DIFFICULT CONVERSATIONS (Podcast Transcripts)

We are always looking for interesting podcast guests and sponsors to help us spread the word,
if you have someone you would like to refer, please contact us today!

Advocating for Rare Diseases with Dr. Marjorie Dejoie-Brewer

Dr. Brewer (0s): When you deal with a rare disease, when you’re able to connect with an individual and a family and a support network that are challenged with the rare disease, it sets you up to deal with and handle all the other diseases so much. I don’t want to say easier because I don’t think any disease processes easy, but in a way that is more manageable because the intricacies in the rare world, the nuances are so much more evident that when you learn how to balance those, when you learn how to have that conversation, because it is about just asking them the right question and then allowing yourself to have that conversation and really listening and allowing you’re opening the door for the patient to have the conversation with you and give you insight.

You’re going to get visions of what you, one you never thought you have, but then can be applied to so many other things on the other end,

Announcer (59s): Welcome to difficult conversations lessons I learned as an ICU physician with Dr. Anthony. Dr. Orsini is a practicing physician and president and CEO of the Orsini way. As a frequent keynote speaker and author, Dr. Orsini has been training healthcare professionals and business leaders, how to navigate through the most difficult dialogue each week, you will hear inspiring interviews with experts in their field who tell their story and provide practical advice on how to effectively communicate whether you are a doctor faced with giving a patient bad news, a business leader who wants to get the most out of his or her team members or someone who just wants to learn to communicate better.

This is the podcast for you.

Dr. Orsini (1m 45s): I am honored today that the Orsini way has partnered with the Finley project to bring you this episode of difficult conversations lessons I learned as an ICU physician, the Finley project is a nonprofit organization committed to providing care for mothers who have experienced the unimaginable, the loss of an infant. It was created by their founder, Noel Moore, whose sweet daughter Finley died in 2013. It was at that time that Noel realized that there was a large gap between leaving the hospital without your baby, and the time when you get home, that letter to start the Finley project to Finley project is the nation’s only seven part holistic program that helps mothers after infant loss, by supporting them physically and emotionally.

They provide such things as mental health counseling, funeral arrangement, support, grocery gift cards, professional house cleaning, professional massage therapy, and support group placement. The Finley project has helped hundreds of women across the country. And I can tell you that I have seen personally how the Finley project has literally saved the lives of mothers who lost their infant. If you are interested in learning more or referring a family or donating to this amazing cause please go to the TheFinleyProject.org. The Finley Project believes that no family should walk out of a hospital without support.

Well, welcome to another episode of difficult conversations lessons I learned as an ICU physician. This is Dr. Anthony Orsini, and I’ll be your host again this week. Well, today we’re going to discuss difficult conversations about sickle cell disease and rare diseases with someone whom I believe is uniquely qualified to have this discussion, Dr. Marjorie Brewer is the owner of mad fit, a medical consultant, wellness and health business. She is also a medical consultant for the national sickle cell disease association of America.

And more recently held the position of patient engagement lead in rare disease, sickle cell for Pfizer, what she has a new title. We’ll talk about that later. And clinical research outreach liaison for the children’s hospital of Philadelphia, her groundbreaking work as a primary medical consultant for the Philadelphia is mayor fun, fit and free program. A key part of the mayor’s commission for health, fitness and inclusion allowed her to apply her training in medicine, exercise physiology, and alternative medicine and integrative community-based preventative format with the primary goal of making Philadelphia healthier city.

From there, she molded a career in functional medicine, herself, a patient of sickle cell disease. Dr. Brewer is a firm proponent and practitioner of comprehensive and preventative health and wellness planning. Over the past 10 years, she has developed relationships with collaborations with various organizations and health initiatives in the rare disease space. Current and past initiatives include organizations such as the American red cross and her life foundation, rare disease summit, American heart association, Susan G Komen and lupus foundation of America.

Dr. Brewer has combined her expertise as a physician, her work in multiple sector settings, her passion for wellness and her experience as a sickle cell patient to address the inequalities of sickle cell patients so that they live healthier lives without distrust of the institution that served them better. Thank you so much Marjorie for being here today. Really welcome. I know you’re incredibly busy, so I appreciate

Dr. Brewer (5m 7s): It. Thank you so much for having me, Dr. Orsini, it’s awesome to be here.

Dr. Orsini (5m 11s): There’s so many great topics in difficult conversations with this is coming up on a year. Now that I’ve been doing this podcast, I get to meet another amazing person every week. And, you know, we always say at every critical moment of your life, it starts with a difficult conversation. And we’re going to talk about some very difficult conversations today. And my promise to the audience is always to inspire and for them to learn some valuable communication techniques. And so we are really going to jump into this. I think this is going to take more than an hour, but I promise the audience I’ll limit this to 30 to 45 minutes.

We might have to have you back.

Dr. Brewer (5m 45s): I’d be happy to come back. Let’s do it.

Dr. Orsini (5m 48s): So let’s Start off just by, you know, again, during your introduction, it was really a mouthful. It was three or four paragraphs. Let’s just start off by letting the audience get to know who Marjorie is, where you’re from, how you got to this point of the pinnacle of your career being on my podcast. So tell us about yourself.

Dr. Brewer (6m 6s): I would love to. So in recent conversations that I’ve been having, I tell people that I went from the kid that didn’t have any boxes checked off the list to being the person in the room that checks all the boxes off the list. I did a presentation recently for my Alma mater for university of Pennsylvania med school for the women’s program. And that’s kind of how I led it and closed it. And I’ll tell you why. So I’m a kid from Brooklyn, New York. I’m a new Yorker.
Dr. Orsini: Wow. I didn’t know that I am. I’m a new Yorker.

Dr. Brewer (6m 36s): I Was in Brooklyn for a whole year. I lived in Sheepshead bay when I did my internship in the Coney island. So it’s pretty cool.

Dr. Brewer (6m 42s): I know that area. Well, did you go to Coney island? Did you do the hot dog thing and do the cyclone

Dr. Orsini (6m 46s): And all that? Did all that. That was pretty cool. Yes.

Dr. Brewer(6m 49s): Fantastic. You didn’t do the beach in five degree temperature and jump in the water though. Did you? I’m

Dr. Orsini (6m 55s): In Florida now because I can’t stand the cold. So that never even was a consideration.

Dr. Brewer (7m 1s): That’s one of the events. I also skip in Brooklyn, but anyway, I digress. So come from Brooklyn. My parents immigrated here from Haiti. So I am first generation here in the United States and my parents really structured my background so that it was diverse. And I’m thankful to, for that, I grew up in this era with them as my shepherds, that I went to public school, where, to me, everything was kind of equal opportunity and very diverse. We had Jewish kids in our class.

I had Italian kids in our class. I had African-American kids in our class. I had every type of teacher from every race and ethnicity and background possible. And my parents are always fostered this mindset as if you put your mind to it, you can do it. And that was from early on. And I kind of give you that as my initial intro because of the time that we live in right now and the challenges that we are facing socially, and that trickles down to every single level and every profession. So, you know, you fast forward to going to public school, getting into college.

I kind of knew my interest in medicine. Right when I was in high school, we had this major event happened with my uncle, where he had a heart attack at our house. And I was at the time of candystriper had just started working for Brooklyn hospital, one of my high school internships. So, you know, I had, do you have to do the whole CPR thing and kind of know. So I walked in cause I was coming back from being on one of the days at the hospital feeling like I know the basis. So I should be able to at least help him. That was my mindset. I know what the five steps are at the time.

I thought it was five steps. I should be able to at least keep him going until the ambulance gets to the house. And he actually by trade was a physician in France. He was from Europe. So he was visiting for a family event and we lost him. He was still alive when he left the house, but by the, they got him to the hospital. Things did not work out. And the heart attack came out of nowhere. That started my mission on not wanting to be in that situation. Again, I did not want to feel like I was helpless or could not help an individual get to their next step.

That started my pathway for medicine. Part of me wanted to do theater. So I was a double major in college. I think my parents were very thankful that I chose the science pathway, not the theater one. I had some good theater skills, but you know, I think parents want more security, which in college I was faced with a counselor who didn’t know me, but from day one suggested that I lower my expectations. And at this time I did not know that I had a chronic disease.

I was getting sick occasionally, but no one was able to diagnose what was going on was me just yet again, coming from a background of individuals that said, parents had said, you can do anything that you put your mind to. It don’t let anybody stand in your way. I kind of let her do her spiel. And I kind of put it to the side. Thank goodness my family introduced different physicians, different people into my life along the way. So they served as my support network. It was unfortunate that that’s how she started our relationship. But you know, it is what it is. I think her perspective was I don’t want this individual to feel like she’s failing as opposed to lifting me up and saying anything is possible.

So kind of referencing back to, I didn’t really check all the boxes off, you know, by anybody’s mean you’re not necessarily living that ideal life or whatever. I didn’t grow up in the best and most expensive neighborhood. My parents didn’t have access to everything necessarily. They immigrated from another country and became citizens here, but they gave me the best that they had to offer and made sure that my background was always culturally diverse, fast forward to getting into med school out of the 12 schools I applied to, I got into 11, which of course my guidance counselor was like, it’s because of her that I got into everything that I got into all of a sudden she was taking credit for it.

And I knew the real story. I knew the backstory, I had my options and opportunities to pick, which is a blessing, a big blessing. It was between MIT and Penn when it came down to what a terrible, terrible choice, terrible choices that was and get this, my parents who at the time. And just to again, give you some example of who I am were upset that I didn’t apply to Harvard. And I was just like, but it doesn’t speak to me. I want to go to somewhere that speaks to me. That makes me feel like I’m going to be able to connect with people and help people because that’s what I felt like my parents had given to me.

And that perception at the time may have been a misperception, but it wasn’t one of my after reading through everything and going through this diligence of, cause I felt like I had to do the homework since my guidance counselor was like, these are the osteopathic medical schools and then osteopathic and peak. Those were that they had just started. So they were considered at the time, maybe easier to get into, which I think is a fallacy. But right now we all know they’re just as competitive at all other medical schools. And sometimes I think prepare you in a way that the traditional medical schools do not prepare you for the outside world, which gives them an advantage.

But after doing my research, I put my top 12 down and I went to my interviews and decided to go to Penn, which was the next chapter of my life. So I applied to my school at the time that affirmative action was at its peak. So it felt like, you know, you have people telling you conversations. So the two most common questions that I got were, what do you feel about affirmative action? And what are your opinions on the right to die? Those were the two hottest topics. When I was applying for med school from again, a background of diversity and you’re in Brooklyn, everybody in Brooklyn is kind of equal.

We all participate. Nobody tells you, you can’t, or you’re here because of the color of your skin. That was foreign to me. I started asking people, why are you asking me that question? Cause I think I’m qualified. That’s why I’m applying to your school. And I don’t know that affirmative action should have anything to do with that. Don’t you want a diverse population of physicians so that they can relate to your patients. It just seemed to make sense, but here’s what was interesting. Every interview that I went to the administrator or inevitably the first person that I spoke to would look at me and say, you’re Marjorie Brewer?

And I’m like, why did I not sound like a Marjorie Brewer on the phone? No, you’re not quite what we thought you were. I was like, oh, I found that interesting. Now again, my friends were like, you know, you talk so proper. I speak English. I just don’t speak about, I mean, this is proper English. My mom’s a teacher. So God forbid you had the wrong sentence, syntax. You were in trouble. Penn gave me a wonderful experience in that in a sea of 121 people. There were only 10 individuals of minority backgrounds.

That to me was very different from what I grew up with. That was a learning curve. I think that was the first introduction aside from college where I started to second guess, am I supposed to be here? And thank goodness I had that strong background that said you are supposed to be here because your voice matters. And this is when I got diagnosed with sickle cell disease and of all places to get diagnosed with sickle cell disease. That was the perfect place to be because chop, which is the pediatric extension of the university of Pennsylvania had one of the leading, if not the leading pediatric program at the time.

So they were able to literally diagnose me what no one had picked up on my entire lifetime because it wasn’t part of newborn screening in New York. And it wasn’t the first thought for the ER people. So I already had experienced my little bit of disparity with the medical community on that end. It was bread and butter to them. So actually my academic administrator, when they heard that I was sick, was like, you know what? That sounds like sickle cell. Let’s just take you over to Dr. Honey from pong and in an hour electrophoresis being what it was.

I knew what I had and that started my next path on figuring out my disease process, how it related to my current journey. Cause I always feel like everything happens for a reason and where I was going to go with my career. So it affected me changing my career path from interventional pediatric radiology to wanting to go more into internal medicine and doing specific work in sickle cell disease and rehabilitative medicine. Because what I really figured out during med school with this diagnosis, with the support network that I had and with participating in a program called bridging the gaps, which was amazing because it gave me a viewpoint of what medicine could be in real time.

It gave me a viewpoint of what medicine was within the community and that we were accountable to the patients we’re serving. And it happened right at the best time, right after that first year of med school, when you’re entrenched in the books and you’re thinking medicine is what’s in this book and what the teachers are presenting. I got a completely different view. That program is led by Lucy two-tone and Dr. David. But it was amazing because it gave me this 360 view of medicine by academics medicine in the community and medicine for me as a newly diagnosed patient, because then what a lot of patients had suffered and experienced, whether it were discriminatory or we don’t have a cure for your disease process, or we don’t know what’s going on with you, what medication are we going to give you?

Because there’s so many labels attached to that disease process in any rare disease process, I had not had a lifetime of experiencing by then. I was already planted in a community that supported me, had a great education in Penn, but also opened my eyes to even more possibilities of what you could do and what medicine could be once you applied yourself. And who my number one agent was that was the patient, graduated from med school, worked with the community again, decided to work for the mayor.

I thought, you know, wellness was the biggest thing, making people healthy was what makes people well. And I believe that when, while people see sick people, they want to stay well. And when sick people see well, people they want to get well. So how did I bridge that gap opened up my own wellness clinic and really focused on rehabbing individuals because when people always want to go back to their level of function of where they felt like they were optimal and in the disease process that I’m suffering from, you get knocked down so many times with each crisis. It’s almost like building yourself back up to where was I when I felt my best?

So where for some people that’s only one defining event or as you age, or, you know, you get a knee issue where you hurt yourself in your rehab or you have a heart attack, they catch it and you rehab back from me It’s continual because every time I get sick, I feel like I started level one again, how do I get myself back up to where that optimal? And I found that people related to that quite a bit, and that was at the crux of what they felt like being healthy was. So I made it, my mission continued to work with sickle cell expanded that career because I felt like I was a really good bridge for the conversation between physicians and patients.

They spoke different languages, but at the end of the day, when I really found a good physician or had a good colleague, they want the same for everyone. They want you to be at your best health. So how do we make that happen without all the barriers and issues that pop up so that the path for the patient is as smooth as possible? I think sometimes as providers, my colleagues got it twisted that their past should be easy and the patient should just then kind of deal with whatever, because I’m giving you my best. And it’s actually the opposite, the patient’s path.

It should be the easiest. And we, as providers should deal with all the obstacles and make it easier for them. So was able to become a medical director for the sickle cell disease association, which was a dream job having my own central was a dream job. And then going back to chop and working with the team that trained me for the comprehensive sickle cell program was also a dream job. And now working in rare disease. And I was able to be patient advocacy director for Pfizer for their sickle cell initiative when they were developing a treatment back then. So that’s kind of me in a nutshell, wow, that’s

Dr. Orsini (18m 56s): wow, that’s A lot to digest. There’s so many things. I took notes here. I want to go back to what you said about getting someone in back to where they were optimal. There’s significant number of our audiences, not in healthcare. Sickle cell is usually diagnosed early on. So when you got diagnosed, that’s very rare to get diagnosed that late. It is a lot of flare ups and back and forth of you feel well, and then you get sick and then you feel well, do you think that people have chronic or rare diseases such as sickle cell every time they have a crisis that they lower the bar to where they want to get back again.

In other words, you know, after their third, fourth, fifth crisis may be that optimal health that they dreamed about, maybe now it’s instead of a 10 out of 10, they settled for an eight out of 10 and then settled for a six out of 10. Is that something that’s real?

Dr. Brewer (19m 42s): I think my consensus is that they redefine what optimal is. And I also think that their definition of optimal is very dependent on the initial team that carried them through the first couple of years of their life. So there are some comprehensive pediatric centers that are more, I mean, I think they all have great wraparound services, but then there are some services that are much more uplifting and give you that mental focus that you are not your disease.

That is a very specific way to speak to a patient so that they never identify them with themselves, with their disease, as opposed to sickle cell is part of who you are. So I find depending on what bucket individuals fall into, I think there is a redefinition of what optimal is every time you get sick. But then I think with the stronger individuals and by stronger, I just mean those that have had more exposure to individuals that can persist in being positive, even when things seem bleak, because that is so important.

The mental state of a patient that is basically going through PTSD, this huge experience that is life altering each and every time and questioning whether they are going to make it through that crisis because many crises and in death, there is a specific way to treat, handle and care for that type of person. There’s a language to use so that you’re able to help them reconnect with what is possible and what their potential is. I find that individual that have a glimpse of that can hang on to it again and think very optimum individuals that have not had that opportunity yet to do that.

redefine, not necessarily lower. It might seem a little worrying to us, but read the fine what optimal is because they are unsure of their capabilities. I think because I have an advantage of being a physician. I know that the body can reboot. It’s so smart. The body is the smartest machine on the face of this earth. So because that’s kind of in my cells in the back of my head, I’m like, if I just tweak myself the right way, they’ll respond, but everybody doesn’t have that option or that reserve.

Dr. Orsini (22m 2s): So What I’m hearing over and over again, and I’m so delighted to hear you talk about communication, the name of my book, it’s all in the delivery. And essentially from what you just said is it’s all the delivery. It’s how the first physician or the final physician really discusses the disease with you. Especially some of these people are children. Many of them are children. And that first conversation, and that’s what this is about of saying you have sickle cell.

And as you know, I got my start 10 years ago, training doctors, how to give bad news how that conversation goes. So my first question is most physicians are not equipped to have that conversation. How can we better equip them? And it’s all about teaching them communication. We know that most physicians are not comfortable giving bad news. So I think that conversation probably goes really well at chop or at university of Pennsylvania at a sickle cell center, but doesn’t always go so well when the family Dr. Maybe in rural medicine is breaking the bad news.

There’s a question in there somewhere of, it’s more of an observation, but how do we help the doctors who are out there help with that initial conversation? And then I’m going to lead up to another question. So let’s start off with that one. What do we frame that conversation for those doctors who have to say you have sickle cell or cystic fibrosis or any rare disease?

Dr. Brewer (23m 32s): I find that that delivery of information is vital. And I can even use myself even when we didn’t know what the diagnosis was. Just the contact and interaction with ed because, you know, ed docs want to have an answer, not being able to give you a concrete answer. It almost completely showed on their faces and their body language when they walked into the ER. So here you have this person who’s screaming to the top of their lungs, two parents who have no reason to think that they’re lying because that wasn’t my style.

As a kid, I had very strict parents. So I felt like they wouldn’t see right through me for lied. So there was no lying going on and I was really screaming for dear life. And you have this person coming in, like my lab work doesn’t show anything. So I’m not so sure what you’re complaining about. It’s like my parents were quite alarmed and struggled with that quite a bit. I do think that if we can approach our conversations with more compassion and then lead in with a sense of how would I feel if I were on the other end and almost play that scenario in our heads, it doesn’t take much, our brains are so capable.

And as humans, we can do so many things before actually uttering that first word. I think that in itself would change the paradigm significantly. I will add that there was a component of when I did find out what I really had of being part of the process. And part of that was because I was a med student there. So I got to, once they drew my blood, I was involved in, this was the electrophoresis. I was watching the sample run through the pages and the little- being part of that. And having that conversation all the way through was actually really comforting.

And I didn’t have an answer yet, but I felt like we were doing it together. We were on this journey of trying to discover together and whatever the outcome was that these people would still be there for me. So I think if we’re able to, as providers and as in whatever environment, you’re in, actually try to keep that in the forefront because I can say the same thing for lawyers is I have friends that are lawyers. If you think about the case that you’re dealing with and you want to interact with the person, can you approach it with a little bit of how would I be feeling if I was going through the same thing they were going through before actually uttering some words, we would be ahead of the game and I think have a better impact and better outcomes.

And at the end of the day, we all want good outcomes.

Dr. Orsini (26m 0s): yeah. At the Orsini Way when we do the workshops, we talk about imagine plan and adapt. And when you’re going into that conversation, the first step is, as we say, before you go into the room to have that difficult conversation, take your own pulse because you’re going to be a little nervous. Imagine what it’s like to be the patient, come up with a plan. You spoke about attorneys. That’s how exactly how we discuss it. The attorneys do this closing argument. They have this plan. So you, we use the breaking bad news program acronym. You come up with a plan. This is what you want to say. And then adapt because you never know what’s going to hit you, right?

You never know how the person, you know, usually you can control the narrative by being better at it. There’s a great book that you probably read. They give out a lot of medical schools called how doctors think by doctor Grutman. And you alluded to that in that book, it starts off by a patient who’s got a chronic illness that I think it was Ciliac disease was undiagnosed who really at her wit’s end. And once she got labeled as a psych patient, no matter how many doctors she saw, they just assumed that she was a psych patient.

And she was actually suicidal until she saw Dr. Groutman. Or it was Dr. Faulk, I think in the book and he didn’t read her chart. He said, I don’t want to read your chart. And she said, why do you were asking me all these questions? You have to desk falls or charts. And he said, I want to hear it from you. So it’s about listening. You talked about the ed doctors, and I think the average time it’s been studied the average amount of time, it takes for a doctor to interrupt. The patient is 11 seconds. That’s a fact 11 seconds.

So we don’t listen. And you were really fortunate because you knew what was going on, but there’s a real issue with teenagers, maybe lower socioeconomic teenagers, minorities are coming in with crises. They’re not going to their main hospital that knows them. And then they’re screaming in pain, whether it’s sickle cell crisis and what happens to them, unfortunately,

Dr. Brewer (27m 58s): Interesting you referenced it because the New York times actually did pieces of which I posted about one recently about some of the social inequities that individuals with sickle cell disease have suffered and because of their illness or because of individuals not believing them and asking the next question or taking the next appropriate step, they’ve been put to the side incarcerated when they should not have been and then have lost their lives because of it. So when you have that scenario where you’re coming in and you’re not believed, and as you and I know as providers in dealing with individuals with rare diseases, the last place an individual actually wants to be is the hospital.

We are in a very special group in that the hospital is an extension of our family. The medical community is an extension of our family because we see them regularly. And when I say regularly where the average person has maybe four to six visits a year, we are in every month and sometimes twice a month. I mean, we know everyone by first name when they walk in the door. Hey, so and so hello. So, and so what did you have for breakfast? Love that? That’s your favorite color? I mean, these people, are an extension of us.

So our perspective is a little different. When you talk about your essential and your family, there’s a component of trust that you want to have and not being trusted and thinking, or being put into another category of being opioid, seeking, negates your word automatically. It lowers your value as an individual where you’re hoping to step into an environment that elevates your value, or at least understands you because they have that medical knowledge. This is kind of your perspective as coming in as a and therefore, because they have that extra knowledge, hopefully will not judge you and look at you first as a human being who needs optimal health.

And when we take that oath, it is to make sure that I provide the best care for this individual. While, I’m dealing with them without any preconceived notions or judgments. I love that in rehabilitative medicine, because that was part of my training. One of my mentors always said, Marge, look at the patient, look at the patient, spend time with the patient, watch them, observe them and talk to them. It will tell you so much more unbiased information and believe them then looking in their chart, that should actually be secondary.

So I love that that book actually references that, but our individuals have been struggling with this label of you’re an opioid seeker. So therefore you’re making it up because pain is objective. And there are no circling back to your question. There are no, you know, real ways real in quotations ways for me to measure your pain. So how do I know that you’re really telling the truth? And unfortunately, that is in the forefront, as opposed to this illness thinks will this person within the next 15 to 30 seconds, if I’m not aggressive enough, so let me take them at their word, provide the treatment.

And if you really need to do that later on, that was ample time to deal with that. But what’s frightening to me is that individuals. And sometimes, cause I talked to as first responders also because sometimes first responders or the people on the scene first when you’re dealing with an individual with a chronic disease or a rare disease, where part of their regimen happens to be opioid medication. And there is no cure in the midst of an opioid epidemic. We have definitely been unjustly labeled as the population that needed opioids the most, but research thank goodness has now shown that we make up one to 2% of what is considered the population that are actually opioid abusers.

And we’re changing the language now, just as exemptions have been made for cancer patients in the literature for providers, the same exemption and exceptions are now being applied in HHS and CDC for patients with sickle cell disease, because there is a difference and that pain is very, very real. And so what I tend to do for med students when I talk to them, because I still participate in the bridging of the gaps program is I try to align the pain with something that they can relate to. So it is the female patient or female individual, excuse me, that might’ve had a baby.

I told them think of their contraction. If it’s someone else that maybe has, has had frostbite at one point or another, I’d tell them, do you remember that pain when you just stubbed your toe or came in from the cold so that I can have them touch a piece of what the patients are going through and hopefully rewire their thoughts because what ends up happening is when you apply those labels, put them into those buckets. And then really what they’re doing because of the book is with drawer care, which draw proper care, you’re doing more damage to that patient than you would have.

If you just listened to them for five minutes, at least gave them the first dose so that They can talk them off the edge and then process it later on down the line. So I’m really hoping that some of these inequities that have come to surface and that are being talked about more now, the social injustices, the opioid epidemic, as it relates to individuals who suffer from diseases like myself, are more in the forethought of providers on all levels, so that they take a step back, take that pause.

As you said, reset before then taking the next step because their decision is a life and death decision and where I, as the patient, I’m feeling it real time. They, as the provider have to click into that and realize we’re talking about someone’s life and not just whether or not they want a couple more pills and the majority of the population, as you know, they’re not going to go in unless they’re really, really sick.

Dr. Orsini (33m 47s): Yeah.I talked about this in my Ted talk a couple months ago, about how we can fix medicine by improving the human connection. And you mentioned a couple of key words there. And the important thing that I want to stress here is listening, but finding commonality. And I think what’s happening right now in medicine. Well in human beings, right? Neuroscientists say that our human brain makes 350 million assessments of someone’s body language per second. So doctors are human beings, no matter what your background is, you’re going to walk into a room and you’re going to 350 million times per second.

You’re going to make an instant judgment about that person. And studies have shown that you’re more likely going to get pain medications if you’re well-dressed and you have a suit on, or if you’re poor or you’re a minority or whatever, maybe that’s human nature. That’s a whole conversation somewhere else. But what I stress in my Ted talk to patients and also to doctors is if possible, now, of course the person’s screaming and they’re really in a lot of pain. My advice to a patient would be to find that commonality with the doctor and the doctor to find the commonality with the patient, talk about something else other than what’s happening right now.

You know, where are you from? And look, you and I is like, you have a Haitian French background. I have an Italian American background. We talked for five minutes. We both found out we were in Brooklyn. And then I trained in Philadelphia. You’re in Philadelphia. I think our last conversation we talked about Pat’s and Geno’s steaks. You can find commonality with anyone. So my advice to a patient is if possible, especially if the doctor looks rushed to you, if you’ve decided that doctor looks rushed, you know, ask them how their day’s going, or, you know, make some small talk with them just for a minute, because that will humanize you and doctors for, it’s not a good thing, but happens all of us.

Sometimes we started to think of, you know, who’s in bin three, oh and behind the curtain is a that’s the sickle cell patient. And in six is the nephrology patient. And instead of their names, right, they become the name of their patients. So I think that’s, that’s great advice to both patients out there and doctors to try to, if you find commonality, things will be better.

Dr. Brewer (35m 60s): I do the same thing. And I tell patients one thing, one piece of advice, and I tell providers and another piece of advice, and only because you made that reference though, awesome reference of the neurons and within a short period of time. So I tell patients, try your best to not wait until you add a 10 out of 10 pain or not wait until you’re at a 10 out of 10 of crisis, because inevitably yes, we all have to deal with biases. Patients have them providers have, you are best served. If you can be a little calmer and be able to receive information a little bit better and then deliver information a little bit better and connect when your level of acuity is a little less.

And I always, always, and I tell patients, you know, kind of in a life-saving way, you don’t want to wait till you’re a 10 out of 10 to then process everything. Cause then of course, everything will get on your nerves and that will not best serve you in an acute situation. As far as providers, I’m a big into wellness and health. Meditation is one of the biggest things that I do. And I tell all newbies that I can get my hands on before you walk in that room, try to take three deep breaths. I tell my regular clients and people that at the top of every hour, take eight, but I tell them to take it so that you can one leave.

What you just did behind, give yourself a moment to catch up with you. And then the third one is one to clear your mind. So you can best serve the patient with clarity and this, you know, the decorum of humanity. Once you walk into the room, because that will serve you volumes. So I just wanted to piggyback on what you said.

Dr. Orsini (37m 35s): great advice. That’s like what we say, take your own pulse. Jokingly, just calm down, forget about what you just did. But I knew we were going to have trouble fitting this all in, but I want to get into before the time runs out rare diseases other than sickle cell. And there are so many of them out there, you name just a few, I think almost universally they’re underfunded, especially the ones that are maybe orphan rare diseases. We somehow don’t want to have a conversation about that. We kinda push it aside.

You know, it’s real sexy to say, let’s donate money to cancer. Let’s donate money to heart disease, but then there’s some really rare diseases out there. And everybody, what’s that, you know, and the government doesn’t want to fund it. And the pharmaceutical companies don’t want to pay for it because well if not that many people have it, I’m not going to get a good return on investment. What are the difficult conversations that we have to have today about these poor people that are suffering from these rare diseases and how do we move beyond that?

Dr. Brewer (38m 31s): You’re speaking to my heart. And of course I’m thinking of the Gaucher is of the world. I’m thinking of the ALS is of the world. I’m thinking of all these rare diseases. So one part of the conversation I will say that I like to start with is one win for a rare disease is a win for all rare diseases. I like to open up the conversation with that. And when it comes to, and I feel like rare diseases, the micro and then the rest of the diseases are the macro. I tell individuals one who liked to go into the sexier as you put it of the disease processes, because that is always more appealing to people that the macro only survive when you know, the micro really, really, really well.

And inevitably the connection of what has helped the macro or the larger those sexier diseases have come from the rare disease population. And what if you could elevate what now, when you talk about diseases and medicine are the minority group, elevate them so that they feel as important to a certain extent as the sexier illnesses, then there is so much more cohesiveness.

And what you will actually see is an answer that you might’ve been looking for has been staring you right in the face all along, but because you were kind of shy in delving into the rare disease world, you missed it! So why would you want to miss that? So I tell people that right off the bat, I also tell people that when you deal with a rare disease, when you’re able to connect with an individual and a family and a support network that are challenged with the rare disease, it sets you up to deal with and handle all the other diseases so much.

I don’t want to say easier because I don’t think any disease processes easy, but in a way that is more manageable because the intricacies in the rare world, the nuances are so much more evident that when you learn how to balance those, when you learn how to have that conversation, because it is about just asking the right question and then allowing yourself to have that conversation and really listening and allowing you’re opening the door for the patient to have the conversation with you and give you insight.

You’re going to get visions of what you, one you never thought you’d have, but then can be applied to so many other things on the other end. So I like to tell individuals, that’s kind of how you’re well-rounded and that’s how you start that conversation. You realize that one where working with rare diseases is actually a doorway and a pathway to helping all the other diseases so much better. If I can get them to kind of just have that. And even if it’s at the debate, even if we disagree, when I first started, then I can kind of stroke that conversation and milk it and show them, look how this connected with this.

This was the first diagnosed or genetically diagnosed illness, or this ALS is showed the first symptoms of this in this short period of time, but it has now helped other neurological diseases. And also it brings continents and people together. When you think of different countries that have a higher rate of a rare disease than others, it brings so many varied people because you have to find the expertise because there are so few people, this is what I love. Also, there are so few people as providers who participate in that rare world, that you then have to pull them from the different corners of the world and put them at one table.

That is an example of the global conversation happening to save lives. And what other bigger mission could there be for our world than to just preserve life and save it. So in that sense, it also brings the most diverse, socially balanced and equitable group of people at a table to have something in common and then expand that conversation. We’re so good at. And when we’re dealing with bread and butter, what you and I used to call the bread and butter diseases, because those are the major things that we, the most common things we’ll see, come in to the ER, the heart attacks and all that kind of stuff.

It’s so easy because there are so many people to kind of be in your microcosm. And this is how we do it at this institution. And this is how we do it at this institution. And then you kind of get into your lane and it can be very automatic and tunnel vision. But when you look at rare disease, because there are so few, you never really have to dip into all 10 universities and bring one person from each and figure out how to make them all have a conversation in one room in 30 minutes or less

Dr. Orsini (43m 8s): so what I’m hearing then is that in order to convince pharmaceutical companies and the government to put more money into these very rare diseases, we have to convince them by having a difficult conversation that yes, this disease may only affect a couple of million people a year, but the research that I’m going to do on this is going to really turn into helping billions of people. That’s what we have to convince them. And we haven’t been there yet. And I know you have a new position at Pfizer and patient experience.

And so I think that’s a conversation that we need to have with the government where the pharmaceutical companies, who’s the low lying fruit here to get them to start putting more money into the rare diseases.

Dr. Brewer (43m 51s): So we’ve always talked about patient focus and patient centered, but can we be patient centric? Can we really put the patient in the middle and then draw those conversations to the eight or nine other buckets that are essential? So that requires taking pharma, politics, hospitals, universities, other well care. And healthcare insurance says to really say, what is my objective as the patient is related first, and then develop your progression from there.

See, and you and I being the communicator that we are, I feel like we always do that, but that is definitely not the mantra for a lot of organizations. And what I love about my new position and being at Pfizer is that it is an organization that is actively and diligently being patient centric. And we’ve had this term in medicine that has shifted it’s patient focus is patient centered, but patient centricity is I think, takes it to another level in that you’re really not just looking at the disease process as it relates to the person, but looking at the person first, that’s where wellness comes in.

You’ve got to look at the person and see how they relate to the illness and then take that then to the next level. And that should be the starting point for the conversation. As far as when you think of the extensions who I think the emphasis should be put on. I think the emphasis is it goes in every single bucket simultaneously because they are so far behind. And because they are part of the same equation, it’s like balancing a math equation. If you’re only looking at the right side of the math equation, you’re never going to get where the equal sign equals because you have to look at both.

You have to balance it out. So there needs to be an equal amount of attention, put on the prongs that lead out from the patient. But the patient gets the most attention, which is not the way we are structured right now, but it is the way that people are going through. And I feel confident because this pandemic has also elevated the patient’s voice in a sense that they are now more connected, looking for more information, have access to more information and not shy about asking the right questions.

So they’re almost demanding the right answers. Like you have to talk to me cause I’m a force to be reckoned with. And if you don’t talk to me as the patient, then you’re not going to get anywhere. It’s interesting how that comes. That conversation has also shifted, but as providers, we always wanted to empower the patient. So if we can keep that at our center, then we’re going to end up in the right place.

Dr. Orsini (46m 40s): Right now, this is audio only. So you can’t see Marge’s face right now, 350 million times per second, I’ve been analyzing Marge’s body language. And then the minute I said, let’s talk about rare diseases. Everything went up like at least a half a level. So she got excited. She was smiling the whole time. Her smile got bigger. And it reminded me of what people say about me when we talk about communication and human connection in medicine. But wow. I mean, I wish the video was on right now. You just were like, oh my God, I can talk about this all day.

This is your passion. And I can see that it is your passion and it’s not work to you because this is what you’ve decided. This is your lot in life and your goal. And I’m so impressed with, with your enthusiasm and thank you for everything you’re doing. We only have a few minutes left, but I have to ask final question. I’m not sure if I warned you about, if you’ve listened to the podcast, you know, the final question always is, and we only have a few minutes. So, but what is the most difficult conversation that you’ve had to have in your life or type of conversation if you don’t want to get personal, what can you give our audience?

Some advice on how to navigate that particular company?

Dr. Brewer (47m 51s): Most difficult conversation that I’ve had to have is delivering bad news to parents of a patient with sickle cell disease, that or being part of a conversation where the patient did not make it through what should have been a routine ed visit. How did I approach it? Carefully, Very empathic in our training.

I am also a yoga instructor, in our training, one of the things we discussed was almost the worst thing you could say to a family or individuals who have lost something is I’m sorry for your loss or say, I know what you’re going. Do you really know what they’re going through? Have you really taken the time to, never say that?

Dr. Orsini (48m 42s): Never say that don’t ever say, I understand unless you’ve had the exact same thing happened to you, do not see you understand.

Dr. Brewer (48m 49s): So for me, the first thing is I just sit and if it’s a family, I know well, which usually it is. I sit in and I hold their hands and I look at them. I stay in their space and I actually allow them to say the first thing, because the news is already evident to all of us and I want to be there for them. I want to serve their purpose. So my body language is more of how can I be of service to you right now in your greatest time of need?

My words to them is usually I am here for you. And then I wait and waiting is the hardest thing. As you said, people want to jump in about 11 seconds into it. Another conversation is all about the silence, the void that so much comes to you in the silence and the void that if you would just give it a moment to be the next best step will actually present itself. So I let the family point me in the right direction. And then as you always say, I listen, I don’t reassess what they say.

I don’t redefine it for myself. I try my best not to question it. Even my, my brain is like really did they just say that they wanted that it doesn’t matter. It’s about them right there. And I follow that lead and it usually does not steer me in the wrong direction.

Dr. Orsini (50m 10s): Great advice. The famous rabbi, Harold Kushner in his famous book when bad things happen to good people wrote in his book. When you don’t know what to say, say you’re sorry, and then shut up. And I love that. I love that. I use that in all my workshops sitting silently tells the person I’m here for you. I’m very comfortable in this situation. I’m not looking to get out the door and I’m not going to leave you. And you know, but it is human nature to get nervous and start speaking.

Especially doctors. When I’ve been doing this for 10 years, doctors get nervous. They go back to rounds and they’ll start explaining physiology. I’ll do some doctors and we’ll say, okay, tell the patient they have cancer. As soon as the patient starts crying, they start describing grading and staging of the cancer. I’m going to add

Dr. Brewer (51m 1s): I’m going to add to what you just said. There’s a famous poem. I believe it’s called transformation. And there’s a line in the poem that says, I want to know that you can sit in the silence in my pain and know what I’m going through. That’s it.

Dr. Orsini (51m 16s): Thats fantastic. Marge. This has been a lot of fun. We could probably go another hour, but I usually like to tell them is my audience. They can listen to it on the way to work. So we’re trying to limit it here, but we’ll do it again. This is amazing. What’s the best way. Real quick for people to get in touch with you. Absolutely.

Dr. Brewer (51m 32s): The best way to get in touch with me would be madfitbody@gmail.com. We’ll

Dr. Orsini (51m 37s): We’ll put that in the show notes and we’ll put all your contact information in case anyone has any questions. This has been amazing. If you enjoyed this conversation in this episode, please go ahead and hit follow on your favorite podcast platform. If you have to reach me, I can be reached at TheOrsiniway.com. Marge,thanks again. Appreciate it. When we’re going to do this real soon again. Well, before we leave, I want to thank you for listening to this episode of difficult conversations lessons I learned as an ICU physician, and I want to thank the Finley project for being such an amazing organization.

Please, everyone who’s listening to this episode, go ahead, visit the TheFinleyProject.org. See the amazing things they’re doing. I’ve seen this organization literally saved the lives of mothers who lost infants. So, to find out more go to the TheFinleyProject.org. Thank you. And I will see you again on Tuesday.

Announcer (52m 29s): If you enjoyed this podcast, please hit the subscribe button and leave a comment and review to contact Dr Orsini and his team, or to suggest guests for future podcasts, visit us theorsiniway.com. The comments and opinions of the interviewer and guests on this podcast are their own and do not necessarily reflect the opinions and beliefs of their present and past employers or institutions.

Medical Liability and Risk Management

Shari Moore (1s):
And what we found in those cases was poor communication led to the patient in many situations, going and looking for their answers from an attorney because they couldn’t get their answers from either the hospital, the physician or somebody that they trusted. And so if they were going to get any answer, they just went and asked an attorney to get an answer for them. And again, many of these lawsuits had obviously no basis. It was just more communication.

Announcer (31s):
Welcome to Difficult Conversations: Lessons I learned as an ICU physician with Dr. Anthony Orsini. Dr. Orsini is a practicing physician and president and CEO of the Orsini Way. As a frequent keynote speaker and author, Dr. Orsini has been training healthcare professionals and business leaders, how to navigate through the most difficult dialogues. Each week, you will hear inspiring interviews with experts in their field who tell their story and provide practical advice on how to effectively communicate. Whether you are a doctor faced with giving a patient bad news, a business leader who wants to get the most out of his or her team members or someone who just wants to learn to communicate better this is the podcast for you.

Dr. Anthony Orsini (1m 17s):
Into another episode of difficult conversations lessons I learned as an ICU position. This is Dr. Anthony Orsini, and I’ll be your host again this week. Today, we’re going to have a conversation about two topics most people don’t really want to talk about, and that’s medical errors and medical malpractice lawsuits. And few people are more qualified to speak about this topic. Then my guest today, Shari Moore, Shari Moore, graduated from the University of Oklahoma with a bachelor’s degree in nursing. She has more than 23 years experience in the acute care setting, including nine years at risk management, three years as case manager, five years as coordinator of nursing recruitement and retention, and six years as maternal child clinical nurse.

Dr. Anthony Orsini (1m 58s):
She is currently the vice president of risk management for the position’s liability insurance company. Also known as PLICO in Oklahoma city, where she has served for over 10 years. Her mission is to provide proactive risk management education to physicians across Oklahoma, to improve the quality of experience for both the physician and the patient. I love that mission and that’s, what’s going to be really the topic of today. I can’t wait to talk to Shari about this. Shari welcome, and thanks for taking time out of your busy schedule for being on.

Shari Moore (2m 30s):
Thank you for inviting me. I appreciate it.

Dr. Anthony Orsini (2m 32s):
You and I spoke a couple of months ago and I’m going to do a little work together, but I was so impressed. It seemed like you and I were always on the same page about everything when it comes to liability and the role that communication plays. And I’m so excited to kind of tease that out today, you know, medical liability and malpractice and medical errors is related to so many things in healthcare, including cost and physician burnout. And when we spoke last about communication and medical errors, but first before we get into really the deep dive of this, I just kind of want people to hear a little bit about your story. And I know you’re a registered nurse as you started out with, and now you’re in the risk management. I also see from your bio that think you’re a lifelong Sooner?

Shari Moore (3m 16s):
No, that’s that is, I have that on my wall. However, we are big Oklahoma state fans though.

Dr. Anthony Orsini (3m 23s):
Okay. All right. So, but Oklahoma, by all your life, you’ve lived in Oklahoma.

Shari Moore (3m 27s):
Yeah, I have. The university of Oklahoma is the only program at the time that had a bachelor’s degree in nursing. So I did all my pre-recs met my husband, and did all that at Oklahoma state. And we actually spend a lot of our time supporting the Oklahoma State Cowboys. All of my children are graduates. He makes me leave my university of Oklahoma diploma at the office.

Dr. Anthony Orsini (3m 52s):
Okay. Well, I love the Oklahoma state Cowboys uniforms. They’re very bright. I’ve always kinda been impressed with them and they do better than my Alma mater. Rutgers has been struggling for 30 years. I’ve been saying my whole life, I can’t die until Rutgers win something. And so when they were doing really well in the basketball NCAAs this year, I said to my wife, oh my God, if they ended up winning, does that mean I’m going to die? I don’t know.

Shari Moore (4m 16s):
Yeah. That’s awesome. Yes, we are. America’s brightest orange. So,

Dr. Anthony Orsini (4m 20s):
So tell us a little bit of how you went from registered nurse to risk management field and now your job at PLICO.

Shari Moore (4m 27s):
Well, it was really crazy. I obviously started out in maternal child health and was in the olden days we were, you know, split and there were, you know, the newborn nurses, the labor delivery nurses, the postpartum nurses. And I was in the era where they started doing cross training for everybody. And we were at had a level three NICU, and that was my primary area to work. And then they moved us in and all of us started doing post-partum and regular nursery. And then I was one of the first ones to go into labor and delivery to do that cross training and found really that I enjoyed that and what I really loved about it and what I found very unique about it was that I had a very different perspective.

Shari Moore (5m 7s):
And I’m sure you can appreciate this in your area. That I was really caring for two patients. Sometimes the labor and delivery nurses didn’t have a really good perspective, like, well, we’ll get the baby out and then we’ll take care of mom. And it’s like, I was looking at, oh, I’m kind of concerned about what the baby looks like when they come out and how they are. So that was kind of a unique thing. And then in the middle of that, I actually saw a position available for nurse recruitment and then moved into a large metropolitan hospital to do nurse recruitment. I took care of all their student programs and all those kinds of things. And it was a very busy, it was during the nursing crisis. I was with sometimes do 10 interviews a day trying to fill positions and things like that.

Shari Moore (5m 51s):
So I did that for about five years and the hospital where I was working at was it acquired by another corporation. And they split my job into three jobs, which was probably appropriate. And that’s when I went into case management and I actually was in your little neck of the woods doing NICU case management. I ran a lactation support service and did OB and NICU case management and did that for a couple of years. And then there was a job at the old hospital where I had originally worked in my community as a case management supervisor, and I was ready to get back to my own community. And so I moved into that job and immediately realized it was not what I wanted to do.

Shari Moore (6m 37s):
And so as a recruiter, I couldn’t have something on my resume that was less than a year. So I backed it up and started working on it. And about six months in the risk management position came open at the hospital. And I had actually just worked on a case with a child where there was an IV infiltration and I had to just basically risk managed it. I mitigated the risks. I set up home health. I did all of those things and knowing that’s what I was doing. And so I moved into the risk management job and the rest they say, I guess its history. It had been opened for about three months and they moved the office. I walked into an office full of files and incident reports and all the things that you get as a risk manager.

Shari Moore (7m 21s):
And so I hit the ground running. And so I was there for about 10 years. Also eventually was regional risk manager. As part of the corporation had 15 hospitals in five states across the United States. And then then PLICO came up and moved from being a, basically an overall kind of risk manager that I knew from being across the spectrum to much more proactive position at PLICO because at the hospital, I did all the claims manager responsibilities and all that, but at PLICO is all proactive. Pretty much once a claim is in, then it goes to another person to handle that. So early on was looking at disclosure, one of the first questions that the CEO asked me if I’d read, “Sorry, Works”

Shari Moore (8m 6s):
by Doug Wojcieszak which has, I had not read the book, but I was following his blog at the time. And so I knew what he was doing and I’d been actually managing planes like that in the hospital already. And so I definitely read the book, the second interview and came into PLICO, loving the fact that they were willing to look into disclosure, empathy and apology as a tactic for taking care, not only of our patients who were injured, but of our physicians. We were one of the first, this was in 2008 and nobody else was really doing it, our defense attorneys. Right, right. Our defense attorneys didn’t know what we were talking about. So we did a ground level defense attorneys, claims manager, everybody, and then into the physicians education about Sorry Work.

Shari Moore (8m 55s):
And so that just built into the whole communication issue.

Dr. Anthony Orsini (8m 59s):
What attracted you to risk management in the first place? And now that you’re still in it for all these years, what is it that attracted you to it?

Shari Moore (9m 5s):
Well, I think it is the problem solving. I love to look at something and try to work through it for the best outcome possible. I always say I’m a plain B kind of gal. There’s a lot of plan A’s that we would love to do in risk management that I know that the physicians, the hospitals, they can’t always do that. And so what can we do? What’s the best case, but what can we actually do that makes things better for the patient and for the physician. And I have always taken the tactic of, if you take care of your patients and they think you care about them, even if there’s a bad outcome, most likely they’re going to give you grace with that.

Shari Moore (9m 47s):
And so by making patients the priority and making their care a priority for the physicians and that attention to them, then you’re just going to have sort of the unintended consequences of not having a lawsuit, even if there’s a bad outcome.

Dr. Anthony Orsini (10m 5s):
I love that you said that. And in my book, I talk about my physician, who was my family doctor, Dr. Merck, and how he practiced for 50 years, I practiced so long. He delivered me. And then I did my rotation with them in medical school. That’s how long you practiced. Then people would say to him, when are you going to retire? And Dr. Merck would say, well, right before I die. And, and sadly, six months after he retired, he died. That was his life. Dr. Merck kept the records. I’m not advocating this, but Dr. Merck kept records on a five by nine index card. And, but he was an expert in building relationships and people loved him. And we talked about the concept in my book.

Dr. Anthony Orsini (10m 45s):
I talk about the concept of it’s hard to fire your best friends, which is, I love that saying. And so the statistics are staggering for people out there about how much medical malpractice lawsuits cost. The AMA estimated between 84 and $151 billion per year is spent either preventing malpractice, paying off malpractice or doctors, practicing defensive medicine because of that. And I think what I want to talk about now is the best defensive mechanism is not to order 25 laboratory tests that are probably not needed. The best defense system is to form that relationship with the patient in the first place. And to get them to like you, it seems like PLICO, and you are kind of ahead of the curve on this.

Dr. Anthony Orsini (11m 30s):
So I want to get into revealing medical errors later, but my father told me when I moved into my very first home, he bought me a toolbox with all the tools in it. And he said, you need them now because when you need them, it’ll be too late. And that is what I want to talk about today. We’re not really educating enough doctors on how to form those relationships and prevent the malpractice in the first place. And then we’ll get into how we’re not educating about medical errors. So how important is this communication training in this whole big number of $150 billion malpractice?

Shari Moore (12m 6s):
Well, interestingly, one of the things that I did when I came to PLICO about two or three years into it, we had been doing a lot of the communication stuff and we’ve done it in so many different ways. I think that is one thing that I’ve figured out is that, you know, the doctors learn differently. Primary care learn very differently than specialists. And so we’ve taken it from a lot of different perspectives and tried to throw it at them and try to see if some of it sticks. But one of the things that we’ve looked at, I had a board member who was retiring and he was going to come on as a consultant. And so I asked him what the first thing we did is we pulled like the top 10 at the time, we were not part of the larger MedPro group organization.

Shari Moore (12m 48s):
And so we couldn’t really trend any of our claims. We didn’t have a net. I mean, as a single state, there was just no way. And so I had him pull like the last 20, you know, high payout indemnity claims and to review them, to see if there were any things that we could look at. And quite honestly, these were just cases that it was just Murphy’s law. I mean, it’s just like, stuffs going to happen. You could put all the risk management tools in place in the world and probably these cases were still going to happen. And so it was kind of frustrating because, you know, so we took a completely different idea and started pulling cases where no indemnity was paid and looked at those.

Shari Moore (13m 34s):
And those that had a high amount of alae, the legal expenses. And that was what was costing us money because we weren’t paying out any kind of indemnity. And what we found in those cases was poor communication led to the patient in many situations, going and looking for their answers from an attorney. And so, because they couldn’t get their answers from either the hospital, the physician or somebody that they trusted. And so if they were going to get an answer, they just went and asked an attorney to get an answer for them. And again, many of these lawsuits had obviously no basis. It was just poor communication.

Shari Moore (14m 15s):
And it just reinforced to me the fact that a lot of the expense that we hear all about the big giant settlements, the big giant verdicts and all that kind of thing, that if you really kind of look at the bottom line of any NPL company, 80 to 85% of these are closed without payment to the patient. And so you’ve just got this blood of claims and lawsuits that probably don’t have any merit. They give a lot of discomfort to the physicians, to the patients who are involved and it takes away from their practice. And many times, if it only had one more time that she came to the office and you sat down and you said, this is what happened.

Shari Moore (14m 58s):
This is how it happened. Or we talked about it beforehand. This was a known risk. Do you remember our informed consent conversation? So we have a lot of those. We include that as well. You know, the whole conversation of adverse events starts at your informed consent process because you want to be able to reference back what you talked about. And so things like that. So that’s what we really have always concentrated on. And every year we do at least a portion of our education is related to communication skills in some form or fashion. And unfortunately the doctors who come to those are probably the ones who don’t really need it.

Shari Moore (15m 41s):
And again, you’ll, hopefully I, we hang it, we give them a carrot because they do get risk management premium credit on their renewals. And we hope that some people will just land in those classes that maybe it was just the best time for them. They don’t really care. They’re just showing up to get their credit. And again, we kind of just throw stuff out.

Dr. Anthony Orsini (15m 59s):
In fact, the American bar association made a statement. I think it’s over 10 years ago that patients are unlikely to file for malpractice if they feel a relationship with their doctor, even if prompted to do so. And so that’s why Dr. Merck went 50 years without getting sued. I’m sure he made mistakes. You know, he’s a good doctor. He wasn’t the greatest doctor that ever lived, but his patients wouldn’t even consider filing a lawsuit. And the communication for prevention is so important physicians, as you know, very small percentage of physicians account for a very large percent of malpractice lawsuits. And many of that is just their bedside manner. And the, I have a friend I just had as a guest, Jeffrey Seigel, who’s a neurosurgeon.

Dr. Anthony Orsini (16m 43s):
And now those is an attorney for malpractice and we discussed this, but I have a friend who just very recently had surgery, had some complications post-op pain. It was a complicated surgery and nobody did anything wrong. It was a neurosurgery. And she kept going back to the doctor until telling the doctor that she was having visual problems, et cetera. And he kind of lost his temper with her and told her to never come back. You’re cured. Don’t ever come back again. My job has done. And what did she do out of anger? She called an attorney and he could have prevented that in the book by Malcolm Gladwell, blink that as famous.

Dr. Anthony Orsini (17m 24s):
He talks about the famous study by Nalini Ambady. I don’t know if you’re familiar with that study, but she analyzed 36 surgeons a way back in 2002. I think she published. Half of them were sued multiple times. The other happened, never been sued. And she recorded interactions with patients with all those surgeons and then put it through a computer analyzed tome. And the computer was able to pick out which doctors had been sued just by analyzing tone. I mean, that’s staggering. So it sounds like PLICO is really on the forefront of this. And the fact that you offer credits, I think is really an incentive for people to go.

Shari Moore (18m 1s):
Well, another thing that we do and it’s of course in the pandemic, we couldn’t do it. But one of the things that we do is that I think is also so valuable for our physicians and other healthcare providers that we ensure is to get the maximum risk credit. We want you to be in-person with us. And that is something that I have seen over the last several years. And of course, last year, we’ll just leave it out. But the people who get together, they talk, they interact with each other. I think it’s super important from a burnout perspective, since we’ve kind of lost the physician lounge, our radiologists are second home, you know, looking at a computer.

Shari Moore (18m 43s):
I think you just had someone was talking about that. And just the opportunity to be together with like individuals who are dealing with the same thing. A lot of people say, oh, we don’t want to have to come. And it’s like, I promise you, I’m going to give you a great meal. I’m going to have you see your colleagues and talk to them and I’m going to give you great content. I’m going to give you great education. And on top of that, I’m going to pay you to come, basically. So that is another piece of it. When you talk about the burnout and especially over the last year, I think things have just gotten so difficult. And when I talk to people and then them reintegrating with their patients and also the patients and their own, I had a call from a doctor and it was like you said, it was a surgery that the husband ended up having a little bit of a more follow-up than was needed.

Shari Moore (19m 32s):
And the wife like lost it. And I said, well, let’s talk about what’s going on with the wife she’s got three kids at home she’s trying to educate right now. Now she thought this was going to be an overnight procedure. And now you had to keep him for a couple of extra days. He goes, oh, I know, no, I know. I feel totally. I mean, he totally got it. He just wanted to kind of talk to me, talk through what he could talk with her about. And he was totally able to deescalate that by recognizing where those people were coming for him that maybe had nothing to do with the surgery, had nothing to do with serving. And those are things that we see.

Dr. Anthony Orsini (20m 9s):
That’s an important tip that when I teach conflict resolution support and tip that when somebody is angry, don’t listen to what they say. I just had a conversation with a colleague recently who had a problem with a patient. I said, what does the patient really want? What are they asking for? Not what they said, as they’re speaking, I want you to listen to them and say, what do they want? Maybe they want control. Or maybe they want some answers. Maybe they want your time. Maybe they want compassion, or maybe as you alluded to before, they just want you to say, you’re sorry. Right? Yeah. So you really have to think about that. So, you know, many of my colleagues will say, oh, building relationships know that primary care doctors get sued less because they have longtime standing relationships.

Dr. Anthony Orsini (20m 52s):
But we also know that there’s some sub-specialists who rarely get sued also in that’s again, how they can form relationships, but you can form a relationship very quickly by learning how to communicate. And I think the work would of Nalini Ambady is really very important because we can teach doctors early on. Like my father had given me that tool box saying, you’re going to prevent it. But sometimes, you know, medical errors are a fact of life. We are human beings and things happen. In fact, one statistic says that medical errors. Now it’s the third leading cause of death in the United States. Things will go wrong. We’ve now trained doctors on how to build relationships and now something goes wrong. Let’s talk about revealing medical errors and how important that is to stop it.

Dr. Anthony Orsini (21m 36s):
So you have the first chance to stop. This is prevention. Now something happens and now you can prevent the lawsuit. So give us some advice and what you’re doing to educate doctors and risk managers on how to now reveal that medical error.

Shari Moore (21m 49s):
Well, I think what you said is about the toolbox is so important because we need to be able to know that the doctor knows in real time how to make that first conversation when something’s gone wrong. And that can’t always include having a call with us ahead of time. They’re going out after a surgical procedure or they’re they just gotten a call about a medication error or whatever, and they need to have a real-time conversation with that patient or that patient’s family. And so we talk a lot about that first conversation being very empathetic. That empathy is always okay to say, I am so sorry this happened.

Shari Moore (22m 34s):
We are going to be looking into what happened. This is exactly what we know now and we’re going to find out more information and we’re going to have a conversation later. But right now the important thing is we’re going to be taking care of your patient, your you or your family member. This is what we need. Even little things like saying, is there someone we can call for you? Do we need to get you a hotel room? You’re from out of town, you were not going to spend the night. We’d had something unexpected happen. And to have that initial conversation. And part of that is don’t say, oh my gosh, I think we screwed up. That’s part of the conversation because we always say you can’t put the toothpaste back to the tube.

Shari Moore (23m 15s):
And so don’t say something you don’t know, don’t assume don’t speculate on what it is that might have happened because you, even though it may seem really clear, once you go back in and look and see everything, it may not be the way it now looks right now.

Dr. Anthony Orsini (23m 38s):
And a perfect example of that. If you don’t mind me, interrupting is leaving a sponge in for surgery. And again, I don’t want people to think that you’re not supposed to say, you’re sorry, as you said, sorry is very, very important. But leaving that sponging is not a breakdown just of the surgeon. I mean, there are counts. There’s a process. There’s people that are in charge of counting the sponges, going in and counting the sponges going out. And so to a lay person, they would think that it’s really the surgeon sole purpose is to, but when actually that’s not true,

Shari Moore (24m 8s):
Right. I’ve seen several of those over the years that, I mean, they did everything, right. I guess, accepted the count. But I mean, even if the account was off, they did an x-ray. They did all those things and still didn’t, didn’t find it because of where it was or whatever. And then had to have figured that out, down the road, and then I’ve had people call it where that wasn’t even part of the process, because it wasn’t something that was typically that you did count. I had that in a labor and delivery case one time. And so, you know, just little things like that, but mainly just knowing it’s okay to go out express that this was not what you expected either.

Shari Moore (24m 49s):
And to say, I’m so sorry. And the main thing right now is we’re going to take care of you. And then also to remind them, if you say, you’re going to get back with them in three days, you better get back with them in three days, don’t promise something and not do it. Cause that’s worse. I’d rather you just giving them your cell phone number, giving them all of those resources so that you can answer questions. We always say it’s about staying on the same side of the table. And when someone calls me and they’d had something, a conflict with a patient, I will tell them our first advice outside of them being abusive to you, abusive to your staff or something like that. Our first advice is going to be, to maintain the relationship with the patient.

Shari Moore (25m 30s):
Because by maintaining that relationship, it decreases your risk of being sued. And then if you are sued and you’re still seeing them as a patient, what better defenses is there than that for, for them to say, well, Ms. Smith, I, I see that you still are a patient of Dr. Jones and well, yeah, it was great, you know, and all that. So yeah, I don’t know that I’ve ever actually seen that happen, but that’s because maybe they didn’t get sued.

Dr. Anthony Orsini (25m 54s):
What do you think the biggest mistake that physicians make when they have that conversation?

Shari Moore (25m 59s):
There’s two, two options. One is speculating of what happened and taking responsibility for something that maybe was either a process issue or was a known risk or the way that they talk about it. The patient doesn’t understand that it’s, it’s a known complication and that kind of thing. They think there’s something wrong. That’s the first thing is saying too much, too soon. Okay. And then the other one is saying too little, never. So those are the two opposite ends of the spectrum. I think of just saying, well, you know, or sending heaven forbid sending the nurse out to give the information, you know, or something like that. Cause they don’t want to deal with it.

Shari Moore (26m 40s):
And then avoiding the patient’s family during rounds over the next couple of days.

Dr. Anthony Orsini (26m 48s):
How about the role of the physician? As far as the person who’s breaking the news about the medical error and you know what I’ve seen in the past, there’s too many people in the room. So the doctor walks into the hospital bed to tell them about the sponge that was left in. And there’s an attorney, there’s a risk manager, there’s the charge nurse to PCC. And I think that right away, that causes a problem. How should the relationship work with the risk manager and the doctor and the revealing medical errors?

Shari Moore (27m 16s):
We handled it. And again, it’s, I’ve been at PLICO for over 13 years. So I’m in the hospital setting though. I would never even really tell anybody if I was going in with a patient with the physician, I would never tell them I was the risk manager. I would just say I’m representing the hospital as administration. And it would usually just be the two of us. And then what I also do and recommend, or outside the hospital setting, having the person in the practice that has the best relationship with the patient, because that may not be the physician, just depending on what has happened. It may be the nurse that they’ve talked to on the phone five times about getting back in or whatever, but making sure that it’s not like this random person, that they really don’t have a lot of contact with.

Shari Moore (28m 8s):
Let’s say that they really always see the PA and then they go and the surgeon is a surgeon and something happens. And then the surgeon is the one trying to maintain this relationship. You know, that may not be the best thing. The other people that are always a challenge. It’s a challenge for them are those physicians who don’t have patient contact like radiologists, like pathologists, you know, there’s a fair number of medical errors that happen kind of retrospectively you see things with those. And so not only are you teaching them about disclosure, you’re teaching them really about communication because they don’t have that interaction.

Shari Moore (28m 48s):
And so if it is something like a pathology error or radiology error, or is that really the best person to go and have that initial conversation that I do find, I think that not only for the physician, because it’s important to them, but for the patient, they need to at least hear from the person who was involved. It may not be the person leading

Dr. Anthony Orsini (29m 11s):
The overwhelming theme here in this conversation. And this is why I think you and I get along so well is the word relationship keeps coming up over and over again, as I do more and more teaching it. And I learned more and more about this subject. We train doctors, the ACGME, the American college of graduate medical education now says that doctors in training need to have some kind of training in revealing medical errors. And that’s interpreted in different ways. Some people interpreted that as a half an hour lecture, right? But we have some program directors who have contacted us at The Orsini Way. And we put residents through scenarios with professional actors and these actors are improv.

Dr. Anthony Orsini (29m 54s):
So they’re not told what to say or what to do. I mean, they’re amazing. They’ve been on TV, they’re great actors. And they’re asked to react to whatever they feel. And it’s amazing to me that we’ll see doctors who do it correctly. And we have one scene where a mammogram was missed for six months. And you have to reveal to the patient that her breast cancer now metastasized to bone because we missed it six months ago, terrible scenario. Everybody has a right to be angry with that, but we’ll have actors who will go through this scene with these. Some of these doctors, the doctor will do it beautifully. And in the end, the doctor’s hugging the patient, right? And then the next doctor will come in and their stuff being thrown by the actor.

Dr. Anthony Orsini (30m 39s):
And I’ll say to these actors who are very familiar with doing this, I just knew that first doctor was really upset about this and that she really felt empathy, as you said, right? And so you have so many ways that we can avoid this adversarial response, you know, first have the relationship in the beginning and then the second, but PLICO is doing some of it. But most doctors aren’t being trained in this, it seems to be the most cost-effective thing you could possibly do.

Shari Moore (31m 7s):
Right. Right. I know it’s funny because to me it’s just such common sense. So I don’t understand those two. Don’t give it enough credence. And in fact, I don’t know if you remember a couple of years ago, there was a study that came out that said, apology laws don’t have an effect on malpractice. And actually my ran MedPro group and I were at a conference for professional liability carriers and they were having a conversation about it. They were having a seminar, you know, a presentation about it. And if you deep dive into that, it’s actually, it’s only about the law. It has nothing to do with application of the strategy of empathy or disclosure.

Shari Moore (31m 53s):
It’s only this state has a law and this is their malpractice. This state has a law and it, you know, and that kind of thing. And so to me, it was a little bit misleading to say the least. And you know, you still have those sort of deniers that, that just don’t believe in it. And overall again, the people who attend our stuff, our educational programs, I have literally had people who, when we first started doing the disclosure things, they would come and they would say, thank you. That’s how I practice. And I’m just glad that PLICO is supporting me now. Or they would say I had something happened 10 years ago.

Shari Moore (32m 35s):
I delivered a baby. They’re the same age as my child. I see them once a week in school activities, there was difficulty with the delivery. And I’m still haunted by not just being able to say to them, I’m so sorry this happened. I’m feeling like I could do that. And so it allows physicians to continue to be physicians, their caregivers. And then we were asking them again, in the denying the fan thing, we’re asking the caregivers, which can’t be good for them. Can’t be good for them, especially not the really caring and compassionate ones.

Shari Moore (33m 18s):
You know, I’ve seen people quit, I had a doctor hospital who was a surgeon who had an outcome and she’s now working as call or something. I mean, she had all this training, all of this intense internship, residency fellowship, all of those things and the error that occurred and the way that things happened, it just totally deflated her. And we lost a good doctor because of it to do different work than she was trained for.

Dr. Anthony Orsini (33m 50s):
I think that most non-healthcare professionals don’t realize that when physicians do you get sued, even if it’s frivolous, that it does hurt, right. And affects us towards professional burnout or, and the worst case scenario where you’re quitting medicine. And if the medical error happens, being able to say that, you’re sorry, and apologize. And show that patient that you really cared and you’re compassionate may prevent the lawsuit. But if it doesn’t, it’ll at least help you that you said, you’re sorry, it’s a great point. Right?

Shari Moore (34m 23s):
Our defense attorneys, we have an apology on Oklahoma, but they’re like, I don’t want to keep that out. I mean, if someone EO, if they showed compassion to somebody after an event or whatever, the last thing I want to do is not let other people know that they kept hearing about, you know, they kept hearing about the patient as they were doing it. And just another thing now that you’ve kind of brought up the litigation, getting sued, we have just implemented last July. We implemented a proactive litigation support program where we assign a board member to each of our physicians who receive a lawsuit and the primary goal, they don’t talk, obviously talk about the lawsuit.

Shari Moore (35m 7s):
The primary goal is to educate and have a resource to educate outside of the defense panel outside of their client’s panel, a physician, to educate them on the process of the lawsuit and how it feels to you and what you might be feeling as a physician during that time. And so we’re coming up on a year and, and learning about that and learning a lot of different things that we know that doctors won’t ask for help. If you just lay it out there and say, oh, by the way, we have this, if you need it, give us a call. And so we made the decision to be very proactive with that and to call them and just say, look, if you have questions, here’s my name.

Shari Moore (35m 48s):
Here’s my number. I’m your guy, I’m your gal, whatever. Give us a call and then doing maybe a six month follow up with them throughout the process, because we do have a lot of research about the opportunity for increased error over the, like, it actually goes up and does not get back down to where a regular practicing physician is as far as risk stratification for about two to three years. So your risk of having another medical error after you’ve received a lawsuit goes up and it slowly comes down and you can see spikes in that based in, it looks like when you look at the timing, it’s when they’re getting deposed or when the expert is getting deposed against them and things like that.

Shari Moore (36m 32s):
So that information I think, is really valuable to physicians to understand and look at it from that perspective, instead of saying, you know, you might get kind of sad. You might have depression, you might drink a little bit too much. You might be mean to your kids, whatever, and or your staff, but here’s what actually is why you need to know about what the process is because you’re at a higher risk for having another error.

Dr. Anthony Orsini (36m 58s):
And that’s really important because it affects us. And we know professional burnout is at an all time high, 60% physicians have the highest suicide rate of any profession right now when someone sues you or there is a medical error, we feel terrible about that. And that spike occurs because we’re still thinking about it. We’re not ourselves. Maybe we’re second guessing ourselves. It happens even in the NICU at a hospital where there’s a death, even when there’s no medical error. And it’s just an inevitable death, that nurse, I’m trying to remember the exact statistic, but the nurse, the chance of that nurse, making a medical error immediately after that death is way up because she’s upset or he’s upset.

Dr. Anthony Orsini (37m 39s):
And we need to take care of our doctors and nurses. If we’re going to help this and doctors, as you said, they, you know, it’s been said that we feel like we don’t need any help. And we have this big S on our chest and we can get through it when it’s just not true. So fixing this issue of malpractice and medical errors is going to help the bottom line of medicine. It’s going to help patients for medical errors is going to help doctors and nurses. And I think it’s a topic that we need to speak more out. So thank you. We’re coming to the end now. And we’re going to come to my final question that I ask all my guests title of this is difficult conversations. And so in your career or personal life, what is the most difficult conversation that you’ve had to encounter?

Dr. Anthony Orsini (38m 26s):
And please give us some good advice on how to navigate through that.

Shari Moore (38m 29s):
I’d love to be able to set great advice for it, but as a manager, I think for me, I’ve always actually been pretty comfortable talking to patients if something happened, because I think I believe in the process so much, but for me, the ones that give me the most heartburn are situations where I have someone that I’m either working with or who worked for me, or maybe it is a physician who needs to have some information given to them that might not be the best, the thing that they like to ask. And for me, that’s the hardest. And most of the time, it has nothing to do with the actual tasks that somebody is doing.

Shari Moore (39m 14s):
It’s generally something that has to do with an attitude or a behavioral thing, which is the hardest to me because I’m very black and white person. So what I find is that easiest for me to do is to really try to just identify the behaviors that are objective and to be able to say, you know, I noticed this, and this is unlike you. This is our goal. This isn’t looking at our mission. You know, I hired you because of all of these strengths and I’m not seeing those right now. And in most of the situations, I’ve laid awake, worrying about it. And then they’re like, oh my gosh, you’re so right. This is going wrong at home.

Shari Moore (39m 56s):
I know. And they literally have almost been waiting for me to point it out to them, but those give me the most heartburn because I have such an investment in my staff and the people that I work with and my expectations for how they treat other people, how they do go about their work is they’re very high. I have pretty high standards. And a lot of that is about being a servant leader. And no matter which job you have have told my husband, I don’t know why we’ve been talking about it the other day. I said, but the thing that makes me the most crazy is when someone treats me differently, because I’m the vice president of risk than they treat one of my consultants, or then they treat my administrative assistant.

Shari Moore (40m 44s):
And in the hospital is the same way they treated me differently because I was a risk manager versus now they treated a nurse or how they treated a nursing assistant. I don’t have a tolerance for that because I think we all have a part to play. And I think we all have value in what is the end goal. And so my expectation for people is that they treat everyone with respect and recognize their contribution to whatever the task is, whether that’s at work at home or wherever. So hopefully that answers your question.

Dr. Anthony Orsini (41m 18s):
I think that’s great advice. My father told me at a very young age, he said to me, you’re not better than anybody in this world, but remember, no, one’s better than you either. And I’ve always remembered that. And it’s true that we need to treat everybody like they want to be treated like we want to be treated and how you start those difficult conversations, make all the difference in the world. And you just gave some great advice. Let somebody, as we discussed, when we talk about conflict resolution, you kind of lead them to the water and then they drink. That’s so much better than saying Tony, you’re doing a horrible job in shape up, or you’re out of here.

Shari Moore (41m 56s):
That way. Why are you acting that way? Generally, if you can start the conversation with something, they can’t really argue with that. You said this, I got this email from someone or whatever. It’s just an objective statement.

Dr. Anthony Orsini (42m 11s):
Leave your office as a leader, they could leave your office saying Sherry, she’s a jerk. I hate her. Or they can leave her office and say, I disappointed Sherry. And that is never going to happen again. And that’s the difference between a true leader. And there’s the segue between communication and medicine and the doctor, patient relationship to the leader, teammate relationship. It’s all about communication. So this has been great Shari. I mean, we covered so many topics in such a short period of time, but it’s a topic that everyone needs to hear about and needs to learn about. And I thank you so much for sharing your wisdom with us and hopefully there’s people out there that are going to really understand that.

Dr. Anthony Orsini (42m 52s):
Let me fill up my toolbox now and learn how to reveal medical errors and learn all this. I’m so excited that PLICO is taking a lead in prevention here, instead of just trying to put band-aids on wounds that already happen. So thanks so much for sharing your time with us. We will put all your contact information on the show notes, and we’re excited for everyone to hear this, just to make our attorneys happy. The views and beliefs of this podcast from the guests and the interviewee are both our own and not necessarily the beliefs of our respective companies and institutions. Always got to make the attorneys happy. If you enjoy this podcast, you’d like to get in touch with me.

Dr. Anthony Orsini (43m 34s):
Please go ahead and get in touch with me through the Orsini way.com please subscribe or follow on apple it’s available and almost every single podcast platform. Thank you, please go ahead and download all previous episodes and I’m so excited and I can’t wait for my audience to hear this.

Shari Moore (43m 51s):
Thank you so much.

Dr. Anthony Orsini (43m 52s):
Thanks a lot, Shari, I appreciate it.

Announcer (43m 55s):
If you enjoyed this podcast, please hit the subscribe and leave a comment and review to contact Dr. Orsini and his team, or to suggest guests for a future podcast. Visit us@theorsiniway.com.

How Do You Define Your Self Worth

Dr. Lisa Strohman (1s):
So what technology does, is it really with the notifications and those bumps in those, all of those things, it’s actually creating a loop of anticipation and it really isn’t the part that like we’re fuels it in the end. And that’s where I think when parents see I’m going to put my kid on ABC mouse, when they’re three and four years old, and they’re like, it’s an educational program. That’s teaching them their letters. What it’s really doing is teaching them that pleasure pathway and that they get a sticker at the end or learning how to draw their letters. And so, as a parent, you need to understand when to cut it off because the minute you see your kid attaching that anticipatory reward system, you’ve got a kid that’s already starting to get into that addictive loop.

Announcer (44s):
Welcome to Difficult Conversations: Lessons I learned as an ICU physician with Dr. Anthony Orsini. Dr. Orsini is a practicing physician and president and CEO of The Orsini Way. As a frequent keynote speaker and author, Dr. Orsini has been training healthcare professionals and business leaders how to navigate through the most difficult dialogues. Each week, you will hear inspiring interviews with experts in their field who tell their story and provide practical advice on how to effectively communicate. Whether you are a doctor faced with giving a patient bad news, a business leader who wants to get the most out of his or her team members, or someone who just wants to learn to communicate better this is the podcast for you.

Dr. Anthony Orsini (1m 27s):
Well, I am honored today that the or way has partnered with The Finley Project to bring you this episode of difficult conversations lessons I learned as an ICU physician. The Finley Project is a nonprofit organization committed to providing care for mothers who have experienced the unimaginable, the loss of an infant. It was created by their founder, Noelle Moore, whose sweet daughter Finley died in 2013. It was at that time that Noelle realized that there was a large gap between leaving the hospital without your baby and the time when you get home, that led her to start The Finley Project. The Finley Project is the nation’s only seven part holistic program that helps mothers after infant loss, by supporting them physically and emotionally. They provide such things as mental health counseling, funeral arrangements, support, grocery gift cards, professional house cleaning, professional massage therapy and support group placement. The Finley Project has helped hundreds of women across the country.

Dr. Anthony Orsini (2m 23s):
And I can tell you that I have seen personally how The Finley Project has literally saved the lives of mothers who lost their infant. If you’re interested in learning more or referring a family or donating to this amazing cause please go to The Finley Project.org. The Finley Project believes that no family should walk out of a hospital without support. Well, welcome to another episode of difficult conversations lessons I learned as an ICU physician. This is Dr. Anthony Orsini, and I’ll be your host again this week. Today, I have the absolute pleasure to have as my guest, Dr. Lisa Strohman. Dr. Strohman is a clinical psychologist, author, public speaker, and the founder and director of digital citizen academy, which we’re going to talk about today.

Dr. Anthony Orsini (3m 11s):
She has a PhD in psychology from Drexel university and a law degree at Villanova university. Dr. Stroman was a visiting scholar for the FBI, working on homicide of pedophilia. When the Columbine tragedy occurred, giving her the opportunity to be on the front lines of how technology impacts our youth. She has continued to work with law enforcement and the FBI on safety and cyber crimes involving adolescents while also lending her knowledge and guidance to the national center for missing and exploited children. Dr. Stroman established the digital citizen academy to proactively prevent and develop curriculum for educators and parents on the issues resulting from technology use and misuse.

Dr. Anthony Orsini (3m 54s):
Dr. Strohman has spent more than a decade working with adolescents and families in our private practice and a career working with schools to address challenges with student mental health and wellbeing. As a frequent speaker on the topic of digital technology and its effects on adolescents, and as appeared multiple times on Newsmax TV, the Dr. Drew show and many other media outlets. I first met her in March when we were speakers at a TEDx event in Phoenix, and we instantly hit it off. I’ve been on her new podcast called The Point that Dr. Lisa and we have become friends in a very short period of time. And that’s why I’m so excited to have her on our episode today, so she can share her knowledge.

Dr. Anthony Orsini (4m 35s):
And I promise you this episode’s going to blow you away. So without further delay, Lisa, thank you so much for coming today.

Dr. Lisa Strohman (4m 41s):
Absolutely happy to be here.

Dr. Anthony Orsini (4m 42s):
This is great. I was just on your brand new podcast called The Point. And that, that was exciting to be interviewed by you. And it seems like now we’re just going back and forth, and this is great.

Dr. Lisa Strohman (4m 52s):
Yeah. It’s exciting. The podcast circuit,

Dr. Anthony Orsini (4m 55s):
When I met you, you were holding out on me because we were all giving Ted talks and we were all kind of nervous. And you know TEDx is a very different kind of lecture that I’m not used to giving. And you never told anybody, you were a second timer until I Googled you. And I was like, she wasn’t even that nervous. You were just pretending.

Dr. Lisa Strohman (5m 11s):
Well, I was a little nervous. I mean, I think that the TEDx GCU with student run for the first time. So I did give another Ted talk in 2016 and I did swear that I would never do it again because as you and I both know, it’s a very different forum than just speaking your mind and going out and sharing your passion with people. So, and

Dr. Anthony Orsini (5m 31s):
I also found the Ted talk being your first one, it looked like was about 16 minutes and Phoenix, you and I were limited to 10 minutes and you know, a famous quote by mark Twain. If you want me to speak for a few minutes, it’ll take me days to prepare. But if you want me to speak for an hour, I can do it right now, paraphrasing, of course. But did you find that was harder to do the 10 minutes than the 16 minutes?

Dr. Lisa Strohman (5m 52s):
Much harder. It’s an art to share a message even in a 60 minute, we had an 18 minute window in the first Ted talk and that’s pretty, I think ubiquitous for Ted talks, they’re usually 18 minutes and the GCU one because of COVID, they were trying to fit more people and do more in less. And I think that nobody but us really realize the stress that that caused.

Dr. Anthony Orsini (6m 13s):
Yeah. For those of you out there, haven’t done a Ted talk, you’d get assigned a coach. And so you show your speech and you write and you send it to your coach. And, and in my case, my coach was Kylie and she was amazing. And Kylie kept saying too long, then I’d shorten it again still too long. I sure like, but I have so much to say, so every word has to count with Ted talk. So it was kind of funny, but I’ve heard those words. You have to know those words and you can’t get them wrong because it’s, you don’t have time to recover. So that was quite an experience. We had a great time and it went off really impeccably. And you said as it was student run and wow, did they do an amazing job for students? I don’t think I could have done. I’m still not that organized many years later.

Dr. Anthony Orsini (6m 54s):
I don’t know how they did it all. So I wanted to ask you, I didn’t know this about you till I started researching you Drexel and Villanova. Are you a Philadelphia person?

Dr. Lisa Strohman (7m 2s):
I’m not. I grew up in Northern California and I went to undergrad at UC Davis and I was in all sorts of programs there for psychology. And I had a professor who said, you should probably get a JD because you liked this policy work. I worked with autistic children at the time. I had a family that had four biological autistic children and fifth from a separate marriage. And I helped them through policy and placements. And so she’s like, you know, a law degree would be a good idea. And I had no idea what I was getting myself into. So at the time there was three programs, Nebraska, Philadelphia, and Florida. Those were my three choices. And so we ended up in Philly.

Dr. Anthony Orsini (7m 39s):
So you spent how many years in Philadelphia? Because I was there for medical school, residency and fellowship. So I was there for 10 years.

Dr. Lisa Strohman (7m 47s):
Oh my goodness. I actually, because my husband was a medical student in Philadelphia at MCP Honamin at the time I did a six-year program in four years and got out. Otherwise he would have had to do his residency there.

Dr. Anthony Orsini (7m 59s):
I liked Philadelphia. I didn’t appreciate it when I was there, because all I was doing was studying and working. But I am a big, big pat steaks person and loves Philadelphia. Yeah. Are you a Geno’s person?

Dr. Lisa Strohman (8m 11s):
No, I’m kidding. I’m as Pat’s person actually just causing some controversy.

Dr. Anthony Orsini (8m 16s):
It is the number one tourist attraction in Philadelphia. I don’t know if he knew that Pat’s and Geno’s and every time across the street from each other, I’d meet my friends there. We do a blind taste test. And then either as people from Philadelphia now, either you are a Pat’s person for life or a Geno’s person for life, and there’s fisticuffs sometimes going over that, just in that argument. So anyway, we’re digressing here, so, but that’s Philadelphia. I do miss Philadelphia. So take us back. So now you got your JD, you got your psychology, you’re working with children’s and adolescents, and then you were also working for the FBI, right? And then something happened. Columbine, tell us how that kind of evolved.

Dr. Lisa Strohman (8m 57s):
So I was assigned, I applied for an honors intern program hip for the FBI, and I was assigned to the unit in Quantico that is called CASKU, child abduction serial killer unit as part of the national center for the analysis of violent crime. And I was really fortunate. That was a summer program. It was paid. I thought it was super wealthy. I was getting like $700 a month or something. Maybe every two weeks. It was very, you. It felt very enriched at the time. And it was just incredible. And at the time the director was Louie Freeh, who had, I think, six or seven kids at the time. And he liked my work. He thought it was very thorough and the unit themselves liked me a lot. And they offered me to come on and do my dissertation in combination with National Center for Missing and Exploited Children on infant abduction.

Dr. Lisa Strohman (9m 44s):
So I went from a honors intern program over to a dissertation project as a visiting scholar with the FBI. And that was in total about five and a half more years as I finished up my PhD and started the research in infant abduction, which was like profiling why people steal babies from hospitals, which is your area? My husband, I didn’t have children for 16 years. It terrified me things that were going on, but that’s how I got into the FBI and why I was there for so long and why I was kind of introduced to this technology psychology issue at the time when I was there.

Dr. Anthony Orsini (10m 16s):
And then Columbine happens and you’re asked to speak about the technology that would devolve tell us about how technology was involved in the Columbine incident.

Dr. Lisa Strohman (10m 25s):
So from a standpoint of where we were as an investigator is Columbine happened in April, the FBI and their involvement didn’t happen until months later because the federal unit, the CASKU unit, you know, the profilers were given all of the information from the local law enforcement. And by the time that all came together and they were asked to quote unquote, profile Dylan and Eric, as the shooters, all of the information that came out, you saw in that situation, that one of the kids, Eric Harris was definitely the lead in that situation when he had at the time posted like kind of a manifesto and had done tapes.

Dr. Lisa Strohman (11m 5s):
And there’s all these things because the internet had just started there still wasn’t my space. There still wasn’t any social media at the time that happened. But there was a lot of things that he was posting into these kinds of websites that he was creating and they had been arrested 18 months prior. And so there’s this history of kind of just seeing these two kids that were one was kind of apathetic and kind of lost and where he was, which was Dylan. And then Eric, who is kind of the shorter kid that was bullied a lot and picked on Dylan was like six, three or six, two is very tall and they just kind of connected and kind of the rest is history. But we, that we were given all that information or the unit was given all that information, I should say.

Dr. Lisa Strohman (11m 46s):
And the profilers that worked in that were the ones that kind of digested all of it and had all of the postings and technology. And from an observation point, I could just see how easily somebody can be manipulated and shifted in their mindset from a pretty normal mental state, into this very evil and hurtful and really pained existence to want to go and hurt people and prove a point.

Dr. Anthony Orsini (12m 15s):
The conversation about social media is getting more and more intense. And I think the movie, the social dilemma I guess, was called the social dilemma, kind of a lot of people are watching that now, but you were way ahead of that curve way back in 2017, when you gave your first Ted talk, you talk about addiction. And I think it’s funny. What were you addicted to at the time at nine years old, a video game?

Dr. Lisa Strohman (12m 40s):
On Atari, yeah.

Dr. Anthony Orsini (12m 41s):
An Atari video game addiction, it was really a great presentation. So tell us about really how we get addicted, the social dilemma talked about that, but how we are all being manipulated. It’s something we don’t want to talk about, but it’s actually happening.

Dr. Lisa Strohman (12m 55s):
Yeah. I mean, I think it was important. I mean, in that Ted talk, I talk about really about how my family background, my parents, both my parents were alcoholics. My mom was addicted to drugs as well. My grandmother at the time we, my parents divorced when I was five. She was the one who noticed that my personality type, which is very type A, wanting to button everything up on everything. It was pitfall at the time. And I would not every single time I missed a jump, Harry swinging through the jungle. I would start the game over again. Oh my gosh. It was incredible four colors. And the graphics were a little pixelated at the time, but the same thing with piano, like I would play a piece on piano at the time.

Dr. Lisa Strohman (13m 39s):
And if I mess something up, I’d go right back to the beginning. I have to start over again. And so she noticed in that pattern in me, she was like, listen, like you should know that both of your parents have this addictive personality. And I don’t think she was born in 1906. And so she was, she lived with on and off with me for like 12 years. I think she didn’t know why she saw it, but she knew that I needed to be careful. And so that conversation with her and the time that I spent with her from that moving forward made me always look at choices I was making in life and what was influencing me. And to understand that I had that addictive potential. And I have a lot of degrees after my name now. And I work a lot of hours. I have three different companies that I run, you know, I haven’t gotten rid of that addiction potential.

Dr. Lisa Strohman (14m 22s):
I’ve just fueled other things that are more proactive in life than the things that are more negative in life. So I think it’s understanding that’s to your point, like technology can be an addiction and we have to look at our family history and we have to look at how technology is built to create addiction in those that don’t have that background and the realities are, we are for sure getting taken over in this industry and they don’t care how much carnage or damage it causes because it’s money. And it’s a lot of money.

Dr. Anthony Orsini (14m 54s):
Although your grandma was born in 19 something and probably never was even on the internet, she was way ahead of the science. So there’s actually science involved in how this affects your brain, right?

Dr. Lisa Strohman (15m 5s):
Tons of science. Yeah. They go in basically and recognize that dopamine pleasure pathway. They actually know how to hack in and people don’t always, they talk about those things that if you think about a text message and how it buzzes, they think that when we get a reward that we have this huge spike of pleasure in our system, and that’s what like makes it actually build the stronger addictive potential. But what we understand now is it’s the anticipation of the reward. So the buzz or the beep or any of those things, it’s not actually that Tony just messaged me. It’s like, oh my gosh, I wonder who messaged me? And then I’m like, oh, it’s Tony. Like, you know, so it’s not the who it is. Although I’d be very excited to see that you sent me a text message.

Dr. Anthony Orsini (15m 47s):
Thank You, Lisa. I was waiting for that. A compliment. My self worth just went up.

Dr. Lisa Strohman (15m 53s):
We’ll talk about that later, but it’s anticipation. And so what technology does, is it really with the notifications and those bumps and those, all of those things, it’s actually creating a loop of anticipation. And it really isn’t the part that like fuels it in the end. And that’s where I think when parents see I’m going to put my kid on ABC mouse when they’re three and four years old and they’re like, it’s an educational program. That’s teaching them their letters. What it’s really doing is teaching them that pleasure pathway and that they get a sticker at the end of learning how to draw their letters. And so as a parent, you need to understand that they need to understand when to cut it off because the minute you see your kid attaching that anticipatory reward system, you’ve got a kid that’s already starting to get into that addictive loop.

Dr. Anthony Orsini (16m 41s):
It’s really as a parent and we’ve all fallen into this. It’s very easy. You know, when you’re at the restaurant, the kids are acting up, they’re throwing their food and, you know, to throw the, the iPad in front of the kid and let her play or let him play. But I think now maybe thanks to people like you, we’re starting to realize that we are doing damage to these kids, but it’s also happening to adults. They knew something about a couple of hours a day, took our social media.

Dr. Lisa Strohman (17m 9s):
Yeah. More so the number of times it’s super easy now with most of the iOS systems or even on the Google system or the Android systems, you can check your screen time use, but anything over two hours, a day of what I call kind of the junk food of social media, like anything you’re doing, that’s not academic or something that’s more creative or things like that are building you up actually starts to cause damage in your neurons. And it actually, you can see the structural and the neuro-transmitters changing in your system. So we have to be really careful on, on how much you spend on those social media platforms.

Dr. Anthony Orsini (17m 44s):
The brain changes. You showed pictures on your first TEDx. Talk about the changes that happened in your dopamine receptors of your brain are very similar to people who are addicted to drugs. Correct?

Dr. Lisa Strohman (17m 53s):
Absolutely. And that’s my biggest message and my biggest frustration of why we’re not doing programming that we know scientifically makes a difference in kids is because I can see that what we used to be fearful of that gateway into drugs. Like people talked about like pot being the gateway or alcohol, being the gateway into future drug use. Now I’m looking at it and saying like, no technology actually is your gateway into later drug use. Because once you amplify that dopamine reward pathway in children, as young as like seven, eight or nine, you’re going to get this open door into the world of porn and drug addiction. I mean, and Snapchat. Now, if you have a kid that’s on Snapchat, like they’re constantly advertising to those kids about how to get drugs and how to get a plug to deliver it to you.

Dr. Lisa Strohman (18m 38s):
So it’s like Uber drugs or Uber delivery for kids. So I warned parents all the time and I feel like those of us that listen and slow down and take the messaging, right? We could be saving generations of kids moving forward, but it’s hard to get that message out.

Dr. Anthony Orsini (18m 52s):
That’s a good segue into the second Ted talk that you gave. How do we define our self worth and how that relates to children? The numbers are alarming about the number of suicides that are up and how many of them are related to the internet and bullying that. Tell us more about how bad this really is,

Dr. Lisa Strohman (19m 10s):
Right? I’ve never been more busy in my career than the last well, the last year during the pandemic was awful. But I think for five years prior to that, like just seeing the escalation of suicidal thinking, suicidal attempts, suicidal groups, like where you’re talking about, like kids kind of banding together. I just had a case a couple of weeks ago about a mass suicide pack where, you know, just one kid was like, Hey, why don’t we all commit mass suicide? And they sent it out to five different high schools. And we had at least one kid from every high school two were successful in committing suicide. Two ended up in the ICU for an extended period of time and a couple ended up in the hospital, but released. And so to me as a parent, you know, if we’re willing to let our children on these devices and we’re willing to allow them to have access to it, you’re giving up your voice over the voice of other 10, 12, 13, whatever the age is to influence your child.

Dr. Lisa Strohman (20m 7s):
And if you’re okay with that, then I would say, you know, again, I’m not a parent for your child and a parent for my own child, but you need to know the facts. And the facts are that kids are impulsive. Kids are failing and their ability to have resilience. And they’re really struggling to figure out who their identity is. And the context of 7.2 billion people in the world, 5.5 billion of which are on social media every day. So it’s a really big crowd for them to feel special in. And so I think that’s why we’re seeing the numbers escalate so much because it feels like you’re nobody and that’s hard as a kid.

Dr. Anthony Orsini (20m 45s):
20 years ago, was the school cafeteria. If you didn’t fit in, or if you were bullied or you weren’t part of the cool crowd. I think that half an hour of lunch where you had to sit by yourself where you didn’t know what table to sit at was pure hell. And now it seems like the internet is a 24 7 cafeteria where people are constantly excluding you and making mean comments. And so bullying has gotten to be really an epidemic in children. And it’s really quite sad. I didn’t, you tell me in our last little one, or you interviewed me that you’re doing something in Colorado now with the increased rates of suicide is so high.

Dr. Lisa Strohman (21m 20s):
I’ve had a really strong relationship in Vail with a group up there. There’s a couple of different nonprofits up there that are dealing with it. Their hospitals actually are in a crisis level. They’ve had to shut down. There’s no more beds available for teens up there because of suicide attempts are so high. So they just created this whole, like, you know, kind of mass distribution. And I don’t know how to get people to listen, you know, louder and like more effectively of like, we have to start putting dollars into prevention, but you and I have talked about this. We talked about it on my podcast when I interviewed you. And I encouraged people listened to that one because I think we’re both frustrated that people are willing to identify the problem, but they’re not willing to put in the dollars to change the system.

Dr. Anthony Orsini (22m 1s):
Yeah. Lisa and I talked about how we both seem like we’re on top of a mountain, top screaming, but no one’s listening. We’re trying to help. But you know, back to the school cafeteria analogy, when a teacher saw that girl or the boy junior high boy or girl or senior, I’m sitting by themselves, at least it was obvious and someone would reach out and maybe they were guidance counselors to help. But when it’s happening on the internet, parents don’t know. And you told a story about Molly Russell. So tell us about her.

Dr. Lisa Strohman (22m 27s):
Yeah. I love your analogy in that. But Molly Russell was a young girl. She was in school. She’s 14 years old. Her parents like from the outside, didn’t really see anything. She had two other sisters, I’m sure, you know, going through life, having a house full of teenage girls was hard already having just one in my household is super challenging at times. And the parents, you know, would see that she was getting kind of more withdrawn and you know, her normal kind of happy, enthusiastic future thinking is how her dad described her was something that they had seen for years. And that, you know, she became a teenager and started spending a little bit more time in a room and they didn’t really know what she was doing online. They didn’t know what was influencing her.

Dr. Lisa Strohman (23m 9s):
And it took them two years sadly to get a court order in a subpoena to be able, even to open up her social media and identified that she had put in terms like depression depressed. And that once you do that, and this is where that the movie social dilemma really identifies and shows that algorithm. But once you start to search terms, whatever that is the algorithm, basically, particularly with young kids only has that to understand what you’re interested in. So if I type in horses, it’s going to send me pictures of various horses. If I type in depression or suicidal, it’s going to only know that I want to learn more about that. And what happened with Molly Russell is that algorithm took over and basically flooded her influence.

Dr. Lisa Strohman (23m 50s):
And every single suggested link was based on suicide depression, and it got darker and darker. And eventually I think that influenced her into obviously to take her own life. Sadly,

Dr. Anthony Orsini (24m 2s):
They were social media, censoring, everyone. You would think that they can stop that, that there’s the technology to stop flooding someone who’s maybe searching suicide

Dr. Lisa Strohman (24m 12s):
A hundred percent. They absolutely have the ability to do that. They absolutely have the ability financially. It’s not something that makes a cost-effective response to them to change whether it’s pornographic, suicidal graphic in nature of like bloody or things like that. Like they made efforts to pixelate out, you know, a wrist that has been slit or, you know, a bloody finger or face or things like that. But they don’t delete posts. They allow the posts to exist and only pixelate at which if you can imagine with a teenager that makes them even more curious and it makes them even dive in deeper. So it hasn’t been fixed psychologically. It is incredibly frustrating because we know how easy it is to change it from a technological standpoint.

Dr. Lisa Strohman (24m 55s):
And they just won’t do it because we don’t have enough voice and we don’t have the power legislatively to change it.

Dr. Anthony Orsini (25m 1s):
Molly’s parents had no idea. So here’s a question for you. I had on this podcast, a man named Joshua Wayne early on, maybe the first 10 episodes, Joshua works with troubled teenagers. And I had asked him the same question, but there’s this debate, I guess, among parents about privacy with the adolescent child and how much you should try to be involved. And I’ve had debates with other parents, you know, about, you know, we used to make sure that our children showed us their social media and it wasn’t always so popular. And there were a lot of fights in the house. And, you know, my father was a police officer and the SWAT team and his saying, when we were growing up was in this house, you believed to be lying until proven otherwise that’s where he used to bring us up.

Dr. Anthony Orsini (25m 48s):
And so there was really no privacy, per se. Of course we had some, but parents are caught between this. You know, I want to give my child privacy, but I also want to make sure that I know what’s going on. And perhaps maybe if Molly’s social media was available to them, I don’t know. I’m not second guessing, but how do you walk that tight rope?

Dr. Lisa Strohman (26m 7s):
Yeah. I mean, I think that’s interesting. I always say trust, but verify in my house with my own kids.

Dr. Anthony Orsini (26m 11s):
My father was the other way around. He automatically assumed you were lying. You had to prove it.

Dr. Lisa Strohman (26m 16s):
I like that. I’m thinking about shifting it now that I have two teenagers. I think that from a standpoint, the kids don’t have privacy anymore. Sadly. I mean, I think some of the speaking I do nationally is really about privacy terms. Like what kids are willing to give up. They don’t have any privacy. The only privacy that they’re looking for is from their parents. And I feel as though I’ve been very neutral in the sense of, I don’t like to tell parents what to do, but as I get older and as my kids get older, I feel more strongly of taking a stand and saying, you’re an idiot. If you don’t look at your kid’s social media and if you don’t have access to it, and if you don’t know your kid’s ID password, I mean, one of the kids that was ended up in the ICU and this mass suicide, the parents had no idea how to access his phone.

Dr. Lisa Strohman (26m 58s):
And the really, the only thing that he wanted when he woke up was to check on his social media and how many responses he got based on him posting that he was, you know, he took 50 pills and I said, you don’t have the password to your kid’s phone and you will not get in that phone, apple. They will not give you the password to access that kid’s phone. And so from a standpoint, as a parent, very strongly now, and as a professional is your kid’s password. And being able to access their phone is a given and a must. We should not let them have carte blanche. And to me, everything that you post online is something that you should anticipate that a parent will see. I used to be a little bit more neutral, but I’m not anymore given the crisis that we’re at.

Dr. Anthony Orsini (27m 38s):
We used to say to our kids, if you’re afraid, someone’s going to find out that you did or said something that probably you shouldn’t have done it in the first place. You know, that’s a good guide. And so maybe if, you know, your parent has your password, maybe you won’t, I’ve been in debates over a glass of wine with other parents that are good friends with mine, who used to tell us, you know, you’re crazy because your kids have a right to privacy. And I said, well, I never did and I turned out okay. You know? And there were a lot of things that I probably would’ve done bad or maybe went offline, but I was total fear of my father that kept me in line. And I’m grateful to that.

Dr. Lisa Strohman (28m 14s):
So, and I think it’s apparent. I think it’s interesting. I think it’s a lot more onerous and difficult as a parent to be that parent who does establish those tighter boundaries and oversees what their kids are doing. And there’s a movie actually that got terrible reviews that I thought was fantastic called men, women and children. And it had Jennifer Garner and Jason Bateman and Adam Sandler. And it got terrible reviews because it was so realistic. And Jennifer Gardner’s character was basically checking her daughter’s phone every day and looking at text message scripts. And it was like way too far on the monitoring. And then there was another mom that didn’t monitor at all. And the daughter turned into this basically online stripper that was selling her body for sex.

Dr. Lisa Strohman (28m 58s):
And so it was like somewhere in between as parents, we have to land

Dr. Anthony Orsini (29m 2s):
Hard because it’s not very popular with the teenager to say, let me see your phone. That’s not going to go over. Well, that’ll be a fight. And you know, in his parents, I mean, I’ve gone through three teenagers. You say, you have to, the best word I can say to having a teenager is exhausting. I mean, you’re just fighting to keep them with you. Joshua Wayne said he had great advice for teenagers. He said, they’re going to get their advice from a lot of other people. And the best that you can hope for is to have a seat at the table. And I always found that’s a great advice, especially in the troubled teenagers. So let’s get back to, because this is really distressing me right now. So we’re being, our minds are being manipulated by digital, but it’s really our teenagers and our adolescents that were worried about the suicide rate is up and I’d never watched it.

Dr. Anthony Orsini (29m 50s):
But I heard a lot of this stuff about the movie, 13 reasons why that’s a, just a horrific, why would Netflix ever put that on is just beyond me, but it just goes to show you that what runs this world is money and our teenagers are being manipulated. What’s the best advice that you can give to not a teenage parent, but a parent of a teenager. But even, you know, I have this three-year-old, who’s grabbing at my phone. What can we do to maybe stop those dopamine receptors from going away? Totally.

Dr. Lisa Strohman (30m 20s):
My best advice is always like tech as a tool. And I think that if you can teach kids why tech can be manipulative, if you give the teenager or the, even the five or six year old, the reasons why they tend to follow that line, kids inherently want their parents to be proud of them. They really do. Even as teenagers, they do, they want us to care. They want us to show up, even when they tell us that we’re the biggest idiots in the world and that we know nothing. And of course in their lives, we do know nothing at that age, but the reality is kids really want you to be happy with them and they want to be able to do the right thing. And what I found, even in this program that I created is that kids, when they know the line and they know the reasons why and how they’re being manipulated, they actually stand up and take a voice.

Dr. Lisa Strohman (31m 5s):
So a super cool example of that was I went to, gave a talk to a school and I talked to, I think it was fifth through eighth graders. And I said, here are the terms of Snapchat. Here are the terms that you’re agreeing to. Here’s how they’re using your data. Here’s how they’re they can resell it. They can repackage it. Here’s why you have no privacy. And I took those legal terms and I basically translated them into kid’s terms. And I said, here’s what you need to know. You are the largest cohort in our history with the largest amount of technology use and dependence ever. And they’re making the rules. You have far more power than they do because the millennial generation isn’t big enough to control you. And if you took a stand and you were able to make those choices, you actually could make a difference.

Dr. Lisa Strohman (31m 49s):
And out of that talk, I had 600 kids on Valentine’s day, write a message through Snapchat and all deleted their accounts at 12:01 PM together to make a stance. Now, I don’t think that they probably all kept them deleted, but they said, we love ourselves more than we love your platform. And they deleted it altogether as a message to Snapchat at the time. And that was cool. That was super cool to get in. My that’s. My biggest messaging is just know your value as a parent tech, as a tool. And it shouldn’t be used to manipulate you. And it shouldn’t be used as a trade. Whether it’s like, again, kids are spent sending naked pictures and they’re doing all these things on technology that is felonies, you know, misdemeanors, like all of these things that can happen, teach them those rules, teach them those hard lines on what electronic harassment is, what child solicitation of pornography is like, just teach them the hard lines.

Dr. Lisa Strohman (32m 42s):
They won’t do it. Kids don’t want to break the rules,

Dr. Anthony Orsini (32m 45s):
It goes back to knowing the why. And when we talk about, on this episode and many other episodes about the conversation, whether you are a business leader or you’re a physician, or you’re a teacher or your parent, when you ask someone to do something, if you’ve explained to them the why, as you just showed with those teens, they all dropped their Facebooks and their social media, even if it was for temporary, but now they understand. And it’s not just mom being a jerk telling me to get off my phone. Tell us about the digital citizen academy. What kind of programs do you have there and not just tell us about how that works?

Dr. Lisa Strohman (33m 19s):
Yeah, so digital citizen academy was something I picked out. Like I, again, I wanted kids to have a voice, so it’s a K through 12 program. We have a peer mentoring program because I always find out that is exciting as it is for me to go up on stage and talk to the kids, talking to each other is far more effective. So if you look up DC foundation.org, it is our foundation piece where we basically rely on business leaders and individuals to help sponsor programming into schools. And every grade has its own unit. So we go through and base everything on the think strategy, truthful, helpful, inspiring, necessary, and kind. And so we say like, do we always want to be truthful online? And we teach little kids. It’s like, maybe we shouldn’t tell people our home address and that’s not being dishonest or not being truthful.

Dr. Lisa Strohman (34m 3s):
It’s because on technology we want, we need to know where our line of truth should be. And those kinds of things of like, how do we create kind digital citizens online? And how do we recognize as they get older and maybe fifth, sixth, seventh grade? How do we recognize if one of our peers is struggling? What if they put a post out there that says that they want to kill themselves? How do we, as, as adults recognize that peers sometimes are the ones that burden that stress and knowledge that the, that their peer or their classmates is thinking about hurting themselves. We definitely want to help them have the tools on how do we get that information to the adults that can help. So that’s what we did, DC foundation.org as a site that talks about it. And my goal is to help this generation grow up and become the leaders in this piece of creating new content and helping themselves understand the world online.

Dr. Anthony Orsini (34m 52s):
Fantastic. Where are you, how many programs do you have so far?

Dr. Lisa Strohman (34m 56s):
I’ve done thousands of, I think our beta test was 10,000 students that we tested in and that was just in Arizona alone. And that’s when we figured out that in a middle school alone, we had a thousand kids and that was our very first micro test. And we saw that when you taught the kids these lines and gave them lessons that were appropriate for online, we reduced technology-related infractions for that school by 72%. And we pretty much hold about that level when we like did the mass beta. And that was about 8,000 8,500 more so 9,500 students where we’re reducing that amount. So now we’ve got our program in Florida, California, Arizona, Colorado, like just everywhere that we can figure out people who want to make a difference in their community.

Dr. Lisa Strohman (35m 40s):
They reach out and we try to make it happen for them.

Dr. Anthony Orsini (35m 43s):
Lisa, I’m thinking that this should be everywhere. I’m thinking that this, if you remember, I’m trying to think about how many years ago, 15, 20 years ago, when we started going into high schools and doing these programs, showing automobile accidents with the whole thing, they’d actually bring a car in that was totally crushed and say, you know, here’s a story of John who was drinking and driving, and this is what happened to him. And this is why you should wear your seatbelt. That program has been very popular and very successful. I mean, my kids never knew what it’s like to be in a car without a seatbelt. And although I still think that dopamine surge, when the phone text comes through, when you’re driving is still really hard to not pick up, I think they’re at least aware of that.

Dr. Anthony Orsini (36m 26s):
And so we’re going to have this program everywhere, because I think if they know about this, it’s going to be just like wearing the seatbelt.

Dr. Lisa Strohman (36m 32s):
I agree with you. The problem is when you come through and you have schools that are like overrun and they don’t have enough time in the day to teach content, this is like five lessons. Each it takes about an hour and a half to get through all five lessons. If you did it on a sequential basis, like that’s what I suggest for the schools. It’s not a lot of time, but they basically, if they can hand out a piece of paper that says, here’s the 10 things you need to know about digital citizenship and the kid reads it, they can check it off on their core standards and say that we actually did education. So they just cut corners and they don’t give the kids the voice again, give them the power to make these choices and understand it in the way that we teach math and English, because it is just as important.

Dr. Lisa Strohman (37m 14s):
I mean, imy book of teaching kids, how, because technology is our future. We have to let them understand it in the same way as they have the foundation with math and English and science,

Dr. Anthony Orsini (37m 24s):
My blood pressure’s going up right now, because this is my world of trying to get people to stop being near-sighted, you know, they want to check the box and say, yeah, I gave the student a piece of paper. And if he or she gets addicted to technology, it’s not my problem because she checked the box and we all could agree that this can prevent suicides. This can prevent depression. This will decrease our medical costs. And everybody says, yeah, we all agree on that. And then we go, okay, well the program costs X amount of dollars and well, maybe it’s not so important. And it just, you and I talked about this before, it drives me crazy. Cause this is my world.

Dr. Lisa Strohman (37m 59s):
Honestly, like through the foundation, we do it through as a cost measure. And it’s like $5 a kid. I mean, it’s literally less than most people at Starbucks. Like bill, when they go in and say, we don’t have time. Yeah. We don’t have time. We don’t have funding. Yeah, absolutely.

Dr. Anthony Orsini (38m 15s):
It’s just crazy. You know, as with my work with physicians and healthcare professionals and talking to hospitals saying, listen, if we can teach your doctors how to have better relationships, you will literally save millions of dollars in malpractice lawsuits and medical errors will go down and they all go. Yes, absolutely. Absolutely. But we don’t have $5, you know, so it’s not really that important, but someone comes in and said, wow, this brand new TV that you can put in the waiting room and it’s really kind of cool. They’ll go. Yeah. How much is it? 10 grand not buy it. It just drives me crazy. So I’m sorry, but I’m getting a little hyped up right now.

Dr. Lisa Strohman (38m 47s):
Oh, then I get it. I mean like the art budget in most hospitals, like when you walk in and people don’t think about like the artwork on the walls and how that’s a contract and people are bringing in artwork for that. And that’s usually hundreds of thousands of dollars in hospital systems and you can’t pay someone to teach doctors how to be more empathic. I agree with you. I get super angry about that.

Dr. Anthony Orsini (39m 7s):
And we throw so much money away back to schools. I had an uncle who was a principal in an inner city for many years. And he said to me, every time I complained that my, my scores go down, the government just throws more money at me and I buy more books and he opened up a closet one day and there were books to the ceiling. He’s got all these extra books he said, but that’s not the problem. The problem is we have to get parents involved in the education and we need some social. And yet no one wants to talk about what’s the word and phrase. I hate the most of those soft skills because they just want to buy something. You know, they want to buy the TV or the whatever. And it just, it’s so frustrating, but your program it’s been proven and it should be everywhere. It should be a no brainer. This is, I’m getting mad,

Dr. Lisa Strohman (39m 50s):
Built on social emotional because it’s me. And I basically hired 16 different teachers. And that, you know, did the K through 12. And a lot of my programming for my high school students is all based on what they felt was important. So for instance, one of the modules that we have now is on kind of the social justice reform and BLM and things like that and gives them context so that they’re looking at and connecting to actual news information, that’s been verified and it’s been something that we would like representative, like here’s the history of it. Here’s where you got to and let’s have them weigh in and have a conversation about it and lets them have a voice. I think again, I think that we write off kids too quickly in our world and we think that they’re just valuable and they’re going to do what we want versus letting them have a voice, even from young ages.

Dr. Lisa Strohman (40m 33s):
And again, technology is so important to them, but if they don’t understand why it’s in control and they’re not, then we’re not doing them a service at all.

Dr. Anthony Orsini (40m 43s):
Yeah. It’s all about the Simon Sinek. I’m a big Simon Sinek fan. Let them know the why. And if you let them know the why even young teenagers will get it. And, but we have to spend the time and the money, $5 a student, Lisa that’s ridiculous.

Dr. Lisa Strohman (40m 58s):
People are like, you should charge more and then they’ll probably buy it. Like I just want all the kids to get it. I don’t know. It’s not about the money for me. It’s about, these are the kids that are going to take care of us when we get older people. Like we have to understand if they’re not okay, we’re not going to be okay.

Dr. Anthony Orsini (41m 12s):
It has to be something that they put their hands on. So maybe you should try selling them a computer for $50,000 and give the class for free. And they’d probably say, oh, okay, we’ll do that. That’s crazy. So anyway, we can talk forever. At least we get to finish with the same question. I asked everyone at the end and that is, tell us about the most difficult type or most difficult conversation you’ve ever had. And give us some advice on how to navigate through that.

Dr. Lisa Strohman (41m 39s):
Good question. I did think about it a little bit before. I think one of the most difficult conversations that I’ve ever had to have was when I sat down with my own father, after not speaking to him for two years and said, I was sorry that I was a difficult teenager, that I really valued having him in my life versus not having him in my life and understanding that because he didn’t have the emotional capacity, he was in law enforcement as well. He didn’t have the emotional capacity to understand why I had anger and being upset. But as a PhD student at the time I, I said to him, I apologize for my end of it. And I appreciated what he was trying to do because like your father, he was a hard father.

Dr. Lisa Strohman (42m 19s):
He was black or white you’re right or wrong. And he was consistent. And I was not as very hardheaded as you can imagine as i.

Dr. Anthony Orsini (42m 27s):
I thought you were such an angel, your whole life is I guess, no, I’m just kidding.

Dr. Lisa Strohman (42m 33s):
Well, and I think that he, again, it created a new relationship for us moving forward. And now he’s 86 and we talk regularly and I have a really good relationship with him. So I would say that sometimes the hardest conversations and the hardest things to approach in life are the ones where, you know, you’ve done wrong or you’ve had challenges on your end and that you have to own those. And you also have to make accommodations understanding that the person on the other side may not own their own. And I knew that he wouldn’t own what he had done in his life with me as a father, because he just didn’t have the capacity to do it. I love him anyway, obviously. And so I would say sometimes you just have to be willing to have some grace in those situations and for the better good of the relationship still have the conversation.

Dr. Anthony Orsini (43m 18s):
That’s great advice. As it been said before, when you don’t know what to say or how to start a difficult conversation, the best way to do that is to say, you’re sorry, and then shut up. I think that’s great advice. So Lisa, this has been amazing and what’s the best way for people to get in touch with you. Give us your website again, we’ll put that all in the show notes for those people who are driving will, how can people just can find out more about what you do?

Dr. Lisa Strohman (43m 40s):
Sure. My site, Dr. Lisa strohman.com, D R L I S A S T R O H M A N .com is my personal site. And then the foundation, if anyone is listening and wants to help kids is DC foundation.org, and that’s a 5 0 1 C 3. You can donate to it. And we always take everything and always all of our profits go back to putting programming into schools. Anything that we get donated, we align up and put it right back in the schools.

Dr. Anthony Orsini (44m 9s):
No, I’m pretty hyped up. So I’m going to donate after we get off of this, pretty, pretty excited about this. So thank you so much. Again, if you enjoyed this podcast, please go ahead and hit follow. It used to be subscribed, but it’s no longer it’s now follow. If you want to find out more about what I do or what we do at the Orsini Wani, any way you can reach me@theorsiniway.com. Lisa, thank you. It’s been a pleasure again, and I hope we speak real soon again. Well, before we leave, I want to thank you for listening to this episode of difficult conversations lessons I learned as an ICU physician, and I want to thank the Finley project for being such an amazing organization. Please, everyone who’s listening to this episode, go ahead, visit the Finley project.org.

Dr. Anthony Orsini (44m 49s):
See the amazing things they’re doing. I’ve seen this organization literally saved the lives of mothers who lost infants. So the find out more go to the Finley project.org. Thank you. And I will see you again on Tuesday.

Announcer (45m 3s):
If you enjoyed this podcast, please hit the subscribe button and leave a comment and review. To contact Dr. Orsini and his team, or to suggest guests for future podcasts, visit us@theorsiniway.com. The comments and opinions of the interviewer and guests on this podcast are their own and do not necessarily reflect the opinions and beliefs of their present and past employers or institutions.

Taking Care of Our Own - True Nursing Leadership

Dena Carey (1s):
You have to find your passion. My passion is people. I love my people and I love that my people love to do what they do. And so if I can have them in a place where they are doing what they love to do and they’re being loved for it, our patients are making out our patients are getting the best care. Cuz I have the right people taking care of the right type of patients being led by the right leaders. And it just makes so much sense.

Announcer (34s):
Welcome to Difficult Conversations: Lessons I learned as an ICU physician with Dr. Anthony Orsini. Dr. Orsini is a practicing physician and president and CEO of The Orsini Way. As a frequent keynote speaker and author, Dr. Orsini has been training healthcare professionals and business leaders how to navigate through the most difficult dialogues. Each week you will hear inspiring interviews with experts in their field who tell their story and provide practical advice on how to effectively communicate. Whether you are a doctor faced with giving a patient bad news, a business leader who wants to get the most out of his or her team members or someone who just wants to learn to communicate better this is the podcast for you.

Dr. Anthony Orsini (1m 20s):
I am honored today that the Orsini Way has partnered with The Finley project to bring you this episode of Difficult Conversations: Lessons I learned as an ICU Physician. The Finley Project is a nonprofit organization committed to providing care for mothers who have experienced the unimaginable, the loss of an infant. It was created by the founder Noelle Moore, whose sweet daughter Finley died in 2013. It was at that time that Noelle realized that there was a large gap between leaving the hospital without your baby and the time when you get home, that led her to start The Finley Project. That Finley Project is the nations only seven part, a holistic program that helps mothers after infant loss, by supporting them physically and emotionally.

Dr. Anthony Orsini (2m 4s):
They provide such things as mental health counseling, funeral arrangements, support, grocery gift cards, professional house cleaning, professional massage therapy and support group placement. The Finley Project has helped hundreds of women across the country. And I can tell you that I have seen personally how The Finley Project has literally saved the lives of mothers who lost their infant. If you are interested in learning more or referring a family or donating to this amazing cause please go to The Finley project.org. The Finley Project believes that no family should walk out of a hospital without support. Welcome to another episode of Difficult Conversations lessons I learned as an ICU physician.

Dr. Anthony Orsini (2m 44s):
This is the Dr. Anthony Orsini. I’ll be your host again this week, you know, I’ve often have drawn parallels between the doctor patient relationship and the business leader to employee team member relationship. For success, both require good communication and trust. Nowhere do these two worlds interconnect more than when it comes to nursing leadership. There are approximately 4 million registered nurses in the United States right now, and another million licensed practical nurses. And with all the talk about physicians and the problems they face, it is the nurses who are undoubtedly the face of healthcare. They are the ones in the trenches, holding hands and healing 24 7.

Dr. Anthony Orsini (3m 24s):
So nursing leadership is more important than ever. And today I am thrilled to have someone who I believe embodies the essence of what nursing leadership and leadership in general is all about today. My guest is Dena Carey. Dena is the Associate Vice President of Women and Infant Health Services at Virginia hospital Center in Arlington, Virginia. She has been a nurse for 15 years and has been in leadership for over half of her career. As a Med Surg and NICU trained nurse, Dena has focused her latest role to build a team of nurse leaders that are engaged, respected, and dedicated to building a team of staff focused on one goal, delivering the best patient care and experience to the families they serve.

Dr. Anthony Orsini (4m 6s):
In July of 2019, Dena was named to the Washington business journal, 40 under 40 business leaders. She is a frequent speaker on Nursing leadership among other topics. As we all know, leaderss are rarely successful that they don’t have good communication skills. That’s why I am especially excited to have Dena Carey as my guest today, or a welcome Dena. Thank you so much for taking time out of your busy day to speak to us.

Dena Carey (4m 31s):
Thank you so much for having me what an honor and exciting moment to spend the next couple of minutes with you just talking about the things that I think we both love.

Dr. Anthony Orsini (4m 41s):
Yeah, last time we spoke was a, a few weeks ago and the conversation went so smoothly. I always say sometimes I was like, I should just hit record because it was great. So hopefully we can copy how great that was, but this is a topic that is near and dear to my heart and communication in general, but COVID and everything else that’s been happening right now. And we’re going to get into all of that later, but I’m excited to hear about, you know, all about that, but first let’s start off just telling your story to my audience, your journey, how you got, where you are. I want to hear about that top 40 to 40. That’s a pretty cool too. So you can maybe finish up with that. So, but you know, who’s Dena Carey.

Dena Carey (5m 22s):
Yeah. Well, Dena Carey is a woman who came from Philipsburg, New Jersey. New Jersey, absolutely Jersey girl here through and through. And so I was always the leader. I was always the outgoing one. I was always outspoken. Everyone always knew what Dena was thinking. And I think that has rang true throughout my entire career. I was the little girl who dissected everything I knew from early age that I wanted to do something in blood and guts and gory. And I think that’s kind of funny. I also grew with a mom who did hair on dead people because they’re is a funeral home right down the street from her beauty shop.

Dena Carey (6m 8s):
And I would go with her to be with her while she did the hair on these dead people. And I liked dead people. I was, I wasn’t scared of that. I wasn’t nervous around them. I held their hand. I would talk to them and I became comfortable in those situations. And as I grew and matured and went through high school, my first job was a secretary in a med surge unit. And I remember the one night I had a moment. I spent hours with this patient. I worked night shift or worked hours with this patient. And she was telling me the names of the wheels on her IV pole, and who they were.

Dena Carey (6m 49s):
And they wear these animals. We talked about them all night and the nurses were like, you’re a really good at creating this relationship with patients and getting them to trust you. And she had a great night. She didn’t fall. She didn’t have any issues. She took all her medicines and they were like, can you come back tomorrow? And it was at that point that I realized health care was my calling. That nursing was my calling, and I want it to be on the other side of that desk with the patients in the room. So I went to James Madison University in Virginia, and I started to study health sciences and did all my prerequisites to enter nursing school.

Dena Carey (7m 30s):
As a second degree, after my four years of JMU, I went out to Bellarmine university in Kentucky. They had a 18 month accelerated program and went through nursing school and really just fell in love with nursing. As you can imagine, I came out as a med surge nurse. I was taking care of five and six and seven patients within six months of being on the floor. I was asked to be in charge of night shift. And I, of course was like, of course, you know, Dena always wants to be in charge. So I gladly accepted that honor and not realizing what responsibility I had over a 25 bed med surge unit night shift five and six patients are at a time admissions coming in and out, but I embraced it and I really liked it.

Dena Carey (8m 17s):
And the seasoned nurses were so excited that somebody else wanted to be in charge. And I always pride myself that my shifts ran smoothly. People knew what was going on. I kept people close knit, helping each other, working together, and people want it to work when I was in charge. And that was cool. And so as I kind of went through it, I was starting to get a little bit burnout cause our patients want it to be fixed, but they didn’t want to fix themselves. Adults don’t really want to fix themselves. They just want you to a quick fix them and then send them on their way. And so I was trying to figure out where was my real calling and I’ve always been drawn to kids babies.

Dena Carey (8m 59s):
And so my friend worked in the NICU and she said, come see me, come hang out for lunch. So I did and I fell in love and I found my niche and I went into the NICU at UVA in Charlottesville, Virginia. I worked as a nurse there for six years. Within those six years, I was on committees. I was chair of committees. I listened to all of my colleagues, the physician’s, the fellow’s, the residents, the interns, the med students, the nursing students. I had one specific nurse practicum student and she really pushed me to my limits as a preceptor, as a teacher, as a mentor, I’m still friends with her today.

Dena Carey (9m 44s):
It was just incredible. I was also always the nurse you got assigned the dying patients, which not everybody always talks about and NICU patients do die. It’s part of what we do. It’s not a fun part of what we do, but it sure is an honor to be with these families during these really hard times. I also remember which physicians I wanted to be in those situations with. And those physicians were so good at communicating with these patients and how to really break this bad news. And I know you have a whole book on breaking bad news, but it’s so true, you know, who can do it and who’s good at it.

Dena Carey (10m 26s):
And who’s not so good at it. And then the families struggle and nurses are left sometimes with picking up those pieces for that family. So after UVA and being in the NICU, I decided that my family and they wanted to be closer too all of our family in New Jersey and Northern Virginia. So we picked up and we moved to Northern Virginia and I was looking for the next step. I was looking for what’s next for Dena. I went to Johns Hopkins. I was traveling to Baltimore every day as a NICU nurse. And my husband was traveling to Washington DC and it was not working.

Dena Carey (11m 7s):
All we were doing was driving. So I said, I’m going to look for a position in Virginia. And I found this little gem in Arlington Virginia, a called Virginia Hospital Center. And when I found Virginia Hospital Center, I tell you, its a gem is not only a jem, It’s a unicorn and I’m not here to promote Virginia hospital center, but I am so fortunate to have chosen a place that has given me the opportunity to just explode as a leader and as a communicator and as a nurse leader that has been given the autonomy to make things happen. And that’s exactly what I did.

Dena Carey (11m 48s):
I came in as a clinical educator for the first year and I helped move our NICU from a level two to a level three and take on the sicker babies. At the same time we partnered with the children’s national medical center. They are neonatologists apartment. And I partnered with the chief of neonatology who came in to build the program with me. And when I say with me, that’s exactly what we did. And I think when people say, what makes you so successful is I’m willing to partner outside of nursing to bring the whole team together.

Dena Carey (12m 29s):
That dyad leadership model is so integral and to what I’ve been able to accomplish. And we were always on the same page. We had conflicts, of course we moved through them together. We would brainstorm together. We would collaborate together. We would show our teams. We were on the same page and we had the same vision for that NICU. And that NICU was to take it from a two to a three and to provide all levels of service from 23 weeks on for gestation. But we also knew our limits. We had two very large level four NICU in our Northern Virginia region. There was no reason for us to compete.

Dena Carey (13m 10s):
We’ll send our babies out when they need to go out to the level fours, but how can we keep our babies in the community where they were born and provide top notch, high level NICU care to keep these moms and babies together. And that’s exactly what we did. So after six years we went from a 14 bed NICU to a 28 bed NICU. Within the first year as I was the clinical educator, I then applied to be, the director was named the director. We continued to grow the program. I doubled my FTEs in nurses. So I went from a around 32 nurses.

Dena Carey (13m 50s):
So today they have over 65 nurses. There are a turnover rate is less than 9%.

Dr. Anthony Orsini (13m 57s):
That is a great statistic. And that’s amazing. And that leads me to really what this podcast is all about. Last time we spoke, you said something that, and I wrote it down. So we were talking about patient experience. We were talking about the happy employees, that turnover rate is amazing. And I’ve seen turnover rates as you know, really high, but you said engaged employees are necessary for a good patient experience. And so I wrote that down in quotes. Tell me about that. As a leader, you also spoke about the dyad leadership, where are you partnered with the doctor to build this NICU? But it seems to me that I think what makes you so successful is you’re actually partnering with the people on the ground too.

Dena Carey (14m 38s):
That’s exactly what I’ve focus on every single day. It’s the people that are doing the actual work that need to be recognized that need to be appreciated. That need to be heard. And every single morning, when I walk into my unit, I walk in with courage, with integrity, with competence, with confidence and a smile. I smile and I say hello to every single person, every single staff member that walks by or that I walk by, I say, good morning to Lamont who cleans our floors. Our floors are the shiniest floors in the hospital.

Dena Carey (15m 18s):
You can see a reflection of them and it’s because of Lamont and his continued dedication to make sure we have the cleanest facility to have a baby in. It’s because of the people that say hello back to you and recognize that your there with a smile and their going to be there with a smile as well, it’s contagious. And it means the world to your staff when you’re there to be personal and to be honest and open with them and to start their day off, right with good morning, how are you? It means so much. I truly believe how I show up is how they show up. So

Dr. Anthony Orsini (15m 58s):
If you’ve heard this podcast before, one of my favorite quotes, I have many, but one of my favorite quotes is that all of the Italian quote that says the fish rots from the head down and what you just said, there is something that is so deep and my beliefs and core is that the people on the ground, they take on their personality and the outlook of their leaders and in a world where there’s so many toxic leaders now I loved that you just said that. My other favorite quote is when your most passionate employees go silent, that’s when you’re in trouble. So other than smiling and being happy and speaking to everybody, what’s the key to keeping them happy that they don’t want to leave.

Dr. Anthony Orsini (16m 38s):
You know, people don’t leave jobs, they leave leaderss so obviously there’s something going on right there, but the 9% turnover. So what do you think the secret is to the young, the charge nurses out there that really wants to learn?

Dena Carey (16m 56s):
Yeah. I think honest, open, transparent communication in multiple formats and multiple ways for your team. I think that is one of the biggest things that we can do is to be open and honest. I can’t tell you how my staff respond to me. When they ask me a question or I present them with a project or a problem. And I’m honest with them and say, I don’t have the answer. I don’t know how we’re going to fix this, but together we’re going to figure it out. And I’m here to make sure you have the resources that you need to figure this problem out or to change this process.

Dena Carey (17m 38s):
But we are going to do it together. You’re not going to be alone. I’m not going to let you fail. And I don’t expect you to let me fail and providing that 200% accountability is they know what my expectations are. We have a problem to solve. We have a project to complete, we need to do it together. And I’m here with you. And I expect you to be here with me too, and I think that that is so integral into what I do every day is making sure that everybody on the team feels like they want to have a voice, two their respected and three that I value them being part of our team here at Virginia hospital center, I’m very fortunate to work for a hospital and an organization that truly selects some of the highest performing highest achieving employees.

Dena Carey (18m 37s):
That’s an expectation coming here. We talk about it in the interview process. So I am very lucky. I’m very fortunate to work with high performers. Many of us are though. So how do you keep those high performers engaged? You have to keep challenging them. You have to keep giving them more to feed on, but you have to be cognizant when you’re asking them to stretch themselves. How far can you stretch them for how long? And are they in a place that they can accept being stretched and do it. And I think most of us, our, most of us stretched ourselves really thin to the max.

Dena Carey (19m 17s):
People always say, how did you do it? Or how do you do it Dena right now on the ABP of women and events, health, I have over almost 200 FTEs underneath me, you know, under my four directors under them or I’m getting my MBA from Virginia tech. I have two children. I have a puppy, which is a lot of work. And I’m like,

Dr. Anthony Orsini (19m 41s):
No, you really needed the ad that to your list.

Dena Carey (19m 44s):
Yeah, exactly. And so, you know, how do I do it all? I make time for it all. And I focus on my people. My people is what are most important? It gets the job done. And if I am not here, I know this place is running because they know what the expectations are. They know exactly what I want to see out of them because I show it to them. And I have continued to show it day in and day out.

Dr. Anthony Orsini (20m 13s):
And let them know that you care, you know, there’s going to be, and that leads into my next question, but there’s going to be times in everyone’s life, where they’re going through a crisis and they may be an employee who has been dedicated and the excellent employee and they have a family crisis and they need a few days off or they need somebody to a shoulder. It is a good leader that says my door’s always open, but actually keeps the door open that we see so many leaders to say, my door’s always open. And then, but when you come in and do you feel like you’re not being heard? And so everyone goes through difficult times and it’s really important that they know you care. Right?

Dena Carey (20m 50s):
And I think it’s interesting. I learned that the hard way of having my door’s always open, I need to go out of my door and see my people. I need to go out to the trenches. If you will, and see what they’re actually doing, what are they experiencing? I opened and started with my labor and delivery director. We started doing GYN surgeries here in our ORs. We have some unproductive time. We are trying to figure out how can we help the main OR who is exploding with surgery? How can we move things around and make our third OR really productive?

Dena Carey (21m 31s):
So we brought GYN surgeries here and to our OR bay, which allowed me to stabilize staffing for the OR, and open PACU. You said that was running full-time with a full-time staff. I go see my people in the PACU. They come in, they go to the PACU, they do their job and they go home. But I go see them in the PACU, I want to know what’s going on in the PACU. You, how was it going? This is a brand new for all of us. I’ve never been an OR nurse. I’ve never been a PACU nurse, but I care about what do they need. I gave them the autonomy to say, we need an ice machine. We need this supply. And we need our own supply of it. I can’t be running down the hallway every five minutes to get this.

Dena Carey (22m 14s):
I need my own supply. We make that happen. And so I truly am a leader who believes, yes, do I have an open door policy? I do. And do I expect my staff to come talk to me? If they have a concern or problem I do, but there’s nothing better than a leader going out of their door to talk to the staff on the other side, because that’s where you’re going to get the real information.

Dr. Anthony Orsini (22m 36s):
That’s fantastic advice. I think that’s really true of the military had something called ground truth in which that means, you know, you really want to know what’s going on the general has to go down in the trenches and as the people what do you need, you know, they have to be there and you hear some stories of these great generals and great leaders that came in and he had a meal with their troops and how much that meant to them. So that’s a great piece of advice. You said something about a stretching people that only when they are in a position to be stretched. Tell me about what happened during COVID because regardless of what we tried to do, we stretched everybody.

Dr. Anthony Orsini (23m 16s):
So how did you navigate the incredible stress that was put on nurses and everyone else at the hospital during COVID?

Dena Carey (23m 23s):
It all came back to the relationship and the trusting relationships that we have built prior to COVID. And we capitalized on that. I was honest and open with them and said, I’m as scared as you are. My office is literally right next to rooms, X, Y, and Z, where they were the negative pressure rooms. They were the room’s for our COVID patients. I was within 10 feet every day of our COVID positive moms. And I came to work every single day and I wore my mask and my eye protection. And I was right by their side.

Dena Carey (24m 3s):
I didn’t stop going through our safety huddles. I didn’t stop rounding on patients. I didn’t stop rounding on them. What are you scared of? What can I relieve for you to open communication? Our CMOs put out a briefing everyday about the changes that we all experienced. The first 60 to 90 days have COVID things were changing within 24 hours. It was so much to keep track of. I followed up every day for the first several months, and then it spaced itself out. But with the updates that came from the main hospital that came from the CMO and how did it relate to us and women and infant health.

Dena Carey (24m 44s):
Our patients aren’t sick, our patients are coming in to have this amazing experience that we’ve just completely changed. No visitation. What do you mean grandparents can’t come? What do you mean aunts and uncles and sisters and brothers can’t come? Siblings can’t come meet their baby brother or sister? ou know, this was a major change for our patient population. But I thought was interesting was in the very beginning, we did lose several staff nurses. That really, it was because they had to take care of their families. It was too much to manage. They didn’t maybe need to work or maybe they did, but it just wasn’t going to be here. That’s fine. We supported them.

Dena Carey (25m 25s):
We said, if you want a job after COVID come back, we were open and honest with our staff about why they left and said, you know, it’s too much for them to handle. It’s not because they don’t want to work here, but how can we further support you? How can we be in this together? And they really stepped up and I say, my retention rate and my turnover rates are low. And just the NICU. I would love to let you know that not just in the NICU, but overall, my turnover rates decreased 59% in total between my three departments from 2019 to 2020, we actually sustained staffing during COVID.

Dena Carey (26m 9s):
We are fully staffed on all three units. I don’t have one travel nurse In-house. It’s a lot to be proud of. And it’s not just me. It’s my leaders. I have hired and engaged four of the most fabulous directors’ that I can find. They match the personalities of the unit’s. They care for. And our labor and delivery is a lot like an ER post-partum and mother-baby is a lot like a med surge floor nursing and NICU as an ICU, they are three very unique specialty areas that I picked and chose who was going to be in those leadership roles that we’re gonna be engaging.

Dena Carey (26m 53s):
Were going to create those relationships with the staff that make the staff want to be there. It’s all about inspiring and motivating your people. And how do you motivate people? You set the expectation and you role model, those behaviors you want to see happen again. I tell all of my people and I have it posted on my computer monitor. I look at it every day, recognized behavior always gets repeated. Always, and that’s in personal life or not. When I’ve recognized my child for hanging in their backpack on the hook, when they walk in the door from school and say, thank you so much for putting your book bag away.

Dena Carey (27m 37s):
They do it the next day. And then they finally don’t need to be reminded of it. It’s no different with your people. If you recognize that you just told that safety story on huddle, like a boss, you did that. Awesome. Thank you for stepping up and sharing that with the team that’s going to get repeated. And so recognized behavior is just it’s at the forefront of inspiration and motivating you’re people,

Dr. Anthony Orsini (28m 6s):
Especially when that behavior promotes teamwork. And we see in the NICU, when the little things that really make a difference, you mentioned babies that are dying. When the nurse says to the nurse is dealing with their family and a very sick baby, let me feed your baby for you, or what could I do for you? And I can say that I’m very proud to be a neonatologist cause NICU’s in general do that, but there’s degrees. And there’s people when you promote that kind of leadership and everyone follows, that’s really where you get that success. We had Lori Gunther on who we both met or friends or a both speaking at this, a Synova conference in November is I’m looking forward to seeing you there. But Lori Gunther was talking about how Sonova is, which is an association for a nurse leaders have to do some debriefings.

Dr. Anthony Orsini (28m 49s):
And I believe she’s still doing them for nurse leaders. You mentioned your four amazing nurse leaders, but it was stressful for them to, so how did you keep yourself sane? How did you keep your leaders sane and positive? ’cause if the top the fishes head is out of control the rest is, is going to fall. How to control too.

Dena Carey (29m 9s):
Yeah. So I asked my leaders to take a hard look at their schedules and to make sure that they were taking time for themselves. And I said, your work is getting done. I need to know that you’re taking time for you. I want to see an adjustment in your schedule. I want to make sure that you feel supported and that you have time to take care of yourself and your family along with this family. And so they all chose to do it in a little different way. I chose to take off using my paid time off every other Monday off three day weekends. I don’t check my email. I don’t do anything but be home with my kids.

Dena Carey (29m 48s):
And you know, they had virtual school on Mondays. Oh, that was asynchronous. They didn’t have teachers. So I spend time with them and I made sure it was good quality time. I made a schedule for us that these are the things we, we are going to do together. When I say make a schedule, I’m a little bit ocd I’m a little bit type A, I did make a schedule. We did school from, you know, eight to 10. And then me and my daughter practice reading because she is still not reading because of COVID and not being in school. It’s hard to see her struggling, but we made time for it. We did a together and she wanted to do it together and they named it mommy Mondays.

Dena Carey (30m 29s):
And that was awesome for me. And that was really meaningful. And they noticed that I took off on Mondays to be home with them, especially being in school. I’m in school part-time, but it’s two nights a week, but I don’t get to be with them. And all that time off, I can’t tell you it was priceless. It was absolutely priceless time. And I made my leaders do that as well. And I think that also gave their assistant directors the opportunity to step up on the days that their leaders weren’t there they stepped up into that role to take on the unit and the management. And I reached out to them when there was issues or concerns or things that needed to be talked about that’s successful leadership, right there.

Dena Carey (31m 17s):
That’s succession planning. That’s exactly what we all have to focus on. If we don’t help our assistant directors step up in the times when our directors are either on vacation or out on maternity leave, we have no plan for when we move on, right? We’re all going to continue to grow, or hopefully we continue to grow. And if we’re continuing to grow and support each other, we have to have a succession plan. And, but we have to mentor and grow them. You can’t just throw them in to the fire. And I expect them to go to swim. And I expect that I, and I, I challenged them every day. Right now. One of my leaders is on maternity leave. And I had a very direct conversation with both of her assistant directors. And I said, we’re going to get through this together.

Dena Carey (31m 60s):
And this is your time to shine. This is your time to be great. And I want you to think about what does great look like a little sideways in their, for you. I love side. I love what she does for us. And we use her theory is a lot, but they both looked at me or were like, thank you so much for telling me it’s okay. I said, it’s okay. And you’re gonna make mistakes. You’re gonna make bad decisions, or we’re going to talk through it and we’re going to support each other through it. We’re going to learn from it and not know that again. But you also are going to do things that do work, and we’re going to celebrate those and lift you up because you are gonna be the next director here or at another place you are going to be.

Dena Carey (32m 40s):
So this is great practice.

Dr. Anthony Orsini (32m 42s):
I’m a firm believer in wherever you put the bar, people will go over it. And I think one of the things I see with successful leaders is that they raise the bar and people go over it. You know, the current NICU that I work in, the nurses there and some of the therapists do stuff that a lot of NICU don’t allow them to do. And they do it well. And the place runs like clockwork and my friends from New Jersey and from New York, when I used the word, we’ll say to me, how did that unit a, a 147 beds run like that? And I said, it is a prime example. When you raise the bar, people will go over it. But the opposite is true too. If you lower the bar, they are very happy to stay there too. One of my other favorite quotes is why would I hire smart people and then not listen to them?

Dr. Anthony Orsini (33m 27s):
That’s a Steve Jobs talk. So I love that. And I think that’s really what a true leadership is really all about. And so we have to take care of our leaders. We have to make sure everyone’s happy. And if they are happy, then they are engaged that they are engaged they take care of the patients, which is ultimately why we’re all here doing that. And that goes, whether things are going well or things aren’t going well. And so I think that’s a really great advice. So this is just an amazing talk and I interview, and there’s just so many good things that the young nurses who want to be in leadership. And by the way, we have a decent size audience out there that has nothing to do with healthcare that, you know, you want to be a boss.

Dr. Anthony Orsini (34m 12s):
We’re having Kristin Baird who is going to on and Cy Wakeman has been invited. I think she was coming on. Kristin Baird talks about how expensive it is for a nurse to replace a nurse and bad leadership we’ve said this many times, bad leadership is expensive. So making sure that you hire the best leaders, Dena, I’m going to ask you one more question before I asked you the final, tough question and all the time, what would be the one piece of advice that you would give to that young nurse who really wants to become a leader? Tell her, where do I go from being a second year med surge, RN, to being a leadership in nursing.

Dr. Anthony Orsini (34m 54s):
What do I have to do?

Dena Carey (34m 57s):
I always tell new nurses, find your passion, find your passion. What drives you? When I was in the NICU and I was a one-year in what drove me crazy was the things we put on baby’s skin without thinking about the longterm effects of those things. There are stickers everywhere, there’s things in their nose. There’s things in their mouth. There’s tape on their face. There’s tape around their hand, on their feet. The IVs, you know, what’s more important losing the IV or keeping the IV, but there’s tape everywhere. And my passion became skin. I then became the skin rounder in the NICU.

Dena Carey (35m 40s):
Then I joined hospital-wide skin prevalence committee. I was the guru of skin and the NICU. I then became on the education council. I then became chair. I found my passion and I followed my passion to climb that ladder. And that was from the very beginning of my leadership career. But you have to find your passion. My passion is people. I love my people, and I love that my people love to do what they do. And so if I can have them in a place where they are doing what they love to do, and they’re being loved for it, our patients are making out our patients are getting the best care.

Dena Carey (36m 24s):
Cuz I have the right people taking care of the right type of patients being led by the right leaders. And it just makes so much sense.

Dr. Anthony Orsini (36m 34s):
And the elephant in the room here that has also tied into all of this is the very high rates of professional burnout among doctors and nurses is the latest number I saw a for nurse It is 60%. I couldn’t believe with a passion, a a a hundred percent. My passion has been communications. So people ask me, why did I talk about it in the book? But for some reason, I gravitated towards that, just like you have at the death and dying of NICU and how many people felt that at that moment, it’s a failure when it’s actually an opportunity to help the family when they need us the most. And you spent 10 years researching how to break bad news. And unfortunately got the nickname breaking bad news doctor, which I’m not so sure is a good title, but this is something that I’m really proud of because it’s something that I’ve taught.

Dr. Anthony Orsini (37m 19s):
So you agree with me, that’s the best way to break this professional burnout problem is that just get people to enjoy their work again.

Dena Carey (37m 26s):
I do. I really do. I think once they can find the joy in what they do and make sure that they have those personal connections with their patients and talk about them, talk about the success of what good care looks like. Share those stories of grateful patients. I read probably once a week, I read a letter written by families to our patient experience department, to our leaders that are rounding after the fact, I read it line by line. I announce who those star staff were, you know, in yesterday’s letter was a Maureen from the postpartum unit.

Dena Carey (38m 12s):
She was the angel of all angels for this family. And I want this staff to recognize her. I want them to walk down the hall and say, wow, Maureen, you really are awesome and pay attention to what Maureen does. And I want to get on there.

Dr. Anthony Orsini (38m 25s):
And I want to be on that letter of next week and to recognize people is so important. So great advice, Dena closing up, I warned you about this question. So what is the most difficult conversationa that you’ve had in your life? And you can say type of conversation, and please give advice to people who are out there that needs, how do you navigate it or did not navigate a correctly and give them some advice on how to do that?

Dena Carey (38m 53s):
Well, I thought a lot about this question.

Dr. Anthony Orsini (38m 55s):
You know, some people, I forget to warn…

Dena Carey (38m 59s):
I am very lucky. I’ve had a lot of experiences with my life, honestly. And I think that in my current role, as an AVP over for different units, I think one of my most difficult moments in conversation is when I’m given a project that I’m not the expert in, and I have to threaten the comfort zones of all the other experts. Okay. That is often the most difficult conversation that I have to have.

Dena Carey (39m 42s):
I have to bring together pediatricians, OB’s, neonatologists nurses, lab directors, and role epic directors. So IT directors, for those of you who don’t know epic and get everybody on the same page and really understand the mission of what we’re trying to accomplish and ensure that they all know how much respect I have four them being the expert at the table. And I think that’s often the most difficult thing I have to do as an AVP. So maybe not your most traditional answer.

Dr. Anthony Orsini (40m 18s):
But that’s a great answer. I’ve found that also that you have to recognize that everyone wants to feel important. Everyone wants to be heard. And when we have that many people in the room, you know, some people would say stroke a little ego’s, but you kind of have to do that, right? Because the egos get in the way and everybody wants their selves to be heard, but they don’t want to listen to everybody else. I think that’s great advice. You got to get everybody on the same page and I mean, look, what’s happening in Washington, DC. Right now, I get nothing done because no one listens to each other. So we won’t get political, but that’s, I think our government should take your advice.

Dena Carey (40m 57s):
And I think that’s, what’s hard. We in health care often our, this is how we’ve always done it. This is how we’ve always done it. And to, and the threaten that comfort is hard. It’s hard to do as a leader. And I know my reputation is often, if anybody can do it, Dena can do it. And often that’s hard to do so. It is hard. But I think like you said, listening and valuing your people, they will always join you.

Dr. Anthony Orsini (41m 34s):
Fantastic. Great words of advice, Dena, the way for people to get in touch with you, your email, or what’s the best way for people to get in touch with you. If they want to ask you a question or get some advice,

Dena Carey (41m 44s):
Either on LinkedIn, Dena, Carey, or feel free to email me. My work email is dCarey@virginiahospitalcenter.com. Their welcome to reach out. I love to mentor. I love to teach. I love to just share what we’re doing because it’s working

Dr. Anthony Orsini (41m 59s):
And your enthusiasm overflows. So we’ll put all that in the show notes, but Dina, thank you so much for being here. I promise my audience every week there’ll be inspired and the like you to learn communication and this certainly fit the bill. So thank you so much.

Dena Carey (42m 13s):
Absolutely. Thank you so much for reaching out. This was an honor and a pleasure and I’m so thrilled. Thank you.

Dr. Anthony Orsini (42m 19s):
Thank you. If you enjoyed this podcast, please go ahead and hit follow. It’s no longer subscribe. They are available on apple, Spotify, and Amazon and just about every other podcast platform. If you want to get in touch with me, you can reach me through the Orsini Way.Com. Thank you again and Dena. Thank you. We appreciate everything that you do. Well before we leave I want to thank you for listening to this episode of Difficult Conversations lessons I learned as an ICU physician. I want to thank The Finley Project for being such an amazing organization, please, everyone who’s listening to this episode go ahead visit the Finley Project.org see the amazing things they’re doing.

Dr. Anthony Orsini (43m 1s):
I’ve seen this organization literally saved the lives of mothers who lost infants. So to find out more, go through the Finley Project.org. Thank you. And I we’ll see you again on Tuesday.

1 (43m 11s):
If you enjoyed this podcast, please hit the subscribe button and leave a comment and review. To contact Dr. Orsini And his team, or to suggest guest’s for a future podcast, visit us at the Orsini Way.com. The comments and opinions have the interviewer and guests on this podcast or their own, and do not necessarily reflect the opinions and beliefs of their present and past employers or institutions.

Fierce Conversations with Susan Scott

Susan Scott (2s):
No, you can see when the penny drops, you just see it and you realize, okay, this person just got it. And this is going to change this individual’s life. Because once you understand that you’re navigating your life one conversation at a time. And one of the other really key notions, which is that, you know, the conversation is the relationship. Our most valuable currency is relationship. Once you understand that and that every conversation you have is either enriching flat-lining or harming your relationship. Once you understand that you can’t not know it, you can’t shut it out.

Susan Scott (43s):
You’re always conscious of it.

Announcer (44s):
Welcome to difficult conversations: lessons I learned as an ICU physician with Dr. Anthony Orsini. Dr. Orsini is a practicing physician and president and CEO of the Orsini Way. As a frequent keynote speaker and author, Dr. Orsini has been training healthcare professionals and business leaders how to navigate, through the most difficult dialogues. Each week, you will hear inspiring interviews with experts in their field who tell their story and provide practical advice on how to effectively communicate. Whether you are a doctor faced with giving a patient bad news, a business leader who wants to get the most out of his or her team members or someone who just wants to learn to communicate better this is the podcast for you.

Dr. Anthony Orsini (1m 31s):
Well, a big warm welcome to another episode of difficult conversations: lessons I learned as an ICU physician. If you’ve listened to this podcast before or attended any of my workshops or lectures, I’m quite certain that you have heard me say this over and over again, that it is my deep belief, that every critical moment in our lives starts with a difficult conversation. How we navigate through those conversations can make the difference between success and failure. Good communication is the key to success and the key to any relationship in both business and in our personal lives. That’s why I am especially excited to have as my guest today one of the leading experts in the field of effective communication.

Dr. Anthony Orsini (2m 15s):
Susan Scott is a best-selling author and the founder of fierce Inc. After 13 years leading CEO think tanks, and more than 10,000 hours of conversations with senior executives, she founded fierce Inc. In 2001. Her clients include such mega companies as Starbucks, Yahoo, Nestle, and Coca-Cola. Susan is the author of two, usually successful and highly respected best-selling books. Her first book, and one of my all time favorites was Fierce Conversations published in 2002. It remains even 20 years later number 12 on Amazon communication and management and top 50 in business communication skills.

Dr. Anthony Orsini (2m 58s):
Her second book Fierce Leadership was published in 2009 and was equally successful. And last I checked was just, yesterday is still in the Amazon top 100 in its category. Susan is a popular and sought after fortune 100 public speaker renowned leadership development architect. Known for her bold practical approach to executive coaching and leadership development. Susan has been challenging people to say the things that are hard to say for over two decades. She lives in Seattle, Washington. I hear in a tree house. I can’t wait to hear that story. I want to welcome Susan.

Dr. Anthony Orsini (3m 39s):
Welcome. And thank you so much for being on this podcast tonight.

Susan Scott (3m 42s):
You’re so welcome, Tony. It’s truly as a privilege, I’ve been looking forward to this. I think you’re one of my new best friends.

Dr. Anthony Orsini (3m 49s):
Well, thank you. You interviewed me a few days ago and I was just saying before we started recording that, I think I’m going to get used to this speaking to Susan a couple of times a week now. So this is going to be fun. So whenever I do an interview or give a lecture workshop, one of the first things that people ask me, and in fact, you asked me when you were talking with me, why I became so interested and passionate about communication. And I talk about it in my book and that everybody has this profound moment, and maybe it’s a lot of little moments. And so I tell my story in the book, but I’ve been waiting to hear yours because I know all about your work and many people know about your books, but how did you get to this point?

Dr. Anthony Orsini (4m 29s):
Who’s Susan and how did she get to be at the pinnacle of her career being on my podcast ?

Susan Scott (4m 39s):
I majored in English and I taught English. So I was not a business person did not have an MBA. Did spend some time as a recruiter, which I began to know a little bit about business. And then suddenly found myself, invited to chair, two groups of CEOs in Seattle, where I live. And that was a miracle because I don’t think I would qualify now all these years later, I think they would look at my background as say no, what could she possibly bring to this. But it was an amazing opportunity that also scared me after death because I was supposed to spend, and I did spend two hours every month, just one-to-one with each of them. And there were 30 total. So that’s a lot of conversations with these CEOs, everything from software to coffee, to manufacturing, everything you can imagine.

Susan Scott (5m 26s):
And then one day, every month, each group would spend the day together to advise one another. So I knew one thing for sure. I was not going to be advising them on what they needed to do in their businesses. I listened. The funny thing was that, you know, when I’d walk in the door, they’d just start talking. I think they were just thrilled to death to have somebody who was hanging on every word, totally present someone to whom they could say anything, because we were sworn to confidentiality. That was the one person, the world that could say anything to you and their spouses were tired of hearing about it. I’m sure. And so they would just talk and talk and talk.

Susan Scott (6m 7s):
But I eventually learned that we weren’t always talking about the thing we needed to be talking about, maybe because they didn’t want to bring it up. That was too complicated. It was too hard. It was too scary. It was too embarrassing, whatever it was. So I realized I need to change the way I begin these conversations. And so I started beginning them with given everything that’s on your plate, everything, that’s got your name on it, everything. What is the most important thing you and I should be talking about today and off we’d go. And then I had a series of questions that would take us deeper and deeper because sometimes, you know, what you put on the table is a symptom.

Susan Scott (6m 48s):
It’s not the issue. You would know that best as a physician. So, you know, what’s really going on. So these questions that would go deeper and deeper and they would arrive at their own insights and their own action plan. And I just had to ask the questions and listen with every subatomic particle of my body pay fierce attention. And then in the monthly meetings where you’ve got 15 pats in the room, some of whom like to take up a lot of airtime, you know, how do you make sure there’s conversation that a member has put on the table that matters a great deal. There’s a lot at stake to gain or lose based on getting this right.

Susan Scott (7m 29s):
I mean, how do you chair that meeting so that we really do get all of the diverse perspectives and we end up with something that is truly innovative, truly complete. I mean, just elegant rather than the simple solutions. It’s really easy to arrive at good plea.

Dr. Anthony Orsini (7m 50s):
Well, I’m thinking back. So you’re young, right? You’re talking with all these big CEOs and you’re coming out with this common thread and these thought process. And I always say you’re best at things you’re most passionate about. You must have just loved all of it.

Susan Scott (8m 3s):
I did love it. And the other thing that I realized was that, you know, when something bad would happen in a company, you know, maybe they lost their biggest client or they lost a key employee for who may have wonderful plans or the team just, wasn’t not implementing the strategy. The team was coming with all their reasons and excuses, why they couldn’t pull it off. And sometimes it would be even a distraught human being who was wondering, how did I manage to lose an 18 year marriage that I was not prepared to lose? So when they would arrive at one of those horrible events results, but when we would talk about the, how did they get there at that awful place?

Susan Scott (8m 48s):
And they got there one failed or one missing conversation at a time, the flip side, you know, when they had something spectacular to celebrate a brand new client that their competition would kill for it, they would become an organization that was a destination for recruiters rather than a resource. People wanted to come there and their teams were strong and their marriages were strong. How did they get there? It was one wonderful one important one productive, one fierce conversation at a time. And the thing that sort of provoked it all was I was reading Hemingway’s The Sun Also Rises and the characters ask, how did you go bankrupt?

Susan Scott (9m 29s):
And he responds gradually. And then suddenly

Dr. Anthony Orsini (9m 31s):
I love that quote. And that must be how you decided to start Fierce.

Susan Scott (9m 35s):
Exactly. Because I thought that’s it, our careers, our companies, our relationships and our lives succeed flat-line or fail gradually, then suddenly one conversation at a time. So really, I mean, it’s all about the conversations, but what gets talked about in a company and how it gets talked about absolutely determines what’s going to happen and what isn’t going to happen. And also who gets invited to the conversation. That’s another very important piece. It shouldn’t always be just the usual suspects.

Dr. Anthony Orsini (10m 7s):
Yeah. I said in my introduction, I say this all the time at every critical moment of your life starts with a difficult conversation. And I truly believe that if we can learn to navigate through those conversations, we’ll be better off professionally and personally. And so you embark in the set, I’m going to start my own company and you started Fierce, correct?

Susan Scott (10m 28s):
I wasn’t going to, I wasn’t going to do any of that. But what happened was that the CEOs were doing really well. They’d be interviewed. They would talk about their conversations with me and their conversations with each other, word got out. Other people who were doing similar work would say, what are you doing with your people? And I would tell them, next thing I know I’d be invited to come inside a company. You know, I want my executives to be able to have meetings like this, to be able to have one-to-one select this. This is so amazing. And over time Tony people said, this is awesome. Please write this down. I can only take so many notes and I love your words. And I finally gave in and wrote it down. And it became the first book, Fierce Conversations, achieving success at work and in life, one conversation at a time and realized that there was something here that the response and this was glow.

Susan Scott (11m 20s):
I was traveling around the world, teaching this long before I wrote the book and the response to these conversations, these approaches and people practicing, having them were so profound. And sometimes people would say, I had no idea. It was even possible to have a conversation like this. And so I knew I wasn’t the only person on the planet who really wanted more than the usual chit chat. And I wanted something deeper, something more meaningful, something that connected at a deeper level with person or the people that you know, I was talking with. And I was in good company.

Susan Scott (12m 1s):
I mean, I think most of us want that.

Dr. Anthony Orsini (12m 3s):
Yeah. I think that’s why you and I become so close because we enjoy the same thing. When we teach someone to navigate through these conversations, that you’ve mentioned that there’s a look in their eyes and sometimes it’s like, they just learned how to play the piano and they look at you and go, oh my God, that’s awesome. I love that. Right. And so what a great feeling.

Susan Scott (12m 26s):
You can see when the penny drops. I mean, you just see it and you realize, okay, this person just got it. And this is going to change this individual’s life. Because once you understand that you’re navigating your life one conversation at a time. And one of the other really key notions, which is that, you know, the conversation is the relationship. And our most valuable currency is relationship. Once you understand that, and then every conversation you have is either enriching flat-lining or harming your relationship. Once you understand that you can’t not know it, you can’t shut it out.

Susan Scott (13m 7s):
You’re always conscious of it. It doesn’t mean you’re going to get it right every time. Cause I certainly still don’t. Sometimes I’ll have to say, Hey, that’s not what I meant to say. Can I have another go? Please

Dr. Anthony Orsini (13m 21s):
Say, sometimes it’s almost like rewiring someone. I think most people don’t even think about the way they had conversations. And then once you bring it to their attention and they’re saying, oh, I’d like that. So that’s great.

Susan Scott (13m 32s):
And it was a skill. It truly is a skill that you can learn and you should be very proud of it. It’s not a, and it’s not a soft skill either. I mean, fierce conversations. It’s a strategy for getting things done. It’s the culture. It’s what you catch. When you come here into a company, it’s how we talk with one another. With our clients, with our customers, with our vendors, it’s such an important part of any organization’s culture. It’s a big deal. It’s more than just taking some training. It’s truly a way of life. Everything that we teach works at home equally well.

Dr. Anthony Orsini (14m 5s):
So it works in your professional and your personal life. And I do believe that it can be taught. I know people out there asking, cause I love the name. Why do you call it fierce conversations?

Susan Scott (14m 16s):
I have to give credit to a guy named David White, a poet actually from the Yorkshire Dales in England. And he was giving a talk and I was listening to him and he used the phrase, fierce conversations. And I don’t know Tony, it went through me like a sort of a little lightning bolt I thought, oh yeah, I want some of that. I love it scares me a little bit, but I think there’s probably something there. And of course I got to define what we mean by a fierce conversation. And it’s really the simplest definition. It’s one in which we come out from behind ourselves, into our conversations and make them real.

Susan Scott (14m 56s):
We disclose what we’re really thinking and feeling. And

Dr. Anthony Orsini (14m 58s):
You say in the book, all conversations are with myself. And sometimes they involve people.

Susan Scott (15m 7s):
That is because the most common experience of communication is misunderstanding. Because you say one thing and I hear something else. I mean, even something as simple as picture your dream house, somebody might picture a penthouse apartment. Somebody might see a little place by the sea at cottage in the woods, a tree house. I mean, who knows, we’re all really different and our context, all of those beliefs and those attitudes and those perceptions that are kind of baked in, we’re running everything that we experience, including what people say through that and interpreting it and often getting it wrong and being misinterpreted in turn.

Susan Scott (15m 50s):
So the part of fierce conversations is okay, here’s what I heard. Is that what you meant?

Dr. Anthony Orsini (15m 54s):
One of the things I love about your book and what you teach is that it’s also very practical. It’s easy to learn. I’m going to talk about a few things about your first book and we’ll get into your second book. But I think to really illustrate how you teach fierce conversations, to me sums it up in the beach ball, reality that you talk about. Can you explain that to the audience,

Susan Scott (16m 16s):
This is about how to lead it an amazing meeting that is almost like a think tank and companies really. I mean, my gosh, they’re so boring half the time, especially if you’re in yet another zoom meeting and you know, you’re doing solitaire under the table or thinking about other things. And I mean, meetings can just be killer in terms of energy. So how do you have a meeting that really wakes everybody up and go someplace interesting and arrives at some place? Even more interesting where people can’t wait to come to the next one and feel very proud of what they did. So I think back to some work that I did with Madeline Albright years ago, we were in Washington, DC.

Susan Scott (16m 59s):
We were working with a bunch of women in politics. God loved them. We took Q and A and someone asked her, you know, if you had all of the, because she was secretary of state at that time, if you had all of the world leaders sitting here listening to you and you could advise them, but you could only say one thing, what would you say? And she said, without missing a beat, she said, I would advise them that what matters anywhere matters everywhere. I love that. What matters anywhere on this beautiful blue marble of a planet of ours matters everywhere.

Susan Scott (17m 41s):
Especially right now with a pandemic. We need everybody to be vaccinated. We need to be safe all of us, but it’s true in a company. What matters anywhere in a company matters everywhere in the company or should. And so the beach ball meeting is you think about what is the topic? Okay, here’s the topic, here’s the problem we want to solve, or the decision we need to make, or the strategy you have to design or the opportunity we need to evaluate. And an important philosophy is of mine is that a leader’s job is, is not to be right. A leader’s job is to get it right for the organization.

Susan Scott (18m 24s):
So to get it right, we need multiple competing perspectives on the topic. And so we need to think about, okay, who should I invite? Whose perspectives would be important for me and for us, whatever’s making the decision to understand before they make that decision. And you invite those people in and you think of it as every single person in a company is standing on a different colored stripe on the corporate beach ball and is experiencing the company from that stripe. If I live on the green stripe and you live on the red stripe, you and I can’t even see each other, we’re on opposite sides of the beach ball. And so you might be talking about how red everything is and I’m sitting here thinking, what is he talking about?

Susan Scott (19m 11s):
It’s green, it’s not red, it’s green. And so if you ask, what color is your company? It’s all of those colors. It’s all of them. So Robert Redford’s really good at this when he’s very creative about who he invites to a meeting. And he says at the beginning, which is something else that not enough leaders do, he says, here’s the topic you were invited because I want to know your perspective on it. I’m going to tell you what mine is. And I’m even going to tell you if I had to make a decision right now today, without your input, this would be my decision for these reasons. Your value here is to tell me what I’m missing. You know, what are you seeing that I’m probably not saying. And if the idea of pushing back on me, challenging me, scares you, it shouldn’t because that truly would be your value.

Susan Scott (19m 57s):
And if we get it right, I will be different. I will be different. When this conversation is over.

Dr. Anthony Orsini (20m 3s):
I saw that quote in your book. I love that. I have it written down right here and say, I’m inviting you to influence me. I want to be different. When this meeting is over,

Susan Scott (20m 15s):
Who ever hears that from their leader, everybody would lean forward into that conversation and want to be very helpful. And also there are methodologies throughout the meeting where you make sure you call on everyone. So if somebody hasn’t spoken, what’s it look like from where you sit. And they’re only two answers that aren’t acceptable. One would be, I don’t know. And if they say that, you would say, well, what would it be? If you did know, I just wouldn’t let them squirm. Or if they said, well, I don’t have anything to add because Kathy pretty much said, you know what I would say, then you would say, what would you add? If you did have something add? So people learn very quickly. You don’t get to come and check out.

Susan Scott (20m 57s):
You are going to be asked for your perspective. And then at the end, when you’ve heard from everybody, then you ask everybody to be quiet, to write down on a piece of paper. What would you advise me the most excellent advice you could give me right now, given everything that we have just explored together. It just one or two at the most things, no big long essay and no talking, no side talking. And then everybody reads what they’ve got. And then the leader says, thank you. Thank you. And thank you. And thank you. And thank you. I feel better prepared. Please put your name on those and give them to me so that if I want to talk with you further about your idea, I’ll remember whose it was.

Susan Scott (21m 36s):
What’s wonderful. Is that somebody who came into the meeting believing that the company is orange and only orange, it’s all orange at the end of the meeting when they say, well, this is, was my advice. You understand that they now see that it is also pink and blue and green. And you know, all these, we do influence one another. And I mean, I did this for an executive a head of an oil company and his administrative assistant was in the room. And at the end I asked her what her thoughts were. And she said, oh, I don’t have anything to add. I’m just the administrator. I hate it. When somebody says, I’m just the whatever. And I said, no, I really want to hear from you because you sit where everything happens.

Susan Scott (22m 18s):
You know, a lot about what’s going on, you know, where all the bodies are buried, you know, so much, what is your perspective? And she just looked like the deer in the headlights and all the guys. And they were all guys. They were looking at me like, huh, don’t do this to her. This is horrible. Don’t put her in this position, but I just waited. And eventually she said, well, you guys are not going to like this. I don’t think we’re talking about the real issue. I think the real issue is, and she put it on the table and everybody just about fell out of their chairs because she nailed it. And they knew that was the real issue. You just don’t know where the wisdom is going to come from.

Dr. Anthony Orsini (22m 58s):
I was fairly honored to hear captain Mike Abrashoff speak. And he was on my podcast. I don’t know if you know that name or so it reminded me of your story. Reminded me of his story. He know he took over the worst ship in the Navy and asked every single sailor what they can do to improve it. And one sailor who was most reluctant asked him if he knew why they had to paint the ship so many times. And the captain said, no, I don’t know why. And his answer was because we use bolts that rust and the rust runs through. And that’s why we have to keep painting the ship. And he said, captain has anybody in the Navy ever heard of stainless steel. And he brought that to the Navy and guess what?

Dr. Anthony Orsini (23m 42s):
They changed the bolt. So no, everybody has really something to add. And I just love that in my business, Susan in healthcare and most of these audiences in healthcare, the beach ball analogy could not be more true. And I just finished the Ted talk, as you know, and I want to hear about yours also. And hopefully that’ll by the time this airs just beyond, but the Ted talk was about the impersonalization of medicine and professional burnout and high suicide rates and doctors. And I can tell you that I worked at a lot of places in there, almost all the same is that the green line is administration.

Dr. Anthony Orsini (24m 24s):
The blue line is nursing. The pink line is patients and the gray line is the doctors and they never cross. And so I think what happens and I, you know, this is that the green line talks about the blue line. The blue line talks about the yellow line because they only see it from their point of view. And then you have the, you talked about the government, they didn’t have the politicians over there. They’re on some tiny black line. I don’t know where they are. Sometimes they’re totally lost. And they’re trying to dictate all the other lines, you know, thousands of miles away. So I think that’s great advice,

Susan Scott (24m 59s):
A little hilarity here. I was given some dating advice many years ago, and I was told there are five things it’s really important to look for in a man. You need to find a man who has a job, hopefully one for which he’s paid need a man who has a great sense of humor makes you laugh. You need to find a man who’s handy around the house. You need to find a man who’s a great lover. And the fifth thing is you need to make sure those four men never meet. That’s funny. Those four people never meet. And yet wouldn’t that be the perfect person?

Dr. Anthony Orsini (25m 39s):
Yeah. Maybe we can get something done. What a thought,

Susan Scott (25m 43s):
An amazing experience. He brought up, you know, he was head of GE and he, they bought a manufacturing company and he called a big meeting in their warehouse. There a thousand people crowded into this warehouse and he said, well, this is a big problem here. We need to solve this. And I want to have your ideas. And a guy in the back and overalls held up his hand, they pass the mic back to him. The guy said, well, I’ve been thinking about that, Mr. Welch. And here’s what I think we could do. And he explained it. And Jack Welch said, that is a great idea. And the guy said, Mr. Welch, all these years, they have been paying for our hands when they could have had our heads for free.

Dr. Anthony Orsini (26m 22s):
I love that. That’s great. That is great. Let’s move on to leadership. One of my favorite topics and the topic of your second book. But before we even get into the details of the second book, and then we have the third book coming out, I was reading your first book and I purposely didn’t read your book. I told you this right? When I was writing my book, I said, I read her book. God forbid something seeps in and I don’t want that to happen. But when I read your book, my mouth was open so many times because I’m like, oh my God. So there’s one part in the book. I didn’t tell you this before. There’s a saying that my grandfather taught me and said it many times. It is a saying that I’ve repeated over and over again in every workshop that I ever give.

Dr. Anthony Orsini (27m 8s):
And no one has ever heard it before. And I was told it was an old Italian saying, which I think it is because I looked it up and I read your book and they’re in big letters. It says the fish rots, right? Lauren, I called my wife. I like it is in her. The fish rots from the head down is the Italian saying. And I believe that boy that we take our keys from our leaders, the whole company. Right?

Susan Scott (27m 40s):
Yeah. And you know, so often the leaders, especially the higher up, they are, they don’t feel they need any learning, anything to do about conversations in meetings. And I remember in one session, we actually did have the boss in the room with his team. And he was sitting in the very front and you know, it was talking about here. It’s really important to do this and this. And he said, this absolutely what I do. And behind him, everybody was shaking their heads and signaling to me, no, he does nodo that. So, you know, a leader definitely does model what is appropriate and what is desired and what is going to get promoted. And what’s going to get attention and what’s going to get his approval or her approval.

Susan Scott (28m 26s):
And it’s not always healthy. It’s not always really healthy and great for the company. And so many times people have said, the problem is our leader, and I don’t know what to do about that. And so how do you go to your leader? How do you go to your CEO or just the head of your brand or whatever it is and say, I want to talk with you about something. If there is a way to do that and still keep your head not be made available to industry immediately, you know, even that, and sometimes that is what it takes for a leader to get the joke that I’m saying that I want innovation. I’m saying that the, how important that is, and I want new ideas and all this.

Susan Scott (29m 7s):
And every time somebody comes up with one, I shoot them down. And I say, yeah, I hear you. But you know, and pretty soon nobody’s bothering to even try. That’s just one example of the mistakes

Dr. Anthony Orsini (29m 18s):
Are people saying my door’s always open, but when you do come in, they’re very short with you. Please leave. I’ve asked this question to several guests because I’m not sure, I think I know the answer, but I want to hear what you have to say. So many companies promote the smartest person in the room and they can’t be leaders. And I think it’s going different ways now? Can you believe it’s possible to take just about anybody and turn them into a leader by teaching them the right way to communicate? Or do you think it’s just most people or do you think you should just take that leader and then teach them the skills?

Susan Scott (29m 59s):
I think it has everything to do with the belief system that persons operating from. You’ve got to get them to understand and grasp the one because you can teach somebody how all day long. But if they’re not convinced about the, why am I doing this? Why do I need to do this? They won’t do it. And I just do feel, we have a saying called smart plus heart. We really want both. We, I don’t think you can be a great leader without both of them. So we need your smarts bring in your brain sales, but we also need your heart. We need you to be able to connect with your employees and your customers at a deep level. We need for you.

Susan Scott (30m 40s):
And you write about this, Tony, the compassion, the empathy that needs to be present as well. And just because you’ve got this exalted title does not mean that is no longer important. That is very important. So smart plus heart. I have seen time and again, and I’m sure everybody has, you know, where someone just brilliant comes into a company with a fabulous plan, great ideas, and ends up riding out the back door on their white horse because they failed to capture people’s hearts. And that happens all the time. So you really need both. And I think if I were going to be working, I do sometimes coach leaders. Well, let’s start with your belief system.

Susan Scott (31m 20s):
For example, I believe that there’s more than one right way to live a life. So let’s not be so judgmental. Let’s not be so clear that your way is the highway. You know, I believe that everybody who comes into your company wants to contribute. And if you keep shooting them down, they become smaller and smaller until they’ll absent their spirit from the work. And then you’re dead. You know, I mean, all of these beliefs are what support the behavior and the behavior is easy to learn. But first you’ve got to understand a few things.

Dr. Anthony Orsini (31m 54s):
And I believe at least in the world of healthcare, we’ve been doing thousands of doctors and nurses, et cetera. Doctors are not known for their phenomenal communication skills. I mean, let’s face it. Some of them are, but they aren’t. But what I find is, and we’ve looked at this, I would say there’s about 20% of the people that come to me and we do our training and, you know, we’re training, breaking bad news, you know, giving really difficult diagnoses, but also patient experience. 20 of them are just natural. And I want to hear what your thoughts are about that, where they’re just phenomenal speakers and people loved them and they walked into a room and it’s just inborn. And then I find about 15 or 20% of the people that I work with.

Dr. Anthony Orsini (32m 38s):
I could train them every day from now until next year. They’re not going to improve much, but the rest, I think once you take that person, so they’re smart, they have a heart and now they have to convey that. And that’s where you come in. Do you find that’s the majority of the people that you speak with?

Susan Scott (32m 59s):
So I think it is the rare person who cannot grasp the importance of the way they’re talking to all of the conference. The rare I’m jumping around. But yesterday I kicked off a rollout of fierce conversations, training in a very large global company. And I had to compliment the CEO because it is the rare leader, given everything that calls for his or her attention. And in this case, it was, it’s a woman, which is a rare leader who turns her attention to the conversations in the company. And yet the conversations are the fulcrum that allow us to solve our issues and to do amazing things. So I find it, once you explain this to people, they get it.

Susan Scott (33m 43s):
I mean, I didn’t get it until I heard some ideas from other people. And I thought, holy smokes, of course, you know, and then I was launched and I find that’s most people’s experience. And there are some who are so terrified about transparency, about being in the room when somebody might be feeling emotional is they just don’t want to be there. They don’t know what to do. They don’t want to experience it themselves. And even they don’t even understand the importance of telling people how great they are in a way that it lands, because just saying good job at a boy and a girl that just doesn’t do it.

Susan Scott (34m 23s):
And you know, you have to be specific. Wow. The way you acted in the meeting today, people were really challenging you and you didn’t get defensive. You just kept saying, say more about that. Thank you for that. You blew my socks off, keep doing that. I mean that that’s part of fierce training. How do you do that? Express your appreciation of people. And so I do find that most people get it and want to learn it and start practicing it and then start seeing results right away,

Dr. Anthony Orsini (34m 53s):
Your book and your training makes people, at least for me anyway, want to like take a pad and a pencil as you’re reading, they’ll be like, oh, I love that. I’m going to write that down. Just like you said, I love that. I’m going to, I always say people just steal from me and I’ll steal from you. And I love what you said. I think it was during your Ted talk, you were talking about your first leadership book and said, you could also have called it the complete guide to the fricking obvious. I love that because that’s true, right. It’s stuff that we didn’t consider, but once you teach it to us, we’ve got to write that down.

Susan Scott (35m 23s):
It’s clear. It’s so clear. It’s like, how did I miss that? You know, how did I miss that? And it was David White that gave me the idea about relationships. He said, you know, the young man who’s newly married is often puzzled, frustrated, even irritated that this lovely person to him me as plight just troth before his face on a regular basis, wanting to talk yet again. But the feeling just talked about last night as something to do with the quality of the relationship. And you wonder is why are we talking about this again? And then he said long about age 42 and I remember he smiled because he was 42 and very long about age 42 of he’s been paying attention. It dawns on him, this robust conversation that I have been having with my wife.

Susan Scott (36m 7s):
It’s not about the relationship. The conversation is the relationship

Dr. Anthony Orsini (36m 12s):
That goes for a spouse that goes for a business leader to team member, doctor patient relationship nurse. It is, I love that it is the relationship. So I love that. I’ll probably steal that though.

Susan Scott (36m 27s):
You know, one time, one time offer that up very early in the training. And that idea came up. And one of the guys in the training shot up out of his chair, ran out of the room, came back about 10 minutes later. And he said, you guys I’m really sorry. But I had just had this feeling that I’ve got a customer who’s about to leave us. And I just called him and he is about to leave us and I’m on the first plane outta here. I gotta go sit down with him and save the relationship he’d been pretending not to know, but he knew somewhere in his subatomic particles, he knew there’s a conversation that needs to take place here. And he just had been putting it off. Yeah.

Dr. Anthony Orsini (37m 5s):
As we’re getting close to the end, I want you to tell me about your new book. Cause that’s coming out soon, correct?

Susan Scott (37m 12s):
January of 22. So which is getting closer and closer and I’m very excited about it. So what has happened all these years, Tony is I get emails from people from all over the world saying, thank you for writing your books. I love it. I’m really using it, but I want you to know I’m using it at home. And I just had the best conversation with my wife or my husband or my partner that I’ve ever had. And I just wish you would write a book just on that. That book has been circling me for many years. You know, I have a wonderful CEO. Who’s running the company. Now it gives me a little bit of breathing room and I’ve written Fierce Love, creating a love that lasts one conversation at a time. And it has eight killer conversations for couples to have that I think are really important and how to have them in true stories that explain, you know, like here’s, this what’s going on with this couple and how they add it in it also busts some very popular myths about romantic love that mislead and derail us.

Susan Scott (38m 11s):
And I’m very excited about it. I think it will probably be more successful than my other books. And they’ve done just fine. But I think this is for the general public. This is not just for the business world. This is for everybody out there who wants to love better. I mean, love it doesn’t make itself. We make it or we fail to make it or we unmake, it. It’s not like God is up there ex machining. What happens in our lives? Certainly not the amount of love we have in our lives. That’s up to us and you know, it can seem complicated, but it really isn’t. It’s all about the conversations because the same thing is true for a romantic relationship. That is true for a company. What gets talked about in a relationship and how it gets talked about determines whether this relationship is going to thrive or flatline or expire.

Dr. Anthony Orsini (38m 60s):
I think the general appeal to that book because who doesn’t want to succeed in their relationship and love. So can’t wait for that book to come out. That’s going

Susan Scott (39m 9s):
To be really excited about that.

Dr. Anthony Orsini (39m 10s):
I’ll tell you a quick, funny story. I was giving a lecture in Oklahoma to a hospital about having difficult conversations and conflict resolution and this very young, of course, as I get older, everybody looks younger and younger, very young girl came up to me. She was a nurse practitioner and she just said, does this work with husbands? She just got married. So she was so cute. It was really funny. So I didn’t warn you, but I warn everybody else. But I know you’ve been on so many podcasts and this is right up your alley. So I didn’t warn you. I finished every podcast with the same question. You’re so knowledgeable.

Dr. Anthony Orsini (39m 49s):
You probably talk for an hour about this, but I always ask every guest, what was the most difficult conversation or type of conversation that you were involved in? And can you please give some practical advice to other people that may be in that similar to help them navigate through it

Susan Scott (40m 9s):
Really personal? It was when I decided to leave my marriage and I had to have that conversation with my husband who should have seen this coming. I couldn’t imagine he was happy because we were like housemates, you know, just housemates for a long time, had totally different goals, totally different interests, but that was really hard. And he and I had not been successful in trying to talk about things. And I found that we just got quieter and quieter and quieter. And the things we weren’t talking about were killing us. And so that conversation which was had in the lake district of the UK, because we had been doing some work in London and went up there at a BNB and it was a long conversation and I was crying.

Susan Scott (40m 54s):
I had a baseball cap that I pulled down because I was embarrassed. I didn’t want anybody to see, you know, my sunglasses on, I’m trying to hide and he’s white as a sheet. And that conversation was really hard, but I had it. I’m not saying that the way I had it was perfect, but I had it. That’s what I want to say to people. If you have a sense that there’s a conversation that has your name on it, you’re right. Get on it. Don’t wait. Actually, it’s the missing conversations that are the most expensive and gradually we’re moving towards a suddenly, if we had been awake during gradually, which where we live, 90% of our lives and we, if we had stayed current with one another, all along the way, we probably wouldn’t have had to have this momentous really horrible, ugly, scary conversation.

Susan Scott (41m 51s):
So my advice is stay current, bring it up. Even if you think it’s going to be awkward or somebody is not going to receive it well, if you say, you know, you’re using some of our approaches, which are all in the book that people can read. I want to talk with you about the effect that this is having on that. And the way you talk about it in your, even your tone of voice, everything about it. It is an invitation that is really hard for someone to decline. And usually they will step into the conversation and you can, you know, at least you’ll be somewhere further than you were before you tried to have it. And you won’t both be pertaining. The thing that I say all the time is that while no single conversation is guaranteed to change the trajectory of a career or a company or a relationship or a life, any single conversation can.

Susan Scott (42m 48s):
So we all know, sometimes we try to pretend if this is not that important, I can put that off for a better day or when I’m in a better mood or he or she is in a better mood. The sun and stars are in the right position, in the right music is playing in the background. That’s when I might have this conversation and it gets put off and put off and put off. And all of a sudden you’re at a suddenly you didn’t want,

Dr. Anthony Orsini (43m 10s):
And your book, a quote from Woody Allen, right? The first rule of enlightenment is to show up. I guess that’s what you’re saying is start the conversation is the hardest part.

Susan Scott (43m 18s):
He said, I’m not afraid of death. I just don’t want to be in the room when it happens. What you think of Woody Allen. He has said some funny things. And I think that is the way some people feel about some of these conversations. I’m not afraid of these conversations. I just don’t want to be there, you know, but you kind of have to be there.

Dr. Anthony Orsini (43m 37s):
Well, just like your books, that’s very sound advice. And I think that’s what I promise my audience every week is that they’ll feel inspired and that they’ll leave with some great communication techniques that will help them in their personal and private lives. And they’ve certainly done that if they listened to this today and if they want to learn even more, your books are both amazing. And I recommend them highly to everyone. And we’ll put all those show notes and all the connections on there before I let you say goodbye though. I wanted to ask you, this was way up on my question list. Do you live in a tree house? Cause I read that somewhere. I got to know about that before I let you go.

Susan Scott (44m 16s):
Yeah. 15 years ago, I had it built. It’s on top of a very small mountain on orcas island off the coast of Washington state. It’s held by seven Douglas, firs. It has all the creature comforts, including a gas fireplace that I use as the heater, my favorite kitchen views to die for and a ramp so that it’s easy to get up in and out and the dogs can do it and everybody can do it. And it’s where I spend about half the time. It is, it’s so beautiful. You know, you have to take the ferry to go there because it is an island. And when I drive off of the ferry onto the island, there’s this breath that I take, the air smells different, feels different.

Susan Scott (45m 2s):
It’s easier for me to be peaceful. And I absolutely love it. And friends and family come up and visit. And there’s a little, I built a little cottage on the ground. So people come and visit and we have the most wonderful talks and we build a fire and we do smores down on the ground. Of course, you know, it’s just a really special, wonderful place

Dr. Anthony Orsini (45m 21s):
I got to ask because I’ve never known anyone to live in a tree house, but I’m the same way. When I see water, especially if it’s salt water, my blood pressure goes down 20 points. And I can imagine that. So Susan, this is great. It’s always so much fun to speak with you. I’m so glad that not only am I getting to know you, but my audience is finally getting to know you the best way for people to get in touch with you is through Fierce Inc?

Susan Scott (45m 47s):
HFierce Inc .com and they can sign up for our newsletter. There are many great articles in the newsletter about conversations and also that’s where people will be notified when they can order fierce love if they want it. So that would be the place to go.

Dr. Anthony Orsini (46m 2s):
So we’ll put that in the show notes. We’ll put all the links in the show notes. If you enjoyed this podcast, please go hit. It’s not subscribe anymore in apple. It’s now follow and download the previous episodes. If you need to get in touch with me, I can be reached@theorsiniway.com again, Susan, thank you so much. This was an absolute pleasure.

Susan Scott (46m 23s):
Thank You for having me, Tony. I always love talking with you.

Announcer (46m 29s):
If you enjoyed this podcast, please hit the subscribe and leave a comment and review you. Contact Dr. Orsini and his team, or to suggest guests for a future podcast. Visit us@theorsiniway.com.

Burning Shield - The Story of Jason Schechterle

Jason Schechterle (2s):
Again, it’s silly and simple to talk about golf when you’re comparing it to fourth degree burns, but it was my recovery process is so important to tell other people that there’s nothing as powerful as a made up mind. And it doesn’t matter what you’re doing. If you’re doing it for somebody else, like as a doctor to help somebody or a cop who’s trying to help somebody or personally, when you’re alone with your thoughts. Which everybody should know, it’s the most dangerous place you’re ever going to be. And you’re there all the time. You’re stuck with your thoughts all the time. That was a big part of me knowing that I was okay, was to get back to just the normalcy and to be good again at something I used to be good at.

Jason Schechterle (48s):
It’s like I played golf before, I play golf now, nothing is different.

Announcer (51s):
Welcome to difficult conversations lessons I learned as an ICU physician with Dr. Anthony Orsini. Dr. Orsini is a practicing physician and President and CEO of The Orsini Way. As a frequent keynote speaker and author, Dr. Orsini has been training healthcare professionals and business leaders how to navigate through the most difficult dialogues. Each week, you will hear inspiring interviews with experts in their field who tell their story and provide practical advice on how to effectively communicate. Whether you are a doctor faced with giving a patient bad news, a business leader who wants to get the most out of his or her team members or someone who just wants to learn to communicate better this is the podcast for you.

Dr. Anthony Orsini (1m 37s):
Welcome to another episode of Difficult Conversations: Lessons I learned as an ICU physician. This is Dr. Anthony Orsini, and you guested it, I’ll be your host again this week. Well, as I approach my 50th episode, I can say that doing this podcast is one of the best decisions that I ever made. Because each and every week, I get to interview some of the most incredible people in the world, leaders in healthcare, and in business who have taught me so much. I also feel inspired every week. And this podcast has given me a new appreciation for the good in people and the unbreakable human spirit. Well, none of my amazing guests have been more inspiring than the man you were about to meet today.

Dr. Anthony Orsini (2m 22s):
I had the pleasure of meeting retired, Phoenix police, officer Jason Schechterle when we were both presenters at TEDx Grand Canyon University back in March. When you meet Jason, he can’t help, but be impressed, inspired and frankly, just like the guy. We hit it off. And I’m so proud, not only to have him on this podcast, but to consider him a friend. Jason’s journey, chronicles his fight for life, his triumph over tragedy, and the inspiration that enables him to continue to overcome unimaginable adversity. His personal narrative exemplifies that the power of the human spirit can never be underestimated or extinguished.

Dr. Anthony Orsini (3m 3s):
His story is also a testament of true love and the dedication Jason and his wife, have in their commitment to honor their family and the vows of marriage in good times and bad. His story is one of life rebirth and transformation. Jason represents the human experience at its very best and is sent from despair to describing himself as the luckiest person alive. Jason is the subject of the book, “Burning Shield” by Landon Napoleon, which we’ll talk about today. If you haven’t read it, go to Amazon right now and buy it. Well, this is what I normally would tell Jason’s story, but I’m going to let him tell Jason, all I can say right now is I’m so excited to speak to you.

Dr. Anthony Orsini (3m 43s):
It’s been great getting to know you and I can’t wait for my audience to get to know you as well. Welcome Jason.

Jason Schechterle (3m 50s):
Thank you o very much back Dr. Orsini, Doc, Tony. Yeah, we got

Dr. Anthony Orsini (3m 55s):
Just Tony, unless you’re my mother and I’m Anthony.

Jason Schechterle (4m 3s):
I love being on your show. I really appreciate the invitation. And it’s nice to be so much more relaxed than the last time when we were spending about 11 hours getting ready for that TEDx talk.

Dr. Anthony Orsini (4m 15s):
Well, you and I speak a lot in public, but I can say, I think we share that was a pretty stressful moment. It’s very different to do the TEDx talks.

Jason Schechterle (4m 26s):
Yeah, It’s an intense day. And because we are experienced speakers, probably couldn’t be considered professional speakers. You have all this bill. I compared it to like all this buildup in the stress and anxiety. And then after 12 minutes it was over. I’m like, well, that was it. So it ended up being a wonderful new friendships came off without a hitch. And I don’t know, you know, if you felt the same way, but it was the first time I’ve been in front of an audience in 13 months. And that just felt amazing to feel the energy in the room and to hear the laughter and the, and the gasps and everything for each thing that we all talked about.

Dr. Anthony Orsini (5m 12s):
Yeah. That it’s nice to be back in front of a crowd. I’ve given so many presentations by a zoom and you know, I gave one University of Virginia a few months back and you don’t even know if anyone’s there until you finish speaking. Hello. Is anybody out there?

Jason Schechterle (5m 31s):
Staring at yourself in the little box that corner? I love zoom. It does connect us.

Dr. Anthony Orsini (5m 39s):
But, and the last thing I’ll say about the TEDx, I told my wife that you came a little bit later. Cause I think he couldn’t make it to the first night, but in 24 hours, we made incredible friends because I feel like we’re all in this boat together and we’re pulling for each other. And it’s amazing that I’ve only been around you for 12 hours that we’ve spoken for awhile. But I feel like you’re my friend. It’s amazing how that happened.

Jason Schechterle (6m 3s):
That’s one of, probably the best part about it. We’re all from different backgrounds, different parts of the country, speaking on different topics. And there was just an instant bond I felt with several of us and it’s because I think the preparation for it, but then once you got there, it was just us, you know, in the ring and it was showtime. And I love that.

Dr. Anthony Orsini (6m 24s):
Well, by the time this goes live, which should probably be in about a few weeks, I’d say probably the end of may. Hopefully it’ll be up and everybody could watch your amazing speech and everyone else’s, but let’s move on because I didn’t really tell much of your story because I want you to tell it. And it’s an amazing story of tragedy and triumph. And I’m just going to give you the mic and just go ahead and tell us your incredible story.

Jason Schechterle (6m 51s):
I think you could tell by my background, beautiful sunny Phoenix, Arizona is where I am right now, where I’m born and raised. And I always do at a young age, I just, a life of service I wanted and had thoughts about being a police officer ended up being pretty good at golf, got a college scholarship out of high school and gave that a shot for not very long was about six months. It didn’t take me long to figure out that I was definitely not on the level that some of these golfers are along with. I realized that at least for me, I was done being a student and ready to move on to that life of service. So I served four years in the air force, which was just an outstanding decision on my part structured discipline, but I wanted and needed came home.

Jason Schechterle (7m 42s):
And then again, life changed pretty quickly. I got married, had a couple of kids and ended up with a great job as an apprentice lineman. The guys that work on the overhead power lines, it’s just kind of cruising through life. You know, I not really faced a lot of adversity. My parents were healthy and happily married. All four of my grandparents were alive and married. Again, I’m just cruising through life, not really paying attention to a whole lot. And March 26 of 1999, I was 26 years old. I came home from work, turned out in the five o’clock news. The lead story was a beach police officer named Mark Atkinson had just been shot and killed in the line of duty.

Jason Schechterle (8m 28s):
And it was my moment of clarity. It was my aha moment that you know what you have to be wearing that uniform. You have to be doing that job. And it’s hard to even put into words when you feel a calling and a pull towards something. So I went right away filled out an application with the city of Phoenix was very lucky. It’s a very difficult job to get, especially back in 1999, a lot of people not like it is today with the way the world is, but back then it was a lot of people wanted it, man. I was very lucky to be given the opportunity. The academy, you know, I found it to be very easy, enjoyable, almost just to learn the tricks of the trade, to learn criminal law, defensive tactics, and then high risk vehicle stops and all of that stuff.

Jason Schechterle (9m 21s):
First graduating class of 2000, being a patrol officer, especially on the streets of the city that I grew up in the city that I love and care about. So rewarding. I always tell people, I still teach at our academy. And you know, if you have the foundation that you do this job with the right honor and the integrity to have a badge, I don’t care what noise is coming across your TV screen. It is the most rewarding career.

Dr. Anthony Orsini (9m 50s):
And I know what you’re speaking of. My whole family are cops. My father is a retired police officer. My brother’s retired, I got three uncles. And I remember as a teenager getting pulled over for a traffic violation, they’d say who’s a police officer. Cause you know, New Jersey had those PBA cards and they’d say who do you know that the police officer real intimidated was saying, who do you know is a police officer? And I’d say, well, let me see my father and my brother had three uncles, 2 cousins. And they’re like, all right, go ahead and go.

Jason Schechterle (10m 21s):
Cops specially in Jersey. And these cops are intimidating places. My dad is from Asbury park, New Jersey. It’s a little more intense. I don’t know if I could have done that part of the job.

Dr. Anthony Orsini (10m 38s):
Anyway. I didn’t mean to interrupt you.

Jason Schechterle (10m 41s):
So yeah, again, I’m cruising through life. I’ve got beautiful young growing family. I’ve got the job that I was meant to be doing and loved every day of it. And about 14 months in ironically on March 26, 2001, exactly two years to the day after Mark’s accident had been killed the reason I became a police officer. Went to work that day three in the afternoon. I was supposed to work until one o’clock in the morning and at 1130 that night, so I’ve gone through more than three fourths of my shift, very quiet, nothing going on. And I responded to an emergency call that was actually out of my patrol area.

Jason Schechterle (11m 22s):
I had no recent answer up to this fall except that the, also that at the time it was a serious call, a sounded like a violent crime, committed it as a dead body. And so I answered up for long ways to go being out of my patrol zone lights and siren on time to get there as quick as I can. And I’ve stopped at a red light. Again, it doesn’t matter what you see on TV. When you are running, what we call code three lights and siren and you have a red light and you still have to come to a stop so the people with the green light will yield to emergency vehicle. And no, it only takes a second and a half to clear an intersection.

Jason Schechterle (12m 2s):
And just as I was going to proceed, I was struck from behind by a taxi cab. The driver was suffering an epileptic seizure at the time. And according to the investigation, he was doing 115 miles an hour. When you run into me and, you know, looking back on it, I don’t know if he had traveled a long way building up to that incredible speed. And when you’re in the middle, you know, a lot more about this than I do, but being in the middle of a grand mal seizure, you are out of control of what’s going on. And you know, I can only assume that in those last few seconds, he was probably attracted to my overhead lights and he hit me right in the back and I never saw it.

Jason Schechterle (12m 50s):
I never felt the impact. You know, I’m very blessed for that. I was knocked unconscious, which had a lot to do with saving my life. My car burst into flames, traveled almost 300 feet through the intersection at that, you know, incredible speed of an impact, how I was propelled forward. And so many miracles, twists of fate timing. I came to rest about 50 feet from a firetruck, which is just unbelievable that there was a firetruck in the exact intersection at the exact moment that I needed the most. And they were given an opportunity to put their training and use their calling. It’s easy to sit here and state facts and state and timeline, but no, we are all human beings.

Jason Schechterle (13m 36s):
You’re an ICU doc. You know, sometimes it’s always nice for, for careers like this. When you get a little bit of detail, you get a little bit of, hey, here’s what’s coming in right now, or here’s the call you need to go to. And it’s a shoplifter, it’s a guy with a gun. It’s a burglary, you know, for a cop, you get a little bit of time to assess. And these firefighters, I think about them all the time, they were on their way to a call. And then all of a sudden, the world actually exploded right in front. And then for them to see it’s a police car, there is a heightened sense of, you know, the comradery and the care that goes into, you know, doctors, nurses policmen, fire teachers that, you know, no shame in any other career fields, that there is a connection with several of us.

Jason Schechterle (14m 22s):
And I think about them all the time that they were again, just human beings who have to put on a uniform at the beginning of that shift, but it doesn’t mean that they are the bravest and the strongest and the fight or flight syndrome is real. So I like to give them a lot of credit for what they did. They got me out of the car in 90 seconds, which is unheard of, I am two and a half miles away from what I would argue with anybody is the best burn center in the United States of America, Maricopa county hospital. The staff inside of this burn center is phenominal. I think they’re the second busiest in the country, outside of Atlanta, but the talent and the training that is inside these walls is amazing.

Jason Schechterle (15m 6s):
And I was on their trauma table in less than eight minutes. And I know as a, as an ICU doc, you can appreciate that nobody gets that that kind of timing. I suffered burns to 43% of my body, my neck head, and face more. The worst, my torso was protected by my Bulletproof vest, thankfully, and again, being unconscious, I wasn’t yelling, screaming and taking in those deep breaths, inhaling the smoke and the flames would surely would have killed me within just a few minutes and having my chest spared from the burns, which firms for those of you listening, who don’t realize burns will keep on burning.

Jason Schechterle (15m 49s):
So it’s like somebody putting a brick on your chest. Eventually your lungs just can’t expand. You can’t breathe. So that helped me a lot. But sitting in the driver’s seat, it was from the neck up my shoulders, my hands ended up again, 40, and I’m not sure how you all come up with these measurements, but 43%. And outside of the burns, I had two cracked ribs and a mild concussion. I mean, I would have gone home just a few hours after the accident. Except for the car bursting into flames. I spent two and a half months in a coma. I mean, it should go without saying I was not expected to live. I had some of the best doctors in America and they told my family and very bluntly, Jason will not survive.

Jason Schechterle (16m 34s):
I was in a medically induced coma. They had to remove all of that dead bacteria fill tissue. And then I was say with, you know, obviously the loss of all those fluids and the protective covering that we are born so I was a tissue recepient. Yet I had dozens of tissue donors. And the gift of life is not just a cliche. It’s not just a few words it means something.

Dr. Anthony Orsini (16m 59s):
You know, reading the book, and I got to say to everybody out there, like you have to read the book. I knew Jason, I heard his Ted talk. I knew your story. We spoke a few times, but I didn’t know the detail of the book. I mean, so now you have severe level four burns and you know, all your entire face you’re in the best place that really you could be. And still when your wife comes to the hospital, the doctors pretty much tell her that you’re not going to survive. Correct?

Jason Schechterle (17m 32s):
Dr. Dan Caruso unfortunately passed away four years ago of cancer at the young age of 53. And he was just one of the greatest healers lifesavers the world has ever known. It was a terrible day to lose him. But he told my family, my parents, my wife very matter of factly, that Jason, I’ve never seen this to a head and face these kinds of burns nobody can survive this. For him to go to work and you know, what I love is it took I’m so into the human side of things, does that always matter? The level of education we have or what outfit we put on every day, we are human beings with emotions and our own story, our own set of adversity and families and things like that.

Jason Schechterle (18m 16s):
And it was probably a year and a half after the accident that I was back in the hospital for a surgery. He came in after a shift one day and pulled up a chair and he sat with me and he gave me a chance to hear his side what he saw, what he felt, why he did what he did from y’all. I wanted to understand why did you have to remove my entire appearance? My nose, my ears, my eyelids. Why am I blind? Which I was at the time. And he said to me that about halfway through the first surgery was seven hours of just removing everything to get down to something I in fourth degree is down the last layer of the muscle to the bone.

Jason Schechterle (18m 57s):
It is as deep as it can go. And he said that about halfway to the surgery, he put up his hands and he actually said out loud to everybody in the alarm, why are we But you are still a human being. doing this. What are we doing? Even if he lives? What’s the point? You know, a lot of people might question, well, you know, you’re a doctor, you took an oath. You, you supposed to have this code, you know, all these things that you’re going to save lives. It was so powerful to me to hear my doctor, the guy who saved my life, say to me that he questioned his own reasoning behind doing it.

Jason Schechterle (19m 38s):
And I’ve never forgotten that, that human intimacy into it. And I love it. I love it.

Dr. Anthony Orsini (19m 43s):
And that’s what we are fighting. That was my talk was about personalizing medicine. I can tell you as an ICU, doctor takes care of the little premature babies. I read the book when that quote comes along, we’re in the middle of the surgery. He says, what am I doing? It choked me up because as doctors, we do struggle with that. We want to heal everyone. As we say in medicine, I’ll do everything I can for you. I just don’t want to do everything I can to you. And we struggle with that. And I’ve struggled with that many times, am I doing something just because I can, or am I doing something to help? And so thankfully he kept going and in the book is incredible. And I think you said 50 surgeries.

Jason Schechterle (20m 24s):
I mean, I’ve had that 56. And to put that into perspective, I have not had one since 2008. I finally reached a point where I was, yeah, I was healthy. I was getting stronger. I was out of pain and all the elective surgeries, I just finally got tired of the little things, you know, the IVs. And then of course there were times I’d go in for what I thought was going to be a minor surgery. And it turned into a 10 day life-threatening staph infection. And I’m like, you know, Jay’ with all you have overcome all your families had to deal with. The rest of it gets solved. The 56 surgeries was really a short seven year timeframe. And I’m sure as I get older, I’m 48 years old right now.

Jason Schechterle (21m 6s):
I’m sure as I get older, I don’t know. What’s come. Nobody’s supposed to have survived. Fourth degree burns. So as I have issues with my eyesight or my breathing, things like that, I’m not going to shy away from taking care of things. But as far as making myself pretty, I’m good.

Dr. Anthony Orsini (21m 24s):
Let’s talk about, since the topic of this difficult conversations, I’m going to ask you something at the end, but you had to have some very difficult conversations with doctors along the way, giving bad news. And also, I’m sure you had to make some decisions about these elective surgeries. You talked about the human spirit and the doctors who really connected with you what did you notice about some doctors and nurses who were really that you were able to bond with and maybe some that just seem to be all business. And can you comment on that? The different types of approaches that they made.

Jason Schechterle (21m 57s):
Yeah, that’s something that I think is so important. Again, your Ted talk is about that side of it. Then I had to learn that the hard way, you know, because before this happened, I just assumed like everybody else who doesn’t know any better, the doctors will do what they’re supposed to take care of. You. I didn’t know about the human side and the emotional side and what you need. That’s sometimes more important than the physical and being injured in the line of duty. I was afforded the opportunities to go wherever I want and see whoever I want outside of obviously the initial emergency and going to, I was caught on, I was on fire.

Jason Schechterle (22m 39s):
So I needed to go to the burn center. But outside of that, I got to travel and I went all over the place. I mean, I was at Fairfax and go to the hospital in Virginia. I was in Boston, in New York city. I was trying to find their work and drop the surgeries. And I did. I, you know, I ran across doctors, nurses, even in the burn center. I know my wife was, she had, I had a couple of nurses that she went to my doctors and said, don’t ever let that nurse get back to Jason’s room. And, and it’s okay to be like that. I think we weren’t against everybody. We weren’t gets every piece of advice or every medical decision and procedure.

Jason Schechterle (23m 20s):
We were against people who did not seem to have what we needed as a family and what I needed personally. And that is just simply, Hey, it doesn’t matter my accident. It doesn’t matter the job that I was doing. It doesn’t matter what I look like right now. I am alive and drawing my own breath. And I, Jason and I need to be treated as such. I needed to be treated as Jason, as a father, as a person who has a reason and a chance to fight and overcome this. And I need some help. I am vulnerable right now. And vulnerability, I have found there’s an incredible amount of strength and beauty inside vulnerability, but you need a lot of help.

Jason Schechterle (24m 6s):
And that’s when you want to surround yourself with people who are willing to help. And, you know, it’s the same thing as you get to choose your friends. And if you have toxic friends, people who don’t have your best interests and supports you that it’s okay to let them go and keep your inner circle close. Well, it’s the same thing for me with the medical profession. I really tried to hone in on the people who had my best interest and we could, you know, we could laugh together. We could cry together it’s okay. Again, you can, even for doc, it’s okay to walk into my room and tell me that not only telling me the truth, but then also to tell me that you’re scared.

Jason Schechterle (24m 49s):
You’re not sure exactly what’s right. And let’s work on it together. And I was lucky over the years to find that in the medical tools are out there. I mean, just like cops and every profession that has a 10% or whatever, that aren’t that good. 90% of doctors, the nurses are out of this world and they want to take care of you. They want to help you. And I had to help them to right? I had to have a fighting spirit. I had to say, you know, I’m willing to try this. It wasn’t always no. Or you’re crazy, or that hurts too much. It was like, I believe that you do say that this’ll work. You want the ball, you know, in the fourth quarter on the last play, then that’s what I need.

Jason Schechterle (25m 32s):
And it was a beautiful thing to have that. And now friendships I’ve built now that I don’t need any medical procedures, I can be just friends with all these people, and it’s awesome. .

Dr. Anthony Orsini (25m 45s):
The X factor. And this is what I really dedicate the last 20 years. So the X factor in medicine is that the medicine’s not only about information, it’s about relation. And there’s a certain X-Factor of those nurses that and doctors that you bonded with. I do believe all doctors, nurses are compassionate. Some of them just don’t convey it when you have that bond. There’s something special about that bond that we had early on. One of my first guests name was Marcus Engle. And Marus Engle had a similar story to yours in that when he was 19 years old was blindsided and T-boned and instantly went blind and had 50 surgeries just like you.

Dr. Anthony Orsini (26m 29s):
But so he’s in the trauma center. Every bone in his face was broken. And Marcus Engle wrote a book called “I’m Here” because what he remembered in the midst of, you know, a 19 year old kid being in a trauma center where people are cutting his chest and screaming and yelling and do this and do that. And he’s bleeding to death and they’re hanging IVs. Someone came, who was a nurse tech nurse assistant held his hand and just said, I’m here. And that’s what he remembered. And I bet you, there’s certain people that you remember that helped you through that. Not including your wife. Those

Jason Schechterle (27m 2s):
Are the people I do remember the ones who would just touch my arm or my hand, and simply say something like that. You know what, I’m right here and I’m not leaving.

Dr. Anthony Orsini (27m 13s):
Amazing. So you go through all this, not only do you survive, you end up going back as a police officer. And I think you even played golf again, right. Even though your hands, are you playing a little golf or are you hitting golf balls?

Jason Schechterle (27m 28s):
You know, I’m very proud of both those things. So many people, my doctors put in front of them, really, everybody said my career was over and I’m the one who stood up and said, you know, I’m a cop, not 40 hours a week. It’s not going to be taken away. I did go back. I ended up being a homicide detective, which was just wonderful to do something so much more important than just me, you know, speaking for victims who couldn’t speak for themselves and working with families like that. And then, yeah. You know, the golf, I think it’s important to talk about that because that is the one thing that I gave up. The one thing that I said I can’t, because I was a two handicap when I got hurt.

Jason Schechterle (28m 10s):
I mean, I could play this game and my hands are very deformed. I’ve had so many surgeries and therapy to get my hands just to where I could do very basics, open, you know, something to make dinner. But the thought of every time you, again, tying a tie was nowhere in my mind, but especially to hold onto the little golf club with these hands and the eyesight that I was, you know, doctors amazing what they did in getting me some eyesight back to where I could drive and work. And, you know, I don’t have 20/20 vision, but I could see good enough to do these things. And when I started to practice golf again, which was around 2006, I worked at it just as I worked at golf, just as hard as I worked at learning how to walk again, learning how to eat food, learning how to talk through these skip graphs or the pain of these hands.

Jason Schechterle (29m 7s):
And I did get back to playing golf on a regular basis. And I got my handicap back down to a one and there was a time I sat there and I said, you know, your handicap is lower than it was when you had 10 dexterous fingers and perfect eyesight. And again, it’s silly and simple to talk about golf when you’re comparing it to fourth degree burns. But it was so important in my recovery process is so important to tell other people that there’s nothing as powerful as a made up mind. And it doesn’t matter what you’re doing. If you’re doing it for somebody else, like as a doctor, you tried to help somebody as a child. You’re trying to help somebody or personally when you’re alone with your thoughts, which everybody should know, it’s the most dangerous place you’re ever going to be.

Jason Schechterle (29m 54s):
And you’re there all the time. You’re stuck with your thoughts all the time. And that was a big part of me knowing that I was okay, was to get back to just the normalcy and it’d be good. Again, that’s something I used to be good at. I don’t think it changed. I played golf before, I play golf now. nothing is different.

Dr. Anthony Orsini (30m 14s):
That’s amazing coming from someone who’s a 16 handicap and taking it down. And whether I play six times a week or once a month, I’m still a 16 handicap. And maybe I’ll have to come out to Phoenix for a few lessons. Let’s talk about someone in the book. I mean, your wife is incredibly dedicated and the love that she showed and that you have for each other, it goes without saying, but there’s another person in your life that really, to me, exemplifies friendship and comradery between two police officers. And that was Brian Chapman. Tell me about Brian.

Dr. Anthony Orsini (30m 54s):
And there’s a part in the book where I can’t remember his name, but Brian’s boss said to him, after that fateful night, your job is to take care of the family. And I think it was a long time before he actually went back. His, that was his only job. And he took it willingly.

Jason Schechterle (31m 11s):
They took it very serious. You know, he likes to tease me that he went from working 40 hours a week to work at 90 hours a week. But yeah, and again, the human side, just the other day I was teaching at the academy and Brian is now the commander in charge of our academy. So when the recruits see him, it’s that level of respect. And of course, chain of command is big with us, but I had him stand next to me. I said, you know, just like all of you, we sat in those chairs and here’s what Brian went through. And you know, he’s the one who identified me at the hospital through a strange set of circumstances that he happened to intercept the ambulance.

Jason Schechterle (31m 52s):
He took one look at me and he actually said, thank God that’s not Jason. You know, he couldn’t get a hold of me. I wasn’t asking myself to answer the police radio. So he thought it was me, but then he saw me and thanks God that it wasn’t, and that’s pretty powerful. And then when they took me into the hospital room and cut up my uniform, he recognized and identified me through a tattoo on my arm. And you’re right. He was faced. He got no time to mourn his own feelings. He didn’t even have time to worry about me along just like the doctors, he knew I was going to die and he had to go wake my wife up the middle of the night and change her life forever.

Jason Schechterle (32m 32s):
It’s so powerful. And I went through this later, not with people I knew and loved. I looked through it. I did a lot of next to kin notifications as a homicide detective. It’s a powerful feeling to know you’re about to change this person’s life forever. As soon as you utter those words. And he said, he pulled up in front of my house and he actually sat there for about five minutes just to give my wife that extra five minutes of peaceful sleep before he knocked on the door. And, and then he was, he took of her, got her to the hospital, got my parents out of bed, all of our friends down there.

Jason Schechterle (33m 12s):
And then he was right there with me through everything from therapy to just great conversations. Tell me what’s going on on the streets, not talking about my injuries. And again, I’m just Jay, I’m still Jason. We laughed about stuff. We’ve talked about our kids, you know, he’s a husband and a father. He understood. And he’s just right there with me. When I first started traveling and speaking, and I needed that emotional crutch of, you know, I didn’t want to get stared at walking through airports alone or trying to go get food and not being able to read a menu or whatever. And, you know, thankfully I finally, I travel alone now and it, it does give me a lot of strings, but Brian was the one he was always there.

Jason Schechterle (33m 52s):
And all these years later, we’re best friends. And I respect what he’s gone through. Again, everybody has a story, right? Nobody would look at him, but what he went through with me was maybe different. But I would say just as difficult, it wasn’t as what I want, it’s harder to watch somebody you love go through that. I firmly believed that I had the easiest part of this compared to my wife and my children, my parents, and my friends. And so, yeah, I’m glad Brian was highlighted because he’s an outstanding individual. And again, now he’s the commander of the academy in the fifth largest city in the country. He’ll end up being the chief of police in the next five years.

Jason Schechterle (34m 35s):
I mean, he’s awesome.

Dr. Anthony Orsini (34m 36s):
Famous Rabbi Kushner that I talked about in this all the time, you know, he wrote when bad things happen to good people. I saw him at an interview many years ago and he was discussing the difference between curing and healing. And he said, God, doesn’t always cure, but God always heals. And what he said is what God does is God sends you people to help. And it sounds like he sent you these amazing doctors. He sent you a wife who I haven’t met her, but she’s an amazing person. And the love that you guys have and people like Brian, and I’m a true believer that in tragedy, God will, God will send you those people that will help you.

Dr. Anthony Orsini (35m 19s):
And that’s just an amazing story. So Jason, last week we were supposed to do this, but you had a final baseball game. I think now tell us the story you have, how many children now

Jason Schechterle (35m 29s):
I have three children and my daughter. So I had two at the time I had a seven year old daughter and a son who turned three while I was in my coma. And I love talking about my kids because you talk about inspiration and watching people overcome. And firstly, my daughter grew up, she’s finishing her final year of a psychology program at Baylor university doing developmental child psychology. She got married three years ago. I got to walk her down the aisle. She is now six months pregnant. I’m going to be a grandpa. And yeah, now at my age, I’m so glad I started so young. She’s 27 and I’m going to be a young grandpa.

Jason Schechterle (36m 11s):
My son who turned three in a column that he grew up with a tremendous amount of adversity. You know, he had a severe eating disorder. He just a ton of anxiety. It’s a lot to go through at that age, that life change. And it was all the way up until he graduated high school. It was a scary thing. And he went off to college and became a hotel management major. And just a week ago, he moved to Manhattan. And I mean, this kid who couldn’t eat or leave home is now living in New York city, working at a hotel at times square. And I just, he really is my biggest inspiration. I mean, I asked you to reschedule last week cause we had a, again, so much credit to my wife and how she overcame this, but we had another baby 18 months after the accident.

Jason Schechterle (37m 2s):
And it really put into perspective for us while I love my doctors and my firefighters. It was a chance to show not only me, but them. This is why you did what you did. This is an entire life. And when he grows up that he has children. If they have children, now we’re talking about something that goes on and on for generations and he’s growing up to be just an amazing man. He’s getting ready to graduate high school. He’s very good at baseball. And yeah, last Monday was the final home game at his high school. And I knew that I was never going to see him at back uniform again. And I wasn’t about to miss it. You know, thankfully his baseball days, aren’t over, he’s gone on to play college baseball in Charlotte, North Carolina.

Jason Schechterle (37m 44s):
And so it’s a weird time of I’m so emotional these days because I’ve got a daughter pregnant in Texas, I’ve got a son in New York city, I’ve got a son moving to North Carolina and all of a sudden the house is empty and I’m like, wow, that’s snuck up on me really fast, but they’re just beautiful souls. So much compassionate love in these kids. And they’re doing great things. I’m very proud of them and they’ve helped me out a lot.

Dr. Anthony Orsini (38m 10s):
I’m sure that through you they’ve seen what the human spirit can do with people who fight through adversity. And sounds like they’ve learned an awful lot from you, by the way, if anybody was not paying attention, his son was born 18 months after the tragedy. So do the math. I mean, that’s a quick recovery, Jason, at any point during all this pain, cause I know it’s a painful procedure at any point, did you consider giving up?

Jason Schechterle (38m 40s):
There were times that first year, especially, you know, I always say whenever something really big happens to you, maybe like the divorce or catastrophic injury or death in the family, you can always look back at a date and say, well, I was doing this on this date and I want to go back to that. So that first year of 65 days, it’s like a, just a little box that you’re stuck in. And once you’ve passed that first anniversary, then it’s like, you can breathe again. At least that’s how it was for me . And thankfully I didn’t want to commit suicide. I didn’t have any serious mental problems over this. I didn’t have any PTSD because I wasn’t targeted. The guy was having an epileptic seizure. He wasn’t trying to hurt me.

Jason Schechterle (39m 21s):
And I’m very lucky for that. I’m grateful for that. And I recognize that, but there were a lot of times that I just was like, you know what, with this appearance, being blind was so claustrophobic and terrifying the shape of my hand. There were times where I just wanted to sit at home and be left alone. And that was okay, you know? And it was okay for people to leave me alone and give me those few hours or maybe a day or two. And then I’d be like, all right, let’s get back into it. Let’s get back to therapy and fight. So I didn’t necessarily want to give up, but there were times when I needed a break for sure. And again, I always tell people this and it’s hard, but it’s okay to not be okay. And it is more than ok to be vulnerable, even though we don’t want to talk about it.

Jason Schechterle (40m 5s):
We don’t most say when we are, but it really is a beautiful place to be because you just build so much strength and you see so much beauty inside of them. And so that helped me a lot even to this day, you know, again, I’m very emotional this week. I have one son moved to New York once I finished high school baseball and I I’ve shed more tears in the past seven days than in the past seven years combined and I still smile when I’m crying because I’m like, you know what? It’s so great to be alive. This range of emotions. And there’s a lot more coming. I know I’m going to go through a lot more in life and I’m appreciative for what I have gone through that.

Jason Schechterle (40m 45s):
I’m where I am and I am smiling. I’m happy. I know I’m going to be okay.

Dr. Anthony Orsini (40m 50s):
And the final part of the book is not only did you do amazing things to help yourself. You are a great role model for your kids and everyone out there who is fighting adversity, but you ended up helping and probably saving the lives of many other police officers because of the Ford motor company. And as I read the book, I’m telling you, you got to read this book. I’m not just blowing smoke up your, you know what, but actually this book could be a movie, Jason. I mean, this is a great book because you know, lawyers as part of a class action, right? Go after the part of the crown Victoria was having problems for years, right?

Jason Schechterle (41m 28s):
A lot of years. And this also helped me not only give me some purpose in life, but again, the added, just keep piling on the gratitude and the perspective so many police officers have died in these fuel fed fires, countless civilians that don’t get discussed on TV. Like my story did. And I’m the one who gets a firetruck at the intersection. So how dare I, no, I’m not going to question God as to why. And I’m certainly not going to be angry at him, but I do think that all of these other individuals deserve the same opportunity to go home to their families and they didn’t get that. I got the firetruck at my intersection.

Jason Schechterle (42m 9s):
So I was darn sure to fight and be a face. It’s easy to talk about people when they die. Right? Cause they’re gone. And well, when you look at my face and you hear my voice, I get to put up a fight. And so you have the advocacy to get these cars to be made safer and then finally quit making them in 2011. And now you do not hear about these accidents. And a lot of lives have been saved through a lot of people worked on this. I mean, so many people fought this fight and I’m very proud of that.

Dr. Anthony Orsini (42m 43s):
You saved numerous lives. You could have easily just said, listen, I’ve been through enough. I don’t want to go through this. Cause you got to give depositions, but you want it to make sure that your fellow police officers or really anyone driving these cars. And so now they’re gone and partly that’s because of you and the other people that were involved in the lawsuit. So that’s amazing. Jason, I usually finish each podcast with a question. This one’s going to be a hard one for you. So maybe not because it’s called difficult conversations out of all the difficult conversations that you had, what do you think was the toughest one? And give us some advice on how to navigate that.

Jason Schechterle (43m 26s):
Yeah. As you could imagine, that old saying you don’t know what goes on behind closed doors is very true. And to say that my wife and I had a lot of tough conversations or you asked just a few minutes ago, I felt like giving up. And I remember during one of my, what I call a quiet periods, my wife, I mean, she, she was yelling and screaming at me. I wouldn’t be surprised that she broke a couple of things in the house. And she told me if you think I’ve gone through what I’ve gone through so that you could give up. Now you’re crazy. That’s not what we’re doing here. And, and then my, you know, my desire to go back to work against the advice. I mean, I even talked to Crusoe who died, I called him and said, I need you to write me a prescription for a Bulletproof vest.

Jason Schechterle (44m 8s):
I don’t know if you know this, but if you get injured, if your vest gets ruined in the line of duty, you get to replace it. Those vests are expensive. They’re like 700-800 bucks. And when I called him and he said, what are you talking about? So I’m going back to work. He goes, no, you’re not at that. I said, yes, I can. I know. So I really don’t know what the, the toughest one is because there are so many surrounding, what’s the best thing to do for our kids at this young age as their minds and their emotions, time to develop. What’s the best thing to do. I mean, marriage is difficult, but you throw in some life changing adversity it gets really difficult.

Jason Schechterle (44m 49s):
You know, we had our fair share of fights and disagreements of discussions, conversations just with doctors. Yeah. I don’t know. I wish I could answer it. No, I mean, i’ve had so many, it’s not a fair question, But so, so many, but the beauty is I remember the good ones. I remember the positive ones and the ones that were life changing for the better. And let me answer the question though, with this, because I want to give my wife all the credit she can get, I want her to get credit for this. My wife was the one, no matter what my parents or family was were saying, and of course everybody’s got their opinion, right?

Jason Schechterle (45m 30s):
Everybody’s an expert, all of a sudden and thinks they know and families, when you go through something like this, you either get closer or you get torn apart. But your spouse is the one who is stuck with the final decision that when a doctor asks a question or says, here’s what I want to do. She has to sign the paperwork. And these fourth degree burns. I needed something to attach my skin graphs to. And it’s called integra. Well, nobody had ever had their entire head wrapped in integra. These doctors did not know if it would work. And it was put squarely on the shoulders of my wife. Do you want to try it or not? And the doctors were very honest and just said, we’ll do it if you want.

Jason Schechterle (46m 15s):
We won’t do it if you don’t want. And she made the decision to say yes, and it saved my life and I get it. So I give her a lot of credit. Cause I can’t even imagine what that conversation would have been. I Can’t even imagine.

Dr. Anthony Orsini (46m 29s):
Yeah. And she’s a God certainly sent her to you as Rabbi Kushner would say. Jason, I want to talk about what you’re doing now, moving forward. But before I say that, if you want it to just tell us the audience, one piece of advice, and I know you do this during your speaking, what would it be?

Jason Schechterle (46m 46s):
Don’t let the pain of today deprive you of the promise of tomorrow. You know, we’re going to experience so much in this life and it’s short. It’s precious. But if we get to continue living, if you get to wake up every day, you find something to be grateful for and to learn from what you’ve got to adjust to do not give up on anything. Don’t forget. You’re only going to experience the sadness and the pain and the anger and all these bad things that we don’t like. You’re only going to experience that if you’re lucky enough to live a nice long life, don’t give up on it. Don’t give up on the promise of tomorrow, because it will come time does heal. I mean, I know you know that as a doctor, but it’s true.

Jason Schechterle (47m 28s):
It does get better. Don’t give up.

Dr. Anthony Orsini (47m 31s):
And nobody symbolizes that more than you. You retired from the police department and now speaking, and where are you speaking? How can people get in touch with you to ask you to present? I heard your Ted talk and it’s amazing. So I know you’re pretty good at it. Maybe not as good as golf, but you’re a pretty good speakers.

Jason Schechterle (47m 51s):
Talks are a good thing because they’re short and only 12 minutes long. My normal presentation is a little over an hour and I have 37 slides and a PowerPoint that I, you know, I just speak from the heart. I love doing it. I, up until COVID hit, I was doing about 75 a year, all over the country from wow, for everything from organ and tissue organizations to law enforcement, hospitals, real estate, accounting firms, you name it. And I just love to go out and share my story and to connect with other people. And you know, I always tell people my former career and my injuries are the two least important parts of this story.

Jason Schechterle (48m 34s):
This is just about life. And we’ve all got a story and we’ve all got things that we need to overcome. And I mean, it’s so easy to get ahold of him because of my crazy last night. And the book is burning shield my website is Burningshield.com. Jason@Burningshield.com. I’m the only one who checks my emails on the only one who scheduled my speaking. I don’t have any, you know, assistant. You can see I’m sitting in my living room right now. I don’t have an office. I don’t have anything like that, but it’s something that I love to do. And I hope to do it or many years to come

Dr. Anthony Orsini (49m 5s):
In the show notes, I’ll put all your contact information. I really recommend that anybody out there is looking for an inspirational speaker call you. This has been amazing. Jason, I am going to be giving a workshop and a lecture in Phoenix in November. It’s a four-day conference. I’m going to be speaking the day one and day four. So if you don’t mind giving me 16 strokes, maybe we can play 15 probably by now at 18 handicap. Hopefully you’re one of those tolerant, good golfers that don’t care.

Dr. Anthony Orsini (49m 45s):
If I’m shanking it all over the place

Jason Schechterle (49m 48s):
November, you know, it’s not a hundred degrees and we have some pretty good golf courses here. So I’d love to treat you and spend time with you and come to the conference.

Dr. Anthony Orsini (49m 56s):
That’ll be fantastic. I can’t wait. I’ll send you all those dates and maybe you can do something with my game to get me down to a 14. I have no idea, but I’ve had so many lessons or they keep telling me every time I take a lesson, they say, stop trying to kill the damn ball and hit it like a baseball. And I go, yes. And then I try to kill it. So it’s in my head. So, but anyway, Jason, thank you so much. This is always a lot of fun seeing you in November and we’ll be in touch real soon. Thanks again.

Jason Schechterle (50m 25s):
Thank you so much.

Dr. Anthony Orsini (50m 26s):
If you enjoyed this podcast, please go ahead and hit subscribe or follow as it is on apple. Now, if you want to get in touch with me, you can reach me. theorsiniway.com again. Thank you Jason, and I will be in touch soon.

Jason Schechterle (50m 41s):
Sounds good. Thank you, sir.

Announcer (50m 42s):
aIf you enjoy this podcast, please hit the subscribe button and leave a comment and review. To contact Dr. Orsini and his team, or to suggest guests for future podcast visit us @theorsiniway.com.

Medical Justice and Malpractice

Dr. Jeffrey Segal (1s):
nnAMeaning that if you practice medicine, you will likely be in the crosshair at some point. It is impossible to see 1 to 3000 patients a year and not have conflict at some point. In particular, something that manifests itself as professional liability, the stats are pretty clear. And this is, I guess this is somewhat sobering. This is a study that was put out in the new England journal of medicine about a decade ago. But it said that if you are a high risk surgeon, which means any surgeon, the likelihood of you going to age 65 and never being sued is less than 1%, less than 1%.

Dr. Jeffrey Segal (41s):
If you are a low risk individual, for example, a pediatrician, for example, or an intern, it’s those who have long relationships with patient, the likelihood of you going an entire career without being sued is still about 25, 30%.

Announcer (59s):
Welcome to Difficult Conversations: Lessons I learned as an ICU physician with Dr. Anthony Orsini. Dr. Orsini is a practicing physician and President and CEO of the Orsini Way. As a frequent keynote speaker and author, Dr. Orsini has been training healthcare professionals and business leaders how to navigate through the most difficult dialogues. Each week you will hear inspiring interviews with experts in their field who tell their story and provide practical advice on how to effectively communicate. Whether you are a doctor faced with giving a patient bad news, a business leader who wants to get the most out of his or her team members or someone who just wants to learn to communicate better, this is the podcast for you.

Dr. Anthony Orsini (1m 44s):
I am honored today that The Orsini Way has partnered with the Finley Project to bring you this episode of Difficult Conversations: Lessons I learned as an ICU Physician. The Finley Project is a nonprofit organization committed to providing care for mothers who have experienced the unimaginable, the loss of an infant. It was created by their founder, Noelle Moore, whose sweet daughter Finley died in 2013. It was at that time that Noelle realized that there was a large gap between leaving the hospital without your baby and the time when you get home. That led her to start the Finley Project. That Finley project is the nation’s only seven part holistic program that helps mothers after infant loss, by supporting them physically and emotionally. They provide such things as mental health counseling, funeral arrangements, support, grocery gift cards, professional house cleaning, professional massage therapy and support group placement.

Dr. Anthony Orsini (2m 38s):
The Finley Project has helped hundreds of women across the country. And I can tell you that I have seen personally how the Finley Project has literally saved the lives of mothers who lost their infant. If you’re interested in learning more or referring a family or donating to this amazing cause please go to the Finley Project.org. The Finley Project believes that no family walk out of a hospital without support. Well, welcome to another episode of difficult conversations lessons I learned as an ICU physician. This is Dr. Anthony Orsini, and I’ll be your host again this week. Today, my guest is Dr. Jeffrey Segal, who is the chief executive officer and founder of medical justice. Dr. Segal was a practicing neurosurgeon for approximately 10 years.

Dr. Anthony Orsini (3m 21s):
During which time he also played an active role as a participant on various state sanctioned medical review panels, designed to decrease the incidence of meritless medical malpractice cases. He holds an MD degree from Baylor college of medicine, where he also completed a neuro surgical residency. Dr. Segal served as a spinal surgery fellow at the university of south Florida medical school. He is a member of Phi beta Kappa, as well as the AOA medical honor society. He received his BA from the university of Texas and graduated with a law degree from Concord law school with highest honors. In the process of conceiving funding, developing and growing Medical Justice Dr.

Dr. Anthony Orsini (4m 1s):
Segal has established himself as one of the country’s leading authorities on medical malpractice issues and internet based assaults on reputation. And I am really delighted to have him here today because this is going to be perfect for my audience. Jeff, thank you so much for taking the time out of your, what must be an incredibly busy schedule to be on this.

Dr. Jeffrey Segal (4m 22s):
I’m really excited to speak with you today. Thanks for the invitation.

Dr. Anthony Orsini (4m 26s):
Jeff and I got to know each other. You heard a podcast that I had done with Dr. Bradley Block. I believe you interviewed me for your podcast. We’ve gotten to know each other multiple times, and there’s so much parallels between what you do and your medical malpractice.

Dr. Jeffrey Segal (4m 42s):
You’re my long lost brother that took a while to meet.

Dr. Anthony Orsini (4m 45s):
Yeah. And I’m excited because I feel like there’s just loads of stuff that we can do together. I think this is going to be a long relationship. When I got to know you, Jeff And I think when people hear your intro and your bio, I think the first thing that everybody thinks is, oh my God, he went to school for a lot of years as a neonatologist. I, you know, I did four years of medical school. Then I did a rotating internship and that I did three years of residency, three years of fellowship. So that was seven years after medical school, 11 after college, you did neurosurgery and then went back to, to your law degree. So I know everybody’s thinking, I want to get to know this guy. So tell us about Jeff or you know, where you’re from and how you’ve arrived at this moment in your life.

Dr. Jeffrey Segal (5m 30s):
So I studied and trained to be a neurosurgeon. Yes, it was a long and winding road. How and why did I get into neurosurgery? And the answer is, I don’t know, but I think this probably had an impact many years ago, my younger brother, two years, junior to me, he walked into a convenience store in Austin, Texas, where he was going to college. Unbeknownst to him, it was being robbed. So he was marched into the back, placed faced down and shot execution style in the back of the head. Now, by the way, this has a happier ending, but he was left in the freezer to die. His girlfriend walked in there several minutes later, cause he had just walked in there to pay for $2 worth of gas and found him, appropriately freaked out called an ambulance.

Dr. Jeffrey Segal (6m 13s):
Now what happened next? The neurosurgeon came in, said he won’t make it through the night. He made it through the night. Then he said, well, if we operate on him, he’ll never wake up. he operated on him and he woke up. He says, well, he’ll never walk or talk again. He walked and talked. He does have deficit, but he was able to go back to college, graduate with honors and actually married his high school sweetheart. We attended his daughter’s wedding a couple of years ago. And here’s what he said. He said, thanks for, and there wasn’t a dry eye in the house, thanks so much for doing this wedding on this particular weekend, because for decades it was the anniversary of him being injured, almost fatally.

Dr. Jeffrey Segal (6m 59s):
And his daughter got married on that weekend. And so he said, that’s been replaced and I was crying like a baby man. I was dehydrated. I needed IV hydration just to not become hypotensive. But anyway, that almost certainly, I mean, he does have some deficits, but he went back and became a social worker, works at the country’s largest or probably busiest head injury unit at a county hospital. He’s a motivational speaker is really my hero in many ways and was very influential in me, at least thinking about neurosurgery as a career, which I then did. And to your point, like you, it is the road that never seems to end every time you turned around, there’s more stuff to learn and do.

Dr. Jeffrey Segal (7m 44s):
But finally I embarked upon a clinical career was doing that for 10 years and then got like many people. I got a hiccup in life where my son was diagnosed with pretty severe autism at the age of three and a medication resistant epilepsy. So what happened? We moved to North Carolina primarily to get services for him. I intended to take a year off to focus on him and then go back to doing what I knew how to do, which is practicing neurosurgery. In, in that one year window, I became convinced that a certain set of pharmaceutical compounds might help him. And they were sitting on a shelf at university of North Carolina and Purdue.

Dr. Jeffrey Segal (8m 27s):
So I naively asked what it would take to kind of move this along because I did think it would help him. They said, well, you got to raise some money. You got a license the compounds, you know, have a nice day. So I raised the money, we licensed the compounds and started a biotechnology company and research triangle park, North Carolina moved these compounds along from preclinical to phase two, before it was sold to a medical device company.

Dr. Anthony Orsini (8m 52s):
So by the way, you make that sound like it was so easy. Like we did that. That had to be incredibly hard, especially for someone who has no idea what they’re doing at the time.

Dr. Jeffrey Segal (8m 58s):
To burst my naivete propelled us forward. If I had known what I was getting into, neither I nor any other rational human being would have moved in that direction. So the key thing was just finding a bunch of people smarter than me and to, you know, the compounds were pretty good and that really helped. And we didn’t need thousands of patients to prove the point. That’s the beauty of having fairly powerful compounds with decent safety profiles, good safety profile, good clinical outcome profile. If you have that, you don’t need 10,000 patients to get a P you know, less than 0.05% is to demonstrate something on paper.

Dr. Jeffrey Segal (9m 39s):
But anyway, that didn’t happen overnight. It took a while. And after X number of years, I had a choice to make, do I go back to doing what I knew how to do, which was clinical practice of neurosurgery or something else. Now it had been five years since I’ve stepped foot in the operating room. And while I’m arrogant enough to believe that I could do it, I doubt I could persuade any rational human being to go under my knife. So I figured it was time to make a lateral move. And I started Medical Justice at that time. And I’ve been doing Medical Justice since then. Medical Justice was formed to keep doctors from being sued for frivolous reasons.

Dr. Jeffrey Segal (10m 20s):
More broadly now works to deescalate doctor, patient conflict, or really any conflict that a doctor might face, including the board of medicine, including employer, employee relationships, and so on. And we also now get involved with protecting and preserving a doctor’s reputation on the internet. And that is the whirlwind tour that takes us to present day and how we met actually.

Dr. Anthony Orsini (10m 46s):
That’s quite a story, the story of your brother. I think I need to get him on the podcast now. So what a great story he is,

Dr. Jeffrey Segal (10m 53s):
Man, he’s really a cool, I mean, I call him a kid. He’s not a kid any longer. I mean, he was injured decades ago, but the story never ceasesbare-bones us to inspire. And you know, if anybody could pick himself up from the bootstraps, I mean, after you hear what he went through and you know, I certainly fast-forwarded, it really took a while for him to just get back to just the bare bones basics. But he remembered when he was starting to make progress when he woke up in a rehab unit and he didn’t know what happened to him obviously. And he saw Rocky and Bullwinkle on television. If you remember that show?

Dr. Anthony Orsini (11m 31s):
Yes, I’m afraid I’m old enough to remember that.

Dr. Jeffrey Segal (11m 35s):
You know, the weird connecting of the dots, he thought he was in Russia. Somehow he gets a Boris Baton up. So I think that was when he started to wake up and realize he had a long road in front of him.

Dr. Anthony Orsini (11m 49s):
So many things that happen to us or to our family members shape who we are. And I had epilepsy as a child and thankfully I outgrew it, but we’ve had other people on this podcast. Marcus Engel was an early guest. Marcus Engel had went blind in a car crash and was spent a year in hospital. I don’t remember the number of surgeries he had, but he went blind instantly. And now Marcus Engel speaks about patient experience and is all lecture and a motivational speaker. Next week, I’ll be interviewing a gentleman called Jason Schechterle, who is a Phoenix police officer who got into a car accident, burned 40% of his body. And now he’s come through that. And they all give us a unique perspective on what it’s like to turn tragedy into triumph, but also give us a unique view of what it’s like to be a patient, which is so near and dear to my heart.

Dr. Anthony Orsini (12m 40s):
And they are experts in telling you what it was about a particular physician or nurse that they remembered in a fond way. And one that doesn’t. So, but that leads us to communication and malpractice. But first of all, your typical medical justice client, who would they be? And is there a particular part that’s kind of doctor that’s been contacting you more and more?

Dr. Jeffrey Segal (13m 2s):
The typical doctor is a doctor, meaning that if you practice medicine, you will likely be in the crosshairs at some point. It is impossible to see 1 to 3000 patients a year and not have conflict at some point. In particular, something that manifests itself as professional liability, the stats are pretty clear. And this is, I guess this is somewhat sobering. This is a study that was put out in the new England journal of medicine about a decade ago. But it said that if you are a high risk surgeon, which means any surgeon, the likelihood of you going to age 65 and never being sued is less than 1%.

Dr. Jeffrey Segal (13m 43s):
I believe that less than 1%, if you are a low risk individual, for example, a pediatrician, for example, or an intern, it’s those who have long relationships with patients, the likelihood of you going an entire career without being sued is still about 25, 30%. I mean, still a big number. Now the good news is you’ll prevail in most of those cases. But the bad news is that getting sucked into the process is onerous, painful, capricious and arbitrary. And you will feel as if you’re alone. And so the question ultimately comes down to how do I avoid this? How can I minimize the risk of being sued in the first place?

Dr. Jeffrey Segal (14m 26s):
And number two, if I am sued or get involved in conflict, how do I turn this around sooner rather than later?

Dr. Anthony Orsini (14m 36s):
And you know, I, in my book, I talk about my family doctor. And I don’t know if I’ve sent you a copy yet, but if I have it, I’ll have to get your address and send you a copy. But may I have your book in my book?

Dr. Jeffrey Segal (14m 50s):
I’ve read it and highlighted it. And people are listening out there, have not yet done that. What are you waiting for?

Dr. Anthony Orsini (14m 58s):
Thank you so much for that plug. “It’s all in the delivery” available on Amazon. In that book, I speak about my family doctor, who must be in that 20 to 25%, although he was not only a family doctor, he was an obstetrician in those days. He was so old his obstetric residency was only one year. That’s how long It was.

Dr. Jeffrey Segal (15m 14s):
He did it all. I mean, he probably did appendectomies at some point.

Dr. Anthony Orsini (15m 22s):
Almost 50 years of practice, not one malpractice lawsuit. And I learned by watching him and I think maybe that’s what shapes us. I watched him, he, me, he delivered me. And then I did my first rotation with him as an elective in a medical school. That’s how long he practiced. But I watched him with patients and I watched the way he looked into patient’s eyes and the way he smiled. And I tell everyone he was a good doctor. He wasn’t the greatest doctor in the world. You know, it was an average doctor and he made mistakes, but patients wouldn’t think about suing him. You know, Jeff, he was in the Italian section of Newark and I would say at least three out of four of his patients would bring him food.

Dr. Anthony Orsini (16m 3s):
They wouldn’t think of coming without food.

Dr. Jeffrey Segal (16m 4s):
And it’s interesting so he delivered you, but that’s not the meaning of “it’s all in the delivery”. You get a nice double entendre there.

Dr. Anthony Orsini (16m 15s):
It’s all in the delivery comes from a quote from WC Fields, the comedian who was asked once, why his jokes were so funny and his remark was it’s all in the delivery. And that’s exactly what that book’s about. Let’s talk about communication. How a doctor, you said you really helped them limit their risk of getting sued. How much does communication play in that? And how much can you help somebody who maybe doesn’t have the best bedside manner?

Dr. Jeffrey Segal (16m 42s):
So here’s, what’s fascinating. When I went into this, I had assumed that I’m not even sure what I assumed. I just assumed litigation was rampant and all sorts of things that were arbitrary and capricious just made this into a lottery and there may be some truth to that. But more often than not and don’t take my word from this. You can talk to plaintiff attorneys that deliver this message. They said, typically not always, but typically a patient will sue when they believe they’ve not been heard. A patient will sue when they believe they’ve not been heard, they’re looking for answers and a few up here, evasive or non-communicative and they’ve exhausted the traditional remedies to getting an answer.

Dr. Jeffrey Segal (17m 32s):
Their next step is well, they will pile on means they go to the internet to a voice their displeasure. They will yell at the front office staff and your employees. They will go to the medical board or they will go to an attorney to, to go through discovery, to find out the answers. So what does that mean? It means that if you make yourself available and you answer questions, preemptively in advance of the patient or their family asking the question you have already done so much to limit the likelihood of you being sued. Again, this is not the magic. This will work a hundred percent of the time, but it’s a game of odds.

Dr. Jeffrey Segal (18m 15s):
If you anticipate a patient’s questions and they believe, or their family’s questions may believe you have nothing to hide and that you are being open and transparent. You have already decreased the likelihood that you individually will be sued. That’s a home run already. Number two is that. And I think this is a point that you’ve driven home multiple times patients tend not to sue people they like. Patients not to say people they like it doesn’t mean they won’t because at the end of the day, if you’ve got a life care plan of $10 million and you’re destitute and you need the cash just to keep your room at the rehab facility, you’ll do what you have to do.

Dr. Jeffrey Segal (18m 55s):
By and large It will be a lot harder to do that. It won’t be as easy to do that. And not infrequently. There are multiple defendants on the chart. They don’t have to sue everyone. And so if a patient likes you and has a relationship with you, it may be that they sue everyone else and leave you alone. So those are the two things being open, honest, and transparent with a patient. And what was the second point that just, I went blank, right? Well, the

Dr. Anthony Orsini (19m 26s):
First point was a drop the mic point because I think that’s the most important thing that you said. Yeah. That light like you. And it really is. And the patients sue because they want answers. And I have an example of a friend of mine who went to a neurosurgeon and he did an Arnold Chiari malformation surgery on her. She had a lot of post-op complications and just kept going back to him saying I’m still in a lot of pain. I’m still in a lot of pain. She had no thoughts about suing or anything. And then one day he came into the office and he said, do not come back. The surgery is done. I don’t want you back in my office anymore. I’ll refer to you to a pain doctor.

Dr. Anthony Orsini (20m 7s):
Now it’s all in the delivery, right? Jeff. He could have said, listen, we’ll call her Jane. I’ve done everything I can for you. I wish I could help you more. But I’m going to give you to a pain doctor who I think could really help you a lot more. But his abruptness of do not come back to my office. You know, when she did, she filed the lawsuit because she was mad.

Dr. Jeffrey Segal (20m 27s):
What’s fascinating is she probably didn’t even have a case against him so what if you win, nobody wins. You just lose less. You just lose les. And I think the script you described would have been great. It could have been, look, you’ve been here several times. If I had a tool to fix you, I would do it. I want you to get better. You’re obviously not getting better. Let me tell you what I think would be a good next step. Dr. Pain doctor is the best of the best. He has helped people in situations, worse than you as to whether he can solve this problem. I don’t know, but I think it’s a great shot. Let me see if I can get you in as soon as possible.

Dr. Jeffrey Segal (21m 6s):
He’s booked four months out, but I’ll see if I can work some magic and get you in sooner. What do you think? I mean, it’s the same statement. You’re just saying it differently.

Dr. Anthony Orsini (21m 15s):
It’s all in the delivery. It drives me crazy when I teach doctors and I do the communication workshops. I’m like, it’s really not that hard. Just think before you speak and let’s say, how can I say this? That’s one of the things I teach before you open your mouth and say, how can I say this? And sooner or later, it’ll get easier for you. But what you just said right there, she would have left that office goin, he’s a great guy. And he really wanted to help me, but he couldn’t. And wasn’t that great that he got me into this really busy pain doctor a month earlier, you know?

Dr. Jeffrey Segal (21m 46s):
And let’s, let’s acknowledge the obvious here. Every doctor, a hundred percent of doctors in the country right now have a list of patients that they wish would never come back to their office every day. Now it’s just an occupational hazard. You practice long enough. There’ll be some people who rub you either. You can’t fix them. And it makes you feel a little less adequate than you’d like to feel with our delicate egos or they’re just, they, these people have no interpersonal skills or they’re angry, but every practice has them. And the worst thing that could happen is if your office staff books them back to back for an entire day, you know, and that’s all you have.

Dr. Jeffrey Segal (22m 27s):
You know, at that point, you just want to get rid of your staff. But because we all have them, the question is, how do we manage them? There are times that you must cut the cord and terminate a doctor patient relationship. But if you have to do that, do it in a way that minimizes the damage to you. I mean, if you just tell someone don’t ever call me again and you’ve not formally terminated them, they can file a complaint with the board of medicine saying you abruptly got rid of this patient without giving them 30 days notice without giving them an option to abandon your patient. Now you need to respond to us. So whatever 20 minute interval you had to spend with this patient before, you’re not going to have to spend hours.

Dr. Jeffrey Segal (23m 10s):
If not days, dealing with a board of medicine. Now, your license is at risk. It’s an unforced error.

Dr. Anthony Orsini (23m 16s):
And then as you mentioned before, about the internet, you know, it’s kind of like breaking up with a long time boyfriend or girlfriend. If you’re nice about it, there’ll be some tears. And that if you’re a real jerk about it, they’re going to go on the internet and say, boy, Tony, don’t date him. He’s a real jerk. So it’s really not much different. Is it going to start off?

Dr. Jeffrey Segal (23m 34s):
It’s not you it’s me. It’s not, you have deficient individual.

Dr. Anthony Orsini (23m 42s):
But things go wrong. And sometimes there are real medical errors. So your first chance of not getting sued for malpractice is to know how to communicate, be nice and all those other drop the mic, things that you told us to do. The second chance is now there’s a medical error and I’m a firm believer in how you reveal that medical error makes another, this is another big chance to mitigate this. And I truly believe that hospitals and some doctors do this all wrong. So give us some advice about that. And what are your beliefs about that?

Dr. Jeffrey Segal (24m 15s):
I follow the advice of Doug Wojcieszak, whose name is hard to spell and it’s even harder to pronounce, but he wrote this book called, “sorry, works”, sorry, works short book. You can read it in moments. And the principles are pretty straightforward. And he came up with his principles when his family member was on the receiving end of a bad experience at a large academic center, medical error just wasn’t handled well. It was denying, defend, deny, and defend. And he said, look, I’ll want to do is get this made right. Principles are as follows. One is as soon as you realize there’s an error, go see the patient or their family and say, you’re sorry, you’re not saying I’m liable.

Dr. Jeffrey Segal (24m 58s):
You’re just saying, you’re sorry, what does that mean? It means you’re a human and you understand that they do not like this outcome. You understand they don’t like this outcome. They’re a human. And you’re a human. You’d be surprised how powerful those two words are in the English language early in my marriage. I wish I had learned that concept. It would have saved me hours of additional issues because I remember one time saying, Hey, I’m sorry. Just okay. All better now. And I go, that’s it. That’s all I had to say, why did’t you tell me that before?

Dr. Anthony Orsini (25m 29s):
I have a friend that I have in front of interviewed him very early on for this podcast, he’s an expert in workplace violence, FBI guy, and all that. And he said, jokingly, I wake up every morning. And I say to my wife, I’m sorry for everything I might do for the rest of the day.

Dr. Jeffrey Segal (25m 45s):
Let’s get it over with. Yeah. So the pediatrician yesterday, my wife was commenting as on blah, blah, blah, Jeff. And the pediatrician just interrupts. It says, say no more, say no more. I’m already. I already got it. He’s guilty. All right. So back to the medical error, say, you’re sorry, then number two, say you’re going to do a root cause analysis to identify what happened, what went wrong. Now it won’t fix the problem for that individual, but most people want to know that that whatever happened to them didn’t happen in vain that there’ll be lessons learned. It’s somewhat counterintuitive because when you’re on the receiving end of a problem, you would expect that you’re the only focus, but the one they want answers and you don’t have to quickly give the answer.

Dr. Jeffrey Segal (26m 30s):
You need to say, Hey, look, I’m going to look into this to identify what happened. I will report back to you within, you know, X number of hours or days in the meantime, here’s my mobile number. So you can call me with any interim questions, but I will continue and to take ownership of this. And we will communicate again, if you have questions in between, you can just call me anytime I’ll work around your schedule. So that’s number two. Then number three is to identify a plan to make it right. If you can, if there are additional surgeries to be had or additional fixes related to what was unanticipated, just define what that course looks like.

Dr. Jeffrey Segal (27m 15s):
Most people can suck it up. You know, most people just want to know that this isn’t the end, that there’s a potential plan. And that plan may be, I can’t take care of you. I need to transfer you to a different facility that has the core expertise to fix your problem. You know? And so, as an example, you may be in a rural hospital having done a gallbladder and you just bag the common bile duck, right at the, or, or the hepatic ductk, right? As it’s coming out of the liver, many rural hospitals do not have the ability to handle that. Some do, but many do not. So if you’re going to send that patient to an academic center, just explain, I’m taking ownership, I’m going to find the right person.

Dr. Jeffrey Segal (27m 56s):
I’m going to keep you posted. And I’m going to follow up with you while you’re there. I will try and get information. So, you know, there’s a nice smooth hand off, and then finally, there may be things you can do to ease the discomfort. And this is a great example. We got a call from a plastic surgeon. Patient had not woken up yet. The intended procedure was a liposuction, but the patient ended up having an abdominoplasty or a tummy tuck, bigger procedure. The patient expected to be out of work for just a handful of days, but with the abdominoplasty much bigger procedure going to be out of work for a longer period of time.

Dr. Jeffrey Segal (28m 36s):
So he says, I don’t know what to do. And then she said, but she looks great and said, well, yeah, sure she does. But you did the wrong procedure. I don’t know what to do. So follow the script. As soon as the patient woke up, apologized said he was sorry, explained what happened or said he would look into it. So it wouldn’t happen again. And there were lessons learned there. And then he was able to identify that because the patient would be at home, recovering, not able to drive. Somebody needed to get Jr to school, need to get groceries in the refrigerator, he took care of that. He basically took care of that. And I said, I’ll make sure your child has a ride. I don’t know how he did it, but he did.

Dr. Jeffrey Segal (29m 16s):
And then he said, I’ll make sure you have food in the refrigerator or meals come into your house. And then he just refund her money. No relief, no questions asked. It’s refunded her money. Now that conversation was not an easy conversation. You said he did not like having it. And she did not like hearing it. But a couple of weeks later, when she came back to the office for a follow-up visit, she started to warm up and he said, six months later, she was his greatest referral source. His greatest referral source. So think about that. He did the wrong procedure on her, but she became his greatest referral source. Not so much because of how she looked.

Dr. Jeffrey Segal (29m 56s):
It’s what he did afterwards. That sealed the deal. So it’s possible,

Dr. Anthony Orsini (30m 2s):
As you said, patients understand that doctors are human beings and it’s impossible to be a perfect human being and mistakes that will happen. But as long as they know that, you’re sorry that you care that you’re not lying to them and not keeping anything from them. You know, not always, but a lot of times they will end up forgiving you and you’re not doing it. I don’t want the audience to think, you know, we’re just faking all this. So we don’t get sued. I mean, it’s just the right thing to do. Right? What your mother taught you is to say, you’re sorry. And that’s, I don’t know how we’ve gotten away from it.

Dr. Jeffrey Segal (30m 36s):
Just create them the way you want to be treated. You’ll find that once you put that in your head, it gets easier to do. Yes, of course you don’t. If it looks scripted or if it sounds inauthentic, it will be perceived as inauthentic and could potentially make it worse. But I think if you are just you and you are treating the patient as if you are a family member, I’d want to be treated by being open, honest, and transparent. And yeah. I mean, sometimes honesty could be equivalent to stating your liable. Okay. But what you’ll find is that honesty sometimes gives you a get out of jail free card. I really don’t know why some attorneys advise, don’t say anything.

Dr. Jeffrey Segal (31m 20s):
Don’t talk, do nothing, nature, abhors, a vacuum. And it gets filled in a patient’s brain. You’re going to be tagged with the worst possible news. Why not just fess up and just very gently, just give a narrative of what it is. Look, there are doctors who said, I don’t know how to tell you this, but we left a sponge in your body. We left some scissors in your body, left a drain tip in your body. These are all never events. Nobody wants to deliver that news. You won’t be the first surgeon in the country to have delivered that news. You won’t be the first doctor to say operated on the wrong level. I operated on the wrong side, but the sooner you rip that bandaid off, the better everybody’s going to feel.

Dr. Jeffrey Segal (32m 5s):
I can tell you that hiding that, or at least trying to explain it away so that you look like the hero will generally backfire. And that will be the invitation to, well, you will have won your audition to be a defendant.

Dr. Anthony Orsini (32m 21s):
Why do you think? Cause it drives me crazy. Why do you think that is medical error happens at a hospital? The doctor has to reveal that medical error and he turns around or she turns around and there we have risk management, the hospital attorney. And in some cases, even the CEO that are walking into the room. To me, that’s the worst possible thing you can do because that becomes disingenuous already. You like, I’m coming in to tell you about this medical error, but I got my boys and girls behind me to back me up too. You know, they don’t have a lawyer or an attorney representing them. Why do you think we’re not getting that? And why do you think that keeps happening?

Dr. Jeffrey Segal (32m 59s):
I think it’s just legacy. That’s the way it’s always been that denying, defend, deny, and defend. I think it gets perceived as a pylon. If you’ve got five people walking into a room for what is otherwise, it should be an intimate conversation between two people, maybe three people. I think it’s a formula for being perceived as a negative experience. You’ve got an opportunity to deliver rotton news. But on your terms, you can deliver rotten news on your terms doesn’t mean that it’s going to be received as such, but if you appear to be authentic, open, honest, transparent, most humans will accept that olive branch, not all, but most

Dr. Anthony Orsini (33m 44s):
The worst thing you can do, I believe in revealing medical errors. But you know, my father used to tell me, you have to buy tools before you need them, because once you need them, it’s too late. And so, you know, my father was a police officer, but before that he was a mechanic. And I remember I bought my first home and my father bought this massive toolbox for me. I didn’t know how to use half of this stuff, but he said, you know, you might not think you need this size screwdriver, but one day something’s gonna happen to your house. You’re going to need it. And it reminds me of what we’re trying to tell doctors. So you don’t think that you’re going to have to reveal a medical error in your coming out of medical school. And so when you have to, you don’t have the tool because you were never trained on how to discuss it.

Dr. Anthony Orsini (34m 26s):
So why can’t we just teach the doctors how to reveal the medical errors? So they already have that screwdriver when they need it.

Dr. Jeffrey Segal (34m 33s):
You definitely need them to talk. It’s I’m from Texas originally. And please don’t judge me harshly because of that. But there’s a saying in taxes that says, if you don’t have a gun or a parachute, when you need it, you’ll never need it again. But to your point point is that it’s better to plan and prepare for the inevitable medical error. Everybody will have a medical error. At some point, it is impossible to see 1 to 3000 patients a year over decades and have a perfect record doesn’t happen. And just to give this color, there was a, I think they call them CPC, Clinico, pathological correlation, or conference in the new England journal of medicine.

Dr. Jeffrey Segal (35m 18s):
There’s typically five to 10 pages of some amazingly esoteric parasitic organism that shows up at mass general, something that nobody will ever see in decades of practice. And they spend five to 10 pages talking about and how they amazingly made this wonderful diagnosis of course the patient’s now dead. And that they’re doing a pathologic examination and we should learn from it and so on and so forth. And they’re mostly esoteric. But 10 years ago, they delivered a presentation of a hand surgeon who operated on the wrong side, wanting to do the right side to the left side. And I think what was fascinating was that they described how it happened and how it, if it happened at mass general it could happen anywhere.

Dr. Jeffrey Segal (36m 5s):
And that was a take home message. Just expect that on rare occasion that, which you hope never happens, it does happen, but you’ve got tools in your toolkit to mitigate the problem. If you have no tools in your toolkit, you’ll be learning from scratch. And that’s not the time to, to be in the driver’s seat.

Dr. Anthony Orsini (36m 28s):
And there lies this seamless relationship that you and I have started because that’s what I’m all about is let’s teach every physician, every nurse, every risk manager, how to break bad news and the kindest most compassionate, effective matter and medical error is bad news. Let’s face it. It’s the same communication skills that you can be proud of when you’re breaking medical errors. When you’re doing conflict resolution at the risk of sounding like I’m crazy. And I need a psychiatrist, I actually enjoy the difficult patients sometimes because I love the, the lessons that I was taught and the techniques that I learned on how to deescalate conflict.

Dr. Anthony Orsini (37m 9s):
I’m very proud of. And can I always do it? No, but when I walk into the hospital and the charge nurse is waiting for me to say, oh good, you’re working today because this mother is really causing problems. I go, Hey, this is a challenge. Let me see what I can do. And then I come out and the nurse goes well, is she mad? I’m like, no, she and I are best friends. She goes, I knew it. I knew that was going to happen. I like, you know,

Dr. Jeffrey Segal (37m 31s):
Challenge and people like to do what they’re good at people. I could do what they’re good at. And if you’re able to deescalate conflict, I mean, how can it not feel good to deescalate a conflict and remember delivering bad news, isn’t always you causing the bad news. You leaving a sponge or leaving the scissors in the patient. Often It’s because the patient has a bad problem. The head went through the windshield. You know, you were not driving the car, but you’re the person on call that has to deliver the news. Now, what are you supposed to do? Deliver information or deliver a feeling. And after the first sentence that you get out in that type of situation, I don’t know that they will in their brain.

Dr. Jeffrey Segal (38m 14s):
Remember what you said precisely, but they will definitely remember how you made them feel. And they’ll remember that for decades. They’ll remember the emotional valence. Was it positive? Was it negative? There’s definitely a time and a place to go through the details of what happened and do a debriefing. But the initial conversation is really how do you just take the fire out? How do you comfort someone? And remember we’re healers. So the job isn’t done when somebody passes, there’s still a family that benefit from healing.

Dr. Anthony Orsini (38m 54s):
And doctors are human beings. Not only makes them imperfect, but we take it personally too. No one wants to make a medical error. There’s no doctor who wants to hurt somebody. And I think if that comes off, that will certainly mitigate the whole process also. But as we’re running out of time, so now let’s move forward. Jeff’s too, I’m a physician. I just got sued. I did my best. I went in there and I did all those drop the mic advice that you gave me. I was great. I was, but there’s just no way around this. As you said, it’s a really bad, I get sued. What advice do you have for those that, that doctor now that he, he just got served,

Dr. Jeffrey Segal (39m 35s):
Take a deep breath, stop, take a deep breath. You are now a member of a large club. The first thing that you all think about before you take that deep breath is that you are so alone, but you’re nearly not alone. You’re a member of a big club. I joined it. Most people will eventually join it. It’s not the end of the world. It’s not a career ender. It’s not humiliating. It’s not embarrassing for most people. The next step is what are the facts, you know, try and figure out what happened. You’ll need to notify your carrier and hopefully identify a fairly talented defense lawyer. You need to educate that lawyer as good as that lawyer is, they will never know as much as you about the situation you were taking care of.

Dr. Jeffrey Segal (40m 21s):
And that means guiding and plain speak that attorney with what happened. So you got to get the record. You need to go through it and recognize that not every record is perfect. Most records are not perfect. Again, not a showstopper, not the end of the world, just be patient. In this case, the plaintiff has the burden. Not you. You don’t have the burden to defend yourself. You’re not guilty until proven otherwise. You are actually innocent. You’re not liable. They have the burden of demonstrating that there was a doctor patient relationship, that there was a standard of care that you needed to follow and that you breached that standard of care.

Dr. Jeffrey Segal (41m 2s):
And that breach caused injury. It’s an uphill battle. They’ll need to get experts to back up their version of standard of care and causation. These are legal details. We won’t bore ourselves with. Now, my point is that take a deep breath. You’re part of a big club right now, and you need to be the best possible educator and partner for your attorney. And just remember most doctors win most doctors win, when they’re sued, when now there are times when you have made an error and it’s obvious, and your lawyer may come back and tell you, Hey, I think we should settle this case.

Dr. Jeffrey Segal (41m 42s):
And if that’s true, then we should talk about, and that we do this record with doctors, how to mitigate the damage. How can you do it in such a way that it has minimal, if any impact on your license, on your online reputation, on your hospital privileges and the payout. You know, if you make a payout for a million dollars policy limits, it will be perceived differently than if it’s a a hundred thousand dollars payout. It will be perceived differently from your carer perspective and underwriting, whether you’re perceived as a good risk and whether you’ll get preferred rates going forward. So a lot to think about, but doing that with a strategic partner like us that have been around here a bit around this block for some time we’re physicians and lawyers.

Dr. Jeffrey Segal (42m 29s):
And so we understand both both spaces pretty well.

Dr. Anthony Orsini (42m 33s):
So at what point do they contact you? Are they always stuck with the hospital attorney? Or can they call up Jeff and say, Jeff, I need you also, what how’s that work?

Dr. Jeffrey Segal (42m 40s):
Yeah. So we can sometimes act as personal counsel, which means we’re looking after your interest and that’s often different than that supplied by the hospital or your carrier. The way I like to think of this as somewhat, typically an attorney should be working for you. Your attorney should work for you, but you can certainly imagine a conflict where if it’s a hospital supplied attorney and there’s a common defense between you and five other people and the hospital, they have to split their brain and their focused among five different defendants and the hospital too. It’s hard for them to be your perfect advocate when there are other defendants.

Dr. Jeffrey Segal (43m 23s):
So we help doctors think through what does that mean? How can you get the best out of this relationship so that, you know, you’re not a sacrificial lamb, we’ve certainly seen it where you have five defendants, for example. And one of the doctors decides to leave and moves across the country to start over. But everybody’s sharing a common defense from this legacy lawsuit, who do you, think’s going to be that sacrificial lamb, you know, the income generators who still remain at the hospital or you, the guy that decided to go from California to Pennsylvania and start your own career. Of course it’ll be you, but how do you minimize that problem?

Dr. Jeffrey Segal (44m 3s):
And that’s where we help you think through strategies.

Dr. Anthony Orsini (44m 5s):
I think that would be very valuable if someone’s getting sued and they feel that they need someone in their corner just to contact you. And we’re going to leave all your contact information for everyone out there in the show notes. One final question, Jeff, that I ask every guest, it’s kind of like my thing at the end. I don’t know if I warned you about this question or not. Maybe I did. Maybe I didn’t, but some people have a hard time with it, but I’m going to ask it anyway. What is the most difficult conversation or type of conversation that you’ve ever had in your life? And can you give us advice on how you navigated through that conversation?

Dr. Jeffrey Segal (44m 42s):
So I’ll use the same situation with two different conversations that were had. So my son, when we first got his diagnosis, I think that the doctor was entirely insensitive to our situation. This was a shock primarily because he was developing normally and then regressed. He wasn’t even born with that, but since he was tracking his twin sister who was neuro-typical and then ultimately regressed and to this day, and we’re talking 24 years later, my wife’s, well, actually was 21 years after that conversation, my wife still remembers that conversation as a negative conversation.

Dr. Jeffrey Segal (45m 22s):
Okay. Next, my son had two craniotomies for epilepsy, university of Nebraska when he was six. In contrast to that initial conversation, that surgeon could not have been more empathetic, more human, more communicative, and helpful. He was certainly a talented practitioner, but no less important. He was a dedicated human being. He was someone that gave us his mobile number. In fact, this is actually really important. And I learned quite a bit about this process, each case, because there was a lot of mapping. There’s a lot of what’s white and white during the operation, while they’re just trying to map the electrical signals of the brain.

Dr. Jeffrey Segal (46m 8s):
And they were diligent about having the nurses, communicate with us and say, Hey, look, we’re just thinking about you. We know you’re out there. Everything is going well. Everything’s going well now in contrast, when I was a surgeon and that was before would frequently get messages from the nurse, a doctor, the families out there, what do you want me to tell them? And you know, it’s a long case. And while we would say, Hey, look, everything has gone. Okay. My internal sarcastic brain was thinking, so if I’m shoulder deep in blood, should we communicate that? Having a hard time swimming? But what I learned by being on the receiving end of a gentle empathetic surgeon with my son was that the message is really little more than this.

Dr. Jeffrey Segal (46m 54s):
We’re thinking about you. And you know, there’s no amazing crisis going on and that’s it. We know you’re out there in the waiting room and where here, we just want you to know we’re doing the best we can to take care of your son, but we know you’re still there. And you’re part of the team

Dr. Anthony Orsini (47m 12s):
And that your son is as part of a family. It’s and your son’s not just the patient. We understand that your son is a son to people. And that goes again, the main theme of my book, it’s hard to fire your best friends. So you felt that you had representation in there from someone who knew that it wasn’t just patient or another operation. So that’s great advice. And you hit on the head.

Dr. Jeffrey Segal (47m 36s):
Front. You would be asking me that question. You didn’t communicate upfront.

Dr. Anthony Orsini (47m 40s):
I was a bad communicator. The last two that I did, I forgot to tell them, I guess, as I get more and more of these podcasts episodes, I’m getting a little sloppy. So I’ll have to start warning my people, but maybe it’s better that I don’t tell you it isn’t

Dr. Jeffrey Segal (47m 53s):
Bad, or just get it from the hip.

Dr. Anthony Orsini (47m 55s):
Jeff, thanks so much for the time that you spent with us, what you do is fascinating. It’s really needed. I have a, most of my audience, I would say about 75% is in the health care. Many of them are doctors and nurses, malpractice, medical errors, communication, medical, justice, all this stuff is so important. It all leads into another topic that we don’t have time to talk about professional burnout and job satisfaction and all that stuff. But to know that there is someone like you out there that I can call when I go into this pure panic, that when that subpoena comes and is I think very comforting. So the best way for people to get in touch with you, I’ll put this all in the show notes, but how can people get in touch with you?

Dr. Jeffrey Segal (48m 34s):
Our website, www.medicaljustice.com, medical justice.com. And by the way, on that homepage, there’s a way to click for a free confidential consultation. All you got to do is select two dates and times, and we’ll say, let’s make it happen. And you get a free consultation. So easy peasy,

Dr. Anthony Orsini (48m 57s):
Fantastic. And to make the lawyers happy. I forgot to say this in the beginning that the views of the interviewer and the guests are their own and not necessarily the views and beliefs of the institutions and the companies that they work for. So there’s a, that’ll make the attorneys happy. Jeff, thanks so much again, if you liked this episode, please go ahead and subscribe apple now, cause it follow instead of subscribe and download all the previous episodes. If you need to get in touch with me, you can get in touch with me through my website The Orsini Way.com again. Thank you, Jeff. And I hope that you and I will be having many more conversations.

Dr. Jeffrey Segal (49m 36s):
As do I.

Dr. Anthony Orsini (49m 36s):
I want to thank you for listening to this episode of Difficult Conversations: Lessons I learned as an ICU physician, and I want to thank the Finley Project for being such an amazing organization. Please, everyone who’s listening to this episode, go ahead, visit the Finley Project.org. See the amazing things they’re doing. I’ve seen this organization literally saved the lives of mothers who lost infants. So to find out more, go to the Finley Project.org. Thank you. And I will see you again on Tuesday.

Announcer (50m 5s):
If you enjoyed this podcast, please hit the subscribe button and leave a comment and review to contact Dr. Orsini and his team, or to suggest guests for future podcasts, visit us@theOrsiniWay.com.

Re-Invent Your Life with Kathi Sharpe Ross

Kathi Sharpe Ross (1s):
But, you know, it’s so crazy. So many people could live this life If they wanted to, they just don’t realize that they were entitled. So people wanted to reinvent their life and do something else, have a different relationship, have more spiritual awareness. Work in a different career, there’s a million ways to live our lives. And a lot of people are stuck in a rut. And if you ask the average person around you, are you happy in what you do with your life? Most people will not say yes. I mean, there’s a handful of us that will, and maybe we fraternize with more people that do, but for the most part, people just don’t necessarily feel complete satisfaction in their life or some part of their life.

Kathi Sharpe Ross (42s):
There might be a very specific part of their life where that is in fact, the case.

Announcer (46s):
Welcome to difficult conversations lessons I learned as an ICU physician with Dr. Anthony Orsini. Dr. Orsini is a practicing physician and president and CEO of the Orsini Way. As a frequent keynote speaker and author. Dr. Orsini has been training healthcare professionals and business leaderss how to navigate through the most difficult dialogues. Each week, you will hear inspiring interviews with experts in their field who tell their story and provide practical advice on how to effectively communicate whether you are a doctor faced with giving a patient bad news, a business leader who wants to get the most out of his or her team members or someone who just wants to learn to communicate better this is the podcast for you.

Dr. Anthony Orsini (1m 32s):
Well, I am honored today that the, our way has partnered with the Finley Project to bring you this episode of Difficult Conversations: lessons I learned as an ICU physician. The Finley Project is a nonprofit organization committed to providing care for mothers who have experienced the unimaginable, the loss of an infant. It was created by their founder, Noelle Moore who’s sweet daughter Finley died in 2013. It was at that time that Noelle realized that there was a large gap between leaving the hospital without your baby and the time when you get home. That led her to start the Finley Project. The Finley Project is the nation’s only seven part holistic program that helps mothers after infant loss, by supporting them physically and emotionally.

Dr. Anthony Orsini (2m 15s):
They provide such things as mental health counseling, funeral arrangement, support, grocery gift cards, professional house cleaning, professional massage therapy and support group placement. The Finley Project has helped hundreds of women across the country. And I can tell you that I have seen personally how the Finley Project has literally saved the lives of mothers who lost their infant. If you’re interested in learning more or referring a family or donating to this amazing cause please go to the Finley Project.org. The Finley Project believes that no family should walk out of a hospital without support. Well, welcome to another episode of difficult conversations lessons I learned as an ICU physician.

Dr. Anthony Orsini (2m 56s):
This is Dr. Anthony Orsini and I’ll be your host again this week. Today, I am absolutely delighted to have, as my guest, Kathi Sharpe Ross, Kathi is a global brand and lifestyle marketing guru and the founder, president and CEO of the Sharpe Alliance. She is also the founder of the Reinvention Exchange, which we will be spending a lot of time talking about today. As a sought after marketing consultant, speaker workshop, leader and philanthropist, Kathi has been helping brands and businesses reinvent build and communicate for over 30 years. She is a frequent contributor to Huffington post and thrive global and regularly interviewed on podcasts and radio. Although I’m sure none as exciting as this one.

Dr. Anthony Orsini (3m 39s):
Australian born and having grown up on three different continents, she learned at a young age, had to adapt, try on new circumstances, make new friends roll with the changes, create the tools to flourish in her world and treat fear as an adventure. Now in her new book, Reinvent Your Life, what are you waiting for? She is empowering people from all walks of life to embark on a journey toward re-invention of all shapes and sizes. Well, Kathi, thank you. You are so busy. I really appreciate you taking the time to come on today.

Kathi Sharpe Ross (4m 9s):
Oh, thank you so much for having me and never too busy to have the kind of conversations that I feel that really affect and impact our lives. I mean, these are the things that kind of ground us in all the craziness of where we are, what we’re doing, why we’re doing it. So it grounds me in all my craziness and hopefully we’ll do that for others that are listening. So it’s a pleasure to be here.

Dr. Anthony Orsini (4m 35s):
I’m really looking forward. We met by zoom a few weeks ago. I think maybe a month ago. My cousin James is a mutual friend and he texted me one day and he said, you really need to interview Kathi and then get to know her. So I looked you up and I’m like, wow, this will be perfect for the podcast. And we just kind of hit it off. I think we probably spoke for about an hour on the phone and I probably could have hit record.

Kathi Sharpe Ross (5m 1s):
So we would had a chance. Hopefully we can extract some of those nuggets today. So that’s great. And I think, you know, James probably mentioned me because he wanted you to read the book because as if you didn’t know him well enough already, but you know, he is featured in chapter 15 and so, you know, never hurts for him to plug it a little.

Dr. Anthony Orsini (5m 22s):
Exactly. So that’s fantastic. You know, communication’s all about relationships. And in order to build a relationship, you first have to find commonality and really relate to somebody on a personal basis. So I usually like to start the podcast off with having my audience, get to know you. So who is Kathi sharpe Ross. And how did she get here? And tell us about Kathi. We want to get to know you.

Kathi Sharpe Ross (5m 46s):
Absolutely thank you. And the mystery of the universe. Who am I, what I’m still trying to figure out. One of my chapters, actually, my book is called, hello? Are you still in there? Which I think is a great question for us to ask ourselves, but to go a little bit, you’ll notice I have a very light twinge of an accent. I’m Australian. I was born in Melbourne Australia, and when I was 10, my parents picked us up and moved us across the world. And we lived in Israel for four years. And that was interesting because it was actually during the time of the Yom Kippur War. So here I was going from this lovely, pristine all girls school, beautiful neighborhood, you know, very tiny neighborhood that I lived in to living in Israel during a war time, extraordinary life-changing eye-opening.

Kathi Sharpe Ross (6m 32s):
And fortunately for me, we have the means to be able to travel a lot because my father’s business. So I got to see a lot of the world at a very young age and four years after moving there, we moved to the U S and specifically to Los Angeles. So it was a really kind of fun upbringing for me. It was always an adventure. It was a question of where we going next and do I get to make new friends and more friends? And I think I started sort of collecting friends and people at a very young age. And, you know, I pride myself on my very large Rolodex today or databases. We now call it. But I think it’s because at an early age I was, you know, very outgoing or had to be outgoing in order to be friend people.

Kathi Sharpe Ross (7m 15s):
I was always the new girl on the playground and it was really a fun way to grow up and a very open-minded way to see the world, to know what was possible to understand how the other, the other half, but really the rest of the world lived. And just sort of, for me, was sort of really spoke to who I am today. My father was very entrepreneurial. My mother was very spiritual. My mother was teaching yoga when I was three years old. So I kind of had the yin and the yang going and old times in my life. And I have two older sisters and we moved to LA and I’ve stayed living in LA since, but I’ve always considered myself home as Australia.

Kathi Sharpe Ross (7m 57s):
My heart is in Israel. I’m a kind of a citizen of the world because we traveled so much. And I knew when I left college, that for me, I would have to continue to live life in that manner that it wasn’t going to be okay for me to just go get a nine to six job, put on a suit every day and go to work with my head down. That was so not in my DNA at that point. So I very quickly started my own business practically out of college. I was 24 when I started my own company and never looked back and 32 plus years later, I’m still doing the same thing. So it’s really been extraordinary for me.

Dr. Anthony Orsini (8m 39s):
You were an entrepreneur in college right?

Kathi Sharpe Ross (8m 41s):
That is right. I started making jewelry. It was sort of the crazy Madonna era of big hair, big rhinestones, big pearls. And I started a costume jewelry business that I think every sorority girl in college was wearing my jewelry to every function and every event. And that was really fun. And I had another clothing line that I started. And so, yeah, when I got out of school, I had a job, I was making money. I had a business. And so I wasn’t jumping through hoops to do those interviews and go get a traditional job. And so that’s kind of how I started in my career path out of college as well.

Dr. Anthony Orsini (9m 19s):
And your father being an entrepreneur, I bet you, that had a big impact on you.

Kathi Sharpe Ross (9m 24s):
A few tried and true lessons that sort of still resonate in my head today. And I will share one of them for all the entrepreneurs out there that are starting a business. My father always said to us, do it best, do it first and do it loudest so that, you know, don’t look over your shoulder, what everybody’s doing, and who’s trying to catch up with you and who’s trying to surpass you just stay focused, do it best, do it fast as do it loudest and get to market and make a statement. And, you know, I think that applies in a lot of ways to different types of businesses,

Dr. Anthony Orsini (10m 0s):
Keeping with the conversation themes. So now you’re 24, you’re starting your own business and you need a client. So how does that first conversation go when you get your first client and how long did that take you and how scary was that?

Kathi Sharpe Ross (10m 12s):
Well, I was sort of meddling in the business already because I was helping my sister with her company. So I had started to build a network. And when I realized that I wanted to start my own agency, I just started talking to people and literally just putting it out there that I was starting a company. The funny thing about it was that I was also about to take off on a six week honeymoon and I was getting married. And so what I did was I teed up clients saying, I’m starting a new agency. I’d love to bring you on board as a client. I’d been, you know, sort of networking and schmoozing. I mean, I was that person that had got up at six in the morning and went to the, you know, tip networking meetings to meet people.

Kathi Sharpe Ross (10m 52s):
And, you know, I made a living out of connecting and giving out my business card and telling people what I do for living. And it took that kind of diligence. It took creating, you know, go into the chamber of commerce, mixes, getting into rooms with people I didn’t know, and talking to them about what I do for a living. So when I started my business, I actually came back from my six week honeymoon to start working with full clients right off the bat. And it was just really, I guess the gift of the gab, it was communicating, it was putting myself out there. It wasn’t going to happen if I was a wallflower, fortunately for me, I wasn’t. So it was about having a level of confidence in what I knew I wanted to do with them.

Kathi Sharpe Ross (11m 33s):
And in those days it was purely public relations. It was working with media, writing, press releases, putting on events, helping promote them. From there it started to grow very quickly.

Dr. Anthony Orsini (11m 43s):
What advice do you have for that young entrepreneur? You’ve already given some, but what advice you have for that young entrepreneurs, a little nervous about starting those conversations and putting themselves out there and cold calling or going to these meetings, any advice for them?

Kathi Sharpe Ross (11m 58s):
Yeah. Practice. You just have to do it over and over and over again. And you may go to functions and events and be in rooms with a lot of people and not walk away with business cards or a conversation that you thought could turn into business, but you never know. And I was steadfast on the communication. I would follow up with everybody. I would write them a note after I met them within 24 hours thing was so lovely to connect. Let’s hop on a phone call and talk a little bit more, or grab a cup of coffee. If it was a business I wanted to learn more about, I did my homework. I did my research before I got back on the phone with them. I figured out who they were. And I have to say, you know, the internet wasn’t exactly at our fingertips 24 years ago.

Kathi Sharpe Ross (12m 42s):
So it wasn’t as easy. But perhaps there were people that I would know who knew the company or someone who had invited people that would know more. And if not, at least be able to get on the phone and ask them questions about themselves. And often it wasn’t about who am I, let me tell you who I am and what I do and what I can do for you. It was asking them about their business and understanding what they were trying to solve for. So listening, it’s not always about talking. It’s about listening and then being able to go, Oh, now I understand what your business is about, what your challenges are. I’d love to give that some thought, maybe I can come back and we can talk further about how we might collaborate and work together.

Kathi Sharpe Ross (13m 25s):
So there was a lot of that, and there were probably lots of hits, a lots of misses along the way, but not every client is for you either. And yet that client may not work out. And then three months later, you get a phone call saying, Hey, remember we had this conversation. Well, I’ve got a guy who wants to talk to, or I know a person who needs your services. So you just never know where that next conversation is going to come from. And it’s funny because there was a time probably midstream in my business where I would marvel, as I was kind of tracking the three, four, five, seven relationships, you know, they kind of where something emanated from.

Kathi Sharpe Ross (14m 6s):
And so you just never know you’ve got to put yourself out there. And I think you have to have a level of confidence, even if you feel like it’s the imposter syndrome creeping in. And that is such a challenge for so many people. I never knew what that was. I never knew that I wasn’t supposed to be proactively talking about the business and going and doing things like that because that’s what I just sort of created that as my path to build a business and do what I love. Nobody said that you can’t do it. There. Wasn’t all this banter and rhetoric about having an imposter syndrome. So I suited up every day. I literally dude it up every day.

Kathi Sharpe Ross (14m 45s):
I never went to work in a pair of jeans and tennis shoes in my life until this year, literally, or maybe casual Fridays. It kind of seeped into my life, but I suited up every day, ready for business, ready to be serious about what I do for a living and taught my team to be the same way and take it that seriously as well.

Dr. Anthony Orsini (15m 6s):
Getting dressed up every day, even during a zoom call, reminds me of the work by Amy Cuddy. I don’t know if you’re an Amy Cuddy fan. She’s the famous psychologist with the Ted talks.

Kathi Sharpe Ross (15m 16s):
No, I’ve not, but I will make a note too. So yeah,

Dr. Anthony Orsini (15m 19s):
She has a wonderful book called presence and she’s a body language person and she’s showed using actually blood tests and everything that if you stand in front of a mirror for a few minutes before an interview that not only do you do better in the interview, but your stress levels go down in your blood and it’s pretty cool stuff. So getting dressed up and getting ready to go. One of the things that I learned in, I guess it’s 10 years now, teaching communication to the healthcare industry and now some businesses is that communication can be taught. And you alluded to that just now that you know, we can teach people how to do this. Doctors don’t have the reputation for being the best communicators.

Dr. Anthony Orsini (16m 1s):
We can all just admit that. And when I first started training doctors on how to form relationships, how to put their patients at ease, how to give bad news, you know, I remember my boss said to me, you know, Tony, not everyone can be you you’re missing this. And I always remembered that him saying that, and I said, no, I disagree with you. I was a shy kid by nature, and I’ve learned, and one of the reasons why I started this podcast is that I realized that the doctor patient relationship is very much like the leader, employee relationship, the team member, relationship, the client relationship. And so it’s all about communication, right?

Kathi Sharpe Ross (16m 41s):
Yeah. And I think we take for granted what we know and our skillset in certain ways, but active listening is critical. Doing your homework and knowing who you’re talking to and what is important or resonates, or is something that you can relate to each other on is important. I think there was a day where, you know, going on LinkedIn felt very sneaky before you got on the phone with someone. Now it’s almost like what you haven’t looked at my profile before you got on this phone with BG and how much time we’re going to waste talking about my background instead of being able to get on the phone and say, Oh my word, I see that you actually worked at XYZ company.

Kathi Sharpe Ross (17m 22s):
I have a colleague there. I did business with them right off the bat. You’re starting with the common area of interest and doing your homework also really just shows that you’re genuinely interested in what you’re about to talk to. And that you respect somebody’s time

Dr. Anthony Orsini (17m 39s):
And communication techniques are not only able to be taught. What I tell everyone is steal from people. I got advice many years ago, which was the best piece of advice I ever got and says, stop looking at the people who are not good at stuff. And look at the people who are good at it and then steal from them. And I tell people all the time when I’m training, I’m doing communication. I see I’m giving you clues on how to do this, but now that you know, what’s good communication, what’s bad communication. Find somebody. Why is that doctor have 95% patient satisfaction and this doctor doesn’t, why is that person closing sales and why? And learn from that?

Dr. Anthony Orsini (18m 20s):
Why does this boss have employees that will walk through fire for her and the other boss they wouldn’t give her the time of day. So I always say, just steal from them and you’ll learn from the best. So I thought that’s great advice. So let’s talk about the book because that’s what I really want to get to. I loved your book. I know what it takes to write a book and you’re running a massive business. You’re working out of two continents. You just told me it’s three, o’clock your time. And you have a whole bunch of meetings still left. I know how much time it takes to write a book. Cause I have one. First of all, how’d you find the time in, what was the push for you to do it?

Kathi Sharpe Ross (18m 59s):
It’s such a precious story for me because I think this is so indicative of moments that we all have and we either hear them and seize them. And what I call these aha moments when we don’t, we might later in life or the, we may have many versions of this. For me the book is called reinvent your life, what are you waiting for? And about, thank you. Thank you. That was not easy to come up with believe it or not, although it feels so natural. What else could it have been made? Had a working title from day one and then, you know, went through the process that one does just making sure you’re really nailing it. But about 11 years ago, I was having dinner with a dear friend in New York. And because of this kind of fun as I call a playground life that I’ve always had doing what I do with companies and businesses that I love as a global marketing agency, I was talking about how people constantly say to me how lucky I am.

Kathi Sharpe Ross (19m 50s):
You’re so lucky you have the slide, you do what you want. You traveling, having a good time. You seem to be making money or whatever. You’re seeing happy and successful or whatever that means to you, but you seem okay. And I thought, you know, it’s not luck. It’s been hard work since I was in college, as we just talked about, and I never stopped working a day in my life since, and I did choose to engage in a business and a practice that I would enjoy. I did choose to create my own business. It was never a thought to go work for another company. I was courted many times over the years to potentially join venture or be absorbed or be acquired. And I just never wanted to be beholden to anybody else.

Kathi Sharpe Ross (20m 31s):
So that was just kind of, not in the cards for me. And as I was having this conversation and talking about this with my friend, I said, you know, it’s so crazy. So many people could live this life if they want to do. They just don’t realize that they were entitled. So people wanted to reinvent their life and do something else, have a different relationship, have more spiritual awarenes work in a different career. There’s a million ways to live our lives. And a lot of people are stuck in a rut. If you ask the average person around you, are you happy in what you do with your life? Most people will not say yes. I mean, there’s handful of us that will, and maybe we fraternize with more people that do.

Kathi Sharpe Ross (21m 14s):
But for the most part, people just don’t necessarily feel complete satisfaction in their life or some part of their life. They might be a very specific part of their life, where that is in fact, the case. So it made me realize that I really felt that there was just an opportunity to share this thinking with people and that if people could put on rose colored glasses and see the world through a different lens, perhaps in fact that they would have this experience. So entitlement became a very big word in that conversation. If we knew that we had the permission or create the permissions within us and around us in a positive way that we could go and do that. So in that moment, I said, yeah, I’m going to write a book about this. And it just came out of nowhere.

Kathi Sharpe Ross (21m 54s):
I, there was I never in my life. I mean, I write for a living because of what I do and I’ve written my whole life in business. So communication has definitely been a skill set of mine, but I’ve never thought, Oh, I’m going to write a book. And I journaled when I was kid, but I had stopped doing that when I was about 15 years old. So there was no more of that. And then even then it wasn’t like one day I’m going to turn my diaries into a book which would make for another, that will be the next book because the stories are crazy, but it was kind of that moment. And I thought, well, this is not really about me and my reinventions. This is about finding all the great reinventors that are out there. This is about curating stories about men and women from all walks of life who have had different experiences, whether out of the opportunity, whether out of adversity to find that aha moment and say, I’m going to pursue that.

Kathi Sharpe Ross (22m 47s):
So for me, the book was kind of a moment like that. I was living that journey for many years. I was writing content, doing blogs for thrive global and Huffington post to start with then thrive global. I was doing speaking engagements. I had a blog and a newsletter. I was putting out there and I created the re-invention exchange, which was a website. And that sort of was my quote media company that I was going to start to build content around. From there as I was writing and writing, I was creating a lot of content and I, there was a book in the works, it wasn’t until I started working with an editor that it really started to take shape. And I was able to hand her hundreds of blogs and articles and content and say, please go make sense out of this and gave her a list of chapter headings and sort of, really sort of the subtext to it.

Kathi Sharpe Ross (23m 39s):
And long story short, it did take 10 years. I was raising my children. I was running a company and I was on nobody else’s deadline, but my own, which I think is really important for people to hear, because there were moments where you’re like, what am I doing? I’ll forget it. It’s never going to happen. Forget it. Or this is a dream. I’m going to do it. I’m not going to guilt myself, make myself feel bad. You know, turn everybody else’s life upside down for this, but I am going to make this happen. And it will happen in due time. And it wasn’t until a girlfriend asked me about six years into it. And she said, why are you writing this book?

Kathi Sharpe Ross (24m 19s):
And I had never thought about that. And funnily enough, I talk a lot about the why in my book, in the conversations that I have on my podcast and my virtual chat series, which is knowing your why, because the moment you understand your, why it pulls you through to the other side of what it is that you want to do. And it’s that reminder on the hard days, the tough days, the busy days, the crazy days, they all forget about it. My dream doesn’t matter. I’ve got to focus on X, Y, and Z. You know, one day, those are the moments when you need to remember your why. And for me, that was the moment with this girlfriend who asked me that very simple question. And I looked at her and I said, you know what?

Kathi Sharpe Ross (24m 59s):
I cannot see you right now. I don’t know. I just don’t. I want to do it. She goes, that’s not enough. And three days later, I called her up and I told her why. And then from that point on, I was on a mission. And within three years that was published

Dr. Anthony Orsini (25m 16s):
Simon Sinek, knowing the why. And she really helped you through it. It took for five years. People kept saying to me, you have so much content, write a book. You have so much content, write a book and look, I don’t have time. I don’t have time. So I started, it took me three years, but writing a book is funny. I said, it I’ve never given birth, but it felt like giving birth.

Kathi Sharpe Ross (25m 36s):
Yeah, definitely and I can tell you that for sure.

Dr. Anthony Orsini (25m 40s):
Right?

Kathi Sharpe Ross (25m 40s):
And it’s a beautiful journey and you’re enjoying the moment, but you can’t stop until it’s done. Like you can, you know, stay pregnant forever. You’re gonna have that baby. And you know, I think there are definitely reality checks along the way. And you know, whether it’s the environment, the people around you, the other jobs, we have all of those things, but it’s sort of your baby and it’s yours. And it’s really precious in that moment. Ironically, the moment of my pub date was March 7th last year, which was, as we all know, the very Eve of the pandemic,

Dr. Anthony Orsini (26m 17s):
Oh boy, well maybe good timing because people had nothing else to do to then. Right?

Kathi Sharpe Ross (26m 21s):
Well that, but also re-invention and pivoting has been like, you know, the 11 o’clock news for the last year and you know, weather for store invited. Everybody has had a shift in their life in some ways, somewhere somehow. And so this book is being called the guide book for now. It’s very much between all of the power tools, which are exercises throughout the book. And other people’s stories that just help you understand that if he can do it, I can do it. If she can do it. You know, there’s a bit of that in me having a re-invention in your back pocket, you never know what’s around the corner, personal experiences, all kinds of epiphanies and moments that you can have that again, as I said earlier, if you listen to yourself, you will hear those aha moments.

Kathi Sharpe Ross (27m 13s):
And sometimes it’s just a question of when or how you’re going to act on them.

Dr. Anthony Orsini (27m 17s):
One of the themes that I talk about in this podcast all the time is that every critical moment of your life starts with a difficult conversation. And these aha momentst are really the difficult conversations you have with yourself that many people don’t want to have do the?

Kathi Sharpe Ross (27m 34s):
Exactly. And they sweep it under the rug. I mean, how often have you thought I wish I could do this. I really would like to do that. I, you know, we sweep it under the rug and we chalk it up to being too busy, being responsible for all the people in our lives that we either take care of or in service of or whatever that is. Oh, I’ll do it in a year. I’ll do it in three years. But the reality is if you put that re-invention roadmap together sooner, rather than later, you put that money in the coffee jar. If you stop having your Starbucks for five or $6 every single day, and put that money aside, you will wake up into three, four, five, seven years, whatever that might be. And there are short term, there are five minute reinventions might be like, I’m going to learn a language and you download babble on your phone and boom, every time you take a walk, now you’re listening to a new language or there are these ten-year plans.

Kathi Sharpe Ross (28m 25s):
And really long-term things that are going to take mentors and advice and education and research and raising money and all kinds of other things. But if you start doing it in baby steps, there is a way forward. There is a way to do that. And it may seem daunting if you look at the whole picture, but the ability to break that down into little bite sized pieces and to really acknowledge when you actually do those things that you are moving towards your goal, your dream, whatever that is, it’s pretty special feeling.

Dr. Anthony Orsini (28m 58s):
And the book is I think 30 stories, correct people,

Kathi Sharpe Ross (29m 1s):
30 stories and 26 power tools. And I am proud to say that Quincy Jones, the famed Quincy Jones, wrote the forward.

Dr. Anthony Orsini (29m 10s):
You stole my thunder. I have that right, right over here. Tell me about Quincy Jones. Like how did you meet him?

Kathi Sharpe Ross (29m 18s):
So through my business, and it’s really been wonderful to see the way my business has supported what I’m doing on this conversation and how being visible all of this year around this topic where I’m helping companies reinvent their businesses have really fed off one another. But because I was involved in a huge concert event that we did in Rome, about 14 years ago, I had the pleasure of working very closely with him and his entire team and continued then coincidentally, be involved in a major charitable organization called the keep the memory alive foundation, which is affiliated with the Cleveland clinic. And we do an annual event in Las Vegas every year called the power of love.

Kathi Sharpe Ross (29m 58s):
And Quincy was an honorary chairman. And we actually did a huge event years ago with him and Michael Kane. They were both celebrating their 80th birthday days and Larry King who interviewed the two of them. And they were having the greatest conversation about all, about what it’s like to be 80 and what they do to get by and true that, and just the ongoing relationship that we maintained, just managed to have this incredible relationship with him, worked on a couple of other business ventures with clients, brought him in and connected. And when knowing him and his personality, his spirit, and talk about an inspired individual who has just done so much and just dared to dream, it was really special.

Kathi Sharpe Ross (30m 40s):
And I reached out and you know, I come from the school of, if you don’t ask you don’t get.

Dr. Anthony Orsini (30m 46s):
I believe that to the worst that could happen is they say no.

Kathi Sharpe Ross (30m 49s):
And he was at the very first person that I thought of. And I thought, you know what? I’m going to ask him and reach out to his team and to him and ask if they would, and you know, said yes, and then wrote the most beautiful foreword for my book. And just, you know, I feel like almost after you read his forward, it’s like a drop mic moment. You’re like, okay, we’re done.

Dr. Anthony Orsini (31m 11s):
We don’t have to read the book. What I love about the book is that there’s some practical tools. It’s not just a philosophical book. You give practical tools. And I want to talk about those in a moment. But before we talk about the tools, there’s really two kinds of pivoting moments. There’s the conscious conversation that we talked about that you have with your life. And you talk about it in your book where you say, I’m not happy with my marriage. I’m not happy with my job. And you make that decision. I’m going to change something. And then there’s the reinvention as you spoke about with COVID, whereas they say the universe nudges you.

Dr. Anthony Orsini (31m 51s):
And we had Kathy Caprino on very early on this and Kathy’s fabulous. And she had a moment where she wasn’t happy in her job and she was very successful. And then one day after 9/11, it was gone and now she had to reinvent herself. So which one’s harder. I think the one that you have to consciously do might be harder. What do you think

Kathi Sharpe Ross (32m 15s):
You’re right when you’re reacting to something you’re sort of forced into the momentum, right? It shows up and you’re going to get carried along with it. And yes, you have to make very specific decisions and you have choices, or you may not have choices. I believe we’re all at choice. Even not making a decision is a choice about things, but the momentum that it takes to proactively create a re-invention moment in your life can be equally hard if not harder. And that’s because it takes everything that you’ve got to change the course that you’re on. Whereas in the other case, something is already changing it for you.

Kathi Sharpe Ross (32m 56s):
It’s just a question of where you go with it and which direction you move. So I do think that what we don’t realize individually is that we do have the power and the ability to shift the course that we are on if we need to or so choose to. And, you know, you can be at the top of your game and love what you’re doing, but still create beautiful reinvention moments in your life, create an add and enhance the things you’re doing. It might be spiritual. It might be personal. It might be hobbies. It might be relationships, but really looking at where we may not be as fulfilled as we’d like to be. I mean, I think, you know, we’re all guilty of looking at social media and going, Oh, look at their fabulous life.

Kathi Sharpe Ross (33m 39s):
And I wish I was doing that. And I wish I had that. And I wish I could go there. And you know, I mean, who, hasn’t had a moment of some sort, and that’s not a very healthy place for any of us to live because clearly those people are only posting the good moments and not all the hard moments that got them there, perhaps. But I think it’s really important that we give ourselves the grace to question. And I mentioned this at the beginning of the show that, hello, am I still in there? Am I living the life that I really want? And who did I want to be when I was 12 or five or 18? And I, you know, I speak of a story of you want it to be a rock star, but maybe haven’t picked up a guitar in 30, 40, 50, 12 years, whatever that is.

Kathi Sharpe Ross (34m 27s):
But what if you picked up the guitar and, you know, buy one on eBay, go on YouTube and take lessons. And maybe the guys down the hall or the gals down the hall that have working with you, your colleagues feel the same way about life. If you will, and you put a garage band together and you’re playing on Saturdays, you may not mind coming to work every Monday anymore because you’re going to have a skip in your step. You’re going to nurture your soul. There’s a story in the book about the man with the violin, Scott, who works at Mattel and had this amazing job. And, you know, he would go literally decided he wanted to play the violin and would go across the street and sit in the park and practices violin every day because that nurtured his soul.

Kathi Sharpe Ross (35m 11s):
And that was his thing. And there’s more to that story. It’s precious, but just the fact that he recognized that he could do something like that for himself, just because

Dr. Anthony Orsini (35m 20s):
You really got to get moving. My Jewish friends out there are probably gonna call me after they hear this and tell me that I got it wrong. That grew up in a neighborhood. There were a lot of Italians, a lot of Jewish. And I think the Jewish saying goes, if you’re dreaming, wake up already. And I love that, you know, stop dreaming and doing right. Yeah. Well, that’s it,

Kathi Sharpe Ross (35m 42s):
You know, that tagline on my book, what are you waiting for? We’re never too old. It’s never too late. There are so many parts for our lives that we can explore more wholeheartedly. And I think fortunately in the last year, that big pause button, which I speak so much of throughout the book, it’s given us that ability to just kind of take a breath, whether it’s one less week, because I’ve been vaccinated, I’ve been out or five nights in a row, all of a sudden go, Whoa, wait a minute. Where’s my quiet time gon you know, how did I so quickly go back to that schedule? And it’s not a regular thing, but obviously there’s a lot of opportunities right now to do that a bit more.

Kathi Sharpe Ross (36m 23s):
And I think we just need to remember that we need to remind ourselves that it’s okay to take a breath. It’s okay to sit and listen to ourselves, to take a walk, to pause, to just reflect on what we are doing with our lives and question what else we might want to do. And it isn’t too late at any point to create what we need or want to have around us or within our lives.

Dr. Anthony Orsini (36m 48s):
Yeah. Your book is very inspiring and tell us about the re-invention exchange and how does that help people who really read your book and they want to take it to the next step.

Kathi Sharpe Ross (36m 59s):
So the website where you mentioned exchange, it was created to really have a place for communication content I have in the last year, when, well, when I couldn’t do my book tour because of the pandemic, I decided to bring the book tour to me. So I launched what was called the reinvention virtual chat series. And I was doing them three times a week for the first, probably four months, summer came along and I thought, okay, who on earth wants to be on front of their computer on the Saturday? And the weather was getting nicer and people were finding ways to get outside with their masks on during the summer. And so I scaled it back to long story short.

Kathi Sharpe Ross (37m 41s):
I’ve now done 84 re-invention virtual chat events since March, which is basically a reading from the book. It’s an interview, but the fabulous guest, it’s a little Q and A, I call it a little business therapy, a little personal therapy, and it’s become a regular place on Tuesday afternoons for people to come on a zoom live call. It’s also on Facebook live. And all of those are actually on the website on the re-invention exchange. So lots of great guests in there. And then I launched a podcast in January and all of the podcasts can be found on every podcast platform, but they’re also there. So it’s kind of a catch-all for blogs, content newsletter, inspired thinking other people’s websites that have inspired content.

Kathi Sharpe Ross (38m 27s):
I want to curate these conversations that help other people figure out what resonates for them, what aligns for them, who they resonate with so that they can just fill that inspired moment to kind of go, Hey, I guess can do this after all. Or I never thought about it that way or geez, that’s how she did it. I’m going to do that to talk to people who will, you know, Wolf of wall street, kind of people who just, you know, had this crazy life. And now a professor at NYU friend who was living the crazy agent Hollywood life, who decided to open a very small boutique retail concept, did it for a year, discovered that it really wasn’t what she thought it was going to be for her and went right back to what she was doing, but in a better version of it.

Kathi Sharpe Ross (39m 14s):
And so there is no wrong, there is no failure. It’s really about finding your way forward. As a matter of fact, the more things we learn along the way when things kind of go, oops, that wasn’t how I planned it even better. That’s how we learn. That’s how we grow. That’s how we learn more about ourselves and evolve as human beings. And in our life,

Dr. Anthony Orsini (39m 36s):
This book is really a large majority of this podcast. Audience is from the healthcare profession and we all know how hard they’ve been working, especially lately, even before the COVID crisis. You may not be aware but burnout among healthcare professionals at an all time high, up to 60%. And that was before COVID physicians had the highest rate of suicide of any profession. And we often joke that every physician now is looking for a side gig and it is very common for physicians as they get older to start thinking about reinventing themselves, you know, in order to become a physician, you, I mean, I was laser focused, right? I couldn’t wait to graduate college.

Dr. Anthony Orsini (40m 18s):
Then there’s four years of medical school and another seven years after that, and you’re dedicating your life to medicine and I love every minute of it. But as you start getting up there in age and you start to feel that burnout. So your book really speaks, I think, to the doctors and nurses or feeling I really love this, but I can’t do this till I’m 70. You know, and, and in many ways, this fulfills me this communication training and doing these podcasts with you. So I think you’re really speaking to the healthcare professionals right now.

Kathi Sharpe Ross (40m 49s):
Thank you for that opportunity. Because for me to know that some of what we’re talking about is going to resonate with someone who’s going to say, wow, I never really thought about it that way. And yeah, what could there be in my life? I want to keep doing what I’m doing or how do I an earth othe passions so that I can have other things going on in my life that will make me feel more fulfilled. I mean, that’s an honor for me to know that I may, in this conversation with you touch other people’s lives in that way,

Dr. Anthony Orsini (41m 18s):
And you touched mine as I read it, it was, everything was resonating. And you know, and it doesn’t mean that you’re giving up medicine. It just means there’s something else like playing violin on the bench. It doesn’t mean. So I think you’re really speaking to a lot of people in this audience. So thank you. I’m not sure if I warned you about this question during the pre-interview, but I asked this question to every guest, as we finish off with it, what is the most difficult conversation that you’ve had or type of conversation that you have, and please give us some advice to the audience on how you navigate the most difficult conversation.

Kathi Sharpe Ross (41m 56s):
Well, you know what I think what’s difficult is when I’m having these conversations with folks and I’m very, let’s say Pollyanna about, Oh, you can go out there and create your own life. And I think the hardest thing for me to hear in those conversations is when someone says, I don’t know what my passions are, and I don’t know how to put my finger on what else is possible. And I don’t have the answer to that. I really don’t. What I do have is I think tools to help people open up their mind, their heart, their soul, their psyche, their memory banks, you know, hello, am I still in there and exercises to help explore what those things will be, but it, it is a hard conversation because it all sounds great until that one person feels that way.

Kathi Sharpe Ross (42m 54s):
And they’re like, okay. And I’m just going to stay here forever because I can’t even figure out how to figure out what I might be interested in doing. And I want to have the answers to that. I want to be able to say, Oh, just, you know, go to the book page 25. It’s not that easy. That’s the individual work that people need to do. And I can’t be there to do it with every one of them to help them work through it. I think the tools open up a lot of that thinking combined. I wish I could do more in that space. And that would be kind of a hard conversation for me.

Dr. Anthony Orsini (43m 29s):
That’s a hard conversation when people say, Kathi, I’m just stuck. I don’t want to do this, but I’m just stuck. But what I like about what you said in the book is you may not be timing. This might not be the right time, but you could still do something little, right? I mean, you don’t have to, you know, get divorced, quit your job and run away to Alaska. You can take little things at a time.

Kathi Sharpe Ross (43m 50s):
Absolutely. And you want to be careful that you’re not impacting other people’s lives in a negative way. You’re being thoughtful. And you’re accountable to one another. If you’re in a relationship that, and this is also a challenge for many that, you know, they’re going to go to a partner, a spouse, the kids and friends, and say, Hey, I’m going to embark on this journey. And most of them are going to look into the you’re out of your mind. So those are the people you don’t want to be listening to.

Dr. Anthony Orsini (44m 19s):
Absolutely. So Kathi, this has been so much fun.

Kathi Sharpe Ross (44m 20s):
I loved this conversation.

Dr. Anthony Orsini (44m 22s):
Every time we speak, I have a great time. I feel like I’ve made a new friend and I hope maybe we can work together someday, but we’ll definitely keep in touch. I promise my audience the same thing every week to be inspired and to learn valuable communication techniques. And you’ve certainly fulfilled that promise you made my job really easy. I thank you again. What’s the best way for people to get in touch with you?

Kathi Sharpe Ross (44m 46s):
Way to reach me is a catchall is the reinvention exchange.com. My marketing company, my global marketing company is called the Sharpe Alliance, but the website is just Sharpe Alliance. And that’s S H A R P E Alliance. You can access me through all social media. So it’s Kathy Sharpe Ross or the re-invention exchange on LinkedIn, Facebook, Instagram, Twitter. So pretty easy to track down. And I welcome anybody who wants to reach out. And my book is available on Amazon and Apple in ebook or in paperback. And if you get it from me directly, which you can do through the website, I will autograph it. And I even had branded face masks that I am sending to everybody is a little extra gift.

Kathi Sharpe Ross (45m 34s):
So

Dr. Anthony Orsini (45m 34s):
I bought the Kindle version. Maybe I’ll get the hard copy, hint hint.

Kathi Sharpe Ross (45m 38s):
I’m going to definitely be sending you the sign copy. with a mask.

Dr. Anthony Orsini (45m 41s):
Thank you. And all those links will be on the show notes. So if you’re driving, please, don’t try to write them down. This has been amazing. If you enjoy this podcast episode, please go ahead and hit follow. It used to be subscribe, and now it’s follow. And please download other episodes. If you’d like to hear more about The Orsini Way and what we do, you can reach me at Theorsiniway.Com. Thank you, Kathi This was amazing

Kathi Sharpe Ross (46m 5s):
So much for having me and I can’t wait to have you on the re-invention virtual chat series.

Dr. Anthony Orsini (46m 12s):
I’m excited. So thanks again. And we’ll be in touch real soon. Well, before we leave, I want to thank you for listening to this episode of difficult conversations lessons I learned as an ICU physician, and I want to thank the Finley Project for being such an amazing organization. Please, everyone who’s listening to this episode, go ahead, visit the Finley Project.org. See the amazing things they’re doing. I’ve seen this organization literally saved the lives of mothers who lost infants. So the find out more go to the Finley Project.org. Thank you. And I will see you again on Tuesday.

Announcer (46m 47s):
If you enjoyed this podcast, please hit the subscribe button and leave a comment and review to contact Dr. Orsini and his team, or to suggest guests for future podcasts, visit TheOrsiniWay.com.

Helping Parents of Premature Babies

Nick Hall (2s):
Well, I didn’t know what we were about to embark on. I knew that it was going to be a roller-coaster and I knew that it was going to require me to be something more than I probably had known myself to be in my life. So it just took on the approach of I wanna use and be present to this experience as fully as I can be, no matter the outcome. So that in the future, if there’s an opportunity to do something, to say something, to share something that could make a difference for someone else, that I’ll be able to do that.

Announcer (46s):
Welcome to Difficult Conversations Lessons I Learned as an ICU Physician with Dr. Anthony Orsini.The Dr. Orsini is a practicing physician and President and CEO of The Orsini Way. As a frequent keynote speaker and author Dr. Orsini has been training healthcare professionals and business leaders how to navigate through the most difficult dialogues. Each week you will hear inspiring interviews with experts in their field who tell their story and provide practical advice on how to effectively communicate. Whether you are a doctor faced with giving a patient bad news, a business leader who wants to get the most out of his or her team members or someone who just wants to learn to communicate better, this is the podcast for you.

Dr. Anthony Orsini (1m 32s):
Well, Welcome to another episode of Difficult Conversations Lessons I learned as an ICU Physician. This is Dr. Anthony Orsini, and I’ll be your host again this week being a Neonatologist, I’m exposed to a world that fortunately only a small percentage of parents have to endure. Statistically, about 10% of all babies born in the U S will need to be cared for in a neonatal intensive care unit. And for those parents of these very sick babies, their are plans of having a healthy baby that they can take home with them in a few days are shattered. Although the majority of the babies admitted to the NICU do well, sadly some do not. Many have long hospital stays with a series of good days, followed by bad days. And sadly, some of them do not make it.

Dr. Anthony Orsini (2m 14s):
These parents find themselves members of a group that no one wants to be in and nothing can prepare them for the long journey they must face. That is why I’m so happy to have as my guest today, two members of an incredible organization called Graham’s Foundation. Graham’s Foundation’s mission is to support, comfort in form and guide families who experienced a premature birth. They collaborate with the healthcare community and parents of preemies to improve the well-being of pre-term babies and families. First, we have Nick Hall with us. He was the founder of Graham’s Foundation. Nicholas has had many titles over the years, but the one he is most proud of being as a dad of Reece and Graham named after his son who was born at 25 weeks gestation Graham died after just 45 days.

Dr. Anthony Orsini (2m 58s):
It was Nick’s vision and desire to start the Graham’s foundation so that no parent who goes to the experience of prematurity alone. We also have the pleasure of having with us Laura Platt Kilstein, who was a micro preemie parent member of Graham’s Foundation. Her son was born at 26 weeks in January of 2017, and he is now a super high energy four year-old. She became a parent mentor in January of 2019, and she was drawn to volunteering to offer Premature parents the support that she had desperately wanted when she was going through the experience. Welcome Nick and Laura, thank you so much for taking the time to be with us today.

Nick Hall and Laura Platt Kilstein (3m 38s):
Well, thanks. Thanks for giving us the opportunity.

Dr. Anthony Orsini (3m 41s):
So I’m really happy that the universe brought us together and through a mutual friend in contact and many people, as I said in the introduction, really don’t know what it’s like to be in the world of neonatology. I live it every day, you’ve lived through it. And so the more that we can educate people about this, I think the better it is. And also I want to tell people from the top of the mountain about Graham’s Foundation and how wonderful it is. So I think its probably just best to start out if you will, or Nick, I really want to hear your story. And how do you share with the audience of your story of Reece and Graham and, and how you start at the foundation that I think that’s a great way to start.

Nick Hall (4m 19s):
Thanks Dr. Orsini. I remember Jennifer and I had a brief tour of labor and delivery and we did a quick walk by the neonatal intensive care unit. You know, it was kind of a standard tour for the expecting Parents and we were at a high risk pregnancy having gone through in vitro fertilization to become pregnant and then having twins. So we have some awareness of the potential risks, but this was probably only a couple of weeks before our world was turned upside down. So looking back, I think there’s so much and we were first-time parents. There’s so much that you’re concerned about and worried about. And I think if you spent too much time talking about the risks of premature birth and what that could mean, that would probably scare a lot of parents away from ever wanting to become a parent.

Nick Hall (5m 8s):
Looking back, I’m not surprised when they did a quick walk by at the NICU and didn’t spend too much time. Fortunately it looking at inside. But needless to say within a couple of weeks, Jennifer was put on bedrest of what we hope four would be several weeks of bed rest, but it turned out to be only, not much more than a week and gone in and out of the labor and delivery a couple of times for being watched. But then the last admittance only lasted three or four days. And I remember the advice was whatever you can do to try and avoid having your twins be delivered on either the weekend or a holiday.

Nick Hall (5m 51s):
So sure enough Thanksgiving day or 2006, the attending doctors said the risk to Jennifer is significant. We know the risks for Reece and Graham, but the risks to Jennifer are significant as well. So she had been through the magnesium sulfate, drip and all the horrors of that. And it was really nothing more. They felt that they could do to give with Jennifer and her twins a chance. So that day you get an emergency C-section 25 weeks or three days gestation. That’s my memory serves and you can imagine they were just a little bit over a pound each day and I’ll never forget as we were going from the delivery room to the neonatal intensive care unit where they would both be intubated the look on the Neonatologist’s face.

Nick Hall (6m 45s):
And I did not know what was going on, but I could tell that it was serious based on the look on her face. So that was kinda my first experience in the neonatal intensive care unit.

Dr. Anthony Orsini (6m 58s):
Why don’t we ask Lord to just tell us at the beginning of her story with her premature birth and that we could kind of talk about this day and some of the conversations that you had during this day. And of course we want to talk about Graham.

Laura Platt Kilstein (7m 11s):
Yes, That, thank you. So this was my first pregnancy. I had gone through IVF with my husband. I was considered maternally old or whatever, the, whatever they can say that, but there haven’t been any specific signs that there was a problem or are there any risks with the pregnancy? And honestly, I didn’t know that I had gone into labor. I was actually at home and my water broke, but I hadn’t yet taken the birthing class. Tell me what that was supposed to be like. And I’d already had a little bit of the pregnancy related incontinence issue. So I just thought that’s what that was. And it just didn’t stop, but it was like 10 o’clock at night.

Laura Platt Kilstein (7m 54s):
And I was like, well, I don’t know what this is. Instead of calling the doctor, I was like, Oh, well I think its probably just the other stuff that I was having and I went to bed. When we got up in the morning there was blood, so then I was like, okay, there’s obviously something going on here. I called my doctor and the doctor was on a weekend And doctor was like, do you need to get to the hospital now. And that, and I still didn’t know why, because I wasn’t having any contractions or feel any labor. I got to the hospital. My doctor met me at the labor delivery and they hooked up the monitor’s and she was like, you’re in labor and your water broke. And because your water broke we really can’t do anything.

Laura Platt Kilstein (8m 35s):
Or if it doesn’t advance, we’ll just keep you in the hospital in advance rather quickly. They didn’t really tell me what was going on. Other than they move me to a different room and said you were in labor and we don’t know how long you’re going to be in labor. And but you’re in active labor and they had a nurse from the NICU come in to the room and say, your baby will be born early. So he’ll be taken. So the NICU, but at the hospital that I was at had a NICU, but they didn’t have a high enough NICU. So they brought in the Neonatologist and they said that once the baby was delivered and stabilized, they were going to send it to a different hospital. So my son was delivered at nine o’clock at night of January 15th and I didn’t even get to see him.

Laura Platt Kilstein (9m 18s):
They have a whole bunch of people around him and intubated him and everything and then took them away and then still stayed there, like not knowing exactly what was going on. They came back and when the ambulance was coming to transfer him and I was allowed to see him in one of the, like the incubator type things and the left and then my husband left and followed the ambulance with the other hospital. It wasn’t that far away, but my mom stayed with me and everybody that was there just to left. And I have no idea what was going on in until that next day. And there were so many things breaking through my head. ’cause, you know, it was 26 weeks. So I knew that it wasn’t that bright to be born that early, but I didn’t know what that meant.

Dr. Anthony Orsini (9m 56s):
So at that point in your life, as I heard a social worker say, and really I love the way you put this, both of your lives were redefined that day. And you went from expecting parents to parents of extremely low birth weight infants with all that kind of a whirlwind going and sadly for Laura didn’t even get to stay with her baby. And that’s always a very difficult. So as Nick and I talked about and many people, know from the audience that I’ve been teaching at a program called breaking bad news for the last 10 years, and we’ve done thousands of doctors in workshops and it’s something that most people don’t realize that doctors don’t have any training in this. So the first bad news that you heard among many, I guess we can start with Laura.

Dr. Anthony Orsini (10m 38s):
Was there going to have this baby? So do you recall that conversation or when did you feel about that conversation? And do you remember anything?

Laura Platt Kilstein (10m 46s):
Yeah, I do. I remember so many minor little details. I just know where my husband and I we’re in a labor and delivery room and hooked up to the monitor. My doctor came up to me and she was, she had tears in her eyes and she’s like, you’re going to have this baby. And I’m a really hysterical, no I can’t. No. And then just sort of it as well, I guess they have to do this. And I kind of almost felt like something else was, it was happening to me, but I wasn’t there. I was sort of going through the motions until they came from time to actually deliver and push. And then I started panicking again. I suppose if somebody who maybe had explained a little bit like what I was going on or what was going to be the process or what to expect, that probably would’ve helped a little bit.

Laura Platt Kilstein (11m 26s):
But I mean, I know my doctor and just, it just so happened that I went into labor when my own personal doctor was on call from the OB GYN he group and she was crying. She looked scared. And so that it didn’t make me feel comforted, but I also felt like at least like she was in this with me.

Dr. Anthony Orsini (11m 43s):
So that’s a really important that you said that and after interviewing hundreds of parents about the time that they heard the bad news and patients, this was a common theme. The appreciation that you have, that your doctor had a tear in her eye or was crying. And that she was really in the moment with you. We had a guest, one of the early guests on this podcast, Noelle Moore, Noelle Moore lost a child shortly after birth. And she now runs a project that’s one of our sponsors called the Finley project, which helps mothers who’ve lost babies. It’s an amazing organization like yours, but Noelle Moore still describes really to the very smallest detail about a teardrop that fell from her doctor’s eye that landed on his beige khaki pants and she remembers the exact spot.

Dr. Anthony Orsini (12m 30s):
And so that’s just the, the power of communication that I think. So Nick, how about you all have a sudden this conversation? One of the things that we say in this podcast is at every critical moment in your life starts what a difficult conversation. And certainly that would apply,

Nick Hall (12m 45s):
Right? Yeah. And for me, Jennifer was quite ill for several days. And so I was the interface almost exclusively with the doctors, both with, as it relates to Jennifer, but also with Reece and Graham. And I don’t remember a specific, there are so many conversations. I can’t remember the specificity of the conversations, but I do remember the energy. I’m very much a kinesthetic. I know that’s how I communicate very much feeling and emotions. And so I can remember the emotion of the Neonatologist as our twins were transported to the NICU. It was similar, maybe a S ups sadness or upset as Laura spoke, but it didn’t believe me with a feeling of hope.

Nick Hall (13m 33s):
So it was a feeling of, Oh, this is bad. I was what I was allowed to with this is not good. And then as I think about transitioning into the NICU after the twins were intubated and I guess had they’re, you know, the term I forgotten it, but the, you know, the first 20, the golden hour an hour. Yeah. Right. And everything’s great, I think is fantastic.

Dr. Anthony Orsini (13m 56s):
For those of you who don’t know, the he golden hour is a timeline that Neonatologists use for the very sick premature babies. And studies have shown that if we can get them intubated and stabilize and put all of their lines in within the first hour that their outcomes are a little bit better. So yeah, there’s a lot of rushing. And as a neonatologist, I have to balance that soft-spoken time with the parents, with the fact that I know that there’s a clock ticking.

Nick Hall (14m 21s):
Well, I think we got to take it to take action. And if we can explain what we’re, you know, it was just so we can later. So I just, I do remember there were over time that there were a certain Neonatologists that I would have a conversation with. If we had to talk about sort of, it can be the hard facts, give me the details. And then not that every Neonatologist didn’t have the capacity for that, but then there was some where clearly, if we want it to have a softer Conversation and more emotive and more, what should we do? And we’re thinking about the process, the journey, and there was a particular Neonatologist that we really leaned on for those conversations and the same thing with the nurses.

Nick Hall (15m 4s):
If we found some were very emotive and some were more technical and in time, I knew which one I wanted to put a new line in if, and when that was necessary, if I had my choice for my option. So a part of it for me, it was not expecting every doctor and nurse to have the same skill sets. It’s a team approach. And over time, recognizing that and understanding that and being able to know how you have an idea that I have a sense of maybe who to talk to her, who to approach depending on what we needed to needed to talk about.

Dr. Anthony Orsini (15m 41s):
So now they are admitted. We are within the golden hour and Laura doesn’t have her baby with her in the same hospital. That’s got to make it even harder. And then we start this long journey. Nick, let’s start with this. So there’s this 45 days journey of Graham. So tell us about Graham and what happened at the

Nick Hall (16m 2s):
While we quickly learned a lot right? So Graham was a baby B. So he was a guest sucking off the fumes of Reece if you will, within the womb. And so while they were born minutes apart, they were not developmentally minutes apart. You could just tell Graham was smaller, was less mature. And of course he learned statistics over time. That graham was male, of course. And he was a Caucasian. And as long as we are not as well developed. And so you just need to catch some breaks and he just didn’t catch any of the breaks that you need too. And it was never a really successful at breeding on his own, his intubation It came out for some reason after maybe 35 days or so, we decided to give it a go.

Nick Hall (16m 53s):
Maybe there was a reason why many ad it was like you had a good maybe 12 hours or 24 hours. And then quickly went, kind of went downhill from there. And the last, probably it was several days. It probably was longer than several days at it, but he was the concern every day, doing the blood gas at the end, they were throwing everything. But the kitchen sink, it felt like in the final days, we knew that. I think we felt that if he were to somehow have eventually be able to survive, given the trauma that he had to endure, the things that we could see physically, and just kind of understanding that the ability for him to have any quality of life, it was really no longer are no longer viable.

Nick Hall (17m 44s):
And we had time to think about it. I had a chance to talk to another parent that had to make the same decisions, we knew that was, we knew it was the right decision and the best decision for Graham.

Dr. Anthony Orsini (18m 9s):
Of course, they’ll have to, all these years you could hear Nick’s voice and how emotional he is. And that’s a decision that no parent should ever have to make. It’s a decision that as a neonatologist, I’ve been involved with more often than I’d like to say, but one thing I can say universally is that these difficult decisions that parents have to make are always done out of love. And that’s a universal thing that I have seen, and I could see that Nick still struggles with it, but that is also was one of love. And I’m so sorry, Nick, that you had to go through that and why you got to yourself.

Dr. Anthony Orsini (18m 49s):
I want to talk about how you turn that into the Graham’s Foundation and turned this tragedy into it. Laura, your son fortunately did well. It sounds like by it, I’m sure as I say to all of my patients, if it’s two steps forward and one step back, so there must have been some incredible bad days and good days. How long was he in the hospital?

Laura Platt Kilstein (19m 10s):
So Joshua was in the hospital four 99 days. Yeah. It was like a week or so. It was so I was like, Oh, I didn’t get to see him until I was discharged from hospital. So it was like two full days before I got to see him. And he initially for like the first, very few days, like everything seemed to be going okay. They actually extubated him. And then the doctors and nurses kind of said that some premies run out at the gate really, really great. And then in the mail, after about a week or so things start to go downhill or there are complications arise. And of course that’s what happened. He, he went into kidney failure.

Laura Platt Kilstein (19m 51s):
They explain to us about the PBA and the issue about it, not closing, but because he was in kidney failure, they couldn’t try to even attempt to close it medically or that they were going to have to do it for a surgery. So she had a PDA ligation and I think like 29 weeks, 20 to 29 weeks. And it just seemed crazy that if a baby that was not, it barely weighed two pounds, was going to have an actual surgery. And the surgeon that did it was like he kinda made light of it is that this is so routine for me. I could do this with one hand tied behind me back and it would be the eyes closed. And I, my husband was like, Whoa, it was like, I’m just kidding. I won’t do that. So it was a, it was an attempt at humor that didn’t necessarily go too well.

Dr. Anthony Orsini (20m 35s):
How’s that make you feel when he did that?

Laura Platt Kilstein (20m 37s):
To me, I was like, okay, well, if this is so routine and this was no big deal, it, my husband and not take it that way. My husband met me and my husband were nervous, but once they did the tubal ligation, it was amazing. The first time you got to see him afterwards, his color, a change, he was taking it as opposed to like the grayish pallor have beingsickley and took on another week or two for his kidney function to, to go back to normal. So then my husband and I approached, okay, this is okay. And then they hit you with the retinopathy of prematurity.

Dr. Anthony Orsini (21m 7s):
Well, that’s a, retinol disease of newborns and a premature babies.

Laura Platt Kilstein (21m 11s):
So I just said, Oh, well, there was going to be a, a retinologist type of knowledge is gonna come through it. And they come in every so often and check all the babies. And they came in and of course they said, well, he had some ROP because he was on oxygen. So that was one of the things that they had to monitor and eventually correct itself at the time he was two years old. So we were all fortunate about that. And then he got to, would they like the graduate faze from the micro premium room to a regular NICU room. And then they moved him there. And that was kind of like a culture shock too. My husband and I, because in the micro premier room, they were keeping the lights low. Everyone was talking quietly, the monitors returned down. They were just sorta trying to recreate that the womb type of environment and cluster care and everything.

Laura Platt Kilstein (21m 56s):
And then we got into the, I call it the adult, baby room and it was a shock because there were so many babies, the lights were bright, there was more noise. And it got to be really difficult because you would see lots of babies come in and leave from your still there. And we were still there. We’re still there when we were still there. Or the other hiccups that we had is he went home on an NG tube when we tried to transition it into a bottle of feed around like 33 weeks. And he wasn’t doing it for whatever reason, the speech therapists was, they were just going to wait until he’s discharged, do anything. And when that news came to my husband and I live in a full panic mode, because what would that be like, how are we going to do that?

Laura Platt Kilstein (22m 37s):
And I would say a credit, the nurses were really good with us practicing on dummies, practicing with our baby, but basically being our cheerleaders. And like you are going to be able to do this. And if the line comes out, you’re gonna be able to pull it back in and that you’re going to be able to do this. You guys can do so much. You don’t realize how much you can do it. It will be fine. You will be fine. And I guarantee that if the nurses hadn’t taken literally days and days of simply telling us over and over that you can do this. It’s okay. It’s not the ends of the world. I don’t know that things would have gone as smoothly when he was discharged.

Dr. Anthony Orsini (23m 11s):
Communication is so important and as to be effective and compassionate, and now he’s doing well, right? He’s how old is he now four?

Laura Platt Kilstein (23m 20s):
He is four and from a physical standpoint, he doesn’t have any residuals. He was a little smaller than kids, his age, but my husband and I aren’t real tall to begin with. So all our pediatrician was like, well, maybe he got us a little shorter end of the stick, but you, no, he wasn’t gonna be a giant anyway. So we’re very fortunate. And we have been told by doctors, I had ever see him, the different doctors that we gone to be thin going to see a kidney doctor for him just to keep an eye on everything. And everybody else says that, like, it’s a miracle that he is where he is today. And I a hundred percent credit, the NICU, you know, doctors and the nurses took care of him because they were like for him to have been born so early and have grown out of every issue that came out because he was a preemie, It’s just amazing.

Dr. Anthony Orsini (24m 10s):
That’s a true blessing. And so Nick back to you, and I wanna thank you for really sharing the emotion with the audience. It’s an unimaginable feeling that almost no one has. And so thank you for sharing. I know this was not easy for you, but I do want to move on to that experience. Reece did Well, correct the rest of the way. Reece is doing okay?

Nick Hall (24m 35s):
Yeah, Reece is doing okay. It was a journey. It was a 119 days. So a bit passed her due date. We were home for a couple of weeks. She developed what we thought was hydrocephalus, and that was a case. So if she needed an emergency shunt. The journey did continue. As parents have premature babies discover that graduated from the NICU to the home on the one here, it is a celebration in, and all of the responsibility is yours. And you don’t have doctors and nurses at your bedside to answer on that.

Dr. Anthony Orsini (25m 8s):
So all of a sudden, you don’t have this monitor monitor in your baby. Like we always thought it was kind of odd. The hospital will not let you come off the monitor until the babies discharged, but then you get that one parent said to me, can I take my baby off the monitor? It was like three hours before discharge where the lawyer’s and the legal people won’t, let us do that. And she goes, yeah, but it, in about three to six hours, I’m gonna be at home. And I said, I thought that it was kinda hard. So let’s talk about that. Sadly Graham passes and there was an incredible moment with you and your wife and the sadness that goes along with it still happening. What made you then at one point, say, I’m going to start this foundation of what was your thought about the Graham’s Foundation? And when did you start it?

Nick Hall (25m 50s):
In some respects, I started it at the moment Reece and Graham are born. And that’s because I was aware that everybody wants to have a great story of if there was a miracle, they made it through our, and we were fortunate. Aren’t we lucky? And I know that not every story ends up that way. While I didn’t know what we were about to embark on I knew that it was going to be a roller-coaster and I knew that it was going to require me to be something more than I probably had known myself to be in my life.

Nick Hall (26m 32s):
So it was just took on the approach of, I don’t want to use and be present to this experience as fully as I can be. No matter, the outcome so that in the future, or if there is an opportunity to do something, to say something, to share something that could make a difference for someone else, that I will be able to do that.

Dr. Anthony Orsini (26m 59s):
Right. ’cause, there’s really nothing out there for parents of premature babies. Like I said, its a small group of people and we had, I had a patient once that wrote it, a photo journal book called catching media rights about the journey of a Premature baby. And she wrote her because she said there was nothing out there to help me. And there is nothing to prepare me for this experience. I’d like to ask you a question, Nick, because of something that I’ve always wondered, what are the special circumstances about being the father? And I’ll tell you why. I asked that. I always tell them in my classes and workshops, especially during the death and dying that many fathers have shared with me, the contrast between trying to grieve, but feeling a responsibility to help the mom or your wife get through that.

Dr. Anthony Orsini (27m 47s):
And many times I’ll tell the nurses to make sure that we don’t ignore the father or it was around the mother and she was holding and the father’s sometimes tests in the background, just out of curiosity. Do you feel that it’s a special circumstances where the father or a different, I should say, not special?

Nick Hall (28m 1s):
You know, I may have had a bit of a different experience myself personally, but, and that is because I was there every day. I was able to through fortunately my employer and my manager, my team, and they were totally on board and supporting me. And I was doing a lot of the communication with friends and family in terms of sharing, I guess it was in Facebook updates, blog updates, I think back 15 years ago. But I was there every day. I was at the bedside along with Jennifer and I was communicating right alongside when they were grand rounds, et cetera. So I think we had a very much a team approach. And so I always felt included because I was also there and being a part of it.

Nick Hall (28m 48s):
That being said, I was certainly an anomaly when I looked around and I think a similar probably experienced a Laura of a room of maybe a dozen micro premies. And I typically was the only father that was there for such an extended period of time. So more,

Dr. Anthony Orsini (29m 7s):
The times the fathers have to go to work and as somebody who has to go to work, they don’t get the time off. It’s a difficult situation. Yeah, totally.

Nick Hall (29m 15s):
Yeah. I mean, there’s all sorts of other things we can go into about and things of that nature and why it’s difficult for both parents, but typically often times, especially the father because the mother is and rightly so the closest connection physically to that baby or babies. So I think father is routinely, its like we are the ones that are responsible for doing things or fixing things or the logistics and that kind of thing. That frankly, if your baby, as a patient in the NICU, there’s really not a whole heck of a lot for you to do and day in and day out and not a whole heck of a lot happens unless it’s something that you’d prefer not to have happened.

Nick Hall (30m 0s):
And so I know it can be a challenge for other fathers, not to feel included in there for not to feel empowered, to help with making decisions when those decisions need to be made.

Dr. Anthony Orsini (30m 14s):
Laura, did your husband have to go to work? Do you think it was the same experience for you and him? Are you and he or different?

Laura Platt Kilstein (30m 22s):
So I would say obviously at the initial, you know, when we were separated and who was not the same experience, but since he just was our only child, so we both were there every day. We no, I was fortunate with my job to be able to kind of shift my schedule around so that I could start earlier in the morning and then would leave. And what would usually happen is I will leave work at like three 30. I would go home and my husband and pick up my husband and we would go to the NICU and we would spend from probably five to about seven, 7:30 every day.

Dr. Anthony Orsini (30m 54s):
Right. And by the way, a a a hundred days it was a long time. And my NICU, there is some others who have to go back to work. I don’t want to think how difficult that must be for them.

Laura Platt Kilstein (31m 3s):
The thing was is that I talk to my work and that I went back to work after the first week, I thought I wanted to leave all of my maternity leave for one of the rest of my maternity leave for when my son was going to come home. And I was fortunate that my employer said that it was okay. So I have 11 weeks later when he’s came home and we both work and we both went and it was a lot of it. It was a blur to be honest, trying to think about what happened that I was like, Oh a a hundred or so days we just can’t. I went through the motions and it all hit me after like he came home and that’s when I like the emotionally immensely actually dealt with what was going on or what I have been through.

Dr. Anthony Orsini (31m 45s):
So that leads us into the Graham’s Foundation. Nick, tell us what the Graham’s Foundation does. You know, this audience has a pretty large audience that I think we have mostly, I’d say 75% healthcare workers that a subscribe to this and many of them are in the neonatology world because that’s just my world. Yeah. So I think it’s a really good that if you could just tell us, so you said you had thought about starting it all at least immediately, but what made you start it and what was the purpose of it?

Nick Hall (32m 10s):
You know, it was pretty simple. It was here I am a parent, well educated. I have an excellent job with insurance. I’m not worried about fortunately again, not worried about paying my bills, had a supportive family. So in so many respects, I had every circumstance going for me that I could, I didn’t feel for wanting anything other than to bring my babies home and with all that it was completely overwhelming. But yet you have to feed yourself, which I did a lousy job of, you know, lost weight. You’ve got to pay your bills. I figured out I did, but it’s just like, you know, you just stop worrying about anything outside of this,

Dr. Anthony Orsini (32m 56s):
The world and Laura is nodding her head. Yes, yes. For the audience. Yeah.

Nick Hall (32m 59s):
Okay. And so I’m thinking if I am struggling and I’m like prepared for this, I’m ready. I can deal with this. And yet I’m struggling to deal with it. What on earth? Our other parents who are our other parents are, what are they doing? And then if all of a sudden it was a struggle for gas money just to get to the NICU or with the complications of work. And I knew that, that there is no fixed to this is the yi and the yang of the technology of modern medicine. I have benefited from it in my life. I understand if this is part of that journey, but if I’m struggling again, what most other parents be dealing with. And so the emotion of it really was for that baby to have the best possible outcome is going to require parents that feel that they are empowered to be a parent, that their voice actually makes a difference.

Nick Hall (33m 54s):
And as soon, or they get that, the better off the baby is going to be. And maybe they don’t get it until they’re home and be responsible for the baby, but maybe they get it earlier and maybe they start to see that they can speak up because maybe they noticed something. I mean, we notice things that saved, you know, one of Reece his fingers, we noticed hydrocephalus in the Neonatologist. Unfortunately he said, no, it was catch up growth. It wasn’t. But again, you, as a parent can notice things that the doctors and nurses might not necessarily notice. And so you can make a difference and you, or your voice does matter. And the sooner you can get involved the better. And so my hope was that over time we would develop and we would find ways to connect with Parents and to be able to encourage them to care for themselves.

Nick Hall (34m 45s):
Number one, and then you are a parent, your voice matters. And to bring that to your next conversation that you have with the doctor or nurse or your family, you know, you could have to deal with family that doesn’t understand why you’re making decisions that you’re making. And, you know, it does require a level of communication that is, is perhaps on life. What many of the parents have had to deal with before, right?

Dr. Anthony Orsini (35m 11s):
But there is sometimes a family that really doesn’t understand the only people that can really understand that the people that went through it and sometimes people are well meaning and say things that really aren’t very helpful.

Nick Hall (35m 22s):
Absolutely. Well-intended well, meaning and you just got to have to smile and say, OK, thank you for sharing and continue on, but it’s amazing. You no. And I started Graham’s almost 11 or 12 years ago. It was, it, it is, has always been, we don’t want to any parent to go through this journey alone and what that means it could be, you know, I’m going to think about Graham’s Foundation. It might just be reading the blog posts that our various parents share, or it could be interacting with our MyPreemie App. And using that to journal your experience. My wish is that every parent had a mentor like Laura had another parent to talk to.

Nick Hall (36m 3s):
It’s the hardest thing to get to is for our parents to be willing, to open up and be vulnerable and talked to another parent. But it it’s the simplest form. It’s the lowest technology. And it has the greatest impact. We didn’t have a mentor program when we started that just naturally evolved. And I mean, I couldn’t be more thrilled at that. You know, it’s one of the features of support that we offer it through Graham’sFoundation

Dr. Anthony Orsini (36m 27s):
And Laura, what made you become a mentor what went through your mind? And how did you get in touch with Graham’s Foundation and connect with them.

Laura Platt Kilstein (36m 35s):
Sure. So when I was going through, when we were in the NICU, I really wanted to talk to somebody that had gone through it all because I didn’t know anybody like most people, I didn’t know anybody that had actually gone through anything like what we were going through. And I just found that the hospital I was at it didn’t really offer a type of support in that way. They were obviously offered us over a tremendous amount of support in different ways, but they couldn’t experience it. Like another parent would experience it. And then after we got out of the NICU, I still felt very isolated. Cause there are issues, as an extent said that come up or previous that don’t come up for regular children that are born at full term.

Laura Platt Kilstein (37m 19s):
And it’s not really knowing where to go, where to look for that. I spent about a year or so. Just kind of going around where I live out in the Chicago area, trying to see if any of the other hospitals had a support thing. Cause I really wanted to give myself to somebody else. So that the knowledge that I have so that somebody else wouldn’t have to feel so lonely about it. I found Graham’sFoundation and it was all excited. Cause I said, Hey, I’m an online my submission about how, what I really want us to be the mentor. And I think initially it was told, so we don’t have any real space for you right now, but it was really upset. And I was like, this has never going to happen. And then a few months later, they reach out to me again. They’re like, since you’ve got to do it and I was like, even when you were going through it, you don’t even know what it is you want to ask or what you should be thinking about.

Laura Platt Kilstein (38m 2s):
But simply to know that there was another parent who made it through the NICU and is on the other side, they can say it will be okay. It turns out okay. Or even if it doesn’t turn out, okay, you can talk to somebody that says, Oh, I know what it’s like to make these kinds of, you know, choices or decisions in the harder it is. But it’s just, nobody can really understand what you’re going through, except someone that’s gone through it.

Dr. Anthony Orsini (38m 27s):
That’s a very profound statement. I think that is really important. And both of you, it always astounds me to see how people turn tragedy into something good and the endless compassion of human beings like you and, and Nick, who wantto help others. It’s one of the amazing things about a human beings. I think that so many people wanna give back and, and I’m really grateful for organizations like Graham’s Foundation for you and Nick and all the other people involved. I live this every day. Most people don’t know about it, but it is a real need for this support group, finding commonality with someone that you can speak too.

Dr. Anthony Orsini (39m 7s):
And I can speak to preemie parents from a doctor’s point of view, but I have no idea, even though I live it everyday, I have no idea what is that a premature baby and all the, you can speak about that. And so I am so glad Nick, what kinds of things that it Graham’s Foundation offers for people out there that want to need help? What are your offer? And then at the end, we’ll tell you all about how they can get in touch with you.

Nick Hall (39m 31s):
Yeah, sure. So we have what we started with initially. So we have a care package program. So we have a care packages that are uniquely designed for when a parent is first in the neonatal intensive care unit. And we have a Care package for when they transitioned home, knowing that it’s a new journey, but we have a care package that were proud of For remembering a baby, if you lost your preemie. So we have our care package, a program, we have our mentor program, of course. And as Laura mentioned, we had probably two to three times as many parents that would like to be mentors. But what we don’t want is mentors that don’t have mentees. And so we’re always wanting to find opportunities certainly to mentor more parents, but we’re really proud of the mentor program.

Nick Hall (40m 18s):
And then when we have the industry leading MyPreemie mobile app, which is available in English and Spanish in Android and iOS app, that helps Parents to not only journal their experience, but also there’s the ability to kind of track the growth of their baby at a feeding tracker. And it has a lot of really useful of all the different terms that come at you. And it has a nice short summary of all the different terms, but not only the term itself, but also then suggested questions to ask If what’s the blood gas, what is, you know, what’s a PDA ligation and if someone says PDA, well, why is that important?

Nick Hall (41m 1s):
Why, what are the, you know, so again, like also to give you a question that I asked so that you can, again, we want to give parents a voice. So we’re really proud of that as well. And certainly just the art sort of digital presence of the website. And that includes all the blog posts that Parents share and the, the social media presence. It’s just, it’s ways sort of be connected. I think kind of to observe, I guess, is as a parent, if you wanna sort of observe and understand our voice in our intention and, and then see if it kinda makes sense then to take that next step and really connect with us directly.

Nick Hall (41m 41s):
And, you know, in terms of following up Graham’s Foundation.org, G R a H a M S Grahams and then Foundation.Org has the best way to connect. Cause they’re, you can directly request care package. You can connect with mentors like Laura, we have a whole platform for that and linked to the mobile app, et cetera.

Dr. Anthony Orsini (42m 4s):
And we’ll put all of that on the show notes so that if you’re driving, as I say, you don’t need to pull over to write this down and it will be all of the contact information from our Laura and Nick will be available on the show notes. This is a wonderful organization. I’m pretty certain But correct me This is a 501C3 and donations are a tax deductible. And that’s just a wonderful thing. I know that there is a massive need for this or that you should be having as short as a mentors, not mentees and more people just need to hear about this and we will do our best. And I will do my best to spread the word because this is an amazing thing. And again, turning tragedy into something good and a legacy for Graham, and this is a wonderful organization.

Dr. Anthony Orsini (42m 50s):
I really support it, guys. Thank you so much for taking the time to do this. If anybody wants to find out more about Graham’s Foundation, we’ll put on the show notes. If you enjoyed this podcast, please go ahead and hit subscribe or follow on an Apple or any of your podcast platforms, or you can contact me through the Orsini Way.Com. Thank you again, both of you. This was a real pleasure. I can wait for my audience to hear this.

Nick Hall (43m 14s):
Thanks Dr. Orsini.

Dr. Anthony Orsini (43m 16s):
Thank you, Laura.

Laura Platt Kilstein (43m 16s):
Thank you.

5 (43m 17s):
So if you enjoyed this podcast, please hit the subscribe button and leave a comment. And for me to contact Dr. A C and his team, or to suggest guests for a future podcast, visit us at the Orsini Way dot com.

Conversations about Listening with Colin Smith

Colin Smith (1s):
I mean, I think the first hurdle to get over is that most people think they are good listeners when the not, they look at it and they go, oh, I’ve got two ears what’s your problem? But it’s the difference between hearing and listening. And I use a very simple thought, which is we hear it from, we listened to, hearing is passive. It is about keeping us safe. Listing on the other hand, I have to intend to listen. If I wasn’t listening to the people I was referring to it, I would not have noticed what had happened. Cause I noticed the subtle shift. There was something that happened. And it could have been I was picking out visually. I could have picked it up hearing or even just a sense that something wasn’t quite right.

Colin Smith (48s):
So once that’s happened, they say, Oh, okay. So maybe I don’t listen very well.

Announcer (55s):
Welcome to Difficult Conversations Lessons I learned as an ICU physician with Dr. Anthony Orsini. Dr. Orsini is a practicing physician and President and CEO of The Orsini Way. As a frequent keynote speaker and author. Dr. Orsini has been training healthcare professionals and business leaders, how to navigate through the most difficult dialogues. Each week, you will hear inspiring interviews with experts in their field who tell their story and provide practical advice on how to effectively communicate. Whether you are a doctor faced with giving a patient bad news, a business leader who wants to get the most out of his or her team members or someone who just wants to learn to communicate better this is the podcast for you.

Dr. Anthony Orsini (1m 40s):
Well, welcome to another episode of Difficult Conversations: Lessons I learned as an ICU Physician. This is a Dr. Anthony Orsini, and I’ll be your host again this week. You know, this podcast is all about communication and an essential aspect of good communication is listening. I believe it’s a lost art in this fast paced world. And that’s why I’m especially excited to have as my very special guest, someone who is commonly known as a listener. Colin Smith, as one of the UK foremost listening skills specialists, he works with individuals as well as teams, within organizations who want to be heard, think smarter and transform their business and personal relationships through active listening.

Dr. Anthony Orsini (2m 22s):
He has an innate ability to actively listen to people, enabling them to articulate their creative ideas, address their personal concerns, express their feelings more easily and to achieve their personal professional and life goals. Having had a varied and successful career in consultancy business development, it and customer support across many sectors, Colin realized much of his success was due to his listening and connecting abilities. This led him to develop a series of programs to develop these skills and others. The importance of which organizations are now waking up to. His inquisitive and curious mind leads and to explore an unusual thought provoking yet grounded observation and alternative approaches to business, people, systems, change and innovations.

Dr. Anthony Orsini (3m 11s):
Well, Welcome Colin, and this is a great topic that fits perfectly into our podcast. And so I’m really happy to have you here today.

Colin Smith (3m 17s):
Yeah. Thank you, Tony. It’s a pleasure to be here.

Dr. Anthony Orsini (3m 20s):
I like to start off all the podcasts because they think it’s always so important for the listeners to get to know the person who is speaking on a personal level. And in fact, we had just talked about it, a Ted talk that I’m giving coming up. It will probably be done by the time this podcast airs, but that Ted talks all about being a genuine person and why it’s so important for doctors and patients to be relatable. And so I think let’s start off with who’s Colin. And how did you become The Listener and your journey and, and how you got here to this moment, which is the peak of your career to be on my podcast.

Colin Smith (3m 57s):
I think, is this a fair question that I often think about it is that bizarrely I am in the third half of my life and in the first half of the three halves, I was working in IT and understanding how computers worked and how they connected. In the second half It was more about working with people, understanding how they worked and how they connected. And in the third half, which has been really probably the last 10 or so years has been more about really connecting people and connecting people with a difference and making a difference. And if I look at that latter part is the challenge for me has been finding myself and I’ve been blessed.

Colin Smith (4m 42s):
And I say, I see that really honestly, about having to go in and go through two divorces. So we’ve got two children, one from each, but each of those has been move on in a way from, if you like to be coming more about who I really am. And that’s why I look at this as the third half, ’cause what I’m now doing is embodying more about who I am. And the idea I started when I sent my own business up as Dexterity Solutions was about connecting with people who make a difference and it still wasn’t quite right. So I knew there was some iterations going on from there. And I looked at the idea of positive deviance, and these are the people who see the world differently, but actually these people often introvert have a bigger vision than themselves, but they don’t shout about it, but there are actually transformational change people.

Colin Smith (5m 36s):
So could I find a way of getting these CEOs of organizations to understand and value these people more than they are now, and also be a voice for those positive deviants who aren’t really sharing themselves particularly well. So that got me thinking and it’s about seeing the world differently. So often when I talk about listening, I see that I’m actually pushing back against everything that’s going the other way. So we were looking at more texting, more messaging, more e-mail more curating who I would like to be rather than being someone real in front of someone. So in this conversation, for example, if I mess up, I’ve got to recover from it. But if I say something that you might not appreciate, I’ve got to recover from it rather than what is it I need to create about myself, that Tony will like.

Colin Smith (6m 26s):
And therefore I start putting on a facade, not being who I am now, and that’s hard work. So I work with that for a while. And then I come up with an idea which I called disruptive dialogue, and then explain to you that it’s two, three hours with me, but there’s no agenda, no perceived outcome. And I was paying for it. It’s a real hard sell that you’re going to have that. So that didn’t last very long. And then over lunch, one day we come up with the idea and we were talking about it and she said, one of the things you do really well is listening. And then we thought, well, what about a listening coach?

Colin Smith (7m 6s):
And the idea was like, this thing, coach has a fixing part of it. And I thought, well, maybe the listener, which is not about fixing it is about listening. And that was where it was born. And what’s lovely is that people send me things. I’ve had one recently from someone who I knew pretty about eight years ago, having spoken to them since, and he’d found an article on listening and he saw it, thought of me and just sent an email.

Dr. Anthony Orsini (7m 36s):
That’s fantastic, but listening is a lost art. And I mentioned it in the introduction. And as you mentioned, there’s this fast paced world of tech and emails and people don’t generally list that. I heard someone say once, you know, people listen to respond, not to really hear. And I find myself doing that ever since I heard that phrase, especially in medicine, there is a great book, famous book called How Doctors Think. And in that book, the author talks about exactly that, that while a patient is responding and were trained in thinking and algorithms yes or no. Yes, no. We might as well be computers and how, because we’re really not listening.

Dr. Anthony Orsini (8m 17s):
How many medical errors and problems that happen in misdiagnoses. So why do you think that, and is it getting worse? Why do you think that people are having more and more trouble listening?

Colin Smith (8m 27s):
Yeah. I think the point that you made and I was alluding to it earlier is that we were getting caught up on the screens and it’s easier to be someone we’re not, but maybe if you start to look underneath that, there’s a sense of, I’m not enough as I am. So the more we can curate my image in anticipation of this is what the recipient might want, Ah I’ve done that. Now, now I’m going to be liked more. I’m going to be accepted. I’m going to get more likes and all of those sorts of things that if I look at it the other side, and it’s interesting, you referred to a particular book, There’s a piece of research done where they interviewed or were watching doctors when they were receiving not a new patient necessary a new patient, but a new condition.

Colin Smith (9m 19s):
And what they found is that three out of four doctors interrupt the patient before they finished speaking. So they’ve gone through your algorithm. Yes. Tick, tick that the note, right? Like is the answer. And what they found is that those three or four interrupt the patient before they finished speaking on average it’s 18 seconds. And for me, I’ll have a sense that when that happens, I haven’t been to speak in and you were already starting to produce the prescription. This is why I get it. And I go, okay. And then I get to the door and I stopped. And I say, Oh, just one other thing. And I finish and the doc says come back here let me have that prescription, tears it up and then write a new one.

Colin Smith (10m 0s):
But I also think that they’re missing. And I think one of the things I’ve heard with doctors is they’re asked to really listen to your patients because they will tell you what’s really going on. But also the other bit is in that is how much confidence do I have in what the doctor’s given me to take? If he or she hasn’t listened to me well enough, I don’t feel heard. I don’t matter. I don’t feel valued. And that is for me as that spiral down, which is the last thing that doctor’s want. But when I talk about that, also say to people in the audience, are you an 18 second father, an 18 second manager, an 18 second leader and you can see people going.

Colin Smith (10m 45s):
Yeah, I am. So when people were coming to me with a problem, I listen to them for a short while I know the answer here it is, get it done.

Dr. Anthony Orsini (10m 53s):
But so many people, what I do, my workshops, we do a little bit on conflict resolution, which I’d like to hear your opinion on also, but sometimes you’ll be dealing with the complaint. They’ll be an unhappy patient. They’ll be an unhappy customer. And we’ll do this little exercise. And I’ll say, what’s the patient really saying? So the person may be complaining in the hospital about the food or a routine procedure with no risks, or maybe not wanting to sign a consent form. And we’re going, why would this mother or this patient not want to say that in many words what did the patients really say? I just wan’t a little control. I try to teach are in conflict resolution to not only listen to the words, but also listen to the non-verbal cues.

Dr. Anthony Orsini (11m 38s):
You know, this is an audio only podcast, but it’s very important that I’m seeing you right now on screen, because it’s really difficult to interact with somebody when you can’t see their facial expressions in 70 to 80% of the language is non verbal. So I guess there’s the, in there somewhere, but can you comment on that a, about the non-verbal and it may be just, let’s start off with a bang and just, how can I be a better listener?

Colin Smith (12m 4s):
I will answer that question. There was a bit, which you alluded to is a question just before, before that, in that, which is the nonverbal cues, and this has happened two or three times that during a conversation where we were just really exchanging ideas, views, helping each other, think better, things like that, but I’ve noticed the subtle shift in, or perhaps their voice, or perhaps the tone perhaps their facial expression. Maybe their eyes or something. And I’ve said, Oh, are you okay? And they have gone. Yeah, I’m fine. And they said, okay.

Colin Smith (12m 45s):
I just thought that might have been something that shifted then when they go, well, actually your right. Yeah. It’s something you said triggered something. Or when you were talking, it brought something up for me, which I find particularly upsetting. And when it happens in a one-to-one, you can let the conversation go to that place. If they want, if its in a smaller group, then it’s a little bit harder. But just noticing even over zoom, you can still notice these subtle things. So I would say from the point of view, being a better listener, I mean I think the first hurdle to get over is that most people think they’re good listeners when they are not, you know, they look at it and they go, Oh, I’ve got two ears what’s your problem?

Colin Smith (13m 28s):
But what’s the difference between hearing and listening. And I use a very simple thought, which is we hear it from, we listen to. So hearing his passive is about keeping us safe. Listienng on the other hand, I have to intend to listen. If I wasn’t listening to the people I was referring to, I would not have noticed what happened because I noticed the shuttle shift. There were some things that happen and it could have been known as picking up visually. I could have picked it up a hearing or even just a sense that something wasn’t quite right. So once that’s happened, they say, Oh, okay.

Colin Smith (14m 8s):
So maybe I don’t listen very well. So we also, we interrupt a lot. In fact, probably far too much of a Nancy Cline with her amazing work all the time to think he would actually say that. Actually she says that interrupting is an assault on the other person. And when I get people to do a non Listening exercise where the speaker is sharing something that is important, then the listener starts with being interested and then gradually just drops off. The conversation, starts to look away their watch and it goes on like that and do it in fact to the disconnect and to ask people what that’s like.

Colin Smith (14m 49s):
And for the speaker we say, I start to think stupid. I didn’t get my thoughts. My thoughts started disappearing. I don’t understand it because I’m thinking, why would they stop listening to me? Why is he keeps looking at his watch? And why is he turned away from me? I think it’s my fault. Is it that I am not interesting. I don’t matter. My words are not important and all of these things, but it also, interestingly for the listener, they say it was really difficult to do. And this is an exercise was difficult to do because I was interested them. But I also thought it was rude. And I say, but we do this all the time. You know? So if I’m talking to you and my phone goes off and I got, Oh, you don’t mind do you.

Colin Smith (15m 33s):
And I picked my phone up. How would that work? If you did it in your Ted talk, you a phone rings and you’d pick it up and we start talking or you don’t mind, do you, okay, thanks people would, what is going on? So it was rude, but we do it. So learning not to interrupt as much as we possibly can. You know, there are going to be times where I got one minute, I need to get this sorted. I need an answer that slight different. But in the main, if we don’t, we also think at different speeds so I can talk it around a 120 150 words a minute. But you can process as a listener about three times as much, 450 words.

Colin Smith (16m 13s):
So there’s a gap. So how do I feel that gap? What usually happens? We get taken off somewhere else. I start thinking about what I’m going to go later. What about dinner? What are we going to get to the grocery store, et cetera, rather than focusing more on the person that is speaking. So what’s going on for them? How am I feeling what’s going on? Those sorts of things. But it’s also true the other way. But I also am thinking of 450 words or more of a minute, but I can only get a hundred and twenty-five words out. So the moment you give me the chance. So when you pause as you are doing so when I stop, because I’m thinking you are not interrupting me, you are not jumping on My, at the end of the reason that pause.

Colin Smith (16m 60s):
So my thinking continues. You might repeat by asking me the question again, or you might say, and what more, but the flow of my answer keeps coming up. And in that pause in my thinking, I get the chance for the second wave of thinking to come through. And the third wave of thinking, and you can ask that and what more questions? Five, six, seven times. There are only often they say, you know, I think you’ve asked it twice. So I’m settling. I’m thinking better. The quality of it is Improving. Also the relationship is changing too I’m starting to like you more, I’m starting to trust you more. I’m feeling more comfortable with you.

Colin Smith (17m 40s):
I’m willing to open up to you a little bit more as a patient. This is something that I probably wouldn’t say it to you normally, because I’m not sure it’s important, but what I’ve noticed is this and this and you think, Oh my goodness, how valuable was that piece of information for me or in a sales role when you do it? And the customer said, I don’t normally tell people, but this is going on in the company. And it’s really worrying me. But for me, there seems to be some disagreement within the board members. And I am beginning to feel more and more isolated. So we share more with each other and we can hear them all.

Dr. Anthony Orsini (18m 21s):
You were talking about people not paying attention and going on their phones and you have two children. I have three adult children. And in order to get to be an adult, they have to go through their teenage years. And I remember many conversations where speaking to my kids could be about anything in right in the middle of the sentence, one or the teenagers do they picked the phone up, then they start texting. Yep. And what is astonishing to this generation? And I’m not putting them down at all. It’s just different. Is that when I would call them out on it, they had no idea why that would be so insulting to me. And I would say to my child, Dad’s talking to you, you were having a conversation and you’re in the phone and they go, Oh yeah, but I’m listening Dad.

Dr. Anthony Orsini (19m 3s):
And so we have a lot of conversations about eye contact. Cause I think that’s preparing them for business. And I think, and I like you to comment on that. But when you’re making eye contact with someone it’s awfully hard for me, I use that as a way to stop you from looking down. Because if I’m looking straight into your eyes while you’re listening, or while I’m speaking, you feel a little, especially rude If you break the eye contact no?

Colin Smith (19m 28s):
To me, I have a, a phrase “going away to think”, Oh, so this is me going in a way to think. And if I come back to you and you’re looking somewhere else or at your watch, it interrupts my thinking, why is he doing that? And it’s not a staring contest. Yeah. It’s sort of light. But then it’s a knowing that your there with them. And I’ve always to get a sense that were moving more from a doing to society, to being with society. I’m not at you, I’m with you.

Colin Smith (20m 11s):
And you imagine that in a medical environment, you know? So when you are arriving to your patient, they know that you’re going to be with them. It feels like you’re with me not doing to me and you absolutely. Right. I believe With the bureaucracy and the paperwork they have to do, I bet it can feel like that. So it was going to ask you a question relating to what you were saying with your children when they pick up the phone or someone is doing something similar while you were talking to them, how does that feel for you at that moment? If you can just put just self into that, what was that like for you?

Colin Smith (20m 51s):
What does it feel like?

Dr. Anthony Orsini (20m 53s):
Well, if I believe it, it makes me feel like I don’t matter that what I’m saying is not important in that I can’t be that interesting If half way through my sentence, you decided to answer a tweet and you know, sometimes my kids, you know what, we’ll be having a discussion about politics or history. And sometimes they’ll go right to their phone. And what I realized in many instances, they’re actually fact checking,

Colin Smith (21m 19s):
Yeah, right.

Dr. Anthony Orsini (21m 19s):
My wife brought it out. Cause my youngest one is very bright and he they’re all bright, but he is really into history and say something and he’ll go right to this phone. And my wife brought it up. She said that he was back checking you, which I guess it was fine. But if you’re going to do that, and I say this to the doctors all the time multi-tasking, as we know is a myth, there is a book called the myth of multitasking, which says that your brain can’t really do two things at one time. But sometimes you as a physician or maybe you have to look something up, maybe you are having a meeting or a business meeting and something comes up and you need to check something I think is important to say to your patient, I’m just going to look up your lab right now. ’cause we assume that a patient thinks that he knows that’s what we were doing with the patient might think, you know, he was looking for a tee time.

Dr. Anthony Orsini (22m 9s):
So it’s all about communication. And if you can’t listen, then that you certainly can’t communicate in your right about the doctor’s interrupting. It’s that algorithm. And I’m not sure how to get away from that because the medical schools are designed right now to still teach that, you know, do you have pain in your arm? Yes or no. They moved out in yes or no. It doesn’t leave any room for our narrative. And we know that when there is a narrative medical errors go down, malpractice goes down because you are listening. And you know, as you said, a lot of times people do leave the doctor’s office feeling that their questions aren’t answered. We did a, an internet survey about two years ago.

Dr. Anthony Orsini (22m 50s):
I think it was about 300 patients that we surveyed in 73% of them said that they frequently left the doctor’s office, feeling rushed without their questions answered. Frequently. And so that’s a huge, and you know, and sometimes it’s out of a misguided, respect my father and I’ll give him a list of things to do. And he goes to see as physicians to ask him about your blood pressure, ask him about your cholesterol after he is done, I’ll call him him. But what did the doctors say? Did you ask them this? No. You know, he seemed rushed. I didn’t want to bother him. So it’s about taking control of your own healthcare and, and in the boardroom right now, I think we have a listening crisis.

Dr. Anthony Orsini (23m 31s):
I’m looking at the politics on the United States and in the UK and everywhere else. And no one is listening to each of us. If you don’t agree with me, you’re automatically wrong. And it, is it a generation thing? Is that, what do you think it’s getting worse or better? I think I asked you this already, but if it’s getting worse, why do you think that it is? Is it the technology?

Colin Smith (23m 53s):
My gut feeling is it, it is more about technology. I think we have rushed. We are trying to do more than we can. So we were stressed with probably more self-serving than we ever used to be. There is less respectful for each other. We’re all fighting our own fight. And the downside is, you know, we are seeing things that are sort of a societal level about mental health, suicide, loneliness, and things like this. And it’s kind of forcing us down that road of, I will look after myself, but if I can do that, that’ll be enough. That’s all I got. The capacity for. It is concerning it. I genuinely think that there is a crisis. You just get back to when you answered a question, I posed about how it felt to a grown man who are intelligent, man, you’re a professional man.

Colin Smith (24m 40s):
And it still was like that for you. And Oprah was saying that when she has people that she interviews and it could be a presidents, it could be mom and dads, people in prison. These sorts of things, she said pretty much every single one of them when we finished, leans over and said, is that okay? Is that all right? Whatever it is, we all need that reassurance that we matter. And so her intention when she’s interviewing people is to validate them. And if all doctors did, If or managers did, was to validate the patient, that their team members, their colleagues, these little things that if we did them a little bit, would make a big difference.

Dr. Anthony Orsini (25m 26s):
Oh, absolutely. It sounds simple, but not as easy. I wish he can come down to the Washington DC in and fix this. Last time we spoke, you mentioned something called survive, dive and thrive. Can you expand on that and tell us what that is all about?

Colin Smith (25m 42s):
Well, thank you. Yes, its the way I’ve used three words to describe the three different dimensions of the work that I do. And the first one is referred to as a survive and it is, I need to be heard. So what I’m here for now with you is to listen fully empathically, actively deeply to you, to not judge, to see you as an equal, to not interrupt, to give you that space so that you feel heard, you feel validated. As we said earlier, the second one, which is about what I call dive is what we found is that the quality of my listening can increase the quality in depth of your thinking.

Colin Smith (26m 27s):
All too often, we give people the answer, really not always, not all the time. So what do you think ’cause even an answer to that question in your respecting them. I want to know what your answer is. I’m interested in the answer because your answer matters. You know? So it might be that when the doctor’s ask them a question or my thoughts could be this, or what do you think? They actually know It doesn’t feel right for me for whatever reason. And sometimes when we’re asking these questions, encourage it to another level of thinking. And we talked about the ways of thinking.

Colin Smith (27m 8s):
And so the quality of my listening increases the quality of your thinking. And then the third, which is what I call Thrive is more about teaching people, the power of listening and some say it’s a super power. And there has been examples of two in particular. One is that you don’t fix it. And I was coaching a young dad and interestingly, so I’m not sure if it’s an age thing, probably in his early twenties, I got a girlfriend lived with her and the conclusion of he came from it at the end of one of our session’s was that for the next two weeks between now the next one is that I’m going to do everything that I can to not fix the problem. So are not offering a fixed or a solution.

Colin Smith (27m 49s):
And he wrote me about three days later, said, I can’t tell you how different the relationship is now. And he said, it does genuinely feel like a super power and all that I’ve done Is not try and fix. I’ve just listened to. And the last time he said, his girlfriend turned, ran to him. So thank you for listening. And that’s amazing. And then the second one, this has happened in a series of workshops that I’m running with different groups and it’s called the three second pause. So wait three seconds after the person has finished speaking. Not all the time, because it can be a bit contrived, but just keep doing it and notice what happens if they keep talking, they tell you more and they’re loving it.

Colin Smith (28m 34s):
Absolutely loving it.

Dr. Anthony Orsini (28m 35s):
I love what you said about what do you think again, just relating that back to what I do. We know that one of the biggest problems with medicine is that it requires trust between a doctor and a patient. I’ve always thought now that we have Google and there’s a lot of misinformation out there that if you don’t and this has been proven, if you don’t trust your doctor, you’re unlikely to finish your medicine. You’re unlikely to follow up. And so trust is really important. And if I said Colin, I think it’s your hamstring. What do you think? And you’re thinking, there’s no way that it’s my hamstring. It’s my back. Then when I prescribe something for your hamstring, you’re going to leave there going, Dr.

Dr. Anthony Orsini (29m 19s):
Orsini is crazy. I don’t trust him. He’s not going to take it. So I think that’s fantastic advice for any person who is a doctor or a nurse out there in health care, ask them what they think. Because if there are too polite to tell you, I think you’re wrong, then they’re just going to leave there and they’re not going to listen to you anyway. And then medicine breaks down. So medicine and I believe this with all my heart and soul, but medicine and life is all about trust. If I don’t trust you, if were on the board together right in business and you and I don’t trust each other were not going very far are we?

Colin Smith (29m 57s):
Totally. So as you listen more to the level of trust goes up as long as your intention is good. So if it was a doctor or as a board member, right, okay. I’m learning this listening malarkey to manipulate people into believing me. Rest assured people will pick up your intention and then it got, are you saying all the right things? But if it doesn’t feel right, there’s something else. There’s a hidden agenda.

Dr. Anthony Orsini (30m 28s):
Well, and I think about the boardroom, I think about a bunch of men and women interrupting each other, arguing, giving their opinions, not listening. And in many cases, they’re the man or a woman who’s sitting in the corner and not saying anything. I, I feel like that’s you. And then in the end, if someone says Colin, you’ve been awfully quiet, what do you think? And then lets out three or four sentences. And everybody goes, wow, he’s really smart. When probably you might not be the smartest person in the room. You were just the only one listening and its so important.

Colin Smith (31m 1s):
But all too often, the person doesn’t get asked. They are not invited into the conversation at the beginning. So Nancy Kline again, talks about the circle about inviting everyone into the conversation at the start, sharing something that’s valuable for them or they’ve done well or on their project or something that personally it has happened, but it gives everyone a chance to speak. And now we’re all in, in the conversation and recognizing that there is no inequality just because you speak more. It doesn’t mean you have a voice has more authority, more power, et cetera. So giving everyone the chance and also the chance that they can pass.

Colin Smith (31m 42s):
If I’ve got nothing to say on this subject, I can pass. But otherwise I am in the round with it. And then

Dr. Anthony Orsini (31m 50s):
I love that. One of my first episodes interviews was with someone called that Kathy Caprino. Okay. And she was on the first and Cathy as a coach and an executive coach for women and teaching them how to empower themselves. She’s an incredible person. She’s a Forbes writer, really, very impressive. And, and she talked to you about that, that many women in the executive boardroom are quiet. There are really good listeners, but many of them leave without being called on and never imparting their wisdom on the group. And so Kathy helps them with the process of how to listen, give your statement and be heard without being offensive. And, and so you, you were discussing sometimes people don’t ever a call on you.

Dr. Anthony Orsini (32m 31s):
It brought to mind Kathy’s great interview inside. It definitely recommend that you think it was like one of our first or second interviews. Wow. This has been really informational, but also inspirational. You’re not going to get out of here though without the toughest question that I ask, everyone gets this question. What is the most difficult conversation that you’ve had to take part in? And can you give us some advice on how you navigated through that conversation in your respect, that would be by listening and responding to it and you can se type of conversation or you can be specific.

Colin Smith (33m 4s):
Yeah, yeah. I like the question. It would be very easy for me to just come up with an answer, but I’ve let that sit, you know, because I was thinking about it, the answer, and then I thought, do you know, all the conversations can be difficult. So if you’re someone who’s not very good socially, even just go into a pub and having a conversation is difficult. So I thought, so what is it that makes conversations difficult or uncomfortable? And what I came to was this idea that it doesn’t feel safe. So safety is a really important element. And part of some of the workshops I’m running, I ask them about psychological safety and there’s a whole raft of work has been done on psychological safety.

Colin Smith (33m 53s):
And part of it is one or two things I can do to make the environment I’m in or the space I’m in or the conversation I’m in a much safer or a little bit safer, such the deeply encourage or the other person to speak. And a simple one might be when the CEO comes in or perhaps a senior physician and says, we got this particular problem. This is what I think. What do you think? Now the majority of them will go, Oh yeah, that sounds like a great idea rather than saying we got this real problem. I am curious to know what you people think because good CEO is good Physicians will acknowledge an answer.

Colin Smith (34m 34s):
Or if they decide that we listened to everyone in the answer they pick was the one that they were coming with. I don’t need to have that as my answer. I can let them have that as their answer. And then we go in with Joe’s answer. So the little things that we can do and the heart of it for me is about listening. So the more we listen, the more trust the safe for the environment is obviously in this, that it’s got to be good intention, that the more trust there is, the safer it is. The more likely is that the conversations are going to get better. So if I’ve got some things I wanted to say to you and it doesn’t feel safe, I’m not going to say to them, if you’re encouraging me, you or it’s becoming more and more of a safe environment for me to do that.

Colin Smith (35m 15s):
And then I might say, you know, Tony, there’s a couple of things I’d like to pick up with you and you go, what’s that then? So immediately I’m trying to backtrack. Now we’ve got two things. Now they need to tell you, and how am I going to mitigate what I say in a way that you’ll find that acceptable. But if I start to share it, you don’t interrupt. You see, Oh my gosh, that I hadn’t realized. I’d tell me I’m now interested when we going, really thank you for that. That has been very helpful. And even just those few things might encourage me to tell you some more or next time I can tell you some more or when I speak to someone else and they say, we’ve been asked to come and see him, Tony, and then I’ll get it.

Colin Smith (36m 4s):
Don’t worry he will listen. Thank you so much. The quality of my thinking improves because I’m relaxed and you know, all of the science behind it, the biology behind and now thinking because I am relaxed. So it’s much easier. So I can think because it’s not stressed. I am not worried that if I say something wrong, I could be fired. How many times in organizations we say, we’ve got no blame culture. And yet at the moment that somebody steps up or steps out, we were not the heads-up, what are you doing that again? And other people go, well, why would it be doing that for myself? And then we ended up with the, the Enron situations, the, the challenger situation, the, the, the Hubble telescope, all of these different things, because people were frightened to speak up and speak out.

Dr. Anthony Orsini (36m 50s):
So I love that, you know, it’s about safety and how many CEOs, it seems like every CEO goes, I have an open door policy. You, but you know, that’s not true. That door is open, but they don’t walk through it, but there are more and more companies. We’ve had Siobhan McHale on, Claude Silver, James Orsini talks about changes in culture, in the boardroom and in the business. And I think that there is a movement towards not only talking the talk, but walking the walk. And I’m optimistic about that in an, I think that our young people, although sometimes they have a reputation that may or may not be good. They are really driving this culture change and they are stepping up and saying, I don’t want to be treated like that again.

Dr. Anthony Orsini (37m 32s):
I would add to that whole culture of safety. There’s a concept in my book that I call it hard to fire your best friend. And it’s something that my mother used to tell me. And what it means is that if you are relatable person, if you really want people to feel safe and be a regular guy, be aregular girl, the CEO who walks in the room, or the physician who is in charge of walks into the room and ask somebody about their children or talks about the baseball game last night, there are real people and, and you feel safe immediately. So I love that advice and this has been nothing but advice. Colin, this has been great. And I promised my audience every week that they’ll be inspired and you’ve done that.

Dr. Anthony Orsini (38m 15s):
And you have certainly really helped us with our communication skills. I want to thank you for your time. I want to thank you for being so gracious and sharing all your wisdom with us. This has been really great.

Colin Smith (38m 26s):
Thank you. I really enjoyed my time with you and thank you for the questions and for making me feel safe and welcome.

Dr. Anthony Orsini (38m 35s):
I hope we can keep in touch and be friends. If you enjoyed this podcast episode, please go ahead, hit follow Apple now went from subscribe to follow, but we are also available on different podcasts platforms, such as Spotify, Amazon, and Google play. If you want more information about the Orsini Way and what we do, you can visit my website at the Orsini Way.com. Colin, how do people get in touch with you? What’s the best way?

Colin Smith (39m 3s):
The best is the website at Dexterity Solutions all one word Dexterity Solutions.Co.uk, right?

Dr. Anthony Orsini (39m 6s):
And I think if you are a business that or anyone who really wants to use Colin’s services, I would highly recommend them. This has been one of the best 45 minutes of learning that we’ve had. Thanks again, Colin. I appreciate it. Thank you.

Colin Smith (39m 23s):
You too. Take care.

Announcer (39m 24s):
If you enjoyed this podcast, please hit the subscribe and leave a comment and review. To contact Dr. Orsini and his team, or to suggest guests for a future podcast. Visit us at the Orsini Way.com.

Speaking the Truth - Debriefing Nurse Leaders

Lori Gunther (2s):
I would say leadership exhaustion is real. I often will say I had a call with a C-suite leader last week, and I said, so let me ask you something. What do you do? Who takes care of you, who talks to you about your leader fatigue and what is your experience? And she said, nobody, nobody. And so that’s what I love is that we can say, well, regardless of your position, if you were in a leadership position, we can help you. We have a community for you.

Announcer (38s):
Welcome to Difficult Conversations: Lessons I learned as an ICU physician with Dr. Anthony Orsini. Dr. Orsini is a practicing physician and President and CEO of The Orsini Way. As a frequent keynote speaker and author, Dr. Orsini has been training healthcare professionals and business leaders, how to navigate through the most difficult dialogues. Each week you will hear inspiring interviews with experts in their field who tell their story and provide practical advice on how to effectively communicate. Whether you are a doctor faced with giving a patient bad news, a business leader who wants to get the most out of his or her team members or someone who just wants to learn to communicate better this is the podcast for you.

Announcer (1m 23s):
.

Dr. Anthony Orsini (1m 24s):
Welcome to another episode of difficult conversations lessons I learned as an ICU physician. This is Dr. Anthony Orsini, and I’ll be your host again this week. Well, continuing on our quest to inspire each and every week and learn valuable communication techniques. I am delighted this week to have Lori Gunther as our guest, Lori Gunther is chief executive officer at Synova associates and a board member of the patient experience Institute. She became a partner at Synova in 2019, bringing 20 years of NICU and perinatal industry experience to the company. She was previously the senior director of NICU innovation at the March of dimes, where she directed their professional education portfolio, spearheaded the development of the March of dimes training Institute and provided the strategic vision for the NICU family support program.

Dr. Anthony Orsini (2m 15s):
A trained professional counselor. Lori is also nationally recognized expert in the fields of patient experience, crisis intervention, PT as the communication skills and maternal fetal health. She has recently published in advances in neonatal care on how to improve, implement parent education in NICUs. Well welcome, Lori, thanks so much for taking the time to be here today.

Lori Gunther (2m 39s):
Thank you so much for having me.

Dr. Anthony Orsini (2m 42s):
You and I, our paths have crossed a few times over the past few years, I’ve done some stuff for you. One of the best things about doing this podcast, to be honest with you is that I get to meet people, but this is our 40 something episode that we’ve done. Although I already knew you we’ve become really much closer and become friends in the last few weeks. So that’s just a total perk on my part. So it’s great to get to know you as a friend. I like to start off every podcast with the audience getting to know who you are, because I think it’s really important as I always say in my workshops, you have to build trust and be a genuine person first. So if you don’t mind, let’s just start out with telling me who Lori Gunther is, your journey to through the March of dimes and how you got to Synova and then we’ll just see where this takes us.

Lori Gunther (3m 32s):
Okay, great. Well, I think given what we’re going to discuss or what I know we were going to discuss, it makes sense for me to talk a little bit about my counseling background and my years as a therapist. So I went and got my undergrad in both politics and psychology at Ithaca College. And then I went on to grad school and got my master’s in community counseling. And I picked community counseling cause I really wanted to focus on victim services and crisis response. And I wanted to work within a community where I felt like my services and my support that I could give to victims mattered. I also was very interested in finding my own voice.

Lori Gunther (4m 12s):
I was a believe it or not a very quiet child. And I had been really impacted as a senior in high school by a session around finding your own voice and a young girl who had been exposed to domestic violence and then shared her story. And I just thought there was such power in that process that I couldn’t tell you her name. I could tell you what she looks like, but she really changed my life. And I thought I want to do that. I want to have that kind of impact. And so that really began my sort of love and passion for speaking, what was my own truth, but also being compelled to speak for those that couldn’t find their voice.

Lori Gunther (4m 56s):
And so that is how I ended up. I wanted to learn how to debate. That’s how I ended up in politics. That’s a major, but I also really wanted to be sort of in a counseling and helping people heal. So right out of school, I worked in two different victim service centers and I was part of the Nova crisis response team, which is the national office of victim assistance. And believe it or not, that was right around 9/11. And that was my very first crisis response that I was called to at a national level. And I wasn’t allowed to respond because I’m from long Island. And I knew people who were in the city, family members, you know, I grew up on the South shore, everybody on the South shore, you know, FDNY.

Lori Gunther (5m 42s):
So I wasn’t allowed to go and feeling like I had this skillset, but I couldn’t go because I was too close to the trauma. What I ended up doing was debriefing the people who had gone onsite as the crisis counselors. So I started to learn the impact of the debrief as a way to ward off post traumatic stress for people who are in critical response situations. And I felt that it was as important as being there was being able to be for the people would have been exposed and re-exposed to trauma over and over again, who are my colleagues.

Lori Gunther (6m 23s):
And so that sort of began a love for the idea of how do we debrief people who are constantly seeing traumatic events happen and they’re being subjected to that. How do we ward off post-traumatic stress? And so that’s kind of where I started. I thought I would do that for the rest of my life. And in 2002, I had my first child, he’s now 18 and in college, yeah, he was born with birth defects and I was a young mom. I didn’t know that before I had him that he would have birth defects. We actually didn’t know everybody was so surprised to go. You didn’t know? I said, no, we really didn’t know until he came out, we looked at him and I said, what’s wrong with him?

Lori Gunther (7m 9s):
And I couldn’t believe given the type of work that I did, that there were no services in place for me as a parent, nothing crisis related was offered to us or done. And I thought there has to be a different way to do this. And so I ended up going and working for the March of dimes actually moved. I gave up a really successful practice that I was in at that time. I was also traveling and speaking all across the country and big universities doing trainings on sexual assault and dating violence. So I was set and then I thought there is this need for young parents.

Lori Gunther (7m 49s):
And then also for the healthcare workers to understand and communicate better about the experience and how can we support them. And so I went and worked at Albany medical center’s NICU in 2004. And that started my journey with the March of dimes, all the, you know, working my way up all the way to the national office as a senior director.

Dr. Anthony Orsini (8m 9s):
It’s really interesting how life as they say, the universe pushes you in certain directions. I’ve heard this before, when you can’t make a decision, don’t worry. The universe will push you. My journey’s similar. I always wanted to be a doctor, always wanted to be neonatologist. And then as I talk about it in my book, this really profound incident that happened when a doctor really struggled with giving bad news. And so this was something that really impacted me. I was thinking about doing this and I really wanted to research and teach how to break bad news. But one day in my church, I’m Catholic and there’s a little retreat that I did. And they played a video from Dr.

Dr. Anthony Orsini (8m 51s):
Rabbi Kushner, the famous man who wrote when bad things happen to good people. And I had kind of read the book or knew about the book, but when I saw his speech that day changed me because that was a lot about the things we say, communication, what people feel and how it impacts them the way they hear the news. And at that point, I said, I’m going to dedicate my entire career to teaching doctors and nurses, how to have these difficult conversations. You are mentioning this person. I think you were a senior in high school that just change it. You went from this shy person to this amazing speaker and then 9/11 comes and you want to help.

Dr. Anthony Orsini (9m 32s):
And it pushes you into this whole debriefing, which we’ll talk about later. But as you’re speaking, I’m going the universe is really amazing, you know, with your son. And I do believe now there’s so many people that are benefiting from what you do. The other comment I’ll make is we talk about PTSD and we’ll talk about that later on. But I think nine out of 10 people, if you said PTSD, the first image that comes to mind is military. And that’s what they think. And they think, well, this only happens to military, but we had on a few episodes ago, we had Dr. Susan Wilson and she deals with second victim syndrome. But it’s a topic that I really want to get into later on.

Dr. Anthony Orsini (10m 13s):
But before we do that, so you’re through the March of dimes. You told me Nova, tell us about how you got more involved in, Synova what they do. And I think the last time we spoke, you don’t have the best timing in the world. Do you?

Lori Gunther (10m 29s):
Sometimes I just wonder about things, but if there’s one quality that I know for certain about myself is that I am an absolute survivor. So I thrive in chaos. My dad used to call me captain chaos. So I do really well in a crisis situation, being thoughtful about how am I going to get myself out of this situation? What is my path? And then I can fall apart later. So I excel in that crisis situation, but I think, you know, I’ve always loved this concept of educating.

Lori Gunther (11m 8s):
And when Ethan was born, he had multiple things wrong with him. But really the thing that I heard the most from healthcare workers was it’s just cosmetic or he’s going to be fine or be so thankful he doesn’t have a syndrome. And what I knew was that my baby was going to have 18 years of surgery. What I knew to be certain was that I felt I had done something wrong and I guess he was about nine months and he had a major surgery and he coded on me at home. And I remember I could tell you everything that I was doing, the movie, I was watching everything.

Lori Gunther (11m 50s):
And I thankfully was trained in CPR at the time. And something me go check on the baby. Now he was in like a full where he couldn’t touch or do anything. You know, he was restrained because of his face. And I remember going up and he was blue and picking him up and his whole body went limp, I don’t remember this but my father-in-law will tell me that I started screaming that the baby was gone. And it was in that moment where I thought may no mother ever hear what I’ve heard since he’s been born, which is our experience Isn’t valid the way that we see it, or the perception of what has happened to us when I had to do CPR and, you know, bring Ethan back.

Lori Gunther (12m 34s):
I was a changed mother. I will always treat my first differently because of that situation and be, as it may, I thought something has to be different. How do we educate the hospital staff to not tell me that? It’s, it’s just cosmetic. If I heard that one more time, I was going to scream. So I think when I got to March of dimes, I really felt very strongly like use my voice. I know I have one I’ve been training for many years. How do I do this? Anything you asked me to do? I would always say, yes, it didn’t matter that I had. Now I had another baby. I didn’t care if I could be out there training and talking to doctors and nurses about at first, it was my experience.

Lori Gunther (13m 16s):
But after a while I found, I didn’t even need to share my experience. I had enough things that I had been sort of privy to and working in the NICU or things that I had seen happen that I thought could have been handled better. So I kind of went on a quest like you did, which was, how do we have better conversations? How do we engage our own empathy? How do we listen more? And think about our words. We never really know what people’s stories before we launch into that, that sort of prerecorded speech that we have. And so being thoughtful about that, it was very important to me. And so when I was at a level at March of dimes, where I was the senior director of strategy and innovation, I was invited to go to a Synova conference.

Lori Gunther (14m 0s):
I think that was probably around 2011. And I had just taken a promotion. I had just had my third baby and they said, you know, this might be good for her. She’s now taking on all new staff. Let’s send her to the leadership conference. And I remember sitting in the background and Peggy Gordon, who was a CNO in Children’s in Missouri, she spoke about her leadership style and it changed me forever as a leader. And I remember walking away, my boss and my boss’s boss were with me, and I said, it’s all different now.

Lori Gunther (14m 41s):
I know what I need to do to engage my team. And I was very proud of the fact that during my time there, I never lost an employee. I never had anybody resigned. That was something I’m very proud of. And it was really every year I wanted to go back, I would fight to go back because to me the energy, the engagement was so important to me. I got to know the people at the conference. And then I was asked to speak and do general sessions. And then I was invited onto the planning committee. I said yes to anything. Yep. Whatever you want. I’m here.

Dr. Anthony Orsini (15m 14s):
That’s fantastic. You said a couple of things. I think you use the term, engage our empathy. And I firmly believe that as physicians and nurses and not everyone in this podcast audience is in healthcare, but physicians and nurses have just natural empathy, natural compassion, it’s within us all, but it doesn’t always manifest that. And we don’t always show it. And I think a part of that is becoming task-oriented, but a big part is also, we’re never taught how to convey that empathy. And so I think that’s what you do is so important because it brings us all to light. Synova brings us to light. And you also said how excited people get in the energy at these Synova conferences because people really want to learn, right?

Dr. Anthony Orsini (16m 1s):
We are just doctors and nurses. Sometimes people say, you know, it sounds like when you give these lectures about poor communication, that you’re being negative. No doctors and nurses are incredible people and therapists and leaders. And it shows when they get so excited at these conferences. The last thing I’ll comment on also is that nursing leadership. And we keep talking about that. That’s what Synova does. One thing that I learned before this podcast and has been solidified with all my guests is that the same communication skills that are required for a physician or nurse to speak with a patient are the same communication skills that are required for good leaders. And if you can learn to master those communication, you can be good at both.

Dr. Anthony Orsini (16m 47s):
Right?

Lori Gunther (16m 48s):
Absolutely. My mom was a nurse leader. She was a manager of an ER. So it was a little girl and she kind of stepped away from that when I was in my early teens, but I was raised by a nurse and my dad was a CEO and he was a CEO of a small company that he grew from two employees up to 400 employees. And he just loved taking care of, he was an excellent leader. And when I was, gosh, a teenager, I didn’t have a choice. I went to work for my dad and he put me in HR. So you learn how to talk. You learn what’s good. I still say things that he told me, which is his mantra was don’t come to me with a problem.

Lori Gunther (17m 29s):
Come to me with a solution. I can’t well, everything, even though my title says president and CEO, I surround myself with the smartest people and we brainstorm together, but don’t come to me with just a problem. And all of my staff know that I’m going to say that. So before you walk in the door, come to me and say, what’s potential solutions. And let’s think about it together because teams together are so much better. And what I love about my job, because I do feel as though I have the most incredible job in the world is that I’m here to make teams stronger. Most of the time, what you just said about doctors, the nurses, the empathy and compassion is there, but what’s also, there is exhaustion and sort of, I would say leadership exhaustion is real.

Lori Gunther (18m 19s):
I often will say I had a call with a C-suite leader last week. And I said, let me ask you something. What do you do? Who takes care of you? Who talks to you about your leader fatigue and what your experience? And she said, nobody, nobody. And so that’s what I love is that we can say, well, regardless of your position, if you were in a leadership position, we can help you. We have a community for you and that’s been fantastic. But you asked me, how did I end up owning Synova? I was, it was a fun process.

Dr. Anthony Orsini (18m 55s):
Yeah. I was talking about your timing. You bought it right before COVID correct?

Lori Gunther (19m 0s):
Yeah, I was, I had a great team, but I knew I was ready to move on from the March of dimes. I kind of had done what I felt I was ready to do. And the Synova partners at the time asked me to lead a strategy session about the vision and growth potential of their company. And so I brought my, see I’m a vision person, but I brought one of my team members, one of my staff with me, and she’s an executer 100%. Like I have the vision that I handed to her and she tells me if we can do it. And if so, how? And so Melissa Gail and I went together and we, we did all the interviews and the dialogue, and we had this big strategy meeting with the partners.

Lori Gunther (19m 41s):
And I remember we were sitting in the airport after the meeting and we were kind of speechless. It was so fun. There’s so much potential for this very small company that was really run as a side business. They had two events and she said, what are you thinking? And I said, I don’t want to draw a strategic plan up and not be part of it. Yeah. So she looked at me and she said, I’m in. I said, I don’t think I could do this without you. And so we decided to leave our job. We made an offer on the company. It was accepted. And nine months later we bought the company, which was in 2019.

Dr. Anthony Orsini (20m 22s):
So right before the pandemic hits and like all of us were struggled through the pandemic. As you said, you’re a survivor. So you got through that and the universe pushed you because I think correct me if I’m wrong. This pushed you into this debriefing that we’re going to talk about. And PTSD, I think before COVID, as I mentioned before, PTSD was only military. Nobody even thought about doctors and nurses, the term healthcare heroes. I’ve never heard that term before COVID and now people were seeing visions of there’s these stock videos on the internet all the time about these, the doctors and nurses, or exhausted lying on the floor in the hallway, we’ve all seen them.

Dr. Anthony Orsini (21m 4s):
And I think the public is a little more aware now of how difficult this can be on us. And I think the secret’s out of the bag now, and maybe that’s the first step towards getting some help. The professional burnout among doctors and nurses, as you know, is an all time high physicians now have the highest rate of suicide of any profession. And maybe this COVID, if anything comes out of this, maybe this will bring this to light. So tell us about the debriefing and the PTSD. And last time we spoke, you were so excited about these sessions. So tell us about this, because I think it is so timely right now.

Lori Gunther (21m 41s):
Yeah, certainly. So, and I am super passionate about it because, you know, when we bought Synova, Melissa, my business partner is a clinical social worker. And we were very nervous about the fact that we are two non-nurses now owning and running a nurse leadership company. And so one of the very first things we did was we created a board of directors and they function as a nurse advisory board and they help us guide the vision and mission of the company, knowing that we were guided under their vision has been unbelievable, because for us, we can go and ask. And so boy was that smart right before COVID hit that.

Lori Gunther (22m 23s):
We had this incredible resource just at our fingertips. And so Covid hits. And I remember it was this week, last year, Melissa was away on a family vacation. Her husband is a physician and I was home. And I was like, our company is going to go down. There’s no way we’re going to survive this. We have to cancel our conferences. And I remember she called me the day she got back and she was in tears and she’s like, we need to meet with the accountants. We need to figure out what we’re going to do. If we go bankrupt. And it was all of those. I sold my house to buy this company. Like I moved my kids. I gave up a very strong career with a company that I was really in love with.

Lori Gunther (23m 6s):
And we’re only a year in, how did this happen? And that survivor gene kicks in for me of what is my skillset? What do I know how to do? And I kept saying, we will figure this out step by step. We’ll figure it out. And I started getting phone calls at night, where I love my nurse leaders. I’m always available to them any. They know that that they’re part of our community. I make myself available and I started getting calls at night, almost every night. They would be on their way home, driving home after a day from what they had never experienced or seen before. And they knew I was a safe person to call because I wasn’t in the hospital.

Lori Gunther (23m 47s):
They know that I’m a trained therapist and they felt as though it wasn’t a burden to me that they knew I could listen to. That had been my job. And I remember calling Melissa saying, we need to do something. This is not anything other than showing up for our nurse leaders. They’ve showed up there who are business is. We need to show up for them. And so we started running twice a week, debriefing calls, and we’re very clear. They’re not support groups. We actually engaged with therapists from all over the country who were interested. We needed to find what services could we offer them and what referrals could we give to them? And what happens if we found that somebody was feeling unstable, where do we send them?

Lori Gunther (24m 31s):
So we did a lot of homework, but then very quickly we put together twice a week calls at night and on the weekend. So we were committed to working seven days a week. It didn’t matter. And those calls were transformative. We created a closed Facebook group for our people. Instead, if you’re interested and you want to come, come into the closed group. And that’s where we post the information on them. So it’s been a year later and we still run them. They’re not as frequent. They weren’t needed once we got into like November. So now we’re, you know, monthly, maybe every three weeks. But when we do have one, they leave work early. They wrap their day around the fact that we have one and the need for them is still very clear and very real.

Lori Gunther (25m 16s):
They openly cry on these calls. They share, they’re transparent. They’re honest, they’re frustrated, they’re angry, but it is a safe place to do just that. And we co-lead those calls, Melissa and I, we start them the same and we end the same. And the feedback we’ve gotten is just unbelievable.

Dr. Anthony Orsini (25m 35s):
Because if you’re not a leader. You can go to the leader if you feel comfortable and ask for help, but who’s the leader go to and in medicine everywhere, but especially in medicine, it is still looked upon as being weak that the doctor who’s exhausted, or the nurses feeling burnt out, or the nurse who has second victim syndrome or PTSD, whatever you want to call it. I think we’ve come a long way, but there’s still a perception. That’s a weakness. We should be carrying this S on our chest. And it doesn’t matter. Give me 20,000 patients today and I’ll take care of all of them. And so it’s great that these nurse leaders have a venue to really express that with you.

Dr. Anthony Orsini (26m 16s):
And the fact that they’re leaving work early, Lori, that’s amazing. I mean, that is something where they’re like, no, this is important to my own health. And it’s really great to see that. So that is fantastic. And I think the other comment I would make is you said it’s not as busy as it was before these calls aren’t as popular, but this occurred before COVID and it’s going to keep going on forever. So I think that need is going to be there forever. Don’t you think?

Lori Gunther (26m 44s):
Absolutely. And I think, you know, Melissa and I are really committed to running these on the schedule that the nurses feel is the most appropriate, which is at night where they can be home and safe to talk. We do really think through the calls and we always lead them the same way we sort of, everybody has to introduce themselves. We don’t always have the same group, although over time, it definitely, we have some of our, like, they wouldn’t miss it. They are on vacation in Maui and they’re calling in. But yeah, so I always ask them with what are they most challenged by, or what do they want to ask the group? And we were thinking of the day that in January, we happened to have a call the week of the riots on Capitol Hill.

Lori Gunther (27m 28s):
And we had some new folks in that group that day. But one of our nurses was the nurse manager of a NICU, very close to the Capitol riots. And I kind of had gone around and said, what are we challenged by? And I asked her, I said, you know, I know you’re very close to there. What was that like for you? And she, she cried. And she said, I don’t know how to lead through something like this. She said, my staff are exhausted and now they’re scared. And I don’t know the words, what can I say? What should I say? What do I say that’s appropriate and not offensive. And she’s not born in America.

Lori Gunther (28m 9s):
So she also is coming from this as a different perspective. And she goes, my family back home are calling me, saying, come home. It’s not safe there anymore. And what happened on that call was amazing because as she’s kind of bearing her soul, the rest of the troops rallied and they all kind of go like this, they put their hands in a heart. They let her know, even if they don’t say it on zoom, everybody’s camera must be on. And they show that, you know, that there’s a sense of love and support there. But then it’s, we had a new nurse who said, let me give you the words that I would say, let me tell you what I have found. That’s worked. And they all surrounded her with sort of strategies as to you, can’t say nothing you must say and be authentic to who you are, and you can phrase it like this and that nurse walked away.

Lori Gunther (29m 1s):
And she said, I always ends the calls with what are you most grateful for? And, you know, to leave with a sense of hope. And in that moment, she just said, I am so grateful for each of you because I came to this call thinking, I’m not sure I can get to need to be a nurse, much less a nurse leader. I’m not sure I can keep going on. And she’s like, I absolutely know that I must. So thank you.

Dr. Anthony Orsini (29m 25s):
That is really powerful. And it makes you really feel good about what you’re doing in life. And it’s, my life is not only about making money and being successful in business, but it’s about helping people. And that must be an incredible feeling when that happens. And it’s something that I think people didn’t think before, because there’s this whole area of nursing leadership that has no support. And they’re caught between the patients, the nurses, and then there’s even higher administration on top of that, many of the times that they have. So they’re getting from all different angles. What is the best advice you can give to someone is a nurse leadership, or perhaps a nurse or a doctor who’s feeling this what’s the best advice you can give them.

Lori Gunther (30m 11s):
I would say it’s to find your community is to have somebody where, you know, you can talk. When we look at, as a therapist, when I think about post traumatic stress, like what can you do? There’s a lot of words out there, resiliency, coping mechanisms, you know, all those things. You don’t go for a run, you know, make sure that, you know, you take care of yourself and you take time off. All those things are great. But what I know to be true and helpful is that you must process the traumatic events in a way that they’re happening. Just sort of bored off that post stress. If we hold it all in it just festers and it can explode. And that’s why we see the high rates of suicide.

Lori Gunther (30m 53s):
That’s why we see the high rates of divorce. That’s why we see people leaving careers that before they had been their whole life, it’s because it’s suddenly become too much. And so if we process it in small batches, in a place where we feel safer, comfortable, the research will show that we are better able to cope with continued traumatization or traumatic events. And so that’s what we do. And so if you’re not coming to us, you need to find your person, find your tribe, find your community, who are they and trust them that doesn’t always work. If I was a therapist, I also needed a therapist I needed. So I was working in the horrors of murder and sexual assault and domestic violence.

Lori Gunther (31m 35s):
So I needed to make sure I had a place to process that as it was happening. And that is my best sort of resources. Who is your person?

Dr. Anthony Orsini (31m 45s):
Well, that’s the drop, the mic advice right there. Lori, that’s amazing. That’s really so important. I was visiting a hospital once and their attempt to deal with this post-traumatic stress or burnout. I remember they had a chart on the wall and it had numbers on one side. And then if you feel these numbers, this is what you should do. And it was go for a massage, go for a run, kind of the things that you said. And I was looking at it and then nurse pass by two nurses passed by and they kind of chuckled at this sign. And the comment was, well, if I had time to do all that, I wouldn’t be burnt out in the first place. And so I think what you just said is just so profound.

Dr. Anthony Orsini (32m 28s):
You don’t go for a massage and then miraculously feel better and you have to speak to someone.

Lori Gunther (32m 33s):
Absolutely. And I think there’s so many different ways to do it. And I’ll give an example of that. So my best friend growing up as a kid was her name is Megan. She’s now Dr. Lochner. She is an OB GYN out in Stony Brook. And she and I talk all the time. She’s in New York, obviously. So she got hit really hard with COVID. But even before that, she was really committed to the idea of debriefing and sort of crisis response hospital-wide to traumatic events in women’s and children’s. And so she spearheaded the code lavender sort of effort in her hospital, and she’s done an amazing job.

Lori Gunther (33m 13s):
But before that had happened, she had experienced a very traumatic event. And she recently did a session for us on that. And what I noticed when that happened, you know, she works 24 hour shifts when she’s on call, was that she would get in the car after this traumatic events would happen. And she would leave me a Marco polo and a Marco polo is an app on your iPhone. And it’s where you can leave a video for somebody. So I would wake up in the morning and it would be a five or 10 minute sort of debrief of her day. And even though I wasn’t present, she knew I would watch it. And she knew I would validate her and that I was there. So even when I’m not there, I could still be there.

Lori Gunther (33m 56s):
And I’ve given that resource to multiple people and said, listen, if you just need to vent, if you just need to literally hand it off to somebody else, there’s ways to do it, where you don’t feel as though you are dumping on them or making them feel overwhelmed. We use that for a good year and a half during COVID. And I knew she was having a tough day. So I would check in on her throughout the day and just say, Hey, how’s it going? What are you doing? What’s for dinner? What’s this weekend. Do you need me?

Dr. Anthony Orsini (34m 24s):
That’s fantastic. That is so important. Great advice. Everyone who’s listening. You can be in medicine or in business and you can be burned out and you need someone to speak to. So really great advice, Lori, usually I give my guests a warning about this, but I forgot to give you this warning. So the last question that I always ask, and then we’re going to have you tell us how to get in touch with you and Synova I ask every guest the same last question. And I have a feeling that maybe I have a guess on what you’re going to say. What is the most difficult conversation that you have had in your lifetime? And give us some advice on how you were able to navigate through that, put you on the spot. I see that this is not fair.

Dr. Anthony Orsini (35m 4s):
I’ll speak for a few minutes and let her think, because usually I send that to the guests ahead of time, but it’s been such a crazy week. It can be a type of conversation. It doesn’t have to be something so personal, but we like the audience to finish with some really good advice on how to navigate the most difficult conversations.

Lori Gunther (35m 20s):
One of the ones that really do stand out to me, I can think of two. Now that it’s coming to me. But one was when I was just getting ready to leave my position at March of dimes. And I had taken over a unit there, their professional education unit and their staff. So March of dimes had been through, you know, sort of pretty far profound layoffs. And I had kind of lived through a lot of them. And I remember when I took over this division, I remember saying to them, you know, I will advocate for you. I love professional education. Don’t worry. I know this is very traumatizing and you’re worried, don’t worry. And then a decision was made that I had to lay off one of my staff and I had to do it via zoom.

Lori Gunther (36m 4s):
And you know, when the decision is made above you and then you have to deliver and you feel as though it was so impossible, you know, we had lived through all of these layoffs. There was multiple times where I had to be part of those conversations, but it was the first time that it was a direct report to me that I had to do that. And approaching that because you knew you were about to change somebody’s life. Somebody who’d worked for the company for over 40 years and it was really tough, but what I took it for me was to not overspeak to let her speak, to ask her what she was feeling about this and what I could do to help. But I was very clear sort of about what the purpose of our meeting was.

Lori Gunther (36m 46s):
But then I also stepped back and said, I’d like to listen. And if you don’t want to talk right now, that’s fine, but I want you to come back to me and tell me what I could have done better in this process or how this went. If there was something that could have been better or something else that you need, and people are angry when something is taken away from them. And it was really hard. I tried very much to not make it at all about myself, but what I could do for that person. And that was tough. No doubt

Dr. Anthony Orsini (37m 17s):
Difficult conversation to have, but what I’m hearing from you is something that I teach all the time and that’s, you didn’t rush through it and use, you were a listener and you gave her time to speak. And in medicine and in life, no one really wants to be in an uncomfortable situation. So our human tendency is to get in and get out. And I think that makes things worse. So that’s great advice. Lori tell us about, more about just as we close up, Synova what’s coming up for Synova how people can get in touch with you. I know you have a couple of conferences coming up. I think this will probably air in mid April. So there’s a conference in April that may or may not be in before this, but tell us about what’s on the horizon.

Lori Gunther (37m 59s):
So we’ve actually come out of last year, just doing tremendously well as a small company, our industry partners, our sponsors really came through. I came at this as, I don’t want to build a community that is in any way financially benefiting from our nurse leaders. We need to be there for them. We need to be a good steward of what our mission is and who we are. And so we’re not an association. We’re just a really small sort of exclusive company and community that caters to leadership development for nurse leaders. And so we do webinars, but they’re sponsored. So they’re free with CES. So we do a different one every month and there are so well attended.

Lori Gunther (38m 42s):
We stream them live on Facebook. So I would encourage people to watch us at Synova Associates on Facebook or follow me on LinkedIn. It’s Lori G Gunther. And because we post all of these free opportunities and we’ve been able to really pivot quite well. We are now doing hospital-based leadership trainings, where the hospital saw what we did virtually and sort of came to us and said, we don’t have the time. We just don’t have the time. Can you run our leadership training in-house and we now do that. Our debriefing calls are free and they’re open if you are a nurse leader and maternal child health, they are free. And then our biggest event will be our 25th anniversary. So we are a company that has been around for 25 years, and that is in November.

Lori Gunther (39m 27s):
It will be in-person. We have our keynote is Cy Wakeman, and happy to say that Dr. Orsini is also going to be joining us on our agenda for that event and doing a pre-con. So we’re really looking at that event, very strategically about leadership in general. We’re not just making it for our nurses. We’re looking at how we can involve our sponsors. They showed up when we needed them. We want to make sure that they have access to leadership training as well. And so it’s just getting more and more exciting as time goes on.

Dr. Anthony Orsini (39m 59s):
They say, if you love what you do, you’ll never work a day in your life for those people who are listening and can’t see Lori’s face right now. She is glowing. When you ask her about Synova and what she does, there’s a pure joy in your face. And yes, I am speaking in November. I’m honored to be asked and I can’t wait. So this has been fantastic, Lori. I use that word fantastic. A lot. My wife tells me, but it has been, and I’m very honored that you took the time to do this. You certainly inspired and educated. I apologize for putting you on the spot at the end there, but you did great. And thank you so much for being on today.

Lori Gunther (40m 34s):
Well, thank you so much for inviting me. I am so enamored with what you’re doing and I think it’s just fantastic. It’s so needed your voice and your work is important on anything that we can do to sort of partner and support you in your work. We’re happy to do. And all that I know right now is that we are stronger together. When I think about things, what’s sort of helped us through this as a company. I’m so blessed. I have a partner. I could never have done this without Melissa. I’m so blessed to have people who showed up for us. No, I came to you without having spoken to you in over a year and said, would you come and do a town hall with us?

Lori Gunther (41m 14s):
It’s a free event for nurse leaders, really? For anybody to attend and without hesitation, you said yes. And so there are things that I think in industry, we all need to lift each other up and support because now is the time when people need it. Now is recovery and rebuilding. So thank you so much for having me. I am going, I am really excited, always happy to be online with somebody from New Jersey,

Dr. Anthony Orsini (41m 40s):
But yes. Down in Florida now, but yes, New Jersey is my route. So thank you, Laurie. This was great. If you enjoy this podcast, please go ahead and hit the follow button. If you want to reach me and find out more about the Orsini way, you can reach me@theorsiniway.com and all Lori’s information will be listed in the show notes. Again, Lori, thank you. This has been inspirational. And I look forward to speaking to you soon. Take care.

Lori Gunther (42m 4s):
Thank you.

Announcer (42m 6s):
If you enjoyed this podcast, please hit the subscribe button and leave a comment and review. To contact Dr. Orsini and his team, or to suggest guests for future podcasts visit us@theorsiniway.com.

Human's First with Mike Vacanti

Mike Vacanti (1s):
But there’s also that person in that room that isn’t the authority, isn’t the boss. But when they speak, all of the attention goes to them. They are the temperature in the room. And that is where everybody’s looking for their cues. That’s the leader, the other person’s just the boss and both are necessary. I believe they can be the same person.

Announcer (28s):
Welcome to difficult conversations lessons I learned as an ICU physician with Dr. Anthony Orsini. Dr. Orsini is a practicing physician and president and CEO of The Orsini Way. As a frequent keynote speaker and author. Dr. Orsini has been training healthcare professionals and business leaders how to navigate through the most difficult dialogues. Each week, you will hear inspiring interviews with experts in their field who tell their story and provide practical advice on how to effectively communicate. Whether you are a doctor faced with giving a patient bad news, a business leader who wants to get the most out of his or her team members or someone who just wants to learn to communicate better this is the podcast for you.

Dr. Anthony Orsini (1m 13s):
Well, welcome into another episode of difficult conversations lessons I learned as an ICU physician. This is Dr. Anthony Orsini, and I’ll be your host again this week. Today, I am honored to have, as my guest, Mike Vacanti. Following many years in advertising and marketing. Mike launched early stage startups and led mergers and acquisitions initiatives for publicly traded tech companies. Five times, he was thrust into the chaos of transformation and help people navigate the doubt, fear and chaos of significant change. His team’s exceeded expectations consistently beat the challenge learned a lot, and as Mike said, had some fun along the way, he believes it’s more than what we accomplish.

Dr. Anthony Orsini (1m 54s):
It’s who we become along the journey. His mission is to lift others, helping people discover their potential, embrace a growth mindset and achieve at inspired levels. Mike has transformed businesses and inspired people to perform at levels they didn’t think possible. Mike’s known as a great listener and collaborator and a creative problem solver. He consistently delivers on the belief that the heart of any organization is people. People drive results. Mike is the author of Believership: the superpower beyond leadership, and he is the founder of Humans First. Well welcome, Mike. I got to say it is really a great honor to have you on today.

Dr. Anthony Orsini (2m 35s):
It’s been really great getting to know you over the last month or so, and I know that you are incredibly busy, so thanks again for coming on and sharing your story and your wisdom with us today.

Mike Vacanti (2m 46s):
I appreciate being here. I loved the conversation that we had earlier in the month. And Anthony, the work that you’re doing is I think really making such a big change out there. So I’m really excited to dive in and explore with you.

Dr. Anthony Orsini (3m 1s):
Thank you. I found you like most of my guests, some of them, I know person, I found you through social media. There are certain things that both of us like. And so we had some interests. I think I contact you through LinkedIn and started to really look into what you are all about and what you stand for. And I said, this is going to be a perfect guest for our podcast. And I always make the same promise to my viewers of my audience. That one, I will promise that at the end of this, they will be inspired and two that they’ll learn some valuable communication techniques. And I have no doubt that’s going to happen. So thanks again.

Mike Vacanti (3m 39s):
Yeah, I appreciate that. Before you jump into the questions, if I may, Anthony, I’m so aligned with the mission that you’re on. It’s not the easiest thing to jump in, kind of against the current and say, Hey, I can just ride this out as a doctor, right? I’m practicing, I’m doing the work. And I understand what the challenges are. And you’re certainly capable of not only doing great work, but navigating whatever the system is, that’s in place, but for you to have the strength and the fortitude and the leadership to step up and, and into the wind, if you will, and say, there’s some things that just can be better here and to take that vulnerable step, to put yourself in front of that and say, let’s break down some of those barriers and make this better for those that are in the system now.

Mike Vacanti (4m 28s):
And those that will come later. And I just want to call that off for the listeners because I give you high kudos for that. Thank you for being that leader.

Dr. Anthony Orsini (4m 37s):
Thank you. You’re very kind. Yeah. When I talk about my journey in the book and why I decided to really dedicate my career to this compassionate communication in medicine and now in business, but, and you’re going to talk about this today. When you see the impact that you’re making on people, I take care of little premature babies and people say, wow, that’s amazing. And you save lives. And it is. And I’m blessed that God has blessed me with the talent to do that. But when people ask me, what is it that satisfies you? Not outside of medicine. When I take a young physician, sometimes even an old physician and put them through our improvisational role-playing or teach them about what it’s like to really connect with your patients and how to do that.

Dr. Anthony Orsini (5m 25s):
And I’m giving a Ted talk, we’re recording this end the February, but the Ted talk will be as the end of the March. And it’s about that. It’s about doctors who really want to connect. And now we’re going to ask you about leaders too. They really want to, and, but they don’t know how. And then when you teach them, I get such warmth. When I see that light bulb go on in a medical student, whether it’s a resident or a doctor and you go, wow, like that makes me feel so good. Because when you walked into this room this morning, you had big frown on your face because you didn’t even want to be here. And now you’re like, I can’t wait to try this. This is really cool. So that’s what drives me.

Dr. Anthony Orsini (6m 6s):
And that’s why I keep doing this. So thank you so much for saying that.

Mike Vacanti (6m 10s):
Absolutely love that.

Dr. Anthony Orsini (6m 10s):
Mike, I’d like to start off because as I say in most of the podcasts, you have to be a genuine person first, before you can build rapport and you have to build rapport before you build trust. So let’s start off real simple. If you don’t mind, just tell us about Mike Vacanti, your story. We’re going to talk about how you did the mergers and acquisitions and how you got into that. And then we’ll lead into how you got into humans first. Cause that’s really exciting.

Mike Vacanti (6m 36s):
Yes. I grew up in an entrepreneurial environment. My dad had a sporting goods company. He had several different companies that I saw growing up. And the one that I lived in through my twenties was our family sporting goods business, where we manufactured protective gear for hockey and football. And I learned a lot about body composition and load testing and what it takes to break down a body. We worked with physicians, we worked with testing on cadavers and all kinds of great experiences in that, but that led me into sales and manufacturing and a deep understanding of all of that. The company went public. I thought that’s what I was going to do with the rest of my life.

Mike Vacanti (7m 16s):
And then there was a proxy battle with the board of directors and I got a business education I’d never thought to experience. And I actually jumped out at that point at 30 years old. And I went into advertising for a couple of years and then had my own marketing company for another dozen years after that. So I spent most of my formative years in business, really being creative and developing and inventing. And I had a child safety device that went onto the market. I licensed a company and it all 5 million was sold over a period of time and it was saving children and automobiles. And so I had these different experiences, Anthony, and it was later in that marketing career that one of my clients had this little technology and I helped him get positioned for a client.

Mike Vacanti (8m 5s):
We won a big contract and then we took that same package out for some venture capital. And so now I’m hitting 40 years old and I’m the co-founder of one of the first unified communication platforms on the planet, right before the internet bubble bust. And when the internet bubble bust, I was helping other companies that got caught in that, you know, funding and startup wave. And I helped them kind of secure their position with their product and get acquired. And that led to a couple of decades of doing mergers and acquisitions, which so it was a crazy career that was following inspiration and leveraging ingenuity and the ad hoc nature of things all the way along.

Dr. Anthony Orsini (8m 49s):
So mergers and acquisitions. I think you did five major, I think I read. And so you’re really in this high power quick world, you’re dealing with some pretty big companies and then something happened or over a course of time where you said, I want to transition out of this. And then that’s how humans first club started, I believe. And tell me about that concept of where did that came from.

Mike Vacanti (9m 11s):
Those five mergers and acquisitions where, you know, dealing with people in the midst of fear, doubt, and chaos, really where you’re mashing teams together, nobody is really happy in the environment. Nobody is, has certainty. What’s going to happen next. It took a different approach to bring people together. And my team’s always succeeded. Matter of fact, they over-perform, and it always amazed me. I, and I didn’t really know why that was. And so I went and did some work on what were people’s experiences during those five mergers and acquisitions. And I learned a lot from that and I put that into the book Believership. And I think we’ll talk about that a little bit from that work and Believership.

Mike Vacanti (9m 56s):
I started working with companies going and doing a workshop on high achieving team work. And so I go into companies and we’d pull in their groups of people. And what I realized is people are really broken. That all of the research reading about low employee engagement, the mental health, the physical health, that the condition of the workforce, the trends that were on, I was seeing them, you know, that research, I was seeing it proven true in all of these situations where teams were barely not even highly functioning, much less high performing or high achieving. So I did more research into what’s really going on there.

Mike Vacanti (10m 37s):
And I decided to get together with the group of people, some friends, people that I knew had a voice, they were focused on the humanity part of business. And we just brought people into rooms and decided to infuse the topics and start a discussion on what’s it like to be human in the workplace today. And as that was building up to the first event that happened in New York city, back in October of 18, people started raising their hands and they said, Mike, I want to do that in my city and my city, my city. And so over a course of a year and a half, we did 15 events in different cities. And it was self-funded.

Mike Vacanti (11m 18s):
It was really just a series of explorations and a research into what’s really going on in people’s lives. What are their experiences?

Dr. Anthony Orsini (11m 25s):
Tell us about more, how these events work, who attends them. I know they, you told me before they’re all over the world, but for someone now, I think there are people in the audience going, Oh, what are these events? So tell us more about how exactly how they work and what they should expect.

Mike Vacanti (11m 39s):
So each month in the live events, we were pulling together four or five speakers and Anthony, we would just infuse 10 minutes of talk from each speaker, just to get some topics on the table and get the juices flowing and invite everybody in. And then we’d spend half the time with open conversation with everybody in the audience. So we kept them small, under a hundred people, rather intimate. So everybody’s voice to be heard. People could speak up and we could have open dialogue. I changed the format from city to city, very intentionally. I didn’t want to roll out a road show. My intention was to do things that weren’t normally done. So we all become taught experts or certified in doing something a particular way.

Mike Vacanti (12m 21s):
And then we just go teach the world that one way and, and try to cajole everybody into that one belief, that one pattern and my intent was to go in and help people break patterns. If things are not working, let’s discover how they can work. And to do that, we can’t follow a method or a process or a format, because that seemed to be what was breaking things, not healing things. And so each event was a little bit different, different speakers. We had a lot of diversity. We openly invited people in. So we had from executives to indepents from coaches to people that were working on the shop floor, it was HR, it was business leaders and sales.

Mike Vacanti (13m 6s):
It was really an organic collection of people that raised their hands self-selected and came in. From there It started to split off. What do we do between these monthly live sessions? And we started doing zoom calls and we’ve been doing a zoom zoom call every Friday, since March, that it will be two years coming up. Here every Friday, a group of people and it’s been from 20 to 60 people on those calls. It’s an open zoom call. After the London event, a group in the UK came together and they started a call at noon. On Monday UK time, that’s still going strong and continuing to build another group open to call based out of Singapore.

Mike Vacanti (13m 51s):
So now there’s an Asia call that happens every week at noon, Friday Asia time. And then a fourth call came up kind of right as a pandemic hit. And it’s called the friendship bench and cooperation or partnership with the 360 nation. And so every week now hundreds of people from around the world get together and we have these open discussions that are co-created, co-facilitated talking about many different topics and we dive right in. And one thing I didn’t realize is that I’d always heard the term psychological safety. And I have to admit that early on, I kind of resisted that.

Mike Vacanti (14m 32s):
It’s like, ah, that feels really squishy. I’m not sure what that is. And while I had read a little bit about it, and there’s a lot of studies about it, I came to understand that’s what was happening inside these live events. It’s the environment that was created on these calls. And it was that great invitation that people were responding to. And now it’s become kind of a, a self-generating regenerative co-creative space, which are terms that when I started, I don’t know that think there were concepts to me. So I’ve learned a lot over the time.

Dr. Anthony Orsini (15m 10s):
We really are a really fork in the road. I think of it’s or a launching point, I guess is a better way to say it because what I’m seeing and we’ve had some really great guests on this podcast, I’ve been so blessed. A lot of the guests are in healthcare. A lot of them are business. We’re talking a lot about changes in cultures, in the workplace, as Siobhan McHale on going to ask you about Claude Silver later on, there seems to me, and I’d love your opinion on this. So there seems to be some of the old school that is looking at the younger generation. Now that’s coming into the workplace and the younger generations, although everybody likes to say oh, they’re soft or all these millennials, it’s kind of like a running joke, but they’re really making change because, well, I’m seeing it in medicine.

Dr. Anthony Orsini (15m 55s):
I’m seeing it in business where these people are saying, I want to be happy in the workplace. I want to, as you say, believe I’m not going to be abused as it were. When I trained the medicine, I got verbally abused every day. And that was just a calling. You had to get through it. And the theory in those days was that if I ask you a question on rounds and I abuse you verbally, and that kind of pressure that you won’t snap when there’s a real pressure. And I bought into that and I’m like, okay, this is when I’d go home. I’d even laugh about it. But the newer generations changing things, I think for the better, right? The new people that are coming on are saying, no, I don’t want to get verbally abused. I want to work for a company that believes in me.

Mike Vacanti (16m 38s):
Yeah. So much is built into the systems, right? So if we know exactly what the outcomes are going to be, and we can orchestrate a system and manufacturing or medicine or whatever the system is, education and of those three, I would say education is probably the most resistant and the most rigid as far as being able to change. So business should be first. Medicine is a little trickier and education is in full resistance, which is really odd because most of those people in education like to think of themselves as rather open-minded, but the systems become so rigid that we look at compliance and capitulation and assimilation, and they’re all basically built around the premise that everybody is the same and some will become exceptional.

Mike Vacanti (17m 29s):
And so we build a system that allows the exceptional, but washes out anybody that is not compliant or capitulating or will assimilate well. And what I believe is we wash out a lot of really good people because we measure them against a standard of sameness that is not really equitable. And I don’t believe we focused on the greatest part of each individual on that their uniqueness. We don’t invite personal development. We invite complying to a pattern of sameness again. And so when we look at personal development, then we allow people to start building character.

Mike Vacanti (18m 11s):
We allow them to become whole in their uniqueness, which means we get more people providing, producing on their true gifts, rather than always trying to just cover weaknesses. It’s a mindset shift. That’s really hard for people to make.

Dr. Anthony Orsini (18m 28s):
Yeah. And I was going to ask you about that because there’s this great movement now to improve cultures and companies. And you’re part of that. And Humans First as part of that. But also when I look around, I see, wow, do we have a long way to go? I’m looking at people that call me in that I speak to all the time. It’s a, at my job, I can’t speak up and I have to keep my mouth closed. And then what I see, and my favorite saying is, you know, when you’re most passionate people become silent. That’s when your company’s in trouble. There’s still so much about that. Now, when you work with companies as a consultant and you’re trying to bring this to them, why do you think some companies are so open to it? Why do you think some companies are just closed down and do you think we’re going in the right direction?

Mike Vacanti (19m 14s):
I believe that it’s pointed in the right direction. Adoption is slow. I think that some of the language Anthony is being adopted very openly, very quickly. However, when new language and these ideals are spoken, but people don’t experience them. I believe that we’re actually creating more harm than just saying, look, we want to stay adherent to the rigid patterns of the past. We’re not allowing all that goodness. And so then people, at least what they’re being told and what they experience will be aligned. The danger I think we’re getting into now, because it’s early in kind of crossing this chasm of focusing on the human being on personal development and growth potential is we’re kind of going toward that We want to say these things, but it’s maybe not what you experienced and when the experience and the words don’t connect, I think we’re maybe causing more harm than good.

Mike Vacanti (20m 17s):
So there’s a learning curve here. And I would say that the key to all this is leadership has to buy into it. And there’s vulnerability in that because you start to lose control when you start to offer people choice. And what I truly believe is when we can move from environments that are driven by choice and commitment, rather than command and control, we will be able to get that creativity, the ingenuity, and actually get people performing above the levels that we would hope for them to achieve at.

Dr. Anthony Orsini (20m 59s):
I love what you said. There’s so many companies out there and hospitals, healthcare, or not, that are saying we do this, or we have an open door policy. If you see anything that you think is unsafe, you need to step up. But then when someone does that, you see them miss that promotion, they’re kind of pushed on the wayside and everyone else is looking at well, gee, Tony spoke up and now he’s in the back. And so in the front, they’re saying, we don’t want yeses. We want people to say, I want to do it this way. But then the guy that speaks up, you have to push that aside. So I love what you said. It’s a lot of people talking the talk, but not walking the walk.

Mike Vacanti (21m 39s):
Yes. And the good news is that I believe that ground swell is really coming to recognition that there’s more voices out there. There are more leaders that are emerging and demonstrating that this can be done and we’re seeing it in business. I believe we’re seeing it in each arena. And I think once more of those proof points are in place that the adoption will grow in certain circles, but just like Jeffrey Moore’s model of crossing the chasm, if early technology adoption, I think we’re into a similar pattern now, Anthony. We’re at that cusp of jumping over the chasm and it’s the innovators and those that have the fortitude to step forward and put their face into the wind.

Mike Vacanti (22m 25s):
If you will, there’ll be the bridge builders of the past before it was those that could hold true to form. Then we’ll stay on the rigid rut, no matter what those are, the bridge builders, right? Cause they would just invite everybody in. Now it is, it’s the innovators. It’s kind of those crazy people that will stand up and take the shots. I think those will become the bridge builders of the future.

Dr. Anthony Orsini (22m 48s):
And the concept of this podcast is really that if you are an innovator or you’re a leader or you have compassion within you, the next step is now is to communicate that compassion. And that’s where we can really help these leaders. You may have it in you, but you’re just, you don’t know how to convey the compassion. And so that’s what I’ve dedicated my career to is listen, I know doctors and nurses are all compassionate people and there’s a lot of leaders who are not very nice. We know that, but there’s also some that are nice, but just seem to have trouble clicking and building that rapport. And I think that’s where we think that everyone’s born good communicator, but it’s actually, it’s learned.

Mike Vacanti (23m 27s):
It’s interesting, isn’t it? So what happens along that journey that we start to become less of ourselves as far as communication goes. That it’s interesting. And I think that we see listening becomes such a great part of communication and it’s harder to go in and be taught how to listen. Well, we could sign up 24 hours a day and be in speaking and presentation classes, but we have to be very diligent about going and find a good listening class.

Dr. Anthony Orsini (23m 59s):
Yeah. And there’s nothing like I saw in your bio too. The do some experiential learning and you’re a believer that there’s nothing like putting someone through that experience of videotaping them and sit and say, well, what do you think? And when they see themselves, they go, Oh, I didn’t really mean that. Or I’m coming off a little aloof and I didn’t know that. And so really is a great learning technique. So I want to talk about the book humans, first stories and Theresa Quinlan, who you wrote the book with. And I know she’s got her own podcast also. And the book is just a compilation of different people’s stories. I noticed chapter two, I think it is where Claude Silver wrote that. And that’s a great story.

Dr. Anthony Orsini (24m 39s):
I have a lot of connections with Claude. Not only was she on this podcast, but my daughter actually works for Vayner and my cousin is an executive at Vayner. So I know Claude. And I think she wrote in the book, Mike and I on Hudson yards or where she works, Mike and I see you and you see me moment. So tell me about the book and then tell me about Claude.

Mike Vacanti (25m 0s):
So I got through my son, Michael, who does some work training, Gary Vaynerchuk. So we’re both connected into there through relatives. That’s how I first became connected with Claude. And so it was, you know, after a couple of phone conversations, it was one trip out to New York and Claude. And I got together in our office and it did just click and she has become a very great friend and an inspiration to me also. And the reason is that Claude really lives these ethos that we’re talking about now, she puts them into place where they are being created and lived and experienced every day.

Mike Vacanti (25m 40s):
It’s a very natural, genuine, organic approach. And she said, it’s such a great position, Anthony, because Gary Vaynerchuk believes those things. And he knows that to keep that culture alive, he needs a second person at the top with him. And Claude’s in that chair right next to Gary, above the CFO. She is the second in command. If you will, with all of the thousand employees in the many different offices. It’s a brilliant exploration that she stepped in and she’s helped with Humans first. She did the first event with me in New York city, kind of held my hand and gave me some of the support and encouragement to make that happen. And she’s participated in three of the events and she’s been a great friend.

Mike Vacanti (26m 25s):
So she is one of the 31 stories along with Teresa’s story. And then I write a little bit at the beginning and the end of a book, just to kind of frame the humans first stuff. It was a great compilation that was built on one of the things I truly believe within humans first is he was first is not to be owned, is to be shared. And I say that very truly and will say, I don’t even know what that means, Mike. And that’s too weird. Explain that to me, tell me what it is and tell me what I need to do. And it’s like, tell me what you would like it to be. And what would you like to do is the answer to that. It’s frustrates people and what Theresa, it occurred to her that, Oh my gosh, there’s all these brilliant stories that people are sharing every week on these calls and these events.

Mike Vacanti (27m 12s):
And it’s hard to describe to somebody what’s going on in these calls. And they pads, she said, why don’t we just capture these stories? And she said, I want to write a book. I want to do this. And she said, Mike, I just need you to say yes. And I said, yes. And so she took the ball and she drove the project and then we pulled it all together. And my role in all of that was to encourage and support and lead in service to her the best I possibly could. She pulled it together very fast. And, and now it’s really exciting to be able to lift people into that and help them express their voice and to start telling stories and open up a great invitation for others.

Mike Vacanti (27m 57s):
The book’s called you belong here. Humans First stories. And I think it exemplifies that you do belong here. And it is an open invitation.

Dr. Anthony Orsini (28m 4s):
I can tell my listeners right now that I finished reading it last week. And when you’re done reading the book or really as you’re reading the book, inspiration is the word that comes. It’s a feel good book. I mean, it is in a world where, you know, we have COVID and so much sadness and you know what I do, there’s there’s sadness in everybody’s life. You need that positive attitude. And I can tell you just, I would tell the audience right now, just read it because it will make you feel good. It’s really a great book.

Mike Vacanti (28m 35s):
Isn’t that funny that men and women, 20 years old to 70 years old, every race, every religion from around the world could come together and sharing a belief of encourage each other, to be our best, be there to hold someone else’s hand when they need it to boost somebody when they need it. And when we can create spaces where people can come in and discover and explore and become whole, it’s amazing what next steps they’ll initiate on their own. And I think it creates a model that hopefully can be employed by those many people in their unique, many different ways in many different industries, because it’s kind of a kernel of goodness and hope, right?

Mike Vacanti (29m 22s):
That gets shared.

Dr. Anthony Orsini (29m 22s):
And it really has to be in front of you all the time. And what I tell people, when I give my workshops, your intentions could be really the best. Then you want to be compassionate. You want to really be a place your employees. First, there’s going to be several times during the day where you get so tied up in your tasks, you become task oriented, happens to doctors all the time. And I give my lectures to patients. I say sometimes that doctor is getting really busy and he could be the nicest, most compassionate person. He’s getting really busy. If you see your doctor doing that in the office and seem rushed, tell him a joke, ask him how he’s doing, ask him if he has a kid or she has a kid because what happens to us is it snaps us back.

Dr. Anthony Orsini (30m 5s):
So what I love, what you’re doing is that it’s this Humans first thing is just there all the time, because I think that we kind of slip into that dark area again.

Mike Vacanti (30m 14s):
Yeah, it’s interesting. Isn’t it? When you were saying that, when you notice that with somebody take that extra moment, that extra moment is seconds. It’s not like it’s minutes. It doesn’t take much effort. If we are crossing paths, we were working together, Anthony, we were crossing paths and you had that, Oh my gosh. It’s, I’ve been at this all night and there’ve been tough cases. And this is really hard. It’s emotionally hard and there’s successes in there, but it’s that mixture of high intensity environment. And if I saw that look on your face, when we walked in the hall and I just stepped in your path and it gave you a hug and to shock you out of it, he was like, can we just like get off of me, but then it would break it.

Mike Vacanti (30m 56s):
Right? And just that simple act of compassion can change a lot of things.

Dr. Anthony Orsini (31m 1s):
There’s a whole big concept around banter and how important banter is in the office and in the hospital, it’s a type of humor. And studies have shown that leaders and doctors who just have just very friendly banter, very innocent style. Then of course, you got to be careful. Those people become human and people relate immediately. So I walk into the office, I see a patient wearing a Yankee hat, just saying they didn’t have such a great year this year or something like that. It takes, as you said, just one second and all of a sudden you’re a genuine person and you and I are friends in my book. I talk about the concept of, it’s hard to fire your best friend. My mother used to say that to me all the time and you just get along with people.

Dr. Anthony Orsini (31m 41s):
So I’m really happy that this is in front of people all the time. And I’m just such a big fan of Humans first, Mike, I want to talk about believeship, because that was your next book. So what was the reason that you wrote that book you had just finished Humans first? I think there only been about a year difference between both books, right?

Mike Vacanti (31m 58s):
Yeah. So the Believership book was first. It was December of 19 and then December 20 was Humans First. And the concept of Believership came out of that deep dive exploration I did. Kathy Crandall has a trademark program saying know your impact. And she asked the question, what happens because of you? So she took me through a process where there’s 40, some deep packets of information that came back from people that had worked for me, my bosses, clients, partners, kind of everybody in the environment around me through those five mergers and acquisitions, even some friends during that time. And the term Believership came out of that discovery.

Mike Vacanti (32m 39s):
That’s kind of what people experienced by how I showed up. And I know there’s four principles to it. It’s genuineness awareness, vision, and belief. Those things become really easy to describe. It’s like, how do you show up, know how you show up, what’s going on around you with others self-awareness and then awareness of the environment, the market, the business that you’re in, certainly the acumen is necessary, but then it’s really a checkpoint on, do you see where you’re going vision? And do you believe you can get there? And it’s just a check point. It’s like, are you real today? Or are you your best self or are you challenged today? So how are you showing up? Do you get what’s going on around you? Can you still see where you’re going?

Mike Vacanti (33m 20s):
Do you believe you can get it done. While that boils it down to the simplest form It’s really a different way to approach the workplace and in Believership what I really explore is we’ve operated off of leadership models that are no longer serving us. And we’re coming into a period where change is going to be more rapid and more significant than at any time in the history. COVID is an example of that. And we simply are not preparing people to become navigators for that rapid significant change that’s ahead of us. And so to pull back and to try to jump off or to ignore that it’s happening, that’s a very ignorant approach to the world.

Mike Vacanti (34m 7s):
So holding onto old norms, old patterns, old stayed operation beliefs is no longer going to serve us going forward. And it’s an invitation to rethink reframe. And I actually selected people in the group that are true leaders at their core. Not those that elbow their way to the top at the expense of everybody else around them.

Dr. Anthony Orsini (34m 28s):
I think you defined the Believership in your book somewhere, the super power beyond leadership. My question is, and I’ve asked the same question to Claude. I’ve asked this question to James Orsini from Vayner are also, and I think even Stephen Covey, when he was on, can this be taught Mike or do you suggest that we promote the guy or the girl woman who has natural leadership or elievership skills over the person who may be the smartest person? And then we can teach them, can this be taught to anybody?

Mike Vacanti (34m 58s):
I believe that it can be taught and I believe that it can be developed. And it’s actually a faster growth path. It’s based more in emotional intelligence than regular vacuuming. You do workshops Anthony, right? So you know the dynamics when you get into a group of people. And so when I go in with a company and it’s very obvious who the authority is in the room, right? Who the boss is. And when that person starts speaking, you see the body language of those around them in the room, and they’re kind of listening and you can see that there’s some hesitation oftentimes, and there’s different levels of buy-in, but there’s also that person in the room that isn’t the authority, isn’t the boss.

Mike Vacanti (35m 41s):
But when they speak, all of the attention goes to them. They are the temperature in the room. And that is where everybody’s looking for their cues that’s the leader, the other, person’s just the boss and both are necessary. I believe they can be the same person. And part of it is that command and control freak, right? I mean, let’s look at the CEOs of most major corporations are pretty close to narcissist Gary Ridge. There’s some brilliant exceptions with WD 40 they’re proving. This model actually is better for longevity. And you know, they have 90 plus engagement and belief scores kind of off the charts year over year.

Mike Vacanti (36m 25s):
So I think there’s great proof points out there that this model is better. It’s just not the one that has been in place. It’s not the common path. So I believe that, yes, we select those people that are already leading, but they’re leading from within, not from that position of authority.

Dr. Anthony Orsini (36m 44s):
I think that’s so important because without a good leader of the employee, as you said, the employee engagement goes down, the turnover, your return on investment goes down. Your bottom line goes down, but I agree with you, Mike. I think it can be taught. When I first started teaching my communication skills, my boss said to me, listen, Tony, I support you, but not everybody can be you. He used to say that you have to remember that. Not everybody can be you. And I said, no, I, I think, I mean, we’re all unique, but I think this can be taught and time and time again, I’ve proven that I’d say about all the people that I’ve trained 10 to 15% of them I can train every day, they’re not going to get it. And I think it’s because they don’t want to get it.

Dr. Anthony Orsini (37m 26s):
And that’s probably your same experience. Yes,

Mike Vacanti (37m 28s):
Yes, yes. It is that you be you thing is really funny, right? Cause, cause I was a bit of a rambunctious kid, right? I kinda, I was like, they don’t rules were to be explored, not adhere to. And so how many times during my school years, was I told by a teacher, Mike settle down, you need to be more like somebody else. And they were pointing to somebody else in that class would be more, less be more like, and it was very rarely though it was encouraged to be more like me or just be a better. So here are the things that would be good to work on. And so I think that we explore it humans first and what I really try to explore and Believership is each unique person becoming their best selves, puts them in the best frame to lead from.

Mike Vacanti (38m 16s):
And that’s where that genuineness is from this. I don’t want to be Jack Welch. I don’t want to be a great business commander that washes out 10% of the people and stack ranks everybody and creates misery and capitulation along the path. That is, I believe the example of the point we want to pivot from not replicated to the future. And so it’s good to have awareness, but we always put models out there. It’s like be more like Steve jobs, right? It’s like, well that Steve jobs, we’re the most unique people on the planet. So go try to do that. We put these models up there to replicate and actually most of those models are some of the most unique people that, you know, we’ve ever experienced.

Mike Vacanti (38m 59s):
It was their uniqueness that made them great. Not their sameness.

Dr. Anthony Orsini (39m 1s):
Absolutely. So Mike, I always ask this question at the end of each podcast and some of my guests get put on the spot. So take a deep breath. This has already been inspirational. What in your life was the most difficult conversation you’ve ever had? And you can say type of conversation and give my audience, just some tips on how you were able to navigate that. So what do you think is the hardest conversation you’ve had?

Mike Vacanti (39m 23s):
I’m to step outside of the marriage conversations, right? Because money and raising kids, those are some good ones.

Dr. Anthony Orsini (39m 32s):
Teenagers they’ll count. That’s everybody’s nightmare

Mike Vacanti (39m 34s):
Along the way, I had worked for a CEO of a company through one of these mergers and acquisitions. And then he moved on after the acquisition, I stayed on for awhile with the company. And then three years later, I jumped out into another opportunity. And it was a year after that, that he became a CEO of another publicly traded company. And he recruited me in. So he pulled me out and he said, Mike, look, I’m building the team behind this and here’s your big salary and here’s your stock. And this’ll be the last business card you’ll ever carry. We’re going to run this company for the next 15 years and you’ll be set. And then the market crash happened, right?

Mike Vacanti (40m 15s):
The real estate market crash happened. So that’s in 2008. So 2009, now I’m out of work for a year because they had a $15 million RIF reduction in force, the sold off business units that really made a mess of it. I set that story up because there was some really deep resentment I had during that period of time because I believed in them. I went with them and felt very harmed from that. Also experienced then a year of pain with my family. I had kids in college and put, survived and moved on and it’s now roll another three years forward.

Mike Vacanti (40m 56s):
And I’m interviewing to jump in to do this fifth merger and acquisition, a Chinese company bought an American company. I’m moving to Seattle at which I did for two years. And it was in that exploration process of me being that person that they had this stack breaking, speaking to that they use the interview process. That was all adhere to that. And during that, you have to invite in all of your ex bosses to the conversation, what would they say about you? So that’s the setup now because this thing that I, you know, had moved on from, and just discarded and got over there, resentment, but ignored this festering bad relationship.

Mike Vacanti (41m 42s):
I had to go back and address that and ask them to step in now and voice their opinion in my being selected for this next merger and acquisition, the vulnerability, the humility, the, I dunno, I would say even some of the shame for forgive, like all those things that are hard to do, were all present at the same time. Stepping into conversation, here’s the cool thing, the person on the other end. And I don’t want to name him. He acknowledged how difficult that had to be for me to approach that. And in the end we talked for a while. We put a lot of things up on the surface, you know, it wasn’t kumbaya.

Mike Vacanti (42m 25s):
I don’t think we ever really landed in the same place, but we got to that point where he said, I got you on this, you are the guy I’m going to support it. And then that was the last conversation we had. But I would say, because it brought up so much from the depths of me that had been buried, that it was probably one of the most difficult conversations I’ve had.

Dr. Anthony Orsini (42m 47s):
Yeah. The teaching point there is that there’s so much hate in this world. And there’s so many bad discussions. If you just stop and sit and speak to someone, even though it’s hard, you felt better after you had to have that conversation, but you were, I think, glad that after it was over, it felt a little better.

Mike Vacanti (43m 4s):
Yeah. And I learned a lot from that, right. Is at any stage in life, we think we can rationalize things and just be strong and hold firm and stick to your values. But that vulnerability and clearing the wreckage from the past, if you will, is so important to be able to move forward with the freedom we all hope to have.

Dr. Anthony Orsini (43m 29s):
Absolutely. Well, we certainly learned a lot from you today. And Mike, we were inspired by you by what you do for Humans First. I can’t wait for my listeners to hear this when this finally launches this next month. So everybody right now has gone I got to learn more. I want to become part of humans. First. I’ll put all this on the show notes and I’ll put in the links to Believership and Humans First Club someone wants to get involved in Humans First, tell us how they do that. How would they get in touch with you?

Mike Vacanti (43m 59s):
So on the website, HumansFirst.Club, there’s many opportunities just to jump in and you can simply sign up and join one of the free and open calls. They’re open to anybody and come in and explore new people are always welcome. There’s a great group of people and people that are there every week that just inspire me and teach me every week. And so that’s an open invitation HumansFirst.Club. And then on social media, please just say, hello, tag me and say hi. And I would love to see whatever I have available in my network to help somebody else. That really is my mission. At this point in my career Anthony is to inspire people, be a catalyst for positive change and inspire people to step into their best selves.

Mike Vacanti (44m 46s):
We can do better, but it’s going to take all of us. And my belief is let’s bring people to their full strength because we’ve got some great challenges ahead.

Dr. Anthony Orsini (44m 57s):
Absolutely very well said, Mike, this has been great. I’m going to be tuning in to humans first. I’m going to sign up because just very consistent what, with what I believe, I feel that I’ve gotten to know you over these last two conversations. I can call you friend. I hope that you and I will stay in touch. And I just want to thank you one last time for really taking this hour out of your time. This has been great. Thank you.

Mike Vacanti (45m 19s):
My pleasure. And my honor, I’m a big fan of your work and I can’t wait to explore further with you also. Thank you.

Dr. Anthony Orsini (45m 26s):
Fantastic, Mike. All right. Thank you again. If you enjoyed this podcast, please go ahead and hit, subscribe and download all the previous episodes. You can also reach me@theorsiniway.com. If you have any questions or concerns. Thanks again, Mike, and have a pleasant day.

Mike Vacanti (45m 42s):
Bye everybody.

Announcer (45m 44s):
If you enjoyed this podcast, please hit the subscribe button and leave a comment and review. To contact Dr. Orsini and his team, or to suggest guests for future podcasts, TheOrsiniWay.Com.

Hospital Leadership During Covid-19

Dr. Noreen Bernard (0s):
The old school leadership model is that of he or she who holds the information, holds the power. And so from an authoritative perspective, I don’t owe you an explanation and in contemporary leadership would tell us the opposite. The more that we tell people why the more we engage them in problem solving, the more that we say, hey, I’m just your teammate. I might have a unique position on the team but we’re all a team and your ideas and your contributions are equally as important.

Announcer (32s):
Welcome to Difficult Conversations: Lessons I learned as an ICU physician with Dr. Anthony Orsini. Dr. Orsini is a practicing physician and president and CEO of The Orsini Way. As a frequent keynote speaker and author Dr. Orsini he has been training healthcare professionals and business leaders, how to navigate through the most difficult dialogues. Each week you will hear inspiring interviews with experts in their field who tell their story and provide practical advice on how to effectively communicate. Whether you are a doctor faced with giving a patient bad news, a business leader who wants to get the most out of his or her team members or someone who just wants to learn to communicate better, this is the podcast for you.

Announcer (1m 16s):
.

Dr. Anthony Orsini (1m 17s):
This episode is being sponsored by Veritus. Veritus offers virtual alcohol drug and trauma treatment programs exclusively for licensed medical professionals. Their programs provide a concierge level of care consisting of evidence-based clinical treatment and are customized to meet the unique needs and challenges of physicians, dentists, pharmacists, and nurses, struggling with substance abuse. Having worked with licensed medical professionals, struggling with substance abuse since 1976, Veritus understands how extremely difficult it can be to ask for help because of how severe the stigma is in the medical community around mental health and how real the fear is of a potential repercussions from colleagues If found out.

Dr. Anthony Orsini (1m 60s):
Their virtual confidential platform provides a safety and security medical professionals need to get help while continuing to work. Confidential, convenient, and compassionate Veritus brings world-class treatment to your home or office. To learn more about Veritus you can visit www.veritussolutions.com. Well, welcome to another episode of difficult conversations lessons I learned as an ICU physician. This is Dr. Anthony Orsini and I’ll be your host again this week. You know, the COVID 19 crisis has affected us all. It it’s affected us in many ways that we hadn’t even thought of before. For instance, many of us no longer take our health for granted.

Dr. Anthony Orsini (2m 40s):
We appreciate our family and friends even more. And we think differently about our healthcare system and the doctors, nurses, and staff who take care of us. It’s also tested us in ways we couldn’t have imagined. As providers It pushed us to the absolute limits. Leadership found themselves in situations that forced them to make very difficult decisions. Decisions that they thought they would never have to make. And nowhere was this more apparent in those who served leadership roles in healthcare. And that’s why I am so excited to have with me today, Dr. Noreen Bernard RN, Dr. Bernard is the current chief nursing officer for a university of Colorado’s health, long peak hospital and Broomfield hospital.

Dr. Anthony Orsini (3m 23s):
She is an adjunct faculty at university of Colorado and adjunct assistant professor at the Nell Hodgson Woodruff school of nursing at Emory university. Dr. Bernard’s research is in the area of nursing administration, resilience, job satisfaction and professional governance. Perfect for this topic. She has published on practice elements, important to the nursing work environment. She serves on national and community boards to advance the profession of nursing. Noreen’s Seminole contribution is the creation of a comprehensive nursing leadership development model that formed the foundation for healthy work environments led by authentic and transformational nurse leaders.

Dr. Anthony Orsini (4m 5s):
She has over 25 years of executive leadership experience with an emphasis on clinical operations, nursing professional practice, professional and organizational development. Dr. Bernard earned her bachelor of science and nursing at the university of Northern Colorado, her master of science and nursing administration at the university of Colorado and her doctorate of education in organizational leadership and organization development from Grand Canyon university. She is nurse executive advanced board certified, and a fellow in the American Academy of Nursing. And we are really, really lucky to have her today. Well, welcome Noreen.

Dr. Noreen Bernard (4m 45s):
Thank you. I’m thrilled to be here.

Dr. Anthony Orsini (4m 47s):
I noticed the Grand Canyon University during the intro. I’ll be giving a TEDx talk there next week. So it’s interesting how there’s so much commonality and there’s so much paths seemed to cross. So that’s pretty cool. I guess it looks like it’s a beautiful place. I’m looking forward to it.

Dr. Noreen Bernard (5m 2s):
Yeah, it, it really is. Campus is nice and that group will be lucky to have you and learn from you and, and I’m sure that it will be a great experience.

Dr. Anthony Orsini (5m 11s):
Thank you. Yeah, I’m looking forward to it. We’re doing a lot of remote training and I just can’t wait to get back in front of an audience and feed off of that energy. And I’ve always been a person who likes to do things in person. I gave a lecture, I guess it was a couple months ago to university of Virginia. And I’m doing the lecture by zoom, but you don’t know if anyone’s laughing at your jokes. I didn’t even know if anybody was awake or anyone’s there, you finished the lecture and at the end of the lecture, you just hold your breath and wait and make sure someone’s still on the other end.

Dr. Noreen Bernard (5m 42s):
Right? Exactly. No, and it’s real easy to get sucked into wondering you’re right. If anybody’s listening, but also just the whole concept of I’m talking to a computer screen.

Dr. Anthony Orsini (5m 51s):
Yep. I’m so big on body language. So that’s so hard to do. That’s why we’re doing this interview where I can see you, even though it’s only audio for those who listen and who’ve read my book, they know that I’m really big on being a genuine person and building trust. And we’ve had a lot of great leaders on this podcast. People really taught me and audiences how to really be leaders. And the word that comes up all the time is trust. And in order to build trust, you have to have commonality with somebody and you have to be a genuine person. So I like to do this for every episode. If you don’t mind, please tell the audience just a little bit about your journey and how you came to finally be in charge of all the nurses at a hospital during the worst pandemic in a hundred years.

Dr. Anthony Orsini (6m 35s):
So tell us a little bit about your journey.

Dr. Noreen Bernard (6m 38s):
Yeah, you bet. And hopefully the only pandemic in our careers. Yeah. It was one of those funny things and maybe it falls back to being the oldest of six kids and by nature always being sort of in charge of a whole house full of activity and watching the small children. But as soon as I graduated from nursing school, I was working in a situation at a very busy OB unit where the nursing shortage had just started. And we were very short-staffed. And within about three months of graduating from nursing school, I was put in charge of the night shift, no less three months. Yeah. And deep down inside. I thought, man, this is great.

Dr. Noreen Bernard (7m 19s):
I love this, but do you not know nearly enough to be doing this? And so I quickly enrolled for my master’s program in nursing administration, hoping that I would at least get some of the knowledge pieces that I needed to be able to apply into practice and the fake it till I made it during that whole first year of my immersion into nursing leadership. And then from there, I found myself in these situations where throughout my career, I was being asked, chronically being asked to take on larger scale, broader positions, higher up in the food chain, if you will, as far as leadership positions go. And each time I just said, sure, you bet I’m all in and navigate my way through that.

Dr. Noreen Bernard (8m 1s):
And it was really a pretty pivotal moment for me back in the mid two thousands. When I was in a very large organization, really providing nursing education leadership for about 2,500 employees that were spread out about all over the state of Colorado, when the vice president of human resources called me in, and that’s not the phone call you want to get because automatically we think we’re in trouble. And he brought me into his office and he said, have you ever heard of organizational development? And of course I said, no, what is that? And so he proceeded to describe to me what OD is. And he said, look, I’m starting up an OD department and we need a nurse since 45% or so of our employees that we’re serving our nurses do want to come play.

Dr. Noreen Bernard (8m 46s):
And I said, well, I don’t know anything about that. He said, that’s okay. If you allow us to teach you about OD, you can teach us about nursing and will make for a great organization development teams. So that was really my first introduction into not only the work of ODI practitioners, but also leader development. And we had a CEO at that time who was a big proponent of leadership development. And so I immediately got the opportunity to really begin to immerse into that field of leader development and found that was something I absolutely had passion for. I loved it and knew that needed to be a priority for all of healthcare leadership positions, not just nursing because of the complexities of the environment that we lead in.

Dr. Noreen Bernard (9m 33s):
And so that was a pretty big defining moment for me. And it really set me forth on my journey to be the very best expert that I could be in the world of leader development, organization development with that nursing lens. Of course, putting me kind of in a unique position, you don’t find a lot of nurses with that type of background or passion. Is it really put me on a great path for not only my future positions, but my educational advancement and a lot of my scholarly work that I’ve done subsequent to all of that. So it’s been an amazing journey, very fortunate, very lucky. And I say this to my staff all the time.

Dr. Noreen Bernard (10m 12s):
What I love about healthcare is that there’s never two days alike. If you’re bored in healthcare, you’re probably doing something wrong and I hit it. I had a pretty pivotal time in my last position at Emory healthcare in Atlanta, where all of a sudden I realized, wow, there actually might be an end date to my career. I had been in denial about that and I realized it was probably pretty important to determine where do I want to live, work and play and make my final set of contributions to give back. And what would that look like? And so I did a lot of soul searching and really just deep reflection around that. And I realized, boy, if I could live in play in Colorado and work in Colorado, that’s really where I enjoy my downtime.

Dr. Noreen Bernard (10m 59s):
And so I made the journey back to Colorado and one of the positions I had always wanted to formally be seated in was that of a chief nursing officer. And that’s because CNOs, not only do they run the hospital, but really more importantly, they’re the culture architects for the hospital. So to take all of the accomplishments, all of the experiences, all of the education and bring it into one position where I could apply that on a daily basis by developing leaders and advancing an organization and making a difference in the patient experience and building a culture and sustaining a positive culture to me was sort of the bow on the package of everything that I’ve done thus far.

Dr. Noreen Bernard (11m 46s):
And so, as I thought about, wow, I want, I think I really want to live, work and play back in Colorado. And I want to be in a role where I can do all this. What I think is cool stuff. What would that look like? And fate sometimes positions us well that this chief nursing officer position opened up, I applied for it came out quickly readapted to the altitude in about 12 hours flat and went through the interview process. And what I found was an organization that was the very first innovation hospital in the state of Colorado. It was a young hospital. I had only been open about two years full of very young and relatively inexperienced leaders, a genuinely kind caring, authentic culture, where the expectations were very high for how people show up every day and how they engage with each other.

Dr. Noreen Bernard (12m 39s):
And when I got the invitation to come join the team and be one of the executive leaders in that CNO position, I knew I would be crazy not to take the opportunity. So as I began to get orientated to my role and immersed in the health system, as well as in our organization within about four months, all of a sudden we got notification maybe six months a year or so ago that by the way, we’re going to have this thing called the global pandemic. We don’t really know what that means, but we don’t really know how long it’s going to last, but good luck. And so, so I, I had that aha moment where I realized, okay, I have two choices.

Dr. Noreen Bernard (13m 21s):
I can either be mad that this is not going to for now be the job that I thought it was going to be, or I can say, all right, how do I adjust, readjust and sort of live in the moment and figure out what I can contribute and what can I learn going into this very dark time for all of us where we really were navigating in the pitch dark. And we did not know at all what we were up against. And so it really is challenging as the last year has been a gift because it’s really for me anyways, re-centered me on, what’s important about our opportunities to lead these healthcare systems and organizations.

Dr. Anthony Orsini (14m 3s):
And we’re going to get into detail about that. But as you were speaking, I came up with a couple of questions that this, the way these interviews work, it just things pop in my mind. So you mentioned that you were out three months before they made you charge. And I know I’ve talked with you before, and I know you’re a very humble person, but I have a reason to ask this. So what is it that you think, and the reason why I’m asking this, I guess there’s people out there. I have a lot of nurses in my audience and there’s a lot of young nurses. So my question is twofold first. What was it that you think you had or that they saw in you that said Noreen, I know you just graduated, but I’m going to put you in charge. And two, what advice do you have to the nurses who are young and saying, I would like to take that path that Noreen took

Dr. Noreen Bernard (14m 47s):
Well, I think it was probably a couple of things. One, I tend to have high energy. And so with that comes sort of this personality of I’m pretty quick to adapt and pretty quick to learn. And I think that they saw that in addition to, I wasn’t afraid to make decisions. And I knew at that time, and thankfully they weren’t really big, hard decisions compared to what I have to do now, but I wasn’t afraid to make those decisions. My mantra always has been since the day I graduated and all new graduate nurses know the one thing that happens to all of us as we go through a phase where we don’t sleep, because we’re pretty sure we killed somebody or we worry that we killed somebody or that we forgot to give a medication that killed somebody.

Dr. Noreen Bernard (15m 28s):
And so after you get past all of that and you realize, wow, I really didn’t kill anybody. Well, how messed up can I make things? If I make a poor leadership decision, am I going to kill anybody? And so I’ve always approached learning nurses, learning new leaders, learning as you’re going to make mistakes but as long as you don’t kill anybody, everything is recoverable.

Dr. Anthony Orsini (15m 52s):
That’s a great . It’s called we call that imposter syndrome, right? And almost every physician I write about this in the book. I think almost every doctor when we’re a resident and when we’re young and even to a certain extent, your entire career, deep, deep down inside, one of these days, people are going to figure out that I’m really not as good as I, of course, it’s not true. And I would go neonatology for 25 years. And it’s funny that you’re talking about killing somebody or not for real, but working in a NICU. This takes a really high at that. And this is why we have second. I just, this week alone, I had Susan Wilson on speaking about second victim syndrome. For those of you out there where it’s February 15th and we’re recording this second victim syndrome and we have physician and nursing burnout, and it’s led to, you mentioned a crisis of nursing.

Dr. Anthony Orsini (16m 41s):
That crisis is I’m sure multiple factors that go into that. One of the factors though, although it worked out for you, one factor is that there’s a lot of nurses who aren’t there nursing school. Now it’s a very large percentage of them who either want to go the administrative route or they want to become nurse practitioners. And I’m seeing this in the NICU that the 25 years experience nurses is getting more and more rare. Don’tyou think?

Dr. Noreen Bernard (17m 3s):
Yeah, it really is. Yeah, it really is. And to answer your second question for any nurses or any young healthcare clinicians or anybody working in that healthcare space, who says, gosh, I think I want to be a leader or what would I do? Right. What would be my advice to all of you would be this, say yes to the opportunities that come your way. Don’t overthink it. There is nobody who is a hundred percent prepared for any position as evidenced by global pandemic. I have all of these years of leadership experience, I’ve got the education, I’ve got all of the credentials. And if you think I was ready for the pandemic, you’re kidding herself. None of us were ready for that. And so there’s a lesson right there, but I tell young nurses, I’ve worked with a lot of new graduate nurses over the years.

Dr. Noreen Bernard (17m 50s):
You know what, lean in, get a seat at the table and say, yes, and you know what? You’re going to have a bunch of people around you who will help you figure it out. You’re not alone in this thing.

Dr. Anthony Orsini (18m 1s):
Great advice. And then do what you did, make sure you do the nut, go that through the route that you’re supposed to go. You went back to school. How many times doctors and nurses have more years in school than I could possibly even think about. It’s crazy. So let’s switch over to the pandemic and the COVID crisis. And the tagline to the general population during the peak of this crisis was healthcare heroes. And it’s still a tagline and you still turn on the TV. And we all see the nurses and the doctors laying on the floor, sleeping and people wearing PPE and wearing the protective gear, not only were their healthcare heroes and nursing and doctors, but we had the cafeteria people, right?

Dr. Anthony Orsini (18m 42s):
The housekeeping, the receptionist, we’re all healthcare heroes, but behind the scenes that you and I know behind the scenes, we know that we put a stop to elective surgeries and there were people not coming to the hospitals and the hospitals were losing millions of dollars. And then there were people like you Noreen who were in leadership areas that had to decide. We know that a lot of doctors and nurses got furloughed, a lot of doctors took a major hit in their pay and their income. A lot of nurses, I just watched them wait every day, is this the day that I’m going to find out that I got furloughed? Is this the day I’m going to have to take my entire vacation in the middle of the winter? When I was planning on going to Bermuda, that must’ve been a really difficult time because you really want to make sure that you treat everybody with respect.

Dr. Anthony Orsini (19m 29s):
How did you navigate through that? That had to be really hard.

Dr. Noreen Bernard (19m 32s):
I think that you’ve touched on some of those really important, complex challenges that were going on behind the scenes that are not public facing. They’re not in the media. And as we sat in multiple incident command meetings for hours every day, trying to put these action plans together, that was one of the things that both here in Colorado, university of Colorado health, as well as at Emory and other places nationally, where I kept in touch with people, everyone was struggling with, how do we manage the millions of dollars a day that we’re losing financially and figure out how do we retain our employees? How do we keep our providers engaged and what a lot of organizations did And we certainly did this probably to the nth degree is not only try and have those authentic, transparent conversations with people along the way, in terms of explaining the very best that we could around the healthcare economics.

Dr. Noreen Bernard (20m 29s):
And the other part of the economic conversation that I had with multiple people was not just about shutting down surgery, which we know is a big revenue generator for all hospitals, but we didn’t have diagnosis codes for COVID 19 patients. And if people take a look at their average length the stay in the hospital, for example, one of my hospitals where we care for a lot of COVID patients are normal like the length of stay is about four days, three and a half to four days, pretty quick in and out, these patients were staying 30 to 60 days. And so with an average of the stay for COVID patients, maybe being around 40, 45 days, we stopped getting paid for them after about that third or fourth day.

Dr. Noreen Bernard (21m 9s):
So with no diagnosis code initially during the first wave to be able to bill for that for the course of their care, we were really feeling it again at the national level, every single health system. And so, you know, what I found myself facing where these conversations with people when I least expected it during rounds, maybe a lot of emails, people expressing their frustration. And so what I found that I really needed to do was figure out how do I show up for them in a way that’s kind, that’s carrying this empathetic, but also educational. So how do I listen and try and understand their individual situation?

Dr. Noreen Bernard (21m 49s):
Because that’s what we saw a lot of, we’re very unique situations for individuals. And I think we had to customize sort of how we responded to those and then what support can I give them? And what are they willing to do that might be outside the box of their normal job descriptions? So for example, we had CRNAs and anesthesiologists because of the surgical shutdown that were completely left out of work. Light switch went off, they were out of work and it took us a couple of weeks to figure out that many of them were critical care trained by background. And so when we realized we were going to be short of critical care nurses and that these, these COVID-19 intubated patients took three and four and five people to turn, and you really needed an entire team.

Dr. Noreen Bernard (22m 40s):
We recognize that we had a resource, a really valuable resource that if they were willing, we could bring them into the team. And so we negotiated some quick contracts. We said, here’s what we can sort of pay hourly or whatever that rate might be and integrated them then into the team as a short term way to sort of compensate for what they weren’t getting financially, but also to help us care for these really complex patients. So there were creative staffing solutions like that, that emerged out of some of those challenging conversations. And what I found was by showing up and truly being a compassionate and authentic listener, sometimes in that dialogue, there was a creative solution or an innovative idea that none of us had even thought of before that would come out, bringing nurses in from nonclinical roles, like your quality department or your education departments, and redeploying them back to the bedside, not to take a traditional full load of patients, but to serve and helping hands roles where they can help with the donning and doffing PPE.

Dr. Noreen Bernard (23m 49s):
And this was actually going on all over the country. I do know nurses, bedside nurses and providers who were also furloughed in different organizations. And I think the dialogues that happen around that time were about this is temporary and we’re in this together. And the most important thing that we have to keep our eye on is making sure we’ve got all of us together when this pandemic subsides so that we can resume normal operations. And so we found all kinds of temporary solutions to try and help at least minimize or reduce that financial burden that individuals were feeling as a result of what the organization was experiencing.

Dr. Anthony Orsini (24m 30s):
I think what I’m really hearing is what my true belief is that it’s all about communicating with the people to let them know and doing it compassionately. I heard you say the word listening, which is so important, and I have learned so much Noreen from doing this podcast. I mean, the guests, including you, that I’ve had on from business, from healthcare, not only did they validate my true beliefs about how important communication is to your professional and your private life, but they’ve really taught me so many things about being a true leader. And in some ways it’s kind of obvious. I mean, the words that you said, compassion, communicate, listen, be an active listener.

Dr. Anthony Orsini (25m 16s):
And if you tell people as Simon Sinek says the why, right? If you tell them the why they’ll understand it. And I think the biggest problems have occurred when people get furloughed and they don’t really understand why me, or maybe some of them thought, well, the hospital’s making a lot of money and yet they’re furloughing me. And by the way, I usually say in the beginning, so I’ll say it now the views of myself or Noreen’s are our views only in our opinions and not necessarily the opinions of the hospitals organizations that we work for. Okay. I made the attorneys happy. So those words just keep coming over and over again. The other thing that I’ll say is healthcare heroes really is true.

Dr. Anthony Orsini (25m 57s):
And one thing that I noticed during the pandemic and also being in the New York, New Jersey area during 9/11 is nurses and doctors and therapists and housekeepers, and everyone that works in a hospital truly do want to help. And you would think, and I’m sure you’ve seen what I’ve seen before is pediatricians running out to do trauma. I was in Orlando during the pulse nightclub crisis. So we’re in a really, an elite group of people that run towards problems and not away. And really, we were all nervous about COVID right? The first you have to wear N95, then you don’t have to wear an N95.

Dr. Anthony Orsini (26m 36s):
And then it seemed like things were changing every day. And I heard all the time, like they don’t know what they’re talking about. And the truth is no one did even the government, but not even knowing whether the N 95 or the level three mask is going to work. The nurses put the level three mask on and they went in there and I have never seen anybody say no when there’s a patient who’s in need. And I just want to say, aren’t we lucky to work with such people,

Dr. Noreen Bernard (27m 4s):
Oh man, it’s such a gift. I, this past year, as a leader has really highlighted for me personally, what an honor it is to serve side-by-side with people who are completely selfless. And they do, they run into, they don’t ever run away from, and man, you really saw that you really saw that this past year.

Dr. Anthony Orsini (27m 26s):
Yeah. And I’ve even seen instances where a patient will need help and a nurse will go in there to help and we’ll grab whatever mask there is or whatever. And we all try to be careful and we’re we follow the guidelines and we listened to our leaders, but they’re really true heroes. If you ask me communication, telling the why these are really all important tips for the leaders out there, I say, this is obvious, but when I go around speaking to people in business and I’m doing this podcast, it’s shocking to me, how many leaders, not only in healthcare, but also in business, we don’t do that. I just don’t get it. I really don’t. It’s not that hard.

Dr. Noreen Bernard (28m 5s):
Well, I think there’s some old school. I’ll put a plug in for old school leadership because I’m so against it. And if I ever become old school, I hope somebody tells me because then I’ll know I need to get out. But the old school leadership model is that of he or she who holds the information, holds the power. It’s I’m from an authoritative perspective, I don’t owe you an explanation. And it, contemporary leadership would tell us the opposite. The more that we tell people why the more we engage them in problem solving, the more that we say, Hey, I’m just your teammate. I might have a unique position on the team, but we’re all a team and your ideas and your contributions are equally as important.

Dr. Noreen Bernard (28m 47s):
That’s really what Simon talks about. And that those are game changing concepts for leaders to really wrap their minds around and embrace in their leadership practice.

Dr. Anthony Orsini (28m 57s):
Yeah. One of my favorite sayings and I’m paraphrasing, the worst thing that can happen to an organization is when they’re most passionate people go silent and you always want those people to be engaged there’s books by Daniel, Goldman, primal leadership, who talks about when your employees are happy and they’ll run through fire for you, and they’re better engaged and there’s better teamwork and draws a direct relationship down to the bottom line of how companies can make more money simply by keeping their employees engaged. So, so we thank you for your leadership in that, and that those are really good pearls. Let’s switch over to patient experience a topic near and dear to my heart because I love talking about patient experience.

Dr. Anthony Orsini (29m 39s):
It’s the hottest topic next to Covid or before Covid came around, it was the hottest topic in medicine. And I really want to talk about what you’ve done there, your hospital to bring patient experience to the top of the list of priorities. And then the special challenges of patient experience during the pandemic. We had patients dying and loved ones who can’t come to visit. Tell us what you’re doing there about patient experience in your whole concept on that.

Dr. Noreen Bernard (30m 6s):
Well, we have a very unique and a very special motto and expectation of every single one of us in our facility. And it was really the Genesis of our first CEO president who opened the hospital. And it’s very easy and it goes like this: Eyes up Energy Forward. And that’s the expectation that we all have of each other. And what that has done is it’s created this culture of focus on you. I together each other, and it’s created this culture of engagement with our visitors, with our patients, our families, everyone in each department. So what it doesn’t mean is it doesn’t mean you walk around looking at your cell phone, reading your messages.

Dr. Noreen Bernard (30m 49s):
What it means is that cell phones in your pocket, your eyes are up your energies forward. You’re greeting people, the five, 10 rules, all of those things, but more importantly, it’s a genuine and authentic grading and checking in with the people around you. And so that IEyes up Energy Forward is something that we hold ourselves very accountable to. We conduct leader rounds all the time, and we make sure that we are living into that and we ask our employees, so how well are we doing with eyes up energy forward? And so I think that’s really a key foundational piece for us in our culture. And when we onboard new employees, they notice it right away and they say that’s really a unique identifier and a differentiator for us compared to maybe where they worked before.

Dr. Noreen Bernard (31m 37s):
Other places where they’ve been employed. The other thing that we try and frame up our patient experience around is all about that relationship with every single patient, every single one of their family members. We ensure that we focus on four things, getting to know me as a patient. So know me and then educate me. So teach me what I need to know. Engage me as a partner, helped me learn about my healthcare diagnosis, my care, my aftercare, et cetera, guide me through that whole process and then support. And I think those four things also then help frame up how we engage with our patients and how we really ensure that we are treating them like partners, not doing unto them, but doing with them.

Dr. Noreen Bernard (32m 24s):
And that they are just as much in charge of their care plan as we are. And that we do those things that are known best practices. We do bedside handoff. We do leader rounding. We have a thing called a new path stone. If I’m walking down the hall and a call lights going off, it doesn’t matter. You know who I am. I go in and I address that call light. Now Covid, that’s such a nice segue to talk about patient experience in the context of COVID because with our COVID patients, that was much more difficult to attain because all of a sudden with the signage on the outside of the door with some special precautions you knew, okay, I can’t just go in and turn off that call light. I’ve got a PPE up.

Dr. Noreen Bernard (33m 4s):
I’ve got to get a head to toe. We’ve got to figure out, is this a COVID patient or is it a different type of infectious disease that’s occurring with that particular patient? And so it made us stop and think a little bit more before we would just sort of plow into a room to help somebody boy, lots and lots of challenging and sad stories about patient experience and visitors and the family’s involvement during COVID-19. You alluded to that a little bit ago when the initial COVID waves started. Of course, I think all hospitals went into lockdown, no visitors whatsoever. Patients it particularly with COVID who were there for these extended length of stays, ICU stays, but had no family support.

Dr. Noreen Bernard (33m 51s):
And for me, one of my observations that I actually met with a family and talked with them about this because as were the administrators there, and then as the administrator on call, which is a week long, a rotation that we’ve all pretty much had to do our whole lives, where you carry the phone and everybody calls you for everything. Extremely

Dr. Anthony Orsini (34m 9s):
Nobody calls nobody calls to say, hello, it’s a big problem.

Dr. Noreen Bernard (34m 13s):
We had a lot of situations where we maybe had to consider visitor exceptions end of life decisions about family visitation. And so when the first wave of COVID, there was a PPE shortage. So we didn’t have enough PPE to confidently say, every COVID patient can have one visitor from 8:00 AM to 8:00 PM or whatever the hours were going to be. We had to conserve this PPE. We didn’t know how contagious it really was. We didn’t know how dangerous it really was. So most hospitals went into lockdown, but as an administrator and administrator on call, I would find myself in these precarious situations where people would contact me and say, Oh boy, we need your help sorting this one out.

Dr. Noreen Bernard (34m 57s):
And in one of those cases, I had made an exception for a family, got the visitor in. We, we did the head to toe PPE was an end of life situation. And the wife was very grateful, very thankful. And as I was talking to her, that light bulb for me, went on and I shared this with her directly. And I said, if this pandemic has taught us anything, it’s the value of family and friends at the bedside to help with the healing process?

Dr. Anthony Orsini (35m 25s):
Absolutely, absolutely. It’s really important. Yeah. And the death and dying thing is hard and doing it through an iPad. And we just did a whole class for another hospital and we just did a learning module on communication with a mask, communicate that with PPE there, I teach in my workshops and you read the book also three types of smiles. Well, now there’s another type of smile behind the mask and your eyes become really much more important. Your communication skills come with more important than telehealth I think is here to stay. And so it’s important that we learn how to build that genuine connection through a screen. And it’s a skill set. So that’s opened up a whole new type of communication that we need to learn.

Dr. Anthony Orsini (36m 5s):
And it’s really important, but it sounds like over there, you really get it. And back to the end of the life, I’ve seen some incredible people do incredible things to bring a loved one in my world with babies dying, you might have, the parents might be there, but it’s really so important to a mother or father whose babies passing away that grandma has not seen the baby. And grandma has to see the baby. Grandpa has to see the baby. We have family and I’ve seen people do things that are safe, but outside the box. And I love that attitude. I’m fortunate to work with people like that. Who okay. Let’s and that’s exactly, I think the way you put it is let’s figure out how to do it. It’s not just no, okay, this is a tough one, but let’s figure it out because we know that nothing’s more important to that family.

Dr. Anthony Orsini (36m 52s):
So that’s fantastic. Noreen. I have two things left. I always finished with the same tough question. And that’s to ask you, what’s the most difficult conversation that you have had in your life or type of conversation and help the audience. Tell us how you navigate through that.

Dr. Noreen Bernard (37m 10s):
I would say that when individuals approach me and describe the situation that they’re dealing with, which I can quickly diagnose as incivility and or bullying in the professional environment. I think those are the toughest. They’re the most complex, there’s deep repercussions. If they’re not handled well, they’re oftentimes linked to power, money authority. They have very significant degradating effects on people’s self esteem, their confidence, which then just puts them into a spin. And what I’ve learned in, unfortunately having many of those over my career, because we’re still not completely there yet in healthcare, as far as really having truly healthy and functional relationships with each other.

Dr. Noreen Bernard (37m 54s):
What I have found that works is to listen very intently, openly, and an active listening to try and pinpoint what is it that this person needs so that they can get themselves through the situation. So sometimes providing some diagnostic open-ended questions to help them actually do, you know, the assessment and the diagnosis about what the situation actually is that they’re dealing with and then providing them with some suggestions for tools, for how to navigate that and helping them identify what are my options and what are the pros and cons of each of those options.

Dr. Noreen Bernard (38m 38s):
Somewhere, usually in there in these conversations, which are very hard because they are so complex and they may be situations that that one individual is not going to be able to resolve because the problem’s bigger than them. Maybe it’s a large department issue, or maybe it’s a provider who’s got multi-millions of dollars a year coming in for research funding, et cetera. But what I always find is an opportunity to teach about oppression theory and really what’s the difference between incivility and bullying. And what’s your role in, and what’s the role of cognitive reversal? What are some things that you can say and do to at least diminish those experiences?

Dr. Noreen Bernard (39m 19s):
And so it goes back to how do they show up differently, but how do I help them get tooled up if you will, for navigating that by themselves? And so it’s a moment of assessment than the diagnosis, right? And then figuring out what’s the plan going to be because usually by the time those conversations happen, things are pretty far gone as relationships. And so again, it boils all back down to relationships,

Dr. Anthony Orsini (39m 44s):
Relationships and communications. Bullying is a really hot topic. We can do a whole episode on that. Maybe we’ll have you back, but it’s difficult to delineate sometimes as a leader, whether the person who is the victim or is the bully, they’re just trying to set a high bar. And we have some nurses who maybe are new and just aren’t cutting it. And they take things the wrong way. And some nurses who don’t mean to be bullies, but are just trying to raise the bar. And it really comes right down to my book. It’s all in the delivery, right? It’s not necessarily what you say, but it’s how you say it. And as a leader, it’s probably very difficult to tease out whether the process go wrong and that’s gotta be tough.

Dr. Anthony Orsini (40m 25s):
So well, this has been really a great interview Noreen. I really appreciate that Martin Luther King said the ultimate measure of a man or a woman is not where he stands in the moments of comfort or where he stands at the time of challenge and controversy. It’s not over yet, but I’ve spoken to you a few times. I can tell that you’ve really navigated through this to the best of your ability. You’ve done a great job. And the, for someone who got thrown into it after three months of nursing school, you’ve shown over and over again, your ability to lead. And I think we need good leaders more than ever. So I just want to say, it’s really an honor to get to know you and an honor to have you on this podcast.

Dr. Noreen Bernard (41m 4s):
Thank you for having me. It’s been a joy to be here.

Dr. Anthony Orsini (41m 7s):
Well, I can’t wait for my audience to hear this Noreen. What’s the best way for people to get in touch with you if they want to email you or contact you?

Dr. Noreen Bernard (41m 14s):
Yeah. Let me give you my email. It’s Noreen and O R E N dot Bernard, B E R N a R d@yahoo.com and welcome any opportunity that I can help.

Dr. Anthony Orsini (41m 25s):
That’s great. We’ll put that all in the show notes. Most people are listening to this driving, so we don’t want them to write that down. It won’t be on the show notes. If you enjoyed this podcast, please go ahead and hit subscribe and download the episodes. If you want to get in touch with me, you can reach me at Dr.Orsini@theorsiniway.com that’s Dr.Orsini@theorsiniway.com or just go through the website. Thank you for listening. And I hope you’ll be back again next week. Thanks again. Appreciate it. Thank you. Bye bye. This episode was brought to you by Veritus. Veritus offers virtual alcohol drug and trauma treatment programs exclusively for licensed medical professionals. Their programs provide a concierge level of care consisting of evidence-based clinical treatment and are customized to meet the unique needs and challenges of physicians that this pharmacists and nurses struggling with substance abuse.

Dr. Anthony Orsini (42m 16s):
The virtual confidential platform provides the safety and security medical professionals need to get help while continuing to work confidential, convenient and compassionate Veritas brings world-class treatment to your home or office contact Veritus for help at Veritus solutions.com.

Announcer (42m 34s):
If you enjoyed this podcast, please hit the subscribe button and leave a comment and review to contact Dr. Orsini and his team, or to suggest guests for future podcasts visit us @theorsiniway.com.

Motherhood and Milestones

Kristen Horwath and Jennifer Ainesworth (2s):
Typically, we get the mom that has been to four other places and they know something’s not right, but they don’t know what exactly that is. They will typically say I’m having issues with feeding. I’m having issues with weight gain. My doctor recommended us to do X, Y, and Z, but I need help. And so we will do a zoom call with that mom and get them on the phone with us. Talk to them, validate their concerns, listen to what is going on to them. And what’s their current situation and then we figure out what the needs are and how we can best serve that mom and baby.

Announcer (49s):
Welcome to Difficult Conversations: Lessons I learned as an ICU physician with Dr. Anthony Orsini. Dr. Orsini is a practicing physician and president and CEO of the Orsini way. As a frequent keynote speaker and author Dr. Orsini has been training healthcare professionals and business leaders how to navigate through the most difficult dialogues. Each week, you will hear inspiring interviews with experts in their field who tell their story and provide practical advice on how to effectively communicate. Whether you are a doctor faced with giving a patient bad news, a business leader who wants to get the most out of his or her team members or someone who just wants to learn to communicate better this is the podcast for you.

Dr. Anthony Orsini (1m 35s):
This episode is being sponsored by Veritus. Veritus offers virtual alcohol drug and trauma treatment programs exclusively for licensed medical professionals. Their programs provide a concierge level of care consisting of evidence-based clinical treatment and are customized to meet the unique needs and challenges of physicians, dentists, pharmacists, and nurses, struggling with substance abuse. Having worked with licensed medical professionals struggling with substance abuse since 1976, Veritus understands how extremely difficult it can be to ask for help because of how severe the stigma is in the medical community around mental health and how real the fear is of a potential repercussions from colleagues if found out.

Dr. Anthony Orsini (2m 18s):
Their virtual confidential platform provides a safety and security medical professionals need to get help while continuing to work. Confidential, convenient, and compassionate, Veritus brings world-class treatment to your home or office. To learn more about Veritus, you can visit www.veritussolutions.com. Well, welcome to another episode of difficult conversations lessons I learned as an ICU physician. My name is Dr. Anthony Orsini and I will be your host again this week. Are you a parent, perhaps a first time mother or father? Maybe you have a baby with special needs, or just have questions about how your baby’s developing or maybe you need help breastfeeding or perhaps have a new baby and can’t find the owner’s manual.

Dr. Anthony Orsini (3m 4s):
Wouldn’t it be great if you had someone to call when not only has the expertise to help, but knows what it’s like to be a mother with all of the concerns and worries that come with having a baby. If that description fits you or someone that you know, trust me, you are not going to want to miss this episode. Today I have with me, Kristen Horwath and Jennifer Ainesworth, Kristen and Jennifer are amazingly talented, pediatric and newborn physical and occupational therapists with over 25 years of combined experience caring for newborns and infants. They are neonatal and pediatric therapists. And as they say, mama’s also who have a passion for wanting to help moms and babies thrive.

Dr. Anthony Orsini (3m 47s):
So after working together at one of the top children’s hospitals in the country, they teamed up with Adrian Alexander, another amazing pediatric physical therapist, and started milestone specialists of America, which is a baby resource development coaching and therapeutic concierge service for moms and their babies. Before leaving to start milestone, I had the pleasure and honor to work with both Kristen and Jennifer, for more than six years. They are top notch, pediatric and newborn specialists. But more than that, they bring with them the understanding that healthcare is about that human to human interaction that I speak about every single week on this podcast.

Dr. Anthony Orsini (4m 30s):
In short, today we have with us the dream team of infant and pediatric physical and occupational therapy. Well welcome Jennifer and welcome Kristen. It is real honor to see you again, I’ve missed working with you, but I know that you’re doing such amazing and exciting things.

Kristen Horwath and Jennifer Ainesworth (4m 47s):
Thank you for having us.

Dr. Anthony Orsini (4m 47s):
So this is a first, I’m doing my first podcast with everybody in the same room. So we’ll see how that works out. It’s so much better because you know, I’m a big body language person, and this is really great to get the vibe and we’re all friends. So this should be a lot of fun. Thanks again. This is going to be awesome. Amy Alexander’s, couldn’t be here today she’s the other partner for milestone, but we’re going to have a really great time. When I do my workshops and I talk about the healthcare provider patient relationship or the business leader, employee relationship. The word that keeps coming up over and over again is relationship and trusting relationship. And the best way to form a trusting relationship is to find commonality and to be a genuine person.

Dr. Anthony Orsini (5m 31s):
I think that’s really important when we discuss how doctors can form relationships very quickly. And so I know you guys, I know how good you are. I know all about you, But before we start, I think maybe we’ll just take a few minutes for each of you to take some time. Tell us about your journey, how you got here, and then we’ll jump in and talk about milestone and all the awesome things that you do at milestone. So who wants to go first?

Kristen Horwath and Jennifer Ainesworth (5m 55s):
I’m Jen Ainesworth and I’m an occupational therapist and a feeding specialist. And one of the co-founders. How I got to occupational therapy. My bachelor’s is actually in elementary education. And I really loved children a lot and wanting to be a teacher forever and then graduated and was ready to get a job. And my dad said, you need to go to grad school. And I was trying to explain to him why that wasn’t possible. And he said, you need to go to grad school. So this was a long time ago because I didn’t need any hours or anything. So within two weeks I found myself sitting in my master of occupational therapy program because it was a place where kids who needed extra help at school could get some extra help.

Kristen Horwath and Jennifer Ainesworth (6m 42s):
And I’m forever grateful for that because I don’t think I would have loved teaching 20 years later. And I truly love being a therapist and working with little people and I just love it.

Dr. Anthony Orsini (6m 55s):
So usually there’s something in our past, you know, I always say we are where we came from and if you’ve read my books, you’ve start off with the story of me having epilepsy when I was a child. And I think that had a lot to do with me being exposed to medicine and what was right and what was wrong about medicine. So this might be a tough question. I’m putting you on the spot. So what do you think in your past that made you get drawn towards occupational therapy, but more pediatric and newborn?

Kristen Horwath and Jennifer Ainesworth (7m 23s):
Kristen might even, this will be news to her, but I actually had five, six maybe surgeries in middle school and high school. And I was in physical therapy frequently because a lot of them were orthopedic in nature and I thought physical therapy was so boring. So I didn’t want to go into that and went into occupational therapy. As I appreciated the sensory components as a sensory child, myself, I felt like I could relate to that a little bit more.

Dr. Anthony Orsini (7m 54s):
That makes sense. All right, Kristen, you’re up. So who is Kristin? How did she get here and why did you choose to go into physical therapy?

Kristen Horwath and Jennifer Ainesworth (8m 5s):
So I went into physical therapy because Jen, I had injuries growing up. I was a competitive cheerleader and through my injuries, I was introduced to the career of physical therapy and I was always athletic and wanting to be involved in sports. And I liked seeing change and helping people get back to what they love to do. And as a physical therapist, that’s what you do. You get people back to what they love doing. And so I went into my doctorate of physical therapy with the notion in mind that I would be an orthopedic sports medicine PT, and then I had my internships and I was in orthopedics.

Kristen Horwath and Jennifer Ainesworth (8m 53s):
And I just found that I ended up being drawn towards pediatrics. Because I felt peds and working with their families, you never knew what that baby or child would bring that day. So there was some sort of spontaneity and I had to be flexible and I liked the change and I could still make an impact on that baby’s life. And a lot of times it’s just bringing the knowledge and education to the families that I just found a passion for. And you set that baby and family up for change from the beginning and it can last through a lifetime.

Dr. Anthony Orsini (9m 33s):
I always tell my patients that the best thing you can do is stay in physical therapy. And so it’s interesting that you said you wanted to do orthopedics because when I entered medical school, that’s what I wanted to do too. I was all excited. I was an athlete in high school. I wanted to become an orthopedic surgeon and do ACL repairs and all that. And I signed up my third year clinical and I said, first thing I signed up for was orthopedic surgery elective. And I go into my first operating room and the orthopedic surgeon has a mallet and it shizzle and a drill. And I remember thinking to myself, if I want it to be a carpenter, I wouldn’t have gone to medical school and got $200,000 in debt, but no offense to the orthopedic surgeons out there, but I always felt more close to the babies.

Dr. Anthony Orsini (10m 19s):
And I really wanted that more human side of medicine and treat the person who’s awake. So it’s interesting that you said that, so let’s move on. So we worked together for probably six years. I think it was, I’ve been there about six years that you guys were really awesome. And one of my go-to people when I needed OT, PT for my little babies, I’ve personally learned a lot from you guys. So you’re working at one of the best pediatric hospitals in the country. And yet you decide to take this leap of faith to start milestone. So what made you say I want to go out and deal? Was it something that you wanted to do more of? What drew you to say? I got to do this and for milestone

Kristen Horwath and Jennifer Ainesworth (11m 2s):
Little side note, I have four little guys and I like to say my youngest is 19 months. So I technically made it through the, at least the infant years with all my four kids and have experienced a lot of different things as a mom, having four different children and my journey as a first time, second time, third and fourth time mom. So I feel like after my years in pediatrics, my years in neonatology, and then as a mom, Kristin and I were just always going back and forth, I would have friends ask me, can you look at my kid crawl? Can you look at my kids’ feet? And I would send a tourist and a picture and she’d respond or vice versa.

Kristen Horwath and Jennifer Ainesworth (11m 42s):
What about my kids feeding? What bottles do I buy? And we would always send each other text messages. Like we’re just throwing money away all the time. And then I had a friend of a friend at my house probably for three hours a Saturday and looked at her baby and FaceTime Kristin. And she did infant massage over video chat. And we were just like, there are moms out there that need a resource that is reliable and invested and truly cares. And we started doing some market reviews and just found that there weren’t that many out there for a baby that needs outpatient therapy. There is a plethora of resources, but not just the mom that needs a little extra, has some questions feels like something’s not right.

Kristen Horwath and Jennifer Ainesworth (12m 30s):
Or doesn’t know what to do next with the whatever her baby is doing.

Dr. Anthony Orsini (12m 34s):
Well, you said, I think it’s on your website or on your Facebook page. You say we’re not only therapists but we’re mamas. So how important is that? You think I’m sure it could be a good physical therapist. I guess there’s a certain familiarity with the mom who can’t get her baby to feed at 3:00 AM and is crying because she wants to go to sleep.

Kristen Horwath and Jennifer Ainesworth (12m 55s):
I think that motherhood changes you. There’s no doubt about that. We actually had a group of new moms last week and a few of them were nurses and the one says I never going to be the same nurse. And we laughed because we feel like that too. Of course, it just allows you to know, Kristen talked about this a lot. That every advertisement, every marketing, it’s always this mom that is just so peaceful and feeding her baby and her makeup’s done and her hair is done and, you know, breast or bottle feeding is going beautifully or they’re playing and everyone’s laughing on the clean play mat with no toys, anywhere else in the room. The whole house is clean and that’s just not it ever.

Kristen Horwath and Jennifer Ainesworth (13m 35s):
That’s never how it looks, ever.

Dr. Anthony Orsini (13m 37s):
Yeah. I know my wife was working when we had our first child. I was a neonatal fellow and I was able to do some research at home for a couple of months. We lost our daycare. And so I took care of my first born at home for a couple months. And she would come home at 3:30 from school teaching and the eggs were still on the table, dishes and the counters were still full and there’s crap everywhere. And she says, what has been going on in here? I’m trying, but, and then you don’t sleep. And so when they finally go to sleep, then you sleep. But it’s real important. I think that you can also relate. What’s the typical client that calls milestone that you have a Jen mentioned that sometimes it just moms are concerned, but I’m sure there are also, some moms will have some real legitimate concerns.

Kristen Horwath and Jennifer Ainesworth (14m 26s):
Typically we get the mom that has been to four other places and they know something’s not right, but they don’t know what exactly that is. They will typically say I’m having issues with feeding. I’m having issues with weight gain. My doctor recommended us to do X, Y, and Z, but I need help. And so we will do a zoom call with that mom and get them on the phone with us. Talk to them, validate their concerns, listen to what is going on to them. And what’s their current situation. And then we figure out what the needs are and how we can best serve that mom and baby.

Dr. Anthony Orsini (15m 12s):
So they’re typically moms who babies have legitimate problems and they just can’t seem to get help. Or do you also get a mom that just is crying? I can’t get this baby to breastfeed. Yeah. Would you say it’s more babies with real serious problems?

Kristen Horwath and Jennifer Ainesworth (15m 25s):
I would say a mixture. There are those moms that have a baby that maybe doesn’t have a medical diagnosis yet, and we can help direct them and to whatever appointment they may need to get to see a specialist. We know who to call. We know the specialists in the area and working at the hospital so we know the direction to send them. So that way they can, regardless of the diagnosis, we’re going to treat the baby. Their symptoms, give that parent tools and education. But in order to get some services, there sometimes required diagnosis. So we will help in that regard, if there’s something definitely medically wrong, but we also get that call from the mom that is just struggling getting her newborn colicky, fussy, irritable, baby.

Kristen Horwath and Jennifer Ainesworth (16m 17s):
And isn’t sleeping. Isn’t eating great is not doing tummy time, not doing all the developmental play activities because that baby is just having a hard time adjusting. We call it the fourth trimester. So that first 12 weeks it’s mom is trying to adjust to being a new mom and getting to know her body and the hormonal changes. But also she’s getting to know the baby and the baby’s getting to know the world and adjusting to life outside the womb.

Dr. Anthony Orsini (16m 44s):
There’s probably a whole bunch of moms out there going that’s me right now. I need some help. So what are the exact services for people out there who are really interested right now? What are the exact services that milestone offers?

Kristen Horwath and Jennifer Ainesworth (16m 59s):
We have physical therapy, occupational therapy, speech therapy, and we have a postpartum doula who can help walk alongside the mom and the baby with lactation needs and just adjusting to life as a new mom, we have a lactation consultant and our OT is also a feeding specialist. So depending on the experience of the OT, we also have that. We have a neonatal pediatric registered dietician that also used to work in the NICU. And we have an allergy advocate mom, who has walked in the shoes with her own daughter, having severe allergies, seven out of the eight common allergies.

Dr. Anthony Orsini (17m 40s):
That covers just about everything. I think that’s just awesome. Did I get you to say some clients come from Europe and they even contact you from out of the country?

Kristen Horwath and Jennifer Ainesworth (17m 47s):
We have had a couple out of the country. One was in Guatemala. The other one was in Brazil. So we were able to help now with COVID times, we’ve been able to reach these moms and give them tools to make them confident in their decisions from afar and not being able to see them in person, but giving them the education and tools to do what they can do with their baby.

Dr. Anthony Orsini (18m 16s):
When I have these difficult conversations with parents in the NICU, perhaps we know that the baby is going to have developmental delays or just has some real challenges. One of the things that I like to say to the parents is that your baby’s fortunate because they have two loving parents who are going to do the exercises that the physical therapist and the occupational therapist has. And not all babies have that I think to me. And I’d like your opinion on this, the most important thing for a mother or a father. Cause we always forget about the fathers is that they want to do something right. Even in the worst set of circumstances. So how important is it that you can do a lot of education? I assume that they can do at home because you can’t see the baby every day.

Dr. Anthony Orsini (18m 57s):
So how important is, and you lay out instructions for them, how important are those home exercises.

Kristen Horwath and Jennifer Ainesworth (19m 3s):
For me, I always tell the moms and the dads like give them a role, something for them to do. And a lot of the dads, even in the NICU, they would love to do the exercises. And then, so that would give the dad purpose to do something with their baby while mom would do feeding. Yeah. I think the first thing though is even, I think we both, don’t all three of us with an array of situations, with all different complexities and a variety of developmental delays. And you always want to give mom and dad, no matter what is going on in the situation, something that they are doing right. And something they can do that will benefit their baby because any parent is of course going to want to help their baby.

Kristen Horwath and Jennifer Ainesworth (19m 48s):
And I think that’s great. And people would often ask, how do you do what you do? I don’t have to break very much bad news. I can always give the moms this is what you are able to do. And to give the positive component of it, even in the worst of maybe a palliative situation, there’s always something positive and give them a memorable experience of ways they can interact with their child, because we all have an idea of how parenthood is going to go. You make a choice sometimes, so you get pregnant or not. And then you have an idea of how your experience through birth and into parenthood is going to go.

Kristen Horwath and Jennifer Ainesworth (20m 28s):
And sometimes your experiences don’t go as you thought they were going to go. And at the end of the day, parents just want to do something for their child.

Dr. Anthony Orsini (20m 36s):
And as you know, I’m a big person on body language and nonverbal language. And when I say that to a parent, this baby’s lucky because they have you. And that these are the exercises that the physical therapist, occupational therapists are going to give you. And I know that you’re going to do them because you’re a loving parent. If you know how to read a face, you could just see it. And you’re looking at me, nodding your head right now. They light up. They just, they want so much to do, even if they know the baby’s going to have big challenges, but the fact that they might be able to minimize that challenge just by a little bit, by doing the exercises. So I would imagine you guys write out a whole list of stuff for them to do and they can follow the plan.

Kristen Horwath and Jennifer Ainesworth (21m 16s):
Yes. And the other thing is we’re very big. So you asked earlier about being moms ourselves. My first little guy had mild torticollis, which required I was told to do these stretches four times a day. I had one child. It was very overwhelming and I didn’t get it done. And I remember thinking, wow, all these moms, all these years that I thought, why can’t they just do this with their babies? And here I was with good resources and a professional myself. This was my field and I still couldn’t get it done with one baby. And there are times that I just, I want to prioritize for the mom and we make an effort to do that.

Kristen Horwath and Jennifer Ainesworth (21m 56s):
We don’t want to give you a big list to do we want it to fit into your daily schedule. So whether we just say, after a diaper change interacts for two to three minutes, it needs to fit into your schedule in order for a parent, not to feel worse. And like you’re giving them a to-do list they can’t accomplish. And the other thing is we have the option to just be more available to the parent if they choose that. And when they get home later, Kristin, this is her line. You always forget what you wanted to ask on your way home. So just text us and we’ll walk you back through it or off, I do a lot of feeding. So I want to know how dinner went and make adjustments for tomorrow night’s meal. I don’t want to wait until next week’s appointment, but I want to know how the next bottle went.

Kristen Horwath and Jennifer Ainesworth (22m 41s):
There was a situation where a mom called us. We had met with her a few times and she called and said, I’m having trouble with this. The baby was sleeping. I said, feed him, made some recommendations, do this after now, call me when you’re done with that, she called me. I was like, let’s make these fewer more tweaks for bedtime. And she’d call me after bedtime. She called me. She was like, great, everything works. I’m going to try that for the next few days, if you have more problems call and it was like, parents are so busy, especially with newborns. They need things that are convenient and that are able to give them realistic ways that they can fix some of the moment-to-moment concerns that they’re having.

Dr. Anthony Orsini (23m 19s):
There’s a wonderful thing is it’s really concierge service. You guys are available 24 seven in my book, I talk about one of the principles of patient satisfaction is be the friend in the business. And that’s basically what you’re doing is you’re the friend of the business. The fact that they’re texting you after dinner, that’s just great. The other comment that you made that I think is really important is about the guilt of you were supposed to do it four times a day and he couldn’t do it four times a day. And I think that sometimes as medical professionals, we do forget that. And then the guilt follows a great example is breastfeeding, right? So you tell them mother that if she doesn’t breastfeed 24 seven, and if her baby ever touches a bottle or her baby takes one drop of formula, they’re not going to Harvard.

Dr. Anthony Orsini (24m 2s):
And so all of a sudden there are parents who can’t breastfeed. We’re a big breastfeeding advocates everywhere, all of us, but it’s a mother has to give a bottle of formula because she can’t seem to produce enough. We don’t realize. And there’s good data on that. There’s good data on baby friendly about the mothers who have shown depression because they can’t do that. So I think that’s really a good point.

Kristen Horwath and Jennifer Ainesworth (24m 26s):
Yeah. I was that mom that couldn’t exclusively breastfeed. So I relate to those moms that are struggling. And with all three of mine, I just had that expectation that it was okay. And I gave myself that, that, okay, you’re going to be fine. The baby’s going to be fine. And I make the comparison all the time with Jen and I she’s on one end, she’s the exclusive breastfeeders and I was the supplement or formula moms. So we offer that support to moms, both ends of the spectrum and how it can all work out in the end. And I have three girls and all my three girls are functioning just fine.

Dr. Anthony Orsini (25m 9s):
Well, and they all love you. They hate you.

Kristen Horwath and Jennifer Ainesworth (25m 12s):
Nobody knew who, if, when they’re all together playing, nobody knows who was breastfed or who was bottle fed. Nobody knows

Dr. Anthony Orsini (25m 19s):
You walk this fine line in medicine about 25% of you out there are not even in medicine, but just so you know, we walked this fine line in pediatrics of really wanting to encourage breastfeeding, but you can cross that line and make that mother who can’t breastfeed feel like a really total failure. And so it is a tough line to encourage, but I find it sometimes hard to find that line. Like, I really think it’d be great for your baby, but it’s you don’t want to it’s. Okay. So it’s tough. And I love what Jen said is generally do what you can do. I think that’s really great. And to have you guys there, when that mother is feeling guilty or is having struggling is really important. Let’s move on to Covid cause you mentioned it.

Dr. Anthony Orsini (26m 1s):
I think Kristen did anyway, I’ve had to really pivot during COVID because most of the teaching that I do is workshop related. I love to stand in front of a crowd and I like to see the faces and we do some interaction that became really impossible during COVID. And so it’s actually worked out for us because it’s forced me to start doing some learning modules. I do a lot more teaching remotely. You went full-time in the middle of Covid. Some people just wouldn’t say that’s crazy, but how has that worked out? Are you able to navigate through it?

Kristen Horwath and Jennifer Ainesworth (26m 32s):
We’re always up for a challenge. I always joke that I learned things the hard way, but honestly, during this time we’ve found that there are so many more moms that are struggling more right now because they can’t find the resources or they can’t make that easy doctor’s appointment that they used to before. And now that offices are opening up more and there’s a longer waiting time and we can get on the phone or get to that mom sooner. We can see or talk to her that day sometimes and see the baby the next day.

Kristen Horwath and Jennifer Ainesworth (27m 14s):
So that’s our biggest goal is to help that mom as soon as possible,

Dr. Anthony Orsini (27m 19s):
But you do infant massage and you teach it, but you also would like to do it. Are you still going to house with masks or are you waiting till I COVID is over, they’re coming to you. How does that work?

Kristen Horwath and Jennifer Ainesworth (27m 30s):
We primarily see the babies and the moms in the clinic with mask and all the precautions. However, there are certain instances where we will go to the home, especially if it’s a mom that doesn’t feel comfortable bringing their newborn out, but our clinic is accommodated to have one family in the office at a time. So it’s more isolated and we can work with that mom just with our team.

Dr. Anthony Orsini (27m 59s):
And I know it’s safe, then you clean it and everybody wears masks. I know there’s still this COVID hysteria out there. Hopefully the vaccinations will come in and we can get back to normal here. So yeah, I think COVID has forced us to be more creative, but in some ways it’s good and I’ve done some pieces on tele-health medicine, which is not going away. Everybody loves telehealth medicine. Now it is really hard to form a relationship over zoom, but it can be done if you use the right techniques. So the title of this podcast is difficult conversations and I make a promise to my audience to inspire and to learn some communication techniques. And so I usually talk about at the end of each podcast, the most difficult type of conversation that you have had, it could be your private, it could be a personal, it could be a specific conversation that you remember that was very difficult or just the type of conversation.

Dr. Anthony Orsini (28m 54s):
So I’ll take one at a time. Tell me about the most typical type of conversation that you have and how you navigate through that conversation and give us some advice on what to say and how you approach that

Kristen Horwath and Jennifer Ainesworth (29m 7s):
In the hospital. I mean, I think the most difficult is of palliative situation is just the most difficult. And I think that everybody constantly thinks they need to say something when it’s the opposite. You actually need to be quiet and just listen. So you don’t have to be equipped. Dr. Orsini clearly offers some excellent communication tips. Then you should listen to them all, but you don’t need to have a script. You really just need to listen and allow someone to speak. They want to feel in the situation. And I even think not a palliative situation, a significant developmental delay, or is my child ever going to walk?

Kristen Horwath and Jennifer Ainesworth (29m 52s):
Are they ever going to talk? And in reality, we don’t have direct answers to that. However, nobody does even a physician. We can suggest things through scans, but we don’t really know the extent and communication for example has an array. It’s not just verbal. It’s actually a lot of it’s non-verbal. So I think always sitting down and getting on eye level with the mom and allowing her to speak and present her concerns and where her baby’s at. So the most difficult is in a palliative situation stating I don’t understand because I haven’t walked in your shoes because that is another thing I know where you’re coming from.

Kristen Horwath and Jennifer Ainesworth (30m 33s):
I haven’t personally lost a child. I don’t know where you’re coming from and validating, I cannot imagine how hard this is and then giving her adequate time or dad to speak and then just providing support. So I always, as a therapist, I’m able to give how they can touch their baby and hold their baby. You can always at any level saying and read to a child and hold at all, I think stages. And so there is always something that can be offered. And I really think that that’s honestly the extent of the conversation, give them a few things to do so they feel useful in this situation.

Dr. Anthony Orsini (31m 19s):
And I talk about the three goals of having difficult conversations. One is that you come off as being compassionate, that they really feel that compassion from you. And it’s great. We use sitting there silently is sometimes the most important way to show that too is to be the expert in the room and to let them know that you’re going to give them some advice on how to get through this. Even though, as you said, you can’t relate to it. You don’t really understand, but you’re the expert in the room and three that you’re not going to leave. That those are the three things. Kristen so I would think, and I know this personally is that we have babies in the NICU. We have babies have gone home that had no, maybe get perfectly normally at birth.

Dr. Anthony Orsini (32m 1s):
The mom calls you. I’m worried. My child’s not rolling over my child’s not sitting up. The pediatrician wants me to go to the neurologist. But as we see, there’s a lot of denial. I don’t think there’s anything wrong with my baby. So I want you to come and evaluate and do you find this baby who’s buried, delayed, maybe hypertonic or whatever. And I always say, when you break bad news, the patient’s job is to prove you wrong. And my advice to doctors out there is provide the evidence first of your bad news and then give the bad news. And so you’re put in a situation, I’m sure where the mom and dad and tell me if I’m wrong or saying, my doctor thinks there’s something wrong.

Dr. Anthony Orsini (32m 44s):
So please tell me there’s not. But then you say you find there is. So how do you approach that conversation? That’s got to be really hard.

Kristen Horwath and Jennifer Ainesworth (32m 55s):
Yes. So we have those situations where Jen and I will be like, something’s not right. And the mom, like you said, is either in denial or hasn’t been told exactly what’s going on. So in that situation, we always make sure that we let them know that we’re on their side to support them, not to. I mean, any mom isn’t going to, or any parent isn’t going to want to be told that something’s wrong with their child. So dealing with that fragile situation, just going in, making sure that they know that you’re on their side and supporting them, regardless of what’s going on and telling them we’re here to help hold your hand along the way.

Kristen Horwath and Jennifer Ainesworth (33m 40s):
Whatever’s going on we’re going to do whatever we can to facilitate typical development in your baby. This is what your baby is doing rather than focusing on what the baby’s not doing. And we always tell the parents that development is it’s a forward progression. So that’s what we want to see going in the right direction. So it doesn’t matter necessarily when they’re going to do it. We just want them to get there and we’re going to help get them there. Whether it takes us two months, three months,

Dr. Anthony Orsini (34m 14s):
Put you on the spot though. Right? Cause they say, tell me the doctor’s wrong. And then what do you say when they say that? It’s like, well, I have concerns. How do you have that? I mean, there’s someone out there that says, I need to know what to say to that question.

Kristen Horwath and Jennifer Ainesworth (34m 28s):
We don’t have the glass ball to say when or what this is going to look like in a year, but we treat what we see and we’re gonna do what we can now. And if something is wrong, it doesn’t mean that something’s going to necessarily get worse all the time. But we had a mom in the NICU that had a kiddo that had, there just wasn’t something right. And we didn’t know the diagnosis at the time, but we made sure that that mom could, we were working with the baby, but could also confide in us and help work through what she was going through, dealing with the situation of accepting what’s going on with the baby, knowing something’s not right.

Kristen Horwath and Jennifer Ainesworth (35m 15s):
Even though we don’t know exactly the diagnosis or the prognosis, she knew that when we were there, we were doing everything we could for that baby and doing what the baby could do and capitalizing on that and giving mom some things that she could do to help her baby, even though things were not right. I think the word hope comes to mind because we want to state what they’re doing and then give the next developmental thing that we would work towards. And it just gives not false hope, realistic hope, and here’s how we’re going to get there.

Kristen Horwath and Jennifer Ainesworth (35m 54s):
Yeah. And even our kiddo that we had was making very slow progress. And so sometimes it could seem like to other people, we weren’t doing much. We were helping maintain that baby’s status and preventing that baby from regressing. So at that point it becomes, we have to maintain where that baby’s at rather than just having the baby get worse.

Dr. Anthony Orsini (36m 21s):
And this podcast episode has come full circle back to what we had spoken about originally that this is about trust and relationship building and being a genuine person. We’ve been doing this podcast every week now for probably about seven or eight months. And I think almost every week, those three words keep coming back, trust relationships, being commonality genuine. And at that particular moment, when you’re discussing this with the mother and having this very difficult conversation, if she doesn’t find any commonality with you, she hasn’t formed a relationship with you. And I always say, you can form a relationship in 56 seconds. This has been studied and she doesn’t feel that you’re the expert in the room and that you’re compassionate.

Dr. Anthony Orsini (37m 3s):
You’re dead in the water. So she’s just going to say, Jen you’re a hundred percent wrong. You have no idea what you’re talking about. I’m going to go find somebody else, or she’s going to listen to you, scale your compassion and say, okay, I trust you and let’s move on and how we can help our baby. And I think this concierge style style that if you don’t mind me using that word or this relationship, this style really forms and helps those relationships with these parents. And you’re offering a service to people that I think from again, from someone who just doesn’t know how to be a mother, I mean, these babies don’t come with owner’s manuals. And sometimes we have moms, grandmas, and granddads that could help us.

Dr. Anthony Orsini (37m 45s):
And some people don’t have that. And then sometimes grandmoms gives us really bad advice, put your baby on their stomach when they’re sleeping. Don’t do that. So what you’re offering I think is great. I think it’s something that’s building and you’re already showing some great success. It’s really great. Everybody out there. What is the best way for them to get in touch with you? I know you have a great Facebook page. So tell us about that. Your social media is awesome, but I’ll put this in the notes, so you don’t have to write it down, but what’s the best way for them to get in touch with you guys. And again, you can be in Europe and this podcast, actually, I have no idea why this podcast is number seven in Spain and health. It’s in English, but in Spain, but we were in top 100 in the United States for a little while.

Dr. Anthony Orsini (38m 29s):
So if you’re out there in Europe listening, how can they get in touch with you or anywhere?

Kristen Horwath and Jennifer Ainesworth (38m 40s):
So our website is www.milestonespecialists.com. And on there, we have a contact page and you can fill in the information and it will send us a message with your contact info. Also, we are on Instagram milestone specialist and Facebook as well. And you can search us as milestone specialists of America. We just want to allow moms to know that they’re doing the best for their baby help you understand the why. So you can enjoy the moments because they pass so quickly.

Dr. Anthony Orsini (39m 15s):
You’re right. I just came on one of those Facebook things, you know, 10 years ago, 11 years ago, my son was playing football. One of my favorite sayings as the days go very slowly, but the years fly by. So enjoy your babies. And these ladies here are here to help you. If you liked this podcast, please go ahead and hit subscribe and go download all the previous podcasts. If you need to get in touch with me, or you can do that through theorsiniway.com, I’ll put all of the milestones specialist contact information on our show notes. And thank you again. And please spread the word and contact me or milestone people at any time. So thank you everybody. And we’ll talk again next week.

Dr. Anthony Orsini (39m 56s):
This episode was brought to you by Veritus. Veritus offers virtual alcohol drug and trauma treatment programs exclusively for licensed medical professionals. Their programs provide a concierge level of care consisting of evidence-based clinical treatment and are customized to meet unique needs and challenges of physicians that this pharmacists and nurses struggling with substance abuse. The virtual confidential platform provides a safety and security medical professionals need to get help while continuing to work confidential, convenient and compassionate Veritus brings world-class treatment to your home or office contact Veritus for help@veritussolutions.com.

Dr. Anthony Orsini (40m 37s):
If you enjoyed this podcast, please hit the subscribe button and leave a comment and review. To contact Dr. Orsini and his team, or to suggest guests for future podcast. Visit us@theorsiniway.com.

Substance Abuse and Physicians

Dr. Sucher (1s):
To be a good physician, you have to be compulsive. You have to pay attention to detail or deal with human lives and wellbeing. We don’t want to make mistakes that the other side of compulsivity in a sense, compulsivity gone wild is the essence of addiction. It’s a continued doing of something in spite of negative consequences. So the very trait that makes us good Physicians also sets us up for addiction.

Announcer (28s):
Welcome to Difficult Conversations: Lessons I learned as an ICU physician with Dr. Anthony Orsini. Dr. Orsini is a practicing physician and president and CEO of the Orsini Way. As a frequent keynote speaker and author, Dr. Orsini has been training healthcare professionals and business leaders how to navigate through the most difficult dialogues. Each week you will hear inspiring interviews with experts in their field who tell their story and provide practical advice on how to effectively communicate. Whether you are a doctor faced with giving a patient bad news, a business leader who wants to get the most out of his or her team members or someone who just wants to learn to communicate better this is the podcast for you.

Announcer (1m 12s):
.

Dr. Anthony Orsini (1m 13s):
Well, welcome to another episode of Difficult Conversations Lessons I learned as an ICU Physician. This is Dr. Anthony Orsini, and I’ll be your host again this week. Well, today I am twice blessed because I have with me two great guests. We are going to talk about something that really affects us all, and that is drug and alcohol addiction among healthcare providers, such as doctors and nurses. It’s one of those things we all know probably exists, but something that no one really wants to talk about. Along with suicide and depression, drug use among physicians is not only hidden and kept quiet, but until these two gentlemen came together, it was extremely difficult to treat. My two guests today are Steven Wolt and Dr.

Dr. Anthony Orsini (1m 55s):
Michel Sucher from Veritus. Veritus offers virtual substance abuse and trauma treatment programs exclusively for licensed medical professionals. And we’re going to learn more about the incredible things that they’re doing to help with this problem, which I think are real game changers in just a moment. But first I wanted to introduce them. Stephen Wolt is the CEO and co-founder of Veritus his personal journey as an executive in corporate America with a substance use disorder. And his recovery was the reason he created Veritus. Years of struggling to manage a career and his own treatment and recovery made him realize that additional treatment resources were needed for executives to are highly functional in the workplace.

Dr. Anthony Orsini (2m 39s):
His goal was to bring together industry leaders in clinical treatment, executive coaching and healthcare coordination to create a virtual outpatient treatment program, specifically designed to meet the needs of the medical and legal communities. Next we have Dr. Michel Sucher, the Veritus chief medical advisor. For over 30 years Dr. Sucher has been practicing addiction medicine, he is regarded nationally as a pioneer and foremost industry expert in alcohol and drug monitoring in aftercare programs. He had served as the medical director of the monitored aftercare programs for the Arizona medical board, the Arizona state board have dental examiners in the state bar of Arizona.

Dr. Anthony Orsini (3m 21s):
He was also the president of the California Physicians health program, and most recently the chief medical director for community bridges, which is a substance abuse and mental health treatment program in Phoenix, Arizona. Dr. Sucher is a fellow of the American college of emergency physicians and a fellow of the American society of addiction medicine. He is the past president of the Arizona society of addiction medicine and has a nationally known speaker on addiction medicine and professional health issues. Well, gentlemen, thank you for taking time out of your busy schedule to be here today. This is truly an honor to have you, and this is a topic that people need to hear about. So I’m really glad that you’re here to share with my audience.

Steven Wolt/Dr. Sucher (4m 4s):
Thank you for having us. Yes, Thanks for having us.

Dr. Anthony Orsini (4m 8s):
And it’s really great to speak to you both about and extremely important topic. And as I said in my intro, it’s a topic that no one really wants to speak about the premise of this podcast. And really my work for the last 20 years is that every important moment in our lives involves a difficult conversation. And if you navigate correctly through that, you can really help someone and help yourself. And each week goes by no matter who I’m interviewing the same things, keep coming up and trust, good communication, commonality, and most importantly relationships. And the one topic that seems to be recurring over and over again is a physician and nursing burnout. And it’s, without a question causing a major health care crisis.

Dr. Anthony Orsini (4m 51s):
Physician’s have the highest rate of suicide of any profession. And depression is at an all time high. And we have explored the many reasons for those statistics on previous podcasts. But today we’re talking about something really important and that’s drug and alcohol use in Physicians. And so the Steven during the teaching of my communication, I tell everybody how important it is before you build trust you first have to first be a genuine person. You have to let people in and let them know you. So maybe we can start off with Steven and then just tell us your journey on how you came to be to CEO Veritus and you know, just a little bit about yourself, so we can start thinking of you and start trusting you and, and this will

Steven Wolt (5m 32s):
Well, thank you for having us on the show and I have become a big fan of your podcast. I listened to it after work on the drive home. So a great job you routinely bring on good guest.s So I hope Dr. Sucher an I will keep that time going, but we recently launched Veritas, which is a virtual substance abuse treatment program for licensed medical professionals that are struggling with alcohol, drugs, and trauma, and were really excited about having that product and market and the journey to get to this point has been a pretty incredible from my perspective. So I am a New Yorker and from the Northeast, similar to you and early in my twenties, I was a quite a successful business man.

Steven Wolt (6m 12s):
I had to put in executive benefits at law firms in hospital systems, and it was really successful early in my career, and which is wonderful in many ways and really challenging. In other ways, but you know, 2004, I started developing a very significant cocaine addiction. And over a four year period of time, I destroyed my life. I had built this really big business. I had a great stellar reputation and that community, I was on boards of nonprofits. I was actively involved in a country club and we were over a four year period of time there was a progression of this cocaine addiction that almost killed me. And then when I look back at that period of time and just how dark and scary it had gotten, it’s really not even sad that I’m here today and so I’m so grateful to be healthy and to be here and happy today.

Steven Wolt (7m 2s):
And then to have survived. I have so much respect for the disease of addiction, it kind of robbed me of everything and destroyed my family. Everything in its wake, it was catastrophic. In 2007, 2008, I started going through what I call the great rehab tour. We were very, I joke around all the time when you see someone with a rock and roll t-shirt, a wall of the city’s that the band visits, those are all of the treatment centers that Steve went to. In those years, I was gone to the best places that money could buy and really unsuccessful. I had a desire to stay sober. I was wanting to put resources and time to go away and get the help. I went around the country in search of that help, but I leave these treatment programs And within a month I’ll be back in a hotel or I’m doing cocaine again and acting out in ways that were really painful.

Steven Wolt (7m 52s):
So i had really reached a point in my life where I was backed into a corner and all of that to become suicidal, that I was seeking the best treatment I thought that was available to me that I couldn’t stay sober. And I was in a lot of pain, 2009. I found a treatment program in Hattiesburg, Mississippi called Pine Grove and Gentle Path. And they dealt with childhood trauma. And I actually was there for three months. And, but that was the turning point in my life. I have such profound respect for people that are in this business because it’s really hard work. And without that organization, the work I did there dealing with my childhood, I probably wouldn’t be here today.

Steven Wolt (8m 32s):
So I had an immense amount of respect, people that specialize in childhood abuse, drug addiction, sex addiction, and all of the things that are a result of problematic childhoods. Like the one I had, I went out to Los Angeles and I got back to my old career . I launched a firm in Beverly Hills back in my old industry, but several years ago just hit a wall. I find myself not wanting to get out of bed in the morning. I had just lost the zest to work. I think the healthier I’ve got personally, the less I wanted to do what I was doing for a living and had lost purpose and meaning. And so I started thinking about my journey as an executive in corporate America with a pretty significant mental health issue.

Steven Wolt (9m 15s):
And I started realizing that there were certain things that just kind of stood out to me, what it stood out to me. It was just how difficult it is to talk about this topic in the workplace and not being a doctor just in corporate America with a significant mental health issue, you know, living in the shadows. So scared talk about that. So I, I just found that to be such a big issue. I also found that this country had these incredible clinical resources where, I could go away over a period of time and then reenter my life. I had a career that was complicated at a personal life that was complicated. And I just felt that the resources to navigate my career in early recovery and navigate my entry back into my life were kind of lacking in the recovery community.

Steven Wolt (10m 3s):
I kind of felt that we tried to treat addiction in this country like you’ve been in a car accident, not like you have diabetes. And so I started thinking about what could I add it to my experience that would have helped me in my journey with addiction. And lastly, you’ll see why I say this in a second before COVID this was a pretty profound comment. I just found that it was so freaking inconvenient to live in New York and the live in Los Angeles and try to patient or a client in an outpatient treatment facility. It would take you an hour to commute, back and forth. I’d walk into a building where I could see my neighbor walking into another place and I’m walking into this treatment program.

Steven Wolt (10m 45s):
And it just, it didn’t sit well with me. I just found it to be so inefficient and just lack privacy. So I started thinking about what maybe I’d like to do something in this space based on these experiences. And I have known Bob Miller, who’s the chairman of board or freedom Institute, which are the large nonprofit in New York city that it since 1976 has been in the outpatient treatment business in Midtown Manhattan and Bob and I just started talking about some of these thoughts I had and some of these experience I had, and I think they would just open to an outsider’s perspective. I was not from the industry. I was not from the field. I’m not a doctor. I’m not a clinician. I’m a drug addict in recovery who was a pretty significant executive at some point in time.

Steven Wolt (11m 26s):
I just felt that things could be done better. Due to a set of circumstances we’ve got to meet Dr. Michel Sucher. Who’s like the guru in the space when dealing with executives and professionals that have substance use disorders. And, you know, the freedom has to have by Miller, Dr. Sucher and I over the last few years to start to collaborate and what we really want you to create pre COVID by the way, we really wanted to create a treatment programs specifically designed for the medical community. It’s specifically designed for the legal community and do so on a virtual platform where we can literally take the in-person treatment experience that freeness who has been doing for decades, combine that with Dr.

Steven Wolt (12m 8s):
Sucher’s as experience, having one physician health programs for decades, bring the two together and create programming, specific to meet the needs of medical professionals in the legal community. COVID hit we decided to put more resources forward and dealing with the medical professionals that we’re in the market today, helping people. So it’s been an amazing journey.

Dr. Anthony Orsini (12m 30s):
Okay. That is an amazing journey. And I’m so glad that you are doing such good things and really you are giving back in so many ways. I think one of the things you take home from that story is the stereotype, that people who are addicted to drugs are lower socioeconomic people who are poor. When actually, as you said, you are a very high performing businessman, and now you’re helping doctors and lawyers and other professional people, but the drug addiction knows no boundaries and that you can be poor or rich are male or female are black and white. But I think that the stigma of a physician being addicted to drugs is really something that no one wants to talk about.

Dr. Anthony Orsini (13m 10s):
So Dr. Sucher, how prevalent it is an addiction among physicians. And I don’t know, do you deal with nurses also? How prevalent is it?

Dr. Sucher (13m 17s):
Well, Yes. Dr. Orsini I do deal with nurses as well, but primarily physicians, dentists executives, most people would tell you that 10 to 12% of the population will deal with the substance use disorder at some point in their life. I’m certain than most literature I’d looked at. And my experience shows me that physicians are at least at that level and probably higher. I have heard estimates up to 18% at some point in their career. And some of that is for a number of reasons. To be a good physician you have to be compulsive. You have to pay attention to detail. We are dealing with human lives and wellbeing. We don’t want to make mistakes, but the other side of compulsivity in a sense, compulsivity gone wild is the essence of addiction.

Dr. Sucher (14m 7s):
It’s a continued doing something in spite of negative consequences. So the very trait that makes us good physicians also sets us up for an addiction. Secondly, we have access to virtually every drug known to man and legal and illegal, and we usually have the money to buy them. And we have enablers. We have family who are invested and are continuing working employees and office staff and colleagues who are invested in often will without realizing it, cover up the disease until it regresses to a point where that’s, you know, not possible to do any longer.

Dr. Anthony Orsini (14m 42s):
But the issue of burnout I mentioned in the intro is so high in medicine right now, but we had Dr. Dike Drummond on who literally wrote the book on physician burnout, and we’ve had a couple other guests and that theme just keeps coming up as COVID has definitely made burnout worse. And there’s various reasons for burnout. So are you seeing a spike in this right now?

Dr. Sucher (15m 4s):
I think we are all of the things that you mentioned earlier, increased suicide, increased depression, burnout, which has been really prevalent in the health professions for quite a long time, has really kind of spiked. And in a lot of ways, burn-out is the precursor to addiction and mental health issues, depression and suicide. So part of the goal is if you can identify and intervene on a burning out physician earlier, there are more likely to prevent the development of an actual disease state and able to restore the person to help by providing support and a structure and resources to help them do that.

Dr. Anthony Orsini (15m 44s):
Yeah, I think you described a whirlwind that we live in as a physician. I can certainly relate to that. I’m 56 years old now, and I’m still doing the night shifts in a hospital and I deal with the sickest of the sick newborns. And I can certainly relate to trying to get to sleep at 11 o’clock at night, if you have a shift to the next day, but you’re still wound up from your last shift. And so I don’t know what it’s like to be thankfully to be a drug user. And it’s, that never happened to me, but I certainly could understand that maybe you start off by taking something to help you sleep or say you can take something to help you get through the shift. Is that generally how it starts?

Dr. Sucher (16m 22s):
Typically? Yes. In a sense, I’ve never met a single individual Physician or otherwise who wanted to become addicted to drugs, people start for a host of reasons, but to help them sleep, particularly after night shift, to deal with anxiety and stress, to deal with pain, even a legitimate physical pain. And then so many doctors find that it helps with their emotional pain too. And that’s how it kind of goes off track anesthesia, which is a very high risk specialty for substance use disorders among physicians are there sort of experts at pharmacology and they feel they know how to titrate these things. And the number that I’ve seen injecting fentanyl ,propofol, versed to manage their mood, manage their sleep the numbers are staggering.

Dr. Anthony Orsini (17m 11s):
It’s a very high stress job. I agree with that, Steven, last time, I guess this can be there for you or Dr. Sucher last time we spoke, we talked about why the Veritus approach works and Dr. Sucher, maybe you could comment on this. So every time I fill out, I have to renew my license every two years, or I have to get privileges at a new hospital. The questions I have to answer it the same 10 or 20 questions. Right. And one question is, have you ever used drugs or alcohol, or have you ever been addicted to drugs or alcohol? Is it a special problem that there is a bunch of doctors out there that maybe are having that conversation with themselves that I need help, but are afraid to do so

Dr. Sucher (17m 49s):
Well, most are very afraid of the stigma, and they typically don’t answer truthfully to questions on a medical board renewal or a hospital medical staff renewal. Most of the time, now we go through the Federation of state physician health programs, working with medical boards to ask questions that are less stigmatizing, less invasive things like do you currently have a condition which impairs your ability to practice their profession which can be medical or psychiatric or a substance use disorder but to try and make the question not have you ever or not? Have you ever seen a psychiatrist or things like that?

Dr. Sucher (18m 32s):
That would be very fear producing and very stigmatizing. We don’t want to do that. We want to provide support and encourage people to get help and get help early. I think one of the things, the whole notion of Veritus is, is to be able to intervene on and help treat people before they end up in front of the medical board or a medical executive committee or heads of their medical group for some serious consequences.

Dr. Anthony Orsini (18m 58s):
And please educate me because I don’t know this. So I’m sure that there’s a bunch of people out there that are listening right now that maybe are having a conversation with themselves. They are afraid to say something that no matter how you word that question, they’re getting ready to check yes. And their afraid am I gonna lose my privileges? Please educate us. What does the law is say for that position at, or a nurse who, or a lawyer who may need some help? Are they being protected? If they say yes?

Dr. Sucher (19m 26s):
Well, the trouble is you don’t know. And every state in every hospital that, you know, every credentials and executive committee are probably different. And it also depends on who’s looking at it. Physician health programs, which exist in almost every state are typically advocacy oriented. Most of them have confidentiality. If you seek help from them before being ordered to go by a licensing board or something like that and they can be a resource. And I’ve operated the Arizona program for over 25 years, I do this kind of work in Nevada and have done it in California. And I’ve always said, please call me up, say your name is John or Jane Doe.

Dr. Sucher (20m 6s):
I’ll be happy to help guide you and answer questions because they’re all afraid. They’re all afraid. And I can imagine Steven, that was what you were going through too, when you’re up high performing executive, I would imagine that it was something that you really tried to keep it as quiet as possible.

Steven Wolt (20m 26s):
Yeah, I think that’s absolutely true not being a physician when they take it to this whole other level, but I’ll tell you what I would never do and just use the resources provided by my employer. Right? So a sophisticated as employment benefit package and or EAPs. I mean, there, wasn’t a chance I would use any of those resources for fear of the consequences for doing so. And it’s interesting as we are, as I get to spend more time in this space and really trying to understand how can we best be of service to this community. It is an uphill battle because as we need to look at the market right now, there is the market for those that have been mandated to treatment where a physician monitoring program and employee, where in the gigs up, he got caught, right?

Steven Wolt (21m 14s):
Your licensed is at risk, but we, we want you to receive and get good quality treatment, allowing you to continue to practice medicine. There’s that market. And we believe that a virtual treatment program can allow for a few other things that can allow you to access care a lot easier to call out for you to continue to work and remain in a home, which is critically important for the right person. And we can deliver care at a fraction of the cost. So telehealth allows you to do that in a way that has never been done before. But unfortunately that’s such a small part of the market. The person that has been caught there is this massive untapped market of medical professionals that are out there today that are suffering.

Steven Wolt (21m 57s):
That no matter what you say or do or not going to seek out any form of treatment. So we’ve been spending quite a bit of time trying to think about less stigmatized solutions to meet people where they are and the realities, finding ways to deliver a coaching services and coaching programs to physicians and nurses. That’s not a clinical treatment really from that part of a market where people are voluntarily seeking out help, if something is still under development, that we are really excited about it as well. But I think it’s really for anybody that’s listening right now as a treatment provider, right? We are not mandated to report you to any type of medical board.

Steven Wolt (22m 38s):
If you are voluntarily seeking out treatment nor is any physician that in the treatment program with you mandated to report you to a medical board, really important to get that point across.

Dr. Anthony Orsini (22m 50s):
That is really important. I want to ask you the topic of this podcast is Difficult Conversations. Dr. Sucher knows is so just by the very nature of being a physician, we are an odd type. What are the guys that didn’t get maybe go out on a Friday and Saturday night? Cause I had a test on Tuesday and then when I was dating my wife in college, she said, are we going out Friday night and I said I have have a test Tuesday? And she just laughed. And I said, well, I need to get an A, if I get a B God forbid, so we’re high strung. And then the, by the very nature of saying I’m willing to put someone’s life in my hand. So we walk around like with a big S on our chest or Superman and sooner or later, there’s a doctor out there who’s starting to realize he has some problems.

Dr. Anthony Orsini (23m 35s):
I guess my question was for Steven. So the first time you realize you had a problem, what do you say to that doctor? There is a conversation that goes on with your self that says I have a problem because I would imagine your first in denial, how does that conversation go? Maybe you could help somebody with that.

Steven Wolt (23m 55s):
But it’s fascinating. The one thing that I find that is so helpful is when I say you need to, I’m not a doctor, I’m not going to lecture you. And I’m a recovering drug addict. You know, I happen to be CEO of this organization, but at the end of the day, when it boils down to it, I know exactly where you have a been. And I totally understand how you’re feeling right now. And there is no judgment, no one of the beautiful things about alcoholics anonymous, which is separate from what we do. And it’s really important part of my life, one alcoholic talking to another alcoholic, magic happens. And so when you have the ability to, to talk to a physician or someone that is struggling with just the ability of someone has heard my story, hopefully someone listens to this podcast and just, it feels a little bit safer to just open it up and have a conversation.

Steven Wolt (24m 48s):
That’s why I tell the story. And I think about the role that I can play right now. And for some reason I survived an insane one with a drug addiction. And I just think about my purpose today, and to continue to try to break down barriers, talking about my story so that perhaps there’s someone listening right now, and I feel safe enough to pick up the phone and call me. And I just feel like that’s my purpose today. And that’s how to answer that question.

Dr. Anthony Orsini (25m 16s):
I’m watching your face. So the audience can’t see because this is audio only, but I’m watching your face. And I can see the passion that you have. And there was nothing more magical than when someone feels a passion to help somebody because they have been there. And so I wish my audience could see your body language right now, but I could hear it in your voice. Dr. Swisher, what about that? S on the chest, what do you tell those people who think they are Superman like me?

Dr. Sucher (25m 42s):
We all do, well denial and minimizing are kind of a universal in substance use disorders. Most of the physicians that I ended up coming in contact with deep down, they know they have a problem and they’re really looking for help and guidance and a way through the fear. The good news is that most physicians are able to get a good treatment, have structured accountable, supportive monitoring, and they do well. Most of the peer reviewed literature, as well as my own experience. 85 to 95% of physicians in five years later are still clean and sober are back to work, families, career, everything in tact.

Dr. Anthony Orsini (26m 23s):
That’s a great stat.

Dr. Sucher (26m 27s):
And if you can look, if you can help us and again, help early. And I also medicalize it earlier, are you diagnose diabetes, hypertension, heart disease, or cancer, more likely it is that you will have a good outcome and all the same is true with a substance use disorder. But I think that’s really a key part of what Veritus trying to do is to early recognition, early intervention, early treatment, to prevent those consequences. I can count on less than two hands the number of physicians who have lost their medical license in the last 25 years. You have to really be a resistant and non-compliant and stay in denial to get revoked is really hard.

Dr. Sucher (27m 8s):
It’s kind of like getting into medical school is really tough once you get in, it’s really hard to not get through it. If you do the work, the same is true here and there. But if you got there, you would probably do really well.

Dr. Anthony Orsini (27m 21s):
But that’s a great stat to know. So for those people that are out there that are worried that there was a light at the end of the tunnel, the internet access right now in everybody has all of these people put stuff up on social media. I think you’ve mentioned Stephen, that the Veritus is, is strictly confidential. So right now you can find out if I got a speeding ticket six years ago, right? If you look up my name, but this is all confidential, I would assume in for those people out there that are afraid it’s going to come out.

Steven Wolt (27m 51s):
It’s all confidential and critically important that this compassionate type care has done confidential this as a safe place. But you know what I mean? It’s also a really interesting then when Dr. Sucher and I, and Bob Miller and freedom Institute were really designing these programs pre COVID. We are talking about the ability to do this virtually and people would look at us and they would turn and look like, you know when a dog looks confused, they turn their head to the side, looks saying what? and what’s fascinating now because of COVID in the entire treatment field, went to some version of tele-health. So literally we thought it would take three to five years took three to five months.

Steven Wolt (28m 32s):
And here’s what the data is coming back at. So we’re a year into this right now. So a lot of the big treatment centers, the Betty Ford clinic, the Mayo clinic, started publishing white papers the Freedom Institute has a white paper coming out, sharing the data over the past year, a virtual treatment as it compares to in-person treatment. And here’s what the data suggests.Number one, you have patients like it and clinicians like It, higher patient engagement and about the same rates of recovery. So it’s a fascinating piece of information that we are now having some real data to support that these virtual platforms work and they’re here to stay in the post COVID world.

Dr. Sucher (29m 18s):
The one other finding is with tele-health is patients are more willing to reveal and to be vulnerable than they are in person. That extra barrier has been helpful in addition to everything that Steven said, which is absolutely true. That’s another added benefit too, a telemedicine and virtual treatment and other things, just a having done this a long time when I started doing this, no matter how low your of severity, If you are going to a 30 to 90 days have residential treatment. And its only in the last five to seven years that we started to see if you look there’s varying degrees of substance use disorders, mild, moderate, severe, and that the mild and maybe early matter to deal with Outpatient and now with the COVID as well as to what we’ve put together, the idea of virtual treatment is absolutely real.

Dr. Anthony Orsini (30m 11s):
You guys were way ahead of the curve. Just to finish off here, walk me through the process how someone out there listening physician, lawyer, because you do attorneys too. Right?

Dr. Sucher (30m 22s):
Right now we’re in the market with a medical program later this year we’ll have our own lawyer program in March.

Dr. Anthony Orsini (30m 29s):
So someone, I guess they call you and they say, Hey Steve or Dr. Sucher I’m not sure I need some help. And then what happens from that point on just take me through the steps?

Steven Wolt (30m 37s):
Well, we are quite often what the, the first phone call comes from more often than not the person who’s referring them to treatment. So it could very well be a, a state monitoring program. It could be an employer, it could be a psychiatrist or psychologist that’s working with a medical professional that needs a higher level of help. One of the things that we’re starting to notice right now that with COVID right now, these frontline providers that are, have experienced significant PTSD and trauma. And there’s a lag between when you experienced trauma and when you start to see a spike in substance abuse, we’re starting to get to that point. So part of our programming is taking some of these trauma modalities and being able to do them virtually.

2 (31m 24s):
So it’s typically quite often the referral that’s calling to us, giving us some specifics about what exactly is going on learning about the type of programs we offer and whether it’s an appropriate fit. Now, once in a while, we’ll get a phone call from the end user. That’s not kind of a premeditated from some types of outside source. We are, will walk them through the program, but at any given situation, someone is going through an assessment, which is about a two hour conversation. It goes on between multiple clinicians and the patient, which is kind of fact finding, fact gathering to find out exactly what’s going on to make sure that this is an appropriate fit because we’re a virtual platform.

Steven Wolt (32m 4s):
Sometimes professionals will need a higher level of care. We also want to ascertain their willingness to get help, right? That comes out in the conversation as well to determine the number one, if, if this is appropriate for you,

Dr. Anthony Orsini (32m 15s):
They want me to interrupting. So this person that takes the intake, are they Physicians, are they counselors? Who was the first person they were speaking to?

Steven Wolt (32m 22s):
The first person you are speaking to is a clinician. And the clinician that we work with at all on our team who have significant experienced significant mental health experience had master’s degrees and have a significant experience working with the physicians and health care providers.

Dr. Anthony Orsini (32m 38s):
Okay. All right. So after you have the intake and it’s a fit, you assigned them a counselor and how does that go?

Steven Wolt (32m 45s):
And then that we have in market right now is something called an intensive outpatient program. So it’s a three month program. So it’s 12 weeks in When, and I would say a very intensive program. So it consists of 10 hours of clinical treatment a week. So there are three, three hour groups each week and the groups are a process with one of the groups is co-facilitated by Dr. Sucher where they have a platform for us to really, for medical professionals and physicians to talk about the issues that are specific to them having a medical license, what do you disclose or they don’t disclose to a patient to an employer. What do you do about being around medications in the workplace, things around that nature.

2 (33m 28s):
It’s also, we’re a DBT based program. That’s a type of treatment modality that we use. It teaches skills and in real time to deal with emotions and feelings. And we just brought on someone to teach guided meditation. So really fascinated, you know, mindfulness is one of the DBT skills and we want to teach medical professional’s how to meditate. That’s what we think that is critically important as well. And the other thing that’s really unique about our program is, is that we incorporate coaching into the program as well. So this clinical treatment, and then in addition to that, there was a weekly meeting with a physician coach, which is really gives you the opportunity to work with a colleague for peer support, but also to help navigate the intricacies of being a health care provider today in today’s day and age.

Dr. Anthony Orsini (34m 16s):
Yeah. And mindfulness and meditation is something that we have Dr. Jonathan Fisher or shout out to him. Who’s had a great interview who talked about how mindfulness and meditation really saved him from major depression. And now he teaches it and it does some great things.

Steven Wolt (34m 31s):
By the way, I like the connection towards you because I listened to that interview. And, and you said you can meditate for 15 seconds. So I was like, wow, that’s my type of guy.

Dr. Anthony Orsini (34m 41s):
Well, I think I said five seconds, but I’d been working on it. And I joked that. I think my add the great thing about that episode is I said, Johnathan, I think I call it the last five seconds. And he said, that’s a long time, I guess it takes time to get there. But I’m learning how to try to do that in Jonathan’s has been helping me with that. Doctor Sucher here with this program is there a point where someone, you may have to refer someone to inpatient or so far that’s been pretty successful?

Dr. Sucher (35m 8s):
Yeah. I think we have done a really good job of screening of people and referring them to a higher level of care on the front end, but sure, like you have any medical conditions, more information or in the course of treatment to say that more severe than we thought and that they may need a higher level of care. And we certainly have the ability to do that. And I have a network of a residential programs around the country that I’ve referred people to for years to understand health professionals.

Dr. Anthony Orsini (35m 40s):
Well thank you. That is really a great conversation that we just had a bout a very difficult topic, something, as I said in the interview, people don’t want to speak about. But I think that one of the things that I love about this podcast is that I learn every single week from someone. And also I think on providing a service or if there’s one person out there who has a concern about a colleague or a friend, or maybe it’s themselves, this as an option that maybe not everybody knows about. So I think you guys are way ahead of the curve on this. I’m certainly nowhere near an expert on this topic, but I’ve learned that awful lot. And what’s the best way for someone out there to get in touch with Veritus.

Steven Wolt (36m 17s):
There are multiple ways you can visit us at our website at www.Veritussolutions.com. Another way to meet us as we just launched a free CME webinars series for those doctors that are on this, listen to this podcast, they can participate and get continuing education webinar credits that’s on March 9th at 12:30 PM Eastern standard time. We have an incredible group of thought leaders. Dr. Sucher being one of them are talking about a roadmap beyond the pandemic. We would think about what the future has in store and working with medical professionals with mental health in what we’ve learned during COVID. So that’s another great way to meet the team as well.

Dr. Anthony Orsini (36m 58s):
Well, and they can sign up for that webinar through your website. Correct. That’s fantastic. So thank you, gentlemen. This has been a really very educational, very inspiring Steven. Your story is inspiring and thank you for giving back. This was such an important topic, so thank you again for your time. I really appreciate it.d

Dr. Sucher (37m 19s):
Absolute pleasure. Absolute pleasure.

Dr. Anthony Orsini (37m 19s):
If you enjoyed this podcast, please go ahead and hit subscribe and download all the previous episodes that we spoke about. All the contact information will be on the show notes and you can get in touch with me through my website, The OrsiniWay.Com or DrOrsini@the OrsiniWay.com. That’s Dr. Orsini@ the Orsini Way.com. So thank you gentlemen, have a great day.

Announcer (37m 43s):
If you enjoyed this podcast, please hit the subscribe button and leave a comment or review . To contact Dr. Orsini and his team or to suggest guests for a future podcast, visit us at the Orsini Way.com.

Conversations About Doctoring with Bradley Block

Dr. Bradley Block (1s):
dddbdAnd all you have to do is, it’ll just take a second, take a deep breath or two to show that you can remember that this next patient is the start in the show, whatever you are doing in the last room, running behind, people in the waiting room, phone calls waiting for you. It doesn’t matter. The patient is the start of the show. I take a deep breath and it will help to remind you that they are at the start of the show. It will make the visit more fulfilling for them. It will make the visit shorter they’ll know from the beginning that you have their undivided attention, because you will have their undivided attention and it will make it more fulfilling for you.

Announcer (31s):
Welcome to Difficult Conversations: Lessons I learned as an ICU physician with Dr. Anthony Orsini. Dr. Orsini is a practicing physician and president and CEO of the Orsini Way. As a frequent keynote speaker and author, Dr. Orsini has been training healthcare professionals and business leaders how to navigate through the most difficult dialogues. Each week you will hear inspiring interviews with experts in their field who tell their story and provide practical advice on how to effectively communicate. Whether you are a doctor faced with giving a patient bad news, a business leader who wants to get the most out of his or her team members or someone who just wants to learn to communicate better this is the podcast for you.

Dr. Anthony Orsini (1m 17s):
This episode is being sponsored by Veritus. Veritus offers virtual alcohol or drug and trauma treatment programs exclusively for licensed medical professionals. Their programs provide a concierge level of care consisting of evidence-based clinical treatment and are customized to meet the unique needs and challenges of physicians, dentists, pharmacists, and nurses, struggling with substance abuse. Having worked with licensed medical professionals struggling with substance abuse since 1976, Veritus understands how extremely difficult it can be to ask for help because of how severe the stigma is in the medical community around mental health and how real the fear is a potential repercussions from colleagues if found out.

Dr. Anthony Orsini (1m 59s):
Their virtual confidential platform provides a safety and security medical professionals need to get help while continuing to work. Confidential, convenient, and compassionate, Veritus brings world-class treatment to your home or office. To learn more about Veritas you can visit www.Veritussolutions.com. Well, Welcome to another episode of Difficult Conversations: Lessons I learned as in ICU Physician. This is Dr. Anthony Orsini, and I’ll be your host again this week. Today, I am blessed to have another great guest today. My guest is Dr. Bradley Block. Dr. Block is an Otolaryngologist Head and Neck Surgeon in long Island, New York, and a partner at ears, nose, and throat and Allergy Associates.

Dr. Anthony Orsini (2m 42s):
He is also a fellow podcaster. Brad created the very successful physician’s guide to the Doctoring podcast. I subscribe to it and I can tell you that it is engaging, informative and he interviews physicians and non physician experts to help teach us, as he says, what we should have been learning while we were busy memorizing the Krebs cycle. The physician’s guide to the Doctoring is a practical guide for practicing physicians, physicians in training and all allied health professionals. But I would argue that it is equally as important to patients who want to be informed. Topics range from personal finance to politics, to improving interactions with patients. Dr. Block graduated in medical school at SUNY Buffalo, where he graduated with research honors.

Dr. Anthony Orsini (3m 26s):
He went on to complete his residency in ears, nose and throat at Georgetown. Brad lives with his wife and three young sons in long Island where he enjoys surfing, skiing, smoking meat, exercising, throwing his son’s across the pool and finding any excuse to quote an eighties movie. Well welcome, Brad. Thanks for coming today. We really appreciate you taking time out of your busy schedule to talk to us. I’m excited to speak with you as well.

Dr. Bradley Block (3m 52s):
Well, Tony, thanks so much for having me. I’m excited to be here.

Dr. Anthony Orsini (3m 54s):
You and I have so much in common. I talked about it in the introduction, but I can’t move on until I ask you about the eighties movie thing. I’m going to tell you mine. Well, first of all, tell me what your favorite eighties movie.

Dr. Bradley Block (4m 9s):
I’m a star Wars kid. Like I grew up with all of the action figures and everything. So it would have to be Returned of the Jedi ,as much as that’s not my favorite Star Wars movie. You know, I was four when it came out. So I guess that’s my best eighties movie.

Dr. Anthony Orsini (4m 22s):
And you said that the eighties line, so what is your favorite line?

Dr. Bradley Block (4m 26s):
Conan the Barbarian, James Earl Jones character. “I am the wellspring firm, from which you float”. Nobody is going to get that. Nobody is going to get that, but if you’ve never seen Conan the Barbarian directed by Oliver Stone, or maybe produced by Oliver Stone, but his name isn’t on it.

Dr. Anthony Orsini (4m 40s):
Okay. I’m going to tell you mine, mine is Arthur in the movie. Arthur. I think that’s the eighties. My favorite line ever is “she’s the princess of a very small country. It’s terribly small, tiny little country. Rhode Island can beat the crap out of it in a war. That’s how small it is”. My roommate’s and I in college just used to watch Arthur and repeat all the lines before they even say it. I had to get that out of the way. The second thing that I have to get out of the way is you’re in long Island, I’m from New Jersey are you JETS and Mets or Giants and Yankees?

Dr. Bradley Block (5m 12s):
It is 80’s again so growing up with the 86 Mets, I have to be a Mets fan and I’m more of Giants then jets by default. But with that being said, please don’t ask me any sports trivia is because 1986, he was really the last time I watched organized sports except for the Superbowl. We just saw.

Dr. Anthony Orsini (5m 30s):
Okay, great. All right. Which is a great Superbowl I’m down in Florida and a Tampa Bay. So it was a big deal down here. So it’s all. Okay. So that’s enough fun. Let’s move on. Cause I really want to talk about your Podcast. There’s so much to learn from your podcast. And I think what’s really interesting about the podcasts is that it’s about, as you say, we should have been learning when we were memorizing the Krebs cycle. And I think your podcast is great. Not only for doctors and allied health, but it’s also very important to patients because they need to know what’s going on in doctor’s lives. You know, I look this up the other day, according to 2019 statistics, there is 985,000 active physicians in the United States and 550 million individuals.

Dr. Anthony Orsini (6m 11s):
So that’s just goes to show you that ratio and most patients don’t realize all the other stuff that’s going on in a doctor’s life. I mean, we have so much going on in your podcast has several themes. And one of the great things about being a podcast host that I’ve found is that I learn so much. That’s what I love podcasts. I learned from listening to them. I’m always listening to podcasts, whether I’m going to work or driving them for a long drive because it’s like free education, right? I mean, how could you turn that there? That’s why I love podcasts so much, but I’m learning from all my guests. And there’s always these common themes that come up. And now my podcast every other week is one, is health care and one is about business, but the same words keeps coming up. But I talked about this all the time in my podcast, trust, relationships, burnout.

Dr. Anthony Orsini (6m 55s):
These words are all coming in. And when I listened to your podcasts, I look at themes. You have had several episodes on each one of these. So these are Difficult Conversations that we have to have with ourselves in their conversations about physicians. And that’s why I was so happy when you agreed to come on the show. So lets pick a few topics if you don’t mind and lets just, you know, I will let you just talked about what you’ve learned through the conversations with your guests on each one of these topics. And the number one topic that we have to talk about is a physician wellbeing because that’s what we all should care about. Whether you’re a physician or allied health or a patient, I wouldn’t want someone who was was burnt out. And you have done several episodes on physician wellbeing. So just tell us a little bit about what you learned from those episodes and from those guests.

Dr. Bradley Block (7m 39s):
Well, so there’s a lot of discussion about physician burnout specifically. There’s an epidemic of physician burnout, but it’s often described in different ways. And yet there are burnout scales. There are things that psychiatrists use scales that psychiatrists use to measure burnout and define burnout. And I think the psychologist name, maybe a psychiatrist, Christina Maslach, Maslach scale, the way Dr. Maslach described burnout was there a really three issues. There is deep personalization so for us as physicians, we are going to stop caring as much about the patients that we take care of. And so this is important because it is important for patients and patient safety that is in the patient’s best interest for burnout not to be happening because it affects them.

Dr. Bradley Block (8m 25s):
So depersonalization is one issue. Another is emotional exhaustion and this is not something that’s unique to the physicians. In many professions you know, you get home to your family and your kids you are exhausted, but emotional exhaustion is a little different, especially in, especially like yours, where you have so many small children that are just teetering on the brink and sometimes patients die and you have to be able to come to work the next day. And so having things in place that can help us to deal with that and manage that and, and grieve appropriately. So depersonalization, emotional exhaustion and then the last one is the lack of personal accomplishment. And one of my earlier episodes was with Dr.

Dr. Bradley Block (9m 7s):
Sanj Katyal. Who’s a radiologist and he is all about positive psychology and he’s a radiologist. And so one of the problems that radiologists have as much as they might have nice hours and can look at their screens from the beach or whatever the rest of us who are patient facing, you know, imagine what a radiologist’s life was like. You know, they are just grinding through their images with no sense of what’s happening to the patient. So that sense of personal accomplishment they’re really detached from what happens to the patients. Whereas with us who are patient facing, they would get to see that when patients are doing better. And so those three issues, depersonalization, emotional exhaustion and lack of personal accomplishment or all part of that burnout syndrome. And so whenever we’re talking about it and I think it’s critical and whenever addressing it, I think it’s critical that those three things be addressed.

Dr. Bradley Block (9m 55s):
And so whenever there’s some proposed remedy for burnout at your institution, you need to ask the question which of these three things, is it addressing. And if it’s not addressing any of those things, then you need to have a difficult conversation with those who are proposing that you do, whatever it is that they want you to do and find out how it’s addressing that. They might have a totally reasonable answer to it. They might have a plan, they might have an agenda. They just, you know, you’re not sure how it works in there. So I think it’s important to ask the question and situate more out of curiosity. And I forgot which one of my episodes where we talk about that like if you’re ever going to question is superior because medicine is very hierarchical, make sure it’s done in a curious way, rather than a cynical and aggressive way.

Dr. Anthony Orsini (10m 42s):
There’s a point right there for the first communication technique. I learned from one of my guests when they are explaining to you how to discuss the problem with a superior a great phrase is “help me understand”, help me understand why we decided to go this way, which is exactly what you just said. Come from the point of view like not that you wrong, but help me understand. In one of the hospitals that I taught at, they had this big chart for physicians. It was really for nurses burn-out and it was just kind of like tic-tac-toe chart. And it said, these are the things that you should do. If you feel burnt out, it was things like meditation, exercise more or get more sleep. And I was walking by it. I heard a couple of nurses joking saying if I have the time to do all that, I wouldn’t have been burned out in the first place.

Dr. Anthony Orsini (11m 28s):
Yeah. It’s a catch 22, right? It’s very easy to say it don’t work so much. But the thing about physician burnout, which is really interesting is that to the average person who doesn’t stop to think about it is that they think, wow, you know, I’m not going to feel sorry for doctors and they make good money. They are working all the time. They live in these big houses. So why should I feel sorry for a doctor that works too much. And the answer is you really shouldn’t accept that. That’s the last person you want to be treating you, right? You don’t. So you should care about it. We know that as you talked about compassion fatigue, what happens after you get burned out? And I do a whole lecture on that, but your doctor is tired. He or she doesn’t think of you as a real person. They started to distance themselves. The next thing you know, what goes up?

Dr. Anthony Orsini (12m 10s):
Medical errors.

Dr. Bradley Block (12m 11s):
I don’t necessarily agree. I don’t think the onus should be on patients to solve physician burnout. I think the onus is on physicians. And this is something that we talked about in my episode with Jack Cochran who used to run Kaiser. He wrote a couple books on leadership. And so the question that I posed to him is exactly what you said. The nurses were saying, I have no time. I have no time. How can I possibly be on another committee? How could I possibly join some other leadership committee I’m already spread so thin? And the answer is because if you don’t someone else will. And so the onus is on us to solve our problems. Personally, I think in some ways this can help address burnout because it’s like man’s search for meaning.

Dr. Bradley Block (12m 55s):
One of my favorite books. If you’re feeling this despair yet you’re working towards solving the problems that are causing it. I think there’s something to that. And so another episode with Lynn Marie Morski, she talks about quitting. One thing that we do in medicine is we say yes to everything. If you think back to when you were in high school, you were on every committee, you played every sport, you are on every club and you had time for all that. Cause that’s all you are doing. And then you went to college, but presumably did the same thing. And then you went to med school and you’re on all sorts of leadership positions and clubs. And I’m sure you have an extracurricular activities. So every step of the way we just end up saying yes to everything and we get so used to saying yes to everything that this is something else that’s contributing to our emotional exhaustion because now we’ve finished our day rounding in the NICU and we’d like to go home and see our family or play poker with our friends or a pick-up game or something.

Dr. Bradley Block (13m 54s):
But we can’t because we got that committee meeting, we got that other meeting we’ve got that project. Or do we’ve got to write that paper. Because every time we always say yes, and the answer is no, the answer needs to be no, he has to be in it. It needs to be, unless the answer is hell yes. And the answer needs to be no. And that’s actually something that I did in my life recently is I quit everything. I quit all these different committees that I was on in my practice. Not like I was doing that much compared to some people, but I will certainly be doing more than some as well, because I was just finding myself spread too thin. And my family was paying for it or my practice was paying for it and I wasn’t willing to give up the podcasts. So if there wasn’t something that I was going to say heck yes, then the answer was going to be no.

Dr. Bradley Block (14m 39s):
So if you’re finding it and this is where it gets to finding the time to do the things that you really are passionate about. And if you’re finding that you are in despair because of the way the hospital is running X or the hospitals running Y, then do you need to be part of the solution and that’s going to help you again, man search for meaning by finding use in it. You’re just going to help your recovery. And then the question is, how do you go about doing that? How do you even get your foot in the door? And you know, Jack Cochran again, and then another guest, Andy Scott, where are we talked about the keys to the C-suite. How do you get into the C-suite? And the answer is what you talk a lot about is relationships.

Dr. Bradley Block (15m 21s):
Yup. You got to build those relationships. How do you build those relationships? You talked to people and so your job to become a leader, isn’t necessarily going to be the one that has all the ideas, because there are plenty of ideas out there. But what you need to do is you may be, you need to become the conduit of communication between different things. You need to be able to form teams. You have to be able to create allies in that comes to the communications. And one thing I know that I’m terrible at is if I’m in the hospital and I’m rounding, I make a beeline for the patient, goes in the chart right in my note and get the heck out of there because I want to go home. But if you want to be in a leadership position in that hospital, you need to be chatting everybody up.

Dr. Bradley Block (16m 4s):
It’s not a waste of time. When you see someone in the hallway and you start chatting to them, that is relationship building. That person is going to therefore be more likely to trust you. They are more likely to tell you what they think is going on. Then you can use that to your advantage, to work with them. And this is how you’re going to work towards changing things within your health system, within your hospital. So then you can make it a better place for everybody. So, you know, I don’t think the onus is on the patients to create the change that we need. The onus is on us. And I think it starts with saying no everything else. And that it’s yes, to the few things that you’re passionate about, that you really want to see change because they were affecting you so much.

Dr. Anthony Orsini (16m 48s):
Well, there’s so much there to unpack. I mean, one of the things that you said that really hit home is something that you’re passionate about. Some people think that it has to do with how much free time you have. To be happy you don’t need free time. Yes, of course my family is important to me. I want to be home with the kids, as you said, throw your kids across the pool. Would you like to do that? But if you are passionate about it, it’s not work right? If you love what you do, you’ll never work a day in your life. Because if you say, you said I wasn’t able to give up the podcast, that’s something that you enjoy. You’re passionate about you. And I both know this podcast has a lot of work. We really get nothing out of it. But I’m very inquisitive, I love to learn from people like you and my other guests, I feel like I’m providing a service.

Dr. Anthony Orsini (17m 30s):
There’s people listening and teaching people. Communication is something that I’m excited about. It I’ll take a couple of days vacation and fly out to go give a lecture in Portland and do a workshop for a very little money and you know, be on the red eye, coming home and then work the next day. But it doesn’t burn me out because I’m passionate about it. Now. I’m not a committee person. I don’t like to sit in a meeting. My ADD probably gets the best to me in these meetings where I’m fidgeting all over the place. And I’m sitting at some of these committee meetings that I’m going to did we talk about this six times, six weeks ago and five weeks ago and four weeks ago and three weeks ago, that’s not me. I’m a doer. And so when I’ve asked to be in leadership positions, I’ve taken some of them, but I had to make that choice, like you said.

Dr. Anthony Orsini (18m 16s):
So do I want to continue on this leadership path and be the guy that goes to the meetings all the time? Or do I want to do my Podcast, fly out at the Portland and do a workshop on communication. And the answer is that’s what I want to do. And I think what you said is so important, you can’t do everything. And you know, in high school you said it, you do try to do everything and sooner or later your parents might say to you, you know, they said, Tony, you can’t play three sports. Like, you know, you want to get it to the college, you know, pick to pick one. Or my oldest one used to play a football game when he was in seventh or eighth grade. And then I would clean him up and then take him to the baseball game. After a while you say, this is crazy. You, you have to pick. So I think that’s really the big message that you mentioned right there is you got to be happy what you’re doing.

Dr. Bradley Block (19m 2s):
Yes. If you’re not passionate about it, if it’s not a heck, yes, then it’s just a no. You can’t please everybody. And you got to start off with pleasing yourself.

Dr. Anthony Orsini (19m 9s):
Yes. it’s been a common misconception. I talked about this story in my workshops, a common misconception that what happens is the compassionate fatigue follows to burnout and more and more data is coming out now. And, and, and I’ve spoken to a few people about this that really the opposite that what happens. So what, what happens is that if you could prevent the compassion fatigue from happening, you’ll prevent the burnout. And so what I mean by that is I talk about it in some of my lectures. So you have the patient’s always there. So for me, I have to pick up the phone and I got to find the mother, or I go downstairs and speak to the mother who is, it was in labor and delivery. But maybe I don’t have these meaningful communication with the mother because I’m really busy. I see the baby, I write for the rounds and I’m off. But then I go home and you know, maybe I’ve done a really great job, but I feel empty.

Dr. Anthony Orsini (19m 54s):
Communications my thing, I’m a person who just loves relationships. And then I go home, go home. And you know, you, you know what happens to me? It happens at night when I’m getting ready to go to bed. Damn it. I forgot the speak to that mom. Or I told her I would call her back and I didn’t call her back. And now it’s 11 o’clock and I’m calling the nurses up, going that mother come in and she is Dr. Orsini is at 11 o’clock at night. And I’m like, yeah, I put a sheet there because I feel really bad. So if you are enjoying being a doctor, I’m not going to say a a hundred percent, but I think you’ll be a little more resistant to it. But when you get caught up in all of these committees, how many different tests we have to take prior to getting a little crazy, right?

Dr. Bradley Block (20m 31s):
It is preposterous is, and if you have privileges at different hospitals, a lot of times it’s redundant. I mean, listen, I’m all for education about sexual harassment, but I had to take it from my practice. I had to take it for one hospital. I had to take it for another hospital and they’re all asking the same thing. One should really be able to apply to all of them. And in my favorite is though is a course on burnout to prevent burnout, right? Cause it’s the course that’s, you know, wasting my time and preventing me from going home. But you were talking earlier about that personal connection, how important it is. And I realized that I had mentioned Sanj Katyal the radiologist. They never actually talked about what he does with his radiologist, which is he recommended that, you know, every so often they reach out to a physician by phone to give them the results because there are so disconnected from the patient care, that one thinks that he found improve their quality of life is that personal connection.

Dr. Bradley Block (21m 27s):
You know, tell me a little bit about the patient. Okay. This is what I’m seeing. This is how I think it will contribute to management. You know, what were you thinking in terms of management? And then you’ve got a little bit of connection. You got a little bit of a story and then you’ll see how the patient has benefited from your reading this scan.

Dr. Anthony Orsini (21m 43s):
That’s an interesting point. You know, a radiologist for those of you out there who are maybe an academic medicine, or if we do the same thing, we do these radiology rounds once a week, for those of you are not in medicine, radiologist sits in this really dark room and then will bring the residents down once a week and Tuesday to go over to the week’s films with the radiologist. And tell me if I’m wrong, Brad, but the radiologist lights up like, Oh, People, I had seven people and they were all listening to me speak. And so I think that’s really a great opinion that I liked that

Dr. Bradley Block (22m 12s):
Well, they love what they do. It’s got to like us. I liken it to being in love when you’re in love. You want to tell everybody about that person and how wonderful they are and how wonderful you’re doing it. And I think most of us feel that way about our specialties were super excited to talk to people about it. So you get down to the end of the radiologist who is had not much a personal connection, except for the person that’s looking at their scans in the little cubby hole next door. And they excited to tell you what they are passionate about.

Dr. Anthony Orsini (22m 38s):
You know, one of the things I talked about when I’m going to have to speak about patient experience and do some workshops, and I’m doing a workshop for a major university about multi-disciplinary and how we can make each other get along with each other, that they have issues with their doctors and nurses and different specialties are not getting along with each other. And we talked about banter and how that makes a big deal for ears, nose, and throat doctor. You know, you go to the OR and you see the, the nurse and the receptionist spending a few minutes asking her, you know, calling her by name, asking her about her kids, complaining about your own kids. That’s called banter. That builds relationships. And they’re like, ah, Dr. Block, he is a pretty cool guy and it makes all the difference in the world, but it’s also what the radiologist generally don’t get as much.

Dr. Anthony Orsini (23m 20s):
I’m sure that he talked about that, but it’s also really important for us not to be laser focused on, I got to get to the OR I’m running late because when you go home, you’ll be more excited about what you did and you’ll be happier what you do.

Dr. Bradley Block (23m 32s):
Yeah. And that’s how you’re going to get referrals too. Like if you’re looking to build a practice, chat everyone up, chat everyone up there, more likely to remember you. And they’re more likely to send your patients because everyone is going to ask their neighbor who works at the hospital, who the best ear, nose and throat ophthalmologists, neuro-surgeon I mean, I guess you can get maybe what people see or find neurosurgeons that way, not just through the trauma Bay, but you know, that’s how they get referrals. So it’s going to help to build for all of the newer physicians out there. If you just move, that’s going to help to build your practice. That’s not in the doctor’s lounge because the doctors have their referral patterns and their set and meaning this new person in the area is not going to cause them to change the referral patterns from the person that they were already sending to.

Dr. Bradley Block (24m 15s):
The things that that is going to cause them to change is when the nurse ends up sending their neighbor to you and the neighbor, then it goes back to their primary care physician and said, I just saw the best ophthalmologist ever. And they keep hearing that over and over. And then they’re going to start sending their patients to you. So you’re not going to convince them but their patients are going to convince them. And that’s how you move to the tide towards, you.

Dr. Anthony Orsini (24m 37s):
And that’s why a patient experience patient satisfaction scores, H caps, whatever you want to call them. They are just extremely important today. Most people do go to the doctors through referrals. There is one statistic that I saw it for every $4 that you spend on marketing for talking about hospitals now is equal to only $1 spent on patient experience. So you can put up all the bulletin boards you want, you can do 12 commercials, a night, but most people are going to ask their neighbor, Hey, how was Dr. Block? You know, there’s thousands of ENT people that can do it, a particular procedure that you do, what are they going to say? Go to him. He’s really nice. He was great. He took the time to speak with me and that’s how they get the referrals because that’s what people really want.

Dr. Anthony Orsini (25m 18s):
And I think you did a podcast episode. I can’t remember who it was that you were speaking to you, but he or she was talking about the same thing about just people want a few minutes of your time, you know, and that’s all they really care about and it doesn’t take time to do that. It only takes a minute or so. So I think it’s really important lesson for a young physicians out there too. Take a few times. We need to do an episode on humor at one point, how you humor is a really helpful.

Dr. Bradley Block (25m 43s):
Yeah. Scott Dicker is the founder of the onion. I have no idea how I managed to get the founder of the onion on my show to talk about humor, but I did. And so we talked about, well, one of the things he ended with, I thought it was great. I said, let’s say your doctor was listening. What would you want your doctor to know about humor? And he said, don’t try and be funny. It’s my job to be funny. I’m the funny one. I just want you to laugh at my jokes. So, and I, and I think that is without realizing what he is doing there. I think it’s important. The patient’s the star of the show. You’re not the star of the show. So it’s important to make them laugh, but it’s even more important that if they’re making jokes, that you laugh at their jokes, because again, they’re the star, they’re the star.

Dr. Bradley Block (26m 25s):
You’re not the star. And he did make a couple points. If you have like a failed joke, you know, we all have our schticks. We all see the same things over and over. And we find ourselves saying the same things over and over. And so my shtick has changed, but it evolves. And so its kind of like a standup comedian who tries something one night and it doesn’t work. And so they change it a little and tried it the next night. Then it may be, it works a little better, but let’s say you try a joke and it bombs. You need to be ready for that. And so one thing that you can do and it’s an easy one is Aw man, I’m glad I’m in medicine and not in comedy. So something self-deprecating. However self-deprecating humor is great just don’t make it about your skills as a physician.

Dr. Bradley Block (27m 9s):
Because if you start denigrating your skills, then they’re not going to trust you. So you can deprecate how you like don’t run on time or are you like, it cannot be about competency, but never ever make the joke and the patient’s expense. And that’s something that is true in the exam room. When the patients are asleep in the operating room on social media, I think what he said was the function of humor is to afflict the comfortable and comfort the afflicted. So you have to no who in this relationship is the afflicted. It’s the patient and who is the comfortable, it’s the hospital system. It’s the pharmaceutical governance.

Dr. Bradley Block (27m 49s):
Then it can never be a drug that is going to undermine trust. But at the same time you are comforting the afflicted, but you never inflict the inflicted. So it’s important to think about that. If you’re ever telling a joke and for doctors, it’s okay to tell dad humor, right? We were both dads. You know, those completely horrible fall flat jokes. It’s fine. It’s fine. It’s not fine for a standup comedian to do that. So if you want to use hokey jokes, it’s totally fine. It because it’s really going to soften things

Dr. Anthony Orsini (28m 19s):
As pediatricians. We do that with the kids, the children come in and it’s funny when I did pediatrics, you, you say it that joke and same age kid , one kid laughs and the other kid who looks at you, what are you an idiot? And you got to know your age, right? You say a dad joke to a junior high school girl. She’s not gonna laugh.

Dr. Bradley Block (28m 38s):
You know, that’s gotta be a tough audience though. That’s like any teenager is going to be a tough audience. Sorry, I’m going to turn the interview around on you. Or do you have any go-to jokes for different situations?

Dr. Anthony Orsini (28m 51s):
You know, I don’t have a lot of jokes with the parents, but what I do is are you talking about self-deprecating if it’s not really a self-deprecating, but to be a genuine person, I talked about that all the time and what I give workshops on patient experience. They want their doctor to be a genuine person. So I will do what I did to you, you know, find out where you’re from, especially nowadays where people keep the same area code. So they might say, yeah, so they have their cell phone in. If I see a 973 or 212, I know that’s a bit Jersey, 718 and I know where that’s from. And so I talked about finding commonality. I do a lot of sports stuff. I do a lot of sports analogies. Sometimes at work is obviously not going to work with a mom who obviously is not into sports, but I try to make genuine concern or you, while you’re at the surfing, that’s a sport.

Dr. Anthony Orsini (29m 35s):
So I try to be a genuine person, you know? And I’ll say things like ti you know, last night my car broke down or you know, if you’re have younger children and I was up too late last night, my daughter couldn’t do her homework we were up to 11 o’clock and physicians have said to me, well, don’t tell them that you were up late last night. You might think no. They know that you are a real person. And you go from Dr. Orsini to Dr. Orsini from New York who likes the giants and that makes all the difference in the world. So I don’t use humor a lot, except that what I’m trying to just be genuine. And now with nurses and respiratory therapists, we joke all the time, you know? And I think that’s the best advice I could give to a young doctor is if you want the nurses and the ancillary staff to really be happy.

Dr. Anthony Orsini (30m 21s):
When you walk in the door, then take a minute to do that banter and make some jokes with them. There’s stuff that I can’t think of any not, but their stuff on Facebook all the time. And it comes up. And if you got to make sure, as you know today in, in the world community, you got to make sure that it’s a perfect one, recent one, someone put on Facebook. I saw it, I showed it to my friends and the nurses. There was a man standing In, in the woods and he was screaming in the caption was if a man says something in the woods and no one hears it, is he still wrong? So, Hey, you know, I will make little jokes about that. So that’s my go-to kind of stuff like that. So yeah.

Dr. Bradley Block (30m 56s):
And don’t buy them donuts. I mean, you can buy them doughnuts, but much better than buying them donuts is knowing their names, knowing their spouse’s name, knowing their kid’s name, knowing the town that they live and knowing their interests, knowing things about them, that you can ask them about that. It’s not the same thing every day. Am I amazing at this? Absolutely not. I am not. I am not, but I’m going to keep trying and my kids or one and a half or three and four and a half. So, you know, we want to, a lot of the Daniel tiger, I just keep trying or you’ll get better. So I’ll just put the effort in putting the effort in, and that’s going to be much more appreciated if you know who they are, you care about who they are. That’s going to go a long way.

Dr. Bradley Block (31m 36s):
And you know, to what you said about humour, you know, you’re in the NICU with two and a half pound babies with all sorts of monitors on them, in intubated with feeding tubes. For me, it’s a lot easier to make jokes. Cause I’m an ENT doing mostly outpatient stuff I’m taking out of your wax and you know, nasal polyps and snoring and deviated septums and tonsils and adenoids and ear tubes. My patients aren’t critically ill. So it’s much easier for me it to make jokes. So that’s why it’s important to know your audience.

Dr. Anthony Orsini (32m 6s):
When you said how young your kids are, I did think of a go-to joke that I use all the time when the baby is getting better and you’re getting ready to go home. And the kid is so cute. You give them a compliment. You’d say the baby is so beautiful. Look how quiet he or she is. And then I’ll say enjoy it now because in 15 years he’s gonna be a teenager or she is going to be a teenager and I’ve gone through three of those already. It’s not fun, but I promise you when they’re 22, they’ll love you again. And so everybody kind of jokes about that. So, well,

Dr. Bradley Block (32m 33s):
I know it’s also nice for them because they had a kid who was just critically ill. And now you’re like, you have got this life in front of you. Now that’s a much deeper statement because it’s not just joking about how difficult teenagers can be. You are going to be like, you’re going to have a teenager one day. Like how amazing is that?

Dr. Anthony Orsini (32m 50s):
Yes, it is amazing. And the doctor is a real person because he didn’t have the key to teenagers either. And it happens to me. It’s not going to happen. So, you know, you’ve had some, I just want to finish up with a, you had Blake Eastman on talked about nonverbal communication and that’s my thing. So I was fascinated and he talked about interest and authority. And when I give lectures on breaking bad news, I always say the three goals are for breaking bad news is to be compassionate, which he calls interest authority to be the expert in the room is part two. And then the third goal is not going to leave You, but he had some great comments about the way you smile and telehealth and how difficult that was. That was fascinating.

Dr. Bradley Block (33m 30s):
Yeah. So he is interesting cause he’s a poker player and he does his own research on nonverbal communication. And a lot of the things that we think about non-verbal communication, he thinks aren’t necessarily true, but there were a couple of points. Yes. So interest and authority, those are the two things that he thought were key to nonverbal communication and authority you express through the tone of your voice. An interest is your facial expression. And so you need to be aware of that stuff because were not necessarily as aware of it as we should be a point that he made is you need to be authentic so you can’t make this stuff up. But at the same time, you can still neglect these things.

Dr. Bradley Block (34m 12s):
If you’re not concentrating on them, if you’re not practiced at it, you can be interested. You can be the authority, but you can be not expressing it. So you can make it up. But at the same time you can neglect it. So it’s important. And so with regards to the interest and the fact that we were wearing masks is not as big a deal as we would think, if you’re in the ICU and you’re on a paper or you’ve got your face shield and your goggles and your mask. So if you’re completely obscured, that’s going to be a problem. But for those of us who might have goggles and N95, the patients can still see your eyes. And so that’s where most of the non-verbal cues are gonna be with regards to the interest are they are going to be surrounded around your eyes.

Dr. Bradley Block (34m 54s):
And so nodding is not as acknowledging as you would think it is. If you’re talking to someone they’re just nodding over and over, it’s not clear whether they are actually paying attention. Squinting appears more engaging than nodding. So if you were really squinting to pay attention to a patient, that’s gonna go a long wait for them to recognize, and you’re not fooling them, or you’re not trying to make them think you’re interested for them to recognize that you’re actually interested. And then with regards to the authority, yet your vocal tonality really does matter. And so us being from the Northeast that doesn’t always convey, you know, we end up sounding like Jerry Seinfeld sometimes where everything we say, Oh no, no, it sounded like a question.

Dr. Bradley Block (35m 35s):
And so it’s important to end things on a down note with more of an exclamation, rather than a question as in the North, or should we have a tendency to do. And then with regards to the telehealth, the main issue was where to position your camera because you can align the vertical, but you can align the horizontal. So at least to make sure that the vertical is aligned. So the patient can see you at least looking at them in one dimension.

Dr. Anthony Orsini (35m 59s):
Yeah. That’s really important. And the body language, and some people don’t like to call that nonverbal communication is so important. 70 somewhere between 70 to 80% have language is non-verbal and you can use your non verbal language to manipulate people. Or maybe you manipulate is not a good word, But to get people to really realize that you are caring and you’re compassionate. And you know, there are certain things you can do consciously what your non-verbal language, but not everybody is an expert in non verbal language. So what I say is use the word, imagine That I think you mentioned it at one of your podcasts actually taking the time before you opened that door, take a deep breath, take a second. As my colleague says, take your own pulse.

Dr. Anthony Orsini (36m 39s):
Imagine what it’s like to be this patient. And he, or she has been waiting in the office for a 45 minutes. And I know this is your 30th patient of the day, but this is his or her only visit. So take a minute too, imagine a compassionate. And most of the time, if you do that, your subconscious will take over and your non-verbal communication will be appropriate. Does it hurt the learner, no. Amy Cuddy. Do you know what Amy Cuddy?

Dr. Bradley Block (37m 6s):
Yeah. With the a superhero stance.

Dr. Anthony Orsini (37m 7s):
Yes, yes, yes, exactly. So Amy Cuddy wrote in her book that just standing in front of a mirror with your arms out, right before you go to a job interview can not only make you do better in the job interview, but also she measured testosterone and cortisol levels and found that the people that stood in front of that mirror, he was just for a few minutes had higher testosterone levels and lower cortisol levels, which meant they weren’t as nervous and they were more confident. And so if you’re out there and you say, gee, I don’t know anything about Nonverbal language and Blake Eastman, I think mentioned this. Just take it a minute to imagine. And you should be okay.

Dr. Bradley Block (37m 40s):
Yeah. There were a couple of people actually that, that had mentioned that one of my first episodes with the Jason Hare is the patient experience advisor for a hospital in upstate New York. And then Oscar Trimboli who, who talks about deep listening. Both of them said the same thing, different iterations, but ultimately before you go to the patient’s room and again, I practice outpatient medicine. So this is my experience. I opened the door. It’s no different in the NICU where everyone’s in it in one big room or stop and take a deep breath or two deep breaths or three deep breaths, an easy thing to do if they are your rooms is to put a little piece of tape on the door, just a little colored piece of tape. This is my own thing that we do. You remember to do it because you need a que, you need a que a in order to, to make it a habit.

Dr. Bradley Block (38m 22s):
And this is another, you know, I have been a couple of episodes of developing new habbit. We won’t get into that. But if you put this little piece of colored tape on the door, it will remind you to do that. And all you have to do is it’ll just take a second, take a deep breath or too, so that you could remember that this next patient is the star of the show, whatever you’re doing in the last running behind people in the waiting room, phone calls, waiting for you. It doesn’t matter. Patient is at the star of the show. I take a deep breath and it will help to remind you that they’re the star of the show. It will make the visit more fulfilling for them. It will make the visit shorter they’ll know from the beginning that you have their undivided attention, because you will have their undivided attention and it will make it more filling for you. And then,

Dr. Anthony Orsini (38m 60s):
Yeah, that is the best lesson of the day that it will make it shorter because that’s the biggest misconception is that if you sit down and don’t multitask, you’ll get out there a lot later and you’re going to get home six, seven, eight, nine o’clock at night. When the reality is, I always say you’re mother was right.o it right the first time and you’ll save time. But how many things come back to what our moms told us? So this has been great. Brad, I can talk to you all day long. I have about another 10 topics that I want it to discuss where we might have to have you back on. But I think the key to all of this is it’s back to communication, conversations about things starting on your podcast. The physician burnout is such an important conversation. I finished every podcast asking the same question I warned you about this.

Dr. Anthony Orsini (39m 44s):
What’s the most difficult conversation that you either had specifically or a type of conversation. And please leave the audience with some little pearls from that, how you navigate that?

Dr. Bradley Block (39m 52s):
No, no. I said earlier, it, most of the stuff that I deal with in my practice isn’t really grave. But you know, periodically I do diagnose patients with cancer, thyroid cancer, which tends to be not so aggressive, but sometimes throat cancer, different head and neck cancers. And so at my conversation is certainly gonna change now because I interviewed Dr. Orsini on my show. And so we talked about breaking bad news. And so, you know, I learned from him that I can be more methodical about it, but for me, those conversations, it was always important that two things, one there’s no ambiguity use the word cancer. Don’t use the word tumor, don’t use the word malignancy, use the word cancer, or the patient needs to leave there knowing that they have cancer, they can’t leave their not being sure what the doctor was talking about.

Dr. Bradley Block (40m 40s):
I think it’s cancer. I’m not sure what does that mean? And then knowing what the next step is, knowing that their going to be looked after knowing that I’m available. I mean, mostly I’m not managing this. I’m sending them to a comprehensive cancer center, but knowing that the person that I’m sending them to is someone that I know very well and trust. And we would go to them, myself and a written plan of what the steps they need to do and that knowing that I’m available for them. But I think the critical part of that is knowing that they are going to be looked after and knowing that they have cancer. No ambiguity.

Dr. Anthony Orsini (41m 11s):
That’s a great point in writing it down because they have to say that C word as it’s called now, they only retain about 10% of what you say afterwords. So writing it down and I think is really key. I just interviewed somebody on child abuse and he is a forensic interviewer. So he’s the one who has to tell people that their daughters had been sexually abused or, or their son who has been physically abused or whatever. And one of the pearls that he taught me, as he said, what I’m for forensic interviewers, they always ask me how long should this take? And my answer is however long it takes. And I think that’s really important when you were talking about telling cancer. If it takes 15, 20 minutes, half an hour, and you’re people are backing up, this is the most important thing that you’re probably going to do that day.

Dr. Anthony Orsini (41m 52s):
So you want to make sure you get it right.

Dr. Bradley Block (41m 54s):
And then when you’re done with it and you’re moving on to the next patient, stop take that deep breath, collect yourself. Cause that next patient is now the star of the show.

Dr. Anthony Orsini (42m 3s):
I love the piece of tape advice. That’s a great piece of advice. So if I ever got an office, I’m going to use that. I like that. So well, Brad, thanks so much for coming on. This has been really great. As I said it, we can talk for hours. I appreciate you having me on your podcast and I’m looking forward for this one to drop so that my audience can benefit from all of the conversations that you’ve had. Again, tell us about how they can get through the podcast is available on every format or most formats?

Dr. Bradley Block (42m 28s):
Yeah. I mean, every format that I’m aware of that exists, you can find it there. If you can’t seem to find it and you just go to the physician’s guide to Doctoring.com. That’s my website. You can listen to the episodes there. I’m on Twitter at physicians Guide. I just joined Instagram, although I’m not very active, my wife@ she been helping me with that at physicians Guide and then on Facebook at physicians Guide to Doctoring. So you just look up the physician’s guide to Doctoring will be able to find it anywhere and share it with your friends. Tony, this has been great. A lot of fun talking to you again, we really have so much in common. We were passionate about most of the same things we could just have an entire podcast is, but the two of us going on each other’s shows. So it’s been great. I love the questions and thank you so much for having me.

Dr. Bradley Block (43m 9s):
Thanks.

Dr. Anthony Orsini (43m 9s):
It was a lot of fun. And as I say all the time, I’m meeting somebody great people and some of them, I really can say most of them that I can call my friends and I feel like you and I would be very happy together and just sit back and have it a few beers. So this has been a pleasure. I will put all of your information on the show notes. So if you’re driving, don’t stop, we pull over. It will put everything there and everybody will be able to get in touch with you. If you enjoyed this podcast, please go ahead, hit the subscribe and download, tell your friends. If you want to find out more about the Orsini Way, you can reach me at the Orsini Way.com. All right, Brad thanks again. I appreciate it. We’ll talk again soon.

Dr. Bradley Block (43m 46s):
Thank you, Tony.

Dr. Anthony Orsini (43m 47s):
This episode was brought to you by Veritus. Veritus offers virtual alcohol or drug and trauma treatment program is exclusively for a licensed medical professionals. Their program is providing a concierge level of care consisting of evidence-based clinical treatment and are customized to meet the unique needs and challenges are physicians that this is pharmacists and nurses struggling with substance abuse. The virtual confidential platform provides a safety and security medical professionals need to get help while continuing to work confidential, convenient, and compassionate. Veritus brings world-class treatment to your home or office contact Veritus for help at Veritus solutions.com.

Announcer (44m 26s):
If you enjoyed this podcast, please hit the subscribe button and leave a comment and review. To contact Dr. Orsini and his team, or to suggest guests for a future podcast visit us at the Orsini Way.Com.

The Power of Nice with Linda Kaplan Thaler

Linda Kaplan Thaler (1s):
So the first person that he sees of course is Frank. And he says Frank, would you tell me why I’m here to see the Capitol Della Group what floor are they on? And Frank breaks out into this big smile. Now he has no idea. He was talking to a CEO of the fourth-largest financial institution in the country, or that we were up for this $40 million account. He says, Oh, I love these guys. They always have a friendly smile for me. You know, they bring in donuts. They always ask how my family’s doing. And I was sick once they visited me in the hospital. He said, you are going to love these guys. Well, Richard Davis, who was the CEO at the time, he said, by the time I got to the 29th floor where you guys were, you didn’t know this, but you had already won the business.

Linda Kaplan Thaler (43s):
When I said, how did that happen? He said, because I thought if there are that nice to the security guards, I can only imagine how nice they are going to be to my staff.

Announcer (54s):
Welcome to Difficult Conversations: Lessons I learned as an ICU physician with Dr Anthony Orsini. Dr Orsini is a practicing physician and president and CEO of the Orsini Way As a frequent keynote speaker and author Dr Orsini has been training healthcare professionals and business leaders. How to navigate through the most difficult dialogues, Each week you will hear inspiring interviews with experts in their field who tell their story and provide practical advice on how to effectively communicate. Whether you are a doctor faced with giving a patient bad news, a business leader who wants to get the most out of his or her team members or someone who just wants to learn to communicate better.

Announcer (1m 38s):
This is the podcast for you.

Dr. Anthony Orsini (1m 40s):
Welcome to another episode of Difficult Conversations: Lessons I learned as an ICU Physician. This is Dr. Anthony Orsini and I’ll be your host again this week. Well, I hope you put aside forty-five minutes to an hour today to listen to this podcast from beginning to end, because I promise you, once you start listening, you won’t want to put it aside today. My guest is advertising hall of famer Linda Kaplan Thaler. Linda is responsible for some of America’s most famous and award-winning advertising campaigns, including the Aflac duck, the hilarious yes, yes, yes. commercials for Clairol Herbal Essence, the Kodak moment and America’s longest running jingle. I don’t want to grow up I’m a Toys or Us Kid.

Dr. Anthony Orsini (2m 21s):
Miss Thaler is a familiar face in the media having appeared on the Apprentice, Good Morning America, The Today Show and CNN. She hosted the oxygen television series, make it big. And it was a judge on the Apprentice and the Mark Burnett reality series jingles. Linda’s talents have earned her the prestigious Matrix Award, the Advertising women of the year Award, UJA’s Mac Dane Humanitarian Award. And was named one of Advertising Ages most Influential Women in advertising. Linda founded that the Ad Agency Kaplan Thaler Group which she grew from a fledgling start-up to a company with over a billion dollars in billings.

Dr. Anthony Orsini (3m 6s):
Today Linda is a renowned motivational speaker and is the national bestselling author of several books, including grit to Great and the power of Nice. And as a graduate of the renowned upright citizens brigade improv company, Linda also conducts improv workshops online and in-person to companies and organizations throughout the U S. Well, this is a real treat thank you, Linda, for coming on.

Linda Kaplan Thaler (3m 29s):
Oh, I know. I’m absolutely delighted. And haven’t gotten through all of your book yet, but you do win the prize for coming up with the best title for a book. That’s great.

Dr. Anthony Orsini (3m 41s):
You know where that comes from right? That is a WC fields quote that when you WC Fields, was asked many years ago, why his jokes were so funny and his answer was it’s all on the Delivery and that kind of, I heard it, that story, and I never forgot that.

Linda Kaplan Thaler (3m 53s):
I know being a baby doc, it was just perfect. It was absolutely perfect.

Dr. Anthony Orsini (3m 57s):
Yeah. So thank you for coming on again, I’d been a real fan of your first book, the power of Nice for quite some time. And there’s actually a story behind that, that I don’t think we shared before. I was doing my communication training for doctors for about seven or eight years. The president of the hospital that I worked with was a real fan of what I was doing. Teaching doctors communication and using improvisational role-playing that I want to talk to you about. And so we were talking about doing future projects and the president of the hospitals said to me, you know, it’s just like the Power of Nice. And I guess she read my body language and I’ll have to admit, I hadn’t been reading a lot of business books, so I wasn’t familiar with it. And she was like, Oh my God, this is the greatest book ever. You need to read this.

Dr. Anthony Orsini (4m 38s):
So she just hands me, her copy. And then it makes me swear that I will return to it. And then it was also about that time. I read your book and I realize that the stuff that I was doing to teach doctors and nurses had to form relationships, how to really make the patient experience, which has a medicine, is all about how as best as you could, or as I like to say, at least bad as you could, it was a very similar to what your talking about in the power of Nice and how being nice and compassionate and doing the right thing always wins. And that’s when I started to realize that what I’m teaching doctors as applicable to the business world also. And so I can share that with you. So you kind of send to me, your books set me on a new trajectory that’s so I want you to let you know that you are responsible for all of this stuff that’s happening.

Linda Kaplan Thaler (5m 24s):
That’s so cool. You know, there is a woman, who’s the head manager for the one that Mark Cuban owns the Dallas Mavericks Yes. And so she’s like, there are a manager coach, something that I didn’t remember, and she wrote me and she said, I want you to know that every new player that comes on has to read The Power of Nice.

Dr. Anthony Orsini (5m 47s):
But I think that’s great. And it’s so powerful. I mean, it’s, it was your first book, right? I mean, there’s four of them that you have now, correct?

Linda Kaplan Thaler (5m 53s):
Yeah. It’s actually the first book was bang, getting, get your message heard and a noisy world. And I speak a lot about that too. Is that it how to become more creative? We’re all inherently very creative. We just have to learn how to tap into it. So

Dr. Anthony Orsini (6m 6s):
Great. So I want to talk about the power of Nice. I know your story, as I said, I’m a big fan, just to let them for the audience to get to know you, you know, tell us about the girl that grew up in the Bronx that ended up owning her own advertising agency. And how did that happen, right?

Linda Kaplan Thaler (6m 20s):
Yeah. Well, I have to tell you, and here I’m going to go back into my Bronx accent, where I used to go up to Alexander’s and I used to shop on Fordham road and not to be confused. The bronx accent with the Brooklyn accent, which was my mother, my father will go and big difference, you know, so I learned a lot of four or four little words growing up in the Bronx, but the most powerful one was NICE. And that was because we didn’t have any money. And the only currency that helped you with social currency, it’s like, if you did a bad thing with one of your friends, the word spread. And so we just grew up to be as likable as possible. And one day my father, who’s an amazing man, an engineer and entrepreneur inventor.

Linda Kaplan Thaler (7m 5s):
He took me to his office and I was about seven years old. And I was so excited because I thought my dad was the boss of this. And I guess he was the boss of that particular group. And he walked over to his assistant. In those days, we call them secretaries or name was Betty. And he said, hi Betty, this is my daughter, Linda, would you like me to get you a cup of coffee? And Oh, she said, thanks. Marvin’s that would be great. And as they walked away, I said, but daddy, she works for you. Why are you getting her a cup of coffee? And he said, well, you don’t understand Linda is that the people who work, who help you, who assist you are the most valuable people in the company.

Linda Kaplan Thaler (7m 52s):
And I want to make sure that she’s very happy here. I don’t ever want her to leave. When I opened up my agency, the very, very first thing I did is I told our little staff of five people, the story about my dad, I don’t think he realized that what he did. He had such an imprint on this seven year old girl that he ever thought I was going to end up only a company that had a billion dollars in billings. And he was alive enough till 95 to see a lot of the success that we had. And I always thanked him for being the North star in terms of how to run a company, right?

Dr. Anthony Orsini (8m 30s):
We had so many people on this podcast, you know, Claude Silver of VaynerMedia, Ann Barr Thompson, Holly O’Driscoll and culture change and being nice is the hot topic right now saying that you work for your employees or employees don’t work for you. And I feel like that was all started back when you did this groundbreaking, crazy idea, that being nice actually makes you succeed.

Linda Kaplan Thaler (8m 54s):
At the time Robin Koval and I, she and I ran the company and written four books together. That was the founding principal at a, you know, in our agency. And that is why I believe this strongest reason that we became a in very short period of time, the fastest growing agency in the United States and considered one of the top 10 Nicest Places to Work in advertising. And people used to make fun of us and say, well, how can you be so productive? And when so many accounts and be so nice. And I said, ’cause the two worked together. And you know that there was a study that was done by Google a couple of years back called, it pays to be Nice and they tried to find out which of the teams and what each of the groups were the most productive in the company.

Linda Kaplan Thaler (9m 39s):
And they’re belief was it, it was going to be the group that had the smartest people, you know, the mensa IQ’s or the most talented people. And what they found was that the success of the group, in terms of profitability for the company, you know, ideation and all of that, were not people who are the smartest or the most talented they’re were the people that created what they called psychological safety. So in each group where they felt that psychological safety, that was the ability for people to throw out an idea, let them finish their sentence. That was a big deal that people were allowed sort of finish her sentences, that they were supportive, that people were not sort of talking at each other, but with each other, they go out for coffee later.

Linda Kaplan Thaler (10m 23s):
They, it was all of those things that made them much more productive. And actually research has shown that companies where there is a very nice and kind atmosphere have an average of one to 2% growth in the bottom line. So it really does pay to be a nice. Harry Truman had a wonderful quote he was considered probably one of the most unpretentious president of the United States. And he said, you can accomplish anything in your lifetime, as long as you’re willing to take credit for none of it. And it was a great philosophy because what we did is we were a creative advertising shop. You know, if I throw out an idea and you know, it just was stewing there and nobody was commenting and we’d talk and eventually somebody else would come up with the same idea.

Linda Kaplan Thaler (11m 11s):
And the first thing I would say as that it’s amazing what a great idea. And Robyn would say to me afterward, she said, but Linda, you had that idea 10 minutes earlier. I said, but you don’t understand Robin this guy Derrick now believes it’s his idea. He is going to work so hard. And so I tried to instill that and you know, in the Advertising culture, it can be very cutthroat. It was that post mad men era, or you have to eat your young in order to survive. And we found that it was actually much, much better for us that people would work longer hours. They would help each other because they know at the end of the day, they will get credit for it. When we won the Wendy’s account, it was a $200 million account.

Linda Kaplan Thaler (11m 51s):
And we were this tiny little agency and we were competing against dozens of shops. We did everything above and beyond because, you know, Robin and I had this philosophy, especially as women, you have to do things 10 times harder to get noticed. And the way we found out that we won the account was that they didn’t call us. But the guard who I can talk about with one of the wonderful garden who protected the whole building that we were in, said, there was a little girl here with braids and she’s wearing this outfit. Can she come up? And they said, yeah. And that was, you know, the Wendy’s mascot, right? That the thing that’s on the way, who is Dave, the founding father.

Linda Kaplan Thaler (12m 34s):
And that was his daughter, you know, Wendy and this is what she looked like when she was a little girl. Anyway, she comes hopping and skipping up and she reads this letter saying that we won it, but we want you to read this letter that comes from the owner’s. And the first thing I did was I knew that I didn’t want to be the one reading the letter. The first thing that I did is I said, why don’t we read a sentence at a time? And I gave it to somebody in the mail room department. He read the first sentence, the second sentence with somebody and the graphics department. And another was an assistant that we went all around till, you know, a lot of people have spoken and the clients said to us, you know, you work with a terrific, but honestly, there was other terrific work at other agencies, but we felt that you really understood Dave Thomas’s reason for being successful.

Linda Kaplan Thaler (13m 22s):
Then we call the Dave’s way. It was all about how you should treat employees with kindness and they will pass that on to the people that they are serving. And they say, and we made a bet that once that letter came, you will not read it yourself. You would pass it down. I said, really? He said, yeah, they had written down. I bet you that Linda is going to do that. And that is sort of part and parcel of the way the agency worked, making it a nice place to work and make people a lot more productive.

Dr. Anthony Orsini (13m 52s):
How did you know there was an, all the Italian Saying I’m from New Jersey at the time from New Jersey. I live in Orlando now, but there was an old Italian saying that the fish rots from the head down, I don’t know if you’ve ever heard that saying before. I don’t think it’s true by the way, but it is a saying. And so when you’re the leader and you’re creating that kind of environment, it’s infectious,

Linda Kaplan Thaler (14m 8s):
It is. And by the way, the fish smell is from the top down, it was the first piece of advice that my husband gave me with that as you do, they will do. Yeah. And so we had this attitude, which is, you know, everybody’s nice to people who can give them something, you know, a potential client of a boss that we had this philosophy that you need to do it for everybody. You know, that Saying how you do anything. It’s how you do everything. And it’s really true. And it is. So it has to be in your DNA that you treat everybody with respect. And one of the people that we adored was the guard for our building, whose name was Frank. And we were just one 10 and among, you know, hundreds of other people, we were a smaller company the time.

Linda Kaplan Thaler (14m 52s):
And we just loved Frank. And, you know, on days where it was cold we would bring them a hot tea. And he had been in the hospital once and people went to visit him and he just had this really great smile. And one day we were up for, against another agency for the U S Bank business. They were at the time, the fourth largest financial institution in the country. And what we didn’t know is that the CEO was going to make a surprise chemistry check. He liked our work. You liked another agency’s work. So it was down to us two, we want you to see how we, where our, when we were in on so to speak. So the first person that he sees of course is Frank.

Linda Kaplan Thaler (15m 32s):
And says Frank, can you tell me I’m here to see the Kaplan Thaler group what floor are they on? And Frank breaks out into this big smile. Now he has no idea. He was talking to the CEO of the fourth, largest financial institution of a country, but that we were up for this $40 million account. He says, Oh, I love these guys. They always have a friendly smile for me. You know, they bring the donuts. They always ask me how my family’s doing it. I was sick once they visited me in the hospital, he said, you are going to love these guys. Well, Richard Davis, who was the CEO at the time, he said, by the time I got to the 29th floor, where you guys work, you didn’t know this, but you had already won the business.

Linda Kaplan Thaler (16m 12s):
And I said, how did that happen? He said, because I thought if there are that nice to the security guard, I can only imagine how nice they are going to be to my staff. And ironically enough. So we won the stat day, this $40 million account. And yes, we gave Frank a bonus very much, but it is fascinating. That little things like that mean so much. Fortunately, our books did very well to continue to do well. And I was on the Martha Stewart. Show talking about the power of Nice at all of that. And unbeknownst to me, somebody was watching it. It was Barbara Walters’. And she said, I’m going to talk about this book on the view, which she did.

Linda Kaplan Thaler (16m 54s):
And it’s going around and talking about the book and Rosie O’Donnell said, you know, because I had this one thing in the book that said anything great has happened in your life. You can usually be drill down to something nice that you did for somebody’s. And Rosie O’Donnell said that had the epiphany on his show. And she said, I just realized when I was starting out, I auditioned for MTV to be a video DJ. And there were about 200 people who are auditioning. She said, I didn’t get it. But I wrote the producer that auditioned me a thank you note, for, you know, just accepting that I even would interview for it. You know, it was totally unknown.

Linda Kaplan Thaler (17m 35s):
Unbeknownst to me, he calls me back and he said of the 200 people that auditioned you are the only person that thought to write me a thank you note, so here’s what I am going to do. We’re starting this new station called VH1 and yours is the only tape that I’m sending over. And so she got her start in VH1 as a video DJ. She said all of the, because I wrote a thank you note to the guy for an MTV. That would be to give you an idea of how powerful it is. You know, one of our most fun accounts is the Aflac duck.

Dr. Anthony Orsini (18m 9s):
Yes, that’s my favorite. Yeah. the Aflac duck. That’s an amazing story. Yes

Linda Kaplan Thaler (18m 15s):
It came about because we believe in, you know, really having a sense of humor when your ideating so that when people laugh, they are much more open to ideas and it arouses all of this, you know, stuff inside of you and endorphins and you didn’t feel good. And so were kidding around and we could have remember the name of what we’re pitching. They only had a few percent and awareness. And I kept saying, it’s Aflac the name is Aflac. So after three weeks of this art, when our director said, say that again, and he pinched my nose, we’re a very informal companies. So you can pitch the CEO’s nose. And I went Aflac and he said, you know, apropos of nothing, you sound like a duck, quack, you know?

Linda Kaplan Thaler (18m 56s):
And the biggest problem that we’re having there was nobody can remember the name of the company. And he was laughing, thought it was a joke. And I’m like, you know what? It gives you an idea how brilliant you have to be to run an ad agency. By the name of a company. It could be a big thing. Anyway, we won it. And it was great. And, you know, and their stock divided like four times over. They made billions. But the thing that I am most happy about, and it really brings a tear to my eyes that Aflac is now. So well-known that when ducks see other Duck’s, they immediately think have supplemental insurance or something like, so we were winning.

Linda Kaplan Thaler (19m 37s):
It was doing well. And they said to Robin, you know what I’m trying to think about. Why do they call us in the first place they are in Columbus, Georgia. We are in Manhattan in a very small Agency at the time. So she’s just, I don’t know, call the owner. So I did. And he said, I said, I don’t know you as well. So I didn’t know before you, and he said, well, you know, you either, you said, but a very good friend of mine, we used to live in New York. And when I was looking for agencies to pitch, he said, you know, this very nice woman named Linda Kaplan took me out to lunch 10 years ago because I wanted some advice on Advertising.

Linda Kaplan Thaler (20m 17s):
I barely even remember, what are you in? Anyway, he said, I have been looking for a way to thank her. So she just started this company. Why don’t you just give her a call or at least put her on the list. And that is how we got to pitch the Aflac account, because they took somebody out to lunch 10 years earlier.

Dr. Anthony Orsini (20m 36s):
That’s a great story. And it goes back to what your mothers taught. You do the right thing and you know, do it right the first time. Be nice to people, treat other people like you want to be treated and things will, but you know, in medicine and I’m sure in business, we get caught up with starting to our outlook looks different. So as a physician, we become task-oriented and we forget to be nice. Or we forget that even though this might be our 35th patient for the day, that’s a patient has been waiting for an hour in the waiting room. And so that’s part of what I teach is to kind of, sometimes you have to remind yourself, but to create an atmosphere where people can remind the boss, I think is really important to, so we did this program in the hospital is called it’s all in the Delivery.

Dr. Anthony Orsini (21m 22s):
The same title is in my book and it teaches us doctors and nurses had a bond with patients reformed these trusting relationships quickly. But it also, it allows that everybody who does this program and the whole hospital basically signed the contract that says, if I’m doing something wrong, that I’m going to get rushed during the day. And I may not spend enough time with that patient. The housekeeper can go to the head of the whole hospital and say, Dr. Orsini it’s all in the delivery. It’s a nice way of saying that. It’s a nice way of saying and my aunt, I have to promise me that my response we’ll be. Thank you, Linda. And I forgot. I appreciate, but it’s all about creating an environment.

Dr. Anthony Orsini (22m 3s):
So one of the things that we keep talking about here is this is a program about communication. And one thing that keeps coming up and I’d love your opinion on this. So you create this great environment and there’s great leaders, as you mentioned, some leaders that workers will do anything for them. Why do you think it’s all about communication to be a good leader? Why do you think that it’s still, even with the big emphasis on culture change, it’s still a problem right now where leaders aren’t able to communicate and appreciate the security guard. You know, I’ll tell you a quick story. My last hospital, they worked for me. There was a gentleman there. His name was Michael and Michael was retiring. After 30 years, Michael was the housekeeper in the neonatal intensive care unit.

Dr. Anthony Orsini (22m 44s):
He had been there for like 20 years and Michael cleaned the units and we had a little party for him to show him how much we appreciated him. And when we thank them and he said, I should be thanking you because you’ve given me the opportunity to save lives. And I thought that was kind of odd, but in his mind, cleaning that crib and he’s absolutely right. He is saving lives because if he didn’t do a good job, the babies would get sick. So everybody’s important. So I guess this is a long-winded question of, do you think it’s a communication issues when leaders are not effective in the employees aren’t engaged?

Linda Kaplan Thaler (23m 19s):
Yeah. I think there’s a lot of things to blame, you know, trying to be nice in the age of mean, you know, it’s, it is very hard and we’ve seen leadership where people are not nice and I think part of it, there’s a lot of reasons. One is the media. We see reality shows that it’s so cutthroat what we’re watching, you know, even on the Apprentice and I was on the Apprentice several years ago, you are made to believe because it’s theatre, right. That, you know, the, the cutthroat they’ll do anything. And that’s what people, and, you know, to a certain extent, its, its like a blood sport, you know, its like I want to say, you know, if she is the, you know, Amorosa, you know, she’s the mean one and all of that and it’s theater, it’s not really how people behave.

Linda Kaplan Thaler (24m 6s):
Most people. And I have met many, many CEOs running an ad agency and the best ones like AG Lafley if a Procter and Gamble, he never said the word I ever in a speech, it was always We, who is like the quietest person in the room and yet brilliant leader. And so I think the media is to blame. And even if you look at books and the non-fiction category, there is a very extreme right or extreme left, I guess, most people in this country or extreme middle, but what sells books is very divisive kind of rhetoric. The other thing is that the incoming amount of data makes it so hard to even look at somebody’s right.

Linda Kaplan Thaler (24m 49s):
I mean, Microsoft did the study that blew my mind. The average attention span of human being is now eight seconds. And what makes this a milestone is that the average attention span of a goldfish is nine seconds. So you get to understand like how pathetic it is. And of course, how can you be nice when you are constantly, you know, all this data is coming in and it’s hitting these target in our brain, that dopamine centers. And when you’re a doctor, do you know better than me. And so it’s like, Pavlov we want more and more. We never satiated or constantly getting this.

Linda Kaplan Thaler (25m 30s):
I think in terms of messaging, the average person gets about five to 7,000 is above messages a day. And so like cook spaghetti, you know, what’s going to actually stick on the wall and how can I focus on you, Dr. Orsini when I’ve got all this other stuff flashing and then this other thing that’s happened with the virtual world, the world we live in, it creates what’s been called the absence presence. Not too sure if you’re familiar with that, but it’s the ability to physically be someplace, you know, you’re in a conference room, but you are virtually someplace else. And so it’s putting a stop gap on talking to somebody, you know, a stranger, you know, on a bus or a cab driver, you know, conversing, you know, with somebody who is in a new country there.

Linda Kaplan Thaler (26m 16s):
I mean all that stuff, the idea to make small talk. And we taught a lot about the book in making small talk becomes almost irrelevant. We’ve got to focus on what we’re doing. And yet what we learned is what are the most important things that you do before that PowerPoint presentation is the five minutes you have of small talk . And small is around for a reason, it’s around because evolutionary psychologist will tell you, it is the way that we break down barriers. Right? So I need you when I go, Oh you lived in New Jersey. Well, okay. I know what bridge I can take you to. I mean, we, we started right.

Linda Kaplan Thaler (26m 57s):
We actually interviewed, and we actually did a film on them. I think it was in our later book. The power of Small I’m not sure if it was in Why Little Things Make All the Difference Tacoma, Washington and are reminded of the story because you were talking about the guy who is cleaning the cribs, how you made them feel so, so important as he was. So in Tacoma, Washington, several years ago, there was a woman named Anne Marie, who would come in every day to get her cup of, I dunno, decaf latte or whatever it was. And Sandy was the barista. Now no one ever talked to Sandy. It was a very transactional relationship. You know, what do you want?

Linda Kaplan Thaler (27m 36s):
Here’s your change? Except Anne Marie will talk to her. They were about the same age they were in their mid fifties. She ask her how you do. And they didn’t even know what each other’s names, but they used to always have this friendly chit chat. Well, this went by for several months and one day Anna Marie walks in and Sandy can see that she’s been crying and she doesn’t look well, her face is ashen and she leans over and she says, are you okay? And the Anna Marie breaks into tears. And she said, you know, I feel comfortable telling you this, but I need a kidney. You know mine they are failing. And I’ve just found out that nobody in my family is a blood match.

Linda Kaplan Thaler (28m 19s):
So waiting for a donor and she’s crying. Then there’s a long line of people waiting to get their decaf latte and Sandy leans over. I always get chills when I think about this story and she puts her hand on top of Anne Marie’s and says, you know what honey, I’m going to get tested for. As luc would have it. She was a perfect blood match. And, and now they share besides sharing stories of their grandchildren. They have also, you know, shared a kidney. And her husband said to Sandy, if you make any more friends, just don’t give any more body parts of away If you don’t have to.

Linda Kaplan Thaler (28m 59s):
We invited them to New York, there I’ve never been to New York. Then we did it a little film with them, which is on YouTube, called the power of smalltalk. And I know we asked each of them to write a letter to each other. And so Sandy writes his letter when she reads it. And she was talking about how you save my life. If you did something that no one else can do. And you know, and Sandy reads her later and she said, you did more for me. You gave my life meaning. And a job that I thought was meaningless. You have made me feel so incredible about the power of what human beings can do for each other. And you know, every time I hear this story, I cry it’s so amazing the power of connections that we make or that we don’t make because we decide to not make small talk with a stranger.

Dr. Anthony Orsini (29m 50s):
Yeah. That’s a beautiful story. We are all about communication. And I know you do improv. In fact, you teach improv, right? Right.

Linda Kaplan Thaler (29m 59s):
I do. I don’t think I’m particularly great at improv, but you know, improv is a very connected to the business as you know, because I know that’s something that you worked with a lot because at the Yes and theory and improv, when somebody sets you’re a scene partner and somebody says your a two headed toad, no matter what you thought you were going to be, you thought you were going to be Abraham Lincoln, but now you’re a two headed toad. You have to go with it and expand on it. We did that a lot with our Agency where we didn’t allow people to say no. So if somebody threw out an idea, you’d have to Yes and it, and sort of improve on it and sometimes turn it around. And I always found that the best ideas were somebody who’s bad ideas that where they felt comfortable enough talking about it.

Linda Kaplan Thaler (30m 43s):
But it also improves listening skills. We don’t know how to listen to each other anymore. We process words faster than we talk. So when somebody is talking to us about half way through where already figuring out how we are going to answer them. And one of the things I talk about is we should more of us to just shut up and listen. We all want to feel like we’re Mensa graduates and want to fill the room with our wonderful information, right?

Dr. Anthony Orsini (31m 10s):
Yeah. It’s been said that we listened not to hear and we listened to respond. I think that’s a big issue.

Linda Kaplan Thaler (31m 17s):
Exactly.

Dr. Anthony Orsini (31m 17s):
Rabbi Kushner who I’m a big fan of it because I have read all of his books. He said, when you don’t know what to say, you say, you’re sorry, and then shut up. And I, I love that. I used that during my day, but improvisational wise, you know, I used that prov and teaching physicians and business leaders, how to communicate and how to use nonverbal language. And I’ve learned so much from the actors that I work with. And these are big time actors. And you know, some of them are local, but some of them are very accomplished and you learn a lot about communication and I’m guessing that’s that improv helped you because you’re obviously a fantastic communicator. So, so I want to move on though. God, I can talk to you for hours, but I want to move on. Because last time we spoke, you shared a personal story.

Dr. Anthony Orsini (31m 57s):
As we segue into healthcare and communication, and you shared a personal story with me about some difficult conversations that you had when you are sick. And if you don’t mind sharing that and we can kind of discuss the conversations that you had to endure.

Linda Kaplan Thaler (32m 13s):
Yeah. And I wrote about it and actually my first book ware at the age of 39 I hadn’t formed my company yet and my husband and I were trying to get pregnant. And it was five years of miscarriages and it was awful. And here I’m approaching that magic age where maybe with a biological clock is ticking. And so I found out that I had breast cancer and I was fortunate. You know, I pulled through my doctor who was a brilliant surgeon. He had operated on, my mother had also had breast cancer. And thankfully lived till the age of almost 95. Like my dad, he calls me to tell me that.

Linda Kaplan Thaler (32m 56s):
And I’m still at Sloan Kettering that the lymph nodes were normal. She had a mastectomy. And when he said, but I have something I have to tell you and bring your husband, what is it? Just bring your husband, you know, that sort of the woman isn’t going to understand or, you know, move the Han. And so he wouldn’t tell me, which was awful. And the next week we go see him and he tells me, don’t get pregnant. Why shouldn’t I get pregnant? I know you want to get pregnant, but here’s why you shouldn’t, you know, and do you have a hormone based cancer and who knows what’ll happen?

Linda Kaplan Thaler (33m 36s):
And he had no bedside manner at all. He wouldn’t explain anything to me. He wouldn’t give me any comforting advice. I finally had to go to my GP was an amazing, who sat with me for an hour with people. And we went in the waiting room and he had one of the best physicians in the country. He just retired. And he drew me pictures of what my particular cancer looked like and why you should feel good about what was done and how it was done. But to have a surgeon who was so short with me, even when I woke up from the, and he went, he didn’t think I was with the biopsy. It, it was going to be cancer.

Linda Kaplan Thaler (34m 16s):
And he just didn’t know. And I wake up out of it. And he says, you have cancer when you get operated on next week. That’s how I found out that I had cancer coming out of it. You know,

Dr. Anthony Orsini (34m 28s):
That’s a terrible, you know, as you and I spoke before and people will listen to this, he knows that this is what I do. ’cause most people will be surprised that there is no training on how to deliver tragic news. There’s no training on physicians on how to have difficult conversations, but it can be learned. And your doctor drew you pictures. But really, if you think about it, it wasn’t, the pictures of that made you feel better. It was his comforting tone and his mannerisms, correct?

Linda Kaplan Thaler (34m 57s):
Yeah. You know, he is the kind of guy I had this awful bout of pneumonia several years ago. And then it turned into this weird virus where it just didn’t go away. And it was just, I, it, it was horrible. And I walked into his office, John allegedly amazing guy, just an amazing guy. And he said, you know, you have this virus, blah, blah. I said, am I going to die? It makes my hand. And he says, Linda you are going to die. So if they’re not going to die, have this particular virus. So he said, my job is not stopping you from dying. It’s creating it to be a longterm procedure if you will. But you know, and it was the humor. And I have to tell you one amazing story that came out.

Linda Kaplan Thaler (35m 38s):
I did visit with Larry Norton, who, I’m not sure if you’re familiar with him, but he’s one of the top breast cancer oncologist in the country. And he was at Sloan-Kettering and he was the one who finally, after my doctor said, I shouldn’t try to get pregnant. He said, it’s okay. And he told me why it was okay. And so he gave me that green light and I said, thank you. And he said, no, I want to thank you because I don’t usually get to give good news. The answer is going on. Right? So fast forward, eight years, I now have my son, Michael, I have two children and Michael, you know, the one Dr. Frank told me not to have became the kindergarten champion of chess in the United States.

Linda Kaplan Thaler (36m 22s):
They wrote a book about him and he just graduated from Harvard with a a degree in Economics I mean, he’s amazing, our daughter is a musician, but anyway, I knew that Larry Norton was going to speak at this lunch, in this fundraising lunch. And, and I said to the woman running it, can you please have me be the first person to raise my hand? If people want to ask the question or whatever, he said, why he said, I’ll tell you why. So raised my hand. I said, Dr Fracchia you probably will remember me. And then I told him the story, that what he had said to me as I left, I said, thank you. And he said, you know what, thank you. That the way you can thank me and send me a picture of your child when he or she is born.

Dr. Anthony Orsini (37m 6s):
Yes, absolutely. I agree with that. Right.

Linda Kaplan Thaler (37m 8s):
So as I am, so, as we were going through this and he says to me, Oh yeah, I remember it. And he said, well, where’s the picture. I was, well, first of all, I have to pictures of a son and a daughter. But today I want to, before I came here, I said to Michael, and he was like eight years old at a time. I said, I want to tell you about a man that made it possible for you to be here today. And he decided to autograph the book. They wrote a book about it when he was seven. And so I gave Dr. Norton a book. He was in tears. And he said, thank you for reminding me once again, why I do what I do. And I heard later that they raised a lot of money if the lunch, and that was good.

Linda Kaplan Thaler (37m 51s):
You know, they raised a lot of money for breast cancer research,

Dr. Anthony Orsini (37m 54s):
But it’s such an impact in medicine on how you deliver that news, whether it’s good or bad news. And it’s all about relationships. And I always make it clear that I do truly believe that every doctor and nurse is compassionate, but that we are not taught. And sometimes we forget that it’s a human being on the other side. ’cause we get task-oriented. I wish there were a nurse behind that Dr. who tapped them on the shoulder and said, Dr it’s all in the delivery. Maybe he would have said, let me try again.

Linda Kaplan Thaler (38m 25s):
My father was an amazing man. He had a heart attack when he was 55. And again, he had one of these doctors that didn’t have any bedside manner. And my father woke, he told me the story years later, because he was embarrassed to tell at the time. And he was a very, you know, brave kind of guy and serious or whatever. And he said, Linda when I woke up after the surgery, I started to cry, really cry. And this Jamaican nurse took me in her arms. My father did not have a good childhood. He did not have good parents. He said, she took me in her arms and she said, Mr. Kaplan is going to be okay, but you can cry as long as you want.

Linda Kaplan Thaler (39m 8s):
And he said it was the most important part of my recovery of this to make a nurse telling me it was going to be okay,

Dr. Anthony Orsini (39m 16s):
What was circling right back to the power of Nice aren’t We for those of you who haven’t listened to every one of these episodes, I interviewed an amazing man called Marcus Engel, that he was one of the first podcasts people that I interviewed. And I’ll share with you his story very quickly. So Marcus was 19 years old and he and his friends are on their way to a hockey game when they got T-boned and his three friends died immediately. Mark has had multiple injuries, including the immediate blindness, and Marcus was barely hanging on and he found himself, he woke up and the trauma bay, there are people putting chest tubes in him and he can’t see so 19 years old, he’s so afraid. He has no idea what happened.

Dr. Anthony Orsini (39m 57s):
And there was someone who came over to him, he grabbed his hand and said, Marcus, I’m here. In fact, that’s the name of Marcus’s book I’m here. And he didn’t know who that was. He didn’t even know if he hallucinated it. But all I knew is that it made him feel better. Well, Marcus forgive me if I’m getting this wrong. But I think it was 20 years later, Marcus Now teaches patient experience. And he goes around hospital’s you have professor at Notre Dame. It, he goes on in hospitals, teaching people what its like to be a, a patient. He was giving a lecture at that hospital about patient experience and the chief of the hospital’s so that I have a surprise for you. And there was the woman who was, and she came out, it turns out that she was not a nurse.

Dr. Anthony Orsini (40m 41s):
She was a tech. And so that person who went to school and his now talking about giving good karma, she is now a chief of nursing. And so what a great story. And I think it all circles back to your book, the power of Nice that little bit extra that your doctor does for you or that your boss does for you is just amazing. So in finishing up, I want to ask you to just one more question. So what advice, because I have to give some valuable advice to get advice from Linda. I mean, this, this is awesome. What advice do you have to anyone, whether you are a boss, a leader or a CEO let’s talk about CEO is your head of your own company and you need to be a better leader to get people rally around you.

Dr. Anthony Orsini (41m 21s):
I know being nice. Any communication device that you would say, this is what you need to do to be successful.

Linda Kaplan Thaler (41m 27s):
You know, it was interesting when I sold my company, they merged with this other company that had very bad culture and I’m a big believer because one of our other books is at the power of small Why Little Things Make All the Difference is, you know, they were a nation that looks, you know, that forest for the trees. And I always say now the most important thing as the leaf, you know, it’s the leaf that makes it ends up being the forest, right? So I am, I don’t mean a micromanager in a bad way, but so important on small things. And when I was leaving the company that I had sold, and there was a person who was taking over as CEO, who was a bad culture, that she was fostering and she said, what am I doing wrong?

Linda Kaplan Thaler (42m 7s):
Before you leave just tell me what I can do. I said, well, you can start by answering the emails that people are sending you. People would send me at the time before I actually left. You know, we are at the time, at this time, there were 800 people in the company and you know, somebody would email that they had a good meeting at Proctor and gamble and I will be on the CC list as well as this other woman. And as well as the other C-suite people, you know, at the agency. And I would always, I didn’t care if I was CC’d I would go back and I said, great, you’ve got a car. That’s fantastic. Or if I can walk by the office, I was stopped by it. I would say, that’s a fantastic, if there was a good test score, we worked on a tremendous amount of pharmaceutical drugs.

Linda Kaplan Thaler (42m 52s):
You name it, we worked on it. So as you know, to go through trials takes years. So if you had a good test scores and it would always answered them and people would always answer me back and say, you realize you’re the only person of the managers that ever e-mails us back. And so there’s woman said to me, Oh, but I am busy. And I said, Oh no. I said, Michael Dell answers 800 emails a day. And he’s a very busy person. I say that Michael Bloomberg has given out his personal phone number. I said, you can’t be busier than you are them. And I said, it, it takes about five seconds to actually say glad you had a great meeting. So my advice to people is always start with really small things.

Linda Kaplan Thaler (43m 33s):
I would always get anybody in the company and find out when their birthday is, I put it on my calendar and I wish them happy birthday. And they will, or they couldn’t believe the CEO remember their birthday or it was such a small thing. But it’s what builds up a groundswell of how you behave. Now, I’m happy to say there’s so many people in our company from years ago have their own companies. And they always say, we teach the methods that you and Robin taught and we’re trying to continue doing that. And so that makes me feel incredible because you create a fertile universe, right? You create your universe and the more positive imprints or like seeds, they come out, they’re going to grow in ways you can’t imagine.

Linda Kaplan Thaler (44m 21s):
And you probably won’t even know about them for 10 or 20 or 30 years, but they will grow. So I always tell, especially young people, don’t worry about networking, call it, Nice working, figure out how many people you can do or say something nice to. And those flowers will bloom

Dr. Anthony Orsini (44m 41s):
Great advice. So B the head of the fish, if you are a good head of a fish, everybody will thrive. Thank you.

Linda Kaplan Thaler (44m 48s):
The problem is though, I only eat it filleted so I don’t get to see the head.

Dr. Anthony Orsini (44m 53s):
Every week I promised my audience two things that they’ll be inspired and that they will learn valuable and communication techniques. And I certainly have done that this week. You are amazing. I wanted to talk to you about Great the Great. So maybe I’ll put you on the spot and get you to come back on to talk about that another time.

Linda Kaplan Thaler (45m 11s):
I would be delighted to you, our one of the best interviewers. And I’m so happy for the work you do, because I know it’s imprinting on so many thousands of people. So,

Dr. Anthony Orsini (45m 22s):
But he heard that she agreed to come back on. So this is the first time I’ve ever offered that.

Linda Kaplan Thaler (45m 26s):
Oh, and by the way, I am fine. If anybody wants to communicate with me is just Linda Kaplan prod P or pro D like Productions gmail.com or are you can visit my website. Kaplan Thaler Productions and just maybe something will spark your interest.

Dr. Anthony Orsini (45m 43s):
Linda will put all that stuff on the show notes. If he enjoyed this podcast, please go and hit, subscribed, and download all of the previous episodes. And if you need to get in touch with me, I am at the Orsini Way.Com, but you can email me directly at Dr. Orsini at the Orsini Way. Com. Thank you Linda.

Linda Kaplan Thaler (45m 58s):
Have a great day everybody. And thank you again for interviewing me. It was my pleasure.

Announcer (46m 3s):
If you enjoyed this podcast, please hit the subscribe button and leave a comment. If you contact Dr. Orsini and his team, or do you suggest guests for a future podcast, visit us at the Orsini Way.com.

Difficult Conversations in the NICU with Dr. Vita Boyar

Dr. Vita Boyar (2s):
I think as a novice people are often afraid to admit that something went wrong. We gave the wrong medicine, or you gave the wrong breastmilk the IV extravasation happened and the baby has a wound. Now I think they have to be able to acknowledge this has happened. And you can say, I’m sorry that this has happened to the child. People are afraid to say, I’m sorry, I’m sorry that you as a parent are going through the angst of being worried about this process. Saying sorry is not accepting the blame, saying sorry is not saying that something is wrong. To me saying sorry and acknowledging that they are worried about it is being on the same level with them, making them feel as a part of a team and have knowledge of what they’re going to do is valid.

Announcer (47s):
Welcome to Difficult Conversations: Lessons I learned as an ICU physician with Dr Anthony Orsini. Dr. Orsini is a practicing physician and president and CEO of The Orsini Way. As a frequent keynote speaker and author, Dr Orsini has been training healthcare professionals and business leaders how to navigate through the most difficult dialogues. Each week you will hear inspiring interviews with experts in their field who tell their story and provide practical advice on how to effectively communicate. Whether you are a doctor faced with giving a patient bad news, a business leader who wants to get the most out of his or her team members or someone who just wants to learn to communicate better this is the podcast for you.

Dr. Anthony Orsini (1m 32s):
This episode is being sponsored by Veritus. Veritus offers virtual alcohol, drugs, and trauma treatment programs exclusively for licensed medical professionals. Their programs provide a concierge level of care consisting of evidence-based clinical treatment, and they are customized to meet the unique needs and challenges of physicians, dentists, pharmacists and nurses struggling with substance abuse. Their virtual confidential platform provides a safety and security medical professionals need to get help while continuing to work. Confidential, convenient, and compassionate, Veritus brings world-class treatment to your home or office. Beginning of March 9th, Veritus will be launching a free CME substance abuse webinar series for the medical community.

Dr. Anthony Orsini (2m 16s):
This CME webinar series will bring together experts for a panel discussions. What the future has in store in a post COVID world helping physicians who are struggling with substance abuse. This is an event that you do not want to miss. You can register for this free CME webinars at www.Veritussolutions.com. Today, I want to introduce to you or another amazing guest today. I had the honor to introduce you to Dr. Vita Boyar. Dr. Vita Boyar and Assistant Professor of Pediatrics at Zucker School of Medicine at Hofstra University She is a board certified Neonatologist Associate Medical Director of the Neonatal Intensive Care Unit and is a certified wound specialist physician practicing both neonatology and wound care at Cohen’s children’s medical center of New York Northwell health hospital system.

Dr. Anthony Orsini (3m 9s):
Dr. Boyer is the only Wound Certified Neonatologist in the country and develop Northwell Neonatal Wound service. The only one of its kind in the area. Her work with neonatal and wound products has been featured on Good Morning America published in various journals and has received awards and honors. Her teaching style and dedication to compassionate care led her to her nomination and completion of the humanistic mentoring fellowship program at the Zucker school of medicine at Hofstra and in 2018, she was honored with Queens Ambassador award for exceptional contribution to the community and the professional field. Born in Eastern Europe she came to us during our high school careers, and that attended college in North Carolina.

Dr. Anthony Orsini (3m 50s):
She’s stayed in North Carolina, graduated medical school at the prestigious University of North Carolina Chapel Hill and then she made her way to New York where she completed her a pediatric residency and fellowship. Dr. Vita Boyar is a reviewer for various medical journals. She is a member of the society for pediatric research and has published extensively in various medical journals herself. Well welcome, Dr. Boyar and we’re so honored to have you here. I think you and I met, I think, a lot about a month or two ago through LinkedIn, I believe correct?

Dr. Vita Boyar (4m 20s):
Yes Tony. Well, first of all, thank you for the kind introduction we have met and it was Linkedin actually, and I came across your podcast by actually looking into the one of my previous colleagues from the pediatric residency that you have interviewed as well. And I was just really at the discussion that you had and they reached out to you and I just wanted to say, Hey, I said this is so great and this is so useful for other people to hear and different aspects of what a difficult conversation might have been a medical and personal life.

Dr. Anthony Orsini (4m 50s):
You know, we had that conversation, we had a quick call and you and I had such a flow of conversation, which happens, you know, every now and then when we have a lot of common, both be in Neonatologist. But then we started talking about my favorite topic Difficult Conversations and I knew right away that you would be a great guest on our podcast. So I kind of grabbed you right there and said, please come on in. And you were gracious enough with your time. So I wanna thank you again. And we’re going to discuss all of that. You know what I make two promises to my audience in every week in that is one to be inspired and two, to learn something about how to have difficult conversations. And we’re going to talk about both of those things and I’m sure I’ll keep my promise today. But first I usually like to start out with just getting the audience to know about you.

Dr. Anthony Orsini (5m 36s):
So who is Vita Boyar. Do you have an incredible story coming from Eastern Europe and how you ended up in New York, long Island? Correct. And so I just want them to find out who the Vita Boyar is it, tell us a little about your professional and what excites you. And I also noticed too, that you have some very cool hobbies and call yourself at adventure junkie, but tell me all about Vita.

Dr. Vita Boyar (5m 56s):
Sure I see from the professional stand point, as you said it, I practice neonatology in long Island, outside of New York at the level four neonatal intensive care unit. And I think that was my first professional passion. You know, as I went through my pediatrics residency, I always knew I wanted to work with children. And my first year that I realized the taking care of the premature and vulnerable babies, having an approach to the patient as a whole and not just ne organ, is important and also a thrill and the excitement of seeing them do better having an inability, to do procedures, collaborate different sub-specialties is what made me wanna be a neonatologist.

Dr. Vita Boyar (6m 38s):
So I think first and foremost, I identify as that. I enjoy teaching, I enjoy a collaboration and this is why I’ve stayed for all of these years in our institutions. It’s an academic institution. They have fellows, we have residents. So in a big part of my day is not just clinical care is actually teaching the residents how to interact with patients, teaching them how we can talk to parents, collaborating this consulting physicians. You want me to think, I identify myself from the professional and point as a Wound Physician as well. This passion came early in my career as a Neonatologist. My early interest were in respiratory care and respiratory kids, and then realized that a lot of our, neonatal babies have very fragile skin and many had skin injures and all of them had surgeries and nothing could have been done, but others were caused by us by the hospital, the equipment by taking care of the really fragile premature or a tiny babies, actually statistic’s is very important to know about 30- 40% of small kids in the NICU have injuries and about 8% of them left as a scar.

Dr. Vita Boyar (7m 46s):
And so when I started this, I realized that I would look around and ask my colleagues, how do I treat this? So how do I enhance this more out there? How do I help these to heal faster? Let’s say, or a baby who is 500 grams in twenty-four weeks. They’ve had a really good answers at that time. And so I think I’m a curious person. And I think I like the challenge. As soon as the beginning of a challenge, I want you to just figure it out for myself. I thought there would be a better way to approach this. And even if there wasn’t a better way to have to know what’s out there, what needs to be developed, what needs to be taught. Then I decided to certify in the adult specialty and I reached out around the country and asked multiple nurses and other physicians help me tell me, is there a guidelines?

Dr. Vita Boyar (8m 30s):
Is there something you could share? And unfortunately there was no who was interested in sharing this. And so I proceeded was doing my clinical and academic and going through the specialty and became the first. And so it was the only one that I think I was the first wound certified Neonatologist in the country and went on to build our own neonatal wound service, as well as seeing too many pediatric patients throughout our hospital. So I think professionally, this is my second and ongoing passion. I combine both neonatology and wound care and that’s really, it has been a great ride. Personally. I am a mom, I would say. And what I liked to do, one of my hobbies, I guess, one of my greatest joys in life is to travel myself, but it was my kid’s.

Dr. Vita Boyar (9m 16s):
And I actually often combine my professional and personal interest in, in this unique field. And I have been lucky enough to be invited to travel to different countries, to present at different conferences and help in difference NICUS, how to build a skin teams and then at the same time in taking opportunity to take my kids with me. As a neonatologist you are very busy, it’s a lot of call, it’s a lot of work and it’s often very difficult to find a balance as a mom and as a professional. And so that’s sort of, what does the two combined.

Dr. Anthony Orsini (9m 48s):
So you describe yourself at one point I heard you say you were an adventure junkie. What does that mean? Where do you like to do? I know you’re a football mom and you played tennis. My family all played football. So we had that in common, but when you say adventure junkie, what do you like to do?

Dr. Vita Boyar (10m 6s):
Well, we traveled, if you find interesting activities, is that some of them, but I would say in my own personal adventure, it doesn’t necessarily go well, you know, and I sort of dragged my kids. And as sometimes we swim is the shark’s and, you know, I’d tell my family later if we had done that. And when we traveled to Australia, find their highest Sydney bridge, just walking on the edge of it. And I have flying the the highest Alaska mountain on the glacier. And it seems like that, you know, it wasn’t too extreme, but at the same time, interesting thing to do.

Dr. Anthony Orsini (10m 39s):
That’s great. And we have to have that work life balance, which is so hard. Most people might not know this with listening, but neonatologists are different. We’d like to small challenges. That’s why you think we picked the little babies and we tend to be into an adventure. Also, your story struck me as you were talking about it, when you are trying to find some information about wound care and didn’t find any, it really paralleled what happened to me when I was in a Neonatal fellow and I was seeking help for people to tell me how to have difficult conversations. And I was asking people, please tell me how to tell a mother that their baby suffered severe brain injury.

Dr. Anthony Orsini (11m 19s):
And the answers that I got mostly where, well, this is how I do it, but I don’t know if that’s right. I was told things like, just say it faster and get it over with really bad advice. And then I did a very similar to what you did. I looked through the literature have found nothing. That was just like you, I had to seek it out. And in my instance, it was just interviewing parents and family members who have heard bad news. So I certainly identify with that. And you’re a trailblazer. And then you’re right. I do find that there are a lot of skin problems in the NICU and having as somebody who is a Neonatologist that can do that is awesome. This episode is about Difficult Conversations. I want to move over to that. And you and I had discussions about you’re also the director of the NICU and in our neonatal intensive care unit, for those people in the audience who are not in Medicine, there are babies that are born very prematurely around one lb, and they sometimes spend over a hundred days in the NICU and even more so not many, but some of those babies go home on ventilators and tracheostomies.

Dr. Anthony Orsini (12m 22s):
And those can be the most difficult conversations I think, to have with a family other than your baby’s dying or passing away, but they are very hard to navigate. You and I talked a little bit about this, but how do you navigate through that conversation that you need to speak to the mother with was we call it a family meeting and try to navigate through that. This is what’s the realistic aspect of what’s going on, and baby might need to go home on a ventilator, et cetera. Tell us how you do that and give us some advice. If you don’t mind.

Dr. Vita Boyar (12m 55s):
I think this is one of the most difficult part of the NICU. You can sort of have this conversation that doesn’t happen abruptly, but then you can have this prolonged States. In a bunch of babies you can have somebody who is about eight months old, who is now in our unit, going to digress for it, like 30 seconds. I don’t remember one time watching the lecture, a psychology teacher who raised a glass or above her head, sort of held him for a while in that students how heavy it is. And the students throw in, you know, five ozs or three ozs is sort of now and then she said, yes, that’s true, but it’s not about that. About the perception. If you hold it for a minute, this is not heavy. If you hold it for an hour or you can sort of hurts, if you hold that for a day, you’ll want to drop it because you are in pain.

Dr. Vita Boyar (13m 35s):
If you hold it up in a longer, it becomes a constant in your life that you will never be able to move on and do anything else until you resolve how to do this? This is babies who are in a NICU for a long time. This baby is chronic lung. It’s like that. It’s a good parallel lives. If you’re in a NICU for a week and its tough, you can manage it. If you are in the NICU for a month and you still see that life in the end of the tunnel? And if you are there for so many months and you have so many ups and downs, this is when it gets emotional. And so hard and so draining. And so the way that we should speak to you, the families, it should be based on that. If you have to understand that they are there for a long haul, it’s not a sprint, it’s an marathon.

Dr. Vita Boyar (14m 20s):
And so I think initially when you start your conversation, you build the rapport as a Physician, as a scientist, you’re tell them what the baby has. This is what it will be going on. But at the time passed us. I think you have to step out of being in this physician. You have to put yourself in a situation of relating on a personal level. You have to relate and then you have to somehow connect. And that is a perception of you as the human being by the parents is what’s going to help you. You too have a successful conversations. I guess they call it. I think there was a bunch of tactical empathy. Empathy is not feeling sorry for somebody it is being able to understand the person who are sitting across from you.

Dr. Vita Boyar (15m 2s):
You find yourself in that person’s shoes and not seeing what they think is right or wrong, but trying to understand what is it that is important to them? How are they feel about some of them and what is it that you can do to help? So when I have this conversation, because these families and it happens more than once, that’s what I do I try to sort of update them. This is where we are. And then explain that this is what’s happening to the child, this is what they are faced with and this is what might be a potential outcome. Then you have to move on and you have to see where do you stand as a parent? Do you understand what they are telling you? What might come from this?

Dr. Vita Boyar (15m 42s):
And what would you like to see? What are you hoping for? You have to hear their side as well. But as far as the basic advice, I think a lot of the newly practiced, Physician have a fear of having a difficult conversation there afraid that the parent’s might be angry and often they are. They are afraid that showing any emotion is not the right thing to do, which is often not taught in medical schools. So there’s a lot of mnemonics actually I think are out there. What they can help you. And I guess if you, important points to talk about is setting. You want to make sure that you speak to as a family and say, I would like to have a meeting with you. What is a good time for you to come? Is there a family member is that they can come and support you in this time.

Dr. Vita Boyar (16m 22s):
And so we usually try and set a time aside in the common areas is the family member or maybe the social work, at least in my practice. Usually they have support that it’s calm it’s quieter. My phone is off. We sit down and we can have a face-to-face conversation where nobody feels that they are being hurried. And you would just sort of on this side of the conversation, it’s a conversation have to be determined. They have to be in as a purpose. And then I think you have to put it in perspective while you are here. You have to send the stage. And that usually like to give it a little bit of an overview, which has happened today or what has happened in the last week. And this is where the challenges are. And if the patient is not doing well and we train, you have our babies who have chronic lung disease, or maybe the neurologic problems, you tell them what are you doing and what the outcomes are.

Dr. Vita Boyar (17m 11s):
And if things are not great, you can say, Oh, I wish there was a feeling better. I wish we could go off on a ventilator settings, but you are still trying to do a everything we can, then you ask the parents to have their turn to summarize. What does they understand? What are they hoping for? What are they wishin for, is there something that we can do for them? Because over many months they are part of the story as much as a child,

Dr. Anthony Orsini (17m 37s):
Right? I think that’s really important. And there are different acronyms out there in my book, it’s on the Delivery I’ve developed an acronym called Program the take home points of what you just said. It is so important. It is about active listening. I’ve trained thousands of thousands of doctors on how to break bad news. We do videotape improvisational role playing. And when I review their tape with them, I’ll ask them, what was your main goal in this conversation? And the most common answer is give information. And I kind of just have heartedly and kind of jokingly say there, why didn’t you just handle it or a piece of paper? And the young doctors will just realize that it’s not about information. It’s about what you had said.

Dr. Anthony Orsini (18m 17s):
It is about forming that bond with them and listening to what you were describing. So well, it was really what people call active listening. Right? And, and I think sometimes we don’t do that. The other thing that I thought that was great, that you mentioned was about this being a marathon and in the NICU it gets to you, right? I love that, that example of holding the glass up. So there’s parents that come in that are the sweetest loving parents and they are just being frustrated. I mean, they maybe had a little bit of setback and we have to do as a group, even though we’re tired. And we were working really fast trying to put ourselves in their shoes and saying, okay, so they yell at, and they act it a little irrationally, but you don’t blame them.

Dr. Anthony Orsini (19m 1s):
That glass is getting awfully heavy. Right. So I think that’s really, really great advice for them. And then there’s also a medical error advice, but I just thought of it because some of the problem’s in the NICU, which you talked about for wound care, as you mentioned, very clearly, some of those are <inaudible> as we say, or they come from the treatment. So I, the infiltrations people in their art in medicine, or NICU the IV catheters we put in these babies are often bigger than their veins. And so sometimes they get infiltrates in wound care and that could be the source of a lot of anger. And it sounds like you’re the one often that has to discuss with the parents, that there may be, may have a scar and you’re doing it.

Dr. Anthony Orsini (19m 42s):
And so any different or a different advice you can give when you’re discussing something that went wrong, because things do go wrong in Medicine.

Dr. Vita Boyar (19m 51s):
I think as a novice people are often afraid to admit that something went wrong, gave a wrong Medicine you gave the wrong breast milk. Did it happen? And the baby has a wound. Now think we have to be able to acknowledge that this has happened. And you can say, I’m sorry that this has happened tothe child. People who are afraid to say, I’m sorry, I’m sorry that you are as a parent going through the angst of being worried about this process saying sorry, it is not accepting the blame. Saying sorry is not saying that I did anything wrong, to me saying sorry is acknowledging that they are worried about it. It Is being on the same level with them, making them feel as a part of a team and acknowledge that what they’re going through is valid.

Dr. Vita Boyar (20m 32s):
And then you have to say what happened in a simple way. Most of our families who are not medical people and explain what does it been willing to do about this? This is what happens when they transition occurs. And this is a treatment and I going to start on a new baby and I’m going to do to make sure that the skin heals well. So that’s one example is simple. The one, but I think are really angry, often brushing injuries from devices or a surgical wounds that this test is often a list. If you have to stop away from the anger and you have to allow them to, then as I say, I hear that you are saying, I understand that is how you feel. And I wish that it didn’t happen but it did.

Dr. Vita Boyar (21m 16s):
And we are going to do everything we can to make them feel better. So I think acknowledgement and connecting to the patient on this case as a parent on a personal level as well. I think it’s not specifically the actual, so this is more of a as the chronic lung kid or a piece for it in the NICU for different reasons. I’ll give you an example. Just recently I had the families was there. They admitted to the NICU. The baby was in the chronic facility on oxygen therapy and has failed us and needed to have a tracheostomy done. The tracheostomy had a really tough recovery for the week after. And mom and grandma came just really, really angry at the hospital and we will do this and this, and this is just very, very angry at this has happened to the child and we sat in a quiet room.

Dr. Vita Boyar (22m 3s):
And they told them what happened. And then on top of this the baby had an externalization. And Mom said, and now because of this the baby has an infection in her foot, and I said no the baby doesn’t have an infection they have a very fragile veins. From the grandmother who’s actually the dominant figure in this family said, Oh yeah, I have really fragile veins. Anytime I have to go for a blood draw they have to poke at me so many times I have bruises and they say, Oh, you know what me too. And it happens to me all the time and it’s, you know, about, so this happened to my son. He fainted once and the rest, and we’ve talked about something else with a personal level. But at the moment I did this, her angry attitude, subsided and her warrior face softened, and we sort of connected to human interaction levels to blame anymore for somebody who understood what she was going through.

Dr. Vita Boyar (22m 54s):
So if you can do that as well as acknowledge and understand what happened and that you are going to try and make it better. So it was as the two key points in the interaction.

Dr. Anthony Orsini (23m 3s):
That’s fantastic advice in, in my book, it’s all in the delivery. I will go through the acronym Program for breaking bad news and also for a patient experience. And when we discuss conflict resolution, which is what you’re speaking about, the G in Program is genuine. And so many times I’m put in a situation or maybe because that’s what I do, or I enjoy it where it’s Dr. Orsini, I’m glad you’re here we have an angry parent and being a genuine person and saying, and you relate it to that grandmother. You said, my son has it too. I have it too. All of a sudden, you weren’t this Dr. Vita Boyar. You were Dr. Vita Boyar, who also is a real person and right away and people in general, I can’t tell you how many times I speak to the risk managers about medical errors.

Dr. Anthony Orsini (23m 48s):
And I’ve done some training at other hospitals about how to talk about medical errors and right now medicine is still far behind business in communication. And, and so there was a medical error and all of a sudden the risk manager wants to come in to the room with you two attorney’s the charge nurse and you are walking in there with five people. And all of a sudden, the mother of the patient is looking at you and they are going something’s really wrong. They are trying to hide something. Why are all these people here? When the best thing that you’ve said is have the doctor go in and say that they’re sorry that this happened. And the patients want to know that your doing whatever you can do to help that and to prevent it from happening again. And the American bar association made a statement 10 years ago, that if you feel a relationship with your doctor, you’re unlikely to Sue even if prompted to do so.

Dr. Anthony Orsini (24m 36s):
So even if a lawyer says, Hey, Tony, I think you should go sue the doctor, I would say, no, I really liked Dr. Boyar. I’m not doing that to her. It was an accident. And then it happened. And so it’s the right thing to do. And this is why I love communication so much. I mean, you could really change the outcome of that. Look how much you made that grandmother feel better instantly. Oh almost like a premature baby is like me we both have fragile veins and I get it. And so that was, I really think that’s awesome. So let’s keep moving on to God, there’s so many difficult conversations that we have. So now you’re such a great communicator. You are teaching the students, the medical students, the residents, it’s still not taught in medical school.

Dr. Anthony Orsini (25m 22s):
Very little is taught about communication. So how do you help? Do you bring them in a medical students? And I’ve said in other episodes before, sometimes I’ll ask the resident, did you call the mother? And then I’ll throw them off by saying, what did you say? And then they go, well, what, what, what do you do? And I said, I want you to know what you’ve said and So, or I’ll say, Oh, go ahead and talk with the mother. And I’ll stand at the back end. I’ll go, well, you didn’t sit down and you didn’t, you know, there was a lot, he didn’t do how much time do you spend going over communication with your residents and for other physicians who want to help them learn better? Communication, what’s your advice.

Dr. Vita Boyar (25m 56s):
So you think you have to balance the fact that you’ve been worked on people and you’re in the room and you give them some of the bad news. Sometimes I have done that. And specifically, when I came on the team, when we have residents, fellows and parents are often there and they try to update them, do an hour of clinical rounds. And so what I have found is sometimes they would tell the residents and sort of on this side and I pull up a chair and they sit next to their parents and they are there in the room. So it was like, you can observe, but they were really not visiting the active conversation, but then having the parents and they have this active conversation with his mom or Dad or both, and I asked them, I said, I would like to give you a update, how baby X is doing.

Dr. Vita Boyar (26m 38s):
We would now be a good time and you can use it now. And I think sometimes the best way to teach somebody how to do something well is to show it to them. With the residents and fellows, how to be empathetic, shows them how to deliver bad news, how to react to potentially a volatile or crying reaction. And hopefully as they can learn and get them to step out of the rooms, I will talk to them soon, too often, before we go into the room, I say, well, if a parent asked them, what would you say? And you have to understand your medical facts first and foremost, because we are in there as a physician, then you’d have to be prepared that you have to do our due diligence and all this.

Dr. Vita Boyar (27m 18s):
I always talk about it. Don’t go into the room saying, Oh, let me get this. You know, Donny is a, not so much. Sure. You have to know. So always be prepared, but finding an appropriate settings, make sure that you understand his parents’ perception. That’s really, really important. The other thing that we pay a lot of attention to is attention to, is it’s important what you say, but it’s important how you say it. And it’s in the body language. As well. Remember, years ago, I heard a lecture by actually an FBI person who usually does a negotiation and he said, it Seven three 65 rules. People pay attention, 70% of what you said, 35% to how you deliver and 55% from your body language.

Dr. Vita Boyar (27m 58s):
So it’s important what you to say it, but how are you saying that could mean you have totally different meanings. If you are a sarcastic, if you are not genuine, if you go to them, if you hide, tell them exactly the same sentence in some totally different somebody’s. If you look an interested in, if you have your phone next to you, when you’re looking to the side, while you were given this bad news, does the family, they want to know you’re not genuine and you really don’t care when you just stay to give you the news and stuff like that. That’s one of the big points that I want my fellows to understand, you really have to be present. And as you said, active listening, but also active engagement in the conversation.

Dr. Anthony Orsini (28m 33s):
In my book, that’s why I called my book “It’s all on the Delivery” because exactly what you say it’s not what you say it’s how you say it. If you’re listening to this podcast, go back to my podcasts listen to the interview with Dr. Helen Riess. Helen Riess, is really the world expert on empathy. And we had a great conversation. Previously. She wrote a book called the “Empathy Effect” and how it affects us in every aspect of our lives, both their professional and our personal lives. And so this is Difficult Conversations. And so one of the things that I do when I try to train healthcare professionals, and now I’m going into businesses now, because it’s the same communication techniques that help managers become real effective leaders and it doesn’t have to be in medicine.

Dr. Anthony Orsini (29m 19s):
These are all Communication that way you talk about active listening, building relationships, building loyalties. These things are really very important in your private, any new professional life. And it also helps in things in marriage and it helps us build a rapport. And sometimes what I’ve learned through medicine I’ve really helped me with my marriage because it’s all the same, right? It’s about building relationships and listening to each other.

Dr. Vita Boyar (29m 42s):
You think it’s all in a communication and while I think marriage is and taking care of the patients, that’s for sure or have any children. That’s another one. But yeah, I think active listening is not easy. I think when they listen, they are almost always sort of thinking ahead, hey, what am I going to answer? Or what would I say to that to respond and you almost thinking about their own experience. So I think it’s really tough to step away from that mindset and just say, I’m just going to listen, hear what the other person says, you don’t have to agree to this point of view. Why didn’t you clean after yourself? Well, because I was busy doing that.

Dr. Vita Boyar (30m 23s):
So it’s not the fact that maybe 12 or to, and she was wrong and why, and what happened to write to really hear somebody else’s perspective. And they think that is the same in business and the management. What is the other person’s point? What is his point of view? Again, you don’t have to agree, but maybe it will make you understand what he/she coming from. And then you can bring your point of view from a different way.

Dr. Anthony Orsini (30m 48s):
And in business and every other week we tried to do business. In business using these communications techniques. If you want to ask your boss for a raise or a promotion, how do you go about doing that? If you have a problem with an employer, a teammate, instead of just being upfront with them and tell them here’s the issue. If I’m giving you a bad progress report to a worker or a team member, or want that person to leave that room feeling that I disappointed Dr Orsini and I want to do better. You don’t want that person to leave being angry. And these communication techniques work, especially during conflict resolution, even in my teenagers where I try to get to come home to visit their mother on Valentine’s day or visit their Mother on their birthday.

Dr. Anthony Orsini (31m 30s):
It’s tough to tell as a kid to do that. But if you do it right, as I say, you lead them to water and my son or daughter who will say that maybe I’ll come visit mom too, is that I’m like, Oh, OK. So you just got to let them up to that. But that communication is wonderful. And with all of these episodes, this is why I’m so excited about this podcast because they just stack up on top of each other and each week we learned stuff from you that I relate to an interview that we had with Helen Riess are we, when we laid back to an interview that I had with Claude Silver, who is the chief heart officer of VaynerMedia and how we use empathy, compassion, relationships to get through our lives.

Dr. Anthony Orsini (32m 10s):
And for me, we just had Dr. Dike Drummond who is a, an expert in physician burnout. And we talked about when you’re engaged with your job, when you’re engaged with your patients, you talk so great about imagining and putting yourself in their place. You go home feeling better about your job. And I think you decrease your incidence of physician burnout. Would you agree to just go home feeling better?

Dr. Vita Boyar (32m 32s):
Oh, I agree. I did listen to the podcast. It was great actually and I can relate to it. It’s not just a physician, but I think in the last six, seven months, this COVID and then a lot of the physicians are under so much stress and strain and in a NICU I mean they are always under stress or a stressful job via a and his life passed quite a bit or a visitor babies who have been in their chronic pain. So I think burnout it’s really, really important is how do you prevent it? I think communication is actually a very, very important to me. Each of you have superiors and you know, itself is a really important, I think if you feel that what you do is valued. If you have spoken to you respectfully, if you are happy with your job, if you enjoy what you do that will lessen that burnout, even if you work many hours and even if you work for a really tough, and if you have a better communication with the nurse, the fellow physicians is the parents.

Dr. Vita Boyar (33m 30s):
I think mental burnout is even harder than physical. I think physicians, they are perfectionists or at least many of us and we are our biggest critics. And if you didn’t do something well, if you didn’t say something well, or if the conversation went really badly with your boss you are going to go home and you’re going to perseverate about it and say, Oh, I could have done this and it could have done that. So I think stopping for a second, thinking about what does it, do you go on to say, how will you going to say is really important? And then in your personal life, sometimes they think they are angry or tired, or if you’re stressed out, maybe stepping out for a minute where maybe sleeping on it for tonight and have that discussion to the next day.

Dr. Vita Boyar (34m 14s):
Same at work as a boss. If you have to give somebody a criticism or a suggestion think about how you are delivering it, not rolling your eyes, facial expressions can say so much, not being sarcastic, tone of voice. All of this, I think are a little tricks that can make somebody feel better and make or break in a relationship.

Dr. Anthony Orsini (34m 32s):
Yeah. And body language is so important and the message, that’s why I call the book. It’s all in the Delivery. When I do consultations and hospitals and we do a patient satisfaction programs that help them improve their patients’ satisfaction scores. As we walk around in the hospital and we read the signs and after a few signs that we bring up or even the administrators start to chuckle and start to laugh. ’cause you see that person put that sign up there and it could have been worded so much better. It sounds like these are the rules and this is what you’re supposed to do. And I showed a sign of three people standing up in my workshop, three people standing up at attention in a row holding briefcases and it says stand online.

Dr. Anthony Orsini (35m 14s):
And so we’ll go over these signs and say, do you think there’s a better way of saying it? You know? So, you know, we will be with you in a second, please wait here. And so after a while, people graduate from my workshops and I can’t stop doing this either. I’ll go to Walmart. And I looked at a sign and go, Oh my God, that sign is terrible. So it’s the message. Communication is a lifelong learning process. I’m learning every week from people like you and from the other guests that I’ve had, even though I’ve taught thousands of thousands of people you constantly learn and you just add on top of it and stack on top of it and it affects every part of your life. And that’s why I love doing this podcast so much.

Dr. Anthony Orsini (35m 56s):
And certainly my audience was inspired by you and you gave such great advice, but we still make mistakes. It’s a lifelong learning. And back to what you talked about with the resident, sometimes I’ll leave the room at the residents watching and I’ll say I made a mistake. I said something that I should have said, what was it? And it’s like a little game. They play in the car. You know what? Dr. Orsini you talked a little too fast or I always sit down. So I never make that mistake, but Helen, Riess talks about what you just mentioned. This empathy Effect slides up and down a part of our day are sometimes our day is bad or we’re not doing well and maybe we need to wait until we’ve had a second alone before we go and have that difficult conversation. I think that’s great advice.

Dr. Vita Boyar (36m 36s):
Yeah, absolutely. I think in a NICU, you know, at night it may have a patient pass away and yet you are expected to complete that task and go on and take care of the 50 other’s. And so being in tune with yourself and if you need to step away for five minutes and being able to take the time to recollect yourself is very important.

Dr. Anthony Orsini (36m 58s):
Yes it is. I can’t tell you how awesome of an episode this was. How informative this whole thing was if anyone wants to get in touch with you, they can do it through LinkedIn or email. How would they, if they wanna speak to you, how it was the best way to get in touch with?

Dr. Vita Boyar (37m 13s):
Yeah, absolutely. I am on LinkedIn and my email is VBoyer@northwell.edu or both will be totally fine.

Dr. Anthony Orsini (37m 18s):
And we’ll put that all in the show notes. So everybody we’ll have the links to that. Thank you again, if you like this episode, please hit subscribe by it. And we’re available in Apple, Spotify, Amazon, and many others Google podcast. And you can go ahead and subscribe to get an automatic download. Don’t forget to go back and listen to all of the other episodes. It’s been great. If you want to know more about the Orsini Way you can contact me, doctor Dr.

Dr. Anthony Orsini (38m 13s):
Orsini @theOrsiniWay.Com, where you can just go to theOrsiniWay.com and get the contact lists. Thank you, Dr. Boyer. It was an absolute pleasure and I hope we will speak frequently. This has been great.

Dr. Vita Boyar (38m 26s):
Thank you for the invitation Tony it has been fantastic.

Dr. Anthony Orsini (38m 30s):
Thank you and have a good night call tonight. Thank you. Bye-bye this episode has been sponsored by Veritus. Veritus offers virtual alcohol and drugs and trauma treatment programs exclusively for licensed medical professionals. Their virtual confidential provides safety and security medical professionals need to get help while continuing to work confidential, convenient and compassionate, or does it brings world-class treatment to your home or office. Again, don’t forget about their free webinar series. Beginning of March 9th, as CME webinars series will bring together experts for panel discussions or what the future has in store or in a post COVID world who are helping physicians who are struggling with substance abuse.

Dr. Anthony Orsini (39m 13s):
This is an event that you do not want to miss. You can register for this free CME webinar series at www dot Veritus solutions.com.

Announcer (39m 22s):
If you enjoyed this podcast, please hit the subscribe and leave a comment or review to contact Dr. Orsini and his team or to suggest guests for a future podcast visit us at the Orsini Way.Com.

Conversations about Child Advocacy with Anthony DeVincenzo

Tony DeVincenzo (1s):
The one thing I think that I always tell people is understand that you’re going into this conversation about to break news of probably like I said, the most horrific thing that has happened, you know, to this family, you are dropping a bomb right on this family. In this field and I don’t know, you know, this may be true of the medical profession too. It’s very easy for us because we’re dealing with tragedy all the time. It’s very easy to get callous. And then we just get focused on doing our job. I’m going to go in, I’m going to do my job. I’m going to tell them what the child said. I’m going to get the information that I need and I’m going to get out because I got it. Then I have to continue on with the next steps of our job.

Tony DeVincenzo (44s):
I think it’s just important to understand that you’re going in and talking to some people whose lives have literally been turned upside down in the last, you know, however many hours we’ve been involved in this investigation.

Announcer (59s):
Welcome to Difficult Conversations: Lessons I learned as an ICU physician with Dr. Anthony Orsini. Dr. Orsini is a practicing physician and president and CEO of the Orsini way. As a frequent keynote speaker and author Dr. Orsini has been training healthcare professionals and business leaders how to navigate through the most difficult dialogues. Each week, you will hear inspiring interviews with experts in their field who tell their story and provide practical advice on how to effectively communicate. Whether you are a doctor faced with giving a patient bad news, a business leader who wants to get the most out of his or her team members or someone who just wants to learn to communicate better, this is the podcast for you.

Dr. Anthony Orsini (1m 45s):
Welcome to another episode of difficult conversations lessons I learned as an ICU physician. This is Dr. Anthony Orsini, and I’ll be your host again this week. You know, I’ve been blessed to have so many great guests on this podcast, far beyond what I had ever imagined when I first started out. And from each one, I can honestly say that I’ve learned something. And after speaking with them, during our typical introduction phone call and then interviewing them for the podcast, I really feel like I’ve gotten to know each and every one of them on a personal basis and call many of them my friend. Well today is especially exciting because not only do we have a perfect topic for the podcast and the perfect guest, but I get to interview a very long time friend, Tony or Divo, as I knew him growing up, have known each other since we were 12 years old.

Dr. Anthony Orsini (2m 35s):
We played on the same baseball team, now we both played on the same high school football championship team, and we’ve also kept close contact for years. So this is going to be a lot of fun, but also informative about a real important topic. And that is child abuse and child advocacy. Today my guest is Tony DeVincenzo. Tony is here to talk about difficult conversations and child advocacy, child abuse. He is currently a training specialist with the Northeast regional children’s advocacy center and that role, he provides training and technical assistance to child advocacy centers and child abuse, multidisciplinary teams throughout the Northeast region of the United States.

Dr. Anthony Orsini (3m 18s):
Tony has also presented workshops on a variety of topics related to child advocacy at regional and national conferences. Before working in the child advocacy field. Tony had a 25 year career in law enforcement, in New Jersey. He began his career as a patrol officer with the Roselle police department, and then served as a detective with the Morris County prosecutor’s office. As a detective, Tony worked at a variety of units, including the child abuse unit and the major crimes unit, but spent the majority of his career investigating crimes against children. Tony retired from law enforcement in 2013 as a Lieutenant supervising the sex crimes, child endangerment unit, internet crimes against children and Megan’s law unit.

Dr. Anthony Orsini (4m 4s):
In addition to his law enforcement career and his role in child advocacy Tony is an adjunct faculty member at local colleges, teaching courses related to criminal justice and child advocacy. Welcome Tony. It’s great seeing you again. Thanks for coming on.

Tony DeVincenzo (4m 21s):
It’s good to see you, Tony. Thanks for having me here.

Dr. Anthony Orsini (4m 23s):
Last month. I guess you do your own podcast. And last month I was a guest on a yours, and that was a lot of fun and I’m glad you were able to reciprocate your so busy. So this is a topic that is really important and something that my audience I think is really going to learn a lot from. And I always promise them to inspire and that they’ll learn something valuable about communication. So this is perfect. I’m looking forward to asking a whole bunch of questions and this is going to be a really great podcast. So thanks again.

Tony DeVincenzo (4m 50s):
I appreciate you having me.

Dr. Anthony Orsini (4m 53s):
From my experience. So you’ve been in this field for what, 30 years now, I guess it is. I hate to say it’s been that long,

Tony DeVincenzo (5m 2s):
But yeah me too, about that….

Dr. Anthony Orsini (5m 2s):
As I said in the introduction, we know each other, since we were 12 or a little league baseball high school football, first as local benchwarmers where we sat together on the bench and then we both got a chance to play. So it’s been a long time. And then we have mutual friends and we lived near each other. So it’s been great. I come from a family of police officers, almost everyone in my family’s a police officer, except for me. And even someone in my family, my brother did a little time in juvenile. I don’t think it was his best assignment. He, I think he liked it, but it wasn’t great, but you did it for a long time and that’s gotta be really hard. Isn’t it? I mean, the stuff that you saw, how were you able to identify that’s what you wanted to do and stick it out for that long?

Tony DeVincenzo (5m 48s):
Yeah. It was hard. Specifically being in the child abuse unit where I spent probably 13 of my 25 years in law enforcement, I spent in the child abuse unit for a County agency. We were investigating all types of child abuse cases, really in all cases involving crimes of a sexual nature, both with kids and adults. And to be honest with you, I got in it by happenstance. I wasn’t looking to go there in the beginning. A couple of friends of mine who were in the unit thought I’d be a good fit for it because you have the opportunity to do a lot of the things that you like to do in law enforcement, doing investigations, search warrants, interviewing suspects, things like that.

Tony DeVincenzo (6m 28s):
But what I found was when I got into the unit, it really just became a passion project. For me. It was a place where I found personally, probably I did the most gratifying work that I did in my entire law enforcement career.

Dr. Anthony Orsini (6m 42s):
There’s nothing more special than helping a child and giving them a second chance. But you must have seen some pretty horrific things. Is there anything particular that stands out or any type of crime that just made you go home and say, wow, that was a rough day.

Tony DeVincenzo (6m 57s):
Yeah, there was a lot, anytime you’re dealing with children and kids that have been hurt in whatever fashion that is, whether it would be child sexual abuse or physical abuse, those cases just tend to get to,you have been thinking about this question because you told me you were going to ask it. And it’s hard to pinpoint a specific case that really affected me more than others. There certainly are a bunch that are out there, but I would say, I think anytime that there was a death of a child, those are the ones that really hit home for me, as part of my job, we had to do death notifications. I had to go to autopsies and watch autopsies and collect evidence during autopsies.

Tony DeVincenzo (7m 37s):
And anytime you’re seeing a child that’s been killed or has died in whatever matter those cases. And I’m sure you, as well as anybody, those cases just tend to, to stick with you and they go home when you take those home. And however you decide to deal with them, there’s a personal issue. Yeah. Do I go home and have a glass of wine or a beer or whatever that may be, but yeah, there’s a lot of cases like that. And then I think anytime that you have to work with kids, a lot of those cases tended to get to me too. I was a forensic interviewer for a long time. So part of my job was interviewing kids about the abuse that happened to them. Just talking to those kids and asking them the questions and hearing the stories that they’re telling about what people had done to them.

Tony DeVincenzo (8m 24s):
A lot of those cases you can’t get away from bringing those cases home with you.

Dr. Anthony Orsini (8m 28s):
Yeah. I would say two things about that. One is having a family of a bunch of police officers, most people in this world, thankfully have no idea what’s going on out there, right? The horrific things that you’ve seen. And some of the stories that my father and my uncles and my brother tell me, and even stuff that I see in the hospital, most people don’t even know that this is going on. And it’s just so incredibly sad that it’s hard. And as you say, just like in my job, when I have a death or whatever, I tend to go home and Lauren, my wife will have maybe dinner on the table and I might just say, I need a minute, pour myself a glass of wine and then just turn on ESPN and sit in the dark for a few minutes just to catch.

Dr. Anthony Orsini (9m 14s):
But people have asked me that question too. And my answer is that, and you said it before, it’s so gratifying in the end because you feel like you’re doing something important and either you run towards it or you run away from it and there’s nothing wrong with running away from it. There’s physicians who choose to deal with the life and death. And there’s physicians that want to do more of the primary care. My family member that was in juvenile, he said, this is not for me. And he did something else and he had a great career, but it is hard. But before we talk about the child advocacy center, let’s talk about, maybe we can talk about that. So tell the audience how this happens, right? So you get a phone call and there’s a report of child abuse.

Dr. Anthony Orsini (9m 54s):
There’s multiple conversations that have to happen versus the police officer. And then it goes, take us through how that works. If you don’t mind,

Tony DeVincenzo (10m 1s):
We’ve really come a long way just as a society in the way that we respond to child abuse cases, probably over the last 40 years or so. Where today we really are engaging in more what we call multidisciplinary team investigation. So all of the different partner agencies at different disciplines that are typically involved in investigating an allegation of child abuse, law enforcement, child protection services, medical people, mental health, family, advocates, all come together at the beginning of an investigation. As soon as there’s an outcry from a child, they come together and really start to work more in cooperation with each other, right from the beginning.

Tony DeVincenzo (10m 42s):
And that’s a big difference in what used to happen. What used to happen is if you can imagine the child makes an outcry. And before we had multidisciplinary teams, before we had child advocacy centers, that child would have to engage with all of these different professionals, a lot of times at different times and in different places. So the child may be brought to the police station and have to talk to a police officer. And then a CPS worker would want to talk to them and show up at the home. And maybe if the circumstances warranted, they’d have to go to the emergency room for a medical exam when the child is being bounced around and at each stop being asked all of the same questions over and over again. And what we were finding was that this system that was really designed to protect kids was retraumatizing kids.

Tony DeVincenzo (11m 26s):
And not through any fault of the players, the people are all doing their work with good intentions. We just didn’t really know how to cooperate and how to collaborate. And that’s where this child advocacy center model came into being. And this idea of doing more multidisciplinary team investigations. So what happens now is that same child will make an outcry. And sometimes someone will respond to the house or to the school or wherever the child may be. And there may be that initial discussion with a police officer and a CPS worker, if the case warrants that kind of a response. And that’s an initial conversation that needs to be had with family members a little bit with the child, anybody else who may have some information about what this allegation is about.

Tony DeVincenzo (12m 12s):
But ideally what we want to do is to have that child brought to a child advocacy center as quickly as possible. And it’s there where that team will come together and start to engage in all of the conversations that need to be had with non offending caregivers or guardians. They will set up a time to do a forensic interview of that child, where someone’s actually going to sit in a room and talk to the child and ask questions about the allegation and then discuss with the family, some followup steps, and what’s going to happen next.

Dr. Anthony Orsini (12m 41s):
So the forensic interview with the child, you did that. And so it’s gotta be very different interviewing a five-year-old and interviewing a 15 year old, how much training do you get for that? And how difficult is it, which one’s harder to interview?

Tony DeVincenzo (12m 55s):
tough to answer, because the one thing I always say, when you’re talking about, you know, you’re not interviewing children, you’re interviewing a child and every child is different, right? So sometimes a four year old can be the easiest interview in the world because they don’t really have a, a concept of what has happened to them is something bad. So they will very easily and almost sometimes even laughing and just tell you about what happened, because they have no context for that. Like teenagers sometimes can be really difficult. If anybody out there has teenagers, you know, how difficult those conversations can be?

Dr. Anthony Orsini (13m 34s):
Oh God, I talk about

Tony DeVincenzo (13m 38s):
In general. But now imagine going into that conversation and trying to ask them about what I would imagine is probably the most traumatic thing that has ever happened in their life. So I think they’re all difficult conversations. We’re trained. Typically forensic interviewers are trained in a specific type of protocol about how to ask the questions. And that protocol is really designed to elicit information in a neutral fact-finding way. Let’s get to stand up in court, that’s going to be legally acceptable. And so there’s training in that and included in that training is a lot of information about child development and how to ask proper questions and things like that.

Tony DeVincenzo (14m 19s):
I think we could do a better job though, in, in training forensic interviewers, and really everybody that’s involved in responding to child abuse in their communities, just around how to have those more everyday conversations and how to just talk to children and talk to adults about child abuse and what’s happened to them.

Dr. Anthony Orsini (14m 39s):
Yeah. So you have the conversations with the child, typically who initiated the complaint. Is it a neighbor? Is it the child? Is it, we always joke. It’s always the boyfriend. Is it the mother, the father what’s the most common?

Tony DeVincenzo (14m 52s):
I don’t know that there’s a common way. Usually allegations have come out in a couple of different ways. You either, it comes out accidentally, the child will be demonstrating some type of behavior. That’s not normal. That would give someone an indication that maybe they’re being abused. And then there’s other purposeful allegations where a child will just come out and say, uncle so-and-so is doing something to me. Or sometimes we’ll see allegations come out in the school setting where something will come up in school, there’ll be some kind of a prevention program or an awareness program, or there’ll be talking about the topic. And then a child will disclose to a teacher or a counselor. Those are a lot of different ways that, that the allegations could come out.

Dr. Anthony Orsini (15m 32s):
So I’ll tell you a funny story just to lighten this up just a little bit. So my oldest one, Joey was I guess, five, and he wasn’t a great eater. He didn’t never want to eat anything. He wanted eat pasta. And that was it. And so when he was really into WWE wrestling, that was his thing. He watched it every night and he loved WWE wrestling. And so the thing that at that time was daddy would come home from work. And then after dinner, we would pretend the wrestle on the ground and he would pretend he was WWE and, you know, think kind of thing a dad does what his son, when he wouldn’t eat dinner, I try a little reverse psychology. And I’d say, Joey, please don’t eat. Because if you eat that chicken, it’s going to make you really strong. And daddy won’t be able to be joined wrestling.

Dr. Anthony Orsini (16m 13s):
And of course he’d shovel the food down one day, Lauren gets a phone call from the kindergarten teacher and she says, Mrs. Orsini I feel really weird about asking you about this. But Joey says that if he doesn’t eat his dinner, daddy beats him. And so Lauren gets, Oh my God, we’re in trouble. So Lauren explains it to the teacher and she gets a good laugh, but I always thought that was a funny story. Like he says, my daddy beats me If I don’t eat chicken.

Tony DeVincenzo (16m 44s):
I’ll say it was a funny story, but I applaud the teacher for following through because one of the challenges that we have in this field is that people don’t know what to do. They don’t know how to respond to a situation like that. And sometimes the easiest thing to do is to say, Oh, they probably didn’t mean anything by that. Dr. Orsini is a doctor and a pillar in the community. There’s no way he would ever beat his child and just leave it at that, which can be dangerous. One thing I will say about being in this field for such a long time, it is the one thing that kind of spans every demographic. You know, I worked in Morris County is where I did a lot of my work, which I think still today is probably one of the 10 richest counties in the United States.

Tony DeVincenzo (17m 27s):
And we’ve had cases that involve some of the richest people in the County and in the country to some of the people that were really disadvantaged. Lawyers to homeless, you name it, men, women, every demographic you could think of there have been incidents of abuse within those communities. You know, one thing I always tell people when I’m out in the community, doing more awareness work is don’t ever think that this can’t happen because, and so is, and you fill in the blank, a doctor or the coach of the team or a teacher or whatever the case may be.

Dr. Anthony Orsini (17m 60s):
I think it’s a common misconception that this is something that happens in the inner city, low socioeconomic, but it’s really not true. And we see that in our emergency room. And we see that just about everywhere. You and I last time spoke about a conversation that occurs after you’ve found out or determined that the child is as being abused. And maybe let’s say it’s uncle Rick or uncle John or whatever, or the boyfriend. We talked about a particular conversation that you have to have when you’re actually sitting with mom and maybe that’s the boyfriend or the uncle. And you have to tell mom, listen, we’ve determined that is being sexually abused by the uncle or whatever.

Dr. Anthony Orsini (18m 42s):
Take us through that conversation because that’s gotta be hard the first convince them maybe, or do they generally know it, but won’t admit it or how’s that go.

Tony DeVincenzo (18m 50s):
It kind of runs the gamut. And it’s interesting. And there’s really, I think two conversations where I have found to be really difficult. One is that initial conversation when a family first shows up at a child advocacy center and let’s just use the example that the family’s coming down to a child advocacy center is when you really have to engage with that family. And it’s that introductory period where family they’re aware that there’s been some kind of an allegation, but they really don’t know what’s going on. And all of a sudden they’re being brought to this new place and a child to keep that in mind too, a child is also being brought to this new place to talk to these new people. And that is a difficult conversation to have with a family, to introduce them to the process, to introduce them to what has been said at that point.

Tony DeVincenzo (19m 37s):
We really don’t know what is true and what’s not true, but we need to tell them what is being said. And then I think what’s equally important is then to get them on board with the process. These are the steps that we are going to need to take to follow through with these allegations. And like you said, you’re dealing with people that can be anywhere from just in complete disbelief, right? There’s no way that this happened. I’ll go through this, but there’s no way that this happened to complete crisis mode. And then they could be anywhere in between. And as I’m sure they can move up and down that continuum, as you’re speaking to them in the middle of that conversation, we can go from disbelief to full blown crisis and then all the way back.

Tony DeVincenzo (20m 21s):
And that is a difficult conversation that I think anybody can be having that conversation. Law enforcement, CPS in our child advocacy centers. Now we have an incredible group of people that are family advocates, and they are just such a great resource to the child advocacy centers. And they really do a lot of work with family members and non offending caregivers, and really help us to have better conversations in that context. And getting back to what you were talking about, the conversation that we had once you do get them on board, and then you go through that forensic interview that we spoke about. There’s another conversation that needs to happen with non offending caregivers, where you’re telling them what happened in that forensic interview.

Tony DeVincenzo (21m 2s):
And it’s that conversation that I kind of parallel to what you talk about a lot about breaking bad news when you’re breaking bad news about a diagnosis. I think it’s that conversation where this really becomes real. If the child has disclosed that they’ve been abused, we need to go into that room and have a conversation about this is what the child said. This is now what we know has happened. And that is not an easy conversation to have. And I’ll be honest with you. We don’t get a lot of training in how to have those conversations.

Dr. Anthony Orsini (21m 33s):
And you approached me a few months ago about maybe the Orsini way, providing some training for your advocates, but just to give some advice because you did it for so long, what’s your best advice on how to begin that conversation and tell that what’d you call it a Non-offending what’s our terminology is usually not offending caregiver. Okay, there you go. A lot of times we step, we go right to mom,

Tony DeVincenzo (21m 56s):
But that’s not always true. And a lot of times it’s not apparent at all. It could be a guardian, it could be an aunt and uncle, some other kids, someone else that’s caregiving that is the caregiver for the child. So we tend to use that phrase, non- offending caregiver, but like I said, we don’t always get a lot of training in that conversation. We do get training, especially in law enforcement, we get a lot of training and crisis intervention. People are in crisis. They need to be deescalated. We get a lot of training around that, how to deescalate people that are in crisis. But I think it’s that everyday conversation that you need to have that I think is so impactful to the family members that oftentimes we don’t spend a lot of time working on. And I use a lot of the tips.

Tony DeVincenzo (22m 37s):
I have Tony, honestly come straight from you. And the work that you do, the one thing I think that I always tell people is understand that you’re going into this conversation about to break news of probably like I said, the most horrific thing that has happened to this family. You are dropping a bomb on this family and this field. And I don’t know, this may be true of the medical profession too. It’s very easy for us because we’re dealing with tragedy all the time. It’s very easy to get callous. And then we just get focused on doing our job. I’m going to go in, I’m going to do my job. I’m going to tell them what the child said. I’m going to get the information that I need and I’m going to get out because then I have to continue on with the next steps of our job.

Tony DeVincenzo (23m 24s):
I think it’s just important to understand that you’re going in and talking to some people whose lives have literally been turned upside down in the last, however many hours we’ve been involved in this investigation. I’m hoping we can get some of your training into the child advocacy center world, but just little things like where you sit, sitting next to people. I think one of the big things about this is to be patient. This is not a two minute conversation. This is a case that needs to take as long as it needs to take. Yeah. It’s hard to say how long it should be, but yeah. And I’ve had people ask me that I’ve had new detectives and new child protection workers.

Tony DeVincenzo (24m 4s):
Well, how long should I be in there? And the answer is this, as long as you need to be, as long as it takes. And I think we have to give a lot of family members, the opportunity to process what we’re saying, that you can’t just leave this on them, wipe your hands and walk out of the room, give them a little time to process what you’re saying, listen to what they have to say. I always think observing how people are reacting to this is also a big part of that conversation. And then just wait and answer whatever questions that they may have for you. The one thing I always tell people is people are probably, and you may know more about this than I do because you’ve done a lot of the research on this.

Tony DeVincenzo (24m 48s):
People are probably processing what, maybe a third of what you’re actually telling them. If that, of the information that you’re giving them,

Dr. Anthony Orsini (24m 55s):
What we teach is that after you break the bad news, you know, your child was abused. They only process 10% after that. And so my biggest advice when I discuss breaking a bad news, and as you and I have spoken before the parallels between what you do and what I do to tell mother or father their child has cancer or their child’s going to pass away. There’s so many parallels to that. But what I always suggest my main suggestion is give the evidence first and let the person who’s receiving the bad news, almost come to that conclusion on their own. So I think there’s a lot of times we make mistakes and say your child has cancer. And then spend the next 20 minutes Trying to what I always say is the person who’s receiving the bad news, their job is to prove you wrong.

Dr. Anthony Orsini (25m 41s):
If you’re saying I’m here to tell you that uncle Todd is abusing your child, their first response is going to be denial. So the same thing is if I’m telling you that you have cancer, you’re going to be in denial. So if I could present the evidence first, and then when I tell you have cancer, you almost already know that it’s coming. I think that’s really important, but yeah, it’s 10% afterwards. And so I love what you said, be patient, because then you have to sit there silently. And if you rush through it, they’re going to think that you rushed through your decision that you’ve made this determination. You’re not even sure. So I think that’s really great advice.

Tony DeVincenzo (26m 18s):
It’s very specific to our field is, and we train on this all the time and I can’t say it enough is, but you should always be number one, always have that conversation. And number two, always give the non-offending caregivers some information. There’s a variety of reasons in a child abuse investigation, where you may not be able to share everything that you know, at that point, but you should never leave them with no information. And I think honesty and just being transparent is listen. There’s a bunch of things that I just can’t talk to you about right now. And that’s not because I don’t want to there’s, but there’s a different re and if you can’t explain why you can’t tell them, explain why you can’t tell them, but just make sure that you’re explaining to them why you can’t do that and never leave them with no information at all, because you could just imagine if you’re being broken that kind of news and someone just walks in and says, yep, your child disclosed that they’re being abused.

Tony DeVincenzo (27m 15s):
We’re going to go on with our investigation and we’ll be in touch. It’s just

Dr. Anthony Orsini (27m 20s):
Not going to go well.

Tony DeVincenzo (27m 22s):
Because honestly, and I’m sure you know, this in the medical field too, a big part of that conversation is you want this family to be on board with the rest of this process. Selfishly, we want people on board because it’s just going to help the investigative process. But we also know from a lot of research that, and I’m sure this is true in the medical field as well, support from non offending caregivers and family members. It goes a long way in helping the child heal from any kind of trauma. And if we can’t get the family on board with that, we’re just putting this child at a disadvantage to process the trauma that has happened to them. And then to move forward through their healing process, forget about the investigative part.

Tony DeVincenzo (28m 5s):
It’s just their healing process that we also need to be concerned about as well.

Dr. Anthony Orsini (28m 10s):
Great advice. Tony, tell us about the Northeast children’s advocacy center, who they are, what they do and your role current role in that position.

Tony DeVincenzo (28m 19s):
So we are, what’s called a regional child advocacy center. We’re a project of the department of justice, who is our grant funder in the North, either for regional child advocacy centers around the country. One of ours in the Northeast that is based out of the Philadelphia children’s Alliance, which is the child advocacy center in Philadelphia. There’s a Midwest region in Minnesota, Western region, out in San Diego and a Southern region down in Alabama at the national children’s advocacy center. And we’re basically, we’re tasked with providing training and technical assistance to the 900 plus child advocacy centers and multidisciplinary teams that are spread out across the United States.

Tony DeVincenzo (29m 1s):
And so that’s what we do here in the Northeast. We do the nine States. I like to say, I draw a line at the bottom of New Jersey and Pennsylvania, and then I just go up the coast to Maine. Those are the nine States that we cover. So we work with teams on training, on a variety of different issues, team development, leadership, team building, all of that kind of stuff.

Dr. Anthony Orsini (29m 21s):
Do you work with every city, every town, or is it their choice whether to participate or not? Or is this, should I assume that every city is involved?

Tony DeVincenzo (29m 31s):
Yeah, like I said, there’s about, I don’t know the exact number. That’s about 900 plus child advocacy centers across the United States. Right now we do regional work where we’ll provide training and technical assistance, more global, more general topics. If a child advocacy center wants us, then we will come in and do a more deeper dive with individual centers, individual teams. But yeah, if you look at any County city, even small towns around the country, and I know you have an audience that spread out around the country, there’s a child advocacy center somewhere close by.

Dr. Anthony Orsini (30m 4s):
You’re a training specialist. What does that mean? That they specifically do?

Tony DeVincenzo (30m 13s):
That’s like I said, we go out, there’s three of us in our region. And like I said, we’ll go out and provide workshops on a variety of different topics from victim advocacy to vicarious trauma for professionals in this field. And then, and like I said, then we’ll do, an