EP40: Compilation of episodes 21-39...

Summary episode! Some themes...CONNECT! HAVE GOOD RELATIONSHIPS! USE EMOTIONAL INTELLIGENCE TO CREATE THEM! SELF-CARE IS IMPORTANT! To save you time, if you missed any of these, each name is hyperlinked back to the relevant episodes. Thank you to Drs. Dirk Elston, Philip LeBoit, David Caruso, Henry Yang, Marie Angele Theard, Kevin Pho, Itiel Dror, Casey Schukow, Will Bynum, Gabriel Robles, Susan Ko, Ade Adamson, Robert Smith, Ian Katz, Eunice Yuen, Allison Osmond, and Thomas Helm!

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[00:00:00] Christine Ko: Welcome back to SEE HEAR FEEL. I started off with trying to explore how cognitive psychology concepts like metacognition, emotional intelligence, the growth mindset, and deliberate practice can help us as doctors, patients, and human beings in general. As we've been exploring together, I believe these cognitive psychology concepts are even more important now than ever before, given the stressors of the pandemic and life in general. This is a compilation of the last 20 or so episodes picking up after the last summary episode. In my conversation with Dr. Robert Smith in episode 34, he speaks of the current medical culture. 

[00:00:37] Robert Smith: Pearl. In a recent book, Uncaring, articulated the culture of medicine. It's medicine's culture, that you are basically working too hard and forced with too many hours a day.

[00:00:52] Christine Ko: Dr. Allison Osmond says a similar thing in episode 38.

[00:00:57] Allison Osmond: And medicine really normalizes, and sometimes even emphasizes, overwork. 

[00:01:04] Christine Ko: In addition to a culture of overwork, American society in general, and the prevalent medical culture, do not give permission to feel. Here again is Dr. Robert Smith from episode 34. 

[00:01:16] Robert Smith: And the society that I was raised in, especially as a man, it is absolutely forbidden to talk about your feelings. So it's not just medical culture, it's the culture more broadly that wants to dismiss our own feelings and emotions, which on the other hand, are the very centerpiece of what keeps society together. It's how you and I and everybody else interact. It's through emotional lives. It's really very important, this broader idea of emotion as central to not just medicine, but to all society. This broader idea is one that the public, these cultures, societal culture, and medical culture, have not quite yet embraced. And it's important. Emotional awareness, emotional intelligence. It's so important. 

[00:02:13] Christine Ko: Dr. Susan Ko in episode 32 supports this idea of the wider culture of society not giving permission to feel. 

[00:02:20] Susan Ko: Still, I think there's a bias against emotions, right, against feeling. It's fluffy. It makes you weaker. You know that whole adage of boys aren't supposed to cry, kids aren't supposed cry, adults aren't supposed to cry. These are all things that I think are still a very deeply rooted part of our society, and until we can really accept that there is a range of emotions and there's value to that range of emotions, we're going to continue to struggle with how to share that, how to have that emotional intelligence, because we're all so busy trying to hide what we actually feel.

[00:02:56] Christine Ko: The spectrum of emotions can be likened to what we can see or what we can't see. Here is Dr. Ian Katz from episode 35. 

[00:03:04] Ian Katz: I've come to really realize that there's a lot of subtlety to what we see. A lot of the stuff we see is a continuous spectrum. 

[00:03:11] Christine Ko: In addition to the prevailing medical culture of overwork and a lack of permission to feel, there is a perfectionistic culture that cultivates maladaptive shame. Here is Dr. Phillip LeBoit from episode 22. 

[00:03:24] Philip LeBoit: I think there's an idea that we're supposed to be infallible, especially if you're at a level where you're getting consultations from other people. Having an aura of infallibility is sort of part of the game that everybody plays, and it's just not true that experts are infallible, and I want to be honest about it. 

[00:03:48] Christine Ko: In episode 29, Dr. Will Bynum also touches on perfectionism as related to very high standards. 

[00:03:54] Will Bynum: We are constantly striving for high standards, I think, in medicine, to arrive at shame. We evaluate ourselves in comparison to a standard. We're constantly evaluating whether we're reaching those standards in any given moment. People often say, I'm not ___ enough, good enough, talented enough, smart enough, worthy enough, hardworking enough. And Brene Brown does a great job of distilling this down to the simplest self-talk of shame being, I am bad. Whereas guilt, which is a related emotion where the blame is placed on some thing: action, circumstantial, situational. The person may say, I did a bad thing, but I am not bad. 

[00:04:31] Christine Ko: And in episode 25, Dr. Marie Theard connects high standards to a larger problem of the fixed mindset that permeates society. 

[00:04:39] Marie Angele Theard: In general, the fixed mindset really characterizes a lot of our society. It's actually much more predominant. People who have this type of mindset, they stay away from challenges. They don't want to be wrong. They are their ability. And so anytime they fail, they take it as a strike as to who they are. They don't look forward to challenges. They avoid them. They're a little bothered when someone else is succeeding. They're a little threatened. They tend to downplay their mistakes, which I think is one of the biggest problems in medicine. Hiding from your mistakes so you don't take the time to understand them and get better. 

[00:05:13] Christine Ko: So what can we do about a less than ideal medical culture of overwork, unfeeling, maladaptive, perfectionism, and a fixed mindset? Dr. Henry Yang says in episode 24:

[00:05:24] Henry Yang: Firstly, you have to be self aware. The first basic fundamental issues is you have to have self-awareness, how much you can handle. Learn to say no. Control your emotions. 

[00:05:37] Christine Ko: Dr. David Caruso says a similar thing in episode 23:

[00:05:41] David Caruso: Mindfulness. It's that reflection on that gut feel, on that feeling, and it's sources. Not the source, but it's multiple sources. And so we can figure this stuff out, but we have to actually pause, take that breath, reflect on it, ask myself how I feel. You have that feeling, but is it reasonable for me to be angry? How would someone else react? And also like how much sleep did I get last night? Did I have breakfast? Oh gee, I didn't sleep very well. I'm just in a bad mood, so my anger is not reasonable. Someone else may not feel that way. And so that gut feel of anger or frustration, that tension in my stomach, no, I can't act on that. That's just junk background noise. 

[00:06:20] Christine Ko: Knowing how you feel requires self care. As Dr. Elston says in episode 21:

[00:06:26] Dirk Elston: The best way to take care of others is take care of yourself a little first.

[00:06:30] Christine Ko: Dr. Eunice Yuen also emphasizes self-awareness and self-regulation in episode 37. 

[00:06:37] Eunice Yuen: We need to regulate our own emotion before we even mentalize someone else. So that's self-compassion. We need to take care of our own self before we can take care of other people. 

[00:06:47] Christine Ko: And Dr. Will Bynum summarizes the importance of being self-aware in episode 30, as difficult events and emotions can impact our identities and core behaviors. 

[00:06:59] Will Bynum: We need to create more space and oxygen for those aspects of our experiences to breathe because they're hard to talk about. It's easier to talk about the technicalities of an error. It's so much harder to talk about the crushing shame I feel because of it. But that's the aspect that festers and that manifests itself in other ways that are often not healthy. 

[00:07:23] Christine Ko: As regards crushing shame, which I have definitely felt, I think it can help to accept that emotions are just data. Dr. Philip LeBoit says in episode 22:

[00:07:34] Philip LeBoit: A key thing is realizing what the range of human emotions is, in not jumping to conclusions, and being curious. 

[00:07:43] Christine Ko: If we are able to remain curious and use emotions as data points, I can take Dr. Dirk Elston's advice from episode 21 a little bit more easily.

[00:07:53] Dirk Elston: It's not the destination, it's the journey. 

[00:07:56] Christine Ko: The journey, the process is helpful because it cultivates resilience as Dr. Will Bynum says in episode 29:

[00:08:04] Will Bynum: When the goal is more process oriented, there seems to be more resilience to shame when a failure occurs or a struggle occurs. 

[00:08:12] Christine Ko: Dr. Bynum suggested that resilience is the "R" word, and if the word is triggering for you, maybe it helps to think about how we learn. Dr. Itiel Dror speaks to this in episode 28. 

[00:08:25] Itiel Dror: The problem is that even though it's great to hear good feedback, we learn from the negative feedback. If you're not defensive, this is where we actually learn the most. If you embrace them, you will make less errors in the future. 

[00:08:40] Christine Ko: And the fact is that all I have to do is just start, as Dr. Kevin Pho says in episode 27:

[00:08:47] Kevin Pho: Just start and it doesn't have to be perfect, and you learn along the way and use those mistakes and failures to strengthen your content and strengthen your voice because that's the best way to learn. 

[00:08:59] Christine Ko: As we start or continue on our individual journeys of seeing, hearing, and feeling more completely and accurately. In episode 26, Dr. Marie Angele Theard comments on the barrier that the fixed mindset presents.

[00:09:14] Marie Angele Theard: When I think about the fixed mindset, I think of detachment. I think of fear. And you're trying to keep that space between anybody new or different from you, and so you stay in your lane. The growth mindset is just full of warmth. It's about engagement. It's about getting in there and really getting involved. It's giving your all to take care of a patient. It's giving your all to teach a resident and really trying to understand them so that you can do the best job you can. 

[00:09:45] Christine Ko: Dr. Ade Adamson touched on in episode 33 that fear is also just an emotion that can be evaluated. It is not as important as engaging. 

[00:09:55] Ade Adamson: Before that paper was published, I was somewhat scared, right? Because I am going at the heart of one of the things that make dermatologists feel like we're saving lives. To question the seriousness of the increase in diagnosis of melanoma really can make dermatologists feel attacked, and I can understand that. But I would also say that it also feels good when people engage with your idea. And think about them. And subsequent to this manuscript, there have been more and more publications now throughout the literature, across the world looking at this problem. That, to me, is deeply fulfilling, as a researcher, that people are engaging with ideas that I wrote down on a piece of paper.

[00:10:46] Christine Ko: Engaging is not easy for me, and I take courage from Dr. Will Bynum in episode 28, who talks about deliberate practice. 

[00:10:54] Will Bynum: Deliberate practice is really based on the notion that by doing something over and over again, you can get better at it, and you will get better at it. But you don't go from zero to 60 without a bunch of practice, right? It requires the acceptance of the fact that I've gotta work hard to learn this and that it's gonna take some failure and it's gonna take some modification and practice over and over. And anyone in athletics or music, I was a musician going up, would tell you that's how you learn something. 

[00:11:25] Christine Ko: In terms of deliberate practice as related to emotion and expressing it and naming it, Dr. Robert Smith touches on this in episode 34. 

[00:11:35] Robert Smith: It's important to address your emotion. It helps to make it okay to talk about them: practicing, just doing it. The first time you express an emotion to somebody, and you realize the roof doesn't fall in. You're still there. Everybody's still there. Nobody's laughing at you. Because these are basic interpersonal skills that revolve around emotions. 

[00:11:59] Christine Ko: It is true for me that when I am vulnerable, when others are vulnerable with me, it can be trial and error in terms of doing what feels right and what feels right to the other person. But it is important work as Dr. Eunice Yuen explains in episode 36. 

[00:12:16] Eunice Yuen: I'm trying to set a really powerful message as a leader that it's okay to be vulnerable. Not to burden other people about your negative emotion, but to send a powerful message that it's okay to be sad, it's okay to be frustrated. Our children or our patient will be able to sense that. It's a permission to feel. Let them know they are okay to share, to speak their mind as well. It's a way to offer space to communicate. I think that could be a really interesting new way to manage people as a physician, as a mother, as a parent. Permission to feel is really important. You are important. Your feelings deserve to be listened to, heard, and shared, and we want to embrace that.

[00:13:01] Christine Ko: We can practice turning toward emotions, as Dr. Susan Ko says in episode 32.

[00:13:07] Susan Ko: How do you turn towards the emotions, especially challenging emotions, rather than run away from them. I think that's a key part of emotional intelligence. Rather than wanting to hide, that you're wanting to express that, to figure it out, even if you don't have the answers.

[00:13:25] Christine Ko: Dr. David Caruso says a similar thing in episode 23. 

[00:13:29] David Caruso: Yeah, let's use that as a signal. Let shame be used as a signal, whether slow down, consult with others, I have difficulties with a certain area. All emotions can be super helpful, right? We say they're data, they help inform us. They should make our lives better. It's a signal that's something got messed up. So let me stop. Let me examine it and let me not do the same thing. Emotion management is really the key and being smart about it and interrogating it. 

[00:13:55] Christine Ko: As we turn toward our own emotions, we will be better able to self-reflect on how we come across. As Dr. Gabriel Robles says in episode 31:

[00:14:04] Gabriel Robles: We need to make sure that we're engaging in self-reflection. Is there something that I'm doing? That could be harmful and can I change it? Even if it's small, like a small thing. 

[00:14:15] Christine Ko: Self-reflection will help us connect as Dr. Will Bynum says in episode 29, and Dr. Dirk Elston says in episode 21.

[00:14:24] Will Bynum: And we need to connect more, in our healthcare environments. We need to connect more, in our society. We need to connect more, in our relationships, and I think that's where we find maybe the greatest shame resilience. 

[00:14:34] Dirk Elston: It's not just a job. It's a human connection, and we're trying to serve someone on the other side. It's a whole lot easier when you're not just running on adrenaline, just trying to finish the day.

[00:14:47] Christine Ko: Dr. Casey Schukow also summarizes this well in episode 28.5. 

[00:14:52] Casey Schukow: Learning how to be comfortable asking for help and relying on friends and developing the relationships make, I think, life overall much more fun and enjoyable. When times are good, when times are tough, and to really reach out for help and say, Hey, I need someone, I need a pat in the back. I need someone to help pick me up. And I think that's something that when I was a football player, I tried not to be that, "I need someone to pick me up guy". I think that's the vulnerability that, now I've gotten into medical school. I've learned when to tell someone, I need someone to pick me up. And likewise, I'm here to pick you up as well. 

[00:15:28] Christine Ko: And a final thought from Dr. Thomas Helm, episode 39. 

[00:15:32] Thomas Helm: I think it's really important that you have healthy relationships, and then you also have to have the ability to appreciate another person's perspective.

[00:15:40] Christine Ko: Thank you to all who are willing to take this podcast journey with me. Thanks for listening.