Difficult Conversations Podcast
Lessons I Learned as an ICU Physician
Episode 165 | February 14, 2022
Wendy Dean, MD
President, Co-founder at Moral Injury of Healthcare
Welcome to Difficult Conversations with Dr. Anthony Orsini. On this episode, we have another amazing guest! Joining us today is Dr. Wendy Dean. Dr. Dean is a writer, speaker, podcast host, and the President and Co-Founder of Moral Injury of Healthcare, which is a nonprofit organization that provides training and consultation to organizations focusing on alleviating distress in their workforce. Dr. Dean has been a practicing clinician, trained in psychiatry. She also worked for the Department of Defense and was an executive for a large international non-profit, supporting military medical research. As always, Dr. Orsini keeps his promise about two things, that you will feel inspired, and you will have learned valuable lessons to be a better and more compassionate communicator.
Dr. Dean shares her background with us and her journey to becoming a doctor. She tells us why she decided to leave surgery and go into psychiatry? Find out why Moral Injury is a better term than burnout when describing what healthcare professionals are feeling right now. She goes in depth about the state of psychiatry and mental health care being in a tough place right now. We hear the story of how Dr. Dean met Dr. Simon Talbot, and what prompted them to start Moral Injury of Healthcare. Dr. Dean shares ways resiliency programs can help people, such as nurses, but they do not fix the problems that causes moral injury. Dr. Orsini and Dr. Dean share their thoughts on hospitals being run now by people who are not in the healthcare industry, and how there is a lack of quality communication. We hear some great advice from Dr. Dean about the future for Moral Injury of Healthcare and what she would like to see happen in facilitating the relationship between the patient and the clinician. After having this enlightening conversation today, Dr. Orsini concludes that physician burnout should be replaced with the term moral injury. If you enjoyed this podcast, please go ahead and hit subscribe on your favorite podcast platform. Go ahead and download this episode now!
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Dr. Wendy Dean (1s):
And so that was what I did with distress and healthcare. And I said, let’s erase everything we know about this phenomenon and start from the ground up. What is driving this problem and what was driving the problem over and over and over again, with the hundreds of clinicians I talked to was that I have trained to know what the gold standard of care is. I have been expected to reach that. And if I don’t, it’s a personal failure on my part. And then I go out into practice and immediately the second I walk into practice, I’m expected to compromise that gold standard of care because of something outside of my control.
Dr. Wendy Dean (45s):
So there are external drivers that tied my hands and made me feel like I have to choose something other than my patient to put first.
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 41s):
Well, welcome to another episode of Difficult Conversations: Lessons I learned as an ICU physician, this is Dr. Anthony Orsini, and I’ll be your host again today. For those of you who are looking for Liz Poret-Christ, my partner, she’s not with me today. It seems like the last few episodes, Liz has been a co-host and has been very popular. I’m getting a lot of emails, so we will have her back on, but today you’re just stuck with me today. We have another amazing guest. Our guest today is Dr. Wendy Dean. She’s a writer, a speaker podcast host, and the President and Co Founder of Moral Injury of Healthcare, which is a nonprofit organization that provides training and consultation to organizations focusing on alleviating distress in their workforce. A psychiatrist by training, Dr.
Dr. Anthony Orsini (2m 22s):
Dean has been a practicing clinician. She’s also worked for the department of defense, was an executive for a large international non-profit supporting military medical research. Dr. Dean graduated from Smith college and the university of Massachusetts medical school. She did her residency training in Dartmouth Hitchcock medical center in Hanover, New Hampshire. And I’m so excited to have her on today. We spoke about a month ago and really couldn’t get off the phone. So hopefully we can fit this all into a 45 minute podcast, because I know that you’re going to want to hear what she has to say, Wendy, thank you so much for being on.
Dr. Wendy Dean (2m 54s):
Thank you so much. I appreciate that.
Dr. Anthony Orsini (2m 58s):
Yeah. I’m really excited to talk to you. We just spoke a little bit before the podcast we first met, I guess maybe a month ago on the phone. I was listening to YouTube about Moral Injury by doctor. I guess he calls Dr. Zubin Damania . He mentioned your name and I immediately started to Google you and Simon. And I said, I just need to have Wendy on this podcast. So, you know, before we get into this whole more injury, because it’s such a big topic and my audience is about 75% healthcare, about 25% business. And for those people who are in healthcare, this is a topic that we’ve done several episodes on physician burnout, nursing turnover. It seems to be the same theme, but Moral Injury, I think really hits the nail right on the head.
Dr. Anthony Orsini (3m 41s):
And we’re excited to have you, but before we get into that, I always like to build rapport with the audience. You know, tell us about, you know, your background. I assume you grew up in Massachusetts. I know a little bit about Smith college. I have a friend whose son went there. I know it’s a small little college, but let’s get the audience to get to know you a little bit. Before we jump in,
Dr. Wendy Dean (4m 0s):
I grew up in Massachusetts, out in Western Massachusetts. I went to Smith college, which is a part of a five college kind of consortium. What I loved about it was I could take classes at a small liberal arts women’s college, or I could go down the road and take classes at UMass Amherst, which is a 30,000 student public university. So there was a huge range of opportunities open to me. And I think that started me down this road of kind of relentless curiosity of asking why and looking until I found good answers for things in whatever places I needed to look. I went from Smith college to UMass medical, which was a state school in Worcester.
Dr. Wendy Dean (4m 44s):
And it was only about 20 years old at the time, which was really kind of fascinating because it was still in the growth phase and wasn’t afraid of trying new things. And wasn’t afraid of just trying to turn out the best students that possibly could, who would go out into the world and do good things as good people. It was still establishing itself as an entity in medicine and the school provided exceptional training. I trained with folks from Harvard and we held our own. So it was an interesting education that I hadn’t planned to have.
Dr. Wendy Dean (5m 26s):
I just sort of said, well, UMass state tuition seems like a good idea. So I kind of stumbled onto that. And then I went and did training in surgery and loved the work itself, but struggled with what it demanded of surgeons. That you had to be a surgeon first and foremost, and kind of only in your life. And then I spent the next several years trying to sort out, how can I be in medicine in a way that does good for my patients, but is sustainable for me. And I was doing that long before there was talk about burnout or any other kind of distress in health care.
Dr. Wendy Dean (6m 9s):
In retrospect, looking back and saying, that’s how I got to this work. But at the time I was just trying to find a way to be a good doctor and not get ground up by the system.
Dr. Anthony Orsini (6m 21s):
That was pretty early, because as you said, No one was talking about physician burnout and it was almost a badge of honor. In those days, I remember about how much you can work. And I remember doing 36 hour shifts all the time. The surgeons used to have this mantra. I’m sure you heard it right. If you worked every other night, you miss half the cases. And you know, we have to work every day and I worked more hours than you. And so you were pretty progressive already starting to think about that work-life balance, et cetera. So you got out of surgery how’d you decide to go into psychiatry?
Dr. Wendy Dean (6m 52s):
Well, actually I went from surgery into working in an emergency room in very rural, Northern Vermont and New Hampshire. And that gave me an opportunity to see all kinds of medicine, everything walks through the emergency room in a rural area. And what I realized was that the psychiatry patients were the ones that really held my interest. They were intriguing. And we also didn’t know an awful lot about psychiatry and we still don’t. It’s still largely a black box. So there would always be something more for me to learn, which is really important for me.
Dr. Anthony Orsini (7m 32s):
You go into psychiatry and then let’s start talking about this Moral Injury. How do you start to, you know, you were very progressive early on, you already knew about this before people even talked about it. And now you, you start getting around this concept of Moral Injury. Tell us about what Moral Injury is, why you like to call moral injury. I think it’s a better term than professional burnout, but also how you got interested in that and how you got into this kind of, you know, little niche.
Dr. Wendy Dean (7m 59s):
So I had actually already left clinical medicine. When I started thinking about this, I practice psychiatry for just about a decade and realized that psychiatry and mental health care in general is a tough place right now. It has been systematically underfunded for decades, and I was not able to do the kind of care that I thought patients deserved. So I had the choice of either becoming someone who saw patients every 15 minutes or every 12 minutes to give them medication, but without doing anything that I thought was meaningful to change the course of their illness, in addition to the medication, or I could take another path, which is what I chose to do.
Dr. Wendy Dean (8m 41s):
So I left clinical medicine and went and worked for the department of defense, doing research, funding oversight. And in that job, I was not only looking at innovative technologies like regenerative medicine and hand and face transplants and understanding how those products got to market. And in the process of that, understanding how the gears of healthcare turn. So understanding all of the drivers of reimbursement and insurance and pharmacy benefit managers and all of that, that are behind how we practice. But I also had the opportunity to see how the military was approaching some of the challenges that service members were facing coming back from Iraq and Afghanistan, in terms of their deaths, by suicide PTSD, all of those challenges.
Dr. Wendy Dean (9m 38s):
And I was looking at what was happening at various medical centers across the country. So I had regular meetings with doctors who were at the tops of their fields across the country to talk about their research. But also as part of that conversation, you check in with them and say, how are things going? And what I did,
Dr. Anthony Orsini (10m 2s):
What year was this?
Dr. Wendy Dean (10m 3s):
Was, 2011 to 2018. And so I was talking to them and they were struggling. These are folks who are at the tops of their fields. They were really good clinicians. They were really good researchers. And yet they were saying, I love my job. I love the work I do, and my patients, but everything else around that, it’s just killing me. So then I, of course, you know, I started looking into this and saying, oh, okay, that’s burnout. You’re talking about burnout. And I would query them on that and say, oh, okay. So you’re feeling burned out and almost to a one, they would say, that’s not quite right. I don’t have any other language to use for that, but it’s not quite right.
Dr. Wendy Dean (10m 45s):
And so I started thinking about what else could this be? So as a good clinician, when I looked at how we’ve treated burnout for 20 years, we’ve tried a lot of things. We tried yoga and meditation and mindfulness and all of those things that we thought should work that have worked in other industries and none of them have worked. And so if I were a clinician and I were treating somebody for what I had diagnosed as pneumonia with antibiotics, and it wasn’t getting better, I would go back and say, do I have the right diagnosis? And so that was what I did with distress and healthcare.
Dr. Wendy Dean (11m 26s):
And I said, let’s erase everything we know about this phenomenon. And start from the ground up. What is driving this problem and what was driving the problem over and over again, with the hundreds of clinicians I talked to was that I have trained to know what the gold standard of care is. I have been expected to reach that. And if I don’t, it’s a personal failure on my part. And then I go out into practice and immediately the second I walk into, I’m expected to compromise that gold standard of care because of something outside of my control.
Dr. Wendy Dean (12m 5s):
So there are external drivers that tied my hands and made me feel like I have to choose something other than my patient to put first.
Dr. Anthony Orsini (12m 14s):
Yeah. And it hits home for me and for so many physicians that are listening out there. And sometimes it’s an external driver, sometimes the external drivers that you don’t have time. I give the example in some of my workshops in the middle of the night, I’m a neonatologist. As you know, we admit a baby for neonatologists at 33 34 week, baby. It’s not a big deal, but for a mother, that’s a big deal. They were expecting to take their baby home. They were supposed to go home, but we’re busy. And I always say this in my workshops. Sometimes I get so busy. I’ll admit the baby, get the baby tucked in, give good care. Maybe the father is up by the bedside, give him a quick update. And I know the right thing to do is to go downstairs and sit with the mother is post-op and can’t come up to see her baby.
Dr. Anthony Orsini (13m 1s):
Tell her, you know, this is a story, introduce myself, bond with her, but I don’t because I get busy or because as you call them external things that happen, or I get three other admissions and then you go home and you’re wondering why you feeling a little depressed? And I read something in a book a long time ago. It’s a, when people act contrary to their core beliefs and values, it causes depression. And that’s basically what you’re talking about is that whether it’s administrators, insurance companies, or the fact that we’re just too darn busy, I don’t really believe there are too many physician’s out there or physician’s assistants that go into medicine for the wrong reasons. I haven’t seen it.
Dr. Anthony Orsini (13m 42s):
I don’t, I mean, I’m sure there’s some, but there’s a lot easier ways of making money. So I think you’ve hit the nail right on the head and it, it really is hitting home with me, but it’s an issue. So you start at the Moral Injury. How did you meet Simon Talbot and how did you guys get together and start this?
Dr. Wendy Dean (14m 2s):
So Simon, one of the streams of funding that I had, that I was responsible for in the army, you know, working for the army as a civilian, not wearing a uniform by the way, was for hand and face transplants. And Simon is a hand transplant. So we were talking on calls. We would meet at various conferences and we actually were working on other things. We were looking at how some of the innovation concepts applied to VCA to hand and face transplant. And the more we started talking, the more we recognized that a surgeon and a psychiatrist, even though we were coming at the field of healthcare from very different angles, we had very similar experience.
Dr. Wendy Dean (14m 47s):
And it also helped that I’m a psychiatrist with a surgical mindset. And he’s a surgeon who is very psychologically minded. So we had that great. We were aligned in how we thought about things. And as we talked about our own backgrounds, we realized, oh wow, we have had the same experience that we haven’t been willing to share with many other people because it doesn’t feel right to say I can’t handle this. And as we talked with each other and we talked about the friends that we knew, we started realizing that this was a much bigger problem than just us individually. And that it’s a shared experience that a lot of people have and that we should maybe be talking about in a different way.
Dr. Anthony Orsini (15m 29s):
And so you hit the nail right on the head. Now you’ve defined the problem. It’s clear to me that you, it is not being overworked. It is not. I mean, this is all part of it. This whole resilience thing, just buck up and be tougher. And I, you know, I always tell the story. As I walked through a lot of hospitals when I’m doing my own It’s All in the Delivery programs for patient experience, and I watched these signs and I pass by this hallway once, and there’s a hospital there and there was a, it looked like almost a tic-tac-toe board. And it said resilience. And there were three nurses looking at the board and it said, if you’re feeling burned out, try these things. And it was, you know, meditate.
Dr. Anthony Orsini (16m 9s):
It was get, take more time off. It was, you know, get more sleep, exercise regularly. And the nurses were laughing. They said, well, if I had time to do that, I wouldn’t be feeling burned down in the first place. And so the hospitals are hiring one person may be in a system of a thousand beds to say, this is the resilience person. So call her if you’re feeling sick, or if you’re feeling like you’re depressed, et cetera. So you define it and you go, this is not it right. That we have to fix it a different way. And so now that you’ve defined the problem, what do you tell the people that are saying, yes, that’s me like, how do you help these people? And what do you think the solution is?
Dr. Wendy Dean (16m 51s):
I want to be clear that I think resilience strategies are important, but they’re not important for fixing the problems that cause Moral Injury. They’re important as a baseline practice. So I like to think of how we approach this as healthcare workers are high-performance machines. So we’re Lamborghini. You can’t leave a Lamborghini in a garage, not tune it up and expect that it’s going to perform well. So that resilience and the meditation and the yoga, whatever you find useful to maintain your baseline is critical. But when we talk about the drivers of Moral Injury, those are things like productivity metrics that are unreasonable staffing levels that are too low.
Dr. Wendy Dean (17m 37s):
The EMR that separates you from your patients during the day and from your family at night, all of those things are the drivers of Moral Injury, no amount of running or salmon salad is going to help you with those things. What we need to do is to start implementing systemic change that comes from leadership. That’s driven by leadership, but informed by the people on the front lines. So the challenge with that is it requires the folks who are experiencing Moral Injury and their leadership to be curious about each other and to ask each other, what are your pain points and how can we co-produce solutions to those?
Dr. Wendy Dean (18m 22s):
How do we reach across those barriers?
Dr. Anthony Orsini (18m 24s):
Yeah. And I think part of the problem is when you have hospitals and insurance companies, administrators, who are run by non healthcare people, non-physicians, non-nurses, it’s pretty common now for presidents and CEOs of hospitals or, you know, they’re accountants and the chief medical officer. I think in my experience 20 years ago, the chief medical officer used to have a lot more power and they were the advocates for the physicians. And now it seems like there’s in many cases, just pushed aside. So what are your thoughts about that?
Dr. Wendy Dean (18m 59s):
Yes. I worry a lot about that. And I also want to say that I don’t think there’s any administrator that goes into healthcare with outright malicious intent. I think they are also doing their level best to do the thing that they were trained to do, which is to keep the organization alive. The problem is that their goals and their training sometimes is divergent from ours. And so they make decisions. Having never been a clinician without awareness of what the impact is going to be on the clinical workforce. And really, I think sometimes it’s an innocent ignorance that they just don’t know how profound that impact will be.
Dr. Wendy Dean (19m 40s):
They don’t even know to ask because it just would not occur to them. You don’t know what you don’t know.
Dr. Anthony Orsini (19m 45s):
That’s a great point. Again, this is about conversations and communication. A lot of it is just a lack of communication. And as Susan Scott, who’s the author of fierce conversations. She was on my podcast and she talks about ground truth, which is, you know, an army thing that is it. You know, the general as the private is this sound right to you, you know, in the privates like, well, that’s actually, that’s not the way we do it. We had as a guest, Captain, Mike Abrashoff, who was a Navy person who graduated the Naval academy was given the worst ship in the entire fleet to command because as he joked, I finished at the bottom of my class. So they gave me the worst ship. And in two years, Dr. Abrashoff turned the ship from the worship to the best ship from the entire Navy in two years.
Dr. Anthony Orsini (20m 29s):
And the way he did that is he met with the thousand sailors on that ship. It’s a great interview. He said, you’re not going to leave my office until you give me a suggestion about how we can improve this ship. And each and every one of them. And some of them didn’t want to speak to the captain of the ship would tell him what he’s doing wrong. And he tells a great story about one Navy sailor who said, who was very reluctant to say anything. And he said, well, you’re not leaving. And so he got a little disgusted and he said, okay, do you know why we paint the ship every two years? And captain Abrashoff said, actually, I don’t know why we paint the ship every two years.
Dr. Anthony Orsini (21m 9s):
He says, because the rust from the bolts leaks out onto the ship and stains the ship, we have to paint the entire ship. And he said, did the Navy ever hear of stainless steel? So that went up the command from that private’s suggestion, the Navy changed the bolts that they were using. And so I think what you were saying previously was, it’s not that the administrators want to do any harm. It’s just that if we can talk, but the administrators say that the doctors want to do it one way, but the administrator has to say, well, Hey, we have to make money communication. How about we sit together in a room and we compromise and say, okay, that’s a great idea. I went to one hospital, I do a lot of patient experience stuff.
Dr. Anthony Orsini (21m 49s):
I went to one hospital. They were so proud of their new professional office building. And it was just finished. And we were walking through the computer station that the doctor has to look up labs and write his notes on while he’s in the office with the patient is against the back wall. So the only way the doctor can look a lab up is the turn his back or her back to the patient. And now they wonder why the patient doesn’t have a good experience. If that architect I’d said to just someone, what do you think about putting the desks here? The private, like, just to go back to the Navy analogy would have said, no, that doesn’t make any sense. I need the face, the patient. And so I don’t know how to fix that though, but it seems to be getting worse now, not better.
Dr. Wendy Dean (22m 34s):
So I think part of the problem is there is no time because we’ve cut staff to the bone in order to eke out more efficiency. So when you’re working 95% of your contracted time in billable hours, which doesn’t account for that hour or more on the backend that you need to use to do that all the non-billable tasks, there’s no slack in the system for communication like that. But that really is what we need to start building in. We need to be intentional about saying it is important to us to talk to each other about this environment that we work in.
Dr. Wendy Dean (23m 18s):
And it’s important for us to talk about what the pain points are, why it’s not good for our patients. What we know about patient care that doesn’t fit with the typical lean management models. There are some parts of lean management that are great, but there are other parts of it. If you’re a non-clinician that you might not understand why they don’t apply to clinical medicine.
Dr. Anthony Orsini (23m 41s):
Yeah. It’s hard. So what advice do you have you have Moral Injury of healthcare, the nonprofit organization. What is it exactly that you do with that nonprofit? What advice do you have and prediction about the future for those people who, my goodness, what’s your estimated Moral Injury? It’s 80% night. I mean, I, I don’t know anybody who doesn’t relate to this topic, no one in medicine.
Dr. Wendy Dean (24m 5s):
We’re actually right in the middle of trying to find that out because, so we have to remember that this is a brand new concept in healthcare, July 26th, 2018 was the date that Moral Injury actually entered the healthcare lexicon. That is a minute ago. So when you think that we’ve been talking about burnout for 20 years, we know a lot about it, and we are just starting that journey with Moral Injury. So one of the things that we’re doing is we’re in the process of validating a survey right now that will help us understand better what the incidents of Moral Injury is across all of healthcare, including administrators, by the way, because I do think that they experience it in their own way, but of course, we’ll be looking at nurses and doctors and physical therapists and all of the other clinicians.
Dr. Wendy Dean (24m 57s):
That’s one of the things that we’re doing. We’re raising awareness, just helping people understand what this concept is and why it’s different than burnout and why that matters. And we are also offering the opportunity for organizations to have us come in and talk about what this is and how they, as an organization can take steps to mitigate it. So what that looks like is changing the culture of the organization. That sounds like a big ask, but it doesn’t necessarily have to be, it means reframing how we think about what care is and what the responsibility of clinicians is relative to the administration.
Dr. Wendy Dean (25m 44s):
So right now we find that clinicians they’re answerable to a lot of different departments in their organization. They may be answerable to risk or to safety or to finance because of their productivity. What would happen if we flip that script and instead said, finance risk, safety, what have you done today to facilitate the relationship between the patient and the clinician, which is the cornerstone of why we’re here. So, for example, when I was working as an executive in the large nonprofit, I had 2000 people across the world who were facilitating research and I wasn’t asking them to come and report to me about what are you doing to make sure that there is no corruption?
Dr. Wendy Dean (26m 29s):
What are you doing to make sure that you’re adhering to compliance requirements? It was how can the compliance office help you? How can our home office help you do the job that you need to do? And that’s what I would like to have happen in healthcare right now. There are 10 to 11 non-clinicians for every physician. I would really love for them to start thinking about how to facilitate the clinician-patient relationship better.
Dr. Anthony Orsini (26m 55s):
Yeah. One of the things that I’ve been a big proponent of what I’ve done when I’ve given some keynotes and other lectures about what I do, communication medicine, building relationships with your patients. And we’ve talked about this many times, it’s even, I spoke about this. You have all this stuff going on, this, this Moral Injury, et cetera. The only Haven that you safety place that you have is in the five minutes that you have with that patient or 10 minutes that you have that patient. And to, at least I have found that it’s very helpful for me to take the breaths, close the door behind me, sit down and enjoy my patient. Try to get that out of your now, you know, there’s all these other stuff.
Dr. Anthony Orsini (27m 37s):
And we do a lot of work with, how do you make that 10 to 15 minute visit with your patient, even though you only have 10 minutes, how do you build that relationship quickly? Like there are certain techniques that you can use and enjoy that. So find at least some satisfaction in that 10 minutes. And I think we need to do that. I’m a big proponent of professional scribes. And I think, I don’t know your thoughts about that and not scribes that are medical students that are going to be gone in a year, but professional scribes that can come into the office and allow you to not put your back to the patient and look in your patient’s eyes and enjoy them and not have to worry about the EMR because 90% of it has done for you.
Dr. Anthony Orsini (28m 21s):
And so I think little things like that, where we have to stop thinking short term saying, okay, well the scribe may take 25, $30 an hour, but the doctor can probably see four more patients. For some reason, we seem near-sighted with that.
Dr. Wendy Dean (28m 35s):
So I think there are two sets of solutions. There are lots of levels of solutions. I think what you’re asking me are, what are the things that an individual can do? And I think you’re absolutely right that right now we have got to do something to relieve the distress that individual clinicians are experiencing. If that takes a scribe, let’s do the immediate thing of getting them a scribe. But why aren’t we pushing back and saying, why do we have an intuitive user interface on the EMR instead of needing a scribe
Dr. Anthony Orsini (29m 7s):
Because the EMR is designed for the billing.
Dr. Wendy Dean (29m 10s):
I understand. I understand. But that doesn’t mean we shouldn’t demand it,
Dr. Anthony Orsini (29m 13s):
Then it goes Moral Injury. Right? Right. And so,
Dr. Wendy Dean (29m 15s):
And when, when I hear the pushback of, well, we’ve already invested, I don’t care about, so your sunk costs. What I care about are your clinicians that your sunk costs are drowning. And I think it is absolutely reasonable to have clinicians demand an intuitive user interface that will be seamless. That will be as easy to use as your iPhone or your other smartphone that you can do in two minutes that doesn’t require 10,000 clicks a day,
Dr. Anthony Orsini (29m 50s):
A hundred percent and let’s enjoy our patients. Yeah. So there’s two solutions. There’s what can I do? The person who’s listening to this right now is Wendy, I’m feeling this, what can I do? And so we talked a little bit about that, but there’s a bigger solution and that’s a bigger bite to take into. I mean, that’s a tough one.
Dr. Wendy Dean (30m 7s):
So it’s sort of this dialectic, which is we’re doing the best we can right now, which is we’re going to get a scribe. If you need a scribe, get whatever you need to get through today, but also think about what you need to be better tomorrow. How could this whole thing be designed better rather than patched together with duct tape and bailing wire.
Dr. Anthony Orsini (30m 27s):
Yeah. Fantastic. So I think that’s just so much to think about I’m optimistic, maybe people like you and your organization and whether they’re calling it burnout or Moral Injury. I think Moral Injury is a better term, but the awareness that wasn’t here five years ago, I did a global summit on physician burnout, just over the summertime. We had Robin Simon on as a guest. She’s the Emmy award-winning filmmaker who made the movie, Do No Harm. It’s a documentary about the number of suicides in residents and physicians and how that’s going. So I’m optimistic. And the topic is really way up there probably next to patient experience.
Dr. Anthony Orsini (31m 8s):
The topic of physician burnout is way up there and I’d started to seep into the general public. And that’s why I’m optimistic. I think the general public is now saying, wait a second, I don’t want to depress doctor. I don’t want a doctor who’s has got Moral Injury. I want my doctor to be at her best.
Dr. Wendy Dean (31m 23s):
And I want a doctor whose hands aren’t tied. I want a doctor who can practice the way they were trained to practice, which is to get the gold standard for their patient and to put their patient in who can keep their promise, which is to put my patient first always. Not the business, not my productivity standards, not the EMR. My patient comes first. That’s all, any of us want?
Dr. Anthony Orsini (31m 48s):
I say that to my residents all the time. You know, you have dilemmas, whether they’re clinical dilemmas or their dilemmas between the system and your beliefs in the end, I tell them, you just sit back and say, what would I do if this were my son? What would I do if this were my daughter, how would I want to be treated? And then you can deal with the issues later on, but you want to protect yourself, say I left and maybe I didn’t do what the administration wanted me to do or the policy, but I treated that baby like it was mine and I’m going to feel good about myself when I leave.
Dr. Wendy Dean (32m 22s):
Yeah. I was in the emergency room a few weeks ago. There were two clinicians who were arguing back and forth about what was okay to do. Can we let this person look at this chart? Is that okay? In order to help us, you know, move these images and from the room I heard, can you please just do what’s right for the patient, from the patient. And that’s really what should guide us.
Dr. Anthony Orsini (32m 44s):
I love that. And you know, we have all these roles with COVID and they’re all good rules, and they’re all really important. But you know, sometimes you have to say, listen, you know, that babies dying and the mother really wants the grandmother to see the baby before she died. So I know the hospital policy says I shouldn’t, but we’re going to figure something out. You know? And most of the time, as you said, the administrators want the best. So most of the time, you know, get perspective. They’re like, you know, Dr. Orsini, you did the right thing and you know, you were careful. And we did that. So I love that. I have an old partner who just retired and 10 times a day, he would just say babies first.
Dr. Anthony Orsini (33m 24s):
That was his mantra. Baby’s first. I love that. I don’t care. You know what the policy is, what about insurance or payment or whatever, or the baby comes first and I’ll deal with that. And I’ve learned a lot. I think that’s a big step. And I think it’s a big step. What you’re doing with your podcast. I’ve had an opportunity to listen to a few episodes. It’s great. I’m learning a lot and we’ll put that all on the notes. I just want to thank you for being here. I think this is so enlightening and it adds to our conversation of five or six other episodes, but physician burnout now is going to be replaced in my vocabulary with Moral Injury because you hit the nail right on the head. So thank you so much for being here.
Dr. Wendy Dean (34m 2s):
It’s my pleasure. Thank you so much.
Dr. Anthony Orsini (34m 3s):
Best way for people to get in touch with you. We’ll put it in the show notes. What’s the best way for them to get in touch with you
Dr. Wendy Dean (34m 10s):
WDean at Moral Injury. healthcare, or they can go to the website, which is fixed Moral Injury.Org .
Dr. Anthony Orsini (34m 17s):
And the podcast is moral matters. Correct. And that’s on, I think just about every podcast platform I can imagine. So thank you so much. If you enjoyed this episode, please go ahead and subscribe or follow, and then you can get in touch with me at the Orsini Way.com. Go ahead and download previous episodes. Some of them that we mentioned today, I’m just so honored to have Dr. Dean here. And I want to thank her one more time and say, thank you so much.
Dr. Wendy Dean (34m 42s):
Announcer (34m 43s):
If you enjoyed this podcast, please hit the subscribe button and leave a comment and review. To contact Dr. Orsini and his team, or to suggest guests for future podcast visit us at TheOrsiniWay.com. 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
Wendy Dean, MD
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