BJ Miller: How Do We Reframe Suffering and Find Our Unique Joy? (#97)

Our Guest Today: Dr. BJ Miller

[updated as of August 2020] Dr. BJ Miller launched Mettle Health.

If you’re a patient or caregiver dealing with serious illness, end-of-life issues, disability or loss, you know how challenging it can be, and so do we.

A lot of the work of being a patient or a caregiver is understanding your options, making tough decisions, and decoding medical language.

That’s where Mettle Health comes in. We’re palliative care specialists from a variety of backgrounds. Whether you’re facing an immediate health challenge or a long-term situation, we’re here to provide guidance so you can make sound decisions.

Dr. BJ Miller is a Palliative Care physician at the UCSF Medical Center. His Ted talk in 2015, What really matters at the end of life was watched by nearly 5 million people worldwide. Death has never been a popular subject, why would so many people want to listen? “BJ Miller thinks deeply about how to create a dignified, graceful end of life for his patients” because we need embrace the subjective. People are transformed by illness. Death is in fact part of life. It is one of the few things we all know for certain. What do we do about this?

BJ answers all the questions you too should know more about. The knowledge and wisdom of how we live and how we die can benefit everyone. Not just the people who are suffering.

From BJ’s origin story as a wounded healer, to choosing to attend medical school after the accident, to an invitation to speak at the main Ted event in 2015 (and the brutal preparation behind Ted, which many people don’t know about), this conversation is very much two friends on a coffee break.

“People Are Transformed by Illness. Death Is in Fact Part of Life.”

BJ took me on a journey of uncovering so much more of who he is, not just a guest every popular show wants to feature with a message to convey in 30 seconds or less. With that in mind, I asked BJ a difficult question – How does he navigate, and how does he feel about the attention from major media? Which part excites and worries him?

I met BJ at the Robert Leffert MD Palliative Care Memorial Lecture in December 2016, which has attracted hundreds of medical and non-medical professional over the years. I want to take a moment to dedicate this episode to the Leffert family – Linda Leffert, Adam Leffert, Dr. Lisa Leffert, Dr. Lee Schwamm, and Dr. Vicki Jackson at MGH.

Watch BJ Miller on Ted

Show Notes

• [06:00] How was the experience of speaking at MGH, memorial lectures?
• [08:50] What do you think about our (natural) tendency to prejudge people?
• [11:30] What is palliative care, and what isn’t? How do you explain it to your patients, friends, etc
• [15:00] Can you share your story? The one behind the TED talk?
• [21:00] How challenging was to study medicine after your experience?
• [24:00] Can you share with us how was to prepare your TED talk?
• [33:00] Which part excites you, and which parts worries you about being a public figure and being in touch with media.
• [40:00] How do you deal with the trade-off of keeping some ideas to yourself and spreading them without fear of being judged because other people don’t agree?
• [46:00] BJ commenting on Fei’s experience breaking the tradition behind her father’s funeral.
• [48:00] What do you see as the future of your work? How can people get more familiar with your work and how can we can start doing something to contribute?

Favorite Quotes

• Suffering can be a joining force, instead of a dispersing one. Philosophical, spiritual, scientific, all angels of the subject in a swirl everyday. You work on the professional subject and it helps you personally, in a sweet way.
• You go through your body, soul, you never would imagine you’d go through. [You build a ] kernel of new confidence. Imagine going through [something] sometimes is harder than going through it [in real life].
• The injury took from me, but also gave a lot. It became a frame of reference. Medical school didn’t seem so hard. Life isn’t an easy path. Life is no easier than med school. Sitting around, I would have a harder time looking at myself.
• You bounce around in language and frame of reference.
• The subject (palliative care) is thirsty for attention. Palliative care needs better branding. It impacts all of us.
• Life is not an easy path, period. Even if you take the path of least resistance, you are going to have the vagaries and insecurities and shocks to your confidence, and wondering who you are.
• It’s in front of us, 100% of us die, it is going to happen, it IS inevitable and, somehow, someway, we figure out a way to avoid that subject, somehow we figure out a way to keep it feeling like death is optional.
• The more we all talk about it, the more light we shine on it. Who knows what’s possible? I don’t have all the answers, I just get to ask questions and provoke people.
• To have more Zen hospices in the world, there’s a policy issue, there’s an awareness issue, there’s a work-force education issue and there’s a system’s issue, so I’m trying to move in all four fronts.
• The healthcare system is doing exactly what it’s designed to do, and the doctors are doing what they are educated to do. Unfortunately, they are not educated to have difficult conversations, or to help people yield things that cannot be changed, or help people to find perspective when there is suffering. These things are not taught in medical school and yet this is the subject matter in any clinic, any day of the year.

Recommended Listening

• Tim Ferriss’ Interview with BJ Miller

Credit: Music by Florian Bur