The Strong MD | Season 2 Episode 8

Dr. Hardin’s Medical Journey & Mental Health Mission

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From Biochemistry to Otolaryngology: Dr. Frances Mei Hardin’s Journey to Rethinking Residency

Doctor Frances Mei Hardin is a full time otolaryngologist

Dr. Jaime Seeman: Welcome to The Strong MD podcast. I’m your host, Doctor Jaime Seeman. On today’s episode, I’m sitting down with Doctor Frances Mei Hardin, a full time otolaryngologist and founder of the brand Rethinking Residency. She graduated from the University of Notre Dame at 20 years old with a degree in biochemistry with honors, completed her medical school education at Case Western Reserve, and finished a five year ent residency here in the midwest. In addition to her ent practice at a rural community hospital, she’s passionate about resident and physician well being and mental health. She’s a proud member of the physician writer tradition and advocating for a change in the culture of medical training. She’s also the host of the Promising young Surgeon podcast here on the Influent Network, a podcast by a surgeon for surgeons and physicians about the dark underbelly of medicine. Enjoy today’s episode.

Doctor Hardin, welcome to The Strong MD podcast

Dr. Frances Mei Hardin: Thank you so much for having me. It’s a privilege to be here. I’m doing great. How are you today?

Dr. Jaime Seeman: I’m. I’m fantastic. Like most doctors, we live these crazy lives, and nobody watching even knows this, but we’re having to record this podcast at an off time because that’s just what doctors do. You just figure it out in your schedule.

Dr. Frances Mei Hardin: Exactly. Make it work.

Dr. Jaime Seeman: Yeah.

Tell us a little bit about your pathway to medicine

Well, tell our listeners a little bit about your background. You’re obviously a doctor, but kind of tell us a little bit about your pathway to medicine.

Dr. Frances Mei Hardin: Sure. So, I am an only child, raised in Chicago, and I had a pretty unusual beginning in STEm. I’ve really loved science from an early age, and I moved away to boarding school at the age of 13, where I was a sophomore in high school at the Illinois math and science Academy. And I have not lived at home since then. at 16, I went to Notre Dame, where I became a biochemistry major. Knowing that I was very interested in either a biochem PhD or potentially an MD. And I really thought it’d be the former. But what happened was basically after several years of, like, computational physics work, astrophysics research, literally going out to, like, Arizona to go work in a telescope and collect data and things like that, it did get a little bit lonely running gels at 02:00 a.m. everything like that. And so when a couple of my close friends were pre med, I kind of got to this point where I was like, oh, my gosh, you guys are going to get to meet dozens of new people a day, take care of people, like, really be on the front lines of human engagement. And I took a medical bioethics class at Notre Dame. It was actually taught by this really cool priest physician, and I really fell in love with it. And that’s when I made that commitment. I took the MCAT, applied to medical school and everything like that.

When you were 18, what did you think medicine was like

Dr. Jaime Seeman: What did you think medicine was like at that stage?

Dr. Frances Mei Hardin: Well, that’s the right question, because, you know, when you’re surrounded by pre meds, everyone’s really young, hungry, bright. There’s kind of this excitement and buzz around it that is very irresistible, especially to a competitive young person. Like, I know that you were a college athlete. I rode at Notre Dame. You know, if somebody said, hey, this is going to be hard, this might be unpleasant, you know, that was attractive when I was 18 years old.

Dr. Frances Mei Hardin: And not only that, but I will also say that, like, that medical bioethics course was very impactful, informative for me. But that being said, the physician who taught that class, he was probably one in a million. He was a very, like, had an incredible character, very empathic guy, and he made medicine. I think he was able to sell it as a more empathic institution than it is in reality. And certainly in terms of the modern healthcare landscape and things like that, it was a little bit, disillusioning.

Dr. Jaime Seeman: Yeah. Is there anyone in your family that’s a doctor?

Dr. Frances Mei Hardin: Nope, I’m the first.

Dr. Jaime Seeman: Okay. Okay. Yeah, same. My mom was a nurse and actually in healthcare administration, so she gave me probably the only window that I really had until, you know, what medicine was like. And I think my mom had a lot of fears with me going into medicine and knowing that eventually one day, I wanted to have a family. And she actually worked with surgeon. She was part of the department of surgery. And I grew up as a little girl, in the conference room in the department of surgery, and I would come in on the weekends with her, and, I would

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Dr. Jaime Seeman: see the trauma surgeons had, you know, I think they were doing m and m conference, these morbidity mortality conferences, and I would see this stuff on the boards, and I thought it was so cool. And I, I did not want to be a biochemist. The basic science to me was, like, so boring. But I loved people and I loved surgery, and I loved, you know, of course, you know, back then, the show er with George Clooney was kind of a big thing. And so I used to watch this sensationalized, you know, version of it on tv, and for me, that seemed so intriguing. And, you know, I’m totally relating to everything you’re saying where? And that’s why I wanted to hear your answer on this, because I think so many people have a vision of what it looks like to be in medicine, and you can shadow and do all these things, but I don’t really know if you understand it until you’re in the trenches. So I really want to unpack that today. For sure.

Dr. Frances Mei Hardin: Totally. And I think of Grey’s anatomy, too, because these tv shows very compelling, and they just sell you, basically, you know, all your coworkers, your bosses will be hot, the attendings are hot. You know, you’ll find love, like, definitely. You know, residency is such an attractive journey in these tv shows. I do think that the resident, the more recent, you know, network tv, longstanding show that is the first one that I’ve ever seen that showed a more realistic. It felt very authentic to me. Depiction of the resident experience.

Dr. Jaime Seeman: Yeah.

Tell us about your pathway in medicine

Okay, so, tell us about your pathway in medicine. So go back to this idea. You’re gonna. Now you’re kind of interested in pre med. Tell us about the rest of the pathway.

Dr. Frances Mei Hardin: Yep. So, because I did make that decision, my medical bioethics course was as a junior in college, and so it meant that I would take a gap year after Notre Dame. So I took the MCAt as a senior. I did some Kaplan MCAT course, teaching, things like that. And then I went and did full time ent outcomes research in St. Louis at Washu. And so during that time, what’s interesting is that I ended up in that office because I wanted to do. I had bio stats experience, and I actually knew the PI who ran that outcomes office. It wasn’t because I knew about ENT. You know, it’s certainly a slightly more obscure surgical subspecialty, you know, ear, nose, and throat, head and neck surgery. But because of my history of studying biostats out there at Wash U and knowing this PI, I got this full time research job. When I came out of that year, I was pretty sold on NT. And so I went into medical school. I moved to Cleveland. I went to case western. And, you know, I. I did know early on that I wanted to do ent, and I had a lot of research experience thanks to my gap year. After medical school, I moved for residency. And there I spent five years doing my ent residency. And now I’m a couple years into practice outside of Nashville in my solo ent general spot.

When I came into medical school, I wanted to do emergency medicine

Dr. Jaime Seeman: I’m very interested to hear how your med school does it. When I came into medical school, I was at the University of Nebraska. We had to make a prediction as to, like, what kind of doctor we wanted to be when we came in. And then, of course, on, graduation day, they hand you back this envelope and you actually read it in front of this whole room. And it’s interesting to see what people chose and what their ultimate outcome was. Did you guys do something similar?

Dr. Frances Mei Hardin: Wow. No, we didn’t. And I think people. Most, I would say most first year medical students would really struggle to even put something down on paper.

Dr. Jaime Seeman: Yeah, 100%. I wrote emergency medicine, and once again, it’s because I had this fantasy in my mind of the show er, and I thought I loved, like, how fast paced it was, and it looks like just an awesome career, and you’re just constantly moving and you’re, like, saving people’s lives, and you’ve got blood down to your elbows, and, you know, at the end of the day, you feel so, you know, incredible that you’ve saved all these lives. And then as I got into medical school and I’m in the emergency room and we’re at an academic hospital, and it’s in a, you know, a particular part of our city where a lot of, you know, underserved, low income, the people who use the er, it wasn’t, you know, we did have trauma, but it wasn’t always, you know, the right access to our healthcare system, and it wasn’t what I thought it was. And as I. As I went through, I was like, well, I for sure don’t want to do emergency medicine. but, you know, I watch even now as a private practice physician, I still work with medical students at the hospital I’m at. And it’s so interesting to me to ask them what they want to do. Many of them have absolutely no clue. And our medical school has actually changed its curriculum a little bit in that it’s getting, medical students out of the classroom

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Dr. Jaime Seeman: a little bit quicker and into the rotations to kind of experience that, because I think there is somewhat of a disadvantage to people when they come in and don’t really know and decide really late. And a lot of that has to do with. With. With the match process and, you know, getting away rotations and. And getting, you know, in it to know people. Right. A lot of sometimes where you end up is like, who, you know, who can get you in there? because it is. It is a highly competitive, you know, field, depending on what. What subspecialty you’re really wanting to go into.

Dr. Frances Mei Hardin: Exactly. And I think that what’s tough with, especially the competitive subspecialties and the current culture around research. There’s basically this medical student, they call it the research arms race because neurosurgery, you know, applicants are expected to have these way high double digit numbers of publications. I’ve actually seen, though I do think that this is going to come to a head probably sooner rather than later in terms of what it does is it churns out more and more publications that may include, like, lower quality pieces or even like, pay to play publication pieces. And so, I’ve seen people propose that maybe they would do something like max of 20 publications that you can list on your application that would force applicants to make those 20 count or be like, of higher quality. But, yeah, it’s incredibly difficult. That’s like, so daunting to think about. You’re a medical student, you’re not 100% what you’re going to apply into, but you know that you need, you know, a dozen publications in that stat.

Dr. Jaime Seeman: Yeah, yeah. And for the people that really aren’t always interested in research, you know, I think you can still be a fantastic clinician and not necessarily have to be published. Right. I think that’s like medicine. There’s academics and there’s, you know, the clinical side of it. And, I don’t think everybody has to be in, in both. In both pots necessary. And it doesn’t mean you’re, you know, not a good doctor, and it doesn’t mean you’re not still contributing to the field.

Dr. Frances Mei Hardin: I know. So we don’t want to lose those people because I totally agree. Like, what if there are incredible clinicians who would be able to, you know, have long careers if not for the fact that maybe they were a couple research projects short to be a competitive applicant in a certain screening setting?

Dr. Jaime Seeman: Yeah, well, and just the demand on are medical learners. I mean, the amount of information that is required to be known now compared to even ten years ago is very different with this day and age of AI and the Internet and genomics and now the microbiome, and we’re really expected to retain much more information and then have a life right outside of that, which I definitely want to talk about.

What’s the return on investment when you give up your life

I mean, you can really just commit every minute of your day to doing this. And then it’s like, what’s the return on investment in the end?

Dr. Frances Mei Hardin: It’s diminishing, for sure. It’s a diminishing return on investment. And I do think that where we’re at right now, the accepted answer is that what you give up is your life.

Dr. Jaime Seeman: Yep. Yep. A hundred percent. 100%.

There are instances where one surgical residential is fired from a program

Okay, so, you matched into ent. You went to residency. Tell us how you got to where you are now.

Dr. Frances Mei Hardin: So my residency experience, it was definitely challenging. And, you know, five years is a long time to be in a work environment that is very disturbing to your mental health. I guess. You know, I always. I’m always working on finding new ways to, pr spin this or kind of say it nicely, but I like to use, for instance, just like, one broad example, because I think that it demonstrates some of, like, the systemic issues that were going on when I was a new fourth year resident, we did not have any rising third year residents. And I’ve certainly met surgeons over the past many years where there are instances where, like, one surgical residential is either, like, fired or quits or lost from the program. And especially in a smaller surgical program, people talk about how much that affects the dynamics. I mean, you know, that can be, like, almost a catastrophic loss, in my experience, losing that whole class. And it was the one immediately under my class that had very significant effects not only on relations, like interpersonal relations and dynamics in the department, but also just very literally on the workflow, because the volume of patients and the number of cases and the number of attendings didn’t change. We just lost, that class of residents. And so I

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Dr. Frances Mei Hardin: do think that that kind of can give people some insight into, how difficult of a workplace situation and scheduling coverage issue it was.

Dr. Jaime Seeman: Are you saying they got rid of an entire class of residents?

Dr. Frances Mei Hardin: Yes, it was just. But the thing is, you know, in Ent, we were a mid sized EnT program, which meant 2323. Every other year, I was part of a three year. The two under us, both gone. One was held back, and one was terminated.

Dr. Jaime Seeman: Wow. Wow. I mean, was this truly, like, bad performance? This person shouldn’t be an Ent surgeon, or do you think it was related to, like, malignancy within the program?

Dr. Frances Mei Hardin: I think that, you know, kind of a combination of multiple things, but just in terms of, you know, subsequent allegations of discrimination based on mental health, allegations of discrimination based on race, there were certainly valid, you know, points to, I think, both of those, somebody picked on, yeah, legal suits that were brought in. But I think that. But here’s the thing that’s so wild to me, and that’s not unique to my program or my experience at all. I have been, like, either privy to or adjacent to various departments, even around the country, where there is a culture in a surgical residency that just says, you know, every couple of years, we pick whoever, maybe, like, the weakest link is, and we fire them and. Or at any given time, like, I mean, I’ve had attending say to me every single class, we pick one person who we don’t like, and, you know, if they can’t cut it, we’ll get rid of them. So that is very much. That’s not an isolated thing. And I have a real problem. Like, I have a lot of questions for surgery and the culture of surgical training. That that is something that exists at multiple programs.

Dr. Jaime Seeman: Yeah, my program, a gal a year ahead of me was let go, and a couple years behind me was let go. Yeah.

Dr. Frances Mei Hardin: I’m not convinced that it’s genuinely because the people who are let go are not capable of being a great physician or a great surgeon. I do think that there is this, like, culture of fear and intimidation that is reinforced by, hey, if you, like, are on your toes, you might be that person who gets picked and fired.

Dr. Jaime Seeman: Yeah. where do you think that comes from? This. I mean, for me, like, the only word that really comes right to the forefront of my mind is, like, hierarchy. Like, there is hierarchy in medicine.

Dr. Frances Mei Hardin: Yeah, the hierarchy. I guess if I could have two words, I would pick, like, power trip. You know, I do think that a lot of competitive, especially surgical subspecialties, there’s, like, a lot of gatekeeping. There’s a lot of this sense that’s like, we’re very elite. You can’t be part of us if you are not, like, the absolute best. But especially in the face of a very real doctor shortage, a, surgeon shortage in the US, like a kind of underserved, you know, population in many areas, I guess that I obviously really believe in excellence. I really believe in high standards. But rather than a lot of the cultures being this, like, supportive, like, hey, you’re a hard worker. You’ve been a hard worker and a very resilient, bright person for 30 years to get here. Like, I’m going to give you props for that. That. And I assume that even if you do need a little bit of extra teaching or a little bit of extra, like, technical or skills work, that we can get you there. Like, we win. If you win and we can get you there, that would be. To me, I’ve never. I’ve rarely seen that, you know, whereas the flip side is just saying, if you show an ounce of weakness, you’re out. Goodbye forever. Like, best wishes to you, you know, as opposed to more of this culture that is, like, if one of us wins, we all win. Because I will say that when I was a junior resident, if a junior resident was doing well, depending on who the chief was, we had some really malignant chiefs. And if the junior did well, then the chief would act as if they were in competition with the junior. But, like, how, you know, how morally bankrupt do you have to be to be threatened by, like, an Internet? Like, if they’re showing promise, that’s awesome, because if that person becomes a great chief one day, they’ll be like, they’ll tell tales of you.

Dr. Jaime Seeman: Yeah.

Dr. Frances Mei Hardin: And how great of a job you did teaching them and things like that and supporting them.

Dr. Jaime Seeman: Yep. Yeah. just back to this, like, idea of hierarchy. It’s kind of like, as a chief, like, you don’t want anyone to look like they’re a better surgeon than you, and they’ve only been here, you know, one year or two years, and you have to, like, keep your pecking order, you know, amongst. And. And, you know, it’s like when you come in as a medical student, right? You wear this short white coat. It’s like, okay, here’s your place. Like, you’re not.

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Dr. Jaime Seeman: You’re not us yet. but it’s so true. I mean, what’s the last person in the medical school class called? Doctor. Right. And I think if we could. If we could have a vision of, you know, if you have 150 people in each med class, like, you should be able to produce 150 amazing doctors. I mean, it’s always going to be attrition, but the competitiveness of it, you know, like, this isn’t the NFL. Like. No. Yes, it’d be fantastic to be mvp of the league, but, what we need in America is lots of really good doctors. And I think all of these people with the right mentors and with the right teachers could be. I’m absolutely with you. I mean, like, I’m just thinking of the two people that. That were let go from my program. Were there some personality things? You know, like, absolutely. We’re all unique individuals, but. But their skills, really, at the end of the day, I mean, of course you want to make sure somebody’s competent to be, you know, have somebody’s hands in or life in their hands.

Hierarchy is prevalent in all medicine, I think it’s prevalent

but it. But it is really sad how we really are eating our own young, in a sense.

Dr. Frances Mei Hardin: Exactly. And, you know, when you talk about hierarchy, which especially. Yes. It’s prevalent in all of medicine, I think it’s to the point that it’s like a cancer in the ors and things like that, there’s. There have even been studies in the literature where they talk about hierarchy in the oR, it was studied in Canada recently, and they talk about the north american culture. They actually experimented on this group of anesthesia residents, and it was pretty funny because I was commenting like, if being a resident is bad enough, these anesthesia residents, they brought in an actor, and they were told that that new actor was an attending in their department. So they were like, listen to this guy. And they put them through these, like, high fidelity scenarios where that new attending was saying, I know that the patient’s a Jehovah’s Witness, and they have declined any blood transfusions, but give them a blood transfusion, like, I’m telling. I’m telling you to do it right now. I’m, the new attending in the department. And then they do all these interviews with the residents afterward where they say in, you know, 15 different ways how strong the hierarchy is. Because, you know, most people would give blood in that situation, not because they’re not aware of the medical record, they don’t understand what a Jehovah’s Witness and declining to consent to transfusion is, but because of how powerful your attending being in your face, you know, or saying things like that is. they do comment in the literature about how there are other cultures, like, in scandinavian cultures, where, like, doctors and nurses are paid much more comparably, and that even plays out in terms of, like, interpersonal dynamics, team dynamics in the or, that makes a lot of team members much more likely to actually just kind of say, hey, I’d like to double check this, or, like, you know, respectfully, I’m going to question this in a way where typically in north american or cultures that is not considered as acceptable.

Dr. Jaime Seeman: Yeah.

In residency training and ent, um, did you have mentors that you really look to

In your residency training and ent, did you have mentors that you really look to that you said, like, you know, I really want to emulate that? Or was it just kind of, you know, blanket toxicity almost.

Dr. Frances Mei Hardin: You know, blanket toxicity is harsh. I definitely. I had some mentors, but what I think I lacked was any strong role model for, like, ways to deal with the system. I think that basically, when you do have that moment of disillusionment, you can decide either to keep your head down and just keep quiet about it and then graduate with as, ah, little, you know, tension as possible. Or you can figure out a way to, again, like, respectfully address it, to respectfully call it out and just say, do we really think that we can defend that? The best teaching style is, you know, scaring the daylights out of people and screaming at them and making them, you know, extremely depressed. I don’t know. I would love to. I’m always open. I’m like, I would love to hear a defense of that. If you think that that is the strongest teaching technique out there, especially when a learner comes and tells you, hey, you know, I do want to just say, like, I learn best if the daylights are not scared out of me. You know, maybe some people do learn best that way. But I do think that in terms of, like, this next generation of surgeons, like, there’s, also going to be a fair number who. Who prefer not to be exposed to that type of a learning environment.

Dr. Jaime Seeman: Yeah, I think. I think as attendings and as leaders in medicine, we have to be approachable. I remember, you know, just being so scared as a med student and even

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Dr. Jaime Seeman: as a resident, you know, they called it pimping. That’s literally what they called it, pimping where you were just pimp the med student. And it was just like, how many questions could you ask that they could get wrong? Like, it was like, notches on your belt. And, it makes learners scared. It makes them not want to ask questions. and I think it’s honestly dangerous, but changing culture is hard, and it really takes good leadership is really what it takes. I mean, it’s a top down issue.

So tell me where the aha moment was, you know, for you

So tell me where the aha moment was, you know, for you, because you’re now doing amazing things. You’ve got this new podcast called the promising young surgeon. I know you have a website called rethinking residency. Tell me where the Aha moment was that you could contribute to the solution and less of the problem.

Dr. Frances Mei Hardin: Yeah. So towards the end of my fourth year, basically there was one specific incident where there was just, like, overt abuse and bullying in the or. And it did lead to me, you know, taking a stand. Like, I’m actually grateful, enough time has passed, enough therapy has occurred that that’s the type of thing where I’m grateful that that happened. Overall, if my residency experience had not been as malignant as it was then, I wouldn’t have had the opportunity to create all of the resources and advocacy that I do now. And I care a lot about it, and it brings, you know, it gives me a lot of, you know, meaning and direction, and so I’m grateful for it, and so I’m grateful for the trauma that led to it. rethinking residency was really born after I graduated. It was while I was an early attending in my practice. But what had happened is that I then spent a good amount of my chief year in therapy. I started dialectic behavioral therapy. DBT Skills group is a subset of, you know, evidence based therapy. And so the first day that I showed up to DBT group, it was a Tuesday evening, and I walked in, there’s a group sitting around the table and they were like, you know, welcome to group. Here’s what we’re going to do for twelve weeks. You know, like, the different modules include distress tolerance skills, interpersonal effectiveness skills, and emotional regulation. And I was like, knock me over with a feather. Like, where have you been for four plus years? It, actually blew my mind. And I was like, wow, I’m so happy to be here now. But again, I could have used you, like, the whole time. And so rethinking residency was built out of this desire to get a lot of high quality resources out to residents today. Like, yes, at the ACGMe level, at the national level, a lot could be done to improve graduate medical education. But I know that the time scales on that are much longer. And so a lot of my work has been like, okay, well, the Internet exists. It’s incredible resource. We should use it to reach some of those people who are suffering. I used to lay on the floor of the bathroom and it was in the basement of the hospital. It’d be like late on a weeknight. I’d be on call. I’d just be in there crying. I’d google things like resident physician suicide, resident physician depression, leaving residency, and I would get almost nothing. No firsthand accounts, like, no, no resources. There was like a one page PDF handout from GME and that was like, you know, take a bath, call 911 if you need to. I guess it was like so impractical and so rethinking residency. Everything that we talk about. I’m promising young surgeon. You know, my podcast, it’s to create more conversation and at least different strategies even on how to survive. I think that the main goal is not only to survive, that would be priority number one. Number two is survive while still survive without graduating as a shell of yourself. Because that happens to a lot of us. And that happened to me. Like, I gave up and I lost a lot of things that I never would have conscientiously or willingly gave up along the way to this path to becoming a surgeon. And so I don’t want other people to also experience that.

Dr. Jaime Seeman: Tell me what you mean by that. You like giving up, family, friends, money? I mean, what is. What, what was the price that you paid?

Dr. Frances Mei Hardin: Yeah, you know, that’s interesting. I guess I would say gave up, you know, any sense of peace for five years, I gave up. I really had, like, who I was as a person. I had my character very much tested in real time, like every day in such a malignant environment. And here’s what I mean by that. The bystander effect’s very real. There were absolutely

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Dr. Frances Mei Hardin: many instances throughout my training where I was neither the person screaming, hurling insults, and I was not the person being screamed at. I was just another team member in the room, in the elevator, in the hallway, in the conference when it happened.

Dr. Jaime Seeman: Yeah.

Dr. Frances Mei Hardin: And we don’t, you know, and. And there are times where I. I mean, I saw and heard some of the most messed up stuff, like you’d ever see or hear in your life. didn’t say anything. You know, I certainly wasn’t, like, the top ranking person in the room in that stamp, in that situation. Often I would be like, an intermediate person. So if I’m a mid level and then, like a five’s yelling at a two or a one, I’m just stuck in the middle. But that being said, I just am a person where, like, I would remind everyone, you have to live with yourself at the end of the day. And I don’t want to be the type of person who is in rooms like that where abuse is occurring. And I don’t say anything.

Dr. Frances Mei Hardin: So there are many instances where I’ve gone back even later and apologized to the victim and been like, you know, I apologize. I should have been like, hey, you can’t say stuff like that. I say, I’m sorry. I didn’t. I was afraid, you know? But I do think that, like, that type of thing, you know, it can be very challenging. I take that really seriously. Like, I take my own integrity and the type of person who I would be in those situations. I just take that all really seriously. So in terms of what it took from me, you know, took a lot of peace.

Dr. Jaime Seeman: Yeah.

Do you think that young, uh, people listening to these stories will want to go into medicine

Do you think that young, people listening to these stories will want to go into medicine? I mean, it’s, you know, I almost fear that we’ll scare the good ones away.

Dr. Frances Mei Hardin: Well, I don’t want to scare the good ones away and those who will be a good fit, you know, I think that we’re doing the right type of work because changing the culture of medicine, having these conversations now, does mean that there’s a good shot for things to continue to change in the future. What I think that a good mentor and role model can do is just do more than saying a lot of what I experienced through med school, through residency, which is that if an event happened, an abusive event happened, and I show up to my mentor’s office crying, then they would listen very patiently, kindly, and they’d be like, I’m sorry, that sucks. And honestly, that’s happened to me. Like, I know, I know it. It happens, and it sucks. And they just patiently, they give me tissues and maybe, like, a small candy bar, and then, But that’s it. The conversation ends there. And I think that that’s part of the reason why not much has changed over. Over the past several decades, I think, in terms of, like, really functionally, practically the culture of surgery, because step one is to validate, you know, what the person is saying and maybe relate to them. But where’s the step three? Where’s the solutions focused approach, which I am all about, that is something that’s been absent. And so I basically did make a commitment in residency where I was the person, you know, seeking all this mentorship. I was getting a lot of that sucks, and I believe you, and also, I’ve seen a ton of that. So, again, like, you’re not telling me anything new, and I’m sorry it happened.

Dr. Jaime Seeman: To you, but mildly validating.

Dr. Frances Mei Hardin: Yeah. Oh, exactly. They were like 1 million%. Like, I’m sorry you’re hurting. And what I wanted to do, I made this commitment to myself. I’m never gonna say that. I mean, I do say all that, but it’s never gonna stop there, because if a young pre med physician, what have you, if a young learner of any kind, if someone comes to me and they’re like, this happened, I’m never going to let myself just phone it in and be like, that sucks. I know. I know it like that. It be like that. Like, that’s not. To me, that’s not a complete and acceptable answer, and it’s not an actionable one, and it’s not a solutions focused one.

Do you think this culture is isolated to surgery or is it across medicine

So do you.

Dr. Jaime Seeman: Do you think this culture does not exist in family practice, pediatrics, internal medicine? Do you really think it’s isolated to surgical subspecialties? I have no idea because I don’t have any. I’m. I’m in a surgical subspecialty. But probably you’ve talked to a lot of people now going through this and building what you’ve created.

Dr. Jaime Seeman: Do you think it’s across medicine, or do you think it’s really isolated to surgery?

Dr. Frances Mei Hardin: I think surgery is one of the last strongholds, you know, it’s a spectrum, and I’m sure that there are some medicine programs that are more hierarchical. That being said, I do think that a couple things make surgery unique. Which one, the or is, like, a pretty secretive, distinct environment, and number two, in the surgical subspecialties that are small programs. I do think that any small program is much more prone to these issues. I’ve actually had. So, for instance, I do have a lot of pediatrician friends who have had overall, extremely positive and supportive learning

00:35:00

Dr. Frances Mei Hardin: experiences in medicine. I have colleagues who loved residency. They did wonderful. They were part of, you know, like a big group. They are brilliant doctors. So they just killed it. Then they went on to fellowship, where they were now in a very small program. Again, spent a couple years, just, like, one to three people per year, and it was a completely different experience. Then their stories of fellowship mirrored mine of residency, which is interesting. That kind of points to. Okay, so is it an issue where if you make this tiny microcosm of, extremely hierarchical, like, it’s these attendings and then these trainees, and they’re all locked in a room together, are those dynamics, you know, prone to being deranged? It seems like it. Absolutely.

Dr. Jaime Seeman: Yeah. Yeah.

After residency, one thing that made a huge difference was starting hypnosis

Okay, so let’s talk about. Let’s talk about solutions. I went to your website. You’ve talked about a few things. Where. Where can somebody start? There’s a resident listening right now, and they’re like, oh, my God. This is. This is what I’m experiencing. Where. Where do they go? Where do they start? Do they just hire a therapist?

Dr. Frances Mei Hardin: Therapy is incredible. We should. We should all give therapy an honest go. I do think you, know, I will say for me, specifically after residency, one thing that made a huge difference was starting hypnosis. And so I actually bring my therapist, who is a member of the National Guild of Hypnotists. Like, she’s incredible. She comes on one of our upcoming episodes of promising young surgeon and even does a hypnosis exercise. So if you do want to start there, she’s really incredible. Therapy makes a big difference. I know residents who have joined DBT group like I did, and then on rethinkingresidency.com, comma, it’s almost like a, newer age and physician specific thought catalog. You know, that’s maybe a dated reference. Like, now you can tell I’m in my thirties. But thought catalog, back in the day, it was incredible because you could just go there, kind of look at the recent news. Look at recent columns. We have two ongoing bi weekly columns. One is about the hidden curriculum of medical training. And that’s incredible. It’s from Ahmed peds attending. She is one of the best teachers I personally know in medicine. So a lot of her lessons from her columns are incredible. And then our other one is a biweekly column on self compassion. And a clinical psych PhD. Doctor Lawson writes that one. It’s really. It’s just great stuff to keep at the forefront of your mind. Right? Because when you’re a resident and your head’s down and you don’t talk to anyone outside your program, anyone outside your hospital, and you’re burned out, it is so hard to be solutions focused, and it’s also hard to have perspective. Residency is a job. Self compassion is important. I don’t see a lot of people in the hospital being like, self compassion is important. Remember, be compassionate towards yourself. Like, no, those reminders may not come from inside the house. So I do think that a lot of those support resources. I have also written a bunch of articles about application of DBT skills, like, to the or, things like that. Those are all on the website. Check out the promising young surgeon episodes, because I bring tons of different physicians or healthcare adjacent professionals on, just to share their expertise with us. And inherently, we even have strategy episodes. The strategy, quote, unquote, episodes of promising young surgeon are about how to have better perspective, how to treat residency like a job that you can excel at, but there’s a world outside of it as well.

Dr. Jaime Seeman: Yeah. You know, I found that, my way of dealing with the stress and the pressure of my medical training was, having a life that I could go back to at home that kind of recentered me, regrounded me, and allowed me to be resilient through the whole thing. And I have an incredible partner. I’m married. I have three children now. and. And, you know, I’m on the other side of it. But there were some really hard years, you know, that. That I went through, and, I was not doing it perfectly, you know, now I’m like. I don’t want to say I’m living a cush life. It’s. It’s just so much different. I’m in private practice now, so I own my practice. I’m my own boss. Like, there is. There’s no one above me in the hierarchy. And it’s not a control thing for me. but it is, in a sense, that, you know, I get to control my own well being. And I think it’s hard when you’re a medical student or a resident to feel like you are actually in control of anything at all. You know, it feels like you’re on this roller coaster that someone else is driving. And,

Camryn Ludwigs says people are leaving medicine in droves

So I love what you’re doing. I just want to say that I love what you’re doing. you know, you are really giving back to the medical community, and, of course, it’s not just surgeons, and it’s. It’s not just doctors. You know, just everybody in medicine right now, it’s a really hard time.

00:40:00

And I’ve talked about this on other episodes that, you know, people are leaving medicine in droves, and if we don’t address this, it’s only going to cripple our healthcare system further. I know you’ve talked about on your podcast, you know, Ama has said, like, 40% of people at any given moment are kind of eyeing their exit in medicine. And, that’s really sad when you think about the, intellectual ability of these people, the financial, investment that they’ve made. Well, we’ve talked about it. The mental and emotional investment they’ve made. I remember years ago, what’s the, Who’s the guy, that does, He’s on social media. Zdoggmd, what’s his name? he put out this social media thing, and it was talking about moral injury in medicine. And that has resonated with me so much ever since I heard that word, because I think about myself as a young girl looking at Grey’s anatomy and er and what I thought it was going to be like and then being on the other side of it and thinking that is not what it’s like at all. And this idea of moral injury just continues to resonate with me, that, you know, just even last night, I came home from clinic with a giant stack of charts to finish, and I’m like, okay, I took care of the patients, but now, like, I’m taking away time from my family and kids because I have to, like, you know, just the clicking of the buttons and the paperwork and the things that. That you have to do as a doctor. but that’s not what I thought, what doctors did, you know?

Dr. Frances Mei Hardin: I know. Well, and thank you so much for your kind words. I really appreciate you. And, you know, of course, everything that you do as well, because I think that by breaking down all these barriers, by really being, like, such a badass physician, I don’t know if I’m allowed to say badass, but, you know.

Dr. Jaime Seeman: Edit it out or say what we want. Don’t you edit that out, Cam.

Dr. Frances Mei Hardin: It’s incredible. Like, you know, and so I really appreciate the role model that you are and kind of the barriers that you do break for the next generation of physicians and everything. So I really appreciate that. And in my case, I’m also in solo practice. You know, I’m hospital employed, but I do control. I’m at a point in my career, even though I’m only a couple years out, I control the environment that I work in. So, in clinic, I have a group, we have a team of six women who all work there together with me. And, you know, I’m very proud to say that people show up to work, they’re not scared to show up to work. They’re not scared to say, like, hey, this is a really crazy question, you know, but what is this? You know, like, it’s not. It’s none of that. I don’t know what this is. And at this point, I’m too afraid to ask what it is. Like, there’s so much that’s important in terms of, like, all the team members were brand new to ent. They had never done ent, and a lot of the words are actually incredibly strange. Like, you would not have come m across them in your normal work, nor just alone. I mean, I know, and the women had done other surgical subspecialties, but. But that doesn’t mean that they know, like, Ludwigs and things like that. And so I do think that once we are at a point in our career where we can control the culture and set the tone, then that’s great. But, yes, kind of focusing on not losing people before they get to this point, I do think is really important.

Dr. Jaime Seeman: Yeah.

You’re working with physician writers on your website, Hippocratic Press

you talked about, people writing on your. On your website, and, I know you’re doing something with physician writers. I wrote my first book. just, I don’t know, it’s been, like, two years now. not something I thought I would be doing in my career, but I think sometimes it’s always good to put words to paper, and I think it’s important for medical students and residents and our other colleagues. what we consume does play a part in the thoughts and how our mind works. And so tell me the work you’re doing with physician writers.

Dr. Frances Mei Hardin: Absolutely. Thank you. So what we need are more candidates, high quality, non anonymous accounts, you know, from physicians and from healthcare workers of all types, because there’s certainly, there is a lot of activity, you know, on Reddit, some, Facebook groups that allow people to post anonymously but I think there’s so much power in just actually putting a name to it. And so I’ve aimed to create platforms for all of that. It’s been such a joy to connect with other physicians and to, you know, write myself because it’s such a great way for us to express ourselves and also to connect with other people in our field. And so I created a publishing house and agency for physicians and healthcare workers that facilitates that process of publishing. And it’s called the Hippocratic press. It’s a relatively newer press, but basically we take all the headache out of self publishing and we give opportunity for people to publish their works on our imprint, which again,

00:45:00

Dr. Frances Mei Hardin: it’s very much dedicated to the same mission of sharing healthcare related stories to improve the overall culture of medicine. And so at this point, we do work with people who have close to finished or finished manuscripts, but we do everything from editing, proofreading, format design, cover art, interior design, and then distribution and royalties, as well as the launch of the book and custom marketing plans and everything like that.

Dr. Jaime Seeman: That’s amazing. And tell people where they can find that if they’re interested.

Dr. Frances Mei Hardin: Yep, hippocraticpress.com.

Dr. Jaime Seeman: Dot hippocraticpress.com. and your other website is rethinking residency.com. yes, I’ve checked it out. It’s incredible. and you have a podcast, the promising young surgeon. And if people want to go check out episodes of that, I know they’re going to find content just like we’ve talked about today. Things that can really help people. and you know, not the sexiest podcast topic, you know, but so helpful and so impactful. And I think it’s incredible that, you’ve used your platform for that and giving others that space to share so openly.

Doctor Hardin has a mantra that defines this era of her life

Doctor Hardin, do you have a mantra that you live by? What makes you get up every day and do what you do?

Dr. Frances Mei Hardin: I do have a mantra and I love mantras, so I’m lousy with them. Like, I just have hundreds of mantras. I think that one that defines this era of my life, though, and that I love because it’s short enough. You need a short. I need a short mantra because I cannot do the longer ones, but it’s let go or be dragged.

Dr. Jaime Seeman: I love that. I love that. yeah, we were talking before we were recording about, reinventing yourself and that every era, every phase, whatever you want to call it, every stepping stone through your medical career, you have the opportunity to change and to grow and to become the person that you want to be. mine has been pay yourself first for a long time. I gave many years of my life for others and finally in my thirties, decided that, what self care actually was, was actually taking care of yourself.

Dr. Frances Mei Hardin: Like, not like shopping. I like shopping.

Dr. Jaime Seeman: Not a pedicure, but, the food that we eat and just like, you know, exercising and mental health and like real authentic human connection and for many years of my medical training, I, it just wasn’t a priority and, and I didn’t have the time to do that. And so thank, you know, thank God I got into a place in my life where I could really focus on that and focus on myself. And coming out on the other side of it has really allowed me to be a better doctor and a better wife and a better mom and a better human. And, version 4.0 is coming this year, so I’m excited to see what it brings.

Dr. Frances Mei Hardin: I love it.

Dr. Jaime Seeman: Yeah. Well, Doctor Hardin, thank you so much. Go check out her work, rethinkingresidency.com comma hippocratic press and the Promising Young Surgeon podcast.

Dr. Frances Mei Hardin: Thank you so much.

Dr. Jaime Seeman: Thanks for listening to The Strong MD podcast. I hope you enjoyed today’s episode with Doctor Hardin. Please go check out her website and her new podcast, the promising young surgeon. It’s time for us to change the culture and medicine, and it starts with each one of us. So if you can do us some help, leave your comments, subscribe, and share this with all your friends. We appreciate you. We’ll catch you on the next episode.

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