The Top Habits and Attitudes of Humanistic Physicians

Session 101

Session 101

Today, Ryan and Allison talks about the qualities of physicians and some habits that really make a great physician in the eyes of the residents that they teach.

The hosts discussed about the September 2014 issue of Academic Medicine, where they featured an article entitled Attitudes and Habits of Highly Humanistic Physicians by Carol Chou, MD, Katherine Kellom, Judy Shea, PhD.

Here are the highlights of their conversation:

  • How the article defines humanism
  • In 2011, the authors pulled 161 residents at the University of Pennsylvania and were asked to nominate up to three attending physicians whom they believe serve as excellent role models for the humanistic care patients
  • 74% responded and invited the most recently nominated physicians to participate in interviews
  • The general demographics: about 40 years old, 56% female, 44% male
  • A breakdown of categories between attitudes and habits
  • A powerful quote by Jayce O’Neal
  • Viewing patients in holistic fashion
  • Dealing with the redundancy of medicine

The 6 sub-themes that represent attitudes that sustain humanism:

  • Humility
  • Curiosity – being a lifelong learner as a physician
  • Standard of behavior – behaving the right way and emulating that
  • Importance for the patients, medically – treating the patient in a more humanistic way, produces better medical results
  • Importance of the doctor-patient relationship – the importance of knowing and understanding your patients on a deeper level
  • Role of a physician as treating more than just the disease – using this opportunity to connect with your patient

The habits of humanistic physician:

  • Actively engaging in self-reflection
  • Connecting with patients
  • Teaching and role modeling
  • Balance
  • Being intentional at work

Other themes mentioned:

  • The environmental support to sustain humanism
  • Humanism as an antidote to burnout

Some pieces of advice for premed students:

  • Think about how you can start honing some of these attitudes and habits.
  • Start looking for these attitudes and habits in the physicians that you’re shadowing.
  • If you have some habits or attitudes that are contradictory to what’s mentioned in this article, then start thinking about it and working on it so you will end up happier and better.

How to best study for the last test of MCAT:

  • Next Step Test Prep: Offers tutoring $100 off their one-on-one tutoring program when you mention that you heard about this on the podcast or through MSHQ

Links and Other Resources:

Listen to our podcast for free at iTunes: medicalschoolhq.net/itunes

MSHQ Podcast Episode  59:  MCAT Retakes – Change and Improve to Get the Score You Want

MSHQ Podcast Episode  7: 10 Traits You Need to Succeed in Medical School:

Next Step Test Prep: Offers one on one tutoring $100 off their tutoring program when you mention that you heard about this on the podcast or through MSHQ

Transcript

Dr. Ryan Gray: The Premed Years, session 101.

Hello and welcome back to the Medical School Headquarters Podcast; where we believe that collaboration, not competition, is key to your premed success. I am your host, Dr. Ryan Gray, and in this podcast we share with you stories, encouragement and information that you need to know to help guide you on your path to becoming a physician.

Welcome back, if you've joined us before. Welcome back to my cohost, Dr. Allison Gray.

Dr. Allison Gray: Hello.

Dr. Ryan Gray: How are you doing?

Dr. Allison Gray: I'm great, how are you?

Dr. Ryan Gray: I'm doing well. If this is the first time you are joining us, listening to this podcast episode, there are 100 other episodes that you can go listen to right now. I got an email just today as we're recording this, I don't know if you saw this email Allison. But somebody wrote in stating they stumbled upon our podcast and over the last six months have listened to all 100 podcasts.

Dr. Allison Gray: I saw that.

Dr. Ryan Gray: That's crazy, that's awesome. So if this is the first time you're here, go to www.MedicalSchoolHQ.net/iTunes, go subscribe for free, get our podcast every week on your iPhone, Apple device, anything you have. Or go listen to us on Stitcher on your Android, and Windows phone. If you're still rocking a Discman then I don't know what I can do for you but good luck.

Dr. Allison Gray: Fast forward to this century. This decade I should say.

Next Step Test Prep

Dr. Ryan Gray: So today we're going to start off the next 100 podcasts talking about some qualities of physicians, and some habits of physicians that really make them great physicians in the eyes of residents that they teach. And we'll talk about all of that and the article- it's in the Academic Medicine Journal. But as we record this, it is October, 2014, the very end of October and the final test sessions for the ‘old MCAT' are coming upon us. January, 2015 is the last time that you can take the old MCAT before the new MCAT rolls out in April of next year. And because I've gotten a lot of emails from students asking about how to best study for this last test, a lot of people are retaking it right at the last second. If you're lucky enough to have a seat in January, and you're retaking it, that's awesome. There aren't a lot of seats at all anywhere. Some open up here and there when people cancel. But what I did was because we're getting so many emails, I reached out to our friends at Next Step Test Prep, who we've had on the podcast before back in Session 59 which you can listen to at www.MedicalSchoolHQ.net/59, where I talk with Brian all about retaking the MCAT and how to best prepare yourself to retake it. And Next Step Test Prep is a test prep company; they are one-on-one tutors. And they are offering $100 off their tutoring program. It's usually $50 off when you mention that you heard them through the podcast. But because everybody is kind of in this heightened state of anxiety, I went out and I said, “What's the best you can do for the people that listen to the podcast?” And they said for these next couple months through January if you're taking the test in January, get $100 off their tutoring package if you just mention that you heard about it on the podcast or through Medical School Headquarters.

And one-on-one tutoring definitely isn't cheap, but I want to read something that one of our Academy members had written to me. I asked her about her experience with Next Step Test Prep, and I'm not going to mention her name because I didn't ask her if I could read this so I'm just going to read it without mentioning her name. But I asked her and she said, “I think they're an excellent resource. I had hit a major plateau studying on my own and even with a study buddy I felt like I wasn't making any more progress. I really enjoyed the webinar that you hosted so I gave them a call.” Just as a break, they came on and did a webinar for our Academy members, that's what she's talking about there. “They responded within one to two hours with a personal phone call to discuss my needs. The conversation was helpful and not at all like a sales call. Rich went over the options available and what might work best for me. It certainly is not cheap, but I feel like I received more value than what I paid for.” She talked about the actual sessions, how they're done through Skype along with a white board web app. “My tutor Jeff was both extremely knowledgeable and an excellent teacher. For me, the latter was the most valuable aspect of Next Step. Jeff was very patient and never rushed through a topic or question that I was having trouble with. In contrast-” one of the other big companies that she used “was the worst with their teaching / lecturing style. Rarely offering more than one way of explaining a topic. For me I think I needed both the structure and resources of this other big company and personal guidance of Next Step to be prepared.”

So I hope that helps, maybe a lot of you are in that similar situation where you went to another big company and didn't really get that personal teaching style that you needed. Go talk to the guys at Next Step Test Prep, they're at www.NextStepTestPrep.com. Tell them you heard about them on the podcast, or through Medical School Headquarters, and you'll get $100 off.

Alright, and good luck on the MCAT. And you know what? If you are worried about taking the old MCAT and you are dreading the 2015, it will be okay. There's a lot of unknown with the new MCAT, but it's just another test. Yes, it will be a little longer, but you will be okay.

Dr. Allison Gray: Yeah, with every generation of physicians there will be a new test. Maybe not every generation, but we took an MCAT that certainly is no longer offered anymore; that was way back.

Dr. Ryan Gray: Paper.

Dr. Allison Gray: Whoa. Bubbles.

Dr. Ryan Gray: Yeah. I guess we're anti tree huggers, just wasting all that paper.

Dr. Allison Gray: True. But, well we did what we were given, so. But it will be okay, I second Ryan's sentiment.

Dr. Ryan Gray: It will be okay. Alright. And if you've used Next Step Test Prep before, let me know what you think about them. Ryan@medicalschoolhq.net.

‘Attitudes and Habits of Highly Humanistic Physicians’

Alright so today I had mentioned we're going to talk about some qualities, some habits of physicians that really make them great in the eyes of the residents they work with. And this comes from the September issue of Academic Medicine. And it's titled- the article is titled, ‘Attitudes and Habits of Highly Humanistic Physicians.' And the authors of the article are Carol Chou, Katherine Kellom and Judy Shea. Allison why don't you explain what humanism really means in this sense?

Dr. Allison Gray: Well humanism, and they- I'll quote here because the beginning of this paper gives us the definition of humanism. And this is important because why are we talking about this? Well this is what humanism is. So they quote- or I quote, “Humanism in medicine combines scientific knowledge and skills with respectful, compassionate care that is sensitive to the values, autonomy and cultural backgrounds of patients and their families.” And Dr. Chou, Kellom and Judy Shea- they actually pulled that definition from the Arnold P. Gold Foundation which is a society that's all about humanism in medicine; pretty cool stuff.

Dr. Ryan Gray: Yeah.

Dr. Allison Gray: So that's what humanism is about, and you can imagine if you're out there as a premed thinking about what it means to be a doctor, why you think you want to be a doctor. If you think about that definition, that sounds pretty good, right?

Dr. Ryan Gray: Yeah, especially in today's day in age of autonomy with patients.

Dr. Allison Gray: And this day in age of technology- of the surplus of technology we have that we have to constantly think about the human side of what we do. So, that's where this is starting with and then- well we can talk about what they did. So in 2011 the authors pulled 161 internal medicine residents, all of the internal medicine residents at UPenn in June of that year. And asked all of these residents to nominate up to three attending physicians who they believed served as excellent role models for the humanistic care of patients. And of those, 74% responded and they then invited the most frequently nominated physicians from those residents to participate in interviews to really understand, well what is it about these physicians that makes them such great role models for these residents.

Dr. Ryan Gray: Yeah. And so out of the 90 or so that ended up being- actually it looks like 100 here they ended up with. 100 physicians that they ended up polling and talking to and interviewing; that general demographics are about forty years of age, 56% female, 44% male. And so I actually just said 100 physicians, it was actually 100% I was reading. Apparently I don't know how to read very well. But out of the physicians that they had there, the average age was forty, and like I said 56% were female, 44% were male. At least I know how to add, that adds up to 100.

Dr. Allison Gray: Yes.

Dr. Ryan Gray: And so they broke it down into two different main categories that the themes and subthemes of these sixteen physicians, and internal medicine attendings to be more specific. Between attitudes and habits. And as we go through these attitudes and habits, if you're premed, start thinking about these now. Think about how you can start honing some of these attitudes and habits. Start looking for these attitudes and habits in physicians that you're shadowing. See if there's a trend or some commonalities between the physicians that you really like, and want to be like when you're older and working as a physician; and see if they match some of these attitudes and habits. And it will be interesting to kind of test these in the real world that the authors of this article kind of pulled out of all these interviews.

Dr. Allison Gray: Mm hmm.

Dr. Ryan Gray: So let's go ahead and start, Allison, with the six subthemes that represent attitudes that sustain humanism.

Attitude #1 – Humility

Dr. Allison Gray: Alright, so the first one that they talk about is humility. And it's interesting because when I think back to one of our very early podcasts, this was something that we talked about and I believe one of the traits that all premeds should have, or I think- actually it was one of the traits that everyone should have as a physician, that you should have as a physician. Humility is something we also talked about. So- but yes. So what is humility? It's basically modesty, it's being humble, right?

Dr. Ryan Gray: Yeah.

Dr. Allison Gray: And if you think about a doctor that you would want, a doctor who you would want taking care of you or a family member; I don't think anyone would ask for or want someone who puts themself above others, and-

Dr. Ryan Gray: Arrogant. No arrogance.

Dr. Allison Gray: Right, arrogance. And some people argue that like a surgeon needs to have some amount of arrogance- we've talked about this before too.

Dr. Ryan Gray: Confidence, they need confidence.

Dr. Allison Gray: Right, but that's the key thing, it's confidence not arrogance. So having humility, being able to be humble. There's a story I like to tell, I saw an attending physician once in the ER when I was shadowing back as a premed. And he was helping in a very critical situation with a patient, and he walked away for a moment and took a carton of urine away to dispose of it. And one of the residents said, “Dr. So-and-so, you don't need to do that.” And he said, “We all have a part to play, and this is something that needs to get done.” And that was it. So, humility. There's no job that's too small, it's a good thing to be humble as a physician.

Dr. Ryan Gray: And that was back in Session 7 that we talked about that; the ten traits that you need to succeed in medical school, and I guess you can extrapolate that to medical school residency and life in general.

Dr. Allison Gray: Yeah, and you know I love what one of the quotes in here, one of the Hem/Onc attendings who talks about the fact that every single patient can teach you something. So sometimes we cruise through rotations or moments in our education as a premed, in medical school and beyond. When you think, “Oh I already know this. Or I'm X, Y and Z about this.' But she's saying- reminding us all have the humility to realize that you can learn something, you can be taught on an ongoing basis from every patient encounter you have

Attitude #2 – Curiosity

Dr. Ryan Gray: Yeah, and that kind of drives along to the next attitude and that's curiosity. And curiosity- we say in medicine all the time, and my own personal opinion is every career is like this, but medicine we say you have to be a lifelong learner. And I think in life you need to be a lifelong learner if you want to be successful in anything you do. But it's very important as a physician because things change. We have new research that comes out says, oh we've been doing it wrong this whole time, we need to change and there are new medications every day that you can start prescribing to patients. And if you're kind of stuck in the times then you're doing your patients some disservice. So you really have to have that drive to be curious and learn from each of those patients if you let them. So it's very important. There's a quote and I'm going to butcher it, but it's something about the moment you think you've learned it all, is the moment that you've decided to die or something. I forget the meaning of the quote but it's basically like if you think you've learned it all, then you might as well just go dig a hole and bury yourself because there's not much left in life.

Dr. Allison Gray: And there's a quote by Jayce O'Neal that says, “If you think you know everything, you know nothing. If you think you know nothing, you know something.”

Dr. Ryan Gray: There you go.

Dr. Allison Gray: That's a powerful quote, too.

Dr. Ryan Gray: Yeah. So the next habit- or the next attitude?

Attitude #3 – Standard of Behavior

Dr. Allison Gray: So standard of behavior. So this part talks about how some of these physicians attributed their humanistic behavior to a desire to sort of be the right- to behave the right way. To emulate that. So basically to keep in mind that these are the ways that people want to be cared for, I'm going to embody that. I'm going to embody what it is to be a caregiver for people who want to be cared for. Did that make sense, Ryan?

Dr. Ryan Gray: Is that- it's almost like the golden rule applied, too. Practicing medicine.

Dr. Allison Gray: Yeah, I think so. It's- but I think it's also sort of carrying yourself in the shoes or walking in the steps of someone who you think should act a certain way. So it's practicing medicine in the way that you think other people think that you should be acting. It's sort of a circuitous thing, I'm not really making sense, am I?

Dr. Ryan Gray: That's alright.

Dr. Allison Gray: Well basically let me read you what they said, because she can explain it- she or he, whoever this was can explain it better. Basically saying, many physicians attributed their humanistic behavior to a desire to emulate the ‘right way to behave,' keeping in mind the basic values of how people should be cared for and being motivated to do what is correct and proper for the person in front of you. So we're wanting to be trusted, we're wanting people to put their faith in us, and so we need to emulate what people come to the doctor for. To be that person.

Dr. Ryan Gray: Yeah, we want to live up to their standards.

Dr. Allison Gray: Yes, thank you.

Attitude #4 – Treating a Patient Humanistically

Dr. Ryan Gray: Perfect. The next attitude on here is importance for the patient medically. And it took me a second to kind of understand what that meant. And then I read it a little bit more. It says, “At least half of the physicians acknowledged that treating a patient humanistically is important for the patient medically.” So basically, they're saying that treating the patient more as a human and more humanistically actually helped their outcomes better. And I think I would never argue that, because we talk about the importance of the connections that you build with physicians for how well patients end up doing. It's very, very important and something that if you take one thing from this podcast, I think that might be the most important one. Is because we're all in this to treat patients, if we understand that the way that we treat them physically and mentally actually helps them medically, then why don't we do more of that better?

Dr. Allison Gray: Absolutely and they talk about understanding the social context that a person comes from. So if you- for example they give here a gastroenterologist was seeing a patient who is coming in needing a paracentesis every two weeks, meaning needing fluid drained from their abdomen. And the patient is telling the doctor, “Well I'm not eating any salt,” and the doctor's saying, “Well then why are you coming in every two weeks needing that?” So the whole point of this is that the patient doesn't have the support of family. And so it's understanding that background about what social structure, what environment is that patient living in and what supports do they have on the outside? And Ryan and I have talked about this before too, just reflecting back we sometimes are so quick in our- we're focused so much on the diagnosis and the treatment and all of the medical part of it that we're forgetting that in order to have this patient succeed, to benefit their health and them as a person, we have to think about them in the larger context of where we send them back to after we discharge them from the hospital, or after we say goodbye to them and they leave the office. Because if they don't have what they need from a physical, an emotional and psychological sort of support after they leave us, then all of these things that we want to do for them may be a complete and utter failure. So we need to really understand the person, the human being underneath the disease and all of the other stuff that we're trying to fix.

Dr. Ryan Gray: Yeah. I agree. Talk about the next one, the importance for the physician.

Attitude #5 – Importance of Doctor / Patient Relationship

Dr. Allison Gray: So this next one is talking about the importance really of the doctor / patient relationship, and how important it is to really get to know your patients. So in a similar- it's a little bit similar to the one we just talked about which is understanding sort of where the patient comes from and their situation. But this is even more about the relationship itself, and how important it is to really get to know your patients on a different level; not just as, ‘Oh this is my seventh patient who I take care of who has MS.' No, ‘This is Mr. So-and-so who has three daughters and lives in this town, and I know he's a carpenter.' It's really understanding the human being there and the person, and that's one of the beauties of outpatient care that I've gotten to learn about in practice now. And I love that, I love when I look at my list of patients for the next day, or the next week, and I see that so-and-so is coming and I think, ‘Oh,' and I wonder about how X, Y, or Z has gone on in the last year for them and their family. Or what's going on with their son who's now in medical school. I mean it's such a different level of caring that I think you bring to the whole encounter as a physician when you really- you know that patient on a much deeper level and their family, and you really look forward to seeing them and hearing not just about what's going on with them medically but about how their life is.

Dr. Ryan Gray: Yeah. It's interesting, when we talk about these and we read all of these attitudes, they all kind of have this underlying theme of being more than just a physician to these patients. Being more than just the person that prescribes them chemotherapy, or cuts out a tumor, or whatever it may be. It's actually being a person and connecting with these people on a more personal level. And that's the last one here, is the role of a physician as treating more than just the disease. You're not the person- like I just said, prescribing chemotherapy. You're the cheerleader as it says here. You are that safe place for patients to talk about different parts of their life that maybe they don't have that kind of outlet to talk about. And so that gives you that opportunity to let the patient really connect with you and get stuff out of their head, out of their mind and out in the open, and help them start healing or doing whatever they need to do which is why they're seeing you.

Dr. Allison Gray: Absolutely. We have such a great responsibility as physicians in terms of providing this care and being healers. And we take for granted so much of the time that patients get naked in front of us and they tell us their deepest fears, and they cry, and they laugh; they show all types of emotion with us and we have the privilege and responsibility of being able to care for these people. And so it's so important- and it's interesting because when that phrase ‘more than just the disease,' what comes to mind immediately for me is the DO philosophy which is all about this holistic way of thinking. I like to think as an allopathic trained physician that we all share that view, that we all like to view our patients in a holistic fashion and not, ‘Oh that's my MS patient,' or ‘my migraine patient.' No it's Mr. or Mrs. So-and-so with whatever they're battling.

Habit #1 – Self-Reflection

Dr. Ryan Gray: Yeah. So those are the attitudes of these humanistic physicians. The next part of the article talks about the habits. And let's work through those and talk about those. The first one is self-reflection. It talks about almost all of the interviewed physicians reports actively engaging in self-reflection. And one of the quotes here says, “I'll do this almost on a daily basis. Take that time to step back and think about what's really happened, what I could have done better and how I could have done things differently.” And I listen to a lot of- I guess you would call it ‘self-help' kind of stuff. Things that kind of make you think better and be better. And almost all of them talk about this self-reflection. Whether it's waking up early in the morning and meditating and thinking about this kind of stuff. Or doing it in the middle of the day, or at an ad-hoc kind of basis when you can. They all talk about this self-reflection and I'm glad that it was brought up here as a habit. I think one of the hardest things to do as a physician, especially as a medical student and as a resident when you're going through the day-to-day routine of medicine; especially as a resident when you're going nonstop for twelve hours in a day. You don't take that time to have that self-reflection. And I think that is one of the factors that leads to this burnout and being a little bit bitter towards the establishment and patients, because you're not taking that step back and going, “You know what? What did I actually do here today? How did I make somebody else's life better, how did I make my life better?” I think it's a very important thing that everybody should be doing, especially as a premed, medical student, resident and beyond.

Dr. Allison Gray: Absolutely. And it's also part of the course correction that we talk about at every stage of your journey; whether you're premed, or medical student, a resident, and as an attending constantly to always be self-reflecting. Always being introspective. It's how we improve, it's how we make patients' lives, make our lives better. If you never self-reflect, then you sort of- you're missing everything I think. Because how can you even really-

Dr. Ryan Gray: How do you improve?

Dr. Allison Gray: How do you improve, how do you really know what's going on?

Dr. Ryan Gray: Yeah.

Dr. Allison Gray: Unless you're constantly asking someone else, which doesn't really work well.

Dr. Ryan Gray: No.

Habit #2 – Looking for a Way to Connect with People

Dr. Allison Gray: So the next one here is about connecting with patients, and I think this is a little bit along the same lines, Ryan, in that it's looking for a way to connect with people. Now we talked just about self-reflection, okay well now how do we connect with other people? And a lot of these physicians believe that part of sustaining this humanistic quality is about seeking a really powerful connection with patients. And for a lot of us as physicians, that's really what- it comes down to what it means to be a doctor and a healer. It's where that meaning lies. And so I know for me connecting with my patients, I try to connect with them certainly on a deeper level, and I try to get to know them and you know it's hard. I mean in the confines of the time we have every day. I mean it was hard as a resident, it's hard as an attending. But part of what makes that journey and continues to make that journey fulfilling and rewarding is getting to know these people, too. And building on that connection and getting to know them. I mean, I remember the first time that a patient gave me a gift in the office and I thought, “Well gosh.” I mean I felt sort of sheepish. But I mean- and then when I was pregnant people brought gifts for me for the baby and I thought- well you know it's humbling because it's just- And I care, when I think back too and I think about my practice and the patients I have, I mean I think about the people and how much I care about them as individuals and what happens to them. And I can't say that I felt that way all the time as a resident, and like you said Ryan, it's hard in certain- the constructs of everything you're dealing with. But I think it's something that you certainly want to strive for all the time. If you're premed out there and you're shadowing or you're volunteering in the ER, you're scribing; I mean take those moments to try to find a connection with people. Because I can guarantee you that that's the other thing. I can guarantee you that when people are in the hospital and they're having some of the worst times of their lives, and their families are having some of the worst times of their lives; that what they will remember when they leave, and the patient is discharged or the patient passes away, is they will remember those conversations that they had with you. Those family meetings, those moments where you just talked person to person. They're not going to remember necessarily all the details of the MRIs and the labs, and the food they ate and this or that; they're going to remember those times when you sat with them and talked with them. And so-

Dr. Ryan Gray: They might remember the food, how bad it was.

Dr. Allison Gray: Well that's true, it's usually really bad. But the point is that those meetings, those moments are so important and you want to do what you can for your own self-fulfillment but also for their care. To try to connect with people.

Habit #3 – Teaching and Role Modeling

Dr. Ryan Gray: Definitely. The next habit on here is teaching and role modeling. And I think this is another excellent one, and one that's almost like the ‘do as I say, not as I do' thing, but the opposite. So these attendings are finding that knowing that they are responsible for the medical students and the residents and their attitudes and behaviors helps them sustain this humanism in their own lives and in their own practice. And so they're trying to be great role models for those that they're training, and it helps them to keep it up themselves and I think that's an awesome part of it. So always understanding that somebody is always watching you. So being that person who you are telling them to be is very important.

Dr. Allison Gray: Absolutely.

Dr. Ryan Gray: So the next one?

Habit #4 – Having Balance Throughout Your Life

Dr. Allison Gray: So the next one is about balance. And this is so important in every stage of your journey and your life as a physician. And what does balance mean? Well so having balance throughout your life, being able to give at work and give at home and give in all of the different aspects of your life. And what some of these physicians talked about is that if- basically you have to be able to find that work life balance to be able to sustain your work on the job. And if you don't, that a lot of these people find that- or have found that they can't. They can't give any more because if you don't achieve that balance and you're just all out at work and you can't decompress anywhere, you're not exercising, you're not having time with your family, your friends to decompress then you burn out and then you can't give any more at work. And so it can become hard to function, that's when you can become resentful and cynical and so always striving for balance even when you have those five or ten other notes to write, or you're behind in your work, or you're- I mean always striving for balance. And we all struggle with that but it's so, so important.

Dr. Ryan Gray: And we're kind of almost forced nowadays with residency at least to find better balance with residency duty hour restrictions. Before when it was 72 hours of call, it was almost like that badge of honor that you were there for three days straight and you saw patients and you did everything and you had no balance at all. And now we're getting away from that and understanding how bad it really is for all of us, including the patients. And so we're kind of forcing people into that balance which is very important. So the next one is mindfulness and spiritual practices; and we'll kind of touch on this a little bit. But I think everybody has their own way of finding this, whether you're religious or not religious, or spiritual or not spiritual. But some way of finding connections with the patients or with somebody higher in your life that helps you with everything. But it's a very important thing, and I almost want to go back to that self-reflection part too that we talked about earlier. How the meditating in the morning and just being- just being mindful of everything around you, and again building those bonds with the patients and whatever else in your life that you think you need or do need.

Dr. Allison Gray: Absolutely. Yeah, that's what came to mind for me when I read this section was about self-reflection. Because that can mean anything. If you're a spiritual person it can mean thinking about God, and if you don't have sort of a faith-based mind then maybe it's something else. But for everyone we can always self-reflect.

Dr. Ryan Gray: Gator football.

Habit #5 – Being Intentional at Work

Dr. Allison Gray: I don't think that's what they were aiming for, but whatever floats your boat. So the next one here is being intentional. So being intentional at work and how does that sustain us? Well so some of these physicians talk about how maintaining their- they'll basically actively try to seek out experiences and encounters that will help them maintain that same humanistic outlook that they're trying to model and trying to embody every day. And so one of the physicians quoted here, and I love this, she said, “I can sense the part of the patient that's like me that deserves to be cared for and respected and loved. And so when I'm in the room with the patient I'm really striving to feel that part. It's definitely not random, it's a conscious choice I make.” And another internal medicine physician said, “I've trained my mind to not think ahead and not be in the past when I'm face to face with a person; just fully present. I realized how amazing it has made my ability to connect with people and care for them.” So they're actively looking for these experiences of being that humanistic physician, of trying to embody a caring individual, a caregiver, and really maintaining that as a priority as they care for their patients. And other physicians talk about how they travel the world, and the serve underserved populations because it continues to ground them in this humanistic philosophy. And so however you choose to pursue your career, or whomever you decide to serve in terms of a patient population, you can continually reground yourself in that philosophy. It doesn't have to be in another country, it can be right here in the states. But it's in each encounter looking for what- for that human being across from you and trying to actively seek that out versus sort of just saying, “Well I like to be humanistic,” and leave it at that. You know they're really trying to live this, not just say that they're living it.

Dr. Ryan Gray: Yeah. And it's interesting, they had that- the intentional work at habits. Not as a habit but as this other subtheme. But I think intentionally working at a habit is a habit in of itself. So kind of could fit in both. Another theme here they have is the environmental support to sustain humanism, and I think you touched on this a little bit. But it's basically the team around you, and we talk about teamwork in medicine all the time on this podcast. But it says three fourths of the physicians indicated that people in their environment, whether it's physician colleagues, nurses, chaplains and residents are important to them to sustain this humanism. That the support that they're getting from their colleagues and everybody else is very important. And I think that just goes back to having a support structure, having somebody else to kind of lean on when you need help, and maybe emulating some of these traits and attitudes that these other people are having that you can kind of see yourself.

Humanism as an Antidote to Burnout

Dr. Allison Gray: Yeah. And the last theme that they talk about here is humanism as an antidote to burning out, which I think is so important. Some of you out there, and physicians too in general might think, “Well I am already so busy, how am I possibly now going to also make time to think about being humanistic and think about caring and think about all this? I just need to get through my work and get the job done and get home.” And what this part is talking about is that if you really try to be humanistic, you try to put the patient- the human side of them first, that that's actually how you move through the day maybe more quickly, but also in a better way. That you leave that day feeling more fulfilled, the patients that you take care of are going to be better served, so that it's actually the opposite. That if you look at each day with each patient as an individual and you really try to care for each person individually that it will actually be a much better day and you probably won't leave the day feeling as burned out by just, oh seven cases of mesothelioma or seven cases of whatever you're treating. There's redundancy, that's the other thing about this which I think about- I always tell people when you're trying to pick a specialty that there's redundancy in all of medicine so you better love your organ, whatever organ it is that you choose to pursue. But so with that redundancy, what makes medicine not redundant? It's the people part of it, it's the patients, right? It's getting to know them and that's what you remember.

Final Thoughts

Dr. Ryan Gray: I agree. So I think this was a little excellent article- not a little-

Dr. Allison Gray: Where are you going with little?

Dr. Ryan Gray: It was an excellent article that I think we hopefully did it justice to let you know as a premed, as a medical student, as a resident, what you can start doing now- now that you know some of this information, take it and run with it. And if you think you have some habits or attitudes that are contradictory to what they talked about here, start thinking about that and start working on those attitudes and habits to help better put you in a situation that when you're on the flipside of all this training, you will be a happier, more productive physician.

Dr. Allison Gray: And I think if you start thinking about these attitudes and habits from really as early as you can, the likelihood that you'll burn out later is a lot less. It's never too early to start embodying these ideals and to start really developing these attitudes. And these don't have to be- we're certainly not saying you have to be curious and you have to do all of these things that we just laid out, but if you look- I mean this is pretty evident space, these are physicians who really are loving what they do, and are walking away each day happy and fulfilled and providing great care. And so- and the residents that, again bringing back to the beginning of this article, these are residents who nominated these people because they see them, they work with them, and they think that they're such great role models as physicians. So it's never too early to start thinking about what makes a great physician, and start trying to really live by those ways of being as a premed, and then as a med student. You'll just carry that with you and develop it further as a physician.

Dr. Ryan Gray: I agree. That was awesome. Thank you Allison for joining us here, another week on the podcast.

Dr. Allison Gray: Thank you for having me, I have to say I'm just delighted and honored that here I am on the first of the second hundred episodes on the Medical School HQ Podcast.

Dr. Ryan Gray: Yes. So coming up we'll have a lot of interviews with some other people, so if you like having Allison on, don't fret she will be back but she will take a little hiatus as we talk to some interesting people to come. And to get those podcasts, if you haven't yet, go subscribe www.MedicalSchoolHQ.net/iTunes or /Stitcher; whatever your player of choice. Get the podcast on your device every Wednesday for free.

If you love the podcast, or if you just love Allison, go leave us a rating and review. That would be the best thing for you to do for us to show that you like our podcast. You can go to www.MedicalSchoolHQ.net/iTunes and leave a rating and review there. We have a bunch of new ones recently, a bunch of new five star reviews. FireyDoctor2021 said, “So grateful.” BJHasGym says, “A must listen.” Epistemist says, “Wonderful podcast.” I thought you were going to read these once. So hard to read.

Dr. Allison Gray: You just don't want to butcher names.

Dr. Ryan Gray: I know. JSMoveco says-

Dr. Allison Gray: Oh no I just think this is great. I'm definitely not going to be reading them. We'll leave it to you.

Dr. Ryan Gray: Says, “Excellent for nontraditional students,” and EzraA says, “Essential for the premed experience.”

So thank you to those listeners that left that.

Dr. Allison Gray: Thank you guys so much. And I'm just laughing at Ryan because I can do that.

Dr. Ryan Gray: Yeah, whatever. Anyway.

Dr. Allison Gray: But really we're just grateful for those amazing reviews. We still get so excited every time we see one, we're just really grateful to you guys.

Dr. Ryan Gray: We get an email every time somebody leaves a review in iTunes, so we love those emails. Thank you for doing that. If you want to say hi to me I am on Twitter, I am @MedicalSchoolHQ. You can shoot me an email, Ryan@medicalschoolhq.net or Allison@medicalschoolhq.net. If for some reason you want to say hello to her, I don't know why.

Dr. Allison Gray: Burn!

Dr. Ryan Gray: She's- I would give you her Twitter handle but she's not on there.

Dr. Allison Gray: You can definitely email me, I'm good with email.

Dr. Ryan Gray: There we go. Alright, I hope that episode was good for you, it was fun for us. I hope you learned a lot from it. And as always I hope you join us next time here at the Medical School Headquarters.

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