Broken but beautiful: Healing ourselves and the world [PODCAST]

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Join Nessa Meshkaty, an internal medicine, pediatrics, and infectious disease physician, as she explores the profound intersections of empathy, human connection, and societal challenges in this thought-provoking podcast. Drawing on insights from her personal experiences, conversations with mentors like Dr. Paul Farmer, and observations from her global travels, Nessa delves into topics such as the Japanese philosophy of kintsugi, the importance of empathy in addressing social issues, and the impact of technology on human relationships. Through engaging discussions and insightful reflections, listeners are invited to contemplate the complexities of the human condition and discover actionable strategies for fostering genuine connections and collective healing.

Nessa Meshkaty is an internal medicine, pediatrics, and infectious disease physician.

She discusses the KevinMD article, “Kintsugi: Embracing brokenness and empathy.”

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Transcript

Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast, and get CME for this episode by clicking on the CME link in the show notes. Today we welcome Nessa Meshkaty. She’s an internal medicine, pediatrics, and infectious disease physician. Today’s KevinMD article is “Kintsugi: Embracing brokenness and empathy.” Nessa, welcome to the show.

Nessa Meshkaty: Thank you, I appreciate it.

Kevin Pho: We’ll talk about your article in a little bit. First off, briefly share your story and journey.

Nessa Meshkaty: I’m a disciple of Dr. Paul Farmer, is what I like to call, the father of empathy, and also the father of global health. And that’s where the article kind of comes through. He was also an infectious disease physician, an anthropologist, and a world traveler, and he really influenced my medical career and my life in general.

Kevin Pho: All right. So let’s talk about that article, and I’m interested in hearing Dr. Farmer’s influence on your professional practice. Your KevinMD article is “Kintsugi: Embracing brokenness and empathy.” For those who didn’t get a chance to read it, tell us what it’s about.

Nessa Meshkaty: It has a lot of information, but some of the main points are that empathy is an endangered species, and human connection and the art of healing and the art of listening are kind of moving to the wayside.

And I think that in bringing back Dr. Paul Farmer, he really taught that to me many, many years ago, in 2005, when I was a first year medical student and I met him, and then worked with him in subsequent years and read his books and was largely influenced by his teachings.

And also it incorporates other contemplative techniques that foster empathy, such as meditation, and even just in the anthropology light, observing human nature, and traveling all over the world and seeing all different types of ways that people foster community. So it touches on those topics.

Kevin Pho: All right. So let’s unpack that. So before getting into some of the details, you mentioned that empathy is in short supply today. What are some of the reasons you think that is?

Nessa Meshkaty: It’s multifactorial, but I think some of the reasons are that we are all struggling ourselves, and it becomes very challenging to offer any support when you yourself are struggling. And so I think that we all have the capacity for empathy, it’s part of our human nature, but that it becomes really hard while we’re facing challenges to cultivate that.

Kevin Pho: And what are some examples of those challenges physicians face that may impede our empathy?

Nessa Meshkaty: Well, if we want to use some of Paul Farmer’s teachings, it’s that he believes in the biopsychosocial determinants of health, and in what he calls staff, stuff, and support systems, in order to have an environment where you can really share and care and do the work that you’re doing. And so I think in our current model those things might be struggling right now, just because a lot of things are changing.

Kevin Pho: So you bring up in your article the Japanese philosophy of kintsugi and use that as a jumping off point. So explain what that Japanese philosophy is, and how empathy, the art of kintsugi.

Nessa Meshkaty: It is to put together all your broken pieces in order to become whole. And I think that that’s really kind of what we all can do in medicine and in health care, to foster the art of healing and be more creative about ways we can serve.

Kevin Pho: So as a physician, what would be a specific example, case study, or a story that doctors can use, some of those broken parts, to better serve? What would be an example of that?

Nessa Meshkaty: Yeah, I think we can be agents of change. I think a lot of physicians right now might feel disempowered, but to really kind of look inside and remember why we chose the field, and do a lot of work on yourself. Because self-awareness, and like I was saying, contemplative techniques, really help shine a light on how we can move forward and continue this really, really hard work.

Kevin Pho: So when you mentioned contemplative techniques, what would be some examples of those?

Nessa Meshkaty: So mindfulness techniques, meditation, I do a lot of asana work. Even writing. I think that the article is an example of writing for self-reflection, and learning how to become more aware of some of the things that you can contribute to the field of healing.

Kevin Pho: Now, how difficult is that for you as a physician? Like you said, so many obstacles and challenges from the system itself that put so much time pressure on us. How are you able to find that energy to do that contemplative work?

Nessa Meshkaty: For me it’s non-negotiable now. It’s become such a big part of my healing and my health. And I really hope that that is incorporated in the future of how we all practice as well, like some of the Eastern philosophies of healing and health are underrated. And I think the techniques can help us all become agents of change and really make a difference in people’s lives.

Kevin Pho: Can you tell us a story about how you used some of these Eastern philosophical techniques and moved that needle in terms of improving your patient care?

Nessa Meshkaty: I think the main thing that I can share is, now that I’ve been doing the work, I’m way more present when I’m at the bedside of my patients. And it really has fostered the art of listening in a way that I never had before. And really, listening and empathy are connected. And so it has made me a better doctor and a better person in general, and I really think that I can feel the impact on the encounter even, because of it.

Kevin Pho: Have you received any feedback from patients, kind of a before and after, that really illustrated that?

Nessa Meshkaty: Well, no, I do inpatient work, so I’m more at the bedside of the really critically ill. But I have received feedback that they feel heard. And I believe it’s because of my meditation history, which I’m about two years into. I’m new.

But I think it really is cumulative when you start to do it. And not only with patient interactions, all interactions. I feel like it just allows you to be present.

Kevin Pho: One of the things that you write in your article is the concept of othering, and how that contributes to the erosion of empathy and the fragmentation of human relationships. So talk more about that concept, and how that is affecting our relationship with patients.

Nessa Meshkaty: Some of the work that does come out when, at least for me, when I do contemplative work or meditation or self-reflection, is I understand the parts of me that even I other. So when you self-reject, or when you shame yourself, and when you start doing that work with yourself, it becomes easier to see how often you do it to other people.

So I think what ends up happening is, you just have a bigger understanding of how connected we are. And so when I say othering, it’s really just adding separation when it’s not needed, because we’re basically one species. And we really are struggling, especially after COVID, and we just need to come together instead of fight with each other.

And that could be on a micro level, when you’re having an encounter with a patient, in a judgment, or on a macro scale, just with big groups of people. It just becomes important for me personally to recognize where my judgment plays a role in how I behave or how I think or how I act.

Kevin Pho: Now, tell us how some contemplative techniques can overcome that othering, overcome that judgment, and make you more self-aware of when you’re doing it.

Nessa Meshkaty: Yeah, it sounds very simple when you bring it up, but it’s not simple, because it requires some kind of discipline to just keep doing it every day. And it really just is like an inner journey.

And when you start to kind of unpack how your behavior is affected by your thoughts, then you start to see the root of your behavior and judgments and actions, and where they derive from. So it’s just like, root cause of your behavior is basically your thoughts. And these meditation techniques help you understand that your thoughts are fleeting and impermanent, and they define your actions but they don’t have to.

Kevin Pho: Talk about the influence of technology in our interactions with patients. Obviously we have the computers, we have the electronic health records, we have social media, we have artificial intelligence now. Talk about the influence of that in today’s relationship with patients.

Nessa Meshkaty: I think that progress in technology is so important, obviously, and so critical to talk about the risks and benefits of.

If we look at, for example, where we are as a society with social media and how it’s impacted mental health and adolescents, for example, we kind of launched it without doing a risk benefit assessment. And as physicians, that’s what we do, right? We offer a certain intervention and we look at the risks and benefits, and we discuss that with our patients.

I feel the same for any kind of progress in technology. It can be life-saving, it can alter things on grand scales in very, very amazing ways, and also the opposite. But it really becomes how we incorporate it into our lives, and how we glean the positives from AI or any kind of technology versus how we mitigate the negatives.

And if we as physicians, some of us are hesitant to incorporate it into our practice, but we can kind of lead the way and help others understand that there’s risks and benefits to everything, and the onus is on us to figure out how to bring the positives into our lives and how to mitigate the negatives.

And I feel that AI is going to be instrumental in helping humans be more empathic. And I think that’s a very radical statement to say, because how could a technology help us be more human? But I think it will actually help us with all the stuff that is automated, it can offer support with that, so that we can actually do the critical thinking part that humans need to do, and the part that is compassion and listening and the human part.

Kevin Pho: So I talk a lot about the influence of AI in terms of doing the more mundane jobs that physicians do, like helping us write our notes. So you’re saying by decreasing the time that we spend doing that, we could spend more time with patients, thinking about our patients, and less time on, say, writing.

Nessa Meshkaty: Yes, of course. And I think even just in the education of medicine, the process of education in the future with the incorporation of AI will take away all that rote memorization requirement that dehumanizes us, and that makes us regurgitate information and doesn’t allow a platform for critical thinking.

I would say, as an infectious disease doctor, critical thinking is the most important. My brain is my scalpel, my surgical tool. And I think critical thinking is also endangered.

And I have hope that AI, if we launch it properly, at least even in our own lives, can help with critical thinking in the resident teaching models, and allow for all the busy work and all the scut work and all the automated, rote memorization, standardized stuff to be already done, so that we are kind of forced to become next level thinkers.

Kevin Pho: You alluded to earlier that you’re relatively early in your contemplative journey, in your meditation journey. So tell us how that journey is, and if someone wanted to start on a path similar to yours, how would they get started on that?

Nessa Meshkaty: There was a confluence of events that occurred that launched me to pursue an alternate path. And I think a lot of people who have undergone trauma or multi-level trauma, and at this point that means all of us as humans, can benefit from it.

And I know that even some people think meditation means just sitting on a cushion and being rigid, and that’s not the way that I use it. I’m an avid gardener, and just having garden meditation. You can incorporate all different types of mindfulness meditation in your day, even as you’re working. You can just be mindful of when you’re walking down the hall to go see your patient, or in between patients.

And I think that it’s something that, my hope is that we bring it into Western medical education and Western kind of healing practices more, and just incorporate it, because it ends up being very, very effective once you incorporate it daily.

And for me, I did the Vipassana meditation, that really helped. Vipassana just means, as it is. And it allowed me to learn how to be present using all my five senses at all times. So I don’t need to go to the cushion to be present, I use all my senses and I’m just more aware and less disassociated.

And the reason why that’s hard is, disassociation is useful for humans, we learned it in order to kind of endure difficult times. So I think what I observe now is, a lot of doctors are disassociated and they go through the day kind of just in survival, like robot mode. And the contemplative or mindfulness techniques break that pattern and then bring you back to your original kind of why you started this, and that helps just figure out how to navigate moving forward.

Kevin Pho: Now, we’re talking to Nessa Meshkaty. She’s an internal medicine, pediatrics, and infectious disease physician. Today’s KevinMD article is “Kintsugi: Embracing brokenness and empathy.” Nessa, we’ll end with some of your take-home messages that you want to leave with the KevinMD audience.

Nessa Meshkaty: I think the take-home would be, there’s a really good quote that I thought of that applies to physicians, and it’s that it is no measure of health to be well adjusted to a profoundly sick society. That’s a Krishnamurti quote. And so I think that we as agents of change can really lead the way to help people find creative ways to heal.

Kevin Pho: Nessa, thank you so much for sharing your perspective and insight, and thanks again for coming on the show.

Nessa Meshkaty: Thank you.

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