Transcript
Speaker: Welcome to Critical Matters, a sound podcast covering a broad range of topics related to the practice of intensive care medicine.
Speaker: Sound provides comprehensive critical care programs to hospitals across the country.
Speaker: To learn more about our programs and career opportunities, visit www.soundphysicians.com.
Speaker: And now your host, Dr. Sergio Zanotti.
Speaker: I was in darkness, but I took three steps and found myself in paradise.
Speaker: The first step was a good thought.
Speaker: The second, a good word.
Speaker: And the third, a good deed.
Speaker: In today's episode of the podcast, we will discuss the science behind the benefits of being other focused and of having a live to give attitude.
Speaker: I believe this is a very important message for everybody, but especially important for our critical care listeners after what we went through
Speaker: in the last two and a half years with COVID-19.
Speaker: Our guest is Dr. Steven Tresjak, a practicing intensivist, physician scientist, professor and chair of medicine at Cooper Medical School of Brown University in Camden, New Jersey.
Speaker: Dr. Tresjak is a recognized clinical investigator with a long list of peer reviewed publications in the most prestigious medical journals.
Speaker: He is also co-author of two wonderful books, Compassionomics, The Revolutionary Scientific Evidence That Caring Makes a Difference, previously discussed
Speaker: on the podcast, and more recently, Wonder Drug, Seven Scientifically Proven Ways That Serving Others Is The Best Medicine For Yourself, soon to be published and the focus of our conversation today.
Speaker: Steve, welcome back to Critical Matters.
Speaker: Sergio, thanks so much.
Speaker: I love being back on your show and I'm grateful for the invitation.
Speaker: Well, I think that it's always a pleasure to have you on the podcast.
Speaker: Just for a little bit of a trivia for our listeners, you actually did the first episode of the podcast and I've been generous with your time and your knowledge several times.
Speaker: So really appreciate it to have you back on.
Speaker: And as I said in the introduction to discuss what I think is a very, very important topic for everybody, but especially I think relevant for where our colleagues are today in critical care.
Speaker: So as a move of introduction, maybe,
Speaker: you could give us Compassionomics in a nutshell and introduce your previous work and your research and focus and how that eventually led to Wonder Drug.
Speaker: Sure, it's my pleasure.
Speaker: For the first 15 years of my career, I studied resuscitation science in the ICU.
Speaker: And specifically, I had a grant to study
Speaker: brain injury after cardiac arrest, my colleagues and I were trying to figure out what's the optimal level of oxygen in the blood to reduce the risk of permanent brain damage after resuscitation from cardiac arrest.
Speaker: And now I study compassion science, which, you know, that's a bit of a departure or a change in trajectory or pivot or whatever you want to call it.
Speaker: But
Speaker: I became convicted, I guess you could say, years ago that although what I was working on was important, especially if you happen to be someone who has a cardiac arrest, I felt the need to work on something that was sort of transcending all the different specialties.
Speaker: And initially I
Speaker: I came up with the, well, actually what happened was I was asked the question, what is the most pressing problem of our time?
Speaker: And of course, there's no such thing as the one single most pressing problem of our time.
Speaker: Really the question is what's the most pressing problem of our time for you through your lens of experience.
Speaker: And so I had to ask myself, what was the most pressing problem of our time through my lens of experience as a,
Speaker: intensivist, physician scientist, chair of my department, healthcare leader in my organization.
Speaker: And what I realized is that as I looked around in everyday practice that a lot of people were really miserable.
Speaker: And I believe it affected how they treated patients.
Speaker: And then you have to ask yourself the question,
Speaker: does it matter?
Speaker: I mean, does compassion, for example, really matter?
Speaker: And that's when we decided that the we being Anthony Mazzarelli, MD, my colleague, collaborator and co-author on both books, Maz is also the co-president and CEO of our healthcare system.
Speaker: And we, uh,
Speaker: generated a hypothesis that compassion matters not just in meaningful ways, but in measurable ways.
Speaker: And so we reviewed a thousand scientific abstracts, over 280 research papers are cited in Compassionomics.
Speaker: And so what we share there isn't what we think or believe, it's not our opinion, it's just what we found in a two year journey through the evidence.
Speaker: And so Compassionomics was really focused on healthcare, healthcare workers specifically,
Speaker: And it tested the hypothesis that compassion matters for patients and for patient care and, importantly for me, those who care for patients or our healthcare providers.
Speaker: Because while we were going through this process, I became keenly aware that I had every symptom of burnout myself.
Speaker: And I know you have a lot of listeners, Sergio, and we all know the data of the proportion of healthcare workers that were burned out before we ever had a pandemic.
Speaker: And now, especially our intensivists and our nursing colleagues and nurses in the ICU and really, you know, everybody in acute care generally, hospital medicine, emergency medicine, you know, burnout is as common as a cold.
Speaker: And I don't like to talk about burnout.
Speaker: I like to talk about resilience.
Speaker: I'd rather talk about the health rather than the disease.
Speaker: But burnout really is an appropriate term because that's how you feel.
Speaker: It's like,
Speaker: You feel like a building, what's left of a building after it's been gutted by fire.
Speaker: And so I found that I was going through burnout myself.
Speaker: And so what was I supposed to do?
Speaker: Well, I became aware of the evidence that compassion is a powerful beneficial therapy for the giver too.
Speaker: And so what I was taught when I was in medical school back in the early 90s is don't care too much.
Speaker: because too much caring, too much compassion burns you out.
Speaker: I was taught that as part of the hidden curriculum and I believed it for like 25 years until I actually went to the evidence myself and found that there was an association between compassion and burnout, but the association's inverse, inverse.
Speaker: So if what I was taught in medical school, like too much caring, too much compassion burns you out, then you'd see them go in the same direction, high compassion, high burnout, low compassion, low burnout.
Speaker: But what you actually see is inverse association
Speaker: high compassion, low burnout, low compassion, high burnout.
Speaker: And what explains that?
Speaker: Well, my hypothesis is that if you care deeply for patients and you have the relationships that flow from that, then you have the good part of taking care of patients.
Speaker: You have the fulfilling part of medicine.
Speaker: And if you don't have that, then all you have is a really stressful job.
Speaker: So I did my, what I call my N of one experiment.
Speaker: I decided very intentionally
Speaker: that I was gonna care more, not less, lean in rather than pulling back and detaching and escaping, because I'm not a believer in escapism.
Speaker: And that was when the fog of burnout began to lift for me, but importantly, it just wasn't for patients and for families of the patients, it was also for the staff, our nurses that I had worked with for almost 20 years, even, well, trainees, colleagues, even at home.
Speaker: And it changed everything for me.
Speaker: And so,
Speaker: After looking through all the, having that experience and looking through all the data, Maz and I asked ourselves the question, we got thinking and said, this can't just be true for healthcare workers.
Speaker: You know, maybe more human connection through serving others is actually beneficial for everybody everywhere, for the general population, not just in the domain of healthcare.
Speaker: So in Wonder Drug now, we've extended our research
Speaker: far beyond the healthcare realm to curate, essentially, all of the scientific evidence.
Speaker: And there are 250 original science research papers curated now in Wonder Drug that serving others is what we call the best medicine for yourself.
Speaker: But specifically, we're talking about physical health effects, mental health effects, beneficial effects, these are.
Speaker: benefits for your happiness, well-being, fulfillment, and even your professional success.
Speaker: So that's how we, this has been now in total a five-year journey from the start of Compassionomics through now the publication of Wonder Drug, which is just about to be released.
Speaker: And it's been a lot of eye-opening as it relates to seeing the data, but it's been real meaningful to us as well.
Speaker: And I think that's an important aspect that you talked about, the 250 scientific studies that support a lot of what we're going to talk about today.
Speaker: And really what I find over and over again when we dive into the data on different topics is that a lot of the data is out there.
Speaker: We just didn't know about it.
Speaker: And maybe it gets published in other realms that we're not really thinking of in medicine.
Speaker: But like you said, burnout is unfortunately a problem among a lot of our colleagues.
Speaker: And this might be one of the many things that will increase resilience, but that can also be applied outside of medicine.
Speaker: Before we move on, Steve, I do wanted to ask you about compassion fatigue.
Speaker: And you were talking about that old paradigm of don't lean in, right?
Speaker: And we've discussed this previously, the whole kind of the real paradox is that we should lean in more.
Speaker: But a lot of people, I think, also misinterpret what compassion fatigue is all about.
Speaker: It's not about caring.
Speaker: It's about maybe caring and not seeing the results or caring and not framing what we're supposed to do in the correct way.
Speaker: Could you expand on that a little bit?
Speaker: Sure.
Speaker: And, you know, I told you that we curated all this evidence.
Speaker: I like to be clear about when I'm talking about something that stands on evidence and
Speaker: when I'm sharing something that is clearly in the domain of my opinion.
Speaker: So right now, as it relates specifically to the question about compassion fatigue, I'm just sharing with you my opinion, but I've been studying this now for this construct of compassion for five years now.
Speaker: So maybe it'll be helpful to some folks, but really not to be too nerdy about this, but I think you actually have to go back to the neuroscience.
Speaker: And so neuroscience studies using the modality of functional MRI, so brain scans that can tell us what part of the brain is being activated at any one particular time.
Speaker: When you bear witness to suffering and you have empathy for the suffering, and actually before I do that, I should just quickly have some distinction in terms.
Speaker: because nomenclature is really vital for any scientific pursuit.
Speaker: So compassion, most researchers define it as an emotional response to another's pain or suffering involving an authentic desire to help.
Speaker: So it's distinctly different from a very closely related word, and that's empathy.
Speaker: So empathy is a sensing, feeling, detecting, and understanding component.
Speaker: But compassion goes beyond empathy because it involves taking action to whatever extent is possible.
Speaker: Now, of course, empathy is vital because
Speaker: If you don't have empathy, you don't detect, sense, feel, understand, you'll miss every opportunity to respond to people with compassion.
Speaker: You'll just miss it entirely.
Speaker: So of course, empathy is vital.
Speaker: But the way to remember it is just empathy plus action equals compassion.
Speaker: Empathy plus action equals compassion.
Speaker: So back to the neuroscience.
Speaker: So functional MRI studies show that when you bear witness to someone's pain or suffering, you have empathy for that.
Speaker: It actually activates the pain center
Speaker: in your brain.
Speaker: So the saying, I feel your pain, there's actually neuroscience data behind that.
Speaker: And we know that experientially because it's really uncomfortable to watch people suffer.
Speaker: But when our mind is focused on taking action to alleviate someone's pain or suffering to whatever extent possible, then what the neuroscience data show is it's not the
Speaker: pain center of the brain that's activated is actually a distinct neural structure.
Speaker: And it's a reward center of the brain, which is associated with positive affect and positive emotion, feelings of affiliation.
Speaker: So really the neuroscience supports that empathy hurts, but compassion heals.
Speaker: And so back to the question now, that was just some background for your question about compassion fatigue.
Speaker: I actually believe, and again, this part, this very specific part is opinion.
Speaker: I believe that when we talk about compassion fatigue, we're probably talking about empathy fatigue.
Speaker: And what I mean by that is the repeated painful experiences of bearing witness to suffering, but not either not doing something about it or feeling like we can't do something about it.
Speaker: Because what the research shows is that when we find some little light, some little thing that we can do that actually is meaningful,
Speaker: for the person who we aim to serve, it'll actually trigger reward centers in the brain.
Speaker: And when you find ways to make differences, even small ways, you feel differently about your experiences and it can change remarkably.
Speaker: So I'll just tell you an example, Sergio, from practice, from clinical practice.
Speaker: Okay, so recently,
Speaker: I had a clinical service in the ICU that was very depressing.
Speaker: And the reason why it was very depressing is I looked up and down the different walk the hall and it was just one case after another of things that were not fixable, things that diagnoses, prognoses that were just, you know,
Speaker: incurable.
Speaker: There wasn't anything we could do for these patients.
Speaker: And I, it was kind of demoralizing, for lack of a better word.
Speaker: And what I found during that time was that I, you know, I actually had a patient who we were able to extubate.
Speaker: He still needed to be in the ICU, but
Speaker: We were able to get him off the ventilator so he was able to talk with me.
Speaker: And I just asked him, you know, help, what are some ways that I can help you today to feel better?
Speaker: And he was having a lot of time, a lot of struggle just eating his eggs that morning because he couldn't even get his hand up to, you know, up to his mouth.
Speaker: And he was just really frustrating him.
Speaker: He was very frustrated.
Speaker: I could see that.
Speaker: And so
Speaker: I just helped him eat his eggs and I just spooned the eggs into his mouth.
Speaker: And the medical students looked at me like, what is going on?
Speaker: They're like, Dr. T, you're the department chair.
Speaker: You don't need to do that.
Speaker: And I said to him, you guys don't get it.
Speaker: Like, you know, after I helped this gentleman with his eggs, he thanked me and I could tell that it meant something to him.
Speaker: And even though it was something little,
Speaker: it was literally the only thing I could do that day that could possibly be meaningful for him because his diagnosis was absolutely not fixable.
Speaker: And so I said to my students, I'm like, you guys don't get it.
Speaker: See, that was my way.
Speaker: That was my only way of making a difference for him today.
Speaker: And I now feel like I did something good for him.
Speaker: Whereas I was really depressed at the end of rounds,
Speaker: in the morning when I literally felt that I couldn't fix any of the problems that laid before me.
Speaker: I at least got a really good conversation and a meaningful moment with this gentleman who was clearly in his, you know, in the last days of his life.
Speaker: And so the reason why I tell you that story is because I actually think when we talk about compassion fatigue, we're often talking about empathy fatigue and it's those repeated
Speaker: insults or injuries, if you will, that from bearing witness to suffering, but feeling powerless to do anything about it.
Speaker: So what I advise my fellows is to find things that you can do that are, even if you can't be a fixer that day, find things that are meaningful for that patient or for that family and do those things.
Speaker: And if you do those consistently, it will change your experience.
Speaker: And I think that's a great way of putting it and
Speaker: I know that you mentioned this in the book as well.
Speaker: And I think Paul Bloom had talked about the case against empathy and talks about rational empathy, right?
Speaker: And what you're really saying is that, yeah, if all we do is feel, is see people's pain, but we feel what there's nothing we can do about it, it can become, I think, quite overwhelming.
Speaker: But the point with the story you just told, I think, is that there's always something we can do.
Speaker: And there's always something you can do that can be meaningful to another human being.
Speaker: And maybe you can't feed eggs to every patient, but every day, I think in every shift, people can find something to do that makes a difference, either to a colleague, to a patient, and that's a way to move forward.
Speaker: And I think we're going to hear more about the science behind that.
Speaker: So that's a great story.
Speaker: Steve, let me ask you, as we move forward, one of the beauties of the book, and I had a chance to read it, so
Speaker: Really appreciate your line to me to do that.
Speaker: It's really wonderful.
Speaker: And like everything in my world that's great, it has three parts, which I think is perfect.
Speaker: So we'll use those three parts to kind of frame our discussion.
Speaker: And it's a diagnosis, a proposal for a cure based on the evidence, and then the prescription at the end, which is what we want people to do based on the science.
Speaker: So why don't we start with a diagnosis and what you and Maz called an epidemic of self-serving and tell me a little bit about the meat culture and especially the meat culture in medicine.
Speaker: So things used to be different as we've tried to be a good student and steward of history and using it appropriately in our book.
Speaker: Going back to the, you know, the greatest generation.
Speaker: So these were people that were born and grew up during the depression and went on to fight in World War II.
Speaker: They were known, well, they were known for many things, of course.
Speaker: They were also known for sacrifice.
Speaker: And sacrifice was one of the characteristics of that generation.
Speaker: And then after that, you know, those in the civil rights movement were obviously dedicated to
Speaker: higher purpose, you know, something much bigger than themselves.
Speaker: And, you know, in the hippies, so to speak, it was all about peace, love, and understanding.
Speaker: And then in the 70s, our research indicates that things started to change a little bit.
Speaker: And there are, you know, sentinel publications from that time showing that in first characterizing the terminology or describing the terminology me culture,
Speaker: I think it's, well, it's gotten worse over time.
Speaker: Data from Sarah Conrath, for example, shows that empathy among college students has been declining over the past two decades, and the speed of the acceleration is accelerating over time.
Speaker: A study from the Harvard Graduate School of Education among 10,000 middle school and high school students in the U.S. found that
Speaker: From the kids' perspective, they feel 80% of them believe that their parents value the kids' achievements and their accolades more than the parents value the kids' kindness for others.
Speaker: And in a striking Pew Research study from just a few years ago, a representative sample of Americans found that fully one-third of Americans said that they don't consider compassion for others to be among their core values that describes them well.
Speaker: And as we've progressed from the 70s and then into the 80s, and in the 80s, the suspender-loving financier Gordon Gekko from Wall Street, his famous mantra was, greed is good.
Speaker: But then later on, we got into the selfie stick, for example, is one researcher called it the greatest totem
Speaker: to interpersonal misunderstanding, because it is more than anything else, the all about me or I'm doing me approach to life.
Speaker: And so what the research shows is, and I should also mention that another, not that there is another podcast besides Critical Matters, but Freakonomics,
Speaker: had a synthesis of the evidence to show that when you or when social science researchers study cultural distinctions or distinctions in culture among nations using a very rigorous methodology, they found that the most individualistic and self-centered nation, they said by far, according to the researchers that were in that forum,
Speaker: is the United States.
Speaker: And so what I think everything points to is that we've got an acute on chronic condition of it's all about me-ism and condition critical.
Speaker: And I think another very interesting point that you make in the book, and we've discussed offline,
Speaker: is this whole idea of building resilience by looking in versus building resilience by looking out.
Speaker: Could you talk about that?
Speaker: Sure.
Speaker: So there was a study done by some intramural researchers from the NIH just a few years back that analyzed people's self-care practices.
Speaker: And we hear a lot about self-care and me time.
Speaker: And let me first say that I think that self-care and me time are very important, but the question is, what do you do with that time?
Speaker: Or what is it that actually refreshes you and fulfills you or replenishes you, if you will?
Speaker: And so what the study showed is that people's self-care practices have become more and more isolating.
Speaker: over time, isolating.
Speaker: So for example, you might put on your headphones or your earbuds and block out the world and put on your Headspace app.
Speaker: And, you know, that's a journey deeper with inward, right?
Speaker: Or whatever meditation app you use or, you know, but that it's all about a journey inward or taking nature walks by yourself.
Speaker: And even yoga for that matter, you know, some, you know, you're mad as your island and,
Speaker: And a lot of practices, whether they're meditation or mindfulness or other things, and there's nothing wrong with any of those things.
Speaker: It's just that they are different from practices in the past in that they're more isolating, if you will.
Speaker: So the contrast would be that in decades past, when people were going through struggle, they found solace in families.
Speaker: and in friends and in relationships.
Speaker: So self-care practices with the data shows, and you can believe that this is bad, good.
Speaker: That's a matter of, I think, interpretation or opinion, but the data show that the practices themselves are becoming more isolating and something that you do by yourself and, you know,
Speaker: go deeper within word perhaps rather than going outward and connecting in a relational way with people that you know mean a lot to us and and you do mention in the book and probably the longest ongoing study is the harvard grant study and they actually at the end of the day maybe you can summarize that for us basically found out that the only thing that really matters is our relations yeah so the so um
Speaker: Your listeners are probably familiar with the Harvard Grant Study, which is the Harvard Study of Adult Development.
Speaker: It's been going on for over 80 years.
Speaker: I think they're on their fourth study director.
Speaker: But what they did is they enrolled Boston teenagers.
Speaker: Some of them were Harvard students and some of them were not college students that were in Boston and they followed them over time and they wanted to know what is the secret to good health and longevity.
Speaker: What they found is that what
Speaker: is the best predictor for good health and longevity into your eighties.
Speaker: Isn't some biomarker in your fifties.
Speaker: It's not your cholesterol level or your systolic blood pressure, your hemoglobin A1C or anything like that.
Speaker: It is, as you said, the quality of your relationships.
Speaker: And we also know that the flip side of that is also true because loneliness kills our current and former surgeon general, Dr. Murthy wrote a book about it.
Speaker: And the public health data are very clear that the,
Speaker: the risk to your health from loneliness and presumably the mechanism is that chronic loneliness is like a chronic stress response and that but the what the research shows is that the risk of early mortality is comparable to the risk of early mortality from obesity or alcohol misuse and even smoking
Speaker: in some research.
Speaker: So what the research shows is that loneliness kills.
Speaker: So relationships matter for good health, longevity, but also, and this is one of the, I would say the sentinel findings from all the research that we've done, not just with Wonder Drug, but even going back to compassionomics is this.
Speaker: And this is true, I believe in healthcare,
Speaker: there is a wealth of data on this outside of healthcare and just the psychology domain.
Speaker: And the best way I can summarize it is to say this, that the key to resilience is relationships.
Speaker: And so it's not just longevity, but it's also thriving.
Speaker: So it's not just longer life, living longer, they also live better.
Speaker: And that's, you know,
Speaker: really a theme that runs through all the pages in the new book, Wonder Drug.
Speaker: So I think this is a perfect segue to talking about the evidence behind the benefits of serving others or what you call the cure.
Speaker: And if you just want to summarize some of the highlights, maybe we can start with physical health benefits and what the science shows in terms of what happens when we really connect to others and try to give to others.
Speaker: Well, before I do that, I'd like to quickly just go over like some of the mechanisms.
Speaker: And so I want to be clear that what this book, I'm going to tell you in a minute, you know, what we call the quote unquote, the cure is, but I want to tell you what the book's not about, right?
Speaker: So it's not transactional, it's transformational because there are bona fide
Speaker: mechanisms that I'll share with you in just a minute.
Speaker: But, you know, what we're not talking about in Wonder Drug is, you know, karma, pay it forward, boomerang effect or anything like that.
Speaker: Because, and those are really important concepts.
Speaker: And of course, we all want to believe that, you know, if you live a good life and you're a good person, that you'll have a better life, a better quality of your life.
Speaker: But,
Speaker: there are no data for that as far as we could tell anyway, but what there are data for are effects that are tied to a few mechanisms that I think are important.
Speaker: So the, the first one, and I'll share with you five in, in, and we'll just do this really briefly.
Speaker: So one of the things I already mentioned was that when you have compassion for others, your mind is focused on compassion for others.
Speaker: You take,
Speaker: you take good care of other people, it feels good, right?
Speaker: Well, that's because as we discussed earlier, it actually activates a reward center of the brain, a reward center.
Speaker: So a direct activation of neural pathways associated with reward, that's one of the mechanisms.
Speaker: There are neurotransmitters and hormones that are re-reduced
Speaker: increased when we serve others, when we're engaged in serving others.
Speaker: So it's endorphins, it's serotonin, it's oxytocin, it's dopamine.
Speaker: We call the Fantastic Four.
Speaker: Since we're talking to a bunch of critical care folks, they're all familiar probably with those, so I won't go into any detail.
Speaker: But it's also important to recognize that research shows that
Speaker: serving others can blunt your stress response.
Speaker: So it can actually reduce your stress, but it can then also buffer your stress as it relates to the effects of stress mediated disease.
Speaker: So while I'll share with you in a minute that there are research studies that associate serving others with longevity, there is specifically research that what serving others does is it blunts the effect of that
Speaker: it blunts the association between stress and early mortality.
Speaker: So it can be stress buffering both in physiological terms, but also in clinically meaningful terms.
Speaker: You also fine tune your nervous system when you're in the mode of serving others, because rather than your sympathetic fight or flight pathways, you activate your parasympathetic,
Speaker: nervous system, so it has a calming effect on you.
Speaker: And all of these things are, if you think about all the things I just mentioned, there are a lot of feel good mechanisms, so they can have beneficial effects for you, but it also feels good to help people.
Speaker: And we all know that experientially.
Speaker: And many of these things that I've already mentioned are responsible for that.
Speaker: But in terms of bunting stress, that's one way that we can see
Speaker: beneficial effects for our own health.
Speaker: And then also there's research that serving others in specific, the kind of happiness that is called eudaimonic happiness.
Speaker: So like a higher purpose kind of happiness rather than hedonic happiness, like hedonism.
Speaker: So rather than just pleasure seeking in the moment, you know, getting pleasure from serving some higher purpose.
Speaker: There's research from Barbara Fredrickson at University of North Carolina and others that shows that
Speaker: you actually down-regulate your gene expression for systemic inflammation when you are with eudaimonic happiness.
Speaker: And so those pursuits can actually be associated with lower systemic inflammation.
Speaker: Of course, if unchecked over long periods of time, chronic systemic inflammation has been associated with everything from cardiovascular disease to cancer.
Speaker: So those are some mechanisms, Sergio, but in terms of physical health effects, there are a number of papers and we cite, I told you there are 250 cited in Wonder Drug, but there are many, there's a substantial chunk of those that are devoted to longevity.
Speaker: And,
Speaker: the association between serving others, and most of them are about volunteering to serve for good causes, and longevity, that data is very consistent.
Speaker: And in my mind, that association is really clear.
Speaker: One of the things you always worry about in studies like that are potential residual confounding.
Speaker: So of course studies can, and all these studies that we cite,
Speaker: to use mathematical models to adjust for potential confounders, anything that they can measure that might be associated with both the exposure, so to speak, of volunteering, as well as the outcome of longevity or mortality.
Speaker: But what about the unmeasured confounders?
Speaker: That's where the residual confounding comes in, and that's what sometimes gives you concern.
Speaker: Like, for example, is it that the people who didn't serve others
Speaker: happened to also eat a lot of junk food or live next to a toxic waste dump or something like that.
Speaker: Well, in order to address that, investigators in a study from the International Journal of Epidemiology enrolled married couples.
Speaker: So a huge number of married couples where in those married couples, the amount of volunteering and serving others was heterogeneous, but what they were able to find
Speaker: was that spouses among married couples that volunteered to serve others, and by the way, I should mention that these were community-dwelling married people who were living under the same roof.
Speaker: So specifically, they were, well, not only living under the same roof, presumably they ate the same dinner, they perhaps had the same friends.
Speaker: A lot of that
Speaker: concern for residual confounding can be attenuated when they're living in the same house.
Speaker: And what they found is that spouses who volunteered to serve others had a mortality benefit, but the non-volunteer spouses did not.
Speaker: So it wasn't the drapes, it wasn't the dinner, it wasn't something in the water,
Speaker: The association appears to be that the spouses that were what we call a live to give approach to life where they were volunteering and serving, the research supports quite clearly that they get a benefit.
Speaker: And the other thing I was going to ask you about it, you talked about the physical and there's also a whole bunch of mental health benefits that we don't have to go into, into, into detail.
Speaker: But one of the things that, that struck me the most, Steve, which is, I think a little bit of counterintuitive to what we're taught is the benefits that a live to give attitude has on your professional success.
Speaker: Could you expand on that a little bit?
Speaker: Sure.
Speaker: So, um,
Speaker: So Liv, just for your listeners, because I know you and I have had some dialogue about this, Liv to Give is just what Dr. Maz and I call somebody who not only is very other focused in their life, they also know that that's where they get a lot of their happiness and fulfillment and well-being from.
Speaker: And so they want to do it as often as they can.
Speaker: And they know that it actually makes them feel better and has tangible benefits for them.
Speaker: And so that's what really keeps it to be sustainable over time.
Speaker: And so what we call live to givers do, as you mentioned, have mental health effects, right?
Speaker: So giving, serving, being other focused has been associated with lower anxiety, has been associated with lower depressive symptoms.
Speaker: And a lot of these data
Speaker: In contrast to a lot of the longevity data, because of course they're gonna study older folks, because those are the people who are gonna experience the outcomes of death more swiftly.
Speaker: And so when you're studying physical health things, you really wanna focus on an older population so you have enough events in the population to test your hypotheses.
Speaker: mental health, that research skews younger.
Speaker: And it skews younger because of, you know, we're all aware now of the mental health crises that is gripping so many of us, but our young people are really at risk.
Speaker: And so that research shows that in young people, less depression symptoms, less anxiety symptoms, better self-esteem, more well-being,
Speaker: And I describe it this way.
Speaker: Think about the last time you were really consumed with worry, but then the phone rings and it's somebody you care about very much and they need you.
Speaker: They're in trouble maybe, but they need you.
Speaker: And you drop everything and you go to help them.
Speaker: And I'm thinking specifically now, this is a UCLA-Yale University collaboration, this study.
Speaker: while you're in the moment and you're helping and you're serving this person that you care about very much, you actually, you're not revisited by those worries until that time is over.
Speaker: So what the research supports is that serving others can actually help you forget your own worries, at least temporarily, not permanently, of course, but at least temporarily.
Speaker: So in the moment and
Speaker: And there's just a wealth of other mental health benefits for being other focused.
Speaker: What the research really supports is the more you're in your own head, the worse off you are as it relates to mental health.
Speaker: And so this is also true for happiness and well-being.
Speaker: And happiness can be defined a number of different ways, but
Speaker: There's some fantastic work by Dr. Elizabeth Dunn and coworkers about spending money and spending money on other people versus spending money on ourselves.
Speaker: And her research shows quite clearly that we get better boosts to our own happiness when we're other focused and we spend money on other people rather than being self-focused and spending money on ourselves.
Speaker: And to your point about success,
Speaker: it's actually serving others is actually beneficial for your professional success as well.
Speaker: I mean, I think we, we, we characterize, or we, we think of, you know, Mr. Burns in the Simpsons, right?
Speaker: Who is this, you know, tyrannical, you know, person who was the, the evil boss.
Speaker: And, um, uh,
Speaker: And realistically, I mean, and we can all think of people who have gotten to the top, quote unquote, that way, but it's going to be harder for them, according to the research, because what the research supports is that those who are giving, serving others, who care about others and work hard for others' benefit,
Speaker: are the people who have the wind at their back as they, in the workplace, in their career, they have the wind at their back rather than a target on their back.
Speaker: And so there was a research years ago, actually a couple of decades ago, on idiosyncrasy credits.
Speaker: What that means is when you build up enough goodwill because you're a good person, you have idiosyncrasy credits where if you don't do that,
Speaker: the minute that you stumble or there's an opportunity to take you out, somebody will do it.
Speaker: And so certainly it's possible to be aggressive, self-centered person and have some professional success.
Speaker: But if you have a long enough time horizon in which to measure it, a long enough time horizon, the people who are the giving, what we call the live-to-givers,
Speaker: will on average do better over time if you have a long enough time horizon.
Speaker: And I know, old adage, or the question, do good guys finish first?
Speaker: Well, if you have a long enough time horizon, the old saying or the thinking would be yes, but there are actually data to back that up.
Speaker: And I'm thinking of a Cal Berkeley study from just a few years ago where they compared
Speaker: the likelihood of attaining power positions in the workplace, comparing aggressive, self-centered, it's all about me kind of bosses versus outgoing, giving employees.
Speaker: And what they found is that the givers were the ones that rose to the top faster and attained positions of power.
Speaker: And that probably trust has a lot to do with
Speaker: because to become a leader, people need to trust you.
Speaker: And I'm not saying that aggressive, self-centered, it's all about me as in people can't do that.
Speaker: It's just going to be harder.
Speaker: And that's not, again, I know I say this all the time, but it's not my opinion.
Speaker: It's not what I think.
Speaker: It's what I believe.
Speaker: It's what we found in our journey through the evidence.
Speaker: And so we've got a lot of research to back that up.
Speaker: So clearly, Steve, you talk about it in the book and you share it.
Speaker: highlights of data supporting the physical health benefits in terms of longevity, mental health benefits, well-being, happiness benefits, and success at a professional level benefits.
Speaker: But there's a catch, right?
Speaker: It matters why you're doing it.
Speaker: Can you talk about motives?
Speaker: So what the research supports is that motives matter.
Speaker: And what I mean by that
Speaker: is if you're listening to this podcast right now and you were thinking, oh, great, now all I'll do is I will go out and help and serve people so my star will shine and my career will soar and I will have, you know, that's what we call strategic helping.
Speaker: Actually, that's what the people, the social scientists who study this call strategic helping.
Speaker: And what
Speaker: what researchers have found is that when you are strategic helping versus genuinely other focused in your helping, it actually activates different centers of the brain when studied with functional MRI.
Speaker: And so that explains, at least in part,
Speaker: why it is that you see differential results.
Speaker: But we devote a whole chapter in Wonder Drug to the concept that motives matter and that you can't game the system, so to speak.
Speaker: And so it's not something that you can willfully leverage for your own benefit.
Speaker: What you do is if you're genuinely focused on other people, the benefits that will come are like byproducts.
Speaker: unintended consequences, so to speak, that aren't the goal, they're not the aim, they're just the byproducts of being focused on helping other people.
Speaker: You know, Sergio, one thing I didn't say early on that I probably should have is I wanna tell people that I don't have any magical thinking about serving others, so no magical thinking.
Speaker: you know, we do share with you the benefits for yourself, for your physical health, mental health.
Speaker: You know, as it relates to physical health, especially, yes, it's true that serving others is the best medicine for yourself.
Speaker: But if the rest of your life is filled with, you know, cheeseburgers and cigarettes, then, you know, probably this isn't going to help you that much because the other things are going to be such a powerful signal in driving your health risks.
Speaker: But,
Speaker: if built upon a foundation of a healthy lifestyle, then the research supports that these things can give you added benefit.
Speaker: The other thing I should have said as it relates to no magical thinking is that it's not a one and done, of course, right?
Speaker: So it's not that I can help and serve now or in this short period of time in my life, and then I'll have good health and longevity into my 80s.
Speaker: Well,
Speaker: That would be like thinking, you know, I can eat my vegetables once and, you know, I'll be set for, you know, good health and long life.
Speaker: And of course that's ridiculous.
Speaker: So the reason why I say that is because the key is building it into your life in little ways and habits and making it a way of life, what we call becoming a live-to-giver, sustained over time for the long haul.
Speaker: So let's talk about
Speaker: how we get there and where you and Maz have called the prescription and you really have created a framework around seven steps that we can start implementing today.
Speaker: And like you said, in small doses, but if you continue to come back at it like compound interest, I would imagine that over time, it really has an enormous impact on, on, on all these aspects of your life that, that you mentioned.
Speaker: So why don't we start with just maybe telling us what the seven steps are
Speaker: Steve, and then just diving into each one of them and giving us a little bit of the context and the data.
Speaker: Absolutely.
Speaker: So number one is, in my opinion, perhaps the most important.
Speaker: So it's start small.
Speaker: If you were a couch potato and you wanted to start an activity program, you wouldn't run a marathon on your first day, right?
Speaker: You might walk around the block a little bit.
Speaker: and you'd work up to it gradually over time.
Speaker: So similarly, to be a live-togiver, you don't need a total life upheaval.
Speaker: You don't need to quit your job and sell all your worldly possessions and move to a third world country and start hauling water from a distant well.
Speaker: You can instead really what the research supports is that just simple prism changes are all you need.
Speaker: that you need new surroundings is that you need to interact with your surroundings in a new way.
Speaker: So what we call, and this is going back to a classical study from decades ago, actually in the Journal of Organizational Behavior, it's called, or the researchers called it a personal paradigm shift.
Speaker: So your paradigm is your framework or the thinking that guides your life.
Speaker: If it's your personal paradigm, your approach to life, well, a personal paradigm shift is then just shifting
Speaker: how it is that you view life, but you don't need to change.
Speaker: You don't need a major life upheaval.
Speaker: You just need little micro acts of compassion and habituate that every day until it becomes second nature to you.
Speaker: And then gradually your experience of life will be wholly transformed over time.
Speaker: But start small because I've had some colleagues or friends say,
Speaker: after, you know, I tell them what the new book's about, they say, oh, that sounds really interesting and, you know, awesome.
Speaker: But, you know, later on in life, when I have more time, I'll be, I'll be a better, you know, I'll be, I'm going to try to be a live together, you know, later on down the road.
Speaker: And I understand that we're all super busy in our daily lives, but
Speaker: what the research supports is that just small acts can really make a huge difference.
Speaker: And so what is the dose, right?
Speaker: Is there some threshold effect for helping and serving others?
Speaker: And the answer is yes, probably.
Speaker: What the research supports is a threshold effect of 100 hours per year to, and that is the number that's,
Speaker: most consistently, if we were looking for a threshold, most consistently associated with longevity benefits.
Speaker: Now, we don't typically take our medicine once a year.
Speaker: We take it every day.
Speaker: So what does that come out to be?
Speaker: 16 minutes.
Speaker: So it's 16 minutes per day, on average, of course.
Speaker: Maybe you want to store it up and, you know, for two hours on a Saturday, go and help a
Speaker: a sick relative or someone who's in need or volunteer for a good cause.
Speaker: But if you want to take it every day, it's 16 minutes.
Speaker: And the reason why we think that's important, and Maz and I call it your daily 16, is it puts your radar up to look for little opportunities that are all around you and to just build it little by little into your
Speaker: into your life every day.
Speaker: So you don't need to, and now I wanna be clear as we're speaking to the critical care community here with your listeners.
Speaker: Obviously critical care is all about serving others, serving patients, but I think that if you're feeling burned out and you're looking for a change, look for 16 additional minutes per day
Speaker: to connect with somebody.
Speaker: It may not be your patients, families.
Speaker: It might be your staff member who's in need of some help.
Speaker: It might be your unit secretary.
Speaker: It might be your nurses.
Speaker: It might be your trainees.
Speaker: It might be at home.
Speaker: It might be your neighbor.
Speaker: But do it and just see if it transforms your experience because there's a lot of research behind it.
Speaker: And talking about time before we move on to number two, you also quote a very interesting study in oncology patients that demonstrated that 40 additional seconds of a script that is compassion embedded really makes a huge difference in how the patients perceive that experience.
Speaker: And again, I mean, we're talking about seconds and minutes and yes, we're busy, but there's always time to incorporate that into our daily practice.
Speaker: So the research does support that on average, and we covered this both in Compassionomics and in Wonder Drug, that it typically takes less than a minute to make a meaningful connection.
Speaker: And we don't always believe that, you know, in the house of medicine, so to speak.
Speaker: So I'm thinking about this Journal of General Internal Medicine study from several years ago now, where
Speaker: 56% of physicians said that they don't have time to treat patients with compassion.
Speaker: But it begs the question, how much time does it actually take?
Speaker: And then we found all that research that you just mentioned that on average, it takes less than a minute, but there was a pivotal study in my opinion from the University of Pennsylvania from several years back now that
Speaker: studied something called time affluence, time affluence.
Speaker: So that's the feeling that you have plenty of time, that you're not in a rush, you're not in a hurry.
Speaker: And what the investigators wanted to find out is what uses of time is associated with an increase in time affluence.
Speaker: So what kind of uses of time make you feel that you have more time?
Speaker: And they randomized in an experimental design, they randomized subjects to four different uses of time
Speaker: One was spending time on yourself.
Speaker: One was wasting time.
Speaker: One was getting an unexpected windfall of free time.
Speaker: And the last one, the only one that increased time affluence was spending time helping other people.
Speaker: So the research supports that there's something about spending time helping other people that makes you feel differently about the time that you have.
Speaker: And so, and some of my colleagues here at Cooper, they just bristle at this conversation right out of the gate.
Speaker: And the reason is because they would say, there should be no time dimension at all.
Speaker: Because you can go through your day with brusque efficiency, letting every person that you meet know exactly how busy you are or how busy you think you are.
Speaker: Or you could go through your day treating people with kindness or compassion or looking for opportunities to serve them better or to help them.
Speaker: And if someone held a stopwatch to you, it really wouldn't be much of a difference at all.
Speaker: But how you feel at the end of the day would be drastically different.
Speaker: And that's kind of what the data shows, right?
Speaker: That's what the data supports.
Speaker: So again, we just try to report on what the data will support.
Speaker: Excellent.
Speaker: So start small, number one.
Speaker: Number two?
Speaker: Number two is be thankful.
Speaker: Now you might have heard that an attitude of gratitude is good for you.
Speaker: But the question we wanted to ask is why?
Speaker: Why is it good for you?
Speaker: And so there was a meta-analysis of 70 studies which found that when you have gratitude, when you are feeling grateful, that you are primed
Speaker: to look for opportunities to help and serve others.
Speaker: What researchers call pro-social activity, which is just a research term for kindness, basically.
Speaker: And that gives us a mechanism.
Speaker: Now I understand why gratitude is good for you.
Speaker: It's because it primes you to do live to give behaviors, which are associated with, you know,
Speaker: robust beneficial effects for yourself.
Speaker: What was interesting is the researchers found that not all gratitude though was created equal.
Speaker: So what they found was most beneficial for motivating you to help and serve others and get all the benefits of that was relational gratitude, relational gratitude rather than generalized gratitude.
Speaker: So what they mean by that is grateful for specific people in your life,
Speaker: rather than just generalized gratitude like I'm grateful to the universe for this good life that I have or something like that.
Speaker: So when we're grateful for other people, specific people in our lives that we relate to, it makes us more likely to help and serve and all the benefits that flow from that.
Speaker: So let me ask you a question for my own benefit here, Steve.
Speaker: So I have a journaling habit, daily journal habit,
Speaker: And one of the prompts at the end is something you're grateful for.
Speaker: So the data would suggest that specificity in terms of relations probably has a heavier weight in our wellbeing.
Speaker: Yes.
Speaker: Noted.
Speaker: Excellent.
Speaker: Let's go to number three.
Speaker: Number three is be purposeful.
Speaker: And so there are a lot of things that I could talk about in this context.
Speaker: but I'll try to be brief.
Speaker: I'll just mention in the broad sense that often, and we're just going through graduation season now, right?
Speaker: So like last month it was the college kids and right now it's a lot of the high school kids, including where I live.
Speaker: And we hear lots of graduation messages, commencement speeches, and oftentimes the messages are things like follow your passion, chase your dream and all that stuff.
Speaker: But what the research that we've synthesized shows clearly in my mind is that really what we should be searching for is purpose.
Speaker: Because it's purpose that actually will give us more happiness, well-being, fulfillment over time rather than following your passion or follow your bliss or anything like that.
Speaker: And specifically in our day-to-day lives, I think that in order to be purposeful in just daily, everyday life, we have to learn how to ask the right questions.
Speaker: Because when you ask the right questions, that's when you see your opportunities to be purposeful and not just go through the motions of everyday life.
Speaker: And so I'm reminded of a study from the University of Colorado that was performed in the emergency department.
Speaker: And they handed out cards to patients in the emergency department and on the card was written, what worries you the most?
Speaker: What worries you the most?
Speaker: And they compared that then, the answers to what was written on the triage form at intake for the emergency department from the triage nurse.
Speaker: And so what they found was that there was only a 26% concordance, so 74% discordance
Speaker: between what the chief complaint was and what actually worried the patient the most.
Speaker: So for example, there was a, they, they showed some examples.
Speaker: The patient's chief complaint was chest pain.
Speaker: And what the man wrote on the card was, I can't stay away from the hospital.
Speaker: I know it's because of the drugs and I'm scared.
Speaker: I'm going to lose my family.
Speaker: And so what was probably going on in that ED visit, cardiac enzymes, EKGs, all the things that are part of standard good clinical care, but really the patient had a hidden problem with addiction.
Speaker: And that if that wasn't addressed, they were never really gonna be able to dive into what was really gonna be meaningful for this patient.
Speaker: Similarly, there was a patient whose chief complaint was first trimester vaginal bleeding.
Speaker: so concerned for miscarriage, of course.
Speaker: And what the patient wrote on the card, what worries you the most?
Speaker: She wrote depression.
Speaker: And she wrote, I don't want to go into depression again because having a miscarriage is really hard.
Speaker: And so if you don't ask, you won't know what is front of mind for people.
Speaker: And then your ability to impact their lives either over time or in that particular moment is greatly diminished.
Speaker: And so there are, I've actually built this into my practice.
Speaker: And so now when I'm in the ICU and talking to patients or talking to families of patients, and I'm at what would conventionally be the end of our conversation and I might get ready to leave,
Speaker: I then try one more question and I add in, what worries you the most?
Speaker: And Sergio, I have been absolutely blown away at what people say.
Speaker: And I'm just amazed at what's front of mind for people.
Speaker: And when you ask that question, what worries you the most, you're giving them the okay to be really raw in that moment and to just tell you what's really front of mind.
Speaker: It has led to some amazing discussions.
Speaker: Sometimes I can allay somebody's fears because the thing that was their greatest worry, you know, was not something that they ought to be worried about.
Speaker: And sometimes I just become aware of something that's front of mind for somebody that maybe I can't necessarily do something about, but I can be present for them in that moment.
Speaker: And, you know,
Speaker: It is one of the best things that I've ever done to change my practice in the 20 years I've been an intensivist.
Speaker: So that's how I think asking the right questions is how you can be purposeful.
Speaker: And along the purposeful theme, two comments, Steve.
Speaker: One regarding the right question, and you talked about this in the book as well, and I've heard it through different venues, but you show some data.
Speaker: But especially in the ICU, when we're trying to also give to those around us who are not patients, we tend to ask questions that have a yes or no answer.
Speaker: And those usually don't take us anywhere.
Speaker: But as leaders or as colleagues, if we could ask, for example, what can I do today to make your shift a little bit better?
Speaker: Or what can I do today to help you?
Speaker: I think we might get much better answers and things that we actually can do for our colleagues that can make a difference.
Speaker: And that's also something very powerful that you talk about in this chapter.
Speaker: That's right.
Speaker: And you said it better than I could.
Speaker: So I'll just leave it at that.
Speaker: But I totally agree.
Speaker: And asking questions that can't be answered with a yes or no is generally helpful.
Speaker: Like the one that really I try to never ask anymore, even though I've probably been guilty of it like a million times in my life is, hey, you good?
Speaker: Great.
Speaker: You know, that just invites, hey, I can't really be bothered with whatever your actual answer is.
Speaker: So, you know, let's not go there.
Speaker: You know, those are those are I try to be very careful with my questions now.
Speaker: And you have to ask the right questions in order to to know what opportunities are there for you.
Speaker: The other comment I wanted to make on purpose was this concept of job crafting.
Speaker: and how ultimately all purpose comes from within and how we look at things.
Speaker: And one of the interesting concept of, in this respect is that if you tend to think about your job or you explain your job to others, not in terms of the tasks that you perform at your job or your job description, but in terms of how you impact other people with your job, it sends, I think a much more powerful
Speaker: message to yourself in terms of what your real purpose is.
Speaker: And that is something that even though we're in healthcare, a lot of us have forgotten or forget at given times.
Speaker: And I think it's a great reminder to describe what we do every day in terms of who are we trying to create a positive impact on?
Speaker: Who are we trying to live to give for?
Speaker: You know, I totally agree.
Speaker: And just to make sure I understand correctly, but also for your listeners,
Speaker: I think what you're describing is, and this is the example I typically think of, so think of somebody for environmental services in the ICU.
Speaker: Whereas if you were to ask them what the tasks are that they would perform, they would say something along the lines of, well, I clean the floor, I clean the counter, I do this stuff.
Speaker: But if you ask them what they do for other people, they'd say, well, my job is to make sure that this room right now is free
Speaker: from any potential infectious risk to the next patient that's coming into this bed because I need to keep them safe.
Speaker: And if you look at it that way, then the environmental services person's job is a lot different than how it may be framed by tasks.
Speaker: Is that what you had in mind?
Speaker: Absolutely.
Speaker: And I think it really relates to the fact that, like you said, the environmental person
Speaker: they're part of a team and they're really preparing something for a patient and making a difference for somebody else, right?
Speaker: It's not only the job description of the tasks that they perform.
Speaker: That's right.
Speaker: So we talked about number one, number two, and number three.
Speaker: Let's talk about number four.
Speaker: So number four is a little dicey.
Speaker: So it's find common ground.
Speaker: Now that's a little easier said than done these days, right?
Speaker: I mean, we're perhaps in the most, um,
Speaker: polarized or divided environment, more than ever before with all the different sources competing for our attention and potentially trying to drive a wedge between us, especially for people who maybe don't think exactly like we do.
Speaker: And so the reason why find common ground is important is because if you are in your foxhole
Speaker: and in your mind you're only interested in the well-being of your own, so to speak, you're cutting yourself off from an amazing number of people in the world and a number of what we'd call live to give opportunities.
Speaker: Much of this research, and by the way, all these seven, this seven step prescription that we prescribe for the reader in Wonder Drug, there's evidence behind all of this.
Speaker: So there's evidence in the prescriptive part as well.
Speaker: But what most of the research talks about is in-group versus out-group.
Speaker: The in-group is what we call our own and the out-group is the, you know, the quote unquote other, the other.
Speaker: And what the research supports is that if we can just, in our mind, it's all about framing.
Speaker: And if we can frame things so that more people are in our in-group than we're maybe inclined to be on any given day with all the forces, you know,
Speaker: social media, the different algorithms that are running through your searches online, cable network TV, any of those things.
Speaker: Like if we can frame it so that more people are in our in-group, then we'll have more and more opportunities.
Speaker: And this goes back, you mentioned Paul Bloom earlier.
Speaker: So in Paul Bloom's book Against Empathy that you mentioned,
Speaker: he talks about parochial empathy.
Speaker: So what that research shows is that if we only have empathy for our own, like the people who think like us or, you know, that are in our, you know, in our bubble, so to speak, then actually what the research shows is that we become less caring for the people that are outside that bubble.
Speaker: And so while we might think that empathy for our own makes us more
Speaker: It gives us more empathy, gives us more compassion.
Speaker: It doesn't because we actually, the research supports, we actually treat other people worse.
Speaker: And so what that part of the prescription, find common ground is all about is have a much, much, much, much bigger bubble and put as many people as, preferably everybody, but as many people as possible into your in-group.
Speaker: because really, you know, the polarization hurts everybody.
Speaker: That's a great one.
Speaker: As we move forward, Steve, with number five, want to talk about see it?
Speaker: Sure.
Speaker: So that relates to seeing the effects of your helping and serving.
Speaker: And what the research supports is when you can frame concrete goals for your helping and serving,
Speaker: that it is more beneficial to you and you'll reap more benefits.
Speaker: And one of the ways that it does that is it makes your giving and serving more sustainable.
Speaker: Because when you see the effects, you are more likely to give and serve consistently over time and sustain it and getting all the benefits.
Speaker: So rather than like maybe abstractly framed goals for helping or serving, you know, the more concrete and the more specific we can be, the more,
Speaker: of the benefits we get.
Speaker: You get more serotonin, for example.
Speaker: Some people call that the pride hormone, but you get more effects, more beneficial effects when you can see what some people might call the fruits of their labor, so to speak.
Speaker: And this is really important for sustaining our live-to-give behavior over time.
Speaker: It's very interesting that obviously it's also about a framework or framing things a little bit different.
Speaker: And in critical care, one of the things that you mentioned in the book during COVID and that we saw throughout many ICUs around the country was the celebration obviously of successes.
Speaker: But I also believe, Steve, that sometimes we just have to redefine success.
Speaker: We've all experienced in critical care
Speaker: patients who die, yet families who are tremendously grateful for what we did for them.
Speaker: And at the end of the day, it's just understanding what can I do today to make your day a little bit better or make your pain a little bit smaller.
Speaker: And again, I think that that aligns with see it as well.
Speaker: And like you talk about in the book, there's plenty of evidence to suggest that that makes it sustainable.
Speaker: And to add to what you just said, which I totally agree with, that we have to see it over
Speaker: over a particular time horizon for the critical care community.
Speaker: So researchers have studied this among firefighters.
Speaker: And what they found is that the benefits of giving and serving, and of course firefighters are involved in heroism, just like the other helping professions, including in the critical care community.
Speaker: But in the moment when they are helping and serving, like responding to a fire, they don't necessarily feel great.
Speaker: In fact, they feel totally wrung out and exhausted.
Speaker: But what the researchers found is that at the end of the shift, at the end of the day, whenever it is that they can then rest and then reflect back upon the good that they did that day, that's when they get their benefits.
Speaker: And so, you know, we can't expect to be feeling the benefits of helping and serving in the moment, so to speak, because research supports that once we're removed from that and can reflect back upon it, that's when we can get, when we're more likely to get our benefits, when we're in a, you know, a field like critical care, especially.
Speaker: And that's perhaps why it's, I, and this is,
Speaker: my opinion, just briefly, it's important to look back and reflect at the end of a day, because yeah, there are always things that you wish could have gone a little bit better, a little bit differently, but, you know, everybody who has been trained in critical care and is, you know, we all do good things every day and looking back and seeing those things.
Speaker: And that's why we call it, see it look at the end of the day, reflecting back on those things.
Speaker: Because research also shows when we have memories of serving others, we actually can get the same physiological benefits, physiological response.
Speaker: So looking back and reflecting upon those things are really important.
Speaker: And that's an evidence-based thing that you can do.
Speaker: Great.
Speaker: Number six.
Speaker: Number six is elevate.
Speaker: Elevate.
Speaker: So Jonathan Haidt is a renowned researcher who really brought much of the research and has advanced the field in the study of elevation.
Speaker: So elevation is an emotional state.
Speaker: It's a state of emotional uplift is what it is.
Speaker: It's a state of emotional uplift where when we bear witness to another person's goodness, heroism,
Speaker: moral excellence, people who go above and beyond, we get that feeling that wells up in our chest when we bear witness to that, that's elevation.
Speaker: And I wanna be clear that nothing, in my opinion, good came from the pandemic where we lost so many.
Speaker: So I wanna be respectful of how I say this because I'm not saying that there's anything good from the pandemic, but there are some things
Speaker: that I learned in the pandemic and that I'll take with me forever that will be helpful to me.
Speaker: And one of those things is elevation because I was and still am consistently elevated by witnessing the heroism of the team in the ICU, the nurses, the therapists, the respiratory therapists that were right in, especially in the early days when we
Speaker: We're worried about everybody getting sick.
Speaker: You know, physicians, of course, trainees, the whole team.
Speaker: I felt elevated.
Speaker: I still do.
Speaker: And when I need inspiration, I actually think back to some vivid memories I have of my colleagues going above and beyond for other people.
Speaker: And I feel that feeling in my chest.
Speaker: And I didn't know until we did the research for Wonder Drug that there was actually scientific, there were research papers about it.
Speaker: And the researchers call it elevations.
Speaker: And it's important for a bunch of reasons, but one of the reasons is that it's really important, and I know this is gonna sound like something you would teach your kids, and it is something you should teach your kids, but it's really important, you should be very careful about who you associate with.
Speaker: And what I mean by that is, the practice that you decide to join, the colleagues that you're gonna have,
Speaker: Because the research shows that, and of course, your associations, your friends, your relationships.
Speaker: But what the research shows is that, and this is the important part, when people are elevated, as opposed to being degraded, you know, by, you know, witnessing, you know, poor behavior and all those things, when people are consistently elevated, they do more
Speaker: giving and serving behaviors, they become better themselves.
Speaker: They raise their game, so to speak.
Speaker: And this isn't just wishful thinking.
Speaker: The research bears this out.
Speaker: And so if you want to do your best job of giving and serving and being other focused person,
Speaker: surround yourself with people who do that and you will be more likely to do that.
Speaker: And there's also research from Christakis and Fowler who showed that these behaviors are actually contagious in social networks.
Speaker: So cooperation, which is a key behavior of serving others and kindness for others is contagious in social networks.
Speaker: And so is happiness for that matter.
Speaker: But being,
Speaker: very careful about who you associate with and who you go into practice with and who you're in relationships with.
Speaker: And, you know, yeah, this is a message that I teach my kids, but it's also something that, you know, I think we all need.
Speaker: The other angle of this that as I was reading and as you were talking, I always think of is that as a member of an ICU, you always have the power to change the tone and that if you act in a pro-social
Speaker: way, if you act in a calm way, other people will pick up on that and it can make a difference.
Speaker: So we always have an opportunity.
Speaker: And the opposite.
Speaker: The opposite is also true.
Speaker: Yeah.
Speaker: Because it only takes one toxic person to ruin it for everybody.
Speaker: And we all know that experientially.
Speaker: You don't need any research for that, but there are actually a bunch of studies that bear that out as well.
Speaker: And last but not least, number seven,
Speaker: Number seven is know your power.
Speaker: And this is something that I teach my fellows, my residents, my students.
Speaker: And especially in healthcare experiences, I mean, there's something about healthcare experiences that just stay with people.
Speaker: And I don't know if it's because of the amygdala where we experience our intense emotions is right next to the hippocampus where we make our memories.
Speaker: But there's something about healthcare experiences that just stay with people.
Speaker: Maz shares one in the book.
Speaker: And they're actually sprinkled throughout the book.
Speaker: But there is something about healthcare experiences that stay with people.
Speaker: And I'll just tell you this quick story.
Speaker: So a couple years back, I was seeing a patient in the ICU, a man in his mid-50s, and he was dying of septic shock.
Speaker: We were doing absolutely everything we could to try to save him.
Speaker: But it looked like he wasn't going to survive the night.
Speaker: despite maximal efforts.
Speaker: And I had to tell that news to his sister, who was just a couple of years younger than him.
Speaker: And it was a really, really hard talk because he had been her rock throughout her whole life.
Speaker: And at the end of that really hard talk, she asked me this question that I don't think I ever had before in the ICU.
Speaker: She said, you don't remember me, do you?
Speaker: And I said, no, I mean, I'm sorry.
Speaker: And she said, it's okay.
Speaker: I wouldn't expect you to.
Speaker: You see so many patients in here.
Speaker: You guys are so busy, but I need you to know something.
Speaker: And she took her hand and she pointed to the ICU bed right across the hall from where we were with her brother.
Speaker: And she said, seven years ago, my mom was in that bed right over there and she was dying and there was nothing that could be done to save her.
Speaker: and you were her doctor and you had to tell me that.
Speaker: So you and I have had this talk before and it took my breath away.
Speaker: But then she said something I'll never forget as long as I live.
Speaker: She said, I need you to know, and she didn't use the word compassion.
Speaker: She used the word kindness.
Speaker: She said, I need you to know those nurses, those nurses, they were angels to me.
Speaker: In those days when my mom was dying, they let me know that I wasn't going to go through it alone.
Speaker: They held me and they were there for me.
Speaker: And so I was, it still hurts to this day.
Speaker: Seven years later, it still gives me a lot of pain because I was so close with my mom.
Speaker: I think about it almost every day, but every time I think about it, every day I think about it, I also think about those nurses and how they cared for me and how they were angels for me.
Speaker: And then she said this, she said,
Speaker: It makes me feel better even now, seven years later.
Speaker: So ICU nurses are Olympic champions at Compassion, no doubt about it.
Speaker: They probably went home at the end of their shift and didn't think about it.
Speaker: But this woman, seven years later, she not only remembered it, she said it made her feel better.
Speaker: even now.
Speaker: So I teach this to my trainees and before, and it doesn't have to be an end of life matter.
Speaker: It could be any emotionally charged discussion because the research shows that those things, they stay with people.
Speaker: Healthcare experiences just stay with people.
Speaker: Before you go in to have that conversation, know your power because for that person, like you might forget it at the end of your day at the hospital and never think about it again.
Speaker: and wouldn't be able to remember it down the road.
Speaker: But they may never forget about it.
Speaker: It could go into this echo chamber where it reverberates over and over and over again, never to be forgotten.
Speaker: So what do you want to be remembered for?
Speaker: But it's know your power because when you know your power that it may echo on and on and reverberate and be there for years and have those effects, you feel differently about the power to treat somebody with compassion.
Speaker: And when you think about it differently and you're in awe of that power because you're aware that it can go on and on and reverberate, you'll just think differently about it and you'll act accordingly.
Speaker: Excellent.
Speaker: So on the podcast, we obviously cover a wide variety of clinical topics.
Speaker: We've always tried to be evidence-based.
Speaker: and provide our listeners with actionable steps for improving patient care.
Speaker: And I think, Steve, that this is obviously tremendously important for our patients, but also for our clinicians.
Speaker: And these seven steps are evidence-based, like you mentioned.
Speaker: And just to summarize, start small, be thankful, be purposeful, find common ground, see it, elevate,
Speaker: and know your power.
Speaker: I think that they're wonderful and there are things that we can start doing immediately in small doses, like you said, to start moving the needle.
Speaker: So Steve, you're a pro on the podcast.
Speaker: You've been on with us several times.
Speaker: So you know that we close with a couple of questions, not certainly related to the topic, but that really pick into a little bit more of your wisdom.
Speaker: Would that be okay?
Speaker: Sure.
Speaker: So the first question is about books.
Speaker: And really, as I read Wonder Drug, obviously there are multiple, not only research papers, but also books that are quoted and mentioned.
Speaker: Is there one book that you would recommend our listeners to read after they read Wonder Drug?
Speaker: Yeah, there's a book that I'd recommend to everybody.
Speaker: And a lot of people have told me that it's been really meaningful for them.
Speaker: And so that's not only why I read it years ago, but it's also its influences are seen throughout the pages of Wonder Drug.
Speaker: And that's Viktor Frankl, Man's Search for Meaning.
Speaker: So it's a story, not a story, it's Viktor Frankl's account of going through
Speaker: the Holocaust.
Speaker: And what he observed, he was a physician, what he observed is that in, you know, some of the worst atrocities that history has ever seen, what he observed is that it was the people who had a purpose, had meaning in their lives, had something outside of the camps
Speaker: that was waiting on them, whether it was a relationship, a family, or maybe just an unfinished work.
Speaker: But the people who had meaning through that purpose, he observed that they were able to, that they were resilient even in the face of these just unspeakable atrocities.
Speaker: it's a book that's really been helpful to me over time.
Speaker: Excellent.
Speaker: The second question is about beliefs and what do you believe to be true, perhaps based on the evidence about a live to give attitude that most other people don't believe or don't act like they believe?
Speaker: I'm optimistic.
Speaker: I think it's easy right now to be awash in cynicism.
Speaker: for a lot of different reasons.
Speaker: But I think that being hopeful is really important.
Speaker: And people, you know, there's a saying in the business world, you know, we've probably all heard it, you know, hope is not a strategy.
Speaker: But I don't know, I think that hope is necessary for every strategy.
Speaker: You know, it was necessary for every strategy to get through the worst healthcare crisis of
Speaker: our professional lives.
Speaker: Hopefully we'll never see anything like that again, but who knows.
Speaker: But hope is vital.
Speaker: And my favorite definition of hope is hope is the belief, really the conviction.
Speaker: Hope is the conviction.
Speaker: Because conviction and belief are different, right?
Speaker: So belief is something you hold, conviction is something that holds you.
Speaker: So hope is the conviction
Speaker: that despair will never have the last word.
Speaker: And I'm optimistic.
Speaker: It's hard these days, though.
Speaker: I'll acknowledge that.
Speaker: There's a lot going on.
Speaker: But I'm hopeful.
Speaker: Excellent.
Speaker: And the last question would relate to what would you want every intensivist listening today to know?
Speaker: Could be a quote, a fact, or a final thought.
Speaker: You are powerful.
Speaker: That's my thought, you are powerful.
Speaker: And the reason why I say that is because there are a lot of things in our patients that we can't fix, but resist the need to always feel like you have to be a fixer.
Speaker: Because sometimes the most powerful thing you can do for a patient or for their families
Speaker: is to just sit with them in their suffering or in their hardest time.
Speaker: And, you know, filling in, and actually a retired pastor friend of mine once taught me this, resist the need to fill the silence sometimes and just being present is enough to tell people that I can't change the circumstances.
Speaker: And I wish you didn't have to go through this, but I'm not going anywhere.
Speaker: And that can be powerful for them.
Speaker: It can be powerful for you too.
Speaker: And so you are powerful, even when you think that you're not making a difference, you can be powerful.
Speaker: You just have to look for those opportunities to impact people in ways that are meaningful for them.
Speaker: So you are powerful.
Speaker: I think this is a perfect place to stop.
Speaker: Steve, thank you.
Speaker: Thank you for writing a wonderful book and I think getting a very important message out there with the backing of science and the style that you will have as well accustomed to an evidence-based approach is something that I think is so important.
Speaker: Thank you for your time and generosity with sharing with us all your expertise and
Speaker: Most importantly, thank you for your friendship.
Speaker: I mean, it's meant a lot for me over the last decades, many decades, and I keep learning from you and really enjoy having you on the podcast and look forward to having you back again.
Speaker: Sergio, you've always been one of my number one teachers, not only in the ICU, but in life.
Speaker: So it's been great to be here and the pleasure is all mine.
Speaker: Talk to you soon.
Speaker: Take care.
Speaker: Thank you for listening to Critical Matters, a sound podcast.
Speaker: Make sure to subscribe to Critical Matters on Apple or Google Podcasts and share with your network.
Speaker: Sound's transforming the way critical care is provided in hospitals across the country.
Speaker: To learn more, visit www.soundphysicians.com.
