Latest / Flourishing in Medicine: From Surviving to Thriving / Flourishing in Medicine: From Surviving to Thriving Episode 2 Ronald Epstein, MD

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Flourishing in Medicine: From Surviving to Thriving Episode 2 Ronald Epstein, MD · Flourishing in Medicine: From Surviving to Thriving

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Welcome to flourishing in medicine from surviving to thriving.
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I am your host, Dr. Mick Krasner, and this podcast is being produced by EmPRO with over
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35 years of experience as a regional medical professional liability insurance carrier headquartered
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in New York State.
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EmPRO has been dedicated to protecting New York, New Jersey, Connecticut, and Pennsylvania's
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physicians, healthcare facilities, and healthcare providers.
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EmPRO has also led the industry in peer support activities, and this podcast is yet another
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way in which EmPRO is supporting the needs of physicians.
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The goal of this podcast is to explore ways that we as health professionals, physicians,
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nurses, nurse practitioners, physician assistants, mental health providers, therapists, and others
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can truly flourish in the complex and challenging world of healthcare.
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This is our second podcast, and I'm very excited to share with you an interview with a colleague
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whom I know very well.
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He is a leader and a transformational force in helping physicians and other health professionals
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flourish.
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Ron Epstein is an internationally recognized physician, educator, researcher, and writer.
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He has published groundbreaking research into communication and medical settings and developed
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innovative educational programs that promote mindfulness, communication, and self-awareness.
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His over 300 scholarly articles and his book, Attending Medicine, Mindfulness, and Humanity,
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is the first book about mindfulness and medical practice written for patients, their families,
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and for doctors and other health providing caregivers.
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It is a groundbreaking intimate exploration of how doctors approach their work with patients.
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In this book, Ron describes how health professionals can flourish, build strong connections with
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patients and colleagues, optimize the care they provide, and become more resilient.
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Dr. Epstein co-directs the Center for Communication and Disparities Research, and with me, he
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co-directs mindful practice and medicine programs at the University of Rochester School of Medicine
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and Dentistry.
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He's a professor of family medicine, oncology, and medicine, a graduate of Wesleyan University
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and Harvard Medical School, and the recipient of numerous lifetime achievement awards relating
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to communication and humanism, a Fulbright Fellowship in Barcelona Fellowships at the
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University of Sydney and the Brochure Foundation in Geneva, and the American Cancer Society's
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highest award, the Clinical Research Professorship.
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And now, our conversation with Dr. Ronald Epstein.
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What I'd like to do is begin with a question that I'm going to strive to ask all of our
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guests.
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It comes out of my experience and a lot of our experiences with other health professionals
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as we begin to dig a little deeper into why they decided to go in the health professions.
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We often hear pretty profound, sometimes poignant stories, narratives about their proximity
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to illness, to suffering, to life events like that, and how those have impacted them.
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Sometimes at a very, very early age, sometimes it's not suffering, but it may be an encounter
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in the healthcare system that did something emotionally, cognitively, physically to one's
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own self.
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So I'd like you to just tell us a little bit about, we could call this our origin story
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in medicine.
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What is your origin story?
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Why did you, among all your many talents, and you have so many, why medicine?
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Why did this happen?
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What happened early in your life that has informed that in a profound and lasting way?
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Yeah.
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Well, thank you.
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How many hours do you have?
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I mean, if you want to go way back, as a child, I was quite sickly.
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Nothing serious, but things enough to keep me at home a lot, and to see doctors pretty
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frequently.
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I had asthma.
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I have recurrent ear infections.
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And it really actually did have an impact on my life, which I didn't realize until subsequently.
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I couldn't run as a child without coughing or getting out of breath, for example.
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So and I remember, really from a very young age, from when I was five or six, the kindness
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of physicians, how much that mattered.
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And just even, not even with the words that they said, because I probably didn't understand
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a lot of the words, but their sense of presence, the way that they touched me, the way that
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they looked at me.
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And that really had a profound influence.
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And then my health improved when I was about nine or 10 or 11.
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But in the process, I became very interested in how people get sick and what happens, and
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would read encyclopedia entries about illness.
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And it wasn't kind of in a morbid way.
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It was a really curious way about how do people live their lives when they're compromised
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in some way?
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What color?
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The other thing that I discovered with my asthma at a young age, I must have been seven
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or eight, is that if I could lie down very still and breathe shallowly, so kind of be
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really aware of my breathing, that it would make it initially was difficult to do.
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But then eventually, I realized that I wouldn't be coughing and I wouldn't be feeling short
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of breath.
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So there was some sense of control that I felt that I had over the illness.
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And now this was the early 1960s.
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So the treatments for asthma were terrible.
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There were no inhalers.
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There were just these drugs that made you jittery.
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And now it would be very different.
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But in those days, so that ability to be involved in my own care and to heal myself in a certain
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way, I think was also pretty fundamental.
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So that's kind of the early stuff.
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And then I was kind of vacillating between being a musician and being a physician.
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I mean, ultimately, I decided to be both, but which to put forward and which to make
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my living at.
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But in my process of going to getting interested in healing, it was kind of a circuitous route
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that kind of took me through Zen training to understanding the kind of Oriental medicine,
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Chinese medicine theory and practice.
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I studied shiatsu and acupuncture and then had this delusional belief that if I really
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wanted to be a healer, I should go to medical school.
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Or I don't know, just kind of tongue in chief.
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But in medical school itself, I didn't find much about healing.
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I found a lot about diseases and curing and protocols and techniques.
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But I didn't find a lot about healing.
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So I felt I was still kind of on my own to discover that and how to synthesize my own
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personal experiences and my experiences with Buddhism and with Chinese medicine and Western
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medicine.
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And that took a while.
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That took a while after I finished medical school, probably, I think it was kind of a
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10-year trajectory for me.
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So that's kind of the beginnings.
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Okay.
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You know, in that beginning story that is still active now, you talk about presence,
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describing that experience as a young asthmatic and that sense of presence and kindness, which
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may be a surrogate word or a qualifier or an adjective to go along with presence.
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And I'll just jump right to your landmark article in 1999 in JAMA called Mindful Practice
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in which you outlined these qualities of the exemplary clinicians that came out of your
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own experience, your own observations, attentive observation, beginner's mind, critical curiosity
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and presence.
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Can you just speak a little bit more about presence and you can include aspects of those
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other qualities and especially maybe the examples of times and moments that you've felt it very,
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very palpable in your own work as a physician, but also as a patient and also times in which
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it hasn't been there that's kind of in some ways motivated you to include this in the
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canon of what you teach?
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I think presence is always presence, but it comes in different flavors.
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So there's the kind of sense of resonance and deep connection with individuals.
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And that happens some of the time.
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And it's really delicious when that happens.
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It's something to savor.
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And sometimes that can happen in a moment of silence.
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Sometimes it can happen when each of us feels that we've been seen and understood.
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But it's something that is not embodied in me as a person and it's not embodied in the
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other person, but it somehow occupies the space between us.
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And so I call that shared mind, that sense.
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It's not that you agree on everything or see the world in the same way, but you have this
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capacity to experience the other and feel experienced by the other.
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So it's kind of this mutual process.
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But there are times when I feel misunderstood and patients feel misunderstood and that connection
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doesn't feel quite that exquisite.
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And that second kind of presence is a moving toward.
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It's not always delicious, but it's recognizing that there is a gap or a gulf and it can be
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because of life experience.
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It can be because of culture.
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It could be because of any number of things.
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But I think that presence, that intention to move toward another is another kind of
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presence that we have to cultivate and often cultivate very quickly in our practice.
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I'm just thinking about, after this interview, I'm going to be talking with an emergency
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room physician who's a mentee and in the emergency room, you have to establish that moving towards
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that very quickly.
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You only have a very short amount of time and you know that your relationship is very
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time limited.
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So that's a second kind.
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And then I think it comes in words, but also in physicality to it.
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And often I feel the greatest sense of presence when I'm touching a patient, when I'm examining
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them, and even procedures, even injecting an arthritic shoulder for the steroid, I can
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feel this sense of presence.
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It's kind of a bodily experience.
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It's not just an emotional experience.
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It has a real physicality to it.
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So I think now I'm just really exploring those different flavors of presence and trying to
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understand what each one is like.
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What happens to you when you are really experiencing that as a clinician, as a physician, health
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professional?
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How does that change the quality of your own experience of work?
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Yeah.
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I think it's really integral to my identity as a healer.
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So I feel that it's, I have this sense of, yes, this is the right place to be.
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This is the right thing to be doing.
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You know, it's the right vocation.
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It's the right action.
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It's just there's something very resonant about it.
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You feel very aligned, in alignment, one could say.
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Attuned, aligned.
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You know, when you're walking with someone and you have the same gait without even knowing
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it, you're stepping in sync with someone else.
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So there's that sense of connection.
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So connecting that presence with those other qualities, attentive observation, critical
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curiosity, beginner's mind.
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And part of your life's work, especially more recently, has been to help others, help your
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colleagues cultivate those already inherent abilities that they have as human beings and
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especially as trained health professionals.
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And this podcast is called Flourishing in Medicine, something that you've written about,
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something that you've studied, something that you're very interested in promoting.
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And maybe you can help us and help our listeners understand what does that mean, even flourishing?
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Can you define what flourishing in medicine looks like and maybe a little bit of contrast
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with what it doesn't look like?
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Yeah.
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I think that for me, when I feel that I'm flourishing, I'm able to get a perspective
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on the things that are unpleasant about my work and put them in their place.
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I mean, we all know all of the drivers of burnout and distress and moral distress in
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medicine.
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And when I feel that I'm flourishing, I know all of that.
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I know that medicine is difficult and that health systems are broken and all of that.
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And at the same time, I feel like I'm doing the work that is giving something important
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to the world and also providing a sense of meaning for myself.
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So it's kind of the opposite of denying that there is distress or denying that there's
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joy.
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There's both.
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It's kind of taking in the whole picture, the beautiful and the ugly at the same time.
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I'm a great fan of Walt Whitman's poetry.
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And one thing that I like about it, I mean, there are all sorts of things, but first of
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all, it's sensual.
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And I think that medicine is a highly sensual profession.
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We're using all of our senses all of the time.
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The second is that it's full of contradiction.
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Things are going well and they're going terribly often at the same time, that people are suffering
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and they're healing at the same time.
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So taking in these opposites without needing to erase one or the other.
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So it's almost kind of an electric, kind of a buzz feeling that I get when I'm in that
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state of, I guess it's kind of radical acceptance of the way the world is, but that's what drives
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my passion to make the world better.
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I don't know if that makes sense to you.
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So without the acceptance, there wouldn't be the drive.
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Everything was beautiful and everything was horrible, but it's that tension, it's that
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dynamic tension that provides the engine for me.
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And maybe this goes back to your origin story.
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How is it that you have felt yourself drawn to be right in the middle of that dynamic
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tension?
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And maybe a better question is, why does being in the middle of the dynamic tension, if it
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does give you such sense of meaning and joy in the work?
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Well, as you know, I was in primary care for 35 years or so.
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And also for the past, what is it now, 17 years, I've done palliative care in the hospital,
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in a tertiary care hospital.
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And I really, I mean, they call me in not for ordinary situations.
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Usually it's when families need to make really difficult decisions about their loved one
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and they're kind of at each other's throats because they disagree and there's a lot of
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tension in the room.
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And I actually find this really energizing because it's not a problem that can be solved.
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Right?
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These are not problems that logic can solve.
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They're problems that you can grow through.
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And if I feel that I'm growing through those problems with a family, with a contentious
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situation, then, and I can see growth in others, for me, that's really energizing.
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And so I see my job as not fixing things, but my job is helping people grow.
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It's kind of the difference between being a mechanic and being a gardener.
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And mechanics fix things because machines usually don't fix themselves.
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But gardeners, you can't fix a plant.
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You can't make a plant grow.
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You can provide the conditions under which they grow.
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And so we need both of that in medicine.
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We need the mechanic part and the gardener part.
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I kind of feel like the mechanic part, I enjoy it to a certain degree, but I also feel that
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that's not the thing that energizes me as much as the gardener part.
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Yeah.
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I'm thinking about life, a statement, life is not a problem to be solved.
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It's something to be lived, to live within.
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And yet, on the other hand, our training in some ways, it's difficult to include that
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uncertainty and chaos and all the problems that cannot be solved in medical training.
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It's difficult, I think, for educators to teach how to be in the middle of that tension.
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You've done an amazing job at doing so.
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And that's just one of many challenges that face health professionals today.
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Maybe you can let us know what do you think are some of the other greatest challenges
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that health professionals face in terms of their ability to work with energy, compassion,
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commitment, robustness, attention, all the things that you've spoken about in the past.
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Yeah.
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I want to start with my own personal experience of going through training and the early years
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of my career, I felt very much as an outsider.
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And I had really good friends in medical school, but they were also kind of at the periphery
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of medical culture.
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And fortunately, I had enough of a life outside of medicine, mostly with musicians, that I
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had a good set of friends and support network.
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But I felt that within medicine, I just didn't fit.
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I subsequently learned that probably a real lot of people in medicine don't feel like
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they fit.
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And it may even be the majority, which is kind of a problem, isn't it?
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Because the majority of us, I think, went into medicine for exactly the right reasons,
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that they wanted to help patients grow and flourish and live lives that they find meaningful,
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and also that they themselves wanted to draw meaning and a sense of purpose from their
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own work.
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And yet the system is set up to undermine that in so many ways.
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And there are all sorts of words that we use to describe ourselves or that are used towards
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us that I think are kind of hurtful, like, don't be over-involved, emotions aren't good,
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you don't have time for this, it's not going to be, you know, it's not, you can't bill
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for this, you can't.
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And those messages are, you know, are pervasive and if anything, getting worse.
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And so that disconnect between who I am as a person and this rather toxic world that
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I inhabit is really, really striking.
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And I'm just trying to put words to what the missing ingredient is.
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I think there's a real difference between taking care of patients and caring for patients,
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okay, and caring about patients.
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And you know, this goes back to Francis Peabody's famous lecture in 1927 and many people have
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said it in different ways.
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But I think the thing that's being erased in our healthcare system is this capacity
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to care about one another.
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And caring means not following rules when the rules are inadequate.
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Caring means making yourself vulnerable in a certain way to help others.
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I think on an individual level, on a person to person level, that is rewarded.
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So most of my colleagues, when they go beyond the call of duty, you know, I say thank you
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and they say thank you to me when I do that.
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And those relationships are really, really important.
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But I have a sense that the institutions and it's not even, sometimes individuals at the
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top but just institutional culture doesn't recognize that.
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And they pile more stuff that's meaningless on us.
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And there's this schism between what we see ourselves doing and what really matters just
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gets too great.
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Now we all find different ways of addressing that.
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So as an educator, I'm very clear with a student who's rotating with me on a rotation that
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I'm interested in their personal experience of being a healer.
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And not just whether they get the diagnosis right or choose the right treatment or even
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communicate well with a patient.
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All those are important.
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But I'll say my fundamental interest is that you become the healer that you can't, that
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only you can be.
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I don't want you to copy what I'm doing.
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You might learn some things, but the long term goal is that you need to find those things
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that you say and do and believe that are going to give you a sustainable sense of purpose
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and meaning.
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And so part of our work together, even if we're just on a two week rotation together,
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is to look at that as well as all these other skills that you have.
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I've yet to meet a student who hasn't reacted well to this.
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And also, what they'll say at the end of the rotation or in their evaluations was, I wish
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there were more of that in medical education.
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So I think the structure of medical education is too fragmented.
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There's no sense that there's one person who's got personal responsibility for you, your
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own growth throughout the four years.
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And there are different programs that, including at our medical school, which are very good
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advising and coaching programs.
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But I think that those longitudinal relationships really should need to be more at the core.
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I'd like to take a closer look, if we can, at two words, joy and meaning.
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And if you could just talk a little bit about the importance, if you think it's important,
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because it's also a reasonable thing to ask a question whether it is important.
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Joy and meaning for the health professional, for the physician.
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If you could just talk a little bit about the importance of that and why.
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I do, I just want to kind of take apart the word joy, because it means different things
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to different people.
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And for me, it's the part of joy that implies fulfillment, a sense of wholeness.
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And so when I walk out of one of those contentious family meetings on the family to care service,
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you know, it's not the jump for joy kind of joy.
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But I feel that I feel a sense of deep fulfillment that and also the word meaning, it's nothing
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that's hidden, you know, it's nothing that could be discovered.
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Meaning is right there.
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You know, meaning is in the action.
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It's not a result of it.
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So I see them as kind of confluence and that sense of fulfillment and that sense of meaning.
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You know, they think they're part of the same thought.
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Why should, say, the general public be concerned about us finding meaning and joy in our work?
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I guess another way of putting that is what is it like to be a patient of someone who
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isn't aligned in that way?
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And what's the alternative experience like to be aligned with that importance?
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And is that relevant to patient care and outcomes?
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I'll tell you from the perspective of a patient.
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I had to have surgery last spring.
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And when I first met the surgeon, he was really preoccupied with electronic health record
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and barely looked at me and hadn't remembered that we had met three years previously about
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a similar issue.
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After the surgery, he looked me in the eye and described some of the procedures he had
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to do as he said, you know, I know this is going to be the recovery will be a little
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rough for a few days.
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It's almost inhumane, but you will feel better after a period of time.
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And just the fact that he was able to resonate with that feeling of utter helplessness and
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vulnerability and pain and discomfort and all of that.
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And you know, he's not a warm, fuzzy person.
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But it was very clear to me that he truly understood and was present with what I was
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experiencing.
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And so that contrast just even within an individual and context, I suspect that that first encounter
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we had was joyless for him and not very present for me.
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And I think at the with the second encounter, the surgery for him actually was challenging.
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It had some there were some things that were that.
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So I think for him, he that sense of connection reflected his sense of.
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Connection probably with the technical part of his work, but also with the human part
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of the work.
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And I felt that I felt really clearly.
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And my wife is a professional musician and she talks about gigs that she goes on where
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everyone is really there and then there are other gigs that she's working where there
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are musicians who are just phoning it in.
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You know, they're just kind of playing along mechanically, doing their job.
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But there's no there elsewhere.
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You know, there and patients can tell if you're phoning it in in a nanosecond.
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So the joy part, the flourishing part, the engagement part, you know, whatever word you
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want to use, the connection part.
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It's it's pheromones.
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It is it is the the way you smile, you know, if it's a sincere smile as opposed to a forced
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smile.
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And we are we have to pick up on that quickly because, you know, that's how we tell whether
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someone's friendly or dangerous or both.
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Right.
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And and and so I think it's integral that now I think I want to separate this from if
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you think about joy as, you know, having lots of things and going on expensive vacations
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and belonging to golf clubs and whatever, that's not the joy I'm talking about.
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And so the public should care less about that kind of stuff, but about having a doctor who's
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really flourishing, engaged, joyous and present about the work that they're doing.
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That's like that's what you look for.
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Yes, I would agree.
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Hundred percent.
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So, you know, talking about joy, it was a joy when your book, Attending Medicine, Mindfulness
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and Humanity, really the first book about mindfulness and medical practice was published
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and reading it was joy to read it in your book.
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You describe in the final chapter, imagining a mindful health care system.
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And I know the book was published seven years ago.
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It's been a while, but describe if you can two things and sort of a little bit imagine
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journey for you.
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The first, your experience as a patient in an encounter, and you can choose any kind
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of encounter within an imaginary health care system that was a mindful health care system
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as you described in that chapter.
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Secondly, describe what it would be like to be a physician working in that same setting
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in that imaginary mindful health care system.
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And then third, I guess, what are some of the ways the work we have to do to get there?
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Okay, yeah.
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Wow.
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As a patient, I think that that sense that even though talk time is limited, that this
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presence that I experienced with a clinician is timeless, that time stands still.
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And we know that patients who really feel listened to also think that their visits with
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their doctor are longer, their psychological time is longer.
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So that sense of timelessness, that sense of really being listened to, the sense that
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you're not put in a category, that you're being treated as a unique individual.
31:13
And I'll put along with that a sense of confidence that this other person, that this doctor knows
31:18
what they're doing.
31:19
Okay.
31:20
So I don't want just someone who's a good talker and really friendly.
31:24
I want someone who knows their stuff, right?
31:27
And so, and how you communicate that, you can communicate that in many ways, but trying
31:33
to be arrogant and self aggrandizing is not one of them.
31:36
So a certain dose of humility.
31:41
As a physician, I would want that everything that led up to the patient walking into the
31:47
door, into my walking into the door of the examining room, would put them in a receptive,
31:56
relaxed and fully aware state of being.
32:01
I know that's asking a lot, but whatever happens before you go into the room makes you feel
32:07
that you can be the person that you are and that you'll be accepted for who you are.
32:14
And that the doctor's interest in you is a genuine one.
32:19
Now, obviously, we see lots and lots of patients.
32:23
We can't be intimate in the same way with all the patients we see, but you can have
32:28
a genuine interest in each person as a human being and recognize their uniqueness.
32:32
And then everything that happens after the visit reinforces the things that are the most
32:37
important.
32:38
Our chart notes in this country are eight times as long as the chart notes in any other
32:43
country in the world.
32:45
And all of it is because of regulatory stuff, right?
32:49
Insurance companies, government, what have you.
32:52
And in the UK, if a child has a sore throat, your note is two lines, sore throat, no fever,
32:58
no adenopathy, follow up in a week or whatever it is.
33:02
Here it's eight pages.
33:04
So that kind of regulatory stuff that we have to deal with does not enhance anything that's
33:10
important in medicine.
33:12
And most of it can be dispensed with, with no harm to anybody.
33:16
Just a little example.
33:17
So making communication among clinicians easier, you should have a sense that you're, if you
33:24
see more than one doctor, that they're actually able to communicate with one another.
33:28
And my experience with relatives in other parts of the country trying to get medical
33:34
care, it's horrendous.
33:40
And to think about just to ask oneself and even ask people who are non-clinicians, but
33:47
are healthcare administrators, what is the most important thing?
33:51
What is the most important thing in healthcare?
33:54
And if people could actually have that question in front of them and direct their efforts
33:59
towards the most important thing, rather than, oh, I have to do this or I have to do that.
34:04
It's probably good advice for life in general.
34:07
But given that healthcare is in such a mess, I think we need to do that in a very conscious
34:14
and deliberate way.
34:16
Now all the details of the pathways to get there and who pays for what and who's responsible
34:22
for what, that gets complicated.
34:26
But I think that needs to be the starting point.
34:30
We're almost finished.
34:32
I just have two somewhat related questions.
34:35
I guess they're related just to finish up.
34:37
And then if there's anything else you'd like to add, you have a great deal of experience
34:44
in sharing and motivating and inspiring other health professionals and physicians in particular
34:50
to take a look at some of these issues to really think about what the most important
34:53
thing is.
34:55
If you were to sum it up in some recommendations, either general or even specific to those whom
35:01
you identify as your fellow health professionals, what would you offer here on this podcast
35:07
to them just as a take home?
35:09
And then a related question or actually request is describe to us something that we've brought
35:15
into our mindful practice training together, which is a practice called 90 seconds for
35:22
the patient.
35:23
If you could just describe that as something people can take home with them.
35:27
First of all, I want to say that mindfulness is not something you do sitting on a cushion
35:33
or going to a retreat center.
35:35
Mindfulness is how you live your life.
35:37
And when we talk about mindful practice for health professionals, we're talking about
35:41
how you live your life as a health professional.
35:43
So where can you, but I think that we also need reminders.
35:49
And so to quote a Zen teacher, the most important thing is to remember the most important thing.
35:55
So part of the problem is remembering.
35:57
So for me, when I was in the depths of despair about the new electronic health record system
36:05
a few years ago, a patient of mine said to me, I'd known him for quite some time, part
36:10
of why I really like you as a doctor is that you really take time to listen.
36:15
And I really feel understood.
36:16
But ever since you got this new computer system, I feel like you've been really distracted
36:21
by that.
36:22
And I mean, he had a tremendous amount of courage to say that.
36:26
And it stopped me dead in my tracks.
36:30
And I said, you are absolutely right that this is not good for me, nor is it good for
36:36
patients.
36:37
And I thanked him.
36:40
Although for me, it kind of felt like someone just stuck a dagger through my heart.
36:45
Because this is what I aspired to do, to be present.
36:48
And he was saying, no, you're not.
36:50
So I just decided, it just popped into my head here, saying, well, what can I do to
36:55
make sure that I'm actually present and listening?
36:57
So I just decided for every patient, for the first 90 seconds of a visit, I wouldn't open
37:03
the electronic chart.
37:05
I wouldn't have any notes.
37:06
I would just sit there and talk with the patient, say, why are you here?
37:10
What's going on?
37:11
What's happened since last time?
37:13
What's most important for you to talk about today?
37:15
And just listen.
37:17
And just listen.
37:19
Ask maybe a few clarifying questions.
37:22
I didn't quite understand what you said.
37:24
Or could you say a little bit more about that?
37:26
But just listen.
37:28
So I would suggest trying that.
37:30
See what it does for you.
37:31
If 90 seconds seems really difficult, start with 30.
37:37
But see what that does to your practice.
37:41
See what it does to the way you feel at the end of the day.
37:44
See if it makes your day any longer.
37:46
It might even shorten your day.
37:48
For me, it actually had no effect on when I got home at night.
37:52
But for me, it gave me a greater sense of connection to the things that were the most
37:56
important.
37:57
The other thing is to think about transitions.
38:00
So when you're going from one room to the next, or one meeting to the next, or one patient
38:04
to the next, what can you do during that transition time?
38:08
So if it involves a walk, can you walk and just notice your surroundings?
38:13
And maybe even notice something that's beautiful, even if it's a sterile hospital environment.
38:18
There might be one thing that's beautiful.
38:21
Or when you're about to enter a room, just stop and take a breath.
38:24
And just be aware of the thoughts and feelings you're carrying with you.
38:29
And make a decision about which ones you really need to carry with you into that room, which
38:32
ones you don't.
38:33
It's not that you're saying they're not worth thinking about or feeling.
38:37
But what's most important right now?
38:42
So those are just two things.
38:44
I mean, clearly we have to fix the system.
38:47
But the system's never going to be perfect.
38:49
It's never going to be anywhere near perfect.
38:51
And so I feel like we all, to some extent, need to take some responsibility for our own
38:57
sustainability.
38:58
Mostly because no one else will.
39:00
I mean, it's really kind of a harsh reality.
39:03
Others can help.
39:04
They can support us.
39:05
But I think fundamentally that we need to find some way of finding connection and meaning.
39:12
Well, that's great.
39:13
You know, I want to again thank you so much for being interviewed or being on this podcast.
39:19
And also what's really wonderful is, you know, we've spent a lot of time together teaching.
39:24
We go to meetings together planning.
39:27
But this was just such a lovely way for me to get to know a little bit more about you.
39:31
Things that I didn't really know.
39:33
And I think the listeners will also appreciate learning about you as a person.
39:39
And really as a force in helping physicians and other health professionals flourish.
39:44
So thanks.
39:46
Thanks for listening.
39:48
We will include a summary of today's podcast and some links to Dr. Epstein and other references
39:53
that were discussed in the show notes.
39:56
I'd like to conclude today's podcast as I conclude each podcast with a practical exercise
40:03
to help you flourish during your workday.
40:07
The intention is for you to develop a toolbox of skills that you can draw upon to enhance
40:12
purpose, meaning, and well-being.
40:15
Ron spoke of 90 seconds for the patient.
40:18
This is a practice for those of you who are engaged in clinical care to use at the onset
40:23
of an encounter.
40:24
As he said, perhaps begin with 30 seconds or 60 seconds.
40:29
And as we advise in medicine, increase as tolerated.
40:34
Another brief practice to do is a hand washing practice.
40:37
Everyone involved in clinical care washes their hands many times daily.
40:43
It's not trivial.
40:44
In fact, it's an important aspect of our work.
40:48
Developing a habit of intentionality and presence can help the effectiveness of hand washing
40:54
at the same time cultivate presence.
40:58
So let's talk about how you would do this.
41:01
You begin washing your hands, turn on the water, you put some soap, either liquid or
41:07
bar soap into your hands, and you begin to wash the hands, paying attention to what it
41:13
feels like to have the water touch the hands, what it feels like to have the soap on the
41:17
hands, what it feels like for you to spread the soap and the water around the hands, the
41:24
palms, the backs of the hands, each finger, doing so with awareness, with the knowledge
41:31
that this is an important part of the practice, that you are actually taking care of yourself
41:37
and taking care of others in the process of washing your hands.
41:43
Be fully with the practice for as long as it takes.
41:46
20, 30, 60 seconds of hand washing can be a very effective way of decreasing the amount
41:52
of germs on the hands and making your ability to work with patients more healthy.
42:01
As you conclude the washing of the hands, rinsing the fingers off, shaking the hands,
42:08
and then taking whatever material you use to dry the hands or an automatic air blowing
42:15
dryer and noticing again the contact of the air, of the cloth, of the paper with the hands
42:23
as you dry the hands.
42:26
This can be done many times a day and the more attention we give to this, the better
42:30
the outcomes of our hand washing is and also the ability to be present with it, to use
42:37
it as a way of dropping into this present moment to what you are actually doing at this
42:42
moment.
42:45
One more thing I would like to share before we close is a poem I heard recently while
42:49
listening to an interview by Tim Ferriss with the meditation teacher Jack Kornfeld.
42:55
Jack shared a poem by Jack Gilbert about a brief for the defense.
43:02
Actually the title of the poem is called A Brief for the Defense.
43:07
Ron spoke early on in the podcast about joy in medicine in the midst of the contradictions
43:13
and how joy is important for health professionals.
43:17
I agree that our joy as health professionals is important and I hope you find joy in listening
43:22
to this poem.
43:23
So here it is, A Brief for the Defense by Jack Gilbert.
43:27
Sorrow everywhere, slaughter everywhere.
43:33
If babies are not starving someplace, they are starving somewhere else with flies in
43:39
their nostrils.
43:41
But we enjoy our lives because that's what God wants.
43:46
Otherwise the mornings before summer dawn would not be made so fine.
43:50
The Bengal tiger would not be fashioned so miraculously well.
43:56
The poor women at the fountain are laughing together between the suffering they have known
44:00
and the awfulness in their future, smiling and laughing while somebody in the village
44:05
is very sick.
44:08
There is laughter every day in the terrible streets of Calcutta and the women laugh in
44:12
the cages of Bombay.
44:14
If we deny our happiness, resist our satisfaction, we lessen the importance of their deprivation.
44:23
We must risk delight.
44:26
We can do without pleasure, but not delight, not enjoyment.
44:30
We must have the stubbornness to accept our gladness in the ruthless furnace of this world.
44:38
To make injustice the only measure of our attention is to praise the devil.
44:43
If the locomotive of the Lord runs us down, we should give thanks that the end had magnitude.
44:50
We must admit there will be music despite everything.
44:54
We stand at the prow again of a small ship anchored late at night in the tiny port looking
45:01
over to the sleeping island.
45:04
The waterfront is three shuttered cafes and one naked light burning.
45:11
To hear the faint sound of oars in the silence as a rowboat comes slowly out and then goes
45:17
back is truly worth all the years of sorrow that are to come.
45:27
I hope you have found this podcast, The Simple Exercises, and this poem useful to you and
45:33
look forward to having you join us for our next episode of Flourishing in Medicine, From
45:38
Surviving to Thriving.
45:40
For more information about EmPRO, please visit www.myempro.com.
45:50
For more information about me and my work, please visit www.mickcrasnermd.com or www.mindfulpracticinmedicine.com.
46:04
Thank you and we'll see you next time.