EP152: Where Passion Meets Professionalism: Dr. Vineet Arora's Approach to Medicine

Navigating Healthcare: Mentorship, Wellbeing, and Innovation with Dr. Vineet Arora

In this episode, we are joined by Dr. Vineet Arora, Herbert T. Abelson Professor of Medicine and Dean for Medical Education at the University of Chicago Pritzker School of Medicine. Dr. Arora discusses her career trajectory, emphasizing the importance of preparation, passion, and leadership in medical education. She talks about the significance of mentorship, addressing how to advance both personal and professional goals. Dr. Arora also delves into the challenges of physician wellbeing, the balance between patient care and self-care, and the cultural shift needed in medical training to prioritize physician health. The conversation covers the compression of work, the potential impact of AI in medicine, and the crucial role of emotional intelligence in patient-doctor relationships. Finally, she shares insights on handling constant change in the medical field.

00:00 Introduction and Guest Introduction

00:57 Dr. Arora's Career Journey

02:56 Mentoring and Coaching in Healthcare

05:40 Challenges in Physician Well-being

09:32 The Impact of Duty Hours and Work Compression

14:05 The Role of Emotional Intelligence in Medicine

15:28 Final Thoughts and Conclusion

Transcript

Christine Ko: ​[00:00:00] Welcome to today's episode. I'm really pleased to have Dr. Vineet Arora with us. Dr. Arora is the Herbert T. Abelson Professor of Medicine and Dean for Medical Education at the University of Chicago Pritzker School of Medicine. She's an internationally recognized expert on patient handoffs and a pioneer in improving the learning environment for medical trainees. As an accomplished researcher, Dr. Arora has developed tools to enhance communication during handoffs, investigated the impact of sleep loss on patient outcomes, and led groundbreaking initiatives to integrate residents into hospital quality improvement programs. Her dedication to equity and innovation in healthcare has earned her numerous awards and recognition, including being named one of the 20 people who make healthcare better by Health Leaders Magazine. Thank you, Vineet, for joining me today. 

Vineet Arora: Thank you for having me.

Christine Ko: How did your career end up [00:01:00] becoming what it is right now?

Vineet Arora: I'm a firm believer in Louis Pasteur and the quote, "Chance favors the prepared mind." I am a strong believer in learning and getting prepared for a whole host of activities. And then also following your passion, understanding that there are things that you may be passionate about that don't pay the bills and then there's things that pay the bills. you know. I went into internal medicine and fellowship trained as a researcher and did a lot of my work on sleep. Also studied handoffs and patient safety and quality in medical training. Thinking about it more from, how do I teach about quality and safety and sleep deprivation?, et cetera. My first leadership jobs were in quality and safety and hospital medicine, you know, working on training residents about quality and safety, embedding them into the health care system, things like that; being what I would call a bridging leader, bridging between medical education and the health system to integrate trainees into various aspects of the learning environment. I was pretty content doing that work and doing my research career. And that's where chance [00:02:00] sometimes occurs. In my case, when the COVID 19 pandemic hit, it was like an opportunity to kind of think, well, what do I really want to be doing? And also see where my research was going. It was sort of at a natural stopping point, if you will. And so then a job position came open as Dean for Medical Education. And somebody was like, Oh, you were nominated, you should throw your hat in the ring. So I did. And so by keeping my foot in the door in medical education in smaller roles, I would say that I was able to position myself for the job that I have right now. You don't need to be necessarily a subject matter expert in everything to be a leader. What you need to do is be able to coach and inspire others who are the subject matter experts to lead in those areas. So that's what really drew me to the role. And I had had a long track record of mentoring and coaching. I'm mentoring and coaching a lot of leaders into their role, partnering with them.

Christine Ko: What is something that you [00:03:00] often feel people In healthcare need mentoring or coaching about that is sort of maybe like an easy fix?

Vineet Arora: There's no easy fix. When you're changing human behavior, it can be hard. And, you know, when we're talking about doctors, right? These are people who have gone through pretty rigorous training to get to where they are. They've sort of adapted with these really incredible survival skills. That's why I think the word resilience sometimes falls flat. These are resilient people. you know. Because a lot of coaching is pretty individual, I don't know if this is an easy fix, but it's really important to me that people feel that they're advancing forward in their goals, you know, not just their professional goals, but their personal goals as well. It's really easy with junior people because they have those exciting milestones ahead of them. I just published my first paper, or I just finished my first course that I taught, or I just did my first case of this interesting, novel thing.... The junior folks in academia have a lot of those moments. But mid [00:04:00] career and senior folks need them to, because they need to be fulfilled. No matter where you are in your career, you should be thinking about your next step.

Christine Ko: I like how you put that. There's no easy fix. Yeah. I was hoping there would be, but I guess there's not. It just really seems like it comes down to awareness. Just thinking, really, and thinking about what you're doing. Like with what you just said, thinking about what your next goal might be or what you would feel satisfied with in terms of your career. 

Vineet Arora: People spend a lot of time working long hours for things they believe in, for things they're passionate about. When people burn out, it's that they no longer have the passion, right? Our job, really, and also the system, is gotta be to allow the passion to survive. A career in medicine relies on this complex combination of technical expertise, and emotional IQ, as well as some passion for the work.

Christine Ko: I love how you just put that. I've [00:05:00] never heard anyone say it quite like that, but I think you're right. 

Vineet Arora: We're not robots, right? There are things that move us, right? And a big part of why we select people to go into medicine is because they are passionate about the work, right? Because we know it's not for everyone, right? You have to have an inner passion for it as well. We talk a lot about work hours and there's a lot of focus on wellness activities, but two things that sometimes need to be really thought about very carefully are, how do you make the work easier? So people have the support they need. And, how do you keep their passion alive? So that while they're doing their work, they still have that sentiment that I'm doing something exciting that I like.

Christine Ko: Do you have advice on how to thrive in this type of high pressure environment?

Vineet Arora: My general advice would be that what works for somebody may not work for you. You have to decide what are the systems in place, people, other things, that will [00:06:00] help reinforce your wellness as you go through. Understanding that your wellness is not just about, do I feel happy at the moment? It's more about, are you able to continue your routine? It's like, how can you continue to work in that homeostatic, you know sort of sweet spot so that you can continue to provide the care that you need to, to others, while you know that you're cared for as well. 

Christine Ko: Yeah. 

Vineet Arora: And sometimes you can't. Sometimes, you know, bad things happen. You may have a death in your family, right? And that's having systems in place so that you can take the time off that you need to, right? So there is a system level component where the system has to value the fact that sometimes people will need to stop working and get well. This is where the tension comes with wellness work, either all seen as like vacation, retreat, pet [00:07:00] therapy, or it's so to the extreme where somebody is like, well, you got to be resilient and just carry on in the face of major pain. The truth is that people have to meet in the middle about it, right?

Christine Ko: Yeah, I like it. My question would be why you think that healthcare systems struggle to prioritize physician well being, even though we do know that it directly impacts patient care?

Vineet Arora: The social contract of medicine, of being a physician, is really to put the patient at the top of your priority list. And the way medical training has been historically structured relies on people to forego sleep and various elements of well being so that patients can get the care that they need. People willingly do that so that they can take the best care of their patients. Now, the challenge is that that sort of goodwill as part of being a physician sometimes has led to the deprioritization of [00:08:00] wellbeing to say, okay, well, of course, the doctors are going to work over the weekend. Of course, they're going to stay overnight. Of course, they're not going to object to this, that, or the other thing. The values of the profession have called upon doctors to place such a high premium on serving their patients at the expense of their own health and well being.

Christine Ko: Yes, the patient needs to come first, but when you're not working, you need to figure out how to prioritize yourself. How did you become aware of this? 

Vineet Arora: I should say it's interesting when you're asking me about well being. I don't consider myself a well being expert. And if you asked people like, am I a model of well being? They might say no. You know, I am a leader in medicine, and I'm Type A like a lot of doctors are. Clinical or nonclinical, I place a high value on work. I don't think that a lot of us have been taught how to strike the right balance. And that is what leads to the burnout. Because if you are taught how to [00:09:00] strike the right balance, you would protect your time. There are times where people are willingly out there prioritizing other things over themselves. And that's a good thing. People do that every day, but too much of that, and you won't have a full cup for yourself. So it's really about making sure that you're well enough to keep taking care of the unwell. 

When did I first become aware of this? I went through a residency, you just stayed. You stayed until the work was done. You stay till your work is done and you work these exhaustive long hours. That was the kind of experience that I had. The first time I realized that this was going to be a huge culture shift was when I was a chief resident, helping to implement the duty hours for the residents coming after me. At that time, it was such a culture shift that we had people often stay over their work hours, right? It wasn't immediate. People would routinely stay over and be like, I got to stay because I'm really invested in my patient. And sometimes you had to let people know, like, Okay. [00:10:00] We have set up a team so that you can exit and it will be okay. We've written a little bit about this concept of professionalism in medicine and what is the ethical tension between professionalism and shift work? Because you know, physicians are not traditionally thought of as shift workers, although that's changing. The introduction of duty hours was important to reform because it really led to people realizing that, yeah, there is a limit to how long doctors should be able to work. For their own health and safety as well as for patients, the system needs to be redesigned to allow for these shift changes to occur safely. There are many industries where shift work is the norm, like nursing and law enforcement. People don't accuse people of being unprofessional because of working a shift. In medicine, that culture was just not there, and it started with the design of training. [00:11:00] Tension here is that in the shift that you create, people are doing more. It's really this concept of work compression. A lot of us, when the duty hours came, it was like, okay, let's just design the shifts to be compliant, right? People didn't actually think, well, should you still be admitting the same number of patients? The caps didn't change. It was like, okay, you'll just admit 10 patients in 12 hours instead of 10 in 24 hours. So, in some ways what got squeezed out, you know, was a little bit of that downtime, you know, when you took long call, you know, you weren't like working every single second. There was a little bit of downtime. Believe it or not, sometimes you could take a nap in the call room; other times you couldn't, but there was time to get food, right? Now, the intensity and pace of work, because of the various demands of the healthcare system and the patients, the patients are sicker, huge focus on throughput in hospitals because of the finances and sort of the pressure [00:12:00] there. You know, discharge before noon. Wasn't a thing when I trained; you just discharge when you discharge. So now you've got all these extra pressures. That's really adding to the work intensity, and the patients are much sicker. A lot of the lower acuity care has now moved into the home, and so as a result, what you see in the hospital are very sick patients. 

Christine Ko: This idea of work compression.

Vineet Arora: The system has set it up that way. It's set up for volume over value. Especially with the advent of AI, you know, what is a doctor? And then, what can you augment a doctor to do with AI? And, what will patients accept? I still think a human element is going to be required. It's hard to imagine that you won't have a human element.

Christine Ko: I like your philosophical question of, what is a doctor? Do you have an answer to that?

Vineet Arora: Recently, a tech company executive who is working on AI had said to me, well, one day we'll put you out of business. You know, you won't need to train doctors. And I'm like, hmm, is that really the case? You've got to have clinical [00:13:00] skills, being able to talk to patients, be able to interpret large amounts of information, you know. Now some of that could be aided with AI, of course. But to reconcile the definition is important. There are some substantive questions here about how to handle new technology and also making sure that the technology is implemented in a way that the American people can accept, you know?

Trust, I think, is something that we really need to work harder at with our patients, with our communities. The role of doctors has to be the trusted agent of the system and the therapeutics that are going to come. Diagnostics and therapeutics. If we're not able to explain those breakthroughs and able to gain the trust of the public, it doesn't matter. Like right now, childhood vaccination rates are going down for routine vaccinations, not even talking about COVID vaccines, but just for regular things like measles. So I think this trust issue is really, really critical and we've got to really focus there on [00:14:00] having trusted open communication with patients so we can meet them where they are. 

Christine Ko: Yeah. You mentioned emotional intelligence earlier. When you said, of course, there's knowledge and there's clinical skills, like procedural skills, but you also have to have sort of an emotional quotient, I think you said. Can you talk about that? 

Vineet Arora: Sure. Patients, you know, they don't follow a book, right? They're looking for an opportunity to maybe tell their story, but there's some parts of their story that they're not willing to share until they know it's safe, right? There's domestic violence in the news a lot lately. So, okay, if you are a victim of domestic violence, you may not be so forthright with your physician about what you're facing. Mental health, depression, lots of things with stigma, right? There is an emotional intelligence of, okay, you may have great knowledge about all of this, right? But if you're not able to connect with your patient and emotionally read their face to maybe ask, at the right moment, is there something more that you want to tell me? Are you safe at [00:15:00] home? And demonstrate that you're asking in an empathic way, then you'll miss the diagnosis. You'll miss the boat, right? So I think that's just one example of, you know, where you have to be able to interpret not knowledge data, but emotional data that's coming at you from a patient to understand where is the right time to insert a question or when's the right time to just let the patient talk and maybe they're gonna tell me. It's a little bit of a give and take.

Christine Ko: Do you have any final thoughts?

Vineet Arora: This was, you know, a great conversation. Medicine is changing, and sometimes that leads to a lot of anxiety as well and uncertainty. Maybe something for you to think about exploring is, how do people handle constant change? In life, there's a lot of uncertainty in a variety of paths, the paradox of choice, and the lack of a playbook. I think that could be an area for further bolstering so people are more understanding of the fact that, yeah, there's gonna be a lot of choices in life, and there's a lot of [00:16:00] uncertainty, but that doesn't mean that you still can't have a focus and a passion that you continue to proceed with.

Christine Ko: Yeah. Thank you. Thank you so much for talking to me. I really appreciate all of your comments and insights. 

Vineet Arora: Okay. Amazing.