Dr. Jillian Horton examines burnout facing healthcare professionals in new book

The Next Chapter19:03Dr. Jillian Horton on We Are All Perfectly Fine

Dr. Jillian Horton talks to Shelagh Rogers about her book, We Are All Perfectly Fine: A Memoir of Love, Medicine and Healing

Six years ago, Dr. Jillian Horton was feeling burned out. She wasn't alone: a 2021 report from the Canadian Medical Association shows 53 per cent of Canadian physicians experience high levels of burn out.

At the time, she attended a five-day meditation retreat for healthcare workers. Horton arrived a skeptic, suspicious about whether a week-long wellness excursion would actually quell the exhaustion built up over years of working in a high-intensity, often overburdened healthcare system. 

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Thankfully, she was wrong. The connections she made and the stories she heard from other healthcare professionals left a profound impact. So profound that Horton decided to write a memoir about her experience. That book is We Are All Perfectly Fine.

Horton, a medical educator, writer, musician and podcaster from Winnipeg, spoke to Shelagh Rogers about writing We Are All Perfectly Fine.

Let me get right into the story. When you arrive at the retreat, you're a rebel. You don't give up your phone like you're supposed to. You don't maintain silence. You don't fully commit to the retreat rules.You knew you needed that break to rest and reflect. So why were you skeptical about the experience that you were being offered?

I think I have the same personality as nine out of 10 doctors. We are people who are conditioned over time — partly because of the nature of our work and the systems that we work in — to be incredibly impatient. I would say that quality, for me, was built over years of working in a high-pressure environment. 

Doctors are used to people offering us quick fixes: meditate and you'll be better able to cope with your stressful job. Do yoga at noon. I had no interest in this stuff. I knew that the problems I was struggling with, and that so many of my colleagues are struggling with, go so much deeper than yoga or mindfulness. 

I knew that the problems that I was struggling with, and that so many of my colleagues are struggling, with go so much deeper than yoga or mindfulness.- Jillian Horton

All those things combined to make me think this was going to be a big waste of my time. But, paradoxically, the main reason I engaged with it is because I thought, "Well, I'll learn something. I'll be able to help my students." Of course, the joke turned out to be on me.

You write that the burnout you were experiencing started in your medical residency program. You tell a story about a moment of maybe misguided pride when you were on rounds as a second-year resident. Do you know the story I'm talking about?

When I was a resident, I was on call and I got a really bad virus and I was throwing up, but I stayed at work. I threw up so much that the vessels in one of my eyes burst. I looked like a Halloween costume walking around. And yet at that time, in our professional lives, this was actually pretty normal. It's heartbreaking because I'm sure there are readers who hear that and go, "That is absolutely sick. A physician who's there to look after other people doesn't even have insight into the fact that she's too unwell to be looking after other people."

I would say insight Is only part of it. The other part of it is culture. When this is what everybody does, if you become the person to say, "I gotta go home," you know that everybody then starts to say, "Ohhhhh, Horton's the weak link. Horton isn't as tough as the rest of us."

LISTEN | Dr. Jillian Horton and other medical experts on the impact of the pandemic: 

The Sunday Magazine18:55Doctor warns COVID-19 crisis exacerbating physician burnout

Dr. Jillian Horton's medical career started in the midst of the SARS epidemic. Now, 17 years later, the Winnipeg-based physician and writer is ringing the alarm about the toll the COVID-19 pandemic is taking on doctors who were already putting their burnout on the back burner. She joins Piya to discuss how fall has taken on a different tenor than spring, what needs to change for doctors who are feeling overwhelmed, and her fears about the festering issues that can linger after the pandemic is over.

How significant was it to share the stories of the feelings that you had for the first time with other doctors there?

I write a lot in the book as if mindfulness really helped me, and mindfulness did help me. Mindfulness did rewire certain things about my brain, which absolutely goes along with the literature on mindfulness. But I think the most healing and critical part was community. 

It was going to this place and seeing physicians from major institutions all over North America — some of them coming from all over the world — and thinking, "Why are you here? There's nothing wrong with you. You're not messed up the way I'm messed up," and then beginning to realize slowly that this is a universal experience. Everyone carries a lot of this self-doubt, imposter syndrome and blame for things that actually have very little to do with them. 

Everyone carries a lot of this self-doubt, imposter syndrome and blame for things that actually have very little to do with them.- Jillian Horton

That was absolutely illuminating, because it does two things. It validates your own suffering. But, then, on another level, it also makes your suffering uninteresting. Not to minimize it, but it makes it less exclusive to you, less something you have to tenderly guard and water and cultivate. 

You can begin to let it go when you understand, in a way that you never really appreciated before, that [your suffering] is part of a universal experience. For me, that was so, so healing.

LISTEN | Dr. Jillian Horton on pandemic burnout: 

There is a poem read to you very early on in the retreat about taking "the step you don't want to take." What was the step you didn't want to take?

The most important piece of it was recognizing my own suffering as worthy, as having some value and not doing what I had done for most of my life, which is what Brené Brown calls comparative suffering. 

I didn't have a brain tumour. My problems are therefore irrelevant. I don't have the blood cancer that my patient has or the horrible socioeconomic circumstances that my patient lives in. Therefore, I should just shut up about my problems. It was suddenly having to have compassion for myself to say, "It doesn't have to be the worst for it to matter." I would never inflict that kind of framework on a patient. I'd never walk into a room and say, "[one of you has] lung cancer and [one of you has] a diabetic foot ulcer. The foot ulcer is the lesser problem so I don't have any compassion for you.

The most important piece of it was recognizing my own suffering as worthy, as having some value.- Jillian Horton

I would never speak to patients like that. I'd be enraged if a student tried to suggest that. So the idea then became: in order for my own compassion for other people to be authentic, I had to find some for myself. 

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At that point in my life, it was hard. But I have to say, it's become easier. For any of us who do that work, it has a quality of life impact that's almost impossible to quantify. It's so profound.

This conversation has been edited for length and clarity.

Interview produced by Lisa Mathews, Shelagh Rogers and Jacqueline Kirke.