FHC #49: An unfiltered chat about ‘the slap,’ emotional doctors, and more

Welcome to Unfiltered, a new show that brings together two iconic voices in healthcare for an unscripted, hard-hitting half hour of talk.

Dr. Robert Pearl has twice appeared on The ZDoggMD Show (see: here and here) opposite Dr. Zubin Damania, who has twice appeared on the Fixing Healthcare podcast with Pearl, alongside cohost Jeremy Corr (see: here and here).

This episode ventures into uncomfortable territory. It starts with “the slap” at the Oscars and asks whether making fun of a medical condition is ever okay. Next up, the two doctors discuss emotion in medicine: should physicians show more of it at work? And finally, four existential questions for healthcare professionals, including: What’s our purpose?

To get started, press play or peruse the transcript below.

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Fixing Healthcare is a co-production of Dr. Robert Pearl and Jeremy Corr. Subscribe to the show via Apple Podcasts or wherever you find podcasts. Join the conversation or suggest a guest by following the show on Twitter and LinkedIn.

UNFILTERED TRANSCRIPT

Jeremy Corr:

Welcome to Unfiltered, our newest program on our weekly Fixing Healthcare podcast series. Joining us each month as Dr. Zubin Damania, known to many as ZDoggMD. For 25 minutes, he and Robbie will engage in unscripted and hard-hitting conversation about art, politics, entertainment, and much more. As nationally recognized physicians and healthcare policy experts, they’ll apply the lessons they extract to medical practice. Then I’ll pose a question for the two of them as a patient based on what I’ve heard. Robbie, why don’t you kick it off.

Robert Pearl:

Zubin, I’ve heard great feedback from our listeners about the first show and our willingness to tackle controversial issues. You’re my social media maven. And I have to ask you about the event that garnered twice as many social interactions than Ukraine, and four times as many as the president of the United States. And of course that was the confrontation between Will Smith and Chris Rock at the Oscars. But rather than talking about the slap, Zubin, I’d like to ask you a different question. Why do comedians think it’s okay to make jokes about people’s medical issues?

Zubin Damania:

Ah, well, boy, there’s so much here. I mean, the truth is comedians, like anybody, their job is to make people laugh or to point out absurdities and that kind of thing. Now, whatever Chris Rock knew or didn’t know about Jada Pinkett Smith’s alopecia, I actually am with Bill Maher on this, where again, there is a free speech protection here where Chris Rock can make jokes all he wants and Will Smith can protest verbally, legally, however he wants to do it. That’s fine. What’s inexcusable is hitting anybody and hitting a comedian for making a joke. Now, whether or not he knew, because Jada Pinkett Smith has been public about her alopecia, there’s a lot to nuance here. It’s more common in African American women. She’s a public figure. So it is traumatic for her. But as Bill Maher said, “If the worst thing you have to deal with is alopecia, I don’t think someone should slap somebody for making a joke about it.” So, I tend to fall on the free speech side on this one myself just being somebody who dabbles in comedy.

Robert Pearl:

Yeah. I agree with you completely. First of all, we both agree that the violence is inexcusable. So that’s why I didn’t want to talk about that. And I also agree with you on this free speech. He has the right, the legal right, the constitutional right to do so. I guess the question I’m really asking, is it worth the pain that’s inflicted?

Zubin Damania:

Mm, this is a great question. I mean, look, in comedy, you’re not supposed to punch down. Anytime you make fun of someone with a chronic disease, you’re punching down, kind of by definition, like Putin could suffer from end-stage renal disease. And if you make a joke about him being on dialysis, you’re still punching down because he didn’t choose to have that disease, and it doesn’t do well for other people with the disease, and it’s stigmatizing. So, as a general rule, right, you don’t punch down in comedy.

Robert Pearl:

Probably because I fixed so many kids with clef lips in the past, and I’ve heard all the jokes and I’ve seen the pain that they experience, I am overly sensitive about this issue. But I guess, as a physician, I would hope that we would keep people’s diseases out of comedy. It may be funny, don’t get me wrong, but I think the pain inflicted on the individual, now, if it’s the president of the United States or it’s Putin or someone, these are very public figures who are at the center of the discussion. If it was about Will Smith, you could say, “Okay, well he’s about to win an Oscar, but” his guest, who happens to be a public figure, but still, to make that be the brunt of the comedy, again, I’m probably overly sensitive, but I’m reacting as a doctor to this. And that’s why I wanted to ask you, because you’re a social media leader. And as you say, you’re quite a funny comedian.

Zubin Damania:

Well, I mean, that’s a great perspective, Robbie, that you’re bringing because you’re actually seeing the suffering that these diseases can cause. And so you compound the suffering if you’re making jokes about it as a public comedian and so on. This situation is a little murky. It’s just hard to know what Chris Rock knew about… Maybe she, in his mind, she had just chosen to shave her head as a style point, in which case, as a public figure, you’re fair game. Right?

But I think your point is very well taken. And again, it’s a question of, are you generating net suffering in the world or are you generating net joy or well-being? And I think that’s a good moral compass for all of us. That’s why comedy, in general, I’ve seen comedy where I’m just like, “Yeah, that was just, not only was it not funny, but it was kind of hurtful.” So it’s kind of like, well, there’s no net benefit. Like I’ll defend your right to make the joke, but it’s just not good comedy. Right? So I think you bring a very valid point here.

Robert Pearl:

Zubin, your comments about the emotional aspect of this encounter, they make me think about a class that I took at the Stanford Graduate School of Business on politics and public speeches. It was about the relative power of emotion versus logic. My favorite clip was from Oliver North and his testimony to Congress in the Iran-Contra affair. It begins with one of the senators who wasn’t a fan of Colonel North showing a video of the FBI agents storming into his office in Washington, DC, as he sat at his desk, shredding all the incriminating evidence. The senator, certainly no fan of North, believes that he’s made Oliver look like a fool. He says, “What were you doing?” North says, “My job.” The Senator’s flummoxed, this is not what his prep team has predicted. The senator stammers. He asked the colonel, “Why do you think this is your job?”

And in this totally unemotional calm face, he says, “If it wasn’t my job to shred documents, then why would the government have given me a shredder? And why would Congress have paid for it?” This complete lack of emotion is powerful. And in contrast, in the same class, the professor showed the 1988 debate between the democratic candidate, Mike Dukakis and the republican candidate, George Bush. The CNN correspondent Bernard Shaw asked Dukakis whether he would support the death penalty if his wife were raped and murdered. His response purely cerebral, “No, sir. I don’t see any evidence it’s a deterrent to deal with violent crime.” The pundits think he may have lost the election because of that one completely unemotional response. So now let me ask you, doctors are taught not to show emotion. Don’t cry, don’t yell. Don’t admit how unfair life can be when it comes to who gets cancer. And yet we’re expected to be authentic. How should we, as physicians, as clinicians, resolve this contradiction?

Zubin Damania:

Man, this is why I love doing this podcast with you, Robbie. I say no to every podcast invite I get. And Robbie’s like, “No, we’re just going to talk about this kind of thing.” I’m like, “Yeah.” So look, this is central to who we are as human beings. And you said the word authenticity. We’re expected to be authentic. And yet we can’t show what we are, which is largely emotional creatures with a little reason tacked on evolutionarily. We really are, as Jonathan Haidt says, “We’re all elephant with this limbic system that is evolved actually to keep us safe”. Emotions are there for a reason. They’re feelings. They call them feelings because you feel them in the body, they’re an energetic pattern. You ignore them or you repress them at your peril. And the reason, Dukakis lost that thing, the reason we loved Spock is not because he was all logic. It’s because you could feel clearly Spock was half-human.

The underlying emotion was there and watching him try to repress it, watching him try to be a good Vulcan and fail very often was what made him human. And that’s why Kirk, at the end of Star Trek II, says, “Of all the souls I’ve encountered in my travel, his was the most human.” And that’s why in medicine, I think it’s important that we’re authentic with our patients. We do need to show some emotion, but we also need to have that kind of cognitive empathy that says, “You know what? Yes, I feel that you’re suffering. I know that you’re suffering and you can feel some of my emotion, but also I’m going to be a source of stability for you. So I’m not going to let it cloud decision-making. I may help with you to use our emotions together to inform what values matter to us.”

And I think that’s important when we ignore that. When we ignore our own emotions, we end up with all kinds of problems. And physicians in particular are the masters and mistresses of emotional repression. Yeah. So to me, focusing deeper on understanding our own emotions and unrepressing them and really feeling them and getting rid of this stigma, oh, there are negative emotions and positive emotions. No. There are energetic patterns that we call emotions, e-motion, energy in motion. Let’s feel them because if you don’t, they’re not in motion, they almost become solidified. And then you tell stories about them and then you act unconsciously on them. So, you know what happened with will Smith? Undoubtedly, there was deep emotional repression for years of being a celebrity and having to swallow this stuff and whatever was going on with him and his wife. And then what happens? It comes out in violence. You don’t have to do that if you’re actually in touch with that stuff on a regular basis.

Robert Pearl:

Let me ask you where the line is. I was talking to a doctor who lost four COVID patients in the same day. This feels to me to be beyond the possible human tolerance. How are we going to address this? And how are we going to deal with the PTSD that invariably is now about to start in even greater force than during the pandemic itself.

Zubin Damania:

Yeah. You know what’s interesting is I think human tolerances are beyond our imagination. Like we, humans are able to tolerate insults and traumas that would just theoretically break anyone and they seem to do it. And some actually find meaning in it and grow stronger. But the difference is you have to have that, in my opinion, in medicine, what we miss is this communalization of pain. We don’t make it okay to talk about this stuff. We don’t make it okay to say, “You know what? I’m suffering too.” And that way, you could tell people, “Look, we’re all in this together. Yeah, man, four patients that we’ve known forever, and now they’re not here.” That is a trauma. So let’s sit and process that, let’s feel the emotion. It’s okay to have grief. That’s normal. If you’re suppressing grief, that’s what’s not going to be good for you.

So providing the tools and resources to actually process that stuff will be important to mental health resources, et cetera, but just changing the culture to say it’s okay to feel these things. This is normal. In fact, if you don’t, maybe that’s the pathological state. And we ought to think about that. So again, I don’t have a magic answer, but I’d say that diving into the pure emotion of loss and grief… One of the things that happens when you go down any sort of self-realization or meditative path is strong emotions start to arise that were repressed by the mind for years and years and years. And they start to unrepress because the mind relaxes and the thought-based structures relax. And one of the things that can happen is you can feel unmitigated sorrow out of the blue, be driving and just burst into tears. And we have no societal container for that. So in medicine, it’s even worse. So we have to start building those containers and those structures to process.

Robert Pearl:

Well, I want to dive a tiny bit deeper and ask you how. Because I’ve seen the response that people have had to individuals who say, “I need therapy,” or “I’m not able to work to my best today because of the emotional experience I had.” I mean, I’ve seen people, a physician get a diagnosis of cancer in the morning and come back and take care of her patients in the afternoon. I mean, I just keep feeling as though this problem is going to be so hard to burst through. How can we start?

Zubin Damania:

Oh, my gosh, man. I mean, that stuff is heartbreaking and you’ve seen it so much as leader of the group. I’ve seen it when I was on the front lines with my own team. And people I used to work with still email me and they go, “I’m at my wits end. I don’t know what to do. Do you have any advice?” And I think… Okay, I’m going to give you an answer that is going to be unsettling for some people and they’re not going to like it. But the truth is, I’m just going to tell you what I know. Recently, I did like a six day semi-silent meditation retreat led by another physician. And they were all healthcare professionals, about six or seven or eight doctors, many nurses, physical therapists. And this was just in November.

So COVID had been going on. People were traumatized and they came in. Many of them had never meditated and had never had this kind of practice, but they saw my show and they’re like, “You know what? I want to do this thing.” And what we found was people opened up and just torrents of emotion and sharing in the non-silent parts in the evening when we did group activities. And the being with yourself and processing that stuff, that unconscious stuff, in a safe space with other people who do what you do is so powerful, Robbie.

When the thing was done, many of them were saying this was the most powerful experience they’d had. And that they went back with renewed sort of resilience to their careers. That doesn’t mean that’s the single answer, but you can see how powerful unrepressing that stuff, having a safe space with your colleagues and doing the deep work of actually introspection. We tend to externalize everything. We project everything we say, “Oh, this is the problem. It’s this guy or that guy.” But when you actually look inside, it’s really all right there, and we create the world. So that’s my really questionable answer to that.

Robert Pearl:

Your story, Zubin, reminds me of a talk I heard Yo Yo Ma give in Silicon Valley. And for any of our listeners who don’t know his background, he was a child prodigy. He performed from the age of four and a half. At something like five or six, he and his sisters gave a concert for President Kennedy at The White House. He’s recorded 90 albums, 19 Grammy Awards. He’s the best celloist of the time. At the event I attended, first he played a series of some of the most beautiful and moving cello pieces I’ve ever heard in my life.

But then he talked about four existential questions that he said he often thinks about. He said that he wonders first, who am I? Second, what am I grateful for? Third, what is my purpose? And fourth, what do I want? Sitting in the audience, Zubin, I wanted to scream at, “Who are you? You’re the greatest living celloist in the world! You’re a musical genius! What do you mean, who are you?” But I didn’t. Fortunately, I didn’t. But it did inspire me, somewhat similar to your six-day event, to ask myself these kinds of questions at various points in my life. So let me ask you, as a profession in the 21st century, as physicians today, first, who are we?

Zubin Damania:

Oh, these are the easy questions, Robbie. These are the easy questions. They’re very hard. So here, okay. I’ll give you two answers to this question that I’ve struggled with myself. There’s a deep who am I question, which is one of the spiritual questions that we ask, who am I? And when you actually investigate and look for yourself in the present moment, keep looking, keep looking, because you will not find a solid self there. And as you keep looking, you may find something really interesting, the real self. And so that’s answer one. That is a little woo-woo for this talk. Answer two is your authentic self, which is in this present moment, you’re an expression of reality, you are. And what is that? So Yo Yo Ma probably knew from a young age, “Look, this is who I am and being authentically me is standing on stage in front of the Kennedys with my sisters doing this and talking about it,” and so on.

Now, many of us in healthcare, we knew authentically. We were drawn to, it’s not something we chose. There was no agency involved in many ways. We were called to do this. And yet, we’re often made to compromise on what it is we know is authentically us. And I think that’s part of that moral injury component that we have to make these compromise. We have to do things we know are antithetical to, maybe not just… Forget about our interests and aptitudes. It’s more just what we fundamentally know we are, and that causes this tension, which you could call… The Buddhist will say is the nature of suffering that you’re diluting yourself by trying to be something you’re not. Now when you really… And that’s why I think that meditation thing was powerful because people could feel in. Like when I did it, what I realized was, I’ve often undervalued my own compassion.

I feel like I’m not compassionate enough. I can be a jerk. I’m self-centered, all these other like me, me, me, me, me, beating yourself up type of things. But during meditation, I realized, wow, there’s an infinite well of compassion there. And I do express it. And sometimes you have to forgive yourself. And when you do that, you can then be authentic. You can say sometimes there’s tough love, like being a little bit hard with people is an act of compassion. And again, that’s connecting with your authenticity. So how do we train or create… It’s hard to train, right? You create a space for people to be them. And that means again, giving them tools, resources, and autonomy to be who they are, which some of its systems change. But some of it is working on ourselves.

Robert Pearl:

Are we healers, experts, teachers, businessmen and businesswomen? As a profession, who are we?

Zubin Damania:

Yes. All of those things. We could be any and all or none. I mean, we may be something totally different within there. And each person is different. Each person may have aspects of it. As a profession, I think it’s tough to paint us with a single brush. The people that we admire the most may have one or two or three of those aspects that are so powerful and we just really are drawn to it. And that’s why mentorship is so important, right? Because the mentors can show us who we, not only who we are, because that’s our aptitude or our draw, but who we can be. Right? So more mentorship, more openness about that stuff, and then we find out who we are.

Robert Pearl:

So then as doctors, what should we be grateful for?

Zubin Damania:

Gratitude is a central practice. It actually is an anchor through all kinds of suffering. Anytime, I was just talking to my mother and she’s now entering our 80s. And my dad is in his 80s and they have their problems. They have health problems. They have problems with their house, the kind of things that happen with your elderly parents. And we were talking about it. And she said, “A year ago, I would’ve really been upset by all these things. And I would’ve stressed and we would’ve been anxious, and so on. But all I have to do is watch the news for five minutes to see people in Ukraine suffering, who didn’t ask for it. And I’m filled with the gratitude that I live here, where I have these first world problems and everything is great. It’s wonderful. It’s beautiful.”

So that gratitude practice is so powerful. In healthcare, the gratitude that you can be with people when they’re at their most vulnerable and they open up in a way they don’t do for anybody else, and they let you be with them in that sacred space. That is deep gratitude. The fact that you are, regardless of your loans and all of that, you’re actually doing okay overall in the grand scheme of things. And you get to do a trade that, there’s almost no other profession on the planet where you get this kind of connection with humans and get to help people this way, no matter what aspect of medicine you’re doing. So there’s an immense well of gratitude there that’s available if you choose to be aware, make yourself aware of it.

Robert Pearl:

If we’re going to deal with burnout, should we be expressing a lot more gratitude about the positive things that we have than I believe we are today? Or is that just too Pollyannish?

Zubin Damania:

Ooh, burnout is such a… I mean, again, it’s that end stage of the chronic injury. So it has multiple facets. So yeah. Gratitude is a powerful prophylactic against… It’s like taking lisinopril when you have chronic hypertension. It’s going to protect your kidneys a little, protect your blood pressure and your heart a little bit, but it’s not the only answer. It’s a piece of it. You also have to stop eating the salt or stop stressing yourself out, so environment matters. Your own personal framing matters. And gratitude is a powerful piece of that. Some kind of spiritual practice, whether it’s prayer or meditation or looking at the night sky and with awe, whatever it is, that’s a piece of it. But then it’s also asking yourself, am I authentically me in this thing? And sometimes, Robbie, I hate to say this, but you got to stand up and say, “This isn’t me. I got to go do something else in medicine or out of medicine.”

And for some people that is the answer and they know it, they know it. I had an OB reach out the other day on Instagram. I was taking a ask me anything thing. And she just said, “Look, I’m an older, morally injured, upset obstetrician. Should I retire?” And I said, “You know the answer if you actually feel into it. You know what the answer is. So why are you asking? You’re really asking for permission to do what you know is right already, whatever that is.”

Robert Pearl:

So that leads into the question of what’s our purpose? Because I’m thinking about that woman you just described. I’d hate to see her lose the purpose that she entered medicine for at the start of her career, maybe different ways she could express it. But as physicians, as doctors, what’s our purpose?

Zubin Damania:

Yeah. It’s great. It’s a great framing of it because if she really feels into what her purpose is, she will figure out a way to fulfill it, authentically. My feeling is I really like what writer Jonathan Haidt, the same Elephant and Rider writer wrote about purpose. He says, “The meaning of life, it’s not without, so it’s not outside us. And it’s not even within us. You don’t find meaning within. You find meaning between.” So humans are, we’re relational creatures. We find meaning in the connections between us and others. And so when we feel into our authentic selves and then we express it in the world in a way that connects with other people, that’s all the meaning you need, even if everything is empty void and it means nothing in that sense, it means something in the relational sense right here and now in this second.

The universe, man, I showed my daughter a picture of the Andromeda Galaxy taken by Hubble. And as you zoom in at 8K on YouTube, you see every single star in that galaxy of a billion stars. And as you start to see, each of those stars has planets around it. And some of them probably have life. And you’re thinking, “God, I feel so small.” I could see her face start to just shrink in horror at the existential terror of that. What is my purpose when I’m this small? And then I told her, “Your purpose is right here. Look what’s happening right in this minute. You and I are having this connection. That’s a purpose. That’s all that matters. It’s right here right now.” So it’s the same with medicine, really focusing on what is and what our relations are with others. I think that’s where a lot of meaning can be found.

Robert Pearl:

I believe, and I hope again, that I’m being realistic, that the purpose of medicine is around health and that medicine today is focused on disease. And I think that a lot of the burnout type of experience, the lack of fulfillment, the lack of satisfaction we have, is that we’re focusing on the wrong purpose. Any thoughts?

Zubin Damania:

Oh, I mean, I think you’re absolutely right. Now, what people would say on the front lines is, “Well, of course, Robbie and Zubin can say that because they’re not having to chart 40 patients a day, and click all these boxes, and to get yelled at for low productivity, and so on and so forth.” And so sometimes it’s tough to see the purpose from the immediate feeling of lack or of overwhelm or of stress. And that’s absolutely valid, but there are solutions to these problems if we work together with people who lead rather than just manage. Right?

So I do think reconnecting with what the purpose is means that you use technology to actually enable the purpose instead of using technology to enable an outside purpose of whatever it is, billing or nonsense like that. The technology ought to enable the human relationship that allows us to connect and heal with our patients and help each other. So if people have those tools, resources, and autonomy, then the purpose is the guiding beacon. But I think what we’ve done is we’ve made the purpose too skewed towards one thing or another, whether it be profit for an institution or whether it be quality measures that don’t measure quality, whatever it is, get those things right. And then the purpose shines through.

Robert Pearl:

We’re in complete agreement. I mean, I think the people who are experiencing these emotions, they’re the victims. There’s no question about that. The question is how to get from here to where we need to get to. And I think that by being able to understand the purpose and exactly what you said, figure out, how do we augment the things that we can do, use the technology to accomplish that, put together the teams to accomplish that? Then that is how we can eliminate our own pain, but more importantly, fulfill our purpose. So what do we want?

Zubin Damania:

Yeah. You’re the master of this, man. You’ve been doing this for so many years. I would be asking you this. But I’ll just say one thing, which is Garry Kasparov, right? With the chess champion who was defeated by Big Blue, the IBM AI, it was written about this quite a bit. He could have gone into a deep depression and felt a lack of purpose and so on when that computer beat him with mechanical intelligence. But what he said instead was, “No, this is a huge opportunity to use a tool, the AI, with a human, me, and I could beat anybody alive in any computer with that tool.” And that’s what we need in medicine is those tools, that technology that takes all the mechanical intelligence away, that it does it better than us.

Let’s just be honest. And so then we get to do what only humans do with our awareness, our comprehension, our emotion, our intuition, our connection, those are the things, and our intelligence, that computers will never have that comprehension. So that’s what we need is those tools and resources that enable us to do the job better. And that means better systems thinking better individual awareness and awakeness, all those things are connected and integrated. That’s why it’s so hard. People say, “Oh, how do you solve this problem? It’s so complicated.” Well, you have to go in all the parts and they add up to bigger than the sum of the whole. So you have to work on everything.

Robert Pearl:

I love the answers and I hope the listeners learned a lot from it. Jeremy, your question as the patient listening to this conversation.

Jeremy Corr:

You both talked about grief and being authentic and being human. As patients, we often look up to doctors, especially in times of major crisis, such as early on in the pandemic, or if a loved one just got in a car accident as being almost above human, almost a godlike figure that can, I mean, essentially perform miracles, help us in our time of need and save lives. We expect perfection from doctors and almost stoic brilliance, but we expect human empathy from physicians, but we really do not allow them and maybe cannot allow them to be truly human. Humans get burned out at work, have marriage problems, have loved ones pass away, things that happen in their personal lives that can impact job performance. But we do not, as patients in our minds, view physicians as having the luxury of being human, making mistakes, having bad days. How do physicians deal with that pressure? And should patients look at physicians as being humans who can make mistakes? And is it dangerous to have patients lose that reverence for physicians? What are your thoughts?

Zubin Damania:

Hmm. This is something that I’ve personally struggled with because there is this aura around the physician that actually has a potential healing piece to it. There’s this therapeutic alliance. Now, what I’ve learned over my years is that the more honest, open, and authentic I can be with patients, the more they actually are able to connect within parameters. You’re not going to behave the way you behave with say your best buddy when you’re at the gym or something, making jokes with a patient. That’s just never going to work, right? So there’s the use of humor. You have to be very careful, and thoughtful, and respectful with patients, but at the same time, some of it is an authentic expression of connection and a rapport. So I think what we, patients are already waking up to the idea that their doctors are not robots or superhuman, and they don’t want that, because a doctor who stares at the computer is not a good doctor in their mind.

They want their doctor to make eye contact, to show a little bit of connection, at least probably more than a little. Surgeons, they’re a little more lenient with, but in surgeons, maybe there’s different degrees of this for different professions, but I’ll tell you for internists in general, they want a little bit of that connection in humanity. And I think that’s one of the reasons that whatever I do online is vaguely popular. As I think people are like, “Oh, this guy’s not so uptight like a lot of doctors that I’ve met. Maybe he goes too far, actually, in the other direction.” But it’s a balance that we have to strike. And some of it is modulating patient expectations, which happen when there’s a million doctors on YouTube making videos that are a little bit funnier and more open.

Robert Pearl:

My answer, Jeremy, is to start with what the data says, which is that paternalism, and now maternalism, doesn’t work. The top-down approaches to work. We know that patients don’t take the medications as effectively as they should, as in terms of their best health. We know that they don’t often follow up on recommendations that will improve their health. The current system doesn’t work and yet we ignore it. And I think physicians don’t recognize the gap between what could be and what is, because they believe that it’s time-inefficient to establish a real relationship with the patient. But I think that that’s what’s necessary. If you don’t have that relationship, and you don’t build the trust, if you don’t build the trust, you don’t develop a level of commitment. And without the level of commitment, the healthcare system doesn’t move forward. And I believe that that’s what we’re seeing today.

And so I think it’s essential that physicians be able to be human. Now, the reality is the person who is sick has come to your office and you’re the healer role. You can go to someone else’s office and they become the healer for you. And you should do that as well. But if there is a complete lack of authenticity, to use Zubin’s word, or a complete lack of openness, then I think the patient leaves and feels like maybe they got some information, but they’re not sure that they’re really going to trust it, believe it, or follow up upon it. I think the teachings of the past around the lack of emotion was really a defense by doctors for their complete inability to treat almost every disease. I mean, if you think about it, doctors could repair lacerations for centuries. They could fix, put bones back in place.

After anesthesia came along, could do appendectomy. But the kinds of problems that we’re facing today, the kinds of treatments that we have, they are so complex that if we don’t invest the time upfront to educate patients, to make certain that they understand the disease they have, the treatment that will make it most likely to get better, if we don’t have a mutual commitment coming out of that meeting, I think it is going to fail. I think doctors wanted to protect themselves from their inability and their lack of success. They saw their job as telling patients. And I think we need to ask more and engage more. And I know a lot of listeners are going to say, “We don’t have time.” Somehow we find the time when the complications happen to treat the problems that ensue, we need to figure out how we can invest in the front to improve the outcomes of the back end, and minimize the need for rework and treatment of medical issues that could otherwise have been avoided.

Jeremy Corr:

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