Flourishing in Medicine: From Surviving to Thriving

Today, we are joined by Dr. Erica Miller and Dr. Emily Salib, educators and physicians from the University of Rochester.Dr. Erica Miller, MD, is a cardiologist and Assistant Professor at the University of Rochester. She serves as Program Director of the Internal Medicine-Pediatrics Residency Program. Dr. Emily Salib, MD, is an Assistant Professor of Medicine and Pediatrics at UR and a Med-Peds hospitalist who holds multiple faculty development and residency leadership roles.In this rich and deeply human conversation, Drs. Miller and Salib join Mick Krasner to explore awe in medicine and how wonder, moral beauty, connection, and transcendence can sustain clinicians amid the pressures of modern healthcare.We also cover:What awe is and Dacher Keltner's researchHow modern medicine may unintentionally train awe out of trainees and cliniciansHow to notice and cultivate awe in daily practiceNew research linking awe and sacred moments to lower rates of burnoutLearn from these two physician-educators about how awe might be a powerful, accessible, and overlooked resource for sustaining meaning and well-being in medicine.Dr. Erica Miller LinkedIn: https://www.linkedin.com/in/erica-miller-md/Dr. Erica Miller Profile: https://www.urmc.rochester.edu/people/112360726-erica-millerDr. Emily Salib Profile: https://www.urmc.rochester.edu/people/112360918-emily-salibGreater Good Science Center: https://greatergood.berkeley.edu/Awe by Dacher Keltner: https://www.amazon.com/Awe-Science-Everyday-Wonder-Transform/dp/1984879685A Grateful Day (by Brother David Steindl-Rast): https://www.youtube.com/watch?v=zSt7k_q_qRU&t=28sGratefulness.org: https://gratefulness.org/EmPro Website: https://www.myempro.com/EmPro Peer Support Program: https://www.myempro.com/peer-support/Physician Support Line: +1(888) 409-0141Physician Support Line Website: https://www.physiciansupportline.com/Dr. Krasner's Website: https://mickkrasnermd.com/Mindful Practice in Medicine Website: https://mindfulpracticeinmedicine.com/Chapters:(00:00) Introduction(06:35) Why Medicine(11:25) Defining Awe(13:35) Awe During the Pandemic(18:15) Awe & Clinicians(21:25) Cultural Fears(25:20) Awe with Colleagues(28:55) Connecting with Awe(32:00) Awe & Grief(37:00) Sacred Moments(41:00) Conclusion

Today, we are joined by Colleen Camenisch, MBA, Executive Director of the Nevada Physician Wellness Coalition.Colleen Camenisch, MBA, is an experienced Chief Executive Officer with a demonstrated history of working with leaders in the mindfulness industry and in the higher education industry and Medicine. She has a wide range of skills that include Management, Strategic Planning, Marketing Strategy, Mindfulness Based Interventions, and Public Speaking. Her strong business development experience with a post graduate training in International Business and Trade Law from United Nations' International Labour Organization (ILO) in conjunction with the University Institute of European Studies adds depth and a worldview rarely found in leaders of a community organization like the NPWC. She is a certified Mindfulness Based Stress Reduction Teacher and Teacher Trainer who regular teaches programs for the University of Massachusetts and Brown University.In the conversation, Colleen shares the deeply personal story of how losing her father to a likely medical error led her on a healing journey through mindfulness and eventually into transformative work supporting healthcare professionals.We also cover:The grassroots evolution of the Nevada Physician Wellness Coalition from responding to physician suicides to a dynamic statewide organizationHow mindfulness practice informs her leadership in navigating uncertainty and holding space for difficult conversationsThe coalition's innovative programs including peer support networks, hospital leadership collaboratives, and medical student mentorshipColleen concludes by envisioning a future where healthcare professionals feel safe, valued, and have time for meaningful patient care, while sharing her hope to replicate the coalition model nationally.Links: Nevada Physician Wellness Coalition: https://www.nevadaphysicianwellnesscoalition.com/ Colleen Camenisch’s LinkedIn: https://www.linkedin.com/in/colleen-camenisch-mba/ TEDx Reno Talk: https://www.youtube.com/watch?v=hQo-CQzoW24EmPro Website: https://www.myempro.com/ EmPro Peer Support Program: https://www.myempro.com/peer-support/ Physician Support Line: +1(888) 409-0141 Physician Support Line Website: https://www.physiciansupportline.com/ Dr. Krasner’s Website: https://mickkrasnermd.com/ Mindful Practice in Medicine Website: https://mindfulpracticeinmedicine.com/Chapters: (00:00) Introduction (03:00) Personal Origin Story and Loss (08:00) Finding Calling in Healthcare Support (11:00) Evolution of the Nevada Physician Wellness Coalition (15:00) Coalition Programs and Services (18:00) Collaborative Working Groups (24:00) Assessment and Net Promoter Score (25:00) Mindfulness and Leadership (30:00) Balancing Training with Broad Impact (33:00) Envisioning the Future of Healthcare (40:00) Conclusion

Today, we are joined by Dr. Susy Stirling, a Public Health Physician and Associate Dean based in Yorkshire & Humber, and Dr. Sandy Miles, a GP and Medical Educator in Devon, both from the United Kingdom.Dr. Susy Stirling MBChB, MSc, MPH, DCH, FFPH trained in medicine and after early career jobs in hospital medicine in the NHS, worked as a General Medical Officer in rural South Africa for 2 years. She returned to the UK to train in Public Health and was previously Lead for Migrant, Asylum Seeker and Refugee Health across the Yorkshire & Humber region.Dr. Sandy Miles is a GP and Medical Educator in Devon. Alongside her clinical role as a GP, she works in Postgraduate GP training, was Clinical Director of Eastleigh Primary Care Network and, together with Dr. Sam Powell, established popular retreats for doctors. In the conversation, Dr. Miles and Dr. Stirling share their journeys from early medical careers through personal challenges and discoveries that led them to focus on supporting healthcare professionals through storytelling, coaching, and addressing shame in medical practice.We also cover:How personal experiences with inequality, family history, and burnout shaped their paths toward supporting healthcare professionalsThe transformative power of medical humanities education and its impact on professional identityTheir collaboration on the National Health Stories experience, creating platforms for healthcare workers to share narratives of hope and humanityDr. Sandy Miles’ LinkedIn: https://www.linkedin.com/in/sandy-miles-4552a294/ Dr. Susy Stirling’s LinkedIn: https://www.linkedin.com/in/susy-stirling-469976146/Relevant Publications:Miles S. Addressing shame: what role does shame play in the formation of a modern medical professional identity? BJPsych Bulletin. 2020;44(1):1-5. doi:10.1192/bjb.2019.49Podcast Interview:https://youarenotafrog.com/episodes/152/Website Links & Phone Numbers:EmPro Website: https://www.myempro.com/EmPro Peer Support Program: https://www.myempro.com/peer-support/Physician Support Line: +1(888) 409-0141Physician Support Line Website: https://www.physiciansupportline.com/Dr. Krasner’s Website: https://mickkrasnermd.com/Mindful Practice in Medicine Website: https://mindfulpracticeinmedicine.com/Chapters:(00:00) Introduction(03:00) Origin Stories: Why Medicine?(08:00) Susy's Path from Medicine to Medical Education(11:00) Sandy's Journey Through Burnout and Recovery(17:00) The Transformative Power of Medical Humanities(31:00) Understanding Shame in Medical Identity Formation(38:00) The Genesis of National Health Stories(43:00) Using Shame as a Compass for Core Values(51:00) The Importance of Connection in Healthcare(59:00) Envisioning a Future Healthcare System(01:07:00) Conclusion

Today, we are joined by Charles Pfeffer.Charles is an organizational consultant and executive coach with over 30 years of experience helping leaders harness their own and their organization's inherent ability to create change through learning and adaptation. He guides partly through his listening skills, honed through a life-long engagement with self-awareness approaches and group dynamics training, guiding his clients to clarify what they want – for their enterprise, their teams, themselves, and the world. Has assisted executives across many varied industries and organizations, including FedEx, Xerox, DuPont, and Medifast, to align teams, develop leaders, communicate rigorously, and produce results, and has coached teams with assignments ranging from bringing the world's first production digital color printer to market to safely closing the NASA Space Shuttle program. Collaborating with Nvolv Partners, Charles worked with Starbucks and Save the Children to align leadership, strategy, and talent, and has teamed with Brimstone Consulting on strategic change initiatives at the New York Times, ExpressScripts, and the State of Maine. Working with the pioneering DEI firm, The Kaleel Jamison Consulting Group, Charles helped to bring the power of inclusion to accelerate strategy deployment at Merck, United Airlines, and EcoLab.In the conversation, Charles shares insights from his "accidental" journey into personal growth work and executive coaching, highlighting how he helps leaders navigate complexity and change while maintaining authentic purpose.We also cover:The fundamental question he poses to clients: "What do you want?" and how this simple inquiry can unlock deeper purposeHow organizations navigate change through disruption and the role of leaders in transforming systemsThe parallels between executive leadership challenges and healthcare professionals' experiencesThe connection between oath, authenticity, and purpose in professional identityHis vision for healthcare environments that provide calm, competent care through better alignment of capacity and demandCharles concludes by sharing his personal approach to flourishing, which includes time in nature - walking in the woods, kayaking, and skiing - as restorative practices that help him maintain balance while supporting leaders through complex challenges.Website: https://www.charlespfeffer.com/LinkedIn Page: https://www.linkedin.com/in/charlespfeffer/-Chapters:(00:00) Introduction(01:15) Charles Pfeffer’s Background(04:15) Charles' Journey into Personal Growth and Coaching(08:00) Early Influences and Moving Beyond Blame(10:30) The Concept of Polarities: Freedom and Responsibility(13:00) How Executive Coaching Works(17:00) Understanding Leadership and Organizational Complexity(22:45) The Challenge of Integration in Healthcare Systems(26:45) Complexity, Disruption, and Organizational Change(33:45) Flourishing Through Authentic Purpose(37:30) What Allows Charles to Flourish in His Work(41:00) Imagining a Better Healthcare Future(45:15) Personal Wellness Practices(46:15) Conclusion

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

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

The guest today is Pat Croskerry, MD, PhD, is a professor in emergency medicine at Dalhousie University in Halifax, Nova Scotia, Canada. Trained as an experimental psychologist, Dr. Croskerry went on to become an emergency medicine physician and found himself surprised by the relatively scant amount of attention given to cognitive errors. He has become one of the world's foremost experts in safety in emergency medicine and diagnostic errors. Dr. Croskerry is currently Director of the Critical Thinking Program within the Division of Medical Education, Dalhousie University. His interests lie primarily in clinical decision making, diagnostic failure, and the role of cognitive and affective bias in decision making. Recent work is aimed at cognitive bias mitigation.During this fascinating conversation, Pat shares his unique path to medicine, stemming from a background in psychology that instilled a focus on critical thinking and cognitive biases, and the discipline to study medicine, informed by his brief rowing career during which, as a member of the Canadian National Team he competed in the Olympic Games. He delves into specific biases affecting medical decision-making, such as emotional affective, anchoring, and search satisficing biases, stressing the need to mitigate these biases for accurate diagnoses. Furthermore, he explores the impact of cognitive load and decision fatigue on physician well-being, advocating for a reconsideration of critical thinking's role in modern medical practice to ensure optimal performance and professional satisfaction.Guest: Pat Croskerry, MD, PhD, FRCPLinkedIn Page: https://www.linkedin.com/in/pat-croskerry-199a8132/Wikipedia page: https://en.wikipedia.org/wiki/Patrick_CroskerryNEJM Interview: https://www.nejm.org/action/showMediaPlayer?doi=10.1056%2FNEJMdo002218&aid=10.1056%2FNEJMp1303712&area=Other references:Croskerry P, Clancy M. Advancing diagnostic excellence: the cognitive challenge for medicine. BMJ. 2022 Mar 29;376:o799. doi: 10.1136/bmj.o799. PMID: 35351777.Olson A, Rencic J, Cosby K, Rusz D, Papa F, Croskerry P, Zierler B, Harkless G, Giuliano MA, Schoenbaum S, Colford C, Cahill M, Gerstner L, Grice GR, Graber ML. Competencies for improving diagnosis: an interprofessional framework for education and training in health care. Diagnosis (Berl). 2019 Nov 26;6(4):335-341. doi: 10.1515/dx-2018-0107. PMID: 31271549.Croskerry P. From mindless to mindful practice--cognitive bias and clinical decision making. N Engl J Med. 2013 Jun 27;368(26):2445-8. doi: 10.1056/NEJMp1303712. PMID: 23802513.