Practicing
Dec 8, 2021
Stephen Liben: Reacting, Responding
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Sam speaks to pediatric palliative care physician and medical educator Stephen Liben about his work with sick and dying children and their families, how mindfulness changed his life and career, and more.
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Show notes:
www.stephenliben.com
"MD Aware" course guide: https://link.springer.com/book/10.1007/978-3-030-22430-1
McGill Programs in Whole Person Care: https://www.mcgill.ca/wholepersoncare/
Article on course in Mindful Medical Practice at McGill: https://www.mcgill.ca/wholepersoncare/files/wholepersoncare/hutchinson-liben2020_article_mindfulmedicalpracticeaninnova.pdf
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Recorded September 9, 2021
Music: Mr Smith https://freemusicarchive.org/music/mr-smith
Art: Jeff Landman
www.practicingpod.com
Twitter: @practicingpod
Instagram/Threads: practicingpod
LinkedIn: Practicing Podcast
More episodes from Practicing
Aug 24, 2023
Autumn Fiester: Seeing the Difficult Patient
Of all the problems we face in clinical medicine, few are more vexing than patient interactions that don’t go well. Dealing with a “difficult patient,” as they’re commonly referred to, can ruin your day and set off a spiraling cascade of thoughts and emotions. Those patient encounters frustrate us and drain us as clinicians. They can leave us feeling at once helpless and self-righteous, empathetic and disdainful. Often, they make us want to run away. Other times, they suck us in, to an uncomfortable degree. I’d say doctors spend as much – if not more – time talking to each other about difficult patients as they do about difficult diagnoses.
Hearing Dr. Autumn Fiester lecture on the difficult patient was one of those rare moments when a phenomenon I thought I had a handle on based on my own experience was completely reframed. Her ideas led me to see the problem from an entirely different angle, and to reinterpret my past experiences as a result.
Autumn Fiester is a philosopher and bioethicist at the University of Pennsylvania, where she is Vice Chair for Education in the Department of Medical Ethics & Health Policy at the Perelman School of Medicine as well as the Faculty Program Director for the Master of Bioethics (MBE) and Master of Science in Medical Ethics (MSME) degrees. She is the Director of the Penn Program in Clinical Conflict Management, which promotes conflict resolution training for clinical providers and clinical ethics consultants. She is the author of over 100 publications in the areas of clinical ethics, clinical conflict management, and more.
I think my conversation with Autumn will really appeal to clinicians who have necessarily had the experience of navigating conflictual or dysfunctional patient relationships. But I also think what Autumn has to say is enlightening for anyone who’s been a patient. As she says, we have all been, or have the potential to be, difficult patients.
*An Announcement!*
This is the 20th episode of “Practicing,” a milestone I’m not sure I ever thought I’d reach when I started the podcast two years ago. It seems like a good time for me to take a break, regroup and dedicate some time to other projects. Now, this isn’t a farewell, it’s just a “see you later.” I may return with the occasional interview over the coming months, but my hope is to come back with fresh ideas. So stay subscribed! Thanks to all of you for your precious attention, and to those of you who sent feedback, subscribed, shared or rated the show, or helped and supported me in countless other ways. I couldn’t have done it without you. And of course thanks to all my guests – you are what Practicing is all about.
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Links:
-Autumn's bio*
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*Recorded July 11th, 2023
Art: Jeff Landman
Music: Mr. Smith
www.practicingpod.com
Twitter: @practicingpod
Instagram/Threads: practicingpod
LinkedIn: Practicing Podcast
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Jul 14, 2023
Vanessa Bonneau and Sylvan Lanken: Loving Fera
A little over two years ago, two good friends of mine, whose daughter Fera was born just a few weeks before my daughter, came to me with concerns about their baby. Fera was about 9 months old and at a routine check-up her doctor had found that her weight gain had slowed.
When her mother, Vanessa, reached out to me about this, I wasn’t too worried – so often in pediatrics health concerns turn out to be nothing, or small hiccups that get better on their own. Not to mention the fact that I hated to imagine that my friends’ baby could be sick. But once I saw Fera’s growth curve and heard all the details of her symptoms, including the fact that she was fussy and always thirsty, constantly soaking her diapers, and preferred water to her mother’s milk, I was alarmed. So I arranged to have Fera seen by a colleague and tested at the clinic where I work.
Within a few weeks, it emerged that something was very wrong with Fera. She was losing everything through her kidneys: water, electrolytes, sugars, proteins. Once that was clear, Fera was hospitalized, and as you’ll hear from her parents, Vanessa Bonneau and Sylvan Lanken, she was diagnosed with cystinosis, a rare genetic disease that causes the amino acid cystine to build up in every cell of a person’s body over time.
Fera’s diagnosis was devastating: cystinosis is degenerative and though it can be managed and treated with a tremendous amount of work, there is no cure.
Over the last three years, I’ve seen Fera and her parents struggle, but I’ve also seen her grow up, stabilize, and play with my daughter like any other child.
I wanted to speak to Vanessa and Sylvan about their experience, about their interactions with the health system and the cataclysm of Fera’s diagnosis. My intuition was that many people – including me – would benefit from hearing their story, and after recording our conversation I’m more convinced of that than ever.
In addition to being Fera’s parents, Vanessa Bonneau is a writer and editor, and Sylvan Lanken is a musician who also works in higher education.
The following interview isn’t easy to listen to at times and it deals with very difficult themes. So please be warned. But I do encourage you to listen if you can – Vanessa and Sylvan brought all of their humanity and openness to this interview, and as a result it is a gift.
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Links:
-Cystinosis Research Foundation
-Basic information on cystinosis (NIH)*
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*Recorded June 29th, 2023
Art: Jeff Landman
Music: Mr. Smith
www.practicingpod.com
Twitter: @practicingpod
Instagram/Threads: practicingpod
LinkedIn: Practicing Podcast
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May 24, 2023
Olivier Drouin: Uncovering Influences
The phrase “evidence-based medicine” is uttered so often in the medical world that it can lose its meaning. So what does it mean? We use the phrase to highlight the ways that medical knowledge and practice are based on scientific data, systematic studies that allow us to determine what really works, to distinguish cause and effect from random associations. And modern medicine has been built around that notion of scientific objectivity.
But I also like to think of the many gaps in that evidence, the known unknowns but also the unknown unknowns. We can only use the evidence we’ve first sought to gather, after all. We can only seek answers to the questions we think – or allow ourselves – to ask.
My next guest, Olivier Drouin, is trying to ask questions that might expand our notion of evidence-based medicine. With his focus on behavioral science, Olivier seeks to better understand the ways we behave and make decisions, the influences that shape and distort our thoughts and actions. As you’ll hear, Olivier sees this as an untapped evidence base, one that scholars in psychology, economics, political science and law are familiar with, but that medicine has tended to ignore.
Olivier Drouin is a pediatrician and health services researcher in the Division of General Pediatrics at Sainte-Justine university health center, a pediatric research hospital in Montreal. He trained as a Research Fellow at Harvard, where he also obtained a Master’s of Public Health. Before that, he completed his clinical training at Sainte-Justine and at the Montreal Children's Hospital, where we were fellow residents. He conducts fundamental and applied research in the fields of behavioral economics, public health, global health, and health policy. He’s often called upon to comment on topics related to child health in local and national media.
Olivier and I first met in pediatric training at the Montreal Children’s Hospital, when he was my chief resident and one of my earliest clinical teachers. We’ve been friends, and occasional collaborators on writing projects, ever since. One thing I’ve always appreciated about Olivier is his commitment to research that has concrete, practical applications, and his broad intellectual range, which allows him to make connections across disciplines.
*A NOTE*: we use the terms “obesity” and “overweight” in this conversation, because they are typical medical terms. However, I realized after recording that they can be hurtful and stigmatizing. I apologize for that, and I intend to use more inclusive and respectful language from now on, but I did choose to keep the discussion on the tape, as I do believe it’s valuable.
*A CORRECTION: *I refer to ozempic and related drugs as GLP-1 receptor antagonists. In fact they are GLP-1 receptor agonists.
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Links:
Olivier's website
Daniel Kahneman: "Thinking, Fast and Slow"
Richard H. Thaler and Cass R. Sunstein: "Nudge"
Daniel Kahneman, Olivier Sibony, Cass R. Sunstein: "Noise"
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Recorded May 2nd, 2023
Art: Jeff Landman
Music: Mr. Smith
www.practicingpod.com
Twitter: @practicingpod
Instagram/Threads: practicingpod
LinkedIn: Practicing Podcast
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