Lucy McBride, MD: Balancing Mental Health & Medicine

Lucy McBride, MD

Practicing internal medicine physician, mother of teens, storyteller, mental health champion

What makes you feel like a grown-up?

Realizing my three teenage kids are all taller than me!

What is the weirdest thing in your tote bag?

Loose change from Kenya.

Your secret superpower?

Hunting down a piece of fabulousness at TJMaxx.

What’s the best thing that happened to you in the 1980s/90s?

Therapy!

Your social media Kryptonite?

Diet culture masqueraded as wellness (“cleanses,” “detoxes”)—it preys on women’s vulnerabilities!

Mental Health in Medicine? Give This Doc Her Megaphone

I come from a family of caregivers; my mom is a social worker, and I was the (self-) designated ringleader of my little gang of siblings and cousins who lived across the street when I was growing up. In high school, my interest in science intersected with a realization that people trusted me with their problems; they seemed to value my advice. That intersection of science and humanity only deepened with my medical education; I was the one doctor in training who truly loved the Patient/Doctor course, where you practice awkward conversations with a professional actor. As scientists, there are so many things we measure in medicine, but many others we cannot—vulnerability, stress, loss. I love that I can manage patients’ cholesterol but also help them manage the human condition, all in a day’s work.

The pandemic has laid bare the critical importance of assessing mental and physical health in tandem, because everyone has lost something—a loved one, a job, a pivotal life experience. What we’ve been through affects how we feel in our bodies, without a doubt. And for those with percolating mental health challenges pre-pandemic, they’re now fully visible and undeniable. As human beings, we tend to gravitate toward quick fixes that we know aren’t healthy, but help numb discomfort—emotional eating, alcohol use, smoking marijuana—and then lose ourselves in a shame spiral. I tell my patients that you can’t “win” a doctor’s appointment. My job isn’t to tsk tsk you for bad habits, but rather to provide a nonjudgmental space to help you problem-solve. Because isn’t it better to have problems you can solve than avoid them until they’re harder to fix?

We’re in a grey area right now, because we’ve lived in fear-ridden lockdown for 14 months and now we’re facing all kinds of complex decisions around venturing out. So it’s not surprising that I’m seeing even more anxiety in patients. It was easy to know what to do when cases were surging and schools were closed, but now we’re in a Neverland of risk, with all the emotional and physical fallout of trauma. Decision-making in a grey area is always tough—especially since we live in a trust desert. People just don’t know who to rely on anymore. Dr. Fauci? Dr. Walensky? President Biden? My own doctor? My own instincts? Everyone who wants one can grab a megaphone these days, so it’s understandable that even the smartest individuals can’t wrap their head around the incredible efficacy of this vaccine. I know triple PhDs who can’t believe they can really and truly get on an airplane after shot #2. It’s hard to pivot back from a fear-based narrative to comfortably take risks again. We need to make nuance great again, because it’s missing from our discourse. Public health experts can’t possibly speak to individuals’ risk, so we need to equip people with nuanced guidance and tools to manage fear. That way they can make hard decisions in the context of broad public health messaging while mitigating the fear of the unknown.

I don’t mean to be glib about the “opportunity” here, when we’ve all been through a virtual hellscape, but the pandemic has given us the opportunity to think about a second act. I love my job and will never stop seeing patients, but my pandemic life has given me the inspiration—and the permission I’ve been craving—to reach more people with messages around mental and physical health, which is my own version of a dream of public service. Our collective experience has provided an outlet to share what I see every day in the parallel pandemic of mental health in crisis. My newsletter has clearly fed an appetite people have for advice from someone they can trust. Last year, a reader (a total stranger) wrote me a handwritten note: “I am a Black man living in North Carolina, and I’m a tough nut to crack. Thank you for writing; I feel seen.” To cross into someone’s life and make someone feel seen? I see no more rewarding reason to get up and do what I do every day.

We’ve had to make a lot of changes out of necessity, but if we have the luxury to consider lessons-learned this can be a moment of reflection. Are there things we do/don’t want to take with us to the other side of the hellscape? Maybe you don’t need to travel as much for work; maybe less of it would help you sleep better. Maybe cocktail party chit-chat with 50 people is far less appealing than a date with me, myself & I on the couch. Maybe, just maybe, no is the new yes. Tell them Dr. McBride made you say it.