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Flourishing in Medicine: From Surviving to Thriving Episode 19 Healing the Healers: Dr. Sara Charles on Malpractice, Mental Health, and Medical Community Transformation · Flourishing in Medicine: From Surviving to Thriving

• 0:00
  What do you think about the work that you do?
• 0:05
  And I think that medicine is morally and existentially serious work.
• 0:13
  I don't think it's like any other work that anyone does.
• 0:17
  Other people may not think so.
• 0:19
  I think lawyers tend to think, you know, it's just a job and just get used to it.
• 0:24
  But it's not. It's not just a job.
• 0:27
  It's much more than that.
• 0:29
  And it deals with birth, sickness, health sometimes, and death.
• 0:37
  And there's nothing certain about any of it.
• 0:41
  So it's a wonder anything gets done that's as well done as it is these days.
• 0:48
  So I think that maybe more appreciation of the nature of medical work might help.
• 0:57
  Welcome to Flourishing in Medicine from Surviving to Thriving.
• 1:04
  I'm your host, Dr. Mick Krasner, and this podcast is produced by EmPRO,
• 1:08
  a medical professional liability insurance carrier headquartered in New York State
• 1:13
  and committed through its many peer support offerings to supporting physicians they protect.
• 1:19
  Today's podcast is titled Healing the Healers.
• 1:24
  Dr. Sara Charles on Malpractice, Mental Health, and Medical Community Transformation.
• 1:30
  Sara is a psychiatrist and a professor emerita at the University of Illinois College of Medicine.
• 1:37
  In 1976, she endured a grueling six-week trial for medical malpractice,
• 1:43
  and the experience of that trial so profoundly affected her
• 1:47
  that she began to study the emotional, mental, and physical effects of malpractice litigation on physician defendants.
• 1:55
  Her pioneering research, published in the 1980s and 90s,
• 1:59
  is still relied on today by physicians, clinicians, and experts in physician wellness.
• 2:07
  She's now retired from active practice, and she remains engaged, however,
• 2:11
  in promoting the wellness of health care professionals who become involved in malpractice litigation.
• 2:17
  Her interest research and investigations has led to the publication of several seminal books
• 2:22
  about the experience of physicians being sued,
• 2:25
  and she also founded and established the Physician Litigation Stress Resource Center.
• 2:33
  And now, my conversation with Sara Charles.
• 2:37
  Welcome to flourishing in medicine. So lovely to have you.
• 2:42
  Well, I'm happy to be here, and happy finally to meet you, who I've heard a great deal about.
• 2:47
  Oh, likewise, likewise.
• 2:50
  I like to start these conversations with all the guests with a very similar question, which is, you know, why medicine?
• 2:58
  What was it in your, was it maybe upbringing, early experiences, maybe experiences you had early on in your college education or beyond that,
• 3:08
  other things that happened to you that had you decide to really make the commitment to respond to a calling?
• 3:15
  And I do believe in a lot of ways it is a calling.
• 3:18
  And you could just walk us through kind of that story, so what we could call the origin story of your profession in medicine.
• 3:27
  Well, nobody's ever asked me before why I became a doctor, interestingly enough.
• 3:32
  I think when I was, I was from a fairly large Irish Catholic family.
• 3:38
  I had six brothers and sisters. Education was very much a goal, I would say.
• 3:45
  Boys and girls were expected to achieve no matter what.
• 3:50
  And we weren't pushed, but we were given the opportunities.
• 3:55
  And I think I started out thinking I'd like to be a social worker.
• 4:01
  But for some reason, I ended up majoring in biology and minoring in chemistry, which isn't exactly the pathway to social work.
• 4:11
  And that eventually led to medicine. I thought about being an OBGYN,
• 4:17
  but I had friends and mentors who suggested maybe psychiatry. I was better fitted. And I think in retrospect, I would have made a terrible surgeon.
• 4:28
  So I think it was the right path to go. That's about it.
• 4:34
  Well, I'm curious about this large family, six brothers and sisters, education being a high value in your family and expectation.
• 4:44
  And this something about you mentioning social work and this desire to when I think of social work,
• 4:52
  I'm thinking of, you know, concern for our connections with our community.
• 4:57
  And even though you chose the sciences as your pathway, what was it that made that important to you, the social issues, the community, the context that medicine is embedded within our culture?
• 5:09
  Was there something about that family dynamic upbringing or experiences you had or what how your parents maybe thought about their role in the larger society that didn't still have?
• 5:23
  Well, I think you tapped into it a little bit. I think my parents were very they weren't certainly overly active,
• 5:31
  but they were active in church and in the general culture of the community in which we lived, both my mother and my father.
• 5:41
  And I think more than anything, if anybody had an interest that seemed to be realistic, they were encouraging about it.
• 5:50
  So that, you know, I began to work in little things, I think, in high school with the Red Cross and things like that. So and that was encouraged.
• 5:58
  I lived in an environment that enabled each one of us to develop. And you can't beat that as far as I'm concerned.
• 6:08
  I agree. I think in some ways that's what I would define as a privileged environment.
• 6:15
  And it doesn't mean financial privilege or any of that. It's really the privilege of having values instilled within your family and also the opportunities,
• 6:23
  at least to pursue education that you weren't thwarted along the way, you were in some ways supported and even pushed a little bit.
• 6:30
  And maybe you can talk a little bit about that kind of privilege being accessible to educational opportunities, other job opportunities.
• 6:39
  And what you thought of yourself as as your role in caring for other people in your community, your fellow human beings, we could say in a broader sense.
• 6:50
  At which phase of my life would you say?
• 6:53
  Well, I'd say early on, say before you began medical education.
• 6:59
  Well, you know, I'm reaching way back. I haven't thought about these things very much.
• 7:07
  So I would have to take some time to think about that. I think that's a question that would take a little contemplation, so to speak.
• 7:16
  But I certainly it was a given in our family. I wouldn't say there were expectations.
• 7:24
  There were there were it was as though this is what you did, you know, and you found your own way.
• 7:32
  And and I would have to say among my own siblings, different people chose different things.
• 7:38
  I had a brother, a lawyer, you know, sister, an administrator and a college. I mean, you know, they did different things and all achieved.
• 7:48
  So we were very fortunate. No, I think you've actually answered it.
• 7:52
  No need to contemplate further that does answer that question.
• 7:55
  So let's come back to medicine now. You've decided to go into medicine and you felt you wouldn't make a good surgeon.
• 8:03
  You sort of matter of fact, we told us about you became a psychiatrist or you went into psychiatry.
• 8:08
  But I'd like to also hear a little bit about that story. Why psychiatry?
• 8:12
  And the reason I'm asking this is, you know, this podcast is about flourishing in medicine.
• 8:17
  And it's really, I think, interesting for our listeners to hear the paths that other people take,
• 8:24
  mostly because we all in some ways identify with there's something that really connects physicians together
• 8:30
  in terms of what initially brings us into this profession and hearing from others, it's sometimes reaffirming one's own path.
• 8:39
  I think, as I say, when I when I first started in medicine, I was interested in OBGYN.
• 8:45
  When I was in medicine, when I graduated from medical school, which I hesitate to take how many years ago it was, there were 121 men and four women.
• 8:55
  So it was a very different world. I mean, it was inconceivable, I presume, for many of today's medical doctors.
• 9:04
  But that's the way it was. So I guess what I would say is that people around me recognize that I listen to people.
• 9:15
  It was little things like that. And I have to say, I don't think it was my clerkships in medical school in psychiatry
• 9:23
  that attracted me particularly to psychiatry. But more once I got into clinical medicine, in general medicine,
• 9:32
  I took my internship in New York City. So it was it was it was an interesting time.
• 9:38
  And I think that's where I began to be interested in psychiatry.
• 9:45
  So really, through caring for actual medical patients, you could see the effects of the whole biopsychosocial aspect of a person's life
• 9:55
  and that you felt very suited toward it. Right. You know, gaining expertise.
• 9:59
  And I was encouraged by others to kind of think that through. Yeah.
• 10:04
  So what I'd like to do is maybe you can walk us forward to the story of how the physician litigation and stress organization
• 10:14
  developed and it may take the form your choice of sharing some personal experiences that actually led to this
• 10:22
  tremendous interest as well as contribution, really, we could say, to our professional well-being through your own experiences and then
• 10:30
  through actually sharing that, including the book The Defendant, The Psychologist on Trial for Medical Malpractice.
• 10:37
  Yeah. Whatever aspects of that you'd be willing to share. But I think that would really be interesting,
• 10:42
  assuming that most of the listeners will not know anything about either your experiences or the physician litigation stress organization.
• 10:50
  I really like them to know about that because such a great resource.
• 10:55
  Well, I'll tell you anything you want to know about those early years.
• 11:00
  I was in private practice in Chicago and I was seeing a young. I think she was a graduate student.
• 11:10
  She was a graduate student in psychology, as I remember.
• 11:14
  This is almost 50 years ago, though. I mean, it's hard to believe.
• 11:20
  And she was a borderline patient, a patient with borderline personality disorder and very difficult, very difficult.
• 11:27
  And it was from a very conflicted family. So that we were working diligently.
• 11:34
  And she had been in the past hospitalized in New York one or two occasions.
• 11:40
  So, I mean, she was she had a history before I saw her and I saw her regularly in psychotherapy.
• 11:48
  And I don't know if you want to know any of the events, but she had gone home to New York for a weekend
• 11:56
  and somehow had one of her storms and got a former psychologist involved and a former psychiatrist involved who medicated her, even though she was my patient.
• 12:11
  All of this occurred without my knowing anything about it. And this happened.
• 12:15
  I think the event would have been in, I don't know, 1974 or something like that.
• 12:21
  At any rate, she flew back to Chicago and oh, I know what it was.
• 12:27
  Her father called her from New York and said, we have medication on the way.
• 12:31
  We're getting this medication for you without, again, my knowing anything about it.
• 12:36
  And she panicked when she heard that these people were going to treat her.
• 12:40
  And she jumped off the roof of her apartment building and was quadriplegic.
• 12:44
  So I went to the hospital, et cetera.
• 12:47
  Interestingly enough, the neurosurgeon that was involved ended up to be the neurosurgeon to Ronald Reagan at the time that he was the White House physician, Daniel Ruge.
• 12:57
  And I remember him saying to me at the hospital that day, he said, you know, this family is going to sue somebody.
• 13:04
  I don't know whether it's going to be you or it's going to be me. It's going to be one of us.
• 13:09
  Five years later, my husband brought him the book at the White House and said it was her, not you.
• 13:14
  So anyway, that's kind of how the whole thing started.
• 13:17
  And of course, I was furious that I and I continued to see her while she was in the hospital and in her rehab.
• 13:25
  And I think I saw her for about a year, almost a year after she had the injury.
• 13:33
  Whatever came about, she decided she didn't want to see me anymore, after which she at which point she sued me.
• 13:40
  And I guess I was sued in nineteen seventy five. So all of this must have happened in the year and a half or so before that.
• 13:46
  That's basically the the onset.
• 13:50
  Now, I don't know what else you want to know about that.
• 13:53
  Well, like to hear the impact that had and how that motivated you to really investigate and open up this whole conversation around what it's like to go through a malpractice action as a physician.
• 14:12
  Well, I first of all, I was angry and I had a wonderful husband who supported me in every possible way. And we really didn't talk about it very much to the family or anything.
• 14:24
  And of course, in those days, you weren't allowed to talk to anybody.
• 14:28
  I mean, you were totally isolated, which was one of the problems.
• 14:32
  Doctors, in fact, in those days didn't talk about anything about how they felt.
• 14:37
  You just do your job and deal with it as best you can.
• 14:42
  So and the case took about almost five years before it was finally went to trial.
• 14:48
  So that it was a long period. And I was certainly angry. I was seeing patients all the time.
• 14:55
  I continued what I was doing, but it was very, very disruptive experience, to say the least.
• 15:02
  So that after the trial was over and I won, I talked with my defense attorney who was very supportive, very helpful.
• 15:13
  And I told him I was going to go to law school. And he said, No, no, no, that's not a good idea.
• 15:20
  I was, you know, I was ready to do anything.
• 15:24
  And he was the one actually who talked me into, you know, see what you can do in your own field. You feel so strongly about this.
• 15:33
  So I did. I started I started with the head of the American Medical Association, Jim Sammons, at the time, who had been a family practitioner.
• 15:42
  And when I told him what I was thinking of doing, addressing the issue, I didn't know quite how to go about it.
• 15:49
  But I know there was no research on it at all. Nobody had asked any doctors how they felt about it.
• 15:55
  And he kind of turned me over to the lawyers. But before turning me over, he told me all about his own lawsuit,
• 16:02
  which had stimulated him to leave medicine and go into academic medicine or into administrative medicine.
• 16:10
  So he sent me to the lawyers and the lawyers told me what they usually tell me.
• 16:15
  So anyway, again, my own lawyer, my own defense attorney was the one who suggested I look into the Cook County jury verdict
• 16:25
  reporter, which was a list of all the lawsuits in the Cook County, Illinois, and named who was named and what the suit was about and the doctors and the lawyers.
• 16:38
  Well, I subscribe to this. I got a monthly report and I saw people I was working with every day at the university who were in this list.
• 16:49
  And it kind of astounded me in a way. And I mean, people that I was head of a committee then and they were my committee members.
• 16:59
  They were sued surgeons mostly. Anyway, I went to the president of the Chicago Medical Society when I gathered this information.
• 17:10
  Al Clemente, who was a wonderful human being and who knew exactly what I was talking about because he'd been sued.
• 17:18
  So then he told me about his lawsuit. But he also gave me the names of names of doctors in Chicago that I could.
• 17:25
  And we did surveys and started to get the information. And it was it was amazing how asking doctors if they'd had the experience and what it was like, I got reams of material.
• 17:36
  I mean, nobody had ever asked them. So it was very, very helpful.
• 17:41
  And then we began publishing a little bit. And that's kind of how it all got started.
• 17:46
  But let me say one thing. The doctors who answered those questionnaires in the early years were enormously helpful. And I always remember a couple of them.
• 17:56
  One of them stressed to focus on the litigation part of it, not on the medical malpractice, which was a very wise thing to say.
• 18:06
  And the other one was that he said, you know, I decided I could be bitter or I could be better. And he said, I decided to be better.
• 18:18
  So, I mean, I was instructed by a great deal from these various doctors who had experienced that. So anyway, that's how I kind of got started.
• 18:27
  Does that answer the question?
• 18:29
  Yes. I'd like to ask a little bit about if you could define that a little further, this statement focus on the litigation, not on the medical malpractice.
• 18:39
  This comment from one of the sounds like courageous number of people who came forward and were willing to share their experiences with you.
• 18:46
  What did that person mean by that? Well, well, it stimulated me to look into the whole issue.
• 18:53
  And really what in my study of it was that medical malpractice litigation has very little to do with medicine.
• 19:01
  It has to do with the tension between insurance and the law. In other words, who's going to pay?
• 19:10
  And interestingly enough, in culture in the United States, gradually, no fault has become kind of the way of resolving the issues between the law and insurance.
• 19:26
  But somehow medical practice or the health care system is immune to that agreement.
• 19:35
  In other words, very few doctors are disciplined as a result of the medical malpractice system.
• 19:42
  They're more harassed than anything from my perspective.
• 19:47
  So that that's what I meant by the distinction between medical malpractice and litigation.
• 19:52
  Yes. No, that makes sense.
• 19:55
  And I'm just thinking this idea of the tension between who's going to pay, whether it's the insurance or, you know, what not.
• 20:02
  I wonder about if that was really deeply understood, would that have changed this whole conspiracy of silence that seems to be still present, although it's maybe not quite the way it was in the mid 1970s.
• 20:18
  But I would say that I know statistically, many of my colleagues have had lawsuits, but I don't know on an individual level, we just never talk about it.
• 20:31
  Well, I think there's an element of shame of being singled out.
• 20:38
  There's a feeling of isolation.
• 20:41
  Somehow it makes you different. It really doesn't make you different, but it does feel like it makes you different.
• 20:46
  I think shame is part of it, even though it's really not shameful to have it happen.
• 20:52
  I think also that from my perspective, the real assault is on the doctor's sense of integrity, that somehow you're not a good doctor, even though you know that's not what it's all about.
• 21:07
  But that's the accusation.
• 21:09
  And if you read the complaints, that's really what they're saying is that you're really not you don't know what you're doing.
• 21:16
  You're not very good at it, and you should be punished for it.
• 21:20
  And the way we're going to punish you is to cost you a lot of money or your insurance company a lot of money.
• 21:26
  People don't want to talk about it.
• 21:29
  Yeah, I think you're right. I was looking through the physician litigation stress website and I pulled up this article that I think I read because I'm a member of the American College of Physicians from almost 10 years ago.
• 21:41
  It's called World Changing. It's in on being a doctor section of the Annals of Internal Medicine.
• 21:46
  I know you're familiar with the article and this physician, that impact on that person's sense of being not just good, but just adequate, competent, all those things which we sacrifice so much for and really care about very, very deeply as physicians, as professionals.
• 22:08
  She just articulates it in that article so beautifully.
• 22:11
  And so I'm wondering, maybe you can talk a little bit about the notion, or at least what you think, how much do medical liability actions and the whole litigation issue factor into this problem, this epidemic we could call it if we want to call it that, of burnout among health professionals.
• 22:30
  You know this podcast, again, is about flourishing ways in which we can have more flourishing, meaningful, successful work life so we can continue to do this and not do say what your colleague who became part of the AMA do is leave the clinical practice of medicine.
• 22:48
  I think the issue from the beginning has been the problem of support from colleagues.
• 22:54
  It's a big part of it. Again, in my experience, and I remember wonderful doctors telling me about this.
• 23:03
  If you've never been sued, you don't want to think about it.
• 23:06
  And you don't want to have anything to do with it.
• 23:09
  And if you have been sued, you don't want to think about it.
• 23:13
  Because it's too painful.
• 23:15
  And yet I think the thing that would be most helpful is, for example, many years ago, we had a wonderful group in the Chicago Medical Society that, I guess it was the Illinois State Medical Society, where we met regularly.
• 23:34
  Doctors who were sued were regularly invited to participate and there was, it was very, very helpful to doctors to hear each other express how they felt about things.
• 23:47
  And I remember the lawyers were a little bit concerned because they might talk about their cases, but they kind of let us go, which was very good of them and it worked out very well.
• 24:01
  And I have to say, one of the things that was most helpful was we had a staff person at the society who coordinated everything very well because the doctors were busy.
• 24:14
  But she, she reminded people and she called people and she, she did a lot of the footwork.
• 24:20
  And when she left, it got much less organized because doctors don't organize these kinds of things, generally.
• 24:30
  I do think peer support is really very, very helpful.
• 24:34
  How to organize it depends on a lot of issues.
• 24:38
  And again, from my perspective, the culture of medicine is so different from when I was practicing.
• 24:47
  I mean, it was just very different.
• 24:49
  The people involved were wonderful, wonderful human beings that really were trying to help people and trying to get through this experience as best they could.
• 24:59
  You mentioned culture, Sara, the culture of medicine and part of that culture begins very early, or at least the enculturation, we could call it, of the medical student and the trainee, the resident trainee.
• 25:11
  And so the medical education system plays a role.
• 25:15
  And I'm wondering about, you know, what can be done in medical education?
• 25:20
  For example, as I finished my medical training, residency training, then went out into practice, I really wasn't that familiar with how to manage uncertainty.
• 25:32
  But I faced it every single day in practice, of course, I was not that familiar with understanding how ubiquitous errors in medicine are and that all the roots of those errors, the systemic multiple causes,
• 25:47
  and that some errors do not lead to bad outcomes.
• 25:50
  Many bad outcomes have nothing to do with an error or not caused by errors, etc.
• 25:54
  So maybe you can share with us some of your thoughts about what can be done at the medical education level to help people understand that, you know, errors is a part of practice, it's a part of life.
• 26:06
  And also uncertainty.
• 26:07
  We are dealing with human beings.
• 26:09
  They're not reading the textbook, as you know, as the aphorism goes.
• 26:13
  They're just having their lives and their illnesses just the way they uniquely unfold.
• 26:18
  Right.
• 26:19
  Well, I'm not sure how I can help towards medical education at the moment, but I can tell you what I think is essential to something that you mentioned just then.
• 26:29
  And that is that in uncertainty and ambiguity is central to the work that we do.
• 26:38
  And I think that medicine is morally and existentially serious work.
• 26:46
  I don't think it's like any other work that anyone does.
• 26:49
  Other people may not think so.
• 26:51
  I think lawyers tend to think, you know, it's just a job and just get used to it.
• 26:57
  But it's not.
• 26:58
  It's not just a job.
• 26:59
  It's much more than that.
• 27:01
  And it deals with birth, sickness, health sometimes, and death.
• 27:10
  And there's nothing certain about any of it.
• 27:13
  So it's a wonder anything gets done that's as well done as it is these days.
• 27:21
  So I think that maybe more appreciation of the nature of medical work might help because I don't think when I was in medical school, anybody.
• 27:33
  I mean, we understood the nature of medical work from the doctors that we worked with.
• 27:41
  That's how we learned, I think.
• 27:44
  And I can still remember some of these wonderful doctors.
• 27:49
  But they were the models.
• 27:51
  And that was really what medicine, the practice of medicine was based on when I was in school.
• 27:58
  I don't know what it is right now, to tell you the truth, because I'm way far away from that.
• 28:05
  But I think the central, as you say, the vocation of medicine is central to dealing with any of these problems, burnout, what have you.
• 28:17
  And the expectations that you have of yourself and your own sense of self as a physician helps to, and your sense of integrity.
• 28:28
  And the things you learn about thinking about others first before yourself, which is a big issue in medicine.
• 28:39
  You can't make the practice of medicine comfortable, I don't think.
• 28:44
  Everything you say, I agree with in that statement, that it's morally and existentially serious work.
• 28:51
  I think that is absolutely true.
• 28:54
  And I also think that, you know, for you not being engaged in current medical education, I think all of that is still alive and well.
• 29:01
  I think the inspiration of our teachers and of our clinicians that are practicing remains an exemplar of what we do in some ways, Sara.
• 29:12
  I think we've made the extraordinary, like you said, it's amazing anything gets done, we've made the extraordinary into very ordinary.
• 29:20
  And I think that's part of the difficulty with communicating to the public is extraordinary is the expectation.
• 29:29
  And so people are very disappointed when that extraordinary doesn't happen for whatever reasons and errors, among other things, being the reasons.
• 29:40
  So thank you for that. That was, I think, really helpful for any medical educators listening to this podcast.
• 29:46
  I think they can think about how to translate that into into an educational environment that that helps that.
• 29:54
  Can we come back, if we could, Sara, to the Physician Litigation Stress Organization, because it is a tremendous resource.
• 30:04
  I was spending time on the website. I've actually contributed an essay to one of the blogs a couple of years ago, but it has so much on it.
• 30:12
  Support resources, online resources.
• 30:14
  Amazingly, I went down the rabbit hole of discovering, you know, there's a lot of things that the U.S.
• 30:20
  government has put out there that is very helpful for people practicing medicine who are either facing or are anticipating a career in medicine of how to manage when a litigation issue comes up like this.
• 30:33
  So can you talk to us about how that formed, how that was created?
• 30:37
  That actually grew out of, I can't remember when we wrote this book, Paul Frisch, who was a wonderful lawyer whose father had been a doctor and his brother was a doctor.
• 30:48
  He was the lawyer with the Oregon Medical Society.
• 30:51
  And I met him through work at the AMA and the litigation long time ago.
• 30:56
  I mean, long time ago.
• 30:58
  Paul has been dead 10 years maybe. But anyway, he and I were working on the book Adverse Events.
• 31:05
  And we had money from a foundation here in Chicago that I knew.
• 31:11
  And we had some money, to tell you the truth.
• 31:16
  We decided that the best thing we could do is set up a website.
• 31:20
  So we got an OBGYN that was the head of the ACOG, people we knew.
• 31:28
  I mean, there was a group of us that knew each other at this point through various things that would have been the late 90s.
• 31:35
  And there was a lawyer from Michigan, Ted Pazano.
• 31:40
  Anyway, and Maureen Mondor, who was, Gerri knows very well, from Boston.
• 31:48
  I mean, just enthusiastic as can be.
• 31:52
  So we got this group together and set it up basically.
• 31:57
  And it just took off.
• 32:00
  So I had a niece who was in the business of developing websites.
• 32:05
  So I don't remember even paying or maybe we did.
• 32:09
  I don't remember whether we did or not.
• 32:11
  But anyway, that's kind of how we got started.
• 32:14
  We had a very good group.
• 32:15
  We met regularly, talked about how to respond and how to develop this and kind of how it started.
• 32:25
  I think it was 2005 when we started it.
• 32:30
  Well, it is a very useful website, very user friendly, has a tremendous amount of easily accessible information on it.
• 32:39
  And we'll certainly feature it in the notes that we'll have about this show so that people who are listening will be able to gain access to it quite easily.
• 32:47
  Well, I want to say that we were very fortunate when we lost Maureen Mondor through retirement.
• 32:53
  We got Gerri Donohue, who brought the same enthusiasm and interest in doctors to the endeavor, which has saved it, actually, since I said I'm getting too old for everything.
• 33:08
  I'm not, but I'm too old for something.
• 33:12
  So anyway, well, that can be a useful excuse to get you to do something else that you're that you're moving toward.
• 33:20
  You are an expert in this field and your work and how you speak about it, even with me right now, is very, very relevant to our current times.
• 33:31
  And perhaps if you could give the listener just a couple of practical things to think about.
• 33:39
  You don't have to be exhaustive in the summary, but I'm thinking about what are some preventive proactive things people can do in practice?
• 33:48
  What are some reactive things they can think about doing in response to an action, at least some early things?
• 33:55
  Resources that you think are really could be really helpful to people, those kind of things. What are some practical things around medical malpractice to enhance our well-being, to be able to manage when these inevitable things come up for so many of us?
• 34:12
  Well, I mean, that's a big request, but I'll do the best I can.
• 34:19
  I think, first of all, you have to practice as best you can. You have to keep competent.
• 34:26
  I mean, you have to be competent. You have to keep up your competence. You have to study constantly, I think.
• 34:34
  You have to keep current. Hard to do these days, I think.
• 34:41
  It's important to keep in relationship with other doctors. You can't go it alone. I think that, I don't know, are you referring to what happens if there's a bad event and that sort of thing?
• 34:58
  If you'd like to give a few easy pieces of advice to get people just to orient themselves.
• 35:05
  You know, there's a lot of emphasis these days on a balanced life, and I think there's a question of what is a balanced life, really.
• 35:14
  Unfortunately, I think a doctor has to think that the work that they do is very important work.
• 35:22
  And that it means that you're thinking of other people more than you're thinking of yourself. Trying to get the balance between what you do, the work you do, and your family is a challenge.
• 35:36
  There's no question about it. So I guess from, again, this is my perspective, if you're going to get married, make sure you know what you're doing.
• 35:45
  Because, again, in my experience, sometimes doctors get into relationships that don't work out, then they're more isolated than ever.
• 35:56
  They're angry about what's happening in their own personal life, and they're angry about what's happening in medicine.
• 36:03
  And as a result, their patients, I think, suffer. And I think good relationships is the key to a happy life.
• 36:12
  Well, you've named a couple of very, very useful things to think about. And I'll kind of summarize.
• 36:18
  Keep current. Keep up to date. Value and develop relationships, especially with your colleagues, because that's going to be your source of support throughout your professional life.
• 36:29
  Keeping the importance of the work you do at the fore and that necessarily that work requires us to think of others at times before we think of ourselves.
• 36:39
  And then the final one, I think what I got out of that was really know yourself and know what your motivations and drives are so that your decisions that follow lead you down a path that is satisfying, not a surprising path where you really know yourself and why you were even there.
• 36:58
  And then suddenly have an existential crisis like this isn't working out quite the way I thought it was going to.
• 37:06
  And you did it better than I did.
• 37:09
  Oh, I don't know about that, but I wanted to rename it because I think it's they were very useful things. But thank you for being very kind.
• 37:17
  Good. Really coming toward the end of this, I would like, I want to hear a little bit about what you do to care for yourself.
• 37:25
  You seem very vibrant, alive, the mind is really clear. What do you do to have fun? We talked a little bit before we started recording about your location on Lake Michigan and how you have a way of getting down to the shore there.
• 37:39
  But maybe you can tell us what it is you do that really feeds you and keeps you wanting to wake up the next day and face the world and be curious about being alive.
• 37:50
  Well, I keep busy, but I keep busy doing wonderful things. I have a big family. I have no children. I have nieces and nephews that are wonderful. Couldn't be better.
• 38:05
  The location doesn't hurt because people like to come to the beach. I have a wonderful housekeeper. So she evens irons their sheets, which they also like very much.
• 38:16
  So it's a nice place to come to. So I have, I have, especially in the summer, I have a very busy time. You know, I have a lot of social life with my family.
• 38:26
  I live actually away from everybody in my family because my family spread not only through the United States, but through various other parts of the world.
• 38:38
  But we, we Zoom and that sort of thing. I do reading that I never had the opportunity to do before.
• 38:47
  I don't really belong to book clubs because they never read what I'm interested in.
• 38:53
  So I'm reading the Divine Comedy right now and I'm in, I've got as far as Paradiso and I'm struggling, but I'm learning a great deal and enjoying it very much.
• 39:05
  And I have a nephew that I talk to about because he likes the same kind of thing.
• 39:10
  I have a Zoom with my sisters bi-weekly that I run. I have a big house. So I have a whole retinue of workers that come and go and fix this and fix that and keep me busy.
• 39:26
  I work with the church a little bit. I work with one of the deacons there a little bit and run a group every once in a while and do things like that.
• 39:36
  I have widows that I go out to dinner with. I'm busy.
• 39:41
  Until recently, I had my 97-year-old sister that I would go to South Bend to look in on every week because she was, had memory problems and was in a facility at Notre Dame, outside of Notre Dame.
• 39:57
  She had been a very well-known, she had been a associate provost at Notre Dame, first woman dean at the University of Notre Dame. She was quite an extraordinary person.
• 40:08
  She died at 97 just before Christmas. So that work that I was doing, keeping her dressed and she liked McDonald's hamburgers, believe it or not, etc.
• 40:24
  So anyway, I keep busy enough.
• 40:27
  Well, that's very inspiring and what an exciting life she must have had and many of your family members and what I'm hearing from you that keeps you going, keeps you alive is in some ways the same things that you chose in your profession, which was relationships, was being kind of intimate with people and being close.
• 40:48
  I did want to share with you, I enjoy a little writing and I recently wrote an essay for my blog on using the Divine Comedy, at least this notion that Dante was exiled when he started to write this and it was a terrible exile from his Florentine roots, which really was his world.
• 41:09
  And so with that came this incredible journey piece of literature that transformed the whole Italian language in a very real way. And I think about, you know, your contributions in medicine and in this in physician litigation and the stress involved.
• 41:27
  In some ways it came out of perhaps kind of an exiled place, a dark place of feeling isolated and alone as you described when you were facing this malpractice action. I wasn't quite as creative as Dante but...
• 41:42
  Some people are geniuses just the way it is. Yeah, yeah. Well thank you. This has been absolutely delightful. I don't know if you have anything more you'd like to add to share with our listeners but I'll give you the opportunity if you there's something else you'd like to finish up with, if not.
• 42:00
  Well you're a very good interviewer and I've done a lot of interviews in my life and you know what you're doing and I think you should keep doing it for the good of medicine because...
• 42:12
  Well then do me a favor just let Gerri know your feelings about that and then maybe she'll keep hiring me to do this so that would be great.
• 42:19
  Well, I have a way with Gerri so we'll see what we can do.
• 42:23
  Thank you so much for listening. We will include a summary of today's podcast and links about Dr. Charles and other references that were discussed in the show notes.
• 42:33
  I would like to conclude by sharing another practical exercise to help you flourish. During the podcast you've heard a number of facets of Dr. Charles's malpractice litigation journey.
• 42:45
  Perhaps this has invoked in you feelings of anxiety or kind of an empathic emotional resonance.
• 42:53
  What's happened possibly is that areas of your nervous system that are in distress became quite active.
• 43:01
  This simple sitting practice will allow those experiences to be present, not denying them, but directs the anchor of our attention on the breath and this can be really useful in times when we are aware of being triggered in such a way.
• 43:15
  So beginning with just an awareness of yourself sitting here or standing here or however you are positioned.
• 43:24
  And directing your attention, which is pretty remarkable, we can actually place our attention very specifically in certain locations.
• 43:34
  Direct your attention on the breathing, the experience of breathing.
• 43:40
  Experience of breathing in, the experience of breathing out.
• 43:47
  The thoughts and feelings and all that other stuff is still going on, no doubt.
• 43:54
  But it's filtered a little bit by this focus on the breath.
• 44:00
  Not what the breath is doing, not what we're thinking about the breath. You can perhaps even say to yourself to remind you, breathing in, I'm breathing in.
• 44:11
  Breathing out, I'm breathing out.
• 44:15
  And so on with each subsequent breath.
• 44:26
  You can continue on with an awareness of the breath for as long as you'd like or just three or four or five breaths and then proceed with your next activity or whatever it is that you are in the midst of doing.
• 44:41
  I hope you found this podcast and the simple exercise useful to you and look forward to having you join us for the next episode of flourishing in medicine from surviving to thriving.
• 44:53
  If you'd like to learn more about EmPRO, please visit www.myEmPRO.com.
• 44:59
  If you'd like to know more about EmPRO's peer support programs, please visit www.myEmPRO.com forward slash peer dash support.
• 45:12
  I'd like to thank Gerri Donohue, the vice president of education for EmPRO for producing this podcast and Stan Sainjour for his technical expertise in recording and editing.
• 45:23
  If you're a physician or medical student and you need urgent support, please consider calling the physician support line at 1-888-409-0141.
• 45:36
  For more information about me and my work, please visit me at www.MickKrasnermd.com or www.mindfulpracticeinmedicine.com.
• 45:50
  Until next time.