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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.

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Can't We All Just Get Along? Full episode audio for MD edition 204:00 min - 96 MB - M4AUC RAP January 2019 Written Summary 375 KB - PDF

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