Adapted from the inaugural address of the 150th Colorado Medical Society Annual Meeting
by Sami Diab, MD, President, Colorado Medical Society
Featured in the November-December 2020 Colorado Medicine Colorado Medicine.
In deciding what to share in my inaugural remarks, I found myself turning to a book by two uplifting and inspiring individuals: “The Book of Joy: Lasting Happiness in a Changing World,” by His Holiness the Dalai Lama and the Reverend Archbishop Desmond Tutu. During this challenging time, especially with the COVID pandemic, it is essential to try to find joy in our professional and personal lives.
Specifically, I would like to examine how certain aspects of practicing medicine can activate the four neuronal pathways that are responsible for the state of well-being and joy.
The first circuit I will explore, although it is fourth in the book, is “our ability to be generous.” Yes, we have an entire brain circuit that is activated by generosity and the positive feelings that result when we engage in acts of giving, receiving or even witnessing acts of generosity. The second pathway of joy is triggered by a positive mind state. These two great spiritual leaders emphasized that the fastest way to a positive mind state is acts of compassion. The third circuit is, “our ability to recover from negative states.” And the fourth, which I will not discuss in detail but find is worth mentioning, is the ability to prevent mind-wandering and practice mindfulness through meditation, exercise, painting and other activities.
I’d like to share some stories that explain the role of joy in my life and how I came to be a doctor, an oncologist and member of the Colorado Medical Society.
The first story I’d like to share with you takes place on Christmas Eve in Damascus when I was a child of seven or eight years of age.
We were driving to my grandmother’s house to celebrate Christmas, as was our family tradition. It was a cold winter’s night in Damascus; it was actually snowing. It typically only snows once or twice a year in Damascus so this white Christmas was very special to me – I still remember it vividly! I was very happy and excited at the evening’s prospects: after all, I was going to receive gifts and play with other children. As we drove, we stopped at a red light outside my uncle’s ENT clinic. Knowing the location well, I glanced towards the clinic and saw a mother and child, standing shivering in the cold, begging for food and money. At that moment I wanted to bundle these two unfortunate souls into our warm car and take them with us to dinner.
St. Paul was inspired on the road to Damascus and I, in my own small way, was inspired on a road in Damascus. I felt a deep need to help others and that need led me to become a physician. So, in many ways, I became a doctor because of that experience which activated my circuit – a circuit we all have – to be generous. I think many of us become doctors out of a sincere desire to help others and thereby experience the repeated feelings of joy that come from helping our fellow human beings. I can truly say that being a doctor has brought me – along with a lot of other feelings – a great amount of joy.
Joining and being active in the Colorado Medical Society has also brought me joy. I joined the CMS Committee on Physician Wellbeing and we explored at length the notion and importance of helping each other as doctors. And, once again, being involved in helping others brought joy to my professional life. Yes, CMS does not have to be, nor should it be, another boring professional organization. CMS membership can, and should be, both an act of and source of joy.
The second story I’d like to share with you is about what led me to become an oncologist.
It was January 1991 and I was assigned to work at the VA hospital. My optimism was muted as everybody told me this was going to be a depressing rotation. I was assigned Mr. Bradly, an oncology patient. I went into the room to find a veteran screaming in pain from a hip fracture resulting from the spread of advanced metastatic lung cancer. I still remember sitting down and, having already taken steps to obtain appropriate pain medication, simply holding his hand and trying to reassure him, getting to know the man behind the cancer. He was very kind and a strong bond formed between the two of us.
I went home feeling grateful and good about myself simply because I had taken the extra time to sit with my suffering patient during a very busy day and that too was a manifestation of joy. The circuit of positive mind states was activated by an act of compassion between a patient and a physician. A compassionate and positive patient-physician relationship triggers joy; that feeling we all have when we leave the bedside and feel like we did a good job and are immersed with the joy of practicing medicine.
For me this brings to my mind the 1891 painting, “The Doctor” by Sir Luke Fildes, part of The Tate Collection. The painting depicts the deep concern of a doctor seated anxiously at the bedside of his patient – a young child who is dying. For me, this painting serves as an evocative reminder of the patient-physician relationship that is at the heart of the practice of medicine and is so crucial to deriving satisfaction and joy from the practice of medicine.
I think a lot of us in medicine are dissatisfied because we feel that we are dealing on a daily basis with many forces that interfere with the sanctity of the patient-physician relationship: Less time with our patients, pressure from insurance companies, pressure from administrators to generate more revenue, more time on the EMR, and other factors that take away from the joy of this connection with our patients.
So, as it relates to CMS, I joined the Committee on Value in Health Care and in that committee, we talked the doctor language about how we can deliver better quality care. How can we improve the quality of care while reducing the financial toxicity on patients? It was all about patient care and doing the right thing for our patients; no hidden agenda, no other motivations. These discussions put me in a positive mental state that gives me joyfulness.
In case you think this is all one big joyride, my third story is sad and pertains to the third circuit, “our ability to recover from negative states.”
One day, as stories so often begin, I was sitting in my office in Parker and I got a call from our nurse in Aurora informing me that one of our patients had a terrible outcome and had died from a complication of treatment. That was a very difficult day in my life and really took a lot of the joy out of medicine.
Recovering from this emotional blow – this negative state – was crucial to me to regaining joy in medicine. I leaned on physicians and physicians’ organizations who were very helpful in enabling me to recover from that negative mind state to allow me to find renewed joy in medicine. To name just a few, Dr. Mike Seiden, physician and CEO of McKesson Specialty Health, was crucial in allowing me to express myself, listen carefully and take actions to bring big solutions. Dr. Seiden introduced Mr. Kirk Milhone to our organization, Rocky Mountain Cancer Centers; he is a wonderful coach of effective organizational culture and a very important person in my life.
I also recognize Dr. Rebecca Resnik, a palliative care doctor who helped me greatly, for being a good and special friend. COPIC provided valuable peer support. Dr. Jason Kelly, Dr. Lisa Corbin and Dr. Joanne Hilden deserve thanks. And, finally, my own organization RMCC was amazing in terms of root cause analysis, hiring pharmacists and revisiting many of our processes to improve quality. Upon reflection, it took a whole team and many organizations to help recover from this negative experience.
As part of my mission as president of Colorado Medical Society, I want the Colorado Medical Society to be a home and a resource for any physician who is experiencing a negative mind state. CMS should be a place to start recovery from any negative situation. I would like CMS to have the resources, programs and the mechanisms to help any doctor in need to deal with the toll of a negative mindset. Unfortunately, we’re all in negative mindsets because of COVID and a host of other issues. Our ability to recover is going to bring us a lot of joy in medicine!
Finally, I would like to take this opportunity to address prejudice because prejudice, as mentioned in “The Book of Joy,” is the product of a negative mind state.
As the authors state when discussing the work of John Bargh and notion of the unconscious prime – part of innate, and often unconscious goals: “Perhaps more sobering, it has also hardwired us to cooperate with and be kind to those who look like our caregivers, who presumably kept us safe. We are more wary of others who look different: these are the unconscious roots of prejudice. Our empathy does not seem to extend to those who are outside our ‘group,’ which is perhaps why the Archbishop and the Dalai Lama are constantly reminding us that we are, in fact, one group – humanity.”
As physicians our group is humanity. We take care of sick people: Black, white, Latinx and others. We take care of the poor and rich. We are trained to look at our group as any human being who is suffering from illness. Our group is unqualified humanity regardless of race, regardless of color, regardless of socio-economic status. So, one of my goals as the president of CMS is to make sure that CMS is involved in tackling prejudice – to put action to our words by addressing discrimination and increasing diverse representation in our leadership.
In summary, I would like to say that CMS, and my involvement with CMS, has brought joy to my professional life. I think you can all find joy through involvement in CMS, and through involvement we can all activate our joy networks. I want CMS to be part of bringing joy to all physicians in Colorado.
Participation and involvement also bring responsibility, and I would like each of you to ask not only, “What can CMS do for me?” but “What can I do for CMS? What can I do to help CMS accomplish the goal of bringing joy to medicine?”
Become a member, be involved, be generous, be positive in your involvement in the experience, and be united to bring a positive mental state to CMS. Please don’t withdraw when you disagree with the organization because, yes, we are all going to disagree from time to time. But, please, let’s stay united so that the house of medicine can be stronger.
Thank you so much for allowing me to be your president.
About Dr. Diab
Sami Diab, MD, is a medical oncologist with Rocky Mountain Cancer Centers in Centennial and Aurora. He completed medical school at Damascus University in Damascus, Syria, and his residency at Wayne State University in Detroit, Mich. He completed a fellowship in Medical Oncology at the University of Texas MD Anderson Cancer Center in Houston and the University of Texas at San Antonio where he stayed on faculty for four years before moving to Colorado in 1999. He also did a fellowship in Integrative Medicine at the University of Arizona in Tucson. He is board certified in medical oncology and hospice and palliative care. He enjoys playing tennis, skiing and painting. He is deeply thankful to his family: parents George and Mary; wife, Liliane; children Nicholas and Christopher; and brother, Joseph.