Artwork for podcast Qiological Podcast
010 Investigating Causes and Conditions in Clinical Practice • Greg Bantick
Episode 1012th December 2017 • Qiological Podcast • Michael Max
00:00:00 00:37:35

Shownotes

In this episode we reflect on the burden and privilege of a clinical practice. How we grow into it by using a blend of our objectivity and subjectivity. And how mindfulness and a curiosity about our own internal landscape all help to inform our clinical work and development as a practitioner. We look at how learning the medicine not only helps the patients we see, but provides a deep benefit for our lives as well. And how to stay  present in the moments of failure in such a way that we can gain a deeper clarity about our work. Listen in for a discussion of how to gain a balanced sensitivity that helps us to navigate the challenges of learning from clinical experience, and support us in moving beyond the comfort of reliable skills when they don't prove so reliable.

Head on over to the show notes page for more information about this episode and for links to the resources discussed in the interview.

Transcripts

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The medicine of east Asia is based on a science that does not hold

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itself, separate from the phenomena that it seeks to understand.

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Our medicine did not grow out of Petri dish experimentation

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or double blind studies.

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It arose from observing nature and our part in it.

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It comes not from the examination of dead structures, but rather

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living systems with their complex mutually entangled interactions.

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Welcome to chill out.

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I'm Michael Maxx, the host of this podcast that goes in depth on issues, pertinent

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to practitioners and students of Chinese medicine, dialogue and discussion have

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always been elemental to Chinese medicine, listened into these conversations with

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experienced practitioners that go deep into how this ancient medicine is alive

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and unfolding in the modern clinic.

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Hello everybody.

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Welcome back to.

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Qiological I'm really happy to be having a conversation today with Greg . Greg

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is a long, long time practitioner who currently lives in Australia.

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He spent a lot of time in the states.

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He has been very involved with our profession for a long time, a teacher

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and school administrator and advisor for many, many years and a practitioner

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who's been at it for decades.

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Today, we're taking a look at, we're taking a look at the learning of

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complex subjects, looking at what an older practitioner might have to say to

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their younger self and how we navigate through those moments of learning.

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As we grow beyond our own models of the world and start to be able to see and

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understand new things in the clinic.

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I'm really delighted to have Greg here, Greg, welcome to geologic.

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Thank you very much, Michael.

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It's good to be with you.

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And I appreciate you putting together these programs.

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I think they're very useful.

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Thank you.

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It's been fun for me.

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I always learned something sort of insatiable that way.

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So delighted to have you.

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You know, one of the things that I've noticed about Chinese medicine in the,

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in the time that I've been doing it is that while there are, in some ways,

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some simple concepts, some very simple and flexible concepts, but they bespeak

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and underlying complexity in many ways, our medicine deals with all kinds of

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complexity, we try to simplify it and in service of learning it and getting some

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mental model so we can orient ourselves.

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But really it takes at least for me a lot of time to learn how this stuff works.

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And I'm curious to hear from you your thoughts, especially for

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newer practitioners, how do you approach the study of complexity?

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Especially complex systems, like the ones like human beings and illness

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and health and all the things that we deal with every day in class.

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It's a good question and a very broad or deep question.

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I think I approach the study of Chinese medicine, maybe a

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little differently than that.

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I was curious, the area of complexity in learning that was of most interest to

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me was my life, how to live a good life.

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What does that really mean?

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And I think I saw in Chinese medicine in the early days, a way to explore

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what that means, but also a very practical application of what you

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were learning in the service of others in being able to help others.

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So, for example, there's an idea that I think we read repeated Lee in

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the early texts, like the Shanghai lawn or the Ong be and aging.

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If you were to expose yourself to something or to do something, then

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there may be a consequences of.

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We now in the nudging, it says settings, like if you do this in one season or

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the conditions are such the external conditions as such in one season,

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then it's likely that these problems may emerge in the following season.

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So we get this idea, which kind of makes sense, particularly as a beginning

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student, that what we eat, how we sleep and exercise all of these things.

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Lead to developing certain things either for the better or for the not so good.

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That is kind of like, uh, we, we might have some initial

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understanding of that in class.

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And then over the years you start to keep revisiting these apparently fairly simple

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statements or ideas and see more and more depths in them so that when you're seeing

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patients that have chronic complicated diseases, You can start to see back to

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all of the, the conditions out of which that current situation may be coming.

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But I think that kind of, that takes time to have that sort of perspective

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even about our own life, but certainly about the life of our patients as well.

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So little by little, that to me has been the way that it's unfolded from.

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Being an American, maybe just being a human being, actually, I don't know.

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And wanting to get something.

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And especially wanting to be able to be of service to my patients.

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It's so inviting to think that I can get something, I can get it down.

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I can be effective almost immediately.

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There's all kinds of workshops that, that will get sold.

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As you're going to go back Monday morning, you're going to have these skills.

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You're going to be able to deal with these things.

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I mean, it's great to have those, and it's great to be exposed

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to some things that can help.

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But what I'm looking at here is these things that take months, years, maybe

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to really start to get a handle on it.

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And guess the question that I've got is how do you keep yourself going in

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the midst of that, especially when you don't have that sense of mastery

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that can only come through what you were talking about with iteration and

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with the passage of time and practice.

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I wouldn't put myself in the category of mastery of anything

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except perhaps laziness.

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But, um, I think you're well aware, Michael, that in our tradition were

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kind of encouraged to in our education, our initial education, it's good to

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be exposed to a variety of different, shall we say, schools of thought.

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It's sort of approaching things where you need to acquire some basic technical

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skills of interviewing of power patient.

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We need to point location.

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We need to memorize a lot about individual Herb's and formulas and things.

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There's these kind of building blocks.

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And then I think we're also encouraged to stick with one way of thinking one school

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of thought for a while, until we develop sense of familiarity and ease of use.

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So we can use it reliably for a, a wide variety of different conditions.

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And then to maybe take on something else, another system, another school

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of thought that may fill gaps.

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And I think that's a good approach.

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I think what's missing in our education is training of a world developed, balanced.

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Subjective sensitivity, like the phrase subjective sensitivity, because I

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think that what keeps us going year after year is that we're developing

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we're noticing developments, not just in our capacity to help others.

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But we're noticing that the way we're using the medicine, the way we're

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training ourselves is benefiting our life.

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Then it's kind of like, it has an onward leading quality to it, as

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opposed to something that's effort fall.

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And I have to keep pushing and shoving myself to do things.

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We see a benefit.

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The benefit to us in our own personal lives is obvious.

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And so that has its own motivation.

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Its own.

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It's sort of like we get marinaded by the word.

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I only with a particular kind of effort, I would think that we see in all healthcare

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practitioners that there's a level of burnout and compassion, fatigue, and

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also a high degree of secondary trauma.

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From hearing difficult stories or being with patients that are really

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suffering or being in a profession that's still socially marginalized.

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It's not an easy profession to be in from external forces on us, but

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also we often don't treat each other.

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So.

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So, how do we kind of negotiate the burden and the privilege of being in

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clinic and not succumbing to kind of habits just doing the same thing over

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and over again, or to watch out for becoming a bit cynical or burnt out.

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And I think what we need.

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As part of our education, but part of our ongoing development as a

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practitioner is if we talk about external conditions, for example, if we're

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exposed to a cold, then we get sick.

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So what are some of the internal conditions that we can cultivate

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that might lead to a greater sense of ease with the work that we do?

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And so I think that things like, um, being reflective on our.

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Uh, and curious about our own internal landscape.

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What is it that I'm thinking, how am I coming to these decisions?

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Why am I having these thoughts about this particular patient?

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W what's my discomfort being with this person?

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Why do I prefer being with them?

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And I have a bit of an aversion to that other person.

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Why do I spend more time with this person?

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I can't wait to get out of the room that other person and these sort of subtle

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background influences to how we work, I think are really important in order to

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not get overwhelmed in a kind of way.

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It's important to be noticing these things and learning how to work with.

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I hear you say this in the first thought that goes through my mind is have

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you been standing in the corner of my clinic and watching me the past few

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months, these are exactly the kinds of things that I've been thinking about.

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This is probably about 42 years.

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And the other day I was getting some needles ready to use and I was

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explaining it was a new patient.

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And I was saying, I'm just, you'll hear me rattling around over here.

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I'm just getting some needles out.

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We use these single use.

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They're all disposable.

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Natals things that I've said quite a few times now.

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And I've unwrapped needles quite a few times over those many years.

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And it's very easy to take a very simple act, but something that we do over an

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either as just boring or something to skim through, or to get through, as

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opposed to, um, always see, I can help my patient even just by explaining

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what I'm doing, letting them know that this is what's going on, asking

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them, you know, kind of inviting them.

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To be involved a little more involved in the relationship that we're

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developing and that keeps every little moment of a clinic day fresh.

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You know, there's always something that might emerge out of it to not just see it

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as a gosh, you know how many times I've done this frigging needle stuff, you know,

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how many more times am I going to do it?

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I think these are the sorts of subtle things that discouraged

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us from continuing a lifelong.

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When I hear you speak of it this way, it sounds like something even

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as small as unwrapping a package of needles is a moment to be mindful,

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a moment to be attentive to our patients, especially a new patient.

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They're hearing noises who knows what's going through their mind.

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They're probably a bit nervous and you know, how can we take this moment where

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we're getting ready to do a needle and make that easel for the person that we're.

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Even though we've done this thousands of times or tens of thousands,

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maybe for you millions, it's always fresh for the person that's with us.

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Yes.

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And it is really for us.

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If the learning of complexity, if the learning of being a good doctor is to

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learn about life and how people get sick and how they get well, again, Then

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to wish away in moments like washing our hands yet again, or unpacking

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needles yet again, is to wish your way, at least a part of our life.

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And that that's kind of like setting up a condition or conditions for

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in attention or for just getting through the day or for, you know,

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looking forward to lunch, as opposed to just being with your patient.

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I want to come back for a moment to a phrase that you use.

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Cause it really caught my attention, subjective sensitivity, and the

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reason that it catches my attention is because so often in the practice

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of medicine, you know, because we get the influence from Western medicine

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and you know, let's, let's face it.

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We live in a, in a world that is apparently doula.

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We often have this idea.

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At least I often have this idea that I'm supposed to be objective about things and

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you know, the best medicine is objective.

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And yet I also know from experience that my own subjective landscape often

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holds vast amounts of information that can be helpful if I can gently access

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it and then use it with the patient.

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I'm curious to hear from you more about this subjective sensitivity and how

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better to cultivate it beyond what we were just talking about with the mindfulness.

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I mean, maybe there's nothing else to do except the mindfulness, but maybe

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you've got some other ideas here.

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We've kind of gone in this direction of valuing or preferencing objectivity.

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Preferencing rationality, a little too far, so that what's considered

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to be the most reliable or valuable information is the most objective as

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in this is what's on a blood test or this is what's in a scan and so on.

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And while those things are useful, we know in clinic that they're not always

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accurate, often inaccurate or misleading, they don't give us the information.

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We need to arrive at a diagnosis.

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So all of us as humans, including our best scientists are left with

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this subjective side of ourselves.

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And I think our modern kind of scientific materialism has gotten

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good at looking at and measuring.

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Other, but it hasn't turned its lens back on the measurer or who is the examiner.

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And I think our medicine offers us that opportunity because it grew

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up in an age before that sort of a fascination with objectivity.

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But then again, subjectivity just doing what we feel like doing.

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Being at the whim of, you know, this thought that thought this feeling and

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so on is also tricky and maybe not very useful both to ourselves in living in.

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But also towards our patients.

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So I would kind of say that what we need to do is develop a more objective.

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And that's what I mean by balanced, sensitive subject activity.

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We need to really know our subjectivity.

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I don't think this is new to practitioners when you're feeling the.

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How do you know what you're feeling?

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You know, our teacher can say, this is what I think it is, but

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still you have to come and go, how do I know what this represents?

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What is this?

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That I'm feeling that knowing is also influenced too, to a degree

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by how we're feeling and thinking, if we're going all on, my teacher

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says, this is a worry pulse, and I can feel these particular quality.

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We might be acquiring some experience in that way, but then

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part of our subjectivity is also our probably never get this.

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Everybody else in the class is probably doing well at it, but I'm not, I'll be

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the lonely one that doesn't really get it.

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And we have our own personal kind of subjectivity or things that unstabilized

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us that make us feel shaky or doubtful or the opposite over and flighted or.

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So, how did we get to know all of these factors, not just the qualities

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of the polls, how do they match with these particular sets of symptoms?

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What does a body look like that has this sort of pulse and developing those sorts

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of skills, but then also the internal skills of what is my subjectivity?

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What are some of the things that influence it that make it more

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soft and open and available?

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What are some of the things that I'm doing, uh, thinking, feeling that

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tend to make me close down or make me judgmental or a little distant

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or pull back or being critical.

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In my opinion, I think we need to know these things, to develop an objectivity

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about that subjectivity, to be able to learn, to use it well for it to

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be more reliable, more predictable.

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It sounds a bit like a Zen koan using our objectivity to develop our subjectivity.

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I mean, it makes sense.

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Mostly it sounds like a practice, a continual coming back to and exploring

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and exploring and exploring, which brings me to my next question about

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learning from our clinical mistakes.

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I remember when I first went to Chinese medicine school, one of our teachers,

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one of our Chinese teachers actually started off telling us a story of

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a case that he really screwed up.

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And at some point got back on track and the patient got better.

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And of course we love these stories, right?

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They're great stories.

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The rub comes in is when we're in the middle of that experience.

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Holy smokes now it's not working.

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And all the judgment kicks in and all the, oh my God, what do I do?

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And I think it's lovely to have the idea that, oh yeah, I'm going to learn

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from my mistakes, but what about keeping ourselves together in the moment where

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it's all just falling apart and we've got to put it back together again.

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What are your thoughts about.

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Well, I've done it so many times.

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The first few hundred times it was really painful and difficult,

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but I think it's inevitable that we're going to misread something.

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We're going to misdiagnose something we're going to give too much of the right

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thing or not enough of the wrong thing.

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And we make mistakes.

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How to cope with those things, I think is just to be as honest

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and as kind towards ourselves as we can, that this is inevitable.

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And then too, when we talk about conditions, how did it kind of come

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about not as a theoretical exercise, but how did my diagnosis come about?

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What were some of the things that influenced my diagnosis?

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How did I get there?

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And then how did I make the choice of.

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Treatment again, we're going back to the capacity to reflect.

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And then there's usually at least in my case, a whole bunch of feelings come up

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as well as gosh, you know, I gave too much of that and I got a stomach upset and I

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was sat on the toilet for a few hours, but then there's also the personal side again

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of, you know, I shouldn't have done that.

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My teacher would never have made that mistake and all of these

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sorts of maybe self criticism.

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The very painful part of, of our mistakes often, or we may have a patient

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as, uh, is really upset with us and is brave enough to tell us, rather

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than just go away is brave enough to confront us and point something out.

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I think in the moment, sometimes these things are just overwhelming

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and we're just struggling to kind of maintain some sort of equanimity, but

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maybe over time as we've practiced.

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We see that these things are inevitable and hopefully not big ones, you know,

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that we get up, we do actually improve and we have less and less blips.

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But in that soup of trying to more, maybe like a being knocked over by a

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wave, we can also develop some sort of sense of balanced sensitivity.

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This is what I'm feeling.

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This is what's going on.

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What do I need?

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How do I help myself through this?

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How do I take care of myself?

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And if the patient's there with you, how do I also look after this other person?

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We're going through this thing together.

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How do we care for each other?

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What's coming to mind is what you said a few moments ago about using

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that objectivity to investigate the subjectivity as well.

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And in this case, not just the patient and what happened, but how we got

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there, put ourselves in that system were, were a part of the treatment.

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Yeah.

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And to be able to see, oh, how I came to this?

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Oh yeah.

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I see how I saw this.

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I saw that.

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I thought I mistook this for that and gave them this herb.

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And now here we are.

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Well, I guess we know something new now.

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Exactly.

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And I think just being honest with our patients and where appropriate to

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explain the process of how we got to, where we got is very helpful for them.

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And it's also part of looking after ourselves taking care of us.

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Not to try to be something other than ourselves and we ourselves make mistakes.

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We'd say the wrong thing.

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You know, we're a bit short.

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We're a bit Curt.

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We're doing this all the time.

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It's just it's okay.

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Let's just try to minimize the harmful effects of our work.

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I want to, um, shift this just a little bit.

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I know that there's a lot of listeners to the show that are fairly new practitioner.

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At one point you were a new practitioner.

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At one point I was a new practitioner.

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Sometimes I feel like I go into work every day and I'm still kind of a

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new practitioner because who knows what I'm going to face in the day.

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But I'm curious to know what sorts of things well, let's,

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let's make it personal here.

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Any advice that you might've had for you 40 some odd years ago when you were

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beginning, this practice things that you couldn't possibly see from the place of

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beginning that at this point, Are clearer to you now that you've spent decades doing

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this, what would you have to say to that?

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Younger Greg about beginning and engaging a practice.

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By way of brief biography.

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I spent the year of 82 half in a Zen monastery and half in China where I did

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one of the world health organization, three months programs, and then

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stayed on for a couple more months.

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And really that year was deciding for me, do I want to be a mark and

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live in a monastery or do I want to be a practitioner I'd already been

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in practice about seven years and had helped establish a school in

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Australia, in Brisbane at that time.

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So I was kind of trying to decide, but I decided at the end of

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the year that I would leave the monastery, but my practice would be.

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Training hall that they were, I would continue to train myself into developing

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this sort of balanced sensitivity, but also where I would bring that

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learning to the way I practice medicine and to what I would teach

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or impart or share with my patients.

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So I may not have gone on if I'd known what I know now, isn't that, so often

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the case it's difficult, at least that that particular path has been difficult.

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It's not been hugely financially rewarding.

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It's difficult in the way I have a relationship with a large number of

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my patients is a very intimate one.

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And so I hear a lot.

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Of stories.

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A lot of which are very difficult or hard to hear, and that has a

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tall in a way, or it's a goad to my own personal practice, but it makes

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quite a challenging clinical life.

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I also am really genuinely interested in and curious about our medicine.

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It's so vast.

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It's so rich.

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It's so.

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Which makes it so incredibly wonderful and also at times just overwhelming it.

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So am I ever really gonna get good at this?

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You know, is there, is there such a thing?

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So sometimes that can be conditions for doubt.

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So I would, I guess I would encourage my younger self that it's going to be.

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It's going to be very challenging, very difficult.

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It might push you at times to the limits of what you think your capacities are,

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and it will be an ongoing inspiration.

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There's wonderful people in your profession that you

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can, you have as colleagues.

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And we have this rich tradition of ancestors that we can also rely on.

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Not least it's incredibly useful to alleviate the suffering of many, many

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people, simply helping somebody with a sprained ankle without medications

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or helping them through their last days of their life with Chinese

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medicine and everything in between.

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To me, it's a very difficult and challenging and

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wonderful way to spend a lot.

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I would raise a glass and toast you to that.

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That's yes, I absolutely agree.

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And you know, I suspect a lot of our listeners have

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that experience too, perhaps.

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That's what has drawn them in.

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And if that hasn't drawn them in that I suspect that's what keeps a lot of us in.

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Is this very thing that you're talking about here, Greg?

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I suspect it's human nature for us to grab it.

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The thing that's worked in the past, we go for the tool.

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We attempt to replicate the success that we found before.

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How can we keep learning and pushing beyond the usual stuff that works?

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Our greatest impediment to inexperience of the divine was

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our last experience of the divine.

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How can we stay fresh to all of them?

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Ah, I like that quote, Mike, I think if we look at what we mean by tool,

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there's the tools of our trade.

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Like our need also now herbs and so on and our skills, our diagnostic skills

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and those, I think we can keep fresh by paying attention, to not letting

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ourselves just become habituated.

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You know, as we've said, I'm just opening up yet another packet of

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needles, but what's it feeling like, what am I, where am I.

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What's going on, how's my patient at?

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What are they looking like as I'm doing this?

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So that's one way of doing it to me.

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I think one of the most kind of inspirational is that our

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body and mind is our tool.

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And so how are we using that?

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What is, what actually is that by extension, to be curious about the

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patient's tools, their body and mind.

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Yeah.

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Mine's or human mind is fascinating.

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And to really sit and look at and listen to and touch another human being and their

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mind is, um, just endlessly fascinating.

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It's very hard to be bored when we're really curious about what's

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going on for somebody else.

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So I think that sort of approach comes with an onward leading.

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Energy, as I mentioned before, I think we need to learn from repetition.

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You know, that recently I've been trying to start these some Chinese

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calligraphy and my teacher who I think is a very good teacher.

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Gave me Keisha, you know, like a printed script of, um, a very

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famous calligrapher and said copy.

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And so I'd copy a whole bunch of them and trace them and just try

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to replicate them and he'd keep pointing out how I had missed things.

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And what he was training me to do was to be able to see all of the strokes,

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all of the nuances of in every stroke.

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And then to be able to reproduce that with a brush.

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Some people go well, it's so boring and repetitive.

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And yet it's not.

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When I talk to my fellow classmates, I look at a whole sheet of their work

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and they go, you know, there might be dozens and dozens of strokes on

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there and they go see these two here.

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I think I really got these good, but there isn't a sense of, I

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failed on all the others, you know, slowly, I'm getting it slowly.

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It's coming together.

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I'm getting a sense.

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That's sort of spirit in our work is the antidote to habitual ways of doing

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things to boredom, to dissatisfaction, you know, after this conversation, I

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don't think I'm going to be able to open a package of needles in quite

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the same way I was doing it before.

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Well, good.

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Greg, are there any closing thoughts that you'd like to share with our

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listeners before we wind this thing down?

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I guess when, when I reflect back over the years sparkle and the thinking of all

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of the people that I've been associated with, both in, in the profession or my

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teaching colleagues, all my colleagues, all the many students that I've

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had some engagement and involvement with quite a few patients by now.

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I feel very grateful that.

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All of these interactions have really contributed so much to my life to be

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involved in this profession and to be able to do what I've done has led to a very

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creative and interesting, frustrating, and annoying and difficult life.

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So for those that are thinking about giving it a go find some good mentors

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and gently weigh it in, it's a wonderful way to be of use to others.

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And.

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Again, Greg, thanks so much for being on the show today.

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