Latest / Flourishing in Medicine: From Surviving to Thriving / Flourishing in Medicine: From Surviving to Thriving Episode 21 Wellbeing in Healthcare: A Conversation with Dr. Maura Kenny

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Flourishing in Medicine: From Surviving to Thriving Episode 21 Wellbeing in Healthcare: A Conversation with Dr. Maura Kenny · Flourishing in Medicine: From Surviving to Thriving

0:00
And the thing about medicine is it holds out
0:01
such promise now that we've almost come to expect
0:04
that we won't suffer and that we'll be incredibly
0:07
healthy until we die peacefully in our sleep
0:10
around 98 years of age, having been able to do
0:13
everything we wanted to up until that point,
0:16
which is just, I think it's a myth that's around
0:19
in the ether because of how advanced medicine
0:22
is. But it's inaccurate. Life is inherently full
0:27
of suffering. The noble truth, number one, there
0:29
is suffering. We have to acknowledge that and
0:31
be with that and take the joy where we can. Welcome
0:35
back to Flourishing in Medicine, From Surviving
0:38
to Thriving. I'm your host, Dr. Mick Krasner,
0:41
and this podcast is produced by EmPRO a medical
0:45
professional liability insurance carrier in New
0:48
York State. that's committed through multiple
0:51
peer support offerings to supporting the physicians
0:54
they protect. The title of today's podcast, Well
0:58
-Being in Healthcare, a conversation with Dr.
1:00
Maura Kenny, a psychiatrist with Southern Australian
1:04
Health and a mindfulness teacher, trainer, and
1:07
researcher with 20 years of experience teaching
1:10
mindfulness courses in both clinical and organizational
1:13
settings. Her special interest is the well -being
1:16
resilience of healthcare staff, and she's developed
1:20
a six -week mindfulness course that has been
1:22
delivered for several years in South Africa's
1:25
public health settings and in other healthcare
1:28
and university settings around Australia, the
1:31
United Kingdom, Singapore, and Taiwan. Maura
1:35
is also the inaugural director of staff well
1:39
-being at the largest healthcare network. of
1:43
over 17 ,000 employees in South Australia Health.
1:47
In this dialogue today, Dr. Kenny traces her
1:50
journey in medicine to psychiatry driven by her
1:54
fascination with biology and a desire to alleviate
1:57
suffering. She discusses her introduction to
2:00
mindfulness -based cognitive therapy for recurrent
2:03
depression by Professor Mark Williams from Oxford,
2:06
which inspired her to integrate mindfulness into
2:10
her psychiatric practice. with notable success.
2:13
This led her to develop mindfulness -based courses,
2:17
adapting them for healthcare professionals and
2:20
to advocate for mindfulness teacher training
2:22
standards. Dr. Kenny's current role is as Director
2:27
of Staff Wellbeing in South Australia's healthcare
2:30
system. She emphasizes the importance of tailored
2:33
interventions to address the unique challenges
2:36
faced by healthcare teams, addressing the culture
2:39
of these organizations and teams, while maintaining
2:42
mindfulness as a centering tool for herself and
2:46
for others who may find it helpful. She reflects
2:48
on the significance of understanding different
2:51
perspectives and fostering positive relationships
2:54
and finding joy amidst the complexities within
2:58
health care. And now my conversation with Dr.
3:01
Maura Kenny. Welcome, Dr. Kenny, to Flourishing
3:06
in Medicine from Surviving to... thriving and
3:10
what i'd like to do as i often do with the guests
3:13
is begin getting to know you a little bit mostly
3:17
want to hear about why medicine why did you decide
3:21
out of all the things you could do to become
3:26
a physician and i think these stories are really
3:30
interesting in a lot of ways and many of us have
3:33
been influenced by early experiences formative
3:36
things in our childhood but not entirely necessarily
3:40
it could be something that happened in your educational
3:42
process or even as you began working in life
3:44
that brought you to this so it's give us a little
3:46
bit of that background story for yourself yeah
3:50
it's interesting to reflect on this and it's
3:53
making me smile actually because i actually was
3:56
intending to become a domestic science teacher
3:58
when i was at school and why was that well it
4:03
was because i was actually good at the cooking
4:07
part of the domestic science piece not the embroidery
4:10
stitching side and then I was going to become
4:13
dietitian because that seemed like an application
4:17
that was more clinical and then I looked into
4:20
going to you know do a dietitian degree and then
4:24
I really enjoyed biology at school and was good
4:27
at that and and I also always had a great love
4:30
of reading so I was reading a lot about what
4:34
being a doctor was about and was really quite
4:37
inspired I think by the profession as the way
4:40
it was portrayed in different novels. So I decided
4:43
I would do medicine. I know that my parents just
4:46
kind of watched in a fairly bewildered way as
4:49
I transitioned from one idea to the next, to
4:51
the next over a couple of years. And they never
4:53
pushed or pulled or really said very much. They
4:56
just let me go with what I wanted to do. I spoke
4:59
to the careers officer at school and she said,
5:01
oh, you'll never get into medicine. It's far
5:02
too hard. And, you know, that was a bit like
5:05
a red rag to a bull to me. It's just like, no,
5:08
I'll get the grades. I'll get in, which I did.
5:12
Yeah, and I don't think I was particularly clear
5:14
about what specialty I would do at that stage.
5:17
I just was interested in the application of biological
5:21
sciences in particular to the human condition.
5:24
And as I went through med school, the things
5:26
that I found interesting most actually was mental
5:30
health, which is why I ended up in psychiatry.
5:33
I just thought those placements were so, so interesting.
5:35
The people in them were so interesting. There
5:39
was that lovely interplay between the art and
5:42
the science and what the individual brings to
5:45
the healing relationship and really met some
5:50
very inspiring role models through that time.
5:53
So it just kept me kind of intellectually engaged,
5:55
emotionally engaged. I did an intern year and
5:59
then straight into psychiatry, which you could
6:01
do back then. Now you have to do a couple of
6:03
years of other things. But I did my intern year
6:06
and then straight into psychiatry training. And
6:10
here I am in quite a different place now after
6:13
all those years. Yeah. Well, we'll get to that
6:17
different place, which is part of what I'd like
6:20
to talk about. But let's just stay on this origin
6:24
story just a little bit because. you said you
6:27
were inspired by the narratives and the depictions
6:30
of the physician in the novel or in what whatever
6:34
you were reading what was it about that what
6:37
were the qualities that inspired you that you
6:40
felt that you identified with that you felt like
6:42
gosh that would really be me that could be me
6:46
that might be me if i apply myself in a certain
6:49
way there is something about the intellectual
6:55
challenge of it the need to study hard which
6:59
I like doing back then that was then applied
7:02
to the difficulties that people have patients
7:06
have in their lives illness suffering something
7:09
about how you had to connect with the person
7:13
before you could apply any of the knowledge I'm
7:16
not being very articulate here around this because
7:18
it was I was so young. I mean, I started medicine
7:22
when I was 17. So I was reading this stuff probably
7:25
when I was 14 or 15 or something. So I look back
7:28
now and I think, wow, so young, so naive. I had
7:32
so little idea really about what the world of
7:34
medicine would be like. And of course, it was
7:37
only after my intern year that, you know, I started
7:40
reading books like Bleeders Come First and House
7:42
of God, which were not the kind of books that
7:45
would have inspired me to start. medicine at
7:47
all. Fortunately, I'd already graduated by the
7:50
time I came to those books and was on the medical
7:53
trajectory. So it is kind of fascinating, isn't
7:56
it, about how literature and film can really
7:59
inform our ways of seeing the world without us
8:02
realising it, like what it's doing inside of
8:04
us and giving us ideas about things that may
8:07
or may not be accurate, but which somehow call
8:09
us. I don't know if I can articulate it any more
8:12
than that. I mean, I think I grew up in a family,
8:14
my Father was very prominent in the church and
8:19
he had a real belief in the application of spirituality
8:23
to relieving the suffering of others. He was
8:26
a primary school headmaster in a very rough area
8:29
of Glasgow and he established things like chess
8:33
clubs and a prefect system and a soccer club
8:36
because he really wanted to show those children
8:40
that There was more to education than reading
8:43
and writing, that you could grow in all sorts
8:46
of ways within a school community, even when
8:49
there were enormous pressures of poverty and
8:52
disenfranchisement and substance abuse in the
8:56
community. There were still ways that education
8:58
could offer you something. You might not be the
9:01
brightest kid at school, but you might be captain
9:03
of the soccer team, for example. It was fascinating,
9:06
if I can just digress. I only heard the story
9:08
the other day from my brother that he set up
9:11
the chess club, which is not a standard hobby
9:14
in the poverty -stricken areas of Glasgow. And
9:18
the kids did really well with it. And he got
9:23
them to play. He started his career in the private
9:27
school system. And he set up a tournament and
9:32
his chess club played the top players in this
9:35
private school he'd previously been worked in.
9:37
And the kids in his school completely wiped the
9:42
board, excuse the pun, with these kids. And when
9:46
he was reflecting on it with my brother afterwards,
9:48
he said, these children have such difficult lives.
9:52
They're used to being three steps ahead all the
9:55
time. in order to keep themselves safe. And they
9:58
are using that in their chess moves. And that's
10:00
why they won. And that was just... Such an interesting
10:04
insight, I think, and such a good way to harness
10:09
the difficulties they were facing to make that
10:11
work for them and give them a sense of purpose
10:14
and esteem and capacity and maybe some skills
10:17
for later life. I'm not sure. But yeah, he was.
10:20
So that was just very much in our family growing
10:23
up that you used your knowledge to try and do
10:26
things in the world, teaching, medicine, whatever
10:30
it might be. Yeah. It seems like you've articulated
10:33
it very well. There's a through line from that
10:37
to where you went and where you are now. The
10:41
theme of an intellectual challenge and actually
10:44
facing difficulties, the intellectual challenges
10:47
themselves can be difficulties. And the application
10:49
of what one learns toward difficulties, there
10:52
is a theme that you've discussed of connection,
10:55
the importance of connection. among the many
10:58
things that your father created was places where
11:02
the children could connect in ways that really
11:06
helped them with their social emotional learning
11:07
as you said not just the book learning and then
11:10
there was this recognition of the suffering that
11:13
was very present and impossible not to see and
11:18
it's kind of you know it's what you began to
11:21
see when you started encountering the world of
11:24
mental health and seeing how fascinating and
11:28
curious and how all these things could be applied
11:31
there so i appreciate that thank you very much
11:34
if you could take us we're going to kind of wind
11:37
around in a little different way because of what
11:40
i know about your background how i know you but
11:42
our connection the intersection of the two of
11:45
us is through the world of mindfulness so maybe
11:48
talk to us a little bit about how that became
11:50
part of your healership we could say and how
11:54
you got involved in teaching teacher training
11:57
involved in groups that are setting standards
12:00
for teacher training and really devoting a big
12:04
part of your life what what is it that you saw
12:06
for people in general and maybe we can you can
12:10
also begin to weave it back into for your colleagues
12:14
because i know a big part of your healership
12:16
has been bringing that work to your colleagues
12:19
so that's such a big topic and I think that where
12:24
it started really, if I maybe just go through
12:27
it chronologically, because that's how it unfolded,
12:30
that when I did psychiatry training, I was fortunate
12:33
enough to encounter more people who were pushing
12:37
the barriers of psychiatric interventions in
12:39
the world. And one of them was Jan Scott, who
12:42
went over to the US and trained with Tim Beck
12:44
and CBT right in the early days, cognitive behaviour
12:48
therapy. So while I was a psychiatrist and training
12:51
and all this sort of... neurobiological elements
12:53
of psychiatry and the prescribing and the management
12:57
planning and the social interventions the psychological
13:01
piece had been very much and was still was very
13:04
much dominated and and to some extent still is
13:07
dominated by the psychodynamic psychoanalytic
13:10
movement and here was this which didn't really
13:13
called to me particularly as a practical way
13:16
of helping people who were suffering. And I always
13:19
felt there was an element of victim blaming in
13:21
that. That might be a little bit controversial
13:24
to say, but the sense that, you know, that you
13:28
just interpret the defences and people would
13:30
somehow gain insight and recover. didn't really
13:34
fit with my lived experience of what was happening
13:36
with my patients and then I was introduced to
13:39
cognitive behavior therapy and it was such a
13:41
practical clear model it was about you've got
13:45
this problem but this is what it's about this
13:48
is what thinking and behavior can contribute
13:50
to that this is within your control you can change
13:52
these things see what happens and then when I
13:55
started using it with my patients and people
13:58
got better it was like oh right okay this stuff
14:00
really works this is this is great. Then I came
14:03
out to Australia and continued with that mix
14:07
of general adult psychiatry and cognitive behaviour
14:10
therapy for depression and anxiety. And what
14:13
I noticed was you could give somebody a course
14:16
of antidepressants, you could give somebody a
14:19
course of CBT or both together, and they would
14:22
recover. But if you're in private practice or
14:25
any kind of practice long enough, clinical practice
14:28
generally, when people come back to you, you
14:30
can see that... Beyond the research studies,
14:34
which might have a follow up period of a couple
14:36
of years, three years, maybe the most in most
14:38
cases. But you're seeing people over five, 10,
14:42
20 years. You know, you get to know your patients
14:45
over a long period of time. And people were relapsing
14:48
again, despite having had these evidence based
14:51
interventions. And so it was quite a demoralizing
14:54
period for myself and for them. Like what next?
14:58
What do we do next? change the antidepressant
15:01
chain, do another course of CBT right from the
15:05
beginning, which had an element of been there,
15:07
done that for both myself and the patient. And
15:10
it can be hard to inject optimism for change
15:13
in that setting. And it was very fortuitous that
15:18
on the 15th of March 2002, a day in my life I
15:22
will never forget, Professor Mark Williams came
15:25
out to Australia on a study tour. and ran a half
15:29
-day workshop called New Directions in CBT. Didn't
15:32
even mention the word mindfulness, just said
15:35
New Directions in CBT. And he spent the first
15:37
half of the workshop talking about the theory
15:40
and the hypotheses about why people relapse in
15:44
depression in particular. And then he talked
15:48
about Jon Kabat -Zinn's work in MBSR and how
15:51
they had spent time with him and how they'd modified
15:53
it and applied it to recurrent depression. Because
15:57
the theoretical hypotheses as to why people would
16:01
have recurrent depression lend themselves beautifully
16:06
to mindfulness practice, stepping out of thinking,
16:10
coming back into the present moment, bringing
16:12
a non -judgmentally accepting, kind attitude
16:16
to oneself and one's suffering. the realization
16:20
that we can free ourselves from suffering by
16:23
where we place our attention and that we have
16:25
some control over that. And they had by then
16:28
run a couple of randomized control trials that
16:31
showed it was effective. And then after a beautiful
16:35
presentation of the theory, he led us in some
16:39
practices, which were, I mean, I think I had
16:43
a couple of epiphanies in that workshop. It was
16:46
quite an extraordinary day, which is why it's
16:48
etched in my mind forever. Because one thing
16:50
was that I noticed I had some pain in my neck
16:53
and shoulders, tension, tightness during the
16:56
practice. And as you know, you watch the breath
16:58
and you watch things unfold moment by moment.
17:00
After a while, I realized the pain had gone.
17:02
And there's something about pain being there
17:04
and pain going within a practice of paying attention
17:08
that was really quite extraordinary. Because
17:12
I think we have an assumption if we've got pain
17:14
or depression is coming back, it's going to continue.
17:19
And this was a fear that my patients had. I've
17:21
got some early warning signs of depression. It's
17:23
going to continue. I'm going to go down the black
17:25
hole again. I'm going to be there for days or
17:28
weeks or months. I'm going to be back in hospital.
17:30
My job, my family life is going to be disrupted.
17:35
And yet that notion of impermanence just showed
17:38
up right away. And things don't always go the
17:41
way you expect them to. So that was very powerful.
17:43
And then he read the guest house poem, which
17:45
is the same thing, you know. But also not just
17:49
that these emotional guests come and go within
17:52
our guest house of experience, but also that
17:55
we can have this attitude of meet them at the
17:58
door laughing, welcome, bring them in, entertain
18:01
them for a while. let them pass out the door
18:05
again. There was something about that whole attitude
18:07
to our experience of suffering that all human
18:10
beings have that was just so different to what
18:14
anything I'd ever been taught before. And, you
18:16
know, endemic in medicine is this idea that the
18:18
doctor diagnoses and takes ownership and responsibility
18:23
of fixing the problem for the patient to the
18:25
patient. And while CBT was much more collaborative,
18:29
you could work on things together. The simplicity
18:32
of just coming to the breath, there's nothing
18:34
difficult about that. It's not a difficult strategy
18:38
to learn, if you want to put it that way. CBT,
18:41
you know, for all it's quite straightforward,
18:43
it's actually for some people quite mysterious
18:46
and hard to remember. Whereas just sitting down
18:49
and focusing on your breath every day for a period
18:52
of time, it's accessible, it's manageable, with
18:56
guidance and support, and you can pick it up
18:58
and do it anytime. So what I then did was apply
19:01
that to my practice and found that when I started
19:04
running eight -week mindfulness -based cognitive
19:06
therapy courses that people who had been relapsing
19:09
stopped relapsing as much. They might still relapse,
19:13
but they weren't as frightened by it. It didn't
19:16
last as long. Their medication dosages could
19:19
come down sometimes. It just was such a useful,
19:23
pragmatic application once again of... an intellectual
19:26
but also experiential understanding and applying
19:29
it to human suffering in a specific way that
19:33
would make a difference. So I really love that
19:36
period of my life. And then, of course, my colleagues
19:39
were hearing about these courses and they said,
19:41
oh, can we come and sit in? And then people were
19:43
saying, oh, can you just run one for us? Don't
19:46
have depression. So modified the same principles
19:49
for stress and stress in health care in particular.
19:54
And then to fast track the whole thing, I realized
19:56
very quickly that particularly the junior staff
19:58
and the interns were falling asleep within two
20:01
minutes of lying down on the floor to do a body
20:03
scan because they were exhausted. And the course
20:08
had to be briefer, the meditations had to be
20:10
shorter, and they were either done sitting or
20:13
standing, stretching and moving. Because I was
20:17
very influenced by Amishi Jha's research that
20:19
showed just 12 minutes could make a difference.
20:22
So I made the meditations 15 minutes in duration
20:25
because that seemed much more accessible. And
20:27
of course, the inevitable happens. I don't have
20:28
15 minutes in my day. 15 minutes is far too long.
20:32
I'm bored after two minutes. And it's like, yeah,
20:34
well, my patients are doing 40 minutes a day
20:37
back in the clinic. So come on, guys, you can
20:40
do this. And it took off. This course, the six
20:44
week mindful self -care course has taken off
20:46
in ways I had never imagined. It went over to
20:49
Taiwan and Hong Kong and China. I've got a whole
20:54
lot of colleagues in the UK and a bunch of NHS
20:56
trusts who have been running the courses there
20:59
after I did some training supervision with them.
21:01
And of course, we continue to run them here and
21:03
they've been picked up interstate around Australia
21:05
and in New Zealand as well. So I guess things
21:09
at work. endure and things that don't pass out
21:14
of our repertoire so with very little promoting
21:18
or prompting because I'm so stretched and busy
21:21
it continues and it is a joy for me to teach
21:24
and to supervise others in this course because
21:27
because the practice of mindfulness just brings
21:30
us back to the immediacy of the present moment
21:34
the capacity to check in with ourselves see how
21:37
we're going stopping the judging and the self
21:40
-criticism I've also been very influenced by
21:42
Paul Gilbert's work and Kristen Neff and Chris
21:45
Germer's work in self -compassion have woven
21:47
this into the six -week course more emphasized
21:50
more the the self -compassion piece because we
21:54
know from the research that physicians especially
21:57
are exceptionally good at self -criticism and
22:01
indeed the whole the hidden curriculum of medicine
22:03
is is being about doing well by beating ourselves
22:07
up and using self -criticism as a motivator to
22:10
higher performance, which can be a short -term,
22:14
fairly effective strategy, but a long -term career
22:16
killer, as we know. So I've gone down the path
22:21
of how I've applied mindfulness in healthcare
22:23
settings. Of course, before that and alongside
22:26
of that, I started getting involved in training
22:30
and supervision in the eight -week mindfulness
22:33
courses. co -founded a teacher training institute
22:37
in Australia, New Zealand with my colleague and
22:39
friend, Tim Goddard, whom we both know and with
22:42
other wonderful faculty. And they have continued
22:45
to run those trainings to this day. I've had
22:48
to step out because I needed to focus on the
22:52
staff wellbeing projects, but the institute continues,
22:55
which is wonderful. And yes, briefly, as you
22:58
mentioned, I... For a year or two, I chaired
23:01
the International Committee on Integrity for
23:04
Mindfulness Teacher Training, which, of course,
23:07
over many countries with their different legal
23:09
jurisdictions and obligations and insurance policies
23:12
was quite a complicated project. So, yeah, it's
23:17
been an interesting career path. Yes. You know,
23:21
it's gosh, it's so wonderful to hear you talk
23:24
about this because. A lot of the experience that
23:27
you share, I've had the very similar experience
23:29
in the very similar timeframe, although not in
23:31
mental health, but in the early 2000s, beginning
23:35
to teach this and then how physicians would self
23:39
-direct themselves to the course and find themselves
23:43
and then asking the question, this would be really,
23:46
really wonderful to do as a collective of a community
23:51
of health professionals. moved into it. It was
23:56
out of suggestions of people who were participating.
24:00
So that's really, really quite interesting. So
24:04
I'd like to just shift a little bit. Maybe you
24:07
can give us now that you've talked about this
24:12
and how you got involved in colleagues and their
24:14
health and well -being through the mindfulness
24:17
teaching program that you created and that is
24:20
now spread. But now I'd like to understand a
24:23
little bit of the landscape of physician and
24:25
other health professionals and their well -being
24:27
or lack thereof or challenges to in South Australia,
24:32
maybe in all of Australia, because you're probably
24:34
familiar. It's not a huge population country,
24:36
so you're probably in touch with what's going
24:38
on beyond just the South Australia region and
24:43
how you then were called to serve in leadership
24:48
in the South Australian health. region as a as
24:53
director of staff well -being how'd that happen
24:55
and what was what led to that yes it really grew
25:00
out of the mindfulness work make it really when
25:03
you're teaching mindfulness to healthcare staff
25:04
and and talking about how to apply it to the
25:07
problems and pressures challenges that we face
25:10
in healthcare you know i'd hear the stories about
25:14
what was happening in the different settings
25:16
and the different organizations that these healthcare
25:19
professionals were coming from and And I could
25:22
see that mindfulness helps us cope with a very
25:27
difficult problem. 21st century healthcare is
25:30
a wicked problem, using that definition of a
25:33
complex problem that doesn't have any straightforward
25:36
answers and probably never does have answers,
25:38
an ongoing interaction with the difficulties
25:42
that arise. That mindfulness is certainly an
25:45
important piece, but it became clearer to me
25:48
as I went on that... If that's all you offer
25:51
people, it's victim blaming, it's tokenistic.
25:55
It assumes that the problem is lying with the
25:57
individual and not with the system or the organisation.
26:01
And then somebody sent me an expression of interest
26:03
to a wellbeing committee that was being formed
26:05
in our network, which is the largest network
26:07
in South Australia. There's about 18 ,000 employees.
26:10
And so I joined that committee and after too
26:13
long a while started chairing that committee.
26:17
We worked very closely with the workforce teams,
26:19
the HR, work health, safety, organisational development
26:24
staff who were involved in this committee. We
26:28
had an executive sponsor who was the executive
26:31
director of... people in culture or workforce.
26:34
And we had a co -chair who was exec director
26:37
of medical services. So the organisation was
26:40
taking the committee seriously. And as we started
26:43
to examine the literature and at the same time
26:46
help with a big whole of public sector survey,
26:50
and we saw the results, it was also happening
26:54
during COVID. So there's a whole lot of things
26:56
we were doing to help staff manage the pressures
26:58
and pain of COVID. that we realized that there
27:03
was this amazing literature from Stanford in
27:05
the Mayo Clinic. on staff wellbeing that was
27:08
really sophisticated. And again, I guess it goes
27:09
back to that thing about being called to the
27:12
intellectual, when there's a persuasive intellectual
27:15
argument and a body of research, you can really
27:18
use that to inform your work. You don't need
27:20
to reinvent the wheel. You can just quickly go
27:23
to work that other fantastic people have done
27:26
and apply it to your setting. And when we had
27:29
the results of our survey, which showed that
27:32
60 to 65 % of our staff, not surprisingly, were
27:36
either burnt out or showing signs of burnout.
27:38
Quite aside from that, 70 % were scoring as highly
27:42
resilient on the resilience scale. This is not
27:45
a failing of personal capacity. Healthcare staff
27:50
are resilient by definition and the research
27:53
shows that. But they were certainly under huge
27:57
amounts of pressure with long working hours and
28:00
other conditions that make it difficult for even
28:02
the most resilient person in the world to do
28:04
the job for a long period of time. So those results
28:07
were very concerning, but also very helpful because
28:11
it gave us the evidence we needed that things
28:14
had to be done. We argued for the creation of
28:17
a position of chief wellness officer, which in
28:19
our organization, they decided to. make, as the
28:24
directors call it, director of staff wellbeing.
28:27
And in other settings, as you probably know,
28:29
chief wellness officers have been just for physicians
28:31
only. But in our organisation, it was decided
28:34
to make it for the whole of the organisation,
28:36
which I actually agree with, because we don't
28:39
work in disciplinary silos. We work in multidisciplinary
28:43
specialties. We work in teams, we work with other
28:46
people, we work with nurses, we work with allied
28:48
health. and in those teams that is your lived
28:52
experience that's your daily experience of a
28:56
professional life is interacting with patients
28:58
their families nurses allied health staff and
29:03
your medical colleagues so and the work from
29:07
stanford is very clear that the interventions
29:10
that you do have to be bespoke for that particular
29:12
unit or department there the pressures that staff
29:16
suffer are not all the same. I mean, they can
29:18
be largely grouped under culture, team culture,
29:23
and things that get in the way of efficiency
29:26
of practice. That's the Stanford model. And then
29:29
the personal resilience piece is in there too.
29:31
Obviously, we try and bring our best selves to
29:33
work. That's a professional obligation to some
29:36
extent. But if those other pieces aren't in place,
29:40
then it doesn't matter how professional resilient
29:42
you are, you won't be able to be effective. So
29:45
that meant having to rethink our approach. When
29:49
the position was created and it was offered to
29:52
me as an interim position and then became a substantive
29:54
position, I'm about 18 months or so into this
29:57
job now. I again went to the literature to look
30:00
at, well, what can we do? This is not about rolling
30:02
out mindfulness programs across the organization.
30:04
Much as I believe in it and personally benefit
30:06
from it, this is not the treatment of choice
30:09
here. We have to go in to the teams that we find
30:13
are struggling and diagnose what's going on and
30:16
what needs to be done to help them and how we
30:18
can help them and how we can teach them how to
30:21
help themselves with things that are within their
30:22
sphere of control. And what we've found is that,
30:26
I'm sure this is true everywhere, but social
30:30
medicine is very high in the political agenda
30:33
here. That attracts a lot of media coverage,
30:36
often adverse media coverage, which is really
30:38
another very good way to burn out hardworking
30:41
staff is to continually see their hospital or
30:45
their team being reported on in a fairly catastrophic
30:48
manner in the press on a regular basis. But there
30:51
is a real social justice element in Australian
30:55
health care. So much of it is available to...
30:59
everyone in the population through our Medicare
31:01
system. And that is provided by people who are
31:04
dedicated to working in the public hospitals
31:06
where all the teaching, training and research
31:09
happens. How do we keep good staff in there to
31:14
provide that excellent level of health care to
31:17
people who have no other means of accessing it?
31:21
It's a political hot potato. It's a social justice
31:25
thing for the people who remain in health care.
31:28
And it's very fraught emotionally for all of
31:32
those reasons. And it has definitely going to
31:37
executives, the department, various high level
31:40
meetings to present. a practical model that says,
31:43
if we do this, if we do that, if we embed wellbeing
31:46
leads in each of the departments or teams or
31:49
clinical streams, we can apply world's best practice,
31:53
measure, evaluate, fine tune, redirect, put in
31:59
the ingredients that that team, that department
32:01
need. Then you will keep people engaged. You
32:05
will give them a sense of hope that things can
32:07
be done and move people out of the... the learned
32:10
helplessness that has arisen when it feels like
32:14
healthcare has been outsourced to the health
32:17
minister or bureaucrats, as people call them,
32:20
or administration or executive. And it has really
32:23
developed a them and us narrative, which is not
32:27
helping. There's a divide that stops people getting
32:30
together around the table, putting their wonderful
32:33
minds and warm hearts to this wicked problem
32:36
of how we deliver. excellent health care to everyone,
32:40
but particularly those who can't afford it in
32:42
any other way. And I feel sometimes like I'm
32:46
a connector between the two sides of the organization.
32:49
I feel squeezed, very thin by both sides. I'm
32:54
using my hands, which of course the audience
32:55
can't see, to just demonstrate how squeezed I
32:58
feel at times or how stretched I feel at times
33:01
trying to bring the two sides together. There's
33:04
this kind of extraordinary void that things fall
33:07
into bureaucratically, never to be seen again,
33:10
that you think, where did that piece of paper
33:12
go? Where did that application go? Where did
33:14
that brief go? There's all sorts of things you
33:17
start to encounter in this job that you don't
33:19
encounter as a clinician working on the floor.
33:22
It's been a very steep learning curve. It's been
33:24
the hardest job I've ever done since I was an
33:26
intern, that's for sure. And as one of my lovely
33:29
colleagues interstate said, who's the first chief
33:31
wellness officer in Australia and a great mentor
33:34
to us, Bethan Richards, she said, this job, either
33:38
people love you or they hate you. You have good
33:40
days or you have great days or you have bad days.
33:43
You never seem to have very much in between.
33:45
That's the experience of the job. And oh, my
33:47
goodness, do you need a mindfulness practice
33:49
to manage all of that? Very well said. Yeah.
33:53
I'm really curious as what you've learned that
33:56
has surprised you thus far into this job. In
34:00
particular, what has surprised you about leaders
34:02
that you had maybe other thoughts and ideas about
34:08
already formed? So in some ways your biases and
34:12
what surprised you about your staff that you
34:16
may have also had similar or different? kinds
34:20
of ideas about and what are some of those great
34:24
parts that really have been a nice surprise for
34:28
you? Well, there have been many. I mean, it's
34:31
been such a blessed and privileged position to
34:34
be in. Doing the Chief Wellness Officer course
34:37
at Stanford last year was so very, very helpful.
34:41
And Tate Shanafelt and his faculty are just standout
34:44
human beings. Huge hearts, as well as huge intellects
34:49
and research capacities. But Tate would say to
34:53
us over and over again, there are no villains.
34:55
There are no villains in your organisation. There
34:58
are no villains. I've got that on a sticky note
35:00
above my desk to remind me that when people do
35:04
things that I don't like, they probably have
35:06
a very good reason in their mind as to why they're
35:09
doing it. And I genuinely try and believe everyone
35:12
is doing their best. I don't think there are
35:15
many psychopaths in this organisation. I think
35:18
most people are really trying to do their best.
35:20
They've got a very clear rationale why they're
35:22
doing it and it doesn't always line up with how
35:24
I see things. I'm trying to step away from conflict
35:27
and to understand what might be going on and
35:31
the various pressures that people are under and
35:34
trying to convey that. to the staff who've become
35:37
very distrustful of admin or exec or management.
35:41
They're generally just lumped into a one -size
35:44
-fits -all category of people that are getting
35:46
in the way of good medicine. Whereas, you know,
35:49
on the other side, I'm working with them closely,
35:51
seeing how hard they're working to try and make
35:53
the system work. And it's a complex, enormously
35:56
complex problem in ageing population and lower...
35:59
tax contributions because younger people, there's
36:02
less younger people in comparison to the number
36:05
of older people that need care and healthcare
36:07
in particular. So that's really important. There
36:10
are no villains. People are trying to do their
36:12
best. Really important to remember that and try
36:15
and keep good relationships with everyone. I'm
36:18
not going to say that's easy. It's a huge struggle
36:21
at times, but I think if we all come to the workplace
36:24
every day with that notion in mind, then we'll...
36:28
get past pointless wars and conflicts that just
36:33
waste everybody's time and energies. The other
36:35
thing that continually amazes me about my clinical
36:40
colleagues, and I'm really struck by that with
36:43
the staff who are staying in Gaza to man those
36:45
hospitals and to continue to provide healthcare
36:48
under just the most awful, awful circumstances.
36:51
To a much lesser extent, we have that here in
36:54
our emergency departments and intensive care
36:56
units all around the system. In fact, people
36:58
are doing extraordinary work. They're just coming
37:00
in every day and getting on with it and doing
37:02
really good clinical work. And you encounter
37:05
the most amazing leaders in the most unlikely
37:08
places. It might be a fairly junior nurse who's
37:11
got a passion for the well -being of her team
37:14
who will set up. barbecues and social events
37:18
and we have a big peer support program that's
37:21
one of the planks of our intervention is to get
37:24
a peer support program across the different teams
37:27
i mean i could talk about all the different things
37:29
we're actually doing to try and fix things but
37:31
one of them is peer support because we know that
37:34
sense of connection and camaraderie is incredibly
37:37
powerful It's always been part of medicine. I
37:40
really noticed that when I became an intern and
37:43
felt part of a team, that it was a difficult
37:45
year, an exhausting year. But we had so much
37:48
sense of connection and laughter and being looked
37:52
after by your seniors and the senior nurses in
37:56
particular that kind of got you through that
37:58
whole fairly mad experience and allowed you to
38:02
do good work. And incredibly difficult to put
38:06
a price on camaraderie, incredibly important
38:08
thing to foster and cultivate because it's priceless.
38:12
It's absolutely priceless. When you harness the
38:17
collective energies of people, some people just
38:20
rise to the occasion and are extraordinary leaders
38:23
who believe in peace rather than war. with their
38:29
colleagues who are really trying to stop narratives
38:33
of them and us or divide and try and connect
38:36
with the intern on the other end of the phone
38:38
in another ward that you're trying to persuade
38:40
to take a patient out of the emergency department
38:43
into an overburdened gen medical bed. And why
38:48
fight? Why not connect? You must be having a
38:52
horrendous day as well. It's really busy. We're
38:54
really overloaded, but we need to transfer this
38:56
patient. And it's all about connection and communication
39:00
and trying to be present to the difficulties.
39:05
Very, very hard to do that in a really stressed
39:07
situation. And I'm always reassured when I remember
39:11
John Kabat -Zinn saying once that mindful speech
39:13
was the most difficult and the most advanced
39:15
practice of all. Thank you. You know, you've
39:19
kind of summarized it in this peer support. And
39:21
actually, that's been a through line through
39:24
so many of the interviews that I've had with
39:26
people, is that that is something that a leader
39:32
looking at the system can look at and say, how
39:35
do we create an environment where people support
39:38
each other both formally, which is important,
39:42
and also informally. And then on an individual
39:44
level, each one of us can come to work and say,
39:47
how can I not only take care of myself, but how
39:50
can I help take care of the person next to me,
39:52
the person on my team? So that's lovely. The
39:54
other thing I wanted to say, you know, there
39:56
are no villains that Tate Shanafelt shared with
39:59
you, and that's now kind of a mantra for you.
40:01
And by the way, we've had Colin on the show who
40:05
did a lot of work in the early days with Tate
40:08
at the Mayo. And a lot of the things that you
40:10
are saying really dovetails nicely with what
40:13
he said. I remember You mentioned Jon Kabat -Zinn.
40:17
One of my early trainings with Jon Kabat -Zinn,
40:20
him saying the following, he said, you know,
40:23
the people that you bump up against and that
40:25
you may not really quite understand where they're
40:28
coming from, and pardon my French, they're not
40:31
assholes. They know what they know, and they're
40:33
trying to do their best, really. And that's something
40:37
that's always kept with, that stayed with me,
40:39
that really... when i would meet adversity i
40:42
would think to myself yeah this person doesn't
40:45
get up in the morning thinking how to make mick
40:48
krasner's life miserable no not at all they're
40:50
trying to kind of get through their day and do
40:52
what they can do so thank you for mentioning
40:56
that and i think that's a wonderful little mantra
40:58
or sticky note to put on us there are no villains
41:01
we're going to be coming to a close you've been
41:04
so generous with your time but i wanted to read
41:06
something to you it's the first time i've kind
41:09
of done this in in these podcasts although other
41:11
people have shared something spontaneously but
41:14
i actually been thinking about joy in medicine
41:18
that you know deep kind of eudaimonic satisfaction
41:23
that our teams get when the work is well done
41:26
maybe on the days that you come in and say it's
41:29
been a great day and when a system can look a
41:33
team can look at the work they've been doing
41:35
for the last several months and say wow there's
41:38
joy in that and i heard this from jack cornfield
41:43
you know a teacher that we both know and love
41:45
and it's not his writing but it's a a poem and
41:49
i'll read it to you and then i want to i want
41:50
to ask you a response to this so it's called
41:54
a brief for the defense by jack gilbert you may
41:57
you may have heard it before but i'll read it
42:00
and mostly for our listeners sorrow everywhere
42:04
slaughter everywhere if babies are not starving
42:08
someplace they're starving somewhere else with
42:12
flies in their nostrils but we enjoy our lives
42:15
because that's what god wants otherwise the mornings
42:19
before summer dawn would not be made so fine
42:23
The Bengal tiger would not be fashioned so miraculously
42:26
well. The poor women at the fountain are laughing
42:29
together between the suffering they've known
42:31
and the awfulness in their future, smiling and
42:35
laughing while somebody in the village is very
42:37
sick. There's laughter every day in the terrible
42:41
streets of Calcutta, and the women laugh in the
42:43
cages of Bombay. If we deny our happiness, resist
42:47
our satisfaction, we lessen the importance. of
42:51
their deprivation we must risk delight we can
42:55
do without pleasure but not delight not enjoyment
42:57
we must have the stubbornness to accept our gladness
43:01
in the ruthless furnace of this world to make
43:07
injustice the only measure of our attention is
43:10
to praise the devil if the locomotive of the
43:13
lord runs us down We should give thanks that
43:16
the end had magnitude. We must admit there will
43:19
be music despite everything. We stand at the
43:22
prow again of a small ship anchored late at night
43:25
in the tiny port looking over to the sleeping
43:29
island. The waterfront is three shuttered cafes
43:32
and one naked light burning. To hear the faint
43:36
sound of oars in the silence as a rowboat comes
43:40
slowly out and then goes back is truly worth.
43:44
all the years of sorrow that are to come. So
43:49
you just feel into that. Maybe you can share
43:52
what you understand about the personal joy that
43:56
has been yours, hopefully, in your professional
44:01
and personal life. Oh, I love that. I love that,
44:06
Mick. That was extraordinary. And you read it
44:08
so beautifully as well. One of the images that
44:11
just stands out from what you just read were
44:13
the women. laughing together while somebody in
44:16
the village is dying and that camaraderie as
44:20
they you know collect water or cook communally
44:23
or whatever it is that capacity we have to connect
44:26
and laugh even in the face of or while other
44:29
awful things are going on around us it's just
44:32
such an extraordinary capacity that we have as
44:34
human beings and i think that One of the problems
44:38
I encounter in the staff well -being work in
44:40
particular is that people often feel I can't
44:43
be happy until this wicked problem of health
44:47
care is solved or until I've paid off the mortgage
44:51
or until my kids have left home or until I go
44:55
on holiday. And one of the practices we teach
44:58
comes from the MVCT course, the Pleasant Event
45:00
Calendar. You know, I call it lifting our gaze.
45:02
You know, yes, everything's really difficult.
45:05
You've had an awful clinic, somebody you care
45:07
about, your patient books has died or relapsed
45:12
or whatever. But you can still open up to the
45:16
beautiful things that the world offers us, either
45:19
the connection with other human beings, the shared
45:22
laughter, the sunset, the sunrise, all of the
45:27
things that nature really offers us as a way
45:30
of coming back to. You know, we're a little tiny
45:34
creature on this earth and we need to remember
45:37
that. And it's not perfect and it's not permanent.
45:42
And we have to somehow pan out, you know, to
45:46
that stance. I think that attitude to life that
45:49
I think we can have this sense of privilege that
45:52
we should have. Everything should be a certain
45:54
way. And the thing about medicine is it holds
45:57
out such promise now that we've almost come to
46:00
expect that we won't suffer and that we'll be
46:02
incredibly healthy until we die peacefully in
46:06
our sleep around 98 years of age, having been
46:09
able to do everything we wanted to up until that
46:11
point, which is just, I think it's a myth that's
46:14
around in the ether because of how advanced medicine
46:18
is. But it's inaccurate. You know, life is inherently.
46:22
full of suffering. You know, the noble truth,
46:24
number one, there is suffering. We have to acknowledge
46:26
that and be with that and take the joy where
46:28
we can. And I just want to add one more thing
46:30
here, which my wonderful colleague, Paul Bernard
46:33
in the NHS, who's a mindfulness teacher there,
46:36
talks about the privilege of being in medicine,
46:40
the privilege of being with people at those moments
46:43
of suffering. The privilege of having learned
46:46
things that we can use to help people, those
46:49
incredible moments that we share with people
46:52
and their families. There is a great privilege
46:55
in medicine as well as exposure to suffering.
46:58
And it's important that we place our attention
47:00
on that sometimes and lift our attention out
47:04
of everything that's wrong with health care.
47:06
Actually, there's more right with it than wrong
47:08
with it in first world countries. You know, I
47:10
say that to my trainees all the time. We'll see
47:13
a headline, you know, hospital in crisis. No,
47:16
our hospitals are not in crisis. The hospitals
47:18
in Gaza are in crisis. We have struggles and
47:21
difficulties. Language matters. We have to watch
47:25
the words we use. They influence how we feel
47:28
and how we behave and how we react. So that poem
47:31
somehow brings all of that together so well.
47:34
Thank you. Well, what a wonderful way to conclude
47:38
what's been a delightful conversation, Maura.
47:42
And I'm just really, really thankful for your
47:45
generosity of your time. And we'll end here.
47:50
Thank you very much for listening. We will include
47:53
a summary of today's podcast and links about
47:56
Dr. Kenny and other references that were discussed
47:58
in the show notes. I would like to conclude by
48:02
sharing another practical exercise to help you
48:05
flourish. During this podcast, Dr. Kenny mentioned
48:08
a poem that was written by Rumi, the 12th century
48:13
Sufi mystic from what is now Afghanistan. Reference
48:18
to this poem can be found in the show notes,
48:20
but I'd like to read it to you. And you can listen
48:23
to this from time to time as you see fit as an
48:26
invitation to welcome both the difficult and
48:29
the easy, both the bad and the good, both the
48:32
comfortable and the uncomfortable, perhaps cultivating
48:36
a sense of potential for all of our lived moments
48:40
and realizing that our life unfolds truly in
48:45
the only moments that we actually have, which
48:48
are right now. The Guest House by Jalaluddin
48:52
Rumi, translated by Coleman Barks. This being
48:57
human. is a guest house. Every morning, a new
49:02
arrival. A joy, a depression, a meanness. Some
49:09
momentary awareness comes as an unexpected visitor.
49:12
Welcome and entertain them all, even if they're
49:17
a crowd of sorrows who violently sweep your house
49:21
empty of its furniture. Still, treat each guest
49:28
honorably. He may be clearing you out for some
49:32
new delight. The dark thought, the shame, the
49:38
malice, meet them at the door laughing and invite
49:42
them in. Be grateful for whoever comes because
49:47
each has been sent as a guide from beyond. I
49:53
do hope you found this podcast and the simple
49:55
exercise this listening exercise useful to you
49:58
and look forward to having you join us for the
50:01
next episode of Flourishing in Medicine from
50:04
Surviving to Thriving. If you'd like to learn
50:06
more about EmPRO and its peer support programs,
50:09
please visit www.myEmpro.com forward slash peer
50:15
dash support. I'd like to thank Gerri Donohue,
50:19
Vice President of Education at EmPRO for producing
50:21
this podcast. and Stan Sainjour for his technical
50:24
expertise in recording and editing. If you are
50:28
a physician or medical student and in need of
50:30
urgent support, please consider calling the Physician
50:34
Support Line at 1 -888 -409 -0141 or visiting
50:40
www .physiciansupportline.com. The Physician
50:45
Support Line provides a safe place to discuss
50:47
immediate life stressors. with volunteer psychiatrists,
50:51
colleagues who are uniquely trained in mental
50:53
wellness and have similar shared experiences
50:57
of the profession of medicine. For more information
51:00
about me and my work, please visit www.MickKrasnermd.com
51:06
or www.mindfulpracticeinmedicine.com.
51:12
Until next time.