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Mindful Self-Compassion: Don Friedman
25 Plays9 days ago
Season 4, Episode 8: Dr. Donald Friedman is a retired rheumatologist and mindful self-compassion advocate based in Philadelphia. Listen to Don discuss the three components of mindful self-compassion, the prevailing myths about this practice and how mindful self-compassion can help physicians cope with clinical errors.
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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, John Neary.
Introducing Dr. Donald Friedman
00:00:21
Speaker
My guest today is Dr. Donald Friedman. Dr. Friedman is a retired physician who was chief of rheumatology at Crozier-Chester Medical Center for 28 years. He is currently a clinical associate professor of medicine on the adjunct faculty at Sydney Kimmel Medical College and Drexel University College of Medicine.
Integrating Mindfulness in Medical Education
00:00:39
Speaker
He has extensive training in the practice of mindful self-compassion and actively works to incorporate this practice into medical school curriculums and physician training programs. Dr. Don Friedman, welcome to the Wound Dresser.
00:00:51
Speaker
Thank you, John. It's great to be here. So one of the leaders in self-compassion research is Dr. Christy Neff from the University of Texas. She defines three core components of self-compassion that I'd i'd like to kind of start by discussing.
00:01:07
Speaker
The first one is that self-compassion is about self-kindness as opposed to self-judgment. Can you kind of talk about how self-kindness plays a role in self-compassion?
00:01:19
Speaker
Well, yeah, that is the most important thing. um You know, first of all, i just want to say from the start that self-compassion is a it's actually mindful self-compassion. But usually people say self-compassion. That's what the people in that field are really talking about because mindfulness is part of it.
00:01:39
Speaker
Anyway, um it is a practice, and it's it means ah really concentrating on the components of mindful self-compassion. um Self-compassion is not, um you know, if you've had a bad day to go have some ice cream or a beer or a glass of wine, that's more soothing, it doesn't really deal with the kindness aspect, which you just brought up.
Practicing Self-Kindness in Tough Times
00:02:05
Speaker
So as you mentioned, self-kindness is a really important component. It's self-kindness versus self-criticism. And, you know, I think generally most people um are more critical of themselves for their shortcomings than they're kind to themselves. And the idea of this is that we need to really be supportive and encouraging of ourselves when we fall short or having a difficult time or we're facing some difficult challenge.
00:02:37
Speaker
um And the idea is that instead of attacking ourselves, we offer ourselves support and
Understanding Common Humanity
00:02:45
Speaker
warmth. And here's the, I think, difficult thing for a lot of people, unconditional acceptance.
00:02:52
Speaker
um The important question i think that Kristin Neff brings up is, what do you need now? This is part of the self-kindness.
00:03:03
Speaker
What do you need at that moment? And you give yourself that kindness. And this is the difficult concept. I actually have to go with this too. You give yourself kindness not to feel better, but because that is what you need at that moment.
00:03:20
Speaker
um So when life is challenging, we try to be kind to ourselves instead of our attacking instead of attacking ourselves. You know, one of her statements, Kristin Neff's statements that really got me is when you are self-critical, you're the attacker as well as the attacked.
00:03:40
Speaker
Just think about that. That's really, that's pretty awful when you think about it. um You know, there's a line in a wonderful poem, and maybe I can read it at the end if we have time, called Radical Acceptance, where the last line is, or one of the lines is, it's by a poet named Poojie,
00:04:00
Speaker
that says each time you judge yourself, you break your own heart. So it is self-kindness instead of self-criticism. That's the first part, which I think you started off with.
00:04:15
Speaker
the The second core component is with self with,
Embracing Failures and Shared Experiences
00:04:19
Speaker
excuse me mindful self-compassion. ah We kind of seek to to find our common humanity as opposed to being isolated. Can you talk more about that?
00:04:27
Speaker
Yes. um This sometimes is hard for people to realize. It's an interesting concept. You know, we're all interconnected, um you know, and we need that sense of being connected to other people.
00:04:43
Speaker
You know, in times of way ancient times of tribes and so forth, if you weren't part of the tribe, you just didn't survive. You needed to be connected in order to have food and protection and community. So connection to other human beings is very sustaining and is still an important part of our lives today, I think. So what does she mean, Kristinev mean by common humanity? It means... that we recognize that we are all humans and that we are all flawed.
00:05:17
Speaker
That's really difficult for some people to accept. You know, I might also point out it's particularly difficult in medicine for some people to accept the fact that we, you know, despite all our accomplishments, that we also have our flaws.
00:05:33
Speaker
um So everybody fails at some time. Everyone is a work in progress. Everyone has hardships and everyone has baggage, if you know what I mean. I call it our stuff that we carry around with us. So the point is everyone suffers from time to time and it's normal to make mistakes. It's normal to experience hardships over and over again. It's part of being a human being.
00:06:02
Speaker
It's normal to have challenging events happen in our lives. But what happens, you know, what she talks about is common humanity versus isolation. So what happens is when something is troubling you, we tend to go into this isolated situation where we think we're the only person in the world who has this problem, when there are probably thousands of people in the world that have the same problem. um And then it moves on to everyone else is happy except me. You know, well, that's just not the case. um
00:06:36
Speaker
Chris and Neff even mentioned some people have the idea that bad things shouldn't be happening to themselves. You know, well, that's not what's involved with being a human
Supporting Physicians Post-Mistake
00:06:45
Speaker
being. So the end result of all this thinking is that, you know, we tend to isolate ourselves and feel alone in our suffering.
00:06:54
Speaker
But the common humanity aspect is that pain and suffering are very much a part of the human experience. And recognizing this can be transforming because it's a chance for connection to realize that you are not alone, ah that other people probably have the same problem. Certainly other people are suffering. And so, you know, it's recognizing the common humanity and the human connection instead of isolating ourselves. It's the idea is I'm a human being having a human being experience instead of isolating.
00:07:30
Speaker
So that's my answer to that. Yeah, I can definitely relate to that isolation, you know, and I think, I think every medical trainee feels like if they don't, if something doesn't go as well as they'd hope in the clinical setting, you can just feel so isolated feeling like, you know, I'm the only person who's made this mistake or, you know, how could I do this? um And it, it, uh,
00:07:52
Speaker
it's it's it's a reflex, you know, it just kind of happens automatically and we don't realize it. Well, you know, it's really, um you know, I think that's one of the problems when it gets to mistakes and we can have a whole, an old section of podcasts mistakes, of course, but, um you know, physicians don't tend to admit that to each other and share things. And that is really isolating. You know, I,
00:08:18
Speaker
I don't think there's any physician anywhere at any institution that hasn't made a mistake, and I don't care how high up they are in terms of administration. do you know what i mean? It's that most people don't talk about it.
00:08:32
Speaker
So anyway, yeah, that's ah that's very rampant in medicine, and it cuts us off from the support that we might get from other people. As a matter of fact, at Jefferson, there's a program. Oh, I can't remember the name of it now. Maybe Jeff Help, where there is a team of physicians, nurses, maybe therapists, um other doctors.
Mindfulness and Self-Compassion
00:08:57
Speaker
um allied professionals that are on call all the time so that if a physician makes a mistake, they can be called to be available to talk to that physician about the mistake. I think that's just an incredible thing.
00:09:13
Speaker
And I think it's very valuable. And that, you see, that's where common humanity comes in, right then and there. So... Yeah, surely the person on the the other end of that phone call doesn't say, wow, I've never heard this before. This is a first.
00:09:30
Speaker
Right. Yeah. And lastly, our so we we we mentioned self-kindness, common humanity, and the last one, self-kindness. which makes sense, the last component of mindfulness self-compassion is mindfulness as opposed to over-identification with some of the sort of attacks, as you said, going on in our minds.
00:09:52
Speaker
Well, you know, I actually had a lot of trouble with this part. I know um that mindfulness is that it's really an essential part of this.
00:10:03
Speaker
and I know you have great experience with it too and can relate to it well. um You know, I struggled with this when I was first learning about mindful self-compassion.
00:10:15
Speaker
um And you know very well what mindfulness is. It's being in the moment, being aware of what you're experiencing. And that includes, you know, thoughts, feelings, sensations, emotions, anything um without any resistance or avoidance. I think this is the difficult part of the mindfulness aspect. um But the important aspect of mindfulness and why it's part of mindful self-compassion is you have to be able to turn to and acknowledge that you're suffering and to respond to the pain of that suffering with kindness and caring.
00:10:55
Speaker
There's a great part in the ah video, I think that you know about the three components of self-compassion that Kristin Neff has on YouTube, where she's talking about turning toward the suffering. And she actually turns her whole body to the side, you know, to sort of symbolize that whole thing of turning toward suffering.
00:11:14
Speaker
Well, let's face it, no one likes to think about their suffering as It's not so
Mindfulness in Overcoming Mistakes
00:11:19
Speaker
easy. um i was at a retreat once where one of my mentors, Steve Hickman, I had 10 minutes, you know, with different people on the staff. It was a mindfulness retreat.
00:11:31
Speaker
And I was having trouble with, you know, my practice. And i he asked what i was doing. And he very quickly said, you're skipping the mindfulness part. And I realized, you know, he was totally right.
00:11:44
Speaker
it's It's just being aware of what you're experiencing and not thinking about it for the story, but just being with it and feeling it and being conscious of it and just beholding your experience. And the reason that this is so important, part of all this, is that you cannot give yourself the kindness that you need at that moment unless you're aware that you're suffering.
00:12:09
Speaker
um Mindfulness can keep our avoidance of other painful thoughts or emotions, allowing us to face what we're truly experiencing. It's really hard to do.
00:12:21
Speaker
um As a matter of fact, just as a sideline, I took mindfulness course at Jefferson, which is quite wonderful, and the the instructor was Diane Reibel, who leads that department. And I was once in a wonderful craft store in media that had these wonderful, funny sayings on these little, um they were plaster-like coasters.
00:12:46
Speaker
Actually, my favorite one was it said, I danced as if no one was watching, but someone was watching and thought I had a seizure and called an ambulance. That was my favorite. My next favorite one was i will try to be in the moment, but if the moment isn't pleasant, I think I'll take a nap.
00:13:04
Speaker
And I thought, how perfect, you know, for a lot of people. And I actually bought that for Diane Reibel. I thought maybe she would enjoy it but Then I got worried she might not, that but I asked her first and I gave it to her and she really liked it. I think it's really, you know, that sums it up. We tend to avoid these painful feelings. It's very hard to do that.
00:13:26
Speaker
So the thing about mindfulness, it's mindfulness versus over-identification. Where does the over-identification come in? Well, I'll tell you something. It comes from when we just get lost in the suffering and we get totally identified with it and and exaggerating it. It really keeps us from being objective. And I'll give you a perfect example of this.
00:13:51
Speaker
My third week of practice after I had finished my fellowship, I made a mistake. It was pretty devastating, actually. I tried to avoid making this mistake. I realized something might be going on. I couldn't document it. It resulted in a mistake.
00:14:07
Speaker
um And so what happened was I went from I failed, I failed at something, to I'm a failure. you see the difference between the two?
00:14:20
Speaker
The I'm a failure is over-identification. It didn't matter that ah I had had three years of internal medicine training and helped a lot of people while I was learning, two years of rheumatology fellowship and helped people while I was learning. That didn't count. I failed, and so I was a failure.
00:14:41
Speaker
And that is definitely an example of over-identification. um Fortunately, I was seeing a therapist at the time, and I really needed some help with that because it was really quite difficult. And it really kept me from going down a rabbit hole. But do you see the difference between the two? I think that's what, you know, over-identification versus mindfulness giving you a perspective.
00:15:05
Speaker
So the main thing about it is, remember, you have to be aware of the suffering um instead of the problem or the experience you're having so you can give yourself kindness. It's just awareness of the suffering.
00:15:18
Speaker
um
Teaching Acceptance of Imperfections
00:15:19
Speaker
I will just say one other little thing about it, which I think is sort of along the same lines. ah You know, on the kintsugi thing that I've talked about, you the ball-breaking process that in Japan you can take a broken bowl to an artisan and have it put together again with gold resin. So you see all the imperfections and the gold and the bowl is regarded as more beautiful, more valuable.
00:15:45
Speaker
And, um you know, that whole idea is beautiful in itself because it means that you accept who you are and your imperfections are part of you.
00:15:56
Speaker
But I noticed, and I've done this exercise numerous times with medical students and now some residents, And what I noticed is after the the students break the bowl that I give them, they immediately get their gloves on to fix the bowl and put the glue on because, you know, as physicians and healthcare people, we we don't like broken things. we don Everything has to be fixed as best it can. So I made it a rule that after they broke their bowl, they had to sit with the broken pieces for a minute.
00:16:30
Speaker
And that turned out to be very difficult. It's very hard to sit with your brokenness. I think it's very hard to sit with your suffering. But, you know, a couple of students said, you know, I really learned a lot from sitting with the broken pieces and sitting with my brokenness. I think that's kind of the mindfulness. We all have broken parts and brokenness. We also have wonderful parts too, mostly. So, you know, it's just that balance and being aware of it.
00:16:59
Speaker
And I think one important distinction I've heard kind of with a related to a lot of what you said is, you know, there's, there's pain and there's suffering. And, you know, if we, we make a mistake or something bad happens,
00:17:11
Speaker
um there is just some of this pain that is unavoidable. It's just kind of built in. But then when we, we, we aren't really mindful of that experience, there's kind of suffering that lays on, lays on top of that.
00:17:24
Speaker
You kind of have that distinction of pain and suffering and, I don't know, I feel like if, you know, we are mindful of our pain, mindful of of things that go wrong, and it doesn't get all better immediately, we sort of assume like, ah, to hell with the the practice. But really, we have to realize that it's it's about, you know, sitting with that pain and and letting some of that that other suffering that may otherwise come come with it to to kind of ah pass along its way.
00:17:53
Speaker
It's sort of accepting it, you know, that's part of the process. And again, you know, you cannot offer yourself kindness unless you realize you need it at that moment. By the way, the same thing, there's work, you know, in the self mindful self-compassion courses where you're taught how to deal with difficult emotions like anger and frustration and sadness and so forth.
00:18:20
Speaker
um to accept those emotions too, that that's part of
Responding to Emotions with Kindness
00:18:24
Speaker
you. And part of it is letting yourself feel that emotion and say it's okay to feel it. And then, you know, be soothing to yourself because you're feeling it and it's okay.
00:18:36
Speaker
You know, before you overreact to a situation. It's kind of very similar, i think, you know the same thing of being aware of what you're feeling. Another ah thing Christy Neff talks a lot about is like mindful self-compassion versus compassion for others. um um I'm curious to hear more about your your thoughts about that and if there's any differences or or you find them to be really same at their core.
00:19:04
Speaker
Well, you know, it it really it's an interesting thing. You know, if you, um you know, the usual thought is, and I'm sure you've been taught this, and a lot has been taught about it now, that, you know, in order the definition of compassion is wanting to relieve the suffering of another person.
00:19:26
Speaker
um And the thought is, in order to do that, you have to have empathy first, try to understand, although you can never completely understand what a person is feeling or thinking or what they're going through. And then that leads to compassion.
00:19:42
Speaker
um But, you know, you can have it do an act of compassion without having empathy. I think that's one thing. For example, if someone falls on the street you're probably not going to say, gee, I wonder what they're feeling because they just fell on the street. You're going to hopefully go over and help them get up, you know, which is an act of compassion. So I think, you know, what I think you're driving at is that if you are self-compassionate, it tends to make it easier to be compassionate to another human being. I think, you know, there's always that question of can you teach compassion, you know, to medical students or to anyone?
00:20:26
Speaker
i think,
Debunking Self-Compassion Myths
00:20:27
Speaker
you know, a lot of most people it's who have or are compassionate, it's just an innate part of them, you know. And I think in some ways it can be taught. And there are probably some people who are never going to be compassionate, no matter how much you, you know, try to share with them about it I think definitely if you're self-compassionate, it makes it easier to be compassionate to another human being. I think that's one of the things that she emphasizes.
00:20:54
Speaker
However, you can certainly on the other side of the coin. You can be compassionate to another human being without being compassionate to yourself. And I will tell you, I've heard this numerous times when I've talked with residents. I always ask that question, is it easier for you to be compassionate to your patients than to yourself? And almost every hand goes up.
00:21:19
Speaker
So I think that's another thing in medicine. We're taught to be compassionate to our patients and then forget about ourselves and what we're going through. And, you know, I think that's one of the many reasons that burnout sometimes happens with people because in in medicine and other fields because people don't take care of themselves well enough in terms of their own feelings.
00:21:44
Speaker
As we as we we both know, ah there's there's a lot of resilience in medicine, toughness, which kind of leads us to thinking more about some of the myths about self-compassion.
00:21:55
Speaker
I'm sure you have people say, you know, I have so many patients to see. i don't have time to be compassionate myself or to the patient or or both. I, you know,
00:22:06
Speaker
I have succeeded in this career because I've toughed things out. ah can you So can you talk more about some of those myths about self-compassion? they are There are a number of myths and I do have something to say about them because you are totally right.
00:22:22
Speaker
They are used by people to resist any kind of self-compassion. um so I'll just go through them really quickly. you know i think you know what they are. There's six of them, I think.
00:22:34
Speaker
One of them, the one is the first one is that self-compassion is really a pity party you know for yourself. um The kind of woe is me, that's what self-compassion is. But actually the research has shown that self-compassionate people who more likely to be perspective takers rather than focus on their own distress.
Benefits of Self-Compassion
00:22:54
Speaker
They're less likely to ruminate on how bad things are um because they realize this is the common humanity aspect that everyone suffers, and they don't exaggerate the extent of their struggles, which again is the mindfulness instead of over-identification. So I think those aspects sort of steer you away from throwing a pity party for yourself. It's actually just the opposite. So that's the first one.
00:23:21
Speaker
um The second one is that self-compassion is for wimps. You know, I have to be tough and strong to get through my life. um And, you know, instead of self-compassion actually making people weak or vulnerable, it's actually a source of inner strength and resilience, which you just mentioned, when they're facing difficulties. You know, the researchers show that self-compassionate people are much better able to cope with difficult situations like trauma and chronic pain. So it's really not for wimps. It's something that can really strengthen people. There was a very interesting study with the Rocky War veterans And the group that actually, I don't know how it happened, but they were taught self-compassion over there. And then they came back and sort of compared groups that knew about self-compassion and groups that did not. And the self-compassionate people were much more resilient in terms of dealing with PTSD issues, chronic pain issues. They fared much better than the people who were not given training in self-compassion.
00:24:32
Speaker
The next one is self-compassion is too selfish and self-focused. um If I'm self-compassion, I won't think about other people. And that's another myth too, um because it's been shown that self-compassion people actually be able to give more in relationships. um They tend to be more caring, supportive, more likely to compromise.
00:24:54
Speaker
and are actually more compassionate and forgiving to others. And all this has been documented by different research studies. um The other one is self-compassion will make me lazy and self-indulgent.
00:25:10
Speaker
I mean, this comes up maybe with the resident it says i have five admissions. I've actually had a resident who said that when I gave a talk on self-compassion group of residents and I said, all you need is two or three minutes to just stop and maybe put your hand over your heart and just breathe and just give yourself some kindness at that moment. And that this is stressful and I'm having a hard time and I am just giving myself kindness. That's all it takes, two minutes.
00:25:40
Speaker
So the lazy and self-indulgent issue um is actually self-compassionate people tend to take better care of themselves health-wise. They exercise more, you know, keep appointments with doctors, eat better. They're more aware of their own health.
00:25:56
Speaker
um The fifth one is I need to be hard on myself, which you brought up when I mess up. ah to make sure I don't hurt other people. That's actually the sixth one that you mentioned. um So some people feel self-compassion is a way of making excuses for bad behavior.
00:26:15
Speaker
But actually self-compassionate people ah tend to admit their mistakes more often. they need to They don't need to blame other people for their mistakes. And they tend to be more personally responsible if things happen because of their actions. They're more likely to apologize. So it's just, again, the opposite of not being aware of other people.
00:26:38
Speaker
And the last one, i will never get to where I want to be in life which is i think what you were talking about. If I'm not harsh on myself and criticize myself, it's the only thing that will drive me to succeed.
00:26:51
Speaker
Well, that is really a myth as well because self-compassionate, people who criticize themselves um actually um um take away their motivation. They're more afraid of failure They tend to squelch their own creativity more.
00:27:11
Speaker
um Self-compassionate people have high personal standards, but they they just don't beat themselves up if they make a mistake and they're not afraid of failure and they're more likely to try again to persist in their efforts. So actually, um this common myth that you won't get anywhere if you're self-compassionate,
00:27:34
Speaker
that it does not undermine your motivation to succeed or your ability to succeed.
00:27:41
Speaker
Yeah, I think when you... if we you know subconsciously buy into this idea that things shouldn't go wrong, it's it's kind of easy to to sort of get on board with a lot of those myths. But when you you recognize that that common humanity piece that we all fail, that we all screw up, that you know things are going to go wrong no matter what we do, ah it's easier to kind of see see through a lot of those myths and say, you know this self-compassion can kind of get me closer to my goals and my values as opposed to to moving me away from them.
00:28:14
Speaker
Yeah, exactly. It's a very good way, actually, of dealing with the inner critic. You know, we all have inner critics. That could be a whole other hour conversation as well.
00:28:25
Speaker
But we all have inner critics that, you know, never go away. they kind of the inner critic comes from childhood. And self-compassion is a nice way to say, no, I'm not listening to you. I'm going to be
Guided Self-Compassion Exercise
00:28:37
Speaker
kind to myself. And Yes, I messed up, but I'm not a total failure. I'm not an idiot. I you know i still have great value.
00:28:46
Speaker
And I'm going to be kind to myself instead of beat myself up, as the inner critic usually tells you to do. We've talked quite a while now about mindful self-compassion and what it is, what are the myths, you know, how it it can kind of affect our healthcare spaces. So without further ado, I think it would be a great exercise now to do a self-compassion break if you'd like to lead us in that.
00:29:13
Speaker
Okay, well, the self-compassion break, there are um many versions of it online. Kristen Neff has one on her website. ah Chris Germer, who is also one of the ah major researches researchers in self-compassion, um he's very interested interested in the mindfulness aspect. There's a very good one online as well.
00:29:39
Speaker
um I'm going to use, there's a wonderful book called The Self-Compassion Workbook that is written by Kristin Knapp and Chris Kerber. And it has, it's actually distills the major points of the Mindful Self-Compassion course. which is run by the Center for Mindful Self-Compassion.
00:30:01
Speaker
It's um usually a week-long course. If you go to retreat center where it's given, um it's also given online frequently. um And there's a shorter version of it too, But this is from the the book really is based on the longer version. So this is the self-compassion break. It's just an easy way to remind ourselves to apply the three core principles.
00:30:29
Speaker
um So, okay, if people are listening and ready to do this, involves some mindfulness. So I have some Tibetan bells here. I'm going to just ring them at the beginning. What I'd like you to do is, if you're listening want to engage in this, is totally optional, um just to make yourself comfortable, feet on the floor, and um ah just close your eyes if you're comfortable, and we'll start.
00:30:59
Speaker
So if you would, let's just start with taking a few deep breaths in through your nose and out through your mouth. And Rachel Rimm, another mentor of mine, likes to bring attention to after the out-breath, before you take the in-breath again, just pause there for a second. It's quite a moment of peaceful relaxation. Just pay attention to that before you breathe in again. It's a nice place to be.
00:31:29
Speaker
So in and out, in through your nose, if you're comfortable, out through your mouth.
00:31:38
Speaker
Now I'd like you to think of a situation in your life that is presently causing you some stress. Or maybe situation in the past that's caused you stress.
00:31:50
Speaker
Something as a health problem, relationship problem, problem at work, some other struggle that you've had, some area of suffering that you've had.
00:32:04
Speaker
And I'd like you to choose and area or a possibility that's maybe a three out of 10, nothing major, something that was distressing but not overwhelming while we do this exercise.
00:32:20
Speaker
So visualize that situation clearly in your mind's eye What was happening? What was the setting?
00:32:32
Speaker
um maybe things that were said, whatever is involved in that situation that was um challenging for you.
00:32:44
Speaker
And now see um if you can feel that discomfort in your body as you bring this difficulty to mind. You might even see if there's a particular part of your body where you feel it more than others and focus on that.
00:33:02
Speaker
And now try saying to yourself, this is a moment of suffering. This is a moment of struggle. You might even say, this really hurts, or this is stressful, or ouch.
00:33:19
Speaker
This is the mindfulness part of self-compassion. And now try saying to yourself, suffering is a part of life I'm not alone.
00:33:36
Speaker
Everyone experiences this, just like I am now. This is how it feels when people struggle in this way. That is the common humanity aspect of this practice.
00:33:53
Speaker
And now, offer yourself the gesture of soothing touch such as placing your hand, one hand or both hands over your heart, some other area in your body where you feel comfortable placing your hands, just to give yourself that soothing touch of caring.
00:34:19
Speaker
You may want to hug yourself as a way of showing that and just see how that feels. can say, may I be kind to myself, may I give myself what I need, may I accept myself as I am, may I forgive myself, may I be patient with myself.
00:34:46
Speaker
If you're having difficulty finding the right words, Imagine that a dear friend or loved one has has the same problem as you do. And think of what you would say to them for this problem.
00:35:00
Speaker
And then say it to yourself. This is the kindness part of mindful self-compassion.
Practicing Self-Compassion in Healthcare
00:35:08
Speaker
So thank you, John, for letting me do that and for anyone who was willing to participate.
00:35:16
Speaker
Thank you for leading us in that practice. It was very... I took some time to think about, you know, some of the challenges I've had in the clinical setting and and kind of beating myself up and trying to be compassionate ah to myself, even with with with those tough moments.
00:35:32
Speaker
You know, the whole idea, which I think is very helpful, it's part of the teaching, is and how you would treat a friend. You know, I often ask medical students, suppose your good friend in medical school flunked a quiz, you know, would you say to them, o you're an idiot, you didn't study enough, or how did you even get in medical school, and I, you know, all kinds of things like that. You would never, most of them say, no, I would never say that to a good friend. Then I said, would you say it to yourself?
00:36:02
Speaker
And they all say yes. So, you know, we are not kind to ourselves a lot of the time. I'd like to to spend our remaining time just thinking more um deeply about how we can bring ah mindful self-compassion to the clinical setting.
00:36:22
Speaker
um I think I've mentioned you before, i just recently finished my surgery rotation and that's probably to to me, like one of the more stressful environments in the hospital, maybe, you know, where self-compassion isn't so much of a priority. And, and I feel a lot of folks in the surgery community, ah you know, definitely just, you know, beat themselves up and even, you know, beat members of their team up and,
00:36:52
Speaker
So I guess thinking, you know, in the setting of the operating room or more even more broadly in health care, like how can we practically bring more mindful self-compassion ah to take better care of our providers and then ultimately take get better care of our patients?
00:37:11
Speaker
Yeah, it definitely gets transmitted to patients, too. You're absolutely right, as well as people that you work with. um Well, I think, you know, I think it can be learned. It's a practice. See, I said that a beginning. It's a practice, which means you have to do it over and over again. you know, who was the famous ah pianist.
00:37:33
Speaker
I don't know whether it was Isaac. I can't remember. ah who i think it was Horowitz ah who was famous pianist. And someone when asked him, how do you get to Carnegie Hall? And he said, practice, practice, practice, you know. So I think, you know, it's like anything, even with like your mindfulness practice, it takes time and and you have to learn what the principles are and you have to do it. And I think, you know, in those moments of doing it on yourself, hopefully that would get not only
00:38:07
Speaker
you know, be kinder to yourself, which would be healthier, but it gets transmitted, you know, to other people you work with that you might step back. You know, one of the things with mindfulness, you're more an authority than I am on that, that it does help you step back from your initial reactions, right? Isn't that part of mindfulness? Am I correct with that?
00:38:27
Speaker
Absolutely. Yeah. Responding, overreacting. Yes. so I think the more that it becomes part of just like that resident said, oh, I don't have time to be kind to myself when I have five admissions.
00:38:39
Speaker
um You know, all it takes is maybe two or three minutes to just go somewhere quiet and just, you know, think there, breathe and just breathe. Give yourself that kindness and say, I know I'm suffering right now. I have a lot to do. I'm not sure I can do all of this, all of that.
00:38:57
Speaker
That's part of the suffering. um And then just being kind at that moment. And again, it's because it's what you need at that moment, not to necessarily make you feel better.
00:39:09
Speaker
That's kind of, I always had a little trouble accepting that at first, but what that really meant. um Anyway, i think starting with oneself, then it can move out to other people.
00:39:22
Speaker
But I think, you know, if you're aware of the common humanity aspect and everybody suffers, including yourself. um I, you know, I think you become much more aware of patient situations and give them a little more ah slack than maybe you might be giving because you, you know, are demanding or expect things that patients can't give at that moment because they're not fully aware of what's happening. Do you know what I mean?
00:39:51
Speaker
um I think it it could be translated into you know something that emanates out to patients as well. I think it is hard.
Dr. Friedman's Personal Insights
00:40:02
Speaker
You can be compassionate other people without being compassionate to yourself, but it increases your chance of being compassionate other people if you are compassionate to yourself.
00:40:14
Speaker
With that, it's time for a lightning round, a series of rapid-fire questions that tell us more about you. oh okay. So we've obviously talked a lot about mindful self-compassion. I imagine you are a regular practitioner. um But what's ah what's another go-to self-care practice for you?
00:40:34
Speaker
um Well, I like to, I think one of the things that helps me a lot is being out of nature. Nature is a very good place to just get in touch with yourself. So I try to get out. I'm not, you know, a long-term, long-mile hiker. Sometimes I can just kind of sit in one place for a half hour or so and just see what happens. I've done some coursework in that and how to be in nature.
00:40:59
Speaker
And I've done a lot of work with Animas Valley Institute, which is they do what's called soul crafting, and getting in touch with, you know, different aspects of your soul and personality.
00:41:10
Speaker
And um that's really been helpful to me. um I like ah I like going to the theater a lot because I find that.
00:41:21
Speaker
I kind of can lose myself in what's going on. That happens easier for me in theater than movies, but I like movies too. So that's another thing. And I like walking. Just walking is an exercise.
00:41:34
Speaker
It's a helpful thing as well. What's a weird skill you have? ah um A weird skill.
00:41:44
Speaker
um Well, i I've gone to a lot of musical theater over the years, and I recently took, as I mentioned to took a course on Broadway musicals, and they had actually named that musical comedy tune as part of it. was sort of a fun contest,
00:42:05
Speaker
And ah I scored the highest by a large amount. with but i It wasn't was way before your time. There used to be a show called Name That Tune where you had to run up and pull a bell if you thought you knew what the tune was. We didn't have this. But um anyway, so ah the guy giving the course said, a couple of people said, you must be a genius, which I quickly told them was not true. And then the guy,
00:42:35
Speaker
course leader said, well, are you an actor? And then I said it was a doctor, which really threw them off. So anyway, yes, that was probably a weird, weird skill. You know, you're Rodgers and Hammerstein, right?
00:42:47
Speaker
I do, plus more. Yes. How ah do you spend a rainy day?
00:42:56
Speaker
Oh, that's a very interesting question. um I usually use it for catching up with all the things that i haven't been doing because I'm still kind of working part time.
00:43:08
Speaker
um Probably maybe even catching up with friends on the phone. um I'm not a big reader. I wish that I were more a reader than that. I don't know. I can just be happy. I have learned that sometimes there's quite a skill in doing nothing. So sometimes, you know, I'm happy with that too.
00:43:28
Speaker
So that's quite an art, you know, doing nothing. So that's not really accepted much in in the world of medicine. So anyway, yeah, I'm happy with, ah I don't always have to have a schedule when it's a rainy day.
00:43:44
Speaker
I know you come from a ah Jewish background. What's your favorite Jewish food? Oh, chopped liver, without doubt. Right from the start. Corned beef is second. Yeah, guess. Do you have my favorite Jewish-style contestant around Philadelphia somewhere? Oh, yeah. Oh, yeah. there's it's If I'm in town, it's 4th Street Deli.
00:44:06
Speaker
In the suburbs, it's Jaime's. So... No doubt. Yes. And lastly, we've talked a lot about medical training, but what's one change you'd like to see in patient care?
00:44:17
Speaker
Well, you know, i did um I did a year of medical psychiatric liaison training between three years of internal medicine and two years of rheumatology. i just felt it was really important to kind of learn how to talk with patients. And so it was a fellowship in medicine. it was actually a downstate in New York and Brooklyn.
00:44:40
Speaker
But I was trained by a psychiatrist, even though I was a fellow in medicine. and I spent my, boy, it was a luxurious year because I spent my whole year talking with patients in the hospital about how they became ill and how they were coping and um and dealing, also talking with patients who had, you know, terminal illnesses and how they were dealing with that. So I became very, you know, much more comfortable in talking about deeper things. And um it really helped in my practice of rheumatology, of really getting to know patients. And um I felt that that was an important part of my care. I could do a lot with medications, but I think medications only do so much sometimes in chronic disease. It's helping patients deal with the other issues they have to deal with, which are frequent patients. the emotional ones.
00:45:33
Speaker
And um so I wish there were more of that. And also I did some work in spirituality in medicine, and I've learned how to do a spiritual history on patients. And I think be knowing what patients' belief systems are or whether they're part of a, you know, a spiritual community, and by that it doesn't have to be a synagogue or church or mosque. It could be a bridge club or a painting group. or whatever, because that type of thing really helps support people in times of you know physical need. So I think that there be more attention. There's a lot of work done at George Washington Institute of Spirituality and Health about that. And I've done work there too um about a patient's spiritual needs. And then the other side is the emotional needs as well. We do not pay attention to that.
00:46:24
Speaker
um And I think it's a very important part of taking care of patients. Of course, today it's so difficult when a doctor may have 10 15 minutes at most to see his or her patients. It's really hard to get into that. But sometimes, you know, asking the right questions at the right time can be very, very helpful.
Closing Remarks
00:46:45
Speaker
Dr. Don Friedman, thanks so much for joining The Wound Dresser. I really appreciate the opportunity and the invitation you gave me, John. It's really a pleasure to talk with you.
00:47:05
Speaker
Thanks for listening to The Wound Dresser. Until next time, I'm your host, John Neary. Be well.