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A Life with Purpose with Gunnar Esiason

Gunnar Esiason (1s):
You really suck at football, you the worst player I’ve ever seen in my entire life. I think I think I was just so unbelievably shocked when I heard that, that I didn’t know what to do. Like I thought we were gonna be talking about my CF. Now, all of a sudden I’m getting criticized for my athletic ability and I just don’t know what’s going on, but really what my dad was doing and maybe not the most poetic way was getting my mind off of this one dream that I had and shifting it to everything else that I had going for me in my life. Despite my CF, I had to think about college, I had to think about my winter hockey season, my senior hockey season. And in a lot of ways, he probably was right.

Gunnar Esiason (42s):
I was probably better hockey player than I was a football player. And it was really more of a conversation about being aggressive with my cystic fibrosis care because there is no other way to treat for CF. There is only one way it’s to be aggressive. And that’s what I took away from that.

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

Dr. Anthony Orsini (1m 45s):
I am honored today that the Orsini Way has partnered with The Finley Project to bring you this episode of Difficult Conversations: Lessons I learned as an ICU Physician. The Finley Project is a nonprofit organization committed to providing care for mothers who have experienced the unimaginable, the loss of an infant. It was created by their founder, Noelle Moore, whose sweet daughter Finley died in 2013. It was at that time that Noelle realized that there was a large gap between leaving the hospital without your baby and the time when you get home. That led her to start The Finley Project. The Finley Project is the nation’s only seven part holistic program that helps mothers after infant loss, by supporting them physically and emotionally, they provide such things as mental health counseling, funeral arrangements, support, grocery gift cards, professional house cleaning, professional massage therapy and support group placement.

Dr. Anthony Orsini (2m 39s):
The Finley Project has helped hundreds of women across the country. And I can tell you that I have seen personally how The Finley Project has literally saved the lives of mothers who lost their infant. If you’re interested in learning more or referring a family or donating to this amazing cause please go to The Finley Project.org. The Finley Projectt believes that no family should walk out of a hospital without support. Well, welcome to another episode of Difficult Conversations Lessons I learned as an ICU physician, I am Dr. Anthony Orsini, and I will not be your host today. For the first time today, we have a very special host and a very special guest. For those of you who are familiar with our podcasts or familiar with the Orsini Way, you already know Liz Poret-Christ.

Dr. Anthony Orsini (3m 26s):
Liz is our director of programming. She’s been on the podcast as a cohost before and as a guest and Liz has a very personal relationship with our next guest. And so I’m going to introduce Liz Poret-Christ, and then let her take over as the host. So go ahead, Liz.

Liz Poret-Christ (3m 42s):
Thanks Dr. Orsini. I’m so excited to be the host of today’s podcast, and I’m so excited to introduce our next guest. Gunnar Esiason is the son of former NFL quarterback, Boomer Esiason. And is well-known for his life long battle with cystic fibrosis. Boomer and Gunnar appeared on the cover of sports illustrated In October of 1993, to raise awareness about cystic fibrosis. He has spent his entire life in the public eye. First as a child of a famous athlete and now as an advocate and resource for those living with CF. Gunnar is a rare disease patient advocate who is passionate about early stage drug development, patient empowerment and health policy.

Liz Poret-Christ (4m 22s):
Professionally he has developed a patient engagement platform for a medical nutrition company, built a venture philanthropy practice at the Boomer Esiason Foundation and was the head coach of his high school alma mater’s varsity hockey team. He has consulted on clinical trial development, real world evidence population health study, and a cystic fibrosis specific mental health and wellness screening tool. Gunnar has been the face of fundraising efforts for the Boomer Esiason foundation, which is yielded more than $160 million raised for the fight against CF. His blog has amassed nearly 1 million page views since 2015, Gunnar is presently working towards a master of public health at the Dartmouth Institute for health policy and clinical practice.

Liz Poret-Christ (5m 8s):
He holds an MBA from the Tuck school of business at Dartmouth and a BA from Boston college. During the Corona virus, pandemic Gunnar was a leading voice in equitable vaccine access for people with underlying health conditions. His health policy opinions have been featured in the wall street journal USA today, the hill and stat news, his podcast, the State of Health is available on all streaming platforms. I must confess that Gunnar has been a household name in my family for the past 18 years. As my daughter Annabelle was diagnosed with cystic fibrosis in 2003, I feel that Gunnar’s own experiences and the mission of the Boomer Esiason foundation have paved the way for us as a family And we’re grateful for his willingness to put himself out there.

Liz Poret-Christ (5m 55s):
We certainly have benefited from that generosity, learning about treatment options, the importance of athletics and insights into the latest medical research. Although there was one blog post about doing a funnel through his G-tube that I may or may not have turned into a cautionary tale, but I digress. The most important accomplishment for Gunnar may be the most exciting one yet. Any minute now, Gunnar’s beautiful wife Darcy is due to give birth with their first child. Welcome to the show Gunnar. We are so excited to have you on.

Gunnar Esiason (6m 24s):
Thanks, Liz. And thanks, Dr. Orsini I really appreciate the opportunity to talk. And yeah, I will caution the listeners that if I have to leave at a moment’s notice we’re expecting an eviction from my wife at any moment.

Dr. Anthony Orsini (6m 35s):
That is very cool Gunnar, do you know what you’re having? Is a boy or a girl?

Gunnar Esiason (6m 38s):
We were having a boy. We were having a name picked out yet, or you want to wait for the big redo. The name is top secret and the name will be revealed probably in the next 10 or 15 days.

Dr. Anthony Orsini (6m 47s):
I thought we were going to get a scoop.

Liz Poret-Christ (6m 51s):
Our promise each week to the audience so that the learn important communication techniques and gain valuable insight and how to lead conversations with compassion. So let’s get into it. People may think that they know who Gunnar Esiason is, but who are you really Gunnar? Can you tell us something maybe that the public doesn’t know or how the journey to get you as this incredible pinnacle of time being my first Guinea pig podcast guest?

Gunnar Esiason (7m 18s):
I appreciate the question who has Gunnar Esiason? I can tell you first and foremost, that I hope that I am remembered for being an excellent father first and foremost, that is my new goal in life. It’s a goal that, you know, I’ll be honest. I’m not sure I ever had that goal for me, considering where we were with cystic fibrosis, not so long ago, but I think that’s the way to describe who I am is patient advocate, friend, son, husband, student, lifelong learner, and someone who is passionate about the rare disease world. People living with rare diseases and especially those who still have medical needs and fight the good fight every day. Like, you know, Liz, our families know all too well.

Liz Poret-Christ (7m 57s):
Wonderful. So no secrets, no things people don’t know I’m going to push you a little bit. Wow. What a hidden talent.

Gunnar Esiason (8m 4s):
Wow. I hidden talent. Okay. Well I, because you already brought it up. I do own the fastest beer funnel of the history of Boston college and the way it happened was as some people with CF do know all too well, I had a feeding good place when I was a sophomore in college. And it’s this, this is a podcast about conversations, especially inside the healthcare settings, as the good doctor knows all too well, critical information just happens to always be conveyed as patients come out of anesthetic hazes. And I came out of surgery after my G-tube was placed. And I was told a critical information about feeding tubes. And this is how you clean. It is how you going to clean the wound. This is what you should do to care for it. This is what you shouldn’t do to care for it. And do you have any questions? But of course, because I was kind of loopy and coming out of it, I asked the nurse, I was like, well, can I put a beer through my feeding tube?

Gunnar Esiason (8m 51s):
I am in College? And the nurse kind of laughed it off, said that I wasn’t the first one to ask her, believe it or not. And left it at that the, without any, you know, yes or no. And believing that conversation any in some gray area, I decided to put it to the test about a year later. And my junior year at Boston college, if anyone’s lived in the city, Boston or knows what the college life is like up there, they know there’s a lot of cold nights. And one night in particular, when our goal is just to get down the street to the bar, morale among the troops was pretty low inside our dorm room. And I decided to put it to the test. I walked into my bedroom, grabbed a funnel, read my feeding tube extender, and I grabbed a Natty light. You may ask why natty light it’s because I was on a college budget at the time. And there you were funneled the beer, right?

Gunnar Esiason (9m 31s):
For my son to the shock of some brand new friends sitting in the room that night. But I think one of my really good buddies put it best in say, or you’ve been given a gift. And I said, max, I don’t know if I would call this a gift, but it’s a great little party trick that I haven’t done since simply because I, that beer came right back up two hours later.

Dr. Anthony Orsini (9m 50s):
This is a public service announcement do not try this at home.

Liz Poret-Christ (9m 55s):
No funnel through your G-tube. Okay, well, we’re off to a fabulous start. You’ve talked a lot about how your family has played in your success and how illness is more of a family affair. And you’ve been very candid about that. Can you talk a little bit about how cystic fibrosis has affected your family and do you feel that it’s defined who you are?

Gunnar Esiason (10m 17s):
Yeah, it’s another great question. Simply because I consider care for cystic fibrosis and Liz you know this to be active and arduous. For listeners at home who may not really know a cystic fibrosis is, but it’s classically associated with progressive respiratory disease and treating cystic fibrosis requires nebulization inhaled steroids and mucolytics antibiotics. And of course the physical therapy that goes along with clearing our lungs. From a very early age, my parents realized that the best way to get me to remain compliant and adherent with the really arduous care routine was to make it a social event around the house. So from a very early age, I never did my treatments alone. And the way my parents sort of came across that realization was I was about four or five years old watching Thomas the tank engine, of course, one morning.

Gunnar Esiason (11m 4s):
And my dad came in to set up my treatments and put the nebulizer mask on my face and then walked out of the room only to hear me cough and then had like a little bit of a come to Jesus moment. Like, oh my God, I just left Gunnar in there by himself to do his treatments. You know, that’s not right. Like I have to go in there and sit by his side to reaffirm to him that he’s not doing this alone. And from that day forward, my treatments were always a social activity, right. My parents set up my treatment station, my treatment cart, the central part of the house, whether the TV room, the family room, whatever we want to call it and believe it or not. Whenever I had little play dates as a child, whenever someone new would come over to the house, my parents would just throw my treatments on me right then and there just so my friends could see what it was like to live with cystic fibrosis, what cystic fibrosis meant to be on a daily basis.

Gunnar Esiason (11m 48s):
And it was important, right? Because it got me comfortable about having CF in front of other people in front of new people. But it also led me to believe that, yeah, my CF health is directly correlated with the other things going on in my life. I could go to school, I could play sports. I could have friends over, I could have family dinners. I could do all of these things if, and only if my health would allow me to do so.

Liz Poret-Christ (12m 14s):
It’s amazing. So I heard your dad came to our local children’s hospital. Probably not very long after Belle was diagnosed. And he told a similar story and that’s what we did in our family too. So when Belle would sit down for her treatments, my husband would go in and they would watch American gladiator and professional bull riding and monster trucks. And to this day, she looks at all of those things so fondly because it was family time and somebody was always in the room with her. And when I say that, the way your family handled things paved our way. It’s not untrue. That was about 10 years younger than you. I think you got your G-tubes around the same time. And I really felt like we were on this journey all together, which when you have a chronic illness and you feel alone a lot of the time, it’s so comforting to know that there’s other people and for your family willing to put themselves out there and show others how to do it well.

Gunnar Esiason (13m 9s):
Yeah,,I think you’re absolutely right. And I think that there certainly is value in the connections that my family were able to make together. Right. It was extra additional time in the day when our family was sitting together. I think so many families look forward to the dinner table conversations and the things that are sort of revolving around the brief period of time when everyone’s either done with school done with the work day, whatever it is, bonding over a meal for us, you know, I feel like we thought it was a little bit of a, an additional bonus period of each day, where we got to spend time as our family unit together. Of course, as I grew up and got older, you know, as my teenage angst took over, I don’t need any of my hawkish parents to be on top of me all the time.

Gunnar Esiason (13m 51s):
And I was happy to sit there with my sister, but I think in those early years, it was definitely pretty formative for me, especially, but also for my sister Sydney, who we still remain very close to this day, although we no longer live under the same roof, it really kind of gave us time to bond early in life.

Liz Poret-Christ (14m 8s):
Do you feel that during the pandemic, when everyone was stuck in their houses or learning about masking in isolation, did you kind of feel like we felt in our family like, oh yeah, we do this all the time. This isn’t that big a deal it’s everyone’s doing what we do. Did you kind of feel the same?

Gunnar Esiason (14m 25s):
It’s funny you say that because I actually reconnected with someone that I hadn’t talked to in a while and I’m noticing the last text messages I had sent to her was a photo of me traveling in February, 2020, right before the pandemic sorta like over it took the entire world. And there I was traveling with my wet ones, my mask and bottle of purellL that as any flight I’ve ever taken over the last 10 years, I’ve wiped down the seat I’ve had purell, I don’t touch anything. And I warned and N95 masks whenever I flew. So I felt like I was an early adopter, but yeah, I definitely noticed a lot of parallels between the contact precautions that suddenly everyone had to learn how to deal and what I’ve, what I’ve been to, what your family has been living for the last, however many years, maybe a little bit of a current joke.

Gunnar Esiason (15m 8s):
But I think back in the world, shut down in March or April of 2020 talking with my dad, of course, over FaceTime. And then he was like, maybe it’s a way to calm me down. He’s like, this is your Superbowl. This is what you’ve been preparing for your entire life. And staying safe from some sort of infectious pathogen. Cause that’s such a big part of cystic fibrosis is any virus, whether it’s a common cold, the flu or whatever, threatens to be, life altering and cystic fibrosis. So there’s really no difference in the way that I was operating on a day-to-day basis. Of course, maybe with some more urgency back in April that time when I think we all kind of thought the air was poisonous and I recalled him, my wife the other day, thinking back about the time when she was like in the middle of the Vermont countryside with like no one miles of returning my ski rental for that season.

Gunnar Esiason (15m 51s):
And there I was wearing in N95 mask and hospital gloves out in the middle of like the Vermont wilderness, like putting my skis into a return basket with no one to be found. So it was definitely a different time for sure. And there was certainly some urgency, but I felt prepared because of my CF, for sure. I’m sure your family get as well.

Liz Poret-Christ (16m 6s):
We did. I was recently in Costco with my kids before they went back to college and we went down the Lysol and wipe Aisle and my kids were like, mom, look, it’s your favorite aisle! I’m like, okay, fine. I admit it. And I was like clutching my three pack of Lysol going like the score of the century. So they’ve been making fun of me about that for a long time. So they’re like, mom, you’re already good at this. I recently read somewhere that you were headed for law school when you were getting out of college.

Gunnar Esiason (16m 37s):
So yeah, Dacry my wife loves to poke fun at me for my dream of wanting to go to law school when I was an undergrad. She’s like, I can’t believe you want it to be a litigator. I came up with that was your dream. And I can’t believe it was my dream either. But back when I was finishing up at BC, I did, I was preparing for law school. I was preparing for the L sat I was preparing to apply. Then that’s when my health really started to kind of collapse on me. And it became quite clear pretty quickly that I was not going to be able to do it. But by the time I was ready to graduate from BC, I saw graduation really as kind of like a finish line because I knew that I needed to start taking my health even more seriously than I already was probably one too many nights with the funneling a beer through my feeding tube.

Gunnar Esiason (17m 21s):
But I do feel like I was in a need of stabilizing my health. It got to the point where in 2013, when I think I wason and off IV antibiotics in and out of the hospital every other month, if not more frequently. And for those who don’t know what, you know, one of the biggest parts of cystic fibrosis care is that we are very aware of the drug resistant bacteria that lives in our lungs. And with every time that I was using antibiotics to treat that chronic infection that I have, you know, you’re sort of dancing with the devil and you’re making the bacteria even more and more resistant, you know, first, second and third line antibiotics. So I was in a pretty rough spot in my trinity go to law school quickly vanished. And I sort of started to shift my thinking towards, okay, well, how can I maintain having patient advocacy impact in cystic fibrosis in rare disease while also being so, so sick.

Gunnar Esiason (18m 11s):
And I think as anyone who’s ever dealt with, you know, the American healthcare system worried with the global healthcare system, like there’s just so many complexities and nuances that go along with it, that it’s just so important to be aware. And I dove in and started to learn about all the different nuances and policies of care delivery in the US from the basic science of cystic fibrosis, to how hospitals operate to billing operations, to insurance, coverage, health care, coverage benefits, all that goes into patient care. And it really illuminated to me some of the really dark and scary sides of American healthcare system, but also really works quite well. And one place where it worked quite well is the rapid advancement of clinical trials, clinical research in our CF care centers.

Gunnar Esiason (18m 55s):
And I jumped into clinical trials as sort of like my way to feel like I was doing something despite my very severe illness. And I learned a very important lesson in that first clinical trial that I enrolled into. It didn’t work, but that doesn’t mean failures are all a loss, a major loss in clinical research. I almost think failures are the wrong way to categorize the outcome of a trial. But my key learning was that within a rare disease population, patients don’t really have the ability to say no to opportunities, right? Patients are our finite resource that exists inside an ecosystem that requires them to play a bigger role than ones that they may be willing to give initially. And it’s because the only way you can advance the understanding of a disease is by actually allowing yourself to be part of clinical research, to understand what drugs are gonna work, what drugs are going to work and where the very finite number of dollars available for that disease should be going.

Gunnar Esiason (19m 45s):
So that was a key one that I had early on. And it was one that sort of filled that void that I think my desire to go to law school sort of left.

Dr. Anthony Orsini (19m 54s):
I have a question. You mentioned patient advocacy a lot. You mentioned patient experience. You talked about clinical trials. I know from Liz’s point of view, nobody’s been through the system more than she has and you and Liz, and I go around the country, teaching hospitals, how to improve that patient experience. We’re real patient advocates, communication. Well, you’ve seen it all. Tell us about what the patient experience and why you’re so excited about the patient advocacy. I mean, you’ve probably seen the best and the worst in your time.

Gunnar Esiason (20m 23s):
I think the health care system is geared to seeing patients wrongly as implicit benefactors of the system that we are just along for the ride and believe me, there may be some people that certainly are, but I think there’s value in really being an engaged patient and understanding what’s happening around you while you’re inpatient or while you’re dealing with outpatient or routine care, because things happen so fast. Imagine for a moment that you’re sitting in a doctor’s office, waiting for the doctor to come in, oftentimes, you know, for that individual patient, like that’s the pinnacle of the day, your they’re waiting for however many hours to have that 15, 25 minute conversation with the provider.

Gunnar Esiason (21m 7s):
Whereas the provider is just sort of going through the assembly line of visit, visit visit. So immediately there’s a disconnect and it’s sort of a dichotomy of an experience that’s happening for the patient and also the provider. And I think in some ways that disconnect can lead to a fast flying conversation, things are left out. Things are considered preference, sensitive care isn’t necessarily on the forefront, on the tip of everyone’s tongue at the top of mind for everyone not to mention the anxiety that goes along with living with chronic terminal illness can also sort of lead to what I consider to be like a false imbalance that exists during clinical encounters and some ways that’s probably the place that needs the most improvement in care delivery is really seeing eye to eye with the patient and understanding what their needs, desires and goals are not only with their health, but also outside of their health.

Gunnar Esiason (21m 56s):
Because I think of every part of my life as a function of my health, I can do the things that I want to do when my health is managed and I cannot do the things that I want to do when it’s not managed. So it’s important for my providers to know exactly what I’ve got going on in my life. And I’ll give an example of what I’m dealing with right now, right? My health is very stable. Things are going well in cystic fibrosis. We’ve had a number of drug breakthroughs that allowed us to get there. And I’m sure we’ll talk about that in a bit later in the podcast, but because I’m expecting a pretty serious life event coming up with the baby, I’ve added on additional supportive care, just to get me going to the point where I know that I will be comfortable to operate in an environment where I can imagine I won’t be sleeping very well. A so those are the things that are long-planned out with my providers, with my doctors.

Gunnar Esiason (22m 40s):
And those are conversations that I think people with cystic fibrosis are used to having some forward thinking or scenario planning with providers, where people who do not have chronic illness, do not think that way. As soon as they enter the care system and it’s complex, it’s something that requires training. It requires a skill and it requires seeing the bad sides of the health industry as well. And I can think of a number of cases where I’ve been inpatient. I have a history of hemoptysis offices and there comes a nurse at me with a, a heparin pen because that’s standard operating procedure on the ward. Last thing I need is a, you know, a blood thinner when I’ve got a history of hemoptysis. So there’s a lot of nuances and complexities that sort of swirl around a hospital floors and hospital systems, my learning and my answer to your question at a very high level is just understand what’s going on around you be constantly aware, and boy, does it help to have someone sitting in the hospital room with you that knows what’s going on and what you need best as well, whether it’s, you know, a caregiver, a parent, you know, I’m sure Liz, you’ve probably had a number of tough conversations with the providers.

Gunnar Esiason (23m 40s):
Like my mom has it more recently, it’s been dark, dark. She’s been running a more one care provider inside the system. That’s my go-to person.

Liz Poret-Christ (23m 49s):
That’s really interesting, how of a shift was it for your mom to give up having that conversation? I was once walking past Belle’s room. I think you guys were on a zoom call and I heard you making fun of the CF moms, but in the most loving way, like, oh yeah, we know about those CF moms because the mama bear feeling takes over and you’re not willing to let anybody in. So it must be a little bit hard for her to transition, to let Darcy do it.

Gunnar Esiason (24m 13s):
You’re right. Belle and I have had a number of zoom calls because of her involvement in the Foundation and she’s a wonderful person. And I think everyone knows the CF mom as like a catchall phrase as the biggest fan for every person who has CF. I can’t say I’ve never met a CF mom who does not share a number of qualities that my Mom also has. And I think you’re right. I think it’s a hard thing to let go for parents, not just moms, but also my dad as well as constantly as to letting the CF patient, the person with CF or whatever chronic disease operate on their own. And I always kind of have said leaving pediatric care and going to adult care was one of the most liberating experiences of my life, but also one of the scariest feelings and moments of my life, because all of a sudden the middleman was cut out.

Gunnar Esiason (24m 60s):
The middleman in my case was both of my parents, maybe the it’ll neck and then a woman it’s because all of a sudden the responsibilities of my cystic fibrosis care from the pharmacy calls, insurance claims, scheduling, whatever was suddenly laid upon me. And I think it’s part of growing up, but it’s a hard transition, but I will say my mom trained Darcy to the best of her ability and Darcy my wife, and it’s been a great transition and I’m pretty sure they’re in cahoots behind my back about how I feel and what’s going on in my life.

Liz Poret-Christ (25m 31s):
Well, since this show’s about communication, do you remember a specific conversation that really made you stop and say, there’s gotta be a better way for this to go on. And can you tell us a little bit about what that conversation was?

Gunnar Esiason (25m 43s):
So back in 2013, when I was very sick and I was going in and out of that hospital or in and out of different health events and I was going from one pulmonary exacerbation to the next one, my symptoms were just like constantly flaring my doctor at the time. So I knocked shaped by the way, she’s a wonderful person, really great. And I had a hard conversation, right? And it was something to the effect of, well, we may have to come to grips with this is what your life is going to look like in the near term. And I know it’s not easy, but the truth is we’re running out of the antibiotic options and it was realistic. It was painful. It was hard, it was the truth, but that all said it was something that I did not want to hear. I was 22 years old thinking that I should be in the peak of my life, you know, right out of college should be making money, should be having a job.

Gunnar Esiason (26m 28s):
But there I was living just like I was in high school and I could not get out of this very ugly and probably deadly cycle that I was in with my health. It was not something that I wanted to hear, but it really grounded me and put me in a position to think about, well, this is it. Like, what am I going to do with the time that I have left? And it really made me double down and think about my future that I may or may not have. Right. It really brought me down to earth. And I still think about that conversational on it. It’s humbling in some ways, because it shows me what I’ve come from. And you know, this is really eight years ago now. So it’s been a long time since that conversation sort of first came to fruition, but it also opened the door to my competitive side where I was sort of feeling like, you know, I wasn’t going to have this.

Gunnar Esiason (27m 14s):
Maybe that’s something that came from my dad. This is a competitive streak that is certainly ingrained in my DNA. And that’s sort of what opened the door to me, thinking about it, stabilizing my health so that I could enroll in clinical trials, stabilizing my health so that I could have the beginnings of some career, whatever that might look like. And in a lot of ways, it really lighted a fire underneath me to think more about my health, not just the day to day scenario as that’s kind of how I had been living, but more of a long-term six months at a time goal where I could break myself out of that cycle. You know, I remember thinking back then when I was experiencing an exacerbation, maybe every other month, my goal initially was, well, let’s have a pulmonary exacerbation every four months or every five months just to stray some good weeks together.

Gunnar Esiason (27m 60s):
And that’s kind of how I reacted to it.

Liz Poret-Christ (28m 2s):
So then Trikafta comes into the picture. Right. And for those of you that don’t know, Trikafta is a new medication for certain people with cystic fibrosis, not everybody. And that for many people has become a very life-changing life altering opportunity, I would say. So tell me what the timing from 2013, when you were so sick, when did the try Trikafta trial happen?

Gunnar Esiason (28m 26s):
So I was fortunate enough to get a spot in the Trikafta clinical trial program in 2018. I think I became a good clinical trial patient because as we see it, there’s two resistant mutations that go into a cystic fibrosis diagnosis. I’m a heterozygote, meaning my two mutations aren’t the same ones. One is quite common. The other one is pretty rare. So I kind of make a good clinical trial participant given my somewhat rarity, what that second mutation that I have. And I went through a trial programs for Orkambi in 2013, and then Symdeko in 2015 and 16, wherever it was both failed for my take your genetic profile on CF. And I think looking back a day, we kind of, it was like a flip of the coin. Like maybe it would work, maybe it wouldn’t work the drugs do in fact work for you about 40 or 50% of the population.

Gunnar Esiason (29m 11s):
You know, people who have two copies of the most common genetic mutation. So they were a proof of concept that the drug maker was on the right path to at least rescuing CFTR for the broader parts of the population, Trikafta trial started in 2018. And it was, I can still remember the day, April 9th, 2018 is when I enrolled and dosed the study drug. Of course it was a blinded trial, you know, half the population got the placebo and the other half got the live drug. And I can tell you that after 12 hours, I knew I had the real drug because all of a sudden my oxygen saturation, which was at a baseline of about 90 to 92%, suddenly peaked at 99% for the first time in my life. And it was amazing to watch it happen. But of course you don’t get your hopes up.

Gunnar Esiason (29m 52s):
Like this is too good to be true. But three days later, I couldn’t deny it. When my cough suddenly went away, my cough disappeared. My energy came back. I started putting on weight almost immediately. And then two weeks later when I was back from my first visit, my pulmonary function skyrocketed. And if you’re looking at a scale to determine the severity of disease, I would say that I’d probably started the trial at severe cystic fibrosis and ended the trial a year and a half later at mild and moderate cystic fibrosis. I mean in no small way has Trikafta transformed and changed my life. And the best way to describe what happened to me was actually during a men’s recreational ice hockey game, the listeners out there may not know that although my dad had a great NFL career his real love, is ice hockey.

Gunnar Esiason (30m 34s):
And when you play ice hockey together, or we did, when we lived in New York for many years, when I was very sick, I would still play. And, you know, trying to get out there maybe 10 or 15 times a year and try to skate up and down the ice and get off and catch my breath and then go back up or a quick shift. And I would just cough, cough. Cough was really uncomfortable experience for a number of years, but that first game after I started on the study drug, it was like a parachute had been flipped off my back. And I was feeling young. Again, I was out there on the ice for, you know, minutes at a time, not coughing breathing deeply to the point where my teammates and my dad were just so completely in awe of what had happened. Like what the hell is happening to Gunnar.

Gunnar Esiason (31m 16s):
That’s when I realized that triple combo was well, was now called Trikafta. But at the time we called the triple combo is the real deal. It was something that suddenly showed me that my future was unlocked after so many years of hard living from 2013 to 2018. When I started the trial, I underweight almost two dozen medical interventions hospital-based care, and it was a hard way to live, but I suddenly had to realize that, wow, I’m healthy again. And it wasn’t until my now wife and I took a road trip. I put her in the car and I was like, we’re going to us and civil war battlefields and big history buff. And she sat along like the trooper that she was the one compromising made was that we had even an old time photo at Gettysburg.

Gunnar Esiason (31m 56s):
And we were touring the Gettysburg battlefield on segues. So I compromise there, but on the way, home from the trip, we were sitting in traffic on the Jersey turnpike. I’m sure you both have been there many times. And she asked me, pointedly is about six months after the trial began. Well, what do you want to do with the rest of your life? And it was the first time that it dawned upon me that I would be able to think about that. Then it was a great, amazing conversation to have. It’s what led me to grad school and to us getting married and, and now expecting a baby in a few days.

Liz Poret-Christ (32m 29s):
That’s amazing. So we ask every guest the same question. Has there been a type of conversation or a conversation specifically that you’ve found the most difficult?

Gunnar Esiason (32m 40s):
Yeah. I can think of a few that have been tough, but one sticks out in particular. I was a senior in high school and like my dad, I wanted to be the star football player on our local high school team. Like that was my goal. Growing up, I started playing high school football as most kids do that. It was kind of thrown right into the knee grinder and they got to make it through those summer workouts through JV years and then work their way up to varsity. And I did that. I had paid my dues and by the end of my junior year of high school, I took over as the starting quarterback of a team. I had a lot of games. I throw a touchdown pass, ESPN covered it. Like it was one of those classic kids overcoming the odds kind of stories that they loved to show on ESPN on Saturday morning.

Gunnar Esiason (33m 22s):
It was a really cool thing. I was riding really high. I was excited. I was looking forward to my senior year when my friends and I were going to be able to play together. And that summer between junior and senior year, I got mononucleosis, which was probably the first time in my life that I experienced declining CF that we couldn’t control. And it was eye opening in the sense that, okay, wow, this is real. Whatever we’re doing is not working. We just kept trying and iterating with our care plan and trying to figure out how to get control of my declining lung function. But while that was going on, I was still trying to work out. I was doing summer practices. I was doing everything in the background that I had been doing in years prior because I was geared up to being the starting quarterback my senior year.

Gunnar Esiason (34m 10s):
But by the time training camp rolled around, it was quite clear to everyone that I was not who I once was. I lost a ton of weight over the summer. I couldn’t keep muscle mass on workouts were just really hard on me, distance runs or sprints or whatever. I was always towards the back of the pack. And it became quite clear that it just, it wasn’t gonna work out. And as we sort of went into the second or third week of practice, I was no longer taking snaps with the starting line up and all that stuff. But now the competitive streak in me just kept pushing me, kept pushing me as hard as I could go until one day we were doing sprints. We were doing conditioning workouts at the end of practice. And I actually collapsed on the field and I was down on my back and everyone’s worst nightmare was coming to fruition.

Gunnar Esiason (34m 52s):
All my teammates that I had CF every once, when was that I had CF, there was no secret. I kind of came to with my entire team sort of standing around me. Like they had all just seen a ghost, new trainer. The coaches are running over and I brushed myself off, pick myself up. I looked down and my entire Jersey was covered in blood. I had a massive hemoptysis right there on the football field. And when I came to, and of course, everyone’s terrified. It’s like I said, the worst everyone’s worst nightmare coming to fruition. And I said, I can breathe. Like everyone just I’m trying to be the adult here, everyone relax. And I said, just call my mom. She’ll know what to do. Don’t call an ambulance, just call my mom. So we quick, got my mom on the phone. And she said, I’m coming in.

Gunnar Esiason (35m 32s):
We’re going to go to the doctor where you you’re rushed right into the CF center at Columbia. And we had what I considered to be one of the most difficult conversations I’ve ever had, where my doctor very plainly said to me, you know Gunnar, I don’t think you can play football this year. It’s just not going to happen. We have to get control of whatever’s happening to you so that you can think about everything else. Like there’s nothing else to think about right now. And I was crushed. I had been looking forward to one thing, my entire life being the starting quarterback of my high school football team. And in a matter of minutes, it was taken away from me and my doctor basically laid out a care plan that was going to be truly intensive and incorporate bronchoscopies.

Gunnar Esiason (36m 19s):
And long-term IV antibiotics and continued follow-up and things that would make it unsafe for me to continue to compete. because my body was going to go under a lot of medical trauma as an addition to whatever else was already happening with accelerating disease. And it was sort of laid out as if I had the choice. Like I had to give the green light to let it happen. And she said, go home, talk to your parents and let me know in the morning what you want to do. So I was on the verge of tears, the entire car ride home. My mom called my dad and my dad was coming from work and be ready. Gunnar needs to have a conversation with you when you get home. So I kind of moseyed on into the, you know, the study or the office that we had and my childhood home and my dad and I had a sort of like a one-to-one conversation and the way he kind of broke the tensity was he started the conversation by saying, you know, like there’s something that I’ve really needed to tell you for a long time and I haven’t done it quite yet.

Gunnar Esiason (37m 14s):
And it’s just that you really suck at football. You are the worst player I’ve ever seen. And I think I was just so unbelievably shocked when I heard that, that I didn’t know what to do. Like I thought we were gonna be talking about my CF and now all of a sudden I’m getting criticized for my athletic ability. And I just don’t know like what’s going on, but really what my dad was doing. It maybe not the most poetic way was getting my mind off of this one dream that I had and shifting it to everything else that I had going for me in my life. Despite my CF, I had to think about college. I had to think about my winter hockey season, my senior hockey season. And in a lot of ways he probably was right. I was probably better at hockeythan I was a football player.

Gunnar Esiason (37m 58s):
And it was really more of a conversation about being aggressive with my cystic fibrosis care, because there is no other way to treat for CF there is only one way is to be aggressive. And that’s what I took away from sort of two very different kinds of conversations talking about the same exact thing. And the next morning we called the doctor said, okay, green light. Let’s get going with this care plan and get this under control.

Dr. Anthony Orsini (38m 18s):
I love the way he kind of redirected the whole conversation and use a little humor and a little hard love. And I think point via the let conversation. Well, I think,

Gunnar Esiason (38m 25s):
Yeah, I mean, he, he probably could have been a coach and maybe in another life, he would’ve been a coach.

Dr. Anthony Orsini (38m 30s):
That’s great. Got it. I want to ask you about the Foundation and what the foundation dealing with athletes, why your dad started, how old were you when he started? When did you take over?

Gunnar Esiason (38m 41s):
So I was diagnosed in 1993 at age two foundations started right then and there. I think my dad recognized that he then my mom recognized that they had a responsibility to do something not only for their son, but also for cystic fibrosis, this community that they were suddenly thrust into. And the truth is that actually prior to me being diagnosed, my parents had been big fundraisers for cystic fibrosis in Cincinnati because my dad was friends with Frank Deford, the sports writer who lost his daughter to CF. So my parents in some maybe weird twist of fate where they’re involved in cystic fibrosis, even before I was diagnosed. So they knew what to expect. They knew enough about CF, but they never imagined that I would live with it obviously, but they felt like they could do something about it since then.

Gunnar Esiason (39m 26s):
The foundations raised about $160 million in the fight against CF. And initially the money went sort of to the cystic fibrosis foundation’s therapeutics development network and the path for sure through that because the CF foundation has so much tremendous success and financing, drug development, and sort of turning itself into a venture capitalist and sort of creating such an amazing endowment strategy. And we, as a foundation had had this sort of pivot what we’ve done to support, and we realized that patients were sort of still being left out, hung out to dry, right drug development takes a long period of time. So we to think about patients in the here and now, so that they can be around and be successful until those new drugs come to fruition. So we spent a lot of time thinking about how best to assist patients in the here and now we provide scholarships for people with cystic fibrosis going through undergrad and graduate degrees and provide transplant assistance grants for people who are at hat stage of theillness.

Gunnar Esiason (40m 22s):
We have provided disaster relief funding for families, sort of not long after hurricane Harvey, just completely uprooted, Southeastern Texas. We started providing assistance for displaced CF families as a result of natural disasters. And then unfortunately recently we’ve had to also open up a COVID-19 economic relief program, but for CF families that have had to make the difficult decision of do I go to work and risk exposure to the virus or do I stay home and protect my CF family? So those are things that we take very seriously and things that we do a lot of work with. We also do a lot of patient advocacy and we recognize that both my father and I, and we have great tremendous platform. And then we were very thoughtful about that platform and we use it to advance cystic fibrosis issues, concerns causes like healthcare access preserving the drug development that exists in cystic fibrosis, equitable vaccine uptake was also another thing that we worked under the pandemic.

Gunnar Esiason (41m 11s):
Do you remember back in the early parts, depending on if near rationing care and maybe unfortunately some of our hospitals are still doing that. We were talking a lot about making sure that cystic fibrosis patients weren’t discriminated against and could access continuing care. Recently, we’re talking a lot about preserving the tele-health that has emerged during COVID-19. I’ve always kind of felt that there’s no reason to ever put a CF patient in harm’s way for a hospital acquired infection. Why not transition that care to being remotely? So a lot of those issues are things that we think about and talk about from an advocacy front. And then we do continue to support research and also technology advances in cystic fibrosis.

Gunnar Esiason (41m 52s):
The Boomer Esiason foundation has actually funded the largest disease specific mental health study, interventional study in cystic fibrosis, looking at a cystic fibrosis specific mental health interventions that’s ongoing, so that we’re funding. And then we also are committed to providing technology for cystic fibrosis care centers and academic researchers translating academic work into therapeutic development, through technology platforms that we’ve helped partner with. So we do a lot, but one of my favorite things that we’re doing right now, and this is, I know something that Liz is very close to, but we’ve engaged into a name image and likeness contracts with six athletes who cystic fibrosis competing at the varsity level of the NCAA. As far as we know, we’re the only non-profit in the United States.

Gunnar Esiason (42m 34s):
That’s actually supporting patients within our own population and competing at that level. We have six amazing athletes of which was Liz’s daughter Belle is one of them. She is awesome. And so are five other athletes that are competing in a lacrosse soccer track and field football and gymnastics. So we are super pumped for our athletes to be brand ambassadors for the foundation that we of course love supporting people with cystic fibrosis directly like Belle.

Dr. Anthony Orsini (43m 1s):
And I remember Gunnar many years ago. I mean, cystic fibrosis, as you said, has come so far. It’s incredible. Thanks. So you, your foundation and other, and all this research, but I remember hearing about, you know, I was always interested in medicine and, but I remember in college or medical school, I think it was during that Boomer Esiason’s son has cystic fibrosis. He’s playing football, he’s playing sports going. Wow, that’s amazing. I didn’t think cystic fibrosis kids can do athletics and now look at where we are hundreds and thousands of them, but it just goes to show you what medicine can do when it combines and teams up with charities. We can do some great things here in the United States. Yes,

Gunnar Esiason (43m 40s):
It really is amazing. I say maybe currently that cystic fibrosis was the greatest story in medicine only he’d be displaced by the vaccines. So I think CF has come a long way. I think that the stat that gives me the most hope and pride to be, part of the cystic fibrosis population is that the number of patients living older than 18 years old continues to grow far beyond the number of patients living under the age of 18. That shows that this is no longer a child disease diseases, unfortunately, something that has to be lifelong managed, but I can promise you that the Boomer Esiason foundation will be around until we have to start thinking about geriatric care for CF patients. It’s amazing.

Liz Poret-Christ (44m 15s):
How does someone get in touch with you? Should they want to reach out to you?

Gunnar Esiason (44m 18s):
Yeah, so I do have a blog Gunnar Esiason dot com. That’s where I blog. I will say I have not been a great blogger lately just because we’ve been busy. Yeah. So, but I do block so Gunnar Esiason not calm is really kind of where you check me out. I do also tweet on Twitter, tweet out my thoughts, follow me on Instagram and stuff like that. But you can also see what the Boomer Esiason foundation is doing @Esiason.org. You can follow our name. Would you like this? Athlete’s also where we’ve got a full list of thei namesr, which includes Liz’s daughter, but yeah, I’m excited about the future for people with cystic fibrosis, we still have work to do. There’s still about 10% of the patient population that does not have like ultra drugs. So we still work for them. And we also of course have patients who are on the other side of receiving transplants who still need supportive care.

Gunnar Esiason (44m 60s):
So you have is maybe not as far from being cured as we had all kind of thought it would be many years ago, but we are on the right path, but there’s still work to do, and we will continue to do it.

Dr. Anthony Orsini (45m 11s):
So for those out there, don’t stop giving don’t stop pushing awareness for cystic fibrosis. Please keep giving we’ll put all of Gunnar’s contacts on the show notes. And this has been really just a great episode, Liz. Awesome job.

Gunnar Esiason (45m 25s):
Yeah. Great job Liz.

Liz Poret-Christ (45m 26s):
Thanks for being my guinea pig Gunnar. I appreciateit.

Gunnar Esiason (45m 30s):
You may have another career ahead of you, hope the doc doesn’t mind.

Dr. Anthony Orsini (45m 33s):
I think I’d go on a six month vacation and let her handle the podcast. Now this is awesome. Gunnar. Thank you so much, Liz. Thanks so much. This has been great. I can’t wait for the audience to go ahead to hear this. If you’ve enjoyed this episode, please go ahead and subscribe on your favorite podcast platform. If you’d like to get in touch with Gunnar, that’ll be in the show notes. If you want to get in touch with Liz or I at the Orsini Way or hear more about what we do, please go head to the Orsini Way. Com and you can contact all of us. So thank you so much, Gunnar. Thank you, Liz. This has been great.

Gunnar Esiason (46m 3s):
Thank you so much. Thanks for having me on.

Dr. Anthony Orsini (46m 5s):
Well, before we leave, I want to thank you for listening to this episode of Difficult Conversations Lessons I learned as an ICU Physician, and I want to thank The Finley Project for being such an amazing organization. Please, everyone who’s listening to this episode, go ahead, visit The Finley Project.org. See the amazing things they’re doing. I’ve seen this organization literally saved the lives of mothers who lost infants. So to find out more, go to The Finley Project.org. Thank you. And I will see you again on Tuesday.

Announcer (46m 38s):
If you enjoyed this podcast, please hit the subscribe and leave a comment and review. To contact Dr. Orsini and his team, or to suggest guests for future podcast, visit us at the Orsini Way.com. The comments and opinions of the interviewer and guests on this podcast are their own and do not necessarily reflect the opinions and beliefs of their present and past employers or institutions.

Holiday Episode- Highlights from 2021

Announcer (2s):
Welcome to Difficult Conversations Lessons I Learned as an ICU Physician with Dr. Anthony Orsini, Dr. Orsini is a practicing physician and president and CEO of the Orsini Way. As a frequent keynote speaker and author. Dr. Orsini has been training healthcare professionals and business leaders how to navigate through the most difficult dialogues. Each week you will hear inspiring interviews with experts in their field who tell their story and provide practical advice on how to effectively communicate. Whether you are a doctor faced with giving a patient bad news, a business leader who wants to get the most out of his or her team members, or someone who just wants to learn to communicate better this is the podcast for you.

Dr. Anthony Orsini (47s):
Well, hello, everyone and happy holidays this is Dr. Anthony Orsini, the host of Difficult Conversations: Lessons. I learned as an ICU physician. This week we do not have a guest. I thought for the holiday season, this would be a great time for Liz Christ and I, Liz, as you know, is the Managing Director for the Orsini Way. And she was our host last week with Gunnar Esiason and I thought it would be a really good thing this week to just look back at this year in review about all the amazing guests that we’ve had for the last year. Talk about the highlights and all that we’re grateful for over the years. So today’s just going to be a short episode, but I think we’re going to hit all the highlights and even going to play a cool game, I think in the end.

Dr. Anthony Orsini (1m 30s):
So Liz is here with me, Liz. Thanks again. This is going to be a lot of fun,

Liz Poret-Christ (1m 35s):
There’s so much to be grateful for this year. The podcast continues to just amaze me with all the wonderful guests we have and all the insights and tips and just amazing conversations that we continue to be part of.

Dr. Anthony Orsini (1m 46s):
Yeah, I’m really so honored and humbled. I think we’re coming up on our 65th episode. I started as any podcast or new podcast or thinking, oh my God, what if no one listens? Oh my goodness. What if nobody wants to come on? And where our downloads continue to be very high we’re high on the charts, but what’s most humbling is that I asked people who are just incredible people. Who’ve done some incredible things and experts in their field to come on and they just say yes, and it’s just amazing. And there’s more to come. We’ve had so many highlights or just trying to think about who was on in 2021. And there’s been so many really great people like Cy Wakeman, and Mike Abrashoff, Liz help me out.

Dr. Anthony Orsini (2m 31s):
Liz. We have so many

Liz Poret-Christ (2m 32s):
Sure. Jonathan Fisher, Jason Schecterle, Dr. Marjorie Brewer. So many amazing guests, Dr. Michele Blackwood, BJ Miller’s, that’s such a great episode, just one after the other. There’s really not a bad one in the bunch.

Dr. Anthony Orsini (2m 47s):
And look at the topics. BJ Miller talked about death and dying and the incredible Cy Wakeman talked about ditching the drama. And she’s one of the top speakers in business. We had Anthony DiVencenzo who talked about a child advocacy, which is such an important topic. And the common theme here is that these are all Difficult Conversations and some of them are in business. Some of them are in medicine. It’s just amazes me that people are very willing to share their personal journeys with us Gunnar Esiason and Dena Carey as leadership we’ve had Lisa Stroman on, who talked about yourself and Dr. Robert Pearl, who wrote one of my favorite books of the year “Uncaring”. So these were just amazing highlights.

Dr. Anthony Orsini (3m 27s):
And the other thing that’s just great for me in this podcast. And I hope we can continue to do this over and over again is how much we learn from our guests. They tell us so much and they dig deep down into the hearts. We started out Liz and I, when we started this podcast, our two goals would be to educate and inspire. And I’m pretty sure that every single one of the guests really did that.

Liz Poret-Christ (3m 50s):
We nailed both of those objectives on every episode. And, and I think what stands out to me is the guests that we’ve had are not afraid to have a really difficult conversation about a really difficult conversation and the topics like you said, death and dying, Robin Simon’s documentary, Do No harm. Those are some really difficult, important conversations that people aren’t necessarily willing to have, that they have so readily with us. And I think it’s been such a great way to make people aware of topics they might not really want to talk about.

Dr. Anthony Orsini (4m 26s):
It’s funny sometimes when I’m at a party I’m speaking to friends and I feel like even Lauren said to me, my wife, one point, you know, it was like your name dropping. Cause I keep saying, I had Dr. Pearl, my podcast, or, you know, when I spoke to Susan Scott from Fierce Conversations, and I said, I’m not really name dropping, but something that they said is so pertinent to our conversation, that I just want to share their wisdom with the people that have been on. And she’s like, yeah, I get that. But you know, when you’re dropping big names like that, and I said, well, they are big names. I mean, I tell Jason Schechterle’s story all the time. What an amazing story. If you haven’t heard that podcast, you really need to hear it.

Dr. Anthony Orsini (5m 6s):
And the parallels of Marcus Engel, which was on the previous year are just there, you know, Michele Blackwood, as you said, with breast cancer. And she really educated our audience about breast cancer, but showed a guy once again, that medicine is not about science. It’s about the human connection and that’s been our theme at The Orsini Way. Anyway, it’s been our passion and it’s been really the theme of the podcast. So I’m just so grateful to all the guests and want to do a big shout out happy holidays to all of them. They’re the gift that keeps on giving because people are able to listen to these episodes over and over again, they find them on the internet.

Dr. Anthony Orsini (5m 46s):
But then when I try to get another big name guests and they hear that I’ve had people on like Lisa Stroman and Steve Lawler and Stuart Levine, they say, oh, okay, this guy is the real thing. And I’m going to come on too, because I want to be included in that. So just a lot to be grateful for.

Liz Poret-Christ (6m 5s):
And I love when people go on their favorite podcast platform and tell us what they love and episodes that they love. So please keep writing the reviews. We’re five star on apple podcast and the way we’ve touched people and the episodes that they love. It’s one thing for us to love them because they’re our guests and it’s our show. But when people tell us how much it’s changed their perspective of something or how much they loved a guest that maybe they didn’t know before, that’s the whole point of doing this project. And I will admit I was a little skeptical when you said, Hey, let’s have a podcast, but it’s been such a wonderful project. I’ve learned so much from our guests.

Liz Poret-Christ (6m 45s):
And we’re going to test you a little bit later, Dr. Orsini, because as you know, every time I transcribe the podcast, I write down my favorite quotes on post-its and my wall is full of quotes from our amazing guests. So we’re going to play a little game where I read the quote and you have to guess who it’s from.

Dr. Anthony Orsini (7m 4s):
Well, I would think that I would do well, but what, who knows, you know, before we started that up, I’ll give a shout out to, you know, that’s been a very high quality podcast, thanks to the people at Peachtree sound that Paul Barr has been. Our editor he’s editing is right now going, wow. They’ve mentioned my name. So that’s pretty cool. And we’ve been really fortunate to get on every podcast platform. And so it’s just been great and I’m ready to go and getting excited for the holidays. This will probably go live between Christmas and new year’s. And next year we already have five or six guests already lined up. I don’t know how long this is going to keep going, but I’m having fun. And thanks to Paul and Peachtree.

Dr. Anthony Orsini (7m 44s):
It’s easy for me. And I’m getting a little bit better at it every year to be able to say that we’re an apple top 100, which we get right away is something that I’m very proud of. All right. So,

Liz Poret-Christ (7m 57s):
Well, first I want to say if anyone has a podcast guest that they’d like to recommend, don’t hesitate to send us a note at info@The Orsini Way.com or you can send it to me, Liz@The Orsini Way.com and give us an introduction to your favorite person or someone that you’d love to see on the show, because we would love to talk to them too.

Dr. Anthony Orsini (8m 16s):
There’s so many topics that we still want to cover because Difficult Conversations are in every aspect of life. So Dorothy Roberts is coming on later on this year, she talks about race bias in medicine. There’s so many different conversations that we can have. So if you’re out there, you have something that you want to say, you’re an expert in a field, or you just want to talk, go ahead and just say, Hey, I’m recommending myself and that we’ll be happy to talk to you. Before you quiz me I’m going to ask you because this is hard because they’ve all been great episodes, but I know that your favorites, the ones that you’re on, no, I’m just kidding. No, my editors said, wow, this is really good. I said, good. She can start doing more and more, but what do you think over the year I sent you a list, all this year’s podcasts we got to exclude last year’s.

Dr. Anthony Orsini (8m 58s):
So give me one or two of your favorite ones.

Liz Poret-Christ (9m 2s):
I was looking through the list and I smiled at every single one that we got to, but there was some common themes that I thought were really great. And one of the common themes that stood out to me was hope and guests like BJ Miller and Jason Schechterle and Dr. Margery Brewer, a lot of them brought up the topic of hope and how hope is an underlying theme in so many of the Difficult Conversations that we have. So I thought that that topic, not necessarily the guests, but the topic was so timely for now and for the way people are feeling. But I think if you had asked me my favorite episodes, couldn’t pick one, but I loved Jason’s episode.

Liz Poret-Christ (9m 48s):
I loved Jonathan Fisher’s to really reveal the hard parts about mindfulness and self-worth and self-care. I thought that was really important and we’ve established such a great relationship with him. That definitely was a wonderful guest in a wonderful episode and Cy Wakeman. So many quotes. I have like four Cy Wakeman quotes sitting on post its.

Dr. Anthony Orsini (10m 12s):
You are helping me now, giving me the answers.

Liz Poret-Christ (10m 13s):
The same thing with Susan Scott. I could definitely not pick one episode. There were so many wonderful ones.

Dr. Anthony Orsini (10m 19s):
That’s fair. Well, I’ll say first, also that the two themes that seem to, and we didn’t plan this, but there’s such hot topics right now that two themes that really go through the whole entire year with all the podcast guests was one leadership. And how important leadership is to the success of the company, but also to the success of the employees. And so early on, we had some great people about leadership and about compassionate leadership and servant leadership. And we had Linda Kaplan Thaler, her book power of nice is one of my favorite books ever, Dina Carey, and Kristin Baird all talked about leadership. And I really learned a lot and leaderships, you know, Noreen Bernard, leadership is all about your ability to communicate and bond.

Dr. Anthony Orsini (11m 4s):
And so that’s something that I firmly believed and all these guests. So this just kept coming out, this kind of theme. And then the other theme was the healthcare crisis with physician burnout and employee turnovers and Jonathan Fisher. And some of these guests, I truly call my friends now like Jonathan Fisher and Susan Scott. So Anthony DiVincenzo, I knew for a long time, but the healthcare crisis right now has been other common theme. And we have a lot of episodes about that, but that’s because it’s just always on everyone’s mind. As Robyn Symon said, physician suicide affects 900,000 patients a year. That’s crazy. And so it was really important that we had many guests on and we’re going to have more guests on this, but Jonathan Fisher, Susan Wilson talked about second victim syndrome.

Dr. Anthony Orsini (11m 52s):
I’m going through all these that just have to do it. Laurie Gunther did an episode on debriefing nurse leaders because they were so burnt out and sad. And the origins of that. So Dina Carey really gave a great episode, I thought on how to be a leader. And so those were the two common themes. I think it’s hard to say. I think some of my favorite ones, Mike Abrashoff , I’ve been a fan of so, so long. And one day I’d love to be able to have his speaking ability, but his story is just amazing. Cy Wakeman Of course, we brought up a couple of times she’s been amazing. God, they’re all so good. It was really hard to say. I think those are the two big ones.

Dr. Anthony Orsini (12m 33s):
Oh, of course Jason Schechterle. I mean, his story speaks for himself. So those would be my three, but again, wow. I have such gratitude for all these people who took time. I’ve been interviewed on many pod casts and it’s not easy. You’ve got to take the time. You got to make sure that you prepare for it a little bit. And you got to make sure that you have your stuff set up the landscapers, not cutting the lawn outside and your housekeepers not banging on the doors. And this is all stuff that happens behind the scene. You know, first few times I did the podcast. I’d get in the middle of it. And the landscapers got the air blower in the back and you have to kind of pause.

Liz Poret-Christ (13m 10s):
I think they are outside my house right now.

Dr. Anthony Orsini (13m 12s):
So anyway, I don’t want to take up too much time.

Liz Poret-Christ (13m 15s):
And I was going to say, a friend of mine just listened to Dr. Michele Blackwood’s episode and she texted me and said, I hope I never have to meet her for medical reasons but she sounds like a really great person. She absolutely is. Yeah.

Dr. Anthony Orsini (13m 29s):
And these people really give me new hope about what medicine is supposed to be. And that’s really what you and I do with the Orsini Way. We reinvigorate our team members, the nurses, the doctors remind them that medicine is about relationships. So all these people give me hope that there’s a light at the end of this tunnel,

Liz Poret-Christ (13m 47s):
Linda Kaplan Thaler’s episode, where she tells the story about Frank, the elevator guy. That’s such a great story that the elevator guy introduces himself to the C-suite people on the way up to see if they wanted her company to be their agency. And because of all the amazing things that the elevator guy said, they got the job. That was such a great story that stuck with me because it just shows the power of being nice to people and be considerate of the people around you. I just love that one.

Dr. Anthony Orsini (14m 18s):
And I’m glad you brought up her episode because her episode, I don’t think got the attention that it should have. If you’re a subscriber, if you’re listening to this and you didn’t get around to listen to Linda Kaplan, it’s an amazing episode. She’s not huge on social media. I think that’s probably why. I mean, she still got a lot of downloads, but if you are listening to this, go back and listen to that one because you’ll just listen with your mouth open because there’s so many words of wisdom. It was really a great interview. And I think I’m going to try to get her back on too, because she’s got so much to teach us.

Liz Poret-Christ (14m 48s):
Okay. You ready for your quiz here? My favorite quotes, let’s see if you can figure out who said them, I’ll start with an easy one.

Dr. Anthony Orsini (14m 56s):
Okay. Ready? This

Liz Poret-Christ (14m 58s):
Is really an easy one. You’re going to get it in a second. That conversation is the relationship

Dr. Anthony Orsini (15m 5s):
That is easy one. And that is Susan Scott and a fierce conversations. And as Susan, if you’re listening, I’ve used that quote in a couple of my lectures, but I do tell everyone, it’s your quote. So I do give you your due credit for it, but what a great line, the conversation is the relationship. I love that

Liz Poret-Christ (15m 25s):
You’re like brain explodes. It makes so much sense. Right? Okay. The next one, there is nothing as powerful as a made up mind.

Dr. Anthony Orsini (15m 36s):
Scroll through my name’s here. Jason,

Liz Poret-Christ (15m 40s):
Jason Schechterle. Well done. Well done. Okay. This is a long one, but a goodie. We have a choice of whether to believe certain thoughts that go through our mind. Are they a fact or are they a thought?

Dr. Anthony Orsini (15m 56s):
I was going to say Jason Schechterle, but I don’t want to say two in a row. So was that Susan Wilson?

Liz Poret-Christ (16m 2s):
Jonathan Fisher.

Dr. Anthony Orsini (16m 4s):
Jonathan. I’m sorry, Jonathan. I didn’t mean to insult you. That makes sense though. That’s what Jonathan does.

Liz Poret-Christ (16m 11s):
So What You permit- you promote

Dr. Anthony Orsini (16m 14s):
Kristen Baird.

Liz Poret-Christ (16m 15s):
You are good. You are on it. Okay. Hope is very powerful medicine.

Dr. Anthony Orsini (16m 27s):
Dr. Michelle Blackwood. Don’t fix the culture. Fix the climate.

Liz Poret-Christ (16m 33s):
Give me a hint, is this is a healthcare one or a business one? It is a business one. And someone you quote all the time. She also said suffering is optional.

Dr. Anthony Orsini (16m 47s):
Is that Linda Kaplan Thaler?

Liz Poret-Christ (16m 47s):
Cy Wakeman

Dr. Anthony Orsini (16m 48s):
Oh my God. I do quote her all the time. The quote I use all the time and trying to think which one, oh, what would great look like

Liz Poret-Christ (17m 1s):
Me too. Thanks Cy. We use that all the time.

Dr. Anthony Orsini (17m 4s):
Cy, I’ll give you credit. And I take the liberty to say, this is a quote from my good friend Cy Wakeman. So that’s what I consider now. You as a good friend, anybody who’s been on this podcast, I consider a good friend now.

Liz Poret-Christ (17m 14s):
Okay. This one’s going to make your brain explode. When well people see sick people, they want to stay well. When sick people see, well, people they want to get well,

Dr. Anthony Orsini (17m 29s):
Karen Knops.

Liz Poret-Christ (17m 30s):
Nope, Dr. Margery Brewer.

Dr. Anthony Orsini (17m 31s):
That was my first impression. And I said, no, I don’t think so.

Liz Poret-Christ (17m 35s):
And here’s the last one. So this one’s a really good one. And you’ll get this one. Our lives succeed flat-line or fail gradually, then suddenly one conversation at a time

Dr. Anthony Orsini (17m 51s):
Is that Susan Scott, BJ Miller said something similar about something that had been suddenly. But yes, Susan, Scott, what did we learn a lot from her

Liz Poret-Christ (17m 59s):
BJ Miller. So I’ll tell you that’s who it is, but his quote, which I thought it was so powerful is your love of life is the most powerful thing to help you through your death.

Dr. Anthony Orsini (18m 10s):
Love that.

Liz Poret-Christ (18m 11s):
Isn’t that so amazing? Like so many amazing quotes, amazing thoughts, amazing humans that we get to interact with. I think it changed me as a person. For sure. I learned so much.

Dr. Anthony Orsini (18m 22s):
I love the fact that you’re putting little post-its for the, So I send me, can you put them in a word document and send them to me? I want to remember them, but yeah, Lauren gets a little annoyed cause I’m constantly quoting these people. Dr. Robert Pearl gave us a story in his book Uncaring. He talked about physician culture and how it hurts us and how it helps us. And I’m always quoting him and people are looking at me like you’re talking about your podcast again. I’m like, well, it’s not the podcast. It’s that I’m learning so much. And so I’m learning and borrowing and stealing. I used the word stealing, of course, but I use credits, but it’s kind of joking. And we’ve gotten some clients from this. And a lot of these people are, these are ongoing relationships.

Dr. Anthony Orsini (19m 2s):
Now, as I mentioned, Jonathan Fisher, he invited me to speak during his big global conference that he had on physician burnout. Anthony DiVencenzo is an old friend, Michelle Attwell, who was one of the earlier ones this year. She is now an instructor for the Orsini Way. Cause she lives right here in Orlando with me, Michelle shares her real wisdom about her daughter who is so sick and how she went into healthcare. And now she is giving back. And that’s the other theme, right? How many of these people are giving back Michelle Atwell, the Jonathan fishers and who else? There’s so many people here that just tragedy. And then at the triumph,

Liz Poret-Christ (19m 41s):
Absolutely, you know, when Susan Wilson taught us about second victim syndrome, I don’t know if I ever thought about that, but it makes so much sense. And when Lori Gunther talked about leadership fatigue, well leadership fatigue during the time of COVID is enormous. And the responsibilities and impact that leadership has now is so much more important than ever before. So there are so many topics that just came up that you might’ve never thought about.

Dr. Anthony Orsini (20m 7s):
Yeah. And Lori Gunther, she just had our 25th conference at Sonova associates and she asked me to do a workshop there. So these are really lifelong relationships that I’m just so grateful to have in you and I have been working together since 2011. And so that’s a long-term relationship. Lauren is so busy at work I probably talk to you more during the day than I do her, but this has been just an amazing journey. And the Orsini Way, I was just telling a friend of mine and a colleague The Orsini Way is really catching on and we are getting busier and busier. And I think our message is finally getting out, doing a lot more keynote speaking.

Dr. Anthony Orsini (20m 48s):
And we’re, you’re doing a lot more patient experience workshops and programs. Our “It’s all in the delivery” program has been really taking off. I think people are starting to get the message. That patient experience is all about communication. And so I couldn’t be more grateful at the end of this year.

Liz Poret-Christ (21m 4s):
Me neither, when I think at the number of physicians that we’ve trained in the past 10 years and the amount of lives that, that improvement in how they communicate, how many lives that it’s affected, it’s a staggering number. You’re talking probably hundreds of thousands of patients that will now have better conversations, even if they’re difficult because of the training that their physician had with us and learned some really key techniques on how to have difficult conversations, break bad news better. And I’m so blessed to be part of this company and have this job. My husband says I’m evangelical when I talk about what I do for a living.

Liz Poret-Christ (21m 45s):
And it’s just because of what we do is so important.

Dr. Anthony Orsini (21m 47s):
And we love it. And so it doesn’t seem like work and we’re going to keep doing this as long as we can. And again, I’m just so grateful. Liz, do you want to say anything before we sign off and wish everybody a happy holiday, whatever you want to say,

Liz Poret-Christ (22m 1s):
Thank you to our amazing audience for all that you do and all that you give us back. We love doing this for you. So reach out to us. If there’s any ideas that you have, we’d love to hear them be safe, happy holidays. And we’ll see you in 2022.

Dr. Anthony Orsini (22m 15s):
Thank you, Liz. And this is a call to action for everyone. Who’s listening, help us get our word out. It’s not about the number of downloads. It’s not about sponsorships. And by the way, we failed to mention our sponsors have been amazing. It’s not about that. It’s about this message. And Liz and I talk about, we have this message that we’re screaming from a mountain top, and we want people to hear it. And that we’ve benefited so much from the wisdom of these guests. If you are a subscriber, if you do listen, just because your friend up in the beyond, please go ahead and promote this on your social media. Let’s double, triple and quadruple the downloads. Not because we want downloads, but because we want our message to get out. So thank you everyone for listening. My gratitude is to infinity for everyone who’s been supporting us.

Dr. Anthony Orsini (22m 57s):
I wish everyone a happy holidays and we’ll be back in two weeks with another amazing guest. So have a great new year in 2022 is going to be amazing. So thank you everybody.

Announcer (23m 9s):
If you enjoyed this podcast, please hit the subscribe button and leave a comment and review your contact Dr. Orsini and his team, or to suggest guests for future podcast, visit us at Orsini Way.com. The comments and opinions of the interviewer and guests on this podcast are their own and do not necessarily reflect the opinions and beliefs of their present and past employers or institutions.

The Problem with Dying with Dr. BJ Miller

Dr. BJ Miller (2s):
Dare, dare to be a human being first. White coats, the accolades, the diplomas on the wall are impressive don’t mean to take that away from us. It is amazing how much work we do to do this, to have the access to the work we do is stunning. It’s okay. But it ain’t everything. And that can go away in a second and dare to learn from your patients. No, we’re always asked to be the experts and we have feels like we have to puff up and posture and know everything. The truth is we can’t know everything. So don’t pretend to, there’s something very powerful when it’s honest, when you say to a patient, sir, ma’am I don’t know the answer to this question. I don’t know what happens after the end of life, I don’t know what happens if you don’t do this treatment, but I’ll not, I’m not going to run away.

Dr. BJ Miller (46s):
I’ll be with you. I’ll be bull looking at a best to get together that I can promise you. That is some most healing, powerful, gorgeous work you can ever do. And you’re not going to find it in a laboratory. You’re going to find it by living your life daring to be a human being.

Announcer (1m 1s):
Welcome to Difficult Conversations: Lessons I Learned as an ICU Physician with Dr. Anthony Orsini. Dr. Orsini is a practicing physician and president and CEO of the Orsini Way. As a frequent keynote speaker and author. Dr. Orsini has been training healthcare professionals and business leaders how to navigate through the most difficult dialogues. Each week, you will hear inspiring interviews with experts in their field who tell their story and provide practical advice on how to effectively communicate. Whether you are a doctor faced with giving a patient bad news, a business leader who wants to get the most out of his or her team members or someone who just wants to learn to communicate better this is the podcast for you.

Dr. Anthony Orsini (1m 46s):
Well, I am honored today that The Orsini Way has partnered with The Finley project to bring you this episode of Difficult Conversations: lessons I learned as an ICU physician. The Finley Project is a nonprofit organization committed to providing care for mothers who have experienced the unimaginable, the loss of an infant. That was created by their founder, Noelle Moore, whose sweet daughter Finley died in 2013. It was at that time that Noelle realized that there was a large gap between leaving the hospital without your baby and the time when you get home, that led her to start The Finley project. The Finley Project is the nation’s only seven-part holistic program that helps mothers after infant loss, by supporting them physically and emotionally.

Dr. Anthony Orsini (2m 30s):
They provide such things as mental health counseling, funeral arrangements, support, grocery gift cards, professional house cleaning, professional massage therapy, and support group placement. The Finley Project has helped hundreds of women across the country. And I can tell you that I have seen personally how The Finley Project has literally saved the lives of mothers who lost their infant. If you’re interested in learning more or referring a family or donating to this amazing cause please go to The Finley project.org. The Finley Project believes that no family should walk out of a hospital without support. Well, welcome to another episode of Difficult Conversations: Lessons I learned as an ICU physician. This is Dr.

Dr. Anthony Orsini (3m 10s):
Anthony Orsini, and I’ll be your host again this week. Today, I have the distinct honor and pleasure of having another incredible guest. My guest today is Dr. Bruce BJ Miller, who is a longtime hospice and palliative care medicine physician and educator. He is also an author fellow, Ted Talk, presenter and keynote speaker. He has given over 100 talks nationally and internationally on the topics of death dying palliative care, and the intersection of healthcare with design. Led by his own experiences as a patient Dr. Miller advocates for the roles of our senses, community, and presence in designing a better ending. His interests are in working across disciplines to affect broad-based cultural change, cultivating a civic model for aging and dying.

Dr. Anthony Orsini (3m 58s):
His career has been dedicated to moving healthcare towards a human-centered approach on a policy as well as a personal level. Dr. Miller is a graduate of Princeton University. He received his MD from University of California and completed his fellowship in palliative care medicine at Harvard University. His 2015 Ted Talk, not whether, but how aka “what matters most at the end of life” has been viewed over 11 million times. And his work has been the subject of multiple interviews and podcasts, including Oprah Winfrey, PBS, the New York times and the Ted Radio Hour. His book, which we’ll be talking about today, A beginner’s guide to the end”

Dr. Anthony Orsini (4m 39s):
was coauthored with Shoshana Berger and was published in 2019. Dr. Miller currently sees patients and families via Telehealth through Mettle Health, a company he co-founded with the aim to provide personalized holistic consultations for any patient or caregiver who needs help with navigating the practical, emotional, and existential issues that come with serious illness and disability. Well, BJ, I am so glad. This is a long time coming. I know you’re so busy and it’s been great. You know, we first got to know each other when I saw you as a fellow speaker at the end physician global summit and conference, and I spoke there and he spoke there later on and I heard your speech.

Dr. Anthony Orsini (5m 22s):
It was amazing. And then I went and did research on you and saw your amazing Ted talk, which has a few more views than mine, BJ. Thank you so much for being on today.

Dr. BJ Miller (5m 33s):
Thank you, Tony. Thank you for everything you do, man. I appreciate you having me.

Dr. Anthony Orsini (5m 38s):
Thank you. I first got to know you a little bit when we did the global summit on physician burnout together, I guess that was back in August and I was an earlier speaker and you were towards the end. And so I made sure I set my alarm to make sure I saw it. And I was really loved your lecture and your speech. And then I became a BJ Miller fan. So I went on, got your Talk 11 million. My Ted talks at about 4,000. So I got a little ways to catch up to you, but

Dr. BJ Miller (6m 5s):
Just add some zeroes

Dr. Anthony Orsini (6m 6s):
it’s getting there. I just started in March. So I got some time it’s there all I got time. So, but I loved your Ted talk. And then I got your book and I’ve been a real big fan of what you do and everything that you say and believe really aligns with what I’ve been teaching and believing too. So let’s start out. I always talk about building rapport, but start out with hearing BJ Miller’s story. And as we like to joke on this podcast, how you reached the pinnacle of your career being on my podcast right now,

Dr. BJ Miller (6m 36s):
Right oh, early in my life, I was not headed for medicine. Let’s just say that I didn’t know where I was headed. And I was at Princeton lucky to be at a place like that in thoroughly in the liberal arts mode, I was there to learn and expand my mind and without clear sense of where all that was leading. So I was sort of a melancholy kid was pretty sensitive kid. I was very close with my mom, still am. My parents are alive, 56 years of marriage and they’re still cooking. God bless them. Yeah. I don’t know how they keep going, man. It’s amazing. And mom had polio when she was 18 months and then post-polio syndrome. It are pretty hard in her forties when I was 8, 9, 10 years old.

Dr. BJ Miller (7m 19s):
It’s so that kicked me. And the reason I mentioned that as well, I learned so much from my mother’s example as a young person growing up around disability. So when I became disabled myself, which we can talk about, I’ve been dying, was primed. I knew thanks to my mother’s example that yeah, these things happened. I was more apt to ask the question, why not me and why me? And it was a very helpful start to being in these shoes. But I think the bigger point there is a child growing up sensitized to disability and sensitized to how humans react to disability and react to difference and how we otherize each other all the time. And I was very tuned into that and was very flummoxed by it.

Dr. BJ Miller (8m 1s):
I didn’t understand why we human beings seem to love each other, but we also seem to really hurt the hell out of each other, coming casually, you know, wayward comments, thoughtlessness. I just was kind of stunned as a kid. Never really understood it, I still am I guess, but anyway, that that experience is something of a caregiver to, for my mom. Just, we didn’t use that language, but in terms of just being available, helping each other out, it wasn’t, it was no big deal, just the way it needed to be done. So we worked that kind of nonchalance around caregiving that seamlessly moving into caregiving role, just son role to brother role to whatever. I think that also really set me up nicely for this career that I’ve chosen.

Dr. BJ Miller (8m 44s):
So that fast forward, that’s sort of my setup in early life. There’s obviously more to tell, but that set me up. So then off I went to college and then sophomore year of college around this time of year, actually 31 years ago, November 27th, friends of mine and I, we were just horsing around and decided to climb atop of a parked train car. And it was just sitting there, the commuter train that runs from Princeton to Princeton junction for bedroom community for fairly in New York. And anyway, we just climbed it like climbing a tree. We didn’t honestly think we were doing anything that nuts, but it turns out that the train wasn’t moving, right. It was just still electrified. And in the New Jersey transit trains, the wires generally are overhead.

Dr. BJ Miller (9m 25s):
So there’s this metal thing that connects the train car to the power source. Anyway, when I stood up on top of the train, I was close enough to that power source and I had a metal watch on and the electricity arc to the watch. And that was that just instantaneous. And that landed me in a burn unit for months and close to death and blah, blah, blah. And well, I’m not blah, blah, blah. I don’t mean to be casual about that. There’s much to say about that, but then I did lose both my legs below the knee and my left arm below the elbow from the burns. And it also opened my eyes in all sorts of ways. And that’s really what set me on a trajectory towards working in medicine and healthcare. So that’s kind of what kickstarted this interest coupled with my experiences as a child, with my mom, coupled with this sort of human entanglement around suffering, how we flee it and how we also cause it, all those things predispose me to be interested in medicine.

Dr. BJ Miller (10m 18s):
And very specifically, really it turns out in palliative medicine, I was going to drop out. I went, I went off after college. I majored in art history and studied art. That was a very important part of this story for me. This is where I learned to see this is where I learned how to work with this thing called perspective and for a young man who was really kind of cut up by all the things he couldn’t change, learning how to change my perspective was magical, really powerful part of my own therapy and also deepen my interest in humans. And then, so after college, I didn’t really didn’t know what the heck I was going to do. And it was a little scary there for awhile, cause it was just enough to get through the day when I went back to school, after my injuries, it was just getting through the day was plenty.

Dr. BJ Miller (11m 2s):
So anyway, I ended up thinking that medicine would be a good use for all these experiences I had just had. A good way for me to work with these experiences rather than just somehow put them behind me. So off I went trying to go to medical school, did the post-bacc pre-med got into UCSF. And my promise to myself was I’ll just keep going until I either can’t do this. This is not meant for not martyring myself or if I find something I’d rather do I wasn’t in love with medical science. I’m in love with the idea of humans working with humans and medicine was a sort of a bag of tricks to work with and allow me to be in front of people with people. So off I went to medical school, blah, blah, blah. I was going to go to rehab medicine, Tony and I fell out of love with that.

Dr. BJ Miller (11m 42s):
But for all sorts of reasons, it was a very, at least at the time, a very mechanical field, it turns out I was much more interested in that sort of philosophical stuff. What do humans deal with? Things that they can’t control? So I was going to get out of medicine, this a deal with myself that I’d made. I was disillusioned with the sort of realities of practicing medicine, but then my Dean talked me into doing an internship. I happened to just do an elective in palliative medicine and honestly within a day was in love with it for all the reasons I bet you are too. And off I went,

Dr. Anthony Orsini (12m 11s):
It’s quite a story. It really just parallels what I believe. And that’s that human-to-human connection. That is medicine. That’s supposed to be medicine. I do not know if you’re familiar with Marcus Engle. He was on my podcast and Marcus Engle had a similar experience. He teaches in patient experience. Now he wrote a book called “Here” and Marcus was T-boned when he was in college and went instantly blind and had trauma. And his friends in the car all died and he woke up in a trauma bay and could not see. And they were putting chest tubes in and I was reading your story. That’s where I’m getting to this and was panicking. And there was a woman who just grabbed his hand. He didn’t even know if he dreamed it or not, but it turned out to be a nursing tech and just said, Marcus, I’m here.

Dr. Anthony Orsini (12m 57s):
And now Marcus spends his life by helping doctors train he works out of Notre Dame. But you had a similar person in your story, a similar person when you were tell us about that person.

Dr. BJ Miller (13m 7s):
Yeah, but the moved, even just reminding me, you’re telling me about Marcus’s story. And then she reminded me of my own. You know, this is such little poignant, exquisite little moments. They’re often very quick, you know, a little eye contact here and there. They’re not exotic per se, very accessible, which I think is part of probably our shared message, but you’ve got to do them. I mean, you got to sit, you gotta be with someone, you gotta be present. It’s that simple and that hard. And so there were several nurses in particular that really affected my course through the burn unit. The first was Joy Varcartabone. So this is New Jersey, the early your place to tell you, this is New Jersey in the early nineties. So you can imagine the hair and the nails and all us.

Dr. Anthony Orsini (13m 49s):
And by the way, I grew up about 20 minutes from St. Barnabas Hospital, as I know the area very well.

Dr. BJ Miller (13m 55s):
So you can, you probably walk past Joy Varcartabone, big amazing red hair and just sweetheart. And I don’t know that she was much older than me really. I don’t know that I ever knew, but anyway, coming into the, I was airlifted from the Princeton little local hospital where they did some emergency work and it cut the fascia autonomies to let some of the heat escape essentially, and then airlifted to St. Barnabas, the one burn unit in New Jersey. And I guess, and I barely remember this. This is all very hazy. And like you said about your friend Marcus, did I dream it? Was it real, I’m not even really sure it’s all kind of fuzzy, but some of the early memories were, they couldn’t get me. I was too tall.

Dr. BJ Miller (14m 35s):
I was almost six, five. And I remember them kind of trying to get me into the helicopter. I remember that being a really clunky, awkward moment in the pilots and then landing at St. Barnabas. And there’s a team waiting to receive this or trauma flights, as you can imagine. And I’m ventilated at this point I’m wide-eyed and this is just hours into the ordeal. Lord knows what kind of pain was happening. But so I landed in there and you could hear people talking, is it, do you know this is work. And people do all sorts of things to get through the day of work. And so some guys are taking bets on whether this guy was a goner, this kind of, sort of talk. And my eyes were just going all over the place. I don’t know what the hell is going on.

Dr. BJ Miller (15m 15s):
And Joy just like you described, just came sort of saddled up Saw me, just took one, look at my eyes and heard know she knew instantly took my hand. I don’t remember her necessarily saying anything. She just took my hand, locked eyes with me and she just let me know she was there and it was orienting and grounding and soothing and all sorts of miraculous effects came from that. And I hadn’t met any such moments from there on, out with joy and a handful of others that made this whole experience possible and even wonderful. I mean, cutting to the chase here, but I remember the day I left the burn unit and as Tony burn units are a hellscape, they are a particular brand of difficult in nature, continually kept at bay infection is the problem.

Dr. BJ Miller (15m 60s):
So their holy unnatural environment, everyone is gowned to the hilt. Anyhow, there’s pain is reverberating around the unit. It’s just, it’s intense. And, and your every day, the tank room and the, the, where you’d get washed and scrubbed and debrieded. But you know, those guys, by the way, the burn techs are some of the funniest, most beautiful people I’d ever met, I don’t know how the hell they did that job. I mean, it is their job was to torture people on, on their own behalf for their own good. And anyway, I just remember one thing to kind of summarize that experience was when it came time for me to leave the burn unit, fine, this is a celebratory moment.

Dr. BJ Miller (16m 41s):
You’re in the clear, you know, you’re leaving this intensive ward to do a step down place and on your way out to the world again, and in so many ways that should be a celebration. This is grad graduating. I made it sort of thing. I wept like a baby leaving the burn unit and this had become my home. Joy had become my, I don’t know what to call her. There was just anyway that even amidst all that pain, even emits all that loss. I was so at home there, thanks to that kind of hand-holding and that kind of eye contact in that very basic human love.

Dr. Anthony Orsini (17m 17s):
And that’s the miracle of medicine. And we are being bombarded with the topics of physician burnout and administrative duties, et cetera, and the working in a busy NICU, but I’m proud to be a neonatologist because I think just as well as any other specialty, but especially in neonatology, the neonatal nurses and the staff do death and dying better than anywhere I’ve ever seen. And it’s in that middle of the night when the mother is holding the baby and the father standing behind that, you really see what medicine’s supposed to be about. And of course, next morning, it’s epic and Cerner and any EMR. But I try to tell the young doctors, that’s not what medicine’s about.

Dr. Anthony Orsini (17m 57s):
It’s about that human connection. So your story and Marcus isn’t anybody who’s listening. If you haven’t heard the podcast, Marcus, it was like the third or fourth episode, Marcus is an amazing story, but let’s go on with your life’s work. So, so death and dying, I love the way you teach. We’ll get to the book later on. But why do you think is a cultural, or why do you think that in the United States, or even now anywhere that we have such a struggle with this and that it’s a topic no one wants to talk about. We’ll get to why physicians don’t want to talk about it, but what is it about death and dying? That’s really in your experience? Why do we keep getting it wrong and seeing it differently?

Dr. BJ Miller (18m 37s):
I think denial, you know, I think the refrain of we’re all in denial is oversimplified but true enough, and there are things we can enumerate to some modern life. But before we do that, I think it’s important to let us all off the hook. I mean, on some level, this is inherently very difficult on a couple of levels for one just hormonally neurologically. We are really wired for a fight or flight or freeze response to anything that threatens our existence. I mean that, that’s a reflex. You don’t really have a choice in that. There’s something in our wiring around this. So a that’s not our fault, you know, fine. And I think it’s also the way this odd, honestly, Tony, I’m not sure if the human mind is a great gift or a great yoke that we’re saddled with.

Dr. BJ Miller (19m 22s):
We can think ourselves into so much trouble with these minds of ours and we can cause so much trouble, but we can also get out of so much trouble with these minds of ours. The jury is still out, whether the human mind is in my mind, it might in my mind, the jury’s out, whether the human mind is a on-balance wonderful thing or a terrifying thing, but let’s just say it is very the way we conceive ourselves away. Mind constructs, a sense of self and identity. You know, there’s a lot to say about that. Both from a sort of a medical science, a social science and just a philosophical or spiritual basis too. And I think it is incredibly difficult for a mind to wrap itself around not existing, not being everything we’ve ever experienced the world, even if we’re completely soaked in the world’s beauty, not ourselves, even if we’re trying to ignore ourselves, it’d be completely altruistic, but we have to acknowledge that the world is, we ever know it is still washed through us.

Dr. BJ Miller (20m 16s):
We only know life through our experience. So anyway, I think it’s very difficult for mind. You’ll try conceiving of not being it’s the second you do. You find yourself being, watching yourself, not being, it’s just you getting these little loops. So anyway, we go on and on about that, that’s a big one, but I think the more interesting things and the things that we can actually affect are the social cues on top of it. Medicine’s commitment since the early 20th century to a disease focus, since the technology revolution around call everything that you don’t like a problem, and then go to war with it, and then we’ll kick it out in the bar experience that has its really severe limits.

Dr. BJ Miller (20m 57s):
It’s also led to incredible breakthroughs in medical science, but at a cost. So we’ve got a sort of a medical system that dominates our view of what life is that life is a pulse essentially, or life is a brainwave that is become the dominant sort of view leading our charge, what life is, what death is. So there’s all the problems of medical science and the limitations of the model that we use to think about life there, that flow from it. Meanwhile, you’ve got the erosion of religion. So places where most normally people would go to get answers to big spiritual questions or existential questions. Those aren’t the same. We don’t have the same general commitment as a community. Family structures are such that we move around a lot.

Dr. BJ Miller (21m 39s):
So you’re not living with three generations under the same roof anymore. So we’re also moving into cities. So I’ve noticed a big difference when I’m taking care of families who are coming off, a farm who are around the cycle of life all the time, birth-death is a daily thing as you and I know it to be, but we organize our lives to distort that reality. And it shows. So we put all of these things together and an economy that thrives on exploiting our desires and our fears and politics that go with it. And before, you know it, we are pulled away from our nature and that’s problematic in a lot of ways, make sense in a lot of ways. But the problem is what we ended up doing is kicking the can down the road. We end up making things more complicated or are harder than they need to be because we haven’t dared to look at it.

Dr. BJ Miller (22m 23s):
We keep them in the closet. We keep them in the dark until it’s just too late until we’re forced to look. And by then, there’s no time to develop a sort of a nuanced or subtle or thoughtful approach. You’re just a bag of reflexes freaking out, and this is what we get.

Dr. Anthony Orsini (22m 37s):
And then we add that to, as you said, a hospital and a physician basis of looking at failure or success by whether someone lives or not. My audience is going to say, oh, he’s telling the story again, but it’s apropos because I’m a big fan of Rabbi Kushner and his work and the author of “when bad things happen to good people”, but he tells a story it’s on YouTube. And I apologize my edits because I probably just said this a couple of weeks ago, but it’s so apropos. He was getting ready to do an interview with an evangelical healer and he’s in the green room. And he says, I’m very annoyed at this guy because this guy’s going around telling everybody that he’s going to touch your forehead and you’re going to be cured for whatever cancer.

Dr. Anthony Orsini (23m 17s):
And so he goes, I kind of have a chip on my shoulder. I’m kind of annoyed at him. And I just couldn’t hold my tongue. And I said, do you really believe that you can heal everyone just by touching their head? And the guy turned to him and said, curing is when you’re getting rid of a disease. Healing is helping someone when there is no cure, I can heal everyone that I touch. And Rabbi Kushner just tipped his hat and said, that was a great answer. And I think that as physicians, I talk about this all the time physicians, we don’t like to talk about that. And in fact, what do we do? We call BJ let’s call palliative care and dump on them because you know, and then my palliative care friends always tell me, yeah, they call me and I’m the bad guy.

Dr. Anthony Orsini (24m 0s):
You should be calling me earlier, which we can talk about physicians, you know, even breaking news. There’s one old study that showed that physicians are often viewed as uncaring compared to police officers. What is it about the physicians that you think is it just our type, a training of, we must cure everyone not heal.

Dr. BJ Miller (24m 21s):
I think culture moves us all in really powerful ways. And the culture of medicine is powerful, is profound. I remember when I was doing my fellowship at, you know, I’m the halls of mass general and stuff. It’s an amazing institution and I can’t help, but be moved by all that it’s achieved in a relatively short time. It is pretty remarkable looking at how we’ve pushed back on death in successful ways. We live longer by blah, blah, blah. So I’m alive. Tony very clearly because of Western medicine. There’s zero doubt about that. So it’s complicated. There’s a lot to love about it, but like so many sort of incomplete models as the medical model is inadvertently causes trouble.

Dr. BJ Miller (25m 2s):
And you say, you put together all our reflexes to run from the subject, the social cues that push us away from the subject. And of course the medical system is made up of human beings who have, and of course it has all the foibles of being a human in it. Our time is so fascinating, but in the west. So since mid 19th century technology revolution, industrial revolution, the time where America per se, as a country per se, has grown up, just happens to be super seduced by technology and by the power of the human mind to think its way through problems that is such a, has been such a successful mode. I don’t blame people for applying it to old age or death.

Dr. BJ Miller (25m 44s):
I think we’re just long enough down that course, where we have to acknowledge this. Isn’t a problem for us to solve. We can’t cure everything, at least not now. And meanwhile, if we’re really committed, if we’re doing medicine because we’re committed to humanity first and foremost, well then that thing called bedside manner isn’t just this kindness on the side. It becomes the thing. What I’d love to see happen Tony would I think HHS our medical system, I think we’re, we need a new Flexner report to tell us what medical education should be. I think we should rewrite our mission statement at HHS for my money. The mission of medicine would look very much like the mission of palliative care and palliative care.

Dr. BJ Miller (26m 26s):
As you pointed out as a specialty, why do you need to call this specialist to come in and remind you of these very basic fundamental things of human connection, et cetera, that inevitability of death, the non-failure of death, et cetera. Well, it’s telling the palliative care is a field as a corrective to a system that’s kind of gone a little wayward with itself and needs to be reminded of why we’re doing all this in the first place. So maybe it is after another dozen or more years of this kind of conversation being less and less exotic. Maybe the system will commit itself again to patient care, to healing versus curing this much bigger, broader goal. And we’ll live in a different place then.

Dr. Anthony Orsini (27m 3s):
Yeah. I also find that our training is so limited and as human beings, we run away from things that we’re not comfortable at. You asked me to do an appendectomy. I’d be really scared. I have no idea. And so what I’ve dedicated the last 10 years of my life is what keeps me going BJ is when I take a doctor, we train them, hour two hours, put them through some, role-playing teach them how to be more comfortable with it and the life or a tragic diagnosis. And then we do the anonymous surveys and they overwhelmingly write these things like this is something that now I feel comfortable because nobody teaches you how to do it. How do you do it? And then the other thought I would say is that one of the phrases that drives me crazy, especially if I’m teaching residents is no, we can’t.

Dr. Anthony Orsini (27m 45s):
There’s nothing else we can do. You know, and there’s always something you can do. You can heal and we are always going to be there with your patient. And so I just think what’s so gratifying is when I do teach a doctor this, or they get that cue of this whole kind of, it’s a human to human thing, their eyes light up. Wow. They didn’t tell me that medical score. Wow. Nobody told me that. Or my attending told me when I was a resident, just call palliative care and they’ll take care of it. So, well you have relationship with that patient for the last two weeks, right? Palliative care is really going to help you, but how about you be there when palliative care learns and then I’ll tell them, and here’s what I’ve learned. I’ve spent 10 years stealing from palliative care, listening to BJ, talk to a patient and saying, I like that phrase.

Dr. Anthony Orsini (28m 28s):
I’m going to use that. And so it’s okay to say I’m stealing. I mean, there’s nothing wrong with that. We’re helping people’s.

Dr. BJ Miller (28m 33s):
Can I say one more thing, Tony, on that, but I just want to highlight what you’re saying, which is the kind of care that you and I are striving for. And hopefully we do generally deliver ourselves, et cetera, et cetera. One of the compelling arguments to go this route is not just for better patient care and family care. It will be better for us as the clinicians. This is part of the answer to why we’re burning out, why this work is so frigging hard anyway. So I just want to make the point that this isn’t just another cue for us as clinicians to go learn yet another skill of being humane and kind, that’s not just to improve your patient outcomes or sort of that is to help you fall in love with the work that you’re doing and learn from it and to be humbled by it, to see yourself as a human being before your white coat, not by blah, blah, blah.

Dr. BJ Miller (29m 22s):
So I just want to highlight the link. You’re making that this is the route to a happier, better physician, not just happier, better patients,

Dr. Anthony Orsini (29m 30s):
A hundred percent. And, and you know, it feels good when I resuscitate a baby and I go home feeling great about myself. And I just, you know, we coded that baby. He’s doing fine, but it also feels good after a baby passes away and I see that miracle in the room and the mother gives me a hug afterwards because I feel like I did something good and we should stop considering that a failure. We did our best. And that’s just, wasn’t meant to be. So thank you for pointing that out. That’s a great point. So let’s talk about your book. I’ll share something personal with you. When I read your book a beginner’s guide to the end, I loved it. And I’m reading for the book and I’m reminded of my father-in-law.

Dr. Anthony Orsini (30m 11s):
So my father-in-law passed away and my wife’s going to get mad because I don’t know the exact age, but 95, 96 years old, he was an amazing man. Went through a very difficult life and was the most appreciative, happy person I’ve ever met. But my father-in-law toward at the end, as I’m reading your book and we’ll explain your book later about, you know, it’s very specific of like things that you should do as you’re preparing for the end. And it’s very practical guide. I’m reading the book and I’m thinking about my father-in-law going, did he write this book? My father did every one of those things. And I was like, he was beyond his years. And you know, in, when he passed, his goal in life, he always said he was ready to go. He lived a great life. He was so happy and I’ll never forget.

Dr. Anthony Orsini (30m 52s):
This is one goal was to live longer than my mother-in-law so he can take care of her. And the second goal was he didn’t want to spend a long time in a nursing home or whatever. So he died in his own house. And his last words was to my wife and he said, Lauren, I won. And that was his lap I won. I won. And I thought that was the most beautiful thing. But tell us about your book. It’s just a practical guide that I think everyone, probably some of it, you know, but you don’t want to talk about it, but it makes you think, I think it makes you think about life, not death.

Dr. BJ Miller (31m 27s):
Oh, right. Thank you. I mean, that is that’s. That is certainly the intent. I mean, so for starters, thank you for that story about your father-in-law. Well, that’s beautiful. Yeah. I agree. He one good way to glow and he makes a point too, that healing doesn’t mean living forever. Healing can still include dying and actually generally died. So thank you to your father-in-law is frigging beautiful. But I think what he played out was if you dare to rope death into your worldview, your sense of reality, your sense of life. If death is a part of life, well, right on the shoots, it loses some of its toxic charge versus this sort of this thing that we’ve inherited, which is more than life and death are opposed, that death is this thing that steals life.

Dr. BJ Miller (32m 14s):
This thing in the night, this thief that’s much harder. It’s a much harder story. It’s more cinematic. Maybe I’m not, maybe it’s more interesting or something, I don’t know, but it’s certainly more hurtful and less accurate. There’s not a living thing on this planet that does not die. It is just so entirely part of the deal. And so what your father-in-law has done and what this book is trying to help us do is this is for one, just help us dare to look at this thing called mortality. Even if you do nothing in the book, the practical steps, that’s fine. We’re all going to leave some kind of a mess one way or another. The whole idea is here is just to be sort of pristine through life and leave no residue. Get out of the way. That’s not at all the point.

Dr. BJ Miller (32m 56s):
So let’s celebrate our mess, but also our triumphs too, and wants to just help people, nudge people to dare, to look at their mortality so that you begin to learn the lessons while you’re still have life in front of you to play them out. I would imagine your father-in-law would make this point that keeping death somewhere. It is proximity. The idea that he’s not going to be on this planet forever can be cathartic. It can be compelling. It can be the thing that gets you out of bed in the morning. Cause you don’t have infinite number of mornings to get out of bed. And I hope you appreciate what you have while you have. It can also help you forgive yourself to not getting to everything because life is bigger than any one person.

Dr. BJ Miller (33m 36s):
And of course it’s probably always unfinished and this idea of closure is beautiful, but that’s a construction. We create closure. Otherwise life is this perpetual crazy thing. Always going, always swirling around with death. Just need to look out your window to see it or inside your own life to see it. So one point here is to help us look at this thi called mortality and therefore look at this thing called reality, and therefore look at the state called nature and human nature and to have a more expansive idea of what it means to be alive. That’s just interesting and compelling, powerful. And then the second step here is what the book is mostly about. And it is called a beginner’s guide to the end for a reason. This is the beginner stuff.

Dr. BJ Miller (34m 16s):
This is sort of the practical things you can do to kind of clear your deck a little bit, but don’t want to reduce dying to a to-do list. But there are all sorts of things that come along with a clerical, just paperwork issues. You got to push back on the medical system that all defaults will have you in an ICU on machines indefinitely, unless you say no, thanks at some point. So part of the point here of the book too, is, is practically how to kind of put one foot in front of the other and move through this experience. It’s also, when you’re paying attention, then you get to know when you’ve had enough. And when do you can just say, no, thanks to that next treatment. That’s going to keep you in the hospital instead of at home or whatever it is, then you can be thoughtful and you can welcome all the beauty into the mix too.

Dr. BJ Miller (34m 56s):
And you can avoid a lot of pain. That’s just not necessary. So that’s sort of the practical pieces of the book. But again, I think the most exciting stuff, if I were to write an advanced that’s the beginner’s guide and then the advanced guide to the end would probably be one or two pages. It wouldn’t be much. It would be love. Go find a way to love this whole dang thing. Don’t pick and choose it all. I love some of my life, but if only I didn’t have that, I just can’t have all good. Just go soak it all up. Bow down before it lean into mystery. Look at things you don’t understand. Just roll around with this thing called life. That will protect you against a fear of death. Big. So crippling it. Your love of life is probably the most powerful thing that help you through your death.

Dr. Anthony Orsini (35m 39s):
But as I’m reading it, I’m thinking like there’s suggestions. Are there write letters to your loved ones? Well, you don’t have to be dying to write a letter to your loved one. You can give them do it now. Exactly. And as you’re writing the letter, it’s actually making you appreciate that loved one. You’re telling the loved one. What it is that you love about them as if you were dying, you may not even be sick, but after you go through these exercises, my father-in-law wrote his memoirs. After you go through this exercise is you appreciate your own life and you appreciate other people’s lives. So as you say, it’s a big circle.

Dr. BJ Miller (36m 11s):
Yes, it is frigging amazing and beautiful. And the good news is you can’t have all the answers. So therefore you don’t have to have all the ends. You don’t have to posture. You don’t have to pretend you can just be wide-eyed. And that’s just honest and beautiful and including it could be terrified. I mean, I think part of the idea here is to de shame the things that we don’t have control over, we should not be ashamed to be sick. We should not be ashamed to die, should not be ashamed to have pain. That’s mean, the way we do that to ourselves and to each other. And it’s just unnecessary. So anyway, there’s a lot to say about this, but one of my favorite things about this subject is it’s not just harm reduction that do these things. So you don’t get torn up by the medical system at the end of life.

Dr. BJ Miller (36m 52s):
This do these things so you can love life while you still have some in front of you.

Dr. Anthony Orsini (36m 56s):
I love that. So BJ in closing here, I’m going to ask you for two more questions. Just advice, advice to the patient who is being faced with some medical challenges, maybe life-threatening or not life-threatening, maybe just getting older and then advice to w healthcare workers who are uncomfortable with this topic and uncomfortable speaking to patients. And if you can give us first the patient and then the healthcare provider. Yeah,

Dr. BJ Miller (37m 25s):
Well to the patient, I think I’d say the most important perhaps summary thing I might ever one way or another encourage a patient to do is pretty simple. It’s participate in your care. The days of just handing yourself over to the family doc, who’s known you for generations and on your family for generations, and you don’t need to describe an advanced directive to cause he knows you so well. And has the time to navigate all the bumps. The Marcus Welby is that does not exist anymore. The impulse to love and care for people exist, but the systems issues, the volume issues. It’s just not possible. So be very leery, be very careful of handing yourself over and sort of just to the medical system.

Dr. BJ Miller (38m 6s):
It’s not a malevolent system, but it’s not a beneficence system either. It’s not going to know what you want. It is too powerful. It can do too many things to you that you may not want to have happen. So I think first and foremost, it’s your life. It’s your death. It’s your care. Participate in. Think of your medical team as your advocates have people to consult with and to advise you and to get help from, but it’s your life. It’s your death. You can say, no, it is always legal and ethical to say no to any treatment. You can’t demand treatments, but you can say no to any of them. And at some point you probably need to from most people’s goals at the end of life. So I might basically participate your death, your life.

Dr. BJ Miller (38m 47s):
This is don’t hand yourself over. Then to the second piece for the clinicians in the crowd, the doctors, I think it’s like apropos. What you and I’ve been talking about. Tony is dare, dare to be a human being first. The white coats, the accolades, the diplomas on the wall are impressive. I don’t need to take that away from us. This is amazing how much work we do to do this, to have the access to the work we do is stunning. It’s okay. But it ain’t everything. And that can go away in a second and dare to learn from your patients. No, we’re always asked to be the experts and we have feels like we have to puff up and posture and know everything. The truth is we can’t know everything.

Dr. BJ Miller (39m 27s):
So don’t pretend to, there’s something very powerful when it’s honest, when you say to a patient, sir, ma’am I don’t know the answer to this question. I don’t know what happens after the end of life. I don’t know what happens if you don’t do this treatment, but I’ll not, I’m not going to run away. I’ll be with you. I’ll be, we’ll look in that abyss again together that I can promise you. That is some of the most healing, powerful, gorgeous work you can ever do it. And you’re not going to find it in a laboratory. You’re going to find it by living your life and daring to be a human being

Dr. Anthony Orsini (39m 56s):
That advice. Thank you so much, BJ. That’s fantastic. So BJ tells us just as closing here about how people can get in touch with you. Tell us a little bit about what’s a Mettle health, your organization, and there’s so many people out there that are probably gonna want to talk to you or reach you in some way. Tell us a little bit about that.

Dr. BJ Miller (40m 13s):
Well, please. So we’re getting better on social media where, Hey, we’re a little old-fashioned, but we’re getting there. So I say we it’s Sonia, my business partner and I who founded mettle health last year. I’ll tell you about that in a second. But so the Twitter handle, I think, is at BJ Miller MD and then our Instagram and the company twitter is just @ mettle underscore health and mettle is M T T L E like metal ones, inner strength, one’s inner reserve. So that’s how to reach us. And we’d love to hear from you, but Sonia and I, we are marinating on what to do next. After the book for a long time, Sonya was our research assistant and she and I have worked together for the last five or six years.

Dr. BJ Miller (40m 54s):
And then the pandemic hit and it made it pretty darn clear. The world needs. We always, we know the world needs more palliative care and we need access to it. It’s lumpy. So you can get palliative care if you’re lucky to be in certain health systems or certain regions of the country. But it’s actually hard to find even if when you realize what it is and get turned on or tuned into what it can do for you. So we started mettle health as an all-in line, accessible to anyone with a smartphone kind of thing, or even just a telephone as a way to make this kind of care more accessible. And we did that by dropping the medical piece. So if you come see me at mettle health, Tony, I will lead with my experience as a human being and as a physician, but I’m not going to be your doctor. I’m not prescribing medications.

Dr. BJ Miller (41m 35s):
I am seeing you in a social capacity to guide you through this experience, to guide you through getting the kind of care that you need to coach you on what to ask your doctors and how to hear your doctors, et cetera, palliative care is multidisciplinary. And one of his charms is it comes at this subject from many different angles, the social angle, spiritual angle, et cetera. So we let go of the medical piece to make ourselves more broadly accessible. You don’t need a doctor’s referral, et cetera can reach out to us anytime, whether you’re a patient or caregiver. So that’s why we started mettle health. And that’s what we’re doing. And we’re trying to build it as we speak. I’ve got a long ways to go, but please come visit us there.

Dr. Anthony Orsini (42m 11s):
Boy is that needed right now, especially with COVID. And we’re going to put all of this in the show notes so you can get visit us. And you can look at the show notes because I have a feeling, a lot of people are going to be contacting you. I certainly feel privileged and honored to have met you kind of in person. If we call zoom in person. So maybe one day we’ll get to meet and really in person. And I just want to thank you so much for being on today and for sharing your wisdom with us.

Dr. BJ Miller (42m 36s):
Tony, it is such a pleasure to talk to you forever. And I do hope we get to meet in person. Meanwhile said of these coasts, thank you for all your work, doing your doing Tony. These are the conversations that need to be more accessible. You need to be out there. I think a lot of our doctor friends want to do this kind of work. Just don’t know how to talk about it. Don’t know how to et cetera. So conversations like these and you putting them out there in the world make a big difference. And I really appreciate it.

Dr. Anthony Orsini (42m 60s):
Thank you so much, BJ. If you liked this podcast and you want to go ahead and please go ahead and hit subscribe or follow. If you need to get in touch with me, you can get in touch with me at the Orsini Way. Com. Thank you so much for being on and thanks for everybody for listening. Well before we leave, I want to thank you for listening to this episode of Difficult Conversations lessons I learned as an ICU physician, and I want to thank The Finley project for being such an amazing organization. Please, everyone who’s listening to this episode, go ahead, visit The Finley project.org. See the amazing things they’re doing. I’ve seen this organization literally saved the lives of mothers who lost infants. So to find out more, go to The Finley project.org.

Dr. Anthony Orsini (43m 41s):
Thank you. And I will see you again on Tuesday.

Announcer (43m 44s):
If you enjoyed this podcast, please hit the subscribe button and leave a comment and review your contact Dr. Orsini and his team, or to suggest guests for future podcast, visit us at Orsini Way.Com. The comments and opinions of the interviewer and guests on this podcast are their own and do not necessarily reflect the opinions and beliefs of their present and past employers or institutions.

Leadership from the Boardroom with Stuart Levine

Stuart Levine (1s):
Once you get past, oh, called the halo of a Harvard education, you still need to talk about the core issue, which is healing. And I, for one, feel very strongly that there is a correlation between my body healing and the person who’s touching me, that clinician, the doctor, and believing that he or she has my best interest at heart. And that’s the joie de vivre, that’s the healing quotient that doesn’t get enough conversation because people sometimes demean it and say, well, that’s a soft skill. Oh contraire, I do not believe that. I think that’s the differentiator. So if you’re interviewing and you’re the person doing that, I think punching the ticket for a great education, we all recognize is very important.

Stuart Levine (50s):
But then asking questions that are experiential. Tell me about the people you have developed professionally. And by the way, tell me about what you do in the community.

Announcer (1m 1s):
Welcome to Difficult Conversations: Lessons I Learned as an ICU Physician with Dr. Anthony Orsini. Dr. Orsini is a practicing physician and president and CEO of the Orsini Way. As a frequent keynote speaker and author, Dr. Orsini has been training healthcare professionals and business leaders, how to navigate through the most difficult dialogues. Each week you will hear inspiring interviews with experts in their field who tell their story and provide practical advice on how to effectively communicate. Whether you are a doctor faced with giving a patient bad news, a business leader who wants to get the most out of his or her team members or someone who just wants to learn to communicate better this is the podcast for you.

Dr. Anthony Orsini (1m 46s):
Well, welcome to another episode of Difficult Conversations: lessons I learned as an ICU physician. This is Dr. Anthony Orsini, and I will be your host again today. Today we have another amazing guest to add to our already great lineup of previous guests. Today our guest is Stuart Levine. Stuart is the chairman of the board and CEO for Stuart Levine and associates. He has significant board and executive leadership experience across multiple disciplines, including financial services, technology, and healthcare. He was the former CEO for Dale Carnegie and associates, which operated in 72 countries. Stuart is an international best-selling author of three books, The Six Fundamentals of Success, which we’ll talk about today, cut to the chase.

Dr. Anthony Orsini (2m 31s):
And he’s also the co-author of Simon and Shuster’s international bestseller “The Leader in You”. Collectively, these books have sold over 1 million copies and are published in 37 languages. Mr. Levine has been delivering speeches around the globe for over 20 years on the subjects of leadership change management and organizational transformation. He’s a monthly contributor for Forbes as well as many other publications, and as a sought after commentator on TV, print and social media. He’s appeared numerous times on top rate at global television programs, such as NBC’s today, show ABC’s world news, Bloomberg, Fox news, and many others.

Dr. Anthony Orsini (3m 13s):
Stuart also has extensive experience in healthcare leadership. He previously served as lead director, Gentiva health services and vice chairman, Northwell health and director for many years. I’m excited to have him as my guest today because I feel that his experience in business and healthcare make him uniquely qualified to speak to us about leadership and the business of healthcare. Well, thank you Stuart for coming on today. I really appreciate this. I know you are a very busy man right now.

Stuart Levine (3m 42s):
Thank you very much, Doc. It’s good to be with you to talk about issues that are things that you and myself think about every day because they impact on the quality of people’s lives. So I’m delighted to be with you today to discuss some of these important local foundational leadership issues.

Dr. Anthony Orsini (4m 1s):
So exciting is that what the premise of this podcast for the last year, almost a year and a half now has really been of course, about communication, but how communication is so important in business and communication in healthcare as well, and how the breakdown of communication to really destroy both the company and a patient-doctor relationship and your experience in healthcare, as well as in business really makes me very excited because I think what we’re going to talk about later is really the business of healthcare. But before we start, I think it’s always a good idea to get the audience, to get to know you. So tell us how STUART LEVINE from long island, New York arrived at the pinnacle of your career, which is coming on my podcast today.

Stuart Levine (4m 46s):
I think most importantly, I grew up in a little town called Bethpage. And one thing about Bethpage was without regard to ethnicity or background, and we all share some common values. So you worked hard and you were straight up with people and you moved ahead. And so for me, that Bethpage foundation of values really became critical. And I think it’s critical to anybody’s success in the future. So I attribute a lot of my success to that foundation. And from there was fortunate to have different turns in my career and always learned into those lean and learn into those experiences. If you will.

Dr. Anthony Orsini (5m 27s):
So big family, little family, how did you end up going into business? What was the driving force of all that?

Stuart Levine (5m 33s):
So I was a school teacher. I started my professional career as a teacher to at the first mandatory environmental education program. Ecology in the state of New York. Was elected to the New York state assembly when I was 24 years old, had the high privilege of serving in the assembly with then governor Nelson Rockefeller in that iteration in my life was a Republican, and we had that little Watergate thing, which historically you may remember and was defeated. And at 26 thought my life was over. Went into business and then eventually joined the Dale Carnegie organization and had the high privilege of becoming the first chief executive office or the global corporation.

Stuart Levine (6m 16s):
But in that part of my life, Tony, I had to learn how to turn a corporation around without an infusion of capital and what I learned through a really studying it. And that’s a tough thing to do in a family owned business was the importance of strategic communication. And so I will call it engaging the hearts and minds of our people throughout the world, building a staff and doing it in a collegial way, a collaborative way became a critical learning for me. Well based I would say on data. And so that became, I will call it a pivot in my career because there, I had very few capital resources, had a lot of human resources, but had to through the establishment of standards globally of instruction and curriculum development move an organization forward.

Stuart Levine (7m 6s):
And that’s where strategic communication first came into my mind concurrent. And I think appropriate where you and your audience today when my wife and myself settled in a little town called Locust Valley on the north shore of Long Island, I was asked by my internist to join the Glen Cove hospital board Glen Cove was about, a 200 bed community hospital. And you know, when your doctor is putting it through the rigors of an annual inspection, it’s tough to say no. I joined the Glen Cove board and saw some things from a quality point of view that I just couldn’t understand. And that really started my next pivot and to healthcare.

Stuart Levine (7m 48s):
When I was in the assembly, I served on the standing committee of a health, but being on the Glen Cove board really got me into a certain venues that were very interesting and formative to my thinking.

Dr. Anthony Orsini (7m 59s):
Let’s start, unpacking a few things that you said. You, you talked about when you went to Dale Carnegie, how important collegial communication was. Things are very different in business now than they were many years ago. Where now we talk about the culture of the boardroom. We talk about the culture, servant leadership. It’s very big in healthcare as well. Cause we kind of, I think healthcare just lags behind business about a decade, but we’re there now the worker for today, especially in millennials, I talked to James Orsini about this awhile ago, there are different. And the days of the hardcore, you know, put your nose to the grind or do what you’re told they don’t work anymore. Right? I had Kristen Baird on a few weeks ago and talked about nursing turnover and people who leave their jobs, not because of the money they leave their jobs because of their boss.

Dr. Anthony Orsini (8m 45s):
It sounds like you were way ahead of that curve. And can you comment about the different types of leadership and why that doesn’t didn’t work then? And it doesn’t work now.

Stuart Levine (8m 53s):
I think I’ll call it the command and control, this is a very important distinction in my mind, where I would turn to you and say, even though you’re a distinguished doctor, I’d say, doc, you do it my way or it’s the highway. There are still organizations that we see today that function that way. You are not going to engage a workforce today and you couldn’t back then. It was a different venue, a different way of communicating with people, but command and control. In my view that never worked. Engaging people based on the following. The premise is that leaders serve. We all serve some body or some thing. And making sure we have common ground on values because absent values people don’t have a common ground to have I’ll call it the requisite character to make good decisions and self-confidence becomes very important.

Stuart Levine (9m 44s):
So for me, that process starts with identifying what my personal values are and what the organization, and that’s the beginning of an engagement. So as an example at Glen Cove hospital, when it became clear to me that the quality of care that we were providing in the community was not where we aspired it to be. The first time we tried to merge with them was sure it failed. And the chairman of the board at that point turned to me. And this is a very important lesson. I think for everybody who’s listening, who wants to understand the mystery? There’s no mystery, it’s hard work and it’s preparation. Every time any of us go to a meeting. In this case, the Glen Cove board, I was very prepared.

Stuart Levine (10m 26s):
I didn’t just ruffle through my papers. I worked in advance. I understood the minutes. I understood what the body was trying to get to and what the strategy was. And then we formed up a conversation about, well, look, what is community health in this little Glen Cove community and build some energy on the board to agree, to move forward with a merger based on clinical outcomes for the, our families and ourselves. So it became personal and then to the community, so leaders serve and they listen. And then when you collect data, it’s really tough doc, to refute data. In this case, I’ll give you an example of quality outcomes.

Stuart Levine (11m 6s):
So we could say, Hey, look, here’s what it looks like from a quality outcome point of view in the community at Glen Cove. At Dale Carnegie, we could say, hey, look, here’s what our customers are saying about us. And by the way, currently, typically here’s where the world is going. And once you agree on values, which gets trust, and then you get an agreement on data that is collected by an independent source, then you can move ahead in an intelligent way or preparation values, and then build the communication that becomes, I think, the basis for a movement forward.

Dr. Anthony Orsini (11m 44s):
It’s interesting. You talk about command and control. And I mentioned that I think healthcare is about 10 years back and we are amazing guests like Claude, Silver. And I mentioned before, we talked about servant leadership. I last week I did a we’re taping this in early September. Last week, I did a conference on physician burnout and physicians is extremely high. There’s a great documentary put out by the number of medical doctors who are committing suicide right now. It’s actually an epidemic. And one of the top things that people talk about as the cause of physician burnout and suicide is lack of autonomy and how right now physicians are feeling like they’re caught in that command and control.

Dr. Anthony Orsini (12m 26s):
That many physicians, 30 years ago, they had their own practices. They were very autonomous. They walked into their office and they were the boss and everybody loved them. And this was their thing. And it failed or succeeded because of them. They find themselves in the year, 2021, maybe a decade behind business where administrators are now telling them, this is what you should do, and you’ll do this and it’s command and control. Exactly. I love that term. How do we get to that point where we can bring that autonomy back to the doctors and when you were on the board, how important is it that you keep the physicians in that loop of the business of healthcare?

Stuart Levine (13m 6s):
Well, number one, I think from a board point of view, it’s about asserting respect because those clinicians who you just referred to who are burning out, who are committing suicide and having difficult times, they’re not feeling the respect from the board and the senior leadership, because it becomes a very tough business and you and myself understand what that implies. But I will tell you that it’s interesting to watch what’s going on in the pandemic because the real shift is something that we predicted years ago on artificial intelligence. And now we say as an example, the only way to deliver efficient healthcare is through telemedicine.

Stuart Levine (13m 48s):
And we haven’t spent enough time with then I’ll call it rank and file. I’m talking about respected clinicians who are really academically sound and sharing with them as a single practitioner, as a practitioner group saying, Hey, look, docs. We’re going to use this technology because right now it’s unsafe for you. It’s unsafe for your staff. It’s unsafe for the patient to come into your office. And by the way, we respect so much what you do for the physicians who were feeling, I will call it unattached and not linked into the mission, there’s not enough conversation, honestly, about the mission of why you’re here, why you train so hard, be a doctor and clinician.

Stuart Levine (14m 31s):
And I think it starts at the top. It starts with the board as an example at Gentiva health services where I was the lead director and something that struck me early there, Tony was here we had 5,000 nurses throughout the country delivering home healthcare. And I was struck by the fact that on the board, we did not have a committee. We didn’t have access to regular data on quality outcomes. And then there are ways to recognize you as clinician to say, Hey, gee, whiz. That was a great thing you did for that patient and are very comp follow-up over procedure and so forth. So I think number one at the board level, it’s making sure that the data is part of the CEO’s dashboard.

Stuart Levine (15m 12s):
And we, as board members should ask for that and where appropriate form committees, because then we have insights and can recognize people. And listen, I think part of my responsibility as a director, I’ll take Gentiva and then I’ll give you the Northwell. So at Gentiva, I thought it was my responsibility to go with nurses to see what we were doing in the field. And when I asked the board to join me there, weren’t a lot of, it was kind of like crickets. Nobody was, is jumping at the opportunity, but I have to say that by going out and making field visits and thanking people for their service really kind of ripples through the organization.

Stuart Levine (15m 56s):
And currently, as an example at Northwell work, the CEO, Michael Dowling has done recognizing the pain all of us are going through and the changes because of the pandemic, every two or three weeks, he makes the portal open for a 45 minute conversation through the infectious disease people to give us information. And by the way, features one or two physicians who are doing something interesting in the whole mix of research, again, throwing his arm out around people to recognize people. So what do we do as directors? It gives us a chance to say, thank you. We respect your work.

Stuart Levine (16m 36s):
And particularly in a board when you’re going through a cultural transformation, if you do not have physicians sitting at that table, and if you do not have research and data that says, okay, doc, here’s what we heard from 350 physicians, then it’s, you know, five people in a room, somewhere making a decision that’s not based on logic and it’s awfully difficult. This is not PR by the way, a lot of people impugn the integrity of communication. It’s not PR it’s about human beings, interacting with each other. And the same way you, as a physician, as a doctor has protocols that are defined for the safety of an outcome.

Stuart Levine (17m 21s):
There should be the same type of discipline around collecting data for the safety of an outcome so that we will understand that she was okay, 350 physicians said the following, and maybe we need to listen to them and then have a couple of doctors around the table to interpret with us. So I think the board’s got to particular in healthcare and people that understand the importance of the clinical side of the business. If you will.

Dr. Anthony Orsini (17m 47s):
You raised an important point there, there’s something about, I think it’s referred to as ground intelligence in the army and let’s draw a parallel again between business and medicine. Again, I had a guest on Mike Abrashoff, Captain Mike Abrashoff was an ex Navy captain who wrote an amazing book called “The best damn ship in the Navy” and he took the worship in the Navy and made it into the best in one year. And the way he did that was by speaking to every single sailor that was on his ship. And every sailor had to come up with at least one idea on how to improve the ship. And he tells a great story of one sailor who was very reluctant to say anything finally said to the captain, do you know why we paint the ship every year?

Dr. Anthony Orsini (18m 32s):
And the captain said, I have no idea. He says, we paint the ship because rust from the bolts leaks onto the ship it’s saltwater. And so he said, okay. And he said, anybody ever hear of stainless steel? And so that young soldier was responsible for changing the whole Navy protocol for putting the guns, et cetera. I think what you were hinting on there is that it’s really important for a business person to go to that team leader. And maybe you can comment more about how important that is to say, you know, I came up with this idea from this tower. Does that make any sense to you? Because sometimes looking from 30,000 feet above is not the same as actually being on the ground.

Stuart Levine (19m 13s):
It’s an excellent conversation. So is what it looks like to me from the board. Here’s what it looks like in business. So I became chairman at north shore LIJ of the ambulatory surge committee quality committee with ambulatory surgery, which fundamentally at that time were represented the underserved population. But what I did with the committee is I invited the committee to go on class trips once a quarter to visit an ambulatory surge site. So, which I have to say was the most incredible learning experience for me, for my colleagues. And it gave us a chance to say thank you to those clinical people, the physicians and teams in those units, and really understand the needs of the communities we were serving by physically going there, those class trips, it turned out to be monumental in moving quality in ambulatory surge discussions, much higher on the food chain, a dashboard, if you will.

Stuart Levine (20m 14s):
So sometimes leadership means you have to do something a little different and it was different. And I wish I could tell you, 100% of lay people who serve on the board, jumped on that bus with us and had box lunches, but you know what, first there were two or three by the time that my tenure three or four years later, we probably had 10 people that would jump on board, but here’s one of the key components that does not get enough attention. And that is, we shared all learning together. And by sharing, learning together, I’m talking to clinical professional staff, the board members on the staff, people who accompanied us, we got to common ground and a common understanding of what our mission was and what our purpose was, which is so important when you’re dealing with somebody’s life.

Stuart Levine (20m 58s):
You know, when you talk about the business of healthcare, every once in a while, I get a Twitch, because at the end of the day, I’ve served the on you know, family owned businesses that manufacture guitar strings. Well, if we miss manufacturer a guitar strings, we’re not going to kill somebody. They won’t be an adverse outcome. In healthcare, you know, the dirty truth that I do. And that is that the Institute of medicine now projects over 160,000 people per annum die in hospitals because of errors, medical errors. That’s a huge problem. And if you really get under the hood there, Tony, at which I’m sure you have, that breakdown comes in communication for one person, a physician, a nurse handing off information to the next person down the line.

Stuart Levine (21m 48s):
And a person gets a thousand milligrams as opposed to a hundred or falls off a gurney because somebody forgot to strap that trick, you know, all those stories. So the point is learning together, understanding the import, and now, you know, serving on a Sentinel event committee at the system gives you more penetrating advice because you’re dealing with the human element. And so that’s why I went to talk to me about the business of healthcare. I really do wins because I see a patient’s face. I see how difficult this environment is. You asked me earlier about my family. I’m blessed. I have a wonderful son, a daughter, and now three grandchildren phenomenal.

Stuart Levine (22m 28s):
But the one thing my experience in healthcare taught me is perspective. And I want to spend a second talking to you about that. I feel very strongly about this. And then thinking back to our conversation, when I was kind of, I guess, the CEO at Dale Carnegie, and, you know, during the day you get involved in all kinds of intense business conversations, your head’s gonna explode and you start to feel, oh my God, the world is coming in on me. And I came into the hospital one night for a meeting. And as I kind of moved through the halls pretty fast, I had a penetrating lesson on perspective. I don’t know where I saw a mother and father whose face was green with fear.

Stuart Levine (23m 8s):
And there was a doctor pushing a very small incubator and I could see a little baby in there. And I knew where they were going. They were going to an x-ray suite. Okay. And I looked at that for a microsecond. So as not to be intrusive, but it was the most penetrating lesson for me and life as a father, as a community member board member. And as I’ll call it a business leader, that perspective, it never went out of my mind because it brought me to the mission. And if you think I have problems, what those poor people were going through that night, I have no idea what the outcome was. That was not my purpose, but instructionally.

Stuart Levine (23m 50s):
And what that did for me as a human being, that perspective is why I encourage people to get involved in healthcare. Because that perspective, I really believe elevated me as a human being.

Dr. Anthony Orsini (24m 3s):
It’s a great point. You know, my Ted talk, “how the human connection improves healthcare” talks about the noise that physicians hear all the time, but, you know, see more patients business of healthcare don’t order too many tests, or you’re ordering too little tests and how that leads to burnout, but also leads to 80. You mentioned a malpractice and medical areas. 81% of malpractice lawsuits are due to communication errors. And those are communication errors, not between doctors and nurses only, but between patients and doctors. Where a patient misunderstands a doctor or a, patient’s afraid to ask a question of a doctor. My premise is that one of the cures for healthcare right now is for physicians and patients to both understand that there’s all this noise out there, right?

Dr. Anthony Orsini (24m 51s):
With this business and medicine and all that. But when you are in a room together, when you’re sitting with that mother and father, as you know, I’m a neonatologist. So I deal with parents with sick babies all the time. When you’re in the room with a patient, it’s all gone, it’s you and me looking in each other’s eyes. It’s me saying, I know I have 30 patients in the waiting room, but right now this is the only person. And I can tell you, Stuart, from my teaching, with the Orsini Way and other workshops that I give your doctors all the time, come to me and say, that thought makes me sane. Because physicians and people who volunteer like you in the end, they all want the same thing.

Dr. Anthony Orsini (25m 34s):
They want to help. They’re healers, they’re compassionate people. And you just have to say, okay, I’m shutting this door and whatever’s going on out there. I’m going to forget. And that’s what we call the compassion of medicine. And I think that’s what you’re alluding to with all this. So that’s just, you know, this, my own add to what you just said, I think is very powerful that that really affected you when you saw that mother and father, but at their child, when you’re on that boardroom, you don’t forget that. Right. That’s in the end, you have to say, okay, that’s true. But I’m going to remember the eyes of those parents.

Stuart Levine (26m 7s):
I think that the soul, which is what we’re talking about right now of the patient and their wellbeing becomes critical to the conversation in healthcare. And when you drift too far away. And that’s why I encouraged directors to go out and make visits with home health care people, to see if in fact, that’s your business, you can’t possibly understand what those numbers imply unless you physically see it and digest it as a human being. And so for me, that becomes part of the responsibility of as a director. And I will tell you today, we know that there is a battle for talent.

Stuart Levine (26m 48s):
That might sound like some rhetoric, but it’s true. People really have a very important decision to make. Whether in fact, they are going to work at your institution or somebody else’s a or B. And the fact of the matter is that if you have a recognized excellent culture, and that’s something you can’t buy with advertising space, that’s over a cup of coffee, one person behind your back and my back saying, yeah, this is a terrific organization. That culture becomes a strategic weapon, particularly going forward in the next number of years. And so for me, understanding cultural issues, understanding, and on a healthcare board, when you ask what is our employee turnover number, and let’s understand it and let’s get under the hood so we can understand whether we can remediate those issues or not.

Stuart Levine (27m 42s):
And sometimes you can, but it’s a strategic weapon. And that’s why you see certain institutions are having, I’ll call it a better run than others in a tight employee-centered environment and understanding how to engage people. You can’t tell me, you trust me unless you share data. And the reason why that’s a critical factor. And so, you know, going back to the Dale Carnegie experience and bringing into healthcare as command and control, you know, in my early days as CEO, they brought me in a manual to a management training program and they said, so what color do you think the binder should be?

Stuart Levine (28m 22s):
And I looked at the guy and I said, what are you talking about? He said, well, you know, typically the CEO makes that decision. I said, not anymore. I said you need to come back here within a short period of time and present me with some data as to what our class members and our prospective customers think the color and the typeset should be. It doesn’t matter what I think it matters what our customers think. And that becomes a lot of people. Again, it’s rhetoric the voice of the customer. Now you have to have real data. You have to build the bridge to those customers. And then that has to impact. And then by the way, have the courage to share it with the people you work with.

Stuart Levine (29m 6s):
In that case, we moved it from the binder to a discussion about the course design. We commissioned global research and we formed a cross-functional team of 18 people, including franchisees and regular staff, people like myself and so forth. We moved product construction from 18 months to about 90 days because we had everybody in the room. We were able to accelerate through every barrier. It’s that type of thinking. I wouldn’t encourage in healthcare. We can bring people together and say, okay, here’s the case. Here’s what happened on that patient outcome. And I want to touch on one other thing that you said triggered in my mind that Tony about patients, a number of years ago, I had the privilege of being on the foundation who worked for the internists and the United States was a big foundation board.

Stuart Levine (29m 54s):
I was the only suit. And what struck me was data that was presented one day about the high level of people who were illiterate. They looked like you and me, Tony, they looked as good as you. And they sounded good. But when they were leaving the institution and people gave them a piece of paper were follow-up protocols. They couldn’t read it and they couldn’t execute against it. So again, back to the point, you said you need to close the door. You need to look at a person. So as you, as the dark, the need to say, do you understand what’s on this paper? And here’s what you can do to help yourself self-heal.

Stuart Levine (30m 35s):
Cause I think that’s a future trend in healthcare. That illiteracy data is still out there and making sure that in the current world that we care for people, there’s no doubt in my mind, but what does that care imply? And sometimes taking five minutes more, makes that person more resilient, puts them in a position to self-manage their disease, as opposed to being readmitted 48 hours later. And I just want them to make that point for the people that are participating with us today.

Dr. Anthony Orsini (31m 7s):
That’s an excellent point. And no matter what I say to a patient, if they don’t trust me, they’re not going to listen to me. So one of the things we talk about during my seminars is how to build that trust and how to do it in a couple minutes and look great. Stuart, you mentioned turnover. Let’s shift over to that right away, because I want to stand on. This is your wheelhouse leadership. Your books are about leadership, your book. I think it was 1995. The leader in you, we mentioned before people leave, not because of money. People leave because of their bosses. And honestly say, that’s been my experience. And I see hospitals that are failing because of poor leadership. And there’s businesses that fail because of poor leadership. Two questions. One is, are leaders born or are they taught?

Dr. Anthony Orsini (31m 49s):
In other words, I asked them this question to many guests in the past. Can you take the smartest person in the room and teach them to be a leader? Or do you have to take the leader who may not be the smartest in the room? And what’s the most important thing in leadership with communication in respect to communication.

Stuart Levine (32m 4s):
I think that leaders are developed. And I think what is implied in that conversation, which is an excellent question is I always want to understand, does that person have the will to learn. To me, a leader is a person that has the will to learn, or we have I’ll call it mentored over 20 people who become global CEOs and major C-suite positions. And the differentiator in that conversation is if a person has the will to learn, they can do pretty much anything they want. So leaders are people that have the will to learn and the will to listen. People who sit on the sidelines and aren’t current aren’t thinking, but making a call it extraordinary demand.

Stuart Levine (32m 49s):
So number one, leaders are people that have the will to learn. I think the second thing is leaders have the self-confidence because of their values, their belief set to look at data that say, gee whiz, our outcomes are not where they should be. Let’s have an honest discussion. I understand in healthcare, we need to have the attorneys in the room, but with no consequences individually, except let’s not repeat that era in the past, or let’s talk about the efficacy of how we prescribe medicine going forward. And so I think leaders listen to people or they share. They trust them by sharing information and current data and don’t hide.

Stuart Levine (33m 32s):
But for me, a leader is developed to be honest with you, I didn’t go to Harvard I didn’t go to Princeton. I went to Beth Bethpage high school and a local college out here. And you know what? This is a great world. You’ll live in. If you are willing to commit to learning and you can pretty much write your ticket. I believe that I still believe it’s true. And the new social order made me more true than ever because it’s tougher to exert intelligent leadership. And part of that is the courage to sit down. I was on a fortune 500 company that went down. And one of the questions I asked that a board meeting, which was penetrating was why is our employee turnover so high in a particular segment?

Stuart Levine (34m 14s):
The CEO, after what I was a young guy at the time pulled me into his office with his custom made suit and mahogany walls said you know, you’re a young guy there question. We don’t have data like that. I knew then Tony, that company was going down six months later, we became a target or a federal investigation. And so my point is asking questions about employee turnover and really understanding why people are leaving. Is it lack of information? Is it work conditions? Are they concerned about safety for patients requires a lot of trust and a lot of self-confidence in some days. And it starts with us when we started the turnaround that Dale Carnegie, where do you think we got the biggest pushback?

Stuart Levine (34m 59s):
When I said, you know, I want to get a climate survey, a real independent climate survey in the organization. And the pushback came from our own senior management team. People said Stuart they don’t like you. I said, okay, I’ll take that. I wanted to understand wh but then six months from today, we can do it again. I want a baseline. And honestly, reading, it was painful for me. It was painful, but that created a baseline in my mind that said, okay, here are the things we’re going to change. Here are the things we can’t change based on economics and other things, but we’re going to make a commitment to move forward as best we can. And it’s that type of collecting data, independent data that becomes really important and executing behind it.

Stuart Levine (35m 45s):
That’s what leaders do.

Dr. Anthony Orsini (35m 46s):
You know? I see this a lot. I guess the question came from my observation, especially in medicine, I’m sure it happens in business. We take that Harvard-trained physician. Let’s say he’s a cardiologist with all the accolades and he’s got multiple research papers. And we bring them to a very prestigious university with the best cardiologists in the group. We bring him or her into that. And we make them medical director of the cardiology department. And now you had all this talent in cardiology and one by one they’re leaving and nobody asks why, you know, so now you had this great group and then you find out later on that maybe this person was brilliant, but they’re not good at communication.

Dr. Anthony Orsini (36m 30s):
They’re a little rough around the edges in the end. You think you’re hiring someone who’s super perfect for the position, but in the end, you lost four great cardiologists because they couldn’t work with her or they couldn’t work with him. This is a tough question, but you probably can answer it. So now you’re interviewing for this chief of the department or you’re interviewing for a new CEO. How can you tell that this person is willing to learn and can do the job? Is there a secret sauce to figuring that out?

Stuart Levine (36m 59s):
Yes, my son, there are some insights I can share. The number one question that I ask, sometimes we are retained, we are a firm to sit on the other side of the table when there is a vetting process going on for CEO succession candidate. I always ask a question. Can you tell me about the people you have developed? Tell me about the people you’ve developed. And in that conversation, you will hear different responses. And I would say if that potential candidate can not legitimately say, hey, I’ve developed Anthony Orsini over here, and he’s a fabulous physician practicing in Cincinnati today.

Stuart Levine (37m 39s):
And you know, there are STUART LEVINE over there practicing down there in Palm Beach and so forth and so on. So I think asking the right questions in that interview, once you get past I’ll call I, the halo of a Harvard education, that you still need to talk about the core issue, which is healing. And I, for one, feel very strongly that there is a correlation between my body healing and the person who’s touching me, the clinician, the doctor, and believing that he or she has my best interests at heart. And that’s the Joie devivre. To me, that’s the healing quotient that doesn’t get enough conversation because people sometimes demean it and say, well, that’s a soft skill, oh contraire.

Stuart Levine (38m 22s):
I do not believe that. I think that’s the differentiator. So if you’re interviewing and you’re the person doing that, I think punching the ticket for a great education, we all recognize is very important, but then asking questions that are experiential. Tell me about the people you have developed professionally. And by the way, tell me about what you do in the community because that tells me what they’re involved in. And if they’re only responses, well, I like to play golf or, you know, drink wine, but that will tell you that they’re not involved with people in a community. And if they’re not involved with people in a community, then you can be pretty well assured they’re not going to be involved when I’ll call it.

Stuart Levine (39m 7s):
That department comes together for a Christmas party or doesn’t have the time to walk down the hall and wish somebody a happy birthday or inquire as to how their family is feeling in the COVID crisis or something like that.

Dr. Anthony Orsini (39m 22s):
That’s the drop-the-mic advice right there. I think because that’s about communication and the ability to be able to communicate. So that makes us full circle here. I love what you said about who have you developed the best boss I ever had. I was early in my career, right out of training. It was at NYU that Karen Hendricks-Munoz hired me and eventually gave me the tools to head up a program in the NICU, which eventually became the largest program in all of New York City. And then the only program in New York City. And I started to receive some accolades for that. What I noticed that really impressed me and made her the best boss ever. She never took the credit for the program, but she took the credit for being smart enough to hire Dr.

Dr. Anthony Orsini (40m 3s):
Orsini. And I loved that about her. And there are some bosses and directors who try to take the credit for everybody else. When you can take all the credit for and say, Hey, I’m the one that hired Stuart in the first place. So I’m really smart, that kind of thing. So I love what you said. That’s just, it’s all about communication and the ability to communicate. And that’s why I’m so passionate about this. So, Stuart, this has been great. I finished every, every conversation with the same question and I’ll start it with you right now in your experience as all the years that you have experienced as a leader in healthcare and through life, what do you think is the most difficult type of conversation that you’ve had to navigate? And can you give us some advice on how you were able to get through that and maybe some mistakes or something that you did well that you want to bring everybody to take home as a lesson?

Stuart Levine (40m 52s):
Listen, there are times when, if you’re a CEO or for that matter, a board member where you have to consider making changes of leadership, and those are painful. Those are difficult conversations. I’ve been on both sides of their conversation. And I think that as long as you understand, it’s got to be respectful and it’s got to be on the merits. And so, as an example, if you have followed intelligent protocol and you understand the humanity of leadership and the responsibility and the privilege that says, Hey, you’ve missed your budget. You’ve missed your outcomes by X percent, the last six months or 12 months.

Stuart Levine (41m 34s):
And by the way, you haven’t recruited or attracted requisite people. And by the way, in your department, we have the highest turnover rate of a nursing staff. And I think then it’s not a personal conversation. People won’t, nobody’s going to enjoy that conversation, including you or myself, but at least then you give somebody a frame of reference. And then I always say to people, Hey, look, you can come back to me in 30 days and we can go have a cup of coffee somewhere and I’ll try to help, you know, you’re going forward. But I think as long as it’s on the merits, people understand that, that you have to make some decisions, but have a serious responsibility. I’m a great believer in codified.

Stuart Levine (42m 15s):
We had a client very recently where they were going to terminate an employee. And I heard it at a board meeting where advising the board and a grab the CEO later said, Hey, by the way, do you have all this documented? He said, no, but I said, stop. You’re going to hurt yourself. And by the way, all of your marketing that you are now doing for your Institute, that marketing is going to feel shallow and hollow. For sure people are going to know you have not had a process. So for me, whether it’s looking at a patient outcomes or a compliance issue, documentation in those cases becomes important. And then you have to do the right thing. If you make the right thing based on patient outcomes, that’s the highest level.

Stuart Levine (43m 0s):
That’s what you love. And I love about healthcare because you’re helping people. And that’s what the privilege of leadership is about.

Dr. Anthony Orsini (43m 7s):
How do you start that conversation? So when you’re bringing in that person to let them go, how’s that conversation start

Stuart Levine (43m 13s):
In my experience where I’ve had to be in those situations, when the person comes into the office, say, Hey, look, there’s no real surprise here because you know, for the last six months, every month I’ve met with you on the following metrics, big word metrics. And I’ve asked you, I’ve provided extra firepower on coaching for you. And I’ve done some with you and meetings with your people, your numbers, quality outcomes, your numbers on recruiting new nursing professionals into your department, aren’t working. And here’s why based on the healthcare economics of where we’re going as an institution where you’re lagging, you’re a department, you’re a unit that you’re responsible for is now lagging the institution by 18%.

Stuart Levine (43m 58s):
I have responsibility to the board and the board is asking these questions. So based on that, what I want to do is give you an out package of whatever is appropriate and try to part in a difficult situation in a professional way so that you can go on and take this as a learning experience. And we can go on to do our work. It’s just like that. And it doesn’t take an hour. That’s probably about the time, just a little conversation.

Dr. Anthony Orsini (44m 28s):
Parallels of what you just said and what we teach. I started the breaking bad news program and program has also an acronym and the G and that program teaches doctors how to give bad news to patients or businessmen, how to let people go. The G is gradual is the most important rule of breaking bad news. And it’s exactly what you said. The rule of thumb is that you have to brace people for what they’re about to hear and that the patient or the worker should already know that the bad news is coming before you give it to them. It’s just like a quarterback is blindsided. If they know it’s coming, they can brace for it. And you mentioned about giving the data and what led up to this, that’s the review and program. And so there’s so many parallels into this. And if you understand how to do that, give bad news in the boardroom or give bad news to patients, you can make it least bad for these people.

Dr. Anthony Orsini (45m 16s):
And again, your intention is not to hurt anybody or be mean it’s just it’s to leave on a good basis. I think that’s great advice. So Stuart, this has been fantastic. I can’t thank you enough. I think my audience is really going to get a lot out of this, the business of healthcare and why we need people like you in healthcare, advising us. And as you mentioned, why we need physicians to be on that board and to be all in the same room, if we’re going to do what’s best for our patients. And so I appreciate all the advice you’ve given us today. What’s the best way for people to get in touch with you.

Stuart Levine (45m 48s):
They can just go to our website. It’s a STUART LEVINE dot com and they can see what we do on committee charters, which are very important in health care to make sure that they’re current and reflect the quality metrics and the issues like that. So just be, you know, STUART LEVINE website, and they can find us.

Dr. Anthony Orsini (46m 7s):
And we’re going to add all that into the show notes. We’ll put all the links to this, into the show notes. So you don’t have to worry about writing this down if you’re driving and we’ll put all of Stuart’s information on that. If you enjoyed this podcast, please go ahead and hit subscribe on your favorite podcast platform. If you’d like to get in touch with me and get in touch with me through our website, the Orsini Way. Com. Stuart, thank you so much and appreciate you donating your time to us because I think my audience really learned a lot today.

Stuart Levine (46m 34s):
Thanks a lot, Doc. I appreciate it. And God bless you.

Announcer (46m 39s):
If you enjoy this podcast, please hit the subscribe button and leave a comment and review. To contact Dr. Orsini and his team, or to suggest guests for a future podcast, visit us at Orsini Way.com. The comments and opinions of the interviewer and guests on this podcast are their own and do not necessarily reflect the opinions and beliefs of their present and past employers or institutions.

Difficult Conversations About Breast Cancer

Dr. Michele Blackwood (1s):
Breast cancer. The field has evolved dramatically those first 10 years in the 1990s to the 2000’s where you saw changes in surgery. We saw changes in reconstruction. We started to see survival rates that were amazing, that hadn’t happened ever in the history of surgery or in the history of that. We were keeping track of the medicine. So I was still my father. I think I joined just like he joined infectious diseases in the sixties when all the new antibiotics and immunology came out. Well, I joined the breast cancer field and sort of the same way as you know, thankfully and Liz knows survival rates are amazing. Women and men can move beyond breast cancer. It doesn’t have to be their whole identity anymore.

Dr. Michele Blackwood (43s):
We don’t look at five-year survivals anymore. We look at full lives up until the age of 90 after 90, I guess we’re kind of on our own.

Announcer (53s):
Welcome to Difficult Conversations: Lessons I Learned as an ICU Physician with Dr. Anthony Orsini, Dr. Orsini is a practicing physician and president and CEO of the Orsini Way. As a frequent keynote speaker and author, Dr. Orsini has been training healthcare professionals and business leaders how to navigate through the most difficult dialogues. Each week you will hear inspiring interviews with experts in their field who tell their story and provide practical advice on how to effectively communicate. Whether you are a doctor faced with giving a patient bad news, a business leader who wants to get the most out of his or her team members, or someone who just wants to learn to communicate better this is the podcast for you.

Dr. Anthony Orsini (1m 38s):
Well, hello and welcome to another episode of Difficult Conversations: lessons I learned as an ICU physician. This is Dr. Anthony Orsini, and I’ll be your host again this week. Well, I’m very excited about today’s interview and about this incredibly important topic that we’re about to discuss. Now, today I’m recording this episode toward the end of October and as many of you know, October is breast cancer awareness month. So although this episode will probably not go live for several weeks, breast cancer awareness should be on our minds all year round. Well, I can think of no one more qualified to talk about breast cancer and the many difficult conversations associated with this diagnosis then Dr. Michele Blackwood. Dr.

Dr. Anthony Orsini (2m 18s):
Blackwood is currently the chief of breast services at Robert Wood Johnson, Barnabas Health and the Rutgers Cancer Institute of New Jersey. She also serves as the Northern regional director of breast services and joined St. Barnabas Medical Center as the Medical Director of Breast Health and Disease Management in 2009. Previously, she served on several leadership positions at Nyack hospital in New York and Stanford hospital in Connecticut, Dr. Blackwood earned their medical degree at the medical university of South Carolina and was a global scholar at Harvard university she’s well-published and highly respected in her field to say the least she has appeared on national and local media programs, including Fox Five, 60 minutes, CBS’s Early Show and Good Day New York.

Dr. Anthony Orsini (3m 4s):
But even with all those credentials, it is her reputation for the compassionate manner in which she practices and her ability to navigate the many difficult conversations that occur when breast cancer happens. That is the true meaning of medicine. So I’m very, very excited to have Michele here with us today. We also have another guest that I’ll tell you about in a moment, but Michele for now, thank you so much for being here. We really appreciate you taking your time out of your very busy schedule.

Dr. Michele Blackwood (3m 32s):
Thank you so much Anthony, I’m thrilled to be here. I have to say, I think this is my first podcast.

Dr. Anthony Orsini (3m 37s):
Oh, that’s awesome. So it’s a lot of fun. We’re going to really have great time and we’re just going to let and see where this conversation goes. But as you know, the topic is Difficult Conversations, and I really want to get into that. Full disclosure, Michele and I grew up one town over from each other, Northern New Jersey, and it is certainly a small world, right? I think I went to high school with your sister, played basketball against your brother. Your father is a noted infectious disease specialist. So you come from a family of medical doctors. And then for those of you who know about the Orsini Way and have listened to this podcast before Liz Poret-Christ is our director of programming at the Orsini Way and a good friend for the last 10 years. And we also have Liz with us today and Liz among many other things.

Dr. Anthony Orsini (4m 21s):
Not only does she teach compassionate communication medicine, but she was also a patient of Dr. Blackwood. So Liz, thanks for joining us. And you’re going to just chime in whenever you feel fit, we’re going to hear it from both sides here.

Elizabeth Poret-Christ (4m 34s):
Absolutely. My two favorite people on a podcast, how could this go wrong?

Dr. Anthony Orsini (4m 38s):
You’re so nice. So Michele, let’s start off with, you know, I always believe in building rapport and building trust. So let’s start off with you just telling the audience a little bit about yourself, your professional career, how you got here, but also, you know, we talked about where you’re from, but just tell us about yourself. So our audience can get to know you.

Dr. Michele Blackwood (4m 56s):
So I am a breast cancer surgeon, as you said before. I always knew I wanted to be a doctor since I was eight years old. I had an illness that took me out of school for a year. My father, as you said, was a well-known physician. And I think my illness was very tough on my parents. And even my siblings, four out of the five of us did become doctors. Only one went on to something other than medicine,

Dr. Anthony Orsini (5m 19s):
Probably the smart one.

Dr. Michele Blackwood (5m 20s):
I was going to say the smart one or the successful one.

Dr. Anthony Orsini (5m 22s):
I mean, that is pretty amazing how many people went into medicine. And the first thought I have now that I have children that are through colleges, boy, that was very expensive for your father.

Dr. Michele Blackwood (5m 32s):
And so I don’t know how they did it. I have had three also through college and it is daunting. I tried to fight being a doctor for a long time. I went to Georgetown and undergrad and took all the pre-med classes. But my father, as you know, is a very influential physician. Very smart man, saved many, many lives. And I had rotated with him in the summers and worked at St. Michael’s in Newark and loved it, but also thought there’s no way I could measure up to that in my lifetime. So I tried everything, but to become a doctor. And so after I graduated from undergrad, I took a year off. Then I worked on the commodities exchange in New York.

Dr. Michele Blackwood (6m 12s):
I worked in retail. I was the best gift buyer in Hilton head island, South Carolina you’ve ever seen. I didn’t know anything about buying by the way, I still don’t. I was a merchandise manager. I had the best wardrobe of my life, but something was missing and I really felt a true calling. And you both probably understand this when you’re trying to figure out what you want to be in life. And I decided I really did want to be a doctor. So I applied to medical school and was thankfully granted admission. And I knew the day I started medical school, I was in the right spot. I just knew in my heart of hearts, I was where I was supposed to be.

Dr. Michele Blackwood (6m 54s):
I enjoyed medical school as difficult as It was, it was for history major to go to medical school. I really loved it. And I loved anatomy, physiology, pharmacology, embryology. I still think about those things every day. And then when I was getting ready to rotate through my rotations, I actually, as you know, Tony, your third year of medical school, basic five basic rotations, my first rotation was psychiatry. And I liked that. I was actually, that was my first one. I was at the VA hospital and I was fascinated. And it was just the time when they were starting the meds like that were groundbreaking in psychiatry. Then I went on to pediatrics, knew pediatrics was not for me, but then I went to internal medicine and I thought I was going to become an infectious disease specialist like my father, but I put surgery last in my rotations because I thought there’s no way I’m going to be a surgeon back then women were not surgeons.

Dr. Michele Blackwood (7m 49s):
And why would I ever want to be a surgeon? And all of a sudden, my last rotation, it all clicked. And I thought, wow, this is what I want to do. I want to fix people. I want to fix them relatively quickly. So then I became a general surgery resident, much to my father’s chagrin. And that’s a five-year road, as you know, back, at least back then. And while I was a general surgery resident, I was the only woman. And I rotated as many of people in the New York area to through Memorial Sloan Kettering cancer center. I rotated there as a medical student. I rotated there for almost a year as a fourth-year resident, and then I rotate it. And then I thought about becoming a GYN oncologist, but suddenly the world of breast cancer surgery was changing and evolving and was fascinating.

Dr. Michele Blackwood (8m 36s):
And I thought, wow, this is something I could do. So I went to Memorial Sloan Kettering. I can’t believe I still do this as a chief resident. And I said, I want to do a fellowship in breast surgery. And they said, oh, okay. Not sure what that would involve, but great idea. So I was their first fellow of breast cancer surgery at Memorial. I was hired by Dr. Kinny and then I worked under Dr. Borgen and Dr. Patrick and Dr. Sherit, it was a great, great year. And I became my passion and I felt like I had something different to offer than most general surgeons.

Dr. Michele Blackwood (9m 15s):
And I really wanted to help mostly women, but I help men as well. Breast cancer. The field has evolved dramatically. Those first 10 years in the 1990s to the 2000’s, we saw changes in surgery. We saw changes in reconstruction. We started to see survival rates that were amazing, you know, that hadn’t happened ever in the history of surgery or in the history of that. We were keeping track of in medicine. So I always tell my father, I think I joined just like he joined infectious diseases in the sixties when all the new antibiotics and immunology came out. So I joined breast cancer field and sort of the same way it’s evolved. As you know, thankfully and Liz knows survival rates are amazing.

Dr. Michele Blackwood (9m 58s):
Women and men can move beyond breast cancer. It doesn’t have to be their whole identity anymore. We don’t look at five-year survivals anymore. We look at full lives up until the age of 90, after 90, I guess we’re kind of on our own, but you know, when I was a fellow, if we had five-year survivals, we were thrilled. Now we’re not settling for that. We’ve gone so far beyond that. You know, at first we escalated all our care in the 1990s. Then we literally in the 2000’s personalized care and now we’re deescalating care. So I see this as an evolution and I enjoy being part of that process.

Dr. Michele Blackwood (10m 40s):
Love my patients, whether they’re my friends or not like Liz is I like helping someone through a very difficult time in their life. And I like having them move beyond that, to where they’re living full and happy lives. I love running into a patient at the grocery store or in church. And they have no idea who I am, but they know they know me. And I like that idea that, you know, at one point, all they thought about was breast cancer. Now sometimes when they go for their mammogram, they even forget which side they had it on.

Dr. Anthony Orsini (11m 7s):
And that really is your reputation. You know, parallel universe is here. So I meet Liz probably 10 or 12 years ago. And Liz and I have been teaching physicians how to communicate for 10 years, not even knowing this at the same time, Liz is friends with you. And so there’s these two parallel universes going on. And then Liz, she could tell the story. So Liz finds out that she has breast cancer tells me she’s going to. And I said, well, I think I went to school with her sister and I know her and she’s wonderful. And so, and now we’re all here together. So then we’re going to ask Liz about some of those conversations too, but I looked up some statistics before I got in. I did a little bit of my homework.

Dr. Anthony Orsini (11m 48s):
One in eight women in the US will develop invasive breast cancer over the course of her lifetime. 43, 600 women in the US are expected to die in 2021 from breast cancer. Even with all those advances that you talked about, but the overall death rate from breast cancer has decreased every single year from 2013 to 2018. And that is really a testament to medicine and how we are getting better and how we are specializing. But here today, I want to talk about really, you know, it’s been said by me and others, that healing can begin when you first heard the diagnosis and medicine in, this is what Liz and I are all talking about.

Dr. Anthony Orsini (12m 30s):
Medicine is about relationships. It’s not about the surgery, although that’s extremely important, but it’s about those relationships that you talked about when you meet somebody in a grocery store and how they say hello to you, but I’ve not heard the word cancer with respect to me. I’ve been very fortunate. Thank God. But Liz has, and Liz found out. And first of all, I want to ask Liz about her experience when you first, and that was a little different cause you’re going to a friend already, but how did that conversation go, Liz? And you talked about it a little bit in your last podcast, and then I’m going to ask Michele how she approaches that conversation.

Elizabeth Poret-Christ (13m 6s):
So breast cancer was not foreign to me, as a child I lost two aunts that I was very close to from breast cancer. And as an adult, I lost two friends that I was very close to from breast cancer. So it wasn’t foreign to me, but I went for my annual mammogram. Now to back up a little bit, I had already been diagnosed in 2016 with a blood condition that is considered a blood cancer. So I had already heard the word cancer in relation to my own health and kind of navigated that terror earlier. So when I went for my mammogram, I was having some pain in my breast and it was weird. And I went to the doctor and she said, well, you’re due for your mammogram.

Elizabeth Poret-Christ (13m 49s):
Do you want us to do a sonogram? I think it’s really unnecessary. And I said, yes, I think I would like that. I don’t understand why I’m having this pain. It’s come on very suddenly. And it’s concerning to me. So I went for my mammogram, they did the 3D mammogram and the radiologist tech comes back to me and says, you don’t need the sonogram. Your mammogram is clear. And I said, I’d really still like to have the sonogram. So they do the sonogram and the radiologists in that practice, they give you your results right away. So they said, please come to the radiologist’s office. She’d like to speak with you and I’m walking and you kind of start negotiating with God on your way into that room. Gosh, I hope everything’s okay. But there’s that nagging feeling in the back of your brain?

Elizabeth Poret-Christ (14m 31s):
That it’s not. So I walk in her office, I sit down and she says,Liz, I’m concerned. And I start thinking of all the training that we’ve done with physicians, it’s now 2018. I’ve been working with the Orsini Way for many, many, many years. And I know when a doctor says that they’re concerned or worried that there’s something wrong. So she said, I’m really concerned. I think you need to have a biopsy. Here’s the name of two surgeons and please go do that right away. I don’t think this is nothing I said, okay. So I just picked the first card that she handed me called and made an appointment and went and had a biopsy. I don’t know why I did it that way. I had been friends with Dr.

Elizabeth Poret-Christ (15m 12s):
Blackwood for years. She was a good friend. I know what a wonderful person she is, but I think I was just in shock and

Dr. Michele Blackwood (15m 18s):
You have my cell phone.

Elizabeth Poret-Christ (15m 21s):
and I had her cell phone. So I just wasn’t thinking I just was in shock. I think I just honestly was in shock. I knew that the words worried and concerned meant something. So I went to somebody I’d never met before I had a biopsy. And he said to me, Liz, I wish I could tell you this is nothing, but it’s not, but I can tell you everything’s going to be okay. It’s very small. It’s very early. It’s actually a miracle that anybody even saw this it’s watermelon seed tiny. So whatever it is you’re going to be okay, but I’m telling you it’s cancer. So my husband and I are like, okay, so at 10 o’clock at night, I get the report from the portal, the biopsy report from the portal that our hospital system used.

Elizabeth Poret-Christ (16m 5s):
And I decided to text it to Michele. And I say, here, look what I got. She calls me and I was half asleep. Cause I go to bed early and she said, why didn’t you just drive to me from the radiologist’s office? Like, what are you doing? And I’m like, for someone that knew how to navigate the system, that already had a complex medical condition, I just was in shock. So my husband and I went to Michele’s office, well, my blood condition complicates matters. I was always one of those people and watched both my aunts have double mastectomies that said, if this is ever me, this is what I’m doing. And then all of a sudden there was a complex complication that said, maybe you can’t do that.

Elizabeth Poret-Christ (16m 48s):
It’s not the best thing to do. So because the biopsy was done by another surgeon, we went to that surgeon’s office. And I said, well, what do you do to prepare for someone that has the blood condition that I have? And that surgeon literally said, I’m not afraid of a little blood. And then that was it. And told me what he was going to do. And we left and we got in the car and we had an appointment with Michele the next day. And I said to my husband, that answer doesn’t work for me. I’m a very medically knowledgeable patient. It’s what I do for a living. I write medical cases for actors. Like I’m not new to this. I have a child with a complex medical like that answer doesn’t work. And then we walked into Michele’s office and she had the genetic lab on the phone with what kind of biopsy we were doing.

Elizabeth Poret-Christ (17m 34s):
She had already spoken to my hematologist. There was already a plan in place. There was already a plastic surgeon picked out and I literally felt like a red carpet had been rolled out for me with the plan with the map. But more than that with the compassion to hold my hand and tell me that everything was going to go be okay. And that she had me and I it’s like that. I’ve got you and I’m not going to leave you. And we’re going to get you to the end of this journey was so incredibly comforting to me. I don’t know if I would have been as strong and as focused without her.

Elizabeth Poret-Christ (18m 14s):
It just was a miracle.

Dr. Anthony Orsini (18m 16s):
And that’s when the healing starts. So Michele, take us through your thought process when you have a patient is coming in and you have that initial conversation because as you and I know, and I know that you, you do this from, you know what Liz told me and, and your reputation, it’s all about building trust and forming that relationship. And we know that how you break bad news and you, how you have that initial conversation. Like Liz had that conversation with the other surgeon who said, I’m not afraid of blood. And she’s like, I’m out of here. Tell us what your approach, your plan and your thoughts on how you have that initial conversation. Because there’s going to be many more after that, but at least the initial one for now,

Dr. Michele Blackwood (18m 52s):
By the way, Liz, thank you for sharing that. It’s important for us physicians to hear those stories too, because you had never know how you come across to someone. Right, Tony. I mean, first of all, I think when I see a patient who’s a friend or not a friend, I always need to know where they’re coming from, what’s going on in their lives. Where do they live? How do they work? How do they make a living? Have they been through a lot in the past year or two? And I’ll be honest with you. I see a lot of patients who come in with a newly diagnosed breast cancer who have had some sort of tragedy or loss the year before, two years before. And right now we’re seeing an overwhelming number, as you can imagine.

Dr. Michele Blackwood (19m 32s):
I think I always see some of my office lately. And you know, we were hit by COVID early. A lot of people have lost someone to COVID in their family in the past year. And some, one of my patients lost eight members to COVID. And again, we were hit early here in New Jersey and we were just hammered by the way, it never gets easier to have that conversation with a patient. Did you know that ?

Dr. Anthony Orsini (19m 55s):
It doesn’t get easier, but we always say, once you get good at it, then you’re proud of that skill you have, as opposed to many physicians who don’t take the time to get good at it. And it’s always a task and they get nervous. So, but yes, it’s always hard, but it’s not hard because you don’t know how to do it. It’s, it’s hard because you’re a compassionate person. So,

Dr. Michele Blackwood (20m 12s):
So one of my professors who, he was a stoic guy from Kentucky, he used to say to me, if it ever gets easy for you to tell someone they have breast cancer, you probably shouldn’t be doing it anymore. So the other day I had to call a couple of patients to tell them what their biopsies were. And it’s never easy phone call. I used to make patients come into the office to have those discussions first. But the reality is I don’t want them coming alone. I want them coming with a family member, somebody who loves them, we could be a second set of ears. So one of the first things I do is I try and find out how they’re doing. They’ve had the diagnosis, they heard it maybe the day or two before, where are they in that? And I’ll be honest with you now that everybody wears masks in my office, the patients and myself included, it’s not as easy to read their faces.

Dr. Michele Blackwood (20m 57s):
You know, usually I’m pretty good at reading a room or reading someone’s face. It’s much more difficult now. And we really have to use our words in a much more emphatic way. So obviously I’ve seen the paperwork, right? I know what kind of cancer it is. I usually know how big the cancer is. I can pretty much stage the patient clinically before I meet them. I’ve seen their films already, but I need more. And I always need to know, do you live alone? Do you live with a partner? Do you have a significant other, do you have children? Did you just lose your job? Are you working from home now? That’s a big deal. Of course. Are you in a safe situation? Are you at all, have any instability with your food sources or where you’re getting your food from?

Dr. Michele Blackwood (21m 39s):
That’s been a big deal this past year and a half. Some of my older ladies, you know, they live alone. They haven’t been able to see their families. Their families have moved out of New Jersey. You know, I find out sometimes that they’re not eating healthfully. You know, I need to know how big or how little we can do surgically for them so that we’re not hurting them. You and I took an oath, do no harm. I take that very seriously. I never, ever, ever want to hurt someone. So I need to know where they are emotional. I need to know where they are physically. Where do they live? I need to know what their home situation is. I need to know what their education level is.

Dr. Michele Blackwood (22m 19s):
I mean, obviously Liz knows everything there is, and it is a daunting prospect to take care of your friend who is watching every word you say and I adore her and Liz has helped me.

Elizabeth Poret-Christ (22m 32s):
You get an A+

Dr. Michele Blackwood (22m 33s):
So, and it grieves you as a physician to take care of a friend, to be honest with you, your heart hurts. Not that it doesn’t hurt to take care of everybody, but when you know someone you love is going through this, it sucks. That’s a terrible word, but it’s harder in many ways, but yet I also know that I’m going to make sure I do everything possible that she’s going to be okay. Liz is a complicated lady.

Dr. Anthony Orsini (23m 13s):
Tell me about it, I work with her every day!

Elizabeth Poret-Christ (23m 15s):
Ok, this is not a roast.

Dr. Michele Blackwood (23m 17s):
Liz can’t do typical genetic testing on her bloodstream. Like I do with my other patients. I’ve been doing genetic testing for years and years because I think it’s important. And now, you know, the American society of breast surgeons agrees with me. So Liz can not do just blood work and have a gene test. We actually had to do on the fiberblast out of her tissue. And in the operating room, I had to have a separate piece of tissue to send it for that, which is a totally different type of genetic testing. Unfortunately it only tests for a few genes when you use fiberblasts, because they actually have to grow her tissue out into a culture. And then do the gene testing on that.

Dr. Michele Blackwood (23m 56s):
I have since Liz it as texted me recently about doing more gene testing and I have literally called friends from mass general all the way down to Charleston to see what their thoughts are. And it is complicated. It’s a complicated complication is a complicated story. And as a physician, you have to think outside the box. But in general, when I see a patient, the first thing I have to see is how they’re doing. I also have to see their eyes. I need to look into their eyes and see are they comprehending anything because 90% of the time, and this has been proven out by many journals when you hear the word cancer and it’s associated with you, your cognitive skill goes down by 40%.

Dr. Michele Blackwood (24m 38s):
The first month after diagnosis. And Liz will tell you she’s a very educated consumer and a very smart woman. There’s no way you can remove yourself from that diagnosis. I’ve seen it with my own family members. Every time one of my family members had to go to the doctor for a cancer diagnosis. I was there to help interpret those because they don’t hear

Dr. Anthony Orsini (24m 59s):
The statistically only about 10% of what someone hears after they hear the word cancer is actually retained. And so it’s really important for you to get what you need to get in as far as information from the patient and information to the patient. Before you say that word, because as we say, you’re actually redefining that person, right? They went from a mother and a wife or a father or whatever, to a breast cancer person, a person with cancer. And you can imagine that their whole world is turned upside down. So let me ask you about that relationship and getting to know the patients. So, you know, I’m not a breast surgeon, so I don’t know, but I know that there’s different options as you go through that diagnosis.

Dr. Anthony Orsini (25m 43s):
So, you know, lumpectomy, mastectomy, there’s different surgical options, but everybody’s different, right? There may be some people have more anxiety about, you know, maybe a lumpectomy would be appropriate, but maybe there’s some, somebody who just can’t handle that stress or the unknown. And so how do you work through that with maybe you think a lumpectomy might be appropriate, but this person’s more anxious or vice versa.

Dr. Michele Blackwood (26m 3s):
So the first thing I do is I try and simplify it. Like you said, there’s basically two surgical options, lots of variations under those two surgical options. But I basically say there’s a lumpectomy and radiation or a mastectomy with, or without reconstruction. And then we move on from there. And then I say, so first of all, there’s a couple of things we need to do as homework. One is a lot of patients, I do an MRI on who have a dense mammogram. Liz knows this, and the MRIs are very helpful at just finding really how big the tumor is, what the lymph nodes look like. It gives me a peak into the lung tissue, the bones, the liver. It really helps clinically stage the patients.

Dr. Michele Blackwood (26m 44s):
So are they really a stage 1? And I have to say, since the use of good breast MRI, I don’t really have many surprises at surgery. Thank God. It’s not perfect. No test is, but it’s very helpful. Second thing is we need to do some sort of gene testing because to your point, some people get anxious because if they keep their breast tissue and they do a lumpectomy, they have a chance of recurrence in their life. If they have a gene mutation that caused that breast cancer, they might have a higher chance of getting a recurrence than somebody else. We need to define that role. I think giving patients options is a great thing. So know that I feel that way, but I think patients need guidance.

Dr. Michele Blackwood (27m 27s):
So as a physician, I think you just suddenly, hi Mrs. Jones, you’re a breast cancer and here are your options. Choose, choose from a or B. It’s not like that. You need someone to say, I think this is a safe option. My dad had a great style. He was very paternalistic and people love that about him. And he was really a father to many, in some ways, I’m more of a, a big sister. I want to tell you, look, you’ve got this or you’ve got, this is your option. But I think in your situation, this works for you. I won’t let you do the wrong thing, but I do give you a lot of options.

Dr. Anthony Orsini (28m 2s):
You know, that’s an extra appointment shell. Liz will tell you that when we teach all the doctors for the last 10 years, it is a very common mistake or misconception that some doctors are taught incorrectly. I believe in you believe our job is to provide information. In fact, we’ll ask a lot of doctors, what was your main goal? And let’s say to provide the information and, and Liz, and I will say, why don’t you just give him a Google doc? So here you can, here’s your options. Let me know which one you want. It’s about relationships. And I don’t think it’s very fair to say, pick one. And we, I joke with the doctors and say, Hey, when you go to the mechanic for your car, the mechanic, doesn’t say, well, I can do the alternator. I can do the battery. Which one do you want me to do?

Dr. Anthony Orsini (28m 43s):
You trust the mechanic? And if there’s no trust, and then there’s no relationship. If there’s no relationship, then maybe there should be a different doctor that they do trust.

Elizabeth Poret-Christ (28m 54s):
I was very grateful to have had Michelle tell me what her expert opinion was. And in fact, she said to me, when I walked in, I have the lemonade from the lemons. I’m like, really? I’d like that. Tell me, here’s what I think we should do. Meaning she and I, we were a team. She had my back and I say this all the time. And I have a really good friend who a very short time after me was diagnosed with a very complicated breast cancer and didn’t have options. I was very grateful that I never felt like my options were taken away, but the best path for me was very thoughtful and presented.

Elizabeth Poret-Christ (29m 37s):
And I trusted Michele completely and said, yep, if that’s what you think I should do, that’s what I want to do. And it wasn’t what I initially thought I was doing, but I was very grateful to have had that guidance.

Dr. Anthony Orsini (29m 49s):
And I think Michele, if you don’t mind me saying, I think the going back to what you initially said about getting to know the patient and building that rapport, because that puts you in the position then to say, this is what I recommend. And when you trust somebody, you’ll say, okay. And sometimes they’ll say, no, I don’t want to do that. That’s fine. But it’s just not fair. I mean, we’re still teaching medical students to be a menu, pick one from a and pick one from B. And I’m hoping we can stop that because especially now we need to be able to, as we say, figuratively, put our arms around the doctor’s shoulders and she’s going to lead me to the next step. I trust you in whatever you say.

Dr. Anthony Orsini (30m 29s):
And I think we’re getting better at that, but something that we need to do more in medical school,

Dr. Michele Blackwood (30m 33s):
I think also you evolve as a physician. I’m sure you evolved in your style. My style has definitely changed over time. You know, I had a patient come in recently and I was a second opinion, which is great. I think it’s not a bad thing to get a second opinion. I think if you got a third, fourth, fifth, sixth opinion, you probably are just looking for someone to second. What you think is important. I don’t think that helps you. I think it confuses the situation, but I did say to her, look, you have to be comfortable with your choice of physician. If you’re not comfortable with me for better or worse, there are hundreds of other breast surgeons out there. And I think you’ve got to find who your, where your comfort level is.

Dr. Michele Blackwood (31m 13s):
I think that there are a lot of options in breast cancer that all lead to the same survival rate, which is of course what we’re looking for good survival. But I also think there’s a lot of ways to get there. The choices I have to had patients completely paralyzed by their choices. So when we get to that stage, and if I, if I feel, if I see that look in their eyes and panic, and they just can’t make a decision, or it’s been weeks now, and we’re still not moving forward on this, I call them and say, look, just let me at least get the cancer out or take a pill. Let’s do something to fight this cancer. Cause I don’t want this cancer to metastasize while we’re waiting.

Dr. Michele Blackwood (31m 54s):
And I think that works well sometimes because it takes the diagnostic paralysis and choice out of their hands. I agree with you, Tony, that I think we give options, which sounds like what we’re supposed to do. But I do think over time you learn, like I had a patient the other day, diabetic hypertensive lady, totally sedentary lifestyle, you know, obese, doesn’t walk. She loves her life and she’s happy there. But I said to her, look, what I do to you is to get rid of cancer, but I can harm you by that too. So we need to meet each other halfway. Somehow you’ve got to prepare for the surgery. I prepare for the surgery too, but it’s not me doing something to you, Liz of course is a very healthful person.

Dr. Michele Blackwood (32m 41s):
So she knows what it takes, but I need those patients to be in sync with me and to be a team member because otherwise we’re not going to have a good outcome. I had a patient recently who had a lot of addictions and I said to her, look, your addictions are going to kill you well, before this breast cancer is going to kill you. And so we actually got her into a couple of programs and I got a, I talked to a psychiatrist and now she’s, her addictions are being treated. And I feel like, you know, we have a chance here, but I really do believe it’s a team approach. I think if you think some doctors just going to wave a wand over you and you’re going to be healthy, it doesn’t work like that. You’re not just going to take a pill and be healthy. We as Americans would love that.

Dr. Michele Blackwood (33m 21s):
I mean, who wouldn’t, but it doesn’t work like that. The body doesn’t work like that. The mind and body also have to be in sync. And I don’t think I appreciated that 20 or 30 years ago. I didn’t realize nutrition was important. I think I had one week of nutrition in medical school. I don’t know about you, but they didn’t give us much. I think it has to be a multi-layered approach too. I think if you think as a physician, you’re going to just fix this person and go on your way. It doesn’t work like that. If they don’t know what to eat before the surgery or after the surgery, if they don’t know they have to stop smoking. If they don’t know that if they could just walk 20 minutes a day before my surgery they will have a better outcome. There’s so many things that we can make small changes in our life and actually have a better outcome overall.

Dr. Michele Blackwood (34m 7s):
So I try and address a lot of this stuff. I can’t tell you I’m perfect at it. But I do know that I’ve had patients with severe anxiety disorders that I have sent them to a good psychologist prior to surgery to try and work on those things. Because your head and you, and I both know this, you don’t function without your brain, but you know, that brain needs to be in sync with what else is going on in your body. And you have to be in the right head space to heal from surgery. You have to know that you have to be an active participant in this. You’re not just a passive person and that, and I think we’ve gotten away from that. I don’t think we tell patients that

Dr. Anthony Orsini (34m 48s):
Yeah, it really needs to be a partnership. Michelle, the last question that I usually ask all my patients is probably going to be the same question that I’m about to ask you all tied together. So we’ll make it together. Walk us through the conversations that you have to have some times when things don’t go well, when you have that patient who options are done and it looks like they’re going to pass away. And I can tell that you have so much compassion. You take that personally, but you’ve had many instances. I’m sure we’ve had to tell patients there’s nothing else. How do you approach that conversation?

Dr. Michele Blackwood (35m 22s):
Interesting. Tony is one of the hardest conversations as you know, you can have with a patient and their family. Within the past year, I had two years out of really one of my favorite patients, just lovely lady developed a secondary sarcoma. And we had to have the conversation about palliative care and you know, the adult kids don’t want to hear it. Of course, I do talk about faith. I do talk about comfort. I talk about quality of life because I think that’s important. You know it with my own family members. I think some of the things I did to prolong their life was probably not the right thing to do. I think when they know that you’re upset by it too.

Dr. Michele Blackwood (36m 4s):
It’s okay to let them know the way I approach it is we’ve run our race. We’ve exhausted all possibilities. I’ve made phone calls. I’ve sent you here. I’ve done a consult there. I try and explain that. We’ve got to start talking about palliative care. Hospice care is a very hard thing to bring up because people feel like hospice care is giving up. I find palliative care is more tolerable for people to hear. And of course, as you know, palliative and hospice is a fine line between them and they kind of meld together. You know, having been through it with my own family members, I have total empathy towards it. I have to say one of the hardest things to have the conversation with is another doctor about their family member.

Dr. Michele Blackwood (36m 44s):
As you know, doctors and nurses, they don’t want to give up. We don’t want to give up on someone, but sometimes you have to say, unfortunately, this is it, but we will make your life comfortable. We will make your time with your family of quality time, as much as we can. And I think that trying to help them bridge that we talked about transitioning before I don’t use that word for this. I tend to use the word quality because I was able to on both my parents’ death bed, be there and speak to them.

Dr. Michele Blackwood (37m 24s):
And there’s not ever closure. I don’t think, but there’s at least peace with what the end should be or should have been.

Dr. Anthony Orsini (37m 32s):
And there’s things that we can do to help people even in dying. And it’s important that doctors take pride in that also or palliative care doctors do, but sometimes people on the front lines like you and me, we forget that. And we feel that it’s a failure. There’s a great story about Rabbi Kushner. Liz has heard this many times, Dr. Rabbi Kushner wrote when bad things happen to good people, love him. And he and I saw an interview with him one time and he was getting ready to do an interview on TV with an evangelical healer. And the healer was one of these guys who said, you know, he put his hand on people’s forehead and he was, they were cured from cancer and, and Rabbi Kushner is like, this guy is such a quack like, you know, he really can.

Dr. Anthony Orsini (38m 13s):
So he said to him in the green room, before the interview Rabbi Kushner goes, do you really think that you can heal people just by touching them on the forehead? And the guy turned to Rabbi Kushner and he said, I don’t cure people. But by doing that, I give them hope. I give them peace. And in my mind, that’s what healing is. And I think that’s what we need to remember as physicians that we may not be able to cure everyone, but in our compassion, in our kindness and our words and, and how we present it, we can certainly heal. And so I think that’s what you were saying. I think that’s where I find the most by doing neonatology. Unfortunately, there’s a lot of sadness and I think neonatologists and many of the NICU nurses do death an dying better than anyone maybe.

Dr. Anthony Orsini (38m 59s):
Cause we see it so much, but also because we understand, so Michelle, before we close, what do you want to tell people today is breast cancer awareness month, right in the middle of it or towards the end. What’s the message that you want to tell people out there, women, men, everything, what they should be doing and any words of wisdom that you can share with everybody before we leave?

Dr. Michele Blackwood (39m 19s):
Well, the, one of the biggest things I think people have to remember is during this pandemic or whatever we’re in right now, please come back and get your screenings done. I, myself am getting my every week I scheduled one more thing to check off my list because I didn’t, I needed my blood work. I just had my mammogram yesterday. You know, you got the women, you still need your screening tests done. And we reached a big birthday this year, my husband and I remind him, we both need colonoscopy this year. How fun. So I do think you got to get back to your doctor’s appointments as you know, and realize, and you’ve done, you know, this people have not come back. They’re still waiting out the pandemic. I get it. Most places are very safe.

Dr. Michele Blackwood (39m 59s):
I do believe in vaccinations. I do want people to get their vaccination. I just had my booster. I think you have to be an active partner in your own healthcare. And I think it’s time to get back, to see your doctors, getting your screenings, get your blood work, come back. We’re here. We’re ready. We’re we’re seeing patients in person. I also think in the breast cancer world, lots of hope so much has changed so much is evolving. It’s continuing to evolve. That’s one of the reasons I love this field. So don’t think if you feel a breast lump, but I have a lot of patients recently who felt this breast lump since March of 2020, don’t feel ashamed. Don’t feel upset that you didn’t get your mammogram for a year and a half.

Dr. Michele Blackwood (40m 39s):
Just come in. We’ll take care of it. They’ll fix it. We’ll figure out what it is. And we have lots of good doctors that are here to do that. And I also think that people need to know that when you’re doing what you’re doing in neonatology or I’m doing what I’m doing, you’ve got to remember that none of this is easy. When you have to tell patients bad news. My father always said, make sure patients know that they have hope. Hope is a very powerful medicine. And I agree with that, but I also think you have to know that a lot of people feel physicians don’t care anymore. That’s just not true. Many, many, many, many physicians, medical students, residents. They do care. We may not be as good at expressing ourselves for patients, but they really do care.

Dr. Michele Blackwood (41m 24s):
I mean, I work with medical students and residents, fellows. They care. It’s just, sometimes our communication may not be as open or honest as we would like it to be. But I do believe that most of us go into this field because we either had a calling or we want to help people. We’re not doing it for any other weird reasons.

Dr. Anthony Orsini (41m 44s):
An important message. There is hope with breast cancer and things are getting better. There’s a very high cure rate now. And I would also as a public announcement say, pretending, something’s not there, it doesn’t make it go away. You know, I had a cousin who had testicular cancer and just refuse to go to the doctor because he did not want to hear the doctors say the word cancer until it was the size of a grapefruit and it was already, you know, grade 4. And he passed from testicular cancer. So I think if you are feeling a lump or it’s time for you to go for your mammography, go because there’s something there, you have people like Michele Blackwood and other great doctors who will get you through this.

Dr. Anthony Orsini (42m 24s):
And Liz is a Testament to that. Liz did great and she’s still helping other people. So that’s, I think really the message that this whole thing that it’s about relationships, it’s about compassion and there’s hope out there. So that’s wonderful. Liz, anything you want to say before we leave Michele, this has been great.

Elizabeth Poret-Christ (42m 43s):
It’s been an odd journey to be on and hear this news, but it’s better to know than to not know because having your plan in place and having a team that supports you and that finds the lemonade from the lemons is the best possible outcome. And you’re going to do better when you believe that everyone’s got your back and I feel incredibly blessed to have had the team that I had.

Dr. Anthony Orsini (43m 6s):
Fantastic. Michele, thank you so much. What’s the best way for people to get in touch with you?

Dr. Michele Blackwood (43m 14s):
The best way is to call Liz. No, She does do that by the way. The best way is my office number. Believe it or not. I still have an old fashioned phone number landline in the office. 9 7 3 3 2 2 7 0 2. Oh, I have a great staff. Kelly de Lascaux is my director of our huge practice. Jen Wiener as my PA rockstar. Yes, exactly.

Dr. Anthony Orsini (43m 36s):
We’ll put all that information in the show notes, Michele, I can’t thank you enough. This has been a lot of fun. It’s really going to help a lot of people. I want to thank you for what you do and how you do it even more importantly. So thank you so much for being on.

Dr. Michele Blackwood (43m 48s):
Thank you for what you guys doing. You’re making a big difference.

Dr. Anthony Orsini (43m 52s):
Fantastic. If you enjoyed this episode, please go ahead and hit follow, download previous episodes. If you’d like to get in touch with me or Liz, you can reach us at the Orsini Way.com. Thank you, Michele. Again, this has been great and I can’t wait for the audience to hear this.

Announcer (44m 9s):
If you enjoy this podcast, please hit the subscribe button and leave a comment and review to contact Dr. Orsini and his team, or to suggest guests for future podcasts. Visit us at the Orsini Way.Com. The comments and opinions of the interviewer and guests on this podcast are their own and do not necessarily reflect the opinions and beliefs of their present and past employers or institutions.

Do No Harm - Conversations About Physician Suicide

Robyn Symon (2s):
So it was only when I was able to link the wellbeing of physicians, the suicide, the burnout, the depression of physicians to the high rate of medical mistakes. Then I thought, okay, this is a public health crisis that everyone should be aware of. So it’s not just your doctors have problems too bad. No. If your doctor is having problems and can’t get help, what kind of care are you going to get for your grandmother?

Announcer (39s):
Welcome to Difficult Conversations. Lessons I Learned as an ICU Physician with Dr. Anthony Orsini. Dr. Orsini is a practicing physician and president and CEO of the Orsini Way. As a frequent keynote speaker and author, Dr. Orsini has been training healthcare professionals and business leaders how to navigate through the most difficult dialogues. Each week you will hear inspiring interviews with experts in their field who tell their story and provide practical advice on how to effectively communicate. Whether you are a doctor faced with giving a patient bad news, a business leader who wants to get the most out of his or her team members or someone who just wants to learn to communicate better this is the podcast for you.

Dr. Anthony Orsini (1m 25s):
ell, welcome to another episode of Difficult Conversations: lessons I learned as an ICU physician. This is Dr. Anthony Orsini, and I’ll be your host again this week. We’ve had several episodes over the past 18 months on the topics of physician burnout, the toxic culture of medicine, and even the high rates of substance abuse and health healthcare professionals. In fact, as recently as last month, I had the honor of interviewing Dr. Robert Pearl. Who’s the author of the recently published book, Uncaring: how the culture of medicine is killing doctors and patients. So this is clearly a topic that I care about deeply and a topic that I speak about during my presentations and workshops frequently back in August, I was asked by Dr. Jonathan Fisher, also a previous guest on this podcast to speak about how better communication and relationship building can change the culture of medicine and limit physician burnout.

Dr. Anthony Orsini (2m 15s):
Jonathan, with no real experience in event planning, was able to produce the first-ever global summit on Ending physician burnout, three days of the most incredible and smart presenters I ever had the honor to be associated with. But where am I going with this? As part of the summit, attendees were able to get a free viewing of a groundbreaking and game-changing documentary called DO NO HARM. This documentary is an honest, deep dive into the increasing rate of physician suicide, its origins, and why this is a serious healthcare crisis, not only for physicians but patients as well today, we are extremely fortunate to have the producer of this documentary is Robyn Symon.

Dr. Anthony Orsini (2m 57s):
Robyn is a two-time Emmy award-winning filmmaker. A former PBS producer, Robyn has written and directed six featured documentary films, which have won top honors at film festivals and have been acquired for international distribution, including television broadcast and streaming platforms such as Netflix and Amazon. Robyn has produced and directed hundreds of hours of television program for various television networks, including PBS, the travel channel, NBC discovery, CNBC HGTV, the reelsfull-feature60-minute channel, and many others. In addition to two Emmy awards, Robyn has won two national telly awards, two NAVJ awards and honors from the associated press.

Dr. Anthony Orsini (3m 39s):
She’s a member of the producers Guild of America and the Alliance of women directors. And we are very lucky to have her as a guest today. Robyn, thank you so much for coming. It’s really an honor to have you on and take your time out of your busy schedule to be here today.

Robyn Symon (3m 54s):
It’s a pleasure to be here, Tony and so will be worth the wait.

Dr. Anthony Orsini (4m 0s):
Well, I was just so blown away by your film and I can’t wait to start speaking. I have a list of so many questions, even though I’ve kind of been speaking about this topic for a while. I learned so much from your film, but before we dive into the film, I just bought my audience as usual to just to get to know Robyn, how you got to this spot, as I say, how you got to the pinnacle of your career by being on my podcast today. So tell us who Robyn is and how you got here.

Robyn Symon (4m 25s):
Great to be here and speak to your audience. And I encourage you to see the full feature version at that conference. They show the 60 minute version and there is a full-feature version of Do No Harm on Amazon. And also you can get to it on a website to DO NO HARM, film.com because that’s really heavy. It’s much heavier than the 60-minute version, but we just wanted to leave a lot of time for panel discussion there, but it’s worth checking out. I started as a TV news reporter and then was a producer at PBS for years, and then went independent and about, I think it was 2014, a friend send me an op-ed piece from the New York times about these two young doctors who jumped from the roofs of their respective hospitals within a week of each other.

Robyn Symon (5m 17s):
And I come from a family of physicians. I had a grandfather and uncle who were physicians. My uncle was actually a surgeon in New Jersey and I have two cousins of the Cleveland Clinic and they never spoke about any issues. So I was really shocked to learn that these two young doctors with so much to look forward to so brilliant why they thought the logical solution to their problems was to jump. And it just set me on this mission to find out why, because we have a physician shortage.

Robyn Symon (5m 57s):
So what would compel them to do? Why would they feel so trapped in their lives when it was just beginning? So I started to investigate the causes behind physician burnout, beginning in medical school. And it was interesting, but you know, suicide is a problem in our culture in general. And I thought as a filmmaker, it might be a tough sell to talk about doctors because, at that point in 2014, there wasn’t a lot of empathy for physicians. Let’s face it. Okay. Doctors were the ones who people, patients value left me hanging in the waiting room while I have things to do.

Robyn Symon (6m 41s):
They don’t respect my time and they’re off playing golf. So

Dr. Anthony Orsini (6m 44s):
I think you’re right, a bunch of rich guys and girls, and take Wednesdays off to go play golf, which is as you know, not close to the truth,

Robyn Symon (6m 51s):
But I thought it would be a tough sell. So it was only when I was able to link the wellbeing of physicians, the suicide, the burnout, the depression of physicians to the high rate of medical mistakes. Then I thought, okay, this is a public health crisis that everyone should be aware of. So it’s not just your doctors have problems too bad. No. If your doctor is having problems and can’t get help, what kind of care are you going to get for your grandmother?

Robyn Symon (7m 30s):
So that’s what started me on this journey in 2014. And it’s been an uphill battle ever since to get the film made and out there.draw-dropping

Dr. Anthony Orsini (7m 41s):
I was watching your film again, even though I’m kind of in that space and speak about it frequently, there is so many statistics that I had learned. There were so many draw-dropping moments that I could really relate to a little bit better in some ways than when I was a young man, but there was the abuse that I went through and all that, that at the time you kind of laughed about, but it really was a lot of jaw-dropping. In some of the statistics that you mentioned, physicians have the highest rate of suicide of any professional. Physicians have a professional burnout rate of almost 60% of most studies. I think you said more than 400 medical students each year commit suicide. 900,000 patients lose their doctors each year due to suicide.

Dr. Anthony Orsini (8m 25s):
69% of doctors report some type of substance abuse during their lives. Those are incredible statistics that none of them to me are surprising, but when you see them, boy, would they be surprising to patients wouldn’t they?

Robyn Symon (8m 40s):
It would be shocking. And I, one of the most surprising things about sharing the film is the reaction of the general public of patients that they had no idea this was going on. And they had no idea of the sleep deprivation that was going on and how vulnerable they, and their loved ones were going into a hospital. My mother’s in the hospital right now. And when I show up, I want to know who’s seeing her. Is it an attending? Is it a resident? Is it a first-year resident? Second, third, how long have they been on shift? I want to know these things. There was actually an incident, a mistake that was made from a first year resident that was in my mother’s room.

Robyn Symon (9m 21s):
And luckily we caught it, but a lot of times you don’t catch it. And it’s an honest mistake, but because they’re so sleep deprived that they’re going to make mistakes. As you saw in the film where a Harvard University professor who says, just imagine you go through all this schooling and then you’re actually practicing and you make a mistake and it could be career-ending, but you’re doing it. But you’re being set up to fail because you’re forced to work these, you know, 24 hour plus shifts.

Dr. Anthony Orsini (9m 58s):
Yes. And we’re a little bit better than just ironically, I’m interviewing you today after working all night. So, I mean, it’s not 24 hour shifts, although that’s still being done very, very common. When I was a resident, it was 36-hou shifts. I remember when I was a rotating intern in Brooklyn, I was every third night, 36 hours and doing surgery. I did surgery for three months. The chief resident called me into the other intern into his office. And he said the third resident was fired. So by the way, you’re now doing every other nights. Then we was like, okay. So for three months I went in on a Monday morning, came back, Tuesday night, went in Wednesday morning, came back Thursday night.

Dr. Anthony Orsini (10m 39s):
And that was after the blue laws were passed where they told me, I think you’ve talked about it in your film. Don’t tell anybody they tell us to clock out at midnight and then you can finish your paperwork, which was seven o’clock in the morning. So I think it’s, I think it’s a little better, but it’s a complex problem because we need doctors. You said that you, in the beginning, you said we’re short. And how do you make sure that physicians and nurses are well cared for? How do you make sure that the you’re not sleep-deprived and still covered the shifts? Yeah.

Robyn Symon (11m 11s):
Right. It’s so complex because you as a resident, don’t want to get your program in trouble. So you’re going to fudge your hours, but you’re also going to be held responsible if you hurt or God forbid, you know, kill a patient, it’s on you. It will be on you. Of course, the hospital’s going to get sued, but you most likely as a resident only wanting to be a great team player, you will be on the chopping block as well. And it’s just, it’s not fair. It’s just, I’m talking about create a system where there’s fairness that gives these young doctors a chance to learn in a healthy environment because after 16 hours, it’s very difficult to absorb and retain information anyway.

Robyn Symon (11m 60s):
So why not give them the best foundation possible to be the best surgeon they can be? Of course, there’s money involved. Residents are paid minimum wage at best. We think of the number of hours they work. They’re paid by Medicaid covers their salary and the hospitals may get like $120,000 per resident. But they’re paid about $40,000. Is that your understanding?

Dr. Anthony Orsini (12m 28s):
Yeah, I think it’s a little better now, but it’s still terrible. There’s pushing for a $15 minimum wage. I think residents make way less than that. I think they would take the $15 in a second.

Robyn Symon (12m 41s):
No, and they were guaranteed, but then are they really accounting for all of their hours Hawkins? Actually in the film, he was punished for writing down his true hours. He says it very kind of quickly in the film, but yeah, we’re told to work, you know, 80 hours, but it’s sort of laughs it off, but you know, you want to be an honest person. And so he’s being told to lie. And if you don’t lie well, then you must be doing something wrong. You must not be quick enough. Maybe you’re not up to the task of being a doctor. So they put it on you as opposed to say, this is not humanly possible to work 80 hours, do all your charting, see all the patients, everything that is being asked of you and then still work 80 hours legitimately.

Robyn Symon (13m 32s):
So it’s tough. It’s a lot to ask.

Dr. Anthony Orsini (13m 34s):
And I can attest it. That’s exactly what happened to me when I was an intern. So let’s talk about Hawkins. Tell us about Hawkins. And he was kind of your main thread throughout the whole 90-minute film, right?

Robyn Symon (13m 46s):
Yeah. Very courageous med student and resident, because it was hard to find someone willing to talk about what’s going on because the risk to your career is great. First there, the internal and then the external factors. Internal, you don’t want to seem like, you know, you’re the weak link as Hawkins says. So you want to be perceived as being up to it. So why would you want to go on film and talk about your deepest, darkest secrets and lay bare for everyone to see? So it’s tough. And especially for, I would’ve liked to have more women physicians and med students in the film and it was just tough.

Robyn Symon (14m 28s):
Like they would talk to me privately, but oh, they couldn’t go on camera. Their parents would kill them and they’d never get a job that they wouldn’t match to a hospital for their residency. So it was almost impossible, but it worked out as all good films should have to have a little bit of luck involved. And he’s a real humanitarian in that his concern for his fellow med student and physician was more important than his own career, in a sense. So he was willing to put it on the line.

Robyn Symon (15m 9s):
So others didn’t feel and experience what he experienced. So he had a suicide attempt and in his third year of med school, and then he came back and he was able to finish med school. And I thought, Tony, that was the end of the film. And we’re going to end with clapping. He graduates from med school. He makes it through. And so we shot his graduation from med school, as you saw in the film. But then over the summer we heard he actually got a residency, which was like a miracle in and ran new program in upstate New York. And we heard things were not going well. He was suicidal, struggling a lot of problems.

Robyn Symon (15m 52s):
And so I, as the director made a decision that this film wasn’t over, we couldn’t stop the film at, with his on a high note, but he was graduating and things were gonna be rosy after that. So I flew to New York and went with Dr. Pamela Wible, who’s sort of like my Erin Brockovich.

Dr. Anthony Orsini (16m 13s):
Yeah. I have notes on her. We’re going to talk about her today. I have a whole bunch of notes.

Robyn Symon (16m 17s):
Yeah. So we went there and he was not in good shape as you saw in the film. And he had a big decision to make about whether to stay and risk his life. I mean, he was actively suicidal and he was having ideations. So we followed him even after he made his decision to leave. And we have this amazing scene where Pamela takes him to a small town because of the doctor shortage. I mean, you couldn’t have scripted it better. It was just like so crazy. The cast of characters at this small town really needed a local doctor. And it was only required to have one year of residency.

Robyn Symon (16m 58s):
So it really could have worked out. Ultimately we left the film there that with hope of the future, maybe I’m getting back together with his wife who left him during residency when this whole thing went down with the suicidal ideation. So we left the film on a high note that maybe they would be back together. Maybe this town would have a new doctor. Ultimately things worked out differently, but that’s where we ended the film. He is doing fine though.

Dr. Anthony Orsini (17m 28s):
That’s good to hear. I mean, he is very courageous to come out and say that some of the guests, we talked about Dr. Dike Drummond, they probably know that name. He talks about physician burnout a lot. I will be interviewing in a couple months, a Navy seal. And we were discussing on the pre-interview how similar the Navy seals are to the doctors in several ways. And that number one, they tend to be overachievers. Number two, they’re afraid to ask for help because we are supposed as Dike Drummond says we’re supposed to have this big S on our chest. And I think that’s part of the problem that we just don’t ask for help. And there’s, as you mentioned, we were speaking before about just to know support systems and that is something that’s really needed.

Dr. Anthony Orsini (18m 10s):
There was a, and I’m drawing a blank on his name St. Louis medical center, who started a program to help their students.

Robyn Symon (18m 16s):
Dr. Staurt Slavin

Dr. Anthony Orsini (18m 17s):
Okay, there you go. And he was an amazing guy and he really showed some good numbers. And then what happened to him?

Robyn Symon (18m 24s):
Ironically, he is now working at the ACGME which is, I don’t know how much he’s going to be able to influence the bureaucracy there, but it’s great that he is there.

Dr. Anthony Orsini (18m 37s):
But the real story is that he did these wonderful things and really showed these programs for his medical students, how much they help with her depression, et cetera. But the real story is how much resistance he got, which is amazing. Isn’t it?

Robyn Symon (18m 51s):
He was fired.

Dr. Anthony Orsini (18m 52s):
And that’s really hard to wrap my head around. I mean, how could for somebody who showed these great numbers, it, but it just goes to show you the culture of where we are right now. And that this is a real issue that I think were thanks to films like your we’re starting to at least show what’s going on. And it will take patients to start to say, Hey, this is a concern. And there’s some companies right now that are looking into monitoring doctors, heart rates, and their bio rhythms. And I just, the person that I’ll be interviewing next month is actually have some data that shows the best time to have surgeries on Monday because your surgeon has slept all weekend. And the worst day to have surgery is on Friday.

Dr. Anthony Orsini (19m 32s):
So interesting stuff. And so it’s all,

Robyn Symon (19m 34s):
And the same thing with residency, like when not to go into the hospital will not July when they just start their residency. Yeah.

Dr. Anthony Orsini (19m 43s):
Yeah. July is the worst time to start. So tell me about Pamela. Wible Dr. Wible, she’s amazing.

Robyn Symon (19m 51s):
She’s polarising because she has spoken out. She’s sort of like the pied piper for med students and physicians. She is not afraid to speak her mind and the way she speaks as you see in the film is very forceful. She doesn’t hold back. So she is a family physician who, after seeing so many suicides in our own community, among her own friends, decided to start a suicide hotline. And she started counting how many suicides, because there was no documentation at that time, nobody was trying to collect data on how many physicians were dying by suicide.

Robyn Symon (20m 33s):
So she took it upon herself to do that. And in the film, she’s showing us the book and she says, oh, I’ve got two or 300 names listed by date of death and how well now she’s got more than 1500 names, many more. And these are just that she knows of. So that’s part of the problem. We don’t really know the true statistics. I think three to 400 physicians dying by suicide every year. That’s a number that’s been floated around for more than a decade. It could be triple, quadruple that number. We just don’t know because many die in a way that can be looked at as an accident.

Robyn Symon (21m 20s):
And families are more inclined to report it as an accidental overdose or accidentally hitting a train or accidentally running into the median in a highway. So many accidentally falling off the roof of a hospital. I mean, literally families. They don’t want to admit it.

Dr. Anthony Orsini (21m 39s):
They had this overachieving son or daughter who was the best in their field and they commit suicide. And part of them doesn’t want to, same thing caused a problem in the first thing, show weakness. And so they hide it. You know, when I was in medical school first year, there was a classmate of mine who I knew peripherally and he didn’t come back for a second semester, should know what happened to him. And they just said all, they found them in his apartment dead and did not occur to me that it would have been suicide. Didn’t even occur to me. And to this day, I don’t know what it was, but they were just saying, and it wasn’t about till about 10 years later, when this topic started to come up and I had this light bulb went on in my head and I said, I wonder if he killed himself and we’ll never know, but you’re right.

Dr. Anthony Orsini (22m 25s):
I think that number is probably much higher.

Robyn Symon (22m 29s):
And the school, interestingly, didn’t create an opportunity for the fellow students to discuss it, use it as a moment to do a checkup on everyone’s mental health. And we, right. It was just like brushed under the rug. I remember the scene in the film where Pamela walks around with the picture of the resident Greg day. And so do you remember him? Do you remember what happened to him? And they were like, he just like, didn’t show up one day. And they were like, yeah. That’s so typical,

Dr. Anthony Orsini (22m 57s):
And he was in my anatomy class and there’s four people per cadaver. And the second semester, there was three people at that group. And we had heard that he was found dead in his apartment, but that was the end of it. The school never mentioned that again. So this has been going on. I’m not that young. So it’s been going on since I graduated 90. So this has been something that’s happening in a long time, you think because of people like Dr. Weibel you think it’s getting better or worse, or are you optimistic about this?

Robyn Symon (23m 32s):
I am optimistic that the conversation is happening more at the same time, I’m concerned about the pressures on physicians. And of course COVID really put more pressure and a spotlight on what physicians were going through. But even though the spotlight’s on them, it doesn’t mean that the pressure is any less. So I am worried that with the shortage of physicians and all healthcare workers, that it puts more pressure on the system. So while the dialogue might be improving, the systemic problems are the same, if not worse. So it’s just a question of, will they be addressed in time for this perfect storm to happen, where there’s like a collapse of the system, because you have burned out doctors or just no doctors there.

Robyn Symon (24m 27s):
And you’re going to see just this high rates of medical errors that we don’t hear about it. We saw in the film that someone from Johns Hopkins was saying, why don’t we hear about this? And Senator Bernie Sanders says, this is like two airplanes going down every day. Why isn’t this on the front pages of the paper every single day. And the physician from Hopkins said, because it happens one at a time and secretly. So that’s why you don’t hear about the medical mistakes and sometimes medical mistakes happen, but many can be prevented if we can change the system. So physicians are working at their best and in the best environment possible.

Robyn Symon (25m 10s):
That’s what we need to provide for them.

Dr. Anthony Orsini (25m 12s):
Yeah. I would agree. I’m seeing things that are a little bit better, although professional burnout among even before COVID among nurses and doctors as an all time high. So in some ways it’s getting better and we’d like to equate it, say, oh, we were verbally abused and other things that happened while we were training. But it’s more than that. That’s better. It’s not gone, but it’s way better. I mean, I can tell you horror stories about what happened to me when I was a medical student, I was yelled at and ridiculed. And

Robyn Symon (25m 39s):
Tell me, just tell me one story Tony, just one good one.

Dr. Anthony Orsini (25m 42s):
You talk about the word pimping in your film for those people that aren’t in medicine that are listening will pimp because when the attending physician starts to ask you a whole bunch of questions and put you on the spot. I remember we were walking down the hallway with about six or seven residents, just like you see in Grey’s anatomy. And the attending physician took a test tube out of his pocket, filled with blood. And he said, Orsini tell me 10 different things about this blood before you send it to the lab. And I was like, that is an odd question. Right? And so I struggled and I came up with like two and he said, well, we’re all going to stand here till you get the other eight. And for, it seemed like an hour, but it was probably 10 minutes of very uncomfortable residents and nurses standing there.

Dr. Anthony Orsini (26m 28s):
And he’s writing his charts and every two minutes he’d look up and he’d go Orsini, you got it yet. And I’m like, I want it to say to him, if I didn’t know it, then I’m not going to know it now.

Robyn Symon (26m 37s):
Okay. That’s here to learn. I’m here to learn.

Dr. Anthony Orsini (26m 40s):
And I was doing surgery as a third-year medical student. That was the time during, when HIV was just coming up. And the surgeon prick my finger with a needle. And the scrub nurse said, Dr. Smith, we’ll call him Dr. Smith. You stuck his finger. And she was being like motherly and protective. And his answer was, well, his damn finger shouldn’t have been in the way, and this was during aids before yet. So it was definitely worse than those days. And we would, I could tell you stories about the Brooklyn hospitals, just, I could keep you up all night. I think it’s better, but the problem is not getting better. In some ways it’s getting worse. And I think the positivity of bringing it out is helping.

Dr. Anthony Orsini (27m 22s):
But if you look at administrators and organizers of medical schools, tell me if you agree. I think the common thread here is this is a real problem. I don’t know how to fix it because it’s complex. So let’s just talk about it tomorrow.

Robyn Symon (27m 36s):
Well, part of the problem, Tony is the corporatization of medicine. So there’ve been studies that when you have a CEO of a hospital who is a physician or who was a practicing physician, that the culture is better, but more and more, we’re seeing these hospital systems run by business people and don’t put patients above all. And so their motivation is the bottom line. So that’s a huge conflict. And we’re just seeing that more and more. We’re seeing these little clinics and hospitals being scooped up by these big medical systems and run by a C-suite full of business people.

Dr. Anthony Orsini (28m 21s):
And there’s a lot of data on physician burnout and dissatisfaction with their job and that they feel that they’re not autonomous anymore. They’re just pawns are just being told by someone who’s never taken care of a patient before do this and do that. And so I don’t want to minimize it because it is an extremely complex problem.

Robyn Symon (28m 38s):
But they do do feel like cogs in a wheel. So what do you think about unionizing physicians? If you’re going to be a cog in a wheel or work on an assembly line, if that’s what they’re trying to create, I know it’s been like a dirty word, taboo topic for decades, but what’s your feeling about unionizing?

Dr. Anthony Orsini (28m 57s):
You know, I have mixed feelings about unionized and I think for nurses, it does help because they’re really strictly workers of hospitals. For physicians I’m concerned that being in a union would take away one more shred of autonomy to me also, because now I have to answer to the union as well as I think what doctors want is to be left alone, to be one-on-one with their patient. I talk about that in my Ted talk that you have all this kind of craziness going around, but when I preach is when you shut that door and it’s just you and the patient now you’re autonomous. Enjoy that relationship. Forget about 20 people in the waiting room. And you don’t need to spend a lot of time with that patient, but this is why you went into medicine in the first place, because you want that relationship.

Dr. Anthony Orsini (29m 44s):
And if you can give back that, and I’ve had so many people that have given workshops to, to come back and say, you know, especially nurses saying, thank you so much, because now I go home happy. I had a conversation with a grandmother about baking or a father about football. And that five minute conversation made my whole day because it wasn’t just work, work, work, work, work. So I think it’s complex, but we’re back to like, yeah, it’s a problem, but I don’t know what to do about it. We know that I work in neonatology. If a baby dies in a nurse taking care of that baby, that nurse I’m trying to remember. It was somewhere between some studies four and 10 times more likely to make a medical error on the next patient. Do you want your baby to be taken care of by that nurse?

Dr. Anthony Orsini (30m 25s):
And yet most hospitals, not all of them will say, yeah, that’s true, but we can’t afford to have relief. And it’s crazy

Robyn Symon (30m 33s):
If we could make that connection to the admins, the guys and gals in the C-suite, if we could make a connection, which is there are studies about the connection between medical errors and physician wellbeing or health care worker wellbeing, there’s a very strong connection. So if you want to reduce the number of lawsuits against you for medical errors, the ones that are actually caught, as many as you know, are not caught, then you need to look carefully at physician wellbeing and you will see a reduction in the payout for medical mistakes, setting aside, you’re not killing patients.

Robyn Symon (31m 16s):
And that’s not. When you’re conscious,

Dr. Anthony Orsini (31m 18s):
We have to be less short-sighted and more longterm. So I’ll say to hospitals that have asked me my opinion, right? You have a NICU here. You can’t afford to send a nurse home, but why don’t you just have one extra nurse on every shift? And that may cost you more money, but it’s going to save you one $20 million lawsuit. And in the end, you’re going to be much better, but they can’t see further than their nose. And that’s the issue. And we have to move to that point,

Robyn Symon (31m 44s):
LA children’s hospital. There were some very happy residents and I went to a picnic with them. I know what’s up with you guys. This is like, my film is miserable residents and what’s going on. And they told me that at LAChildren, and I’m sure they’re still doing it now, if they hired a lot of these MAs medical assistants and many of them were pre-med students, but it, and these MAs were responsible for entering things in the computer, doing all the scrub work. That was their job. And it freed up time for the residents to really learn more.

Robyn Symon (32m 28s):
And to spend more time with patients

Dr. Anthony Orsini (32m 29s):
Seems like a no brainer, right? It seems

Robyn Symon (32m 32s):
Like it. How much can the MES or MAs cost you? You know, well, like you’re saying one shift, how much could it really cost to prevent a possible error and to make these residents feel like they’re thriving. And because that’s the cause of Burnout, if you feel like you’re not thriving, that there is moral injury at work that you’re not supported, these are the causes of burnout or among the causes of burnout. So just hiring some, a few extra people. So if you need to go to a doctor, there’s somebody there to fill your shift so you can take care of yourself.

Robyn Symon (33m 13s):
I mean, they’ve done all these studies, millions of dollars in studies about how to prevent burnout and what they keep coming back with is the number one way to prevent burnout is to give physicians time off. Yes. I mean, it’s like a no brainer as you say, but why not add just a few more, a few more residents. The government pays for X number of residents, and that number has been frozen since like 1997, but that doesn’t prevent the hospital from hiring some extra residents to totally change the culture.

Robyn Symon (33m 54s):
At Cristiana care health center they have something. When I go on tour with the film and we talk about solutions and they do something called the quick fix and they go around to each department and they say, what can we do for your department to make your lives easier, better, happier, and let us know. In one department so no one person is on the hotspot and complaining it’s a floor by floor. So one floor sent a request in that there was a phone that was ringing incessantly and they have to stop whatever they were doing to answer it and deal with it. And so within 90 days or less, maybe a month, they rerouted this phone somewhere else.

Robyn Symon (34m 39s):
And everyone on this floor felt empowered. They felt listened to, and it was such a inexpensive thing to do. But the result was less burnout feeling of that you were heard and connected and the culture morale improvement. So you know, why not?

Dr. Anthony Orsini (34m 59s):
Yeah. That’s one way to fix it. They call that ground control. Like let the people down at the bottom usually. Cause that’s the biggest complaint is while they’re up there and they haven’t asked us what we can do. And so that’s ground control instead of command and control the group, the command and control would never know that that phone was driving them crazy.

Robyn Symon (35m 17s):
Someone at a hospital system, I won’t name said to me, oh, well, we don’t need to do that because they can just call me directly. If anyone has a problem or a suggestion. And I said you don’t get it. They’re not going to email you. They’re not going to as wonderful as you think you are, is great a relationship you think you have with everyone here, which I know is not true. They’re not going to, and there’s a reason why they did this program because it doesn’t identify one person as, asking.

Dr. Anthony Orsini (35m 53s):
And I think it’s really important that they’re not medical professionals are not going to admit that it’s very difficult for them to admit that there’s a problem. So a lot of the hospitals going back to the baby that died in the nurse, a lot of hospitals will say to me, well, we always ask the nurse If she wants to go home, I’m like, well, how often does she say yes, almost never. So I’m saying to you, Robyn, your baby just died. You’re very upset. Would you like to go home and show everybody that you’re weak and not get paid for the rest of the shift? Or would you like to tough it out? Make everybody think you’re tough and get paid

Robyn Symon (36m 22s):
Not to mention looking like you made some horrible mistake on top of,

Dr. Anthony Orsini (36m 28s):
So the hospitals that have adopted this and there are some in which is really nice. I’ve said, Robyn, you’re going home and you’re going to get paid though. And if you need anything, let me know. So there’s a difference between asking people if they need help and they’re not going to. And I think same thing with medical school, if you’re struggling, you’re not going to ask for help. And that was a common thread in your movie also. So I think that what your film is doing is bringing more light to this. Again, I’ve been telling everybody they need to watch it and they need to look and see what we can do to help. It’s not just about sleep. It’s not just about burnout. It’s about as Robert Pearl talks about the culture of medicine.

Dr. Anthony Orsini (37m 9s):
It’s about identifying ourselves as being human and letting everyone know that it’s okay to say, I need a day off because if I operate tomorrow, I’m going to be doing that really at my substandard. And until we get to that point, I think we’re going to continue to have an issue, but I’m hoping, and I’m optimistic that we’re moving in the right direction.

Robyn Symon (37m 29s):
Film is about opening a dialogue. And I like to share the film at a hospital or a medical school followed by a panel discussion where we can first event what’s going on here, but then shift and focus on solutions and walk away with real solutions that will be actionable that next day. And this makes everyone feel great about it. So we show the 60 minute version. Sometimes they show a grand rounds version, which is 30 minutes also good and can follow up with discussion. It just opens dialogue, but I love to show the 60 minute version and then have a panel discussion.

Robyn Symon (38m 8s):
And we’ve been doing it virtually too, and it’s worked out wonderfully. So yeah, it’s a tool. It’s a tool to open a dialogue. It’s not pointing fingers or by having the film at your hospital or your clinic or med school, it’s just, this is a cultural issue. We, haven’t a problem here to a lesser or greater degree, but it’s an issue. And let’s use this as an opportunity to talk, just to check in with each other and see how much work we need to do.

Dr. Anthony Orsini (38m 42s):
That’s the best thing about the film is that as you said, it opens up dialogue after you watched the film, I’m telling the audience right now, if you watch the film, you’ll immediately want to talk about it. And if we can do that in a big auditorium or in a small group, I think that would be perfect. So Robyn, before we end this great interview, I always ask every guest the same question that the name of the pod guests is Difficult Conversations. I ask everyone, if you can tell me what your most difficult conversation you’ve ever had, or type of conversation, if you don’t want to get personal and how you found the best way to navigate through that.

Robyn Symon (39m 18s):
Well, as it relates to this film, as you saw in the film, because I left it in the edit is a conversation that I had with the president of the ACGME, they’re in charge of graduate medical education in charge of all the residents. And it had just learned that they had increased the hours to 18 hour shifts to 24 plus four hour shifts for interns. And he was telling me all about wonderful things that the ACGME is doing. And then I, it’s just hard to listen to this. And then I presented to him a stack of petitions from people saying, we need help.

Robyn Symon (40m 8s):
Nothing is happening. And I took the stack of petitions and handed it to him on camera. And it was a difficult moment. And he was defensive. Well, we are doing things, we’re doing a lot of things, but yet you just increased the hours from 18 to 24 plus four hour shift based on some strange studies that really didn’t measure what was happening with residents was like the mortality of patients. And it didn’t matter whether residents worked 18 or 24 hour shifts.

Robyn Symon (40m 48s):
The mortality was the same. Well, of course, because these residents weren’t operating on the patients. So why are you measuring this connection to justify that residents should work 24 plus four hour shifts? So it was a difficult conversation and maybe I could have left even more in the film, but I think the point was well made, but it wasn’t easy. It wasn’t easy. And I haven’t been invited to show the film at the ACGME.

Dr. Anthony Orsini (41m 20s):
I wonder why so disappointing. I think, again, it’s a conversation that you’re starting and I always say every critical moment in your life starts with a Difficult Conversations. So I think that maybe you having that uncomfortable conversation with him probably made him think, and I’m optimistic that things are going to get better. Thanks to people like you. And there’s some good people like Dr. Wible and, and people are really doing a lot of things positively. We’re going to try to healthcare is broken to begin with. So this is just one small part of the way we can fix it. So Robyn, thank you so much for being on what’s the, again, I saw your film on, I think I bought it on Amazon prime. How else can people get this?

Robyn Symon (41m 59s):
So you’re going to DO NO HARM film. If you’re an institution, you can go and get a subscription to it on the, Do No Harm, film.com page, or you can email us at info at Do No Harm film. If you want to schedule just a one-off screening and we would help get involved with panel discussion and promoting it and all of that. So you can email us or get a subscription where you can show the film throughout the year as many times as you want, but we don’t offer a support for that. Or let us help you plan a screening or as an individual, you can watch it on Amazon or from the website. You can watch the film. And then there were all these panel discussions, if you want to watch that afterwards.

Robyn Symon (42m 44s):
So there are lots of ways, but the website is a good place to start.

Dr. Anthony Orsini (42m 47s):
A very good friend of mine that I work with is head of all the residents at the hospital system that I work at. He is a wonderful man who is constantly trying to figure out how to do things good for the residents and how to make them good people and good doctors. And I’ve told them about this film. So there are some great people out there and we’re moving towards improving that things are getting better. Robyn, thank you so much. This has been a lot of fun that really appreciate you taking time out for this.

Robyn Symon (43m 13s):
I enjoyed It. Thanks so much for all you’re doing Tony as well.

Dr. Anthony Orsini (43m 17s):
Thank you. If you enjoyed this podcast, please go ahead and hit subscribe. Or now it’s follow on apple because I guess they changed it. But if you need to get in touch with me, you can email me at Dr. Orsini at the Orsini Way dot com. Thank you again for joining us and Robin. Thank you again.

Robyn Symon (43m 32s):
My pleasure.

Dr. Anthony Orsini (43m 33s):
If you enjoy this podcast, please hit the subscribe button and leave a comment and review. To contact Dr. Orsini and his team, or to suggest guests for future podcasts. Visit us at the Orsini Way dot com. The comments and opinions of the interviewer and guests on this podcast are their own and do not necessarily reflect the opinions and beliefs of their present and past employers or institutions.

The State of Healthcare - Moving Forward with Steve Lawler

Steve Lawler (1s):
One of the challenges we have in healthcare is actually humanizing healthcare. A lot of folks kind of view us as like this big business, because we’ve got lots of bricks and mortar and lots of buildings. They hear that, you know, hospital executives are making high salaries. So I think one of our challenges to kind of improve that connection to community is humanizing the face of healthcare and moving it from being a perceived as being about big business to, you know, really what the fundamental purpose of healthcare is, which is caring for people. I think, as you pointed out, the best way to develop that new brand for the field is to develop these intimate and really mutually supportive relationships.

Announcer (49s):
Welcome to Difficult Conversations: Lessons I Learned as an ICU Physician with Dr. Anthony Orsini. Dr. Orsini is a practicing physician and president and CEO of The Orsini Way. As a frequent keynote speaker and author, Dr. Orsini has been training healthcare professionals and business leaders, how to navigate through the most difficult dialogues. Each week you will hear inspiring interviews with experts in their field who tell their story and provide practical advice on how to effectively communicate. Whether you are a doctor faced with giving a patient bad news, a business leader who wants to get the most out of his or her team members or someone who just wants to learn to communicate better, this is the podcast for you.

Dr. Anthony Orsini (1m 34s):
Well, welcome to another episode of Difficult Conversations: Lessons I Learned as an ICU Physician. This is Dr. Anthony Orsini, and you guessed it I’ll be your host again this week. Today I have the privilege and the honor to have as my guest Steven Lawler. Steve has been the President of the North Carolina Healthcare Association since 2017. Prior to his current position, Steve served various roles providing health in Eastern North Carolina for over 20 years, including seven years as the President of Greenville Hospital. Prior to that he took the position as Senior Vice President Regional Group of Carolinas HealthCare System until his current role as President of the North Carolina Healthcare Association.

Dr. Anthony Orsini (2m 16s):
Well welcome Steven, really great to have you today. Thank you for taking time out of your busy schedule to talk to my audience.

Steve Lawler (2m 23s):
Great to be part of this conversation.

Dr. Anthony Orsini (2m 25s):
Know we had a really great conversation a week or two ago about the future of health care, and I think it’s a really important and difficult conversation to have with all the politicizing of healthcare. And so I really just want to dive into this and I don’t think there’s many more Difficult Conversations than when we talk about healthcare. So, but before we start, let’s just start off as I usually do. Just tell the audience a little bit about yourself, where you’re from and how you got to be the president of The North Carolina Healthcare Association.

Steve Lawler (2m 53s):
Well, so I grew up in North Carolina. I grew up in Eastern North Carolina, which typically is kind of a rural part of the state. So it’s east of 95. So folks that have lived in Charlotte and Raleigh, they kind of thought it was like Columbus going off the side of the earth. Both of my parents were educators. I grew up in a family that was committed to being part of some kind of a business or industry that was based on service. So grew up there, went to college at the Citadel in Charleston and then got into healthcare administration as an army officer. So spent several years doing that, taught you a lot about leadership and teams and the kind of selfless service and servant leadership got out, had an opportunity to come back to Greenville where I grew up and be part of that health system and that medical community, and did that for 22 years.

Steve Lawler (3m 45s):
I had the opportunity to do everything from running a critical access hospital, to running a thousand bed teaching hospital, built a system and then retired from there. And I’ve had the opportunity to kind of reinvent myself in two different roles. And now have the great privilege of leading the North Carolina healthcare association, which supports all 130 hospitals in the state.

Dr. Anthony Orsini (4m 10s):
Did you always know you want to do something in healthcare or did the universe just kind of take you there?

Steve Lawler (4m 15s):
And I think I always had an interest in healthcare. My mother was a public health nurse and kind of like the old school, public health nurse that had clients and people that she would go visit at their homes. And that was when population health was kind of something that they did versus a slogan. Yeah. So it had kind of the idea that something that I was interested in after first semester of college chemistry, I realized that I may be better supporting those people that are taking care of people versus getting into the science of it. So just been really fortunate. You know, I’ve had a career where my purpose was to care for people that were caring for others.

Dr. Anthony Orsini (4m 57s):
That’s great. And the North Carolina Healthcare Association, I think represents 130 members. Can you tell us a little bit more about healthcare associations in general, but mostly North Carolina Healthcare Association and really what you do there for the people of North Carolina?

Steve Lawler (5m 11s):
Well, I mean, healthcare associations really are a membership organization and with the sole purpose of supporting our membership so much like other state associations, I mean, we do that on a variety of different fronts and with the focus of providing support and services to give our membership, which includes all kinds of hospitals from state hospitals to private not-for-profits, we have for-profit systems in the state, we have governmental hospitals. So I mean, our purpose is to provide programs and services to support them. So our sharpened really is about lobbying and advocacy and development of policy.

Steve Lawler (5m 52s):
We also spend a significant amount of times providing support structures for data and policy gathering, and then shaping that data and information in a way that allows our members to best continue to improve their practice, to improve quality of care. Or it gives us a frame of reference when we are trying to shape policy or lobby. We’re now using that data and analytics to really take a deep dive and looking at equity of care and making sure that as we look at outcomes, we’re not just looking at the end and declaring victory when our numbers are below the national average, we’re really drilling down to fully understand what it means to different populations, and then using that knowledge and understanding to shape better practice and processes and shape a way that we connect with community to really improve those outcomes.

Steve Lawler (6m 47s):
And then finally, we’ve got a shared services company that creates some economies of scale and buying power. So it’s kind of like a brokerage portfolio that offers services for our members. And we’ve got one of the largest healthcare foundations in the country that does a variety of things from providing technical assistance to other community-based foundations, to being a platform for granting, for organizations that are community-based, but have partnerships with hospitals and health systems to get at those issues that are either barriers to equity or that are creating disparities in care.

Steve Lawler (7m 27s):
So, you know, it’s an incubator for good ideas. And I like to think about it as like this translational kind of research center that is focused on best ideas for practical solutions for better health within a community.

Dr. Anthony Orsini (7m 42s):
And for those people that are listening that are aren’t in healthcare, we know that is so hard to do any research or quality improvement, especially if you’re a smaller hospital without some kind of partnerships with organizations and to have all 130 of these hospitals kind of contributing and talking about their experience. And you’ve mentioned inequities, and that’s a hot topic right now. And so some of your hospitals, I’m sure in very rural areas and some of them are in the city and to be able to get those numbers and to not only look at the end, but to say, okay, what are we doing? That’s best practices is really extremely important if we’re going to get any better. And I think healthcare right now, as far as quality of care, in my opinion is going up and up and we’re getting better at what we do.

Dr. Anthony Orsini (8m 29s):
And my world is neonatology. And I remember as a medical student, which I don’t want to tell you how long ago that was 30 years or whatever that was telling me that it’s 28 weeker was the earliest survival premature baby. And now we’re saving 22 weekers. So that kind of a consortium is so important. You mentioned something earlier about helping with negotiating powers with insurance companies and costs, I went on the website, the North Carolina Healthcare Association, and I saw a little video explaining cost transparencies, which I think was the best explanation of how hospital costs occur and how we pay for healthcare in this country.

Dr. Anthony Orsini (9m 12s):
And then during the Trump organization, transparency was a big topic. So tell me how we are in a crisis right now with healthcare, with we’re trying to get better and better care, but it’s getting more and more expensive. There’s those people who have made healthcare into a political push, where do you see healthcare going with universal healthcare versus private? And what can we do to kind of make the numbers work better and still keep that quality of care?

Steve Lawler (9m 41s):
First of all, I think if I were a young man or woman that was interested in a career, I can’t think of a more exciting time to get into healthcare. And it’s a challenging time as you’re point out. I mean, healthcare is expensive and it’s driven by just these amazing discoveries and clinical advances, it’s driven by new technologies that help support that clinical advances. And it does driven by pharmaceutical prices, which are double the healthcare rate of inflation. So the fact is that we need to work together to make healthcare more affordable and less expensive. And I think that’s a fact. The idea of transparency I think is really important and something that we certainly embrace and what should go hand in hand with decisions that patients and families make in regards to where they get their care.

Steve Lawler (10m 31s):
And then I think even more importantly, what their plan of care looks like. And we talked a little earlier about the importance of conversation between patients and families and then the provider community. Well, I think that becomes even more important as we talk about kind of quality outcomes and affordability, because there is a lot of things that we can do for people. I think one of the tough questions and you’re an intensivist, so you can appreciate this, but what’s the right thing to do to maximize quality of life for individuals. So the things that we’re working on for the future of health care in North Carolina is we’re looking at value-based care and an alternative payment models, which actually return economic value to the place within the system of care that has the greatest potential to improve health and reduce costs.

Steve Lawler (11m 25s):
So that’s kind of thinking outside the four walls of a hospital and looking at how do we make investments with relationships and partnerships throughout the community, be it primary care, the faith community, or just community partners to better engage patients in their care early on so that we are not left with a healthcare system that is only focused on sick care that only focuses what happens when that patient becomes in distress shows up at the ed. So I think it’s really about thinking about where are we making investments in the future. It’s pushing managed care companies and managed care companies have done very well claiming to be the solution for patients and families.

Steve Lawler (12m 11s):
And the fact is they do play an important role, but they play an important role as a middleman in the process. They play an important role from a finance and administration perspective, but they’re not the ones that are driving kind of what happens to that patient. So I think the future of healthcare really is about physicians and hospitals and health systems and other partners that are touching and creating value for patients kind of taking their rightful spot as the trusted advocate for patients and families and replacing the managed care companies who have worked hard through marketing and other approaches to kind of fill that gap.

Steve Lawler (12m 55s):
So I think those things are really important. Then I do think that any time a physician in a hospital can provide the total experience of care for that patient family or community, which means that not only they’re providing clinical care, but they’re also providing the full compliment of support structures that typically may be available through a managed care company. Anytime we can build that ourselves and offer that to the community. I think what we’ll find are communities lead better outcomes and care will be cheaper.

Dr. Anthony Orsini (13m 28s):
Yeah. You mentioned some really key words there, trust relationship and costs. And I think they’re so related to each other. One is getting your routine care, getting your routine checkups. It always shocks me that everyone knows that if you take your car to get the oil changed every 5,000 miles, you’re less likely to break down, but we don’t do that for ourselves, right? We don’t go for a colonoscopies, but there’s a lot of data that says that most people don’t do that maybe because they don’t have the relationship with either their doctor or their community hospital and, or there’s a relationship there just because they’re local, but there’s really no trust in the system. I think one of the best things that happen in healthcare is in the last 10 years was the elevation of the patient experience.

Dr. Anthony Orsini (14m 15s):
And more than ever, the experience that a patient has, we know improves outcomes and they’re more likely to go for their health care visits. And so I think that’s one of the best things that we have done, but I think we do have to form those relationships with the community, as you said, how are we doing with that? Because I really need to teach these community hospitals better on how do you make those relationships so that people come in for their routine visits.

Steve Lawler (14m 45s):
I mean, if you look at polling data from national firms, nurses and doctors are the most trusted professionals. So I do think that understanding and leveraging individual relationships or people’s perception of groups of people is really important. And I do think that one of the challenges we have in healthcare is actually humanizing healthcare. A lot of folks kind of view us as like this big business, because we’ve got lots of bricks and mortar, lots of buildings. I mean, they hear that hospital executives are making high salaries. So I think one of our challenges to kind of improve that connection to community is humanizing the face of healthcare and moving it from being perceived as being about big business, to really what the fundamental purpose of healthcare is, which is caring for people.

Steve Lawler (15m 37s):
And I think as you pointed out, the best way to develop that new brand for the field is to develop these intimate and really mutually supportive relationships with key community partners that look like, and that have close connections with the people that we’re so privileged to take care of and having been a hospital administrator and a healthcare executive for 40 years, I can tell you that we’re great at fixing problems. We’re not great at listening. So I think the listening to these community leaders and really understand what’s the solution to the issues that are either barriers to care, what are the solutions to issues that cause readmissions to hospitals, because people may not have the right support structure when they discharge, what are the barriers from creating access?

Steve Lawler (16m 35s):
We can come up with solutions all day to the problems that we think are going to work, but really listening and developing these kinds of intimate relationships. And then being courageous enough to ask people for help, that may not be as large and complex and sophisticated as you are. Well, that’s the solution. And I’m excited to see those conversations start to happen. But again, we’re in a business of problem solving. I mean, you’re as a physician, I mean, you’re perfectly trained to diagnose and solve a problem. We’re perfectly trained to kind of say, okay, I’ve got all these resources, let’s apply them to make things better, but you know, having fumbled in that kind of communication.

Steve Lawler (17m 19s):
And thankfully, I had a minister that was kind enough to point out where I was missing the boat and helped me kind of connect in a more meaningful way to get stuff done. I think that’s a critical aspect for making progress in the future.

Dr. Anthony Orsini (17m 34s):
Tell me about that conversation. So the minister sit you down and say, Steve, we’re getting this all wrong. How’d that go?

Steve Lawler (17m 40s):
The CEO of a thousand bed teaching hospital. Let me, once a month, I had like this techie medical lunch. So I got all the faith community members together and we break bread and it was fantastic. I thought it was fantastic. It was marvelous. And I give them updates on everything that we’re doing and what’s new about the medical center and here’s all the things we’re doing to fix all the community woes. And after about three or four months of this, one of the most influential African-American pastors sat me down and said, Hey, Steve, but he said, you have a second. So after everyone left, we sat down and we’re drinking our iced tea. And he said, this is a complete waste of time and you’re not getting anything done. I was like shocked. And he said, we appreciate your effort to get us together.

Steve Lawler (18m 22s):
And by the way, it’s a great lunch. He said, but you’re missing the point. We’re not here to listen to you tell us how to solve our problems. We’re here because we want a relationship. We want you to listen to us so we can help you understand what the barriers are. And then we can help give you the fill in the blank answer is to get this right for our community. So I was just grateful that we thought enough of me to sit me down and tell me I was getting it wrong.

Dr. Anthony Orsini (18m 50s):
I love that. That’s a great story. It’s all about relationships. And to me, it, you know what we do at the Orsini Way, we train doctors on how to form relationships with patients. And then that just moves up in my mind. This is a, an upside down pyramid. So we always say a patient can have a relationship with a person it’s hard that you can have an abstract relationship with a community or a hospital, but there has to be this upside down pyramid where the patient feels a strong, trusting relationship with their family doc who’s on the ground, who they have a relationship with. And then when their family doctor says, this is the test that I think you should have, they go for that test. And that’s been shown over and over again, that if you trust your doctor, you’re going to do it.

Dr. Anthony Orsini (19m 33s):
And then when the family doctor says, I need to bring it into the hospital and this is what you should have it done. And so we just get wider and wider. And, but without that, one-on-one community doctor. And I think, and I’d like you to comment on this. I think part of the problem is the community doctors don’t have enough time because of the restraints put on them to sit and really talk to their patients, or maybe the community doctor going to the local church and saying, this is why you need to have your colonoscopy. That’s what I’d like you to comment on the, really the restraints on that community doctor to really take the time for those relationships.

Steve Lawler (20m 8s):
Yeah. So I think that’s a great comment. So I think, I mean for no better term, it’s about how we value time and how we assign some kind of financial support or payment for that time. So I do think moving to some kind of universal payment or some global payment, or even a capitated rate where we’re clinically integrated networks are responsible for a population and they’re paid for that population. I think that creates the kind of dynamic that allows that community physician, that primary care physician to invest more time in conversation and understanding. So they can customize that plan for patients because right now, I mean their time is so fashioned toward productivity, that it doesn’t incent that, and I think once you become responsible for the health of a community, you’re investing your time differently, you’re using your healthcare team differently.

Steve Lawler (21m 11s):
I mean, right now, most primary care physicians have a patient panel between two and 3000. I think that’s kind of how they view when I used to be a practice manager. I think that was our target. So what would happen if your practice at 10,000 people and you had advanced level practitioners that were taking care of those things that are reasonable for a nurse practitioner or a PA, or either even a health educator and the physician’s time was really dedicated to helping customize those plans for people that really needed care. So I do think when we look at value based care or alternative payment models, part of the long-term goal is to use talented people at the point that they’re most effective and the way we can get our primary care physicians to really understand how to customize care plans that are easy for people to follow and that enable individual patients to get it right.

Steve Lawler (22m 8s):
I mean, it’s kind of like coaching individuals. Some people you can give them the plan, they’re out the door and they’re doing great. Other people just need some additional support and rehearsals to kind of go through it over and over again before they get it right. So for those of us who have had the privilege of like coaching our kids in sports, which is kind of like a thankless job, because every other parent thinks they’re smarter than you are. And they’re quick to tell you, but you know, you’ve got kids with different levels of ability. So patients are very much the same way. Some get it immediately, they’re out the door, others just need some additional support. So wouldn’t it be great if those primary care physicians had the time to provide that additional support and coaching,

Dr. Anthony Orsini (22m 54s):
Just give it a Ted talk that dropped last week about personalizing medicine. And I think that’s one of the things that is one of the biggest struggles with medicine right now with electronic medical records and all the documentation and all the billing I’ve had doctors come to me and say, just don’t understand. I have really a good doctor. I do practice really well, but my practice is not thriving. I’m not getting those two or 3000 and mostly it’s not their abilities as a physician or a scientist. It’s just, we need to train them a little bit more on, on how to form that relationship with a patient when they walk into the room. But how do you find that commonality? How do you become as my mother would say, the best friends walk in and Dr.

Dr. Anthony Orsini (23m 36s):
Lawler Is my best friend. And by really see them not just as a doctor, but as a person, et cetera. And so making that personalization of medicine from the doctor, and then it goes right up to the community hospital is really so important, but I don’t think we give enough protected time for that kind of, and I hate this term, but it’s still being used soft training for physicians and for health, it it’s software. It’s not soft training, it’s actually required.

Steve Lawler (24m 4s):
Well, I’m going to be interested to see having the CEO of a big teaching hospital that was a partner with a medical school. And we had 400 residents and fellows. I’m going to be interested to see how our next generation of physicians and these are young people that are extraordinarily skilled in social media and communicating that way and how they transition into a profession that really is based on like personal conversations and personal connections. So they’re going to be taking care of people that have never texted before and use an ATM machine for God’s sake. That’s going to be a new skillset that we’re going to be asking folks in medical school and residency to grasp and understand pretty quickly.

Steve Lawler (24m 53s):
And I mean, how do you deal with conflict with a group of people that like text each other while you were mean to me and versus kind of have these like really tough conversations. So I’m going to be really excited and interested to see how we, how we help prepare those young men or women, because it is going to be different.

Dr. Anthony Orsini (25m 11s):
It’s a great point right now. This is a generation that’s growing up with instant information and whatever disease your doctor mentions that they can look it up. And so the doctor patient relationship is less informational. And 20 years ago, the doctor would explain everything that’s going on. And that was their main goal of that conversation. And now I’m teaching the young people that your main goal is not necessarily information. You do have to provide that, but it’s really relationship. And so one of the exercises we do is I take a doctor and I’ll say, okay, I want you to speak to somebody here and tell them the diagnosis and then explain what it is.

Dr. Anthony Orsini (25m 53s):
Okay. And I want you to watch their eyes. Now tell them what it is first. And then say, we call that and I’ll write it down for you. And what happens, Steve is it’s nine out of 10 times. If I give you a diagnosis, hyperemesis, gravidarum the patient looks up and starts to figure out what, how to spell it.

Steve Lawler (26m 14s):
It’s like a really complicated name. Exactly. Right?

Dr. Anthony Orsini (26m 17s):
So whatever it is, it could be ulcerative colitis. But what they’re doing is almost universally, especially the young people. They’re trying to remember how to spell it because as soon as they get home, they’re going to Google it. That’s just the fact you and I never did that when we were younger. So by you telling them, these are simple things that we teach, this is what it is. This is what we call it. And I’ll write it down for you. As soon as we’re getting ready to leave, what happens? Your attention snaps right back on me. And now we’re listening. And so little things like that. Yeah. I mean just little things that we can do to teach, because right now you’re right. I have three kids. My youngest one is 21. My oldest one is 28 and they totally text.

Dr. Anthony Orsini (27m 0s):
And this is the way they communicate. And I work with them all the time, just because that’s what I do. But many of these kids can’t communicate. And sometimes we’re having a conversation. My youngest one will just start going on his phone. And I used to get really angry with them. I’m like, TJ, his name is like, what are you doing? Like I’m speaking to you. And Lauren, my wife says, she’s looking it up. So, so that’s what that generation is doing. So if I say, give my son advice, even from his father, he’s looking it up as we speak to see if I’m right. Yeah,

Steve Lawler (27m 33s):
No. If you asked your kids, I mean, I’ve done this, Hey, when’s the last time you taught, I’ve got two kids in there. They’re amazing. And thank God they took after their mother, but when’s the last time you talked to your brother and they don’t talk on the phone. There is like communicating back and forth in a different way. So there’s a lot we can learn from this younger generation. And I can tell you anytime we had an issue with our electronic medical record, I had a, an advisory group of residents. I just like turned them loose on that. Here’s a problem that like some of the older faculty are dealing with. And I mean, they come up with a solution in like a matter of hours on how to make something easier. So that’s pretty exciting, I think. But I do think getting to our earlier point in our conversation, making it all personal, even though we’ve got all these amazing tools and technology, it’s really about relationships.

Steve Lawler (28m 24s):
And it’s about just having that personal connection. That’s the currency. I mean, relationships are the currency we use to get anything done.

Dr. Anthony Orsini (28m 32s):
And it ties into everything that we do both in our personal and professional life. But as far as medicine, if you have a relationship with your doctor, you’re less likely to file for malpractice lawsuit to be out of a relationship with your doctor. You’re more likely to listen and take your medication and you’ll have better outcomes. One of the things that I’m hoping that we’re going in the right direction and the patient experience is pointing us that way is let’s teach our healthcare professionals how to have those relationships. And then we’ll go on. So one more question, before I get to the final question. So if you take out your little crystal ball, now you’ve been in healthcare for all these years, 10 years from now, what do you think will be?

Steve Lawler (29m 9s):
So I think 10 years from now, I think we’ll be more clinically integrated and that doesn’t necessarily mean it’s like a balance sheet exercise where people are taking over other people. I think it means that we’ve been smart enough and wise enough to figure out if we’re all responsible for the health of a geography or health of a state, or even the health of a region, figuring out how to leverage the best ideas and the best locations, and kind of bringing that into a package to make it easier for patients and communities to receive the best care at the right location, right time and navigate that care.

Steve Lawler (29m 51s):
So I think we’ll see that. And I think that’s pretty exciting. I think we’ll see those clinically integrated networks move to provide coverage options for people in geographies. I think that that makes a lot of sense and I think it creates some efficiencies for the system. I think we’ll see more advances and movement towards kind of hospital at home and kind of using technologies where patients and families have more control over where they’re getting care and then being closer partners and how that care is managed and delivered. And then finally, I think we’ll, we’ll continue to see improvements in quality and patient outcomes and patient safety and tied to that.

Steve Lawler (30m 38s):
I think we’ll see advances and equity and reducing disparities because I do think that by following the same game plan that we followed after Don Berwick’s hundred thousand lives campaign kickoff, where we took this very focused and systematic approach to reducing patient harm, I mean, following that same game plan for equity and disparities, we’re going to see significant progress over the next 10 years. So I’d like to think that at least in North Carolina and I’m sure other states would say the same that our health outcomes and kind of rankings as a state on how healthy we are, are going to improve.

Steve Lawler (31m 24s):
And when we focus on that, it’s kind of like the rising tide it’s going to lift all boats. And then finally, I just like to see our hospitals and health systems continue to build on that level of trust and confidence that we have coming out of the pandemic. That’s something that has been a good thing where people realize where this like amazing force for good. Sometimes we’re not at our very best talking about that, but I think we’ve proven that over the past 18 months. So I think building on that really is important. And part of that, I think ties back to humanizing Healthcare.

Dr. Anthony Orsini (32m 4s):
So one of the few things that did come out of COVID I agree is this healthcare heroes campaign that came out from COVID showing how hard doctors and nurses really are working and work for your health. And I do think that it did form more trust with the healthcare system prior to that because of either political or media reasons, we were starting to paint positions in hospitals, as a, as you said early on is people in organizations who are just looking to make loads and loads of money by the Jaguar. But then we saw nurses on the floor, sleeping in the hallway during COVID and caring for patients. And I think that humanized it, so I’m pretty optimistic about where medicine is going.

Dr. Anthony Orsini (32m 46s):
And I think we are definitely getting better with the quality we’re getting better with safety, but the only caution is that we have to make sure that we are keeping the personalization, especially with, I mean, we’re using electronic medical records to maximize billing and to maximize safety. But I had one doctor say to me last month, you know, I feel like I’m treating the computer and I’m not treating the patient. And so as long as we’re careful about that, I think I agree things are going in the right direction. So Steve, I’m not sure if I warned you about this question when we spoke or now this is the last question I ask every guest before we leave. What in your 20 plus years experience in healthcare or in your personal life, what do you think is the most difficult conversation you have had to have type of conversation?

Dr. Anthony Orsini (33m 30s):
And please give the audience some advice on how to navigate through that type of conversation.

Steve Lawler (33m 34s):
I would say the most difficult conversation I’ve had is been with my aging parents for all of the wonderful things we have in healthcare. It’s hard to navigate and for helping an aging population develop a plan for themselves for the future for that was a really hard conversation. When we sat down with our folks and said, let’s talk about kind of, how do we create the conditions for you to meet the objectives that you both have? So it was a really, I mean, I think these are probably conversations that are going on all over the country. And part of it is the difficulty. And you’ve seen this and having critical conversations with families about a critically ill grandfather in the hospital that is not going to be able to leave that hospital and do all the wonderful things that individual loved doing.

Steve Lawler (34m 29s):
So for my folks. So it was really sitting down and saying, what’s important to you in this kind of last chapter of your life and it was being together. So I’m happy about that. And they’ve been married for 60 something years and I said, wow, in order to do that, if you want to be together, you’re going to have to change. And some of the things that you, hold dear, we’re going to have to work with you to change so you can meet your objective. And that was a tough conversation because it required some decision-making and support. They didn’t necessarily want if they were orchestrating the plan by themselves. And it taught me a lot about just, you know, how to kind of in a very respectful and caring way, have a conversation that leads people to where they want to be, and then work backward from there to make it work for them.

Dr. Anthony Orsini (35m 23s):
I think that’s great advice. And the way to navigate those is to let them make the decision on their own kind of lead them where you want to go. But I think all too often, we, we tend to dictate these difficult conversations like mom and dad, this is what has to happen. This is what you need to do. And I think it works best if they can make that decision on their own. Wouldn’t you agree?

Steve Lawler (35m 43s):
I would completely agree.

Dr. Anthony Orsini (35m 45s):
Well, that’s great advice, Steve. Thank you so much for taking the time. You’re crazy busy. I know. And thank you so much for your time for what you do for promoting health care and thank you for my audience, because I think they really learned a lot from you today and it was a great conversation. Thanks.

Steve Lawler (36m 1s):
I really appreciate you doing this because I mean, it’s a great venue for people to be up to date and grew up regards to what’s going on, but also kind of lifts the shroud of secrecy sometimes in regards to what actually takes place versus what people think.

Dr. Anthony Orsini (36m 16s):
That’s, what we hope to do, Steve, the best way for someone to get in touch with you. If they’re listening to this,

Steve Lawler (36m 20s):
It’s like an email me at Steve Lawler at NCHA.org.

Dr. Anthony Orsini (36m 25s):
And we’ll put that in the show notes to be enjoyed this conversation. If you joined this episode, please go ahead and hit follow on your favorite podcast. It’d be like, get in touch with me I’m available at the Orsini Way.com Steve. Again, thank you so much.

Steve Lawler (36m 38s):
Take care. Thank you.

Announcer (36m 40s):
If you enjoyed this contest, please hit the subscribe button and leave a comment and review your contact Dr. Orsini and his team, or to suggest guests for future podcast, visit us at the Orsini Way.com the comments and opinions of the interviewer and guests on this podcast are their own and do not necessarily reflect the opinions and beliefs of their present and past employers or institutions.

Ditch the Drama with Cy Wakeman

Cy Wakeman (1s):
So there’s just so many things that we work on are mostly problems of the mind that people have come to believe things. Not true. People are believing their own thinking. I’m like stop living your own thinking. And we can just in small, quick ways start to loosen the ego script and people see a different way forward and things turn immediately. And here’s the key, is you get this immunity, I work with bad players all the time. It doesn’t change my quality of life. It doesn’t change my level of peace during the day, but you have to learn that.

Announcer (36s):
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 on how to navigate through the most difficult dialogues. Each week you will hear inspiring interviews with experts in their field who tell their story and provide practical advice on how to effectively communicate. Whether you are a doctor faced with giving a patient bad news, a business leader who wants to get the most out of his or her team members or someone who just wants to learn to communicate better this is the podcast for you.

Dr. Anthony Orsini (1m 21s):
I am honored today that the Orsini Way has partnered with The Finley Project to bring you this episode of Difficult Conversations Lessons I learned as an ICU physician, The Finley Project is a nonprofit organization committed to providing care for mothers who have experienced the unimaginable, the loss of an infant that was created by their founder, Noelle Moore who’s sweet daughter, Finley died in 2013. It was at that time that Noelle realized that there was a large gap between leaving the hospital without your baby and the time when you get home That led her to start The Finley Project. The Finley Project is the nation’s only seven-part holistic program that helps mothers after infant loss, by supporting them physically and emotionally. They provide such things as mental health counseling, funeral arrangements, support, grocery gift cards, professional house cleaning, professional massage therapy and support group placement.

Dr. Anthony Orsini (2m 15s):
The Finley Project has helped hundreds of women across the country. And I can tell you that I have seen personally how The Finley Project has literally saved the lives of mothers who lost their infant. If you’re interested in learning more or referring a family or donating to this amazing cause please go to The Finley Project.org. The Finley Project believes that no family should walk out of a hospital without support. Well, welcome to another episode of Difficult Conversations Lessons I learned as an ICU Physician. This is Dr. Anthony Orsini, and I will be your host again this week today, I am extremely excited to have the incredible Cy Wakeman as my guest today. Cy Is a drama researcher, a global thought leader and New York times bestselling author, who is recognized for cultivating a counterintuitive reality-based approach to leadership.

Dr. Anthony Orsini (2m 59s):
Deemed the secret weapon to restoring sanity to the workplace Wakeman has helped companies such as Google, Facebook, NBC universal Johns Hopkins and countless others how to navigate our rapidly changing world using good mental processes to harness energy wasted in workplace drama and reinvent that effort into achieving profound business results. As a highly sought after conference headliner, she’s a regular contributor on forbes.com. success.com the Huffington post and has been featured on the Today. Show the Ask Gary Vee Show, which I have some connections with Gary V and that group chat or TV, and the New York Times Business Insider Cy was voted the top 100 leader professionals to follow on Twitter for seven years in a row.

Dr. Anthony Orsini (3m 48s):
She has published three books. The latest of which we’ll talk about today, No Ego, how to cut the cost of drama and entitlement and Drive Big Results. Well welcome Cy, thanks so much for taking the time to be on the podcast today,

Cy Wakeman (4m 0s):
Thanks for having me, I’m very excited to talk about drama and all things ego with your audience.

Dr. Anthony Orsini (4m 6s):
I had it inside because I’m like, gee, I’d love to get signed on this podcast. And then I saw we were speaking together in November. So I was so glad when you returned my LinkedIn requests. And I was so excited. And then as we just got done speaking, like we were supposed to do this like two weeks ago. And then when I came home for vacation, my whole entire first floor was flooded from a burst pipe and the audio studio was all flooded. So I said, oh, kind of like both sides, so busy. So I was so glad we can reconnect. So a double thank you for that.

Cy Wakeman (4m 36s):
No worries. I love your topics, the Difficult Conversations and I, myself, I’ve worked with healthcare teams and physicians and just trying to connect better as humans. So I think we have a lot in common.

Dr. Anthony Orsini (4m 48s):
What I love about your work and we’ll get to it later is that you take a different perspective than everyone else. I mean, I’ve done 50 of these interviews now. We’ve had some incredible guests and we’ll talk about that later, but what I’m really fascinated by how you take a totally different approach. And I always say, whenever you hear Cy speak, it’s kind of like a ha stuff. Cause it’s like, oh, that makes sense. That makes sense. So, but before we jump into that, I always like to start with getting people to know Cy Wakeman. And so just tell us about Cy and how you’ve arrived to this pinnacle of your success being on my podcast.

Cy Wakeman (5m 20s):
This is my big achievement. So current Cy, I am a researcher and writer. I live in Baja, Mexico. I just relocated and enjoy the ocean on the daily. And it’s been a wonderful, peaceful place to work. I started out life focus on micro lending and international relations and third world economic development, and really wanted to work with organizations like physicians without borders and be in the, in the peace Corps and go out and just bring love and healing to the world. And somehow I got involved in an aftercare group with adolescents and found out, I absolutely loved counseling and therapy.

Cy Wakeman (6m 1s):
And so I got another degree in social work and started working with families and individuals that struggled with addictions and then working at a health center. I got my master’s of healthcare administration and started putting together behavioral health centers. And during that process, I was really able to get insight what we know about human behavior and what reaches leadership curriculum, leadership development curriculum, were at the time, very unconnected that leadership development was not evidence-based. And yet everything we were doing on the medical side that was when evidence-based medicine was starting to be the mainstream. So I had some really unique experiences, my master’s program, where I started to connect the dots that there is something happening called emotional waste suffering that is optional.

Cy Wakeman (6m 52s):
And that it happens because we, especially as caregivers, we don’t understand how our mind works. So we get played by our ego all the time, and we don’t understand how the world works. And so, you know, we argue with reality, which is an argument we’ll lose a hundred percent of the time. And during that course, I started working with, at the time they were called impaired professionals, which were physicians or nurses that traditionally presented with some type of addiction issue that impaired their work. And I would work with the medical board of our state to just ensure they were ready to go back to work and protect their own wellbeing and also deliver safe care.

Cy Wakeman (7m 33s):
And that’s when I really discovered the needed healthcare for people to understand our jobs are stressful, but a majority of our stress is not caused by the reality of what’s happening. That actually is what we love. That’s why we’re in it. It is the stories we make up about the reality that’s happening and that most of what the people I worked with were upset about never even happened except in their own heads. Like it just never happens. And that became my lifelong pursuit. I want to help people understand that suffering is optional, that you can transcend beyond the ego and you can work in some incredibly healing and fulfilling ways, even in health care, which is a very tough industry.

Dr. Anthony Orsini (8m 17s):
And your work is so important. Especially now I talk about my Ted talk and other presentations about the high professional burnout and in nursing and physicians even before COVID, but I really love your whole philosophy of the ego and it’s in our head and you gave a statistic. I think you’d given most of your talks about how many hours we spend per day being wasted. And everyone goes, wow. And then they go, yeah, I could get that. I kind of get that

Cy Wakeman (8m 43s):
Part of my research. It was not early research by updated every three to four years is I want it to be able to quantify, to prove to people the value of working on this. And if we couldn’t quantify it and measure it and get it down to dollars and cents, we couldn’t sell it. So the average person and we aren’t talking hardworking, super achieving great professional. We’re not talking drama, Kings and Queens. The average person spends two and a half hours a day in drama in the workplace. And this is 816 hours a year, 816 hours a year that people are not only not doing their best work.

Cy Wakeman (9m 24s):
Now they’re working hard, but they’re working hard with a grudge. They’re not doing their best work and they’re miserable in. It’s not necessary. And the example I give for those of us that work in some of our big medical centers, it’s not that when we find a lost family member, we don’t follow the script and do the right thing. We ask them where they’re going. We way finds them. We even go out of our way to walk that we all got that class. We all do the right thing. That’s not what stresses us out. What stresses us out is in our minds. The story we tell ourselves, this is absolutely ridiculous. I am a chief nursing officer and I have to point patients in the right way and their family members. This signage is awful.

Cy Wakeman (10m 5s):
This is absolutely, I can’t believe facilities can not figure this out. Why are they even designed buildings like this? If I were an architect, I would design that totally. That is a big part of our burnout that we don’t realize we have ultimate control and impact. We have the ability to impact it. Yes, our days are really busy, but the stories we tell ourselves where we assign motive and we assume a victim position and we see things as hopeless and we dragged the past around and we predict the future anytime or other, the present moment. Not only are we not present with the people we’re serving, but we are adding stress. If you want stress, get a future. If you want shame, get the past. It’s like anything that’s not now is a problem.

Cy Wakeman (10m 48s):
When it comes to avoiding burnout,

Dr. Anthony Orsini (10m 50s):
You know, the majority of my career, teaching physicians, how to communicate and build relationships. And it kind of transitioned lately into physician burnout as we discussed. And what I often say during my presentations is if you ask physicians and nurses, why are you burnt out? They’ll say, well, I’m over work. But then they start getting into the complaints, right? Hospital administration is on my back and I’m always seeing this and all that. Some of that is true. Some of that is not true, but the one thing that I think the simplest way that we could prevent burnout is what I try to tell healthcare professionals is that when you’re in the exam room, when you’re in the room and it’s just you and the patient, nobody is telling you what to do.

Dr. Anthony Orsini (11m 31s):
That is you and if you can forget all that outside stuff, if you can just get rid of it and say, okay, yes, I’m buried with paperwork and I have all this other stuff. This is my moment with my patient. And we’re going to have, my philosophy is it’s all based on something called it’s hard to fire your best friend. And that is in the next 20 minutes that patient’s going to be your best friend. And if you can do that, you’ll have happiness all day long. And then, you know, there’s other stuff to deal with, but I love that whole it’s perceived. And the, you told the story early on. I’m not sure if this is your talk in your book, that you were young and you were a manager. And there was a nurse who was complaining about a patient who was set to have a surgery that she wasn’t supposed to have.

Dr. Anthony Orsini (12m 17s):
And she was very upset and you turned it right around. Then I thought that is a true leader. Like tell us that story about how she was so mad and you turned it around on her.

Cy Wakeman (12m 26s):
Yeah. So let me preface it by saying, I believe that a modern leader doesn’t manage people. They manage the energy of the space that they’re in. They manage the energy of people away from why we can’t to how we could and what if we could away from why we shouldn’t have to. And that leaders are also translators in a most important role of a leader. Even if you’re leading yourself is translate your drama to your reality. It’s just reality. Hospital administrators are always on my back, translated I am often contacted by hospital administrators wanting to talk to me about financial issues. It’s very different reality,

Dr. Anthony Orsini (13m 3s):
It’s all in the delivery

Cy Wakeman (13m 5s):
And so I don’t want people to even forget it. I want people to realize that they’ve added so much so people come in they’re like we have three patients dumped on us and like somebody physically dumped a patient. Well, no. And I’m like, oh, we have three new intakes. Got it. You know, or the people in it suck and they’re trying to kill us. I’m like, oh, our colleagues in it have implemented a change. We have to translate. So what happened early in my career, I was young, but I was so grateful that I brought so many of my therapy skills and my knowledge about human behavior into leadership. I was advantaged, but I believe in two things, you love people up and then you call them up.

Cy Wakeman (13m 46s):
And so when I’m a leader, I was working peri-op and I was a co-leader because I am not medical by backgrounds. And I would show up about four or five in the morning as teams were coming in and I focus on loving people up, I would go around, I would anchor us in the sacred work we’re doing. I would love them up and thank them for bringing their talent to our facility. And then I would remind them that we’ve done important stuff to do while I’m doing that. One of my nurses showed up for her first patient of the day and she was working pre-op. And for those of you that are familiar with Periop, when we get the preop assignment, we’re kind of relieved. It’s checklist on purpose. It’s safe. It’s kind of predictable. I mean, you’re just going through the medical record.

Cy Wakeman (14m 27s):
You’re making sure the lines are right. There’s a checklist in front of you. It’s a little bit of a relief. Cause not a lot goes wrong in preop. So you’re not having to be like on guard. So she’s getting the patient checked in and going through routine work to make sure it’s safe. And as she’s intaking, this person, the woman becomes absolutely hysterical. She starts to cry. She says, give me my clothes. Give me my husband. I want out of here. You’re not going to touch me. And her. We asked was so out of proportion to the work being done that, of course the nurse, this is a great nurse. Turns to the patient, focuses solely on the patient, comes to find out. The reason for the hysterics is there’s a mistake in the medical record. The patient came in for basically a cosmetic nose job.

Cy Wakeman (15m 10s):
And the nurses prepping her for a partial hysterectomy. And this one was like 30 years old. She’s like, what? So the nurse does what she can to calm the patient down. And the patient’s less hysterical, but the nurses furious. And she said, this is unacceptable. I’ll be back. And she comes out looking for leadership. And she’s like, Wakeman are you the leader on deck. And I’m loving people up. I’m like, absolutely. How can I help you? Just because it’s telling me her story. And she’s like, the people in admissions can’t manage their way out of a paper bag registration. They don’t care about the safety of our patients. People would die. They don’t realize the cost of their mistakes are people dying. And I have to clean up everything. And if it weren’t for those of us from pre-op, we would have all these medical errors, but this are butt on the line, this my license on the line, and she’s calling for heads to roll.

Cy Wakeman (15m 57s):
She wants everyone in registration fired. She’s upset. She’s scowling. She’s looking down. Her whole energy is like big. And I know what I did in that process was disarming to her because I use a whole different skillset than most leaders have available to them. The first thing I do is sematic. And now we’re starting to learn with the book. You know, the body keeps the score. We’re learning that most triggers are sematic. And the first thing people do is they stop breathing and their breath holders. And so I don’t know where I learned how to reset the parasympathetic and sympathetic nervous system, but I turned to her and the first thing I did was calmed myself and I learned that from an ed that they were coming in hot before you do anything, like you get neutral.

Cy Wakeman (16m 46s):
So I got neutral. I didn’t want to meet her energy. And I just said, first of all, and they sit with all the love of my heart, take a deep breath. And then another deep breath, like she was commenced, her being chased by saber tooth tigers. And there just wasn’t any danger. And she looked at me startled, and she’s like breathing. And I’m like another deep one. And I said, now, I said, if you would answer me one question, if you were great right now, what would great look like? And she stuttered. But to her credit, she entertained the question. As she went from calling for a heads-up role to, she looked up, you could just see, she tapped into a different part of her brain. She couldn’t see any way that she could have impact until when she looked up, she was like, you know, I could go back into the patient room and explain to them, this is actually a process that’s working.

Cy Wakeman (17m 36s):
The reason we do this five times and check and sign people’s foreheads and draw on, you know, body parts to ensure there are no mistakes. She very quickly took two minutes. She said, I could call a bedside. And the ENT, he could reveal. He’d never even probably done a hysterectomy. So there’s no danger of that. And she came up with, we called training quickly. She’s like, oh, we were just trained. If there’s ever a mistake to turn the monitor towards the patients called visual queuing and they see you fix it. It doesn’t matter what she came up with. But the key was all I said as a leader is if you were great, what would great look like? And she knew, I cared about her.

Cy Wakeman (18m 16s):
And she instantly had all these ideas and that all I had to do as a leader, which isn’t very stressful, doesn’t lead to a lot. Burnout is say, oh my gosh, awesome, go be great. And she did. And some people are like, so you just dropped her. You know, some people that hear this through ego, they’re like, oh, great support. You shamed her. You just suck it up. Buttercup. Nope. I followed into that bay area minutes later, not to rescue her, but to show the patient that we have additional oversight on this issue to add another calming force. And then I did what most leaders don’t do. Leaders, leave learning on the table in therapy.

Cy Wakeman (18m 56s):
We know the integrations, everything. Even if we use like a psychedelic, we want you in therapy to integrate whatever that journey you went on. Like we know the integrations, everything. So just naturally I said, can I have some time? And I loved her up. I said, thank you for the way you pivoted in that situation. Amazing. You rocked it. Now, let me ask you this. What did you learn about yourself in this moment? What did this reveal to you? And she was such a good self reflector. She’s like, you know what? I got self-righteous and judgmental. And I said, I don’t have to give you that feedback at a performance review that makes you mad. I just said wonderful.

Cy Wakeman (19m 37s):
Now that you know that about yourself, now that you know better, you can do better. And the whole key to this is what I want people to hear. This isn’t me correcting someone. This is the same nurse. When she’s toggled down, as we call it, seeing the world through the lens of ego she’s, self-righteous judgmental calling for heads to roll. But self reflection is the ultimate drama diffuser, because there’s a glitch in your mind where you can’t vent and self-reflect at the same time, they’re mutually exclusive. You cannot judge and help at the same time. So when I ask a question, if people are open, they can’t stay venting when they’re reflecting and problem solving.

Cy Wakeman (20m 17s):
So without shaming her, without saying, you’re very negative, or without saying, you need to think differently without punching the Eagle in the face. I just bypassed it. And I just asked her without asking to use a different part of her brain and the message I want listeners to have. Is that the cool thing about the superpower? If they would just start to use it is it’s the same nurse toggled up or down. And here’s why that’s important. My people go well, wasn’t there a process issue? Oh my goodness. Yeah. When we upgraded epic and we reloaded procedures, somebody did it alphabetically. And for those of you that know Latin, you know that a single bowel makes a lot of difference in the life of a patient.

Cy Wakeman (20m 58s):
Like whether there’s something goes in or out, we screwed up, it increased clicking errors and intake. But who would you rather have working on the issue with you? The self-righteous judgmental nurse calling for your head to roll or the self-reflective curiousness interested in patient safety. I would take the second nurse. Think of all the committees you’re on. What if you had nurse number two, who is toggled up and self-reflective in your problem solving efforts and your continuous improvement in your lean efforts, in your compliance efforts. That’s where we can get stuff done without the drama. That’s where a one hour meeting can really move us forward to solve a lot of problems. So I got to be known for that technique where I just disarmed people unintentionally when they would come to us, but I would fix their language.

Cy Wakeman (21m 45s):
I would ask them to breathe. I would make sure if they’re coming in hot, I did not match their energy. And I would tell, you know, physicians are typically nurse practitioners on that care team when we’re giving clinical care in the position of a leader. And so I coach so many physicians on energy management of their own. It does not help. If somebody is coming to hot for you to meet that energy, it’s alchemy, you can transmute some of these intense energy just by the existence of your peaceful presence. You can manage the energy of the entire room. And like you said, that is so powerful. It’s you and a patient manage that energy.

Dr. Anthony Orsini (22m 20s):
You talked about toggling up and toggling down yourself. I think you call it the high self and low self. If I’m not mistaken. What I tell doctors when I’m giving my presentations is that no matter how good you are at communicating, building relationships, being happy that you are either on a daily basis at one point in time or every now and then you are going to become task oriented. You’re going to forget about that relationship. It happens to me. It’s inevitable. You’re in a busy ER, you’re busy NICU and that’s okay. The important thing is to recognize I’m becoming task oriented stop. And I think that’s what you’re talking about. Toggling up and toggling down. I think you talked about, you have to do three things.

Dr. Anthony Orsini (23m 1s):
Tell us about the three things you have to do when you recognize that you’re low and you need to get high.

Cy Wakeman (23m 6s):
The easiest, quickest way to toggle up is to use self inquiry. Now, ultimately you do that in the moment to change the moment. But if you do long-term contemplation and meditation and we don’t just pull out wellbeing practices. When we’re stressed, we need these habits and dedications to really, they can change our entire brain chemistry, how we want, but when your stressed and the first question to ask yourself is what do I know for sure? Like, I’m going to be here to midnight that I’ve got all this stuff to be done. And I’m the only person that cares. And I’m the only one that can do this. And I’m behind because of the electronic medical record. And it’s like, what will, what do you know for sure right now? And I call it come close in.

Cy Wakeman (23m 47s):
A lot of that times, I’ll say, come close in. What do you have to do in the next hour with three patients? Do you have everything you need to do that? Yeah. Then start there. What do you need to do today? And so when we get tasks, focus, when we get stressed with our tasks, we usually have toggled down. When we’re into tasks, I am the martyr. I am the victim, I am suffering. And so I just ask people, what do you know for sure. And if you get it down to, you know what today I know for sure. I’ll see some patients, I’ve got some dictation to do. I have some families to meet with, to make calls to make. What you’re going to find is that your days are pretty similar. Only every single day. It’s your reaction? That is so out of proportion, people come to me and they’re like, I want to be a surgeon.

Cy Wakeman (24m 30s):
I’m like, oh my gosh, be a surgeon. They’re a family practice doc. I’m like, I need more surgeons. And we have a med school right across the street. And they’re like, yeah, but I don’t want to go to four more years. I’m like awesome. Then be a family practice, doc. You already are one. I want to make what a surgeon makes. Awesome. I will put you on the search and eggs, just be a surgeon. And they’re like, I don’t want to do the schooling. I go great. The, be a family practice doc. And they’re like, you are preventing me from getting what I want. And I’m like, you have me in reality. So confused. I am here helping you get what you’re willing to have. And it all comes down to seeing reality for what it really is. All you have to do today are probably some of the same tests you had to do yesterday. All of your problems today are probably the same problems you had yesterday.

Cy Wakeman (25m 11s):
Like you don’t delegate, you don’t learn to keyboards. So electronic medical records hard. So what do you know for sure that releases the eco scrip on your reality. I’m driving to work. Someone moves over into the lane in front of me, the guy cut me off his male chauvinist pig. Look at this bumper stickers. He doesn’t like women drivers. He’s reckless. He’s irresponsible way. Ask stuff. What do I know for sure. All that happened as the person moves into my lane, allowing me less room than I prefer, that’s it. So the Eagle script has done that. Frees me up to say, what can I do next to help stop judging and start helping. I could let him into my lane safely.

Cy Wakeman (25m 51s):
And then if I were great, what would great look like? And those three questions, I run people through all the time. So we got three patients dumped on us and they purposely held these in the ed until they knew we had shift changed. And then they expect us to stay over and they lock us down. And this is, I’m like, whoa, what do we know for sure? We have three new intakes from the ed they’re in search protocol. That sounds really evidence-based and safe. They’re safer on our unit than they are in the hallways of the ed. Let’s commend our colleagues. When we get time. Now, what could you do to help? And we just drop the past and we go, well, I could intake these people. Perfect. If you were great, what would that look like? Well, I’m working on asking for help.

Cy Wakeman (26m 32s):
So I would ask my tech to do the following things and get the initial blood pressures. And I’m like, I love how you’re thinking. And the role of a leader is to help move us using self-reflection up to our highest and best self, because that is where we don’t burn out. We are tapped into an energy source that I don’t think people understand in medicine, how they get energy, because I see them when they start to feel stress and burnout, they do exactly the wrong things to try and conserve their energy.

Dr. Anthony Orsini (27m 4s):
So those are the three ways. And I think that works for just everyday life. The other thing that you said I thought was really important is really everything’s perception and how you perceive things. One of the things that I do that I actually love, I think you’re probably gonna think I’m crazy, but I love conflict resolution. And so I’m the doc that when I walk into the hospital, the charges nurse is like, so there’s an unhappy parent. There’s an unhappy patient. Can you go talk? And I smile. Like, I think I’m good at this. And I love doing this. And it’s a matter of perception. I’ll tell you a quick story. Many years ago, for those people that aren’t in medicine, when babies have to go usually four or five days, premature babies without forgetting to breathe before we’ll will send them home. And many of those babies need car seat pass. You put them in a car seat, make sure they’re okay.

Dr. Anthony Orsini (27m 44s):
These are all processes to make sure it’s safe to go home. So there was a baby who had a car seat, test pass, and then was changed to a different room. And the nurse didn’t know that the car seat test was already done. She did it. And the baby failed. So the parent was very upset because we sat down. Now we have tomorrow, we have to check it again. So it was one extra day in the hospital that night, the baby forgot to breathe. And that meant that now that baby had to stay five extra days. So the people who decided to handle this the way it was handled initially was again, how you deal with this. I’m sorry, Mr. The second nurse shouldn’t have done the car seat test. Otherwise your baby would have been home by now. And so that went crazy, right?

Dr. Anthony Orsini (28m 25s):
Well maybe dead, maybe not. So now the father is calling a friend, whose another doctor and it’s a big deal. So I come in and I go, oh, I could take this. And I introduced myself and I just said to the father, you must have an angel looking after for your daughter. There’s so many in heaven looking after your daughter. And he’s like, what do you mean? I said, thank God that second nurse did the car seat test. Cause your baby could have been home. And he looked at me and he said, my God, you’re right. And just the fuse by how you look at it. Right? I mean, so that’s basically what you’re saying. It’s just, and what you do. And you were talking about being a great leader, great leader. Just make you self-reflect right. They make you think about how to look at things differently.

Cy Wakeman (29m 7s):
I see things from a bigger perspective where it’s not just about you or how you, your ego is zeroed in on this moment of one mistake. It lets you see things from a bigger perspective, which always comes with relief and peace and conflict resolution. Like whenever we can widen our perspective. So many more options open up to us and physicians in particular do not realize their additional power because patients believe more of what physicians say than others. So when you even taking a different perspective with your rank, there’s a superpower you have that you can either add fuel to the fire. Like the friends did, that was called. Maybe that was the physician.

Cy Wakeman (29m 47s):
They shouldn’t have done that. Or to add that perspective. People want resolution, people want peace. People want a way to save face. People want a way out of conflict. And we don’t often give them that by giving them benefit of the doubt or gratitude or seeing things in a different perspective

Dr. Anthony Orsini (30m 4s):
And giving them a chance to toggle down to when you have an angry patient or an angry person. I do my four pillars of conflict resolution walking into the room when someone’s ready for a fight and saying, well, you’re a Yankee fan. I see that you have a Yankee’s hat, that disarms them, right? Like

Cy Wakeman (30m 22s):
That’s from my background, that’s cognitive dissonance. Like I want to hate this guy, but now he just want me likes the Yankees. There’s so few of us that like the Yankees,

Dr. Anthony Orsini (30m 33s):
I was so ready for a fight. And now I’m

Cy Wakeman (30m 35s):
Disarming. What would great look like disarming? So just translating for people, anything in disarming your first pillars, genius.

Dr. Anthony Orsini (30m 43s):
Well, thank you. I want to get to this question that as I’m reading your books and I’m listening to your talks and you know, we’ve had so many great people on this podcast and it’s incredible that people like you and other many amazing people that have been on the podcast. And a lot of times we talk about leadership and we’ve talked about leadership and a common topic is culture in business. And so I said at the beginning of the interview that you take a different perspective about that because you’re talking about the bitch moaning and whining. What would great look like many of the other people that I’ve spoken to it’s real big now is to talk about what a good leader should be. And you’ve mentioned that my question that I’m finally getting to after all this time is there are some bad leaders, there are some really bad leaders and those leaders create a bad culture.

Dr. Anthony Orsini (31m 34s):
And if we allow it, if we allow it, when you go into a business or a hospital and you have this dysfunctional culture, how do you Cy Wakeman decide whether this is a bitch moaning and why does your call BMW problem? And we need to, what would great look like and all that and get the workers to look differently. Do we need to train the leaders and are there some leaders that just have to go?

Cy Wakeman (32m 1s):
So when I’d want an organization, the first thing I introduce is non-dualistic or polarity in thinking, is this a bad leader? Or are these people whiners? Because that’s what most people, they want to be on this spectrum of duality. I’m like let’s transcend that. We probably have under-skilled leaders. We probably have a few social paths. If you look at the number of people employed and what gets you to be a leader, like here’s what I know for sure. We led comes mostly in this flavor. A few months are involved. We have some people overreacting to some poor leadership decisions made by some good leaders and some bad. So there are some people who need to go and there are also things to work on where people overreact or allowed their peace to they’ve outsourced their emotional experience to some CEO, three systems away that they’re like don’t ever see on a regular basis.

Cy Wakeman (32m 54s):
So what is coaching the person in front of you? So if it’s someone in front of me who said, I have a bad leader, I’m like, you know, some days are like that. So you either need to stay, enjoy and get skilled in working in the reality where a leader isn’t like you prefer, or you need to leave in peace, but staying in hating and staying in venting will ruin you and your health. You are the own source of your own suffering there. I have done great work for leaders. I didn’t prefer, I believe that work with the love HR. There are leaders that have misused privilege and have profound bias and do harassing things.

Cy Wakeman (33m 36s):
And I fired surgeons for throwing a scalpel at somebody because they were mad at them. And then there’s like, are there people who, when they’re believing, they’re thinking do horrendous things. Yeah. And what most people don’t do is they don’t move to transition some of the other system early enough. They have all this decision bias about keeping folks. And so I have one plus valve only work with the willing. So it doesn’t matter what your skill set is. Are you willing to learn this with the people need to evolve and need life skills no matter who they’re working with. And so some of that came to me and they’re like, I can’t be on shift with that person.

Cy Wakeman (34m 16s):
They’re horrible. It’s personality conflict. And I said, well, we’re not going to work around that. But what I can do is help you grow so that your care you give is unaffected by the behavior of colleagues or family members or patients. And then you can walk through the world freely. You know, I, you want me to control reality, but I could teach you how to evolve in the way that you can walk through the world freely. If you had the skills where you can kindly, but solidly call timeouts and you say, no, you can protect a patient from bad things. You have all that power. So when I come in, I tend not to say, let’s work on the whole culture. I tend not to want to scapegoat the leader.

Cy Wakeman (34m 56s):
I say, let’s start with you living well in your current reality. And then if you decide what those skills that you prefer, a different reality, you can always go and then we’ll work. Also another level, what we’re working with leaders to get them skilled up and their leaders to make sure that we’re not feeding the wrong group, that we’re not putting our great people on hold and having them be held hostage for a few. So when I’m with CEOs and CFOs and CMOs, I start with them and I say, you have 10 courageous decisions, your 10 courageous decisions away from a much better work culture. And they write the list and I go, not there yet. They write the list, not there yet.

Cy Wakeman (35m 37s):
And then things appear, we’ve got to get out from under the hold of this. I make that’s one courageous decision. And then when I work with people that have been promoted and aren’t yet skilled leaders, we skill them up. We do a lot of leadership development, but what we do that people don’t do we work with the employee is how can you walk through the world? Skillfully, personally, accountable with good change skills, top resiliency. So many people. And I interrupt to this. So you don’t have to fix the culture. We have to fix the climate, which is the team you work with, like your Neo. And they tell us, you have to fix the climate on that unit or in that division. And if enough leaders said that we always had great climates, we can control our workplace.

Cy Wakeman (36m 23s):
And at the times we had the interact with others that were more toxic because of the way we interacted. They would hand us the tug of war rope and we wouldn’t even pick it up. And so we started to find other climates and then we knitted those climates together. And that changed the culture or enough of the culture for our tastes. And so I don’t even believe in culture change as much I believe in climate change and then knitting those climates together. Cause I think it’s something we can do, but we’ve got to help people understand that people say change is hard. Change is only hard for the unready its readiness. During the pandemic, people are like site, how do I get my people resilient? And that people aren’t broken.

Cy Wakeman (37m 4s):
They already are resilient. These people made it through hard programs. The people who are in our dietary area, you know, are managing homeschooling kids and getting their butts to work. Like we have resilience, but resilience. The old thing is that people believe resilience is muscling through persevering. And my confidence is I’m the smartest person in the room or I’m the most prepared for every situation. True resilience from our research is collective genius. It’s not the person who has the most stamina or the person we’ve tortured the most in medical school. It’s the person who is able to be vulnerable, ask for help and crowdsources things. So think about COVID the first calls I got from ed that’s in New York Presbyterian.

Cy Wakeman (37m 47s):
And then they were like, what is going on? I don’t know how to deal with this. The respiratory illness is pretty easy. It’s pretty matter of fact, like it’s and they’re like, I used to know what I would see coming in my ed. I used to know everything about this. I’m like, no, that was how I was an illusion that certainty. And so I said, what if you include your confidence in the collective of genius of the whole, are you meeting with the ICU nurses? Are you tapping in to the CDC and tapping into? And all of a sudden they started learning about positioning patients and when the events, all of that learning came from people tapping into collective genius. And so there’s just so many things that we work on are mostly problems of the mind that people have come to believe things.

Cy Wakeman (38m 30s):
Not true. People are believing their own thinking. I’m like stop living your own thinking. And we can just in small, quick ways start to loosen the Eagle’s grip and people see a different way forward and things turn immediately. And here’s the key is you get this immunity I work with bad players all the time. It doesn’t change my quality of life. It doesn’t change my level of peace during the day, but you have to learn that. So an example is I had a physician who wouldn’t cover his tattoos, his a neurosurgeon. He had eight skulls tattooed up his arm. So whenever he would go out to brief the families, he wouldn’t put his lab coat on.

Cy Wakeman (39m 11s):
And so I first worked with them. I’m like, Hey, look, I got hooks. There’s no door. You can go out of that. There is no white coat with your name on it. And I even put chocolate in the pocket. So like, that’s your reward? Like, put your coat on. And I mean, I was necessarily, I’m like, I know you have a hard job. I will hire people to stand by the door, but you have to cover your tattoos. So I kept meeting with him. He goes, so you’re gonna fire me because I won’t cover my tattoos. And they go your thinking of quitting medicine so that you don’t have to cover your tattoos. Cause see, that’s how our mind turns things. And like, no, we simply have a policy. So you’re thinking of giving up your medical career because you don’t wanna wear a lab coat. What’s that about?

Cy Wakeman (39m 51s):
I couldn’t get him to do it. And finally he goes, I said, are you ever going to say yes, so this, and he goes, I’m just going to say no to this. I said, have you ever considered what would happen if you just said yes, just for a minute. He’s like, well, I probably wouldn’t have to meet with you every Monday morning. I go. Yeah. Like that, most of us don’t even consider it. If we just said yes to what’s being asked of us and how that frees us up. So I don’t believe at working on culture because it outsources our emotional experience to something vague let’s work on our climate, which is our relationship and how we lead and how we serve patients or customers. And that we can measure as well.

Dr. Anthony Orsini (40m 29s):
I mean with that, cause we all find ourselves doing that, right. Bitching and moaning and whining. And I heard about your Michelangelo thing. And David saying that all he did was he removed the imperfections. He didn’t create David. Right. And I love that. And I remind myself of that often because it’s easy to get into that bitch, moan and whine. It’s just, it is very easy to become task-oriented but I want to ask the same question that I ask every single guest. And that is please share with us your most difficult conversation that you’ve had during life or the most, if you’d like difficult type of conversation and give the audience some advice on how you were able to navigate through that conversation,

Cy Wakeman (41m 7s):
They have made a career out of having difficult conversations. I mean like you, I kind of, my mom would say she rushes in where angels dare to tread. So one of the most difficult conversations and there’s been many I’ve had, and I’ll give you my tips. I was very young and I was I’m working on the inpatient psych unit and there was a man named Dr.

Cy Wakeman (41m 49s):
O, he’s retired. He loves the story. So he won’t be mad. He was hell on wheels. So we had all heck breaking loose and it was time to give the medications to our patients. And I’m not licensed to do that. And we had just everything you can imagine going wrong on a psych unit was going wrong and all staff were engaged. So I called him and I said, Dr. O, I need you to return to the unit please. And he screams, he goes, I was just, f-ing on that unit. And I agreed with them. I dropped my into the tug of war rope. I go, yes. I just want to validate for you. I did see you. You were just on the unit. I think 5 minutes ago. He’s like, so I was just on that unit. I was just, there I go. You know, I think even if we checked security cameras, I could validate that you were just here and I wasn’t being sarcastic. My tone of voice. I’m like, I have found that when people want to argue with you or vent, just not collude with them, just if, as factua, that part’s factual. When people say you don’t know everything about this, I go, I think you’re absolutely right. I don’t. So that was my first technique.

Cy Wakeman (42m 29s):
And I said, I do need you to return. And I need someone here to pass meds. And he goes, are you an idiot? And I checked myself and I go, you’ll actually, I am, I hardly passed pharmacology. And that’s why I became BSW. And I didn’t go on to be a physician because in pharmacology, I can’t remember all those words and he just starts laughing and I go, seriously, I’m an idiot. And I can’t do this. Will you come up? So by the time he comes up, we need to go tend to a patient who’s out of control. And I said, before we do this, I’m glad you’re here. You and I need to go down. And at the time we called it the take down, there’s a person that’s going to harm himself and we need to give them some medication IV.

Cy Wakeman (43m 12s):
So he was yelling at me. He goes, this is absolutely ridiculous. And who runs this unit? You guys all don’t know what you’re doing in the middle. You hear is horrible. And I said, I’m glad to listen to all of those things. If we could focus on this, I’ll spend as much time as you want on those later, another technique, like let’s just deal with the issue at hand. And then he was yelling at me. And so one of the things I did, I learned as a therapist, as I started moving closer to him because you can’t raise your voice. If in a non-threatening way, I’m really close to you. And I started whispering, I lowered my frequency of my voice. And I just said, you know, you really need to focus right now. And he said, well, let’s go do this, take down. And I said, well, before we do, this is only you and me that care about your safety in that room.

Cy Wakeman (43m 53s):
And you’re smaller than me. And so I really need to protect you. And I’m just not sure. Cause I’m so mad at you right now. My feelings are so hurt that I would do a good job. It’s like what? They go. You need to apologize to me. No one asks for an apology. I do. You need to apologize to me. I would like that. What would help? I go to the apology he go say, I’m really sorry. I go, thank you. Let’s go in. And then as I deescalate that situation, my tips in this is before you go into a tough conversation, you’ve got to manage your own energy. Before you go have a conversation, you’ve got to get out of your own story. This sector, sector’s no right to yell at me. Is that? Yeah, that’s not right.

Cy Wakeman (44m 34s):
I had to get rid of all of that. All I knew is what do I know for sure? I have a doctor who’s not at his best. And I have patients who need him. So forget me. I’m going to connect the two. And then I had to not take any bait. And then I had to ask directly for what I hoped for. And I needed to manage my energy and speak my truth. The way I see it broaden perspective. There’s only two of us that care about your safety. And one of them is pretty upset here. And the thing I would tell folks is you cannot do this on the fly. You’ve got to get your techniques down and don’t practice with your hardest case. Practice, take your bravest moments with the most willing, even tell the most willing I’m about to practice something on you.

Cy Wakeman (45m 16s):
And will you go easy on me? Will you participate? So I’ve had so many of those conversations in the moment, you know, we all do in health care. We tell people they have STDs. We tell people that have cancer. We I’ve asked for two divorces. Those are hard. We agreed on this. You’re not living up to that. I need to divorce like, but we can’t always be open-hearted open-minded and we’ve got to remember, we ask for what we need and we tend to them. We don’t try and change them and tend to us. We get that so wrong. We want to control the other person and tend to our hearts. And what we need to do is control ourselves and tend to their hearts. And if you do that, I think that you’re good to go.

Dr. Anthony Orsini (45m 57s):
That’s great advice. So we always joke. I started by teaching, breaking bad news, how to teach doctors, how to give somebody tragic diagnoses. And we joke say the first thing you need to do before you enter the room is take your own pulse.

Cy Wakeman (46m 8s):
That’s thing. Me take your own pulse. And by the way, I would say evolve worked through your own death issues. Yeah. Like most of the people I worked with that wouldn’t refer to hospice just hadn’t worked through their own accumulated grief. It’s like,

Dr. Anthony Orsini (46m 23s):
Well, it happens with breaking bad news is that we don’t train our doctors. And when you are asked to do a task that you’re not comfortable doing. So if I said Cy, can you go do an appendectomy? You’re going to be pretty nervous. And so what we do is we don’t train the doctors or we give them an hour lecture. Then we say, all right, go tell that mother that her five-year-old died. Of course you’re going to be nervous. Of course your heart rate going to go up is going to be like Cy performing an appendectomy. So what we can do is we can teach them how to have these difficult conversations, make them proud of the skill, just like you’re talking about. So now when they have to go in, they don’t have a rapid pulse because they’re like, I’m good at this. And I can really make a difference in this family because I learned how to do it.

Dr. Anthony Orsini (47m 3s):
So stop asking people to do stuff that they’ve never been trained.

Cy Wakeman (47m 7s):
You’re being asked to do stuff you haven’t been trained on quit blaming medical school 15 years ago

Dr. Anthony Orsini (47m 14s):
Cause you can get trained now.

Cy Wakeman (47m 14s):
Evolve. But I think it’s so important. Most people when they’re under stress want to change reality. And what I encourage people to do is increase your skillset. So you can walk through the same reality, more skillfully. That’s how you reduce your stress. You don’t pray that reality will be different. Evolve yourself. The more you evolve yourself, the more loving you can walk through the world. The more peaceful you can walk through the real world. My next book is called life’s messy, live happy. And the whole premise is it’s not about what’s happening outside of you. It’s about the way you’re contemplating evolving and your habits and dedications so that you can walk through even chaos, skillfully and have these conversations.

Cy Wakeman (47m 57s):
And by the way, if we’re working with humans who have health issues, we’ll have hard conversations, but only a hundred times a day. Like why wouldn’t you want to be skilled on that?

Dr. Anthony Orsini (48m 8s):
That’s what I’m doing. And so we’re promoting this and I love your work. And this has been amazing, I know you’re up on a hard stop here, but I can probably do this to for two or three more hours. So we’ll talk more in Phoenix.

Cy Wakeman (48m 20s):
It’s going to say I will come back. The reason that people in our field, yours included love to come on podcasts is we want to help people. I mean, that’s why we got into this. So I hope our conversation. It helps. I’m glad to have many more. I hope we see each other in-person in November. That will mean the world is improving.

Dr. Anthony Orsini (48m 36s):
That’s fantastic Cy. The best way that people get in touch with you ?

Cy Wakeman (48m 39s):
Any way on social media is at Cy Wakeman, C Y w a K E M a N. My podcast is called the No Ego podcast. We talk about all kinds of great things and our website, RealityBased Leadership.com.

Dr. Anthony Orsini (48m 52s):
We’ll put all that in the show notes. So if you’re driving, you don’t have to worry about pulling over. Cy, thank you so much. This has been an amazing, if you enjoyed this podcast, please go ahead and hit, download and subscribe on your favorite podcast platform. I can be reached at Dr. Orsini at the Orsini Way.com. Thank you so much. This has been a lot of fun. Well, before we leave, I want to thank you for listening to this episode of Difficult Conversations Lessons I learned as an ICU Physician, and I want to thank The Finley Project for being such an amazing organization. Please, everyone who’s listening to this episode, go ahead, visit The Finley Project.org. See the amazing things they’re doing. I’ve seen this organization literally saved the lives of mothers who lost infants.

Dr. Anthony Orsini (49m 34s):
So to find out more go to The Finley project.org. Thank you. And I will see you again on Tuesday.

Announcer (49m 41s):
If you enjoy this podcast, please hit the subscribe button and leave a comment and review to contact Dr. Orsini and his team, or to suggest guests for future podcasts, visit us at the Orsini Way dot com the comments and opinions of the interviewer and guests on this podcast are their own and do not necessarily reflect the opinions and beliefs of their present and past employers or institutions.

Be The Leader Nobody Wants to Leave with Kris Baird

Kris Baird (1s):
You look at what does turnover really due to that patient relationship and the confidence that the family or the patient has in the caregivers. So there’s that, but then there is a huge financial implication. Right now, the data shows that the average nurse turnover costs in the organization, $44,000 and the average hospital, is spending between three and $6 million on turnover every single year. And so when you look at that and you think about, well, why are people leaving? And to have two of the main reasons that come up is their leader and the culture.

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

Dr. Anthony Orsini (1m 32s):
I am honored today that the Orsini Way has partnered with The Finley project to bring you this episode of Difficult Conversations Lessons I Learned as an ICU Physician, The Finley project is a nonprofit organization committed to providing care for mothers who have experienced the unimaginable, the loss of an infant. It was created by their founder, Noelle Moore, whose sweet daughter Finley died in 2013. It was at that time that Noelle realized that there was a large gap between leaving the hospital without your baby and the time when you get home. That led her to start The Finley project, The Finley project is the nation’s only seven part holistic program that helps mothers after infant loss, by supporting them physically and emotionally, they provide such things as mental health counseling, funeral arrangements, support, grocery gift cards, professional house cleaning, professional massage therapy, and support group placement.

Dr. Anthony Orsini (2m 26s):
The Finley project has helped hundreds of women across the country. And I can tell you that I have seen personally how the Finley project has literally saved the lives of mothers who lost their infant. If you are interested in learning more or referring a family or donating to this amazing cause please go to the Finley project.org. The Finley project believes that no family should walk out of the hospital without support. Welcome to another episode of Difficult Conversations Lessons I Learned as an ICU Physician. This is a doctor Anthony Orsini, and I’ll be your host again this week. Nursing leadership is a that we’ve discussed more than once on this podcast, as I’ve had the privilege of interviewing Lori Gunther from Synova Associates, then more recently, Dena Carey from Virginia hospital center, both discussed the importance of nursing leadership and how it can negatively or positively affect not only the culture of the hospital, but the patients and the nurse’s wellbeing.

Dr. Anthony Orsini (3m 22s):
My guest today as taking those concepts in a topic of employee retention too, the next level, Kristin Baird is a nurse and former healthcare marketing executive. She is the Founder of Baird Group, a consulting firm that helps healthcare leaders create cultures where patients want to come for care where physicians want to practice and where employees want to work. She is the author of five books and hundreds of articles on culture leadership and patient experience. Her flagship learning course, which we’ll be discussing today is called Be the Leader Nobody Wants to Leave: eight skill Builders for Busy Leaders is earning international accolades for increasing employee engagement and retention by building a central leadership skills.

Dr. Anthony Orsini (4m 5s):
Kristen earned a bachelor’s of science and nursing from the university of Wisconsin, Madison and a master’s in health services administration from Cardinal Stritch university in Milwaukee, Wisconsin. Baird was appointed by the secretary of health, to serve as an advisor to the national health service. She is a highly sought after speaker for state and national conferences where she pushes leaders to think differently about their roles in culture and engagement. Well, Kristin, thank you for taking your time out of your busy schedule for joining me. I’m excited about this conversation where it’s going to lead us. And I think the audience is really going to get for a real treat today. So thank you, Kristin.

Kris Baird (4m 44s):
Yeah. I mean, one of the things that has just really it’s been a gut punch, I think for the entire industry is grasping where we are with turnover right now. And when we look at the bureau of labor statistics data, it’s one, half to two times somebody’s annual salary to replace them. Well, when I started researching turnover, I was just appalled to see what the number’s really looks like. And when you are looking at healthcare across the nation, it’s around 16%, which is troubling enough, but then when you drill down into different segments, like long-term care, you know, that it’s become accepted, that they ranged between 45 and 50% turnover.

Kris Baird (5m 37s):
And you look at homecare, you know, with the aging boomers, we need more home care than ever. And the turnover there is that 65% and you stop and think, you know, I just mentioned home care in longterm care. Those are the relationships you develop with your caregiver because they’re not as episodic is the acute care. And you look at what does turnover really do to that patient relationship and the confidence that the family or the patient has in the caregivers. So there’s that, but then there’s a huge financial implication. Right now, the data shows that the average nurse turnover costs an the organization, $44,000 and the average hospital, is spending between three and $6 million on turnover every single year.

Kris Baird (6m 32s):
And so when you look at that and you think about, well, why are people leaving? And two of the main reasons that come up, is their leader and the culture,

Dr. Anthony Orsini (6m 43s):
Most people would think it’s money. It’s not money, right?

Kris Baird (6m 47s):
No, money doesn’t come in at the top of it is not typically money. And just an interesting story, when we go into organizations and we do focus groups, we’ll talk to the frontline people and we’ll say, you know, what inspires you to do good work? And they will almost always speak from the heart. You know, I want to make a difference. I would want my mother treated this way. I would want my grandma treated this way. So they speak from the heart. And then we asked leaders, what inspires you to do good work? And the leaders will say the same thing. You know, I believe in what we do. I want to do what’s best for our patients. But then we ask another question that is pivotal in this whole equation.

Kris Baird (7m 32s):
We asked them, what do you think inspires your staff to do good work? And so often they say money. And when you hear that and you realized the staff is saying heart and their speaking wallet, then the manager who has that belief, isn’t going to go out of their way to really work on engagement, to work on, you know, giving recognition and reinforcement and creating a culture because they think I can’t change the budget.

Dr. Anthony Orsini (8m 4s):
Right. I think when, when people get a raise or the money is great, you know, everybody loved, like where can I buy in how I can move to a bigger apartment? But I think the raise really symbolizes is the money symbolizes that recognition. You know, when I was young, my father was a police officer and then he went into the private sector, worked in the security and banking. And I remember maybe being a junior high student and my father coming home, all excited because he got a promotion and they couldn’t wait to tell her my mother he got a promotion and my mother who’s, you know, her jobs to pay the bills, right to make sure that the supermarket makes sure they don’t run out of money. And my mother’s says, well, how much money did you get in?

Dr. Anthony Orsini (8m 45s):
He said, Carol, their not giving me any more money, but I got a promotion. She looked at him and said, but I need to pay the bills. And so the point of that conversation is that my father was excited. Not because of the money because he got recognition, right? I mean, that’s what you really crave. Right?

Kris Baird (9m 3s):
That’s normal people do crave recognition. And so often we’re speaking two different languages. You know, we have one person that says, I don’t feel we need to give recognition. That’s their job. And yet we ask people all the time, you know, what inspires you? What gives you that extra surge of wanting to do better. And it’s usually recognition. I can’t think of a time anybody has ever said it’s when I get more money, it’s usually the recognition.

Dr. Anthony Orsini (9m 31s):
One of my favorite quotes is the worst thing that can happen to a business’ is when their most passionate employees goes silent. The people want to be heard. And I’m going to ask you how we can fix that, you know, later on down the line. But I think that’s a common misunderstanding what makes a good leader. And so a lot of that is communication. So you speak a lot about culture and leadership. And you mentioned before that they are related what comes first, the chicken or the egg, is it the poor and leader that makes the poor culture, or is it the poor culture that brings on the poor leader?

Kris Baird (10m 10s):
Yes. Okay. So let me just kind of start in the beginning, which, you know, I don’t know the chicken or the egg , let me just start with the definition. And so when we talked about culture, there’s all of these scientific definitions of a culture that are very flowing pros. I’m going to give you the down and dirty, straight talk culture is how we really do things around here. So you can put anything you want on that mission, vision value of plaque, the hangs in the boardroom, but real culture is how things are really done around here. And so you cannot separate leadership from that because so much of the culture is dictated by leadership.

Kris Baird (10m 54s):
And there was a Gallop study on that long ago that said 70% of culture is directly attributed to leadership. And you stop and think about just one pat phrase, What you permit, you promote. What you permit, you promote. So you can say in your mission, vision values statement, this is what we stand for. This is who we are. This is what we value. But when you come into an organization and this is how things are really done around here, it is very much about how the leader interacts with their people, what expectations they set, how they communicate, how they hold people accountable, how they built the ownership, a sense of ownership, all of those things come right back to the leadership.

Dr. Anthony Orsini (11m 49s):
Yes. And to be able to communicate and build a relationship. Because one of the things that I see a is a frequent mistake, is being inflexible, right as the leader, but not valuing, we’ve talked about it before or not value your people. I’ve seen in the hospital, setting that even in the business where you have an employee who says, you know, my life circumstances have changed. She may be your best nurse, or what are your top nurses? And then now I can’t work Tuesdays anymore. Or, and now I can’t work Thursdays. And the poor leader will just say, well, I can’t help you. If I do that for you, I’ll do that for everyone else and be inflexible. And then what happens is you lose her.

Dr. Anthony Orsini (12m 29s):
So how do you balance that? You know, I don’t want a permit things, but I need to make sure that I keep my employees. I don’t want to be so inflexible then that I’m losing good people.

Kris Baird (12m 40s):
There’s being permissive. And there’s being flexible. Now, the example you gave a logical human being would hopefully be flexible and meet people where they are in lead with empathy, you know? Oh, wow. Things have really changed at your household. You know, I’m sorry to hear that. Let me see what I can do to help. And rally the team, get the team to talk about how can we support one another. I remember when I was a new nurse leader and there was all of this discussion about hours and schedules and so on. And I pulled everybody together and I said, look around this room, where are all working mothers?

Kris Baird (13m 21s):
And most of us have kids. I mean that they were ranging from newborns to, I think the oldest might have been in junior high, that it was just a circumstance where we we’re all, you know, with the young families. And I said, look around there is going to be a day when Sally, when you’re kids are sick and you are going to need to lean on somebody and you know, Lisa, you’re going to have a situation too, how can we create an environment where are we all feel supported? And we want to work and we want to be here together. And so people really rally instead of being inflexible, where I take everybody has to do this schedule.

Kris Baird (14m 3s):
We really work together to make it a reasonable work environment. And it was completely foreign to every nurse in the unit. They had never had anybody even ask their opinion before.

Dr. Anthony Orsini (14m 16s):
Yeah. I see that inflexibility as a, an issue, even when the physicians are making their schedule, a physician A says, I can only work to three to 11 shift in a Physician B says I hate the three to 11 shift. I liked to work for a seven to three shift If you let them switch, everybody’s happy. But you see some leaders that’ll go, Nope, everybody’s going to work the same amount of shifts. Why let’s try to make an environment where people want to come to the work where it fits into their lives. And I guess COVID made that even more important, right? Cause now people have all this sudden their children or not going to school. So how do you deal with that as a leader or that, that you really gotta be flexible. I would imagine.

Kris Baird (14m 57s):
So you have to be flexible. And over 2 million women left the workforce during COVID because the bulk of the home responsibilities and the family responsibilities fall to the woman and you look at healthcare is predominantly women. And so if we can not learn to be flexible, we’re dead in the water. And what’s what’s the definition of insanity, doing the same thing over and expecting different results. We have got to be flexible. And especially since we have five generations in the workforce right now,

Dr. Anthony Orsini (15m 32s):
Wow, I didn’t think of that.

Kris Baird (15m 34s):
And there are a very different mindsets among those generations. I mean, you go all the way from the traditionalist all the way down to the gen Zs and what is important to a traditionalist or a boomer is very different than, and X, millennial are Z. And that flexibility is huge. And if we keep going at a problem with this rigidity, we’re never going to be able to solve the whole turnover issue.

Dr. Anthony Orsini (16m 3s):
You referred to several times when you were in a nursing leader and I, and that’s clearly your background then how you came up. So tell us a little bit about that. So after you graduated nursing school and, and how you move into leadership, why you decided to move into leadership and why you decided to take those lessons that you learned then to where you are now, where are you you’re teaching or other leaders?

Kris Baird (16m 23s):
I absolutely love being a nurse. I’m very passionate about the work that nursing does. And my clinical background really was, well, I worked my way through college as a nursing assistant in open heart unit, which gave me an amazing experience. But then I also worked in med surge and then critical care. And I was one of those people who had a family and I thought, oh gosh, you know, a public health looks pretty good for that hour. So I did public health and then went back to the hospital for a while in obstetrics and then worked in a community outreach education. So I was all about reaching the community and had an affinity for marketing. And so I started doing some of that work too, and then this guy named Quint Studer,

Dr. Anthony Orsini (17m 7s):
Who are we all love? Well,

Kris Baird (17m 9s):
He was a marketing director at the time. He hired me to be the ask a nurse manager. So asking the nurse was a triage and health information hotlines, but it was how it is in marketing. And so aye, all of a sudden had this job where I could be that nurse leader, but also keep my fingers into the marketing and business development. And he promoted me to marketing director. And then I went on to other organizations working in marketing and business development, but I’ve always had an affinity for leadership and culture and really asking why I was that kid that said and why all the time I was that kid.

Kris Baird (17m 54s):
So I always could see, wow, we can do better than this. We can make this a better organization. Let’s ask people what they really want. You know, so I’m a natural researcher, qualitative research. So my master’s thesis was on patient perceptions of quality in clinical settings. And at the time this was the early nineties and I was doing my thesis research. And I can’t tell you how many doctors would say to me, well, Ms. Baird patients, aren’t qualified to gauge quality. And I would say, well, you know, they don’t know that they’re not qualified, so they’re doing it anyway.

Kris Baird (18m 36s):
So let’s ask shall we? so they had really was my foray into the patient experience and culture and leadership. So they all kind of melded together and I am truly blessed to have, have the journey that I’ve had. Right?

Dr. Anthony Orsini (18m 50s):
Yeah. And then you go on in you, right. Your five books. And to really start to teach more and more leaders how to lead, but I want to really get into the learning course. I love the name, Be the Leader. Nobody Wants to Leave eight skill Builders for Busy Leaders. So tell us about that course. And I think everyone’s asking right now, what are the eighth Skill Builders? So maybe tell us a brief history of brief synopsis of that, because I think that’s such a great course. I think I mentioned this to you last time I’ve had leaders or bosses as a physician that if you said anything bad about him or her, I would smack you a slap.

Dr. Anthony Orsini (19m 30s):
You like so loyal to her that I don’t care what you say. She was the best ever. And then I’ve had leaders where I’m like, oh my God, this is just miserable. I got to get out of here. So this is something that’s near and dear to my heart. And I’m frustrated that in business and in medicine that we don’t always have the best leaders. So tell us about the course and how we can maybe learn from it.

Kris Baird (19m 51s):
Yeah. I’d love to first, let me say that. One of the reasons we don’t have the best leaders is that we have really good intentions when we promote people from within, we see this potential, we see the raw potential in, let’s say, as a nurse or a physician or a, a, a tech. And we say, oh, we need a new manager. We need a, a leader in this area. You know, you’re a really good nurse. Why don’t you step up? And so we create this environment where we’re trying to reward somebody like your dad, you know what you were talking about with your dad. And we want to give them and say, Hey, we really trust you. We want to elevate you.

Kris Baird (20m 31s):
And then we, we abandoned them that they have a great skillset for working on the frontline, but they don’t have a leader skill set. And the more I dealt into that, the more I saw that, oh my gosh. I mean, everything from hiring right down to the crucial conversations and being able to coach a lot of it is communication. And so we’ve been offering workshops and trainings for the last 25 years. And what I wanted to do is I want them to take the best of the best in the most, you know, hard hitting pieces of all of those trainings and pull them together.

Kris Baird (21m 11s):
You know, because as I talked to these nurse leaders across the country, they were constantly saying, Hey, it’s leadership, it’s culture in the two are inextricably linked. So I started to look at all of the things that were the biggest gaps in the research. And I started at the very beginning and I thought, all right, let’s start from hiring. Let’s hire for fit. So that’s one of the skills that we really teach in your thinking, yeah. Hire for fit. But you wouldn’t believe how many people take this course. And some of them are long-term leaders who say, oh my gosh, I realized now I’ve been winging it.

Kris Baird (21m 51s):
I’m trying to make this match. And I’ve been going into this, these interviews winging it, or I’m rushed, or I don’t have a clear sense of what is a good fit for my team and what is a good fit for our organization. So helping them to define that. So there’s hiring for fit. Then the, the conversations that keep people engaged. And so we call that one in mastering the state interview. And so how do you recruit people? And so you have to know how to have these conversations and it’s not a drive by, Hey, Tony, how’s it going? That’s all nice and friendly, but it’s not going to make you feel engaged in value.

Kris Baird (22m 35s):
So learning to sit down and have the conversation with you about what makes a good day at work, how can I help you have more of those? What might make you dread coming to work? How can I help mitigate any of those situations? You know, when was the last time you thought about leaving? What was the circumstance around that? What could I do differently? So helping the person to know how to have those conversations, I think back of this dentist, one time being kind of a smart Alec, he goes, you don’t have to brush all of your teeth, just the one’s you want to keep. So I always think about that when I’m thinking about you don’t have to do stay interviews with everybody. It just, the ones that you want to keep.

Kris Baird (23m 17s):
You know, I love that. So thinking about that as re recruitment, talking with people about managing expectations, because most of the time we don’t manage expectations until somebody fails to meet them. And then we stop and think, huh? I wasn’t clear. So a lot of that has to do with communication. And then there’s coaching, mentoring, modeling, you know, managing how do you do those things on a day-to-day basis to make sure that you’re creating the culture that you really want to create? So there is a heavy emphasis on coaching, how to have conversations with people, crucial conversations, if you will, but you know, looking at how do you look at somebody’s behavior, what they produce, how they interact with other people and then diagnose which level, are they fully engaged, somewhat engaged or disengaged based on those criteria.

Kris Baird (24m 16s):
And then once you can spot the level of engagement, now we teach you how to coach to that level so that you can coach them up or coach them out. And we get really good results from that. The other thing we talked about to Tony is, is recognition. So we spend some time on that or how to give meaningful recognition, how to connect to purpose. For me, I’ve always had this strong connection to purpose in healthcare. But as leaders, you’ve got to a two-prong responsibility, one is seeing yourself as the leader, what’s your connection, there, why do you want to be a leader, helping them to articulate that?

Kris Baird (24m 58s):
Why did you choose this? You know, what fills your cup right now? The second point of that is now that you’ve got all these people here, how do you help them connect to purpose? How do you look at their job description and tie it back to the mission, vision values? How do you help this person to see that they are making a big difference in the organization?

Dr. Anthony Orsini (25m 21s):
So you talked about these conversations that you’re having with each employee. You could have those conversations, but if the employer doesn’t really think that you are listening than what’s the point. I have been in situations before, I’ve heard this before, when you know, you are hiring a new nurse, are a new physician or new business person. Then you asked three or four of your colleagues’ to where you are, nurse leaders is to interview them. They all interviewed the person. And then the boss’ pics who he or she want’s any way. And then after a awhile you go, are you asking me in your opinion, what do you think have that person we’re, we’re thinking of hiring where the, what I’m thinking deep down inside his what’s the difference, you’re not going to listen to me anyway.

Dr. Anthony Orsini (26m 1s):
So those stay conversations. We had someone on this podcast, a captain, Mike Abrashoff people’s say to me all the time of my wife says that you’re always talking about you’re podcast. And the reason why I think I do that is that over the last 50 episodes, I have learned so much from my guests. And so many things in life hit home that when things happen, I’m like, oh yeah, well, you know, here’s a story about Kristin Baird. And she mentioned that and I had a podcast. And so I’m doing that again. So for my audience, but Mike Abrashoff is so I would really recommend going back and listened to his podcasts interview because he’s amazing.

Dr. Anthony Orsini (26m 41s):
He was a graduate of Annapolis finished at the bottom of his class. When it was time to give out a ship, they gave him literally the ship that was the worst ship in the Navy. Year in year out was the lowest performance. And Mike turned this from the lowest to the top ship in one year. And one of the things that he did was sit and make sure that he had an interview with every single one of is hundreds of sailors. And then my favorite story, he has the sailor, or what can we do to make things better? And the sailor was very shy. Didn’t want to say anything. He said that to the sailor, and you’re not leaving until you give me a suggestion. And the sailor said to, do you know, why we paint the ship every six months?

Dr. Anthony Orsini (27m 24s):
And the captain said no, actually, I don’t know why he says it because the bolts that we used to tie down, the gun’s they rust and the rust goes down. And he is, I always wondered, how does the Navy I ever heard of a stainless steel and so on? So this is Sailor was responsible for the Navy changing all of their bolts, to stainless steel. And so I love that story. I tell it all the time. But as you were talking about these conversations, I thought you can do lip service as a leader. You have to have the communication skills and the nonverbal language to show the person that you are speaking to you, that you actually care when you’re listening to her.

Dr. Anthony Orsini (28m 6s):
And not everyone has that skill.

Kris Baird (28m 8s):
We always teach you listen with your eyes, as well as your ears. You know, that there’s so much that is revealed by the nonverbal communication.

Dr. Anthony Orsini (28m 19s):
Yeah. If you’re a multi-tasking, if I asked you a question and what, you know, what can I do to keep you here? And while you’re answering, I’m looking over at the, you know, email, I’m just going to stop speaking. So I wonder in your experience, I asked this question a lot, also, in your experience, can you take anyone or what percentage of people can you take? And even if you invested all the communication skills as they took your class, but they really want it to anyone learned to be a leader, or do you have to make sure that when you do that interview, that fit, that you identify the ones that are never going to be a leader,

Kris Baird (28m 54s):
Right? You hate to be a Pollyanna. I like to see the positive in people. I think that if people have the desire and are coachable, then a lot of wonderful things can happen. But there are people who I have coached who actually get into leadership positions. And as we’re talking about what fills their cup and what really drives them, they realize they don’t want to be leaders, that they are much better being one of the worker bees that they really don’t want that role. And that’s okay. We don’t all have to be leaders, but I think that the ones that do want to be leaders of the ones that they accept the responsibility in the title, they must do whatever they can to hone skills, to be the best that they can be.

Kris Baird (29m 46s):
And really we’ve got to help them distinguish between management and leadership. There are things that we do that we have to manage, but when we’re leading, we’re really trying to bring out the best in everybody who works with us. You know, we want everybody to reach their maximum potential and that’s, you know, maybe not for everybody.

Dr. Anthony Orsini (30m 9s):
So what is the best advice you can give to someone when they are interviewing someone for a Nursing leadership? So you are looking for an assistant nurse manager and you’re their nurse manager. What would be the best question or what are you really looking for a during that interview to see if this was a good fit?

Kris Baird (30m 25s):
Right? First thing that I would do is I would bring together the staff and I would ask them about from their vantage point, what makes a good leader and what would be a good fit? What are some of the values we have in our department that are non-negotiable. That as we’re trying to build the culture to be even better than it is today, what are the things that we must look for in a person? So how have the staff help you to identify those qualities. You mentioned earlier, you have these panel interviews and then the boss hires, whoever they want in any way. Well, there is a better way of doing that, and that is bringing people together to talk about what is an ideal fit, what are the characteristics that we are looking for?

Kris Baird (31m 14s):
And therefore, what are some questions that we should ask that are behavior based that we’ll get at that the best candidate. And so, for instance, you know, you need somebody who can manage conflict. So if I already ask anybody, you know, how are you at managing conflict? What do you think people are going to say? Oh, I’m really good. Okay. That’s easy. So we don’t ask it that way. We say Tony, tell me about a time where you had to work with a team that experienced conflict. Tell me about that. You tell me about it, then I’ll say, you know, what do you feel was your role in that situation in hindsight, what would you do differently?

Kris Baird (32m 2s):
How did the team resolve that conflict? And what about that worked well? You know, and like I said, you’re probing, you’re getting at really delving down into it. And that is a learned process. Or your first identify the quality’s, you have the team to say, okay, if this is the quality we’re looking for, what are some behavibehavior-basedor based questions that we can ask? And then how are we going to score the responses? Because there are people who come into interviews are very charismatic. They’re charming people, they win you over immediately. And then when you really look at how they answered the questions, if you have behavioral-based interview, you can really separate the wheat from the chaff by having a scoring system.

Kris Baird (32m 47s):
And so those are some of the elements that are often missing.

Dr. Anthony Orsini (32m 52s):
It really is so important to identify it. As you said, that starts with the intake. ’cause we often just say, especially when someone from outside of the organization, right now, we often say that we are going to hire the person who has the Ivy League education with the most letters after her name or the most letters after his name. And yet maybe it is not the best communicator. I think that the biggest mistake we made in medicine is the biggest mistake they make in business. And I would say you’re bridging the gap really once again. And there’s so many parallels between what I say, that the patient-doctor relationship to the nursing patient relationship, that business leader or employee relationship to the leader is all the same way.

Dr. Anthony Orsini (33m 35s):
And it’s really based on two words, as far as I’m considering all the three words, loyalty, trust, and relationship, and that’s where communication comes in. How can we create those three things? We had Stephen Covey on the area and bringing in a previous podcast

Kris Baird (33m 49s):
Trust. Yeah. The speed

Dr. Anthony Orsini (33m 51s):
Of trust. Yeah. So that’s something that’s not a soft skill. Just kind of circling back to the beginning of my pet complaint. And yet I don’t think hospitals and businesses really invest enough in that, what can we do to make the people with the money, the bean counters as they call them invest in this kind of training for their leaders. So

Kris Baird (34m 13s):
You always want to prove a return on investment for anything that you do. Okay. So from the medical standpoint, I’m with you a, a hundred percent. So we teach engagement, empathy, communication, gestures ofrespect when done well foster the relationship that builds the trust. And when the trust is there, you have higher compliance. When you have a higher compliance, do you have better outcomes? So you can follow that whole thread through and say they are as an accountable care organizationorganization we wanna make sure that we have a, you know, so that’s one way to go to go another, his, to go the route, have turnover and say, look, if we can reduce turnover by 1%, it’s usually worth $306,000.

Kris Baird (34m 60s):
That’s the average, what would it mean to us? If we could reduce turnover by X amount? So his, sometimes you have to go in with that data in order to be able to, when the argument it’s often speculative and finance people, don’t like that. They want a guarantee and that’s not always possible. So you have to be ready with some case examples, you know, and it’s hard because of the whole industry has been hesitant to invest in this. And yet what’s the definition of insanity. We keep getting what we’ve always gotten. So let’s try and shift the course a little bit

Dr. Anthony Orsini (35m 40s):
Or moving in the right direction. I think the gen Z people, you spoke about the generations, whether it’s business or health care, that they don’t tolerate bad leaders, as much as we used to and our generation, they are stories have doctors throwing charts and, and nurses getting yelled at by their leaders. And it was, you know, I’m going to take it because I want my job, et cetera. I’m talking to more and more companies right now in the biggest topic right now is creating a culture of safety in a culture of inclusiveness in the gen Z people that are not going to tolerate that. There are just they’re, they’re going to leave their gone. Kristin is shaking her head no

Kris Baird (36m 22s):
So in 2025, 75% of our global workforce will be Millennials. That is a major shift. So the millennial and gen Z’s have a different perspective on things and they are not gonna tolerate. And so many have the millennials now or are moving into leadership positions. So I’ve been coaching a lot of millennial leaders, which is very exciting because they bring a fresh perspective. So you don’t, I hope that we’re moving in the right direction. I really hope that we are.

Dr. Anthony Orsini (36m 51s):
I really feel that we are in healthcare. We are, the whole patient experience is driving now possibles to put more emphasis on communication skills, building relationships with patients, because again, the millennials and the generation Z, I remember a very common phrase, but I was growing up as he’s a good doctor. He’s got a lousy bedside manner, but he’s a good Dr. So I’m going to go to him or go to her. Generation Z and the millennials are not going to tolerate that. You can be the greatest Dr. In the world, if you don’t have good communication skills that are going to find someone else. So it is moving in the right direction than millennials get a bad rap, but they are doing some really good things in gen Z.

Dr. Anthony Orsini (37m 32s):
And it’s making us more aware of culture in a, and I think, and your doing that too. So you’re work is amazing. Kristin, I don’t know if I warned you about this question before hand. I always finished with it, the same questions on every podcast. And when that is, what do you think is the most difficult conversation you’ve ever had? A, can you give us some advice on how to navigate that? And it doesn’t have to be personal. It could be a type of conversation, but lets leave the audience with some really pearls of wisdom on how to navigate the most difficult conversations.

Kris Baird (38m 3s):
Well, I’m not so sure that its the most difficult conversation I’ve had, but if I could stretch that out just a little bit, I am one of 10 children and we had this big, crazy loud family. And when I was four years old, my parents brought home. My younger sister and mom and dad both knew that something was not right from the very beginning. And she kept worrying. You know that all Patty is just not doing things like the other children. She doesn’t cry. My mom was very concerned and they brought her for all these batteries of tests that the university of Wisconsin and they were finally going to get the results.

Kris Baird (38m 45s):
And my parents sat down in this doctors office and he came in and he didn’t even sit down. And he and his arms crossed and his white coat and he said to my parents your daughter’s severely retarded and she’ll never sit up. You have to put her in an institution. And my parents were heartbroken. I mean they were devastated and both of them are educators. And so my father said, you know, I really believe we should just take her home and give her as much stimulation and opportunity as possible. And he said, no, she is your eighth child. There is no way you are going to give her the attention she needs.

Kris Baird (39m 28s):
She needs to be institutionalized. There’s no way. And my mom said, no, we have to try this. And he looked at him and said, well, go ahead. Some people feel they make good pets. Oh my goodness. My parents sobbed all the way home. And you seeing their grief and hearing this story over the course of my life, that was horrible news to get. But how it was delivered was absolutely it was unconscionable. And what it has taught me is that we have so many opportunities. We have so many opportunities in healthcare, whether we like it or not.

Kris Baird (40m 14s):
We are part of people’s stories every single day. And we have a responsibility to ask ourselves, what do we want that story to be like 10 years from now, 20 years from now, when their telling a story about their experience with us, what are they gonna say? And so that would be probably one of the most difficult conversations in my family that was severely botched. That has been pivotal for me in my life and in my career. And by the way, Patty did learn to sit up. She learned to walk and she went to high school, she got a diploma, she works a job. She lives independently.

Kris Baird (40m 54s):
So guess what my parents were right. And he was wrong.

Dr. Anthony Orsini (40m 58s):
Yeah. And as you know, I mean my presentation breaking bad news. That’s how I started. That’s really what I’ve dedicated my life to is to teach the physicians and nurses, how to have that initial conversation with breaking bad news. Because as you know, better than anyone, it can affect you adversely not only in the immediate time when you hear the news, but also studies have shown that the, how you receive that news kind of affect someone up the 30 years and we’re still counting. And so how many years ago is that? I don’t want to give you all right.

Kris Baird (41m 35s):
No, it was over 50 years. Honestly, I take that into my workshops. And one of the techniques I use is to look at an audience and say, I want you to think back to a time when a healthcare provider made an indelible impression on you, it could be good or bad, but just think to a time when a healthcare provider left this indelible memory or indelible impression and people share their stories and some are really good and some are really bad. But again, it goes back to, we have these moments in time, the small moments in time, where we get to make a choice about how we are going to deliver the news or how we’re going to empathize, how were going to engage with another human being at a time when they are most vulnerable.

Kris Baird (42m 29s):
And you see tens of thousands of patients on the course of your career, and you’re not going to remember them all, but guess what? They’re going to remember you .

Dr. Anthony Orsini (42m 38s):
Absolutely, and it’s to be fair or what I have found and my hate to say the decades of research and, and working. But this topic is its not just about to be fair to the doctors in the, nurse’s not just about telling them to be nice, right? Where to sit down, which is what we’ve done. We’ve failed them by not training them, how to do it and then told them to go do it. And I always say to my doctors, when I’m training them, would you read a book on how to do an appendectomy and then go do surgery? And this is what we’re doing for this really important communication skills to say, here’s a lecture, you know, I’m going to give you a quick acronym. Now go do it. So I think it’s human nature when you’re are very uncomfortable with doing a task, you rush it and you botch it.

Dr. Anthony Orsini (43m 25s):
And so I’ve dedicated my life to helping physicians start to think about this really important conversation as a skill that they can be really proud of. And I don’t wanna tell that person that their child is going to be developmentally delayed, but I know how to do it. And I know how to help. And here I go. And once we get there and again, this whole podcast is making a full circle. Now it’s all about communication. So that’s why I knew you’d be a perfect guest. So this has been great, Kris thank you so much.

Kris Baird (43m 56s):
Oh, it’s my pleasure.

Dr. Anthony Orsini (43m 56s):
What’s the best way for people to get in touch with you at the Baird group?

Kris Baird (44m 3s):
The best way is just to go to our website info at Baird, B A I R D hyphen group.com. Then you can send a message that way and we’ll get back to you as soon as we can, but we have our next cohort coming up. We start new cohorts of Be the Leader Nobody Wants to Leave Eight Transformational Skill Builders for Busy Leaders. We start them every eight weeks. So the next one is coming up in July.

Dr. Anthony Orsini (44m 31s):
Okay, great. And I’ll put that on, on the show notes so that we’ll able to find you so they don’t have to jot that down at media type. Thank you again. If you’ve enjoyed this podcast, please go ahead, hit follow up on your favorite podcast platform and download all the previous episodes. Cause I’m telling you, everyone of them is just as good as Kris and Kris has been amazing. I’m really a better person for knowing you, Kris, I’m excited about what you do and I hope that together we can keep pushing this communication and leadership training and make it better for everyone. So thank you so much, Kris.

Kris Baird (45m 5s):
Thank you. It’s an honor.

Dr. Anthony Orsini (45m 6s):
Well, before we leave, I want to thank you for listening to this episode of Difficult Conversations Lessons I Learned as an ICU Physician. I want to thank The Finley Project for for being in such an amazing organization, please, everyone who’s listening to this episode, go ahead, visit the Finley Project.org. To see the amazing things they are doing. I’ve seen this organization literally saved the lives of mothers who lost infants. So to find out more and go to the Finley project.com.

Announcer (45m 33s):
If you enjoyed this podcast hit the subscribe button and leave a comment and review. To contact Dr. Orsini and his team, or to suggest guests for a future podcast, visit us at the Orsini Way.com. The comments and opinions of the interviewer and guest’s on this podcast or their own. And I do not necessarily reflect the opinions and beliefs of their present and past employers or institutions.

Uncaring- How the Culture of Medicine Kills Doctors and Patients with Dr. Robert Pearl

Dr. Robert Pearl (2s):
No. I always think back to many of the trips I did around the globe doing volunteer surgery, kids with upper lip and cleft palate, and how the members of the team. They spent 10 days in a central American country. It was hot. There was no air condition, they ate rice, and beans, their GI upset. They come back filled with energy. I think about a doctor that volunteered and we paid his way to go to Liberia, to take care of patients with Ebola had to have IVs in his arm, because he was sweating so much in the protective suits he would have otherwise passed out. He was the happiest human being ever met when he came back.

Dr. Robert Pearl (42s):
This purpose and mission. I think that we’ve given up some of this, the rod from a spine insurance cup is broke companies, hospital, administrators, they have taken it. We also ourselves really to give it up voluntarily. And I think in that process, we’ve robbed ourselves of some joy and certainly a lot of fulfillment than satisfying.

Announcer (1m 6s):
Welcome to Difficult Conversations: Lessons I learned as an ICU physician with Dr. Anthony Orsini. Dr. Orsini is a practicing physician and president and CEO of The Orsini Way. As a frequent keynote speaker and author, Dr. Orsini has been training healthcare professionals and business leaders how to navigate through the most difficult dialogues. Each week you will hear inspiring interviews with experts in their field who tell their story and provide practical advice on how to effectively communicate. Whether you are a doctor faced with giving a patient bad news, a business leader who wants to get the most out of his or her team members or someone who just wants to learn to communicate better this is the podcast for you.

Dr. Anthony Orsini (1m 51s):
Well, I am honored today that The Orsini Way has partnered with The Finley Project to bring you this episode of difficult conversations lessons I learned as an ICU physician, The Finley Project is a nonprofit organization committed to providing care for mothers who have experienced the unimaginable, the loss of an infant. It was created by their founder, Noelle Moore, whose sweet daughter Finley died in 2013. It was at that time that Noelle realized that there was a large gap between leaving the hospital without your baby. And the time when you get home, that letter to start The Finley Project. The Finley Project is the nation’s only seven part holistic program that helps mothers after infant loss, by supporting them physically and emotionally, they provide such things as mental health counseling, funeral arrangements, support, grocery gift cards, professional house cleaning, professional massage therapy and support group placement. The Finley Project has helped hundreds of women across the country.

Dr. Anthony Orsini (2m 46s):
And I can tell you that I have seen personally how The Finley Project has literally saved the lives of mothers who lost their infant. If you are interested in learning more or referring a family or donating to this amazing cause please go to the Finley project.org. The Finley Project believes that no family should walk out of a hospital without support. Well, welcome to another episode of difficult conversations lessons I learned as an ICU physician. This is Dr. Anthony Orsini And I’ll be your host again today. A few weeks before this recording, I started reading a book to be honest, it was an audio book, probably driving from my home in Florida to my family home in New Jersey.

Dr. Anthony Orsini (3m 29s):
I was listening to this book as I often do during long drives. And this book was very different from the very first chapter I was hooked. The book is called “Uncaring, how the culture of medicine kills doctors and patients”, in my opinion, it’s the best analysis and synopsis of the state of healthcare today that I have ever read. And to be honest, it really spoke to me. It confirmed all of my beliefs about medicine and what I’ve been teaching for over a decade, but much more eloquently. The book really said something to me. Today, I am honored to have the author of the book as my guest, Robert Pearl MD is the former CEO of the Permanente medical group, the nation’s largest medical group, a position, which he held for more than 18 years.

Dr. Anthony Orsini (4m 18s):
In this role, he led over 10,000 physicians and 38,000 staff and was responsible for the nationally recognized medical care, 5 million Kaiser Permanente members on the west and east coast. Named one of modern healthcare’s 50 most influential physician leaders. Pearl is an advocate for the power of integrated prepaid technologically advanced and physician led healthcare delivery. He serves as a clinical professor of plastic surgery at Stanford university school of medicine, and is on the faculty of the Stanford graduate school of business, where he teaches courses on strategy and leadership and lectures on information technology and healthcare policy.

Dr. Anthony Orsini (4m 60s):
Dr. Pearl is the author of mistreated. Why we think we’re getting good healthcare and why we’re usually wrong. A Washington post best seller and offers a roadmap for transforming American healthcare, his new book, and the book we’ll be discussing at length today is called “Uncaring, how the culture of medicine kills doctors and patients”, and is available now. All proceeds from this book are going to doctors without borders, Dr. Pearl’s also fellow podcaster, he hosts the popular podcast, fixing healthcare and coronavirus the truth. He publishes a newsletter with over 12,000 subscribers called monthly musings on American healthcare.

Dr. Anthony Orsini (5m 42s):
And as a regular contributor to Forbes. He’s been featured on CBS this morning, CNBC NPR, and in Time, USA today and Bloomberg news and has published more than 100 articles in medical journals and contributed to numerous books. He is a frequent keynote speaker at healthcare and medical technology conferences. From 2012 to 2017 Pearl served as chairman of the council of accountable physician practices and participated in the bipartisan congressional task force on delivery system reform and health it in Washington, DC. Well, that’s quite a mouthful. Robert, thank you so much for being here today

Dr. Robert Pearl (6m 22s):
Thanks so much for having me today. Yeah. Life is full and it’s wonderful and free listeners, all profits for the book for doctors without borders, which is an amazing organization, a charity providing care to victims around the globe. So I encourage people to look at that organization and hopefully buy the book and benefits doctors without borders.

Dr. Anthony Orsini (6m 46s):
I know plenty of my colleagues that are involved in that. It’s a wonderful organization and a yes, I encourage everybody to get involved. So I’m very excited for you to be on this podcast and to talk about your book. I’m a big believer in building trust, through communication and building rapport. So before we dive into the book, I just wanted to ask you, if you might spend a few moments, just telling my audience who Robert Pearl is, where you grew up and how you became the CEO of Kaiser. And then eventually wrote the book.

Dr. Robert Pearl (7m 15s):
The word I would use is serendipity. I grew up on the east coast and I wanted to be a university professor. And that was my plan. I want to start in college, but my hero, a professor who ultimately became the chairman or read. So he was an excellent researcher and publisher didn’t get tenure because of his politics. And as strange as it might sound, I went into medicine to stay, out of circumstances of politics, cause what could be less political than saving the human life.

Dr. Robert Pearl (7m 56s):
So I went to medical school at Yale, and then I went out to Stanford actually to become a heart surgeon. And I became disillusioned again because I was seeing that people getting referrals when not the best surgeons, they were often the people who belong to the right country clubs had the right connections. And I almost left medicine at that point. But a professor in plastic surgery took me on a volunteer trip to Mexico. And I watched cleft lip and cleft palate, which is my specialty in plastic surgery. I was moved. This has changed the human life and there’s small amount of time.

Dr. Robert Pearl (8m 36s):
And then again, when I finished my training, I was going to south America and actually spent a year fixing children with cleft lip and cleft palette and a plastic surgeon at Kaiser Permanente died in a tragic plane crash. They said come for a few months. I said, what can I lose for a few months? I’d never heard of Kaiser Permanente again, it’s all serendipity. And then along the way, actually I was there for one year and someone came to me, the head of the medical staff and said, would you become the head of the operating room committee? I said, this must be a great honor. It’s my tremendous credentials. No, everyone else was smart enough to say no.

Dr. Robert Pearl (9m 17s):
When I moved in this area, I enjoyed it. It Was a little bit like the scientific method. You have a problem, you test it, you solve it. And I was able to make some advances in a time of major nurse shortage. Again, when the CEO role opened up and the medical group and the, of the medical group, the delivery, half of Kaiser Permanente, the CEO is actually selected by the doctors and it was not a job I really want. And I love being an operative surgeon, but the people who wanted the job were not the ones that I wanted as a Permanente was in trouble was down to two days of cash, they had borrow cash to stay in business when no one else was stepped forward, that I could support.

Dr. Robert Pearl (9m 59s):
I ended up stepping forward and getting chosen. So again, a series of changes. I was CEO for 18 years. And then when I wrote my first book mistreated, or we think we’re getting good health care, we’re usually wrong, became a Washington post bestseller. And I had to make another decision between traveling and speaking about the book and keynoting various events or staying on. So staying on and it was the right time to move forward. And that’s how I got here today. If I had tried to do it, I never could have accomplished it. But the path in retrospect makes total sense

Dr. Anthony Orsini (10m 30s):
As is often the case, as they say, the universe pushes you in ways that you never even imagined. So went from a professor to head of Kaiser Permanente. And none of it was really, it just happened. That’s great along the way. So let’s talk about the book because the book is really, like I said, I wasn’t just blowing wind up your, you know, why the book really did speak to me. You talk about physician culture and really two topics that are really the hottest topics of medicine right now is the cost of healthcare and the rising costs and physician burnout, and many ways their related. As you mentioned in the book, but let’s talk about physician culture and in your book, you speak about it so well, how it’s helped medicine and how it’s hurt medicine, maybe start off by just defining what physician culture is for the audience that’s really not in medicine.

Dr. Robert Pearl (11m 16s):
Culture is the values, the beliefs and the norms that people follow for physicians. We learn it in medical school and residency. You don’t find it a textbook. There’s no professor lecturing on it. It’s the stories that are told the language that’s used. And to me, it’s very much like an invisible force like gravity. You can’t actually see gravity. Can you see as the impact gravity has on objects as they fall towards the ground, the same thing happens in culture. We can figure out what the culture is. When we look at the behaviors, some of which are very positive, but I don’t want any of the listeners to think that this is a negative book.

Dr. Robert Pearl (12m 4s):
I love medicine. I love being a physician. This is really the story that comes out of love of a history going back thousands of years. But at the same time, I can’t help, but notice some of the challenges. I think if we’re going to advance it, particularly areas you just mentioned, we’re going to have to improve the shortcomings and failures. And so I point those out as well in the book.

Dr. Anthony Orsini (12m 34s):
Culture has held us back many ways. And it’s also advances, I’m going to butcher up this person’s name, but tell us the story about Ignaz Semmelweis. How do you say his name? Ignaz

Dr. Robert Pearl (12m 46s):
Yes. Ignaz Semmelweis so he’s a physician in Austria at the leading hospital and he is appointed the head of the delivery service. In some ways like myself, it was just serendipity and he takes the job and he looks at the situation that’s happened. The mortality rates 18%. Wow. The time is that while at the time, the leading cause of death was puerperal fever a roaring infection of the uterus that goes on to kill the recently delivered mother of the delivered child.

Dr. Robert Pearl (13m 26s):
And the causes felt to be myasmas. These particles drifting up below, but then you looked around a little bit in the hospital. That’s adjacent one where the delivery service isn’t run by famous professors, but by nurses, midwives, it has a mortality rate, two thirds lower. And once again, serendipity plays a role, a colleague nicks his finger while doing an autopsy of a woman who dies of fever. And he goes on to develop, not just a local infection, but a systemic disease. That’s identical to what these women are dying from. And some of the hypothesizes, maybe there’s something that’s being carried from the autopsy room to the delivery room.

Dr. Robert Pearl (14m 12s):
And he tells the obstetricians, you have to take off these leather aprons that at the time to cover their wealth, press three piece suits put on a clean apron and dip their hands in chlorinated water lo and behold, within a month where mortality drops from 18% to under 2%, he writes this up. He writes some maternity service directors across Europe. Guess what happens? Nothing, no one changes behavior. Despite a 90% reduction in mortality, it doesn’t make sense.

Dr. Robert Pearl (14m 53s):
Why wouldn’t they adopt this behavior? This is this invisible culture. Why don’t they? Because the doctor sees himself, they’re all men at the time as being a healer. The idea that they’re transmitting disease would diminish the stature, diminish the esteem and the respect, not the death diminishing it, but just the back of they were seen as the carriers and those leather aprons. It was signs of experience. The more blood, the more puss, the better it was. There would be 50 more years to Louis Pasteur finds the theory of infection.

Dr. Robert Pearl (15m 37s):
That behavior changes tens of thousands of women die. What I love about the story is now we are 150 years later and what’s the leading cause of death in hospitals, hospital acquired infection. What’s the bacterium C difficile. What do we know about it? It’s not like a Corona virus that goes through the air. It’s carried on the hands of people. And what do we see in research studies at leading hospitals across the United States done multiple times. One in three times when a physician goes from one patient’s room to the next, they fail to wash their hands with the alcohol based disinfectants.

Dr. Robert Pearl (16m 18s):
It takes a fraction of a second. There’s no cost. The reasons we normally think it’s too much time. It costs too much don’t exist. It’s still that culture. We see ourselves as healers. And when a patient dies from hospital acquired infection, we assume it was someone else who carried that bacterium from one patient’s room to the next.

Dr. Anthony Orsini (16m 42s):
It’s amazing story. And it took years before we even recognized that he was correct. And that’s the sad part. You know, when I do my workshops and I discuss how doctors are poor communicators, and we’re not really trained on how to do that, especially difficult conversations, someone I respect very much said to me, once you gotta be really careful because you want to make sure that you understand that, you know, you might be insulting some doctors, right? When you say they’re not good communicators. And so I’m very careful in explaining that I don’t teach compassion because I believe all doctors are compassionate people. I teach you how to convey that compassion, how to show it.

Dr. Anthony Orsini (17m 23s):
Did it ever concern you when you were writing this book that someone was going to say, wow, what a jerk he’s really bad. I don’t think you did because you were clear in the book, but was that something that you were aware of while you were writing it?

Dr. Robert Pearl (17m 34s):
I knew it would happen and I knew it would happen because as you know, from having read the book near the end, I talk about the Kubler-Ross five stages of grief. And I believe that we’re in a time period. Now, the 21st century, when evolution is going to happen in healthcare because of external pressures, cost pressures, being brought as our nation tries to recover from the economic devastation of the COVID-19 period we’ve just been through. Changes in technology, changes in the power of the consumer. In every industry.

Dr. Robert Pearl (18m 14s):
It can’t avoid healthcare. And I knew that doctors would go through these five stages, denial being the first one where people would say, no medicine was really fine in the past. There’s no need to change. Despite the data that says we’re not only twice as expensive as any other country in the world, but our results lag the other 11 industrials nations in terms of life expectancy, childhood mortality, maternal mortality, you’d go down the list of clinical outcome measures that I knew that anger would come next and always does. And so I expected that people would say, how could you pull back the veil?

Dr. Robert Pearl (18m 57s):
In fact, actually I didn’t think there was say that I thought they would attack me personally or things about me. They didn’t like the fact that I was the CEO of a company and assume therefore that I had gone to the dark side or whatever it was going to be. Not recognizing that I was chosen by physicians, not by shareholders or administrative individuals or business leaders that I knew that they would bargain. And we’re seeing that. And I’m sure you saw the data Tony that said that now 70% of doctors work for either a hospital insurance company or private equity, and half of them are paid a salary.

Dr. Robert Pearl (19m 38s):
Those organizations that doctors think they’re going to be protected. They’re not going to be. And depression. We both know that this is a major problem for their physician 400 suicides a year. And my push was that we had to get to acceptance and acceptance, as you well know, is not the same as liking. It’s an acceptance of what this new reality is. You know, the doctor in the 20th century carried all of the knowledge. The patient had no choice, but to come to the doctor to get that information, because the only other place was in the library. If you wanted to carry all medical information with you needed a 50 pound backpack.

Dr. Robert Pearl (20m 22s):
Now it’s called a smartphone. You know, as doctors, we don’t think the internet is good medical advice. We think patients shouldn’t go there. If they’re going to go there, that’s where they go for their information. And this notion of the patient as a consumer, we think that’s terrible. He’s a patient’s doctor patient relationship, but that’s not how the patient’s going to say this is a new evolving world. Add the values that made the 20th century physician successful are not going to be the same ones as the 21st century. I mean, just think about it. How are we chosen for medical school? We were able to memorize a huge number of arcane facts that we get then use on the medical school entrance examination, the step one examination, every tests along the way, we were able to memorize your facts with a smartphone.

Dr. Robert Pearl (21m 19s):
It’s not that relevant. How do we use that information? But along the way that transition, yes, Tony, I was pretty confident that what would happen is people would become upset about that. And I would say that is the cost of being an author and as part of the process of change.

Dr. Anthony Orsini (21m 41s):
Yeah. I run across that also, you know, it is hard to change. We’ve come a long way. I think one of the best things that’s happened is the elevation of the patient experience and the HCAPS scores. And you still see a lot of the more mature doctors really fighting that, you know, there’s hospitals now that are posting publicly the doctor’s patient satisfaction scores. And I know a lot of hospitals that have pulled back because there was such backlash from the doctors. I’ve always been a big advocate of showing your patient satisfaction scores or your HCAPS scores to the public. The hospitals should be doing that. And when doctors challenged me on that, I said, you know, you can’t play baseball and not tell anybody your batting average, you know, well, coach, what’s my, I can’t tell you.

Dr. Anthony Orsini (22m 24s):
I don’t want to tell him, you know, so I think it makes us more transparent, but you’re right. It’s all about the relationship. Now we have so many really smart doctors who are excellent physicians and maybe don’t have great practices or their patient satisfaction scores are low. And then on the other hand, as you know, there’s, there’s some doctors who are great communicators, lousy doctors are mediocre. Doctors would get great scores, but that’s not a bad thing. It pushes you into a different relationship. It’s all about trust. As Stephen Covey said, in one of my podcasts, if the patient trusts you, they’re not going to second, guess you as much as possible, but this also forces us to be in a relationship.

Dr. Anthony Orsini (23m 6s):
So I get that too. Now we’re going to talk about physician burnout in a minute, and then we’re going to talk about healthcare costs. But one of the things that helps me when I give my workshops is that I’m one of them, right? And so there’s a lot of people out there teaching doctors how to communicate and a lot of coaches that aren’t doctors. And I think I get a little bit of a pass because I say I’m one of you. So let me tell you what works for me. You’ve walked the line and still do administrator and physician. And there’s a lot of tension in medicine right now between those two groups. How do you able to walk that line? Because physicians, they give you as administrator administrators think of you as a physician. What do you think just really helped you in both areas?

Dr. Robert Pearl (23m 47s):
I believe it helped in both areas. I continued to practice full time, even as I was taking on greater and greater responsibilities. Even as the CEO, I actually work of the operating room during the Christmas holidays. The hard part of being a surgeon, of course, if you can’t operate in the leave town, because something bad happens to a patient’s problematic. And so take two weeks, I’d see a bunch of patients that go to the operating room. I noticed that people with me were doing it full time. So no one should be afraid of what that might look like. But I had done the cases thousands of times. And usually as I was operating, people already knew me and people sometimes who were the children of the parents might operate on with the class originally.

Dr. Robert Pearl (24m 30s):
So the outcomes were good. And I did that to maintain a lot of the credibility. I also did it because I enjoyed doing that type of work. So people saw me as a clinician, as well as an administrative leader, at least in sort of the very, very end of my tenure as CEO. But for the people listening in who are not inside, if physician run organization, I mean our entire board of directors were doctors. Half of whom had no administrative titles, they were simply clinical physicians practicing. So that type of dialogue and back and forth communication is intrinsic in the organization. And it’s not like any CEO appointed by a board of directors of shareholders who has no direct clinical relationship with the people inside the delivery system.

Dr. Robert Pearl (25m 22s):
People saw me as being different than that way, but it is a unique role in healthcare. And so I felt that I had that relationship with people, but I also was very careful. Something I valued highly is that twice a year I’d go to every medical center and there were 19 of them. So it was 38 days that I would spend meeting with individual physicians, hearing their thoughts, finding out their ideas. And as I I’ll say course, I brag that I stole all my best ideas from the clinicians providing the care. And my job was to find the best ones out there and then scale it.

Dr. Robert Pearl (26m 5s):
And to the extent that we were effective. And when I took over a Kaiser Permanente, we were middle of the pack and quality. We became number one in the national committee for quality assurance out of a thousand programs. We were lagging around patient satisfaction and JD power and associates who became number one in California. So I feel really good about the things we accomplished, but they weren’t my ideas. There are ones that I learned from the doctors that were in each of the medical centers and there were ones then that we could quickly spread everywhere. And again, I want to offer gratitude to the physicians that I lead for their willingness to take on new ways of providing care.

Dr. Robert Pearl (26m 50s):
And that’s my hope in writing this book, how the culture of medicine kills doctors and patients, because it is the culture I think, and holds physicians back. But also as you said very much so it’s the culture that allows us to be heroes that we can’t give up. I mean, look at the Corona virus. You know, we went to the hospital 12 and 24 hours a day, particularly the doctors in the ed and the critical care units. You know, they didn’t have protected gear that they’ve donned garbage bags and salad lids. When there were no masks, protective gowns available, they knew that every time you’re a critical care physician, every time you pass that to through the mouth, into the lung, and it goes through the vocal cords patients, cough, spewing the virus in their face.

Dr. Robert Pearl (27m 37s):
And they did it anyway, this is a remarkable tradition and doctors are hardworking. They dedicate a decade of their life training. I can’t say enough positive things, but that doesn’t offset the fact that some of these negative ones, maybe we’ll talk about them in a second, do exist. And they’re areas that we need to improve. Some of them have systemic affect. All of them have systemic causes. I think about it as those two snakes whining around the producers, around the staff and the producers, that symbol, we were on white coats and book covers the systematic issues and the culture issues intimately entwined, you can’t pull one thing apart without getting bit by the other.

Dr. Robert Pearl (28m 22s):
You’ve got to address both of them. And part of that process is acknowledging shortcomings that exists. And with things like chronic disease, things like racism, things like unnecessary procedures that raise cost without adding value. These are realities. Each of them have systemic causes, but all of them also have cultural ones.

Dr. Anthony Orsini (28m 49s):
Let’s talk about, let’s go there then. So what are the biggest problems with physician culture that are holding us back? You think

Dr. Robert Pearl (28m 55s):
So one aspect is what do we value? You asked me earlier, you know, we value intervention more than prevention. We elevate the interventional cardiologist above the primary care physician, but what does the data show at 10 primary care physicians to a community and you improve longevity two and a half times more than adding 10 specialists. And yet that’s not. That was an

Dr. Anthony Orsini (29m 22s):
Amazing fact that I read in the book. That’s phenomenal that facts

Dr. Robert Pearl (29m 25s):
And the reasons are cultures have that esteem and respect and position in the hierarchy. If you’re individual cardiologists, you go in the middle of the night and you’re unblocking, coronary artery. We know who saved the life. We know whose life was saved. If you’re taking care, a panel of patients, you save 10 lives through better prevention. No one knows that their life was saved because they don’t know they would have died. This is the problem. So it’s like hypertension, the number one cause of stroke, major contributor to heart disease and kidney failure across the United States. We control it 50 to 60% of the time. Now some of that is systemic insurance companies don’t pay enough for prevention.

Dr. Robert Pearl (30m 9s):
As an example, you know, doctors are too rushed to focus on the areas, but in Kaiser Permanente, we were over 90%. We had a 40% lower stroke at heart attack rates than the rest of the nation, because we had a higher value. A lot of that is the fact that we were paying on a capitated basis. This is the intersection of the system and the culture. So chronic disease is an issue and I’m not blaming the doctors. I’m just pointing it out. That shortcoming that’s there, that we should be addressing. Another great example to me is the cost of care.

Dr. Robert Pearl (30m 50s):
The Mayo clinic show that 30% of what we do. Doesn’t add any value. We still do it. You know, Tony, when I wrote this book, I started to write the book was December of 2019 2 months before coronavirus came up and I read a report from the federal government that predicted that healthcare costs would rise five to 6% a year every year for the next decade, I did the math calculation of what that would mean on a cumulative basis. 2.5 trillion more dollars, 2.5 trillion. Could we not use that money for prevention, education technology?

Dr. Robert Pearl (31m 30s):
How can we use that money? So many ways better than simply continuing the old healthcare system. And I looked around and I wanted to see a medical organization saying, this is ridiculous. This is absurd. And no one did. That’s the culture. We just accept the way we do things today is the right way. And I want to point out that the $2.5 trillion could be used in far better ways than we’re using it today. Particularly if we can augment it by eliminating some of these other aspects and racism, you know, where’s the culture say the culture says, we treat every patient the same.

Dr. Robert Pearl (32m 10s):
The data says it’s not true. Ask doctors why, what patients have two to three times the mortality during COVID-19 as white patients and not point to the systemic issues. They had jobs that they couldn’t do from home. So they had to travel by bus and subway to work and live in multi generational homes. Some of them have a higher rate of uninsurance than in the white community. All those systemic issues. There’s nothing that’s not accurate about that, but didn’t explain why early in the pandemic, when a black patient or a white patient came to the ed with exactly the same symptoms, we tested the white patient twice as often.

Dr. Robert Pearl (32m 54s):
And when they had a procedure done, we gave 40% less pain medication. That is part of the culture. Now it’s not the racism. That’s part of the culture. Doctors are not intrinsically discriminatory. It’s the fact we do an out of implicit bias, which comes out of our history, you know, 20,000 years ago, when you inform, appeared on the horizon, we entered the nanosecond, the side, where there was a tribe member to welcome, or someone from another tribe that we better shoot with an hour before they shoot us, that tribalism still persists in our subconscious allows us to recognize people who look like us, have the same skin color, speak, the same language, worship, the same God, whatever point we want to be.

Dr. Robert Pearl (33m 43s):
But it leads us to treat people who are different others, less well with less empathy than we do people who are like ourselves. Racism is not implicit bias. Knowing that it exists and not doing anything about it that is racism. And that is embedded. I believe in the practice of medicine, these are the kinds of things that are just not right. People dying unecessarily from chronic disease, people going bankrupt because they can’t afford the healthcare. People who are treated differently, not as well because of the color of their skin.

Dr. Robert Pearl (34m 25s):
Doctors are not to blame or also not to be fully excused. The system needs to change, but so does the culture.

Dr. Anthony Orsini (34m 30s):
So I’m working on a piece right now, but working on it for a while called the second second. And it speaks exactly to what you just said, that this is tribalism and it’s a nanosecond, but let’s for argument’s sake called the first second. That first second is going to happen. It’s in your DNA, but it’s what we do with the second. That makes all the difference. And we have to recognize that and work towards that. One of the ways that I’ve truly believe we can fix things and make preventative care better. It’s well known that if you have a relationship with your doctor, if you trust your doctor, even if you met the doctor for the first time and you trust that doctor, you bond, that you build rapport, you’re more likely to take your medication.

Dr. Anthony Orsini (35m 13s):
You’re more likely to follow up and follow the treatment plan. And yes, studies have shown as you know that they have better outcomes. So if we can teach physicians and practitioners and providers, how to really build that rapport, even if it’s in an emergency room, how do you walk in? How do you sit down? How do you introduce yourself? And we did an informal study. Many years ago, we asked mothers, I think it was 50 moms. And I said, what makes you more comfortable? A doctor introduces himself as one of the pediatricians or a doctor introduces himself as the intern responsible for your baby. And 40% of them said they chose the intern.

Dr. Anthony Orsini (35m 56s):
And I said, do you know, an intern doesn’t know anything? And he said, yes, but that in turn is taking responsibility for my baby. The other doctor is saying, Hey, I’m just one of the pediatricians so if something does wrong, don’t blame me. I’m just a small cog in a big wheel. And so it’s all about building relationships. And sometimes we could use that tribalism to our advantage. For instance, we know that African-American patients are more comfortable going African-American doctors and Hispanic patients would much rather who had trouble with English language would much rather go to a doctor who speaks Spanish. That’s fine. We can use that to ourselves. You know, I really preach that rapport a lot.

Dr. Anthony Orsini (36m 37s):
I’ll go call a mother from the NICU and I’ll see a 973 area code cause everybody keeps their cell phones now. And I’ll say, that’s nice. 973, that’s New Jersey, right? Mom lights up. Oh, you’re one of me. You’re from New Jersey. I’m from New Jersey. So it’s all about building that relationships. And that’s why I think we have to do a better job in teaching our doctors and nurses, how to bring that personal touch as you saw my Ted talk, how to bring that back. And I think it makes it better for us because I think we’ll enjoy that enjoy medicine even more again. And that leads me into professional burnout. And what your thoughts on what we can do about, you mentioned doctors with higher suicide rates, professional burnout, people leaving.

Dr. Anthony Orsini (37m 24s):
What are your thoughts on that? And how can we make that better? Other than what I had said, just getting doctors to enjoy their work.

Dr. Robert Pearl (37m 31s):
So before we get the burn out, let me get one common. First of all, I loved your Ted talk. I thought the story about that physician explaining something at the time of death was so moving and so indicative of the challenges of culture. And he obviously knew it because he told you afterwards blown it, but he still did it that way because that’s how we’ve been trained in his residency. And most likely he trained a lot of other people that way until we figure it out, it was the wrong way to go. And I can’t emphasize enough what you’re saying. This ability to build trust with patients, you know, in marketing, there’s a notion, don’t tell people about features, tell them about the benefits, establish that relationship.

Dr. Robert Pearl (38m 17s):
You know, one of the things I used to do that would be remarkable to people is I always give my home phone to patients. I mean, after 10,000 people, 10,000 people could be calling me home every night, three calls. And the entire two out of those three had problems that I wanted to immediately know about. One call in all these years because patients respect that and their time, they’re not going to take advantage of them or for the patient to know I have the doctor’s home phone. Imagine how much better they slept that night. And I love what you said earlier about the fact that what you teach people is not how to convince people.

Dr. Robert Pearl (38m 58s):
It’s how to express the trust and the caring that’s inside themselves. Because when you learn medicine, hide your emotions, never let yourself become exposed as exactly the opposite of what needs to happen. And that leads to the issue you’re raising about burnout. So if you ask doctors about what causes burnout, they’ll give you three reasons. It’s very consistent, but then a lot of studies, number one, I don’t get paid enough, which means I see too many patients. Number two, I have two new bureaucratic tests, particularly around getting approval for the things that I do. And number three, there’s this computer that gets between me and my patients. So literally between me and my patients, all those parts disrupt the time and the experience with patients.

Dr. Robert Pearl (39m 43s):
And they’re all right, every one of the needs to improve, but they don’t fully explain the problem. And that’s what I think we need to understand because in this pernicious part of the physician culture, status the hierarchy is very important. And if you look inside the data on burnout, you start to see some inexplicable differences. So we look in the pre COVID period, the specialty that was the most burnout was urology or urologist earn almost a half a million dollars a year. They earn double what pedicatrician’s earned 10 points more burned out.

Dr. Robert Pearl (40m 26s):
They can’t be simply the money and the number of patients being seen per day. And if you compare urology, that’s one of the most burnout against orthopedics ophthalmology too, are the least burned out specialties. These other surgical specialties have to get the same authorization, go through the same bureaucratic tasks. They use the same computer systems to how do we explain a 25 point difference? And the answer is, is this hierarchy in the hierarchy that we spoke about earlier, the puts the interventional cardiologist at the top and primary care at the bottom when it comes to urology in 2010 urologists were not very burned out. They were pretty happy.

Dr. Robert Pearl (41m 6s):
And then what happens? The U S task force on preventative services stops recommending the PSA. So the number of men diagnosed with cancer who need prostatectomy start to decline. And then we learn that watchful waiting is offered as good as intervention without the risk of impotence and urinary incontinence. And the centers of excellence start to happen more and more urologists, stop doing this operation. And why is that significant? Because the prostatectomy that’s been done in the last decade is a robotic prostatectomy, a star wars like procedure elevated status. And now if you’re not doing the star wars operation, even though you’re making just as much money, your position in the hierarchy starts to drop and much like Michael Marmot is a sociologist in England is pointed out the relationship that status is important as money, low status negatively impacts mental health and physical health.

Dr. Robert Pearl (42m 9s):
And people have found that a dropping status is the worst in terms of your wellbeing, you become unfulfilled, dissatisfied, and fatigue is, or the triad of symptoms of burnout. So this is I think, a major issue on top of the problems that exist relative to systemic issues in medicine. And I think the second part that’s happening in medicine in general, why 44% of doctors are burned out. You know what I’m talking about 10 or 20%, we’re talking about almost what’s happened to medicine overall. And in the 20th century, as you mentioned earlier, the doctor had all the knowledge is very paternalistic type world, very much vertical hierarchy.

Dr. Robert Pearl (42m 59s):
That’s gotten flattened as patients go to the internet and bring information into play. They don’t see the doctors, the ultimate authority anymore, they see it as an advisor and they will make the final decision. We see physicians now a channel for what patients do, and they don’t see that as being a major part of their job. Their job was to offer expertise. And now they’re having to evolve into helping patients get better, very uncomfortable. These factors, I don’t know if they are 20% of 40% or 60% of the problem, but if we don’t address those along with the systemic, we’re not going to improve burnout.

Dr. Robert Pearl (43m 44s):
And I believe, and this is where I think some of your listeners may disagree, but I believe we’re not going to be able to address either the problems with patient outcomes or the physician culture, unless we can evolve for a fee for service world that simply rewards volume and complexity to one that is prepaid capitated, whatever word you like to have. But now all of a sudden, a capitated world at the delivery system level, not the insurance delivery system prevention becomes more important. Avoiding the complications for chronic disease, patient safety.

Dr. Robert Pearl (44m 27s):
You stopped doing the 30% of the things that don’t add any value you start offering telemedicine not as simply an inferior means of an office procedure, right? An opportunity to make a diagnosis earlier, provide higher quality and more convenient ways. You start engaging with patients differently. And I think in that process, not only we improve clinical outcomes, but we will elevate physician satisfaction. You know, I always think back to many of the trips I did around the globe doing volunteer surgery on kids with cleft lip and cleft pallette and have the members of the team, they spend 10 days in a central American country.

Dr. Robert Pearl (45m 13s):
It was hot. There was no air condition. They ate rice and beans had GI upset. They come back filled with energy. I think about a doctor that volunteered and we paid his way to go to Liberia, to take care of patients with Ebola, he had to have IV’s in his arm, because he was sweating so much in the protective suits. He would have otherwise passed out he was in the happiest human being I’ve ever met when he came back, this purpose and mission. I think that we’ve given up some of his, the rod insurance stuff, drug companies, hospital, administrators, they have taken it. We also ourselves really to give it up voluntarily.

Dr. Robert Pearl (45m 55s):
And I think in that process, we’ve robbed ourselves of some joy and certainly a lot of fulfillment and satisfaction.

Dr. Anthony Orsini (46m 3s):
So I couldn’t agree with you more and you’re right. All these aspects are really putting a lot of pressure on physicians. What I try to talk to physicians about when I give my communication workshops is yes, you have the electronic medical records. You have the hospital, administrators you’ll have all the extra things that you have to do. I mean, every day it seems like you’re proving that you’ve got to get CMEs and you got to take this and you, but here’s the thing. When you go into the treatment room and you meet a patient where you go into the hospital room, no one else is there. It’s you and the human being on the other side of the table. And that’s where you’re in total control as a doctor.

Dr. Anthony Orsini (46m 45s):
And you could make those the next five or 10 minutes, a meaningful interaction between two human beings. And when you have a connection between two human beings, whether it’s at a party or it’s in a treatment room now, of course, if it’s an emergency or someone dying, there’s difference, but either way, all that stuff that’s out there goes away. Those are your 10 minutes to be the doctor that you wanted to be when you first started. And no one can take that away from you. So I try to get doctors to remember, yup. I feel the same way I’m experiencing it right now with my job.

Dr. Anthony Orsini (47m 25s):
But when I’m speaking to a mom about a baby, nobody is there. There’s nobody telling me about CME credits or electronical medical records. And I can go do my EMR later on. This is my time that when I leave the 10 minute interaction, part of my book, I sent it to you is, you know, it says it’s hard to fire your best friend. When I leave that interaction for 10 minutes, I feel like I had a best friend and you will go home happier and remind yourself why you went into medicine in the first place. And I think that’s where we have to start. So just my little plug on that, but I really truly believe that. So we’re getting down to the end here. I have 10 more questions, but we’re not going to be able to get to those. So I’ll finish with a question that I always finished with, since this is about difficult conversations and we’ve had some, your whole book is a difficult conversation, basically with doctors and healthcare providers, what do you think is the most difficult conversation that you’ve had in your life?

Dr. Anthony Orsini (48m 20s):
And it could be a type of conversation if you don’t want to get personal, give us some advice on how you navigated through that.

Dr. Robert Pearl (48m 26s):
There was difficult conversations I had have had to do with families of patients who have died, that I was part of the death process. In the book I talk about a young girl and Cathy who I consulted on for a necrotizing fasciitis say severe infection of her arm and had to make a difficult decision around, opening it up and being able to take out the dead tissue that was there and ultimately her demise. And I had to tell her parents, this is their only daughter.

Dr. Robert Pearl (49m 6s):
They weren’t going to have any more family. This was their pride, their joy. She was a great student. She was an athlete. She played soccer. He couldn’t have better, more adoring parents than Kathy. And now her daughter, after a battle with leukemia and a surgical procedure was dead. And I had to I’ll say tuck in my own emotions because I had to, in that moment support them. I had seen the impact of death on my cousin Alan’s death on my aunt and uncle that I also talk about in the book. And I knew what the family would be going through on. I think that was one of the most difficult conversations to be able to tell them the truth that their daughter was now dead.

Dr. Robert Pearl (49m 54s):
And we had done what we could do, but then I was sorry for their loss. And I had to have that conversation in a way that I could help them if only a small amount to be able to go to sleep that night. And then I had to twist and turn, stay up most of the night and the next morning I had to get up again. Cause there was another child, another family, this one with a cleft lip who needed my skill to repair it. If I was still thinking about Cathy her parents, I couldn’t do my best for this next child, the rest of her life. And I think in that enrollment, I don’t know that the conversation was the sole point that I was saying was so hard, but the tremendous emotion going by and the sense that almost no matter what I did, I couldn’t make it right.

Dr. Robert Pearl (50m 46s):
And that as a physician is probably one of the most difficult things that we have to accept about the profession we’ve chosen. It’s the price we pay for our patients. And I think in the end it gives us the purpose and the meaning and the mission of the wonderful choice of becoming a doctor and participating in the practice of helping people get healthier.

Dr. Anthony Orsini (51m 11s):
Well said, as you know, that my life’s work is about teaching doctors specifically in the beginning was to teach them how to break bad news. And that kindness matters. There is a right way and a wrong way of doing that. And as I it’s been often said that if you do it correctly, the healing can start with the news. And if you do it incorrectly, you’re going to really mess that up. And so it’s important to navigate. I agree. That’s the most difficult conversation to have with a family. So thank you for that. Robert, this has been great again, I’m trying to keep this less than an hour because I have about 10 more questions, but maybe we’ll have you back on, but it’s been a real pleasure. And an honor to get to know you, the book is called uncaring.

Dr. Anthony Orsini (51m 51s):
Robert. What’s the best way for people to get in touch with you.

Dr. Robert Pearl (51m 53s):
The best place to go is my website, Robert Pearl md.com. There, they can learn more about the book. They can sign up for my monthly musings that comes out the second Tuesday of every month. That has a lot more information on all these different aspects, both of the system of medicine and the culture of medicine, engage with your friends. Think about the topics that are there. Let me know your ideas. I have my thoughts, but I recognize they’re certainly incomplete at this point. As we try to make American medicine, once again, the best in the world. Thank you, Anthony for having me today.

Dr. Anthony Orsini (52m 29s):
Fantastic. If you enjoy this podcast, please go ahead and hit follow on your favorite podcast episode. If you want to get in touch with me or find more about The Orsini Way and the programs that we offer, you can reach me@theorsiniway.com. Thank you again and thanks everyone for listening. Well, before we leave, I want to thank you for listening to this episode of difficult conversations lessons I learned as an ICU physician. I want to thank The Finley Project for being such an amazing organization, please, everyone who’s listening to this episode, go ahead, visit The Finley Project .org. See the amazing things they’re doing. I’ve seen this organization literally saved the lives of mothers who lost infants. So the find out more go to The Finley Project .org.

Dr. Anthony Orsini (53m 9s):
Thank you. And I will see you again on Tuesday.

Announcer (53m 17s):
If you enjoyed this podcast, please hit the subscribe button and leave a comment and review you. Contact Dr. Orsini and his team to suggest guests for future podcasts, visit us@theorsiniway.com. The comments and opinions of the interviewer and guests on this podcast are their own and do not necessarily reflect the opinions and beliefs of their present and past employers or institutions.

A Year in Review - Difficult Conversations Anniversary Episode

Liz Poret-Christ (1s):
You spend two seconds in the room and you leave. And then the patient has all these questions and then you have to answer 15 phone calls. Had you just sat there for two more minutes you might’ve answered all of those questions. So if I were to present the perfect situation, I would say, you know, you are going to save money by training your physicians right, right off the bat. And you’re going to save time by implementing this as a top down philosophy so that everyone’s wired the same way. You don’t have a couple of key people that do it, and no one else follows. It kind of has to be everyone’s trained the same way so that everyone speaks the same language. So everyone’s empowered to say, Hey, Dr.

Liz Poret-Christ (43s):
Orsini, I saw you are standing in the doorway of that room. Why don’t you sit down? Why don’t you go in and sit down, so that everyone understands what it takes to be successful.

Announcer (55s):
Welcome to Difficult Conversations: Lessons I learned as an ICU physician with Dr. Anthony Orsini. Dr. Orsini is a practicing physician and president and CEO of The Orsini Way. As a frequent keynote speaker and author, Dr. Orsini has been training healthcare professionals and business leaders how to navigate through the most difficult dialogues. Each week, you will hear inspiring interviews with experts in their field who tell their story and provide practical advice on how to effectively communicate. Whether you are a doctor faced with giving a patient bad news, a business leader who wants to get the most out of his or her team members or someone who just wants to learn to communicate better this is the podcast for you.

Dr. Anthony Orsini (1m 40s):
I am honored today that The Orsini Way has partnered with The Finley Project to bring you this episode of Difficult Conversations: Lessons I learned as an ICU physician, The Finley Project is a nonprofit organization committed to providing care for mothers who have experienced the unimaginable, the loss of an infant. It was created by their founder, Noelle Moore, whose sweet daughter Finley died in 2013. It was at that time that Noelle realized that there was a large gap between leaving the hospital without your baby. And the time when you get home, that letter to start The Finley Project. The Finley Project is the nation’s only seven part holistic program that helps mothers after infant loss, by supporting them physically and emotionally, they provide such things as mental health counseling, funeral arrangements, support, grocery gift cards, professional house cleaning, professional massage therapy, and support group placement.

Dr. Anthony Orsini (2m 34s):
The Finley Project has helped hundreds of women across the country. And I can tell you that I have seen personally how The Finley Project has literally saved the lives of mothers who lost their infant. If you’re interested in learning more or referring a family or donating to this amazing cause please go to The Finley Project.org. The Finley Project believes that no family should walk out of a hospital without support. Well, welcome to another episode Of difficult conversations lessons I learned as an ICU physician. My name is Dr. Anthony Orsini, and I will not be your host today. Today. I thought we would do something different. Today my good friend and colleague Peter Winick will be our host.

Dr. Anthony Orsini (3m 14s):
Peter is the founder and CEO of Thought Leadership Leverage and host of his own podcast called leveraging thought leadership, which I believe has over 300 episodes now. For the past two decades, Peter has helped individuals and organizations build and grow revenue streams to designing and growing their thought leadership platform, as well as acting as a guide and advisor for increasing business to business sales of thought leadership products. Through The Orsini Way I’ve been working with Peter for almost six months now. And he has certainly helped us move in the right direction and expand. Today, Peter will be interviewing me and Elizabeth Poret-Christ. Liz is The Orsini Way’s managing director, my friend and colleague for almost 10 years now. She makes The Orsini Way run and is a master communicator, an expert in patient experience.

Dr. Anthony Orsini (3m 58s):
As you may recall, I interviewed Liz on episode eight back in September of 2020. And if you haven’t heard that I highly recommend recommended her story is definitely worth hearing. Well, enough said, I’m going to hand the reins over to Peter. There are no preset questions here, and Peter’s going to have the ability to ask us anything he wants. So let’s see what happens, Peter.

Peter Winick (4m 20s):
Thank you. Thanks for that. I’m excited about today because when we started working together several months ago, I was enamored slash fascinated by not just the work that you do, but the story behind the story. So I think most people know your story. Tony, just give us a little bit of background, cause you’re usually on this side of the mic and I want to dig a little bit deeper on what got you going here, what problems you’re trying to solve and the bumps along the way.

Dr. Anthony Orsini (4m 45s):
Yeah. So as most people know, who’ve heard this podcast before or read my book or listened to my Ted talk. You know, I had a profound experience when I was training as a neonatal fellow that made me really realize how important it is for doctors, not only to have the art and science of medicine down pat, but also learn how to communicate and build relationships. And I saw from a very early age that although we were scientifically doing extremely well and medicine was getting better and better, our communication skills over time just got worse. And because many people, not in medicine wouldn’t realize that we’re actually not trained on that. So after that profound experience of witnessing a doctor who was a very compassionate doctor who gave tragic news to a parent in a very abrupt way, I really dedicated 10 years of my life to learning.

Dr. Anthony Orsini (5m 37s):
If there is a proper way of communicating with patients both during difficult times and during good times the answer was yes, and it took me 10 years to figure out and come up with a program that teach doctors how to communicate. And then in 2010, I started a program called breaking bad news, which was the first of its kind that trained young doctors on how to discuss tragic news. After presenting that at a conference, it kind of blew up and that we became very popular. There were programs all over the country that were asking us to, to train their doctors. And then I think it was a year later that I met Liz who wanted to get involved in the program. Liz has her own story that I’ll let her tell.

Dr. Anthony Orsini (6m 19s):
And then really the rest is history. We’ve been teaching doctors, nurses, first responders, and now even some business people on how to communicate in addition to being a neonatologist and a physician. My passion really is communication. I think it’s fascinating. It’s cool. If you will, to know that you can change a word or change a nonverbal cue and make all the difference. And that’s why the name of my book is called it’s on the delivery because it truly is. And so now I just spend all my free time teaching and doing the podcast, writing the book, and Liz has been a central part of that from the very beginning and together we have a mission and that is to improve communication in medicine and in business.

Dr. Anthony Orsini (7m 0s):
So, so that’s where I am now and you and your company is helping us reach our goals of expanding that. And so I’m just so excited about what I do.

Peter Winick (7m 8s):
And it comes through all the time. So one of the things I found fascinating when we started working together is really two things is number one, it’s not a judgment or a character flaw that doctors are horrible at this. It’s a logical outcome. So if someone asked me to do what you do as a doc, I would fail miserably because I have no training or experience you wouldn’t, God forbid, hand me a scalpel to deal with it. Yet doctors go out there and they’re good people, good intentions, trying to do good things and cause horrible, long-term psychological damage. One of the things that was fascinating to me when we started working, I had a story about my dad who had a heart attack in his 40’s. Bill, my right hand was a very sick child and his mother who’s like 80 still cringes And could quote back when a doctor told her in the early seventies, your son’s condition is incompatible with life.

Peter Winick (7m 57s):
Like, oh, that’s compassionate. And I think we’re not special. I think everybody has that story. They doctor giving us news in a way that’s just awful horrible or whatever. That’s a big and noble problem to try to fix. And that’s why I love the work that you’re doing. I want to go to the other side because you’re coming at it from the professional realizing, Hey, I’m going to call what I see, which is my profession does a really terrible job at this. And it causes undo pain, stress suffering. And I want to dedicate my life to fixing it. Liz is amazing. And Liz and I have spent a ton of time together over the last several months because unfortunately she’s been on the plays, the role of the receiver, if you will, because she’s been on the patient side of this more than any of us would like to share some of your stories.

Liz Poret-Christ (8m 40s):
Sure. So I had a very successful career in the fashion industry, which has absolutely nothing to do with this. And when I gave birth to my twins, my daughter was diagnosed with cystic fibrosis. At that time, I was a stay at home mom. And the idea of having a child with a chronic medical condition really overwhelmed me with feelings of being helpless and the way that I decided to channel that intensity of feeling like I had no control over what was going on in the world was to become active in our local children’s hospital. And I joined something called the family advisory council, which kind of served as the doctor to patient patient, to doctor translation.

Liz Poret-Christ (9m 22s):
So we met with doctors, we met with different ancillary departments in the hospital and just try to explain to them what it felt like to be communicated with from the patient or family member perspective. And I really loved that work. I thought it really just empowered me in a way that I don’t know anything else that could have done that. And then I was at a conference in Washington, DC where CHOP was talking about role-play to teach doctors and nurses what it was like from the patient perspective, except the doctors played the nurses and the nurses played the doctors. And I sat in the audience just completely overwhelmed with how amazing this role-play scenario was.

Liz Poret-Christ (10m 2s):
But I kept thinking that why could it, the patients or the family members participate in that to give them a more realistic view? So I ran back to our director of pediatrics full of all my big ideas. And he was like, okay, calm down. There’s a doctor, that’s starting a program. That sounds like what you’re talking about. So why don’t you go talk to him? So I called Dr. Orsini and I said, please, let me help. Please let me be part of this. And he was like, okay, but we use actors and I was like, actors, why do you need actors? You have all these family advisors and all these parents waiting to help. And he said, no, trust me. It works this way. And I was very, what’s the word I’m looking for? I was suspect. I said, no, I think we could do just as good a job.

Liz Poret-Christ (10m 44s):
He said, well, why don’t you come watch? So I went to watch and I was so overwhelmed by the realism and the improvisational aspect of giving these doctors such a safe environment to learn how to do something that’s so incredibly difficult to do that. I absolutely fell right on my sword and said, you’re right. You’re right. And how can I help? And what I thought was so unique was in the review session with these physicians that were going through the role-play was a family advisor, giving that feedback, giving that this is what it feels like. This is what I hear as a patient or family member. And that was so unique to any other kind of training that I’d ever experienced that I instantly was hooked and said, whenever you need me, I’ll come.

Liz Poret-Christ (11m 27s):
How can I help? And I did that. Tony, what do you think? Like four years, three, four years. And as the company got bigger and we had more clients, we really needed somebody on the ground when Dr. Orsini was going and being a doctor to really handle the clients and the handle, you know, what was going on with the company. And Tony said, Hey, you want to leave your successful fashion industry career and come work for me, it’s a nonprofit. I was like, yeah, sure, great. I’ll do that. So I left and actually I went, part-time at both jobs and I never looked back. I absolutely loved what we do. And I feel like, I always say, I have a changed the world job and I have a change your clothes job.

Liz Poret-Christ (12m 8s):
And the change the world job is just really so rewarding.

Peter Winick (12m 12s):
It totally comes through in everything you both do when working with clients. So I think, you know, on Tony’s side of the house, it’s showing docs that you’re doing something that is causing harm. And then there hasn’t been one that you’ve exposed it to that says, no, I think I’m going to continue to do it the way I was doing. Like, I kind of liked inflicting, suffering on people. So that’s amazing. And then Liz take being on the receiving end, it’s a magic combination. So I want to talk about to the business side of this. So everybody on both sides of the equations realizes this is an issue, or once they come to be told the story of it goes, yeah, oh, geez, we got to do better at this. Talk a little bit about the journey because there was a nonprofit piece to this and then a typical business to this and then a corporate business to this.

Peter Winick (12m 57s):
And it, you know, in my work, I’m dealing with people that are typically really smart and savvy on the business side, developing capabilities in others so that they can do their jobs and perform better. And as long as there were an ROI, you know, business is fairly simple, like making investment, get a return on it. It’s not quite that simple in the health and medical universe talk about sort of the journey and some of the obstacles you’ve had to overcome.

Dr. Anthony Orsini (13m 21s):
We started out, you know, my initial idea as Liz alluded to, we started out as a non-profit. It was called the BBN foundation. And I had this grandiose ideas that everybody was going to recognize how important this was and just donate money. And, you know, everything was all idealistic. And we did that for three or four years. We had a board. I’ll never forget quick story. A friend of mine who was on the board, was also a big time lawyer. He’s a music lawyer, but he had some friends and he brought me to Now we’re getting ready to start the non-for-profits. So he brings me to this big place on fifth avenue in New York. And he, we sit down and my friend and I are sitting there waiting for the lawyer to come into this big boardroom.

Dr. Anthony Orsini (14m 3s):
She walks in and she says, before we start, I want you to know that the government is assuming that you’re doing this to launder money. Anything that you do incorrectly can put you in jail.

Peter Winick (14m 21s):
Not you personally, let me just clarify

Dr. Anthony Orsini (14m 23s):
that non-profits are considered you, you have to prove that you’re legit. So my friend and I looked at each other and said that we want to keep doing this. We said, okay, let’s go. So we did it. It was a foundation for about three or maybe four years. It started out with a bang and then like many things, the board of directors got busy. It was a lot of work. We were putting on big galas and we realized that the gala was great people donating money. And then by the time you pay the caterer, by the time you pay the DJ, there’s nothing left. And Lauren, my wife and I looked at each other and we said 75% of the money has been donated by us. And every time I need to do something, I need to clear the board and I’m losing sleep because I might lose a receipt for $3 and 29 cents for a hamburger at lunch and go to jail.

Dr. Anthony Orsini (15m 8s):
And so we made the decision to make it an LLC, mostly just to make things easier. And now we can move more quickly as an LLC. And then we started to expand. It was, you know, first just teaching, breaking bad news. But then we realized it was the same communication skills that made certain doctors perform better on patient experience scores. And you know, and I want to say that the problem with communication in medicine is really, as you said earlier, these doctors and nurses are just genuinely great people who went into medicine for the right reasons, but like anything else, if I asked you to do something that you really never been trained to do, you’re going to feel that you’re going to be nervous. You’re going to have anxiety and you’re going to rush through it and just botch it up.

Dr. Anthony Orsini (15m 51s):
So, so that’s how we’ve evolved from a nonprofit to an LLC. And we rebranded from BBN to The Orsini Way after a couple of consultants said, BBN just doesn’t make any sense. You know, it was for branding purposes and here we are now, and now we’re doing, and then we expand it into business, which we’ll get into later on because COVID kind of changed everything.

Peter Winick (16m 12s):
Yeah, exactly. Again, so most of my work is in the business world, right in the business world. If you can make your case that investing, it actually leads to Y and Y is a good thing. Great. And occasionally things that you just do things because they’re the right things. What I’ve learned from my work with you guys is, yeah, nobody disagrees that this is a good idea.

Liz Poret-Christ (16m 31s):
Now you have to get it funded. Now you have to get probably the scarcest resource other than money is time of really high value people like docs. Like we all know how many hours collectively we spend over our lifetimes in waiting room to get eight minutes with the doc to argue that I need them for a half day, a whole day, two days, that is a monumental ask. So the follow the money here at some level is patient experience scores, which directly impact reimbursements that medical centers and such receive from the government, which is kind of an equal that of customer experience in the business world, but in a perfect world. And I know you’re doing a lot of this with residents is where should I be introduced to this capability, this concept, this mastery of a better way to communicate terrible news.

Dr. Anthony Orsini (17m 16s):
I think Liz would agree with me. What we found is, you know, when you’re a medical student and this is well chronicled in books, when you’re a medical student, you’re very altruistic and you’re just there to save lives. You know, I started medical school thinking I was going to cure cancer and then the demands of, but you don’t realize that there are people that die and you don’t realize that you’re going to have to tell people that they’re going to die. And you don’t realize that you’re going to have to see 30 patients and six hour period. And so it’s well chronicled that you, the reality of healthcare kind of comes to you. So Liz and I have really found probably the best time to start this process. We’ll introduce a medical school, but we really want to start the process in as a resident and as a young physician, because as a resident, you’re not really worried about billing.

Dr. Anthony Orsini (18m 4s):
You’re not worried about your practice. So you just kind of have patients. And then you get out into the real world. And many of these physicians or big hospital programs are realizing these guys are brilliant doctors and brilliant nurses, but our patient experience scores are low. Why is it that we have great outcomes where our scores are low? And so the earlier the better, I think is the best way to train them what we want to do at the Orsini way, which I think is so cool is we don’t teach them what to say. We kind of rewire the way you think about communication. So you don’t have to be a doctor to take our program. We can teach anyone how to communicate and you’re going to go, wow, that’s really cool. I liked that. I didn’t know, raising my palm 90 degrees made a big difference on what I say and you know, there’s, so it’s kind of cool that when you train people, how to do this, they’re rewired for life.

Dr. Anthony Orsini (18m 49s):
And that’s the other thing that we do. And Liz, we’ll talk a little bit about more about this. Once we train you, you don’t need more training. So many of these programs want you to come back every year, et cetera. So it’s rewiring your brain, right?

Peter Winick (19m 0s):
So let’s talk to that rewiring. And then I want to get to Liz for a minute. So in terms of the rewiring, what’s interesting is this isn’t sort of a hack or here’s the five hacks to do. Everybody wants to hack and you know, how do you get your email box clear and all that? And I know from our work together, like I’ve learned a couple of little things like when doctors are standing, literally looking down at sitting parents, delivering news as a totally different experience and taking whatever it takes three seconds to grab a chair and look me in the eye at face level. Like I think once people learn that, like you said, there’s no refresher course. That’s just, that’s what you do. They would never go back to the old habit and revert to doing it the other way, because they didn’t realize the outcome of that.

Peter Winick (19m 42s):
Liz talk a little bit about some of the good, the bad and the ugly of getting installed inside of organization. Because I look at the work you’re doing, is it, wow, this is amazing stuff. We wish it was easier to get people, to get it and bring y’all in, in the door and say, of course we need to do this.

Dr. Anthony Orsini (19m 59s):
So I was going to say back to the other point, we have a client that really has embraced this program for their residents. And they actually do it twice in the three-year residency. They do it as a first year when you know, the skills are really growing and the access to patients is increasing.

Liz Poret-Christ (20m 19s):
So they do it in the first year and then they bring them back again in the third year and give them a more complicated scenario, usually involving a medical error. So not only is it meeting a requirement of their training to learn how to disclose medical errors, but they’re getting that in that super safe environment to learn how to do this incredibly difficult task. And I think there’s such a great example of the success of investing in both the time and the finances of doing this kind of training because those doctors are walking out and going into their fellowship so far ahead of their competition. And I would have to imagine, and I love at some point to do a study on this.

Liz Poret-Christ (21m 4s):
I love to hear like in the interview process for their fellowship, is this something that they talked about? Is this something that made a difference? Because we see them year one, and then we watched them again, year three. And sometimes when they do a really extraordinary job, we go back and pull that year, one video and show the progress. And it’s amazing. Like it amazes me every time and it’s like a clean slate. Every time you get to a new doc to Tony’s point about rewiring their brain, we’re not telling them what to say. We’re teaching them or giving them a roadmap on how to make this easier for themselves and more successful for their patient. And I think that in a perfect world, I would love to see everybody do it that way, because I think it’s really impactful.

Liz Poret-Christ (21m 52s):
And this client in particular also has a very robust team of doctors that sit in on that review panel. So they’re speaking the language as well. And we all know that when you’re trying to implement a philosophy it’s top down. So they’re top believes in it and it filters all the way down. And I think they would be my perfect world in a perfect world. Everyone would do it just that way.

Peter Winick (22m 13s):
So I want to ask a similar question to what I asked Tony. So I asked Tony earlier where in the process he’d prefer. And we, we talked about getting it early in your most often interfacing on the other side, on the administration side and the contracting side and the dollar side and all that sort of stuff. You know, if I said to you, here’s your magic wand? What would you like folks that are on the buy-side, the healthcare administrators or whatever, to be thinking differently, doing differently, realizing making this a bigger priority to make, to get access to more folks.

Liz Poret-Christ (22m 46s):
So I would say that if it’s a teaching hospital, I’d like to see them do that kind of first year, third year situation. And then I really do think it’s important that once a new physician is integrated into a hospital system, end of year one, year two, we go through this again, because listen, we can help remediate behaviors that maybe don’t end in great outcomes, whether it be lawsuits or some kind of litigation or whatever. But if that roadmap is hardwired and this is the way you do it, you walk in the room and you sit down, you look your patient in the eye. You don’t have one foot out the door, all these things that seems so simple, but nobody has the time to do.

Liz Poret-Christ (23m 27s):
We show you that you actually save time by doing it right the first time, instead of trying to backtrack, like when you spend two seconds in the room and you leave, and then the patient has all these questions, and then you have to answer 15 phone calls. Had you just sat there for two more minutes. You might’ve answered all of those questions. So if I were to present the perfect situation, I would say, you know, you are going to save money by training your physicians right off the bat. And you’re going to save time by implementing this as a top down philosophy. So that everyone’s wired the same way. You don’t have a couple of key people that do it, and no one else follows. It kind of has to be everyone’s trained the same way so that everyone speaks the same language.

Liz Poret-Christ (24m 11s):
So everyone’s empowered to say, Hey, Dr. Orsini, I saw you were standing in the doorway of that room. Why don’t you sit down? Or why don’t you go in and sit down so that everyone understands what it takes to be successful?

Dr. Anthony Orsini (24m 24s):
I think that’s a good point. You know, Peter, we do really ideally, although we train one doctor at a time with improvisational, we have big workshops and prefer to do whole hospitals. I think one of the problems with, as you alluded to what the ROI is, and this is why my life is so frustrating sometimes because did you ever feel like you have a really simple solution to a very complicated problem and nobody else is listening. So that’s the way we feel. So patient experience is a really hot topic and patient experience. Multiple studies have shown that it’s all about relationships and communication. And if you can train the doctors and nurses, how to form relationships with their patients and communicate well, your patient experience scores are going to go up and you’re going to make more money.

Dr. Anthony Orsini (25m 6s):
It’s so simple yet because it’s a soft skill. We still have many hospitals who say, well, that sounds great. But I still think if we had nice TVs, they might give us a better score or let’s improve the food because those are tangible things that we can touch. The other thing that Liz was talking about is about following these young doctors later on. I don’t, I didn’t even tell Liz this, but just last week I got a Facebook messenger, long message from one of the doctors that I trained really early. I think it was even the first year. And she sent me this long texts that she, I loved my Ted talk, but really hit home. And she said, I just want to let you know that 10 years now I’m in practice in Nashville. And I still stop every time I have a difficult conversation and think about what you’ve taught me and I want to thank you.

Dr. Anthony Orsini (25m 50s):
And if you’re ever in Nashville, please stop by. And I, you know, when you get, that’s what I’m talking about, that’s evidence that we’ve rewired people.

Peter Winick (25m 58s):
Well, and you guys have taught thousands of doctors over the last 10 years. And then you think of the tens or hundreds of thousands of patients. We’ve had conversations, Tony offline about the frustration. And just so everybody listening, you know, Tony has put his blood, sweat, tears, investment, everything into this as has Liz. This type of works that pays a fraction of what the fashion world does. And you guys both have your hearts and brilliant minds in an amazing place to continue to do this. And I just hope that that frustration that you have eventually little by little, the world goes, geez. Yeah, there is a better way. And I want to touch on another piece of this story, because I think this connects to Liz was talking about from the patient standpoint, from the administrative standpoint, I would imagine, although I don’t know firsthand, if I’m a doc and I have to deliver bad news, that’s not something I, you know, obviously it’s not a thing.

Peter Winick (26m 45s):
It’s not a good thing. It’s not something I enjoy. I’m going to have anxiety over it. And I know that every time I do it, it’s awful. That’s going to make me feel pretty crappy and awful. And you can’t, you know, alleviate the pain and suffering that someone has to go through. But how much better does a doctor feel knowing that they’re doing what they have to do in a way that is, you know, with the most dignity and respect and compassion, empathy, love, whatever that they can to a patient. How does that change their brain?

Dr. Anthony Orsini (27m 13s):
That’s basically what I was alluding to before. And I want to say it, you know, we don’t just teach bad news. We also teach general communication skills. When I said before, I feel like I have a simple solution to a complicated problem in right now, if you look at the problems in healthcare, it’s number one, rising costs and number two, physician and nursing burnout. So physician burnout now is up to 60%. It’s the highest suicide rate of any profession. Nurses are about the same. Substance abuse among nurses and doctors is rising every year. And a lot of that has to do with the growing demands that are being placed on physicians, as far as time and the less money and the administrators telling you need to do this, and you need to do that.

Dr. Anthony Orsini (27m 54s):
And there’s great books about this. You can read about it. In fact, I soon will be interviewing Dr. Robert Pearl, who just wrote a book called Uncaring, and he talks about this, but what I say to positions during my workshop, and I think this is why they really listen so intently is that you weren’t doing this training, not only for the patient, because the patient’s going to benefit from your better communication skills, but you’re also doing it for yourself because whether it’s a bad news, then now you’re delivering bad news, but you’re confident that you’re doing it correctly. Or it’s a routine office visit. When you walk into that treatment room, there’s nobody telling you what you have to do.

Dr. Anthony Orsini (28m 39s):
There’s no administrator over your shoulder. There’s nobody telling you what the document and that is your time to build rapport and form that relationship with the patient. And it only takes a few minutes, but when you do that, you’re going to leave that room feeling fulfilled. And you’re going to say, wow, this is why I went back in the medicine. This is why I went into medicine in the first place. And you leave the day. So fulfilled that to me this is the solution. Not only for a patient experience, not only did the, to decrease futile malpractice lawsuits, not only to help doctors with their anxiety, but to improve professional burnout. If we can learn to get back to that, you and I are in this treatment room right now, and we are going to be best friends for the next 10 minutes.

Dr. Anthony Orsini (29m 25s):
And we’re going to build a rapport and you’re going to feel really comfortable, opening up to me to tell me your issues because you trust me. And I’m going to treat you with respect because I’m comfortable doing the communication. And I’m locking out all that other for lack of a better word, crap with documentations and worried about malpractice lawsuits. And I’m going to give you 10 minutes of my undivided time. You’re going to leave really fulfilled. I’m going to leave really happy. It’s not going to take any longer. Patients in the waiting room won’t wait that long. Everybody goes home. There’s less medical errors. It’s a simple thing. And so that’s why 10 years of my hard earned time and money has been screaming from a mountaintop going guys, you know, and that’s the whole premise of the TED talk.

Dr. Anthony Orsini (30m 10s):
I keep plugging the Ted talk, but I’m going to plug the TED talk.

Peter Winick (30m 13s):
Go listen, it’s on YouTube now, but have them go listen to the Ted talk, but also depending on who’s listening now, this is your opportunity for an ask because I’ve been in the background trying to do my best to support you all for the last six months, because this needs to be unleashed. There’s no doubt in my mind, like we will all be in a better world if X percent or 10 times as many communication skills. So what’s an ask you might have, and I’ll ask it to each of you. So what’s an ask you may have?

Liz Poret-Christ (30m 49s):
I guess my ask would be to administrators, whether it be business or medicine, if you have a team of people that need to not only communicate with each other, but with clients or patients, you need to teach them how you need to teach them what compassion and empathy and, you know, being a productive human in a difficult rushed, complicated world, there’s a tool. There’s a gift you can give them. And I always say, when I onboard a resident, this training is a gift that your hospital is giving you to teach you how to do this in a way that will affect the rest of your professional career.

Liz Poret-Christ (31m 33s):
And sometimes as Tony’s alluded to, I feel like we have the secret. Like I feel like I hold a secret in my hand for a physician that gets in their car at the end of the day and they’re hindbrain or you know, is telling them like, Ugh, I didn’t do this well. And there’s a way that they could be taught to do a better, why wouldn’t that be something that everyone wanted to give their team? And I’ve certainly worked in professional environments where some management or some team members didn’t communicate well and didn’t, and it affected the whole team. And if there was a better way to do it, why didn’t anyone want to give it to them? So that would be my ask. Like, if you have a team, you need to teach them, you need to give them the skills.

Liz Poret-Christ (32m 14s):
Don’t just assume that they have it just because you can hire the brightest person in the room. Doesn’t mean they have the skills to communicate with anybody around them.

Peter Winick (32m 24s):
And Tony, who would you ask?

Dr. Anthony Orsini (32m 27s):
I agree with Liz, like the, the administrators of a hospital or big practice or a business really need to understand that the save your money and the food and the TVs and let’s invest in this. But I would also say, you know, it reminds me of, if you’re watching a cable network, it says, if you don’t get this channel, call your cable company and demand that you hear that all the time. I think from the physician’s point of view and the nurse’s point of view, if you’re not getting this kind of training and you care about yourself and your patients go ahead and demand it. and The Orsini Way now has so many different educational formats that we now offer CME’s for that if you don’t have the time to do it improvisational role-playing, or if your hospital is not supporting you, there’s other ways we give workshops, I speak at so many different conferences.

Dr. Anthony Orsini (33m 19s):
We now have remote learning modules for CME credits.

Peter Winick (33m 21s):
I just want to unpack that is brand new. I mean, that’s literally just launching as we speak, which makes a huge difference because I think one of the issues here has been, yeah, I get it. I get it. I get it. But I need CME’s that I’m not going to get credit for these. So check the box another excuse, hopefully neutralize.

Dr. Anthony Orsini (33m 37s):
And here’s the thing I would say to physicians and nurses is that I know you’re really busy, but the biggest satisfaction that Liz and I have when we’re doing workshops is we see that many of these times that the administrators are making the doctors go, they’re making the nurse ever wants to do it. And you see them up there. And given, you know, sometimes up to three hour workshop and there’s always a bunch of people with their arms folded and their body language is saying, you gotta be there at two o’clock on Tuesday. They really happy about it. Many of it is, are the doctors because the nurses are getting paid for that. Usually the nurses get paid to sit there. So they’re like, okay, this is fine. And then I start off with telling everyone that, you know, I’m a physician, I’m one of you.

Dr. Anthony Orsini (34m 20s):
And many of these other companies that are doing similar programs, aren’t run by physicians. I use these communication techniques that I still go home at a decent time. And my patient satisfaction scores are sky high for umpteen years or whatever it is. So then they set up a little more straight and then we start showing them the cool techniques and why communication. And all of a sudden they’re like, I can’t wait to try this. So whether you’re doing this in a workshop or you’re doing a learning module for an hour, I promise you that you will come away with something that will make you excited to try it out the next day or the light bulb will go on go. I never thought of that. You know? So things like that. So I think the ask is there’s many different levels on a large level.

Dr. Anthony Orsini (35m 3s):
Yes, we need healthcare to embrace this on a big level. But if you don’t get this news channel demanded from your cable company, I think I would say, well, I want to thank you for that.

Peter Winick (35m 14s):
Thank you both for that. So I want to pivot a little bit over to the corporate side because that’s fairly new. And you know, if you look broadly at the communication space, which is where this sits in corporate, there’s a lot of stuff out there and like anything else, there’s a continuum of total crap to awesome. And then somewhere in the middle is good stuff, wrapped in a bit of what I’d call shtick, you know, learn, you know, what will blah, blah, blah, from a hostage negotiator. Okay. Well, most of us in business are, don’t get a call at two o’clock in conference room C is going to put a gun to someone’s head. Can you figure that out? Talk a little bit about the power of this in corporate because as a business guy is when we first started working together, like, wow, I thought I’m having to tell, you know, I’ve got it.

Peter Winick (35m 58s):
You know, here’s my schedule. And I got to communicate some bad news to a client or a price increase of 3% on a five-year thing. And I’m losing to business folks.

Dr. Anthony Orsini (36m 12s):
So it’s interesting that, you know, it became more and more evident as we’re doing the podcast. And which is really the premise of starting the podcast is that the doctor patient relationship is extremely similar to the leader team member relationship in business. And that if you can teach your leaders how to communicate, we know in business, right? The biggest problem is turnover. It costs millions and millions of dollars every year and loyalty to the company and to the leader, we know that most people leave their job. Not because of the money they leave their job because they don’t like their boss. And so a lot of that has to do with communication and trust. We are, we had Stephen Covey on the podcast. We really got into working with businesses during COVID right?

Dr. Anthony Orsini (36m 52s):
So during COVID I got a call from one, well, a few. Now we started off with a major international company that called me through a friend and said, we’ve had a thousand people die of COVID in our company internationally. And there were in India, they were in a bunch of, and the human resource people are told that they have to call up the team members from home and say, Hey, you know, Johnny who used to sit in the cubicle next to you for the last 10 years he died. Wow. And they’re not really ready to do that. So I gave a one and a half hour webinar trained hundreds of human resource people from different countries. And then another one came in.

Dr. Anthony Orsini (37m 32s):
And so, so that’s when I really started realizing what the podcasts be awesome in that I can really blend leaders in healthcare and leaders in business and talk about how the communication techniques and being a good communicator will help you and how there’s very, a lot of similarities. Again, we’ve done now a year of podcasts. This has been awesome. And every week I learn, but also every week I get reaffirmed, what I’m doing is correct. And the God, my wife gets tired of me talking about the podcast because she’s like, yeah, you bring up the podcast. It’s because somebody will say something and I’ll go, yeah. You know what, Stephen Covey, I had him on my podcast and he said the same thing. And then I go, because every day it’s like Seinfeld episode, everybody remembers, you know, something happens to you during the day.

Dr. Anthony Orsini (38m 15s):
And you go though, that was a Seinfeld episode, you know? And so, so she goes, you really gonna start bringing up your podcast? I’m like, well, not really bringing up the podcast. I’m bringing up my awesome guests, but I’m learning so much. So it’s been great.

Liz Poret-Christ (38m 26s):
My husband, actually, when we go to a party or go to somebody’s house, they’re like, please don’t ask Liz what she does. Please don’t ask her. She’s just so evangelical. And like I did that the other day friend’s house stayed a couple of other friends over, and this guy was talking about how he hates his job. He’s in banking, any hates his job because he hates his boss. And I go, well, you know, people don’t leave companies. They leave leaders. And he was like, my husband’s like, oh God, here she goes. I’m like, we had an episode of our podcast and I started talking about it and he’s like, yeah, there she goes again. So it’s so true.

Liz Poret-Christ (39m 7s):
It’s so true that the relationships are the same, whether it be business or medicine, that trust is everything.

Peter Winick (39m 12s):
Yeah. It’s just that what we’re focusing on is different, you know, onto the podcast, it’s been a year, right? So this is sort of a, we’re using this as a milestone to say, wait, let’s talk to the folks behind the microphone and a little bit of a different way about the journey, the struggles, the passion, the goals. And I’ve never worked with two more passionate. I mean, companies talk all day about mission-driven whatever. And it’s like, well, you sell tires. It’s like, I get it. Not the companies are bad. There are companies that are more mission driven than other, but I’ve never seen one that is truly 1000% mission driven in every touch point of working with you guys, sort of behind the scenes in front of the scenes, delivering the outcomes on the other side are amazing.

Peter Winick (39m 57s):
So I hope that folks listening will keep the wishes of both Liz and Tony in terms of these words and say, Hey, we heard of this thing called The Orsini Way way. Let’s have a conversation on Liz’s side that sort of opening the aperture and the vision to give people, need the skills to do the things they need to do. And I think if any leader in health or in business, or thinking about this, like why would you expect anyone working for you to do a decent, decent job of something they have absolutely no training in. And then ask yourself to change that word with communication and say, you know, and be honest with yourself because most of us do a horrible job of developing these capabilities in our people, particularly when they’re front line and doing important, incredibly powerful, any final words from you two?

Dr. Anthony Orsini (40m 40s):
No, I mean, this has been a lot of fun the podcast over a year, again, you know, great people and Ann Bahr Thompson and Siobhan McHale and Stephen Covey and Liz and people like Noelle Moore who suffer tragedies and Michelle Neier , Marcus Engle. I mean, it’s been a great journey and I’m making more and more connections through it. We’ve been great, you know, and the The Orsini Way is still evolving. And to the point now where it’s wonderful that if your hospital or group doesn’t support it, you can just go online and buy a learning module yourself. And so I would just say, keep listening to the podcast, visit the TEDx, you’ll see what Liz and I are all about.

Dr. Anthony Orsini (41m 21s):
We’re still screaming on the mountaintop. We’re getting more and more traction. There’s been some, you know, a lot of movement, people are starting to realize that this works, visit the website The Orsini Way.com and just, you know, try it out. It’s an hour of your time as a little as an hour of your time. And you’re going to be like, wow, I want more of this. This is awesome. So it’s been a lot of fun, Liz. I, you know, I tell this all the time she quits, she always done, I put pressure on her. I’m like, I can’t do it without her because to look at every aspect that she does from the experience of being a mother of a sick child and her other experiences and her dedication has been amazing. And I can do my job as a doctor and worry about the presentations and the workshops and doing my thing and let Liz handle everything else, which is awesome.

Liz Poret-Christ (42m 12s):
I would just add that. I never thought a pandemic could have helped drive our ambition even further than it did because when COVID hit, you know, we couldn’t go into hospitals and we couldn’t do our training. And very early in, I would say, March, I called Tony and said, we need to pivot. And this is some ideas of how, what do you think? And as we do with everything, we go over it, we take it apart. We dissect it. We figure out the best way that we can do it and put our spin on it and his vision. And we rearranged our entire company. And when Tony said, I want to start a podcast, I was like, we really need something else we need to do, but okay.

Liz Poret-Christ (42m 55s):
You’re the visionary. Okay. I have complete faith that if you think this is a good idea, we’ll do it. And it’s been so amazing. I was never really a podcast listener before, but I find that you can just be so productive and get so much from a podcast at the same time. Like I can walk four miles and listened to an amazing podcast and like just multitask my brains out. It’s amazing. And we changed all of our training to be virtual. So if there’s a client that’s too far away, we can address those needs now, too. And that’s been something that I don’t know if we would have been shoved to do that before, but so grateful that we’ve been able to pivot in that way.

Liz Poret-Christ (43m 35s):
And I think it’s only helped us become stronger. So it’s been, it’s such a great journey. I couldn’t have asked for a better job.

Peter Winick (43m 42s):
Well, this has been great. I want to thank you both. You’re both heroes and doing amazing work and we just gotta get more of an out there to more people every single day, as many formats and modalities as we can to change the world for the better. So thank you both.

Dr. Anthony Orsini (43m 56s):
Thank you. And if you’re having someone that you want, you think would be great for this podcast, talk about difficult conversations. Let us know that the Orsini way.com you can email Liz or I, and just, we’re going to keep moving forward. It’s been so much fun. Thank you, Peter. Okay. If you liked this podcast, please go ahead and hit follow. It’s no longer subscribe on podcasts. There was too much confusion on my understanding is that people thought they had to pay when they hit subscribe. So now it’s the follow button for podcasts. We’re on apple, Amazon, Google, you name it. We’re on everyone. If you want to find out more about what we do, just go ahead and visit us at The Orsini way.com. Thank you everyone. Thank you, Peter. Appreciate it. Well, before we leave, I want to thank you for listening to this episode of difficult conversations lessons I learned as an ICU physician.

Dr. Anthony Orsini (44m 43s):
I want to think The Finley Project for being such an amazing organization, please, everyone who’s listening to this episode. Go ahead. Visit The Finley Project.org. See the amazing things they’re doing. I’ve seen this organization literally saved the lives of mothers who lost infants. So the find out more go to The Finley Project.org. Thank you. And I will see you again on Tuesday.

Announcer (45m 7s):
If you enjoy this podcast, please hit the subscribe button and leave a comment and review to contact Dr. Orsini and his team, or to suggest guests for future podcasts, visit us@theOrsiniway.com. The comments and opinions of the interviewer and guests on this podcast are their own and do not necessarily reflect the opinions and beliefs of their present and past employers or institutions.

Advocating for Rare Diseases with Dr. Marjorie Dejoie-Brewer

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

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

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

This is the podcast for you.

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

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

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

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

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

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

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

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

We might have to have you back.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Some advice on how to navigate that particular company?

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Medical Liability and Risk Management

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

How Do You Define Your Self Worth

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Taking Care of Our Own - True Nursing Leadership

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Fierce Conversations with Susan Scott

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Burning Shield - The Story of Jason Schechterle

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Medical Justice and Malpractice

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Re-Invent Your Life with Kathi Sharpe Ross

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Kathi Sharpe Ross (12m 42s):
So it wasn’t as eas