[00:00:00] Christine Ko: Welcome back to SEE HEAR FEEL. Today, I have a compilation of episodes 61 to 79. In the last compilation of episodes 41 to 59, we touched on the importance of recognizing the emotional landscape, our own as well as that of others. Emotions help us take care of ourselves as well as others, including patients. And compartmentalization and detached concern are probably not optimal. Emotions are actually also involved in error, and normalizing the fact that we all make mistakes helps me stay more vulnerable and open. Together, I think and hope we can make changes in the culture of medicine. And that is the major theme of the last 20 episodes: togetherness, self in the context of others. As Dr. Warren Heymann says in episode 61:
[00:00:49] Warren Heymann: The older you get, you realize what Jackie Robinson said, the life matters for how it affects other people. What we do directly affects other people. And that's the other person, whether it's your student, your patient, your colleague. It's not all about you, it's about everyone. And I think it takes time to learn that.
[00:01:09] Christine Ko: And Dr. Stephanie Preston says in episode 75.
[00:01:13] Stephanie Preston: The affect and appraisals of the people around you are gonna influence how you respond. People are thinking, If I don't show any emotion, I can't make the people around me upset, right? Like you have to set a good example and set a good emotional tone for the team. It's like an intuition based on the idea that we do know emotion is contagious, that we try to tamp it down, in professional settings. They're thinking, oh that way we'll be objective and avoid bias, but it's actually a false understanding of emotion and decision making when people do that because all decisions are affectively laden.
[00:01:57] Christine Ko: Doctors do compartmentalize. We have to, and yet as Dr. Peter Whang says in episode 73:
[00:02:03] Peter Whang: As a human being, sometimes compartmentalization isn't necessarily good. And I think that's one thing that's been really interesting is that there are ways to use your emotions to strengthen certain aspects of your life.
[00:02:14] Christine Ko: In episode 76, Dr. Stephanie Preston addresses a common myth regarding emotions and empathy - that they lead to burnout.
[00:02:19] Stephanie Preston: Burnout is one of the reasons people give to justify eliminating empathy from medical care, right? They'll say you can't empathize because that will lead to burnout. And I think they're confusing empathy with personal distress or like emotional contagion. Rather than telling people they shouldn't have empathy, it would be good to train people as to the benefits of having empathy, and how it can be successfully integrated into medical care, and how to address burnout by adding some efficacy to whatever the people can do. So finding ways that they can be of assistance is gonna solve the problem a lot better than just telling them not to have emotions because this has been part of your biological makeup for hundreds of millions of years. We share this affective brain with rodents, with monkeys with all kinds of species.
[00:03:21] Christine Ko: We all have relationships, whether at home or outside the home. In episode 77, Dr. Ellie Stillwell puts emotion into perspective as related to the work setting.
[00:03:32] Ellie Stillwell: Work relationships actually make up a big chunk of our emotional and social support network. Emotions and relationships become so important at this kind of work, non-work interface. When I talk about emotions, the perspective that I take is that emotions serve a social function to help us connect with people, to communicate with how we're feeling with people. Emotions have social functions that they play in social relationships. So when we express emotions at work, what we're doing is we're trying to connect with someone on that kind of social emotional level of, you need to understand me as a person, as a human.
[00:04:08] Christine Ko: And understanding others is an individualized process that takes practice. Dr. Barry Schwartz describes practical wisdom in episode 78.
[00:04:17] Barry Schwartz: There's a kind of wisdom that enables us to make very concrete, practical decisions on a daily basis, like how to talk to a patient. Whether to be honest in a conversation with a friend. We all think that you always wanna be honest, but sometimes when you're honest, all you are is hurtful and you need to figure out how to balance honesty with kindness.
[00:04:40] So it takes judgment to know how to approach a patient, a friend, a romantic partner, a student in a class.
[00:04:51] Christine Ko: Circling back to burnout, just as Dr. Heymann emphasized the importance of others, it is others who can keep each of us on a practice path. Dr. Kira Schabram emphasized in episode 62, that people with a calling have the least burnout when the calling is not about personal identity or what I alone can contribute but about practicing together.
[00:05:12] Kira Schabram: We called that the practice path. Number one, they did not see themselves as unique. They saw themselves as part of a community of practice. And so they didn't constantly feel the onus to take on everything. Instead, they were there to learn from others and then also to delegate and train others. So I think that's one really important bit about if you view work as a calling, make sure that doesn't isolate you, that instead you realize that there's lots of other people out there with that calling, and that the only way to do this sustainably is to be part of that community.
[00:05:42] Christine Ko: Dr. Schabram continues in episode 63:
[00:05:45] Kira Schabram: People who we describe as being on that practice path seem to naturally be doing the things that we would advise to do if you are looking to combat burnout.
[00:05:53] So they are engaging more self-care. They know when it's time to go home and take a break, and they're also engaging in more other compassion. They are creating this community. They're mentoring other people. They are helping others. And not only are they feeling good about that and learning from that, but when it came time to rise into leadership positions, people would nominate them because they'd say, Hey, here's this person who looks out for others.
[00:06:16] Christine Ko: In terms of compassion, this is Dr. Schabram's definition from episode 64.
[00:06:21] Kira Schabram: Compassion is a behavioral process that starts with noticing when someone's going through pain, either yourself or others, putting yourself in their shoes in the case of others, or feeling the sense of common humanity. This could happen to anyone. I can't blame myself for that. And then importantly, doing something about it. So when I talk about compassion, I talk it about: Noticing, feeling, empathy, and then doing something.
[00:06:46] Christine Ko: And I still love her concept of compassion as a muscle with self-compassion and other-compassion working that same muscle, from episode 64.
[00:06:55] Kira Schabram: The more you notice other people needing, the more you can also notice your own needs. The more you respond to others, the more you give yourself grace. So all of this tends to go hand in hand, which I think is really beautiful.
[00:07:07] Christine Ko: And in episode 69, Dr. Yu Tse Heng speaks to the fact that self- and other- compassion do not have to be time consuming.
[00:07:16] Yu Tse Heng: The benefit of self- and other- compassion is to be aware of our suffering and being able to alleviate it in small ways. We're in a pretty fast paced society where we're always on the go, what's next?
[00:07:26] Christine Ko: In episode 66, Dr. Vinh Chung quotes:
[00:07:29] Vinh Chung: There's an African proverb that says, if you want to go fast, go alone. If you want to go far, go together. And that to me summarizes the transition that we all need to make as doctors. Where we are incredible individual achievers, but we need to move beyond achieving and to learn how can we collaborate and connect with our team?
[00:07:56] Christine Ko: In episode 79, Laurie Zorn says,
[00:08:00] Laurie Zorn: Where growth mindset is so important in this work is recognizing you have agency. You have ability to move. And that is the work I do in my practice, to help people not only recognize it but create movement and create new behaviors. So they are able to be flexible and agile given the challenges, issues, opportunities that they face in this ever-changing world.
[00:08:21] Christine Ko: Similarly in episode 68, Dr. Jacob Towery talks about shame attacking as well as mindset shifts because...
[00:08:28] Jacob Towery: People can get tricked into thinking it's events that determine how we feel, but it's far more common that our thoughts, our interpretations, determine how we feel, which in some ways is great news cuz you and I have little control over earthquakes and tsunamis and trains and all sorts of things in the world. But we can learn how to have more control over what thoughts we tell ourselves in our mind.
[00:08:48] Christine Ko: This type of control takes thinking about how we think as demonstrated by how we see and observe. In episode 67, Dr. Irwin Braverman talks about truly seeing a patient versus inspecting for particular physical exam findings.
[00:09:04] Irwin Braverman: You would think that this skill of looking carefully at the patient, not just the skin, but looking carefully at the patient, would've been something that would've been instilled in us when I began medical school. But what was emphasized was called inspection, when you did a physical exam. The catch was that what we were inspecting for, we were told what to look for in advance. We were not taught to really look carefully. We were taught to look for specific physical findings that would be part of some disease.
[00:09:44] Christine Ko: And this dovetails with what Dr. Mel Goodale says an episode 70, that what we perceive is really influenced by what we have experienced in the past.
[00:09:53] Mel Goodale: People come through different labs, different traditions, different training regimens, and so therefore they apply what they've learned in the past to interpreting what they see. Absolutely true. I think that happens. It's not unusual.
[00:10:06] Christine Ko: We definitely do use past experience to guide us because we live in an uncertain world. As Dr. Gerd Gigerenzer notes in episode 71:
[00:10:16] Gerd Gigerenzer: Most of our decisions are decisions under uncertainty, not under risk. We do have data, but not enough.
[00:10:23] Christine Ko: Interestingly Dr. Gigerenzer connects uncertainty with emotions in episode 72.
[00:10:28] Gerd Gigerenzer: Oh, I have a positive attitude towards uncertainty. So imagine the world would be totally predictable. Certain we would know everything that happens in the future. We would know when we die. We would know on what we die. We would know everything. And how boring would that be? There would be no disappointment, no hope, and no reason to have any emotions. You don't even have to trust someone because you know already. Without uncertainty, we wouldn't need emotions. We also would need no intelligence besides maybe calculation. And, nothing would ever be new. No innovation.
[00:11:10] Christine Ko: So if uncertainty allows for innovation and emotions, both can create more meaning in life. As Dr. Kira Schabram says an episode 62,
[00:11:19] Kira Schabram: Human beings need meaningfulness in their life. I believe that, and I think the empirical evidence backs that up, that meaningfulness can come from work. And if you are lucky that you see work as a calling and it meets your expectations, I think that can be a really wonderful thing. But if you find meaningfulness outside of work from your family, from your hobbies, your civic organizations, your church, I don't think we should judge that.
[00:11:42] Christine Ko: And Dr. Casey Schukow gives good advice in episode 74, with which I will end this compilation.
[00:11:48] Casey Schukow: That's a take home message: just try to have fun doing what you do. You're gonna have setbacks. That's life. Take it in stride. Your priorities, stay true to them.
[00:11:58] Christine Ko: Thank you for listening in to this podcast, I would love your support. And if you're willing to give it, please follow, share, and rate the podcast. I hope that we can all have more fun as we follow our passions and search for meaning.
