Finding Joy: The Health Care Professional’s Journey to Well-being

What Happened When One Doctor Reimagined the Hippocratic Oath by Focusing on the Well-being of Health Care Professionals

September 12, 2023 Mukta Panda, MD, FACP, FRCP-London Season 3 Episode 7
What Happened When One Doctor Reimagined the Hippocratic Oath by Focusing on the Well-being of Health Care Professionals
Finding Joy: The Health Care Professional’s Journey to Well-being
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Finding Joy: The Health Care Professional’s Journey to Well-being
What Happened When One Doctor Reimagined the Hippocratic Oath by Focusing on the Well-being of Health Care Professionals
Sep 12, 2023 Season 3 Episode 7
Mukta Panda, MD, FACP, FRCP-London

Mukta Panda, MD, MACP, FRCP-London, award-winning physician, speaker, and facilitator as well as Professor of Medicine and the Assistant Dean for Well-being and Student Education at the University of Tennessee in Chattanooga, brought the wisdom she gained through decades of practicing medicine in places all over the world. An author of over 60 publications, including Resilient Threads: Weaving Joy and Meaning into Well-being, the most common thread in Dr. Panda’s decades-long work is a dedication to transforming the foundation of patient care and promoting the well-being of health care professionals. Listen to the episode to learn more about Dr. Panda’s “How to Live” art therapy curriculum, used to unpack the difficult and uncomfortable emotions and conversations health care professionals experience, what she believes it will take to transform patient care, her unique technique for creating what she calls, “a culture of belonging” where health care professionals work and learn, and more! 

“Finding Joy: The Health Care Professional’s Journey to Well-being" is a podcast resource developed by a team of interprofessional education researchers from Washington State University Health Sciences Spokane. They’re promoting well-being among students, faculty, and healthcare professionals during challenging times. Funding is provided by the Health Resources and Services Administration.

The Interprofessional Education Research team wishes to thank the following individuals for their invaluable contributions to this project:

• Dr. Barb Richardson, nurse, educator, and interprofessional champion;

• Cameron Cupp, creator of the “Finding Joy” musical score and current enrollee at WSU Elson S. Floyd College of Medicine;

• Washington State University staff from Marketing and Communications, Financial Services, and the Collaboration for Interprofessional Health Education Research and Scholarship; and

• Claire Martin-Tellis, Executive Producer, and Solen Aref, student intern, who developed the first five episodes of the “Finding Joy” podcast.

This episode of “Finding Joy” was produced by Doug Nadvornick, Program Director, Spokane Public Radio.

If you would like to reach out, please contact our team by sending an email to: medicine.ipoc@wsu.edu We also encourage you to visit our podcast blog as well as our team's website at: https://opioideducation.wsu.edu/about/.

Show Notes Transcript

Mukta Panda, MD, MACP, FRCP-London, award-winning physician, speaker, and facilitator as well as Professor of Medicine and the Assistant Dean for Well-being and Student Education at the University of Tennessee in Chattanooga, brought the wisdom she gained through decades of practicing medicine in places all over the world. An author of over 60 publications, including Resilient Threads: Weaving Joy and Meaning into Well-being, the most common thread in Dr. Panda’s decades-long work is a dedication to transforming the foundation of patient care and promoting the well-being of health care professionals. Listen to the episode to learn more about Dr. Panda’s “How to Live” art therapy curriculum, used to unpack the difficult and uncomfortable emotions and conversations health care professionals experience, what she believes it will take to transform patient care, her unique technique for creating what she calls, “a culture of belonging” where health care professionals work and learn, and more! 

“Finding Joy: The Health Care Professional’s Journey to Well-being" is a podcast resource developed by a team of interprofessional education researchers from Washington State University Health Sciences Spokane. They’re promoting well-being among students, faculty, and healthcare professionals during challenging times. Funding is provided by the Health Resources and Services Administration.

The Interprofessional Education Research team wishes to thank the following individuals for their invaluable contributions to this project:

• Dr. Barb Richardson, nurse, educator, and interprofessional champion;

• Cameron Cupp, creator of the “Finding Joy” musical score and current enrollee at WSU Elson S. Floyd College of Medicine;

• Washington State University staff from Marketing and Communications, Financial Services, and the Collaboration for Interprofessional Health Education Research and Scholarship; and

• Claire Martin-Tellis, Executive Producer, and Solen Aref, student intern, who developed the first five episodes of the “Finding Joy” podcast.

This episode of “Finding Joy” was produced by Doug Nadvornick, Program Director, Spokane Public Radio.

If you would like to reach out, please contact our team by sending an email to: medicine.ipoc@wsu.edu We also encourage you to visit our podcast blog as well as our team's website at: https://opioideducation.wsu.edu/about/.

This is “Finding Joy: The Health Care Professional’s Journey to Well-being.” It’s a podcast developed by a team of interprofessional education researchers from Washington State University Health Sciences Spokane. They’re promoting well-being among students, faculty, and healthcare professionals during challenging times. Funding is provided by the Health Resources and Services Administration.  

 

[theme music] 

 

I’m Doug Nadvornick. We all dealt with the Covid pandemic in our own ways. In health care settings, doctors, nurses and their colleagues had to juggle their work, their obligations to their patients and their own fears of getting sick. 

 

Mukta Panda: “My name is Mukta Panda and my title currently is Professor of Medicine and the A ssistant Dean for Wellbeing and Student Education at the University of Tennessee in Chattanooga. Not only were we trying to change the wheels of the bus while it was going at 250 miles an hour, we had to learn how to drive this new bus simultaneously. It was a rural conglomeration of mixture of emotions. They were personal emotions, professional emotions, emotions for others around us, not just the patients, but loved ones. A big one was anxiety and fear of the unknown. There was also this great sense of wanting to do something about it, and there was one of care and support, and I think I saw that not just within myself and felt it, but also in the teams that I was with.” 

 

In the midst of the pandemic, Dr. Panda was communicating with patients, with her family and also her medical students and residents. 

 

Mukta Panda: “I remember the first day talking about, okay, we are going to be very careful. This is what we are going to do. We are going to try to minimize going into patients’ rooms. It was hesitant, it was formal, but that was not working. So I just broke the silence. I said, look before we start today, I just want to say I'm really scared. And I want us to start the day by being very intentional. I did this with my family. I want us to think about three silver linings in spite of where we are today. And I said  these are the things that I have. I can still communicate with my family. I'm grateful for FaceTime. I'm grateful for a family that understands. And I'm grateful that I have security and, you know, I have the intellect to seek the knowledge and make a difference snd we are in this together. I have support. And then they started talking. There was a little bit of a relief that I felt in the body language of all of us. The next day I was getting ready to start and the senior resident says, ‘Dr. Panda, can we start by Silver Linings?’ And he said, ‘I went home and I did this with my family and it really helped us all,’ and we are going to be doing that. And I'm getting goosebumps as I'm talking about it, because it was so profound, this reframing of the mind intentionally to connect it to something that is bigger than us, something that connects to our why, of why we are in this to start with, helps us to reframe to the positive and gives us courage and strength. And the other thing I did was to be very intentional to walk and talk outside because we were so cooped up. And luckily it was March. The cherry blossoms and the Bradford plays were in bloom. So while it was beautiful, yes, allergies, but we had the masks on, so we were physically distanced, but we were walking and talking, and as we were walking the neighborhood, I continued that for quite a few times during the pandemic. There were signs that said, you know, doctors are the heroes and things like that. There was a lot of talk about that. But that was a reflective point about how do we accept that? How do we feel about this? Does this make us feel good or does it make us feel that we have a responsibility? And does that weigh us down even more? It allowed me to have meaningful conversations with my team.” 

 

Doug: So was this sort of a line of thought that you'd had before the pandemic started? Or was this kind of a 90 degree turn that was caused out of necessity by the pandemic? 

 

Mukta Panda: “I have always invited, for myself and for the people that I interact with on a regular basis, opportunities for reflection and solitude when, if they want, or in community. And definitely in community, we do it at least once a week on what gives us meaning and purpose. And I think that is so important to sustaining our own joy, and I'm going to use that word joy. I’ve spent a lot of time thinking about what is this joy for me. And I've realized it is not intense excitement or even intense happiness. It is something much more. Joy is what I feel.  It's what I feel with all my senses, something that moves me to tears or laughter or goosebumps. A nd I ask myself, why is it that I cry when I see somebody else's wedding on the television or when there is the sports and somebody wins or there's a spelling bee competition and the little child and everybody's clapping. I'm with tears of joy in my eyes. Recently, I got an email from one of my students who said that he's got a very high leadership position at an academic institution. I called him right away, and as I'm talking to him, I'm crying. I'm so excited. That is joy. And that's what gives me meaning and purpose.” 

  

Doug: How did the pandemic change that? I n real times, you're sitting there in the same room having FaceTime conversation with this and it changes when you're doing the telehealth thing. And then how do you teach your students, the most basic thing that you teach in medical school is taking a patient history. How does that change in the flesh versus as we are right now talking via computer screen? 

 

Mukta Panda: “ I would go into the patients’ rooms with my mask and a big screen on and PPE and they've got their mask on. And I would start off by saying, ‘I’m sorry, I'm speaking loudly. I have a mask. If you can't understand what I'm saying, please ask. I am so sorry. I don't like it this way. I know it's difficult for you, but we are here to help you.’ And then I would say, ‘I know this is very hard because your family can't come in.’ B  ut our nurses, they made every attempt to FaceTime with the family as much as we could so that they could have that connection, our patient. So that was when we were inpatient. I do the same thing on telehealth. We know it's not the same, however, this is the reason we are doing it. And then I try to make some connection with what I'm seeing on their background if they don't blur their background. Tell me a little bit about that picture. There are ways if we seek that.” 

 

We’re talking with Dr. Mukta Panda, a physician in Chattanooga, Tennessee and a Professor of Medicine and the Assistant Dean for Wellbeing and Student Education at the University of Tennessee in Chattanooga. 

 

Doug: You have been a doctor for quite a while. Is this a new movement toward physician wellness, toward making sure that physicians have what they need in order to be the best doctors they can be? Is this revolutionary? Is this something that has been coming? Is this  something that was given new juice by the pandemic? 

 

Mukta Panda: “I have seen the practice of medicine across the globe since very late 1969, 1970, when I used to see my parents and I was about six years old at that time. And till now, and I've seen it across different countries, continents, and in different healthcare systems. The system in which medicine is practiced has changed tremendously. True, it is a business and I'm not in any way saying that is wrong. However, the very essence of what it is to be a physician or not perhaps was not the priority. That human touch has been buried because of technology and all, not that technology’s bad, but it didn't happen in parallel. We didn't just arrive here. This is the direction we took knowingly, but majority of it unknowingly. And, you know, as physicians, perhaps we did not advocate for ourselves very well. I think what the pandemic did was reveal the tip of the iceberg for the physician burnout, but it also revealed the other factors that lead to it. The issues around what we are seeing, climate change and the lack of attention to it, the economic issues, the just culture, diversity, inclusion, equity issues. So I think we are in a very unique situation right now to say that, yes, we feel that healthcare has become a commodity. It's like a corporate model. It's a business model, but medicine needs more. We have to change the culture and we have to ask ourselves not what is below the tip of the iceberg, but why did that iceberg get formed? And that re-imagining will require us all to come together, build relational trust, align the missions and the common goals for the greater good, and decide, okay, what is it that is at the core center? We keep people and people's humanity at the center. I think we definitely can come to that. And I think that's where this revolution, that what we are seeing now, this momentum, is how do we blend the touch and tech together so that it's not one at the cost of the other and realizing that the caregivers are human too. So we published the Oath to Self-Care and Wellbeing, which was part of a group that I'm on the steering committee for and have been since the inception of the group. It's called CHARM, Collaborative for Healing and Renewal and Medicine. And it was really born from the understanding that the Hippocratic oath is timeless, but it was written at a time when healthcare was very different. What we need now, today, is those same altruistic values, but realizing that we also need that unashamed, unapologetic invitation to know that we are humans and we need to make our own care and the care of each other a priority, and that we need to partner with our healthcare organizations. It's not us versus them, it is us together, have to partner as we reimagine this system to give the best care to our patients and community. And it came out, you know, at a time just around the pandemic.” 

 

Doug: How does that trickle down to medical education? And I think especially of those interns, those residents who come in and work long, long, long hours learning.  Are they coming in with that notion that we don't need to do it the way we did 20, 30, 40 years ago where we're working 80 or 100 or 120 hours a week, that, from the very start, they understand that I need to be filled up as a doctor so that I can be the best for my patients? 

 

Mukta Panda: “I think I do think that, yes, because of the increased awareness that there is. However, I will tell you that medical schools across the nation, including ours and training programs, have made very intentional and mindful changes in how they administer and how they educate and what the schedules and structure looks like to make this time for wellbeing and also professional fulfillment a priority and there is education around that. There are structures built into it. We talk about it at orientation of medical students. We make sure that they are part of the design of what that wellbeing needs to look like because wellbeing is such an individual concept. In addition, we are normalizing the culture, that being human, we have emotions and we need emotional support just as when we come in, we need a physical fitness for duty. There is nothing wrong. We all need emotional support. So we have counseling that is available on site and I was able to get a counselor in our office here in the dean's office in Chattanooga, Tennessee, and some of the leaders of different departments, chairs, program directors, broadcasted openly that they were going, setting the stage that we are going to normalize this. There is nothing wrong with this. So, making it part of the culture that emotional wellbeing matters and then also making sure that we are educating with skills. How do you manage these? You know, we are dealing with a human emotion every day in a physician or a learner's life. We have moments of joy, but we also have moments of deep sorrow, deep loss. And if we don't take intentional attempts to unpack that and find meaning with it, then that's when they get buried and then they suddenly erupt and they transfer maybe as bad coping habits or self-destructive habits or harmful behavior or disruptive behavior. So how do we unpack that together? And that other pandemic of loneliness is dispelled because we are doing it together in community. So something that we do every week with my team is, it doesn't take long. I take time and just ask them to reflect on three things. What about our work together gave us hope, gave us meaning and surprised us?  And in addition to that, I have a partnership with our museum here where we do what is called the art of integration and it's called the How to Live curriculum. For about two hours, once a month, the students gather and we use art and embodiment and writings as a third thing to unpack those uncomfortable and difficult conversations like the imposter syndrome or how to deal with death and dying or grief and loss or powerlessness. That's a beautiful time for a little respite from the busyness. And then, when they graduate, we talk to them about the oath and we share the oath and then we ask them to write their oath. What was their going to oath to self-care and wellbeing look like? And then they write it and then we have pictures of them holding it together and individually, and then we laminate and give it to them. And now they want it digitally, so I email it to them.” 

 

Doug: So let's finish with this. There's a lot being made about how stressful this has been a time over the last few years to be a healthcare worker. What do you think? Is it a good time to be a doctor? 

 

Mukta Panda: “I look at the question two ways. I'm going to answer it for myself first. I think there are days when I feel it's a difficult time. But at my core, when I really take time to unpack and think why I am saying it, because that's maybe an initial reaction, the times I feel like that is when I feel my voice is not heard or that I'm banging my head against a wall, trying to advocate for a patient or against an insurance company or a prior authorization or something. I know when I need to pause or when I need to halt is when I get too hungry, angry, lonely or tired. But that's me and I have to decide for myself, how am I going to unpack that? And then I tried to reframe. I said, okay, why am I upset about this? And then what do I have control over? So to me, I still find meaning and purpose in my work. So I think whether it's a hard time or not for doctors, I think the external pressures are tremendous. I think, yes, this is a difficult system to change the culture because there are so many moving parts. We didn't get here overnight, so it's not going to change overnight. But I think it's also the most exciting time. I think it's the most important time for us to come together as a community. Our community comprises of such intelligent forward thinking, altruistic, committed people, and who better to work together, and they are working together, all across the nation, all across the globe. So I think this is the time that change is happening and out of this chaos, this change, come creative opportunities. So I think we have to seize the moment. But we have to seize it collectively. We have all faced collective trauma, but together, coming together collectively, creating a culture of what I call belonging, where we are all connected to a meaning and purpose and we are all speaking a language that keeps the human at the center, that keeps relational trust, meaning, purpose, joy. I may disagree with you, but I will always respect you for the human you are. Then I think we move together with collective hope and collective action.” 

 

Dr. Mukta Panda is a Professor of Medicine and the Assistant Dean for Wellbeing and Student Education at the University of Tennessee in Chattanooga. We thank her for joining us. 

 

[theme music] 

 

We also thank the following individuals for their contributions to the Finding Joy podcast series: 

 

• Dr. Barb Richardson, nurse, educator, and interprofessional champion; 

• Cameron Cupp, creator of the “Finding Joy” musical score and a current student at WSU Elson S. Floyd College of Medicine;  

• Washington State University staff from Marketing and Communications, Financial Services, and the Collaboration for Interprofessional Health Education Research and Scholarship; and 

• Claire Martin-Tellis, the original executive producer of the podcast, and student intern Solen Aref. They developed the first five episodes of “Finding Joy.” 

This episode was produced by Doug Nadvornick. 

If you are interested in sharing your perspective about well-being as a healthcare professional or would like to reach out, you can contact our team by sending an email to: medicine.ipoc@wsu.edu. We encourage you to visit our website at:  https://opioideducation.wsu.edu/about/