EP93: Dr. Jules Lipoff on why medicine needs creativity

Learn how it is that Dr. Lipoff and I ended up connecting to have this conversation! (for the impatient ones [like me], find this info at 5:44). Dr. Jules Lipoff, MD is a dermatologist practicing in northwest Philadelphia and Clinical Associate Professor (Adjunct) in the Lewis Katz School of Medicine at Temple University.  He runs a PRIDE clinic (PRoviding Integrated Dermatology for Everyone) serving both LGBT patients and patients living with HIV for every major health system and LGBT center in the Philadelphia area.  He also serves as senior subspecialist telemedicine consultant for Medecins Sans Frontieres and writes as a columnist for the Philadelphia Inquirer.  In addition to his over 100 published academic articles, his creative work includes podcasts, screenplays, short films, medical consulting for television, and beyond the Inquirer, his writing has appeared in The New York Times, The Los Angeles Times, Slate, Vox, The Hill, STAT News, and JAMA.

Transcript

[00:00:00] Christine Ko: Welcome back to SEE HEAR FEEL. Today, I am excited to be speaking with Dr. Jules Lipoff. Dr. Jules Lipoff is a dermatologist practicing in northwest Philadelphia and Clinical Associate Professor (Adjunct) in the Lewis Katz School of Medicine at Temple University. He runs a PRIDE clinic, and the PR in PRIDE stands for PRoviding, and then I for Integrated, D for Dermatology, and then for E, Everyone. So PRIDE clinic serving both LGBT patients and patients living with HIV for every major health system and LGBT center in the Philadelphia area. He also serves as senior subspecialist telemedicine consultant for Medicin Sans Frontieres and writes as a columnist for the Philadelphia Inquirer. In addition to his over 100 published academic articles, his creative work includes podcasts, screenplays, short films, medical consulting for television, and beyond the Inquirer, his writing has appeared in the New York Times, the Los Angeles Times, Slate, Vox, The Hill, STAT News, and JAMA.

[00:01:06] Welcome to Jules.

[00:01:07] Jules Lipoff: Thank you. It's really great to be here. Really. I'm excited to be invited to talk to you about creativity and stuff. 

[00:01:13] Christine Ko: Can you first share a personal anecdote about yourself? 

[00:01:16] Jules Lipoff: Back in college, I joined a humor magazine, and I also ended up getting to intern for the Onion and Mad Magazine as a part of getting into that world and getting interested in writing. I even took an improv class at the Upright Citizens Brigade, and then I went into medical school because I was after all biochemistry major, and that was the original plan. I struggled to figure out how to integrate, how to connect both sides of my person. In medical school and then in residency, I worked on a project in Uganda where we supported a population with a lot of HIV and tuberculosis. I developed a teledermatology program for that population later, and so I had this expertise in telemedicine. My favorite TV show at the time was Game of Thrones, and there is this fictional skin disease in the show called greyscale. And it struck me, what if I tried to actually diagnose this? What is the cause of this? How does this really make sense? What if we just took it completely seriously? An editor at Vox was really interested, and they published this article on what is greyscale? My thesis is that it's predominantly based on misconceptions of leprosy.. This article got published and got tweeted by one of the producers on the show later. This single article is probably still the most read piece of writing I've ever put out there, right? It really made me change my frame of mind about what's valued and what would be impactful and what I want to spend my time on. And I think that is important and maybe indicative of how I became more interested in writing things like screenplays or making short films or pursuing things like consulting on a TV show because I wanted to not just be in an isolated academic tower, I wanted to engage and have a conversation with the public at large. 

[00:03:03] Christine Ko: Yeah, I like it. The public at large. Can you talk about why you think creativity is needed in medicine? 

[00:03:09] Jules Lipoff: Yeah, so I think medicine as a whole is really the opposite of creative most of the time. It is very challenging field. But I would say it's also an incredibly risk averse field. Once you enter medical school, you get on a train and you advance to the next level every single year. Basically, if you don't screw it up, you're going to go to residency, fellowship, what have you, and have a career and it'll be totally fine. Yeah. But I don't think that prepares you well for challenges, for rejections, for failures, for really growing. And I think it also makes us be fixated on external validation in certain ways. What is the next carrot that we can achieve? And it could be different carrots depending on the type of career you have. It could be more publications. It could be the next grant. It could be a fancy car or a house or something like that. But what happens is that when you get that thing, that sort of feeling of being unfulfilled is still there. As we get accustomed to certain things that we have accomplished, and we see other people similarly doing certain things, it's not good enough anymore. We have to keep driving, and that ambition can often make it difficult to continue to feel happy and successful, right? Maybe it's corny to say, but I really think it's, the journey, not the destination, and creativity can get you thinking more intrinsically about, how we practice. Laurie Santos has this podcast Happiness Lab about how what we think is going to make us happier is not necessarily. Like if you say as an academic dermatologist, I will only be happy and have a successful career if I get a paper in New England Journal. You're saying there's only one way to be happy, and every other way is a failure. You're setting yourself up for problems. But if you set up a career where you're just following your own intrinsic passions, and there's probably a hundred ways that you could find success, you really can't fail. So it's about really being flexible and creative and not being beholden to the expectations of other people of what is success that will free you to, I think, have success and happiness, not only in your career and in life... 

[00:05:13] Christine Ko: You mentioned failure before. Do you have ways to embrace failure? 

[00:05:18] Jules Lipoff: I wish I could say failure is always easy to embrace, but I think with time I've tried to find strategies to deal with it. When someone pimps you on rounds or asks you an unknown and you get it wrong, it's really hard to see that as a positive, right?

[00:05:36] If you try to reframe it, you could say, if you get something wrong, you have identified something you don't know. And that's an important thing. So it's a matter of spinning it. 

[00:05:44] Like our conversation leading to this podcast came out of a rejected paper at JAMA Dermatology. So how to spin that into something positive? We connected about talking about stuff, and there's a new connection, new opportunities. 

[00:05:58] There's this book, talking about our creativity that I like, that had this anecdote in it. It's this book art and fear. I like it because it talks about how we think about failure and how we grow and what we learn. Supposedly, I think this is supposedly at Stanford. There is a ceramics class. They wanted to do a study. They said, we're going to split the class in half. Half of you, the grade will be simply based on how many pots you make this semester. If you get 40 pounds of pots, you will get an A. 30 pounds, a B. 20 pounds, a C, and so on. Doesn't matter how good it was, just how many they did. Or how heavy. The other half of the class, they said, listen, You will be judged based on the quality of a single thing, whatever the best thing that you make. That's what we judge. And so they proceed through the semester. And at the end, they look at all the pots and blinded, evaluate the quality. And it turns out the best quality pots came from the group of people who are incentivized just to make a lot of stuff. Why would that be the case? To me, it's not that quantity is better than quality. It's that quantity leads to quality. The people that had one thing would fuss and fuss on the one thing and try to get it perfect. But, they didn't learn because they weren't failing, right?

[00:07:12] Whereas the people who were just going through the process, just churning stuff out, didn't care, didn't fuss, didn't get too cutesy about the things. They learned how to deal with the mistakes that came along, and then they just happened to learn how to make things better. I think this speaks to how, perfectionism can drive us towards excellence, but it also can be pretty counterproductive. Really just trying to learn by doing things, failing, and just, we all have to fail, so just fail as quickly and efficiently as possible so we learn the most from it. 

[00:07:42] Christine Ko: Yeah, I love it. Okay. So is how you reframe failure related to how you combat burnout and imposter syndrome? 

[00:07:52] Jules Lipoff: I think so. I think a lot of what contributes to burnout is when we feel like we're doing something that has little meaning, something feels very tedious or pointless. That's like a lot of EMR, why it burns out so many people. There's all these clicks, all these things that we have to do, and what does it really contribute to patient care?

[00:08:11] It's something that can really grate on us, but I think creativity is something that can really help us. Refocus what we're doing. I looked this up because I wanted to quote it. We talk sometimes we talk about self actualization. I read this book Deep Work by Cal Newport. He quotes this Hungarian American psychologist. His name is Mihaly Csikszentmihalyi, who says this, "the best moments usually occur when a person's body or mind is stretched to its limits in a voluntary effort to accomplish something difficult or worthwhile". So he's describing a mental state of flow, right? And so there's important things there. If you get worked hard, if it's involuntary, that's not going to do much for you. You're going to hate it. If you're voluntary, but it's not really intellectually or physically challenging, you're like, eh, what am I getting out of it?

[00:09:00] But that combination of choosing something that challenges you, something that you're enjoying, right? When you get totally lost, you lose track of time or anything around you. And that can help fight burnout.

[00:09:11] As far as something like imposter syndrome, I think we all are subject to, especially in the social media era, where we're constantly seeing the lives, or at least the projections of the lives of everyone around us. And we feel like we're not measuring up, but that's because we're looking externally. I like this story about Olympic medalists. When they were comparing the happiness, at least, of the expressions of the gold, silver, and bronze medalists. The gold medalists, super happy, but who are happier, the silver medalists or the bronze medalists? And the funny thing is, it's the bronze medalists. Why are bronze medalists happier than silver medalists? The silver medalists are looking up and saying, I didn't get first place. Err! Bronze medalists are looking in the other direction.

[00:09:53] They're like, I almost didn't medal! Awesome! And so a lot of it is just framing yourself creatively. I think in a lot of academic departments, it's very surprising how a lot of us think of ourselves. I was talking when I was on faculty at Penn, I was there 10 years, I was talking to a peer there, someone who I highly respect.

[00:10:10] And they were admitting to me, they were maybe complimenting on something that I had done or published and telling me that they didn't think they were doing enough and they could do so much more and I'm looking at them and saying, What? First of all, you're an incredible person. And also, I feel the same way about you. I feel like I'm not doing enough looking at you. So what is it internally that's happening in these sort of academic environments that can be kind of toxic, that pushes us, maybe takes advantage of our achievement oriented drives? It maybe drives us to produce more, but it's not necessarily healthy for long term success.

[00:10:47] So I think reframing as best you can. I mean it's hard like obviously when you want something and you don't get. It's hard. That's why I like to have a lot of irons in the fire. If I have several papers or projects out being submitted, one rejection doesn't hurt as much, right? But if I have all my eggs in that one basket, it's gonna be a little harder to take. 

[00:11:06] Christine Ko: Do you have any final thoughts? 

[00:11:08] Jules Lipoff: First I would say like I'm giving advice about how to handle some of these things, failure, burnout, but I don't want to pretend that I am some awesome, like on top of all this, myself.

[00:11:18] I am certainly a work in progress. I have an ego. I have dreams. I have ambitions. There are things that I want to do. And sometimes things don't work out the way that I want or the way I envisioned, but I've learned like that I think I really have come to embrace. It's kind of silly, but I really have come to embrace the phrase, "perfect is the enemy of good", so much as I would say a recovering perfectionist. Really, like, there's so many tasks that do not require that level of intensity. Certain things are really important. You got to strive to be the best, but everything else should just be automated or delegated or however much is possible.

[00:11:54] And, I think also when I'm giving this advice, I don't want to be suggesting that any old doctor needs to be starting to write comedy or make films or do podcasts. I think for some of us who like podcasting and such, it's fun. It's a creative outlet. You don't have to make a career out of it necessarily, but I think you should be true to yourself, like whatever that is.

[00:12:14] And maybe that's just playing some video games. Maybe that's reading a book sometimes, maybe that's none of the above, but whatever it is, you don't have to justify it to anyone. Maybe just a hobby, which is hard for me. Sometimes, I have trouble just doing things just for fun and not trying to be like extremely excellent at it. Just promoting different ways of thinking creativity can only be a positive thing for everyone. 

[00:12:36] Christine Ko: Thank you so much for doing this with me. Really enjoyed it.

[00:12:40] Jules Lipoff: Likewise. Thanks again. And I hope that this conversation is helpful to someone.