Central Line
Episode Number: 82
Episode Title: Finding Gratitude
Recorded: November 2022
(SOUNDBITE OF MUSIC)
VOICE OVER:
Welcome to ASA’s Central
Line, the official podcast series of the American Society of Anesthesiologists,
edited by Dr. Adam Striker.
DR. ADAM STRIKER:
Hi. Welcome back to
Central Line. My name is Dr. Adam Striker. I'm your host and editor. And today
we have a friend of the show back with us, Dr. Mohammed Rafiq. Dr. Rafiq is the
guest editor for December's ASA Monitor on a subject I think we can all
appreciate gratitude. We're recording this show in November to post during
Thanksgiving week, which is certainly a good time to delve into why gratitude
matters, what it looks like, and how we can all be more intentional about being
grateful. I'm looking forward to this one. So welcome back, Dr. Rafiq.
DR. MUHAMMAD RAFIQUE:
Thank you very much, Dr.
Striker. Glad to be back.
DR. STRIKER:
Really briefly, why do
we need to talk about gratitude? I have a whole Monitor devoted to this.
DR. RAFIQUE:
Practicing gratitude
helps us to be resilient and mentally strong and positive. And there's a whole
host of research which supports this statement. This is what research has
shown. And one of the features of this month's, you will see that Dr. Gustin argues that gratitude towards your patients, your
colleagues and everyone around you is a very effective way to combat physician
wellness and burnout. And happy and healthy physicians are definitely a very
important piece of the puzzle to enhance the patient safety and patient care.
So that is the common goal of all the health care providers. So that is why
gratitude and practicing gratitude is very important for all the practicing
physicians and practicing anesthesiologists.
DR. STRIKER:
As we talk, I'm sure
there's a lot of layers that don't seem quite as apparent. And when you first
hear that term as to what we can discuss when it comes to gratitude. And so
let's start off by defining it. Webster's Dictionary defines gratitude as the quality
of being thankful, ready to show appreciation. But physiologically speaking,
what is gratitude? How does it impact us holistically?
DR. RAFIQUE:
Gratitude is unique
among all the emotional responses because most emotions like pride and joy or
anger, etc., can be self-centered, but one has to be thankful to someone or
something else. It can be a colleague, a spouse, somebody who made a piece of
technology or the ultimate gratitude to the divine being or deity. It is
accepting the humility that recipient could not achieve a certain task or
benefit without help of others to whom one is thankful. One has to be thankful.
In last few decades, a
lot of research has been conducted for this, for its psychological effects on
the human behavior, human well-being. And gratitude even changes our brain
neural connections in a very unique way. It is well known that area of the
brain, which you can call Gratitude center, is located in the ventromedial
prefrontal cortex, anterior cingulate cortex.
A fascinating study
which came out from Indiana University and was published about seven years ago.
They recruited a group of patients who were entering therapy for anxiety and
depression. They divided them into two groups. One group was therapy as usual,
and the other was Intervention group labeled Gratitude Group. In this
intervention group, the participants wrote a letter of gratitude to someone of
their choice. Every week for three months. After three months, all the
participants, both the control group and the gratitude group, had a functional
brain MRI while doing a pay forward activity, and the Gratitude group exhibited
neural activity in the medial prefrontal cortex of the brain and was not seen
in the standard therapy patients, which shows us that although we may not think
that, but when we are practicing gratitude, our brain definitely changes in a
very special way, which is more permanent than just for a few seconds.
DR. STRIKER:
Okay. And then how does
that translate to how we feel, whether we should engage in gratitude or not,
specifically the studies?
DR. RAFIQUE:
There's another very
fascinating study by expert in this field, Dr. Emmons. And he and his
colleagues recruited volunteers and not the patients and divided them into
three groups. Before the start, everybody underwent a very thorough evaluation
for their mood and mental condition, as well as health. And for ten weeks, they
had three groups. One group, they called it Gratitude Condition, where they
were supposed to write down five things they were thankful to in the previous
week or grateful in the previous week. Single sentence. It didn't have to be
something heroic, just whatever they felt. The second group was a condition
they called it, and they had to write five things which they had which had
bothered them in the last week. And the third group, which was kind of control
group for them, they said events, condition, they called it where they were
supposed to write something which they thought was significant in the last
week. And the results were amazing. The gratitude condition were, according to
their measurements, 25% happier. They had very few physical complaints or
symptoms compared to the other two groups. Also, people in the gratitude
condition were naturally exercising about one and one half more per week, more
than the other two groups. And they did a follow up study where they pretty
much kept the same activities and instead of doing it every week, did it every
day. And after 21 days they again evaluated their mental condition and all of
those things. And they found that the people who were writing the gratitude
things, they were much more joyful, enthusiastic, energetic and all the good
emotions and physical attributes compared to the other two groups. So it shows
that being actively grateful has definite positive effects on the practitioners
or humans in general.
DR. STRIKER:
It's nice to have some
objective evidence to show what I think a lot of us know, which is that you're
happier if you're grateful for things in your life or at work or in your
professional life. So as we move forward, though, is it harder or easier given
the last couple of years for anesthesiologists specifically to find gratitude,
to look for those pockets of things to be grateful for, especially given what has
happened in the past couple of years, which shows no signs of slowing, whether
it's workforce shortages or increased workload and burnout.
DR. RAFIQUE:
As we all can relate, it
is very easy to be grateful when we are healthy and happy and prosperous. But
it is probably much more challenging to be grateful when facing difficulty. If
we turn to the religious texts, probably the story of Jobs, in Arabic they call
Prophet Ayub, has a lot to teach us. As the story
goes, he was grateful in prosperity and health, as well as when he faced a most
challenge in the health and wealth. He remained grateful despite he was incited
to do otherwise. And it is a great question which philosophers, thinkers and
theologians have been trying to answer -- how to be grateful in times of
adversity. Actually in this Monitor the article by Dr. Williams actually
reflects on this aspect and argues that a difficult circumstance like recent
pandemic brings an opportunity for growth and invites us to change our
perspective to one of gratefulness and bringing peace to life. It is
fascinating to read. I am very thankful for his contribution.
DR. STRIKER:
So are anesthesiologists
uniquely positioned in some ways to find gratitude. We deal with some of the
most stressful moments of any patient's life and many times in our own lives
taking care of these patients. It's incredibly stressful. But does that provide
for an opportunity that many other practitioners do not have to find gratitude?
DR. RAFIQUE:
It is all about
perspective. As we said earlier, as anesthesiologists, we see patients coming
for a trivial procedure to the heart or brain surgery. So it all depends on
perspective. If we are able to focus our attention to the positive emotions and
see the brighter side, it can help us to be better physicians. Actually, I was
just looking last week ASA sent out a survey, I think it is being conducted by
researchers at Harvard, which aims at understanding the very question of
burnout and how to combat it and increase physician awareness. I think we
probably all have received it and we should respond so that we can know more
about what physician wellness and burnout conditions are at this time and how
we are going to become better at it.
DR. STRIKER:
Before we move on, I can
hear, I'm sure, plenty of anesthesiologists out there or some of our listeners,
they're listening to this and they're saying, you know, this sounds awfully
similar to what my administrators tell me. I should just go about my work and
be happy and go take some yoga classes, meditate, get a free granola bar in the
lounge, and I should just then move on with my work and see this as validating
what I've been told. How do you respond to those individuals?
DR. RAFIQUE:
Gratitude is an essential,
emotional, emotional act that needs to be practiced more frequently at the
workplace. It is a lifelong process to cultivate and learn gratitude and be
able to practice it more than other negative emotions. As we know from
psychology, research, that behavior change is a slow process and everyone has a
learning curve. Dr. Emmons, in his famous book Thank You, has given a list of
actionable tasks which can help to grow and establish a habit of gratitude.
These are keep a gratitude journal. Use visual reminders to help with the
gratefulness, for example, involves reminding of gratefulness. Be careful with
words. Choose what you say and how you say it. Self-reflection by asking
questions too, like what I received from others today. What I give to others.
Did I cause any trouble? Learn to give gratitude in the form of prayers, etc..
These are the actionable things which, if we start practicing, may help us to
be grateful in the long run. And as I was pointing out, that behavior change
takes time, and practicing gratitude constantly over time definitely has
positive effects, both on our emotional health and on our physical well-being.
So probably these are the actionable items and you can see more detail in the
article.
DR. STRIKER:
Certainly it's not the
end all, be all to burnout or wellness, but certainly can be a valuable tool in
any physician's belt. Well, I want to discuss a little bit more about gratitude,
so please hang tight. We're just going to take a short patient safety break.
(SOUNDBITE OF MUSIC)
DR. ALEX ARRIAGA:
Hi, this is Dr. Alex
Arriaga with the ASA Patient Safety Editorial Board. Preoperative critical
event debriefings are important for patient safety and the provider experience.
Yet research suggests only a fraction of perioperative critical events are
followed by any form of debriefing. The time, shortly after a critical event,
presents a valuable opportunity to reflect, provide feedback, identify systems
gaps, and look out for each other's well-being. At a local policy level, there
are crisis checklists, emergency manuals and other tools that can be a starting
point to discuss events where debriefing may be most supported. Medical
simulation may be a way to generate rare events and facilitate debriefing
training in a safe space. Leadership support for a critical event debriefing
can improve buy in. Efforts to improve critical event debriefing practices can
benefit the individual team and overall health system.
VOICE OVER:
For more information on patient safety, visit asahq.org/patientsafety22.
DR. STRIKER:
Well we’re back. Some of
us learn very differently. Is gratitude something that can be taught? Is it
something that has to have a special methodology to learn?
DR. RAFIQUE:
We all lack training in
this domain. Now it is being included in medical curriculum because the
research clearly indicates that emotional intelligence is a very useful tool in
a doctor's armamentarium, and physicians trained in this regard have better
patient satisfaction scores and better emotional health for themselves. And it
should be part of residency curriculum in anesthesia. And as a matter of fact,
all specialties.
DR. STRIKER:
In residency curriculum.
Is that something that we are not spending enough time on?
DR. RAFIQUE:
Probably not. I don't
remember, when I did my residency, I don't remember anything like that being
talked about or considered. It was all about work, work, work and learning new
techniques and getting to this conference or that conference. But I think I
have seen recently in our program actually here, at our residency program, that
these things are being talked about. And once one starts talking about these
things, then the more time and resources are devoted to it and they ultimately
lead to some action and probably betterment of the overall community.
DR. STRIKER:
The articles in the
December Monitor are unique in some respects. There are several personal
stories from anesthesiologists about how and why they've intentionally
cultivated gratitude and what it means to them personally. What did you take
from these stories and what do you hope the readers will take from reading
these stories?
DR. RAFIQUE:
You are right. We had
some amazing authors who written excellent feature articles for this. If we go
from the articles we have, Dr. Gustin's article
emphasizes on the use of gratitude as a tool against burnout, and he argues in
this article in a very good manner that if we are grateful even to our
patients, because these are the patients who are giving us the opportunity to
have an impact on their life and realizing and acknowledging that fact is a
very good way to start and is a very good tool to combat the burnout. In the
article by Drs. Williams, a husband and wife duo, they talk about unique
perspective of reflecting on the blessings and difficult times and finding
strength and learning from the experiences. The feature by Dr. Sabina Khan is
really unique. It describes her experiences as being a physician and training
to the highest level and practicing cutting edge anesthesia. But she concludes
that we could be the best of the best in the world, but to find the real peace
and harmony, we have to learn the art of gratitude. Dr. Jaworwicz
has written a beautiful biographical account, and he finds gratitude for his
parents and wife and family the most. And in the end, Dr. Dutton, who is a
pillar in our specialty, has a very unique article showing our day-to-day life
and how finding little things in place during clinical practice are priceless
for safe care. And he thinks only with gratitude we can be successful professionally.
DR. STRIKER:
I'm really looking
forward to reading those stories in the December Monitor, but it kind of gets
to the heart of why a lot of us chose to be physicians and finding gratitude in
our professional lives, I think what we haven't really covered as much is
receiving the gratitude from patients we take care of or coworkers that we help
out or administrators that we're helping. I just want to get your take on how
much receiving gratitude is beneficial. How do you see that? The other piece,
the other direction.
DR. RAFIQUE:
I think we are still
learning about it. There is some research that if, at a workplace, the
leadership are the people around you show gratitude, it increases our
happiness, our productivity, and even productivity at the job with the
gratitude. It is a ongoing process to learn how we
are going to find more and more ways to be grateful and more and more ways to
receive gratefulness. I would say throughout my journey to be here, there are
countless people who have helped me, so if I want to name a few, I would say my
first thank goes to Allah Almighty, then my parents, who made a lot of
sacrifices for me, my wife Maryam. And in a professional world, my mentors. I
want to mention Dr. … at Southwestern
and my former chairman, Dr. Heinrich Worm. Also everyone around us who made the
day possible for us residents, nurses, or even the environmental services
workers. Without each and every one of them, we are unable to accomplish what
we do on a daily basis. And also I'm thankful to ASA staff for making this
activity possible.
DR. STRIKER:
It's wonderful to hear
that, and I think it's a good lesson for a lot of us. What you've just
articulated about yourself is that in spite of the difficulties and despite the
burdens we're all placed under, there's always some ways we can find to be
grateful and should strive to do that, as evidenced by what we've talked about
here today, don't you think?
DR. RAFIQUE:
Yes, definitely. Finding
gratitude in small things, finding help from others and acknowledging it has a
very big role in the social fabric we are in and more we acknowledge than I
think better we are as a society.
DR. STRIKER:
Dr. Rafiq, is there
anything else you'd like our listeners to think about regarding gratitude or
anything else you'd like to leave us with before we wrap up the discussion?
DR. RAFIQUE:
Having a active mind out that everything matters and we are all
dependent on others to be able to function and to be able to do a good job and
to be able to take care of our patients. So if we give thanks to others who are
helping us, probably they will be more happy and healthier and probably they
can play their roles in a better way and make our jobs even easier. So it is a
two way traffic if we start doing things, being a health care provider and a
health care leader, probably people around us will realize more and more that
their work is valued and their lives matter and probably they will be more
productive and more helpful.
DR. STRIKER:
As we wrap up here, I
think hopefully we provided a little bit of positivity for the month of
Thanksgiving for all our listeners, given all the stresses were placed under
and something that doesn't take a lot of effort but can potentially provide a
lot of high yield in terms of helping in terms of wellbeing. So Dr. Rafiq,
thanks for joining us today on Central Line.
DR. RAFIQUE:
Thank you very much for
having me. It was a pleasure.
DR. STRIKER:
And for all our
listeners, be sure to check out December's ASA Monitor, which has all the
articles on gratitude that Dr. Rafiq has alluded to. And please tune in again
next time on Central Line. And if you feel like it, drop us a review. Tell a
friend about our podcast and we'll talk to you again soon. Take care.
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