Show notes
Welcome to Unfiltered, a new show that brings together two iconic voices in healthcare for an unscripted, hard-hitting half hour of talk. Dr. Robert Pearl has twice appeared on The ZDoggMD Show (see: here and here) opposite Dr. Zubin Damania, who has twice appeared on the Fixing Healthcare podcast with Pearl, alongside cohost Jeremy Corr (see: here and here). This episode ventures into uncomfortable territory. It starts with “the slap” at the Oscars and asks whether making fun of a medical condition is ever okay. Next up, the two doctors discuss emotion in medicine: should physicians show more of it at work? And finally, four existential questions for healthcare professionals, including: What’s our purpose? To get started, press play or peruse the transcript below. * * * Fixing Healthcare is a co-production of Dr. Robert Pearl and Jeremy Corr. Subscribe to the show via Apple Podcasts or wherever you find podcasts. Join the conversation or suggest a guest by following the show on Twitter and LinkedIn. UNFILTERED TRANSCRIPT Jeremy Corr: Welcome to Unfiltered, our newest program on our weekly Fixing Healthcare podcast series. Joining us each month as Dr. Zubin Damania, known to many as ZDoggMD. For 25 minutes, he and Robbie will engage in unscripted and hard-hitting conversation about art, politics, entertainment, and much more. As nationally recognized physicians and healthcare policy experts, they’ll apply the lessons they extract to medical practice. Then I’ll pose a question for the two of them as a patient based on what I’ve heard. Robbie, why don’t you kick it off. Robert Pearl: Zubin, I’ve heard great feedback from our listeners about the first show and our willingness to tackle controversial issues. You’re my social media maven. And I have to ask you about the event that garnered twice as many social interactions than Ukraine, and four times as many as the president of the United States. And of course that was the confrontation between Will Smith and Chris Rock at the Oscars. But rather than talking about the slap, Zubin, I’d like to ask you a different question. Why do comedians think it’s okay to make jokes about people’s medical issues? Zubin Damania: Ah, well, boy, there’s so much here. I mean, the truth is comedians, like anybody, their job is to make people laugh or to point out absurdities and that kind of thing. Now, whatever Chris Rock knew or didn’t know about Jada Pinkett Smith’s alopecia, I actually am with Bill Maher on this, where again, there is a free speech protection here where Chris Rock can make jokes all he wants and Will Smith can protest verbally, legally, however he wants to do it. That’s fine. What’s inexcusable is hitting anybody and hitting a comedian for making a joke. Now, whether or not he knew, because Jada Pinkett Smith has been public about her alopecia, there’s a lot to nuance here. It’s more common in African American women. She’s a public figure. So it is traumatic for her. But as Bill Maher said, “If the worst thing you have to deal with is alopecia, I don’t think someone should slap somebody for making a joke about it.” So, I tend to fall on the free speech side on this one myself just being somebody who dabbles in comedy. Robert Pearl: Yeah. I agree with you completely. First of all, we both agree that the violence is inexcusable. So that’s why I didn’t want to talk about that. And I also agree with you on this free speech. He has the right, the legal right, the constitutional right to do so. I guess the question I’m really asking, is it worth the pain that’s inflicted? Zubin Damania: Mm, this is a great question. I mean, look, in comedy, you’re not supposed to punch down. Anytime you make fun of someone with a chronic disease, you’re punching down, kind of by definition, like Putin could suffer from end-stage renal disease. And if you make a joke about him being on dialysis, you’re still punching down because he didn’t choose to have that disease, and it doesn’t do well for other people with the disease, and it’s stigmatizing. So, as a general rule, right, you don’t punch down in comedy. Robert Pearl: Probably because I fixed so many kids with clef lips in the past, and I’ve heard all the jokes and I’ve seen the pain that they experience, I am overly sensitive about this issue. But I guess, as a physician, I would hope that we would keep people’s diseases out of comedy. It may be funny, don’t get me wrong, but I think the pain inflicted on the individual, now, if it’s the president of the United States or it’s Putin or someone, these are very public figures who are at the center of the discussion. If it was about Will Smith, you could say, “Okay, well he’s about to win an Oscar, but” his guest, who happens to be a public figure, but still, to make that be the brunt of the comedy, again, I’m probably overly sensitive, but I’m reacting as a doctor to this. And that’s why I wanted to ask you, because you’re a social media leader. And as you say, you’re quite a funny comedian. Zubin Damania: Well, I mean, that’s a great perspective, Robbie, that you’re bringing because you’re actually seeing the suffering that these diseases can cause. And so you compound the suffering if you’re making jokes about it as a public comedian and so on. This situation is a little murky. It’s just hard to know what Chris Rock knew about… Maybe she, in his mind, she had just chosen to shave her head as a style point, in which case, as a public figure, you’re fair game. Right? But I think your point is very well taken. And again, it’s a question of, are you generating net suffering in the world or are you generating net joy or well-being? And I think that’s a good moral compass for all of us. That’s why comedy, in general, I’ve seen comedy where I’m just like, “Yeah, that was just, not only was it not funny, but it was kind of hurtful.” So it’s kind of like, well, there’s no net benefit. Like I’ll defend your right to make the joke, but it’s just not good comedy. Right? So I think you bring a very valid point here. Robert Pearl: Zubin, your comments about the emotional aspect of this encounter, they make me think about a class that I took at the Stanford Graduate School of Business on politics and public speeches. It was about the relative power of emotion versus logic. My favorite clip was from Oliver North and his testimony to Congress in the Iran-Contra affair. It begins with one of the senators who wasn’t a fan of Colonel North showing a video of the FBI agents storming into his office in Washington, DC, as he sat at his desk, shredding all the incriminating evidence. The senator, certainly no fan of North, believes that he’s made Oliver look like a fool. He says, “What were you doing?” North says, “My job.” The Senator’s flummoxed, this is not what his prep team has predicted. The senator stammers. He asked the colonel, “Why do you think this is your job?” And in this totally unemotional calm face, he says, “If it wasn’t my job to shred documents, then why would the government have given me a shredder? And why would Congress have paid for it?” This complete lack of emotion is powerful. And in contrast, in the same class, the professor showed the 1988 debate between the democratic candidate, Mike Dukakis and the republican candidate, George Bush. The CNN correspondent Bernard Shaw asked Dukakis whether he would support the death penalty if his wife were raped and murdered. His response purely cerebral, “No, sir. I don’t see any evidence it’s a deterrent to deal with violent crime.” The pundits think he may have lost the election because of that one completely unemotional response. So now let me ask you, doctors are taught not to show emotion. Don’t cry, don’t yell. Don’t admit how unfair life can be when it comes to who gets cancer. And yet we’re expected to be authentic. How should we, as physicians, as clinicians, resolve this contradiction? Zubin Damania: Man, this is why I love doing this podcast with you, Robbie. I say no to every podcast invite I get. And Robbie’s like, “No, we’re just going to talk about this kind of thing.” I’m like, “Yeah.” So look, this is central to who we are as human beings. And you said the word authenticity. We’re expected to be authentic. And yet we can’t show what we are, which is largely emotional creatures with a little reason tacked on evolutionarily. We really are, as Jonathan Haidt says, “We’re all elephant with this limbic system that is evolved actually to keep us safe”. Emotions are there for a reason. They’re feelings. They call them feelings because you feel them in the body, they’re an energetic pattern. You ignore them or you repress them at your peril. And the reason, Dukakis lost that thing, the reason we loved Spock is not because he was all logic. It’s because you could feel clearly Spock was half-human. The underlying emotion was there and watching him try to repress it, watching him try to be a good Vulcan and fail very often was what made him human. And that’s why Kirk, at the end of Star Trek II, says, “Of all the souls I’ve encountered in my travel, his was the most human.” And that’s why in medicine, I think it’s important that we’re authentic with our patients. We do need to show some emotion, but we also need to have that kind of cognitive empathy that says, “You know what? Yes, I feel that you’re suffering. I know that you’re suffering and you can feel some of my emotion, but also I’m going to be a source of stability for you. So I’m not going to let it cloud decision-making. I may help with you to use our emotions together to inform what values matter to us.” And I think that’s important when we ignore that. When we ignore our own emotions, we end up with all kinds of problems. And physicians in particular are the masters and mistresses of emotional repression. Yeah. So to me, focusing deeper on understanding our own emotions and unrepressing them and really feeling them and getting rid of this stigma, oh, there are negative emotions and positive emotions. No. There are energetic patterns that we call emotions, e-motion, energy in motion. Let’s feel them because if you don’t, they’re not in motion, they almost become solidified. And then you tell stories about them and then you act unconsciously on them. So, you know what happened with will Smith? Undoubtedly, there was deep emotional repression for years of being a celebrity and having to swallow this stuff and whatever was going on with him and his wife. And then what happens? It comes out in violence. You don’t have to do that if you’re actually in touch with that stuff on a regular basis. Robert Pearl: Let me ask you where the line is. I was talking to a doctor who lost four COVID patients in the same day. This feels to me to be beyond the possible human tolerance. How are we going to address this? And how are we going to deal with the PTSD that invariably is now about to start in even greater force than during the pandemic itself. Zubin Damania: Yeah. You know what’s interesting is I think human tolerances are beyond our imagination. Like we, humans are able to tolerate insults and traumas that would just theoretically break anyone and they seem to do it. And some actually find meaning in it and grow stronger. But the difference is you have to have that, in my opinion, in medicine, what we miss is this communalization of pain. We don’t make it okay to talk about this stuff. We don’t make it okay to say, “You know what? I’m suffering too.” And that way, you could tell people, “Look, we’re all in this together. Yeah, man, four patients that we’ve known forever, and now they’re not here.” That is a trauma. So let’s sit and process that, let’s feel the emotion. It’s okay to have grief. That’s normal. If you’re suppressing grief, that’s what’s not going to be good for you. So providing the tools and resources to actually process that stuff will be important to mental health resources, et cetera, but just changing the culture to say it’s okay to feel these things. This is normal. In fact, if you don’t, maybe that’s the pathological state. And we ought to think about that. So again, I don’t have a magic answer, but I’d say that diving into the pure emotion of loss and grief… One of the things that happens when you go down any sort of self-realization or meditative path is strong emotions start to arise that were repressed by the mind for years and years and years. And they start to unrepress because the mind relaxes and the thought-based structures relax. And one of the things that can happen is you can feel unmitigated sorrow out of the blue, be driving and just burst into tears. And we have no societal container for that. So in medicine, it’s even worse. So we have to start building those containers and those structures to process. Robert Pearl: Well, I want to dive a tiny bit deeper and ask you how. Because I’ve seen the response that people have had to individuals who say, “I need therapy,” or “I’m not able to work to my best today because of the emotional experience I had.” I mean, I’ve seen people, a physician get a diagnosis of cancer in the morning and come back and take care of her patients in the afternoon. I mean, I just keep feeling as though this problem is going to be so hard to burst through. How can we start? Zubin Damania: Oh, my gosh, man. I mean, that stuff is heartbreaking and you’ve seen it so much as leader of the group. I’ve seen it when I was on the front lines with my own team. And people I used to work with still email me and they go, “I’m at my wits end. I don’t know what to do. Do you have any advice?” And I think… Okay, I’m going to give you an answer that is going to be unsettling for some people and they’re not going to like it. But the truth is, I’m just going to tell you what I know. Recently, I did like a six day semi-silent meditation retreat led by another physician. And they were all healthcare professionals, about six or seven or eight doctors, many nurses, physical therapists. And this was just in November. So COVID had been going on. People were traumatized and they came in. Many of them had never meditated and had never had this kind of practice, but they saw my show and they’re like, “You know what? I want to do this thing.” And what we found was people opened up and just torrents of emotion and sharing in the non-silent parts in the evening when we did group activities. And the being with yourself and processing that stuff, that unconscious stuff, in a safe space with other people who do what you do is so powerful, Robbie. When the thing was done, many of them were saying this was the most powerful experience they’d had. And that they went back with renewed sort of resilience to their careers. That doesn’t mean that’s the single answer, but you can see how powerful unrepressing that stuff, having a safe space with your colleagues and doing the deep work of actually introspection. We tend to externalize everything. We project everything we say, “Oh, this is the problem. It’s this guy or that guy.” But when you actually look inside, it’s really all right there, and we create the world. So that’s my really questionable answer to that. Robert Pearl: Your story, Zubin, reminds me of a talk I heard Yo Yo Ma give in Silicon Valley. And for any of our listeners who don’t know his background, he was a child prodigy. He performed from the age of four and a half. At something like five or six, he and his sisters gave a concert for President Kennedy at The White House. He’s recorded 90 albums, 19 Grammy Awards. He’s the best celloist of the time. At the event I attended, first he played a series of some of the most beautiful and moving cello pieces I’ve ever heard in my life. But then he talked about four existential questions that he said he often thinks about. He said that he wonders first, who am I? Second, what am I grateful for? Third, what is my purpose? And fourth, what do I want? Sitting in the audience, Zubin, I wanted to scr…
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