And from WXXI News.

This is connections.

I'm Evan Dawson.

Well, our connection this hour was made over the course of four years.

And it began with the question, why medicine?

That's what Doctor Matt Krassner asked a number of first year medical students as he began a long term project that tracked their journeys through training.

He captured those experiences in a film called The Healer's Journey.

The documentary follows five students through day one of medical school, and offers a raw look at the challenges they face, both academically and personally.

And seeking to balance the demands of the rigorous coursework and how to maintain their empathy when navigating the demands of working in a hospital.

So what does it take to become a doctor?

The question is more nuanced than you might think.

And after watching the film, you may have a better sense of how truly demanding and all encompassing this career path can be.

It helps humanize some of the statistics we see when it comes to physician burnout, which is when well covered.

Research from Stanford shows that the number of physicians reporting job burnout has declined in recent years, but the rates remain worryingly high in the field.

Meanwhile, according to the Association of American Medical Colleges, the total number of students who want to become doctors has reached a new high.

So what's driving people into medicine?

And how can medical schools create programs that not only train students to become the best doctors they can be, while also protecting their mental health?

The film The Healers Journey explores those questions.

You'll have a chance to see the film in the coming weeks.

We'll tell you how.

But first, we're previewing it and talking about some of those big questions with our guest, and I will welcome them.

Now, Doctor Krasner, professor emeritus of medicine at the University of Rochester School of Medicine and Dentistry, co-chief medical officer and vice president of education for M Pro Insurance Company and executive producer of the Healers Journey.

Welcome, Doctor Craster.

Thanks for being with us.

Thank you.

Evan, thanks for having me.

And, featuring the film.

Well, it's great to have you.

It's great to have Doctor Abe Cho's next doctor.

Krasner, a psychiatry resident at the University of Rochester School of Medicine and Dentistry, featured in the The Healers journey.

Thank you for being with us.

Thanks so much.

Great to be.

Here.

And Doctor Tricia Paul, assistant professor in the Department of Pediatrics, Division of Hematology Oncology and Palliative Care and the Department of Health, Humanities and Bioethics at the University of Rochester Medical Center.

Doctor Paul, welcome to you as well.

Thank you.

Doctor Krasner, let me just start by asking why now, for this particular film and this particular story.

I think it's a timeless story in a certain way and also a critical story at this juncture.

Now, because we're facing huge changes in medicine, we're facing it.

Students are facing, a future in which managing information, holding information and being the expert of that isn't really what it means to be a physician.

And the identity of the physician is now being changed, especially with artificial intelligence.

So that part of the story is really important.

And then all of us want to have, people who care for us, professionals who care for us, who are human in practice, in a humanistic way.

And I think this film begins to explore some of the early identity formation which creates that humanity, but also can challenge it.

So the opportunity for the public to see the film, is really five fold coming up here, first of all, in person at Writers and Books on Saturday.

That's right.

This Saturday, 6:30 p.m.

we'll have more information on our website, but out at Writers and Books with the first viewing and then on WXXI TV.

Monday, April 6th.

Saturday, April 11th.

Sunday, April 12th.

Monday, April 13th.

So you're going to end up seeing it on TV during those those days.

You get multiple chances to see it.

But I, I do want to ask all of you a little bit about that.

What I feel like there's some dissonance, the dissonance that I see.

We've talked probably 3 or 4 times in the last decade on this program about physician burnout.

We talk about nursing burnout.

We talk about physician burnout.

And yet, according to the professional organizations that that track this, this is an all time high in this country for students who want to become doctors and surely they've seen the headlines, they've seen the challenge, what it is like.

So let me go around the table and I'll I'll start with Doctor Krassner here.

Why do we have more students than ever in this country who want to become doctors?

And at the same time, a lot of doctors feeling torched.

What's going on there?

Well, medicine as a profession is extremely meaningful.

It is also extremely demanding.

And I think it really, comes down to our biology, comes down to the way we are reinforced with rewards when we care for others, when we care compassionately for others.

The rewards are beyond our social status or paycheck.

The rewards are very physiologic.

And to be involved in something which we continuously or frequently have that reinforcement that we're doing the right thing, that it feels good.

In some of these biochemicals, many people know more than I do about them.

Things like oxytocin, all these really just support this.

And I think students and young people that are facing, what are they going to do in their career, really want something meaningful and something that reinforces that sense of doing something good, that feels good, that is good for our communities, and we are social creatures.

And that's why that biology exists to keep us connected.

What do you think, Doctor Paul?

Yes, I completely agree.

I think that the desire to help people and to accompany them through illness and in their journeys with health, I think that's a timeless desire that resonates with people nowadays, just as it did in the past.

Doctor Cho Yeah, I agree, especially that notion of I mean, you ask any pre-med why you want to become a doctor?

And the the most common response you're going to hear that I often talked about is I want to help people.

I want to care for people, want to help people.

And I think one question that came up to my mind thinking about this, because if I'm going to be honest, that that statistic of more and more people wanting to be doctors is is news to me.

And it's a little bit of a surprise, but it makes me wonder, is there an increasing desire to be wanting to serve others?

And what does that say about the social fabric?

Regarding, I think that the second part about this, I don't know if this is why so many people want to become doctors, but it's something that we talked about on the Camino, and it's this idea of a calling.

And I've thought a little bit about some of the reflections we did in the reading.

We did well on that.

And, I would hope that's a very important reason as to why people want to become doctors as well.

We're going to talk about the trip to Spain in just a moment.

Here.

But but let me follow up, Doctor Cho here, because you took a year off after your second year to care for your mental health, and you said my gas tank was empty at the end of the day.

So I, you know, I'm in the public eye.

Can't possibly frighten you about this career choice.

Enough.

You've seen enough.

But if this early in your career, you're feeling the tank is empty, what does that portend for the next few decades for you?

So to clarify, my tank was empty.

I'd say by the end of second year, and which is why I needed that year off.

Yeah.

Since then.

There might be moments where it feels like my gas tank is empty, but I would say, I love my job, I love my job, and no matter how tired I am, I have the meaning, the purpose, the fulfillment.

I mean, what's the saying about, with the right.

What is it you with the right?

Why, you can accomplish anything.

Something along the line.

So something has changed, though, for you?

It seems to me, yes.

That you are sort of navigating the possible burnout elements better or more effectively.

Absolutely.

Is that fair?

Absolutely, yes.

So how not to get too philosophical here.

But, go ahead.

You know, I really feel like I discovered myself and really found out who I am and why I'm here during that time off between second and third year, when you don't really have a full certainty as to why you're doing what you're doing, you don't have a strong sense of identity and who you are.

I think, the grind feels a lot harder.

But when you know why you do what you do and you find meaning and purpose and fulfillment in it, you know, I feel like that's a almost an immunity to burnout.

And I feel like this can be applied to a lot of different careers.

You're describing, of course, your career in medicine or in helping others.

But when you know why you do what you do, it helps you avoid burnout.

Why do we get derailed?

Why do we sometimes lose sight of the bigger picture of why we are doing what we are doing?

It's a really good question.

And, I personally think one important factor here is whether the workspace allows you to do what you believe in and the external constraints that the workplace can have.

So if you know what, why you do what you do and you believe in it, but you're not able to act in that way.

I mean, that's going to I feel like that's a recipe for burnout.

Yeah, I you want to jump in there, doctor Pressman.

Go ahead.

I do.

I think one of the things that could be helpful in mitigating burnout is creating a little space where we could reflect that.

Students could reflect on what they're becoming as they're becoming it.

There's very little room for reflection.

There's so much information to master.

The students talk about it being like a fire hose in your mouth.

One of the things when we screened the film that Barcelona had a large medical education conference, and one of the comments from the educators there was that this is like an intervention with the intervention that being filmed for the students gave them many opportunities for reflection.

And I don't know, I don't want to speak for a but I think the students had this ability.

We asked them as filmmakers many, many, many times, to reflect on what they were becoming as they were becoming it, rather than just the doing, the doing part of becoming an early professional through medical education is taxing.

It's huge.

It's very stressful.

It's very resource and time intensive.

They need a little space.

And I think that's where this narrative, reflective medicine, really can play a crucial role in creating that space.

I want to ask you and Doctor Paul.

I mean, we got a little bit of Doctor Cho's story, but why did you get into medicine in the first place?

Why did I get into medicine in the first place?

Yeah, I think for many of the same reasons that most of my colleagues and students talk about it was wanting to have a meaningful work, wanting to do something that's pro-social, that supports community, want to be connected with community.

And I think those are the main drivers, and I think they remain the drivers for almost everyone that I speak with and contact with.

One of the things that I do in my work life is, well-being interventions.

For two decades now with practicing physicians and other health professionals and part of what we do there is have them reflect back on that question, because once you connect with that question, then you can begin to to sort of adjust, change, modify, modify, modulate how you work within what are imperfect systems.

They're imperfect because they're human systems.

They're very complex in medicine, in the medicine culture, medical culture is very complex and can have the effect of making us cold, callous, what is described as moral distress?

Well, I think some of what you're describing is some of what Doctor Cho described really kind of hits home for me.

And probably a lot of listeners don't even have to be in medicine.

I think it is easy in the day to day if you feel overwhelmed, burned out by the amount of work that you have in front of you, that you feel like it's an endless series of tasks that you're trying to get done in a certain time period every day, and that you know it's only going to pile up more the next day.

And by the end of the week, you're feeling behind and you're feeling the stress that work can bring into your personal life.

And it is easy just to start to view that in the terms of the A list, a list of items to do as opposed to an impact to make that relates to the larger purpose of what you're doing.

I mean, it affects me.

I there are times where I feel scorched, kind of like today.

And and it's important to pull back and say, why are we why are we doing this?

What is the purpose here?

I don't think, Doctor Fraser.

We can reach a level of perfection where every day is some sort of, you know, this nirvana of reaching a state of perfect service.

But I think if we can't get out from under the daily to do tasks, whatever our job is, we're in real trouble.

Long term in terms of mental health, wanting to stay in the job, how we treat people, whether we are kind.

I think all of those things compound, don't they?

Oh, of course, you know, I agree with you 100% that, there's so much on the to do list having that reflection, I think a put it literally perfectly being connected with the why, but without a little space, without just a little pause between stimulus and response.

But we can't ask that way.

And I think that's, the call out to our colleagues.

And when we have experts like Doctor Paul here who really, uses narratives, stories from our work in medicine as a way of having us reflect on what our why is.

So, doctor Paul, why did you get into medicine?

Yeah, I can speak a little bit to this.

And I would say that what connected me to the why and began my journey is I was interested in learning more about medicine in high school, and I signed up to volunteer at my local children's hospital, and I found myself placed at a in a playroom for children with cancer.

And that was my first exposure and experience getting to spend time with children and adolescents with cancer, getting to spend time with their siblings and their parents and their families.

And for me, that was a really formative experience, just really getting to be with these children as they're going through, serious illness and complex and intense medical treatments in the hospital setting and to get to know their families and their siblings and what everyone around them was going through as well.

The this experience of being and being present with children and adolescents as a volunteer, really motivated me to want to spend time with these patients and families.

And that launched my my decade long journey of wanting to be a pediatric oncologist.

Along the way, I studied English and found myself drawn to illness narratives and the stories told by patients and families.

And I was interested in how children and adolescents share their experiences and tell their own stories about cancer.

And so I spent I have spent a lot of time doing research where we've learned and asked children with cancer about their experiences.

Along the way, I became interested in the experiences of parents and ultimately as well, the experiences of the clinicians who care for these patients and families.

All of which has led to my interest in pediatric palliative care as well, which I pursued additional training for.

And so to think a little bit about that commitment to the why, I think about the people, the patients and the families that I get to care for on every, every day, as well as my colleagues, the, the interpersonal relationship and the care we get to take of the people we care for, their families and the people who are in this work with us.

That's what I think makes medicine such a fulfilling and unique experience for us.

I think you got to be built a little different to to want to work in something that feels so unfair, like pediatric cancer.

And I wonder how you kind of compartmentalize enough to be able to not let that break you.

Sometimes.

I think it's a dynamic process.

And for me, it's a little, it's a little less about compartmentalization and a little bit more about allowing fluidity and allowing.

What do you mean by that?

I think of my patients and their families as part of my life.

I think I, I bring them home with me and I think about them quite frequently.

And that's part of how I've chosen to do this work.

It's a little bit less boundary than other people.

I think in my profession, in pediatric oncology specifically, a lot of us have a level of care and we build long relationships, longitudinal relationships with our families that are intimate and close.

And so I think while I get to care for them as my patients and the parents of my patients, I also think about, and care for them as fellow humans.

So can you give me a definition for bioethics?

Well, I practice a little bit more in the health, humanities and narrative medicine space, but I think bioethics is, my, my interpretation of how I would define it.

And, my ethics specialists might have their own, more specialized definitions, but I would say it's an application of asking questions about why and about, the ethical ways that we and take care of people in medicine.

Do you feel like more doctors should adopt your approach, which is to say, I'm not going to put up that wall.

I'm going to expect that sometimes work does come home with me.

I'm going to embrace that.

I can't fully separate.

And that's just going to be part of of the work in the flow of my life.

I think it's actually an incredibly personal decision.

And for me is a decision I make every single day in real time and a decision I expect that I will spend the rest of my life making in different ways.

Yeah.

Go ahead, doctor question.

But I have a question that's sort of questioning the underlying.

What I'm feeling is an underlying assumption, assumption of and I'm wondering about what makes you ask the question about compartmentalization, or why would you think we would naturally do that?

Because I'm not sure it's a given that we have to do that.

Clearly it isn't.

And I actually think Doctor Paul's answer is really telling and really illuminating for me.

I think I struggle with, the idea that if I ever worked in something that felt as heavy as, for example, pediatric cancer or palliative care, that I struggle with the idea that I wouldn't need that wall of separation just kind of let myself decompress and not perceive it on certain ideas.

But I also think that that at times could be a false choice.

At times you could be, you know, maybe not engaging enough with allowing yourself to feel something as a person.

Because we are people and, you know, you're doctors, but you're human beings.

So I don't know.

I think the assumption I was making was that most people feel like work life balance inherently means a wall of separation, you know, a way to turn your brain off to certain things, even different identities at home or in the workplace.

And I can understand Doctor Paul's answer is really interesting to me.

I wonder, what do you think they're doing?

No.

It is, I'm thinking, you know, a lot of times we're now using the term work life integration, which really says a little bit more than just work life balance, as if it's like if I do a little more on one side.

Yeah, yeah.

And the other.

Yeah.

And I'm thinking about even in your work, you, when you're at home or when you're doing anything else, you probably have your antenna out for different stories, different things that really gather your interest and curiosity.

Likewise, I think for physicians, we take on this identity.

And it's it's not just a professional identity.

It becomes who we are.

And that's why when we run into difficulties in our work, it is so personally difficult and challenging for us because it threatens our personal identity, not just this compartmentalize professional identity.

And I think the film that I undertook was really about let's get underneath this early professional identity.

What are the influences on it?

How can we support these budding professionals in some of those domains that medicine maybe doesn't do as well, that, you know, we're very good at competencies in terms of information and technical competency.

But the company says competencies that have to do with, meaning have to do with, our sense of identity, who we are, our sense of emotional intelligence.

That's a little more challenging to teach.

So that's, I think, part of my answer.

Yeah.

And I think probably part of the reason I made the assumption that there is this wall that has to be there is when it feels like work becomes too much of a business.

Doctor Rob Horvitz in your film talks about when when medicine is a business, it can really get in the way of the calling, which, you know what a beautiful person doctor Rob is.

I'm not surprised to hear him say that, but I feel that in a way similar that when when work here for me, there's the only job like this in this region, and I'm aware of the weight of that, and I'm aware of the importance of that when it feels like there are so many things to do that it is just check, check, check, check, check.

Now something else is done as opposed to can I sit for a moment and ask, what's the most important thing that we can do for our entire audience on every platform, and reach more people and offer more of a chance for growth and learning and and community.

And it doesn't always work.

I mean, like there are times where I just feel so torched, like I want that wall of separation.

And then there are times where I think maybe to Doctor Paul's point, I don't mind that work comes home with me because something really powerful happened, and I want to sit with that, too.

And I want to learn from that personally, not just professionally.

And and I want to then grow in different ways from that.

So I just find all of that interesting.

And so I didn't mean to detour here.

And the answer I just find that so fascinating.

And I think Doctor Horvitz points, I think other points in the film kind of point toward this desire.

Like Doctor Cho is talked about, to feel more of the why.

And I think at least as a one of your viewers, that's what part of the film seems to be about.

Fair enough.

Yeah.

No, that's fair then.

Thank you for explaining that.

I think that this is all the more reason why the film is relevant to the public, not just other professionals, because they begin to see that the physicians and their students, they're human beings.

And in some ways, they want to be seen as fully as they would like to be seen.

Yeah.

And I don't think that bi directional seeing can happen without, a little bit more understanding both ways.

I agree.

And, in our second, if I were going to talk about, some other aspects of the film, the last point I want to make here is I want to hear from all of you about how I feel in the public, about medicine, and similar to what we've talked recently about with policing and air traffic and pilots, I don't want the police officer who is if I have to interact with a police officer, I'd rather them not be on their 70th hour for the week.

If I'm on a plane, I'd rather a pilot not be on the 15th hour of a shift.

If I've got to see a doctor, I would like them to not be on nine days in a row at 12 hours a day.

You want people to be fresh at the same time.

The reality says we're all doing more and just about every profession.

So what's a reasonable expectation for the public if you want to be a healer, if you want the public to see doctors and nurses and everyone in that ecosystem as healers and part of that healing process as opposed to, I can't even get five minutes, no one is listening to me.

What does it take for that to improve?

I'll go around the table.

Doctor Paul.

I think it takes a lot for that to improve, but I think that one thing I've learned this week, part of our event that we're having it Writers in Books on Sunday is promoting a recent book called Where It Hurts Dispatches from the Emotional Frontlines of Medicine, which is an anthology based on a, journal of Narrative medicine that I've been an editor for for the past eight years.

And I was in New York City for a book launch event earlier this week, and I was so moved by an audience of, I think, primarily patients and families and non-medical people who were just so touched and emotionally moved hearing the voices and experiences of clinicians.

And so I think, to answer your question, a place where we start is we continue to humanize healers for everybody else.

Okay.

Doctor Cho, what do you think?

To make sure I heard correctly, can you repeat the question?

Well.

Yeah, I want to know what it's going to take for you to feel like you can be what the public is going to need you to be, which is not someone who views them as another box to check or someone to get in and out of the office, or minimize time with.

So it's not eating into other tasks, which is how people in the public often feel when they have to interact with the medical system.

So I think this is, when we really need to start talking about community and relying on others.

The idea of it takes a village, I think could be applied here in the sense that there have been times I'm in my intern year right now, which, granted, I'm in a lighter program or a specialty compared to others.

But I've definitely had my fair share of those long stretches, and I'm exhausted.

And it's in those moments where I have to rely on the help of my seniors, ask for help, recognize when I need help.

Because at the end of the day, we need to remember, like, what is most important.

What why are we here?

It's going to be for the patients.

So if I'm, you know, reaching that whatever day after however many hours, you have to have the self-awareness to know when you've hit your limit and, and ask for help from others.

And to be able to ask for help also means that you need to be in a supportive environment.

And feel comfortable enough to ask for help.

So I guess my answer would be community.

Really.

I think related is probably its own conversation about what's happened.

I think mostly in the last ten years in this country.

I feel like the last decade or so, maybe a little more.

There's never been more conversation about mental health, never been more ostensible awareness about mental health.

And yet we've never had so many mental health issues identified, labeled, etc.

and that it's complicated.

There's not a simple answer, but I'm hearing you say you got to recognize when you need help and ask for it.

That doesn't mean that you don't value resilience.

And resilience is key here.

And I do think at times I'm probably guilty of hosting conversations where it's like, well, we talked a lot about a lot of things, but we didn't talk about resilience as if it's almost like, well, this resilience just means you're supposed to suck it up and take abuse.

I don't think that's what anybody is saying, but it's also saying everyone's got to develop some level of resilience and then know where your limits are.

Do you feel like you're getting better at that?

That was a huge, key to being able to enjoy third and fourth year and even intern year as much as I have so far, is have cultivating that self-awareness and, being able to identify, you know, where your limits are.

It's hard, though.

It's not.

At least for me, it's not.

It took a lot of work to develop that sense of awareness.

And, you know, especially when you're in a field where you can always give more and I would say, like what led to the burnout and then the suffering at the towards the end of second years, I've lived my life of if you work harder, you can accomplish anything.

You pair that with a field like medicine where there is no such thing as enough, you know, you know, it's got to be on you to have that self-awareness, to realize I am way beyond what I'm capable of.

And I need to take a step back here.

And add Doctor Krasner.

It's wonderful to hear a reflect on that.

I just back to your question.

I think, one of the things that we're looking for and that our patients certainly are looking for, that we would like to find, it's a quality we'd like to have in our friends, our loved ones, but especially our health professionals.

Is presence this ineffable quality of just being there?

In our in the training program we have for physicians that flourishing in medicine, we have a mini practice so that they can actually practically apply this.

It's called 90s for the patient.

Come into the room to see the patient.

You don't turn on the computer and look at the career, sit down and you just give 90s.

You can even time it.

And just for the patient, that sense of presence making that the most important thing that's happening at that moment.

And you can do that when you're tired.

You can do that when you're fresh.

You can do that in many ways.

I did want to mention one thing.

There's a lot of challenges to that, and some of them are systemic challenges.

A colleague of mine published an article in Jama called The Cost of Technology, where she showed a crayon drawing that a young child had created based on the the visit to the doctor.

And what you see is the child in the center and the mother holding the baby.

And then off to the side is this figure is turned away is, typing.

That's the doctor typing on the computer.

I was going, I thought you were going to say on the phone, but but, you know, it's interesting.

When you mentioned 90s, my first thought was 90s isn't that much time.

And then I thought, no, if someone comes in to talk to you and they're not looking at a phone for 94 seconds and they're not looking at anything else, it's just eye contact.

It's just active listening.

That's enough to establish a real sense of this person's, let's say to me, it's person is here for me and it's and it's an in in modern society it's kind of rare.

Yeah, I love that.

We're so we got to take our only break.

Tim in Pittsford.

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Join the chat if you're watching on the Sky news YouTube channel, we're talking about a film that is going to be showing writers and books on Saturday starting at 630, The Healer's Journey, and we're going to be showing it on proudly Monday, April 6th at 9 p.m.

and then again Saturday, April 11th.

Sunday, April 12th Monday, April 13th.

You can see the healers journey.

We're talking to some of the folks not only behind the film, but who are working and talking about these themes in the film, and we'll come right back and take your feedback on connections.

Coming up in our second hour, we talk about women in the trades.

Men still dominate most of the trades in big numbers, but that is starting to change, especially with programs like the ones we are going to highlight next hour that bring in young women in high school earlier and let them see the trades and do the trades firsthand.

That's coming up next.

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Oh, welcome back to connections.

Talking about tech issues.

We got so many great people.

And then you have me who can screw up anything.

So I should tell you what's coming up next hour, because I was supposed to do that in automation and I didn't do that next hour.

We're talking about the skilled trades, and we are in part talking about women in the trades, which a vast majority of people in the skilled trades remain men.

That is starting to change.

And one of the reasons that's starting to change is women are often viewing this in terms of surveys and looking at future career opportunities as I proof.

So we're talking about the trades and especially women in the trades next hour on connections.

Okay, Tim in Pittsford has been waiting on the phone to jump in and I'm going to grab that call now.

Hello, Tim.

Go ahead.

Hello.

Yeah, I have a question for the panelists.

Really?

There's a lot of discussion around community and everything of that nature, and I was interested in their personal reflection on the role of faith or religion or some sort of, broader, bigger picture thing that they have a foundation in that helps to, you know, create presence when they're seeing with their patients and dealing with all of the the demands that they that they face every day.

Okay.

Doctor Krassner, you want to start on that one?

I'm sure I think it's I think I will call it cosmology.

It would be it would be helpful for us in, as health professionals to have some sense of what the universe is about, what life is about, and what the sense of meaning in it is.

If it's from a a particular traditional faith perspective, great.

If it if it's from something else.

But having explored the question in general of what is my purpose?

What is the purpose of this earth, that we live on the environment?

And I think it's really helpful.

I think, many of our patients who come from faith based backgrounds, we would like to connect with them, in that personal way.

And we don't necessarily have to be of the same faith in order to do so.

Okay.

Doctor Cho.

Yes.

And ditto.

You want to endorse that?

There you go, doctor Paul.

Yes, I agree, I think spirituality is really important for our patients families and for us as a health care community.

And so I think, palliative care has taught me to really learn about my, my patients faith as.

And it's been something that even amongst my colleagues to learn about all the different ways we are supported by our faith and spiritual beliefs has been very interesting.

Has that been a change in your field over time, willing to sort of address that, talk about it, be open to it?

I think in the field of medicine, I think it's something that there's a growing interest in, in understanding and inviting patients to share their spirituality with us.

And so I think in palliative care and attention to the spiritual needs and beliefs has been has been a part of our field for a long time.

And we have dedicated chaplains that are able to meet our patients and provide support.

But even as a palliative care clinician, I have received some training about how to engage with my families, about, spirituality.

Tim, thank you very much for that.

Jack in Greece next.

Hey, Jack, go ahead.

Oh, hi, Ivan.

But, thanks for taking my call.

Sure.

Hey, Evan.

Got a couple of questions for the doctors, if you wouldn't mind.

First has to do with.

I wonder, how much of the stress that is being put on.

By the way, doctors are so important in our life, so I appreciate you doing this, but, the idea of how much pressure, might be put on our doctors because, based over my lifetime, I've seen the doctors practices being brought up into larger and larger practices by the hospitals.

So there's a lot seems to be a lot more pressure on doctors to move patients through quickly to be efficient, if you will.

The other is, I'm curious if you know, like from a structural standpoint for the doctors, if, you know, as patients, how many times do you have a patient come in that has an anti-science bent where they don't trust prescription drugs?

How much pressure or frustration does that does that put on the doctors?

And finally, the other thing that I have is, the cost, for a young person going through medical years of training, difficult coursework and then being saddled with, possibly huge debt and, and, and I sense that it's not the doctors that are making the money in our health care system today.

So I just wonder structurally how much we're, we're laying on them to, to do the great work that they do.

Yeah.

Jack.

Thank you.

So there's three prongs that and we're actually going to work backwards because I have an email that is similar to Jack's first question.

So first is, the subject of cost.

And, you know, I don't know, doctor Cho, are you worried about, you know, debt and bills piling up here?

A jack feels like that's a big concern, especially for aspiring doctors.

I've got quite a amount of debt from schooling, for sure.

And if the self program did not exist, I might have seriously reconsidered my specialty choice.

Just because the Public Service Loan Forgiveness program where after ten years you can have, your debt forgiven if you practice at a nonprofit or another, you know, approved organization.

I think it's and I feel lucky because just recently now they've capped the amount of loans you can take to go to medical school.

And I really worry about how that's a barrier to providers who would be excellent clinicians and be able to connect with communities that others might not be able to.

So yeah, I think it's a really important question.

And, yeah, I, let's just say I'm not in it for the money.

And I've been I've heard that growing up day in and day out.

And if you think you're going into medicine for the money, you're you're choosing the wrong career path.

Jack's asking if all of you have had any issues with an anti-science sort of mindset either permeating conversations, causing any frustration, etc.. Anything to add to Doctor Krassner?

You know, sir, sure.

I've had over 30 years of primary care internal medicine practice and run into that.

My approach basically is to meet the patients where they're at and try to explore the underlying concerns they have.

And I think on that level, there are very few people I cannot connect with, whether they're anti-science, anti-vaccine, whatever, that I can't connect with on that underlying what is their concerns?

What are they worried about?

What would they like to see most?

And then try to explain my point of view?

I don't try to argue and really negate or put down their point of view, but it's coming from something and it's coming from somewhere.

And they're human beings and they're intelligent creatures, intelligent more than creatures.

They're intelligent beings that I have to make that assumption first and then try to connect with them.

Okay.

And then a third question from Jack dovetails with what Amy emails and systems and structure.

So here's how Amy puts it.

She says, I work as a psychologist, and I've been in several health care systems over the years.

One of the things that has always bothered me about discussions of burnout in health care is how it's discussed as an individual's problem, when it is a system problem, when you see such high levels of burnout, it's clear that this is so.

Burnout is a moral and ethical problem in modern health care, as it is indicative of a conflict between the kind of care that the provider feels is appropriate and what this system will allow for.

Thank you for addressing this.

That's from Amy.

I'll go around the table.

Doctor Paul, what do you make of Amy's point?

There isn't a system problem.

Yes, I completely agree, Amy, and I think that there is a slow but growing awareness that burnout has systemic roots and that we as a health care system and as a as fields in medicine, should be doing more on at a systemic level to, to better care for the people working in our field.

I think narrative medicine as a field that has really grown in the past 20 years, has really drawn attention to the stories not just of patients and families, but also of physicians and other clinicians who are all working in this space.

And I think a growing attention and an awareness about our individual experiences and our emotions has a lot has been a tool and a resource for us.

When I want to come back to the question of narrative medicine in just a second, but just briefly, do you favor an entirely different kind of system of health care?

Probably.

There's a lot wrong.

With not that you have the keys to the policy, Castle in this country, I get it.

There's definitely a lot that's that's wrong and a lot of room for improvement.

And so I think that getting back to the humanity and anything we can do in our system, even to reclaim our moments, our individual moments of humanity with our patients and families and with our colleagues is really important.

Doctor Krasner, do we need a whole new system?

Is this is a is this a systemic problem?

Clearly it's a systemic problem.

I think there's universal agreement that burnout in those issues that affect health care quality is, at the end of the day, are systemic issues.

But we have to ask ourselves, what is a system and what is the medical culture?

And it's made up of people, conversations, interactions, relationships and the skills that these individual people have.

So how can we address systemic change without really looking carefully into ways in which we can have people relate differently, reflect differently?

The narrative medicine issues that, that Doctor Paul talks about, I think is one of the keys to doing that, attending to some of these other dimensions, what we used to call soft skills, but really the skills of being able to communicate clearly, emotional intelligence, relationship centered skills could go a long way.

And that should be, something throughout the system, from the leadership on down to the rank and file doctor Cho.

Time for a new system.

I mean, I think it the question deserves a little bit more nuance when you're talking about systems.

What kind of organization institution are we talking about?

Big reason I wanted to stay, and I'm not saying this just because I'm currently employed by the University of Rochester, but, I wanted to stay because of the people I met and the support I felt.

And, you know, the the way that things are run here, I think, in other institutions, maybe it's not the same story.

So I think it does go back to the people, the conversations that we're having, working with what we've got.

So, yeah, I think, I think there's nuance to this.

I would also say to Amy, I mean, I appreciate the point, and I think we're part of the implication.

Amy, tell me if I'm wrong.

It is part of the critique of American health care in general.

Often those critics will point to other countries.

And what I don't know, Amy, is I don't know if physicians are burnout at the same high level in the UK or in Denmark or in Canada or anywhere.

So, I mean, I maybe they are.

It's definitely possible I don't have that data in front of me.

It is worth asking.

But I do take the larger point that you're making there.

Amy.

So briefly, Doctor Paul, we keep hearing narrative medicine for people are tripped up on the term.

What do you mean by narrative medicine?

Yeah.

So narrative medicine is a field that was started about in the 2000 by, Rita Sharon, who's based in Columbia University.

And this field was she brought together scholars from the humanities and clinicians and wanted to think about what it could look like to develop expertise in narrative competence and to encourage people in medicine to learn more about stories and how that could transform clinical care, how that could encourage empathy and understanding and improve communication between patients and clinicians.

And so the field of narrative medicine over the past 25 years has really grown.

And in many and most medical schools, there's some narrative medicine and health humanities education that's being being given.

In 2020, the IMC actually released a report about the fundamental role of the arts and the humanities in medical education.

And so not only in our educational practices, but in clinical care, there's a growing attention to inviting and attention to the stories that patients are sharing with us about their illnesses.

And really bringing that attention to storytelling, to how we are at the bedside and how we care for each other.

And I had a doctor question.

You've seen it have an impact over the years.

Have it here.

Oh, absolutely.

So the narrative medicine field is Doctor Paul describes this huge and one branch of it that we've worked with in our flourishing medicine program has to do with having students, trainees, physicians, other health professionals reflect on their stories, the stories they've experienced and then share with each other.

And it's a reflection that doesn't usually occur in our usual discourse and in our usual culture, in medicine and it's highly, evocative of meaning.

And it really supports our sense of well-being in the work itself.

So you can see, medicine is a series of individuals who have stories, or you could view medicine in terms of scores and competitions and grades.

And I don't wanna give away too much of the film, but I want you to tell me a little bit about the idea that when you travel abroad, you can find systems where students essentially it's not as competitive, it's not as high pressure, all stress, you know, you go to Fribourg, Switzerland and visiting Germany and and students aren't necessarily just just ranked.

They're more focused on the actual training.

What do you see in places like that?

Well, the underlying question is we do a lot of exams and assessments on students and the idea, the assumption is that doing well on the exam makes you a good physician.

That's a big leap.

In those systems, they're turning that upside down and saying, what does it take to create the professional that I would like to become, that we would the institution would like you to become?

If you're just concerned about passing the next exam, you're going to focus your energies.

I'm passing the next exam.

If you turn that upside down and say, my concern is how what kind of physician I want to become, then you're going to do assessments completely differently rather than a summative assessment, which means how well are you doing?

How much do you know the assessments are geared toward what is it that you don't know and where should you put your energies?

And then you when you work in an intimate setting with with educators, you can help devise your learning plans such that you can meet those goals and become that, professional that you'd like to become.

My best sense again as the outsider, just watching debates about how we assess students medical school or otherwise, is that a lot of people create these systems in this country, feel like there's just not time to do that detailed, layered assessment.

Are you going to become a good doctor?

Are you are you a good law student?

Are you a good student in any field they feel like, you know, it's not perfect, but we got to have scores.

We got to have tests here.

Can we get to a better place in society where we can see that more layered assessment and not just based everything on a number?

I think so I think it is very difficult for those who design tests and assessments to design it in such a way that it changes.

You know, what we focus on.

I had the opportunity of screening the film with the National Board of Medical Examiners.

This is an organization that designs the licensing exams for the for the United States and Canada, and the chief executive of that organization who had seen the film said to me, you know, my people, they're all researchers, statisticians, designers, but they're removed from the actual lives of the students.

They would love to see a film like this so that it will connect them so that as they design the test, as they design the exam questions, they can think about who are they designing for?

So that's just a start, and one of many ways in which it could change.

It's a really interesting set of insights.

Also wanted to ask you briefly about the decision to you and the students to go to Spain.

Heard a little bit of that about that earlier.

Why tell us about a little bit about the why behind that?

Well, this early period in their professional identity formation is very transformative, hugely transformative.

They become in some ways I wouldn't say a different person.

They become a much different, much larger person.

And so it's about transformation and it's also a journey and it's long.

And so the metaphor of a pilgrimage, the Camino de Santiago pilgrimage, is a pilgrimage that takes place in northern Spain since the Middle Ages, where pilgrims go there in order to connect with others companionship, to reflect, and to ultimately transform at the end of the pilgrimage.

Traditionally, they would end at the tip of the Iberian Peninsula called Cape Finisterre, end of the world.

As they look out west over their future.

And who will they become in the future?

And we did exactly that.

We took the students on that.

And as they were walking on the pilgrimage for about ten days, we had them reflect on all the things we had filmed during the prior four years and ultimately took them to the very tip to finish there and have them look out over the ocean and think about what is it they're committing to.

And you'll see that in the film.

Doctor Cho, you're one of them.

Yeah.

And just hearing about it and we talked a little bit about this, about how this film allowed for opportunities for reflection.

All I can really think right now is how how lucky I am, how grateful I am to have had these experiences, because I do think back on this quite a bit.

And it's, having that a part of my history and being able to think back on it.

Gosh.

Just feeling really lucky and grateful.

Because it does steer where you're going.

And I do agree, I like to not know who I was until, I really discovered who I truly am throughout this journey.

And it's a journey that's still going.

So as we wrap here one more time, you got a chance to see the film coming up, starting with writers and books.

It is Saturday, 630, right?

That's right.

What's the event?

Sunday?

There's an event?

Yes, Sunday there's an event, at Writers and Books from 2 to 4.

With with authors from the Where It Hurts anthology, as well as it's the 21st 25th anniversary of The Healing Muse, which is a medical literary journal from upstate.

So wonderful programing with writers and books this weekend, Saturday night for the film, Sunday for the event, the doctor Paul just talked about.

And then on ITV Monday, April 6th 9 p.m.. You want to set your calendars?

The film will show there and if not, then, then Saturday, April 11th.

Sunday, April 12th.

Monday, April 13th at different times we're going to be showing, the healers journey.

So this is a chance for you to see what we've been talking about.

And, frankly, a lot more than what we've just been talking about.

And I want to thank our guests for coming in and doing that.

Doctor MC Krasner, a professor emeritus of medicine at the University of Rochester School of Medicine and Dentistry, co-chief medical officer and vice president of education for Impro, and executive producer of the Healers Journey.

Thank you for being here, doctor.

Thank you.

Doctor Abe Cho, psychiatry resident at the University of Rochester School of Medicine and Dentistry.

Thanks for telling your story here today.

Thanks so much.

Been pleasure.

And Doctor Tricia Paul, assistant professor in the Department of Pediatrics, Divisions of Hematology, Oncology and Palliative Care, and the Department of Health, Humanities and Bioethics at the University of Rochester Medical Center.

Thank you for sharing your expertise as well.

Thanks for your great questions.

More connections coming up in just a moment.

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