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Beyond Pixar: Perfectionism, EQ, and the Middle Way

Neda Frayha, MD, Lawrence Levy, JD, and Todd Cassese, MD
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What does the former CFO of Pixar have to do with physician burnout and the culture of medicine? We find out in this segment. Neda interviews Dr. Todd Cassese and Lawrence Levy, who helped build Pixar into the company it is today. Together they talk about changing professional cultures, the narrative of medicine being out of sync with the reality of medicine, perfectionism, emotional intelligence, and how Eastern philosophy’s The Middle Way can apply to all of our lives.

Pearls:

  • Three themes emerge from Lawrence’s work as the former CFO of Pixar and his current work with the Juniper Foundation that he applies to the current state of physician burnout today:

    • 1. We can change the narrative of medicine from one that values perfectionism to one that values balance.

    • 2. We need to carve out time for self-care.

    • 3. The system is a problem; however, we can continue to work on ourselves even before the system completely changes.

 

  • Lawrence is a lawyer by training who worked as CFO of Pixar with Steve Jobs, before eventually getting into meditation by founding the Juniper Foundation. He and Todd, an internist and medical educator, connected around the issue of physician burnout.

  • Three major themes around medical culture and the work of clinicians:

    • 1. The narrative of medicine is out of sync with the realities of medicine

      • Until we change the narrative of physicians as infallible, we cannot change the reality of constant pressure and fear of being wrong

      • Overemphasis on IQ over EQ when humans are emotional beings first

    • 2. Physicians spend far too little time on self-care and self-nurturing

      • Self-care must be a continuous habit of self-nurturing and mutual support just like food or exercise

      • Check-box yoga or meditation is not the answer → building time into the day and committing to self-care is how such practices can be sustainable

    • 3. While we need to change the system to address burnout, we can’t wait to also change ourselves

  • Things Lawrence learned from journey to Pixar and then to Juniper:

    • Pixar’s narrative needed to change from one of a graphic technology company to an entertainment company

    • Companies like Pixar create amazing things through the tensions between people (ie: technology people and creative people) and a culture of collaboration enables this tension to create amazing things

    • There were costs to high-performance culture: high levels of stress/anxiety, living life as a race and low levels of meaning/self-worth/joy/fun. These costs led Lawrence to explore anecdotes to them in Eastern philosophy and meditation. He found the key is figuring out how to master the outer world and inner self.

  • The Middle Way:

    • 2500 year old philosophy of harmony that states humans do better when in harmony with the inner and outer worlds. Suffering comes from one extreme or another (ie: too much of the bureaucrat or too much of the artist in all of us)

    • From an organizational perspective it means putting some structure in place to keep the momentum going without stifling the artist spirit too much

 

Reference:

Burns D. Feeling Good: The New Mood Therapy. William Morrow and Company; 1980.

 

Elton C. Also Human: The Inner Lives of Doctors. New York, NY: Basic Books; 2018.

 

Gazoni FM, Durieux ME, Wells L. Life after death: the aftermath of perioperative catastrophes. Anesth Analg 2008;107(2):591-600.

 

Goyal M, Singh S, Sibinga EMS, et al. Meditation programs for psychological stress and well-being: a systematic review and meta-analysis. JAMA Intern Med 2014;174(3):357-368.

 

Hari J. Lost Connections, Uncovering the Real Causes of Depression, and the Unexpected Solutions. New York, NY: Bloomsbury; 2018.

 

Hill AB. Breaking the stigma: a physician’s perspective on self-care and recovery. N Engl J Med 2017;376:1103-1105

 

Schwenk T. Resident depression: the tip of a graduate medical education iceberg. JAMA 2015;314(22):2357–2358.

 

Shanafelt TD, Dyrbye LN, West CP. Addressing physician burnout: the way forward. JAMA 2017;317(9):901–902.

 

Simpkin AL, Khan A, West DC, et al. Stress from uncertainty and resilience among depressed and burned out residents: a cross-sectional study. Acad Pediatr 2018; pii: S1876-2859(18)30122-0. doi: 10.1016/j.acap.2018.03.002. [Epub ahead of print]

 

Simpkin AL, Schwartzstein RM. Tolerating uncertainty -- the next medical revolution? N Engl J Med 2016;375:1713-1715.

 

Jessica O. -

This was great! I am a human being that works as a family nurse practitioner but I am also a human being who works with nature and raises cattle and am working with a wolf/livestock coexistence group and much of this applies there. There is tremendous tension and fostering collaboration with ranchers, conservation groups, government agencies and the public is our goal.

Here is the email I shared with the members:
I have been meaning to share with the group a great medical continuing edu podcast I just listened to by one of the top guys at Pixar. It is the free January 2019 chapter. I am not sure if you have to create an account to listen or not.

Beyond Pixar (Part 1): Perfectionism, and the Middle Way.

He talks about how Pixar’s culture & narrative had to change from one of a graphic technology company to an entertainment company. He feels like people view Pixar as this great place to work and a story telling utopia but his experience was completely opposite (this is at about 6:30mins into talk). He talks about this tremendous tensions between people (ie: technology people and creative people and the business people) and a culture of collaboration enables this tension to create amazing things (about min8).

My take away from this through the eyes of ranching are:

- The narrative of ranching is out of sync with the reality of it. I think I struggle bouncing between the 2.

- Part of creating a new narrative is to separate who we are from what we do. I can do this easily with medicine because it has always just been a job for me but ranching is my life and I don’t know how to separate that. But the podcast talked about changing thinking about yourself as a rancher but as a human being that ranches.

- I am a rancher vs I am a human being who works with nature or raises cattle. This may be a great way to rebrand ranching to the urban public!

- He talks about how this opens up possibilities of value & shifts perspective. Something to meditate on. That we need to restore the joy, meaning and humanity to our work.

Check it out!

http://www.mtshastawild.com/california-wolf-center-endorsed-beef/

Neda F., MD -

Thanks so much, Jessica! How cool! We appreciate you sharing your story. The first half of the conversation with Lawrence Levy and Todd Cassese can absolutely be shared and listened to without a subscription. We hope your ranching colleagues enjoy it. It just goes to show these themes are universal to so many different lines of work. --- Neda

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Hello, New Year! Bye Bye, PPIs? Full episode audio for MD edition 201:19 min - 94 MB - M4APC RAP January 2019 Written Summary 386 KB - PDF

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