Operate with Zen: Recent Episodes
Phil Pierorazio
While incredibly rewarding and honored vocations, careers in medicine and surgery are fraught with stress, burnout and challenges in work-life balance. OWZ is intended to open dialogue about a mindful approach to surgery - to create a space where physicians and surgeons can enhance their life's work and life experience with a focus on presence, purpose and practical skills. OWZ combines didactic-like monologues to provide baseline information and available scientific data on practical topics like time management, sleep hygiene and burnout; as well as interviews with surgeons and experts to share what works and doesn't work in their daily routines.
Scott MacDiarmid, MD is a private practice urologist in Greensboro, North Carolina and the author of “Fist Pumps” – a self-help book to lift up physicians and healthcare providers who serve (https://www.amazon.com/Fist-Pumps-Scott-MacDiarmid/dp/1088078184). Similar to my journey in Operative with Zen, Scott wrote the book thinking, “If I can help one other person.” We talk about the stresses of being a physician and surgeon in modern American healthcare and strategies to deal with that stress. Finding purpose, developing (what Scott calls) a suit of armor through mindfulness and gratitude, and seeking your own personal mountaintop – where you find peace, joy, virtue, and contentment – allow us to limit our exposure to the inevitable and deep valleys of burnout. Lastly, Scott encourages us to care for ourselves and care for our communities as we serve those around us. Enjoy this conversation!
Fist Pumps (Amazon): https://www.amazon.com/Fist-Pumps-Scott-MacDiarmid/dp/1088078184
Paul Maroni, MD is a urologic oncologist at the University of Colorado in Denver. He is a repeat guest on OWZ (#41. Joy in the Service of Others… https://www.buzzsprout.com/1811662/10549621) and a good friend. We share an interest in the physical health of our patients and ourselves as physicians and surgeons. This conversation focuses on practical strategies (and the science behind them) to optimize physical health and well-being through movement, exercise, and nutrition. There is no perfect work-out routine or diet. But being mindful and intentional about how you care for your body and what you want out of your physical being are the first steps to a healthy and sustainable career and beyond! We discuss lots of external resources and links are provided in the notes. Enjoy!
Slow Carb Diet, Tim Ferriss: https://tim.blog/2012/07/12/how-to-lose-100-pounds/
Nature Wants Us To Be Fat, by Richard Johnson (Amazon): https://a.co/d/fvubmJp
Knees Over Toes Guy (YouTube): https://www.youtube.com/c/thekneesovertoesguy
By Peter Attia:
Outlive (Amazon): https://a.co/d/0FIdViJ
On Huberman Lab Podcast:
(web) https://www.hubermanlab.com/episode/dr-peter-attia-improve-vitality-emotional-and-physical-health-and-lifespan
(YouTube) https://www.youtube.com/watch?v=ufsIA5NARIo
Caprice Greenberg, MD, MPH is the Chair of the Department of Surgery at the University of North Carolina at Chapel Hill and a Surgical Oncologist. She is the President and Co-founder of the Academy for Surgical Coaching (https://surgicalcoaching.org/) and is responsible for most of the academic literature regarding surgical coaching and outcomes directly or inspirationally. We talk through the basics of surgical coaching from the operating room to the clinic, executive coaching through professional development for junior surgeons. We talk about the practicalities of coaching: who should be coaching, who should be coaching, and what are the good qualities for both. And we discuss all the ways coaching can be delivered – through personal coaches, intraoperative video assessments, and organizations like the Academy for Surgical Coaching. Enjoy!
The Academy for Surgical Coaching: https://surgicalcoaching.org/
Dr. Greenberg’s Publications on Coaching (Pubmed Search): https://pubmed.ncbi.nlm.nih.gov/?term=Greenberg+CC+AND+coaching
Ms. Nadine Coull, MBBS, MS, FRCS (Urol) is the Deputy Medical Director of the National Health Services (NHS) and President of the Urology Section of the Royal Society of Medicine. In addition, she is the Deputy Medical Director of Kingston Hospital. Nadine never envisioned herself as a leader of a hospital, hospital system, or the NHS – but through deep beliefs in compassion and kindness found herself rising through the leadership ranks first locally then nationally. She is a strong believer in boundaries – professionally and personally – to promote health and wellness. We touch on her presidential address, The One with the Pink Bag, offering perspectives of being a strong woman in medical leadership. And she gives us unique perspective on leadership with an international angle – allowing us to compare and contrast promotions and leadership in the US and the UK. We arrive on an important similarity – “Don’t underestimate the power of kindness.” I hope you enjoy, I certainly did.
“All healthcare is delivered through relationships.” This is the key statement from this episode of OWZ and highlights that effective communication is a key component of delivering excellent patient care. Marissa Theofanides, MD is a urologist at Montefiore in the Bronx and expert in communication skills. She is certified by the Academy of Communication in Healthcare (https://achonline.org/) whose motto is “Better Communication. Better Relationships. Better Care.” In this podcast, we help you understand that communication is a skill – a skill that can be taught, practiced, and improved upon just like throwing a suture or writing a clinic note. Dr. Theofanides lays out a framework to improve your clinic communications that is rooted in mindfulness! Setting an agenda, creating space for effective communication, and assessing understanding highlight the mindful principles of intention, presence, and non-judgement. There’s lots of practical knowledge in this discussion and it promises to make your clinical interactions and your life better! Enjoy!!!
Academy of Communication in Healthcare (ACH): https://achonline.org/
Dr. Mick Malotte, MD is a retired ENT surgeon from California who has been practicing mindfulness as a surgeon for over 30 years. Not only does Mick practice mindfulness through a daily practice and retreats, but he teaches mindfulness to physicians and surgeons around the country! Mick gives us a brief history of mindfulness in medicine and helps us understand how mindfulness practices are adopted to medicine and surgery. We talk about burnout, data and physiology, and the religious and social implications of widespread mindfulness practices! Importantly, Mick gives us easy-to-perform micro practices that can be performed within our daily practices to be better surgeons, physicians, and human beings. If you are interested in talking with Mick or exploring mindfulness training at your institution, reach out to Mick through his website. Enjoy!
https://www.mickmalotte.com/
Dr. Angela Smith is a frequent flyer on the Operate with Zen podcast. She is guru to me and many others for life hacks and practical, personal improvements to be more efficient and to have more ease and enjoyment in our daily routine. In this podcast, we discuss “A Day of Reflection” – what exactly that means, how to set one up, and how to make it successful. A day of reflection creates the opportunity to be present for oneself, to assess prior performance (in a non-judgmental way), and to set intentions (or goals) for an upcoming period of time. Periodic days of reflection will prevent you from aimlessly getting caught up in life. They will empower you to feel productive and fulfilled no matter if in your personal or professional life. This podcast is full of practical tips to help you achieve that Day of Reflection and the benefits moving forward. Enjoy!
Dr. Kelly Casperson, MD is a surgical rockstar!!! … a urologist and sexual medicine expert, a extremely successful podcaster, author and now Ted-Talker! Kelly hosts the “You Are Not Broken” podcast (https://www.kellycaspersonmd.com/podcast) which empowers women (“and the partners who love them”) with science and conversations to break down sexuality improve the intimate lives of the tens of thousands who listen each month! But we are not talking about sexuality in today’s podcast… not really. Dr. Casperson and I discuss her journey to find purpose and how her true self re-emerged after years of surgical training and practice. We discuss mindfulness and personality traits, and how a better understanding of yourself and those that surround you enhance our ability to be phenomenal surgeons and doctors. And yes, human sexuality serves as the backdrop for the entire conversation. Woven in and out of the context of our lives, understanding sexuality by understanding self, communication, and personal interactions leads us to a more mindful existence and relationships with our intimate partners and others. Enjoy!
"You Are Not Broken" Podcast: https://www.kellycaspersonmd.com/podcast
"You Are Not Broken" Book (Amazon): https://a.co/d/hdI7JPT
Ted Talk (pending)
Being a cancer surgeon can be tough. Being a cancer patient even tougher. Brian Lane, MD is facing both daily. He is an accomplished surgeon and academic urologic oncologist. In this thoughtful and honest discussion, we cover facing tough diagnoses as a patient and a surgeon; developing perspective as a patient to help our patients; finding purpose and meaning despite tough circumstances; and ultimately finding peace in faith and community. This conversation is inspirational and grounding. I hope you enjoy.
Kevin Turner, MA, DM, FRCS (Urology) is a Consultant Urological Surgeon at Royal Bournemouth Hospital. In 2015, he helped to start the Surgeon Wellbeing Research Team with colleagues from the Department of Psychology at Bournemouth University. Kevin and team ran a UK national survey from 2016-2019 – data from which has helped us understand how complications affect surgeons, the pervasiveness of this issue, and helped to create important objective measures and definitions in the field – like the difference between complications and errors. They also ran a randomized trial of resilience training in surgical trainees based on ACT (Acceptance and Commitment Therapy). Since then, Kevin has become a leader and mainstay at academic meetings bringing our understanding of the impact of adverse events and complications into a major spotlight. Backed by data, but full of tremendous personal insight, this conversation is a must listen for surgeons who are interested in understanding why complications hurt us and how we can alleviate that impact to better care for our patients and ourselves.
More from Dr. Turner:
Surgery Harms Surgeons. What Can We Do? Journal of Urology. https://www.auajournals.org/doi/10.1097/JU.0000000000002861
Turner, K., Bolderston, H., Thomas, K., Greville-Harris, M., Withers, C. & McDougall, S (2022). Impact of adverse events on surgeons, British Journal of Surgery, 2022.https://doi.org/10.1093/bjs/znab447
Bolderston, H., Greville-Harris, M., Thomas, K., Kane, A., & Turner, K. (2020). Resilience and surgeons: train the individual or change the system? The Bulletin of the Royal College of Surgeons of England, 102:6, 244-247.https://doi.org/10.1308/rcsbull.2020.170
https://podcasts.ox.ac.uk/impact-complications-and-errors-surgeons
Andrew Gabrielson, MD (@urogabe) is currently a resident at the Brady Urological Institute and Department of Urology at Johns Hopkins. He is a budding pediatric urologist and developed an interest in surgical ergonomics and physical well-being before he started residency. He is an integral member of the Society of Surgical Ergonomics and well-published in the field despite his young age! He gives us lots of practical knowledge for the operating room (how to stand, how to set up your room, gel pads and shoes!) and a framework for incorporating ergonomics as a thought process to enhance our physical well-being as surgeons. In addition, he talks about his experience and how following an interest piqued during undergraduate and medical school turned into a passion for the remainder of his professional life! Enjoy! Lots of links below including data supporting a lot of the discussion.
Society of Surgical Ergonomics
https://www.societyofsurgicalergonomics.org/
Twitter: @SocSurgErgo
Epidemiology of work-related pain among surgeons
Epstein, S. et al. Prevalence of work- related musculoskeletal disorders among surgeons and interventionalists: a systematic review and meta-analysis. JAMA Surg. 153, e174947–e174947 (2018).
Stucky, C. H. et al. Surgeon symptoms, strain, and selections: systematic review and meta- analysis of surgical ergonomics. Ann. Med. Surg. 27, 1–8 (2018)
Intraoperative and perioperative stretching
Park, A. E. et al. Intraoperative “Micro Breaks” with targeted stretching enhance surgeon physical function and mental focus: a multicenter cohort study. Ann. Surg. 265, 340–346 (2017).
Hallbeck, M. S. et al. The impact of intraoperative microbreaks with exercises on surgeons: a multicenter cohort study. Appl. Ergon. 60, 334–341 (2017).
Dorion, D. & Darveau, S. Do micropauses prevent surgeon’s fatigue and loss of accuracy associated with prolonged surgery? An experimental prospective study. Ann. Surg. 257, 256–259 (2013).
Monitor Placement
van Det, M. J., Meijerink, W. J., Hoff, C., Totte, E. R. & Pierie, J. P. Optimal ergonomics for laparoscopic surgery in minimally invasive surgery suites: a review and guidelines. Surg. Endosc. 23, 1279–1285 (2009).
Omar, A. M., Wade, N. J., Brown, S. I. & Cuschieri, A. Assessing the benefits of “gaze- down” display location in complex tasks. Surg. Endosc. 19, 105–108 (2005).
Erfanian, K., Luks, F. I., Kurkchubasche, A. G., Wesselhoeft, C. W. Jr. & Tracy, T. F. Jr. In- line image projection accelerates task performance in laparoscopic appendectomy. J. Pediatr. Surg. 38, 1059–1062 (2003).
Hanna, G. B., Shimi, S. M. & Cuschieri, A. Task performance in endoscopic surgery is influenced by location of the image display. Ann. Surg. 227, 481–484 (1998).
Table Height
Berguer, R., Smith, W. D. & Davis, S. An ergonomic study of the optimum operating table height for laparoscopic surgery. Surg. Endosc. 16, 416–421 (2002).
van Veelen, M. A., Kazemier, G., Koopman, J., Goossens, R. H. & Meijer, D. W. Assessment of the ergonomically optimal operating surface height for laparoscopic surgery. J. Laparoendosc. Adv. Surg. Tech. A. 12, 47–52 (2002).
Manasnayakorn, S., Cuschieri, A. & Hanna, G. B. Ergonomic assessment of optimum operating table height for hand- assisted laparoscopic surgery. Surg. Endosc. 23, 783–789 (2009).
Gel mats
Haramis, G. et al. Prospective randomized evaluation of FOOT gel pads for operating room staff COMFORT during laparoscopic renal surgery. Urology 76, 1405–1408 (2010).
Graversen, J. A. et al. Prospective randomized evaluation of gel mat foot pads in the endoscopic suite. J. Endourol. 25, 1793–1796 (2011).
Cognitive Ergonomics
Chrouser KL
Jeff Bloovman, BSN, RN, is an operating room nurse with really unique interests and perspectives on life. He has been an actor and director, is currently a firearms and combat instructor as well as an avid practitioner and instructor of Brazilian jiu-jitsu. Like many of us, Jeff is also challenged by an extremely active mind. What do all of these experiences have in common? They are all enhanced through mindfulness practices. Whether focusing on a gun, your combatant, a theatre scene, or a busy operating room – being in the moment, both enjoying the moment and focusing in the present, can enhance the experience and the outcome. I hope you enjoy this really fun conversation, I did!
Below are some of the links referenced throughout Jeff’s conversation:
Practically Tactical Podcast: https://www.practicallytactical.com/episodes
Rolling Stone:
Pink Pistols: LGBT Gun Owners Unite in Arming Gay Community https://www.rollingstone.com/culture/culture-news/pink-pistols-lgbt-gun-owners-unite-in-arming-gay-community-177899/
Washington Post:
For years, he tried to get other gay people to the gun range. Would they come now? https://www.washingtonpost.com/lifestyle/style/for-years-he-tried-to-get-other-gay-people-to-the-gun-range-would-they-come-now/2016/06/21/0f672b02-3724-11e6-9ccd-d6005beac8b3_story.html
Huffington Post Video:
At The Shooting Range With The Pink Pistols, A Gay Gun Group https://www.huffpost.com/entry/at-the-shooting-range-with-the-pink-pistols-a-gay-gun-group_n_5b4f4938e4b004fe162f865e
The Feed YouTube: Gays & Guns: Fighting homophobia with bullets - YouTube
One Man Army (Discovery Channel): Season 1, Episode 1
https://www.discovery.com/shows/one-man-army/episodes/brothers-in-arms
Physical ailments are a part of life, and all surgeons will encounter physical pain or injury in their career. Good friends and fellow surgeons, Angela Smith, MD, and Jay Shah, MD, (and repeat guests on the show) are no strangers to injuries. In this podcast we discuss chronic and acute physical injuries from diagnosis through long-term changes to our surgical and work-out routines. Coping mechanisms, management of pain in the operating room, adjustments to workouts, and evolution of personal identity are all discussed in this fun and inspirational hour. If you have struggled or are struggling with a physical injury, this podcast is for you. Enjoy!
Dr. Joan Naidorf, DO (https://www.drjoannaidorf.com/) is an Emergency Room physician who, through clinical experience, developed expertise in managing the difficult patient. She is the author of “Changing How We Think About Difficult Patients: A Guide for Physicians And Healthcare Professionals” (https://a.co/d/fWLWY5W) and was featured in a Washington Post article on the topic (Some doctors don’t like some patients - The Washington Post). While not being explicitly “mindful,” her approach to understanding and managing “difficult” situations employs concepts of intention, presence, and a non-judgmental approach to situations we all experience in healthcare. Throughout this podcast, she will help you understand why patients may behave poorly and how our reactions and interactions may improve the experience. I hope you enjoy!
Website: https://www.drjoannaidorf.com/
Book: https://a.co/d/fWLWY5W
Washington Post: Some doctors don’t like some patients - The Washington Post
Jeremy Grummet, MBBS, Master of Surgery, FRACS is a urologist in Melbourne, Australia and a world leader in prostate cancer imaging and diagnostics. He is also a deep thinker and deeply interested in the wellbeing of surgeons and his colleagues. Our conversation meanders through personal struggle, burnout or "spin" as Dr. Grummet calls it, mental illness, and emotional challenges associated with life and surgery. Core concepts of modeling vulnerability, the dichotomy between being a caregiver and a recipient of care, as well as self care are woven throughout the conversation. Jeremy is a master of thought and process, you will love this conversation.
Some of the books and references discussed:
School of Life, by Alain de Botton
Waking Up, by Sam Harris
Thriving Doctor, by Sharee Johnson
Know Thyself, by Craig Hassed
Dr. Carter Lebares, MD is a Gastrointestinal Surgeon at the University of California San Francisco and the Director of the UCSF Center for Mindfulness in Surgery. In addition to being a thoughtful and skilled surgeon, she ran two randomized trials incorporating mindfulness based practices into surgery. She developed ESRT or Enhanced Stress Resilience Training from principles of John Kabat-Zinn’s Mindfulness Based Stress Reduction (MBSR) to specifically apply to surgeons and surgical training. With focused lessons and practical exposure Dr. Lebares has shown objectively that improvements in attentional focus, emotional recognition, and cognitive reappraisal learned through mindfulness translate into better surgical performance and training in and out of the operating room. She tells us her story, how mindfulness impacted her career and continues to impact her development as a surgeon and human. Dr. Lebares is one of my inspirations as we try to spread the benefits of a mindful approach to surgery and I enjoy every moment I get to speak with her. I hope you enjoy as well!!
UCSF Center for Mindfulness in Surgery: https://mindfulsurgeon.ucsf.edu/
Randomized Trial in JAMA Network Open: https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2734060
Bradley Block, MD is an otolaryngologist in New York and founder of the “Physician’s Guide to Doctoring” podcast. The founding principle of the Physician’s Guide is “all the stuff we should have learned in medical school but didn’t.” While we only have an hour, we cover a lot of it! We talk personal and professional development, social engineering and how it impacts patient and personal interactions, and vulnerabilities as a busy surgeon in a busy practice. We settle on intention and exploring the WHY of so many things we do in medicine hoping the break the cycle of inefficiencies, improve our daily lives, and make the field better. I really enjoy talking to Brad and I hope you do too! Check out his podcast, the variety of topics are sure to grab your attention, and listen to some of the great guests he has interviewed!!!
Physician’s Guide to Doctoring Website: https://physiciansguidetodoctoring.com/
Apple Podcast: https://podcasts.apple.com/us/podcast/physicians-guide-to-doctoring-with-bradley-b-block-md/id1429047634
Dharam Kaushik, MD is a urologic oncologist who does big time cancer surgeries. He is also a researcher and educator at the University of Texas San Antonio where he runs the urologic oncology fellowship program and leads the kidney cancer research program. Despite an upbringing in India and early exposure, he only recently picked up yoga as an outlet for wellness in his life. We explore yoga and mindfulness as strategies to combat burnout and stress at work, but expand the discussion to other forms of physical activity that can improve our surgical well-being. During the COVID pandemic, Dharam was certified as a yoga instructor and now expands his practice to healthcare workers at UT San Antonio – offering free classes to any employee or student who is interested. And he doesn’t take it easy on them! He talks and teaches about suffering and struggle in a yoga class as a great metaphor for surgery and life. I love talking with Dharam and I hope you do too. If interested in a yoga class or experience at a urology meeting, please find Dharam or I and join us or we can help to set it up.
And stay tuned for some bonus content! Dharam will take us through a breathwork exercise that you can use anytime to prepare for surgery, destress, or as part of your mindfulness routine.
Michelle Quirk, MD is a pediatrician and pediatric hospitalist in the Philadelphia area. She is also a certified run coach and started Mindful Marathon (mindful-marathon.com) to help busy professionals develop well-being through running and fitness. Importantly, Michelle was not always a runner, but over the years learned how to engage with her own personal wellness through running and fitness. That engagement led to the Mindful Marathon passion project – by which trains doctors and other busy professionals how to run and coaches them through short- and long-distance challenges. We talk about Michelle’s journey into running, how a pledge to patients to get healthier inspired her to be healthier and how running became a great stress outlet for her. WE take many analogies from the running world and bring them into medicine and surgery including training, nutrition, and recovery. I love talking to Michelle, I hope you enjoy too!
If interested in learning more about Michelle or having her be your run coach, you can find her at:
Mindful-Marathon.com
YouTube: @MindfulMarathon
Dr. Elizabeth "Betsy" Koehne, MD is at the wonderful transition between training and complete surgical independence. She is a urologist and Acting Instructor and Society of Urologic Oncology fellow at the UW School of Medicine in Seattle. While she is may be junior is her surgical experience, she is seasoned in transcendental meditation, yoga, and incorporating mindfulness into her daily and surgical existence. I learn a ton from Betsy every time we speak and I hope you enjoy this conversation.
Dr. Bradley Erickson is a Professor of Urology, a reconstructive urologist, and Director of Functional Urology at the University of Iowa. We are great friends and bonded over similar loves of baseball and skiing – sharing quite a few lift rides and challenging mountain runs in Colorado. Brad is also an extremely accomplished academic surgeon from very early on in his career – in fact, that’s what brought us together. I say this all because i had no idea, about 2-3 years into his practice, he had a major breakdown and called into question all of his motivations and purpose in surgery. This podcast covers that breakdown and his pathway back to purpose through the darkness of anxiety and insomnia. We talk about mindfulness meditation, dharma and the three H’s of hands, head, and heart, and achieving self-awareness and presence. Throughout the podcast we talk about the insane privilege of being a surgeon and how that impacts us all as human beings. I hope you enjoy.
Diana Londoño, MD is a urologist in Los Angeles with a specific interest in coaching surgeons through tough times. She is the founder of Physician Coach Support (https://physiciancoachsupport.com/), a free peer-to-peer service for surgeon personal development. She is a mom, a yogi, and so much more! We discuss how Buddhist principles guide coaching, how being both a healer and a teacher are important to our roles as surgeons, and gives practical tips on how to organize a surgical life for well-being. Enjoy!
https://dianalondonomd.com/
https://physiciancoachsupport.com/
Kristen Chrouser, MD, MPH is an Associate Professor of Urology at the University of Michigan and Section Chief of Urology at the VA in Ann Arbor Michigan. She is an expert in intraoperative stress - something all surgeons are familiar with - and tackles it through a variety of academic avenues. We discuss physical stress through ergonomics and pain both in and out of the OR. We talk about the OR environment and mindsets that are conducive to a healthy and long surgical career. And we talk about how pain is the manifestation of so many stressful events in our life - whether they be physical, emotional, or psychological. This conversation is fun and full of practical pearls on how to keep yourself pain free and healthy.
Jason Han, MD is a cardiac surgery resident at the University of Pennsylvania, a columnist for the Philadelphia Inquirer, and the founder of The Modern Surgeon. Jason provides unique perspective from a trainee with his eyes uniquely on the future - he graduates from residency this year! We talk about the changing perspective from student, to trainee, to surgeon and how being present and simplifying one's own principles can keep you grounded. We stumble across this podcast's title, "The Space Between Technique" when we discuss all the things missing from surgical education - how to think and behave, not just operate. It's a great conversation and I hope you enjoy!
Philadelphia Inquirer:
https://www.inquirer.com/author/han_jason/
The Modern Surgeon:
https://www.themodernsurgeon.org/
https://twitter.com/modern_surgeon
https://www.instagram.com/themodernsurgeon/?hl=en
Louise Phipps Senft is the founder and CEO of Baltimore Mediation. She is a well-respected attorney and mediator. Louise practices "Transformative Mediation" in a number of complex settings -uniquely in healthcare - where techniques of mindfulness (like presence and non-judgement) are implemented routinely. She is an expert in personality assessment, personal and relational interactions. In addition, Louise is the host of "Blink of an Eye" Podcast (https://blinkofaneyepodcast.com/) which chronicles her families experience with trauma, the medical field, and awakening. I love talking with Louise and I hope you enjoy the conversation.
References:
https://www.baltimoremediation.com/louise-phipps-senft-bio/
https://blinkofaneyepodcast.com/
Books
The Essential Enneagram
The Body Knows the Score
Humans are creatures of habit who crave control in sometimes uncontrollable circumstances. In this episode, OWZ regular Angie Smith, MD and Professor of Urology at UNC Chapel Hill and I discuss "control" in a variety of surgical settings. Control in the operating room, control in patient encounters outside of the OR, control over how we structure our lives, and how we achieve balance. Parallels are drawn to illness uncertainty for patients and the conversation weaves through vacations, Nietzsche, mirror neurons, and fear. I hope you enjoy.
David Canes, MD is a urologist at the Lahey Clinic in Boston. He is incredibly thoughtful in his approach to medicine and his approach to life outside of medicine. Early on in this podcast, we discuss not letting urology [or surgery] to be the only thing of which you are proud. We talk passion projects and David's newest adventure (wellprept.com). And we talk about ways to avoid "pressing play" - David's analogy for just going through the motions with a patient, but creating the environment in which you can be truly present with a patient, with a surgery, with your family, or your next adventure. Enjoy!!
Check out WellPrept at: https://wellprept.com/
Amanda North, MD is an accomplished Pediatric Urologist at Montefiore in the Bronx. She is also an outstanding advocate for surgeons - leading the movement to understand burnout in our specialty (urology) and women in surgery. Our conversation meanders through fascinating topics with a focus on the key components of a sustainable career. We even touch on Ted Lasso (see picture behind her).
Chris Jaeger, MD is currently a pediatric urology fellow at Boston Children's Hospital. He is a recent graduate from the Ohio State urology residency where he co-created and implemented a 12-week wellness program for the residents. Chris shares his experience with the research protocol, thoughts on institutional wellness, and identifies "priority domains" highlighted by his work and reflected in his daily wellness practice. An excellent episode especially for trainees as they transition from residency to fellowship (or beyond). And great for anyone involved or interested in a surgical trainee's experience.
Kyle Richards, MD, FACS is an Associate Professor and Urologic Oncologist at the University of Wisconsin. This is his second OWZ podcast. In this episode we talk about managing complications in a mindful way. Starting with the emotions that arise when something bad happens to one of our patients, we discuss how to engage members of the team, the patient, and the patient's family to improve everyone's outlook and outcome.
To accompany the podcast, a great 10 minute practice great for all experience levels of meditation.
Neda Gould, PhD is a clinical psychologist in the Department of Psychiatry and Behavioral Sciences at Johns Hopkins. She is also the Director of the Mindfulness Program at Johns Hopkins for faculty and staff. In this episode, we talk through the scientific foundations of meditation practice and how to incorporate them, practically, into your life as a busy surgeon or physician. We talk through our own meditation practices and hope you feel more grounded and empowered to start your own practice after this episode.
Resources:
Books: Mindfulness for Beginners by John Kabat-Zinn; Altered Traits by Daniel Goleman and Richard J. Davidson.
Podcast: How to Train Your Mind by Chris Bailey, available on audible: https://www.audible.com/pd/How-to-Train-Your-Mind-Audiobook/B08N5C3QLB
Tait Shanafelt, MD is an outstanding human being and doctor. In addition to being a well-respected and renowned medical oncologist, he is the Chief Wellness Officer at Stanford Medicine and one of the most prolific writers of medical literature regarding wellness and burnout in medicine. In this episode of OWZ, we discuss both individual and institutional approaches to wellness highlighting both the responsibility of each of us, as surgeons, to our patients and institution, as well as the responsibility of the field of medicine, our institutions, and hospitals to us to promote a culture of wellness and well-being. As we better understand well-being and all of its implications on patient care, satisfaction, job turnover, etc., we recognize the only recipe for success involves physicians, surgeons, administrators, and hospital working together. We briefly touch on his concept of “Physician Well-Being 2.0” and the article link can be found here: https://pubmed.ncbi.nlm.nih.gov/34607637/. I really enjoyed speaking with Dr. Shanafelt, I hope you enjoy listening. (Music Credit: Sunshine, Simon Jomphe Lepine.)
Taylor Riall, MD, PhD, FACS is the real deal! Accomplished academic hepatobiliary surgeon, executive coach, competitive athlete, and a genuine inspiration to all who encounter her. Dr. Riall was a major inspiration in my (ongoing) path to wellness and the creation of this podcast. We tackle a lot in this discussion but start with changing surgical culture one surgeon, one inspiration at a time, move to mindfulness and resilience. "Sitting with the Pieces" refers to the Japanese art of Kintsugi where pottery is intentionally broken and put back together with gold. The metaphor is incredibly strong - what once was broken can be beautiful and have form. We are all made of pieces that, when assembled, define who we are. (Music Credit: Sunshine, Simon Jomphe Lepine.)
Tracy M. Downs, MD, FACS is a Professor of Urology and Chief Diversity & Community Engagement Officer at the University of Virginia. Tracy is a deeply thoughtful and compassionate surgeon and person. His approach to life parallels his approach to patient care which parallels his approach to diversity, equity, and inclusion. We explore the metaphor of endurance built during distance running to the endurance needed to overcome the struggles of a surgical career and, similarly, the long-term work toward a more inclusive medical community and world. In addition, the relationships he models with his family parallels the care and compassion with which he approaches his patients, colleagues, and his profession. Lots to learn from Dr. Downs, enjoy. (Music Credit: Sunshine, Simon Jomphe Lepine.)
Abraham Maslow was an American Psychologist who created a "Hierarchy of Needs" to describe an individual's ability to achieve their full potential - what he called self-actualization. Achieving "wellness" in one's life is a challenge. Understanding the framework of Maslow's Hierarchy and how it applies to medicine and surgery may help you climb the pyramid toward self-actualization and your highest potential. (Music Credit: Sunshine, Simon Jomphe Lepine.)
Negative Feedback can arrive in a variety of forms in surgery including direct feedback from peers or bosses, patient complaints, or complications. This solo podcast discusses a 4-step process to deal with negativity in our lives. (Music Credit: Sunshine, Simon Jomphe Lepine.)
Paul Maroni is a urologic oncologist at University of Colorado in Denver. He also runs the American Urological Association course on “Winning the Battle Against Burnout.” Paul is also an extremely thoughtful and mindful surgeon, physician, and educator. In this episode of OWZ, we tackle a lot more than burnout. We discuss extreme ownership of the good and bad that occurs in our surgical practices, we talk about putting successes and failures into perspective, and, in Paul’s own words, we seek to find “joy serving others.” We would be lying if we said everyday as a surgeon is amazingly positive. But everyday can be amazing with the right perspective and approach. (Music Credit: Sunshine, Simon Jomphe Lepine.)
Anne M. Suskind, MD, FACS, MS is an Associate Professor of Urology; Obstetrics, Gynecology, and Reproductive Sciences; the Associate Chair of Faculty Affairs and Diversity, Equity and Inclusion; and the Chief of Neurourology, Female Pelvic Medicine & Reconstructive Surgery at the University of California San Francisco. She is an accomplished surgeon scientist and a wonderful human being. She is strongly interested in faculty and personal development and, in this podcast, discusses the rationale and process of her recent online course "Unlock Your Power." We discuss her personal background and interests in mindfulness, anthropology, and psychology. We discuss how discipline and insight are needed to make positive changes in who we are and align our purpose with our passion. Her course can be found at https://suskina.wixsite.com/unlockyourpower or you can email her at suskina@gmail.com if you are interested in learning more. (Music Credit: Sunshine, Simon Jomphe Lepine.)
Dr. Casey Seideman is a pediatric urologist at Oregon Health and Sciences University. A few years ago, Casey never ran a complete mile. Now she is an outspoken advocate for wellness in the operating room and beyond. In this podcast we tackle small changes and their ability make big impact, how mental preparation promotes a health surgical community, and how, as a surgeon, you can achieve great things you never thought you could do. (Music Credit: Sunshine, Simon Jomphe Lepine.)
The United States military is among the elite fighting forces in human history. Fostering a great military starts with fostering great soldiers. Tanya Ivey-Bloom is a nurse practitioner at the Johns Hopkins Hospital but also the current Commander of the 336th Medical Detachment of the US Army Reserves in Fort Meade Maryland. We compare and contrast military and civilian medicine, leadership styles, and how the military embraces a mindful approach to training soldiers (and physicians). (Music Credit: Sunshine, Simon Jomphe Lepine.)
No one is born with a mindfulness practice. It takes time to discover your needs, to personalize your practice, and to cultivate that practice as you evolve as a mindful person. Dr. Sima Porten is a skilled urologic cancer surgeon and incorporates mindfulness into her everyday routine. Both her surgical skills and her mindfulness practice developed over an extended period of time and minor adjustments are continually required to reach the expert levels at which she performs. In this episode we talk about developing and refining a mindfulness practice as a surgeon – how to incorporate those skills into the operating room, clinical care, and our home lives. Dr. Porten also recently completed a clinical trial investigating the impact of mindfulness on perioperative outcomes for patients undergoing a major cancer operation. Her balance and positive attitude are an inspiration to all who know her, and hopefully to all who listen to this episode. (Music Credit: Sunshine, Simon Jomphe Lepine.)
"Life isn’t about waiting for the storm to pass. It’s about learning how to dance in the rain."
– Vivian Greene
Dr. James Harris is a general surgeon and Chair of Surgery at Howard County General Hospital of Johns Hopkins Medicine. James is an incredible surgeon and role model whose personal story has taken tremendous twists and turns. Despite the ups and downs, James always finds a way to "dance" and dance well. He newest endeavor, Doc Health & Fitness (dochealthfitness.com; IG: dochealthandfitness; YouTube: DocHealth & Fitness) combines passions for health, fitness, and well-being with his love for surgery and caring for patients. (Music Credit: Sunshine, Simon Jomphe Lepine.)
In Season 1, Episode 11 we spoke about Understanding Bad Behaviors. In this podcast, we literally talk to the person who wrote the book. Dr. Jody Foster is a psychiatrist and Assistant Dean for Professionalism at the University of Pennsylvania. Among other roles, she is also the team psychiatrist for the Philadelphia Eagles. She encounters “bad behaviors” for a living and, in this episode, discusses the common bad actors we may see in surgery and medicine and, in my opinion, most importantly, how to empathize and understand them to promote a positive workplace and a strong team. If you want to read more, check out Dr. Foster's book, The Schmuck in My Office (How to Deal Effectively with Difficult People at Work), co-written with Michelle Joy. (Music Credit: Sunshine, Simon Jomphe Lepine.)
Many of our guests on Operate with Zen are established in their careers and working to figure out a more mindful, healthy approach to medicine and surgery. Jake Taylor, MD (Twitter: @doctorjakeuro) is a Chief Resident at NYU and while still developing in his surgical career, has well established routines and principles of mindfulness. A great podcast for listeners at all levels of surgical and mindfulness expertise, but especially poignant for those in training. (Music Credit: Sunshine, Simon Jomphe Lepine.)
Many of us can remember mentors who shaped our careers and are responsible for the situations in which we currently work or reside. Kirsten Greene, MD (Twitter: KGUROmd) discusses many of the wonderful mentors she experienced through her evolution from a general surgery intern at UCSF to the Chair of Urology at the University of Virginia. Strong examples of female and male mentors are offered, concepts of mentoring up as well as down are discussed, and creating a community of surgeons interested in each other and our collective well-being is brought forth. (Music Credit: Sunshine, Simon Jomphe Lepine.)
Very few physicians finish their career in the location or role in which they started. Aditya Bagrodia, MD (Twitter: @AdityaBagrodia) is a urologic oncologist who recently transitioned from UT Southwestern to UC San Diego at about the same time I transitioned from Johns Hopkins to the University of Pennsylvania. Reasons and rationale for transition are discussed as well as practical considerations for when you are considering moving from one job to another. (Music Credit: Sunshine, Simon Jomphe Lepine.)
Time and space together can help us create routine. Proactively designing spaces to maximize function is just one way to enhance efficiency and performance - this is what Ashley Cantley (Twitter: @AshCantley) is an expert in. Trained in human design and Feng Shui, Ashley talks us through concepts of personal space design providing valuable insights in organization and structure of our work and hospital spaces to maximize our efficiency and make work more pleasant. Read more at: High-Vibe Feng Shui found on Amazon (https://www.amazon.com/High-Vibe-Feng-Shui-Steps-Achieving/dp/1635862388). (Music Credit: Sunshine, Simon Jomphe Lepine.)
Many Eastern and Western Philosophies are rooted in a desire to understand who we are and what is our purpose. Kyle Richards, MD (Twitter: @Uro_Rich) is a urologic oncologist who found his medical purpose in caring for patients with cancer. Dr. Richards also talks about how to "repurpose" some of our challenging activities as doctors to make them more meaningful and discusses life outside of the hospital helping us to understand how our sense of self is tied to who we are as surgeons and as people. (Music Credit: Sunshine, Simon Jomphe Lepine.)
Jay Shah, MD (Twitter: @BladderCancerMD) is a urologic oncologist and Vice-Chief of Staff at Stanford Health Care. His journey brought him through several outstanding medical institutions in this country and he discusses his evolution from trainee to academic and research all-star, and his now burgeoning leadership career. Philosophies on leadership are discussed in addition to practical advice for those interested in future leadership positions or currently working in leadership roles. (Music Credit: Sunshine, Simon Jomphe Lepine.)
Michael Joyner, MD (Twitter: @DrMJoyner) is a physiologist and anesthesiologist at the Mayo Clinic with expertise in human performance - specifically human physical performance. We discuss analogies between sports and surgery, and how to function with maximum output, and peak efficiency in our surgical existence. (Music Credit: Sunshine, Simon Jomphe Lepine.)
Repeat guest, Angela Smith, MD (Twitter: @angiesmith_uro) is an incredibly efficient urologic oncologist, academician, and mom. Coordination and time management are keys to not only surviving, but thriving in each situation. In this podcast, Dr. Smith breaks down the concepts of effective time management as well as providing practical advice to structure your week for maximal efficiency and happiness. (Music Credit: Sunshine, Simon Jomphe Lepine.)
Surgery is a physically and mentally challenging profession. While many of us address physical health outside of operating room through a variety of activities - few of us are mindful about how to approach our physical well-being in the operating room. Tim Anderson is an experienced personal trainer and creator of the Original Strength program designed to utilize simple concepts and movements to generate a healthy mind-body connection. He discusses concepts of physical well-being, mind-body connection, and how to integrate them into a healthy, strong, and long-lasting surgical career. (Music Credit: Sunshine, Simon Jomphe Lepine.)
You can find more information about Tim and Original Strength at:
https://originalstrength.net/
https://www.youtube.com/user/OriginalStrengthSys
[Amazon] https://www.amazon.com/Pressing-Reset-Original-Strength-Reloaded/dp/1624220290
Challenges and resilience are a part of life, and each of us struggles to achieve fulfillment and happiness through these struggles. Nishant Patel, MD (Twitter: @nishanturo) has his fair share of struggles including not matching (twice) into urology residency and medical issues with his family. But none of these experiences are as profound as his story with alcoholism and sobriety. Described as "an accomplished surgeon and an accomplished alcoholic" on the podcast, The Payoff with Pete (https://podcasts.apple.com/us/podcast/the-payoff-with-pete/id1550520979), Nishant's honest and insightful story provides lessons in humility, purpose, and overcoming challenges. If not already aware, it should open your eyes to the struggles of addiction and lower the stigma of interacting with people struggling through addiction or in recovery. If you are struggling with addiction, believe that someone is struggling, or know someone who is, please do not hesitate to reach out to Dr. Patel or this podcast for direction. (Music Credit: Sunshine, Simon Jomphe Lepine.)
Being grateful and expressing gratitude are important tools in the armamentarium of the mindful physician and surgeon. In this brief solo podcast, I will review how being grateful can positively impact our lives and surgical experience, how expressing and exploring gratitude can help us overcome negative situations in our lives, and, if your interested, how to incorporate gratitude practices into your every day routine. (Music Credit: Sunshine, Simon Jomphe Lepine.)
Complications and bad outcomes are a part of medicine despite our best efforts. Dealing with the complication, the patient and their loved ones can certainly be a challenge. Dealing with the personal fallout from a bad outcome is another challenge that is rarely discussed in medicine in surgery. In this solo podcast, we will discuss some of the stresses that can make bad outcomes, mistakes, or complications more likely, and how to handle the emotional and psychological stress caused by these bad outcomes. Second victim syndrome is introduced and future podcasts, with surgeons, will discuss the management of complications both medically but emotionally and psychologically. (Music Credit: Sunshine, Simon Jomphe Lepine.)
Medicine and surgery require complex problem solving and tough decisions are made every single day. A mindful or thoughtful approach to decision making is one framework by which we can simply our day and decision-making process. In Part 1 of this three part, solo, mini-series, concepts of decision fatigue, what makes a great surgeon, and kindness are discussed. References and reading: Peak Performance, Attending: Medicine, Mindfulness, and Humanity. Music Credit: Sunshine, Simon Jomphe Lepine.
Angela Smith, MD is an Associate Professor of Urology, Vice Chair of Academic Affairs and Director of Urologic Oncology at the University of North Carolina at Chapel Hill. In this episode we discuss taking time away from work, managing your calendar, your email and other communications while away. Tons of practical tidbits for providers of all levels are shared. (Music Credit: Sunshine, Simon Jomphe Lepine.)
Stephen Nakada, MD, FACS, FRCS (Glasg.) is the Chairman of the Department of Urology at the University of Wisconsin. Dr. Nakada is well-recognized as a leader in academic endourology but also lectures extensively on leadership and leadership cultivation. He is also the editor of Navigating Organized Urology, a text offering practical guidance to developing a successful career in urology (and surgery). (Music Credit: Sunshine, Simon Jomphe Lepine.)
Medicine and surgery require complex problem solving and tough decisions are made every single day. In Part 3 of this three-part, solo, mini-series, the frameworks of heuristics, biases , emotion, ethics, and other challenges to effective decision making are reviewed in hopes of avoiding poor decisions. (Music Credit: Sunshine, Simon Jomphe Lepine.)
Dr. Patrick C. Walsh is the Chairman Emeritus of the Brady Urological Institute and a Professor of Urology at the Johns Hopkins School of Medicine. He is recognized internationally as a pioneer in the diagnosis and treatment of prostate cancer. His life-story and career in surgery reflect presence, kindness, faith, and resolute commitment to purpose. (Music Credit: Sunshine, Simon Jomphe Lepine.)
Karen Swartz, MD is Director of Clinical and Educational Programs at the Johns Hopkins Mood Disorders Center. Depression, suicide and the specific relations to medicine and surgery are discussed in this sobering podcast. (Music Credit: Sunshine, Simon Jomphe Lepine.)
As part of the Mindful Decision Making series, Dr. Granville Lloyd and I review 7 Ways to Think Differently by Looby McNamara. This book is based on principles of permaculture where the creation of resilient, healthy, productive systems shape decision making. The parallels to medicine and surgery are clear and we hope you enjoy. (Music Credit: Sunshine, Simon Jomphe Lepine.)
Rob Kramer, PCC and Kara Penfield, PhD are founders of the Spiro Coaching Institute and the Academy for Academic Medical Center Coaching Program. Together they have a tremendous history and experience coaching executives and other professionals in healthcare. Coaching, interactions with colleagues, and professional development are discussed in a framework of mindfulness. Find out more about coaching, Spiro, or the AAMCC program at: https://www.spirocoaching.com/. (Music Credit: Sunshine, Simon Jomphe Lepine.)
Medicine and surgery require complex problem solving and tough decisions are made every single day. In Part 2 of this three-part, solo, mini series, we review pillars of self-management, choice architecture, and how to say, "No." References and reading: The First 90 Days, Nudge, Essentialism. Music Credit: Sunshine, Simon Jomphe Lepine.
Dr. Yotam Heineberg is a clinical supervisor for therapists in training and lecturer for Palo Alto University, as well as a collaborating scientist with the Applied Psychological Interventions Associate at CCARE, Stanford University. His focus on compassion-based therapy is applied to numerous clinical settings to help individuals and teams cope with systematic burnout. To learn more about Dr. Heineberg, visit: https://www.dryotamheineberg.com/. (Music Credit: Sunshine, Simon Jomphe Lepine.)
Granville Lloyd, MD is an Associate Professor of Urology at the University of Colorado in Denver. In addition to being a phenomenal physician, surgeon, and teacher, Dr. Lloyd is an avid outdoorsman and athlete. Dr. Lloyd discusses balancing work and life interests on this episode of OWZ.
Sleep science and sleep hygiene are discussed to optimize routine, brain and body recovery. Reading and References: Peak Performance, Essentialism, Think Like a Monk.
Why is a urologic surgeon talking about mindfulness? The background story of OWZ and rationale for recording this podcast. Disclaimer: This is not designed to be a "self-help" podcast, but to catalog concepts of mindfulness in surgery and refine a framework how incorporate well-being into surgery. Hopefully you find it interesting!
Understanding personality provides insight into how to best enhance your strengths and complement your weaknesses. While personality is more static, energy levels can fluctuate - negative energy can be catabolic and positive energy can help you and others grow. Reading and references: Predictably Irrational, Atomic Habits, Energy Leadership, Think Like a Monk.
The Self dimension can be thought of as physical and the mental/emotional self. Concepts covered include play and achieving mindfulness through physical activity and experiences. Yoga presented as an example of transcendence through physical activity. Reading and references: History of Yoga, Peak Performance, Essentialism, The Body Keeps the Score.
In the first episode, listeners are introduced to Buddhist concepts of the "enlightened" and how these translate into surgery in 2021. Frameworks for work-life balance are introduced and discussed. Understanding and intentionally managing our "dimensions" can improve efficiency and create time to maintain wellness. Tips and tricks about time management, and both conceptual frameworks and tips to maximize time efficiency are discussed. Reading and References: Think Like a Monk, Essentialism, Peak Performance.
Concepts of time management from the previous podcast coupled with concepts of creating efficient working spaces unleashes the strength of routine to shape an efficient and competent surgical practice. Routine allows us condition ourselves toward desired behaviors and consistency in routine allows us to be creative in unexpected ways. Reading and References: Think Like a Monk, Peak Performance, The Last Dance, On Writing: A Memoir of the Craft.
The principles of routine and efficiency are grounded in the science of brain power including decision fatigue, unconscious and subconscious modes of thought. Reading and References: Peak Performance, Essentialism, The Warrior's Meditation, Think Like a Monk.
The sense of self is one of the most powerful sources of human strength and angst. This episode provides a framework for cultivating one's sense of self and purpose. Concepts of dharma, as well as psychological and scientific constructs of self are discussed. References: Think Like A Monk, Altered Traits, Navigating Organized Urology, Peak Performance, Man's Search for Meaning.
Angela Smith, MD is an Associate Professor of Urology, Vice Chair of Academic Affairs and Director of Urologic Oncology at the University of North Carolina at Chapel Hill. In addition to being an extremely successful academic urologist, she is a mom and staunch advocate for faculty development and well-being. In this podcast, we discuss good and bad habits and how to integrate them into a surgical life.
This episode focuses on concepts of bad behaviors and attempts to understand why our colleagues, our institutions, and us as individuals may behave poorly. Understanding negative thinking is the first step in addressing and improving individual behaviors and institutional cultures and, in general, taking better care of each other. Reading and References: Think Like a Monk, Energy Leadership, The Truth of Yoga, Mindfulness for Beginners.
Chris Bordoni is a former athlete, elite consultant, cancer survivor, and resilience coach. Chris is also the host of "Reinvented" a podcast about resilience and resilient people. Chris and I discuss resilience and how it applies to surgery, surgeons and a healthy life outside of work. You can find out more about Chris at: https://chrisbordoni.com/. You can find the Reinvented podcast at: https://chrisbordoni.com/reinvented/.