Operate with Zen

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

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.

5 minute breathwork exercise.

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

Dr. Elizabeth "Betsy" Koehne, MD is at the wonderful transition between training and complete surgical independence. She is a urologist and Acting Instructor and Society of Urologic Oncology fellow at the UW School of Medicine in Seattle. While she is may be junior is her surgical experience, she is seasoned in transcendental meditation, yoga, and incorporating mindfulness into her daily and surgical existence. I learn a ton from Betsy every time we speak and I hope you enjoy this conversation.

Dr. Bradley Erickson is a Professor of Urology, a reconstructive urologist, and Director of Functional Urology at the University of Iowa. We are great friends and bonded over similar loves of baseball and skiing – sharing quite a few lift rides and challenging mountain runs in Colorado. Brad is also an extremely accomplished academic surgeon from very early on in his career – in fact, that’s what brought us together. I say this all because i had no idea, about 2-3 years into his practice, he had a major breakdown and called into question all of his motivations and purpose in surgery. This podcast covers that breakdown and his pathway back to purpose through the darkness of anxiety and insomnia. We talk about mindfulness meditation, dharma and the three H’s of hands, head, and heart, and achieving self-awareness and presence. Throughout the podcast we talk about the insane privilege of being a surgeon and how that impacts us all as human beings. I hope you enjoy.

Diana Londoño, MD is a urologist in Los Angeles with a specific interest in coaching surgeons through tough times. She is the founder of Physician Coach Support (https://physiciancoachsupport.com/), a free peer-to-peer service for surgeon personal development. She is a mom, a yogi, and so much more! We discuss how Buddhist principles guide coaching, how being both a healer and a teacher are important to our roles as surgeons, and gives practical tips on how to organize a surgical life for well-being. Enjoy! https://dianalondonomd.com/ https://physiciancoachsupport.com/

Jason Han, MD is a cardiac surgery resident at the University of Pennsylvania, a columnist for the Philadelphia Inquirer, and the founder of The Modern Surgeon. Jason provides unique perspective from a trainee with his eyes uniquely on the future - he graduates from residency this year! We talk about the changing perspective from student, to trainee, to surgeon and how being present and simplifying one's own principles can keep you grounded. We stumble across this podcast's title, "The Space Between Technique" when we discuss all the things missing from surgical education - how to think and behave, not just operate. It's a great conversation and I hope you enjoy! Philadelphia Inquirer: https://www.inquirer.com/author/han_jason/ The Modern Surgeon: https://www.themodernsurgeon.org/ https://twitter.com/modern_surgeon https://www.instagram.com/themodernsurgeon/?hl=en

Kristin Chrouser, MD, MPH is an Associate Professor of Urology at the University of Michigan and Section Chief of Urology at the VA in Ann Arbor Michigan. She is an expert in intraoperative stress - something all surgeons are familiar with - and tackles it through a variety of academic avenues. We discuss physical stress through ergonomics and pain both in and out of the OR. We talk about the OR environment and mindsets that are conducive to a healthy and long surgical career. And we talk about how pain is the manifestation of so many stressful events in our life - whether they be physical, emotional, or psychological. This conversation is fun and full of practical pearls on how to keep yourself pain free and healthy.

Louise Phipps Senft is the founder and CEO of Baltimore Mediation. She is a well-respected attorney and mediator. Louise practices "Transformative Mediation" in a number of complex settings -uniquely in healthcare - where techniques of mindfulness (like presence and non-judgement) are implemented routinely. She is an expert in personality assessment, personal and relational interactions. In addition, Louise is the host of "Blink of an Eye" Podcast (https://blinkofaneyepodcast.com/) which chronicles her families experience with trauma, the medical field, and awakening. I love talking with Louise and I hope you enjoy the conversation. References: https://www.baltimoremediation.com/louise-phipps-senft-bio/ https://blinkofaneyepodcast.com/ Books The Essential Enneagram The Body Knows the Score

Humans are creatures of habit who crave control in sometimes uncontrollable circumstances. In this episode, OWZ regular Angie Smith, MD and Professor of Urology at UNC Chapel Hill and I discuss "control" in a variety of surgical settings. Control in the operating room, control in patient encounters outside of the OR, control over how we structure our lives, and how we achieve balance. Parallels are drawn to illness uncertainty for patients and the conversation weaves through vacations, Nietzsche, mirror neurons, and fear. I hope you enjoy.

David Canes, MD is a urologist at the Lahey Clinic in Boston. He is incredibly thoughtful in his approach to medicine and his approach to life outside of medicine. Early on in this podcast, we discuss not letting urology [or surgery] to be the only thing of which you are proud. We talk passion projects and David's newest adventure (wellprept.com). And we talk about ways to avoid "pressing play" - David's analogy for just going through the motions with a patient, but creating the environment in which you can be truly present with a patient, with a surgery, with your family, or your next adventure. Enjoy!! Check out WellPrept at: https://wellprept.com/

Amanda North, MD is an accomplished Pediatric Urologist at Montefiore in the Bronx. She is also an outstanding advocate for surgeons - leading the movement to understand burnout in our specialty (urology) and women in surgery. Our conversation meanders through fascinating topics with a focus on the key components of a sustainable career. We even touch on Ted Lasso (see picture behind her).

Chris Jaeger, MD is currently a pediatric urology fellow at Boston Children's Hospital. He is a recent graduate from the Ohio State urology residency where he co-created and implemented a 12-week wellness program for the residents. Chris shares his experience with the research protocol, thoughts on institutional wellness, and identifies "priority domains" highlighted by his work and reflected in his daily wellness practice. An excellent episode especially for trainees as they transition from residency to fellowship (or beyond). And great for anyone involved or interested in a surgical trainee's experience.

Kyle Richards, MD, FACS is an Associate Professor and Urologic Oncologist at the University of Wisconsin. This is his second OWZ podcast. In this episode we talk about managing complications in a mindful way. Starting with the emotions that arise when something bad happens to one of our patients, we discuss how to engage members of the team, the patient, and the patient's family to improve everyone's outlook and outcome.

Neda Gould, PhD is a clinical psychologist in the Department of Psychiatry and Behavioral Sciences at Johns Hopkins. She is also the Director of the Mindfulness Program at Johns Hopkins for faculty and staff. In this episode, we talk through the scientific foundations of meditation practice and how to incorporate them, practically, into your life as a busy surgeon or physician. We talk through our own meditation practices and hope you feel more grounded and empowered to start your own practice after this episode. Resources: Books: Mindfulness for Beginners by John Kabat-Zinn; Altered Traits by Daniel Goleman and Richard J. Davidson. Podcast: How to Train Your Mind by Chris Bailey, available on audible: https://www.audible.com/pd/How-to-Train-Your-Mind-Audiobook/B08N5C3QLB