Latest / Flourishing in Medicine: From Surviving to Thriving / Flourishing in Medicine: From Surviving to Thriving Episode 16 Navigating Complex Health Systems: A Conversation with Dr. Justin Klamerus

Transcript

Flourishing in Medicine: From Surviving to Thriving Episode 16 Navigating Complex Health Systems: A Conversation with Dr. Justin Klamerus · Flourishing in Medicine: From Surviving to Thriving

0:00
I try to bring that awareness to my work is to try to leverage the things that I can for
0:12
our frontline workers in such a way that their lives are better, that our patients lives
0:17
are better, and that we're enriched through that service.
0:25
Welcome to flourishing in medicine from surviving to thriving.
0:28
I'm your host, Dr. Mick Krasner, and this podcast is produced by EmPRO, a medical professional
0:34
liability insurance carrier headquartered in New York state and committed through a
0:38
number of peer support offerings to supporting the physicians they protect.
0:44
Today I'm really excited to share with you my conversation with Dr. Justin Klamerus,
0:48
vice president and chief clinical officer for McLaren Health, a large integrated nonprofit
0:54
healthcare delivery system in the state of Michigan. An oncologist by training Dr. Klamerus'
1:00
leadership involves overseeing the clinical operations of this complex healthcare delivery
1:05
network with over 14 hospitals and over 700,000 covered lives in Michigan and Indiana.
1:13
During this conversation, Dr. Klamerus discusses his leadership in McLaren Health, highlighting
1:18
the organization's dedication to its medical staff, as well as to many diverse communities
1:24
while navigating financial constraints and significant public health challenges such
1:30
as the Flint, Michigan water crisis, gun violence, and maternal healthcare delivery issues.
1:37
He shares his vision for how large and complex healthcare systems can improve workforce stability
1:43
and community engagement through fostering an environment where staff receive the support
1:49
needed to excel in complex patient care delivery and to address social issues.
1:55
He underscores and seems to live the importance of transparent, authentic, and engaged leadership,
2:01
mindfulness and personal connections alongside emergent technologies in driving changes that
2:08
can help healthcare in the future. I found his candor, humor, genuineness, and warmth
2:14
to be really comforting, and it helped me to better understand the connection we can
2:19
all have with people who embody true leadership. And now my conversation with Dr. Justin Klamerus.
2:28
Welcome Dr. Klamerus, flourishing in medicine from surviving to thriving. And one of the
2:33
reasons I'm really excited and wanted to have you on the podcast is this podcast is about
2:40
flourishing in medicine. It's about helping physicians and other health professionals
2:44
improve their wellbeing so they can do the work they do and maintain high quality. And
2:50
interestingly enough, we've had people from different aspects and different domains of
2:55
medicine. We've had academic leaders involved in peer support programs such as Joe Shapiro
3:02
from the Brigham. We've had people that are involved in medical student undergraduate
3:06
medical education looking at the antecedents of wellbeing or burnout, let's say it's opposite,
3:14
and seeing what medical education has to offer to address this issue. We've looked at the
3:19
10,000 foot level with people like Colin West from the Mayo Clinic who really looks at the
3:25
bigger issues and what's going on here. But for you as a leader of a health system, a
3:31
very large health system that has a lot of complicated moving parts, it's going to be
3:38
really interesting because you have both the service mission and educational mission, a
3:44
community mission. You have many, many missions. So thank you very much for joining us.
3:50
My pleasure.
3:51
Wonderful. What I'd like to start with is, and I start with all my guests on the program.
3:58
I'd like to hear a little bit about you, mostly if you can focus your comments about why medicine
4:05
for you, what was the calling if there was a calling, if you saw it that way, what was
4:10
the draw? Were there some experiences you could share that you had in your formative
4:15
years, either very young or even in your educational years that really moved you in this direction
4:20
that has confirmed this choice of career, which I would like to say it's a calling for
4:26
many of us. And I'd also like to say that it's not easy. I think we know that. And so
4:32
there's something about it that keeps us in it, that moves us toward it. And it would
4:36
be really interesting to hear your story.
4:39
Thank you, Mick. I'm so happy to be on the program as well and have been so touched by
4:45
many of your previous guests in the powerful messages that have come out of the discussions
4:50
you've had with them. I, like you, believe medicine and many, many careers that we might
4:56
choose in our lives are indeed callings. I think that I felt that from a very young age.
5:02
I grew up in a small rural community in the Upper Peninsula of Michigan, in fact an island.
5:08
The thinking of the no man is an island unto himself. We were very aware in small rural
5:16
northern Michigan that community was really important and that individuals in that community
5:22
depended upon one another. I wasn't quite sure from a young boy what exactly I would
5:27
do, but I knew that I wanted it to be, I wanted my career to be related to service. I loved
5:34
school and loved learning. And early on in elementary school, I remember the American
5:39
Heart Association sent me a medical illustration of the Frank Nutter diagram of the heart.
5:45
And I remember opening that envelope and thinking that that message had been sent directly to
5:51
me and how fascinating it was and words that I couldn't understand from Latin and the structure
5:58
of the heart. And that triggered for me an idea that I would think about becoming a physician.
6:04
And it really followed me through my younger years, including a lot of very formative experiences
6:10
with mentors that helped guide me and also believe that this fourth or fifth grade student
6:17
knew something about what you might want to do and took me seriously.
6:21
That's fascinating that the image itself would call on actually we sometimes think of it
6:27
as imagination or imagination, imagining our future and the word of course, you know, comes
6:33
from image, taking an image and then projecting that into something that could be. And was
6:40
there, you know, an aesthetic quality to what you saw in those drawings? Because I remember
6:45
being touched by the Frank Nutter drawings as a medical student and thinking, oh, how
6:50
I would love to have a full set of the Nutter, of all the Nutter books, you know, on my shelf
6:55
one day in the future as I become a successful physician or something like that. Was it the
6:59
aesthetic was it something about heart itself, you know, something beyond the picture of
7:06
the heart, but what it really meant to you, you know, just maybe you can say a little
7:09
bit more about that because I'm curious.
7:12
The fascinating question. I've actually never thought of it as sort of that the image happened
7:17
to be the heart and what that might mean. For me, there was certainly a sense of wonderment
7:25
that this is the thing that we think gives life itself, right? It's the one thing in
7:32
our bodies we can feel our pulse, we can place our hand on our chest and feel the heart beating
7:38
beneath us and be aware of our vitality itself. So there was something, I imagine, you know,
7:45
very powerful about that itself. But for me, in terms of a driver, it was much more, I
7:52
was aware of the knowledge one would have to have to understand how that worked, to
7:57
understand the structure of that organ too. And I was mesmerized by the idea of being
8:03
able to learn something as complex as the human heart or as complex as the whole body,
8:09
much more, much more magical. And to be able to have that be your life's work coupled with
8:16
that I was just very privileged to have some very kind physicians myself that not only
8:22
cared for me, but cared for family members in our community, that I was able to see that
8:28
drawing that intense study that would be required to understand it, but also then connect that
8:34
to a larger frame, which was this individual who very much was a part of our life and shaping
8:41
our life, our family physician. And I saw his work as so noble. And I saw the importance
8:47
that he was the only physician on the island we lived on. So one can imagine, you know,
8:53
the place that he had in our community. And it's one of the things as I reflect today,
8:59
and we think about the challenges that healthcare providers are facing across the, doesn't matter
9:06
what job you have in the health system, the burnout, there was a nobility of the work
9:10
that he did, and I connected with that. And it's also for me now, commonplace that I look
9:16
back to when times are tough, we have to remind ourselves of the importance of our work. And
9:23
for me, that's a sort of a wellspring of maybe of imagination and of hope of what I wanted
9:29
the work to do, but also a very real example of the powerful work that I saw being done
9:34
by a young physician in our community.
9:37
I also remember physicians that took care of me when I was a young child and the influence
9:43
that had on me. And maybe you could talk a little bit about then, how did you or in what
9:50
way did you carry that sense of practical nobility, somebody doing something, but it
9:55
was very practical. This was a very real tangible thing that this family physician offered into
10:01
your training and career path as it developed. Maybe walk us from that moment when you're
10:08
committed to become a physician through the various ways you were trained to maybe a realization
10:16
that the wellbeing of your colleagues and the larger healthcare service community was
10:23
a really important part of your personal mission.
10:27
Good question. And I think because there's a large span of distance and as a 47 year
10:34
old, it just seems like yesterday, but lo and behold, that was many decades ago as that
10:39
journey began. But certainly what I was aware of from my physician mentor at the time and
10:45
his name is Scott Aldridge, a wonderful, wonderful man, he's retired now, but was a sense of
10:51
character, a sense of duty and service that did carry with me as I went through my journey
10:58
in school, which is a long journey. I went to medical school in Michigan that was very
11:04
focused on providing care to all of the state with a mission to make sure that our rural
11:10
communities and underserved communities like Drummond Island, where I grew up and Flint,
11:15
Michigan, where we're headquartered, that they had physicians went to the College of
11:19
Human Medicine at Michigan State and very, very humanistic. It's in its name, a very
11:24
humanistic medical school. I thought I would be a primary care physician, but I fell in
11:29
love with internal medicine and oncology specifically. I saw so much hope in my patients with cancer.
11:38
I saw that not only was I able to apply cutting edge science to the work as an oncologist,
11:45
but I also had patients in front of me every day reminding me that there's so much more
11:50
out there than my challenges. If I came to work on a particular day and had problems
11:56
with traffic and my logon wouldn't work for my EMR, I only needed to see a patient for
12:03
a minute to realize that those are all small problems. To me, that service of what kind
12:09
of provider I wanted to be was shaped into the love of science and then that reminder
12:15
from patients. As I sort of evolved through my career to help lead a cancer program in
12:21
multiple states and then now to serve as a chief clinical officer of a health system,
12:27
I try to bring that awareness too. My work is to try to leverage the things that I can
12:34
for our frontline workers in such a way that their lives are better, that our patients'
12:39
lives are better, and that we're enriched through that service. I hope that answers
12:44
or speaks to it, but that's been sort of the evolution for me.
12:49
I did do other things for a while. I went to a very academic oncology training program
12:55
at Johns Hopkins. I had envisioned myself being a clinical trialist, but I was very
13:00
aware that that work, although critically important, I wanted to be much more about
13:06
how we would organize care, how we would determine ways to deliver that care, especially back
13:13
in my home state, which is why I find myself in the role that I'm in now.
13:18
I'd like you, if you could, to describe McLaren Health to them. I think there will be a lot
13:23
of identification. Many of us work in large health systems and large health system networks,
13:29
and I think they may be able to relate to something as complicated as McLaren, especially
13:35
from someone who came up as a clinician first before taking on the mantle of leader in that
13:43
system. If you could tell us a little bit about McLaren Health and then maybe move us
13:47
into what are some of the major challenges that you in your position see that your rank-and-file
13:52
medical staff are experiencing. How do you stay in touch with that?
13:57
Sure. So McLaren Health Care is a large integrated delivery network. We are, from a clinical
14:03
perspective, based in Michigan. We have 14 acute care hospitals, about 30,000 employees.
14:11
We have two health insurance plans, one in Indiana and one in the state of Michigan,
14:16
where we cover about 800,000 covered lives, largely in a Medicaid HMO and Medicare Advantage
14:24
population. We touch patients from the middle of the upper peninsula all the way to the
14:31
Ohio border. From a clinical perspective, we own an NCI Comprehensive Cancer Center,
14:37
the Karmanos Cancer Institute. It was the cancer program I referenced earlier. And that
14:43
organization is one of 55 NCI designated comprehensive cancer centers in the country. We touch one
14:50
in three patients that are diagnosed with cancer in the state of Michigan. And our health
14:55
system really, in those geographies, oftentimes is the primary provider of care in those communities.
15:04
We have many what would be considered traditional safety net hospitals, having a hospital in
15:09
Flint, Michigan, and Pontiac, Michigan, and communities that have all kinds of modern
15:16
challenges to very rural areas of the state, where some of our providers might be the only,
15:23
for instance, a gentleman I was speaking with a couple weeks ago, is the only pulmonologist
15:28
in a 22 county area of the state. And so it's a very unique organization. We're about $6.5
15:37
billion in net revenue. As an organization, we grew from a single hospital in Flint, Michigan.
15:44
Relative to our medical staff and our providers, we try to be very cognizant at McLaren of
15:50
the communities we serve and the places we're from, if you will. We very much have communities
15:57
are very distinct, as I outlined, but we try very much to make sure that our mission in
16:05
those communities is meeting the community need, is reflective of the communities we
16:10
serve and the variety that's there. But increasingly, as many of your listeners may know, in healthcare
16:17
today, systems have to really organize themselves to deliver efficient, high quality care. That
16:24
doesn't happen on accident. And the margins we struggle with in Michigan, where many health
16:31
systems are struggling for a 1% to 2% operating margin, that's a daily struggle and a daily
16:37
challenge in our state. When we see the workforce shifts that we've seen with large vacancies
16:43
and recruitment challenges, it's even more difficult to recruit to some of our very rural
16:48
areas that we staff. So we have to constantly be aware of our workforce, aware of the needs
16:55
of our community, true to our nonprofit service mission for those communities, true to the
17:00
fact that in most of our communities, we're the number one employer in those areas. So
17:05
the full ecosystem of challenges confronts us, right, in each of our markets. And so
17:11
I, as someone in charge of our clinical programs in the health system, try to be as engaged
17:17
as possible with our medical staff, visiting our hospitals, getting to the front line,
17:23
thanking our teams for their service, for the work that they do every day, making sure
17:28
that they have the right tools and instruments that they need to do their work. But increasingly,
17:33
you know, today, as you question sort of the challenges of the time, how do you inspire
17:38
us to take a breath, recognize the challenge of the last five years, but also find within
17:45
us a wellspring to continue to show up every day and work hard for our patient and for
17:51
our communities. And that is, each day is a struggle. But I will also say that each
17:56
day I meet people that are rising to that in ways that are awe-inspiring and so rewarding.
18:04
That's really, really great to hear. And the challenges are overwhelming in some ways,
18:09
as you describe. And yet I think we're equally up for them collectively. And I think it does
18:14
take the collective. It's not on any individual. Because you mentioned the communities, some
18:19
of the communities, and because one of them in particular has garnered pretty significant
18:23
national attention, maybe you can just give us a little bit of an impressionistic view
18:28
of Flint, Michigan, and the community issues that have garnered that national attention
18:34
and how it has impacted healthcare delivery and how your clinical staff, especially physicians,
18:40
have had to kind of sort of pivot themselves in order to meet those challenges.
18:46
It is something that I think is in the very fabric of our company in that our first hospital
18:51
was in Flint, Michigan. And we see the challenge of the infrastructure of the city of Flint.
18:57
You can see it in the highways and roads. We certainly, you know, tragically for the
19:02
Flint water crisis that garnered national attention saw just the real dangers of some
19:08
of the decisions that can be made by our government officials that were made to try to shore up
19:14
the economic resources of the community. In principle, for your listeners who may not
19:19
know, decisions were made by emergency managers of the city to convert the water supply for
19:25
the city of Flint from the Detroit water system, the Detroit River, to the local Flint water
19:31
system, a system that hadn't been used for many years, if not decades. That led to a
19:36
large amount of lead coming into the water supply. And for many community members, individuals
19:43
who still have not had full water restored to their homes, we can easily take for granted
19:49
shelter, water, food, those of us, the lives we live in are gainfully employed, et cetera.
19:58
But I think in Flint, we realized that even with those things provided, there are issues
20:03
related to public health and public infrastructure that must be met. I am very proud to say that
20:10
Flint is also a success story in that we have seen an enormous amount of commitment to the
20:16
city to get things fixed. The issues related to racism and poverty in the city are explored
20:23
and are open more now than they probably have ever been. We still have clear economic challenges
20:30
in the community. Yet I do think our local government, our state government has responded
20:35
and we're on our way again. But there is no doubt that when you go through an episode
20:41
like that, when you go through a gun violence issue in our communities that most of us now
20:48
have all gone through in one way or another, you realize that we're a part of a greater
20:52
whole and that these issues around us don't escape us, that we do our work even in those
20:58
very real challenges. And the pandemic has really shown how the medical communities have
21:04
actually lived up to their commitments to take care of their communities. And I think
21:10
it is noble, as you said earlier. As a leader, I am curious because there's so much about
21:18
that when you were say working in the front lines that we're not aware of. Maybe you can
21:24
just share what are some of the things that you grapple with that many of your frontline
21:30
people just it's not so transparent to them and it would be helpful for them to at least
21:36
know and understand because I think ultimately we all have to work together and ultimately
21:42
actually every one of us is a leader in a certain way, especially as physicians, even
21:46
though you may not be, you may not see yourself that way you actually are. What are some of
21:52
the things that if you can think of some that are just not so clear to the rank and file
21:57
that would be helpful for them to know that the leaders are thinking about and struggling
22:02
with and grappling with and have them in mind?
22:05
I think your very question as I experience it is something that I continuously trying
22:13
to figure out the right way to convey. I think it is easy for us to assume that Washington
22:22
doesn't understand our problems, that our corporate office doesn't understand our problems,
22:28
that they're holding back on and maybe don't fully appreciate what it's like. Work every
22:34
day with the same conviction that I came to when I was medical student, when I was a resident,
22:40
a fellow, a young attending physician, a young leader, or now someone who has been in healthcare
22:45
administration for going on two decades. I come to it with the same commitment that I
22:51
want to do right by my community, right by my patients. The things that I have to manage
22:58
and the things that I need to be aware of are much more complex and are much more systemic
23:05
now than they were when I was taking care of one patient at a time. But what I hope
23:11
our frontline team understands and I think they do when we trust our leaders and when
23:18
our leaders are transparent and when we're communicative, I stand that we have their
23:22
backs, that we too are working diligently to solve some of the challenges. You know,
23:28
what comes to mind today and we're, I think, in many communities, if not nationally, starting
23:33
to see finally some of the fruits of our work to mitigate healthcare disparities and to
23:39
identify issues related to health equity. We are launching a massive maternal health
23:45
campaign in our organization. And if we look at maternal health deserts, not only across
23:50
Michigan but across the country, you know, we're coming together as leaders to make sure
23:55
we have the right tools and technology to reach out to patients, to care for patients
23:59
properly, especially vulnerable patients in vulnerable communities. And then we're able
24:04
to take that message of what the corporate investment is and what that leadership structure
24:09
is, what those resources are, and use the full power of our health plan that has many Medicaid
24:15
members. We are beginning to make inroads and connections with community service organizations,
24:21
with faith-based institutions. And so I hope our communities, our providers are seeing
24:27
that we at McLaren and we as healthcare systems are much more deeply engaged. And I think
24:33
that the pandemic or crisis that any of these large issues teach us is that we are all dependent
24:39
upon one another. And I hope that our staff understand that we're committed to that and
24:48
using our resources wisely to serve them.
24:52
What you described, this maternal health program that you're talking about seems really timely.
24:57
I just listened to a podcast series, I don't know if you're familiar with The Nocturnist,
25:02
out of the California Medical Association, but they did a podcast on maternal health
25:08
in the post-Roe era. And just thinking about where Michigan is placed in the country and
25:13
its bordering states, I'd imagine there are interstate demands and issues that are also
25:21
part of what comes across the border and impacts the delivery and service network of McLaren.
25:30
So I think those are really important things to address.
25:34
Yes. We were very aware in the state of Michigan, regardless of one's policy view or religious
25:42
view on the issue of access to reproductive health services, we as healthcare providers,
25:48
of course, believe we have a duty to our patients. And certainly we were concerned in the early
25:54
days, Michigan had what was referred to as a trigger law from the early 1900s that after
26:00
the DOPS decision no longer being in place, that trigger law was set to be enacted in
26:08
the state. And we were very concerned. We had to plan for that as a board, plan for
26:12
that with our physicians and medical staff, thinking about the legal vulnerability, et
26:17
cetera, and certainly the criticality of the care that our moms needed to receive. It certainly,
26:23
God forbid, a pregnancy be in jeopardy, their life be in jeopardy, as we hear and see now.
26:28
What we see after that, of course, is Michigan passed a law that allows for access to reproductive
26:35
services as a state law. But we are seeing, being a border state, patients enter our communities
26:41
from other states. And I think that adds an added pressure as well to our OB-GYN physicians
26:50
and to our providers more broadly. It has certainly brought an awareness to how we safely
26:58
provide care for our patients, but also respond knowing that Michigan has lots of conservative
27:04
areas that also might have a different view than the public health enterprise or the health
27:10
delivery enterprise may have to engage.
27:13
Yeah. I appreciate you commenting on that and sharing that because I think it is, those
27:18
are really challenging public issues in the public discourse, much like the issues around
27:24
the gun violence or the water quality in Flint and without easy solutions. But we have to
27:30
turn toward them as medical people. We live it. We can't, you know, we've taken a note
27:35
not to turn our back on what's right in front of us. So thank you.
27:39
I want to just shift a little bit. Maybe this may be a little, I don't know, easier maybe
27:44
not quite where we've been sort of talking about pretty challenging issues, but this
27:49
may be a little fun, I think. I want to do a little imagination exercise and I'd like
27:54
him to imagine that it's five years from now. And the issues that you've been struggling
27:59
with in your health system environment, well-being of providers, nursing shortages, staff issues,
28:08
et cetera. Let's imagine that they've all improved to the point that the environment
28:13
and the staff feel extremely strong, robust, energetic, creative, committed, and fully
28:20
resourced to handle even the most complex patient care and even the most complex social
28:26
issues. So I know it may be a bit of a stretch. I love it.
28:33
Imagine and yeah, you'd probably be thinking to yourself, well, I probably be, I won't
28:36
have a job when that happens, right? So how would you feel as a leader yourself, what
28:42
would that feeling be like if you're five years from now and you've been part of the
28:47
system that has brought this about that people are feeling that way? What would your leadership
28:52
experience look like in that imaginary world? That is a welcome diversion from its current
28:59
existence, its current place. You know, what I would hope and the first thing that came
29:06
to mind, because I thought you might go in a little different direction with the question
29:11
is I'm fascinated by how medicine is going to change relative to generative AI and using
29:18
machine learning and other technologies to know as much as we possibly can, whether we're
29:23
a clinician trying to make a decision or we have sort of the panoply of experience that
29:30
a patient had fully known and digestible in that encounter. What I hope we will get back
29:38
to is the beauty of medicine. With all of the challenges that you described being lifted,
29:45
we're able to be back in the room, back in with that and to have presence and presence
29:51
is a beautiful thing. I think that probably is the greatest experiential threat to fulfillment
30:02
and a trigger for burnout is that disconnection from that moment with our patient, that time
30:11
to truly be present and not have 52 alerts go off on our EMR and a pager and not that
30:19
those things won't still be there, but I do think that many of the challenges that do
30:24
burn us out today, you describe a system in which those are gone and I have, you know,
30:31
even experiences of losing patients and times where I was present for the death of a patient.
30:39
I can remember the beauty of those moments as well and I hope that's there and I think
30:46
that can be restorative. All these issues, what they in effect do is they move the patient
30:54
a little bit to the periphery when the patient is really at the center and if we, when we're
30:59
able to keep the patient at the center and when we're able to be present to that and
31:04
engage in that, that's, you know, the source of meaning, that's the source of well-being
31:08
and actually it's also the source of completing our mission or fulfilling our mission. There's
31:14
no completing of it because it's endless, but the fulfilling of the mission of being
31:19
a physician, being in healthcare. I'm wondering, so let's say, you know, we've gotten to that
31:25
point five years from now in this imaginary world and the patient is returned to the center
31:30
where it needs, where they need to be and we see that and we're present to that. In
31:36
those five years, what did you as a leader have to learn in order for that to happen?
31:43
It's kind of like asking you, hmm, what are my learning, what's my learning plan in the
31:49
next five years to kind of get from point A where we are now to point B. It can help
31:55
us actually and all our listeners orient ourselves toward what could be possible and what are
32:00
some of the steps we can do to move in that direction?
32:05
One question. One of my first thoughts was an individual, a leader who I was able to
32:11
have a couple of encounters with an undergraduate, Dr. Stephen Covey, who wrote the very popular
32:18
book, The Seven Habits of Highly Effective People and many other great books, but Stephen
32:23
studied the behaviors and habits of highly effective people and one of the habits that
32:29
he talked about, habit number two, is to begin with the end in mind. And so really your question
32:33
is in five years with that end in mind, what do we do to get ourselves there? And I sure
32:40
hope, and I believe this to be true, that number one, there's an enormous transforming
32:48
capability of young people to help us see things and show us a way that those of us
32:55
who helped create these problems, we didn't have that wisdom when we created these problems,
33:01
right, or were present with them. We have allowed a medical documentation system in
33:06
the form of the electronic health record to almost totally isolate the doctor-patient
33:11
relationship to a keyboard and a computer screen at times when touch and connection
33:18
are deeply meaningful and powerful and lead to resiliency, right? So I hope that we are
33:24
going to listen to our young people. We're going to find and identify that we need greater
33:30
balance, that we can only push people so far. We need to do our work more intelligently
33:36
and more efficiently, effectively. We need to realize that health and wellness don't
33:42
come from an enterprise that's just focused on traditional sick care or the delivery of
33:51
treatment for illnesses and disease, but are transformational in developing clean water,
33:56
and developing good diet and nutrition, et cetera, that those things will ultimately
34:02
also make working in a health system more enjoyable. So while these things are disruptive
34:09
and challenges now, I think we really do have freeing power ahead. A challenge that we also
34:16
have to deal with though in the US, of course, is the rising cost of care and the notion
34:23
that, you know, costs more to receive care in the United States than anywhere in the
34:29
developed world, and we're really not seeing outcomes that we need to see. So I think that,
34:35
you know, we will continue to see disruption affecting what now seems to be our equilibrium,
34:42
but may itself end up being a transforming force to a better way in the future. And I'm
34:47
an oncologist, so I'm always an optimist, just hardwired that way.
34:52
I really also like your pointing out the youth and also bringing in the potential of these
35:00
new technologies, machine learning, generative AI, that could actually, if used properly,
35:06
could really free us up and help us do our work so we can actually not have to carry
35:13
and possess all this knowledge, but understand how to use that knowledge and apply it in
35:19
much more effective, efficient, and meaningful ways, both for our patients who receive our
35:26
care, but also for ourselves who enjoy that whole enterprise of being a doctor, being
35:33
engaged with patients. We're almost done here. I wanted to just two things. The first is,
35:40
I had mentioned this earlier about leadership, so understanding that each medical staff member
35:46
is a leader in a certain way and that the leadership, yourself and others at McLaren
35:51
and other places, are made up of many folks who at one time were working on the front
35:57
lines. And so understanding that and knowing that, is there a message you'd like those
36:02
medical staff to understand from what you've learned as a leader that could help them right
36:06
now feel a little bit more resourced, feel themselves like they actually, it may seem
36:13
like they have very little control and a huge amount of responsibility, and that is true,
36:18
but there may be small ways in which they can feel themselves part of a change that
36:24
is needed?
36:25
I think that recognizing that everyone's part is critical to me has always been a part of
36:32
my leadership philosophy and frankly just witnessing effective teams and how we effectively
36:40
work together. For me and for other leaders at McLaren, certainly having integrity and
36:47
being true to our mission, even in challenging times, being mindful of the growing contribution
36:53
that all team members make to that outcome is really important. At a personal level for
36:58
me, a changing experience in my life was learning a meditation practice and a mindfulness practice
37:06
that I, when I'm doing it right, do every day. But even in, it's not 30 minutes or 20
37:14
minutes on the cushion in the morning, as I often do, it is simply just dropping into
37:20
an awareness of this moment as it is and accepting it and trying to bring presence to that moment
37:28
and recognizing that not only does finding presence bring usually a calmer, more rational,
37:37
more inclusive view of things, it also brings forward compassion and an understanding that
37:46
it's all changing. And having awareness of that as a leader for me was a critical lesson.
37:53
I didn't always have it. And now today, if I'm in a board meeting and there's a challenging
38:00
moment, I am sitting back in the chair and feeling my back on the seat, I'm feeling my
38:07
legs on the floor and I'm noticing my in-breath and my out-breath and that moment alone can
38:14
help me to recognize the things I mentioned. And so that's a personal element that I use.
38:20
No, that's a really, that's a wonderful message to give a practice to have and something that
38:27
really does can reset, help recalibrate ourselves, especially when we're feeling most likely
38:34
to be thrown off as you describe in that meeting. Okay. And just finally, what do you like to
38:41
do to take care of yourself, to have fun? Just let's get a little sense of Justin Klamerus
38:46
as a person. It may be the things that you're doing at work. Maybe that's how you get your
38:51
most fun, but there may be other things in your life you want to share with our listeners
38:55
and then anything else you'd like to add to the podcast as well.
38:59
Sure. Well, thank you. You know, I think like so many of us, our friends and family are
39:04
so important to me. The challenges of the pandemic when we were isolated really from
39:10
a lot of our friends and family reminded me of that importance. But when I'm not working,
39:15
that's a key priority for me. Of course, scheduling that and making sure as a busy executive that
39:21
that still remains a priority and that I promise to be home to cook dinner tonight and that
39:26
I hold my end of the bargain. We have three dogs, two French bulldogs and an English bulldog.
39:32
So love the, just the ability to be silly and to relax at the end of the day from that.
39:40
I just try to, and I think at various points in our careers where we're either successful
39:47
or feel like we're not successful, but to sort of continuously ask the questions of
39:51
myself, how am I spending my time? How are the priorities being addressed both in personal
39:58
life and professional life? That is something that I am deeply reflective on and something
40:04
that I find very centering and grounding, especially in these challenging times that
40:09
we're in, because the world as you describe it in five years and in that period isn't
40:14
that way today, but there are elements there and we can work towards that.
40:20
Fabulous. Great. Thank you so much, Justin. Thank you very much for listening to today's
40:27
podcast. We will include a summary of today's show and links about Dr. Klamerus and other
40:32
references that were discussed in the show notes. I would like to conclude by sharing
40:37
another practical exercise to help you flourish. Toward the end of the conversation, Dr. Klamerus
40:43
mentioned his own mindfulness practice as a key to his own wellbeing and making it possible
40:49
for him to continue to work with the challenges that he confronts daily, whether at work or
40:54
at home. Today, I'd like to offer the following mindfulness practice to you that M-Pro produced
41:00
with me several years ago. It's about three minutes long and we'll also make a video version
41:05
available to you in the show notes that you can download and keep on your devices for
41:10
future use. I suggest you use it to guide you weekly for the next several weeks and
41:15
then as often as you'd like to going forward. I would invite you to sit with me for a few
41:22
minutes and engage in a very brief meditation practice that you can do at the beginning
41:28
of your workday, at the end of your workday, in the middle of your workday, even right
41:32
before you enter a patient's room. So as you sit, starting with an awareness of your physical
41:40
body, your feet touching the floor, your legs, your thighs, your bottom touching the seat
41:48
of the chair, your back against the back of the chair, noticing how your arms are at your
41:56
sides and noticing how you're resting your head upon your neck. You don't have to sit
42:03
any particular way but think of sitting in a way that wakes you up. And as you sit quietly,
42:17
reflect for a few moments on what brought you into medicine as a profession. What drew
42:23
you into medicine? What was the calling? It may be that it hasn't turned out quite exactly
42:35
the way you planned and that's okay. Reflecting for a few moments about what were those inklings,
42:46
those feelings, those desires you had to attend to the care of others. When did you first
43:01
notice that you were interested in working with life and befriending life, if you will?
43:16
As you reflect on your sense of calling, noticing how you can call on that sense of calling
43:25
even now in the practice of medicine right now in this moment as you begin your day,
43:34
as you end your day, as you encounter the next patient. Noticing how this feels in your
43:50
body, noticing the effects it has on you emotionally in terms of joy, satisfaction, meaning, and
44:04
meaning. Perhaps noticing how it engages your mental activities with a desire to do a good
44:19
job, to work diligently, and also to enjoy yourself. Thank you for joining me and I hope
44:37
you'll try this once in a while and see how it works. I hope you have found this podcast
44:43
and the simple exercise useful to you and look forward to having you join me for the
44:48
next episode of flourishing in medicine from surviving to thriving. To learn more about
44:53
EmPRO, please visit www.myempro.com and their peer support programs www.myempro.com forward
45:04
slash peer dash support. If you're a physician or medical student and you need urgent support,
45:09
consider calling the physician support line at 1-888-409-0141 or visit www.physiciansupportline.com.
45:21
For information about me and my work, feel free to visit www.MickKrasnermd.com or www.mindfulpracticeinmedicine.com.
45:34
Until next time.