The Mindful Physician: Michael S. Krasner, MD, FACP

Transcript

[0:00] I think some of the messages we’re getting from our leadership, especially with the creation of wellness officers, is that something’s wrong with you.
You need to do something and you need to listen to this prescription for success with Mick Krasner so you can pick up some tips and become more resilient.
Uh-uh, you’re already resilient enough. We work within imperfect systems and structures.

[0:26] Music.

[0:39] Music.

[1:03] Dr. Randy Cook Hello, everyone, and welcome to Prescription for Success.
I am Dr. Randy Cook, your host for the podcast, which is a production of MD Coaches, providing leadership and executive coaching for physicians by physicians.
Overcome burnout, transition your career, develop as a leader, or whatever your goal might be, visit MD Coaches on the web at MyMDCoaches.com because you’re not in this alone.
And don’t forget that CME credit is available when you listen with us.
Look for CMFI in the show notes to learn how.

[1:42] My guest today is an internist who has been teaching mindfulness-based programs to patients, medical students, and healthcare professionals at the University of Rochester School of Medicine and Dentistry for more than 23 years. He is a highly respected advocate for physician well-being.

[2:01] So let’s hear my conversation with Dr. Michael Krasner. I’m really looking forward to my conversation today with Dr. Michael Krasner, who prefers to be called Mick, I believe. And I want to make sure if I’m right about that, is it okay if I call you Mick, Dr. Krasner? Yes, it’s perfectly fine if I can call you Randy.
Absolutely. That’s the idea. Welcome to the show. Heard a lot about you and I’m really looking looking forward to our conversation. You’re coming to us from up in Rochester, New York, or at least I assume you’re in Rochester. Are you there today?
I am in Rochester today, yes. It’s a beautiful part of the territory up there. My wife and I took a trip to upstate New York because I wanted to visit the Cornell Lab of Ornithology, which we did back in October, and a really wonderful trip. But that’s not what we’re here to talk about. So, let’s go ahead and do what we always do, Mick. We want to explore the entire trajectory of your career from beginning to end. So, let’s talk about your roots. You grew up in California, is that right?

[3:13] Yes, grew up in a fairly large family, six children in Southern California. My parents, supportive parents who had trouble having children originally. So they actually went to the Masters and Johnson Clinic and they were living in the Midwest and tried to figure out how to have children. They wound up adopting my oldest brother and then they had four sons after that biologically.
That’s interesting. I was the fourth one and then they wanted to have a girl so they adopted my sister. So there’s six six of us, the bookends are adopted.
And it was a really chaotic, lovely, exciting, and uncertain kind of upbringing.
Yeah, yeah, that’s really interesting.
But let’s get back to you. We always like to begin at the beginning on this show and I’d like to know where your early interest in medicine came from.
Were there medical types in the family? Was it something else entirely? What’s the story?
Well, there weren’t any physicians or even nurses in our family.
And, you know, at a young age, I knew I had some kind of interest in this.
I remember very vividly as a four or five or six year old.

[4:34] Or maybe over those expansive years, going to the pediatrician and being in the office.
I remembered in the way that we remember things embedded deep in our brains, like from a physical sensory experience that was very positive.
I remember the pediatrician’s cool, but soft hands palpating my abdomen.
I remember just being astounded by the sense of quiet kindness that I saw from this pediatrician and also a sense of something full of knowledge and wisdom within that demeanor. And there was something that I was very, very, very drawn to that. And something around that time happened.
And I received a monetary gift from a relative, $10 maybe it was at the time, for a birthday or some family event.
My mother and I went to the department store and there was a table of books.

[5:42] For about half an hour, I was trying to figure out, am I going to purchase three or four Dr. Seuss books, which I loved.
I was like, wow, I could, with that $10, I could buy four of those books. Or there was another book called The Human Body, and it was beautifully illustrated and had chapters on the organ systems and this and that. But it was really designed for a young person, probably not a five or six or seven year old, maybe a 10 year old. But it was kind of beyond my comprehension to read the text in it.
But I was really drawn and I turned to my mom and said, I don’t know what to do.
I loved Dr. Sue so much fun reading those, but I don’t know.
I really like this human body book. There’s something about it.
And she said, I think you should get the human body book. And so that- Good for your mom.

[6:35] That was really, really an interesting experience. And I, um, I then actually focused my education, uh, high school and early college on liberal arts, mostly languages and anthropology and history.
And then there’s some other elements that led me to medicine.
So when you started undergrad at UC Berkeley, you hadn’t made your mind up at that point that it was gonna be medical school, is that right?
Oh, that is correct. Yeah, my first year I had no science classes whatsoever.
I took, of all things, I took a year of Swedish for no good reason other than I wanted to do a language I studied.
I was a little puzzled by that. When I looked at your CV, you have a Bachelor of Arts, not a BS, although you do have a biochemistry major.
Yes. And I apologize for the interruption. Go ahead and tell us. that.

[7:34] Took history, English, literature, which I really loved, and writing, which I found full of toil, but I found competency and I really enjoyed expressing myself through writing, although it was a lot of work and I knew that, and anthropology. And then I don’t know what happened, but I decided to just try out some biological sciences in my second year. Actually, not even biological sciences, the chemistry. And I just got very, very interested and I remembered back, I distinctly remember thinking about those early days and early years of being interested in the human body. And then there was some family events, one, my brother next oldest to me, so sibling, the number four, if we were in order very frequently, my mother could, would get our names so confused that she would just call us by our number, number five child.
Really? Yeah. So, and even that is like number five, number three.
She’d call it Bruce Glenn Scott, Mick. Oh yeah, Mick.

[8:44] But he had a neurodegenerative disease, eventually died of it, but lived well into his 40s.
And at the time, early on, developmentally, we were matched, but fairly quickly I surpassed him.
He wound up going to high school and finishing a few years of college.
And there was something about my relationship.
We were the closest in age. There was 14 months that separated Steve and myself.
And I just realized there was something about serving in that way, in a direct way, and the biological sciences and my fascination with the human body, along with my fascination with Dr. Seuss and the written word that had me just try it out as a sophomore at Berkeley.
And then I just pursued, continued to pursue that and went into medicine.

[9:39] Well, and you were clearly a good student. It sounds like you’re one of those that could get interested in just about any subject that was put in front of you.
You made a successful application to medical school at UC San Diego.
And I wonder when you got there, what were those early years like?
Did it feel like you had landed in the right place or did it take some time for that to develop?
What was your frame of mind? Well, Randy, that’s a great question. Medical school was enjoyable, although.

[10:16] When I got into the third year, I mean, I think I did very well in the first two years.

[10:21] Enjoying all the classes. The school UC San Diego was a fairly new medical school. I think, maybe we were the 20th class that had graduated. And at the time, I think it really was, set on making a mark in medical education and in medical bioscience. And so very heavily research oriented. I had a wonderful couple of first two years experience over at the Salk Institute working, in some basic science research. But when I got into my third year, I was somewhat ill prepared for, my encounters with suffering. You know, nowadays, I am being in medical education myself now.

[11:06] The students are becoming involved and engaged with real patients and real illness, much, much earlier. Much earlier, that’s right. Yeah, but even though I had it in my family, and the other interesting thing is that, you know, I think if we scratch the surface of many of our colleagues, we’ll find that there is elements of, you know, something that closely touched them in their own personal lives relative to their choices to go into medicine. But I struggled. I was in my third year of internal medicine clerkship at the VA hospital, and around that time, an incredible article came out by Eric Kassell called The Nature of Suffering and the Goals of Medicine.
He wound up writing a book by that. And at that time, I was actually doubting if I want to have a clinical career, if I finished medical school, but wasn’t sure what, because it was really tough to see the suffering and then.
What one of my residents gave me who was on the team when I was a student was that article and said, I think you should read this.
I think I shared with her what was going on with me. It really had a very profound impact on how I framed my role as a nascent, forming health.

[12:27] Professional physician and how I was to understand suffering.
One of the things that I’ll never forget about that article is that you really can’t understand the nature of someone’s suffering without being engaged in an inquiry process, without asking.
Because their suffering may not be their physical pain. It may be the fact that they’re worried that what’s their family going to do?
It may be financial. It may be existential. It may be so many different domains that really has them concerned.
You really can’t address that unless you really know. And so then I became really fascinated and also committed to the relationship centered part of my education, how I will connect with patients and how I will be as a physician.
And I think that informed my choices, my career choices from that point on.

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[14:46] Hi, I’m Rhonda Crowe, founder and CEO for MD Coaches. Here on Rx for Success, we interview a lot of great medical professionals on how they grew their careers, how they overcame challenges, and how they handle day-to-day work.
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[15:48] Dr. Reagan We’ll get back to our interview in just a moment but right now I want to tell you a little bit about Physician Outlook.
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[16:55] That’s a very insightful frame of mind for somebody in the midst of all the pressures that medical school brings.
And it made me think of something, an experience of my own. I don’t want to personalize this thing for me.
I want to get your feelings on this.
In my first junior clerkship, for a lot of unimportant reasons, I found myself in a family practice rotation.
The leader of this family practice program, family practice clerkship was Dr. Gail Stevens, who you probably are aware is a big name in family practice, wrote a textbook.
And one of the things that he said to us early on that really caught my attention was, it’s very important for you to understand that the patients that come to you have chosen to be sick.
And I thought, well, now this is a lot of nonsense. But he went on to talk about the fact that you don’t step away from your comfortable life just because you got a hangnail.
You do it because you’re having difficulty coping with something and it’s not always the disease process. Had a profound impact on me and I’d like to get your reaction to that.
I think what I hear from that statement from…

[18:20] The very skilled and wise physician was that the patient has to begin to come to terms with, the fact that something’s not right in order to then become a patient and seek that care.

[18:35] So it’s a recognition. And frankly, many of us, including myself at times, live in denial of things that are actually right in front of our faces that exist. So it’s a really challenging, you know, people joke about, you know, physicians being terrible patients because maybe partly, because we have even more difficulty accepting the fact that we may need help in this or that domain, whatever that domain is, whether it’s hypertension, high cholesterol, a hangnail, an ache in our back.

[19:08] Numbness in our foot, or emotional distress, and depressed mood, whatever it may be.

[19:15] So what I take from that is that you have to choose. It’s like, I like to think of it as acceptance.
And I use that word very carefully defined as followed, not resignation.
Acceptance is not about resignation.
This is the way things are. And I’m screwed. There’s nothing more I can do.
My life is, and then fill in the blanks.
But acceptance is, this is the way things are right now. It’s an honest assessment.
And it’s the starting point for change. It’s saying, this is the way things are, this is how I see things, and now what do I need to do? How am I going to work through this? How am I going to negotiate the future of this thing that’s going on right now? And from that acceptance, you can decide, well, I need help. I need some support. I need to go see my physician. I need to talk to a counselor, whatever it may be. I think what I get from that statement is a degree of acceptance, not resignation, and recognizing that when you walk into the room to see a patient for whatever they’re coming for they have at least begun to come to terms with that acceptance. Mm-hmm.
So let’s use that to get back to your experience in medical school.
I gather at that point, you had at least some kind of a shift in attitude that sort of informed.

[20:41] The rest of the way through medical school for you, at least in terms of how you lived the experience.
Can you talk about that at all?
I just became more engaged and interested in patient stories, in who they were, in the kind of bigger picture of their lives.

[21:01] And I’ll tell you, I loved many from that point on of my clinical rotations.
I was sent to the Naval Hospital at Balboa Park in San Diego for my surgical rotations.
Oh my gosh, it was incredible. At that point, I said, absolutely, I’m going into surgery.
There’s no question about that.
It was such a positive experience. And then, you know, the same thing.
Not many people feel that way, you know that, don’t you? Oh yeah, but it was like incredible.
And there was something about the no-nonsense, but deep, deep committed to the patient care that I saw among the surgical attendings and the other people I saw there.
And there was a mission too around being in the military and serving the country.
So that was really kind of inspiring. And likewise, as I took some advanced clerkships in the following year in primary care and internal medicine and intensive care and pediatrics, I realized that this part of me that wanted to be relationship-centered for me could best be manifest through broad training in medicine and pediatrics or family medicine.
And surgery, it’s.
There’s no question in my mind, and I know many of surgeons who’ve attended our training programs that we hopefully will get to later in our conversation are able to do the same thing.

[22:29] Express their healership, which is driven by this intellectual curiosity and their sense, of relationship and how to serve and how to give their gifts in surgery. For me, it became clearer that I could best do that in medicine.
I like to joke that I, at that point, then made the biggest non-decision of my life, which is instead of choosing family medicine or internal medicine or pediatrics, I just figured I don’t have to, I can delay that decision.
I’ll just do both internal medicine and pediatrics. So I did this MedPeds program, which now is much more popular. At the time, there were very few established programs in the country.
So, very smart decision at that point in your career development when I look back on my own education and I understand the kind of pressures there are to make decisions when you’re kind of not really ready.
But one big decision that you made was to leave sunny California and go to Rochester, New York, which sounds a little unseemly. Could you talk about that a little bit for us?
Yes, well, it really was driven by this, the MedPeds aspect.
There were a few programs that were in existence and had some track record.
One was at the University of Rochester.
One was at Chapel Hill University, North Carolina. And then there were a lot of.

[23:58] Kind of a few up and coming programs. I probably interviewed at about half a dozen.
The other ones were more like, we will create a program for you.
You wanna do both, we’ll make it happen.
It wasn’t as if it was established and actually a bona fide, kind of thought out integrated.

[24:15] Program. So a few out in California. And I wasn’t so averse to a change of scenery coming northeast in it and I was a little bit wondering about being in a small city versus moving to New York or Philadelphia or Boston or DC would be one thing because I had lived in a suburban but close to a very large, very large urban area and there was comfort in that. But being in a smaller city was a little bit different. I’ll never forget one of my childhood friends was visiting before I moved to Rochester having matched here and he was a businessman and he said something like, oh yes.

[25:03] In typical Southern California fashion, he said the following, oh yes, I’ve been to Rochester, you know, they have pretty nice weather there if you happen to be there on the day they have summer.
That’s a good one. So, but actually never having had winter or seasons much for that matter growing up in, you know, coastal Southern California, I just, you know, the weather was not the problem.
I actually loved it. I loved the change, all the challenges. I loved the grittiness of having to, you know, kind of do it and get into it and face the weather. And then now I embrace it, you know, now I like to ski, I like to hike, I like to be outside in it. So I don’t see myself moving.

[25:50] Obviously I haven’t moved back since, so I don’t see myself moving back and establish my family life here. I had a partner when I was practicing in South Florida whose favorite expression was ho hum, another perfect day. Right. You don’t have to worry about that in Rochester, I suppose.
So, well, let’s get back to your training. You did what is kind of rare nowadays, it sounds like a rotating internship and that led you to…
Eventual board certification both in internal medicine and emergency medicine or you tell the story.
I’m a little confused on that. Yes, so this program was medicine and pediatrics. So I became board certified in both internal medicine and pediatrics. You’ve read carefully my CV because.

[26:40] At the time that I finished residency and became certified, I was really thinking, you know, where am I going to practice? And I actually, at that time, did move back to initially Northern California. Had just been married and wound up working in emergency medicine just kind of as a.

[26:59] Placeholder. I had done some moonlighting and we had a fair amount of critical care training, a lot of critical care training and emergency training in those residencies. And at the time, Also in the late, in the early 90s, it was possible to be working in emergency departments without emergency medicine, direct training, which I would be, it would be impossible now.
So it’s such a field that’s just incredible now. And so became pregnant with our first and her family is from the Rochester area. So we actually wound up coming back Northeast initially to an area in way upstate New York near the Canadian border on Lake Champlain right across from Burlington, Vermont, a place called Plattsburgh, New York, where I really got in over my head in emergency medicine.
It was a level two trauma center. Staffing was tough.
I was working oftentimes overnight by myself with a lot of vehicular trauma from the Route 87, which goes from New York City up to Canada.

[28:10] And very, learned a huge amount and picked up a huge amount of skills, which now by, you know, nowadays in emergency medicine residency train would already have those skills by the time they did what I was doing.
And then made our way after a few years back to Rochester, New York with our second child and found a practice eventually after a few more years.
I was never thinking emergency medicine was going to be a career path, but I did it for five years and then went in and then had to decide.

[28:42] How to combine both internal medicine, pediatrics, or just do one. And by that time, after having a couple of children at home and dealing with like their illnesses and etc. Being a father.
I decided I think I’m just going to focus on adult medicine.
And it was a good choice for me.
Joined a practice that within a very short period of time became folded into the University of Rochester faculty practice.
And then the next phase of the story you may ask me about happened after a few years of primary care internal medicine practice, which by the way has been a phenomenal experience.
I bet it has. And I really appreciate you filling in some substantial blanks there.
I wouldn’t have guessed any of that from going over your CV, but I was very interested in how you made that circle back to an academic appointment.
But I gather that it was in that setting that you must have had an opportunity to look around and take stock of how things are being done.
I’m guessing, I want you to correct me if I’m wrong on this.

[29:55] You probably had a feeling all along that there are some things that we are overlooking in the way that we deal with patients, and perhaps more importantly, in the way that we deal with ourselves as physicians.
So am I in the right territory?
You are completely in the right territory.
It’s a thank you, it’s a nice setup, so I appreciate that. You sort of tee it up for me. So yes, as I got into primary care and internal medicine, and I think you’re right, I was aware already that there were some systemic and structural things that made practicing in some ways maybe more challenging than it should be. And people write and talk about and study an issue of moral distress, but we can simply define it is being knowing through our training and skills what the right thing that we need to do is with our work. But because we work within complex, complicated, chaotic and imperfect systems, we find ourselves unable to make that happen. And so I began having these experiences where I knew what was kind of the right and proper thing to do, but there were some barriers and limitations on.

[31:14] How much impact I could have. At the same time, the pace of the work, the beginnings of a lot of challenges, which have now only, as you know, and as all the listeners you all out there know, have only multiplied and become more intense, have really eroded in some ways that quality of our agency as physicians and healers, but also impacting very directly the well-being of our communities and our patients.

[31:48] And we could use words like burnout, but I think they are helpful in the sense.

[31:56] Of describing what was happening for me, a sense of feeling like this is taxing emotionally maybe more than it needs to be. There are times where I’m behaving in ways that I don’t really like the way I’m behaving. I’m finding myself objectifying things around me in times of high stress, so I’m treating people that I work with and even patients at times almost as an object, in a transactional way. And then coming home and feeling like a low sense of accomplishment. So, all these are hallmarks of this burnout phenomena. So, at the same time when this was happening, and this is now a half a dozen, eight, 10 years into that practice, a family event process began to happen. My father became ill. He became ill with pancreatic cancer. And this was kind of in the mid-90s already and into the late 90s. And I had dabbled a little bit in contemplative disciplines and I’d come across a PBS special called Healing and the Mind, and it was a six-part special looking at ways.
That the mind-body connection work and what are ways in which medical science, modern medical science is thinking about how to engage our healing in innate healing capacities.

[33:23] And one of the sessions of this six-part series involved a scientist who has devoted his life, he was a molecular biologist, but devoted his life to developing contemplative sciences that that are now branched into a whole field of contemplative neuroscience.
His name is John Cabot Zinn.
He was at the University of Massachusetts. He started a program called Mindfulness-Based Stress Reduction.
And he had put out a book called Full Catastrophe Living. How do we live with this inevitable full catastrophe of our lives?
And I really connected with the ideas because I was finding it wasn’t like, my life was any more important than anyone else’s, but feeling a little bit of the catastrophe of all this investment and all this drive from that early age as a child, wanting to have that presence that my pediatrician had, and with my fascination with the human body, with all of that going on, that I felt wasn’t quite working out that way.
So I shared that book with my father, and he read it, Full Catastrophe Living, and took up the practices of.
Mindfulness meditation that was taught in the book and then began attending workshops and retreats in his final years of life. He wound up living about three and a half years with the illness.

[34:41] Which I don’t know what to attribute it to, but part of me really feels strongly that the quality of his life was quite high toward the end. So that whole experience at the same time that I was, finding myself beginning to struggle with burnout had me think about, boy, what would it be like for me to kind of really engage in some of that self-awareness, cultivation of self-awareness.

[35:07] That may be a way in which I can find my way back to that energy and vitality that I felt in medical work. It’s very insightful of you and I’m not sure what decade, what era we’re talking about here, but I don’t think there are a lot of people speaking in those terms at about that time.
So this seems to be something that you came to very much on your own or am I missing something?
Yeah, well, I think just being open and seeing that out in the public domain and then.

[35:47] Finding out how I could explore that. And then, yes, I don’t think there were quite a lot of people, but by the late 90s, I found myself attending some training programs for health professionals. And eventually, I steeped myself in the practice of awareness of contemplative practices as a way of kind of personally helping myself. And then I found such great value in it.
I began offering it initially to patients. I learned how to teach this program. And then I began offering it to patients.
Over time, physicians wound up, they weren’t necessarily my patients. People heard about this course I was offering a couple times a year and physicians found their way into it. And then one day, one of them, took me aside and said, you know, this is really transformative. It’s helping me as a leader. I can see how I can use this to.

[36:44] Engage in some change, structural changes that need to happen in medicine. And have you thought about offering this as a physician or health professional only continuing education program? And at that point, I began doing that. And I engaged physicians in this program. And one thing led to another is kind of a long story. But by the middle of the 2000 decade, but 2004, 2005, I was regularly doing that and then found a like-minded colleague here at the University of Rochester and together we applied for a.

[37:23] Grant from what was called the Physicians Foundation. The Physicians Foundation for Health Systems Excellence was created after a very large lawsuit against large national health insurance company, an anti-raconteering lawsuit, and And as a result of the lawsuit, there was a large fund produced that was designed to support efforts to improve the grassroots experience for medical practitioners.
So we were in their second round of funding requests. We applied and were funded to create a novel program that was based on the things I was teaching through mindfulness.
And it includes elements of contemplative practice.
It includes communication skills building and a way of encountering the challenges and pain points in our work using a.

[38:15] Technology, we could call it appreciative inquiry, which is a strength-based approach to change rather than a problem-focused approach. You know, we look at our electronic record and we see a big problem that’s very important, very important to address those problems. But one of the things that we don’t see explicitly is something that we all know implicitly is that we are engaging patients and leveraging their strengths and capacities to do something for themselves in their relationship and advice that we give them. And so, this is an approach that really focuses on inherent strengths that are already present even amidst the most dysfunctional and challenging situations. So, we created this program. We enrolled initially 70 physicians in it. We studied some of the effects of it and we found pretty significant effects over the course of a year of this program, about 50 hours, improvements in burnout and well-being, improvements in patient-centered oriented care, and also improvements in this construct called mindfulness.

[39:25] It’s basically an ability to pay attention, it’s awareness, and that there was a strong correlation between the improvements in well-being, burnout, physical and emotional well-being and patient-centeredness and mindfulness. In other words, to the extent that we can cultivate this ability for awareness, self-awareness, interpersonal awareness, awareness of our environment. We.

[39:48] Can feel better, we can do better, and we can do better work, we can be more patient-centered.
And from that, that was published, our results were published in JAMA, and interestingly enough, we wrote into the report that, you know, the curriculum that we had created is available upon request, and we were inundated not so much with requests for the curriculum, although people did request it, we were inundated with physicians who wanted to experience and attend a program like that.
I can’t say I’m surprised. So yeah, it kind of surprised us, because we weren’t planning on going into the business of workshops.

[40:30] But one thing led to another. And we have created now for the last 12 to 13 years these training programs, multi-level, including teacher training programs, that now probably 2,000 physicians and other health professionals have participated in.
We have an advanced training program where there’s, we probably have about 40 physicians who are, we could call them certified teachers of this.
They could develop new materials and they’re scattered over across the world.
We brought this to African continent, South America, Australia, Europe, and Asia, because you know what, Randy is physicians in particular struggle with these very issues of burnout and how they can reconcile the desire to do what they’re trained to do with the realities of working within these systems. This exists all over the the world. This isn’t just local.
I’m sure. I want to get just a little bit into the weeds here. I think it’s, unquestionably profoundly obvious that if there are two things more diametrically opposed, I can’t imagine anything that illustrates that better than the notion of putting, appreciative inquiry side by side with an electronic medical record.

[41:51] And I’m sure that that’s at least a chapter, if not an entire multi-volume encyclopedia of things that need to be learned about that.
But I am interested if you can, to give us your ideas as succinctly as you can about how you can begin to help people undo that dreadful situation that we have found ourselves stuck in.
Yes, yeah, thank you.
Well, there’s several ways to answer that question. And one has to do with listening deeply to what are the real challenges, what are the pain points that we experience as health professionals and what are the ways in which we actually feel reinforced.

[42:40] To want to be a physician, want to be a health profession.
You know, people talk about the stress response and they talk about fight, flight, freeze.
There’s also a fourth dimension to the stress physiology, which is built in evolutionarily reinforced, which is connection, which is some people call it tend and befriend.
It’s been studied, it may be a more gendered, nuanced approach, at least in some of the studies that have been done.

[43:10] But we all need community, we all need connection, we all are supported by that.
So just the fact of getting people together, colleagues together, having relationships that are unencumbered by some of the pressures that we feel day to day, that alone is huge.
So many of our workplace experiences are impoverished with that sense of community.
Many, many institutions, hospitals and so on, have done away with the physician lounge for whatever reasons, which was a place of maybe even a moment of a cup of tea or coffee and talking about the soccer game that your children are in as you pass your colleague surgeon in the morning, in your morning rounds or whatnot.
So what we’ve done in this program is we’ve looked at what are some of these pain points.
So we look at things like errors, conflict.

[44:12] Teamwork, our relationship to suffering, the grief we experience.
And we also look at some broader based themes about how we pay attention, noticing, how.

[44:26] To engage in dialogues that we can bring awareness to.
And we’ve focused on, in each of those domains, trying to identify things that actually are already working.
So let me give you an example. We have a module. We teach in a modular form, often a couple-hour module that we work with folks where there’s contemplative elements, there’s some didactic elements, and there’s interpersonal dialogue elements.
So let’s say we’re working in errors.
Errors is really a difficult thing for us to talk about, but it is a reality.
I mean, it happens. We know that.
We know it very well. We’ve all been engaged in errors, whether personally errors of ourselves, most errors of course are multifactorial and due to systemic and structural issues, not necessarily from individual deficiencies.
But when we begin to talk about errors with each other, we frame our dialogues in such a way that we become curious talking with a colleague about an error they were involved in, and what are the strengths and capacities they had to help them get through it?
What did they, what did they draw upon to work through that error or.

[45:43] Or the error that they’re working through, what are they able to turn toward as a mode of support and strength? Number one. Number two, not everyone has that capacity or strength. How did they get that capacity or strength? And then number three is the question of, boy, if you have that strength, you see that showing up in other areas in your life. And you begin to discover things about yourself that normalize some of these difficulties, conflict, errors, encountering, suffering, grief, but also give us a recognition and a reinforcement of the already inherent ability that we have to work through this.
I like to say, I like to make it very clear actually, people that come to our programs and all of the listeners out there that if you’re in medicine, if you’re a health professional, if you’re a physician in particular, listen, you’re already very resilient.
You are not lacking resilience. I think some of the messages we’re getting from our leadership, especially with the creation of wellness officers, is that something’s wrong with you.
You need to do something and you need to go, you need to listen to this prescription for success with Mick Krasner so you can pick up some tips and become more resilient.

[47:00] Uh-uh, you’re already resilient enough. We work within imperfect systems and structures and we need to draw upon the strengths we already have and we need to actually find out where can we be most effective in engaging change so that we seek care that will get the quality of care that we would love others to receive so that our children and our grandchildren will also have a future where they’ll receive the kind of care that we.
Would find optimal. Meg, I had the feeling when I was doing my research on you that this would be a conversation that I could literally carry on for many hours, which is unrealistic on the other hand. I think I might have a place for you as a return guest on this program in the future.
So I hope you’ll keep that in mind. In any case, this has really been a profoundly informative and very gratifying conversation for me and I do so much appreciate you being here. But we’re going to close out this part of the program right now and get into the most important part.
And that is where I give you the opportunity to address our audience all by yourself. So.

[48:18] Audience, here is Dr. Mick Krasner with his personal prescriptions for success.
Thank you, Randy. It’s interesting for me to give you all advice. And so, rather than giving advice, I’d just like to share some things that I’ve found to be true in my life and how they apply.
And maybe you’ll find some resonance in that, maybe not. I’d like to start with actually sharing a brief poem because I think it speaks volumes about the things that I’ve learned.
And it’s called Optimism and it’s written by a poet named Jane Hirschfield and it’s pretty brief.

[48:57] And I’m thinking about when I was in medical school on the Torrey Pines mesa, there’s a pine tree called the Torrey Pine that grows there, its species exists nowhere else because it’s the result of an interaction between its own genetic endowment and its environment. So that’s just a little background, but she writes in this poem, optimism, more and more I have come to admire resilience, not the simple resistance of a pillow whose foam returns over and over to the same shape, but the sinuous tenacity of a tree finding the light newly blocked on one side it turns in another. A blind intelligence, true, but out of such persistence arose turtles, rivers, mitochondria, figs, all this resinous, unretractable earth.” When I think about that, I’m thinking about just the diversity of the natural world and the diversity of the human world that we see that if it wasn’t for being challenged, it would be flat out there. It would It would be like Wonder Bread, you know, like have no flavor, no, it just wouldn’t have the texture that life has.
And so resilience is built into being human and you’re already resilient.
It’s a community activity and it involves growing stronger from challenges.
There’s a writer that I listened to, a read named Anne Lamott, and she says, wherever the great dilemma exists is where the great growth is.

[50:23] And so conflict is inevitable, challenges are inevitable, but it’s in the middle of all the uncertainties and challenges and intimate nature of the work that we are in some ways gifted to do as physicians, that meaning, satisfaction, robustness, and our calling to be healers intersect, collide.
Addressing suffering by turning toward it may actually support us building resilience and well-being. How do we do it?
So this is how I found to do it through cultivating presence, which means deep listening, inquiry, curiosity.
You know, most people’s, I think the writer Stephen Covey wrote this, most people do not listen with the intent to understand.
They listen with the intent to reply. But if we can flip that all around and really listen with the intent to understand, using our capacity for awareness to observe, to be curious, to approach experience with what.

[51:25] We call a beginner’s mind to develop presence.
And that’s kind of what I think worked for me. Finally, I talked about my father, interestingly enough, in this session.
And so I’m just going to share this, this comes up right now, is that my father often, at least in the last few years of his life when we would speak, he would say something, I’ll paraphrase it along the lines of asking me to think about exploring the quote, non-superlative life, the non-superlative life.
And I think he said, you may find that it is actually extraordinary.
And I think what we do in medicine is actually extraordinary and it becomes very ordinary in the mundane day to day.
And this is something that I think my father left me with.
To stay in touch with that extraordinary aspects of just the most ordinary experiences such as.
This moment that you’re listening to this interview. And Randy, I think I’m set.

[52:27] Well, Mick, I’m sort of overwhelmed by that. There’s just so much wisdom packed into those thoughts and I really appreciate you sharing with us. I love the analogy to the Torrey Pine.
I think that really says it all. And again, I can’t tell you how much I appreciate you being with us. Before we go, I want to give you an opportunity to tell our audience where they can find you, books, websites, upcoming appearances, or anything that you’d like to share.
Thank you, Randy. The easiest way to kind of keep track of where I am at right now and our programs is through a website that’s hosted at the University of Rochester, but it’s quite simple.
It’s mindfulpracticeinmedicine.com. So, www.mindfulpracticeinmedicine.com.
Dr. Michael Krasner, thank you so much for being with us on Prescription for Success.
Thank you, Randy.

[53:26] Thank you so much for listening with us today. We hope you’ll help us reach more listeners with your five-star rating and also visit our Patreon page for membership-only material, like personal rapid-fire Q&A sessions with our guests. To be sure you never miss an episode, visit our website at rxforsuccesspodcast.com to subscribe. And while you’re there, check out our companion podcast, Life Changing Moments with Dr. Dale Waxman. Both podcasts make you eligible for CME credit. With CMFI, details are on the website. Special thanks to Ryan Jones who created Dance performs our theme music, also to Craig Claussen of Claussen Solutions Group who edits the show. And remember, be sure to fill your prescription for success with my next episode.

[54:15] Music.