Operate with Zen

“All healthcare is delivered through relationships.” This is the key statement from this episode of OWZ and highlights that effective communication is a key component of delivering excellent patient care. Marissa Theofanides, MD is a urologist at Montefiore in the Bronx and expert in communication skills. She is certified by the Academy of Communication in Healthcare (https://achonline.org/) whose motto is “Better Communication. Better Relationships. Better Care.” In this podcast, we help you understand that communication is a skill – a skill that can be taught, practiced, and improved upon just like throwing a suture or writing a clinic note. Dr. Theofanides lays out a framework to improve your clinic communications that is rooted in mindfulness! Setting an agenda, creating space for effective communication, and assessing understanding highlight the mindful principles of intention, presence, and non-judgement. There’s lots of practical knowledge in this discussion and it promises to make your clinical interactions and your life better! Enjoy!!! Academy of Communication in Healthcare (ACH): https://achonline.org/

Dr. Mick Malotte, MD is a retired ENT surgeon from California who has been practicing mindfulness as a surgeon for over 30 years. Not only does Mick practice mindfulness through a daily practice and retreats, but he teaches mindfulness to physicians and surgeons around the country! Mick gives us a brief history of mindfulness in medicine and helps us understand how mindfulness practices are adopted to medicine and surgery. We talk about burnout, data and physiology, and the religious and social implications of widespread mindfulness practices! Importantly, Mick gives us easy-to-perform micro practices that can be performed within our daily practices to be better surgeons, physicians, and human beings. If you are interested in talking with Mick or exploring mindfulness training at your institution, reach out to Mick through his website. Enjoy! https://www.mickmalotte.com/

Dr. Angela Smith is a frequent flyer on the Operate with Zen podcast. She is guru to me and many others for life hacks and practical, personal improvements to be more efficient and to have more ease and enjoyment in our daily routine. In this podcast, we discuss “A Day of Reflection” – what exactly that means, how to set one up, and how to make it successful. A day of reflection creates the opportunity to be present for oneself, to assess prior performance (in a non-judgmental way), and to set intentions (or goals) for an upcoming period of time. Periodic days of reflection will prevent you from aimlessly getting caught up in life. They will empower you to feel productive and fulfilled no matter if in your personal or professional life. This podcast is full of practical tips to help you achieve that Day of Reflection and the benefits moving forward. Enjoy!

Dr. Kelly Casperson, MD is a surgical rockstar!!! … a urologist and sexual medicine expert, a extremely successful podcaster, author and now Ted-Talker! Kelly hosts the “You Are Not Broken” podcast (https://www.kellycaspersonmd.com/podcast) which empowers women (“and the partners who love them”) with science and conversations to break down sexuality improve the intimate lives of the tens of thousands who listen each month! But we are not talking about sexuality in today’s podcast… not really. Dr. Casperson and I discuss her journey to find purpose and how her true self re-emerged after years of surgical training and practice. We discuss mindfulness and personality traits, and how a better understanding of yourself and those that surround you enhance our ability to be phenomenal surgeons and doctors. And yes, human sexuality serves as the backdrop for the entire conversation. Woven in and out of the context of our lives, understanding sexuality by understanding self, communication, and personal interactions leads us to a more mindful existence and relationships with our intimate partners and others. Enjoy! "You Are Not Broken" Podcast: https://www.kellycaspersonmd.com/podcast "You Are Not Broken" Book (Amazon): https://a.co/d/hdI7JPT Ted Talk: https://youtu.be/rqI6YKLmdlk

Being a cancer surgeon can be tough. Being a cancer patient even tougher. Brian Lane, MD is facing both daily. He is an accomplished surgeon and academic urologic oncologist. In this thoughtful and honest discussion, we cover facing tough diagnoses as a patient and a surgeon; developing perspective as a patient to help our patients; finding purpose and meaning despite tough circumstances; and ultimately finding peace in faith and community. This conversation is inspirational and grounding. I hope you enjoy.

Kevin Turner, MA, DM, FRCS (Urology) is a Consultant Urological Surgeon at Royal Bournemouth Hospital. In 2015, he helped to start the Surgeon Wellbeing Research Team with colleagues from the Department of Psychology at Bournemouth University. Kevin and team ran a UK national survey from 2016-2019 – data from which has helped us understand how complications affect surgeons, the pervasiveness of this issue, and helped to create important objective measures and definitions in the field – like the difference between complications and errors. They also ran a randomized trial of resilience training in surgical trainees based on ACT (Acceptance and Commitment Therapy). Since then, Kevin has become a leader and mainstay at academic meetings bringing our understanding of the impact of adverse events and complications into a major spotlight. Backed by data, but full of tremendous personal insight, this conversation is a must listen for surgeons who are interested in understanding why complications hurt us and how we can alleviate that impact to better care for our patients and ourselves. More from Dr. Turner: Surgery Harms Surgeons. What Can We Do? Journal of Urology. https://www.auajournals.org/doi/10.1097/JU.0000000000002861 Turner, K., Bolderston, H., Thomas, K., Greville-Harris, M., Withers, C. & McDougall, S (2022). Impact of adverse events on surgeons, British Journal of Surgery, 2022. https://doi.org/10.1093/bjs/znab447 Bolderston, H., Greville-Harris, M., Thomas, K., Kane, A., & Turner, K. (2020). Resilience and surgeons: train the individual or change the system? The Bulletin of the Royal College of Surgeons of England, 102:6, 244-247. https://doi.org/10.1308/rcsbull.2020.170 https://podcasts.ox.ac.uk/impact-complications-and-errors-surgeons

Andrew Gabrielson, MD (@urogabe) is currently a resident at the Brady Urological Institute and Department of Urology at Johns Hopkins. He is a budding pediatric urologist and developed an interest in surgical ergonomics and physical well-being before he started residency. He is an integral member of the Society of Surgical Ergonomics and well-published in the field despite his young age! He gives us lots of practical knowledge for the operating room (how to stand, how to set up your room, gel pads and shoes!) and a framework for incorporating ergonomics as a thought process to enhance our physical well-being as surgeons. In addition, he talks about his experience and how following an interest piqued during undergraduate and medical school turned into a passion for the remainder of his professional life! Enjoy! Lots of links below including data supporting a lot of the discussion. Society of Surgical Ergonomics https://www.societyofsurgicalergonomics.org/ Twitter: @SocSurgErgo Epidemiology of work-related pain among surgeons Epstein, S. et al. Prevalence of work- related musculoskeletal disorders among surgeons and interventionalists: a systematic review and meta-analysis. JAMA Surg. 153, e174947–e174947 (2018). Stucky, C. H. et al. Surgeon symptoms, strain, and selections: systematic review and meta- analysis of surgical ergonomics. Ann. Med. Surg. 27, 1–8 (2018) Intraoperative and perioperative stretching Park, A. E. et al. Intraoperative “Micro Breaks” with targeted stretching enhance surgeon physical function and mental focus: a multicenter cohort study. Ann. Surg. 265, 340–346 (2017). Hallbeck, M. S. et al. The impact of intraoperative microbreaks with exercises on surgeons: a multicenter cohort study. Appl. Ergon. 60, 334–341 (2017). Dorion, D. & Darveau, S. Do micropauses prevent surgeon’s fatigue and loss of accuracy associated with prolonged surgery? An experimental prospective study. Ann. Surg. 257, 256–259 (2013). Monitor Placement van Det, M. J., Meijerink, W. J., Hoff, C., Totte, E. R. & Pierie, J. P. Optimal ergonomics for laparoscopic surgery in minimally invasive surgery suites: a review and guidelines. Surg. Endosc. 23, 1279–1285 (2009). Omar, A. M., Wade, N. J., Brown, S. I. & Cuschieri, A. Assessing the benefits of “gaze- down” display location in complex tasks. Surg. Endosc. 19, 105–108 (2005). Erfanian, K., Luks, F. I., Kurkchubasche, A. G., Wesselhoeft, C. W. Jr. & Tracy, T. F. Jr. In- line image projection accelerates task performance in laparoscopic appendectomy. J. Pediatr. Surg. 38, 1059–1062 (2003). Hanna, G. B., Shimi, S. M. & Cuschieri, A. Task performance in endoscopic surgery is influenced by location of the image display. Ann. Surg. 227, 481–484 (1998). Table Height Berguer, R., Smith, W. D. & Davis, S. An ergonomic study of the optimum operating table height for laparoscopic surgery. Surg. Endosc. 16, 416–421 (2002). van Veelen, M. A., Kazemier, G., Koopman, J., Goossens, R. H. & Meijer, D. W. Assessment of the ergonomically optimal operating surface height for laparoscopic surgery. J. Laparoendosc. Adv. Surg. Tech. A. 12, 47–52 (2002). Manasnayakorn, S., Cuschieri, A. & Hanna, G. B. Ergonomic assessment of optimum operating table height for hand- assisted laparoscopic surgery. Surg. Endosc. 23, 783–789 (2009). Gel mats Haramis, G. et al. Prospective randomized evaluation of FOOT gel pads for operating room staff COMFORT during laparoscopic renal surgery. Urology 76, 1405–1408 (2010). Graversen, J. A. et al. Prospective randomized evaluation of gel mat foot pads in the endoscopic suite. J. Endourol. 25, 1793–1796 (2011). Cognitive Ergonomics Chrouser KL

Jeff Bloovman, BSN, RN, is an operating room nurse with really unique interests and perspectives on life. He has been an actor and director, is currently a firearms and combat instructor as well as an avid practitioner and instructor of Brazilian jiu-jitsu. Like many of us, Jeff is also challenged by an extremely active mind. What do all of these experiences have in common? They are all enhanced through mindfulness practices. Whether focusing on a gun, your combatant, a theatre scene, or a busy operating room – being in the moment, both enjoying the moment and focusing in the present, can enhance the experience and the outcome. I hope you enjoy this really fun conversation, I did! Below are some of the links referenced throughout Jeff’s conversation: Practically Tactical Podcast: https://www.practicallytactical.com/episodes Rolling Stone: Pink Pistols: LGBT Gun Owners Unite in Arming Gay Community https://www.rollingstone.com/culture/culture-news/pink-pistols-lgbt-gun-owners-unite-in-arming-gay-community-177899/ Washington Post: For years, he tried to get other gay people to the gun range. Would they come now? https://www.washingtonpost.com/lifestyle/style/for-years-he-tried-to-get-other-gay-people-to-the-gun-range-would-they-come-now/2016/06/21/0f672b02-3724-11e6-9ccd-d6005beac8b3_story.html Huffington Post Video: At The Shooting Range With The Pink Pistols, A Gay Gun Group https://www.huffpost.com/entry/at-the-shooting-range-with-the-pink-pistols-a-gay-gun-group_n_5b4f4938e4b004fe162f865e The Feed YouTube: Gays & Guns: Fighting homophobia with bullets - YouTube One Man Army (Discovery Channel): Season 1, Episode 1 https://www.discovery.com/shows/one-man-army/episodes/brothers-in-arms

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