On Becoming a Healer artwork

On Becoming a Healer

49 episodes - English - Latest episode: 10 days ago - ★★★★★ - 26 ratings

Doctors and other health care professionals are too often socialized and pressured to become “efficient task completers” rather than healers, which leads to unengaged and unimaginative medical practice, burnout, and diminished quality of care. It doesn’t have to be that way.

With a range of thoughtful guests, co-hosts Saul Weiner MD and Stefan Kertesz MD MS, interrogate the culture and context in which clinicians are trained and practice for their implications for patient care and clinician well-being. The podcast builds on Dr. Weiner’s 2020 book, On Becoming a Healer: The Journey from Patient Care to Caring about Your Patients (Johns Hopkins University Press).

Medicine Health & Fitness Society & Culture Relationships bias caring engagement boundaryclarity burnout contextualizingcare discrimination empathy learningdisability qualityofcare
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Episodes

What a James Baldwin story can teach doctors and patients about care amidst suffering

March 19, 2024 10:30 - 1 hour - 86 MB

“Sonny’s Blues” is a 1956 story by the author, James Baldwin, about a “sensible” and pragmatic algebra teacher and his younger musically gifted younger brother (“Sonny”), who struggles with heroin addiction. Both of them, raised in Harlem, are deeply affected by anti-Black racism.  Although the older brother, who narrates the story, feels responsible for Sonny, he struggles to relate to him. With the help of an English professor, Laura Greene at Augustana College, we reflect on some of the l...

How confronting racist ideas I didn’t realize I had is shaping me as a physician and a person

February 20, 2024 11:00 - 55 minutes - 76.3 MB

In a 2021 episode that we reran last month, “About me being racist: a conversation that follows an apology,” Saul talked with a former Black colleague after apologizing to her for something racist he had done twenty years earlier that hurt her for a long time.   Since then, Saul has been thinking about how he got exposed to racist ideas and notions of power as a white male growing up in the United States (in his case in a liberal, highly educated community) and suggested that he and Stefan...

How effects of racism were mistaken for “race” in clinical algorithms: What clinicians should know

December 19, 2023 11:30 - 1 hour - 87.9 MB

For years, when physicians order tests to assess lung function, or blood work to determine kidney function, or look up guidelines for managing high blood pressure the results have been adjusted for race. This practice has been based on studies that seemed to indicate that the same result means different things if the patient is Black vs white. So, for instance, an “uncorrected’ creatinine of 1.6 was thought to be less concerning in a Black than white patient as Blacks were thought to have gr...

Drug testing at time of birth: How physicians are co-opted into harming families while thinking they are doing the right thing

November 21, 2023 11:00 - 1 hour - 86.1 MB

The practice of urine drug testing during pregnancy and then often reporting positive results to Child Protective Services triggers a cascade that can result in separation of mother and newborn, with devastating consequence for both. These practices are more common when patients come from marginalized communities even when baseline substance use rates are the same. As our guest -- obstetrician/gynecologist and addiction medicine expert Mishka Terplan MD, MPH -- points out, illicit substances...

Directly and Covertly Observing Care: How it Can Transform Medical Education and Improve Clinical Practice

October 18, 2023 10:00 - 50 minutes - 69.7 MB

Direct, covert observation of health care is a novel and underutilized tool to assess health care trainees and clinicians. In this episode we talk with experts about two such approaches: the unannounced standardized patient and patient-collected audio. In the former, actors are sent incognito into practice settings, and in the latter real patients volunteer to record their visits on behalf of a quality improvement team.  Both approaches address the question, “How are our learners and exper...

"Dire Consequences": When students do not receive appropriate accommodations on the USMLE examinations

September 19, 2023 10:00 - 43 minutes - 59.8 MB

In the prior episode we learned that there is no evidence that time-limited testing improves test validity and that, in fact, there is ample research showing that it makes tests less valid and less equitable. In this episode we discuss how, despite the data, the NBME denies accommodations on the USMLE exams to over half of medical students who have a documented learning disability and are approved for accommodations at their medical school (e.g., extra time). We talk with a leading medical e...

Why it's time to remove time limits on tests, like the USMLE exams

August 22, 2023 10:00 - 39 minutes - 54.2 MB

There is a widely held perception that being able to complete a test quickly is an indication of mastery when compared with those who need more time. As a result, it is often difficult to obtain accommodations on high stakes examinations, including the USMLE exams.  Many students who request extra time because of a disability are denied accommodations and many other students who need it aren't eligible (e.g., English is a second language) or are inhibited from applying (e.g., Veterans, stude...

Running the Gauntlet: My Journey into Medicine with a Learning Disability

July 25, 2023 10:00 - 20 minutes - 28.8 MB

Stefan interviews co-host Saul about his experiences becoming a doctor with a learning disability.  This episode, first run in 2020, sets the stage for two that will follow – in August and September, with experts on the science of student learning assessment and its implications for the USMLE examinations. These will address questions such as: Does struggling with multiple-choice tests under time pressure predict anything about future performance in the clinical setting? Do time limits mak...

Why are doctors turning to ChatGPT for help relating to patients?

June 27, 2023 10:00 - 33 minutes - 46 MB

A recent New York Times article, titled "When Doctors Use a Chatbot to Improve Their Bedside Manner," should raise questions about why physicians are turning to artificial intelligence for help talking with other humans. While GPTChat can generate things to say, what comes out of AI is impersonal, as it knows nothing about the individuality of the doctor asking them, or of their patient, or of the relationship between the two. Much of the joy of being a physician is forming personal, heali...

Prescription Opioid Reductions and Suicide: What Should Caring Physicians Do in the Face of Uncertainty?

May 23, 2023 10:00 - 36 minutes - 50.8 MB

The narrative that getting patients with chronic pain off opioids makes them safer was reinforced by a recent paper that got substantial media attention showing an association with reduced suicide rates at the population level -- But other data, at the patient level, shows an increased rate of suicide.  Which is closer to the truth? And, if there's an answer, how does it apply to the individual patient? Is it ever okay to taper a patient when it’s not a shared decision?  How do you ta...

My patient’s in shackles: Can we take these off?

April 18, 2023 10:00 - 39 minutes - 54.6 MB

We might assume that a patient who is chained to their hospital bed must be restrained for good reason, but our guest challenges that assumption in a published account of a man in shackles who is intubated, sedated, and paralyzed in the ICU.  He and his co-author write that "Over-policing and mass incarceration have led to Black prisoners being disproportionately represented in jails and prisons. Those of us in positions of power may disregard the shackle, or not question its purpose, or eve...

From medical student mistreatment to burnout: How can we change the culture?

March 22, 2023 11:00 - 40 minutes - 32.4 MB

In this second of a two-episode series on medical student mistreatment, we discuss its impact on burnout with a colleague who is working to change the culture of medical education and practice through research and leadership.

Medical Student Mistreatment: A Wicked Problem

February 21, 2023 17:17 - 43 minutes - 34.7 MB

How is it that a healing profession -- medicine -- has such a deeply ingrained culture of harming its own?  And what can we do about it?  In this first of two back-to-back episodes on medical student mistreatment we consider the scope of the problem and attempts to confront it. We hear from one medical school that, with external funding, developed a program with online resources available to any school that are designed to foster discussion and self-reflection among all stakeholders: attendi...

Uncommon wisdom from a family physician and medical educator

January 19, 2023 17:13 - 33 minutes - 45.3 MB

Simon Auster, MD, was a family physician, psychiatrist, and medical educator who had extraordinary insight about practicing medicine but absolutely zero interest in drawing attention to himself. His students and patients had the good fortune of having him as their teacher or doctor but far too few have benefited from his wisdom. Today we discuss some of Simon's saying's -- "Simonisms" -- that are remarkable because they are not the usual cliches one hears. Some challenge us to reconsider our...

Challenging Questions to Help Physicians Reflect, Grow, and Find More Joy Practicing Medicine

December 15, 2022 11:00 - 43 minutes - 59.7 MB

Medical training and practice habituates physicians to a culture that narrows the possibilities we see for finding joy and meaning in our work. We often become efficient task completers, stuck in routines, and prone to burnout.  Saul and Stefan discuss a set of questions that challenge physicians to look at their work and themselves in fresh ways, can be used for mentoring or teaching purposes, as prompts for reflective writing exercises, or to engage thoughtful colleagues (perhaps over a be...

Organic Chemistry and the Questionable Ways We Select and Train Physicians

November 16, 2022 11:00 - 30 minutes - 24.1 MB

In October, the New York Times published the first of several articles about an eminent professor at NYU who was dismissed after his students complained that his organic chemistry class, essential to medical school admission, was too hard. Thousands of comments were unsympathetic saying, essentially, that students who couldn't hack it shouldn't be doctors. But is that really true? Saul and Stefan debate not only whether organic chemistry should be a gateway into medicine, but what else is qu...

Contextualizing Care in a Nutshell (and a New Study)

October 24, 2022 18:07 - 27 minutes - 22 MB

Today, Stefan talks with Saul about his favorite topic (and life's work), contextualizing care. We're re-releasing this conversation (from January of last year) because Saul's research team has just published a new study -- an RCT, titled "Effect of Electronic Health Record Clinical Decision Support on Contextualization of Care: A Randomized Clinical Trial," which is open access, so you can read it by clicking on the link. This episode provides a brief "one-stop-shop" for anyone who wants to...

Medical Gaslighting: Why Are We A--holes?

September 19, 2022 12:38 - 35 minutes - 48.7 MB

Recent articles in mainstream media about "medical gaslighting" have struck a nerve with thousands of comments on social media platforms. People are complaining about how their doctors are treating them, with women and underrepresented minorities disproportionately telling some of the worst stories.  Meanwhile physicians are responding, mostly on the defensive. They're saying their jobs are too tough and patients are unreasonable. We explore what's going on. 

Urine Drug Screening: How it can traumatize patients and undermine the physician-patient relationship without helping anyone

August 11, 2022 14:15 - 38 minutes - 52.2 MB

Urine drug screening (UDS) is used in the care of patients with opioid use disorder, and for patients receiving opioids for chronic pain. There's no strong evidence that testing helps patients, however, and no consensus on what to do with the results anyway. These tests, often mandated, may cause serious harm when physicians don't realize how often there are false positives or react punitively by cutting off treatment. Testing can resemble a criminal justice encounter, where failing could re...

Pursuing a Medical Career While Black: What it Takes and Why it Matters

July 14, 2022 17:04 - 55 minutes - 44.6 MB

Making it into and through medical school is tough even for those who have all the advantages: excellent schools starting at a young age, well-educated parents who may be doctors themselves, lots of role models and…white skin.  In this episode we hear from two pre-meds and one newly minted physician, all Black, about their journeys with few of these advantages.  Despite their remarkable optimism, their burdens are evident, and many do seem tied to race, as it is understood in the US. The...

Rescuing medical professionalism: Could “cup-of-coffee conversations” do more good than committees and letters-to-the-file?

May 26, 2022 15:14 - 42 minutes - 57.8 MB

Medical students may be subject to professionalism review by committees, most commonly for “unreliability” such as not responding to emails, falling behind on compliance requirements, showing up late for assignments and so on. Then they hit the wards, and frequently experience mistreatment by residents and attendings (many of whom also don’t answer their emails etc…), most commonly in the form of public humiliation. This seems like a recipe for cynicism and burnout, rather than growth as a pr...

Rescuing medical professionalism: Could “cup-of-coffee conversations” do more good than committees and letters-to-the-file?

May 22, 2022 23:02

Medical students may be subject to professionalism review by committees, most commonly for “unreliability” such as not responding to emails, falling behind on compliance requirements, showing up late for assignments and so on. Then they hit the wards, and frequently experience mistreatment by residents and attendings (many of whom also don’t answer their emails etc…), most commonly in the form of public humiliation. This seems like a recipe for cynicism and burnout, rather than growth as a p...

Why Residents Unionize

April 21, 2022 12:00 - 36 minutes - 29.3 MB

Many residents are not doing well, psychologically, and sometimes physically -- and with good reason. High levels of mistreatment and harassment, patient care that some experience as moral injury, and a lack of voice in the workplace, contribute to burnout and can adversely affect the kind of physicians people become.  A growing path to empowerment is unionization. What are resident and fellow unions doing to create healthier training environments? Today we hear from a recent residency progr...

Opioids and the physician-patient relationship: What are we getting wrong?

March 15, 2022 14:47 - 41 minutes - 57 MB

The opioid crisis was precipitated by physicians overprescribing opioid pain medication, egged on by the pharmaceutical industry, contributing to suffering and death from addiction and overdose. Now, many physicians are forcibly cutting patients off of opioids and refusing to prescribe in the setting of a backlash, contributing to suffering from pain, and death from suicide. Saul and Stefan consider some of the striking similarities in how we -- the medical profession -- are getting it wrong...

False Positives Traumatize Patients...If Clinicians Aren't Careful

January 19, 2022 14:28 - 30 minutes - 24.2 MB

On January 1st, the New York Times ran a story about prenatal genetic tests that are "usually wrong" -- but they got it wrong. These are actually just tests to tell if someone is high risk. The real story is that clinicians are not communicating with patients about what these tests mean, causing confusion and trauma. This happens across medicine and we discuss how to avoid it.

False Positives Traumatize Patients...If Clinicians Aren't Careful

January 18, 2022 01:04

On January 1st, the New York Times ran a story about prenatal tests that are "usually wrong" -- but they got it wrong. These are actually just tests to tell if someone is high risk. The real story is that clinicians are not communicating with patients about what these tests mean, causing confusion and trauma. This happens across medicine and we discuss how to avoid it.

Healing Interactions: What are they made of?

December 26, 2021 15:00 - 27 minutes - 22.1 MB

There are two qualities we may experience in others who comfort and ground us when we feel vulnerable and lost.  First that they engage with us, meaning that they are fully present with a sense of shared humanity. Second, that they respect our personal boundaries and know their own. Such boundary clarity makes them a safe sounding board. In this episode, first aired last May, we explore the interdependence of engagement and boundary clarity and their essential role in healing interactions.

Kind People on Airplanes

November 24, 2021 21:53 - 19 minutes - 11.6 MB

Lately we've been hearing about bad behavior on airplanes. Here we discuss an incident in which a passenger unselfconsiously stepped up at an inconvenient time to assist a group of passengers in a tough spot. Saul and Stefan reflect on the qualities of people who go through life making the world a better place in small ways.  As millions travel during Thanksgiving, we thought this episode (originally released last year) might inspire  those flying the not-always friendly skies.     

When an attending yells at a resident

October 28, 2021 17:00 - 25 minutes - 19.9 MB

Our guest, a physician a few years out of residency, describes an experience from her training when an attending yelled at her and hung up the phone when they were discussing a patient.  We talk about resident abuse, its impact on patient care, and what can be done about it. 

When your patient has a Swastika tattoo

September 09, 2021 15:45 - 38 minutes - 31.2 MB

Our guest, a resident physician, describes her reaction and what followed, when she discovered a symbol of hate tattooed on her hospitalized patient's leg.  Most of us appreciate that as physicians we don't get to choose who are patients are, and that all deserve good care. But is there more to it than that? Can one grow as a physician and person, and even feel privileged when caring for patients who one might otherwise shun?  

About me being racist: A conversation that follows an apology

July 28, 2021 22:37 - 42 minutes - 32.3 MB

Saul reached out to a former colleague whom he worked with closely so that he could apologize for something he did many years ago that he now sees as racist. Saul is a white man and his former colleague, a subordinate at the time, is a black woman. Because of his apology, along with their longstanding relationship, they are able to have an open and honest conversation about how it affected her life, why it happened and how to prevent and respond to racist behavior in the workplace. Stefan mo...

The Dartmouth Debacle: Why the culture of medical education needs to change

June 21, 2021 17:00 - 43 minutes - 32.4 MB

In a widely reported incident, Dartmouth Geisel School of Medicine accused, suspended and expelled medical students for cheating based on faulty data -- and then retracted the decision amidst a large public backlash. During the episode students were allegedly given only 2 minutes to defend themselves and were encouraged to plead guilty. When they complained about the administration online, the school passed a policy on social media that would ban some forms of communication. In this episode,...

Vaccine Hesitancy and the Doctor-Patient Relationship

May 17, 2021 13:48 - 23 minutes - 20.5 MB

A primary care doctor in solo practice in a small mid-west city who is deeply trusted by his patients talks about talking about vaccine hesitancy.  

Engagement and Boundary Clarity:

May 09, 2021 23:00 - 27 minutes - 22.1 MB

We feel safe and can open up in conversations when there is full and open engagement combined with a clear, respectful sense of personal boundaries.  Why are such exchanges so rare and yet so important to medical practice and to the good life? 

Judgementalism

March 22, 2021 14:00 - 25 minutes - 20.5 MB

Physicians are neither judges nor God, and yet we seem prone to judge our patients...and ourselves. Saul and Stefan discuss. 

Contextualizing Care: What it means and why it matters

January 19, 2021 18:00 - 27 minutes - 21.8 MB

Saul and his research team have listened to and analyzed thousands of audio recordings of medical encounters for clinician attention to the life context of each patient when planning their care. Here is what they've learned.   

Part 2: International Medicine

January 03, 2021 22:27 - 25 minutes - 20.2 MB

In Part 2 of our interview with Dr. Bhalla, hear what makes for a good fit for a long term career practicing medicine and leading projects in international settings

Part 1. International Medicine

January 03, 2021 22:22 - 40 minutes - 30.1 MB

A physician describes what attracted her to international medicine where she’s worked for Doctors Without Borders in many challenging places. Guest: Naina Bhalla MD, MPH   Intro and Outro are Prelude by J.S Bach, arranged by Sophocles Papas, with permission from Carl Fischer. Also, Largo from Four Seasons by Vivaldi, arranged Per-Olov Kindgren. Guitar played by Saul Weiner.

My Learning Disability

November 29, 2020 18:00 - 21 minutes - 17.4 MB

Stefan interviews Saul about his experiences becoming a doctor with a learning disability, leading to questions such as: Does struggling with multiple choice tests mean you won't be a good doctor? How do grades shape our self image and the culture of medicine? 

Asking patients "Why?"

November 10, 2020 14:33 - 16 minutes - 13 MB

What should a doctor do when  a patient behaves in a way that doesn't seem to make sense?  Saul and Stefan discuss a case. 

Part 2: “This is what I trained for.”

October 31, 2020 13:50 - 28 minutes - 22.6 MB

In Part 2 of our interview with Dr. John Scala, hear how an experienced primary care physician in solo practice responds to the pandemic, particularly as he thinks about the physician-patient relationship, the well being of his staff, and personal risk. 

Part 1: Meaning and Joy in Solo Practice

October 31, 2020 13:34 - 55 minutes - 44.8 MB

A primary care physician describes why he's loved being a solo doctor, mostly avoiding corporate medicine.  His patients love him too. Learn how and why this kind of practice is still possible.  

Part 2: Hope and Healing for Those Who Follow

October 19, 2020 12:47 - 36 minutes - 29.2 MB

Dr. Conway responds to violence and hopelessness in her community, traumatized by systemic racism, by establishing the I Am Abel Foundation as a haven and resource for young people aspiring to careers in medicine. 

Part 1: Pursuing a Dream and a Calling

October 19, 2020 11:54 - 43 minutes - 34.9 MB

Dr. LaMenta Conway shares what she experienced and learned growing up in an economically and socially marginalized community in Chicago, pursuing a dream to become a physician. 

Forced Opioid Taper

September 11, 2020 00:18 - 16 minutes - 13.6 MB

A middle aged man had been on a high but stable dose of opioids for years for chronic pain.  His provider decides to wean him. He says "I'm not sure I can handle it," but they keep going.  Is this what a caring or evidence-based physician would do?  

Airplane Guy

September 10, 2020 23:38 - 19 minutes - 11.6 MB

What's a better way to pick a student for medical school: High MCAT scores or seeing them help a vulnerable stranger when it's inconvenient and they think no one's watching? Reflections on healing as an organizing principle.

Patient Abuse

September 10, 2020 23:25 - 16 minutes - 9.92 MB

A very bright physician scares a patient from a marginalized community out of the ER with a nasty prank -- and "I laughed too."  How does this happen? Saul Weiner reflects on a moment from residency.

The "Difficult" Patient

September 10, 2020 22:36 - 24 minutes - 14.3 MB

A patient got labelled as "difficult" who really wasn't so difficult, and it cost him his life.  Where did things go wrong? Details changed to assure patient confidentiality.

Introducing: On Becoming a Healer

September 06, 2020 22:36 - 3 minutes - 2.6 MB

Introducing a new podcast that takes a critical look at medical training and the culture of medicine. Explores how interpersonal boundary clarity and the capacity to fully engage are essential to effective medical practice, mentoring, medical education, and a nourishing career. Designed to challenge you, help you grow, and prevent burnout,    The podcast features Prelude by J.S. Bach, arranged for classical guitar by Sophocles Papas, and played by podcast host Saul J. Weiner. Used with w...