![Close-up photo of Ron Epstein, smiling.](https://www.cmaj.ca/content/cmaj/191/41/E1146/F1.medium.gif)
Jillian Horton: How do we reconcile the quality of care we wish to provide with that which we feel we’re limited to provide?
Ron Epstein: I’ve been in primary care for 35 years. I can’t say that it’s ever been easy. I used to know all of the specialists to whom I would refer. Now, that’s much more difficult because everyone’s isolated in their own offices. Alone, we can’t do a lot, but as a community, we can do more. The places I see that have been moving in the right direction start with a sense of community and shared vision.
JH: When many physicians feel that the health care system is failing, that the profession’s culture is toxic and that burnout seems an appropriate response, why should we have hope for the future?
RE: When you look inside yourself … and look at what you do in your day-to-day work, there will be things that will be concordant with your sense of purpose and meaning and things that will be discordant. Part of this is self-awareness. I can hold both the positive and negative at the same time. Medicine is toxic. It’s in trouble. It’s also glorious and inspiring and redemptive. The ability to hold that paradoxical view of medicine is the reason that I and many colleagues are able to maintain a sense of purpose and sanity and direction in their work.
JH: Could you talk about how individual physicians can use appreciative inquiry to get a better sense of their own strengths and what is working for them?
RE: The idea behind appreciative inquiry is that there are 2 modes of dealing with change, whether institutionally or personally. One is identifying problems and trying to solve them. Another is identifying things that are going well and trying to enhance them. It’s not that one is better than the other, but, in medicine, we are pathology oriented. We look for things that are wrong, broken and not going well. Even in systems that are troubled, some things are going well. We know that it’s easier to build on success than to try to repair failure. How can we channel that energy better?
JH: So in some ways this is a strategy we can use to overcome our negativity bias …
RE: We are programmed to remember negative experiences more vividly than positive ones. If you think about it, that’s a survival skill. You eat a mushroom, you get sick and you want to really remember what that mushroom looked like so it doesn’t happen again. We all have mistakes that continue to haunt us, whereas we often forget the successes. And so it’s a way of rebalancing and saying, yes, all these negative things happened but let’s talk about positive potential and how you can go a lot further.
JH: As health care institutions rush to incorporate wellness programming, what is the risk that mindfulness just becomes one more box to check off?
RE: Requiring everyone to meditate is not the answer. We should offer people a menu of ways to become more mindful. I also think that people teaching mindfulness in professional settings need to be either members of that profession or have worked very closely with that profession … it’s not that someone offering a workshop for surgeons has to be a surgeon, but they have to have worked closely enough with surgeons to understand the language and culture, to know what opportunities there are in that world to be just a little more mindful in everyday work. It’s not about becoming “good” at meditation or “good” at yoga. It’s about finding what is at the core of the work that we do every day and achieving a fundamental shift in the way we do business as usual.
Footnotes
This is an excerpt from a longer podcast. You can listen to the full interview here: cmaj.ca/medlife
RONALD EPSTEIN is a family physician, teacher, researcher and writer. He directs the Center for Communication and Disparities Research at the University of Rochester Medical Center and codirects the Dean’s Teaching Fellowship program and Mindful Practice Programs at the University of Rochester School of Medicine and Dentistry.
The interview was conducted by Dr. Jillian Horton, director of the Alan Klass Health Humanities Program at the Max Rady College of Medicine, University of Manitoba, Winnipeg. She hosts Med Life with Dr. Horton on CMAJ Podcasts.
Podcast