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CLOSLER: Richard Schaefer
26 Plays3 months ago
Dr. Richard Schaefer is an orthopedic specialist at Johns Hopkins Medicine and an editor at CLOSLER. Listen to Richard discuss the pillars of CLOSLER, his past writing pieces, and helpful strategies for connecting with patients.
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Transcript
Introduction to The Wound Dresser Podcast
00:00:09
Speaker
You're listening to The Wound Dresser, a podcast that uncovers the human side of healthcare. I'm your host, Jon Neary.
Meet Dr. Richard Shafer
00:00:21
Speaker
My guest today is Dr. Richard Shafer. Dr. Shafer is an orthopedic specialist with Johns Hopkins Medicine. Prior to joining Johns Hopkins, Dr. Shafer served for over 30 years in the US Army, retiring at the rank of Colonel. Aside from clinical and teaching
Editorial Role at Closler
00:00:36
Speaker
duties, Dr. Shafer serves on the editorial team of Closler, which is a clinical excellence initiative at Johns Hopkins School of Medicine. Dr. Shafer, welcome to the wound dresser. Thanks, John. Thanks for thanks for having me.
Mission of Closler: Humanistic Medicine
00:00:49
Speaker
um So yeah, I know you, like I just said there, do a lot of work with an initiative called Closler. Can you talk more about ah what that initiative does at the Johns Hopkins School of Medicine? Sure. um Well, the the name Closler is a play on words. It's it's getting moving us closer to Osler. So Sir William Osler, really one of the founding physicians of American medicine, um and he was at Johns Hopkins. ah Um, back in the day before moving to England. Um, and William Osler is known to be a humanistic physician. Um, probably have heard a lot of Osler expressions. You may not have realized that they, they were from, uh, him, but, uh, so he was known as a great humanistic physician and, uh, getting to know patients and, and the importance of that. And so the closer initiative.
00:01:49
Speaker
is to move us closer to getting to William Osler to the ideal of how he practiced medicine. And it's ah it's a free daily online medical publication that includes short short reads written by ah medical students to seasoned physicians, trainees, medical students. um we even have We have also some non-physicians, some nurses that write. And and these are short,
00:02:19
Speaker
vignettes ah that have a message, a take home, a take away message for us to help us care for patients.
Exploring Closler.org
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And it's at, it's online, closeler.org, C-L-O-S-L-E-R.org.
00:02:36
Speaker
Great, yeah, um definitely have to to sign up for that. Just kind of get my, it sounds like a daily dose of of humanistic medicine from Closler.
Four Pillars of Humanistic Medicine
00:02:44
Speaker
I know within the initiative, there's kind of like four pillars. There's creative arts and medicine, ah connecting with patients.
00:02:51
Speaker
passion in the medical profession and lifelong ah learning and clinical excellence. So we can kind of maybe ah take those one by one. So creative arts and medicine, what are what are kind of some things that closer and perhaps you are involved with ah in in that sort of space?
Creative Arts in Healthcare
00:03:10
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Yeah, so um creative arts and medicine is is one example of of the ah category of postings and There's a ah variety of of mediums. um There's poems, paintings.
00:03:25
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um Somebody wrote about, for example, pottery and and how that practice helps them with their technical skills. Usually there's ah an artistic ah display and then ah a short article about the feelings and thoughts about practicing medicine and how that how that work of art helps us. I think it's interesting how we can you know some we talk about personal identities in medicine and professional identities. Closer and and the creative arts section is a good example shows us how
00:04:08
Speaker
we can think about our personal identities, maybe our artistic endeavors, and how that really is is part of our professional identity as well. So just to expand on that a little bit, how do you think the arts can help ah physicians and patients kind of just build a better healthcare system in general?
00:04:28
Speaker
ah i I think in a number of ways. but One is they can help our observation skills. I mean, looking at ah looking at a work of art and and and studying it and um they can help our observation and interpretive skills. And in in addition, I think working on art can be a stress reliever. I like to paint, for example, and and I find the act of painting um relaxing. um
00:05:00
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And so they can help us with unwind and and in that regard as ah as a stress reliever and a recreation and a relaxation um tool.
00:05:14
Speaker
And in addition, I think the arts can help us with better understanding ourselves and in in our patients. you know And that the arts may be you know think broad category, but could be reading a you know ah a story and and thinking about how that that story makes us think about our patients, our our our work.
00:05:42
Speaker
or it can be writing a story. We encourage in our ah medical school, for example, to to ah students to to write um certain after or certain prompts and and write things about how they're feeling. So I think i think the arts can can help us in a variety of ways.
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Going
Connecting with Patients: Personal Touches
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to the kind of the second ah kind of pillar that we mentioned, connecting with patients ah through some of the posts on Quosler. Have you kind of attained any nuggets of wisdom that are really ah helpful for connecting with patients in the the clinic?
00:06:18
Speaker
yeah and and just um if it's okay, just to kind of go back to the creative arts section for a second um in closer. We ah at Johns Hopkins Medical School had our our inaugural, we called it Hopkins Evening of the Arts, which was medical students ah presentation of art of all forms, spoken word, dance, speaking, um singing, painting, photography,
00:06:47
Speaker
And we we think that in in addition to closer events like that, our our model for that was building community through express through expression. And I think helped us, our medical school students grow closer together. And we're excited about having our second one this year. um And for the you know yeah the the second category, connecting with patients. Let's give you talk about an example of of one ah one that I wrote was was very simple. It was called Socks and Ties. And and it had to do with, um i I always, I was in the army for 30 years and wore a uniform, didn't have much choice in what I was going to be wearing. When I joined Johns Hopkins, had to get a wardrobe, and including ties. And I came to enjoy wearing colorful ties um and sort of became
00:07:47
Speaker
my thing and and apparently some patients noticed. I stopped wearing ties during COVID um out of the thought that maybe it was potentially, ah you know, that that the virus could be on the tie, but I don't think there's really good evidence to that. And and a patient came in and said, um where's your, I miss your colorful tie. where where Where is that today? And I said, Oh, I stopped. So I brought them back and, and, um,
00:08:15
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And it's it's interesting how patients may may comment on that. so it's ah its And and i I started wearing matching socks, if you if you will. And some patients have noticed that. And some look and said, well, next time I want to you know i want to see a different color sock. So it's just a little small, way fun way to interact, connect with patients in a clinic.
00:08:40
Speaker
which can be a stressful environment for for them and us. So um that's that's been one example of an article that I wrote a short one. So now thinking about just going, I'm just going category by category here, passion in the medical profession. um you know What are some things at Johns Hopkins or or through Closler that you've kind of been doing that have have have our are ways to kind of reignite that passion in a lot of healthcare care practitioners and students?
The Symbolism of the White Coat Ceremony
00:09:12
Speaker
I think, um example, ah ah ah again,
00:09:18
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ah a piece that I wrote recently called White Coat Ceremony. And it was about my role and I am an advisee of medical students and I have five or six a year. And during the White Coat Ceremony, I have the privilege really of doing that cloaking of my student advisees. And it reminded me of the the continuity of of of medical physicians from Hippocrates on down and and how that white coat is symbolizing a continuum of physicians, you know, it's a sort of sort of passing the torch, if you will, putting the white coat on the next generation.
00:10:02
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ah physicians and how how privileging and that that is and how Motivating that is of of the importance of of mentoring ah Medical students like like yourself and how in teaching them and the next year they're gonna be you know You're gonna be taking over the practice of medicine. And so it just ah was an example of how thinking about that ceremony um Is exciting and and and ah makes ah I feel passionate about what what I do. Did you especially feel like a leak of that like passion during during COVID? Was that kind of demoralizing for you and your team ah to kind of provide the best medical care in those you know tough set of circumstances?
Redeployment Experience during COVID-19
00:10:49
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Yes. um although um
00:10:52
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and then it It leads ah to a discussion of the first closer piece I wrote was called jumping into redeployment. As um at Johns Hopkins, there was a call for non ICU physicians like myself to help out in the COVID ICU. And i i I know that You know, I'm not skilled as a pulmonologist or ICU physician, but there was some training ah before and I was well supervised by pulmonologists. And I, I served in that capacity and it was made me really proud to be part of the medical profession that was responding to the COVID ICU. And I, and I wrote a piece called jumping in into redeployment because standing outside the COVID ICU,
00:11:48
Speaker
reminded me of a time when I was in the army when I went to parachute school and standing at the door with ah with a parachute. well Well, this time in the COVID ICU, I was wearing PPE instead of ah instead of a parachute. But that that experience was really ah motivating for me and and helped.
00:12:08
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um you know I enjoyed, it was 12 hour fatiguing days, but I enjoyed the team that I was working with and and the mission. the nurses, the the physicians, the residents. So it was was exciting to be part of part of that and and and felt um felt needed. So i that was a time in the COVID experience early on where I had the opportunity to do something different.
Importance of Ongoing Learning
00:12:36
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so So lastly, do you have um as part of our our little 10,000 foot view of Closler, have you kind of gained any wisdom about you know lifelong learning and clinical excellence? i It kind of feels like as a young trainee looking at some of the but older folks in in healthcare care that people can kind of drag their feet on continuing medical education and things like that and trying to stay motivated. So how can we you know build a system of professionals who are you know really motivated to keep on learning?
00:13:06
Speaker
Yeah, well, um, William Oster said, uh, you know, we need to, you know, constantly change and. And and adapt old ideas that about live their usefulness to current facts, you know that that was William Osler ah Saying and and there's a lot of in in terms of certainly in terms of like my field orthopedics There's additional learning maybe maybe you know newer techniques newer ah Procedures newer medications but um
00:13:39
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it closer is about, you know, connecting with patients and, and there was a beautiful piece of just came out this week written by, uh, in closer a medical student, uh, Kyra Ru and, and she, she talked about how her experience going to the dentist, um, or the dentist asks, you know, are you flossing? And she said, well, you know, not, not as much as I should. And she related that experience to.
00:14:06
Speaker
per patient, you know are you are you taking the cholesterol medication? And well, not not as as it was prescribed. And and you know that was kind of a fun way for her to relate that, but but also to learn that, okay, this is how you know I need to ask patients, not not in a judgmental way, but but let's instead of telling, oh, you should be taking it, she she she went to an open-ended question. Well, what are your concerns about it?
00:14:35
Speaker
And it led to um an adjustment in the in the medication doses because of the patient. But it was a beautiful example of, ah for me, learning, OK, that's a great way that she asked the patient about the medication, not martin drilling it. But hey, what what are your concerns? And so I think um you know some some different expressions. And I learned expressions from how medical students interact with patients, um different different questions, different ways I see them.
00:15:06
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interact. And here's, here's another one that just just came out and she really interesting how funny how she related to the flossing and then said, okay, she asked her patient about the medication and it made her think about ways to ask that question and to ask the patient's concerns.
00:15:23
Speaker
Yeah. So maybe just like part of, uh, you know, keeping learning exciting. Like, like you said, when it feels like it can be weighed down by a lot of like the technology and techniques and stuff like you were talking about with orthopedics, like just sprinkle in some of that, like, uh, you know, fun stuff, fun fun kind of, you know, phrases you can use in your clinical encounters or just like those little other things that make medicine enjoyable.
00:15:45
Speaker
Yeah, I'll tell you, there was another early on when I was learning about Closler. There was Dr. Crystal Brown, and she's an obesity researcher. And she wrote one, I don't have the exact title, but racial discrimination in larger bodies about the intersection of obesity bias and racial bias in her experience. And that was That was very informative to me in terms of my lifelong learning. And I since, I reached out to Dr. Brown afterwards and was able to connect with her and and and talk about these concepts and and learn so learn some more. um So that's that's ah another example of a closer piece that that to me ah i I learned from.
00:16:39
Speaker
So speaking widely about healthcare in general, though, uh, for, you know, uh, in your own career or for your colleagues or for medical students you work with, what do you kind of see as the ops obstacles to practicing that in that humanistic way that it sounds like you is really important to you?
Challenges in Humanistic Medicine
00:16:55
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Uh, you know, I think can i time pressures, financial, uh, pressures and and maybe in,
00:17:03
Speaker
uh, you know, so-called hidden curriculum in, in medical school, or maybe, you know, we just think, ja Hey, maybe it's, it's, it's not important. One of, one of my, uh, uh, mentors, Dr. Augustus white said, um,
00:17:17
Speaker
it is important, seize on it, it's okay, it's okay to appreciate connecting with patients on ah and a human human level. So um I think there's there's some barriers, but ah there's also some simple ways that that we can we can do it in the in the clinical setting. And some of that may be even just simple sitting down when when we're talking to patients, sometimes ah you know being on the same level as them, that's just ah ah a simple example and where, you know, is maybe it's it's fat to come in and stand, you know, above a patient, you know, hey, how's your knee? But just even sitting down, make an eye contact, smiling, um letting the patients know you you're you're hearing them. There's a number of ways we can do it.
00:18:06
Speaker
Yeah, I think from, from at least my, my brief experiences, I feel like in general, everybody wants to practice humanistic medicine, but people don't realize, you know, when they, they are and they aren't, uh, they don't really, you know, I think it's just, um, just like reminders, like, like clothes, like, like little, little kind of daily doses, just reminding people to do these things like over and over again is going to go like a long way. I know another thing I've experienced that can be sort of difficult, uh, when practicing, like.
00:18:36
Speaker
humanistic care for a patient is that like, if you're in a ah team of practitioners, right, you're kind of like either rounding or doing something and you want to like, kind of be very efficient and move on, you're not really in the driver's seat as like a part of the the care team. So it's hard to kind of set the tone with like, you know, being really cordial with the patient or being like really ah sort of talkative because you're kind of just, you know, moving as a team and and trying to be as efficient as possible, so.
00:19:05
Speaker
Sometimes the medical students on the on the ward, you know, get to know the patients to even, ah you know, on the in the inpatient side, even ah ah a greater degree. And, and um and you know, sometimes the the medical students can be, you know, very helpful because they, is patients get, you know, they may be the first one seeing them and the every morning and and patients may get to feel like they get to know them and and share their concerns with the medical students. That that happens.
00:19:34
Speaker
um quite a bit. um The other thing that I was going to say about my mentor, Dr. Augustus Wyden in his book, Seeing Patients, um you know practicing humanistic ah egalitarian care can be ah what he calls a triple win, a win-win-win. Our patients win because we we can you know provide better care for them. We win because it's it's it can be enjoyable ah practicing in that way. and and society wins, that you know and in medicine, you know we can connect with patients and practice humanistic, egalitarian medicine.
00:20:15
Speaker
I'm curious to hear what your experiences in the military, did you feel like being in the military versus being in a more, um I guess what's the word, civilian setting, ah that Was it easier to kind of have those deep relationships and connect with patients in the military compared to being in sort of ah a civilian hospital system? Or how do you kind of compare your ability to connect with patients in those two settings?
Military vs. Civilian Patient Connections
00:20:40
Speaker
Yeah, I i think you know probably more similarities than then differences and in the sense of um you know some of the medicine is you know very similar goals and and and and principles. um But there there may be you know in the military ways you know in terms of connecting. ah For example, i I spent a couple of years before my residency assigned as um as a medical doctor to an infantry division. And and it it gave me an opportunity to learn more about what an infantry soldier does and gave me a greater appreciation and and potentially then when taking care of that soldier, having an understanding about what the demands on on their you know knee, for example, what what what that what that's like, what what their lifestyle is like, what their but the demands of their job is like. so
00:21:38
Speaker
some respects that, you know, that, that was, that can be, you know, maybe a different sort of a unique aspect to, to military, military medicine. um But, you know, in civilian side, and there's things that I, that I don't know, try to learn from my patients, if I, you know you know, try to understand what, what the demands on of their lifestyle is, trying to gain an appreciation ah For that on the on the civilian side and and and you know, for example trying to understand You know, hey, what what are your barriers to go to physical therapy? And well, this is ah but you know, potentially a single mother who's also taken care of of elderly parents so taking care of her children her parents and
00:22:27
Speaker
And where do they have time to go to physical therapy? That may be ideal, but you know and when they're going to do that. So I think there's things that I think if we're curious about our our patients and and and open and empathetic, and we we can learn from you know a variety of experiences, military or or civilian.
00:22:49
Speaker
Um,
Appropriate Self-Disclosure in Patient Care
00:22:50
Speaker
so lastly, last, last kind of point I wanted to hit here was I know I read a piece you did about humanism in in one of the orthopedic journals. And one of the kind of, you know, one of the kind of nuggets that is always in ah the back pocket for a clinician or somebody is kind of this idea of self disclosure, right? Like how do you bring ah yourself to like a clinical setting? And I don't know, is there any kind of wisdom you give to to medical students about, you know, when it's skillful to kind of share things about yourself and when, when, you know, it's maybe better to just keep them to yourself. Yeah, it's a great question. And I think that, you know, there are individual,
00:23:33
Speaker
probably preferences there, individual on the physician side. And and one one thing you know have to be careful of is is not self-disclosure to the um you know neglect of the patient. you ah So for example, ah you know the patient may say, ah you know, they hurt their knee and, uh, you know, then the physician, you know, maybe talking about, well, I hurt my knee before and, you know, start talking more about their own knee as opposed to the, you know, the, the, the, the patient's concern. So we have to be, we have to be cautious about that. Um, uh, the patient's concerns are, are paramount, but you know, that may be an example where maybe we could, you know, say, Hey gee, yeah I, I, you know, just for example, Yeah, I know that hurts. I had that myself as well. Gee, that that um so I can appreciate that that's painful for you. Yeah, tell me more about it. So um that's that's maybe some some different examples. As far as you know talking to talking about our ourselves, um
00:24:38
Speaker
you know we had ah just just this morning, I had a patient who was wearing Baltimore Ravens gear and I'm a Buffalo Bills fan. so I mentioned that to to the, bay we just had, you know, shared ah a little bit of discussion about about football. and And so that's just, you know, one example of of of that. So I think, um and then i what i I wrote about, I i had an older woman patient one time that came in and she asked me, doctor, what are you doing this weekend? I said, well, um you know,
00:25:14
Speaker
sure I'm going to visit my mother, I'm going to Florida, going to visit my mother there. And you know it's interesting, every time ah she came in, she'd she'd say, hey, how's your mother doing? I said, oh, gosh.
00:25:28
Speaker
you know, thanks for reminding me, I need to, I need to give her a call. I'll give her a call today. So, and she would gently remind me of that. And so it was kind of a fun connection there, some self disclosure. And then, uh, you know, one time, uh, she came in, I saw this patient over the course of a few years, she came in and said, how's your mother doing? I said, Oh, my mother passed. Uh, and, and the patient was very empathetic and in fact wrote me a, wrote me a sympathy card that said, and so,
00:25:57
Speaker
that That's just an example for that worked for me, that that kind of self-disclosure. And it was just um patient asking, patient curious about about about me and where I was sharing something about my family. But you know I think there's individual preferences there.
00:26:15
Speaker
So with that, it's time for a lightning round, a series of fast paced questions that tell us ah more about you. So yeah, we've mentioned a couple of times that you're a big Buffalo Bills fan. Who's your your favorite Buffalo Bills player of all time? Oh gosh. Um, well, I, I would say, uh, you wouldn't know that Jack Kemp, uh, number 15, he was quarterback when I was a kid, when they're back in the American football league and, uh,
00:26:44
Speaker
Jack Kemp later became a member of Congress. And in that role as a member of Congress, he nominated me to go to you need to go to West Point. He was my ah congressional representative and nominated me to go to West Point. night I later connected with him probably 20 years, 20 plus years after I graduated. I ah just serendipiously ran it with him and chatted with him. so I'd say Jack Kemp, he he's ah ah passed away. He he was ah he was ah his presidential election. He was Dole's running mate when when Bob Dole ran for president. He was the vice presidential ah candidate, but Jack Kemp, number 15. Best part about being a military doc? Comradery with colleagues and patients. What's an art form you connect with?
00:27:42
Speaker
i I've ah recently enjoyed acrylic painting abstract. i can't I don't have the skills to be able to draw something recognizable, but I like putting colors on paper, what what I'm thinking about. And lastly, which one change you'd like to see in healthcare?
00:28:05
Speaker
ah one of and One of the things that we do with the medical students, and we we do a lot of peer support sessions, and I think I'd like to see more peer support, be have that normalized in healthcare. care thats That's one change, peer support.
Engaging with Closler Community
00:28:25
Speaker
Yeah, I wonder if I could say just ah things about Closler, a little bit more about that. Would that be okay, John? Fire away, yeah. Yeah. so um Encourage all ah you know medical practitioners to subscribe. It's free online.
00:28:43
Speaker
um yeah C-L-O-S-L-E-R dot org. And but you can subscribe and get on the email list. They get the weekly emails of what the ah what the what those little summary of the articles for that week. So you can you can subscribe and get on the email list. Or you can just go online and and and look at them.
00:29:04
Speaker
We're also on X and Instagram. There's a podcast now. There is, um ah we're also on LinkedIn. And um the the authors of the pieces are not, while Closler comes out of Johns Hopkins, the authors are are are not exclusively from Johns Hopkins.
00:29:28
Speaker
ah Like I said, you know there was a medical student from the University of Pennsylvania published one this week. um there're from There's authors from overseas and and they range. So if somebody is interested in in writing for Closler, I would encourage them and and please reach out. And um the these are short articles and we're we're happy to help and we're looking for, we're always looking for new new readers, but also new authors.
00:29:57
Speaker
Awesome. Yeah. There you go. Clothesler.org, right? Yes. C-L-O-S-A-L-E-R dot.org. All right. We'll check it out. Dr. Richard Chafer, thanks so much for joining The Wound Dresser.
00:30:18
Speaker
Thanks for listening to The Wound Dresser. Until next time, I'm your host, John Neery. Be well.