Our guest today is Dr. Jane Fogg, a physician leader and executive with broad experience leading health care delivery, focusing on primary care, systems redesign, and value-based delivery models and a Senior Physician Advisor for the division of Professional Satisfaction & Practice Sustainability at the American Medical Association. Prior to this, she was the Executive Chair of Internal Medicine Family Medicine at Atrius Health, an innovative value-based healthcare leader in Massachusetts, and a member of Optum, responsible for the care delivery and outcomes of a practice with 350 physicians and advanced practice clinicians caring for 400,000 patients. She implemented advanced primary care redesign for reliable systems that are team-based, patient-centered, innovative, and return joy to the practice of medicine. Dr. Fogg is a Lecturer at Harvard Medical School, Affiliate Faculty at the Center for Primary Care, and speaks internationally and locally on value-based care delivery, innovation in health care, physician wellbeing, and in basket reduction.

During this conversation, Dr. Fogg recounts her interest in a medical career that was spurred by experiences as a medical assistant in oncology, where she experienced the pivotal role of relationships in healthcare. Reflecting on her over three-decade career hence, she has grown increasingly aware of systemic deficiencies in the organization of healthcare, especially in primary care, which have fueled her commitment to addressing these issues in her many leadership roles. While grappling with physician burnout and systemic challenges, Dr. Fogg advocates for fundamental changes in healthcare deliver, in particular promoting and implementing value-based care which aligns financial incentives with quality patient care. She emphasizes quite persuasively that the transition to value-based care and data-driven decision-making while optimizing clinical operations can enhance physician wellbeing as well as practice efficiency. She shares actionable strategies such as in-basket workload reduction while championing honesty, gratitude, and joy in healthcare practice and leadership.

Guest: Jane Fogg, MD, MPH, Lecturer on Global Health and Social Medicine, Harvard Medical School, Affiliate Faculty, Center for Primary Care, Harvard Medical School

LinkedIn Page: https://www.linkedin.com/in/jane-f-fogg-md-mph-52a61349/

Resources/References:

AMA STEPS Forward® practice innovation strategies offer real-world solutions to the challenges that your practice is confronting today. Gain the tools you need to overcome barriers and restore the joy in your practice of medicine: https://www.ama-assn.org/practice-management/ama-steps-forward

Jane Fogg, MD, MPH, and Christine Sinsky, MD: In-Basket Reduction: A Multiyear Pragmatic Approach to Lessen the Work Burden of Primary Care Physicians Published April 19, 2023, NEJM Catal Innov Care Deliv 2023;4(5)

DOI: 10.1056/CAT.22.0438 https://catalyst.nejm.org/doi/pdf/10.1056/CAT.22.0438?download=true

“Participant joyfully in the world…” a quote by Campbell from the book This guidance occurred in the 1991 book Reflections on the Art of Living: A Joseph Campbell Companion which consisted of material selected and edited by Diane K. Osbon.

Anthropologist Angeles Arrien re the four questions a healer would ask (YouTube video of Dr. Arrien): https://www.youtube.com/watch?v=HUJQlVeGZzY&t=34s

The guest today is Pat Croskerry, MD, PhD, is a professor in emergency medicine at Dalhousie University in Halifax, Nova Scotia, Canada. Trained as an experimental psychologist, Dr. Croskerry went on to become an emergency medicine physician and found himself surprised by the relatively scant amount of attention given to cognitive errors. He has become one of the world's foremost experts in safety in emergency medicine and diagnostic errors. Dr. Croskerry is currently Director of the Critical Thinking Program within the Division of Medical Education, Dalhousie University. His interests lie primarily in clinical decision making, diagnostic failure, and the role of cognitive and affective bias in decision making. Recent work is aimed at cognitive bias mitigation.

During this fascinating conversation, Pat shares his unique path to medicine, stemming from a background in psychology that instilled a focus on critical thinking and cognitive biases, and the discipline to study medicine, informed by his brief rowing career during which, as a member of the Canadian National Team he competed in the Olympic Games. He delves into specific biases affecting medical decision-making, such as emotional affective, anchoring, and search satisficing biases, stressing the need to mitigate these biases for accurate diagnoses. Furthermore, he explores the impact of cognitive load and decision fatigue on physician well-being, advocating for a reconsideration of critical thinking's role in modern medical practice to ensure optimal performance and professional satisfaction.

Guest: Pat Croskerry, MD, PhD, FRCP

LinkedIn Page: https://www.linkedin.com/in/pat-croskerry-199a8132/

Wikipedia page: https://en.wikipedia.org/wiki/Patrick_Croskerry

NEJM Interview: https://www.nejm.org/action/showMediaPlayer?doi=10.1056%2FNEJMdo002218&aid=10.1056%2FNEJMp1303712&area=

Other references:

Croskerry P, Clancy M. Advancing diagnostic excellence: the cognitive challenge for medicine. BMJ. 2022 Mar 29;376:o799. doi: 10.1136/bmj.o799. PMID: 35351777.

Olson A, Rencic J, Cosby K, Rusz D, Papa F, Croskerry P, Zierler B, Harkless G, Giuliano MA, Schoenbaum S, Colford C, Cahill M, Gerstner L, Grice GR, Graber ML. Competencies for improving diagnosis: an interprofessional framework for education and training in health care. Diagnosis (Berl). 2019 Nov 26;6(4):335-341. doi: 10.1515/dx-2018-0107. PMID: 31271549.

Croskerry P. From mindless to mindful practice--cognitive bias and clinical decision making. N Engl J Med. 2013 Jun 27;368(26):2445-8. doi: 10.1056/NEJMp1303712. PMID: 23802513.

The guest today is Justin Klamerus, MD, MMM, Executive Vice-President and Chief Clinical Officer for McLaren Health, a fully integrated, nonprofit health care delivery system committed to quality, evidence-based patient care and cost efficiency. The McLaren system includes 14 hospitals in Michigan, ambulatory surgery centers, imaging centers, a 490-member employed primary and specialty care physician network, commercial and Medicaid HMOs covering approximately 700,000 lives in Michigan and Indiana. McLaren operates Michigan’s largest network of cancer centers and providers, anchored by the Karmanos Cancer Institute, one of only 51 National Cancer Institute-designated comprehensive cancer centers in the U.S. McLaren maintains academic affiliations with medical schools at Wayne State University, Michigan State University and Central Michigan University. McLaren’s GME campuses offer residencies and fellowship programs that train over 650 future physicians annually.

A medical oncologist by training who joined McLaren in 2009, he went on to hold numerous positions at McLaren including president of McLaren Cancer Institute and principal investigator of the McLaren Center for Research and Innovation. Following the acquisition of Karmanos Cancer Institute by McLaren in 2014, Klamerus served as chief quality officer and later president of the Karmanos Cancer Hospital and Network. in 2020, he was appointed to the Public Health Advisory Commission by Michigan Governor Gretchen Whitmer, and in 2022 he became Chief Clinical Officer for all of McLaren Health.

During this conversation, Dr. Klamerus discusses his leadership in McLaren Health, highlighting the organization's dedication to its medical staff as well as to many diverse communities, while navigating financial constraints and significant public challenges such as the Flint Michigan water crisis, gun violence, and maternal health delivery issues. He shares a vision for how large and complex healthcare systems can improve workforce stability and community engagement through fostering an environment where staff receive the support needed to excel in complex patient care delivery and to address social issues. He underscores the importance of transparent, authentic, and engaged leadership, mindfulness, and personal connections, alongside emerging technologies, in driving positive changes in healthcare delivery, community health outcomes, and physician and health professional well-being. I found his candor, humor, genuineness and warmth to be comforting, helping me to better understand the connection we can all have with true leaders.

Guest: Justin F. Klamerus, MD, MMM

Executive Vice President and Chief Clinical Officer, McLaren Healthcare

Faculty Profile: about Dr. Klamerus- https://www.mclaren.org/main/news/mclaren-health-care-appoints-justin-f-klamerus-md-3906

LinkedIn Page: https://www.linkedin.com/in/justin-klamerus-md-mmm-a42b293b/

About McLaren Health: https://www.mclaren.org/

3 Minute Meditation Session with Dr. Mick Krasner

Our guest today is Rita Charon is a general internist and literary scholar and one of the founders of the field of narrative medicine. She completed the MD at Harvard Medical School and the PhD in English at Columbia University. She is the Bernard Schoenberg Professor of Social Medicine, Professor of Medicine, and founding chair of the Department of Medical Humanities and Ethics at Columbia University Vagelos College of Physicians & Surgeons. Her research in narrative medicine has been supported by the NIH, the NEH, and many private foundations. She authored, co-authored, or co-edited four books on narrative medicine. She lectures and teaches internationally and publishes extensively in leading medical and literary journals.

In this interview, Dr. Rita Charon discusses how early experiences with her father's medical practice inspired her to pursue a career in medicine. She also reflects on her love of literature that led to her deep dive into that field, connecting profoundly with narrative theory. This instantly enriched her medical practice by enhancing her listening skills and her ability to unearth deeper meanings in patient interactions. She highlights the importance of narrative medicine in helping health professionals cope with the emotional challenges of their work, particularly during crises like the COVID-19 pandemic, and reflects on the broader implications of narrative competency, the importance of listener trust, and the systemic challenges in healthcare that impact equitable access to care. The close reading of non-medical texts she maintains can help health professionals recognize and address structural inequities within the healthcare system. Rita emphasizes the importance of activism among clinicians and the need for providing models of activism for students of medicine while protecting clinicians from systemic pressures that erode the patient-clinician relationship. This fascinating, lively, and connecting conversation with Dr. Charon makes a compelling and inspiring call for all of us in medicine to consider a deeper literary engagement to enhance empathy and understanding in medical practice.

Guest: Rita Charon, MD, PhD

Bernard Schoenberg Professor of Social Medicine, Professor of Medicine, and founding chair of the Department of Medical Humanities and Ethics at Columbia University Vagelos College of Physicians & Surgeons

Faculty Page, Columbia University: https://sps.columbia.edu/faculty/rita-charon-md-phd

Resources/References:

Dr. Charon’s Jefferson Lecture for the National Endowment for the Humanities: https://www.youtube.com/watch?v=7yI0rdQEAj8

About Luke Fildes painting The Doctor, 1891: https://en.wikipedia.org/wiki/The_Doctor_(painting)

David Rothman Strangers at the Bedside: A History of How Law and Bioethics Transformed Medical Decision https://www.taylorfrancis.com/books/mono/10.4324/9781315130286/strangers-bedside-david-rothman

About Henry James: https://en.wikipedia.org/wiki/Henry_James

About Hans-Georg Gadamer, philosopher: https://en.wikipedia.org/wiki/Fusion_of_horizons

Emily Dickinson:

“A word is dead when it is said…” https://www.americanpoems.com/poets/emilydickinson/a-word-is-dead/

“Tell all the truth but tell it slant…” https://www.poetryfoundation.org/poems/56824/tell-all-the-truth-but-tell-it-slant-1263

Our guest today is Helen Riess, M.D. is Chief Scientist and Chairman of Empathetics. Dr. Riess is Associate Clinical Professor of Psychiatry at Harvard Medical School and Director of the Empathy and Relational Science Program at Massachusetts General Hospital. In addition, Dr. Riess is the author of The Empathy Effect and a core member of the Consortium for Research on Emotional Intelligence in Organizations (CREIO) and faculty of the Harvard Macy Institute. Dr. Riess is a psychiatrist who developed an empathy training approach based on research in the neurobiology and physiology of empathy that has been rigorously tested in pilot studies and a randomized, controlled trial at MGH. She completed her residency and Chief Residency at MGH and Harvard Medical School. Dr. Riess has devoted her career to teaching and research in the art and science of the patient-doctor relationship. Dr. Riess received her M.D. from Boston University School of Medicine and her B.A. From Wesleyan University.

In this conversation Dr. Riess shared the influence of her family's experiences as refugees from war-torn Europe, which sensitized her to trauma and resilience. Her interest in psychiatry began during medical school when she was drawn to understanding the mind and healing through narrative and empathy. While a small percentage of people lack the neural mechanisms for empathy, for most, empathy is a mutable trait influenced by their environment and mental state, and burnout among healthcare professionals diminishes their capacity for empathy, not because empathy is inherently harmful, but due to the overwhelming demands and flawed systems they work within. To address this, Dr. Riess speaks of the importance self-regulation and self-care skills, recognizing the human needs of healthcare workers, and creating supportive, empathetic organizational cultures. Helen discusses four pillars of what she describes as institutional resilience- supporting healthcare workers with safe environments, caring communication, community cohesion, and mental health normalization. The personal anecdotes she shared illustrate the profound impact of empathetic interactions, both professionally and personally, and the importance of meaningful connections for self-care and fulfillment, all reflections of her infectious passion and inspiration as well as her deep humanity.

Guest: Helen Reiss MD

Chief Scientist and Chairperson of Empathetics, Director, and Associate Clinical Professor of Psychiatry at Harvard Medical School and Director of the Empathy and Relational Science Program at Massachusetts General Hospital

LinkedIn Page: https://www.linkedin.com/in/helen-riess/

Website for Empathetics: https://www.empathetics.com/

Resources/References:

Dr. Riess’ TEDX Talk: https://www.youtube.com/watch?v=baHrcC8B4WM

The Empathy Effect: https://rb.gy/96awc2

The Consortium for Research on Emotional Intelligence in Organizations (CREIO): https://eiconsortium.org/

Riess, Helen. Institutional Resilience: The Foundation for Individual Resilience, Especially During COVID-19. Glob Adv Health Med. 2021 Apr 6;10:21649561211006728. doi: 10.1177/21649561211006728. PMID: 33889440; PMCID: PMC8040559.

About Heinz Kohut and Self-Psychology: https://en.wikipedia.org/wiki/Self_psychology

The guest for this podcast Ellen Langer, PhD, Professor of Psychology at Harvard University, a Fellow of The Sloan Foundation; The American Psychological Association, the American Psychological Society, The American Association for the Advancement of Science; Computers and Society; The Society for the Psychological Study of Social Issues; The Society of Experimental Social Psychologists. She has been awarded a Guggenheim and the Liberty Science Genius Award among many others. In addition to her many honors, she has been a guest lecturer in Japan, Malaysia, Germany, and Argentina.

Langer has had a significant influence on the positive psychology movement. Along with being known as the “mother of positive psychology” her contributions to the study of mindfulness have earned her the moniker of the "mother of mindfulness." Her work helped to presage mind/body medicine, which has been regarded by many scientists to be an important intellectual movement and one that now has "considerable evidence that an array of mind-body therapies can be used as effective adjuncts to conventional medical treatment." She has co-authored experimental research indicating a connection between time perception and wound healing.

She has published over 200 articles and academic texts, was published in The New York Times, and discussed her works on Good Morning America. Additionally, in many introductory psychology courses at universities across the United States, her studies are required reading. She is the author of numerous books including her most recent one, The Mindful Body.

In this conversation, a rich exploration unfolds of the intersection between mindfulness and healthcare, beginning with Dr. Langer’s personal journey into health studies, catalyzed by a miraculous recovery in their family. This narrative weaves through the profound influence of the mind-body connection, drawing on examples like the "Counterclockwise Study" to underscore the potential for psychological factors to significantly impact physical health. She advocates for a healthcare approach that recognizes the unity of mind and body, emphasizes the importance of mindfulness beyond meditation, and addresses the dynamic nature of health with a flexible, engaged attitude towards patient care. The discussion also highlights the challenges of conventional medicine's problem-focused approach, proposing a shift towards leveraging patients' strengths and capacities through mindful observation to variability. By illustrating how mindfulness can transform both personal experiences and professional practices, the conversation champions a healthcare paradigm that values meaningful connections and fosters an environment of non-judgment and safety, suggesting a communal shift towards a more mindful, holistic view of health and well-being.

Guest: Ellen Langer, PhD

Professor of Psychology, Harvard University

Faculty Profile: https://scholar.harvard.edu/langer/home

Website: https://www.ellenlanger.me/

LinkedIn Page: https://www.linkedin.com/in/ellenjlanger/

Book titles by Dr. Langer: see https://www.ellenlanger.me/home#book-s

This episode’s guest, Dr. Gail Gazelle, with 25 years as a practicing internist and hospice physician, combines practical, evidence-based strategies with her extensive medical and mindfulness expertise. She is a recognized figure in the media, featured in outlets like CNN, NPR, Oprah Magazine, and has been published twice in the New England Journal of Medicine as well as other leading medical journals.

Her latest book, “Mindful MD: 6 Ways Mindfulness Restores Your Autonomy and Cures Healthcare Burnout,” underscores her significant contributions to wellness. Utilizing mindfulness to become the master of the mind, she shares the keys to reducing reactivity, decreasing burnout, and restoring the true autonomy that we can all retain. Using dozens of real-life stories, she helps readers see that they don’t have to hand over their happiness to a complex and dysfunctional healthcare system.

In this podcast Dr. Gazelle shares insights into her work addressing physician burnout and fostering flourishing. Reflecting on her own journey, she discusses her initial interest in end-of-life care, shaped by complex family experiences. The conversation explores burnout roots in medical training, discussing self-critical thoughts, perfectionism, and the imposter syndrome among physicians. Dr. Gazelle advocates for mindfulness as a key tool in regaining autonomy, reconnecting with purpose, and challenging negative thought patterns. She introduces a coaching model incorporating mindfulness to help physicians find meaning and acknowledge positives, emphasizing individual empowerment and systemic healthcare challenges.

Gail defines mindfulness in terms of awareness and mind training. In addressing health professional burnout, she stresses the need to focus on present moment experiences and work with what is-how things actually are- accepting the current state in healthcare as lived reality as an honest and workable starting point for transformation. She also explores the impact of stories in our professional lives, differentiating between helpful stories that add meaning and purpose to our work and unhelpful narratives that keep us stuck with an unrealistic and unworkable view of ourselves and our situations. Finally, the conversation touches on the transformative power of flourishing in healthcare, both as a recipient of healthcare and as a provider of care to others.

Guest:

Gail Gazelle, MD

Website: www.gailgazelle.com

Email: drgazelle@gailgazelle.com

LinkedIn: @gailgazelle

Facebook: facebook.com/groups/539466187211003

X: @gailgazellemd

Other resources:

Mindful MD: 6 Ways Restores Your Autonomy and Cures Healthcare Burnout- available at Amazon and free chapter download available at Dr. Gazelle’s website.

Other resources available on Dr. Gazelle’s website: The Daily Dose of Calm; Imposter Syndrome Guide; Everyday Resilience Book; Leading in a Time of Crisis; and 10 Steps to Avoid Physician Burnout

3 Minute Guided Meditation with Dr. Mick Krasner

This episode continues an investigation of medical education that began with last episode’s interview with Dr. Bonvin, now with a 4th Year Medical Student, Malayna Hocker, who shares her journey into medicine as a career and evolution as a teacher. Initially resistant to the idea of pursuing medicine due to negative childhood experiences in hospitals, she explored various paths but eventually found her way back to medicine through teaching. Inspired by her love for science and a desire to serve the community, Before entering medical school Malayna taught in challenging environments, facing issues like student violence and family difficulties.

As she navigated this non-traditional path to medical school, Malayna's teaching experiences continued to shape her perspective, as her teaching focus has evolved into an advocacy role, addressing discomfort and questioning aspects of medical culture. Malayna emphasizes the need to break the stereotypes in medicine, challenging the notion of perfection and the acceptance of toxic aspects within the profession. She believes that open conversations about challenges, doubts, and well-being are essential in reshaping the culture of medicine. Malayna also sees teaching as a means to advocate for both patients and fellow trainees, fostering a culture of empathy, understanding, and collaboration.

Malayna emphasizes the need to break the cycle of isolation and shame ingrained in medical training and advocates for fostering a culture of support and openness. She believes that finding connection and breaking out of isolation are crucial for addressing burnout in the future. Malayna expresses joy in learning, helping patients live the lives they want, and engaging in teaching. She highlights the importance of maintaining one's personhood and finding fulfillment both in and outside of the medical profession.

Guest:

Malayna Hocker, 4th Year Medical Student

University of Rochester School of Medicine and Dentistry

Other resources:

America Reads Program: existing in amny institutions of higher education, this website describes the program at Arizona State University: https://communityengagement.education.asu.edu/programs/america-reads

Shame in Medical Education:

Bynum WE 4th, Varpio L, Lagoo J, Teunissen PW. 'I'm unworthy of being in this space': The origins of shame in medical students. Med Educ. 2021 Feb;55(2):185-197. doi: 10.1111/medu.14354. Epub 2020 Sep 13. PMID: 32790934.

The Shame Conversation: A short documentary film created by Dr. Will Bynum depicting conversations about experiences with shame in healthcare.

https://www.theshamespace.com/film