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Read the transcript of Dr. Orsini’s podcast with Forbes writer Kathy Caprino
Kathy Caprino (3s):
What they found is if you make a value statement, it works better. So for instance, you might say in that
situation, I really value honesty and transparency. So I have to share, I don’t agree with the direction the
team is going. And just saying that value statement allows it to be heard.
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.
Dr.Anthony Orsini (1m 7s):
This is the podcast for you. Well, hi everyone. This is Dr. Anthony Orsini, and welcome to another episode of
difficult conversations lessons I learned as an ICU physician. You know, when I started this podcast, I made
a promise to myself and a promise to you that each and every episode will not only be informative, but
inspiring as well. And I’ve been very fortunate to have some great guests to my admire and I respect. And
today is no exception. We are very lucky tonight to have Kathy Caprino with us.
Dr.Anthony Orsini (1m 37s):
Kathy is an internationally recognized career and leadership coach, a writer, a speaker, and educator
dedicated to the advancement of women in business. A former corporate vice president, Kathy is now a
trained marriage and family therapist and a seasoned executive coach. She’s a senior Forbes contributor
and the author of two amazing books. Her most recent book titled the most powerful use seven bravery
boosting paths to career bliss was just released on July 28th and is now available on Amazon and other
Dr.Anthony Orsini (2m 8s):
Kathy’s core mission is to support a finding brave global movement that inspires and empowers women to
close their power gaps, create more impact and make the difference they long to in the world. Kathy is the
founder and president of Kathy Caprino LLC, a premier career coach and executive consulting firm offering
career and leadership development programs and resources for professional women or finding brave
podcasts is in the top 100 on Apple, Kathy as a former TEDx speaker. And by the way, I checked it out.
Dr.Anthony Orsini (2m 38s):
It was great. She’s a frequent keynote speaker and top national media source on women’s issues, careers
and leadership. Well, that’s quite a resume. I think I’m going to have to take a break a second to catch my
breath. Wow. A lot of words. Well welcome. But I must say it’s quite an honor to have you on this very
recently launched podcast, a big fan of yours. And I think the last I checked your head 130 episodes, maybe
Kathy Caprino (3m 5s):
I have, and I can’t thank you enough for having me. I’m so honored and grateful. Tony, thank you.
Dr.Anthony Orsini (3m 12s):
Well, that’s really impressive. And I know it’s a lot of work now from personal experience, so it’s more
working people understand, I think, but it’s certainly, I recommend your podcast, everyone. It’s really great.
So I have so many questions for you, and I want to talk about your latest book, but in full disclosure, we’re
recording this in early July. So the book is actually not out yet, but I’ve already, pre-ordered mine on Amazon
and I can’t wait for it to come, but you and I first got to know each other, I guess it was about six months ago
when you were doing a Forbes piece on the keys to navigating tough conversations with employees.
Dr.Anthony Orsini (3m 48s):
And I remember calling you afterwards just to follow up and you were so easy to speak to. We had a great
time. We shared stories with each other. I think I looked up at the clock. It was 45 minutes later and we built
instant rapport. It was, it was just great. So when I decided to do this podcast, I said, you know what? I
wonder if Kathy will do it. So you were the, one of the first people that I thought about it.
Kathy Caprino (4m 14s):
That’s so kind. Thank you we did have a great chat. I think it could have gone on for hours.
Dr.Anthony Orsini (4m 19s):
Yeah, it was so easy. It really was.
Kathy Caprino (4m 23s):
But I think we’d see things similarly in terms of how we talk to people, how we connect, right.
Dr.Anthony Orsini (4m 29s):
And it’s all about communication. And that’s why I started this podcast because I’m just fascinated by the
way people communicate. It’s just amazing or people can’t communicate. I’m also fascinated about that also.
So before we talk about your book and get into all the questions, cause I have so many questions for you,
you know, I know your story because we shared it that day on the phone and many people do. But for those
people that don’t, could you just spend a few minutes to tell us about your personal journey and how you got
to be where you are right now?
Kathy Caprino (4m 59s):
Hmm. Thank you. I’d love to quick story. Long story short, I had an 18 year corporate career marketing
publishing membership services. And on the outside it was successful on the inside. It was not. And I had
bumps all along the way, rough profit experiences. But when I hit 40, they, they became crises truly. So I
faced sexual harassment, gender discrimination, toxic colleagues and narcissistic bosses. And who knew
what narcissism was.
Kathy Caprino (5m 30s):
I didn’t until I became a therapist. And I’m like, Oh, that’s what happened. Narcissism zero work, life balance.
I was chronically ill for every three months or four months. I get an infection of the trachea as a physician. I
know, you know what that is, but no one could help me. They’re like here take antibiotics. It was such a
mess, Tony and not in the fabric of my young kids’ lives, but honestly, more painful than all of was waking up
and thinking, is this the work I’m going to be doing this?
Kathy Caprino (6m 3s):
This, it was meaningless to me except for the paycheck, which was big. So I knew I had to make a change.
And I tried, I saw therapist. I saw career counsel. I couldn’t do it because at 41, with two kids in a big house,
what are you going to do? Number one, most people don’t even know what they would do if they could, if
they won the lottery, I couldn’t figure it out. So what happens when we don’t move forward on our own, the
universe stepped in one month after moving to this bigger home in a more affluent area was nine 11.
Kathy Caprino (6m 33s):
And one month later I was laid off and this is one thing we were talking about. It was so brutal to me, how it
was done and it wasn’t even, you know, it wasn’t abusive. It’s just, when you think you’re a valuable person
in an organization and you are kicked to the curb and when the conversation leaves you feeling less than in
confused, it’s devastating. So I will make this brief, but it was a breakthrough moment for me. I said, I’ve had
enough. I’ve had enough of not feeling in control, not feeling valued, not feeling I could be myself.
Kathy Caprino (7m 9s):
And I became a marriage and family therapist, which was life changing in and of itself. This is how I’ve
learned so much about empathy and communication and how you really match with someone and help
them. And you can’t help someone if you’re judging them and looking down on them. Right. But then I have
to say, I found coaching career coaching and especially for women. And I’ve been doing that for 15 years
and it is the most rewarding thing in the world. But this book is a combination of what I’ve seen. That is an
epidemic of powerlessness, Tony, it for women.
Kathy Caprino (7m 43s):
So there are seven damaging power gaps that I’m seeing every day. And I did a survey just to check that it
wasn’t just my self selecting pool in 98% of the women surveyed are having at least one of these gaps and
over 75% have three or more. And when you have these gaps, you can’t thrive at the highest level. So that’s
my story in three minutes.
Dr.Anthony Orsini (8m 7s):
Well, it’s amazing story. And I know you can go on and on forever and I can talk, I can talk to you forever. So
it’s, it’s great. So you talked about the life changing moment. How that conversation, you speak about toxic
bosses in your first book, and you talk about the way that you were let go. How did that conversation go?
And now that you’re a coach, how do you think the conversation could have gone better? Because part of
this podcast, even though I’m a physician, I’ve trained some HR professionals and we have dr.
Dr.Anthony Orsini (8m 38s):
Larry Barton coming on in a few weeks, who is a crisis management expert. And we talk about how to let
people go with compassion. How do you think that conversation could have gone better? If it could.
Kathy Caprino (8m 50s):
I would like to talk about that, but can I talk about the context to anyone who’s listening as a manager and
leader has to understand this, and if you haven’t been through it, you can’t really understand it. But after nine
11 happened, we heard that a lot of people would be laid off. So, and they tried to do it quickly, but I think it
was a good three weeks that closed doors, everyone thinking, was it, is it me? Is it me? Is it me? Is it me?
And when you are in that scenario, it’s so scary. Especially if you have big financial responsibilities, right? So
first of all, you’re scared to death and you’re thinking, could it be me?
Kathy Caprino (9m 23s):
It can’t be me. And so I just want to say this one thing, why this was also hard. I make friends with
everybody. That’s just my Greek Italian nature. As you can see everybody and the office manager who got
all of our equipment and I was a vice president, then he was a good friend of mine. And the day we were
going to hear who it was, who got laid off, he couldn’t look at me. I could just cry. So the very first
devastating thing is don’t make people wait like this. Don’t do something different where we’re not all
wondering, am I going to be dumped?
Kathy Caprino (9m 56s):
When he ignored me? I was sick to my stomach. So I knew they were going to tell everybody the next day.
And what I heard was you were going to get walked out. You were going to have 30 minutes to get
everything, get stripped of your card, key in your computer and Lee and be walked out like a criminal. Okay.
People do not do it like that. Okay. So how did I learn this? Another vice president who was a great friend of
mine. He said, he knew he wasn’t one of them.
Kathy Caprino (10m 28s):
This was the night before. And I said, can you go find out if I am? And he came back and he was this burly, I
love him, loved him, burly Megan’s man. He actually sat down talk about difficult conversations. And he had
a tear in his eye, this man who I never saw a vulnerable moment for two years. And he said, it is you. And
you know, you’re full of these emotions. You want to throw up you a, how can it be there’s rage? And so I
said, would you go back and ask the boss? Would he do it now so that I can leave with some dignity and
have some time?
Kathy Caprino (11m 2s):
And the boss said yes. So I went in to talk to him and this is why it’s so painful. And anyone who’s had, I’m
not saying this guy was a narcissist, but anyone who has had emotional manipulation in their life is going to
know what I mean. I said, why, why me? Because I had had great promotions, a huge promotion, big raise.
Why would you be laying me off? And he said, I did some speaking around.
Kathy Caprino (11m 33s):
And I talked to two people who work with you. And they said, you’re difficult to work with. And what’s really
difficult is, you know, when you’re being gaslighted, you know, that’s a term in narcissism of all the people I
work with, you chose the two people that I don’t like and who don’t like me. So BS, you are just covering your
yep. And when you’re being gaslighted in that way, it’s so I just shake even thinking about it. Don’t be asking
me. So, number one, in a difficult conversation, don’t lie to cover your tush.
Kathy Caprino (12m 9s):
That’s how we had felt now, am I right? I don’t know. I, you know, we have been in touch and I didn’t want to
go there. It’s painful. But the second thing he said that I will never forget. And I learned never to do. He said,
you know, I think the world of you, and this is harder for me than it is for you. No it isn’t. And when Tony, we
were talking about this, don’t ever say something like that to someone who you are giving terrible news to,
and you know why that’s so bad. I was just thinking about this earlier.
Kathy Caprino (12m 39s):
I learned this as a therapist, frankly. I think we should all have therapeutic training. Everything you share with
someone should not be for your benefit. It should be for their benefit. If, I mean, not in a friendship, of
course, you’re going to be honest and open, but when you’re delivering that kind of bad news, it should not
be about him and his feeling. How dare you and how not empathetic. I just bought a huge house because
this company told me to do it. The president told me to buy the biggest house I could buy.
Kathy Caprino (13m 9s):
So you’ve just stripped away a lot of my future. And you’re saying you feel worse about it than I do. It’s so
angering Tony. So I know you have both books about this. You have years of training by the, what do you
think about what I’m saying here?
Dr.Anthony Orsini (13m 27s):
You’re right on. And I’ve been training doctors and nurses, how to have difficult conversations. I started out
by training doctors, how to give bad news. And there are certain words or phrases. And I was thinking about
this when you were speaking that are just no nos. And you don’t say them. Sometimes people say words
that are phrases, that they don’t mean what they’re really saying. And maybe they’re just nervous and maybe
would take that back now. I don’t know, but there’s certain phrases.
Dr.Anthony Orsini (13m 58s):
When you tell someone they have cancer and they start to cry and the doctor says, I understand the patient
turns around and says, why you have cancer too? How could you possibly understand in my field as a
position, as a neonatologist, a mother loses her baby, her baby dies. And you hear doctors and nurses. And
they don’t mean anything by Kathy, but they’re saying I understand. And I go, no don’t ever say that you can
switch the words around and say, cause I know this is what you mean.
Dr.Anthony Orsini (14m 28s):
Just say, I can’t imagine what you’re going through right now. It’s comforting. And, and you know, physicians,
when I teach physicians and even business leaders, they hear these phrases and they go, Oh, I like that. I’m
going to use that one. You know? But there’s certain things that you say, my mother-in-law just a quick story.
My mother-in-law who recently passed away when she was this little old Italian woman who was very quiet,
believe it or not Italian women, it’s quiet. Right? So you’re Italian. Oftentimes I can tell you, but she was very
quiet and she never really spoke a bad word about anyone.
Dr.Anthony Orsini (15m 2s):
But when she had her third child, it was the third day. And those days you stayed in the hospital for like a
week when you had a baby. And on the third day, the nurse didn’t bring the baby to her. And she said,
where’s my baby. And the nurses said, well, the doctor will call you about half hour later. The doctor calls. He
doesn’t come in on the phone because on the phone. And he says, and she tells a story. And he says, you
know, your baby died last night. And he says, I’m sorry.
Dr.Anthony Orsini (15m 32s):
And he says, you know, these things happen, which was the first thing. And the next thing was, you’re
young. You could have other children. So when my mother in law told that story, this kind little gentle woman
still refers to him 60 years later as the a-hole who told her that, you know, and if you heard her curse, it’s
actually funny when you hear this woman Paris, because there’s certain things and words that you can just
change and you can learn. And for you, it was, you know, this hurts me more than you.
Dr.Anthony Orsini (16m 5s):
That’ll never leave your mind. Right? So
Kathy Caprino (16m 8s):
What a story I want to riff on that for a second. Could I, because you’ve said something really important
when people share, if they’re kind decent people, I don’t mean narcissists and fools, but if they’re kind
they’re, what’s coming out of their mouth is their way of making you the, they think they’re making you feel
better. I want to tell you, I was talking to my son, my 22 year old son about this one yesterday. Here it is. And
I really want people to understand this. My 96 year old mom has just recovered from COVID.
Kathy Caprino (16m 40s):
Wow, God bless God bless what a warrior spirit. But you know, there’s other issues about, you know, that
come about in terms of an older person that doesn’t move for four months in her room. You know, there’s
other issues. But this is what people have said to me twice. In two times in my life, my dad was 93. When he
died of cancer, that spread everywhere and dementia. It was hellacious to watch this man, thank you.
Kathy Caprino (17m 9s):
Fade, who is so brilliant and wonderful. And here’s what people said, Tony, I can’t tell you many people said,
well, you know, he lived a great long life. I can’t tell you how angering that is. And I was telling my son about
my mom, that people have said, I said, mom has COVID. And they’re like, well, how old is she? Yeah. Wow.
And I say 96. And they’re like, well, you know, she’s lived a good long life. I want to tell people don’t ever say
that because the reality is yes, 93 and 96.
Kathy Caprino (17m 43s):
It’s a long life. But that, isn’t what I’m talking about right now. I’m talking about having lost dad or I’m talking
about the idea that I could lose my mother without seeing her. I don’t care how old she is. And my son and I
were talking that well, mom, so many people have lost their parents at much younger ages. If you’ve lost
your father at 60, when he was 60 or your mother 80 to them, 93, 96 is amazing. But see again, Tony, it’s
about them. Yes. So he said, gosh, mom, I think I probably would have said that.
Kathy Caprino (18m 16s):
Trying to make someone feel better. And I said, well, here’s what I want to teach. You need to communicate
in a way that you validate what the person is feeling, not what you’re feeling. And we don’t need statistics.
Like the doctor going, look, this stuff happens and you’re young. We don’t need data. Would you agree with
that? Is that
Dr.Anthony Orsini (18m 37s):
I think we say things sometimes out of being nervous because no one likes to have these difficult
conversations. No one really knows what to say. When you tell them that your 96 year old mother has
COVID. And, but what I teach communication is think about here’s what I want to say to you. It’s not about
you. And sometimes we say things because we feel like we have to say something, you know, in the words
of Rabbi Kushner, who was the man who wrote when bad things happen to good people, when you don’t
know what to say, say you’re sorry, and then shut up.
Dr.Anthony Orsini (19m 8s):
And I think that’s great advice. And I quote him all the time. There’s so many phrases that really hurt. So I
think that’s fantastic. And that’s great. One other thing,
Kathy Caprino (19m 20s):
I have a friend who had cancer and she told me that she’s never felt so alone because she would walk in the
grocery store and her friends when they’d see her, they would go the other way. And it’s because they didn’t
know what to say. And she knew that, but it made her feel so alone. So here’s something I say, just like
Rabbi K ushner saying, you know, say, I’m sorry. And shut up. Sometimes that doesn’t feel like enough. Like
if we say, Oh, I’m so sorry, Tony, what I always say when I don’t know what to say is how are you holding up?
Kathy Caprino (19m 51s):
Perfect. So you tell me how you’re doing. And then, you know, most often they share because a lot of people
don’t ask them how they’re really doing. So that can be another one you can have in your toolbox. Yeah.
Dr.Anthony Orsini (20m 5s):
That’s referred to when people ignore you, someone referred to that as the bushes effect, he said he had
just found out his son had cancer. And every time he came home, his neighbors would jump in the bushes
because they didn’t know what to say. And they were trying to hide from him. So it’s common. So very
interesting stuff. But I want to move on to a couple other things, because I know you’re busy. You talk about
in your first book, breakdown and breakthrough giving you say that hating, what you do is giving yourself up.
It’s giving the power to someone else.
Dr.Anthony Orsini (20m 37s):
During my communication workshops, I talk about physician burnout, professional burnout, and there is a
clear epidemic of physician burnout right now. It’s about 60 positions are the highest rate of suicide of any
profession right now. And that’s correct. Yeah. It’s been like that for a couple of years now. And I kind of say
it differently than you say it. Like what happens in medicine right now is that physicians used to have control
of how they practice medicine, their hours.
Dr.Anthony Orsini (21m 7s):
They were entrepreneurs. If you would, they had their own practices. Medicine right now is very task
oriented. You’re pushed to be efficient. And what happens is, and I always quote, when people act contrary
to their beliefs and core values, burnout increases, and you were telling your story about how you just hate it,
what you were doing. And I think there’s a real good parallel. There’s a lot of parallels between what I do and
what you do. There’s a real good parallel because what happens to physicians is they realize I went into this
Dr.Anthony Orsini (21m 39s):
I went into this to form relationships and I want to comfort. And what am I doing? I’m being forced to see 25
patients in two hours. And so what happens is we go home as physicians and we don’t understand what’s
going on, but we’ve done a good job, but we feel empty. We go home because gee, I did really good. Maybe
I saved a couple lives. Maybe I really helped people, but in the end, why do I feel so empty? And it’s that
emptiness is because I wanted to bond with my patient a little more. And so we were actually teaching
doctors and nurses to spend that extra minute.
Dr.Anthony Orsini (22m 14s):
And it, and it is literally an extra minute to feel more fulfilled about their job. And so I want to know what your
comment is about that. Oh wow.
Kathy Caprino (22m 24s):
Wow. I feel so much for the, the health care community right now.
Dr.Anthony Orsini (22m 28s):
It’s really everyone who has not fulfilled. It’s it’s what happened to you, right?
Kathy Caprino (22m 34s):
That’s interesting. I haven’t ever heard this before. I think why so many I’m right there with you that when
your values aren’t aligning with how you’re being made to work, what I see with career professionals is they
feel either like an imposter that I don’t really know enough or what you’re asking me to do. I don’t know how
to do well enough. Number two, I thought I liked this work, but this company is so toxic and the outcomes
that I’m being made to deliver, I don’t care about.
Kathy Caprino (23m 7s):
So there’s a misalignment or a disconnection. It’s not exactly what you’re talking about, that I can’t make
relationships, but from a lot of people, like for me in a number of years, I can’t be who I am, who I really am.
Like, I’m a loving, caring person and I’m gentle and I’m compassionate. And I remember in one of these jobs
that wasn’t appreciated that wasn’t what we wanted in that role. That’s not what they wanted. And I talk
about six dominant action styles that I’ve seen people take or follow in terms of pursuing goals and achieving
Kathy Caprino (23m 41s):
Striver seeker, pacer, researcher, challenger, advocator. So for instance, if you’re an advocate of, you’re like
a striver, you get things done. You’ll climb any mountain, but you have to be doing work. That’s advocating
for something bigger than yourself. If you can’t do that, if you’re one of these styles and that style isn’t
allowed, I’m a seeker. You know, I just want to learn and I don’t want to just all get it done. And it’s all about
the goals. If you can’t pursue those styles in your work, you’re going to be miserable, but you’re not going to
Kathy Caprino (24m 14s):
So it’s interesting. I think in the physician world, it sounds like people understand, clearly I’m being treated
like a robot that I got to come in and do it and leave. I think for corporate professionals is a myriad of things
that are going wrong, that don’t fit with their soul.
Dr.Anthony Orsini (24m 29s):
Yes, I agree. Yep. Yeah. That makes a lot of sense. You talk about in your book also, and I want to get to
your new book, but standing up for yourself and how especially women don’t do that or not good at it. And
you give a variety of reasons. How do you coach that, Kathy? How do you coach to stand up for yourself?
And I’m a big person on body language. So, you know, 70% of language is nonverbal. And when I train
people on communication, I tell them, you can use all the right words, right? You can tell them exactly what
to say, but if they’re saying it in their nonverbal language is meek or scared, it doesn’t matter because 70% of
it is nonverbal.
Dr.Anthony Orsini (25m 6s):
And that’s the message you’re going to give, regardless of whether I give you a script or not. How do you
coach that to your, to your students?
Kathy Caprino (25m 13s):
So two things of the seven gaps that the most powerful you book talks about. One is commute. Number two
is communicating from fear, not strength, which women 70% have said they suffer with. And number five is
acquiescing, instead of saying stop to mistreatment. So I want to talk about women for a minute. There’s a
lot of research. I’m not making this up a lot of data about how, when girls hit about 12 or 13, they go
underground. Their voice goes underground. They were on par with boys before that, in terms of thinking
they were leaders interested in STEM topics, you know, all of it, but at 13 it changes.
Kathy Caprino (25m 52s):
So what I ask women to look at and you know, I teach a course and I see them 30 people on my zoom call
once a week, you can see everything, right. You can hear it. You can see them looking down. You can see
how afraid they are, but the communicating from fear not strength. The first thing I ask women to look at is
where are you weakening your message. And I don’t, I don’t necessarily train about eye contact. I get to the
core of where you communicating generally from fear. So where are you over apologizing?
Kathy Caprino (26m 23s):
Tons of research that women say, you know, I’m sorry, exponentially more than men. And it’s true. Really?
I’m sorry about everything. They weakened their message. For instance, when they’re about to say
something in a meeting, you know, I’m not sure this is right, but you know, if you are saying that you’re
broadcasting, don’t listen to me, right? Or you allow people often men to cut you off. So for instance, I’ll train,
listen, if you’re continually cut off, here’s what you say. Oh, thanks Fred. That’s an interesting point.
Kathy Caprino (26m 53s):
I would like to finish. I wasn’t done with my point very calmly, but there’s also this amazing thing I learned
when I interviewed these guys, the behavioral science guys, Joseph granny, and David Maxfield. When they
showed a video of a woman saying a forceful thing and another video to another audience of a man saying
the same forceful thing, I’d own agree with the direction the team is going. Her perceived competence
dropped exponentially and her perceived dollar value dropped exponentially compared to the guy saying this
exact same thing.
Kathy Caprino (27m 26s):
So what they studied and here’s the end of the story here is, are there statements you can make before?
You’re about to make a forceful statement that isn’t going to go over well, that is going to mitigate the
backlash. So I teach this a lot. What they found is if you make a value statement, it works better. So for
instance, you might say in that situation, I really value honesty and transparency. So I have to share, I don’t
agree with the direction the team is going. And just saying that value statement allows it to be heard better
rather than people feeling slapped down because everybody wants their ideas to be accepted where all
week, well, I don’t know if that’s a hundred percent true.
Kathy Caprino (28m 9s):
We’re all vulnerable. We all want validation. So when you say, I don’t agree, you’re going to get a rise out of
people. So there are ways you can say things that will mitigate the backlash, but we must say the difficult
things. We must.
Dr.Anthony Orsini (28m 24s):
I’m a big person on tone and body language. I don’t know if you’re familiar with Amy Cuddy. She’s a
Kathy Caprino (28m 31s):
Amy cutting the power stance. Right?
Dr.Anthony Orsini (28m 34s):
Awesome. Right. Yes. She’s done studies to prove that if you just stand in front of a mirror before you have
that conversation, you’re actually will be more confident that she measured cortisol levels and testosterone
levels. And that she’s brilliant. I love and I love, but it’s really the nonverbal and the tone of your voice.
There’s a great study out of a sociologist. I think her name is Nina <inaudible>. She did a study trying to
predict which doctors would have malpractice lawsuits. And so she took 36 surgeons.
Dr.Anthony Orsini (29m 4s):
About half of the surgeons had been sued multiple times. The other half had never been sued for
malpractice. And she put little cameras in the patient’s rooms and she videotaped and audiotaped the
surgeon going in for a routine visit just by dr. Sini. Then she took those, those interactions. She put it in a
machine that analyze just tone, not the words, just the tone and the machine predicted which doctors were
sued multiple times in which doctors weren’t just by their tone, the tone, harsh cars, condescending, harsh.
Dr.Anthony Orsini (29m 38s):
She had a whole bunch of things. And then she did something really cool. She just the videotape to people
with no audio. And they were able to pick the ones that were sued. So these people were blowing it, both
roles. So I teach that the positions, because when you’re having a serious conversation and you’re having a
difficult conversation with someone, you don’t want a doctor who looks me, you don’t want a doctor who
looks confused. You don’t want a doctor that says maybe, you know, I always tell physicians, the word think
should never come into your language. Take that out.
Dr.Anthony Orsini (30m 8s):
You shouldn’t say, I think you have cancer because the response is going to be,
Kathy Caprino (30m 14s):
How about no?
Dr.Anthony Orsini (30m 15s):
Why don’t you know, why don’t you find someone who knows that’s going to be the answer, right? But you
can change that one word. And you can say, I’m very concerned. I looked at the, or Jessica’s right. And I’m
very concerned that you have cancer. It means the same thing. It means I’m not a hundred percent sure.
Kathy Caprino (30m 29s):
Ask a question, Tony, I got to ask where I was going with. What you were saying was that I bet you, these
people are narcissists because narcissists has zero ability to sit in other people’s shoes. So they’re saying it
in ways that are so off putting, but I don’t think that’s what you mean. Do you, you’re talking about doubt
insecurity is that it is that what was coming out that made these people,
Dr.Anthony Orsini (30m 57s):
Oh, you’re going back to the lawsuit. What made people get sued as people generally don’t Sue for
malpractice because of bad outcomes. They Sue for malpractice because they’re angry because they feel
that they didn’t have that relationship.
Kathy Caprino (31m 9s):
These people are narcissists. We need to go back on that study and overlay narcissistic tendencies.
Dr.Anthony Orsini (31m 16s):
It could be. In fact, the study is in the famous book, blink. He refers to that study and how insurance
companies, instead of setting malpractice rates, by your record of how many times you’ve been sued,
insurance companies are moving towards just analyzing doctor patient relationships to set the malpractice
rate. Because if you have that tone, if you have that empathy in your voice, you’re less likely to get sued. So
it’s fascinating. Do we have time, Tony? Can I talk about this to you? We have as much time as you want
Kathy Caprino (31m 45s):
Three hours. So sometimes, and it happens less and less with me now, but every once in a while, I will have
a coaching client who does something that’s inappropriate for me. So for instance, someone said that I came
late to a meeting too, and I was late eight minutes and I had said, I would give her eight minutes. And she
said she was so rattled that she wanted a complete redo. I’m not going to go into that for a minute, but I am
going to go into the answer was no, that is not going to happen.
Kathy Caprino (32m 21s):
And there was, and I’ll give you another example. There was one guy we were talking about, you know, how
to change careers. And he wasn’t taking the advice, the coaching, he wasn’t taking the steps. And all of a
sudden in a Mo in one morning, I get a lambasting email. You’re not helping me at all. He lost it. And I do
think know, he told me he suffers from bipolar. I think this was a bipolar moment. So I want to say that in all
of these times that, and I’ve grown in this. When someone attacks me or asks for something that I feel you’re
not going to get it.
Kathy Caprino (32m 54s):
And I think the guy might’ve even said, I want a refund. There are no refunds for working with me. And I
make that very clear. Why? Because you can see 500 videos of me in podcasts and you can check out my
approach, right? It’s the approach works. But I wrote to him, I got upset, but I wrote to him and said, I hear in
your voice, how angry you are. I hear it. I don’t think I said, I understand. I hear it. And this is what I would
like to share. And then I was very clear and very calm that this is not how I see what has gone down in our
Kathy Caprino (33m 31s):
And here’s what I see has happened. And number three, if I ever get an email from you like this, again, we
will be done in there. As you know, there are no refunds, but I’m here. If you would like to have a
conversation, I would love to talk on the phone. This was before zoom at Benanna was calm. I was not
judgmental and cruel, but I laid it on the line here. I will not get another one of these emails. And he, two
hours later wrote, I am so embarrassed. I was having a very bad morning and I was so overwhelmed.
Kathy Caprino (34m 4s):
And I, I see now. And I think I said, I would like you to read this again, your email from a really calm place.
And tell me what you would do. If I sent this to you and he said, I’m mortified. So why am I saying I’m the
best communicator in the world? No. However, I’ve had to hone it a lot in working with people that want
things that aren’t appropriate to give them. But I think the keys are stay compassionate, stay understanding,
but be very clear what you will and will not accept.
Kathy Caprino (34m 42s):
And you don’t have to. Somebody once said, and I say it all the time. You can say anything. When you say it
with love in your heart, I would say a lot of people go love. I don’t have love at work. Come on now. I think
you can say anything when you say it with compassion in your work.
Dr.Anthony Orsini (34m 56s):
And there’s a difference between we use the word, empathy and compassion interchangeably, but there’s a
difference. It’s a difference. Empathy is understanding someone’s pain, right? But compassion in Latin
compassion means with pain. It means feeling someone’s pain. And before you’re going in to have that
difficult conversation, it would really help. If you just take a minute to pretend or feel like you’re the other
person, like, what’s it coming? Like, what’s it from their point of view and with emails and reference to what
you just said, people don’t do that. Cause they just rattle off an email. They hit send.
Dr.Anthony Orsini (35m 26s):
And they, in the old days, when I was younger, you wrote a letter nasty letter. And by the time you mailed it,
the next morning you ripped it up. But people don’t do that. What emails they hit send, and then they regret
it. So put in the other person’s shoes, I think is great advice for someone who’s having those difficult
Kathy Caprino (35m 43s):
And isn’t there also another, there’s a lot of research on didn’t. They do it in the, whatever, what, in the fifties
of this, they recruited a team of people to turn a dial and sensibly. The person that you couldn’t see was
feeling a shock and you know, an electric shock. And you know, the instructors had turned it up and you’d
hear it was an actor, but they didn’t know that you’d hear the person’s screaming and the instructor, no, turn
it to 10. And they’re screaming. What they found is when you’re not seeing the person, you are going to
follow instructions even to the detriment or even to the death of another person.
Kathy Caprino (36m 21s):
So, and other pieces, get on a zoom call with them, Dar fire off an email, look them in the eye.
Dr.Anthony Orsini (36m 29s):
There’s the body language again, the nonverbal cues. It’s so important. The energy of the person. Exactly,
exactly. So, well, before we finished, I want you to tell me, by the time this airs, I’m already going to have
read it, but I haven’t read it yet. So tell me what I should expect when I read this book. And how’s it different
from your first book?
Kathy Caprino (36m 48s):
Thank you for asking. So the most powerful you is about, and it comes from the 10 years of research on
what a, here’s, how it happened. I was looking at why is it? So I’ve worked with thousands of women right
around the world. I sat back and said, I don’t get it. How is it possible that all of these women at every first of
all country level socioeconomic level education level fueled, how are they coming with the same problems
over and over and over again?
Kathy Caprino (37m 20s):
And here’s the question I wanted to answer. Number one, what is missing in their lives and work that they’re
coming to me for help with. And number two, what is coaching with me, giving them? And the answer was
bravery and power. That’s what is missing. And when I ask women, tell me about power. A lot of women who
said, I don’t want power. And I say, why not? And they say, because it’s abused. So that is the biggest lesson
that I wanted to share that you can’t have what you want in this life without internal and external power, but
I’m not talking about power over.
Kathy Caprino (37m 56s):
I’m talking about power to power to create power, to impact, power, to change. So, and bravery in my view is
the ability to recognize what isn’t working and take accountability for what you can change. Power is the
ability to change it. So this book is the seven damaging power gaps. And what I love about it, you know, all
of us who are in thought leadership are doing podcasts. It’s fun to hear yourself talk for a while, but it’s much
more fun to hear other people’s messages and strategies and, and research.
Kathy Caprino (38m 29s):
I find. So the book talks about not only my coaching strategies, but it’s every chapter is a real life client or
course member who, how she suffered having the gap and how she overcame it and what she did. And it
talks to 30 plus of the nation’s top experts in things like Susan Cain, introversion, Terry, real, what it is to live
in a patriarchal society and what that does to both men and women and Judy Robinett about how we need to
network in the right room and network up and Ivan Meisner about networking.
Kathy Caprino (39m 1s):
So it’s really powerful. And I’m so proud of it. I have to say it’s a culmination of 10 years. And I think every
woman on the planet should read it. And I think men who men have these gaps, do we, they just process
them a little differently. But I think also if you lead and manage, you need to read it because you need to
understand, speaking of empathy, you need to understand the internal lives of the women you’re leading and
what they’re going through in certainly male dominated organizations in careers, but even in the patriarchal
world we live in.
Dr.Anthony Orsini (39m 34s):
Yeah. You know, you just heard about something else too. The difference between a manager and a leader,
and wow, I’m trying to really get the message out. Cause I’ve had some toxic bosses as you call them. And
I’ve had bosses that I would walk through fire for. And the difference is how they communicated with me,
how they made me feel, how they valued me. They didn’t try to push me down to make themselves look
better. They tried to lift me up to make themselves look better. You know, I always say, if the person you
hired it comes great.
Dr.Anthony Orsini (40m 8s):
You can still say, Hey, I was smart enough to hire her. You can still take the credit. You don’t have to push
them down. And so it’s really important that we, we learned communication in business and how those
conversations go. So I’m so excited to read your book. I can’t wait for it to come. This has been great. If you
want any more information, you can contact Kathy Kathy caprino.com and her podcast finding brave is
available on Apple. It’s been a pleasure. And while you did not disappoint, this was a great interview.
Dr.Anthony Orsini (40m 40s):
Thank you again. If you liked this podcast, please go ahead and hit the subscribe button. If you want to find
out more about what we do and how we teach communication, you can contact email@example.com.
Hopefully you’ll listen again every week. And I’m excited. And thank you again, Kathy.
Kathy Caprino (40m 55s):
Thank you so much. And thank you for the work you’re doing in the world. Tony. It’s so meaningful.
Dr.Anthony Orsini (41m 1s):
Thank you. That means a lot.
Announcer (41m 4s):
If you enjoyed this podcast, please hit the subscribe button and leave a comment and review to contact
Read the transcript of Dr. Orsini’s podcast with Author and patient experience leader Marcus Engel
Marcus Engel (3s):
It was just the bare bones type of information. That was all I could really take. But what was even more
important was that as she held my hand, Jennifer just kept repeating the two lowest compassionate words
that I feel any human being can say to another. And those words are here. She held my hand and she just
kept saying over and over Marcus I’m here.
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 wet as a frequent keynote speaker and author.
Dr. Orsini has been training healthcare professionals and business leaders. How to navigate through the
most difficult dialogue each week, you will hear inspiring interviews with experts in their field who tell their
story and provide practical advice on how to effectively communicate whether you are a doctor faced with
giving a patient bad news, a business leader who wants to get the most out of his or her team members or
someone who just wants to learn to communicate better t his is the podcast for you.
Dr. Anthony Orsini (1m 10s):
Well, welcome everyone. This is Dr. Anthony Orsini, Welcome to difficult conversations. Lessons I learned
as an ICU physician today is a very special day because I get interviewed one of the most amazing people
that I’ve ever met. His story is one of tragedy, triumph, and success. And I promise you, by the end of this
podcast, you will truly be inspired. But just as importantly, whether you’re a healthcare professional or a
patient, you’ll have a whole new perspective on what healthcare should be all about.
Dr. Anthony Orsini (1m 42s):
And what patient experience really is through my years of teaching communication techniques to healthcare
professionals, I of course, had heard about Marcus, this story and the great work he was doing. So when a
mutual friend told me, I think about three years ago that she knew Marcus, I immediately jumped at the
chance to meet him. We talked on the phone for awhile and I was honored, but Mark has accepted my
invitation to attend one of my patient experience workshops right here in Orlando. And I got to say, I was a
little nervous speaking in front of someone with Marcus, his reputation, but let’s talk more about Marcus as a
professional speaker and author Marcus angle is considered an expert in communicating the patient’s
perspective and inspiring healthcare professionals towards excellence.
Dr. Anthony Orsini (2m 24s):
Marcus speaks from personal experience like few others can, after being blinded and suffering catastrophic
injuries at the hands of a drunk driver, he endured years of hospitalizations, rehab and recovery blending,
personal narratives with evidence based research. Marcus helps put an unforgettable name and face to the
patient experience movement. Martin’s holds a BS in sociology from Missouri state university and a master’s
in narrative medicine from Columbia university. He is currently an adjunct faculty member at the university of
Dr. Anthony Orsini (2m 55s):
Marcus has authored four amazing books, which are being used by scores of nursing schools, med
students, and allied health care programs to teach strategies for excellent patient care. He’s also a certified
patient experience professional through the Beryl Institute and certified speaking professional through the
national speakers association and in 2017, the Philadelphia college of osteopathic medicine, awarded
markers and honorary doctorate for his contributions in the field of healthcare Marcus lives in Orlando, right
near me with his wife and his seeing eye dog Elliot.
Dr. Anthony Orsini (3m 29s):
Well welcome Marcus. Thank you so much for coming on.
Marcus Engel (3m 32s):
Thanks for having me, Dr. Orsini and thanks for all of the incredible work that you’re doing in the realms of
patient experience too. Thank you. I didn’t know that you received an honorary doctorate from the
Philadelphia college of osteopathic medicine. I don’t know if you’re aware. That’s my Alma mater. Excellent,
wonderful. Yeah. This was actually the branch that is in Georgia, but still part of the same college. Yeah.
Dr. Anthony Orsini (3m 53s):
You know, as I got into the communication world and training doctors on communicating and patient
experience, I started to really think about my time at PCOM because PCOM, even back then when it wasn’t
the most popular thing, really pushed compassion to medicine. I mean, osteopathic medicine does that as
you know, but I didn’t realize when I was learning it, but I think it really shaped who I am now today, and it’s a
very special place. So when I saw that, when I was doing my research and I saw that, I thought, wow, what a
Dr. Anthony Orsini (4m 24s):
That that’s really great. So if you don’t mind, I think, you know, I know so much about your story and so
many people do. I really would like to start off with you just telling everyone out there, your amazing story of
tragedy and triumph. And then afterwards, I’d like to, you know, this is about difficult conversations and no
one’s had more than you and your book is so insightful of how those conversations can affect you both in a
positive, negative way. So if you don’t mind, you just tell your story. I think it’s an amazing story. And I want
everyone to hear it.
Marcus Engel (4m 55s):
I’ll give you the cliff notes version. And currently I’m 45 years old. I grew up in st. Louis, Missouri actually
grew up in Ferguson, Missouri for the first 10 years of life. And then what I, my parents moved to the rural
farm land of Missouri, where I really consider my hometown to be high Hill Missouri, nice little wide spot in
the road with a population of less than 200 now. And I grew up a typical red blooded American Midwest kid. I
was in all the high school activities, played football national honor society.
Marcus Engel (5m 30s):
And I decided that I wanted a big college experience in contrast the small town that I grown up in went to
Missouri state university and six weeks into my freshman year of college. I came home for the weekend. It
was my first weekend home from college. And on Saturday night, I drove into st. Louis to meet up with three
friends who were also all 17 and 18 years old. We ended up going to a st Louis blues hockey game.
Marcus Engel (6m 2s):
That night had a great time at the game. And on our way home from that game, our car was struck
broadside by another car. This is at an intersection in South st. Louis. There were four people in the car that
I was riding in. I was riding shotgun, front passenger seat, and the car that struck us hit directly where I was
sitting. So there was just a piece of thin Toyota metal between 50, 60 miles an hour.
Marcus Engel (6m 32s):
And my self not only did that crash, crushed every bone in my face, I’ll afford three fracture, but also caused
permanent and total sight loss and both arms. I can remember laying in the street. I can remember, you
know, just the most enormous pain. I think any person could experience having all the bones in my face
crushed. And I remember laying in the street and not being able to see, but I, I just thought it was because I
had been knocked for a loop.
Marcus Engel (7m 6s):
I didn’t realize that that was permanent blindness. Luckily that crash site was only maybe two or three miles
away from a level one trauma center at Barnes Jewish hospital, Washington university’s med school. And
they pulled me into the emergency room that night. And that started my journey to recovery, which as you
stated was extensive, it was long, it was detailed. It was painful, not only the physical recovery and literally
hundreds of hours of surgery, but then also the adaptations to a totally new way of being a totally new life
Dr. Anthony Orsini (7m 49s):
That’s quite a story and your books, and we’ll talk about them later on, but your books really detail your
journey. And it’s really amazing. You have some practical, really advice that we’ll get into later on. I also saw
a while back something that happened to you. So your accident was in 1993, correct? Correct. Yeah. So
there’s something that happened to you in 2013 with meeting someone. And I wonder if you would share that
story because that’s also amazing story.
Marcus Engel (8m 20s):
Sure. So as you can probably imagine that night that they rolled me into the emergency department, my life
was hanging by a thread. I had been cracked in the street by paramedics. That’s how extensive the facial
damage was. And you know, they pull me into the emergency room. I remember just little bits and pieces
about that. First night. I remember pain. I remember darkness. I remember terror, but what I remember the
most was the fact that there was a female who held my hand the whole night in the emergency room.
Marcus Engel (8m 56s):
And she would just, every time she could tell I was conscious, she would say, Marcus, my name is Jennifer.
You were in a car accident, you’re in the hospital. And it was just the bare bones type of information. That
was all I could really take. But what was even more important was that as she held my hand, Jennifer just
kept repeating the two most compassionate words that I feel any human being can say to another. And
those words are I’m here.
Marcus Engel (9m 27s):
She held my hand and she just kept saying over and over Marcus, I’m here, I’m here. And I have been going
around the country for the last gosh, at least 15 closer to 20 years talking about the experience that brief
encounter with Jennifer and I, gosh, I’ve written books. One of my books is called I’m here, compassionate
communication and patient care. But the truth of the matter is after that night in the emergency room, I never
knew anything of Jennifer.
Marcus Engel (9m 58s):
Again, I’ve never known her last name. I’ve never known her title or her physician in the emergency room.
Even my close friends and family had to ask the question, you know, was Jennifer even real? And there’s
every chance I could have hallucinated her that. So in 2013, I just graduated from Columbia’s narrative
medicine master’s program. I was continuing to speak around the country and I got the invitation from the
very hospital that saved my life Barnes Jewish hospital in st.
Marcus Engel (10m 33s):
Louis. And while I was there keynoting for their patient experience efforts, I had my mind absolutely blown
when I got done giving a keynote speech and the director of the patient experience department came up to
the front and she said, Marcus, we’ve got a surprise for you. We found Jennifer. And first time in two
decades, I finally got to hold her hands again.
Marcus Engel (11m 3s):
I finally got to say, thank you. And I finally got to learn the other bits and pieces that I didn’t remember. And I
learned that at the time Jennifer held my hand. She was just 20 years old, just year and a half older than me.
And she was a patient care tech in the emergency room. And today I’m just honored that I can call her. My
friend and Jennifer has gone from being a patient care tech at 20 years old in st.
Marcus Engel (11m 33s):
Louis till just a year or two ago, she accepted her first job as a chief nursing officer of a 500 bed hospital in
Nashville, Tennessee. Fantastic. Wow. It’s amazing. The lies that have been laid out over the years. So
that’s a great starting point. I’m here. And when I Talk about difficult conversations and I’ll talk about my book
in a second, but we talk about difficult conversations. I was listening to an old video of dr.
Marcus Engel (12m 4s):
Rabbi Cushner. I’m sure you might know. He is the person who wrote what bad things happen to good
people. And his story is that he had a child who had a disease called progeria, and he’d found that his child
was going to die very young. And he talks about something called the bushes effect, which means he said
his neighbors didn’t know what to say. So when he drove home, after he had had the bad news, his
neighbors would jump in the bushes because they didn’t know what to say to him. And his answer to just
say, you’re sorry. And then shut up is what he said.
Marcus Engel (12m 35s):
But a lot of people don’t know what to say. And this young woman who was only 20 years old, had to have a
very difficult conversation. And all she said was I’m here. And that changed how you felt. And so the point is
conversation doesn’t have to be long. It doesn’t have to be complicated, just has to be done with
Dr. Anthony Orsini (12m 58s):
And I’m guessing that you felt that compassionate in her voice
Marcus Engel (13m 1s):
When she said that, certainly, certainly. And holding a hand. I know that we’re in COVID times right now, the
idea of shaking hands, much less holding hands is a little not acceptable, but boy, just holding a person’s
hand during such a tragic time of their life. It communicates as much as words can. And I always say that
that I’m here. Those are the two most compassionate words that any human being can say to another
because it can’t change anything, but it means that I am willing and able to sit with you in your suffering and
just be present.
Marcus Engel (13m 42s):
Just give you the gift and the magic of simple human presence.
Dr. Anthony Orsini (13m 48s):
Exactly. And exactly what you said is just saying that I’m here and being there. And when I train physicians
and nurses on how to provide a better patient experience, how to be more compassionate, I tell them, start
by sitting down and show them that I’m not in a rush. And you’re the most important person there. I want to
share something with you personally, if you don’t mind, I saw you, I think two years ago at the Berlin Institute,
you probably don’t remember, but I mentioned to you, Marcus, I’ve been writing this book for three years.
Dr. Anthony Orsini (14m 24s):
I have both of your books, but I’m really afraid to read them because I don’t, I don’t want to accidentally have
any of those things in my mind. And so my teaching and communication to physicians and compassion pain
from years of research and I interviewed probably almost a hundred patients about death and dying and their
experience, et cetera. And so took me few years to write the book. The book came out in March, it was
published. It’s called it’s in the delivery, improving healthcare, starting with a single conversation.
Dr. Anthony Orsini (14m 55s):
And you were at my workshop that the book is based on and I’m giving it from a physician’s point of view, not
from a patient’s point of view. Although I got it from patients, I read your book for the first time a few weeks
ago, the one I read to them, the other end of the stethoscope and I’m here, and my wife came into the room
and I gotta be honest with you. I was choked up crying and she said, what what’s going on?
Dr. Anthony Orsini (15m 28s):
And a lot of what you said in that book is what I teach. And I actually got choked up because it validated
what I was teaching. And I wanted to just share that with you, that I felt, thank God I’m teaching it the right
way because Mark has lived it. And I just want you to know how much that meant to me. I was really moved.
I’m like, thank God I got it. Right. I’ve been teaching the right stuff.
Marcus Engel (15m 55s):
You’re sharing that. And thank you for reading my stuff too. I always try to come at this from the angle of
what we’re talking about with communication. It’s not rocket science, but it does take being vulnerable and
intentional in your communication. And Jennifer was very much that way to me that first night. And as you
bred, I had many other caregivers who I don’t want to say that they would humble themselves, but to a
certain extent they would, because they would move into a place of vulnerability with me to let me express
what I needed to express and then not to take it personally.
Marcus Engel (16m 36s):
I’m not a clinician, but I feel like a lot of times with clinicians, we have to come back to the idea that this
individual is hurting, right. There are patient and sometimes hurting people, hurt people. And I very much
hurt many of my physicians mentally and emotionally. And you know, the day that the ophthalmologist told
me that I would never see again, I wanted to hurt them physically. And that was a difficult conversation. And
maybe that’s a, that’s a good jumping off point for us.
Dr. Anthony Orsini (17m 8s):
Yeah. I try to tell physicians when I speak about that, what the terms that the phrase I use is it’s not about
you, if that, and you spoke about it in your book, if that patient needs to yell at you now, as you know, I’m a
neonatologist, so my patients don’t speak, but the parents do. And it’s the same thing. And if a parent needs
to yell at you and scream at you, and that’s the way that they can get through this, take that on, on your
shoulders and think of it as a gift. There’s no reason to take it personally, or your concept of one, a couple of
the other things that you were just discussing is how people humble themselves or the people that you were
Dr. Anthony Orsini (17m 44s):
I call that being genuine. Don’t be just the doctor. Be Dr. Orsini who likes the New York Yankees and is also
treats me like a person and sitting down. I want to talk about the person in your life named Barb that you
speak about, because I think she epitomized to me from the book being genuine and being a person. Can
you speak a little bit about her?
Marcus Engel (18m 7s):
Sure. So Barb is a nurse for life. Barb was an ICU nurse and after my first major facial reconstruction, that
was a surgery that took 25 hours. I was put into the ICU post-op and Barb was my first nurse post-op and it
was also about, you know, that was, I don’t know, 10 days or two weeks after the trauma. So I was kind of
starting to come out of the fog of pain and morphine and loss and all that.
Marcus Engel (18m 41s):
And I remember my very first conversation with Barb. She set the tone for the rest of my hospitalization, just
with the way that she communicated. And you have to keep in mind at this point in time when Barb was
communicating with me, I’m TRAPed. So I have to write everything out on a pad of paper, but Barb came up
to me in my room. She shook my hand as if there was nothing wrong with me. As if every day she’s taking
care of patients that just went through 25 hour facial reconstruction, she introduced herself and she said, my
name is Barb.
Marcus Engel (19m 19s):
I’m a nurse here in the ICU, and I get to take care of you for the next eight hours. And when she said that
word, I get to take care of you. It really laid out the foundation of this person when we get to do something
right, we’re, we’re fortunate. We’re lucky, we’re privileged. And by Barb using that little three letter word, it
showed me that she actually wanted to be there invested and intentional taking care of me.
Marcus Engel (19m 51s):
Barb also asked me questions about previous surgeries that were not really relevant to why I was in the
hospital now, but it showed a genuine, as you said, genuine deep humanity for wanting to know this patient
as a person, not just a room number, not just a diagnosis or prognosis, not just as a procedure, but as a
human being, I fully functioning human being. And one of the things that are did as well, she asked me, what
do you want me to call you in that first conversation?
Marcus Engel (20m 26s):
What you want me to call you now, even a Barb could pick up the chart at the end of my bed and read it.
She didn’t. She asked that question, what do you want me to call you? Do you want to be called Marcus or
Mark? So she wasn’t just seen that, Oh, this is a <inaudible> three patient. She’s actually getting down to the
personal human connections that I have preferences and opinions and likes and dislikes, just like any other
human being would. And by her asking you that question, what do you want me to call you?
Marcus Engel (20m 57s):
It really showed me that she thought of me as a human bar became, she was my primary nurse over the
next several weeks of hospitalization. I was initially hospitalized for about six weeks and then back and forth
once or twice a month for more surgery for the next year. Barb just retired last year, after 42 years, working
on the same floor at the same hospital, that big rarity and anyone who knows Barb knows just what a
fantastic person she is.
Dr. Anthony Orsini (21m 34s):
That’s a great story. And you know, one word can change something, right? So I talk about that all the time.
So she said, I get to take care of you. You notice that. And I think as physicians from the other end or nurses,
can we get task oriented, right? We just, we get moving. We forget. We also, aren’t very educated on
communication and we don’t understand how one word makes a difference for decades. Many, many years,
I was taught because that’s the way everybody else introduce themselves.
Dr. Anthony Orsini (22m 4s):
As I’m Dr. Orsini, I’m one of the pediatricians. And when I did my interviews with dozens of family members,
more and more of them said to me, when you say you’re one of it kind of means like you’re not really taking
any responsibility for me. And I’d love to hear your comment on that. When you say I’m the pediatrician,
who’s in charge of your child today, all of a sudden they’re relaxed. I have a face of someone and a voice of
someone who’s taken responsibility.
Dr. Anthony Orsini (22m 36s):
And interestingly enough, we did a little poll and I asked parents what makes you more comfortable? I’m one
of the pediatricians, or I am the intern. Now, most of the parents knew that interns are right out of med
school. They don’t know anything. Right. They actually felt more comfortable with the intern just by changing
that word. And I said, you know that they don’t know anything. Right. And they said, yes, but that’s my
Marcus Engel (22m 60s):
Yeah. Yeah. Taking ownership, right? They feel a bit of ownership over the situation. I would say, especially
in pediatrics. Now you have to keep in mind. I was a bit of a different patient because I was just five months
past my 18th birthday. So I was on an adult floor while my friend who was driving in the car, went to a paeds
floor near opioids. And I’ve always found that kind of, I was walking that line between adulthood and
childhood, but my parents certainly needed that comfort to know that this was dr.
Marcus Engel (23m 34s):
Jones. He is Marcus’s plastic surgeon. He’s not a team member. He is the guy. He is the guy. And I feel like
when parents are in such a difficult time of having a child hospitalized much less hospitalized in the ICU, you
have no control. Right? You realize how little control that you have and how much you have to trust in the
physicians and the surgeons, and then in the care team and just in the process itself.
Marcus Engel (24m 6s):
But whenever you can build that trust in where parents feel a little bit of control, I think that’s giving them a
great gift when everything seems so out of their ability to control anything.
Dr. Anthony Orsini (24m 21s):
Exactly. And that is part of the patient experience, knowing that this person nowadays we’re in medicine is so
sub-specialized, you know, you have how many doctors, my goodness, I can’t even imagine how many
doctors you had, but you need kind of a captain of the ship, right? You need somebody to know that’s my
doctor. And sometimes people don’t know who their main doctor is. And it’s important for them to know that
as physicians. And you know, when I say that the physicians, they go, wow, that sounds great. I’m going to
use the from now on. But it comes back from 20 years ago. We, as physicians were taught to be, act like a
Marcus Engel (24m 54s):
And that’s important too, but you can do both, right? You can say I’m in charge of your care and act as a
team. But back to your book, when you give some practical advice, one of the advice you give you talk about
you’re in the best place and that’s teamwork. I’d like you to talk about that. Sure. So that’s a Barb story too,
that when she asked me, you know, Marcus, this is at our first introduction, you know, I’m still coming out of
the recovery room. I’m still very, very doped up. And she asked me about if I had had any previous surgeries
before this terrible car accident.
Marcus Engel (25m 30s):
And I wrote out on my pad of paper, yes. Why is I’ve had hernia surgery? And she said, Oh, okay. Well,
made conversation, ask where those surgeries were done. What was the hospital? And I told her, and she
said, well, you know, that hospital is a great hospital. She said that now, Marcus, you need to know that you
are in the best hospital. And she went down the list of just a few different accolades and awards and
recognition that the hospital had received.
Marcus Engel (26m 3s):
And what does that say to the patient? It tells the patient that they’re in good hands, that they’re in a quality
competent facility that has been recognized for its quality and competency. I think it’s not only important to
build that amount of trust that the caregivers that are going to be laying hands on the patient are quality, but
also that the entire facility is trustworthy and has been recognized or how well they do things.
Marcus Engel (26m 35s):
I think that’s a really good way that clinicians can help patients and families feel more secure in the patient’s
Dr. Anthony Orsini (26m 46s):
Yeah. I mean, I think that’s really important. I go out of my way to tell the parents two things. One is I’m going
to treat your child as if she were my own boop and you see their shoulders kind of drop a little bit with
relinquish. And the other thing is, if this were my baby, this is where I’d want him to be. And I think that’s so
important because no one wants to be in a hospital. That’s not the best. Right. So you don’t want to hear
that. I want to talk about one more thing from your book and then get some advice from you because it
Dr. Anthony Orsini (27m 16s):
And I love this title of this chapter. Screw your policy because I talk about that all the time. And just a little bit
about that. I really want to hear what you have to say about that.
Marcus Engel (27m 27s):
So screw your policy, boy, that came from a night that, okay. So my university ride started off at college was
three hours away from st. Louis, where I was in the hospital. And I had several of my best friends from high
school had also gone to another state university that was two or three hours away from my hospital room.
And as you know, college kids don’t always keep normal businessman’s hours. So my friends showed up at
nine o’clock at night.
Marcus Engel (27m 59s):
And this, you know, this is back in the early nineties when there was a lot more restriction on the visiting
hours and how many people can be in the room, et cetera, et cetera. And I remember having one of my
clinicians or caregivers said that my friends, they just arrived. They didn’t get there until nine o’clock at night,
visiting hours stop at 10. And they wanted to shoe my friends out of the room. They wanted them to leave.
And gosh, especially you think about from a teenager’s perspective, their friendships are, you know, the
most important thing to them, friendships and relationships with peers and I, I was hold well, it’s a hospital
policy that visiting hours end at 9:00 PM.
Marcus Engel (28m 47s):
And I remember saying, screw that policy. I want my friends to stay. And where was the teaching point in this
is that that clinician actually let my friends stay. After hours provided that we were quiet and we kept the door
closed, didn’t interrupt in it, or, you know, bother any other patients. It made it feel very personal to me that
the clinician could take into account. This is not a normal situation. They looked at it as an individualized
personal situation, and then they acted accordingly so that there isn’t a, they weren’t necessarily following
the rules, but they were helping bend the rules for the benefit of the patient, which I think when we’re
benefiting our patients and families, that’s ultimately what we’re there to do, right?
Marcus Engel (29m 37s):
That’s ultimately what clinicians and care teams are there to do. I, and I always say that
Dr. Anthony Orsini (29m 42s):
Words, policy and rules should really be avoided as much as possible we can. And when you do bend the
policy or bend the rules, it goes a long way. I’ll share a quick story with you. When I moved to Orlando, my
inlaws were both in their upper eighties. They came to visit me and for no fault of my own, they both ended
up being hospitalized within the first week. My mother-in-law had congestive heart failure. My father in law
fell and hurt his knee. They were both in the hospital at my hospital at the same time. So my brother in laws
were called, what did you do to my parents?
Dr. Anthony Orsini (30m 15s):
I’m like, I swear I didn’t do anything. But so my mother is on the 10th floor and she’s in the cardiac unit. My
father goes downstairs and he’s an orthopedics. And the one of the nurses came in. It was, she was in
charge and I was doing around and she knows that my father in law was very sad, even though he’s kind of
always generally happy person. And she asked him and he said, well, to be honest with you, today’s my, I
don’t know, 50th anniversary. And it’s the first anniversary. I’m not going to scream at my wife. And she
spoke to him a little bit.
Dr. Anthony Orsini (30m 45s):
Didn’t really say much. And then about 10 minutes later, an orderly came in and when the wheelchair, and
he said, you know, cardiac units, not supposed to have any visitors, but I have been instructed to take you
down to the gift shop. And he grabbed his wallet. He bought a Rose and he brought her up for 15 minutes to
be with his wife. Well, it does not matter from that point on, it did not matter if anything went wrong with the
hospitalization, they could have forgot to feed him for days, no matter what happened.
Dr. Anthony Orsini (31m 19s):
My hospital was the greatest hospital in the world to him because somebody took a moment just to do
something extra. And so breaking that policy, I think just having your friends visit probably meant the world to
Marcus Engel (31m 31s):
Yeah, absolutely. Again, anytime it’s a, a patient’s needs can be looked at individualistically and personally
you’re going to make such a great impression with patients and families.
Dr. Anthony Orsini (31m 43s):
Yeah. That’s just great advice. So in closing, being such a patient experience person, and I want this too,
you’re such an expert on it. I’d like you to go and speak to both dot both clinicians and to patients and what
made I’m putting on the spot. What’s just a few sentences of advice that you can give to physicians, nurses
first about how they can make being in the hospital as least horrible.
Marcus Engel (32m 10s):
I always say, and this is something that I teach my students at Notre Dame to my premeds, that human
presence, simple human presence is the cornerstone of caregiving. And you can convey that presence with
those words I’m here, but you can also convey that this is the, it’s not just the cornerstone of caregiving
presence is the, it’s the foundation of our humanity. So whenever you’re using those words, I’m here with
Marcus Engel (32m 43s):
You’re not just speaking compassionately. You’re speaking to them, human being to human beings. I just
always love for clinicians to remember that, Hey, you’re in the hospital, you’re in the assisted living facility or
in the rehab center. It may be an average day on the job for you. It’s just the Tuesday, but it could very well
be the worst day of that patient’s life. I literally keep that in mind that we have the opportunity to provide
compassionate, personalized care on the worst day of someone’s life.
Marcus Engel (33m 19s):
I hope that keeps us more aligned with our personal mission, visions and values to, to be the best, most
quality, compassionate caregivers that we can be. Patients. Boy, what is my advice for patients? Do what the
doctors say? Let the doctors say, I always want patients to, to remember that they are the focus. They are
the focus, but it does have to be mutual effort of clinicians and the patient working towards the same goal.
Dr. Anthony Orsini (33m 52s):
So sometimes I think patients get the idea of, well, I’ll lay here and you guys will fix me. You clinicians will fix
me, but there has to be some forward motion in the patients. I don’t want to say their treatment of him or
herself, but in their care process to where they’re putting one foot in front of the other to get better. That’s
great advice. So, well, I can talk to you all day long, but you’re a busy man. And I just want to thank you
again for coming on this podcast, taking the time out of your busy schedule.
Dr. Anthony Orsini (34m 25s):
It was really truly an honor. If you want to book Marcus to speak or get in touch with him in any way, or you
could reach firstname.lastname@example.org and that’s E N G E L, just to be clear and his books are still available.
If you enjoyed this podcast, please hit the subscribe button, leave a review. Reviews are really important to
get the word out. And if you’d like more information about your senior way and communication training, or
you’d like email me personally, visit me at <inaudible> dot com. If there’s a topic that you’re interested or you
want to nominate someone for this podcast, please let me know.
Dr. Anthony Orsini (34m 58s):
And finally, if you want to learn more about communication, remember my book just came out in March.
Marcus. I’m going to, if you send me your address, I’ll be happy to send you one. The book is called it’s all in
the delivery, improving healthcare, starting with this single conversation. And you can get that on Amazon
Kindle and Apple books. Thank you, Marcus. And thank you for all you do, and for being such an inspiration
to me and everybody else. Thank you. Thank you so much for having me and, and continued success when
bringing this notion of compassionate communication
Marcus Engel (35m 27s):
To all clinicians. Thank you. And I hope to work with you soon. That was great. Thank you.
Announcer (35m 32s):
If you enjoy this podcast, please hit the, and leave a comment and review to contact Dr. Orsini or his team or
to suggest guests for future podcast. Visit us at The Orsini Way. com.
Read the transcript of Dr. Orsini’s podcast with Dr. Michelle Neier as they discuss how to break bad news
Dr. Michelle Neier (2s):
One of the things I always try to stress to parents. He’s like being a kid comes first. That’s their job. Their job
is to have fun. Their job is to go to school. Their job is to see their friends. Having cancer is a side gig. If you
will, you know, that’s, that comes second. And I think we always have to remember that that without the
beauty and the happiness in life and without those wonderful moments, the rest of it doesn’t matter.
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, to read 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 t his is the podcast for you.
Dr. Anthony Orsini (1m 26s):
Well, welcome to another episode of difficult conversations lessons I learned as an ICU physician. This is dr.
Anthony or Sini your host today and every week moving forward. Now, if you’ve listened to this podcast
before you know that I promise my audience two things each and every week, number one, to feel inspired
and number two, to have valuable communication techniques that you can go and take home with you. The
next time you have a difficult conversation. And I am very certain that I will keep my promise today.
Dr. Anthony Orsini (1m 59s):
Today we have dr. Michelle Neier. Dr. Neier is a board certified pediatric hematologist oncologist and
integrative medicine physician. In 2005. She completed her pediatric residency at Schneider children’s
hospital at North shore university in long Island. She continued her training in New York city where she
finished her hematology oncology fellowship at Morgan Stanley children’s hospital in New York, Presbyterian
Columbia in 2008 after practicing pediatric hematology and oncology at Goryeb children’s hospital in
Morristown, New Jersey, she elected to further her training and recently completed an integrative medicine
fellowship through the university of Arizona integrative medicine department.
Dr. Anthony Orsini (2m 37s):
Dr. Neier has a strong interest in the medical humanities and especially narrative medicine. She is
passionate about teaching and as a breaking bad news instructor for the, or see any way in April, 2020, Dr.
Neier started olive tree integrative health olive tree integrative health mission is to provide quality integrative
medicine care, which honors each individual’s story. Dr. Nigher is passionate about her goal to help children
and young adults we’re dealing with chronic or life threatening medical illnesses, as well as those children
who have multiple symptoms, but do not yet have a diagnosis talk denier and olive tree integrative health
understands that disease is multifaceted and healing includes supportive her patients and the caregivers as
Dr. Anthony Orsini (3m 19s):
She resides in New Jersey and in her personal time is an avid reader loves to practice yoga and spend time
with her family, and recently started knitting, but welcome Michelle. It’s so nice to have you on my new
Dr. Michelle Neier (3m 31s):
Thanks Tony. It’s great to be here.
Dr. Anthony Orsini (3m 34s):
You know, we’ve never met in person, but we’ve been doing breaking bad news together. You’ve been an
instructor for the, or see any way for several years. And I try to get the most of the sessions, but our paths
never really crossed. We didn’t get to do the same one together, but everyone from the very beginning, so
nicely about you and said you had so much to offer the young residents. You were really passionate about
communication, just like me, and just received constant accolades about your wisdom and how well you
teach and everything that you say.
Dr. Anthony Orsini (4m 6s):
So I was really excited to finally get to interview you. When I decided to take this leap for this podcast, your
name was one of the first names that came up, because I think you’ll be easily full, be able to teach our
audience something about communication, especially in your field. One of the premises of this podcast is
that if you can have that conversation with someone about cancer or death, and pretty much the rest of the
conversations in your life will be relatively easy. So today I’m really excited for the audience to hear your
story and to really learn something about communication from you.
Dr. Anthony Orsini (4m 42s):
So thank you for coming on. I know you’re very busy these days
Dr. Michelle Neier (4m 45s):
I am, but I really appreciate the compliment. It’s a big honor to be here. I think what you’ve done is amazing
and what you’re doing is incredible, and it means a lot to participate in this.
Dr. Anthony Orsini (4m 59s):
You know, I have a, a personal story that I’ve shared on a previous episode about why I became passionate
about communication. It really started when I witnessed a physician, tell someone that their baby died in a
very cold manner and it profoundly changed me. And that was when I was a fellow in neonatology way back
when. And so everyone seems to have a story and I want to, if you don’t mind sharing with the audience
here, yours, I’d like to know why you chose hematology, oncology, and maybe a story about what really
moved you either with a patient or what made you so passionate about teaching communication to the
Dr. Michelle Neier (5m 38s):
So I think in hindsight, the seeds of hem-onc were back, even in childhood, I mentioned to you that I’ve been
an avid reader and as a child, there was a book I read about a girl with leukemia. And I think I must’ve read
that story over and over and over a dozen times. And it just always stuck with me. I started pediatric
residency and thought for sure, I was going to do general pediatrics.
Dr. Michelle Neier (6m 9s):
I just wanted to do good preventive care and sure enough, the best laid plans always change. So I was a
resident and I met a young girl. I still remember her and think of her fondly. She had a solid tumor. She was
probably about seven or eight when I met her. And she used to walk around her and her mother walked
around with a pin that said cancer socks. And I just thought it was amazing that this young kid could speak
so loudly to what was going on in her life and just be so clear about it.
Dr. Michelle Neier (6m 50s):
But yet at the same time, be so positive and so motivated. She started a jewelry shop, I guess you could call
it. And she was selling jewelry to raise money, to support cancer research. And I still have the necklace. She
sold me. She was just always happy and inspiring and amazing. Despite walking around with like pain that
clearly said cancer sucks. She wanted to change things. She wanted to make it better. And I think that
changed things for me a bit. It just moved me in a way that general pediatrics didn’t, it felt a little bit more like
a calling, something like I needed to do.
Dr. Michelle Neier (7m 30s):
And I think it just rolled from there quite quickly, actually.
Dr. Anthony Orsini (7m 35s):
Yeah, that’s a, that’s a really interesting hematology. Oncology always move me. It’s different, but it’s a lot
like neonatology and that there’s emotional highs and emotional lows. You’ve been given so many accolades
on how you communicate and how you speak to your patients. And it really shows when you give your
valuable lessons to these young residents, but there’s someone in during your training, either as a resident
or a fellow, or maybe earlier on that you looked at because there were people in my past, I told you about
the horrible story when the doctor did it.
Dr. Anthony Orsini (8m 10s):
So coldly, but you know, that doctor was extremely compassionate. That doctor he’s the opening story in my
book, he was one of the most compassionate people that I’ve ever known. And yet when he delivered the
news, he did it so quickly, I think because he was so uncomfortable to do it, but I’ve also had some really
good role models. Some of them in neonatology, some of them in palliative care, and I watched him speak
and give bad news or have those difficult conversations. And in the back of my mind, I’m thinking, wow,
that’s a golden tongue.
Dr. Michelle Neier (8m 42s):
Like I love that phrase. I’m going to steal that. And most of the stuff that I use today, I’ll be honest, has it
been stolen? So is there someone that you remember that you said, wow, I want to, I want to speak like that.
Without doubt, I Had two amazing mentors when I was a fellow Julia Glade bender and Linda Granovetter,
and I really credit the way I deal with patients and communicate with patients to them.
Dr. Michelle Neier (9m 14s):
They are two of the smartest, most incredible physicians, women I have ever met. And I, I look back and I
don’t, while there were so many things in so many words and so many phrases that they used with patients,
I don’t think it was about the words so much as about their presence. And, you know, I used to teach Julia
when we’d be in the work room, she was all over the place and doing a million things and distracted.
Dr. Michelle Neier (9m 46s):
But when she got in that room with the patient, she was there, nothing else mattered. She wasn’t in a rush to
leave. She was truly in that moment with them. And I remember she had a young patient who was critically
ill, was dying. And Julia just sat by the bedside without mother and talk to her and held her hand and listened
to her and really absorbed what that mother’s fears were and got her to a different place, a different place of
never acceptance, but of understanding and the same thing with Linda.
Dr. Michelle Neier (10m 30s):
I have clear memories of sitting in Linda’s office with a patient that I know Linda and I think of often and will
never, ever, ever forget. And I just remember Linda looking at those parents, not as a physician, but as a
human and really feeling their pain and absorbing their pain. And I think that alone changes the conversation
because I think, well, so many people remember the words and they remember little things that we say.
Dr. Michelle Neier (11m 9s):
They also just remember us being together. And I think that goes a long way. You know, I don’t think most of
us are in medicine. Yes. We enjoy the science and we enjoy, you know, learning about biology and all of the
other things, but we’re really in medicine because we want to help people. It’s not about being a doctor. It’s
about taking care of each other. And so when I saw LinkedIn and Julia work, that’s what they were about.
Dr. Michelle Neier (11m 40s):
That’s what they are about. And that always stuck with me. And it changed me.
Dr. Anthony Orsini (11m 46s):
That’s an excellent point. The word presence is a word that keeps coming up during this podcast. And I don’t
know if you’re familiar with a book called I’m here, but we had a few weeks ago, a guest, his name is Marcus
angle. And Mark his angle has an incredible story. If you haven’t heard the podcast, please go back and
listen to it. But Marcus was in a car accident when he was 17 years old, he was hit by a drunk driver, went
blind instantly. I had a facial fractures and ended up being in the hospital for almost two years.
Dr. Anthony Orsini (12m 21s):
And Marcus has the story that when he was in the trauma Bay, they’re putting in chest tubes or trying to
intubate someone who literally barely has a face. They had to do a cricoid split. And Marcus only remembers
that he was blind. He couldn’t see there’s all this stuff going on. And one woman grabbed his hand and said,
Marcus I’m here. And he didn’t find out who that woman was for another 20 years, but it changed his life
Dr. Anthony Orsini (12m 50s):
And that’s the exact word that he uses presence. And I agree with that. Totally. But it’s about being there.
And I think that if we can learn one thing from this episode of podcast, it is that is that physicians are all
compassionate people. I truly believe that that’s why we went into medicine, but no one wants to be the
bearer of bad news. And we’re all uncomfortable doing it to a certain extent. And I think when we’re
uncomfortable doing that, we tend to rush through it and want to get in and get out.
Dr. Anthony Orsini (13m 23s):
Now, Michelle, I’ve done a lot of breaking bad news programs. And sometimes when we do the videotape
filming with professional actors, the young doctor, and we’ve even done, senior doctors will just come out
and say, my name is dr. Orsini, you have cancer. And I’ll say, when we do the video review, I’ll say to the
doctor, why were you so abrupt? And he, or she will say, well, that’s what I was taught. I was told, get it over
with and get out of there.
Dr. Anthony Orsini (13m 54s):
And so we’re fighting decades of bad teaching. And I’m so glad that you had mentors that made you who
you are today. And I think together, along with other people, hopefully we can change that, but the word
presence, what a great word. And I think that’s probably going to be number one on the top of things that you
need to do when you’re having difficult conversations, just be present. It doesn’t have to be a medicine,
right? Someone could be a friend who lost a loved one. Someone had just got a divorce, other things, other
difficult conversations in our lives.
Dr. Anthony Orsini (14m 28s):
We have some guests that are going to speak about getting fired from their workplace. You know, there’s a
lot of bad things that happened to people. It doesn’t have to be health-related, but as a friend, people say,
what should I say? Well, maybe all you should do is just say, you’re sorry. And sit there. And that’s probably
the best advice. So thank you for that. That’s great. I want to ask you about the particular challenges of the,
as they say, tweener or a teenager, they tend to handle things differently, right? So teenagers, although they
might understand cancer, maybe they’re in denial or maybe they’re a little on the young side to understand
Dr. Anthony Orsini (15m 7s):
I mean, that’s telling a five year old is a whole different skillset. What about that? 12 year old, 13 year old?
Are there any special advice that you can give to someone who has to speak to a 12 year old about cancer?
Dr. Michelle Neier (15m 18s):
So I think one of the biggest mistakes that we make in medicine, whether it’s an oncology or any other fields,
or even frankly in parenting, is that we underestimate our children. I think we underestimate our children,
whether they’re five years old or 25 years old. And we tend to think that they can’t understand or handle the
information we’re afraid of telling them things.
Dr. Michelle Neier (15m 53s):
You know, I’ve had friends say, well, I don’t want to tell my 12 year old daughter they ask because she’ll be
afraid because she won’t be able to handle it because she’ll freak out to a certain extent. They’re right. The
kids might freak out. You know, they might get hysterical, they might cry, but that’s normal and that’s
appropriate. And that’s okay, that’s a human emotion. But the point is that kids can also heal. And part of the
process of getting them to the other side is allowing them to have those emotions, allowing them to be
scared, to be angry sometimes to be in denial.
Dr. Michelle Neier (16m 35s):
I think it just depends on the kid. I’ve seen 12 year old kids who say, okay, I have leukemia. Let me get back
to my video games now. And I’ve seen other 12 year old kids who say, Oh, I have leukemia. Well, what type
and what type of chemotherapy are you giving me? And how long will I be in the hospital? And what are the
names of all my organizations? It’s so variable. I, I think more than the tweens, the younger adults are the
ones that I’ve really struggled with.
Dr. Michelle Neier (17m 12s):
I think tweens are still used to being taken care of. They’re used to being with their parents. They’re used to
being fed information. I think the young adults, the 19, 20, 23 year olds are the ones that for me have been
the most challenging, but also the most rewarding population. You know, their lives are interrupted at such a
crucial stage when they’re leaving the nest, when they’re becoming independent.
Dr. Michelle Neier (17m 49s):
And then in many ways, least in oncology or when someone’s diagnosed with a chronic illness, we take
away that independence. We completely interrupt and arrest their development at a certain stage. So I think
that’s the population probably more than the tweens that I’ve struggled with. I think the tweens these days
are so knowledgeable. They’re so connected. We very quickly develop amazing support systems.
Dr. Michelle Neier (18m 19s):
We have a young girl in our community who was recently diagnosed with leukemia and she very quickly
came out on social media and announced our friends. This is what’s going on. I’m going to lose my hair, but
it’s going to be okay. And so I think the way they communicate has changed, but I think maybe that helps
them. I think they’re able to find resources that even 10 years ago, weren’t available to them.
Dr. Anthony Orsini (18m 45s):
My niece, who was an ex premature baby. And then she got through that and then 17 years later finds out
she has lymphoma and they had to do reconstruction on her neck. And she went through chemotherapy and
I interviewed her. She became a instructor for breaking bad news. I got her because she was in nursing
school. And now I’m so proud. She’s an oncology nurse and Cincinnati, but she came to a breaking bad
news program as a student instructor.
Dr. Anthony Orsini (19m 19s):
And I said, you have such a wealth of knowledge because you speak from a personal point of view. And I
asked her during a impromptu interview, I’m trying to get her on this podcast because I’m telling you you’d be
blown away. And I’m so proud of her. I still cry when I, when I think of her. But I asked her about her
hematologist oncologist who took care of her at chop. And I said, what do you remember about her?
Because she was 17. And she said, what I remember most about my oncologist is that she said, I am not
going to forget that you’re 17 and that you have things to do.
Dr. Anthony Orsini (19m 54s):
And so we’re going to make sure you go to your prom. And if you need to skip a session or skip a
chemotherapy, we’re going to do that. And you’re going to live your life. And you’re going to get through this.
And you could hear my voice cracking because I’m so proud of her. She got through it. She went to her prom
with no hair. Her boyfriend also shaved his head and she had an great outlook on life. And now she moved
to Cincinnati because believe it or not, where she went to nursing school, she tried to get several jobs as an
Dr. Anthony Orsini (20m 27s):
But you know, there’s a long waiting list for that. I said to her, I said, Lauren, tell them that you you’ve been
through this. And so she is a pediatric oncology nurse in Cincinnati right now. I’m so proud of her, but that’s
what she remembers the most about her oncologist saying, I’m going to let you be a teenager. And I’m sure
Dr. Michelle Neier (20m 50s):
Yeah. So it sounds like you have a lot to be proud of about Lauren. She’s been through a lot. It’s pretty
amazing that again, a young person can recover the way they do and go on to do really tremendous things
with their lives. One of the things I always tell parents when I need them, whether it’s a parent of a kid with
cancer or a parent of a kid with sickle cell disease, which I saw plenty of and I think has its own challenges.
Dr. Michelle Neier (21m 26s):
But one of the things I always try to stress to parents is that being a kid comes first. That’s their job. Their job
is to have fun. Their job is to go to school. Their job is to see their friends. Having cancer is a side gig. If you
will. You know, that comes second. And I think we always have to remember that, that without the beauty
and the happiness in life and without those wonderful moments, the rest of it doesn’t matter.
Dr. Michelle Neier (22m 5s):
You know, we have to keep in mind, what are we doing this for? We’re doing this so that like you say, they
can go to their problem so that they can see their friends so that they can go to a barbecue. And I fully agree
with those people down at chop, those docs down there, do a great job. They’ve got it right. We have to
prioritize normalizing life for these kids.
Dr. Michelle Neier (22m 35s):
As much as possible life will be the same, but it will be someone always said it, Maurice town, it will be a
new normal, there’ll be a different kind of normal, but that involves all of the milestones. Whether they’re
graduations or communions or bat mitzvahs, they may not happen in the same way, but we have to find a
way to make them happen. And when they can’t happen, where they don’t happen on time, we have to really
acknowledge the sadness in that we have to, we have to again, feel their pain and relate to their pain, not
blow it off.
Dr. Michelle Neier (23m 24s):
I think that’s one of the things that we’re seeing in Corona right now. You know, they, kids are so sad about
missing things and it’s very easy to say, okay, it’s not a big deal. You’re missing something. But there is
sadness in that because for a child missing an event, missing a milestone is a big deal and it is a big
disappointment. So it’s okay to be sad for a moment. They, the work isn’t in not being sad, the work is in
healing from being sad and in getting over, being sad and recovering from that.
Dr. Michelle Neier (24m 4s):
And so when you think, whether you’re a pediatric oncologist or you’re a parent or a friend, the goal is the
same. It’s to be with somebody in their emotion and to help them process it so they can recover and get to
the other side
Dr. Anthony Orsini (24m 22s):
And not let it define you who you are. We talked about communication and in my line, there’s a lot of
emotions. There’s a lot of babies who are dying, who are very sick and they stay in my hospital. You know,
sometimes 30, 60, 90, a hundred days. These premature babies are with us. And I have a lot of emotional
times with the parents, but in between that, it’s very important for me to come up as a genuine person. When
I teach about patient experience and how to use communication, the patients and the patient’s families need
to know you as dr.
Dr. Anthony Orsini (24m 59s):
Neier who’s from New Jersey, who, you know, is a person, not just their doctor and doctors need to
remember that. That’s the person on the other side of this is going to lead me to the integrative medicine part
of what you do, but it’s important, correct? To start off the conversation by asking them how’s school what’s
going on instead of all business. And one of the problems that medicine has right now in my belief is that we
are pushed so much that we become very task oriented as physicians and nurses.
Dr. Anthony Orsini (25m 34s):
And that’s really affected the patient experience. We have 25 patients to see, we have to write notes. We
have to move on. And I discuss in my book how you can sit down, find something that’s common in
someone. Maybe you love reading. So if you find someone whose parents reading a book, when you walk in
to comment on that book and tell them about the last book that you read, especially if they’re a teenager, it
takes their mind off of it. You know, we don’t want it to be all business. It’s important, but you’re a person too
Dr. Michelle Neier (26m 4s):
I try to be a person. My kids might not always agree.
Dr. Anthony Orsini (26m 11s):
We see in my field, we see people that we feel that that’s just the parent of the baby. Who’s the 29 weeker.
And I discussed the importance of finding commonality with people in every day and with every single
patient, for instance, I’m down in Orlando now, but every now and then I will see a patient. And when I go to
call the mother cell phone number, it’s nine, seven, three. And that is an instant bond with that family,
because I can meet that family and say, nine 73 area code that’s where I’m and the patient’s family lights up.
Dr. Anthony Orsini (26m 48s):
He’s one of us with nothing to do with race or background or whatever. Just the fact that we both lived in
New Jersey, or I’m lucky enough to see a parrot. And during a very difficult time, over the course of 30, 60
days, maybe they might be wearing a Yankee hat, or there’s a book that I used to read and finding that bond.
And if you go back to the story of my niece, Lauren, she bonded with that doctor because her doctor came
up as a friend and a teammate we’re in this together.
Dr. Anthony Orsini (27m 22s):
And I think that’s what medicine is all about. Right?
Dr. Michelle Neier (27m 25s):
Yeah. I completely agree on so many levels. You know, I’ll tell you a brief story. When I was a fellow, one of
my very first patients at Columbia was a little girl. She was very, very, very religious Jew from upstate New
York. And I will never forget. I went down to see her in the ER. And I said to the family, Hanukkah was
coming up and I said to them, Oh, you must be so excited.
Dr. Michelle Neier (27m 58s):
How did I know it was coming up? And the mother looked at me and she said, Oh, you’re Jewish. I said, Oh
yes. And we started a whole conversation. And I told her where I lived and they lived in a very isolated
community of very religious Jews. We really, in many ways had nothing in common, but that was my way of
crossing a barrier.
Dr. Michelle Neier (28m 29s):
And it started a relationship that lasted for years long after I left Columbia, they taught me about their
community. I taught them about my community. Yes, I treated her leukemia, but it was so much more than
that. We developed a relationship. And you know, when I was a fellow and a resident, one of the messages
usually unspoken, but sometimes spoken also was that you have to maintain a professional barrier and that
you shouldn’t cross those boundaries.
Dr. Michelle Neier (29m 7s):
And I was always so afraid of crossing those boundaries. Did I cross the boundary? Did I cross the
boundary? I wasn’t sure as a young physician where that line was, but I was so fearful that if I crossed it, that
if I became too personal with families, I was risking something. And as I moved on in my career, I found the
opposite was true. That the more I gave of myself personally, and the more I crossed boundaries, and that’s
not to say, don’t be professional.
Dr. Michelle Neier (29m 42s):
I think that’s a different thing. You always have to be professional. You are a physician. You need to be a
leader, but when you let people into your lives, they let you into their hours. And I think that was what
sustained me as a physician. That was the beauty of my job. That was the heart and soul of the work.
Dr. Michelle Neier (30m 14s):
Especially with the young people, you know, the young adults. You talk about walking into the room and
asking about what’s going on. I never, I shouldn’t say never because I’m sure I did, but I’ve tried not to walk
in the room and say, are you taking your medicines? You’re getting this too much today. You’re getting that
today. I tried to walk in the room and ask an open ended question. How are you doing? What’s going on in
your life? Tell me about school.
Dr. Michelle Neier (30m 46s):
And I found that it changed our relationships. I am so blessed that I have a number of young adults in my job
who stayed in touch with me. And you were talking about your niece. It makes you cry. It makes me a little
verklempt, a little emotional to think about how those patients have really become friends. And I think by
crossing those boundaries, it allowed me to be a better physician.
Dr. Michelle Neier (31m 17s):
I’ll give you one more example. I took care of a young adult. He had leukemia and we became very close.
And when he relapsed, he didn’t want to get therapy he was so angry. And I understood that he had a hard
time. We had interrupted his life. It’s so much going on, but because I had taken the opportunity to get to
know him and his mom and his girlfriend, we were able to sit down and have one of the most emotional
conversations I’ve ever had in my career.
Dr. Michelle Neier (31m 59s):
But we listened to him. We just sat with him and he cried and he was angry and he yelled, and thank God.
He decided to go ahead. And he decided to continue with his, his therapy. And he’s doing great. Now he’s
back in school. He’s living on his own. He’s amazing. I speak to him all the time, but I do wonder if I hadn’t
crossed those boundaries.
Dr. Michelle Neier (32m 29s):
Would we have been able to have that conversation? Would we have been able to be that open with each
other? And I don’t know, I just don’t know the answer to that, but I’m grateful that we were, and I think that’s
the benefit of opening yourself up to people and to learn about who they are, not as a patient, but as a
Dr. Anthony Orsini (32m 56s):
I would make two comments on that. First of all, you’re exactly right. The patient and the patient’s family. And
right now doctor is crying. So I just want everyone to know that. And the reason I want them to know that is
that that’s what medicine’s all about, right? Those bonds that we made through the years, and, and I got
emotional about my niece and you get emotional about your patients. I still receive Christmas cards. I think
we’re going on now. There’s one family, 14 years that I receive a Christmas card from a premature baby who
Dr. Anthony Orsini (33m 31s):
And to me, that is one of the things I’m most proud of. Not that she died, but that, that family holds me in
their heart. Even in the tragedy, they could have been very angry. You didn’t see my baby, but we really
bonded. And to get a Christmas card from her 14 years later, it’s just one of the things I’m most proud of. So
another great teaching point here is that it’s okay to cross those boundaries. In fact, I think it’s preferable the
patients and the families will always know that you’re the doctor.
Dr. Anthony Orsini (34m 6s):
And I think that some of us make mistakes into thinking that if I crossed the boundaries, don’t forget that I’m
the doctor and that’s not true. They’ll respect you even more in my book, it’s all in the delivery. I go over the
five principles of patient experience. And number one is called, it’s hard to fire your best friend. And the point
of that whole section is find the commonality, build the rapport, cross the lines a little bit, and you will be their
best friend and who doesn’t need a best friend, especially during these critical conversations, right?
Dr. Anthony Orsini (34m 40s):
I mean, that’s, that’s what they need. They need a friend. They need, they know you’re the expert in the
room. They respect you. And they’ll respect you more when they realize that you are a real person.
Sometimes just going into a room and saying, my five-year-old just wouldn’t go to school today makes you a
real person, you know, you bond because they say, well, this is a real person. This is not just a doctor who
thinks that I’m leukemia or just calling me by my disease. So another great teaching point for the audience
before we go, Michelle, I want to talk about your integrative medicine.
Dr. Anthony Orsini (35m 12s):
So you made that change. And I, I kind of know, just from speaking to you, why you did that, but I want you
to talk about why you decided to, you had a very successful practice treating hematology, oncology patients,
but decided that I want to be even better and go back to school for integrative medicine. So tell me about
that transition and how that happened.
Dr. Michelle Neier (35m 33s):
Sure. So it was a slow journey in my personal life. I had struggled with some chronic pain issues, some GI
issues. And to be honest, wasn’t quite finding the answers that I was looking for in traditional medicine. And
so I started asking questions on a personal level. I am very blessed. I found some amazing practitioners.
Dr. Michelle Neier (36m 6s):
I really think of them as healers in my life. Physical therapists, massage therapists, acupuncture is yoga
instructors, amazing people with a whole different skillset than I had learned about in medical school and in
my training. And at the same time that I was on that personal journey professionally, I found that I was
opening myself up a little more.
Dr. Michelle Neier (36m 37s):
And as I did that, I was being confronted with different questions, questions. I didn’t know the answers to
questions like my kid is getting chemotherapy and I don’t think I should give them sugar anymore. What’s the
right thing to do, or my kid has nausea, but I don’t want to medicate them all the time. What else can I do
questions that I didn’t know how to answer? And so I started looking for the answers and my personal and
professional paths, I think really came together in that way.
Dr. Michelle Neier (37m 17s):
And as I started looking, I found that integrative medicine is the framework to answer those questions. So I
think people think of integrative medicine as being kind of hokey witchcrafty, weirdness. That’s not at all what
it is. And that’s what I love about it. It is really a framework for in fact, many of the things we’ve talked about
in my training, one of the things we’ve talked the most about is forming relationships, how to communicate
Dr. Michelle Neier (37m 54s):
That’s really the basis and the foundation of integrative medicine. The idea is to harness the body’s ability to
heal. So it’s not a replacement for traditional medicine. It’s a way to enhance traditional medicine the way to
enhance ourselves, to focus on the mind body and the spirit. And so for me, I think it was a very natural
progression into this type of medicine and for a number of reasons, it was the time it was the time to leave
Dr. Michelle Neier (38m 37s):
It was the time to take on new challenges, different challenges to learn different skills. And so everything just
kind of collided and came together at the right time. So here I am, it was without a doubt, the most difficult
decision I’ve ever made in my life. I love pediatric hematology, oncology more than anything.
Dr. Michelle Neier (39m 7s):
I am so grateful to all of the patients and their families that I’ve met, but it was time personally for a change.
And this felt like the right one,
Dr. Anthony Orsini (39m 19s):
One of our previous guests, Kathy Caprino who had a life changing moment when she changed from being a
big financial person to coach for women. I think her quote was, you know, when you’re not sure what to do
the universe steps in, and it sounds like that’s what happened to you, that everything came together and I
can see in your face, this is audio only, but for the audience I could see in your face, how you laid up when
you speak about integrative medicine. So it sounds like you’ve found your calling and you’re happy with it.
Dr. Michelle Neier (39m 51s):
Yeah. My second calling.
Dr. Anthony Orsini (39m 55s):
So you open the olive tree and that just opened up in April.
Dr. Michelle Neier (39m 59s):
Yeah. So a couple of months ago, I decided why not in the middle of a pandemic, I’ll start in your business.
So I opened that. I opened up olive tree to telehealth patients only, and my, now that things have calmed
down my physical office space in Springfield, New Jersey should be ready in about a month is a really, really
excited. It’s a beautiful, quiet, sunny space.
Dr. Michelle Neier (40m 30s):
And I really want it to be a place where people feel safe, where they feel safe to express themselves, to ask
questions, to talk about what they need so often and, you know, by necessity. So often many medical offices
are crowded. They’re busy, they’re sterile.
Dr. Michelle Neier (41m 1s):
We walk in, we have, you know, two minutes with the physician to ask all of our questions. I really want this
to be a different kind of experience. I want people to be able to sit in a comfortable chair, have a cup of tea
and to take a breath. You know, I always joked one of our amazing massage therapist at Mars town used to
say to me, Michelle, breathe, just breathe, just breathe. And I would joke around with her and say, Oh God,
leave me alone with the breath already. But she’s right. You know, I want people to just take a minute for
themselves so that we can really have a meaningful and productive conversation about how to improve their
lives, how to make things better, how to get to a better place.
Dr. Michelle Neier (41m 45s):
So I’m very excited. I’m very hopeful. I am looking forward to this next stage, this next journey.
Dr. Anthony Orsini (41m 54s):
That’s fantastic. As a osteopathic physician, that integrative medicine component has been kind of pushed
into me since I was, you know, first entered medical school. And so I think it’s so important. It’s something
that’s up and coming. I think more and more people are realizing that medicine is not about just giving
medicine, that there’s a whole body approach and you have to treat the mind, the body and the spirit. And so
I love the way you smile when you talk about that. And I’m so blessed that you agreed to come on this
podcast, we accomplished our goal of inspiring and teaching, and I knew we would.
Dr. Anthony Orsini (42m 33s):
So I want to thank you so much for coming on. It’s been really great. Thank you, Tony. And it’s just really an
honor. If you want to find out more information, you can contact me at <inaudible> dot com. If you enjoyed
this episode or any of the other episodes, please go ahead and hit subscribe, leave a review. It’s very, very
important. And anytime you want to refer someone to the podcast as a guest, please let me know again,
thank you to the audience and I will see you again next Tuesday, Michelle.
Dr. Anthony Orsini (43m 3s):
Thanks again. I really appreciate it. Take care Michelle.
Narrator (43m 7s):
If you enjoyed this podcast, please hit the subscribe button and leave a comment and review. If you would
like to contact Dr. Orsini and his team, or to suggest guests for future podcast, visit us at The OrsiniWay.Com
Read the transcript of Dr. Orsini’s podcast with Chief Heart Officer of VaynerMedia Claude Silver
Claude Silver (2s):
You know, just reminding myself that we’re all in this together. We are all humans. We are all going through
something before you enter that door. Or before you turn on that zoom, you have had a life, you know, you
have to homeschool your kids right now. You have to get lunch ready. You got to take the dog out, whatever
it is. And so let’s remember that when we enter in to a conversation or when we go to work, let’s remember
that other people are doing exactly what we’re doing or waking up.
Claude Silver (35s):
We’re putting our feet on the ground. We’re having a cup of coffee and we have other things going on in our
lives. Other than just the hustle that we do at work.
Welcome to difficult conversations lessons I learned as an ICU physician with D r. 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, y ou will hear inspiring interviews with experts in their field who tell their
story and provide practical advice on how to effectively communicate.
Narrater (1m 17s):
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.
Anthony Orsini (1m 30s):
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 today. Today, my friends you are in for a special treat because
today I have the distinct honor and pleasure to interview Claude silver, who is the C hief Heart Officer at
VaynerMedia. And for those of you not familiar with VaynerMedia, VaynerMedia is a full service digital
agency serving fortune 500 companies.
Anthony Orsini (1m 57s):
Claude works alongside Gary Vaynerchuk, the CEO of VaynerMedia , who is a serial entrepreneur and
public personality. His podcast, the Gary Vee Audio E xperience is one of the most popular podcasts on
Apple for the last two years running. And I highly recommend it and I do subscribe myself as Chief H eart
Officer, Claude oversees everything at anything that has to do with the people who make up the incredible
company called Vayner media. Claude’s current role is the capstone of a career spending over 20 years at
numerous fortune 50 companies, she has known for taking a particularly human approach to human
resources, unlocking employee’s potential for forming close person to person connections, fostering an
inclusive culture, empowering purpose-driven teams and inspiring the entire organization.
Anthony Orsini (2m 44s):
Her success is driven by a passion for creating spaces in which people can succeed. So welcome Claude.
Claude Silver (2m 52s):
Wonderful to be here, Tony, thank you so very, very much. And thank you for all of the work that you’ve been
doing. Well, I have say that, although
Anthony Orsini (3m 0s):
It’s an often overused word, I really am truly honored that you are on this podcast with me. I’ve heard so
much about you and full disclosure. My daughter’s Summer works at VaynerMedia . I think it’s a little bit
more than two years now. So I know firsthand that when it comes to providing a supportive and empathetic
environment that Claude and VaynerMedia practice what they preach, my daughter loves working there and
she loves the environment that you and Gary have created. So I can attest to the audience right now that
Claude and Gary just don’t say the right things, they actually do the right things.
Anthony Orsini (3m 37s):
So please listen, because cloud’s can have a lot of great things to tell you COVID each and every week I
renewed my promise to my audience that by the end of the podcast, they’ll feel inspired and they will have
learned practical communication techniques that will help them in their private and personal lives. Especially
during those difficult times and having you on this show, I have no doubt that I’ll keep my promise. So
Claude, as you know, this is about communication and the difficult conversations that we have, but before
we get into that and go into the communication part of it, I just want them to know a little bit about you.
Anthony Orsini (4m 14s):
So tell us about who Claude Silver is, and maybe perhaps providing just a little context on the incredible title
that you have of chief heart officer.
Claude Silver (4m 25s):
Fantastic. Yes. Thank you. Thank you again, my name is Claude Silver. I am the C hief Heart Officer at
VaynerMedia and in a nutshell, Gary and I came up with the title chief heart officer for a very, very basic
reason. Human beings have hearts. Hearts are the central operating system of any human and human
beings are the central operating system of any organization. We consider people to be human and hearts,
not employees, not people that work for us.
Claude Silver (5m 2s):
We work for them. It really is a self fulfilling organism, if you will. And I got my start a long, long time ago, I
got into the digital world in 1998. I had been working towards getting my MSW. I thought that I would go
down the same path as my mom being a psychotherapist. I have a heart that wants to help. That is just the
way I was raised and the massive belief that I have that through compassion and empathy, listening, and
creating value for people that we can do just about anything.
Claude Silver (5m 37s):
So I’ve been in this world in terms of mentorship and coaching for a very long time, ran ropes courses,
outward bounds, you name it, and I’m here to hold space for people. And then to spring into action is what I
Anthony Orsini (5m 52s):
That’s fantastic. You once said, and I’m going to quote you here. ” I want to bring the human back into
human resources and humanity back into the corporate culture. I believe that everyone needs to know that
they belong. I believe in empathetic cultures and servant leadership, and I’m on a mission to create a
revolution of tenderness. We no longer need to be known as our titles. And that’s pretty important. I’ll get into
that because that’s another parallel between you and me. We are human beings. First. I’d like to know how
difficult has that been for you to do that at Vayner?
Anthony Orsini (6m 25s):
And why do you think other companies are lagging behind vain or when it comes to that?
Claude Silver (6m 29s):
Yeah. So I’ll start with the second part of the question first, which is, I believe that people see leadership as
an authoritative role. I believe people still see leadership as a title leading from an ivory tower. You work for
me. I don’t, it doesn’t really matter to me what goes on in your life other than the eight and nine hours that
you’re punching in and punching out, I report to, this is what a leader would say. I report to my shareholders,
or I have to hit my quarterly numbers so forth and so on.
Claude Silver (7m 4s):
And right then and there, it removes the entire human from the process. It’s an Excel sheet. It’s a, I need to
get from point A to B and you’re going to do that for me. So I think there’s a lot of micromanagement. I think
there’s a lot of power and control and we can get into that in my ideas of why now, the way that we do that at
VaynerMedia comes from the top. We have an incredible leader and Gary Vaynerchuk, who is not only a
CEO, he is a practitioner. He is an executioner.
Claude Silver (7m 34s):
He knows what is going on with all of the people there, with the process there, it’s amazing that someone
that is so busy can really concentrate as he calls on the sky and the dirt and the dirt, meaning like the
operations what’s going on under the hood there. So Gary is an empath. He is full of self awareness and EQ.
And if you’re going to work at VaynerMedia media and succeed, that’s the name of the game. It is very, very
rare that you will find a micromanager or a control freak there.
Claude Silver (8m 8s):
It just doesn’t work. You would be the odd man woman out. And you know, that’s not what you want to do at
Vayner. You want to be part of the collective. We are seriously a culture of we not, I. It’s something that I’m,
I’m so incredibly proud to co cultivate on a daily basis, along with everyone, including your daughter, you
know, it takes a village.
Anthony Orsini (8m 30s):
Do you think other companies are having trouble getting to where you are? Is it that they don’t want to, or
they’re just not evolved or, or, and, or maybe possibly they are, is this catching on?
Claude Silver (8m 40s):
Well, I think it’s a mixture of both. I mean, I think there’s a new Dawn right now. Now not only because we’re
in COVID and we’re really all awakening to the black lives matter movement. I mean, yes, that is incredibly
important where we are currently, but we’ve got the millennial generation with us and we’ve got generation Z
right on its tails. And these folks will not stand for the old guard. They will not stand for how it used to be with
boomers or gen Xers like myself.
Claude Silver (9m 10s):
They want to work at a place that makes them feel proud. They want to find meaning in their work. They
want to be given actionable feedback. They want growth and development. They want purpose. They want
to take part in something they don’t want to just be adjuncts. So that I think is one of the real reasons that we
do need to change to meet this incredible workforce and to retain this incredible workforce, because that’s
really key. The other thing is that as we know, you can open up any HBR article or any, you know, inc
Claude Silver (9m 45s):
There is a lot of talk about mental health right now about anxiety. This generation, or these generations are
very open about what’s going on in their worlds and what they’re dealing with. And so we need to meet them.
We need to cross the bridge and link arms with them. Now, I don’t think we have a choice. And by the way, I
wouldn’t want the choice. This is the way to be. Why wouldn’t I treat the people I work with eight, nine hours
a day, the same way I treat my friends when I go out to brunch with them or my soccer team friends, or my
aunt, my, you know, whomever like why I don’t understand.
Claude Silver (10m 22s):
I never have really understood the difference between shutting off one part of your yourself, your being to
walk into a door. And all of a sudden it was just like, you don’t have no feelings or, you know, you’re much
more of a stick figure. So anyway, long way, winded saying times have changed. The revolution is
happening. And I do know that we will continue to evolve and transform into much more empathetic cultures
Anthony Orsini (10m 52s):
So that, that leads beautifully into what I want to discuss next. And there’s so many parallels between what
you do and what I do as you know, I’m in the medicine space. Medicine’s a little bit differently in that, you
know, in the early 1900s, medicine was all about healing compassion. There wasn’t many procedures that
we had other than hold someone’s hand and say, you know, I hope you get better. But over the years, since
1912, to be exact over the years, physicians and nurses have been told not to feel.
Anthony Orsini (11m 23s):
And they’ve been told that you can be a better scientist if you’re not empathetic. And what I saw in medicine
over the last hundred years is that you see that the rigors of being efficient, the administration coming down
on physicians saying that you need to see more patients in a faster amount of time and economics of
medicine. And then being told from the beginning that you’re not supposed to feel, but it’s happened is
there’s been this major gap between the healthcare providers and the patients, and that has led to burnout.
Anthony Orsini (11m 55s):
And we were told to beginning that we wouldn’t burn out. If we didn’t feel when actually the opposite now is
coming to light. And that there’s more and more studies showing when you feel, when you show that tear,
when you show that compassion and you actually protect yourself on burnout. So I guess there’s a question
in there somewhere and what I mean by that. And so, by the way, the RC, anyway, that’s what we do. We
teach people how to reconnect. I believe that every human being has compassion or empathy, it’s there,
whether you’re a physician, a nurse, or you’re a business leader, but I think what happens is the rigors of
everyday life just kind of get to you.
Anthony Orsini (12m 31s):
And sometimes we forget. Do you think that’s what happened in business is, was the pursuit of the bottom
line and the perception that if you’re feeling and compassionate and empathetic, that you were weak, is that
how we got here in the first place? And now we’re recovering?
Claude Silver (12m 46s):
Well, I think that’s, you’ve, you’ve summed it up pretty well. For some reason, I believe probably in, after the
great depression people had to feed their families and people had to punch in and punch out. And there was
not a lot of emotion required, required. I saying in parentheses required, needed, or probably desired at the
workplace. It was a place that you were potentially moving up a ladder, but really you were bringing home
bread and butter for your family.
Claude Silver (13m 19s):
And the working world was very much still manual. We started going into our head towards the information
age and you know what, that the head right there, if you’re, you know, going in and building code or techie or
whatnot, you’re really almost decoupled from your heart. I mean, you work in this world. It’s incredibly, very
scientific and it’s very analytical and it’s very left brain. So I think what ended up happening towards, you
know, this is just a one person’s opinion, but I think at some point in the late seventies, the markets opened
up and people began to see that they could make a lot of money.
Claude Silver (13m 58s):
And I think Michael Douglas portrayed it incredibly well in wall street. That greed is good. That’s the
American way, having whatever you want when you want it and work hard, put your head down, you’ll get it,
you’ll get the boat, you’ll get the cars, whatnot. But that is so devoid of heart. That is so, I mean, put your
head down right there. There’s not like w w how about the notion of get your heart into it? So I think society
in many ways, dictated or translated to people what they needed to do if they wanted to get from a B to C,
and here we are, you know, 20, 20, 20, 20, 21 in a global pandemic where what we need to be doing, what
we are doing is putting our hearts into it, to help one another.
Claude Silver (14m 51s):
We are in this collective pandemic together, regardless of what, what, what race you are, regardless of who
you’re going to vote for. We’re all experiencing the same thing. And there’s something I think, incredibly
special and tender about this collective and this experience that we’re going through right now.
Anthony Orsini (15m 10s):
Let’s talk about the pandemic. You once said that it’s your job to keep the pulse of everybody at
VaynerMedia to know about what’s going on. I’m a big body language person. I teach a lot of body language.
70% is nonverbal of our language. I would think that that’s easier to do while you walk the floors of
VaynerMedia to look around, to see what’s going on and pick up things. But now all of a sudden everyone’s
working at home. And so how difficult has it been for you, during COVID to keep the pulse of the company?
Claude Silver (15m 39s):
It’s actually not that difficult because I’m sitting here on a screen and other people are coming on and they’re
sitting on a screen. So, I mean, there’s a real presence here. I mean, when you and I are on a screen
together right now, and we’re looking at one another, I’m not reading the magazine or I’m not looking up and
down. So I’m very focused on you. And you’re very focused on me. And I think that that’s something that by
the way, takes intention, I have to read you in a different way. I have to hear your tonality in a different way
when we’re on these zooms.
Claude Silver (16m 10s):
And we all occupy the same size square. There’s something really fascinating about that, right? It really like
it strips power and superiority and leveling just right out of the window there, because we all take up the
same amount of square. It’s, it’s fascinating. But the thing that I’ve been talking about since we entered the
pandemic in March is that there is a, an incredible awareness that we need to have as we enter someone
else’s domain. As I enter your living room, your closet, wherever it is, you’ve set up shop because, you know,
look, we’re doing what we can.
Claude Silver (16m 45s):
You’re, you know, some people are sitting in a closet, some people are working from bed and as leaders, we
need to be incredibly sensitive and aware and awake to what we are being invited into, because that’s not
the way the working world really was set up. Right. You go to an office, you all look the same for the same
cubicle. So I think there’s this extra element of a listening, making sure that everyone has an opportunity to
speak is incredibly important. That is an and I think ritual.
Claude Silver (17m 15s):
And it’s something that I’ve talked quite a bit about because as you walk around the office, as you walk
around the hospital, you’re able to say, hi, how are you? How high five, you get a coffee with someone you
check in, whatnot. You go to the bathroom, that’s three minutes of interacting with people, right? And now
you don’t have those micro breaks and you don’t have those micro moments to kind of decompress and
cognitively shut off for a second. So now what we need to do is make sure is make sure that we’re getting
those micro breaks and being able to take our mind off of the screen for little moments in time.
Claude Silver (17m 52s):
So, you know, checking in with people, making sure that you have the rituals when you get back online. No.
How are you talking about something that’s very, almost very benign just to kind of, you know, shoot the, you
know, what, for a bit to remind each other that we’re human and we’re each going through this and then get
into whatever it is you want to get into.
Anthony Orsini (18m 10s):
Great, fantastic. So let’s shift over to difficult conversations now. So what is the most difficult conversation
that you have with your employees and what advice can you give to managers? And to have those
conversations, I’m a firm believer that the difference between a manager and a leader is how they
communicate. And that the biggest problem that companies have is promoting the smartest person in the
group who can’t communicate, who doesn’t have any empathy and then can’t retain employees.
Anthony Orsini (18m 41s):
So what would you say in your every day, or even either a common communication that you do every day
that’s difficult or maybe the most difficult?
Claude Silver (18m 51s):
Yeah. That’s, I mean, it’s a great question. I think that, you know, obviously when you are terminating
someone and letting someone go, it’s a terribly challenging conversation because you are changing that
person’s life right there, you are eliminating a paycheck, potentially. However, those are not the difficult
conversations for me. In fact, when I have those conversations and the person is sitting there with me, what I
will say is this is going to be a challenge in conversation, or this will be a difficult conversation because that
is the truth.
Claude Silver (19m 24s):
So those aren’t the hard conversations. The harder conversations for me is when I have to get out of my own
way and stop chickening out. And I need to tell someone feedback and observations, and what’s really going
on, where are they not excelling? How are they misbehaving? If you will, what we need to see from them?
Performance plans. You know, those are harder for me because look, I know the minute I start that
conversation, the person is waiting for the other shoe to drop.
Claude Silver (19m 55s):
And so how am I holding that person? And how am I holding that space? Whether or not it’s on a screen or
in person so that I can really, really try to help their cortisol levels go down. So their anxiety goes down.
That’s really key. Otherwise, look, fight or flight is happening every minute of the day. If not. So the harder
conversations are more challenging for me because I have to make sure I can be honest and empathetic.
But the honest part is really, you know, I have to be crystal clear with feedback.
Claude Silver (20m 26s):
You have to be very specific with feedback because me telling you, Hey, great job. Nothing. That means
nothing me telling you it was okay. You could have done better. That means nothing, but so I have to go the
extra mile and that’s what we have to train people to do to go the extra mile of the why and how am I going
to help you get there? My book that
Anthony Orsini (20m 48s):
I just published with a few months ago, it’s called it’s all in the delivery. And that’s a quote from WC Fi elds
that old comedian, they asked him why his jokes were so funny and his, his answer was it’s all in the
delivery. And I stressed that so much during my communication training. And it sounds like you’re very aware
of that. How do you teach your managers to do that? Do you use certain exercises or how do you teach our
manager to give good feedback?
Claude Silver (21m 13s):
Well, we role play. That’s exactly how you do it. And so, you know, whether or not we’re doing improv or I’m
giving them some examples to get up on in front of the room and role, play that out with a colleague. That’s
what you have to do. And yes, it’s funny, right? It’s almost like an SNL skit, but why is it also funny is
because we also know how poor we do feedback. It we’re laughing because it’s, it’s, you know, so Kim Scott
wrote an incredible book called radical candor and radical candor is a way to critically give someone
feedback while caring about them personally.
Claude Silver (21m 47s):
And she’s got some steps that are lined out, which is, you know, being clear, being specific, being kind,
obviously being current. So don’t give me feedback from something I did three months ago, or even three
weeks ago and actionable. And we use those principles to really train people on feedback. I call it feedback
training one Oh one, and we take the org through it at least three or four times a year and do a lot of
practicing. And so that’s what, you know, that’s what some of the learning and development that we’re doing
and training and development, because we can’t expect as much as I would love to say, everyone knows
how to turn on their empathy gene.
Claude Silver (22m 28s):
And everyone knows how to turn on their compassion. That’s not the case. People are wired differently. So
the training and getting it instilled into their DNA really is what we need to do.
Anthony Orsini (22m 40s):
When I train physicians on how to have interactions, especially during break venues, we use professional
actors, actors that have been on Broadway, who volunteer their services. And we’ll play a mother who just
lost the baby, or we’ll play a husband who just heard that he had cancer because it has to be so real. We
bring these doctors in and nobody wants to be videotaped. We actually videotape them. And then we bring
them in the room and that’s where they really look. And they see their body language and how
uncomfortable they were in this situation.
Anthony Orsini (23m 11s):
We had one doctor, I was asked once by a hospital administrator to speak to a doctor who was particularly
not very pleasant to his patients. And he was, he was in trouble losing his job. And so we put him through an
improvisational role-playing and he didn’t want to be there. He was very angry. This was remedial stuff for
him. And we brought him in and he had to discuss a medical error. He had to tell the actor that they left a
sponge in her and the actors. She’s amazing. And she was great. And she was playing this old Italian
women with the Italian accent.
Anthony Orsini (23m 43s):
It was really, it was very, it was very clever. The point is he sits back after the conversation is over. He sits in
the room with me, we’re watching the video tape with me and my team and my team is going, he was so bad
and he was such a jerk like D r. Orsini, you’re going to take this one. I I’m not even gonna say anything to
him. And I said, just let him watch. So he watched for about two and a half minutes and part of my language,
he looks up at me and he goes, I am such an asshole. I said,
Claude Silver (24m 15s):
Anthony Orsini (24m 15s):
You said, you think so like, well, you know what, I’m trying to be positive with them. But the point is that that
kind of role playing, he is now an instructor for me. And he teaches other doctors on how to be empathetic
and compassionate. He just didn’t know. And I think the role playing really makes a big difference. The back
to the COVID in the last few months, there’s, you know, the hospital’s been so busy. I haven’t been doing a
lot of training with the hospitals, but what I have had is I’ve had several companies contact me, one
international company that said our human resource, people now are in a position for the first time to call
people on the phone and say, Sally, John who sat next to you for the last five years, just die to COVID.
Anthony Orsini (24m 57s):
And we can’t have a Memorial service because we have to do it by zoom and I have to call. And they’re just
not prepared for that. So what advice for, I don’t know if you’ve had to do it personally, and I don’t know. I
hope they enter, hasn’t lost anyone to COVID. I know you’re one over 800 people, but that’s an incredible
conversation to have. How would you approach that? Or what would you say to your HR people that need to
learn how to do this? This is a terrible time,
Claude Silver (25m 25s):
Terrible time. I mean, it gives me shivers. We have not had that situation happen. Thankfully, there are times
that I’ve had to share with other people that one of their parents has died because I got the phone call first,
but that is a, that’s a different story. You know, my version and my vision for HR is that we are seen as
coaches and we are seeing much more as, you know, Sherpas, if you will. So guides and guides like anyone
else need the same type of training.
Claude Silver (25m 57s):
They need to know what the trail is going to look like before they get on that trail. And so the training is really
important. How you enter into that conversation is with as much grace gentleness and what I like to call, you
know, a generosity of spirit, because you are delivering such life altering news to another person that you,
you may feel ill-equipped, but you know, the idea of empathy is that I’m walking alongside you.
Claude Silver (26m 32s):
And so let’s try to imagine, even though it’s a horrendous leap to imagine that one of your coworkers has
died or your, your family member has died, try to imagine it would be like hearing that news, put yourself in
that position and what would you need to hear and how you need to hear it and then go forth and do it.
There are tons of ways we can step in the doodoo tons of ways, but there are even more ways that we can
leave someone at least feeling held and seen and cared for.
Anthony Orsini (27m 8s):
My audience is probably getting tired of me, quitting rabbi Kushner, they author of When B ad Things
Happen to Good People. I I’ve read everything that he ever had. And Rabbi Kushner talks about those times
and says, when you don’t know what to say, just say, you’re sorry. And shut up for you. Say something
stupid. We teach this, I developed this acronym called program on how to discuss bad news. And the P is for
P lan. It’s amazing how many people go into these difficult conversations, no matter what they are review a
termination as separation as they like to call it without a plan.
Anthony Orsini (27m 40s):
And I think that’s the first step. And the G is that is gradual and genuine. If they feel that you genuinely care.
And part of the plan is that take a deep breath, imagine what it’s like to be that person and then speak to
them. So I think it’s just wonderful advice that you gave before we close. Just a couple other questions,
difficult conversations with your boss, you and you and Gary. I’ve seen so many different interviews with
you,. And you and Gary have this great relationship.
Anthony Orsini (28m 11s):
And you’ve, I think you’ve even described yourself as two sides of one coin, but good leaders don’t surround
themselves with people who say yes all the time, because, and I’m sure Gary doesn’t want to do that either.
So although you guys are so great together, there’s probably, I’m sure sometimes you disagree with Gary.
How do you think that conversation? Cause that’s a difficult one.
Claude Silver (28m 32s):
It is a difficult one. You know the thing about Gary that I know, I always know ahead of time, is that at least
he’ll listen. And I mean, at least isn’t even the right word. Gary will listen and he may disagree, but he will
always hear me out. And then tell me his side of the coin. We’re always going to come at things with the
same type of heart, which is based in humanity. And we’ve had a lot of these conversations as of late, as
there have been things due to COVID are due to diversity, equity and inclusivity that we’ve had to move on
very, very quickly.
Claude Silver (29m 8s):
And so there’s not a lot of planning that takes place. So some of what we’re doing is shooting from the hip
and you know what? His hips may say something different, but they’re always going to be aligned in some
way, shape or form or else. I wouldn’t be able to work there if he and I were so off base, if the way he and I
communicated was so off base or our beliefs, then it wouldn’t be the right match. So that’s the first thing. I
think the second thing that he and I are both getting much better at is being candorous with one another is
just there and where my, you know, none, he, he nor I like conflict.
Claude Silver (29m 47s):
And that’s kind of where, again, we’re the two sides of the same coin, but you know, well, so be it, you got to
get involved in some of these conversations. So we both been doing a better job at being much more
candorous with one another.
Anthony Orsini (30m 4s):
So there’s a millennial out there, or a gen Z or someone who is in a position they’ve been at work for three,
four, five years. They want to have that conversation with their boss and they want to go in and they want to
say, you know, I don’t think that I’m, I’m not going to put words in your mouth, but they want to move up.
They want to do more. What advice can you give that person to say, this is how you speak to your boss
about, Hey, I’m ready to do more. I’m ready to move up.
Claude Silver (30m 30s):
So the boss is always going to be listening for what are you going to do for me? How are you bringing me
value? So, I mean, I think that’s really a huge part of it. So I think that you want to couch that conversation in,
I believe I’m a good fit for this role because I have done X, Y, and Z. And I can bring more value to you by
training the rest of your staff or by going after the bigger kahuna or whatever it is. So, you know, look bosses
are going to, managers are going to want to hear, like, in a way, like, what are you going to do for me?
Claude Silver (31m 4s):
What are you going to alleviate for me or for the team that is, that is true, right? Because we’re all hustling
here. But I also want to just say for that gen Z or that millennial, it is also okay to say this is a hard
conversation for me. I’m working on myself, confidence, hear me out. I may stumble on my words. Like,
there’s nothing wrong with saying things like that because it’s real. And I know not every place is like Vayner.
I know it. So these are not easy conversations, but when someone takes that second to just, you know, give
them the real, real, I believe that you are then activating some kind of feeling of goodness in that other
person, the person listening, where you can almost be like, okay, I can get a little soft here.
Claude Silver (31m 50s):
I can be vulnerable here as well. I remember what it was like to be 23 years old asking for a raise. And the
drum that I want to always beat at is, remember you were there. Remember you were there. There’s no
difference between me and someone that I manage. I was already there. And also that’s why as a leader, I’m
very, very clear that I’m here to turn them into a champion I’ve already been there.
Claude Silver (32m 20s):
So they, yeah. So, so they got me whatever they needed.
Anthony Orsini (32m 24s):
So one final question before we leave, I had something happen to me early on that we discussed earlier
about why I got into communication and compassionate and medicine. And I know Gary’s had a big
influence on you, but other than Gary or your parents, I see the soul in you. And it comes through in your
body language and what you do in this heart and this really full soul, if you would. So other than your parents
or Gary, who was it that you can look back on and say, I happened to see him or her and I, she just had such
an influence on me.
Anthony Orsini (32m 58s):
Was it one person that you can name or maybe two?
Claude Silver (33m 1s):
I mean, it was my Nana. So I talk a lot about, yeah, she would have been 105 yesterday. She had the most
empathy of anyone I’ve ever known. She had the biggest heart. In fact, we called each other Heart. I’ve
written a couple of pieces on that. And I’m telling you, she wouldn’t leave trading. I mean, it’s, it’s incredible.
And she was alive, you know, when I got the role, but she would leave trader Joe’s or leave the bank or
leave whatever. And she would say, Tony, cause she’d see your name tag.
Claude Silver (33m 33s):
Would you do me a favor? Would you have a nice day?
Anthony Orsini (33m 39s):
That is so sweet.
Claude Silver (33m 40s):
I mean, right. And so she’s with me every day. And you know, just reminding myself that we’re all in this
together, we are all humans. We are all going through something before you enter that door. Or before you
turn on that zoom, you have had a life, you know, you have to homeschool your kids right now. You have to
get lunch ready. You got to take the dog out, whatever it is. And so let’s remember that when we enter in to a
conversation or when we go to work, let’s remember that other people are doing exactly what we’re doing or
Claude Silver (34m 19s):
We’re putting our feet on the ground. We’re having a cup of coffee and we have other things going on in our
lives. Other than just the hustle that we do at work.
Anthony Orsini (34m 27s):
Tony Robbins talks about building rapport with people and how you connect with people and finding
commonality. And we’re so different. We’re so diverse. And that’s a great thing. When I teach physicians and
healthcare providers and even resource people. What I try to say to them is there’s commonality in everyone
that there is the matter of who you are. There is something that we have in common, right? It doesn’t matter
how many differences we have. And you could find that commonality in just a few seconds, because what
you said was people are going through the same things that you’re going through.
Anthony Orsini (35m 1s):
And so I teach physicians, you may walk into a room and see a book on the table, or you may walk in a
room. And you know, I have patients down in Florida that I’ll walk into the room. Maybe the mother or the
father is not happy because something went wrong with the hospital. Stay, I walk in the room, I see a
Yankees hat and I know bingo I’m in. Right. And so be genuine. And I see that in you. And we can find
commonality with everyone. And this is a time where everybody’s so divided. But if we think about it, no
matter how divided you are, there’s something in common.
Anthony Orsini (35m 34s):
It probably can take less than 30 seconds to find it. Yeah. Well, this has been incredible. I know how busy
you are and I really appreciate you being here. I think my audience is going to be really thrilled when they
hear this drop and it’s just another journey and I’m so happy what you’re doing. And I see so many common
things. I’m in the healthcare, moving into the business. You’re already doing this hard stuff in the business.
My daughter loves working for you. She loves working at VaynerMedia. My cousin also works there. James
Orsini. I hope to have him on to someday.
Anthony Orsini (36m 6s):
I’ll speak to him about that in a few weeks, but thanks again so much for coming. I really, really appreciate
that. Thank you. Thank you and to your audience. So thank you so much for doing what you do every single
day. I really appreciate you. Thank you so much. If you enjoyed this episode, please click download and
please share on social media. You can hit the subscribe button. If you want to learn more about the Orsini
way, we’re at TheOrsiniWay.com and you can contact me with any questions and I’ll be posting this up soon
and we’ll let you know. So thank you so much.
Claude Silver (36m 36s):
Thank you, Tony.
Narrater (36m 38s):
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 at TheOrsiniWay.com
Read the transcript of Dr. Orsini’s podcast with Dr. Larry Barton as they talk about Difficult Conversations in the workplace
Larry Barton (3s):
No, the person may have padded their travel expenses. I’m not trying to say it’s not an important issue, but
the war is nothing about it. This person has to go home with their family, right? And this is what, again, the
people that just praise in HR, sometimes they’re also part of the problem or their supervisor. You know, Janet
Marco, I’m placing you on leave because we’re conducting an investigation. What in God’s name are we
doing? Why do we have to say that? So what I try to say to people is we’re conducting a review and some
people might say, well, that’s too soft. Well, I have to take that word investigation home to my family and say,
listen, I’m on leave.
Larry Barton (38s):
Why am I at home rather than going to the office of the plant every day? So it’s the words we use.
Welcome to difficult conversations lessons I learned as an ICU physician with Dr. Anthony Orsini is a
practicing physician and president and CEO of the Orsini way as a frequent keynote speaker and author. Dr.
Orsini has been training healthcare professionals and business leaders. How to navigate through the most
difficult dialogue each week, you will hear inspiring interviews with experts in their field who tell their story
and provide practical advice on how to effectively communicate whether you are a doctor faced with giving a
patient bad news, a business leader who wants to get the most out of his or her team members or someone
who just wants to learn to communicate better.
Announcer (1m 28s):
This is the podcast for you.
Dr. Anthony Orsini (1m 31s):
Hello everyone. This is Dr. Anthony Orsini. Welcome to this episode of difficult conversations. I’m very
excited to have another amazing guest today, dr. Larry Barton, I’ve had the honor of knowing Larry for years,
he’s somewhat of a friend and a bit of a mentor, and I promise you that you are in for a real treat today. Dr.
Larry Barton is one of the world’s leading experts in crisis management and threat assessments. He
currently serves as the distinguished university professor of crisis management and public safety at the
university of central Florida, barely graduated Magna cum laude in speech and communication from Boston
Dr. Anthony Orsini (2m 6s):
He earned his master’s of arts and international law and diplomacy from Tufts university. And he continued
his education at Boston university, where he earned his PhD in international relations and public policy. Dr.
Barton has the distinction of being named the very first ever Fulbright scholar to Japan and crisis
management prior to his current position. Dr. Barton served as president and CEO of the American college
from 2003 to 2013. And for the past 14 years, dr. Barton has remained the highest rated instructor at the FBI
Academy in us Marshall service, where he teaches courses in threat evaluation to federal and state law
Dr. Anthony Orsini (2m 46s):
Barton design strategies and solutions addressing workplace violence prevention and crisis mitigation is a
frequent commentator on television networks during and after incidents of public violence for CNN, the BBC
and CNN, BBC, and other news outlets. He is the GoTo man. Larry is the author of four bestselling books on
crisis response. His book crisis leadership now was voted one of the best business books of the year and his
latest book, which I just finished reading and really enjoyed it is titled the violent person at work.
Dr. Anthony Orsini (3m 16s):
The ultimate guide to identifying dangerous persons and is already a big hit in 2018, dr. Bart was named the
recipient of the distinguished service award from the international security management association. The
world’s latest organization of chief security officers prior recipients included the director of CIA, the director of
the FBI and the U S secretary of state. That’s quite a list. Larry, thank you so much for coming on and thank
you so much for accepting this invitation. I’m really very excited.
Larry Barton (3m 47s):
Well, I’m delighted to be with you, Tony, and thank you for the opportunity. Yeah.
Dr. Anthony Orsini (3m 50s):
You know, each week I promised my audience two things that they’ll be inspired and they will learn
something about communication. And I have no doubt that I’m going to keep my promise this week. So
Larry Barton (4m 1s):
I’ll try not to let you down.
Dr. Anthony Orsini (4m 3s):
Well, you and I met about, I think about four or five years ago, and we have so much in common and you
came over to see what I do with breaking bad news and wanted to observe. So you drove into Orlando and
was one of our instructors. And for those people who don’t know our breaking bad news program, trains
young doctors on how to give tragic news to patients and families. And we use videotaped improvisational
roleplaying with professional actors. And Larry sat in and the other instructors looked at Larry and you were
so nice and immediately had such amazing advice for the doctors.
Dr. Anthony Orsini (4m 39s):
Even as someone who’s not a physician, because you’re so good at having those difficult conversations.
And we became instant friends and you’ve been giving me advice ever since. And so thanks for being kind of
a mentor to me.
Larry Barton (4m 51s):
Oh, first I think you really struck something in me, Tony, which I had never thought before, just as a civilian, if
you will, that you know, many physicians and you taught me something, which was, people don’t think about
this, but physicians are really not given an hour in medical school on compassion and empathy and death
notification. You’re a specializations. You know, the curriculum is so robust in every other area, but when it
comes to people’s skills, it’s just something that you either have it or you don’t where you learn it or you
don’t. And you’ve brought that now to be really a center of excellence.
Larry Barton (5m 23s):
So I learned from you just to, hopefully it’s a two way street, so thank you. Thanks,
Dr. Anthony Orsini (5m 28s):
Larry. I want to talk about your books specifically, your latest one, but I really can’t even start until we begin
to talk about what’s going on in the world today. And I’m sure that you are busier than ever. We have the
COVID 19 crisis, which is worldwide and the United States, we’re experiencing some difficulties with racial
relations right now, and tensions are high everywhere. How has that really affected what you do and your
phone must be ringing off the hook?
Larry Barton (5m 58s):
Well, it’s very Interesting. My phone was ringing off the hook until February in terms of daily, multiple calls
regarding really my specialization know people that are posing a risk of suicidal employees, people that are
on a performance improvement plan, someone who threatens to retaliate against their employer, somebody
who might be going through intimate partner violence, and she’s a victim. And she’s concerned that, you
know, the husband is in the parking lot and may come in and basically shoot up the place. So workplace
violence and threats is the heart of what I care about.
Larry Barton (6m 30s):
And I would say, yes, the phone was going crazy in that realm until February, and then not surprisingly with
people working from home for the most part globally, it was a dramatic shift to stress and fatigue and sleep
disorders and people who could not process the new world of work. And so my practice, this is really bizarre.
It’s stronger than ever. And that’s a, I don’t like that. In other words, it’s not a good thing to be able to say
businesses up. It’s a different kind of business.
Larry Barton (7m 1s):
I’m still dealing with the occasional difficult employee and the person who is mentally ill or dealing with some
type of personal or professional stress bullying. You know, you think about all the different situations, but I’ve
had a really readjust my way of thinking Tony and support for employers in terms of dealing with fatigue and
the case load. And whether you’re a supervisor in a manufacturing plant, or you’re working in a hospital
wherever you may be, you’re an accountant, you’re a real estate broker.
Larry Barton (7m 31s):
You’re the way you look at work and the way that you’re even dealing with your children and your personal
life work balance. You know, we talk a good game about it, but we’ve had to relearn a lot. And candidly, I
think we’re at the first chapter of a very long novel. I don’t think we’re in any way, even close to
understanding the enormity, the gravity, and maybe the opportunity. And I like to know I’m an optimist. I’d like
to think this is an opportunity, but we have to look at it that way. What are we learning about the way we
govern ourselves and our people,
Dr. Anthony Orsini (8m 4s):
You and I worked on a project COVID related with some human resource people that are finding themselves
in situations that they really never were prepared for. And we have a guest coming on shortly from human
relations also. But from your point of view, what advice are you giving them? And how are the human
resource professionals holding up during this COVID crisis?
Larry Barton (8m 27s):
Well, before this call with you today in this podcast, I had a call with the senior HR person for huge company.
And I will tell you what she basically said about her people is they’ve gone from being recruiters, worrying
about compensation and benefits and performance reviews to being caregivers, internal caregivers. They’re
actually calling employees, Tony in the hospital saying, how are you? He goes, many people don’t have as
you and I have a spouse or partner or a so for single people, especially, it’s a very troubling time, whether
they’re at home, possibly sick symptomatic or in a hospital.
Larry Barton (9m 5s):
And regardless of that, a lot of people just worried about their future. So human resource people are dealing
with the uncertainty of, will there be a job for me if the company or the nonprofit can even survive what
they’re going through. So HR is probably the greatest unsung heroes of this whole COVID process.
Dr. Anthony Orsini (9m 22s):
Yeah, it’s been very difficult. I think in years, if I talk to my human resource, people they’ve told me before,
the way they separated people from employment was very legal. They had to do it very particularly now,
chief of human resources are now being renamed, chief heart officers, and compassionate is something
that’s becoming more and more part of their job. I would imagine
Larry Barton (9m 43s):
One of my favorite HR people in the country, she’s in the hospitality industry, but they’ve renamed her chief
people officer. And I just think that’s a wonderful way to look at it, which is human is kind of distant, right? It
sounds a little too formal and businesslike and Harvard business school. But when you’re a chief people
officer that kind of speaks to the compassion that you’re talking,
Dr. Anthony Orsini (10m 2s):
My daughter works in a very large company in New York city and they have a chief heart officer. And when
she told me that was the name of her chief of human resources, I thought that is great. What a great idea.
Cause it really does really does show that the employer cares. So that’s awesome. Let’s talk about your
books for a little bit. You know what I love about reading your books and I’ve read the last two is that,
although they’re very informative, they’re just not to do books. This is how you should do this.
Dr. Anthony Orsini (10m 32s):
Although again, there’s a lot of that in there, but what you do in your books is you tell real stories about real
things that happen and show the consequences of what happens when you do it correctly. And what
happens when you don’t do it correctly. And a lot of that has to do with the communication and how you deal
with that crisis afterwards. So tell me how important in your mind is communication during the crisis and give
us any advice that you can to someone out there who is dealing with the crisis.
Larry Barton (11m 4s):
Sure. Well, part of this, I think kind of parallels what you’ve done in the ERC. Any way communication is the
heart. It’s absolutely the dominant issue in terms not always, but it’s the dominant opportunity as to whether
or not when you’re giving somebody performance review or you’re giving them some kind of insight as to
whether or not they’ll take it well. And I’ll give you a couple of examples. Many of the companies over the
years, Tony, that I work with and you know, I’m on call to them 24 seven. Sometimes they’ll get on a call and
say, Hey, dr. Barton, you know, we’re currently pursuing an investigation of this person in accounting.
Larry Barton (11m 38s):
And in the moment I hear that it’s like kryptonite. I go like, I’m like curly from the three Stooges of Whoa. I
mean, I would so want to say to them, like, what are you MCIs what are you the FBI you’re conducting an
investigation. You know, the person may have patted their travel expenses. I’m not trying to say it’s not an
important issue, but the war is not think about it. This person has to go home with their family, right? And this
is what, again, the people are just praise in HR. Sometimes they’re also part of the problem or their
supervisor. You know, Janet Marco, I’m placing you on leave because we’re conducting an investigation.
Larry Barton (12m 10s):
What in God’s name are we doing? Why do we have to say that? So what I try to say to people is we’re
conducting a review and some people might say, well, that’s too soft. Well, I have to take that word
investigation home to my family and say, listen, I’m on leave. Why am I at home rather than going to the
office or the plant every day? So it’s the words we use. I’m talking about, you know, and this is the policies
and not, I think we’ve made a huge impact in the past couple of decades with many, many employers. Think
about the handbook that you have at your place of employment, Tony and many right up to, and including
what’s the phrase termination.
Larry Barton (12m 47s):
Now thinking about it, that’s one of the most offensive, outrageous phrases that we should ever have in a
human resources manual, where we talk about we’re going to terminate you and it’s, to me, that’s like
cancer. It’s terminal. You may or may not come back, but it doesn’t sound good. So I try to say up to and
including separation and people say, well, again, that’s kind of soft. Well, you know what? Separation is a
hell of a lot better. If you’re in a headline or God forbid that person comes back with a gun or a knife or
retaliate or engages in self harm. You know, I would like to think that when you are in front of a jury or in front
of just your own conscience that you review, the inventory of words you use, so communication, the way you
speak, the way you give them an opportunity to hear and process, to not be routine, to not go through a
checklist who actually give somebody a fair hearing before you make a decision, that’s how you reduce the
opportunity and their interest in retaliation, or even just bad melting your company.
Larry Barton (13m 44s):
So even if you’re not interested in workplace violence and how many people, you know, nobody comes to
work thinking someone is going to be violent today, right? Nobody ever has come to work saying somebody
is going to shoot up the place or do something outrageous. Think about rehearse, take your time. Those are
qualities of communication.
Dr. Anthony Orsini (14m 2s):
In a previous episode, I interviewed Kathy Caprino and Kathy Caprino is a life coach for women. And she
has a amazing story. She was a senior vice president at a big firm. And after nine 11, before nine 11, her
president told her to go ahead and buy a big house because she’s got a great teacher. So she did that. And
then after nine 11, she was one of the vice presidents that they decided to let go. And the words that she
remembers is our boss telling her this hurts me more than it does you.
Dr. Anthony Orsini (14m 33s):
And when I speak to physicians about breaking bad news tragedy cancer, I explained to them that at that
critical moment of their lives, that person is going to remember every little thing about what you said, your
body language. And I want to talk about language in a second, but they’ll recall everything in that one phrase
or the word termination will stick with them forever. And so, you know, many years later, Kathy keeps
remembering that this boss, that it hurts me more than it hurts you, is that she just bought a big house.
Dr. Anthony Orsini (15m 10s):
I doubt it really hurt him more.
Larry Barton (15m 12s):
Right? But your whole point here, Tony is really important for people to understand, which is you do recall
that years and decades later, the way you were treated, was it done with compassion was a genuine, you
know, I try to really focus on authenticity and I’m very blunt and saying to people, you and I were given the
gift of intuition at birth. Your mum and dad gave each one of us intuition at birth. What happens in the
workplace is we tend to tune it down. We just want to get back because we’ve got the badge we’ve been
vetted. You know, we’re part of this community.
Larry Barton (15m 43s):
We can, but guess what? If your intuition kind of says, this isn’t going well, or when Kathy was told, this hurts
me more than it hurts you. If her intuition was what a phony might be a really nice person, but that statement
is a phony. It’s just not believable. That can turn a really wonderful trusting relationship. I’m not sure it’s into a
toxic one, but it’s into one that certainly will never be the same. And that’s how friendships, it’s how you lose
people in your family that you love. You know, why, why to brothers and sisters stop talking to each other,
Larry Barton (16m 16s):
Why, why do we cut off neighbors? It’s because of that one moment in time where we just didn’t manage it
properly, it doesn’t mean you’re going to be perfect. Six Sigma 24 seven, but you can’t screw up the big
ones, right? Yeah.
Dr. Anthony Orsini (16m 29s):
Yeah. I’m going to quote your latest book and you wrote, I quote, it sounds menial, but in the midst of this
crucial conversation, the words chosen an even in the way a person is escorted out of the building are
subsequently cited by violent offenders, as something they recall as a key determinant in why they assaulted
a supervisor, their recall can be uncanny. In other words, an ounce of prevention, amazing thought. I think
that that on. So I want my audience to be inspired and to learn something.
Dr. Anthony Orsini (17m 2s):
So what advice do you, You have to the, The leader out there, the manager who has to separate an
employee, what do you tell them? Give me just a few do’s and don’ts
Larry Barton (17m 13s):
Sure, I think it’s a couple of things. One would be, and we’re talking here not about the routine, right? We’re
talking here more about where, again, back to intuition, your gut basically says this person may or may not
take the news. Well, and it might be because of past infractions, their attitude, something they’ve put on a
blog, whatever it may be. But your gut kind of says, this is not going to be a routine separation from the
company. Or even if it’s not a separation, it’s a timeout. You know, we need to go home for a few days and
hula while we conduct our review.
Larry Barton (17m 43s):
So a couple of things I try to say to them is first rehearse, rehearse the conversation. Don’t assume this is
going to be a routine conversation because it’s likely not going to be. And that’s where you can kind of
remind yourself of some of the words to emphasize such as your employee assistance program, such as I
encourage you to reach out to me, but I’d like you to do it between two and 4:00 PM in the afternoon. And
people say, well, Larry, why would you give them a time? Well, one of the reasons we’ve learned, you know,
you steal this from psychology. If you say to an employee, you can call me anytime in the next few days, but
please do it between two and four.
Larry Barton (18m 18s):
That’s a test Tony of compliance. Are they going to be a compliant person and respect boundaries? But if
they start giving you voicemails or calling you at seven o’clock in the morning, that’s another indication that
this is probably not going to have a good outcome. So first rehearsal, secondly, kind of set boundaries as to
who can do what during this period of anxiety and the third. And this is what you mentioned in the book.
That’s gotten a lot of attention because I interview offenders. I actually interviewed people that have become
violent and I interviewed them in prison. Interview them as part of my work for the FBI and elsewhere is that
they do recall this parallels, your work in terms of what you do with physicians.
Larry Barton (18m 54s):
They do recall the manner in which they were treated. And so, for instance, let’s say you worked at a facility
30 years and they’ve made a determination that because you sexually harass someone or bullied or racial
slurs or whatever it may be, you’re you are being separated. Can I go back to my locker? I go back and get
the things on my desk. Well, the time to sit there and fumble is not in front of the employee, think about it in
advance and have a process, right? Which might include, you know, Carlos, I’m sorry. We do not allow that,
but you have my promise.
Larry Barton (19m 25s):
I will package up everything in your desk or in your locker. And we will have it delivered to you within the
next day, telling them that and tell him who will be accountable, because they don’t want some fumbler to be
going through their personal things. You’ve given them accountability and you’ve told them how it will be
delivered. So that matters. Also, if you do walk them out of the facility, how that’s done, right? Think about it.
If it’s done at shift change, when you have 300 people coming into the facility, you’ve just humiliated them.
Not just personally, but in front of an audience, it’s like a mini theater.
Larry Barton (19m 59s):
So how you do it, where you do it, what you say to them and from a safety perspective, one more, and I’m
sorry for the long answer, but this is the heart of keeping people safe will be, if you are worried, if your
intuition says this person could be violent to themselves or to someone else, while you’re conducting, think
about this while you’re conducting this conversation, you have someone go out in the parking lot and kind of
walk around their vehicle, just walk around it gently, because I don’t know if in the back seat there could be a
Larry Barton (20m 29s):
There could be a Bible. I mean, there could be, it could be living in squalor. What if this person is literally
living in their car? So that kind of soft Intel can be very helpful, but when you have a security guard, walk
them to the vehicle, just remember you’re putting that guard at risk. If they reach into that vehicle and grab a
pipe baseball or something else. So those are just a few quick top of mind ideas.
Dr. Anthony Orsini (20m 52s):
That’s great advice. And in medicine and in my world, even when there’s a medical error that occurs, if we
teach the physicians how to discuss that medical error, how to be genuine, go in there with a plan. You
talked about having a plan and have your answers ready. It’s amazing to me, how many people that I’ve
trained. And I said, what was your plan when you went into that difficult conversation? I don’t know. I didn’t
have a plan. Like how could you not have a plan like Nirvana? Even if it doesn’t work out, you should have
something ready, but it’s amazing how many people don’t have a plan, but how you discuss a medical error
can make the difference between a lawsuit or in some cases, a hug, right?
Dr. Anthony Orsini (21m 34s):
And hospitals and lawyers sometimes get this all wrong. There’s a medical error. The doctor’s told that he
has to be honest, or she has to be honest, but he or she walks in with risk management, the legal team, the
CEO of the hospital, and the patients looking at them, what is going on? And I’ve given advice to risk
managements in hospitals before. And I said, listen, I know you want one of your representatives there. But
if you walk into my room as a patient with six guys wearing suits, I’m going to say, Oh my God, what just
Dr. Anthony Orsini (22m 10s):
But if a physician walks in and says, listen, I gotta be honest with you and says it in a compassionate
manner, that patient is much less likely to be super angry, to file for a malpractice lawsuit or everything
worse. So it’s amazing to just have a plan, right? That’s the biggest bite.
Larry Barton (22m 26s):
Yeah. You nailed it. I’ll tell you one strategy that your listeners can definitely steal. And this is part of the
whole reason that I think your program as real value, I do a lot of work in retail and we’ve done. I think a
great service to the, you know, think about a customer service desk at a target, a Walmart, a CVS, whatever.
It may pick a region. Those people get abused every day. I mean, they just, they are slammed their body
slammed. They are verbally slammed. I’ve tried to encourage them, their leadership to allow them to say the
following sentence. And it’s going to sound a little awkward, but just stay with it.
Larry Barton (22m 56s):
And I think your listeners will get it 20 years ago. If you and I went into one of those retailers, Macy’s pick it
up. You were just losing it, right. That person basically did have to take it, but they weren’t allowed to say
anything right now. We are encouraging them to say, I’m sorry. You feel that way. Ma’am I think about that for
a minute. I’m sorry. You feel that way, sir. Now a lawyer. And I’ve had a lot of, you know, a lot of battles with
lawyers. Oh, Larry. We can’t say we’re sorry. Oh really?
Larry Barton (23m 26s):
But guess what? You’re going to really feel sorry when that person has their cell device that you didn’t know
is on and you’ve got a really toxic person on the other side of the counter, let’s empower them. There is no,
no acknowledgement of guilt. When you say, I’m sorry that you feel that way. So this parallels what you just
said, you’re not saying, I’m sorry that we screwed up the app index to me. Right. Or we cut out the wrong
artery. Okay. There’s a big liability issue with that. But there’s no liability in saying, I’m sorry for the way that
Larry Barton (23m 60s):
That is an act of goodness. That’s an act of compassion. And guess what? Tony, when people do it, they
have come back and reported years later, literally the number of incidents and blow back and compliance
calls people calling corporate has gone down. And in fact, a number of people will say to that person, wow,
that’s nobody. Nobody has ever apologized to me. Thank you. So it kind of ends it, it takes away part of the
Dr. Anthony Orsini (24m 24s):
Probably the biggest piece of advice that’s going to come out of this interview today is say, you’re sorry.
Medical errors. Even when a patient dies and doctors were told when they were in medical school, not to
say, you’re sorry, it could be natural causes that. You’re not saying you did anything wrong. And in medical
errors, even if it was something that you did wrong, you cut off the wrong leg. It’s okay to say, I’m sorry. The
system broke down. I’m sorry that this happened. And in fact, in many States right now, the words, I’m sorry,
can’t even be brought up in court.
Dr. Anthony Orsini (24m 58s):
It’s not part of the litigation because we’ve seen that patients cope better short term and longterm and are
much likely to Sue. If someone just says a lot of people Sue, because, and they’re in the courtroom and
they’re saying, I just wanted someone to see,
Larry Barton (25m 13s):
You’re going to find this not I’m using because you know me pretty well, but I, every morning I wake up and I
say to my wife, you know what, good morning. And then I say, I love you. And then I say, I’m sorry. And
there’s growth. And I did this going back 17 years. She’s like, what are you? Sorry? I was saying, you’re
sorry for. I said, because whatever I do today already absolved by saying, I’m sorry. Okay. So you gotta have
a little levity with this. You have to be able to say it and to, you know, for a situation, we mean it. And, but
also understand that this is part of the compassion that you’re talking about saying, I’m sorry for how you
feel. It just diffuses a lot of anxiety.
Larry Barton (25m 45s):
Dr. Anthony Orsini (25m 46s):
Yeah. I agree. A hundred percent. You know, neuroscientists tell us that our hindbrain, our ancient brain
makes millions and millions of assessments on someone’s body language per second. That in less than a
second, you’ve already made an assessment of someone. If you’ve read Malcolm Gladwell’s book, the blink,
he calls these slices. They’re split second decisions that you make about someone usually they’re correct.
Not always. And they really depend on the body language and the message that you receiving.
Dr. Anthony Orsini (26m 16s):
Non-verbally when you train people on how to speak to people during and after a crisis, how much of that do
you go into the, you go into their body language to tell them to sit down and things like that.
Larry Barton (26m 28s):
The answer would be no, not the way you just described. And I’m glad you asked, because I think your
listeners will really appreciate this. It’s not really about trying to read a person who does that best would be
police officers. It would be interrogators. It would be those that are conducting formal authorized
investigations, but I’m more interested in, in trying to help people would be where to sit. In other words,
before you bring someone in, as you do in a physician’s capacity, but in an employment setting, when you
preset yourself at the edge near the door with your paperwork, so that the employee you’re talking with
giving counsel to maybe promoting, maybe demoting, have them be further away from you.
Larry Barton (27m 7s):
You don’t want them at the opposite end all the way down the end of the table, because that obviously is
offensive. But the point is presetting the room, thinking about having an exit strategy. If back to intuition, you
think that it may not be a positive. The person might slam their fist, might yell, might turn the table over.
That’s why having security around the corner. Discreetly if need be to intervene matters. So I’m into more of
the situational safety aspects, as opposed to reading people. I’ll give you a ten second story about reading
Larry Barton (27m 38s):
It has nothing to do with rancor, but I think might be of interest to your listeners. But this is kind of a, it’s one
of my moments from I watched somebody do exactly what you’re talking about. Maybe eight years ago, I
hosted a huge banquet at the Kennedy library in Boston presidential library. And the guest speaker was
Kathleen Kennedy Townsend. And she was the former Lieutenant governor of Maryland and really smart
person. I’d never met her before. Now, the audience, this is important to the story she’s coming in, getting all
ready to talk about at that point, Obamacare and what was going on with national healthcare.
Larry Barton (28m 11s):
She had her whole presentation, but those are the big black tie bank, but in about 400 people, well, she
comes in and she realizes at the cocktail hour, because if one comment by one person, Oh my God, this is
mostly a Republican audience. And it was, it was mostly a conservative audience. Now she tried him and
she goes, Oh my God are most of these people conservative. And I said, yes, they are. All right. She put her
notes, which are in her pocket book aside, this woman got up 20 minutes later and she just talked about
Larry Barton (28m 42s):
She did a whinging and it was the most amazing, authentic, genuine, because she talked about nothing that
she had visited talking about, talking about Rose Kennedy, her grandmother, and the rosary. She talked
about living in a Kennedy household. She talked about, you know, what? They had to eat naughty. She
talked about the levity of family and the importance of love and compassion. And the point is she did a
complete about face. And I love that because she read the whole audience by one little slice of a couple of
Larry Barton (29m 13s):
And she looked around, she was like, Oh my God, this is going to be a complete disaster. So there’s
different ways to read people. And it’s not always one-on-one. I mean, why does an entertainer, why does a
singer Frank Sinatra who I, you know, I had the privilege to watch him eight times in concert. You know, why
would Sinatra before every, and we’re going back to the paramount in 1940, all the way back into the 1980s.
Why did he always peak around? And you’ve got video of him doing this. Why did he always peak around
the curtain before even Frank Sinatra? Right? The most consummate performer ever.
Larry Barton (29m 44s):
Why did he peek around the curve? He wanted to read the audience. That’s a really insightful to me, slice of
just being human.
Dr. Anthony Orsini (29m 53s):
That’s a great story. I didn’t know about that. That was, that’s a great story. Yeah. So, you know, we talked
about having a plan, but there’s a great example of sometimes your plans not ready and you have to change
Larry Barton (30m 3s):
Dr. Anthony Orsini (30m 6s):
And in medicine, I do that. Sometimes you walk into a room and we’re going to have an episode on program
pro G R I M, and the O stands for observation. And you have to walk in to a room and you have to say, okay,
I had this plan, which you have to have it, but this is not going correctly. You know, sometimes I’m,
unfortunately I have to give bad news to a parent about their child not doing well. And the parent reading the
parent in a he or she is smiling, right? My intuition says, okay, they’re not getting this.
Dr. Anthony Orsini (30m 38s):
We need to start over again. Or I’m giving good news and they start to cry. So you have to think on your feet.
I think that’s a great story. So I know you’re, you’re a busy man, but I want to talk about your book, your
newest book and what people can expect. I already read it. It’s awesome. And to my surprise, I was in it,
Larry Barton (30m 56s):
Dr. Anthony Orsini (30m 60s):
I think you checked me, cause you said, I told you I’m reading the book, but you didn’t tell me. And I think
you were probably testing me to see if I said, Oh, the book was great, but didn’t mention that I was in it. He
probably would have said, Oh, he’s lying. He never read it. So
Larry Barton (31m 13s):
Yeah, it was two years of work. And I, a lot of people don’t understand how much time goes into writing a
book. It is. And especially this kind of book of business book, because it’s filled with facts, right? So the fact
checking as opposed to a novel, which can go in any direction, but when you are writing a business book
about cases of caring for people, litigation, security, human resources, just the governance of people and
being good to people and also being prepared for crisis management and business recovery. And you’d
better know your stuff. So it took two years and a lot of fact finding, but it was a journey that I loved because
30 years ago, I was not very interested in violence at work.
Larry Barton (31m 51s):
My background was really focused on crisis management. You know, the storm, the hurricane, the
earthquake, the issues of any calamity that could disrupt a business. But about 20 years ago, I really started
to move into this journey because of the postal service killings and many other issues that were happening in
society. And because with the prevalence of guns, we just saw more people acting out with school shootings
and houses of worship, et cetera. So to make a very long story short, I’ve really spent 20 years now, deeply
looking at victimology. Why are people injured at work?
Larry Barton (32m 22s):
Why do people become perpetrators or wonderful employees and very good people, but why did they turn
and trying to understand and demystify for the reader? Because to your point, I’m not a physician, I’m a
behavioral scientist, but I try to really demystify what is mental illness and understanding why we have
counselors and why sometimes people need time off. And those words that we talked about earlier and how
you use them appropriately and helping keep an employer safe, but we lose two people a day on average,
Tony in the United States, they’re killed at work by coworkers in the midst of COVID.
Larry Barton (32m 58s):
Nobody’s talking about that. But you know, in the past couple of weeks, we’ve had three shootings in three
different workplaces. One of them was at a hiring event. Okay. It wasn’t a retaliatory issue of just X employee
was just at a hiring event. So it’s really trying to help people understand. And we’ve tried to unlock the
reasons why people become angry, how you can diffuse them and just be a better employer and stay safe.
That’s ultimately what it’s about. That’s fantastic. And I really did enjoy it. I love the stories. That’s the best
part of it because you don’t, like I said, it’s not just do this, don’t do that.
Larry Barton (33m 31s):
And it brings a real, it’s interesting you say that because I would say, you know, you get a lot of feedback
from meters, right? The one story in that book that probably more people than anyone has said to me, Hey,
Larry, I have either forgotten or didn’t know that story is actually about a psychiatrist in Seattle and we won’t
get into it here, but it’s the story of somebody who is very well vetted, highest credentials. You could possibly
imagine incredible impeccable pedigree as a professional, and yet who was a very deviant and a very
Larry Barton (34m 3s):
So helping to understand that it can be people in all walks of life, right? Not necessarily who’s down and out.
People in all occupations can be deviant. And to try to understand that psychopath, that sociopath, or just
that individual who is on a journey of evil is an important one for us to discuss. That’s great. And your book is
available right now on Amazon and other outlets. And if anyone wants to get in touch with you, what’s the
best way to do it, Larry. Sure, absolutely. Just write to me.
Larry Barton (34m 33s):
My email is email@example.com and I’ll be glad to hear from all of your listeners happy to, well, thank you
so much. I am really honored to call you a friend and I am very excited that you agreed to do this. I know that
you are extremely busy. So for you to take an hour out of your time to speak to my audience, I really do
appreciate that. Thank you so much. Thank you for what you do for all your people, Tony. Great to be with
you. Thank you. If you enjoy this podcast, please go ahead and hit the subscribe button and leave a review
and download more episodes.
Dr. Anthony Orsini (35m 3s):
We have some great guests every single Tuesday. So I want to thank everybody for joining us. And once
again, thank you, Larry. Appreciate it.
Announcer (35m 9s):
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 at The Orsini Way.Com
Read the transcript of Dr. Orsini’s podcast with Dr. Helen Reiss - The Power of Empathy
Dr. Helen Riess (1s):
The fact that the human brain is still so wired to perceive difference is a real challenge in our global society. I
do believe that the survival of our planet and our species is going to depend on seeing humans as human
period and a story. You’re a human I’m a human
Welcome to Difficult Conversations Lessons I learned as an ICU Physician with Dr.
Narrater (1m 11s):
Anthony. Dr. Orsini is a practicing physician and president and CEO of The Orsini Way. As a frequent
keynote speaker and author. Dr. Orsini has been training healthcare professionals and business leaders,
how to navigate through the most difficult 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 or 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 14s):
Well, welcome to another episode of Difficult Conversations lessons I’ve learned as an ICU physician. This is
dr. Anthony Orsini and I will be your host again this week. Today, we are very blessed again, to have another
amazing guest, dr. Helen Riess talk the reef as a psychiatrist, an associate professor of psychiatry at
Harvard medical school. She has a director of the empathy and relational science program at Massachusetts
general hospital in Boston, and is widely considered the leading expert on the topic of Empathy. In 2012, Dr.
Dr Orsini (1m 44s):
Riess found empathetics.com, which was an organization that provides empathetic training for healthcare,
business education and law enforcement. She has devoted her career to the art and science of healing
relationships. Her research has been published in leading medical journals and has won many awards. Her
groundbreaking Empathy training research, which was highlighted in a 2012 New York Times article was the
first study to demonstrate that empathy can indeed be taught. This was the answer to decades of major
media attention, demanding more empathic care from medical professionals.
Dr Orsini (2m 17s):
Helen’s amazing TEDx talk titled the power of empathy has been viewed almost 600,000 times so far. I saw
it. It’s amazing if you haven’t seen it, go do it as soon as this podcast is over. Her new book The Empathy
Effect has been translated. Helen I think in 10 different languages now, is that correct?
Dr. Helen Riess (2m 36s):
It’s been licensed in 10 countries.
Dr Orsini (2m 38s):
That’s fantastic. Dr. Riess and her teams are dedicated to transforming health care into compassionate care
systems, and I’m especially excited to have her on this podcast, especially during that time, when we need
empathy more than ever. Thank you, Helen, for accepting my invitation. It’s OK that I call you Helen right?
You know, you and I had so much in common. We are both dedicated our careers to bringing compassion
back into health care. In full disclosure. You and I have never met before.
Dr Orsini (3m 9s):
In fact, up until just a few minutes ago, we’d never even spoken, but I’m a big fan. And when I decided to do
this podcast, you are on my short wishlist. But I thought about just taking a shot inviting you. And I think I
contacted you through LinkedIn and you immediately you got back to me and you were a gracious with your
time. And I want to thank you again for being here.
Dr. Helen Riess (3m 26s):
My pleasure. Thanks for inviting me.
Dr Orsini (3m 28s):
OK. So this is a time in each podcast and I renewed my promise to the audience. By the end of this episode,
you will feel inspired and you will have learned valuable lessons to be a better and more compassionate
communicator. So get ready audience you are about to be blown away. So thanks Helen for coming again.
I’m so excited, Helen, as I mentioned before, my big hurdle in preparing this talk was really getting it down to
a reasonable amount of time. I had so many questions for you after I read your book. I know what about you
for a while now? So there’s just so many questions that I want to ask.
Dr Orsini (3m 58s):
I’ll try to keep it down to just a few questions, but lets start off with what we really need to do is get on the
same page. if you would just defining what Empathy is and, most time we get that mixed up between
empathy, sympathy and compassion. And if you don’t mind just telling me audience how you perceive
Empathy and how that relates with those other terms.
Dr. Helen Riess (4m 19s):
Sure. Those terms are often confused. So it’s a great place to start. So Empathy is the newest of those
terms. It’s only been around for a little over a hundred years and it is defined as the ability to feel with and
understand the emotions and situations of others’ as if they were our own without losing the, as if quality.
Dr. Helen Riess (4m 51s):
So we temporarily our brains are hardwired to resinate with the feelings of others and we have the capacity
to use our imaginations to perceive the situations of others and because of this really unique capacity human
beings and some animals too are moved to help. And so when we perceive suffering in others, we feel
something and we’re often able to imagine what that might be like.
Dr. Helen Riess (5m 27s):
And that creates empathic concern. And once we feel concern were then at a decision point of whether we’re
going to act on what we have perceived or whether we’re not going to. And if we take the action, which can
be as brief and simple as a caring, look, a touch on the arm, a phone call or making a large donation to a
nonprofit organization. Those are acts of compassion because I view compassion as the action arm that is
motivated by empathy Sympathy, on the other hand is a really old term that really recognized that people
have similar feelings and that we catch emotions from one another, but it has really kind of morphed too
mean, feeling bad for people taking pity on them and feeling sorry for them.
Dr. Helen Riess (6m 26s):
And it’s a much more sort of self-focused feeling like I feel so bad. Like that happened to me too. I feel so
bad for you. Whereas Empathy really stays with the other person’s experience and mirrors that for the other
Dr Orsini (6m 41s):
The key word that you said was Imagination there and when I talked to Physician, it’s so important that we
do imagine or put ourselves in the other person’s shoes, especially before we give tragic news to the patient,
but even during our genuine interactions with patients. How do you train that? I know that you do a lot of
training of young physicians. How do you get them to that point where, you know, we’ll talk about burn out
later on, but how did you get them to that point where you train them to just imagine for a second, the they’re
the patient, and go from the sympathy to the Empathy to the compassion?
Dr. Helen Riess (7m 17s):
Well, it’s not a one-step process, but it does begin with opening our perceptions. So one of my favorite
sayings is the face is a roadmap of emotion and its the only part of our body’s that we don’t routinely cover.
So if we just start with looking at a human face, there is a wealth of information about the emotional state
that one of our key pieces of training is just open your eyes, go get your head out of the computer and out of
your iPhone or whatever you’re looking up and really just appreciate that there’s a unique human being
sitting in front of you.
Dr. Helen Riess (8m 1s):
That’s not just bringing a broken arm and illness or a disease to you, but a whole person with a background
and relatives and a past and a the future. And just to take that moment and recognize that this person, you
know, maybe hanging on every word you say, and if you don’t first perceive where they are emotionally, you
can create a disconnection, you know, in a half a second.
Dr Orsini (8m 30s):
So one of the things that I really love about your book is that you really go into the neuroscience of empathy
and we think that Empathy is something that either way you have, or you don’t and you have proven beyond
a doubt, but I think that’s true that empathy can be taught, but Empathy sometimes there’s a lot of, it was just
a soft thing, but there’s actually neuro-transmitters and there’s a Science basis for empathy and it’s based on
survival. Correct? Absolutely.
Dr. Helen Riess (8m 57s):
Right. I mean, if you really think about the most basic function of Empathy, it starts with mother infant
bonding. You can imagine if a mother is not moved by the sound of her crying baby or can’t feel a pit in her
stomach, if her baby is sick or about to, you know, step on glass or do something really dangerous, not too
many human infants would survive. So Empathy is built in to the human caring for offspring.
Dr. Helen Riess (9m 27s):
And of course it extends because we don’t live in isolation. We live in communities and it’s thought to be
hard wired because especially in the days of Hunter gatherers, most of the time males would go off hunting
and the women would be left in the village where they had to cooperate and collaborate to take care of
children while some of them sought food and you know, picked berries or whatever they did. And that they
had to perceive not only their infants cries or distress, but those of their, you know, fell on mothers and their
children to keep the community safe and well
Dr Orsini (10m 10s):
That’s great. And later my big question at the end, we are going to talk about In-groups and I can’t wait to
talk to you about that, but we’re going to save that for later. A question that you might not have been
expecting today is I want to talk to you about before we go on to talk about more about Empathy and, and
communication training in your relationship with Alan Alda because, and I’ll tell you why they have a special
story about Alan Alda. I’m a big fan of his, and I know that he wrote the foreword too. Your book, people ask
me on a regular basis, what made you decide to go into medicine and without hesitating my answer is
Dr Orsini (10m 41s):
It’s exactly true. Alan Alda. talks about in your book and he talks about it in his book and I love his book. The
title is amazing if I understand you, would I have this look on my face. I just love that title. But he talks about
very similar things that you speak about. It was very important to Alan all the way that the character of
Hawkeye Pierce was not just funny, but that he was a real person, and Alan Alda really show that he was a
doctor who cared. That character, Hawkeye Pierce, had Empathy flowing and compassion and you can see
that he would cry and he would get upset.
Dr Orsini (11m 19s):
He would get mad. He would go through anger. And if it sounds weird, but I’m a big MASH fan. I can
probably give you the lines of every MASH that was ever shown on TV, but that’s the kind of doctor I want to
be. How do we teach doctors? How to do that? How do we teach them to feel that empathy? You spoke a
little bit about imagining being the person in there, putting yourself in that shoes, but tell me about your
empathy training when you train young doctors.
Dr. Helen Riess (11m 49s):
So I’ll get to that, but I just, I am a true fan of Alan Alda and I just want to share that’s the way we got
connected is when he reached out to me to see if he could interview me for his book because he
understands Empathy like no other when it comes to putting himself in the shoes of others and being a
genuinely caring, connected person. But he wanted to learn about the neuroscience. And, you know, he
spent 10 years interviewing scientists’ on Frontier’s of American Science.
Dr. Helen Riess (12m 23s):
And the way, he could fully immerse himself in wanting to learn how Empathy works. It was such a great
example of his two interests coming together, being a TV doctor, but really also wanting to understand how
do we teach this in? How do we enable this in physicians? So I guess it really goes back to the reason why I
got interested in empathy training first, I really was watching a lot of burnout, a lot of patient dissatisfaction.
Dr. Helen Riess (12m 55s):
This is going back 10 to 15 years. As you know, you know, in the introduction of the electronic health record,
there was a lot of distraction and having to learn new ways to input information was requiring physicians to
load information into computers. Some of whom have never taken a typing coarse. And so they’re really was
a breakdown in the doctor-patient, patient- doctor relationship, because we just didn’t have the focus.
Dr. Helen Riess (13m 26s):
And as a psychiatrist, I was hearing a lot of pain about this feeling that people just weren’t paying attention to
them. Didn’t hear them ask the same question over and over again. And I could see that this was really
causing harm. You know, patients were losing motivation to stop smoking, to lose weight, stay on their
medication. That’s the first oath we take when we graduated from medical school is first do no harm. And I
realized that through these communication gaps and lapses that we were doing harm.
Dr. Helen Riess (14m 2s):
And so I reasoned that empathy can be beaten out of people. We certainly should be able to put it back in
because most people who choose medicine and nursing professions are they have some empathy, they care
about people or they would be doing other things. And so it just didn’t seem right, but well, meaning people
were suddenly just not connecting in a way that that was helpful to people.
Dr. Helen Riess (14m 32s):
So I studied the neuroscience of empathy for a couple of years. I did a fellowship at Harvard and got to really
immerse myself in that literature. And that’s where I realized that this is a brain-based capacity. It’s not just a
nice to have like being nice skill. It’s a survival skill. And if we could get physicians to lift their heads up and I
mean, physicians, nurses, medical students, residents to the whole team, PAs NPs, and really connect with
Dr. Helen Riess (15m 6s):
I really believe it, that is what’s needed to really engage people in being partners in their own healthcare.
And so it became a real quest of mine to understand how the brain perceives processes and expresses
empathy and compassion. And then to figure out ways that we could kind of expand this awareness building
and perspective, taking through some classroom instruction. And that’s when I did a study to see if what I’ve
put together actually could be perceived by patients in a study in a randomized control trial.
Dr Orsini (15m 44s):
And one of the things that I noted early on in my story that I talk about and my book about how I saw an
incredible doctor and mentor of mine, who was a very compassionate person who couldn’t communicate that
compassion to a patient. And that’s what made me so interested. He just, and the story, he just comes out
and tell somebody of your baby’s dead. And I knew this man was such a compassionate person, as most
physicians are empathic. And so I really understand what you’re saying is it’s all about the patient experience
that I think as physicians, we all get tied down, we get busy as nurses, but it also think, and I would like you
to comment on this there’s a lot of communication techniques out there that a lot of people don’t know, a lot
of people don’t understand.
Dr Orsini (16m 29s):
And when you teach them these techniques like tone of voice, which I’ll ask you about thinking really convey
that Empathy, that they had inside. But maybe didn’t know. When I was at a young resident, did a rotation
with the doctor who delivered me. That’s how old he was. And he practiced almost 45 years and was never
sued. And I had a great role model and he was able to look at each and every patient that came in there,
whether he met them are not and he was best friends with them in one minute.
Dr Orsini (17m 1s):
And he looked in their eyes really, really close. And I had a great role model. So talk a little bit about you talk
about the acronym that you used. Empathy a little bit about how some practical tips on how physicians or
anybody. I mean, it’s all about building rapport, right? And so give it some tips. There’s a great example. You
talk about in your book “Nice Shirt” and the different ways you’d change the tone. I love that because that’s
something that I also discuss all the time. So tell us about these, some of these techniques that you can give
to our audience.
Dr. Helen Riess (17m 33s):
Well, you’re starting with the middle of the acronym. Is that where you want me to start?
Dr Orsini (17m 37s):
I got to keep my promise. You’ve already inspired them. So I’m want to keep my promise. We’ll give them
some tips on how they can in the short version. I know this takes a long time to learn, but just little tips about
eye, posture, all of that stuff
Dr. Helen Riess (17m 52s):
Okay. So after doing all this neuroscience research, I just thought, how do we compress this into, you know,
teachable skills and human behaviors that people are gonna remember? And you know, on a walk in the
woods one day, it sort of came to me that the word Empathy held, I like most of the behaviors that express or
perceive empathy. And so the first one you already said is eye contact. And so we all think we’re making eye
contact. When we say hi, Mrs.
Dr. Helen Riess (18m 22s):
Smith, how are you? But one tip I give is to notice the person’s eye color. And when you leave, I don’t mean
staring at anybody. But when you meet someone’s gaze with intention, it’s a very different experience than if
you glance up and say, Oh, hi, Mr. Smith, how were you doing? And then you start typing. So write in that
first, second, you have a choice to either connect meaningfully or to just treat the person more like an illness
or an injury.
Dr. Helen Riess (18m 54s):
The M in Empathy stands for muscles of facial expression because there’s no F in Empathy for face. So I
had a fudge that one a little bit, but part of our empathetics training has facial expression, decoding
techniques, so that we learn the subtle differences between anger, disgust, contempt, and sadness. For
example, they all sound very different, but it’s hard for people to see the difference unless they get training.
Dr. Helen Riess (19m 25s):
And we also just try to get people to look at others, faces. Cause as I said, there are a roadmap of the
motion mixed facial expressions or a very common and suppressed emotions are common in patients. So
they won’t necessarily show you that they’re confused or angry. That’s why we have to become better at
reading the face. The P stands for posture. And there’s a lot, you can tell about a person’s mood just by how
they sit or stand.
Dr. Helen Riess (19m 55s):
And also we really encourage physicians to sit down at eye level. So they are not in a dominant position,
which doesn’t really foster collaboration in a cooperative conversation. The A stands for an Affect, which all
of your doctor, audience and nurses will know stands for emotion. And many people have used the term. If
you can name it, you containment. So if we can name an emotion like that person looks really anxious or
agitated, just naming in our heads.
Dr. Helen Riess (20m 30s):
It makes us attend to that differently than if we are just getting kind of catching the agitation and feeding off
of it. And then deciding I need to be more soothing. I needed to help calm this person down. T is tone of
voice. And of all of these empathic behaviors, tone of voice actually conveys the most about what we are
truly feeling. And so in the example you gave, that’s a nice shirt compare to that’s a nice shirt or that’s a nice
Dr. Helen Riess (21m 6s):
So one of them sounds like a genuine compliment. And the other one sounds critical and the other one
sounds like I can’t believe you’re actually going to walk out of the house wearing that.
Dr Orsini (21m 19s):
Even the way you say, how are you when you meet someone, it’s something that you notice all the time.
People will see somebody in the hallway and say, how are you? And it’s clear that they don’t really care. Your
just being polite. And you’re walking by in the other person who could say my dog died and you probably
wouldn’t even notice, but you can come and say, Hey, how are you? And that shows that you really care
what, and how you smile with your eyes or with your eyebrows. You know, we talk about that all the time. So
yeah, tone of voice, I think, is something that most people don’t pay attention to, but once it’s brought up and
they realize that I think they noticed it a lot more.
Dr. Helen Riess (21m 52s):
It’s something that a lot of people are not aware of. Like, I think that this is one of the ways that couples off
and get into arguments is that they’ll say things to each other where they’re not aware of just how like
disrespectful or disgusted they sound. They just think, Oh no, all I said was, you know, X, Y, and Z, but it’s
the tone. And 90% of what we are talking about is conveyed in tone. So that it’s really important. And there
are specific skills like trying to match the volume of the patient that you’re talking with.
Dr. Helen Riess (22m 28s):
So that if someone talks softly and slowly that we don’t come with a booming, you know, wild, fast voice, and
just, we talk about many adjustments. People can become more conscious of with tone,
Dr Orsini (22m 40s):
A famous director, Gary Marshall, I saw something on him, a documentary about him. They were talking
about when he directed during the scene, when the scene was filming, he would turn his back on the actors
and just listen to the tone and the cadence and the reflection of the voice. And he would be able to say, that’s
a wrap or do it again without ever seeing the scene. And that just as a great example, I think of how
important tone is
Dr. Helen Riess (23m 4s):
Definitely. So H stands for hearing the whole person, not just hearing and listening, but embedded in hearing
the whole person is perspective taking which means viewing the person and looking at their lives through
their lens, not our own. I think about like taking off my glasses and putting on yours so that I can see the
world as you see it because many people will say, Oh, treat the person like you would want to be treated.
Dr. Helen Riess (23m 38s):
We really need to treat the person like they would want to be treated. Right. So hearing the whole person
gets at that cognitive arm of Empathy, which is perspective taking and other people have talked about
perspective getting. Some people will say, well, why aren’t we are just trying to imagine, why don’t we just
ask the person so we can get their perspective. But sometimes we’re thinking about a patient before they
ever come into the office, you know, will know that a woman who’s husband died four weeks ago is having
Dr. Helen Riess (24m 14s):
And so we might think about that woman differently than if she were just coming in with chest pain. Cause
we can maybe imagine that there’s a lot going on in there. And then the final letter of the Empathy acronym
is Y, which is your reaction to the person. And that is to me like the key piece, because we all do share
emotions. And if we are at a pretty mindful place, when we enter a patient’s room and all of a sudden we’re
feeling either annoyed or agitated or confused, we must consider that we’ve just picked up their emotion
because we weren’t feeling that before.
Dr. Helen Riess (25m 0s):
And that’s the importance of settling ourselves before we walk into a patient’s room or bedside so that if we
start to pick up other feelings, we can really think about why am I having this reaction? And if we are
suddenly feeling agitated, you know, maybe you were picking up at that person is agitated or all of a sudden
we’re annoyed. And this is so important for medical professionals. Think about, could that person be
Dr. Helen Riess (25m 33s):
And I’m feeling annoyed. Cause they were annoyed in us. Like maybe if we said, we’d come back in 20
minutes with some results and now it’s four hours later and now they’re a little bit nichey or ya know, put out
and they are not being super respectful. And so is it our place to now be annoyed at the patient? Or should
we be really thinking maybe there are annoyed because I didn’t follow through with what I said and maybe
there’s an apology that’s needed.
Dr Orsini (25m 59s):
Well, it’s important to know that, you know, we are talking a lot about Healthcare because you and I are both
physicians, but these are great tips, no matter whether you’re in healthcare or not. In fact, a lot of my
audience is not in the health care sector. In fact, every other week in this podcast, we generally have a
guest, not from a health care at all. So these, our communication, as I say, if you can learn the communicate
and convey our empathy or compassion, you’re pretty much gonna be great in both your professional and
your personal life. The people who are good communicators, people who show empathy, as you say in your
book, just tend to do better in life, better for themselves and seem to go further.
Dr Orsini (26m 37s):
So it’s really important that these tips that Dr Riess is giving us are important for everybody and not just for
medical professionals. I know time is running out. So I wanna get to my, a great question that have been
waiting to ask for a long time. He goes the, the times here are very difficult times in the world right now. And
you talk about in your book about in grouping and I’ve long known and they say, neuroscientists have said
that within the first or second that you meet somebody, your chemicals in your brain have already decided
that whether that person is like or unlike or a friend or foe.
Dr Orsini (27m 12s):
Correct. So this is something happens quickly. And I do this talk sometimes about that. I called what
happens in a second second, and let’s discuss about how that you talked about empathy and the in
grouping. And that really came from survival and evolution. But now we’re not the same as we were when
we were in little tribes and caves. And we’re more of a global people. How do you get there? Because it’s in
your DNA per-say. How do you get to the second, second where we can then all be one?
Dr. Helen Riess (27m 44s):
That’s really the $10 billion question? Isn’t it? You know, I think it’s so important to recognize that it’s not that
long ago, given human history, that we were often separated by mountains, rivers, oceans, where we never
saw people that weren’t like us. And if we did, it was usually an invasion or somebody who was going to
compete for scarce resources.
Dr. Helen Riess (28m 14s):
And so recognizing Other was crucial to survival and that unfortunate change where nothing separates us
now, you know, except COVID shut down, but we can travel anywhere. I see people that are totally unlike
us. The fact that the human brain is still so wired to perceive difference is a real challenge in our global
society. I do believe that the survival of our planet and our species is going to depend on seeing humans as
human period End of Story.
Dr. Helen Riess (29m 1s):
You’re a human, I’m a human and all of these labels and identities and all of these things that we attribute to
one another that separate us. We’re in a very critical moment in history where we have to challenge these
automatic fears, mistrust difference competition, and be. There are so many feelings that go with perceiving
otherness. So I do think it’s the question of our time.
Dr. Helen Riess (29m 32s):
And I think we’re at a level of national discourse about this that’s different than its been before because of
our great conductivity. We have all seen the, of George Floyd dying, these ideas that certain people deserve
tough treatment. Like we just can’t accept these things anymore. So our work is truly aimed at humanizing
everyone and to stop dehumanizing anyone.
Dr Orsini (30m 4s):
Tony Robbins talks about building rapport and defines it as a finding commonality between two people. And I
think that is where the key lies. But when I coach physicians on patient experience or I talk to people about
teach them how to build a rapport, it’s all about finding commonality. And although your tribal response would
be, that person looks different once you can understand that no matter what they look like or where they’re
from there is something in common.
Dr Orsini (30m 34s):
And that gets you into the second, second, if you will. And when I discuss how to improve patient experience
scores, the physicians, and how to make that a patient experience better in build a relationship with the
patient. It’s been shown that you can do that in 56 seconds. A lot of it is just as you spoke about eye contact,
posture mirroring, but it’s also finding commonality. And as a physician, I’ll walk into, I’m a neonatologist. So
they take care of babies. So its not the patient experience. So I’m looking at it’s a family experience, but a
walk into a room when a mother who’s very upset about her baby, be in the neonatal ICU.
Dr Orsini (31m 10s):
If that mother was upset and before I would just introduce myself, I can find at sometimes it will be a book on
the table or they’ll have a TV. Sometimes they’re upset about something that happened. Maybe they’re angry
about something that they can go well. And I see that they have in New York Yankees hat on where they’re
wearing a Yankee shirts, what are they have a 973 area code? What I call them on the phone if I can just
say, Oh my goodness, are you from New Jersey? Because I recognize this area code. It’s an instant bond.
And that’s what you were talking about In-grouping. So the in group might not be our group here.
Dr Orsini (31m 42s):
I think we could find it in group with anyone. Don’t you agree?
Dr. Helen Riess (31m 45s):
Sure. Hope so. I mean, I think one in the most powerful ways to find common ground, his people who have
suffered in similar ways, you know, so if you’ve been through a loss and you’re patients going through a loss,
you know, to say, I really get this, you know, I’ve been so close to this, myself and people who are in support
groups together, let’s say something tragic, like losing a child or a teenager in a car accident.
Dr. Helen Riess (32m 18s):
It’s amazing how quickly the difference is between those people disappear. They have what your calling
common ground like. So common suffering is an incredibly powerful bond and but it really does mean
exposing vulnerability, right? Yes. And that I think is the key. Like we’re all human. We all have our foibles.
We’ve all had our disappointments, our rejections, our trauma’s or whatever.
Dr. Helen Riess (32m 48s):
When we share these things, that’s what unites human to human. But if we stand apart in judgment or
superiority or whatever, that does not allow these human bonds to form.
Dr Orsini (33m 2s):
And if you’re a physician who’s speaking to a patient, the first thing you want to do, I use an acronym called
PROGRAM and the G is for a genuine, if you could show that patient, you’re not just a doctor, that you’re a
real person. I’m from New Jersey. You had a rough day because you’re five-year-old, wouldn’t go to
kindergarten. Then you got off to the late start or going on vacation. Well, where you going Dr Orsini? I’m
going to see Mike family. And the important thing is too for leaders, right? What’s the difference between a
manager and a leader, a manager doesn’t know how to communicate and convey empathy.
Dr Orsini (33m 34s):
Right. But a leader knows how to do that in the best bosses I’ve ever worked. They were real people. They
didn’t stand up on the top. And I think that’s, that goes back to that commonality. Right?
Dr. Helen Riess (33m 43s):
I would hope that there are a lot of managers with Empathy and I’m sure there are, but I think what you’re
saying is the managerial role might be just to get tasks done, but a leadership role is to build morale, you
know, inspiration and to connect people.
Dr Orsini (34m 2s):
Yeah, that brings you to a different level. That’s my point is that for the whole thing? So why is it so important
to have empathy in that we’re not changing our first second or those neurotransmitters are those tribal
instincts immediately, but back to the Empathy we can train. Empathy like you’re doing such a great job in
medicine and in business. And we can train people to be more empathetic, to be better communicated, to
find commonality than maybe we can go to that global, scene that you’re talking about because we can, it’s
going to take time to change our DNA, but we can fix The Second Second, very quickly.
Dr Orsini (34m 38s):
And I think that’s how this relates.
Dr. Helen Riess (34m 40s):
I really loved that idea of the first and the second second, because you know, Empathy is automatic in most
people. There are certainly some people who just don’t have it, but it’s the exception of the rule. Many
people feel empathetic and were able to shut it off. And especially if we’re tired, hungry, overworked,
overwhelmed, sick. That all interferes with expressing empathy.
Dr. Helen Riess (35m 11s):
And so I think it’s so important for the Physician and health profession audience to understand that Self
Empathy, which is the last chapter in my book. It probably should be the first one that if we don’t treat
ourselves with proper care, sleep, nutritious food exercise, if we don’t fill the tank, we are going to get
depleted and it will show up as burnout. And when we’re burned out, we tend to objectify people, refer them
by their, to them as their disease or their condition, you know, instead of the human being that they are.
Dr. Helen Riess (35m 53s):
So empathy is really a key input output, just like so many things. There’s an afferrent and efferrent. We’ve
got take good care or to put us in the best position to give good care.
Dr Orsini (36m 6s):
I think that’s a great way to finish this whole interview. Take care of yourself first, because we’ve all been
there before, where we get for a lack of a better word, grumpy and we lose our Empathy. We talked about
In-grouping and that we tend to have empathy towards people that are like us more than people that are
unlike us. So I think the solution to that is to find commonality and perceive everybody is like you, and it will
be easier to empathize. And I think the work you’re doing is just absolutely amazing in my small way, I’m
doing the same thing, but I really love the way you’re doing all the teaching that your book is phenomenal.
Dr Orsini (36m 43s):
Your Ted talk is great. What’s next on the horizon for you? You’re doing so much.
Dr. Helen Riess (36m 48s):
I mean, I think it, as you said earlier, we were in a very critical time in the world where we need empathy
more than ever. And you might be noticing it’s mentioned in the news, like almost constantly. The most
exciting new development is being approached by law enforcement to help police forces, to humanize many
of the situations that they find themselves in many, the challenges because our police are being called in to
take care of mental health issues, domestic violence issues, you know, violence issues and getting a cat out
of a tree issues like they are, they pretty much have to do everything.
Dr. Helen Riess (37m 29s):
And you know, many of them are being asked to take roles that they’re really not trained to do. So I see this
as an opportunity to really make a difference in how just everybody, every professional is trained to like
appreciate the human being in front of us and to bring our best to every interaction.
Dr Orsini (37m 53s):
I think it’s great that you’re starting to work at law enforcement. I in fact, come from a whole family of law
enforcement. I’m the only physician in my family. Everyone else is police officers as a retired police officer for
my father, my uncle, my brother, my cousins. And so I think the topic that we really have to speak about is
that self empathy for themselves because they talk about burnout. My father said to me, when I was very
little Anthony, my mother and father are only ones that call me Anthony, Everyone else calls me, Tony.
“There’s only two people in the world that have to be perfect doctors and police officers.”
Dr Orsini (38m 24s):
And he said that for many, many years. And I think that that pressure it’s something that needs to be
acknowledged. So that Self Empathy that you talk about is so important because you do get jaded and
physicians to the exact way. We have a highest burnout rate of any profession right now. And so taking care
of ourself, I think is really a great thing. So it’d be want to be empathic towards other people. You have to first
Dr. Helen Riess (38m 47s):
It’s called putting on your own oxygen mask first it’s we get this instruction every time we’re on an airplane,
but so few people apply it to self care. People think of self care as being selfish. Yeah, there are definitely
ways people are selfish, but attending to your own physical, emotional, and social needs is just critical to
being effective in the world.
Dr Orsini (39m 13s):
You love that analogy, put your own oxygen mask on before he can help anyone else. And that’s fantastic.
So Helen thank you so much for doing this interview. I can talk to you for hours, but I know you have to go. It
was really a great interview and you certainly inspired the audience because I think it’s going to make people
speak about Empathy more, the more we speak about it, the more we’re aware of it. The more we’re aware
of when our Empathy slides up in their slides down, we can catch ourselves finding that commonality, using
the great techniques that you gave us communication techniques with the eye contact in the Empathy
acronym is really going to help them.
Dr Orsini (39m 49s):
And I think, especially when you’re doing Difficult Conversations, which is what the name of this podcast is.
So I really wanna thank you for being here and I just love the work you’re doing and I’m just make sure to
see what your next big thing is with the law enforcement. I think that’s awesome.
Dr. Helen Riess (40m 4s):
And might be picking your brain about that.
Dr Orsini (40m 8s):
I don’t remember as a kid, someone who would say to me, who is a police officer or in your family, and I
would say my uncle three cousin’s father and grandfather’s then they say, well, why don’t you go into the
police Academy? My answer was I’m afraid of guns. So I decided for something easy, like to become a
physician. So it’s so easy, right? So, but thank you for all that work you’re doing. Thank you for being such a
gracious host and for taking the time to be out here and thank you for inspiring our audience. Thank you.
Dr. Helen Riess (40m 35s):
You so much for having me. It’s been a genuine pleasure getting to know you.
Dr Orsini (40m 39s):
Thank you. And I hope we can speak again sometime soon. If you liked this podcast, please go ahead and
hit subscribe. Go ahead and download all the episodes. You’ll see a new episode downloaded every single
Tuesday. If we need to learn more, please contact firstname.lastname@example.org and Helen, how can they contact
you? What’s the best way. That’s great.
Dr. Helen Riess (40m 58s):
Dr Orsini (41m 1s):
Okay, so please contact telling if you have any questions, if you’re interested in her training, its amazing in
go ahead and I hope everyone has a great week and I will be here again next Tuesday. So thank you again.
Have a great day care. If you enjoyed this podcast, please hit the subscribe button and leave a comment in
review contact dr. Sini.