Podcasts

Do No Harm, a film by Robyn Symon on Physician Suicide

Robyn Symon is a two-time Emmy Award-winner, and an accomplished writer,

producer/director, and editor. She is the producer and director of the documentary film, Do No Harm, about the healthcare system that drives us to take our lives.

We discuss how prevalent physician suicide is and how the real numbers and demographics are so difficult to track. We talk about the difference between paying lip service to change and what changes may actually help. We also talk about how the current coronavirus epidemic will make more apparent how overtaxed and overburdened many physicians really are. There will be an upcoming virtual screening on April 19 (see below).

 

Ms. Symon began as a television news reporter in Texas, then joined PBS in Miami where she hosted and produced documentaries, public affairs programs and the TV series Florida! (6 seasons; Travel Channel). She wrote and produced the docu-series “Voices of Vision,” which focused on the work of non-profit organizations worldwide. She has produced hundreds of hours of TV series for major cable networks including Discovery, CNBC, HGTV and currently produces a series on the Reelz Channel.

DoNoHarmFilm.com

Virtual Screening

WHEN: Sunday, April 19th at 8 PM EST/7 PM CT/5 PM PST

WHERE: FOR TICKETS: ZOOM WEBINAR LINK https://zoom.us/webinar/register/8715849795868/WN_x–X68dnR_i6_kTXvCyVFA

Introduction to Meditation for Physicians with Jill Wener, MD

While this episode was recorded before the COVID-19 pandemic, it is all the more relevant. Meditation is an arrow we should all have in our quivers.

After over 10 years practicing Internal Medicine at Rush University Medical Center, Dr. Jill Wener knows firsthand what severe stress and burnout feel like. In the midst of her own burnout, she was introduced to Conscious Health Meditation, and it had a profound effect on her resilience and reactivity. After 2 years of coursework, Dr. Wener completed her 3-month teacher training in Rishikesh, India in April, 2016 and now teaches meditation, among other stress reduction techniques, full-time, primarily to physicians.

This is an introduction to meditation. She starts by defining meditation and then delve into the different types, and why she has chosen to teach Conscious Health Medication over the others. She is a skeptic turned believer and helps us to start heading in that direction. In addition to meditation, she also teaches tapping, similar to exposure therapy, and we briefly discuss this as well.

Dr. Wener’s 8+ years of practicing and teaching stress-reduction modalities such as meditation and tapping, combined with the teaching and mentoring skills developed during her academic medical career, her personal experience with burnout, and her intimate understanding of the healthcare system, make her uniquely suited to teach meditation and other stress-reduction techniques to healthcare professionals from all fields.

theresttechnique.com/

jillwener.com/

Please be sure to leave a five-star review, a nice comment and SHARE!!!

This and all episodes can be found at PhysiciansGuidetoDoctoring.com

 

EPISODE TRANSCRIPT

Disclaimer: This is the transcript to the episode. This transcript was created by a talk to text application and the function of having this here is to improve the page search engine optimization. This transcript has not been proofread, so please listen to the episode and don’t read this. The information contained herein will inevitably contain inaccuracies that affect that quality of the information conveyed and the creator of this content will not be held liable for consequences of the use of the information herein.

After over 10 years practicing Internal Medicine at Rush University Medical Center, Dr. Jill Wiener knows firsthand what severe stress and burnout feel like. In the midst of her own burnout. She was introduced to conscious health meditation, and it had a profound effect on her resilience and reactivity. After two years of coursework, Dr. Wiener completed her three month teacher training in Rishikesh, India in April 2016. And now teaches meditation among other stress reduction techniques, full time primarily to physicians, something we could all use a bit more of right now. This is an introduction to meditation. For the uninitiated. She starts by defining meditation and then delves into the different types and why she has chosen to teach conscious health meditation over all of the others. She’s a skeptic turn believer and helps us to start heading in that direction. In addition to meditation, she also teaches tapping, similar to exposure therapy, and we briefly discussed this as well. Dr. wieder is eight plus years of practicing and teaching Stress Reduction modalities such as meditation and tapping, combined with the teaching and mentoring skills developed during her academic medical career. Her personal experience with burnout and her intimate understanding of the healthcare system, make her uniquely suited to teach meditation and other stress reduction techniques to healthcare professionals like us from all fields.
Welcome to the physicians guide to doctoring A Practical Guide for practicing physicians. Dr. Bradley Block interviews experts in and out of medicine to find out everything we should have been learning while we were memorizing Krebs cycle. The ideas expressed on this podcast are those of the interviewer and interviewee and do not represent those of their respective employers.
And now, here’s Dr. Bradley Block.
Dr. Joel Wiener. Thanks so much for being on the podcast.
Thanks for having me.
So let’s start off with your origin story. How did someone start out being a hospital Put a list internist and then become the internist Yogi.
Oh, such a lovely story. For me it started with burnout. And in 2011, they changed the residency work hours. And I don’t know where when you started when you did training, but a lot of the work ended up falling on the attendings. And that was my five year mark into being an attending and so I think it was a perfect storm, a bunch of other stuff that happened leading up to that, so I got really burnout, like it hit me like a Mack truck. It was pretty intense. And I was crying every day, one little bad thing would happen. And I would just get up and leave our office where we’d all be writing our notes and doing our documentation and go home. I just had no I had the shortest fuse and I had no ability to adapt to anything that happened to me. I wasn’t yelling at people I was just more like defeated and sad and crying and
and So,
around that time I met someone who told me they meditated twice a day. And Previous to that point, I had been the most skeptical unspiritual type a doctor, I had done some yoga before, but nothing, nothing crazy. And but something in me said, Sure, I’ll go hear your teacher speak. And when I went to go hear the teacher speak, he’s his yoga teacher from LA who was in town yoga teacher turned into a meditation teacher. And I everything he said was just like speaking to my soul. I don’t know how to describe it any other way. And I showed up. Like, I didn’t Google him, I had no idea what I was getting myself into. But I just was wearing my skeptical doctor pants and I was like, whatever, I’m smarter than everyone I know all the things about all the things and I’m gonna go there and I’ll just walk out and not have to do anything because I know better. And he started talking about stress and the way it affects our physiology and the way it affects our behavior. And that feeling of constantly being almost out of gas, that feeling of constantly being running on fumes. And he just spoke about that in a way that helped me understand how I why and how I had been feeling for the last couple of months before that. His course started the next day I had evening plans four nights in a row or four days in a row, about two hour one and a half to two hours each session. But I was like start me yesterday, I’m signing up, it was a week salary. So I was also very, very panicked about having to spend a lot of money on something that I didn’t know anything about no one I knew meditator This was we’ve come a long way. And in nine years, there was no one I knew, at least in my community that was meditating. And I signed up for this class and took it so that for me, and what I noticed was, oh, my god, these meditations are easy to do. It’s not mindfulness. It’s almost the complete opposite of that in terms of the actual practice. So it’s easy to do. You’re sitting comfortably with your back supported you’re not trying to control your mind at all. not fighting with what your mind does naturally. And I was having meditation experiences on the second day of class. So I was getting this like carrot approach rather than a stick approach that made me realize I’m actually doing something real and holy smokes. I cannot believe this was something that’s been in the world this whole time that I was just too skeptical or closed to realize. And I was able to fit it into my day. We carry pagers on us 24 hours a day, in my hospitalist job, depending on what we what service we’re on, but I was able to fit it into my day and make it work and I actually look forward to meditating and then my burnout went away. I mean, I started having benefits really quickly. I lost my road rage in three weeks, and
after a couple months, I just I wasn’t crying anymore. I wasn’t sad. I was
living in Chicago at the time, right?
Yeah, I was working at rush in Chicago and right,
downtown Chicago. Road Rage is probably different from rural Alabama. Road Rage right?
Well yeah, it’s not it’s not this is no fun. I wasn’t like a psychopath. I wasn’t like plowing into people and stuff, but I just didn’t get that like, panic anymore. And then I started to be like, Oh, actually the reason why I’m panicking right now is because I’m late because I left the house late so this is kind of my fault so me getting all freaked out about it isn’t going to help the situation I should have left earlier. And then usually when you get there and you’re late, the other person is even later and it all works out. So I I just kind of stopped mostly unconsciously stop sweating the small stuff but also was able to keep my head in moments where I would have been losing it and sometimes also doing additional talking myself down. So I felt great. You know, I burnout was great. I wasn’t at all thinking about anything else other than meditating is 20 minutes twice a day. All I was like thinking was I’ll meditate 20 minutes twice a day for the rest of my life because I’m never going back to how I felt before and then went on a retreat in India with my teacher. had some pretty incredible experiences there. And, like, you know, kind of, oh my god, even more amazing beyond what I had already been experiencing. And at that moment I was the, the stress, you know, compared to the rest of the group on the retreat, I was the closed minded doctor still, I was still very much like in my doctor world. And he said, Have you ever thought about becoming a teacher? And I was like, No, I’m a doctor, what do you mean I’m gonna be a hospitalist forever. And, but then I thought about it and I thought, Okay, well, like practice medicine and teach meditation and the teacher training is three months in India. So it’s a very intense training process Plus, it’s a couple years of prep work advanced coursework beforehand. So this is a pretty major undertaking. And so that was going to be my plan. hospitalist, you know, maybe point six FTP and then and then teach meditation the rest of the time. Then I had a really cool opportunity, opportunity to move overseas to China, and I had started to go Get some sort of itch of like, Hmm, maybe I’m going to be 65 one day and have been happy enough, but was starting to think that there was something else for me. And I’d be happy enough practicing medicine forever. But something else is out there and I had the opportunity to to China and that’s actually why I left my hospital, his job, moved to China for a few months, then went to India for my teacher training. And then that once I had been out of medicine for about six months, and did my teacher training and realized I had had a skill. That’s something other than medicine that I could do, that I was so so passionate about that I had personally experienced how life changing it could be. That’s when I realized I don’t think I want to go back to practicing medicine. I don’t see myself living that life anymore. I see myself doing things to help healthcare professionals to prevent them from getting to the point where I got where I was crying every day and losing it and to make everybody happier and higher performing and less stressed in at work. And at home as well. And so that’s that’s the answer.
That is quite the origin story.
Yeah.
So how do you define meditation, what makes meditation, meditation and not just sitting with your back straight in your eyes closed.
So meditation, meditation and mindfulness and yoga all kind of like tie in together. Yoga is typically thought of as physical poses that people do in order either to get exercise but but but traditionally, it’s physical poses that you would do to prepare yourself to sit in meditation. There’s all sorts of different types of meditation meditation in the Buddhist tradition. So what I what I teach them when I practice isn’t part of a religion. It comes from the Vedas, which is a body of knowledge that predates religion. Yoga comes from the Vedas. Ir VEDA, which is a holistic health practice that comes from India comes from the Vedas. There’s also Vedic warfare in Vedic architecture
the neti pot comes from and we use that all the time to learn
ology. Exactly, exactly. So, there’s a ton of really, really practical knowledge that comes from the Vedas, Buddhism and Hinduism. Both also came from the VEDA. So Buddhism, those types of meditation practices tend to be more contemplative meaning like you’re sitting and you’re focusing on something, you’re concentrating either on a word like a mantra, or your breath, or a physical sensation in your body, or what someone is guiding you through those, you tend to be sitting more upright. And those tend to be more what had been adapted to mindfulness practices. Now, they are also mindfulness practices that what we think of now as mindfulness is more adapted from the Buddhist lineage. Mine is more of more related to Hindu but it’s again, not at all religious, and it’s not Hinduism. But we are the difference is we are shifting our physiologic state rather than maintaining alertness and maintaining focus. Which is mindfulness, we are shifting our physiologic state when we meditate with my technique. The tradition is called Vedic meditation. I call it conscious health meditation for many reasons. But if you’re listening to this and wanting to look up more about it, Vedic meditation is where you would go. It’s also very similar to Transcendental Meditation. But I am not at all part of the TM, corporation or company or organization in any way. So I’m an independent teacher.
Why did you just have to clarify that?
I didn’t clarify that because tm is like an A Corp. It’s a corporation. And they teach people to meditate the same way I teach people to meditate, but they are their bigger cultural phenomenon. Some Some people love it. Some people get a little bit turned off by it because it’s a little bit. Some people find it maybe a little bit aggressive or a little bit culty. I’ve actually never been to any of their specific meetings. So I can’t speak for that. I’m just speaking for what people what people have reported back to me, but I tried to take any question. to try things out as hard as I can to take any of the trappings out of this practice because for me getting back to your question of like, what is meditation? It’s its physiology. It’s really so beautiful. I think one of the things that attracted to me attracted me to it so much is it made sense scientifically and medically to me, I didn’t have to stretch my brain to understand why it was working. It just was like, oh, okay, cool. That makes sense. So when we’re meditating, rather than sitting with our backstraight, and focusing and trying to cultivate present moment, awareness, which is awesome, and I think present moment, awareness, present moment, awareness is very important. That’s mindfulness. That’s not what I’m doing. When I’m meditating. When I’m teaching people to meditate. We’re using a mantra is the one that we use as a Sanskrit sound, and it has, there are many of them. I choose which one to give to my students, but there’s many different mantras that when you use them with the technique that I teach, they allow your your brain and body to settle into a distinct physiologic state. That is separate from sleeping, waking and dreaming, that is two to five times more restful than sleep based on the SPO. Two. So you’re actually more efficient, your body becomes more efficient. the metabolism of oxygen from your from hemoglobin is more efficient than sleep when you get to this physiologic state. And it’s super easy to get to and everybody can do it. I’ve never had a student that can’t get to it. So and you’re
seeing them that’s for conscious health meditation or for all forms of meditation
for what I teach. So people often will say that meditation mindfulness are the same thing. They’re like, Oh, I’m doing I’m on a meditation app. I’m doing a guided meditation. You could consider that but I think of those as more mindfulness and meditation is the actual transcending waking state consciousness and going to a different physiologic state, which then allows your body to it’s like defragging a computer. I also sort of think about it like a cooling protocol in the ICU, if you have cardiac arrest, and then you go, you know, you get the cooling blankets and everything to do Increase inflammation and free radicals so that the body is able to kind of cool off and then recover more quickly and have less damage from the cardiac arrest.
So that’s interesting. So you’re saying mindfulness meditation. For those who practice mindfulness meditation, you’re saying Actually, that’s not meditation? That’s something different. We’re using the same word. But actually, these are two different things.
Yes, I believe so. And there would be people who would be like, absolutely not what I’m doing is meditation. And I’m not gonna argue with them, I don’t care at all. It’s just a different you know, it’s on some level, it’s semantics. But it’s important to recognize that not all meditation is the same not all meditation requires sitting comfortably and maintaining alertness and fighting with your brain to make a do something that it’s not built to do because the brain just like the heartbeats, and it’s gonna beat all day long. The mind has thoughts all day long. And so to try to control those or, or or force the mind to do something other than is very uncomfortable and challenging. And that’s why you hear people being like, yeah, I meditated for three minutes today. And after, you know, four weeks, I moved up to five minutes. And then I stopped doing it because it was so hard. And I, you know, like, it’s not, it’s much more difficult to stay with it when it feels so challenging. And so this is so restful, and it feels so good that you come out of it feeling like you took the most amazing catnap ever.
So before we go take the deeper dive into the type of meditation that you practice, we just break down the other forms first, just so we know what’s out there and what the differences are.
Sure, sure. Do you have specific ones or you want me to
join? Well, I mean, you can, why don’t you start and then if there are any others that you don’t mention, then I’ll ask.
So mindfulness already talked about and mindfulness is a is a big umbrella. That’s gonna cover a lot of other types of meditation. So and again, I’m calling it meditation now, so I don’t, it doesn’t really matter to me, I just everyone always says At what I do is mindfulness and I just like to help educate people that there is a type of meditation out there that’s very different. So mindfulness meditation requires involves, you know, generally sitting comfortably, but with your back unsupported often with your legs crossed, but often not. And there’s a, an attempt to focus and cultivate your attention on something specific mantra breath, your body. The idea is becoming more aware in the present moment of what’s going on so that when you get into your real life, you are able to feel emotions coming up inside of you, and you’re not just completely a victim of the emotions as they come up and you can be more aware and maybe change the way you’re behaving a little bit. I’ve taken the Mindfulness Based Stress Reduction course I took that a few years after I learned Vedic meditation, and I loved it and I thought it was great. And it required a lot of homework and it required a lot of time to practice it. And I was just felt like, Okay, if I have to pick between one of the two, I’m going to stick with VEDA because I’ve got And such amazing results from it. And I can’t meditate all day I do want to do one to actually live my life. guided meditation or guided visualization is also a type of mindfulness because you’re, for the most part, you’re listening to what someone is saying and trying to put your attention on that and follow their instructions as they’re talking you through the sound of a waterfall or how you feel when you’re, you know, at the ocean and you hear the waves or imagining light coming through your head or you know, out of your head, whatever that is. That’s also cultivating awareness and attention. There’s chakra meditations. So chakras are energy centers throughout the body that are very much a huge central integral part of yoga practice, which we don’t always know when we go to a practice and get really sweaty. The yoga practice is all about opening and balancing these energy centers. I don’t really get into chakras much, if any at all when I teach my meditation, but that is a type of meditation where you go through There’s one at the top of your head, the corner the like your forehead and between your eyebrows, your throat, your, your chest, your heart chakra. There’s a few other ones. You can do a chakra meditation where you’re focusing on those energy centers and trying to open them or balance them. So that’s another thing. And chakras are really cool. They’re just not I’m not, I don’t have a expertise in them. And a lot of people will say, Oh, that’s too. That’s too woowoo. For me, I don’t want to get into that. But it’s actually pretty, pretty interesting. And there’s a lot of science behind it as well. So for anyone interested in taking it further, I do highly recommend that. Although studying with me isn’t, is not going to get you that what else there’s mantra meditation. So mantras. There’s tons of different types of mantras, there’s English ones, and Sanskrit ones, and German, let you know whatever language you speak, you can speak it in your own language or you can have it be some other ancient language, the ones that we use and you can say them out loud. You can say them silently. You can try to focus on them and concentrate on them in In the type of meditation I teach, you’re not focusing and concentrating on the mantra, it’s actually designed to be forgotten. Which maybe sounds a little confusing, but it’s not. You’re not trying to focus on that mantra for 20 minutes, as you’re meditating. So mantra meditation is a huge umbrella that can include mindfulness type practices that conclude what I do, which is more of a transcendental type of meditation. And that’s a umbrella term that can be there’s not just one type of that. Are there other ones that I’m
not? So that sort of sorry, the mantra meditation, you use a mantra in transcendental meditation, so as mantra meditation, the same as Transcendental Meditation.
So there’s Transcendental Meditation with like a capital T. That’s like the transcendental meditation brand. And then there is lowercase t transcendental which is just like a meditation that you do that’s going to shift your level of calm consciousness to a transcendental stage, kind of like, oh god, I’m trying to think of an example of that, you know, like Catholic, there was a lowercase E. And then there was a capital C, but I don’t remember I was a religion major in college.
I feel what they’re saying about Transcendental Meditation reminds me of like, when Bruce Lee came to America, and was teaching martial arts to Americans, and it was something that was supposed to be just within the Chinese community. And it was a problem that he was teaching it to, to non Chinese people. And I feel like that’s what you’re saying about Transcendental Meditation. It’s like, it’s this pre determined community. And if you you have to, you have to follow their rules and go within their rules and their scope and use their brand and sell their t shirts and coffee mugs.
Yes, to some extent, and bear in mind, some people who take the courses have no awareness of that and they just like learn to meditate and love it and it’s fine and some people do get much more involved. And in either way, they’re teaching people to meditate really well, and people love to practice. So. But yeah, it is a little bit more it’s like a more of a cultural community type, lifestyle kind of thing. Maybe there are types of meditation that allow you to shift to this other level of consciousness is transcendental consciousness. They’re not all capital transcendental tea, you know, capital T transcendental capital M meditation. mantras can be used for a meditation that might help you transcend waking state. mantras can also be used for mindfulness. If you think of you know people only as a mantra people sometimes meditate chanting a bunch so and and it also if you said, you know, I’m a, I’m a strong doctor, and I’m gonna kick ass at my job today. And you know, if you repeat that to yourself six times in the morning before that can also be considered a mantra and that’s English and that’s out loud. So, so there that that spectrum is very, very wide and and not very specific.
And so how did you arrive at conscious health Meditation of all of them. And I think you’ve, you’ve really covered it. But you know if you could take a deeper dive into, into, I mean, had you tried others it sounds like you tried others after you had already been a conscious health meditator and even a conscious health meditation. How did that? How did you arrive at that?
Sure when I learned that I was Vedic, so the community is Vedic meditation. So I was like zero to 60. I had no, I had done some, like, you know, very little mindfulness stuff at spas or at yoga. But I had never really been I wasn’t like looking for meditation. I was just desperate. And I was broken down enough that my consciousness cracked open just enough that I was receptive to something like this because I would not have been otherwise. Absolutely not would have, you know, if anyone listening to this is like, what is this crap? She’s just woowoo whatever. I was there, that was me. You know, I never would have been in anything like this. So. So I was I’ve met the person who told me they meditate and I went to go get the teacher. Speak. I honestly didn’t research. Not only did I not research, other types of meditation, I didn’t even research, Vedic meditation. I just signed up for the course. And it was awesome. So that that’s how I like to say it found me because it was sort of that moment in my life or something needed to change majorly. I call it conscious health meditation for a variety of reasons. I had a physical space, like a meditation, I usually teach from my home, but I when I first moved back to Atlanta, I grew up here. And so this is where I moved after my teacher training. I didn’t end up going back to China. So since 2016, I’ve been here in Atlanta, and I had the opportunity to open up like a commercial space of a meditation studio. And it wasn’t anything I expected to do. But I did and I decided the name of that was conscious health, meditation and wellness. It was not, but I was still teaching Vedic meditation. That’s what I was still calling it and then it sort of evolved over time because I teach positions. There’s also you people listening here have probably heard all sorts of horror stories about You know, the crumb crumb and Yogi Bhajan, and lots of other different guru types who have founded big movements who have done some not so good things to the people in their community. And there are some issues about that in my community as well. And I didn’t know that that happened directly to me. So I didn’t have this like big story to share. But I wanted to remove myself from any of that influence or connection. So that’s another reason why I call it conscious health meditation. So I like to be pretty forth. You know, honest about that. When asked about it, but so, for me, it’s a natural progression, but also an intentional thing as well to keep it my own community and my own brand,
so to speak to the skeptics out there, hmm. For those of us because because I’ve actually tried meditating before with my wife, we did the we did an app. We did it right before bed, because that’s really the only time that we were settled enough to do it. Yeah, man, I can’t even remember the name of the app. At this point, it’s one of the it’s one of the Uber popular ones. Yes, yes, it was headspace. And now we’re back to just scrolling our phones back right before bed. It’s you know, it didn’t, it didn’t stick. So, you know, convinced me that I should be doing it, but from a more, you know, physician skeptic kind of tilt.
Yeah, absolutely. And I love that you asked about this, because I have people telling me I’m like, it sounds too good to be true. And I agree it does. But it’s awesome. I think the only it doesn’t one thing I will say it does not fix everything. And I I was sort of sold that bill of goods a little bit when I learned so I was like, oh, if I just meditate enough, like everything in my life is gonna be perfect. And that’s not the way it works. But what I tell people and anyone that’s going to tell you that what they’re doing specifically is going to fix every problem in your life. You need to run away from them very quickly, because that’s there’s nothing that does that. There’s always going to be a side of Fact or a downside or, or an incompleteness to something you’re doing, I usually tell people 70 to 80% of things in your life, we’re going to get 70 80% better. This is if you practice consistently, this is not just taking the course, but actually doing it, taking the course and then actually doing the practice, some things in your life are going to get 50% better, some things in your life are going to get 100% better, and some things are going to be like the positive and negative symptoms of schizophrenia, but in a good way. It’s not just that the bad things are going to get better. But there’s going to be also these wonderful enrichments to your life that you didn’t necessarily know you could have or that would that you were missing, but just kind of got worse. What’s going to get worse.
You don’t have to take that question seriously.
No, I the only thing that would get worse, I think is when you start down the path of like, it can feel a little rough. Sometimes if you start down the path, this technique, as you’re going to this two to five times more restful state than sleep. It’s unwinding stresses from your entire lifetime. stresses that stress scars that we carry around with us. If you think about a song you hear on a radio that might remind you of a breakup or a particularly painful time in your life and yours, your friend is rocking out to the song and you’re like, oh, turn softball, and your heart’s pounding, and you’re sweating and you’re crying a little bit. You can’t bear to hear but someone else is having a completely different experience. It’s something in you that has this stress scar that is that you’re carrying with you. Or maybe you smell something that reminds you of your grandmother’s kitchen from when you were eight years old. And you’re like, Oh, this smells just like I could I’m right there with her God, you know, we carry these stress scars around with us, and they build up this wall around us, kind of like layers of an onion, I guess. And so you get kind of tough, and you feel like maybe you’re a little numb to the world, but it’s a survival mechanism. So it’s sometimes easier to go through life not feeling things, but also you don’t usually feel the good stuff, either when you’re that shutdown. And I think for physicians, in particular, with all the stuff that we see that just gets like layered upon layers upon layers upon us that we’re expected to just interact Realize that can happen. So as you start to peel back those layers, that’s another difference between mindfulness and this. What I’m calling metta. I’m just differentiating mindfulness and meditation. Mindfulness is great and burning off the stress, right then mindfulness will help get you out of your stressed out brain, right in that moment, and and calm the stress down. But what this technique is doing it’s it’s shifting your your nervous system from sympathetic, overdrive survival mode to parasympathetic activity. And that’s a healing mode, it’s rest and digest and, and healing. And so we’re actually able to reverse damage that’s that we’ve been stressed damage that we’ve been carrying around with us for days, weeks, months, years, decades. So this stuff as it comes out. Usually in meditation, sometimes you’ll be meditating and you’ll be like, Ooh, I’m anxious. Or I’m feeling annoyed or why is my you know, spouse making that weird noise when I’m trying to meditate or whatever it is. That’s just stress coming. Have you. And also as you start to become as that stress starts to peel to come out of you, you start it’s like peeling back the layers of the onion again, it can sometimes feel more raw and more vulnerable in there. But it’s a beautiful, it’s a beautiful space. But it’s it’s something that’s happening gradually. But I always tell my students, it’s not like you’re going to stop having emotions. I’m not, you’re not going to forget that these bad things happen. You might feel more, you might feel you might cry more commercials, if you’re watching if you’re ever watched commercials anymore, more emotionally affected by beautiful things around you as well. Because you no longer have that wall of stress around you. So for the most part is beautiful. But for some people, at times it can feel a little sensitive. But that’s why you have me when you take my my live course with me, you have me as your teacher for life. So you can email me and text me with questions at any time. And hey, I’m feeling this and I’ll explain why. So it’s not like the apps don’t do that. You know, you can’t write into the app and say hey, I had this experience while I was meditating Any thoughts? Because it isn’t a human being with expertise. So I would say that would be the only or the only downside as a long winded answer to that question, but I think it’s an important one. Absolutely. What’s some
of the science behind conscious self meditation?
Did I answer your skeptic question, by the way?
Well, I think that’s going to be more in the science aspect. Okay.
The other thing I will say is that it’s experiential. No one, no one quite understands where they’re about to get their songs get themselves into unless they know somebody who did it. And even so you still don’t know how awesome it’s going to be. Because no one believes that they’re actually gonna be able to meditate and that they’re actually going to do it and that they’ll everyone says, Oh, my mind is the only one I am the only one with monkey mind. I’m the only one who has thoughts all day long. That get louder and crazier. When I sit down to meditate. I’m the only broken one you know, I’m too my brains too active. Everybody says that. So so I don’t have to, you know, learn the techniques. Do the class and you will experience what it’s like rather than me having to convince you. So it’s kind of nice people, you know, definitely by the fourth part of the course, but generally well before that, or meditating very easily and successfully. So the question you had said the science behind it. I mean, there’s they’ve done studies on mindfulness, a lot of that that’s one of the great things about mindfulness is when it’s been adapted and secularized from the more Buddhist religious type practices to a more secular version. There’s been a lot of studies on benefits, pain control, and depression and anxiety. The Transcendental Meditation organization has a lot of money and they have done a lot of scientific studies as well on this practice. So what I teach again, is pretty much identical because my my teacher trained in that organization for 30 years and then and then he left so that organization has a bunch of studies they have but like anything you know, if you remember there’s one study about Rifaximin. Preventing hip hop encephalopathy and it was this like, oh my god is amazing results. But it was sponsored by the drug company. So you always want to be a little careful when the study is sponsored by the organization that is profiting from from the intervention. But so there’s great data there. And so there’s data on on improve school performance for kids improved depression, anxiety, pain, and and I’m talking specifically for the type that I teach, but there’s, there’s not a lot in the meditation can’t help. It makes you it’s they’ve done studies where it prevents secondary events for coronary artery disease and people who have already had events it can lower blood pressure, Gazprom so yeah, yeah, I mean, it’s, it’s you have the more benefits, the more consistent you are with the practice, but so there’s some pretty cool data and I think overall, the the body of the data suggests that it has a lot of really great impacts, but I think that studying meditations really hard because I I know that like when my students are coming to me, when they’re coming in, they’re choosing to learn to meditate because they really want to learn to meditate. They don’t like, that’s the choice that they’ve made for themselves. They’re going to be much more open and excited about it and committed to it, then if it’s something that like work is paying for, for example, that they’re like, Sure, why not some bias there? Yeah, yeah, exactly. So So and I, you know, I think that met it, it’s like a little slippery. It’s I think it’s a little bit hard to pin down and it can be frustrating. But when you do the practice, you feel the benefits. It almost stops mattering about the data, because it’s like, well, I’m doing it. I have this practice. I’m doing it I feel amazing. Data is great data helps make things more particularly something like meditation, it makes it more accepted by the mainstream scientific community, but it’s ancient knowledge that’s been around for thousands of years, if not longer. It’s it’s science. It’s science but in a difference presented differently. You know,
I wonder if there’s a minimally effective Right, like, at some point, if you don’t do it for long enough, you’re really not going to see benefits. And if you do it for longer it starts to be diminishing returns. I wonder if there’s an inflection point?
Sure, sure. Well, in my, in my technique from what I’ve been taught, at least, so that the man who started the transcendental meditation movement, who brought this technique over from people who were mostly like, monks and people who meditated all day long, he, he adapted this technique to people like you and me who have jobs and families and eat pizza and live in the world and drive cars and stuff. And so he, from what I’ve been told, tested it out. So right now it’s 20 minutes twice a day, but like, will it work with an hour once a day or two hours you know, and 20 minutes twice a day. In this in this type of meditation and and other types of meditation seems to be what people come out with as the sweet spot. I teach my course live. And in my live course, I do a ceremony on the first day and sounds good. Beautiful, but it’s you know, definitely for me it was outside the box for what I was used to, but I was I didn’t care. I thought it was lovely. I give a mantra to each person. And I’m teaching a practice, it’s 20 minutes twice a day, and my students are getting there are not 6 billion mantras. So not every student gets a different one. But it’s individualized to each student. I also teach an online course and both of my courses are CME accredited get CME for taking my courses. My, and I’m getting somewhere with this, I promise my online course. I use a this everyone gets the same mantra. And it’s 15 minutes twice a day, instead of 20 minutes twice a day, the type of mantra I use in the online courses just slightly less powerful because the students who take that don’t have that full access to me for a lifetime. And it’s important to have that ongoing contact with the teacher. But even with a different mantra, different, slightly different type of mantra that’s used in the same way. And the 15 minutes twice a day. My students are having incredible results who are taking it online, so you don’t necessarily need to go above 20 minutes twice a day. It’s like your receptors, your bliss, receptors are already full and there’s no need to stay in. Once you’re wet, you’re wet. And if you think about like dunking yourself in a swimming pool, you don’t need to dunk longer to get more wet, you’re already wet. But the 15 minutes also has been quite effective. So I think you can go a little bit less to that less than that. The 20 minutes, but generally I say less than 13 minutes is not going to be as effective.
Interesting. So where can people find those courses? My website,
I have a website meditation in medicine calm, and that’s going to have all the information about my online courses, my retreats that I do so I have a retreat for women and healthcare that I do in October at mirrorball spa. It’s the most amazing spot ever, and that’s all types of women in healthcare. But we’re not we’re it’s basically meditation and enjoying the spa and I do a little PowerPoint free little group lecture on Vedic knowledge and how it relates to life as a woman in health. Healthcare. So that’s really focused on the meditation and the stress reduction, I do another event called transformed with with my colleague, Marjorie Stiegler, who that’s more of a professional development, life transformational event. And we do that in January in Mexico. So registration for both of those are open for October this year in January of next year, and then the online courses as well. And I do another technique called tapping, which we haven’t really gotten into here. But that’s something else I do. That’s another really cool technique that helps people more with like specifics. If you want to global global life overhaul, you want to get more efficient at your job, you want to be happier, you want to be less reactive, meditations, what you want to do, but if you have a specific thing you’re trying to get over, you’re having specifically anxiety or a difficult decision to make or a phobia or trauma, difficult relationships, that’s, you can use this thing called tapping. So I have tapping question As well on that website,
what exactly is tapping.
So tapping is also called the Emotional Freedom Technique or EFT. And it is a technique that I first learned about when I was teaching my meditation course at a medical conference, the psychiatrists and psychologists came and they talked about using tapping and a few others similar modalities, with their veteran patients at the VA who had PTSD and the incredible results that they were getting. So I heard about it from a very, maybe a sanction inside the box source. And then I’ve heard about it more outside of that and people it’s it’s similar to maybe energy work, but you use the same meridians as an acupuncture or traditional Chinese medicine. But instead of using needles, you tap on them. And most of the meridians we use are on the face in the chest and you are basically tapped in and it works really really the the most effectively if you work one on one with a coach but you can also find free tapping videos on YouTube if you want to, you say negative things, whatever it is. bother you, let’s say you have a phobia of flying. As you tap through the meridians, you’re going to be saying out loud, I have this fear of flying, I’m afraid that we’re going to crash, I’m afraid that I’m gonna, you know, lose my life. I’m afraid that whatever it is you’re afraid of you say it over and over again, as you’re tapping, it actually sends Calming Signals to the hippocampus, as you’re saying it so it decouples that trigger from stress. And so the hippocampus is then not sending that stress message to the amygdala. And the amygdala is not going off into fight or flight. So you basically are changing the way your brain is reacting in the face of things that used to be very stressful, and it works very quickly. It’s very powerful. It’s incredible. I love it so much. And the results, if done right. are, they’re permanent, like you don’t have to keep tapping to get rid of the phobia. Once the phobia is gone, the phobia is gone. So I do that as well. I have an online course about using tapping for physician burnout. And I do a lot of tapping workshops at my retreats as well because people love it and you can do it very, you don’t have to get a full training in it to be able to tap on your own. That’s pretty much everything I do and teach people is to be a self sufficient practitioner at that. So I’m not guiding people through meditation, I’m teaching people specific techniques that they can do on their own without any apps, or they put their phone away. They meditate on their own same thing. Tapping, yes, you can work with me in person. But once you’ve done enough, a few sessions, then you are familiar with what to do. And you can just kind of keep it simple and treat yourself with it. It’s interesting.
It sounds familiar. It sounds similar to exposure therapy, for phobias, where you just started thinking about it and you look at pictures of it, and then you get a little closer to it and then eventually you just become habituated to it.
Yes. And the only difference is that as you were doing those sequential exposures, you will tap as you’re saying out loud, what emotion you’re having about it, what the fear is or what you’re afraid is going to happen and so what happens like, even faster and even more, it’s very streamlined. Right? So you don’t have to you can just think about it and tap on it you don’t actually have to like do it when you’re on an airplane in order to benefit from it. So you can do it sequentially like you were just suggesting as well. All right,
well, I really appreciate you taking the time to talk to us today and your website that’s where you can find all the courses Gil Wiener calm, correct. Spelling I have
comm w e n er that’s my like website for everything but I meditation in medicine calm is my website that’s more geared towards doctors to the programs that I do for doctors. So if you want to see more doctor specific programs and meditation in medicine, calm and then I’m on social media as well. Instagram and Twitter are at Gil Wiener MD. Remember it’s w e n er, and then Facebook. I have way too many professional Facebook pages and it’s Instagram and Twitter are much better if you’re like actually wanting to follow me And see what I put out into the world more streamlined, more streamlined. Yeah. And I tend to post there more often
will include all that in the show notes. Again, thank you very much for your time.
You’re welcome. Thanks for having me. This was fun.
That was Dr. Bradley Block at the physicians guide to doctoring. He can be found at physicians guide to doctoring comm or wherever you get your podcasts. If you have a question for a previous guest, or have an idea for a future episode, send a comment on the web page. Also, please be sure to leave a five star review on your preferred podcast platform. We’ll see you next time on the physicians guide to doctoring.
Transcribed by https://otter.ai

Introduction to Meditation for Physicians with Jill Wener, MD

While this episode was recorded before the COVID-19 pandemic, it is all the more relevant. Meditation is an arrow we should all have in our quivers.

After over 10 years practicing Internal Medicine at Rush University Medical Center, Dr. Jill Wener knows firsthand what severe stress and burnout feel like. In the midst of her own burnout, she was introduced to Conscious Health Meditation, and it had a profound effect on her resilience and reactivity. After 2 years of coursework, Dr. Wener completed her 3-month teacher training in Rishikesh, India in April, 2016 and now teaches meditation, among other stress reduction techniques, full-time, primarily to physicians.

This is an introduction to meditation. She starts by defining meditation and then delve into the different types, and why she has chosen to teach Conscious Health Medication over the others. She is a skeptic turned believer and helps us to start heading in that direction. In addition to meditation, she also teaches tapping, similar to exposure therapy, and we briefly discuss this as well.

Dr. Wener’s 8+ years of practicing and teaching stress-reduction modalities such as meditation and tapping, combined with the teaching and mentoring skills developed during her academic medical career, her personal experience with burnout, and her intimate understanding of the healthcare system, make her uniquely suited to teach meditation and other stress-reduction techniques to healthcare professionals from all fields.

theresttechnique.com/

jillwener.com/

Please be sure to leave a five-star review, a nice comment and SHARE!!!

This and all episodes can be found at PhysiciansGuidetoDoctoring.com

Compassion Fatigue and Assertiveness with Nathalie Martinek, PhD

Nathalie Martinek, PhD is a recovering developmental and cancer biologist who transitioned out of the controlled environment of the laboratory into the messy world of human behavior and relationships. She continues to apply her critical and objective lens honed as a scientist to understanding drivers of human behavior in the various relationships that exist in healthcare contexts to discover what prevents and promotes wellbeing and professional satisfaction.

Dr. Martinek is a speaker, listener, coach and consultant who facilitates training programs and workshops worldwide for diverse health professional audiences to enhance their capacity for human connection, abuse prevention and healing through cultivation of psychologically safe and stable therapeutic partnerships. She recently published her first book, The Little Book of Assertiveness, to provide scripts for shifting power dynamics in professional relationships to embody the qualities of a respectful and compassionate healthcare culture that enables everyone to thrive.

We discuss how to be assertive in a hierarchical environment like medicine without offending your superiors – and it starts with being curious. We then pivot into discussing compassion fatigue, first by defining it and then by exploring ways to interact with patients in a way that doesn’t end with us unnecessarily burdening ourselves with no benefit to the patients. We then end with some self-care practices that allow us to process those burdens.

Find her at drnathaliemartinek.com

Please be sure to leave a five-star review, a nice comment and SHARE!!!

This and all episodes can be found at PhysiciansGuidetoDoctoring.com

Compassion Fatigue and Assertiveness with Nathalie Martinek, PhD

Nathalie Martinek, PhD is a recovering developmental and cancer biologist who transitioned out of the controlled environment of the laboratory into the messy world of human behavior and relationships. She continues to apply her critical and objective lens honed as a scientist to understanding drivers of human behavior in the various relationships that exist in healthcare contexts to discover what prevents and promotes wellbeing and professional satisfaction.

Dr. Martinek is a speaker, listener, coach and consultant who facilitates training programs and workshops worldwide for diverse health professional audiences to enhance their capacity for human connection, abuse prevention and healing through cultivation of psychologically safe and stable therapeutic partnerships. She recently published her first book, The Little Book of Assertiveness, to provide scripts for shifting power dynamics in professional relationships to embody the qualities of a respectful and compassionate healthcare culture that enables everyone to thrive.

We discuss how to be assertive in a hierarchical environment like medicine without offending your superiors – and it starts with being curious. We then pivot into discussing compassion fatigue, first by defining it and then by exploring ways to interact with patients in a way that doesn’t end with us unnecessarily burdening ourselves with no benefit to the patients. We then end with some self-care practices that allow us to process those burdens.

Find her at drnathaliemartinek.com

Please be sure to leave a five-star review, a nice comment and SHARE!!!

This and all episodes can be found at PhysiciansGuidetoDoctoring.com

EPISODE TRANSCRIPT

Disclaimer: This is the transcript to the episode. This transcript was created by a talk to text application and the function of having this here is to improve the page search engine optimization. This transcript has not been proofread, so please listen to the episode and don’t read this. The information contained herein will inevitably contain inaccuracies that affect that quality of the information conveyed and the creator of this content will not be held liable for consequences of the use of the information herein.

Dr. Natalie Martin Nick is a recovering developmental and cancer biologist who transitioned out of the controlled environment to the lab and into the messy world of human behavior and relationships. She continues to apply her critical and objective lens honed as a scientist to understanding drivers of human behavior in the various relationships that exists in health care contexts to discover what prevents and promotes well being and professional satisfaction. Dr. Martin Nick is a speaker, listener, coach and consultant who facilitates training programs and workshops worldwide for diverse health professional audiences to enhance their capacity for human connection, abuse prevention, and healing through cultivation of psychologically safe and stable therapeutic partnerships. She recently published her first book, The Little Book of assertiveness to provide scripts for shifting power dynamics and professional relationships to embody the qualities of respectful and compassionate healthcare culture that enables everyone to thrive. We discuss how to be assertive in the hierarchical industry. That is medicine without offending your superiors. And it starts with being curious. We then pivot into discussing compassion fatigue, first by defining it. And then by exploring ways to interact with patients in a way that doesn’t end with us unnecessarily burdening ourselves with no benefit to the patients. We then end with some self care practices that allow us to process those burdens.
Welcome to the physicians guide to doctoring A Practical Guide for practicing physicians, Dr. Bradley Block interviews experts in and out of medicine to find out everything we should have been learning while we were memorizing Krebs cycle. The ideas expressed on this podcast are those of the interviewer and interviewee and do not represent those of their respective employers.
And now, here’s Dr. Bradley Block.
Dr. Natalie martynuk. Thanks so much for being on the podcast.
Thanks for having me, Bradley.
So let’s start with your origin story. What what’s your PhD and And what was your thesis?
My thesis so this is a really awesome title. It’s spark is required for basal lamina stability by mediating type for collagen deposition during embryonic development of just soft lemme Lana gastric.
Oh, Monica master mind my favorite my old friend. Yeah, that sounds that sounds really interesting and really that tends to be the theme of this podcast is everything that can be learned about the basal lamina of a I’m not even sure if that’s what you said of the dressage. That’s right. So what what does that make your PhD in? You are a developmental biologist,
development biologist, so I was really interested in understanding the unsexiest the least sexiest part of a body, which is the connective tissue, the extracellular matrix, all the environment outside of a cell. So while everyone’s studying inside, what’s going on inside the cell, I was looking at what’s going on outside of the cell that is eating influencing how cells behave, how they move, how they invade. And that led into my postdoc in cancer research. And the reason I was interested in that is because it’s a less controlled environment, you know, whereas you’re working in a cell, you can kind of manipulate the proteins being made, or you know, the enzymes, and you can see its effect of what’s going on inside the cell. Whereas what I’m interested in what I was interested in is looking at what the cell is producing how it influences its behavior, as well as the development of the organism. Yeah, so that’s basically where I started and I was looking at the cells, the macrophages of the of the fruit fly, which are involved in surveillance and removing pathogens and other things that invade that you don’t want in your body.
So is that what you’re working on right now?
I guess yes and no, biologically No. So where that led to was trying to understand how to relate this the cells that normally move around the body play a role in the music system monitoring surveillance protection against, you know, my microbes and pathogens into still using your software to study tumorigenesis. And so is looking at what how do cells move from an original location and invade into tissues and start to migrate and take over the body basically co OPT the defense system of a body of an organism for its own means of survival. And so while that was occurring, during my postdoc years, I started to become very interested in the conditions within a workplace environment that would enable certain behaviors to start to manifest as bullying or to, you know, spread around an environment and create a sort of toxic culture. So what I’m studying biologically was mirrored mirroring or mirrored in my external workplace environment, and that became more of an interest to me.
Oh, I was hoping that that was the direction you’re We’re gonna take this in, because I was hoping this wasn’t gonna be an entire podcast about Drosophila. And knowing you and what you’re doing now, I was like, man, I hope. I hope she ties this in. Oops, didn’t go back to the lab, and she’s gonna be talking to us about pipetting. Again,
no. Okay, looking at the conditions that exist that promote or prevent certain behaviors from existing and amplifying what what made you make that transition suddenly different things? burnout is one of them. You know, and the way my experience of the way I experienced burnout is that when you’re working in an environment or in a, in a in any place where you believe that it’s the right direction for you based on your training and education, what’s expected but yet it doesn’t speak to your heart. It doesn’t address some of your major interests. And what else you could be doing, the longer you stay in that situation, the less I guess the more energy is required in order to make maintain that, that makes sense. So you’re not actually living a fulfilling, at least not your work life. And it’s and it seems to spread into all your other parts of your life.
Well, sometimes it seems like it’s, you’re like a hamster on a wheel, and you’re kind of that idea of publish or perish, that you’re almost doing it for someone else, not for yourself, not for your own interests, not for not for the research, but more like you have to produce something, just in order to keep your job and keep your grant. Even if it’s just kind of like paying lip service, not not what you’re, you know, not not that you’re trying to answer a question.
Yeah. And when I start exactly so when I started to think about well, why what’s not right, what’s not going well here for me why, you know, on the surface, this should be what I’ve always wanted, interrogating the mysteries of life using fruit fly and biology. And then I was looking at the culture around me and seeing, you know, the effect of being an environment like that. on me, I was turning into someone I didn’t like in order to survive. And that that type of pressure and environment, looking at the way we address illness and try to get a better idea about the mechanisms behind disease. And we’re using a lot of data or theories or beliefs that are quite biased and, you know, got to the point where I’d be listening to someone’s talk or reading a paper and I’d be able to spot the unconscious bias very early on, and would poke too many holes within their story that I couldn’t listen to anymore. And after a while, I’m like, if this is my, if this is my experience, why am I still here? The other thing is we’re looking at human disease, you know, cancer, which doesn’t happen in a fruit fly naturally, or quite rarely, but doesn’t have the same impact. And we’re trying to understand the mechanisms of this disease in the fruit fly, but we’re using almost assumptions that by understanding the mechanisms in a fruit fly, we can apply it into the human experience, which we can’t because only humans are the only organisms on the planet who can make meaning about their life experience who, you know, we’re not looking at the impact of trauma, intergenerational trauma, community healing, we’re not eight emotions, we’re not able to study that in the controlled environment of a lab or in a tissue culture. So I started to become disillusioned with what we’re trying to achieve and whether or not what I’m doing in the lab applies to that patient that was in the floor underneath me, you know, in the in the floor down with their chemotherapy treatment, is this what they want? Is this the kind of research that they’re wanting us to do? Is this really what’s helping them? And the answer kept coming back to me No. So after a while, it was just I recognize that this is not ethical or within my integrity to continue in this way. And I had to make that tough decision to hang up my lab coat for good, at least in that setting.
So it sounds like you were so distanced from the intervention itself, like, you know, the research that you were doing was so far down the road from the eventual intervention which was then you know, distance very far from the patient itself. Then it was hard to, to continue doing that work. And it was almost like you were in the academic rat race.
Totally. No. And, and it felt a bit exploitative because we’re, we’re getting public funds, we’re using public funds. We’re justifying our, you know, the rationale for our research by saying this can potentially have some sort of direction towards a cure. But we don’t know when we’re kind of building up hope. And I, you know, I recognize the importance of that, but it’s like, it didn’t feel authentic, that we’re actually caring about the patients that were in the same hospitals or Research Institute. We weren’t actually talking them to find out what’s meaningful for you, what is it that you need us to be studying in order to support your experience? So it just felt so removed?
So then you pivoted and one you wrote a book on assertiveness, which I would imagine a lot was taken from your experience in academia and in that lab setting and then you also To speak on compassion fatigue. So, first, with regards to the shortness tell us just tell us a bit about the book and your workshops.
So assertiveness, you know is this topic that I didn’t anticipate would be this common thread running through my life since I was a kid. I noticed over the years, especially as a Canadian having moved to Australia, you know, there’s so many similarities between these two countries. So there’s quite some massive differences. And I noticed the one difference is that people were not as upfront with the feelings or their truth being honest. So you wouldn’t know where you stand with everyone. Everyone’s working hard to make sure everyone you know, looks good. Feels good. In which country? Australia In Australia, okay. Yes, sorry. And no one would really raise issues. It’s only that you know, you only discover that there’s an issue when it just becomes conflict, like boom, out of nowhere, and then it would make me think about why why that is. Why are people so afraid to speak honestly about their thoughts and feelings or ideas. What are we so afraid of, and it wasn’t quite my experience in Canada, people would be upfront with where things stood. And you’d be able to, I don’t know, work together. And maybe it was the environments that I were that I was in. But I found among really educated people, and this is not just in Australia, this is widespread. And this comes from doing lots of coaching and training work with physicians and other health professionals among health professionals. The common theme is that people are too afraid to challenge ideas, especially the ideas that come from someone who’s perceived as an authority figure, or someone who’s more knowledgeable than that than they are about a topic or an area of expertise. And so they’re more likely to be compliant and listen, or be combative in order to push their, their viewpoint across instead of challenging. And then when I started to, you know, go deeper into it, the skill involved in challenging an idea and learning more about it or getting to shift perspective is assertiveness, it became clear that we need some more information about what assertiveness could look like that is not combative, aggressive, trying to control a situation to get the outcome that you want. It’s looking at what are our values? What do we really want? And what is best for the US, not just me to see you, but we
Yeah, medicines very hierarchical, right? Like, you’ve got your medical students, your residents, your fellows, your attendings, you have the nurses and the nursing assistants, you have, you know, this is a complex system but with a very clear hierarchy. So, it can be challenging to assert yourself without being disrespectful or, you know, without fear of the repercussions of at least being viewed as disrespectful. So what recommendations do you have for within within that hierarchy for asserting ourselves, right? If we See, if we have a quiet if you’re a resident, we have a question for attending. If we think that a patient’s we should be paying more attention to lab value, or we think that the surgery may not be the best thing for this patient. You know, what, what recommendations do you have for asserting ourselves without being disrespectful?
Hmm, it’s a good question because I think there’s this assumption that assertiveness comes with disrespect that we can’t be assertive and respectful at the same time. Whereas my version as I described in the book is extremely respectful. It’s acknowledging the role that we each play among in a team that we each have an important role, and they’re all required in order to fulfill a purpose or to achieve You know, this desired outcome for all of us, including the patient, so as best as we can, so assertiveness, the way I use, it is about applying inquiry or curiosity. So we all have different assumptions. We all have different beliefs, we all are, view our roles differently and each other’s roles differently. So how do we know what we’re thinking? Unless we ask the question, tell me more. Tell me more about what you understand about the situation, or you help me understand what you mean by that. So I’m on the same page as you. So we have to recognize everyone’s role is important. Therefore, we should be respectful that we don’t each know everything. There’s something that I can learn from someone else. And I want to learn from you in this moment. So please help me understand. So I see that just the asking, asking questions instead of expecting to know all the answers, because that’s part of the culture as well that you just should know. And that’s a sign of weakness. If you ask questions, assertiveness kind of breaks through that and goes, I don’t have all the information. I don’t know everything. I’d like to know what you know, please teach me please show me I want to, you know, you have some wisdom that could benefit me and us I’d like to know it.
So it sounds like you would maybe rephrase the question as if you’re acknowledging that you may be wrong. So like, if you’re questioning the way a surgeries, the plan for the way the surgery is going to be done, it should be you think it should be done. B. And the plan is to do it a, you would more ask it assuming that A is the correct way to do it, but you think it’s B. Right? So like, yeah, the assumption is that the person who is asserting themselves doesn’t, is actually incorrect. But they want to know why. You know, why? Why answer a is actually correct. So that’s one way that you’re being deferential within the hierarchy. But at the same time, maybe, you know, that’s the way that you’re questioning the authority.
Yes, you’re not coming across as I know better than you and you must be wrong. And I’m also not coming across as I’m wrong. I’m not making any assumptions. I’m just saying I’m, I’m wondering about your plans, please describe them to me because I want to make sure I understood them because I may have missed something. And that way I can ask questions as to, you know, explaining why you’re doing it that way, not because I think you’re doing the wrong thing, or I don’t trust your judgment. I’d like to know. I’m curious because it’s part of my learning. It’s coming from this place of humility, curiosity. I want to learn more. I want to learn more from you.
So that if this patient were to walk through my door, I don’t know if I would have made the same decision. How did you arrive at that decision?
Yes. Okay. So share your thinking process behind it. Because I’m, I want to, I’m curious about how you approach a problem or you approach a situation and it’s, I’m curious to know if it’s the same as an as a how I would do it. It’s like, it’s like that just the idea about learning. I’m here to learn.
Are there any and those individuals, right, that’s what their primary role is, right? They’re apprentices so they’re, they’re likely to learn Yes. Are there particular phrases that you found useful? Or the opposite and any phrases that that are particularly toxic that we should avoid,
or anything to do with feelings where you’re trying to describe someone’s feelings. So when you say, you know, when someone’s expressing something and they’re coming across as little agitated, I see you’re really agitated. Or don’t do that, because you’re just gonna tap into their agitation and amplify it. It’s also kind of suggesting you understand their experience better than they are, when you’re pointing out their feelings. You know, the other way of doing that is I can see that there’s something that’s there’s an outcome here or there’s something that happened, that wasn’t what you expected. Can you tell me what’s going on? You know, what’s happening right now. So that’s what I call a safer way less emotive, potentially less condescending sounding, even if that’s not your intention. Another thing is, I’m sorry, you feel that way. You know, if you said something or did something that was the right thing in that situation with that other person. You’re not taking responsibility when you say I’m sorry, you feel that way. I’m sorry. That what I said was hurtful or I’m sorry, that what I said, didn’t land? Well, that wasn’t my intention. Let me try this again. You know, that’s taking responsibility for the impact you have on someone else rather than I’m sorry, you feel that way. Which is pretty much saying, Yeah, it’s like, your problems, you know, your feelings, your problems. I had nothing to do with it. Like, that’s not.
That’s sorry, Your reaction wasn’t what I expected. Yeah, yeah. Okay. Yeah. But with regards to the the assertiveness, are there particular phrases that that would be useful?
I guess it depends on the context, because in the book, it’s talking about different situations and barriers to assertiveness, what kind of power dynamics are occurring, that makes it hard to speak up. Because, you know, like what you mentioned, there’s a hierarchy. But there’s also other inequalities that are present within any, any environment. We don’t all have the same starting line in life. So we can’t just go I’m going to stand up for myself because you could be making your situation a lot worse. If you don’t Understand the unwritten rules of the place. So it’s always about understanding what are the values that we each share here and communicating that I see that you want this best outcome. So what do we each need to do in order to achieve that? very proactive?
Alright, let’s pivot now to your other area of interest, the compassion fatigue, right, something that a lot of us in medicine are experiencing. We had a speaker on the podcast a little while ago, Dr. Tory SEPA, she’s a psychiatrist, and something that she’s written about is the fact that we give so much to our patients that when we get home at the end of the day, we really have nothing left for our family. So first, let’s define what is compassion fatigue?
Hmm, yeah, I’m interested in what you said. It’s like we give so much to our patients that there’s nothing left for us. That’s exactly it. We are giving too much and we’re not able to monitor the level of which we give and whether When it when it’s enough, you know when is our level of giving sufficient to get the job done or within the realm of our role and responsibility with that patient, which will differ slightly with every other patient, the definition of compassion fatigue. So there’s, there’s a few definitions out there, because it was coined in 1995. By figley. And from my own study of doctors and other health professionals over the year, I’ve come to a different definition, which is less about compassion and more about empathic overload. So compassion fatigue is not because we are being too compassionate, it’s because we’re not being compassionate. That’s the problem. So there’s empathic overload that resulting from an imbalanced emotional investment in helping another who we perceive to be in a more vulnerable or disempowered position coupled with an absence of self care practices. So we are dealing with this sort of power imbalance or this perception that this person is so needy that I need to get Give them more than I can then I have the reserves for and I’m not doing enough practices within myself to recharge my supply of energy. So that’s how I see compassion fatigue.
Alright, let’s unpack that. Let’s go to the to the first part. So the fact that we’re we’re feel like we’re giving so much to the patient that we have nothing left. It sounds like you’re saying the assumption of that means that they require so much of us, and often it is the case that they do not. Mm hmm.
Yes. So do you have an example of when you’ve given too much to a patient? What that looks like?
Well, I would think, let’s say I just I have to give some bad news, right? So the bad news could be, we’ve been monitoring somewhere to cancer and their cancer came back or if I have someone that, you know, we’re gonna have to do a biopsy on you because there’s a possibility that you’re right. That’s the big concern. That’s the elephant in the room is his cancer, right? So let’s just use that as the example. So right. So I see up to that 30 patients in a day. And so what might happen is I have someone in whom I have to give that type of bad news. And now I’ve got someone across the hall with a completely unrelated problem. And now I need to somehow reset, forget the patient whose room I just left because now their hand right there, I give them the news, they have a plan, they have a strategy, but I’ve explained everything to them, but, but that can be really emotionally fatiguing. So now I’ve got to be able to go and completely refreshed to this next patient who has a completely different problem from you know, starting from zero. So, you know, doing that over and over and over and over, is just, it’s really taxing. So, you know, that that that’s really the, the scenario that I that I think our listeners need to be able to work with.
Okay, so let’s let’s do this in a stepwise fashion because as you’re as you’re sharing the situation with the other contexts, you know, my mind is going off of like, oh, you’re doing it this way. And then you’re doing that way. And of course, it’s going to be texting, let’s go back here with the patient, you have the results of a test, and it’s not positive, you’re sharing the news with them. And they have, you know, an emotional reaction to it, I imagine some sort of reaction. And at the same time, you also want to make sure that they they’re informed about their follow up actions, their options, etc. And so you’re working hard, you’re working really hard to try to help this person. equip this person with what you think they need in order to feel a bit more in control. After having received this news.
They’re overwhelmed. They’re shocked. They don’t know what questions to ask. Yeah, they’re asking more logistical questions than anything else. like where do I go next? What’s the phone number? Is there parking there? Because they’re just so shell shocked about their diagnosis.
That’s right. So you’re already working. You’re already doing too much work there because what you have what is required, which Just the compassion thing. So it’s not saying any other ways not compassionate, but it’s like the right action that’s needed in that moment is giving them space to process that a little bit. And so what can happen is because we’re feeling really uncomfortable with their, the first of all that the information you have to give, how it’s going to be received by them, and then their emotional response to it. We tend to go into this, give information, I need to do something to appease my discomfort at saying something that upset someone else, but you’re just the messenger, you’re not the cause of their upset. There’s a situation that is happening for them, you’re reporting to them, what the tests have shown. And what is needed is to allow space for them to just receive that information and process it in that time and space you have with them in the way they need to. That might mean that they ask you questions, but when you start giving information, they have no room and capacity to do anything with it. It’s just more energy that you’re You know, putting out in order to somehow fulfill this kind of role or obligation you feel to make them feel better. But you’re working hard to do that you’re trying to force them from the state that they’re in, which is deeply uncomfortable for you into a different state that might feel more comfortable for you, even though it’s not wonderful overall. Does that make sense?
Yes. But, you know, if they’re, if they’re asking these questions, I don’t see. You know what I mean? Like, like, realistically, a lot of times they can’t they’re so overwhelmed with this new diagnosis with this new complete change in their world, right. It’s hard for them to process any information, totally. But they’re still asking you the questions. So I don’t see a situation in which I would redirect them and tell them listen, this is not the time for you to be asking those, you know, I, I’m not sure how to pivot from there.
Yeah. So it’s almost like you know, this is big news. And this may not be what you expected or might be what you expected. But we don’t know how we’re going to you know how how we’re going to feel about it in the moment? Do you need some time to process this? Do you need time and space? You know, I’m here to answer any questions you have. But I want to make sure you’re in a headspace where you can actually do something with this information. So you’re giving them permission to take space. The problem is you have, you know, I can only imagine that there’s short appointment times, or maybe there’s a longer appointment time if there’s test results to disclose, and that everyone is trying to the patient is trying to get as much as they can from you in that time. But like what you said, they’re not in any position to be able to process any event. So sometimes it’s a good thing to go, Hey, this is big, you might need some space. And I can answer questions after before you know, so that you can be in a different headspace where you can look at all your options and look at the next move you need to make and I’m here to support you with that. Would that be okay? Or do you have questions you want to ask now? So you’re giving them choices, and it’s less laborious for You know, and then you won’t walk away feeling like you had to do all this stuff in a certain ritual within a short period of time, and then have to move on to the next patient, you gave space you allowed, you allow the space for them to decide what they need next, which is I’m not saying that that’s not what’s done. It’s just a different way of doing it.
Yeah, that is more than I want to know, just acknowledging out loud, that this is gonna, this is a very overwhelming thing. And they might have difficulty processing it all at once. And so if you know, if they need just a little bit of time before we regroup and decide what happens next, then when they can do that, you know, at least in my practice, I could very easily just go, I could go see the next patient and give them at least a few minutes to kind of, you know, maybe they want to call a family member if they came close, or something like that.
Yeah, that’s right. So there’s ways you can manage the time. Definitely. So you see those options now. And it gives you room to breathe. It’s the you probably holding your breath for a whole day. Sure. If you’re going back to bed, Patience gives you the space to breathe with them.
So you, you know, we talked about compassion, fatigue and empathic. I apologize. It was
empathic overload. empathic overload.
So what’s the difference between compassion and empathy? Or, I guess empathy is?
Yeah, compassionate empathy.
So again, there’s so many different ways that I see people describing it. Empathy to me, is emotionally neutral. It’s the ability to basically attune to what someone else is feeling. It’s not about being in someone else’s shoes. We can never ever, ever be in someone else’s shoes. We have our own experiences, our own ways of perceiving the world. We can’t actually enter into someone’s shoes, but we can imagine what it might be like for them to to experience the bad news or, you know, experience living with cancer experienced an illness. We can imagine it and we can also be, we can also appreciate how they’re using their resourcefulness to live with With it, to deal with it to manage it. That’s empathy. It’s not about feeling what other people feel. But because we are emotional beings as well as you know cognitive beings, we can actually feel in our bodies, what people are feeling. I know for me personally, the more time I’ve spent working with people I can feel in my body where they have pain. So I already know where their pain is, before they even disclose it to me that we could start to believe that’s our pain. If we didn’t know better, we didn’t know differently. So empathy is what connects us. We need that in order to build a rapport and trust in a therapeutic relationship with a patient or client. But what can happen is we can feel people’s feelings so extensively, and we can just dive into the their story of their suffering, that we fail to see all the other positive things that are also occurring in their life at the same time, we can fail to appreciate their strength in their capacity to overcome challenges that we all have and we can just see We’re the we’re the one that ruin their day because we gave them bad news, we put that on ourselves. And so we become overloaded by all those feelings, those negative feelings and we become, it can feel quite heavy. And if you’re doing this daily with so many different patients day in, day out, and not going through any sort of internal process or debriefing process or any sort of self care process where we can make sense of it and unload it from ourselves, we become quite exhausted very quickly. So let’s talk about the debriefing process. Oh, what I didn’t act that I didn’t mention was compassion. What is the difference? So compassion is recognizing that we all suffer and we all have joy. Just because you’re in the doctor patient doesn’t mean we’re so different in that way. We all have these feelings. We all have, you know, our experiences, so I can, I can appreciate that you’re in suffering right now. But you know, there are other areas of your life that are also joyful or pleasurable, that it’s not only about the suffering, and my job is not to make you suffer less than this moment or feel differently. I’m here to recognize that we all suffer, we all feel joy, and I can see them both with equanimity. And my role is to do what? To do the right action in this moment. So how, what do I need to do with this person who’s just received news that upsets them? That is compassion. Compassion is not making them trying to make them feel something different. Like what I mentioned before it’s holding it’s it’s holding space for them to experience whatever they need to experience right now. That to me is compassion. So that’s the difference between empathy and compassion. Compassion is like what I call love with action, check. It’s empathy plus action, his compassion, and empathy is just being tuned into their experience, whatever they’re what they’re feeling and thinking. And it requires some listening skills, some inquiry skills, so asking certain questions to get a better understanding of what’s going on for them and just being curious about that rather than feeling what they’re feeling and trying to make them feel something else.
So it sounds like the theme here is really giving the patient space either really giving them space or verbally acknowledging the fact that they may need to take some space and that’s gonna unburden us at least just a little bit. Definitely. What about the that debriefing that you were talking about? Can you elaborate on that?
Yeah. So I don’t mean the debriefing that occurs, if that can occur after an adverse event. I’m talking about just the everyday the stuff that weighs on us the things that we encounter on a day to day basis, you’re as a physician, you’re seeing suffering, pain, joys, everything on a day to day basis, who are you talking to about this because it can be burdening especially if something that you’re experiencing doesn’t make sense to you or you haven’t, you know, resolve it within yourself. We have all these unresolved stuff that we carry every day, unless we give a voice to it and, you know, debrief it, disclose it, offload it, it just stays inside us and it becomes again, quite heavy. So it’s having a trusted person in your life. Whether it’s a therapist, a counselor, appear, a colleague, a manager supervisor, doesn’t matter as long as you feel safe with them, and you trust them. And they’re not trying to give you advice, and try to make you solve the problem. It’s about holding space for you, to giving you space to disclose the things that are weighing on you. And through that process, you might develop your own aha moments. So it’s just again, give allowing yourself to have the space the same way you’ve just given for your patient.
Is there a role for journaling in there, you know, there, there might be some issues with legality and HIPAA, at least in the United States, just being able to talk to people about what’s happening with your patients, although it’s easy to make these fairly anonymous. You know, if you’re speaking to a spouse, or a colleague about a patient, it’s really important that you leave out any identifying information because the legal issue Yeah, so here’s the thing. So your lawyer before you Yeah, before you Again,
well, it’s not about your patient. In the end, we can say it’s about our patient, but really is it’s about us where there’s something that we experienced with the patient that’s bothering us. So it’s you don’t even have to talk about the patient. It’s about what’s bothering you what’s unresolved in you, that working with a certain patient has brought up, but it’s not about the patient at all. It’s about your experience of that. So it’s working with someone, again, trusted, confidential space where there’s no risk that they will expose that information. And you can, again, de identify everyone involved in the situation, but really is about an opportunity to talk about yourself and learn about yourself. And journaling is definitely part of it. But it requires a structure like, you know, we could do a stream of consciousness where you’re just writing whatever’s on your mind and just offloading it. There definitely can be therapeutic. You can use a self reflection practice that is helping you get clarity about a problem or, you know, again, something that’s weighing on you. By the way, what I find the most powerful is when you’re doing it in the presence of someone else. Someone else is witnessing you. They’re not trying to solve your problem because they can’t, it’s not them. They don’t have more expertise in your problem than you do. It’s your problem. It’s them just being open and holding space and allowing whatever that’s lying underneath to reveal itself. So, so is the
listener, an empathic listener, or a compassionate listener?
I think the both of you need both. You can’t have compassion without empathy. It’s like I say, empathy is the doorway to compassion because you don’t know compassion is the action. You don’t know what to do unless you are able to attune to what’s needed by that person. What’s needed or what’s needed in that situation. And what’s needed is not dictated by you. It’s dictated by the moment you know, like I said, some Breaking Bad news. You think you have to kind of appease them and make them feel better before you know you send them on their way. That’s not necessarily compassionate because you didn’t give them space to actually grieve and maybe they’re not really great at grieving or, you know, expressing emotion You allow that you enable that to happen, which is a really good thing. So compassion is the enabling the allowing the permission, the non compassion is the pushing the for things that are trying to control.
Are there any other self care practices that you recommend? And
I’m all about talking as you can tell some of the talking and
debriefing with again, a trusted person who knows how you how they can support you, you’ve told them or you’ve trained them on how to support you. Big one is reflective practice. So, you know, one form of that or shorts rounds where you know, that’s a way of getting together with other physicians or your team and talking about things that occur in the workplace and, you know, holding space for these conversations to happen, which are often held secret and buried in shame because somehow we’re supposed to believe we know everything, and that we could do everything perfectly and that that’s not possible. So the short surrounds is One format reflective practice is a more structured format that also allows you to figure out what next step to take or how to do something differently. Because you would have reviewed the impact of your actions with a patient with a colleague, whatever the situation is, and then learn from it, and learn and think about how you could take a different step forward next time. And it’s really, again, non judgmental, very open, and about Problem Management. So those are two very powerful ways that can prevent compassion, fatigue, and they all involve talking about everyone’s favorite subject themselves themselves, right? But what we also learn from everyone in the group, what you learn about from someone in the group also applies to you. So one person shares their issue and it becomes a group kind of learning opportunity, because we all experience these things.
Is there anything that we didn’t talk about today that you’d like to mention to our physician audience, either about assertive Or compassion fatigue?
Yeah, cuz. Yeah, I think overall it’s learning I guess overall, it’s learning how to be okay with the myriad of emotions that we get exposed to and the emotions that we feel. And the more we allow ourselves to be uncomfortable, the easier it becomes to be with someone when they’re going through their toughest day, and not trying to make them have any other experience and the one they have, and it’s less and less energetically taxing on us. And it’s actually more supportive for the for the patient. So everyone benefits from that kind of interaction.
I think I heard Tim Ferriss once say, a successful life is judged by the number of uncomfortable conversations you have. I think there’s something to that,
that and that’s assertiveness, exactly. It’s it’s naming the elephant. So in my book, I talk about ways I provide scripts on naming the elephant and it breaks the tension in the room and again, it brings some relief to everyone in there.
So we’re getting People find the book and where can people find you online?
Well, I’m on Twitter a lot. And it’s where I found you. That’s very family. So I’m at NATS for number four docks. And the book can be found on Amazon. And it’s called a little book of assertiveness. And don’t let the name fool you,
Dr. Natalie martynuk. Thanks so much for being on the show today.
Thank you so much, Dr. Brad for having me.
That was Dr. Bradley Block at the physicians guide to doctoring. He can be found at physicians guide to doctoring calm, or wherever you get your podcasts. If you have a question for a previous guest, or have an idea for a future episode, send a comment on the webpage. Also, please be sure to leave a five star review on your preferred podcast platform. We’ll see you next time on the physicians guide to doctoring.
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What Can Victorian Literature Teach Us About Coronavirus/ COVID-19?

What can an English professor with expertise in Victorian Literature teach us about the coronavirus? Germ theory became popularized during that era, so this is when people realized that we were the vectors of our own illnesses. One would think that this would cause us to isolate ourselves from one another, like we are doing now, but the literature of the time, which reflects the thinking of the time, shows us that it brought us closer together. A message of hope in these dire times.

Dr. Kari Nixon is an assistant professor of English at Whitworth University. She teaches medical humanities, Victorian literature, and is forever interested in death, disease, risk, and why we fear them. Dr. Nixon’s work has been shared on Huffington Post, March for Science, and more.

Her first book, “Kept from All Contagion:” Germ Theory, Disease, and the Dilemma of Human Contact will be in print Spring 2020.

She got her PhD at Southern Methodist University in Dallas, TX, with a dissertation in Victorian Bioethics, which she turned into the aforementioned book. She teaches both Victorian literature and contemporary medical humanities. She can be found at MKNixon.com

Find this and all episodes on your favorite podcast platform at PhysiciansGuidetoDoctoring.com

Please be sure to leave a five-star review, a nice comment and SHARE!!!

What Can Victorian Literature Teach Us About Coronavirus/ COVID-19?

What can an English professor with expertise in Victorian Literature teach us about the coronavirus? Germ theory became popularized during that era, so this is when people realized that we were the vectors of our own illnesses. One would think that this would cause us to isolate ourselves from one another, like we are doing now, but the literature of the time, which reflects the thinking of the time, shows us that it brought us closer together. A message of hope in these dire times.

Dr. Kari Nixon is an assistant professor of English at Whitworth University. She teaches medical humanities, Victorian literature, and is forever interested in death, disease, risk, and why we fear them. Dr. Nixon’s work has been shared on Huffington Post, March for Science, and more.

Her first book, “Kept from All Contagion:” Germ Theory, Disease, and the Dilemma of Human Contact will be in print Spring 2020.

She got her PhD at Southern Methodist University in Dallas, TX, with a dissertation in Victorian Bioethics, which she turned into the aforementioned book. She teaches both Victorian literature and contemporary medical humanities. She can be found at MKNixon.com

Find this and all episodes on your favorite podcast platform at PhysiciansGuidetoDoctoring.com

Please be sure to leave a five-star review, a nice comment and SHARE!!!

EPISODE TRANSCRIPT

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What can an English professor with expertise in Victorian literature teach us about the Coronavirus? Well, germ theory became popularized during that error. So this is when people realize that we were the vectors of our own illnesses, that one would think that this would cause us to isolate ourselves from one another, like we’re doing now. But the literature at the time, which reflects the thinking at the time shows us that it actually brought us closer together. So a message of hope in these dire times. Dr. Karen Nixon is an assistant professor of English at Whitworth University, and she teaches medical humanities Victorian literature, and is forever interested in death, disease risk, and why we fear them. Dr. Nixon’s work has been shared on the Huffington Post march for science and more. Her first book kept from all contagion, germ theory disease, and the dilemma of human contact will be in print in spring 2020. She got her PhD at Southern Methodist University in Dallas, Texas, with a dissertation in Victorian bioethics, which she turned into the affer mentioned book. She teaches Both Victorian literature and contemporary medical humanities, and can be found at MK Nixon calm.
Welcome to the physicians guide to doctoring A Practical Guide for practicing physicians. Dr. Bradley Block interviews experts in and out of medicine to find out everything we should have been learning while we were memorizing kreb cycle. The ideas expressed on this podcast are those of the interviewer and interviewee and do not represent those of their respective employers.
And now, here’s Dr. Bradley Block.
Professor Carr Nixon, thanks so much for being on the podcast.
Thank you so much for having me. I’ve been really looking forward to it.
So how is it that you wrote a book about epidemics that’s set to come out in April of 2020. And, and it was the topic of your dissertation. So this was done years ago. Mm hmm. And it’s being released in the midst of The worst pandemic The world has seen in 100 years. So where is your time machine? What stocks have you been buying Now that everything’s down? So clearly, I can’t ask you about sports betting since the NBA and the NFL have been canceled. So right, how do you? How does it happen?
Uh, you know, the funny thing is that I think, I mean, I guess there’s not too many of us disease scholars, but I would venture to bet and apparently I’m good at betting, you would say, I would venture to bet that most disease scholars would just simply say that diseases always relevant, unless that seem just any professor who is of course going to say that there are esoteric specialty in research is always relevant, which I think is a sort of professorial thing to say, for me, the idea I mean, of course, it is oddly coincidental that my book is coming out in the middle of this pandemic book For me, the reason I wrote the book and the reason I’m fascinated with what society does in the face of disease is because it’s always just a matter of time. It is an inevitability. And that’s sort of a crux of my book on an individual level. I argue that disease is an inevitability we will all get sick. People say death and taxes, but I say death, taxes and disease are the three things you can depend on in life. And so if you think about any other catastrophe, I don’t know, war, maybe I can visualize a way in which we could theoretically avoid war, because we’re talking about diplomacy and people may be negotiating. We don’t get to negotiate with diseases. There’s diseases and disease outbreaks, which are essentially one form of, I guess, a natural disaster. So for me, it’s not that surprising that it happens to come out in this really Relevant time because Have you seen that meme? It goes around a lot of Kermit sipping tea?
What is he saying? Well, he’s sipping tea and what kind of tea is it?
I think it’s Lipton tea tea, okay, he’s always it’s usually captioned with, but that’s none of my business. But he has this kind of look on his face, like he could have told you this was gonna happen. And I just keep visualizing myself that way. Like, the coincidence doesn’t seem coincidental to me, because I feel like the very nature of my book has been kind of screaming into a void, that disease is coming for all of us. And we ought to think about that, when we’re not in that moment of crisis, to understand what we will feel like in the moment of crisis and do better at that point. So,
yeah, so if you can use that time machine again, right, your your book is arranged by disease, each disease, you cover, get to chapter right. So So, you’ve now written a Coronavirus chapter. What are some of the highlights? Or are there no, is there no Coronavirus chapter since people are now mostly buying into germ theory? I’m sure there are some fringe people out there. But really, it’s not. I guess it’s not germ theory anymore. So is that even a chapter?
Right? It’s not really a theory anymore, is it? It’s just germs. You know, I actually think there’s a really great parallel between the things I cover in my book, the diseases I cover, and the emerging Corona virus disease right now. The reason I cover the specific diseases I do and the time period I do is because in the 1880s to the 1818 9597, this 15 year period is this really interesting slice of history in which most people are buying into germ theory at that time, although they are still calling it germ theory. Most people pretty much believe it. They’ve started using Robert Cook’s theories to identify certain bacteria under a microscope. And I’m sure anybody who’s done laboratory science in undergrad or post grad is familiar with Cook’s postulates of how we culture a bacteria in a petri dish and then correlated with the causal pathogen that we see creating clinical manifestations in a patient. So people were believing in bacteria at this time as disease causing vectors. But they had they couldn’t do anything about it. Anything. We don’t even have penicillin till 1928. So there’s this really interesting time period and this little 15 year segment that I studied, in which there’s sort of just this existential horror, and I know that sounds sort of like an unscientific term, but I just love when the sort of cerebral realm of science and history meets up with what are the undeniable Least human components of our existence such as fear and hope and a desire to live. So there’s this existential horror that I noticed in this time period where they suddenly see and identify everything that’s killing them. And they have zero tools against it, except maybe they had started to understand antiseptics. At that time, they had a few they did understand that hand washing and sanitation helped. And isn’t that exactly where we find ourselves today at 6:15pm Pacific central time on March 16 2020. When we have a disease that is an emerging infectious disease, an ID that we don’t fully understand, we are back in the Victorians footsteps where we see something and we definitely see the epidemiological data that proves that it is killing people and all we really know to do is our basic sanitation practices. Just it’s so for me it is exactly that human and societal reaction that I wanted to isolate culture, if you will to use cooks words and Petris words, in this book that I’m seeing, again here with this infection, it’s like you’ve got all the same ingredients, the same media in that petri dish. I’m going to stick with that metaphor until it gets rolled. And and what I’m seeing are the same social reactions on all ends of the spectrum that I identified in my book happening to the Victorians. What do you mean, what are some examples? Well, the thing that I talked about in my book, and sort of the crux of it is that germ theory as it really took hold, and as people sort of looked up, I sort of imagine a married couple looking at each other over their morning coffee with the slow, cold realization that that’s the person that probably gave you tuberculosis. I always see it very cinematically, in my mind. My thesis is that That moment in history, catalyze this sort of individualistic, neoliberal idea that we should just isolate ourselves and protect ourselves. That’s the only way to survive these things that we don’t know how to control called germs. And yet, what I identify in my chapters and as you note, I do it disease by disease because I highlight the different specific social questions coming out of each disease. I identify these really beautiful moments in history where people are saying, No, I will look out for the greater good. I’m not just going to try to hermetically seal myself away in my house to preserve what I call bare biological life, a beating heart, but I’m going to help my community members engage in rich, fulfilling intrapreneurs relationships that are what make life worth living.
Okay, but if you’re listening to this, and the Coronavirus epidemic is still hot pandemic is still happening. Don’t do that. Right. Your house?
Well, no, no.
Listen right now this comes later.
Right now double down. I’m gonna double down. It’s what I do. Here we go. So yes, we are isolating and staying in our home and social distancing, which I would actually love to talk a bit more about this because my first chapter goes way before the Victorian era and talks about Daniel Defoe writing about plague in 1722. Way before germ theory and he my whole chapter is about how he promotes social distancing. Before I became apprised of that term with Coronavirus, but no, I mean, of course, I don’t mean ignore public health mandates and that would never be the goal of medical humanities. The first thing I would say is of course, my book is a literary criticism books. I am able to identify the ways that authors promote the communal good in the imaginative space of literature, right, where people are actually dying from this. But secondly, I actually think that we have much greater opportunities to live this out real in reality than the Victorians did because we have social media. I mean, I’m sitting here right now having a really fulfilling, Enriching conversation with you, in spite of the fact that we can’t leave our house
and then never would have taken place had we not gotten in touch over social media. Exactly the toxicity that occurs in there.
Yeah. And I mean, I haven’t seen so many people saying, you know, people with people that are extreme extroverts people with really high anxiety right now people with substance abuse disorders that can’t get to their a meetings right now. Reach out to me, I’m seeing that on Twitter. I’m seeing people develop groups Hangouts and FaceTime and acknowledging what I, again, sort of as an academic feel like I just kind of scream into the void of my office so often, that these social relationships are why we’re trying to keep staying alive. It’s not just the functional existence of a beating heart. It’s because we like other people, and others,
right? Yes, yes. And you’ve seen the great videos coming out of Italy, I’m sure that have gone viral. Haha, pun intended, intended of the Italians singing together from their balconies, and enjoying the communal space of song across a busy street and a balcony. So they’re safe, but they’re together. I mean, I just, I actually think we absolutely are doing these things because we’re lucky enough to have this technology. Now.
Another thing that I’m seeing is crowdsourcing of information I’m a member of a bunch of physician communities, and just the exchange of ideas globally, and I’m just floored by how smart people are like, like, you know, yet we don’t have a vaccine for this. We don’t have a medical treatment for this. But what worked into your IC? What’s been working for you? Have you tried this? Have you tried, we tried this, like, just, you know, clearly not disclosing patient information, but like, just the back and forth and the exchange of ideas is, you know, across the globe, it’s a testament, you know, how social media just shows the rawness of how horrible we can be to each other, and how creative and wonderful we can be.
Yes, I always say it’s becoming more and more of my mantra, as I think these things become, I think, as you say, more more raw and exposed in times of crisis, which again, is why I think diseases is interesting space to study. I’ve been seeing more and more humans are my Least favorite and most favorite part of humanity? Um, yeah, I’ve been seeing it in my profit sorial communities, because so many of us are now having to suddenly teach online. And just the way people have come together to make sure that we all are focused on the most ethical way to handle this with our students. I mean, initially, I was thinking, we’re talking on a zoom meeting right now You and I, I was like, Well, great. Like, we’ll just zoom all our classes, it’ll be fine. And I start seeing people posting and making Google Docs that are open access, saying, you really can’t assume that your students have internet reliably at home, if they can’t live in the dorms anymore. For many of them being on a college campus was a vital point of access to resources. Please don’t do synchronous learning. You’ve got to do asynchronous learning where they can get on when they can. And I’ve just been so grateful that as much as I try to do my best as well that we can crowdsource these things and Think about things that we may not have thought of. Or, for instance, I was home insecure as an undergrad, I didn’t have reliable housing outside of my dorms. So my students that might have been displaced into an unsafe non existence or unhealthy home when the doors closed, it was at the forefront of my mind. And I emailed all the professors in my department and I said, What do we do like we could probably offer students a place to stay. But I don’t want to offer students that are currently taking my courses a place to stay because that gets kind of thorny when I’m still in greeting authority. And we sort of develop this elaborate system by which we would house one another students to make sure that nobody was housing a student they were grading but that all the students have housing turned out to be unnecessary because my university opted to keep limited dorms open because they weren’t thinking about students, housing security, but like you I’ve seen my communities coming together and I also say, you know, academics can, they can sometimes not be the most pleasant people. But I’ve seen like the best and my most, my favorite sides of academia and why I became an academic coming out of this crisis, one of
the questions that I had was gonna lead to, can you please restore my faith in humanity with all of the horribleness that’s about to ensue? And you did. So we will not be able to skip that question. Thank you for restoring my faith in humanity. So, during our first season of my first season of doing this podcast, I had an episode called bad words. The title was longer than that. But the idea is words. While we think that our ideas help us choose our words, and they do, words can shape our ideas so that the interview was in the terms of patients with weight issues. But you say that our words can shape our ideas with regards to Even a pandemic, so and can ultimately influence the pandemic. So given that this is a largely physician audience, how can we as physicians utilize language that we use with our patients to convey the appropriate amount of gravity, right and help to help to shape that outbreak narrative that you talked about? Right?
Well, I think what you’re referring to is something that I started calling it this in my teaching, just kind of, because it’s what made sense to me and my students have found it really helpful. So I’ve, I’ve kind of developed it further, I believe it was in my cnn article, and it’s a huge part of my my second book, I call what you’re discussing this dynamic, this socio scientific discursive cycle, meaning that of course, as you say, the way we talk about things can affect the way we frame scientific questions and inquiry. One really concrete way to think about that as it may frame the grant money that people ask For and what they’re asking to study with certain grant monies, but that also, of course, the way we develop that science then filters into the way we speak, generally. So the fact that we just mentioned something a meme going viral Porsche that comes out of the original notion of biology developed in the 1940s or so. Yeah. So, initially, what I was focusing on with this pin, well, before it was a pandemic, or recognized as one was really talking about Origin Points of viruses, that has been something kind of a soapbox of mine, I suppose you would say that when, when we try to identify a patient zero. And this is where you’ll have to let me know if you if if I’ve lost you, because people sometimes bristle at this idea. I’m not saying that epidemiology is incorrect when they identify a patient zero, but what a medical humanism General would ask is when we frame the question that way to pinpoint a single source of an infection. What are we implying by that? And what are we looking for? And what might we be not thinking about? When we ask that question? The answer to that I would suggest is, I mean, we essentially are wanting someone to blame. I would think right now, there may be broader scientific reasons why we just need to know an origin point and I cannot speak to those nor do I intend to. But I do think it’s very, very stunningly human that we would like to figure out what started at all, and I think, therefore, that easily slides all too easily into blame. One of my favorite scholars ever from whom I learned everything I know about patient zero and healthy carriers and outbreak narratives. That’s her term. Her name is Priscilla Wald. She’s at Duke and one thing I love about her book. In her intro, it’s called contagious cultures, carriers and the outbreak narrative. she identifies the way that over and over and over again in history, we tend to say that diseases come from the east. We being Of course, Western culture. And what’s great about the way she does this intro is she does not at all address, whether she’s saying the epidemiology is accurate or inaccurate. It’s not a point of her argument. That’s not her field. She’s a literature scholar like me. She simply presents it as the narrative that we’ve said about h one n one and SARS and MERS. And she just lets the that speak for itself, so that you can leave her book in my opinion as a reader without thinking that’s just a little too convenient for us over in America and it makes you want to know more About if there might be some myopia in the way we’ve constructed these epidemiological questions that perhaps keep leading us to the same answer at the exclusion of other possible answers. I hope that didn’t sound too much. Like I’m trying to debunk the entire field of epidemiology. I’ve, as I was editing my cnn piece over and over, I kept getting that criticism, and it’s certainly not my or any medical humanists. I know. It’s not our intention,
know that the pattern is definitely there. Is it coincidence? Or is there actually something there? I’m certainly under qualified or completely unqualified to answer a question like that. But But I would think identifying a patient zero identifying where this came from, you know, we need things like that in order to find order in the chaos. Right? And just that’s, that’s a very human it’s a scientific need. Right? Where did it come from can help us hopefully prevent another one but it can also inform us as to What might help in terms of treatment? Now? I’m just I’m just guessing there, do we need to know patient zero in order to in order to accurately track the spread? Clearly, that didn’t help us here? Because it was being community spread before we realized it. So, yeah, I don’t know. Those are definitely interesting concepts that bear some evaluation, right. always seem to come from the quote, other.
Right, I think and something you said and the way you said that back to me, maybe it kind of clarified for me a better way to say it, but what we would say in the medical humanities is not that it’s necessarily wrong or not wrong, but that if we as a society aren’t seeing that there might be a potential bias there. If we’re incapable of possibly identifying possible biases, then you’re just absolutely certain to get some biases, right. So we’re always just trying to get people to like, think in different frameworks all the time to make sure that we do better science to make sure that we’re not missing something.
Yeah, we’re always bringing in our biases, we need to recognize that in order to account for it in order to make sure we’re being as objective as possible.
Exactly, exactly. I think I might have answered your question in a really circuitous way, the xenophobia was on my mind. First of all, as the disease has developed, what I’ve been more concerned with is ablest language, people saying, you know, well, it’s only gonna affect the infirm and the elderly. And there were great disability scholars coming out on on Twitter and Social Media and saying, you know, that’s unacceptable to phrase that as though the rest of you know people without those conditions can stop worrying because that treats that population as disposable. I I feel like the medical community has done really great with this. I would not suspect generally that doctors would have been perpetuating any of those problematic stereotypes. But I do think that risk is really hard to convey accurately to patients who are almost certainly not medically as medically literate as their doctor, right, by definition. Well, and
that also has been a problem in our past, as you mentioned in the that same cnn article, right. So syphilis was seen as a disease of sex workers, not a disease of the husbands that were then taking it home, their wives who were then giving it to their children, you know, their their unborn children, or HIV being a disease of homosexuals. So thinking that it was only affecting homosexuals while it was rapidly spreading in the heterosexual community as well. So by thinking it was a disease of the other, right, that helped it to continue spreading, and that’s happening right now with the Coronavirus, right like I’m sure we all have seen pictures of millennials out at bars, carousing and spreading them. Guess that shows that I’m not a millennial prior to them as carousing, and potentially spreading the virus among themselves, and then spreading it to others beyond that, right, so they’re disregarding it because it’s a disease that primarily affects the older population and those with comorbidities.
Right, exactly. I mean, we’ve talked about seeing the the most beautiful parts of human nature, and that would be the part that has disturbed me the most is that again, that I identify in my book, that sort of individualism of well, if I’m gonna be okay, then who cares about anything else. And the American concept
it is It is I, the older I get, maybe I’m showing my age here, but the older I get, the more I’m convinced that that’s the root of all our problems in America. But I think
also the root of our solutions, like, I can figure this out. Whereas in America, you feel more empowered to be able to innovate. Whereas other countries, if you’re the member of a cast, I mean, we do really poor this poorly with this in terms of socio economic status and race, right? Where you might not feel as empowered as you otherwise would be if you were a white male, who feel like caught as a white male, you know, you feel a constant sense of empowerment. But but in America, like you do have more social and mobility than in other places, and more of an opportunity to innovate. And that’s why we see all these, you know, innovation happening, certainly happening other places in the world. But, you know, America is definitely a popular place where that for that to take place. So the individualism is horrible, when you’re being horrible to each other and ignoring other people’s needs. But at the same time, you know, I have an idea. I think I can do this in vain,
that American gumption
like that, yeah, yeah. And do attitude.
No, but you’re absolutely right. I mean, I think that’s the sort of problematic attitude that, in fact, is allowing it. I mean, we see it epidemiologically It’s a fact that that is how it spread, because people weren’t worrying early enough about the most vulnerable among them.
Yeah, unknowingly putting themselves at risk because, right some of the data that we’ve seen said there’s the mortality from this is point 2%. in I think it was like 10 to 40 year olds and and point 4% in 40 to 50 year olds. So right point 2% seems like it’s not going to happen to you, but if you’re if you’re in a high school of man, am I going to do this math correctly? Let’s say 500 people, right, your high school class then that means that I’m gonna get this wrong, you know, one or two people are gonna dive It doesn’t mean the middle but you know, that’s what this is. So, so like, right, well, that you know, like, and yet you’re out and passing into among each other thinking that you are invincible, right.
And one of my students told me about Coronavirus parties Where people earlier on were using it for the masks and stuff for costumes. And again, that speaks to this sort of privileged flipping, see that it’s not going to happen to you. And yeah, I think one of the ironies I tried to highlight in my cnn piece is that you get really rude awakenings when you behave that way. One of the texts that I discussed in my chapter on syphilis, actually is by Henrik Ibsen. It’s a play called ghosts. And it is literally about the the way that his mother tried the main character his mother tried to hide from the main character, the fact that he had syphilis. She tried to stay with this philandering husband to have this perfect seeming home, that that in fact delayed him getting this imaginary treatment in the realm of the play and causes his death doodoo syphilis and He was writing that in direct response to exactly what you said, these sort of, quote unquote good Victorian middle class women who are giving birth to babies with the sniffles. You kind of only learn about this in medical school anymore because you don’t typically see congenital syphilis these days, but the sniffles and the notched teeth and all these very physical signs that a mother could see the second she held her baby just as easily as a doctor could that this was not what she had imagined. And it was striking visual evidence of the epidemiological fact that these were, as Epson called it. The ghosts of their behaviors and prejudices coming back to haunt them.
And it’s happening now. Well, history repeats itself, so that’s why we need It’s why we need more historians out there. I’m sure you’ve been shouting from the rooftops for a while from the very beginning here.
Yeah. Well, I mentioned the Kermit tea thing. That’s kind of how I keep thinking, you know, a zombie class this January. And we use that to talk about access to health care ableism cognitive alterity so many different things. And one of the movies of course we watched was contagion even though that’s not a zombie movie zombies have become sort of synonymous with contagious disease these days. And it’s been funny to watch people online now watching contagion because now it seems relevant to them. And, and as I said in the beginning of this interview, for me, it’s always it’s always been relevant. It’s always been about to happen to us. And now just finally have
your classes next semester are going to suddenly get a whole lot more popular.
I know my poor kids in my zombie class thought it was all theoretical. And
then I Oh, and the CDC years ago played on the popularity of the zombie theme by having a page for what to do during the zombie apocalypse, but it was just a way for them to publicize disaster preparedness. For any disaster, there are a few things you’re going to need. And they just, that was just the same list they had for every disaster.
And then the required text in that class a stroke of genius. Yeah, they have to read that and analyze it and kind of tell me what they think it means about our society.
So, do you have any any parting words for the physician audience in the age of Coronavirus? What we should be looking for what should be prepared, how we should be talking about it, how we should be addressing it to to patients or we happen to have the media in front of us?
Ah, well, I mean, I think I would just circle back to sort of the theme of this whole interview that times like this give us the ability to really live our values, whatever those may be. And that applies to doctors of course to right now. I feel like doctors just by you know, being on the front lines of this even in private you know, non hospitalist practice are doing that but I think just kind of realizing teach my medical ethics students all the time, my my sort of mantra, I hope I don’t get in trouble for this. My mantra to these, these pre med kids is Kaiser Permanente is coming for you. You think that you want to help people, that’s why you want to be a doctor and because you’re smart, and nobody’s going to warn you until they throw you into the trenches that you’re going to have a 15 minute appointment slot per patient. seven of those minutes need to be writing up orders and notes. So you get eight minutes for a patient who is a human with a history and needs and worries that are uniquely theirs. And I mostly spend my entire medical ethics class teaching my students about the lack of ethics in the pressures that are put on doctors today, and just trying to give get their heads wrapped around that so they can prepare now for how to make maintain their humanity and the good heart that got them into doctoring. When those pressures arrive, and I guess I would just say that this is a great time to try to, if you can like be in the moment and just be the human talking to another human. That is the reason you got into medicine because at the end of the day, nobody really knows perfectly what to do. And so I think more than anything, what we’ll call them patients down is that human connection that so many people crave from their doctors, and I say all that background to say that I completely recognize the pressures that are on doctors to do that to stop for a minute and say, Okay, I’m a person, I’m talking to a worried person. Let’s start from there. But I think you know, in modern society, we all unfortunately are under those very frustrating economic Productivity pressures. And it behooves all of us even myself as well to stop sometimes and just remind myself why I’m doing this to begin with and as doctors, and for me, too, as a disease scholar, this is that moment where I think we are called to do that as part of our calling.
I don’t think we can hear that enough. No, we do. We do hear that. But certainly, we could hear it more. So I appreciate that. Professor Carr Nixon author of kept from all contagion, germ theory, disease and the dilemma of human contact. When is that available? And where can we find it
should be coming out in June? I have not been willing to ask it if it’s delayed because of the COVID issues, and it’s coming out from SUNY press. You can follow them on Twitter, and they’ll definitely be there promoting the book a lot lately because of
its relevance to the press. I’m a Sunni graduate, myself and your alumni in Washington.
Yeah,
that’s awesome. So you press All right. Well, Professor Carr Nixon. Thank you again. And hopefully we will get to do this again. Thank you so much.
That was Dr. Bradley Block at the physicians guide to doctoring. He can be found at physicians guide to doctoring calm, or wherever you get your podcasts. If you have a question for previous guests, or have an idea for a future episode, send a comment on the web page. Also, please be sure to leave a five star review on your preferred podcast platform. We’ll see you next time on the physicians guide to doctoring.
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Trauma Response for Good Samaritan Physicians with Stephanie Streit, MD

Stephanie Streit is a trauma surgeon at University Medical Center in Las Vegas. She went to med school at the University of Cincinnati and did a general surgery residency at MUSC. She is currently active duty in the Air Force. She is also the host of the Breaking Scrub Podcast, where she interviews surgeons about the interesting things we do outside of the operating room. She is convinced that success outside of the OR breeds success in the OR. Did you hear that, med student? Stop tying knots and pick up your clarinet!

We start out talking about some of the more routine and mundane parts of being a trauma surgeon. We then discuss something I didn’t quite expect: how important it is to her to address the mental trauma, not just the physical trauma, in her patients. We then discuss the beginning of a trauma assessment, which is CAB, not ABC and how stopping a life-threatening hemorrhage is likely the only thing you can do if you find yourself at the scene of a trauma. Hold pressure and stop the bleeding! We close with discussing why we podcast and her biggest takeaway from her show.

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EPISODE TRANSCRIPT

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Stephanie straight is a trauma surgeon at the University Medical Center in Las Vegas. She went to med school at the University of Cincinnati and did a general surgery residency at USC. She is currently active duty in the Air Force. She’s also the host of the breaking scrub podcast where she interviews surgeons about the interesting things that we do outside of the operating room. She’s convinced that success outside of the or breeds success in the or did you hear that med students stop tying knots and pick up your clarinet, we start talking about some of the more routine and mundane parts of being a trauma surgeon. We then discuss something I didn’t quite expect, how important it is to her to address the mental trauma, not just the physical trauma and her patients. We then discuss the beginning of a trauma assessment, which is c a b, apparently not ABC. And how stopping a life threatening hemorrhage is likely the only thing that you can do if you’re finding yourself at the scene of a trauma. So hold pressure and stop that bleeding. We close with discussing Why we podcast and her biggest takeaway from her show?
Welcome to the physicians guide to doctoring A Practical Guide for practicing physicians. Dr. Bradley Block interviews experts in and out of medicine to find out everything we should have been learning while we were memorizing Krebs cycle. The ideas expressed on this podcast are those of the interviewer and interviewee and do not represent those of their respective employers.
And now, here’s Dr. Bradley Block.
This episode is brought to you by Orange County, bookkeepers, healthcare, accounting, and all in one accounting firm for small healthcare businesses and private medical practices. One thing that I personally love about OCB accountants is that they are quickbook professionals with over 20 years experience focusing specific Typically on health care, the utilize a tailored approach individualized to your needs. There are a full service bookkeeping firm specializing in accounting, payroll taxes and financial planning. And for our listeners for limited time, they’re offering 25% off their services for the first three months. You can visit them at OCB med.com. That’s OCB m Ed, or call at 833-671-3873 or 949215 6200. And check out the show notes for more information. Dr. Stephanie stripe. Thanks so much for being on the podcast.
Yeah, thanks for having me.
So if you had a medical student who was considering going into trauma surgery,
what is it that you’d want them to know before choosing the field that isn’t readily apparent during the rotation? So you got you got your third year student, they love the rotation. They’re like, Oh, torture, shredding. Definitely. I definitely To be a trauma surgeon like you, and you had to sit down with them, what were some of the things would be some of the things that you would tell them that maybe they weren’t, wouldn’t be privy to?
Yeah, you know, this is happening more and more and it for some reason, It surprises me still that I get these young people who and even I’ve mentored high school students who want to be trauma surgeons, and I didn’t even know what a trauma surgeon was when I was in high school and college.
Yeah, er isn’t on TV anymore,
is exposure. And even most of them it was only Eric was out. It was a surgeon and all the other ones were doctors. I didn’t get that when I was in junior high either. But no. So, you know, a lot of young people will get excited by the pace or the adrenaline or they’ll have you know, one really intense interaction. Maybe somebody comes in really sick after a car crash or they’ve gotten shot and they students experiences really intense interactions, and wow, I really want that But maybe what they don’t see is the what we’re doing when that’s not happening. A lot of trauma care is not exciting. It’s following up on CT scans and doing wound care. And, you know, a lot of times it’s telling people that they’re going to be fine, because they’re not injured. And you have to be happy with those things, too. You have to be sustained by the boring stuff. And you can’t just rely on the adrenaline rush, because it’s really actually depending on where you work, it may be really few and far between how does
the well then they can fill their time by getting active on the blogosphere, they can share they could get involved in real estate investing or something like that. Like we’re, you know, we’re seeing a lot of that out there. Well, first you said, you know, you see some patients that are fine, how I would think that those wouldn’t end up in front of you like what are the patients our the patients that are fine, ending up being evaluated on it? trauma surgeon if they’re fine?
Well, you know, it really depends on what kind of center you work in and what kind of trauma system you’re in, that most trauma centers are dictated by some variation of the CDC guidelines on what’s called pre hospital trauma field triage criteria. So those are CDC recommendations for who should be taken to a trauma center that doesn’t necessarily say who should be a trauma activation, meaning the trauma surgeon is there when they get there. But every center and every system is a little bit different on how it actually brings the trauma surgeon to the ER how and when or for whom I should say the trauma surgeon is brought into the emergency department for when the patient arrives, there’s a degree of what’s called over triage in every system, which means that it’s basically Better safe than sorry, that you would rather over call your trauma surgeon than under call your trauma surgeon. So there’s always a person percentage of people who end up you know getting a full evaluation and going home at the end of the day because even though things look bad on the scene, you know, by mechanism, maybe it was the car was dented by more than 18 inches in the passenger compartment for example, which is a can be a marker for somebody being injured, but in modern day vehicles, that’s often just a reflection of how the materials are meant to crumble and is not actually and people are actually quite safe. So those those triage mechanisms are meant to be better safe than sorry, got it.
You were kind of getting into that. And this is something we spoke about on your show, which was finding joy in the routine. So you said you know the routine stuff for minefield it would be like ear wax and that’s what we discussed. Like I just didn’t I enjoy it. much I enjoy removing it but like I have, you know, these recurring patients where it’s like low stress situation, how you doing, talking about your family, I’m kind of like a barber it’s, you know, if I find out join it. So, first, you mentioned a couple. But could you elaborate more on on some of the more routine things and then go into some of those routine things that you manage to find the joy in that on the outside look kind of boring?
Sure. So you know, blunt trauma is most of what we do. So that’s people who get into car crashes or motorcycle crashes or they fall. And they often have relatively low energy injuries. And the ones that bring them into the hospital most often would be things like having broken ribs, and there’s a lot of anxiety associated with broken ribs because it’s your breathing. And if you if it hurts, every time you breathe, a lot of people will become very anxious about that. And they can get into this kind of mental spiral. And, you know, and then they’re coughing and then they’re not using good respiratory mechanisms, and then they’re actually ending up in a more morbid Not that’s not the right word. But they they can end up in a being a little sicker than they necessarily were to begin with because they become so anxious and so fixated almost on their breathing and on their on the injury. So part of what I tried to find comfort in or not comfort but I find joy in is coaching people on the experience of discomfort, fulfillment, I think you find your mean you find fulfillment in this Yeah, that’s that’s a better word for it. I when I can coach people through the discomfort and have them be more be you know, just breathe easier, literally, and figuratively breathe easier on the other end of it. That’s a really common thing that I didn’t think that I would find fulfillment in but I do
wonder the difference between your field Mine is, you know, I’ve ongoing relationships with a lot of my patients. And, and you don’t. And so when you choosing the field, I would think that that’s something that you kind of actively decide is less of a priority, right? Like is is the doctor patient relationship yet somehow you’ve managed to make that an important part of your, your practice. Like that’s something that’s that’s become important to you that you find fulfillment is that is that interaction?
Oh for sure. It’s definitely different than what you have where I don’t see people over and over again. Well, hopefully I don’t see people over and over again. And so maybe don’t necessarily get to know their families or follow their kids sports, like you might get to but the intensity of the situation definitely creates an opportunity for a really meaningful patient interaction, just the same
real human connection. Mm hmm.
And it can be really hard, you know, a lot of patients, probably one of the things that I hear You know, really, really often that is frustrating to me. And almost hurtful is how often patients say, well, you don’t understand. And it’s no matter how hard I try, no matter how long I sit and try and listen, the intensity of the situation really is isolating to patients in a way that’s very unique and very personal. And so I can’t possibly understand I don’t know what their what it is that they’re losing out by being in a hospital bed. I don’t know, their financial situation or their family situation that’s being harmed by them being in a hospital bed and not being at work or being in school or whatever it is. But it’s, I still find that very motivating, to try to try to understand,
well, you’re you’re highly trained for the physical trauma, but you’re also managing to treat the simultaneous mental trauma
you know, I try but that’s something Our whole system just really doesn’t do a good job of, we’re just now starting to recognize the long term psychological consequences of physical trauma. More somewhere between Some studies have said, you know, 20, and up to 60% of patients will have symptoms of either depression or PTSD or both at six months after a significant trauma. And our system just is not good not capable of absorbing that right now. But the first step is is acknowledging that it’s happening. And and that starts with the immediate post trauma care while they’re still in the hospital.
Yeah, it seems like a great opportunity to even you know, once they’ve had time to process the whole situation to inform them that this is a possible outcome that they need to be aware, so that rather than you know that they they see it happening to them.
And I, you know, that’s a conversation that I have in clinic and follow up a lot. And sometimes even just acknowledging it is a huge relief to patients when even just saying it out loud and saying it’s okay. And this is normal. Sometimes that’s enough to take a little bit of the burden off in the short term while they can while they’re still recovering. But we definitely saw a lot of work to do as a as a system.
Oh, I’m sure I’m sure they think they’re going through going mad. You know, they’re they’re falling apart at the seams and, and this is they don’t know where it’s coming from. And yeah,
yeah, they feel weak. They feel like they did something wrong and they feel like, you know, other people don’t feel this way. It’s incredibly isolating, especially when you end up you know, relatively homebound or missing your work or your school or whatever your routine is. And they definitely get into a spiral and sometimes just Now alleging the spiral is enough to at least slow it down, if not break it.
This conversation with a trauma surgeon is definitely not going in the direction that I thought it was. But But still, it’s, you know, extremely interesting, extremely informative. So but let’s get let’s get back on the path of the of the physical trauma. So, let’s say you get called to evaluate a patient and you’re the second physician to see this patient. So, you know, it’s still still I’m not so clear on the pathway of who gets seen by the ER doctor and who gets seen by a trauma surgeon. But let’s say for whatever situation, either the ER doctor and internist, maybe in a resident that’s rotating on your service, either way, you are the second physician to see this patient. What do you hope has already been done and I know I haven’t given you any information about what the trauma was. But that’s kind of what I’m looking for is like, you know, ABCs the ABCs of trauma
What I was going to say, I hope somebody already did the ABCs Yeah, depends on depends on the situation because if somebody has already seen them before me, then the chances are they’re not as sick. But yeah, I hope somebody has done the ABCs and somebody got an IV and Okay,
come on, you’re stuck in the elevator just like help me out with this scenario here. Right? You’re you’re running down seven flights of stairs because the elevators broken and there’s already another doctor there. What are you hoping this doctor has already done by airway, breathing circulation, so that
breathing circulation so in in trauma, you know, a lot of people will put it as Civ especially for penetrating trauma. You know, so if there’s uncontrolled bleeding, I hope somebody put some pressure on it or put a tourniquet on it. If it’s an extremity
and don’t do that nosebleed please.
My neck, you know,
we cut off the circuit Quarter
stopped, we stopped,
can’t get the start at two been in the immediate care for trauma, you’re looking at the things that can kill you right away. So those are your tension pneumothorax, your cardiac champ, an odd traumatic brain injury related respiratory failure, and then uncontrolled hemorrhage. Those are your immediate life threatening things that I that are always on the top of my list whenever someone comes in to make sure that they’re not present. So I hope that somebody is doing that for me.
And then and then what happens from there. So so you’re going to control a hemorrhage, you’re going to make sure that there’s not some immediate like life threatening injury, like tension pneumothorax, cardiac term temper nod or they’re going to herniate their brainstem potentially and stop breathing. And then and then what happens from there with regards to the assessment,
so depends on in general, we’re following what’s the American College of Surgeons advanced trauma, life support and so on. After you do your primary survey where you’re looking at airway, breathing, circulation, disability and exposure, then you’re looking, you’re using things like chest x rays and fast exams, which is an ultrasound to the abdomen and the heart and the lungs. And, again, looking for those immediately life threatening things. And if those aren’t present, then you moving on to your secondary survey, and you’re creating a plan to finish your assessment. So in most cases, if people don’t have an immediate life threatening thing, they don’t need to go to the operating room right away. Most patients are going to end up in the cat scanner.
So we’re going to change the scenario a little bit. So one thing that I like to cover on this podcast is, is how to be a good referring doctor. So if I’m interviewing a specialist, what is it that you want your referring doctors to know so that they can do something before they refer to you or stop referring you this type of patient or something like that, but I would imagine you don’t really have referring doctors right now. You know, that they’re just that’s not helpful. end up in your travel bag. So on the other hand, right. The other thing that I like to cover is what every doctor should know about your specialty because we’re all doctors, right? And so there’s a certain expectation of what we’re going to know. And so, you know, I had spoken to an ER physician about a cardiac arrest. How do we handle that? If we’re a pathologist, who knows what cardiac tissue looks like, under a microscope, but right, they don’t know how to deal with cardiac arrest. so in this situation, we’re gonna make it more of a trauma situation. I’m out for a walk with my family, right. And I see a car Korean into a tree. So I run up to see how the drivers doing. And everybody’s looking at me and expecting me to know exactly what to do. If you could walk us through a trauma assessment where you don’t have access to your cat scanner where you don’t have access to maybe a syringe to to emergently drain cardiac temping odd if I if that’s actually you know how you do it or put it another way Let’s say I’m in Iraq. I like to choose other specialties, right? So put another way, I’m a neurologist that happens to be a bystander at the trauma. But I’ve left my reflex hammer and tuning fork at home.
But everybody’s looking at me to do something because I’m a doctor. Sure.
So I would say, first of all, your pre hospital providers are your best friends. So first thing is just call 911. You can’t you really can’t do a whole lot without your tuning fork. So if the things you can do on scene after trauma would be to assess for life threatening bleeding elbow, I’m sure a lot of people have heard of stop the bleed, which is a campaign that was started by the American College of Surgeons along with the joint trauma system and the pre hospital organizations to teach bystanders how to be lifesavers when it comes to life threatening bleeding. So I think any physician should be able to look for and assess for life threatening bleeding and then try to stop it. I carry attorney Get with me almost all the time, but I don’t expect everybody else to. So just doing things like holding pressure to an area that’s bleeding to try to slow it down until pre hospital providers get there. Did you use something like a belt? You know, we don’t really recommend that people try to improvise tourniquets mostly because while you’re trying to improvise the tourniquet, there’s still bleeding. And the majority of bleeds can be stopped with direct pressure or with packing a wound with something like a you know, clean t shirt. Most bleeding is going to be venous so you can overcome the pressure in the venous system, just with direct pressure most of the time.
Sorry, while we’re on the topic of tourniquet, I think it just bears mentioning for my specialty that you can’t turn a kit a nosebleed so a lot of people when they’re trying to stop a nosebleed will put the pressure over the nasal bones. Mm hmm. Thinking that that’s where the blood supply comes from. Mm hmm. That is not where the blood supply comes from. The blood supply comes from underneath the septum. It comes from behind the septum. It does not come from the the skin or the nasal bones, you’re not creating a tourniquet effect by doing that, you’re just waiting for the blood to clot. So if you are going to stop a nosebleed, you pinch the nostrils shut. That’s it because the vast majority nosebleeds are from the anterior septum. And you put pressure on the ampere septum by pinching the nostril shut. So sorry, I thought you mentioned the tourniquet and applying pressure, so I just wanted to put that little PSA in there. Okay. Sorry. Okay. So, so, so don’t go looking to improvise a tourniquet your bandana? Whatever, just put pressure on it.
How much
Okay, so that but you said it’s not ABCs? Right? It’s si si a be
a lot of time, man. It’s me. Okay, because, you know, in the majority of preventable deaths from trauma is from hemorrhage. So if you can find external hemorrhage or an external source of hemorrhage and slow it down or stop it. That’s the most The way that you can be most impactful, got it.
Okay. And then you can even task somebody with doing that, once you’ve identified it, put them on it, and then you can go over to the airway.
Yeah. And you know, because there’s not a whole lot you can do without your trusty oxygen tank, they you carry around. So there’s not a whole lot in the pre hospital setting that a doctor can do, apart from try to do like a jaw thrust, because in general, we don’t, you know, and when people are in a significant trauma to the point that they have an airway problem, we also worry about their spine. Yeah, so you don’t want to move them around a whole lot. Or for example, put them in a position of comfort or recovery position, which is typically kind of on their side towards almost towards a fetal position.
Although you don’t want them to swallow their tongue turn them on their side. Yeah, not not a good idea.
Right. So that’s where the pretty much the only thing you can do pre hospital before your MS folks arrive is to do something like a job for us to keep their their fair is open if their mental status is altered, otherwise, you know, the majority of people will breathe, it will be breathing just fine on their own.
They’re awake, just stop their bleeding. So that remain awake. Yep. Okay, and then just wait for 911 I think that’s, that’s something that separates physicians from from lay people in situations like this is we kind of understand when we’re at the limits of what can be done, like, you know, someone else might be running around. I don’t know, what else can we do? What else can we do? What else can we do? The doctor you know, we know this is it. This is what we can do. We just have to wait. And then you know, wait for em is too common?
Yeah, I’ve you know, I’ve stopped it car crashes and motorcycle crashes and even as a trauma surgeon, apart from I literally will come to the scene with my tourniquet in my pocket and assess for life threatening bleeding and somebody’s bleeding. No. bleeding. Are you bleeding to death? No. We’ll wait. We’ll wait for the ambulance. See at the hospital.
Yeah, just picking up the shift right now. So let me reach it. I’ll be better if I just get back in my car. Exactly. Right. He there.
Exactly right.
Okay, so is there anything else about trauma surgery? Knowing that this is a primarily physician audience, maybe some trainees that that you want to tell us?
Um, you know, it’s a really it’s a changing field
changing Really?
Yeah, that you know, there are more and more women in the field.
More and more people are getting involved in advocacy and public health and are really trying to be a part of injury prevention solutions. So in the same ways that cars were made safer through research and advocacy in the 50s and 60s that, you know, has drastically brought down the rate of injury and death due to Road Traffic incidences. physicians are just are trying to do the same sorts of things when it comes to violence, interpersonal violence, gun injuries, especially when it comes to children. And also things like elderly falls, which is the fastest growing mechanism for trauma. activation these days is elderly people who fall so a lot of your trauma surgeons are out there trying to come up with solutions to make your community safer. Not just the not just the Cowboys slinging scalpels in the emergency room.
Yeah, the social determinants of health, the things that are more likely that you will be the person that ends up in, in the trauma bay is something that that will have a far more powerful effect on the outcomes of the population, you know, minimizing how social determinants of health can affect outcomes, I guess, will have an outsized influence to, you know, our ability to suture,
right. And so, you know, ultimately we’re trying to put ourselves out of business through, you know, public health mechanisms. Yeah, another,
you’re not likely to happen anytime soon.
Well, but you know, you say that, but in Europe, for example, trauma surgeons are orthopedic surgeons, because the vast majority of trauma there is falls in Road Traffic incidents. And so the majority of injuries are orthopedic interesting, whereas in America, they have always been general surgeons because there’s an outsized proportion of interpersonal violence that needs immediate, you know, life saving intervention within the first hour of injury that is in the chest or abdomen or the peripheral vasculature. That’s why general that’s why general surgeons are trauma surgeons in the United States. So there’s examples across the globe of how, how we can do better how we can do better. Yeah, good way to put it.
See, I thought in Europe, they were they were all the surgeons were barbers, because they were the only ones with the sharp instruments
back in the day. Yes. But yeah, the trauma surgeons are the orthopods. Interesting.
So taking a little turn away from trauma surgery. I know you’re not No longer doing the podcast, but I loved it while it was around. And is there anything that you would like to mention that you learned from doing your podcast about medicine? from some of your guests? your podcast wasn’t about medicine, right? It was outside the operating room. It was all about what we do outside the operating room. So one or two highlights of your favorite interviews and you know, it doesn’t have to be mine.
I did learn a lot and
I think the
I think I needed the podcast more than any listener did. Because that helps me to remember that we’re all just human beings trying to do our best and what your best is, and my best is and somebody else’s best is not the same thing. So you know, one of my guests was a woman who, I mean, she just had it all and did it all and she had the the world’s greatest A CV, that every you know, college kid who wants to be a doctor would just dream of.
She hated it,
and was miserable and almost quit before she, you know, took a step back and found different ways to look at her life and what she wanted and how she was going to get there. And, you know, she’s still a very intense, very driven, very motivated person, but it was through having an executive coach and then becoming an executive coach that she was able to just put a different lens on her path and her motivation and what she ultimately wanted to get out of life. And it was enlightening for me to see somebody. You know, when we, when we think about, we see stories of people who change careers or who change who burned out, you know, terminal a burnout. You know, we think of people who like run off and be Yogi’s or run a smoothie shop or something. We don’t think of people who burn out and come back. And she burned out and came back even stronger in a way that was really, really motivating, really powerful to me. And she also reframed burnout for me a little bit in a way that I guess kind of unburden me a little bit of my own guilt, about, you know, the days when it’s hard to get going. So that was probably the thing that, that I was most impactful for me about doing the podcast. And like I said, I think I think I sought out the guests that I needed more than what anybody who might have been listening needed.
Doesn’t this is this is you’re basically saying my podcast right here, which is I just, I have questions. I would like them answered. And I figured if I’m interested in finding these answers than others, People are interested in finding these answers, but it’s still all about me. So
one has to be right. Because, you know, like, people don’t realize how much work this is, you know, you’ve got a wife and three kids and it’s nine o’clock at night. And here you are, you know, talking to a relative stranger on the other side of the country. It’s, it’s work, it’s fun work, but it’s work and it takes time. And so you have to get something out of it too.
But I think to what you were saying about the the burnout and and how you got something out of it. I think it’s it’s important to have these haven’t cultivate these outside interests. You know, I when I joined my practice, I was, I guess, 3332. And this was after that same training, the rest of us do, right, I went to college. I took a year off in between, I went to medical school, I did my residency. So every four or five years, you were onto something different. Mm hmm. I was hired. I got My job, had my exam rooms, and I looked at my exam rooms. And I said, Okay, so this is where I’m going to be for the next 38 years. Hmm.
And isn’t that horrifying,
like doing the same things over and over. And so you need to have those, those those other things. And you need to be able to evolve in your in your job, right, you need to be able to keep improving to know like, you know, keep going to conferences, keep reading, keep learning so that you can keep evolving. And it’s not the same thing. Because the way that I’m treating sinus infections now might not be the way that I’m treating them. 10 years from now, the way I’m doing sinus surgery now, there’s probably not going to be them doing sinus surgery 10 years from now, so you know, so improving your craft in this way. But also you got to have that outside stuff. You got to have the outside stuff. So you’re not just grinding and grinding and grinding and grinding and grinding. So there’s like a different, something just completely takes you out of that. And that’s that’s what it sounds like that’s what it was for you and that’s what it was. That’s what it is for me.
You know, and the, you know, the thing that my guests said the most, which, you know, I still kind of hold on to is that whatever it was that they were doing outside of the operating room, it made them a better doctor. Yeah. So, you know, we go through all that training and you know, I spent 11 years after college, and every single day, it was all about the patients, and it was all about the patients. And if it ever wasn’t about the patients, then you were wrong. And it’s got to be about the patient.
terrible person. Yeah.
Right. And you know, and then you lose what precious hours of sleep you might get, because you didn’t make it about the patients and it still is. But so many people acknowledged over and over and over again, that whatever they were doing made it easier to show up the next day refreshed or invigorated or whatever you want to call it, and able to make it about the patients because if you’re miserable, and all you’re thinking about is how you don’t want to be there then that can’t be about the patients either.
Yeah, the facts are wrong. Absolutely for sure. so wonderful. Well, I do miss your podcast. I hope you I hope you do manage to find find a way back to it but if you don’t know, I’m glad you’re finding the reason that you’re not doing it is because you don’t need it anymore. Because you found if you’re finding joy in other things in other ways like like hockey
absolutely that’s that’s where my my extra time goes now is being the world’s greatest amateur 36 year old female hockey player.
Fantastic and I love the that you drop that Slap Shot reference in our conversation before the show. What incredible movie incredible movie if you’re listening to you haven’t, and you’ve never seen it Paul Newman, the Hanson brothers.
Classic, most beautiful man to ever live Paul Newman.
Well, Dr. Stephanie strike. This has been a long time coming. I’m glad we were finally able to do this and it’s been a lot of fun.
Thanks, Brad. Appreciate it.
That was Dr. Bradley Block at the physicians guide to doctoring. He can be found at physicians guide to doctoring calm or wherever you get your podcasts. If you have a question for previous guests or have an idea for a future episode, send a comment on the webpage. Also, please be sure to leave a five star review on your preferred podcast platform. We’ll see you next time on the physicians guide to doctoring.
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Trauma Response for Good Samaritan Physicians with Stephanie Streit, MD

Stephanie Streit is a trauma surgeon at University Medical Center in Las Vegas. She went to med school at the University of Cincinnati and did a general surgery residency at MUSC. She is currently active duty in the Air Force. She is also the host of the Breaking Scrub Podcast, where she interviews surgeons about the interesting things we do outside of the operating room. She is convinced that success outside of the OR breeds success in the OR. Did you hear that, med student? Stop tying knots and pick up your clarinet!

We start out talking about some of the more routine and mundane parts of being a trauma surgeon. We then discuss something I didn’t quite expect: how important it is to her to address the mental trauma, not just the physical trauma, in her patients. We then discuss the beginning of a trauma assessment, which is CAB, not ABC and how stopping a life-threatening hemorrhage is likely the only thing you can do if you find yourself at the scene of a trauma. Hold pressure and stop the bleeding! We close with discussing why we podcast and her biggest takeaway from her show.

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Cutting the Crap on the Gut Microbiome with Frank Cusimano, PhD

Dr. Frank Cusimano, PhD, has a doctorate in Nutrition and Metabolic Biology from Columbia University and is currently a medical student at the Arizona College of Osteopathic medicine. Having done his PhD on the gut microbiome, a hot topic, we dive into the science of prebiotics, probiotics, postbiotics and antibiotics. What can we actually recommend to patients to help them with GI upset while on antibiotics? How does the microbiome influence inflammatory bowel disease? How can the gut actually influence our brains? A previous guest discussed how the colon is the window to the soul. Turns out there’s science behind that!

Having been a sponsored athlete as an adult, Dr. Cusimano is currently a medical student uniquely blending his understanding of biochemistry with human physiology and human potential. In college he received both a BS and BA from SMU in Chemistry and Biology and then went on to complete a MS from Johns Hopkins University in Biotechnology concentrating in Bioinformatics, all in addition to his PhD. He is the host of the Surviving Medicine Podcast and a regular contributor for Medscape and Doximity.

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Twitter: https://twitter.com/frank_cusimano

Instagram: https://www.instagram.com/surviving.medicine/

Website: http://survivingmedicine.org/

Podcast: http://itunes.apple.com/us/podcast/surviving-medicine/id1276029472?mt=2