How to keep your optimism in medicine [PODCAST]

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“Interviewing for medical schools was intense, excruciating, and terrifying. Despite the difficult questions, there are three that stand out to me. The first was to differentiate sympathy from empathy, where I spent 30 minutes defending my answer to be met with complete silence. He could have asked me anything, yet he sat in silence for almost my entire interview and asked me to explain emotional differences between two incredibly similar words. Or are they? I have been left to contemplate this repeatedly, and I have come to realize my first medical school lesson happened before I was even in training. That day, he taught me to see how we as physicians need to examine emotions, become aware of our capacity to both feel and heal, understand our patients, share their struggles and triumphs even if we haven’t walked in their diagnoses, and take the time—even if it is painful and met with silence—to realize the gravity of our position is not only responsibility for people’s lives but to be emotionally available.”

Erika Visser Aragona is a family physician.

She shares her story and discusses her KevinMD article, “The life cycle of emotion in medicine.”

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Hosted by Kevin Pho, MD, The Podcast by KevinMD shares the stories of the many who intersect with our health care system but are rarely heard from.

Transcript

Kevin Pho: Hi, and welcome to the show, where we share the stories of the many who intersect with our health care system but are rarely heard from. My name is Kevin Pho, founder and editor of KevinMD. Today on the show we have Erika Visser Aragona. She is a family physician, and she wrote the KevinMD article “The life cycle of emotion in medicine.” Erika, welcome to the show.

Erika Visser Aragona: Thanks, Kevin.

Kevin Pho: So we’ll get into the article in a little bit, but first off, can you share your story and journey to where you are today?

Erika Visser Aragona: I’m a family medicine doctor. I always knew I wanted to go into that. I love taking care of the whole person, and my journey to medicine started really young. I was 12, and my dad was diagnosed with melanoma, and I was actually the one who found it. It was really tough being a kid and not understanding disease and how to handle that, how to treat it. So I started writing right away to explain my emotions and kind of understand the process of healing, and I decided to actually major in English literature because of that. So instead of just doing pre-med, I really embraced the writing aspect and getting into kind of the depths of why we do what we do instead of just doing it.

So I published a book in college called “A Certain Innocence,” and it talks about emotional medicine. It’s poetry, and it blended what I saw as a student shadowing, but how I didn’t understand it, because I was still naive and I wanted all of this hopefulness in medicine, and I was so optimistic. Right? The biggest thing is, we all go into medicine because we love patients. We’re going to fix the world, and that’s what I thought we would do.

So I decided to go into osteopathic training because I love the whole-body approach. I love how they were holistic and embraced a whole body, mind, and spirit philosophy. But I love traditional medicine too, and so I chose to train in a dual residency with allopathic and osteopathic training. It was awesome, because I got to blend all of my background with the traditional side as well, and sitting for both boards and seeing how similar they were, training with DOs and MDs right next to me, it was really nice to see our similarities and come together. So now I’m an attending physician in Boise, Idaho, and I teach women’s health studies at the local medical school, and that’s really where I found my passion.

Kevin Pho: So with your background in English literature and your writing background, tell me how that has helped you during your medical journey and education and as an attending.

Erika Visser Aragona: It helped a ton, because I wasn’t always as positive. I think we have to put it in perspective. Med school’s tough. I mean, it’s dog-eat-dog. You’re really in an isolated situation a lot of the time, away from friends and family. I had no idea what was going on in the world. You’re just cramming every day, and you lose a sense of self a lot. So I didn’t write at all in med school. I just didn’t have time. And I think if you even talk to the people I trained with for residency too, you develop this tough shell out of self-preservation. We kind of have to.

So it was really about getting out on the other end and seeing all these travesties, of seeing a patient die right in front of me, being the person to call the code and feel the breath slip away right as a patient dies under my hands. That’s hard. That’s stuff we don’t prepare for in medicine at all. And I came out and had that arrival fallacy of, “OK, I’m done. The hard stuff’s over. I’m going to start my practice,” like we all do, with this hopefulness. And yet there was still this void. I was still kind of empty and searching for something.

So I finally had time again to start writing, and that’s where I’m so grateful that you’ve published some of my pieces, and I’ve put them out in local news media too. I think that is really where I found my passion again, in reaching the community in a relatable way, talking to patients as if they’re our friends and they’re not just our patients, and writing about their stories and writing about my own. So when I talk with them, we’re friends. We’re not just patient-physician.

And it opened up a huge door too. I mean, the satisfaction that I felt was huge and tremendous and palpable, and it wasn’t just patients feeling a sense of being listened to and having their emotional troubles also taken care of instead of just their physical ailments, but it completely changed the way that I saw my life. So choosing this positivity and the cheerfulness in medicine that I talk about so much, and broadcasting it on media, has really been lifesaving for me. It’s changed the way that I practice day to day.

Kevin Pho: So many physicians share their stories on social media sites like KevinMD and on this podcast, and it’s just been fascinating listening to all their stories. Sometimes physicians are a little bit hesitant when it comes to writing. They may say, “I’m not good at writing. I’m not good at finding my voice.” Now, with your writing background, what kind of tips can you share with other clinicians who may be listening to this on how they can find their voice and how they can articulate themselves in writing?

Erika Visser Aragona: Yeah, that’s a great question. I think you have to be raw and unfiltered and genuine. The best pieces that I put out, I don’t really think about them. I sit down and I just write what comes to mind, from emotion and from my heart, and genuinely. I think that’s what we’re trying to convey to patients, our family, and ourselves anyway. So when you get in your head and try to write this wonderful piece, it never turns out right. But when you just express how you’re feeling and your emotion, I think everyone would be floored by what they produce, because that’s the material that we want to hear. That’s what people want to see.

When I’m on the news and I’m reading scripts, and I feel like I’m kind of just saying what I have to say, it doesn’t feel authentic either, and I think viewers can see that. So I love changing it to a realistic approach, and really my passion is being relatable and being that doctor that people want to talk to, because it feels like you’re talking to a friend. You’re not in an office scared to ask your questions or often intimidated, because a lot of times what we’re talking about is hard. Medicine’s not cheerful. Medicine’s not always happy. Most people come to see us when they’re dealing with something difficult or they’re upset. It’s our job then to put a positive spin on it, to make them realize that they can talk about anything. It doesn’t have to just be physical. It can be their fears, their emotions, their struggles, and that opens up so much more of healing.

So the same thing goes for writing, and that’s where I started actually teaching medical students and allowing them to have writing assignments with me. I say “allowed” instead of “encouraging,” because they enjoy it. It’s fun, and we talk about, from day one, how to use a stethoscope. I teach them how to use their otoscopes, and it’s fun. But we also talk about the emotions, that excitement from the very beginning that you and I felt, where we both were so excited to be doctors, save the world. Why can’t we feel that way? Why can’t we be optimistic and never lose that?

So when I wrote the last piece with you, I talked about how I went from super hopeful, optimistic, and almost got shot down during my interview, because the physician was like, “That’s not realistic. That’s not what medicine is.” And it kind of made me sit back and say, “Wow, am I going into the career that really is meant for me if this is my personality?” And then I lost it. I was closed off, protectively keeping myself from getting hurt from all of the death and harm and hurt that I saw through my training.

So what I’d like to do instead is write now about how we can try to never lose that in the first place: encourage students to feel their voices, accept their emotions, allow themselves to cry and feel and heal with other residents, with other patients, with other doctors, because that’s what medicine is. It’s an art form. It’s not just a science. We are scientists, but we’re healers, and that means taking care of all aspects of ourselves emotionally, as well as patients.

Kevin Pho: So you talk about your last article. It’s titled “The life cycle of emotion in medicine,” and you told that story where you were interviewed by that physician, and he took a less optimistic perspective when it came to medicine. Now that you’ve been in primary care for a little while, and in primary care, let’s face it, it’s a very difficult job, how are you able to maintain optimism through all those obstacles that we face as primary care clinicians?

Erika Visser Aragona: It’s hard. It’s a daily choice, and I think that’s what my message is to everyone out there. It’s not easy. We still deal with really tough cases, really hard patients struggling with disease and death and morbidity all the time. So it’s a conscious choice to put a positive spin on it and be optimistic, and hug your patients when you can, smile with them, talk to them about what makes them them instead of just their disease.

And I’ll be honest, there are days that I still struggle. I mean, you have to be realistic. Medicine is not all fluffy. I wish it was. I would love for our field to be happy all the time. It’s not. But we have an honor to serve patients in probably the hardest times of their lives by helping them just have support. So if you can be positive for them, even if they aren’t, I think that radically improves their overall care as well.

Kevin Pho: Now tell me a story of a time where you were faced with a challenging obstacle or a situation, and you made that conscious choice to put a positive perspective on it, and that helped you going forward. Can you share a specific example of when that happened to you in the past?

Erika Visser Aragona: Yeah, absolutely. It actually happened about a month ago. That was a previous article I wrote for you, talking about how sometimes I really hate my job, and I like to use really aggressive emotions, because I don’t think we can just say cheery, happy-go-lucky. Sometimes I hate my job. I had a patient who was mid-30s, late 40s, and everywhere in between, where I do a lot of women’s health.

So the patient that I wrote about in this last article was young and suddenly had a breast lump, and I did an exam and felt like everything was hopefully OK, but we were going to get some diagnostic imaging, and hopefully it was cystic or nothing concerning. And unfortunately, it came back a pretty aggressive carcinoma, and we weren’t expecting it. And I had to make that phone call, and that’s the time where all of your training hits you, and you think, “How do I say this scientifically and give the facts and be quiet and let the patient absorb it?”

But I knew this patient well. I had been taking care of her for years. So when I delivered the news, I paused just to hear her reaction, and then told her I was right there on the other side of the phone listening, and I wasn’t going anywhere. And we talked for about 10 minutes about how she felt about the diagnosis, what her emotions were, how she was doing. Her husband came home. We got him on the phone, and we talked about how we’re going to work together instead of just fighting a disease, and a scary thing, very scary to tell someone over the phone, what we’re going to do to work together, and that at any point she could call me again. And we talked about her goals and her strategies in her life, not her treatment, and I think that changed the tone.

At the end of the call, she felt hopeful and positive that we had a treatment plan, but she was still allowed to go out and enjoy the rest of her day and her afternoon walk that she had planned with her husband. Life continued. It didn’t stop with the bad news. It was the next step. How can we keep positivity and keep your optimism in this difficult situation so that your outcome can hopefully be the very best one possible?

Kevin Pho: We’re talking to Erika Visser Aragona. She is a family physician, and she wrote the KevinMD article “The life cycle of emotion in medicine.” Erika, so for those primary clinicians who are out there, let’s say we’re talking to our 25th patient of the day, we’re running an hour behind, and we step into the exam room with that 26th patient. What are some actionable tips on how we can maintain optimism at that moment?

Erika Visser Aragona: Breathe. Have self-care and self-compassion. We’re not perfect, and we try so hard to be. If patients see you as a real person from the very beginning, you establish that rapport. They know you have families. They know you have external hobbies and interests. They can see you’re tired too. Let yourself be real, and let your patients know that you’re human just like them.

Your patients all have stories, but we do too, and I think it’s a beautiful world when we work cohesively, where your patients see you as just another person, as just another friend, not just a physician, so that when you’re healing, when you’re tired, when you have needs as well, they allow you to feel, to heal, to work with them, instead of expecting you to be completely on point, because we all mess up. We have to be honest about that. But if your heart is genuine, if you’re trying your best, and your patients know that, then I think you’re doing everything right.

Kevin Pho: And my final question: What’s your take-home message that you want to leave with the KevinMD audience?

Erika Visser Aragona: Yeah, we all have the ability to choose positivity. We all do. Our training is amazing, but we need to focus on ourselves. We need to focus on self-care and how we can put a positive spin out there, for not just us, but also our family and our patients.

Kevin Pho: Erika, thank you so much for sharing your stories, time, and insight, and thanks again for being on the show.

Erika Visser Aragona: Thank you so much, Kevin.

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