See, Hear, Feel: Exploring Cognitive Psychology and Emotional Intelligence in Medicine With Christine Ko, MD

Oncology Data Advisor: Welcome to Oncology Data Advisor. I'm Keira Smith, and today I have the pleasure of being joined by Dr. Christine Ko, who is the host of the See, Hear, Feel podcast. Dr. Ko, thank you so much for coming on the show today.

Christine Ko, MD: Thank you, Keira. Thanks for having me.

Oncology Data Advisor: Would you like to introduce yourself and what your work and research focus on?

Dr. Ko: Sure. I'm a Professor of Dermatology and Pathology at Yale University. Dermatology, for people who aren't sure, is doctors who look at skin, hair, and nails, and that's their specialty. In pathology, usually you're looking at tissue samples. If you've ever had a biopsy or surgery where they removed something from you—for a dermatologist, it's a little bit of skin, or for a breast surgeon, part of your breast—someone is looking at that tissue under the microscope to give a diagnosis on that tissue, for example, whether it's skin cancer or not. That's the pathology part, and we call that dermatopathology, or skin pathology. I do dermatology and look at patient skin, and I also do dermatopathology and look at skin under the microscope.

Oncology Data Advisor: Awesome. I'm excited to learn more about, See, Hear, Feel. What led you to start the podcast?

Dr. Ko: It's sort of a long story, but to make it a little shorter, I think that there are certain concepts in cognitive psychology that are really important that I never learned somehow. Maybe I had a course that mentioned them, but definitely not in college. I didn't take psychology in college, so that's probably one of the reasons that I've never heard of them, because they're common concepts; they're not really out there. But I didn't learn them and I don't think that I really had a medical course in them. I definitely didn't have a whole course, but maybe they were introduced here and there, and I didn't really pick up on it.

I heard today that you really need to hear something about 17 times before it sticks. Maybe I heard it once or twice, I don't know. We need to really think about our thinking and have a growth mindset, which can be hard. Really appreciating when you fail at something—because it is true, I think people do know this—that's oftentimes when you grow the most. But it's hard; it's never fun to fail. We can really think about our thinking and have a growth mindset and deliberate practice, which is when you see a challenge and think, "I failed at something, so how do I get better?"

A lot of deliberate practice focuses on like chess players or musicians or sports, because I think those are more obvious skills in which people can get better. They have a coach oftentimes, or a music teacher, or someone who's saying, "You didn't play that scale right, let's practice it, and this is what you need to do with your fingers on the piano." But I don't know that I really do that in dermatology and dermatopathology. I realized that if I think about that more—just thinking about my thinking, having a growth mindset, and doing deliberate practice—I really think it makes me a better doctor.

Oncology Data Advisor: Definitely. That's so important, and really interesting.

Dr. Ko: The podcast goes over those concepts because I think that we don't really talk about them that much. The last piece is emotional intelligence. I talk a lot about emotions. I'm Korean American, and growing up, we didn't really talk about emotions in my family. When I came home from school, my mom never asked, "How are you feeling?" Or "You look a little troubled, what's going on?" We never talked about things in that way, and we don't talk about emotions in medicine. At least I never learned how to do that.

Oncology Data Advisor: That's definitely important. What are some of the specific topics and subjects in this field that you talk about in the podcast?

Dr. Ko: Initially I thought it would just be a short season of a couple episodes, and I would talk about thinking about your thinking—metacognition and critical thinking as related to diagnostic work in medicine and patient encounters, a growth mindset, deliberate practice, and emotional intelligence.

I started off with emotional intelligence because Yale is pretty well-known for emotional intelligence. The president of Yale was definitely a pioneer in creating that term and the field of emotional intelligence. I had the opportunity to work a little bit and speak with and learn from David Caruso, who was a graduate student and a post-grad with Peter Salovey, who's the President of Yale. He is an expert in emotional intelligence, and he was willing to speak with me and teach me and just have conversations with me about emotional intelligence and how you can do little things on a daily basis that help you.

That's also why I think the podcast is helpful, because for one thing, I like listening to podcasts and I get exposure to things that I wouldn't have otherwise. It's nice when I'm washing dishes sometimes, or even if I'm going for a run and I can just listen; I don't have to be in front of a screen. Then I thought, "If I could cover these concepts that I think are important and also talk to doctors about how they use the concept or if they even know what it is, if they read a little bit about it and if it's important to them, that would maybe make a small change in the medical culture." That's what I was hoping.

Oncology Data Advisor: That's awesome. What are your goals for the podcast in terms of how the listeners can enhance their emotional intelligence or wellness by listening to it?

Dr. Ko: I think that we all have more power than we think, or at least I have a tiny bit more power than I think. When you feel like you're being confronted by a huge medical system, you can feel tiny. The medical system doesn't care about me as one doctor, and even when I'm a patient, the medical system doesn't really care about me as one patient. We're finite in that sense. But I think that at the same time, we don't fully realize how big an impact we can have on one other person or several other people who are directly surrounding us. That's what I mean by saying we have more power than we think we do.

A really quick example would be my kids. They totally have power over me in the sense that when they come home all dejected, having some problem with a friend or something, it really affects me. They have that power. There are concepts like emotional contagion and things like that, which I don't really go into, but I try to break it down so it's really simple. We are really affected by the emotions of the people around us. For me to be able to regulate my own emotions and also manage how I react to other people's emotions, I think is so important—just in daily life as a mom, for example, but also in that patient encounter.

When I'm a doctor and there's a patient in front of me, if I don't address any emotion at all, I've realized more and more that it's a very clinical encounter. The patient probably won't tell me any barriers, for example, that they already know regarding the treatment plan I'm giving. Or if they don't believe me for some reason, they're not even going to try to follow what I ask them to do. It's just poorer care, I realized. For me, since I started off having very, very little knowledge of emotional intelligence, I realized that just a little bit of attention to it could really change patient interactions a lot. I'm hoping that for doctors and hopefully anyone listening to the 15 minutes—they're usually 15 minutes or shorter—it can make a difference.

Oncology Data Advisor: Definitely. I think that's something that everybody can benefit from listening to—doctors and clinicians, anybody can definitely benefit from learning more about this. Anything else you would like to mention or share?

Dr. Ko: I will just say, because you mentioned wellness before, part of what the podcast covers is wellness and combating burnout, especially with COVID. I was listening to another podcast today called Fixing Health Care. They were talking about how health care was already in trouble before COVID, and COVID was like the match that just set it all aflame. COVID is to a certain degree controlled, and there are the vaccinations and everything, but the point of the podcast I was listening to this morning was talking about the idea of "I was taught this way, I thought this way for most of my career, and it's only recently that I saw the light or just started to have an idea that I was on the wrong track." We think we're supposed to see a medical problem that the patient brings, talk to them about it, give them a plan, and ideally fix it—a problem and a solution.

But what the podcast I was listening to today was saying was that it's really about the relationship. Most of the time, people really just need reassurance. There are serious medical problems, for sure, but people still need some degree of reassurance of what's to come and what to expect. It's not that there aren't big problems, but a lot of times for well-baby checks or yearly pediatrician checks, or even when women go to the gynecologist, oftentimes there's not a problem. Patients want the doctor, with their expertise to say, "This is okay," and to spend enough time to say it's okay. Before, I probably had more impatience—"Oh, you don't have a problem, let me just say bye to you and move on to someone who has a real problem."

That is part of the issue, because the more that patients feel, to a certain degree, dismissed when they're actually relatively healthy, they won't necessarily listen and do the preventive things that a doctor might want them to do. They also might not contact the doctor right away when there's a problem. I've had patients tell me, "Oh, well, I know I had this, but I know you're busy, so I didn't want to bother you." I say, "No, you should tell me right away. Maybe I'm not going to answer you in 30 seconds, but definitely let me know. Don't let a month, two months, six months pass, thinking I'm too busy. That's not right."

I think there's a prevailing sense that, "My doctor is too busy for this." It's true. I think especially with COVID, like I said, it was like this match that turned everything a flame—we don't have that much time anymore, we have even less time than ever before. My podcast definitely doesn't fix that, but I think it can help with maximizing the time that you have. That's what it's about, and that's why the thinking part is important. Being able to notice and regulate and manage emotions is important; I'm still not good at it. How do I manage my own emotions when I'm dealing with an angry patient's emotions in a very short visit and still accomplish what needs to be accomplished in that medical visit, especially if they have something serious? The anger in that case would be in the way, but if I'm skilled enough, I can get around it, and I can probably get around it relatively quickly if I'm good at it.

That takes the failing at it and the growth mindset, thinking, "Okay, I'll try again," with the deliberate practice. Especially now, sometimes I think, "Can I notice one emotion that I had in an interaction? Was I tired and stressed and honestly not that interested?" That's not good, so then I think, "Why did I feel that way? Did I not get enough sleep?" Then sometimes I just say, "Okay, well, did I notice one emotion of the patients? Were they worried? Did they seem happy? Did they also seem a little bit impatient to just get out of there?"

I think that noticing emotions helps me tailor a visit more to what the patient really cares about, and then it also helps the patient to pay attention to what I want them to pay attention to, because there's connection. We connect through emotion, so if I ignore it, there's no connection or a connection that's not as good.

Oncology Data Advisor: Well, this was really interesting to learn about. I'm excited to listen to more episodes of your podcast on all these topics. Thank you again so much for coming on today and talking about all of this.

Dr. Ko: Thank you, Keira.

About Dr. Ko

Christine Ko, MD, is a Professor of Dermatology and Pathology at Yale School of Medicine. She specializes in diagnosing skin biopsies and in caring for patients who are at high risk for skin cancer due to receiving immunosuppressive medications for organ transplants. Her research focuses on clinical-pathological correlation of skin cancers, including squamous cell carcinoma and keratoacanthoma, and mechanisms of carcinogenesis. Dr. Ko is passionate about enhancing clinical practice and patient care through cognitive psychology and emotional intelligence. She is the creator and host of the See, Hear, Feel podcast, which explores these topics that are also covered in her book, How to Improve Doctor-Patient Connection.

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Transcript edited for clarity. Any views expressed above the speaker's own and do not necessarily reflect those of Oncology Data Advisor.