Love is the strongest medicine [PODCAST]

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“We know this is true in our hearts and minds, but we also know it to be true in documentable terms. Studies have proven that strong, empathic engagement between doctors and their patients increases patients’ willingness to report symptoms and concerns. That in turn improves diagnostic accuracy. Empathy increases patient engagement and compliance. Some studies suggest it even improves survival rates. Connection is a powerful intangible—like family, or love, or hope. So how can a doctor bring connection into the room in the small, often intense increments of time we have with our patients? Often, it’s through surprising secret tools—things like laughter, empathy, and music.

There’s notable science to each. Laughter has been shown to reduce stress and improve immune function. Empathy strengthens patients’ ability to cope with difficult treatments and eases suffering during end-of-life care. And music—wow—studies show music can lower patient anxiety levels during invasive procedures, ease the nausea caused by chemotherapy, decrease pain perception, and inspire feelings of peace and spirituality. And that’s just the medical stuff. On a personal level, listening to and making music together creates a sense of shared experience and kinship. It fires up emotional receptors that otherwise remain dormant. It is an honest, authentic shortcut to connection.”

Steven Eisenberg is a hematologist-oncologist and author of Love Is the Strongest Medicine: Notes from a Cancer Doctor on Connection, Creativity, and Compassion.

He shares his story and discusses his KevinMD article, “Love is the strongest 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 Steven Eisenberg. He’s a hematology-oncology physician, and he’s the author of the book “Love Is the Strongest Medicine: Notes from a Cancer Doctor on Connection, Creativity, and Compassion.” Steven, welcome to the show.

Steven Eisenberg: Thanks for having me, Kevin. I was, you know, a huge fan from our early days on Twitter together, and I’m just super, super happy to be with you and super impressed with where KevinMD is in the world right now. It’s just great. Thank you for having me.

Kevin Pho: Well, thank you so much for following all these years. And we’ll get into your book in a little bit, but first off, can you share your story and journey to where you are today?

Steven Eisenberg: I went into oncology because I wanted to make a difference for people who were super, super scared. I think this is a field where communication, connection, and compassion are one of the most vital of all the things that we do, because when you hear those words, “You have cancer,” your body and your mind go into this post-traumatic stress experience. And I felt like I could bring perhaps a unique skill set in terms of communication and the way I was, you know, learning to be with patients. I thought this would be a good field to really explore the human side of cancer.

The biology and the molecular stuff is incredible. What we’re doing now in how we can cure people and treat people with precision oncology is huge. But I got into it primarily because I was fascinated by the human side of cancer: how we can impact the entire family, the caregivers, the whole milieu of going through this horrible experience. Could I make a dent in that? And that’s why I ended up in oncology.

Kevin Pho: And tell me some of the challenges facing oncology today.

Steven Eisenberg: I hate to say it, but I truly believe that there’s a compassion crisis in medicine right now. And the way that doctors are burning out, left and right, 50 percent of doctors are burning out, and we see it a lot in oncology. We have oncologists who are, you know, very good. You’ve got to have the great clinical skills as an oncologist. That’s first. You’ve got to have that.

But what the research is now showing is that if you take two patients, the exact same treatment, clinical excellence on both sides, but one is delivered with compassion and one is just sort of straight, just the regular, let’s call it sort of flat, the patients who get the compassionate care actually are doing better. There’s new data. There’s this great book that I found called “Compassionomics.” Have you heard of this? There are two doctors out of Cooper Medical, right over the river from Philadelphia, in New Jersey, and they wrote this amazing book about all of the research around compassion over the last 20, 30 years. And now the data’s catching up to what we knew all along: that actually empathy and compassion are not just the soft science anymore. It actually helps, but it helps even more on the burnout side, which we’ll get to later.

Kevin Pho: Now, you mentioned that there’s been a decrease in compassion that may be leading to burnout. What are some of the underlying causes for that, in your opinion?

Steven Eisenberg: Well, you know, I think that we all go into medicine, and you’ve had 400 episodes, I think we’ve all gone into it because we give that answer at the med school interview. You know the answer: We want to help people, right? And it’s true. And it’s anyone. You know, we don’t go into it for the money. That ship has sailed, right? That is not why we go into medicine anymore, or if we ever did in the first place. It’s because we want to help people.

But then I believe it gets drained out of us: the long hours, the stress, the medical records, the insurance battles, the HMOs, having to ask permission. You know, I kid with my patients, “Hold on, I need to ask your insurance permission if I can go get a cup of coffee right now.” It’s crazy.

And, you know, I did see it. I saw the joy of medicine sort of dissipate, slowly but surely, in my own father. I come from a line of doctors. My own father was in family practice in the ’70s. He was loving medicine in the ’80s. But then HMOs started to creep in, in the early ’90s. I saw it. I saw it with my own eyes: His joy, his passion, his fire for medicine was sort of leaving a little bit each day, and it was heartbreaking for me. And so I was at this crossroads when I went into my own med school interview. If I was going to do this, I needed to find the joy and to keep that fire alive.

And was I successful? Not always. I went through my own really serious episode of burnout when I first went into private practice. You know, I trained at Georgetown, a super academic, fabulous program, Lombardi Cancer Center, the greatest training in the world, but there’s no training on what to do when you go out into private practice and you’ve got to beat all your competition. You’ve got to build the most successful practice, and you’ve got to have a full patient schedule, and you’ve got to get them in, get them out, get the medical records perfect, get all the referrals away from your competition. And it nearly, you know, it nearly killed me.

At the lowest point, I was so stressed out, my immune system was so low, and my cortisol was so high that I got cancer. The young oncologist got cancer. I had a super aggressive skin cancer right over my heart, my left chest. I needed a major surgery, a super wide excision. It was pretty aggressive. And here I was, trying to save people, trying to bring the best I could to oncology, and I was now a major victim of burnout, because I had no clue, coming out into practice, how stressful it would be.

And I had to go through this huge journey of rediscovering my own joy, this vision I had even way back in med school to bring love, light, creativity, and compassion to those who need it the most, in my humble opinion, those people battling cancer. And it was the creativity that I decided to bring into the chemo room that not only changed my course of oncology forever but ended up saving me, ended up saving me and my soul as an oncologist.

Kevin Pho: Yes, so let’s talk about your book, where you talk a little bit more about that journey. It’s titled “Love Is the Strongest Medicine: Notes from a Cancer Doctor on Connection, Creativity, and Compassion.” So, Steven, why don’t you talk about some of the things that you did to turn that burnout around? What are some of the specific ways that you changed, and what are specific things that you did in the exam room to change?

Steven Eisenberg: Yes. It’s actually quite paradoxical, it’s actually quite paradoxical, in medicine. You remember from med school in Boston, we’re taught to keep this wall. We’re taught to keep this wall between the patient and the doctor, and to build it stronger and higher and thicker, because, you know, that’s going to somehow protect you from burnout. Well, what the data is showing is it does the exact opposite. The less connected you are as a doctor to your patient, the more risk you have for burnout.

So what I’m saying is to break down the wall. Break down the wall. Actually become more connected to your patient by being vulnerable, sharing your life, sharing what you love to do in your spare time, and actually ask the patient what they love to do. And so how do I do this? I say, “I’m going to treat you like my aunt or my uncle, my sister. Let’s talk like that. What do you love to do when you leave this office, when you get unplugged from the chemo? Where do you go? What do you do? What were you like as a child?”

And it all came to the tipping point when I first brought my guitar into the chemo suite, because I’ve always been a songwriter, Kevin, and I wanted to meld these two worlds of creativity and patient connection. So, yeah, did I get a few stares from the chemo nurses? Were my partners going, “What is he doing?” Yes. But the patients loved it.

The feedback when I brought it in, and I was just making up some spontaneous songs, I’d be like, if I was writing you a song, it’d be like, “KevinMD, he’s the guy, he’s the number one doc on the Twitter now.” And I would just sort of make it up and make up some lyrics, and they started to smile. They started to respond, and they said, “You know what, doc? For a few minutes there, we forgot we were getting chemo.” And so it started off as this pleasant distraction, and then I said, “I’m onto something.”

And so I started writing personalized songs. I would call the patient up and write 20, 30 minutes of notes. I would ask very specific questions, like you asked in this podcast, but I’d ask them, “How did you meet your loved one? What were you like as a child? What were your biggest hobbies? What do you want the world to know on a billboard that you create, and it’s there for a month? What are you going to put on that billboard?” And just these little things turn into lyrics, and now we have a song that helps them battle through the chemo, and it reminds them who they are. They’re not their illness. They’re not their cancer. They’re a human being who’s going through cancer treatment.

And so all of this is a way that I created to just connect deeper with my patients. But again, not everyone’s a songwriter. Not everyone writes poetry. But what I’m saying is any doctor can do this, but you find what it is for you. Do you like to go fishing? Share a fishing story or your pictures from your latest fishing trip with your patient. Go deeper. Connect to your patient on a soul-to-soul level.

In the exam room, what I try to do is realize every day, and it takes practice every day, that we are two souls going through a human experience together. I happen to be the doctor in this scenario. They happen to be the patient. But what I’ve learned is they’re teaching me. My patients going through cancer treatment are teaching me more about life, about being a better human being, a better father, a better husband, a better physician in general, than I could ever teach them about how to beat cancer. Of course, I’m giving them the treatment. I’m giving them all the best I can do. But what I’m really trying to do is give them the best of the human spirit: that together we can fight this, that they don’t feel alone.

And what I discovered, Kevin, was that by breaking down that wall, by being vulnerable in the chemo room and making them laugh and just making up some songs, I noticed my own symptoms of burnout starting to dissipate. After that first chemo concert, I called it, some of that fog started to lift, some of that brain fog, because I felt like I was stuck. I was just going through the motions, and my guitar was gathering dust in the corner. I wasn’t who I said I wanted to be as a doctor all those years ago: “I want to help people.” I was helping people, sure, but I wasn’t doing it using every single thing I had in my heart and my mind and my body. And only when I started to really connect on this deeper level did all the symptoms start to go away.

So it’s actually the opposite of what we’re taught in med school. It’s to go deeper. And what they’re showing, again, in this great book, “Compassionomics,” is that compassion, when you bring it authentically from your heart, actually turns around the burnout. And so it’s not about isolation. It’s not about separating from your patient more; that puts you at more risk. It’s going deeper into the connection. And this is all chronicled in the book.

And so part of this book is really chronicling my own journey from burned-out oncologist to songwriting oncologist. And the patients have loved it, and they’re doing well. And somewhere in the back of my mind, I truly believe that when their mind and their body become this great ally with the chemo, with the biologics, with the immunotherapy, it actually is helping. It is actually helping them. And I think they do better than if it was the same exact treatment just delivered without any compassion.

And so that’s sort of where the book starts. And where does it end? It ends on this: a revolution in medicine, trying to reinvent the doctor-patient relationship, which you guys talk about so much on KevinMD. My favorite articles are the ones where these beautiful human beings who are doctors are sharing their own experiences of burnout and how they overcome it. And, I mean, 50 percent of us, Kev. And then the physician suicide rate is also twice as high as the national average, and we’ve got to turn this around. And I think my book is just a small part of it. But what I’m learning is that maybe, just maybe, all those years ago, I was onto something. The data is actually supporting what I was doing.

But as a physician, you can do it anyway. You can just say, “Hey, Mary, what’s your favorite song lately?” Pull it up on Spotify, sit next to the patient, put your arm on their shoulder, of course wearing your mask, but put your arm on their shoulder and listen to a song together. It’s two minutes. People go, “Well, isn’t that going to take so much more time?” They looked at that in these studies. It didn’t take more time to deliver your care with compassion. It didn’t ruin your schedule. It didn’t.

And so you can do this. Everyone who is listening can do this. The clinicians who are out there: Do the opposite of what you were taught in med school. Go deeper, connect, share who you are, your heart. Share a little bit more about yourself. Ask them a little bit more about themselves, like you would if they were your aunt, your uncle, your niece, your nephew, and you’d be so surprised at what happens. You start to rediscover the joy of medicine.

And obviously, having a scribe was a big deal for me too, because I think you’ve got to have that eye contact. And it was really cool: This woman on this podcast that I just listened to broke down the word “empathy” into the seven huge steps that you need. E was eye contact. M was muscles of facial expression. P, I wrote it down, I forget what it was, but it was just so beautiful how she broke all of these things down. And we can all bring those into the room, and it will turn around your joy for medicine. It will start slowly to turn around your own physician burnout. And we’ve got to be there for each other.

I think what you’re doing is so important, because you’re bringing it to light. And in the 400 episodes, I know you’ve talked about burnout, and these are just tips and tricks that I’ve gone through in my own life. Oncology can be super stressful, but after I started doing this, Kevin, I’ve never had another symptom of burnout. It just hasn’t happened. Am I just getting lucky? I don’t know, but I swear to you, it’s because I’m bringing the guitar in. I’m doing these creative acts, and I’m not just writing the song for the patient. We’re doing it together. It’s a co-creation, because I’m taking their words, their sentiments, their stories, and they’re becoming the lyrics of the song.

You don’t have to write a song, but you do have to get in there and connect at that soul-to-soul level. That’s my humble opinion, but I’m telling you, it works. It works. If it’s writing a poem together, I don’t care, if it’s listening to a song together, if it’s watching two minutes of “Seinfeld” together, if they love “Seinfeld,” for example, it’s a shared experience that you as a doctor and physician can create. And it takes practice. It takes practice every day. It’s a creation. And that’s why the book is about compassion, creativity, and connection.

Kevin Pho: We’re talking to Steven Eisenberg. He’s a hematology-oncology physician. He’s the author of the book “Love Is the Strongest Medicine: Notes from a Cancer Doctor on Connection, Creativity, and Compassion.” Steven, as you said before, a lot of things in medicine are going the opposite of what you say, right? We have these computer systems in the room that force doctors to click all these checkboxes, so it’s hard to focus on the patient when you’re talking to them. There’s productivity, there are relative value units, where, yes, physicians are just pressured to do more in less time. And against that backdrop, I know you’ve talked about this earlier, about some tips that physicians can use to really inject that creativity into the exam room. But what are some other actionable ways? So let’s say I’m a primary care doctor. I have 15 minutes with a patient in the exam room. What are some ways that I can inject some of that creativity in the exam room?

Steven Eisenberg: Perfect question. Well, the first thing is, again, if possible, have a scribe with you. The first thing is to go in and really just look the patient in the eyes and have that eye contact and smile. And before you get into the exam and the physical exam, just ask. Just do the opposite. Ask a question that you normally wouldn’t ask: “What’s the favorite thing you did between our last two visits?” And take that little bit of extra time. You’ve got 15 minutes, maybe even less in some cases, but if you start off with a completely unrelated question, you’re just an interviewer. Just almost pretend you’re doing a podcast with this human being in front of you. Ask them something completely, you know, shock them in a way.

And when I give them CPR, what I mean by that is connection, presence, and resilience. Connect with them, be fully present with them, and that’s going to translate into resilience in that exam room, their resilience, your resilience. And we’ve got to shock ourselves with that, which is what I call CPR: connection, presence, resilience. If every time you go into the exam room you bring that little shock, then the love is going to start to be cultivated. And I’m talking about love of profession, love, self-compassion, love of that human being sitting across from you. How many times have we seen doctors and patients in conflict, and, “Oh, I hated that, I hate that doctor,” or, “Oh, man, I’ve got a full, I’ve got, you know, 25 patients,” and it just becomes this burden?

But if you can, every time you walk in, do this little shock of connection, presence, resilience, connection, presence, resilience, you just keep repeating it. And, yeah, go in and have a two-minute podcast with that person in front of you. Look, you’re not recording it. It’s not going to be in the medical record. But you’re now doing something that is completely the opposite of what you think you should: Just go straight in and go, “All right, what brings you in today? Blah, blah, blah. OK, what can I do for you?” You know, just the things we know that you’re supposed to do first thing. No. It’s like George Costanza: Do the opposite.

And then you’re going to have this breakthrough in that exam room. The patient’s going to start lighting up. They’re going to start telling you what’s really bothering them, instead of having that be the thing on the way out of the door. You know how patients tell you the real problem when you’re like, “OK, I’ll see you in a couple of weeks.” “Wait, doc, one last thing.” And that’s the whole reason they’re there.

So I’m saying, yeah, if you’re having this authentic connection, and you have to create it with a little shock, a little connection, presence, resilience, then they’re really going to open up. There’s going to be a more honest-to-goodness camaraderie there. They’re less likely to have, you know, conflicts, and you do actually save money, because you have happy patients. You get better Yelp reviews. You’re not going to have, you know, as many litigation issues, and defensive medicine is a whole other topic. But what I’m saying is connect at all costs. Connect at all costs, and your joy for medicine will start to slowly return, for those of us who are feeling burnout like I did.

Kevin Pho: And, Steve, my final question: Please give your take-home message to the KevinMD audience.

Steven Eisenberg: Do not forget who you were in that med school interview when you said, “I want to help people.” We all said it, and then we forget it, and it gets drained out of us through all of the stress of what we’re doing. But I want you to know that you can turn it around if you’re feeling burnout. It does get better, but what you need to do is shock your system with a little CPR: Connect, be present, and then you will start to feel more and more resilience coming back into your practice, and joy. And don’t forget, you went into this because you love people, and that’s what “Love Is the Strongest Medicine” is about. It’s loving that fellow human being right across from you.

And I’m sending you a lot of love today, Kevin, because I love what you’re doing and the difference you’re making in the world of medicine. It’s huge. So props to you, and sending you a lot of love today, man.

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

Steven Eisenberg: Thanks for having me.

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