EP. 113: FOSTERING MORAL LEADERSHIP

WITH IRA BEDZOW

May 21

WITH IRA BEDZOW, PHD

An ethicist and Director of the Emory Purpose Project at Emory University shares what moral leadership means to him and how he guides students, clinicians, and scholars in reflecting on their values and purpose.

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Episode Summary

In today's world, the idea of “identifying your values” is so ubiquitous, appearing from corporate mission statements to self-help books, that it can seem trivialized to the point of meaninglessness. But in this episode, Ira Bedzow, PhD reminds us it does not have to be this way—explorations of personal values can be an inspiring, holistic, and thought provoking process that transforms everything that we do, from finding joy in work to building fulfilling relationships.

Bedzow is the executive director of the Emory Purpose Project, an initiative at Emory University that provides opportunities for students to develop a capacity for reflection on purpose and meaning. He is also an associate professor in the Department of Medicine, a core faculty member of Emory's Center for Ethics, a senior fellow in Emory's Center for the Study of Law and Religion, and an Orthodox rabbi.

Over the course of our conversation, Bedzow discusses how he helps people discover their life purpose, how he teaches moral leadership, how he wrestles with questions of moral relativism, the connection between a loss of purpose and burnout, how he counsels clinicians on resolving ethical quandaries, and more.

Ira Bedzow, PhD. is the Executive Director of the Emory Purpose Project at Emory University, whose mission is to unite diverse partners across the Emory community in providing opportunities for students to develop a muscle for reflection on purpose and meaning. Bedzow is also an Associate Professor in the Department of Medicine, a core faculty member of Emory’s Center for Ethics, a senior fellow in the Center for the Study of Law and Religion, and the unit head of the International Chair in Bioethics at Emory University.
His interests relate to understanding the ethical implications of biotechnology and healthcare policy as well as how organizations can create an ethical culture through values-driven leadership. When it comes to ethical leadership, he tries to show that making a values-driven decision and implementing it effectively consist of different skills and face different challenges. Understanding the difference between asking “what to do” and “how can I act on my values successfully” is key to leadership and organizational success.
Bedzow is also Senior Scholar of the Aspen Center for Social Values, co-director of the Maimonides Institute for Medicine, Ethics and the Holocaust (MIMEH), and a regular contributor in Forbes. He is also an Orthodox rabbi.
In this episode, you will hear about:
• 2:21 - The varied roles that make up Dr. Bedzow’s current career
• 8:06 - What “values” mean
• 15:53 - The principles Dr. Bedzow employs when counseling students on their career and life aspirations
• 19:07 - Applying ethical thinking to medical scenarios
• 27:36 - How Dr. Bedzow counsels leadership at an organizational level
• 31:02 - The connection between a loss of sense of purpose and burnout
• 39:01 - How organizations and individuals can proactively foster a sense of mission
• 42:05 - The deep meaning that Dr. Bedzow finds in his religion
• 45:23 - Truths that Judaism can offer the world
Henry Bair: [00:00:01] Hi, I'm Henry Bair.
Tyler Johnson: [00:00:02] And I'm Tyler Johnson.
Henry Bair: [00:00:04] And you're listening to The Doctor's Art, a podcast that explores meaning in medicine. Throughout our medical training and career, we have pondered what makes medicine meaningful. Can a stronger understanding of this meaning create better doctors? How can we build healthcare institutions that nurture the doctor patient connection? What can we learn about the human condition from accompanying our patients in times of suffering?
Tyler Johnson: [00:00:27] In seeking answers to these questions, we meet with deep thinkers working across healthcare, from doctors and nurses to patients and health care executives those who have collected a career's worth of hard earned wisdom probing the moral heart that beats at the core of medicine. We will hear stories that are by turns heartbreaking, amusing, inspiring, challenging, and enlightening. We welcome anyone curious about why doctors do what they do. Join us as we think out loud about what illness and healing can teach us about some of life's biggest questions.
Henry Bair: [00:01:02] In today's world, the idea of identifying your values is so ubiquitous, tossed around from corporate mission statements to self-help books that it can seem trivialized to the point of meaninglessness. But in this episode, Ira Bedzow reminds us, it doesn't have to be that way. Explorations of personal values can be an inspiring, holistic, and thought provoking process that transforms everything that we do from finding joy in work to building fulfilling relationships. Ira is the executive director of the Emory Purpose Project, an initiative at Emory University that provides opportunities for students to develop a facility for reflection on purpose and meaning. He is also an associate professor in the Department of Medicine, a core faculty member of Emory's Center for ethics, a senior fellow in Emory's Center for the Study of Law and Religion, and an Orthodox rabbi. Over the course of our conversation, Ira shares how he helps people discover their life purpose, how he teaches moral leadership, how he wrestles with questions of moral relativism, the connection between a loss of purpose and burnout, how he counsels clinicians and resolving ethical quandaries, and more.
Henry Bair: [00:02:16] Ira, welcome to the show, and thanks for joining us.
Ira Bedzow: [00:02:19] Yeah, thanks. It's a pleasure to be here.
Henry Bair: [00:02:21] So I'm excited to hear the insights you have to offer us in medicine. But as listeners will have noted, you do a lot of teaching at Emory University, not at the medical school. And are yourself a rabbi? Given how varied your work is, can you tell us what your day job currently looks like?
Ira Bedzow: [00:02:39] So I'll start with every day looks really different for me. I teach classes in the law school at Emory. Typically I teach either health law or leadership classes. I also teach in the master's of bioethics. I also teach undergrad courses. This semester I'm teaching a Jewish Business Ethics course. Next semester I'll teach a class in moral leadership, and then in the spring, I'll probably teach a class on virtues not only what they are, but how we can develop them, while at the same time, I'm not simply just an academic or faculty. I work in the provost office on something called the Emory Purpose Project, which is part of their Greater Student Flourishing initiative. And really what the Purpose Project is trying to do is it's trying to orient the educational experience not only for undergrads, but for all the graduate and the professional schools away from simply providing information, hoping that the students gain knowledge, but trying to also provide students opportunities to develop the skills and the capabilities that can allow them to not only take that information and have it become knowledge, but allow them to reflect on what matters to them, why it matters to them, what their beliefs are, what their goals are, what their values are, and how they can pursue whatever career or aspiration that they have personally or professionally, in a way that can allow them to be successful. And when I say successful, I don't simply mean financially successful, but I mean successful in the sense that they are achieving their goals and they are acting on their values as opposed to against what they believe in or what they care about.
Henry Bair: [00:04:16] Mhm. When you talk about envisioning the role of higher education in shaping not just the minds, but also, dare I say, the souls of students, it calls to mind a conversation we had with William Deresiewicz, a former professor at Yale, who believes that much of higher education has lost sight of the original purpose of the liberal arts, which goes far beyond knowledge transference and really should be about helping students discover who they really are and help them articulate what a life worth living means to him or her. So I heard you mention teaching classes on moral leadership and business ethics. How did you get to this point? What equipped you to teach moral leadership?
Ira Bedzow: [00:04:58] So how I got to where I am. I love this story because it's it's not your I think it's not your typical story. Undergrad. I was like everybody else majored in politics and economics. I was really, really interested in thinking about how people make decisions and how societies or communities establish themselves given the assumptions they have on how humans make decisions, as well as what they think is the best way to create an organization, or a society or a community that can use that decision making for whatever good needs to be, you know, pushed or aspired to. But after I graduated, I went to work in real estate finance, and it was the best ethics education I ever got. Most people say, oh yeah, because, you know, real estate finance is an ethical. That wasn't the reason, really. What I learned working in real estate finance, after really studying politics and economics in the ways that I did, I saw that really, if you want to advocate for a position and you want to be, you know, strategic and successful, what you can't do is say, I have all of this information, just listen to me. I know what I'm talking about, and this is what we should do. I needed to really think about who are the stakeholders, what's at stake for them, what are the obstacles? How can I bring people in to not only understand my vision, but I can understand theirs as well? How can I think about the structural obstacles, the interpersonal obstacles, the incentives that might not be aligned with people's motivations in order to not only give a decision or give an option that I think is beneficial, but show people how it could be beneficial and possible to achieve.
Ira Bedzow: [00:06:37] So once I saw that that was the way to be persuasive, I quickly recognized that that needs to apply also in the ethics space as well. It's not simply a matter of moral philosophy, or the study of what good is and how good can be achieved, or what right is, or what how right can be achieved intellectually. Ethics is a really practical science, so I spent the rest of my time thinking about in various ways. I mean, I did my PhD and then I worked in a medical ethics department, and now I'm at Emory. But I spent a lot of my time thinking about, at least from a virtue ethics perspective, how do we become aware that we're in a situation of moral tension? How do we make decisions that speak to our goals and our values, as well as the various stakeholders that we're impacting? And how do we be really strategic in implementing what we want to do? Recognizing that ought implies, can and cannot implies order. So this process of moral perception, moral deliberation and strategic implementation has to be a recursive process. And it's not simply linear. So I really took that into everything that I do. I really see myself as an ethicist, and I see as those those ethics skills is, if not universal, at least ubiquitous. So I apply those skills to the business world and teaching business ethics. I apply it to the the medical world in terms of either looking at organizational ethics in hospitals or looking at even the clinical environment. And I also look at it in terms of personal personal development.
Tyler Johnson: [00:08:06] So I want to ask a really big picture kind of society level philosophical question that I think has really deep on the ground resonance. If you're counseling with a student or with a professor or with the provost or whatever, right. I've recognized over the course of many of our conversations, some of which Henry alluded to a moment ago, that and, you know, let's just be really upfront here, right, that I am at best an armchair philosopher. Right? So I do not have a PhD. I am, you know, not Chidi from The Good Place. I'm just, you know, some guy who reads and thinks and says more probably than he should. But all of that said, I've recognized that in our postmodern world, there are two very different ways. At least two different, very different ways of talking about values which are descriptively and normatively. Right. So one way that you can talk about values, which seems to have been the most frequent in the discussions that we've had with many different people, in many different sort of walks of medical life, is that values are just a thing that is inside of you, and your job is to figure out what they are and then to align your life with them. So there there is no moral valence to the values, they just exist and value. A that I have is just as good as value B that you have.
Tyler Johnson: [00:09:29] There's no hierarchy, there's no right or wrong, it's just a description of what's inside of us. And if we try to do things that are not aligned with that, then we will feel sort of this kind of fundamental existential mismatch, and we're likely to be frustrated. A different way of thinking about values, or an additional way at least, is to say yes. Values are a way of defining what's important to you. There is a descriptive function, but there is also a hierarchy of values. Some values are better than other values, and some values are more worth pursuing or worthier of pursuing. And so I guess that I wonder, because part of what I hear you saying when you describe your day job is that you are both helping students to sort of discover and align their lives with their own values, and also even helping the institution of Emory, including its leaders, to think about the mission and values of the institution. But as you do those things, do you think of values primarily as descriptive things or as normative things? And like how do you negotiate the difference? And then after you give a general answer, I might pose a specific scenario to you to sort of help us think through how you would approach that. But first of all, in a general way, how do you think about that?
Ira Bedzow: [00:10:50] Okay, that's a big question. Let's tackle it piece by piece. So first off, you mentioned Chidi from The Good Place. So I'm really glad that you mentioned Chidi. He is one of my favorite characters. We used to play a game in my house, which was go find daddy's book on the bookshelf, which whenever Chidi would bring a book out, the kids would then go find the book. Um, but you know why Chidi was in hell, right? I gave the story away. I hope that's okay. But you know why he was in hell, right? He had all of the philosophy at his fingertips and couldn't make a decision.
Tyler Johnson: [00:11:21] Right?
Ira Bedzow: [00:11:21] As an ethicist, I don't want to be that person. Right. That's one of the big differences between ethics and moral philosophy, at least in my perspective. Moral philosophy might allow you to talk well about many different issues, but an ethicist is going to help you live your life. I'm hoping a good ethicist. Now let's get to the objectivity relativity problem. So I try to avoid it in conversation for a few reasons. And then I'll tell you what I do, because I end up going back to it, is when we start getting into the relativity objectivity perspective. One of the things that we start priming ourselves to think of is all of the places where we might disagree in our values. We don't think about the places where we agree on our values. Okay. So if we look at where we agree versus where we disagree, we may agree on many, many aspects and disagree on on a few. We may not. But if we see it that way, then we're going to start thinking of okay, well, values may be subjective or personal. Are we so atomized and so individualistic that even when they might be subjective, there's no common ground or no common care of this community that we that we can't speak to each other.
Ira Bedzow: [00:12:30] Right. But let me let me get to what I actually do instead of going into the objectivity relativity thing. Typically, when I speak about values to people and I ask them about their values, I'll never talk about, like, what are your values? Because whenever you say, what are your values? Everyone goes to the internet and clicks in values, gets that big? What is it that PowerPoint slide that has like a list of 50 values on it, and then they start picking words, right? I don't find that helpful. I just I really don't find that helpful. So if it's about a decision I'll ask them what do they want. If it's about a value and we're really just talking about values, I'll say, okay, well what do you care about? They'll tell me and then I'll say, okay, do you want to want that thing or do you care about that, or do you want to care about that thing? Like, do you feel like it's coercive or is a choice just to start picking at it? Then I'll say, well, what does that say about you as a person, like someone who who cares about that thing? Like, what does that mean in terms of how you describe yourself? Is it part of how you describe yourself to determine how much you care? Or is it really I say I care about it, but you know, it's not part of who I am. And then typically I'll then ask them like a further question in terms of how does that care? Or that won't play out in other areas of your life. So what I'm really trying to do is I'm not trying to ask them about their values, but I'm trying to figure out what it is that they value. Like I'll put the words to it afterwards, but I want to see like, where is that thing?
Ira Bedzow: [00:14:04] Let me say one more thing about values, which helps when you think about the PowerPoint meaning like the 50 words all over the place. Typically we have these words that we somewhat know what they mean, and people might have a shared meaning, but operationalize in very, very different ways. The great example that I love to give is when the President's Commission on Bioethics was thinking about, like pediatric research for counterterrorism, there was a huge group of people that said, we need to do this research in order to protect the children. There was another group that said, there is no way in the world we should be doing this research because we need to protect the children.
Ira Bedzow: [00:14:43] But if you notice, they had the exact same value of protecting the children. That led to completely opposite decisions in how and how that plays out. Right? Because one was framing it of if, God forbid, there's a terrorist attack and an anthrax, then we need to do this type of research in order to find a vaccine or preventive. The other was framing it in, God forbid, we're never going to have this terrorist attack. The the probability is so low. Why would we put someone into unnecessary harm as a vulnerable population? Right. So the value is the same, but the way it was contextualized in their assumptions and therefore their decisions was different. Right. So when I think about values, I think about what beliefs do they contain, what behaviors do they motivate. And then the third question is when you make a decision on that value, what are you excluding or what are you forgetting when you do those types of exercises, values take on a very different meaning. And even if they may be subjective, they're not relative in the same sense of any value matters at that point, because they have to be grounded into something. And that typically is our engagement in the world around us.
Tyler Johnson: [00:15:53] So I'm curious though if you have, because I agree with you. Another problem I think with that, you know, the list of however many values is that there are some things that you kind of know that you're supposed to pick and other things you know, you're not supposed to pick. So even if you really in your heart like the things you're not supposed to pick, you're probably not going to tell someone that those are the things that matter to you, right? Because that's just embarrassing. But I'm curious if you had a student, let's say, who, for whatever reason, ended up in your office and said, I, you know, I'm just trying to figure out my life and my direction and what I want to do when I grow up and I'm, you know, trying to discover myself, whatever. And you, through the course of talking to them, figured out that it really did seem like at bedrock, the thing that mattered the most to them in their life was to make a lot of money. Then what? Like, do you consider that a an opportunity for you to help them see a better way? Or do you consider that because of respect, I don't know, for their autonomy or whatever that your job is to then help them figure out how to put together a life plan so that they can make a lot of money.
Ira Bedzow: [00:17:02] Yeah, this is a great question because I'm now thinking in my head, especially because you talked about autonomy. What is the responsibility of a physician who has a fiduciary responsibility for their patient, and they rely on autonomy just to get out of hard conversations. They're like, oh, that the patient wants it. So. Right. Who am I to say? So look, as a teacher, I think that it's always good to to question people when you think that they may not be thinking. It's not that they're not thinking clearly, that they're just not thinking everything through. I think this has actually happened to me before, where students didn't say that. They just wanted to make a lot of money, but they wanted a position at a company. They're like, my goal is to have a position at a company, right? This student I'm thinking about in particular, I first asked them, okay, well, what does that mean? Like what would you be doing every day? And then it gets to the same kind of idea in terms of positions are states of being whose value is kind of relative to how people perceive it. Right. Money is a means of exchange or it's a tool to for other things.
Ira Bedzow: [00:18:08] But once you know that, then you start asking those types of questions of if money is a means to other things, then what do you actually want? Do you want the purchasing power? Do you want the social comparison? You go back into these same questions. I can never tell the student, I'm sorry. It's just stupid to say all you want is a lot of money. That would be a horrible teaching process, but I can question that. I think I should question that, right? I think that if we frame our lives in terms of the activities that we do and the people that we interact with, then it makes it a lot easier to see. Okay, well, thinking that way, what does having a lot of money do for me, knowing that I'm still going to have to interact with people and I'm still going to have certain activities that I want to do, I wouldn't just accept someone's autonomy as a way of saying, well, I can't ask you anything more about yourself or provide a means to self reflect a little bit deeper.
Henry Bair: [00:19:07] Your response to that question brings to mind situations that clinicians often encounter in real life, which is when a patient comes to us and wants something to be done. And if that something involves matters of life and death, it can be so difficult to think through those issues that we just defer to whatever the patients want. Here's what I mean. So I'm currently working on the hepatology service taking care of sick patients with liver diseases. There's this patient with terrible end stage liver disease with all the complications of cirrhosis you can think of. Her liver failure was leading to heart failure and kidney failure. Fluid was accumulating quickly in her abdomen and her lungs. Despite our frequent efforts to drain this fluid, toxins were building up in her blood such that she was now encephalopathic, essentially comatose all day. Her family had decided to pursue a liver transplant. Well, as part of the evaluation for that transplant, we were going to have to do things like a pap smear, a colonoscopy, a heart stress test, and possibly cardiac catheterization. Pretty much all the doctors involved the cardiologists, the surgeons, the gastroenterologists, the anesthesiologists expressed grave misgivings about the utility of going down this path. They were worried that this process of evaluation itself was going to kill her. And yet we didn't even consider telling the patient's family that perhaps transplant wasn't in the patient's best interests. To your point, we could have and should have engaged the patient and really dug into what their values were, what was the end goal of all of this? But it was so much easier to just follow the algorithm of liver transplant evaluation, because that's what the family indicated they wanted. So in this case, what would be your advice if we had consulted the hospital ethics committee? What would you tell us?
Ira Bedzow: [00:20:57] It's funny as I'm listening to you, and before you said that, no one's doing anything. I thought you were going to say is. Well, we actually asked the same questions that you ask, IRA, because we would ask family members, what do you hope to achieve by by us doing everything. Do you know both the benefits and the potential risks of the choice that you're making? Do you imagine that your family member would want to undergo those risks or not? If you don't think that the family member would want to undergo those risks, are you trying to advocate for this because of something that you're feeling? Whether it's a sense of responsibility, a sense of doubt, or something else? I mean, these are the types of questions that palliative care trains their clinicians to ask, which is really just not telling the person, look what you're doing or what you're asking for is extraordinary care. You're letting them come to the realization of is what they're looking for, what they're actually wanting. That's what I would have thought you would have said. And I guess by saying that, I guess I'm telling you, maybe that's the approach you might want to think about taking.
Henry Bair: [00:22:08] The family member of this particular patient has relatively low health literacy, and everyone who's had a conversation, including myself, we acknowledge that the family member does not really understand the implications and how dire the situation is. So there's that, too. Like we've tried having these conversations, maybe not enough.
Ira Bedzow: [00:22:30] I'll say this if someone doesn't understand, then having a conversation in a way that they can't understand is not helpful either. Now, it might be very possible that you say to me, well, look, they'll never understand. And it's literally just easier to go through the motions than it is for that person to make a different decision. But if we're really going to rely on patient autonomy and at least hear through a surrogate patient, autonomy does not simply mean that the patients can make decisions willy nilly. There is an incumbent duty on the clinician to ensure that the person can make a decision, like, do they have the information? Do they know what various treatment alternatives are? Do they know the risks and benefits of various treatment alternatives, and are they making a decision based on if it's a shared decision making model, which I'm sure it is based on their goals and values as opposed to, you know, just because perfunctory, they know how to go through the process.
Tyler Johnson: [00:23:21] Yeah, it's it's actually a really interesting to me because Henry knows that at Stanford, I helped implement this shared decision making model precisely for end of life situations. That is based on a model that was developed by Atul Gawande's group at Harvard. And the model, once you have seen it, feels so simple and intuitive that you can't believe that you ever tried to conduct a discussion in any other way. But in effect, what it does is it spends the first. It's a script to have a conversation. Like if you have a person who, for example, is approaching the end of their life but is still getting chemotherapy, and you're wondering if that's really best for them anymore, you spend about the first two thirds of the conversation trying to better understand the patient's values. And priorities and whatnot, so that you can then spend the last third or maybe quarter of the conversation in effect, laying out, because I understand that you value X, and given the medical realities and the meaningful options that are available, I would recommend that you do A, B, C because that best achieves the things that matter the most to you in the following ways, as opposed to whatever other options.
Tyler Johnson: [00:24:37] Right. And I think it is a fair point that the medical establishment in general, I think, has swung, you know, 50 or 60 years ago, there was this incredibly paternalistic model where sometimes you didn't even talk to the patient about options. You just did the thing right. You just made the decision for them. And I think that we have rightfully swung away from that, but now have swung to a place where oftentimes we act like waiters, right? Where it's like we show up like as if we have a menu and say, well, would you like one of these or one of these, or one of these or one of these? Right. Which to your point, I think actually is really sort of a way of hiding our head in the sands and just sort of avoiding doing what is sometimes one of the hardest but also most meaningful parts of our job, which is to integrate the patient's values with our experience and expertise to make a meaningful recommendation.
Ira Bedzow: [00:25:26] Don't feel so bad. It's not just medicine, it's everywhere. I mean, in society today and all the places that I touch it, I see the same idea of we have a difficulty or a hesitancy of pushing back on people and asking questions like, why? Or what does that mean for you? Or is this really what you want to consider? We just take whatever is said as that is the fact, and then we say, okay, given that now what? What are our options in terms of response? I would say ethics to Gawande's point isn't simply about what one ought to do. You're going to have to know what something is in order to know how to relate to it. So having those questions in terms of what's the state of affairs, to then know what could be done and what ought to be done is a really good decision. And I will say, the last thing I'll say is. Some of the reasons why we have these difficulties. Having these conversations speaks to something called the moral motivation gap. So the moral motivation gap can mean one of two things. It either means I know that I should do something. I don't know how to do it, so therefore I'm not motivated to carry it out.
Ira Bedzow: [00:26:39] Right. There's like a gap there in terms of it's too hard because I don't know how. So I'm just going to rationalize that I really don't want it or I really can't do it, so I'm not going to do it. There's the other moral motivation gap, which is I know that I want to do it. I know that it's the right thing to do. I know that I could do it well, but I also just don't care. So then there's the jump between knowing to actually end up doing it, I don't think clinicians. Um, had the moral motivation gap that says I just don't care. Other industries might. I think that if you knew what was right and you knew how to accomplish it, you would do it. But I think that some of the difficulties in terms of having these hard conversations is that you just don't know how they're going to go, so it's just easier not to do them, because you might be very risk averse and say, well, if that doesn't go well, it's going to even be worse for the patient.
Henry Bair: [00:27:36] Mhm. Yeah. You know we've been discussing a lot of situations in which we're relating like person to person at a very just granular level. We're talking about clinicians with patients or you with students. But you also earlier mentioned that you do a lot of work on a more organizational level. And I'm wondering what does it even mean to look at organizational behavior from a moral perspective, like, do you counsel leadership or do you help them make decisions or what does that look like?
Ira Bedzow: [00:28:06] Yeah. So I mean, it's really it's really interesting. I mean, and I think that goes back to even my undergrad studies in economics and politics. There's a big assumption in economics and politics that it's not exactly true anymore, but it used to be more true that the body politic was a good metaphor, because the collective of individuals is basically just an aggregate, and therefore very similar to one individual. So if you can figure out how one person works, you can figure out how a community or society works. Right? The same process of thinking about moral perception, moral deliberation and strategic action that I lead individuals through on individual decision making works really well for organizations like they're faced with the challenge and they, let's say, want to write a policy or they, you know, want to make a decision that's going to affect the organizations like Modus Operandi. Right. The same questions apply, right. In terms of what are you perceiving? The challenges are who are the stakeholders, right? Instead of asking personal goals and values, you ask about mission and values. Does this speak to mission and values? And then you start thinking about all of the ways that that policy speaks to the challenge and how it will be implemented. Writing a policy that sounds really good without thinking about implementation is like what I said, I'm an expert. We should do it. Just listen to me. Right? So a lot of the work in that on the leadership side is either how do you communicate decisions so that they turn into practice so that they change culture? Or how do you create an environment in the organization such that individuals can make decisions that speak to both their personal goals and values, but are also mission and value aligned? Right? Like, do you make it possible that people at all levels of a hierarchy can feed information up so that good decisions can be made and then communicated down or not? Or can they make decisions at their own level? Okay.
Ira Bedzow: [00:30:04] The process is really, really similar. Just the domain is different and the implications are different. So think about it like when I said, when I think about values, what are the beliefs, what are the behaviors that they entail? And when you make a decision, what is it not considering? When you have a hospital value of community or inclusivity, what is that belief? Who does it include? What behaviors does it entail? How does it speak to policies and decisions you're making? When you make a decision based on inclusivity, who might you be excluding by the decision that you're making and is it actually inclusive or not? You can use the information that people give you to be able to analyze whether they're making decisions that are coherent or not. So there it's coherence doesn't necessarily mean objectively right or wrong, but it does speak to a level of either personal or organizational integrity, which is, I think, a good place where we can be.
Tyler Johnson: [00:31:02] So let me tell you a brief story and then ask you a question that sort of gets to what you've been talking about, and also takes us a little bit in a new direction. So one of our very first guests at the beginning of the program was a woman who considers herself a coach, largely for academic physicians. And one of the main things that she does is people who are very senior in their jobs. She basically talks with them if they're feeling sort of aimless or like they're wandering professionally and tries to help them figure out how to get back on track. And one of the things that she said that became really striking to her when she started this work is that she would talk with these people, some of whom are literally considered the top of their academic medicine niche, maybe in the entire world. And yet when she would go on a walk with them because they were feeling frustrated or burnt out or whatever, and she would say, well, let's before we get to your specific set of problems, let's just focus on the big picture for a minute.
Tyler Johnson: [00:31:58] Like, what is it that gets you up in the morning? Like, why are you here? Why are you doing this? Why do you want to be a, you know, fill in the blank with whatever the job is and that many of them had, in effect, lost the ability to articulate the answer to that question, like amidst all of the, you know, awards and grants and research and publications and leadership positions and whatever, they didn't even know why they were there anymore. Like, they didn't even know what their motivating purpose was. So I bring that up to say, you wrote this article for Forbes, I think, in 2022, called How Purpose and Employee Empowerment Can Stop Burnout. And in particular, this is interesting to us because one of the impetuses for this podcast is to talk about the causes of burnout and how we might address those. So I'm curious, what do you think is the connection between a loss of a sense of purpose and burnout? And how would a leader or a teacher cultivate a sense of purpose among their students or employees?
Ira Bedzow: [00:33:03] I will say the title is catchy. I don't think it covers everything, but it covers enough for this conversation. And I will say it's funny. I've actually had two students about a week ago. Uh, read that article and come talk to me about it. And they said, you know, as students, we're also burnt out. And I said, that's so sad because typically we talk about employee burnout. You're like, as a student, you're here. You don't have to be here like, you're not. You're paying to be here. You shouldn't feel this sense of burnout, like burnout. I feel bad that this is the word that you're using. And to which they said, even if it's the wrong word, the description of what burnout is based in your article is how we feel. So let's talk for a second about both what burnout is. And a lot of people have different definitions. So how I think about burnout. And then I'll think about how purpose and empowerment could speak to that. Right. So when I think about burnout, I think about like chronic stress. But it's a very specific type of stress, right? It's not simply that the work is hard and you're tired, right? Because, look, I work really hard. I get very tired, but I still wake up every day really excited for for what what I'm going to see. I think burnout really speaks to it. And I think that the visual metaphor, like, hits it right of like a sense of failure, um, or a sense of impotence or even a sense of helplessness or hopelessness. Right. Meaning like you may be acting or you may be doing things, but your your actions don't seem to make sense anymore either.
Ira Bedzow: [00:34:37] They're not achieving what you want them to achieve, or the actions themselves have no meaning. Right. And it's not like you feel like that. You're the futility of your actions is not. It's almost outside of your control. Right? So, for example, let's talk about like clinician burnout. I doubt clinicians think that their burnout comes from a sense that medicine doesn't matter anymore. It's stupid to help patients. I don't think that's the source of the burnout. I think there's a strong sense of medical professionals that want to help people and want to care for people. The burnout comes from the the sense that they get that they no longer can or no longer are. Right. So their actions don't matter. Not because it's essentially doesn't matter, but it's just not achieving what it's meant to do. Like you're meant to care for people and cure people, and you're not doing that whether you don't have enough time or have a sense of just complete overwhelm, that you're not making a dent, and so forth. There's other organizational aspects to it where you think that there's lack of fairness or values mismatch, or that it's not that you don't have a lack of recognition or reward, but typically recognition or reward is not, in and of itself important, but it's the fact that you're seen, meaning you have efficacy because you're seen for that. Poor relationships at work also affect burnout, because even if you think the work is good, the people that you're working with are is so draining that it takes away from the sense of meaning of I'll never be able to work with this person.
Ira Bedzow: [00:36:23] And as a social being, it's very difficult for me to be in a situation where my sociality is being stymied. But if you notice, if all of this is really coming to a sense of efficacy, then it's not purpose per se, meaning it's not. I'm wandering. I have no sense of purpose. It's that I have no sense that I can achieve my purpose. Right. So having the the the empowerment side is not empowerment in terms of we should just be empowered for the sake of empowerment. It's how do we find ways to be empowered such that we can feel like we're efficacious. Now this is all for the sense of purpose, meaning you have it and you're not being able to pursue it well. But think about just the A43 argument. Like if someone who has a sense of purpose or a purpose orientation that feels that they can't achieve it has a sense that their life may not matter right, or that their daily activities have less mattering or meaning. Imagine someone who doesn't have a sense of purpose and wandering. They also feel like their actions are the activities that they do don't have the efficacy of constituting a meaningful life. I can I can see how like it may not be considered burnout, but it's definitely very similar in the sense of what it does to a person's psyche or psychology. So that's why I think purpose matters.
Tyler Johnson: [00:37:45] That's an interesting framing, because what I hear you saying is that there are two levels of effectively like if you think of a sense of purpose or a sense of mission being this kind of source of energy that is at the core of most of the meaningful decisions that we make, right? Whether that's engaging with kids at home or leaning into, you know, your marriage or it's, you know, your teaching or taking care of patients or whatever it is you do, right. That sense of meaning and purpose is at the core of most of the important decisions that we make. But what I hear you saying is that on the one hand, the core of energy has to be there, right? You have to have something to tap into, but then you also have to be able to effectively tap into it. Right? And even if the sense of purpose is there. So in the example of health care, what we have heard a lot on the program is that people talk about things like the corporatization of medicine, the bureaucratization of medicine, the digitization of medicine as things that in many cases, it's not that medicine has ceased to be meaningful because of those forces, but rather that those forces make it so difficult to tap into the sense of meaning that it's as if you know, the sense of meaning, might as well not be there because you just can't connect to it.
Tyler Johnson: [00:39:01] But we have also wondered if there is potentially at the center of that, and maybe because of those things, a withering of the shared sense of purpose in the first place. And so I guess that that's a way of asking. So part of it is clearing the obstacles away. But what about fostering the sense of mission itself? And this could apply again, yes, to medicine, but to any aspect of like, like if there is a thing that you recognize that you want to be more passionate about, but you're trying to figure out how to foster your own sense of meaning about that thing, is that a thing that you can proactively do? Like, how do you like let's say that I want to be more committed to my family or to some other, you know, thing that I think is important, but I just am never quite as tapped into it as I want to. How do I foster that sense of mission proactively? Is that a thing that I can do?
Ira Bedzow: [00:39:58] My background is in virtue ethics. So I think that everything can almost be fostered into a virtue or capability in terms of personal development. Even when we have talents or when we have weaknesses, we need less or more molding. So the way I typically see, see these things are choices can lead to actions. Actions can lead to habits. Habits could speak to identity, and identity could speak to like that sense of wholeness or integrity of what we do. Right. So if you say, you know, I really want to spend more time listening to patients, I only have 15 minutes. How am I going to do that? Time is not not on my side on this one. Right? So I'm like, great. Is this a choice that you can make? Can you choose to listen to your patients better? You may say, no, I just told you I have only 15 minutes. I would say, no, no, but you still have a choice because the ability to listen to patients better could either speak to more time or better retention. Can you increase your attention and your focus when listening when speaking to them? Yes. Okay. What actions would facilitate that? Should you? When you walk into a room, make sure that you make eye contact.
Ira Bedzow: [00:41:08] How long does it take to actually build rapport? Certain people can build rapport within a minute, right? Like what are those behaviors and skills that you can do that? How can I make sure that in that little time that I have, I can reduce the amount of distractions that come with that encounter to make sure that the patient feels heard. And I'm actually listening, that seems really overwhelming and hard. Those are a lot of choices and a lot of actions to make. How can I start incorporating them so that they become second nature once that they become second nature? How does that then, like speak to my approach towards patients and others in general? Because, you know, if I can increase intention and that's one domain that skill will carry over in others as well. And what does that say about who I am in terms of my engagement with other people? Big questions can be broken down into many, many small steps. And if you focus on those small steps and build on them, you can make those changes.
Henry Bair: [00:42:02] Thank you for sharing those thoughts with us. Up until now, we have focused on your approach to counseling students or organizations, and you've approached our conversation with either practical or academic frameworks. But I also want to spend a little time on the personal level to hear more about your own experiences. As we mentioned very early on, since you are a rabbi, religion plays an important part of your self-conception. Can you share with us what your journey with religion has been and how it shapes your worldview?
Ira Bedzow: [00:42:34] I don't know what you mean by journey with religion, but I'll just tell you what religion means for me. So as I say this, I know that at every step until the end it can be misinterpreted. So I'm asking for patience and grace. So I will say this. I have a very deep and I would say my entire being is dedicated to God. I truly believe that not only is my reason for being here to serve God's will, but the impact that matters to me is in that service. Right. I don't see that service as being egoistic. Like I'm not looking for a personal salvation. I don't think that's the point of why I'm here. I think the point of why I'm here is, given both who I am and what I can accomplish, which may or may not be a lot like I have no idea what the measure is, but my duty is to have as much impact on this world as possible. So when I think about what I study and what I'm interested in and who I want to affect, I'm very, very careful and very intentional in terms of thinking, am I doing something for the sake of me or for the sake of my obligation to the world? So I read a lot. I spend a lot of time with my family and friends. I'm not like crazy in the sense of zealous or dogmatic, but I am very intentional.
Ira Bedzow: [00:44:08] Meaning time is the only thing that you know goes one way and I can never get back. So I really want to make sure I use that time well. The manner in which I want to impact the world does not mean that I want to convert everybody or make everyone see what I see in the world. I think that my my professional purpose, and it speaks to my personal purpose, is that I look to challenge the assumptions that people make and the ways that they think, so that they can think better and make better decisions about themselves. So the courses that I teach are very self reflective. I don't teach simply just content courses. I want the information not to be something like, oh, I took this course, I now know something about X. I also want the students, whether it's a law student, a medical student, a graduate student, undergrad student to say I also, through this knowledge, learned something about me, not me. I like me as in like the student. So that's that's really how I approach things. I take people out where they're at and hopefully nudge them to where they want to go, which isn't always where I want them to go. But it's not about me. So that's how I see myself.
Tyler Johnson: [00:45:23] So I have realized over time that people who are really deeply dedicated to a religious tradition, it's as if they have cultivated this ability to see this gloriously beautiful thing that most people just can't see. I'm not to say that I don't mean to suggest that it's not there, but it's just not visible to most people, or at least not in a way that is meaningful or that they can articulate. But people who are very deeply dedicated that then informs their lives and helps them to become the people that they are. So as a person who is both an academician and is also a rabbi and is also a believing Jewish person yourself, if you were to distill down 1 or 2. Sort of great truths, transformative truths that you think Judaism could offer the world. That if the world better understood these things, the world would be better off? What would you say those would be?
Ira Bedzow: [00:46:22] All right. That's a really hard question, because I think that once truth is taken out of context, it loses its meaning. But I'll say a couple of things that I guess is from my experience, my experience has taught me a few things. One, the world is not about me, but I can play a strong role. The second is I have deep gratitude for being here. But gratitude doesn't simply mean thankfulness. It also motivates me to share it. And then the third, which is more particularly Jewish, is, I think living as a Jew in a Christian or a secular culture allows me to see the assumptions that that culture makes on my tradition. Like we live in what we think is a Judeo-Christian world, at least in America, or we, you know, we have conceptions of law that we then think come from, quote unquote, the Old Testament. But the interpretations of those texts, those beliefs, those values are very different than the way I read those texts. And I see those values and the same way. Crazy. Enough of we both value protecting children, but some people want to vaccinate and some people don't want to go through the vaccination research. One of the things that I think the Jewish tradition really has provided a good eye to for me, which I would love to share, is don't think that the way you see something is the same as the way everybody sees it. You know, there's no real objective view here, although I do not believe in relativity, but we're all standing somewhere. No one's standing nowhere.
Tyler Johnson: [00:48:00] That is a beautiful note to end on that I will be thinking about for a long time.
Ira Bedzow: [00:48:06] Well, thank you guys for the opportunity. I really enjoy having conversations like this and this one was really good.
Henry Bair: [00:48:13] Thank you so much for for taking the time to share with us your thoughts, your story, your perspectives. We also always enjoy. I mean, most of our guests are clinicians, but we absolutely enjoy sharing voices who are also some in some ways involved in healthcare, but perhaps not in as intuitive and direct of a way as most people might imagine. So thank you very much for bringing your your your perspective.
Tyler Johnson: [00:48:35] Thanks so much, Ira.
Henry Bair: [00:48:40] Thank you for joining our conversation on this week's episode of The Doctor's Art. You can find program notes and transcripts of all episodes at www.theDoctorsArt.com. If you enjoyed the episode, please subscribe, rate and review our show available for free on Spotify, Apple Podcasts or wherever you get your podcasts.
Tyler Johnson: [00:48:59] We also encourage you to share the podcast with any friends or colleagues who you think might enjoy the program. And if you know of a doctor, patient, or anyone working in health care who would love to explore meaning in medicine with us on the show, feel free to leave a suggestion in the comments.
Henry Bair: [00:49:13] I'm Henry Bair.
Tyler Johnson: [00:49:14] and I'm Tyler Johnson. We hope you can join us next time. Until then, be well.