Interview with Dr. Claire Unis
In today's podcast, Dr. Claire Unis describes how creative writing restores vitality.
At Dartmouth College, Claire double-majored in creative writing and literature. She participated in the Master of Fine Arts program at the University of San Francisco while attending medical school at UCSF. At USF she concentrated on memoir and narrative nonfiction writing. She finished both degrees at the same time.
Claire is a pediatrician who is currently in part-time practice. She works for one of the largest medical groups in northern California as a communication coach for other physicians. As a part of the Clinician Wellbeing Program, she mentors medical professionals and delivers seminars.
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Balance, Pedal, Breath: A Journey Through Medical School
The urge to hold on to that motivation for being a doctor and that earlier self (a fairly innocent and naive person who applied to medical school and wrote lovely, glowing entrance essays about how this was the most important profession in the world) led Dr. Unis to write the book.
Writing about her experiences during medical training helped her make sense of those experiences. It also helped her reconnect with her purpose.
The goals of her book are to help the general public understand what physicians in training go through and to provide those considering a career in medicine to develop a deeper understanding of the profession.
Narrative Medicine
The medical humanities discipline of narrative medicine is a way to connect doctors with their non-medical side. And it assists them in overcoming burnout by enabling them to define meaning in their lives.
Dr. Unis uses her abilities as a creative writer in other ways:
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Literary Inspiration For Expression (LIFE)
Dr. Unis designed her first lesson to be a true reminder that we are more than our professions. We have life experiences that may be influenced by our work but are not entirely defined by them. - Book Club
Those who wish to write but don't feel comfortable doing so can share their writing in a safe nonjudgmental environment. The primary objective is to improve clinicians' well-being by expressing themselves through writing. -
Medical Group's Weekly Blog
Claire writes a brief reflection essay about anything that is happening in the world or in her life every week. People appreciate being reminded that others are going through these very human situations.
Summary
Dr. Unis' book can be found on her website. Additionally, it is offered directly at Warren Publishing, and at Barnes & Noble, Amazon, and Kindle. You can contact her through her website, Facebook, and Instagram.
NOTE: Look below for a transcript of today's episode.
EXCLUSIVE: Get a daily dose of inspiration, information, news, training opportunities, and amusing stories by CLICKING HERE.
Links for Today's Episode:
- Dr. Claire Unis' Website
- Buy Balance, Pedal, Breath: A Journey Through Medical School [this is an Amazon affiliate link]
- How to Become a Marvelous Medical Mystery Author – 231
- Add Discipline to Creativity to Be a Successful Medical Writer – 179
- How to Influence the World by Writing a Medical Thriller – 116
- NewScr!pt
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Podcast Editing & Production Services are provided by Oscar Hamilton
Transcription PNC Podcast Episode 259
How Creative Writing Prevents Burnout and Restores Vitality
John: I have a great respect for physicians who write and especially those who also get paid to do so. I was very pleased to meet today's guest and convince her to tell us about how she has integrated writing into her career while she's still doing clinical medicine. So, with that, I will say hello and welcome Dr. Claire Unis.
Dr. Claire Unis: Hi John. Thank you so much for having me on the show.
John: Yeah. I kind of feel like I need to support writers, whether they're writing some fiction or even a technical writer or whatever, because I think a lot of physicians think that writing is not really an option in terms of either part-time or full-time replacement for medicine, but some have made a great living doing it as well enjoy doing it. So, that's why I thought it'd be great to talk to you today.
Dr. Claire Unis: Thank you. I'm really grateful to be on your show.
John: Let's see, we do have some things to talk about, including a memoir that you've written, but why don't you tell us a little bit about your background, your education, where the writing came in and then we'll go from there?
Dr. Claire Unis: Sure. I actually went to Dartmouth for undergrad and although I entered college knowing that I wanted to become a doctor, I was delighted to find out that you don't actually have to major in a basic science to become a doctor. And once that avenue was open for me, I tried all kinds of different things, but landed on something I've always loved, which is writing. I was actually a writing and literature major in undergrad, and then was fortunate to be accepted to UCSF for medical school. And I went down that road for a little while and part way through, looked up and said, "Wait a second. I need to write about this."
Before I graduated from medical school, I enrolled at USF, university of San Francisco in a master of fine arts program in writing. I was able to spread out my UCSF education by a little extra six months at the edge. So, I graduated in December 2000 from there and with my MFA in creative writing in May of 2021. So, I was able to get both degrees before starting residency that same June at children's hospital Oakland where I started residency in pediatrics.
John: Okay. Now you've been practicing since you finished your residency, correct?
Dr. Claire Unis: That is correct. I went right on into it like I think most of us do when we look up and realize that we need to make some money. Yeah.
John: And do you still enjoy pediatrics to a large extent?
Dr. Claire Unis: I really do. I really do. And I think partially I can say that was so much enthusiasm because I've been able to bring writing back into my life. I think like many of us, once we get to a certain point in our careers, we have a certain level of mastery of what we're doing most days. You start to look around and say, "Okay, what else? What else can we do?"
John: That's true. For me, as a family physician, it became pretty mundane after a couple of years. And most of what I was seeing was trivia anyway. All right. So, tell me, why is writing so important to you? Obviously, you've been interested for most of your life, but what is the draw of writing, particularly non-technical writing, which I don't think you're doing at this point?
Dr. Claire Unis: You're correct. I'm not doing technical writing. I thought about it very early on and realized that if I wrote for a career, if I wrote things I wasn't excited about, it was not going to have the same resonance that writing has for me now. I probably started writing very young. I found a journal at home where I wrote a song/poem when I was in like first grade. Not super sophisticated stuff, but clearly, I always have had this impulse to write things down. I think in adolescence is when it became something that was really part of my life. It was how I made sense of things, how I made sense of that burgeoning understanding of mortality and just all of those changes. So, I started writing regularly then.
And then in college when I returned to it, it's really because of that musicality, it's the way that the right words, the right description of an experience that you relate to really resonates and really kind of gives you that moment of "Yes, someone understands me" or "Yes, we share this experience." That resonance is what has kept it so important to me and has made it so hard for me to give up that creative writing.
John: Well, I think I can relate to that. Not so much as a writer, but as a reader. And we have each our own preferences, but boy, when I read something that communicates well, that it creates a story in my head, in my mind, I can visualize it. There's just something about it that is beyond watching a TV show or playing a video game or something like that, which tries to bring it into reality, but it's better when you're imagining it, I think.
Dr. Claire Unis: Absolutely. Absolutely. And being able to bring that experience back out to something you can share with someone else and have someone read it and say, "Wow, I really felt that" or "Wow, that really meant something to me" is just an amazing feeling.
John: Well, this is a good point to segue then, because as I was reading something this past week, which was your memoir, I could visualize what you were doing, what you were describing. And there's a lot of active things going on in some of the writing list of chapters I was looking at. So, why don't we go ahead and talk about that. It seems like you used that even maybe through medical school to get through medical schools. Tell me how that whole idea of white writing a memoir and then later publishing it, how that came about.
Dr. Claire Unis: Boy, that's a great question. One of the wonderful programs that I was able to participate in at UCSF was called The Healers Art. It was a program put on by Rachel Naomi Remen. And as I understood it, it was designed to see if we could prevent doctors from burning out in the future by putting first year medical students in touch with the reason that they came to medical school to begin with.
And this was fantastic for me. I had taken a year off to be a ski bum between college and medical school. And so, I really came in probably little prepared for the rigors of study that was in front of me. And so, this was a great course that allowed me to use creativity. I think we were drawing pictures and writing little things just to reconnect, be like, "Okay, is this worth it? This is painful. Do I really want to do this?" I think it first got ratified in some way or I first felt like it was going to be okay to pursue some creative pursuit in addition to medical school with that course. And then as you go through medical school, you can feel yourself changing. You can feel how transient those experiences are and how some of them you really just want to forget. And others of them, you realize that, "Wow, I really hope I can remember what I learned from this situation."
I think the impetus to write the memoir really came from the desire to hold on to that reason for becoming a doctor and hold on to that before self, a rather innocent and naive person who applied to medical school and wrote wonderful, glowing admissions essays about how this was the most important work in the world.
So, writing about it really put me back in touch with my purpose and also helped me make sense of some of those experiences as I was going through it. That's kind of a long wordy answer but as I look back at my journals, which I journaled like an inch of text maybe every day. I had a little tiny daily calendar. So, I would just write down some little thing about every day.
But when I go back and look at that, the idea about writing about it came to me pretty early in third year. And I approached the admissions office at UCSF and spoke to somebody in that department. And being told that I could do this, being told that I could be accepted and could write just opened everything up for me because suddenly there was somewhere to put all these experiences as I was going through them. And it wasn't just something I had to hold onto and endure.
John: Okay. That's one of the questions I had as I was reading some of the book. You were journaling at the time. And is there a difference between journaling and writing a memoir or is that two separate things? Did you just happen to use some of the journal entries in the memoir or were you actually writing the memoir as you were journaling?
Dr. Claire Unis: That's a great question. I started out with just the journaling. As most of your audience, if you're in medicine knows there was just no time to write very much as I went through medical school. But because I could feel that change happening and because I really wanted to be able to remember this later in order to write about it, I wrote those little tiny journal entries as I went through.
During my fourth year, I spread my fourth year out over that extra six months. My fourth year was actually like an 18-month year. I was simultaneously in classes at UCSF. And so, then I was actively writing while I was going through fourth year. But as we all know, the fourth year is a little less rigorous than all the years that have come before. So, it was possible to really focus on my writing for a month and then be in my clinical rotation for a month and then focus on my writing for a month. A little bit of both, but I was aware that I needed to synthesize these journal entries and really write while it was still fresh.
John: Then at some point, there's something called "Balance, Pedal, Breathe" came into existence, but it wasn't at that point. How do you feel having published it and what made you decide "Okay, I actually want to put this in a way that can be out there for other people?"
Dr. Claire Unis: Yeah. I had to finish some version of it to graduate from UCSF, which I did. And I knew it wasn't finished even at that time. As a new graduate, you don't really have that much confidence in what you know or how you're going to use these experiences. And I think part of me was really very nervous about getting this into final published form had I really been able to do at that time. And I did have an agent interested and there was some back and forth, and I think I kind of just panicked and then I started residency and there was no time.
But what got me back to this, and then of course, over the years I actually wrote the chapter on my OB rotation during my pediatrics residency when I was working and taking care of the babies. Some of these chapters came later. Most of them were at least initially conceived during the end of medical school. But I came back to this when the pandemic hit. It was kind of like being handed this little gift of time. And I think many of us were like, "What am I going to do with this sudden gift of time?" And there wasn't any question in my mind, I really needed to come back to this. I was facing symptoms of burnout and feeling like something had to change and pulling this out and rereading it really kind of got my heart all flutter. It was like, "Oh my gosh. This is what I felt when I went into this." And this is what I experienced. I think writing the memoir at that point or getting back into it sort of put me back in touch with my purpose, but it also, and this is the uncomfortable part, it made me face things I wasn't very proud of either. It's been many years since I graduated from medical school.
And during that time, there were things that I did that were selfish, that at the time, I didn't know how else to get through. And then when you look back, you go, "Okay, that doesn't actually create a human that I can be proud of being." Some of going back to this later inspired me and some of it forced me to evolve a little bit more yet than I've even evolved over the years as we all do. But getting it published is literally a dream come true because I always wanted to. At the same time, it's a little bit like walking around naked sometimes because people are reading some of your inner thoughts and I definitely had some feelings of panic as it was being released of, "Oh my gosh, maybe I shouldn't do this." But it was too late.
John: That's not a trivial thing. I thought if I were to write some kind of book, sort of a fiction book, and I wanted to make it interesting, I'm afraid I had to put things in there that I had done or experienced to make it sound real. But then I wouldn't want people to read it because I'd be embarrassed by what was in there.
Okay. Now I'm going to put you on the spot. We knew you knew we were going to talk about the book. So, sell me on the book. Who should buy this book? It's out there, it's available. Tell us where you can get it and who would it resonate the most with? Because there's got to be an audience for it, right?
Dr. Claire Unis: Absolutely. And I've been really fortunate that anyone who has read it has come back to me with glowing reviews. "Oh, my goodness. I didn't know you could write like this." And while this really resonated with me and I had no idea what medical school was like, or those who have read it would have gone to medical school. Actually, it's really funny. I guess I shouldn't say who it was, but somebody I knew well in medical school got in touch with me and said, "I now have a clearer memory of your medical school experience than my own." And I say, "Well, that's a fascinating thing to say." I think it's absolutely relevant for anyone who's thinking about going to medical school, anyone who has gone to medical school, the nurses who I'm friends with who have read it have really resonated with it as well.
But ideally, I think this is a book that could do very well with book clubs. I don't think you need to be in medicine. And my whole goal in writing it, was to help someone who's not in medicine, understand what your doctor has gone through to get to that point. And I think that's really important and that is part of what drove me back to it during the pandemic as well. There was this huge disconnect between the general public and the people who are trying to take care of them. And I just have always felt understanding is the key. If people could understand each other's experiences, it would take us so much closer to being able to communicate well and bridge those differences. So, I really wrote this book to have universal appeal and to be relevant to anyone who's interested in what someone going into medicine has experienced.
To answer your second question, it's available on Amazon, it's available on Barnes & Noble. You can buy it from the publisher, which is Warren Publishing, and they were fantastic to work with, but I will tell you that you can get a lot faster through Amazon. And it is available also on Kindle.
John: Okay. Two comments. One, Warren, because I don't want to get into too much detail, but everyone always asks, "Well, how did you publish it? Was it traditional? Was it self-published?" And Warren is one of those that's in between, right?
Dr. Claire Unis: Yes. Warren is a hybrid publisher. So, what that means is that there's some shared expense in terms of what goes into publishing the book. They help with curating the editors that you work with. So, I know you've previously interviewed Deborah Blaine who is a friend and a wonderful writer of medical thrillers or medical mystery. So, she's a great example of someone. And she actually turned me on to Warren Publishing. And then once you sign on with them, there's a developmental editor, there's a copy editor, there's a proofreader. There's a lot of rounds of editing that they help and then making sure that everything is in line as it should be so that it can be presented as well as a traditionally published book. And it can be sold in bookstores, which is something that most bookstores won't carry self-published books. So, for me, it was a faster process than going through a traditional publisher and it allowed me to put out a product I can be extremely proud of.
John: Yes, it's very professionally done, obviously. The second comment I was going to make, and I hadn't thought about this before, but when you said it would be something that someone who was thinking of going to med school or was starting med school would read, I think back, I could have really used that darn book because I had no one in my family that was in medical school. The first rotation that I did in my third year of medical school, I had no idea what was happening. I just showed up. It's like, "Okay, what's going to happen now? I'm in the surgical rotation with some Vietnamese doctor who was at the VA and I got to be here every third night and stay here?" Oh my gosh, it was a total culture shock.
Dr. Claire Unis: Absolutely. Nothing really prepares you for that. Your first two years don't prepare you for that. We had one panel where the upperclassmen told us a few things to make sure that you had with you and then off you go. So, thank you.
John: Yeah, that's really good. And you know what? I'm the only one that has mentioned the title of the book. So, tell us the title, the complete title. And then we'll move on to my next question.
Dr. Claire Unis: Sounds good. The title is "Balance, Pedal, Breathe: A Journey Through Medical School." And the reason for the title is that this book is every bit as much about my other outdoor pursuits or outside medicine pursuits as it is about medical school. And I think that's also part of the universal appeal.
For example, when I talk about my pediatrics rotation, I'm also talking about paragliding and traveling and learning a new language. And when I'm talking about the surgery rotation, I'm also talking about swing dancing, which was something I did quite during medical school.
Balance also has to do with rock climbing. There's a chapter that is called "Unsure Footing" that's about a multi pitch long climb that I went on. And I interweave that with stories of uncertainty in medicine. Pedal was mountain biking. Biking absolutely saved my soul, I think during the second year as we approached boards. And then breathe because so much of this book revolves around images of breath. And breath drives everything. It's how we deal ourselves, to deal with whatever we have to deal with. It's how we recover from something that's difficult. It's how we center ourselves. And it has so much to do with any active outdoor pursuit.
The title very much harkens to all the other experiences that are interwoven with the medical experiences here. And then the subtitle "A Journey Through Medical School" because it very much was a journey both emotionally and physically.
John: Very nice. Yeah. There's a lot to talk about here but this is a thing that impressed me and what we're going to talk about for at least the next 10 minutes or so. So, you published a book like, "Okay, that's your writing and how it's manifest in your life now?" No, you're doing like three or four other things in which you've incorporated and integrated writing into your daily, I guess, life. So, explain what you're doing from that aspect. The teaching, the coaching, whatever you want to talk about. We only have so much time, but I want to hear about those things. I think the listeners will too. And some of those things, I think you're actually getting paid for as part of a program at the university.
Dr. Claire Unis: Yes. Thank you. When I looked up and realized I needed to do something more than just clinical practice, that was actually before the pandemic. And at the time I had recently learned about narrative medicine, which is a field of medical humanities that came into being right around the time I graduated with my MFA, feeling like I was the only person in the world who wanted to merge the humanities with medicine. It turns out I was not.
There was a team of doctors and other writers and all kinds of collaboration was going on at Columbia university to create narrative medicine, which is basically the use of texts, which could be pictures, photographs, any kind of example of the humanities to connect doctors with the other side of themselves, the nonmedical side of themselves and give them something to talk about that will also get in touch with basically geared against burnout by allowing people to talk about something nonmedical and get at the meaning behind what is going on in their lives. Because we doctors learn very early on that we don't share what's going on emotionally with our patients, that we are supposed to be quite stoic in the face of all kinds of trials. And obviously over a lifetime of that, that's a recipe for burnout. And I think of creativity as an antidote to burnout.
So, I'd come across this narrative medicine program. And I was thinking about enrolling, although having two children and a practice on the west coast, it was terribly practical to go to the east coast for a program. And in talking to someone who I would consider a mentor at my work, he said "Wait a second, you have an MFA in writing. Do you really need another master's degree?" And I thought about it and I was like, "Wow, you're right." It was already in the works before the pandemic. I was creating a program involving writing and literature appreciation for other doctors, modeled loosely on what they're doing with narrative medicine at Columbia and then the pandemic hit. So rather than be able to meet with people in person, suddenly everything went virtual. And it was honestly perfect timing because suddenly everybody had a little bit more time to spend, checking out something new.
So, the first class I put together was something that I called LIFE - Literary Inspiration For Expression. And in this class, I would provide a short story to people ahead of time and they would read it and then we would get together and discuss it for a little while. And then I would give a writing prompt to which people could free write and they didn't have to share their writing with anybody. It was just a chance to a little bit of personal reflection based on the discussion that we've had.
I deliberately chose stories that had nothing to do with medicine. This was really intended to be true enrichment and a true reminder that we are much more than our professions and that we have life experiences that are perhaps informed by our jobs, but certainly not completely circumscribed by our jobs. And that class was very popular.
And so, from there, I went on to develop some writing workshops. I found that there were a number of clinicians who were trying to write on their own and really could benefit from having people to bounce their ideas and their writing off of. I created a book club. I worked with one of our patient family advisors to develop a writing class. So, people who didn't feel comfortable with their writing, but wanted to write, could learn some techniques. And then ultimately after taking several narrative medicine workshops, I did feel comfortable working with someone else who was in that program to offer some narrative medicine classes also.
So, I've been very busy offering classes to clinicians with the main goal being to improve clinician wellbeing. And I was fortunate also that some of this work was funded by a grant. I worked for Sutter medical group. And Sutter Health had a joy of work committee formed that received a grant to support work that would help or kind of augment clinician wellbeing.
And so, I was a recipient of some of that money that funded some of my time to put into program development. And that was a real boom because like many of us, it's hard to take time out from other things that we're not getting paid for, or take time away from things that we are getting paid for to really develop something like this. And so, it gave me the permission to say, "Okay, this is part of my job. I have to create something." That seems like that was a lot of talking on my part, but that's a summary of what I've done with the writing. And one more thing, I've been able to write a weekly blog for our medical group. So each week I just write some short reflective piece about something that's going on in the world or in my life that I consistently get nice feedback on. I think people like to hear just a reminder of other people are having these very human experiences alongside the medical obligations.
John: Now, the one thing I think that I remember from discussing before we got on the call was some kind of communication coaching. Is that encompassed in what you've already described or is that something different?
Dr. Claire Unis: No. Fantastic. That's a great reminder. Actually, even before I started all these writing programs, I have held the title of clinician communication coach. And in that role, I would sometimes shadow other doctors and just help with techniques that would help with communication with patients.
And the goal of this is really to make the day a little easier. Many people struggle with how do you get out of the room, for example, after you've finished a visit? How do you avoid, "Oh, doctor, one more thing" and not feel like a jerk if you say "We can't handle that today?" How do you make sure that patients know you care, even though you also have a time constraint?
So, we have some classes actually that we teach through that department and I really enjoy that as well. Honestly, I've found that working to help clinicians enjoy their work and help them manage symptoms of burnout, if not get rid of them somehow, have been all things that I've really enjoyed. So yes, clinician communication coaching is something that I've been doing for several years. Now, I'm going to say we're probably getting close to five but I did start that long, long before. And that wasn't my idea. I was fortunate to be hired into that role. And it's part of our patient experience.
John: Well, it sounds like you have an array of things that you're doing that aren't strictly practice and you've cut the hours and the practice down I guess significantly, but you're still seeing kids and doing that. So, you've got that going. And I take it. I don't hear a lot of burnout right now coming from you or at least evidence of it. But I don't know, I haven't given you a questionnaire to complete or anything. So how do you feel right now doing everything that you're doing?
Dr. Claire Unis: For me, this is a great balance. I'm working 50% clinical time in medicine, and honestly, I was doing that long before. And even with that, there were days that I was feeling like it was too much because there's so much nonclinical extra work that we do every time we set foot into the office and it starts to feel less appreciated. I think doing the clinician communication work has helped me also be a little bit more efficient in my interactions with patients and feeling good about them. That's really what it's about. If you get out of that room feeling good about the interaction, you feel a lot better about your workday also. So, I've been able to really enjoy that. But having time to create and help others create has done wonders for my ability to feel like I have a great balance. And I look forward to my clinical days. I look forward to seeing patients. I really enjoy my time. I do not think there's any way on this planet that I could do it full time. So, I'll be fully honest about that. The time away is essential for being able to be fully present.
John: Yeah. And I think that's common and probably underrecognized by most people. I think we forget when we're in it that medicine is very intense. And not that these other things don't take a lot of time and energy to do, but the intensity of taking care of patients, having the responsibility, the threat of a lawsuit, plus all the paperwork piled on top. I really personally can't see how someone can practice more than 20, 25 years without kind of segueing into something a lot simpler. But it sounds like you've got a great balance that could go on for quite a while, as long as you're enjoying all of it.
Dr. Claire Unis: Absolutely. I want to add one more thing to that. And I think this is something that most of us are feeling is that more and more we're being told what we need to achieve in an office visit. That's not necessarily the goals that we need to set out there, right? There are all these metrics that we're supposed to meet and these extra things we're supposed to be doing. And the more we're told to just toe the line and do something that does not involve our own creativity, the more important it is that we have some creative pursuit outside of it. So, it's soul sucking not to have that self-determination. And so, I think it's just extremely important and it doesn't have to be writing, obviously. It's not everybody's jam. But it is essential to honor that creative side of ourselves. Everybody has a creative side, and it really deserves to be expressed in some way.
John: All right. That was very inspirational to me and probably to the listeners as well. I hope you enjoyed that people. But before we go, a couple questions. First, tell us what's the best way to get ahold of you or just to find what you're doing? Do you have a website and other ways on social media we could track you down?
Dr. Claire Unis: Absolutely. My website is www.claireunis.net. And on there, there is a "Contact me" little section. So please feel free to drop me an email, especially if you're interested in classes. I'm not sure once this grant runs out, exactly what my next move is going to be, but I've certainly had some people outside my medical group ask about classes. So, I'd love to know if you're interested. I can also be found on doctorsonsocialmedia.com. You can look at my name, and my book is also on there. On Facebook or Instagram, basically, most of the socials I'm at Literary Art in Medicine. And the book I think I mentioned can be found on Amazon or Barnes & Noble, or there's a link through my website also.
John: Excellent. All right. I will put all those in the show notes too so people don't have to hurriedly write down right now or if they're in their car or something. Before I let you go, though, I'm going to just basically ask you what advice you might have for my listeners. I think you have a pretty good idea. It's basically physicians, some of whom are burnt out, maybe a high percentage are thinking about doing something else. And so, maybe you just have some pithy answer to their problems. But just tell us what advice you would give them right now.
Dr. Claire Unis: I guess my best advice is just that you need to honor your creative side. If there's something that you really wish you could do more of in your free time, maybe look into that, look for classes, look for ways to develop yourself further in a totally different avenue. It will make you a better doctor. It will make you more present when you are in the office.
For many of us financially, the thought of pivoting to something else is really daunting. And I know John, you are way more an expert in that than I am. But speaking for the sole satisfaction side, the more happy you are, the more you tend to your own needs on the outside, the more present you are on the inside. So, hopefully that's helpful to people, whether it's writing or something else.
John: I think it's very helpful. And some of the principles that we follow here that really as a physician you should have a life that's joyful and fulfilling, that you wake up to in the morning not dreading. And whether that means adding something to it or doing something different, what you've told us about today can be very helpful in that regard. I really appreciate that. So, I think we are out of time now. I guess all I can do now is say goodbye and thank you again for coming on the show today.
Dr. Claire Unis: Sure. My pleasure, John. Thank you so much for having me. I really appreciate it.
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Transcription PNC Podcast Episode 259
How Creative Writing Prevents Burnout and Restores Vitality
John: I have a great respect for physicians who write and especially those who also get paid to do so. I was very pleased to meet today's guest and convince her to tell us about how she has integrated writing into her career while she's still doing clinical medicine. So, with that, I will say hello and welcome Dr. Claire Unis.
Dr. Claire Unis: Hi John. Thank you so much for having me on the show.
John: Yeah. I kind of feel like I need to support writers, whether they're writing some fiction or even a technical writer or whatever, because I think a lot of physicians think that writing is not really an option in terms of either part-time or full-time replacement for medicine, but some have made a great living doing it as well enjoy doing it. So, that's why I thought it'd be great to talk to you today.
Dr. Claire Unis: Thank you. I'm really grateful to be on your show.
John: Let's see, we do have some things to talk about, including a memoir that you've written, but why don't you tell us a little bit about your background, your education, where the writing came in and then we'll go from there?
Dr. Claire Unis: Sure. I actually went to Dartmouth for undergrad and although I entered college knowing that I wanted to become a doctor, I was delighted to find out that you don't actually have to major in a basic science to become a doctor. And once that avenue was open for me, I tried all kinds of different things, but landed on something I've always loved, which is writing. I was actually a writing and literature major in undergrad, and then was fortunate to be accepted to UCSF for medical school. And I went down that road for a little while and part way through, looked up and said, "Wait a second. I need to write about this."
Before I graduated from medical school, I enrolled at USF, university of San Francisco in a master of fine arts program in writing. I was able to spread out my UCSF education by a little extra six months at the edge. So, I graduated in December 2000 from there and with my MFA in creative writing in May of 2021. So, I was able to get both degrees before starting residency that same June at children's hospital Oakland where I started residency in pediatrics.
John: Okay. Now you've been practicing since you finished your residency, correct?
Dr. Claire Unis: That is correct. I went right on into it like I think most of us do when we look up and realize that we need to make some money. Yeah.
John: And do you still enjoy pediatrics to a large extent?
Dr. Claire Unis: I really do. I really do. And I think partially I can say that was so much enthusiasm because I've been able to bring writing back into my life. I think like many of us, once we get to a certain point in our careers, we have a certain level of mastery of what we're doing most days. You start to look around and say, "Okay, what else? What else can we do?"
John: That's true. For me, as a family physician, it became pretty mundane after a couple of years. And most of what I was seeing was trivia anyway. All right. So, tell me, why is writing so important to you? Obviously, you've been interested for most of your life, but what is the draw of writing, particularly non-technical writing, which I don't think you're doing at this point?
Dr. Claire Unis: You're correct. I'm not doing technical writing. I thought about it very early on and realized that if I wrote for a career, if I wrote things I wasn't excited about, it was not going to have the same resonance that writing has for me now. I probably started writing very young. I found a journal at home where I wrote a song/poem when I was in like first grade. Not super sophisticated stuff, but clearly, I always have had this impulse to write things down. I think in adolescence is when it became something that was really part of my life. It was how I made sense of things, how I made sense of that burgeoning understanding of mortality and just all of those changes. So, I started writing regularly then.
And then in college when I returned to it, it's really because of that musicality, it's the way that the right words, the right description of an experience that you relate to really resonates and really kind of gives you that moment of "Yes, someone understands me" or "Yes, we share this experience." That resonance is what has kept it so important to me and has made it so hard for me to give up that creative writing.
John: Well, I think I can relate to that. Not so much as a writer, but as a reader. And we have each our own preferences, but boy, when I read something that communicates well, that it creates a story in my head, in my mind, I can visualize it. There's just something about it that is beyond watching a TV show or playing a video game or something like that, which tries to bring it into reality, but it's better when you're imagining it, I think.
Dr. Claire Unis: Absolutely. Absolutely. And being able to bring that experience back out to something you can share with someone else and have someone read it and say, "Wow, I really felt that" or "Wow, that really meant something to me" is just an amazing feeling.
John: Well, this is a good point to segue then, because as I was reading something this past week, which was your memoir, I could visualize what you were doing, what you were describing. And there's a lot of active things going on in some of the writing list of chapters I was looking at. So, why don't we go ahead and talk about that. It seems like you used that even maybe through medical school to get through medical schools. Tell me how that whole idea of white writing a memoir and then later publishing it, how that came about.
Dr. Claire Unis: Boy, that's a great question. One of the wonderful programs that I was able to participate in at UCSF was called The Healers Art. It was a program put on by Rachel Naomi Remen. And as I understood it, it was designed to see if we could prevent doctors from burning out in the future by putting first year medical students in touch with the reason that they came to medical school to begin with.
And this was fantastic for me. I had taken a year off to be a ski bum between college and medical school. And so, I really came in probably little prepared for the rigors of study that was in front of me. And so, this was a great course that allowed me to use creativity. I think we were drawing pictures and writing little things just to reconnect, be like, "Okay, is this worth it? This is painful. Do I really want to do this?" I think it first got ratified in some way or I first felt like it was going to be okay to pursue some creative pursuit in addition to medical school with that course. And then as you go through medical school, you can feel yourself changing. You can feel how transient those experiences are and how some of them you really just want to forget. And others of them, you realize that, "Wow, I really hope I can remember what I learned from this situation."
I think the impetus to write the memoir really came from the desire to hold on to that reason for becoming a doctor and hold on to that before self, a rather innocent and naive person who applied to medical school and wrote wonderful, glowing admissions essays about how this was the most important work in the world.
So, writing about it really put me back in touch with my purpose and also helped me make sense of some of those experiences as I was going through it. That's kind of a long wordy answer but as I look back at my journals, which I journaled like an inch of text maybe every day. I had a little tiny daily calendar. So, I would just write down some little thing about every day.
But when I go back and look at that, the idea about writing about it came to me pretty early in third year. And I approached the admissions office at UCSF and spoke to somebody in that department. And being told that I could do this, being told that I could be accepted and could write just opened everything up for me because suddenly there was somewhere to put all these experiences as I was going through them. And it wasn't just something I had to hold onto and endure.
John: Okay. That's one of the questions I had as I was reading some of the book. You were journaling at the time. And is there a difference between journaling and writing a memoir or is that two separate things? Did you just happen to use some of the journal entries in the memoir or were you actually writing the memoir as you were journaling?
Dr. Claire Unis: That's a great question. I started out with just the journaling. As most of your audience, if you're in medicine knows there was just no time to write very much as I went through medical school. But because I could feel that change happening and because I really wanted to be able to remember this later in order to write about it, I wrote those little tiny journal entries as I went through.
During my fourth year, I spread my fourth year out over that extra six months. My fourth year was actually like an 18-month year. I was simultaneously in classes at UCSF. And so, then I was actively writing while I was going through fourth year. But as we all know, the fourth year is a little less rigorous than all the years that have come before. So, it was possible to really focus on my writing for a month and then be in my clinical rotation for a month and then focus on my writing for a month. A little bit of both, but I was aware that I needed to synthesize these journal entries and really write while it was still fresh.
John: Then at some point, there's something called "Balance, Pedal, Breathe" came into existence, but it wasn't at that point. How do you feel having published it and what made you decide "Okay, I actually want to put this in a way that can be out there for other people?"
Dr. Claire Unis: Yeah. I had to finish some version of it to graduate from UCSF, which I did. And I knew it wasn't finished even at that time. As a new graduate, you don't really have that much confidence in what you know or how you're going to use these experiences. And I think part of me was really very nervous about getting this into final published form had I really been able to do at that time. And I did have an agent interested and there was some back and forth, and I think I kind of just panicked and then I started residency and there was no time.
But what got me back to this, and then of course, over the years I actually wrote the chapter on my OB rotation during my pediatrics residency when I was working and taking care of the babies. Some of these chapters came later. Most of them were at least initially conceived during the end of medical school. But I came back to this when the pandemic hit. It was kind of like being handed this little gift of time. And I think many of us were like, "What am I going to do with this sudden gift of time?" And there wasn't any question in my mind, I really needed to come back to this. I was facing symptoms of burnout and feeling like something had to change and pulling this out and rereading it really kind of got my heart all flutter. It was like, "Oh my gosh. This is what I felt when I went into this." And this is what I experienced. I think writing the memoir at that point or getting back into it sort of put me back in touch with my purpose, but it also, and this is the uncomfortable part, it made me face things I wasn't very proud of either. It's been many years since I graduated from medical school.
And during that time, there were things that I did that were selfish, that at the time, I didn't know how else to get through. And then when you look back, you go, "Okay, that doesn't actually create a human that I can be proud of being." Some of going back to this later inspired me and some of it forced me to evolve a little bit more yet than I've even evolved over the years as we all do. But getting it published is literally a dream come true because I always wanted to. At the same time, it's a little bit like walking around naked sometimes because people are reading some of your inner thoughts and I definitely had some feelings of panic as it was being released of, "Oh my gosh, maybe I shouldn't do this." But it was too late.
John: That's not a trivial thing. I thought if I were to write some kind of book, sort of a fiction book, and I wanted to make it interesting, I'm afraid I had to put things in there that I had done or experienced to make it sound real. But then I wouldn't want people to read it because I'd be embarrassed by what was in there.
Okay. Now I'm going to put you on the spot. We knew you knew we were going to talk about the book. So, sell me on the book. Who should buy this book? It's out there, it's available. Tell us where you can get it and who would it resonate the most with? Because there's got to be an audience for it, right?
Dr. Claire Unis: Absolutely. And I've been really fortunate that anyone who has read it has come back to me with glowing reviews. "Oh, my goodness. I didn't know you could write like this." And while this really resonated with me and I had no idea what medical school was like, or those who have read it would have gone to medical school. Actually, it's really funny. I guess I shouldn't say who it was, but somebody I knew well in medical school got in touch with me and said, "I now have a clearer memory of your medical school experience than my own." And I say, "Well, that's a fascinating thing to say." I think it's absolutely relevant for anyone who's thinking about going to medical school, anyone who has gone to medical school, the nurses who I'm friends with who have read it have really resonated with it as well.
But ideally, I think this is a book that could do very well with book clubs. I don't think you need to be in medicine. And my whole goal in writing it, was to help someone who's not in medicine, understand what your doctor has gone through to get to that point. And I think that's really important and that is part of what drove me back to it during the pandemic as well. There was this huge disconnect between the general public and the people who are trying to take care of them. And I just have always felt understanding is the key. If people could understand each other's experiences, it would take us so much closer to being able to communicate well and bridge those differences. So, I really wrote this book to have universal appeal and to be relevant to anyone who's interested in what someone going into medicine has experienced.
To answer your second question, it's available on Amazon, it's available on Barnes & Noble. You can buy it from the publisher, which is Warren Publishing, and they were fantastic to work with, but I will tell you that you can get a lot faster through Amazon. And it is available also on Kindle.
John: Okay. Two comments. One, Warren, because I don't want to get into too much detail, but everyone always asks, "Well, how did you publish it? Was it traditional? Was it self-published?" And Warren is one of those that's in between, right?
Dr. Claire Unis: Yes. Warren is a hybrid publisher. So, what that means is that there's some shared expense in terms of what goes into publishing the book. They help with curating the editors that you work with. So, I know you've previously interviewed Deborah Blaine who is a friend and a wonderful writer of medical thrillers or medical mystery. So, she's a great example of someone. And she actually turned me on to Warren Publishing. And then once you sign on with them, there's a developmental editor, there's a copy editor, there's a proofreader. There's a lot of rounds of editing that they help and then making sure that everything is in line as it should be so that it can be presented as well as a traditionally published book. And it can be sold in bookstores, which is something that most bookstores won't carry self-published books. So, for me, it was a faster process than going through a traditional publisher and it allowed me to put out a product I can be extremely proud of.
John: Yes, it's very professionally done, obviously. The second comment I was going to make, and I hadn't thought about this before, but when you said it would be something that someone who was thinking of going to med school or was starting med school would read, I think back, I could have really used that darn book because I had no one in my family that was in medical school. The first rotation that I did in my third year of medical school, I had no idea what was happening. I just showed up. It's like, "Okay, what's going to happen now? I'm in the surgical rotation with some Vietnamese doctor who was at the VA and I got to be here every third night and stay here?" Oh my gosh, it was a total culture shock.
Dr. Claire Unis: Absolutely. Nothing really prepares you for that. Your first two years don't prepare you for that. We had one panel where the upperclassmen told us a few things to make sure that you had with you and then off you go. So, thank you.
John: Yeah, that's really good. And you know what? I'm the only one that has mentioned the title of the book. So, tell us the title, the complete title. And then we'll move on to my next question.
Dr. Claire Unis: Sounds good. The title is "Balance, Pedal, Breathe: A Journey Through Medical School." And the reason for the title is that this book is every bit as much about my other outdoor pursuits or outside medicine pursuits as it is about medical school. And I think that's also part of the universal appeal.
For example, when I talk about my pediatrics rotation, I'm also talking about paragliding and traveling and learning a new language. And when I'm talking about the surgery rotation, I'm also talking about swing dancing, which was something I did quite during medical school.
Balance also has to do with rock climbing. There's a chapter that is called "Unsure Footing" that's about a multi pitch long climb that I went on. And I interweave that with stories of uncertainty in medicine. Pedal was mountain biking. Biking absolutely saved my soul, I think during the second year as we approached boards. And then breathe because so much of this book revolves around images of breath. And breath drives everything. It's how we deal ourselves, to deal with whatever we have to deal with. It's how we recover from something that's difficult. It's how we center ourselves. And it has so much to do with any active outdoor pursuit.
The title very much harkens to all the other experiences that are interwoven with the medical experiences here. And then the subtitle "A Journey Through Medical School" because it very much was a journey both emotionally and physically.
John: Very nice. Yeah. There's a lot to talk about here but this is a thing that impressed me and what we're going to talk about for at least the next 10 minutes or so. So, you published a book like, "Okay, that's your writing and how it's manifest in your life now?" No, you're doing like three or four other things in which you've incorporated and integrated writing into your daily, I guess, life. So, explain what you're doing from that aspect. The teaching, the coaching, whatever you want to talk about. We only have so much time, but I want to hear about those things. I think the listeners will too. And some of those things, I think you're actually getting paid for as part of a program at the university.
Dr. Claire Unis: Yes. Thank you. When I looked up and realized I needed to do something more than just clinical practice, that was actually before the pandemic. And at the time I had recently learned about narrative medicine, which is a field of medical humanities that came into being right around the time I graduated with my MFA, feeling like I was the only person in the world who wanted to merge the humanities with medicine. It turns out I was not.
There was a team of doctors and other writers and all kinds of collaboration was going on at Columbia university to create narrative medicine, which is basically the use of texts, which could be pictures, photographs, any kind of example of the humanities to connect doctors with the other side of themselves, the nonmedical side of themselves and give them something to talk about that will also get in touch with basically geared against burnout by allowing people to talk about something nonmedical and get at the meaning behind what is going on in their lives. Because we doctors learn very early on that we don't share what's going on emotionally with our patients, that we are supposed to be quite stoic in the face of all kinds of trials. And obviously over a lifetime of that, that's a recipe for burnout. And I think of creativity as an antidote to burnout.
So, I'd come across this narrative medicine program. And I was thinking about enrolling, although having two children and a practice on the west coast, it was terribly practical to go to the east coast for a program. And in talking to someone who I would consider a mentor at my work, he said "Wait a second, you have an MFA in writing. Do you really need another master's degree?" And I thought about it and I was like, "Wow, you're right." It was already in the works before the pandemic. I was creating a program involving writing and literature appreciation for other doctors, modeled loosely on what they're doing with narrative medicine at Columbia and then the pandemic hit. So rather than be able to meet with people in person, suddenly everything went virtual. And it was honestly perfect timing because suddenly everybody had a little bit more time to spend, checking out something new.
So, the first class I put together was something that I called LIFE - Literary Inspiration For Expression. And in this class, I would provide a short story to people ahead of time and they would read it and then we would get together and discuss it for a little while. And then I would give a writing prompt to which people could free write and they didn't have to share their writing with anybody. It was just a chance to a little bit of personal reflection based on the discussion that we've had.
I deliberately chose stories that had nothing to do with medicine. This was really intended to be true enrichment and a true reminder that we are much more than our professions and that we have life experiences that are perhaps informed by our jobs, but certainly not completely circumscribed by our jobs. And that class was very popular.
And so, from there, I went on to develop some writing workshops. I found that there were a number of clinicians who were trying to write on their own and really could benefit from having people to bounce their ideas and their writing off of. I created a book club. I worked with one of our patient family advisors to develop a writing class. So, people who didn't feel comfortable with their writing, but wanted to write, could learn some techniques. And then ultimately after taking several narrative medicine workshops, I did feel comfortable working with someone else who was in that program to offer some narrative medicine classes also.
So, I've been very busy offering classes to clinicians with the main goal being to improve clinician wellbeing. And I was fortunate also that some of this work was funded by a grant. I worked for Sutter medical group. And Sutter Health had a joy of work committee formed that received a grant to support work that would help or kind of augment clinician wellbeing.
And so, I was a recipient of some of that money that funded some of my time to put into program development. And that was a real boom because like many of us, it's hard to take time out from other things that we're not getting paid for, or take time away from things that we are getting paid for to really develop something like this. And so, it gave me the permission to say, "Okay, this is part of my job. I have to create something." That seems like that was a lot of talking on my part, but that's a summary of what I've done with the writing. And one more thing, I've been able to write a weekly blog for our medical group. So each week I just write some short reflective piece about something that's going on in the world or in my life that I consistently get nice feedback on. I think people like to hear just a reminder of other people are having these very human experiences alongside the medical obligations.
John: Now, the one thing I think that I remember from discussing before we got on the call was some kind of communication coaching. Is that encompassed in what you've already described or is that something different?
Dr. Claire Unis: No. Fantastic. That's a great reminder. Actually, even before I started all these writing programs, I have held the title of clinician communication coach. And in that role, I would sometimes shadow other doctors and just help with techniques that would help with communication with patients.
And the goal of this is really to make the day a little easier. Many people struggle with how do you get out of the room, for example, after you've finished a visit? How do you avoid, "Oh, doctor, one more thing" and not feel like a jerk if you say "We can't handle that today?" How do you make sure that patients know you care, even though you also have a time constraint?
So, we have some classes actually that we teach through that department and I really enjoy that as well. Honestly, I've found that working to help clinicians enjoy their work and help them manage symptoms of burnout, if not get rid of them somehow, have been all things that I've really enjoyed. So yes, clinician communication coaching is something that I've been doing for several years. Now, I'm going to say we're probably getting close to five but I did start that long, long before. And that wasn't my idea. I was fortunate to be hired into that role. And it's part of our patient experience.
John: Well, it sounds like you have an array of things that you're doing that aren't strictly practice and you've cut the hours and the practice down I guess significantly, but you're still seeing kids and doing that. So, you've got that going. And I take it. I don't hear a lot of burnout right now coming from you or at least evidence of it. But I don't know, I haven't given you a questionnaire to complete or anything. So how do you feel right now doing everything that you're doing?
Dr. Claire Unis: For me, this is a great balance. I'm working 50% clinical time in medicine, and honestly, I was doing that long before. And even with that, there were days that I was feeling like it was too much because there's so much nonclinical extra work that we do every time we set foot into the office and it starts to feel less appreciated. I think doing the clinician communication work has helped me also be a little bit more efficient in my interactions with patients and feeling good about them. That's really what it's about. If you get out of that room feeling good about the interaction, you feel a lot better about your workday also. So, I've been able to really enjoy that. But having time to create and help others create has done wonders for my ability to feel like I have a great balance. And I look forward to my clinical days. I look forward to seeing patients. I really enjoy my time. I do not think there's any way on this planet that I could do it full time. So, I'll be fully honest about that. The time away is essential for being able to be fully present.
John: Yeah. And I think that's common and probably underrecognized by most people. I think we forget when we're in it that medicine is very intense. And not that these other things don't take a lot of time and energy to do, but the intensity of taking care of patients, having the responsibility, the threat of a lawsuit, plus all the paperwork piled on top. I really personally can't see how someone can practice more than 20, 25 years without kind of segueing into something a lot simpler. But it sounds like you've got a great balance that could go on for quite a while, as long as you're enjoying all of it.
Dr. Claire Unis: Absolutely. I want to add one more thing to that. And I think this is something that most of us are feeling is that more and more we're being told what we need to achieve in an office visit. That's not necessarily the goals that we need to set out there, right? There are all these metrics that we're supposed to meet and these extra things we're supposed to be doing. And the more we're told to just toe the line and do something that does not involve our own creativity, the more important it is that we have some creative pursuit outside of it. So, it's soul sucking not to have that self-determination. And so, I think it's just extremely important and it doesn't have to be writing, obviously. It's not everybody's jam. But it is essential to honor that creative side of ourselves. Everybody has a creative side, and it really deserves to be expressed in some way.
John: All right. That was very inspirational to me and probably to the listeners as well. I hope you enjoyed that people. But before we go, a couple questions. First, tell us what's the best way to get ahold of you or just to find what you're doing? Do you have a website and other ways on social media we could track you down?
Dr. Claire Unis: Absolutely. My website is www.claireunis.net. And on there, there is a "Contact me" little section. So please feel free to drop me an email, especially if you're interested in classes. I'm not sure once this grant runs out, exactly what my next move is going to be, but I've certainly had some people outside my medical group ask about classes. So, I'd love to know if you're interested. I can also be found on doctorsonsocialmedia.com. You can look at my name, and my book is also on there. On Facebook or Instagram, basically, most of the socials I'm at Literary Art in Medicine. And the book I think I mentioned can be found on Amazon or Barnes & Noble, or there's a link through my website also.
John: Excellent. All right. I will put all those in the show notes too so people don't have to hurriedly write down right now or if they're in their car or something. Before I let you go, though, I'm going to just basically ask you what advice you might have for my listeners. I think you have a pretty good idea. It's basically physicians, some of whom are burnt out, maybe a high percentage are thinking about doing something else. And so, maybe you just have some pithy answer to their problems. But just tell us what advice you would give them right now.
Dr. Claire Unis: I guess my best advice is just that you need to honor your creative side. If there's something that you really wish you could do more of in your free time, maybe look into that, look for classes, look for ways to develop yourself further in a totally different avenue. It will make you a better doctor. It will make you more present when you are in the office.
For many of us financially, the thought of pivoting to something else is really daunting. And I know John, you are way more an expert in that than I am. But speaking for the sole satisfaction side, the more happy you are, the more you tend to your own needs on the outside, the more present you are on the inside. So, hopefully that's helpful to people, whether it's writing or something else.
John: I think it's very helpful. And some of the principles that we follow here that really as a physician you should have a life that's joyful and fulfilling, that you wake up to in the morning not dreading. And whether that means adding something to it or doing something different, what you've told us about today can be very helpful in that regard. I really appreciate that. So, I think we are out of time now. I guess all I can do now is say goodbye and thank you again for coming on the show today.
Dr. Claire Unis: Sure. My pleasure, John. Thank you so much for having me. I really appreciate it.
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