“A few months ago, I embarked on an ethnographic study to understand what health care professionals saw as the psychosocial needs of pediatric patients. This involved conversations with several doctors in Pakistan, who had volunteered to share their views about pediatric patient care. As I engaged in deep, organic discussions with my interlocutors, I found doctors willing to explore personal experiences which had left indelible memories. I had somehow tapped into a need for them to reflect on their own struggles to gain trust, counsel, and understand patients psychologically and the impact this had on them. An unexpected by-product of my research was that I had created a safe space for doctors to unpack their emotions. While they appear clinical and detached, doctors have a heartbeat that races when they share personally meaningful stories about their work in rare places where they feel completely comfortable.”

Maryam Chloé Pervaiz is an anthropologist.

She shares her story and discusses her KevinMD article, “Listening to the doctor’s heart.”

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Hosted by Kevin Pho, MD, The Podcast by KevinMD shares the stories of the many who intersect with our health care system but are rarely heard from.

Transcript

Kevin Pho: Hi, and welcome to the show, where we share the stories of the many who intersect with our health care system but are rarely heard from. My name is Kevin Pho, founder and editor of KevinMD. Rate and review the show at KevinMD.com/rate. Subscribe at KevinMD.com/follow. Today on the show, we have Maryam Pervaiz. She is an anthropologist, and she wrote the KevinMD article “Listening to the doctor’s heart.” Maryam, welcome to the show.

Maryam Chloé Pervaiz: Thank you for having me.

Kevin Pho: So we’ll get into your article in a little bit, but first off, can you share your story and journey to where you are today?

Maryam Chloé Pervaiz: Yeah, so I suppose for as long as I can remember, I’ve been interested in science, but also in human stories. I think anthropology as a major really spoke to me in college, and so I picked that and stuck with it. And specifically, I wasn’t hyperfocusing on cultural or social anthropology. What really spoke to me was medical anthropology and telling those human stories in health care. One of my heroes is Dr. Paul Farmer, who was a physician and a medical anthropologist, and people like that really spoke to me and channeled that journey for me.

And so when I was looking into what to write for my thesis in undergrad, I was looking at all those elements of patient care: What does that mean? How do we humanize health care for patients and people? And so I looked first at home. I looked at Karachi in Pakistan, and I saw that one of the big teaching hospitals here had invited Dr. Patch Adams, who is an American physician, but a very unique physician. He likes to take that extra time with patients. He likes hour-long meetings instead of 15-minute meetings. They invited him in, and I went to them and said, “Well, what inspired you to do that?” They really wanted to talk about humanizing health care and what that means to them. And so through that, I was able to channel what I wanted to write about and think about.

And I got on board with them just on their first play therapy pilot program. They were assessing the psychosocial needs of pediatric patients through a child’s language, through that language of play, and using that for pain management, using that for all sorts of things. So I got to be a participant observer in that experience, talk to the clinical psychologists who were running it, see them at work with the patients and their families, and really understand what those needs were and how they were highlighted for the pediatric patients.

And now I’ve continued that journey. For my master’s thesis, I’m doing somewhat of a comparison between the U.S. and Pakistan and seeing what both sides see as the psychosocial care needs of pediatric patients, which leads me to the article, because I found one of the unexpected byproducts of this journey. I mean, I set out to understand the psychosocial needs of pediatric patients, and I came away learning more about the physicians. So that was fascinating for me.

Kevin Pho: Yeah, so let’s talk about that article. It’s titled “Listening to the doctor’s heart.” Now, for those of you who get a chance to read your article, can you just walk my audience through it and share the story of why you decided to write it?

Maryam Chloé Pervaiz: Yeah, so I work with someone very special, Dr. Suzanne Koven, and she always says, “You write when you sense there’s an unstable moment.” And I think that came to me when I was doing this research. I found that, more than relaying what the needs of the patients were, the physicians were talking about themselves and their journey. And I felt very grateful and special to be able to experience that and to be that safe sounding board for all of them. This was peak pandemic. Burnout rates were high, and it was a topic of discussion, and to be, in a way, at center stage and to see that from the front lines was very eye-opening. It really intrigued me, and I wanted to write about my experience and maybe explore why someone would talk to an anthropology student about that, why that need arose in them, what that means to me, and what that means for the future of physicians and such.

And so I talk about how, yes, there’s burnout, and yes, it’s been exacerbated by the pandemic, but there is a need for doctors in general to unpack their work, and they don’t necessarily take that home. Many hospitals do provide lots of different types of ways to combat that. They have groups, but they don’t seem to be working, or maybe we haven’t invested enough of our resources in that. And so I found that these wonderful health care professionals felt safe opening up to a third-party person who was just a sounding board for them and hopefully provided some comfort. That made me think, well, what if we had such systems in place, where someone totally removed from their work or family is listening to them or just letting them speak freely? So I think just listening to the doctor’s heart after they’ve listened to yours is a really interesting way to look at it.

Kevin Pho: So tell me about some of the stories that these clinicians have told you.

Maryam Chloé Pervaiz: So there was one gentleman. I hadn’t ever met him before, of course. This was a new field for me. I’ve been branching out, looking at health care professionals from all over Pakistan, and hadn’t met anyone before. I’d just been cold-calling people. And one of them spoke about a dialysis patient he had. It was a young child who required a transplant, and there was no match in the family, and it was proving to be a very tough situation. When they finally did find a match, it was wonderful, except that the child was extremely scared and would not want to go through the process.

And he found himself very conflicted, because the parents had given up. They said, “All right, we didn’t think she had long to live anyways. It’s all right. We can’t do this, so let’s just take her home and forget about it.” And he just had that moment where he said, “How can I just let this child pass away? How can that just happen?” And so he worked really hard. He found a friend who was a psychologist, and he said, “How can we work together to make her feel comfortable with the hospital, with me?” and so many things. And this is a story he hadn’t told anyone, and he just shared it with me. He was moved to tears at the thought of someone dying on his watch, but he was able to change that for her, and he saw the difference that he made.

And just something that powerful, or people telling me, as young junior doctors working in the NICU for the first time, about seeing an infant breathe their last breath. That’s something that takes a toll on you, but you have to move on. You have to continue with the rest of your day. If something like that happens at 8 a.m., you can’t go home. You can’t tell anyone. You can’t even stress your older colleagues or your younger colleagues. You just have to move on. And so, yeah, just many powerful stories like that.

Kevin Pho: So tell me about that intersection between medicine and anthropology. How can a background in anthropology make some people better physicians?

Maryam Chloé Pervaiz: Yeah, I think if you look at the example of someone like Dr. Paul Farmer and his team and Partners In Health, they’re really great examples of understanding not just, say, structural elements. We know what’s wrong with the health care system. We know even the structural elements of an individual: We may know what’s wrong with the body, and we’re trying to fix the body. But we are trying to understand the individual as well as the social surroundings, even maybe up to the political level, looking at it more holistically, seeing a person as a product of society and as an individual, and just understanding them, seeing where they’re coming from and their story. That’s when the real healing begins, and that’s when you can make a difference.

And I mean, you can give someone medicine, but if you watch his brilliant film, Bending the Arc, you can give them medicine, but if you don’t have someone to encourage them to take it, what will that do? And to have people they trust tell them to do things, for them to see a result, and for you to work closely with someone, that makes all the difference.

Kevin Pho: So you talked to so many medical professionals in Pakistan, and they shared their stories with you. What would you say are some of the biggest surprises you had after listening to all these stories from these medical professionals in Pakistan?

Maryam Chloé Pervaiz: Yeah, I think in Pakistan, and also just reading so much online about the greater global community, just experiencing so much of this burnout. We can’t just attribute it to the pandemic. I think it’s also highlighted a lot of the cracks in the system in general that have just been exacerbated by the pandemic. I think it’s how maybe the health care professional is failing the health care professionals, right? I think that’s a really tough one.

And I think, in a place like here, we are a resource-poor country. That is true. And our main push is to provide, as they told me, “We focus more on getting people medicine, getting people treated.” The psychosocial needs are very low priority on our lists, and where they are a priority, in bigger teaching hospitals, maybe they’re not given as much importance as they should have. And so I think, surprisingly, we’re all in the same boat, perhaps, is the main takeaway, which seems funny, but it’s true. Some may lack those psychosocial resources, not just for patients but for physicians, for older patients. Some may lack them, and some may have them, but they may not be working. So yeah, that’s something that I’ve taken away.

Kevin Pho: We’re talking to Maryam Pervaiz. She is an anthropologist, and she wrote the KevinMD article “Listening to the doctor’s heart.” Through your lens as an anthropologist, are there any takeaways or pieces of advice that you give to clinicians? Because obviously, as an anthropologist, you are heavily invested in human stories. So through that lens, give us some advice on how we as physicians can better connect with that patient in front of us in the exam room.

Maryam Chloé Pervaiz: I think one of the things that I’ve learned looking at both sides is that your fears and doubts are probably as valid as those of your patients. And I think that’s important to reflect on. On the health care professional side, we see ourselves as focused, detached: This is our job. Patients, we see them as vulnerable. But like I said, we’re all in the same boat.

And I think, in many ways, what’s most important, looking through that human lens and thinking about humanizing health care, is that we do need to share our stories. We do need to find those safe spaces. And I touch upon this in the article. I think that element of the third-party objective person was so important to establishing those relationships for me that I wonder if there’s any way we can curate that in the world. Not just maybe hotlines, but maybe some sort of volunteer service where you talk to physicians about why they joined, why they stayed in it, why they did it, and what’s not working now. So I think just unpacking that and creating those safe spaces is very important. It starts with feeling comfortable to share, sharing with each other, and then sharing beyond. And essentially, once you humanize health care for the professionals, we can definitely try to humanize it for the patients as well.

Kevin Pho: And my final question: What are some of your take-home messages that you want to leave with the KevinMD audience?

Maryam Chloé Pervaiz: I think just that we are all human. And I think, if anything, the pandemic has brought us closer together in many ways, which is important, and we should reflect on that. We should work toward creating those safer spaces for ourselves and those among us, and know that it’s OK to be vulnerable, and that, in many ways, is your strength, not your weakness.

Kevin Pho: Well, thank you so much for sharing your stories, time, and insight, and thanks again for being on the show.