KERCasts

Mindfulness and coaching for chronic disease

October 07, 2020 KER Unit Season 1 Episode 1
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Mindfulness and coaching for chronic disease
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KERCasts
Mindfulness and coaching for chronic disease
Oct 07, 2020 Season 1 Episode 1
KER Unit

In this first installment of our KER Cast series, join Dr. Victor Montori as he interviews Dr. Roberto Benzo, a pulmonologist and founding director of the Mindful Breathing Laboratory at Mayo Clinic. In this wide-ranging conversation, Drs. Benzo and Montori discuss the practice and benefits of mindfulness in patient care and beyond, the importance of finding meaning in one’s work, and the roles of authenticity, generosity, and kindness in a team-based setting. 


Show Notes Transcript

In this first installment of our KER Cast series, join Dr. Victor Montori as he interviews Dr. Roberto Benzo, a pulmonologist and founding director of the Mindful Breathing Laboratory at Mayo Clinic. In this wide-ranging conversation, Drs. Benzo and Montori discuss the practice and benefits of mindfulness in patient care and beyond, the importance of finding meaning in one’s work, and the roles of authenticity, generosity, and kindness in a team-based setting. 


Victor Montori:

It is 10 o'clock and we are starting the KERCast. I am your host Victor Montori and on behalf of the Knowledge and Evaluation Research unit, we would like to welcome you to these KERCasts. The purpose of the KERCast is to discuss with distinguished guests about the their careers, their lives, their principles, and how these connect with the goal that we have of helping care fit in the lives of patients. Our first guest is Roberto Benzo. Dr. Benzo is a physician at the Mayo Clinic, a distinguished investigator and researcher into how might we improve the lives of patients with breathlessness. He's federally funded, manages a large research team, and has been successful in developing and implementing a series of interventions using mindfulness and coaching that allow patients with breathlessness to live better lives. Roberto, Welcome to the KERCast.

Roberto Benzo:

Thank you so much for having me here.

Victor Montori:

Excellent. So to start our conversation, one of the things that we we would like to understand is how we said that people become who they are, how is it that they arrive at a situation in their life where they are Roberto Benzo. Tell us a little bit about what has motivated your journey?

Roberto Benzo:

Well, I think is a lot of passion, I think, try trying to have some kind of a sense where you going. And but also being humble enough that you don't control the variables,

[Victor:

what do you mean you don't control the variables? What is that?]. There's a lot of serendipity in life. And, and then I think that we need to honor that, that things happen. And then we need to prepare for them. And then we start kind of pressing buttons that are in front of us, we don't press any button that is just too far. You press the one that is at the reach of your hand and for that you have to be very, very attentive. I think that, you know, it's like, you know, Steve Jobs kind of addressed a Stanford commencement one time and said, you really connect the dots backwards. I mean, really, I mean, the thing is that you don't really know right now to kind of say for what was going to happen, but you actually when you look back, you say, oh, that happened. And I was able to press that button. And it went, it took me to another place. I never thought I would be doing what I'm doing right now. I mean, kind of a kind of sense of caring for patients. And but you know, there were some crisis that you go through when I realize that I don't fix everybody, I don't fix at all.

Victor Montori:

So what you're telling me is when somebody asks you, oh, what are you gonna do when you grow up? You? You did, you couldn't answer what you're what you're doing right now.

Roberto Benzo:

There, you know, you we talked before about, you know, how we plan for the future, I think that you plan for the future standing very well, where you are right now. I think that you actually what now? So the thing is that what is it that you really passionate about that you're really willing to put 100% behind, and then move forward? And that may not be what society or your father or your mentor wants?

Victor Montori:

Or research funders, right? Because research funders would like you to set up a career plan and career goal. And it's always set up in, in five year time periods. And I think as the cruel joke goes, nobody sitting in 2020 would have answered in 2015. What do you plan to do in five years, you know, we wouldn't be in the midst of COVID. So it's a very strange expectation, isn't it that we can plan ahead with such a long runway.

Roberto Benzo:

It's, it's also a lot of courage. I think that you know, I think that when you are really working on creativity, there are a couple of things that you need to know. I mean,

you need, important for me:

being curious, and overcoming the fear of changing. So the thing is that, I mean, I, when I had my initial funding the K and then of course, I was learning to kind of drink every drop of my mentors, comments, and that but the issue is at some point, I realized that I didn't belong, that I was going to go into another direction. I used to be an institution that honor kind of molecules and genes and I was doing self management, talking about people quality of life and what is important for you today, so so it kind of was out of favor of that environment and then I said to myself, I need to go somewhere else. And then when, and then, you know, Mayo Clinic, came to my, my journey, I know. So what I can tell you is serendipity exist, life is bubbling in the present moment, things are actually bubbling in front of you, if you're attentive to push that button.

Victor Montori:

It sounds like paying attention, being present, being acceptance of chance, and being able to act on chance have been important to get you where you are.

Roberto Benzo:

and then having the passion. So knowing exactly what

Victor Montori:

I can't tell that you have any passion, I don't know. I mean, you seem to hide it well.

Roberto Benzo:

is like, you know, what actually moves you is? I think it's a question that we need to ask permanently. And that changes life change, like, is very promiscuous, you know, because what moves you now, it doesn't really, I mean, maybe it doesn't move you again, but it's kind of what life is kind of bubbling in the present moment is the eternal now, you know, and so, that is, I think, an important thing to go to.

Victor Montori:

If I were to ask you, what has been the primary value that has moved you through your research career through your personal life, what would the primary value be?

Roberto Benzo:

I think I wanted to make people comfortable content with their life with I think that was something that stayed with me since I became a resident. You know, is like, I think that goes beyond knowledge. Is that stayed with me. Also kind of, at the same time, kind of creating condition for contentment, and, and then also have that authenticity, when you're talking to people and, you know, I mean, the one thing I, you know, I mentioned in our, in our, when we chatted before, together, it's like, the number one patient that you need to change or work on is the one that you see in the mirror. And so I started to kind of, uh, make sure that, you know, I, I can produce that contentment and authenticity with my own self. But the thing is that, you know, I would say that that was a stay with me in my career. You know, and then founded is the foundation of what then became my research and my work

Victor Montori:

it sounds like authenticity was was the one of the triggers that move you from realizing that the molecular was not yours, you know, that the environment that honors that was not yours, and you had to, in the KER unit, in our research unit, we have three, three values that we we think orient our work and bring us together patient centeredness, integrity, and generosity. Do any of those ring particularly close to your heart?

Roberto Benzo:

Oh, generosity, I think is what I think is, is what actually gave me the biggest, if you will, satisfaction. You know, it was going out not what is coming in. So it's like this. You know, it's like, I proved myself again and again, that sometimes I think I'm not giving anything and people are so appreciative. And I ask myself, what, I'm just, we're just chatting, we're just kind of discussing, we just kind of, uh, but as like, I think that generosity means a lot of attention, you know, a lot of attention to, I'm just saying, when we are in, in an encounter with with a friend with a patient with a is it's about how much are you there? One of my teacher says if you're thinking too much, you're not here. So the point is that how much are you really there and people actually have this sincerity meter inside that knows that you actually completely there? And so you know, so that generosity start with the attention I think.

Victor Montori:

So going to this work that you do with mindfulness to help people with breathlessness. What role does generosity play in that?

Roberto Benzo:

Well the main thing is that I will say listen and so when inevitably called coaching call and every health coaching call the biggest mindfulness back is to listen to just shut shut up and to just come drop everything drop the idea that you want to change people kind of what's going on with you Victor. So tell me about it and becoming genuinely curious about it. I think that I am convinced I became a better doctor since I listen more or it's not that I got it. You know, let's just get that very clear. It's like it's the intent is the is the always climbing trying to come up with get to this idea of total attention. Or and I would say refocus kind of your mind was somewhere else, you just bring it back here kind of. And I think that it made me more, more attentive to not only to the conversation but more attentive to the lab values, more attentive to the CT scan, more attentive to interpreting the, you know, the data, kind of putting together the data to actually the patient, the patient condition. So, I think that to me, has been one of my assets or the thing that helped me be trying to be a better doctor.

Victor Montori:

Roberto you are a, a breathless, breathless, breathlessness expert. And one of the things that characterizes 2020 is breathlessness. Right? We have gone from COVID taking away people's ability to breathe, to the George Floyd murder, which, which has George Floyd's final words be I can't breathe. Breathlessness has been a description of, of this year. And you, it finds you as one of the world's preeminent breathlessness expert. And using a mindful approach towards mindfulness that helps patients, you want to tell us a little bit about how is it that this approach helps patients with breathlessness? And perhaps, you know, we can listen to this with two ears? You know, one is as a clinical tool, which is how you I think you've developed it, but also to think of it as a strategy to deal with the breathlessness of 2020.

Roberto Benzo:

Yeah, so I think that the one thing to realize is that breathlessness is very promiscuous, too. So the thing is that there's a lot of stuff that make you short of breath. And even if your lungs are fine, many people say I cannot breathe, and the lungs are completely fine. So there are many factors that goes into into the feeling short of breath. And it's good to actually pay attention to those is that something that is coming from kind of a pneumonia linked to COVID, or is it because somebody is actually grabbing your neck or somebody because you're you're sad or anxious, or so there are many things that actually go into that. So I think that I think that what we're trying to do is to try to kind of a tease out those different things. So of course, we have, I'm a doctor, I want to see the lung function, I want to see the X ray, I want to see all those things. But also I realized over the years, that, there are many other things that bring you to the sense of I cannot breathe. And and so the thing is that we try to kind of if you will synergize the power of knowledge, but also with the power of listening and the power to kind of find out what are the things that we can fix. I deal with patients with chronic obstructive pulmonary disease, smoking related lung disease, and then we cannot regenerate those lungs, but I can tell you that shortness of breath improve with interventions that not necessarily improve the lung function. And that is actually will keep us going because the thing is that what is it that we actually can get better? What are the factors that we can improve? So we work on obesity and obesity's a Pandora box, because, I mean, that means, you know, the mean, the awareness, what you eat, how much you move. I mean, the thing is that, you know, the how you see your body, and then you mean all the way to physical activity, all the way to meaning in life, all the way to relationships, with relationships, one of the things that may take our breath away, so many times in a good way and in a bad way. So I think its that so, so the thing is, that, if you will it is a multicomponent approach to breathlessness. I remember when people come to Mayo Clinic, they already receive every bronchodilator under the sun and you know, the thing is that we're looking outside the box, we're looking at trying to kind of, you know, seeing the big picture, the helicopter view of the breathlessness of the patient. And for that you need to kind of ...

Victor Montori:

You still got me at the breathlessness of relationships. I'm still stuck there for a second. Thank you for that. Tell me so what is how does it work? So if I'm a patient with with difficulty breathing and and i mean your program, what is my experience?

Roberto Benzo:

Well, the number one you actually again, when we get to these patients, they already have a few if you will the basic assessment on the physiology. So that we we kind of characterize a patient that is in the from the if you will has the standards of care that you need and then we start to tease out these other parts and so we my my current work is on remote monitoring, and then home based programs in which people wear like a Garmin, and they actually to go into a tablet and they put their, you know how much short me overall, how are you today, well-being, the level of fatigue, the level of shortness of breath, and the step, the progression to their step goal that they actually agree with their coach. And so the thing is, the, so we talk about those things. And then, and then we discuss about, you know, some physiologic factors because people actually do some yoga at home and move, and then we check their oxygen, and then we see the extent of the saturation of oxygen. But the point is that we try to kind of go over the amount of steps, our time you actually move, tell me more about that people actually do become more confident and self-efficacious of actually, of what they are doing. Also, we set a step goal. And then the step goal, I mean, it can be also graded every day. And if you we use techniques from behavioral economics, because if you actually achieve this step goal 25 cents per day goes to UNICEF for a child hunger. And if you actually go for beyond 1000 steps from your step goal, 50 cent per day go to UNICEF for child hunger. So they actually they are seeing that there are things that are bigger than themselves, you know, not only that they Oh, they set goals to actually feel better. And because physical activity improve everything under the sun. Picture yourself, that kid actually receives that 50 cents from you.

Victor Montori:

So it's interesting that the intervention itself introduces generosity into the into the intervention itself.

Roberto Benzo:

Yes, that is how it looks like so but the thing is that and then a theme by itself can take the whole coaching call. It can be that we're talking about your daily steps, and steps is a behavior, is very strong, if you will measure because you do steps to do things that you want to, or at least you try to, we investigate that what is it that you're doing with these 500 or 6000 steps, I mean, so it's kind of a cool conversation in itself, then we talk about, you know, how they raised their well being. Tell me about that. And also like, tell me about that day, which you said your well-being was excellent, oh my kid came to home or I did went to actually see my father in the hospice or something like that, then you start to identify things that provide meaning, we also try to kind of tease out the difference between meaning and happiness in the way that, you know, happiness has to do with actually will actually give you the sense of joy. Now, meaning is such a long term that you actually do it. And many times when generosity kind of a put those two together kind of I think, is the link of meaning and happiness going together so generosity is big kindness is big. So, so we took, you know, you can, you know, it's usually a 20 minute call for 12 weeks. And that's the intervention that we're testing that we're trying to now to roll out as an implementation intervention. And one of the things I say in my mind, like, last few years that who's gonna pay for this, and then we're, you know, but the thing is this look at serendipity life, two years ago, Medicare came with remote patient monitoring codes. And then we ended up having you know, we those fit with our intervention, and we're kind of we're rolling out something that actually would have, you know, it will be cost zero probably will make some money, not a lot of money, but the return on investment, decreasing rehospitalization, COPD, improving quality of life, improving behavior [Victor: So you have an implementation package in that way] right I mean, so it's like a how do we we can put it in the field that says, And what did I do for that? I did nothing that was life that wanted to happen. So you know that, having that I think that having that great hope that what you're doing really will pay off. I mean, hope, I think has everything to do with high performance. Yeah. And that, you know, you know, because as I said before, we can't control the variable.

Victor Montori:

Yeah. So you you are at the KERCast, and we're talking to Roberto Benzo from the Mayo Clinic, as you can hear is a passionate researcher in helping patients with chronic conditions through mindfulness and implementing that in the course of clinical care and in patients' lives. Roberto what, what's your favorite collaboration?

Roberto Benzo:

Well, the biggest collaboration I've had in my life is my wife. So, I will be nothing without her and a you know, a, I was kind of another very good student in medical school and we got married when I was in medical school. So she made me finish and then she supported me in my career here when I was a non speaking medical resident. No speaking English medical resident in Canada, very broken English. So, so I went through a lot. So I think that was my biggest, most successful collaboration.

Victor Montori:

It also seems to me that that was your first experience with major luck.

Roberto Benzo:

Yes, serendipity, the most positive way you can think of, and, but, but I think that, you know, I learned that I learned that I want to really pick what is my inner circle. And so I think that I really believe in, in a, you know, in a culture based organization in a relationship based organization. My lab is a relationship based lab, we care about each other. We know we really do. Hands down. And the other thing is that is that collaboration means that people working with me will do things I don't know how to do, and or I don't do it as well. And then. So it's, I think, I really believe that, you know, a, that's why kind of a collaboration. Yeah, I want to make it to happen and in a way that I really want to be on that relationship. And to, for me, to put that to work in it to to be a relationship based organization.

Victor Montori:

So your program is based on coaching. Have you had collaboration with a somebody who has made coaching phenomenal?

Roberto Benzo:

Well, yeah, well, you know, I didn't invent that. I mean, over the years, I work with tremendous people that some of them taught me coaching. And there's a guy they told me, yeah, we maybe I mentioned coaching to you, but it was already inside you. So I think that is what actually great, great collaborators are is like, they find something inside you that is worth cultivating and and then you grow out of that. And yeah, so I did have since I came to the Mayo Clinic, I work with tremendous people. And, also, I would say I wouldn't be here. If it were not for them, you know, because I didn't know about coaching before coming to Mayo Clinic. It is not that I knew it. You know, I got it before.

Victor Montori:

But most most listeners will hear about coaching and then unless they're initiated into this kind of health coaching, they will think oh, you know, like you mean like athletes? Right? And so have you been being coached by by someone in that circumstance?

Roberto Benzo:

I was touched in my life to be trained by Michael Gervais, who is a sports psychologist for the Seattle Seahawks. And who work with the Seattle

Victor Montori:

Seahawks are a football team, right?

[Roberto:

Yes] I mean, I'm a soccer guy so I have no idea what

Roberto Benzo:

It's like, the thing is that they do have that culture. I mean, Pete Carroll, the healthcoach and Michael Gervais have a kind of a kind of crochet coin, this idea of kind of merging, you know, mindfulness and a lot of other things like philosophy, what's your philosophy? Like? What guide you vision? Where do you want to go? I mean, [Victor: they do that with the, with the football players?] Yes. I mean, and the but the thing is, that now its like infecting, they did that work in Boeing, Starbucks, a, you know, Microsoft, Netflix, I mean, so it is. So I learned that and, you know, it's like, one of those things that you said, okay, you know, things that actually make you different after you learn those kind of things. So, I learned that high performance only happens in the present moment. That was profound to me, because we were talking about mindfulness and the present moment, they say very clear to me. High Performance only happens now. So the thing is, that is also I learned and I coined this idea that is, yeah, it's okay to win the Superbowl. I think it's much stronger is to say, in the last 15 years, we went to the playoffs 15 times. So you are on that top level, you are on that, you know, it's like, no, I will never get a Nobel prize. I know that, but the issue is that I will try to kind of get my my ideas to be funded and to be disseminated and to be implemented and help people so trying to be your that, you know, that level of if you will, intensity and to be able to be at that sustained high performance.

Victor Montori:

You know, the people that are watching you are seeing something behind you but the people that are listening to this may not you have a sign in the back behind you that says Enough is Possible. What's that about?

Roberto Benzo:

Oh, that's a That's a work from Peter Tunney, Peter Tunney, is an artist that he used to be a, you know, a broker in Wall Street. And then at some point, he decided to kind of leave that life of, you know, making money or thinking about money into disseminating his art and his, and his philosophy of life. And he, he kind of Co-founded Wynwood, which is a, it's a, it's an art neighborhood in Miami, and I just things like that. So like a, like a, you know, his work is like time is now, but enough is possible is, is, is very profound, because is, is fostering the idea of enoughness. You know, it's like a, they mean, a, you know, stopping the idea that something is missing to the present moment. So, you know, is but for that enough is possible, kind of, to me, it's a practice, because you only know, the enoughness, when you stop when you actually have the helicopter view. So it's like, otherwise, he said, You know, I think that the idea that happiness is now so it's not happiness is not coming, when you I do this, and I do that kind of, it's kind of let's put happiness before. And before we we before doing things, some many times the, the paradigm is do this, and then you will achieve it. I think that, how about if we achieve it and see, let's see what we do. And so, so is so enough is possible, I think is, is recognizing that the the, you know, the enoughness of life now. And I think that again, this guy, when I was walking this neighborhood, Wynwood in Miami and I met, I met his art, I became completely in love with this idea of delivering very short but profound and I bought this. I couldn't stop.

Victor Montori:

I'm glad you were paying attention to it.

Roberto Benzo:

Right, like I you know, it's such a, you know, those simple things that struck you, you kind of walk in the middle of it.

Victor Montori:

So this, this guy went from money to meaning, which, which I think takes me to ask you, so what's the meaning of your work? What does it mean, what you do?

Roberto Benzo:

I think that we're delivering, we're trying to foster people to discover meaningness and meaning in life and enoughness. And, and in the context of that, some happiness. And then I think that that goes hand to hand with all the outcomes that every every institution is willing hospitalizations, ER vistis, days in the hospital, we just recently published that people that actually, that loneliness is independently associated with ER visits in patients with COPD. So what so and the and the reason behind that is that when you are not lonely, you have you when you have somebody to ask about, Hey Victor, what can I do I am very short of breath. So when you have nobody to actually ask anything in your life, and you feel socially distant, and then the first thing you do is 911, and you end up in the ER when there's a problem, but I think that there are some factors that are very, that are the very core of your of your life. That is you can have a very primitive stuff like a feeling lonely or not. And so that has to do with ending up in the hospital or not. So not everything is.

Victor Montori:

So going back to the COVID analogy with breathlessness. We are isolated, we are lonely, we are separated from each other. We are feeling constrained, perhaps even breathless. And you're saying that through this process of mindfulness and coaching, you move people from panicking when the breathlessness rises to a certain level and then seeking medical care in the emergency room and so forth to a situation where they're able to recognize what's going on and manage it in a way that is that is different. That doesn't doesn't call for that kind of help. Am I getting that right? Is that is that sort of the reframing that you do? How would that help us now how would that help us? Now in this in this time, how, how does it help you do you? Do you reframe do you do you? Do you find meaning in this times in ways that will make you Don't let don't let, don't let yourself panic and, and go running for help.

Roberto Benzo:

So I think I would try to create conditions for people to express themselves, particularly in situations like this in which we are, if you will, physically isolated. So I think that there's a lot of engagement between the coaches and the patients. And so and there's a lot that we will we learn from just listening to our own words, there's like, it's like when you go to get, you know, some psychotherapy, and then many times, they just listen to you. And then you actually kind of listen to what you're saying, which is your own self. And then you make decisions out of that we try to kind of create a, you know, coaching by itself is a clinical decision support tool. So the thing is, that is like, allows people to make good decisions, I mean, and to, to at least to weigh those decisions with that person that they trust, so much which is the coach. And then we try to be very focused. It's not, it's not chatty, chatty. But mean, the essence is to engage people make sure that you're there with them and they know that, and then to focus on something to evoke what is important for them in that in that in those things that they want to talk about, and then make a plan.

Victor Montori:

I like to invite the attendees to begin to use the q&a box to ask some questions of Roberto as we as we go into this next section here. So I'll be paying attention to those questions and try to ask them as well. So we've learned so far that you've gotten to be who you are, through paying attention responding, letting serendipity guide you, being authentic, built on strong collaborations, and bring a spirit of support, connection humanity, to the work that you do to the intervention design to the implementation process that you follow. And that you do it in the collaboration of people in your lab. And you said that you care deeply for each other. Our unit is interested in this notion of care. What does care mean to you? And how do you think we do, we do better when we make care fit in the lives of the patients that we care for.

Roberto Benzo:

So we usually say, in the lab that we we want to make sure that what we're doing matters to each one of us, this is beyond work, we all grind with work every day, we think that we don't like but the thing is, most of the time, the overarching idea is that we're doing something that is making a difference. And then kind of every every one of us is try is kind of convinced that we are a critical piece of that machine. And so is, you know, that's why we we coined the idea that team, the word team doesn't have an I in it. There's no I in team. So this is there's no letter I, it's pretty much about the group. And so the other thing is that there is a great deal of sincerity that need to happen. And so it needs to go Yeah, we are a team as soon as you do your work. So it's like a, you know. So and the other thing is that I things are done many times in other ways than I would do it. And that took me a while to actually understand that by the thing is that they are done probably better. Forget probably, kind of off the record probably, the things are done better, because I don't have my hands into it. So the thing is that this level of if you will trust that people are putting their best to do things. It's a it's a very, very, very important part of that, you know, it's like, Yeah, do it but show it to me before. So it's I think that trust is one of the things that also is an is a one of the issues, one of the key factors in high performance, and in a relationship based organization

Victor Montori:

it creates, it creates conditions for flourishing.

Roberto Benzo:

Absolutely. Yeah. And the other thing is that if I, so I want to coin a comment of Steve Jobs again. Steve Jobs said if you ask yourself five days in a row, why you're doing what you're doing. You probably could be thinking about doing something else. But the thing is that the issue is that everybody there is kind of a, I mean, I asked them to do that question. And and so to make sure that we are, we are kind of pushing along, like a kind of like in, you know, together, you know, it's something that you, you build. And you know, I mentioned before to you, Victor, it's not that I got it. I'm trying so I think that, you know, I see myself, I mean,

Victor Montori:

you're trying but you're already at a very high level. And so, so one of the questions that we've received is, you know, how, what, what advice do you give to people, people who are still looking to find the sense of meaning in their work?

Roberto Benzo:

Well, the thing is, so ask that question. So it's, so it can put your phone away? I mean, to stop the TV, sit down and start asking that question when you're walking now in the in the middle of the fall. And so what is it I mean, I mean, it's kind of a self discovery. So, this is about what is meaningful for me. And the thing is that, let me just say, this is not that tomorrow, you actually can change everything. Because we are we always need to pay the you know, to pay the rent, and we have food in the in the place of our kids. But the thing is that life is fair. And then I will bring you to a to a decision tree, and of actually changing if you but in order to change, you need to get there with that sense. Yeah, I gotta go. I gotta, I gotta get out of here. I got. And so I think that, you know, ask yourself many times, what is the good and the and the not so good at what you're doing and pay, pay a lot of attention to the opportunities in front of you.

Victor Montori:

Some of us are afraid to ask that question. I think fear is an important barrier or motivator. Right?

Roberto Benzo:

Yeah.

Victor Montori:

So I've actually have a question that is coming in, they're asking you, what is the challenge that you had to overcome? And how has overcoming that challenge impacting your work impacted your work?

Roberto Benzo:

Yeah. So the I think that one of the challenges that I needed to face is that, that at some point, I thought, I think everything kind of depending on my decision, or everything kind of depending on me, or what I actually say, is, I think that trusting more was a very important part of me, moving forward, and trusting more people around me that they, so is, that's why collaboration is important, but also picking who you're working with, and make that decision. And that so it's I think that was that was one so kind of a stop thinking about, you can control I mean, I think that's everything and and then, you know, because in the context of passion, oh, yeah, we want to do this, I want to do it that way, then, no, wait a minute, you know, this is a direction, but may not be the right way. So and then stop and listen, and because people around, you may be able to have the answer or try other things. So that kind of, uh, that was something that was a challenge for me.

Victor Montori:

It's interesting, because, you know, I grew up with my dad telling me that my approach to feel to deal with challenges, if you imagine a challenge, like a wall, was to just run really quickly against the wall and just, you know, tried to crush through it. And, and he always encouraged me to find ways around it or over, that I don't have to go headfirst into the wall. And in fact, one of the questions that we've received is, you know, how do you encounter adversity? Do you feel it as a barrier to work around as a challenge to face and overcome, or as a block to navigate around to avoid clearly the person asking the question doesn't use my approach or just going trying to go through it? So how do you take how you take those apparent barriers, how you handle them,

Roberto Benzo:

There is a Zen saying that the obstacle is the path. The obstacle is the path, I think that the obstacle is what actually would pay kind of a higher attention I mean how we actually will move think about the water when it comes in from the top of the mountain and encountering rock, it just goes on the side it doesn't really try to push the rock to actually go through, it just goes on the side. So we just need to be like water, kinda kind of try to find out a way around that situation. So I think that is is difficult, but it's meaningful. So it's important. It's about seeing those problems and it's an opportunity of higher awareness. And for that you need to stop on a daily basis because problem kind of pop up. Like, uh, you know, permanently and knowing yourself that you need help. So, and then try to get your, your circle to help you. But the point is I think it's a cliche, but I really think it is right. Problems. Challenges are opportunities, and I became to love challenge. And I think that is when you go into the high performance field. I mean, I, what I learned from the Seattle Seahawks and their organization is that people that are Olympians, people that are at that level love challenge, they just love it, kind of bring it on. So the thing is that, you know, it's like, so the thing is that, you know, so and you have to be also, I like to quote, the people from the persuasion lab in Stanford that they're working on, on the, you know, on how attention is being paid, because attention is one of the biggest commodity in our lifetime. So, the thing is that they work on tiny habits, they work on tiny things like floss, one tooth, like, what I'm trying to say with that is that when you're trying to kind of change your path, your path in front of you start very small, because but that will create a condition to go to the next level. So be two twos, and then they your whole, your whole team that they so is, is really a process and identifying the problem, finding the tiny, tiny change, prove it go back for that you need to kind of sit down...

Victor Montori:

For many of our listeners who are involved in improvement, this is part of their mantra, one of the questions that that we get is that there is a this challenge of generosity when it comes to clinical care. And the person asking the question is quite concerned that some people, perhaps even people with your passion and your commitment, it might come to care with a lot of generosity and a lot to give. And that could have and the question asker points to two potential problems. One is that over eagerness to help, might be misguided and might do more harm than good. And the other one is that it might end up extinguishing whatever energy that you have that brought you in, in the first place. you're passionate guy, you're coming in all in? How do you how do you manage that? How do you how what are the boundaries of that generosity that you bring to your work.

Roberto Benzo:

So we need to make a good distinction between cheerleading people with, through with, you know, the sense of generosity of your attention. So I actually am actually pretty serious, and when I, but I sit with a patient and, and I listened, I try I try to listen very deeply, trying to find out what actually what is needed, what is possible. The other thing I do is I want to make sure that what I get there, I am balanced myself. So it's like when you want to make sure that you are in a good position to give. Some days you, me and everybody in the world have situations and then some days you're not at a beat or So the thing is that this allow, as I said before, the biggest patient you want to change is the one you see in the mirror, or you start by actually trying to make sure that you're generous with yourself, you are attentive to condition today, if you have a problem with your wife today, or your kids or your bank account, or I mean, you probably will not be the same thing as other days. So I think is that so we are careful. And the other thing is that when I sit with a patient, I need to pay attention to what I need to pay attention. So of course, it's not that I'm going to be talking about mindfulness and they know that the obstacle is the path, I just need to make sure that their lung function is fine. The X rays is perfect. And so the thing is that we've put together the whole thing, and that is what actually we need to try to get health come from the word whole mean that means that health is about being in balance with everything that's going on. So the thing is that but we need to we as provider, we tried to put that together. So we mean cheerleading doesn't help anybody. Of course we can be cheerful. But yeah, it's about the the issue is that this cheerleading is not coaching

Victor Montori:

So just Just to be clear, when you talk about generosity, what do you mean by generosity?

Unknown:

is giving myself completely to the present moment with a patient.

Victor Montori:

Giving yourself completely to the present moment with the patient.

Unknown:

So in that in, we're talking about the medical act, right? So yes, yeah. I think the same happen with your kid. The same happen with your wife, the happenn with your friend. The same happen when you actually, when you're riding the bike, just ride, okay, don't do anything just ride, or just swim, or just run. Or just jump. Its that wholeheartedness, That you actually...

Victor Montori:

But multitasking is lovely, isn't it?

Roberto Benzo:

But it's, I think it's applicable here that the beauty of this Victor is that is applicable to every walk of life. And so the thing is that, so the, you know, sometimes, of course, and you make mistakes, sometimes you go too much in being too too cheerful with a patient, he or does he or she doesn't like it or, but the point is that, are you paying attention to this to what actually need to be pay attention in the moment. So if they're coming to the Mayo Clinic, because they want to know what to do with their lungs. So let's start being very clear, so...

Victor Montori:

competence and compassion, not just not just one or the other?

Roberto Benzo:

I think the actual alchemy is to actually put it together, and then kind of, so and getting something better

Victor Montori:

talking about that. If you were to think about for someone who's paying attention to what's going on and trying to serve the serendipity, have you gotten to a point where you wish you had done something differently?

Roberto Benzo:

I asked very careful to myself, if I if there will be any benefit of that kind of a kind of questioning. So yes, I know. So to make sure that you're not always kind of reflecting on Oh, I should have done this. Because that now the present moment is full of those kind of frustrations. Okay. But so the but the point, yes. I mean, you look carefully at I mean, that's, that's the that's the essence of, you know, examining life in the present moment. So the thing is that you, it's not a kind of a cognitive thing, you sit down what is happening, if you actually feel that you did something that it should be done different, you just do it. Or, or you just do it, you put the conditions for that to happen different in the next time.

Victor Montori:

You've hinted at a notion of self care, right? That there is there's a notion that when you when you show up and so forth, and you want to be in the moment, there's a there's a, there seems to be a discipline behind this, not just mentally to be present, but put your put your neck in a good place. How do you, how do you do you separate your life from your work? Is it a big, you know, soup? Or do you have boundaries? How do you handle that? That's the the famous balance of work and life or is that an artifical construct that you don't pay attention to?

Roberto Benzo:

I really don't I think that, you know, I think that, and so I think that I'm not sure if it is work life balance, I think there is life, and we're trying to, and we try to be balanced with that. So I think that I like so much what I do that, you know,

Victor Montori:

you seem to have integrated your work into your life and your life approach to your work approach in a way that it seems seamless at the moment

Roberto Benzo:

Well, the thing is that but many times I think about a mechanic or I think about a janitor I mean in which all those very those professions are normal by themselves, but you know, probably, you know, you probably don't choose, sometimes people you are forced to do things that you don't like, I mean, I'm coming from a country in which a lot of people are workers, and they are poor. And so the thing is that so those people, you know, sometimes they cannot really find the same degree of enjoyment that I have in my own work, but they are looking they're happy they're trying to survive with that. And then you know, the balance come from other things like uh, you know, having, you know, having the great degree of community that happens in the, in the Latin countries and also you know, what they do, I mean, look watching soccer and getting together. So other thing that compensating that other thing that we need to grind for, for a higher meaning because you have to pay the rent, you have to kind of keep bring food to your kids. So, you know, is is not easy.

Victor Montori:

So you are in an academic medical center. How can you Balance all these, you know, being mindful and generous with people you work with, with your patients, with your colleagues, with this notion that you have to be strategic politically, even in the way you handle yourself in an academic medical center, that is that is often set up to be very hierarchical and results focused. How do you handle that bit? Or is that one of those things that you also don't care about?

Roberto Benzo:

I am, my politic is no politic. I tried to be

sincere, really. [Victor:

Some of us when we get when we are when we are trying to be sincere, we get into a lot of trouble]. Yeah, the thing is that sometimes it is the way we are sincere and but I think that I try to float with the system. And if I can do something to improve it, I will do it. I. But I like the idea of like a cork that float in the water, I try to flow with the system, understand it, and then making sure that I have an opportunity to, to actually say something or change something. I think that in my experience, opportunities came to me in which they asked me for stuff, I don't try to go change anything, especially in coaching. I don't want to change anybody anything. Because we don't change people by telling how to do it, or what to do. We don't change that behavior change doesn't happen that way. It happened when you create conditions to change.

Victor Montori:

It is a magical thing when when I listen to you, Roberto, because you get the sense of someone with a very clear direction, or directionality I guess might be the term in your life. And yet your metaphor is a cork on the water. No, sail to catch the wind, no, no rudder to, serendipity as as an explanation for your success. It's hard to maintain to but you do it right. But it's hard to keep those two ideas in balance a clear way of looking at the world and how you're going to be in it. And at the same time being completely open to what the present brings.

Roberto Benzo:

Let me just say this Victor, I trust, I trust life, I really do. And that I really do, I really do. I really trust that we life evolves in the in the right way. And then if we pay attention, we will actually will fulfill for what we are here for and its an evolving concept. And so is, but it's very beautiful to feel like that you're trying to do something that you know is who you are. And even if even if you are in the intent, and then it's not about getting to the summit is about climbing is about keep climbing, keep going. And, uh, you know, so that's what I mean. But I, you know, I don't know,

Victor Montori:

there's there's someone here that's interested in building a team. And they're saying, Well, if you were to start to build your, your lab from scratch, how do you go about doing that to get to get to the point where you're talking about we all care about each other and so forth.

Roberto Benzo:

Well, you need to have the sense of connection with the first person. And unless you need to be there, this mark test, or the sense of connection and use that in the in the, in the in the in your inner heart saying I can work with this person, I feel like I can work with this person. So it's so it's so we need to be very careful about our connection, collaboration. And because everything is about the team, and so the thing is, so my recommendation is very deep. You know, as much as you can knowledge of that, you know, person that you bring in, make sure that you express yourself about what you want to do. And that this communion into that. I think everything started there. I think.

Victor Montori:

It's incredibly hard, I mean, just during our conversation I had in my own computer, multiple alarms, alerting me of different things that are coming up and there's a lot of a lot of things competing for our attention, a lot of things trying to take us away from the present. And and it's it's incredibly challenging. I have two more questions. Roberto, with all that openness to the present moment and the generosity for for you, you take care of patients directly. You might have found yourself in a situation where in taking care of a patient with you completely open. This was a a, you know, a hard, difficult emotionally challenging experience. How do you how do you handle that? Is there? Is there an Is there something that comes to mind in relation to that particular situation?

Roberto Benzo:

Thank you for the question. I think it's very appropriate because I think that we handle the patient as a team, I cannot really say how many times my, my, my assistant helped me a lot in the care of my patient in the nitty gritty of things. I mean, you know, I mean, yeah, of course, I wouldn't be willing to actually do 20 phone calls to the pharmacy to the insurance. So we need to make sure we have in a proper network. So the the physician assistant that work with us, the nurse that work with us, the our secretaries and us. So we're all in that sharing of that sometimes burden, because we're talking about Yes, kind of identify things of breathlessness on the show and talking about behavior change. But you know, this, this life the life that you're talking about is that or 20 phone calls that need to be answered. And we need to have a way to share that and to and they and the burden need to be light, not overwhelming because when the burden is overwhelming people get burned out.

Victor Montori:

That's that's the essence of our minimally disruptive medicine approach, and of this series of these KERCasts focused on care that fits. We've been talking to Roberto Benzo and we've learned quite a bit, Roberto, about you about what animates you about what animates your work about the challenge to how central to your work is authenticity, how central to your work, is generosity. It's been an absolute delight to chat with you. I have one last question to close this, this KERCast with you Roberto and to thank you for it. What's next for Roberto Benzo?

Roberto Benzo:

What now for Roberto Benzo. So, whatever is going on now is the foundation of my future. I really, you know, it's like it's bringing me to the what now What now? What actually entertain me. What? How different is my grief right now? How different is my passion right now? Where's that take me it is the stream, you know, is that, you know, I don't I don't push the river, I let the river just go into its own course. So the thing is that, yeah, so if I actually pay attention to it, I mean, I think that it will take me to the next step, presently, you know, presently, and so, you know, I don't think too much on 2030. I think about 2020. And I really want to kind of get with everything every every cell of my body, how much are we changing our life, everybody because of something that we never thought possible? COVID. So the thing is that this should be a wake up call that kind of we just need to be attentive, because we probably need very quick changes. I the last thing

I want to say, Victor, is this:

we need research that is done quickly, and will be done. So we can actually provide answers quickly to respond to the needs now. That's why I think NIH is changing to that kind of shorter, shorter awards. And to be able to actually respond quickly to the needs of the now. So what is now is the thing.

Victor Montori:

So what's next for Roberto Benzo is what is now. Roberto. What a wonderful, wonderful conversation. It's been absolutely lovely. I've enjoyed myself tremendously. Your presence through it and your generosity in answering the questions of those who join us today has been a demonstration of the words that you shared with us today. Thank you again for coming. Thanks, everyone who could join us live. And if you're listening or watching this afterwards, thank you for your attention. Don't miss the next KERCast produced by the Knowledge and Evaluation Research Unit at Mayo Clinic and please take care.

Roberto Benzo:

Thank you so much.