Burn the Map with David Elkin, MD
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What is the background of Dr. David Elkin and the purpose of this episode?
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This is The Nocturnous, Stories from the World of Medicine. I'm Emily Silverman. Today I talked to David Elkin. David grew up outside of Philadelphia, earned his MD from the University of Pennsylvania, and after a false start in internal medicine, completed his psychiatric training at UC Davis and received a master's in the study of law from UC Hastings. A clinical professor at UCSF, he's worked at SF General for over 30 years on the Psych Consult Liaison Service, which he now co-directs. He's also served on the Hospital Ethics Committee and for many years anchored both the Physician Well-being committee and the Schwartz Rounds at SF General. But before we chat with David, we'll hear the story of how an improv workshop transformed his interaction with a patient on the psych consult service.
Here's David.
So I'm standing in a doorway. In a hotel in downtown Denver. It's one of those meeting rooms that could be anywhere. Um it's a large ballroom. We've all seen them at conferences. This conference is on medical education, and it's the first day. I'm tired. But I'm looking through the schedule, I'm trying to decide what to go to, and I get a phone call from a colleague back home. Complicated ethics consult. And I'm twenty minutes late. I look through again. Two of the workshops seem really dry. So I picked the other one. It's on improv comedy. And I figure, okay, that might be good for a few laughs. I'll sit in the back of the dark room, watch some PowerPoint. You know, if it's really boring, I can take a little nap.
I push open the door. And now I'm really confused. There's no dark room, there's no power point. The lights are fully up, people are milling around. And I realize to my horror it's an experiential workshop. And I've missed the instructions. So I turned to leave. But curiosity gets the better of me. And I try to take the whole scene in. So off to my left. There's about six people and they're apparently forming a pirate ship with a table. And I can tell it's a pirate ship because one woman is leaning off, she's the pirate captain, she's yelling our she's hanging off the mast, which is some other guy. They're laughing. In the middle of the room, there are about two dozen people, and they've amazingly self-organized into a ceiling fan.
There are about five people in each spoke and they're each they're all just revolving in synchrono perfect harmony and synchrony, counterclockwise. There's a woman in the middle, and I recognize her as like the assistant or associate dean of education from some med school back east, and she's on her back. And she's deliriously laughing as she goes around in a spiral on her back. To the right there are four people and they're forming a toaster. Someone says ping and the two people in the middle jump up. Okay, I've seen enough. I'm turning but it's suddenly too late. My colleagues recognize me, they wave me over, I can't escape. The door closes with a thud behind me. I join a group of people, I'm very trepidatious.
They're making a refrigerator. They've already made the refrigerator though, so I think fast, I crouch down. I'm the freezer. And I'm wondering What am I doing here? It doesn't take long to figure out why I'm here.
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Chapters
8 chapters
1
What is the background of Dr. David Elkin and the purpose of this episode?
0:00–6:02
2
How did an unexpected improv workshop change Dr. Elkin’s approach to patient care?
6:02–11:41
3
What were the key moments and lessons from the suicide‑risk patient interview?
11:41–16:39
4
How does improvisation help clinicians move beyond checklists to genuine therapeutic alliance?
16:39–20:53
5
What practical improv tools (e.g., ‘yes‑and’, using the room) can be applied in medical encounters?
20:53–27:59
6
Why do physicians rely on agendas and checklists, and how can they balance them with humanistic care?
27:59–34:01
7
How can the ‘burn the map’ metaphor guide clinicians in focusing on what truly matters?
34:01–40:36
8
What are Dr. Elkin’s final reflections on teaching, burnout, and keeping the spark alive in medicine?
40:36–46:25