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Certified coach and professor Kathleen Muldoon discusses her article, “The humanity we bring: a call to hold space in medicine.” She shares how her experience as a mother in the neonatal intensive care unit transformed her understanding of empathy and reshaped how she teaches future clinicians. Kathleen explains why health care professionals must hold space for patients and themselves, embracing presence, storytelling, and authenticity as tools for healing. Viewers will learn how humanity is not separate from medicine but its foundation, and how connection and compassion can restore both patients and practitioners.

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Transcript

Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast. Today we welcome back Kathleen Muldoon, coach and professor. Today’s KevinMD article is “The humanity we bring: a call to hold space in medicine.” Kathleen, welcome back to the show.

Kathleen Muldoon: Hi, Kevin. Thanks for having me.

Kevin Pho: All right. Tell us the story of this latest article.

Kathleen Muldoon: This article came to be as a response. I won the 2003 Northrop Educator of the Year award from the Student Osteopathic Medical Association, and it’s a national award. It was such a big deal, a highlight of my career, and I was invited to write an acceptance speech or a response to it.

I got such a nice response back from what I said that I wanted to make it available to your readers, your clinicians, and your students who follow your space. What I was struck by in their nomination letter and in the things they said about me is that the reason why I won this award wasn’t because I teach embryology really well (which I think I do) or I know a lot of anatomy (which I think I do).

It’s more about holding the space for authenticity and humanity and modeling that, but also trying to teach that in various ways to our clinicians. Initially in the classroom, and now I do it from the coaching corner as well. That who you are is not something that you need to check at the door of the clinic or leave behind when you experience the white coat ceremony. It’s something that I think medicine really needs right now in creating a culture of caring.

This piece came from the fact that some people do think that humanity in medicine is something that you’ll have to hide or that it’s soft or even anti-science. But I really think it’s structural. I think we need to think of it as the foundation of moving this field forward.

Kevin Pho: The genesis of this article came from your own personal experience, right? Let’s start there. Tell us about the story that led to this.

Kathleen Muldoon: The story that I begin the piece with, and I think was really a Damascus moment for me in thinking about who I am in this space, was when my middle child was born. His name is Gideon, and it was a textbook pregnancy. When he was born, about 18 hours after birth, he was whisked away from me to the NICU, where he was eventually diagnosed with a congenital cytomegalovirus infection. Up to that point, I had already been an award-winning embryology professor at an Ivy League school.

It was really the first time, especially in those wee hours of the morning when my son was sleeping and I wasn’t, sitting in the chair next to his crit. I would just walk the floor and see all of these tiny people with the diagnoses that I had been teaching. I think a lot of people teach embryology this way, where it’s the “blue box,” as we tend to think of it in the textbooks. It’s: “This is how the story is supposed to go, and this is how it goes.” I hate to use this, but: “And when it goes wrong or when it’s interrupted.” I don’t use those words anymore.

I realized I would see the words that had just been on the page and that are on the page for a lot of students. I think it’s very easy in practice to slip into seeing people as diagnoses and not understand that these are real, live humans.

Now that prenatal care is so great, you can even think about that. There’s a whole way of being a human, a disabled human, that is chronic and long-term and isn’t cured. I think that is a promise that some people feel called to or what they think medicine is. I see students come in all full of hope. Their definition of helping somebody in the power of that is very curative. But there are so many conditions. All of life is a chronic condition, you could say.

Learning how to partner with your patients in that uncertainty. For me, in my own life, I realized this in that moment when my daughter came, who was about 3 years old at the time, for the first time to the NICU. I was all prepared to apologize for her experience of becoming a sister, and I didn’t know what it was going to be like. She slipped into the armchair next to me and gingerly maneuvered around all of Gideon’s sensors. She looked at me and said, “Mom, isn’t he perfect? He has a head.”

That childlike wonder. I thought, “He is perfect. He is here exactly how he is. I don’t know what the future is going to hold.” His pediatrician came to the NICU and just sat with me for several hours. That was everything, just being present. Not offering any solutions, not offering treatments, but understanding that being present to the situation and that partnership was the best and most healing moment for me.

Kevin Pho: That story, of course, was very powerful. That concept of holding space, being present, is not often taught in a formal way during medical training, is it?

Kathleen Muldoon: Not in my experience, unless you have purposely made space for it. Often, even in the less traditional medical school curricula, there are just a lot of “in nova tables” or practicing scripts with standardized patients. I’ve been lucky that I’ve been allowed to have some time in the curriculum, the core curriculum at our school, to inject what I think needs to be a workshop, a discussion. Really sitting in those uncomfortable spaces with things that are not solvable.

We do it through a series of courses that I teach that force us to examine unsolvable (at least by any individual) current challenges in medicine: health disparities, disability features large in the course. Students always want to jump to, “Well, what’s the solution?” They always offer, “Well, we should have a policy against this. We should be doing this.” I have to tell them, “Stop ‘shoulding’ on yourself,” because that’s the number one thing to distance a problem.

But how do you sit with it? We’re in Arizona. In a classic situation I like to present, you can present it as a case, or you can present it as just looking at data. For example, someone who lives up north in Arizona on the Navajo or Diné reservations comes down with an A1C that’s incredibly high, like 13. Does that mean that they don’t know how to control their diabetes? Or does it mean that there’s one doctor for every 100,000 people up in their area and they made it down the four hours to Phoenix, where we’re located, to get care? How do you partner with that person and understand their story and understand that there isn’t an easy treatment in that situation? Holding space for that, experiencing what I think is the greatest thing, then is to experience that discomfort.

That challenge, because it does feel like a challenge. Instead of saying, “Well, they should be better about their care.” What if they can’t? How do we walk to the edges of what’s possible with our patients, with our colleagues, with our peer students, and see what is possible? A lot of times that is healing in and of itself.

Kevin Pho: That last statement that you just said, just holding space, being comfortable with a problem that may not be solvable, in itself can have a huge impact on patients and their families, even if the clinician can’t come to an immediate solution.

Kathleen Muldoon: I believe so, and I can speak to that as a caregiver myself and from my community of disabled individuals and their caregivers. Having someone who, even if they can’t fully understand your situation, can understand that there’s a challenge. Taking that moment to pause and say, “This must be hard for you. What does this mean for you?” And accept that you may be bringing into that clinical encounter your own experience with something that is difficult.

Can you use that to connect with some other time that you’ve been worried about the health of somebody that you love or your own child? Even if it’s something minor. We’ve all been there, but can you connect with me in that moment? Bring a little bit of yourself into that encounter and help me to be seen, but also help you to understand that caring is part of the core science of being a doctor.

You have to be who you are in order to do that. I think holding space allows not only the patient to feel heard, but also the physician to reconnect with their own humanity. I think taking that into every clinical encounter will do a world of good for some of the challenges that medicine is facing right now, like burnout and overwork, all of the things that I see from my position as a coach.

Kevin Pho: You mentioned that you had some workshops. You influence the core curriculum to include facets of what we’re talking about. How do you train medical students to hold space? What are some exercises, what are some things that you do?

Kathleen Muldoon: I have a series of courses that I offer that begin with a course called Humanity and Medicine. In that course for first-year students, we look at data illustrating health disparities. It’s very intentional in creating small-group spaces for that, facilitated by upper-year medical students and some faculty, understanding that everybody’s going to interpret that data a little bit differently through their lens.

What does it mean that there are disparities in vehicle ownership, and what does that have to do at all with medicine? It does. Access to care. Not everybody of every socioeconomic status is going to have access to transportation. That’s going to affect how they show up to the clinic. These are divided, a lot of times, along racial and ethnic lines as well.

Having them practice that ability not only of interpreting the data, but also hearing other people’s interpretations of the data and how they bring themselves into it, I think is really powerful.

Students who want to continue in that skill and be able to hold those conversations and hear other people’s reactions to the data, I offer a training series of courses that I call the Gold Series for humanity and medicine and humanism in medicine. That includes a medical improv workshop. We do exercises. These exercises were developed to create presence and empathy and being with each other. They’re not, sometimes they’re called theater games, but we don’t do any performances. It’s really accepting ideas that come to you, accepting your own reactions, and responding to usually just a partner in unscripted ways and knowing that it’s OK to make mistakes in these low-key environments because you’re trying. There’s very much a difference between making a mistake because you’re trying, versus not being prepared and not accepting what is in front of you.

I also offer a narrative medicine course where we not only read poetry and other pieces to elicit that response in yourself (I love poetry; it’s like an invitation) and lots of people see things differently, but then we practice writing your own piece. This is also practice for being able to write your own personal statement for residency applications, because I see so many students that don’t know how to do that anymore.

I feel that if you don’t know how to write your own statement, if you hand it over to AI or worse (I’ve even been offered money to write other people’s statements for them), you’re going to end up somewhere that’s not a good fit for you. I know there’s a lot of stress on the match and on making it into the specialty that you’ve had your heart set on for so long. But if it’s not a good fit, I think you’re setting yourself up for a career of heartache.

That’s the series. Students often come back to help facilitate the first-year course. I think it works really well in creating a community of care. I’ve been so grateful, as was indicated by this award that I got, but also for students that have gone out now into residency after this training and are creating these circles of caring in their own placements. I just think that to me is that grassroots effort of seeing the future that takes those parts of medicine that are so wonderful and just grows them in lots of different places.

Kevin Pho: It sounds like a lot to me that we’re asking students today to share a little bit about themselves, to hold that space, to be vulnerable, and to express their own vulnerability to their colleagues, to patients, and to their families. Up until this point, students really aren’t trained to do that at all. They’re, in fact, trained to do the opposite of that. They’re not supposed to show any vulnerability. It’s a shift in mindset; it could be a little jarring for some students.

Kathleen Muldoon: It really is. There are some students that armor up, and they don’t feel comfortable doing it. That’s OK because we’re planting seeds, and I understand this is a bit of a pushback. But I truly do stand by the tenet that every honest encounter is a moment of advocacy.

We see so much data that supports an understanding that having that (not coming in and totally disclosing your whole life, but allowing your patient stories to be a gift back to you instead of something to deal with) shift, that understanding, creates patients that are more satisfied with their care, that are more adherent or compliant (whatever word you’d like to use), and that have better long-term outcomes.

If you’re somebody that does truly care about improving the lives of your patients, which I think every student comes into this field wanting to do, and then the process of enculturation can cause them to abandon that part of themselves. But if you stick by it, if you work through the discomfort, and understand, especially now, there are so many different kinds of people that come to medical school. We need every single one of you. It is hard. It is uncomfortable. It’s just as hard as learning all those biochem cycles. Stick with it because I promise you it pays dividends in the end.

Kevin Pho: We’re talking to Kathleen Muldoon, coach and professor. Today’s KevinMD article is “The humanity we bring: a call to hold space in medicine.” Kathleen, as always, let’s end with some take-home messages that you want to leave with the KevinMD audience.

Kathleen Muldoon: I would love to leave this audience with an understanding that we can’t always heal what’s broken. That includes in your patients, it includes parts of ourselves, and it includes the systems that we’re working in right now. But we can honor what’s human. I think if we remember that, that’s the why of medicine as a field of practice. Our stories, our identities, our care. I think that’s what makes and will keep medicine whole.

Kevin Pho: Kathleen, as always, thank you so much for sharing your story, time, and insight. Thanks again for coming back on the show.

Kathleen Muldoon: I really appreciate your time. Thank you so much.