Difficult Conversations Podcast
Lessons I Learned as an ICU Physician
Episode 126 | January 12, 2021
Healing The Heart Of Medicine
Dr. Jonathan Fisher
Cardiologist, Mindfulness, Heartfulness and Happiness Facilitator
Welcome to Difficult Conversations – Lessons I Learned as an ICU Physician with Dr. Anthony Orsini. My special guest today is Dr. Jonathan Fisher, a Harvard-trained physician, practicing cardiologist, certified Mindfulness Meditation Teacher, and global keynote speaker. With over 20 years of experience, Dr. Fisher has helped thousands of individuals live longer and better lives. Having recovered from his own painful and long journey through anxiety, depression, and burnout, he now helps organizations, leaders, and teams heal and reverse the spiral of disengagement and burnout by sharing proven concepts and methods to enhance joy and peak performance. Dr. Fisher currently serves leadership roles in various departments and is the Founder of Mind Heart Now, LLC, and leads transformational interactive programs for teams and organizations. He is here today to discuss a variety of topics that are seriously affecting our healthcare with respect to provider crisis.
We begin with Dr. Fisher sharing the story of his life growing up, how he became a physician, and the struggles he had starting in his teenage years. He talks about when he recognized that what he was experiencing was more than just stress and anxiety, but depression. We learn how Dr. Fisher recovered from his depression, which started simply by googling, “How can I be happy again?” Dr. Fisher discusses meditation and yoga and the research behind it, and the significance of “I feel, therefore I am.” He also tells us about “mindfulness of the heart” to prevent heart disease, and the American Heart Association endorsing meditation as an adjunct to treating cardiovascular disease, which was an incredible validation that this stuff not only helped heal his own anxiety and depression, but is helpful for patients as well. Find out what Dr. Fisher has to say when he discovered that mindfulness has a lot to say about communication. Dr. Orsini and Dr. Fisher chat about the importance of forming a real relationship with patients, how information does not heal people, and how powerful compassion’s effects on the human heart is. Dr. Fisher gives great advice on how to have a conversation with yourself first and how to move forward. We end with Dr. Fisher sharing with us his most difficult conversations that he’s had and some amazing advice.
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Jonathan Fisher (2s):
To be a physician who’s fully present with a whirlwind of COVID going around us life and death situations for you It’s parents who maybe have lost children. For me, it’s loved ones whose family members are at life and death, or looking at someone in their eyes while they are dying. If we can learn to do that and to regulate our emotions and feel our emotions and still be human, that’s a skill that applies to any business anywhere in the world.
Welcome to Difficult Conversations Lessons I Learned as an ICU Physician with Dr Anthony Orsini. Dr. Orsini is a practicing physician and the President and CEO of The Orsini Way. As a frequent keynote speaker and author Dr Orsini has been training health care professionals and business leaders how to navigate through the most difficult dialogues. Each week, you will hear inspiring interviews with experts in their field who tell their story and provide practical advice on how to effectively communicate. Whether you are a doctor faced with giving a patient bad news, a business leader who wants to get the most out of his or her team members or someone who just wants to learn to communicate better this is the podcast for you.
Dr. Anthony Orsini (1m 14s):
Welcome to another episode of Difficult Conversations: Lessons I learned as an ICU Physician this is Dr. Anthony Orsini. I will be your host again this week. Today, my special guest is Dr. Jonathan Fisher. Jonathon is a Harvard trained physician and a practicing cardiologist with over 20 years of clinical experience. He has helped thousands of individuals live longer and better lives. In addition to being a board certified cardiologist, he is also a certified Mindfulness Meditation teacher, a corporate wellbeing consultant and a global keynote speaker. Having recovered from his own painful decade, long journey through anxiety, depression, and burnout as a cardiologist, working on the front lines of life and death.
Dr. Anthony Orsini (1m 55s):
He now helps organizations, leaders, and teams heal and reverse the spiral of disengagement and burnout by sharing proven concepts and methods to enhance Joy peak performance and the bottom line. Dr. Fisher currently serves in leadership roles in various departments at Nova and health in North Carolina, including rehabilitation and wellness programs, organizational resilience, and wellbeing team COVID-19 burnout prevention and recovery task force, empathetic communication training team, corporate onboarding and leadership development teams is also the Founder of Mind Heart Now LLC and leads, transformational interactive programs for teams and organizations.
Dr. Anthony Orsini (2m 35s):
And he is here today to discuss a variety of topics that are seriously affecting our health care with respect to physician and provider crises. If you are a health care professional, I promise you that is extremely important that you hear what Jonathan has to say today. And if you’re not in the medical field, it’s important that you listen so that you can be more informed patient and to advocate for your family. Jonathan Welcome. Thank you for coming today.
Jonathan Fisher (2m 59s):
Thank you so much. Tony I’ve been waiting for this conversation. I love talking with you.
Dr. Anthony Orsini (3m 4s):
It’s amazing that you and I met and we’d been going back and forth and you might be the only person that the busier than I am in the whole world. And we’re both, we both had parallel. Our first love is medicine, and we still do that and we love to heal through that, but we’ve also found other passions. And I think that’s where we have so much similarities, but just finding an hour to do this, we talked a couple of times, but finding and hour to put it together, I think it took us a couple of months. So I’m glad we finally made it happen.
Jonathan Fisher (3m 32s):
For sure. The hospital has kept us both very busy these days.
Dr. Anthony Orsini (3m 36s):
Yeah. The hospital COVID. And then we both have our passions me with communication and training and you with mindfulness. And last time we spoke, you told me your story. And I think it’s really important. And I usually start these podcasts with people telling us about themselves. But I think for you, it’s even more important because it lends to your credibility about what you went through as a person, as a physician at how you got to be where you are today. So you told me a great story, which you would share that with the audience today,
Jonathan Fisher (4m 5s):
Right? So I like you and from New Jersey suburb of New York, where my dad would hop on the bus every day and go into the city and do his work. He was a doctor, a physician. He was still living age 94, still in New Jersey. God bless him. And mom and dad wanted to have lots of children and wanted to have their children help the world. And so one after another, until there were seven children, I was the last one. So the youngest of seven children, the oldest couple literally went on house calls with my dad. So with the old leather bag, they would get in the back of the station wagon. They’d go around this town, Livingston, New Jersey, seeing patients with low blood count with chest pain.
Jonathan Fisher (4m 47s):
And so my oldest siblings were programmed early on into this life of medicine this life of healing. And then in my family, there’s so many kids you couldn’t help, but look up to the brother or sister that was above you and say, hey, what’s this person doing? And so one by one, we all became physician’s and that
Dr. Anthony Orsini (5m 4s):
All seven of you are physicians? Wow. And that’s a lot of money for tuition. And I’ll tell you that
Jonathan Fisher (5m 8s):
I used to calculate when I was a kid going through a school. Okay. How much money is Dad having to earn? He just works in the basement basically. So in our house, he set up shop. He had the old fashioned shingled, like Norman Rockwell. He was the town doctor. There were back then there were 20,000 people, Livingston, New Jersey, and people would come to our house with anything. I mean, he was a general internist. So we had so much fun as kids. We would go downstairs, like after the meals, whether it be microscopes, there would be old slides. There would be, there was a treadmill for stress tests. There was an x-ray machine. So that was back when a doctor did everything. It wasn’t super specialized like today. So I always looked up at my dad in awe.
Jonathan Fisher (5m 48s):
And then there were all of these old medicine jars. Like when it’s a little hand printed labels, there was alcohol rubbing out. Right.
Dr. Anthony Orsini (5m 56s):
That’s Oh, I think I remember those. Yes.
Jonathan Fisher (5m 58s):
So the old jars, so I grew up in a house where medicine and service were a big deal. And mom wasn’t a slouch either. She was a physicist. Wow. Before it was a thing where women would get to go to college and do advanced training. She was born in 1928. She went to teacher’s college at Barnard in New York. And she got a PhD in biochemistry. And eventually she worked in the field of nuclear physics. So I was incredibly imprinted, I would say at a very young age that I had a dad who served for the whole town healing people and a mom who was working on nuclear physics. And her greatest role model was Albert Einstein.
Jonathan Fisher (6m 39s):
She loved Einstein, and this was the house I grew up in where there was only one picture on the wall of our house, living room house. And it’s still there. It’s about four feet by three feet, one portrait. And it’s nobody in our family. It was Albert Einstein. Albert Einstein, on the wall right now, my pictures there and my wife, my kids were all they’re on the piano. But back then growing up, it was a lot of pressure you could imagine, or you’re this five, six, seven year old kid, and you’re looking around for role models and how should I be in the world? And you say, okay, I got to be real smart. I have to do something that helps a lot of people in.
Jonathan Fisher (7m 19s):
So that was part of the belief system, the mindset that we grew up in, where it was about service and it was about healing. And it was about the intellect, which has, it sounds great. I’d discovered about 30 years later that it has some downsides. So I learned pretty early that being smart, being a thinker, always analyzing was a really good thing because you come up with lots of creative solutions as a doctor, it helped me make a broad differential diagnosis, figuring all the possibilities that could be going on, not just zoning in too soon on one and missing something else. What I realized as I started to feel some loneliness, teenage years, college, years, I felt his difficulty connecting with other people.
Jonathan Fisher (8m 4s):
And I had really didn’t understand why a part of it was because my particular mindset tended towards predicting bad things in the future. So I was really good at worrying, amazing at worrying. And I realized that this kind of made me a good doctor because I could worry about all the possible things that could go wrong. But I didn’t realize is that over time, this was creating a chronic stress inside of me, even as a kid, as a college student, medical resident, always finding things to worry about. And nobody taught me that it’s important to let some of those things go or it can wear literally it can wear on the heart. Now we now know there’s this thing called broken heart syndrome, where you carry too much stress and worry around too much grief and it can be devastating.
Jonathan Fisher (8m 49s):
So that was a backdrop. And then I started my practice in New York. I worked there for a couple of years and it was busy. Lots of patients, very sick in Manhattan. And around that time, my best friend called me. And she was about 40. At the time. She said my vision has been blurry and didn’t think it was much. She went to the eye doctor a couple of times and it turns out she has a radiologist read her own brain scan, and she was diagnosed with a brain tumor. And she was my sister, Andrea. So sorry. Thank you. So Andrea was the person, one person in my life who saw that I was struggling and suffering for many years through college and residency.
Jonathan Fisher (9m 35s):
She saw that I wasn’t happy. She saw that this wasn’t exactly the life that I had imagined. And she was the person who said, Hey, why don’t you get some help? And for me in my family of upbringing, it like it, wasn’t a thing that you would talk about. My dad is an amazing example of strength and courage and intellect and all of these things. One thing he doesn’t do is he doesn’t complain and he doesn’t talk about weakness. And so we all kind of learned that subconsciously that it’s not okay to admit I was going to call a weakness, but now I will just call it humanity human. The human condition is that we’re all frail. We all have our weakness and vulnerability, but it took me a while to learn that it’s not the end of the world.
Jonathan Fisher (10m 19s):
If we start to be honest about our own weakness, our own fears and imperfections. Because when I chose my residency, I remember I was at a, at Mount Sinai in New York and I was choosing, and I was told not to apply to the Brigham Harvard hospital because I wasn’t going to get it. Cause I was like number 17 out of a couple of hundred people. And I just decided to apply. I ended up getting into that particular system. It was incredible, but all the time that I was there Tony I felt like I was pretending. I was hiding so much stress and anxiety and nervousness inside of me. I saw all of these other people who seem to be totally capable, totally smart. And I had this great imposter syndrome that I was walking around them later on.
Jonathan Fisher (10m 59s):
I found out that a lot of other people had the same thing.
Dr. Anthony Orsini (11m 2s):
Actually, I’ll talk about that in my book. I think, tell me if you agree. I think almost every physician when they become a resident has some type of imposter syndrome. Wouldn’t you agree? Were all there going, how can I possibly do this? I’d been faking this, but I’ve passing my boards. And so I can definitely relate to this.
Jonathan Fisher (11m 19s):
Oh, it absolutely is. I think its there and there’s part of the psychology of being a physician that says you have to know everything. You know, it’s kind of like the Sam chef in the house of God. And there’s this idea that we have to be all knowing, but we have to be all powerful in many ways. And this can lead to a disconnect between who we think we have to be and show up as, and this is a human condition we all know about when we’re imperfect. And so shortening the story during my residency, I recognized that something was, it was more than just stress. It was more than just the anxiety. It was depression. And even now Tony for me to talk to you publicly about this.
Jonathan Fisher (12m 2s):
There are laws, there are statutes in medicine that whenever we have to re fresh and renew our certification, they say, do you have any history of depression, anxiety, which is called mental illness. It’s a hard thing because there can be repercussions professionally, personally, et cetera. So just for me to be saying this to you right now, you may say, Oh no big deal, but it’s still is a big deal. And I just wanna recognize that for a moment. And the reason that I’m saying this, it’s very intentional because right now I’m speaking to you Tony but I’m speaking to the me from 10 and 15 years ago, who had nobody else out there in medicine saying it’s normal to feel anxiety. Some of us are depressed about 15 to 20% of us, frankly have some form of clinical anxiety or depression.
Jonathan Fisher (12m 46s):
Post-traumatic stress from watching patients die, but none of us talks about it. And so part of my own healing journey was recognizing that I wasn’t alone. And so I want other physicians. I want other nurses, pharmacists to know, I’m not alone. And only when we start to have the courage to talk about it. And frankly face the repercussions. If people listening to this patients here, this doctor had anxiety and depression because I don’t know, they may judge me. They may say, I don’t want to see that heart doctor. I happen to be a top rated doctor and the patients know before COVID they all want it to hug me, but it still, and then people who are the administration in my hospital system, Oh my gosh, Dr.
Jonathan Fisher (13m 29s):
Fisher had anxiety and depression? Does that impact his ability to practice medicine? Now the American psychiatric association and many other boards have come out very firmly saying that having these things does not impair a physician’s ability to give good care. And in fact, for me, I believe that this is improved my skills in my ability and my empathy as a doctor.
Dr. Anthony Orsini (13m 51s):
Yeah. I think you really hit you on a very important note there Jonathan and as a physician and you’re speaking right now to a bunch of physicians and a bunch of nurses, as you said, it’s very high probability that a physician is going to have some type of depression, burnout. This leads to burnout, which is the health care crisis that we’re talking about right now is some of the numbers that I’ve seen at about 60% of the physicians have at least one symptom of burnout, maybe more for nurses. We had a Dr. Dike Drummond who makes his living on helpin physician burn out. So that was one of the earlier episodes. I’ve interviewed Dr. Susan Wilson, which hasn’t aired yet, but may or before yours, Dr.
Dr. Anthony Orsini (14m 33s):
Susan Wilson deals with something called second victim syndrome, which you’re nodding your head. Yes. But you know about it. I did not know about that. And for the people out there, that’s when a physician has something terrible happen to a patient, dies, et cetera, and then goes into this depression or feeling like their failure and starts to feel sad and anger and burn out the doctors in the nurse’s are the second victim. So I, with you that there’s this certain pressure to not admit it because we think we’re going to be seen as weak. But I also talk about it in my book being genuine. And you used the word human, and I personally think that it makes you a better physician. I personally think that it makes you more empathetic, makes you more compassionate and it makes you have a better person.
Dr. Anthony Orsini (15m 15s):
It also makes you more relatable. I’m really glad that your coming out and saying this, because I think that there’s a whole bunch of people out there listening to this going. Yep. That’s me. So now you’re feeling depressed and all that. And then what did you do to get out of this? I mean, now look at you now to take us through your journey now of how you recovered and you got into meditation and yoga, and now what you’re doing now,
Jonathan Fisher (15m 37s):
And it started with a very practical approach. Tony I hit bottom after my sister had died. I will remember I was on the upper West side. My wife was in the bedroom. I was curled up on the floor, crying. My best friend was gone. She had been my emotional support. And eventually I said, I got to find a way forward because I’ve got thousands of patients who were depending on me. And I’ve got a wife, New kids, and I got on the internet and I Googled, how can I be happy again?
Dr. Anthony Orsini (16m 4s):
Oh, good. Old Google is, is there for you. No matter what you need, Google is there for you.
Jonathan Fisher (16m 9s):
Thank goodness for that. And so that took me into this incredible journey. The answers started with, hey buddy, there is this science called positive psychology, where for 50 years, the best minds in psychology psychiatry have tried to answer this question. And they have, and it’s not just snake oil. This is validated peer reviewed research studies on what are the practices and skills that the most well-adjusted most fulfilled, happiest people who have been doing not just for 50 years, but for thousands of years, going back to Aristotle and his theories on happiness. I started with positive psychology. I read everything I could about the subject.
Jonathan Fisher (16m 49s):
I discovered that in 1998, the head of the American psychological association, his name is Martin Seligman said, I am going to shift the way we talk about the human mind. And we are no longer going to focus like so many German and Austrian psychiatrists and psychologists and Sigmund Freud about how broken we are. But what instead we’re going to look at what does a fully functional adjusted peak performing happy human mind look like? And what are the habits? The daily habits that person engages in. And one of those early habits was Meditation. There is a book called the How of happiness by Sonja Lyubomirsky and she said, research has shown that people who meditate for a couple minutes every day, they feel happier.
Jonathan Fisher (17m 34s):
As I said, okay, better put that on my list, I bought an MP3 and I listened? I thought I was going crazy. I couldn’t sit still for two minutes.
Dr. Anthony Orsini (17m 41s):
Yeah. You know, I wanted to ask you about that. I was waiting for this to ask you about that. I’ve tried the meditation thing and I get about three seconds in. If you could tell your story, why don’t you give us some tips on how to do that?
Jonathan Fisher (17m 53s):
I will. And first of all, Tony, congratulations, because we have three seconds isn’t bad. Some people, it can’t be one second.
Dr. Anthony Orsini (17m 60s):
All right, well maybe I’m giving myself too much credit,
Jonathan Fisher (18m 3s):
You know, three seconds, five minutes, seven minutes. Eventually I work my way up and I learned a lot about my own mind that I didn’t know for 30, 40 years, that’s the first of all, my mind was all over the place. Second of all, I had a thousand nervous thoughts and hour and third of all, I actually could choose whether or not to believe those thoughts. That was it. That was the key. The key was I had identified my whole life with my thinking. Mind remember Einstein on the wall for me, that’s what a human being was. It goes back to Rene Descartes, who is a 17th century philosopher said, we all know what he said,
Dr. Anthony Orsini (18m 38s):
“I think, therefore I am.”
Jonathan Fisher (18m 39s):
So he said, he told her, goes to him. So I was this nerdy kid. Then I was like, yeah, I think a lot. So I really must AMH be a lot. It turns out that he had it wrong, Descartes had it wrong. And what I realized slowly is that it’s not, I think therefore I am. It’s I feel therefore I am. And I know that. And I started to learn how to feel and to label and recognize and notice feelings in my body. I started to recognize this whirlwind. The is often a storm of thoughts in my mind, leading me into very unhappy dark places. And I realized that the root of all of my own suffering as a doctor and more was in my own mind. It was purely the thought’s in my mind.
Jonathan Fisher (19m 20s):
And there was another piece of the puzzle and that was my body. So stress. We can talk for a long time about stress. And I see it every day, about 70% of my patients in the cardiology clinic are suffering from some form of stress. And they either do or don’t know it stress lives in the mind, but it also lives in the body. And so I read that yoga had therapeutic effects. So I’ve started doing yoga and I’m an overachiever, right? So I started going on retreats and weekends here and there. My wife was like, what are you doing? What’s is yoga stuff. So I would fly to Boston by myself for a weekend and learn from the best teachers. We would start going on meditation retreats for a day to days, three days, seven days in a silent Zen monastery.
Jonathan Fisher (20m 3s):
And so over 10 years, Tony, I started going deeper and deeper thousands of hours of just sitting quietly, moving slowly, noticing what was happening in my mind, body and heart. And that was the beginning of the end of my journey. And that’s going to be the rest of my life on that journey. Meanwhile, part of it was I came back to work and in 2012, I said, I gotta start sharing some of this, but like you, I’m sure of that. Sometimes when you’re teaching, you’re benefiting as well because its cementing your knowledge and learning, and it’s therapeutic for you in a way when you help other people learn to communicate better. So for me, I came back in 2012 to my hospital and I gave a medical grand rounds and it was something that people weren’t talking about so much it was called Mindfulness and the Heart.
Jonathan Fisher (20m 47s):
So what’s the Mindful is that eight years ago I did all the research, I said, Oh my gosh, this is not some crazy 3000 year old thing where people in robes or floating off a pillow, or this is stuff that’s actually helping prevent heart disease. So it turns out five years later, 2017, the American heart association comes out with a position statement, look at it. It was a meta analysis and it said we endorse meditation as an adjunct to treating cardiovascular disease. So for me, that was an incredible validation that this stuff that had helped heal my own anxiety, depression, et cetera, was helpful for patients. So perfect combination for you.
Jonathan Fisher (21m 27s):
It was a combination of, so what I recognized was that not only more of my patients struggling with stress and all anxiety and broken hearts, but my colleagues would come up to me after talks and after I would speak out and say, Hey, can I get some of that? I’m really having a hard time. I’m burning out. What is that? And so I just started teaching meditation here and there. Eventually I spent the week at Oxford in the UK a couple years ago when I’ve got certified as a Teacher people in my own organization where we have 30,000 employees said, we’ve heard about this Mindfulness thing. Can you share some of that? And that was about three years ago. And since then in my spare time and the organization is supported me, I’ve put it on about 40 programs for close to 3000 people live.
Jonathan Fisher (22m 13s):
This was before COVID and now starting in June, I’m going to be spending 40% of my time at an organizational level, not just talking and teaching about the skills of mindfulness, but specifically teaching compassion. I do a lot of work in communication because I believe that so much of what’s broken about our healthcare system is broken relationships, disconnection and all of them. So between administrators and physicians and nurses, physicians, and patients, and I really believe that the core of all healthy relationships and organizations is communication. Communication is the relationship, not just verbal communication, nonverbal communication.
Jonathan Fisher (22m 57s):
How do we show up with our bodies? And so I then discovered that Mindfulness has a lot to say about communication.
Dr. Anthony Orsini (23m 5s):
Well, I’ll tell me about that. What does that elaborate on that?
Jonathan Fisher (23m 10s):
So even in the 1960s, there is a man named Marshall Rosenberg who is, I believe in Detroit and there was a race riots and civil unrest, an injustice going on. And he developed this technique called nonviolent communication, which was based in being aware of what’s happening in your own body and being aware of your own thoughts and feelings. And since then, The a lot of experts in the West, namely among them and an amazing person named Oren, J Sofer who wrote a book called say what you mean he described at this skill have Mindfulness, which anybody can learn. It improves your ability to communicate the way it works is we could talk about communications all day.
Jonathan Fisher (23m 53s):
And I know that that’s what you love to do the way I see Mindfulness being helpful is that a lot of the problems with communication are that we’re trying to tell were busy telling people things based on our own thoughts, what we think is right. And not enough is about feeling what is the person we’re with is feeling right now. So right now Tony, I’m looking at you on the screen and I’m looking at your eyes, I’m looking at your face, I’m looking at your body posture, trying to see how are you receiving this at the same time? Tony part of my mindfulness practice is as I’m speaking, I’m feeling the air move through my lungs. I’m noticing whether there’s any tension or tightness in the middle of my chest or my low abdomen to tell me, how are we connecting here is my message coming across clearly.
Jonathan Fisher (24m 41s):
So this is part of just a small piece of what the mindfulness practice does to inform my ability to communicate it. It helps me be present in my body so that I don’t get so carried away in my mind when I’m speaking. Does that make sense?
Dr. Anthony Orsini (24m 56s):
It makes a lot of sense. And we talk about physician burnout and then when I teach communication and I say all the time, physicians believe that our job is to just give out information that this is the way we’re taught. Like you need to educate the patient and I’m going to sit here and I’m going to do a great job because I am going to spend 20 minutes talking about congestive heart failure. And I’m going to tell you down to this cellular mechanism about what happens. And as I teach it, and it’s been 10 years now, and I’ll say, what was the point of your interaction? And nine out of 10 times positions, I want to provide all the information. And then I jokingly say to them, why didn’t you just hand them a Google doc? If it’s about Information you can print out a PDF, you can give them a book on it. Of course it’s about Information, it’s our job to educate.
Dr. Anthony Orsini (25m 39s):
But it’s also about building that relationship with that patient one-on-one and more and more data, as you said, is coming out that shows that if I can connect on a human to human basis with my patient and part of that, as you’re speaking, I’m thinking if I could understand my own body and what I’m going through with Mindfulness, I’ll be better at understanding what they’re going through and my patient and I are going to connect. And we’re gonna form that real relationship. And studies have shown that if you have a trusting relationship with your physician, you’re more likely to take the medication. You’re more likely to follow the therapeutics. You are more likely to follow up and you have better outcomes.
Dr. Anthony Orsini (26m 19s):
And so one of the failures of medicine has been to tell physicians that their job is to educate. And it is to a certain extent, but not their number one job or their number one jobs was to build trust. As you were speaking about understanding your own body, I was thinking about how important that is. And then we also have to fight the 100 years. And in my book I talked about the year 1912 and how that was a big turning point of medicine. We have to fight almost over a years of saying, Doctor, don’t feel your job has to be a robot to give out the information. And if you feel any emotion at all, you should fight it. And tell me if I’m wrong, but that must cause amazing stress.
Dr. Anthony Orsini (27m 2s):
When you feel like crying or are you feel like being really sad and you have that medical school professor who said to you stop that don’t do that. And then you go home and you’re feeling really dissatisfied with yourself, correct?
Jonathan Fisher (27m 14s):
Tony, you just gave a masterclass at what you said. And so many things that I agree with you. If I can go back to the first thing that you said, you talked about how we are so busy telling our patients that as doctors, we think that’s our job. It’s something that really changed. The way that I practice was I was talking with a psychiatrist friend of mine and he said, you know, the data, the data on anti-anxiety anti-depressants and all of that. So what are you talking about? He explained that the majority of the benefit that people get in terms of healing, whether it’s the mind, whether it’s the body is not the pills, it’s not the medication. It’s the therapeutic deep trusting almost I’ll say a loving relationship that either does or does not exist with their physician or nurse.
Jonathan Fisher (27m 57s):
That was radical for me. It was against everything. I had never learned that in medical school, nobody ever taught me. I was so busy teaching and proving how smart I was Information does not heal people. No it does not, I really want it to linger on that point. Because for me, once I was convinced of that, it was like a no-brainer Oh my gosh. If I can start to be, first of all, heal myself enough so that I’m not thinking about the next patient and the last patient and the patient who died. And I can be fully here for you. When I walk in the room, if I can regulate my own emotions, first of all, then I can connect with you and make you feel heard and seen and understood as a patient.
Jonathan Fisher (28m 39s):
And maybe, and this is controversial. Maybe even feel loved a little bit by me maybe Tony, I know as a cardiologist that there there’s research that we can talk about the research on Compassion’s effects on the human heart and blood vessels. I know that’s more powerful than any drug I can give you.
Dr. Anthony Orsini (28m 57s):
Absolutely. And then if you do feel some emotion because your patient is dying or are you just made it a critical conversation, breaking bad news, and you understand that it’s okay. You let it happen. Yep. And then when you go home at night, and this was the problem is that a lot of physicians have the second victim syndrome that we need to go home at night. You’re not kicking yourself saying I let myself get upset. Why do I let myself feel that emotion? I should’ve stayed stoic. Why? This is over a hundred years of misinformation. And so I love that let’s understand our body and what’s going on right now.
Jonathan Fisher (29m 29s):
And I can say one more thing about that because I didn’t get to the second part of your question about what happens if we don’t allow ourselves as doctors, if we go around like robots, like I spent 20 years, like a robot, like a brain on stilts, these emotions, some of them are traumatic emotions. When I saw my first patient die, he was 24 year olds who came in with a cardiac arrest. And I think did CPR for, I don’t know how long I never processed that. Tony. I carried that I’m not in my mind, but I carry that in my body. And we know now about trauma that the whole field of trauma was wrong for a, the trauma or the way we heal from emotional stress as doctors is, we should just talk about it. It just tell the story is over and over about all the bad things that happened.
Jonathan Fisher (30m 13s):
That’s not it so much of healing now from post-traumatic stress in what they call it. A second victim or vicarious trauma. Secondary stress that Susan Wilson was talking about is that we have to work with our bodies. Maybe moving our body is stretching our body’s. We hold the emotions in our bodies. We know that now that’s what, that’s why they called feelings. Cause we literally feel them and our body. And so I don’t want people to think that the work of healing ourselves as physicians from burnout is all about thoughts in the Mind and working with anxiety and stress. That’s a big part of it. Another part of it is learning to be with and work with feelings in our body to loosen up the things that we’ve been holding onto for so long.
Dr. Anthony Orsini (30m 53s):
And this applies about 60 to 75% of my audience is in the health care in this podcast. But we have a growing number of people in the business world. And if you’re listening to this podcast and many of you have been very loyal every week. And I appreciate that. I want to say, thank you. If you’re listening to this podcast and you’re saying, okay, I’m not a doctor or a nurse, does this have to do with me? And my answer is this has a lot to do with you because you need to know as a patient, what you should expect, how to choose a doctor. And I have had many friends, I’m sure a Jonathan you’ve had too. Call me and say, Doctor told me This or they say it to me. You said this to me yesterday, Dr. Orsini and my cousin just called me the other day.
Dr. Anthony Orsini (31m 36s):
The doctor told me this, but I Googled and it said something else. My answers are always the same. Either your trust, your physician, or are you don’t and it’s OK to be an informed patient. But in the end, if you have that trusting relationship with your doctor, you’re not going to listen to Dr. Google. And Dr. Google is very good. I don’t wanna say anybody who shouldn’t be an informed patient, but it really comes down to that. And if the doctor is himself or herself, if the doctor is tuned in a mindful, lets them feel emotions, bond, there is a genuine person. Your going to read that Google document. And you’re going to say, I know it says this, but I trust Dr.
Dr. Anthony Orsini (32m 19s):
Fisher and that’s what medicine is all about. It’s about human to human. So if your thinking, why am I listening to this podcast? Because I’m not a physician or nurse the answer Is it even more important to you? Because you’re going to go to a physician and you’re going to say, I don’t know. I just didn’t. I didn’t feel that there was no relationship there. And I don’t know if I trust him. And the answer is that’s fine. He may be a great doctor, but find somebody else. And if you’re a Physician out there, as we increase the patient experience, the importance of it, you’d better learn how to do this. You’d better learn how to communicate. You better learn how to build trusting relationships because patients or our consumers now patients want more than a smart Dr.
Dr. Anthony Orsini (33m 0s):
Being a smart doctor is, is assumed. The rest of it is all about loyalty and same thing with a hospital. If you’re a hospital administrator, or if someone goes to your hospital and it doesn’t feel that they had a good experience there not coming back. So they take home messages here and find a doctor who is able to understand them, build genuine relationships. So the only thing I’ll say is there is a, you were talk about mindfulness and understanding yourself. I don’t know if he, if there was a guy named Garrett Kramer. And Garrett Kramer, or if you call them the sports psychologist, he would get angry with you. And he’s at Jersey boy, and I’ve met him several times. You wrote a book called Still power and he talks to the highest level sports people, Derek Jeter, big time sports people.
Dr. Anthony Orsini (33m 46s):
And he talks to them about how he only internal factors affect you your emotions, external factors don’t affect the emotion. And I met him a few times and he told me a story one time about Derek Jeter. We’re going off on tangent here, but I got to tell you this because its amazing. And there are a leader, went struck out three times and he made an error in the ninth inning. You put the other teams ahead and at the bottom of the ninth he had to back. He led off and you get to a home run and they win the games. And the reporter says to them afterwards, how hard is it to get your mind ready to get up at the plate five minutes after he made the game-changing error in the field. And this is a great story. Derek Jeter looked at the reporter and said, I don’t understand the question what fielding have to do with hitting?
Dr. Anthony Orsini (34m 35s):
and it’s a great example of 99.9% of us would be upset, if we did this upset to the point that Garrett teachers’ and I highly recommended this book. He is awesome. Is that your feeling from that error when it comes from inside and these right, the fielding has nothing to do with hitting and the highest level that people can think that Way most of us can’t though. So just a great story that we want it to share it with you. So I thought that it was great.
Jonathan Fisher (34m 58s):
That’s amazing. Tony that makes me think of two things. One is the, the whole series of books called the inner game, write the inner game of golf. It’s all about that. Its about if we can master our ability to know where our attention is going and then choose where we put our attention. And that includes not just on the golf ball or the baseball, but also in the boardroom or is it on something stressful that happened yesterday? Or can I be with you right now, Tony? So that’s where Mindfulness also, it comes back in again. Mindfulness is not some mystical thing. It for me, it’s, it’s a way of training attention. This is what it is. And there are parts of the brain in this singular cortex frontal cortex that literally get stronger. The more we do these practices and it allows us to do exactly what Derek Jeter did, which is he was able to let go of something that may have been a memory of being in the field that may have been the guilty feeling of making a mistake.
Jonathan Fisher (35m 51s):
All of those swirling emotions. Part of what these practices have allowed me to do is to let them just drop them. Just let them go so I can be fully present with you and meet your needs. And then you asked, how is this relevant to people outside of medicine? I was asked to speak at IBM’s global conference about six weeks ago, just to give a keynote on leadership. And there’s incredible. Tie-ins these practices. Number one, to be a physician who’s fully present with a whirlwind of COVID going around us life and death situations for you It’s parents who maybe have lost children. For me, it’s loved ones whose family members are at life and death or looking at someone in their eyes while they are dying.
Jonathan Fisher (36m 32s):
If we can learn to do that and to regulate our emotions and feel our emotions and still be human, that’s a skill that applies to any business anywhere in the world. And I found that they were very interested in how do you lead from your heart? We talk about the here a lot now about human centered leadership, heart centered leadership was a cardiologist. I know what happens in the heart when we’re leaving and it can be very stressful. It can be very lonely and there may be a tendency to isolate ourselves and to pretend like we’ve got it all together. And there are ways to be more vulnerable, to be more human that people actually find it appealing and they want to be on your team. It’s just the opposite of what we thought.
Jonathan Fisher (37m 13s):
So incredible usefulness outside of medicine. And then last week I spoke at Merrill Lynch, giving a keynote there for their financial planners. I said, how could I help you guys? And they said, you know, so much of our business is our relationship with our clients. And if we lose that relationship, we lose our livelihood. And I said, this is it. This is what we do as doctors. This is what mindfulness allows us to do. This is what communication, when you really study communication, not just read five bullet points, but go deep and you can develop the skills to become a master communicator so that you don’t lose your clients so that people want to work with you. So what were talking about, I personally believe has implications, not just within medicine, but beyond Medicine as well.
Dr. Anthony Orsini (37m 58s):
Absolutely. During the last few months, most of my lectures have been non-healthcare lectures have been with companies who their human resource department wants to know how to give bad news. Their leadership wants to know how do you have that difficult conversation with an employee who’s not doing well and the skill sets a skillset. And really that’s how it came up with a title for this podcast. Lessons I learned as an ICU Physician because if you can have those difficult conversations, if you can tell someone that they’re baby has a major bleed in the brain and is going to have lifelong deficits and you can do that and still form that relationship than I can teach a leader, how to get that kind of employee engagement that he or she is looking for also.
Dr. Anthony Orsini (38m 44s):
So there are so many different parallels in this and so that’s great. No, this is a difficult conversation. So I’m going to finish up a couple questions. The one that I always finish up with, but the first question I wanted to ask you is, OK, so I’m out there and listening to this, I’m a physician, I’m a nurse, a business person I’m feeling burnt out. I’m feeling depressed and feeling like, Oh, this is not working for me. I’m not coming home fulfilled the first conversation has to be a conversation with yourself. So can you give us any advice on that and then, and where do I move from there as well? So let’s say I’m a physician out there and, and I’m feeling all of this, give me some advice on how to have that conversation with myself and then move forward.
Jonathan Fisher (39m 24s):
I love how you said that that the first conversation is with ourselves and there’s something called self-talk. It’s also called the inner narrative. And many of us don’t even here that we’re so busy with our I-phones and with ah, watching the news, getting into arguments. Well, we can’t hear that inner narrative, but to do the work and to start to heal ourselves, we have to slow down and you have to get quiet at least for three seconds or a minute to start to hear the thoughts that are actually going on about 80,000 thoughts a day Tony and about 60% of them are negative. And about 60%, at least are repetitive from yesterday. So I would advise anybody listening, who is dealing with that stress. I know it’s hard because we’re so used to being active and on all the time, give yourself permission, but just be alone for a few minutes, take away all distractions, put your phone in the other room, turn off the TV.
Jonathan Fisher (40m 16s):
Just sit quietly. Don’t think about your patients. Don’t think about the job just to watch your breath for a minute or two. Just notice what it feels like in your body without judging it. So that’s the first step is doing the opposite of what we’re used to doing, which is racing around all the time. Like a chicken with our head cut off to give yourself that time. Number two remember that we always have a choice. We have a choice of whether to believe certain thoughts that are going through our mind, like the burnt out Doctor or the stressed out business person there saying, what’s the number one thing that I can’t do this. I can’t handle this. It was too much. I’m overwhelmed. So really the first step is to realize that that’s actually a thought.
Jonathan Fisher (40m 57s):
It’s not a fact. And so if we recognize that we’re suffering, we are struggling because we are believing something that’s coming from our own mind. Hey, I have a choice. My choice is I don’t have to believe every little thought that comes into my head. I can choose other thoughts. If I say the thought is COVID is so overwhelming. I can’t take it anymore. And worried about my family and kids getting sick. I could have another thought. And the other thought Tony it could be by choose to believe that COVID is going to teach us a lot of lessons as a society is going to teach us how we are all connected as a world. How despite all these differences, as we want to put up black and white and a Republican and Democrat, we are all human beings. We’re all vulnerable. And we all bleed the same blood.
Jonathan Fisher (41m 38s):
So that can be another way or another thought that I chose to have instead of what it was me. I can choose to have a thought instead of woe is me, but I’m not alone here. Hold on. I’m stressed out right now, but there’s a million other people just like me having the same worries. Oh my gosh. I am not alone. So for me, that’s really the most important part is recognizing the number one. We have a choice about whether to believe every single thought going through our head and wo giving ourselves permission, to slow down, to feel whatever we’re feeling. It’s okay to feel sad, stressed out, afraid, just start giving it a name. Just start labeling your emotions. Oh, it gives us a little objectivity.
Jonathan Fisher (42m 18s):
So much of our struggling Tony. And for me personally, it was, I didn’t even recognize what was going on. I just was so busy being anxious and depressed that once I learned to call it what it was, which was, Oh, this is what it feels like to be anxious. It created some distance between the emotional state and my mind. And in that distance, I was able to start to say, this is just a feeling in my body right now. And I’m not really falling apart so we can go further. But the first step is remembering that choice we have and our thoughts and disconnecting just a little bit from all the stress that’s going on.
Dr. Anthony Orsini (42m 54s):
That’s fantastic. There’s so many parallels between you and me. We’re both dedicated physicians and I love my job and I’ll stop, but we’re both on never stopped, but we’re, we’re both so passionate about helping other people. And I said something to someone many years ago and I said, you know, I saved lives and babies are just, as you do all day long. And yet the work that I do with teaching communication and teaching physicians, how to bond and build those relationships to me is the most important thing that I’m doing and that shocks people. And then when I elaborate and at the same thing with you is every physician is going to have 200 to 250,000 patient interactions before they retire.
Dr. Anthony Orsini (43m 39s):
And so if you and I together can somehow improve those patient interactions, make the patients and the doctors be able to bond the ripple effect on a individual basis on a train, almost 10,000 people do the math. That’s a lot of patient interactions and boys that really fulfilling for me. And I can tell from your face, this is not something that you’re doing just as a side gig at, this is something you believe in and do you want to do this? And there’s an excitement in your voice. And I totally can relate to that because the same thing happens with me. It’s like that you have this information that you just found the source of gold and you just am I right? And I feel the same way, or like I have found this step in the fountain of youth.
Dr. Anthony Orsini (44m 20s):
And I want to tell somebody, so please listen. And so I think this is going to be a great format for people to get out and add here. And right now I know that you were touching certain people that are listening to you, both in business and in healthcare. And they’re going, you know what, this great. Maybe they’ll at least start by going to their room and shutting off their phone. And I think that would be a major step Jonathan. I finished every podcast because I know you listen with the same question and it’s usually people hate me for it because it’s a difficult one. Share with us your most difficult conversation either that you’ve had personally or that you have on a regular basis.
Dr. Anthony Orsini (45m 2s):
And give us some advice about that tough one, huh?
Jonathan Fisher (45m 6s):
It’s a tough one. And if I’m going to be honest, the most difficult conversations happen at home and they happen with my wife and they happen with my children. And the most difficult conversations often happen when I am feeling angry or frustrated, or I find myself behaving in ways that I’m not proud of. You know, I pride myself on being kind and empathic and compassionate and yet Tony, I still, even after a thousands of hours, I still find myself acting like a jerk. I act like a jerk. What a person in his right mind, what a father would ever yell at his children.
Jonathan Fisher (45m 50s):
And yet I do that sometimes. And so for me, the hardest conversation is twofold. One. It’s the conversation now that I know to have with myself when I’m about to yell or just afterwards. And it’s a conversation that looks and treats myself as if I’m just another kid and try not to beat myself up and, and giving myself a little permission to say, you know what? You really mess this up. But if you’re a human and you’re trying and you really studying this stuff and you’re trying to be better. And then the other half of the conversation is to say to my son, if I’ve yelled or if I’d been a jerk, I said, look, I just behaved in a way that it is, I’m not the father that I really want to be for you. And I really am committed to working on this with you. Can you be patient with me?
Jonathan Fisher (46m 31s):
And can you share with me what it’s like, what it’s like to be with me when I’m like that. And so that’s my most difficult conversation. And it’s one I’m, I’m sad to say, but I’m realistic. It hasn’t just happened once it, and it’s going to happen again. And I get a little better each time.
Dr. Anthony Orsini (46m 45s):
If it happens to all of us, I think that’s great insight. And it makes you feel any better than my wife will tell you that men really never do grow up. That were just big boys. And I’m sure your wife probably, he says the same thing. We really don’t know. Even for birthday presidents on holiday presents, we’re always asking for a cool gadgets. Like were still a little kid. You know, Jonathan, this has been a really very revealing, you’re so easy to speak to. This was one of the easiest podcast interviews I’ve ever given. And I want to thank you for that. What’s the best way before we close. I’m sure you hit a lot of people in the heart, wink, wink, what the double meaning there, but what’s the best way for someone to get in touch with you if they really need more advice, or if they really want you to speak as the best way to get in touch with you,
Jonathan Fisher (47m 33s):
Just remember a happy heart MD and easy to remember. That’s who I am. And that’s also what my mission is to help people live with Healing their hearts and also happy hearts. So if you go to happy Heart md.com. That’s my personal website. I have a YouTube channel. It’s happy. Heart MD Oh, I love connecting on LinkedIn. I’m just by my name or a Google happy Heart MD. And there you’ll find online for physicians and people in health care. I have started a global Conversation for ending physician burnout. And so if you look up ending physician burnout, there’s going to be a couple of summits that are coming up as well for that. And I’m also on Instagram.
Dr. Anthony Orsini (48m 9s):
Love it. That’s fantastic. And we will put all of those. Like I say, if you’re driving, I don’t want you to stop and write this down. So I’ll put this on the show notes. They’ll be links to Jonathan and how to get in touch with him very easily. If you like this podcast, please go ahead and hit subscribe. And I’m going to ask my listeners to do something else. And every one of you, you go out five or 10 of your friends and say, Hey, I just heard of this amazing podcast with Dr. Jonathan Fisher, here’s the name of it hits subscribe. We are available on everything, but I’ve been so blessed to have amazing guests the way I get amazing guests now, Jonathan, and it wasn’t that case. We just kinda hit it off from the beginning. But a lot of guests that I try to get one to know how popular my podcast is.
Dr. Anthony Orsini (48m 53s):
And I’d been really lucky that I hit top 100 right away in Medicine. And yeah, I’m really excited about that and we’re moving forward. But if you like this podcast and you want another amazing guest and another amazing guest, let’s just say to yourself, Hey, it’s free. Tell your friends it’s free. It doesn’t cost anything hit subscribe. If you leave a review that even helps more. It looks like on begging here. And I’m not begging. I would just go ahead and just spread the word is what I’m saying. So go ahead and hit subscribe. If you want to get in touch with me, I’m always available at the website. The Orsini Way. com, Instagram, LinkedIn, et cetera. Go ahead. I’m big on LinkedIn. That’s when I met Jonathan. So please go ahead, Jonathan. Thank you. And you had just been amazing and I hope people get in contact with you because you’re services that are really well needed.
Dr. Anthony Orsini (49m 39s):
Well, thank you. ,
Jonathan Fisher (49m 42s):
Tony was a pleasure. Thank you.
Announcer (49m 45s):
If you enjoyed this podcast, please leave a comment or review. To contact Dr. Orsini and his team or to suggest guests for a future podcast, visit our website The Orsini Way.Com.
Dr. Anthony Orsini
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