More than three decades after he completed medical school, Michael Krasner M.D. will stop practicing medicine in December. The primary care physician, part of Olsan Medical Group, has chosen to dedicate his time to education and a film that explores professional identity in medicine.
A professor of clinical and family medicine at University of Rochester School of Medicine and Dentistry, Krasner is widely known for helping health care professionals learn to manage stress. He teaches mindfulness-based stress reduction to patients, medical students and health care professionals. Krasner is intrigued by the connection between the well-being of health care professionals and the effectiveness of the healing relationship.
His film is called “The Healer’s Journey.” A five-year project, with four years of filming, the documentary follows a group of medical students at the University of Rochester as they earn their degrees and balance their ideals and motivations with the realities of working in a hospital.
“They come in early with an amazing set of ideals and notions about medicine. … I think you never lose those kinds of ideals and motivations, but they get sort of buried sometimes and clouded over for a whole host of reasons,” Krasner says. “I have my own theories about them, but I didn’t want to be so attached to my theories. I wanted to get a beginning way of looking at how that happens to people.”
Pursuit of an idea
Krasner has a deep love for cinema. However, his only direct experience with the medium goes back to his teenage years in Southern California. Along with a fellow surfer, Krasner made a 25-minute film on surfing for an Explorers project on film and photography.
Four years ago, Krasner was bit by the film bug again, this time choosing to focus on his profession. After learning how to write a synopsis for his idea, he met Emmy-winning filmmaker David Marshall through a colleague.
Marshall, a driving force in the nonprofit Blue Sky Project, is known for films like “Hitching a Ride,” a journey on the Great Lakes, and “Autumn’s Harvest,” a look at AIDS and America’s migrant farm population. A recent film was “Her Voice Carries,” which tracks mural artist Sarah Rutherford’s discovery of heroic women who live and work in various Rochester communities.
“I like the idea of a project that takes a bit of time to come to conclusion and that’s the case with this one,” says Marshall, adding that it makes for a rich story.
“I just find it sort of fascinating to follow someone’s journey as they move from being sort of a layperson to being a professional,” he says. “And medicine has some unique characteristics in that regard because there’s an entire language, and we certainly have created a mystique and a culture around medicine as a society.”
Krasner, who has invested time and resources into the project himself, has been able to raise $100,000 so far. It will take at least double that amount to complete it to his liking, Krasner says. Blue Sky has a call out for support.
“The Healer’s Journey” follows the path of the medical student (from their first day), the physician in training and the practicing physician through critical experiences of training and medical practice over four years.
“These are people who (are) well-rounded individuals with a lot of intrinsic positive qualities, pro-social equalities (like) compassion, caring, intelligence, wanting to apply that to helping others, community orientation, service orientation,” Krasner says. “And I think it’s important for people to realize or see that even with all those qualities, when you become involved and part of a very large, very complicated, very complex system of health care, sometimes it’s challenging to maintain your values, to express those.”
Stephanie Brown Clark M.D., associate professor and interim chair of the Department of
Health Humanities and Bioethics at UR, finds Krasner has a good angle and calls it a thoughtful choice.
“Because the way that we train doctors and how they are impacted by the educations that they have, and how it shapes their values, and their goals of care, so much of that hangs on the education and the training that they have,” she says. “And so, to document that, and to see how they develop professionally and personally because of the teaching, but also how they respond to some of the ways that maybe we are not as successful as we should be as educators, is really interesting.”
Clark says that becoming a doctor is a profound experience. Typically, prospective students engage in the sciences and demonstrate a commitment to community through volunteering and other activities. Community work helps students interact with people and begin their understanding of the human experience.
The curriculum at medical school then switches into high gear—not only exposing doctors-to-be to anatomy, pharmacology and physiology but also exploring the intersection of science with human behavior, and social, political and economic systems.
“I think people will want to know what goes into that training as laypeople because these are the folks who actually will become future physicians who will be taking care of us,” Krasner says. “And I think it’s nice, it’s really helpful to kind of know what their journey has been like, and what are some of the challenges.”
Giuseppe Erba M.D.,professor emeritus at UR’s Department of Neurology, is enthused about Krasner’s film.
“Young people struggle much more with everyday life than the seniors do at this point,” he says of Krasner’s film. “So, the curiosity about knowing more about the journey, I think, was very well motivated. And I could understand why he would dedicate so much time and energy and now even closing his practice, just to do it full time. It’s fantastic. He has the capacity of really making an understanding of what is behind this journey.”
Clark says students are prepared for the rigors of practicing medicine—whether it is socioeconomics or understanding what happens on a hospital floor and in health care systems. However, she notes, perfect solutions to the complexities of some of these factors do not exist.
“I don’t know where the responsibility lies, if that should be a curriculum piece, which is already filled with scientific knowledge that is absolutely required and good practice,” Clark says. “But we also are trying to teach the human dimensions, the power of the relationship, the therapeutic relationship between the person who is suffering, the patient, and the person who is providing the care.
“But even that model is a simplification because it is no longer a single physician. It’s a team of clinicians; some of them are social workers, some of them are chaplains and then there are multiple teams that are looking at the same patient and see very different things.”
Like all other professions, the work of medicine, she observes, is deeply human.
“So it is, by its very nature, imperfect and uncertain,” Clark says. “And sometimes the way that students come in very idealistic … and the way we teach them is, in an ideal world, ‘this would be the way that you deliver patient-centered care.’”
Students can ace exams, but helping with patients in the way physicians want to most often has nothing to do with science. It has more to do with insurance systems and social determinants of health—where patients live, work and play. Though students are given tools to deal with these challenges, there are systemic complexities that can frustrate and disappoint these budding physicians.
“Then the work is to try to deliver the best care that you can,” Clark says. “For a lot of physicians, it doesn’t feel good enough, not for the patient, and (doctors) don’t feel that they’ve been good enough, either. So, it’s really complicated.”
Portrayals of doctors in the media don’t help. They are larger-than-life heroes who are brilliant and exhibit little emotion. Flat characters, as Clark calls them.
“That is simply not true,” she says of such portrayals. “There are certainly all kinds of varieties, but there really is true care and care is really deeply human, it is relational.”
She adds: “The drive to help is such a strong one in this profession and sometimes (the public sees) physicians in a very different way than what I see on the ground of people feeling really sad, or really angry or really frustrated, or really elated.
“There is so much that is extraordinary and remarkable. Patients will say something so profound that you feel you can’t imagine a better profession, lots of surprises in good ways that make you believe in grace and engender humility and hope,” she says. “That’s not science that I’m describing, (it is) what it is to be a human being trying to help someone who is suffering, in whatever ways they can.”
Erba says many patients come to idolize their provider. He believes it is important for patients to see human frailty but not interpret it as weakness.
“I think that it’s important that they know that doctors get burned out like anybody else and recognize, hopefully, the causes of this,” he says.
Erba points to technological burdens during a visit, for example. At the tail end of his practice, Erba recalls how he had the luxury to spend time with patients, as he supervised medical fellows in the clinic.
“I must say that those five minutes (with a patient) were so rewarding, and I was hoping that the fellow who was busy working with the e-record and so forth, he would see and appreciate how important that was for me, not only for the patient,” he says. “He was just doing his job otherwise, so I was free in those five minutes that I could be mindful and be communicating. I think that’s something that has to enter in the medical education.”
Krasner hopes that viewers will be able to see that humanity. Often, patients assign high authority to medical practitioners and expect right answers, with little room for error, to their health problems. It is not uncommon for students and trained doctors to suffer from imposter syndrome, a fear of being exposed as a fraud despite competence.
A recent study by Stanford University medical researchers found that imposter phenomenon experiences are common among U.S. physicians, and they have more frequent experiences of disappointment in accomplishments than workers in other fields. Such experiences are associated with increased burnout and suicidal ideation and lower professional fulfillment, the study states.
Medical students are trained for perfection, Krasner observes.
“But if you take perfection too far, the need to have it just right, you wind up really having trouble with uncertainty,” he says. “You have a great deal of difficulty dealing with uncertainty because you want to get the right test and the right answer. It may drive test-ordering behaviors.
“We’re also expected to be very compassionate and empathic. Well, you know, you can be so empathic and compassionate that you ignore yourself, you don’t take care of yourself and your loved ones, you wind up actually overworking. Workaholism is a problem.”
The pandemic exposed some of these strains on doctors, who were front and center, tending to patients as the country went into lockdown. The Physicians Foundation’s 2022 Survey of America’s Physicians found that the state of physician well-being remains low. Six in 10 physicians have felt inappropriate feelings of anger, tearfulness or anxiety while a third have felt hopeless or that they have no purpose and half report withdrawing from family, friends and coworkers.
Dealing with uncertainty
Krasner and Marshall filmed through the height of the pandemic. At first, they mulled the idea of a dry run—filming with masks felt more like a period piece—and they, like most others, expected COVID to last six months.
“(Marshall) and I both had fallen head over heels for the students just getting to know them,” Krasner says. “Then as time went on, and it turned out the pandemic dragged on, and this thing became much more embedded in our culture, with masking and all that stuff, we just realized (that) this is kind of an opportunity to see how also how medical education adjusted to these challenges.”
Then, doctors and nurses became even bigger heroes. This has been described as a “risky myth” by some researchers who say it could exacerbate health care providers’ emotional need for perfection and add fire to imposter syndrome.
“Some part of our training has to train us to be comfortable with uncertainty, to know that our knowledge is limited, to be able to work in teams and to create psychological safety within teams,” Krasner says. “All these things impact how students and trainees are rewarded. You’re rewarded for getting the right answer. You’re rewarded if you’re exemplary … but we have a great deal of difficulty when things are uncertain.
“Frankly, uncertainty is more common than certainty in our work. We’re dealing huge amounts of uncertainty all the time. If you think about it in medicine, you’re basically looking at the arc of human life from birth to growth and development, aging, and then death. … We are placing ourselves as if we are in the middle of that, we can stop that arc from happening. You can’t, it’s going to happen no matter what.”
He hopes the film will show the transformation that students undergo during their course of study. The crew now is going to follow the students in their most intense year yet—when they meet people who are hospitalized with severe illnesses.
“There’s an exponential increase in learning on all levels from physical skills to cognitive load to all the content,” Krasner says. “So, they’re probably putting in 70, 80, 90 hours a week in education right now.”
In addition to educating the public about the training of physicians—the subjective experience and the journey for the physicians themselves—Krasner hopes the film will help those who are considering the profession.
“It will also be a nice reflective piece for people who practice medicine,” he says. “There’s a connection (among) healers that’s multigenerational. It’s like a thread that runs through all of us whether we train 15 years ago, or 10 years ago, or right now.”
The film could make its way into instruction, offering insight to the next generation of doctors. Tremendous responsibility lies on the shoulders of educators, Erba says, to prepare students for a changing landscape of medicine, including fast-moving technology and shifts in patient expectations.
“I believe that the concept of mindfulness, which is really curiosity about the human condition, in general fits very well into this exploration,” Erba says. “So, who else better than Mick to do this? I’m very highly supportive of what he’s doing. And I think this will be breakthrough work, and hopefully will be publicized enough, reflected upon from many points of view, and it certainly has the potential of leading us to some breakthroughs.”
Adds Clark: “I think this really is a wonderful tool not just for generating other conversations that you and I will never hear, or even reflections that sometimes allow people to say, ‘I felt exactly like that,’ and then it’s surprising how many people will say ‘me too,’ in ways that without a film like this, they may not have a chance, they may hold it inside, and we know what that has done—how damaging that can be for anyone.”
For his part, Marshall relishes working on the project and is looking forward to continuing the journey. He is impressed by the process of becoming a physician and says the system has created the right template to build a doctor. However, he wonders if the bigger question is, where are these smart, empathetic, young physicians going? Does the environment reflect who they are?
“If they’re banging up against the wall, then they’re going to be unhappy,” Marshall says. “But my bottom-line position is that these are incredibly smart, really gifted young people. So, you’re getting the very best of the best going into medicine.”
Smriti Jacob is Rochester Beacon managing editor. Data visualization by Jacob Schermerhorn, contributing writer. The Beacon welcomes comments from readers who adhere to our comment policy including use of their full, real name.