Mindfulness and the art and science of medicine: 'Operating with Zen' podcast
Podcast aimed at surgeons with lessons for us all
By Howard Wolinsky
One story leads to another.
I wrote recently about my lunch with three urologists and a urologic naturopath in a vegan Chinese restaurant during the American Urological Association’s annual meeting in Chicago.
Dr. Geo suggested I check out a podcast (and YouTube broadcast )called “Operate with Zen.”
So I did and interviewed the podcaster, urologic oncologist Phillip M. Pierorazio, MD, chief of the section of urology at Penn Presbyterian Medical Center and professor of surgery at the Hospital of the University of Pennsylvania in Philadelphia.
Pierorazio used Zen in the generic sense in naming his podcast. “It's not necessarily about Zen meditation or Zen Buddhism. It's kind of a play on words, right? Operating or functioning with mindfulness or with peace. It’s the concept is how can we live a more calm, meaningful, mindful existence,” he said. “And honestly--a big issue in surgery right now is surgery sustainable, right? We're seeing a lot of strife, a lot of burnout, a lot of recidivism in surgery. And can we help people live more healthy, long, sustainable surgical careers?”
Though he aims the podcasts—67 to date— at his fellow surgeons, other health professionals, patients, and everyone else could benefit from the concepts he discusses with colleagues during the programs. Pierorazio is a well-spoken questioner and commentator and also is an excellent listener.
“Operate with Zen” started as a COVID-19 project. So I just started thinking, what can I do to be a better surgeon and live better, feel better, while I have this downtime? And so I started with yoga just to work out flexibility and yoga turned into mindfulness, and I started reading. And I said this resonates with me. This makes a lot of sense. I need some format or venue to put it down, and I said, well, a podcast kind of makes sense. And I can speak to it rather than having to write or create presentations.”
Pierorazio said these are hard times for surgeons as they experience burnout and the evolving image of “tough guy” surgeons, who bark orders and spare no feelings.
“I started collating my thoughts and putting them into the podcast and quickly realized in Season One that people didn't want to hear me talk, but they really liked discussions and interviews with other professionals and people. And so, it morphed more into discussional conversations around wellness and mindfulness in surgery. And I specifically make it for surgeons. Although I will tell you, I think the podcast is widely applicable because surgeons need a little bit of love and to be called out.”
There are spiritual components to the podcasts, but they also include data. Pierorazio was a physics major and is a researcher, so he couldn’t resist.
“Remember the audience is surgeons and scientists and data is hugely important for them,” he said.
What is mindfulness, anyway?
“The definition I like best is kind of being purposefully aware of the moment. And it typically has intention, presence, and a component of being non-judgmental. So that's that's mindfulness to me,” he said.
Here’s a sampling of programs:
—Dr. Bradley Erickson, a reconstructive urologist, and director of functional urology at the University of Iowa, describes how a couple of years into practice, he experienced a major breakdown and questioned what he was doing,. Pierorazio said, “This podcast covers that breakdown and his pathway back to purpose through the darkness of anxiety and insomnia.”
This one gets a bit Zen-ish,
Pierorazio said, “We talk about mindfulness meditation, dharma and the three H’s of hands, head, and heart, and achieving self-awareness and presence. Throughout the podcast we talk about the insane privilege of being a surgeon and how that impacts us all as human beings.”
—The next one gets yoga-ish.
Dharam Kaushik, MD is a urologic oncologisr at the University of Texas, San Antonio, talks about how he became a yoga instructor during the pandemic. Pierorazio said, “We explore yoga and mindfulness as strategies to combat burnout and stress at work, but expand the discussion to other forms of physical activity that can improve our surgical well-being.” Kaushik also runs through breathwork exercise to prepare for surgery, destress, or as part of your mindfulness routine. We all could benefit.
This doctor offers yoga classes to his fellow urologists at scientific meetings.
Neda Gould, PhD, a clinical psychologist in the Department of Psychiatry and Behavioral Sciences at Johns Hopkins and Director of the Mindfulness Program at Johns Hopkins for faculty and staff, explains the scientific foundation of meditation practice and how to apply them to your life.
(TheActiveSurveillor.com has covered meditation and mindfulness, yoga, Tai Chi, and how they can help active surveillance patients.)
One podcast topic grabbed me: “The difficult patient.”
I immediately thought of the Seinfeld episode (“A Difficult Patient”) in which Elaine Benes (Julia Louis-Dreyfus), on the sly, looks at her medical chart and discovers she had been labeled a “difficult patient.” Hilarity ensues. The “difficult” label leads to her being blackballed by other doctors through the American Medical Association.
Pierorazio featured Joan Naidorf, DO, an ER physician with expertise on “difficult patients.” She is the author of “Changing How We Think about Difficult Patients: A Guide for Physicians and Healthcare Professionals.” (This book was her pandemic project.)
She said some doctors simply don’t like their patients, who give them a hard time or who are noncompliant and fail to do follow-ups
Emergency departments can be minefields for bad behavior. Pierorazio mentioned the 1978 cult classic “House of God,” in which difficult ER patients are called GOMERs—'“get out of my emergency room.”
About 15% of patients are considered “difficult.” These experiences significantly contribute to physician feelings of burnout, including exhaustion, cynicism, and a lost sense of purpose.
Pierorazio summarized what he learned from Naidorf: “There really are not difficult patients. There are people who are in difficult situations and who may behave in a difficult fashion. It's more focused on yelling, stressful, inappropriate interactions.”
He said Naidorf provides “a mindfulness framework where you can kind of try and better understand where somebody else is coming from to understand why they're behaving or acting like they are and ultimately not to judge them but to give grace in difficult situations and recognize that we're not all perfect beings all the time.”
Pierorazio said patients labeled “difficult” are those who may need the most attention and support from their physicians.
If you’re difficult or not, check out “Operate with Zen.” You’re going to learn a lot of yourself, your doctors, and the patient-doctor relationship.
‘Holy Smokes:” Getting the (Gleason) score right on a Seattle broadcaster’s low-risk prostate cancer
By Howard Wolinsky
It seems like everyday news when media report about prostate cancer being diagnosed in public figures, such as sports announcers and coaches, along with politicians and actors.
Typically, the articles say that the cancer was detected early and the patient underwent surgery or radiation.
So, it was a bit of a surprise when local media reported on Rick Rizzs, 69, veteran announcer for the Seattle Mariners, being diagnosed with Gleason Grade 1. The reports don’t contain the “AS word”—for active surveillance—but clearly that’s what Rizzs is on.
He blurted out his diagnosis last week during a game between the Mariners and the Pirates.
Michael Milken, prostate cancer patient and founder of the Prostate Cancer Foundation, joined the broadcast in the second inning to hype the PCF’s Home Run Challenge fundraiser and promote prostate cancer awareness.
“Michael, this is something now very close to me,” Rizzs said. “I was diagnosed with prostate cancer about three, four months ago. So I want to applaud you and everybody at the foundation for doing what you are doing because this is a cancer that can be cured. But the key is early testing.”
Low-risk prostate cancer is not exactly PCF’s cup of tea. But still, the sentiment is in the right place.
Rizzs didn’t go into detail, which led to wild speculation on Mariners’ social media about what was going on with the broadcaster, whose catchphrase is “Holy Smokes.”
Rizzs doesn’t follow Twitter and so clarified his diagnosis to the media that he has a Gleason 6, Grade 1 and was diagnosed in December.
“I was lucky,” he said. “We detected it in its earliest of stages. It’s the best grade you can get in terms of treating it.”
Media incorrectly reported Rizzs didn’t have a tumor. Readers, you’ll know the score on this: You don’t get a Gleason score without a lesion.
Rizzs will undergo intense monitoring. He’s had one MRI and plans two more this year. He’ll have his PSA tested every few months and a follow-up biopsy in December.
Rizzs gave a plug to screening: “Guys, if you are over the age of 45, get your PSA levels checked and monitor their levels to see if they are going up.”
Very few celebs and public figures have acknowledged being on AS.
The Mariners fared better on this issue than the San Diego Padres, which blew an opportunity to educate their community when their manager had a mysterious prostate issue a year ago:
Maybe Rizzs will start a new trend and celebs on AS will come out of the PCa management closet?
Specifics on Epstein’s second opinion back-ups
TheActiveSurveillor.com reported last week on Dr. Jonathan Epstein, the second opinion guru at Johns Hopkins, going on a leave of absence for undisclosed reasons.
His administrator sent me this note:
Good Morning, Howard,
Dr. Epstein is indeed out on a leave of absence, and we don’t know when he’ll return.
In the meantime, however, you can suggest that they continue to contact Johns Hopkins if they’d like a second opinion. Drs. Andres Matoso, Tamara Lotan, and Ezra Baraban, the three other GU pathologists on staff, have been trained by him, worked with him for years, and will be assigned his cases to review, so they’ll be in good hands.
Take care,
Suzanne Hoffman
Assistant to Drs. Andres Matoso, Tamara Lotan, and Ezra Baraban
410-614-6330
shoffm29@jhmi.edu