Serving Others is the Best Medicine for Yourself – Dr. Stephen Trzeciak, Bestselling Author and Chair of Medicine at Cooper Medical School of Rowan University

Shiv Gaglani: Hi, I'm Shiv Gaglani. Today, we're going to talk about something all medical providers should be interested in these days: A way to increase your resilience, energy, and overall health, while also reducing anxiety, depression, and burnout or moral injury.

With us to explain it all is Dr. Stephen Trzeciak, who's the Chair of Medicine at Cooper Medical School of Rowan University, and author of the brand-new book, Wonder Drug: 7 Scientifically Proven Ways that Serving Others is the Best Medicine for Yourself. This definitely resonates with us at Osmosis, because it aligns with many of our core values, including our first and foremost one: Start With the heart.

Before we get started, I wanted to thank Dr. Tom Rebbecchi, who's been on the podcast before, for making the introduction to Steve. Steve, thanks for taking the time to be with us today.

Dr. Stephen Trzeciak: Shiv, the pleasure's all mine. Thanks for having me on the show.

Shiv Gaglani: Of course. We always like to start by asking our guests in their own words to talk to us about what got them interested in medicine, and in your case, internal medicine, and going into intensive care.

Dr. Stephen Trzeciak: Sure. As it is with just about everything in my experience, the three most important determinants of one's trajectory—whether it's career or life—those three things are mentoring, mentoring, and mentoring. I've had some great mentors over the years. One was a physician, an awesome teacher, by the name of Dr. Ken Wood, at the University of Wisconsin. He prompted me to be really interested in the physiology of critical care. Then Dr. Phil Dellinger, who was my mentor, and still is to this day by the way, not only trained me in critical care, but got me interested in research and was responsible for turning me into a research nerd.

Shiv Gaglani: I couldn't agree more. Mentors have shaped my life as well. We had one on the podcast a couple months ago, Dr. Daniele Rigamonti, who is a neurosurgeon that taught me at Hopkins. For those listening, many of them are early-stage career professionals, finding the right mentor and maintaining that relationship is key.

Dr. Stephen Trzeciak: Absolutely.

Shiv Gaglani: You've described your mission, or you've recently described it as raising compassion and altruism globally, through science. You could have gone so many different directions in medicine through these mentorships and opportunities. How did you wind up going down that road?

Dr. Stephen Trzeciak: Going way back to college, I was actually a philosophy major. By the way, I was a terrible philosophy student -- not that my grades were bad because they weren't, but I was not in the usual mold of a philosophy major where I could go down and quote all the famous philosophers and the major tenets of their area of study. But what I was really good at was not shying away from big questions and really embracing them, even though they're some of the toughest to take on. 

I trained in research, and as a researcher, that's essentially what you're doing is you're asking questions. You generate a hypothesis and then you design a set of specific aims and experimentation to test those hypotheses, but ultimately, it's responding to a question.

For the first 15 years or so in my career, I was studying resuscitation science in the ICU. I was not in the market, so to speak, for any sort of change in trajectory. We were getting research grants from the NIH to support our work and were publishing in the journals, so everything was going as planned. I wasn't in the market for a change. 

Some of the biggest changes in trajectory in life can be totally unexpected. I had to ask myself some big questions because I found myself facing burnout. This is myself. I had every symptom of burnout after, at that time, 15 years of working in the ICU, and you often meet patients and families on the worst day of their life. I had to figure out what I was going to do, facing burnout. 

Essentially, what we were able to curate is all this scientific evidence that compassion matters, not just in meaningful ways, but in measurable ways. What the research really points to, not just in healthcare but outside of healthcare in the psychology domain, is that the key to resilience is relationships. I became aware of this body of evidence that compassion can be a powerful, beneficial therapy for the giver, too, and I wasn't buying any of the data that suggested that escapism was the best cure for burnout—go on nature hikes or take more vacations—because that thinking was just to me, if I can just get away from my patients as much as possible, everything will be fine. I thought something had to fundamentally change at the point of care. 

The evidence points to more human connection is associated with more resilience and lower burnout. Rather than escaping, I leaned in and connected more, not less, not just with patients and their families in the ICU, but with staff, with the nurses I've worked with for the last two decades, with colleagues, even at home, and through that human connection, that is when the fog of burnout began to lift for me. The big question was, does compassion really matter? The answer that we found, my colleague and co-author, Dr. Anthony Mazzarelli: The answer is yes.

Shiv Gaglani: That resonates at a very fundamental and deep level to me. In fact, whenever a new teammate joins Osmosis, we have them go through a relationship building workshop about how to strengthen the connections they have based on evidence like that famous Harvard study, following men at Harvard 75 years, and showing that the biggest predictor of their happiness and health, 75 years later, was the quality of the relationships. I get that.

Going into specific strategies people can use, obviously for some people like spouse, children, parents, siblings, you can develop those relationships if you have continuous exposure, you know a lot about them. Then there's other relationships that maybe a little more transactional or could be transactional. What are some strategies you found as you were trying to climb out of that burnout hole that really made a difference in terms of the quality of the relationships you were able to build and then the compassion that resulted from that?

Dr. Stephen Trzeciak: One of the studies that I think back on often was a 2005 report that was in JAMA, and it was talking about a concept that was actually taken from all different industries, service industries, but like call centers and all sorts of things where they have to deal with people that are going through a really rough time or challenges. The concept that comes over is emotional labor. 

You don't always feel it in the moment, especially if you're really tired in a moment, but we do this all the time, especially for any of your listeners that have kids, right? When you come home from a long day at work and you're completely tired, totally wiped out, and your kid wants story time, what do you do? Well, most people can very intentionally get themselves to the emotional state to connect with their kid in that moment. It's not faking; It's love. You had to get there very intentionally, and in that moment, those emotions are real. You just have to be very intentional about it.

Some people have—including this article from JAMA from years ago that I'm referring to—equated it to method acting, like Daniel Day-Lewis or Heath Ledger, all these people who became their character, they weren't faking it and they weren't really acting. They were just becoming their character through intentionality. Similarly, when we are having difficulty connecting with another person, whether it's a patient or their families, or a friend, a colleague, family member, anybody, if we remember that we can get there but we have to be very intentional about it, that we can, in fact, get there, and then all the benefits from that can be experienced.

Shiv Gaglani: That's a great analogy. I think that'll—at a very gut level—be heard by many of our audience who have kids and they realize they can switch because of that love. Applying that love, though, from your kid to a patient, to the person who cut you off in front of the road is difficult. It takes a lot of practice. 

Do you have any advice? I know the book itself goes into the seven proven ways that serving others is the best medicine for yourself. Happy to go into more of those ways or any other tips or tricks that you can provide our audience as many of them are starting their careers, and before they get moral injury and decide not even to practice, not even go to residency or whatever, maybe it could be really well-timed advice for them as they're going through the rotations or something like that?

Dr. Stephen Trzeciak: When I went through my struggle with burnout and came to the realization that not only is there evidence behind it, but in doing my own n-of-1 experiment and leaning into relationships, again, very intentionally, and realizing through my experience, that's when the burnout began to lift... Sharing that story and all that evidence through a prior book that Dr. Mazzarelli and I wrote, called Compassionomics... We shared it far and wide with other frontline healthcare workers and they told us that they tested the compassion hypothesis for themselves, and they had the same experience, so there were more data. What it made us realize is this can't just be true for people that happen to go into healthcare. There had to be some sort of universal, if everyone was having the same sort of experience.

What we did, then, for this next book, this project is called Wonder Drug: 7 Scientifically Proven Ways That Serving Others is the Best Medicine for Yourself, we curated 250 original science research papers to show that when we serve others, it not only has physical benefits, it has psychological benefits, it can bring us more happiness and well-being, and it can even bring you more professional success. 

These seven ways to serve others better in order to enhance our own experience through that: The first one I'll share with you is just start small. People don't need to quit their job and sell all their worldly possessions and move to some third world country and start hauling water from a distant well. You can actually just start where you live. There is ample evidence that if we just start at home with those that are closest to us, whether it's a partner or with our kids, or anyone, we just serve the people that are closest to us, or any of our co-workers, for that matter, that we are in regular contact with, that's a great place to start. The evidence Shiv, indicates that on average, the threshold effect for anybody is 100 hours per year of serving others to get the benefits, as it relates to longevity and all the physical health benefits. 

Most people don't take their medicine once a year. Most people take it every day, so we used a really sophisticated computational device called a calculator. If you divide by 365, you get about 16 minutes a day. That's what we call the daily 16 or the daily dose, if, on average, we serve others and we are other-focused for 16 or more minutes per day, we are then over the threshold where we can get all the benefits for our physical health, psychological health, emotional health, and so on. You may want to take it every day—that dose, 16 minutes—or you might want to just save it up and do a two-hour power service or power helping and volunteering on the weekends. Of course, for those of us that are in healthcare, we don't need other opportunities because the opportunity to serve others is right in front of us every day.

Shiv Gaglani: That's absolutely right. It aligns really well with another guest we've had, BJ Fogg at Stanford, who wrote a book called Tiny Habits. Sixteen minutes a day doesn't sound like a lot, even 100 hours a year doesn't sound like a lot, and so trying to find ways to start small, as you say, and not boil the ocean and think that you have to renounce all worldly possessions to get there.

Dr. Stephen Trzeciak: I think it's important to just recognize it that first of all, I don't have any magical thinking about serving others. I'm a researcher by background, so what I'm sharing with you is data.

For example, the evidence supports that compared to people who don't serve others regularly, those who do, whether it's volunteering for an organization or other ways, that they actually have longevity benefits. I'm reminded of a study that actually studied it in the context of married couples. There's always the possible for studies where we're reporting associations that there is residual confounding. For example, the people in these studies, who don't serve others, did they also happen to have an awful diet or live next to a toxic waste dump, or something like that? 

Well, they studied married couples. These are married couples who live in the same house, eat the same dinner, probably have the same friends. What they found is that spouses that serve others had a longevity benefit, meaning how long they lived, whereas those that did not help or serve others didn't have such benefits. That is a way that they handle the possibility of residual confounding in such that it's not the carpet or the drapes or something in the water. The association was because they were involved in other-focus, and specifically serving others.

Shiv Gaglani: That makes a lot of sense. Start small is one of your pieces of advice. We have time. I'd love to hear, if you could share another one or two.

Dr. Stephen Trzeciak: Absolutely. I gave you the first one. I'll give you the last one. The last one is know your power. If you know your power—meaning your power to impact people's lives in meaningful ways—and you're aware of that, it makes you feel differently about your opportunities to serve others, and it makes you want to serve others in meaningful ways over and over again.

I'll share a quick story with you, if you don't mind, as it relates to that. I'm an intensivist and so we often meet patients and their families, as I said, on the worst day of their life. A few years back, when I was working in the ICU at Cooper, I had a patient who was in his middle 50s. He had septic shock. He had multiple organ failures. All of his organ systems were failing, and despite the maximal therapies that we were giving him, it looked like he wasn't going to make it through the night. 

I had to tell his sister, who was just a couple years younger than he was. It was a really hard discussion because he had been her rock throughout her whole life. When I was done with that really difficult discussion, she asked me a question that I don't think I ever got in the ICU before. 

She said, "You don't remember me, do you?" I said, "I'm sorry, I don't." She said, "Oh, it's okay. I wouldn't expect you to. You see so many patients here in the ICU. You guys are so busy. I wouldn't expect you to remember me, but I need you to know something. I need you to know that seven years ago, my mom was in that bed right over there." And she pointed right across the hall to another ICU bed. She said, "she was dying and there was nothing that could be done to save her. You were her doctor and you had to tell me that so you and I, we've had this talk before." 

It just took my breath away, but then she said something I'll never forget. I'll never forget it as long as I live. I'm very thankful for it. She said, "I need you to know something. Those nurses," and the word that she used was kindness. She said, "The kindness of those nurses: They held me, they let me know I wasn't going to go through this alone, and I didn't. Over those days when she was dying, I felt cared for like never before, in a hospital." 

What my mind keeps coming back to is what she said next, actually. She said, "My mom's death is still really painful to me. I think about her every day because we were so close. But what I wanted you to know is that when that memory comes back to me, I remember the kindness of those nurses and it helps me, still, even now." It was seven years later, Shiv, that the kindness of the nurses, seven years after that, it still made her feel better. That was striking to me because perhaps, those nurses went home and didn't think much of it because they're superheroes of compassion. That's what they do for a living, but for this woman... and there's something about health care experiences that stay with people. Perhaps it's because there's so much emotion involved in them. For this woman, the kindness of the nurses is something that seven years later, it kept echoing and reverberating, and coming back to her.

I teach this now to my medical students, my interns, residents, fellows in the ICU. Know your power. Know that you have that power to affect people's memories years and years later, because there's something about healthcare experiences that stay with people. When you go into a discussion and you know that there's going to be a lot of emotion in that discussion, what do you want to be remembered for?

Shiv Gaglani: That's incredibly powerful. Thanks for sharing that. I agree, we don't often know the impact we can have. For those listening, even you as a student, if you're a student or resident, the impact you could be having on a patient or their family members, or a peer, we obviously know what some of the burnout suicide rates among our audience. And then even younger students who are interested in pursuing and following that footstep, it's important to know, just by being there, you have lot of power. I think it's really important that people are reminded of this, and that's why the books you've written are key. We encourage our readers to go check them out and read them, as well.

We've done a lot on our podcast recently to talk about moral injury and burnout, and there's been amazingly scary statistics. Elsevier's Clinician of the Future Report shared that something like one out of four clinicians have left the profession in the last two years. Ninety percent of nurses are considering leaving or switching jobs. That came out of a different report that I just read this past week.

Burnout, moral injury, improving resilience is one tactic, and helping remind people serve others, very important tactic, getting that intrinsic motivation, strength into healthcare professionals. What are some other things that we need to be thinking about to stem the tide of this burnout epidemic and get more people into the profession?

Dr. Stephen Trzeciak: We had an epidemic of burnout even before we had a pandemic with COVID-19, but those aren't the only two crises, so to speak. There's a third one that was emerging before the pandemic, and now is very clear and present. That is a workforce shortage, specifically in my hospital, as it relates to nurses and technicians. This is a nationwide problem, so it's really a perfect storm, so to speak, because it's a confluence of three different crises at exactly the same time. 

The most important thing that I would want to share with your listeners, especially those who are at an early stage of their career, is the message that I started with earlier, is that the key to resilience is relationships.

For me, in emerging from burnout, it was connecting with patients and families and nurses, but also my colleagues. But it goes beyond that. When I gave the first grand rounds of the academic year here at Cooper in September, I spoke to not only our whole department in medicine, but specifically to our 80 trainees in the internal medicine residency program. I told them that my expectation—and I didn't frame it as like a challenge or anything like that—but I shared all the data that human connection has powerful, beneficial effects for yourself. What I messaged to them is that, "I do want you to take good care of yourself, but I also want you to take good care of each other. It's vitally important not only for the culture that we have and for the people that are around us, but it is also beneficial to ourselves. 

"There is ample evidence that compassion for those around us, they don't have to be patients, it can be for colleagues, it can be for anybody, but it can not only promote resilience and resistance to burnout, but also resistance to symptoms of depression, resistance to symptoms of anxiety. Looking for those opportunity to serve each other around us can actually buffer our own stress and help us get through this pandemic, which is, hopefully, the greatest healthcare challenge of our lifetimes." My major message is that "The key to resilience is relationships." There is abundant data to support that.

Rather than going inside of yourself, putting on the headphones and blocking out the world, or just doing your Headspace app or whatever you use, or going on a nature hike by yourself... by the way, all those things are important. But research shows that over the last decade, people's self-care strategies and approaches have become more and more solitary, whereas in decades past, we found solace in family and friends, and gathering, and relationships. Now, our self-thinking is more and more solitary in nature. 

The evidence doesn't support that. What the evidence supports is that it's human connection and relationships that are key to resilience. Lean into the relationships with those around you and take good care of each other, not only because it's good for them, but it's good for you, too.

Shiv Gaglani: Really wonderful points, and obviously very applicable to healthcare.

Just this past week, former President Obama was at Stanford and gave a really interesting talk on disinformation and the information pandemic. He made a similar point where, there's a lot of societal trends before the pandemic and epidemic of burnout, but even before then, there's been this general reduction in community-based activities.

Obviously binging Netflix, being on your smartphone, not connecting with those around you. Or connecting, but virtually, in these virtual spaces that don't have the same effect than an in-person connection at a place of worship, or bowling alley, or even the corner store, which has all been replaced by Amazon Prime delivery same day, has really removed those roots and those connections.

I echo your sentiment that the key to resilience is relationships, both mentally and how it makes you feel, but also if and when you do need help, you have a network of people who are there to help you, and whether you directly ask for it or they just sense it because they know you. I think it's really key advice.

We're coming up in time and I just wanted to end with two questions, if you don't mind. The first is, you've already given listeners a lot of advice about approaching their careers in healthcare, but what other advice, if any, would you like to leave them with beyond everything we've talked about, with regards to building relationships and compassion?

Dr. Stephen Trzeciak: I'll continue my theme on human connection. I told you early on the three most important determinants of one's career trajectory are mentoring, mentoring, and mentoring. When you're young in your field, gravitate to people that are doing it exactly the way you want to do it someday, the people that are your role models.

There was a study in the New England Journal of Medicine years ago that showed that the number one factor amongst teachers to be considered role models by students in the next generation of physicians is focusing on the doctor-patient relationship. That is the number one thing that the next generation sees in more seasoned physicians that they want to aspire to.

Find those people that practice compassion, not just the technical aspects of medicine, but those that also care about human connection, and gravitate to the people. When you ask a mentor for mentoring, meaning, "I want to do it just like you do it," it's incredibly flattering to prospective mentors and so don't be afraid to ask.

One of the other things I also want to communicate is again, I don't have any magical thinking about compassion or human connection. The most important determinant of clinical outcome is clinical excellence. If you're a physician who prescribes the wrong medication, or proceduralist who has a major technical error, there's no amount of compassion that's going to undo those things. It's not an either/or. It's an and. 

In the theme of mentoring, mentoring, mentoring, you should gravitate to people where it's an and. They are technically speaking the best and most knowledgeable in their field, but they also know the human connection on top of that makes not just meaningful differences, but measurable ones, as well.

Shiv Gaglani: That's great. Wonderful advice. My last question: Is there anything else that we haven't covered on this conversation that you'd like to leave our audience with?

Dr. Stephen Trzeciak: Sure. I told you about my journey through burnout and then we curated all the evidence that serving others can be the best medicine for yourself and not just physical health or psychological or emotional health, and well-being and happiness, but even professional success. Really, the evidence is for everybody. There's evidence that it's a universal. It's not just for people going into health care.

I actually now, as the chair of my department—I'm an intensivist by training, but I'm responsible for the Department of Medicine and all the patients that we treat here at Cooper—that these are important messages for patients, as well. There's evidence that leading an other-focused life versus just serving yourself is actually good for you. The evidence is not just for longevity and for physical health, but for staving off depression, anxiety, promoting well-being. I think that we need to, first of all, seriously examine the evidence. That's what we did in writing the book, Wonder Drug, but I think we need to consider very carefully how being other-focused and serving other people can actually be a bona fide health intervention, because there is really a mountain of evidence for this. I think we just need to look at it through that lens.

Shiv Gaglani: Yeah, absolutely. Well, this has been a fascinating discussion, Dr. Trzeciak. It's been a pleasure to have you on, and thank you for all you've done not just on this conversation to share your wisdom with our audience, but more importantly, the work that you d, for helping your own patients and running an entire department. Really appreciate your time.

Dr. Stephen Trzeciak: Thank you so much.

Shiv Gaglani: With that, I'm Shiv Gaglani. Thank you to our audience for checking out today's show. Remember to do your part to flatten the curve and Raise the Line. We're all in this together. Take care.