Humans Leading

Creating a Fulfilling Career: Pediatric Palliative Care and the Power of Communication with Dr. Jared Rubenstein

• Dr. Jillian Bybee • Season 1 • Episode 15

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In today's episode, Dr. Bybee talks to Dr. Jared Rubenstein, a pediatric palliative care physician, medical educator, and fellow creative.

In their conversation, they discuss:

  • How Jared got into medicine (including his unconventional dinner table conversations!)
  • Practices that can be helpful for navigating the challenges associated with working in high stress environments
  • The importance of communication, including active listening
  • Building a supportive work culture
  • Creative expression as self-care including Jared’s video series 
  • Advice for medical trainees


This episode has something for everyone, even if you're not in healthcare!

Things mentioned in the episode:


Connect with Jared:


Upcoming workshop announcement: If you’re feeling overwhelmed or looking for practical strategies to stress less and find more balance in your day, join Dr. Bybee in her upcoming workshop (early 2025), Transform Your Day: Stress Less with 3 Simple Strategies. 

It’s designed for busy professionals who want to take control of their well-being without adding more to their plates. 

If you’d like to be the first to hear details about the workshop and how you can get registered, head to Dr. Bybee's newsletter, Humans Leading and sign up for updates. 






Join me for more over on social media:
Website: Contact — Jillian Bybee, MD (jillianbybeemd.com)
LinkedIn: Jillian Bybee, MD | LinkedIn
Blog: Humans Leading | Jillian Bybee
Instagram: Jillian Bybee, MD (@lifeandpicu)
X: Jillian Bybee, MD (she/her) (@LifeandPICU) / X
Threads: @LifeandPICU

If you’re ready to kickstart your journey (or your team's journey) to a less stressed life…then I’m ready to help you! You can get in touch about 1:1 coaching or inviting me to facilitate a workshop for your group, get in touch via my website.

Dr. Jillian Bybee:

Hello and welcome to Humans Leading a podcast aimed at restoring the well-being and joy of high achievers who have burned out on their way to success. I'm Dr Jillian Bybee, a pediatric critical care medicine physician, medical educator, coach and leader in well-being and professional development. I use my personal experience with burnout recovery to help others do the same. This podcast is for anyone looking to move beyond hustle culture in order to find true fulfillment and well-being. In each episode, I share practical solutions on a variety of topics, including limiting beliefs, stress management, leadership, well-being and more. If you're looking to feel less stuck and redefine what a successful life looks like for you, this is your podcast. Come join me. Hello and welcome back to the podcast.

Dr. Jillian Bybee:

Today, I'm incredibly excited to share a conversation with Dr Jared Rubenstein, a pediatric palliative care physician, who I've been following for years on social media. It was so exciting to finally get to sit down and have a conversation with him. His humanity, creativity and dedication to his work have always stood out to me. In this episode, we dive into some truly important topics communication in healthcare or in life in general, the challenges and nuances of end-of-life care and what it means to create a strong, supportive workplace culture. We also discuss the vital importance of taking care of ourselves and our teammates, especially as healthcare workers, in such demanding environments. Whether you're in healthcare or not, I think you'll get something out of this episode, because Jared has a lot of wisdom to share. This is a conversation full of insights and I can't wait for you to hear it. All. Right, jared, thank you for coming on the podcast.

Dr. Jared Rubsenstein:

Yeah, thank you so much for having me.

Dr. Jillian Bybee:

Yeah, I was wondering if you could tell the listeners a little bit about yourself.

Dr. Jared Rubsenstein:

So I'm a pediatric palliative care doctor. I work at a children's hospital taking care of children and families who are dealing with serious illnesses, and our goal is to be that extra support for them, whether it's for pain and symptom management, helping plan for the future, helping maximize their quality of life and just helping them deal with everything they're going on, both the kid and for the family. I'm also a fellowship program director. I love medical education and I'm a husband and father of two little kids.

Dr. Jillian Bybee:

Great, I love that you started to delve in a little bit about what palliative care is, because I know not everybody understands. That's what we were talking about right before we started recording, so I was wondering if you could talk a little bit about how you chose pediatric palliative care and then what you do in your job.

Dr. Jared Rubsenstein:

Yeah, so I had a little bit of a sideways journey. I never thought I wanted to be a doctor at all. When I was a little kid I was scared of hospitals and so couldn't go visit, couldn't go see them. But my dad was a adult pulmonary critical care doctor. My mom was a social worker and so our dinner table conversations would often be about my dad's end of life patients and talking about you know how he would take people off fence to support them in a comfortable death, or talking to families and having hard conversations or going to funerals and it felt like little palliative care, interdisciplinary team meetings, and it always stuck out of my mind as something that was interesting but never considered it as a real career possibility because of the whole hospital fear thing.

Dr. Jared Rubsenstein:

And then eventually, when I found my way back to medicine and decided I was going to go to medical school, I realized that there was a name for that and it was a field of palliative care. And I did an elective and just loved it and it blew my mind and I knew that was exactly what I wanted to do. And then I was all set to do adult palliative care. And then I did my pediatric rotation after that and realized I love pediatrics and then thought you know, is pediatric palliative care even a thing? And it wasn't where I was a medical student or a resident, but I went elsewhere and did an away elective in pediatric palliative care and loved it and that's been my career and I feel like I just sort of fell into the best possible job.

Dr. Jillian Bybee:

Well, I think that's a great story and I can imagine a bunch of people listening to this wondering like, oh, you guys talk about death at the dinner table and I think that was one of the reasons I was so excited to have you on the podcast and chat with you, because I think there's so much for us to learn just from being kind of up close to death and being transparent about these conversations. But how was that to be a child having those, a younger person having those conversations?

Dr. Jared Rubsenstein:

It felt really normal. I mean, I didn't, I didn't know any better. I think, like like kids for all topics, until you like layer on all the social stigma and the baggage that we pick up as we get older, things just feel normal until somebody makes them not. And I think as a kid I just felt like it was nice to hear that my dad was doing this work of supporting people going through really hard times and it was just resonated with me as just feeling like that was something that was kind of nice and normal and it was just resonated with me as just feeling like that was something that was kind of nice and normal.

Dr. Jillian Bybee:

I imagine that was kind of a nontraditional environment. But I can also imagine that allowing you to see what life is all about and you know, it's not always the sunny parts, it's sometimes ups and downs that that had a lot of good effects for you and clearly influenced you either, you know, down the line to pick your career. But now that you're working in pediatric palliative care and you work so close to pain and suffering and death, I can imagine a lot of people also have a misconception that it's this very sad, you know, group of people walking around the hospital mourning all the time. But what is your day-to-day life really like?

Dr. Jared Rubsenstein:

Yeah, I mean, I think people imagine us as like sad little grim reapers walking through the children's hospital and when people meet our team or spend time with us or do an elective rotation with our team, they're always surprised that we're great and they have fun with us and they feel supported. And I think a big part of that is that we have. We maybe see more, more than the average share of sadness and difficulty, and but nobody that works in a children's hospital is immune to that and I think in our work we just it's normalized to have processes to cope with it, and so you know our day. We come in in the morning, we look at charts, we figure out which of our patients we're going to see today, and then we make a huddle with our our team. And that's sort of part of the beauty of palliative care is that I almost never see patients alone. I'm either with a nurse or a nurse practitioner or a social worker or a chaplain and we kind of roll as a posse and that's the whole. The beauty is that we're doing, we're in the same place at the same time, providing care together, so it's not just like we all see the patient and then talk about it later. Like we're all there in the moment together and it's great and we'll go around and we'll we'll do teaching. If we have trainees with us, we'll do the visits and then after most visits we'll just pause for a few minutes to chat and if we have trainees, we'll we'll do some teaching and talk about, you know, the communication strategies we used or the pain management we did or the other symptom management. But then, whether we have trainees or not, we also use that five minutes to do some processing and talk about it. Like you know, how did that one feel for you? Was it? Was there something that was particularly challenging? And being able to kind of talk about it and process it and put it to bed a little bit before we go into the next room is really powerful and I think having a team where we do that and we support each other in that is huge.

Dr. Jared Rubsenstein:

We try when we're on service together, we eat lunch together most days. That's something. I'm a I'll die on the hill that like I don't think you could be a good doctor with a full bladder and an empty stomach and I don't understand the culture of self-sacrifice and I always make sure we stop during the day and we eat one just to sort of get some nourishment and take care of ourselves. But also that's more time to kind of process, and sometimes during lunch we're talking about the visits of the morning. Sometimes during lunch we're talking about something not at all related to the care we provide, so that we can just have a little break from it and be together and talk and have camaraderie. And then in the afternoon we go back out and do it some more and do more patient visits. Sometimes we'll have family meetings or do new consults in the afternoon, talk to the other medical teams and it's just.

Dr. Jared Rubsenstein:

I feel honored that I get to be part of this work. And oftentimes I do get that question, like you know, that's so sad, how do you do it? And a big part of it is the processing throughout the day and sort of normalizing that you know we all do hard stuff. We should support each other in it and talk about it and to some extent it does. Let let me leave it on the field and be able to go home and I have my other self-care stuff that I do at home too. But but being able to sort of process and work through stuff as part of a team I think is huge.

Dr. Jillian Bybee:

I mean I could put exclamation points all throughout what you just said, especially the part where you were like I don't understand people and their self-sacrifice. As someone who you know, writes and speaks a lot about how I used to self-sacrifice and how poorly that went for me, I think that I could really relate to that, and I think hearing that you all sit down and have a meal, I think it's probably earth shattering for a lot of people in medicine, most people I talk to don't eat, they don't drink water, they don't hydrate, and I think you're exactly right that if we're not doing these things for ourselves, we can't possibly be taking care of other people and understanding everybody's schedules are different. That's one of the ways that we can do things to care for ourselves. But the other thing there that I think people don't do at all and the reason I part of my career is what it is is nobody really understands how to process these things. So what does that look like when you're talking about them as a group?

Dr. Jared Rubsenstein:

So it's really not rocket science Like we're. We're just talking and we take five minutes before we go into the next visit and say you know how this one sometimes people will talk about. You know, we all have hard times if the visit reminds like brought up something in your own life, like if we're seeing a kid that's the same age as our own kid or reminds us of them, or if a parent reminds us of ourselves. Sometimes it's just talking about the distress at seeing somebody who seems nice going through something really hard. Sometimes it's talking about the moral distress we feel from being part of a system that's broken and that we have to be part of doing things that we don't always feel great about and we wish there was a better way. And that's sort of the very informal parts.

Dr. Jared Rubsenstein:

The formal is more sitting down sort of, when we and saying you know we're going to explicitly talk about this patient or this case or this condition, and we get called sometimes to do debriefs for other teams after they've had a particularly hard day or a hard week and I love doing it, but I also. It always strikes me as kind of funny because I don't and I think most of us aren't. We haven't been trained as debriefers or as facilitators for these things. We just go and we say how's it going? I hear you guys wanted to talk about something and then just kind of listen and sometimes reflect stuff back and sometimes try to pick out themes and draw attention to them, but it's mostly just listening and at the end of all of them I always had the feeling that like they could have done that, like had they made a time and sat together for an hour and didn't invite me, it would have been just as good.

Dr. Jared Rubsenstein:

But it I think saying you're having the palliative care team to do a debriefing gives it gravity. That's honestly unnecessary. But understand that in a culture of where we don't do stuff like that and don't talk about that, it makes a difference, and one that I was excited in my mind. We did for another team at the hospital and afterwards the division chief, who was wonderful said you know, thanks so much for coming and having us do this. I hope we don't have to do this again for a really long time. And I said no. No, you have to do this again for a really long time.

Dr. Jillian Bybee:

And I said no no, you have to do this every day.

Dr. Jillian Bybee:

That's the whole point, absolutely, I think. As a person who didn't get trained to debrief people and who now speaks nationally about how you might start your own processing spaces, I also am always surprised how people won't just start. I think it's probably the culture in medicine where they're like oh, there has to be some formal process and formal training and there must be data about this and really it's just you sitting down, like you're describing, and saying how are you actually doing? And I think the other thing in there that your specialty and you specifically have experience doing is the ability to just be present with hard things and to not run away from them, because I think they make a lot of people uncomfortable. I think a lot of people could benefit from being able to be more present with hard things instead of saying the platitudes like things happen for a reason or whatever. But how do you actually start to cultivate that presence, like if you are one of these people who wants to start doing debriefs, or just someone who's dealing with a grieving friend or family member?

Dr. Jared Rubsenstein:

I think, like most things, it's just by it's by doing it and practicing. It's like it's a muscle that you have to strengthen and it's so. And you brought up the platitudes. I think we're all acculturated to have these platitudes and say everything happens for a reason or somebody's in a better place, or whatever these meaningless things are that we were all taught to say at some point. And it's, it's like a lot of things, it's an unlearning process. It's it's learning. You know that nothing, nothing good comes from a sentence that starts with at least, or nothing good comes from. I mean any of these platitudes and just being able to be there. And it's hard. It takes practice because it's not something we're used to Like.

Dr. Jared Rubsenstein:

When they they looked at their study study of doctors at some point where they looked at like how long we let a patient talk before we interrupt and I think it was some crazy like 17 seconds and so like if we're used to interrupting people in 17 seconds, like it takes practice to let someone talk for minutes at a time, but I always tell people to. Another study that I think was really mind blowing is that people are, I think in medicine we're always rushed and hurried. We worry it's going to take longer if we let people talk and as much as we may want to, we're worried it's going to derail our efficiency. The big word and there was some study of a surgery clinic, of all places, where they randomized the doctors to ask open-ended or closed-ended questions, like most of us are taught to, and surprisingly, the people who asked open-ended questions actually the visit ended sooner.

Dr. Jared Rubsenstein:

Because if you ask people what they want to talk about and let them talk, you get there faster and they tell you what's important to them and they tell you what matters, and then you can actually help them with what they want to be helped with, instead of what you think they may want to be helped with with all your close-ended questions. And so I think there's so many things that it's a more satisfying encounter. It's better you take better care of people. It's more satisfying for you to feel like you can just sort of be with a person and sit with them for a few minutes instead of having such an agenda, and in a lot of cases it is actually more efficient.

Dr. Jillian Bybee:

I think that's the soundbite right there. It's more efficient to just let people talk about what they want to talk about and also it is therapeutic to let them do that too, Like you're describing, that they have something there to say and sometimes they don't know how to say it and it might take a little bit longer. And I think that's the painful part is it can be really hard as inpatient medicine people or people outside of medicine to sit in silence. But I think that is also a thing in my background that I learned too is sometimes you just have to give people space and sit there next to them and allow them to be feeling whatever they're feeling, and so that you know they're not feeling shamed, they're not feeling judged by what they're having. They're just having a normal human emotion, and I think that's one of the things in medicine that we're not like.

Dr. Jared Rubsenstein:

It gets trained out of us in a lot of the different disciplines, especially surgery, like you mentioned you know, you're not a human, you're a robot, so you should not have emotions and clearly that's not the way absolutely, and on my team all the time we talk about sort of cultivating a practice of active listening, that like when you're listening you should really be listening as opposed to thinking about what you're going to say next. And I think, especially when you're in training, you should really be listening as opposed to thinking about what you're going to say next. And I think, especially when you're in training, you feel like you have to be thinking about what's to say next because you won't know. But the secret ends up being that like if you're actually listening, to listen and to understand what somebody's saying, you won't have to think that hard about what to say. It'll just come out and you'll know because you've been present with them and you've been listening to what they're saying, instead of missing stuff because you were thinking about what you thought you were supposed to say.

Dr. Jillian Bybee:

Yeah, it's really, you know, moving beyond surface, listening to respond and really listening to the emotions and the intonation of voice and the pauses and what's not being said. It's the sort of tuning into intuition which I think, again, in medicine is a scientific discipline. We've really taken a lot of the humanity out of it and we do ourselves a disservice in the process where we don't allow ourselves to show up as human beings. We're like the doctor robot and what you're talking about and what I'm talking about is how do we deprogram some of that and just go back to how we are as people, being together and caring for each other in a way that doesn't require us writing a prescription? Absolutely. You mentioned a little bit ago, speaking of listening, that you have inside the hospital practices for your self-care and kind of outside the hospital practices. How do you navigate such a potentially emotionally heavy career that also is very demanding of your time?

Dr. Jared Rubsenstein:

Yeah, and so some of the inside the hospital practices are the ones that I talked about earlier, and outside of the practices are sort of they they feed each other. That you know, when I'm, when I'm not at work, I try not to be at work and be with my family, do stuff with my kids, go to the gym, working out and getting out energy is really helpful for me. And I think having sort of having the forced mindset of like, um you know, I see kids and I'm sure you feel this too you know we see kids who are sick all the time and and it's easy to get terrified of your own kids that there's something going wrong and sort of having the mindset of like you know, at this moment my kids are healthy and they're okay and like I'm just going to be with them. And one of the other things that I do for sort of the work, wellness and and um, end of things is really thinking mindfully about you know, we spent so much time at work, like we spend more time at work awake than we do at home awake, most of us, and I think I see a lot of people where they think you know, my wellness is outside of the hospital and I'm just work something I do to get through and then I go home where my wellness is. But I feel like that's a missed opportunity, like I think we can be well at work and well at home and I think sort of taking some time to think about you know what it looks like If we talk with our trainees about what we call you know, creating a kind of work culture that you want to be part of, and for me I think that's huge, like sort of my, for better and worse, doctors are tasked with creating work culture in hospitals and we're really bad at it.

Dr. Jared Rubsenstein:

And I think being mindful about you know what your day looks like and thinking about you know, if I'm going to be here for eight to 10 hours, like I shouldn't just try to get through it, I should try to do my best work and enjoy it and make the most of it. And I think I think both are possible and it's it's a mind shift to get there. But but I think it's really important and I always talk to residents about that when they are getting ready to graduate because, like, if you don't mindfully do like, you're finally going to have control of your life to some extent when you're done with training and if you do things the same way you did as a resident. It's sort of the counter of like that, the financial advice like live like a resident for the first, however many years as faculty to save money which I think is great advice. But work-wise, I think you immediately have to remember you're not a resident and start mindfully. Now, this isn't three to five to eight years that you're trying to get through, it's the rest of your life and thinking about you know what you want that to look like and how you want to make the most of those days at work. And I think you can.

Dr. Jared Rubsenstein:

I think it's also an unlearning process because I think there's so much that's toxic in medical culture that we were all acculturated to. But certainly you know taking that dedicated time to say you know how do I want? I'm going to be here for eight to 10 hours a day. What am I going to do to make it enjoyable for myself and make it better for my colleagues and have colleagues that do that for each other. And that's been one of the beautiful parts of being in a palliative care team, where it's so interdisciplinary, is that I learned so much from the other folks on my team, whether it's the nurses or the chaplain or the social workers, like they actually have training and experience in creating better work practices than we do, and sort of thinking about that together and what it looks like to build that culture together as a team has been really important.

Dr. Jillian Bybee:

I love that and also I can hear probably the same people who say this to me as I say what you say being like, oh, it's a system problem. You know, 80% of burnout things are system issues. And I always say, well, we're part of the system and we help change systems. It's not just the healthcare system, like we're part of it. I guess what's the response from either trainees or even, you know, faculty members when you talk about the importance of bringing self-care practices into the workplace?

Dr. Jared Rubsenstein:

Yeah, and just understand. I mean, I hear that I think we are part of a broken system that like needs to be fixed and broken all the way to the ground so that we can build it back better. And I think it's too nihilistic to say that like we have no control over ourselves because we work in a broken system. I think we have so much control over things that there are things that we can control that we should take control of, like eating lunch. You know I hear all the time you know I'm too busy, I can't eat lunch, and I think there's true real emergencies in the hospital that can't wait five to 10 minutes. But most things we do can and that's all it takes to like grab a sandwich and eat. It take five to 10 minutes to have a real lunch.

Dr. Jared Rubsenstein:

And I think I saw you post something about eating lunch with a knife and fork and like I think that's such a good force practice of like you can't be running from one thing to another if you're eating with a knife and fork, and I think that's huge and it doesn't, doesn't take long and it's.

Dr. Jared Rubsenstein:

It's just. I think there's, I think it's it's sort of a false macho culture of medicine that that makes us feel like we have to say we don't have time to eat or we're not being a good doctor, and I think it's the opposite. And so I think it's being mindful of the things you can control, like that, I think it's being mindful of the way we are with each other. You know, we work in a big, I work in a. I think it's the biggest children's hospital in the country and it can be a big, nameless, faceless place sometimes and with a thousand faculty you don't always know everyone. And I think it can be easy to be unkind to people on the phone when you don't. You can't picture the person on the other side and know you're not going to have to see them in person. And I think being mindful of that too, and that you know if, if we're trying to bring some kindness to what we're doing and trying to put ourselves in other people's perspectives, I think that goes a long way too.

Dr. Jillian Bybee:

I mean, I think there's I think there's so much we could, despite our broken system. I think there's a lot we can do with the time and the power we have if we want to. Yeah, I think it is exactly what you said it's both and it's both. The system needs to change and we're part of it and can do these practices and take responsibility for unlearning and pushing back, and I think that is how a lot of the things in my own workplace have changed, and changed around me. Is enough people deciding that they're going to do it differently.

Dr. Jillian Bybee:

When I first joined, we do seven days on service, but sometimes stacked with other days. So at times, I was working up to 11 days in a row and I would block my calendar on the next available day, whether it was a weekend day or not, and I got a few people commenting to me like your calendar's not available. Yeah, well, it's a Monday, I don't care. I've been working 11 days in a row. I am off on that day, and sometimes I would only take one day which to my family members who work in a row. I am off on that day, and sometimes I would only take one day which to my family members who work in corporate America, where they get a weekend every week. It's just like you're only taking one day off.

Dr. Jillian Bybee:

Oh my gosh, but even just doing that was revolutionary, and it doesn't have to be a whole day. I now coach people to block off some parts of their calendars because it's these little things and usually the people who get the maddest are the people who are completely unwilling, like you said, to take their lunches, and I joke with those people all the time that my job has actual emergencies in it, like sometimes there are actual emergencies that I'm attending to and I would never not attend to those things in service of, like eating a lunch, not once, not ever. No one will ever do that. And still, most of the things that we think are emergencies are just created that way, because we live in these chronic stress cycles that make us feel like we have to be rushing from one thing to the next at all times, absolutely.

Dr. Jared Rubsenstein:

So I love that you said that there's that great Grace Hopper quote about. Like you know, the most dangerous phrase in the language is that we've always done it this way, and hospitals and medical culture is huge about that that. You know, we were not good at imagining that things could be different and we just do things the way we've always seen them done.

Dr. Jillian Bybee:

I agree, and I think the other thing about the medical system is we talk a lot about generational trauma and other spaces and we don't talk a lot about medical generational trauma and what we do to each other. Because you know, I had to work without duty hours or I never got any lunches, or I never got a family leave or whatever the insert toxic practice here is family leave or whatever the insert toxic practice here is and we just perpetuate them on each other and don't allow the next generation to grow and don't allow ourselves to grow either. Because I think one of my favorite things about being in medical education, like you are, is watching other people poke the system in a way where it needs to be changed and then also watching people in my you know, late millennial generation also started to get their feathers ruffled by the next generation of people, and it's kind of fun to watch actually. Uh-huh yeah.

Dr. Jared Rubsenstein:

My, my sort of controversial take is I think Gen Z is maybe going to save medicine. It's going to be everyone's going to hate it. But, like I think, medical culture for so long, and now all of the nefarious outside forces like insurance companies and healthcare conglomerates, are happy to take advantage of doctor self-sacrifice that we were all trained to do because that's what we, that was what was the right thing to do at that time. And I think the next generation is going to come along and is not going to be willing to sacrifice as much as we are, and I think everyone's going to hate it and I think it's going to be awesome and I think it's going to force a rebuilding of medical and hospital cultures around people who aren't willing to sacrifice themselves for an organization.

Dr. Jillian Bybee:

I love that hot take and I am on board with it. I'm seeing it and the other thing about it, because there have been some unfortunate articles in very prominent medical journals that I won't name now who seem to paint it like you can either be a very dedicated physician or you can be well and care about that and not the middle ground, which is what I think we're talking about. But I've never seen one of the trainees of a different generation not attend to the patients in an emergency either. Not once, not ever, and I don't think that's what we're talking about. I think that is what I've seen some people alluding to, like, oh, you'll just won't be living up to the profession, like there's a different way and it certainly is not the way that health care is right now.

Dr. Jillian Bybee:

But as we can see by the numbers of people leaving. This way is not working. Like there's a lot about this that isn't working. Like there's a reason. My time is going up to be an internal coach in my organization because a lot of my colleagues including me at one point we're experiencing burnout. This way is not working either. So I think something drastic does have to happen.

Dr. Jared Rubsenstein:

Absolutely yeah, when I was talking earlier about that that sort of when I talked to people about creating positive work culture, we talked about it enough that we got asked to give it as like an actual formal talk, and it's one of my favorite talks to give.

Dr. Jared Rubsenstein:

It's me one of our social workers and one of our former administrators who I asked to give the talk to me because I thought the two of them were so foundational in creating positive work culture from our team. And I opened the talk just with talking about the Johns Hopkins residency, where sort of residency like the original original residency model that now it's known was founded on a giant pile of cocaine and the work hours that were thought to be normal doctor work hours were fueled by giving all of the trainees cocaine and having them stay up all the time. And now we do that same thing without all the cocaine and we don't understand why it's not working. And I then handed off to the people that actually understand work culture and asked my colleagues to talk about all the things that they've introduced to our team to make really positive change, Because I think we have to unlearn all that.

Dr. Jillian Bybee:

I mean for the people listening who don't know that story I think that should just be evidence enough that the way that the system is not built on a healthy practice for anybody, it's not really the way that we should be doing things. But you know, as you think about the practice of building a healthier culture and not just, you know, relying on individual practices, like what does actually make a difference in terms of building a positive work environment.

Dr. Jared Rubsenstein:

So I think it's so many things.

Dr. Jared Rubsenstein:

To some extent, I think it's about knowing your people and knowing your colleagues and knowing what they like and what they need.

Dr. Jared Rubsenstein:

I think I've always felt like my offhand math for burnout is an equation of something to the effect of the amount of work you do that feels either joyful or effective, divided by the total work you're doing, Because I think there's plenty of people that don't work that much and are burnt out because none of it feels impactful or joyful, and I think there's people that work a ton of hours that aren't burned out at all because a significant portion of it is joyful or impactful feeling.

Dr. Jared Rubsenstein:

And so I think that's something that I try to bring to work, that you know that, whether it's the way we laugh and talk with each other on rounds between rooms like I think you know as a team that has to be so on and so professional and so kind and supportive when we're in the room and our patients deserve that and we owe them that I think it's also okay to say we don't need to be that way with ourselves one second more than we have to, and so when we're walking, I think we can, we can laugh and we can talk and we can joke and in between rooms and in our time where we're not with patients, like I think we can, we can have fun with each other and should encourage that.

Dr. Jared Rubsenstein:

I think you know, having having different practices to feel like helping people find joy throughout the day and then helping people increase the amount of their time, that feels impactful and I think sort of for me, for whatever control I have over things, trying to have those two as sort of guiding stars to how I want to spend my work days is trying to increase the amount of joy and increase the amount of time that feels impactful, because there's going to be so much stuff regardless that doesn't feel impactful.

Dr. Jillian Bybee:

That's all baked into the system yeah, no one ever feels like they're impacting a lot of the system when they have to fill out a prior auth or, um, you know, fax a bunch of documents in this antiquated way.

Dr. Jillian Bybee:

And also, yeah, we can choose things that bring joy and we can choose to tune into them. Something I write a lot about is how I'm trying to be more mindful of just the things that are appearing in my day to day interactions. Like you were mentioning pediatrics, it's such a beautiful place to work because even in the pediatric ICU like sometimes, we throw children birthday parties like this is a joyful experience, whether the child is in the hospital or not, and it doesn't mean that you're overlooking all of the hard things that are happening. It just means that you're tuning into the fact that you get to bring the patient and their family and loved ones joy and that you're making a real impact as you do your day to day work. Creat Creativity also, for me, has been really important. That's obviously why I started this podcast, it's why I do writing, it's why I do a lot of the teaching that I do, and I know for you, you are involved in a lot of social media. That's how we met and you make videos.

Dr. Jared Rubsenstein:

Yeah, so that actually started by accident. I'm not. I've always liked having kind of creative outlets, like I'm at the hospital with our work when we like start a new conference or have a new initiative. I've always taken on sort of the advertising of it in the market, like I before I was a doctor, I thought I wanted to be an advertiser and so I've always kind of leaned into that and enjoyed it, but otherwise never really thought it was a real part of work.

Dr. Jared Rubsenstein:

And then I was coming back from a frustrating consult request, like so many we get in palliative care that because of all the bias and stigma against palliative care among healthcare workers was told you know, we'd like you to see this patient, but don't, don't take away hope and maybe just talk about pain and don't talk about anything scary and don't talk, don't take away hope and maybe change the name of your field and just don't say palliative care. And I came back to the office and I was thinking you know it feels like if you called the fire department and then ask them not to say the word fire because they would scare the people whose house is burning down. And I had the thought. You know I remember seeing when I was in med school there were these little animated animal videos and I was like, oh, maybe I could make a little cartoon video about this and just made it and made what became the palliative care where the fire department not the fire video and showed some colleagues on my team and they laughed and so I put it on social media and it went kind of surprisingly palliative care viral. And then I thought, oh, that's good, maybe it'll start a conversation about some stuff we should talk about as a field and didn't really plan to do anything else with it and then got a lot of encouragement from colleagues I admired. He said you know, this is maybe this is a way to start messaging stuff in palliative care, and so from that one video it's become, I think, like 60 or 70 now.

Dr. Jared Rubsenstein:

And you know it started out being about palliative care and serious illness topics but then realized, you know, as a kid who grew up on the Simpsons in South Park, you can use animation and satire to have really important conversations and the idea that you know, in one or two minutes you can talk about something that's culturally relevant and important and show people a different viewpoint.

Dr. Jared Rubsenstein:

And because of the animation and sort of the clunky voices, it can feel kind of disarming and then hit them with something that feels impactful, and so one of my favorite things about it has been the collaborations I've been able to make with folks in other fields and who have expertise I don't, and have been able to branch out from palliative care to mental health and medicine, to sort of the weaponization of professionalism, to talking about gender equity and gender identity in medicine and talking about racism in medicine. And one of the big sort of spinoff collaborations we've done is partnering with a couple of folks Andrea Tatum and Princess Denna to create the anti-racism animation series and have a whole separate YouTube channel where we make videos about the pervasiveness of racism in medicine and teaching people how to be more anti-racist.

Dr. Jillian Bybee:

I mean that's amazing. A lot of people I talk to who are looking at starting something else or doing something else are like oh, I could never do that because, whatever, what kept you going as you started to build the videos? Obviously, you didn't just go from one video that you put out to, all of a sudden, all of these collaborations, but, like, what kept you going through all that?

Dr. Jared Rubsenstein:

Yeah, and so a few things. I think one is that for me it became kind of self-care, that like the way the first one that was born out of frustration, a lot of them had been born out of frustration and when I have an interaction that feels unsatisfying or feel like there's been a missed opportunity for education in there, I think like, can this become a video somehow? And is there like a satirical, humorous angle to talk about this hard topic? And so for me, being able to it's helped as a way to process stuff that, like when something frustrating happens that I wish I could have changed or done differently, channeling into a video has been helpful, I think I've. Also, I've always wanted it not to feel like work and I've always committed.

Dr. Jared Rubsenstein:

I think part of the reason I'm not that great at social media is that I can't get on board with, like, the cadence of publication and making X number of posts or X number of videos every so often, because I didn't.

Dr. Jared Rubsenstein:

I didn't want it to feel like work and so I've said that it's taken there's 70 of them, I think, but it's taken about five years because I've said's not work, that it's something that's sort of just for me and to kind of help process things to then put out in the world. I think a lot of people assume when they see them that I have like animation or tech savviness, and I very much don't. It's an app on my phone. It's called Plotagon. For anyone that wants to download it, it's a free app that you can just make these little videos with and make characters and type in the text, and the program does all the rest for you. So you don't need any particular tech savviness, and I think it's been a way to sort of channel frustration, the desire for education at scale, and then also the idea of you know that being able to flex the creative muscle that I think we don't get to do very often in medicine but but felt important and felt really satisfying.

Dr. Jillian Bybee:

I think it's so important Like I've rediscovered this, it's so important to have something else and also not to bring in all of my perfectionist tendencies to it. I think that's people decide with this podcast or with other things, like again must have some sort of tech savviness to be able to do this, like I taught myself how to use a program and I am certainly not an audio engineer, and so people hear that in my episodes. But that's not what these are about. It's not why I started it, and when I'm writing, I'm like I burnt out last year on writing a blog for fun, which I thought was the most perfect, intensivist thing of all time, and I never thought I would write again because I was like, oh, this is how it has to be, and I thought, well, what if I just do something I want to, like you're describing with the videos? What if I just write when I have something to talk about?

Dr. Jillian Bybee:

And now I find that everything is sort of a little inspiration, and maybe it's not like I read a blog post every day, but it kind of fuels me and I take that into work and I feel like a different person in the world because I'm doing things that aren't just all dedicated to medicine and are not just my identity as a pediatric ICU physician. So I think that's one of the ways, too, as we're thinking about what is self-care, what is, you know, taking care of ourselves in medicine? Look like it's not losing yourself completely in the system, like you're telling the trainees before they go out.

Dr. Jared Rubsenstein:

Absolutely.

Dr. Jillian Bybee:

I love that. Trainees before they go out. Absolutely. I love that. Well, as we kind of wind down our time, I wanted to go back to not my favorite topic, but one of the reasons I wanted to have you on here specifically is that I know we connect on this idea of you know, at the end of life, when we're physicians and we're caring for people, like people a lot of times say we're going to withdraw care and it's like nails on a chalkboard.

Dr. Jillian Bybee:

Yeah, me too, and I feel like I go on and on about it because clearly we're not withdrawing care. But I wondered if you could talk about that idea a little bit.

Dr. Jared Rubsenstein:

Yeah, I think I mean to some extent that's.

Dr. Jared Rubsenstein:

That's another of the platitudes we talked about earlier that that becomes meaningless, but I think also it's it's laden with, I think, what a lot of people really feel that you know we go into medicine to cure and make people better and healing can get lost along the way and there's the sense that you know you're you're a failure if you don't cure the person for the thing you said you were going to try to cure them for, instead of acknowledging that sometimes that's not possible and that it's not, it's not your failure, it's not the another one of those phrases that I think is like the Alzheimer's trouble is the patient failed treatment, like it was their fault that they didn't, they didn't want it bad enough or work hard enough, and sometimes treatments fail people because we don't have perfect treatments for anything and what we see a lot is that you know there's, there's been this compounded abandonment where the people in the doer fields that were trying to cure something are unable to cure it and then, because of either guilt or shame or just feeling like they don't know, know what to do if they're not curing something anymore.

Dr. Jared Rubsenstein:

Stop showing up for people and we talk to patients and families all the time that share that they feel abandoned by their primary medical team, who they've been with for years, because near the end of their life, when they're not being treated for something anymore, they don't see the people.

Dr. Jared Rubsenstein:

And it's sort of a double hit that they're not getting better and they've lost these people that are there with them. And we try to encourage people all the time to say, like you know, like we talked about earlier, that presence is so important and just going and sitting and being with people and showing them that you value them as a person and that you're there for them and you're going to keep showing up. And not only are we not withdrawing care. We might be withdrawing chemotherapy, we might be withdrawing a ventilator, but we're turning up the care and we're showing up as people and we're making sure we're maximizing pain and symptom management, we're maximizing all the different support the hospital has to offer. We're asking family members to come visit more, we're doing legacy work, we're doing all kinds of things to really maximize care near the end of life, because that's when people need it the most.

Dr. Jillian Bybee:

Absolutely. I think that you know, I only get to see the very serious inpatient side of this, but I even see it in the ICU where you're like, oh, that patient's palliative or oh, they're out of life. And you're like, okay, well, have you been in there? You know, the things that I'm offering in these cases is not like, okay, can we do the latest treatment for X condition, or, you know, add more machinery or whatever. It's more like hey, can I sit with you? Can I bring you a blanket? Do you need any? You know food or water. I think these are the things that you really turn up the humanity and like turn up the caring, like you said, in these cases, because that's all you have, um, and I think it goes back to the thing that we were talking about earlier, where people get scared of the human part, of the just being present, or like they're going to do something wrong.

Dr. Jillian Bybee:

I think that often is I don't know what to do, so I just won't do anything. Um, and you actually don't have to do anything. You can't do anything to change it. The thing that you can do to make a 1% difference and that's always the marker for me is like can I leave this situation 1% better than it otherwise would have been if I didn't try to do this? It's just be there and I think that's the thing that weirdly gets me and I'm sure you and many of your colleagues thank you letters after people have died is like the showing up as a human being, and it's not any sort of specialized medical technology, it's not all of the other ways that I utilize machinery in my job. It's like thank you for being a human and for showing us that our loved one, our child, mattered.

Dr. Jared Rubsenstein:

Absolutely. I think some of the nicest compliments we get is when we'll have medical students or residents that come rotate with us after they've been around the block some and seen a lot of other fields, and after a week with us they'll say this is what I thought being a doctor was going to be like when I wrote my application essay and like this is what I envisioned being a doctor would feel like. And it hasn't felt like that until now and I'm like, yeah, that's why this is the best field we get to do. It's like not super fancy, there's not all the machinery, but like we get to be I, like we get to be.

Dr. Jillian Bybee:

I think what, for a lot of people, their vision was it being the doctor was sort of being with people and helping take care of them through the hardest stuff. That is a great compliment and probably a great soundbite. To end on, I just want to say thank you for this conversation and for all the work that you're doing out there in the world. I know that medicine is better because you're in it and making videos and doing social media in a way that seems genuine for you, so I just want to say thanks.

Dr. Jared Rubsenstein:

Thank you so much for having me. It's been awesome to talk with you and for sharing your platform, and I'm grateful for your platform and doing what you're doing to put out in the world so that we can all work on feeling better. In this job we have to do every day.

Dr. Jillian Bybee:

Thanks for tuning in today. I hope you enjoyed this conversation with Jared as much as I did. I hope it gave you some fresh perspectives on the importance of communication, compassion and caring for ourselves and each other. As we talked about today, stress management and self-care are essential, especially in higher pressure environments like healthcare, but certainly just in being a human in the world today. One of my favorite parts of the conversation was when Jared talked about how important it is to do work that feels impactful to you, because often we're doing a lot of work that doesn't feel impactful but that someone else told us was important.

Dr. Jillian Bybee:

I know firsthand that doing a lot of work that doesn't feel impactful can lead to chronic stress and eventually to burnout, as it did in my own life. If you're feeling overwhelmed or looking for practical strategies to stress less and find more balance in your day, I'd love for you to join me in my upcoming workshop Transform your Day Stress Less with Three Simple Strategies, which will be coming early next year. It's designed for busy professionals who want to take control of their well-being without adding more to their plates, because you already have enough to do. You don't need one more thing to add to your day, but you do need and deserve stress management in order to keep going. If you'd like to be the first to hear details about the workshop and how you can get signed up, head to the link in my newsletter in the show notes, or go to humansleadingsubstackcom to get signed up for my newsletter and get the details. Take care and remember small shifts can make a big difference in your life. Thank you.

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