Difficult Conversations Podcast
Lessons I Learned as an ICU Physician
Episode 155 | September 21, 2021
Ditch The Drama
Global Thought-Leader and Author
Welcome to Difficult Conversations with Dr. Anthony Orsini. Today, my guest is the incredible Cy Wakeman, who is a drama researcher, a global thought leader, and New York Times best-selling author. She has been deemed “the secret weapon to restoring sanity to the workplace” and has helped companies such as Google, Facebook, NBC Universal, Johns Hopkins, and countless others how to navigate our rapidly changing world using good mental processes to harness energy wasted in workplace drama, and reinvent that effort into achieving profound business results. As a highly sought-after conference headliner, she’s a regular contributor on Forbes.com, The Huffington Post, and has been featured on the Today Show, Ask Gary Vee Show, and the New York Times Business Insider. Cy has published three books, the latest of which we’ll talk about today called, No Ego: How Leaders Can Cut the Cost of Workplace Drama, End Entitlement, and Drive Big Results.
Cy tells us about herself and she shares with us her lifelong pursuit. She reveals some statistics about her research with hardworking, super achieving, professional people and how they spend two and a half hours a day in drama in the workplace. Dr. Orsini shares some advice about how he teaches healthcare professionals to help them prevent burnout and his concept of “It’s hard to fire your best friend.” Cy tells us she believes in two things, “you love people up and then you call them up,” and shares a story about an upset nurse and why she said to her, “If you were great, what would great look like?” She also talks about how self-reflection is the ultimate drama diffuser. Cy explains her concept of toggling up and toggling down. Dr. Orsini talks more about why he loves conflict resolution with a great story and clarifies how great leaders make you self-reflect and how to look at things differently. The topic of leadership and the culture of business comes up in the conversation, and whether or not we need to train the leaders and if there are some leaders that just have to go. Find out why Cy doesn’t believe in working on culture and why she said, “We don’t have to fix the culture, we have to fix the climate.” If you enjoyed this podcast, please hit follow, and download all the previous episodes.
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Cy Wakeman (1s):
So there’s just so many things that we work on are mostly problems of the mind that people have come to believe things. Not true. People are believing their own thinking. I’m like stop living your own thinking. And we can just in small, quick ways start to loosen the ego script and people see a different way forward and things turn immediately. And here’s the key, is you get this immunity, I work with bad players all the time. It doesn’t change my quality of life. It doesn’t change my level of peace during the day, but you have to learn that.
Welcome to Difficult Conversations Lessons I Learned as an ICU Physician with Dr. Anthony Orsini. Dr. Orsini is a practicing physician and president and CEO of The Orsini Way. As a frequent keynote speaker and author. Dr. Orsini has been training healthcare professionals and business leaders on how to navigate through the most difficult dialogues. Each week you will hear inspiring interviews with experts in their field who tell their story and provide practical advice on how to effectively communicate. Whether you are a doctor faced with giving a patient bad news, a business leader who wants to get the most out of his or her team members or someone who just wants to learn to communicate better this is the podcast for you.
Dr. Anthony Orsini (1m 21s):
I am honored today that the Orsini Way has partnered with The Finley Project to bring you this episode of Difficult Conversations Lessons I learned as an ICU physician, The Finley Project is a nonprofit organization committed to providing care for mothers who have experienced the unimaginable, the loss of an infant that was created by their founder, Noelle Moore who’s sweet daughter, Finley died in 2013. It was at that time that Noelle realized that there was a large gap between leaving the hospital without your baby and the time when you get home That led her to start The Finley Project. The Finley Project is the nation’s only seven-part holistic program that helps mothers after infant loss, by supporting them physically and emotionally. They provide such things as mental health counseling, funeral arrangements, support, grocery gift cards, professional house cleaning, professional massage therapy and support group placement.
Dr. Anthony Orsini (2m 15s):
The Finley Project has helped hundreds of women across the country. And I can tell you that I have seen personally how The Finley Project has literally saved the lives of mothers who lost their infant. If you’re interested in learning more or referring a family or donating to this amazing cause please go to The Finley Project.org. The Finley Project believes that no family should walk out of a hospital without support. Well, welcome to another episode of Difficult Conversations Lessons I learned as an ICU Physician. This is Dr. Anthony Orsini, and I will be your host again this week today, I am extremely excited to have the incredible Cy Wakeman as my guest today. Cy Is a drama researcher, a global thought leader and New York times bestselling author, who is recognized for cultivating a counterintuitive reality-based approach to leadership.
Dr. Anthony Orsini (2m 59s):
Deemed the secret weapon to restoring sanity to the workplace Wakeman has helped companies such as Google, Facebook, NBC universal Johns Hopkins and countless others how to navigate our rapidly changing world using good mental processes to harness energy wasted in workplace drama and reinvent that effort into achieving profound business results. As a highly sought after conference headliner, she’s a regular contributor on forbes.com. success.com the Huffington post and has been featured on the Today. Show the Ask Gary Vee Show, which I have some connections with Gary V and that group chat or TV, and the New York Times Business Insider Cy was voted the top 100 leader professionals to follow on Twitter for seven years in a row.
Dr. Anthony Orsini (3m 48s):
She has published three books. The latest of which we’ll talk about today, No Ego, how to cut the cost of drama and entitlement and Drive Big Results. Well welcome Cy, thanks so much for taking the time to be on the podcast today,
Cy Wakeman (4m 0s):
Thanks for having me, I’m very excited to talk about drama and all things ego with your audience.
Dr. Anthony Orsini (4m 6s):
I had it inside because I’m like, gee, I’d love to get signed on this podcast. And then I saw we were speaking together in November. So I was so glad when you returned my LinkedIn requests. And I was so excited. And then as we just got done speaking, like we were supposed to do this like two weeks ago. And then when I came home for vacation, my whole entire first floor was flooded from a burst pipe and the audio studio was all flooded. So I said, oh, kind of like both sides, so busy. So I was so glad we can reconnect. So a double thank you for that.
Cy Wakeman (4m 36s):
No worries. I love your topics, the Difficult Conversations and I, myself, I’ve worked with healthcare teams and physicians and just trying to connect better as humans. So I think we have a lot in common.
Dr. Anthony Orsini (4m 48s):
What I love about your work and we’ll get to it later is that you take a different perspective than everyone else. I mean, I’ve done 50 of these interviews now. We’ve had some incredible guests and we’ll talk about that later, but what I’m really fascinated by how you take a totally different approach. And I always say, whenever you hear Cy speak, it’s kind of like a ha stuff. Cause it’s like, oh, that makes sense. That makes sense. So, but before we jump into that, I always like to start with getting people to know Cy Wakeman. And so just tell us about Cy and how you’ve arrived to this pinnacle of your success being on my podcast.
Cy Wakeman (5m 20s):
This is my big achievement. So current Cy, I am a researcher and writer. I live in Baja, Mexico. I just relocated and enjoy the ocean on the daily. And it’s been a wonderful, peaceful place to work. I started out life focus on micro lending and international relations and third world economic development, and really wanted to work with organizations like physicians without borders and be in the, in the peace Corps and go out and just bring love and healing to the world. And somehow I got involved in an aftercare group with adolescents and found out, I absolutely loved counseling and therapy.
Cy Wakeman (6m 1s):
And so I got another degree in social work and started working with families and individuals that struggled with addictions and then working at a health center. I got my master’s of healthcare administration and started putting together behavioral health centers. And during that process, I was really able to get insight what we know about human behavior and what reaches leadership curriculum, leadership development curriculum, were at the time, very unconnected that leadership development was not evidence-based. And yet everything we were doing on the medical side that was when evidence-based medicine was starting to be the mainstream. So I had some really unique experiences, my master’s program, where I started to connect the dots that there is something happening called emotional waste suffering that is optional.
Cy Wakeman (6m 52s):
And that it happens because we, especially as caregivers, we don’t understand how our mind works. So we get played by our ego all the time, and we don’t understand how the world works. And so, you know, we argue with reality, which is an argument we’ll lose a hundred percent of the time. And during that course, I started working with, at the time they were called impaired professionals, which were physicians or nurses that traditionally presented with some type of addiction issue that impaired their work. And I would work with the medical board of our state to just ensure they were ready to go back to work and protect their own wellbeing and also deliver safe care.
Cy Wakeman (7m 33s):
And that’s when I really discovered the needed healthcare for people to understand our jobs are stressful, but a majority of our stress is not caused by the reality of what’s happening. That actually is what we love. That’s why we’re in it. It is the stories we make up about the reality that’s happening and that most of what the people I worked with were upset about never even happened except in their own heads. Like it just never happens. And that became my lifelong pursuit. I want to help people understand that suffering is optional, that you can transcend beyond the ego and you can work in some incredibly healing and fulfilling ways, even in health care, which is a very tough industry.
Dr. Anthony Orsini (8m 17s):
And your work is so important. Especially now I talk about my Ted talk and other presentations about the high professional burnout and in nursing and physicians even before COVID, but I really love your whole philosophy of the ego and it’s in our head and you gave a statistic. I think you’d given most of your talks about how many hours we spend per day being wasted. And everyone goes, wow. And then they go, yeah, I could get that. I kind of get that
Cy Wakeman (8m 43s):
Part of my research. It was not early research by updated every three to four years is I want it to be able to quantify, to prove to people the value of working on this. And if we couldn’t quantify it and measure it and get it down to dollars and cents, we couldn’t sell it. So the average person and we aren’t talking hardworking, super achieving great professional. We’re not talking drama, Kings and Queens. The average person spends two and a half hours a day in drama in the workplace. And this is 816 hours a year, 816 hours a year that people are not only not doing their best work.
Cy Wakeman (9m 24s):
Now they’re working hard, but they’re working hard with a grudge. They’re not doing their best work and they’re miserable in. It’s not necessary. And the example I give for those of us that work in some of our big medical centers, it’s not that when we find a lost family member, we don’t follow the script and do the right thing. We ask them where they’re going. We way finds them. We even go out of our way to walk that we all got that class. We all do the right thing. That’s not what stresses us out. What stresses us out is in our minds. The story we tell ourselves, this is absolutely ridiculous. I am a chief nursing officer and I have to point patients in the right way and their family members. This signage is awful.
Cy Wakeman (10m 5s):
This is absolutely, I can’t believe facilities can not figure this out. Why are they even designed buildings like this? If I were an architect, I would design that totally. That is a big part of our burnout that we don’t realize we have ultimate control and impact. We have the ability to impact it. Yes, our days are really busy, but the stories we tell ourselves where we assign motive and we assume a victim position and we see things as hopeless and we dragged the past around and we predict the future anytime or other, the present moment. Not only are we not present with the people we’re serving, but we are adding stress. If you want stress, get a future. If you want shame, get the past. It’s like anything that’s not now is a problem.
Cy Wakeman (10m 48s):
When it comes to avoiding burnout,
Dr. Anthony Orsini (10m 50s):
You know, the majority of my career, teaching physicians, how to communicate and build relationships. And it kind of transitioned lately into physician burnout as we discussed. And what I often say during my presentations is if you ask physicians and nurses, why are you burnt out? They’ll say, well, I’m over work. But then they start getting into the complaints, right? Hospital administration is on my back and I’m always seeing this and all that. Some of that is true. Some of that is not true, but the one thing that I think the simplest way that we could prevent burnout is what I try to tell healthcare professionals is that when you’re in the exam room, when you’re in the room and it’s just you and the patient, nobody is telling you what to do.
Dr. Anthony Orsini (11m 31s):
That is you and if you can forget all that outside stuff, if you can just get rid of it and say, okay, yes, I’m buried with paperwork and I have all this other stuff. This is my moment with my patient. And we’re going to have, my philosophy is it’s all based on something called it’s hard to fire your best friend. And that is in the next 20 minutes that patient’s going to be your best friend. And if you can do that, you’ll have happiness all day long. And then, you know, there’s other stuff to deal with, but I love that whole it’s perceived. And the, you told the story early on. I’m not sure if this is your talk in your book, that you were young and you were a manager. And there was a nurse who was complaining about a patient who was set to have a surgery that she wasn’t supposed to have.
Dr. Anthony Orsini (12m 17s):
And she was very upset and you turned it right around. Then I thought that is a true leader. Like tell us that story about how she was so mad and you turned it around on her.
Cy Wakeman (12m 26s):
Yeah. So let me preface it by saying, I believe that a modern leader doesn’t manage people. They manage the energy of the space that they’re in. They manage the energy of people away from why we can’t to how we could and what if we could away from why we shouldn’t have to. And that leaders are also translators in a most important role of a leader. Even if you’re leading yourself is translate your drama to your reality. It’s just reality. Hospital administrators are always on my back, translated I am often contacted by hospital administrators wanting to talk to me about financial issues. It’s very different reality,
Dr. Anthony Orsini (13m 3s):
It’s all in the delivery
Cy Wakeman (13m 5s):
And so I don’t want people to even forget it. I want people to realize that they’ve added so much so people come in they’re like we have three patients dumped on us and like somebody physically dumped a patient. Well, no. And I’m like, oh, we have three new intakes. Got it. You know, or the people in it suck and they’re trying to kill us. I’m like, oh, our colleagues in it have implemented a change. We have to translate. So what happened early in my career, I was young, but I was so grateful that I brought so many of my therapy skills and my knowledge about human behavior into leadership. I was advantaged, but I believe in two things, you love people up and then you call them up.
Cy Wakeman (13m 46s):
And so when I’m a leader, I was working peri-op and I was a co-leader because I am not medical by backgrounds. And I would show up about four or five in the morning as teams were coming in and I focus on loving people up, I would go around, I would anchor us in the sacred work we’re doing. I would love them up and thank them for bringing their talent to our facility. And then I would remind them that we’ve done important stuff to do while I’m doing that. One of my nurses showed up for her first patient of the day and she was working pre-op. And for those of you that are familiar with Periop, when we get the pre-op assignment, we’re kind of relieved. It’s checklist on purpose. It’s safe. It’s kind of predictable. I mean, you’re just going through the medical record.
Cy Wakeman (14m 27s):
You’re making sure the lines are right. There’s a checklist in front of you. It’s a little bit of a relief. Cause not a lot goes wrong in preop. So you’re not having to be like on guard. So she’s getting the patient checked in and going through routine work to make sure it’s safe. And as she’s intaking, this person, the woman becomes absolutely hysterical. She starts to cry. She says, give me my clothes. Give me my husband. I want out of here. You’re not going to touch me. And her. We asked was so out of proportion to the work being done that, of course the nurse, this is a great nurse. Turns to the patient, focuses solely on the patient, comes to find out. The reason for the hysterics is there’s a mistake in the medical record. The patient came in for basically a cosmetic nose job.
Cy Wakeman (15m 10s):
And the nurses prepping her for a partial hysterectomy. And this one was like 30 years old. She’s like, what? So the nurse does what she can to calm the patient down. And the patient’s less hysterical, but the nurses furious. And she said, this is unacceptable. I’ll be back. And she comes out looking for leadership. And she’s like, Wakeman are you the leader on deck. And I’m loving people up. I’m like, absolutely. How can I help you? Just because it’s telling me her story. And she’s like, the people in admissions can’t manage their way out of a paper bag registration. They don’t care about the safety of our patients. People would die. They don’t realize the cost of their mistakes are people dying. And I have to clean up everything. And if it weren’t for those of us from pre-op, we would have all these medical errors, but this are butt on the line, this my license on the line, and she’s calling for heads to roll.
Cy Wakeman (15m 57s):
She wants everyone in registration fired. She’s upset. She’s scowling. She’s looking down. Her whole energy is like big. And I know what I did in that process was disarming to her because I use a whole different skillset than most leaders have available to them. The first thing I do is semantic. And now we’re starting to learn with the book. You know, the body keeps the score. We’re learning that most triggers are semantic. And the first thing people do is they stop breathing and their breath holders. And so I don’t know where I learned how to reset the parasympathetic and sympathetic nervous system, but I turned to her and the first thing I did was calmed myself and I learned that from an ed that they were coming in hot before you do anything, like you get neutral.
Cy Wakeman (16m 46s):
So I got neutral. I didn’t want to meet her energy. And I just said, first of all, and they sit with all the love of my heart, take a deep breath. And then another deep breath, like she was commenced, her being chased by saber tooth tigers. And there just wasn’t any danger. And she looked at me startled, and she’s like breathing. And I’m like another deep one. And I said, now, I said, if you would answer me one question, if you were great right now, what would great look like? And she stuttered. But to her credit, she entertained the question. As she went from calling for a heads-up role to, she looked up, you could just see, she tapped into a different part of her brain. She couldn’t see any way that she could have impact until when she looked up, she was like, you know, I could go back into the patient room and explain to them, this is actually a process that’s working.
Cy Wakeman (17m 36s):
The reason we do this five times and check and sign people’s foreheads and draw on, you know, body parts to ensure there are no mistakes. She very quickly took two minutes. She said, I could call a bedside. And the ENT, he could reveal. He’d never even probably done a hysterectomy. So there’s no danger of that. And she came up with, we called training quickly. She’s like, oh, we were just trained. If there’s ever a mistake to turn the monitor towards the patients called visual queuing and they see you fix it. It doesn’t matter what she came up with. But the key was all I said as a leader is if you were great, what would great look like? And she knew, I cared about her.
Cy Wakeman (18m 16s):
And she instantly had all these ideas and that all I had to do as a leader, which isn’t very stressful, doesn’t lead to a lot. Burnout is say, oh my gosh, awesome, go be great. And she did. And some people are like, so you just dropped her. You know, some people that hear this through ego, they’re like, oh, great support. You shamed her. You just suck it up. Buttercup. Nope. I followed into that bay area minutes later, not to rescue her, but to show the patient that we have additional oversight on this issue to add another calming force. And then I did what most leaders don’t do. Leaders, leave learning on the table in therapy.
Cy Wakeman (18m 56s):
We know the integrations, everything. Even if we use like a psychedelic, we want you in therapy to integrate whatever that journey you went on. Like we know the integrations, everything. So just naturally I said, can I have some time? And I loved her up. I said, thank you for the way you pivoted in that situation. Amazing. You rocked it. Now, let me ask you this. What did you learn about yourself in this moment? What did this reveal to you? And she was such a good self reflector. She’s like, you know what? I got self-righteous and judgmental. And I said, I don’t have to give you that feedback at a performance review that makes you mad. I just said wonderful.
Cy Wakeman (19m 37s):
Now that you know that about yourself, now that you know better, you can do better. And the whole key to this is what I want people to hear. This isn’t me correcting someone. This is the same nurse. When she’s toggled down, as we call it, seeing the world through the lens of ego she’s, self-righteous judgmental calling for heads to roll. But self reflection is the ultimate drama diffuser, because there’s a glitch in your mind where you can’t vent and self-reflect at the same time, they’re mutually exclusive. You cannot judge and help at the same time. So when I ask a question, if people are open, they can’t stay venting when they’re reflecting and problem solving.
Cy Wakeman (20m 17s):
So without shaming her, without saying, you’re very negative, or without saying, you need to think differently without punching the Eagle in the face. I just bypassed it. And I just asked her without asking to use a different part of her brain and the message I want listeners to have. Is that the cool thing about the superpower? If they would just start to use it is it’s the same nurse toggled up or down. And here’s why that’s important. My people go well, wasn’t there a process issue? Oh my goodness. Yeah. When we upgraded epic and we reloaded procedures, somebody did it alphabetically. And for those of you that know Latin, you know that a single bowel makes a lot of difference in the life of a patient.
Cy Wakeman (20m 58s):
Like whether there’s something goes in or out, we screwed up, it increased clicking errors and intake. But who would you rather have working on the issue with you? The self-righteous judgmental nurse calling for your head to roll or the self-reflective curiousness interested in patient safety. I would take the second nurse. Think of all the committees you’re on. What if you had nurse number two, who is toggled up and self-reflective in your problem solving efforts and your continuous improvement in your lean efforts, in your compliance efforts. That’s where we can get stuff done without the drama. That’s where a one hour meeting can really move us forward to solve a lot of problems. So I got to be known for that technique where I just disarmed people unintentionally when they would come to us, but I would fix their language.
Cy Wakeman (21m 45s):
I would ask them to breathe. I would make sure if they’re coming in hot, I did not match their energy. And I would tell, you know, physicians are typically nurse practitioners on that care team when we’re giving clinical care in the position of a leader. And so I coach so many physicians on energy management of their own. It does not help. If somebody is coming to hot for you to meet that energy, it’s alchemy, you can transmute some of these intense energy just by the existence of your peaceful presence. You can manage the energy of the entire room. And like you said, that is so powerful. It’s you and a patient manage that energy.
Dr. Anthony Orsini (22m 20s):
You talked about toggling up and toggling down yourself. I think you call it the high self and low self. If I’m not mistaken. What I tell doctors when I’m giving my presentations is that no matter how good you are at communicating, building relationships, being happy that you are either on a daily basis at one point in time or every now and then you are going to become task oriented. You’re going to forget about that relationship. It happens to me. It’s inevitable. You’re in a busy ER, you’re busy NICU and that’s okay. The important thing is to recognize I’m becoming task oriented stop. And I think that’s what you’re talking about. Toggling up and toggling down. I think you talked about, you have to do three things.
Dr. Anthony Orsini (23m 1s):
Tell us about the three things you have to do when you recognize that you’re low and you need to get high.
Cy Wakeman (23m 6s):
The easiest, quickest way to toggle up is to use self inquiry. Now, ultimately you do that in the moment to change the moment. But if you do long-term contemplation and meditation and we don’t just pull out wellbeing practices. When we’re stressed, we need these habits and dedications to really, they can change our entire brain chemistry, how we want, but when your stressed and the first question to ask yourself is what do I know for sure? Like, I’m going to be here to midnight that I’ve got all this stuff to be done. And I’m the only person that cares. And I’m the only one that can do this. And I’m behind because of the electronic medical record. And it’s like, what will, what do you know for sure right now? And I call it come close in.
Cy Wakeman (23m 47s):
A lot of that times, I’ll say, come close in. What do you have to do in the next hour with three patients? Do you have everything you need to do that? Yeah. Then start there. What do you need to do today? And so when we get tasks, focus, when we get stressed with our tasks, we usually have toggled down. When we’re into tasks, I am the martyr. I am the victim, I am suffering. And so I just ask people, what do you know for sure. And if you get it down to, you know what today I know for sure. I’ll see some patients, I’ve got some dictation to do. I have some families to meet with, to make calls to make. What you’re going to find is that your days are pretty similar. Only every single day. It’s your reaction? That is so out of proportion, people come to me and they’re like, I want to be a surgeon.
Cy Wakeman (24m 30s):
I’m like, oh my gosh, be a surgeon. They’re a family practice doc. I’m like, I need more surgeons. And we have a med school right across the street. And they’re like, yeah, but I don’t want to go to four more years. I’m like awesome. Then be a family practice, doc. You already are one. I want to make what a surgeon makes. Awesome. I will put you on the search and eggs, just be a surgeon. And they’re like, I don’t want to do the schooling. I go great. The, be a family practice doc. And they’re like, you are preventing me from getting what I want. And I’m like, you have me in reality. So confused. I am here helping you get what you’re willing to have. And it all comes down to seeing reality for what it really is. All you have to do today are probably some of the same tests you had to do yesterday. All of your problems today are probably the same problems you had yesterday.
Cy Wakeman (25m 11s):
Like you don’t delegate, you don’t learn to keyboards. So electronic medical records hard. So what do you know for sure that releases the eco scrip on your reality. I’m driving to work. Someone moves over into the lane in front of me, the guy cut me off his male chauvinist pig. Look at this bumper stickers. He doesn’t like women drivers. He’s reckless. He’s irresponsible way. Ask stuff. What do I know for sure. All that happened as the person moves into my lane, allowing me less room than I prefer, that’s it. So the Eagle script has done that. Frees me up to say, what can I do next to help stop judging and start helping. I could let him into my lane safely.
Cy Wakeman (25m 51s):
And then if I were great, what would great look like? And those three questions, I run people through all the time. So we got three patients dumped on us and they purposely held these in the ed until they knew we had shift changed. And then they expect us to stay over and they lock us down. And this is, I’m like, whoa, what do we know for sure? We have three new intakes from the ed they’re in search protocol. That sounds really evidence-based and safe. They’re safer on our unit than they are in the hallways of the ed. Let’s commend our colleagues. When we get time. Now, what could you do to help? And we just drop the past and we go, well, I could intake these people. Perfect. If you were great, what would that look like? Well, I’m working on asking for help.
Cy Wakeman (26m 32s):
So I would ask my tech to do the following things and get the initial blood pressures. And I’m like, I love how you’re thinking. And the role of a leader is to help move us using self-reflection up to our highest and best self, because that is where we don’t burn out. We are tapped into an energy source that I don’t think people understand in medicine, how they get energy, because I see them when they start to feel stress and burnout, they do exactly the wrong things to try and conserve their energy.
Dr. Anthony Orsini (27m 4s):
So those are the three ways. And I think that works for just everyday life. The other thing that you said I thought was really important is really everything’s perception and how you perceive things. One of the things that I do that I actually love, I think you’re probably gonna think I’m crazy, but I love conflict resolution. And so I’m the doc that when I walk into the hospital, the charges nurse is like, so there’s an unhappy parent. There’s an unhappy patient. Can you go talk? And I smile. Like, I think I’m good at this. And I love doing this. And it’s a matter of perception. I’ll tell you a quick story. Many years ago, for those people that aren’t in medicine, when babies have to go usually four or five days, premature babies without forgetting to breathe before we’ll will send them home. And many of those babies need car seat pass. You put them in a car seat, make sure they’re okay.
Dr. Anthony Orsini (27m 44s):
These are all processes to make sure it’s safe to go home. So there was a baby who had a car seat, test pass, and then was changed to a different room. And the nurse didn’t know that the car seat test was already done. She did it. And the baby failed. So the parent was very upset because we sat down. Now we have tomorrow, we have to check it again. So it was one extra day in the hospital that night, the baby forgot to breathe. And that meant that now that baby had to stay five extra days. So the people who decided to handle this the way it was handled initially was again, how you deal with this. I’m sorry, Mr. The second nurse shouldn’t have done the car seat test. Otherwise your baby would have been home by now. And so that went crazy, right?
Dr. Anthony Orsini (28m 25s):
Well maybe dead, maybe not. So now the father is calling a friend, whose another doctor and it’s a big deal. So I come in and I go, oh, I could take this. And I introduced myself and I just said to the father, you must have an angel looking after for your daughter. There’s so many in heaven looking after your daughter. And he’s like, what do you mean? I said, thank God that second nurse did the car seat test. Cause your baby could have been home. And he looked at me and he said, my God, you’re right. And just the fuse by how you look at it. Right? I mean, so that’s basically what you’re saying. It’s just, and what you do. And you were talking about being a great leader, great leader. Just make you self-reflect right. They make you think about how to look at things differently.
Cy Wakeman (29m 7s):
I see things from a bigger perspective where it’s not just about you or how you, your ego is zeroed in on this moment of one mistake. It lets you see things from a bigger perspective, which always comes with relief and peace and conflict resolution. Like whenever we can widen our perspective. So many more options open up to us and physicians in particular do not realize their additional power because patients believe more of what physicians say than others. So when you even taking a different perspective with your rank, there’s a superpower you have that you can either add fuel to the fire. Like the friends did, that was called. Maybe that was the physician.
Cy Wakeman (29m 47s):
They shouldn’t have done that. Or to add that perspective. People want resolution, people want peace. People want a way to save face. People want a way out of conflict. And we don’t often give them that by giving them benefit of the doubt or gratitude or seeing things in a different perspective
Dr. Anthony Orsini (30m 4s):
And giving them a chance to toggle down to when you have an angry patient or an angry person. I do my four pillars of conflict resolution walking into the room when someone’s ready for a fight and saying, well, you’re a Yankee fan. I see that you have a Yankee’s hat, that disarms them, right? Like
Cy Wakeman (30m 22s):
That’s from my background, that’s cognitive dissonance. Like I want to hate this guy, but now he just want me likes the Yankees. There’s so few of us that like the Yankees,
Dr. Anthony Orsini (30m 33s):
I was so ready for a fight. And now I’m
Cy Wakeman (30m 35s):
Disarming. What would great look like disarming? So just translating for people, anything in disarming your first pillars, genius.
Dr. Anthony Orsini (30m 43s):
Well, thank you. I want to get to this question that as I’m reading your books and I’m listening to your talks and you know, we’ve had so many great people on this podcast and it’s incredible that people like you and other many amazing people that have been on the podcast. And a lot of times we talk about leadership and we’ve talked about leadership and a common topic is culture in business. And so I said at the beginning of the interview that you take a different perspective about that because you’re talking about the bitch moaning and whining. What would great look like many of the other people that I’ve spoken to it’s real big now is to talk about what a good leader should be. And you’ve mentioned that my question that I’m finally getting to after all this time is there are some bad leaders, there are some really bad leaders and those leaders create a bad culture.
Dr. Anthony Orsini (31m 34s):
And if we allow it, if we allow it, when you go into a business or a hospital and you have this dysfunctional culture, how do you Cy Wakeman decide whether this is a bitch moaning and why does your call BMW problem? And we need to, what would great look like and all that and get the workers to look differently. Do we need to train the leaders and are there some leaders that just have to go?
Cy Wakeman (32m 1s):
So when I’d want an organization, the first thing I introduce is non-dualistic or polarity in thinking, is this a bad leader? Or are these people whiners? Because that’s what most people, they want to be on this spectrum of duality. I’m like let’s transcend that. We probably have under-skilled leaders. We probably have a few social paths. If you look at the number of people employed and what gets you to be a leader, like here’s what I know for sure. We led comes mostly in this flavor. A few months are involved. We have some people overreacting to some poor leadership decisions made by some good leaders and some bad. So there are some people who need to go and there are also things to work on where people overreact or allowed their peace to they’ve outsourced their emotional experience to some CEO, three systems away that they’re like don’t ever see on a regular basis.
Cy Wakeman (32m 54s):
So what is coaching the person in front of you? So if it’s someone in front of me who said, I have a bad leader, I’m like, you know, some days are like that. So you either need to stay, enjoy and get skilled in working in the reality where a leader isn’t like you prefer, or you need to leave in peace, but staying in hating and staying in venting will ruin you and your health. You are the own source of your own suffering there. I have done great work for leaders. I didn’t prefer, I believe that work with the love HR. There are leaders that have misused privilege and have profound bias and do harassing things.
Cy Wakeman (33m 36s):
And I fired surgeons for throwing a scalpel at somebody because they were mad at them. And then there’s like, are there people who, when they’re believing, they’re thinking do horrendous things. Yeah. And what most people don’t do is they don’t move to transition some of the other system early enough. They have all this decision bias about keeping folks. And so I have one plus valve only work with the willing. So it doesn’t matter what your skill set is. Are you willing to learn this with the people need to evolve and need life skills no matter who they’re working with. And so some of that came to me and they’re like, I can’t be on shift with that person.
Cy Wakeman (34m 16s):
They’re horrible. It’s personality conflict. And I said, well, we’re not going to work around that. But what I can do is help you grow so that your care you give is unaffected by the behavior of colleagues or family members or patients. And then you can walk through the world freely. You know, I, you want me to control reality, but I could teach you how to evolve in the way that you can walk through the world freely. If you had the skills where you can kindly, but solidly call timeouts and you say, no, you can protect a patient from bad things. You have all that power. So when I come in, I tend not to say, let’s work on the whole culture. I tend not to want to scapegoat the leader.
Cy Wakeman (34m 56s):
I say, let’s start with you living well in your current reality. And then if you decide what those skills that you prefer, a different reality, you can always go and then we’ll work. Also another level, what we’re working with leaders to get them skilled up and their leaders to make sure that we’re not feeding the wrong group, that we’re not putting our great people on hold and having them be held hostage for a few. So when I’m with CEOs and CFOs and CMOs, I start with them and I say, you have 10 courageous decisions, your 10 courageous decisions away from a much better work culture. And they write the list and I go, not there yet. They write the list, not there yet.
Cy Wakeman (35m 37s):
And then things appear, we’ve got to get out from under the hold of this. I make that’s one courageous decision. And then when I work with people that have been promoted and aren’t yet skilled leaders, we skill them up. We do a lot of leadership development, but what we do that people don’t do we work with the employee is how can you walk through the world? Skillfully, personally, accountable with good change skills, top resiliency. So many people. And I interrupt to this. So you don’t have to fix the culture. We have to fix the climate, which is the team you work with, like your Neo. And they tell us, you have to fix the climate on that unit or in that division. And if enough leaders said that we always had great climates, we can control our workplace.
Cy Wakeman (36m 23s):
And at the times we had the interact with others that were more toxic because of the way we interacted. They would hand us the tug of war rope and we wouldn’t even pick it up. And so we started to find other climates and then we knitted those climates together. And that changed the culture or enough of the culture for our tastes. And so I don’t even believe in culture change as much I believe in climate change and then knitting those climates together. Cause I think it’s something we can do, but we’ve got to help people understand that people say change is hard. Change is only hard for the unready its readiness. During the pandemic, people are like site, how do I get my people resilient? And that people aren’t broken.
Cy Wakeman (37m 4s):
They already are resilient. These people made it through hard programs. The people who are in our dietary area, you know, are managing homeschooling kids and getting their butts to work. Like we have resilience, but resilience. The old thing is that people believe resilience is muscling through persevering. And my confidence is I’m the smartest person in the room or I’m the most prepared for every situation. True resilience from our research is collective genius. It’s not the person who has the most stamina or the person we’ve tortured the most in medical school. It’s the person who is able to be vulnerable, ask for help and crowdsources things. So think about COVID the first calls I got from ed that’s in New York Presbyterian.
Cy Wakeman (37m 47s):
And then they were like, what is going on? I don’t know how to deal with this. The respiratory illness is pretty easy. It’s pretty matter of fact, like it’s and they’re like, I used to know what I would see coming in my ed. I used to know everything about this. I’m like, no, that was how I was an illusion that certainty. And so I said, what if you include your confidence in the collective of genius of the whole, are you meeting with the ICU nurses? Are you tapping in to the CDC and tapping into? And all of a sudden they started learning about positioning patients and when the events, all of that learning came from people tapping into collective genius. And so there’s just so many things that we work on are mostly problems of the mind that people have come to believe things.
Cy Wakeman (38m 30s):
Not true. People are believing their own thinking. I’m like stop living your own thinking. And we can just in small, quick ways start to loosen the Eagle’s grip and people see a different way forward and things turn immediately. And here’s the key is you get this immunity I work with bad players all the time. It doesn’t change my quality of life. It doesn’t change my level of peace during the day, but you have to learn that. So an example is I had a physician who wouldn’t cover his tattoos, his a neurosurgeon. He had eight skulls tattooed up his arm. So whenever he would go out to brief the families, he wouldn’t put his lab coat on.
Cy Wakeman (39m 11s):
And so I first worked with them. I’m like, Hey, look, I got hooks. There’s no door. You can go out of that. There is no white coat with your name on it. And I even put chocolate in the pocket. So like, that’s your reward? Like, put your coat on. And I mean, I was necessarily, I’m like, I know you have a hard job. I will hire people to stand by the door, but you have to cover your tattoos. So I kept meeting with him. He goes, so you’re gonna fire me because I won’t cover my tattoos. And they go your thinking of quitting medicine so that you don’t have to cover your tattoos. Cause see, that’s how our mind turns things. And like, no, we simply have a policy. So you’re thinking of giving up your medical career because you don’t wanna wear a lab coat. What’s that about?
Cy Wakeman (39m 51s):
I couldn’t get him to do it. And finally he goes, I said, are you ever going to say yes, so this, and he goes, I’m just going to say no to this. I said, have you ever considered what would happen if you just said yes, just for a minute. He’s like, well, I probably wouldn’t have to meet with you every Monday morning. I go. Yeah. Like that, most of us don’t even consider it. If we just said yes to what’s being asked of us and how that frees us up. So I don’t believe at working on culture because it outsources our emotional experience to something vague let’s work on our climate, which is our relationship and how we lead and how we serve patients or customers. And that we can measure as well.
Dr. Anthony Orsini (40m 29s):
I mean with that, cause we all find ourselves doing that, right. Bitching and moaning and whining. And I heard about your Michelangelo thing. And David saying that all he did was he removed the imperfections. He didn’t create David. Right. And I love that. And I remind myself of that often because it’s easy to get into that bitch, moan and whine. It’s just, it is very easy to become task-oriented but I want to ask the same question that I ask every single guest. And that is please share with us your most difficult conversation that you’ve had during life or the most, if you’d like difficult type of conversation and give the audience some advice on how you were able to navigate through that conversation,
Cy Wakeman (41m 7s):
They have made a career out of having difficult conversations. I mean like you, I kind of, my mom would say she rushes in where angels dare to tread. So one of the most difficult conversations and there’s been many I’ve had, and I’ll give you my tips. I was very young and I was I’m working on the inpatient psych unit and there was a man named Dr.
Cy Wakeman (41m 49s):
O, he’s retired. He loves the story. So he won’t be mad. He was hell on wheels. So we had all heck breaking loose and it was time to give the medications to our patients. And I’m not licensed to do that. And we had just everything you can imagine going wrong on a psych unit was going wrong and all staff were engaged. So I called him and I said, Dr. O, I need you to return to the unit please. And he screams, he goes, I was just, f-ing on that unit. And I agreed with them. I dropped my into the tug of war rope. I go, yes. I just want to validate for you. I did see you. You were just on the unit. I think 5 minutes ago. He’s like, so I was just on that unit. I was just, there I go. You know, I think even if we checked security cameras, I could validate that you were just here and I wasn’t being sarcastic. My tone of voice. I’m like, I have found that when people want to argue with you or vent, just not collude with them, just if, as factual, that part’s factual. When people say you don’t know everything about this, I go, I think you’re absolutely right. I don’t. So that was my first technique.
Cy Wakeman (42m 29s):
And I said, I do need you to return. And I need someone here to pass meds. And he goes, are you an idiot? And I checked myself and I go, you’ll actually, I am, I hardly passed pharmacology. And that’s why I became BSW. And I didn’t go on to be a physician because in pharmacology, I can’t remember all those words and he just starts laughing and I go, seriously, I’m an idiot. And I can’t do this. Will you come up? So by the time he comes up, we need to go tend to a patient who’s out of control. And I said, before we do this, I’m glad you’re here. You and I need to go down. And at the time we called it the take down, there’s a person that’s going to harm himself and we need to give them some medication IV.
Cy Wakeman (43m 12s):
So he was yelling at me. He goes, this is absolutely ridiculous. And who runs this unit? You guys all don’t know what you’re doing in the middle. You hear is horrible. And I said, I’m glad to listen to all of those things. If we could focus on this, I’ll spend as much time as you want on those later, another technique, like let’s just deal with the issue at hand. And then he was yelling at me. And so one of the things I did, I learned as a therapist, as I started moving closer to him because you can’t raise your voice. If in a non-threatening way, I’m really close to you. And I started whispering, I lowered my frequency of my voice. And I just said, you know, you really need to focus right now. And he said, well, let’s go do this, take down. And I said, well, before we do, this is only you and me that care about your safety in that room.
Cy Wakeman (43m 53s):
And you’re smaller than me. And so I really need to protect you. And I’m just not sure. Cause I’m so mad at you right now. My feelings are so hurt that I would do a good job. It’s like what? They go. You need to apologize to me. No one asks for an apology. I do. You need to apologize to me. I would like that. What would help? I go to the apology he go say, I’m really sorry. I go, thank you. Let’s go in. And then as I deescalate that situation, my tips in this is before you go into a tough conversation, you’ve got to manage your own energy. Before you go have a conversation, you’ve got to get out of your own story. This sector, sector’s no right to yell at me. Is that? Yeah, that’s not right.
Cy Wakeman (44m 34s):
I had to get rid of all of that. All I knew is what do I know for sure? I have a doctor who’s not at his best. And I have patients who need him. So forget me. I’m going to connect the two. And then I had to not take any bait. And then I had to ask directly for what I hoped for. And I needed to manage my energy and speak my truth. The way I see it broaden perspective. There’s only two of us that care about your safety. And one of them is pretty upset here. And the thing I would tell folks is you cannot do this on the fly. You’ve got to get your techniques down and don’t practice with your hardest case. Practice, take your bravest moments with the most willing, even tell the most willing I’m about to practice something on you.
Cy Wakeman (45m 16s):
And will you go easy on me? Will you participate? So I’ve had so many of those conversations in the moment, you know, we all do in health care. We tell people they have STDs. We tell people that have cancer. We I’ve asked for two divorces. Those are hard. We agreed on this. You’re not living up to that. I need to divorce like, but we can’t always be open-hearted open-minded and we’ve got to remember, we ask for what we need and we tend to them. We don’t try and change them and tend to us. We get that so wrong. We want to control the other person and tend to our hearts. And what we need to do is control ourselves and tend to their hearts. And if you do that, I think that you’re good to go.
Dr. Anthony Orsini (45m 57s):
That’s great advice. So we always joke. I started by teaching, breaking bad news, how to teach doctors, how to give somebody tragic diagnoses. And we joke say the first thing you need to do before you enter the room is take your own pulse.
Cy Wakeman (46m 8s):
That’s thing. Me take your own pulse. And by the way, I would say evolve worked through your own death issues. Yeah. Like most of the people I worked with that wouldn’t refer to hospice just hadn’t worked through their own accumulated grief. It’s like,
Dr. Anthony Orsini (46m 23s):
Well, it happens with breaking bad news is that we don’t train our doctors. And when you are asked to do a task that you’re not comfortable doing. So if I said Cy, can you go do an appendectomy? You’re going to be pretty nervous. And so what we do is we don’t train the doctors or we give them an hour lecture. Then we say, all right, go tell that mother that her five-year-old died. Of course you’re going to be nervous. Of course your heart rate going to go up is going to be like Cy performing an appendectomy. So what we can do is we can teach them how to have these difficult conversations, make them proud of the skill, just like you’re talking about. So now when they have to go in, they don’t have a rapid pulse because they’re like, I’m good at this. And I can really make a difference in this family because I learned how to do it.
Dr. Anthony Orsini (47m 3s):
So stop asking people to do stuff that they’ve never been trained.
Cy Wakeman (47m 7s):
You’re being asked to do stuff you haven’t been trained on quit blaming medical school 15 years ago
Dr. Anthony Orsini (47m 14s):
Cause you can get trained now.
Cy Wakeman (47m 14s):
Evolve. But I think it’s so important. Most people when they’re under stress want to change reality. And what I encourage people to do is increase your skillset. So you can walk through the same reality, more skillfully. That’s how you reduce your stress. You don’t pray that reality will be different. Evolve yourself. The more you evolve yourself, the more loving you can walk through the world. The more peaceful you can walk through the real world. My next book is called life’s messy, live happy. And the whole premise is it’s not about what’s happening outside of you. It’s about the way you’re contemplating evolving and your habits and dedications so that you can walk through even chaos, skillfully and have these conversations.
Cy Wakeman (47m 57s):
And by the way, if we’re working with humans who have health issues, we’ll have hard conversations, but only a hundred times a day. Like why wouldn’t you want to be skilled on that?
Dr. Anthony Orsini (48m 8s):
That’s what I’m doing. And so we’re promoting this and I love your work. And this has been amazing, I know you’re up on a hard stop here, but I can probably do this to for two or three more hours. So we’ll talk more in Phoenix.
Cy Wakeman (48m 20s):
It’s going to say I will come back. The reason that people in our field, yours included love to come on podcasts is we want to help people. I mean, that’s why we got into this. So I hope our conversation. It helps. I’m glad to have many more. I hope we see each other in-person in November. That will mean the world is improving.
Dr. Anthony Orsini (48m 36s):
That’s fantastic Cy. The best way that people get in touch with you ?
Cy Wakeman (48m 39s):
Any way on social media is at Cy Wakeman, C Y w a K E M a N. My podcast is called the No Ego podcast. We talk about all kinds of great things and our website, RealityBasedLeadership.com.
Dr. Anthony Orsini (48m 52s):
We’ll put all that in the show notes. So if you’re driving, you don’t have to worry about pulling over. Cy, thank you so much. This has been an amazing, if you enjoyed this podcast, please go ahead and hit, download and subscribe on your favorite podcast platform. I can be reached at Dr. Orsini at the Orsini Way.com. Thank you so much. This has been a lot of fun. Well, before we leave, I want to thank you for listening to this episode of Difficult Conversations Lessons I learned as an ICU Physician, and I want to thank The Finley Project for being such an amazing organization. Please, everyone who’s listening to this episode, go ahead, visit The Finley Project.org. See the amazing things they’re doing. I’ve seen this organization literally saved the lives of mothers who lost infants.
Dr. Anthony Orsini (49m 34s):
So to find out more go to The Finley project.org. Thank you. And I will see you again on Tuesday.
Announcer (49m 41s):
If you enjoy this podcast, please hit the subscribe button and leave a comment and review to contact Dr. Orsini and his team, or to suggest guests for future podcasts, visit us at the Orsini Way dot com the comments and opinions of the interviewer and guests on this podcast are their own and do not necessarily reflect the opinions and beliefs of their present and past employers or institutions.
Dr. Anthony Orsini
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