The host of White Coat, Black Art tells us how his diverse career path has made him a better physician
What was it like to apply for – and get into – med school?
I entered med school in the late-70s, around the time dinosaurs ruled the earth. At that time, academic achievement was all you needed for med school. A good GPA, good MCAT scores. Today, of course, you have to find new and interesting ways to distinguish yourself: research, fieldwork, special projects, working in developing countries. We didn’t do anything like that. You just needed decent marks, and I had decent marks. If I tried to get in now, I’d probably have a much harder time.
Why medicine? Was it something you always wanted to do?
I have to admit, I wasn’t on a mission to cure the sick—I went into medicine because it was something a lot of my cohort did. I found my mission along the way. One of the nice things about medicine is the latitude to try a lot of different things. I originally wanted to go into paediatric neurology, but one day, while I was doing an elective at Johns Hopkins, I slept in and missed my chance to present rounds to impress my mentors. It was humiliating at the time, but a blessing in retrospect. I came back to Toronto wondering what I was going to do. I ended up in internal medicine, and towards the end of my residency had some friends who were moonlighting in emerg. They said I should try it out, so I did. And I liked it. And it liked me.
Why did you like it?
Best thing about emergency medicine, for me, was the shift work. It gave me time to write, and to pursue my interest in broadcasting.
Tell us a bit about how you got into journalism and broadcasting?
I wrote a series of articles on prescription drug traffickers, and that eventually turned into my first radio story on CBC’s Sunday Morning. And that was when I really caught the broadcasting bug. After that, I did a number of stories, and was eventually invited to teach a course at Ryerson on freelance documentary writing. From there, I worked with what was then called Alliance Atlantis to launch the Discovery Health Channel. But I never forgot radio, and when the CBC was developing new pilots for new programs, I pitched an idea that had actually been the concept for a book I’d been planning to write about the disconnect between what doctors say to patients and what they say to each other when no one is listening.
How did that evolve into White Coat, Black Art?
I turned the book proposal into a radio show proposal. And as I was developing the show with producers, one of them kept using this phrase: what’s the “black art” of this, what’s the “black art” of that? I kept imagining these doctors in white coats practicing the black arts. The pilot episode was all about why you have to wait so long in emergency. That show debuted in 2007, and today we’ve produced more than 250 episodes. Which is very unusual for this kind of program. It has become beloved to listeners.
You cover a lot of ground on the show—how do you generate that number of diverse stories?
Many of our stories originate with emails from listeners. Either from someone who has had a particular experience or is immersed in a particular issue. Why we have to tell that story is usually obvious from that email. The original premise of the show was to pull back the curtain on the world of medicine, but along the way our mission changed, and became about the people who are affected by the issues we’re pulling back the curtain on. I knew early on that we would explore the culture of modern medicine, but now, it’s more about the experience of the patient within the culture of modern medicine. And that ensures we have a never-ending list of story ideas. We carved out our own niche by exploring things like doctor bullying, aspects of death and dying, loneliness, physician burnout, PTSD acquired from cancer treatment. We’re also well aware of what people are talking about in the wider culture. Our show on the keto diet was one of our most popular in recent memory.
What skills from the world of broadcasting have helped you as a doctor (or vice-versa)?
As a broadcaster, I’m in the business of communicating clearly with a large audience, and, likewise, I’ve always felt it was important to communicate clearly with patients and their families. The difference between how I communicate in the examination room is simply this: there is a lot of bad communication that is forgiven in the examination room that is unforgiveable in broadcasting. When you’re on the air, you have to communicate clearly—failure is not an option. I try to bring that ethos to the examination room. Good communication is all about empathy. You put yourself in the place of the person you’re speaking to, and, when you do that enough times, you build a capacity for it.
Is that what inspired you to write your newest book on empathy?
Yes. I wanted to write a book about empathy in health care – we all know there are patients who have wonderful experiences and others who don’t – but there was so much great material that I wanted to take a big-picture view, and it expanded to become a book about empathy in the wider world.
What did you learn?
One thing I’ve learned in health care is that there are a lot of factors that get in the way of empathy and kindness. Burnout, stress, time-pressure, sleep deprivation. The pertinent thing for med students to understand is that they have the highest levels of empathy when they enter med school—and the lowest when they exit. That’s something that the new generation of physicians will have to find a way to overcome.
Has your second career helped you to maintain your empathy?
You don’t have to do something outside of medicine that directly feeds into it. But if you have that second career, or that vocation, it can really nourish and regenerate you. On your most bleak days as a physician, you can say: I’m also a good cook, I’m a great cyclist, I love painting. Whatever it is, you want it to free yourself from the stress of being a physician, allow your mind to calm down. You want something that will nurture you. I’m not the best doctor. I’m not the best writer. And I’m not the best broadcaster. But I might be the best doctor/writer/broadcaster.
Where do you see yourself ten years from now?
Still writing books, still doing the show. We’re serving an important service – improving health care by calling attention to what works and what doesn't – and I see myself writing more stories about what drives physicians to do bigger and better things, more stories about how patients and families can overcome huge odds to find help, more stories that focus on the shortcomings of the medical system with aim to solve them. The role of physicians and how they practice is evolving – there are more apps, more technology, more diagnosis power in the hands of patients – and I want to help point the way to the future.
Up Next: Dr. Brian Goldman gives us his unique perspective on where the health care system is going—and what we can do to fix it.
Dr. Brian Goldman
Dr. Brian Goldman is a veteran ER physician and award-winning medical reporter. As host of CBC Radio’s White Coat, Black Art, he uses his proven knack for making sense of medical bafflegab to show listeners what really goes on at hospitals and clinics. He is the author of The Night Shift and The Power of Kindness: Why Empathy is Essential in Everyday Life.