[REBROADCAST] Flourishing in Medicine with Xavier Symons

00:00 Unknown[Intro music] 00:06 John RheeWelcome to the Hippocratic Society Podcast. This podcast is a project of the Hippocratic Society. 00:11 John RheeIn 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. 00:22 John RheeThank you for joining us and we look forward to engaging with you through this podcast. 00:29 Michael EganHi and welcome to the Hippocratic Society Podcast where we aim to help physicians and trainees thrive by giving them the tools to pursue and practice good medicine. 00:38 Michael EganMy name is Michael and I'm joined today by Dr. John Rhee and Dr. Xavier Symons. 00:43 Michael EganDr. Rhee is a neuro-oncologist and palliative care physician working at Dana-Farber Cancer Institute and Harvard Medical School. 00:50 Michael EganHe is the executive director and co founder of the Hippocratic Society. 00:54 Michael EganDr. Symons is a bioethicist and philosopher and director of the Plunkett Centre for Ethics at the Australian Catholic University. 01:02 Michael EganHe was previously at the Harvard Human Flourishing Program and is our faculty advisor for curriculum for the Hippocratic Society. 01:09 Michael EganThank you both very much for joining us on the show today. 01:12 Xavier SymonsGreat to be here with you. 01:13 John RheeThanks so much for having me. 01:14 Xavier SymonsGreat. 01:15 Michael EganIt is an honor and pleasure to have you guys here and I'm very excited for the discussion today. 01:19 Michael EganSo today we are dealing with a pretty big topic, flourishing, 01:23 Michael Eganspecifically flourishing and medicine. So why don't we just jump right in when we're talking about flourishing, what does it actually mean? Does it mean that I feel good? That I'm safe, healthy and happy? 01:34 Michael EganIs it objective? 01:36 Michael EganLooking up a definition online, 01:38 Michael EganI found that to flourish means for a person, animal or other living organism to grow or develop in a healthy or vigorous way, 01:46 Michael Eganespecially as the result of a particularly favorable environment. 01:51 Michael EganSo this begs the question, is it a matter of doing certain practices? How circumstantial is it? 01:56 Michael EganJust in general, what is flourishing? Xavier, would you like to start? 02:01 Xavier SymonsFor sure. And thanks again for having me on the podcast. Michael, I've thought a little bit about this question over the last few years and I think that those are really good topics that you raised in terms of how to try to explain flourishing as it is distinct from other accounts of human well being or welfare. 02:21 Xavier SymonsAnd I think you're right to say or question whether flourishing is objective or subjective, because I think that's maybe one dimension of flourishing that sets it apart from other ways of thinking about what it means for a life to go well, to have a life that's high in well being, 02:38 Xavier Symonsto have a Life that's full of the sorts of human goods that we take to be constitutive of a good life. 02:44 Xavier SymonsAnd as I mentioned, like flourishing, I think is an objective state of a person's life where all aspects of that life are good. 02:54 Xavier SymonsAnd we can debate about what those different domains of a good life are. We can think about family, we can think about work, we can think about whether someone has good health or financial and material stability in their lives. 03:08 Xavier SymonsBut in terms of just conceptually defining flourishing, it's plausibly a state in which all aspects of a person's life are good and including, 03:18 Xavier Symonsimportantly, not just their individual lives, but also arguably as well, the communities and societies of which they are a part. 03:26 Xavier SymonsSo it's probably not just an objective concept, 03:31 Xavier Symonsbut also a very relational concept. And something that I think cuts against the grain of perhaps more individualistic ways of thinking about what the good life is. 03:41 Xavier SymonsAnd as you say, that does beg the question. 03:44 Xavier SymonsIs flourishing a matter of developing certain capacities in particular that we take to be important in a good life? Is it a matter of following social practices and rules as well, though, like, given that human beings, we're not just out there in the wild, we kind of exist in these societies which have norms and conventions, 04:04 Xavier Symonscertain structures that govern human behavior. 04:08 Xavier SymonsI think that's all true, but I think at the same time, we want to maintain a sense that flourishing is about realizing your potential, 04:18 Xavier Symonsrealizing your human nature, 04:20 Xavier Symonsand doing well as a human being, functioning well as a human being. So there's something very biological as well at the root of this concept. 04:29 John RheeI think that the only thing that I would add there, Xavier, is to perfect answer, 04:35 John Rheeis how this relates to our audience. And I think that a lot of trainees who are listening to this and a lot of attendings as well, have gone through medical training may be reflecting on whether they felt they were flourishing in medical training. 04:49 John RheeAnd I found that even for myself, 04:52 John Rheethere were times in medical training where I thought about whether certain things should just be on hold. And I think that a lot of people think about this as well, too, this idea of having children or going into relationships, 05:07 John Rheethat there's a sense in which. Because medical training is so arduous, so difficult, and that it's such a long process that a lot of people just place things on hold and say, I will come back to this. 05:20 John RheeAnd there's a sense in which they're not just placing things on hold from a logistical standpoint, 05:26 John Rheebut perhaps not recognizing that by placing these things on hold, such as relationships, 05:32 John Rheemeaningful relationships, 05:34 John RheeOne's even health, own physical health, 05:37 John Rheethat there is a sense in which implicitly one is also saying, like, I'm not going to flourish for this period of time. 05:44 John RheeAnd that also affects the mentality in which people may go through medical training. Because if you have an idea that you're not flourishing, 05:51 John Rheethat then there's a certain kind of frame in which you're approaching medical training. 05:56 Xavier SymonsI think that's a great observation, John. And I think that it's a really nice way to link the biological foundation of flourishing to the social lives of doctors, the real lives of doctors. 06:08 Xavier SymonsAnd I would say that this is a big risk, is that we can sometimes as human beings get so focused on one particular pursuit, in this case kind of professional life, that we can neglect other aspects of what it means to be human and what it means to live a good human life. 06:26 Xavier SymonsSuperficially and in the moment that could seem like a really good idea. You've got this promotion you're going for in the hospital or clinic that you're working in, or you just need to get through the training program to get your accreditation. 06:40 Xavier SymonsBut I think that in the end, when we fall into that sort of psychology, often that can be our approach to our whole lives. 06:47 Xavier SymonsWe can end up constantly putting other aspects of our life on hold. And life can go quickly and you can end up well into your career realizing that you've neglected things which actually are no longer goods that are no longer realizable in the same way that they were earlier. 07:04 Xavier SymonsAnd so maybe that's an interesting little nuance to give to this concept of flourishing, that at different stages of our life, different human goods are more or less realizable. 07:13 Xavier SymonsAnd so it's not just necessarily about thinking about the good life in the abstract, but it's what is the good life for me right now, given the stage and circumstances of my life currently. 07:24 John RheeYeah, I think that's also a really interesting point that you bring up, Xavier, because there's also a sense in which even at work there may be a frame in which somebody approaches work from a perhaps non flourishing framework. 07:40 John RheeRight. And what I mean by that is when one feels like one is overworked because work has just become like so consuming both inside and outside even the hospital, 07:50 John Rheethat perhaps when one is inside the hospital, one can approach work from a standpoint of trying to do the minimal amount that's necessary because one is so tired, 08:02 John Rheeor just perhaps trying to punt consults, or trying to do the least necessary and perhaps in the moments of the rare downtime that One has that one could then turn to perhaps distractions like social media or just kind of superficial distractions rather than meaningful interactions with one's co residents, 08:24 John Rheefor example, 08:25 John Rheeor those who are around other patients because of this idea that right now flourishing is on hold. 08:31 Xavier SymonsFor me, 08:33 Xavier SymonsI think during the pandemic, John, we saw a lot of this coming to the fore, actually, 08:37 Xavier Symonsand we saw a lot of language developing around what it means not so much to live a flourishing life, but a life where you're, you're languishing, where actually things are not going very well. 08:49 Xavier SymonsAnd there's something like an exercise in quiet quitting going on in your professional life where you're doing just the bare minimum to get by. I mean, my understanding is quite. 09:00 Xavier SymonsQuitting is you don't actually quit your job when you're dissatisfied with it or unhappy with some aspect of it, but you, 09:07 Xavier Symonsyou work in such a way that you may as well have quit. 09:11 Xavier SymonsAnd that can happen in people's lives, particularly in medicine, maybe because it is such a stressful career at times, and there are so many pressures on doctors today to perform and resource constraints in the health sector such that it can be very tempting just to think, okay, 09:31 Xavier SymonsI'm not really finding meaning in my work anymore, so I'm just going to do the absolute bare minimum and perhaps even a little bit less, 09:39 Xavier Symonsand hopefully my colleagues pick up the slack and then I'm going to engage in these exercises of escapism into whatever it is, social media or more serious things like substance use or what have you. 09:51 Xavier SymonsAnd so I think that relates as well back to your point earlier about how professional life intersects with other domains of a person's life and how those go. Because I think that often when one domain of a person's life isn't going particularly well, 10:07 Xavier Symonsthere can be a kind of seepage into the other domains as well. And that's why I think flourishing is a very powerful concept, in part because it picks up on the connections between the different domains. 10:18 Xavier SymonsIt's not just you have these different aspects of what it means for your life to go well, 10:24 Xavier Symonsbut also that they are interrelated. 10:26 Xavier SymonsYour professional life affects your social life and vice versa. Your relationships, the way you live those relationships can impact your professional life. Your virtue and character can intersect with how well you're performing in your job. 10:38 Xavier SymonsAnd also our health can be affected by all of those things. 10:42 Xavier SymonsSo I think there's an important connection to be drawn there. 10:47 Michael EganYeah, that's a very good point, Xavier, and a lot of extremely important points. Both with medicine and flourishing as a whole. 10:53 Michael EganAnd it seems like obviously very important for doctors and physicians and all healthcare providers to flourish in their work and in life. 11:01 Michael EganAnd in terms of just giving our audience kind of a framework to understand flourishing, I wanted to introduce a concept that was developed by Dr. Tyler VanderWeele, who works at the Harvard Human Flourishing Project. 11:15 Michael EganHe has developed a five component measure of human flourishing, 11:20 Michael Eganwhere a lot of these aspects, you touched on Xavier, in that last point, which are happiness, 11:25 Michael Eganhealth, 11:27 Michael Eganvirtue, 11:28 Michael Eganrelationships, and purpose. 11:30 Michael EganSo he isn't arguing that these are the only components of flourishing, but rather that these components of flourishing are common in all situations where someone is truly flourishing, where an individual has developed a flourishing life. 11:46 Michael EganHe also developed a concept of how to reach these five aspects, and he identified these as work, 11:52 Michael Eganfamily, 11:53 Michael Eganeducation, and religious participation. 11:56 Michael EganSo basically, he is identifying four common pathways to reach different aspects of flourishing. And I would just like to get both your opinions or if you guys have any thoughts on how these specifically relate to medicine or how these relate to flourishing in general, whether one is more important than the other, 12:14 Michael Eganspecifically for doctors, 12:15 Michael Eganor what could you say about that framework in general? 12:20 Xavier SymonsThanks very much, Michael, for raising the flourishing framework. And I would say that this is a really good way to start your thinking about the topic of human flourishing. I worked with Professor VanderWeele for two academic years, and as you say, there are these five domains of flourishing that he posits. 12:37 Xavier SymonsAnd importantly, the five domains are not supposed to be an exhaustive list of what the good life consists in, but rather a set of near universally accepted goods or ends of a human life that we take to be constitutive of flourishing and also pretty important, essential, arguably, aspects of the good life. 13:02 Xavier SymonsSo we've got health, 13:03 Xavier Symonswe've got virtue, we've got social relationships, we've got meaning and purpose, and then happiness or life satisfaction, as you mentioned. 13:10 Xavier SymonsAnd that strikes me as a kind of a really. A really good starting point for these conversations, because I think all of those things do seem to matter. And then also, as you said, that the pathways to flourishing, 13:20 Xavier Symonsthat they're sort of like exposures in public health, things that you get exposed to throughout your life. 13:27 Xavier SymonsAnd then the domains of flourishing, the five domains are sort of like outcomes, 13:31 Xavier Symonsthings that are causally related to the exposures and that are moderated depending on the extent to which the exposure is present in someone's life. So to the extent that you have meaningful work, 13:44 Xavier Symonswonderful family life as a vibrant religious life, participation in religious community, 13:50 Xavier Symonsand good education, that's going to have a very significant impact on how well you go in these different five domains of flourishing. 13:59 Xavier SymonsAnd then I think to cut though to the question that you had, I mean, whilst what's the relevance of this to medical students, 14:06 Xavier Symonsto medical trainees, 14:08 Xavier Symonsto doctors, 14:09 Xavier SymonsI think it's important to see how, 14:13 Xavier Symonsin a way, like, a lot of these pathways intersect with the discussion we had just in the previous to the previous question that you asked where we were considering, like, 14:23 Xavier Symonswhat are the aspects of a person's life that need to be going well for them to be flourishing? And education, 14:30 Xavier Symonsfor example, was one important aspect and work was another. 14:35 Xavier SymonsSo you could take a medical trainee who's trying to educate themselves or being educated in their training and also they have meaningful work. 14:44 Xavier SymonsBut then there are these other pathways in this case family and religion, which would be also relevant to consider. Like, are there aspects of those pathways which have just dropped off the radar are not present because someone's giving so much attention to these, these other pathways of work and education? 15:02 Xavier SymonsSo I think there's a good insight there. And then lastly, I would say that the domains are not just like different goods on a horizontal plane that is sort of basically equal and interchangeable. 15:19 Xavier SymonsI think they actually really map more to some subjective features of. Of what it means for life to go well and some objective features. So. So life satisfaction and happiness is, is like a kind of subjective mental state, an attitude we have towards the world and specifically our lives and how well we think it's going. 15:37 Xavier SymonsMeaning and purpose as well has a. Has a significant kind of subjective dimension to it. But then there are other aspects which are a bit more objective, like the state of one's relationships probably has a bit of both. 15:47 Xavier SymonsHealth certainly has an objective dimension and virtue arguably as well. People can deceive themselves about their state of virtue and this can happen in medicine even. Like you can have a doctor who thinks, I'm actually fantastic with patients and I have the best relationships with my colleagues and really, 16:03 Xavier Symonspatients think this doctor is terrible in their bedside manner and their colleagues think he's just like a lousy clinician who doesn't give good advice. So I don't know. I mean, that can be important as well to take into account whether we in a way are engaged in an elaborate exercise in self deception sometimes when we try to assess how our own lives, 16:26 Xavier Symonsprofessional or otherwise, are going. 16:29 John RheeYeah, and Xavier, I just was reflecting on two different points as you were talking. One being that one of the objectives of the Hippocratic Society is to help medical trainees and those in medicine to reflect on some of these bigger questions. 16:45 John RheeOftentimes, I think in our culture today, 16:47 John Rheewe don't have much space, or maybe ironically, we don't have time to think about what is most meaningful to us. 16:55 John RheeAnd when we're caught up in this cycle of habitually placing work first, 17:02 John Rheewhich naturally, a lot of people in medicine are, 17:05 John Rheemyself included, type A personalities, where we have clear goals and we're kind of aiming at those goals and going on. And clearly, in this framework, work is actually considered a pathway to flourishing, right? 17:20 John RheeAnd that one of the things that's important in flourishing is also this idea of virtue that we said, this idea of prudence, this idea of balance, this idea of temperance, right? 17:31 John RheeThis idea of fortitude, all these virtues that come into play. 17:34 John RheeAnd also then being able to say to myself, 17:38 John Rheewhat am I doing this for? 17:40 John RheeWhy am I doing this? 17:42 John RheeAnd what made me come into medicine in the first place? 17:45 John RheeI found that as I went through medical training, there was a lot of questioning that I found among other medical trainees where they were spending all these hours in the hospital and were feeling burnt out. 17:59 John RheeAnd some of the burnout is just that perhaps a number of hours itself is unreasonable. 18:06 John RheeAnd I think that there is a sense in which people have lost a sense of what they were doing or why they were doing things and were doing things kind of from a checklist mentality, 18:17 John Rheejust going through the motions and forgetting what brought them to medicine in the first place, 18:23 John Rheewhich often are these ideals, these virtues that people feel are meaningful. 18:29 John RheeAnd as I went through training and out of my own curiosity, whenever I would ask people what drove them to medicine, 18:37 John Rheethe primary things that people mentioned were a spirit of service, a desire to help others, 18:42 John Rheeespecially those who are suffering, 18:44 John Rheeand a desire to build relationships with patients, to have meaningful relationships with patients. And again, those fall within the framework of a flourishing. 18:56 John RheeAnd so I think that the second thought that I was just having there related to that, and I'll let you respond perhaps to that, is just this idea that though this flourishing framework is important for people in medicine, that, of course, all of what we're doing here is to also direct what we're doing to patients, 19:14 John Rheeright? 19:14 John RheeAnd sometimes, 19:16 John Rheein the way that modern medicine practices, 19:19 John Rheewe can approach patients from a very biological level, 19:23 John Rheesometimes one could even say dehumanizing level, because it's so biological. 19:28 John RheeAnd we forget that flourishing is actually what we're hoping to have patients achieve. 19:34 John RheeOf course, doctors may not have all the tools to help a patient achieve full flourishing. 19:40 John RheeAnd at the same time, we have to recognize that physical health is one component of flourishing and that there are other things, factors in flourishing in a person's life. 19:50 John RheeAnd that as a doctor, when we're entering into somebody's life, 19:54 John Rheethough we are the expert on the health, the biological functioning of that patient, that we have to put that into context in the person's whole life. 20:03 John RheeSo that even if what we were hoping to do for that patient in this inpatient stay is not perfect, if it means that this patient can leave the hospital earlier without a perfect treatment plan, 20:17 John Rheeyet allows them to go on this vacation with their family that they've been looking forward to for so long and is so meaningful to them, 20:25 John Rheethen perhaps this is how we should be thinking about our treatment plans from a flourishing model, rather than perhaps just a purely biological approach to each patient. 20:34 Xavier SymonsThanks, John. Yeah, I think that I would say that there are obviously, as you mentioned, some challenges here, and maybe we can circle back to this later, but I think that doctors are not necessarily experts in many of the domains of flourishing that we've mentioned. 20:50 Xavier SymonsSo doctors are not relationship counselors, but they may have at least some experience dealing with patients who are in complex social situations and have complex relationships with people who matter to them. 21:08 Xavier SymonsAnd as a doctor, there's probably a minimum level of ability to try to help people in those situations and provide holistic care. 21:18 Xavier SymonsEven when people have these kind of complex social circumstances, that's required to be a good doctor. And it shouldn't be that you have to kind of be the one who not just kind of restores them to health, but also helps them to sort of catch up the sort of tensions and frayed edges of their marriage or something like that, 21:38 Xavier Symonsand also to try to cultivate a whole series of virtues that they've lacked throughout their life. Like there's. There's limits. There's a kind of ceiling, I think, to. Or a professional limit to how much flourishing comes into the picture. 21:53 Xavier SymonsBut I think the mistake that people make in the literature and in practice is they think that because we can't do everything, 22:00 Xavier Symonswe can't do anything. 22:02 Xavier SymonsAnd I think that's conceptual error, that it's. 22:05 Xavier SymonsIt doesn't have to be the case that the doctor is providing spiritual care to a patient in the way that a chaplain would for a doctor to be able to say some words that help them existentially at a tough time, that there is some work to be done in clinical practice which cuts into these other domains of flourishing. 22:27 Xavier SymonsEven if, in the last analysis, it's going to take other professionals from other professions to come in and do, I think, a more holistic job of providing support in relationships or spiritually or financially material stability. 22:42 Xavier SymonsThese considerations shouldn't drop out of the picture in medicine. And so maybe that relates to some of these other considerations you mentioned, John, of virtue, 22:51 Xavier Symonsfor example, and its role in medicine and the role of the cardinal virtues. Because I think if you're going to try to help a patient to grow, 23:00 Xavier Symonsnot just to recover health, but also to grow like in character and spiritually and so forth in their lives, 23:08 Xavier SymonsI think that you yourself need to have good moral character, at least a minimum level of good moral character. It's very hard to give what you don't have. And I think that when it comes to providing these kind of broader forms of social, 23:24 Xavier Symonsemotional, 23:25 Xavier Symonsspiritual, existential character, 23:28 Xavier Symonsforms of support, 23:29 Xavier SymonsI think that we have to have a minimum of moral character ourselves and spiritual depth. And so maybe that's, that's, that's another reason, yet another reason why to be a good doctor you can't neglect these other domains of flourishing. 23:44 Michael EganGreat. Thank you so much, Xavier. Those were some very excellent points and very eye opening in terms of what doctors can really do for patients, what their role is, 23:54 Michael Eganand a little bit about that intermixing of all the aspects of flourishing that doctors can touch on. 24:00 Michael EganSo I wanted to shift a little bit. We have been talking a lot about how flourishing is very important for doctors, 24:07 Michael Egannot only in their helping patients, but also in their own lives and flourishing, especially through medical school and training, where they're working long hours, studying long hours, 24:18 Michael Eganvery grueling stuff. 24:20 Michael EganAnd a lot of people have been prone to burnout or experienced burnout in the past. 24:25 Michael EganAnd so in light of this and the importance of flourishing that we have just been talking about, 24:31 Michael Eganwhat is stopping me? I'm applying to medical school right now. 24:35 Michael EganWhat's stopping me from saying, okay, I get into medical school, 24:39 Michael Eganthe next four to eight years through medical school and residency are just going to be pretty grueling. And I'm just going to accept that I might not be the happiest over the next eight years, but I'll be working hard, maybe growing in virtue, 24:51 Michael Egantry to keep my health up as much as possible, 24:54 Michael Eganand then I can flourish when I'm attending at 30 or so. 24:58 Michael EganThat seems like a very real, maybe not realistic, but maybe a common attitude for a lot of medical students who just want to put their heads down and say, okay, my 20s might suck, but my 30s and 40s and 50s are going to Be great. 25:13 Michael EganSo why flourishing? Essentially? 25:17 Xavier SymonsGreat. 25:17 John RheeYeah. Thanks, Michael. I guess I could start with this one. 25:20 John RheeI have two thoughts related to that and hoping that Xavier will also respond to some of these things. But my first is that it's something that I talk to medical trainees a lot about, which is in the context of suffering, a suffering patient, 25:35 John Rheeespecially as a hospice and palliative care trained physician, 25:39 John Rheethere is an opportunity there as well. Now, that might sound a little bit hard to hear, 25:45 John Rheebut I think that all of us have experienced it to varying degrees. 25:50 John RheeWhere, when we are in the middle of a challenge, or where we're in the middle of something that is particularly difficult, 25:57 John Rheeit can be a moment in which we give up on life or on that particular thing, or it can be a moment of really intense growth for us. 26:07 John RheeAnd I see this repeatedly, both in medical trainees and also in patients that in these very difficult, serious illnesses, 26:17 John Rheethat patients who are able to see the small aspects of their illness that also help them grow, 26:25 John Rheeperhaps grow in relationships. A lot of these aspects of flourishing that a lot of patients tell me that this illness actually has brought their family closer together, 26:35 John Rheethat they've mended relationships with a sibling who they haven't spoken to in a while, that there is a sense in which they go deeper into the core foundational things that are most important in their lives. 26:47 John RheeAnd I liken that to medical training as well. 26:50 John RheeWhere sometimes I find that medical trainees can approach training as this idea of, okay, this is a period of suffering for me. This is a period where I just want to put my head down and just get through it. 27:03 John RheeAnd I think that that misses a huge opportunity where this could actually be a time of great growth, 27:11 John Rheeespecially in virtue. Because in what other circumstance are you perhaps being pushed to your limit of compassion? Because you saw 15 patients that day, and your last patient has newly diagnosed metastatic cancer, 27:26 John Rheeyou still have to be extremely compassionate and attentive to that patient. 27:31 John RheeThat helps you grow at the edges of your ability to really love that patient. Right. And be there completely for that patient, 27:39 John Rheedespite the exhaustion. 27:41 John RheeAnd there is a deep growth to that that I think leads to a profound human flourishing if that opportunity is taken advantage of and if framed and reframed in that way. 27:54 John RheeAnd so in some ways, medical training actually is perhaps one of the best places where one can grow and flourish because one is challenged so deeply in all aspects, both physically, 28:09 John Rheementally, 28:10 John Rheeand then I would also say existentially and spiritually, because when we see people dying, when we see patients dying, when we see a Lot of suffering. It brings up in us a lot of questions of why and the meaning and the purpose in which we are doing things. 28:25 John RheeAnd then the second thing that I would say goes back to something that Xavier was talking about earlier, 28:31 John Rheewhich is what I call a continuity, perhaps, or a unity of the way that one is living. 28:39 John RheeBecause it is true that doctors are not relationship counselors. It's true that we are not experts in aspects of flourishing. 28:47 John RheeAnd yet, if we grow in this virtue and we live that well outside and inside the hospital, that there is a continuity of this sense in which we are striving for this desire to give of ourselves not just to patients, but when we're home with our families, with our friendships, 29:04 John Rheethe spirit of service, 29:05 John Rheethat when we are with patients, then we can approach that from a standpoint of, 29:11 John Rheeyeah, this idea of, 29:13 John RheeI may not be an expert on your particular challenges with relationships, 29:18 John Rheeand at the same time, I could reach into my humanity and be another person here with you. 29:25 John RheeAnd it's not just that I happen to be another human being here with you, but rather, 29:31 John RheeI am here as a doctor, and it is my profession as a medical doctor that has allowed us to have this conversation where you are being vulnerable, 29:40 John Rheeand you are allowing me to enter into this space with you of vulnerability. 29:46 John RheeAnd that is a very privileged space. And not a lot of people have the privilege of being there. 29:52 Michael EganRight. 29:52 John RheeAnd so just by the fact of being there as a doctor, you are able to then truly connect with that patient in a moment of deep suffering and also reach deeply into my own humanity and accompany that patient in that moment of suffering. 30:10 John RheeAnd I think there's this beauty to this idea of suffering where just sharing your suffering somehow alleviates that burden. 30:19 John RheeThe patient who just even talks about the suffering, 30:23 John Rheeactually there is some load that's lifted off. There's a sense in friendship, too, right. In all relationships where if you share something with a loved one that's been ailing you, 30:33 John Rheejust the conversation itself seems to lift that burden off your shoulders, at least somewhat. 30:39 John RheeAnd I think in that sense, being another person to that person is also critical and in some sense is not what we're trained to do and at the same time is part of what we do because of the fact that patients come to us in the place and state in which they are at. 30:57 Xavier SymonsI think those are all excellent points from John. And I would add that we can fall into the fallacy of thinking all of these considerations, all of these judgments that we need to make about how to act in particular situations in Medicine that they're sort of either or situations. 31:14 Xavier SymonsBut really I think there's a lot of both. And in this case, 31:17 Xavier SymonsI think the mistake that's being made is there's a view that to prioritize, 31:24 Xavier Symonssay, 31:25 Xavier Symonstechnical excellence in medicine, like doing my job well or even just like in the case of studying for the exams, like getting through the exams, that that somehow has to be to the exclusion of growth in virtue or cultivating important close social relationships. 31:42 Xavier SymonsBut that's just not the case. And I think like John provided some really nice examples of that, like how in fact, I mean, by studying well, you're cultivating virtue, that these, these are not, as I mentioned, they're not just kind of goods sitting on a horizontal plane such that you can't pursue one while pursuing others as well. 32:01 Xavier SymonsRather, I think they're kind of integrated into a whole. 32:05 Xavier SymonsThey're overlapping and co extensive in some cases. 32:08 Xavier SymonsAnd as a result, I think you can become a good person by being a good student, by being a good doctor. And that doesn't have to be a trade off that you make. 32:18 Xavier SymonsI mean, it is your question though, Michael is a good one, which is that, 32:23 Xavier Symonsfor example, 32:25 Xavier Symonscan we give greater focus to certain goods, to the pursuit of certain goods at certain points in our lives while not violating or directly contravening other goods? And I think that's true and that's a prudential judgment that you have to make. 32:39 Xavier SymonsSo by studying hard for your exams, it's not like you're saying, I'm never going to have meaningful relationships, 32:47 Xavier SymonsI'm never going to get married, say, 32:49 Xavier Symonsbut it might just be like I'll kind of consider relationships with greater intentionality once I get through the exam. And in that way you're not, 33:00 Xavier Symonsyou're not saying that those goods don't matter, that they're not important. You're not somehow like undermining, doing something that directly contravenes those other things, but you are making a prudential judgment to prioritise in this case, getting through the exams, the good of knowledge, education and establishing oneself as a professional for this period of your life. 33:20 Xavier SymonsSo I think as well though, 33:23 Xavier Symonswe can maybe dwell a little bit more on this topic of just being with your patients and being present to your patients. I thought that was a really nice reflection from John. 33:33 Xavier SymonsAnd I mean, this is another case where maybe we can fall into this fallacy of mutual exclusivity where we think, okay, you either provide adequate healthcare for your patients by seeing as many as possible and just trying to kind of churn through a caseload, 33:53 Xavier Symonsor you spend time with patients, being with them and accompanying them in their suffering. 34:00 Xavier SymonsAnd maybe there can be a mistake where we think of something like presence as a finite resource. 34:08 Xavier SymonsAnd I don't necessarily think, like, being present with patients is like that. 34:12 Xavier SymonsTo just simply listen to a patient, at least for a little while, 34:17 Xavier Symonsmay not necessarily have a huge impact on your day. But when you discern that a patient is really suffering and that listening is the most valuable thing that you can offer them at this particular point in time, 34:29 Xavier Symonsit may be worthwhile doing that, taking a little bit of extra time to. 34:34 Xavier SymonsTo listen to the patient. I recently read Ross Douthat's The Deep Places of Journey of Illness and Discovery, which is a book about his experience with Lyme disease and kind of various other health complications following that. 34:49 Xavier SymonsAnd it seems just sort of looking at the book as a whole. But perhaps the most frustrating thing about illness for Ross Douthat was the fact that he wasn't understood. 34:59 Xavier SymonsHe didn't felt feel, he didn't feel understood by others, 35:04 Xavier Symonsparticularly because he had an illness, which is kind of hotly debated in the literature. 35:09 Xavier SymonsAnd I think that's a good example of where perhaps the best thing for someone like Ross in that case would have just been for someone to sit with him and listen and try to understand what he's going through and suspending, in a way, 35:23 Xavier Symonsthe kind of clinical judgment that you might actually otherwise have. 35:28 Michael EganThank you both very much. That sound. Those are both very good points and a lot of helpful advice. 35:33 Michael EganIt sounds like even though it is a very hard time, it's both an opportunity to grow. 35:38 Michael EganAnd also flourishing itself allows you to serve your patients better, 35:43 Michael Eganwhich, again, helps you grow. It seems like kind of a positive feedback loop. 35:48 Michael EganAll right, so with this idea of how important it is to flourish in medical school, 35:53 Michael Eganboth for our patients and ourselves, 35:55 Michael Eganwhat are some practical tips that we can use to help ourselves flourish in medical school and training in our later careers as physicians and just as humans in general? 36:06 Xavier SymonsThanks very much, Michael. 36:08 Xavier SymonsI think in terms of practical tips to flourish, 36:11 Xavier Symonsthere's a few parts to my answer that I would like to cycle through. And I mean, the first thing I would say is that, 36:21 Xavier Symonsin fact, there's. There's a lot that we can do individually to help ourselves to flourish notwithstanding challenging circumstances. 36:30 Xavier SymonsAnd I know that Professor Tyler VanderWeele at Harvard has published a paper reviewing a whole series of positive psychology interventions and also relationship interventions, 36:43 Xavier Symonsinterventions to grow in meaning and purpose, 36:46 Xavier Symonsthat are a nice outline of Little steps that we can take to try to improve our own flourishing, to increase our own flourishing. And these are things like gratitude, kindness, forgiveness, interventions, interventions related to improving close social relationships, exercises in meeting purpose, imagining your best possible self, 37:09 Xavier Symonsand so on. And I think those little steps are very practical measures we can take to help ourselves, particularly if we're going through a difficult period, say like preparing for a challenging exam, 37:24 Xavier Symonsor we've got a complex work environment at a particular point in time. Sometimes like going back to these methods of trying to improve our own mindset with regard to our circumstances can be very helpful. 37:38 Xavier SymonsAnd then also this idea that flourishing need not be seen as are incompatible with challenges, and in fact actually challenges help us to thrive is a core observation here. And I think that maybe if we're going to offer a takeaway to our audience, 37:54 Xavier Symonsthat's it, that when you face challenges in your life, this in fact is one of the greatest opportunities you're going to get to grow to become more human. 38:05 Xavier SymonsAnd maybe something that hasn't come up yet in the conversation, but is a good point to bear in mind is that being vulnerable and being dependent to greater or lesser degrees at different points in our life, 38:18 Xavier Symonsthat's part of being human. And that's an important complement to the cultivation of the capacities of emotion, 38:29 Xavier Symonsfortitude and courage, will, intellect and so forth that we've talked about already. 38:34 Xavier SymonsThat in addition to trying to cultivate human excellences, 38:39 Xavier Symonswe need to be good at acknowledging our limits. And in fact, as Martha Nussbaum says, 38:43 Xavier Symonshuman limits structure human excellences. 38:47 Xavier SymonsThat by learning what our limits are and accepting those, and I think graciously and joyfully embracing those as part of what it means to be human, we in fact can become better people, better professionals ourselves. 39:03 Xavier SymonsAnd in fact, it can sometimes be the case that a doctor who has, has been through a lot emotionally, 39:10 Xavier Symonsjust in terms of their own kind of psychological well being, that can actually prepare them very well to help patients who are having similar problems. So those are a few takeaways. 39:20 Xavier SymonsAnd the main thing I would, I would finish with is that we want all the participants of the Hippocratic Forum to avoid the kind sort of damaging reductionisms that I think you see in medicine today and that you encounter in all aspects of the health system and also medical training. 39:39 Xavier SymonsTemptations to view the human person in a reductive way, just as a sort of an organism or a sort of specimen for examination, 39:49 Xavier Symonstemptations to reduce medical practice and excellence in medicine to just technical efficiency, more proficiency, and also kind of maybe economic Efficiency, 40:00 Xavier Symonsand then also reductionisms whereby we maybe try to downplay the moral aspects of medicine. 40:08 Xavier SymonsWe try to deny that, in fact, at the heart of medicine is a human good. 40:12 Xavier SymonsAnd that is what we, I think, are trying to emphasize in this podcast, to focus on flourishing as an end of medicine as the ultimate goal of medical practice and indeed, human life. 40:24 John RheeYeah, that was so well stated, Xavier, that I don't have too much to add. Only to say that following this podcast, we will have sub podcasts related to this larger podcast where we go into each of the aspects of flourishing in greater detail with the purpose of thinking through with all of you what are practical ways to grow in these different aspects of flourishing. 40:48 John RheeAnd so it's a perfect segue to keep you listening. And these sub podcasts within this larger podcast, the purpose of them are for them to be shorter so that one can listen to it and come away with a particular idea or a way to practice during that week or the next two weeks. 41:06 John RheeAnd I would say that for me, 41:08 John Rheeone thing that I did during intern year that perhaps we could just leave you with is this idea that there's deep meaning, especially in the area of relationships, where if we go back to why we came into medicine in the first place, oftentimes it has to do with relationships. 41:23 John RheeAnd so even taking an additional two minutes to ask one's patient about who they are, where they're from, what drives them, what motivates them, 41:31 John Rheecan actually totally change the tenor of the discussion that you're having with the patient who is in front of you, which ties nicely into what Xavier is saying about treating the person in front of us. 41:43 John RheeSo I hope that this podcast also just frames for all of you listening, 41:48 John Rheethat there is more than work, even maybe more than work and family, that there are other aspects of human flourishing. And perhaps one thing as you're continuing this journey in medicine is to think about how I am, or perhaps have been placing on hold other aspects of flourishing, 42:06 John Rheeand perhaps which of those aspects of flourishing I may need to devote a little bit more of myself to in order to then find ultimately, 42:16 John Rheethe hope with flourishing is to actually live both a good life, but also a happy life, a life that is deeply satisfying. 42:24 Michael EganThat's very beautiful, John, and thank you both so much. These are very helpful tips and a fruitful conversation in general that hopefully will help me to flourish. 42:33 Michael EganThank you so much again for being here, 42:35 Michael Eganand we hope to catch you next time on the Hippocratic Society podcast. 42:39 Xavier SymonsThanks very much, Michael. 42:40 John RheeThanks. Thanks so much, Michael. 42:42 John RheeThank you very much for joining and reflecting with us today. 42:45 John RheeKeep up with new episodes by subscribing to the Hippocratic Society Podcast. 42:50 John RheeFor more information on the Hippocratic Society, 42:52 John Rheevisit us at hipsoc.org. The Hippocratic Society is a 501(c)(3) and depends on the generous support of its listeners. 43:00 John RheeAnd as always, we'll see you next time on the Hippocratic Society Podcast.