Bernie Lown is My Hero

Bernie Lown is my hero and a exemplary role model for physician healers, scientists, and social activists.

As co-founder of International Physicians for the Prevention of Nuclear War, Bernie Lown accepted the Nobel Peace Prize for this organization in 1985. Before that, we was one of the founders of Physicians for Social Responsibility. An accomplished academic cardiologist, he actually has an arrhythmia named after him, the Lown-Ganong-Levine Syndrome. (Please don't ask me to describe it). Bernie is a medical inventor as well. He developed the first direct current defibrillator and still holds an academic position as Professor of Cardiology Emeritus at the Harvard School of Public Health.

For decades, Bernie has been an outspoken critic of the growing medical industrial complex and the business of medicine. He writes eloquently about how these developments contribute to infatuation with and overuse of technology, overtreatment, waste of health care resources, escalating health care expenditures and, most importantly, unnecessary harms to patients.

Now in his 90s, Bernie is still voicing his concerns, as well as encouraging medical practitioners to return to the core values and behaviors that characterized medicine before it became a business. These principles include:

• listen to your patients and to their "stories";
• put patients and their needs, values and preferences at the center of your attention;
• build and nurture healing relationships with patients, using empathy and compassion;  
• evaluate new and emerging technologies carefully and choose wisely;
• engage patients and caregivers in informed and shared decision-making; and
• focus on enabling and empowering patients to help them stay healthy and engage in self-care and self-management.

These principles were the bedrock of good medical care when Bernie, and my dad, completed medical school in the 1940's. I dare say they were core elements of medical training in the days of Flexner and Francis Peabody, when my grandfather trained in the early 20th century. As Francis Peabody remarked in 1927, "One of the essential qualities of the clinician is interest in humanity, for the secret of the care of the patient is the caring for the patient."

Recently, a wonderful interview with Bernie was published on a blog created by Melanie Lown, a communication specialist and Bernie's granddaughter. See: The Lown Conversation.

Melanie is the daughter of Beth Lown, Bernie's daughter, a friend and colleague and a wonderful physician and educator. (See the photo on The Lown Conversation blog of Bernie and 6 year old daughter Beth, taken when Bernie arrived in Boston after accepting the Nobel Peace Prize.)

See also the following sources for more vintage Bernie:

• Lown lecture on Avoidable Harms - 2012
• Bernard Lown's Blog

The Empathic Appreciative Closer

Tonight, after pitching a perfect 8th inning for the American League in Major League Baseball's All Star Game, Mariano Rivera told TV reporter Ken Rosenthal that he appreciated the standing ovation he received from fans, fellow players and even opposing players and coaches from the National League. Choked  up with emotion, Mariano, who is retiring at the end of the season at age 43 after an amazing record setting career that all consider to be the best ever as a closer, told Rosenthal that the experience walking off the mound was "priceless" and "up there" with his experience closing World Series victories.

This show of emotion and sincere appreciation for the adulation he received from fans and peers  is not an unusual response for this great athlete with a huge heart. See the article that appeared in The New York Times today to learn how Mariano has chosen to spend his last day in each of the cities he is visiting this year: http://www.nytimes.com/2013/07/16/sports/baseball/yankees-rivera-spends-his-goodbye-tour-saying-hello.html

Fear + Avoidance + Reflection + Courage = Compassion

My colleague, Anna Reisman, a practicing internist and talented writer,  published a touching,  revealing and instructive New York Times blog post that demonstrates the value of reflective practice. See: The Death House

Anna writes movingly about her angst and ambivlance about visiting one of her patients at an inpatient hospice. Her ambivalence is rooted in her fears and anxieties about what she might experience during her visit, imagining suffering, sadness, hopelessness and a heavy dose of death (.."a steady line of hearses idling in the parking lot like taxis at a train station"..). Her avoidance is also linked, she reveals, to concerns that her patient will be suffering or too ill to acknowledge her presence, and she shares her worries that she will not know what to say to family members who may be present at his bedside. I would guess that most, if not all,  caring and compassionate clinicians harbor similar feelings....I know I have had these fears and anxieties when I was clinically active and had patients who were dying. However, Anna also feels a strong desire to visit her patient to pay her respects and provide some measure of comfort to the patient or his family. So, she wills herself to visit the hospice, where she is pleasantly suprised to find a homey, supportive and even healing environment, and, most importantly, a patient who is grateful for her presence. I was deeply moved by her prose.

Anna's courage to share her inner thoughts and feelings in her blog is remarkable, and courageous. As you might expect, her post has stimulated many comments, and though most commend her for her compassion, there are also several posts that judge her harshly for having and sharing negative thoughts and feelings about the hospice. This is unfortuante, as I believe these critics are missing the point. The fears and worries that Anna reveals are ubiquitous among clinicians. These feelings often lead to avoidance of patients during the last stages of life, which is unfortunate for both patients and clinicians. Taking the time to reflect and acknowledge  the feelings, in a non-self punitive way, is a step towards challenging them and summoning the courage to confront them. The result is often highly rewarding, and, hopefully,  reinforcing.

I hope Anna's post will stimulate others to be mindful and perhaps help them free up their inner capacities for empathy and compassion.

Does Empathy Produce Poor Moral Decisions? I Think Not!

In the May 20th issue of the New Yorker, Paul Bloom argues that empathy can lead to irrational decisions that are "parochial" and "narrow-minded". He concludes that, "a reasoned, even counter-empathetic analysis of moral obligation and likely consequences is a better guide to planning for the future than the gut wrench of empathy."

However, I agree with the point of view expressed by Michael Zakaras in his blog post, The Case Against the Case Against Empathy, which appeared on the Huff Post World on May 16th. Zakaras reminds us that empathy is more than just a gut reaction; empathy involves cognitive processes similar to imagining and perspective taking.  As Zakaras notes, empathy "requires careful thought, self-awareness, and real listening."

Zakaras continues, "But to truly empathize is not easy. In this sense Bloom is right: we're more likely to do so with those who look and think like we do. So rather than dismiss empathy, why not commit ourselves to practicing it more deliberately and more often, and expanding our spheres of empathy to those who are not just different but who challenge some of our very own moral foundations?"

I agree strongly with Zakaras. We need to practice and deepen our capacity for empathy. And, we must also use the understanding gained from empathy to choose and act wisely. As my colleague Vaughn Keller taught me, compassion is empathy in action.

I Love This Story: College Commencement Speaker Emphasizes Empathy

I love this story!  Empathy can fuel motivation. When combined with passion and persistence, wonderful things can happen! College Commencement Speaker Emphasizes Empathy - The Hoya

The Value of Teaching Empathy

See this thought provoking article from Forbes, Teaching Empathy: The Ancient Way is Now Cutting Edge,  on the importance of teaching empathy and emotional intelligence skills.Though the focus in on teaching children, the points made in this article apply to any educational setting.

Obama Makes Empathic Appeal for Empathy in Israel

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See the blog from CNN for an excellent article on President Obama's empathic appeal for empathy for Palestinians.
CNN empathy-president-gives-an-empathy-speech