PODCASTThe Science of Happiness

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Dr. Omar Guzman reflects on how a practice to cultivate more respect shaped the way he interacts with his patients.

Episode summary:

As an ER doctor in an overworked healthcare system, Omar Guzman isn’t always able to build the relationships with patients the way he’d like to. For our show, Omar tried a practice called the 7 Elements of Respect. By contemplating his own motivations and biases, practicing deep listening and prioritizing relationship-building, Omar was able to develop a meaningful connection with a patient and was reminded of why he decided to pursue medicine. Later, we hear from Diane Johnson, the creator of this practice, to learn more about the multifaceted aspects of respect, and how developing empathic relationships can shape and strengthen our sense of community.

Practice:

1. Acknowledge the conflict and affirm your commitment to understanding and moving forward.
2. Ensure that you are staying honest and true to yourself.
3. Hear new perspectives by practicing deep listening.
4. Recognize the importance of emphatically interacting with others.
5. Let go of any pretenses or sense of ego by practicing humility.
6. Notice how these actions affect your internal motivations.
7. Practice building relationships and connections with others.

Today’s guests:

Omar Guzman is an ER doctor in Visalia, California.

Diane Johnson has a PhD in Organizational Behavior and is a consultant focused on leadership, change management and organizational development. She is the creator of the 7 Elements of Respect.

Learn more about Diane and her work: https://www.mmapeu.com/

Resources from The Greater Good Science Center:

Four Ways to Help Your Coworkers Feel Respected: https://tinyurl.com/2p8uvhnb

How Do We Ensure That Students of Color Feel Respected?: https://tinyurl.com/5n8534ek

What Middle Schoolers Can Teach Us About Respect: https://tinyurl.com/4ua4va6s

Five Ways to Have More Constructive Disagreements: https://tinyurl.com/tt26uy84

More Resources on Cultivating Respect:

MIT - Creating a Culture of Respect: https://tinyurl.com/44kzr95s

NYT - How to Be More Empathetic: https://tinyurl.com/nf675dkk

BBC - Deep Listening: Finding common ground with opponents: https://tinyurl.com/yjby4zjx

How do you cultivate respect in your life? Email us at happinesspod@berkeley.edu or use the hashtag #happinesspod.

Help us share The Science of Happiness!

Rate us on Spotify and share this link with someone who might like the show: https://tinyurl.com/mszb2wfx

This episode was supported by a grant from the John Templeton Foundation, as part of our project on “Expanding Awareness of the Science of Intellectual Humility.” To learn more, go to https://tinyurl.com/2dj6hw29

Transcription:

Omar Guzman: Tulare County is basically a physician desert. Not enough physicians to treat the community as it deserves which puts a lot more stress on the emergency department and hospital system to kind of meet up for that.

It really takes a lot of the humanism out of medicine and so when we talk to patients about simple things like bringing in your child with a fever for us it’s, well, you don’t have an emergency. You need to take some Tylenol. It’s probably viral, go home. But for the patient, it’s, this is my child and I think there’s something wrong with them, and that’s why I brought them to you.

You know, I wanna treat people with respect so that I can earn their respect.. And that’s one of the reasons that I went into medicine.

Dacher Keltner: Welcome to The Science of Happiness, I’m Dacher Keltner.

Our guests today challenge us to think about respect and humility as important tools for strengthening relationships – nourishing us as individuals, and communities.

Doctor Omar Guzman is an emergency physician in an underserved community in California’s Central Valley. He tried an exercise to form and nurture more meaningful relationships through a practice called The Seven Elements of Respect.

Doctor Diane Johnson created this practice. And later, she’ll share how cultivating respect can affect us at both individual and community level.

Diane Johnson: If we peel back the components of respect there’s something about the simplicity that hopefully it makes it less daunting.

Dacher Keltner: More, after this break.

Welcome back to The Science of Happiness. I’m Dacher Keltner. Today we’re exploring how showing respect and humility can help strengthen our relationships with others, even during tense and uncomfortable conversations.

Our guest is Dr. Omar Guzman, an emergency physician who works in the very hospital that he was born in – in Tulare County, California.

It’s an agricultural community where people have a lot of healthcare needs, but there’s a shortage of providers to care for them.

We asked Omar to try something that might make his everyday interactions more fulfilling, both for him and his patients — a seven step practice for cultivating respect.

Omar, thanks so much for joining us.

Omar Guzman: Yeah. Thank you for having me.

Dacher Keltner: Whenever I teach a large class, I have 500 students and I’m trying to relate to each student and I find like, oops, I don’t connect, or I misfire, didn’t, you know, honor the principles of teaching. Do you ever find that, you know, you feel like you didn’t quite give the respect to a patient you had wanted to, or does that ever happen in your day?

Omar Guzman: Oh, a hundred percent. Yeah. I think, it’s really what we’re incentivized to do. You know the majority of the community that I serve is on a government funded insurance and that creates a deficit in reimbursement for the hospital and so we’re already working with limited resources, and then it sometimes causes you to think of your practice as a business with inputs and outputs. Rather than people’s lives and that’s what leads to you having this moral injury, of doing things that are wrong when you know that they’re wrong because the system forces you to do it and you wanna do what’s right.

Dacher Keltner: Omar, you used Diane Johnson’s Seven Steps to Respect with a patient with fibromyalgia. Those seven steps include acknowledging there’s an issue. Being authentic and honest, listening deeply, showing empathy, exercising humility, practicing introspection, and then prioritizing, building and sustaining connections.

How did you implement the seven steps and tell us the story about how it went.

Omar Guzman: Well I’m a nocturnist, so I only work night shifts. And so every night we are seeing multiple patients. And in different acuities, some life-threatening, some not as life-threatening. And e try and prioritize those with chief complaints that are going to possibly be life threatening things. And this was just a normal shift and I saw this patient been sitting there for probably an hour wait. I think the chief complaint was like, pain all over their body. I just knew that the reason the patient wasn’t being picked up was because of the chief complaint. And so I picked up the patient. And then I started to kind of think about these seven steps.

Dacher Keltner: How did you do that with this patient? Just the first step of acknowledgement and then kind of bringing your authenticity second step in this interaction.

Omar Guzman: I think just telling myself, you know, you have biases. You need to acknowledge them, put them aside, and you need to listen.

I was trained during the start of where we started acknowledging the opioid crisis so I remember having a lot of arguments with patients about pain medications and whether or not I’d be prescribing them some. And so this brought back a lot of those sentiments and one of the things that we do as physicians unconsciously, is we have our biases.

Is there an emergent reason that this patient has pain all over their body? Is the question that I should be asking, not how am I going to convince this patient that they don’t need narcotics? And so I kind of needed to acknowledge my own biases and my own feelings about entering into this case before going in.

And I walked in and I asked the same open-ended question and that’s how can I help you today?

Dacher Keltner: Do you think that’s a good gateway to the third step of this respect program? Is deep listening?

Omar Guzman: I think so. I think that there are times where you have to get to the point. I see that you’re here for a gunshot wound, let’s get to it.

Dacher Keltner: Yeah.

Omar Guzman: But sometimes it’s, I’m here for weakness, and weakness is just such a general term. I’m here for pain. Pain where, pain how. and you just have to open up and say, how can I help you today.

Dacher Keltner: And the fourth component is empathy showing fellow feeling and there’s amazing research showing, you know, nursing professionals will treat pain more effectively in black patients who often are misdiagnosed for pain,when those nursing professionals practiced empathy. How do you practice empathy in your work?

Omar Guzman: Well, I mean, I thank them for sharing. Because honestly, they don’t have to share their life experience with me. Sometimes they share a lot about their life and, and I get to show empathy there. There is also a psychological component to pain. There’s a stress component to pain that nobody’s helping me and I still feel it.

And so I think that part of the empathy component is highly important because you’re able to kinda show the patient that you care.

Dacher Keltner: Yeah. And I know there’s a long history of studying empathy in doctor, patient relations, how powerful it is, just they feel more trusting and satisfied. I wanna turn to humility, which is one of my favorite components of. Diane Johnson’s seven step respect process. And I’m curious what that looked like for you with this patient.

Omar Guzman: Yeah. humility’s always been a big thing for me.

I’ve always carried an imposter syndrome with me about what we think of a physician, the perfectionist, the know-it-all, the, the person in power, because that’s not my personality. But in this case it’s the humility of knowing what you don’t know.

Dacher Keltner: Yeah.

Omar Guzman: And I do not know this patient’s life, and I don’t know where she’s coming from. I don’t have a lived experience in having chronic pain.

Dacher Keltner: Yeah.

Omar Guzman: And so therefore, I need the patient to educate me on what it is that they feel on a daily basis, and how I can help.

Dacher Keltner: How does introspection our sixth step, in this respect giving process work for you? How did it work with the fibromyalgia patient?

Omar Guzman: I think that being introspective is sitting there and realizing that I wanna do this, so I wanna cut him off. I wanna move on. I wanna get up, and, and being introspective into my own intentions of how I would normally go about it, but there I just found myself thinking like, no, you need to sit down. You need to listen there’s more to this.

Dacher Keltner: Absolutely. And then finally, and this seems to define a lot of your approach to medicine, Omar, just building relationships, being the seventh step of respect.

Omar Guzman: The biggest thing about emergency medicine is that we have to form a relationship with a patient within the first five seconds. I mean, I have to get a patient to like me, trust me, and spill their deepest secrets right now because we have a five minute conversation and so that’s the other part about listening, is listening for connections. Your human connection with that other person, and sometimes it’s we’re both fans of the Raiders, or sometimes it’s, you know, we both have kids or, you know, things like that. Making somebody feel comfortable. Because if not, they’re gonna shut off and they’re not gonna trust you and you’re not gonna get the full history that you need.

This particular patient told me that she had a family member that was in medicine. And that was from forcing myself to listen and it’s a very small community and so it turns out that I actually knew her family member.

And I think what really helped was she felt like somebody from her community and I was always taught that my community is just an extension of my family, so somebody from her family took care of her. Somebody that she cared about too and really listened to her and I think that the patient went home happy, she felt satisfied, she felt secure going home. And to me it was an honor to be able to provide that kind of care.

It really brought me back to the reason I went into medicine.

Dacher Keltner: Omar, thank you so much for your work and thank you for being on the show. It’s been an inspiring conversation.

Omar Guzman: Yeah. Thank you for having me. I appreciate it.

Dacher Keltner: If Omar’s experience exploring these elements of respect moved you in some way, share this episode with a friend. We’d really appreciate it.

Up next, we’ll learn more about Dr. Johnson’s elements of respect, and how ultimately, they’re all about connecting across differences.

Diane Johnson: It has to do with intention and prioritizing and what we spend time on and this is why actually it is so difficult to build relationships.

Dacher Keltner: More on the elements of respect, after this break.

Welcome back to The Science of Happiness. I’m Dacher Keltner. We’ve been talking about ways we can show respect, and how it can transform our interactions.

Doctor Diane Johnson is an ordained minister with a PhD in organizational behavior.

Diane Johnson: I was grappling with like at the core, the, what’s the one thing that I consistently saw that was not happening. That created confusion, misunderstanding, toxicity. And it occurred to me that it really is respect,

Dacher Keltner: Diane created the seven steps Omar tried for today’s episode, and I got to speak with her about why she believes these elements are so effective.

Here’s part of our conversation.

One of my favorite studies in this space is when judges sentence people to, you know, prison sentences if they treat, you know, the individual with respect that individual feels the system is fairer and does better with that. And same in workplace settings. And it’s such a rich concept that it translates to behavior you can engage in with people, a feeling inside.

So, point one or first principle on the path to deep respect is acknowledging tensions. So how do you guide people to reflect on that?

Diane Johnson: I think that a really basic principle is how important it is that we explore and acknowledge what is in front of us. Like what is the context? What is the frame that we are in. I very often use the metaphor around the Petrushka dolls. The nesting dolls. Where the smallest doll – this tiny, it’s like half it like tiny. And that little doll, if that’s an individual and then that doll is in a larger doll, which is your family, and then there’s another doll that’s a little bigger, that might be your community. And then the other doll is like where you work. And then the other doll is like the region of the country and you know, so, what’s so powerful about that metaphor is it speaks to, that there are relationships from the largest doll to the smallest doll.

One of the most important elements that I have found in this work is how essential it is to recognize that we as individuals are part of systems and structures, and how do we understand the relationship between our individual lived experiences? And how that is informed and encased into a larger structure and a larger system.

Dacher Keltner: And it nicely moves into this deep fifth principle of yours, of humility and it’s just starting to get studied in the social scientific literature.

Diane Johnson: I think one of the things that is so directly related to humility is this capacity to have a social analysis. Like how do we have a sense of radical self-reflection and having an ability to see what is happening at the systemic and structural level.

Dacher Keltner: Yeah.

Diane Johnson: Because people say, well, I’m not privileged. I worked my way, you know, and was able to pick myself up by my bootstraps. Some people don’t have any boots. Hello.

And that humility and that self-reflection is related to understanding. What is happening at a systemic and a structural level.

Dacher Keltner: Diane, I love your last principle, which is building relationships. You know, it’s just almost a truism now in our literature. Strong relationships, 10 years of life expectancy, lower cortisol, better immune profiles, et cetera. and happiness, of course, but it’s hard. Right?

Diane Johnson: I think it has to do with prioritizing and what we spend time on.

There are so many different industries. Whether you’re a faculty person and you have to build relationships with your students, someone who is involved in the criminal justice system. There is a level of intentionality that will facilitate us creating the relationships that are going to support the growth of the communities.

If you’re a business where you have bottom line or you’re social sector organization where you’re seeing clients, the context or the frame is transactional, like metrics? You’re a doctor, How quickly are you seeing patients and turning around?

Dacher Keltner: Yeah.

Diane Johnson: That is the, in a sense, the antithesis of the time and energy that it takes to build relationships. But the reality is we have to do it.

Dacher Keltner: Diane Johnson, thank you for being on the show.

Diane Johnson: Pleasure. Delight.

Dacher Keltner: This episode was supported by a grant from the John Templeton Foundation, as part of our project on “Expanding Awareness of the Science of Intellectual Humility.” To learn more, go to ggsc.berkeley.edu/i-h.

Next time on The Science of Happiness, we’ll dive into the benefits of progressive muscle relaxation with journalist Nelufar Hedayat.

Nelufar Hedayat: Oh, I felt that one, the lower back, like a release, like a buzzing.

Dacher Keltner: We’ll explore how relaxing the body, impacts the mind.

Nelufar Hedayat: I feel as though my bubble of awareness. That I usually carry around in a day with me is about a millimeter away from my skin.

Dacher Keltner: This episode was supported by a grant from the John Templeton Foundation, as part of our project on “Expanding Awareness of the Science of Intellectual Humility.” For more info, go to ggsc.berkeley.edu/IH.

This episode was produced by Pauline Bartolone. Our Executive Producer of Audio is Shuka Kalantari. Our producer is Haley Gray. Sound designer Jennie Cataldo of Accompany Studios. And our associate producer is Maarya Zafar. Our executive director is Jason Marsh. The Science of Happiness is a co-production of UC Berkeley’s Greater Good Science Center and PRX.

I’m Dacher Keltner. Thanks for joining us on The Science of Happiness.