20 Questions: Psychiatrist Jessi Gold, MD, MS

Last Updated on October 16, 2024 by Laura Turner

Psychiatrist Jessi Gold, MD, MS, is the Chief Wellness Officer of the University of Tennessee System and an associate professor in the Department of Psychiatry at the University of Tennessee Health Science Center. She is a fierce mental health advocate and highly sought-after expert in the media on everything from burnout to celebrity self-disclosure. Dr. Gold has written widely for the popular press, including for The New York Times, The Atlantic, InStyle, Slate, and Self. In her clinical practice, she sees healthcare workers, trainees, and young adults in college. A graduate of the University of Pennsylvania (with a degree in anthropology), the Yale School of Medicine, and the Stanford University Department of Psychiatry, she spends her free time traveling with her friends, watching live music (especially Taylor Swift) or mindless television, and on walks with her dog, Winnie. You can find her on X, Instagram, TikTok, or Threads @DrJessiGold, and order her new book HOW DO YOU FEEL (release date October 8, 2024).

Tell us about yourself.

Dr. Jessi Gold: My gut response is to tell you what I do, which is: I am a psychiatrist who focuses on and clinically sees healthcare workers and college students. I’m also the chief wellness officer of the University of Tennessee System, which means I work on wellness across five campuses (about 59,000 students in total) all over the state. I am also an author and mental health advocate who has written and been featured widely in the media. My first book, HOW DO YOU FEEL?: One Doctor’s Search For Humanity in Medicine, is out October 8th and available for preorder now.

But I kind of hate how much of our identity in medicine is wrapped up in work, so: I am also a sister—I have two brothers and one sister; an aunt to seven nieces and nephews; a dog mom to a maltipoo named Winnie; and a friend. I like traveling, Taylor Swift, and sometimes traveling FOR Taylor Swift (I most recently saw her in London!). 

When did you first decide to become a physician? Why?

I am one of those people who always wanted to be a doctor because of a love of science, and a doctor dad (he is also a psychiatrist!), but I went through multiple phases of doubt. During the first, in undergrad, I just didn’t feel like I belonged in pre-med classes and struggled with the information, the competition, and the curve. I found anthropology, which balanced things out and in many ways helped me keep going, but I often wondered if this was the right fit for me. 

I’d love to tell you that when I got in, I knew I made the right decision, but I continued to question it throughout med school (not always to helpful ears and many who basically said keep going because I got in), and, now, years later, truly believe that questioning a path this tough, long, and expensive is necessary and actually healthy. Questioning it means I actually forced myself to answer the why, and not just the why because that is what I am supposed to do or my family expected me to do. I hope other people question it along the way too, and feel empowered to do so; it makes the actually being and working as a doctor part much more satisfying.

How did you choose the medical school you attended?

What if the answer is: I got in? 

The other answer is: It didn’t have grades or ranking, and I just didn’t think I could handle that aspect having already struggled in pre-med, and coming in with the BARE MINIMUM of requirements and science background. It felt like I could manage it, and thrive within it, not feel constantly like I was failing or behind.

What surprised you the most about medical school?

I think I was most surprised by truly being able to find a community and mentors. I worried a lot having struggled in the pre-med group so much in college that the med school group would be even worse, but I found a lot of like-minded people and we supported each other through it all (you have to!!). I also found a mentor who helped me not drop out and find psychiatry, and who above all has become one of my favorite humans and closest friends at this point. I feel truly lucky about that. 

What was the biggest challenge you faced in medical school?

A lot of my book is about what I learned in medical school through some of the challenges, and even in pre-med before, and all of the issues I struggled with—but the biggest thing for me was mistreatment and hierarchy. That wrapped up in subjective evaluations during third year that regularly felt like a personality assessment was a perfect storm for me to feel frustrated and uncomfortable in a truly broken system that I often felt I didn’t fit into. I have found my own space and thrive in it now, but it made many big emotions come out first and a lot of “why is this how we train”—which honestly has led me to work to change it.

Why did you decide to focus on psychiatry?

Again, I go into this in much bigger detail in my book, but psychiatry was the place I fit in the most. I loved the content and that I could see 100 people with depression and the reasons for their depression could all be different, and they mattered (not just the diagnosis or treatment). Their stories were key to helping them, and I have truly always been interested in people’s stories (hence the anthropology background). I also found myself wanting to be the soft and supportive landing for college students that I didn’t have when I asked for help in college and was told I wasn’t sick enough to get help in campus counseling and needed to go off campus. That invalidation always stuck with me, and I knew I could help people feel supported, heard, and safe, and hope I always get that opportunity. When people say things like “You are the only person I’ve ever told this,” it is hard not to love my job and feel honored to do it. As an added bonus for me, psychiatry also had people in the field who wrote, who did advocacy, and who didn’t just see patients, and that balance was (and still is!) incredibly appealing to me.

HOW DO YOU FEEL? pulls back the curtain on many less-discussed aspects of providing mental health treatment, including detailing the complex emotions you’re navigating during your sessions with patients. These reflections are often vulnerable—you reveal that therapists sometimes struggle to maintain detachment, experience self-protective impulses, find themselves heading into a session in a state of agitation, and worry about avoiding secondary trauma. Why was it important to you to reveal the more challenging aspects of the practitioner’s experience? 

Psychiatrists don’t often have the best reputation to the public. Maybe because of Freud our silence comes off as uncaring, and maybe because of people’s bad experiences with one doctor or another, we now have a reputation for just being drug pushers, and not curious about patients’ stories. But, in my experience, all of that couldn’t be further from the truth. By pulling back the curtain, quite literally into my own head, I wanted not just to show people what we do but also to emphasize our humanity. The latter is important for both patients and mental health practitioners to recognize. Too often we pretend our jobs don’t affect us, and that to truly do our jobs well, they can’t. But that is a myth. I often think about a quote by Rachel Ramen: “The expectation that we can be immersed in suffering and loss daily and not be touched by it is as unrealistic as expecting to be able to walk through water without getting wet.” I think it’s about time we talk about the water, and what it feels like to be constantly rained on. Silence isn’t helping anyone.

If you had it to do all over again, would you still become a psychiatrist?

If I still went to med school, I would always choose psychiatry. I can’t see myself doing anything else in medicine. I do sometimes wonder if I would still be a doctor, given the chance to do it all over again, but what I’ve found to do for work, and the capacity for advocacy and creating change, I’d never be able to do without med school. People listen to me a lot more because of my background, and that matters to getting things done. So yes. I think I would.

You’ve become an authoritative voice in the media on burnout, an issue you also address with patients in your clinical practice. How did you come to develop that niche?  

I didn’t wake up one day and decide to be a burnout expert, but it more or less found me. When I was in college, I started to observe that people in pre-med who were kind, not cutthroat, and would have made awesome doctors, regularly dropped out. I became so curious about why, that I studied pre-med as a culture for my master’s thesis in anthropology. After that, once my eyes were open to some of these challenges and disparities, they were constantly aware. I studied med student mental health and access to care in medical school, and started (and helped lead) support groups for medical students as a resident. Aware that burnout was a major issue I was hearing about in all levels of training even before the pandemic, in March 2020, I had the background to jump in quickly and help. I was clinically seeing healthcare workers, students, faculty, and staff, and also working on outreach and education. At the same time, noticing the same issues across the country, I was talking about it in writing (e.g. I wrote a STAT piece on it in April 2020 long before it was covered elsewhere) and on social media. COVID didn’t create the mental health crisis in healthcare, so it doesn’t stop just because COVID did. It is my job to remind people of that.

Describe a typical day at work.

I don’t really have a typical day, which is why I love my job. I juggle a few things—meetings, travel, talks, writing, and patient care—and all of that put together in some mix makes up my typical week. It Includes a lot of thinking on different levels (individual with a patient, system with the wellness role), interacting with others, advocacy and outreach, and thinking and executing big ideas. I love the balance because it doesn’t get boring and allows me the breadth and time to do it all. 

 How did you get into writing?

I started writing as a way to process. I wasn’t on the student paper in high school or college, but I knew medical school brought up a lot of opinions and feelings and I wanted to write about them (in part because I wasn’t sure I could share them out loud otherwise!). I had also always liked physician memoirs (e.g.., by Atul Gawande) and that helped me understand the field. One time when I was on a rotation I was (long story short) tricked into performing cardiac massage on a patient who was already dead (physically pumping the heart and thinking I was saving him). After that, I went to talk to my dean and she said something like, “We’ve talked to him, that is just how he is.” Feeling defeated, I took to writing about it. I then showed it to my mentor who suggested I write it up for a medical journal, and I did. It was published in the Annals of Internal Medicine, and was the first time I realized my story and experiences could be used to educate and advocate. My dean even sent it to the whole school and I felt like I somehow gave her a different voice on the issue, too. I have kept writing ever since, using my experience and observations as they have grown, to expand on topics and conversations that need to be had. 

Is writing something you would tell pre-meds to get into? 

Absolutely. People often say things like “I am not an expert, what can I write about?” and I often think about something a mentor told me once, which was “Who decides who the experts are?” In truth, you are an expert in your own experience, on being a pre-med, and then a med student, and then a resident, and there is power in what you see and think about. You also have a different, almost uncorrupted view of medicine that many people lose as they go on in training. It can also be just something you pick up to cope with all the weird and hard things you see, and if no one else sees it, that is also fine. Writing itself is powerful, and important, and can help you get by in many ways.

Throughout the book, you talk about self-disclosure, both as it pertains to your therapy itself and to overall medical care. Can you share more on that subject? 

Self-disclosure is an interesting topic because it’s an area that even mental health professionals discourage. You are supposed to be a blank slate so that a patient can’t come in with beliefs about you because of your story. But I have a public presence (through writing and social media) that has grown to include more of my own experiences over time. It wasn’t easy, say, to write about being on medication and stigmatizing myself for it, but I decided it was necessary, and that if it helped one person who read it, it was worth it. That doesn’t mean no one in my academic life has ever judged me for it, or that I didn’t worry about the consequences. But I’ve decided self-disclosure is not just important for a patient; it’s necessary for culture to change around mental health in general.

Part of the reason it has become easier for me to be so vulnerable is work in my personal therapy. I’ve talked about writing and what parts of my story I owe others (hint: none), and I’ve also seen my therapist use self-disclosure beautifully to make me see things I wouldn’t otherwise (like telling me she is on meds to emphasize it didn’t change my opinion of her). It is no wonder that data suggests clients who have therapists who practice self-disclosure had lower levels of distress and liked their therapists more. Our lived experiences also make us more empathetic to the experiences of patients, and I personally think I’m a better doctor for all of it.

You disclose that you experienced burnout yourself. What pushes healthcare workers towards burnout? What are some of the warning signs? What coping mechanism did you employ to handle burnout? What advice would you give to others experiencing burnout? 

Burnout is a workplace-associated condition, meaning that the systems and circumstances where you work cause you to feel the symptoms you experience. In healthcare, the reasons for burnout are vast and include everything from documentation and electronic medical records, to insurance companies and safety in the workplace, to a general lack of support. It is no wonder that doctors are burned out at rates as high as 50 percent, and more than other fields. Burnout is not simply “being tired from work” but rather is defined as three different overall symptoms:

1. Emotional exhaustion: This looks a lot like physical exhaustion, but you just feel “done” at the end of a workday
2. Depersonalization (or cynicism depending who you ask): Feeling disconnected or more angry/frustrated
3. A reduced sense of personal accomplishment

In my practice, and personal experience, the first two symptoms are often blown past and ignored as predictable outcomes of work, especially in medicine where the baseline is basically to not sleep, not eat, and be burned out, but once someone feels they are doing less, or someone else might think they are doing less, they start to take notice.

This means, though, that the more subtle symptoms, like overwhelm, a change in your schedule, or procrastination are often ignored, and it is more severe by the time you pay attention and try to take action, which happened to me (and so many of my patients!). By that point, time off is really all that can help and allow you a break and reset, as something like yoga will feel useless, and even detrimental as a suggestion. Once I reset, though, it was important that I didn’t just go back to the same ways of coping with a bad system that I did initially. One of the things that helps now is paying more attention and asking myself how I am feeling regularly, and not just when things are bad. Not only does it remind me I am part of the equation and might have reactions, it lets me notice changes earlier, with more options for interventions to help. I tell this to anyone who asks, as a good place to start: So, how do you feel?

What systemic changes would you like to see to help prevent burnout? How can supervisors identify and better assist someone who might be struggling?

Across the board in studies, the things that help with burnout are meaning, purpose, and supportive supervisors. Meaning and purpose can feel intangible and philosophical even, but what it really means is when we spend more of our time mentoring or seeing patients (what we signed up to do, and derive meaning from) instead of paperwork and charting and yelling at insurance companies, we feel less burned out. To do this, systems need to look at what is in place to support their healthcare workers—other staff, time off, changes to the electronic medical records—and invest in helping their teams spend more time on their purpose. The concept of a “supportive supervisor” is vague, in some sense, but has to do with communication, transparency, and the culture in the workplace. Supervisors need to be trained to recognize burnout and talk about burnout with their teams, but also in how to create supportive work environments. The good ones should be rewarded, often, and others should be given education and skills to help their behaviors. Policies, like leave and remote work, come into play here as well, as a more flexible workplace that supports work/life balance will lead to less burnout. Ultimately, every area of the system interacts with burnout in some way, which is why jobs like mine, as a chief wellness officer, even exist. We can be the ones to work across the silos, and remind people of the humanity of the workforce every chance we get.

What kind of issues do pre-meds deal with in terms of their mental health?

There is not enough data on pre-med mental health, but from what I’ve seen clinically it is not like we magically have issues in medical school that we never had before—particularly around perfectionism and anxiety. There is some data to show that we enter med school with equivalent rates of depression as our age-matched peers, and med school can lead us to, by the end, have higher rates of depression than those same peers, but I don’t think we were ever 100 percent great before. I saw that in myself, my friends, and now, my patients.

I think because of competition at every stage and challenging classes/hurdles to overcome, we put so much pressure on ourselves to succeed to the point of being perfect. That leads to anxiety, particularly around things like tests, which I experienced; one of the patients I discuss in my book, Naya, did as well. When we fail (because we will), we then have a really hard time dealing with it, because it is seen as a never thing that can happen, instead of a probable, human occurrence. If we learned to deal with mistakes and have self-compassion at an earlier stage, like pre-med, med school, residency, and even the workplace might be a different world.

In your position now, knowing what you do—what would you say to yourself 10 years from now?

I hope I can say I made a difference. That I actually helped change the system that has long frustrated me instead of just being mad at it and not fighting/implementing change. I hope I made people feel seen and understood, through my writing and my work, and that at the same time, I found balance in my own life between work and life, and feel fulfilled in all of it. 

What information/advice do you wish you had known when you were pre-med?

I wish I knew that perfection is impossible, and being able to learn from my mistakes is growth. I wish I could’ve looked around in my classes and known other people were struggling, too, and I wasn’t alone. I also wish I knew that feelings were normal, and didn’t interfere with that perfection or success, and allowed myself to acknowledge and deal with them, instead of judging myself for them, or pushing them down until they became bigger and more challenging. 

What is your number one kernel of advice for someone interested in a career in medicine? 

Be prepared for the fact that the job will impact your mental health and learn ways to cope and deal with it along the way. You are human, and that is what drew you to the field in the first place, to help people, so of course the work can take a toll (even though psychiatry isn’t the long hours that take a toll, but instead, we listen to trauma all day, and that is no easy task). Acknowledging that up front, and going in with open eyes, trying to find ways to take care of yourself along the way (and not just other people), is key to a successful career. 

How do you feel?

Anxious and even a little afraid, but also proud and excited—like any good expression of vulnerability.