WEBVTT 00:00:09.769 --> 00:00:12.390 anesthesia enthusiasts, and welcome to Style 00:00:12.390 --> 00:00:15.990 Points. My guest today is Dr. Jay Mizrobian. 00:00:16.129 --> 00:00:18.589 He trained in anesthesiology at the University 00:00:18.589 --> 00:00:21.609 of Pennsylvania and completed a pediatric anesthesia 00:00:21.609 --> 00:00:23.870 fellowship at the Children's Hospital of Philadelphia, 00:00:24.149 --> 00:00:27.829 and he has practiced in academic, private, hospital 00:00:27.829 --> 00:00:30.469 -employed, and national group settings for more 00:00:30.469 --> 00:00:33.570 than 25 years. He served as national medical 00:00:33.570 --> 00:00:35.890 director and chief clinical officer for Team 00:00:35.890 --> 00:00:39.549 Health Anesthesiology. leading roughly 1500 clinicians 00:00:39.549 --> 00:00:43.070 across 23 states. He's a past president of the 00:00:43.070 --> 00:00:45.969 Wisconsin Society of Anesthesiologists, served 00:00:45.969 --> 00:00:48.869 as treasurer of the ASA, and has served on the 00:00:48.869 --> 00:00:51.509 boards of the ASA, the Anesthesia Quality Institute, 00:00:51.710 --> 00:00:54.189 and the Anesthesia Patient Safety Foundation. 00:00:54.649 --> 00:00:56.990 He holds a degree in philosophy from Princeton 00:00:56.990 --> 00:00:59.890 and a physician executive MBA from Tennessee. 00:01:01.770 --> 00:01:04.730 Jay, welcome to the show. It's great to be here. 00:01:04.810 --> 00:01:07.500 Thanks for having me. It's a real honor and privilege 00:01:07.500 --> 00:01:10.079 to have you. I'm glad that you stopped by after 00:01:10.079 --> 00:01:11.920 your Grand Rounds talk, after you've already 00:01:11.920 --> 00:01:14.319 been talking to people for close to an hour. 00:01:14.659 --> 00:01:16.900 You caught me at a good time. It's a good time 00:01:16.900 --> 00:01:19.620 to just keep me talking. So let's go. I'm excited. 00:01:19.879 --> 00:01:23.099 That's good. I appreciate that. To start, I wanted 00:01:23.099 --> 00:01:25.359 to ask a question that I've been asking all of 00:01:25.359 --> 00:01:28.739 my guests for a long time, which is my who would 00:01:28.739 --> 00:01:31.340 you take to dinner question. If you had the opportunity 00:01:31.340 --> 00:01:33.920 to have dinner with anyone, could be somebody 00:01:33.920 --> 00:01:36.959 from the past or even from fiction, who would 00:01:36.959 --> 00:01:40.480 you have out to dinner and why? It's a tough 00:01:40.480 --> 00:01:42.400 question. It's kind of like picking my favorite 00:01:42.400 --> 00:01:44.760 child or favorite song. But I'm going to give 00:01:44.760 --> 00:01:47.040 you one I thought about yesterday. As our plane 00:01:47.040 --> 00:01:49.659 was landing in Cincinnati, Ben Franklin popped 00:01:49.659 --> 00:01:53.579 into my head. And I thought about someone who 00:01:53.579 --> 00:01:57.620 could probably have insight into but also amazement 00:01:57.620 --> 00:02:05.299 at science. politics, journalism, a man of many 00:02:05.299 --> 00:02:08.699 talents, and I would love getting his perspective 00:02:08.699 --> 00:02:10.719 on what we're doing today and how we're doing 00:02:10.719 --> 00:02:15.740 it. He's really interesting. He's a polymath, 00:02:15.819 --> 00:02:19.060 as I recall, and he had so many different talents 00:02:19.060 --> 00:02:21.960 across so many different fields, which I think 00:02:21.960 --> 00:02:24.120 is something that seems like it's a lot more 00:02:24.120 --> 00:02:27.280 rare today. I think there's something, though, 00:02:27.300 --> 00:02:29.699 common to everything he did, which is he had 00:02:29.699 --> 00:02:33.900 intense curiosity. He had the ability to listen 00:02:33.900 --> 00:02:38.759 and develop consensus around ideas. He was an 00:02:38.759 --> 00:02:41.319 amazing influencer around the development of 00:02:41.319 --> 00:02:44.819 the Declaration. Probably our first effective 00:02:44.819 --> 00:02:48.979 ambassador for his time in France. A scientist. 00:02:49.539 --> 00:02:51.719 Before he did all that, he published a paper. 00:02:51.939 --> 00:02:56.979 So he understands that confluence of Public thinking, 00:02:57.319 --> 00:03:00.400 public opinion, but also how do you advance an 00:03:00.400 --> 00:03:04.740 idea? Now, after you've given your grand rounds, 00:03:04.900 --> 00:03:07.479 I already have some of the answers to the questions 00:03:07.479 --> 00:03:09.979 that I was going to ask you. But for the rest 00:03:09.979 --> 00:03:11.639 of my audience who didn't happen to be at grand 00:03:11.639 --> 00:03:14.120 rounds, I'm going to cover some of the same ground 00:03:14.120 --> 00:03:19.860 pretty briefly. Philosophy, that was your major. 00:03:20.639 --> 00:03:25.639 Tell me about how that has served you. what your 00:03:25.639 --> 00:03:28.180 take is on philosophy and medicine in general. 00:03:28.620 --> 00:03:31.479 Yeah, I will. You know, when I decided to be 00:03:31.479 --> 00:03:33.120 a philosophy major in college, that was many 00:03:33.120 --> 00:03:36.520 decades ago. And I did it because I liked the 00:03:36.520 --> 00:03:38.439 subject matter, I liked the way it made me think, 00:03:38.580 --> 00:03:42.099 and I liked the way it held me accountable to 00:03:42.099 --> 00:03:44.539 having an argument or a discussion that made 00:03:44.539 --> 00:03:48.219 sense. How did it influence me? I don't think 00:03:48.219 --> 00:03:50.199 I really appreciated it for the first couple 00:03:50.199 --> 00:03:55.550 decades. When I really had to get into roles 00:03:55.550 --> 00:03:59.789 where how I brought teams together successfully 00:03:59.789 --> 00:04:04.229 or unsuccessfully, how I made decisions, often 00:04:04.229 --> 00:04:06.090 in the face of evidence that may not have been 00:04:06.090 --> 00:04:12.430 clear. When those type of deeper under the waterline 00:04:12.430 --> 00:04:14.849 challenges started coming up, that's when I started 00:04:14.849 --> 00:04:17.870 appreciating it. I would often get told in meetings, 00:04:18.029 --> 00:04:21.990 man, you ask a lot of questions. You always want 00:04:21.990 --> 00:04:24.589 to get... understand why ideas make sense. And 00:04:24.589 --> 00:04:26.649 that's when I started, when people started giving 00:04:26.649 --> 00:04:29.569 me that feedback, for better or worse, is when 00:04:29.569 --> 00:04:33.110 I started appreciating that seed training that 00:04:33.110 --> 00:04:36.350 was planted in college around assessing others' 00:04:36.470 --> 00:04:38.550 ideas, do different points of view make sense 00:04:38.550 --> 00:04:42.250 or not? And how do you ask more questions to 00:04:42.250 --> 00:04:45.410 get more clarity? And ultimately, how do you 00:04:45.410 --> 00:04:47.389 make sense of something and make a decision, 00:04:47.529 --> 00:04:49.649 even though you may not have a final answer? 00:04:50.170 --> 00:04:52.410 So it wasn't evident right away. I think it took 00:04:52.410 --> 00:04:55.310 time to develop the experience to allow that 00:04:55.310 --> 00:04:58.649 latent education to kind of bubble up. Did you 00:04:58.649 --> 00:05:02.230 always want to do medicine? Like many of us, 00:05:02.230 --> 00:05:03.889 to be perfectly honest, I went into medicine. 00:05:03.949 --> 00:05:06.529 I had an older brother who was an anesthesiologist, 00:05:06.629 --> 00:05:08.569 11 years older than I am. He didn't influence 00:05:08.569 --> 00:05:11.329 decision for anesthesia. But so I had a little 00:05:11.329 --> 00:05:13.529 bit of a role model in health care in general. 00:05:15.069 --> 00:05:17.470 I was like many of us. I had very simple reasoning. 00:05:17.920 --> 00:05:19.480 I wanted to help people. I thought it would be 00:05:19.480 --> 00:05:22.879 challenging. And I liked the idea of doing it. 00:05:22.980 --> 00:05:26.139 So I went into it with some very simple, basic 00:05:26.139 --> 00:05:28.300 things. I really did not know I wanted to do 00:05:28.300 --> 00:05:31.079 it until I was well into college. One thing that 00:05:31.079 --> 00:05:35.920 I found interesting about looking through your 00:05:35.920 --> 00:05:39.519 history was that you did a Peds Fellowship. Tell 00:05:39.519 --> 00:05:42.860 me about what led you that direction. It was 00:05:42.860 --> 00:05:44.920 just, you know, how you rotate different areas 00:05:44.920 --> 00:05:46.959 in the operating room or outside the operating 00:05:46.959 --> 00:05:49.759 room, and some of it's just, what's comfortable? 00:05:50.019 --> 00:05:52.519 Do I like the people I'm working with? Do I like 00:05:52.519 --> 00:05:55.740 interacting with parents? In our specialty, you 00:05:55.740 --> 00:05:58.319 have people who avoid certain things like the 00:05:58.319 --> 00:06:00.600 plague. They'll avoid pediatrics, avoid cardiac, 00:06:00.740 --> 00:06:04.399 avoid OB. I wasn't very good at cardiac. That 00:06:04.399 --> 00:06:06.000 was pretty much a no -brainer. I wasn't going 00:06:06.000 --> 00:06:08.720 to go into B cardiac. But something about peds 00:06:08.720 --> 00:06:12.399 resonated. I loved the teamwork in it. I loved 00:06:12.399 --> 00:06:14.779 the intense focus on the patient. There was something 00:06:14.779 --> 00:06:18.579 a little different about kids. So it was a natural 00:06:18.579 --> 00:06:23.279 to just kind of make that decision. Is working 00:06:23.279 --> 00:06:27.600 with children something that helped prepare you 00:06:27.600 --> 00:06:31.920 for leading large groups of adults? I'm going 00:06:31.920 --> 00:06:34.360 to tell you a funny story about that in retrospect 00:06:34.360 --> 00:06:36.899 when we get to the end. But yes, that's a great 00:06:36.899 --> 00:06:38.680 question I hadn't thought about, but I would 00:06:38.680 --> 00:06:43.959 say yes, because Unlike adults, children are 00:06:43.959 --> 00:06:45.600 not always telling you what they're thinking, 00:06:45.720 --> 00:06:49.360 feeling, or how they're understanding what you 00:06:49.360 --> 00:06:52.740 say to them. So how you present yourself, how 00:06:52.740 --> 00:06:55.560 you develop a safe environment for them to kind 00:06:55.560 --> 00:06:59.339 of relax, to understand what's going on without 00:06:59.339 --> 00:07:03.759 pressing you, pressing them to do something creating 00:07:03.759 --> 00:07:07.319 stress, is very much applicable to how you manage 00:07:07.319 --> 00:07:10.079 teams of people. Now, having said that, I'll 00:07:10.079 --> 00:07:11.680 tell you a story that just this last summer, 00:07:11.759 --> 00:07:14.939 I had my first opportunity to coach an urban 00:07:14.939 --> 00:07:17.740 little league team in Milwaukee of T -ballers. 00:07:19.319 --> 00:07:21.980 Hands down the hardest management task I've ever 00:07:21.980 --> 00:07:25.019 had in my life. So I do think there's something 00:07:25.019 --> 00:07:28.019 in there about how do you relate to children 00:07:28.019 --> 00:07:31.540 to gently get them to see what you're trying 00:07:31.540 --> 00:07:35.360 to say, communicate what your idea is so that 00:07:35.360 --> 00:07:37.339 they will do in general what you'd like them 00:07:37.339 --> 00:07:41.680 to do. I had the opportunity to watch my wife 00:07:41.680 --> 00:07:44.819 coach my five -year -old daughter's soccer team 00:07:44.819 --> 00:07:48.300 last night from 7 p .m. to 8 p .m., which is 00:07:48.300 --> 00:07:51.160 a terrible time to have soccer practice for five 00:07:51.160 --> 00:07:58.720 -year -olds. And her struggle was apparent. It's 00:07:58.720 --> 00:08:02.000 like herding cats. Even in the best of times. 00:08:02.079 --> 00:08:04.759 She's a pediatrician. She knows how to manage 00:08:04.759 --> 00:08:08.949 kids. But, boy, it was... hard to maintain their 00:08:08.949 --> 00:08:11.170 focus. You know, same thing. I remember doing, 00:08:11.189 --> 00:08:13.529 taking care of these kids and, you know, 90 degree 00:08:13.529 --> 00:08:16.250 weather outside. And one point, one of them looked 00:08:16.250 --> 00:08:18.269 at me and he got this lower lip out and he goes, 00:08:18.350 --> 00:08:23.009 you're mean. And I thought to myself, oh yeah, 00:08:23.149 --> 00:08:25.410 maybe I need to lighten up. But that, you know, 00:08:25.410 --> 00:08:27.529 that's, that's, you asked, started this question 00:08:27.529 --> 00:08:31.850 by, is this analogous to how you lead? Absolutely. 00:08:32.450 --> 00:08:34.389 Because if someone, if you're coming across to 00:08:34.389 --> 00:08:39.289 someone as autocratic, dictatorial, or mean you 00:08:39.289 --> 00:08:41.889 have a problem and you need to adapt. You need 00:08:41.889 --> 00:08:44.250 to adapt on the spot. So if you want the best 00:08:44.250 --> 00:08:46.730 example of how is that applicable to leadership, 00:08:46.950 --> 00:08:49.149 that's how. You have to be able to adapt with 00:08:49.149 --> 00:08:51.029 kids. You need to be able to adapt with teams. 00:08:52.370 --> 00:08:54.929 Children, I've found, have the distinct ability 00:08:54.929 --> 00:08:59.649 to give direct feedback very well. Probably more 00:08:59.649 --> 00:09:02.870 than your team. More than I'd like sometimes 00:09:02.870 --> 00:09:06.620 as a father of three. I remember those days. 00:09:06.639 --> 00:09:12.139 I get it. So you were recently on the ASA's podcast 00:09:12.139 --> 00:09:14.600 Central Line. Yeah. And you were talking about, 00:09:14.679 --> 00:09:17.500 I would imagine, some of the same things that 00:09:17.500 --> 00:09:20.000 you talked to us in Grand Rounds about just now, 00:09:20.100 --> 00:09:24.679 which is humanities in medicine. Can you give 00:09:24.679 --> 00:09:28.120 sort of a synopsis of, not necessarily your whole 00:09:28.120 --> 00:09:31.860 talk, but your philosophy when it comes to instilling 00:09:31.860 --> 00:09:35.279 humanities in medicine? Yeah, I will. Let me 00:09:35.279 --> 00:09:38.320 preface this by saying, what are we talking about 00:09:38.320 --> 00:09:41.720 the humanities? We're talking about art, music. 00:09:43.080 --> 00:09:45.799 But in my case, what I talked to you all about 00:09:45.799 --> 00:09:48.519 this morning was really literature. So great 00:09:48.519 --> 00:09:52.200 literature, novels, history, poetry, philosophy, 00:09:52.340 --> 00:09:56.980 religion. The thesis I'm laying out for you based 00:09:56.980 --> 00:09:59.659 on my own experience, but also increasingly on 00:09:59.659 --> 00:10:04.070 neuroscience and leadership science. is that 00:10:04.070 --> 00:10:09.129 the humanities have a historical connection to 00:10:09.129 --> 00:10:12.470 our present -day challenges in leadership. And 00:10:12.470 --> 00:10:15.289 that in healthcare, we still often select leaders 00:10:15.289 --> 00:10:19.590 based on technical, financial, operational expertise, 00:10:19.769 --> 00:10:23.750 which are all critically important. But ultimately, 00:10:23.809 --> 00:10:25.570 what's going to help you succeed as a leader 00:10:25.570 --> 00:10:28.850 are what I call soft skills that are really hard. 00:10:30.350 --> 00:10:32.730 And those are the things such as resilience, 00:10:33.049 --> 00:10:37.149 discernment, getting perspective, asking questions, 00:10:37.490 --> 00:10:40.409 being able to understand the context of the situation 00:10:40.409 --> 00:10:43.070 you're in, the capacity for deep reflection. 00:10:43.950 --> 00:10:46.110 Those are the things that are going to really 00:10:46.110 --> 00:10:49.809 drive your success as a leader. But we don't 00:10:49.809 --> 00:10:53.049 train for those very much in health care. So 00:10:53.049 --> 00:10:54.950 that's really what I talked about is how can 00:10:54.950 --> 00:10:57.789 we make that connection between the humanities. 00:10:58.720 --> 00:11:02.899 as a tool to help you develop those types of 00:11:02.899 --> 00:11:05.860 soft, hard skills. And I think there is a role 00:11:05.860 --> 00:11:08.799 for them as a complementary support for leader 00:11:08.799 --> 00:11:12.299 development. Do you think there's enough emphasis 00:11:12.299 --> 00:11:16.919 on this in selecting candidates for medical school? 00:11:17.019 --> 00:11:19.419 I remember being part of an admissions committee, 00:11:19.519 --> 00:11:25.940 and this was back when I was in the tail end 00:11:25.940 --> 00:11:28.539 of medical school, actually. They asked me to 00:11:28.539 --> 00:11:31.320 interview a few candidates. And one of the things 00:11:31.320 --> 00:11:34.500 that I remember them saying was, we're trying 00:11:34.500 --> 00:11:39.840 to get more than grades. We're looking for people 00:11:39.840 --> 00:11:44.100 who have the capacity to be reflective, to be 00:11:44.100 --> 00:11:46.639 thoughtful, that can interact with patients better. 00:11:47.320 --> 00:11:49.519 Do you think there's enough emphasis on that? 00:11:49.600 --> 00:11:52.259 Or are we pushing too hard towards people who 00:11:52.259 --> 00:11:55.360 are good at taking multiple choice tests? Having 00:11:55.360 --> 00:11:57.399 not been on an admissions committee for medical 00:11:57.399 --> 00:12:00.500 school, I'll caution my comments, but with that, 00:12:00.539 --> 00:12:02.659 okay, so I certainly don't sit in the seats of 00:12:02.659 --> 00:12:07.559 those who do that work. I think there is a role 00:12:07.559 --> 00:12:09.860 for it, but perhaps it's a little limited. Let 00:12:09.860 --> 00:12:14.159 me explain what I mean. Yes, I would love candidates 00:12:14.159 --> 00:12:16.360 who have the ability, regardless of what they 00:12:16.360 --> 00:12:20.779 majored in in college, to pause before they speak, 00:12:20.960 --> 00:12:24.100 to take time to reflect on the situation they're 00:12:24.100 --> 00:12:27.210 in. to think about why am I studying this topic 00:12:27.210 --> 00:12:29.309 as opposed to getting the grade? How will this 00:12:29.309 --> 00:12:34.250 impact my thinking as a clinician? It's more 00:12:34.250 --> 00:12:37.549 an affect. But I think in medical school, we've 00:12:37.549 --> 00:12:40.210 kind of defaulted, and probably rightly so, to 00:12:40.210 --> 00:12:45.169 two things. Empathy and kindness is kind of the 00:12:45.169 --> 00:12:47.210 attributes you want to cultivate in students. 00:12:47.289 --> 00:12:49.029 And those are very good things to cultivate, 00:12:49.289 --> 00:12:53.259 but they're very different. than a broader executive 00:12:53.259 --> 00:12:55.460 skill set, the things I mentioned a couple minutes 00:12:55.460 --> 00:12:59.419 ago. You could argue that a medical student will 00:12:59.419 --> 00:13:01.980 not have the capacity or the practical experience 00:13:01.980 --> 00:13:05.059 to really talk about that type of deep skill 00:13:05.059 --> 00:13:07.980 set. So I think in a way it's unfair to require 00:13:07.980 --> 00:13:10.960 them to bring that. But I want to assess their 00:13:10.960 --> 00:13:13.980 capacity to develop in that way. I think that's 00:13:13.980 --> 00:13:16.639 very important. So I'd do it in a limited way. 00:13:16.679 --> 00:13:19.500 I certainly wouldn't make it. probably as much 00:13:19.500 --> 00:13:21.559 of a factor as it might be if I were selecting 00:13:21.559 --> 00:13:23.580 them 30 years later to run a large enterprise. 00:13:25.220 --> 00:13:30.460 I recall in medical school it being very competitive. 00:13:30.559 --> 00:13:33.360 We were all trying to get the top grades, get 00:13:33.360 --> 00:13:35.960 into the residency that we wanted to. It was 00:13:35.960 --> 00:13:40.919 very stressful. And I think a lot of my colleagues 00:13:40.919 --> 00:13:42.759 at the time, and I would guess that it's the 00:13:42.759 --> 00:13:49.879 same now, sort of something to brush to the side. 00:13:51.320 --> 00:13:55.220 How do we make the humanities more important? 00:13:55.379 --> 00:14:01.320 How do we emphasize it without encroaching on 00:14:01.320 --> 00:14:05.279 sort of the professional responsibilities that 00:14:05.279 --> 00:14:09.679 one has in trying to get those top scores? It's 00:14:09.679 --> 00:14:13.200 a really wonderful question. I would answer this 00:14:13.200 --> 00:14:18.090 way. If you make it a mandatory course, which 00:14:18.090 --> 00:14:24.049 you can do, that's fine. It gets more exposure. 00:14:24.289 --> 00:14:27.250 Everyone has to take it. You develop more rigor 00:14:27.250 --> 00:14:31.529 in the curriculum. That's great. But then it 00:14:31.529 --> 00:14:35.590 becomes no different than immunology, biochemistry, 00:14:35.889 --> 00:14:40.909 or anatomy. And so people will assess it based 00:14:40.909 --> 00:14:43.620 on... How useful is this to me? Am I really going 00:14:43.620 --> 00:14:45.820 to be using this or am I going to just put that 00:14:45.820 --> 00:14:47.899 book back on the shelf and forget it when I'm 00:14:47.899 --> 00:14:51.460 done? I think the goal of the humanities piece 00:14:51.460 --> 00:14:55.200 of education is to drive lifelong learning and 00:14:55.200 --> 00:14:58.740 appreciation. So, you know, as we discussed a 00:14:58.740 --> 00:15:02.419 little this morning, not being a sitting in the 00:15:02.419 --> 00:15:04.480 seat of those who develop medical curriculums, 00:15:04.519 --> 00:15:06.759 I would still wonder whether the better approach 00:15:06.759 --> 00:15:10.889 is. a more Socratic atmosphere where you're exposing 00:15:10.889 --> 00:15:14.210 students to a different way of thinking, discussing. 00:15:14.750 --> 00:15:18.049 I think critically important to success is sharing 00:15:18.049 --> 00:15:21.070 ideas with your colleagues. How does this make 00:15:21.070 --> 00:15:24.769 you feel, me feel? How might I, I hadn't thought 00:15:24.769 --> 00:15:27.110 of that type of conflict I might come into based 00:15:27.110 --> 00:15:30.570 on the reading you had us do. What I'd really 00:15:30.570 --> 00:15:33.269 want is a successful outcome for that is they 00:15:33.269 --> 00:15:36.389 say, you know what? I am going to keep this on 00:15:36.389 --> 00:15:39.789 my burner. for my entire life. I'm going to come 00:15:39.789 --> 00:15:42.210 back to reading. I think that's your outcome. 00:15:42.429 --> 00:15:44.389 So I want to be real careful. However you frame 00:15:44.389 --> 00:15:47.789 it up should be in a way that drives that outcome, 00:15:47.970 --> 00:15:49.809 not we got you through the semester, you got 00:15:49.809 --> 00:15:51.570 exposed to a little humanities, and you're done. 00:15:53.490 --> 00:15:55.549 One of the things that you talked about this 00:15:55.549 --> 00:15:57.750 morning that I thought was really interesting 00:15:57.750 --> 00:16:01.029 was where you were made professional director 00:16:01.029 --> 00:16:05.480 of your group, and then it ended up that the 00:16:05.480 --> 00:16:07.600 role was dissolved 18 months later, I think you 00:16:07.600 --> 00:16:15.379 said. You put your failure sort of front and 00:16:15.379 --> 00:16:18.820 center of the talk, and I think that that sort 00:16:18.820 --> 00:16:21.879 of vulnerability is really important. One of 00:16:21.879 --> 00:16:23.679 the talks that I have been giving to medical 00:16:23.679 --> 00:16:26.940 students for a long time that just sort of follows 00:16:26.940 --> 00:16:30.919 me through undergrad, medical school, and residency 00:16:30.919 --> 00:16:37.830 is called Mistakes I Have Made. It's an increasingly 00:16:37.830 --> 00:16:43.590 long talk. What do you think the role is of vulnerability 00:16:43.590 --> 00:16:48.129 and making connection with people and putting 00:16:48.129 --> 00:16:52.049 your failures up front? I think it's important 00:16:52.049 --> 00:16:55.429 in this type of discussion to be honest and share 00:16:55.429 --> 00:16:58.009 your experiences about where you failed and why. 00:16:58.789 --> 00:17:02.889 And I've failed later in life too. I remember 00:17:02.889 --> 00:17:08.329 distinctly failing with a practice leader once 00:17:08.329 --> 00:17:12.670 in one of my roles where I was probably being 00:17:12.670 --> 00:17:15.029 a little too forceful with what we needed to 00:17:15.029 --> 00:17:17.630 do at a broader level and not realizing the impact 00:17:17.630 --> 00:17:22.349 on him. So I don't want to make it seem like 00:17:22.349 --> 00:17:24.769 I just had one experience early in career and 00:17:24.769 --> 00:17:27.849 everything was great, but I used that early experience 00:17:27.849 --> 00:17:32.460 as a big miss. And I think about it almost every 00:17:32.460 --> 00:17:36.539 day of what should I have asked? What should 00:17:36.539 --> 00:17:40.599 have been defined more clearly? How would I have 00:17:40.599 --> 00:17:42.859 gathered the right group around the table to 00:17:42.859 --> 00:17:46.059 develop meaning and mission around this new position? 00:17:46.640 --> 00:17:50.140 What would successful outcomes look like? What 00:17:50.140 --> 00:17:52.359 are the areas we're all concerned about that 00:17:52.359 --> 00:17:54.319 are ambiguous about this that we're still going 00:17:54.319 --> 00:17:57.299 to have to work in? At the time I was offered 00:17:57.299 --> 00:17:59.660 that position, four or five years into practice, 00:18:00.349 --> 00:18:05.910 I had no experiment or experience -based context 00:18:05.910 --> 00:18:10.309 to really succeed there. And I own that. But 00:18:10.309 --> 00:18:13.529 I still think we do that a lot to clinical leaders 00:18:13.529 --> 00:18:16.170 today. We still pick them because they show up 00:18:16.170 --> 00:18:19.490 on time, get stuff done, colleagues like them, 00:18:19.630 --> 00:18:22.869 good clinically. Well, let's see if they're good 00:18:22.869 --> 00:18:25.190 for a leadership role. And as I said earlier, 00:18:25.660 --> 00:18:28.000 It's a different skill set that you have to add 00:18:28.000 --> 00:18:31.539 on to your subject matter expertise. Absolutely. 00:18:33.359 --> 00:18:36.720 One of the previous guests on this show said 00:18:36.720 --> 00:18:39.339 that the hardest part of leadership was knowing 00:18:39.339 --> 00:18:43.799 when to step down or step back. And he really 00:18:43.799 --> 00:18:45.859 struggled when there was unfinished business. 00:18:45.980 --> 00:18:48.880 Is that something that resonates with you as 00:18:48.880 --> 00:18:54.680 well? It does. You know, you always want to go 00:18:54.680 --> 00:18:56.940 into a meeting or a decision -making process 00:18:56.940 --> 00:19:00.200 or something with some sort of resolution because 00:19:00.200 --> 00:19:03.259 that's how we are trained as physicians or other 00:19:03.259 --> 00:19:07.200 clinical leaders. Get a decision, get the information, 00:19:07.519 --> 00:19:13.380 make a decision, develop consensus. There is 00:19:13.380 --> 00:19:15.539 no doubt in my mind that sometimes it's better 00:19:15.539 --> 00:19:20.619 as a leader to perhaps not make a decision. If 00:19:20.619 --> 00:19:25.759 you think there's more you need to learn, discern, 00:19:26.079 --> 00:19:28.700 ask questions about, or get different perspectives. 00:19:29.440 --> 00:19:31.980 A lot of times you have to make a decision based 00:19:31.980 --> 00:19:35.519 on inadequate evidence or in an area you're uncomfortable. 00:19:36.640 --> 00:19:38.640 Another way of framing an answer to what you 00:19:38.640 --> 00:19:42.720 said is, as a leader, as physicians, we're always 00:19:42.720 --> 00:19:44.680 taught to lean in. You're leaning into the clinical 00:19:44.680 --> 00:19:48.619 care. It's different as a leader. There's leaning 00:19:48.619 --> 00:19:51.750 in. They're sitting still where you let others 00:19:51.750 --> 00:19:55.109 around you develop the idea and you kind of moderate. 00:19:55.829 --> 00:19:58.150 There's also leaning back where you almost will 00:19:58.150 --> 00:20:00.509 actively take yourself out of a decision making 00:20:00.509 --> 00:20:03.930 process other than being there. So I think it's 00:20:03.930 --> 00:20:06.329 really important to kind of decide ahead of time 00:20:06.329 --> 00:20:07.730 which one of those characters you're bringing 00:20:07.730 --> 00:20:11.009 forward on the stage. And if it's not working 00:20:11.009 --> 00:20:14.450 to be able to adapt in a meeting or in a process 00:20:14.450 --> 00:20:18.339 and change your role. That's the key role compared 00:20:18.339 --> 00:20:22.779 to what you do in clinical work. Compared to 00:20:22.779 --> 00:20:26.880 when you were a little bit earlier in your life 00:20:26.880 --> 00:20:30.079 and your practice, over the past 10 to 20 years, 00:20:30.160 --> 00:20:34.700 how has your thought process evolved or changed 00:20:34.700 --> 00:20:39.420 when it comes to leadership and your philosophy 00:20:39.420 --> 00:20:45.160 in general? A couple things evolved over the 00:20:45.160 --> 00:20:49.740 years. One is try not to go in with any hard 00:20:49.740 --> 00:20:53.660 assumptions. We always say listen a lot, gather 00:20:53.660 --> 00:20:56.640 perspective. I think one of the prerequisites 00:20:56.640 --> 00:20:59.160 to doing that is really going in with a clean 00:20:59.160 --> 00:21:02.400 slate in your head and an open mind to listen 00:21:02.400 --> 00:21:07.180 genuinely. So if you go in with preconceptions, 00:21:07.180 --> 00:21:09.160 you've already turned off a lot of your ability 00:21:09.160 --> 00:21:12.210 to gather perspective. And I think that's a detriment 00:21:12.210 --> 00:21:15.170 that I've learned to try to manage effectively. 00:21:16.009 --> 00:21:20.829 The other thing I learned was, and is your physical 00:21:20.829 --> 00:21:25.910 affect and your physical presence can often influence 00:21:25.910 --> 00:21:30.609 how people see you. So I got told during the 00:21:30.609 --> 00:21:34.170 high days of Zoom, right after COVID, where people 00:21:34.170 --> 00:21:36.390 were meeting all on Zoom, one of my team members, 00:21:36.549 --> 00:21:38.470 we were in one -on -one conversation. She goes, 00:21:38.589 --> 00:21:41.609 hey, I just want to tell you. We can tell when 00:21:41.609 --> 00:21:44.869 you're upset on Zoom. Oh, really? And my face 00:21:44.869 --> 00:21:47.309 just blanched. I went, oh, no, I thought I was 00:21:47.309 --> 00:21:49.650 doing a pretty good job at this. But she goes, 00:21:49.769 --> 00:21:52.490 no, we can tell when someone says something and 00:21:52.490 --> 00:21:54.789 you kind of get a look, like you might look aside. 00:21:54.910 --> 00:21:57.250 And I went, I need to manage that. Because the 00:21:57.250 --> 00:21:59.710 minute people see that, you're not maintaining 00:21:59.710 --> 00:22:05.390 some evidence of neutrality, being open, but 00:22:05.390 --> 00:22:08.200 also holding people accountable. If you're inconsistent 00:22:08.200 --> 00:22:10.660 on that, they don't know what to expect from 00:22:10.660 --> 00:22:13.359 you. So those are two things I've learned, probably 00:22:13.359 --> 00:22:16.920 that physical affect, but also really turn off 00:22:16.920 --> 00:22:18.960 your brain before you go into a meeting if you're 00:22:18.960 --> 00:22:22.519 really going to listen and get perspective. How 00:22:22.519 --> 00:22:26.720 did you learn the skill of managing your own 00:22:26.720 --> 00:22:30.079 emotions to that degree? I'm not sure I ever 00:22:30.079 --> 00:22:36.460 really fully learned it. I think a lot of it 00:22:36.460 --> 00:22:38.640 goes into your preparation before a meeting. 00:22:38.799 --> 00:22:40.539 You know, you asked the last question, what did 00:22:40.539 --> 00:22:44.380 I learn differently? When you get to that, I 00:22:44.380 --> 00:22:46.839 learned to prepare myself better for a meeting. 00:22:46.980 --> 00:22:50.200 So I think many of us are so equipped going Zoom 00:22:50.200 --> 00:22:51.960 meeting to Zoom meeting to in -person meeting 00:22:51.960 --> 00:22:54.720 to other meeting to phone call, you never really 00:22:54.720 --> 00:22:58.660 pause to do that deeper level of thinking. Why 00:22:58.660 --> 00:23:01.900 am I doing this? Why am I going to the next meeting? 00:23:02.140 --> 00:23:06.039 What do we hope to achieve in this meeting? A 00:23:06.039 --> 00:23:07.980 very good person gave me advice a while ago. 00:23:08.019 --> 00:23:09.759 He said, there are only three reasons to call 00:23:09.759 --> 00:23:14.579 a meeting. Education, decision -making, or relationship 00:23:14.579 --> 00:23:18.299 building. So one check I put on myself, to your 00:23:18.299 --> 00:23:21.700 point, what of those three are we trying to accomplish 00:23:21.700 --> 00:23:25.500 at this meeting? And if we can't identify one 00:23:25.500 --> 00:23:28.000 of those three, I would ask, why are we having 00:23:28.000 --> 00:23:32.660 the meeting? What's the point? So I think the 00:23:32.660 --> 00:23:35.769 third thing, how I adapted was, understand the 00:23:35.769 --> 00:23:40.410 purpose of the conversation, the meeting, and 00:23:40.410 --> 00:23:43.269 make sure everyone understands it. Since part 00:23:43.269 --> 00:23:45.869 of your success is it's not just that I understand 00:23:45.869 --> 00:23:47.690 it if I'm running the meeting, it's how does 00:23:47.690 --> 00:23:49.289 everyone around the table understand what we're 00:23:49.289 --> 00:23:51.130 accomplishing there and make that clear up front. 00:23:52.970 --> 00:23:57.029 Do you miss the OR? I still work there. When 00:23:57.029 --> 00:24:01.049 I was in my executive role with Team Health and 00:24:01.049 --> 00:24:04.660 also Medical College of Wisconsin, I did not 00:24:04.660 --> 00:24:06.720 work in the OR full time, but I still was able 00:24:06.720 --> 00:24:08.779 to work there usually a day a week, two days 00:24:08.779 --> 00:24:14.500 a week now. Wow. I did miss it. I missed it because 00:24:14.500 --> 00:24:23.240 it was in a lot of ways an oasis of safety and 00:24:23.240 --> 00:24:27.140 pleasure and actually in a lot of ways more certainty 00:24:27.140 --> 00:24:30.980 than a day when you're not in the OR. So I did 00:24:30.980 --> 00:24:33.640 miss it. I missed the camaraderie of the team, 00:24:33.720 --> 00:24:37.799 and I missed that truly genuine bond we have 00:24:37.799 --> 00:24:40.000 when a patient gets the look on their face that 00:24:40.000 --> 00:24:42.539 says, I trust what you're doing with me. Right. 00:24:42.759 --> 00:24:47.839 That's special. When residents are thinking about 00:24:47.839 --> 00:24:51.420 what sort of career they imagine for themselves, 00:24:51.640 --> 00:24:55.039 and they're thinking to themselves, you know, 00:24:55.059 --> 00:24:57.420 maybe I've done a lot of leadership positions 00:24:57.420 --> 00:25:02.970 in residency. I might want to aim towards a career 00:25:02.970 --> 00:25:08.829 or in the executive role eventually. What advice 00:25:08.829 --> 00:25:10.890 would you give them? What would you tell them? 00:25:12.450 --> 00:25:17.289 I think it's very rare that residents come out 00:25:17.289 --> 00:25:19.769 and say, aha, I have a path I'm going to go on 00:25:19.769 --> 00:25:23.289 so that in 20 years I'm here or here or here. 00:25:24.289 --> 00:25:27.150 You can lay the goal out, but how you get there. 00:25:27.599 --> 00:25:29.559 It's going to largely be organic. It's going 00:25:29.559 --> 00:25:31.960 to be based on your own interest, where you identify 00:25:31.960 --> 00:25:35.019 your own strengths over time, and where opportunities 00:25:35.019 --> 00:25:39.819 come up, which is a long way of saying be adaptable, 00:25:39.880 --> 00:25:42.920 be flexible, and be open to opportunities you 00:25:42.920 --> 00:25:45.359 may not have thought about. A couple personal 00:25:45.359 --> 00:25:49.200 examples. Early in my career, I told the story 00:25:49.200 --> 00:25:51.579 this morning or last night to the residents about 00:25:51.579 --> 00:25:54.720 my boss telling me post -call, I want you to 00:25:54.720 --> 00:25:58.119 go down to the statehouse. I was post -call. 00:25:58.240 --> 00:26:00.839 I was, you know, 34 years old. I'm like, Chris, 00:26:00.839 --> 00:26:02.940 do I really? Yeah, I want you to go. I want you 00:26:02.940 --> 00:26:05.299 to spend the morning there with our director 00:26:05.299 --> 00:26:08.559 of South Carolina Society of Anesthesiologists. 00:26:09.599 --> 00:26:13.539 That was the launching point to getting involved 00:26:13.539 --> 00:26:17.160 in eventually the State Society, Wisconsin Society, 00:26:17.480 --> 00:26:21.079 ASA. And those relationships and experiences 00:26:21.079 --> 00:26:24.200 shaped my career in ways I never would have imagined 00:26:24.200 --> 00:26:26.380 that day he asked me to go down to the Statehouse. 00:26:26.829 --> 00:26:29.490 If I hadn't have done it, I would have closed 00:26:29.490 --> 00:26:33.750 off a remarkable opportunity. So I think try 00:26:33.750 --> 00:26:37.170 to be open to doing things that are outside as 00:26:37.170 --> 00:26:40.490 a resident or a young attending your immediate 00:26:40.490 --> 00:26:44.170 responsibility sphere. Try to do something new 00:26:44.170 --> 00:26:48.470 every year. Do one thing that's not in that job 00:26:48.470 --> 00:26:51.670 description. And that's how you're going to grow 00:26:51.670 --> 00:26:55.119 and also start to learn. What really gets me 00:26:55.119 --> 00:26:58.500 excited about health care in general? And what 00:26:58.500 --> 00:27:00.819 might I be pretty good at that I can work on? 00:27:02.559 --> 00:27:06.980 One of the things that I have noticed about myself 00:27:06.980 --> 00:27:09.339 and some of my own leadership development, I'm 00:27:09.339 --> 00:27:11.220 one of the associate program directors here, 00:27:11.319 --> 00:27:17.460 is that I switch modes sometimes between being 00:27:17.460 --> 00:27:22.220 a clinician and interacting with... The patients 00:27:22.220 --> 00:27:25.680 and trainees and operating room staff. But when 00:27:25.680 --> 00:27:27.799 I have to step back and act in a different role 00:27:27.799 --> 00:27:33.480 as a leader, I have to change my mindset a little 00:27:33.480 --> 00:27:38.000 bit. And you've done that to a much more advanced 00:27:38.000 --> 00:27:41.779 degree, I would say. Can you talk about what 00:27:41.779 --> 00:27:44.980 that frame shift looks like and how you put yourself 00:27:44.980 --> 00:27:48.400 in one mindset or the other? Yeah, and I'm going 00:27:48.400 --> 00:27:51.390 to. answer it in the sense of I've also, as I 00:27:51.390 --> 00:27:54.150 said earlier, failed in that later in my career. 00:27:54.730 --> 00:27:57.369 I think there are a couple things to make that 00:27:57.369 --> 00:28:02.910 shift as successful as it can be. One is when 00:28:02.910 --> 00:28:06.609 you're entering into a new circumstance, maybe 00:28:06.609 --> 00:28:09.549 a new meeting, a new topic, a new group of people 00:28:09.549 --> 00:28:12.970 you never met with before, there has to be an 00:28:12.970 --> 00:28:18.359 example where you slow down Why is this taking 00:28:18.359 --> 00:28:21.319 place? What is going to be my role here? Do I 00:28:21.319 --> 00:28:24.480 understand the other people coming to this enterprise, 00:28:24.740 --> 00:28:27.619 this initiative, this meeting, whatever? What 00:28:27.619 --> 00:28:29.559 are their perspectives? If I don't know them, 00:28:29.599 --> 00:28:32.059 how am I going to understand them better? So 00:28:32.059 --> 00:28:35.119 there's a pause button you really need to hit 00:28:35.119 --> 00:28:37.319 where you're asking yourself those questions 00:28:37.319 --> 00:28:42.259 so that you can be an effective contributor. 00:28:43.099 --> 00:28:45.079 or co -leader in a group like that so i think 00:28:45.079 --> 00:28:50.380 that pause is number one number two is try not 00:28:50.380 --> 00:28:54.039 to go into a meeting uh when you have to make 00:28:54.039 --> 00:28:56.799 that transition if you're not in a good emotional 00:28:56.799 --> 00:29:01.539 state try to get yourself in a state where you're 00:29:01.539 --> 00:29:05.680 open you're listening you're you're engaging 00:29:05.680 --> 00:29:09.950 with the right posture and you're making people 00:29:09.950 --> 00:29:11.829 feel comfortable, talk to you, because people 00:29:11.829 --> 00:29:13.769 will see it. If you come into a meeting and you 00:29:13.769 --> 00:29:16.589 look rushed, upset, may have nothing to do with 00:29:16.589 --> 00:29:19.670 what's going on at that moment, they'll get quiet, 00:29:19.750 --> 00:29:22.210 and you won't hear what you need to hear. So 00:29:22.210 --> 00:29:23.630 those are two things I would do to make that 00:29:23.630 --> 00:29:28.970 transition. One thing that I've seen that you've 00:29:28.970 --> 00:29:30.869 asked before is whether we should be teaching 00:29:30.869 --> 00:29:33.470 operating room management as aggressively as 00:29:33.470 --> 00:29:38.339 we teach airway management. One of those things 00:29:38.339 --> 00:29:44.079 is something that we really focus on in residency. 00:29:44.259 --> 00:29:46.140 We really want to make sure that our residents 00:29:46.140 --> 00:29:49.759 can manage those challenging areas. Talk to me 00:29:49.759 --> 00:29:52.400 about why operating room management is so important. 00:29:52.680 --> 00:29:56.380 Sure. And I want to be clear when I say that, 00:29:56.460 --> 00:29:58.920 I'm not saying teach it to the detriment of airway 00:29:58.920 --> 00:30:01.880 management. Airway management is still core to 00:30:01.880 --> 00:30:04.859 what we do clinically. There are three reasons 00:30:04.859 --> 00:30:08.119 I would say. I believe that, and I believe it 00:30:08.119 --> 00:30:12.380 very deeply. One is there is no one better equipped 00:30:12.380 --> 00:30:15.900 to take on this role than an anesthesiologist. 00:30:16.680 --> 00:30:19.779 We're the only people who see the entire perioperative 00:30:19.779 --> 00:30:22.940 enterprise who are involved in it clinically 00:30:22.940 --> 00:30:29.180 and operationally. Second reason is this is an 00:30:29.180 --> 00:30:33.119 area of critical importance to our partners in 00:30:33.119 --> 00:30:37.250 the healthcare system. It's incredibly important 00:30:37.250 --> 00:30:38.950 to have an operating room that is efficient. 00:30:40.430 --> 00:30:43.349 And being blunt, you don't want to waste time 00:30:43.349 --> 00:30:47.309 or money. You want to make patients feel satisfied 00:30:47.309 --> 00:30:49.410 and have a good experience coming through the 00:30:49.410 --> 00:30:54.549 system well. You don't want to incur costs you 00:30:54.549 --> 00:30:57.809 could have avoided. It's a critically important 00:30:57.809 --> 00:31:02.029 role. And the third reason is so that anesthesiologists 00:31:02.029 --> 00:31:06.859 really gain the stature, and the position to 00:31:06.859 --> 00:31:11.119 which they can influence the success of both 00:31:11.119 --> 00:31:13.559 the practice and the system, I see it as a huge 00:31:13.559 --> 00:31:16.599 opportunity for alignment between anesthesiologists 00:31:16.599 --> 00:31:19.859 and hospital systems. With the caveat it's one 00:31:19.859 --> 00:31:22.900 that can begin a lot of hard conversations, and 00:31:22.900 --> 00:31:26.299 there are a lot of stakeholders involved. But 00:31:26.299 --> 00:31:28.400 it gets back to the philosophy, if we don't do 00:31:28.400 --> 00:31:32.180 it, if we don't see the value in it, If we only 00:31:32.180 --> 00:31:34.559 really focus on our time in the operating room 00:31:34.559 --> 00:31:38.200 in the immediate pre - and post -op period, what 00:31:38.200 --> 00:31:40.839 are we really bringing to the enterprise? What 00:31:40.839 --> 00:31:42.599 value are we bringing that someone else could 00:31:42.599 --> 00:31:45.180 probably bring, or at least in a partial way? 00:31:45.539 --> 00:31:48.839 So I would say there's a strategic imperative, 00:31:49.259 --> 00:31:52.779 there's a relational imperative, and there's 00:31:52.779 --> 00:31:55.799 a what -do -anesthesiologists -do imperative. 00:31:56.099 --> 00:32:00.140 It covers all three. When you're thinking about 00:32:00.569 --> 00:32:04.990 leadership, do you see it as more nature or nurture? 00:32:05.230 --> 00:32:08.710 Is it something that can be developed from scratch 00:32:08.710 --> 00:32:12.549 or is it something that people have more inborn 00:32:12.549 --> 00:32:15.789 and then just sort of develop along the edges 00:32:15.789 --> 00:32:20.089 of? Boy, that's a really, really good question. 00:32:20.250 --> 00:32:22.670 And if I rephrased it, I would say, can anyone 00:32:22.670 --> 00:32:25.910 develop into an effective leader? That is a shorter 00:32:25.910 --> 00:32:30.109 and perhaps better way to ask the question. I 00:32:30.109 --> 00:32:36.650 love it. I think it's both. I do think there 00:32:36.650 --> 00:32:42.049 are some inherent skills that can be built upon 00:32:42.049 --> 00:32:46.329 slowing down, reading, reflecting, thinking, 00:32:46.569 --> 00:32:50.450 being comfortable, getting perspective as opposed 00:32:50.450 --> 00:32:52.910 to jumping to conclusion or trying to be quick. 00:32:53.630 --> 00:32:56.210 Some of those are attributes some are born with 00:32:56.210 --> 00:32:59.619 more than others. Now, having said that. When 00:32:59.619 --> 00:33:01.660 I think back to initial leadership development, 00:33:01.779 --> 00:33:04.940 it was modeling for me. I still remember the 00:33:04.940 --> 00:33:07.220 three or four people who I first said, wow, they 00:33:07.220 --> 00:33:13.279 have something different. They really understand 00:33:13.279 --> 00:33:16.700 how to really make everyone in the room think 00:33:16.700 --> 00:33:18.680 they're having a one -on -one conversation with 00:33:18.680 --> 00:33:23.559 him or her when they're really not. So I think 00:33:23.559 --> 00:33:26.930 about modeling as a critical role in that. But 00:33:26.930 --> 00:33:28.950 I believe it is something that can be nurtured, 00:33:28.970 --> 00:33:31.910 to your point. It can be taught. It can be learned. 00:33:33.230 --> 00:33:35.569 It doesn't mean you won't skin your knees someday 00:33:35.569 --> 00:33:39.690 again. But everyone, I think, with rare exception, 00:33:39.890 --> 00:33:42.769 can develop the skill set to some degree. So 00:33:42.769 --> 00:33:47.829 I think there's a lot of nurture. When somebody 00:33:47.829 --> 00:33:51.450 is thought of as a great anesthesiologist, it's 00:33:51.450 --> 00:33:54.210 not necessarily, in my experience, the same. 00:33:54.990 --> 00:33:59.470 as being a great leader, although one can certainly 00:33:59.470 --> 00:34:03.049 be both. What do you think is the difference 00:34:03.049 --> 00:34:08.789 between somebody who is more of a great anesthesiologist 00:34:08.789 --> 00:34:10.949 versus somebody who is more of a great leader? 00:34:14.829 --> 00:34:18.610 There's a lot of overlap between the two if we're 00:34:18.610 --> 00:34:22.469 willing to accept it and do it. I can be a great 00:34:22.469 --> 00:34:30.920 anesthesiologist. clinically, by myself, in a 00:34:30.920 --> 00:34:35.199 room, taking care of patients. I absolutely can 00:34:35.199 --> 00:34:38.440 be a great anesthesiologist. I can be effective, 00:34:38.719 --> 00:34:43.739 kind, efficient, clinically excellent. And at 00:34:43.739 --> 00:34:45.559 the end of the day, I say, I got all my patients 00:34:45.559 --> 00:34:51.599 through well. That's leading yourself. The next 00:34:51.599 --> 00:34:54.340 step is how do you lead others? How do you bring 00:34:54.340 --> 00:34:58.119 others along to see your vision? So part of the 00:34:58.119 --> 00:35:00.079 challenge, and you hear a lot of anesthesiologists 00:35:00.079 --> 00:35:02.860 say, and I'm sure I bet you nurse anesthetists 00:35:02.860 --> 00:35:06.480 too, it's easier to work by myself than with 00:35:06.480 --> 00:35:09.639 a team. You hear it a lot. I have heard that. 00:35:09.780 --> 00:35:12.599 And it kind of is because you're only accountable 00:35:12.599 --> 00:35:16.159 to yourself. There's no imperative to help others 00:35:16.159 --> 00:35:18.840 understand decision -making, shared decision 00:35:18.840 --> 00:35:21.780 -making, making sure perspectives are understood 00:35:21.780 --> 00:35:24.800 on each side. the additional communication that 00:35:24.800 --> 00:35:29.420 has to go into that process. So in a lot of ways, 00:35:29.460 --> 00:35:32.460 working in a team, getting more perspective is 00:35:32.460 --> 00:35:36.579 just, it's more work. But as a leader, that's 00:35:36.579 --> 00:35:39.219 how you really drive things forward. If I'm just 00:35:39.219 --> 00:35:42.559 working by myself, how much am I going to really 00:35:42.559 --> 00:35:44.900 push forward beyond the immediate clinical care 00:35:44.900 --> 00:35:49.480 I'm giving? Very little. So if we're going to 00:35:49.480 --> 00:35:51.460 be leaders in the health system, leaders in our 00:35:51.460 --> 00:35:54.320 practices, leaders with patients, it's going 00:35:54.320 --> 00:35:57.820 to require working with others in the ways we've 00:35:57.820 --> 00:35:59.920 talked about. That's, I think, the main difference 00:35:59.920 --> 00:36:02.880 I would put out at either end of the bell curve, 00:36:02.940 --> 00:36:06.800 so to speak. I want to pick your brain a little 00:36:06.800 --> 00:36:11.159 bit about developing leaders and the role of 00:36:11.159 --> 00:36:15.679 mentorship versus the role of coaching. Do you 00:36:15.679 --> 00:36:19.199 see... There being a big difference between mentorship 00:36:19.199 --> 00:36:22.500 and what the new buzzword seems to be is coaching. 00:36:23.340 --> 00:36:27.679 What do you think? I would give this initial 00:36:27.679 --> 00:36:30.199 response, and I may be offbeat here. I may be 00:36:30.199 --> 00:36:33.480 misstating it. Mentorship to me is a little more 00:36:33.480 --> 00:36:38.239 of an informal process. That story I told last 00:36:38.239 --> 00:36:39.840 night to the residents about one of the first 00:36:39.840 --> 00:36:43.059 mistakes I made in practice. And the head of 00:36:43.059 --> 00:36:45.500 my group, who still I regard as a huge mentor, 00:36:45.659 --> 00:36:49.900 Dr. Chris Yackel, he didn't berate me. He took 00:36:49.900 --> 00:36:53.119 me out for beer and wings. And we talked about 00:36:53.119 --> 00:36:56.619 why I wrote the note I did and the email in this 00:36:56.619 --> 00:36:59.840 case. That's mentoring to me. It's modeling. 00:37:00.300 --> 00:37:04.679 It's guiding. It's not informing. Coaching to 00:37:04.679 --> 00:37:06.519 me is a little more formal. It involves taking 00:37:06.519 --> 00:37:10.019 a specific situation you're in that may be ongoing. 00:37:10.940 --> 00:37:13.199 Maybe you're having challenges with a dyad partner 00:37:13.199 --> 00:37:15.599 in your leadership role. Maybe you're having 00:37:15.599 --> 00:37:18.159 trouble getting your team to really respond to 00:37:18.159 --> 00:37:21.699 you. It's a little more focused on taking an 00:37:21.699 --> 00:37:25.920 ad hoc problem or an ongoing problem and how 00:37:25.920 --> 00:37:28.360 are you addressing it in a way that creates better 00:37:28.360 --> 00:37:31.260 results for you in your role. So that's how I 00:37:31.260 --> 00:37:32.880 see the difference. I see the coaching a little 00:37:32.880 --> 00:37:36.079 more prescribed and the mentoring a little more 00:37:36.079 --> 00:37:42.559 ad hoc or organic. One of the experiences that 00:37:42.559 --> 00:37:45.239 you've had that I haven't gotten to talk to very 00:37:45.239 --> 00:37:47.440 many people about is leading very large groups 00:37:47.440 --> 00:37:50.920 of people. Is it correct to say that you've led 00:37:50.920 --> 00:37:54.539 about 1 ,500 clinicians across 23 states? Well, 00:37:54.579 --> 00:37:58.559 it is, but I would say leadership is a multi 00:37:58.559 --> 00:38:03.150 -level thing. Yes. If I could expand. So I'm 00:38:03.150 --> 00:38:05.710 chief clinical officer for anesthesiology for 00:38:05.710 --> 00:38:08.389 Team Health. And yes, there are 15 or so clinicians 00:38:08.389 --> 00:38:11.590 in the clinician cohort of the company and the 00:38:11.590 --> 00:38:15.210 practice. But the leaders are multiple levels. 00:38:15.230 --> 00:38:17.389 There are other physician leaders regionally. 00:38:17.389 --> 00:38:19.650 There are, most importantly, the leaders of the 00:38:19.650 --> 00:38:22.650 practices on the ground. You know, what you would 00:38:22.650 --> 00:38:24.849 call the chief of the department or the president 00:38:24.849 --> 00:38:27.900 of the group. So when we say I've led 1 ,500 00:38:27.900 --> 00:38:30.260 people, what it means is I'm trying to enable 00:38:30.260 --> 00:38:33.820 them and those who are also leading, the regional 00:38:33.820 --> 00:38:36.360 managers and the practice leaders, do they have 00:38:36.360 --> 00:38:39.119 the tools, the resources, the information for 00:38:39.119 --> 00:38:41.260 them to actually lead the group successfully? 00:38:42.340 --> 00:38:44.320 So when I say lead, I want to be real clear. 00:38:44.360 --> 00:38:48.500 It's not to tell them what to do, not to manage 00:38:48.500 --> 00:38:51.239 their practice. It's to ask them, what do you 00:38:51.239 --> 00:38:54.840 need? Can we provide it for you? and have a shared 00:38:54.840 --> 00:38:57.880 vision of success. It's exactly that thing we 00:38:57.880 --> 00:38:59.920 talked about earlier about stepping back a little 00:38:59.920 --> 00:39:04.099 bit and trying to hear what they need and supporting 00:39:04.099 --> 00:39:09.019 them, not jumping in to do it for them. One thing 00:39:09.019 --> 00:39:13.179 that I've noticed about my colleagues and myself, 00:39:13.500 --> 00:39:17.219 to be honest, in anesthesia, is that we all have 00:39:17.219 --> 00:39:22.659 very strong opinions about the ways that leadership 00:39:23.730 --> 00:39:30.170 has maybe not done the best job. It's a common 00:39:30.170 --> 00:39:34.630 refrain that something should have been done 00:39:34.630 --> 00:39:37.429 differently. And that's something that's discussed 00:39:37.429 --> 00:39:40.190 in physician lounges, I think probably everywhere. 00:39:41.909 --> 00:39:45.469 How do you think about that when you're thinking 00:39:45.469 --> 00:39:49.250 about leading such a large group of people who 00:39:49.250 --> 00:39:52.010 are very intelligent and who also have an element 00:39:52.010 --> 00:39:56.800 of rugged individualism to them. You know, one 00:39:56.800 --> 00:40:00.599 of my physicians, practice leader at Team Health, 00:40:00.780 --> 00:40:02.940 said something to me that stuck a number of years 00:40:02.940 --> 00:40:05.619 ago. He said, you know, we're all trained to 00:40:05.619 --> 00:40:09.179 be master builders. We all think of ourselves 00:40:09.179 --> 00:40:14.000 as master builders. So my way of kind of my vision 00:40:14.000 --> 00:40:17.820 is right. I think when you're leading a large 00:40:17.820 --> 00:40:22.730 cohort of people, One size does not fit all. 00:40:22.869 --> 00:40:26.289 So there's a balance between each practice being 00:40:26.289 --> 00:40:29.730 a master builder. And there are differences between, 00:40:29.829 --> 00:40:32.010 you know, a four -clinician practice in rural 00:40:32.010 --> 00:40:35.750 Ohio versus a large urban practice in Florida 00:40:35.750 --> 00:40:38.769 with 100 clinicians. They have different needs, 00:40:38.949 --> 00:40:40.769 different imperatives, different relationships 00:40:40.769 --> 00:40:42.530 with their clinicians and with their hospital. 00:40:43.929 --> 00:40:46.349 Yet at the same time, there are some things you 00:40:46.349 --> 00:40:49.489 want to make sure are aligned. And that's around 00:40:49.489 --> 00:40:54.369 how are we defining quality of care? Do we agree 00:40:54.369 --> 00:40:57.349 that operational excellence is something we're 00:40:57.349 --> 00:41:00.650 hanging our hat on? Do we believe that patient 00:41:00.650 --> 00:41:05.309 experience in anesthesiology is an actual thing 00:41:05.309 --> 00:41:08.650 that is important and valuable to what we do 00:41:08.650 --> 00:41:12.469 as opposed to an add -on or a luxury? And do 00:41:12.469 --> 00:41:15.190 we believe that leadership at the ground level 00:41:15.710 --> 00:41:18.530 and maintaining relationships with your coworkers, 00:41:19.429 --> 00:41:21.309 perioperative staff, and hospital leadership 00:41:21.309 --> 00:41:24.909 is a critical aspect to what we do. So when you're 00:41:24.909 --> 00:41:27.389 talking about leading large, diverse groups, 00:41:27.550 --> 00:41:31.030 I think you have to align on principles and what 00:41:31.030 --> 00:41:34.110 you define as success, but at the same time, 00:41:34.110 --> 00:41:36.329 that will look different in those two different 00:41:36.329 --> 00:41:40.110 types of practice settings. They will not do 00:41:40.110 --> 00:41:42.409 the exact same thing, but they will have, in 00:41:42.409 --> 00:41:48.530 a lot of ways, goals strategically. I think that 00:41:48.530 --> 00:41:53.170 makes a lot of sense. Let me ask you a little 00:41:53.170 --> 00:41:57.010 bit about our specialty in general and where 00:41:57.010 --> 00:42:00.510 you think things are heading. Do you think that 00:42:00.510 --> 00:42:07.570 anesthesiologists are positioned well to be leaders 00:42:07.570 --> 00:42:11.340 in the operating room? Do you think that there 00:42:11.340 --> 00:42:13.619 are areas of vulnerability that we need to address? 00:42:14.500 --> 00:42:19.179 Based on your more national, zoomed -out perspective, 00:42:19.599 --> 00:42:23.800 I wonder where you think things are headed. I 00:42:23.800 --> 00:42:26.159 think we're in a great position for success. 00:42:26.679 --> 00:42:29.460 As I said earlier, I think we have enormous value 00:42:29.460 --> 00:42:32.500 in the perioperative space, and most people recognize 00:42:32.500 --> 00:42:36.610 this. clinical initiatives that are truly groundbreaking. 00:42:36.909 --> 00:42:39.070 It started with the perioperative surgical home, 00:42:39.130 --> 00:42:41.110 which has morphed into perioperative medicine. 00:42:42.409 --> 00:42:46.469 We have become gradually experts around operations 00:42:46.469 --> 00:42:50.269 as well as clinical outcomes. I think we've developed, 00:42:50.489 --> 00:42:53.150 both at the societal level and individually, 00:42:53.570 --> 00:42:56.849 an increasing ability to step into leadership 00:42:56.849 --> 00:42:59.449 roles, and you see more anesthesiologists doing 00:42:59.449 --> 00:43:02.269 that. So I think we have enormous opportunity. 00:43:03.119 --> 00:43:06.159 to drive not just what our practice looks like 00:43:06.159 --> 00:43:09.960 in coming years but what health care looks like 00:43:09.960 --> 00:43:13.079 how it's delivered and address the larger questions 00:43:13.079 --> 00:43:17.679 around technology workforce etc the one caveat 00:43:17.679 --> 00:43:21.860 i would put in is that it's really easy to get 00:43:21.860 --> 00:43:26.719 caught listening to your own bubble sphere and 00:43:26.719 --> 00:43:30.079 think you're going to bring solutions to the 00:43:30.079 --> 00:43:33.610 systems the market without really understanding 00:43:33.610 --> 00:43:37.409 how they're seeing their needs. What do I mean 00:43:37.409 --> 00:43:40.190 by that? I'll tell a story, if I may. Please. 00:43:40.690 --> 00:43:43.809 I was in a meeting a couple years ago with some 00:43:43.809 --> 00:43:48.369 other fellow leaders at a societal level, and 00:43:48.369 --> 00:43:51.030 one of them made the comment, I don't really 00:43:51.030 --> 00:43:55.010 care what a hospital CFO thinks. All we have 00:43:55.010 --> 00:43:57.489 to do is give quality. And I cringed when I heard 00:43:57.489 --> 00:44:01.079 that. Because to me, that's the essence of I'm 00:44:01.079 --> 00:44:03.800 not going to listen to what our partners or our 00:44:03.800 --> 00:44:07.360 patients or our hospital executives are saying 00:44:07.360 --> 00:44:09.659 they need an anesthesia. We're just going to 00:44:09.659 --> 00:44:13.380 tell them what they need. That's how you take 00:44:13.380 --> 00:44:16.900 all the expertise we've developed and throw it 00:44:16.900 --> 00:44:20.460 in the water. So you have to listen effectively 00:44:20.460 --> 00:44:23.500 to the market. You adapt when you can. You don't 00:44:23.500 --> 00:44:25.880 when you think it's unsafe. And that's getting 00:44:25.880 --> 00:44:27.800 back to it. There's your leadership challenge. 00:44:28.780 --> 00:44:31.800 How do I know what my values are? How do I know 00:44:31.800 --> 00:44:34.699 when I need to step up and apply them and speak 00:44:34.699 --> 00:44:40.460 to them? But to simply discard people with whom 00:44:40.460 --> 00:44:42.340 we work and say, I don't need to listen to them, 00:44:42.440 --> 00:44:45.059 that's where we could get in trouble. If we get 00:44:45.059 --> 00:44:49.340 that kind of intellectual ego, we'll be in trouble. 00:44:51.579 --> 00:44:55.260 You've done some work in Milwaukee with startups. 00:44:55.400 --> 00:44:58.559 Can you talk to me about that? Oh, you mean in 00:44:58.559 --> 00:45:03.000 terms of practices? I think you did some mentoring 00:45:03.000 --> 00:45:06.219 in the I -Corps program. Oh, gosh, that was fun. 00:45:07.860 --> 00:45:09.760 Yeah, and that's actually a model in a lot of 00:45:09.760 --> 00:45:12.719 ways, I think, for how anesthesiologists can 00:45:12.719 --> 00:45:17.219 develop new sources of revenue, perhaps. So the 00:45:17.219 --> 00:45:19.940 I -Corps program is a standardized program, mostly 00:45:19.940 --> 00:45:23.019 at the undergraduate university level. It's a 00:45:23.019 --> 00:45:26.519 regional national organization that... allows 00:45:26.519 --> 00:45:31.380 professors and their students to bring ideas 00:45:31.380 --> 00:45:35.480 to be evaluated. It's a rigorous process. So 00:45:35.480 --> 00:45:39.059 in my case, I was advising a professor who was 00:45:39.059 --> 00:45:44.280 developing a new type of anchor for tunnel and 00:45:44.280 --> 00:45:47.960 parking garage ceilings because these fail. And 00:45:47.960 --> 00:45:50.920 I'm thinking, I have no expertise in engineering. 00:45:51.179 --> 00:45:53.579 They said, that's not the point. The point is 00:45:53.579 --> 00:45:55.199 for you to make sure they're asking the right 00:45:55.199 --> 00:45:57.500 questions. They go through. So the I -Corps process 00:45:57.500 --> 00:46:00.340 is it's six weeks and it's very intense. It's 00:46:00.340 --> 00:46:03.480 present your project. What do you think? You 00:46:03.480 --> 00:46:06.480 get feedback from a number of people in the advisory 00:46:06.480 --> 00:46:09.679 group, which I was on about who do you need to 00:46:09.679 --> 00:46:11.619 go talk to in the community? You need to go talk 00:46:11.619 --> 00:46:14.599 to. the construction firms you need to go talk 00:46:14.599 --> 00:46:16.539 to the inspectors you need to go talk to the 00:46:16.539 --> 00:46:19.460 state regulators you need to go talk to the building 00:46:19.460 --> 00:46:22.880 architects which they did in six weeks they probably 00:46:22.880 --> 00:46:26.139 talked to 40 people and got feedback all designed 00:46:26.139 --> 00:46:31.260 to help you hone and make a better presentation 00:46:31.260 --> 00:46:35.880 of your idea it's a remarkably efficient process 00:46:35.880 --> 00:46:39.440 it works I was talking where I did this at University 00:46:39.440 --> 00:46:41.440 of Wisconsin -Milwaukee of how many hits have 00:46:41.440 --> 00:46:45.059 you actually had? She said, over 20 years. Very 00:46:45.059 --> 00:46:49.239 successful because it helps them get from concept 00:46:49.239 --> 00:46:53.320 to effective product presentation and really 00:46:53.320 --> 00:46:55.559 hone in what's the purpose and who are the stakeholders. 00:46:56.420 --> 00:46:58.360 Certainly a process that might have application 00:46:58.360 --> 00:47:00.960 to what we do. Again, when we think about we 00:47:00.960 --> 00:47:03.320 have a great idea to bring to the market in anesthesia. 00:47:04.059 --> 00:47:06.449 We have a perioperative medical home. Great. 00:47:08.010 --> 00:47:10.829 Do we know who wants it? Do we know what cost? 00:47:11.429 --> 00:47:13.289 Do we know what trade -offs they're willing to 00:47:13.289 --> 00:47:16.409 make? What about other competitors in the market 00:47:16.409 --> 00:47:19.030 who are already doing this? Those are the key 00:47:19.030 --> 00:47:21.289 questions asked. So the beauty of the I -Corps 00:47:21.289 --> 00:47:24.909 process was it's not just about your idea. It's 00:47:24.909 --> 00:47:27.090 about all those other things that go in that 00:47:27.090 --> 00:47:29.429 will drive the success of it, which I found was 00:47:29.429 --> 00:47:31.489 a fascinating experience. I'd love to do it again. 00:47:32.710 --> 00:47:35.949 That's really interesting to hear about. Get 00:47:35.949 --> 00:47:41.110 involved with that. One of the friends, one of 00:47:41.110 --> 00:47:44.449 my main hobbies is I cycle. One of the guys in 00:47:44.449 --> 00:47:46.630 my cycling group was the head of the University 00:47:46.630 --> 00:47:48.449 of Wisconsin -Milwaukee Center for Innovation. 00:47:48.769 --> 00:47:51.110 He was an engineer by training who had been in 00:47:51.110 --> 00:47:53.849 this role 10 years, and he kind of oversaw this 00:47:53.849 --> 00:47:57.750 process. So he said, hey, why don't you come 00:47:57.750 --> 00:48:00.909 and just be an advisor on this, which I, it's 00:48:00.909 --> 00:48:03.570 a wonderful experience. It gave me a fresh perspective 00:48:03.570 --> 00:48:08.469 on what. what developing success looks like. 00:48:10.070 --> 00:48:12.710 When I was doing a little bit of research on 00:48:12.710 --> 00:48:15.210 you, one of the things that I saw is where you 00:48:15.210 --> 00:48:19.429 described seeing Eric Clapton. And one of the 00:48:19.429 --> 00:48:22.090 things that stuck with you wasn't necessarily 00:48:22.090 --> 00:48:25.170 him playing, but the other musicians stopping 00:48:25.170 --> 00:48:27.329 to watch out of respect. I wonder if you could 00:48:27.329 --> 00:48:30.769 expand on that story a little bit and tell me 00:48:30.769 --> 00:48:34.079 why that stuck with you. Other than my desire 00:48:34.079 --> 00:48:36.539 to have some level of expertise that even approaches 00:48:36.539 --> 00:48:41.599 Eric Clapton? Yeah, that would be great. It was 00:48:41.599 --> 00:48:43.699 something very evident. Remember I talked earlier 00:48:43.699 --> 00:48:46.719 about the mentoring aspect and the modeling, 00:48:46.780 --> 00:48:49.880 and when you see someone who knows when to step 00:48:49.880 --> 00:48:53.940 forward, step back, listens with purpose, you 00:48:53.940 --> 00:48:56.940 go, huh, I see that. There's something there. 00:48:57.420 --> 00:49:02.639 You want to model that. When I saw him on stage 00:49:02.639 --> 00:49:05.860 a couple years ago, and when he would, you know, 00:49:05.860 --> 00:49:08.000 he was, I told this in the story, he was older, 00:49:08.119 --> 00:49:11.000 his voice was a little shot, but he could still 00:49:11.000 --> 00:49:14.099 play the guitar. And when he did those half dozen 00:49:14.099 --> 00:49:17.280 Clapton -esque things that only he can really 00:49:17.280 --> 00:49:20.440 do in a concert, you saw the other people, the 00:49:20.440 --> 00:49:22.840 keyboardists, the other guitarists, everyone 00:49:22.840 --> 00:49:25.800 was looking at him. And the sense I got was it 00:49:25.800 --> 00:49:27.400 wasn't just, well, we're waiting for the cue 00:49:27.400 --> 00:49:30.019 as to when he's going to finish the solo. It 00:49:30.019 --> 00:49:33.559 was really like, what's he doing? How's he doing 00:49:33.559 --> 00:49:37.000 this? You could see it in their faces. It was 00:49:37.000 --> 00:49:39.840 really different. Because they've rehearsed. 00:49:39.880 --> 00:49:43.119 They know when he's going to end the solo. But 00:49:43.119 --> 00:49:44.900 they're watching him because of what he's doing. 00:49:46.179 --> 00:49:49.400 That's, to me, modeling at its best. You're just 00:49:49.400 --> 00:49:51.639 presenting something aspirational and making 00:49:51.639 --> 00:49:55.380 them feel better about the overall thing you're 00:49:55.380 --> 00:49:58.139 developing. I gave an example this morning of 00:49:58.139 --> 00:50:02.409 the Duke Ellington autobiography, where he interviews 00:50:02.409 --> 00:50:06.190 himself. It's called Music is My Mistress. And 00:50:06.190 --> 00:50:08.309 it's a funny way he writes it, but he basically 00:50:08.309 --> 00:50:10.769 says, well, how do you make sure the whole band 00:50:10.769 --> 00:50:14.070 is inspired together, not fighting? He said, 00:50:14.170 --> 00:50:16.369 I make sure everyone understands their role. 00:50:16.429 --> 00:50:18.769 I make sure they know their role matters. I make 00:50:18.769 --> 00:50:20.969 sure they know that they're building something 00:50:20.969 --> 00:50:24.949 better than their individual parts. And then 00:50:24.949 --> 00:50:26.710 he says, of course, you have to manage them too 00:50:26.710 --> 00:50:30.340 if they show up late. That part about starting 00:50:30.340 --> 00:50:33.260 with, what are you doing? Why does it matter? 00:50:33.780 --> 00:50:36.260 Why does it matter for the larger success of 00:50:36.260 --> 00:50:39.699 what we're trying to do here? And now I go, aha, 00:50:39.940 --> 00:50:42.760 now I'm going to blend in as part of the larger 00:50:42.760 --> 00:50:46.719 big and know that my part contributes. So I think 00:50:46.719 --> 00:50:49.480 I saw that reaction on stage with Clapton, and 00:50:49.480 --> 00:50:52.320 I read about it in Ellington's autobiography, 00:50:52.380 --> 00:50:55.380 how he managed a very large band so successfully 00:50:55.380 --> 00:51:01.349 for decades. The last question that I typically 00:51:01.349 --> 00:51:06.869 ask people is a question about what your style 00:51:06.869 --> 00:51:08.610 points are. And I'm going to ask you the same 00:51:08.610 --> 00:51:10.590 question, but I also want to point out that I 00:51:10.590 --> 00:51:13.469 feel like our entire conversation has been a 00:51:13.469 --> 00:51:15.929 series of asking you that in different ways. 00:51:16.610 --> 00:51:22.289 But if you were to pick out something that you 00:51:22.289 --> 00:51:26.090 would say is one of your main style points, things 00:51:26.090 --> 00:51:28.030 that are one of your personal preferences, the 00:51:28.030 --> 00:51:29.909 way that you interact with people, the way that 00:51:29.909 --> 00:51:34.150 you lead, what would be that quintessential piece 00:51:34.150 --> 00:51:40.329 of advice that you would give? For me personally, 00:51:40.610 --> 00:51:43.730 the one that bubbles up when you ask that question 00:51:43.730 --> 00:51:48.789 is patience and hear people out. The one thing 00:51:48.789 --> 00:51:51.170 that will get my goat in a meeting is when people 00:51:51.170 --> 00:51:54.849 interrupt each other. Now, occasionally you have 00:51:54.849 --> 00:51:56.590 to, if someone's really, really going on, you 00:51:56.590 --> 00:51:58.190 have to say, hey, let's take a break and maybe 00:51:58.190 --> 00:52:02.389 invite another perspective. But I really respect 00:52:02.389 --> 00:52:05.349 listening to someone articulate the full thought, 00:52:05.489 --> 00:52:09.309 not letting them or me interrupt them or vice 00:52:09.309 --> 00:52:13.949 versa, so that you really are gathering perspective 00:52:13.949 --> 00:52:16.989 in all its fullness. I think that is absolutely 00:52:16.989 --> 00:52:20.170 critical part. So that patience you have to have 00:52:20.170 --> 00:52:22.769 to listen through. If there's an opportunity 00:52:22.769 --> 00:52:25.590 to ask a follow -up question that helps get the 00:52:25.590 --> 00:52:28.809 idea out better, you should do it. But I think 00:52:28.809 --> 00:52:31.289 that's a critical thing in terms of a personal 00:52:31.289 --> 00:52:33.710 style point that I really want to see happen. 00:52:35.730 --> 00:52:38.170 Jay, thank you so much for joining us. This was 00:52:38.170 --> 00:52:40.610 enormous fun today. Thanks for having me. I hope 00:52:40.610 --> 00:52:45.329 it's helpful and I appreciate it. That's it for 00:52:45.329 --> 00:52:48.440 this episode of Style Points. My thanks to Dr. 00:52:48.539 --> 00:52:50.619 Mizrobian for sticking around after grand rounds 00:52:50.619 --> 00:52:53.760 and giving us so much of his time. Since he made 00:52:53.760 --> 00:52:55.639 the case for reading his leadership training, 00:52:55.880 --> 00:52:59.039 I'll add a recommendation of my own, An Astronaut's 00:52:59.039 --> 00:53:02.139 Guide to Life on Earth by Chris Hadfield. I've 00:53:02.139 --> 00:53:03.679 been recommending it to anesthesia applicants 00:53:03.679 --> 00:53:06.519 for years, and it's as good a book on preparation, 00:53:06.880 --> 00:53:09.420 humility, and learning from your mistakes as 00:53:09.420 --> 00:53:12.460 I know of. If you got something out of this episode, 00:53:12.619 --> 00:53:14.780 the single best thing you could do to help other 00:53:14.780 --> 00:53:17.000 people find the show is to leave a rating or 00:53:17.000 --> 00:53:20.460 written review. You can always reach me at stylepointspodcast 00:53:20.460 --> 00:53:25.280 at gmail .com. Take a deep breath. Open your 00:53:25.280 --> 00:53:27.500 eyes. We're all done.