See, Hear, Feel

EP100: Compilation of episodes 81 to 99!

February 07, 2024 Professor Christine J Ko, MD Season 1 Episode 100
See, Hear, Feel
EP100: Compilation of episodes 81 to 99!
Show Notes Transcript

2023 was a tough year for me (if you've been listening, you know some of the reasons why). My memory was somewhat affected, and it was hard for me to hold things in my head (thankfully, this has gotten better). Listening back to these past episodes was a treat for me, and I hope that this compilation might help other listeners as well. 

Christine Ko: [00:00:00] 2023 was a difficult and also beautiful year that made me realize the importance of emotions and emotional intelligence, especially for self-regulation, all over again. This was especially true in my personal life with some challenges related to identity, appearance, and energy. And any time there's personal upheaval, I've come to realize more and more, it affects other aspects of my life, even if I think I am successfully compartmentalizing. In any case emotions and emotional intelligence helped me through 2023. And here's a compilation of the last 20 episodes.

In episode 83, Dr. Kavy Bhan emphasizes that emotional intelligence helps us in our workplace.

Kavy Bhan: The key component of a clinician's daily practice will involve multiple aspects that are heavily affected by emotional intelligence. Teamwork, the communication, both with patients, with colleagues, building that trust with patients and the overall clinical performance of an individual clinician, all of this is [00:01:00] affected by emotional intelligence. You need to take steps basically to be self aware, to be able to read up on all of this, to train yourself and help yourself to become a better clinician.

Christine Ko: And in episode 98, Dr. Jeff Cohen also touts emotional intelligence.

Jeffrey Cohen: Emotional intelligence is key. You can know as much as you want to know, and you can be as good intellectually as you want to be, but ultimately without a sense of emotional intelligence, it's really hard to make a connection with patients or with colleagues.

Christine Ko: In episode 84, Dr. Ellen Peters says that emotions can really serve as guides or beacons of light. She also relates emotions to dual process theory and Systems 1 and 2, which of course I enjoyed.

Ellen Peters: The way that I think emotions usually work, and what the data say, are that emotions guide us in our lives. They act as beacons in a world that's really complex and murky. [00:02:00] Sometimes we don't know exactly where we should be going. We can't quite see it. Emotions acts as a beacon of light, telling us to go in this direction or to move away from that direction. That kind of feeling is based on a whole heck of a lot of experience. It's not just that you're guessing, it's that you have years of experience of seeing something, making a decision, getting feedback about whether you're right or wrong, making another similar decision. It's that kind of world of experience that ends up getting wrapped up into these gut feelings. That doesn't mean that it's always going to be exactly right, because there are a lot of close calls out there. And then, it's not that you have to stop there with the feeling. You can also bring in that, that deliberative, okay, but let's imagine it's not this diagnosis, but the diagnosis is not something particularly serious. So even with that gut feeling, it's not that your System 1 self, your experiential self, lives on its own. It lives in conjunction with our ability to bring more thought to bear, from our System 2 selves.

Christine Ko: So [00:03:00] why do emotions get a bad rap? Empathy, or feeling another's emotions, is also lumped with sort of having a bad rap. In episode 90, Dr. Jeremy Howick addresses the importance, though, of empathic communication. He emphasizes that empathy actually improves job satisfaction, and it does not increase burnout. It's rather the opposite. 

Jeremy Howick: Empathic communication improves patient outcomes, improves practitioner outcomes, and improves patient safety because again, poor communication, including lack of empathic communication, increases medical complaints and medical errors, improves doctor job satisfaction. This is counterintuitive. People think if I'm empathic, I'll get burned out. That might happen in some cases, but the evidence clearly shows an inverse relationship. 

Christine Ko: Going a bit further, in episode 95, Dr. Rita Charon delves into common misconceptions that likely take root early on in a medical career. 

Rita Charon: There are many things that are [00:04:00] not taught to us in medical school. And one of them is, we are fellow mortals. And what happens to our patients will happen to us. And yet, isn't there this fantasy that because we're around death and serious illness so much, by now we must be immune to it. And we go to great pains, all that objectivity and the defensive distance from patients. "You must protect your objectivity. You must protect your detachment", right? And we are acculturated into this distanced, slightly ironic position, separate from those suffering patients and their frantic families.

Christine Ko: So bottom line, when we discount emotions, problems can arise. Dr. Jules Lipoff talks about the lack of creativity in medicine in episode 93, [00:05:00] something that likely creates increased fear of failure. 

Jules Lipoff: Medicine as a whole is really the opposite of creative most of the time. I don't think that prepares you well for challenges, for rejections, for failures, for really growing.

Christine Ko: And in episode 81, Dr. Samantha Dodson addresses the lack of communication skills training across many different disciplines, not just medicine. 

Samantha Dodson: A lot of people don't get that sort of training. We might get it in our families. Hopefully, you're being raised by people who are trying to teach you empathy and communication skills. But when we think about it applied to your work, I think it's something that's really lacking in curriculums across the board, not just in medicine; I've seen it in engineering, I've seen it in computer science. I've seen it in so many of these fields that we prepare students to have the technical skills to execute their jobs, but we do not prepare them for [00:06:00] these relational aspects. To assume that they can learn it on the job is a faulty assumption because oftentimes these workplaces are not set up to teach that. In a medical environment, for example, we would love to have a physician who has good bedside manner and who is supportive and compassionate and communicative with their patients, but who's teaching that, right? They're not getting feedback on their bedside manner. 

Christine Ko: In episode 88, Dr. Daniel Waters believes that empathy definitely is a skill. 

Daniel Waters: Empathy is a skill. But it takes a little work. The vast majority of physicians want to be empathetic. They just don't know how. Whenever I would talk about teaching empathy, I said, it's like looking at an impressionist painting. There's a distance that's optimal. With empathy, it's not visual, it's psychological distance or psychic distance. If you get too close, you lose [00:07:00] your objectivity. But if you're emotionless, you step too far back, and you can't really understand what the patient's trying to tell you. 

Christine Ko: Ultimately most doctors and healthcare workers care a great deal about what they do and the effect on patients. Dr. Paige Porter touches on this in episode 87.

Paige Porter: We care about our future patients that we're treating. We care about the medical field. We truly care about what we're doing. 

Christine Ko: And as much as we care, in episode 95, Dr. Rita Charon courageously confronts how medicine is being corrupted.

Rita Charon: We have to face the facts. Our noble profession has been corrupted by, some people call it an end stage capitalism, and we don't by nature as physicians have the chutzpah to unionize and get out and protest and walk off. It's not how we behave. But that's where we are. And it's not impugning[00:08:00] the integrity of the individual persons in the hospital executive suite. We've all been corrupted. So when you say how do you have time for that? The mild answer is, you can get good at this. I can listen to a patient in much less time it takes for other people. Because I know how to do it. But that's just a temporizing answer. The deeper answer is we have to confront how medicine has been deformed by corporate practices.

Christine Ko: So what can an individual do in the meanwhile? Taking pleasure in art, or harnessing the power of art, can help refocus us as Dr. Ed Vessel speaks to in episode 85.

Ed Vessel: Highly aesthetically moving paintings, it's a signal that kind of tells your internally focused network that you should pay attention. Under most circumstances, that inward focus versus external focus tend to be antagonistic and [00:09:00] mutually inhibit. You have this kind of like standard, "business as usual consciousness" where you're either like out there or in here, and they're pretty divorced from each other.

Maybe it's the case that certain meditative states, and others kind of states, can break that wall down a little bit, moments where the external world can influence ourself a bit more, or it might be moments where we are like really integrating the external world into ourself.

Christine Ko: Related to that, Dr. Earl Glusac talks about meditation in episode 91.

Earl Glusac: Regarding the benefits of meditation, for myself or for others, I'd say most of the things like improved concentration, improved emotional awareness of one's own emotions and therefore those of others as well, a sense of centering or calmness, health benefits of meditation; and these are talked about a lot in our media today. Most of these, I would consider side effects of meditation. Beneficial side effects, to be sure. And those are all great. The primary effect that I think [00:10:00] meditation brings about is, one, it meets a need that I think we all have, however deeply buried it might be, to get closer to the core of what we really are, deep inside, as a mind. That, I think, is the primary benefit. 

Christine Ko: So in addition to using art and meditative states to sort of help wake us up, self-compassion is important as Dr. Doris Day addresses in episode 89.

Doris Day: We have to be kind to ourselves. Our instinct is to criticize and to find flaws because we're hardwired to do that. My hope is that we can show more self love, still want to grow and improve. We have to be kind to ourselves and to those around us.

Christine Ko: And in episode 99, Dr. Ashley Wysong gives tips on how to be kind to ourselves. 

Ashley Wysong: There are things that I've been really deliberate about to help with that. We talked about some of those tactics earlier for avoiding , right? The avoidance piece, like setting boundaries, learning to say [00:11:00] no, early warning signs of burnout. Those things. But in addition to that, there are the things that I've added to my life for balance. For me, that's been practicing gratitude. Genuinely practicing gratitude. I have a gratitude journal. The other thing that I think has helped me a lot for balance is being present, really being present. Literally, I have it right here on my desk. Be here now. Focus on staying in the present. And I think that has really helped me from a balance perspective.

Christine Ko: I also appreciate Dr. Samantha Dodson's comments in episode 81 and Dr. Daniel Waters,, in episode 88 related to system changes. 

Samantha Dodson: As a professional, I can lean in, I can take a seat at the table. I can negotiate my salary every year or, request stretch assignments or leadership opportunities. And, once I'm in a position of power, then I can help [00:12:00] us rethink the structure, right? We can look at it both ways, and the individual can work, and the systems can work to both solve the problem together. Can we rethink publication? Can we rethink authorship or requirements for tenure? There's so many different ways that we could rethink this. Academia is not well suited for mothers, right? To me that's one of those systemic issues.

Daniel Waters: As physicians, you take bumps and bruises. It's like an NFL season, except it never stops. There's no off season when you're a doc. Deaths or the complications, they could be devastating. I think of them as emotional concussions, and they don't have to be big. They're repetitive, and they're every day. I think if you're a regular person with feelings, it wears on you. And so what did the NFL do? I always look for parallels. They got better helmets. They changed the rules a little bit; they started to worry about the health of their players. I don't think medicine is there [00:13:00] yet.

How do you get a better helmet? A better helmet is taking physicians from their student days on and saying, this difficult business, there are going to be things that are going to just tear you apart here, and you got to start early on learning how to deal with that and find role models. 

Christine Ko: Medical errors can certainly create bumps and bruises. I spoke in episode 92 with Dr. Jason Lee.

Jason Lee: Errors are unavoidable. It happens. It's part of human nature. I think you're right. We need to face it, and we need to figure out why it's made, and try to minimize it. We just have to be aware. I think that'll help. And when the stakes are high, like melanoma or not, Daniel Kahneman says, it's unavoidable to make errors. 

Christine Ko: Self-compassion relates to not being too quick to blame or praise ourselves for the outcomes of certain difficult to impossible decisions. In episode 94, Dr. Laurie Paul talks about how we make decisions in the real world versus idealized decisions.

Laurie Paul: [00:14:00] What's possible, what should we expect of ourselves, and what should we not expect of ourselves? And one thing that's really helpful in this context is to separate out responsibility from attributions of praise and blame. When making decisions, separate out being responsible for the action that you take with blaming yourself for doing something where you couldn't have actually appreciated all the dimensions of the implications before you did it. 

Christine Ko: And in episode 96, Dr. Rita Charon discusses narrative medicine, and how understanding and being able to write narratives can help us understand patients, doctors, and the world around us.

Rita Charon: Attention, Representation, and Affiliation. That's what we aim to equip our learners with. Undiluted attention. Nothing escapes you. Representation. You write it out, you capture it, you sketch it; we teach our medical students figure drawing and cartooning and playwriting. What it's all for [00:15:00] is the affiliation with a patient, with a family, with a colleague, with a nurse, with the receptionist in your practice; the affiliative investment in the wellbeing of another.

So that's what we mean by narrative medicine. It's not just, oh let's give the kids a break. Let's bring them a poem. It's not that. It's really deeply a gradually transforming set of capacities to humbly listen to another, to not get pulled away by your own ideology, your own position. 

Christine Ko: Ultimately on the deepest level, Dr. Benjamin Doolittle also emphasizes that the inner life needs attention.

Benjamin Doolitle: There's this inner life, that's so important for us to cultivate. [00:16:00] Our patients struggle with their own inner struggles that are beyond their physical illnesses. The hard part, I think, is how do we alleviate suffering? Or doubt? Or anxiety? Or worry? And some would argue, That's not medicine's job. Our job is to fix the sick body. I don't know, I think our patients come to us for more than that. I think right underneath the surface of medicine are deep interior questions that are ultimately spiritual questions. 

I think we have to show up for our bodies and our spirits and our minds, right? So we go to the gym. We exercise, we go to sleep, all that stuff. We must show up for our inner life, through reflection, introspection, worship, exercising our wonder and awe. And then we must show up for our mind and deepen our skills and our intellect. [00:17:00] Maybe when through the grind of life, if those three things get out of balance, that's when we suffer our existential crisis or our burnout. And so it does make sense to pay attention to those three things in a very intentional way.

Christine Ko: Thank you for listening to this podcast. If it means anything to you, please rate and or follow the podcast, recommend it to others and ask them to rate or follow as well. I appreciate you.