the key to marketing and attracting patients to your practice. Like, just be yourself and say, hi, I’m a doctor. I want to help you. Like, patients love it. Like, marketing is not, like, that hard when you’re a doctor, honestly.

Dr. Frances Mei Hardin: Well, especially if you can be yourself, because I agree. We’re just along the journey, premed to med school to beyond graduate medical education. Like, we are definitely very much taught subconsciously to hide the parts of ourselves that are otherness in any way. because otherwise, you know, like we’ve talked about, that target may be put on your back and so, like, keeping your head down, trying to blend in. For some of us, it works better than others. you know, that that is very much part of the journey and it should not be because. Agreed. Like, typically, I think a lot

01:00:00

Dr. Frances Mei Hardin: of the best doctors I know have a lot of broader perspective and variety that they bring, like, a diversity aspect. that certainly it’s worth thinking about.

Do you believe in karma? No, I do. And in the end, if you have a habit of treating others poorly

And I do want to end with, I ask everybody, do you believe in karma?

Dr. Brittany Busse: No, I do. And the fact that, like, when you are, you have this belief in other people’s self worth because you have this belief in your own self worth. I think, like, at least those of us who are good, I think some people who are narcissists believe in their own self worth and not others. But most of us good people believe in the inherent worth of ourselves and others. And so for that reason, we treat people well, and people treat us well in return because they feel that shared connection and humanity. Whereas when you get the reputation for treating other people’s people poorly, like, we are a human society who, you know, for better or worse, loves to gossip, and we will always tell other people who treated us well and who treated us poorly. And in the end, if you have a habit of treating other people poorly, that is definitely going to come back and bite you in the butt.

Dr. Frances Mei Hardin: It absolutely. Well, thank you so much.

We really appreciate you joining me today, Doctor Busse

We really appreciate you joining me today, Doctor Busse, and it’s just been such a pleasure, you know, to learn about you and your story and your current work now.

Dr. Brittany Busse: Thank you so much. It was a fun conversation, a little traumatic for me at times, but I’ll survive.

Dr. Frances Mei Hardin: Oh, my gosh. Well, sincerely, you know, thank you for being so candid with us and your story, which you have shared in a variety of ways. It must make people feel less alone when they have similar experiences in their own graduate medical education, you know, journeys.

Dr. Brittany Busse: And just anyone can reach out to me anytime just to, like, put that out there. Like, I’m on LinkedIn. That’s the best place to find me. And if you want somebody to tell your story to, I am here, I will listen to you. And I, might not be able to help, but I can at least listen.

Dr. Frances Mei Hardin: Thank you so much. Yes, well, absolutely. We’ll put all your information in the show notes below and. Alrighty. So follow me on Instagram at FrancesMei, Md. And ah, rethinkingresidency. Visit my website, rethinkingresidency.com to learn more about resident physician stories and ways that residents can most effectively navigate the game of residency. I cannot wait to connect with you on the next episode of Promising Young Surgeon.

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