Conversations About Doctoring

Dr. Bradley Block (1s):
And all you have to do is, it’ll just take a second, take a deep breath or two to show that you can remember that this next patient is the start in the show, whatever you are doing in the last room, running behind, people in the waiting room, phone calls waiting for you. It doesn’t matter. The patient is the start of the show. I take a deep breath and it will help to remind you that they are at the start of the show. It will make the visit more fulfilling for them. It will make the visit shorter they’ll know from the beginning that you have their undivided attention, because you will have their undivided attention and it will make it more fulfilling for you.

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

Dr. Anthony Orsini (1m 17s):
This episode is being sponsored by Veritus. Veritus offers virtual alcohol or drug and trauma treatment programs exclusively for licensed medical professionals. Their programs provide a concierge level of care consisting of evidence-based clinical treatment and are customized to meet the unique needs and challenges of physicians, dentists, pharmacists, and nurses, struggling with substance abuse. Having worked with licensed medical professionals struggling with substance abuse since 1976, Veritus understands how extremely difficult it can be to ask for help because of how severe the stigma is in the medical community around mental health and how real the fear is a potential repercussions from colleagues if found out.

Dr. Anthony Orsini (1m 59s):
Their virtual confidential platform provides a safety and security medical professionals need to get help while continuing to work. Confidential, convenient, and compassionate, Veritus brings world-class treatment to your home or office. To learn more about Veritas you can visit www.Veritussolutions.com. Well, Welcome to another episode of Difficult Conversations: Lessons I learned as in ICU Physician. This is Dr. Anthony Orsini, and I’ll be your host again this week. Today, I am blessed to have another great guest today. My guest is Dr. Bradley Block. Dr. Block is an Otolaryngologist Head and Neck Surgeon in long Island, New York, and a partner at ears, nose, and throat and Allergy Associates.

Dr. Anthony Orsini (2m 42s):
He is also a fellow podcaster. Brad created the very successful physician’s guide to the Doctoring podcast. I subscribe to it and I can tell you that it is engaging, informative and he interviews physicians and non physician experts to help teach us, as he says, what we should have been learning while we were busy memorizing the Krebs cycle. The physician’s guide to the Doctoring is a practical guide for practicing physicians, physicians in training and all allied health professionals. But I would argue that it is equally as important to patients who want to be informed. Topics range from personal finance to politics, to improving interactions with patients. Dr. Block graduated in medical school at SUNY Buffalo, where he graduated with research honors.

Dr. Anthony Orsini (3m 26s):
He went on to complete his residency in ears, nose and throat at Georgetown. Brad lives with his wife and three young sons in long Island where he enjoys surfing, skiing, smoking meat, exercising, throwing his son’s across the pool and finding any excuse to quote an eighties movie. Well welcome, Brad. Thanks for coming today. We really appreciate you taking time out of your busy schedule to talk to us. I’m excited to speak with you as well.

Dr. Bradley Block (3m 52s):
Well, Tony, thanks so much for having me. I’m excited to be here.

Dr. Anthony Orsini (3m 54s):
You and I have so much in common. I talked about it in the introduction, but I can’t move on until I ask you about the eighties movie thing. I’m going to tell you mine. Well, first of all, tell me what your favorite eighties movie.

Dr. Bradley Block (4m 9s):
I’m a star Wars kid. Like I grew up with all of the action figures and everything. So it would have to be Returned of the Jedi ,as much as that’s not my favorite Star Wars movie. You know, I was four when it came out. So I guess that’s my best eighties movie.

Dr. Anthony Orsini (4m 22s):
And you said that the eighties line, so what is your favorite line?

Dr. Bradley Block (4m 26s):
Conan the Barbarian, James Earl Jones character. “I am the wellspring firm, from which you float”. Nobody is going to get that. Nobody is going to get that, but if you’ve never seen Conan the Barbarian directed by Oliver Stone, or maybe produced by Oliver Stone, but his name isn’t on it.

Dr. Anthony Orsini (4m 40s):
Okay. I’m going to tell you mine, mine is Arthur in the movie. Arthur. I think that’s the eighties. My favorite line ever is “she’s the princess of a very small country. It’s terribly small, tiny little country. Rhode Island can beat the crap out of it in a war. That’s how small it is”. My roommate’s and I in college just used to watch Arthur and repeat all the lines before they even say it. I had to get that out of the way. The second thing that I have to get out of the way is you’re in long Island, I’m from New Jersey are you JETS and Mets or Giants and Yankees?

Dr. Bradley Block (5m 12s):
It is 80’s again so growing up with the 86 Mets, I have to be a Mets fan and I’m more of Giants then jets by default. But with that being said, please don’t ask me any sports trivia is because 1986, he was really the last time I watched organized sports except for the Superbowl. We just saw.

Dr. Anthony Orsini (5m 30s):
Okay, great. All right. Which is a great Superbowl I’m down in Florida and a Tampa Bay. So it was a big deal down here. So it’s all. Okay. So that’s enough fun. Let’s move on. Cause I really want to talk about your Podcast. There’s so much to learn from your podcast. And I think what’s really interesting about the podcasts is that it’s about, as you say, we should have been learning when we were memorizing the Krebs cycle. And I think your podcast is great. Not only for doctors and allied health, but it’s also very important to patients because they need to know what’s going on in doctor’s lives. You know, I look this up the other day, according to 2019 statistics, there is 985,000 active physicians in the United States and 550 million individuals.

Dr. Anthony Orsini (6m 11s):
So that’s just goes to show you that ratio and most patients don’t realize all the other stuff that’s going on in a doctor’s life. I mean, we have so much going on in your podcast has several themes. And one of the great things about being a podcast host that I’ve found is that I learn so much. That’s what I love podcasts. I learned from listening to them. I’m always listening to podcasts, whether I’m going to work or driving them for a long drive because it’s like free education, right? I mean, how could you turn that there? That’s why I love podcasts so much, but I’m learning from all my guests. And there’s always these common themes that come up. And now my podcast every other week is one, is health care and one is about business, but the same words keeps coming up. But I talked about this all the time in my podcast, trust, relationships, burnout.

Dr. Anthony Orsini (6m 55s):
These words are all coming in. And when I listened to your podcasts, I look at themes. You have had several episodes on each one of these. So these are Difficult Conversations that we have to have with ourselves in their conversations about physicians. And that’s why I was so happy when you agreed to come on the show. So lets pick a few topics if you don’t mind and lets just, you know, I will let you just talked about what you’ve learned through the conversations with your guests on each one of these topics. And the number one topic that we have to talk about is a physician wellbeing because that’s what we all should care about. Whether you’re a physician or allied health or a patient, I wouldn’t want someone who was was burnt out. And you have done several episodes on physician wellbeing. So just tell us a little bit about what you learned from those episodes and from those guests.

Dr. Bradley Block (7m 39s):
Well, so there’s a lot of discussion about physician burnout specifically. There’s an epidemic of physician burnout, but it’s often described in different ways. And yet there are burnout scales. There are things that psychiatrists use scales that psychiatrists use to measure burnout and define burnout. And I think the psychologist name, maybe a psychiatrist, Christina Maslach, Maslach scale, the way Dr. Maslach described burnout was there a really three issues. There is deep personalization so for us as physicians, we are going to stop caring as much about the patients that we take care of. And so this is important because it is important for patients and patient safety that is in the patient’s best interest for burnout not to be happening because it affects them.

Dr. Bradley Block (8m 25s):
So depersonalization is one issue. Another is emotional exhaustion and this is not something that’s unique to the physicians. In many professions you know, you get home to your family and your kids you are exhausted, but emotional exhaustion is a little different, especially in, especially like yours, where you have so many small children that are just teetering on the brink and sometimes patients die and you have to be able to come to work the next day. And so having things in place that can help us to deal with that and manage that and, and grieve appropriately. So depersonalization, emotional exhaustion and then the last one is the lack of personal accomplishment. And one of my earlier episodes was with Dr.

Dr. Bradley Block (9m 7s):
Sanj Katyal. Who’s a radiologist and he is all about positive psychology and he’s a radiologist. And so one of the problems that radiologists have as much as they might have nice hours and can look at their screens from the beach or whatever the rest of us who are patient facing, you know, imagine what a radiologist’s life was like. You know, they are just grinding through their images with no sense of what’s happening to the patient. So that sense of personal accomplishment they’re really detached from what happens to the patients. Whereas with us who are patient facing, they would get to see that when patients are doing better. And so those three issues, depersonalization, emotional exhaustion and lack of personal accomplishment or all part of that burnout syndrome. And so whenever we’re talking about it and I think it’s critical and whenever addressing it, I think it’s critical that those three things be addressed.

Dr. Bradley Block (9m 55s):
And so whenever there’s some proposed remedy for burnout at your institution, you need to ask the question which of these three things, is it addressing. And if it’s not addressing any of those things, then you need to have a difficult conversation with those who are proposing that you do, whatever it is that they want you to do and find out how it’s addressing that. They might have a totally reasonable answer to it. They might have a plan, they might have an agenda. They just, you know, you’re not sure how it works in there. So I think it’s important to ask the question and situate more out of curiosity. And I forgot which one of my episodes where we talk about that like if you’re ever going to question is superior because medicine is very hierarchical, make sure it’s done in a curious way, rather than a cynical and aggressive way.

Dr. Anthony Orsini (10m 42s):
There’s a point right there for the first communication technique. I learned from one of my guests when they are explaining to you how to discuss the problem with a superior a great phrase is “help me understand”, help me understand why we decided to go this way, which is exactly what you just said. Come from the point of view like not that you wrong, but help me understand. In one of the hospitals that I taught at, they had this big chart for physicians. It was really for nurses burn-out and it was just kind of like tic-tac-toe chart. And it said, these are the things that you should do. If you feel burnt out, it was things like meditation, exercise more or get more sleep. And I was walking by it. I heard a couple of nurses joking saying if I have the time to do all that, I wouldn’t have been burned out in the first place.

Dr. Anthony Orsini (11m 28s):
Yeah. It’s a catch 22, right? It’s very easy to say it don’t work so much. But the thing about physician burnout, which is really interesting is that to the average person who doesn’t stop to think about it is that they think, wow, you know, I’m not going to feel sorry for doctors and they make good money. They are working all the time. They live in these big houses. So why should I feel sorry for a doctor that works too much. And the answer is you really shouldn’t accept that. That’s the last person you want to be treating you, right? You don’t. So you should care about it. We know that as you talked about compassion fatigue, what happens after you get burned out? And I do a whole lecture on that, but your doctor is tired. He or she doesn’t think of you as a real person. They started to distance themselves. The next thing you know, what goes up?

Dr. Anthony Orsini (12m 10s):
Medical errors.

Dr. Bradley Block (12m 11s):
I don’t necessarily agree. I don’t think the onus should be on patients to solve physician burnout. I think the onus is on physicians. And this is something that we talked about in my episode with Jack Cochran who used to run Kaiser. He wrote a couple books on leadership. And so the question that I posed to him is exactly what you said. The nurses were saying, I have no time. I have no time. How can I possibly be on another committee? How could I possibly join some other leadership committee I’m already spread so thin? And the answer is because if you don’t someone else will. And so the onus is on us to solve our problems. Personally, I think in some ways this can help address burnout because it’s like man’s search for meaning.

Dr. Bradley Block (12m 55s):
One of my favorite books. If you’re feeling this despair yet you’re working towards solving the problems that are causing it. I think there’s something to that. And so another episode with Lynn Marie Morski, she talks about quitting. One thing that we do in medicine is we say yes to everything. If you think back to when you were in high school, you were on every committee, you played every sport, you are on every club and you had time for all that. Cause that’s all you are doing. And then you went to college, but presumably did the same thing. And then you went to med school and you’re on all sorts of leadership positions and clubs. And I’m sure you have an extracurricular activities. So every step of the way we just end up saying yes to everything and we get so used to saying yes to everything that this is something else that’s contributing to our emotional exhaustion because now we’ve finished our day rounding in the NICU and we’d like to go home and see our family or play poker with our friends or a pick-up game or something.

Dr. Bradley Block (13m 54s):
But we can’t because we got that committee meeting, we got that other meeting we’ve got that project. Or do we’ve got to write that paper. Because every time we always say yes, and the answer is no, the answer needs to be no, he has to be in it. It needs to be, unless the answer is hell yes. And the answer needs to be no. And that’s actually something that I did in my life recently is I quit everything. I quit all these different committees that I was on in my practice. Not like I was doing that much compared to some people, but I will certainly be doing more than some as well, because I was just finding myself spread too thin. And my family was paying for it or my practice was paying for it and I wasn’t willing to give up the podcasts. So if there wasn’t something that I was going to say heck yes, then the answer was going to be no.

Dr. Bradley Block (14m 39s):
So if you’re finding it and this is where it gets to finding the time to do the things that you really are passionate about. And if you’re finding that you are in despair because of the way the hospital is running X or the hospitals running Y, then do you need to be part of the solution and that’s going to help you again, man search for meaning by finding use in it. You’re just going to help your recovery. And then the question is, how do you go about doing that? How do you even get your foot in the door? And you know, Jack Cochran again, and then another guest, Andy Scott, where are we talked about the keys to the C-suite. How do you get into the C-suite? And the answer is what you talk a lot about is relationships.

Dr. Bradley Block (15m 21s):
Yup. You got to build those relationships. How do you build those relationships? You talked to people and so your job to become a leader, isn’t necessarily going to be the one that has all the ideas, because there are plenty of ideas out there. But what you need to do is you may be, you need to become the conduit of communication between different things. You need to be able to form teams. You have to be able to create allies in that comes to the communications. And one thing I know that I’m terrible at is if I’m in the hospital and I’m rounding, I make a beeline for the patient, goes in the chart right in my note and get the heck out of there because I want to go home. But if you want to be in a leadership position in that hospital, you need to be chatting everybody up.

Dr. Bradley Block (16m 4s):
It’s not a waste of time. When you see someone in the hallway and you start chatting to them, that is relationship building. That person is going to therefore be more likely to trust you. They are more likely to tell you what they think is going on. Then you can use that to your advantage, to work with them. And this is how you’re going to work towards changing things within your health system, within your hospital. So then you can make it a better place for everybody. So, you know, I don’t think the onus is on the patients to create the change that we need. The onus is on us. And I think it starts with saying no everything else. And that it’s yes, to the few things that you’re passionate about, that you really want to see change because they were affecting you so much.

Dr. Anthony Orsini (16m 48s):
Well, there’s so much there to unpack. I mean, one of the things that you said that really hit home is something that you’re passionate about. Some people think that it has to do with how much free time you have. To be happy you don’t need free time. Yes, of course my family is important to me. I want to be home with the kids, as you said, throw your kids across the pool. Would you like to do that? But if you are passionate about it, it’s not work right? If you love what you do, you’ll never work a day in your life. Because if you say, you said I wasn’t able to give up the podcast, that’s something that you enjoy. You’re passionate about you. And I both know this podcast has a lot of work. We really get nothing out of it. But I’m very inquisitive, I love to learn from people like you and my other guests, I feel like I’m providing a service.

Dr. Anthony Orsini (17m 30s):
There’s people listening and teaching people. Communication is something that I’m excited about. It I’ll take a couple of days vacation and fly out to go give a lecture in Portland and do a workshop for a very little money and you know, be on the red eye, coming home and then work the next day. But it doesn’t burn me out because I’m passionate about it. Now. I’m not a committee person. I don’t like to sit in a meeting. My ADD probably gets the best to me in these meetings where I’m fidgeting all over the place. And I’m sitting at some of these committee meetings that I’m going to did we talk about this six times, six weeks ago and five weeks ago and four weeks ago and three weeks ago, that’s not me. I’m a doer. And so when I’ve asked to be in leadership positions, I’ve taken some of them, but I had to make that choice, like you said.

Dr. Anthony Orsini (18m 16s):
So do I want to continue on this leadership path and be the guy that goes to the meetings all the time? Or do I want to do my Podcast, fly out at the Portland and do a workshop on communication. And the answer is that’s what I want to do. And I think what you said is so important, you can’t do everything. And you know, in high school you said it, you do try to do everything and sooner or later your parents might say to you, you know, they said, Tony, you can’t play three sports. Like, you know, you want to get it to the college, you know, pick to pick one. Or my oldest one used to play a football game when he was in seventh or eighth grade. And then I would clean him up and then take him to the baseball game. After a while you say, this is crazy. You, you have to pick. So I think that’s really the big message that you mentioned right there is you got to be happy what you’re doing.

Dr. Bradley Block (19m 2s):
Yes. If you’re not passionate about it, if it’s not a heck, yes, then it’s just a no. You can’t please everybody. And you got to start off with pleasing yourself.

Dr. Anthony Orsini (19m 9s):
Yes. it’s been a common misconception. I talked about this story in my workshops, a common misconception that what happens is the compassionate fatigue follows to burnout and more and more data is coming out now. And, and, and I’ve spoken to a few people about this that really the opposite that what happens. So what, what happens is that if you could prevent the compassion fatigue from happening, you’ll prevent the burnout. And so what I mean by that is I talk about it in some of my lectures. So you have the patient’s always there. So for me, I have to pick up the phone and I got to find the mother, or I go downstairs and speak to the mother who is, it was in labor and delivery. But maybe I don’t have these meaningful communication with the mother because I’m really busy. I see the baby, I write for the rounds and I’m off. But then I go home and you know, maybe I’ve done a really great job, but I feel empty.

Dr. Anthony Orsini (19m 54s):
Communications my thing, I’m a person who just loves relationships. And then I go home, go home. And you know, you, you know what happens to me? It happens at night when I’m getting ready to go to bed. Damn it. I forgot the speak to that mom. Or I told her I would call her back and I didn’t call her back. And now it’s 11 o’clock and I’m calling the nurses up, going that mother come in and she is Dr. Orsini is at 11 o’clock at night. And I’m like, yeah, I put a sheet there because I feel really bad. So if you are enjoying being a doctor, I’m not going to say a a hundred percent, but I think you’ll be a little more resistant to it. But when you get caught up in all of these committees, how many different tests we have to take prior to getting a little crazy, right?

Dr. Bradley Block (20m 31s):
It is preposterous is, and if you have privileges at different hospitals, a lot of times it’s redundant. I mean, listen, I’m all for education about sexual harassment, but I had to take it from my practice. I had to take it for one hospital. I had to take it for another hospital and they’re all asking the same thing. One should really be able to apply to all of them. And in my favorite is though is a course on burnout to prevent burnout, right? Cause it’s the course that’s, you know, wasting my time and preventing me from going home. But you were talking earlier about that personal connection, how important it is. And I realized that I had mentioned Sanj Katyal the radiologist. They never actually talked about what he does with his radiologist, which is he recommended that, you know, every so often they reach out to a physician by phone to give them the results because there are so disconnected from the patient care, that one thinks that he found improve their quality of life is that personal connection.

Dr. Bradley Block (21m 27s):
You know, tell me a little bit about the patient. Okay. This is what I’m seeing. This is how I think it will contribute to management. You know, what were you thinking in terms of management? And then you’ve got a little bit of connection. You got a little bit of a story and then you’ll see how the patient has benefited from your reading this scan.

Dr. Anthony Orsini (21m 43s):
That’s an interesting point. You know, a radiologist for those of you out there who are maybe an academic medicine, or if we do the same thing, we do these radiology rounds once a week, for those of you are not in medicine, radiologist sits in this really dark room and then will bring the residents down once a week and Tuesday to go over to the week’s films with the radiologist. And tell me if I’m wrong, Brad, but the radiologist lights up like, Oh, People, I had seven people and they were all listening to me speak. And so I think that’s really a great opinion that I liked that

Dr. Bradley Block (22m 12s):
Well, they love what they do. It’s got to like us. I liken it to being in love when you’re in love. You want to tell everybody about that person and how wonderful they are and how wonderful you’re doing it. And I think most of us feel that way about our specialties were super excited to talk to people about it. So you get down to the end of the radiologist who is had not much a personal connection, except for the person that’s looking at their scans in the little cubby hole next door. And they excited to tell you what they are passionate about.

Dr. Anthony Orsini (22m 38s):
You know, one of the things I talked about when I’m going to have to speak about patient experience and do some workshops, and I’m doing a workshop for a major university about multi-disciplinary and how we can make each other get along with each other, that they have issues with their doctors and nurses and different specialties are not getting along with each other. And we talked about banter and how that makes a big deal for ears, nose, and throat doctor. You know, you go to the OR and you see the, the nurse and the receptionist spending a few minutes asking her, you know, calling her by name, asking her about her kids, complaining about your own kids. That’s called banter. That builds relationships. And they’re like, ah, Dr. Block, he is a pretty cool guy and it makes all the difference in the world, but it’s also what the radiologist generally don’t get as much.

Dr. Anthony Orsini (23m 20s):
I’m sure that he talked about that, but it’s also really important for us not to be laser focused on, I got to get to the OR I’m running late because when you go home, you’ll be more excited about what you did and you’ll be happier what you do.

Dr. Bradley Block (23m 32s):
Yeah. And that’s how you’re going to get referrals too. Like if you’re looking to build a practice, chat everyone up, chat everyone up there, more likely to remember you. And they’re more likely to send your patients because everyone is going to ask their neighbor who works at the hospital, who the best ear, nose and throat ophthalmologists, neuro-surgeon I mean, I guess you can get maybe what people see or find neurosurgeons that way, not just through the trauma Bay, but you know, that’s how they get referrals. So it’s going to help to build for all of the newer physicians out there. If you just move, that’s going to help to build your practice. That’s not in the doctor’s lounge because the doctors have their referral patterns and their set and meaning this new person in the area is not going to cause them to change the referral patterns from the person that they were already sending to.

Dr. Bradley Block (24m 15s):
The things that that is going to cause them to change is when the nurse ends up sending their neighbor to you and the neighbor, then it goes back to their primary care physician and said, I just saw the best ophthalmologist ever. And they keep hearing that over and over. And then they’re going to start sending their patients to you. So you’re not going to convince them but their patients are going to convince them. And that’s how you move to the tide towards, you.

Dr. Anthony Orsini (24m 37s):
And that’s why a patient experience patient satisfaction scores, H caps, whatever you want to call them. They are just extremely important today. Most people do go to the doctors through referrals. There is one statistic that I saw it for every $4 that you spend on marketing for talking about hospitals now is equal to only $1 spent on patient experience. So you can put up all the bulletin boards you want, you can do 12 commercials, a night, but most people are going to ask their neighbor, Hey, how was Dr. Block? You know, there’s thousands of ENT people that can do it, a particular procedure that you do, what are they going to say? Go to him. He’s really nice. He was great. He took the time to speak with me and that’s how they get the referrals because that’s what people really want.

Dr. Anthony Orsini (25m 18s):
And I think you did a podcast episode. I can’t remember who it was that you were speaking to you, but he or she was talking about the same thing about just people want a few minutes of your time, you know, and that’s all they really care about and it doesn’t take time to do that. It only takes a minute or so. So I think it’s really important lesson for a young physicians out there too. Take a few times. We need to do an episode on humor at one point, how you humor is a really helpful.

Dr. Bradley Block (25m 43s):
Yeah. Scott Dicker is the founder of the onion. I have no idea how I managed to get the founder of the onion on my show to talk about humor, but I did. And so we talked about, well, one of the things he ended with, I thought it was great. I said, let’s say your doctor was listening. What would you want your doctor to know about humor? And he said, don’t try and be funny. It’s my job to be funny. I’m the funny one. I just want you to laugh at my jokes. So, and I, and I think that is without realizing what he is doing there. I think it’s important. The patient’s the star of the show. You’re not the star of the show. So it’s important to make them laugh, but it’s even more important that if they’re making jokes, that you laugh at their jokes, because again, they’re the star, they’re the star.

Dr. Bradley Block (26m 25s):
You’re not the star. And he did make a couple points. If you have like a failed joke, you know, we all have our schticks. We all see the same things over and over. And we find ourselves saying the same things over and over. And so my shtick has changed, but it evolves. And so its kind of like a standup comedian who tries something one night and it doesn’t work. And so they change it a little and tried it the next night. Then it may be, it works a little better, but let’s say you try a joke and it bombs. You need to be ready for that. And so one thing that you can do and it’s an easy one is Aw man, I’m glad I’m in medicine and not in comedy. So something self-deprecating. However self-deprecating humor is great just don’t make it about your skills as a physician.

Dr. Bradley Block (27m 9s):
Because if you start denigrating your skills, then they’re not going to trust you. So you can deprecate how you like don’t run on time or are you like, it cannot be about competency, but never ever make the joke and the patient’s expense. And that’s something that is true in the exam room. When the patients are asleep in the operating room on social media, I think what he said was the function of humor is to afflict the comfortable and comfort the afflicted. So you have to no who in this relationship is the afflicted. It’s the patient and who is the comfortable, it’s the hospital system. It’s the pharmaceutical governance.

Dr. Bradley Block (27m 49s):
Then it can never be a drug that is going to undermine trust. But at the same time you are comforting the afflicted, but you never inflict the inflicted. So it’s important to think about that. If you’re ever telling a joke and for doctors, it’s okay to tell dad humor, right? We were both dads. You know, those completely horrible fall flat jokes. It’s fine. It’s fine. It’s not fine for a standup comedian to do that. So if you want to use hokey jokes, it’s totally fine. It because it’s really going to soften things

Dr. Anthony Orsini (28m 19s):
As pediatricians. We do that with the kids, the children come in and it’s funny when I did pediatrics, you, you say it that joke and same age kid , one kid laughs and the other kid who looks at you, what are you an idiot? And you got to know your age, right? You say a dad joke to a junior high school girl. She’s not gonna laugh.

Dr. Bradley Block (28m 38s):
You know, that’s gotta be a tough audience though. That’s like any teenager is going to be a tough audience. Sorry, I’m going to turn the interview around on you. Or do you have any go-to jokes for different situations?

Dr. Anthony Orsini (28m 51s):
You know, I don’t have a lot of jokes with the parents, but what I do is are you talking about self-deprecating if it’s not really a self-deprecating, but to be a genuine person, I talked about that all the time and what I give workshops on patient experience. They want their doctor to be a genuine person. So I will do what I did to you, you know, find out where you’re from, especially nowadays where people keep the same area code. So they might say, yeah, so they have their cell phone in. If I see a 973 or 212, I know that’s a bit Jersey, 718 and I know where that’s from. And so I talked about finding commonality. I do a lot of sports stuff. I do a lot of sports analogies. Sometimes at work is obviously not going to work with a mom who obviously is not into sports, but I try to make genuine concern or you, while you’re at the surfing, that’s a sport.

Dr. Anthony Orsini (29m 35s):
So I try to be a genuine person, you know? And I’ll say things like ti you know, last night my car broke down or you know, if you’re have younger children and I was up too late last night, my daughter couldn’t do her homework we were up to 11 o’clock and physicians have said to me, well, don’t tell them that you were up late last night. You might think no. They know that you are a real person. And you go from Dr. Orsini to Dr. Orsini from New York who likes the giants and that makes all the difference in the world. So I don’t use humor a lot, except that what I’m trying to just be genuine. And now with nurses and respiratory therapists, we joke all the time, you know? And I think that’s the best advice I could give to a young doctor is if you want the nurses and the ancillary staff to really be happy.

Dr. Anthony Orsini (30m 21s):
When you walk in the door, then take a minute to do that banter and make some jokes with them. There’s stuff that I can’t think of any not, but their stuff on Facebook all the time. And it comes up. And if you got to make sure, as you know today in, in the world community, you got to make sure that it’s a perfect one, recent one, someone put on Facebook. I saw it, I showed it to my friends and the nurses. There was a man standing In, in the woods and he was screaming in the caption was if a man says something in the woods and no one hears it, is he still wrong? So, Hey, you know, I will make little jokes about that. So that’s my go-to kind of stuff like that. So yeah.

Dr. Bradley Block (30m 56s):
And don’t buy them donuts. I mean, you can buy them doughnuts, but much better than buying them donuts is knowing their names, knowing their spouse’s name, knowing their kid’s name, knowing the town that they live and knowing their interests, knowing things about them, that you can ask them about that. It’s not the same thing every day. Am I amazing at this? Absolutely not. I am not. I am not, but I’m going to keep trying and my kids or one and a half or three and four and a half. So, you know, we want to, a lot of the Daniel tiger, I just keep trying or you’ll get better. So I’ll just put the effort in putting the effort in, and that’s going to be much more appreciated if you know who they are, you care about who they are. That’s going to go a long way.

Dr. Bradley Block (31m 36s):
And you know, to what you said about humour, you know, you’re in the NICU with two and a half pound babies with all sorts of monitors on them, in intubated with feeding tubes. For me, it’s a lot easier to make jokes. Cause I’m an ENT doing mostly outpatient stuff I’m taking out of your wax and you know, nasal polyps and snoring and deviated septums and tonsils and adenoids and ear tubes. My patients aren’t critically ill. So it’s much easier for me it to make jokes. So that’s why it’s important to know your audience.

Dr. Anthony Orsini (32m 6s):
When you said how young your kids are, I did think of a go-to joke that I use all the time when the baby is getting better and you’re getting ready to go home. And the kid is so cute. You give them a compliment. You’d say the baby is so beautiful. Look how quiet he or she is. And then I’ll say enjoy it now because in 15 years he’s gonna be a teenager or she is going to be a teenager and I’ve gone through three of those already. It’s not fun, but I promise you when they’re 22, they’ll love you again. And so everybody kind of jokes about that. So, well,

Dr. Bradley Block (32m 33s):
I know it’s also nice for them because they had a kid who was just critically ill. And now you’re like, you have got this life in front of you. Now that’s a much deeper statement because it’s not just joking about how difficult teenagers can be. You are going to be like, you’re going to have a teenager one day. Like how amazing is that?

Dr. Anthony Orsini (32m 50s):
Yes, it is amazing. And the doctor is a real person because he didn’t have the key to teenagers either. And it happens to me. It’s not going to happen. So, you know, you’ve had some, I just want to finish up with a, you had Blake Eastman on talked about nonverbal communication and that’s my thing. So I was fascinated and he talked about interest and authority. And when I give lectures on breaking bad news, I always say the three goals are for breaking bad news is to be compassionate, which he calls interest authority to be the expert in the room is part two. And then the third goal is not going to leave You, but he had some great comments about the way you smile and telehealth and how difficult that was. That was fascinating.

Dr. Bradley Block (33m 30s):
Yeah. So he is interesting cause he’s a poker player and he does his own research on nonverbal communication. And a lot of the things that we think about non-verbal communication, he thinks aren’t necessarily true, but there were a couple of points. Yes. So interest and authority, those are the two things that he thought were key to nonverbal communication and authority you express through the tone of your voice. An interest is your facial expression. And so you need to be aware of that stuff because were not necessarily as aware of it as we should be a point that he made is you need to be authentic so you can’t make this stuff up. But at the same time, you can still neglect these things.

Dr. Bradley Block (34m 12s):
If you’re not concentrating on them, if you’re not practiced at it, you can be interested. You can be the authority, but you can be not expressing it. So you can make it up. But at the same time you can neglect it. So it’s important. And so with regards to the interest and the fact that we were wearing masks is not as big a deal as we would think, if you’re in the ICU and you’re on a paper or you’ve got your face shield and your goggles and your mask. So if you’re completely obscured, that’s going to be a problem. But for those of us who might have goggles and N95, the patients can still see your eyes. And so that’s where most of the non-verbal cues are gonna be with regards to the interest are they are going to be surrounded around your eyes.

Dr. Bradley Block (34m 54s):
And so nodding is not as acknowledging as you would think it is. If you’re talking to someone they’re just nodding over and over, it’s not clear whether they are actually paying attention. Squinting appears more engaging than nodding. So if you were really squinting to pay attention to a patient, that’s gonna go a long wait for them to recognize, and you’re not fooling them, or you’re not trying to make them think you’re interested for them to recognize that you’re actually interested. And then with regards to the authority, yet your vocal tonality really does matter. And so us being from the Northeast that doesn’t always convey, you know, we end up sounding like Jerry Seinfeld sometimes where everything we say, Oh no, no, it sounded like a question.

Dr. Bradley Block (35m 35s):
And so it’s important to end things on a down note with more of an exclamation, rather than a question as in the North, or should we have a tendency to do. And then with regards to the telehealth, the main issue was where to position your camera because you can align the vertical, but you can align the horizontal. So at least to make sure that the vertical is aligned. So the patient can see you at least looking at them in one dimension.

Dr. Anthony Orsini (35m 59s):
Yeah. That’s really important. And the body language, and some people don’t like to call that nonverbal communication is so important. 70 somewhere between 70 to 80% have language is non-verbal and you can use your non verbal language to manipulate people. Or maybe you manipulate is not a good word, But to get people to really realize that you are caring and you’re compassionate. And you know, there are certain things you can do consciously what your non-verbal language, but not everybody is an expert in non verbal language. So what I say is use the word, imagine That I think you mentioned it at one of your podcasts actually taking the time before you opened that door, take a deep breath, take a second. As my colleague says, take your own pulse.

Dr. Anthony Orsini (36m 39s):
Imagine what it’s like to be this patient. And he, or she has been waiting in the office for a 45 minutes. And I know this is your 30th patient of the day, but this is his or her only visit. So take a minute too, imagine a compassionate. And most of the time, if you do that, your subconscious will take over and your non-verbal communication will be appropriate. Does it hurt the learner, no. Amy Cuddy. Do you know what Amy Cuddy?

Dr. Bradley Block (37m 6s):
Yeah. With the a superhero stance.

Dr. Anthony Orsini (37m 7s):
Yes, yes, yes, exactly. So Amy Cuddy wrote in her book that just standing in front of a mirror with your arms out, right before you go to a job interview can not only make you do better in the job interview, but also she measured testosterone and cortisol levels and found that the people that stood in front of that mirror, he was just for a few minutes had higher testosterone levels and lower cortisol levels, which meant they weren’t as nervous and they were more confident. And so if you’re out there and you say, gee, I don’t know anything about Nonverbal language and Blake Eastman, I think mentioned this. Just take it a minute to imagine. And you should be okay.

Dr. Bradley Block (37m 40s):
Yeah. There were a couple of people actually that, that had mentioned that one of my first episodes with the Jason Hare is the patient experience advisor for a hospital in upstate New York. And then Oscar Trimboli who, who talks about deep listening. Both of them said the same thing, different iterations, but ultimately before you go to the patient’s room and again, I practice outpatient medicine. So this is my experience. I opened the door. It’s no different in the NICU where everyone’s in it in one big room or stop and take a deep breath or two deep breaths or three deep breaths, an easy thing to do if they are your rooms is to put a little piece of tape on the door, just a little colored piece of tape. This is my own thing that we do. You remember to do it because you need a que, you need a que a in order to, to make it a habit.

Dr. Bradley Block (38m 22s):
And this is another, you know, I have been a couple of episodes of developing new habbit. We won’t get into that. But if you put this little piece of colored tape on the door, it will remind you to do that. And all you have to do is it’ll just take a second, take a deep breath or too, so that you could remember that this next patient is the star of the show, whatever you’re doing in the last running behind people in the waiting room, phone calls, waiting for you. It doesn’t matter. Patient is at the star of the show. I take a deep breath and it will help to remind you that they’re the star of the show. It will make the visit more fulfilling for them. It will make the visit shorter they’ll know from the beginning that you have their undivided attention, because you will have their undivided attention and it will make it more filling for you. And then,

Dr. Anthony Orsini (38m 60s):
Yeah, that is the best lesson of the day that it will make it shorter because that’s the biggest misconception is that if you sit down and don’t multitask, you’ll get out there a lot later and you’re going to get home six, seven, eight, nine o’clock at night. When the reality is, I always say you’re mother was right.o it right the first time and you’ll save time. But how many things come back to what our moms told us? So this has been great. Brad, I can talk to you all day long. I have about another 10 topics that I want it to discuss where we might have to have you back on. But I think the key to all of this is it’s back to communication, conversations about things starting on your podcast. The physician burnout is such an important conversation. I finished every podcast asking the same question I warned you about this.

Dr. Anthony Orsini (39m 44s):
What’s the most difficult conversation that you either had specifically or a type of conversation. And please leave the audience with some little pearls from that, how you navigate that?

Dr. Bradley Block (39m 52s):
No, no. I said earlier, it, most of the stuff that I deal with in my practice isn’t really grave. But you know, periodically I do diagnose patients with cancer, thyroid cancer, which tends to be not so aggressive, but sometimes throat cancer, different head and neck cancers. And so at my conversation is certainly gonna change now because I interviewed Dr. Orsini on my show. And so we talked about breaking bad news. And so, you know, I learned from him that I can be more methodical about it, but for me, those conversations, it was always important that two things, one there’s no ambiguity use the word cancer. Don’t use the word tumor, don’t use the word malignancy, use the word cancer, or the patient needs to leave there knowing that they have cancer, they can’t leave their not being sure what the doctor was talking about.

Dr. Bradley Block (40m 40s):
I think it’s cancer. I’m not sure what does that mean? And then knowing what the next step is, knowing that their going to be looked after knowing that I’m available. I mean, mostly I’m not managing this. I’m sending them to a comprehensive cancer center, but knowing that the person that I’m sending them to is someone that I know very well and trust. And we would go to them, myself and a written plan of what the steps they need to do and that knowing that I’m available for them. But I think the critical part of that is knowing that they are going to be looked after and knowing that they have cancer. No ambiguity.

Dr. Anthony Orsini (41m 11s):
That’s a great point in writing it down because they have to say that C word as it’s called now, they only retain about 10% of what you say afterwords. So writing it down and I think is really key. I just interviewed somebody on child abuse and he is a forensic interviewer. So he’s the one who has to tell people that their daughters had been sexually abused or, or their son who has been physically abused or whatever. And one of the pearls that he taught me, as he said, what I’m for forensic interviewers, they always ask me how long should this take? And my answer is however long it takes. And I think that’s really important when you were talking about telling cancer. If it takes 15, 20 minutes, half an hour, and you’re people are backing up, this is the most important thing that you’re probably going to do that day.

Dr. Anthony Orsini (41m 52s):
So you want to make sure you get it right.

Dr. Bradley Block (41m 54s):
And then when you’re done with it and you’re moving on to the next patient, stop take that deep breath, collect yourself. Cause that next patient is now the star of the show.

Dr. Anthony Orsini (42m 3s):
I love the piece of tape advice. That’s a great piece of advice. So if I ever got an office, I’m going to use that. I like that. So well, Brad, thanks so much for coming on. This has been really great. As I said it, we can talk for hours. I appreciate you having me on your podcast and I’m looking forward for this one to drop so that my audience can benefit from all of the conversations that you’ve had. Again, tell us about how they can get through the podcast is available on every format or most formats?

Dr. Bradley Block (42m 28s):
Yeah. I mean, every format that I’m aware of that exists, you can find it there. If you can’t seem to find it and you just go to the physician’s guide to Doctoring.com. That’s my website. You can listen to the episodes there. I’m on Twitter at physicians Guide. I just joined Instagram, although I’m not very active, my wife@ she been helping me with that at physicians Guide and then on Facebook at physicians Guide to Doctoring. So you just look up the physician’s guide to Doctoring will be able to find it anywhere and share it with your friends. Tony, this has been great. A lot of fun talking to you again, we really have so much in common. We were passionate about most of the same things we could just have an entire podcast is, but the two of us going on each other’s shows. So it’s been great. I love the questions and thank you so much for having me.

Dr. Bradley Block (43m 9s):
Thanks.

Dr. Anthony Orsini (43m 9s):
It was a lot of fun. And as I say all the time, I’m meeting somebody great people and some of them, I really can say most of them that I can call my friends and I feel like you and I would be very happy together and just sit back and have it a few beers. So this has been a pleasure. I will put all of your information on the show notes. So if you’re driving, don’t stop, we pull over. It will put everything there and everybody will be able to get in touch with you. If you enjoyed this podcast, please go ahead, hit the subscribe and download, tell your friends. If you want to find out more about the Orsini Way, you can reach me at the Orsini Way.com. All right, Brad thanks again. I appreciate it. We’ll talk again soon.

Dr. Bradley Block (43m 46s):
Thank you, Tony.

Dr. Anthony Orsini (43m 47s):
This episode was brought to you by Veritus. Veritus offers virtual alcohol or drug and trauma treatment program is exclusively for a licensed medical professionals. Their program is providing a concierge level of care consisting of evidence-based clinical treatment and are customized to meet the unique needs and challenges are physicians that this is pharmacists and nurses struggling with substance abuse. The virtual confidential platform provides a safety and security medical professionals need to get help while continuing to work confidential, convenient, and compassionate. Veritus brings world-class treatment to your home or office contact Veritus for help at Veritus solutions.com.

Announcer (44m 26s):
If you enjoyed this podcast, please hit the subscribe button and leave a comment and review. To contact Dr. Orsini and his team, or to suggest guests for a future podcast visit us at the Orsini Way.Com.