Operate with Zen

Jeff Bloovman, BSN, RN, is an operating room nurse with really unique interests and perspectives on life.  He has been an actor and director, is currently a firearms and combat instructor as well as an avid practitioner and instructor of Brazilian jiu-jitsu.  Like many of us, Jeff is also challenged by an extremely active mind.  What do all of these experiences have in common?  They are all enhanced through mindfulness practices.  Whether focusing on a gun, your combatant, a theatre scene, or a busy operating room – being in the moment, both enjoying the moment and focusing in the present, can enhance the experience and the outcome.  I hope you enjoy this really fun conversation, I did! 

Below are some of the links referenced throughout Jeff’s conversation:

Practically Tactical Podcast: https://www.practicallytactical.com/episodes

Rolling Stone:
Pink Pistols: LGBT Gun Owners Unite in Arming Gay Community https://www.rollingstone.com/culture/culture-news/pink-pistols-lgbt-gun-owners-unite-in-arming-gay-community-177899/

Washington Post:
For years, he tried to get other gay people to the gun range. Would they come now?  https://www.washingtonpost.com/lifestyle/style/for-years-he-tried-to-get-other-gay-people-to-the-gun-range-would-they-come-now/2016/06/21/0f672b02-3724-11e6-9ccd-d6005beac8b3_story.html

Huffington Post Video:
At The Shooting Range With The Pink Pistols, A Gay Gun Group https://www.huffpost.com/entry/at-the-shooting-range-with-the-pink-pistols-a-gay-gun-group_n_5b4f4938e4b004fe162f865e

The Feed YouTube:  Gays & Guns: Fighting homophobia with bullets - YouTube

One Man Army (Discovery Channel): Season 1, Episode 1
https://www.discovery.com/shows/one-man-army/episodes/brothers-in-arms

Andrew Gabrielson, MD (@urogabe) is currently a resident at the Brady Urological Institute and Department of Urology at Johns Hopkins.  He is a budding pediatric urologist and developed an interest in surgical ergonomics and physical well-being before he started residency.  He is an integral member of the Society of Surgical Ergonomics and well-published in the field despite his young age!  He gives us lots of practical knowledge for the operating room (how to stand, how to set up your room, gel pads and shoes!) and a framework for incorporating ergonomics as a thought process to enhance our physical well-being as surgeons.  In addition, he talks about his experience and how following an interest piqued during undergraduate and medical school turned into a passion for the remainder of his professional life!  Enjoy!  Lots of links below including data supporting a lot of the discussion.

Society of Surgical Ergonomics

https://www.societyofsurgicalergonomics.org/

Twitter: @SocSurgErgo

Epidemiology of work-related pain among surgeons

Epstein, S. et al. Prevalence of work- related musculoskeletal disorders among surgeons and interventionalists: a systematic review and meta-analysis. JAMA Surg. 153, e174947–e174947 (2018).

Stucky, C. H. et al. Surgeon symptoms, strain, and selections: systematic review and meta- analysis of surgical ergonomics. Ann. Med. Surg. 27, 1–8 (2018)

Intraoperative and perioperative stretching

Park, A. E. et al. Intraoperative “Micro Breaks” with targeted stretching enhance surgeon physical function and mental focus: a multicenter cohort study. Ann. Surg. 265, 340–346 (2017).

Hallbeck, M. S. et al. The impact of intraoperative microbreaks with exercises on surgeons: a multicenter cohort study. Appl. Ergon. 60, 334–341 (2017).

Dorion, D. & Darveau, S. Do micropauses prevent surgeon’s fatigue and loss of accuracy associated with prolonged surgery? An experimental prospective study. Ann. Surg. 257, 256–259 (2013).

Monitor Placement

van Det, M. J., Meijerink, W. J., Hoff, C., Totte, E. R. & Pierie, J. P. Optimal ergonomics for laparoscopic surgery in minimally invasive surgery suites: a review and guidelines. Surg. Endosc. 23, 1279–1285 (2009).

Omar, A. M., Wade, N. J., Brown, S. I. & Cuschieri, A. Assessing the benefits of “gaze- down” display location in complex tasks. Surg. Endosc. 19, 105–108 (2005).

Erfanian, K., Luks, F. I., Kurkchubasche, A. G., Wesselhoeft, C. W. Jr. & Tracy, T. F. Jr. In- line image projection accelerates task performance in laparoscopic appendectomy. J. Pediatr. Surg. 38, 1059–1062 (2003).

Hanna, G. B., Shimi, S. M. & Cuschieri, A. Task performance in endoscopic surgery is influenced by location of the image display. Ann. Surg. 227, 481–484 (1998).

Table Height

Berguer, R., Smith, W. D. & Davis, S. An ergonomic study of the optimum operating table height for laparoscopic surgery. Surg. Endosc. 16, 416–421 (2002).

van Veelen, M. A., Kazemier, G., Koopman, J., Goossens, R. H. & Meijer, D. W. Assessment of the ergonomically optimal operating surface height for laparoscopic surgery. J. Laparoendosc. Adv. Surg. Tech. A. 12, 47–52 (2002).

Manasnayakorn, S., Cuschieri, A. & Hanna, G. B. Ergonomic assessment of optimum operating table height for hand- assisted laparoscopic surgery. Surg. Endosc. 23, 783–789 (2009).

Gel mats

Haramis, G. et al. Prospective randomized evaluation of FOOT gel pads for operating room staff COMFORT during laparoscopic renal surgery. Urology 76, 1405–1408 (2010).

Graversen, J. A. et al. Prospective randomized evaluation of gel mat foot pads in the endoscopic suite. J. Endourol. 25, 1793–1796 (2011).

Cognitive Ergonomics

Chrouser KL

Physical ailments are a part of life, and all surgeons will encounter physical pain or injury in their career.  Good friends and fellow surgeons, Angela Smith, MD, and Jay Shah, MD, (and repeat guests on the show) are no strangers to injuries.  In this podcast we discuss chronic and acute physical injuries from diagnosis through long-term changes to our surgical and work-out routines.  Coping mechanisms, management of pain in the operating room, adjustments to workouts, and evolution of personal identity are all discussed in this fun and inspirational hour.  If you have struggled or are struggling with a physical injury, this podcast is for you.  Enjoy!

Dr. Joan Naidorf, DO (https://www.drjoannaidorf.com/) is an Emergency Room physician who, through clinical experience, developed expertise in managing the difficult patient.  She is the author of “Changing How We Think About Difficult Patients: A Guide for Physicians And Healthcare Professionals” (https://a.co/d/fWLWY5W) and was featured in a Washington Post article on the topic (Some doctors don’t like some patients - The Washington Post).  While not being explicitly “mindful,” her approach to understanding and managing “difficult” situations employs concepts of intention, presence, and a non-judgmental approach to situations we all experience in healthcare.  Throughout this podcast, she will help you understand why patients may behave poorly and how our reactions and interactions may improve the experience.  I hope you enjoy!

Website: https://www.drjoannaidorf.com/

Book: https://a.co/d/fWLWY5W

Washington Post: Some doctors don’t like some patients - The Washington Post

Jeremy Grummet, MBBS, Master of Surgery, FRACS is a urologist in Melbourne, Australia and a world leader in prostate cancer imaging and diagnostics.  He is also a deep thinker and deeply interested in the wellbeing of surgeons and his colleagues.  Our conversation meanders through personal struggle, burnout or "spin" as Dr. Grummet calls it, mental illness, and emotional challenges associated with life and surgery.  Core concepts of modeling vulnerability, the dichotomy between being a caregiver and a recipient of care, as well as self care are woven throughout the conversation.  Jeremy is a master of thought and process, you will love this conversation.

Some of the books and references discussed:
School of Life, by Alain de Botton
Waking Up, by Sam Harris
Thriving Doctor, by Sharee Johnson
Know Thyself, by Craig Hassed

Dr. Carter Lebares, MD is a Gastrointestinal Surgeon at the University of California San Francisco and the Director of the UCSF Center for Mindfulness in Surgery.  In addition to being a thoughtful and skilled surgeon, she ran two randomized trials incorporating mindfulness based practices into surgery.   She developed ESRT or Enhanced Stress Resilience Training from principles of John Kabat-Zinn’s Mindfulness Based Stress Reduction (MBSR) to specifically apply to surgeons and surgical training.  With focused lessons and practical exposure Dr. Lebares has shown objectively that improvements in attentional focus, emotional recognition, and cognitive reappraisal learned through mindfulness translate into better surgical performance and training in and out of the operating room.  She tells us her story, how mindfulness impacted her career and continues to impact her development as a surgeon and human.  Dr. Lebares is one of my inspirations as we try to spread the benefits of a mindful approach to surgery and I enjoy every moment I get to speak with her.  I hope you enjoy as well!!

UCSF Center for Mindfulness in Surgery: https://mindfulsurgeon.ucsf.edu/

Randomized Trial in JAMA Network Open: https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2734060

Bradley Block, MD is an otolaryngologist in New York and founder of the “Physician’s Guide to Doctoring” podcast.  The founding principle of the Physician’s Guide is “all the stuff we should have learned in medical school but didn’t.”  While we only have an hour, we cover a lot of it!  We talk personal and professional development, social engineering and how it impacts patient and personal interactions, and vulnerabilities as a busy surgeon in a busy practice.  We settle on intention and exploring the WHY of so many things we do in medicine hoping the break the cycle of inefficiencies, improve our daily lives, and make the field better.  I really enjoy talking to Brad and I hope you do too!  Check out his podcast, the variety of topics are sure to grab your attention, and listen to some of the great guests he has interviewed!!!

Physician’s Guide to Doctoring Website: https://physiciansguidetodoctoring.com/

Apple Podcast: https://podcasts.apple.com/us/podcast/physicians-guide-to-doctoring-with-bradley-b-block-md/id1429047634

5 minute breathwork exercise.

Dharam Kaushik, MD is a urologic oncologist who does big time cancer surgeries.  He is also a researcher and educator at the University of Texas San Antonio where he runs the urologic oncology fellowship program and leads the kidney cancer research program.  Despite an upbringing in India and early exposure, he only recently picked up yoga as an outlet for wellness in his life.  We explore yoga and mindfulness as strategies to combat burnout and stress at work, but expand the discussion to other forms of physical activity that can improve our surgical well-being.  During the COVID pandemic, Dharam was certified as a yoga instructor and now expands his practice to healthcare workers at UT San Antonio – offering free classes to any employee or student who is interested.  And he doesn’t take it easy on them!  He talks and teaches about suffering and struggle in a yoga class as a great metaphor for surgery and life.  I love talking with Dharam and I hope you do too.  If interested in a yoga class or experience at a urology meeting, please find Dharam or I and join us or we can help to set it up.  

And stay tuned for some bonus content!  Dharam will take us through a breathwork exercise that you can use anytime to prepare for surgery, destress, or as part of your mindfulness routine.

Michelle Quirk, MD is a pediatrician and pediatric hospitalist in the Philadelphia area.  She is also a certified run coach and started Mindful Marathon (mindful-marathon.com) to help busy professionals develop well-being through running and fitness.  Importantly, Michelle was not always a runner, but over the years learned how to engage with her own personal wellness through running and fitness.  That engagement led to the Mindful Marathon passion project – by which trains doctors and other busy professionals how to run and coaches them through short- and long-distance challenges.  We talk about Michelle’s journey into running, how a pledge to patients to get healthier inspired her to be healthier and how running became a great stress outlet for her.  WE take many analogies from the running world and bring them into medicine and surgery including training, nutrition, and recovery.  I love talking to Michelle, I hope you enjoy too!

If interested in learning more about Michelle or having her be your run coach, you can find her at:

Mindful-Marathon.com

YouTube: @MindfulMarathon