Dr. Sarah Smith [00:00:04]:
Welcome to the sustainable clinical medicine podcast. I am your host, Sarah Smith. I am a practicing rural family physician and the charting coach. This is the podcast for physicians and advanced practice providers who are ready to step back from the busyness of their clinical day to share ideas, question everything, and redesign their clinical day. We are redesigning clinical medicine to create sustainable clinical days and create time for our lives outside of medicine. Join us for discussions with world experts who are helping design sustainable models of clinical medicine and the physicians or clinicians who have discovered or designed sustainable models of clinical medicine for themselves.
Dr. Sarah Smith [00:00:50]:
Hi, everybody. Welcome back. It's fun to be in the, North Americans again. I'm here for November, which is super fun. Today, we have with us, doctor Jatoo Sanesi, and she's gonna walk us through her journey through medicine and some of the fun things she's doing now in terms of wellness. So I'm excited for this and welcome. I'll let you introduce yourself.
Dr. Jattu Senesie [00:01:12]:
Thank you so much. I appreciate it. Yes. It's so interesting that your, podcast is about sustainable medicine because that's really what I recognized when I was practicing. I couldn't I thought that I could not make clinical medicine sustainable for me and ironically, it wasn't until I stopped practicing clinical medicine that I realized maybe some things I could have done differently to make it work better for me. So, as was stated, I'm, doctor Jati Sanesi. I am an OBGYN by training, board certified OBGYN who is originally from the DC Metropolitan area, in the United States. I trained in Atlanta, Georgia.
Dr. Jattu Senesie [00:01:52]:
I did medical school and residency in Atlanta, Georgia and then moved back to the DC area for my training. And part of where I moved back was because I wanted to be close to family, and, honestly, I did not love medical training. And I think I held it against the city of Atlanta a little bit. I was like so I finished training in 2004 and no hyperbole. It was probably till 2016 before I could go to Atlanta and not have a little bit of, like, this is where it all went down type of situation. So, I love I always wanted to be a physician since I was I always wanted to be an OB GYN. I'm one of those, I guess, kind of unicorn people who said I wanted to be a doctor and knew what kind of doctor I wanted to be and worked towards that my entire life because I was the child in middle school who said I think maternal fetal physiology is really cool. Most people don't know what maternal fetal physiology is.
Dr. Jattu Senesie [00:02:47]:
I thought maternal physiology and the endocrinology part and I was like okay you have 2 beings in 1, in one body. I thought that was all very very very interesting. And so I did all the science, I was in a science program in high school. I did all of those things going through college with the focus of I'm going to be an OB GYN. And then I got to medical school and the first couple of years back when I trained, 1st 2 years you're just in class. And I remember sitting in class and being like, this is not as exciting as I want it to be. This is a lot of cramming information in your head. And everyone says, well, when you go to the second 2 years when you're in the wards, when you're applying what you've learned then it's gonna be better.
Dr. Jattu Senesie [00:03:30]:
You're gonna like it. And it was better. It still was like, this is what I spent the past decade and how many 1,000 of dollars learning how to do. And yet again, everyone said, you're gonna go to residency. You wanna be a women's health physician. So you don't wanna deal with, you know, babies with RSV and and, 80 year old men with MIs. When you get to, like, exclusively women's health, it's gonna be better. And then I got to residency, and I did not like residency.
Dr. Jattu Senesie [00:03:57]:
I loved learning. I loved taking care of patients. I loved my fellow residents. The grind of residency. It was so disconnected from the concept of well-being. I didn't even recognize it at the time, but it was just so much. I did not enjoy residency. Yet again though, the prize was a little bit further.
Dr. Jattu Senesie [00:04:16]:
Everyone said, when you finish residency, you're an attending and you get to live the life you like. So that was the carrot that was being held out in front of me. Okay. Once you get out, you get control over your life and you can make it work the way you want to. So again, every single time people were not wrong. It was always better. It's just never was quite good for me. So that's I I left rest.
Dr. Jattu Senesie [00:04:39]:
I left Atlanta and I was like, okay. I'm gonna come back home and it'll be better. And, again, better, not great. And that's part of where I realized the opportunity to make get that make it better was there at that time and I didn't fully grasp it because I thought, okay, once I get the shackles of training off me then all of a sudden automatically things will be better because I will no longer be oppressed and I didn't realize how intentional I needed to be about actually designing a life that I liked. Because everything I was really good at following a a path, Everything was very blueprinted out. When you decide when you're 12 that you wanna be an OB GYN, it's very clear it sounds, you know, it sounds like a lot. However, if if you're really good at taking tests and you're really good at following plans, it's quite remarkably simple to do, ironically. But then you get out and there's no longer a plan, there's no longer a blueprint, there's no longer a this is what you have to do to like your life because you're supposed to like your life because you passed all the tests and you did all the things.
Dr. Jattu Senesie [00:05:45]:
Because OBGYN has an oral board exam, I was able to give myself 2 more years to say, okay. Once I get past this, I will really like it. And then once I pass my oral boards, there was no other thing to say, oh, this is what's keeping me back from liking my life, and then I had an existential crisis.
Dr. Sarah Smith [00:06:02]:
Right. I can imagine.
Dr. Jattu Senesie [00:06:06]:
And that's why I was like, well, I did all the things and I like the light. I'm supposed to like my life, and I thought there was something wrong with me because I had done all the things and I was supposed to like this life that I had. Like, that close to family, you know, board certified, making, you know, good money compared to most of the country, and I thought there was something wrong with me. And I ended up going to see a therapist because I was like, clearly, there's something wrong with me because this system has worked for years for other people. Everyone else seems to be doing okay with it. Didn't realize at that point that everyone else just wasn't talking about how not okay they were with it, but I thought it was something wrong with me. And I ended up taking a 100 day sabbatical from work. And people were like, are you ill? Are you this? I was like, no.
Dr. Jattu Senesie [00:06:53]:
I just haven't had a break since I was 4, so let me just give it a shot. And I randomly picked a 100 days. That was based on nothing. I just had never had that much time off. That sounded like an amazing amount of time off. And because I am wired the way many a high achiever physician is, I didn't really take time off. I went abroad to do Spanish immersion. I went abroad and did a, medical mission, which in retrospect, I realized I probably had pneumonia at the first half of it.
Dr. Jattu Senesie [00:07:27]:
Wow. I was on I was on the plane. The night before I was supposed to fly, it start it started hurting to breathe. And I was like, this can't be okay. And I was on the plane and I might have been, like, you know, minorly febrile, but because it was a medical mission and we had a pulmonologist with us, he hit me with a Z Pak and by, like, 3 days in I was feeling better. But that's still the mindset I had when I was taking my break just to give you a sense of how I'm wired. But I said okay I'm gonna come back and everything's gonna be great. And I didn't wanna leave my practice because I liked I liked my patients, I liked my, the people whom I worked with.
Dr. Jattu Senesie [00:08:01]:
So it's like I just need to switch some things around and I switched some things around. However, I made this grand plan as to how to switch things around when I was in the depths of burnout before I took the break. Didn't have the vocabulary to call it burnout at the time, but knew I needed to take a break. And I realized again with that wonderful 2020 hindsight that that plan that I put in place again was better, still wasn't the best for me. And I liked I switched my hours around because I was like, okay, you're working all the time. You can't even take, you can't even take care of yourself. So I had one day a week where I started early. This was a big thing because I had to have staff come in early so I could end early.
Dr. Jattu Senesie [00:08:42]:
That actually started when I was seeing my therapist because, like, I need to get out early enough to be able to go see my therapist. So I shift with one day a week where I had one day that I could take have appointments in the afternoon. I when I came back from my sabbatical, I went down to 4 days a week because I was, like, okay. Only 4 days a week. I even switched where my practice had 4 different offices. I switched the offices I was going to because I wanted to look closer to, like, the city because I was I was young and single so I wanted to be closer to the city. I did all of these things that ostensibly were meant to make it better and still I was like, the problem was now I had the insight as to what was wrong, so when it came back up again so quickly I couldn't ignore it and pretend that it wasn't there. The error I made was I was like, well, I've done all the things I can do.
Dr. Jattu Senesie [00:09:32]:
So I didn't think I could make it better. And so I ended up actually leaving clinical practice because I was like, okay, I've been doing this for long enough to know this doesn't work for me. However, I'm young enough to go find something else, and I'm and here's where the hubris comes in. I was like, I'm smart enough to find something else. I was like, I'll figure it out, so I left with no plan. I do not recommend that. I tell people all the time, you maybe don't have to have a full plan. I had no plan.
Dr. Jattu Senesie [00:09:56]:
I didn't even have the sketches of a plan. I was like, I'll figure it out. So that's how I ended up leaving clinical practice. And when I left clinical practice, I thought I hated being a doctor. I did actually think that I hated being a doctor. In retrospect, I didn't like my life as a physician and I didn't think I could I didn't think it was within my capability to design a life, a sustainable life as in clinical medicine. And again, it wasn't until I left clinical medicine and I recognized that I had been in that typical high achiever mindset of doing, doing, doing and totally disregarding well-being. I knew I wanted to leave medicine to be well.
Dr. Jattu Senesie [00:10:35]:
I didn't realize I hadn't thought about well-being really the entire time that I had been practicing political medicine and that was a large part of why I was unwell. So long story as to how I went from very enthusiastic middle schooler to burnt out woman in my mid thirties and being like, I gotta go find something else to do.
Dr. Sarah Smith [00:10:54]:
Yeah. Yeah. Thank you for taking us on that journey. I have a few follow-up questions.
Dr. Jattu Senesie [00:10:59]:
I I don't doubt.
Dr. Sarah Smith [00:11:02]:
So I wanna go back to that place where you have you were working 5 days a week. So you're an attending, early attending, and you've moved location because you're like, this location sucks. I need to go back towards my family. And you've got a position that you've chosen. You've got boards coming up in a couple of years. But what was it exactly about? What was medical clinical medicine costing you at that point? So tell us about what the day or the week looked like, that was really not creating sustainability, that was feeling unsustainable.
Dr. Jattu Senesie [00:11:34]:
So as I mentioned, OBGYN practice. So we had a large practice. We had 4 different offices. We covered 2 different hospitals. I was only covering 1 hospital, so that was actually good. And the way our practice was big enough that you didn't have to cover 2 hospitals on 1, at one time, and so I only took call at the one hospital. However, the way our practice was set up, you covered the hospital the entire day when you were on call. So you covered labor and delivery, you cover any emergencies, and you also scheduled your surgeries on the days you were covering l and d.
Dr. Jattu Senesie [00:12:13]:
Mhmm. So you didn't actually have block time. I did not realize how stressful that was for me because I like being in the OR. I like because that was the one time where that was the time that was the most similar to what I thought it was gonna be. Because you go in, you play the music you like, the bed's at the height you like, you get the gloves you like. You know, depending on what the patient's pelvis looks like, things could get a little, you know, sketchy, but it was nice block time. However, when you're doing surgery at the same time you're also covering labor and delivery, you're managing you're hoping nobody's gets complete while you're sitting there trying to close the vaginal cuff. So that actually sucked some of the joy out of that particular piece, and I actually covered the hospital 2 days a week.
Dr. Jattu Senesie [00:13:01]:
So I at that time, I was doing Mondays Tuesdays. So I would generally do cover Monday during the day, take Monday night call Tuesday during the day. So I was in the hospital for, like, 36 hours. Then I was in the, office for 3 days a week. And despite the fact that we had a lot of practitioners in our practice, we had a lot of patients. And so if somebody went on vacation, we just have just so they would try to double book everyone. And I had to have a I had to have a conversation with our front desk staff and I was like, I can't do double booking because the OB patient, visits were 10 minutes anyway. So then when they double booked it, it was 5 minutes.
Dr. Jattu Senesie [00:13:41]:
I said, I can't even log in. I was like, at this point to do 5 minute OB I was like, no. And they're like, oh, well, doctor so and so does that. I said, I understand that. I cannot do that. I was like, that is not sustainable for me. I was like, I can't get that done, and I'm making the transition into attending life and trying to figure out how to chart and do all those things. I was like, I can't.
Dr. Jattu Senesie [00:14:00]:
I'm sorry. Thankfully, I was on, I I was on a salary, so it wasn't an RBU type situation. So I was like, I'm just trying to get my bearings. Mhmm. Might be maybe, like, 9 months into my 1st year. So we were still doing paper charts when I first started. We switched to we switched to EMR. We were actually early adopters to EMR.
Dr. Jattu Senesie [00:14:24]:
So I was just getting the hang of doing charts in the evening, and we switched to EMR. And I really hadn't gotten the hang. I would be there late at night doing charting to the point that once I went on vacate I was always there when the, cleaning people came. I went on one vacation one week. The cleaning people were worried about me. They asked where's the doctor who's always here in the evening because I was always there when they came to clean at night. And when I finally got to the point where it's getting a little bit of a handle on the charting, we switched to the, EMR. And because we were early on, I think nowadays well, I think nowadays everybody's just EMR.
Dr. Jattu Senesie [00:14:59]:
But years later, I heard that folks would hire someone to take all the records and put them in the, in the computer. What R Wise practice chose to do was you, doctor Sannessy, the first person who sees this person from the paper to the computer, you put all of their stuff into the computer. So if it's somebody for their first visit, that's one thing. Our practice had been in place since the seventies. So if I'm seeing a nice lady for her pessary check, and she's been coming since the seventies, it's on me to put her entire history into the computer.
Dr. Sarah Smith [00:15:40]:
Yeah. Right. Okay. Did did did you all have a have a a suggestion about that back to them? I don't even
Dr. Jattu Senesie [00:15:50]:
I don't even think I did. I don't even know that that occurred to me. I think we were just kinda like, it was sound like, okay. This is just what you do. The only paperwork suggestion that I I'm very proud of that I I didn't even come up with it. I got this from my best friend from residency is with filling out medical leave forms for all the pregnant ladies had to get the medical leave forms because we always had to do it. And my one friend was just like, oh, we have somebody on our staff do it and we just sign it. I was like, that's a thing? So I brought that to my boss, and so that was a thing that we implemented.
Dr. Jattu Senesie [00:16:23]:
The staff did not love it, but my fellow, physicians thought that was a fabulous idea. That was the only paperwork improvement thing that I even that I ever suggested, and I didn't even come up with it. I borrowed it from a friend.
Dr. Sarah Smith [00:16:36]:
Got it. Okay. So we're hearing about you starting the week with this very big schedule of both booked, surgeries and alcohol for labor and delivery and anything that goes wrong in the night, bump in the night for that whole night, and and then you gotta do it again until Tuesday evening. When you were in the hospital system, was that charting going well? Like, was you keeping up with the documentation around your surgeries and and labor and delivery, or was that also something that would then carry on past that Tuesday end of shift?
Dr. Jattu Senesie [00:17:09]:
The admissions, the surgeries, that was fine. Where it could sometimes get backed up, it was discharges because whoever did the delivery did the discharge. It wasn't necessarily the person who discharged them home.
Dr. Sarah Smith [00:17:22]:
It was
Dr. Jattu Senesie [00:17:22]:
the person who did the delivery. So you would deliver somebody and you would be back for another week, and then the chart is there. So that could sometimes get a little backed up. So again, some days if it wasn't busy on labor and delivery and I didn't have any cases scheduled, just go down the, medical records and do your dictation. So that could also be something that could get a little bit backed up. Yes.
Dr. Sarah Smith [00:17:43]:
Yeah. Yeah. And we talk about the the surgeon in the operating room, and that is a protected time where you're busy really concentrating on what you're doing and you're in a zone where very little should be interrupting you in that moment. And then you're having people, phone call. How was this delivery of information coming to you about the labor and delivery ward?
Dr. Jattu Senesie [00:18:08]:
I would you let the folks on labor and delivery know you're gonna be, in the OR. Generally, if everyone's pretty stable, you don't get called. But if there's an emergency, they will call you. And depending on what's going on, you could say if it's, like, emergency emergency, you can somebody's crowning, ask one of the other docs if they can, you know, catch the baby for you. If something else is going on thankfully, our office wasn't super, super far from the hospital. Maybe you can call somebody to come in. The the thing that actually tended to, have well, there was just the general stress of, like, okay. I can't just be in this case.
Dr. Jattu Senesie [00:18:47]:
But then there were also times where you had a surgery scheduled, and then somebody's, somebody's about to deliver, so you have to, bump the case. OR does not love that. Patients do not love that. It was it was just challenging to me. You're managing personalities. You're managing schedule. You're doing a lot of that stuff, and it's on you because you are the face of this entire, operation.
Dr. Sarah Smith [00:19:12]:
Mhmm. Did you have any conversations with patients that, hey. Your your surgery date will come up, but I'll also be on call?
Dr. Jattu Senesie [00:19:20]:
You know, I don't think I ever sometimes if in the morning, if I knew that labor and delivery is busy, I would, you know, go to pre op and I would say, okay. This is what's going on. We might have to reschedule. But generally didn't say when we're backing people, oh, because sometimes nothing's going on and it's not an issue. So yeah. So that wasn't a standard pre op discussion. No.
Dr. Sarah Smith [00:19:44]:
Yeah. And when you were looking at mentors and other, colleagues and they're seeing patients perhaps in that same 10 minute window in clinic, What is different or what did you need? Or what do you think if you looked back now that you needed so that the work if you were gonna choose this 10 minute slot for obstetric, that would actually get you out of the office faster. What what was the difference, do you think?
Dr. Jattu Senesie [00:20:11]:
So, I prob in retrospect, I probably documented too much. I probably I had that I wrote too much. Not as much for the OB, for the GYN, definitely. I probably was more because I was always like, well, if somebody else has to see this patient after me, then I want them to be clear about what was going on. And so I was, you know, writing little books, and I realized now, who's reading those books and I probably could have been more efficient in the way, I charted it. And then it was also, I think, prepping beforehand, prepping the, case I generally would, like, look in the morning and see who I had and kind of have a sense of that. With the OB patients, it wasn't the documenting wasn't as hard as much of a thing as just just getting in and out of the room. Mhmm.
Dr. Jattu Senesie [00:21:00]:
With the GYN patients, it was a little bit more challenging with the documentation. Yeah. Got it.
Dr. Sarah Smith [00:21:05]:
Okay. And you said the janitor staff noticed that you were still there. Did any of your colleagues kinda check-in and see how you're doing? So any of that sort of oversight of, hey. You're here all the time. What's going on? No. Oh, okay.
Dr. Jattu Senesie [00:21:23]:
It's it's I have recognized and I've been told that I'm a, I'm pleasant, miserable person. I remember even when I decided to stop practicing, the nurses so here's the thing. When I came back from my sabbatical, I actually, started working at both hospitals. So, I was taking call at both hospitals. At the the was taking call at both hospitals. At the the newer hospital where I was, working, they were just like, oh, you always seemed happy. They're like, so and doctor so and so seems miserable all the time. I wouldn't be surprised to hear that they were leaving.
Dr. Jattu Senesie [00:21:50]:
I was just like, well, I felt no need to make your lives unhappy just because I felt unhappy. That doesn't that's not how I function. But, I think it just kinda put my head down and just powered through. And so it was a very no squeaking from this wheel, so no one really bothered.
Dr. Sarah Smith [00:22:09]:
Yeah. Yeah.
Dr. Jattu Senesie [00:22:10]:
And patients liked me. I think if I was, you know, a jerk to patients and patients complained, maybe somebody would have pulled me aside and been like, are you okay? But I was nice to patients, and I did a good job, and so nobody was concerned.
Dr. Sarah Smith [00:22:22]:
And I that's part of what you had described about your whole middle school and high school and then into universities. You just did what was required at all times, did it straight from the lines. You know, you knew which way you were going, direction you were going. Do you think that where do you think the burying you to be the always pleasant on the outside? Where do you think that came from? Like, what was that? Was that always had been your strategy, like a a way of coping or had that developed within medical school? What do you think?
Dr. Jattu Senesie [00:22:57]:
I think it's interesting because I have friends that I've been friends with since I was a child, and I remember a couple good friends from high school. I asked them what I was in the when I was thinking about leaving, clinical medicine. I was like, y'all have known me for a long time. When was I last, like, genuinely happy? They're like, do you I was like, do you think I was happy in my high school? They're like, yeah. You seemed happy in high school. And I'm like, in retrospect, I think I was genuinely happy in high school and probably through at least junior year of college, interestingly enough, is when I started studying for the MCAT. It's probably when it's hard to take a turn, but I was genuinely happy up until that point. And I think that it was probably around medical school that I was just kinda like, well, I'm supposed to like this.
Dr. Jattu Senesie [00:23:45]:
And I still had that hope. So I think it was just kinda like, okay. Let's not get caught up in the less than greatness right now because it's going because it's hopeful. I think if and I think that's part of how why I got to the point where it's like, okay. This is how it's gonna be. Once I realized there was no change coming, that's when I had to be honest with myself about like, okay. I just don't like this.
Dr. Sarah Smith [00:24:09]:
Yeah. As you, didn't choose this 100 days, which fascinates me too, what maybe now that you've looking back on it or maybe you noticed what it was, what was it about you that said, enough. That's enough. I am definitely stepping out now. What were you noticing about you within your work schedule or you with your patients? Or what was it that really said it's a no. We're leaving now. We're having some time off.
Dr. Jattu Senesie [00:24:40]:
I was so tired. I remember being so I actually I've been talking with my therapist about, you know, maybe altering my schedule, but it's one of those things, like, you don't alter schedule because when you alter your schedule, that makes it worse for everybody else, and you don't wanna be that person. So I was working through at that in my whole head. And then there was a week so like I said, standardly, I had 2 days in the hospital. And there was some week where I think there must have been a lot of people on vacation or something. I covered the hospital from Monday morning. I think I got during the day, Monday day, Tuesday day, Wednesday day, Thursday half day. And I had a couple of nights in there.
Dr. Jattu Senesie [00:25:26]:
And by, like, that Thursday half day, I was, like, this is for the birds. And I knew that wasn't every week but I was, like, the fact that they would have me do this is some nonsense. And that's when I was just, like, this is ridiculous. And I think I was just so tired that I was unable to filter out the fact that I did not wanna do this anymore. I was like, I gotta take a break from this. And I remember it wasn't that day, but it was within a couple weeks after I made that decision. I had the conversation with my boss. And the good thing was I was once I once I make a decision, I'm very clear.
Dr. Jattu Senesie [00:25:55]:
I'm like, you're not changing my mind. I went and talked to my boss and he was like, well, maybe we can cut back your hours now. I said, no. No. I just need to take a break. And he was just like, oh, well, maybe we do this. I said, no. We can do 40 days a week when I come back.
Dr. Jattu Senesie [00:26:07]:
I said, but right now, I just need to not be here. And I was like, I like you all. I like this practice. I like the patience. I said, but I need to take a break. I said, so I would love to come back here when I take when I'm, you know, feel rejuvenated. I said, but if you can't do this for me, I'm just gonna resign. And it was not meant to be any kind of threat.
Dr. Jattu Senesie [00:26:32]:
It was just where I was. Like, I need to not be working right now. So either I come back here or I go somewhere else.
Dr. Sarah Smith [00:26:38]:
Yep. Yeah. I I hear you. So you bottled it down so far that they don't even notice that you're struggling. So by the time this amazing physician opens her mouth and says, I've had enough, you're like a 100% committed to I've had enough. And they're like coming out of it's coming out of the blue for them perhaps. Right. Why? I want what? You don't need time off.
Dr. Sarah Smith [00:27:06]:
You could just cut your hours, change your hours, blah blah blah. And you're like, no. It's no. I I didn't open my mouth until I was, like, completely done. Right. Yeah. Okay. So we we noticed that this is ridiculous.
Dr. Sarah Smith [00:27:19]:
I'm so tired. I cannot continue in this way. Okay. So that's that was a clear, you know, this is not happening. And then you said, I tried changing everything that you thought was possible all within your control, and that included days of the week you worked. And what else about the days that you're working? What else did you specifically say, I want this, I want this, I want this.
Dr. Jattu Senesie [00:27:47]:
So when I came back, I came back to 4 days a week. I moved. So I had been further so I'm in a DC suburb. So I was in one of the excerpts, and I was working at our furthest out office. So I moved closer down to the the office that was closest to the, city. So I was like, I want this to be my primary office. And I was told, okay. Yes.
Dr. Jattu Senesie [00:28:11]:
That could be your primary office, but all of your patients for the past few years are this other office, so you still need to go there for one day a week. I was like, okay. I'll do that. And then my because of scheduling, I even had one day Monday, actually, I started late. Monday didn't start till 12 because we had to stagger office. And so I was like, okay, then I get to you know, my weekend goes later. This is how I knew it was time for me to go. Because I was like, even though I didn't start till 12, I still had the Monday, like, I do not want to go.
Dr. Jattu Senesie [00:28:43]:
So because of but I was like, I'm gonna come back and I'm gonna give it my all. And actually, I had been renting. I bought a condo because I was like, I am committed. I am gonna be here. So I was, working there, then I was working to the working at the taking most of my call at the hospital that was closer that was further south. I remember my boss tried to he had a conversation with me about decreasing my salary because I was going from 5 to 4 days a week. I was like, well, here's the thing. I was like, I've always made a bonus, when we've worked.
Dr. Jattu Senesie [00:29:20]:
I said, and we know that you make most of your money in the office, not on labor and delivery. I said, and I'm not dropping my office days, I'm dropping my hospital days. I said, so how about we do this? Let's actually take a look and see how let's let's just see how my revenue is and see if that actually is necessary. Because I am not a very economical financial person, but what I did know was once my money went down, it was never coming back. So I was like, okay. I was like, let's just keep me at this same salary and just see if this works. So we were able to maintain the same salary, And I've been pretty thank you. And we have been I had been pretty good about kind of adjusting my schedule and adjusting my times and adjusting the things.
Dr. Jattu Senesie [00:30:04]:
And he and many of my patients who had seen me at the one office, they actually worked for their self, so they came and saw me in the new office. So it was never a problem. So I was doing the things. I'm changing my schedule around. I'm changing, you know, my office schedule. I'm changing my call schedule. I thought that things were gonna be better. And I'm like, okay.
Dr. Jattu Senesie [00:30:23]:
I'm gonna, you know, be more social, and I'm gonna and my, you know, I'm gonna make sure I make the most of my free time. But the thing is, I was still tired all the time. So even though I technically was closer to the city, I still didn't go out because I was tired all the time. And I just couldn't figure out how this kind of work was going to allow me to feel like I was thriving in any kind of way.
Dr. Sarah Smith [00:30:48]:
Yeah. Yeah. And and that's, at the end of these clinical days, were you still staying late to finish charting?
Dr. Jattu Senesie [00:30:59]:
Oh, here's the thing. At this point, we've gone to the EMR so I could go home and chart.
Dr. Sarah Smith [00:31:03]:
Okay. So you're going home and charting?
Dr. Jattu Senesie [00:31:05]:
So I'm still doing some, charting at home. Yeah.
Dr. Sarah Smith [00:31:09]:
Yeah. And what would that look like in relation to, like, hours of sleep and, like, any other interests outside of medicine? Was anything else happening even though you changed these other things about you seeing a therapist, you're having 4 days a week, etcetera, 5 days a week, but you still got this, like, overflowing work? Yeah.
Dr. Jattu Senesie [00:31:29]:
So because I was like, I'm gonna do more social things. I joined because I played volleyball in high school, so I joined, like, a a rec volleyball team. I was doing, like, volunteer stuff at my church. I was trying to do other things outside of work. And I had a bunch of friend I went to college, in Maryland, so I had a lot of friends from college who were still around, so I was trying to spend more time with them. But it was funny because all of their kid when I moved back, everyone's kids were around this age where they the moms didn't have a lot of time to hang out. So even with those efforts, they weren't they were more sporadic than they would have been. And then my friends who were single lived, like, in the city in the city.
Dr. Jattu Senesie [00:32:08]:
So even though I was closer to the city, it was still a little bit of a hassle to go hang out with them. So my social life was still not as vivacious as I had hoped it would be.
Dr. Sarah Smith [00:32:18]:
Yeah. Okay. So it's a lot of restrictions on you being able to be connected to your people, rest and recover, enjoy some of those things outside of the work hours and still taking up a lot of time with work. Got it. Okay. So then you said, okay. I can't fix anything else, so I'm gonna have to leave. Yes.
Dr. Jattu Senesie [00:32:38]:
Yeah. I, yes. I was fortunate that I did not have the high amount of school loans that many people had. So I was able to finish my to pay off my school loans before I left. So that gave me some, flexibility because I didn't have to keep paying back those, loans and I had money in savings. So I was like, okay. I'm gonna spend some time and figure out once I left clinical medicine, it's like I'm gonna spend some time and figure out what I wanna do next. And it really took me a while before it was more of my my money is gonna run out.
Dr. Jattu Senesie [00:33:12]:
I need to get a job more so that I I really wanna go back and do something. And I even maintained, like, my malpractice insurance, because I was like, I'm retiring. But I maintained my malpractice insurance for the 1st year just in case I wanted to go back, and I did not go back. I had practices that people from practices that worked at the hospitals where I worked, they're just like, if you wanna come back, you can come back and work for us. I was like, I don't though. And I really just at that point, I still didn't want to go back and unpractice medicine. So I was looking at different things. I was looking at, maybe doing something in public health because I still was just like, I did go to school for a bazillion years.
Dr. Jattu Senesie [00:33:49]:
I would like to somehow use this medical training that I have, in a way to earn money and to actually be of service. Interestingly, what I ended up doing that utilized my medical degree was doing, chart reviews. Somebody I knew had had was medically unable to practice anymore. And so he had started doing that kind of work. So he connected me with some people. So I did, medical chart reviews. And because I had been an athlete, I also started I was like, I wanna do thing. Because I've been an athlete and I was interested in, like, wellness and well-being, I was like, I should do personal training.
Dr. Jattu Senesie [00:34:27]:
So at one point, I was doing personal training and medical chart reviews. Those were kind of, like, the jobs that I was doing. And still trying to figure out, okay, is this all I wanna do? I think I wanna do some other, stuff. And through that, I ended up hiring a coach to try to figure out, okay, what do I really wanna do? After flailing on my own because, again, I wasn't good at direct being self directed. So I was like, okay. Let me speak with this, this coach. And through working with her, I was like, oh, you know what? As wonderful as my therapist was, I was like, I think I could have benefited from working with a coach, and been more directive and, like and the being more directive about kind of what my goals are. And this coach that I was working with was focused on well-being and kind of having well-being being the foundation for everything.
Dr. Jattu Senesie [00:35:16]:
And I was like, oh, this was what I was missing is I kept saying, I'm doing all this stuff, and I can't it won't allow me to be well. I'm doing all this stuff, won't allow me to be well. And I realized it was because I kept trying to tack on a sense of well-being to all this dysfunction that I was in the midst of, and switching it around to being, like, oh, start with well-being. So you're incorporating well-being into the entire process. You're considering how you wanna feel once you do the thing, and so you're incorporating well-being through the whole process is actually a much more sustainable way than saying, I'm gonna do all this stuff or I'm gonna see, you know, 30 patients in the day, and then I'm just gonna and power through it. I'm gonna do all my notes at the end of the day, but then you're tired at the end of the day. And so you're talking to yourself, and then you feel bad when you go home because you haven't done the notes, but you also don't feel like doing it. And then one of the things for me was once I moved from one place to the next, once I went home, my body was no longer in you need to do work mode.
Dr. Jattu Senesie [00:36:18]:
So then I'm feeling bad because I don't wanna go sit in front of the computer. Mhmm. And whereas if I had started with the, okay, this is how you wanna feel when you end the day, there's no way I would've saved all that stuff to the end of the day. And that was that mindset shift that I realized would've been super helpful to me, like, 3 years earlier.
Dr. Sarah Smith [00:36:37]:
Okay. Okay. That's true. But then you had to fit it into the day. So if you didn't want it at the end of the day, was that possible with the with the appointment schedule the way we had it, with the call schedule that way you had it? Because if it had been possible, could you have fitted it into the day?
Dr. Jattu Senesie [00:36:57]:
I not the way I was currently scheduled, but I think I probably would have I would have had the conversation about even because the over the time, I I scratched all my appointments longer. Like, whatever they had said they were gonna be, like, when I first started, I was like, nope. Need more time. Nope. Need more time. I think I probably would have been bolder about asking for that in order to allow myself to have that time. Because even because when I first started, we had I was given 30 minutes for lunch. And, you know, by the time you've been late in the morning and then you're asking for something, you have no time.
Dr. Jattu Senesie [00:37:33]:
So I said, I need an hour for lunch. Mhmm. So over so there were little things that I asked for, but I think I was again, it was always till I was till the brink of falling apart. And I think if I had started with the fact of, okay, this is what I need to do to actually, again, be sustainable. Because I, like, I powered through for 6 years, but then I Yeah. Fully burnt out.
Dr. Sarah Smith [00:37:55]:
Yeah. Then this is the the conversation that we need to have, that we need to bring forward is what did you need that you didn't ask for until you were at that breaking point that then you asked for it. And it sounds like you were actually in a place that accommodated quite a few of your requests and suggestions. And but you were completely physically exhausted by the time you got to those points each time. And so you're what you're saying is a coach kinda gave me the the ability to see what I needed and ask for it potentially earlier. That would have been useful, dear therapist.
Dr. Jattu Senesie [00:38:33]:
I could have reduced myself. Because it's one of those and I will I'll be perfectly honest. I also had better once when I was working with the coach, I also, you know, my HPA access had chilled out a bit, so I was probably better able to see things. And my therapist was telling me things, but it's also these things where you're just like, you don't know my ex because, you know, we always think we know everything. I was just like, you don't know my you don't know my life. You can't say these things. Of course, it's easy for you to be there and say this stuff, but you don't know the experience. But in retrospect, I'm like, yeah.
Dr. Jattu Senesie [00:39:06]:
I probably could've done stuff. Because I remember even when I wanted we first talked about me taking a, sabbatical, I was like, well, they're not gonna have people, blah blah blah. She's like, can they not hire because she worked with a lot of physicians. She was like, isn't that what locum tenens is for? She's like, if they basically, if they need somebody, they can hire somebody. It was her whole thing. I was like, no. No. Because I I had the full pathological altruism thing where I wanna be I wanna help people, and I must always put other people's priorities ahead of my own.
Dr. Jattu Senesie [00:39:33]:
And even though I knew that that I felt in my heart that's what I needed, I didn't wanna put anybody out to get what I needed.
Dr. Sarah Smith [00:39:40]:
Yeah. Yeah. So this is a great, great insights. Now tell us where you ended up now, so what you're doing now, within this wellness space.
Dr. Jattu Senesie [00:39:52]:
So as they always talk people always talk about turn your pain into your passion. Now that I have recognized what could have been helpful to me back in those early days, I I now work as a coach. Funnily enough, in working as a coach, I was like, oh, these would have these skills and tools and insights might have helpful to me back when I was practicing. So I decided, okay, let me be a coach for physicians. And I really, really enjoy working with early career physicians, making that transition from trainee life to attending life to help them be intentional. Again, not be like, okay. It's all just kinda gonna work out. Like, no.
Dr. Jattu Senesie [00:40:27]:
No. You've been intentional for everything up until your early thirties. Just give me a couple more just give a little bit more time to lay it out for the rest of your life. So that's what I do now is I, I work with, mainly, physicians and people in health care around starting with well-being to design a life of sustainable success. And because like myself, a lot of people aren't in a space where they think that that's realistic for them because that's really a challenge to get people to believe that you actually can have success at all, much less sustainable success with starting with well-being because they're just like, oh, that's woo woo. I also do a decent amount of speaking just to kind of increase awareness to people. Like, just consider it. Start with it in a small way and see that how that might work.
Dr. Jattu Senesie [00:41:16]:
So, yes, that's my main thing now. It was coaching and speaking around, success with satisfaction and well-being.
Dr. Sarah Smith [00:41:23]:
Yeah. Nice. And when you're talking with the new career physicians, where are some of the big points that you hit that are worth kind of understanding so we can kinda realize how this could look have looked if we thought about it earlier?
Dr. Jattu Senesie [00:41:40]:
One of the big things is, releasing attachment to a survival mindset. I think that because of the way our training goes, we develop habits that get us through training and that work to get you through training because training is constantly flipping. You're between 6 to maybe 12 weeks max, you're on a rotation. And you're just like, I just need to get to the end of the ICU rotation, then I'm gonna go to the next thing. And so we have these small periods of time and so we develop these habits to get us through that chunk of time. Helping folks understand that some of that will help you as you go out. However, you want to start developing habits that are sustainable. You wanna start developing habits that allow you to keep doing because you're gonna be doing a lot even as much variety.
Dr. Jattu Senesie [00:42:32]:
Part of why I like OB GYN is you have variety. Even with as much variety as you have and whatever specialty you have, there's still gonna be certain things that are kind of the same and you have to figure out how to be sustainable and how to be able to pivot and do new things. So releasing that survival mindset and embracing, well-being as a basis for sustainability. And in that, learning how to honor your priorities. Learning how to honor your priorities while respecting the priorities of others. Because sometimes and especially, god bless the youth. Sometimes with one of the things I hear from older physicians, talking about younger physicians, like, they're so selfish, they're so this, and helping people recognize. Okay? You can honor your identify your priorities and honor your priorities and know how you wanna be.
Dr. Jattu Senesie [00:43:19]:
However, we live in community and we live in a society and you must also take into account other people's, priorities. And if you feel like you're in a circumstance where you can't respect other people's priorities, maybe you do need to pivot and and be somewhere else. So figuring out how to honor your priorities while respecting other people's priorities so that you don't fall into pathological altruism, but you don't also don't turn into, like, you know, a selfish jack hole.
Dr. Sarah Smith [00:43:43]:
Got it. Yep. Yep. I understand. Alright. That, ability to advocate for what you need, ahead of time, so before you hit that crunch, how do you identify that something is not sustainable? What are the things that, perhaps you teach on about that?
Dr. Jattu Senesie [00:44:04]:
So, again, kind of going back to the start with well-being piece, I generally, any goal. Let's say someone says I want to become the CMO of my, organization. I always ask them, like, what do you want that how do you wanna experience that? How do you wanna feel? It's It's very interesting because good and happy comes up all the time. Like, good and happy is not very descriptive. So I ask people to actually sit and think, okay, how do you wanna feel? How do you wanna experience it? And if you think about that as you're going through, and if in the process, you know, I wanna feel at peace. I wanna feel confident. If in the process, what you're doing is in no way supporting you feeling at peace and feeling confident, that's a sign. Those are some red flags.
Dr. Jattu Senesie [00:44:53]:
That's when you need to start taking a step back and being like, is it the thing that I wanna do? Is it the way that I'm doing it? Do I need to tweak it? Do I need to toss it? You know? Or is this working? So I and that's kind of where the start with well-being piece, comes comes from. That's usually how I work with clients. It's like, okay. Let's figure out how you wanna experience it. And if how you say you wanna end up and how to get there is completely different, then we maybe need to do some things differently.
Dr. Sarah Smith [00:45:19]:
Oh, yeah. That is really, really good. I totally understand what you're talking about. The, the journey has to have some elements of how you want it to be at the end. Exactly.
Dr. Jattu Senesie [00:45:33]:
Because it's like, okay. Misery misery because they that's the thing is that
Dr. Sarah Smith [00:45:36]:
how we misery when I get there, it'll be better. That is a warning sign.
Dr. Jattu Senesie [00:45:41]:
The thing is though, that's how we feel in medicine. We're just like, oh, no. But once I get through medical school, then it'll be great. Then you're like, why am I not as excited as I thought I was gonna be? Because you were miserable, and you didn't take time to actually incorporate joy to any part of the process.
Dr. Sarah Smith [00:45:56]:
Yes. Okay. This is really good. Where do people find you or reach out to you if they wanna learn more?
Dr. Jattu Senesie [00:46:02]:
So the probably the best place to reach me is at my website, essence of strength dot com. So my business is called essence of strength. So essence of strength as one word.com. You can reach out to me. You can see my resources, everything there.
Dr. Sarah Smith [00:46:17]:
Beautiful. I love it. And final pieces. So if there's somebody stuck in that, maybe it's that right before the sabbatical experience that you were having that, you know, this can't go on. I've had enough. I don't want to, whether they're in residency attending, what are your, pearls of wisdom for them?
Dr. Jattu Senesie [00:46:38]:
So, honestly, take a step back. Usually, if you were thinking about taking a break, you may be maybe it's not a full break, but you might actually need to do less so that you can have space to figure out how you wanna proceed. Because usually, if you're already in the space of I wanna do this, you know, I I don't wanna do this. I wanna stop doing this. You probably whether it's if it's possible, seeing you know, maybe seeing fewer patients at work. Sometimes we think, oh, I don't like work, so I'm gonna do 50,000 extra, curricular things. Sometimes you maybe need to resign from few boards or resign from a few things and actually just give yourself space to figure out a very simple thing. I'm a fan of journaling.
Dr. Jattu Senesie [00:47:31]:
Some people are not fans of journaling. I think that it's a way to get thoughts out of your brain and just help you kind of free think and just consider, okay, how do I actually again, going back to the being, how do I actually wanna experience life? How do I wanna experience work? How do I wanna feel going to work? How do I wanna feel coming home from work? How do I wanna feel once I've left work? Thinking about those things and journaling about it and kind of figuring out, okay, what's the gap between where I am and where I wanna be, and what are the things that need to happen?
Dr. Sarah Smith [00:48:05]:
Yeah. That's good. That's very good. What about, the the connection piece? So you said that you'd had some friends along the way. You didn't really have anyone noticing how damn hard you were working. How do you bring back in to you those people who can help you or can notice you or you can vent to? Like, how do we start to reconnect?
Dr. Jattu Senesie [00:48:32]:
I I was blessed that I had people in my residency class who I was very close with. I know some people even though I didn't like residency, I love my my fellow residents, so I could reach out to them. So even though they weren't local, I could, you know, reach out, talk to them. I will say it is it has been my personal experience. It can be challenging to talk to people outside of medicine about your challenges in medicine. Sometimes you just wanna however, I do think it's important to know people outside of medicine because they can give you a perspective on how the nonsense that we think is normal. It's just sometimes you have to figure out what conversations you have with them. So I think it's important to have kind of both.
Dr. Jattu Senesie [00:49:13]:
Have once I stopped practicing medicine and I started talk spending more time with people outside of medicine and I told them what we did on a regular basis, they're just like, wait, what? And so that can be important just to have another perspective. And but also figuring out who are the people in medicine that I can vent to. I did have friends in my practice, people who I'm still and all this none of us are with that practice any longer interestingly, but who I'm still friends with that we could, you know, talk about things and be like, okay. Maybe consider this, maybe consider that. Recognize who are the people who are concerned about your well-being. K.
Dr. Sarah Smith [00:49:50]:
One final question. If there's nobody left in that center, if you were to go back into that, place maybe before your sabbatical and you were to come in as a wellness expert, what do you think that you would be working on with those own OBGYNs and that team? What do you think would have looked different had they had someone like you come into their workplace where there are people who are at the that point of burnout there, you know, they are not sustainable right now. How does that look to interact at that level?
Dr. Jattu Senesie [00:50:26]:
It's so interesting because it's one of those things where you have to balance between the realities of the business and the realities of the actual employees. And it's kind of helping the the money people recognize. Actually, I'm a take a step back for with all those words, helping everyone acknowledge everyone else's humanity. I think that that's really where we kind of lose our way in medicine is the bottom line is part of it. We have you have to keep the doors open. You have to do all that. But I think if we start with recognizing people's humanity because I think that when we say double book folks, double do this, that comes from disconnecting from humanity. And that's another thing that comes out of training is you what is the basic things? You eat? You sleep? You pee? And these are all things that you just put to the side when you're in training.
Dr. Jattu Senesie [00:51:29]:
So when you disconnect from your own humanity, it is really hard for you to see the humanity in other people. So I think that starting with helping everyone recognize their own humanity will help you recognize the humanity in other people and thereby not maybe not completely get rid of it, but diminish the times that you ask someone to do something ridiculous. There was a time when I was post call. I think I've been in the hospital on Monday Tuesday. I had been actually on call Tuesday night. Wednesday, I was in the office with one of my colleagues who was covering the office from his covering the hospital from the office. And he asked me at the end of the day as we're going to our cars, hey. You wanna come up? Because he hadn't rounded yet.
Dr. Jattu Senesie [00:52:14]:
You wanna come over with me and knock out some, some of he's like, we can go over a round together and knock out these, these rounds, together? I said, absolutely not. Like, why would you even ask me that? And that's one of those things, like, if you're acknowledging the humanity in other people, you don't go to somebody who's been at work for 36 hours and say, hey. Do you wanna come back to the hospital and round with me?
Dr. Sarah Smith [00:52:39]:
Got it. Okay. Yes. Yeah. Thank you for that. Because, you showed us a lot of, little glimpses into your life as a OB GYN that we're like, what? Wow. How how did they manage that? And, I'm just thinking that, yes, as if you were coming back into that environment, what where would you start? But, yeah, just recognize the humanity. I think that's really important for ourselves, for our colleagues, for our workplaces, for our teams.
Dr. Sarah Smith [00:53:05]:
This is beautiful. Thank you so much.
Dr. Jattu Senesie [00:53:08]:
Thank you for the conversation.
Dr. Sarah Smith [00:53:09]:
Alright, everyone. Have a wonderful rest of your week. We'll leave you there, and, we'll see you next time.
Dr. Jattu Senesie [00:53:14]:
Bye, honey. Take care. Bye.
Dr. Sarah Smith [00:53:17]:
Thank you for being part of the sustainable clinical medicine podcast. If you'd like to learn more or join us to help you get home with today's work done, go to chartingcoach.ca. There you'll find all the information on the premier lifetime access charting champions program that is helping physicians get home with today's work done with all the proven tools, support, and community you need to create time for your life outside of medicine. We would love to see you there. Until next time. Thanks for listening.
