First used in the context of Vietnam war veterans, the term "moral injury" refers to the psychosocial, behavioral, and spiritual distress that comes from perpetuating or witnessing events that contradict deeply held moral beliefs. In recent years, moral injury has increasingly been used to describe one of the main challenges clinicians face in modern medicine — the challenge of knowing what care patients need but being unable to provide it due to constraints beyond the clinicians control, such as limited time or misaligned financial structures. Even more than emotional exhaustion and detachment, moral injury leads to profound shame and guilt. One of the leading voices addressing moral injury among health care workers is Wendy Dean, MD, a psychiatrist who has written widely on the issue, most recently in her book, If I Betray These Words: Moral Injury in Medicine and Why it's So Hard for Clinicians to Put Patients First. In this episode, Dr. Dean shares her own winding journey from orthopedic surgery to general surgery and finally to psychiatry, discusses where moral injury comes from and what it looks like, and explores what clinicians can do to address it.

In this episode, you will hear about:

• Dr. Dean’s early explorations in medicine - 2:35
• How Dr. Dean’s desire to become a surgeon was deterred by gender discrimination - 5:12
• What led Dr. Dean to psychiatry, and then eventually out of clinical medicine entirely - 13:22
• A discussion of what moral injury is and why Dr. Dean began to study it - 18:03
• Examples of how moral injuries occur in the day-to-day of medical practice - 24:19
• How physicians and hospital administrators can address moral injury, citing as an example the court case of Raymond Brovont M.D. vs EmCare Holdings Inc - 38:57
• Dr. Dean’s advice for how navigate and push back against seemingly insurmountable bureaucracy - 42:22
• Moral Injury in Healthcare, the non-profit Dr. Dean founded - 47:39
• What setting personal and professional boundaries looks like in medicine - 53:04
• Dr. Dean’s advice to students and clinicians about fighting burnout - 57:37

In this episode, we discuss Achilles in Vietnam: Combat Trauma and the Undoing of Character by Jonathan Shay, MD, PhD, and The Business of Health Care is Built on the Exploitation of Doctors and Nurses by Danielle Ofri, MD, PhD.

Dr. Wendy Dean is the cohost of the Moral Matters podcast.

You can follow Dr. Dean on Twitter @WDeanMD.

Visit our website www.TheDoctorsArt.com where you can find transcripts of all episodes.

If you enjoyed this episode, please subscribe, rate, and review our show, available for free on Spotify, Apple Podcasts, or wherever you get your podcasts. If you know of a doctor, patient, or anyone working in health care who would love to explore meaning in medicine with us on the show, feel free to leave a suggestion in the comments or send an email to [email protected].

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When COVID-19 rapidly emerged, the World Health Organization (WHO) was thrust into an unprecedented challenge. The global pandemic response was in disarray; health care resources were limited and inequitably distributed; and misinformation burgeoned. At the center of this maelstrom was Soumya Swaminathan, MD, who served as the WHO’s first Chief Scientist, from 2019 until 2022. Dr. Swaminathan not only spearheaded efforts to disseminate the latest scientific findings about the coronavirus and vaccine development, but also became one of the major public faces of the WHO. In this episode, we discuss Dr. Swaminathan's formative years becoming a pediatrician in India, specializing in treating children with tuberculosis and HIV, as well as the challenges she faced as a leader at the WHO in a time of eroding public trust.

In this episode, you will hear about:

• Dr. Swaminathan’s experiences training to become a doctor in India - 2:05
• How Dr. Swaminathan discovered the balance between her interests in clinical medicine and research - 6:00
• Dr. Swaminathan’s reflections on the challenges of caring for children with tuberculosis and HIV - 9:38
• A discussion of global research funding disparity - 14:08
• How Dr. Swaminathan joined the WHO and eventually came to fill such a critical leadership role there - 19:04
• Dr. Swaminathan’s recollections of the arrival of COVID-19 from her perspective as the WHO’s first Chief Scientist - 21:28
• Lessons learned in health communication from the pandemic - 27:46
• The experience of being a lightning rod for online harassment and misinformation - 35:07
• Dr. Swaminathan’s advice to new clinicians who are considering pursuing a career in global health - 39:25

You can follow Dr. Swaminathan on Twitter @DoctorSoumya.

Visit our website www.TheDoctorsArt.com where you can find transcripts of all episodes.

If you enjoyed this episode, please subscribe, rate, and review our show, available for free on Spotify, Apple Podcasts, or wherever you get your podcasts. If you know of a doctor, patient, or anyone working in health care who would love to explore meaning in medicine with us on the show, feel free to leave a suggestion in the comments or send an email to [email protected].

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Navigating the unforgiving hours and ethical challenges of medical training while holding onto humanism; the medical and cultural history of the human heart; the moving journey of a doctor as he wrestles with his duties as a son and caregiver for a father with dementia. These are just some of the diverse subject matters our guest in this episode, Sandeep Jauhar, MD, has written about. Dr. Jauhar is the director of the Heart Failure Program at Long Island Jewish Medical Center and a multiple-time bestselling author whose writings have also appeared in the New York Times, Wall Street Journal, and other publications. In the first half of our conversation, Dr. Jauhar shares his journey in medicine and struggles with burnout; while in the second half, we discuss his poignant experiences caring for his father, the subject of his most recent book, My Father's Brain: Life in the Shadow of Alzheimer's. 

In this episode, you will hear about:

• How Dr. Jauhar’s immigrant parents influenced his choice to pursue a career in medicine - 2:02
• Dr. Jauhar’s reflections on the role of indecisiveness in shaping his path to cardiology - 4:49
• A discussion of a doctor’s struggle against a corporate medical system that inflicts moral injury on physicians - 12:51
• Dr. Jauhar’s advice to physicians on ameliorating moral injury - 18:54
• Reflections on how Alzheimer’s disease affects the patient’s family, and an overview of Dr. Jauhar’s recent book My Father’s Brain - 25:10
• A discussion of therapeutic deception, also known as validation therapy, in which caregivers and loved ones are encouraged to “play along” with the distorted reality of a patient with dementia - 36:43
• The conflicts between Dr. Jauhar and his siblings concerning end-of-life care for his father - 43:18
• How the medical system needs to changed so that more support is given to dementia patients and their families - 49:05

Dr. Sandeep Jauhar is the author of several best-selling nonfiction books: Intern: A Doctor’s Initiation, Doctored: The Disillusionment of an American Doctor, Heart, A History, and My Father's Brain: Life in the Shadow of Alzheimer's

Dr. Jauhar also responds to medical students and residents on his blog Advice on Your First Year.

You can follow Dr. Jauhar on Twitter @SJauhar.

Visit our website www.TheDoctorsArt.com where you can find transcripts of all episodes.

If you enjoyed this episode, please subscribe, rate, and review our show, available for free on Spotify, Apple Podcasts, or wherever you get your podcasts. If you know of a doctor, patient, or anyone working in health care who would love to explore meaning in medicine with us on the show, feel free to leave a suggestion in the comments or send an email to [email protected].

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Since 1938, the Harvard Study of Adult Development has followed the lives of hundreds, and eventually thousands, of American adults, with the goal of discovering what enables people to live healthier, more meaningful lives. Joining us in this episode is Robert Waldinger, MD, professor of psychiatry at Harvard Medical School and the current director of the study. He is the author of the book The Good Life: Lessons from the World's Longest Scientific Study of Happiness. Over the course of our conversation, we explore the origins and evolution of the study, what adult development actually means, whether happiness is a choice, how social media shapes our relationships, Dr. Waldinger's interests in Zen Buddhism, and the key to leading a fulfilling life.

In this episode, you will hear about:

• What drew Dr. Waldinger to the field of psychiatry - 1:53
• Dr. Waldinger’s reflections on the work and daily practice of a psychiatrist - 3:31
• An overview of the Harvard Study of Adult Development, the longest running scientific study on happiness - 6:54
• The medical and psychosocial concepts of “adult development” - 9:49
• The most important and surprising findings of the Study of Adult Development - 16:20
• Why relationships are critical to health and happiness - 23:07
• How social media distorts reality and why it can be quite harmful to mental health - 29:37
• Whether happiness is a choice - 34:48
• The impact of Zen Buddhism on Dr. Waldinger’s life and work - 43:55
• Dr. Waldinger’s advice to clinicians on leading fulfilling careers - 50:02

In this episode, we discuss the book Wherever You Go, There You Are, by Jon Kabat-Zinn.

Dr. Robert Waldinger is the author of The Good Life.

You can view Dr. Waldinger’s acclaimed TED Talk What Makes a Good Life.

You can follow Dr. Waldinger on Twitter @RobertWaldinger.

Visit our website www.TheDoctorsArt.com where you can find transcripts of all episodes.

If you enjoyed this episode, please subscribe, rate, and review our show, available for free on Spotify, Apple Podcasts, or wherever you get your podcasts. If you know of a doctor, patient, or anyone working in health care who would love to explore meaning in medicine with us on the show, feel free to leave a suggestion in the comments or send an email to [email protected].

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When we hear about people with cancer, the stories often end when the treatments end—either the battle has been won and the cancer cured, or in more tragic circumstances, the cancer takes the patient's life. But for patients who survive, that's not where the story ends. Cancer has fundamentally transformed their lives. How are they to make sense of the existentially threatening experience they have gone through? That's where cancer survivorship comes in. Joining us in this episode is Tara Sanft, MD, director of the survivorship clinic at Yale Cancer Center, where she helps patients thrive after cancer. Dr. Sanft is also a breast oncologist and the Chief Patient Experience Officer at Smilow Cancer Hospital. In this episode, we discuss the importance of cancer survivorship, how Dr. Sanft navigates the emotional challenges of her work, and what all clinicians can do to better support patients through difficult times.

In this episode, you will hear about:

• How the death of a family member influenced Dr. Sanft’s decision to go into medicine - 2:04
• Why Dr. Sanft’s decided to focus on palliative care - 6:02
• Reflections on how communication and building relationships are key to palliative care - 14:20
• A discussion of cultivating sacred moments in medicine - 19:53
• The purpose of a cancer survivorship clinic - 26:02
• A discussion of the most challenging aspects of Dr. Sanft’s practice - 33:35
• How Dr. Sanft shoulders the emotional toll of her work - 36:30
• Dr. Sanft’s duties as the Chief Patient Experience Officer at her hospital - 40:25
• How to create culture change in medicine - 43:17
• Dr. Sanft’s advice to clinicians on how to better foster self-compassion and create effective healthcare teams - 48:18

You can follow Tara Sanft on Twitter @TaraSanftMD.

Visit our website www.TheDoctorsArt.com where you can find transcripts of all episodes.

If you enjoyed this episode, please subscribe, rate, and review our show, available for free on Spotify, Apple Podcasts, or wherever you get your podcasts. If you know of a doctor, patient, or anyone working in health care who would love to explore meaning in medicine with us on the show, feel free to leave a suggestion in the comments or send an email to [email protected].

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In the Judeo-Christian tradition, the Sabbath is a day of rest during the week. Our guest in this episode, Judith Shulevitz, is a journalist and literary critic who has thought deeply about what the secular world can learn about meaningful rest from the practice of the Sabbath. In her book The Sabbath World: Glimpses of a Different Order of Time, she explores how, despite our culture of workaholism, we can still discover the restorative joy of rest, reflection, and family. Shulevitz is also a regular contributor to the New York Times and the Atlantic, and is the chief science writer of the New Republic. Over the course of our conversation, we discuss the origins of the Sabbath, the ideals this tradition can bring back for the individual and community, and how clinicians can create space for purposeful rest amid their busy lives.

In this episode, you will hear about:

• What drew Shulevitz towards re-engaging with her Jewish faith as an adult - 2:50
• What observing the Sabbath looks like in a traditional Jewish household - 5:20
• An exploration of the idea of a “secular Sabbath” and what it could mean for the modern world - 10:33
• The relentless culture of medical residency training and the factors contributing to it - 13:00
• How medical training affects physicians’ sense of community - 36:37
• Shulevitz’ advice to those with very busy schedules on how to make space for purposeful rest in their lives - 38:52
• Reflections on the need for physicians to process the extremes of emotion and suffering they encounter - 47:36
• Why it is critical to be present in the real world during times of rest - 50:45

Judith Shulevitz is the author of The Sabbath World: Glimpses of a Different Order of Time.

You can follow Judith Shulevitz on Twitter @JudithShulevitz.

Visit our website www.TheDoctorsArt.com where you can find transcripts of all episodes.

We are joined in this episode by Eric Reinhart, MD, an anthropologist, psychoanalyst, and psychiatry resident at Northwestern University Feinberg School of Medicine. While Dr. Reinhart is the first resident-in-training we've had on this program, his path has been far from straightforward. Prior to residency, Dr. Reinhart conducted ethnographic work in Chicago's South Side, India, South Africa, and migrant communities in Southern Europe. Through this research, he addresses the multifaceted effects of poverty and social inequities on community health. In this conversation, we discuss how he applies his anthropology training to create culturally sensitive systemic changes and how healthcare providers can play a more active role in engaging with their communities.

In this episode, you will hear about:

• How having a deaf brother led Dr. Reinhart to medicine - 1:54
• Dr. Reinhart’s observations of the disconnect between the ideals he heard in medical school and the reality of how profit-driven hospitals operate - 5:59
• Why Dr. Reinhart pursued a study in anthropology to learn how to address contemporary social ills - 12:46
• How a case study of drug-resistant tuberculosis in Russian prisons informed Dr. Reinhart’s evaluation of pandemics - 19:37
• What drew Dr. Reinhart to psychoanalysis and psychiatry, and how he applies them to his field studies - 26:41
• A discussion of the power structures inherent to medico-social field work and how to properly determine what a community needs - 32:04
• Advice on how doctors and medical trainees can become empowered to help change the systems they work in - 41:21
• How Dr. Reinhart hopes to apply his experiences to improve community-based care - 48:42

You can follow Dr. Eric Reinhart on Twitter @_Eric_Reinhart.

Visit our website www.TheDoctorsArt.com where you can find transcripts of all episodes.

If you enjoyed this episode, please subscribe, rate, and review our show, available for free on Spotify, Apple Podcasts, or wherever you get your podcasts. If you know of a doctor, patient, or anyone working in health care who would love to explore meaning in medicine with us on the show, feel free to leave a suggestion in the comments or send an email to [email protected].

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The wellness industry saturates our cultural consciousness, with juice cleanses, organic skincare, and spa retreats flooding our social media feeds. But what does this plethora of dazzling — and often-expensive — lifestyle products all amount to? Not much, argues Pooja Lakshmin, MD, a psychiatrist who specializes in women's mental health and clinical assistant professor at George Washington University School of Medicine. As she writes, "our understanding of self-care and wellness is incomplete at best and manipulative at worst. We cannot meditate our way out of a 40 hour workweek without childcare. These wellness products keep us looking outward, comparing ourselves with others or striving for perfection." She details her ideas for achieving true wellness in her recently released book, Real Self-Care: A Transformative Program for Redefining Wellness. In this episode, Dr. Lakshmin joins us to discuss how she overcame her own struggles working in medicine and details practical strategies for real self-care, which, in her words, "isn't a thing to do or buy, but a way to be." 

In this episode, you will hear about:

• How Dr. Lakshmin’s rocky initial foray into medicine led her a career in psychiatry - 2:15
• Dr. Lakshmin’s disillusionment with medicine, her two years away from the profession, and what she learned from immersing herself in the wellness industry - 5:34
• Reflections on the state of the wellness industry - 10:42
• An overview of Dr. Lakshmin’s book Real Self-Care and what real self-care looks like - 15:52
• A deeper dive into the first principle of real self-care: boundary setting - 18:47
• A discussion of how the American healthcare system often exploits doctors and nurses - 24:25
• The second principle of real self-care: self-compassion - 32:08
• The third principle of real self-care: knowing your values - 38:44
• The fourth principle of real self-care: empower oneself to create change - 45:09
• Dr. Lakshmin’s advice on getting control of your self-care journey - 50:43

In this episode, we discussed the essay The Business of Healthcare Depends on Exploiting Doctors and Nurses by Dr. Danielle Ofri, published in the New York Times.

We also discussed Dr. Lakshmin’s article How Society Turned its Back on Mothers, published in the New York Times.

Dr. Pooja Lakshmin is the founder and CEO of GEMMA, a women’s mental healthcare education community focused on impact and equity.

You can follow Dr. Pooja Lakshmin on Twitter @PoojaLakshmin.

Visit our website www.TheDoctorsArt.com where you can find transcripts of all episodes.

If you enjoyed this episode, please subscribe, rate, and review our show, available for free on Spotify, Apple Podcasts, or wherever you get your podcasts. If you know of a doctor, patient, or anyone working in health care who would love to explore meaning in medicine with us on the show, feel free to leave a suggestion in the comments or send an email to [email protected].

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Approximately 1 in 700 babies in the United States are born with Down Syndrome. Yet, despite how common this condition is for people, we don’t often have the chance to hear their stories. In this episode, we are joined by Dashiell Meier, a young aspiring filmmaker and disability advocate who has Down Syndrome. Over the course of our conversation, we have the wonderful opportunity to explore how Dashiell sees the world as he reflects upon the stereotypes that society holds against people with disabilities, discusses what makes his favorite doctors stand out, shares his passion for storytelling, and offers advice to clinicians on how to better connect with patients who have disabilities.

In this episode, you will hear about:

• How Dashiell currently helps Stanford medical students learn to communicate with patients with disabilities - 1:47
• Dashiell’s academic interests and career aspirations in the entertainment world - 3:22
• Dashiell’s interactions with doctors and what makes his favorites stand out - 5:22
• A discussion of the stereotypes that people with Down Syndrome face - 7:42
• What Dashiell wishes people knew about Down Syndrome - 11:00
• The movement for people with disabilities that Dashiell is spearheading, and what he hopes to achieve through it - 19:10
• Advice on building good relationships with people who have disabilities - 27:00
• The projects Dashiell intends to create as a filmmaker - 32:04
• How to develop greater empathy for people with disabilities - 34:46
• Advice to new clinicians and trainees on how best to interact with patients with disabilities - 37:10

You can follow Dashiell’s film and video projects on his YouTube channel. You can also follow him on Twitter @DashiellMeier.

Visit our website www.TheDoctorsArt.com where you can find transcripts of all episodes.

If you enjoyed this episode, please subscribe, rate, and review our show, available for free on Spotify, Apple Podcasts, or wherever you get your podcasts. If you know of a doctor, patient, or anyone working in health care who would love to explore meaning in medicine with us on the show, feel free to leave a suggestion in the comments or send an email to [email protected].

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From Tanzania to India, from Tibet to Antarctica, Jonathan Reisman, MD, our guest in this episode, has practiced medicine in truly diverse regions of the world. Dr. Reisman's talents and passions are unparalleled in their variety; he is, among many things, an emergency physician, naturalist, food writer, travel writer, and wilderness survival expert. He is the author of The Unseen Body, an exploration of the human anatomy through all of its miraculous, mundane, bizarre, and surprising parts, presented through the eyes of a lifelong adventurer. Over the course of our conversation, Dr. Reisman shares his experiences traveling through the most remote areas of the world, what his voyages have taught him about health and illness, the impact of emerging digital technologies on the doctor-patient relationship, and much more.

In this episode, you will hear about:

• How a love of the natural world led young Dr. Reisman to travel abroad and ultimately to the medical profession - 2:04
• Dr. Reisman’s early adventures studying sociology in the Russian Far East - 5:30
• The parallels between exploring the natural world and the human body - 9:26
• The puzzle-solving aspects of medicine and the impact of emerging technologies and artificial intelligence - 12:18
• Dr. Reisman’s reflects on his time practicing medicine in India, Tanzania, Nepal, and Antarctica, and the importance of the physical exam in these settings - 21:15
• The strengths and limitations of the physical exam, especially as they relate to the clinician-patient relationship - 31:53
• How artificial intelligence will complement human physicians in the future - 36:38
• What Dr. Reisman believes is critical to the future of medical education - 46:12
• Dr. Reisman’s advice to young clinicians on how to keep their curiosity alive - 55:10

Dr. Jonathan Reisman is the author of The Unseen Body: A Doctor’s Journey Through the Hidden Wonders of the Human Anatomy.

Visit our website www.TheDoctorsArt.com where you can find transcripts of all episodes.

If you enjoyed this episode, please subscribe, rate, and review our show, available for free on Spotify, Apple Podcasts, or wherever you get your podcasts. If you know of a doctor, patient, or anyone working in health care who would love to explore meaning in medicine with us on the show, feel free to leave a suggestion in the comments or send an email to [email protected].

Copyright The Doctor’s Art Podcast 2023