Lytt til Flourishing in Medicine: From Surviving to Thriving

Today, we are joined by Dr. Carter Lebares. Dr. Lebares is an Associate Professor of Surgery in the Division of General Surgery and the Director of the Center for Mindfulness in Surgery at the University of California, San Francisco. She is a gastrointestinal and bariatric surgeon who specializes in treating gastrointestinal disease, using minimally invasive surgery, such as robotics and surgical endoscopy. Her expertise includes treatments for reflux disease, obesity, early esophageal or gastric cancer, esophageal motility disorders, hernias, gallbladder disease and some kinds of biliary disease. Lebares' research interests include resilience and mindfulness in surgery, mindfulness and nutrition in metabolic syndrome and obesity, the neuroendocrine and cognitive effects of stress on learning and performance. She has developed and studied a customized curriculum specifically designed for surgeons, the Enhanced Stress Resilience Training (ESRT), which has been demonstrated to improve burnout and global executive function. In the conversation, Dr. Lebares shares her journey from biochemistry to academic surgery, driven by a deep commitment to advocacy and empowering others through resilience-building approaches. We also cover: * Her early experiences advocating for disadvantaged youth that ultimately led her to medicine * The evolution of surgical training environments and challenges to physician wellbeing * Development of the Enhanced Stress Resilience Training (ESRT) specifically designed for surgeons * Her vision for systemic changes in healthcare to preserve medicine as a "pillar of civilization" Dr. Lebares concludes by reflecting on finding joy in the simplicity of everyday life - being outdoors, connecting with people outside medicine, and appreciating ordinary moments that meditation helps bring into focus. Guest: Carter Lebares, MD Associate Professor of Surgery, Division of General Surgery Director, Center for Mindfulness in Surgery Principal Investigator, The Lebares Resilience Lab University of California, San Francisco Faculty webpage: https://generalsurgery.ucsf.edu/faculty/acute-care-surgery/carter-lebares,-md.aspx Lebares Resilience Lab Website: https://carterlebares.org/ LinkedIn Page: https://www.linkedin.com/in/carter-lebares-a3970b8/ Selected Resources/References: About Ann Masten PhD: https://en.wikipedia.org/wiki/Ann_Masten Libby Zion Law: https://en.wikipedia.org/wiki/Libby_Zion_Law Luton OW, James OP, Mellor K, Eley C, Hopkins L, Robinson DBT, Barlow E, Lebares CC, Lewis WG, Egan RJ; Welsh Surgical Research Initiative (WSRI) Collaborative. Enhanced Stress Resilience Training for UK Surgical Trainees; Effect and Evolution Evaluated. J Surg Educ. 2023 Oct;80(10):1395-1402. doi: 10.1016/j.jsurg.2023.07.017. Epub 2023 Aug 9. PMID: 37567800. Luton OW, James OP, Mellor K, Eley C, Hopkins L, Robinson DBT, Lebares CC, Powell AGMT, Lewis WG, Egan RJ. Enhanced stress-resilience training for surgical trainees. BJS Open. 2021 Jul 6;5(4):zrab054. doi: 10.1093/bjsopen/zrab054. PMID: 34323917; PMCID: PMC8320339. Lebares CC, Coaston TN, Delucchi KL, Guvva EV, Shen WT, Staffaroni AM, Kramer JH, Epel ES, Hecht FM, Ascher NL, Harris HW, Cole SW. Enhanced Stress Resilience Training in Surgeons: Iterative Adaptation and Biopsychosocial Effects in 2 Small Randomized Trials. Ann Surg. 2021 Mar 1;273(3):424-432. doi: 10.1097/SLA.0000000000004145. PMID: 32773637; PMCID: PMC7863698. Lebares CC, Guvva EV, Ascher NL, O'Sullivan PS, Harris HW, Epel ES. Burnout and Stress Among US Surgery Residents: Psychological Distress and Resilience. J Am Coll Surg. 2018 Jan;226(1):80-90. doi: 10.1016/j.jamcollsurg.2017.10.010. Epub 2017 Oct 26. PMID: 29107117.

Today, we are joined by Dr. Maura Kenny. Dr. Kenny is a psychiatrist with Southern Australian Health and a mindfulness teacher, trainer and researcher with 20 years of experience teaching mindfulness courses in both clinical and organizational settings. Her special interest is the wellbeing and resilience of healthcare staff, and she's developed a six week mindfulness course that has been delivered for several years in South Australia's public health settings and in other healthcare and university settings around Australia, the United Kingdom, Singapore and Taiwan. Maura is also the inaugural director of Staff Wellbeing at the largest healthcare network of over 17,000 employees in South Australia Health. In the conversation, Dr. Kenny traces her journey from aspiring domestic science teacher to psychiatry, driven by her fascination with biology and a desire to alleviate suffering. We also cover: * Her pivotal encounter with Professor Mark Williams that introduced her to mindfulness * Adapting mindfulness practices specifically for exhausted healthcare professionals * The limitations of individual interventions without system-level changes * Her role as Director of Staff Wellbeing and the challenges of connecting different parts of the healthcare system * The importance of peer support and camaraderie in medicine Dr. Kenney concludes by reflecting on finding joy amid the inherent challenges of healthcare and the privilege of being present for patients during significant moments in their lives. Chapters: (00:00) Introduction (03:00) Dr. Kenny's Path to Medicine (11:40) Introduction to Mindfulness in Practice (15:20) Pivotal Workshop with Professor Mark Williams (19:40) Adapting Mindfulness for Healthcare Professionals (24:20) Healthcare Staff Wellbeing in Australia (31:00) Social Justice in Australian Healthcare (34:00) Leadership Challenges and "No Villains" Mantra (37:20) Importance of Peer Support and Camaraderie (41:00) "A Brief for the Defense" Poem Reading (44:20) Finding Joy Amidst Challenges (48:00) Conclusion and The Guest House Poem Guest: Maura Kenny, MBChB, MRCPsych, FRANZCP Director, Staff Wellbeing, SA Health (South Australia Health) LinkedIn Page: https://www.linkedin.com/in/dr-maura-kenny-b5bb1b53/ [https://www.linkedin.com/in/dr-maura-kenny-b5bb1b53/] Website for the Mindful Self Care Course: https://www.mindfulscp.com/ [https://www.mindfulscp.com/] Resources/References: Kenny M, Luck P, Koerbel L. Tending the Field of Mindfulness-Based Programs: The Development of International Integrity Guidelines for Teachers and Teacher Training. Glob Adv Health Med. 2020 May 7;9:2164956120923975. doi: 10.1177/2164956120923975. PMID: 32426180; PMCID: PMC7218322. Amishi Jha, PHD and her work and research: https://amishi.com/ [https://amishi.com/] Guest House Poem, Rumi: https://www.scottishpoetrylibrary.org.uk/poem/guest-house/ [https://www.scottishpoetrylibrary.org.uk/poem/guest-house/] Mindful Self-Compassion, Kristen Neff PhD, and Chris Germer PhD: https://centerformsc.org/about/ [https://centerformsc.org/about/] A Brief for the Defense, Poem by Jack Gilbert: https://genius.com/Jack-gilbert-a-brief-for-the-defense-annotated [https://genius.com/Jack-gilbert-a-brief-for-the-defense-annotated]

Today, we are joined by Dr. Janine Kirby, an integrative medical doctor, homeopath and mindfulness teacher based in East London. After completing her medical degree, she obtained a Diploma in Child Health, a Diploma in Obstetrics and a Masters in Family Medicine. She worked in the public sector for many years before starting her own integrative medical practice and acquiring professional qualifications in Homeopathy. She has a passion for helping her patients understand the importance of the intimate connection between the body, thoughts and emotions in healing. Janine enjoys teaching, having facilitated both under- and post-graduate Family Medicine training. She has been teaching the 8-week Mindfulness Based Stress Reduction Program (MBSR) with psychologist Barbara Gerber since 2010. She also co-facilitates mindfulness-informed programs for healthcare practitioners dealing with stress and burnout, and is the current Chairperson of IMISA, the Institute for Mindfulness South Africa, involved on national and international levels in promoting mindfulness programs and developing teacher training standards. In the conversation, Dr. Kirby shares the profound impact of her early life experiences and the environment of apartheid South Africa on her journey into medicine and mindfulness. We also cover: * How her brother's illness shaped her holistic understanding of healing * The challenges of integrating traditional and modern medical practices * Her work with the Institute for Mindfulness of South Africa (IMISA) * Dr. Kirby’s mindfulness programs * The balance between professional challenges and personal fulfillment She concludes by sharing her desire to expand mindfulness programs and contribute to the global mindfulness conversation and reflecting on the balance between professional challenges and personal fulfillment. - Chapters: (00:00) Introduction (03:31) Dr. Kirby’s Medical Journey (04:39) Janine's Experiences with Her Brother’s Illness (08:52) Traditional Healing in South Africa (14:19) Challenges in South African Healthcare (22:54) Burnout and Mindfulness in Medicine (26:33) Janine's Personal Journey with Mindfulness (38:17) Future of Mindfulness in South Africa (43:14) Conclusion Guest: Janine Kirby, MBChB Family Practitioner / Homeopath in private practice; Chairperson of IMISA (Institute of Mindfulness SA) LinkedIn Page: https://www.linkedin.com/in/janine-kirby-525b595a/ Institute for Mindfulness South Africa website: https://mindfulness.org.za/ Facebook Page, Institute for Mindfulness South Africa: https://www.facebook.com/instituteformindfulnesssouthafrica/ Resources/References: Kirby JM, Milligan PD, Conradie HH, McIntosh BM. A mindful approach to physician self-care. S Afr Fam Pract (2004). 2024;66(1):e1-e4. Published 2024 Jan 30. doi:10.4102/safp.v66i1.5836

Our guest today is Sara C. Charles, MD, a psychiatrist, and professor emerita at the University of Illinois College of Medicine. In 1976, Dr. Charles endured a six-week trial for medical malpractice in federal court which resulted in a defense verdict. The experience of the trial so profoundly affected her that she began to study the mental, emotional, and physical effects of malpractice litigation on physician defendants. Her pioneering research published in the 1980s and 90s is relied on today by physicians, clinicians, and experts in physician wellness. A prolific writer, books co-authored by Dr. Charles include Defendant, A Psychiatrist on Trial for Medical Malpractice (written with her husband, Dr. Eugene Kennedy), and Adverse Events, Stress and Litigation (written with her dear friend and attorney, the late Paul Frisch). Retired from active practice, Dr. Charles remains engaged in promoting the wellness of all healthcare professionals who become involved in malpractice litigation and in this conversation, she shares her journey into medicine, shaped by her upbringing in a large Irish Catholic family that valued education. Despite initial thoughts of pursuing social work, she pursued a path in biology and chemistry, ultimately finding her calling in psychiatry due to her ability to connect with patients. She recounts a pivotal event in their career when a patient sued her, sparking an interest in addressing the emotional toll of malpractice litigation on physicians. Her experiences during the lengthy malpractice proceedings highlighted the lack of support and isolation physicians face, driving her advocacy for cultural change within the medical community to better address the psychological impact of litigation. Her interest, research, and investigations about this topic led to the publications of several seminal books about the experience of physicians of being sued and the establishment of the Physician Litigation Stress Organization. Emphasizing the importance of peer support and cultural change within medicine, Dr. Charles advocates for a deeper appreciation of the moral and existential nature of medical work in medical education, aiming to address the emotional toll of malpractice litigation and improve physician well-being. Her varied interests and deep social connections underscore the role of community, the importance of medical work, and the cultivation of an integrated social fabric in finding flourishing in medicine and in life. Guest: Sara Charles, MD Founder, The Physician Litigation Stress Resource Center Website: https://physicianlitigationstress.org/ [https://physicianlitigationstress.org/] Resources/References: Charles SC and Frisch PR. Adverse Events, Stress, and Litigation: A Physician’s Guide [https://www.amazon.com/Adverse-Events-Stress-Litigation-Physicians/dp/B015X3Z2QA/ref=sr_1_2?ie=UTF8&qid=1519673567&sr=8-2&keywords=Adverse+Events%2C+Stress%2C+and+Litigation%3A+A+Physician%E2%80%99s+Guide] New York. Oxford University Press, 2005. Charles SC, Kennedy EC. Defendant: A Psychiatrist on Trial for Medical Malpractice New York. Random House, (Vintage Books), 1986. Plumb EJ. World changing. Ann Intern Med. 2015 Apr 21;162(8):594-5. doi: 10.7326/M14-2076. PMID: 25894031.

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/ [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 [https://www.youtube.com/watch?v=HUJQlVeGZzY&t=34s]