Richard Gunderman, MD, PhD

By Richard Gunderman, MD, PhD
ISMA President-elect
ISMA Wellness Steering Committee Chair

Co-authored by Kian Naimi Shirazi
MS-IV IU School of Medicine

Many physicians appreciate the perspective that health does not end at the skin – that the health of each person is deeply shaped by relationships with others, as evidenced in the US Surgeon General’s 2023 report, “Our Epidemic of Loneliness and Isolation.” Yet to some, putting such insights to work in medical education and practice appears daunting.

To incorporate togetherness into practice, it is helpful to shift attention away from statistical associations derived from large epidemiologic studies and instead focus on the practice of individual physicians and educators. So much of learning in medicine is grounded in emulation, and having good role models can make all the difference.  

One such role model is John Tang, DO, a professor of gastroenterology at the Indiana University School of Medicine. According to students who have worked with him, Dr. Tang is an apostle of togetherness, someone who goes out of his way to foster fellowship among members of his team.

One student, on the first day of his GI service, reports that Dr. Tang immediately took him to the hospital coffee shop so they could get to know one another – and this approach is not confined to orientation. Says the student, “This is the way he teaches and mentors, practices medicine, and treats people in general.”

When Dr. Tang enters the team room each day around noon, his first question is, “Have you eaten yet?” He makes sure the members of his team are well-nourished daily, regularly taking them to the cafeteria and ensuring they find the time to sit down together and enjoy good conversation while they eat.

The technical term for this practice is commensalism, from the Latin roots meaning sharing a table. Even during the busiest weeks, when the census is high and the team is short-handed, they gather to enjoy table fellowship. And at day’s end, he often offers a coffee, recognizing that for the students, the day’s studying is just beginning.

During these conversations, he emphasizes to the assembled learners his philosophy that medical education cannot be passive. Instead, it must be active. Students should not endure but embrace their education, not only doing required work but seeking out opportunities to contribute and learn more.

Dr. Tang proudly considers himself someone who welcomes consultations and other forms of work as opportunities to learn, foster expertise, and build connections across different medical fields. Nuturing such reputations and relationships, he says, always pays dividends in ways that can be difficult to foresee.

He regards competitiveness, back-biting, and cynicism as the plague. Instead, he says, each medical student, resident, and physician needs to promote a sense of unity.  Just because we do not understand or agree does not mean that someone else is wrong. We need to remember that we are all in this together and everyone is trying to help the patient.

Others often ask Dr. Tang why he seems so happy. He is not sure that he truly is happier than others, but he does understand the importance of some things, one being work-life balance, something he was focusing on long before attention to physician well-being became popular. To thrive as a physician, it is important to thrive as a person.

If colleagues see each day of work, or their career as a whole, as a sentence to be served, like time in prison, it will prove impossible for them to find fulfillment in their work. But if we embrace medicine’s many opportunities to work together for the good of our fellow human beings, we can learn to love it.

A key step in this direction, Tang says, is to embrace what it means to be an attending.  Our mission is truly to attend to our patients and our colleagues. When they ask a question, we need to be fully present in answering it. For him, it resembles a meditative practice – being fully attentive to the one we are with, something we can learn to embody more fully over time.  

Tang credits his training in osteopathic medicine for this insight. As a practice, he creates space and time for connecting with his team and encouraging members to ask questions and share experiences as fellow physicians, especially over a meal or coffee. 

At the table, there is no hierarchy. Everyone is there to learn, to improve, and to bring out the best in fellow team members. The emphasis is on community and collegiality. Again, we are not competitors but colleagues, depending on one another to ensure that our patients are well cared for, the ultimate source of professional fulfillment.

Eventually, one of the students reports, all members of the team begin to feel that they are important collaborators and contributors to patient care.  At the same time, instead of needing to prove themselves, even medical students, the least competent members of the team, are welcomed as colleagues, not inferiors.

Tang is on to something, fostering a sense of togetherness that dissolves loneliness, fear, and resentment and replacing them with a sense of genuine camaraderie. By daily practicing what he preaches, he serves as a living embodiment of the truth that, at its best, the practice of medicine builds deep friendships and community.