DIFFICULT CONVERSATIONS (The Scripts)

The Podcast Scripts

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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):
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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, and we also do more individual work. So we’ll go in and work with a team on strategic planning, on setting goals for their team on team building activities, and really trying to get that multidisciplinary team to work as collaboratively and cooperatively as they possibly can when they’re responding to child abuse.

Dr. Anthony Orsini (30m 49s):
Sounds like an absolutely wonderful thing. And I’m really so glad. Is it a 501C3 or is it funded? Can people help out if they want to help out?

Tony DeVincenzo (30m 58s):
Yeah, like I said, we’re grant funded from the department of justice, but my suggestion would be, if you were interested in getting involved, find your local child advocacy center, there’s probably a child advocacy center somewhere in your community or close by. There’s a national organization to the National Children’s Alliance that works with all the child advocacy centers around the country. You can look and they have a website. You could look into helping them if you wanted to do something on a bigger scale. But I love to direct people to their local child advocacy centers because it’s down there that on the ground level where people are doing that direct service work, that’s where a lot of the magic is happening. And that’s where just, you will find a group of passionate, dedicated people whose sole purpose is to help these kids that have been traumatized.

Dr. Anthony Orsini (31m 46s):
There’s nothing more satisfying than helping a child because you’re literally changing their trajectory of their life. They’re going down the wrong way and you help them out. And, and these amazing people that work with you are doing it for very little money. No, one’s getting rich doing this.

Tony DeVincenzo (32m 4s):
Absolutely not. And that’s everywhere from the law enforcement people that are working in this unit to the CPS workers, to the mental health and the medical staff and all of the people that are working in the child advocacy centers. I don’t know too many that are becoming wealthy doing this. I can tell you that that doesn’t affect the passion that they have for this work. It’s probably been the biggest joy of being involved in this for so long. And you asked me one of the questions you asked me earlier is how I’ve stayed in this for so long. And I think that’s probably one of the biggest reasons that I just have the opportunity to meet and engage with some of the most passionate people that I’ve ever met in my life.

Tony DeVincenzo (32m 44s):
And I’m amazed every day about the work they’re doing and just how dedicated they are to help these kids. And that hasn’t manifested itself more than it has over this past year because child abuse hasn’t gone away just because we’ve been quarantined. Has it gotten worse because of the COVID you think it’s hard to say right now? I think reporting has certainly Jew everywhere of reporting has gone way down because children just aren’t being exposed to a lot of the people in the places where it would make these reports, schools, physicians, things like that. And I don’t know what the numbers are saying yet, but I would guess that the numbers are going to be just as high, if not higher than they ever were.

Tony DeVincenzo (33m 26s):
I know there’s been some early research around people are seeing a lot more severe physical abuse cases than we’ve seen in the past. People are bottled up and emotions are running high. And sadly in a lot of cases that gets taken out on the kids that are in the home.

Dr. Anthony Orsini (33m 39s):
Yeah, I know alcoholism’s up drug abuse abuses is up depression, suicide. The kids are home from school. Their suicide is up for the kids. Maybe as you said, tempers are running short because the kids are home all day. So I would urge everybody to take Tony’s advice and support your local child advocacy center. Tony also has his own podcast. The name of the podcast on

Tony DeVincenzo (34m 3s):
Our podcast is called the NRCA C team talk podcast. And we focus on really things that are happening in child advocacy centers around the country.

Dr. Anthony Orsini (34m 12s):
Fantastic. And thank you so much for being on today. If they want to get in touch with you or someone where you are, what’s the best way to do that.

Tony DeVincenzo (34m 19s):
You can check out our website, it’s www N R C A C.org. I can put my contact information into your show notes as well. If anybody wants to reach out to me directly, the national children’s Alliance is another great resource for information about child abuse. They have a website which I will give you their website, too, that you could put in their show notes. I’ll put it in the show notes. And then, like I said, if you want more local information, please, I would direct you to your local child advocacy center. They’ll have a wealth of information about child abuse in general, how to report all of that kind of information. And they are always looking for support from the community.

Dr. Anthony Orsini (34m 59s):
That’s awesome. Thanks so much. Who would have thought that when we were 12 years old, these two goofy kids, what ended up interviewing each other on their podcast? So it’s an issue we’re just trying to get through life. Tony, thanks so much for coming on. This was fantastic. Put all the stuff for contact information on the show notes. If you want to learn more about the Orsini way, please contact me@ Dr.Orsini@theorsiniway.com. Our website is TheOrsiniway.com. Tony. Thank you. It was a pleasure and hope to talk to you soon.

Tony DeVincenzo (35m 30s):
Yeah, I really appreciate it, Tony. Thanks for the opportunity to let people know about this issue. And I will just leave you with, if you do suspect something just report it. There’s ways that you can report it in your community, in your individual States. So don’t hesitate to make those reports If you suspect something.

Dr. Anthony Orsini (35m 47s):
Thank you for doing what you’re doing, it’s really important work. And it’s like you said, it’s not something you get rich on, but you get rich inside and you get rich I believe in heaven because this is great work. So thanks again. And I will speak your real soon. Thank you.

Announcer (36m 1s):
If you enjoyed this episode 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.

Positive Culture Change in the Workplace with Siobhan McHale

Siobhan McHale (0s):
Culture is co-created and each part within the organization plays a role in the co-creation of the culture. However, culture changes leader led. So if you want to change the culture, you’ve got to get leaders at all levels, actually, to step into the role, to change the culture in their parts. But what often happens is that the leaders step into their business as usual role, and they delegate culture change to HR. So they say, Oh, well, that’s the soft stuff. That’s the HR department. I’m too busy running the hospital or running my medical practice. I’ll just give that to somebody else. And that invariably is disastrous for the change effort.

Announcer (42s):
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 26s):
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Dr. Anthony Orsini (1m 28s):
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, in keeping with our format of combining the best leaders in healthcare and the best in business. I feel exceptionally fortunate today to have Siobhan McHale as my guest this week. Siobhan is one of the world’s leading experts in culture change in the workplace. She is the author of the well-known book, the insider’s guide to culture change. And over the past 30 years has helped thousands of leaders create more agile and productive workplaces. Siobhan began her career as a management consultant at Price Waterhouse Coopers in London, and later with the international Chicago-based consulting firm, Accenture.

Dr. Anthony Orsini (2m 12s):
After a decade as a consultant, Siobhan became the executive in charge of change at a series of large complex organizations. Siobhan is most well-known for steering a radical seven-year culture change project that Australia and New Zealand bank group Limited ANZ and transformed the organization from the lowest performing bank in Australia into one of the highest performing and most globally admired banks in the world. Her work with ANZ was so incredible that it was used as a case study by professor John Kotter at Harvard business school to teach MBA students how to manage change. The insider roles that Siobhan has had gave her a different perspective on culture change compared to the views of academics, consultants, and journalists who are mainly writing on the topic of transformation, the insights she has gained has allowed her to develop a groundbreaking approach to bringing about real and lasting change described in her book.

Dr. Anthony Orsini (3m 9s):
Her book insider’s guide to culture change has been described by culture pioneer, Carolyn Teller, as “the most groundbreaking thinking on how to change workplace culture that I’ve seen in many years” and so well welcome Siobhan thank you so much for coming on today.

Siobhan McHale (3m 26s):
Thank you, Tony. And thanks for that glowing introduction.

Dr. Anthony Orsini (3m 30s):
Well Siobhan is coming to us from Australia down under, so it’s early in the morning there and late in the evening here. So I thank you for taking some time out. I’m really excited to talk to you today. We combined, every week we try to alternate healthcare and business and the same topics keep coming up every single week. And those are words such as communication, trust, culture, leadership and I’ve been really looking forward to speaking to you. And as I’ve been doing this podcast now for about six months, multiple people have kept bringing your name up. And so when we finally spoke on the phone a couple of weeks ago, I knew this was going to be a really great episode.

Dr. Anthony Orsini (4m 13s):
So thanks again. Now I’ve got so many questions to ask you, but I always want to start out the same way. One of the things that I teach when I teach communication is being a genuine person. To be a leader you have to be a real person. You have to have people get to know you, whether that’s your patient and I’m a physician or it’s an employee and a leader. So before we even start, just tell us a little bit about Siobhan. And so we can get to know you.

Siobhan McHale (4m 36s):
I was born in Ireland and as you can probably tell by my accent. And, but I moved to Australia in 1994, actually. And I’ve spent most of my life living here in Australia. I studied psychology by background, but rather than taking the route that all my other classmates were taking, which was more into clinical psychology, I decided to take the less worn path, which was trying to figure out how people can work, optimally, how can they be at their best and highest in the workplace and what actually makes productive and constructive workplace culture. And that was really my passion and where I’ve spent my whole career is this whole exploration of workplace cultures and creating better places for people to work in.

Dr. Anthony Orsini (5m 24s):
One of the reasons why I’m so excited to speak to you is that, you know, I’ve been in healthcare my whole life. I think healthcare right now, no matter what country you’re in is in a crisis. And I can’t speak for other countries. I think the problem with healthcare, if you ask me, is the non-starter of healthcare leadership and healthcare leadership really seems to be lacking. It’s almost like we’re decades behind business, and there’s really no leadership. And there’s a culture of healthcare that is going really in the wrong direction where starting to get away from the human aspect of medicine. Healthcare is not run by physicians, at least in the United States.

Dr. Anthony Orsini (6m 6s):
Now anymore, it’s run by a bunch of administrators and CPAs and people who are telling you what you need to do that has led to in medicine, physician burnout, nursing burnout physicians with the highest suicide rate in the country of any profession is physicians. So this is why I’m so excited to talk to you because I think if anybody needs you, it’s the healthcare sector, but before we talk about it in your book, which I loved you define culture as how things work around here. So just elaborate. Cause we, we have to define it before we can fix it.

Siobhan McHale (6m 42s):
Absolutely. And I think how things work around here is my working definition of culture. And often the big myth about culture is that it’s just about employee relationships and about engagement. When actually culture is much broader than that. Culture is how you design, you fulfill your customer needs, you manufacture your goods, you serve your patients. It’s from Whoa to go. It’s not just about whether employees feel engaged. So I think we’ve got to redefine culture in its whole sense. It’s about the whole functioning of the hospital or of the business entity.

Siobhan McHale (7m 22s):
And often underpinning are at the heart of culture are the passions or the hidden agreements that are actually running the hospital are running the business. And those patterns are often deeply embedded and they’re difficult to detect you become caught by them and they just, the way that things are done. So the first step in culture change is to diagnose those deeply embedded patterns.

Dr. Anthony Orsini (7m 47s):
So let’s talk about this depth. Let’s go over. If you don’t mind telling this story of ANZ when you got there and what kind of the systematic approach that you took when the bank was having trouble so that people out there can learn about what are the first steps that we have to do. So let’s use ANZ as an example of how to turn around a company.

Siobhan McHale (8m 8s):
Yeah. So the first thing we did when the CEO John McFarland got there in the early 2000s, there was a lot of noise. There were a lot of, there was bank bashing and the media, there was a lot of noise about how the banks had behaved badly. And he had turned the company around from a financial perspective, but he knew there was more work to do and that he had to fundamentally change the culture and restore the faith and the trust of customers and the community in the bank. So we started out step number one, we had to diagnose what was really going on and uncover and have those difficult conversations about what was the reality. And one of the things we noticed was a big pattern that was running the organization, where the people in head office had stepped into role of order givers, and they were giving the directions, they were in charge.

Siobhan McHale (8m 60s):
They thought of themselves as in control and the 700 branches where there were 40,000 staff, they were in role of order takers and they saw the job is just taking the orders, almost a victim mentality and just going through the motions. And when I walked into these branches, what I saw was paint peeling from the walls, customers standing, shuffling and long queues and not getting the answers that they needed when they eventually got to the top of the queue. So the passion or the hidden agreement between head office and the branches was that you’re to blame for the poor customer service. So each part was pointing the finger at the other and saying, no, you’re too blame for the poor customer service, no your to blame for the poor customer service.

Siobhan McHale (9m 46s):
And meanwhile, the bank had the lowest levels of customer satisfaction of any bank in the country. So yeah, it was absolutely abysmal. So the first step we took was to see the roles that they were taking up and to use the power of role reframing. So this is one of the things I talk about in the book, the remarkable power of role reframing, which you can do at an individual level, but you can also do at a collective level. So we reframed the role of head office from order givers to support providers. They would be the enablers providing all sorts of IT services or HR services or risk services or strategy services to the branches.

Siobhan McHale (10m 32s):
And the branch’s role was reframed from order taker to service provider to the customer is essentially, and this role reframe was supported by a whole lot of processes and system changes. But this new operating model that we put in place really was the trigger for a massive transformation. And within seven years, we had gone from the worst performing bank in the country in terms of customer satisfaction, to the number one bank in the country in terms of customer satisfaction and also the number one bank in the world on the Dow Jones sustainability index.

Dr. Anthony Orsini (11m 12s):
Wow, that’s incredible. You know, one of my favorite quotes is “the biggest concern for any organization is when your most passionate employees go silent”. And it sounds like that I truly believe that I see it in all these toxic places that I’ve worked or people that I speak about. Once you start silencing the people on the ground, I guess it’s game over

Siobhan McHale (11m 34s):
It is game over. But also what happens is that culture is incredibly powerful. So you can have a person that has one set of values and beliefs outside the hospital system. And when they walk into that hospital, they are captured by the culture they are captured and they step into these roles inadvertently with all the best intentions, they can just step into roles instead of caregivers, we’re administrators, that’s our role is to financially balance the books and they haven’t got the interest of the multiple stakeholders at heart. So the first step is to see that pattern that is running the organization and naming that pattern and seeing the roles that different parts are taking up because often what happens is people say, Oh, well, it’s the administrators they’re to blame their fault, but they don’t see how the pattern is co-created by multiple groups or multiple parts in order to be sustained.

Siobhan McHale (12m 33s):
So diagnose the patterns is the first key step in culture change.

Dr. Anthony Orsini (12m 38s):
I’ve found that when I do a lot of patient experience, what you do, I do on a different level. It’s walking into a unit of a hospital that has having difficulty with their patient experience scores, which is the same as customer experience. And when we start speaking to people, what we used to do is we used to train the doctors in one room and train the nurses in another room. And what I invariably got was the doctors saying, we’re really good. We’re really nice. We’re really sweet. But the nurses, they just ruin everything. And then the nurse would say, Dr. Orsini, I’m doing everything I can, but that doctor comes in and he, or she’s just a jerk. And so they just, like you said, they’re pointing fingers.

Dr. Anthony Orsini (13m 19s):
And so now what I do is I make sure that they’re all in the same room and we train them together and we give each one of them, a license to give positive and negative reinforcement. But it is kind of like that, right? Everybody says, it’s not me, it’s you?

Siobhan McHale (13m 35s):
Yeah. You can get all sorts of dysfunctional patterns depending on what the culture is. And again, it’s not one size fits all. So every organization, the culture is unique as a thumb print. And it’s also assessing what type of culture do you need for this particular business? So this particular practice, and that’s not always a one size fits all. As I said, sometimes it depends. It depends on the context. It depends on the challenges depends on the client base that you have.

Dr. Anthony Orsini (14m 5s):
My grandfather used to tell me about an old Italian saying that I love that says the fish rots from the head down. And it’s usually often the leader that causes it. Is that true that you find that really it starts with the leader on whatever attitude or culture there is.

Siobhan McHale (14m 21s):
Culture is co-created and each part within the organization plays a role in the co-creation of the culture. However, culture changes leader led. So if you want to change the culture, you’ve got to get leaders at all levels, actually to step into the role, to change the culture in their parts. But what often happens is that the leaders step into their business as usual role, and they delegate culture change to HR. So they sell that’s the soft stuff. That’s the HR department, I’m too busy running the hospital or running my medical practice. I’ll just give that to somebody else. And that invariably is disastrous for the change effort because the change ends up being seen as HR has responsibility, the line managers, the general managers at every level, just see it as something that’s off to the side.

Siobhan McHale (15m 10s):
That’s nothing to do with them. And you don’t get what I call leader led change without leader led change. It’s usually the benefits will not be realized.

Dr. Anthony Orsini (15m 19s):
Yeah. Do you find that, you know, I get a lot of hospitals that call me and say, my CEO told me to fix this patient experience to fit the culture here, but I don’t have a budget. I don’t have a staff. It’s all me. And he, or she said to me, fix it. I don’t know how to do it, but just go ahead and do that. So I guess if the CEO or the head of the company is really not totally vested in it, it’s going to be difficult.

Siobhan McHale (15m 44s):
Yeah. It is going to be difficult. And often the fix is seen as a technical fix. So many managers try to fix it with processes or policies worked in one organization where they had a safety problem and they implemented about 5,000 different safety policies and nothing changed. In fact, the safety incidents got even worse. So you can help to change the culture with policies, procedures, and systems, but you must also change these patterns or these agreements, these hidden agreements between the parts, because otherwise people find work arounds. They work around the new process, the new tools, the new system, and nothing really changes on the culture goes back to it’s old ways.

Dr. Anthony Orsini (16m 30s):
And it all comes down to how important is the leader to be able to communicate well, because that’s what this conversation is all about, is about conversations that leaders have. How important is communication at every level in order to fix this culture that’s gone toxic.

Siobhan McHale (16m 46s):
I think it’s critical, but I often say communication on its own it’s communication from what role. So I worked with one CEO who was in an infrastructure company and he wanted to create a better, more commercial, higher performing culture. And he had a teleconference with his top 200 leaders. And afterwards he was really frustrated and he said, Siobhan, I’m really frustrated. Nobody on the call said anything, and everybody was just waiting for the call to finish so that they could get back to their jobs, their day jobs. And I said, what role do you, so they’re not really changing anything. We’re not becoming higher performing we’re not becoming more commercial..

Siobhan McHale (17m 29s):
We’re still losing money on our key contracts. And I’m really quite upset about it. And I said, what role do you think that your top 200 leaders are in? And he thought about it for a while and he said, Oh, they’re just in business as usual role. So they’re just involved delivering business as usual. And I said, and what role do you think you’re in? And he said, Oh, I’m in the change leader role. You’re the one change leader and they’re in delivery business as usual role. And as soon as he saw that, he called a conference and brought them all together for a two day event and he reframed their role. And he said, I’m the change leader, but now I’m also inviting you into the change leader role.

Siobhan McHale (18m 13s):
What are you going to do to create a more performance driven and commercial culture within your part of the business? What is your plan? So he reframed the role and the agreement between them, the agreement was they had an agreement was that the CEO would do the change and we can just focus on what we’ve always done.

Dr. Anthony Orsini (18m 32s):
Yeah. That’s a great point. So there’s people out there listening right now, going, okay. I want to improve my culture in your book. They’re hoping right now I can feel it. They’re hoping that I’m going to get some, really some concrete advice from Siobhan. And so in your book, you talk about the culture disruptor and the four steps to positive culture change. So if you don’t mind take us through that. So this whoever’s on the other end, listening to this with their piece of paper and pencil, trying to get some notes, of course, by the book, that’s the best way to do it, but can you take us through those four steps and what you mean as the culture disruptor and that some practical advice?

Siobhan McHale (19m 8s):
Yeah. The first critical step is to diagnose. So it’s a little bit like a doctor. You’ve got to diagnose what’s going on in the culture and you can do that by getting multiple perspectives. So you can’t just talk to one part, you’ve got to talk to multiple parts and figure out what is going on. So mid-block a, and Zed, R and Z is there. You might call them. I walked in there and I was told the people in the branches are the problem, they don’t know how to serve customers. Imagine if I had gone in and put, you know, thousands of people in the branches on a training course, we need to improve your customer service skills. What do you think would have happened would have created even more noise and more discontent.

Siobhan McHale (19m 50s):
But what we did was see the passion of the branches or enroll of order taker. The head office is enrolled of order giver. There’s an agreement between them that they blame each other. We’ve got to reframe that we’ve got to change the operating model. So rather than focusing on the individual is how do you change the operating model and reframe the roles of the parts within the organization, and then enroll your leaders. The third one said, there’s reframing and there’s breaking the pattern. So every day the leaders have to be seeing that pattern of blame and breaking it. Often we collude with the pattern we say, Oh yeah, I really do agree that they are the problems.

Siobhan McHale (20m 31s):
So people pick up on that stop the bland game or whatever the pattern is. Don’t step into that yourself. And then the fourth one is you’ve got to keep your foot on the accelerator and you’ve got to consolidate your gains over the longer term. So many management teams that I see, they go away for a couple of, they have the off-site, they have lots of ideas and brainstorming two weeks later, they’ve run out of steam. So do less three priorities at a time, get those completed and keep your foot on the accelerator for the longer term.

Dr. Anthony Orsini (21m 4s):
I think that’s so important when we do patient experience programs, we do something really silly after everyone is trained. There’s a phase four of our program called see something, say something. And we allow everyone to take the program, allows themselves to be open to criticism in a nice way. And they also allow themselves for positive feedback. So we have these little stickers. Siobhan that just say it’s all in the delivery of the programs, call it to all the delivery and you can give the chief medical officer of the entire hospital and nurse would hear a doctor have a beautiful relationship and a nice conversation. The nurse will give the doctor this sticker that you used to get excited about when you were three years old, going to the pediatrician and this 65 year old man will get so excited about getting the sticker, but it keeps it going.

Dr. Anthony Orsini (21m 57s):
And if someone does something that maybe is not with the culture that we want, the housekeeper can say to the doctor, Dr. Orsini, it’s all in the delivery, it means I call you and that keeps it going. So keeping your foot on the accelerator, I think is a great way of saying that because you fall back into your old patterns don’t you.

Siobhan McHale (22m 14s):
Yeah. And I love that example of one of the ways to fuel that journey because it is a bit like, and marathon it’s a long journey is to get feedback, get that positive energy. And what I love about that story as well is that every body is co-creating the culture. So it doesn’t matter where in the organization where I’m in the hospital, they are, they see themselves as part of the culture journey. One of the things we did today and say, for example, was we implemented a value called lead and inspire each other to, rather than the leaders will be the leaders and inspire people know it’s lead and inspire each other.

Siobhan McHale (22m 54s):
So leadership exists at all levels within your hospital, within your organization.

Dr. Anthony Orsini (22m 58s):
So you’ve done a lot of consulting when you come in and you’re in that first phase where you’re just watching or observing, you’re gathering data when you’re trying to fix culture. And there’s someone, maybe not the top leader, the CEO, but maybe somewhere down the line who is really resistant. I’m sure you’ve come across that many times where they’re not interested in culture change. They’ve been doing it this way. They don’t want to change. And I guess they could even sabotage the whole thing can’t they?

Siobhan McHale (23m 25s):
Yeah. Once you’ve got to realize is that one individual actually represents a part of the culture that is very valid. The culture that exists today came about for a very valid reason. It doesn’t exist in isolation. It came about because if help the organization in some way to adjust to its context, and you start to appreciate that there is a valid reason within its context, why that culture has served the organization in some way, for some of the stakeholders, then you start to appreciate that one individual actually represents probably they’re the tip of the iceberg. There will be more people who think like that, but actually that way of thinking.

Siobhan McHale (24m 10s):
So for example, I worked in a construction company where they were very relationship focused because they had grown up in a soft contract environment where all they had to do was to deliver the project, build the bridge, and they got a hefty margin on top. So what became important in that culture was the relationship with the client. But after a while, the environment shifted to a hard contract environment and actually the culture needed to become more commercial. You couldn’t be giving away favors for free to the client because you’d end up with a budget that was in the red, the project that was in the red, but yet they were still acting like that. They were doing lots of free favors for the clients without charging for the work as if they were still in a soft contract environment.

Siobhan McHale (24m 56s):
Now getting them to change. Why would they change? The client thinks I’m a nice guy. I liked being the nice guy. The clients always asked me for favors for free, build the wall over there and move that pipe three inches. Or could you fix up that leaking valve? And I’ll always do those extra favors for free. So we had to take those people on a journey and reframe their role from relationship managers, to basically commercial leaders who are managing the budget and the relationship with the client and showing them if we continued like this, the company would go out of business, but you can see why they acted in that way. And there was culture, there was a rational reason and the culture always has an internal logic within its context.

Dr. Anthony Orsini (25m 42s):
That’s a great point. I quoted you and your book. You said, culture change is the hardest work you will ever do. And it sounds that way, but can you expand on that? Why is it so hard?

Siobhan McHale (25m 57s):
It’s hard because it’s not a technical task. I think if you want to, people want to build a bridge. There’s a blueprint. If you want to create a budget in an Excel spreadsheet, that’s been done before some technical tasks, you can sit in a room with a few individuals and you can solve for those problems. Whereas culture change is complex. It’s adaptive. There’s no one blueprint that can guide you because every single situation is unique. And it requires a whole range of adaptive skills that leaders haven’t been taught. And this is one of the reasons that I’m so passionate about culture change is that I see in the workplace that leaders are trying to figure this out through trial and error.

Siobhan McHale (26m 39s):
They haven’t been given the toolkit for culture change. And yet we talk about it as one of our greatest assets. But when you ask people, well, how do you change a culture? How do you manage your culture? I haven’t been given a toolkit. So it’s a bit like doing an operation without having the right gear, the right tools.

Dr. Anthony Orsini (26m 56s):
How important is that emotional intelligence? Because that’s the hot topic right now, emotional intelligence for the leaders. Is that something really important? Do you believe that you can teach any leader to be an effective leader and to move culture change in a positive way?

Siobhan McHale (27m 11s):
Of course, emotional intelligence is important, but also I think what we need to appreciate is the power of role and the role that you’re stepping into and giving you a simple example. If you wake up in the morning and role of husband and you speak to your wife and say, good morning, then you might walk down the card or you meet your children. You step into the role of parents, your behavior changes. Then you go into work. You’re the director of a department in a hospital and you step into another role. Then you meet a colleague. You step into role of colleague. Then you are in a meeting where you’re negotiating that piece of equipment, medical equipment for your department. You step into role of negotiator that evening. You go out for drinks with some old school friends, you step into a different role again.

Siobhan McHale (27m 55s):
So in each one of those interactions, you’re still your same authentic Tony. You haven’t changed. You’re still Tony, but you have changed your role and your behavior has changed as a result. Even people who are not great listeners are you, haven’t the greatest IQ I’ve worked with them to say, in this situation, you have to step into role of listener. Now they might say, what are you think? And what do you think? And what do you think that might still be very directive and controlling, but they have stepped into a different role and the role has influenced their behaviors. So I think if we can think about role in the workplace, rather than trying to change who we are and our personality, which is very hardwired, I think we can get a lot more, a lot more change with less noise by reframing role.

Dr. Anthony Orsini (28m 42s):
I believe it can be taught teaching communication. There’s so many people that I come across to just I’m told this person’s a lousy communicator, but it can be taught. And I think, as you said, that particular role may be something that he or she struggles with, but with time you can teach it, right?

Siobhan McHale (29m 0s):
Yeah. Oh, I think you can. And I’m the first step in that is exploring with that person. What role do they see themselves in? And often if they draw a map of that role, it turns out that they see their role purely in technical terms often. So they see themselves as I see myself as a doctor and a deep expert in this specialist area, and I’m helping patients and I’m doing operations or whatever it might be rather than seeing their role in terms of the culture leader in the hospital or in the business. And if they frame their role in that way, then it’s, Oh, if I’m a cultural leader, then I have to do a whole lot of other things that I haven’t been doing. I’ve got to engage with people.

Siobhan McHale (29m 40s):
I’ve got to communicate. I’ve got to keep people updated on where we’re at. So reframing their role can be a first key step, as well as giving them the skills. But often that is a huge impetus on the change journey,

Dr. Anthony Orsini (29m 54s):
Putting them in a position to succeed rather than a position that they’re gonna fail or bound to fail. Now, next question I have is you’ve been an insider or you are an insider, but you’ve also done some consulting work. What are the advantages to accompany that, of having someone inside the versa consulting and what do you find to be easier or harder? What’s the positive and negatives of each one when you’re coming in.

Siobhan McHale (30m 18s):
I think as an outsider, as an external consultant, which I’ve spent half my career, as you have a great advantage, because you can see things objectively, you can see the passions often that people within the organization have become blind to. So you can go in and say, Oh, this is the way it works. And that’s the way it’s happening. And they can go, wow, that’s such a revelation for us, even though it’s so resonant for us. So that’s the big advantage of being an outsider. And often you can name things that it’s more difficult to do as an insider, but as an insider of which I now am. So I’ve been the executive in charge of culture change in a series of multinational firms. One of the great advantages of being an insider is that you’re on the journey over the longer term.

Siobhan McHale (31m 3s):
So one of the things that I found a bit frustrating about being a consultant was flying in and out and you not really on the journey, you’re just coming in and out and flying in and out and not really doing the change just coming in and advising. So being an insider, you roll up your sleeves, you’re in the middle of the change storm and you’re making it happen with the other executives. And that’s very satisfying.

Dr. Anthony Orsini (31m 27s):
So positives to both. Yeah. I find sometimes as an outsider coming in and doing some consulting work, that it’s easier for me because when you’re inside and it’s your home, what’s the old saying the shoemaker’s wife has the worst shoes. And so sometimes when you’re an insider and you have relationships, sometimes you’re not taking this seriously, but as a consultant, also, you leave and you don’t know what happens afterwards, or you worry about what happens afterwards.

Siobhan McHale (31m 54s):
Yes that’s a very good point.

Dr. Anthony Orsini (31m 56s):
I have one last question. This has been great. And so very practical advice. And we’re going to put your book on, on all the show notes. And again, I highly recommend it. I think I warned you about this question because I asked everybody this question at the end, the name of the podcast is difficult conversations. I ask every guest at the end, what is the most difficult type of conversations that you’ve had in your life professional personal, and give us some advice on how you navigate through those.

Siobhan McHale (32m 26s):
So often some of the most difficult conversations are the ones with CEOs where they are, co-creating a culture that’s not working or certain stakeholders. So one example was then that ahead of an infrastructure company. And he was trying to create this culture of accountability and he was failing. And I had a meeting with him and I could see that he was really struggling with this culture of accountability. And when I walked into the room, I could see he was really annoyed. So I said, Oh, what’s up Ben? And he said, Oh, I’m really annoyed. Because, so what’s been happening is that all of us, Tim, the head of marketing three months ago to put a billboard on the top of the building, on the rooftop to advertise our services in the area and this billboard still hasn’t appeared and it’s three months.

Siobhan McHale (33m 18s):
And it’s just another example, Siobhan of a lack of accountability in the culture, rather than thinking on, in a difficult conversation here. And I have to give him this feedback. What I did instead was say, well, who have you spoken to then about this billboard? You know, this miss deadline for the billboard. And he said, I’ve spoken to the head of finance. That’s spoken to the head of HR. I’ve shared it with the head of X, Y, and Z ed person. Instead of talked to a whole lot of people about I’m really annoyed. I said, yeah, but have you spoken to the head of marketing about it, Tim, the head of marketing. And there was a silence, anyone he went, no, and his jaw dropped and he looked at me and he said, Oh my goodness, I’m part of the problem, the passion.

Siobhan McHale (34m 6s):
And I just looked, I didn’t have to have the difficult conversation. I had to ask the right question. And often with my work, I’m looking for what’s going on right now. And how is that happening? And what is your role in that and how, what conversations have you had? And the penny drops. So rather than me thinking the stress of I’m going to have a difficult conversation, now I’ll just go in and I explore what’s going on. What’s whose role is that? What role are they in? What role are you in? And it emerges.

Dr. Anthony Orsini (34m 41s):
Yeah, I’ve loved what you just said, because the old saying is, let them think it’s their idea. And I do this in my book. I talk about the four pillars of conflict resolution. And at the end, that’s number four is let them think it’s their ideas. There’s an old joke that I’ll share with us. As we part there wasn’t a comedian and he was doing a show and he had a big audience and he was talking about marriage. And he said, how many people here have been married 20 years? And a bunch of people raised their hands. Then he says, 30 years, 40 years, he gets the 50 years in this very old couple raised their hand. And the comedian says stand up. And so they stand up and he said, 50 years. That’s amazing. Can you tell us what your secret is? The man puts his chest out the husband and he says, she makes all the little decisions and I make all the big ones.

Dr. Anthony Orsini (35m 29s):
So the comedians, that’s interesting. Give me an example of a big decision. And he said, I don’t know, we haven’t had one yet. So there’s a great example. Is she let him that he was in charge the whole time. I’ll part with that. Siobhan this has been really a pleasure. Like I said, your name always kept coming up and I was so pleased when you said yes, your book is amazing. We’ve got to put it on the show notes. I think culture is so important right now, as I said, six months of doing this podcast, culture, trust leadership, communication comes up every single episode. It’s so important in your professional life, but it’s also important in your private life, the culture of your house and how things run there.

Dr. Anthony Orsini (36m 12s):
And so I’m really glad that you were able to give some really practical advice to the audience. And what’s the best way for them to get in touch with you. Probably LinkedIn, you can follow me, connect with me on LinkedIn. That’s fantastic. And we’ll put all those links in the show notes in case you’re driving. I don’t want you to stop or pull over. So we’ll put that all in Siobhan. Thank you again. Really appreciate you coming on.

Siobhan McHale (36m 36s):
Thank you, Tony, for having me as a guest and for all the great work you’re doing in the space.

Dr. Anthony Orsini (36m 40s):
If you like this podcast, please go ahead and hit subscribe. If you want to hear more about The Orsini Way and the programs that we do here, you can reach me at Dr. Orsini@theorsiniway.com. Siobhan thank you. Have a great day. Appreciate everything. If you enjoyed this podcast, please hit the subscribe button and leave a comment and review you. To contact Dr. Orsini and his team, or to suggest guests for future podcast. Visit us at TheOrsiniWay.com.

Conversations about Second Victim Syndrome

Dr. Susuan Wilson (2s):
So the classic definition of second victim syndrome is the impact of an unanticipated adverse medical event on a clinician. So the concept is the patient is the first victim of the bad event, but the clinician and this really applies to anyone, so any member of the healthcare team, whether it’s the physician, mid-level provider, nurse, pharmacist, tech, anyone involved in a case. So they become the second victim. And there are some very well described symptoms that come along with these episodes. So they’re both physical symptoms and psychological symptoms.

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 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 29s):
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. That 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, 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 24s):
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. 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 will be your host again this week. Well since our first episode on August 4th of 2020, we’ve had a variety of guests from both healthcare and the business sector.

Dr. Anthony Orsini (3m 8s):
And if you’ve been listening on a regular basis, you’ll probably recognize that there’s many parallels and overlap between the two. Now a frequent topic during the healthcare episodes has been physician burnout and the high suicide rate among physicians and healthcare workers. In fact, one of our earliest episodes, I interviewed Dr. Dike Drummond, who literally wrote the book on burnout. And if you haven’t heard that yet, I highly suggest that you go back and listen after this interview because it’s really very inspiring and you can learn a lot. Well today I have another physician and coach who’s here to talk about physician and nurse wellbeing and a topic that I must admit I knew very little about before I spoke to her.

Dr. Anthony Orsini (3m 51s):
And that’s the topic of second victim syndrome. My guest today is Dr. Susan Wilson. Dr. Wilson has been practicing emergency medicine since 1994. After attending Loyola school of medicine in Chicago and completing her residency at the medical college of Wisconsin in Milwaukee she retired from clinical practice in June of 2019. Wanting to maintain involvement in medicine, Dr. Wilson completed coursework in coaching, forming SJW professional coaching services, LLC, with the goal of providing guidance and support the healthcare professionals, her 25 years as a hospital-based board certified physician has afforded great insight into the challenges of medicine into this arena.

Dr. Anthony Orsini (4m 37s):
Having seen the evolution of medical practice and witnessing firsthand how these changes have impacted her colleagues, Dr. Wilson sees professional coaching as an important tool to addressing issues of burnout among health care providers. She is currently affiliated with vital worklife, EAP and surgeon masters as a physician peer coach. She is a member of physician coaching Alliance and also serves as a volunteer physician coach for California medical association. Susan is particularly passionate about second victim syndrome, which I find fascinating. So please keep listening. You’ll learn a lot. It’s an extremely important topic.

Dr. Anthony Orsini (5m 17s):
And one that every healthcare provider should know about and every patient should care about. Susan has been a Midwesterner her whole life, and I’m happy to get an opportunity to learn from her today and to truly be inspired, Susan, welcome. And thank you for taking the time out to be a guest today.

Dr. Susuan Wilson (5m 34s):
Thanks so much. It’s great to be here. Great. To be able to talk about something that’s very near and dear to my heart.

Dr. Anthony Orsini (5m 41s):
I just said, told everyone you’re at Midwestern your whole life, but you just told me right before you’re in California, at least for a few months now, is that correct?

Dr. Susuan Wilson (5m 47s):
It is. Yes. I’ve been in actually did my entire career in the Milwaukee area. And I’m originally from Northern Illinois and yeah, now just spending a few months of the winter in California, but otherwise in Northern Wisconsin during the summer.

Dr. Anthony Orsini (6m 4s):
Fantastic. So last time we spoke, you told me about your journey and it’s fascinating and how you got here. And I really want to talk about second victim syndrome about coaching. And of course this is always about difficult conversations, but I also love to start out with having my audience, get to know you. So if you just tell us about who is Susan Wilson, how did she become a physician and how did she kind of evolve into now doing what you’re doing now?

Dr. Susuan Wilson (6m 29s):
So I actually am from a medical family. My mother was a practicing internist. And so that subsequently spurned me on to go into medicine. And so I have done all my training, as I said in the Midwest. I started practicing emergency medicine back in 1994 and actually had to retire last year in June, 2019 because I have developed this progressive retinopathy. And so my vision has become an issue really to the point where I couldn’t practice effectively anymore. So I had to retire. And then I was thinking a lot about what I wanted to do, what the next chapter would be.

Dr. Susuan Wilson (7m 10s):
And I really still wanted to be involved in medicine and I really wanted to still be interacting with my colleagues. So I thought, well, coaching would be a great way to do that. Especially, you know, given the fact that people seem to be having a lot of struggles now with job satisfaction and burnout. And so I really wanted to try to help my colleagues with that piece. And then also I’ve along the way, become super interested in the concept of second victim syndrome. And so also really wanted a way that I could continue educating my colleagues about the syndrome and the fact that there is actually help out there and their support.

Dr. Anthony Orsini (7m 53s):
Fantastic. And before we get into the second victim syndrome, if anyone has not heard the interview with Dike Drummond, but if you’re in healthcare, you really know that physician burnout is a problem and suicide rates of physicians higher than any other profession, which most people that I meet do not know. I just like your point of view now that you’re coaching, and this is an issue that you deal with all the time, how bad of a problem is it, and what do we really need to do to kind of bring these suicide rates down? Just tell us your feelings about how we can stop this terrible thing from happening.

Dr. Susuan Wilson (8m 26s):
Well, you know, it is the more and more I learn and I hear about burnout, particularly in medicine. It’s just become very clear that, I mean, it’s a multifactorial issue. And really, I think traditionally, you know, you think about somebody getting burnt out, you think there’s something actually wrong with them and that they can’t handle the job. And there’s an inadequacy there, but more and more, I think we’re seeing that it’s not the physician. It’s really the environment that they’re in, that’s causing them to become burnt out. And you know, it’s interesting, there’s actually an article. You may be familiar with this that came out just this year.

Dr. Susuan Wilson (9m 9s):
I think in July in JAMA talking about the kind of correlation between resiliency, particularly in physicians and burnout and what the article pointed out was number one, that physicians have higher resiliency rates than it, than the general population, but then also there’s still a significant amount of burnout even in the most resilient physicians. So I think what they quoted in this article was like, even the physicians that scored highest and resiliency still had up to a 30% rate of burnout. And I think what that speaks to is, you know, the idea that really, it’s not the physician they’re already super resilient and they’re already coping with challenges, but what are speaks to, I think is the fact that we really need to change the environment that we’re practicing in.

Dr. Susuan Wilson (10m 2s):
And so then you’re starting to talk about trying to reach out to the healthcare organizations, the administrators, and really get the culture to change. And I think that’s the big challenge right now. I think getting that message out there to the big organizations is the strategy that really needs to happen.

Dr. Anthony Orsini (10m 23s):
It seems to me and from my own personal views, and I’m getting ready to interview Quint Studer, who you may be familiar with. The founder of the Studer group and Quint is a very successful entrepreneur, but also very successful person in healthcare does a lot of really successful stuff with patient experience, but also is a really world-known speaker on leadership. I just finished reading his last book. They talked about the importance of employee engagement and the success of a company. My personal view about physician burnout is very similar to employee engagement. I think in the 26, 27 years that I’ve been practicing I personally feel that the patients appreciate us just as much.

Dr. Anthony Orsini (11m 9s):
I don’t believe that administration and, and the leaders in healthcare appreciate us. Do you think that’s a major role? Am I dead on with that? That it’s really not feeling like you’re not appreciated at the end of the day.

Dr. Susuan Wilson (11m 21s):
Yeah, I really think there’s a lot to that. You know, it’s kind of interesting when I think about, I mean, I’ve been observing the changes in medicine really for 40 years. I mean, when I think about what I remember my mother’s practice was as an internist and that I think about my own career, I think about how I have observed the shift from, you know, physicians practicing independently or being members of independent groups to now the vast majority I think are employed and the whole transition, you know, from handwritten clinical notes to an EMR, but the pressure that’s put on the physician, you know, to see more patients more quickly.

Dr. Susuan Wilson (12m 5s):
And I don’t think, I mean, just from what I’ve observed, I don’t think necessarily that those challenges have been really appreciated by administration, but how difficult they are. So I definitely think that there has become a progressive disconnect between the physician and the practice and what they’ve been asked to do and the administrators.

Dr. Anthony Orsini (12m 29s):
And if you’re a physician out there, I think you’re going to relate to this. If you’re not a physician, you’re probably going to learn something, but on a journey of a physician, you’re a medical student and then you say, if only I can get past this, I’ll do better because I’ll be a resident I’ll have more control than you realize you’re the low resident on the totem pole. If only it could be the chief resident that I’ll have more control. If only I could be the attending physician, I’ll have more control and you work your whole life towards this autonomy. And then you find out that you never get it. And I think that’s what, in my opinion is, what’s leading to this and that’s why we need coaches like you. And we’re going to talk about your coaching style and your theories about that in a second. I think I want to tie that in what second victim syndrome be honest with you.

Dr. Anthony Orsini (13m 12s):
I had never heard a second victim syndrome until we spoke and I know my audience out there is going, I need to know what this is. So tell us about second victim syndrome and why it’s such a problem.

Dr. Susuan Wilson (13m 23s):
So I have to say, interestingly, I had never heard this term myself either until 2017 when I went to a lecture. And so, you know, I’ve been practicing well, I had practiced up to 25 years until, until I retired. And I realized after hearing about it, I have been living this my entire career. So yeah, it’s something that just, I observed that the majority of physicians really don’t know. I mean, I think they know what it is because they’ve experienced it, but they don’t know that there’s a name for it. And so the classic definition of second victim syndrome is the impact of an unanticipated adverse medical event on a clinician.

Dr. Susuan Wilson (14m 6s):
And so the concept is the patient is the first victim of the bad event, but the clinician and this really applies to anyone. So any member of the healthcare team, whether it’s the physician, a mid-level provider, nurse, pharmacist, tech, anyone involved in a case. So they become the second victim. And there are some very well described symptoms that come along with these episodes. So they’re both physical symptoms and psychological symptoms. And for example, the physical symptoms are things like elevated heart rate, high blood pressure, GI symptoms are pretty common like nausea, even vomiting and diarrhea, sleep disturbances.

Dr. Susuan Wilson (14m 52s):
And then there are a whole host of psychological symptoms that come along with this, including things like feeling, shame, grief, feeling irritable, feeling inability to concentrate, certainly lack of self-confidence is a big one. People oftentimes will describe stress and anxiety. That’s increased depression and even suicidal ideations really fall into this category.

Dr. Anthony Orsini (15m 20s):
So it’s, so something happens at the hospital, which is inevitable because we’re human beings. There could be a medical error. There could be no medical error, right? Just the death of a patient that you’ve bonded with. And I’m a big proponent of not blocking our emotions because I think that makes things worse. And, you know, with my patient experience teaching and my teaching with breaking bad news, I tell doctors all the time it is okay to show emotion. In fact, it helps, but basically second victim syndrome is something happens that doesn’t go perfectly well. And we often think that maybe as lay people or physicians, you know, the patient dies. There’s a medical error. We feel bad, but we carry that with us a long time.

Dr. Anthony Orsini (16m 2s):
Correct?

Dr. Susuan Wilson (16m 3s):
Oh, absolutely. Absolutely. And as you alluded to, I mean, I think medical error is probably the number one cause of this syndrome, but there are so many other scenarios that fit this and, you know, complication of a procedure. If you miss a diagnosis or you’ve had delay in diagnosis, obviously a patient death, all of these things really can then contribute to this feeling. And I actually even would put the whole concept of medical malpractice lawsuits in here because I really think that, you know, a physician or any healthcare professional that’s named in a lawsuit, really, it brings up a lot of these, both physical and psychological symptoms.

Dr. Anthony Orsini (16m 47s):
Most people don’t really understand that this is how this really affects us. I had a colleague that I really looked up to. He had practiced neonatology for many years in New Jersey. He was phenomenal with patients and with families. And he had gone his whole life really with no malpractice lawsuits. And then something happened with a baby who needed to have their eyes checked after they went home for retinopathy of prematurity, which is a common blood vessel disease of premature babies. He had documented multiple times that the mother had to follow up and it was in writing and the mother for some reason did not.

Dr. Anthony Orsini (17m 29s):
And the child sadly went blind because of no followup. And really, I don’t know what else he could have done just on a personal note to explain, but whatever. So he got sued and although the documentation was there and they settled and you know, he watched the lawsuit, but I got to tell you, Susan, he was probably 30 years into his practice. Every day he came into the office. He was thankful for being a physician. And on that day that he lost the lawsuit. I can tell you, it was never quite the same. So you don’t have to do something wrong or cause a medical error, just the act of being sued.

Dr. Anthony Orsini (18m 10s):
He just felt he took it personally, which she probably shouldn’t have, but we’re human beings. Right? You counter that a lot too, just with the malpractice that these people just can’t get over it.

Dr. Susuan Wilson (18m 19s):
And you know, I even think to my own career and to my own personal second victim experiences and yeah, I mean, even if you know, you did everything possible and you did everything correctly. Yeah. You just, you know, there is just, there’s an emotional scar there. And I think the challenge in these situations is how to get through that, how to deal with it. And interestingly, one of the things that we learn about second victim syndrome is there’s a very well-defined recovery trajectory and there’s all these different stages that people go through. It’s kind of like the Kubler-Ross stages of grief.

Dr. Susuan Wilson (18m 60s):
And after you’ve gone through all these different stages, the very final stage is moving on. And so people will either thrive, survive, or they’ll drop out. And so I think what happens to a lot of us and I think it’s, I think it depends on the scenario. I think you can certainly thrive through one scenario and maybe you’re just surviving through another. But basically what happens is if you’re thriving, you’ve learned something from the event, it makes you a better clinician. You kind of get in the long run, it’s sort of a positive experience that kind of spurs you on in your career. Then the whole idea of surviving is that you have gotten through it, you are figuring out how to cope, but you still have, you’re having a really difficult time forgiving yourself.

Dr. Susuan Wilson (19m 51s):
And so you sort of have this permanent emotional scar. And so while you’re still practicing, you’re still going through the motions. Yeah. It’s just there and it changes you. And then as I said, there’s even some people that just after an episode like this, they completely drop out. So whether they quit where they’re working and find another group to join and to have a fresh start, whether they leave the specialty of medicine that they’re in and go into something else or whether they leave medicine altogether is certainly a possibility.

Dr. Anthony Orsini (20m 22s):
That’s where you come in. We need physicians to stay on the job. We need nurses to continue. Especially during this crisis, I come from a family. I’ve mentioned this before in previous episodes, you came from a medical family. I come from a family of police officers. They’re all police officers, except for me, I went into medicine obviously, but my father who was a police officer for 30 years, said to me, when I entered medical school, he said, there’s only two people in this that have to be perfect every time. And that’s police officers and doctors. And that kind of stuck with me, especially pertinent right now, right with what’s going on in the news. But what people forget is that police officers and doctors are human beings also. And human beings by definition are not perfect.

Dr. Anthony Orsini (21m 5s):
And I think we need to recognize that for ourselves and for other people that we make mistakes. It doesn’t mean that we’re a bad person and it doesn’t mean that we’re mean, but we often make mistakes. So how does this work now? So let’s assume there’s a physician there. If he or she is feeling very depressed or feeling a little burnout, there was possibly an event that occurred and now they need some help. How does it generally happen? Did they reach out to you? How do you get that referral? Is it mostly from someone else or that he says, find you and say, Susan, I need some help.

Dr. Susuan Wilson (21m 43s):
Well, I think, you know, there’s multiple ways to get the help. And I think the one thing that I would like to kind of point out is that the second victim scenario, I really kind of feel like that is an acute event. Whereas somebody seeking coaching for issues of job satisfaction or burnout, that’s kind of more of a chronic ongoing process. And so it’s almost like, I think an analogy to make would be, you know, you go to your primary care doctor once a year for your, like your annual checkup and you have your ongoing medical care, you’re checking your cholesterol, blah, blah, blah. And these second victim events are really more like unscheduled care.

Dr. Susuan Wilson (22m 25s):
So it’s like, you know, you cut your finger and you have to go to the urgent care to get it sewn up, or you’re having a heart attack and you need to go to the emergency department. So the coaching strategies for both those with burnout and job satisfaction, and then those with second victim scenarios, the principles are kind of the same, but it’s just getting the help in a timely fashion specific with second victim. So in terms of how to get it. So in terms of the second victim scenarios, there are actually several large hospital organizations that have established what’s called peer support processes.

Dr. Susuan Wilson (23m 6s):
And that is peer support is what we describe as the treatment, if you will, for second victim syndrome. And so like for example, John Hopkins has this, their program is called RISE resilience in stressful events. And then university of Missouri has the four U team. And that actually is basically a team within the hospital that responds like within, I don’t know, 30 minutes to someone that has experienced an adverse event. So those are ways to get help quickly through hospitals if they have these programs in place. But challenges that I think the vast majority of institutions across the country don’t have these kinds of things.

Dr. Susuan Wilson (23m 51s):
So oftentimes what happens is that if someone, if a clinician is identified as being a struggling after an event, they’re oftentimes referred to maybe HR or maybe their EAP and then the EAP would in turn, refer them. I work at, I’m actually a consultant with an employee assistance program, which is EAP who specialize in providing services for healthcare organizations. And I’ve actually set up a protocol or process with them that if a client is referred to them specifically for a critical event, like a second victim scenario that they connect with me immediately, and then we get the ball rolling to provide the support because it is really important for these people to get the support in a timely fashion.

Dr. Anthony Orsini (24m 43s):
What percentage of people that come to you after a second victim event come reluctantly? And what portion do you think are really seeking help?

Dr. Susuan Wilson (24m 51s):
Well, it’s interesting. So the people that I’ve been helping so far with the peer support piece have come to me through the EAP and one of the gals, she didn’t even know that this was even a benefit that she could access. So she didn’t know anything about, you know, the service that the EAP offered. It was only when she was in crisis that she had a supervisor say, Hey, you know, let’s get you some assistance. So I think it’s kind of, it’s kind of all over the board. I think some people are aware of it, but the vast majority, and again, I’ve worked with mainly physicians, but the vast majority of the physicians that I’ve worked with don’t necessarily know that this is even available for them.

Dr. Susuan Wilson (25m 36s):
And so that’s the piece. I think it’s really important to get the word out that yes, coaching is out there. It’s both for you for ongoing support to help you realize your ultimate goals in terms of your work, but that also it’s there for you for these acute events as well.

Dr. Anthony Orsini (25m 56s):
We think we’re Superman and Superwoman and I can handle it. And until you can’t and I think it would be really nice if we can convince physicians that you don’t have to be as Superman or Superwoman and that it’s okay to go to a coach or a psychologist. And so I think my guess is, and tell me if this is true, that there’s a whole bunch of people out there that need your help and need coaching. That just don’t even know they need it or know they need it and won’t come.

Dr. Susuan Wilson (26m 29s):
Absolutely well. So interestingly, I think some of the data about second victim syndrome mirrors some of the data regarding burnout. So I’ve heard like burnout up to maybe 50% of physicians feel burnt out. So the data with second victim syndrome is that it’s estimated that 50% of all healthcare professionals will experience this at some point in their careers. And I really do think that number is probably closer to a hundred percent because I feel like if you are in a profession where you have any significant interaction with a patient, this is going to happen at some point.

Dr. Susuan Wilson (27m 10s):
I mean, you know, you may not have somebody die, but you know, some, something will happen that you will, that will trigger this feeling. And then of the people that even admit that they have suffered this right now only 30% of those are even seeking help. So the vast majority obviously are just suffering in silence. And again, I think part of that is because of, as you talked about, you know, the stigma notoriously, you know, physicians feel like they just can handle anything themselves and they don’t want to seek out help. But then also just not knowing that this kind of support is available.

Dr. Susuan Wilson (27m 50s):
So, yeah,

Dr. Anthony Orsini (27m 52s):
So I interviewed Helen Riess, Dr. Helen Riess psychologist, and one of my earlier interviews and Dr. Riess wrote a great book. And Alan Alda was the writer of the foreword for her book. And I often joke that I became a physician because I was a big mash fan. And I know mash probably every episode, every word is just my thing. But when you really think of Hawkeye Pierce, as you were speaking about second victim syndrome, you were speaking about physician burnout. And I know there’s a lot of people that are listening right now that are so young, they’re going, what’s mash. But if you’re old enough to know what my peers had, classic physician burnout, he was someone who, and in the end, I think it’s the last episode.

Dr. Anthony Orsini (28m 37s):
He actually has a breakdown, a mental breakdown. And I think this happened a lot during the war, from what I read, you know, just seeing people die over and over again. So I just went off on a tangent, but just classically Hawkeye Pierce just came into my mind. So now they come to you and how do you help? You know, I come to you, Susan something’s happened, I’ve been referred EAP. How do you take me on that journey of feeling better?

Dr. Susuan Wilson (29m 4s):
First of all, I will say that as I’ve mentioned earlier, the quote unquote treatment for second victim syndrome is this whole concept of peer support. And so I will say that physician coaches, I think are uniquely qualified to provide this kind of support because not only are they a peer, but they also have these specific training of coaching skills. So these kinds of conversations really require strategies that we’ve all been taught as coaches. So for example, so when I have someone that I’m talking to specifically about a critical event, it needs to be obviously a very confidential conversation.

Dr. Susuan Wilson (29m 48s):
They need to be reassured that it’s just the two of us. It’s non-judgemental I think the important thing for any healthcare professional experiencing this is to know that they have a safe space when they’re talking to you. And so by ensuring that they have the safe space, then they feel comfortable. They can vent, they can say whatever they want and it’s okay because, you know, this is where they are certainly the types of questions that we have been trained to ask as coaches they’re called open-ended questions. And they are very important because that’s kind of then allows the clinician to really elaborate on how they’re feeling and maybe getting some new perspective and new insight into the event for themselves.

Dr. Susuan Wilson (30m 39s):
And so the initial conversation really is kind of establishing a relationship with the individual. And then the other piece of it, it’s really important to have several conversations, you know, to have follow-ups. So for example, when I’ve had peer support interactions with people, I’ve had at least four different conversations with them, so that, you know, we’re kind of, you know, making sure that they’re kind of heading in the right direction in terms of their thoughts and their emotions. The other piece of it is that if you’re having these peer support conversations with someone, certainly as a physician coach, we know what it looks like for somebody to have a significant mental health problems.

Dr. Susuan Wilson (31m 22s):
So if you identify that somebody now looks like they are clinically depressed, they’re having debilitating anxiety recognizing that, and then being able to refer them for a higher level of mental health care, whether that’s a therapist or a psychiatrist is important.

Dr. Anthony Orsini (31m 39s):
Yeah. And so this is not a short journey back. This is something that takes a long time with you. And then even afterwards, I would think that, especially in a medical error, I weep for the ones out there, God willing, it won’t happen to me. But as you said, it’s something happens to all of us that is feeling that they need help and don’t seek that out. And I think that’s what happens with the physician suicides. We had, I know somebody from a colleague that did do that sadly, and we don’t really understand what that is. And I think part of that is our ego. We really got to get over that ego and ask for help and people like you and other people now, I think physician coaching is getting exponentially more popular.

Dr. Anthony Orsini (32m 25s):
Isn’t it?

Dr. Susuan Wilson (32m 26s):
Yeah. You know, interestingly, I just was a part of a physician coaching summit this past weekend and yeah. You just realize there’s so many people out there that are practicing coaching. Interesting a lot of the physician coaches that I’ve encountered so far have come to coaching because of their own burnout story. And the thing I kind of feel is a little unique about me is that I left medicine, not because I was burnt out, but because I had to physically. And so I kind of feel like, you know, what, I still, I mean, I love medicine.

Dr. Susuan Wilson (33m 6s):
I always have, it’s always been a part of my life. And I loved like, you know, you hear a lot of people talking about how they just absolutely, you know, they couldn’t stand medical school or residency or anything. And I actually have really fond memories of both medical school and residency. And I kind of feel like I, through my career was able to find the formula to make it really satisfying for me. And so now as a coach, I want to help others find their own formula because I do feel that as we’ve talked about earlier, with all the new challenges that have kind of developed in the last 25 years, that people do need a little bit more guidance and a little bit more support in terms of finding where do they fit in and how can they feel really good and really satisfied and fulfilled with their career in medicine.

Dr. Anthony Orsini (33m 57s):
And I do a fair amount of coaching as well, but on a totally different end, my coaching as you know, is to help that physician and that nurse communicate with their patients, build better practices, enjoy their job more. So it’s a different end, but an event it’s also physician coaching. And I don’t think we’ve all had coaches in our lives. There’s no reason why we shouldn’t keep having coaches and mentors, especially when there’s areas that we need help for. And there’s not a lot of people that turn to, so that’s why people like you are just so important to our profession, especially at this time during COVID, it’s been much harder on healthcare professionals.

Dr. Anthony Orsini (34m 37s):
As I mentioned in one of my previous podcasts where the general public is looking out and seeing things like healthcare heroes, and we’re seeing pictures on TV of these doctors and nurses who are working 24 seven during the COVID crisis. But those of us working in the hospital and also seeing the other end with the burnout, the nurses who are getting furloughed doctors who are losing their practices. And so we only see the one end, it looks like to the public that every doctors and every nurse is working 24 seven, but because of all the elective procedures and everything going down, actually many nurses have lost their job. And so that makes it even harder. Susan, before we break, I always ask everyone the same question last and most people say it’s the hardest one.

Dr. Anthony Orsini (35m 23s):
So get ready. You have a lot of difficult conversations. And is there one conversation that particularly stands out or it could be a type of conversation that you can point out that is the most difficult and then teach the audience something about how you approach that?

Dr. Susuan Wilson (35m 40s):
So I, in terms of coaching, I would definitely say that the peer support conversations are the most difficult. And the reason I say that is because I am entering into this relationship with these clinicians when they are truly in crisis. And so, you know, that is the challenge. I will say, even though it’s the most difficult conversation, I have definitely found it the most rewarding because I really feel like in a relatively short period of time, I mean, when I have my follow-up conversations, I mean, these are occurring over like two weeks. So I may have four conversations with somebody over the course of 14 days, because I want to make sure that they are getting through that they are coping, that they are finding ways to, you know, wrap their head around what’s happened.

Dr. Susuan Wilson (36m 31s):
And so it is really rewarding to me when I go from the first conversation where somebody may be actually crying and in tears for 20 minutes to maybe the fourth conversation where I can just tell, I can just hear it in their voice, they’re much stronger and they’re kind of regaining their old self back. So that is the most challenging for me, the way I approach those is as kind of, we talked about earlier, really reassuring the clinician that, you know, this is confidential. I’m not writing anything down. This is just me being here for you. I’m just providing you emotional support. And so this time is for you to vent and say what you want to say.

Dr. Susuan Wilson (37m 11s):
And then I do probe a little bit in terms of asking them, how are they doing, who is supporting them? I think one of the other things that’s super important, both in peer support and in regular coaching is ensuring that the client has some kind of self care that they’re following. Because I think we all tend to sacrifice our own personal self care for that of our patients or our career.

Dr. Anthony Orsini (37m 41s):
So for the person who, Oh, I’m going to ask two follow up questions. One is the person who’s in the hospital, doctor, nurse, who recognizes someone that they care for care about and kind of starts to see this physician burnout or an event has happened. Can you give me or someone else some advice on how to approach that person? I mean, that’s gotta be a really difficult conversation.

Dr. Susuan Wilson (38m 9s):
So if it was me and I identified, one of my physician colleagues in the emergency department seemed to be struggling or just wasn’t doing well. I think the first thing I would do is I would just ask them, you know, how are you doing? And you just kind of allowing them and, you know, and probably they’re going to say, Oh, I’m fine. Everything’s cool. And then trying to gently probe, I mean, obviously you don’t want to push somebody and you can’t force something on someone that, you know, they don’t want, but I think then my follow up would be, well, you know, I just want to make sure everything’s okay. It just seems like maybe some of the situations that we’ve been in recently seem like they’ve been really difficult and I want to make sure that you’re feeling okay with that.

Dr. Susuan Wilson (38m 57s):
And I just want you to know that I’m here and I’m happy to talk through some issues with you. And I think, you know, just being gentle and just kind of letting people know that you care. And certainly we as physicians that we empathize with our colleagues, I think that’s super important, you know, not being condescending and not trying to be in a superior role. I think letting them know that you want to collaborate with them to help them find a better solution or you want, you know, you’re a colleague and you’re an equal, I think that’s really important.

Dr. Anthony Orsini (39m 30s):
And having someone that you can recommend I think would help. So before you have that conversation and say, listen, I know this great person, and she’s done some great things and you know, why don’t you just call her it’s can’t hurt, you know, let’s refer her to, so that’s where you come in and other physician coaches. So having said that as we finish up, what is the best way for people to get in touch with you, whether they want you to speak more about second victim syndrome, or they need some help or they want to refer somebody what’s the best way to get in touch with you.

Dr. Susuan Wilson (40m 4s):
So I actually have a website it’s S J W professional coaching.com. And that kind of gives a little bit more detail about my coaching services talks about the methodology that I’ve used. And then my email is Susan WilsonMD@gmail.com. And certainly anyone is welcome to connect with me either on that email or going to my website. I do want to emphasize that there is so much overlap between the whole concept of burnout and second victim syndrome.

Dr. Susuan Wilson (40m 44s):
And I really think it’s important also for clinicians to understand that if you do seek out coaching, that doesn’t mean that there’s anything wrong with you. It’s kind of like having a personal, yeah, it’s kind of like having a personal trainer. Like when you go to the gym, you have your personal trainer, that’s helping you optimize your fitness. So I kind of feel like the coaches just really helping you optimize. There’s so many different aspects in people’s lives that they can get coaching for. It’s not all about just your job, there’s personal issues, but whatever it is that you really want to improve, or you want to optimize coaching can really help that.

Dr. Susuan Wilson (41m 25s):
And that does not mean there’s anything wrong with you. It just means that you are trying to be the best you can be.

Dr. Anthony Orsini (41m 31s):
Oh, that was a great analogy. How ironic is that? You know, if you tell somebody, Hey, I’m going to LA fitness and I have a personal trainer, everybody goes, wow, that’s really cool. But for some reason you don’t say, Hey, I’m going through this coach to work on my mind. So that’s just a society thing that we have to get over with. But, and for those people listening, Susan, there’ll be, all of your links will be on the show notes. So we just go to the show notes, the links will be there to contact Susan. So you don’t have to worry about writing it down. It’ll be all there. Susan. This has been really very inspiring and enlightening. And I think my audience really got a lot out of this and most of the healthcare people out there now know what second victim syndrome is.

Dr. Anthony Orsini (42m 10s):
And we just have to keep pushing to tell physicians and nurses that it is okay to say, I just need to speak to somebody and we’re a long way there, but I think we’re getting there. So thank you so much. This was great.

Dr. Susuan Wilson (42m 25s):
Well, thank you, Tony. I really appreciate the opportunity to talk about this because as I said, I’m really passionate about the subject and you’re right. I think just continuing to try to get the message out there and educate our fellow healthcare professionals is so important.

Dr. Anthony Orsini (42m 41s):
Well, we’re going to push this episode on social media. I’m going to take a screenshot of you as soon as we’re done with this interview. So we can post that. If you liked this episode, please go ahead and hit subscribe. This is available on Amazon, Apple, Google play, Android and Spotify. So please go ahead and hit subscribe this way you’ll get automatic downloads every week. This episode drops every Tuesday. If you want to hear more about the Orsini way and what we do for coaching and also for patient experience in breaking bad news, please go to the Orsini way.com and you can contact me through that, Susan. Thanks so much. And thank you again for being on this and I can’t wait for this to drop so everybody can hear it.

Dr. Susuan Wilson (43m 19s):
Thanks again, Tony. I really appreciate it.

Dr. Anthony Orsini (43m 22s):
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 to find out more, go to the Finley Project.org. Thank you. And I will see you again on Tuesday.

Announcer (43m 52s):
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 TheOrsiniWay.Com.

Connect and Be Heard with Dr. Kevin Pho

Dr. Kevin Pho (0s):
Social media while blogs at that time had really the power for us to extend our influence, extend our voice outside of the exam room, where doctors can, instead of traditionally talking one-to-one to patients in the exam room, we now could talk one to many. And I think that idea has only snowballed over the past few years because we have these really influential platforms for better or for worse. And we’re going to be talking about some of the downsides of that, but I think that that influence is something that I’ve been talking about for the last 15, 16 years and how it’s really important for physicians to really get online and use these platforms to influence patients outside the exam room.

Announcer (42s):
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 28s):
Well, 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. 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 11s):
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. Well, welcome to another episode of difficult conversations lessons I learned as an ICU physician.

Dr. Anthony Orsini (2m 51s):
This is Dr. Anthony Orsini. You guessed it, I’ll be your host again this week today, we have a very special guest and the audience is really in for a special treat today because my guest today is Dr. Kevin Pho. Dr. Pho is a Practicing board, certified internal medicine physician, a nationwide media commentator, and coauthor Of the book establishing, managing, and protecting your online reputation, a social media guide for physicians and medical practices. He has been a leader in healthcare, social media since 2004. And if you are a healthcare professional, you likely know about the Kevin MD website, Dr. Pho built the Kevin MD platform from scratch in 2004, and now receives over 3 million monthly paid views and exceed 250,000 followers on Facebook and Twitter.

Dr. Anthony Orsini (3m 42s):
Kevin has been named the Web’s top social media influencer in healthcare and medicine. The New York times called Kevin MD, a highly coveted publishing place for doctors

Dr. Kevin Pho (3m 53s):
And patients, Forbes magazine

Dr. Anthony Orsini (3m 54s):
Called Kevin MD, a must read health blog and CNN named @Kevin MD. One of its five recommended Twitter health feeds as a highly sought after keynote speaker. Kevin shares his story nationwide with both clinicians and non-clinicians. His signature keynote connect and be heard, make a difference in healthcare with social media takes the audience through Kevin’s social media journey since 2004, with video audio and an emphasis on storytelling. He inspires audience to use social media and be healthcare influencers. These perspectives define his unique social media journey, and the story has brought audiences to their feet.

Dr. Anthony Orsini (4m 35s):
So welcome, Kevin, I’m excited to have you as a guest this week, and I’m sure my audience is in for a real treat.

Dr. Kevin Pho (4m 40s):
Thank you so much for having me on the show.

Dr. Anthony Orsini (4m 44s):
So one of the things I stress about teaching communication to healthcare professionals and business leaders is that to be a true leader and build a trusting relationship, you must be a genuine person. So what I mean by that is that in order for patients to trust us, they must first think of us as real people and they have to get to know us. And I go through some exercises on how to share personal information with patients so that you you’re a real person. It’s also important for leaders when they’re trying to be good leaders for their employees.. So if you don’t mind, let’s just take a moment to tell my audience who Kevin Pho is. Tell us a little bit about yourself, your journey, and how you got to where you are with the Kevin MD website.

Dr. Kevin Pho (5m 28s):
Sure. I’m an internal medicine physician. I practice in Nashua, New Hampshire. I’ve been here for almost 20 years now. I trained at Boston university, so not too far from here. And I still practice. I see patients two and a half days a week. And as you mentioned, I’m also the founder of Kevin MD, which I founded back in 2004. And what that is, is a platform on Kevin md.com, but also on Facebook, Twitter and LinkedIn, where people across the healthcare spectrum can share their stories. And I often say, it’s, we hear the stories of those that we don’t normally hear from in the healthcare world.

Dr. Kevin Pho (6m 7s):
Because a lot of times when patients think about their doctors, they think about doctors making a lot of money. They don’t think a lot about some of the issues and obstacles that doctors have when we’re treating patients. So I want to have a platform where doctors can really share those stories behind the curtain that they talk about things like physician burnout. We talk about things like student loans. We talk about healthcare reform, and of course over the last year, we talk about the trials and tribulations of the coronavirus and COVID-19, and the effects of the pandemic has on the medical profession. And now we talk about the vaccine and although my audience and my writers are primary clinicians, I also have a lot of non-clinicians as well.

Dr. Kevin Pho (6m 51s):
I have nurses, I have respiratory therapist, physical therapist, and of course I have patients as well, because just as it is important for patients to hear what doctors are going through, I think it’s important for physicians to hear what patients are going through as well. Because a lot of times we’re insulated from a lot of the hardships that patients are going through. So my goal over the last, how many years has it been? It’s been almost 15 years of doing this is really to bridge that gap between doctors and patients and having a platform like Kevin md.com. And of course the various social media platforms that extend out of that, it’s an ideal medium for those conversations to happen.

Dr. Anthony Orsini (7m 31s):
So take me back. The reason why I went into communication training is I really had a profound moment during my training when I witnessed physicians struggle to give bad news. And that kind of sparked way back when I was a neonatal fellow, this interest on how do we teach doctors, how to communicate. So I can point to a moment in time where I said, this is where I’m going to go with my career. Was there something leading up to starting Kevin MD? Or how did the idea of Kevin MD really come into play?

Dr. Kevin Pho (7m 58s):
Well, I could lie and say that I had a plan for the very beginning to be what it is today. But back when I started in 2004, I think very few physicians had blogs. I think blogs were just entering the vernacular and it was something that I started because one of my family members said, Kevin, do you have a lot to say about health care? You know, you should start a blog. So I started one a blog, or I wrote a few articles and I wasn’t really sure where this was going to go. I didn’t really appreciate the applications that might have, but I think there was one time back in the early two thousands, there was that anti-inflammatory Vioxx and it got pulled from the market because of some cardiovascular risk. And at that time we had a lot of patients on Vioxx.

Dr. Kevin Pho (8m 40s):
And I remember writing an article about that, about what patients could ask their doctors about what are some substitutes and what patients should do if they’re on that medication. And I didn’t really think much of it. It was just my commentary and opinion. What happened a few days after I wrote that article, I remember walking into the exam room and I walked in and that’s the first thing that patients said to me. I read your blog post this morning, and I was really comfortable what you had to say. And now I realize I have other options other than vioxx. And I realized that time, that social media, while blogs at that time had really the power for us to extend our influence, extend our voice outside of the exam room, where doctors can, instead of traditionally talking one-to-one to patients in the exam room, we now could talk one to many.

Dr. Kevin Pho (9m 28s):
And I think that idea has only snowballed over the past few years because we have these really influential platforms for better or for worse. And we’re going to be talking about some of the downsides of that, but I think that influence is something that I’ve been talking about for the last 15, 16 years and how it’s really important for physicians to really get online and use these platforms to influence patients outside the exam room. Because as we both know that patients are getting this information anyway, and there’s a whole misinformation pandemic that’s going on. And I think it’s really up to us in healthcare to really get online, use these platforms and connect with these patients and direct them to reputable sources of health information.

Dr. Anthony Orsini (10m 7s):
I’ve been a fan of Kevin MDs for awhile while I had known about it for a long time. I visited frequently. Recently I submitted a contributing article. I was excited when you accepted it. And then I was really honored when you interviewed me for your podcast. So, but I was really excited when you agreed to come on to this podcast because Kevin MD is all about conversations, as you mentioned. And I think that in medicine right now, there are not a lot of ways that physicians can speak to each other and get information, but I’m also really concerned with a lot of websites out there and a lot of the ways that patients get information.

Dr. Anthony Orsini (10m 46s):
And it’s a great way for patients to really go on and see how doctors are thinking, what they’re saying. What percentage do you think of the Kevin MD visits our patients? And non-clinicians,

Dr. Kevin Pho (10m 58s):
I would estimate about a quarter, perhaps are non-clinicians and that’s to expand on the point that you mentioned. I think I read an article just a few weeks ago is that I think one third of people get most of their news from Facebook. And we’re not just talking about health news, but just their news in general, if you look at some of the data from the Q research and they estimated that people going online to look for health care is a third most popular use on a web. So there’s a tremendous thirst for health knowledge. And I think a lot of that is part of our own doing as well. It’s, it’s very difficult sometimes to talk to a physician. And I think the medical profession, we need to do a better job at being more accessible, because if we aren’t assessable, patients are going to go elsewhere for the health information and that’s happened to their own detriment.

Dr. Kevin Pho (11m 46s):
If you look at the whole problem with the false connection between vaccines and autism, for instance, I think a lot of that has been propelled by social media because you have all these anti-vaccine activists, they know how to do search engine optimization. They know how to gain the YouTube and Facebook algorithms. And they’re light years ahead of us in a medical profession. And that lead time has caused a tremendous amount of damage because they can now propagate false information online. And patients are just exposed as information without any interpretation and take it at face value. And I think that we have a lot of catch up to do regarding that.

Dr. Anthony Orsini (12m 25s):
And a lot of physicians I falsely or incorrectly I think will encourage their patients not to go on the internet. I think there’s a problem with that. Twofold. One is it’s not going to happen anyway, no matter how much you tell them not to go on the internet and get their information, but two, this is all about trust. So the main theme I would say that has come through me doing this podcast since August now, and we’ve fed over 10,000 downloads and every week, whether we’re discussing business or healthcare, the word trust comes in over and over again. And during my workshops, that’s exactly the word that I use is that you have to, as a physician and we, as physicians are not taught how to communicate as you know, in medical school.

Dr. Anthony Orsini (13m 8s):
And if we’re taught how to communicate, it’s more about information. This is how you do it, history and physical. This is how you do a review of symptoms, but they don’t say this is how you bond. And so this is all about trust. And so I encourage physicians to say, listen, I know you’re going to go home and you’re going to look this up on Google. Google’s become a verb, right? You’re going to Google this. Here’s some really good websites or whatever website you go to you and I trust each other. We have a great relationship. Let’s actually talk about it afterwards. And one of the techniques we use for communication is I always tell physicians, when you give a diagnosis, many physicians will say you have cardiomyopathy, and this is what it is.

Dr. Anthony Orsini (13m 53s):
And one interesting thing, what happens when you say the word cardiomyopathy, you instantly see the patient on the other side, their eyes go up and what are they’re doing? They’re trying to figure out how to spell it. And they’re trying to remember it because they can’t wait to go home. So one of the techniques we teach doctors is to say, you have a disease of your heart called cardiomyopathy, and I will write that down for you when you’re done. Because by doing that, you’re basically bringing their attention back to you. And so having websites, I guess my point, I mean, websites with such as Kevin MD, that you can say, listen, here’s a list of websites, which I think are really great because you’re exactly right. You look up immunizations or vaccinations. There’s all kinds of false stuff out there.

Dr. Anthony Orsini (14m 35s):
Isn’t there.

Dr. Kevin Pho (14m 36s):
That’s absolutely true. And if you Google that you get a lot of false information. Although we’ll talk about this later on about how platforms I think are now taking responsibility. They’re starting to realize the power of their platforms, and they’re starting to prioritize reputable health information. They’re starting to de platform false actors or actresses that spread false information, but it’s taken a pandemic really for them to act. This has been going on for 15 years now. And this is something that I’ve been trying to advocate for years, and it doesn’t have to take a pandemic. It doesn’t have to take something as serious as that for them to really take action and take responsibility and take accountability for what’s going on in their platforms.

Dr. Kevin Pho (15m 17s):
And just to expound on what you said about patients researching online. And I think you’re absolutely right. I think rather than trying to be adversarial and telling patients not to go online and don’t trust Dr. Google, you just have to realize that they’re going to do it anyway. And we need to partner with patients and we need to guide them to reputable sources of health information. And if they come to us and say, I read this on this particular website, or is this supplement, okay? We just need to tell them that this may not be reputable information. You tell them that, Hey, you know these supplements, it’s not vetted by the FDA. You don’t know what’s inside them and just partner with them and guide them to something that is reputable. You could tell them that, Hey, this website may not be reputable, but you may want to go to the CDC website.

Dr. Kevin Pho (16m 3s):
You may want to go to these hospital websites. You may want to go to these.gov websites instead. And some of them may not listen to you and that’s fine, but at least there is going to be a proportion of patients who will listen and say, Hey, next time I Google this stuff online, I’m going to remember what my doctor said about whether this is reputable or not. So rather than trying to encourage them not to go online partner with them. And that’s really my philosophy when it comes to doctor patient relationship, I think we do need to be partners and we need to be more guides. And I think that’s certainly a shift from medicine back to yesteryear when there was a more of a paternal relationship right now is I think we’re more guides for our patients.

Dr. Anthony Orsini (16m 42s):
And you discussed being a leader in social media. Let’s talk about, cause we brought it up a couple of times already today. Let’s talk about what’s going on without getting too political with social media. Now, censoring different websites, as you said, it’s a good thing. Sometimes it’s a slippery slope other times. Are you concerned about the future of social media, where you have someone who may not even be a medical clinician, who’s censoring what you’re saying or what someone else is saying?

Dr. Kevin Pho (17m 9s):
So I think the thing with social media is things are evolving so, so quickly. In terms of its ramifications, I can’t predict what’s really going to happen in the next year, let alone six months. I think that the fact that social media platforms and we talked about things like Twitter de platforming, Donald Trump, and you think about Facebook and YouTube, they’re also involved in de platforming. Should they be also D platform purveyors of false information? So I think that’s a question that we need to discuss. I know that whenever there’s false medical information regarding COVID, if you go on Facebook, they specifically say this is false information and go to this website instead.

Dr. Kevin Pho (17m 49s):
I think the issue is that a lot of these platforms they’re trying to do it algorithmically. They’re trying to curate information and they’re trying to find what’s false information, just algorithmically and the robots and machine technology. And sometimes I think with healthcare, I think it’s a little bit more nuanced than that. I do think that there needs to be a human curation component to it. And I know that’s going to take a lot of people power for that to happen. But I think that’s something that we need to do, especially with Facebook. Facebook is certainly so influential. You have billions of people on Facebook. And as I mentioned in that study before a third of people get their information from Facebook. So I do think that needs to be some human curation component rather than outsourcing.

Dr. Kevin Pho (18m 29s):
I know that Facebook, they try to outsource all their curation to these third parties and they try to shift responsibility away from Facebook itself. But I think that more resources need to be done in terms of curation and something that’s obviously harmful, for instance, anything that’s anti vaccine or anything that perpetuates the false connection with anti-vaccine and whether they need to be de-platformed I think that needs to be seriously considered because from a medical standpoint, from a physician point, it really makes our work a lot harder. When you have patients come in and they express doubts about vaccines that are proven to be safe, proven to be effective like MMR vaccines and the vaccines that should be without any scientific question.

Dr. Kevin Pho (19m 12s):
And I think that we need to have a discussion about whether people who spread false information against such a public health good need to be the de-platformed or not.

Dr. Anthony Orsini (19m 21s):
But it really comes back to the word again, trusting relationship. If you have a trusting relationship with your doctor, I get this all the time. I mentioned this in a previous podcast, someone will say to me, I went to my doctor. He was a cardiologist. This is what he told me. But then I read on Google about this, and they’re asking me, I’m in neonatologist, It’s about a cardiology problem, which I’m not qualified to speak about. And my answer is almost always the same. You either trust your doctor or you don’t, and you need to find someone that you trust. And of course, you’re always going to have control of your own healthcare, but if you have a trusting relationship with your doctor, you’re going to trust them. And I do the same thing as a physician. If I’m going to an orthopedic surgeon for a hip replacement, either I’m going to trust them, or I’m not going to second guess them.

Dr. Anthony Orsini (20m 5s):
And you know, as a physician, I get second-guessed all the time. I’d rather do this. I’d rather do that. But it’s also about the relationship with your trusted websites. And so that’s why I think Kevin MD is such a great platform for non-clinicians to visit because everything there is legitimate and you can trust and have a trusting relationship with the website. Let’s move on to your keynote speaking because you do a lot of that. I do that also. I love it. There’s nothing to me, more fun than standing in front of an audience and giving a keynote. But some of the topics that you discuss, we listed one topic I want to discuss today that we’ve discussed in other episodes before is physician burnout.

Dr. Anthony Orsini (20m 52s):
I don’t know if the average patient understands the healthcare crisis that we’re in right now between physician and nursing burnout. And I know you speak about that at your keynote. So tell us what your views about that are and give us some advice about that.

Dr. Kevin Pho (21m 6s):
So I think physician burnout was, has been a phenomenon even before the pandemic. If you look at the studies before COVID-19 hit, almost half of doctors experienced symptoms of burnout. And a lot of it is because that we’re losing control of the profession. You talk to a lot of doctors. I think one of the biggest reasons they feel burned out is that they don’t feel that they have any control in terms of what they do. They’re told by higher powers, corporate powers that they have to see more patients. They have to see more patients in less time. They have these electronic medical records foisted on them. And it just adds time. I think there was a study where for every hour we saw patients, we spent another two hours on a computer doing charts. And I think that we’re just losing a lot of control in our profession.

Dr. Kevin Pho (21m 47s):
And I think to me, that is the biggest driver of burnout. You go into medicine, you want to see patients, you want to develop that trust. As you said, you want to spend time with patients, especially in primary care, you want to sit with them. And I think that’s the only way really to garner trust is really spend time with patients, but really all the forces that medicine over the last five, 10, 15 years really is against that, where we’re based on these metrics, where based on how many patients we see, in fact, a lot of our compensation is based on productivity, right? The more patients to see the more RV use relative value units you earn and that your compensation is based on that.

Dr. Kevin Pho (22m 27s):
So all the incentives is really towards quantity and productivity. And I think that certainly leads to burnout. And now you have COVID-19 in addition to that, and you could only imagine the added stress that’s placed on frontline clinicians. I think early on, back in last March, April, you had doctors speaking out about the lack of personal protective equipment. And for those, you heard news stories about these doctors who spoke out or wrote on social media, they got fired for speaking out. So I think that there’s that added stress. So not only are you on the front lines dealing back then, which was an unknown pandemic, you’re not given the proper protective equipment you get fired for speaking out, and you have all those stresses added to the burnout that was already present before the pandemic.

Dr. Kevin Pho (23m 13s):
So I think that it’s something that I certainly highlight on my site. I don’t think a lot of patients know about physician burnout. They think about doctors. And first of all, let me just say, patients are also going through tremendous hardships as well. It’s very difficult to be a patient in the United States healthcare system. And a lot of patients themselves of course, are going through tremendous hardships during this pandemic as well. But one of the things that I do want to emphasize is that it shouldn’t be an us versus them thing. And that’s one of the things I talk about my keynote is that doctors and patients really should be on the same page because if doctors are burnt out, if they quit medicine, if they go part-time, if they leave medicine, because they’re burnt out, really who’s going to see patients.

Dr. Kevin Pho (23m 53s):
So I try to frame burnout, not only as a physician issue, but a patient issue as well, patients should care about physician burnout, because if there is a doctor to see them, then it’s not going to help patients at all. So that’s one of the ways I try to frame burnout and try to get patients to care about some of the things that we go through. So whenever I have stories on my side about some of the ordeals that physicians are going through, some of the pressures that they’re facing and some of the reasons why they’re burnt out, I don’t hesitate and put that on my site. And, and these stories are very visceral. They’re tremendously powerful. And I get emails from patients all the time saying, I didn’t realize what you guys are going through. And just having that empathy from patients about what physicians are going through.

Dr. Kevin Pho (24m 36s):
I think if we could change a few minds and hopefully get us on the same page together, that’s going to affect some change.

Dr. Anthony Orsini (24m 42s):
And when I give lectures on burnout as well, a lot of it has to do with, you could be in business. It doesn’t have to be physician burnout. When you enjoy what you’re doing and you leave home satisfied. It doesn’t matter how hard you work. I mean, we know entrepreneurs like you and other business leaders, they work 12, 15. My wife’s a realtor. She works 18 hours a day on the computer. But when you enjoy what you’re doing, you’re going to decrease burnout and you hit the nail right on the head as physicians, I had Dike Drummnd on who’s one of the leading experts in physician burnout early on. And he talked about how physicians spend their whole life looking for control. But you’re a lowly college student who can’t go out to party because you have to get straight A’s and then you’re in medical school and you can’t do anything cause you have to get straight A’s and you say, but one day I’m going to have my own practice.

Dr. Anthony Orsini (25m 29s):
I’m going to be in control. And then you go through residency and you’re the low man on the totem pole. And then all of a sudden you get to be a physician and you find out that you’re being told what to do by hospital administrators and by insurance companies. What I try to do is try to remind people why they went into medicine in the first place. And I think that’s where that genuine and that conversation comes into play. And if we can use certain communication techniques to, for you and I as a patient in a, with our patients, if we can come up with certain techniques where we can have a laugh and we can bond real quickly and still be out of there and not too much time, then it’s a win-win situation.

Dr. Anthony Orsini (26m 10s):
But physician burnout is a crisis. And I’m glad that you’re bringing light of that to that, because it’s also a dangerous thing, right? So physicians who are burnt out, don’t perform at the level that they’re supposed to. So we have to bring medicine back to that human to human interaction that is so important and that all starts out with communication. So I think that’s a real topic that we need to really delve into more and more, and I’m glad your website is bringing it into that. So thank you for doing that. What advice do you have? So you’re really an entrepreneur. I just mentioned that. So I’m seeing more and more physicians maybe it’s because of burnout, I’m seeing more and more physicians looking I don’t want to call it a side gig because people like to call that. I don’t think that’s a good thing.

Dr. Anthony Orsini (26m 49s):
I’m doing that with this podcast. And with my workshops, I’m seeing more and more physicians saying, I need an exit strategy. Now, yours wasn’t because of an exit strategy because you’re still young. But what advice do you have for doctors who want to say, I’m passionate about this and I want to get into something else.

Dr. Kevin Pho (27m 4s):
So I wouldn’t call it an exit strategy. I think that it’s so important for physicians to have a passion outside of medicine. Now let me say, if you’re passionate is clinical medicine, then by all means be 100% involved in your profession. But for the majority of doctors, they don’t be defined by medicine because you don’t want to be defined by what you do. You want to be defined by who you are. You want to be remembered as a good husband, father, wife, mother. You want to be defined as the person you are because physicians, no matter how hard you work, you can always be replaced. So he’d been working for 30 years at a hospital and you could put your blood, sweat, and tears into that job.

Dr. Kevin Pho (27m 45s):
And to the hospital, you could just be easily replaced by the new graduates. So I see a lot of doctors who may not be 100% invested or 100% passionate about what they do. And they work 80, 90, a hundred hours per week. They will do this for 30 years and the hospital lays them off because not enough revenues are coming in because of the pandemic. So to the hospital, that’s an easy decision. So I think it’s important to have a passion outside of medicine. So you talk to a lot of physicians who want something outside of medicine. And for me, it, of course happens to be social media has to be speaking during a pandemic. I actually got furloughed because a lot of primary care doctors got furloughed because of decreased revenue. And I wasn’t able to speak, obviously because of the, we weren’t able to travel because of the pandemic.

Dr. Kevin Pho (28m 28s):
So what I do, I started a daily podcast. It was something that I had a time to do. And it’s something that I’ve been wanting to do. I did some research and it does take a lot of time to do a podcast, but it’s tremendously rewarding, but it’s something that I was passionate about. So I do encourage physicians to have that passion outside of medicine. And if you could make some money from it, I think all the more reason why that’s good, because you don’t necessarily want to 100% rely on what we call your W2 job, your job within medicine, because that can go away in an instant. So if you could have another leg on the stool that can support you where you can cut down and it doesn’t have to be social media.

Dr. Kevin Pho (29m 9s):
We have a lot of doctors who are interested in investing in real estate. They write books, they do online courses. There are dozens of ways where physicians can leverage their MD degree to make an income outside of clinical medicine. And if that income allows you to cut down a little bit on your clinical responsibilities and reduce them on a burnout, ironically, that’s going to make you stay in medicine a little longer than you ordinarily would have, because there are so many doctors who don’t have these proverbial side gigs, and there are 100% invested in what they do. And they get burnt out to leave medicine earlier. And you contrast that with a physician who may be only working 75% clinically, they’re happier.

Dr. Kevin Pho (29m 49s):
They have something else outside of medicine that they’re passionate about and they end up staying in medicine longer. So from a patient standpoint, you want the physician who stays in medicine longer. You’ll want the physician who is less burnt out, because as you said, when a physician’s worn out they actually make more medical errors. So I definitely don’t want to shy away from having passions outside of clinical medicine. I think that the days where the physician does medicine and only medicine for 100 hours per week are over, I think for physicians to survive these days, we do need to have an interest, a passion. You could call it entrepreneurial spirit.

Dr. Kevin Pho (30m 30s):
You need to have some way of alleviating some of the burnout that is associated with being in medicine all the time. And if you could make money from that and be less reliant on your W2 job, I think that is definitely helpful going forward.

Dr. Anthony Orsini (30m 42s):
Yeah. I love what you said. I tell my kids that all the time when they were growing up, what you do is not who you are and that’s really important. And physicians get caught up in that many times. It’s you know who you are, I’m a physician. No, you may practice medicine, but you have other skills. The other thing I would say that I totally agree with is for someone who does a lot of workshops, a lot of lecturing and has the podcast and does patient experience stuff. I find that that makes me so happy that when I go to work to see babies and take care of the neonates, I think it makes me a better physician because I’m happier. I have variety in my life, which I’m sure you could agree with.

Dr. Anthony Orsini (31m 25s):
And that when I come back to see those patients and I’m still full-time actually, but I come back and see those patients. I really am in the moment. And I think it just makes me better. And especially when it’s something you’re passionate about, I said on other podcasts, sometimes you feel like you have this thing to teach and you want to stand up on a top of a roof and say, I found the secret. Let me just tell you about it. And so this podcast has been a way of doing that and I couldn’t agree with you more. So, Kevin, as we’re getting to the end, I think I warned you about this. I ask everybody the same question and all my guests tell me that it’s the most difficult question that I’ve asked them, but the title of this podcast is difficult conversations.

Dr. Anthony Orsini (32m 7s):
And so I’m going to ask you what I ask every other one in medicine, in your personal life, what do you think are the most difficult types of conversations that you need to have? And what advice can you give my audience about how to navigate through those really difficult conversations?

Dr. Kevin Pho (32m 24s):
I think of two examples. And I think to me, when people have difficult conversations, what does that really is? People have a fundamental disagreement with what you say and what you believe in. So there are two instances where I think that happened. I think one was after I was giving a keynote and there was a keynote to primarily a patient advocate audience. And I was giving what I said before about how we need to get doctors and patients on the same side. And in order for us to make any changes in healthcare, whether it’s to alleviate burnout, whether it’s to give more time to primary care doctors, physicians, themselves, can’t do it. We need patients on my side. And I think that after that keynote, I remember a group of the audience member came up to me and kind of vehemently disagree with what I said.

Dr. Kevin Pho (33m 8s):
And I think they believe that doctors were in it for the money. And a lot of primary care doctors just churn through more patients and we want to do it to bump up our incomes. And in that instance, no matter what I said, I really couldn’t. All I could say is that that’s not true. I think we were on your side and we would like nothing more to spend more patient, but there are forces above what we can do. It’s not like we can magically conjure up more hours in a day to do do what we do. The second incident was my thing related to, I think what I said before in terms of having a passion outside of medicine. And I think I did talk to a physician who did believe that, you know, medicine should be 100% all in and physicians who are part-time, they’re just wasting their degrees and physicians who go into social media.

Dr. Kevin Pho (33m 56s):
Again, it’s a waste of the degree. They had no use for that. And again, I was sharing my story and really talking about what we talked about today in terms of it’s better to have someone who is part-time clinical medicine, but lasts longer than someone who is a burnt off physician full-time. But again, he would have none of that and basically said, I was like wasting my degree. So I think in both of these disagreements, I think that I always believe that when you have a general audience, I always divide it up into thirds. So I think that there is a third of people who will always agree with you, no matter what you say, I’m really passionate supporters of you.

Dr. Kevin Pho (34m 37s):
And I think there’s a third of people who actually won’t agree with what you’re saying. We see that of course, online, very polarized environment that we live in. It’s very difficult to change some people’s minds, no matter what you say. And of course there’s that middle third, right? Who can kind of be persuaded either way. And I always tell fellow physicians whenever, especially when they’re online, there’s a lot of disagreements, very polarized online is that you don’t necessarily want to speak to your supporters because they already agree with what you say. You don’t necessarily want to speak with people who cannot be convinced because no matter what you say, they’re always going to be entrenched in their beliefs, but it’s that middle persuadable third that I think that you want to speak to.

Dr. Kevin Pho (35m 18s):
So in these two instances, when I was talking to people who disagree with what I said, or I struck a nerve with what I said, I didn’t expect to really convince all of them. My job really isn’t just sway everyone to think the way I do. But if there were like three people there and if I could maybe have one of them, think twice and maybe change their minds, even to me, that’s a success. So I think that’s really the lesson that I want to give is that whenever you’re online or whenever you’re trying to influence someone, when you’re trying to persuade someone, your goal isn’t to persuade 100% of the audience that you’re talking to. I think your goal is to maybe make a third of the people that you’re talking to just think twice about what they believe in going in.

Dr. Kevin Pho (36m 2s):
And if you could make that proportion of people, think twice, I figured my job is a success.

Dr. Anthony Orsini (36m 7s):
Boy, with the political climate that’s going on right now that’s great advice. I mean, I wish our politicians would take that advice and stopped just speaking to the people that like them and against the people that disliked them and started speaking to the middle. Maybe you should be running for Congress someday. So, but that is a great way to end because that’s just fantastic advice. Kevin, I want to thank you for your time. This has been really great. I think the audience is going to be fascinated. We’ll put all your contact information on the show notes, but everyone should just contact you through Kevin MD?

Dr. Kevin Pho (36m 40s):
Yes, that’s correct.

Dr. Anthony Orsini (36m 40s):
Okay, great. So thank you so much. If you enjoyed this podcast episode, please go ahead and hit subscribe. If you want to find out more about The Orsini Way, please go ahead and go to our website@theorsiniway.com. It has been an absolute pleasure to have you Kevin, thank you so much. And hopefully, and I will continue to visit Kevin MD as I always have. And hopefully my audience will too. So thanks. Thank you so much.

Dr. Kevin Pho (37m 3s):
Thanks for having me on.

Dr. Anthony Orsini (37m 4s):
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 to find out more, go to the Finley Project.org. Thank you. And I will see you again on Tuesday.

Announcer (37m 37s):
AIf 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.

Leading Your Ship to Success with Capt. Mike Abrashoff

Mike Abrashoff (2s):
And I interviewed every sailor on the ship individually, all 310 of them. I’ve never been done before in the Navy and it wasn’t about business. It was getting to know them. Tell me about your family. I learned the names of every sailor, their spouse’s name and their children’s names and their home town, their favorite football team. It enabled me to connect with them and get them to feel like I care about them. And you know, if the people who are dealing with, think you care about them, they will follow you in the battle. And so only at the end of the interview, did business come up, you know, tell me what would you like to improve about the ship? What do you hate most ?

Announcer (39s):
Welcome to Difficult Conversations: Lessons I Learned as an ICU Physician with Dr Anthony Orsini. Dr. Orsini is a practicing physician and the President and CEO of the Orsini Way. As a frequent keynote speaker and author Dr Orsini has been training health care 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 are 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 25s):
Welcome to another episode of Difficult Conversations Lessons I learned as an ICU Physician. This is Dr Anthony Orsini, and you guessed that I’m your host again, this week, today, I’m really fortunate to have amazing guest. Today is someone who I really had on my radar for the last six or seven months. And I’m so glad that he’s on today. And that’s Captain Mike Abrashoff. Captain Abrashoff is a graduate of the U S Naval Academy in Annapolis, Maryland. An was a Military Assistant to the former secretary of defense, the honorable William J Perry. He left the Navy in 2001 and co founded GLS worldwide, a consulting agency that provides practical solutions on how leaders can achieve breakthrough results. At age 36, Mike Abrashoff was the most junior officer in the Pacific fleet when he took command of the near worst performing ship,.

Dr. Anthony Orsini (2m 13s):
12 months later, the USS Benfold was the best ship of the entire Navy using the same crew. The story of that stunning transformation has become legendary inside and outside of the Navy, Mike establish a set of management principles that he calls the Leadership Roadmap at the core of his leadership approach is as a process of replacing command, the control with commitment and cohesion. Mike is the author of three books. His first book is It’s your Ship: Management Techniques from the Best Damn Ship in the Navy and has sold over 1 million copies. And was a New York times and Wall Street Journal bestseller and we’re going to spend a lot of time talking about that book. His next book, It’s our Ship and the best title ever Get your ship together showed how Mike leadership principles have been put into action by leaders in their own organizations everywhere.

Dr. Anthony Orsini (3m 2s):
In addition Mike is a highly sought after keynote speaker for audiences to looking to ramp up organizational performances. I heard him speak a few years ago at my company’s conference, and I was just blown away. Mike and you were a literally one of the best keynote speakers I’ve ever heard. I also spoke at that conference by the way. And after hearing you speak to my first thought in my head was, thank God. I didn’t have to follow him. So thank you so much for coming on today. I really appreciate it.

Mike Abrashoff (3m 29s):
It’s an honor. Thank you.

Dr. Anthony Orsini (3m 30s):
Thank you. So there’s so much I want to talk to you about, so I actually, the last few hours I’d been spending here, try to get this down from three hours to one hour, because I’m such a fan of your book and I was such a fan of your speech, but before we jump into communication leadership and your book, I always like to start off letting my audience find out a little bit about who Mike is. And I’m such as a student that we are where we come from. And so if you don’t mind just telling us to hear a little bit of your background. I understand that you’d come from the military background, how you all the events that led up to your command of the USS Benfold.

Mike Abrashoff (4m 5s):
Well, I’m from a small town in Pennsylvania, a place called Altoona, and there were 10 of us living in our home growing up and we had one bathroom. And so when I get out of the Navy, he was able to buy my first home, but it has four bathrooms in it and I use every one every day, just because I can, that’s basically all you need to know about me. I’m number 6 of 7 kids and the best path to get an education for me was to go to the Naval Academy. And so I graduated in 82 from the Naval Academy and then worked my way up, going from one progressively tougher job to the next culminating in getting command of USS Benfold, which incidentally was named after somebody from the medical field, it was named after Edward C.

Mike Abrashoff (4m 53s):
Benfold, who was a medic in the Korean war. And one afternoon he was tending to two wounded Marines in a foxhole when several enemy soldiers stormed in the foxhole, throwing grenades into it. And at the age of 21, Edward Benfold decide that he was going to become a leader. He picked up those grenades, he stormed the oncoming enemy, soldiers blowing them up, blowing himself up, saving the lives of those two wounded Marines. So I use to take them to see on his ship every six months or so, in addition to the neighboring a ship after him, he was also awarded the medal of honor. And I used to tell his crew, make sure Edward Benfold as smiling down upon us tonight. And I would also tell them, you never go wrong when you do the right thing.

Mike Abrashoff (5m 34s):
If your doing the right thing nobody’s ever going to criticize you just, if what you’re doing appeared on the front page and the Washington post tomorrow, would you be proud or embarrassed, and if you would be embarrassed, don’t do it. And then if you’re proud, I will support you 100% of the time. And so from there, we got featured in the Harvard business review, and that was my big break. Literary agent started calling him and said, you have to write a book. And I didn’t think I can do it at first. And it was actually an easy process. I talked into a tape recorder every night and it had the recordings transcribed and in low, and behold the book came out in 2002. It’s a sold over 1.1 million copies.

Mike Abrashoff (6m 13s):
And in a year ago this month, a business owner in Canada bought 11,000 copies for each one of his employees.

Dr. Anthony Orsini (6m 21s):
Smart move. I read the book, that’s a smart move, but I do believe we are where we came from. And I do know Altoona, Pennsylvania only because they have a Penn state campus. There is one thing they do, when you are applying to Penn State, I went to Rutgers university and no offense. They said you would have to spend a couple of years in Altoona first before you go to the main campus and I said, no, I don’t think so. I’m a big city boy from New Jersey. So that was the end of that.

Mike Abrashoff (6m 47s):
My parents, children left home at age 17 and never returned to Altoona. We think my mother, should write a book on parenting on how to get your kids to leave home.

Dr. Anthony Orsini (6m 59s):
That’s a good one. My kids keep coming back. And now with COVID, my adult children are living with me down here in Florida. And I have two of the three of them work in New York city so there are certainly back. Our experience really shape who we are and before you became, I read in your book, before you popped into the Benfold that you had a couple of setbacks, right? I mean, you weren’t always at the top of your class, everything that you did, wasn’t always successful, but what really came out about your book is that every time things didn’t work out perfectly for you, you learn from your mistakes. So tell us about that.

Mike Abrashoff (7m 29s):
Well, it’s true. I graduated at the top 80% of my class at the Naval Academy.

Dr. Anthony Orsini (7m 34s):
That’s the name of my book. It’s All in the Delivery and I loved the way you said that top 80%. That’s right.

Mike Abrashoff (7m 39s):
I never got all the best assignments starting out, but you play the hand that you’re dealt and you make the most of it. And instead of complaining, I worked hard and learned my trade. And as I got more senior and senior, I would always watch the commanding officers that I worked for for the traits that I admired and one of the emulate, but also for the traits that I have abhorred and didn’t wanna fall into that same trap. So you can learn from both great leaders and poor leaders. If you have the self-awareness to understand how you’re showing up. So I’ve learned from both types of leaders and I’ve picked and chosen the traits that matter the most to me.

Mike Abrashoff (8m 28s):
In prior to getting commanded of the ship, I was selected to be the number two assistant to the secretary of defense. His name was William Perry. And it’s interesting. He is the best leader I’ve ever worked for, or seen an action. And it wasn’t because he was charismatic, because he lead with a sense of humility and it really appealed to me. I would eventually come to call his leadership style excellence without arrogance. And it didn’t matter who you were, you could be a janitor or in the halls of the Pentagon, or you can be the chairman of the joint chiefs of staff, every interaction with him, he made it seem like you are the most important person on the planet. And I would watch people and how they would respond to that.

Mike Abrashoff (9m 10s):
And they became more loyal and dedicated and committed to him. So this concept of excellence without arrogance, it’s something that I’ve tried to take with me and, and emulate myself. And I believe my crew responded to it. And also I believe the audiences that I’ve spoken to over the last 20 years, appreciate that humility, as opposed to I’m a Leadership expert. I know him at all. I’m here to tell you what to do. No it’s a journey and you live and learn and you get better because none of us is a perfect leader and none of this is a born leader. So it’s all about having self awareness to understand, but yet they were pretty good, but we are not perfect.

Mike Abrashoff (9m 52s):
And life has a journey and we needed to continue to improve each and every day.

Dr. Anthony Orsini (9m 57s):
I’ve always said, when I give my lectures, when we talk about we as a society, often look at the people who fail and we give them a hard time in who are not doing well. And what we should be doing, this is exactly what you’ve talked about just now, is we should be saying, there is a person who has succeeded. I want to figure out why William Perry succeeded to where he was, what made him the best leader. And if we spend more time watching the people who are good at what they do, we can learn so much more from that. So that’s a great point. The other point, I’ll draw parallel to what I do in medicine, in and teaching physicians, how to build trust with their patients.

Dr. Anthony Orsini (10m 36s):
And I talk about frequently and my book being a genuine person. And by being a genuine person, you are building trust. And in many ways, the reason why I do this podcast is that physician to patient is kind of like a leadership role in that I know we’ll talk about it later, but trust is the most important thing when your being a leader. And we know that when patients don’t trust their physician, they are less likely to take their medications they are less likely to follow up with their care, they’re more likely to sue or never come back. And so I think it’s really important that you are a genuine person. And that seems to be what you’re saying right now about Dr. Perry, right?

Mike Abrashoff (11m 14s):
So sometimes we perform the way we think that the organization wants us to perform. And there was always this, when you’re a captain of a ship, this is what you need to do for you. You need to tell people what to do. You need to be decisive, bark orders. And what you get is people who are performing the way they think others expect him to be instead of being in their genuine self. And I give people the credit to know a fraud when they see one. And if you’re trying to be somebody that you’re not the people will see right through that, but you’re genuine and authentic self, as you say, and that’s people want to surround themselves with.

Dr. Anthony Orsini (11m 56s):
It looks fake, right? So, and I tell physicians that all the time, if you walk into a room and there is a patient waiting for you and you say, you know, I teach them, let’s talk about just for one minute something that’s not medical. Let’s not walk in and immediately get down in the business, but to talk about the Yankees or what happened to me today, or how are you doing? And I noticed in your book that you did that with your sailors a lot. Sometimes you, you bent the rules, you did the movies and you did stuff from morale that made you really, they respected you. And sometimes I think that leaders think that if you’re not rigid, you’re not going to get respected. I think is the opposite way. Isn’t it?

Mike Abrashoff (12m 31s):
I firmly believe it’s the opposite way. And I interviewed every sailor on the ship individually, all 310 of them and never been done before in the Navy. And it wasn’t about business. It was getting to know them. Tell me about your family. I learned in the names of every sailor, their spouse’s name and their children’s name, their hometown, their favorite football team. It enabled me to connect with them and get them to feel like I care about them. And you know, the people who are dealing with the things that you care about them, they will follow you in the battle. And so only at the end of the interview is the business come up, tell me what would you like to improve about the Ship? What do you hate most? And so the first part was about establishing that connection and engagement and make them feel like you care about them.

Mike Abrashoff (13m 18s):
And only then would I talk about the business side of it, and by the time you have the, you know, and then they’ll open up and they’ll give you ideas, it will start taking greater ownership, greater accountability. But I can’t order that from the beginning of an interview, you’ve got to lay the groundwork and we’ve now been in COVID crisis since last March. Everybody is doing online calls. Whenever I do any calls with any of my people. First, we talk about family what’s going on. And everybody in this country has been impacted. And to be honest, there are days when I’m depressed, like why you even get out of bed this morning. And so if we’re depressed because of this, it’s only natural that the people we’re dealing with maybe down as well, they may have lost a loved one.

Mike Abrashoff (14m 5s):
They may have somebody who’s hurting physically as a result of COVID. And so if you go right to a business, you won’t understand the personal drama that everybody in this country is going through right now. And by talking about it in an advance, it gives you some context so that you can better design how you’re going to communicate with them and connect with them. So it’s all about the personal touch in caring. Now be your genuine, authentic self. If you don’t care, they don’t ask some people don’t care. And you know, if you try to act like you love them and you don’t, they are going to be suspicious of you. But if you genuinely care take the time to talk to them about it.

Dr. Anthony Orsini (14m 47s):
But it’s also going to help you when you’re trying to run that ship or that company, I’m a Rutgers university graduate. And the Rutgers university and the early eighties was very difficult at it. From the athletic point of view, they were horrible in football and they’re horrible in basketball. They were good at women’s basketball. It was not much better now, but it is a little better. But my point is in the eighties, I decided I needed to adopt another team just to root for. So I got very interested in Duke basketball and become a big coach K fan. Coach Krzyzewski fright, every one of his leadership books. And in his book, one of his books, he says he takes the incoming freshmen and they spend, I don’t remember a day or a weekend with him and his wife at the house one by one.

Dr. Anthony Orsini (15m 30s):
And they get to know them. And through that, he learns, you know what? This kid can do, what he will respond to. Some kids respond to being yelled at. Some kids will need more encouragement in your book. You talk about, put a round peg in a round hole. How much of that interview helps you with that?

Mike Abrashoff (15m 50s):
Well, I would say a a hundred percent by interviewing every sailor oftentimes I found out they knew what they didn’t want to do, but they couldn’t quite figure out what they did want to do. And I have a feeling that’s what coach K does in that weekend with each kid. Do you have a choice between going down the wrong path or choosing the correct path? And many of them have never had role models in their lives to coach them and to mentor them. And the only way you can do that is to learn about them. And so the more I can learn about them, the more precise I could be in helping to coach them and mentor them in helping them choose the right path that fits them so that they could make something of themselves.

Mike Abrashoff (16m 35s):
And so that’s where the enormous satisfaction came from was helping young men and women decide how the chart their own course for their lives and become successful.

Dr. Anthony Orsini (16m 48s):
And so after you became genuine, you build that bond, you’ve got to know the names of them. Then you ask them what the Ship can do to get better. And there was a story about a sailor and the rusty bolts that I have repeated 20 times since I heard you speak, because I think is just amazing. Can you share that with us?

Mike Abrashoff (17m 6s):
So when I found out how smart my sailors were in, and we offered the sat exam, onboard the ship, and I had never had never been done on a small ship before 50% of my crew took the sat because there the interviews I found out that they may want to go to college. So let’s help them get in one of my entry level seamen scored a 1490 out of 1600, which was almost double what I took when I say preparing for the Naval Academy. And it hit me how smart these young men and woman are. And there were even smarter today. ’cause they have access to information that we never had access to. I couldn’t get into the Naval Academy today because the kids out there are so smart.

Mike Abrashoff (17m 47s):
And so when you realized how smart the people are that are working for you, why not unleash that potential, because who better than the people on the front line going to work, they actually have ideas on how to improve the way that you do the work. So when I found out how smart they were, I added three questions in the interview. What do you like most about Benfold? What do you like least? What would you change if you were the captain of the ship? Once they learned, came in and says, do you know how many times we’ve painted their ship in the last 12 months? I said, no. And he said six times, but every time we paint the ship, it takes us a month to paint it. So every other month we’re painting the ship. And then he said, have you ever painted you’re home? And I said, yes.

Mike Abrashoff (18m 27s):
And you said, it’s sucks, doesn’t it? And what’s your point? We have been painting ships for 244 years. He said, did you ever stop to notice why we have to paint the ship every other month? He said, whenever a new piece of equipment is added top side to the hull of the ship it’s being held in place with nuts and bolts, screws, washers, and fasteners that are made out of ferrous metal, that rust in saltwater. But when it rusts, rust stains down on the side of the ship, he said, have you ever heard of stainless steel? Well, now that doesn’t rest in saltwater, now I’d been in the Navy 16 year by this point, I walked past that every day, because that’s the way we’ve always done it.

Mike Abrashoff (19m 11s):
And when the sailor pointed it out to me, it hit me. I’ve got sailors hanging from a safety harness on the mast of the ship. And I’ve got sailor is hanging over to the side of the ship with a life preserver on, and it’s an inherently dangerous task that provides $5 an hour or a value to us. And so why not get out of the lines of work that we’ve been doing for forever so that we would have the time of the day to do higher value work. So we scoured the globe, looking for the right materials to change this stuff out. With spent about $25,000 changed out everything we could painted the ship. We did not have to paint a ship again for the next 10 months.

Mike Abrashoff (19m 54s):
And some people from Washington came out to inspect the ship, and they were amazed that it looked like a brand new ship and the newer than most new ships coming out of the ship yard. And so they start doing investigations at a Navy wide level. And the people who procure this equipment in Washington never took into account the man hours that the sailors have to spend maintaining this equipment. Total cost of ownership. Wasn’t part of their criteria at the lowest bid was, well, if you go for the lowest bid and then I have to spend all these man hours doing $5 an hour of work, we’re not working together.

Mike Abrashoff (20m 36s):
So now whenever a new piece of equipment is bought, the total cost of ownership has to be addressed so that we are not putting undue burdens on the sailor’s out on the ships to have better things to be doing, like figuring out how to defend ourselves better. So that all of that came from a 21 year old, who was free to challenge. Why are we painting the ship every other month?

Dr. Anthony Orsini (21m 0s):
That’s an incredible story. After I heard you tell that story, but no exaggerating. I must’ve told 10 or 20 people. I heard this guy speak, and here’s the story of this first class seaman or whatever he was, but basically change the Navy with something that has basically common sense, but it’s just, it’s a great story. It really is. Let’s move on. So you come on to the Benfold and tell the story of how the former captain left and he didn’t leave under the best circumstances. In fact, it was some disrespect paid to him as he left that must’ve of scared you as like, what am I getting myself into? But you also mentioned that one of the issues was that he was an extremely smart guy who micromanaged.

Dr. Anthony Orsini (21m 43s):
Can you tell me more about that?

Mike Abrashoff (21m 45s):
My predecessor was absolutely brilliant. Nuclear trained engineer may be the best nuclear trained engineers in the Navy. And when he left, as his departure was announced on the public address system, my crew stood and cheered at the fact that he was leaving and to my knowledge, and it never happened before in the history of the Navy. And I take a step back. And the first thing I thought was, what do I have to do to keep that from happening to me.

Dr. Anthony Orsini (22m 10s):
What am I getting myself into?

Mike Abrashoff (22m 13s):
The second thought that went through my mind was I may never be liked. It’s not part of my job description, keeping them safe is so I examine what went wrong and he was so brilliant. He tried to do everything himself and not only that directed how everything was to be done. And so what he created was 310 order-takers. People are just waiting around to be told what to do in order to takers, don’t accept accountability for their results. Things go wrong. He said, well, I’m just knowing what I was told to do. And so I realized I needed to go from that top-down command and control to the one where I added a four word question, when a sailor who would come and asked me how to do something.

Mike Abrashoff (22m 58s):
And my response to them was what do you think? I think those are the most powerful words in the English language, instead of telling him the answer. What do you think, and get them to come up with the answer? And one sailor said, nobody on the ship is ever asked me to think before, and the way I’m asking you to think, how would you do it? So he says, well, this is what I do is to do it. He turned it in flawless performance and he lifted burdens off my shoulders. So if, if I know that he’s out in doing a good job on something, I don’t need to go to micromanage him. So that gives me time in the day to go do something more important, like figure out how to defend ourselves better. And so to your micromanager listeners out there, I say, it’s time to change.

Mike Abrashoff (23m 45s):
And the way that start is those four words. What do you think?

Dr. Anthony Orsini (23m 49s):
I think it was Steve jobs that said it, it doesn’t make sense to hire smart people and tell them what to do. And I’ve had a few leadership roles in the, my past and present, and I’ve had some fantastic bosses. Bosses that I would walk from fire for and other bosses who were nice people are really smart, but it just would never allow anyone else to develop themselves. One of the theories is that is a self confidence thing that it takes a lot more confidence to do to let your people run. I know that I have found when I was training as a physician, there were some of my senior physicians who used to say to me, this is how you have to do it.

Dr. Anthony Orsini (24m 29s):
You have to use his exact dose. You had to use this exact medicine, but the real smart ones, the ones that I looked over said, Tony, there’s three or four different right ways of doing it And one wrong way, don’t pick the wrong way. So you think that’s a self confidence issue right now?

Mike Abrashoff (24m 43s):
Absolutely. And, and I was full of insecurity as well. Like, am I doing the right thing, but I never went wrong when I trusted my sailors. And so I had to get over my own self confidence. And once they started delivering results, I became more confident that as a leader, knowing that this was the right way to do things. And the other temptation I would advise your listeners to avoid sailors would come to me with a solution that may not have been the way that I would have done it, but if it could get the results, I would always say, do it your way.

Mike Abrashoff (25m 23s):
Just like you said, you just don’t pick the wrong solution. There are three or four ways to do it. It doesn’t have to be the way that I would have done it, but I do it. And let’s see what happens. And what I found out was sometimes the way that I would have told them to do it was better or more times than I care to admit the way that they chose to do it was better than the way I would’ve told them how to do it. And so that’s the only way people learn is through experience and giving them the opportunity to make a decision and then go back and look at it and say, was it the right decision? Or is there a better decision than the constantly learning and improvement?

Dr. Anthony Orsini (25m 58s):
And when you micromanage a really lowering the bar, aren’t you, as opposed to raising the bar and say, this is what I’m expecting you to do, and I trust you to do it. I think that makes people really rise to the occasion. Or do you think so?

Mike Abrashoff (26m 11s):
Well, when I worked for the secretary of defense, I was a number two assistant. And honestly, I was a glorified gopher. My job was to push paper and the senior Military assistant is a three star, Colin Powell had a job. John Kelley had the job and it’s our most important three-star job. And once the general started to trust me, he started delegating more and more of his responsibility to me. He put me in charge of the sec, they have security detail, the trip planning team, the communications team. I had 45 people report to me and a job that historically have been an individual contributor job. And I never got any feedback from the general as to how I was doing.

Mike Abrashoff (26m 52s):
But then one day his wife came into the office, comes back to my desk and says, I wanna thank you for everything you were doing for Paul. Because the first time since he has had this job, he comes home at night happy. So he could have continued to hoard all the power and all that responsibility, but he wasn’t going home happy at night. And he found that the more of his responsibility he could delegate to me, it freed him up to do the important three-star work. He’s getting more pride in getting better results. And it frees him from the mundane stuff so that he can go home happy at night.

Mike Abrashoff (27m 34s):
So that’s my challenge to your listeners is what can you do to lift burdens off your shoulders so that you can go home happy at night? Because Lord knows we are working hard enough as it is. There’s no need to make our jobs even tougher. So how do we lighten our load? And to me, it comes from bringing our people all along and training them and delegating to them. And we can do the a thousand dollars an hour work as well

Dr. Anthony Orsini (27m 59s):
For the leader out there, whether it’s in health care or not, who is coming in. And we had Stephen M.R. Covey on a few months ago, the author of speed of trust. And Stephen spoke a lot about trust. We’ve had Claude silver on chief heart officer of VaynerMedia. The overwhelming theme of that was the trust. The word that we’re using right now is servant leadership. Things have really changed over the last 10 years. I would say, now this is the way, but yet we still have a lack of leaders. I think we have more managers that we do leaders. What advice do you give to that person? Who said who’s a, in a leadership position? He or she is scared to death. I had just been promoted and I have the 310 people underneath me.

Dr. Anthony Orsini (28m 41s):
The first thing, how do I establish that trust? What’s the first thing that you would say to them?

Mike Abrashoff (28m 47s):
Two months after I took command and the crew didn’t trust me, they thought everything I was doing was flavor of the month and it wasn’t going to work out. I would revert to the old way of doing things. And then the big day left and we left San Diego en route to the middle East for a first appointment. And the first seven days of the transit was spent doing a major exercise design to increase our ability to defend ourselves for doing this with, to other ships, Harry W. Hill U S a scary admirals embarked on Harry W. Hill. And the exercise was to be over the following Friday afternoon at 5:00 PM. At which point we were to enter Pearl Harbor spend the night in Waikiki. Well, instead of being over at 5:00 PM, that Friday afternoon, it was unexpectedly over at 9:00 AM.

Mike Abrashoff (29m 33s):
We had achieved. All of the objectives were sitting off the coast of Waikiki. Stephen in circles, wasting fuel, wasting taxpayers’ money, waiting five o’clock because that’s what the plan called for in the way that we enter, port in the Navy is by the day to rank have the senior officer or in each ship. The admin was on Harry w HIL. They were to go in first. I was the junior captain in the entire Pacific fleet by date of rank. We were to go in last so I can see why I can see Waikiki through my binoculars, but I’m not going to say to you, and this is stupid and what are we doing out here when we should be there? So I call the Captain of the Harry w HIL on an encrypted satellite voice radio that any sailor or any of the three shift can punch on the button and listened to the conversations.

Mike Abrashoff (30m 17s):
And I said, why don’t you ask the Admiral if we can go in early, he said, I can’t, I’ve got an engineering problem. I can only have fix it at C. I have to stay out. I call the Captain of the next Ship. He explodes at on the radio for the sailors on all three shifts to hear. You’re the junior captain you’re going in last don’t challenge to the plan. So I call the Admiral. I I’m in my cabin on this ship, I can tell by the gruffness of his voice, he had been listening to these two conversations. My hand literally starts to shake while I’m talking to them on the phone and he said, why should I grant Benfold something I’m not granting the other two ships. I said, most of the exercise is over early were sailing in circles wasting fuel I said, I got a piece of broken equipment I can only fix in port.

Mike Abrashoff (31m 6s):
When I said reason, number three, I’m going to put my crew on the beach early in Waikiki today. Now, when he said that I was two decks above the operation center were 30 sailors were on watch. When he said permission granted, I could hear cheering through two decks of steel. Now we have four engines on a Arleigh Burke-class, a destroyer, and our normal configuration has only the steam on one engine because that’s our most fuel efficient. You can do up to 18 knots on one engine. And unless it’s an emergency, everywhere we go, we’re allocated one engine, but you can do 24 knots on two engines and use twice the amount of fuel. You can do 27 knots on three engines, and you can do 31 knots on four engines.

Mike Abrashoff (31m 52s):
When the Admiral said permission granted, I put all four engines online, came up to the full power. When an Arleigh Burke-class destroyer is at full power it’s a thing of magnificent beauty. It kicks up a rooster tail of water. That’s two stories high. Wow. Ship vibrates from the power and we screaming in Pearl Harbor at full speed, tied up at 10 15 off the Ship at 10 45 on our way to Waikiki, never did save taxpayers one drop of fuel that day. Next day, we get underway to continue our transit to the middle East. And the first sailor comes up for his interview.

Mike Abrashoff (32m 33s):
And he says, you know, Captain, it seems to us the crew that you don’t care if you ever get promoted again. And I said, where on earth did you get that from? He said, what you did for us yesterday, you had nothing to gain. You did it for us. We want you to know we got your back. And to me is trust is when you have your people’s back and they have your back for us. There was this magical moment, but trust is like a bank account. And you’ve got to make deposits each and every day. And after awhile of making a deposit in every day, you have a nice sum in your account. And that’s what trust is by demonstrating that you’re going to do the right thing, that your people can count on you to do the right thing.

Mike Abrashoff (33m 21s):
And if they have that sense, they will have your back. And it’s the same with your patients and its the same with your customer’s. But you can’t order it you have to earn it and you need to know your people who are watching you every day. And if there’s a disconnect between what you say and what you do, then that will erode the trust that you’re trying to build up.

Dr. Anthony Orsini (33m 48s):
And it, it really is a difference between good leadership and bad leadership, but also it affects the bottom line. So you talk in your book about employee turnover or in your case, Navy turnover and how many people re up. I think if you look at it, it surveys, it’ll tell you that most employees leave because they don’t like their manager. It’s not about money. And yet I think when you took over, there was a big turnover on the ship. And then you had, I want to say a hundred percent retention?

Mike Abrashoff (34m 14s):
So the quarter before I took command on our retention rate was 8% meaning we were retaining 8% of the sailors eligible to re-enlist. And in my last year, our retention rate was almost 100%. We had the highest retention of any ship in the Navy. And when I first got there, the retention was that our burning issues and the Navy couldn’t generate replacements as fast as we were losing them. And so I had a sailor getting out of the Navy the next day I call them up to my cabin. And by this time his mind’s already made up and I said, why are you getting out? He said, Captain nobody ever asked me to stay.

Mike Abrashoff (34m 55s):
And I started thinking, sometimes we overthink this. Maybe if I just asked them to stay, they’ll stay. And so I implemented a program nine months prior to any sailors contract end date, that sailor would come up to my cabin for another interview. And I would ask them, are they thinking about staying in or are they going to get out? And if they’re thinking about getting out, what is it that I can do to help you change your mind? And here’s what I heard. T if you get me this training or this education, I’ll stay, if you put me in this different job, I’ll stay, my family’s on the East coast If you transfer me back to the East coast I’ll re-enlist. And so if you give me nine months to solve a problem, I can generally do it.

Mike Abrashoff (35m 36s):
If you give me a day to solve a personnel problem where they’ve already decided to get out, I can’t do that. So it was about putting in a discipline process to find out what’s on sailors mind and what would get them to stay in, keep them interested. And then delivering. I didn’t have a 100% goal that was one sailor at a time. And then over a period of a year, it’s like, wow, we haven’t lost anybody. So it’s just having a disciplined process to get people to know that you want them to stay and then see what you can do to keep them because what does it take to train a Dr and how much money or a nurse nurse’s most hospitals have tremendous nursing turnover.

Mike Abrashoff (36m 23s):
I think about how much money is spent on their training and how many opportunities they have. And I had known nurses who we’ll stay at a certain hospital and make less money, but stay because they get treated with respect and they know they are appreciated. You know what? Those physicians have a direct impact on that. And it doesn’t cost a dime. It just costs them self awareness and giving the nurse a pat on the back and are not demeaning him or her. And it’s not rocket science, but you get so many people don’t do it because they don’t have the confidence in themselves to make a difference.

Dr. Anthony Orsini (37m 4s):
And it really underlines the importance of communication is your first sailors said to you, and no one ever asked me to stay and people want to know that their valued. And if they are valued, their going to be loyal, we are ever having a health care crisis right now. And that is because of the bureaucracy of health care right now there’s more doctors and nurses working for hospitals instead of doctors being in private practice and a thriving hospitals value their doctors and nurses. But there are many hospitals right now we’re saying, listen, I know you have 20 years’ experience as a nurse, but if you leave, don’t let the door hit you in the way out. I got six graduate nurses. And by the way, there are $10,000 a year of cheaper because there are just starting out.

Dr. Anthony Orsini (37m 48s):
And what do we doing in the end? We were wasting money. And in the end, who suffers the patient ’cause now the patient gets a nurse has got three months experience instead of 10 years. And so they think that’s a really important thing is let’s communicate how important everybody is to you in, and that really helps.

Mike Abrashoff (38m 5s):
Then that sends a signal to the next nurses who have been there 10 years if this is how are you get treated after 20? Why should I hang around? So everybody watches what happens to everybody else.

Dr. Anthony Orsini (38m 17s):
Communication is a return on investment. So I know we’re running out of time. I just want to get some more great advice from you about communication. I am sure that being in the Navy all those years, you have had many difficult conversations. I want to talk about two types. Can you give us some advice to people who have to have a difficult conversation with their boss, or maybe you don’t agree with the boss? Maybe you need to, must be even harder in the Navy, but do you want to say to your boss, Hey, I disagree with what’s going on. I’d like to do it this way. Can you give us some really good advice on how to start that conversation?

Mike Abrashoff (38m 51s):
For you have to choose wisely the time when you make that appeal. If your boss is under a lot of pressure and frazzled and is under pressure, that’s not the time to do it. I would always do it late in the day. Especially with the General in the Secretary of Defense, his office, I never challenged him in the heat of the battle. I never did it publicly. So if you’re doing it publicly with other people listening, that’s not a good idea. I would always do it. One-on-one when it’s a calm moment. So I’m a football player. I loved football. And in the NFL, when the head coach disagrees with the call by the official he throws what’s called the red flag, which means I would like an NFL instant replay on this.

Mike Abrashoff (39m 40s):
And so if you do something that has disarming that doesn’t put them on the spot and on the defensive, I would say, hey boss, I would like to throw the red flag on this decision. And it’s a completely changes their demeanor and their mindset so that they are more open to listen to your ideas. And so I would never CC anybody on an email. If I had to do it by an e-mail, it just one-on-one communication. And I would say, you know, boss, Admiral, here’s the deal. I know this is what you want to accomplish and this is how you told us to do it, but we’ve looked at this and if we do it this way, we might be able to deliver better results and accomplish what you’re looking for.

Mike Abrashoff (40m 21s):
So when I’m challenging a decision, you don’t put the person on the defensive and you don’t challenge them in public. And you also give a solution instead of dropping another problem on your boss’s doorstep, provide the solution. And then you have a greater chance of being able to do it your way. And so I bet, you know, I won 90% of my NFL instant replays, and if I lost, I saluted and I said, you have my a hundred percent support. But the key is the timing and not to put your boss on the defensive and embarrass them in front of others.

Dr. Anthony Orsini (41m 1s):
As I say, as the name of my book. But as I say, 10 times a day, it’s all in the delivery. And so if you went to your boss and said, hey, I disagree with you. That kind of gets their back-up right? And now there ready for a fight. But I love that can throw a red flag. It’s almost kind of funny and it makes light of everything. And then you can have a nice conversation.

Mike Abrashoff (41m 17s):
Their response would be to laugh and shake their head. That’s better than to get their claws out. They want to dig into you, laugh, shake your head. Okay Abrashoff what do you want?

Dr. Anthony Orsini (41m 27s):
I love that. I think I’m going to steal that from you. And I think a lot of people out there I’m going to steal that also. And then finally you’ve had have Difficult Conversations in your life that you’ve run with either with your sailors or et cetera. So I always finish the podcast with the same question. What is the most difficult Conversation you have ever had to have? Or what type of conversations do you think is the most difficult that you’ve had to learn to navigate?

Mike Abrashoff (41m 52s):
So the problem in organizations is not everybody is going to get with the program. I call them cave dwellers, citizens against virtually everything. I looked at it and no matter what your for their against And, I bet you have one or 2% of the crew on Benfold, where they were disgusted. They just couldn’t wait to get out. They couldn’t wait for their contract to be up in, nothing I was ever going to do or try to connect with them was going to make any difference. But they’ve got a different interview with me. It was a cave dweller interview, and you never let this interview become emotional or confrontational. William Perry called it iron logic. They go into the conversation with 20 facts that the person can’t refute of how their performance didn’t compare favorably to the rest of the sailors.

Mike Abrashoff (42m 41s):
And you get them to admit that they are not performing. And you can do that with generalizations. You have to have cold, hard facts. So I would get the person to admit that they are not performing at the same level as their shipmates. And then the follow up question is why. And honestly, here’s where my education came in. Some sailors chose to share with me personal issues like they’re in debt or marital issues, or kid’s on drugs. We got family members with COVID and your home schooling your children. I mean, these are problems that we’ve never had to face before, but our people are now facing. So there are, they become impediments that we have to deal with.

Mike Abrashoff (43m 24s):
And so if you understand that, then you can help him in a, for sailor shows to share with me on a personal issue. Do you know what I’m a compassionate and humane person I’ll help you. If I can, I’ll give you some time to address it. And hopefully you’ll be back in a couple months, ready to go. If a person didn’t have the training, I’ll get you the training. But if a cave, dweller was a cave dweller, because they just didn’t want to be there. I put them on a six month program, they got to come see me once a month for six months. And if they made no effort to improve, I separated them from the Navy and I had to get rid of five sailors this way. I hated every time. And I got no sleep the night before getting rid of the first sailor and I come to work and I said, you know what?

Mike Abrashoff (44m 9s):
I lay line in the sand. I got to separate the sailor. So I did. And then the most amazing thing happen. The 98% of the sailors who did care started stopping me in the passage way and said, what took you so long? We owe it to the good performers, not to tolerate disruption from one or 2%. And that’s what a critical conversation is about. Leadership is not a paycheck. It’s about having those critical conversations and getting to understand why people aren’t performing as expected. Help them if they are having a personal problem, but also tell them what will happen if they choose not to get with the program, because we owe it to our patients.

Mike Abrashoff (44m 54s):
We owe it to our customers. We owe it to the rest of our staff, not to tolerate disruption from a few malcontents.

Dr. Anthony Orsini (45m 3s):
Successful people know how to communicate. And I think that’s the bottom line. And that’s why I worked so hard to do, to help people learn to do that. That’s what I have this Podcast, that’s why I had you on. ’cause you’re a master communicator, a leader. And I want to thank you so much, but before we leave, how has COVID effecting you or the GLS worldwide? I have been here. I used to do a lot of speaking and that came to a halt. And so it must be, what are you doing nowadays to keep busy?

Mike Abrashoff (45m 28s):
I am doing virtual keynotes. I’m doing probably five or six a month. And my business partner, Stacy Cunningham three years ago had developed a virtual leadership development program. And so in times of COVID, people are looking for ways to break up the endless zoom calls. So we’ve got this 26 Lessons virtual program. Each lesson takes about 15 minutes. And so we’re getting pretty fantastic results with that. But I haven’t flown in an airplane since March 14th and I normally fly probably 200,000 miles a year. And the first six weeks I’d love that. I’m going to be thinking, boy, this pandemic is great.

Mike Abrashoff (46m 8s):
I’m on vacation, but I was bored for the next two months until I started doing the virtual keynotes. And so you adapt and I realized somebody always has it worse than you. So I’m very fortunate, but you make the most of it. And I set up a studio in my basement where I do my virtual keynotes from and continue pushing the consulting side and also taking some time for myself and, and just thinking about what the future holds and how I’m going to position myself and how I can be of value to clients because of the challenges they’re facing with COVID as well. Y

Dr. Anthony Orsini (46m 47s):
eah, I’ve done some virtual keynotes too. I love to speak in front of a crowd because you get that feedback, right? you can be on that stage in your speaking and you get a lot of verbal language that confirms what the head nods hard to do that on virtual, because you have no idea if anyone’s sleeping or not.

Mike Abrashoff (47m 2s):
And, and not that people would care, but in a virtual setting, you have to stand still in one place in front of the camera. And my first keynote, I, for some reason, I dressed up and put my hard soled shoes on, even though you can only see from the waist up and I’m standing on the same hard floor and the exact same spot for an hour and a half. And what I was done, my legs and feet were shocked. Like they’ve never been before. And I had to sit down for like four hours until her recovered. But now I wear sneakers whenever I’m doing a virtual keynote, but the audience is probably to ever think of that, but it’s tough standing up in the same place for an hour and a half.

Dr. Anthony Orsini (47m 40s):
It sure is. And you know, just last week I gave one it and you have no idea whether anybody is still out there right now, you’re, you’re talking away and you’re giving us and it’s not until maybe you get an email or afterwards where the moderator comes up and says that it was a great lecture, whatever, but I can’t wait to get back to in-person stuff. I got my first COVID vaccine worked for taking it one week before Christmas, I got my first vaccine two days ago. And as a health care worker, and it looks like God-willing, we are going to be getting this out to everybody in the next five or six months in. Maybe we can get back to normal. Lets the hope so, thanks to Mike. I can’t thank you enough. I think this is going to be an awesome episode for the audience.

Dr. Anthony Orsini (48m 20s):
My audience is really lucky that you’re out there and that you did this. What is the best way for them to get in touch with? You will put it in the show notes. So if you’re driving, go write this down, but what’s the best way to get in touch. MAbrashoff at APG Leadership. com.

Mike Abrashoff (48m 33s):
Great. And we’ll put that in the show notes. Thank you so much for being on today. Thank you everybody for listening. If you like this podcast, please subscribe on Apple or, or your favorite podcast platform. If you want to learn more about what we do at the Orsini Way you can reach me at The Orsini Way.com. Thanks again, Mike. Appreciate it.

Dr. Anthony Orsini (48m 50s):
And have a wonderful holiday.

Mike Abrashoff (48m 55s):
You got it Doc, Take care of.

Announcer (48m 55s):
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

My Journey into Medicine with Michelle Atwell

Michelle Atwood (1s):
But I try to help them understand that accepting this is necessary. It’s going to happen to all of us. We’re all on this journey. None of us are getting out of here and some of us are closer than others, but the most important thing is, is that we all have to live every single day, the best we can so that we can move forward and have a life that we can say was worth living. And that we are with the people that we love and we care about. And we have a little bit of control at the end, over what we do.

Announcer (34s):
Welcome to Difficult Conversations: Lessons I Learned as an ICU Physician with Dr. Anthony Orsini. Dr. Orsini is a practicing physician and the President and CEO of The Orsini Way. As a frequent keynote speaker and author Dr Orsini has been training health care 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 19s):
Well, 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 who 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 3s):
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 others 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 the hospital without support. Welcome to another episode of Difficult Conversations: Lessons I learned as an ICU Physician.

Dr. Anthony Orsini (2m 43s):
This is Dr. Anthony Orsini and I will be your host again this week. Well as many of you already know, it was early in my career as a training physician that I was very aware of how frequently physicians struggled navigating difficult conversations with patients specifically when delivering sad or tragic news. In fact, in my very first podcast ever, which was the only one that I didn’t interview, a guest, I talk about the life changing moment that led me to a 10 year quest to eventually develop the breaking bad news program that started in 2010. And as of now trained thousands of physicians and healthcare professionals across the country. As I mentioned, many times, few people would realize that as a whole physicians and healthcare professionals get very little training on communication skills, especially when it comes to delivering tragic news.

Dr. Anthony Orsini (3m 34s):
One of the reasons that the breaking bad news program is so impactful, I believe is that in addition to receiving feedback from other doctors, the participants also get feedback from nonmedical instructors that have experienced real tragedy and can give real advice from firsthand experience. What I have found over the years is that that communication is all about building trusting relationships with patients. Physicians and healthcare providers who are able to be genuine and learn to relate to their own life experiences are able to provide the best care, especially during difficult times. Well, today I am honored and privileged to have a guest Michelle Atwell.

Dr. Anthony Orsini (4m 16s):
Is it safe to say that few health care professionals possess the depth and breadth of experience in the patient care giver dynamic that Michelle does. First as a mother managing the diagnoses of the life threatening illnesses to her daughter and son. And now today in her role as a physician assistant at a major health care system in Orlando, Florida. After the tragic loss to her first child and only daughter, Michelle who had a successful career in the banking industry was driven to invest her grief in the care and care of other patients battling similar afflictions. She began volunteering with Shepherd’s Hope Clinic first as a member of the general volunteer staff.

Dr. Anthony Orsini (4m 57s):
And today as a licensed healthcare provider. Michelle is a proud alumni of the university of central Florida with a degree in life and biomedical science and social and behavioral science. And she now has a physician’s assistant degree at Nova Southeastern university. Michelle didn’t stop there. She’s volunteering with beautiful feed international mission teams. She’s in the middle of a publishing, a contributing article to an upcoming medical genetic textbook. She is a member of the American association of physician’s assistants. And winner of the 2017 Nova Southeastern University PA Program Gold Standard Award. Well Welcome Michelle thank you so much for being on today.

Michelle Atwood (5m 40s):
I’m so glad to be here with you and speaking with everyone. Thank you for having me.

Dr. Anthony Orsini (5m 45s):
I was like, you know, I want to say we both work at the same health care system, and by the way, as always, I must disclose that neither Michelle nor I, are representing that health care system and our views are solely our own. I always have to disclose that to make the lawyers happy. Michelle although we work at the same health care system, since you work with adults and I work with pediatrics, our paths really never crossed until I think it was about a month ago. Wouldn’t you say?

Michelle Atwood (6m 10s):
You did a training a few years ago, and I was a guest at the training and I heard you speaking, and I was a brand new employee wasn’t even credentialed to work yet. And it was so interesting to hear your perspective and how you were teaching people to approach patients. And I thought, wow, that’s great. I’m working for this great organization where they are really teaching these doctors how to talk to people. And it’s so important even before I start there, making sure I get this training. And it was really excited about that. And so then I looked you up again, and I saw that you were doing all of this podcast and that you actually had an entire training program. And I was really impressed. And so just wanted to get back in touch with you.

Dr. Anthony Orsini (6m 51s):
That was about a month ago. And we spoke for about an hour and I want to say it was really moved by our conversation and your journey and so will get it. This is right off the bat. I know I’m a big fan of you and what you’ve gone through and, and where you’ve come right now. I would say, I want to say right away that your story was deeply moving to me and is very important to my audience. I liked to have Michelle take you through her journey because, you know, I always promised the audience the same thing that they’ll be inspired and learn communication skills. And today your story is so inspiring. And I think this we’re going to learn so much in the next hour from you, but if you would, let’s just take the audience along your journey.

Dr. Anthony Orsini (7m 33s):
And where are you started with your daughter, Victoria? You were in the banking industry, as I said in the intro, and then your daughter gets sick. So can you just tell us about that a little bit? And specifically as you go through her story, some of the conversations that you had to have with the medical professionals.

Michelle Atwood (7m 50s):
So my daughter was in fourth, it was the summer between fourth and fifth grade, and she was starting to have some issues where she would get sick and throw up a little bit here and there. And I didn’t really know what was going on. And so I took her to her pediatrician and I said, there’s, you know, something going on here. She is starting to feel sick more often. And I had been divorced. I had just gotten divorced and maybe in the last six months before that, and the pediatrician really said to me, you know, it could be that she’s upset about your divorce, or she could be having onset of menses. So it could be just emotional and let’s start with changing her diet.

Michelle Atwood (8m 30s):
So I changed her diet and we went to therapy. I did all the things that you should do it. And it wasn’t Improving. So after about two or three months of that, there was more, now I’m having headaches. Then I’m also throwing up more. And I thought this doesn’t seem right. So I took her back in. I said, we changed the diet. We did everything you said still it’s happening. And she goes, I think your daughter just wants some attention from you so I was doing. everything to give her a lot of attention. And she goes to bed at any rate, lets get you some propanolol which his, a beta blocker. I know nothing about any of this. I was working at a bank and I was very young and I thought, great.

Michelle Atwood (9m 10s):
They gave him her beta blocker. We’re going to take this beta blocker. And that started sometime after Thanksgiving, between Thanksgiving at Christmas, we were having this beta blocker and it helps with anxiety. But and there wasn’t quite so much throwing up. But in the meantime we were noticing that her hands were starting to shake too. And so part of me was the mom saying, well, you’re kind of being dramatically stopped that. But then there was a, the other part of me saying, you need to drink your soup with a straw and instead of having a spoon and so we went home for Christmas and my mom said, this is very unusual. She hadn’t seen us since summertime.

Michelle Atwood (9m 50s):
And so for her to change was so drastic. She is like completely different. Like she’s does it feel well all of the time then I said, what could be the medicine she was taking this medicine? And my mom said, no, you have to go back to that pediatrician. There’s gotta be more than this. So, and so we came home from Christmas break and I went to the pediatrician and I said, my mom insists that something be done. This is not the right answer. And in the meantime, while we’re waiting for that appointment for a neurologist, I had a customer come into the bank and her husband had Parkinson’s disease. I had no idea what was going on with the husband. I just knew that he was this old guy and he had some unusual mannerisms and it reminded me of what I was starting to see at home with my daughter.

Michelle Atwood (10m 32s):
And so I asked her, what, what is it that your husband has? And she goes, well, he has a neurological condition called Parkinson’s disease. And I said, do kids ever get that? So innocently? And she said, no, kids don’t get that. And some of the things he does, the way he’s holding his hands and things are very similar to my daughter. And she said, you have to get that checked right away. And I told her that we had this upcoming appointment. And so we came the day that we went to the neurologist’s office, the neurologist was great. He did his exam, a great neuro exam. And he immediately said, we’re going to send you across the hall or down the hall to get an MRI done.

Michelle Atwood (11m 11s):
And so we went and straight away to do that. And I thought, well, this is unusual. I fought so hard to get here. Now they’re just doing everything right away. But I lived in Vero beach, this was Melbourne. And I thought, wow, I’m in the big city. They are getting everything done quickly. So he sends me down there. And so while they’re doing it, that gentleman that was doing the scan, I was in the room and I thought, well, I don’t know anything about this, but it looks weird. There’s like a butterfly in her brain. And I thought, well, that’s really cool. It looks like there’s a butterfly. Of course my daughter’s in fifth grade butterfly’s are cool. I just think it’s really pretty. And so the guy says, well, we’re going to need to get you some lunch. The doctor wants you to wait here. And then he’s going to have you go back to the office.

Michelle Atwood (11m 52s):
And I say, well, is this normal way that things are done? And he says not usually. Usually, we are able to have people come back and get their results later. And at that point it was kind of dawning on me that this was an unusual progression of a day at a doctor’s office. When my daughter had always been healthy. So I’d never seen any kind of thing like this, where it was, see the doctor, do the test, go back right away, get the results. But he brought me into the room and he said, well, what you suspected was right. There is something that’s unusual. We did find that there is this tumor. And so he starts throwing a lot of big words. That mean bilateral fam thalamic And things that I had no idea what any of this meant. And I said, so you’re saying, and how big is it?

Michelle Atwood (12m 35s):
And he goes, well, it’s the size of a Tangerine. So maybe five to eight centimeters. And of course, I don’t know if five to eight centimeters are. So I’m thinking it that’s a pretty big and is that the butterfly? And so he actually pulled up the, the film and put it on the wall, old school, let me look at it. And he said, yes. And we’re going to need you to go right away to have a neurosurgeon, look at this and as well, is there any way it can be anything else because this doesn’t seem likely she has always been healthy. We don’t have any, we are not, she’s not been sick. And he said, well, how long has this vomiting been going on? And I told them it was maybe six or eight months. And he said, well, that was the first time that really she was having any impact.

Michelle Atwood (13m 17s):
And prior to that, it had been there, but it had been growing unchecked because it was in an area called the ventricles, which are like a Lake or a river. And so there was plenty of room for the growth without really affecting to much of the function. So from there I remember calling my boss, my daughter was super excited though, because she said, yeah, it’s a tumor. I was so excited. It’s not that I’m just really bad at handwriting anymore. And she was making jokes about talking like, Arnold wants to know if it’s a tumor in. So she was very funny. And I remember being in the car and I had to call my boss and say, yeah, so it’s just the tumor I fully expect to be at work tomorrow will be no problem.

Michelle Atwood (13m 58s):
But on Friday they want me to go to Arnold Palmer and I’m going to go have to see this neurosurgeon And but everything will be fine. I’ll be back at work. No problem. And my boss was so wise and she said, how about you? Give me a call back later when everything is kind of settled down and let me know what you think.

Dr. Anthony Orsini (14m 15s):
So in retrospect, if you don’t mind me interrupting, so the neurologist says tumor, at that point, you, you can really understand the severity of it or so you just thought this was a good day.

Michelle Atwood (14m 26s):
So I thought it was a mistake. I really thought it was a mistake. There was no way that my daughter had a tumor number one, number two, just impossible. That It was what he was saying. There’s no way it’s where it is. There is no way it’s that big. The, the pictures were wrong, something was wrong. And I was completely and totally in shock. I don’t remember much of the other things he says.

Dr. Anthony Orsini (14m 52s):
Tell us about the conversation when you first understood the seriousness of the diagnosis with Dr. Was it the neurosurgeon, then

Michelle Atwood (15m 0s):
It was the neurosurgeon. So the next morning I went to school and I took her to check her in and I told the front office, you have to check them in. And I said, she’s got a brain tumor and she’s got to go to this appointment. And I’m kind of in shock. I don’t know what I need to do. And the secretary said, you know, there’s another kid here who has a brain tumor, and I’m going to get her mom to talk to you. And I thought, Oh, this is great. There’s another mom. And so this other mom contacted me and she said that she’d been seen in Boston. And she said, do not go to the local people. This is a Florida, there is no good health care here. You have to go to the Northeast. That’s where all the good health care is in America. He must go northeast and so she sent me up to this neurosurgeon and she did all of the phone calls.

Michelle Atwood (15m 43s):
This mom was terrific. She called the office at Brigham and women’s. She was able to say, this mom needs an appointment. Another friend of hers, the mom bought had her friend donate money and bought me a ticket. Literally we were in Vero beach on Wednesday getting a diagnosis. Then on Friday, we were in Boston at one, o’clock sitting in an office 48 hours later at this neurologist office, this very well-known neurologist.

Dr. Anthony Orsini (16m 12s):
Tell us about that conversation. When he came in and tell you the news,

Michelle Atwood (16m 16s):
It was a very difficult day because he said that he had reviewed the films and that it was a really large tumor. And based on the location that doing a surgery would be impossible. He said that because it was bilateral, meaning on both sides of the brain, that there could be too much damage to the optic nerve, to her cerebellum and that she could have a physical deficits, things that she wasn’t already experiencing, and that they wouldn’t be able to do that. There would be no way for them to debulk the tumor at all. And I said, Well well, how do you know what kind of tumor it is? Or how do we know how bad it is then if it was there for a long time, it’s got to be slow growing.

Michelle Atwood (16m 59s):
So is probably going to be fine, right? What are we going to do? And he said, well, let’s do the biopsy and I’ll be able to give you some more information. And so at this point still, I don’t have a good idea of what’s going on, but we checked into the Ronald McDonald house that afternoon. And that’s when it became very obvious to me that I was now a member of a club that no one wants to be in. And that’s the mom of a very sick, possibly terminally ill child. And that it was going to be very difficult from here on. And so there were pictures of the kids on the wall, kids that have been treated at the same facility and who had seen the same surgeon.

Michelle Atwood (17m 42s):
And there was even a ward of this Ronald McDonald house where the bone marrow transplant kids lived. And so you couldn’t go down there and we would sit at the table and we were eating with children that their hair was falling out in their soup. And they were so sick. And the scared look at the hall of faces of all the other moms and was so hard for me to believe that this was actually really happening to me. And it was just the two of us. I was a single mama at that point. So it was just me and my daughter. And she was my whole world. And I felt that wasn’t going to be the case. And I was super scared. So when he actually did the surgery, the following week, he came from the biopsy and dad had arrived at the time of the biopsy.

Michelle Atwood (18m 25s):
He was there for results and we were in the waiting room and he came out and he says, we were able to get a piece of the tumor. And I said, there really was a tumor? I kept thinking maybe it was just water or a, some kind of cyst. Maybe it’s not really a solid tumor because we were able to get a piece of the tumor and I’ll get that down to the lab. And so this was maybe only five days, six days later, I literally threw up in the floor of the family waiting room because it was so unbelievable to me that it was actually real at that point. And he goes, so I’m going to have to let you know, based on the biopsy findings, how bad this tumor is, and then what the treatment plan will be after that, that will get it over to the tumor board and they will make a good plan.

Michelle Atwood (19m 11s):
And so that, that was that conversation. It was just extremely difficult. He was all in his scrubs and he stayed distant from me. So he was very, to the point it was, we are going to find out, we’ve got some of it. We are going to find out more.

Dr. Anthony Orsini (19m 26s):
And so, as we say, we were teaching the classes, I’m sure you would agree that at that moment, the doctor delivered that news, your life changed forever. And you think it’s safe to say that you remember everything about that conversation? It sounds like.

Michelle Atwood (19m 39s):
Yep. I remember the, the look of the title on the floor. I am going to tell you right now that floor versus any other hospital floor, everything about it.

Dr. Anthony Orsini (19m 49s):
And that started a long journey with Victoria with multiple procedures and chemotherapy. And sadly Victoria passed in November.

Michelle Atwood (19m 60s):
It was 2003. So she fought for 30 months. We went through all of the treatment protocols, chemotherapy radiation. So she was so sad when she got home from Boston. And she realized that we went to the radiation appointment to get fitted for the skull helmet that they wear during radiation for stereotactic radiation. And she was doing all this fitting and she goes, why do I have to do this? I already had brain surgery. And the doctor said, well, they didn’t get the tumor out. And she just started crying. Yeah. I had told her that they took a biopsy, but I guess I didn’t realize as her mom, but I hadn’t said the tumor was not there anymore.

Michelle Atwood (20m 46s):
I did never clarify to her that tumor was still there. So that day she went home and she actually contacted a friend of mine whose husband had been in the military. And she said, can you shave my head? I want the military cut. I do not want to have chemotherapy. She’s 11. And she called my friends and said, I want to cut my hair. And so she got her head shaved because she wanted to go back to school different. And at that time there was this Jim Carrey movie, the mask. And literally when she got the haircut, she goes, somebody stopped me. And she had such a sense of humor. And she goes, Oh, all I need is some really big teeth so that I can really make this work.

Michelle Atwood (21m 27s):
And so she just had such a great sense of humor and realized we were going to need that. And so I really tried to lean into her way of looking at things, but she shaved her head. It was done by the time I got home from work had no choice. So then she started doing things on her own. There was a big field trip for all the fifth graders. And she goes, I planned on going to get Tallahassee and I’m going to right mom? The school was kind of afraid. I said, you know what, nothing bad’s going to happen on this trip or worse than what’s already happening. She went on the trip. We did radiation. The tumor grew, we did chemotherapy. The tumor stayed stable. There were lots of trips back and forth. So in Orlando, I was being seen by a team of a bunch of different doctors.

Michelle Atwood (22m 12s):
And so it was being seen by Neumors so than I was being seen at it. It was called the Walt Disney, children’s it? But it was at what it is now. Advent health is a great doctor there that he was an adult neuro oncologist. There wasn’t a pediatric neuro-oncologist in Orlando. So I was kind of piecing together. This guy does oncology for kid’s. This guy does neuro oncology. So it can put these two guys together. And we have a pediatrician back in Vero who can coordinate some things. So there was a lot of coordinating on my part,

Dr. Anthony Orsini (22m 40s):
A lot of conversations along the way, just to bring it back to there. And when you contacted me about your experience on the patient family side, and now as a physician’s assistant, as I said in the intro, a few people really have that perspective and Medicine on both sides of that. We had a couple of guests, my niece was an early guest and she had, I am so proud of her and she had a cancer and survive leukemia lymphoma, sorry. And this is now a pediatric cancer nurse, but along the way, can you give us some memories of maybe one particular Physician you don’t have to say the name who in somehow made it a little bit better by the way, he or she can communicated it and maybe tell us about a conversation or maybe it was that first conversation with the neurosurgeon.

Dr. Anthony Orsini (23m 29s):
That seems to be because of the lack of communication skills may be made things a little worse.

Michelle Atwood (23m 35s):
So the neurosurgeon was an excellent neurosurgeon. He had a great team, but basically they just handed me back and said, we are not going to be able to do anything more because we’re neurosurgeons and you have a surgery and you’re going to need to contact, some people down there. And that’s when I was looking for who’s going to take care of this. And the one doctor that was just the oncologist, who just didn’t feel real comfortable talking about how we were going to approach this brain tumor. And it was really an inoperable. And I did have a very unfortunate incident happen with them. And that’s what made me look for different practice and why it ended up going to Duke. But he actually said, this is so unusual. May I have students come and speak to your daughter?

Michelle Atwood (24m 16s):
And I thought one or two, maybe, or maybe one at a time. And he sent a pack of students and it must have been eight or 10 residents that came in. And I felt like we were in a zoo. Like my daughter was a specimen that everyone was looking at and it really freaked her out. She goes, is it really is so weird. I mean, is it so bad mom? And I thought, I don’t know. I have no idea.

Dr. Anthony Orsini (24m 43s):
So the doctors really are, I believe are all compassionate as you probably know right now. But sometimes we really have to remind ourselves that Medicine at its best is a human to human interaction. Right. And when I teach patient experience as a Michelle, sometimes, you know, and we don’t mean anything by it, but you’ll see, you’ll hear our nurses and physicians talk about are the kidney patients in three or two and a heart patient in four. And that’s what made you feel that I think your daughter uses the word specimen, is that what she used at 11 years old? That’s remarkable. And then looking back, you go to Duke and was there a particular, I think I know the answer to this. Was there a particular Dr. That just seems to make things a little bit better?

Michelle Atwood (25m 26s):
Yes. So then they have a team, they have this Duke brain tumor group. And so I had heard of these doctors on a, basically like a Facebook group of back then. We didn’t have Facebook. It was some group that we would text each other late at night on the computer. And they were talking about the Friedman’s and these guys would fight for their patients. And so, and I said, wow, I want to be part of this. I want to be fighting this thing as much as possible. And so they had all of the team. And so the doctor would come in and he would explain what was going on. But then he had the child life specialist and the other teams. And he had people who were looking at the lungs and the eyes and the physical PT and OT and neuro-psych, and they were just able to let us know that this affects the entire child.

Michelle Atwood (26m 15s):
In in fact, it’s your entire family. And we’re here to support you in all of these ways. And they really were putting everything together. They even worked with the doctors here and they said, this is who you need to see. And they streamlined the process for us. And they said, this is where you’re going to go. This is who you are going to see. We are going to communicate about these things on our end. You don’t have to, as the mom walk around carrying MRI’s wherever you go. And also the last doctors notes, because I have to have everything with me all the time. This is because doctors weren’t talking to each other. So I felt like I was just the keeper of the information. And I wasn’t being the mom. You know, that I was noticing all the other things that were going on. So when they started coordinating their care and talking to each other, and these doctors were working together and they were coordinated is the biggest thing I think.

Michelle Atwood (27m 4s):
And they were taking care of her and me, and they were making sure that we were taking care of physically, mentally, emotionally, and even financially, they worked with the social workers to help. We’ve got in touch with Ronald McDonald. Your, this is where the address for that is we didn’t have GPS back then. I would drive with my little map. I would write down, I’m going to take the second left and I’m gonna go to this Ronald McDonald house. Then I would walk in and I would say the person’s name. And they would say, yes, we have a room for you. You’re going to be here for three days.

Dr. Anthony Orsini (27m 34s):
What a great experience. You had there with him. I am in my book and then the break and bad news program. And now that you are an instructor, you’ve heard me say this before we talk about the three goals of discussing tragic news. One is to show your compassion, which are clearly, it sounds like that neurosurgeon didn’t have much. Or, and even though the neurologist has brought it up on all the students, but to do is show them that you’re the expert in the room. And as I say, in my classes and in the book that patients should feel as if they can figure to put their arms around your shoulder and you will lead them to the next step in, as you’re speaking, I was feeling really good about myself, because I see just a tiny smile on your face. When you talk about Duke and clearly they had an impact, but clearly It was that you really felt that you are in good hands, right?

Michelle Atwood (28m 21s):
Absolutely. No one had told us before what the prognosis was. It was Duke. And I was already maybe four months into it. At the point I got in touch with them, like, what’s the prognosis? What does this road look like? What do I have to do? What can I expect to happen? And no one had really sat down and giving me a comprehensive look at that. Everyone had told me there are parts. The surgeon was excellent, but it was all about, this is what you can expect after the surgery. This is what we can do. The radiation oncologist. This is what radiation I was like, and this is what we do after that. But Duke was able to give us the entire perspective of what all of it look like, the good and the bad. And I think that was the biggest thing was he didn’t shy away from the fact that we are getting ready to go into a very difficult thing.

Michelle Atwood (29m 7s):
And it was going to be really hard, but that we weren’t doing it all alone. And it wasn’t just giving us a tiny bit in saying, this is fine. We’ve got this one part, but we are not going to tell you all the rest of it. We really knew what it was. And we were able to look at the thing and say, OK, so we’re going to do all of this. And we could still have a really bad outcome, but along the way, there’s going to be these supports. And we are going to be in this guy’s trusted hands. And that guy was with me the whole time. And he’s now in Florida. I’m so happy that in Florida, when I found out he came to Florida, call them and I thanked him for coming here.

Dr. Anthony Orsini (29m 46s):
You can say his name.

Michelle Atwood (29m 50s):
Oh, good, Dr. <inaudible> If you’re out there,thank you. He is at university of Florida and now, and he’s running they’re neuro oncology center there. Fabulous at Shannon. So, so happy that he’s here and we’re having this care available in Florida because I was literally driving my old Honda, you know, 850 miles each way. But when she got really sick at the end and we were changing so quickly, I would just have to get to Duke. Well, I have to have the doctor at, Duke see her to tell me what’s happening. It was a seizure that signaled the end, that there was a big change. Something happened. She wasn’t speaking correctly anymore. I now know that it’s called word salad and that the brain tumor had grown a lot And.

Michelle Atwood (30m 35s):
So I even remember calling him and he answered his phone on a Saturday morning, and he was at his kid’s soccer game. And I said, is hospice the right thing to do now, is this what you would do? And he said, you have done with everything else that you could do medically. And as a mom, this is what you can do. And it’s okay to do that. And I felt like I needed his permission to give up because he had fought with me so hard for so long. It was almost three years. I saw him every 10 weeks for three years when he was part of my life and part of my family. And I just felt like he was just taking care of us.

Dr. Anthony Orsini (31m 7s):
And you said that you needed his permission. And I think that’s many of the, that happens a lot when we’re dealing with end of life. We’re going to have Dr. Knops on in a few weeks and Dr. Knops Is one of the most amazing palliative care people I’ve ever met. And I learned a lot from her, but in the NICU and even in the life, when we teach about end of life discussions, many people are in fact looking for permission, not that they need our permission, but they need somebody to say, who’s the expert in a room once he established with you that he was the expert in the room, but to say, that’s okay, it’s a loving thing to do as a parent. And so it, it’s amazing that you said that.

Dr. Anthony Orsini (31m 47s):
So sadly, Victoria passes on November 14, 2003, I can’t imagine how difficult that must have been for you. And then you try to get through this. You are still a banker at this point,

Michelle Atwood (32m 0s):
Still in banking. So luckily when all of this has happened to you, right? Remember September 11th, I also happened and I had been working at the bank a really long time. So I had had a lot of stock and I cashed out my stock right before September 11th happened because I needed to pay and be out of work. So had cashed out my stock. When I think bank of America was 60 something dollars a share. So really high. And I had a nice little nest egg of money. I had gone back to work while she was sick in having chemo. But for the first, maybe for six months, I was out. So I had this money and I was able to take some time off. But after she passed November, I thought I needed to be home.

Michelle Atwood (32m 43s):
And I was home about a month and I couldn’t be home anymore. And I got in touch with a friend of mine and she said, we need you back. We need you to come back to work. And I said, I don’t think I can do it. And she goes, we are here where your team were. You can come back in. So I went to work for a smaller community bank with people who were my friends. I was very happy to be there. And so I worked full time all day, Monday through Friday eight until 5:00 AM and until six on Fridays. And then I also went to school full time. And that was just taking some classes I did not ever want to have one minute of my day, that was not occupied. So I went to school full time and I work full time.

Michelle Atwood (33m 25s):
And I just, I went from bed to work, to school, to bed at four to six months, try to keep busy, staying busy and just trying to put one foot in front of the other and maintain some semblance of normalcy in my life. And so that was a very difficult or recovery. And

Dr. Anthony Orsini (33m 43s):
Then in September of 2005, what happens is that summer of 2005.

Michelle Atwood (33m 49s):
So I met and got married to the most wonderful husband ever 16 years now we’ve been married and I was pregnant. And in September I went into labor a couple of weeks early. And so our little boy was on the way. And we were so excited. We went to our local hospital, we had done our hospital plan to have him. There was absolutely no indication that there was going to be anything but a normal delivery. I had a normal delivery of my daughter. I thought it was going to be a, just a perfect delivery. We went to the local hospital and when he was born, usually there’s that moment, you know, they kind of cut the cord and they hand you the baby. And I was so looking forward to that minute, I had been without my daughter, as herself, since 2001.

Michelle Atwood (34m 35s):
So this is 2005. It’s been five long years. Here’s this baby. And I am going to hold this baby. And they didn’t hand him to me. And I’m like, what is happening? They should have handled the baby in my husband is the first time dad. So he doesn’t know what’s happening. It was like, I don’t know if there’s a bunch of people over there. And I said, what kind of people are they? What are they doing? And he goes, they were putting a mask on him and they say, well, he shouldn’t need a mask. He’s a newborn. And I couldn’t remember, did he cry? Did he cry? And they said, yeah, he cried. And so I asked the nurse what happened? You know, when his apgar was great, he was at 10, but then he drops really suddenly. And I had no idea what they are talking about it. I just knew that something was wrong. He’s not getting enough oxygen.

Michelle Atwood (35m 17s):
I thought, well, there’s not been a problem. I’m advanced maternal age. I’ve had these scans the whole time and there shouldn’t be a problem. This is a perfect baby. They promise me all along. I did all the testing to make sure everything was fine. If that was not the case. So they put him with oxygen that we weren’t allowed to really hold him. He was in a box. They moved him into some special unit. I’m just struggling to understand what’s happening. My OB doctor comes in and I said, what happened? It was a perfect pregnancy. I didn’t have any problems. I mean, I had to do a blood thinner. I G I gave myself a shot every day for nine months. So I could have this baby and everything’s should be fine.

Michelle Atwood (35m 57s):
And when they said that there was something wrong and he was blue, he was a blue baby. And I says, well, why what’s wrong? Has it his lungs, there are always fine at, and they said, no, it’s his heart. And I thought that this is impossible. I did everything. I did everything I was supposed to do. And so they said that they were going to change him to a different hospital. They were taking him downtown to the hospital, where they had some pediatric doctor who could help him because the doctors in the hospital where we were really didn’t know what to do. And I thought, well, this is impossible. I can not go through this again. I just went through this. I cannot have this happen to me again, too

Dr. Anthony Orsini (36m 37s):
Much, too much.

Michelle Atwood (36m 38s):
And I thought, well, I can’t not be in this room. I can’t be here. I can not have my son in another hospital if I’m not there. And so at this point, I did learn a few things on my previous. And I said, I want to know exactly. I started asking the people in the unit, who’s the best person to go to for this kind of problem. If this was your kid, where would you send them? Who has the best outcomes? What are the typical survival in a situation like this? I want to leave AMA right now. I want to go in. And of course there is a whole lot of pushback. No, it hasn’t been wasn’t even in three hours. I don’t think And so meanwhile, my son has put into an ambulance and he’s taken downtown and I’m still there.

Michelle Atwood (37m 23s):
And I am convincing everyone that I am leaving. Whether they gave me permission or not, I call it the OB doctor. And I say, I have got to go. I can’t, I can’t not be where my sonis. If he is going to leave this world I’m going to be in the room. I’m going to be there with him. I have to go. And so he signed papers. Then I was able to go in. So we went downtown and we met Dr. Garcia. He’s a pediatric cardiologist. And he’s amazing. He came into the room and he was so it’s been a long day for you. I said, yes, definitely. He is. I can’t believe you were able to get here. And I say, well, thank you. And it was so as your son got here this afternoon, we were able to do the testing. And here’s what we found.

Michelle Atwood (38m 4s):
Big words. Again, lots of them. We have a transposition of the great vessels. There is one thing is going over. The other thing that your son’s blood isn’t going out into his body. It keeps re-circulating the oxygenated blood into the lungs to the heart, but it never goes through the body. So this incompatible with life is incompatible with life. And he goes, and I said, well, where, what, what do we do now? And then he said, well, we have surgeons. You can go to Tampa or you can go to Miami. And Tampa is closer and families closer. And as well, I want to know about the outcomes, all these questions that I asked earlier of the team and our ultimate, they ask the exact same questions and they recommend a We that Tampa had a very good outcome.

Michelle Atwood (38m 48s):
So that in Miami, just to make a choice, whatever is most convenient for your family. But he’s took the time to sit and draw the picture of the heart. For me, show me where the vessels we’re going to tell me exactly what the surgery would look like. How many surgeries this surgeon had done. How are these outcomes are all of the patients that he has to come back from this and how he treats them until they’re adults and even into adulthood and all of the good outcomes that he had. And I thought, okay, I believe you I’ll sign the papers. So my son can go to another hospital for all of this next part.

Dr. Anthony Orsini (39m 30s):
And so To Tampa, he has this surgery or more difficult conversations. I can’t imagine what your thinking right now, if that would help you in the Victoria.

Michelle Atwood (39m 39s):
Yep. So this was Lucas of Lucas is the boy and he’s born. And he is Victoria’s first brother And. So Lucas was so amazing. He was just so beautiful. And that the doctors start explaining what about surgeries? Surgeons are so different than all the other doctors may know exactly what they are going to do. And it’s so clear to them what’s going to happen. And they have these conversations all the time, but it just seems to me like they are so familiar with it. They don’t realize how hard it is for us to imagine that they’re going to take some tool and they’re going to cut right into your kid.

Michelle Atwood (40m 21s):
And that somehow we’re supposed to believe that it’s all going to be OK. And then at the end of it, you have to sign a paper saying, but if it isn’t and I already know that if I already know that this may end in death at the end of all of them it’s and death. And it’s a really awful as a parent to have to, to say, I know that this could lead to death, but I’m counting on you that it’s not going to be. And it’s not, I don’t believe it’s really in the doctor’s hands. I mean, I know we do everything we can, but at some point, but it’s much higher than us and things will go the way they are going to go. But Dr. Do the best that they can.

Michelle Atwood (41m 1s):
But he, they came in and he was, he told me about the patients that he saw and the great outcomes that he’s had. And I just felt really comfortable. And he warned me. Thankfully about what after surgery was going to look like, because that’s what you can not be prepared for all the tubes and the swelling and your kid doesn’t look like a baby anymore. And it’s an awful thing. It will look like some kind of a freakish Halloween.

Dr. Anthony Orsini (41m 34s):
So tubes or coming Out everywhere, there’s lines there. So Lucas comes home, but on his due date are basically so wow. What a great story that is. I mean, think, thank God it, it worked out, but I, I can’t imagine what you went through a second time, but you have been through the ringer to say the least and unimaginable pain, bad obstacles to go through with health care of your children. And many people would say, I never want to see another doctor again, and I never want to enter hospital again, but you did something quite differently.

Dr. Anthony Orsini (42m 18s):
What you decide that you want to go out and help people. And so how do you go from those two really horrible experiences? And Thankfully look, he is doing well.

Michelle Atwood (42m 28s):
Yes, he’s doing great. 15 years old and Jacob and I do what Jacob is almost 13. So two very healthy boys that enjoy life and are very active in, which is a good thing.

Dr. Anthony Orsini (42m 38s):
So Now you have a conversation with yourself. You say, Michelle do I want to do that?

Michelle Atwood (42m 43s):
And with a therapist as well. So After Jake between Lucas and Jacob. I was okay. It seemed like everything was fine and there’s about two years difference. But when Jacob came along, I started really going through the stages of grief that had a perfect life. I lived in a perfect home. I had a great husband, two beautiful children, and yet there was this sadness and I thought, what is going on? Why can’t I just be happy? I should be happy. I have everything I could want and everything I never thought was possible. And why can’t I be happy? So those are seeing a therapist and part of the, a therapy was really looking for, and she would say, well, we have to look at this.

Michelle Atwood (43m 24s):
And so I would look at things and I would say, it doesn’t make any sense. None of this makes any sense. I don’t understand. And she says, well, have you found you again then? Because I had been seen as a single mom working and everything and used to be doing my own thing. And I was a stay at home mom at that point. And she goes, well, what do you do? That’s just for you. And the answer was absolutely nothing at all. It’s really hard to be a stay at home mom. So shout out to all of the, stay at home moms that are out there finding their way, especially after maybe you’ve had a very successful career. It’s very challenging. So my therapist said, well, you’ve got to do something that’s just for you. And I thought, well, I want to learn about this brain tumor thing. How did this happen? And it was such a shock to me. And how did I not know it was the mom guilt?

Michelle Atwood (44m 6s):
Or why didn’t you realized something was wrong, six or seven months sooner, you could have done something better. So I go over to UCF and it was great. I said, I would like to be a non-degree seeking student. And I just want to take this class on neurobiology. And it’s a junior level course. And the reason I had to be non-degree seeking as I didn’t have a medical or a pre-med or any of the prerequisites needed, and they wouldn’t let me take the course. And I said, well, I’m not degree-seeking. I just, just wanna sit in and find out what this is all about. And I said, well, okay. And I did great. And I really enjoyed the course. And so I thought, well, this is neat. I’ll take another course or too. And so I started taking these courses and found a lot of Information.

Michelle Atwood (44m 47s):
So you guys learn a lot in medical school. So I am like, well, this explains everything. I can see exactly all the things they should have done. And I kept taking the classes, I got to be in a lab. I got to see brains and pathology. And it was really exciting. And at some point along the way, one of my professor said, well, your here with all of these pre-med students, what school are you planning on going too? And I says, Oh no, I’m just not going into medicine. So I’m not going to be doing that. And he said, well, you really need to do that. And luckily, everybody knows Dr. Sam Because. He teaches over at UCF and everyone has to get through his anatomy course in order to become a doctor. And everyone knows that.

Michelle Atwood (45m 27s):
So he really encouraged me. He said, you should do it. And I said, I have two little kids at home. And with my tragic loss, I didn’t want to waste time. I did. There was not enough time to spend with them anyway. So I was only taking a couple of a class two days a week when they were in school. So I didn’t want to waste their time. But as they were getting older, they were going to day school, a couple, two or three days a week, and I would go to school. And so I’m part-time and no one’s part time. Pre-med everybody knows when you are. Pre-med. If I wouldn’t say that to me, how are you doing this part time? And I say, well, if it works out and if it does, and I’ve learned a lot, so I just kept going. And at some point, the banker in me says, is this financially worth the time and effort you’re putting in.

Michelle Atwood (46m 10s):
And you’re about to spend a lot of money. And I said, okay. And so I had to sit down and make the spreadsheet. And I decided the best thing for me to do was take the courses that can get me a job in health care that I can find out. So I started volunteering. That was a Pat and those doctors were like, you should do it. You are missing nothing, but it was an outpatient clinic. And there wasn’t anything terribly tragic going on most of the day. And so I said, I’ll go be a scribe at an ER. And if I can take that blood on, probably could do. Okay. And it was bloody. And there were people coming in there with all kinds of situations. And I was so happy and I realized that the reason I was so miserable and the bank it’s, I had gotten used to the level of urgency that was possible in that environment.

Michelle Atwood (47m 0s):
And also knowing what to do, seeing this situation, handling this situation that I got used to it. I really got used to the flow of a hospital, the beeping, the everything. And I missed it when I was not in a hospital, but I didn’t want to be sick anymore. I didn’t want to have a sick child. I just wanted it to be there. And I was going to do it no matter what. So when I interviewed for the PA program and one of the doctors that I was interviewing me so well, you already are a very successful person. You have this career, or you have these children in obviously doing well in your personal life. Why would you come and do this? Why would you put yourself through what you’re going to go through to get this degree? And I say, well, here’s the thing I’m gonna do it.

Michelle Atwood (47m 41s):
Whether or not I have a degree or not, and I will volunteer forever, but I am going to be helping people one way or another, and I’m going to do it, whether I’m getting paid or not, because I’m okay with that. I can do it for free, but this is what I’m going to do. And that was a sufficient enough answer. And my interview, well, there were a whole bunch of other questions, but that was, I think the one that really made me decide right then and there, that whether I got into that school or not, I was going to continue helping people. And I had already been doing all of the things I had done fundraisers in for the national children, cancer society for a March of dimes, for a brain tumor center, for all kinds of fundraisers. But this was where I want it to be. I was going to be helping one way or another.

Dr. Anthony Orsini (48m 22s):
That’s fantastic. So you can get your PA degree. We are running at a time. So I want to get some real good advice that you get your PA degree. And now your PA in treating congestive heart failure, cardiac adults. And as I said, in my intro, a few people have the experience that you have of that can really help your patients for the physician. The nurse is the PAs and NPS nurse practitioners, all the people out there that treat patients. And many of us don’t have the experience that you have, and not as much more fortunate than you are. We, most people haven’t had the experience of losing a child. How do you use that? In what advice can you give to people after you’ve had all these conversations good and bad is a great experience at Duke other experiences, not so much.

Dr. Anthony Orsini (49m 11s):
How do you use that? Michelle if at all, while you take care of your patients, how do you think it’s impacted you?

Michelle Atwood (49m 16s):
I look at every single patient and family as if it were me and my daughter or me and my son. And I think about where they are in the process. So some of them are newly diagnosed, so it’s a brand new, fresh there, scared to death, and they just need someone to let them know what the road looks like. Some of them have been at it a while and they’re tired of fighting, or they’re really used to how things are going, but they’re kind of scared about what the future looks like. And I want them to understand what those outcomes can look like. And then I’m there, I’m a fighter with them. And then I’m also there end stage. And I help a lot of patients and their families understand that we’ve come to the point where I am doing everything I can in.

Michelle Atwood (49m 57s):
You’ve done everything you can. look at the outcome that’s happening now is we need to prepare for the next stage. And that is where I try to really let them know that it’s okay to stop fighting because children will try to make their parents stay in fight longer. And it’s really hard for the parents because they don’t want to let their kids down. And husbands don’t want to let their wives down. And they feel like its a losing battle that I try to help them understand that accepting this is necessary. It’s going to happen to all of us. We’re all on this journey. None of us are getting out of here and some of us are closer than others. But the most important thing is, is that we all have to live every single day.

Michelle Atwood (50m 42s):
The best we can so that we can move forward and have a life that we can say was worth living. And that we are with the people that we love and we care about. And we have a little bit of control at the end over what we do.

Dr. Anthony Orsini (50m 59s):
That’s just so beautifully put and I wish this were a video podcast. We can see your face because there’s so much authenticity to your facial expressions in whether you choose to share your journey with your patient or not. When you speak about the decisions that need to be made in the journey. And just when you speak about allowing people to have permission, your face really says it all Michelle, you can see there is some genuine credibility to what you’re saying and your tone of your voice and through this really difficult journey of yours and that’s a true gift that ends up for your patients. And that’s why we said in the intro, how it was really a fan and I’m really in awe of where you’ve come from to where you are now and your patience through your going to school for PA at withtwo children after all of that, your patients are really the ones that are really getting the benefit of that.

Dr. Anthony Orsini (52m 1s):
And so that’s really just incredible. This has been an inspiring story. Michelle is now going to be working with me. It just so everybody knows and the breaking bad news program. And she will be teaching physicians in healthcare providers alongside of me, teaching them from both the patient family point of view, but also from the doctor PA point of view. And that is a gift that she was going to be giving to all these doctors that we train. I’m really privileged and honored that you have chosen to work with me and honor that you have agreed to tell your story today that you have shared with me before that this is a difficult time of year for you as many people with a loss.

Dr. Anthony Orsini (52m 44s):
And I want it to be sensitive to that. And I appreciate that you are willing to tell your story for the benefit of my audience and for any other patients, family members that are out there going through the losses. So this has been an amazing hour and I just want to thank you so much for being on this episode and really do. Is there anything you want to say before we close out,

Michelle Atwood (53m 9s):
Be safe over the holidays and enjoy the time with your family? Even the things that are awkward end up being the fondest memories that you miss.

Dr. Anthony Orsini (53m 17s):
Thank you, Michelle so much. We really appreciate having you on. If you like this podcast, please go ahead and hit subscribe to tell your family and friends about the podcast. Go ahead and download all the previous episodes if you want to get in touch with me. You can reach me at the Orsini Way.com and we are going to be here at each and every Tuesday. So hit subscribe. Now, Michelle, thank you so much. I hope to see you real soon and I’ll be praying for you during the holidays and enjoy.

Michelle Atwood (53m 40s):
Yeah. Well thank you Tony and you as well. Thank you.

Dr. Anthony Orsini (53m 44s):
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 and visit the Finley project.org. See The amazing things they are 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 (54m 15s):
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.

Healthcare Leadership During COVID with Anthony Viceroy

Anthony Viceroy (1s):
What we found to be the most effective form of getting through those dark days was over communication. And I can’t stress that. It, it seems so simple. And so if someone says now, how did you get through a pandemic? And they want this magic formula there wasn’t one. But my every day we would talk to the whole organization, whatever we heard, good or bad we share. And I think that was important to build up credibility and to build up again that trust. And you know, whether it was a difficult conversation or if they was a little bit better, we had to share it, right? Every one was in this together and everyone needed it to appreciate what was going on, what would be expected of them and how the plans will change.

Announcer (51s):
Welcome to Difficult Conversations: Lessons I Learned as an ICU Physician with Dr. Anthony Orsini. Dr. Orsini is a practicing physician and the President and CEO of the Orsini Way, As a frequent keynote speaker and author Dr Orsini has been training health care 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 are 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 36s):
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 who 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 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. Orsini (2m 20s):
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’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 the hospital without support. Well welcome to another episode of Difficult Conversations: Lessons I learned as an ICU Physician this is Dr.

Dr. Orsini (3m 1s):
Anthony Orsini and I will be your host again this week. You know, with the COVID crisis, it’s really affected everyone, but especially those of us in the health care organization, those of us had to provide quality care, really under incredible circumstances. The best organizations have learned how to adapt, adjust, and survive the things that are just they’re just different now. And as a physician, I’ve never experienced this before. Hospital and healthcare executives have had to make some very tough decisions that are along with those decisions, come some very tough conversations. So today I have is a guest, someone with a proven record, whose going to talk about how health care organizations adapted to this crisis.

Dr. Orsini (3m 43s):
So in 2015, Anthony Viceroy has been the chief executive officer of Westmed medical group and award-winning multi-specialty outpatient organization comprised of 500 physicians and advanced care providers, and more than 1500 employees throughout Westchester County, New York and Fairfield County in Connecticut. As one of 548 accountable care organizations in the United States Westmed has earned a national reputation for its focus on improving the quality of care for patients while reducing unnecessary costs in the health care system. And we’re going to talk a little bit about that today? According to the CMS, Westmed has ranked within the top 6% nationally for total savings generated compared to the benchmark and has achieved savings consistently in each year.

Dr. Orsini (4m 31s):
In addition to his focus on maintaining excellence and quality initiatives, Mr. Viceroy has also championed enhancements to the Westmed patient experience and has led the group to achieve an impressive 95 percentile ranking for overall patient satisfaction. Westmed is on repeat the industry recognition as one of the best work places in the country by fortune magazine, under Mr. Viceroy’s Leadership, And we’re going to talk a little more about that. I can’t wait to actually talk about that. Mr. Viceroy received his MBA in global management and corporate finance from Fordham university and his BBA in public accounting, my Iona college. He holds an executive certificate from Cornell university in Healthcare Leadership. He is a CPA and a chartered global management accounts.

Dr. Orsini (5m 14s):
In addition to his work at Westmed Anthony Viceroy is a member of the board of advisors for a New York medical college, and started as a member of the board of directors of the West Chester County associates. He’s also a member of the board of trustees at Manhattanville college in Harrison in New York. And that was quite a long introduction, but Anthony thank you so much for joining us today.

Anthony Viceroy (5m 34s):
Thank You Tony I’m happy to be here.

Dr. Orsini (5m 36s):
you know, we met through a mutual friend, my cousin and we spoke on the phone a month ago and two guy’s name Anthony I guess we just hit it off. So it was really exciting to get to know you. And the more I learned about your work and about Westmed the more excited I get, because I know we’re going to learn a lot from you today, but before we get into that, I always like to start the same way. Who’s Anthony Viceroy how did you get here today? Tell us a little bit about yourselves and learn about you.

Anthony Viceroy (6m 7s):
That I’m still trying to discover who Anthony Viceroy is. I think I’m a self-proclaimed workaholic. I love what I do, and I’m very fortunate to be doing what I do, especially as we’ve seen throughout this global pandemic. It’s just how important, you know, health care truly is. My background is extremely out of the ordinary. I would say I spent probably about two weeks in the morning coming out of college and realized that, that it was something that I didn’t have a great passion for. I had moved over to the corporate tax and spent a number of years doing both domestic and international tax, four, three of the Large, s accounting firms and did a brief stint do in some management consulting.

Anthony Viceroy (6m 52s):
And then I ended up at Novo. Nordisk’s a Danish by a pharmaceutical company where it was there for five years, working my way through to become a treasurer of North America. And after Novo Nordisk had a great opportunity to join Omnicom Group, which was a fortune 200 global marketing and communications company. It was there for 10 years. That’s where I got to meet our mutual friend, James and probably the first six years I was in corporate roles, had a portfolio of agencies kind of, you know, under me or working closely with the CEO’s and CFO’s at those organizations. The last two was really doing much more on the client side.

Anthony Viceroy (7m 37s):
If you think back to 2007, 2008, there was a lot of focus around reducing costs in marketing spend, especially for these large brands for large organizations. So my role was really to kind of be as, you know, work effectively as part of the team to drive greater value or demonstrate that value to the Proctor and Gamble’s, at HBS of the world. And then in 2009, I ended up joining one of the agencies, ordering a belly as initially I came in as a global CFO, and then we moved into a global president of the organization. And then in 2012, I had an opportunity to join Westmed medical group. And even though I had a biopharmaceutical experience, so I have no real healthcare background and I thought it, it was definitely a great industry at that time.

Anthony Viceroy (8m 27s):
It was probably 17% of GDP. You knew that health care was just on the verge of doing something special. It needed to kind of progress. Most of what was in health care was the old model as it was a good to be more focused around delivering care in a more efficient manner and, and core structure. I thought this was a great opportunity to kinda get in and, you know, learn a new industry, but also be part of change, which I thought would have been exciting. So I’ve been fortunate that, you know, for the last eight years I’ve been part of such a wonderful organization and just a lot of great physicians, nurses, front desk managers.

Anthony Viceroy (9m 7s):
I mean, really everyone is just outstanding and really have shown who they are, especially during this global pandemic in this crisis when we mentioned the front line, your roles. And, you know, although we are not a hospital, we are in an outpatient facility still when you’re going through COVID patients that are coming in and wanting to be tested, not sure if they have it, but showing a lot of symptoms, it takes a tremendous amount of resolve to not to come in here every single day in deliver the highest possible care that you can, the, the, the most extreme, or at least on my lifetime of circumstances that anyone has ever seen. So, you know, it’s definitely been a great learning experience.

Anthony Viceroy (9m 47s):
And like I said, I was just very fortunate to be in this position.

Dr. Orsini (9m 51s):
So I’m going to jump right into it. We’re going to talk about COVID in a second, but when I’m reading about Westmed and I was reading about you and I’m looking at what you’ve accomplished there. So you’re an accountable care organization, which means that you really focus on cost reduction for people out there that don’t know what that is. Maybe you can, Mentioned talk more about that. So you’re in the top 6% nationally for total savings generated during the 95 percentile in patient experience. And you, one of the best at the fortune magazine named is one of the best work places in the country in health care. There are many people Anthony that would say that you can not have all three of those.

Dr. Orsini (10m 32s):
That to save money to have that kind of higher patient satisfaction and that kind of employee engagement would be a pipe dream. And yet you were able to do that. How did you pull that off? I personally believe they’re all tied together. You don’t see that trifecta.

Anthony Viceroy (10m 47s):
You know what I’ll say is this, I mean, every day you work at it, right? I mean, nothing, you know, are, is as simple as you know, and it isn’t one person or even a small team. It really is an organization that has to be committed to delivering this type of care at this type of satisfaction every single day. And you know, in our market in New York and Connecticut, you know, to the very hyper competitive market, large health systems, you know, technology companies looking to be disruptive. So I think it’s important that we always have to balance kind of the needs of all the key stakeholders always look for ways to improve each and every day.

Anthony Viceroy (11m 30s):
And I think when you bring that level of a mindset and you surround yourself with a very talented people, you’ll be surprised when you’re able to accomplish. You know, there are days where I feel like we move may be a little bit better on, in one direction than the other, but I think that’s how you need to, to balance your organization and balanced the business. It’s hard to be great at everything. And there’s a lot of organizations that celebrate not being great in some in areas because they are very great in other areas and that’s their brand, but when you’re delivering care or as you can appreciate why you can’t make that distinction have what’s important and what isn’t. And I think today we had, when I entered back in 2012, it really wasn’t about patient experience.

Anthony Viceroy (12m 14s):
So it was really just starting to get formulated. It was still a much more of a physician driven practice. And my personal belief is that, you know, we probably have shifted a little bit too much now. So the other extreme where I think physicians are often forgotten about in this equation and they have such a very important part of making sure that care it gets delivered effectively. So what we try to do was make our physicians feel valued and an important a part of the solutions, but we also have to appreciate that in the eight years, since I joined the world has changed and moved into a very digital platform, access and convenience and experience is the future of health care.

Anthony Viceroy (12m 58s):
And you have to be able to anticipate what your patient who is also a consumer now purchasing Healthcare what their needs are and what they want. And then how do you build that into a culture that has to be continuously look to perform at a very high standard? So, you know, its about recruiting. I think the right people initially I’m very much a big believer in talent, but also in shared beliefs. I’ve seen a lot of talent that people who come in to the system, but if they don’t believe what you believe culturally, it just doesn’t fit. So I think it’s important that you have shared beliefs and everyone kind of buys into what we’re trying to accomplish here.

Anthony Viceroy (13m 40s):
Then you have to just everyday work at it. And I think, you know, part of why I love what you’re doing in particular is now a Difficult Conversations are important conversations. And the more of that you have these compensations, they become less Difficult, but more importantly, when you start to build trust, build relationships. And that’s how I think they were able to accomplish a lot more when there is mistrust and a lack of relationships, you’re not going to be able to move as quickly as you need to move. And especially today when we talk about agility, but it is so important to be able to move rapidly because you know, otherwise you’re just left behind.

Dr. Orsini (14m 21s):
You know, you said trust and relationship, but I can tell you, this is probably about the 25th, 28th episode that I’m recording right now. And I don’t think it’s an exaggeration at a 20 or 22 of those episodes. Those two words came up and we know whether we’re talking business, whether we’re talking doctor, patient relationship and employee leader relationship, it is all about trust. So we dropped Stephen Covey’s, Episode just recently the speed of trust. And that was just a great episode, but they are really inerlaced. I’m not sure a lot of people understand that. So patient experience, which I’m so passionate about as you know, it clearly effects clinical outcomes.

Dr. Orsini (15m 3s):
So you are providing good care. If you are providing patient experience and you can’t provide good care If you have unhappy nurses, unhappy doctors and unhappy receptionists. You know, I often wonder sometimes when I go to a doctor’s office, does the doctor ever call his own office? Does he realize how has the phone as being, you know, the name of my book, it’s all in the Delivery. It’s like what I tell a story in my book about, I called a cardiologist or maybe it’s in my workshop. I called a cardiologist for an appointment and the cardiologist’s that the receptionist so that they don’t have anybody for any appointments for four weeks. And I said, I don’t really like to do this, but does it help them have a doctor? You know, maybe, you know, I’m a doctor at this hospital and she said, I will never forget this.

Dr. Orsini (15m 46s):
She said nope. And I said, OK. So I hung up the phone, I called another group and she didn’t have an appointment for four weeks either. But she said, you know what, doctor, let me see what I can do. She got on the phone for 30 seconds later. And she said, I really tried. I just can’t. And I appreciate that. And I felt so much nicer about her. And there’s a difference between just having it, a happy employee and another employee. Who’s not so happy. So the top 80, I think he was 69% of all hospital executives and leaders have named patient experience and their top three priorities for the year or 2018.

Dr. Orsini (16m 26s):
I believe it was Yet very few or If while some of them have, but most of them have not really put the resources into improving patient experience, but it sounds like Westmed has, I think he used some outside organizations to help you and just place that emphasis on everybody. How important do you think that whole thing is to the success of Westmed?

Anthony Viceroy (16m 46s):
I think its vital. I think it’s a, unfortunately were not in an evil war atmosphere anymore. Right? So you have to do a very good job of engaging physicians. And I keep going back to, you have to have physicians be part of the solutions as Healthcare has so many issues. Yeah. I look around at other organizations and you know, physicians are used much more interchangeably, you know, a much more salary type of not only model, but also just to have a mindset. We don’t have that. Right. We want our physicians to feel like they’re very much engaged. They are owners of the business and every which way, but you have to also nurture that relationship.

Anthony Viceroy (17m 29s):
So we do things like I have monthly dinners pre COVID, but will bring, you know, where a large multi-specialty practice or will bring 15 to 20 different physicians out once a month. Then we share ideas. I explain on a macro level of what is going on and the industry kind of what direction we’re going in as an organization. And then on a micro level, kind of what it is now, what’s really going on inside the clinics and you know, what’s working, what isn’t working? What, what they liked to see happen. And I think exchanging that type of information back to the trust and relationship goes a long way. It also really highlights what’s wrong in the company. How quickly can you fix it?

Anthony Viceroy (18m 10s):
Going back to the speed being so imperative. And then I think there’s other things that we do. We know that we’ve been having, a burnout series now where we were trying to create more wellness for our physicians and trying to balance, how do you deliver a high level of care with a large patient panel, but not get burnt out. And its interesting, you know what my experience has been surgeon’s never burn out, but primary care will tend to feel the pain. And this is, you know, as access is even more important, more patients want to get in that level of burnout starts to become even more important. So we’re very cognizant of that and we try to balance it out and work with our physicians, whether it’s on their panel size, but just some of their mental wellbeing.

Anthony Viceroy (18m 57s):
I mean we’ve offered even through COVID, you know, our behavioral health services internally to both physicians and employees to have a resource in order to kind of work through these issues. We do a lot around career planning and leadership training and things like that. So we, again, we don’t assume that everyone knows how to do things. And then, you know, on the other side of the day, so that’s one of the Physician in an employee side on the patient experience side. It’s just something that we work at every single day. I know there’s so many great programs out there, but if you really think about it, it really comes down to how do you wanna be treated? And if you treat your patients the way you wanna be treated, if you were going somewhere else, I mean, that’s really the basic success of a patient experience.

Anthony Viceroy (19m 45s):
We are at the 95th percentile overall, which were very proud of it. But I think what I’m even more proud of is our physicians who are at the 97 percentile. You know, so again, that relationship between physicians and patients, it’s just so vital and to affirm that our patients really see value in what our physicians are doing and truly appreciate the physician relationship is important. We want to celebrate them and we want to continue that. Then we moved over to This NPS now. So what we were using the press ganey for those in health care, in the press Ganey, but, but even our NPS four is 87, which for a net promoter score, it’s a very high numbers as well.

Anthony Viceroy (20m 25s):
So it was just something that we were always very cognizant of it and we appreciate, we have to continuously work to be the best that we can be. It’s not, I think a lot of organizations roll that out because it’s an imperative and you know, we kind of check the box that you did this, but then the following year, you’re onto another initiative and you’re not giving it the right level of love and maturity and looking to go to 2.0 or 3.0 every single year, how do we improve upon where we’re at? And you know, we’re mindful of that. So we very much are working to keep building upon the success that we’ve had and you know, we’ve gotten great national recognition because of it.

Anthony Viceroy (21m 7s):
We were presenters at the Cleveland clinic patient experience summit. So again, like I think that’s just a testament to the organization and everyone who worked so hard around building these programs and making sure that they, they stick and then we keep building it, you know, year over year to make it work.

Dr. Orsini (21m 22s):
I have a lot of physicians right now that are listening to this interview and I know exactly what they’re saying as your speaking, he gets us. That’s what they’re saying right now because you do get us the way to make a physician happy is to give him or her independence, give him a, her the autonomy, show them that they are appreciated. We all wanna help people. That’s what we went into medicine at the first place. I’m a firm believer that there is a very small percentage of people that went into the health care for the money. If you did, there’s better ways of making it to be honest with you, but you get it. And so what happens is it sounds like you understand what makes we as physicians and nurses and people tick.

Dr. Orsini (22m 4s):
What makes us happy. When we’re happy our patients are happy. What are our patients are happy? We have good patient satisfaction scores, and then you have great employees best workplaces have les turn over. So it doesn’t seem that hard Anthony but you have been able to nail it. And a lot of people have not. So I wanna thank you for that. To me, that’s clear that as you’re speaking, why are you Westmed has been so successful and so having said that, Anthony, Mr. Viceroy, let’s move in to Covid because that’s really what this is about. As I mentioned before and other episodes, when I’ve spoken to other leaders, the general public looks out on T V during the COVID crisis, especially March, April, May they see rightly so doctors and nurses who are just exhausted beyond the brink sadness everywhere.

Dr. Orsini (22m 53s):
And we hear about hospitals being full, but the reality is very different behind the scenes, right? I mean, we stopped elective surgeries, we’ve stopped elective procedures. And most of the time, although the hospitals may have had a big group of patients with Covid, many of them are empty. And as a primary care provider, you may have been swarmed with COVID patients, but the average routine checkup, people are staying away. Most hospitals have had to make some very difficult decisions, furloughing nurses, moving people around doctors, who’ve had to take big cuts in pay. I know, especially in the anesthesia group, but other primary care.

Dr. Orsini (23m 35s):
So now that you’re trying to navigate this as the CEO of Westmed tell us about the difficult decisions you have to make and the Difficult Conversations that you, you had to go through it for those.

Anthony Viceroy (23m 47s):
Sure. I mean, I think in hindsight, now you can start and you can appreciate all that went into it, but you know, candidly, I know we just went forward. I mean, it wasn’t even real a lot of time to think Tony, I mean, it was, we started planning for this, my executive team probably, but the very end of February, as they really started to see that, you know, it wasn’t just for a very bad shape. It was, it was coming, you know, we have all of our policies and our protocols around how to deal with disasters. No one had anything for this.

Anthony Viceroy (24m 28s):
And every day you’re hearing so much news that is just devastating and you’re trying to figure out how to handle this. So the first thing that I did very quickly on was I shore up our finance. And so I kind of felt like, you know, the capital markets or go to be a little crazy for the short term and maybe access to capital will be a bit of a challenge. And especially if patients who are, when I’m going to be receiving care and how would you keep the doors open? So I immediately leveraged us all to be able to secure enough cash flow to get through a year. We’ve been very fortunate and we were financially at a very disciplined organization. So my debt is virtually nothing, I was able to take advantage of very early on.

Anthony Viceroy (25m 11s):
And I talked to others in the industry and that kind of waited until April. And at that point it was much harder in order for these banks to kind of, of land and the amounts. So they would give out with just as much less. So we move very quickly to shore up our finances. And then what I realized very quickly is we had a, a, a PPP problem, a PPE problem by we couldn’t get the right information. I mean, every single day, what we heard from the department of health, when we heard from the CDC was conflicting. If it was changing every hour, you know, give a mask, don’t give a mask. As long as the doctors wear a mask the patients doesn’t have to wear a mask, not the doctor and this went on every single day,

Dr. Orsini (25m 53s):
Level one mask, level, two level one, the next day, level three. It was crazy.

Anthony Viceroy (25m 59s):
it was insane. And And after maybe two or three days of this team together and just said, we’re masking everyone. You know, we don’t know anything about this virus other than what we’ve been hearing people dying in Europe, its now here, there is a community spread and you have to assume that it’s going to be highly contagious. And even if wearing a mask, doesn’t stop this virus. There is a part of just confidence of having the mask. They do feel a little bit less, right? Whether it’s a patient or an employee who is on the frontlines.

Anthony Viceroy (26m 39s):
So we started asking everyone and when we did that, I realized that our PPE volume was going to be a matter of days out. So we were very fortunate. I think like many we have to navigate all of the back channels in order to get inventory. There was no water, no 3m N95 masks to be found anywhere. So we just took a large shipment of KN95 masks is probably enough for, you know, years worth of, of a mess. So that way I would insure that all of my staff, all of our patients would be master and try to protect them as much as we call it. We then move very quickly to set up protocol’s as far as visits, we, I think got about, we were already on tele-health, but not leveraging much of the utilization was still a relatively low or within 48 hours.

Anthony Viceroy (27m 32s):
Every one was up and trained on virtual visits. And you know, we tried to take car as many patients, you have some that had non COVID medical conditions that were afraid to go to the hospital and all those that just said, how do I think I was in touch with someone who has it? And how do I know if I have it? It just really just patient education. We were dealing with a lot to that virtually and you know, what we found to be the most effective form of getting through those dark days was over communication. And I can’t stress that. It, it seems so simple. And you don’t know if someone says now, how did you get through a pandemic?

Anthony Viceroy (28m 13s):
And they want this magic formula. There wasn’t one. But every day we would talk to the whole organization, whatever we heard, good or bad we shared. And I think that was important to build up credibility and to build up again that trust. And you know, whether it was a difficult conversation or today was a little bit better. We had a share it, right? Every one was in this together. Everyone needed to appreciate what was going on, what would be expected of them and how the plans will change. And we’re not going to be married to any specific plan. The virus will disrupt your strategy and that’s the message I kept giving them.

Anthony Viceroy (28m 56s):
So we have to try to anticipate what’s going to happen. So we’re playing both offense and defense at the same time. And I appreciate that because its complexities and ambiguity, but we have to manage that. And if we work together, we will get through it. And it was hard. I mean we had to furlough some staff to the patients weren’t coming in, governor Cuomo in New York, as well as the whole tri-state area. Governor sent me, they shut everything down, but we weathered through the storm. And I think having those conversations was just so important in making sure everyone was all painted, we would say on the phone. And so every question was answered even if some of the questions started to become repetitive because we go on the phone for so long, it was important for every single person at WESTMED to feel like they were heard.

Anthony Viceroy (29m 45s):
We heard them and we are going to give you the best answer that we can possibly give. And then in those times where we didn’t have an answer, we say, we don’t have an answer. And once we do, we will come back to you. And I think that really want a long way. I think the other thing too was when you had the level of media, that was your sharing, a tremendous amount of bad news every day. Number of body bags, outside of Manhattan, hospitals, and things like that. It’s very hard to get, to wake up and be motivated to say, I want to come to work in and do this. I mean, it, it was fear or there was just a complete exhaustion that it was, you know, so many different emotions.

Anthony Viceroy (30m 28s):
You know, we try not to tell everyone, you know, I understand how bad it seems like it’s going to get better. We have to believe that. You know, I, I think, although you can say hope is not a strategy when you’re in the middle of a global pandemic and everyday seems worse than the day before I think hope and having a reassuring message is so important because your mental outlook and how will you going to tackle this giant taskin front of you is very challenging. So as best as we were able to do without being too optimistic, but with being cautiously optimistic that we will be to get through this, it kind of worked out because once the middle of may came about things started to lighten up a little bit.

Anthony Viceroy (31m 14s):
And once we got into June and definitely into July, I mean our demand patient volume was probably a 140 plus percent. Yet we still we’re at a 95% capacity because we didn’t want to disrupt the protocols that we had put in place. You know, the virtual waiting rooms, things like that. It was still in the community, not as bad as it was in March and April, but we never want to let our guard down with this virus. That’s the message that you’ve been not as of last week when we were talking to our entire organization, you can’t be asleep at the wheel. So to speak with this virus because it gets out of control back with us,

Dr. Orsini (31m 54s):
It sounds like the immunization is coming soon. And then you’re gonna have a whole issue. You are going to have to deal with that on how to give out the immunizations. That will be good news. The important words that keep coming up, communication, trust relationships. And you know, it’s been said by many leaders, people will do things to help the organization and they will follow the rules. As long as you provide the Y you know, in my experience, the Y is what is missing often when people hand down rules, as I said it in other episodes. And especially when you’re dealing with doctors, you probably even dealing with doctors as long enough.

Dr. Orsini (32m 33s):
We don’t like to follow rules. We’re not rule followers we’re independent free minded thinking. But if you tell us something and then you’d give us the why, then we will certainly abide by those rules, you know, this podcast really came about because during COVID, you know, I’m teaching in 10 years now, I’m teaching doctors how to break bad news on teaching patient experience on teacher communication. And then all of a sudden in March or April, I get contacted through a friend two major in international companies had hundreds of employees die of COVID and asked me to train their HR people because its now for the first time ever an HR person has to call someone up and a different country to say, Tony, you know Jim, who you used to sit next to you in that cubicle for the last 20 years he died and they weren’t prepared to do that.

Dr. Orsini (33m 28s):
And this podcast came about because I started to realize more and more if you know how to communicate, if you know how to give bad news to a patient or a family member than having those difficult conversations with employees where you have to furlough where God forbid you are telling them about their workmates, who just died from COVID. So COVID is changing everything. And really, I would say if it weren’t for Covid it wouldn’t be doing this because of the whole concept of this podcast is it doesn’t matter whether you’re in business. Does it matter whether you are in health care? If you can learn to communicate my goodness, that’s it, it sounds like the reason why you have such a good employee there and you’ve navigated through this is that you provided the why as much as you knew.

Anthony Viceroy (34m 7s):
I mean, I think I’ve been fortunate enough to be a follower of a Simon Sinek so yeah. So understanding the why and where that fits in the overall communication strategy is a very important, but again, it’s the, over-communicating the why I realized a long time ago. Tony it’s not what you say is what someone hears. And a lot of time, when you asked a question and you’ll also get an answer and you say, you know, there are any questions or do you guys are great? How many times no one says anything. You know, most people say, Oh, okay. They all agree with what I’m saying. And that’s not.

Anthony Viceroy (34m 48s):
My experience has been, that is not the case. Silence does not necessarily equate to an agreement. It just means that I don’t want to be disruptive and an audience to tell you that I disagree with him. And so we try to figure out, especially during this COVID crisis, you know, what are the multiple ways in multiple channels so that we can try to get this message across, but also try to look for those signs where it is and then how do we have a level of comfort? So if there are questions or even a disagreement, you know, we can bring that to the forefront sooner. I said, I wish I had all the answers. I clearly do not. So if anyone has better suggestions, this is the right time, the right place to be able to have these types of conversations.

Anthony Viceroy (35m 31s):
But here’s what I think is the right thing. Here’s why I think it is right. And if it turns out tomorrow that it isn’t right, we’ll certainly now pivot accordingly. And I think that just builds a lot of trust in the system. Plus the truth as we were all in this for the first time it was a world. It wasn’t even as Westmed, it wasn’t even as the U S and it was, you know, it was a global pandemic. And so in many ways, no one had the answers. And I think that is allows us to kind of come together because it wasn’t, I disagree with you. It’s like, I don’t know. So we’ll follow you until we see that, you know, what’s not working. And the first wave of this virus, luckily it, as far as now, you know, being in New York where clearly into the second wave of this virus, and we’re starting to have these communications again with our employees, we’re doing a tremendous amount of patient outreach.

Anthony Viceroy (36m 25s):
So that way they will understand what to expect. I mean, it’s sad to say this after everything that everyone has been through, when there is so much COVID fatigue, as we enter the second wave of this virus, you know, there still isn’t enough testing. And you know, my ability to want to test every single patient who needs a test is very limited. So, you know, its not just the treatment of patient care, it’s going to be the communication of how, you know, when should you come in for the test I know that with the holidays coming up Thanksgiving next week, every one who wants to go to their aunt and uncle’s house for the holidays wants to come in and get a test.

Anthony Viceroy (37m 8s):
I don’t have enough tests on fortunately to be able to do that. So I can only really test symptomatic people who are like a rule out flu and strep throat and, and then sit down and say, okay, test for COVID now? So hopefully it will have more tests and in the near future, but I would have thought after this first wave, that would have been something that we wouldn’t be having this conversation about. But I think the hospital will be unfortunately overwhelmed as well. And it was just something that is unlike first wave that we didn’t have the experience of this with the second wave we kinda know what’s comming, I think all of us in the community, are you going to be much better prepared or not to say it’s going to be easy by any stretch, but its not going to be as foreign as the first wave was were literally minute by minute, you had no idea what to expect.

Dr. Orsini (37m 59s):
New York city took such a bit hit, I’m a New Jersey person and moved down to Orlando was six years ago. In Florida.

Anthony Viceroy (38m 7s):
It took a hit to hospitals and all that. I think what we did anticipate though, is people are asking for a test because they wanna go see Aunt Edna. we had assumed that people should go for a test or when they were exposed to or when they were feeling sick. We didn’t think that I’d like to go to see and Edna for Thanksgiving. So let me go for a test or even though the number of that unbelievable amount of testing, it’s still not enough at every day. I pray for the vaccine to to come out.

Dr. Orsini (38m 38s):
I think that’s the only way we are going to finish this and get back to normal. Is Westmed still having furloughs and issues. And what are you coming back?

Anthony Viceroy (38m 49s):
Again, very fortunate. I wish I could say that it was, you know, the great execution of the strategy, but our business bounced back very quickly, but it was just a tremendous demand. We probably had about six weeks that I would say were a bit rough. But as I mentioned earlier, I think financially we short everything up. We continued to have a virtual visits. My biggest concern was that there were many patients who needed treatment or which we were tooveafraid to come out. And if they didn’t get that treatment, their chronic illness they’re, you know, the complexities of what they had was going to get worse.

Anthony Viceroy (39m 30s):
So even in a pandemic, we have to think about how we deliver a care to those patients that need it. So we’re constantly thinking about how to reinvent our own model and disrupt the whole model because this is going to be the new norm that we’re facing. But after six weeks we were really kind of back to normal where I said I had to like limit the amount of appointments just to try to keep everything safe. So from that perspective, you know, economically it’s been very well. But again, it’s just something that I think when you go through this and every one who’s experienced this firsthand with I’m sure what it is great, it’s humbling, but it also, you don’t forget it easily and going into the second wave that it’s as if March was just yesterday, even though the differences between March and April felt like a year in between those, you know, a couple of weeks, the rest of the year has been so fast moving into November.

Anthony Viceroy (40m 26s):
But now that we’re in the second wave, I feel like it was just yesterday and most darkest hours. And that is still front and center on my mind.

Dr. Orsini (40m 34s):
Do you still got PTSD? You know the word you said before, cautiously optimistic, which I think is really important because we’re trying to go through this fine line of being optimistic, telling people that they need to be concerned about this. This was serious without panic. And I know that there is a bunch of people who have died at home from strokes and heart attacks. And just last month I got a call from a friend of mine saying, please speak to my dad. He’s having chest pain. I think he’s having a heart attack, but he refused to go to the hospital because he doesn’t want to get Covid. And so it’s a fine line to walk. And I think that’s where the media sometimes needs to maybe pull back a little bit on the panic. I know he sells newspapers, but its tough to say, Hey, you need to take this really seriously, but not so seriously that you’re willing to have a heart attack and die because you’re afraid to get on Covid in the hospital.

Dr. Orsini (41m 23s):
And I think that’s been the challenge and I hope that we can come together as a country and try to understand that if as I was taught a long time ago, if you think a problem has a simple solution, then you obviously don’t know what the hell is going on. And the solution is, Oh, well everybody will wear a mask and everything. It’s just going to have to be fine or let’s lock down and everything will be fine. That’s making a very complex problem. Very simplistic. So it sounds like Westmed has been able to do that. Anthony we were running towards the end that I know your time is very valuable, but I always ask my guests the same final question. Most of them hate it. So I’m going to, I’m going to ask you, so the name of this podcast is Difficult Conversations, you’ve been an executive, you’ve been a leader.

Dr. Orsini (42m 10s):
You’re a CEO you been in health care out of health care. What type of conversation do you think now for me it’s breaking bad news, telling a patient they were dying, but in your experience, what type of conversation is the most difficult conversation that you have to have? And can you give anybody advice on how to navigate through that?

Anthony Viceroy (42m 30s):
I would say for me, the most difficult conversation to have is when you have to let someone go out and shore, most of your prior guests probably had the same thing. So it’s extremely emotional. Especially when you work closely with someone for years, you may be built a personal relationship who made like them, but you just reached a point where may be that effective in their job or it’s just not the right job for them. It doesn’t mean the not a good person is just not the right job for them. Those are really hard. And I remember one in particular that unfortunately I had a like, Oh, and I felt so horrible ’cause his child was just about ready to go to college and he was trying to pay for college and he asked me, how am I supposed to pay for my daughter’s tuition?

Anthony Viceroy (43m 21s):
And you take that home, you get to the top and you look around and you realized you’re by yourself. You have no real support system. And every decision that you will ever make impacts everyone who was under your care. And I think maybe I was a bit un prepared for that in the beginning and it was harder. But I think the best advice I can give is know there is no silver bullet, but I think just again, like everything communicate honestly, you know, tell them where they went wrong. Try to help them land another job. I mean, in this particular case. So they said, no, no, this is not the right position for you. But I actually know someone who was looking for someone who has your skills and I’m going to put the two of you together.

Anthony Viceroy (44m 6s):
And, and I think if you treat people the way you wanna be treated and you make that aspect very personal, it’s not business. I think you can take a very difficult conversation and make it a little less difficult. It’s never been to be easy. And there is such a big human element to, with no different than what you must experience telling patients about end of life conversations. There is no easy way of doing it, but it’s so important and it has to be done. So I don’t think it’s so much at times what you say is it’s how you deliver the message, which I believe is also a a hundred at the title of your book is It’s All in the Delivery. And I, and I think that it is just really so important.

Anthony Viceroy (44m 49s):
It doesn’t take the pain out of it, but it helps get you through it. And I think that you also have to understand that when you’re dealing with people, it’s much more than just the situation that you have at hand. And I’m always mindful of the fact that people have families, people have health issues. People had other issues besides of their job. So, you know, you have to at least be aware of what goes on inside of people’s lives. Treat them the way you would wanna be treated, treat them with dignity, but always be clear and nothing should ever be a surprise. So in my example, we’ve had multiple conversations before there was a performance reviews.

Anthony Viceroy (45m 31s):
You never want to surprise anyone good or bad in my opinion, right? I think business relationships are no different than any other relationship. They need to be nurtured and they need to come a long over time. So again, that’s probably the best advice I can give you. So it was a very hard and gut wrenching experience, the look of that kind of news to someone.

Dr. Orsini (45m 52s):
Yeah. And you hit the nail right on the head. That should never be a surprise. When I teach breaking bad news, we use an acronym called Program. The G is for gradual. And what I teach physician’s all the time is that by the time you give that bad news, the patient should already know it’s coming in. We use different verbal non-verbal language. And even when I interviewed James Orsini from the Sasha Group I ask them the same question. He almost gave it the same answer. You said, first of all, I think as responsible is, first of all, I should never be a surprise, but how you deliver that news, it’s all on the delivery is so important in my business. And when you deliver a tragic news, if you do it wrong, it can affect somebody for 30 years and it should not be informational.

Dr. Orsini (46m 34s):
When you get bad news, it should be relational so that you were upset about that. And he probably noticed from the tone of your voice on the way he took that, that in the end, he would appreciate that, you know, the way doctors give out discuss medical errors, as you probably know, it makes a huge difference on whether you’re going to get sued for malpractice are not. And we’ve gotten that wrong. So many times the medical errors happen. You send out a lawyer, you send it to the CEO in the hospital or the administrator. And in the end they were looking at a whole bunch of guys in suits and the messages you’re just afraid of getting sued. You sending a physician who had been trained and we do a lot of Medical error training and says, He sorry, or is she sorry?

Dr. Orsini (47m 17s):
And discuss it with them. The American bar association said you are much less likely to get sued. If that doctor does it and does it in a compassionate manner and says, you, sorry, in fact, in, I think 14 States now the word I’m sorry, it wasn’t even admissible in court. Any more patients want to hear them? Sorry. So as you said, you care and how you’d deliver it makes all the difference. I think that’s fantastic advice and it’s amazing how consistent those answers get. But I appreciate that. Well, Anthony, this has been great. I think you’ve really shed some light on the amazing things you’re doing at Westmed again, being on top of patient satisfaction top and for accountability care organizations and best workplaces.

Dr. Orsini (48m 2s):
That is a trifecta. That is very impressive. And it’s all about relationships. And I think a lot of that has to do with people on the ground, but also you, so thanks so much for being on this podcast. I really appreciate it.

Anthony Viceroy (48m 12s):
And I know thank you. Tony it was so happy to be on it. And I think, you know, congratulations to you and to keep this up because I do think this matters, you’d be surprised. A lot of people do not know how to have difficult conversations and it makes the world of difference as you’re going through difficult situations. And I applaud you for what you’re doing here. And I think a lot of people are gonna learn a lot on it. That’s what’s most important. We have to share our knowledge, Nike

Dr. Orsini (48m 40s):
Yup. Steal from each other. I say we steal from each other. So Anthony, what’s the best way. If someone wants to get in touch with you, I’m going to put all your stuff on my notes, but what’s the best way to get in touch with you?

Anthony Viceroy (48m 50s):
Yes. Through my email contact is always the best way to get in touch with me. And as I said, I’m a professional workaholic, I work seven days a week and that’s because if it’s something that I’m very passionate about.

Dr. Orsini (49m 4s):
Thanks again. If you like this podcast, please go ahead and hit the subscribe button. Go ahead and download all the previous podcasts, especially the ones that we referred two today. If you want to find out more about what we do in the training positions, patient experience and communication training, you can contact me through my website. The Orsini Way.com. Thanks again, Anthony. And really appreciate your time. I know it’s a very valuable, thank you. All right. Wel before we leave, we want to thank you for listening to this episode of Difficult Conversations Lessons I learned as an ICU Physician. I don’t want to thank the Finley project for being in such an amazing organization, please. Everyone who’s listening to this episode, go ahead.

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

Announcer (50m 1s):
If you enjoyed this podcast, please hit the subscribe and leave a comment. To contact Dr. Orsini and his team or to suggest guests for a future podcast. Visit our site at TheOrsiniWay.com.

2020-We are in this together

Announcer (2s):
Welcome to Difficult Conversations: Lessons I Learned as an ICU Physician with Dr. Anthony Orsini. Dr.
Orsini is a practicing physician and the 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 (47s):
Well I’m 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 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, 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 (1m 41s):
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. I am Dr.
Anthony Orsini and I am delighted to be here with you again this week. This can be a very difficult time of
year for many, and I don’t believe that anyone would disagree with me when I say that 2020 has been a
particularly bad year for everyone.

Dr. Anthony Orsini (2m 26s):
There seems to be sadness everywhere. The COVID-19 crisis has affected everything. Almost 2 million
people have died worldwide. And then another 65 million people affected as of this month. Hospital workers
have been overworked, overwhelmed, and businesses shut down. People across our nation have lost their
jobs and can’t pay their bills. In an often overlooked aspect of the COVID-19 crisis is the number of people
who have died from cancer or heart disease, stroke, and other illnesses because routine health care
screenings were postponed. But for many who have lost loved ones in the past, this has been a sad season
year after year.

Dr. Anthony Orsini (3m 6s):

And that’s why on this episode, I chose not to have a guest, but rather spend just a few minutes talking
about this podcast and show my gratitude to the many guests that I’ve had on and the larger audience that
has been listening each and every week. I can’t believe that it’s already my 23rd Podcast Episode. We
launched our first three episodes on August 4th of this year with two amazing guests and my introductory
podcast. And here we are in a flash of the week before Christmas, when I started the podcast, I don’t mind
telling you that it was really nervous. I thought, what if no one listens? What if I can’t find guests, what if I fall
flat on my face and just sound ridiculous.

Dr. Anthony Orsini (3m 49s):
But to my pleasant surprise, in the first two weeks of the podcast at the Apple, top 100 in medicine going as
low as number seven and the top 200 for health and wellness. Week after week, I’ve been able to somehow
convince the most amazing people to come on to share their incredible stories, inspire my audience and
share their knowledge about various Difficult Conversations. For me, this has been an awesome experience.
I get to meet people that I thought I would never get to know. And now I call them friends. And just like those
of you are listening. I learn something each and every episode. You know when I first got the idea of having
this podcast, several of my friends said to me, why are you interviewing people who weren’t in the health
care field?

Dr. Anthony Orsini (4m 36s):
My answer was that this podcast is about effective and compassionate communication. And it doesn’t matter
if you’re a physician, a nurse, a business leader, or an HR professional, or just someone who wants to
communicate better with your spouse, your child, your teenager, and even your boss. Good communication
builds trusting relationships and is the keystone to everything that we do. And so I went on a search to find
the best guests that I can find to the best of my ability. Alternate, the weeks from healthcare to business. I
started with Kathy Caprino a Forbes writer, a top 100 Podcast to herself and author of the book The most
powerful You.

Dr. Anthony Orsini (5m 19s):
Kathy shared her wisdom and coaching tips for women who want to be more empowered in business and
gave incredible tips. Kathy’s Episode has been downloaded almost 1000 times and remains the most
downloaded episode. We also heard from Marcus Engle, who shared his incredible journey of his tragic car
accident that caused him to be instantly blind and how a nursing assistant held his hand and got him through
the trauma simply by saying the words “I am here”. And together, we heard more amazing and inspiring
stories. In episode four, Noelle Moore told her inspiring story of how she tragically lost her baby at birth.

Dr. Anthony Orsini (6m 2s):
And now Noelle runs a charity, helping mothers who lost a child get through the unimaginable sadness. And
then Episode 17 Debbie Haine shares or a story of stillbirth and how she turned that around to make a
difference in how hospitals around the country handle a stillbirth babies. These are incredible stories of

tragedy and triumph. And perhaps in my favorite episode, episode 11, I interview, my niece Lauren who tells
her story of how she went from a childhood cancer survivor to a registered nurse, treating kids with cancer
all by the age of 24. These are amazing people with incredible stories of strength, resilience, and hearts,
bigger than mountains.

Dr. Anthony Orsini (6m 47s):
People will make you feel better than knowing what they went through and pushing us to go forward no
matter what. As the Dalai Lama said, “tragedy should be utilized as a source of strength”. I also had some
incredible guests who have inspired us and made us believe that business leadership is not just about the
bottom line, but about people, guests such as Claude Silver from VaynerMedia James Orsini from The
Sasha Group showed us really how people should be treated. Holly O’Driscoll, Anne Bahr Thompson and
Stephen Covey talked about trust and relationships and how a true leaders lead and how the culture of the
business means everything.

Dr. Anthony Orsini (7m 27s):
These people made me feel really optimistic about the future of business. Now I’ve said before healthcare is
broken, we all know that, and I discussed their problems with health care and the solution’s in my book, It’s
all in the Delivery. But after interviewing people, such as Dr. Michelle Neier who treats pediatric cancer
patients, and Jason Wolf the President of the Beryl Institute who works tirelessly to improve the patient
experience I am optimistic about health care as well. I was also delighted to have Dr. Dike Drummond, who
was addressing the real crisis of physician and nurse burnout in medicine and Dr. Helen Riess who proves
to us in her book that empathy can be taught and is contagious.

Dr. Anthony Orsini (8m 11s):
And just a few weeks ago, I interviewed the incredible Quint Studer who was really an icon in health care
leadership and patient experience. So in closing, I understand that these are difficult times, and I hope that in
a small way, this podcast and the work that I do with The Orsini Way has inspired all of us to come to realize
how many incredible people are out there who have magnificent hearts. This podcast has made me believe
more than ever that the future is bright and the sky is the limit for all of us. In the coming months I will
continue to have inspiring guests and talk about how great things come from relationships and how our
relationships start with communication.

Dr. Anthony Orsini (8m 56s):
So in closing, I’d like to wish everyone who is listening a happy holiday season, and I hope you will continue
to listen as we all look forward to a much better 2021. Happy holidays. Well, before we leave, I wanna 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 are doing. I’ve seen this
organization literally saved the lives of others who lost infants. So to find out more, go to the Finley

project.org.

Dr. Anthony Orsini (9m 37s):
Thank you. And I will see you again on Tuesday.

Announcer (9m 40s):
If you enjoyed this contest, 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.

Achieving Excellence in Healthcare with Quint Studer

Quint Studer (1s):
One of my messages for years in healthcare is learn how to say, thank you. Learn how to look what’s right,
because I think in health care, Tony, we filter out the positives. You take the patient home that you didn’t
work, you take the employee home, that you weren’t effective with, and you miss all of the positive things
that have been done. And so, you know, were a big believer that if you start off with meetings with the wins,
you end of the day with what are you here to be grateful for? Because I think health care or any leadership is
a great, great position, but I just think we just get worn down because we play defense instead of offense,
because we find out what’s wrong instead of focusing on what’s right.

Announcer (43s):
Welcome to Difficult Conversations: Lessons I Learned as an ICU Physician with Dr. Anthony Orsini. Dr.
Orsini is a practicing physician and the 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 28s):
Well, I’m 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 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 11s):
They provide such things as mental health counseling, funeral arrangements, support, grocery gift cards,
professional house cleaning, professional, and 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 mother’s 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. Well, welcome to another
episode of Difficult Conversations: Lessons I learned as an ICU Physician.

Dr. Anthony Orsini (2m 52s):
This is Dr. Anthony Orsini and I will be your host again this week as well. Okay. Everyone, each and every
week, I promise you, by the end of the episode, you’ll feel inspired and you will have learned a valuable
communication skills that will help you be more successful in your professional and your private life. Well get

ready because this week I have the incredible fortune and honor to interview one of the biggest experts in
the fields of leadership in health care and in business, whose name is frankly considered as synonymous
with a patient experience. And you’d be hard pressed to find anyone in health care that doesn’t know his
name. So you are tuned into this podcast will be inspired and to learn while there is so much a bolt in this
man that I can literally do 10 weeks of interviews, and you’ll still be learning something new every day.

Dr. Anthony Orsini (3m 40s):
Today I have the honor. And the pleasure to introduce to you Quint Studer. Quint is a businessman, a
visionary, and an entrepreneur, and a natural mentor to many. He has worked with individuals at all levels of
leadership and across a variety of industries to help them become better leaders and create high performing
organizations. As you will quickly realize during this interview, Quint has a gift for translating complex
leadership and business strategies, into simple behaviors that allow organizations to achieve long-term
success and profitability. He is a teacher at heart. In fact, he began his leadership journey working with
special needs children. And we’re going to talk to him about that today.

Dr. Anthony Orsini (4m 20s):
He entered the healthcare industry in 1984 as a community relations representative. He then went on to hold
leadership positions at mercy health system in Wisconsin and Holy cross hospital in Chicago, Illinois, where
their initiatives in patient care lead to their winning Hospitals Magazine’s greatest comeback award. In 1996,
he became president of Baptist Hospital in Pensacola Florida and lead that organization to the top 1% of
hospitals nationwide in patient and employee satisfaction. That’s quite a feat. In 2000, Quint formed the
Studer group to help hospitals achieve the same results as he brought to Baptist Hospital. He frankly put
patient experience on the map by connecting patient care and customer service.

Dr. Anthony Orsini (5m 4s):
Through his work at Studer group, he served as a role model for hundreds of CEOs and other administrative
leaders around the country. Studer Group became the go-to patient experience in hospital leadership
consultants. And during that time, he was honored to receive several accolades for his leadership. Quint has
authored nine books. In addition to the Busy Leaders Handbook, which reached number five on wall street
journal’s bestselling list. We want to talk about that a lot today. His book Results that Last also made the wall
street journal bestseller list and in the great employee handbook he shares insights from working with
thousands of employees during his career. Now, let me tell you every time I read one of his books, the first
thing that comes to mind is a list of friends and families that I want to purchase it for a present.

Dr. Anthony Orsini (5m 50s):
So if you want to be successful, these are books that are really on the mandatory reading list. Quint has
spoken to a variety of audiences across the United States, and it is nationally recognized expert regarding
leadership. He is often interviewed by radio and TV shows as well as magazines and newspapers across the
country. And I’m deeply humbled that he’s agreed to do this podcast. He and his wife are residents of

Pensacola Florida, they’re passionate about giving back to the community and they share their time and
resources with local and national nonprofit organizations. Well, thank you Quint this is quite an honor, and
that’s quite a lengthy introduction. How are you today?

Quint Studer (6m 28s):
I could have done the same thing and I want to thank you. You know, I’ve got your book. I keep it on my
desk. It’s all on the Delivery and I just will tell you a real quick, I love page 70. Tell me, I forget, show me, I
remember and involve me I understand. I also like your comparison with, if you’re a spikes in your program,
you hit the toughest issue in healthcare and leadership is that these difficult conversations. So thank you for
what you’re doing to make healthcare better.

Dr. Anthony Orsini (6m 55s):
Thank you so much coming from you that means a lot. And I’ve been in really forging forward with my
passion to teach communication. We’ll talk about that in a little bit. You know, at first I think is probably a
good idea. If you don’t mind, just to tell the audience, I kind of started this way all the time, who is Quint
Studer and how did you get here?

Quint Studer (7m 12s):
I got here with a winding road and I think I volunteer my time a lot in particularly in university settings,
teaching healthcare administration, sort of a, if you do have an hour and you want to have some of these
speak to your class, and I get this question quite a bit, and these are students that are great universities that,
you know, get their bachelor’s, their master’s. Mine was an interesting journey. My parents didn’t go to
college. I was lucky enough to go to college. I didn’t know what to major in. So my first two years, Tony was
like, what they call undecided major, and then 60 hours they call you in. And they say, you’ve got to pick a
major. Or courses you’re taking might not count toward graduation.

Quint Studer (7m 53s):
And I had like a four year deal. I didn’t have a four and a half or a five. I had to get out four. And so I thought
of people that had a huge impact on my life. And one of them was my high school soccer coach. And, and in
a study hall, he let me come into his classroom and work with his students, to work towards a special
education teacher. That’s what he was. So I became a special ed teacher and it, it was one of the great gift
I’ve ever had. ’cause I think what I’ve really done is taken what I have learned there into all of my jobs.
There’s no, I’m just been working on the same game plan in different fields, which is you diagnose, you start
off an assessment. You’re a physician.

Quint Studer (8m 33s):
And the challenge in leadership sometimes is we just don’t slow down to do an assessment. We read a good
book, or hear a consultant. When we rush into a treatment plan without doing an assessment, then you set a
lofty goal. Then you get everyone on the same page and then you take, and you break it down into steps,

just like you are. You know, I meet Tony so many doctors that they call me and they say, Quint, you know,
I’m now in administration. What should I do? I say, use the same skill sets you used as a physician, but
instead of a patient, you now have an organization. Frank Burn was probably the first Physician that when he
was a part of you ended up in a Madison, Wisconsin that I had this conversation with that.

Quint Studer (9m 14s):
So I did that. Then I ended up working in a behavioral medicine center, which I loved. It was 35 beds ended
up working in, in hospitals. You know, I got assigned patient satisfaction. I mean, I just happen to be the guy
who drew the short straw of that day at an administrative meetings. Our CEO, Mark Clemat was going to
divide us all up. We were sort of a new administration team and he gave our chief nurse officer quality,
clinical quality at the time. He gave our human resource person, employee engagement, employee turnover,
and he gave our CFO finance. And there’s this thing called patient sat, which was the fourth little thing.
Seeing they all had something, he turned to me and said you’re in charge of patient satisfaction.

Quint Studer (9m 58s):
And I did the same thing I had done everywhere. I did diagnosis. I was, I think the first hospital administrator
that I ever went to the press Ganey and sat on site to understand the tool and how it works. And then I came
back and started benchmarking places like Southwest airlines and other places and, and how you do it. And
then I came back and I was desperate enough that I actually started doing some of these things. And then
they sort of worked and then Tony what happened to me is I got discouraged in healthcare and I wasn’t
enjoying it like I used to because I’ve got into it. I like that. But then, you know, all we talked about at
meetings where FTEs and adjusted occupied beds and market share and should we take risk or not take
risks, should we be capitated or not be capitated?

Quint Studer (10m 44s):
And it wasn’t like a special ed or any of those things. And, and I got lost Tony and I don’t even know I got
lost. I just know it wasn’t fun anymore. And I don’t mean fun, just wasn’t feeling worthwhile. And then I’m
doing this patient sat stuff, which meant I had to go up on the units and ask a nurse’s what we should be
doing. And all of a sudden, after about six, seven months of it, I started getting the letters that people would
write to the hospital about their care started funneling to me because I’m now the patient sat guy, and some
of them were complaints. But one day I get this letter that just talks about their father dying in the hospital
and how this nurse held his father’s hand until he could get there.

Quint Studer (11m 27s):
And he said, I hope you appreciate that nurse. And because I had been gone up on units because I had
been doing behavior that was different than I have been. I rediscovered purpose worth while work on making
a difference. And that’s what changed my career. As a patient experience changed my career cause a nurse
made a huge impact. Like they do every single day.

Dr. Anthony Orsini (11m 48s):
That’s a great story. And I was when we were speaking, or I’m thinking about the issues that we have today
with physician burnout, with employee engagement in the healthcare system, and what you said, you were
going through about thinking more about FTEs than about the patient. I think today it’s worse than ever
where doctors and physicians are often forgetting why they went into medicine in the first place. So I do my
workshops about patient experience and communication I do a little thing and it’s in my book about physician
burnout. And we’ve been told for a, a a hundred years physicians that the best thing to do not to get burned
out is to just treat it like a business and not make those human connections.

Dr. Anthony Orsini (12m 32s):
It goes back to the 1912 believe it or not when Dr. Osler gave his speech to physicians who were graduating
John Hopkins and said, you can only be a good physician if you detached yourself. And so that’s exactly the
opposite because I think exactly what you said, once you started talking about the patient and you heard that
story about the nurse who held the patient’s hand, you got excited again. And I think that’s what I’m trying to
get doctors to get excited about again. Right?

Quint Studer (12m 60s):
I think you’re absolutely right. I think sometimes we hear things and because we hear it from people, me and
might respect with all good intentions, we think it’s accurate. And maybe it was at one time or maybe it
wasn’t. So here’s a couple of myths that I had to stop listening to. One of the myths was you balance your
positives and negatives. So if I compliment you, I also criticized you. I’m a one on one guy. Well, then I found
out I was completely wrong. One-on-one creates negative relationships at two to one creates neutral to
positive, to one criticism, three positive to one criticism creates positive relationships. So let’s go back to
Healthcare. We are trained you as a physician.

Quint Studer (13m 42s):
Other people are trained to notice what’s wrong. When I come to you, it’s not for a Well person checkup
probably. And in fact, I will tell you, and I like this about physicians. When I would go to my, one of my
doctors, I’d walk in, in the first thing they would say is what seems to be the problem or once a month. And
I’m glad they did that because that is why I am there. However, we have to be careful in our culture because
in our culture, it’s a little bit different. So I find that many of the things that I tried to create, where things to
play off the fence to find out what’s right. So when you look at a doctor, particularly by Dr is used to hearing
from anyone in health care or what pharmacy doesn’t call them with a compliment.

Quint Studer (14m 25s):
You, you know, the OR doesn’t call them to say, good news. Dr we’re running on time. I can’t wait to hear
what that patient is going to be ready for you. We normally only talked to the physicians when we have
something negative to say to them, and then we wonder why they get wore out. You know, I tell people when
you see a physician come down the hallway, if you say to them, can I talk to your doctor? There are already

coming up with an exit strategy to avoid that conversation because it’s not going to be positive. And some of
my greatest memories is when you start recognizing physician’s in a positive way and watch them flourish.

Quint Studer (15m 5s):
So I think healthcare has been built on a culture of what’s wrong. And I get that. We have to find out what’s
wrong, but we miss what’s right in my book, “healing physician burnout” I think I was ahead of the game. I
got a phone call from Dr. George Fort in San Antonio. He said, Quint, you’ve got to deal with burnout. She
sent me 72 pages of research. I wrote a book on it, but I think I was just not at the right time, but I had
moved from there. And I, and I go on a little bit here because I think it is so vital. Diana Handel wrote a book
recently is going to be coming out. In fact, I wrote the foreword and she is a CEO that decided that she
ended up being in post traumatic stress syndrome from her role as a CEO of a hospital and reading that
book, I came up with the new awakening.

Quint Studer (15m 51s):
That, you know, Tony, you know, we all know the pain scale. If I had come to you and I say your, a patient,
and I say on a one through 10 with a smiley face and the sad face, what are you? You are gonna say a six or
a four. I’m not gonna say to you what, you shouldn’t be a six. You should be an eight so that you have a
great pain threshold. Or I don’t say, well, you should be a two. You big wimp. I just acknowledge that your a
six, because you feel like you’re a six. Well, I think when you look at healthcare today, we’re so focused on
stress and resiliency. We might be misdiagnosing the organization because when I look at what’s happening,
we might actually be on the verge or in trauma.

Quint Studer (16m 37s):
And I think if we don’t treat it right, you know, if you treat stress and this is new stuff, so I’ve never talked
about this before on the air, because it’s just all new learnings for me. Fantastic. I got an exclusive. So what,
what happens is I was all about, I actually create, help create a stress tool kit. So that’s where I was two
months ago. And of course resiliency is. So if I treat you for stress and tell you meditate, eat right exercise,
it’s going to be healthy for you. But if you have trauma, it’s not enough. So if you look at this stress, I’m
creating a pain threshold for our organizations. And so I think if you want to be a leader, you always gotta be
looking around corners.

Quint Studer (17m 18s):
You’ve got to be figuring out what’s coming. And I think right now where health care is at, you mentioned, you
mentioned burnout, doctor suicide it’s because I think we are treating it as stress when really we’re really in
trauma. And let me quickly just to give a quick thumbnail definition, stress is usually something that, you
know, I’m stressful, but I’m going to go back to normal when it’s done. You know, you’re applying for medical
school, there’s a lot of stress, but why once you get accepted the stress changes. You have a talk, stress
changes. So there is stress we all go through it. But normally when we go through the situational stress, it
gets better. Or we go back to normal. Now the challenge is with trauma.

Quint Studer (17m 59s):
That’s a little bit different. With trauma, It can be one incidents or can be multiple. But if you look at trauma,
we know we’re not going to go back to the way it was. We feel powerless. We feel hopeless and we’re losing
trust for what’s going on in the situation. And our job is changing. Our role is changing. It’s now think of
COVID-19 you’re a physician or your role is different because now your a tele-health physician you’re using
different technology than you’ve ever used before. They’re still adjusting to electronic health record. They’re
changing your RV use. They’re changing the payment methodology.

Quint Studer (18m 40s):
You might even be asked right now to take a reduction in pay because COVID has hit the revenue streams
and you’re losing trust. And you’re feeling a little powerless and hopeless. So what are my hopes in 2021 is
to really start helping people call it what it is. I’m not saying that it’s trauma, it could be stress, but at least
we’ve got to help the organization diagnose themselves correctly. So I’m probably not the, maybe the topic
we all planned on, but I think you’re onto something when you mentioned burnout and what’s happening in
this year. So I’m very pleased that Diana Hendel who’s much smarter in this than me. He asked me, right,
the forward to her, a book on this, because I walked out of there saying there is a new light bulb that just
came on.

Quint Studer (19m 26s):
Its sort of like in patient experience, I had to move it from service excellence to If we do the right things we
will improve the clinical outcomes. ’cause when we start getting people to do difficult behavior or
uncomfortable behavior. When we connect it to the clinical outcomes with their values, your book is a perfect
example. I gave a talk two days ago on when we hit these crossroads, do we pick character or comfort?
Which way do we go? And I’d like to tell you that I always pick character, but I don’t at times I pick comfort,
but you know what you teach Tony, which has the most vital thing you teach is how to do those
uncomfortable things. But their the right things to do.

Quint Studer (20m 7s):
But when we do those uncomfortable things, eventually we’re more comfortable because we have done the
right thing. Your book is unbelievably great for people in health care. Cause the number one issue and all the
years I’ve done in healthcare is people struggle with difficult conversations, whether it’s with a patient, a
family member, a coworker, or their boss.

Dr. Anthony Orsini (20m 28s):
Exactly. And that’s something that Difficult Conversations is something that everyone has to do. Doesn’t
matter whether it’s in your professional, your personal lives. As you know, I started off with teaching the
Difficult Conversations to physicians on how to discuss tragic news. And then as time went by, I went into the
difficult conversations and how to communicate and build rapport and form relationships. And then right

before I did the podcast, it was really the basis of the podcast was that whether you’re in business for, in
medicine it’s really the same skill set. And I have to say, as we move into your book, your latest book The
Busy Leader is Handbook. I read that book and almost every paragraph of every sentence you were
speaking about how to be a good leader.

Dr. Anthony Orsini (21m 10s):
They realize that this book, you can easily take the word Leader put in Physician and you can easily take out
the word employee when you were talking about communication and put it in the word patients or nurses
that really it’s all about the relationships. And then how are you even say it on the it “leaders must be able to
build strong relationships. They are the foundation for everything else. And that communication is the basis
for that great communication from leaders. You say sets people to do their best work, helps them improve
and grow and connects them”. So that’s the parallel, right? Do you think that’s why you went from a business
person who taught leadership to a patient experience so smoothly because it’s really the same thing.

Quint Studer (21m 53s):
It’s my background and special ed, which was the same thing. Because when you go and keep going back to
this, but again, as a special ed teacher, you assess the situation, you set lofty goals. But the other thing you
have to do is build up trust. Then you build up trust by recognizing what’s right. And I think when I first got
into Healthcare people thought I was a nut job because I was so complimentary. But you know, when you’re
teaching special ed and I was in some schools with kids with lots of different, special, multiple needs, you
will learn how to recognize certain behaviors because you want that behavior to be repeated, recognized
behavior gets repeated.

Quint Studer (22m 34s):
And sometimes you recognize people for doing things such as sitting, when the class starts, putting stuff
away. We had a girl that would get so excited about popsicles, that she had put one in her mouth without
taking off the wrapper. And the first day she took off the wrapper, you had a thought she’d won an olympic
gold medal in. So I think my training in that was very helpful because I tend to notice what’s right. And I tend
to start with what’s right. It doesn’t mean you don’t have Difficult Conversations but you still build that
emotional bank account to noticing what’s right. So when you do have to take a withdrawal, you haven’t
bankrupt the relationship.

Quint Studer (23m 15s):
And I think that’s one of the great challenges in health care. We all get so busy. We don’t make those
deposits. And then the external environment, he starts making withdrawals on us. You know, I used to say to
the employees, you know, please, I’m not the one telling Medicare to not pay us this. I’m not the one that
there are certain things that the external environment drives that we’ve got to be able to manage. So I think
that was really helpful to me. I think again, when you are a special ed teacher, you also have be good at
Difficult Conversations because you’re sometimes telling parents that their child isn’t going to be as

independent as they would make their child to be there’s diagnosis that you wish you didn’t have to provide
to a, a family With that.

Quint Studer (24m 0s):
And there’s also some consequences. So one of the stories that I always tell is I taught at the high school
level for a while and we had, sadly, we had some kids that would be taken advantage of by other people in,
in the school system. Or you might have a girl that you have to tell her not to get into the car with anybody.
She doesn’t know not to take a drink. If she doesn’t know what’s in it or not to give money to people, these
are all students and in a, you wish the society wasn’t like that, but it was so we had to be very good about
consequences and accountability too. So I’ve just been really blessed. And you know, I remember years
ago, Tony, the hospital is that won a big award and a guy came up to me and he said it tongue in cheek.

Quint Studer (24m 46s):
He said, how does a guy who was a special ed teacher end up running a hospital? And I said, well, as a
special ed teacher here is what you did. And he looked at me and said, my gosh, I wish I had a degree in
special ed. It’s really good preparation for what we do.

Dr. Anthony Orsini (24m 60s):
Yeah, you talked about the characteristics of a good leader? One of the things that you talked about really
early on in the book is a good leader, has humility. And I call that genuine in my book as a good physician is
genuine and it’s a real person. And there is a lot of parallels between that again, wouldn’t you agree?

Quint Studer (25m 18s):
Well, I think the deal that anybody has to have is clarity and self awareness. So when I think of the word
humility, I don’t want to confuse it with false pride. So for example, if somebody comes up to you, Tony and
says, wow, that was a great presentation. You did a great workshop. I feel so much more comfortable now
going out and having these difficult conversations. And you say, Oh, it’s nothing. I’m just lucky. That’s false
pride. You’re pushing away a skillset. Humility is being able to see one as they are. It’s the clarity. And I think
that’s really vital because that means you see your strengths and you see what you’re not good in.

Quint Studer (25m 60s):
Periodically because I’m in Healthcare, you know, if you’re in a health care, people come to you just thinking,
you know, no more than, you know, so that we will come to me and they’ll say, well, Quint my doctor is
referring me to the specialist out of town. And I said, well, you should thank them because obviously they
feel that you can get treatment somewhere else beyond what they can offer you right now. I said the most
dangerous thing is somebody who doesn’t know their own boundaries and their own limitations. So that’s
that humility of seeing ourself clearly in my first chapter of my book, it’s self awareness. And I think that is
the key that opens the door to everything. So how, where am I? And sometimes I think of the older we get
Tony, the more self aware we get ourselves, but early on it, we need people around us to give us feedback.

Quint Studer (26m 48s):
I do that even today. I say, Hey, don’t let me go off grid. Don’t be afraid to push me when they have to tell all
the executives to do all the time, but their teams is throw out something they know is crazy and see who on
their team challenges them, because you need people that are going to challenge you and you surround you
with that. So, yeah, I think self-awareness on being genuine, being authentic. People ask me, what’s one of
the big skills every leader has that says to be authentic, to be themselves.

Dr. Anthony Orsini (27m 19s):
Yeah. And it’s really very important that you think of your boss as a real person who is not just your boss. It’s
also extremely important. I talk about it in my book that you think of your doctor as a real person. So I try to
teach doctors, don’t walk into the room and say, you know, what are you here for, walk into the room and sit
down and say, hi, how are you? Or if you’re really lucky, you can find some commonality with, Oh, are you
reading that book? Or I didn’t realize you’re a Tampa Bay fan. And then all of a sudden you become a real
person. And there’s this whole concept that I talked about called it’s hard to fire your best friend. Right? So if
your boss is your best friend, or do you feel that your boss is a trustworthy guy whose a real person or a
trustworthy girl, I think you’re going to give them more slack.

Dr. Anthony Orsini (28m 5s):
And that’s what makes a good leaders. Don’t you agree?

Quint Studer (28m 7s):
I think you’re going to share more. I think the reason people struggle when their physician retires or leaves or
they get referred to someone, is that idea of being vulnerable. You know, you have to have a story to start
Raphael Bueno is a doctor in Boston, who I have great respect for him as a lung cancer specialist at one of
the people who I admire greatly here, he got referred there for lung cancer. And by the time the fella got to
see Dr. Bueno, Dr. Bueno had actually look the guy up and knew something about him and talked to him and
sort of took interest in him. I think the, the issue always comes in to the fact Is are you interested or
interesting? And I think the big factors bring to the table is if I’m being interested in you, you’re going to be
more sharing.

Quint Studer (28m 53s):
You are going to be vulnerable. I mean, I’ve gone to mental health therapy on and off my whole life because
I’m a big believer in brain health. And I was going to a therapist named Martha Horton. And I used to tease
her. Cause I’d say on the way to her, my appointment, I’d wait till the last possible minute. Hoping she might
cancel, you know, something comes up, then I’d sit in before I would walk in, in, in case you want to cancel
the last minute, then I would sit here and say, here’s what, I’m not gonna tell Dr. Horton today. She’d come
meet me. At the time I had walked to her office. I’d already thrown out, but I wasn’t going to talk to her about.
She created that trust in that safe environment.

Quint Studer (29m 33s):
And that’s what doctors have such skill sets and doing because people have to feel safe than I can share
some embarrassing moments with you. I got a phone call from our friend maybe three months ago. And he
said, I got to tell you I’ve had suicidal thoughts. And I was so pleased he felt safe enough to tell me those
things right. And we can do something about it. So I think it’s that measure of feeling safe with yourself in a
safe environment and even what you teach Tony. And I’m a big fan of yours. When you do a workshop,
you’ve got to create the environment because you want people to practice it. You want people to
demonstrate it. Well, I’m not going to do it.

Quint Studer (30m 13s):
If I don’t feel I’m in a safe, safe environment. So one of the things that you do is you create that safe learning
lab environment for people to practice something that they feel it’s very difficult to do.

Dr. Anthony Orsini (30m 24s):
Okay. You really opened yourself up when you have to really start those show people how to communicate.
Cause its a skill. When I have been doing it for 10 years, With teaching the doctors individually, we’ve done
probably seven, 8,000 doctors by now teaching them how to communicate bad news. I have found it about
15% of the doctors that we train, no matter how young they are, knock it out of the park. They are just
natural communicators, compassionate people, 15% of them I have a real hard time and sometimes I feel
like I can’t teach them, but the other 70% are genuinely compassionate, great people who just want to learn
how to build that rapport. Get good communication. I suspect that in business it’s the same that most people
want to be good leaders and good communicators, but just need to be taught.

Dr. Anthony Orsini (31m 11s):
I guess my question for you is back to the business and where I’m trying to go back and forth and relating
business with health care and back and forth. The leader and the Physician. My question is, do you think if
you’re hiring a new manager or a new Leader I know you mentioned that in your book, how important
communication is . Do you pick the guy who could communicate or the girl who could communicate or do
you pick the smart person and the room and teach them how to communicate and be a leader? Can it be
taught?

Quint Studer (31m 36s):
It can be taught if the person who wants to be taught. Second chapter in my book, Busy Leader Handbook is
on once you’re self aware or are you coachable? Now, one of the challenges in healthcare Tony, you and I
both know is how we shortchanged training and development. We just short change people. And going back
to your research, as my research is about 34% of the leaders could probably learn this on their own it’s
natural, they’ll study it, but the rest of them need help. You don’t want to create an environment that they are
stoic people, health care people. So that they don’t want to raise their hand and say, why I need help on this

may be once in a while, I remember once again doing a training workshop years ago and a big health care
system, 75 doctors to this workshop I was doing.

Quint Studer (32m 24s):
And it was neat to see them over the day or two transform themselves from something that they thought they
could do. You know, sometimes we don’t know what we don’t know and the physicians truly are doing the
best job they can do based on what they know. And physicians that’s pretty challenging environment
because they don’t get to watch other people do it. Nobody says let’s double book physician’s in the ER
today. So they can learn from each other. Let’s watch this person. So, one of my favorite stories in the
emergency department, there was a healthcare system and they posted the patient satisfaction or a patient
experience scores by doctor.

Quint Studer (33m 3s):
And this doctor noticed that he was sort of at the bottom. No, he didn’t go to another doctor. He went to a
nurse and said, what are these guys are doing that I’m not doing. She said, well, here’s some things they do.
So I think you’ve got to almost create that training and the environment. So it’s not optional. It’s sort of
mandatory. And then when people get there, they get so much more out of it than they think you’re right,

Dr. Anthony Orsini (33m 31s):
I think a hundred percent. And when I give my workshops, you see a group of physicians or nurses or
anybody that I’m training with their arms folded in the back. And there are there because they were told they
had to be here. But I tell you, there is nothing more rewarding right then by the end of that workshop, that
person is writing stuff down and is excited. And I mean, that’s what gets me going. I love when that happens.
Cause they are like, Oh, I like that. I’m good. And I tell them, I’m going to talk to you about different things.
And I’m going to show you some communication techniques that I want you to steal from me. That’s the way
I call it a deal for me. And, but often I think what we do is we concentrate on people who are doing poorly.
And instead of concentrating on people who are doing poorly or just saying, gee, my satisfaction scores are
low or my employees aren’t listening.

Dr. Anthony Orsini (34m 15s):
Why don’t you just sit back and watch that doctor who’s having really good patient satisfaction scores. And
even without me and without you, you’ll probably say she does something a little different here. She sits
down and she talks about it. And I think that’s one of the things that I try to teach my kids now that they are
all almost adults is watch the guy who is good.

Quint Studer (34m 35s):
All right, well, you’ll hit something Tony. And this has been researched. Now the Heath brothers and their
book “switch change when change is hard” they say the same things, they don’t use medicine. They use
other examples. So they say that there’s been a study after study on a child who drops out of high school,

but they find the child that doesn’t drop out of high school that lives in poverty that is moving around from
foster home to foster home. And just trying to figure out what is different in that child. So I’m a huge believer
in what you said. And I fell into this by accident. So I am at Holy cross hospital. Our patient satisfaction is
crummy across the board, which was beautiful because then we could all blame the patient, the place where
consistently crummy and then all of a sudden, dang it.

Quint Studer (35m 24s):
If one nursing unit doesn’t pop way up. Now we start sitting here with our smart intelligence executive brain’s
we say those are the same patients that are in all the other units are probably the same payer mix, the same
shared rooms, the same community, the you know, the same intercom they’re hearing the same. gheel’s on
the cart. That’s to know. I see, because these are all the excuses we had for us not being Good. So the
challenge is Tony, because people don’t see other people do it. If you ask that person, what are you doing
differently? They are going to say nothing. I’m just doing what everybody else was doing.

Quint Studer (36m 6s):
And they think they are. So I released a fellow named Don Dean who worked for me. And he was like part of
our measurement team. He was in radiology. And I said, Don, Michelle doesn’t think he is doing anything
different, but something’s got to be different because those patients are so much feeling better about the
care than any place else. Go up there and I want you to just observe her for the next five days. And I know
you will probably be a pain to her. She’ll say nothing, but just watch everything she does. So about the third
day, he said, Michelle, I noticed that one of the first things you do in the morning, is you go visit every single
patient on a unit.

Quint Studer (36m 46s):
And she said, it isn’t everybody doing that? We said no, nobody is doing that. Well pretty soon. And
everyone was doing it and now we’ve got better at it. You know, you’d find recognition to come out reward
that I absolutely a a hundred percent agree with you. I had an ER in Texas, they put a camera up. They were
really clear about not doing the patient, but they then took all the physicians. And they basically, and I think
you’ll really, this is what you’re talking about. And then they created sort of a, like you would an athletic If
analyze the video. And what they did is they study the doctors that had the best patient experience.

Quint Studer (37m 25s):
That’s what they did. And then they took the physician in that didn’t have as good. And they showed the
physician, their video. And then they showed that video, the doctor with the best patient experience, within a
matter of months, everybody had a great patient experience. Because once they could just see, ahh, they
said, I don’t know, they offer a blanket. I don’t, they talk about it. I want to do everything I can to reduce your
pain. They narrate the care better than me. Doctors are smart people and what they saw it done. And they
were doing the best they could, but remember physicians and all health care people have a disadvantage
cause they don’t get to see the other people, the best practices where, you know, again, I own a minor

league baseball team.

Quint Studer (38m 11s):
The player’s watch the other people bat . That they watch other people’s pitch. They are constantly
observing what their peers are doing. And Healthcare the last time he got to see a peer or do anything. It
was your residency.

Dr. Anthony Orsini (38m 24s):
Yes. That’s a great point. So yeah. And so watch here at some of the take home messages, I have two
quickt more questions for you. I take our message to be positive reward. You mentioned about one to one
positive and negatives, but it actually should be three to five. In the previous episode that I did really have
the pleasure of interviewing Dr. Helen Reese. Who’s one of the big names for empathy and, and she brings
that up all so that when you’re bringing up children, that’s the same ratio, three to one, five to one positives,
negatives

Quint Studer (38m 54s):
Workplace. You’ve at least got to get three and outside of the workplace at home, you gotta hit five now. So
I’m sure if you can get five everywhere, I always teach people in health care where sometimes so unused to
hearing what’s right. We even get nervous when we hear what’s right. You know, what’s happening? I tell
people, Oh, it was my, when you start being more positive, you better tell people why you’re doing it. Are
there going to think somebody had changed your medication and they are going to be a little bit nervous
about it.

Dr. Anthony Orsini (39m 20s):
And the other thing that was really cool that you mentioned to me is that it is amazing. No matter how old
you are, how much do you like positive feedback? When I do my program from the book, it’s all in the
Delivery. When we go in and we do the workshops, we do communication training for everyone, the doctors,
the nurses, the final phase of that program is called. See something, say something. And we have little
stickers, tiny little stickers that go on your chest and little stickers that go on in your badge holder. And we
say to everyone who takes the class, the workshop that if you see something good, anytime you see a good
interaction, it doesn’t matter if you’re the housekeeper who sees an interaction with the director of medicine
or a director, a medicine that see’s a good interaction with the housekeeper, give them a sticker.

Dr. Anthony Orsini (40m 5s):
And at first people said to me, you know, directors, chief medical officers, directors of the NICU directors of
the programs, get these stickers and get this big smile on their face. They put it on their lab coat and some
of them even put it on their doors outside of their office. And there was a 60 year old man or a 60 year old
women. So everybody needs a little positive feedback.

Quint Studer (40m 30s):
I think too in healthcare sometimes we’d sort of joke about these things. We almost make fun of them at first.
Then you say the affect. Two little stories that I just love. We have this thing at the Hospital I was at Baptist
where you can give a wild card. So when somebody does something good, you right out and you give them
a wild card and it was cute. It was nice. You know, it, it was wonderful, but I underestimated the impact of
these wildcards. So I’m going up to see Dr. Troy tippett. He is a neurosurgeon and he’s a really spectacular
physician. And you know, I go out again in here, he’s got a wild card that somebody gave him a nursing
assistant had written him a wild card handed a to him.

Quint Studer (41m 12s):
And he had it next to his diploma from medical school, this wildcard. And it hit me how much of the impact
that it had. The other story is sometimes even when it’s not sincere at first, it has an impact and that we
joked and even insincere recognition works in health care time. So my story was, is this again, working a
hospital, there was a nurse. And she was very frustrated because she had always wanted her own children.
And adoption is wonderful, but you always wanted her own children and she could not conceive. And she
was in a busy ER in a inner city hospital and people are coming and either pregnant or maybe not taken care
of themselves.

Quint Studer (41m 55s):
And prenatal care may be very young. Pregnant may be sometimes beyond with two or three kids. So she
would get very judgmental. And this nurse manager got complaints about her treatment and it wasn’t just
them. It was, she treated people differently depending on different characteristics in it. She was very
judgmental. So the nurse manager brought her in and told her she’d have to be nice to everyone. And she
says, I know that’s hard on you. I don’t care. You know, she started made a joke. She said, I’ll give you a
smiley face teeth of plastic. He can put it in your mouth to look like you’re happy.

Quint Studer (42m 35s):
She said I don’t care if you’re a sincere and not sincere, or you have got to treat people better, no matter
what. So that next day she came in and almost went overboard. Well, hello, how are you going to get you
this? Let me do this for you. And then she would say, what’s the patient’s, that’s not me. It’s the patients. So
at the end of the day, the nurse manager called her in and said, well, how did the day go with, you know,
treating everybody night? And she said, today didn’t count because everybody was nice to me. So all of a
sudden it clicked on her at the message is you started to get what you reap. And I think the fact that you
talked about reward and recognition at first, these wild cards are sort of a joke or who, wow, Oh, here’s
something, Whoa, wow, you’re doing a good job.

Quint Studer (43m 24s):
But then all of a sudden it clicked up when I was again, president of Baptist people got little light bulbs so
that they made us better. So they got all these little light bulbs, right? Ideas and something. They look like

military people with all these little light bulbs. So USA today came to do a story on us. So what they were
walking around the hallways, they saw some of the staff with these light bulbs. And they said, tell me what
that is for it. Do you know, the staff member could go by every single light bulb and tell me why they have
that light bulb. And I think sometimes maybe we’re not comfortable with recognition. Cause in Healthcare,
you know, we are not used to getting it. And one of the things I used to always talk about and health care,
sometimes Tony, it’s even hard to compliment somebody.

Quint Studer (44m 8s):
You tell somebody, they do a good job. They start arguing with you. I could do better. I can do it better. And I
shared again, in one of my therapy stories, I went to Catholic social services years ago, Amy Storme was my
therapist. And she said, Quint, I’m going to give you some feedback. I went there because I was depressed.
And she said, you know, and I get some positive feedback. You rejected that you deflect. If you tell me why
it’s not true. And she said, I think one of the reasons you feel bad about yourself as you filter out the positive,
one of my messages for years in Healthcare is learn how to say, thank you. Learn how to look what’s right.
Because I think in health care, Tony, we filter out the positive. You take the patient home that you did help.

Dr. Anthony Orsini (44m 50s):
You take the employee at home you weren’t effective with. And you miss all of the positive things that have
been done. And so, you know, were a big believer that if we start off meetings with the wins, you end of the
day with what are you here to be grateful for? Because I think health care or any leadership is a great
position, but I just think we just get worn down. ’cause we play defense instead of offense, because we find
out what’s wrong instead of focusing on what’s right. And you’re one of those right. People in healthcare. I
mean, you know, you’re taken care of the most difficult topics in health care. I mean its easy to teach
rounding its easy to use key words at key times, its easy to talk about making a phone call.

Quint Studer (45m 30s):
It doesn’t mean it’s simple, but it’s easier than what you teach. You teach the most difficult thing. And
Healthcare my first grandchild was stillborn birth. Oh I’m sorry. My daughter-in-law was a full term maybe a
week before she was due. Her placenta released. And she didn’t know at the time that was going to be an
issue. She went to the hospital, she delivered a baby, they named her Ella and she was still born. Now when
she got to the ER, she sort of had that feeling something was wrong because of the blood, but she still has
held out hope that her baby was alive.

Quint Studer (46m 9s):
And somebody had to sit down with her and my son-in-law and tell him that the baby had died. Hard right?
Excellence of course of the book story at the end is Brian’s story was about my nephew who has killed at 19
in a car wreck. And somebody had to tell my sister-in-law and brother-in-law that your, you know, your son is
dead. I’m so sorry. But what I learned amazes me is how people have the skillset to do it in a way. So when
you, four years later, I go to speak at that hospital that Brian died on me and I call him his parents and tell

them I’m going to speak at Christ hospital in Chicago and immediately my sister-in-law Cathy said, tell them,
thank you.

Quint Studer (46m 49s):
They were so kind to us. So what you teach Tony is just how to do the most difficult thing in Healthcare and
they have to break bad news and have difficult conversations. So I want a thank you for the impact that you
make and thousands of thousands of lives.

Dr. Anthony Orsini (47m 4s):
Oh thank you. And it’s something that is so important. I don’t think most people know how important it is,
how you break bad news can affect somebody for up to 30 years of you don’t do it correctly. There’s not a
person in the world, a doctor, a nurse, a police officer at a first responder who wants to be bad at it. But we
are just never taught on how to do that. And when things don’t go well, we tend to get upset, but I’m going to
tell you what it brings me really. It makes me feel good is when and now it’s been 14 years, but I get letters
and Christmas cards from the mothers and fathers who’ve lost her baby that was in my care or a premature
baby had died for a variety of reasons.

Dr. Anthony Orsini (47m 48s):
And and I got a Christmas card from them 14 years later. If that doesn’t make you proud and be happy that
you went into medicine, then I don’t know what will because many people would to see that as I failed, but in
the end I was there for the family and they appreciate it. And it’s something that I think we just need the team
more and I’m trying Quint I mean, I’m trying to train every doctor out there on how to do that and build the
relationships and we’re doing it one at a time. Sometimes we’d do it in big groups, but I feel that is even
more important than what I’m doing as a physician, but it’s at least equally important.

Dr. Anthony Orsini (48m 27s):
And I thank you for your compliments, that’s really very nice of you to say.

Quint Studer (48m 30s):
I think I will tell you have to look at the physicians and yes, most physicians what they major in and it wasn’t
a sociology or psychology behavioral medicine per say it was usually science, biology, chemistry. If you take
the Myers-Briggs and you get most physicians, about 90% of them are going to be an I, which means they
like to think internally before externally. And that means some things are not going to be as natural to them.
And I think that’s why you’ve got to make it safe for them to be vulnerable, safe for them to say they don’t
know because they were sort of a program to know because they picked the major that they are really good
in.

Quint Studer (49m 13s):
They’ve always been very successful. So I was talking to a person, a Harvard medical school, student

science major and the whole BIP or biology or chemistry. And I said, isn’t it amazing that most of your
training’s going to be scientific at your job’s going to be all about relationships.

Dr. Anthony Orsini (49m 30s):
Yeah. I love that a a a hundred percent. You’re exactly right.

Quint Studer (49m 34s):
And so I think the fact that you create a safe environment for clinicians or every one on how to have these
conversations, how to say they’re tough. And I know we are going way, way long, but you know, I love
doctors and I think doctors knew I liked them. And I think that makes a big difference. You can’t fake it
because their diagnosticians. One of the biggest impact I had from a physician who was my first week in
administrator on call, you know, that’s When in the old days, you got a beeper in you. Your role comes in to
the administrator on call. So it was a Saturday morning and be in a administrator and call. You have to walk
around the Hospital. My big skill was learning to say to the house supervisor, what do you think we should
do?

Quint Studer (50m 15s):
And then I’ll tell you. So I had heard that a person I sort of knew not well, but knew of them. She’s mid
forties. Her husband had a severe stroke, couple of teenage children. I knew she was in the hospital and I
turn the corner and there she is with her kids and Dr. Ram Rao, who’s an internal medicine physician. And
he was sitting there with the family, going over the decisions that they have to make. The decision was when
you look at it, do we keep him alive per se, artificially, or let him die naturally.

Quint Studer (50m 55s):
And I watched him walk through the family with this and they made the decision to let sort of nature take its
course. There wasn’t any real other option, but you know, there is always another option, but they have
tools, all sorts of things, Andy. And then you said to them, now I am available. Here’s my number here’s my
beeper. This is beeper day. If you changed your mind or need to talk about it, I want you to call me. Now, I
think he knew that they probably wouldn’t call him. But the sense of understanding and comfort was really
quite remarkable. And I’m sitting there and I’m thinking I’ve never had to tell somebody that, and I’ve never,
you know, Dr.

Quint Studer (51m 37s):
Steve base and a good friend of mine tells about the fact when he’s telling a patient, a woman in her
husband that she’s got terminal cancer. She’s the same age as his wife and the kids are the same age. I
think physicians have to do some of the most difficult things of anybody. And what do physicians really want?
You know, treat me with respect to have things go on in time. They don’t have a lot of demands. So I’ve
always been a, a, a big fan of physicians. And that’s why I think in this environment, providing them the
support with training, because they’re not going to ask for it. I don’t think if the chief medical officer says,

Hey, raise your hand.

Quint Studer (52m 18s):
If you want some additional training on how to help be more effective talking to your patients, nobody is
going to raise their hand. Nope. Once you provide the training and the education, they’re so grateful for it. So
I think what you do is just a difference maker in Healthcare. And I’m very honored you have asked me to be
on your podcast.

Dr. Anthony Orsini (52m 37s):
Well, thank you Quint and what you have done for a patient experience really can not be underestimated.
You really made patient experience what it is today. We have a long way to go. There’s still, and I don’t have
time for the question, but we, we do know that most hospital executives place, patient experience in their top
three priorities and Yet many of them have not yet invested in patient experience, but thanks to you. It is now
put on the map

Quint Studer (53m 5s):
In 1999. It wasn’t even in the top 10, nor was employee engagement, I think two. And when you tie it in a
clinical outcomes, which I tried to do all the time, that’s where that all of a sudden it clicks just like an
employee engagement. You know, when the research came out and said, there’s a correlation between
employee turnover and your mortality, rate? So it’s no longer we’re lowering turnover at a lower, longer
turnover. We’re lowering turnover to save lives. So it’s really exciting for me to see there is an association
like the Beryl Institute that didn’t even exist. There’s a, job’s called patient experience. Chief patient
experience officer that didn’t exist. CEO is even having in their incentive comp that’s when you know, it’s real
when it’s, so we have a long way to go, but man have we’ve come a long way also.

Dr. Anthony Orsini (53m 54s):
And a lot of that has to do with you. You mentioned the Beryl Institute. Jason Wolf I interviewed just a couple
of weeks ago. His interview will probably drop early December, maybe right before yours. So Quint, this has
been amazing. I sent in the beginning of this introduction that we could probably do 10 of these. And I think
the audience now believes me because you have so much to offer what you’ve done for Healthcare or what
you’ve done for leadership and business is just amazing. When you agreed to come on in this podcast, I was
just elated. So thank you so much for coming. Thank you for spending your time. I’m going to put all the
references in our show notes about what’s the best way for someone to get in touch with you. And I’ll put that
in the show notes for those of you who are driving.

Quint Studer (54m 34s):
Sure. It’s my email is Quint@quintstuderstuder.com. I have one time, somebody sent me a note and I
responded right away. And the person’s husband said, yes, it’s not him. He has someone that does that for
him. So then she wrote me in another one and I confirm it really, it was me. So, you know, I pray every

morning just to be useful to people. So when people reach out and allow me to be useful, I feel I’m blessed
or a good friend of mine. And I went to thank him one day and he said, the one thing you and I will never
agree on us, who should be thinking who so, Tony, thank you. And anybody who reaches out, I’d be very
grateful to do whatever I can do to help them.

Quint Studer (55m 16s):
And I guarantee I’ll end up getting more from them than I’ll ever give them. Right.

Dr. Anthony Orsini (55m 20s):
Thank you. Quint this has been an amazing, if you like this podcast, please go ahead and hit subscribe and
download all of the previous episodes that we referred to during this podcast. If you want to know more
about the Orsini Way or about the book, you can go to the Orsini way.com. Thank you again, and thank you
again. Quint and I can’t. Thank you enough. It’s been great. So grateful. All right. Take care of 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 projects for being in such an amazing organization, please.
Everyone who’s listening to this episode, go ahead. Visit the Finley project.org. See the amazing things that
are doing. I’ve seen this organization literally saved the lives of mothers who lost infants.

Dr. Anthony Orsini (56m 5s):
So to find out more, go to the Finley project.org. Thank you. And I will see you again on Tuesday.

Announcer (56m 11s):
If you enjoyed this podcast, please hit the subscribe button and leave a comment in a review. You can
contact Dr. Orsini and his team, or to suggest guests for a future podcast? Visit us@theorsiniway.com.

Brand Citizenship with Anne Bahr Thompson

Anne Bahr Thompson (1s):
And Brand Citizenship is very much of the five step model is very much not just about communications in
that way of advertising, marketing campaigns, digital communities. It’s very much a conversation in terms of
full behavior of an organization, how a company behaves in every single action. And I think very much, I
know, as someone who goes to doctors periodically your responses very much, and based on the action of
the physician, not just his words.

Announcer (37s):
Welcome to Difficult Conversations Lessons I Learned as an ICU Physician with Dr. Anthony Orsini. Dr.
Orsini is a practicing physician and the 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 22s):
Well, Welcome to Difficult Conversations Lessons I Learned as an ICU Physician. This is Dr. Anthony Orsini
and I will be your host again this week, today I’m very honored to have Anne Bahr Thompson as our guests
today, Anne is the author of the book “Do Good Embracing Brand Citizenship to Fuel Both Purpose and
Profit” a Trust Across America 2018 Top thought leader and a 2020 Superbrands Top 10 Branding Leader,
Anne Bahr Thompson has been using the Brand as a motivating force for change relationship building and
profitable growth for more than 25 years. A former executive director of strategy and planning and the head
of consulting at Interbrand, the world’s leading brand consultancy Anne is the founder of one sixty fourth, a
strategic and creative consultancy that helps integrate purpose and social responsibility into brands,
business strategy, and corporate culture.

Dr. Anthony Orsini (2m 15s):
Anne brings the knowledge and understanding that only comes from interacting with a lengthy list of the
world’s most prestigious brands. Anne is the author of Do Good. as I said before, Embracing Brand
Citizenship to Fuel Both Purpose and Profit. Her pioneering model of Brand Citizenship, which will be talking
about today is a win, win, win solution, mutually beneficial to people society and the bottom line. Anne’s
writings have been published in the top industry publications. She has been interviewed on numerous
podcasts, radio shows and Fox Business and spoken to the business schools, conferences internationally,
and the UN, but nothing as prestigious as this podcast .Anne holds an MBA from the Darden school of
business at UVA, and has been an adjunct professor at Stern NYU school of businesses, London campus.

Dr. Anthony Orsini (3m 3s):
Anne welcome, I know you’re incredibly busy and I’m very honored to have you take some time out to talk to
my audience today. How are you today?

Anne Bahr Thompson (3m 10s):
Well, and thank you. It’s a pleasure to be here.

Dr. Anthony Orsini (3m 13s):
So that’s quite an, an introduction and you’ve built up quite a resume. So I’m really excited that my audience
is going to get to learn all about Brand Citizenship and what you do, because I think it’s fascinating. I read
your book a few months ago and I thought it was incredible, I couldn’t put it down because I really like all the
kind of stuff that you talk about. So I want to get to the book, but first as I usually start off all my podcasts
with, I just would like my audience to get to know and Bahr Thompson and who you are. So please tell the
audience a little bit about yourself, about your book and how you came to found Onesixtyfourth consulting.

Anne Bahr Thompson (3m 48s):
Well, I’ll put myself in the context of my book since that’s why we’re here today. And I think what’s important
is I never set out to write a book or even create a model for Citizenship or Purpose or sustainability, whatever
you’d like to call it in today’s world. And what happened is very much exhibits who I am. I didn’t set out to do
this, as I said, but I actually followed the signs. I have a friend in the UK who calls it cosmic breadcrumbs,
and I followed the cosmic breadcrumbs over the course of a seven year period effectively, which culminated
in the book being published. The book is a result and my investigations into Brand Citizenship, which
actually didn’t start out as Brand Citizenship.

Anne Bahr Thompson (4m 32s):
It started out more as a business leadership, is a result of my being curious, my interest in understanding
how a cultural sentiment constantly shifts and moves forward, and my ability to connect the dots and relate
seemingly discreet things in ways other people haven’t related them.

Dr. Anthony Orsini (4m 51s):
A bit more about how you define Brand Citizenship because many people out there might not know what it is
and then we can move from there.

Anne Bahr Thompson (4m 57s):
So technically Brand Citizenship as a five Step Model that runs across something called the me too we
continuum. And I suspect will talk a little bit of more about both of those things.

Dr. Anthony Orsini (5m 6s):
Absolutely we will talk about the 5 steps.

Anne Bahr Thompson (5m 10s):
And I think what’s interesting is to deconstruct the phrase Brand Citizenship to actually understand what it is.

So technically, as I said, it’s a five-step model, but if you think of what a brand is and there’s definitions about
perceptions and how people view things, et cetera, but really the brand is a human face of a business. It’s
the thing that was, we relate to as people, as employees, as customers, as other stakeholders, the brand is
the human face. That’s the thing that causes you to have a relationship with the company in a certain
manner. So if you take brand as the human face of the business, and then you take the word Citizenship,
which is about being an active participant in society, Brand Citizenship beyond that five step model on a
technical level is very much about businesses being active participants in society and taking a role as a
citizen would.

Dr. Anthony Orsini (6m 8s):
So many of my audience. And I think when we spoke last month Anne you have that kind of the same
question, I looked at your face and I think you were asking the same question my audience is asking right
now, the name of this podcast is called Difficult Conversations. And I think when I was reading your face,
you were kind of had this little look like what is Brand Citizenship have to do with Podcast and how are we
gonna relate this? But the premise of this podcast is that all types of conversations that we have during our
time are really important, especially during those critical times in our lives. But the other part of the Difficult
Conversations is that there’s conversations that we have with ourselves there’s conversations that we have
with others, and that we’re not even aware of.

Dr. Anthony Orsini (6m 49s):
And if we can learn about these conversations and learn about how we communicate, that will be better off
than navigate through our professional lives and our personal lives. And as I read your book, I thought this
was really a type of conversation that companies and businesses are having with their consumers and the
public. Correct. And I think that’s how I think of this as you’re really trying to communicate with us. And that
isn’t, that what you’re teaching when you are discussing Brand Citizenship ?

Anne Bahr Thompson (7m 16s):
I would say it’s about communications and it’s about actions and aligning your words with your actions. So I
started out my life in the university, undergraduate as a biochemistry major. And one day I woke up and I
was looking at this book by Desmond Morris called man watching. And it was compelling me and it was
pulling me in and I actually started thinking, wow, this is more interesting to me. And I was in a special
molecular bio program at the time that there are a lot of people from China and India and their livelihoods
and their lives actually dependent on doing well in this program. And they would sabotage experiment
sometimes in the lab notes in the library. And I really was getting tired of all of that.

Anne Bahr Thompson (7m 56s):
And I wanted to learn more about people and the way people interact. And this book does by Desmond
Morris, man watching pulled me in, and that’s what drove me to go to communications. And in many ways,
the combination of biochemistry and communications makes me a natural anthropologist. And the first thing I

learned in communications in my very first lecture was things are not linear. You know, you say something,
you have a body movement, you have an action. It causes a reaction. You respond to how someone else is
behaving in the same way you were saying, you saw my face and say, Hey, you want it to answer that
question.

Anne Bahr Thompson (8m 36s):
You are responding to an action, not necessarily a word. So I think what’s important to note is that
conversations are not only the words we have. They extend into the actions we have and whether your
physician having a conversation with a patient, or whether you’re a business, having a conversation with a
customer, with an employee, with a supplier, with an investor, with any range of stakeholders, what you say
and how you behave both creates that conversation. And brand Citizenship is very much, the five step model
is very much not just about communications in that way of advertising, marketing campaigns, digital
communities.

Anne Bahr Thompson (9m 24s):
It’s very much a conversation in terms of full behavior of an organization, how a company behaves in every
single action. And I think very much, I know as someone who goes to the doctor’s periodically your
responses very much, and based on the action of the physician, not just his words. And I think those two
things relate very much. I think the other thing that is very important to note, and I should’ve probably said
this before, is that I never set out to wrote a book, but I never set out to create this model either. What
happened was, is I was researching for, to come up with trends at the end of 2011.

Anne Bahr Thompson (10m 6s):
So five trends for 2012 to go out and market my business and have conversations with clients and potential
clients. And in the course of this research, two findings emerged that peaked my curiosity and led me down
this pathway to deconstruct Brand Leadership from Good Citizenship and favorite brands. So this Model
make so much sense. It resonated so much with you and others who read the book because it’s built from
the grassroots up. It wasn’t that I was in a corporate boardroom in a classroom, or even at home having a
glass of wine and saying, I want to come up with a model for Purpose or Citizenship because I think that’s
where the world is going.

Anne Bahr Thompson (10m 47s):
Actually, this was an advance of that being highlighted in spotlight it and people we’re calling for this. So the
model makes sense because it’s a five steps that will build from the grassroots up. And I think that’s very
important in relationships too, having empathy and listening to the people who are your audience, not
creating something, always in a vacuum.

Dr. Anthony Orsini (11m 10s):
And that will lead us beautifully to the five steps just this week where we’re recording this on November

fourth today’s date, November 4th, talking about just yesterday. We went live with my interview with Stephen
MR Covey, who wrote the famous book, the speed of trust. And we had a great conversation and I
encourage everyone to take a listen to that. And now this is like our 18th or 20th recorded episode may be
more. And one of the things that keeps coming up every single week, whether I’m speaking to people in
business, whether I’m speaking to patients or doctors or people in healthcare is the word trust and trust is at
the beginning of everything.

Dr. Anthony Orsini (11m 55s):
Whether it’s a marriage, a doctor, patient relationship, and how you establish that trust. And I really loved the
way you said it really is not what you said, but it’s how you say that because that’s my whole life. And that’s
what I teach. I go through hospitals and train doctors and nurses, and try to explain to them, it’s not that you
didn’t say the correct words. It’s that for some reason there was something on your face, something how you
said it’s something in your phrase, your tone inflection, that the patient looked at you and didn’t trust you.
And it doesn’t matter in medicine. I teach you one simple thing. Doctors should never use the word think,
they really don’t want a doctor that says, I think that you have that.

Dr. Anthony Orsini (12m 36s):
Now. That just means you’re stupid. And so we say, when I trained them, I say, of course you don’t always
know. We don’t always know everything, but if you find the mass or an abnormal picture on the x-ray, it, it
looks like cancer. Don’t say, I think it might be cancer. Say I’m concerned or I’m worried that this might be
cancer and that we need to work this up further. And by changing that one word you’ve really bought into
that trust. You went from a doctor who’s stupid. and doesn’t know anything to a doctor who really cares. And
so that leads us up into our five steps because here it is again, and the first step was trust, right? So can you
tell us more about that?

Anne Bahr Thompson (13m 16s):
And before I jump into that, I do want to say one thing in reaction or in response, I should say, not really in
response because they’re having a circular conversation here. Now I’m representing communication to what
you said is that it’s having a point of view. I think doesn’t represent a point of view, but I worry has a point of
view and people are looking for leadership everywhere and they are looking for guidance and having a point
of view is essential and trust begins with living up to your point of view. If you think of the word purpose,
which is a big loaded word at the moment in business, purpose is something that is the highest order reason
why your business exists is that plays on day at, in France.

Anne Bahr Thompson (14m 2s):
You know, it’s this highest order reason, but it has to be tied to what your business is about and your
industry. It’s not a social mission, but it’s a broad enough truths, a human truth. That’s broad enough and
deep enough that it fits the social mission. So once you have this point of view and this, purpose people
know how to benchmark you. And that’s the essential point of trust is knowing what to benchmark you from.

Prior to the global pandemic in the research, what happened was trust was based primarily on living up to
your product promises and commitments. So your product and services, you say, you’re going to do this. You
have to live up to it.

Anne Bahr Thompson (14m 42s):
And that’s how trust was based. In loyalty and retention work, which is a lot of my background from many
years ago. Trust used to be the end game for people in reputation management trust is the end game, but
actually, as you said, trust is the starting point for a meaningful relationship with the brand, with a business in
the same way it is for your wife or your friend, or for whomever. So you start with a living up to your product
and service promises, and then today’s world with COVID are actually living up to your claims, of your values
as a business what you say matters to you has been spotlighted and matters more. So the idea of what trust
means has grown deeper and wider in the course of the pandemic.

Anne Bahr Thompson (15m 26s):
So you move from trust, which is the me side of the equation, to enrichment, which has step two, which has
made my life better, more inspired, help me through your products and services, you know, make things just
feel more exciting. Then step three, which is the pivot point between being a me brand and a we brand is
responsibility. And it’s funny because when I was writing the book, I suddenly realized, Hey, at the middle
point, Step three is the pivot point between being a me brand and a we brand when the steps are emerged
from modeling and, and the research and the grassroots up, I didn’t even realize that the middle point was
actually a pivot point.

Anne Bahr Thompson (16m 7s):
So again, it wasn’t curated. It wasn’t contrived. It’s something that just emerged naturally through modeling
of what people told us. So responsibility is about the typical common things people associate with corporate
social responsibility, but, and this is a critical, but because it’s been highlighted more and more again with the
pandemic. Responsibility begins with treating your employees well and fairly. And what was happening is
because that started being a little bit of a given the environmental, treating the environment well was starting
to rise. And especially with climate change being highlighted, and so many people starting to acknowledge
and recognize it, and the UN SDG, sustainable development goals and companies signing on to deliver that
the environment started rising higher and higher as an important factor for people in being responsible.

Anne Bahr Thompson (16m 59s):
But then when employees health and employee’s safety started going to risk, what happens? Treating
employees fairly comes again with social justice issues. What happens treating employees equally and with
equity starts rising again. So responsibility to get credit for the good you’re doing in the world. You have to
first show people, your treating your employees well and fairly. So we have trust enrichment responsibility.
And then the We side of the equation, is community, connecting people through shared values, bringing
them together. And this is not just, you know, online communities, which is so easy to resort to, but actually

bringing people together and shared community program days in a variety of things, it’s businesses coming
together because they share our values and want to save forests or they want to save water.

Anne Bahr Thompson (17m 55s):
So it’s also business associations. So it’s multilevels of community bringing people together because you
share our values and you share our approaches to solving problems. And then contribution is make my world
better. And by my association with you, I am contributing to the world. So you are doing good and you’re
doing good on my behalf. So it’s making me feel bigger than I am when I stand on my own.

Dr. Anthony Orsini (18m 25s):
So, Anne in your research, and in your book, you mentioned a lot of different companies and one company
that you mentioned is my favorite company of all time. And that’s Apple and Apple was always at the top.
And it seems from your book, it’s a lot of people’s favorite company. And I was reading the book and I’m
trying to decide, looking at your book. Why is it that Apple is my favorite company? And I think I agree with
what you said in the book, but also a part of me was I remember that commercial many years ago, the first
Apple commercial, I think what the briefcases, you know, I was just graduating medical school. So I’m going
to say nineties ?

Anne Bahr Thompson (19m 7s):
The George Orwell commercial you mean?

Dr. Anthony Orsini (19m 12s):
Yes, yes where every day for people out there that don’t know, it was just a whole bunch of IBM like business
people in the same suits, walking like soldiers and the Apple message was be different. And I thought that
was cool and I became a big Apple fan. And there’s nothing, that’s not an Apple product in my house right
now. We don’t have any windows, any IBM. And so tell me a little bit about Apple and how are they able to
get to that point?

Anne Bahr Thompson (19m 32s):
the first thing that’s important to note is Apple actually is one of the reasons that I spent five years after the
first study investigating and deconstructing Brand Leadership from Good Citizenship and favorite brands. So
in that very first study in 2011, that was meant to come up with five easy trends to go talk to companies
about it for 2012, two interesting findings came about. We asked people which brands they thought would
exhibit leadership in the coming year, and which brands were good citizens. And within this, we also asked
why. And when you look at it, a lot of these studies that are published, what you often don’t know is many of
them don’t let you say whatever brands you want.

Anne Bahr Thompson (20m 18s):
Many of them are actually having you rank or rate or discuss a specific set of brands and that they don’t talk

to you about it. You have to have done a lot of this research to know that. So we had a completely
open-ended playing field and we had 2200 brands named as good corporate citizens, which means it was a
very fragmented market. It means that the definition of corporate citizenship was pretty vast for people.
There wasn’t a single definition that honed in on 10 great companies. And Apple came up as the number one
good corporate citizen, which normally I ask you to tell me which brand and 20 at the end of 2011, you might
think, but since you started with Apple you preempted that question.

Anne Bahr Thompson (21m 9s):
So it was curious to us at Apple was named as the number one good corporate citizen. We absolutely
expected it to be named as the number one Leadership Brand, but we never expected it to be named as the
number one good corporate citizen, especially at the end of 2011. Probably I think it was starting in 2010
Apple was in the middle of a bit of a scandal with activists and in the media because they had a chip that
was causing some problems and illnesses in China. And there was a whole lot of people on them because of
their supply chain and then not taking responsibility for the supplier’s they chose. So Apple was by no means
anyone we expected to come up in their, it didn’t even come up in conversation, but it was the number one
good corporate citizen.

Anne Bahr Thompson (21m 55s):
And why it was goes to the me to we continuum and goes to your question. So when you ask people, why
was Apple? Why did you say Apple? You know, it is number one it’s because Apple transformed the way I
communicate with other people across the globe because of the iPhone. Apple brought joy into my life by
bringing me music 24 seven, Apple changed so many things in the way we behave, communicate, and just
spend our time that’s in people’s mind that made it a good corporate citizen. So it was a very me proposition,
another brand that was a good corporate citizen that came up in the top three to five was Walmart.

Anne Bahr Thompson (22m 39s):
And this study was done in the U S and the UK, the UK, there was a comparable brand called Tesco to
Walmart that came up. And when you asked people why, because of their pricing policy, I’m afforded a better
lifestyle. Again, a me proposition, there was no way we expected this. And Ford came up because Ford had
been recovering. We are now great recession, 2008, end of 2011 Ford turned around and if Ford can turn
around that means America can turn around. And if America can turn it around, that means I can turn
around.

Dr. Anthony Orsini (23m 17s):
And Ford didn’t take any of the money that the other companies did, so that kind of made them, I can do it
on my own kind of look at it. Yeah.

Anne Bahr Thompson (23m 26s):
That spirit of self-reliance that I can turn my life around, but all of these were me propositions and who

would’ve ever thought of good corporate citizenship as a me proposition. And each of these brands had
corporate citizenship initiatives that people didn’t know about. So it was sort of mind boggling two us. So
that’s one finding. And then the contradictory finding that came up this study was people were saying they
wanted business to step in and reform society and make things in society better because government was
unable to do so because politicians we’re so divided. And if you think back, and we are speaking to the day
after an election at the end of 2011 was a, another election year of 2012 election.

Anne Bahr Thompson (24m 7s):
So people then thought there was a huge range of partisanship and that politicians weren’t going to solve
anything. And so they were saying business faces no opposition in the way, if a politician does, although
What, they weren’t realizing. And I talk about this in the book is the business does have a bit of an opposition
and, and it has a board. It has to, to go to the shareholders. It has to go to and deliver it too, but it’s different
type of opposition then being a politician. So business needs to step in a reform society. We proposition
Apple that are in my life, me proposition. And this is what is the thing that really sort of made us step back
and pause and say, what’s going on here? This makes no sense Citizenship is supposed to be about We.

Anne Bahr Thompson (24m 49s):
But what we learned is that about me and we, and balancing those things out and Apple over time has really
bettered its performance on the We side. You know, you see Apple doing more and more to deliver on the
We side, as it delivers on the Me side. And why is Apple your favorite brand? Because it’s at step two, it’s at
enriching your life strategically. It just makes you feel better. It inspires every moment of your life, but it has
the other steps. It has elements of the other four steps. And so it slides back and forth along that continuum
of Brand Citizenship, it serves you as me and it serves you as we.

Dr. Anthony Orsini (25m 27s):
I’m going to draw some parallels to what I do at health care on everything you just said. First of all, what I
love about your model, as you said, it’s from the ground up. And when I teach physicians and other people
about communication, patient experience, as a big deal right now, where in medicine right now are finally
giving the patient a voice before they never had that voice before. And there’s very good physicians that are
struggling. They’re excellent physicians. They’re not trusted because they have that look in their eye, or
they’re just not good at communicating, or they just don’t know how to bond to their patients. And we are
often taught a look at people who are good at something and trying to learn from them. And I think that’s the
exact opposite.

Dr. Anthony Orsini (26m 10s):
And I think you’d agree because that’s what you did. When I speak to groups, I’ll say to them, you know a
physician or a nurse or a business leader, an administrator, who walks into the room, and everybody loves
him or her. And you know, that person who, when on their patient satisfaction scores as a doctor gets a 98
percentile. And he’s awesome. That’s the person that you should be looking at. We’ll look at her and say,

what is it that she’s doing that I’m not doing? And I don’t think society has really done that, but that’s
basically what your model was. Right? You looked at, you found that Apple and Walmart we’re up there. And
then you went back and said, why.

Dr. Anthony Orsini (26m 50s):
Right. And I think that’s a good parallel to what we do when it goes back again to the trust and the
leadership. And so there are so many parallels in every day, life and personal and private life. These are
conversations that companies are having with their employees.

Anne Bahr Thompson (27m 6s):
You have to look at great examples, whether you’re a business or you’re a person, but you can’t necessarily
do what they do in the same way they do it. And so the notion of purpose or being, you know, authenticity is
a trendy word. And I’ll in a moment tell you why I actually am not so fond of the word anymore, but you have
to do it in a way that’s true to who you are, because if you completely mimic them and that doesn’t sit in your
center and it doesn’t reflect who you are or how you look or what people know as your values, it comes off
as insincere and people won’t believe it. So you have to take cues and notions from leaders, but then follows
through in a way that’s true to who you are, make it true to your purpose.

Anne Bahr Thompson (27m 54s):
So what I like to think of it as is actually, how do you feel comfortable and confident to go out there every day
and be your best self? And to me, whether you’re a business or an individual physician working with a
patient, that’s the true thing. Sit in your center, be grounded in yourself, in your true purpose and be your
best self. Yes. Learn from others, but do it in a way that’s true to who you are.

Dr. Anthony Orsini (28m 21s):
Agree. 100% in the fact that the word that we use is be genuine and you have to be genuine. And you’ll see
the best people that are able to build rapport. They have good conversations, create loyalty. Whether there
are a leader in business or their are a doctor, they are genuine people. And so, yeah, correct. You can’t copy
somebody, but you can look at them and say, what is that they’re doing? You know, wow, this person’s being
himself. He commented on baseball. Or he sat down with his patient. He wasn’t typing on the computer while
the patient was speaking and he looked in his eyes and so on, but you’re absolutely right, people will identify
fakeness if you will, in a heartbeat.

Anne Bahr Thompson (28m 58s):
Yeah. I think that’s the problem with authenticity in the social media world. Back in 2007, we have millennials
telling us that authenticity in today’s world was curated at best and contrived. The more typically and how
they spoke about that had to do with their playlists. And they would talk about how they knew their friends