Difficult Conversations Podcast
Lessons I Learned as an ICU Physician
Episode 171 | May 16, 2022
Communication IS Care with Jennifer George
Award-Winning Author, Speaker, Podcast Host
Welcome to Difficult Conversations with Dr. Anthony Orsini. Today, we have another incredible guest joining us that I know you’re going to love. Jennifer George is an award-winning author, speaker, podcast host, and compassion-focused physiotherapist, with a lot of experience in the private and public sectors of care. She became a caregiver to her chronically ill father and it was this personal experience of witnessing his journey through the healthcare system that shaped her professional practice. She has spent the last 14 years learning and reflecting on the importance of communication in our health and educational systems. Jennifer is the host of the Healthcare Provider Happy Hour Podcast and the author of Communication is Care: 9 Empowering Strategies to Guide Patient Healing. Jennifer is also a mentor to future and current health providers on discovering their purpose, achieving fulfillment, and creating an empowering patient experience.
As always we start off with Jennifer sharing her remarkable story about taking care of her ill father. We hear her journey of how she became a patient advocate, and how it blossomed into writing her book. Dr. Orsini talks more about how in healthcare, we tend to confuse the term communication with the term information. We discuss Jennifer's book in depth and her philosophy which sets the tone; - “In a lot of ways, my patients have lost their sense of identity. They have gone from living life on their terms to living life within the framework of the health care system.” Jennifer discusses in depth each of the 9 Empowering Strategies to Guide Patient Healing.
Dr. Orsini shares a funny story about his cousin who had to be savvy at a doctor’s office and tells us that Jennifer’s book reminds us that as a provider, you can make a difference and choose not to let any system or any pressure from the outside stop those special moments that you have with your patient. We end with Jennifer sharing the most difficult conversation she had in her life and advice on how she navigated through it.
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Jennifer George (1s):
For me, I ended up being on both sides of the system and it was always conflicting for me because I was a strong advocate for my dad. And then I was on the other side, treating patients and deeply empathizing with providers and the complexity of our own barriers as healthcare providers working in the system as well. But I think one of the biggest things is the navigational piece that we as providers, we don’t even in schooling, like we’re not even taught about stuff like that. That’s a part of the care and expressing that and guiding our patients through that is a big piece of the care that I think we just don’t realize how valuable it is and how much stress it can take off of someone’s plate, patient or caregiver.
Jennifer George (46s):
Cause a lot of our frustration came from, from that.
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, I am honored today that the Orsini Way has partnered with the Finley project to bring you this episode of Difficult Conversations Lessons I Learned as an ICU Physician. The Finley Project is a nonprofit organization committed to providing care for mothers who have experienced the unimaginable, the loss of an infant. It was created by their founder, Noelle Moore who’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 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 29s):
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 families 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. Well, today we have another incredible guest, someone who I know you’re going to love. I know that when I met her a few weeks ago by zoom, we hit it off and it was just a great conversation.
Dr. Anthony Orsini (3m 11s):
So I expect the same thing today. Jennifer George is our guest today. She is an award-winning author, speaker podcast, host and compassion focused physiotherapist, who has a lot of experience in the private and public sectors of care. At the onset of her career she became a caregiver to her chronically ill father. And we’re going to talk about that today. And it was with this personal experience of witnessing his journey through the healthcare system that ultimately shaped her professional practice. She has since spent the last 14 years learning and reflecting on the importance of communication in our health and educational systems. As I said, she’s a fellow podcaster, the name of our podcast is called healthcare provider podcasts.
Dr. Anthony Orsini (3m 52s):
It has more than 160 episodes that have been recorded. And when I heard about her book, titled Communication IS Care nine Empowering Strategies to Guide Patient Healing. I just knew that I had to meet her. Jennifer is also a mentor to future and current health providers on discovering their purpose, achieving fulfillment and creating empowering patient experience. As I said, she and I had a great conversation a few weeks ago and I know you’re going to absolutely love this. So Jennifer, let’s just get started. Let everybody meet you. How are you today?
Jennifer George (4m 22s):
Hi Tony. Thank you for having me. I’m great. How are you
Dr. Anthony Orsini (4m 25s):
Good, Jennifer comes to us from Canada And I’m all the way down here in Florida, but things it’s a bit of crazy world right now. And as we’re recording this, our hopes and prayers are with the people from Ukraine. And just a moment, there are a lot of those people will be patients and they’re just in our prayers. So Jennifer let’s just hit the ground running here. Let’s start off with, you know, you have a great story. The story is so important to not only who you are as a person, but why you wrote the book. And I know that you were still in school. I think when your father got sick. So tell us the story so we can get to know you.
Jennifer George (4m 60s):
Yeah, so I was in my mid twenties at the time I was doing my masters in physical therapy in London, Ontario. I was in my second year and I have to say like during that time of my life, I really had no concerns. You know, all I had to focus on with schooling. And I was very grateful for that. I was very aware of that. I also was very aware of the fact that my parents were aging. You know, my parents were deep into their sixties at that time where a lot of other people didn’t have parents as old as them. So that was kind of unique for me. And I was the youngest in my family. So I was always appreciative of that. And then my dad started falling ill towards the end of 2006, which was towards the end of my first year.
Jennifer George (5m 40s):
And he started to experience hemorrhaging actually. And we eventually found out that he needed a liver transplant. He had end stage liver cirrhosis and he also had liver cancer. So we knew my dad had been, you know, I middle Eastern and my dad had always gone to his followup appointments for many years by himself or with his brother too, I think has hepatologists from saying it right? So he had liver cirrhosis for many years. He was basically at end stage at 10 years in, so we never knew the extent of it. So when he recovered post hemorrhage, so when they bandaged his esophageal varices and he was back to his usual self, you know, we were happy.
Jennifer George (6m 20s):
We just thought, okay, this was, this was all it was. And then I’ll never forget when I was sitting on the, his bed at the hospital. And the hepatologist kind of said to me, you know, this is going to happen again, you know, basically needs a liver transplant. So he continued to hemorrhage three or four times after that. And due to his age, they were reluctant to do the liver transplant. It wasn’t really recommended because he was older than the average candidate. But again, I’ll never forget my dad saying in front of the social worker, we were all sitting around like kind of in a conference type setting. And he said, you know, you’re just going to send me home to die basically. So he saw his fate when he was getting sicker and sicker. And so we advocated strongly.
Jennifer George (7m 1s):
We knew that the liver was the only thing that was his issue. And they decided to actually assess him. So they did preop testing and they listened to us, which was awesome. And they deemed him capable of being on the transplant list. So we were excited. We had more hope now. So this was February now, 2007 fast forward. And my dad finally gets the call that there’s a matching liver. So I am in London, Ontario, and he’s going to have his transplant in the same city, which was a couple hours away from my hometown. And the expectation for me was, okay, great. He’s going to have his liver transplant. He can stay with me in my apartment as an outpatient for a few weeks afterward and life will be back to normal again.
Jennifer George (7m 46s):
So he basically was going into the surgery and my dad was always kind of prophetic. He always had some kind of intuition about him and he came across as being funny in the moment, but he basically said, is this liver good? Cause I don’t want to do this again to the physician. And the physician said, well, Mr. George, you know, you always have a choice. And we really didn’t feel like we had a choice in the sense that time was of the essence for him because he was getting sicker and sicker. So obviously we consented, he consented and he got through the transplant like a champ and I’ll never forget my sister and I checking in on him after the surgery. And he looked up at us and with relief in his eyes that he had finished the surgery and got through it.
Jennifer George (8m 29s):
And then he closed his eyes and he didn’t open them again after that. So we eventually realized that he was going into multiorgan system failure and then he ended up being on the top of the nationwide list. And I’ll never forget I was home studying for an exam, praying and crying and knowing that my dad’s life was in the hands of medical professionals. And then God really at this point, so praying for a donor, finally one did through that evening and he had surgery the next day. And he got through that surgery stable, but critical. And yeah, from then on, we found out I, I was getting ready for school one day after that. And I found out he had a seizure.
Jennifer George (9m 9s):
And so being a physio school, knowing that that’s not a good sign. Now we’re dealing with the neurological issue, not knowing it then, but that it would end up being an actual, severe neurological disorder, a seizure disorder that they thought was maybe just from my hypoxic brain injury, because he was so sick. They clearly didn’t know the reason. So now neurology becomes involved. And at this point we’re encouraged to take them off life support because there was no neurological activity. So we went from being hopeful right to morning. So it was this roller coaster of emotions on the caregiving end of things, and on the family end of things. And thankfully my dad’s transplant surgeon was in that discussion with neurology because he was able to advocate and say that the liver was doing well.
Jennifer George (9m 56s):
And to give it a little bit more time. So that’s thankfully what we all agreed upon. And later that night, he started to show signs of, of neurological improvement. And I was with the neurologist at the time, looking at the EEG. And he literally said to me, this was remarkable. He had never seen anything like it, that my dad’s story should be documented and little did I know back then in ’07 that I would be documenting it 12 years later. Right. But yeah, all of these events were transpiring and not knowing that this was kind of my future in healthcare in a way too. And I was learning along the way outside of my own schooling. So we went back to being hopeful again, but we were, you know, it was a lot of highs and lows from that point onward, his recovery was very slow.
Jennifer George (10m 40s):
We were told many times that he would never be able to walk, talk, eat, breathe again on his own that he wouldn’t know who we were. So he literally was in the hospital for a year to the day of his surgeries and he eventually made it home. So he came home. My mom took care of them. And then I moved home at the end of my schooling and not the onset of my career to be a caregiver as well alongside my mom. So
Dr. Anthony Orsini (11m 3s):
No, the universe or God or whatever you want at the end, it pushes us in different directions. And there is a plan and things happen. And as we speak, you don’t know this today’s March 1st, as we’re doing this interview, we have a dear family friend who’s been waiting for a liver transplant for over a year and a half. And my father called me at 10 o’clock this morning and said, Marcelo is on his way to Jacksonville. And they called them and he’s got so many hours to get here. And so our prayers go out to Marcelo. Who’s probably right now this minute, getting a liver transplant.
Jennifer George (11m 39s):
Dr. Anthony Orsini (11m 40s):
The irony of the timing is, is amazing. Truly, Jen, you said something that really, really hit home with me because there were certain things that you, you had to navigate this very complicated medical experience with your father. And now you do what you do and you can really call both of us patient advocates, right? I mean, that’s basically what we do and be the advocate. That’s not to say that sometimes giving up and letting someone peacefully go is the right thing to do. But there’s certain times where you have to be the advocate and it’s a complex medical system. And I don’t see how the average person can really navigate through this thing.
Dr. Anthony Orsini (12m 23s):
You know, I have a personal story. My mother-in-law many years ago, 20 years ago had endocarditis. She had a bunch of blood clots after a dental procedure. And my wife came back and this was one of the best hospitals in the world in New York city. And my wife came back from seeing her and she was crying and I was playing baseball in the yard with my oldest son. And I said, what’s what’s wrong? And she said, well, the cardiologist said that she’s got severe clots on her valves and that operating would be too dangerous and that she should just go home and wait to have a stroke. That was the, okay. So talk about poor communication and that there was nothing to do. And I said that, you know, that doesn’t really make sense.
Dr. Anthony Orsini (13m 5s):
It’ll let me pick up the phone and make a few phone calls. And luckily those of us who are in medicine, you know, let’s face it. Somebody who’s more likely to take my phone call. And I say, I’m a doctor, right? And I called the doctor and I won’t say his name. I called the chief of cardiothoracic surgery at this hospital and extremely impressive. And he was like 40 years old and already the chief of, you know, an ethanol, I’ll go take a look at her. And he went over, he called me back about an hour later. And he says, yep, we’ll book your mother-in-law for surgery tomorrow. And I said, I’ll never forget this Jenn, the cardiologist said it wasn’t operable that it was too dangerous. And he said, not in an arrogant way because you know, some people would come up.
Dr. Anthony Orsini (13m 49s):
His answer was, it is for almost everyone, but for me, it’s not. Wow. Normally you would say that sounds really arrogant, but he didn’t say it arrogant. He said it in that, in a confidence that made everyone feel great. And that really is what advocacy has now. I had a little bit of advantage being a physician, but there are people like you, or even though you weren’t in medicine, still in school, but the take home message, I think for this whole podcast is how to be an advocate, right? I mean, how do you navigate? And physicians are compassionate people, but the healthcare system is so fragmented and so broken.
Dr. Anthony Orsini (14m 31s):
And you know, you have at least in the United States, hospitalists who are in charge of your care for 24 hours and six or seven different specialties. And nobody’s in many ways, there’s nobody keeping track of, you know, the hospital says, well, this doctor said this, and then you go, well wait, but the other specialists, and then they look at you like, oh, I didn’t know that. So just start your journey of, of learning, how to be a patient advocate. And how did that blossom from how taking care of your father to writing this amazing book that we’re going to talk about?
Jennifer George (15m 4s):
Just to kind of talk about what you just mentioned there as well about advocacy. My dad, when he came home. So 2008, he was his sharpest. So we meet like just right after he came home and he vividly remembered that second surgery. He recalled memories of doctors saying, let him go, it’s time to give up on him. And then he remembered one specific doctor who I’m sure I knew who it was. His transplant surgeon, like the head of it. The team basically said, no, we have to keep going. We have to keep going. And my dad actually remembered that. And it was just kind of phenomenal to hear that. And you do hear stories of people being in surgery and kind of being aware to those conversations that are happening.
Jennifer George (15m 47s):
But that speaks to his spiritual sense too. In a lot of ways, my dad was very in tune and people didn’t know that side about him. And I think his story was so powerful. And along the course of his chronic health journey, we had 11 years longer than anybody ever expected. We would have, he was literally named Lazarus by his team because he literally like, no, they really can’t medically explain his recovery. And, and I love that they don’t try to in a way, right. And they all had a hand in it, but they don’t say it was just all medicine, right. Because my mom was a big, a big advocate too, just as much. So for me, I ended up being on both sides of the system and it was always conflicting for me because I was a strong advocate for my dad.
Jennifer George (16m 30s):
And then I was on the other side, treating patients and, and deeply empathizing with providers and the complexity of our own barriers as healthcare providers working in the system as well. But I think one of the biggest things is the navigational piece that we as providers, we don’t even in schooling, like we’re not even taught about stuff like that. That’s a part of the care and expressing that and guiding our patients through that is a big piece of the care that I think don’t realize how valuable it is and how much stress it can take off of someone’s plate, patient or caregiver. Cause a lot of our frustration came from that. Like you said, nobody communicating with each other, just things were so siloed and you’re repeating the story over and over and over again.
Jennifer George (17m 16s):
And in healthcare we think technology is going to solve all of this, but kind of like you said, it’s still hasn’t happened. It’s, they’re still human beings operating the technology.
Dr. Anthony Orsini (17m 25s):
That is a great point. And it’s a point in a lot of my workshops. And in healthcare, we tend to confuse the term communication with the term information and that we want to improve communication medicine. And we try to do that with better medical records, better systems, better healthcare records when actually it’s this subtle points of communication that you and I speak about. That’s human to human. Information is great and we need to have our lab values handy immediately and have everyone’s health records and on computers, but it’s really a human, the human art medicine, right? Yeah.
Jennifer George (18m 5s):
And if no, one’s conveying that information in a way that is compassionate or in a way that’s timely or in a way that gives patients the time they, they are looking for it kind of gets overlooked even by the patient or unheard in a way.
Dr. Anthony Orsini (18m 18s):
Absolutely. Let’s talk about your book. I was only into, I’m going to say the first few pages, you, maybe you even know what pages and I wrote down, something that you put that is so profound that really sets the tone for a book. You said In a lot of ways, my patients have lost their sense of identity. They have gone from living life on their terms to living life within the framework of the health care system. That is profound. Can you elaborate on that?
Jennifer George (18m 46s):
I got goosebumps. Yeah. I work on an inpatient rehab unit. Like you mentioned at the beginning with respect to my bio, I’ve worked in private practice. I worked in community and you know, going to people’s homes and I’ve also worked in long-term care. And in every situation there tends to be a loss of identity, even if the patient’s not in the hospital environment and they’re in their own home, they’re still operating within the framework of the healthcare system from their own home. And so I think it’s really important. And I think that’s where we have to start with empathizing more or about imagining the possibility of being fine one moment and completely losing independence in some way. And having to now rely on strangers essentially to guide us back to recovery.
Jennifer George (19m 31s):
And that’s just life changing. It’s not about the diagnosis so much, but about the change of life that’s just transpired.
Dr. Anthony Orsini (19m 39s):
It’s very easy for us. We, as healthcare providers to start to, as I always say, become task oriented and that’s the kidney failure in room 312, and the liver failure here and the pneumonia in 316. And there’s been many books written about, you know, when the doctor or the nurse becomes the patient. And all of a sudden, now you are the person sitting in the bed with your butt hanging out of the gown and 16 people coming into your room. And it’s a big difference. And I think that we all start off remembering that, but every day I tell my physicians that I’m coaching and the nurses every day, you’re going to become task-oriented at one point in the day, it’s just a matter of how quickly you can catch it before you go onto too many patients.
Jennifer George (20m 28s):
Yeah. That self-awareness is huge. And then yeah, people become a bit depersonalized because of the influx of all the task demands that they have to do. And so referring to people by their diagnoses, like you said, or their room numbers sometimes in the hospital and just forgetting about the person in front of them, which is all that matters. And I know that’s hard to do. I know that as a provider, I know that’s really hard to do, but my goal with this book was just to more or less ground providers and, and understanding that they are doing enough and that they’re doing the best they can by attending to the person that’s there and right in front of them in that moment. I also think too, like we’re so conditioned to know so much.
Jennifer George (21m 8s):
And even I struggle sometimes with being on an inpatient unit, again, operating within the system and patients having a limited time with me knowing how much potential they have or the recovery that they have in store and not being able to completely fulfill that. I sometimes take personally, but yet I have to remember that I too am, am limited by the system and that I am doing the best I can, you know, within the framework that I have to operate in as well. And so that’s kind of the purpose of the book when it speaks about purpose and just kind of in reflection and things like that is just kind of understanding those pieces and at the carrier providing in the moment is the most critical.
Dr. Anthony Orsini (21m 50s):
Let’s talk about the book and what I’m going to do is you have the it’s called nine Empowering Strategies to Guide Patient Healing. And so if you don’t mind, we’ll take just a few minutes and we’re going to go down each strategy. Is that okay? Let’s talk about that. Okay. So the strategy one define and align your purpose.
Jennifer George (22m 7s):
Yes. So defining and aligning your purpose is more about you. So the way that the book’s written is it starts with the provider basically ends with the provider in mind. So kind of being more self-aware of your health needs at this point in your career, if you’re starting to feel unsettled, if you’re losing a sense of self, we know that burnout, moral injury, those can all lead to increased patient safety risk. And ultimately if we’re not feeling aligned, chances are that we have to kind of check in with ourselves. And if we’re fortunate enough to work with an organization that also checks in with us, you know, it could even be better by doing that as well.
Dr. Anthony Orsini (22m 44s):
Yes, absolutely. And sometimes we forget why we’ve gone into medicine in the first place and remembering that is huge in helping us stop burnout and moral injury, et cetera. Okay. Number two, practice with compassion, empathy. That’s my favorite.
Jennifer George (22m 60s):
So empathy really is, from my perspective, it really is just trying to understand your patients, emotions, experiences, thoughts, perspectives. And for me, it starts from before I even meet them. You know, I kind of have a picture in mind by reading their chart by kind of getting as much information as I possibly can and then meeting with them and validating all of that and then empathizing validating where they’re at. But then also being cognitively aware enough to know that I’m there to help them and to then offer the solutions compassionately as much as possible. You know, sometimes if we can be too empathetic, we can become less objective and overly consumed and that can lead to burnout and compassion fatigue as well.
Dr. Anthony Orsini (23m 43s):
So we had Helen Reiss, one of our early guests, who’s really an amazing person, does a lot of work with empathy. And as you said, empathy is understanding someone’s pain, compassion kind of brings it to the next level. As most people would say is where you’re actually feeling the pain. And, you know we always say, the difference is empathyExactly, plus imagination equals compassion. So like once you take that understanding and really feel for the patient, and you said, you have to be careful, but it’s, it’s a healing art and you have to be compassionate. So again, stop being task oriented. Right?
Jennifer George (24m 16s):
Yeah. The story is so important to me. It’s just the narration that matters most
Dr. Anthony Orsini (24m 21s):
Love that. All right. Number three. Listen, presently love that. And completely.
Jennifer George (24m 26s):
Yeah. So this is really about what you’ve been saying about not being so task focused. It’s so hard when you’re in the presence of a patient and you’re thinking about the next person who’s coming, but that is easily sensed by our patients. They can tell when they don’t have our full attention and that’s where communication does break down sometimes as well. So really being present is a big part of that asking questions, being engaged. It’s okay. To be honest and truthful. If somebody is waiting for you in the waiting room, let them know that you’re going to just check in on that person. You’ll be right back to give them the attention that they need, rather than like you said, just being so task focused.
Dr. Anthony Orsini (25m 1s):
We had also another guest, Colin Smith, who goes around giving classes to people on how to listen. They, they actually, his nickname is the listener, which is interesting. And he said in the podcast that most people listen to create a response instead of just listening to understand. And we do that all the time. That’s a skill that whether you’re just for your life, just in personal life, our minds are everywhere and now we have technology and oh my God, does it drive me crazy when I’m talking to one of my children and they have their head down on the phone, like look at my eyes. You know,
Jennifer George (25m 41s):
That’s one of the things for me that I’m aware enough to know is probably one of the hardest things for me to communicate on essentially is, is being an active and engaged listener. It’s just, yeah.
Dr. Anthony Orsini (25m 51s):
Electronic medical records. I’ve made that really tempting, not to look at someone and we’re missing 70% of communication because it’s body language. You’re not going to pick up someone’s body language. If you’re typing in the EMR,
Jennifer George (26m 3s):
Exactly, It’s so frustrating.
Dr. Anthony Orsini (26m 4s):
So take the time, be in the present and listen completely. I love that. Number four guide from a place of dignity
Jennifer George (26m 13s):
From integrity. Yeah. So integrity for some people can be a way of living in this context. I’m also talking about that, but acting from your moral compass, essentially from your ethical compass and doing what’s right. Even if sometimes that’s difficult to do, because I do think patients are always watching us, even if we’re not in their direct view. I think they’re always observing. They see us more than we see each other because they’re especially in a hospital they’re there 24 hours a day. So they kind of make those comparisons and they see who’s setting a bar in some way and acting out in guiding out of integrity. So it’s really just doing the right thing based on your moral agreements, essentially.
Jennifer George (26m 54s):
And patients taking wind of that too.
Dr. Anthony Orsini (26m 57s):
You are definitely being watched. Neuroscientists tell us that your brain is looking at 30 million times per second is assessing someone’s body language. And so when we’re walking around the hospital and also patients are sitting in a bed with really nothing else to do, but listen to what’s going on in the nurses station. And so we have to be careful. We’re always being watched. That’s great advice, strategy, number five, empower patients to be their own advocates. We talked about that already,
Jennifer George (27m 25s):
Dr. Anthony Orsini (27m 25s):
Many people can’t be their own advocate. Right? We need Jennifer’s and
Jennifer George (27m 29s):
Yeah. And that’s the biggest thing. I think, as healthcare providers, if we could adopt the mindset that we’re stronger patient advocates, I think we would be able to empower patients to be their own advocates more. I think we have to kind of get out of our own heads a little bit and not think that people are always looking for fault in us or that people are criticizing us because I think that’s just our own self-talk as well. I think that if we are aligned with our purpose, if we are compassionate and empathetic, I think we’re more prone to empower patients, to be their own advocates of care, to involve them in their plans of care. Going through my dad’s journey. A lot of times we were seen as barriers as caregivers rather than facilitators.
Jennifer George (28m 11s):
And that was probably one of the biggest lessons I learned going through my dad’s personal journey was that caregivers are facilitators of care. Most oftentimes. I mean, just the communication around all of that as well as super important.
Dr. Anthony Orsini (28m 24s):
Yeah. We know that when there’s an improved patient experience or when a patient really feels a strong relationship and trust their healthcare provider, they’re more likely to follow directions are more likely to, and have better outcomes. And so first before you even start, make sure you have some trust in the doctor and the physician and the healthcare system that you’re in. People ask me all the time. What do you think about this? You know, as a doctor, but he’s always asking me people, relatives and friends call me up from different states. You know, what do you think? And I, I generally answer them. Do you trust your doctor? And if you don’t, that’s fine. Find another one, but you got to find one.
Dr. Anthony Orsini (29m 5s):
You want to be your own advocate, but you can’t fight every little thing either. There’s gotta be some trust. I think that’s on us as the providers. We have to build that trust. So that’s great advice. All right. Strategy, number six, focus on solutions, not barriers
Jennifer George (29m 20s):
It’s, you know, from my experiences. Anyway, my patients are often focused on barriers and understandably because of what’s happened to them. And oftentimes it’s difficult for them to see, even though their goal might be to become more independent. Again, for example, it’s hard for them to put that together and see that actually happening. So that gets in the way of their progress as a physio. Part of what I do is guide patients along, focusing on the next step, the next solution at that time, rather than overwhelming them with the big long-term goal, which is ultimately what they usually have, but maybe even breaking that down a little bit in a way that’s more digestible and realistic in a way that kind of ensure success as much as possible.
Jennifer George (30m 4s):
So I think it’s so important to have that mindset going into any patient care scenarios that there’s always hope. And that there’s always a solution. Somewhere.
Dr. Anthony Orsini (30m 14s):
Glass is half full kind of thing. All right, we got three more strategies, seven create a safe therapeutic environment.
Jennifer George (30m 22s):
So if you consider the patient experience, it really is from the moment they engage in the health care system. Like from the moment they schedule from the moment they meet the front desk staff to the moment they actually get admitted. Let’s say until the moment they’re discharged out of the system, all of that is super important. And along the way, patients need to feel safe. And most recently I had a patient who had a lot of things in her room and anytime a staff member would say like, you don’t need all this stuff here. For example, she would say, well, this is what makes me feel safe. I was quite proud of her for using that word. Very rarely. Do you hear a patient say that like that that’s something makes them feel safe or not safe? So just even being understanding of that, like to me, that’s something small that could help improve the trust tenfold, right?
Jennifer George (31m 8s):
And their adherence to care and ultimately their outcomes as well. So anything that you could do to create a safe environment matters, personal touches. I like to do at the beginning of the session at the end of the session. So for instance, you know, asking if they want the blinds down and let’s say they have a headache, for example, and the sun is beaming, something like that, or at the end offering a glass of water or offering to plug in their phone. Anything like that, I think goes a long way in creating safety in an environment that is so unfamiliar.
Dr. Anthony Orsini (31m 39s):
That’s great advice. Number eight, prevent unnecessary conflict. And that’s one that we all want to try to do,
Jennifer George (31m 46s):
Honestly, there’s, I don’t know if this is kind of that slightly cynical side of me, but I do see conflict come before it tends to grow bigger and bigger. That’s one of the things that I can say about myself, but is a strength of mine. So something so simple, like scheduling, for instance, like that could go such a long way in minimizing a complaint down the road, whether you have to reschedule someone or whether you’re giving them a notice that, you know, you’re delayed or whatever it might be having patients be involved in the plan of care. That way I think is super important. We can’t prevent all conflict. Conflict is inevitable, but if there are ways to minimize it, and like I said, if you foresee it coming, I highly recommend that you intercede as much as possible rather than expecting another provider to take care of it.
Jennifer George (32m 32s):
Just go ahead and get the ball rolling, because you really can save a lot of time and energy and, you know, present a complaint down the road.
Dr. Anthony Orsini (32m 41s):
And we also don’t educate our nursing leadership, physician leadership or any of the healthcare providers, what to do when there is that conflict. As you said, there’s going to be some conflict. If you handle it right, it’ll deescalate quickly and handle it wrong. And in my journey, I’ve met so many people who don’t know how to handle the conflict, maybe just their body language or the way they approach it, et cetera. But it also starts with trying not to have that conflict, you know, can we make things easy, a quick story. I’m a storyteller. So I have a cousin who has a child. Who’s now an adult and he’s severely autistic. He had cardiac issues. He’s had multiple cardiac surgeries.
Dr. Anthony Orsini (33m 23s):
She has learned to work the system and not in a bad way, but in a good way. She knows how to be the advocate for her son. She knows when things don’t make any sense when the system is in the way. And so she went to see a gastroenterologist at one of the children’s hospitals many years ago, and the gastroenterologist said, okay, we’re going to schedule your son for a colonoscopy. You know, you have to schedule it. So she said, fine. So she’s walking out and she’s in this big clinic and the woman behind the barrier, she said, I’d like to make an appointment for the colonoscopy. And the woman tells her what you have to do that by phone. And she says, but I’m here. Can I just do it now?
Dr. Anthony Orsini (34m 3s):
So the woman just kept insisting that she has to do it by phone. And so being very savvy, my cousin said, well, what number do I call? And she gave her the card and she said, call this number. And so without getting out of line, my cousin picked up her cell phone and called the number and the woman right in front of her answers the phone. And she said, I’d like to make an appointment for a colonoscopy. And the woman goes, okay, no problem. Just a funny story that, you know, but she had to be savy, right? She has to know the system. So
Jennifer George (34m 37s):
Good for her
Dr. Anthony Orsini (34m 39s):
The woman had no problem with picking up the phone. She saw her who was, you know, it was just kind of laughed. And she said it and the afterwards the woman that goes, yeah, that is kind of a dumb rule. Isn’t it? She says you think,
Jennifer George (34m 50s):
Okay. So, I mean, I can empathize with maybe the clericals, we’re all in not being able to take it any other way, but I don’t know. I probably would’ve probably would have broken the rules a little bit if it were me.
Dr. Anthony Orsini (35m 0s):
Exactly. All right. The last one is strategy number nine, reflect and grow with impact.
Jennifer George (35m 6s):
So reflection is a huge part for me. It’s always been, I’ve always been a writer. So for me, writing has always been powerful and healing for me. I wrote my book, you know, in healing and mourning for my dad, basically. But as providers, I think it’s so important to reflect non-judgmentally on our own practice and sometimes doing this alone, whether you’re writing, whether you’re just thinking about it, but also debriefing I think is really helpful too, with staff. And we don’t get the opportunity to do that much in our practice. You know, we’ve seen that that has a positive impact on burnout and communication overall, but yet many organizations just don’t do it. But I think that reflection kind of reinforces purpose again on an individual level and kind of helps you reconnect with that as well.
Jennifer George (35m 50s):
And kind of the whole idea behind the book is kind of build all that up. So the more you, you reflect, you become more purposeful and then you start to be more empathetic, more compassionate. You listen better, you empower more, you see conflicts coming before anybody else potentially, and kind of intervene and then focus more on solutions along the way too. So that’s kind of how it all supposed to is connect together. And that’s the flow of it from when I envisioned writing it.
Dr. Anthony Orsini (36m 19s):
Well, it’s very, well-written easy to follow you. You bring up a lot of points and to all the healthcare providers out there, you’re all very special people. No one goes into medicine just for the money. I truly believe that no one goes in, certainly physiotherapists don’t do it. So now we’re not making a million dollars, but no one goes into medicine. I really think 99.9% of all healthcare providers go into medicine for the right reasons. We have hearts of gold. We want to help. And sometimes we just feel helpless because we can’t make a difference. The book reminds you, I think, as a provider, that you can make a difference. You are making a difference. You’re a special person just by virtue of what you do.
Dr. Anthony Orsini (37m 2s):
And don’t let any system, I talk about this in my Ted talk though, that any system or any pressure from the outside stop, that precious moments that you have with your patient, because that’s, what’s going to make you feel whole and improve patient experience. So I think the book really outlines that really, really well. And it’s no wonder that you did such a great job with a book because you know of your father and, and what you went through. And it really lends credibility to what you’re saying, because you’ve been there. And so thank you so much. It was just a wonderful read when that’s available on Amazon, right?
Jennifer George (37m 39s):
Amazon, it’s pretty much available anywhere. If you Google Communication IS Care, but Amazon’s probably are your most accessible.
Dr. Anthony Orsini (37m 46s):
And we’ll put that all in the show notes. All right Jennifer, we end up with this last question all the time. Some of my guests give me dirty looks when I asked them this, because I didn’t prepare, I did prepare you. I gave you 15 minutes, give you five minutes. We do pre-interview talks and phone calls and easily. Sometimes I remember to warn people. And sometimes I forget. So for you, I gave you a five minutes notice. So what is the most difficult conversation you’ve had in your life? And please give some advice on how you were able to navigate through that.
Jennifer George (38m 17s):
I think the hardest, but yet it was a quick conversation. So when my dad’s first surgery failed, because there was concern about the risk and his age and everything like that, it was really important for me to know if it was the liver that failed my dad, or if it was my dad’s body that failed the liver, essentially the liberate come from a non heart beating donor, which wasn’t commons so much back then anyway. So they were just hoping that it would kind of soften it as body. That’s what they were expecting when they did the surgery, but that didn’t happen. So I’ll never forget when that second surgery happened and he got through it critically and stable, but he was quite sick and I’ll never forget my dad surgeon just giving us that news.
Jennifer George (38m 57s):
And I was so fearful to ask this question, but I needed to know if it was my dad or if it was the liver. That meant so much to me to know that I asked the surgeon. I said, you know, I just have one question. Was it my dad? Or was it the liver that failed? And, you know, made him have to go through the surgery all over again. And I’ll never forget the surgeon put his head down. He was the kindest, most empathetic, compassionate person put his head down. You could tell, he felt awful. And he said it was the liver. You could just tell it. And you just saw that human side of him. And it broke my heart because it was just luck of the draw, essentially, that that had happened to him. But it meant so much to me that he was so honest about it. And he was just truthful and why it happened.
Jennifer George (39m 39s):
It made the trust in him, even greater from our family and trusting in his care along the way he went on to advocate for me, I failed my first physio exam because I had been by my dad’s bedside all the time. My focus was not on my licensing at the time. And he advocated for me to rewrite it because he had known what we were going through as a family. And I think that is just, I just, I don’t know. I’d never met anyone like him. So for me, that, that went a long way. So it was a hard conversation to have because I wasn’t trying to blame, but I, it was just something that I needed to find peace with and knowing that,
Dr. Anthony Orsini (40m 13s):
Well, there’s a big teaching point in that story and that the physician could have become defensive, worried about you getting angry that you gave my father a bad liver, et cetera, but the manner in which he said it, you saw that compassion. You saw the empathy, you saw an. It actually brought you closer to
Jennifer George (40m 33s):
Dr. Anthony Orsini (40m 35s):
That is a huge teaching point, right? There is that, you know, medicine is physicians and nurses and physiotherapists. We’re not perfect. And sometimes we have to say, you know, we have to admit, but most patients will understand when things don’t go well, as long as it’s coming from your heart, Great teaching point, Jennifer, thank you. This has been a lot of fun and I’ve become a big fan of yours. And I really appreciate you taking the time to come on here. What’s the best way for people to get in touch with you. We talked about your podcast. We’ll put that link in. What’s the best way for them to get in touch with you.
Jennifer George (41m 10s):
So I would say the best way is just to go to my website. It’s Jennifer, George dot co, and all of my social media contacts, my podcasts, my book, all of that stuff is connected to there
Dr. Anthony Orsini (41m 21s):
Fantastic. And we’ll put that all in the show notes. If you enjoyed this podcast, please go ahead and hit follow, subscribe, whatever it is now, the different platforms are changing. It it’s all free. Whether you have followers subscribe or on every single podcast you could possibly imagine. If you want to get in touch with me, you can get in touch with me at DrOrsini@theorsiniway.com. Jennifer. Thanks again. Appreciate it. And I can’t wait for my audience to hear this.
Jennifer George (41m 47s):
Thank you so much, Tony.
Dr. Anthony Orsini (41m 50s):
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.
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Dr. Anthony Orsini
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