EP98: Dr. Jeffrey Cohen on being mindful

Dr. Jeffrey Cohen took a course called Mindful Medicine as a medical student, and it continues to influence him today. He learned about metacognition and cognitive biases, and he emphasizes approaching all interactions with humility, curiosity, and grace. Dr. Jeffrey M. Cohen, MD is a board-certified medical dermatologist and the Director of the Psoriasis Treatment Program at Yale School of Medicine. Graduating from Harvard Medical School, Dr. Cohen completed his dermatology residency at New York University School of Medicine. His current research focuses on skin condition epidemiology, the links between skin disorders and other medical issues, and improving the delivery of dermatologic care. He has over a hundred peer-reviewed articles and serves on the Editorial Board of the Journal of the American Academy of Dermatology and the Medical Board of the National Psoriasis Foundation.

Transcript

[00:00:00] Christine Ko: Welcome back to SEE HEAR FEEL. Today I'm with Dr. Jeffrey M. Cohen. Dr. Jeff Cohen is a board certified medical dermatologist and the Director of the psoriasis treatment program at Yale School of Medicine. Graduating from Harvard Medical School, Dr. Cohen completed his dermatology residency at New York University School of Medicine, my alma mater. His current research focuses on skin condition epidemiology, the links between skin disorders and other medical issues, and improving the delivery of dermatologic care. He has over a hundred peer reviewed articles and serves on the editorial board of the Journal of the American Academy of Dermatology and the medical board of the National Psoriasis Foundation. I'm happy to call Jeff one of my colleagues. 

[00:00:46] Jeffrey Cohen: Thank you. Thank you for having me. 

[00:00:47] Christine Ko: First off, would you share a personal anecdote? 

[00:00:50] Jeffrey Cohen: Absolutely. So, I think a good way for us to start is to explain how I became interested in mindfulness and cognitive biases and all the things that you know, you spend time talking about on the podcast. My last year of medical school, a new elective called Mindful Medicine was offered. And honestly, without really knowing much about what it was, I decided that I would do that. And the two people that were leading the seminar were Jerome Groopman, who's a New York Times bestselling author who writes a lot about cognitive biases, and Pamela Hartzband, another physician who also has a strong interest in these areas. The seminar was really amazing. That really started my interest in all of this and has carried through to this day. 

[00:01:35] Christine Ko: That's cool. Sounds like such a fun course. 

[00:01:37] Jeffrey Cohen: It was great.

[00:01:38] Christine Ko: So can you talk about mindfulness and medicine?

[00:01:40] Jeffrey Cohen: Yes. I think for everyone, the way that mindfulness plays out in their professional or personal lives can be a little bit different. I think the core of it is really allowing yourself some space to think about how you're thinking and do that in a somewhat critical way. Not to say that you should always think you're wrong or that you've always missed something, but to keep in the back of your mind that idea that there could be something you've missed, there could be something more that's there, there could be some error in the way that you're judging a situation.

[00:02:14] And that may not be because of you. It may be because of the interpersonal interaction you're having with somebody else. It may be because of what happened to you 10 minutes ago. It may be because you're hungry. There are many reasons why things may not flow as smoothly as they could in your mind.

[00:02:30] And so to me I take that to remind myself that humility is key. 

[00:02:35] With patient interactions, everybody comes in, and they don't just bring their skin condition, they bring their kind of whole life background with them, and sometimes the way that they respond may not be what you would predict, or what they want may not be what you think they want, or their goal for treatment may not align with yours. Being mindful and having a mindful approach to the interaction can really help navigate some of that when it comes up. 

[00:02:59] Christine Ko: I like that. The patient comes with their whole experience behind them and their goals of treatment, for example, may not be the same as yours. Another question I have for you is: any thoughts about emotional intelligence?

[00:03:12] Jeffrey Cohen: Similar to what we've been talking about with mindfulness, emotional intelligence is also 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. We have all sorts of different people in a very multidisciplinary way that we're working with. And if you don't have any sort of sense or put any value on emotional intelligence, it's very hard to really navigate situations.

[00:03:48] I find actually sometimes when things feel like they take longer than they should, or they're less efficient than they should be, or less streamlined than they should be, and I reflect back on: why are we still talking about this?, or why is this still happening?, or why is this problem not solved yet? A lot of times I actually think it's an emotional intelligence problem more so than a knowing the solution problem. Without paying any attention to some of these things, you can't have good interactions with patients or with colleagues, and it's also just less fulfilling. It feels good when you walk out of a room and you feel like, Hey, I had a nice connection with that person. Some of the tips that you have in your book, like noting the eye color of someone, taking a deep breath when you walk in the room, some of these things can just help bring you down and have you be very present with someone. And in the end of the day, that feels good.

[00:04:40] It doesn't feel good, even if you give someone great advice, to feel like you were in and out like a Zephyr, even if you maybe solve the problem. And so I think the emotional intelligence end probably also fights a bit of burnout because not feeling fulfilled, not feeling like you did a good job, not feeling like you took the kind of care of someone that you would want to are among the contributors to burnout. 

[00:05:02] Christine Ko: I totally agree with what you said. I like how you put it, that emotional intelligence probably helps combat burnout. How do you work on improving emotional intelligence? 

[00:05:12] Jeffrey Cohen: I think the most important honest answer to that question is you really can't always prevent a disconnect. That may be because the issue at hand is actually quite challenging and difficult. Other times it can be because you are moving too quickly, and you're not taking that time to check people's emotional pulse, so to speak. The key thing to me is approaching situations with a sense of open minded curiosity. Just try to feel it out.

[00:05:38] Is that person able to accommodate what you want at that moment? Are you asking the right person to do something? Does that person seem like they are willing and able to help at that time? Sometimes those things are very important and it doesn't take a long time to do that. You can ask someone what you would always ask them. If you ask someone, Hi, how are you? Or, how's it going? Oftentimes their response to that will give you a sense of their emotional valence at that time. I think that's the probably best most practical way. You don't necessarily have time, in your daily interaction, sit down with someone and have a cup of tea. It'd be nice, but you can't do it. So you have to try to come up with, almost like System 1 ways, of just trying to do like a quick pulse check on someone. You have ways that you've developed over time to get a sense, like, what is going on with this person broadly?, and then you can dive in and figure out what the details are to try to determine kind of their state of mind or their emotional state at the moment.

[00:06:35] Christine Ko: It's coming back to mindful medicine that you are just mindfully aware also of what emotions might be there. Or I like how you put it, the emotional valence of the situation. And just being present enough to notice, if someone does seem like they have a lot of things going on or not, because I think sometimes part of the problem is that, especially if I'm like stressed or frazzled about something, I don't even really notice what's going on with other people. So that's where then I can make mistakes. Based on your other answers, I have a sense of how you're going to answer this, but I might be wrong. How do you continuously improve?

[00:07:13] Jeffrey Cohen: It's a good question. It is hard to always feel like you're improving, you always hope that you are.

[00:07:18] Honestly, if if you look at how anyone improves at anything, there are a few ways that they do that. There's a lot of social and behavioral science data suggesting that repetition is important. So if you want to be good at something, you practice it. That's key. If you want to improve, you keep practicing. You have to keep practicing.

[00:07:37] The other way is to think about how you're doing. And I think this is the part that people miss. They practice and practice. But they're not looking and saying, where did that not go? I was trying to do X. I didn't achieve X. I achieved Y. How do I get from Y to X? What is it that I did? What was the kind of root cause of not getting where I wanted to go and getting where I ended up? And, there are lots of ways then to try to address that. If you can try to pinpoint factors, you can potentially look and say, okay, is there something about my environment that's causing a problem? Can I change that? Is there something about my mindset? Mindfulness is important for improvement.

[00:08:13] I think those are some of the keys. I'm certainly no expert in this, and sometimes I improve, sometimes I don't. You just got to do the best you can each day. 

[00:08:20] Christine Ko: Yeah. I think that's true for all of us, right? Going back to one of the things you said initially about mindful medicine and being mindful: in practicing medicine or just living your life that to think critically, maybe assume that you're wrong or that you missed something. So it's like assuming that there is a way to improve in that situation. I wasn't perfect. I didn't do it 100%. I think the bias and the drive of just human nature and human thinking is to think that we are right, because somehow it's uncomfortable for us to always have to try to be better and improve.

[00:09:00] Jeffrey Cohen: It's true. And if you're, too focused on trying to improve in every way, that can be a little bit exhausting. There are certain things that you really need to improve on, and you know, people, generally know what those things are, and those are the things that are worth exerting effort and trying to get better at and really trying to do that.

[00:09:23] Being mindful doesn't make it so you reverse psychology things. You know, It makes it so that you may have an awareness of some of these psychological pitfalls, but it doesn't mean you can defeat them. And even the people who create these studies, it doesn't mean that they never fall into some of these situations. That's why they're interesting. That's why it's worthy to think about. And that's why it's so fascinating in my opinion is because even if you know about it and you know how to maybe use some choice architecture to try to lean on some of these tendencies to talk to people or to interact with others, you still yourself cannot completely prevent getting into these traps as well. 

[00:10:04] Christine Ko: It's true. Yeah. Cognitive biases are just so strong. I'm gonna ask a different question. How do you balance the various responsibilities you have?

[00:10:13] Jeffrey Cohen: Sometimes I don't know that I feel that I balance them as well as I could, but I think everybody has their own sort of way of doing things. I'm someone who often has a checklist. That's how I keep track of things. That way I know I'm not forgetting something important. I have always tried to prioritize when I could, there are things that need to get done right now, and there are things that don't need to get done right now. Try to prioritize and then allow yourself to focus on the things that you need to do right now, as opposed to allowing your mind to run to things that are not needed right now, can help with efficiency, because if you're spending 50 percent of your brain power focusing on the other things that you need to do at some point, that's brain power that you're not devoting to the task at hand. 

[00:10:56] And then honestly, not being afraid to ask people for help, delegating something to somebody else, allowing other people around you to help you do things so that you're doing the things you need to do, and they're doing the things they need to do, and you're not trying to duplicate effort. It can be sometimes hard to let go of stuff, but you have to try.

[00:11:18] And then I think one day at a time, trying not to get overly ambitious, overly stressed out, just try to do what you can. 

[00:11:25] Christine Ko: Cool. Do you have any final thoughts? 

[00:11:28] Jeffrey Cohen: Firstly, just I want to thank you for inviting me onto the podcast. It's been so nice to have a great conversation and to think about all of these exciting and important topics. The last thing that I would leave people with is to just give themselves a little bit of grace. It's easy to hear about people talking about mindfulness and how to idealize certain interactions or have an optimal outcome.

[00:11:53] Give yourself some grace. It's not always possible. Even people who are interested in this, who think about this, who read books about this, who write about this, who talk about this. It doesn't make you perfect. There is no perfect. Many of these situations involve lots of factors that you can't control, involve individuals other than yourself. You cannot control others behaviors or responses to things.

[00:12:16] And a lot of this is, you think about what you imagine is the right approach, but it doesn't mean that for everyone it's the right approach. And so there are times when there's just that disconnect, and allowing yourself a little bit of room for that and a little bit of margin for error and not taking it too hard but walking away from the situation saying well, I tried the best I could. There's really no way to be perfect no matter how much you try or how interested or devoted you are to it.

[00:12:41] Christine Ko: Yeah, there's never a perfect. It's true. I love it. Thank you so much for spending time with me. I really enjoyed it. 

[00:12:47] Jeffrey Cohen: Thank you. It's been great. Thanks for having me.