EP88: Dr. Daniel J. Waters on The Healing Power of Empathy: Insights from a Veteran Cardiothoracic Surgeon

Join Dr. Waters and host Christine Ko in this insightful conversation that delves into the emotional and human side of healthcare, offering guidance for both patients and healthcare providers. Discover practical tips for developing and teaching empathy to healthcare professionals and the positive impact it can have on patient care. Learn about the challenges patients face when navigating the complex healthcare system and how having an informed advocate can make a significant difference. Explore the joy and humanism in the field of medicine as Dr. Waters shares his passion for the profession. Discover the therapeutic benefits of writing as a form of self-expression and reflection for healthcare professionals, and how it can contribute to their overall well-being. Dr. Daniel J. Waters, DO, MA, retired in 2019 after three decades as a cardiothoracic surgeon and medical educator. He graduated from Rowan SOM and earned his advanced writing degree from Lenoir-Rhyne University. He is the author of six novels and numerous published scientific papers, stories, essays, poems and opinion pieces spanning more than 40 years. In 2019, he received the Charles L. Ballinger Distinguished Osteopathic Surgeon Award from the American College of Osteopathic Surgeons. He has also received writing awards, including the Nancy Pearl Award for Best Book for his title, Ship Bottom Blues, as well as first place in Creative Nonfiction/memoir for his piece, “Breathe for Me”, by the Pacific Northwest Writers Association Annular Literary Contest.

Transcript

[00:00:00] Christine Ko: Welcome back to SEE HEAR FEEL. Today, I am honored to be with Dr. Daniel Waters. Dr. Daniel J. Waters, DO MA, retired in 2019 after three decades as a cardiothoracic surgeon and medical educator. He graduated from Rowan School of Medicine. Previously, that's the University of Medicine and Dentistry in New Jersey, and earned his advanced writing degree from Lenoir-Rhyne University. He is the author of six novels and numerous published scientific papers, stories, essays, poems, and opinion pieces spanning more than 40 years. In 2019, he received the Charles M. Ballinger Distinguished Osteopathic Surgeon Award from the American College of Osteopathic Surgeons. He has also received writing awards, including the Nancy Pearl Award for best book for his title, Ship Bottom Blues, as well as first place in creative nonfiction/memoir for his piece, "Breathe for Me", by the Pacific Northwest Writers Association Annual Literary Contest.

[00:01:00] Welcome to Dan. 

[00:01:02] Daniel Waters: Thank you. Thank you for having me. 

[00:01:03] Christine Ko: Would you first share a personal anecdote? 

[00:01:06] Daniel Waters: I'm going to tell you, I've been a patient more times than I would like to tell you. My medical rap sheet is fairly checkered. And one of the things I will tell you about being on the other side of the bracelet, as I like to say, is we are nothing like we think we are when we're physicians. So I had a thing show up on a chest X-ray 18 years ago, and my good friend and colleague was a pulmonologist, and the first thing he said, Is it okay if we get a CAT scan? And I said, Do I need a CAT scan? And he said, Yeah. I said, Then why are you asking me if it's okay? Very interesting when you deal with doctors. So I went and I got the CAT scan, and I'm laying on the table and you feel vulnerable on your back and in a gown. And next thing, the radiologist, lovely woman who I'd known for a little while, comes out, and she was tongue tied, and all she could say to me was, Yeah, there's something in there. And then she left. I thought, Wow, that's a learning experience. Ended up being a thymoma. It was benign, but I will never ever forget that. And if I had to write a memoir, it would be, there's something in there.

[00:02:18] Christine Ko: Thank you for sharing that, Dan. You have had experiences on both sides of the bracelet, the patient side, the physician side. Can you talk about teaching empathy, which you've written about? 

[00:02:30] Daniel Waters: Empathy is a skill. But it takes a little work. 

[00:02:34] Christine Ko: Like any skill. 

[00:02:35] Daniel Waters: 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 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.

[00:03:03] The other thing I would always emphasize is that 90 percent of communication is non verbal. You have to be paying attention. And what really worries me is the way medicine is evolving, we're distracted from the thing we should be paying attention to. 

[00:03:21] Christine Ko: Yes. With your experience as a physician, as a patient, do you have any sort of simple tips from that skill perspective? 

[00:03:31] Daniel Waters: Put yourself on the level with the patient. Being a patient, being in the bed, supine, even if you're elevated to 30 degrees, is daunting. You feel very vulnerable when you're on your back and you're not in control. And so you can alleviate that almost right away by simply sitting down, and then, look at the patient, look them in the eye, look their family members in the eye, make some sort of human contact.

[00:04:01] Don't be afraid to reach out and put a hand on them in comfort. And then, don't start with, so what brings you to the hospital today? Try and weave in a few questions about the patient. Are you working, are you retired? What sort of things did you do? Have a little back and forth. I think the message that you need to send is, I see you as more than just a set of symptoms or findings in the bed. I see you as another person. 

[00:04:25] Christine Ko: Yes. When I'm a patient, in that first couple seconds, I'm really deciding, should I trust this doctor or not? Is this someone who does see me as a person or not? And it's interesting. I think I am time poor, like I don't have a lot of time. And so I am not so willing to switch doctors once I already have one. But yeah, it does help me as a patient if I feel like I do trust the physician, and they do see me as a person rather than just a set of symptoms or disease or diseases.

[00:05:04] You've written about listening, too, that listening is a skill. Do you have any tips on how to listen well, like what you could start with if you're trying to improve? 

[00:05:13] Daniel Waters: The easiest thing to do is ask a few non clinical questions, just a few personal questions, to flesh out, so to speak, the person in front of you. That starts you on the road to listening. 

[00:05:27] Christine Ko: Yeah. Small talk is very important, but I will say that I didn't know that earlier on in my career. It's actually something I only learned in probably the last couple of years, sadly. I don't know if I just missed that sort of tip somewhere along the line. So now I'll ask about a tattoo they have or jewelry they have or a book that they're reading when I come in, or something. You're right. It just humanizes the entire interaction for the patient, but also for me. It sets my brain a little bit in a slightly different way.

[00:06:03] Daniel Waters: All the things you've said are absolutely true. In the hospital, there's a gold mine of things to ask about, and that goldmine is right in front of you on the bedside table. Conversation starters are almost everywhere.

[00:06:16] The other thing I learned is that you can extend some of those things. Like when we would do our timeout before a big case, I would always mention something personal. This is a retired veteran, served in the Vietnam War. This nice farmer from Southern Iowa did this or that. And again, you don't want to go too far but this humanizes the patient to the whole team. 

[00:06:39] Christine Ko: I really love that. I've had surgery myself. That's so comforting to hear that you, at least one surgeon out there, does that while the patient is under and not aware. 

[00:06:53] Daniel Waters: These are things that I can't say I walked out of the fellowship and said I'm going to do. Like you said, they're just things as my consciousness a little bit expanded about this, maybe this is a little better.

[00:07:04] Christine Ko: That's good. In one of your articles, you had a phrase in it, "chronic repetitive emotional injury", that the doctors are subject to throughout a career. Can you talk about that a little bit? 

[00:07:16] Daniel Waters: Yeah, I nudged that further and said it was like carpal tunnel of the soul. 

[00:07:20] Christine Ko: Yes. 

[00:07:21] 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 don't have to be a thing that knocks you out, but they're repetitive, and they're every day. I think if you're a regular person with feelings, it wears on you. 

[00:07:46] Christine Ko: Yeah. I like all your analogies. So carpal tunnel syndrome is analogy for this chronic repetitive emotional injury. And earlier, when you were talking about the impressionist paintings and that to have empathy, you need to be at the right distance. How do you deal with this chronic repetitive emotional injury? Say you are even at the right distance....

[00:08:08] Daniel Waters: It's a really good question. 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 yet.

[00:08:21] 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. The last few years, when I was a director of medical education, I did a narrative medicine seminar with students and the interns and occasionally faculty would show up. We ended up just talking about how do you deal? Most programs don't teach you the one important thing is how to deal. What do they say about physicians? We compartmentalize. We internalize. And I just read an article that suicide among surgeons is at an all time high. And, and I think we do our students a disservice at some point if we don't have some sort of structure, here's how to be in better emotional shape. Think about strength and conditioning in football. One of my kids is a strength and conditioning coach and it, yeah, the better conditioning you have, the less injury you have. We could think about medical training that way, the better conditioning you have, the less injurious the things that we have to see become.

[00:09:35] Christine Ko: I love that. You've put it so well. I think that's why I've been working on my own emotional intelligence the last couple of years, because I think that does help me have the strength and conditioning to deal with patient encounters, but also my own life beyond that, things that happen with colleagues, things that happen with my kids or friends or whatever. That's helpful. 

[00:09:59] So related to that, do you have tips for navigating the healthcare system? 

[00:10:05] Daniel Waters: Yes. You need an advocate, and if you have an informed advocate, all the better. The system is not really geared to helping you. It is between Byzantine and labyrinthine, trying to get anything done, and trying to understand, and how not to go down a blind alley. The other thing is, do a little research ahead of time. Go in with some questions. Always ask what the alternatives are. And when you go to the doctor, record things if you're allowed to write things down because patients remember 5 percent of what you say because to them, the experience is overwhelming. To you, it's another day at work. 

[00:10:45] Christine Ko: Yeah, I like that.

[00:10:46] Daniel Waters: You can't do it by yourself. It wouldn't matter what specialty you were in. You cannot do it by yourself. And, there are realities of practice. Doing the best you can, some days, it's an impossible job. So that's another thing you have to be like, okay I'm doing the best that I can. 

[00:11:02] Christine Ko: It comforts me to hear you say, you just can't do it alone. Doctors are very independent people. I think we're used to just pushing through a lot of times on our own. It helps to hear someone say that you just can't do it alone, at least not all the time.

[00:11:17] And so reach out for help, ask for help. It's not always going to be there, but I think when we can get it, and hopefully we can set ourselves up to have it, that's probably really wise. 

[00:11:26] You first got a certificate and then you got a master's in narrative writing. 

[00:11:31] Daniel Waters: I was a writing nerd in high school, the editor of the high school newspaper, and I wrote in college where I could, I had a liberal arts education courtesy of the Jesuits. And then when I got to medical school, I was like, man, there's all kinds of cool stuff to write about, writing as something therapeutic and something expressive. You don't have to be a writer to write. You can write for yourself, click save, and put it away, and it's exquisitely therapeutic. 

[00:11:56] Christine Ko: Yeah. Do you have any final thoughts? 

[00:11:59] Daniel Waters: Yeah, medicine is the world's best job, it just is. It's my own personal bias, the joy in medicine. There's tons of it. The humanism, the ability to sit and look at a patient. We're taking care of human beings. To humanize the profession wherever you can is maybe one of the biggest challenges, and that not only helps the patients, it makes for healthier and better physicians. 

[00:12:24] Christine Ko: Yeah. Thank you very much for your time. 

[00:12:26] Daniel Waters: Thank you for having me.