10.1 - The Good Work of Medicine with Dr. Chris Lisanti

[Intro music]

Hi and welcome to the Hippocratic Society Podcast. This podcast is a project of the Hippocratic Society.

In the podcast we aim to reflect on deeper questions in medicine, all with the aim of rediscovering the ideals that brought us to medicine in the first place in order to better serve our patients and colleagues.

Unknown

Thank you for joining us and we look forward to engaging with you through this podcast.

Michael Egan

Alrighty. Welcome back to the Hippocratic Society Podcast.

Michael Egan

Today I'm joined of course by Dr. John Rhee and Dr. Chris Lisanti, which we are very glad to have him. So Chris Lisanti is a diagnostic radiologist and assistant professor at USUHS.

Michael Egan

He's also the assistant Program Director for Research in Radiology at Brooke Army Medical center and the Medical Director for the Pregnancy center in San Antonio.

Michael Egan

His current research explores the intersection of medicine, philosophy and theology,

Michael Egan

which is also the basis of his podcast called Roots of Flourishing.

Michael Egan

He has coached 12 to 18 year old students for over 12 years in both values and parliamentary debate.

Michael Egan

He retired at the rank of colonel after serving for 24 years in the United States Air Force.

Michael Egan

He's married to Claire, his wife of 28 years, and they are home educators of their four children.

Michael Egan

So super accomplished. We are very glad to have you here. Dr. Lisanti, thanks for joining.

Chris Lisanti

Well, thank you, Michael. It's a pleasure to be here with you and John. Yeah.

Michael Egan

So today we wanted to talk about the good of work in medicine and what that looks like from many different perspectives and why it's a topic that's very important to speak about today.

Michael Egan

So the first question I wanted to pose to you guys,

Michael Egan

is medicine inherently good?

Michael Egan

And going off of that a little bit, maybe to dive deeper is,

Michael Egan

is the work of medicine different from other professions inherently?

Chris Lisanti

Yeah. So when we talk about things being either intrinsically good or inherently good, that certainly has its own debate. And we certainly debated that just recently in our speech and debate league,

Chris Lisanti

not specifically regarding health, but regarding the acquisition of knowledge.

Chris Lisanti

But I think a better way maybe to look at it really is to look at it in the way the new natural lawyers look at it in terms of the basic goods.

Chris Lisanti

And I know when I read the Way of Medicine, I was introduced to the concept of the basic goods and think that that's a very good starting point for looking at health amongst a variety of other basic goods such as life and work,

Chris Lisanti

specific to our podcast today. Really.

Chris Lisanti

And so I think that the basic goods are the foundation goods by which we should be going ahead and trying to aim and achieve for and make certain that we prioritize these goods, perhaps above many other goods that we perhaps could be seeking,

Chris Lisanti

such as money or fame or pride or some sort of psychological buzz or things of that nature.

Chris Lisanti

And so I think that by looking at that from, from that perspective, I think that it helps us to understand the importance of it. And then it tries to get us out of some sort of, you know, maybe a conundrum as to trying to figure out, you know, is it intrinsically good,

Chris Lisanti

meaning can we go ahead and use any means possible to actually go ahead and achieve health? And I would say that you, you can't. You can't go ahead and use any means achievable, you know, or at our disposals in order to achieve health.

Chris Lisanti

I mean, certainly there's going to be some limits on things to include limits of respect for patient autonomy,

Chris Lisanti

particularly an important principle that we have within medicine, but not necessarily an end goal of medicine. The end goal, of course, would then be the objective health of the patient.

Chris Lisanti

And certainly that goes back to Aristotle and certainly been reframed in Leon Kass's work and things of that nature.

Chris Lisanti

And so that's what I would say about that. And certainly all of our work, whether it's paid,

Chris Lisanti

otherwise known as employment,

Chris Lisanti

or everything else that we do, whether it be, you know, doing the dishes or gardening or things of that nature,

Chris Lisanti

is all forms of work. And there's always an internal excellence to every work that we can actually put forward. And certainly going back to the basic goods, certainly the new natural lawyers would also instruct and inform us that no basic good should be intentionally harmed.

Chris Lisanti

So again, that puts some nice limits on the things that we can or can't do. Now, we don't necessarily have to go forward and do everything possible to try to achieve a basic good.

Chris Lisanti

Obviously we're finite, we're limited creatures,

Chris Lisanti

so we're going to have to make those decisions. And so sometimes with prudence, we have to understand, particularly in medicine, what is the vocation of our patient, what is their overarching goals and things of that nature?

Chris Lisanti

And how does taking,

Chris Lisanti

you know, putting forth the effort in terms of the means,

Chris Lisanti

the medicines, the time that we're going to spend in the clinic, the procedures and things of that nature, how does that actually then dovetail into the greater schema of this person in terms of their vocation in life, in terms of other potential priorities such as family,

Chris Lisanti

marriage,

Chris Lisanti

knowledge,

Chris Lisanti

harmony with the divine, things of that nature, Other basic goods that the new natural lawyers have informed us about?

John Rhee

Yeah, thanks, Chris. I think I agree with all of that. And the only thing that I was thinking about, including, was this idea that any honest work can be a means to pursue the good.

John Rhee

Right. And so I think that in that way, medicine is one of many professions in which one can pursue the good through one's work.

John Rhee

What I would say is perhaps unique about medicine is more about the particular practice of medicine in the sense that it involves the care of the sick and suffering and therefore at a particular moment or place in a patient's life where they are especially vulnerable,

John Rhee

and that the illness can be a moment of profound,

John Rhee

either identity disruption and disintegration or a moment of consolidation and deep meaning making,

John Rhee

and that the physician is at the crossroads of that.

John Rhee

And so there's a sense in which there is a perhaps deeper or maybe at least in an absolute sense, fairly significant endeavor in the particular work that we do as clinicians because of the moral valence there or the weight there in which we encounter a patient where they are in their moment of illness.

John Rhee

And because of that moral valence, there's more of a weight or a consequence to how we accompany the patient in seeking the good in the context of their health.

Chris Lisanti

Yeah, that's an excellent point. Really, the depth that medicine has, because it does affect a basic good,

Chris Lisanti

and particularly a basic good life and health,

Chris Lisanti

which is foundational to our own humanity in terms of the finitude that we all will experience or potentially have already touched or experienced. It really has a much more profound impact on.

Chris Lisanti

On not just our lives as physicians, but of course, the lives of the patients that we're caring for and suffering, along with, in a sense, in terms of compassion, things of that nature.

Chris Lisanti

So, yeah, medicine is a profoundly noble and very, very profound profession just because it does touch on such so many deep issues. I mean, the profession of law, for instance, is also a very important profession, as is the traditional profession of the clergy.

Chris Lisanti

Again,

Chris Lisanti

you know, doing things that are professing to a higher standard. And then a lot of the virtues of self efface, self interest, and things of that nature come into to play,

Chris Lisanti

I think, with the traditional professions. And all of them have a sense of a very deep gravity. So, for instance, if you're on trial for a certain crime, I mean, you may be at risk of losing your liberties for months or even years.

Chris Lisanti

So those things have a profound impact and again, go back to the identity of not just the lawyer or the priest themselves, but of course, the parishioner or the client who is in those times of difficulty.

John Rhee

Chris, one thing that I'M wondering if you could just talk briefly about.

John Rhee

Just because most of our audience are clinicians and may not be as familiar with the idea of new Natural law. I know you mentioned it a few times. If you could just give kind of a broad overview or just a summary for clinicians.

Chris Lisanti

Yeah,

Chris Lisanti

certainly. I'm not an expert when it comes to new natural law. I'm an armchair philosopher. In fact, I was talking with a cardiologist this morning and we were talking about human flourishing and I was going to be on this podcast and that sort of thing.

Chris Lisanti

He goes, well, what was your major at the Air Force Academy? And I said, well, it was just biology and general chemistry. And that reminds me,

Chris Lisanti

all the stuff I'm saying is not the official policy of the U.S. government.

Chris Lisanti

So I had to get that little disclaimer out there and stuff.

Chris Lisanti

It's all my own views and stuff. But new Natural Law I think is a great. And it goes back to natural law, basically looking at the world as it is and trying to determine elements of human flourishing.

Chris Lisanti

And so a variety of very bright philosophers have come together and thinkers and theologians and have come together.

Chris Lisanti

And the way I look at it is that the human flourishing kind of goes to these kind of basic goods. The 10 basic goods that I like are from Chris Tollefsen, who happened to be the co author, author of the book the Way of Medicine with Far Curlin.

Chris Lisanti

And they are life and health, obviously applying to medicine,

Chris Lisanti

work and play,

Chris Lisanti

knowledge and aesthetic experience,

Chris Lisanti

marriage, friendship, personal integrity and harmony with the divine.

Chris Lisanti

So, and then one of their, one of their principles is that we should always be looking to promote human flourishing. And wherever we're at, whether it's work or play or the pursuit of knowledge,

Chris Lisanti

our harmony with the divine, whatever those things are, we should be looking to promote human flourishing and promote the basic goods. And again, one of their overarching principles or limiting criteria basically is that we should not do anything to intentionally harm one of those basic goods.

Chris Lisanti

Okay. And so I think that that's, you know, that's probably a very, very superficial sketch of new natural law theory, but I think that that's some of the important take home points that I have taken and then used incorporated, I think to hopefully some good effect to some of my own thinking regarding approach medicine.

Chris Lisanti

How do we approach life? You know, when I'm stuck with a decision to watch a movie or to spend some time with family playing a game,

Chris Lisanti

I can look at those things and say, well, which one is going to then realize more of the basic goods, right? And so we talk about friendship or we talk about marriage, or is it about, you know,

Chris Lisanti

pleasing myself psychologically by doing what I want to do.

Chris Lisanti

And so certainly some of the stuff that I've talked about in some of my podcasts and some of my papers and things of that nature is the need to transcend the psychologic.

Chris Lisanti

I call it self transcendence.

Chris Lisanti

Actually, Viktor Frankl talks about that in Man's Search for Meaning. He says that this little sentence, he says that the key to self actualization is self transcendence. And certainly in our own culture in this day and age where we have this whole notion of it's all about me and my truth and.

Chris Lisanti

And you do you,

Chris Lisanti

and if it feels good, do it and things of that nature.

Chris Lisanti

Some of this older thinking runs contrary to that. However,

Chris Lisanti

I would say that the new positive psychologists and that whole thousands of empirical studies and things of that nature actually lend credence to the fact that you actually it's more blessed to give than to receive,

Chris Lisanti

as the Bible would say. And that bears itself out frequently in human flourishing. So our chances of actually looking to achieve those basic goods and to be mindful of,

Chris Lisanti

you know, in those moments where we have to make a decision that we can go ahead and hopefully cultivate the virtues in our lives,

Chris Lisanti

remind ourselves that these are more important than pleasing myself psychologically or happening to do what I want to do in that moment in time and to actually go ahead and try to attain to the higher virtues and to get back to the basic or the higher goods, if you will,

Chris Lisanti

and to keep those in mind about things that are instrumental goods,

Chris Lisanti

such as money or my own little comforts or prestige, and to make certain that we prioritize as much as we can in the foremost of our minds,

Chris Lisanti

the basic goods, the higher goods, if we will.

Michael Egan

Yeah, really fascinating. Yep. I think that was a wonderful overview of new natural law. And thank you for doing that. It's very refreshing to hear. I'm doing a master's in bioethics right now,

Michael Egan

and we went over virtue theory and I was a huge proponent of it. I mean, I'm kind of biased because I work for Hip Sock, but one thing that I love that I think you just drew out perfectly right there.

Michael Egan

Some people would argue against this, but how practical it is,

Michael Egan

especially when combined with something like new natural law,

Michael Egan

where in small situations where it doesn't seem like a huge moral decision whether to watch a movie or play games with your family, this idea of basic goods makes it very practical and down to earth to Be like, okay, what am I actually pursuing here?

Michael Egan

What is, what is the good?

Michael Egan

Rather than something like utilitarianism where you have to calculate all the possible goods, or in, in some versions of the utilitarianism.

Michael Egan

Anyway, I, I thought, I really appreciated that overview of new natural law and how bringing virtues into that, we can, we can live a good life through that.

John Rhee

Yeah. And one thing that I wonder, Chris, if you would comment more on is perhaps something that physicians in modern times are struggling a bit with, which is,

John Rhee

according to the new natural law,

John Rhee

that there's an idea that, as you said, you cannot intentionally damage any of the basic goods. And I think there's been this sense in modern medicine that whether a physician's role in life or health in terms of intentionally damaging it,

John Rhee

what is allowed, what is not allowed?

John Rhee

I think that in a certain sense, the tradition of medicine would speak about hastening death as therefore not in the purview or the role of the physician who is always seeking the health of the patient,

John Rhee

but that in more recent times, there have been people who have spoken about the idea that perhaps hastening death is okay if that's like, what the patient wants.

John Rhee

Yeah. Any thoughts about that in the context of the idea of new natural law? And what I'm hearing you say is that intention there is really important.

John Rhee

And then also that there's a sense in which the whole purpose of the idea of these basic goods is to give us a sense of, like, what are the things that lead, to lead to our flourishing or lead to like, a meaningfully lived life.

Chris Lisanti

Yeah, I mean, certainly the end of life issues you're much more familiar with than the diagnostic radiologist sitting on the other side of the podcast.

Chris Lisanti

But nevertheless, you know, I mean, you have to have kind of this philosophy or approach to life, and then if there are going to be some exceptions, that they have to be very, very well reasoned and very overwhelming,

Chris Lisanti

I think,

Chris Lisanti

in the necessity for those things,

Chris Lisanti

you know, and so there should be within it somehow some. Some good limiting criteria. So, for instance, if you want to try to heal a patient, we can't coerce that patient to do that because we have this general sense of respect for patient autonomy.

Chris Lisanti

And I think that that would be a very good limiting and fairly, you know, well defined sort of boundary, basically,

Chris Lisanti

when we're talking about end of life issues. And certainly this then goes into even bigger understandings of what it really means to be human. Right. And so as we're trying to achieve some of these basic goods,

Chris Lisanti

how does that look like, or what does that start looking like when the patient's body is failing?

Chris Lisanti

What sort of goods can we actually achieve?

Chris Lisanti

You know, and, and as a physician in the biomedical model, you might just throw up your hands and go, no, we're not getting anywhere in here. And in fact, we just might as well throw in the towel, let's just hasten things and just be done with it sort of thing.

Chris Lisanti

Everyone doesn't seem to be very you happy or pleasing in this sort of thing. You know, the family may not be happy, the patient's obviously suffering,

Chris Lisanti

and then what then do we do as physicians? But again, if you have a broader perspective of what it means to be human,

Chris Lisanti

and this is where I think, to me, the biopsychosocial spiritual model comes into play as well as the basic goods. I mean, certainly you can then look at the basic goods and say,

Chris Lisanti

you know, is there any other basic goods that we're perhaps missing out in this end of life experience basically, is harmony with the divine.

Chris Lisanti

Where is that? And again, that's a spiritual aspect of things. Traditionally left more towards the hospital chaplains or visiting priests or pastors and stuff. But I think that those are important topics to bring about as we're talking about these, these difficult decisions, you know, reconciliation with, with family members.

Chris Lisanti

Certainly there's all sorts of people out there,

Chris Lisanti

probably our own family included, where there's, you know, there are issues that are unreconciled.

Chris Lisanti

And is there an opportunity then to reconcile those? And then, of course, on the other hand, what is it doing to us as humans for those caring for these individuals?

Chris Lisanti

Right.

Chris Lisanti

You know, I mean, there's been a lot has been said about people who, you know, arguments against the death penalty, for instance, can also be called on about what does that then do for the people who are pulling the trigger or pushing the button or giving the lethal injection?

Chris Lisanti

Okay, so it's affecting our own humanity as well, perhaps giving us moral injury,

Chris Lisanti

moral stress and things of that nature. So it's not good for our own flourishing frequently,

Chris Lisanti

and we're missing out on potentially some other basic goods. And again, if we look at that biopsychosocial spiritual model, the human is more than just the failing body in front of us, but it's also their thoughts, emotions and desires of the psychologic, their social relationships.

Chris Lisanti

Okay. Whether they be family or with the environment or other animals or things of that nature. Certainly the social environment includes a lot of dogs for us dog lovers out there.

Chris Lisanti

And then of course, the spiritual. Are we then. And the way I look at it and Sulmasy talked about the spiritual being, the sense of the transcendent, but I think of it as the transcendently good, true and beautiful.

Chris Lisanti

So are we then being able to develop the transcendent goods, which I think would be the virtues,

Chris Lisanti

and so are we then able to have this social environment, environment where we're interacting with fellow suffering individuals, and are we then able to go ahead and use those and as an opportunity for increasing our own virtues, not to mention perhaps even the suffering patient as well, and then a variety of other virtues,

Chris Lisanti

and then of course, like I said, harmony with the divine and those sort of transcendent spiritual sort of implications.

Chris Lisanti

So there's probably all sorts of dynamics that can go along with that. And I know that you, John, as being also a palliative medicine guy, can certainly attest to a lot of those sort things and probably even explain them in greater depth and detail and go beyond that.

Chris Lisanti

But I think that that would be an interplay to me of, you know, sort of this model, the model of the human being, and then superimposing that with the basic goods.

Michael Egan

Yeah, fascinating. So essentially bringing what you were saying before, where medicine is pursuing these basic goods and maybe in itself could be called some basic profession or something, you know, where it's more directly pursuing basic goods for self and others,

Michael Egan

expanding these basic goods sort of informs the practice of medicine and its scope and limits and what that might look like.

Michael Egan

Interesting. Yeah. And one thing to that point, one thing that just came to mind when you were saying, what is it doing to us, us humans who,

Michael Egan

who might be ending someone's life in some way.

Michael Egan

I. I read this paper that said that for firing squads and the death penalty, they used to give one person a blank, but they wouldn't say who it was. And so, so each person could feel like, oh, it wasn't me, I had the blank.

Michael Egan

I didn't actually shoot the person who died. Which I thought is fascinating inherently knowing that it would take its psychological toll on the people doing that. And so even finding a way to give themselves an excuse or make themselves feel better is telling us to what that sort of action does to us.

Chris Lisanti

Yeah. And certainly the new natural lawyers would talk about,

Chris Lisanti

you know, we're trying to optimize and promote human flourishing for everyone involved. Okay. So although when the patient comes,

Chris Lisanti

they're the focus of our attention, and undoubtedly that's the reason we're there,

Chris Lisanti

but we're not unemotionally involved robots administering some sort of drugs or procedures to the patient, but we are real live human beings as well. And that's the importance of redeeming the good of our own work.

Chris Lisanti

Because we just can't be just these efficiency model machines generating and churning out patients and RVUs and things of that nature. But we are real life human beings, beings. And that we need to have that connection and a sense of meaning and purpose to what we're doing.

Chris Lisanti

And so, you know, a lot of times the institution has an adverse role to play with that or they can do a very supportive role in terms of what we're doing.

Chris Lisanti

And certainly from the individual perspective there's an important part to play of our own mentality. Are we actually looking at our work for its own internal good and benefits, or are we looking at it as an opportunity to make money or to be known as somebody important and, or famous or something along those lines?

Chris Lisanti

And so, you know, it's a day to day decision and a moment by moment decision that we all have to contend with, I think. And certainly every institution is going to be a little different and they're going to have their own pros and cons.

Chris Lisanti

And like I said to folks, you know, I mean, there's no such thing as a perfect system. If there is, don't join it, you'll probably mess it up sort of thing, you know.

Michael Egan

Yeah. And then just touching on that point, I,

Michael Egan

I wonder if you could talk more about that difference between the individual and institutional levels, especially when it comes to this good of work.

Michael Egan

I think this idea of pursuing basic goods through medicine and medicine being an important profession because of that, is certainly a traditional way of looking at medicine.

Michael Egan

And a lot of recent times, and even in the Hippocratic Society that we've been talking has recently come up this idea that institutional pressures and finances and insurance companies and all these, these metrics are distorting that good in medicine and how it's pursued.

Michael Egan

So I wonder if you could talk a bit about how individual versus institutional pursuits of the good are seen in medicine and maybe if we could dare to be optimistic.

Michael Egan

I know there is a lot of things wrong with medicine, but obviously there are also a lot of good things. So I'd love to hear from either of you whether you've seen an institution that really does it well,

Michael Egan

even if not perfect, as you were just saying, Dr. Lisanti, whether you see an institution that does pursue, that does promote the pursuit of these basic goods for its clinicians and its patients in what you would consider a great way.

Chris Lisanti

Well, I mean, and the way I look at this. And I think a lot of times when we look at burnout in medicine, we have a tendency frequently to focus on the institution or something about some get.

Chris Lisanti

Well, sort of things within our own person. I mean, and they're all valid. But the way I look at it, again,

Chris Lisanti

is to try to boil it down as simple as possible, but hopefully not simpler.

Chris Lisanti

And so to me, there's the individual and then there's the institution. Both have an important and vital role to play in terms of redeeming the good of our work.

Chris Lisanti

So when it comes to the basic goods, we should be trying to pursue these basic goods for their own internal benefit and good. Otherwise, if we were to go ahead and, like, say I wanted to pursue knowledge in order to write a book, to be famous and make a million dollars or whatever,

Chris Lisanti

then I'm really using knowledge as an instrumental good, you know, in order to be famous and. And make a lot of book royalties and things of that nature.

Chris Lisanti

So again, it goes back to the notion of the internal good.

Chris Lisanti

And. And again, we're. We're mixed creatures, you know, I mean, I have to admit, you know, I mean, I go ahead and. And I don't do my job here at Brick army for free.

Chris Lisanti

I go ahead and. And do my little,

Chris Lisanti

you know, timesheet and make certain that I get paid for what I'm doing. Again, I don't have any problems with people making the money, okay? We have to keep the lights on, and then we have to pay the people well, okay?

Chris Lisanti

But that should not necessarily be our highest priority. And again, it's going to be this tension. So what I tell folks, if you want to redeem the good of medicine or your work, whatever you're doing, and it doesn't necessarily have to be medicine.

Chris Lisanti

It could be, you know,

Chris Lisanti

any other employment that you do. We have some guys who are the do it yourself guys for the house, because I'm not very clever at the house. And these guys just love their work.

Chris Lisanti

I mean, they're true craftsmen. They love to create beautiful bathrooms, living rooms and stuff like that. And they have a real joy about the work that they're doing. And so we need to do and can do that ourselves.

Chris Lisanti

So what I tell the individual, which is really the thing that you have the most control over, right?

Chris Lisanti

You have the most control over your thoughts and emotions and desires, the things going on between your ears. The two things is you have to love the job.

Chris Lisanti

In our case, medicine for its own internal good and benefits, okay? And then we have to love those associated with it which would be our patients, our colleagues, our support staff, the nurses, the whole nine yards.

Chris Lisanti

Okay? And then the other half is the institution.

Chris Lisanti

Now I think the institution can play a very supportive and encouraging function. But what I see frequently, frequently, at least at the minimum, is the negative effects that the institution currently is playing in our culture, in medicine.

Chris Lisanti

And so I say that. And being a speech and debate coach, I like alliterations, right? And so I say that the institution can degrade,

Chris Lisanti

dilute or distort the good of your word. What do I mean by degrade? Degrade means that they don't give you the appropriate time and, or resources. Time of course, being a resource course in order to do the job well.

Chris Lisanti

Dilute means that they're giving you too many extraneous jobs or functions to do that don't directly impact the good of your work. You know, computer based training is probably a great example of a lot of extra layers of stuff.

Chris Lisanti

I mean, I don't need to know anything about some of the things that are required for everyone.

Chris Lisanti

It seems like one size fits none sort of thing or a lot of the insurance,

Chris Lisanti

you know, bureaucracy and things like that has very little to do with the actual delivery of health care to our patients. And then finally distort.

Chris Lisanti

Distort would mean that we're actually using medicine not to achieve the internal good of the health of our patients, but we're now using it frequently to achieve monetary profit. Okay?

Chris Lisanti

So those are kind of the way that I look at that. And then so I think that it's important for us to understand kind of an, a big broad view picture as to what,

Chris Lisanti

what the components are. And then we try to facilitate whatever we can in those components. So from an individual perspective, and this is the thing I like about the Hippocratic Society is that we trying to go ahead and form and sustain clinicians in the practice and pursuit of good medicine.

Chris Lisanti

And so we have to continually be mindful of that because there's so many other things in our workday that can distract us from that internal good, okay? And so we have to continue to be mind of that.

Chris Lisanti

And so that's why I take a well being walk at noon every day. I go out around the center for the Intrepid and the Fisher House and things like that.

Chris Lisanti

I see the squirrels, I see a train go by, I see the birds fly, that sort of thing. But I'm also mindful of the things that I've been able to do that morning, okay?

Chris Lisanti

And I'm grateful and thank God for being able to make a diagnosis and to work with a resident, show them how to do something properly or had a good interaction with another staff member, encourage them, that sort of thing.

Chris Lisanti

And so there's a variety of things, and I know you guys have talked about this on the podcast a number of times, and it bears repeating because we really, really do need to hear it.

Chris Lisanti

We need to make times in our lives where we can just be quiet and reflect on the day.

Chris Lisanti

That sense of mindfulness and things like that. You don't have to be a Tibetan monk or some sort of great guru to have these sort of important experiences that you can have each day.

Chris Lisanti

But again,

Chris Lisanti

and the positive psychologists call it the what went well? Or three blessings exercise. So at the end of the day, just sit quietly for five minutes, reflect upon your day, and look at the three things that went well that day, and just be grateful for someone else or for God and his intervention,

Chris Lisanti

whatever that made that opportunity possible for you. And really, in terms of gratitude, I mean,

Chris Lisanti

I didn't make a CT scanner. I mean, I teach mri, but really,

Chris Lisanti

the M stands for magic. Really, you know, at the end of the day, when I get down to as much as I know about MRI physics to my residents, I say, well, really, in the end, it's just magic.

Chris Lisanti

Okay? But nevertheless, you know, there's so many things, I mean, from. From a pharmacy, you know, a drug perspective, we didn't make any of these drugs, you know, but we get to then use these things for the benefit of our patients.

Chris Lisanti

And then these are the tools that we get to use to experience joy in accomplishing what. What we've been called to do in medicine.

Chris Lisanti

So from a diagnostic radiology perspective, I tell my residents and fellow staff, I said, you know, the job of a diagnostic radiologist is to reduce diagnostic uncertainty. And so if I'm able to do that, I derive joy from that.

Chris Lisanti

And certainly it can sometimes be very obvious because a resident will send me a report and I'll say, you know what? You didn't see this thing or that, or you didn't see something in the patient jacket that actually tells us that this is a stable finding rather than something that may necessarily,

Chris Lisanti

necessarily need more workup or something like that. And again, I tell folks that, you know, in order to,

Chris Lisanti

you know, anxiety comes from uncertainty. And so really, it's psychoradiology, right? So as I'm reducing that uncertainty, that diagnostic uncertainty, I'm bringing and reducing the anxiety that our patients and my fellow clinicians have regarding what's going on with their patient.

Chris Lisanti

And at the same time, I'm achieving internal excellence. Now, there is a limit sometimes as to how much diagnostic uncertainty I can eliminate. That's why I said our job is to reduce diagnostic uncertainty.

Chris Lisanti

For any of you guys who have read radiology reports, you know, sometimes it doesn't necessarily reduce uncertainty. Maybe it makes more uncertainty. I apologize for that. It's part of the business, unfortunately.

Chris Lisanti

But I think on the overall, we're trying to reduce that uncertainty. And again, we have some amazing tools to do this job. But again, there's the effort and the excellence of the craft itself,

Chris Lisanti

just like there is for neuro oncologists, just like there is for general surgeons, in terms of actually realizing the benefit of the craft. And obviously, the institution has an important role to play.

Chris Lisanti

And I think that there's some institutions out there who have a visibility on this, and some of it might necessarily be just because they're reacting to the burnout that they see within their physicians.

Chris Lisanti

And it's not good for business, so to speak, if all of a sudden you have a large turnover or dissatisfaction.

Chris Lisanti

Physicians who are then disgruntled and frustrated with the system, and then subsequently the patients are thinking, well, I don't like this healthcare system. Maybe I'll take my healthcare needs somewhere else.

Chris Lisanti

And so I think that that might be part of the role.

Chris Lisanti

Whatever we can do to go ahead and bring this to the attention. But I think from an institutional perspective, I think if you look at those three things that I mentioned,

Chris Lisanti

is it degrading, diluting, or distorting the good of the craft that we're doing right, Then we need to go ahead and take positive impact for that.

Chris Lisanti

And basically I say the institution should be looking at everything through the lens of this one basic question.

Chris Lisanti

Does this increase,

Chris Lisanti

keep the same or decrease the amount of time that clinicians spend with their patients or healthcare professionals spend with their patients?

Chris Lisanti

So from a diagnostic radiologist, I want to have more time to spend with my virtual patient, the images in front of me, so that way I can go ahead and make certain that I don't miss any of the findings and I think properly about everything.

Chris Lisanti

The same thing for John as a neuro-oncologist and palliative care specialist, we want to increase the amount of time that he has interacting with the patient, not the emr,

Chris Lisanti

not trying to track down something, not filling out insurance requests. Okay?

Chris Lisanti

Important as all that may be.

Chris Lisanti

So from an institution's perspective, we really need to try, and this is where efficiency can be helpful,

Chris Lisanti

is we need to Try to make all these non person to person interactions as efficient as possible.

Chris Lisanti

So if all of a sudden AI is able to bring up PSA levels for me when I'm looking at a prostate. Mr. And it pulls up automatically, the pathology results from the prior biopsy and the urology note that I am very, very happy with that and that will allow me then not to be,

Chris Lisanti

you know, I can be more mindful about looking at the images and less mindful about well, where do I get this?

Chris Lisanti

Do they have a psa? What was it? What's their trend? What did the urology note say? Things of that nature.

Chris Lisanti

And so whatever we can do to increase that important and vital aspect because really what ends up then happening is that the clinician and the patient then form a more trusting relationship.

Chris Lisanti

The clinician can, then it becomes more bi directional,

Chris Lisanti

the physician finds out more about the patient which then gives them critical insight, I think as to the things that were going to go right with the patient or things that may not go so well, you know, in terms of therapies or treatments or things of that nature.

Chris Lisanti

So I think whatever institutions are able to increase that amount of face to face interaction between clinicians and their patients, patients is going to be bringing about important, huge steps I think for that.

Chris Lisanti

And again, time is critical. Time is so critical and they're compressing the time in order to increase the RVUs and the throughput and some of it might just be to meet access care standards and things of that nature.

Chris Lisanti

But unfortunately that brevity just makes it a very superficial sort of understanding between the clinician and the patient. And this, then it ends up having downstream effects. You probably give more medications that maybe you wouldn't have given just because you're not really exactly certain.

Chris Lisanti

And their abilities to follow up and you know, the follow up is, is kind of haphazard and then maybe you're getting more imaging because you're, you're a little more, more uncertain with the patient.

Chris Lisanti

I mean that happens all the time in the emergency room, right? I mean these poor folks are dealing with, with people they don't know hardly anything about. They have very little if no relationships with them apart from that encounter that day.

Chris Lisanti

They tend to use imaging, not that I mind it. I mean I'm here to reduce that diagnostic uncertainty. But the thing is that we can, you know, by increasing that amount of time and that trust we can perhaps have fewer amounts of medications.

Chris Lisanti

We'll get to the right medication or the right therapy, we'll have less diagnostic imaging. And I Prefer to see imaging that really has some impact. Right. You know, just ruling out appendicitis.

Chris Lisanti

Well, it's kind of equivocal or whatever,

Chris Lisanti

or those sort of things don't give me quite as much joy as seeing something that is either truly emergent or something really quite substantive. So I think there's a variety of things that the institution can certainly do, and that just touches a few of the things, basically.

John Rhee

I think the only other thing that I would add is a theme that we talk a lot about in the Hippocratic Society, which is that we're not trying to decrease the importance of how these institutional environments or cultures affects the daily practice of clinicians.

John Rhee

In fact, they play a huge role and that what we are trying to do is to increase,

John Rhee

for every individual clinician,

John Rhee

the individual locus of control internally in terms of how they meet each of the challenges that they do meet and still can find within those challenges an opportunity for growth or challenge or flourishing.

John Rhee

Right. And so this importance of the fact that we do have to start within ourselves and from that have an overflow to try to change first, like the culture around us and our friends, our colleagues,

John Rhee

I think that there's also related to that an important consideration of,

John Rhee

well, two things, I think, one, which is also a key concept in the Hippocratic Society, which is just friendship,

John Rhee

and how we cultivate those environments where we are in our institutions, where are we friends with our colleagues.

John Rhee

And perhaps I could throw that question out to people who are listening too, in which we can ask ourselves,

John Rhee

maybe it would be also just less burdensome, or there may be less burnout if we were going through this thing with a true sense of deep friendship for those people that we are working alongside with.

John Rhee

That that may make actually the things that oftentimes can be really hard in medicine, which may be the long hours,

John Rhee

right.

John Rhee

Just a little bit less difficult or challenging. And I think that that good of friendship can really help alleviate that.

John Rhee

And then the second thing being just this idea or a concept of subsidiarity,

John Rhee

which is the small units in which we find ourselves in and which we organize and our communities around.

John Rhee

And so between the individual and the institution, there may still be opportunities to create smaller communities,

John Rhee

whether that be around friendship. In a residency class,

John Rhee

another small unit may just be like the people that you're working with in your particular unit or team,

John Rhee

and how to create a sense in which there is an overflow of your interiority so that the others are affected by that sense of joy or that sense of Hope or optimism and that sense of desiring the good for the patient, because in these smaller units,

John Rhee

sometimes the individual can have an even larger role or impact on those around them.

Chris Lisanti

Yeah, I agree with you, John. I mean, the impact of one individual can be quite astounding.

Chris Lisanti

I remember in my MRI fellowship that, you know, we had five of us in the fellowship, and I came back one time after some vacation, and they said, well, the glue is back.

Chris Lisanti

And I went,

Chris Lisanti

the glue? What does that mean? And they said, well, you know, Chris, when you're here, here, you're just like the glue that keeps the team together. And then when you're gone,

Chris Lisanti

it seems like there's something really important that's missing, basically.

Chris Lisanti

And this is another little thing that I have around here. The people in my department know this for my Mocha Wednesdays,

Chris Lisanti

and so trying to bring the good and the joy of our work to others. So there's a little coffee stand here.

Chris Lisanti

I love their mochas, but I also know about hedonic adaptation.

Chris Lisanti

And so I know that if I got a mocha every day would not be a big deal. But I get one once a week on Wednesdays. And so I show up, and for some reason, and I've been doing this for years,

Chris Lisanti

it's become known as Mocha Wednesday.

Chris Lisanti

And so the. The baristas, they really get into it. They write on their happy Mocha Wednesday.

Chris Lisanti

They. They. I mean, it's. It's a real thing. And then. And then in my department, people are always asking me, well, did you get your mocha today? And I. And I try to remind them it's not just a drink, but it's a spirit.

Chris Lisanti

It's joy, you know, and so I'm trying to, you know, ignore. Again, you could go ahead and go to the barista and say thanks or something like that. You know, not every encounter with somebody outside of medicine or on the floor has to be some Mocha Wednesday experience.

Chris Lisanti

But I think going back to what John was saying, whatever we can do to help find and help to let people know about the good of the work that they're doing and that we appreciate that work, I think, goes a long way.

Chris Lisanti

Again, that sense of gratitude,

Chris Lisanti

you know, it's one thing to say it in your mind when you're doing your gratitude exercises, but we also need. And I need to hear this myself, is to actually go to people and say, hey, thank you for doing your job.

Chris Lisanti

You know, you did it, and it was a cut above, and it made a difference in my life. And in my practice and in this patient.

Chris Lisanti

So, yeah, that's some really, really good stuff.

John Rhee

Yeah. And I think it's sometimes when we think too much about institutions, we may have almost like a helpless mentality where we're like, oh, the institution should take care of it.

John Rhee

But thinking about again, this idea of subsidiary, where we may actually have a large influence on smaller groups, and those are also ways in which that can multiply in effect for other groups around them.

John Rhee

Right. And so what are the communities that exist even within an institution in which we can make a change or impact?

Chris Lisanti

Yeah. And really,

Chris Lisanti

whatever those things,

Chris Lisanti

like a lot of times if the system is down for some reason. Reason. Right. They're doing some sort of upgrade and we're all sitting around doing nothing. You can either fume and say, oh, we're getting behind on the list and,

Chris Lisanti

or I can just say,

Chris Lisanti

well, what this is now an opportunity for me to do something different. Let's, let's talk. What's going on with you?

Chris Lisanti

How's the residency going for you? Or maybe a staff member, you know, is there anything I can do? You got some research ideas, that sort of thing. And so there's a variety of other things that we can do with the time.

Chris Lisanti

And like I tell people, people,

Chris Lisanti

you know, you don't have to waste time, you choose to waste time. Okay. So there's usually something you can be doing even if you're just standing there by yourself. You can then take that as an opportunity to have some, some, some quiet time, some reflection again, do those, those gratitude exercises,

Chris Lisanti

you know, and just, just quiet your soul. So that way you can go ahead and then, then listen to that small voice to get you going in the right direction again and then to kind of re.

Chris Lisanti

Get things back in balance and working in harmony again.

Chris Lisanti

So.

Michael Egan

Yeah, I love that too. Because then even those individual practices in some sense can be perceived as institutional where you're building a culture around you where people want to work there.

Michael Egan

Because it's perceived that the whole organization is really filled with joy and wanting to support each other,

Michael Egan

even if it's not necessarily for, from an institutional directive or organization that is starting that.

Chris Lisanti

Yeah. And certainly, I mean,

Chris Lisanti

yeah, I mean, just, you know, I mean, I'm not like, you know, I'm a clear eyed realist and the systems, the problems that we have and things like that. But also again, like we said that there's, there's only certain things that you can do at your little local level.

Chris Lisanti

And then, you know, but there's so much of a Great. Still good of our work that we should be able to, to take enjoyment with, even if there's some hurdles,

Chris Lisanti

some, you know, problems with connections and the system goes down or, you know, this certain process is clunky and things like that. And again,

Chris Lisanti

those things, again, you know, the old thing is it takes nine atta boys or atta girls to offset that one. Oh, no. Right. And so if we focus too much on all the negative things, we're going to totally overshadow the good of the work that we're doing.

Chris Lisanti

And I'm certain everyone who's listening to this podcast is doing amazing work, work with their patients and in their hospitals and clinic situations and things like that. And sometimes we lose that sense of the great work that we're doing because we're so distracted by the death by a thousand paper cuts,

Chris Lisanti

basically. And so we have to, again, take that step back and be mindful about it and reconnect with the good that we're doing and then encourage others to do the same.

Michael Egan

Yeah, no, I love that. And I think that naturally leads to our maybe final wrapping up. Point is,

Michael Egan

we've already said a lot, especially. Yeah. Dr. Soni, there's so many good ideas that you've shared with us here and anecdotes, which I love. But very practically, what are a few tips for people to renew the good of their work and the joy in their work, especially when, as you say,

Michael Egan

those thousand paper cuts seem like a mountain, when it's just a molehill or really getting bogged down by the hours, even if it's not the type of work.

Chris Lisanti

Yeah, again, I think it goes back to those two things. Love medicine for its own internal good.

Chris Lisanti

Take the time to actually rejoice and take joy in the fact that you assisted that patient, you made a good diagnosis,

Chris Lisanti

you got them through a difficult time, whatever it is. I mean, we're doing good work every single day, but sometimes we just kind of get into this habit of that's just my job, you know, it's just another diagnosis, whatever.

Chris Lisanti

But again, we need to be mindful of just really doing it for its own internal good and then rejoicing in the fact that we've done a good work. And again, as we've talked about loving those associated with our work.

Chris Lisanti

Right. The friendships that we make are so critical. You know, on your deathbed,

Chris Lisanti

you know, or when you retire or whatever, they're not going to say, oh, yeah, he was the RVU king or boy, he could really slip in a subclavian line. Boy, that guy was fast.

Chris Lisanti

You know, know, they're going to say, that person took time,

Chris Lisanti

they took time, they stopped, they listened,

Chris Lisanti

they showed concern, right? And I think Josh McDowell, an author, said, you know, love is spelled T I M E.

Chris Lisanti

And so sometimes in the frenetic, frantic sort of craziness that is modern medicine,

Chris Lisanti

we don't have enough time, it seems like,

Chris Lisanti

so we have to be be mindful of trying to make that time again. Again.

Chris Lisanti

Many people are already under the gun with just doing too much. And again, that's an institutional problem.

Chris Lisanti

But there's also that element of ourselves where we get caught up in the rat race, so to speak, and then we get going on that merry go round. I think it was Gandhi who said that there was more to life than in just increasing its speed.

Chris Lisanti

And I think we really need to take some of that philosophy to heart because we can get so busy in our lives that we can, cannot, we, we just can't slow down,

Chris Lisanti

you know, no matter how important it is. So sometimes, like when I'm at home at, you know, after a busy day, my wife will ask me something. I'm, I'm like, well, hurry up, come on, get to the point here.

Chris Lisanti

You know, and, and the thing is, is that, no, no, no, I need to stop and slow down. I don't have to be running a million miles an hour, you know, Mach 3 all the time in, in my whole life.

Chris Lisanti

And the same thing can happen at work, Work too. You know, in spite of the fact your, your schedule might be pretty busy that day, you might just have to ask, pause for a moment and say, is there anything more I need to do with this patient or with the staff member or a colleague and things of that nature.

Chris Lisanti

So again, just being mindful and then, and then pausing, I think we can, we can press that pause button. For those of you guys who still know what that pause button, you know, it's on there, it's on everything, right?

Chris Lisanti

Put. Press the pause button for at least five or 10 seconds, maybe 15, and then hit the play button again. And I think that will really benefit greatly. I mean, people, you'll find out stuff about people,

Chris Lisanti

you'll really make a connection with them. And I think that, you know, we'll. Again, you know, the joy of what we do isn't always just necessarily just the craft itself, but it's frequently the meaning of the people and the impact of the people that we're actually doing this job or service for.

Chris Lisanti

So again, that would be my comment. Comments, I guess, John, you've got something, I'm certain.

John Rhee

Yeah,

John Rhee

no, that was really great, Chris. And I think the only other idea that I was thinking about is that work itself, whether it be medicine or not,

John Rhee

can be both formative or malformative.

John Rhee

And a lot of how it becomes formative for us or versus malformative is the intention in which we are doing it. And so like you were saying earlier, Chris, that if you're doing work for just personal gain,

John Rhee

that could in many ways become malformative because one becomes then more and more focused over time on one's own interests or self.

John Rhee

Whereas if we're able to transform the intention as work as a means of service,

John Rhee

as a means of loving others,

John Rhee

and also as a means of personal growth,

John Rhee

because we spend so much time and work every day,

John Rhee

that work can be a means of a lot of growth for us, right? Whether that be the way we do our work, with order,

John Rhee

the way that we look out for our colleagues in the way that we do our work. I think in medicine those kinds of examples are abundant, right?

John Rhee

How you tidy up all of the things that you're doing that day for your patients, patients directly impacts the person who's the overnight person who has to be covering those patients.

John Rhee

And if we do it with good order or we really go and update the patients so that the,

John Rhee

the person who takes over at 8pm who gets the page of like, can you give me an update of what happened today? And they're like, I don't know,

John Rhee

you know that that doesn't happen, right? If we are being very intentional about also serving the person who's taking over after us. And of course this is to say, like, we make mistakes.

John Rhee

So, but, but it's. Then it's not actually about the.

John Rhee

But in the way in which the intention which we're doing it and trying to purify and grow in that intention over time,

John Rhee

in all of the small actions and to reflect back on how am I bringing that intentionality to all the aspects of my work where I see those aspects as opportunities for changing myself towards the good and then changing others around me towards the good by being a good example through my work and then perhaps even changing the work itself,

John Rhee

which is like what we're trying to do do in the Hippocratic Society, which is like we're trying to reorient the whole profession of medicine, which is like a big goal, but reorient the profession of medicine towards the good.

John Rhee

Right? Of what good medicine means. And so if we have that approach to work where we're thinking about it in terms of like, how can work transform me?

John Rhee

How can work transform those around me?

John Rhee

And then also how can work transform the profession itself?

John Rhee

That seems to me perhaps three levels in which we could think about how we approach our work can be so really transformative on many different dimensions.

Michael Egan

Yeah. Wow. Okay.

Michael Egan

Some above and beyond tips right there. Yeah. That in itself,

Michael Egan

doing the work of this podcast, I think, has affected my life for sure.

Michael Egan

No, but thank you guys so much. I think this was a very fruitful conversation.

Michael Egan

And one thing I wanted to mention before we left that I forgot at the beginning is that Dr. Lisanti,

Michael Egan

thank