Flourishing in Medicine: From Surviving to Thriving

The guest for this podcast was Dr. Christine (Tina) Runyan, a clinical health psychologist, the Co-Founder of Tend Health, and Professor in the Department of Family Medicine and Community Health at the University of Massachusetts Medical School. After starting her career as a psychologist in the US Air Force, she focused her research, clinical service, and teaching on behavioral science in family medicine as well as promoting models of integrated primary care. Dr. Runyan is also a mindfulness teacher at the University of Massachusetts Center for Mindfulness. At the height of the pandemic, recognizing the undeniable need for expert mental health services for healthcare professionals, she launched Tend Health.

During this conversation, Tina Runyan walked us through not only the collective effects on physicians and other health professionals of the COVID pandemic, but also highlighted how physicians, although remarkably resilient, resourceful, and empathic, have always had unique challenges in their continual facing into suffering and uncertainty. Not seeing even the most suffering among them as “broken,” she outlines the interrelated nature of systemic and individual responses to address these challenges. Calling upon our capacity to heal and make, as she describes it, that “U-turn” that moves our empathy forward towards compassion, she derives great joy in helping our most precious resource, the health professional, find value, purpose, meaning, and sustenance within the calling of medicine.

Knowing that systemic issues primarily drive their distress, she states, pragmatically: “My experience in working with a lot of distressed healthcare professionals is that the promise of that fix has been coming for a long time, right? It’s just around the corner, keep going, we’re going to get there. And it works at a fairly glacial pace. And there’s a lot of perverse incentives that are maintaining the status quo. And so, while I am very much in support of a lot of those systems fixing those systems drivers, in the meantime, we have a lot of people who are suffering.” Finally, she shared with us about Tend Health, a company which she began just a little more than 3 years ago with a colleague, that is exclusively dedicated to caring for the mental health and wellbeing of healthcare professionals. It is a fully telehealth platform for the full continuum of mental health care, coaching, counseling, medication management, individual offerings, and group offerings.

Guest: Christine Runyan, PhD

Tend Health website where you can find out more about Dr. Runyan and about the work of Tend Health: https://tend.health/

You can hear more about her perspective on COVID and mental health here:

https://onbeing.org/programs/christine-runyan

https://www.cnn.com/videos

https://www.youtube.com

Other mentions or references during the podcast:

A Piece of My Mind: Several collections have been made over the years of wonderful essays of stories in medicine published in JAMA. Here is one of them, and others can be searched for on Amazon.

Instructions: Poem by Rudy Francisco. Can be found here: https://genius.com/Rudy-francisco-instructions-annotated

The guest for this podcast was Dr. Tim Cunningham. Tim is Vice-President of Practice and Innovation at Emory Healthcare in Atlanta where he also functions as co-chief wellness officer for the Woodruff Health Science Center Office of Well-Being. In addition, he is an adjunct associate professor in the Nell Hodgson Woodruff School of Nursing.

Before joining Emory, Cunningham served as the director of the University of Virginia’s Compassionate Care Initiative. Clinically, his background is as an emergency/trauma nurse and he’s worked at multiple level-one trauma centers in the U.S. while also having served clinically in humanitarian crises such as the West Africa Ebola outbreak, post-2010 earthquake in Haiti, and in the ongoing humanitarian crisis on the Myanmar (Burma)/Bangladesh border.

His research and publications focus on methods to advocate for well-being while measuring the impacts of specific wellness-related practices. Cunningham’s co-authored book, Self-Care for New and Student Nurses (2020), examines ways to keep well-being relevant for the individual as well as for health systems. (I was fortunate to contribute a chapter to that book, which honored Dr. Dori Fontaine, the now-retired Dean of the School of Nursing at the University of Virginia.)

A registered nurse by clinical training with a specialty in emergency nursing, Tim holds a doctorate in Public Health from Columbia University. But perhaps his most important credential that gives him the authority to speak on flourishing is his work as a professional clown and involvement in Clowns Without Borders, where he has given humanitarian healing aide to some of the poorest and conflict-ridden settings on our planet.

In our conversation with Dr Cunningham, we explore how the burnout process touched his family and created a spark in him to become a health professional, and how important he has found staying connected with a sense of meaning to inoculate him against burnout. He discussed the challenges in his current role and challenges for chief wellness officers generally, with a practical approach of using empirical evidence to drive leadership innovation and change. He predicts that soon the return on investing in medical staff well-being will become a “no-brainer” with such strong evidence that he expects he will be out of this job at that point. And that will be just fine with him. You may find the parallels and connections he makes between clowning, theater, and healthcare not only entertaining, but also poignant as he shares personal stories of all.

His take on flourishing in medicine quite simply is about making space, as he says: “healing can really resonate when we create a space. Maybe it’s not us flourishing. Maybe this podcast should be about how we just let health flourish or healing flourish.”

Mentioned or referenced during the podcast:

Clowns Without Borders: clownswithoutborders.org

Unforgetting Compassion, TEDx Charlottesville:

Self-Care for New and Student Nurses by Dorrie K. Fontaine, Tim Cunningham, and Natalie May

Zen and the Brain: Toward and Understanding of Meditation and Consciousness by James H. Austin, M.D.

Media:

Linked In: http://www.linkedin.com/in/tim-cunningham-rn

Instagram: @timcunninghamrn

The guest for this podcast was Dr. Jillian Horton. Dr. Jillian Horton, a general internist who has served in multiple leadership positions at University of Manitoba’s Max Rady College of Medicine in Winnipeg. These have included: the inaugural Director of the college’s Faculty of Health Sciences programs in Physician and Learner Wellness; Director of the Alan Klass Health Humanities Program; and Associate Chair of the Department of Internal Medicine. Dr. Horton has also served as the Associate Dean of Undergraduate Student Affairs at the medical college. She has won numerous awards for mentorship, professionalism, and teaching.

Dr. Horton co-authored a poignant graphic novel, Medicine, which focuses on the intense challenges of a medical student. Her latest book, We Are All Perfectly Fine, a Canadian bestseller is a memoir about mindfulness, and reclaiming our full humanity – and a call to reimagining medical education. I encourage you to read this beautifully written, highly personal, provocative, humbling, and at times shocking look into bringing oneself completely to the serving of others in the medical profession.

During today’s conversation Dr Jillian Horton shares stories of how the resiliency within her family upbringing contributed to her choice of medicine as a profession and vocation. She speaks of how the character of Hawkeye Pierce in the TV series MASH and the persona of Alan Alda has been a blueprint for her survival. She challenges the pursuit of joy in medicine and has us instead examine deeply what is meant by joy and how we must first attend to foundational needs among the hierarchy of needs found in experiencing this human existence. She explores how relativism can often discount the need for humanism and the importance of meeting each person where they are in the medical encounter. The power of deep listening and the centrality of presence are messages she lives and offers as gifts for us to explore as we work towards flourishing in medicine.

Guest: Jillian Horton, MD

Mentioned or referenced during the podcast:

Med Life with Dr. Horton Podcast

Jillian Horton on Storytelling to Address Burnout, American Medical Association

Ask Dr. Horton Podcast

About the graphic novel Medicine, by Dr. Horton

Canadian bestseller We Are All Perfectly Fine: A Memoir of Love, Medicine and Healing by Dr. Horton

The guest for this podcast was Dr. Ronald Epstein. Ron Epstein is an internationally recognized physician, educator, researcher, and writer. He has published groundbreaking research into communication in medical settings and developed innovative educational programs that promote mindfulness, communication, and self-awareness. His over 300 scholarly articles and his book, Attending: Medicine, Mindfulness and Humanity, show how health professionals can flourish, building strong connections with patients and colleagues, optimize the care they provide and become more resilient. Dr. Epstein co-directs the Center for Communication and Disparities Research and Mindful Practice in Medicine Programs at the University of Rochester School of Medicine and Dentistry where he is Professor of Family Medicine, Oncology and Medicine (Palliative Care). A graduate of Wesleyan University and Harvard Medical School, he is recipient of numerous lifetime achievement awards relating to communication and humanism, a Fulbright fellowship in Barcelona, fellowships at the University of Sydney and the Brocher Foundation in Geneva, and the American Cancer Society’s highest award, the Clinical Research Professorship.

Attending: Medicine, Mindfulness, and Humanity is the first book about mindfulness and medical practice written for patients, their families, and for doctors and others providing health care. It is a groundbreaking, intimate exploration of how doctors approach their work with patients. From his early days as a Harvard Medical School student, Ronald Epstein saw what makes good doctors great, how they deliver more accurate diagnoses, make fewer errors, and build stronger connections with their patients. This set the stage for his life's work—identifying the qualities and habits that distinguish master clinicians from those who are merely competent. The secret, he learned, was mindfulness.

During today’s conversation, Ron spoke about some of his early experiences including his asthma that related to his choice of profession as well as his interest in meditation. He spoke of the ineffable quality of presence and how it is experienced in the medical context, with some ideas of how to cultivate it as a professional quality. He related flourishing to the way Walt Whitman speaks of the contradictions present in life experiences, and how medicine asks its health professionals to hold the dynamic tension as he put it between flourishing, joy, and suffering, and that his process involves radical acceptance. Reflecting on a famous talk given by Dr. Francis Peabody in 1927, he highlighted the difference between care of patients, caring for patients, and caring about patients.

Guest: Ron Epstein MD

Current Appointments Professor of Family Medicine, Oncology and Medicine (Palliative Care) American Cancer Society Clinical Research Professor Co-director, Center for Communication and Disparities Research Co-director, Mindful Practice in Medicine University of Rochester School of Medicine and Dentistry

Social Media:

www.ronaldepstein.com

www.mindfulpracticeinmedicine.com

Mentioned or referenced during the podcast:

Francis Peabody lecture: The care of the patient. By Francis W. Peabody, M.D. 1927; J Am Coll Health.1985 Apr;33(5):210-6. doi: 10.1080/07448481.1985.9939607.

A Brief for the Defense: From Collected Poems by Jack Gilbert. Copyright © 2012 by Jack Gilbert.

The guest for this podcast was Dr. Ni-Cheng Liang, a mother of two, wife, cancer survivor, pulmonary physician, and mindfulness teacher. Dr. Liang is the Director of Pulmonary Integrative Medicine at Coastal Pulmonary Associates affiliated with the Scripps Health Network. She also serves as a Voluntary Assistant Professor of Medicine at the University of California San Diego School of Medicine while volunteering for the UCSD Medical Student-Run Free Clinic for uninsured patients. She attributes allopathic medicine and participating in a clinical trial for ​saving her life from cancer, but integrative therapies, such as mindfulness meditation, acupuncture, and yoga for continuing to maximize her quality of life.

She returned to medical practice after cancer treatment passionate about promoting physician wellness, and teaching mindfulness to patients, healthcare professionals and their students. She was voted as a San Diego Top Doctor in the annual San Diego Magazine “Physicians of Exceptional Excellence” survey in 2017, 2019, 2021 and 2022 and awarded the 2019 American Lung Association San Diego Lung Health Provider of the Year and Outstanding Mothers Award. She is also the founder of the Mindful Healthcare Collective, an organization that seeks to provide free wellness sessions during the global pandemic, and co-host of the Mindful Healer’s podcast.

During today’s conversation, Ni-Cheng shared some of her inspirations for a life in medicine and the reciprocal relationship of the healer and patient. She talks about the challenges of lack of time and spaciousness in medical work and how mindfulness, by helping her to be present, seemingly opens the space and slows time. On the importance of meaning and joy in medicine, she describes joy and connection and gratitude as balms for wounds that are in healthcare. The Mindful Healthcare Collective that she created with her colleague Dr. Jesse Mahoney in response to the predictable effects the pandemic was having on health professional well-being, continues to be one of many ways that Dr. Liang contributes to helping her colleagues flourish. In this podcast, she states “To be a healthy flourishing healer, we have to make healing ourselves part of our daily practice.” Part of how she heals herself includes dragon boat racing with other breast cancer survivors like herself. Poignantly and inspiring, she shares “There’s something to be said about bringing joy and feeling empowered after the shared experience of suffering.”

Guest: Ni-Cheng Liang, MD, ATSF

Current Appointments: Director of Pulmonary Integrative Medicine Coastal Pulmonary Associates, Scripps Health Network UCSD Voluntary Assistant Professor of Medicine Mindfulness Teacher

Media:

mindfulhealthcarecollective.com

AwakenBreath.org

X (Twitter): @DrNiChengLiang

Instagram: Awaken_Breath

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