The Second Osler Symposium - Doctoring in the 21st Century, October 20-23, 2012 in San Diego, CA

THE STORY BEHIND THE OSLER SYMPOSIA

by Janice Mancuso

I remember, like it was yesterday instead of 25 years ago, how I felt when I began reading the evaluations from the attendees at one of UCSD’s first Wilderness Medicine conferences in Snowmass, Colorado. Over 400 doctors, from 40+ states and Canada, representing 30+ specialties and sub-specialties rated the program higher than any other I had managed to date. What was most notable however, were the thoughtfully written attendee comments about how they felt about the experience itself. Pediatricians liked learning next to trauma surgeons and radiologists. They liked wearing shorts and t-shirts to the meeting and then going hiking after a morning of excellent didactic lectures. They said it was wonderful to be able to share the fun with their spouses and families. And the most significant, common theme was how they felt renewed and energized about their profession. “I haven’t felt this good about being a doctor in 20 years. Thank you.” That comment stayed with me.

Those were unintended consequences. We asked ourselves why and concluded it was the combination of a stellar, passionate faculty, unique medical and non-medical topics, a beautiful location, time to play (as well as learn), and the camaraderie and friendships that were formed over the course of a week.

An idea was born. What if we intentionally created a physician well-being conference for doctors that dealt with practical and esoteric topics related to their stresses and frustrations and used the Wilderness Medicine model… Would they come?

I left UCSD and moved to Colorado to raise our young sons. The idea came with me. I began collecting articles, reading books, attending lectures and keeping notes.

In May 1989 I wrote a response to a letter from George Sheehan, MD on my IBM selectric typewriter and laid out my idea for a Physician Heal Thyself conference.

“I think doctors want to feel good again about their chosen profession. I believe they need to be reminded about why they chose medicine and possibly have a forum where they can commiserate and share their fears and frustrations – as well as their joy.”

“In Ellen Goodman’s 8/30/88 column (TIME magazine), she wrote, ‘Sitting here, idle at last, I am finally conscious of the gap between being productive and simply being… But I am not convinced that inefficiency is our problem. Instead, it may be the passion for efficiency… Friendship takes time. So does family. So does arriving at a sense of well-being.’”

“I truly know from the inner core of my being that if physicians were offered an opportunity to spend 4-6 days in a peaceful retreat-like setting, an educational opportunity that appealed to both their right and left brain, afforded them TIME and even encouraged them to be with and have fun with the people they love, they would leave that experience, renewed, refreshed, wiser and happier. I am enough of a realist to know that once they got back to their daily grinds they would fall back into grooved patterns, but at least they might have a place to go within themselves where they could recall the joy they found during that special meeting with their peers.”

“And I can’t help but believe that they would be better physicians – no matter what kind of medicine they practice – for having attended. And ultimately their patients would feel the positive fallout of their time away.”

Unfortunately because of his battle at that time with prostate cancer, George wrote back that the mind was willing but the body was weak. The conference idea was again moved to the back burner.

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I grew up in the age of Dr. Kildare, Ben Casey, and later Marcus Welby, but before them my favorite doctor was Fred Bush, MD, my pediatrician who cared for me until I left for college. Dr. Bush made house calls. Mrs. Bush was his nurse. I hated shots and would hide under the exam table when it was time for vaccinations. He understood and would patiently coax me out. Mrs. Bush always gave me a lollipop anyway. Dr. Bush was kind and gentle and we always felt better after seeing him.

At 19, my first real job was as a medical secretary for Dr. Jerome Rudolph in the Ob-Gyn Department at the University of Rochester. He loved being a doctor and his patients loved him. I have always revered physicians, yet over the years I have come to learn and appreciate that they are simply human beings who have accepted a noble calling.

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The idea for this physician wellness conference moved from the back burner to the slow-cooker by the time my 82 year old father passed away in 1992. But events surrounding that loss reinforced my desire to develop “the conference” (as my family and friends have come to know the object of my affection) because I was more concerned than ever that physicians as a group were not that well.

My father’s primary care doctor had been his physician for 15 years. They had a long-term relationship. At the time, it never would have occurred to me that he wouldn’t, at some point, call my mother following my father’s passing in the wee hours of the morning to offer his condolences, or to simply say something – anything. Surprisingly, when Dr. Bush (92 at the time) saw my father’s obituary, he called my mother to acknowledge my dad’s death. Mind you, my father was a cab driver, not a prominent person outside of our family, and Dr. Bush had not been our family’s doctor for over 20 years. But he remembered the relationship. He was a good doctor indeed.

I became increasingly concerned about what was happening to the doctors and healers of today. I continued cutting out articles and reading books. My library grew.

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After moving back to California in the mid 90s, the quest to produce the conference intensified and my 15-year personal odyssey began in earnest.

Since that time I’ve owned one business and have been part-owner of another – both producing CME meetings. I’ve had “two tours of duty” with both the Wilderness Medical Society as its Conference Director (an organization that continues to hold a special place in my heart) and with the Endorphin Power as its Executive Director. I’ve been an independent contractor for a nutriceutical company and a start-up nonprofit. I’ve worked at two universities, a for-profit CME company, a publishing company, a psychologist’s office and a real estate company. I’ve been unemployed. I went through a divorce and declared bankruptcy. I’ve cleaned houses and walked dogs. I’ve had 11 different addresses in 4 cities and two states… several twice. My sons grew up.

The only constant was my desire to create “The Conference.” I kept reading, listening and writing.

I read Bernard Lown’s Lost Art of Healing that confirmed there was a need for this conference and re-affirmed my commitment to the project. “The memory of [my mother’s] death evokes pain and tears but I weep more for what is happening to my profession.”

In 1999, I was introduced to Sir William Osler when I read Osler–Inspirations from a Great Physician by Charles S. Bryan. At that point I knew the conference should rather be a series of conferences and would be named in honor of this great doctor and good man.

There was a September 1999 issue of Newsweek in which Zee Neuwirth, MD wrote, “Considering the potential consequences of physician stress on patient health, it’s surprising how little has been done to remedy the situation.”

Larry Dossey, MD – author of many books including Reinventing Medicine – wrote in 2000, “If I could produce just one change in medicine, it would not be a cure for cancer, heart disease, or AIDS, but a transformation in doctors – opening up to that part of the psyche that is smothered in the process of becoming a physician. We must recover the wisdom we have collectively forgotten – how to harmonize intellect and intuition, reason and feeling – which makes it possible to connect with those we serve at a “heart level.” Otherwise we will continue evoking resistance and antipathy from patients without knowing why, and feel unappreciated and rejected in the process.”

In his 2001 book (Integrative Health Care ~Complementary and Alternative Therapies for the Whole Person), Vic Sierpina, MD, with the University of Texas Medical Branch at Galveston, wrote “As Bernie Siegel says, ‘People need inspiration so that they can undergo a transformation which allows them to use the information they have to choose healthy behaviors.’”

Rachel Naomi Remen, MD wrote “The struggle for meaning” in the Feb 2002 issue of Clinical Psychiatry News. “Doctors nationwide admit the work has lost meaning for them--an unprecedented crisis in the history of medicine. … We will have to fight for our sense of meaning--defending and strengthening it against fatigue, numbness, overwork, unreasonable expectations--in order to maintain our commitment and to preserve the meaning for those who come after us.”

In 2005, I attended a lecture by James Gordon, MD, humanitarian, author and founder of the Center for Mind-Body Medicine, a nonprofit educational organization in Washington DC. “Meditation should be central in education to open the mind to change. Otherwise what we’re teaching becomes another technique.” “Any group therapy is powerful.” “The only way to teach self-care is to experience self-care.”

In the Lancet in 2009, Jean Wallace and Jane Lemaire wrote, “Physician wellness: a missing quality indicator.” “When physicians are unwell, the performance of health-care systems can be suboptimum. Physician wellness might not only benefit the individual physician, it could also be vital to the delivery of high-quality health care.”

In December 2010, Andrew Weil, MD spoke to a group in Albuquerque and encouraged doctors to become less politically apathetic because it will take enlightened physician leaders at the grass roots level to help affect the social and cultural changes that need to occur.

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I love quotes and was sustained by the words of many:
“Success is the ability to go from failure to failure without losing your enthusiasm.” ~ Winston Churchill

A traveler in ancient Greece, the story goes, met an old man walking along the road and asked him how to get to Mount Olympus. The old man, who turned out to be Socrates, replied: “Just make sure that every step you take is in that direction.”

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I learned something valuable from each situation listed above… including the dogs. I learned about switchbacks… that even when you’re going in the opposite direction from your final destination you are getting higher and closer to it. I met people along the way who were instrumental in creating the Osler Symposia.

Bill Norcross from UCSD gave me the Osler book and has been supportive since the early days. I worked with Wadie Najm during my short stint at UC Irvine and he became my doctor. He walks tall in both academic and clinical medicine. No one has come closer than he to my memories of Dr. Bush. To my delight, Wadie agreed to be the Program Chair. Paul Auerbach and Eric Johnson, both with the Wilderness Medical Society, walk the talk and exemplify balanced medical lives with a strong service component. And then there’s Sam Slishman, the ED doc who founded the Endorphin Power Company. Our paths crossed for the first time in Cozumel at a CME conference in 1998. Years later I decided to volunteer and work for him at EPC. During a casual conversation in 2009, Sam unlocked the door giving me the opportunity to finally bring the symposia to life by offering to have EPC produce the series. I had reached my Ithaca… aka New Mexico.

Working with these doctors, putting together the program for the conference and assembling this esteemed faculty has been the richest, most gratifying professional (and in many ways personal) experience of my life. George Sheehan ended a lecture at the UCSD conference where the idea was born with the following prescription for a healthy life… “Be fit. Have a sense of humor. Love what you do and the people you do it with.” Good words to live by.

Thank you for reading this story. Hope you join us in our upcoming Osler Symposium or somewhere down the trail.

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