The Doctor's Art

Tom Frieden, a former Health Commissioner of New York City and leader of Resolve to Save Lives, discusses his pioneering public health initiatives to combat tobacco use and infectious diseases. He shares his journey into medicine and highlights the ethical dilemmas between individual freedoms and community health. Frieden also addresses challenges in tuberculosis control, the politics shaping public health, and innovative strategies to tackle cardiovascular disease. His insights on transparency during the COVID-19 pandemic stress the importance of public trust in health initiatives.

In this conversation, Dr. Mariel Buqué, a health psychologist and expert on intergenerational trauma, draws on her own experiences as an Afro-Latina immigrant. She discusses how trauma from one generation affects the next, often perpetuating cycles of emotional instability. Dr. Buqué emphasizes the importance of understanding the origins of trauma and its multifaceted impact on individuals and families. She also highlights the significance of empathy, breaking mental health stigmas, and fostering trust in therapeutic relationships for effective healing.

The Genocide Against the Tutsi, occurring in Rwanda between April-July 1994, was a devastating episode of mass violence in which nearly 1 million people were killed over a period of 100 days. Fueled by longstanding ethnic tensions, political power struggles, and a deep seated history of discrimination, the genocide saw members of the Tutsi ethnic group slaughtered indiscriminately by extremists of the Hutu ethnic group. Growing up amid this chaos, Christian Ntizimira, MD witnessed some of humanity's most horrific atrocities. Instead of turning away, however, he chose to enter medicine, a profession that would allow him to address the immense suffering he saw. Today, Dr. Ntizimira is a palliative care physician and the founder and executive director of the African Center for Research on End of Life Care. In this episode, Dr. Ntizimira joins us to share his personal experiences with the Rwandan Genocide, his journey to palliative medicine after initially exploring a career in surgery, what palliative care means to him, what it looks like to honor the dignity of a patient, how he advocates better access to palliative care and chronic illness care, and his unique approach to medicine rooted in “ubuntu,” a philosophy emphasizing the universal bond that connects all humanity that is best summarized by the phrase “I am because you are.”In this episode, you’ll hear about: 2:45 - How Dr. Ntizimira’s experience as a young person during the Rwandan Genocide inspired him to become a physician, and how he eventually found himself drawn to palliative care  14:25 - Dr. Ntizimira’s distinction between “treating the disease” and “treating the person”20:22 - How Dr. Ntizimira teaches doctors to fully conceptualize patients as people instead of focusing only on their medical ailments 25:50 - The heart of palliative care that transcends cultures30:54 - The importance of presence in palliative care38:27 - What “reconciliation” means in Dr. Ntizimira’s approach to palliative care 47:17 - “Ubuntu,” an African philosophy emphasizing a shared connection among humans, and how it can revolutionize how we care for patients    Dr. Christian Ntizimira is the author of The Safari Concept: An African Framework for End of Life Care.Dr. Christian Ntizimira can be found on Twitter/X at @ntizimira.Visit our website www.TheDoctorsArt.com where you can find transcripts of all episodes.If you enjoyed this episode, please subscribe, rate, and review our show, available for free on Spotify, Apple Podcasts, or wherever you get your podcasts. If you know of a doctor, patient, or anyone working in health care who would love to explore meaning in medicine with us on the show, feel free to leave a suggestion in the comments or send an email to info@thedoctorsart.com.Copyright The Doctor’s Art Podcast 2024

Mikołaj Sławkowski-Rode, PhD, a philosophy professor who dives deep into the themes of death and grief, illuminates how modern society often sidelines these crucial experiences. He discusses the essential role of mourning in fostering empathy and social connections. The conversation explores the intersection of love and grief, challenges of isolation in contemporary culture, and the superficial pursuit of happiness. Sławkowski-Rode also reflects on the significance of memory in the grieving process and the need for revitalized communal rituals.

For a profession like medicine in which suffering — be it physical, psychological, existential, or spiritual — is so commonly encountered and experienced, we have developed remarkably little shared vocabulary to talk about what suffering means. That is, if we even have the conversations at all.In early June 2024, during the American Society of Clinical Oncology annual conference in Chicago, we hosted a live podcast event at Northwestern University's Feinberg School of Medicine, gathering Sunita Puri, MD and Jay Wellons, MD, MSPH to explore the great problem of suffering. Dr. Puri, a palliative care physician and author of the best selling book That Good Night: Life and Medicine in the 11th Hour (2019), last joined us on Episode 74: The Beauty of Impermanence. Dr. Wellons, a pediatric neurosurgeon at Vanderbilt University Medical Center and author of the memoir All That Moves Us: A pediatric neurosurgeon, His Young Patients and Their Stories of Grace and Resilience (2022), last joined us on Episode 28: The Brain and All That Moves Us. The four of us, the guests and co-hosts, start by sharing our personal encounters with suffering, both in our patients and in ourselves, before discussing our philosophical approaches to and practical strategies for accompanying patients through suffering, managing spiritual distress, contextualizing our own humanity in these encounters, maintaining our own well-being, and searching for meaning amid these tragic moments, if it is possible. After our main discussion, we also answer audience questions about managing the sometimes unrealistic and complicated expectations patients have of clinicians, and the role of interfaith discussions among healthcare professionals.We thank Kelly Michelson, MD, MPH and the Center for Bioethics and Medical Humanities at Northwestern University for making this event possible.In this episode, you’ll hear about: 3:58 - Stories of confronting suffering, both in professional and personal contexts29:02 - Practical tips for coping with suffering and uncertainty as a physician31:53 - The importance of psychological safety in feeling and expressing your emotions as a physician 36:52 - Being present in the moment while accompanying patients through difficult times40:00 - Helping doctors re-connect with the deeper reason of why they feel called to medicine 42:24 - The inexplicable relationship between love and loss 52:04 - The deep sense of meaning inherent in the work of a physician and what makes it “real” 54:41 - Q&A: How physicians can better navigate the challenging expectations patients have as well as medical skepticism1:04:05 - Q&A: How we can better incorporate interfaith dialogue into medical training and practiceDr. Jay Wellons is the author of All That Moves Us (2022) and can be found on Twitter/X at @JayWellons5.Dr. Sunita Puri is the author of That Good Night (2019) and can be found on Twitter/X at @SunitaPuriMD.

Robert Sapolsky is a neuroscientist and primatologist at Stanford University, renowned for his insights on stress and behavior. In this engaging discussion, he argues that free will is an illusion shaped by our genetics and environment. He explores how this perspective can change our approach to crime and mental health, advocating for compassion over blame. Sapolsky also delves into ethics within a deterministic framework and reflects on the paradox of self-deception in navigating life's challenges. His thoughts provoke a deeper understanding of human agency in an unequal society.

Dr. Samuel Wilkinson, a professor of psychiatry at Yale University, offers a fresh perspective on evolution and its implications for human existence. He discusses how an existential crisis in medical school spurred his exploration of life's purpose. Wilkinson argues that evolution can align with spiritual beliefs and emphasizes the necessity of personal relationships for mental well-being. He delves into the complexities of human nature, the debate on free will versus determinism, and the importance of reconnection with one’s purpose in medicine.

Mark Lewis, MD, is an oncologist deeply shaped by cancer, both personally and through his family's journey. He shares the emotional toll of watching his father battle the disease and his own cancer diagnosis linked to a genetic syndrome. Dr. Lewis discusses the transformative power of faith in his healing, the impact of advanced treatments like immunotherapy, and the importance of empathy in doctor-patient relationships. This heartfelt conversation navigates resilience, hope, and the delicate balance of science and spirituality in medicine.

The Bill & Melinda Gates Foundation, with an endowment of over $50 billion, is one of the largest and most influential philanthropic organizations in the world. With a focus on addressing global health, poverty, and education, its initiatives have led to the reduction of malaria mortality by 60% over the past two decades, the near eradication of polio, increased educational opportunities of millions of students, and improved sanitation conditions for millions of people in developing countries. For six years, oncologist Sue Desmond-Hellmann, MD, MPH was the CEO of this organization. Prior to that, she served as Chancellor of the University of California at San Francisco, as well as President of Product Development at Genentech, where she oversaw the development of Herceptin, Avastin, Rituxan, and other blockbuster cancer drugs that are now staples in the arsenal of many medical oncologists.The topics of our discussion in this episode are as varied as Dr. Desmond-Hellman's career. We discuss, among other things, how seeing the work of her pharmacist father encouraged her to pursue a career in medicine, how her early experiences treating HIV patients in Uganda spurred her to tackle global health challenges, how she discovered a passion for product development in the pharmaceutical industry, how she reconciles the ethical quandaries of developing medications that can cause serious adverse effects and that can sometimes cost hundreds of thousands of dollars per dose, what her mission while at the Gates Foundation was, and her perspectives on the role of artificial intelligence and human health and well-being, now that she has joined the board of directors of OpenAI, the company behind ChatGPT.In this episode, you will hear about: 2:50 - How working in her father’s pharmacy led Dr. Desmond-Hellmann to a career in medicine4:56 - A brief summary of Dr. Desmond-Hellmann’s multifaceted career trajectory15:36 - What the day to day work of pharmaceutical drug development looks like 18:30 - The challenging ethical concerns that surround drug approvals especially as it pertains to safety concerns23:44 - Dr. Desmond-Hellmann’s experiences in Uganda that forever transformed her views on poverty 27:55 - The aims of the Gates Foundation 30:47 - How Dr. Desmond-Hellmann views her work both in the non-profit and the for-profit sectors 37:15 - Dr. Desmond-Hellmann’s mission when she took on a leading role at The Gates Foundation 38:38 - How Dr. Desmond-Hellmann thinks about shaping the future of AI as she takes a seat on the board of OpenAI45:14 - Dr. Desmond-Hellmann’s advice for medical trainees and clinicians on how to navigate the many opportunities available to them along their career pathDr. Sue Desmond-Hellmann can be found on Twitter/X @suedhellmann.Visit our website www.TheDoctorsArt.com where you can find transcripts of all episodes.If you enjoyed this episode, please subscribe, rate, and review our show, available for free on Spotify, Apple Podcasts, or wherever you get your podcasts. If you know of a doctor, patient, or anyone working in health care who would love to explore meaning in medicine with us on the show, feel free to leave a suggestion in the comments or send an email to info@thedoctorsart.com.Copyright The Doctor’s Art Podcast 2024

Ira Bedzow, PhD, is a multifaceted expert in ethics, medicine, and moral leadership, serving as the executive director of the Emory Purpose Project. He discusses how identifying personal values can lead to meaningful leadership and healthier relationships. Bedzow also explores the ethical dilemmas faced by clinicians, the connection between burnout and loss of purpose, and strategies for students to align their aspirations with their values. His insights challenge listeners to think deeply about purpose and ethics in both life and profession.