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Emily Silverman: You're listening to The Nocturnists' conversations. I'm Emily Silverman. What makes a truly great doctor? Is it clinical reasoning, a can-do attitude, or something more intangible, like empathy, humility and the ability to listen? In an era of AI-driven diagnostics and increasingly fragmented care, the art of medicine remains deeply human, shaped by relationships between doctors and patients, and mentors and trainees. Today, I'm joined by Dr. Marcy Bolster, Dr. Jason Liebowitz, and Dr. Philip Seo, three rheumatologists and educators who set out to explore this very question in their new anthology, A Masterclass in Medicine: Lessons From the Experts.

The book is a collection of essays written by some of the most revered clinicians in medicine, many of whom are Marcy, Jason, and Philip's personal heroes. Through personal storytelling, these physicians reflect on the defining moments of their careers, the lessons learned from mistakes, the challenges of uncertainty, and the enduring power of medical humanism. In my conversation with Marcy, Jason, and Philip, we talk about how they came up with the idea for the book, how they selected the master clinicians featured in its

pages, the role of mentorship in shaping great doctors, how learning from failure fosters growth, the evolving challenges of modern medicine, and the essential qualities that define true clinical excellence.

If you've ever wondered what separates a good doctor from a great one. This episode is for you, but first, take a listen to Jason reading an excerpt from their anthology, A Masterclass in Medicine: Lessons From the Experts.

Jason Liebowitz: in 1891, Luke Fildes completed his painting, The Doctor, a work that is considered to be one of the most significant depictions of the practice of medicine in the annals of art history. In this painting, a young girl appears pale and listless as she lies with one arm draped over the side of her bed, her eyes closed and her body still as she languishes from illness. In the background, her parents despair. The mother sits with her head buried deep in her arms, hands clasped together in a sign of prayer. Her father stands with his palm on his wife's shoulder while he looks expectantly toward his daughter and the man sitting next to her.

The seated man is a physician. He leans toward the girl with hand on chin, wearing a look on his face that is a mixture of intense contemplation and consternation. The artist has illuminated the figures of both the girl and the doctor, clearly drawing the viewer's attention to these two individuals and making them appear almost celestial. The painting is frequently shown to medical students, and one would be forgiven for thinking that it was based on real-life events in which a brilliant doctor is able to solve this patient's medical mystery and provide a cure.

However, the true story is much more complex and surprising. Fildes was inspired by his own family's tragedy in which his one-year-old son, Phillip, died of typhoid fever on Christmas morning in 1877. The son had been visited by a doctor as he lay dying, and although the physician could not save Phillip's life, Fildes was moved by the compassion and worry

that the doctor displayed on behalf of the young boy. As you will read in the chapters of this book, medicine is not always about finding the right answer or providing a specific treatment that resolves a medical condition.

Instead, the practice of medicine is so often about the development of a deep and meaningful relationship between two individuals, a bond that is multifaceted and frequently evolves over time. Doctors often meet patients and their families in times of great need, and through the combination of empathy, cooperation, and a willingness to truly listen, they seek to

provide the emotional and spiritual support that is as much a part of a person's health and well-being as is their response to a particular medication.

Our goal for this book is to allow for physicians, widely considered by colleagues, to be master clinicians, to share their stories and reflections on what has allowed them to achieve this level of clinical excellence. When we approached these doctors with invitations to pen a chapter, each one protested in calling themselves an expert or master clinician. The academic achievements and reputations of these authors clearly demonstrate that they are indeed among the best and brightest of physicians. However, their chapter contributions reveal a quality that they all possess, and that, as you will see in reading this book, is essential to good doctoring, humility.

Indeed, as these incredible physicians write eloquently on such wide-ranging topics as dealing with uncertainty, communicating and collaborating with patients, respect and more, you will see that their most profound lessons routinely come from unexpected sources, including their own mistakes or personal tragedies. With introspection, humor, creativity, and a refreshing openness, these physicians describe in rich detail what it means to develop one's own skills as a lifelong learner, mentor and role model while providing truly outstanding and humanistic care for patients.

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Emily Silverman: Jason, Phil, and Marcy thank you so much for being here today.

Jason Liebowitz: Thank you for having us.

Emily Silverman: Jason, you reached out to me several months ago to tell me about this book, this anthology that you were putting together. When you sent me the names of the colleagues who you were working with, I noticed that all three of you were rheumatologists. That made me very happy because this is a book about clinical excellence. I found that, as I was coming up through medical school and residency, a lot of my favorite doctors, the doctors who I felt were amazing diagnosticians, excellent listeners, critical thinkers, these were the clinicians that I looked up to.

I actually almost became a rheumatologist. I came very close to applying for fellowship. In the end, I didn't end up going down that route. All of that said, I was wondering how to open this interview. I was thinking, three rheumatologists walk into a bar and start talking about clinical excellence. How did you come together and get the idea to put together this book?

Jason Liebowitz: Thank you so much for having us. It's really an honor and a pleasure. I'm a long-time listener and big fan of the podcast. Great to hear about your own passion for rheumatology. Even though you didn't become a rheumatologist, I'm sure it's sprinkled throughout your clinical interactions with patients, and actually speaks to the story of, I'll tell my story, and Phil and Marcy can share as well, so many of the things that I think drew me to rheumatology, or what you've talked about and what we try to get at in many of the essays in this anthology, rheumatology is a field that I think, above all else, feels the closest to medical mystery solving as you can get.

We really have this wonderful opportunity to help patients who are often struggling with mysterious, systemic, unusual symptoms, signs. They and their families are not sure what's going on. They've often seen many different doctors. The skills that make for a excellent rheumatologist, a willingness to really delve deeply into the stories that patients tell us, to think broadly, to be a great internist and think about not just within our own specialty, but other specialties or diseases or organs that may be involved in this patient's disease. It really feels like rheumatologists, even in 2024, try to be a master clinician, as you would have found 50 or 100 years ago, in terms of that nuance and subtle understanding of what's going on. That certainly is something that drew me to rheumatology. Maybe Marcy and Phil can share their stories as well. I

Philip Seo: I always tell trainees when they're thinking about rheumatology that it's a great field for people who want to get advanced training in internal medicine but don't want to pick an organ. I remember being in a position trying to find a field and thinking about cardiology, but also knowing I didn't want to just concentrate on the heart and forget about the other organs. There's a famous clinician in Johns Hopkins, who ran our CCU for many years. He was famous for saying, "Below the diaphragm, I don't care." He just wanted to hear about the heart. Didn't have an opinion on the management of anything else. He completely deferred that to the house staff. Rheumatology is one of those fields where you can't afford to do that. That, as a rheumatologist, I need to know a little bit about everyone else's fields because everyone else's fields might integrate into my own, so I think it makes us natural clinicians.

The other thing I think, is that rheumatology is probably the last great frontier of internal medicine because we simultaneously have the most tests, and we're most likely to ignore all the tests that we get. That we are the people who tell you to ignore the ANA or to ignore the ANCA, or don't worry about that angiogram that says that patient absolutely has vasculitis because they don't. We know that because we've examined the patients, and we talked to the patient, and we've been able to make a clinical assessment that goes beyond the tests that we have available currently.

Marcy Bolster: Emily, thank you for including us and inviting us. It's a pleasure to be here with you and with Phil and Jason. I have very little to add to the beauty of rheumatology because it's been so well stated by Jason and Phil, but I will say that one of the other aspects of rheumatology that I really value is the patient-centeredness of it. As Jason mentioned, it's about the stories that patients tell. By putting the patient in the center and listening to the story and trying to find the nuances of the story and the exam to put the story together, often even before the labs are delineated, I think there's a real treasure in that.

Emily Silverman: The title of the book is Masterclass in Medicine: Lessons From the Experts. Maybe starting with you, Philip and Marcy, since you're a little bit further on in your careers than Jason, why this book? Why did you feel that there was a need to put together pieces of writing with wisdom and advice from clinical masters?

Philip Seo: I will start by complimenting you on the very delicate way that you indicated the age difference between us and Jason. That was very kind of you, and I appreciate that. With age, comes perspective. It's an interesting counterpoint to many of the discussions we currently have in medicine, in particular, where we've been talking about the enormous potential for artificial intelligence to take the place of many of the activities that are currently conducted by physicians. I think what that conversation missed is the fact that humanistic intelligence is actually so crucial to what we do. That's the interaction with the patients, in particular, that I think is getting lost in those conversations. There's so much that is learned by time with experience. I think that that's what these clinicians had to offer. Their perspective and the lessons they learned through the mistakes that they've made. That's really just such a precious gift for us.

Marcy Bolster: I came onto the scene late in the design of this book, so I will credit my colleagues, Jason and Phil, with coming up with the idea and putting forth the proposal. I was invited by the publisher to provide feedback on the proposal and to review it to see if it was something that should be published. As I read the proposal, I became more and more interested and enthralled, and thought, what a fabulous idea this is, to be able to share the wisdom of master clinicians with people at all stages of training because the master clinicians have such great stories to tell, and there are so many.

Certainly, we didn't include all the master clinicians. We couldn't possibly, but in reviewing the book proposal, I decided I really wanted to be part of this project that sounded like a

very interesting and fun project. I actually spent a long time crafting about a three-sentence email to Phil and Jason to ask if they would consider including me as a co-editor. I got an email back within probably 10 minutes that they were delighted to have me join. It's been a wonderful collaboration, and as with many things that we do professionally, it's a way to grow for each of us. I certainly grew a lot by reading and providing feedback to these master clinicians on how to tell their story in a way that would be appealing to a very broad audience.

Emily Silverman: How did you go about identifying the authors for this anthology?

Jason Liebowitz: One of the joys of putting together this book was the opportunity to honor and work with some of our own personal heroes. I think we can all speak to this. The very first people that we reached out to were the clinicians who've most inspired each of us in our own personal journeys. I can mention Dr. David Hellmann, Dr. Roy Ziegelstein, who are some of my heroes in medicine who I interacted with substantially as a medical student, and then as a resident and a fellow, who, for me, really role modeled and exemplified what, in my mind, it meant to be a master clinician.

Then, from there, it was a little bit friends of friends. I think some of the authors that we reached out to were referrals from people who we personally admired and had a personal connection to. It was really a wonderful way to reach many clinicians who we had never personally interacted with or professionally been aware of. We did also identify some fairly well-known physician writers. Suzanne Koven is someone I know you've had on this podcast, who's the writer in residence at Massachusetts General Hospital, who wrote a beautiful book Letter to a Young Female Physician, which I highly recommend. Perri Klass, who wrote the forward for this book is well known and has been writing for many years, and is known to many readers. Rita Charon, who's at my institution, Columbia, who's actually the mother of the entire field of narrative medicine, and wrote an absolutely beautiful, artistic chapter. We started with our personal heroes, and then through that, we were able to find other incredible clinicians and writers.

Marcy Bolster: I agree. It was really an opportunity to invite personal heroes. That would include my closest mentors, which would be Rick Silver, Nancy Allen, Steve Paget, and others who I dreamed of getting to know. I knew of their work and of their philosophy and of their teaching, and really just wanted to see if they'd accept the invitation and contribute.

Philip Seo: One of the wonderful things about this book is that we've been able to take our personal heroes and given them a much broader stage. The example I was thinking of is Rick Silver, who is a personal hero of mine. I've heard him speak for years on medical humanism and the interaction between art and medicine. I'm just so glad that his wisdom is now getting to a much broader stage.

Emily Silverman: After putting together all these essays, I was wondering if each of you could tell me about an essay that you were especially drawn toward. Maybe it was something that taught you something new, or something that surprised you, or something that articulated an idea that you had been thinking about for a long time, but maybe they put it into words in a particular way that you found helpful. I'm starting with you, Jason. Tell us about some favorites. Which essays have changed you?

Jason Liebowitz: Obviously, every chapter in this book is phenomenal. I'm not going to pick a favorite, but I would like to speak about the chapter on empathy. I've heard from so many people about how this chapter has really touched them. Just to give a little bit of background, the chapter on empathy is from Dr. James Kahn who is in Internal Medicine at Stanford, actually someone who we had never met before or were aware of. I think he actually did some of his training at Johns Hopkins, but we were referred to him in the process of finding authors for these chapters, and he very quickly said he'd like to write a chapter on empathy.

I think what's so striking about this chapter is his willingness to be vulnerable, his incredible openness in making this not just a very academic meditation. In particular, he describes his own process of understanding what it means to truly be empathic, not just as a physician, but as a son, when he's with his father in the hospital in the last few minutes and hours of his life. When he challenges himself to be truly present for his father, to be not only what his family is asking him to be, where they were, asking him to be the doctor in the family and help make medical decisions but to also just truly be physically, emotionally, and spiritually present for his father in these last moments of his life, and to be willing to

experience all of the emotions that run through each of us when we're in the final moments of a loved one.

I think it was just such a incredible feat of courage to see a physician who's clearly regarded as a master clinician, and very easily could have written a whole chapter about empathy from a much more intellectual standpoint. I found that extremely powerful and meaningful.

Emily Silverman: How about you, Marcy? Any chapters that stuck with you?

Marcy Bolster: There were so many chapters, actually. Our first chapter is called The Good Doctor, and I think that brings great perspective to the book. David Johnson wrote this chapter on defining what is the good doctor. I think there are so many different ways that he brings out in trying to define the good doctor. Everybody wants a good doctor, and I think people look at that definition differently.

He talks about how patients say they have a good doctor, and what does that mean? Does it mean that it's somebody that they get along with? Is it somebody who listens to them? Is it somebody who's competent? There are so many levels of good, and you want somebody who does all of these things. It's a delightful chapter to read, and I will just read the very last two sentences. "Good doctors are defined by what they do when no one is looking. That is why it is so difficult to define the good doctor. Hopefully, you'll know it when you see it." He takes a very interesting perspective on trying to define something that is so hard to define.

Philip Seo: For me, I'm going to single out a chapter written by David Pisetsky, which lands right in the middle of the book. I hope that doesn't cause people to overlook it because it really captures an era of medicine that is long gone. I would say, good riddance. I'm not quite as old as David Pisetsky, but I certainly remember training in a day before the 80-hour work week, when perhaps trainees were given a little bit too much freedom and not enough supervision. David took a chapter from his particular training that would never occur nowadays and talked about a scenario that he ran into and how he managed to fumble his way through it.

One of the reasons why I like it is, of course, it makes me nostalgic for my own training, but the other reason is because I think it highlights one of the themes in the book, which is the power of making mistakes, the fact that no one is really born as a master clinician, that we all learn by stumbling our way through different scenarios and hopefully taking those as moments to grow and to become a better physician than we started. I think that David just took a humorous take on that lesson.

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Emily Silverman: These moments of growth that you're referring to, there are so many of them across a medical life. I can think of so many examples from my own practice. Sometimes specific patient cases or stories, but even moments, even phrases that have stuck with me. This one is random, but I'll never forget there was a nephrologist giving a lecture, and at one point she was like, "The kidneys can really dump phosphorus." I don't know why, maybe it was something about the way she said it, but I remember writing it down. I still have it in my notes, and when I am reviewing calcium and phosphate metabolism and the way it's handled by the kidney, I still always remember her voice and the way that she said that. Just for some reason, it's a flashbulb memory for me. It's a bit random. I'm wondering if there are any moments for the three of you, whether they're quotes or passages from this book or maybe something from a mentor who said something to you or nudged you in one direction or another, that stays in your memory and that helped form you as you became a clinician.

Marcy Bolster: I'm going to pick up again on Rick Silver's chapter on humanism. He is a mentor for me, and he talks a lot in his chapter about being at the bedside with the patient. I'm not sure I understood the true value of it as a medical student, and I've learned it even more so as a faculty member who is teaching medical students, residents, and rheumatology fellows, that being at the bedside has so much value. It puts the patient at the center. The team, they're gathered around the focal point, which is the patient. They're not sitting in a conference room somewhere.

The patient can interact. The team listens. Anyone can ask a question to the patient. We can review nuances of the patient's story together. We're all hearing it at the same time. We can examine the patient together, and someone can point something out because the patient is there. Someone else can show a technique for examining the patient, and we can come up with a plan that can be discussed with the patient. The entire process is very patient-centered. Rick influenced me, as a rheumatologist, to always have the presentations in the clinic at the bedside.

I then went to a presentation, a talk at a conference, and there was someone talking about bedside presentations on the inpatient side, which I had not been doing as a rheumatologist on the consult service. It was game-changing for me. I thought, "How could I possibly have missed that opportunity? I'm going to try this. I'm going to see how this works for me and for the team." I love it. It's great. It just is a reminder of why we're there, taking care of the patient. There's so much learning, and there's so much value to the patient as well.

Philip Seo: Along those lines, I'm going to reference David Hellmann's chapter, where he tells an anecdote about the importance of asking the patient what they think is going on and what they think that they have, which I've known David Hellmann for literally decades, and I've never heard him say this particular phrase before, which really stuck with me. I don't want to tell his anecdote because I don't want to steal his thunder, but I'll tell you an analogous anecdote from the days when I was an assistant chief of service at Hopkins, which is analogous to being a combination, teaching, attending and chief resident at the same time. You're attending on your own internal medicine service after recently having graduated from your own training program.

My colleague on his team just admitted a patient who, after an intensive evaluation, they realized had Marfan syndrome. They got medical ethics involved, and consultants from genetics. They were getting all their information together and finally walked into the patient's room so that they could present a unified front and give him the serious news that they realized he had a genetic disease called Marfan. The patient looked up and said, "Oh, my brother, has that." [laughter] When I read David's chapter, that lesson definitely resonated with me in a way I wasn't expecting.

Jason Liebowitz: Dr. Hellmann is one of my true heroes in medicine. I remember being a medical student on my medicine clerkship. I should put this a little bit in context. The first two years of medical school for me were tough. I did not do very well on a number of exams. I found it to be this fire hose of knowledge that I was trying to engulf but struggling to do so. I entered the clinical rotations having been humbled by those years and hoping maybe I can turn the corner at Johns Hopkins Bayview, where I did most of my medicine rotation, and ultimately would go on to be our chief resident there.

As a medical student, you got to be involved in chiefs' rounds. Dr. Hellmann was, as a chair of medicine, one of the chiefs who would go to the bedside with a team, and either a medical student or an intern from the team would share a patient's story. Really, it was meant to be not just the medical details of that story, but also getting to know this

patient as a person. I remember I was a medical student assigned to a patient who was a young man who had really severe Crohn's disease and was struggling so much, had not yet received effective biologic treatment.

He was a young man who truly loved doing things with his family. He was an avid hunter, and he'd really lost the ability to do any of the things that brought him joy and meaning in

his life. As a medical student, the most I could do is probably collect his story and share it with the team and try to incorporate the medical facts. I did so. Dr. Hellmann asked me to meet with him later that week, or the following week. He called me into his office. I was thinking, "Oh boy, another thing I probably did wrong, and he's going to give me some constructive criticism to get better."

He actually told me, "You did actually a really great job of sharing this patient's story. I think you get what we are trying to do with these rounds, which is humanize medicine and make it not just about the medical details of a patient, but about their life story." He said this one phrase that has carried me through the rest of my career so far, which was, "I want to be the wind in your sails." It was just what I needed to hear as a third-year medical student who had struggled in my pre-clinical years. It really felt like turning the corner and feeling like, you know what? Clinical medicine is something that I can engross myself in, and maybe I have some natural ability or talent that I can inculcate with the right mentorship and the right training. It's certainly something that I appreciate so much, having someone who you so respect and admire giving you those words of encouragement that really propel you forward.

Emily Silverman: Marcy, you've been training rheumatology fellows for a long time. In your bio, it says that you've trained over 70 rheumatology fellows. I was just thinking about that. It's easy just to say, "Oh yes, I teach," but these are generations of rheumatologists who have been touched by you and who go out into the world to take care of people. It's just really staggering. I wanted to start just with a word of acknowledgment and appreciation for all you've done for medical education, and then ask you to reflect, maybe. I'm sure you serve as a hero for some of these people, as a role model, the same way that you're talking about having role models of your own.

How do you think about educating the next generations? When you see people come up in the system, and the system has changed a lot in the last 10, 20 years, there's a new set of challenges in 2024 different than there was in 1999, for example. The composition of medical trainees is changing, people coming from all different walks of life, many more walks of life now than before. Now, as Phil mentioned, we have a lot more technologies to use. There are so many more drugs on the menu in rheumatology. It feels like every day I'm watching TV and there's a commercial for some new drug that I've never heard of. How do you think about educating the next generations?

Are there any common mistakes or mindsets that you see that you work on helping people along their growth curve, or any particular strengths, things you look at in a trainee when you're like, " Yes, that person gets it."? Just wondering if you could reflect a bit about being an educator.

Marcy Bolster: Wow. Thank you, Emily. I have been at this a while, and it's just so much fun. I really love what I do, and things do change. The learners change, the environment changes. Certainly, it's very palpable to think about what it was like during the height of COVID and the learning that had to happen that was so different then, but I think it helped us realize how adaptable we can be. I would say, when I approach medical education and the generations of learners, I really try to embrace the challenge of it. By embracing the challenge, it helps me want to solve the problems or come to resolve or find new levels of excellence.

When fellows start in their training program with me, or if I'm meeting someone in a different training program, my approach is I want each fellow to become the best possible rheumatologist they can be. That's a patchwork of lots of different influences. If I can have some small influence on somebody, that's fantastic, but it's not about me. It's about how can I create an environment where they can have influence from lots of different people, both within the institution and outside of the institution, so that they can have all the opportunities possible to incorporate into their own being to be the best possible rheumatologist.

I actually had one fellow walk into my office very early in his fellowship and say, "Dr. B, what do you think makes the best rheumatology fellow? What do I need to do?" I said, "You just need to be a sponge. You need to absorb everything around you, listen to the conversations other people are having about patients, and ask your own questions or go read about that." All of this comes together to say, I think the challenges that we face with new technologies and the ability to use telehealth to take care of patients, not just to take care of the patients across the street from the hospital during COVID, but to reach out to underserved communities and to people who don't have the same access to healthcare.

It's really to embrace how do we use these technologies to expand the way we do things, and how do we train our trainees who are going to be the new entrants into the workforce, to embrace these new technologies. As Phil said a few minutes ago, we're grappling with AI, and I think this is exciting. How can we explore AI to enhance what we're

doing?

Emily Silverman: Rheumatology is an interesting field because there is still so much that we don't know and that we don't understand. Like you were joking, Phil, there's all these blood tests that we order in rheumatology, and often we ignore a lot of the results, or we say, "It doesn't matter unless--" or really looking more at the full picture. It's not just the blood test, but it's the blood test and the symptoms. It's not just the blood tests and the symptoms, it's the blood test and the symptoms over time. What do you see as some of the most interesting unsolved mysteries in rheumatology? Maybe things you hope to see resolved in your lifetime, or maybe in the next generation. Now that we have all this technology, we can use AI to understand how proteins fold in two seconds, whereas years ago, it took years and years to even understand how one protein would fold. The pace of acceleration of our technology is so high. How do you see this impacting the field?

Philip Seo: In medicine, as you know, there is a expression that uncommon manifestations of common disease are more common than common manifestations of uncommon disease. I think that that is a motto that we use, particularly in rheumatology, but I think in all fields of medicine when we look at a patient. The way I've been thinking about more recently is Seza Ozen, who is a pediatric rheumatologist, who is the head of the International Pediatric Rheumatology Group, recently said that what you think of as an uncommon manifestation of a common disease is probably a common manifestation of a genetic disorder that you've never heard of yet.

Those words have really haunted me because I think that what technology is really demonstrating to us is the limits of clinical phenotyping, which pains me to say, as an Ostler Marine because I was taught that the clinical evaluation tells all, but I think that we're now discovering, with newer technologies, and especially the ability to look at genetics and epigenetics, the fact that there are a lot of diseases that we assumed we understood, that are actually genetic disorders that are being caused by overlapping pathways and need different treatment approach and need to be assessed in a different way. I think we're just at the cusp of that with diseases like VEXAS and DADA2. I think those are just going to

become increasingly common.

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Emily Silverman: What do you hope readers will take away from Master Class in Medicine? How do you envision the book being used by students, clinicians, even patients?

Jason Liebowitz: Think we probably have two audiences that we're hoping that this reaches. We do want this to reach as many medical students, medical trainees. We were very honored to have a review of the book describe this as being something that every medical student should read at some point in their training, not because it gives you this one text that I read this book and I become a master clinician, but because it speaks to so many themes that I think are so important as medical students and trainees mature towards being the physicians that they aspire to be.

I think we're very hopeful that portions of this book might find a home in classes on the clinical foundations of medicine or narrative medicine, and that would allow people who are developing their skills and their habits as clinicians to really benefit from the stories and the wisdom that's shared in this book. Then I do think we also have the hope, and we're so honored to be on this podcast because hopefully, beyond just medical students or clinicians or healthcare providers reading these stories, I think there's so much that could be gleaned from this book by a much wider audience.

We're all touched by healthcare and medicine, whether personally, family members, friends. None of us will escape having interactions with the healthcare system, with medicine. I think the success of other books like How Doctors Think, many of the writings from physician writers like Atul Gawande or Abraham Verghese or Lisa Sanders all speak to a thirst among people far outside medicine or science to connect with the stories that we are privy to as clinicians, The stories of patients, the stories of medicine, its successes and failures, the uncertainty that we deal with, the learning from mistakes. So many things that every person deals with in general and would appreciate so much by reading these really poignant essays that have been put forth by these physician writers.

Marcy Bolster: I would add that when I think about this book, the one word that comes to mind is reflection. I hope that when people read the book, it gives them pause for reflection on what a student may hope to be able to achieve, or what a clinician has worked on in their own practice or aspires to achieve, or someone who is not a healthcare provider and can reflect on the experiences that doctors have and the goal of excellence that physicians hold so close to their hearts. The book offers the opportunity to look into the window of excellence for the clinicians that are writing these stories.

Philip Seo: I would just add to that. What I hope for this book is that people will not only read it, but they'll put it down for maybe a few years and then come back to it and read it again because, I think especially for people who are in training and becoming physicians of whatever sort, that the lessons of this book and the way that these essays will resonate with them will be different as they grow and they develop their own life experiences, and they see these stories through a different lens.

Marcy Bolster: We all received emails from the authors asking, "When is the book coming out? I can't wait to read the other chapters."

Jason Liebowitz: These are a group of people who are incredibly accomplished, the awards, the publications, the lectureships, and many contributing authors told us that this was one of the highlights of their career, that they felt so honored both to contribute to a text that included colleagues that they so admired and respected. I think it was also, honestly, in some ways, therapeutic and rewarding for the authors to reflect on careers that span, sometimes several decades, and think about those formative experiences, those patient stories, those personal stories. I think it was a great experience that the authors themselves really treasured, as Marcy and Philip said.

Emily Silverman: I think that's a great place to end. Can we do a quick lightning round?

Jason Liebowitz: Yes.

Philip Seo: Sure.

Marcy Bolster: Sure.

Emily Silverman: I wanted to do a lightning round because, as I told Jason offline, this is the first time I've done an interview with three people all in one, and I thought it'd be a fun activity to end on. We're going to go in this order. Jason, Marcy, Phil. The first question, white coat or no white coat?

Jason Liebowitz: No white coat.

Marcy Bolster: Depends.

Philip Seo: No white coat [unintelligible 00:41:05] than not.

Emily Silverman: Favorite drug to use in rheumatology?

Jason Liebowitz: Methotrexate.

Marcy Bolster: TNF-alpha inhibitors.

Philip Seo: Mepolizumab.

Emily Silverman: If you weren't a doctor, what kind of career would you have?

Jason Liebowitz: Ooh, history professor.

Marcy Bolster: My dream has been to have a retail store that sells gourmet everything and has a very high bar for excellence in all departments in the gourmet store, from food to wine, to serving dishes and all accessories for the kitchen.

Philip Seo: Constitutional lawyer.

Jason Liebowitz: Marcy, you should open up that store.

Marcy Bolster: You know what? Rick Silver and I talked about it.

Jason Liebowitz: I would be a patron.

Emily Silverman: Quick book recommendation. Could be most recent book or favorite book.

Jason Liebowitz: East of Eden, John Steinbeck.

Marcy Bolster: Educated.

Philip Seo: Tony Fauci's biography, the name which I can't remember.

Emily Silverman: Last question, which crystals are more beautiful? The crystals for gout or pseudo-gout?

Jason Liebowitz: Both are beautiful, and I can never remember the negative or positive birefringence. I always have to look that up.

Marcy Bolster: Oh, I'll share my trick with you. Gout. There is nothing more pleasing than that bright yellow crystal piercing a neutrophil.

Philip Seo: I am with Marcy.

Emily Silverman: This was a lot of fun. I really look forward to spending some more time with this book and learning more about the amazing clinicians who contributed to it. Thank you so much for going to all the work and effort to bring these people together, to inspire them to write in a different way, maybe than they typically write, and for creating what I imagine is a wonderful resource for people all across the spectrum of medical education. Jason, Marcy, and Phil thank you so much for coming on the show.

Jason Liebowitz: Thank you for having us. It was fantastic.

Marcy Bolster: Thank you so much, Emily.

Philip Seo: This is great. Thank you.

Emily Silverman: This episode of The Nocturnists was produced by Sam Osborn, with mixing and editing by Jon Oliver. Our executive producer is Ali Block. Our head of story development is Molly Rose-Williams, and Ashley Petit is our program manager. Original theme music was composed by Yosef Munro, and additional music comes from Blue Dot Sessions. The Nocturnists is made possible by the California Medical Association, a physician-led organization that works tirelessly to make sure that the doctor-patient relationship remains at the center of medicine. To learn more about the CMA visit cmadocs.org.

The Nocturnists is also made possible by donations from listeners like you. Thank you so much for supporting our work in storytelling. If you enjoyed this episode, please, like, share, subscribe, and help others find us by giving us a rating and review in your favorite podcast app. To contribute your voice to an upcoming project or to make a donation, visit our website at thenocturnists.org. I'm your host, Emily Silverman. See you next week.