1 Revisiting an Old and Underappreciated Medicine Richard R Szuster MD Medicine is Forward Looking: Research: 170 billion dollars/yr. 120,000 medical scientists. New understandings, new treatments. But like the Roman god Janus - we want to look both ways.
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1
Revisiting an Old and Underappreciated
Medicine
Richard R Szuster MD
Medicine is Forward Looking:
Research: 170 billion dollars/yr. 120,000 medical scientists.
New understandings, new treatments.
But like the Roman god Janus -we want to look both ways.
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An Old and Under-
appreciated Medicine
Therapeutic Effects
• Blood pressure: Better control.
• Surgery: Less post-operative
meds, better wound healing.
• Trauma: Improved outcomes.
• Terminal Illness: Longer survival.
• Back Pain: Reduced pain intensity.
• Migraine: Reduced Frequency.
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Therapeutic Effects
• Irritable Bowel Syndrome: Reducedsymptoms.
• Diabetes: Better glucose control,less metabolic complications.
• Common Cold: Shorter duration,more robust immune response.
• Depression/anxiety: Improvedoutcomes.
• Response to antidepressants:Improved.
Compassion
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The patient, though conscious that their condition is perilous, may recover their health simply through their contentment with the goodness of the physician.”
Hippocrates, 400 BCE
“In God we trust; all others must bring data”
W. Edwards Deming
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Compassion is an integral part of medical care
The physician’s presence matters
Compassion
I Am (2011) – Tom Shadyac
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Compassion Satisfaction:
Uplifted feeling when we are compassionately engaged with
helping others.
Brain: Increased ventral striatum and septal area activity - reduced
amygdala activity.
Net result: Less stress, better health and more satisfaction.
Burnout
Demands Resources
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Burnout
Emotional Exhaustion
Depersonalization
Low Satisfaction
The Medical Journey
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Undergrad
Better than average physical and mental
health
Burnout
Med School: 40 %
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Burnout
Residency: 60 %
BurnoutPractice: 50 %
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Burnout Compassion
Sorrowing Old Man (At Eternity’s Gate)
Vincent Van Gogh
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Coping with
Suffering
Responses to Stress
Overwhelm
Emotional DistressWithdrawal
Depersonalization
Mindful Presence
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Mindful Presence:
“Moment to moment purposeful attentiveness to
one’s mental processes during every day work with the goal
of practicing clarity and compassion”
Mindful Practice
Ronald M Epstein; JAMA1999
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How to develop the capacity for mindful
presence?
Mindful Presence
Settled body
Clear mind
Open heart
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Burnout Compassion
Compassion Burnout
Compassion is not a zero sum game.
It helps both the receiver and the giver.
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Horowitz CR (2003), Ann Int Med
RelationalEcology:
What Sustains Doctors in
Their Careers?
Meaningful connections with their patients.
Making a difference in patients’ lives.
Experiences that underscore the profound nature of life and being
human.
Compassion
Altruism
A Segue
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Danbrun (2017), PeerJ
Self-centeredness:
Fluctuating happiness
Selflessness:Authentic – durable happiness
The Happiest Person in the World
Matthieu Ricard
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An Old and Under-
appreciated Medicine:
• Remember it and administer it liberally
• Do this forever
• Everyone benefits
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