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Professor and coach Kathleen Muldoon discusses their article “Why humanity in medicine requires peace with a spine.” Kathleen explores the dangerous misconception that peace in health care means silence or compliance. The conversation highlights how teaching medical students to smooth their edges and avoid conflict often leads to burnout, moral injury, and emotional numbness. By redefining peace as an active skill that requires a spine, Kathleen outlines how clinicians can navigate hierarchy and uncertainty without erasing their own humanity. This episode examines the vital difference between keeping the peace and protecting dignity in high-pressure clinical environments. Real professionalism demands the courage to pause and stay present when the room feels chaotic.

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Transcript

Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast. Today we welcome back Kathleen Muldoon, professor, medical educator, and coach. Today’s KevinMD article is “Why humanity in medicine requires peace with a spine.” Kathleen, welcome back.

Kathleen Muldoon: Thanks for having me.

Kevin Pho: All right. Tell us what your latest KevinMD article is about.

Kathleen Muldoon: The latest piece came about because I have been sitting with people at several stages of their careers, especially in my roles. I see students in their first, second, third, and fourth years of training. Then I see through coaching clinicians who come back and want to unpack some of the ways in which their training has gotten them into a place that does not feel right or good, or where there is a misalignment in their career path.

In the context of the last few months, and maybe even especially the last few weeks, the idea of what peace means in clinical spaces came to the forefront of my thinking. I have had several instances where people have come to me and really wanted to discuss some of the hardships that medicine is going through right now. We have talked before about how clinical spaces can feel very polarized.

People do not know how to use their voice as clinicians to address some of the policy changes that are happening. These could be in the hospital systems, statewide, or nationally. So what does it mean to kind of use your voice, especially when in a lot of cases clinicians, caregivers, and anybody in the caring professions can feel like keeping the peace means holding your tongue or being silent? That does not feel right to a lot of people right now.

So I started thinking about what that actually means and how that ties to the larger themes that I tend to think about, which are humanity and medicine.

Kevin Pho: Now, how did it get this way? What are some of the reasons you think why physicians are so hesitant in expressing some opinions?

Kathleen Muldoon: I think the idea of clinical detachment can sometimes be emphasized in a way that can be interpreted as “smooth out your edges.” You are told to leave your humanity at the door because you are there to treat the person in front of you, and that is your only job. So all of these larger systemic issues do not matter. But the truth is, it is the container that is framing the way you practice. It affects how that person came to be in your clinic, the interactions that everybody is having in the hallways, the clinical spaces, and all of those things.

I think the idea has become implicitly embedded in some spaces that professionalism means leaving your humanity at the door, biting your tongue, and not engaging in difficult conversations. That is coupled with the hierarchical nature of clinical training and the power dynamics. You ask yourself: “Is this going to affect my audition rotation? Is this going to affect my promotion? Is this going to affect my evaluations if I say something?” I think having a skillset to bring peace into a conversation does not have to be these grandiose things that upset the whole hierarchy. They can be very simple skills that we exercise every day.

Kevin Pho: So you apply that there is a little bit of a fine line, right? Because like you said, there is a skillset to expressing an opinion but doing so in a way that does not get you into trouble with the traditional medical hierarchy. You mentioned that there is a connection in terms of how physicians are trained and some of the issues that come up later. So what are some of the skills? How do we balance that? How do we thread that needle?

Kathleen Muldoon: I want to address something you said too. It is not always just expressing your opinions or making your opinions known. Instead of getting defensive, because we do all have opinions and we do not leave them at the door, they are going to affect how we interact with each other. I think the skillset is a very clinical and very professional one: staying curious.

Stay in the moment when something feels off to you or when you feel that impingement. What do I do in this situation? Then pause. That is an easy thing to do. Take a pause and take a breath. Even visibly taking a breath creates that sense of safety in your autonomic system for yourself, but also for people in the room.

We need to normalize naming what we are feeling because the idea of everyone having this sense of tension in the room but just letting it go without saying anything can cause a lot of harm. So even something as simple as saying, “I’m feeling a little tension here. Are you feeling that too?” or “I just want to make sure I’m observing the same thing that other people are” is not challenging. I think that is a way to diffuse tension without getting into personal politics or opinions. Those are some simple steps right there that are easily practiced in clinical spaces as well as in interactions in professional spaces.

Kevin Pho: So I am hearing three things. Number one, staying curious. Number two, sometimes taking a pause. And number three, sometimes naming what people are feeling. Sometimes it could be uncomfortable, but explicitly naming it sometimes can diffuse that tension. Now give us an example. It could be through a medical education sphere or through your coaching where some of these strategies can come into play. So what would be an example of that?

Kathleen Muldoon: An example that has come up recently was through the coaching space. Somebody works, as many people do, especially in hospital systems, in interprofessional settings where there are clear role boundaries. A patient brought a concern that was being dismissed. Somebody in the nursing profession who is not the director of clinical care felt that the patient wasn’t being heard. This is somebody who understands that there is some danger to being able to navigate a situation that involves different professions.

She was replaying a scenario with me in which she did just pause the conversation. She literally said, “I think can we pause the conversation here? Maybe it’s good practice for us to all put in our words about what is happening in the situation.” Even doing that in the situation of a rounding event meant that they came to understand that they weren’t all on the same page with each other, let alone the patient.

It wasn’t somebody telling another clinician that they were wrong. It wasn’t putting a student or a resident into a place, although this nurse did say that she could tell that the student was feeling uncomfortable in the moment. Just naming it helped. Then they went back to the patient and they just said, “We just want to make sure that we’re understanding you correctly.” So it was a benefit to the whole team. It turned out that they were able to get clarity and provide a better clinical path forward.

Kevin Pho: In your article, you make the distinction between real peace and false peace. Tell us more about that distinction.

Kathleen Muldoon: I think it goes back to this idea that not rocking the boat, smoothing out your edges, and staying silent can lead to problems. Even if you do notice something throughout your day, saying something like “I’ll deal with that later” or “I’ll come back and have that conversation another time” can lead to almost a feeling of numbness.

Sometimes clinicians come to me because they cannot stop replaying different situations when they go home from work. One of those involves times where they feel like they should have said something and they didn’t, or it should have gone somewhere. That kind of silence where you sense that you took a course of action that didn’t honor your own instincts or your own gut is silence. That kind of peace is silence, and I would call that a kind of false sense of peace.

It may be comfortable and things may feel peaceful at work, but “peace with a spine” or courageous peace doesn’t always feel peaceful, like you said before. I think it is understanding that there is an element of moral courage to being a clinician. There is an element of advocacy that means naming things when they feel uncomfortable and pausing a situation when it escalates.

Even as a parent or as a patient myself, it has struck me that over the past few years there are so many signs up now that say, “We will not tolerate inappropriate behavior towards our clinicians.” I understand that it is necessary because of the tension that can occur in these clinical spaces. I just feel like that courageous kind of peace involves naming something that feels contentious as a way to diffuse it.

Another example that students come back to me with a lot of times is when they are learning to take the clinical history in pediatric settings. Part of the questionnaire is asking if there are guns in the home. That can feel like a very tense question, especially when a parent might answer, “It’s none of your business.” Pausing there and saying, “This is part of the history and part of safety reasons so that we can make sure that there is appropriate storage,” can diffuse the situation.

It is not that the person reacting that way is wrong. They are coming from their own framework that you can get curious with them about. They may be hearing something else in your question that relates to a belief system or a political orientation that may not be the intention of the question. It is really about saying, “You’re here because you care about your kid. I also care about your kid. This is one of the questions that we’re asking just to make sure that your child stays safe.”

Understanding that that kind of thing is part of your job and it might not feel comfortable is important. Having the courage to not sweep that tension under the rug but engage with it fully prevents some of the long-term implications of hiding your feelings. It prevents those gut reactions and the rumination that happens when you cannot turn off your brain after encounters during the day. It prevents allowing that to turn into the kind of numbness that feeds into some of the longer and larger issues that we see in professionalism these days, such as moral injury and burnout.

Kevin Pho: You alluded to guns, and it is not just that in this political climate. Vaccines, for instance, can sometimes lead to potentially tense situations. Now when you teach students, and I am sure a lot of clinicians can use your help with this, how do you go about teaching that? How do you teach your medical students how to conduct a history and sometimes talk about politically charged topics in a more detached way? How do you teach that?

Kathleen Muldoon: We do a lot of improv or computer-based techniques where we do role-playing. Sometimes we put up scenarios and we name our own reactions to them so that we can practice what that feels like. As psychologists say, “You name it to tame it.” If you are not in touch with what it feels like to you, it is harder. Especially in medical school, you just kind of go from one thing to the next thing to the next thing. You just go, go, go.

So understanding that that pause is part of your professionalism training is one of the things that we do. We put up highly charged scenarios that have either come to me and then I have anonymized through my coaching work or from social media. I ask them to notice their reactions. Then I say, “OK, what is the core value of this person?” We have an exercise where I actually ask them to introduce the person who is wearing that slogan on their T-shirt, the patient. I say, “OK, this is my friend Pat, and their core value is blank.”

So meeting from that space where you are curious about where this is coming from helps. You can connect with them because you also care about the safety of that child. Then you are able to build forward. We know that shoving facts down somebody’s throat is not the way to get them to change their mind or decrease tension in any situation. Understanding that you are both human and connecting from that point allows you to move forward.

We play other games that play with the power dynamics. I put them in situations where I have given them undisclosed positions of power and different hierarchies even in a non-clinical role-play setting. I tell them to act as if they have this status and just notice those behaviors and mannerisms that come out even in exaggerated ways and how it makes them feel. For example, if you are at the top of the heap, and if somebody else is at the bottom, then after the game is done, I say, “Look who has the power in this room right now?” They will say, “Me.” And I will say, “Yeah, well, how have I democratized that? Or who has the power in a clinical space? Is it the patient or is it the doctor?”

I just call attention to it in a way that I hope plants seeds. It gives them the skillset to pause when they are later in the clinical setting or as they move through their training. I remind them that they are seeing people in their most vulnerable positions, often on the worst day of their life. Tensions can run high. Sometimes those emotions mask core values. They can seem more polarizing than they actually are. So it is not setting yourself aside, but it is staying curious, having that empathy, and understanding that you have a lot of power in that human interaction to navigate a situation that creates a sense of peace for yourself and for that person in that clinical moment.

Kevin Pho: We are with Kathleen Muldoon, professor, medical educator, as well as a certified coach. Today’s KevinMD article is “Why humanity in medicine requires peace with a spine.” Kathleen, let’s end with some take-home messages that you want to leave with the KevinMD audience.

Kathleen Muldoon: I just want to remind people that in every interaction, especially in medicine these days, it can feel like there are so many large, polarizing, and systemic issues that are ours to solve. Making a human choice in a single interaction is a very powerful way to move with peace and humanity through your day. That will help both you and your outlook on your own professionalism, but really change the course of interaction for your patients as well. So, just stay human. Stay in those choices.

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

Kathleen Muldoon: Thanks for having me.