Latest / Flourishing in Medicine: From Surviving to Thriving / Flourishing in Medicine: From Surviving to Thriving Episode 9 Ghazala Radwi, MD

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Flourishing in Medicine: From Surviving to Thriving Episode 9 Ghazala Radwi, MD · Flourishing in Medicine: From Surviving to Thriving

• 0:00
  Welcome again to Flourishing in Medicine from Surviving to Thriving.
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  I'm your host, Dr. Mick Krasner, and this podcast is produced by EmPRO, a professional
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  medical liability insurance carrier headquartered in New York State.
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  I've been working with EmPRO for quite some time in their physician support programs,
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  and this is just another one of their many programs that they offer to support physician
• 0:52
  well-being and decrease risk.
• 0:54
  So today I'm really excited to share with you my conversation with Dr. Ghazala Radwi,
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  who is a hematologist and transfusion specialist from Alberta, Canada, Edmonton, Alberta.
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  She's the medical lead for transfusion medicine for the north sector at Alberta Precision
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  Laboratories.
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  She's also clinical assistant professor in the Department of Laboratory Medicine and Pathology
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  at the University of Alberta.
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  And she is very involved in wellness activities.
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  She serves on the wellness and safety representative for the hematopathology residency committee
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  and collaborates with the Office of Advocacy and Well-being at the University of Alberta
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  to help develop programs to support physician well-being.
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  So what you'll hear in this podcast is some words about her journey in medicine.
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  It's quite interesting.
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  And that was influenced by her father, who was also a physician, and also by her deep sense
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  of calling.
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  Her conversation delves into challenges faced by health professionals in Alberta, Canada
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  in particular, especially political turbulence, burnout, racism, and trauma within the health
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  care system.
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  And she emphasizes the importance of trauma-informed approaches in medical training, advocating
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  for transparency and leadership, and highlights the importance, the significance of joy and
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  play in fostering teamwork and professional well-being within the medical field.
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  So now our conversation with Dr. Ghazala Radwi.
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  So Ghazala, welcome to Flourishing in Medicine podcast.
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  It's really wonderful that you could join us today.
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  And I wanted to actually begin at the beginning of kind of what brought you into medicine.
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  It's really curious and really interesting and very informative to think about, you know,
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  why did we choose to become physicians?
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  What were the maybe early experiences we had in life, family experiences, personal experiences,
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  or things we had in our educational process over the years that really solidified this
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  calling?
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  And I really do believe it is a calling.
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  So if you could share with us that story, your story about how you got into this.
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  It's a pleasure to be here, first of all, always a pleasure to have a conversation with
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  you, Mick.
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  It goes quite a ways back for me.
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  I can think of when I was four years old and wearing a little doctor's white coat.
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  My father has passed away since, but he was a physician himself.
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  And so my earliest memories, I think, were of him.
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  And so all I can remember ever in my life was I wanted to do medicine and be a doctor.
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  There was nothing else since age four.
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  I remember playing with a little doctor set and opening my, my siblings are younger than
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  me opening their mouth and doing all those mouth examinations and all those things.
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  So age four is as early as I can remember.
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  And then I remember at age 12 wanting to find a cure for cancer.
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  So I was drawn to cancer oncology.
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  I eventually ended up doing hematology and did have a practice where I saw patients with
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  cancer.
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  My father, I think, was a large influence in my life in terms of becoming a physician
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  and how he immersed himself in it and how much of it he gave.
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  I would often go with him where he worked.
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  Like that was where I hung out.
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  So nerd from day one.
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  That was what I did for fun.
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  I was hanging out in hospitals.
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  The kidney dialysis unit was where I often hung out with my dad on evening shifts.
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  I knew all the nurses there and I knew some of the patients.
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  And so those are some of my memories.
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  It always just felt very much at home for me to be around people who needed help and
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  to kind of help heal.
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  I know that sounds really cliche, but it was always this kind of drawn towards healing,
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  helping others and seeing my dad do that.
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  So he was immersed in that and I would be with him there.
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  It's really curious, interesting at that early age that you could sense that calling and
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  made complete sense, total sense to you on so many levels, I'm sure, at age four, at
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  age 12, wanting to actually realize that there's disease in the world and you'd like to do
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  something about it.
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  And then having your father as that role model.
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  How is this story, this origin story we can say, lived in you?
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  How has it been present to all the different things that actually have unfolded?
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  I'm sure you couldn't completely chart out your future life at age four or 12 that it
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  actually unfolded in ways that are surprising sometimes and not straight.
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  But how do you see that story still living in you even now?
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  Well, it's interesting how you say that it was sort of known to me and without doubt.
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  And I find that interesting because I don't know how I knew.
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  I couldn't tell you how.
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  There was nothing else I thought of.
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  It was just, this is it.
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  There was no question about it.
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  There was no...
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  I like writing, so maybe that was the other thing I could have maybe done.
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  But this was by far the thing that always drew me in.
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  And then I loved biology throughout school, did really well in school.
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  And then I eventually, I actually, so I did my medical training or medical school in Saudi
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  Arabia.
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  So it's a different system than it is here in North America.
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  I was actually 16 when I started medical school there.
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  And I got in, again, things just aligned and my grades and then I applied and things just
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  made...
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  It was being made.
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  The path was being paved for me and it just fell into place one step after the other.
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  I remember my father having a conversation with me at different stages of this and going,
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  are you sure?
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  Is this really what you want to do?
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  This isn't just a job.
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  It's not...
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  It's a whole life commitment.
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  And are you sure you're signing up for this?
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  And I'd be like, no, I'm sure.
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  And he had that conversation with me.
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  I remember just before med school, but also after I graduated from med school.
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  And then I decided I wanted to do internal medicine for residency.
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  He's like, are you sure?
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  Yes, I'm sure.
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  And then when I wanted to do hematology, it's like you keep picking these things that are
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  really hard and all consuming and whatever.
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  And it was just, yes.
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  It was always just yes.
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  And so things fell into place.
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  There were mentors along the way.
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  There were people that showed up at different stages of life who helped move me along.
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  There's so many names I can mention and some are still alive, some are not, but they all
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  had these kind of took my hand and moved me forward a few more steps onto it.
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  And I continue to have that happen.
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  So I've learned to trust that over time, that there is this, I don't know, there's this
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  knowing, there's this intuition.
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  And it's part of that.
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  I also believe it's a calling.
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  And so it's, but it doesn't always show you kind of too far out into the future.
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  So you have to sort of trust it.
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  And that's scary to do.
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  But I've never been disappointed when I've taken that step forward.
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  It hasn't always, it's usually not been what I thought it would be, but it's always been
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  really good for me.
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  I'm really struck by this question that your father asked you on a number of times.
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  You know, are you sure?
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  Do you know what you're getting into?
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  And now looking back and knowing what you know now, what do you understand about that
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  question?
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  And why is that an important question?
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  I think I understand it more as time passes.
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  I didn't quite understand it when he was asking me.
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  I thought I understood it.
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  Like I understood it back then as being, you know, it's a lot of years of training.
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  It's hard work.
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  There's their own calls.
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  How are you going to do this work life?
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  What do they call it now?
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  Not balance, whatever they call it.
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  Work life.
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  Integration or something.
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  Integration, right?
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  So I thought it was along those lines.
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  But I realized, because he was very much, like he was always at the hospital and he
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  was so invested with his patients.
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  Like it was the question I think that he was asking me was, this is going to be your soul's
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  journey.
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  Your heart will be drawn into it.
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  You will be taken to these kind of depths of vulnerability.
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  You're going to see suffering.
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  You're going to sit next to people who are going through immense suffering and you're
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  going to feel helpless and you're going to feel agony and despair.
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  Are you sure?
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  This is where you're going to go.
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  But there is also great joy.
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  There's also, because he, he did it all his life, you know, and patients loved him.
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  So that I think that was the question in retrospect.
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  And I think it's a very important question.
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  I didn't quite realize what he was asking me back then.
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  I think I do now.
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  I never asked him that.
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  I wish I had the chance to have asked him.
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  What did he really mean by that?
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  But anyway.
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  Yeah, thank you.
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  It's a question I think I'd like to think, and I think there's some evidence that it
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  lives within many, many of our colleagues, perhaps most of our colleagues.
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  And so I just wanted to shift a little bit because you, you know, you had your education
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  in Saudi Arabia and then you came and you're practicing in Alberta, Canada.
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  Could you just share with us what you've learned about the challenges that are facing health
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  professionals in Canada, especially in Alberta?
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  You know, I think it's important.
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  Many of the listeners of this, I hope we'll get a lot of Canadian listeners, but for sure
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  in the U S physicians predominantly.
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  And I think it still would be informative to hear about what you've seen there because
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  I, as you know, you know, we have people in our mindful practice program to come from
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  all over.
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  Why do they come?
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  There's so much of the challenges in medicine.
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  Yeah.
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  So I like specifically in Canada or just a comparison of
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  No, just what you're what you've learned about the challenges that face health professionals
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  in Canada and what's maybe unique to Alberta in Canada because it's probably each province
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  is pretty unique.
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  Yeah, that's true.
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  There's number number of challenges.
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  I think the main one that we've currently had, well, I've been in Alberta for about
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  four years now, so I could only speak from a limited sort of experience so far.
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  And there's history to this, but already in the four years I've been here, the political
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  climate is turbulent.
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  And with those changes, the delivery of the healthcare system, how it functions, it shifts
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  so much.
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  There's like who's in charge, what's happening, even within transfusion medicine and lab that
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  I'm a part of at the moment, that org structure has changed so many times, so many changes,
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  constant influx.
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  And it's not necessarily what's best for patients and what's best for the physicians and what's
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  a better functioning healthcare system.
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  It's often tug of war between different political parties.
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  And there's a lot of external influences that definitely to people, it feels like they don't
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  have say, they're not being heard, they're being shifted one way.
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  You just get used to one system, then somebody else comes in and wants to do it completely
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  differently.
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  Ponds in this big game of chess, right?
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  It really has impacted morale.
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  And then this happening during a pandemic, there were already high rates of burnout in
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  Canada prior to the pandemic.
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  They've like doubled or tripled since, and all of this is adding to it.
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  Cuts in funding, changes in the electronic systems, so many changes.
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  And it's like the joke now is like, will there ever be a steady state?
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  There probably will never be a steady state because when I talk to my colleagues who've
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  been here in this province for longer than I have, it's like, well, when was it never
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  like this?
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  And then how do you cope with constant change and change is hard on us as humans, right?
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  Even if it's change, that's good.
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  It's still change, it challenges your nervous system.
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  I think that's one of the main things.
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  There are other challenges as well.
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  I think there's racism within the healthcare system, there's microaggressions, macroaggressions,
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  there's all kinds of trauma.
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  There's the background of history and everything that brings forward as well in terms of trauma
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  and the sense of equity and justice.
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  So those are major, major factors as well, not always talked about and still sort of
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  like, you know, hash, hash, and it isn't as easy to talk about in different provinces
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  will vary across the country in that way.
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  But I think Alberta has a large problem in that perspective as well.
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  So all of those, I think really impact physicians, both at a systems level, but also at individual
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  levels.
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  Also, high rates of physician suicide.
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  So we don't, we've heard about a few in the last year, let's say, but there's, you know,
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  we hear that there's so many others that we don't get to know about.
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  Though it takes a toll, you know, it takes a toll when you're hearing about all this
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  and it feels like there isn't stability and there's all of this, like it's easy to start
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  spiraling downwards.
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  So I think that's some of where we're at, people are leaving the province a lot, a lot
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  of physicians have left to neighboring either provinces or countries.
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  So there are shortages, there's like urgent care centers, emergency centers, hospitals,
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  smaller ones, rural especially that have shut down because there's no physicians.
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  So yeah, overall, it's stormy.
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  It's turbulent.
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  Yeah, it sounds very turbulent.
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  You mentioned challenges to the nervous system collectively and individually, and you brought
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  the word trauma up.
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  And I'm really glad you brought that up because I had written here in my notes in preparation
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  a little bit about trauma and you've sort of become kind of a person that's exploring
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  that and writing about it.
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  You know, what I've read is that we understand it as a psychological, invisible wound that
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  continues long beyond the initial event as deep emotional, psychological, neurobiological,
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  physical consequences.
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  So you've written about it, you've explored it in medical education and the need for creating
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  what's called trauma-informed learning environments.
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  So could you describe what's needed?
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  Why is it needed that we need to bring that understanding of how trauma factors into our
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  ability to learn into these learning environments in medicine?
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  So you've asked me a question that I could talk for hours about.
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  So you've opened a can of worms, Nick.
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  Okay.
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  At your own risk.
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  You're going to have to like, you know, kind of tell me where to go with this, but because
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  there's a lot, but I feel really passionately about this topic and to kind of look on writing
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  about trauma-informed medical education.
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  We talk about trauma-informed, you know, clinical care a lot more, I think, than we talk about
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  trauma-informed medical education.
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  And the reason I wanted to focus on the medical education part is because that's the platform,
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  that's the foundation.
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  So if we are like bringing in people and then we're inflicting this trauma of the way we
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  do our medical education, in addition to what they're exposed to, in addition to what they
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  may be bringing in, in terms of their own trauma, pre-existing, generational, otherwise.
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  And then we choose to remain unconscious about it.
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  Recipe for disaster, right?
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  Like so many times we've heard in our, even in our mindful practice programs, right?
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  I wish someone had told me.
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  The question that my dad asked me, do you know what you're signing up for?
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  Like, do you get it?
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  And so that's the question.
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  So I feel like it's not a question of will there be trauma during medical education or
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  not?
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  It's not a question of will there be burnout?
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  When will it happen?
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  And how are you going to deal with it?
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  I think that's a better approach versus kind of this naive, not naive, but kind of unconscious
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  approach of like, okay, we're just going to push along, roll along.
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  And then when it shows up, we're like, oh, we're surprised now.
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  Now we deal with it.
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  Let's be proactive about it.
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  Let's call it out.
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  Let's go.
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  Okay.
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  Here are the ways there are things that we can't really control, you know, that are outside
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  of our control influence in terms of traumatic events.
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  But here are things that we can work with.
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  Here are ways that we can make it at least that where we don't amplify or re-traumatize
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  or re-trigger or inflict new trauma.
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  So here's what we can do.
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  And that's where I'm hoping that we can bring our focus to through some of these things
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  I've written.
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  Can we at least that relational aspect, because we know trauma occurs within that relational
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  aspect and healing also occurs within that aspect.
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  So I'm still starting with where let's recognize how trauma can occur, how we can traumatize
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  each other.
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  And then the hope is that we would move towards how can we help each other heal as well, because
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  you know, they're two sides of the same coin.
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  Sure.
• 18:19
  Well, I really like the frame that you placed around it is that it's not like you can avoid
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  it.
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  It's how are we going to develop ways that we can work with it so that it doesn't deteriorate
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  our wellbeing and our ability to deliver high quality care, that trauma will just happen.
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  It's the nature of being in highly emotionally charged environments where there's a lot of
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  suffering and of course, what you said, we bring in our own experiences into it.
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  Could you just maybe give us a little bit of a picture into what would be some way in
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  which you would work with either a health system organization leaders or individual
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  groups of physicians to have them begin to develop some assets that they could use to
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  bring to bear for this dynamic?
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  I've already been doing some of that work.
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  I've been doing it for a while.
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  And my focus has been on helping people understand how their nervous system functions and kind
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  of really going to that core basic level of nervous system, because it eventually impacts
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  how you think about things, the emotions that come up, and then the stories we make and
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  the meaning we make, right?
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  It all stems down to this nervous system.
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  Are you safe?
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  Or am I safe?
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  Am I not safe?
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  Really just comes down to that.
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  Not to kind of really simplify it and minimize it, but it really is about am I safe or not
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  safe or degrees of safety?
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  And then it's how do you show up?
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  Here are some ways the nervous system organizes itself in response to threat.
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  Whether it's overwhelming stress, chronic stress, or whether it's threat to life, you
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  know, what feels like survival.
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  And there's so many things for us as physicians, I think, because we're so, you know, this
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  physician identity is so much a part of who we are that when something goes wrong, when
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  there's been a medical error, when we feel like we're going to be cast out by our people,
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  our tribe, you know, that belonging it triggers deep survival, you know, threat that feels
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  like I'm going to die.
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  So what happens to the nervous system when that occurs?
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  And to sort of understand it at first at a general level, but then in some of the workshops
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  that I do, we have our immersive breakouts, and I've done quite a few of them in person
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  now, they're always so fun.
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  And people are, you know, they go in, they feel really like, what are we doing?
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  But then they come out and they use that information.
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  What is what is that?
• 20:48
  What is the flavor for you?
• 20:49
  What does it look like for you?
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  How does fight show up for you?
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  How does flight show up for you?
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  How does freeze show up for you?
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  What about fun?
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  You know, I think we have so much of a fun response, you know, as well in healthcare where
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  it's like, yes, I'll do this, yes, I'll take it on, yes, yes, yes, yes, yes.
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  And we don't recognize that one because we go, oh, great, they're such a team player.
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  Oh, wow, they're so flexible.
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  Oh, wow, they never say no.
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  Ah, yeah, that person who never says no, what's going on with them, you know?
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  So I think that's one that we don't always recognize.
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  I mean, we know fight, you know, flight may be better.
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  We don't always recognize freeze.
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  It may look like people not attending a certain activity or they're not showing up to a meeting
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  or whatever.
• 21:32
  And you go, oh, they're just not interested.
• 21:33
  No, what's happening there?
• 21:34
  So that's kind of the area because it's such a big topic, right, to work with.
• 21:39
  So I've experimented with different things and kind of the current theme that I've been
• 21:45
  working with for the last, I don't know, several months, maybe two, three years has been working
• 21:51
  with the nervous system because I also find that that's where the most impact is.
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  Like if you learn to even become aware of where how your nervous system is organizing
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  itself before you jump to interpreting and making assumptions and you just kind of check
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  in with yourself.
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  Oh, I'm in, you know, freeze right now.
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  And when I go into freeze, this is how I start viewing the world.
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  This is how these are the thoughts and kind of assumptions I have of my colleagues.
• 22:19
  No one cares.
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  I'm alone.
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  Doesn't matter.
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  What's the point?
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  Maybe that's that's freeze.
• 22:26
  And so if you make a decision when you're there, is it really aligning with your values
• 22:31
  and what who you really who you really are?
• 22:34
  Or is it or was this a trauma response?
• 22:36
  So those kind of things, it's difficult work.
• 22:39
  It's hard, but it's very fulfilling when people kind of take it and they sit with it and then
• 22:44
  they come back and they go, oh, we're kind of using that language now, you know, the
• 22:48
  nervous system, the hierarchy and the ladder and those sort of things.
• 22:51
  So that's been some of what I've been doing.
• 22:54
  And I've been doing this at different levels.
• 22:55
  I've been doing this with our trainees.
• 22:57
  I've been doing this with program directors.
• 23:00
  I've been doing this with like teams, leadership.
• 23:04
  And I've also been doing it with because I work with lots.
• 23:07
  So we also have our operational staff and our technical staff.
• 23:11
  So I've sort of expanded to also include from the medical side of things like nurses and
• 23:16
  other health care workers and then and then also like technical and operational staff
• 23:20
  as well, because ultimately we're all working together to help patients.
• 23:23
  Right.
• 23:24
  So in my mind, it doesn't matter what your role is.
• 23:27
  I think we all are kind of feeding into that same that same funnel.
• 23:31
  You've actually become quite a leader in recognizing the need for attention to physician well-being,
• 23:38
  creating programs to help support individuals and organizations, the ones like you described.
• 23:43
  I know you're involved in something called Well Doc Alberta.
• 23:48
  Could you just tell us more about that?
• 23:49
  I think especially because of the like I say, a lot of the listeners will be from the United
• 23:54
  States.
• 23:55
  It's really helpful to hear other models where organized medicine is taking the lead to employ
• 24:02
  ways of actually addressing this, that it's not all on the docs themselves individually
• 24:08
  because that's really the wrong message because they're in fact quite resilient, quite skillful
• 24:13
  themselves.
• 24:14
  I started collaborating with Well Doc Alberta, I want to say two or three years ago now.
• 24:20
  And I sort of, when I first came to Alberta, started searching and going, okay, where,
• 24:25
  who can I reach out to?
• 24:26
  That's always everywhere I go.
• 24:27
  I'm like, okay, who is like-minded people?
• 24:30
  How can I find them?
• 24:31
  And so Well Doc Alberta, I contacted them a couple of years ago and the way they function,
• 24:35
  so they're an independent body.
• 24:38
  So they're not like funded by a particular hospital or university.
• 24:42
  So they're an independent body and they are there to bring in different physician collaborators
• 24:48
  and with different areas of expertise and different models that they work with and they
• 24:53
  kind of oversee or work with them, let's say to develop different types of modules.
• 24:57
  And they also do assessments basically for burnout.
• 25:02
  And then they do measurements and they do pre and post measurements after these different
• 25:07
  interventions.
• 25:08
  And then they put that together as well.
• 25:10
  So they have their metrics that they follow and they're quarterly and all of that sort
• 25:13
  of stuff.
• 25:14
  So they really try to do evidence-based and scientific methods in terms of even applying
• 25:20
  all of this.
• 25:22
  So that was where I started collaborating with them and my areas of interest were Gatton's
• 25:28
  mindfulness and then working with uncertainties when I did with Well Doc Alberta as well.
• 25:33
  And then we haven't quite gotten into that just yet, but we wanted to do one on mindful
• 25:38
  self-compassion as well because I think that concept of self-compassion, I know I certainly
• 25:42
  struggled with it and continue to, and I think a lot of physicians struggle with that as
• 25:46
  well.
• 25:47
  So just building the module with them, they look for collaborators who have, as they call
• 25:53
  the, are the content experts and they help them to bring in the, like help put together
• 26:01
  the module and the slides and kind of do all that part.
• 26:05
  So it really is a collaboration and they don't basically, all they ask for, for when they
• 26:11
  go to hospitals or departments who have kind of gone through their catalog and picked and
• 26:16
  gone, okay, what is something that could benefit our department?
• 26:20
  And then they would contact Well Doc Alberta and go, this is what we're looking for.
• 26:24
  And then all they ask for is that, you know, an honorarium is paid to the physician collaborator
• 26:29
  for their two hours of, let's say the module that they're doing.
• 26:32
  So it ends up not being very expensive for the physician groups who are requesting it.
• 26:37
  And then, well, Doc Alberta is funded separately.
• 26:39
  So that's kind of how that model works.
• 26:41
  So it really is like their website has the list of collaborators, but also like a, like
• 26:47
  I was saying, like a catalog of different things that they offer.
• 26:50
  And then people can just go through that and go, okay, this is what we want.
• 26:53
  Or they could also reach out to them and say, here's our team is struggling with, you know,
• 26:58
  XYZ or we don't really know what our team needs.
• 27:02
  Can you help us figure that out?
• 27:04
  So they can help do that too.
• 27:05
  And then on the back end, they'll contact us, you know, ask us collaborators and go,
• 27:10
  here's this team.
• 27:11
  Do you think you'd be able to help them?
• 27:12
  That sort of thing?
• 27:13
  Yeah.
• 27:14
  Well, I think we're going to, based on this discussion, place in the show notes for this
• 27:18
  episode, the website of the Well Doc Alberta so that people can have a look at it.
• 27:23
  And you share maybe a few, a couple concrete things that individuals, organizations can
• 27:29
  do concrete things.
• 27:30
  Also that's based on your model that you use, that you shared with us about understanding
• 27:36
  the nervous system and how it tends to want to move toward things that are safe and move
• 27:40
  away from things that are danger.
• 27:42
  I think a really important one is transparency and contacts.
• 27:47
  Like when we talk about nervous system safety, context is such an important one.
• 27:52
  Like it, to me, it sort of comes to the top because we know that the nervous system is
• 27:56
  wired to fill lack of contacts with negative assumptions.
• 27:59
  Like we know that's going to happen.
• 28:01
  The information that you don't know, you're going to assume the worst.
• 28:04
  But despite that, I find that organizations, leaders, even individuals, like we have this
• 28:09
  tendency to want to either minimize or hide because we think that people are going to
• 28:15
  get overwhelmed when you tell them about problems.
• 28:18
  And so let's kind of hide that from people, kind of deal with it at the back end ourselves
• 28:23
  and kind of struggle with it.
• 28:25
  But it ends up having the opposite effect.
• 28:27
  People start to assume, you know, there's people start to talk and things happen and
• 28:31
  that creates a lot of chaos that I think is unnecessary and also creates distance.
• 28:36
  Because again, as the nervous system starts to feel unsafe, it's going to disconnect.
• 28:40
  Like it's not going to go into that ventral space of where there's the need to connect
• 28:44
  and want to connect and collaborate and be curious and be nuanced.
• 28:49
  It's going to go into that black and white snap like thinking assumptions more of protect
• 28:54
  rather than connect.
• 28:56
  And so context, where possible.
• 28:59
  And I recently had a leader come to me and ask me about a situation.
• 29:03
  And I was really happy to hear the question from this leader because the question was,
• 29:08
  do you think I should share this with the organization and kind of like going down with
• 29:15
  all the bench staff and so on?
• 29:17
  Or do you think I should present it this way?
• 29:20
  And the question was posed to me, knowing that from that perspective of that trauma
• 29:24
  informed and so that was to me, that was a kind of a radical question because I hadn't
• 29:29
  expected it from this person.
• 29:31
  And I said, I think if you share the struggles, you will actually gain buy-in and not the
• 29:39
  other way around.
• 29:40
  And people will realize that we're on the same team.
• 29:45
  And paradoxically, maybe it feels, but that will give them hope.
• 29:51
  You think that if you tell them the problems, they will become hopeless and despair.
• 29:56
  I think it'll give them hope.
• 29:58
  And it made sense to this person and they did.
• 30:00
  And so, yeah, so that's context.
• 30:03
  I think it's so important and vulnerability, right?
• 30:05
  Like, yeah, we're struggling.
• 30:07
  And so then they go, okay, we're struggling together.
• 30:09
  There's something about we're struggling together versus you're in this bubble.
• 30:14
  You're my leader.
• 30:15
  You have no idea.
• 30:17
  And versus you're down here with me and we're all struggling.
• 30:19
  And oh, I have empathy for you now because actually they actually checked in with that
• 30:24
  person and went, how are you doing?
• 30:27
  Like here we were going, oh my God, this is terrible.
• 30:30
  Like how are you doing as a leader?
• 30:32
  Because you're carrying so much on your shoulders in the face of like these government issues
• 30:36
  and these huge issues and the weight of like needing to make those decisions.
• 30:40
  So it shifted that dynamic and all it required was, you know, I won't say all it required
• 30:45
  because that's hard to do, you know, to be vulnerable and share, but it was a shift.
• 30:50
  And yeah, so context and transparency.
• 30:52
  You know, I think we can't underestimate the power of especially a leader being vulnerable
• 30:57
  and creating an environment that's psychologically safe for then others to actually be really
• 31:02
  authentic and honest and feel the human side.
• 31:06
  Like that's our leader is a human.
• 31:08
  It's not just someone that we vilify because we're experiencing all these problems.
• 31:12
  So a little shift here.
• 31:14
  I wanted to, you know, we met a number of years ago through the mindful practice and
• 31:18
  medicine program trainings.
• 31:19
  I've never really never asked any of my guests so far about their experience, but you brought
• 31:24
  it up earlier.
• 31:25
  So I thought, okay, this is fair game.
• 31:27
  I just want to, if you could share some of the, some of what you learned there and how
• 31:31
  it applies to your work that you're doing in well-being.
• 31:35
  So many, again, another kind of kind of worms, like a happy one too.
• 31:38
  You know, I think the self-compassion bit would be the highlight for me from that initial
• 31:44
  workshop.
• 31:45
  I remember that so, so well when I put my hand up and I said to you, it was you, and
• 31:50
  you said, I said, I don't know how to investigate with kindness.
• 31:53
  Like, I don't know what that looks like when we were talking about investigating and kind
• 31:58
  of sitting with whatever we're feeling and then investigate with kindness.
• 32:01
  And I remember it feeling like such a foreign concept, like, what are you talking about?
• 32:05
  And then you helped me walk through that.
• 32:07
  And you said, can I ask you a little bit more about that?
• 32:11
  And you said, but you know about being kind.
• 32:13
  I've observed you behaving in ways that are kind with other people.
• 32:17
  And then, so then you said, where is the block?
• 32:21
  And it was like, it's the kindness towards myself.
• 32:24
  I don't know how to do that.
• 32:26
  And then there were tears.
• 32:27
  And then there were like 50 people in the room wanting to help and tell me to put my
• 32:33
  hand on my heart and tap into that kindness.
• 32:37
  And it was just like this moment of collective, the energy of the room changed.
• 32:44
  I remember being so touched by it.
• 32:46
  And it helped me learn to turn that kindness towards myself.
• 32:50
  I needed this whole group to hold me while I turned and allowed myself to have that.
• 32:55
  And it was such a gift.
• 32:57
  It's such a gift, I think, because whether it's an error, whether it's a difficult conversation,
• 33:05
  whether it's somewhere in your life where you're feeling like you're not good enough,
• 33:08
  whatever it is, if when you're able to turn towards that with kindness, it shifts the
• 33:12
  energy and then you can actually do something about it amongst so many other things that
• 33:18
  was one of them.
• 33:19
  And then the other thing I remember as well, I remember sharing this with you at the time
• 33:22
  and going when we did that exercise of again, sitting with each other and talking about
• 33:28
  something somewhere in our medical careers that there was an error where we had, you
• 33:34
  know, felt a lot of distress around or shame or guilt.
• 33:37
  And people started sharing stories that they'd never shared with anyone ever.
• 33:41
  And then to be able to mirror back to each other, the strengths and how we navigated
• 33:48
  that with resilience, I thought that was just like it was to me, it was like, oh my gosh,
• 33:53
  that's why we can't actually truly see our full selves unless someone mirrors it back
• 33:57
  to us, just like we can't see our own faces, right?
• 34:00
  Because you need a mirror.
• 34:01
  You can't see those until someone mirrors it back to you.
• 34:04
  And then the importance of that just became really clear in my mind of why we need each
• 34:10
  other.
• 34:11
  I mean, I knew we need each other, but this was at a deep kind of existential level of
• 34:15
  like you truly, truly to fully show up in this world with everything you have, we need
• 34:21
  to do that with each other.
• 34:22
  And there's something very different about it when it happens with someone who you go,
• 34:30
  okay, this is a physician, this is a colleague.
• 34:33
  It just creates a whole other space of something that lights up within you.
• 34:39
  And so then that became kind of like my mission moving forward is like helping people just
• 34:45
  just aligning, helping people align and then they'll find this out for themselves and kind
• 34:49
  of just watching as it unfolds.
• 34:54
  And it's always so deeply meaningful.
• 34:58
  So those have been the themes as well for me.
• 35:02
  And I often draw from either my own experiences or those of people that I know really close
• 35:07
  to me.
• 35:08
  And people really resonate with those.
• 35:10
  Like they really resonate with those when you draw from your own struggles, because
• 35:14
  you'll have them, you know, and but we're not always like there's shame around them.
• 35:20
  Just like I when I put my hand up and said, I don't know how to investigate with kindness.
• 35:25
  And I remember my friend turning around because she's sitting next to me and like she'd looked
• 35:29
  around and she said, What are you talking about?
• 35:31
  Like, I'm here, like, what?
• 35:33
  What do you mean?
• 35:34
  And I'm like, stop looking at me, don't judge.
• 35:38
  And so I had that safety of the group.
• 35:41
  And it was so interesting, because this is a group of strangers, and maybe it was easier
• 35:44
  to do, because it was a group of people that I didn't really, where I could kind of be
• 35:49
  myself with, you know, there weren't the existing judgments that I had to worry about, or an
• 35:55
  image that I had to uphold.
• 35:56
  Yeah, I mean, that's a really good point.
• 35:59
  And that's why, you know, putting oneself in situations, and actually, there is an element
• 36:04
  of vulnerability that you showed and courage, but in situations where, you know, it's not
• 36:10
  your own home environment where you have to go to work the next day, and you have to work
• 36:15
  with these folks.
• 36:16
  On the other hand, I think underlying the things that you reflected on really does speak
• 36:21
  about the need for more kinds of environments that are psychologically safe to share with
• 36:27
  colleagues, our experiences at a real authentic level.
• 36:34
  We have so many incredible experiences.
• 36:35
  It's not all about like the bad things.
• 36:38
  It's like about the good things too, because we don't pay much attention to that, but being
• 36:43
  able to share with colleagues, because they get it, you know, they've lived it.
• 36:48
  They know what you're talking about it, about having been through it and being physicians
• 36:54
  and other health professionals.
• 36:55
  Yeah.
• 36:56
  And oh, you mentioned joy when you first started, you lit up when I had asked the question,
• 37:00
  because you said it was a joyful thing to reflect upon.
• 37:04
  So I did want to ask about the importance of joy and meaning in medical work in general.
• 37:09
  Oh, gosh.
• 37:10
  Just talk a little bit about that.
• 37:13
  Joy is such an important, joy and play, I think are so, so, so important.
• 37:18
  And they were a pleasant surprise for me when I did the mindful practice of medicine, the
• 37:24
  first workshop, I remember going, oh gosh, you know, that when we threw around those
• 37:27
  little beanie things and like the play brought out a whole other aspect of not just learning,
• 37:33
  but connection.
• 37:35
  And I don't think we have enough play or joy in medicine.
• 37:38
  It's, we become like these serious, busy, busy, crazy, busy, serious, like, and it's
• 37:45
  almost like the more serious you are, the more dedicated you are as a physician, right?
• 37:49
  And it's like, what happened to the joy?
• 37:51
  What happened to the play?
• 37:52
  How can we bring it back?
• 37:54
  And for me, that's been hard.
• 37:56
  I've had to learn how to, how to play.
• 37:59
  And I think some of it was just preexisting, even coming into medicine, like I think the
• 38:04
  kind of people that are drawn into medicine, you know, very dedicated, very serious about
• 38:10
  their work, able to delay gratification, right?
• 38:13
  Until eternity.
• 38:14
  It's like delay, delay, delay, delay.
• 38:17
  We're so good at it.
• 38:19
  And when do you experience the gratification?
• 38:22
  And there's always the minute we reach a certain milestone or goal, we put the bar up higher,
• 38:27
  like you don't even touch the bar yet and you're like, you've raised it higher for yourself.
• 38:31
  You don't really sit and allow any of your achievements to really land and feel good
• 38:36
  about them because you know, oh, like that's just, you know, no, no, no, move on to the
• 38:41
  next thing, right?
• 38:43
  And so that's some of like, how do you bring that back?
• 38:47
  And I did, I've been doing escape rooms with teams and I love escape rooms because I like
• 38:54
  winning and I like solving puzzles and instead of playing in those rooms, I become like,
• 39:01
  we need to do this.
• 39:02
  So kind of, you know, need to remind myself, this is play, this is play.
• 39:06
  But doing those escape rooms together, I did it back in Regina when I was in Regina with
• 39:10
  my clinical hematology team and I'm still doing clinical hematology.
• 39:14
  And it brought the team together, I think in a very different way than the roles we
• 39:19
  knew ourselves in.
• 39:22
  And it brought out sides that we didn't know about each other.
• 39:24
  Oh, this person is really good at this.
• 39:26
  Oh, this person is really funny.
• 39:28
  Oh, this person is really like this.
• 39:30
  And it was because when you're in that room and it's times ticking, there isn't time to
• 39:36
  put your mask on and your fix your image.
• 39:38
  You're just like, okay, what am I doing here?
• 39:40
  And you start to divide and do your roles and whatever.
• 39:44
  And so strengths come out and this different bonding happens.
• 39:49
  And it carried forward.
• 39:52
  So that's just an example, you know, and then we would, our team would always celebrate
• 39:56
  each other's birthdays.
• 39:57
  So we always had cake and so we tried to bring some fun in that way.
• 40:01
  And so yeah, I think it's really, really important to be intentional about that and to not think
• 40:06
  of it as frivolous or who has time for that.
• 40:10
  It's just so essential.
• 40:11
  I don't think we ever outgrow the need to play.
• 40:13
  We think it's only for kids.
• 40:14
  I think kids are smart and they know they need to play.
• 40:19
  We as adults forget about that and think, oh, we're so serious, so important.
• 40:23
  There isn't time to play.
• 40:24
  It's like, no, essential.
• 40:26
  So yeah, play and joy.
• 40:28
  Missing, missing, majorly missing in medicine.
• 40:32
  Just one more question, but I wanted to share something that just, just at this moment I
• 40:37
  remembered, I was listening to an, an ethologist, animal behavior specialist, a woman from South
• 40:44
  America, but she studied bonobos in Africa, in the Congo.
• 40:49
  That was her PhD thesis.
• 40:51
  And as opposed to chimpanzees and the bonobos and the chimpanzees are our closest relatives
• 40:56
  in the primates, the chimpanzees live lives that are somewhat violent, a lot of competition.
• 41:03
  When the bonobos find themselves in resource rich environments where their needs are met,
• 41:09
  there's plenty of food, what do they do?
• 41:12
  They don't fight with each other over those resources.
• 41:15
  They actually play in a way that is quite different than the chimpanzees.
• 41:21
  So I think it's something to really think about, you know, play and the role of play
• 41:26
  in our work lives and personal lives.
• 41:28
  So I guess the final question is, what else do you like to do for fun and enjoyment to
• 41:33
  remind yourself that play is important and that it's really, those momentary joys are
• 41:38
  as much a part of life as, you know, the challenges that we encounter and the suffering that we
• 41:44
  encounter.
• 41:45
  What else does Hazzana and Rod we like to do?
• 41:48
  Well, outside of escape rooms, which are kind of an addiction, my kids, my kids are a constant
• 41:55
  reminder of the need to play.
• 41:57
  They say, Dr. Moms, the other day, one of my daughters, I have twins, right, who are
• 42:02
  six, you've heard some of their stories, but the lately one of them has been saying to
• 42:07
  me, Dr. Moms are bossy, they're bossy.
• 42:10
  And they always say no, because everything is bad for your health.
• 42:17
  And she was really upset with that and made me laugh.
• 42:20
  But it was a reminder that probably not playing enough with them.
• 42:24
  The whole bossy is coming from, you know, probably too much of that structure and wanting
• 42:29
  to kind of nurture and care in their diet and what are they doing and all of that stuff.
• 42:32
  But where's the play?
• 42:34
  Where's the play?
• 42:36
  And I remember reading recently somewhere, where they're like a child will not come and
• 42:41
  say, I want you to spend time with me or I need to or tell me you love me.
• 42:45
  They'll say, can you play with me?
• 42:48
  And so I really think that playing with like play is a form of love is a form of connection,
• 42:56
  right?
• 42:57
  So my kids constantly remind me that I don't that I don't play enough and I'm Dr. Moms
• 43:01
  are bossy mom.
• 43:02
  So so kind of in sitting with that one.
• 43:05
  Yeah.
• 43:06
  I love that Dr. Moms are bossy moms.
• 43:09
  I'm gonna have to write a piece about that.
• 43:12
  That's really good.
• 43:14
  My daughter will help you write that one.
• 43:17
  She has lots to say.
• 43:19
  Wonderful.
• 43:20
  So is there anything else you'd like our listeners to know?
• 43:24
  You've shared so much of yourself and it's been just a wonderful conversation, very personal
• 43:30
  and engaging, as well as really concrete about what's what we have to pay attention to and
• 43:37
  what's out there and what's possible.
• 43:39
  Anything else you'd like to share with our listeners?
• 43:42
  You know, what's coming to my mind is something I was recently chatting with a friend about.
• 43:46
  We were talking about a person that she had recently she had been working with a lawyer
• 43:50
  and what she was telling me was that this person was really compassionate, really good
• 43:55
  listener and she said, just a human before, before he's a lawyer, you know, and it's like
• 44:01
  the human part, right?
• 44:02
  Like if you think of the person that you met randomly in the grocery store, who helped
• 44:06
  to find something or your kids, you know, school teacher and the people that were really
• 44:12
  drawn to what is it about them that that draws us in, right?
• 44:16
  It's their humanity and you go, they're human before you think about their skills of this
• 44:21
  and this stuff.
• 44:22
  It's that humanist.
• 44:23
  Physicians, we forget that sometimes is that people are looking for the human in us and
• 44:29
  wanting us to see the human in them and everything else comes second.
• 44:34
  That's hard to do.
• 44:36
  Sometimes easier to focus on other stuff and kind of connect human to human because there's
• 44:40
  so much vulnerability in doing that.
• 44:41
  But that's what I've been sitting with is how can I show up as a human first in whatever
• 44:47
  I do?
• 44:48
  Thank you.
• 44:49
  This conversation has been a very human conversation.
• 44:51
  I feel very connected to you as you know, at a human level.
• 44:55
  So thank you.
• 44:56
  Thanks for listening to this podcast of flourishing in medicine.
• 45:00
  We will include a summary of today's podcast and links about Dr. Radhwi and other references
• 45:06
  that were discussed in the show notes.
• 45:09
  I'd like to conclude by sharing another practical exercise to help you flourish during your
• 45:15
  work day.
• 45:16
  And I hope it adds to others that we've shared before.
• 45:18
  So you have access to a toolbox we could say of skills that you can draw upon to enhance
• 45:23
  your sense of well-being, your meaning, your purpose in your work.
• 45:27
  During the podcast, there was discussion about trauma-informed approaches to leadership and
• 45:31
  to medical education.
• 45:32
  And one of the references that you'll find in the show notes is a book written by Dr.
• 45:37
  Bessel van der Kolk called The Body Keeps the Score.
• 45:41
  And part of that book talks about how somatic domains contain the remnants of our experiences,
• 45:47
  of all our experiences.
• 45:48
  So in this brief practice, I'd like to guide you in a very short what we would call a body
• 45:53
  scan.
• 45:54
  And the only objective here is really to bring awareness to your physical sensations.
• 45:58
  And by practicing this regularly, we can begin to experience exactly how we are experiencing
• 46:07
  things in the body.
• 46:09
  And that can begin the process of a healthier integration of those experiences.
• 46:13
  So just follow along, maybe it'll last about a minute or so.
• 46:18
  So just directing your attention to awareness of your body.
• 46:21
  You can say the body as a whole or we could just say one particular part of the body.
• 46:26
  So maybe try both.
• 46:27
  Just how do you feel in your body as a whole physically?
• 46:31
  Maybe starting with your feet, feeling the sensations in the feet touching the ground
• 46:36
  or touching the chair.
• 46:38
  However it is, directing your attention up the legs, knees, thighs, noticing sensations
• 46:46
  in the pelvis, the low back, the abdomen and chest, shoulders and arms and perhaps for
• 46:57
  a moment directing your attention to whatever sensations are present in your hands and in
• 47:03
  your fingertips, there's a rich supply of very specialized structures that help us experience
• 47:10
  and touch the world through our fingertips.
• 47:13
  So noticing sensations in the fingertips.
• 47:17
  Maybe moving from the tips of your fingers to an awareness of your neck and then up into
• 47:21
  your head and to the various regions of the face.
• 47:26
  Lots of muscles and sensations that one can be aware of in the face, this very complex
• 47:34
  and wonderful expressive part of our personhood through the faces.
• 47:40
  Maybe just ending this brief body scan with an awareness of sensations of air moving across
• 47:47
  your nostrils as you breathe in and as you breathe out.
• 47:54
  I hope you found this podcast and this simple exercise useful to you and look forward to
• 47:59
  having you join us for the next episode of Flourishing in Medicine from Surviving to
• 48:04
  Thriving.
• 48:05
  If you'd like to learn more about EmPRO, please visit www.myempro.com and for more information
• 48:13
  about me and my work, please visit www.MickKrasnermd.com.
• 48:21
  You may also want to visit the website that describes the Mindful Practice in Medicine
• 48:26
  program at www.mindfulpracticeinmedicine.com.
• 48:31
  See you next time.