Let’s make compassion go viral [PODCAST]

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“We are social beings. Evolution has taught us that in order to survive, we must work together. Community trust (trusting your fellow citizen) is a very effective way to build community resilience when hardships strike. Studies have been done in the wake of natural disasters and have shown that social infrastructure and connections have equal, if not more, impact on the ability of a community to ‘bounce back’ than physical infrastructure.

During this terrible pandemic, let’s make compassion go viral. Let compassion be the vaccine for society. As so eloquently said by the Dalai Lama:  ‘Compassion is not religious business, it is human business, it is not a luxury, it is essential for our own peace and mental stability, it is essential for human survival.'”

Aseem Desai is a cardiac electrophysiologist and author of Restart Your Heart.

He shares his story and discusses his KevinMD article, “During this terrible pandemic, let’s make compassion go viral.”

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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. Today on the show, we have Aseem Desai. He’s a cardiac electrophysiologist. He’s the author of the book Restart Your Heart: The Playbook for Thriving with AFib, and he wrote the KevinMD article “During this terrible pandemic, let’s make compassion go viral.” Aseem, welcome to the show.

Aseem Desai: Thank you very much, Kevin.

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

Aseem Desai: Absolutely. I’m a cardiac electrophysiologist in practice in Southern California. My main focus is on AFib, but also a variety of other arrhythmias, and I do the whole gamut, from clinical care to robotic heart ablation and a variety of other technology uses.

In terms of my upbringing, I grew up in Chicago, and then I went to college and med school at Northwestern University as part of the seven-year med program, and then did all my postgrad training at Stanford. My first job was actually as faculty at the University of Chicago as an electrophysiologist, and then I landed in Southern California back in 2005. It’s been that long now, and I’ve been a practicing electrophysiologist here.

Kevin Pho: And as an electrophysiologist, how has the pandemic affected not only your practice but the patients you’ve been seeing as well?

Aseem Desai: Yeah, it’s interesting you ask that, Kevin. It’s almost like EP suits itself to telemedicine, because so many of our patients have implantable devices. So whether it’s a pacemaker, a defibrillator, or an implantable loop monitor, we’re able to assess our patients’ rhythm from a telemedicine standpoint. We can pull up most of the data online at the various vendor websites, and we can look at their real-time rhythm and at the arrhythmia history. So that has really, I think, been helpful in terms of remote monitoring and how we can use that to take care of arrhythmia patients.

What’s interesting is a lot of our patients, and in particular AFib patients, are really struggling right now. You have the emotional stress component, and we know about the brain-heart connection and how the autonomic nervous system certainly plays a role in triggering arrhythmias. Then you also have the increased rate of alcohol use, and alcohol is an enormous trigger for atrial fibrillation and other arrhythmias. And the last piece is that people are just less active, and we know that obesity and weight gain are also large triggers for atrial fibrillation.

So I think the pandemic has opened up a lot of doors in terms of how we can help people and really focus on lifestyle rather than just doing procedures. It really kind of helps us bring the focus back to lifestyle for people and how that can actually make a big impact on their arrhythmias.

Kevin Pho: All right, let’s talk about your KevinMD article, “During this terrible pandemic, let’s make compassion go viral.” Now, for those who haven’t read that article, can you walk my audience through it and maybe share the story of why you decided to write it?

Aseem Desai: Absolutely. I’ll start with some of my personal story. I went through physician burnout myself a few years ago. I had all the signs and symptoms. And I don’t know about you, Kevin, but whenever you’re faced with these different challenges in life, sometimes you have to fall really hard to have your eyes opened, and I think that’s happened to a lot of health care providers who have gone through burnout. During that time, I came up with the idea of a resilience toolbox, and so I started accumulating these different self-care tools, whether it was mindfulness or exercise.

The thing I came across was a conference a few years ago in San Francisco, the American Conference on Physician Health, and the prior surgeon general, the 19th surgeon general, Vivek Reddy, Murthy, excuse me, actually talked quite a bit about the epidemic of isolation and how we need to use compassion more in our own lives and for our fellow citizens. As I started going through the self-care and learning about techniques for self-compassion, it then resonated with me as things were happening in the pandemic. You sort of had this polarization: people who were actually lifting up and trying to help their fellow citizens, and then people who were obviously struggling and putting out a lot of negative energy, so to speak.

So that really got me interested in the idea of not just self-compassion, and how it’s really a skill, almost like a subset of mindfulness, but also how you can develop skills for compassion with others. People often think that we’re all sort of born with these inherited traits, whether you’re compassionate and intellectual or not, and that’s simply not true. A lot of science has now shown us that you can actually develop this sort of skill, almost like a mind muscle, a muscle memory kind of thing.

So the real focus of the article is how you can have a win-win-win during the pandemic. The first win, by helping another person, is that you help another person. And it’s important to distinguish empathy versus compassion. Empathy is stepping into someone’s shoes and sharing that experience. Compassion is doing that, but also doing something about it. It’s the action, and I think that’s the key part of compassion.

So the first win is really about, say, you go shopping for someone and help them get groceries. That’s their win. And then the win for you is the automatic mental boost and emotional boost, that dopamine boost of helping people, and there are a lot of studies that show that helping others really can affect one’s quality of life in a good way. And then the third win is this upward spiral you can see in a community. I talk about a couple of examples of natural disasters and how certain communities that had this sort of looking-out-for-each-other mindset actually recovered much faster from a physical infrastructure standpoint than communities that didn’t.

So this obviously has a lot of relevance now, not just in the pandemic but with what’s going on in politics in our country and everything else: the idea of really being thoughtful of whoever you’re interacting with and trying to develop that skill for doing so.

Kevin Pho: So a lot of my audience are primary care clinicians. I’m a primary care internal medicine physician myself. So can you walk us through some scenarios where physicians can practice that compassion and put themselves in that position for that win-win-win that you talked about?

Aseem Desai: Yeah, absolutely. So let’s talk about the individual physician. A lot of physicians or health care providers are really struggling right now. If they’re on the front lines, they’re getting burnt out. There are a lot of pressures from a variety of standpoints: intensivists who are having to take people off ventilators when no one else is in the room, and the sort of feeling of isolation.

So I think doing that compassion practice helps, and an example of that would be a loving-kindness meditation. A loving-kindness meditation is pretty well studied. You can even Google it; I talk about one in the article. You really start by focusing on yourself, and you say, “May I be happy. May I be safe. May I live in equanimity.” You can pick a variety of different phrases, and then you start imagining other people. So for a physician, for example, you may imagine a patient and say, “May you be safe. May you be healthy.” And then you can start to connect it to family members.

I think what’s key about the compassion part is that you start there, and then you start going into people you feel neutral about, and then into people you may have challenging relationships with, or people you don’t know whom you’re really struggling with when you’re watching them on TV or what have you. I think it really kind of takes you out of that fight-or-flight response and gives you more of a bird’s-eye view and a better perspective on how everyone is fighting a battle in some way, whether it’s internally or externally.

So I think for practicing physicians, if you take care of yourself and put your own oxygen mask on first, you’re going to be a better clinician. And there are a lot of physicians who are into mindfulness and are teaching these things in their practices, and you can use a variety of different tools that are out there. The Institute for Functional Medicine, for example, has a lot of tools to teach patients how to meditate or do these compassion practices.

Kevin Pho: What are some of the resources that physicians can look to if they want to practice more compassion? What kind of suggestions online can they read?

Aseem Desai: So my favorite app is Calm. I think it’s widely available; most people know about it. LeBron James actually just got on the app, so he’s talking about being in that flow state from an athlete’s standpoint. But that Calm app, for example, has so many different options in there, and there are several meditations on compassion and self-compassion. That’s partly how I learned about the loving-kindness meditation practice, actually, through the Calm app. But there’s Headspace, and there’s a variety of other online resources as well. I personally find the Calm app very helpful, and you can only take a few minutes a day, and it can really make a big difference for you and for the rest of the day and how you interact with other people, for example.

So I think a big teaching point that I learned myself, which can really make a difference, is that how you spend those first few minutes of the day can make a total difference in the rest of your day, personally as well as in how you can help other people. So for me, for example, I get up in the morning, I do a little spiritual reading, I do a meditation, I go for a run, and I do some kind of social interaction, whether it’s with my family or colleagues or what have you. It’s only a few minutes, but it really makes a big difference.

And that’s something that your audience, for example, may already be doing. And if they haven’t done it, they can take that micro step of trying something out, whether it’s just getting the free Calm app and trying a few meditations, but just taking that micro step for behavior change.

Kevin Pho: When it comes to physician burnout, a lot of it is because of external factors that are outside of physicians’ control. It could be the electronic medical record; it could be pressure from administration to see more patients. So without changing the systemic factors, I guess my question is: How effective can resilience training and mindfulness and meditation really be if we don’t fix the systemic factors that contribute to burnout?

Aseem Desai: That’s the key question, Kevin, and it’s a great one. That’s something they discussed at the conference on physician health that I went to several years ago, and you have ongoing discussions now in our health system, for example, in Providence. We’re talking about it as well. There’s that dichotomy, or that disconnect, between the values that an institution or health system states it has versus what it’s actually doing, and electronic health records are a great example of that. So it’s really a responsibility of the health system as well as the individual.

But as you said, you basically make a list: What are the things that you can do personally to take responsibility for helping to either reduce your burnout or prevent burnout? And I think a lot of it really comes down to that daily skill set. Mindfulness is not going to be enough to necessarily completely protect you from burnout, but it certainly will reduce the degree of burnout. Again, it’s about developing that personal resilience, and then you have this infectious effect. That’s kind of the idea of the article, too, this viral effect.

For example, people saw this shift in me. Even when I would go in and scrub down for an ablation in the EP lab, to do an AFib ablation, in the past I used to get stressed out. I’d hear the cath lab staff talking about their weekend plans as I’m doing an eight-hour flutter ablation, and it was really, really frustrating. As I started doing this mindfulness practice, it just put me into the zone, this flow state, and people notice it. Your colleagues notice it, and they say, “What are you doing differently?” So I think that kind of thing also can have an exponential effect. It doesn’t fix the whole problem of health care provider burnout, but I do think it has to start in many ways with the individual.

And I think more of us who practice really need to get involved in teaching others. I have some colleagues I’ve connected with through social media. For example, Jonathan Fisher is pretty well known in the social media circle for being a teacher of compassion and mindfulness for health care providers, and he’s done a lot of great work in that area, and he’s taught me a lot. So I think we can learn. Social media in particular, I mean, that’s how I connected with you. Social media in particular, I think, is an opportunity for physicians to not feel alone, and I’ve bonded with people across the Atlantic with whom I find we connect on certain things.

Oftentimes, I feel like with the things I’m interested in, it’s hard for me to find colleagues in the local area who may have those same interests, whether it’s mindfulness or what have you. But then I’m able to do it through Instagram, or I’m able to do it through Twitter, and I think that’s how we can use social media in a positive way.

Kevin Pho: We’re talking to Aseem Desai. He’s a cardiac electrophysiologist. He wrote the KevinMD article “During this terrible pandemic, let’s make compassion go viral.” Aseem, you’re also the author of the book Restart Your Heart: The Playbook for Thriving with AFib. Can you share with my audience a little about that book?

Aseem Desai: Yeah, absolutely. So I’ve had my own medical issues over the years, and when I was first diagnosed, I really could have used a credible playbook, something that’s easy to read, that walks me through what the disease is all about and then the next steps to take in terms of managing it. And that’s the idea I came to the playbook with.

One day, I was walking a gentleman out who had been in persistent AFib for five or six years, and he was told nothing could be done about it. He was told that by other cardiologists and by other physicians. And as electrophysiologists, we live and breathe AFib, and I was able to offer him some of the newer techniques and technologies, and he walked out in sinus rhythm. He turned to me, he teared up, and he said, “I wish I had known about this years ago. I wish I had some guide that took me through the process.” And then a light went off in my head, and I said, “I got to create this playbook.”

So the playbook is not just for patients with AFib. It’s actually for families, and it’s actually for your audience. It’s really hard to have a conversation with patients in a 15- or 20-minute office visit about AFib or other issues, and here you can provide a resource and say, “Hey, this is more information that you can learn.” And it’s an integrative approach, so it does incorporate things about diet and lifestyle and the brain-heart connection, but then also the technology part, and really the whole gamut of how to prevent AFib, identifying risk factors. It’s also a book for people who are obese, people who have diabetes, and people who have sleep apnea. So obviously, I see AFib as an initial audience, but really, it’s kind of got that broader effect.

And honestly, the reason why I wrote it in the beginning, Kevin, was the grieving process. I didn’t even know I was going to write about AFib. I had never written a book; I’ve written a lot of articles. My mom suddenly passed away from a cardiac arrest, and I was just overwhelmed with everything that happened: getting a call in the middle of the night that they were coding her, and I had no idea she was even sick. And so it was hard to process that.

For me, writing has always been a therapeutic thing. If you look at the introduction of the book, it’s actually the story of when I was a kid and my dad had a heart attack, and it kind of talks about these different things. And then it connects over into how these experiences have helped me be a better doctor and have allowed me to be more empathetic and compassionate for my patients. And that’s what led me to think: What would I want if I had AFib? What kind of credible source?

There’s a lot of misinformation out there on AFib. It’s a very individual disease. People talk about how so-and-so had five ablations and it didn’t work, or so-and-so had a pacemaker, or so-and-so’s doctor said, “Don’t do ablation; it doesn’t work.” And it’s not that it’s all about ablation, but the point being that we really need to deliver more credible information out there on AFib and other aspects of health.

Kevin Pho: One of the other KevinMD articles that you wrote was about a connection between atrial fibrillation and burnout. Can you just briefly share with the audience what that connection is?

Aseem Desai: Yeah, it’s interesting. There was a study that I referenced, and it actually was almost 12,000 people they followed over many, many years, almost 20 years, and they looked at different risk factors for burnout. They ended up discovering that the development of atrial fibrillation actually was strongly connected to burnout. And there are obviously a variety of other variables that go on in there, but AFib, like many other conditions, is a sort of systemic disease. It’s this inflammatory disease, and then you have the brain-heart connection that I mentioned.

And so it naturally makes sense that if you’re living in a chronic fight-or-flight response, which is really what burnout is, your autonomic nervous system is activated. So it’s going to increase your risk for cancer, it’s going to increase risk for stroke and a variety of other things, and it’s no surprise that AFib is now part of that. So I think it really highlights the relevance of AFib. It’s really arthritis of the electrical system. One in four people over age 40 at some point in life is going to get AFib. One in four people, one in four of your audience members. And that’s controlling for all the other risk factors. It’s an aging-related arrhythmia, among other things.

And then I think the last piece to mention about AFib and the concept of burnout is that we have a lot of young people now who are showing up with AFib, a lot of athletes, and there are reasons for that related to the autonomic nervous system and the vagus nerve. But the point being that you get this perfect storm of someone, for example, who has a lot of workplace stress, and then they’re drinking a lot of alcohol, and then all these other components, and then they get AFib. So it’s kind of an interesting twist on things, and just yet another reason to try to work on ways to prevent burnout.

Kevin Pho: Sure. And my final question is: What’s your take-home message that you want to leave with the KevinMD audience?

Aseem Desai: My take-home message is for those who don’t meditate to learn how to try, because it really makes a big difference, and especially during these times right now. We’re under so much stress that any kind of resilience toolbox or self-care can make a huge difference, and even small little steps every day can really make a big difference. So my advice is really to meditate, to be compassionate to yourself, and to be compassionate for others.

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

Aseem Desai: Thank you, Kevin.

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