Latest / Flourishing in Medicine: From Surviving to Thriving / Flourishing in Medicine: From Surviving to Thriving Episode 14 Building Institutional Resilience: Dr. Helen Riess on Empathy and Support in Medicine

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Flourishing in Medicine: From Surviving to Thriving Episode 14 Building Institutional Resilience: Dr. Helen Riess on Empathy and Support in Medicine · Flourishing in Medicine: From Surviving to Thriving

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  Part of the empathic network is the ability to self-regulate and that our brains are wired
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  for self-other distinction. When we're tired, exhausted, burned out, that line between this
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  is happening to that person, not to me, gets very fuzzy and we can start to see like I can't deal
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  with one more person crying today, one more person who's in distress, I'm going to shut down. But that
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  is not because empathy is bad, it's because the systems that are producing overworked,
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  overburdened, unsupported people is flawed. Welcome to flourishing in medicine from surviving to
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  thriving. I'm your host, Dr. Mick Krasner. This podcast is produced by EmPRO, a medical professional
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  liability insurance carrier from New York State committed through its multiple peer support offerings
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  to helping support the physicians they protect. The title of today's podcast is Building
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  Institutional Resilience, Dr. Helen Riess on Empathy and Support in Medicine. Helen Riess,
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  MD is a chief scientist and chairman of empathetics and associate clinical professor of psychiatry at
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  Harvard Medical School. She also directs the empathy and relational science program at the
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  Massachusetts General Hospital. In addition, she is the author of the empathy effect and a core member
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  of the consortium for research on emotional intelligence in organizations and faculty of
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  the Harvard Macy Institute. She is a practicing psychiatrist who developed an empathy training
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  approach based on research on neurobiology and physiology of empathy that's been rigorously
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  tested in pilot studies and randomized control trials at Massachusetts General Hospital.
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  In this wonderful conversation, Dr. Riess shares the influence of her family's experience as
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  refugees from war-torn Europe, which sensitized her to trauma and resilience. Her interest in
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  psychiatry began during medical school. She was drawn to understanding the mind and healing
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  through narratives and empathy. She points out that although a small percentage of people lack
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  the neural mechanisms for empathy, for most of us, empathy is a mutable trait influenced by
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  environment and mental state. And importantly, and this actually was really an important thing
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  she wanted to point out, that burnout among healthcare professionals diminishes their lack
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  or the capacity for empathy. Not because empathy is inherently harmful at all. That was mistakenly
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  believed in the past, but due to overwhelming demands and flawed systems within which these
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  health professionals work, empathy has a negative effect. Helen discusses four pillars of what she
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  describes as institutional resilience, and they are supporting healthcare workers with safe
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  environments, caring communication, community cohesion, and mental health normalization.
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  And she shared her results about the value of empathy training, demonstrating improved wellness
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  and retention rates, and significantly reduced medical costs for a medical group. She is a
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  passionate, inspiring, kind, and dare I say, very empathic speaker and listener. I hope you enjoy
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  this conversation. Welcome, Dr. Riess, to Flourishing in Medicine. It's just so lovely to have you.
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  Haven't seen you for some time, but I'm really happy to have you on and have this conversation
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  with you. Pleasure to be here. Thank you for inviting me. Well, I'd like to start with what
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  I start with all the guests really is you to tell us a little story about why medicine actually to
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  begin with. You know, people come into medicine for a whole variety of reasons, and there's a
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  whole lot of influences in their lives, maybe early influences in their families or people
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  close to them or something that happened in your educational journey along the way. And perhaps you
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  can share with us what was that really early or the earliest things you can remember that
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  motivated you to enter into this challenging and wonderful profession? I think the answer to your
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  question is multi-dimensional. You know, my earliest memories were recognizing that my parents had come
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  from war-torn Europe as refugees. And so there were many stories of trauma that sensitized me
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  to people who had suffered. In spite of that, they had tremendous resilience and created a very good
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  life here in the United States. And I also had a brother who had a congenital issue that required
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  an operation that had never been done before to heal some stability from a missing bone in his neck.
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  And so that was a very memorable experience because I was in seventh grade and he was in fourth grade.
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  And so the desire to help and the desire to recognize suffering, I think, was very evident
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  to me as an early teenager and wanting to go into a health profession was just something I always
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  wanted to do. Thank you. Would you tell us then about from that point and you decided to do all
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  the preparatory things one has to do to prepare for the medical education experience? Walk us
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  through how that happened and how you got interested in psychiatry. My interest in
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  psychiatry was kind of a surprise, but it started in my first year of medical school when I realized
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  that the reading assignments and the literature that I was most drawn to was actually the
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  psychiatric courses that we took. And I think the life of the mind was way more interesting to me
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  than the miracle that our human bodies are, which was also just a fascinating and very
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  privileged education that I'm so grateful for. But how the mind works and how people heal
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  from trauma, how people come to make sense of their experience and how you can learn to draw out
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  a narrative from people who have been harmed and who are hurting and who are suffering from mental
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  illness was just a natural magnet for me. I went to medical school thinking I would become an
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  internist. And at one point I loved surgery. And then I thought if I had to make a choice,
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  it would be psychiatry. So that's where I ended up. Well, you've mentioned several things, Helen,
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  that sort of sparked my interest. One is the use of the word narrative that you mentioned,
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  making sense of our traumas, healing through making sense. And at some point you realized or
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  learned or had the experiences that empathy or the empathic resonance that we have was actually
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  central to not only your work as a physician and especially as a psychiatrist. I wouldn't even say
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  especially, but as a psychiatrist, but also our lives as human beings. So what I'd really love to
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  hear now is a little bit about how you got interested in empathy as an entity, as a dynamic,
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  as a, say, research subject, as well as what it meant personally for you.
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  That's such a great question. And it really happened in my last year of psychiatry residency.
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  So all during the training period, we learned about obviously psychopharmacology. But again,
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  I was way more drawn to psychotherapy because it had to do with understanding people. And so we
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  learned Freudian theory, which was all about how these drives motivate people, the drive
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  for aggression and sex and how that underpinned people's behavior. We learned about
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  ego psychology. We learned about relational psychology. And it was sort of foundations
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  of building understanding that we're not just these organisms driven by adrenaline and passion
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  and rage, but that we really seek to be understood. And when I became familiar with the work of
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  Heinz Kohut, that's when I really felt like I had learned what was really going to impact
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  my patients and heal them. And so Kohut is famous for having really become the father of what's
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  called self-psychology. And it may sound like we're talking about being selfish, but it's just the
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  opposite. Self-psychology, the underlying principle is that when people feel understood
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  that their life is relatable, shareable, and they find somebody who says that happened to me too,
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  or I understand that, that is the healing power. And he called that empathy. And he's known for
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  saying that empathy is psychological oxygen. And so I had a really great teacher who did
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  a seminar on self-psychology, and this was just an elective. His name was Dr. Geist. And
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  he took us through several cases where by purely reflecting back and listening and really
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  understanding where that person's desire to be understood lay, we could get a narrative out of
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  them that would be the secret to understanding how they saw the world, how they felt injured,
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  how they felt misunderstood, and just provide a listening ear that validated how they saw the
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  world. And once you established that connection, you had the trust to then work with things that
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  might have been a little irrational or misperceptions. You had won or earned the credit
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  to gently challenge some assumptions that maybe were interfering with getting along with others,
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  or even with getting along with themselves. So let me just reflect on something that you said.
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  It had to do with this need to be understood and that that's sort of a central to what Hans Kohut
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  and this self-psychology field was talking about, and just the power that you just described of
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  actually making that connection and then building that trust as being almost necessary in order to
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  enact the sort of oath that we take as healers, as physicians, to actually do the work that we
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  do. I watched your TEDx talk from Middlebury from 10 or so years ago. It's just fantastic,
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  which we'll also link in the show notes. You spoke of empathy and how we all want to be seen,
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  heard, and have our needs met, kind of what you were just talking about. But you also added
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  that our survival depends on our capacity for empathy. And I'm thinking about Darwin,
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  and Darwin did actually seem to write more about empathy or sympathies, I think is what
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  the word he used more than the fight-flight-freeze reactions. And I just wonder if you can unpack
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  that for us. Say a little bit more about how our survival is so intimately connected with our
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  empathic capacities. It's nice that you've mentioned Darwin because many people think
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  it was all about survival of the fittest. Like if you can just run faster and get the heck out of
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  danger, we were all set. So if you're the strongest and if you're the mightiest, you're going to
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  survive. But Darwin actually challenged that because Darwin, when he was really examining
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  how animal and human societies worked, he noticed that survival had more to do with cooperation,
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  reciprocity, and collaboration than just beating the other person out. So obviously, you might run
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  the fastest, but you might need a few more people to be running to look where the next field that
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  had food, you can't do it by yourself. And so I think it's a paradox that Darwin is sort of
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  famous for introducing the survival of the fittest concept. When he actually wrote about
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  compassion, and he understood the cooperative nature of humans, mostly through the lens of
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  the fact that we care because we hurt when we see other people hurting. And that of course,
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  leads us to the neurobiology of empathy, which is the fact that when we observe other people
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  suffering, our own pain centers get activated. And I use this example in the TEDx talk, because
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  I think it's so apt that if you're in a parking lot and you see somebody get their hand slammed
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  in a car door, we don't just passively look at that and say, Oh, wow, look at that we flinch.
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  And why do we flinch? Because nothing has touched us. But our pain centers recognize that as a very
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  painful stimulus. And so Darwin understood that we flinch for two reasons. The first is, we learn,
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  don't slam your hand in a car door because it really hurts. So we can learn vicariously by
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  watching others in pain. And equally important, we experience to some attenuated degree that this
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  person has just really gotten injured, they hurt. And when things are working well, that motivates,
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  so empathy is in part motivation to help. And then when we actually do it, that is an act of compassion.
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  So many people mix up empathy and compassion. And I think the easiest way to distinguish the two
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  is that empathy is the input. Empathy is what we perceive, and then it hits our pain and emotional
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  centers. And if we register that someone is in pain just by seeing their face, their tone of voice,
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  it doesn't have to be an actual physical injury. Something can happen to them. And so,
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  something happens in our pain centers to say, this was a noxious stimulus, this person is hurting.
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  And if everything's working well, like if we're not distracted, burned out or exhausted,
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  it motivates us to help. And then when we actually do the helping behavior, that's the efferent or
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  the output, and that is compassion. That is a really useful model or kind of metaphor to use
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  the input and the output that empathy motivates us to enact compassion. And I really like what you
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  just said about when we're not, say, burnt out or there's other factors. You know, Eve Beckman,
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  a colleague of ours and I wrote this paper on the neuroscience of empathy. And in certain situations,
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  because of our conditioning or certain circumstances, we may, rather than enact
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  compassion, become distressed ourselves, let's say, or other distance, other people. So I think
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  that's a really useful way of looking at it. A lot of your work, which I want to point out to our
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  listeners, has been really revolutionary in a certain way in that it raised the question,
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  studied it, and then showed that one can cultivate, or we could say learn empathy, but I think you
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  would probably not use that term, learn empathy. I would think maybe what I get from reading your
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  work is learn to realize that empathy is already inherent in our nervous systems, and it's about
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  kind of bringing that online and using that in a way of creating connection to motivate us to then
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  act in compassionate ways. Can you say a little bit about learning how you discovered that we can
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  actually cultivate, let's use that, or realize the empathy that's already inherent in us?
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  Well, I agree with you that most people, except for maybe 1% to 4% of people, have the neurological
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  makeup for empathy. There certainly are people who do not react to seeing other people in pain,
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  with pain themselves. There are sociopaths and people who are, I think they're missing the
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  mirror neurons to give them that quick hit of pain that makes them care. Some sociopaths actually
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  enjoy seeing people in pain, so we're just putting those people aside because I don't
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  think there's a whole lot you can do about people who lack the neural mechanism for this
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  survival technique. The rest of us have to face the fact that empathy is a mutable trait.
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  It's not something you have that's baked in, that it's got the same strength no matter what's
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  happening to you. So we've all experienced times when we've seen somebody who needs our help,
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  and we're either distracted because we're helping somebody else, or we're rushing to something,
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  or we're just exhausted and we can't find it within ourselves. So in every person, there is a
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  mutable kind of spectrum of how much empathy they can show. This is why the epidemic of burnout
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  in healthcare is so excruciatingly damaging, because burned out people, they tend to focus
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  on their own distress more than the distress of others. And there's one really important
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  clarification I want to make, because at some point in the early 2000s or maybe in the 2010
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  decade, this notion that empathy causes burnout started to get some followers. And I think it was
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  really a disservice. Empathy, when it's working as it should, gives us a touch of somebody else's
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  painful experience or their suffering experience. Our whole pain matrix does not light up when we
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  see others in pain. Only part of it does, and that's to say, hey, take notice, this person is
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  hurting. If we are too distracted, we might just feel like, oh, not one more person needing my
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  help and start to feel overburdened. But that is not what empathy is supposed to be doing for us.
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  It's supposed to give us just a light hit of someone needs us. And what many people who are
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  in the empathy causes burnout and distress don't realize is that part of the empathic network
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  is the ability to self-regulate and that our brains are wired for self other distinction.
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  When we're tired, exhausted, burned out, that line between this is happening to that person,
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  not to me, gets very fuzzy. And we can start to see like, I can't deal with one more person crying
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  today, one more person who's in distress, I'm going to shut down. But that is not because empathy is
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  bad. It's because the systems that are producing overworked, overburdened, unsupported, overworked,
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  overburdened, unsupported people is flawed. So at Empathetics, a big part of our training involves
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  self-regulation skills. And I think you and Eve were very clear that you need to develop ways to
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  manage the distress if it's becoming overwhelming, or you may need to take a break, you may need to
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  say, I need some time off. But when our empathy gets that challenged, that we're not responding well,
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  we are in danger, our patients are in danger, and the systems that we're working in are in peril.
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  Thank you for that clarification. And it is an important point. So I'm glad you mentioned that.
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  What I'm taking from this is maybe I'm oversimplifying it, but in the right environment,
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  or in the more normal environment, empathy is doing exactly what it is designed to do. And that,
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  I think, can be shift this conversation to discussing the world of medicine for physicians.
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  This podcast, after all, is called Flourishing in Medicine from Surviving to Thriving. You've
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  spoken, Helen, about how employers want engaged and productive workers, patients want to feel
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  cared for by their health professionals. And you point out that those who do not have longer
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  recovery, poorer immune function, students who are disengaged are more likely to drop out,
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  marriages without empathy are more likely to fail. I'm thinking of the Gottman's and, you know,
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  seeing the actual contempt within very brief periods of watching couples communicate. So I
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  asked, what do we know about empathy's role in physician wellness? And it's nice as coming after
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  that clarification that you said about the mistaking of research connecting empathy,
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  physician empathy, and poorer well-being. So the role of empathy in physician wellness,
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  burnout, and distress related to, say, quality of care, quality of caring, and also just
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  meaning and satisfaction as a professional. And also, what can we do about it?
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  So this is a critically important question. What can we do for these health care physicians,
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  nurses, and other providers? The first thing that we need to do, and we're doing this
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  at Empathetics, is teaching about self-empathy. Now, that is, those two words have not been used
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  together until I realized during the pandemic, that to try to talk to any health provider about
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  being more empathetic to patients was going to be actually harmful. They were already way beyond
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  their physical and emotional capacities. They were scared for their own lives, scared for bringing
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  the contagion home to their families, and to start talking about, well, you still need to be more
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  empathetic. And oh, by the way, you can't go into the room with a family member. Like everything was
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  working against these people. And I realized throughout medical training, we never, ever had
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  a course in how to take care of yourself. It was always put the patient first. It's not about you.
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  We learned stoicism, high standards for excellence, taking the oath, taking the high moral ground. And
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  those are all wonderful expectations. But no one ever talked about what you need personally in order
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  to sustain those types of attitudes and values. And so, the idea that people have to learn to take
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  care of themselves, I think it's a new dawn. And the expansion of wellness officers in health
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  systems across the country is a start. At least health systems are realizing we need to
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  promote wellness. This is not just a luxury. We've got to do something. And I go to many wellness
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  and burnout conferences, and I think the need is very acknowledged. I'm not so sure that budgets
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  are aligned as they should be with understanding that people need to learn not just about self-care,
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  which kind of puts the whole burden on the healthcare worker, but also how do you create
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  an empathic organization? How do you create a place where people's needs, their desire to do
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  the right thing is backed and supported with the ability to do the right thing by recognizing
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  that these people are human beings. And many of them are working not just during the day,
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  but then spending four hours at home at night doing the charting. You can't expect people to
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  be able to be very patient focused, while also requiring them to enter all kinds of documentation
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  into the electronic health record, because that pulls their faces away. It pulls their attention
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  away. And it's just impossible to be looking at two things at the same time. So my hope is that
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  some of the promises of artificial intelligence with recording what's going on while a patient
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  visit is happening so that the physician is freed up from having to type everything him or herself,
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  that some of these innovations will actually free people up to be truly patient centered.
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  I agree with you. I think there's great promise in that. And I hope that we can craft it and move it
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  in that direction. I'm going to also include empathetics and the contacts and the website in
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  the show notes, because what you have offered to organizations and individuals is really a wonderful
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  thing. And I think people, our listeners, would want to know about that. I also really appreciate
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  how you started with this sense that it's not something you have to go do, take a course to
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  become empathic. Although one can cultivate it, there's some skills, because like you say,
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  of the different natures of our interaction between ourselves and our own empathic neurophysiology
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  and the environments in which we work. I always like to also say, like in my own teaching,
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  that some people could call resilience training, which now I shuttered at because I think physicians
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  and other health professionals also are reactive to the need to go have a training to become more
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  resilient. They're already resilient. Health professionals, in fact, by most measures are,
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  have greater degrees of resilience. And I think, correct me if I'm wrong, but you would probably
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  argue that they're already empathic by virtue of being human, number one. And also there's
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  something about, say, your origin story that you shared with us about being moved in a certain way
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  by the suffering of others that have brought us into this profession in the first place. I think
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  that sets us in some way as a special case. I don't want to say special, but as a subset of
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  empathic humans. I'm wondering if you could just comment, what could organizations and
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  health care institutions do to make the culture more, we could call it empathically aware,
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  empathically intelligent. I'm thinking about the relationship, and I know you've done some work
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  on this between emotional intelligence and how that relates to success and well-being
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  among individuals and organizations, how that may mirror what we could call, what I'm calling maybe
• 27:53
  incorrectly, empathic intelligence. Is there something along those lines that could work
• 27:58
  for organizations and institutions? Well, you're really tapping into the subject of an article I
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  wrote, the Journal of Communication in Health Care. It was called institutional resilience.
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  And I realized exactly what you just said. Doctors and nurses are some of the most resilient people
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  in the world. Just to get through their training, you've got to be pretty resilient. So the idea
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  that these people suddenly need resilience training, we have to look at what's caused the change.
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  And so institutional empathy begins with recognizing that your workforce is comprised
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  of human beings who have needs, who in many cases have partners, families, loved ones,
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  that their job is not the only thing they have to take care of. So you just think about a working
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  female physician, and whether it's the male or the female who's the primary caretaker,
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  still today it's most often the female who's having the children, bearing the children,
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  and adding that responsibility to taking care of a full caseload of patients. That's a lot
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  of need. And to not recognize that these people need support is just a giant mistake. So in my
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  article, I talk about the need for institutional resilience by recognizing that you won't have an
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  institution if you don't have healthy people working in it. And they deserve, I think, four
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  basic things. They deserve a safe environment. That means get the PPE ready now for the next
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  epidemic, because it's going to come and we better not fall on our faces again. Make sure you have a
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  safe environment. Number two, use communication that is not just accurate, but caring.
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  Many people were threatened if they didn't come to work when we didn't know what the
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  pandemic was all about. They were told you're going to lose your bonus, you're not going to
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  get your retirement. People were actually scared to death to come to work and then go home and
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  infect their children. And instead of just being heard and talking to them and saying what could
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  be done to make these fears be somewhat allayed, they were threatened. I think this was the biggest
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  mistake. It just made people throw their hands up. What a dilemma that is. And we need community
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  cohesion. People were so isolated and they still are. Many people haven't seen their colleagues
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  in like five years and they're suffering alone. And the fourth is normalizing a need for mental
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  health. So those are the four points I raise. And I want to come back to what can institutions do?
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  And you said like not everybody can take a course in self-care, but I'm going to challenge that
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  because that is how we start with empathy training now. We start with a brief course or workshop on
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  self-empathy. And it's not just make sure you exercise and eat good food. It's also giving
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  people a chance to come together and really process their trauma. So we can't skip over that healing
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  process. And I know from being a psychiatrist, you can't have someone go through trauma and say,
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  okay, well that was then, but this is now. And now let's just get back to normal. And that's what a
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  lot of places are. Let's just like get back to, there's no normal now. The world has changed and
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  we need to normalize the need for self-care. And also it's a way for the organization to show that
• 31:57
  they care about their people. Right? And so I think one of the key, most rewarding things that
• 32:05
  have happened by bringing empathy education and skills workshops and e-learning to organizations
• 32:12
  is that one of our partners reported that not only did their burnout, it got better. The mini
• 32:20
  Z-scores got higher with empathetics trained physicians. Their wellness scores got better.
• 32:28
  And this would be probably the most important thing for hospital CEOs to hear. We had a 17 times
• 32:36
  greater retention rate in empathetics trained doctors. And if, so this meant that only 0.5 of
• 32:45
  the empathetics cohort of over 400 doctors in this one cohort, only 0.5 of them left their job
• 32:52
  during 2023, whereas 8.5 who weren't trained in empathy left their jobs. This means that it saved
• 33:01
  this one big medical group almost $19 million because they didn't have to hire new people,
• 33:08
  new people, which costs about a million dollars per doctor. So many times at conferences, people
• 33:15
  say, what's the ROI? How can we convince people? What can we say that people understand at the top
• 33:22
  that this is not just a nice to have, this is going to actually save you money? You know,
• 33:27
  and it's just such a great statistic to share because it really proves that when you do the
• 33:33
  right thing, you're always going to save money. Sometimes it takes a while to realize it,
• 33:39
  but we've got to get the focus back on being a caring institution. And some of them are coming
• 33:46
  around and it's really rewarding to see that it's being prioritized. Well, thank you, number one,
• 33:53
  for pushing back on that notion that just another thing we have to do to learn about. And, you know,
• 34:00
  our organizations and institutions often require us, mandates us to take all sorts of things on
• 34:06
  risk management, on sensitivity training. If there's an effective way to train this and if
• 34:12
  you have that kind of return, that's fantastic. So thanks for going over that. And also thank
• 34:17
  you for going over those four components that I think are really important to safety, the caring
• 34:23
  communication, community cohesion, and then recognizing the need for mental health supports.
• 34:29
  We're coming down to the end of this conversation, Helen, and I feel like I'm going to miss talking
• 34:36
  with you because I'd like to go on and on, but maybe we'll have to have you back. Two things,
• 34:40
  first, I'd like you to, if you could, share a personal experience that for you illustrates the
• 34:45
  intersection of empathy and your sense of meaning, purpose, well-being, we could say flourishing as a
• 34:52
  physician. And then after that, and I'll remind you if you haven't gotten to that, I'd really love
• 34:57
  to know like, what do you do to take care of yourself? What do you do for fun and enjoyment
• 35:01
  that really nourishes you and keeps you in the game, keeps you so curious and passionate
• 35:07
  and excited about what you're doing? Those are such great questions. So because I'm a psychiatrist,
• 35:14
  I can't share the multiple stories of having patients say how grateful they are to have someone
• 35:24
  listen, to sort through. Sometimes they're very conflicted, messy emotions to come out, to
• 35:31
  appreciate what's going on around them and to get a new perspective and to heal. So I can't share any
• 35:38
  of those, but I am going to share a story of a nurse who was so empathetic to me when my dad
• 35:45
  was on his deathbed. My parents live on the West Coast and I got a call that said, your father is
• 35:52
  not doing well and he's in the hospital and we're not sure he's going to make it till the next day.
• 35:58
  So if you want to come say goodbye, you need to get here. So I got the last seat on an airplane
• 36:06
  from Boston to Portland. And my sister picked me up and we went to my dad's hospital room and
• 36:15
  his breathing was very labored and that they talk about the death. It was just awful, but I got to
• 36:24
  sit and hold his hand and I got to say the things that were most important to him. He lost his
• 36:33
  parents in World War II when he was 14 and he always believed he would see them in the afterlife.
• 36:40
  And I held his hand and I said, dad, your parents are going to be so happy to see you when you go
• 36:47
  on the other side. And he literally took three slow breaths and his heart stopped. And I had said,
• 36:57
  I love you and all the other things, but that was, I was there when his spirit left his body and
• 37:07
  a nurse named Teresa came into the room and she said, did he just pass? Because the monitor in
• 37:14
  the nurse's station went flat. And I said, I think so. And she said, he was waiting for you.
• 37:24
  And I really believe he was. I mean, it was such a transition from seeing such suffering to
• 37:33
  such suffering to letting go. And I just thought those simple words and I wrote to that nurse and
• 37:42
  I hope she got the, no, cause I only knew her first name, but I sent her a copy of my book.
• 37:50
  And you know, it's one of these things I just wish and hope that she got it. Cause I didn't hear back,
• 37:54
  but it's just an example of saying just the right thing to a grieving family member can
• 38:02
  just make you feel like, you know, I feel like I barely got there in time, but like it was what
• 38:08
  he needed to hear. And I forgot your last quest. Oh, what do I do to take care of myself?
• 38:15
  Well, thanks to hiring a new CEO and empathetics, I am now practicing more self care than I have in
• 38:22
  the last decade. So I've been exercising, just taking really good care of myself physically,
• 38:32
  cause I've been sitting at a computer too much, but really one of my favorite self care things to do
• 38:38
  is in the morning when it's early, before I start work, I think about who would just enjoy getting
• 38:46
  a postcard? Like who could I just connect with or send a text? But often it's actually writing
• 38:53
  something and putting a postcard stamp on it and just telling people in my little universe that
• 38:58
  I'm thinking of them. And that is, I think that what I want to end with is when we really feel
• 39:06
  like we're connecting meaningfully with somebody, it's called exquisite empathy. Because you know,
• 39:13
  you get this grateful text or a little line back and I just want to end with when you give caring
• 39:21
  and love out to people, it just comes back. And so it's like an empathy loop. So we're not draining
• 39:27
  ourselves when we're being empathetic, we're fulfilling ourselves. That is such a lovely way
• 39:34
  to end. Thank you so much. I'm thinking about my first question, comment, one of my first questions
• 39:40
  or comments to you and how both the story of your father's passing and also the story of what you do
• 39:47
  to kind of feed that feedback loop for your own empathy. And it has to do with how we all want to
• 39:52
  be seen, heard and have our needs met. And boy, who wouldn't love to get a postcard from a friend
• 39:58
  that you haven't heard from just that you're thinking of them and who wouldn't want to hear
• 40:03
  what you know, we have been carrying with us our entire lives that would be reassuring and comforting
• 40:10
  in those very important moments at the end. So it's just been lovely, wonderful. Thank you
• 40:16
  so much, Helen and look forward to connecting in the future.
• 40:21
  You made this such a nice conversation. I really have enjoyed it. Thanks so much for listening.
• 40:27
  I'll include a summary of today's podcast and links about Dr. Riess and other references that
• 40:32
  we discussed in the show notes. And I'd like to conclude by sharing another practical exercise
• 40:38
  that you can do from time to time to help you flourish. So what I'd like you to do is
• 40:44
  find a magazine or a book with photographs or paintings or drawings of people and please open
• 40:50
  that and begin to look at the photographs. And as you do bring awareness to your own somatic,
• 40:57
  emotional and cognitive experience, as you turn the pages of this book or magazine and view other
• 41:04
  photographs, continue to notice this natural curiosity, the natural feelings, the natural
• 41:10
  sensations that are part of the experience of empathy. Noticing at any point arising feelings
• 41:18
  or thoughts of othering or distancing or even disdain if present, not judging those, but
• 41:23
  considering the possibility that other aspects of your lived experience that you have carried
• 41:28
  into this moment, influence, filter the natural arising of empathy. You may wish to repeat this
• 41:36
  practice from time to time, noticing the effects of different times of day and different moods that
• 41:40
  you're in or different demands that you're carrying that are having on this experience of empathy.
• 41:47
  I hope you found this podcast and the simple exercise useful to you and look very forward
• 41:52
  to having you join us for the next episode of flourishing in medicine from surviving to thriving.
• 41:57
  To learn more about EmPRO, please visit www.myEmpro.com. If you'd like to know more about
• 42:04
  EmPRO's peer support programs, visit www.myEmpro.com forward slash peer dash support. I'd like to thank
• 42:14
  Gerri Donohue, Vice President of Education at EmPRO for producing this podcast and Stan Sainjour
• 42:20
  for his technical expertise in recording and editing. If you're a physician or medical student
• 42:24
  and in need of urgent support, consider the physician support line at 1-888-409-0141.
• 42:32
  This support line provides a safe space to discuss immediate life stressors with a volunteer
• 42:37
  psychiatrist colleague who's uniquely trained in mental wellness and has had similar shared
• 42:43
  experience of this profession. For more information about me and my work, please visit www.MickKrasnermd.com
• 42:53
  or www.mindfulpracticeinmedicine.com. Until next time.