Where does the joy and meaning in medicine dwell? [PODCAST]

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“The same question could be asked about the joy and meaning in medicine. Where does it dwell? And the answer may be the same. It dwells wherever we choose to let joy and meaning in medicine into our physician-healer lives.

As I look back upon my career, it saddens me to know that those doors to my dwelling were closed shut so often. For so often, I had not a clue as to where lay the key to unlock them. For so many years, this encounter would have been chalked up to another annoying, unfathomable “little old lady dizziness syndrome.” But, on that day, in that encounter, I was graced to have those doors opened by an 86-year-old, dizzy, square dancing roller skater.

I hope the doors of that dwelling never close again.”

Scott Abramson is a neurologist who blogs at Doctor Wisdom.

He shares his story and discusses his KevinMD article, “Where does the joy and meaning in medicine dwell?”

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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 Scott Abramson. He is a neurologist, and he wrote the KevinMD article “Where does the joy and meaning in medicine dwell?” Scott, welcome to the show.

Scott Abramson: Kevin, thank you so much for having me. I really appreciate it.

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

Scott Abramson: I was a neurologist at Kaiser Permanente in Northern California. I joined in 1979, and I retired in January 2020. So that’s 40 years; actually, if you add it up, it’s kind of parts of six decades, ’79 to 2020. So I retired in 2020, and it was a great career.

For the first 20 years of that career, I did what everybody else did. I was one of these find-it, fix-it, explain-it doctors, and I was competent at what I did. I took care of my patients, I kept good notes, and I have OCD in my DNA, so I could manage my clinic, and I thought I was doing a good job. I really did. And I didn’t feel burned out. It was tough, but I thought I was doing good.

But about 20 years into my career, Kaiser offered this communication course for its doctors, teaching bedside manner, you might say. I took that course, and then I became one of the leaders in that mission, and that changed my life so much. It changed my approach to how I dealt with patients, and it gave me such an incredibly better connection with patients and a better connection with joy and meaning in my own practice. So that’s my journey.

Kevin Pho: So what exactly did it teach you in this course that really changed your perspective on how you connected with patients?

Scott Abramson: Well, Kevin, the Kaiser model was, we called it, the Four Habits Model, and it’s like a lot of other communication models. We call it Four Habits. It’s the habit of establishing rapport quickly, getting the patient’s perspective, making an empathic statement, and closing the visit. And in each one of those things, there are a lot of skills.

For example, let me just give you one simple thing in, let’s say, habit one, which we call establishing rapport. Now, this may not, I know, Kevin, you’re a generalist, family medicine, but for those who have been consultants or hospital doctors or ER doctors, here’s just a real simple thing about establishing rapport that can make all the difference.

So, Kevin, if you were, let’s say, in the emergency room, and I were called down to see you as a neurologist, I might be saying something like, “Hello, Mr. Pho. I’m Dr. Abramson. I’m the neurologist,” or, “I’m from the neurology department,” or, “Your doctor in the ER called me to see you. I’m your neurologist.” That’s what we would traditionally say. But if we just use one different word, it can turn the whole connection around. So what if I come in and I say, “Hello, Mr. Pho. I am your neurologist”? I’m not just the neurologist who happened to come down here; I’m your neurologist.

And there are so many things in this communication course, in all of those different habits that we learned, that are just fantastic, just fantastic things that bring this connection to patients and bring greater joy and meaning into our lives as physicians.

Kevin Pho: Now, as you reflect on your long career in neurology, talk about some of the challenges the profession faced and some of the rewards that you faced, now that you have time to reflect on your career. So tell me about some of the challenges and rewards of your long career in neurology.

Scott Abramson: I think the challenges are like everybody else’s. It’s the challenge of being overwhelmed with so much to do and so little time to do it. And part of the problem, and part of the challenge, is from our own idea of who we are. A lot of us worked hard our lives to get into medical school. In middle school, in high school, we aced our PSAT, our SAT, our med boards, and we did things right. We always did things right. I mean, we memorized the Krebs cycle, for God’s sake. So now we’re in a position where we just can’t get everything right. We can’t answer all those messages on time. Maybe we should talk to a patient and call them back, or maybe we get a call from a page, and maybe we should work them in, maybe we should see them, but we can’t. And that just sort of chips away at our self-value, of who we are.

And I think the other thing is that most of us who go into this field see ourselves as compassionate people: “My gosh, I’m so compassionate. I want to save the planet. I want to save people, help people.” But we find that a lot of times, we just don’t have that compassion. I remember, right before I retired, I got a call from this family. Their loved one had Parkinson’s and was not doing well. They just: “Please, can you see him, Doctor?” I couldn’t see him. And instead of feeling compassion, I was feeling angry. I was saying, “Why are they calling me at 4:45 on a Friday?” I was sort of angry at them, I was angry at Kaiser, I was angry at myself for feeling angry at all this stuff, and frankly, I was feeling a little annoyed at God for creating all these people with defective basal ganglia. So I think that’s the thing: We see that we don’t live up to our measures of doing things right and doing it with compassion. It’s a struggle. It was a struggle for me all those years.

Kevin Pho: So let’s talk about your KevinMD article that you wrote, titled “Where does the joy and meaning in medicine dwell?” Now, for those who didn’t get a chance to read the article, can you just walk my audience through it and share the story of why you decided to write it?

Scott Abramson: Yeah, sure thing, Kevin, and thank you for giving me the opportunity. Actually, the title of the article was “Where does God dwell?” That was really the title, “Where does God dwell?” And really, I think one of the things that this communication course taught me, and what I learned in those last years, the last half of my practice, was to take joy in the mundane, in the everyday stuff.

So I’m seeing this lady. She’s 86 years old, her name is Eleanor, and she’s come to me for what we call “little old lady dizziness.” No one knows what it is. It’s there. And so she’s telling me her story. She’s 86 years old, and her husband died nine months ago. She said they met at a roller skating rink when they were 19. He was the cutest guy in the roller skating rink, and for the next 67 years, they skated together. They were friends, lovers, square dance partners, RV camping buddies, and all that. And so I’m listening to her story, and she had a good cry, and she had a good laugh. I couldn’t do anything about the dizziness. She left just as dizzy as she came in.

But as I’m driving home that night, I’m thinking, “Wow, I really felt good about the encounter.” I felt like I connected to someone. I felt like it was a real special moment, just talking with her. And I remember when my kids were little, I used to come home late at night and miss soccer practice or dinner, and they’d say to me, “Dad, Dad, how many lives did you save today?” And I thought to myself, if they had asked me on that night, I would say, “You know what? Maybe I did save a life.” But the life I saved was not Eleanor’s, because on that day, in that encounter, I allowed joy and meaning to bless my own life.

And so what does this have to do with “Where does God dwell?” Well, there’s a saying in the Jewish Bible. It’s a rabbi’s little story. A rabbi asks his students, “Where does God dwell?” And one student says, “Heaven.” One student says, “Well, we’re only humans. We can’t know where God dwells.” And the rabbi says, “No. God dwells wherever we choose to let God in.” And I think it’s the same thing with joy and meaning in medicine. Where does it dwell? It dwells wherever we choose to let it in. And I was so blessed that on that day, in that encounter, I was able to allow joy and meaning into my own dwelling. But for many years, honestly, I would have just written this, “Little old lady dizziness. Who can figure this out? Next patient.”

Kevin Pho: Now, you talked about some of the issues facing medicine, the pressures, the time pressures, and a lot of physicians I talk to are not able to see that joy and meaning in medicine. So talk about the lessons that you’ve learned from that encounter. How can other physicians learn from this story? How can they find joy and meaning in everyday encounters?

Scott Abramson: Believe me, Kevin, this is something that I struggled with every day that I was practicing. It wasn’t like a flip of a switch and all of a sudden, “Wow, everything is wonderful.” But I would work at it. And a lot of days, we always say, “Oh my God, I don’t have any compassion.” And we write this off to compassion fatigue: “Oh, wow, I give so much compassion to everybody. I just don’t have anything left.” See, I don’t believe that. I believe compassion fatigue is a myth. I believe that it’s not that we’ve given too much of ourselves, too much, and we just don’t have anything left. We don’t, I mean, we never, we don’t have it when we start out.

And I can attest to that. A lot of days, if you asked me what percent of my patients I felt actual compassion with, I might say maybe 5 percent on a good day. But there’s one thing we can do, and it’s a simple thing. I knew the answer all along, and I bet all of your audience knows the answer, and I’m sure you know the answer, but it’s a simple thing. All it is is just put yourself in their shoes. Put yourself in your shoes.

So that guy that comes in, he’s got this chronic back pain, and he can’t play catch with his son: Imagine yourself in that situation, not being able to play catch. A guy that’s up all night with an itch or a rash or something: Imagine yourself, what it’s like. Imagine yourself, what it’s like waiting on the other end of a telephone for the doctor to call you with a result, the anxiety that you have. If we can put ourselves in our patients’ shoes, I think that’s one step toward realizing the blessings that we have of being in the position we are.

Kevin Pho: We’re talking to Scott Abramson. He’s a neurologist. He wrote the KevinMD article “Where does the joy and meaning in medicine dwell?” Scott, as you reflect on your career, is there anything that you would have done differently in medicine if you were to do this all over again?

Scott Abramson: I wish that I would have taken this communication mission when I started out, because, like I said, Kevin, for the first 20 years of my career, my approach, like so many other docs, was, “What’s the matter? What’s hurting? Where does it hurt? Does it hurt on Tuesdays or Thursdays? What’s the matter? Let me find it, let me fix it, let me explain it all to you.” That was my approach.

So what I learned from the communication training at Kaiser is it’s not about, I mean, it is about what’s the matter. We’re doctors; we have to know that. But it’s a balance. It’s not just what’s the matter; it’s what matters, what matters to patients. I can see someone with a tension headache that’s gone on for years. They don’t need a whole explanation of what’s the difference between tension and migraine, what about SSRIs. Maybe they just need you to ask, “What are you most worried about?” “Well, Doctor, is this a brain tumor? Could it be an aneurysm?” If that’s what really worries them, and you can address that worry, then you’ve addressed what matters, what matters. And I just think that if I could have started out with that perspective, my dwelling would have been filled with a lot more joy and meaning for the first 20 years of my career.

Kevin Pho: My final question: What’s your take-home message that you want to leave with the KevinMD audience?

Scott Abramson: I think that probably, above all, the one message is to concentrate not so much, or balance it, not just on what’s the matter, but on what matters, what matters. And when you can make that connection to people, it not only will bring them closer to you, with more trust and more connection, and they’re going to be more compliant with your advice and have a better outcome, but you are going to experience more joy and meaning and connection with your patients in this profession that you’ve chosen.

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

Scott Abramson: Thank you, Kevin. I so much appreciate it.

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