In the 100th episode of SoundPractice, host Mike Sacopulos spoke with luminaries who shed light on the need to provide physicians with business training and leadership skills for the betterment of healthcare delivery. Peter Angood, MD, president and CEO of the American Association for Physician Leadership, provides expert commentary.
This transcript of the discussions has been edited for clarity and length.
Mike Sacopulos: Welcome to SoundPractice, the American Association for Physician Leadership’s podcast for physicians and healthcare leaders. To celebrate the milestone of our 100th podcast, we have chosen highlights from 10 of the most popular downloaded podcasts.
The following are excerpts chosen by AAPL editorial staff, plus additional commentary from Peter Angood, MD, president and CEO of the American Association for Physician Leadership. Peter will put these podcast episodes in context for physician leaders.
I encourage you to re-listen to these 10 original SoundPractice podcast episodes and subscribe to our channel. The links to the top 10 episodes are included in each summary below.
Excerpt 1: Anthony Fauci, MD, “Physician Leadership in the Time of COVID-19”
www.soundpracticepodcast.com/e/physician-leadership-in-the-time-of-covid-19-with-dr-anthony-fauci
In this episode, Dr. Peter Angood interviewed Dr. Anthony Fauci on the nuances of physician leadership during the pandemic. As the director of the National Institute of Allergy and Infectious Diseases, Fauci, who has been a physician leader himself and at the forefront of medicine since the 1980s, explained how he navigated and balanced clinical issues and political situations through seven presidential administrations, and he gave advice for those aspiring to physician leadership.
Peter Angood: We’re curious about your own leadership journey. As a globally recognized physician leader, quite influential over the course of your career, what have been the experiences for you that confirmed your leadership? When did you know that you could create a larger scale of influence based on those experiences?
Anthony Fauci: Well, thank you for that question, Peter. It’s a little bit of a complicated issue, but I think I could simplify it by some fundamental principles. I found when you’re in a position like I’ve been in, where I had the opportunity and the privilege to advise now seven presidents about areas of domestic and global health, my principle has been to always stick by the data, evidence, and facts and be consistent in what you do.
I advised President Reagan in the very early years of the HIV/AIDS pandemic, which was a very sensitive and difficult situation. The White House did not really feel it important to come out and use the bully pulpit to get people aware of the danger of this emerging outbreak, at the time, among young gay men.
A very wise person who became a very good friend of mine and who had been in the Nixon White House gave me good advice. He said, “Whenever you walk into the White House, to the West Wing, to brief the president or people at the higher level, tell yourself that this may be the last time I’m ever going to do this.”
It is a haughty and heady experience to go into the White House. If you go into it feeling you want to get asked back, you may wind up hesitant to tell the president something that he might not want to hear, mainly a truth, but an inconvenient truth. So, you’ve always got to stick by the facts, stick by the truth, and don’t ever veer from that. Even if it means you’re not going to get asked back again.”
And I’ve lived by that. And I’ve gotten asked back for seven presidents, so it seems to have worked.
If you really want to maintain that leadership capability, you’ve got to be consistent. You’ve got to be based on fact. And you’ve got to really live by example.
I think the example of what you do, your fairness, your consistency, is what people look for when they look for leaders. They don’t like inconsistencies. You’ve got to articulate what your goals are. One of the things I pride myself on as the director of NIAID is that there is no doubt in anybody’s mind what my goals are, and what my vision is.
If you want to be a leader, you can’t have a leader where people don’t even know where the leader’s going. Like, “What direction is this person going?” You’ve really got to be very articulate in saying, “This is the institution I’m the leader of. This is where we want to go. These are the principles upon which we’re going to operate. So we’ve all got to be pulling together to get to the common goal.”
That’s what people really want in a leader. They don’t want vagueness. They don’t want inconsistencies.
Peter Angood Commentary: Tony Fauci has been at the forefront of work regarding COVID-19. This was a welcome opportunity to hear from him regarding his own physician leadership journey. This was not the usual type of interview Dr. Fauci conducts. His take on the tactical side of physician competencies, complete with specific instructions on what to do and not to do in a leadership position, is sage advice for any physician. As we say here at AAPL, “All physicians are leaders at some level, and this is what society expects of us.”
Dr. Fauci’s advice to physician leaders on the concepts of humility and courage was an intimate and useful perspective from a man with years of experience in physician leadership. Gosh, seven presidents he has advised, pretty impressive overall!
Excerpt 2: Gary Schwartz, MD, “Leadership Lessons for Physicians from Ted Lasso”
www.soundpracticepodcast.com/e/leadership-lessons-for-physicians-from-ted-lasso
Mike Sacopulos: Apple TV launched Ted Lasso in the fall of 2020. This series focused on an American football coach played by Jason Sudeikis, who is hired to coach an English soccer team. But Ted Lasso is less about sports and more about leadership. In this episode of SoundPractice, I talked with Dr. Gary Schwartz, president of Associated Eye Care from Stillwater, Minnesota. He wrote a LinkedIn article, “Leadership Lessons from Season One of Ted Lasso.” Dr. Schwartz found 10 crucial leadership lessons woven into the Ted Lasso series. This episode serves as proof that SoundPractice can be hip, socially relevant, and educational all at the same time!
We’re going to be talking about Ted Lasso. For those unfamiliar, could you give me a plot summary?
Gary Schwartz: Sure. Ted Lasso was a show that Season 1 aired on Apple TV a couple of years ago. We’re recording this prior to the dropping of Season 2. Ted Lasso is an American college-level football coach who, for reasons that are plot devices, ends up taking a job in England and becoming a premier league soccer coach. And it just follows his story, kind of a fish out of the water story of someone who goes from college level to the highest professional level and goes from American football to European football or soccer.
For something to do this winter while we were all shut in, I’d watched Ted Lasso and had made some connections that there’s some really interesting leadership lessons in here.
I just wrote this [article] for fun…It started off as just a fun, one or two-pager that turned out to be a seven or eight-page thing. And I posted it on my LinkedIn page just for fun. And then, when I joined the AAPL, I posted it there as well, and it just got some notice.
So here we are talking about it.
There are 10 leadership lessons that I’ve culled from the series, and one of them is related to culture. Culture is central to everything. The way we see culture play out in the show is fundamentally in the locker room and on the practice field. Also, how the players treat one another and how the players treat one character in particular, Nathan, who’s the kitman. He’s a low-level employee, like the guy who does the laundry and makes sure the lockers are stocked up.
In Episode 1, the Ted Lasso character can see in the locker room that there’s trouble. There’s different camps. There’s the leader of the team, the team captain, who’s the former leader of the team, the character named Roy Kent. He sits back and is complicit in the bad behavior because he doesn’t step in to stop it.
There’s an unofficial leader, the star player, a younger player named Jamie Tartt. He’s both an informal leader and he’s a bully. And he has a group of followers who are bullies. What Ted Lasso determines is that this is a culture that needs improvement and he’s going to work to improve the culture.
Sacopulos: Lesson No. 2 that you came up with is, “You do not have to know everything.” I have to say, that is reassuring to me, Doctor. What can you tell us about lesson No. 2?
Schwartz: As far as the Ted Lasso character is concerned, so he comes to England from America, and he seems to make very little effort to learn the sport of soccer or to learn English culture in general. I mean, there’s this repeated joke where he’s about to cross the street in England and he looks to the left, which is the way you would look in the United States, and he’s about to step off the curb and somebody puts their arm out and stops him because the cars come from the right and not the left in England.
He comes into the job not knowing much about the sport of soccer. But, what does he know? He knows how to coach. He knows how to get the best from his players. He knows how to develop young men. He knows how to create a good culture in the locker room. So that’s what he does know, and that carries the show. So the analogy for your AAPL audience is, if you are a physician, yeah, you’ve got to know everything to be a good physician. But if you’re a physician leader, things kind of change. Right?
Let’s look at me. I’m an ophthalmologist, and I am the president of a 15-doctor, 160-employee group. That’s what I know. That’s my space. But let’s say I get courted away. Let’s say some healthcare system or some major hospital says, “Hey, Gary, do you know what? Instead of being the president of a small ophthalmology group, mid-size ophthalmology group, how would you like to be the CMO of our hospital? Or how would you like to be in charge of ambulatory services of our hospital?”
Many physicians spend their time as physicians thinking they have to know everything. A job like that would cause analysis paralysis. Right? Because you can’t learn everything for the new job. So you have to be comfortable with this idea that “I don’t have to know everything.”
For me, I understand how a clinical practice works. I understand ophthalmology, but ENT is probably similar in a lot of ways. Primary care medicine is probably similar in a lot of ways. The similarities probably outweigh the differences. I know how to lead. I’ve led a company of 150 people, so I should be able to lead a department, or I should be able to lead a medical staff. I don’t need to know everything about the hospital or everything about all the subspecialties that will be under me in my new position, but enough from my current position should carry over that I should succeed.
That’s the analogy for the physician leader: I wouldn’t be a good ear, nose, and throat doctor. I don’t have the education for that. But I might be a good CMO, or I might be a good head of clinical services.
Sacopulos: Lesson four is one of my favorites: Call people by their name. And it seems to me that this applies in a wide variety of arenas. But in healthcare, maybe this is part of the art of medicine over the science of medicine.
Schwartz: Yeah, there’s a touchy-feeliness toward using people’s names. It’s definitely the art of building a practice. What do I mean by that? When I was a resident at the University of Minnesota, we had a lecture from an older, sage ophthalmologist, Mac McConnell, who would tell us how to be in practice. You’ve been a resident, you’ve been a student, how do you be in practice? And one of the things he told us was (this was in the age of paper charts), “If you learn something about a patient that’s interesting, write it on the chart cover. So next time you see them a year later, when you really don’t remember them from the 15 minutes of last year, you see this note you jotted down, and then you bring it up.”
I trained and practice in Minnesota, but I’m from Boston. So any Boston connection at all, if a patient tells me their kid was in Boston, their daughter goes to school in Boston, their son did military service in Boston, I always jot that down. And in our electronic health record, we have a place for that because I set that up. And it works. And I’ll say to them, “Oh, is your daughter still in Boston?” And they’ll say, “Oh my God, Dr. Schwartz, you always remember that. Yeah, she still is.” “You get out to see her at all?” And if I bump into them in the grocery store, I might not remember that detail. But if it’s in the chart, I remember that.
Peter Angood Commentary: Today’s medical graduates are superbly trained to practice state-of-the-art clinical medicine. However, only in rare instances are they trained to self-manage their career as physician leaders and as physician executives. Ted Lasso took the world by storm, and in many ways it was the perfect antidote to a world that seemed upside-down because of the pandemic, political differences, and overall world strife. Not only is it a show about kindness, but it also covers many basic tenets of leadership and emotional intelligence. The original article is linked in the podcast’s show notes.
Another item to point out here is to remind us of the power and the influence that can be harnessed for good by social media. If it weren’t for Dr. Schwartz posting his article on LinkedIn, we likely would not have known about his work. In fact, I didn’t even know about the television program at that time. From one of our AAPL staff members reading Dr. Schwartz’s posts, we invited him to post in our community forum for members and that resulted in an article in our Physician Leadership Journal, and then to an invitation to be a guest on our SoundPractice podcast. This all started with Dr. Schwartz’s post that went viral — good for social media and good for us.
Excerpt 3: Joan Naidorf, DO, “Treating the Difficult Patient”
www.soundpracticepodcast.com/e/treating-the-difficult-patient-by-joan-naidorf-do
Mike Sacopulos: Physicians enter their professions with the highest hopes and ideals for compassionate and efficient patient care. Along the way, however, problems arise in their interactions with difficult patients. Addressing a problem that is rarely discussed in the patient care context, I interviewed Dr. Joan Naidorf about her new book Changing How We Think about Difficult Patients: A Guide for Physicians and Healthcare Professionals.
Could you tell us how providers choose thoughts so that difficult patients don’t seem so difficult? Maybe walk me through a scenario of a difficult patient and how you would approach that situation.
Joan Naidorf: One of the types of people we saw in the ED, someone who was very angry and oppositional, was a patient with chronic obstructive pulmonary disease. Usually, these people were smokers for a lot of their life. When they were young, people like my father, a service member in the World War II, they gave cigarettes to the soldiers. And this is just something that they did. They turned a whole generation into smokers before we knew how harmful that was.
And instead of blaming them for [being smokers], when we see those people, we need to ask better questions and be more curious. “Could I be wrong about what I’m thinking about them?” This is a question that we have to ask ourselves when we’re dealing with a difficult patient. “Can I give this person the benefit of the doubt? Is this angry person somebody’s father or mother?”
There’s a person who may be an angry man with COPD, but it’s somebody’s father. And if my father came into the emergency department, even though he might be grumpy, I’d like everybody to give him the benefit of doubt and give him the best care.
Another question we could ask to change our thoughts and think more intentionally about these people is, “Is some of their behavior a symptom of their disease?” And the answer is often “Yes.” Someone who’s very grumpy, a kind of anger is a part of this chronic disease. They’re thinking, “Why me? Why did this happen to me? I was always doing what I was supposed to be doing.” And they’re grumpy about or angry about having to be on oxygen all the time. It feels terrible. I mean, can you even imagine how awful it must feel not to be able to catch your breath?
If you think about someone more in those terms, I think that you’ll have more compassion for them and you’ll not view them as difficult. Now, you may find... I like to use the word challenging, and I think, “Are you challenged by them?” Yes, you are. But you’re up to the challenge. You can find a way to bridge the gap with that person and come up with a solution to get better results, better treatment, get them feeling better.
Sacopulos: The book is Changing How We Think about Difficult Patients. This is certainly a book that will make you a better physician and I think make your life better in the practice of medicine. It’s an important book, and I certainly recommend it to all who are listening.
Peter Angood Commentary: Well, we certainly all have had difficult patients, and I remember them, almost all of them, actually. So, it was a pleasure to see Dr. Naidorf’s book. She references the 1978 landmark article from the New England Journal of Medicine by James Groves, “Taking Care of the Hateful Patient.” Dr. Groves described four general categories of hateful patients. He called them dependent clingers, entitled demanders, manipulative help-rejectors, and self-destructive deniers.
I have to say I’ve seen all of those at some point. Dr. Naidorf, in this podcast and in her book, dives in deeply and encourages physicians and healthcare providers to really examine the thought distortions, implicit biases if you will, that we all have.
These are complex emotions involving the doctor-patient relationship and Dr. Naidorf introduces simple, actionable tools that every physician, nurse, and care provider can use to help change their mindset. Exacerbated by the perception of demanding and unappreciative patients, especially during a global pandemic, I encourage our physician leaders to listen to this entire podcast and also to read her book. This book should become a part of the medical school curriculum, as we all deal with learning about implicit bias, but more importantly how to manage it.
Excerpt 4: Shannon Prince, PhD, JD, “Racial Justice in Healthcare”
www.soundpracticepodcast.com/e/dr-shannon-prince-on-racial-justice-in-healthcare
Mike Sacopulos: The pandemic has cast new light on healthcare disparities. Vaccine hesitancy and vaccine availability in minority communities has led to further discussions of mother and infant mortality and other care disparities. While some may debate the origins of these disparities, few would argue that they are not disturbing. In this episode of SoundPractice, I spoke with Shannon Prince PhD, JD, author of the new book Tactics for Racial Justice: Building an Antiracist Organization and Community. We started by discussing how one could become an anti-racist physician.
Dr. Prince, you’ve used this term “anti-racist physician.” Can you define that for the purposes of our discussion today?
Shannon Prince: Sure. An anti-racist physician is a doctor who recognizes that race can have a negative impact on one’s life and on one’s health, and consciously works to mitigate those effects.
Sacopulos: How does one become an anti-racist physician?
Prince: The most important thing is to recognize that color blindness can literally kill. For example, it can be tempting to think of a non-white body as just a white body with more melanin. And that’s actually not the case.
The way systemic racism manifests itself results in all sorts of disparities such as access to healthy food, access to clean air, whether or not we are vulnerable to stressors such as police harassment. People of different ethnic backgrounds age differently, they sicken differently. So if you are a physician, you need to be aware that you have to be on the watch for chronic disease in a black patient a decade earlier than you need to for a white patient. You need to recognize that a black woman is at a greater risk for maternal mortality than a white woman is.
And then you also have to respect the fact that race not only determines how we get sick, but also it determines how we heal. Although you should never assume that a patient of color is poor, it is important to recognize that in America, we have a wealth gap. White families have exponentially more wealth than families of color. The median white family has 22 times more wealth than the median Latino family. That white family has 41 times more wealth than the median black family. And the average white family has 10 times the net worth of a non-white family.
Why does that matter for medicine? If you’re going to tell a patient, “For your health, you need to eat healthy,” that may not take into account the fact that if they’re someone from a community of color who is more likely to be poor, they may live in a food desert. They may not have access to healthy food. If you tell a non-white person to exercise, you have to keep in mind that because of poverty, they may not live in a neighborhood where there are sidewalks that are safe to walk or jog on. They may live in an apartment that’s too cramped to do cardio in. They may live in a neighborhood that’s so polluted that if they go outside and try to exercise, they’re going to trigger an asthma attack.
You have to think about how to work through those issues with your patients. So the first step to being an anti-racist physician is not being color blind, it’s seeing color and then treating the effects of color.
Sacopulos: Physicians occasionally encounter explicit racism. How should physicians respond?
Prince: The first thing to keep in mind is that the time to decide how to respond to an act of explicit racism is not when it happens. It’s not when the patient is there in the hospital bed saying, “Well, I don’t want a doctor who is Asian or Hispanic or Black or Native American,” and everyone is trying to decide in the moment what happens.
You need to come up with a plan for what you’ll do if the situation is an emergency, which, of course, is going to be to stabilize the patient, but also what to do if the situation is not an emergency. You can make a decision as a practice that if you have a family practice, or if you’re a primary care physician and a patient is racist, you just won’t treat that patient.
But you need to look at all sorts of situations. What are you going to do if a child comes in with a racist parent? Make that plan before that incident happens. What are you going to do if a colleague is called a slur? Even if it’s an emergency situation, and in the moment everyone is focusing on stabilizing that patient, after the incident occurs, don’t pretend like nothing happened. Debrief about it. Comfort that person. Understand how to be an active bystander so that if you’re in a non-emergency situation and a patient says something racist about a colleague, you understand how to handle it.
For example, you address the comment and not the patient. You say, “You know, Mr. Doe, what you said was racist.” As opposed to, “Mr. Doe, you are racist.” You’re very firm about the fact that you don’t tolerate that behavior in your practice. And then, you’re just mindful of what your colleagues deal with. The fact is that when a doctor of color walks in the room in his or her scrubs, that doctor may be assumed to be an orderly. You need to know that your colleagues are dealing with that stress. You need to know how to support them in it.
So just make a plan for how to deal with explicit racism and be clear that if it’s not an emergency situation, you won’t tolerate it. You will address it, and then you will check in with your colleague after the fact.
Peter Angood Commentary: Dr. Shannon Prince holds a PhD in African and African American studies from Harvard University. She also received a law degree from Yale and is the author of Tactics for Racial Justice: Building an Antiracist Organization and Community. This was a compelling interview and Mike Sacopulos and Dr. Prince discussed how race and ethnic background factors into patient care both from the provider perspective and the patient’s perspective.
In the podcast, Dr. Prince provides concrete suggestions — for example, how to make a plan to handle explicit expressions of racism directed to members of the healthcare team. It turns out preparation is the key, rather than handling a situation on the fly when it happens, and it will happen. She also encourages physician leaders to do checkups on themselves.
You can give a CME offering on caring for multicultural populations and gather colleagues to share what was learned. You can create an anti-racist physician reading group, where everybody reads a journal article about a health issue affecting a population of color or ethnic diversity such as sickle cell or cystic fibrosis. Then you can circle up and discuss the findings.
You don’t have to be the head of a department to initiate these efforts. Anyone can do it. Even starting those practices in medical school can combat all sorts of racism in medicine. We can all play a productive part by making decisions and deliberately taking small steps. Diversity, equity, and inclusion are critically important for healthcare, and we must all make efforts regardless of our own ethnic or racial backgrounds.
Excerpt 5: Peter Hotez, MD, PhD, “COVID-19”
www.soundpracticepodcast.com/e/dr-peter-hotez-on-covid-19-bonus-soundpractice-episode
Mike Sacopulos: In the early part of the pandemic, when vaccines were starting to roll out, we interviewed Dr. Peter Hotez, MD, PhD, as a bonus SoundPractice episode. We learned some things — especially when he described the targeting of minority communities with anti-vaccine messaging and the role of social media and other organizations in that effort.
This intentional spreading of misinformation directed to certain ethnic groups, well, it frankly floored us.
He is a professor of pediatrics and molecular virology at Baylor College of Medicine where he is also co-director of the Texas Children’s Center for Vaccine Development and endowed chair in Tropical Pediatrics. He is a vaccine scientist who has led the development of vaccines to prevent and treat neglected tropical diseases and coronavirus infections.
Dr. Hotez, you wrote an important piece about the coming crisis among the black, brown, and indigenous citizens of our country. The biggest concern is that vaccine rollout numbers are showing disparities when it comes to race. Could you comment on the really perfect storm of vaccine hesitancy coupled with the vaccine unavailability? What outreach would you suggest?
Peter Hotez: I am very worried about black and brown communities for a few reasons. One, they often tend to be linked to low-income neighborhoods where people are essential workers. By that, I mean, they’re not home on Zoom and Skype, they are working in family-owned businesses or in construction sites or in the service industry, and therefore are exposed at a higher rate.
They often live in multi-generational homes, so if you’re a 20-year-old kid on a construction site, you’re then coming home to your parents and your grandparents and they’re getting infected. And then, there’s a high rate of comorbidities such as hypertension and diabetes, so all of these things are combining together.
And the fact that we seem to be vaccinating people of color at lower rates than Caucasian populations, that’s also worrisome. For instance, according to the recent Kaiser Family Foundation study, in Mississippi, where the African-American population accounts for 38%, only about 18% have been vaccinated. So there is that two-to-one disparity in vaccinating. Addressing that’s got to be a big priority as well.
Sacopulos: How do you think it’s best to address that?
Hotez: I think there are a few things going on. One is making vaccines more accessible. I think opening up vaccination hubs in low-income neighborhoods, that’s got to be a priority. For instance, here in Houston, our mayor, Sylvester Turner, has made that commitment and announced it. I think that’s the kind of thing we have to think about doing.
I think the other is addressing the pretty high rates of vaccine hesitancy that we’re seeing, especially in the black community. We did a study led by a colleague of mine, Tim Callaghan, who’s a social scientist at Texas A&M and found that black populations, African-American groups, are the second highest vaccine-hesitant group. And the Kaiser Family Foundation did a similar study with different methods that came to the same conclusion. So addressing the vaccine hesitancy issue in the black community is going to be important as well.
Sacopulos: And the hesitancy in the black community, are you seeing that across the country equally, or is it greater or lesser in different geographic areas?
Hotez: I don’t think we know. We just have those two or three studies. It seems to be across the country, and a lot of it is around fears about the safety of the vaccine, that they feel it was rushed. We’ve had our research and development program for a decade around coronavirus vaccine, so there’s nothing really rushed about it. But there’s been a lot of mis-messaging.
The other thing that we have found is that very tragically, the African-American population specifically has been targeted by anti-vaccine groups. This is a new battlefront from the anti-vaccine groups—targeting specific groups. They did this with the Somali immigrant community in 2017 — convinced them that vaccines caused autism, drove down vaccination coverage, and caused a measles epidemic. Then they did it again with the Orthodox Jewish community in 2018, 2019, and did it in a very inflammatory way, depicting messages with yellow Jewish stars with the word “vax” and a typeface that made it look like Hebrew letters. I mean, that’s about as offensive as you could get. And now they’re doing this with the African-American community, comparing COVID vaccines to the Tuskegee experiments and experimentation on people in the black community that ended in 1972.
I’m spending a lot of time now countering all of that disinformation campaign. At least on a daily or every other day basis, I’m going on African-American talk radio shows and podcasts to try to reach those groups and explain why. What we’ve seen now in the black and brown communities is that about 35% of the deaths are under the age of 65. So that’s the other piece to this.
When we talk about COVID-19 deaths, the narrative that’s out there is that it’s a virus known to cause severe illness in people over the age of 65. That’s not true in black, brown, and Native American communities, where 30% to 35% of those who die are under that age. What we’re doing is we’re losing a generation of moms and dads and brothers and sisters, and that’s really devastating. So I’m trying to do whatever I can to dispel the misinformation that’s out there.
Sacopulos: It sounds truly monstrous. Has there been any assistance from social media platforms in dealing with this deliberate misinformation campaign?
Hotez: Yeah. The anti-vaccine groups dominate the internet and social media. I mean, go to the Amazon.com site and type in “books” up at the top, as everyone has done, and press “return.” You’ll get the help guiding on the menu at the left. You click on that again, then “vaccination,” and it’s all fake anti-vaccine COVID conspiracy books. So how you counter that is tough, and I’ve been dealing with this for years because I’ve been going toe-to-toe with the anti-vaccine groups.
I have a daughter with autism and I wrote a book a few years back called Vaccines Did Not Cause Rachel’s Autism because that’s one of the anti-vaxers’ central tenets. As a physician-scientist, I go into the detailed information, showing there’s no link between MMR, thimerosal, or any of those things in autism and how autism begins in early fetal brain development. Then this is tough because they are so dumb and they are so ubiquitous on the internet, on Facebook. There are maybe 10–12 major anti-vaccine groups who are perpetrating this. And it wouldn’t be that hard to take it down but so far, no one’s got the appetite to do it.
Peter Angood Commentary: Throughout the pandemic, Dr. Peter Hotez has been a tireless figure in the media, appearing in outlets on all sides of the political debate. He’s participated in the media on topics such as the origins of the pandemic, COVID-19 vaccine development and rollout, and the science of infectious disease. We are pleased that he could spend some time with us on our AAPL podcast.
Although misinformation is a problem for physicians on the front lines, especially primary care and emergency physicians, Dr. Hotez provides a clear-eyed look at the positive and trusted role physicians exercise in this and every sector of the healthcare industry.
In this interview, Dr. Hotez provides talking points for physician leaders on understanding their role during the pandemic; the importance of recognizing the enormous pressures that physicians and healthcare workers continue to face — emotional, mental, physical — and how physician executives and physician leaders can help. Clearly, this has been a period of unprecedented duress, and therefore a lot of the comments that he makes are still very relevant.
Excerpt 6: Laurie Cameron, “Mindfulness and Healthcare: A Discussion”
www.soundpracticepodcast.com/e/mindfulness-and-healthcare-a-discussion-with-laurie-cameron
Mike Sacopulos: Mindfulness. It is a word that we see on covers of magazines, at the grocery checkout, but what exactly is “mindful” practice or “mindful leadership”? I had the opportunity to interview Laurie Cameron for SoundPractice. Cameron is a mindful leadership expert and is the National Geographic author of the bestselling book The Mindful Day: Practical Ways to Find Focus, Calm, and Joy from Morning to Evening.
A student of Zen Master Thich Nhat Hanh for more than 25 years, Cameron integrates emotional intelligence, positive psychology, mindfulness, compassion, and neuroscience into practical strategies. Here, she describes starting in a mindful practice for physicians and healthcare workers.
Laurie Cameron: Mindfulness really involves three points of a triangle. If you were envisioning a triangle, you could think of intention on one point, attention on the other point, and attitude on the third. So it’s about attention, but it’s the way we’re paying attention. We’re paying attention with a beginner’s mind, a curiosity, an open-minded receptivity, which is very different than the way many of us are trained and educated and conditioned in the West to pay attention. We usually pay attention with more of a judgmental mind.
If we pay attention to our mind, we find that we’re often judging up to 20 times an hour. We judge ourselves. We judge those we interact with. We judge situations. We judge the weather. We make things right, or we make things wrong. So mindfulness is the ability to pay attention to what’s happening when it’s happening. That’s step one. It’s just to know, “What’s going on with me right now? I’m stressed out. I just watched a patient die in the hallway. I’ve got to walk into this next room where I know someone is right at the brink of life and death. And I’m noticing a tsunami of emotion in my body.”
That’s a mindful moment, to pause and notice what the direct experience is so we can take that second pause, just that breath, and bring attention to the breath. Calm and regulate the body, connect to how you want to show up as you walk in that next patient room and then be able to do so. So we can build those competencies with practice.
Mindfulness is an evidence-based best practice method of replenishing and renewing. A few minutes of mindful breathing, where we drop below the choppy waters and turbulence of the life that we’re in. I love to use the metaphor of an ocean that these physicians and nurses and frontline workers are in very turbulent, choppy, churning waters, and they stay in that all day, hours and hours and hours. Then they might come home and not have anything left. It might be a martini and a Netflix binge before they collapse in the bed because there’s just no energy left.
They can learn very small, short, very effective practices — I call them micro-practices — that they can weave throughout their day so that they’re not adding a mindfulness class [that’s] one hour or two hours at the end of an already exhausting day. They’re weaving and integrating very strategic mind–body moves to shift their state in the moment, which impact their own wellbeing as well as patient outcomes. So the ROI is quite significant.
And that is really the heartbeat of the work I do. When National Geographic asked me to write the book, The Mindful Day, they wanted a science-backed book on mindfulness. Their audience isn’t known for incense and beads. Their audience in National Geographic are explorers, and we like to think of this book as supporting inner explorers. What’s happening on the inside?
They wanted a book for people who weren’t going to go to the Himalayas, or don’t have time to add a weekly Monday night class, but who want to find out how to integrate the benefits of mindfulness, which are cognitive, psychological, physical, emotional. It impacts relationships, wellbeing. To get those benefits in the existing life we already lead, we’re doing consistent practice daily to build up muscles or skills or new mindsets. The neuroscientist, Richard Davidson at the Center for Healthy Minds at the University of Wisconsin, says, “With repetition, with consistent practice, we are wittingly shaping our mind.” He says, “We are shaping our minds every day, wittingly or unwittingly.” I love that phrase he uses.
We now know what the science is and what the research is, and that if I go to this mental gym every day consistently, if I get up in the morning and have a cup of coffee, walk the dog, and then sit in my living room chair and exercise my attention muscle, if I run and if I do a mindful breathing practice, I’m strengthening the circuitry between the PFC, the prefrontal cortex, and the amygdala. So that I am better able to respond instead of reacting when stress hits. I’m going to the gym to build up my skills and create that muscle memory.
To the second part, I am shifting how I’m responding to stress when it happens. And what we’re doing here is we’re interrupting conditioning. We all have habituated patterns in how we react. And some of it is from our biology, our evolutionary biology as human beings. We’ve got a flight, fight, or freeze response. We get triggered. We react. And part of it is our conditioning. We’ve modeled and learned from parents, schoolteachers, basketball coaches, and so on. So what we’re doing with mindfulness in the moment, on the floor, in the hallway, in the OR, wherever we might be is we are noticing that reaction rising and then interrupting our habituated response in the moment, and using a new response, a new skill, which might be pausing and breathing.
It might be the STOP practice: Stopping, taking a breath, observing what’s happening in the body, using inquiry, looking at the thoughts in the mind. “What am I believing about this other doctor or about this patient” or whatever might be going on? And then P is proceeding with a calm, clear, intentional next action.
So we’re doing both. We’re building up our muscles, a new way of being every day with discipline, and then we’re integrating these practices at point of need when they happen.
Peter Angood Commentary: One of the most difficult tasks for physicians who seek lifestyle balance is being able to recognize their own lack of balance. Many physicians, earlier in the training, deny their emotional and physical needs as a means of surviving. We are clearly taught, directly and indirectly, to suck it up, to work until the work is done, to be tough emotionally and physically. Remember that old maxim, “sleeping is a weakness”?
At the same time, physicians are likely tired of the constant drumbeat of strategies to combat burnout: eat well, get enough sleep, do yoga, other suggestions of self-care.
Well, physicians are already among the most resilient of individuals around. So no wonder they get a little bit tired of that. We expect our physicians to be resilient, but we also expect them to work within the system that may not always help them. We know that healthcare has systemic issues of what it expects from its workers, just like every industry, and work there continues and must continue.
But back to the interview with Laurie Cameron. Why would National Geographic publish Laurie Cameron’s book, A Mindful Day? What I learned from this interview is that National Geographic, the company that specializes in explorers and adventurers, wanted a book that concentrates on internal explorations. And that is what Cameron delivered.
What I liked about this interview is that Cameron understands the world of the physician and healthcare worker. She talks about the mindfulness as something that physicians can practice, incorporating it into their day by using what she calls little micro-practices. Just breathing a certain way before entering a patient’s room, settling the mind before one has to deliver bad news to a family, techniques to use when giving tough feedback to a colleague who did something negligent in the OR or somewhere else.
Yes, micro-practices need to be learned, but it is not a time commitment that would stand in the way for a physician wanting to embrace the work. Paying attention on purpose, in the present, with curiosity, openness, and compassion, self-compassion, it all begins with a physician having a receptivity to the concept of mindfulness.
And mindfulness is demonstrating through functional MRIs, that it clearly changes our brain and operational work for the better. Give this Laurie Cameron podcast a listen to see if these techniques may help you as you get started on a mindfulness practice.
Excerpt 7: Kara Swisher “Medical Misinformation, Tech Platforms, and the Threat to our Public Health”
Mike Sacopulos: FDA Commissioner Dr. Robert Califf announced his concern about how social media magnifies and disseminates false information about science. Covering this topic, we were delighted to interview tech columnist, thought leader, and podcast host Kara Swisher. Swisher has been on the tech scene since the early ’90s. She has written for The Wall Street Journal and The Washington Post. She started the All Things Digital conference with Walt Mossberg, also from The Wall Street Journal, back in 2003. She has a podcast with Scott Galloway, the Pivot podcast.
This engaging episode is a tutorial for physicians on tech landscape, the lack of accountability for tech companies, and an overview of Section 230 of the Communication Decency Act, which impacts physician practices in ways that you don’t think of daily in this country.
As you know, SoundPractice is a podcast to educate physicians on issues that have an impact on their patient care and their positions as physician leaders. Certainly, platforms such as Facebook, Twitter, and Google have substantial control over the information our fellow Americans see. And I know you’ve been vocal about the lack of regulation surrounding tech companies and the content that they are producing. And of course, what comes to mind is COVID-19 misinformation. Right? We know the playbook. It’s, “COVID isn’t dangerous. The vaccine is dangerous, and you can’t trust doctors or scientists.” How did we end up here?
Swisher: Well, I think it’s been part of a long stretch of the ability of these companies to act as platforms and not as media companies, which they are in a lot of ways, and get the protections of platforms which come from a law that was passed many, many years ago called Section 230.
The companies that are running these platforms have no responsibility to put out accurate information, and they become de facto news organizations; it’s how people get their information. Whether they like it or not, these tech companies are media companies. But what happens is the platforms flood the zone with all kinds of misinformation or give equal time to patently false things and then do nothing about it. Spotify is the perfect example of this. They’re trying to pretend they’re just a platform, but they have a media relationship with someone.
Sacopulos: Emergency room physicians are certainly now on the front lines for the anti-vax rhetoric coming from unvaccinated patients and pediatricians have been dealing with this for many years. The anti-vax movement certainly is not new. And people somehow forget that we’ve had outbreaks of measles in Oregon and Orange County, California, all tied back to the anti-vax messaging. So it really appears that social media has turbocharged all of this. Would you agree with that statement?
Swisher: Oh, yes, 100%. They’ve gotten turbocharged by the internet and the ability to use these tools. These are malevolent players following a playbook, and they’re getting better at it. They pop up here or they pop up there. It’s hard to regulate them.
Facebook and others have really tried hard. It’s just that they waited too long. On one hand, it’s great for people to protest whatever they feel like protesting. On the other, it creates the ability to put out false information. I don’t mind if people have an argument. “Here’s my argument. And this is what it is.” And I’m sure doctors hate it. You can only do so much with people. But there is such a thing called the public good and public health. We all agree not to go through a stop sign.
We need social contracts with people and with other people in our society. And if it’s going to be an anything goes kind of thing, it’s really problematic. There’s lots of studies of that. It always degenerates into chaos, and you know, I’m sure doctors are already sick of Dr. Google, right, when people come in and say, “Let me just tell you what I read on the internet.” Right?
Sacopulos: Give me some ideas how we can involve physicians to make them part of the conversation or to get lawmakers to make changes here to get some degree of accountability because it really is a matter of life and death.
Swisher: It is indeed. Start with the premise that you’re never going achieve a perfect society like that. You’re always going to have people who go back to the old adages like, “Drink vinegar. That’ll cure cancer” or whatever it happens to be. My grandmother had 90 different solutions to all kinds of illnesses. For migraines, she had something with oil and a knife under the bed.
But I think one strategy is strengthening the public’s view of science as a trusted institution. One of the problems is that it’s been claimed that science can’t make mistakes. It makes mistakes, and that’s very obvious to a lot of people. So how do you then get people into the mode of thinking that this is a group that’s trying to help you and trying to figure it out, and sometimes they’re wrong, but they’re almost always right on things.
These platforms can’t be the only place for this information. The government has to do a better job of disseminating information far and wide. Doctors have to realize that. Someone in the government told me the most effective way to convince people to get a vaccination is by hearing it from the doctors themselves, who have a close relationship with their patients and take the time to talk to them.
Lobbying Congress to break up some of these companies and encourage innovation may result in more ways to disseminate information that isn’t just confined to one or two companies. Google has 97% of the search market. Are they a utility? Yeah, kind of. Facebook has a huge share. Then of course, there’s public pressure. Amazon recently stopped selling a chemical that people used for suicide after much media and public pressure.
That’s another way to do it. Tell your stories, tell the stories of what can happen if we don’t do take action. And then talk a lot about the idea that there should be more choices for people to get their information. And it shouldn’t be a single place. But if it is a single place, the people in charge have to do a better job of moderating what’s happening there.
Peter Angood Commentary: Kara Swisher provided a no-nonsense commentary about technology platforms acting as publishers and news outlets. And she described in detail, the nuances of Section 230 of the Communication Decency Act, which allows companies to post information that may not be factual. And stating the obvious, misinformation about science is a significant public health threat. With tech platforms currently not being accountable, social media has turbocharged anti-science messaging, putting physicians on the front lines with patients. Swisher discussed the problem with how platforms such as Facebook, YouTube, Amazon, Reddit, and others, proliferate the disinformation and what physicians and healthcare professionals can do to stem false information.
Excerpt 8: Luis Pareras, MD, PhD, “Is It a Good Idea or a Good Business Opportunity? A Discussion with an Entrepreneur and Venture Capital Founder”
Mike Sacopulos: Unfortunately, good ideas are not enough to advance healthcare. Business skills, a team operating with clarity, and capital investments are all needed. The stakes for venture capital in the healthcare sector, and for the general population could not be higher. Luis Pareras, MD, PhD, is the founding partner of two venture capital funds, Healthequity and Invivo ventures. These funds focus on early-stage investments in the healthcare sector.
Dr. Pareras has led the investment strategy and transaction process for both of these funds. He is based in Barcelona, Spain, and I had the opportunity to discuss with him what makes a good business opportunity and what makes a good business pitch. This is an insider’s opinion from the perspective of someone who awards venture capital in the healthcare sector. You won’t want to miss this.
I find that many of my physician clients initially focus on protection of intellectual property, copyrights, trademarks, well before thinking about competition and marketing plans. Do you see this as well?
Luis Pareras: Once you get your idea in front of you, it’s not as much as protection. I mean about the business plan that you have at least in medicine or in biotech but about the problem you’re trying to solve and the regulatory roadmap that you have in front of you and the strategies that you want to deploy to better protect your idea. And all this roadmap really gets to the patient. Right? It starts as an idea, but then it gets to the patients more quickly than people think sometimes.
To judge how good or bad an idea is, let me tell you that when I present some ideas to my team, if everybody agrees with me that this is a good idea, I am too late already.
That’s a saying also in my field, “If it works, it is already obsolete because people are working on the next version.” I don’t care too much about marketing plans or these kinds of things. What I care about is the idea and the roadmap, the plan to make it happen.
The value of an idea is zero. Nothing. If you take it to the marketplace, then it can be worth a lot of both money and social return on investment as well. But the value of an idea is in its execution. So I’m worried about the execution of the idea, how the team needs to make it happen. What are their skills? What are their motivations, their internal drive? And above all, will this be a part of the future of medicine?
There are many, many ideas that are great. But maybe there are some other approaches to that very same problem that would be more interesting for the future. So when choosing your idea, you need to be very careful that it’s not only a good idea, but also it is in a field that it’s going to project itself into the future and become a part of medicine in the future.
If you want an example: Gene therapy versus a small molecule treatment for a rare disease, probably the gene therapy is going to solve the disease much better, right? I mean, solving a problem is not enough. That’s maybe the central message that I wanted to convey with this part of the interview. It’s not about solving a problem. It’s about solving a problem better than the other approaches that you have around.
Peter Angood Commentary: What is the value of my idea? Many physicians ask this question when they consider an invention, a new device, a new procedure, or a new healthcare business or innovation. And Dr. Pareras gives his opinion here in this straight-talking podcast. He encourages questions like these: What is the problem you are trying to solve? How do you get that idea ultimately to benefit the patients?
Our experience with leadership training in AAPL has shown the need for physicians to have master’s equivalent skills, some type of advanced education beyond medical training, and Dr. Pareras, in his podcast with Mike, discusses this in no uncertain terms.
In business pitches and in entrepreneurship, activity competencies such as negotiations, communications, and team building are crucial skills and are what partners and those individuals financing innovation are looking for. AAPL offers courses in all of those topics, and I’m sure many of you have taken them.
Deeply involved in the innovation ecosystem, Dr. Pareras is a member and advisor to many healthcare innovation organizations, has served at the board of directors of many life sciences companies, and is the author of Innovation and Entrepreneurship in the Healthcare Sector: From Idea to Funding to Launch. Dr. Pareras is also quick to say that physicians and healthcare leaders can think successfully about adding a business dimension to their perspective while they continue to pursue their careers, dreams, goals, and aspirations. It just takes focus and clarifying the value of that big idea.
Excerpt 9: Jennifer O’Brien, “An Insider’s Perspective on End-of-Life and Palliative Care”
Mike Sacopulos: Jennifer O’Brien has spent her career as an administrator and an executive working in healthcare and managing medical practices. Life took an unexpected and awful turn when her husband, a palliative care physician, was himself diagnosed with a terminal illness. She documented her journey through art and ultimately via a book, The Hospice Doctor’s Widow.
Jennifer O’Brien’s unique perspective on healthcare and end-of-life experiences in caregiving frame this episode of SoundPractice. She offers sage advice to caregivers and provides guidance for physician leaders on how they can be examples in their own families and communities.
Jennifer O’Brien: Our healthcare system has run into this problem where there’s such a gap between a specialty like oncology, hematology, and palliative care, and then ultimately hospice. And so, in oncology and hematology, palliative care is misunderstood as to what it is. Some see it as “giving up.”
I remember when Bob was ill. It was a real struggle. You’ve been with this doctor and there’s a relationship. He or she has helped you through some very difficult times. I think this is the biggest issue. And now, when it’s time to say, “I don’t want to try any more chemotherapies. I just want to be comfortable. I want to live the rest of my life,” there’s this heart-wrenching goodbye that has to happen between you and this oncologist who has taken you through really difficult stuff.
And some oncologists are part of the process, but most have this whole, “Well, once you say you don’t want any more treatments, you can’t see me as a patient.” And it’s heart wrenching. So it makes what’s already painful more so because you’re dying, and as a caregiver, you’re losing your loved one, and now you’re having to have this breakup.
Sacopulos: I think you’re hitting on something, and I really want to give you an opportunity to make recommendations to the SoundPractice audience and healthcare executives and physician leaders on how to improve palliative care and the process for caregivers.
O’Brien: Well, I think there are a number of ways to do it both formally and informally. The CAPC, which is the Center for the Advancement of Palliative Care, has some great programs on leadership and how to develop a palliative care program.
There’s a really incredible organization called Rebel Health that has a program called ARCHANGELS that is getting organizations to acknowledge family caregivers and to take a pledge to support family caregivers. And I would contact them and get an organization-wide pledge to recognize this role because this is a big deal: 54 million people, one in four adults, taking care of somebody they love is huge.
And I think at the very least, we recognize that caregivers are there. I can tell you from a very personal standpoint, you end up feeling quite invisible at times. There’s a big gap between what physicians and healthcare organizations can do for patients and what the caregiver, [who] is frequently referred to as the forgotten second patient, really needs. And so that’s more of a palliative care philosophy that says, “Let’s take the whole...”
If I were a healthcare leader right now, I would read Jessica Zitter’s book, Extreme Measures. This is a physician who is a career critical-care physician who at some point realized, “You know what? Cracking the chest of an 86-year-old woman who’s got end-stage ovarian cancer is not the way to go.” So she did a fellowship in palliative care. Now she marries the fact that sometimes critical care is in order, and many times palliative care is in order. Right? Because we live our lives and then we complete them.
Peter Angood Commentary: This was a powerful interview with Jennifer O’Brien. The art journal she kept as a form of self-care during her late husband’s 22-month illness was published in the Hospice Doctor’s Widow: A Journal. Quite the title, if you think about it, though.
O’Brien educates physicians, nurses, and other healthcare professionals about the role of family caregivers and the importance of end-of-life preparations for their own wellbeing and agency. I quote her here: “We live our lives, and then we complete them.”
Beyond just caregivers, this podcast with concrete recommendations to physician leaders offers a good amount of intellectual capital for when it comes to end-of-life care and end-of-life planning. The podcast and the book are really a tutorial. O’Brien also talks about the concept of precious time and the value in planning for end-of-life care and end-of-life wishes — topics that even that we as physicians tend to avoid. She also references useful resources for physician leaders, and those links are shown in the notes.
Excerpt 10: Sylvie Stacy, MD, MPH, “Pivoting, Tapping Out or Trading Up: Physicians Transitioning to Nonclinical Careers”
Mike Sacopulos: We’ve all seen those statistics on physician burnout. We all know about physicians who have changed course mid-career. We all know that there’s a gig economy out there. Moving away from clinical practice is not something to be done lightly or without planning.
Dr. Sylvie Stacy has written 50 Nonclinical Careers for Physicians: Fulfilling, Meaningful, and Lucrative Alternatives to Direct Patient Care. This episode of SoundPractice, examines career options and motivations for change with Dr. Stacy. She shares excellent questions a physician should ask him- or herself before considering a significant career change. Listen to her sage advice before pulling the rip cord.
Dr. Stacy, can you give me three questions that a physician should ask him or herself in preparing for a nonclinical career pathway?
Sylvie Stacy: For physicians considering a nonclinical job because of stress or burnout in their clinical jobs, one piece of advice that I often give is to avoid making a career change out of frustration. Being exhausted and disengaged can really cloud our decision-making. So if you’re in that situation, one question to ask yourself is, “Do I truly dislike patient care or do I just dislike my current clinical job? Or do I just dislike the type of patient care that I’m doing, or the setting in which I’m doing it?”
And if one of those latter situations applies, it may not be a nonclinical job that is going to satisfy you. It might just be a transition to a different type of clinical job. And in fact, I could write an entire book on the unconventional types of clinical careers that are available. So before anyone decides that they want to stop seeing patients entirely, I really think they should ask themselves if they truly are disliking patient care enough that they want to transition to nonclinical work.
Another question that applies to physicians who are feeling frustrated and burned out, and those who are pursuing nonclinical jobs for other more positive reasons, is how nonclinical work aligns with your professional and personal goals. I think that each job change that we have in our careers needs to somehow move us toward the goals that we have or help us to further define them. And so asking yourself this question will help you select the right type of role to pursue. And it will also help you convey your interest in a job when you’re applying and you’re interviewing.
And then, the third question, I would say, ask yourself, “How do your clinical skills and other skills transfer to a nonclinical job?” A lot of physicians wishing to transition from clinical work feel like they’re underqualified for all of the nonclinical opportunities that they come across because they don’t have experience in that industry, or they haven’t done the particular type of responsibilities described for that position.
But our clinical work relies on a lot of the same skills that are important for nonclinical jobs. And these include both soft skills such as communication, and technical skills like quality improvement techniques or statistical analysis. So coming from clinical work, it’s important to think broadly about your skills and how they might be applied to different types of responsibilities outside of an outpatient clinic or a hospital.
Peter Angood Commentary: I routinely encourage physicians to pursue deeper levels of personal and professional development throughout their career trajectory. So it was interesting when Sylvie Stacy contacted me about a book she was writing on nonclinical career choices for physicians. Although that was back in 2019 and before the pandemic, at AAPL, we could see the general trends of physicians being interested in this topic of alternative careers separate from clinical life. By the time they realize their career in clinical medicine isn’t everything they thought it would be, some physicians believe they’re too invested in their trade to turn back. Feeling burned out, disengaged, unfulfilled, and burdened by high student debt or compensation incommensurate with the demands of their jobs, many may feel trapped without options and nowhere to go.
We find that a number of our AAPL members are looking for ways to leverage their clinical skills to transition to another career — sometimes out of healthcare entirely. And that again was even before the COVID-19 pandemic. Some physicians are looking to extend their brand or to add that nonclinical side gig or an activity to their current work situation.
I ended up writing the foreword to Dr. Stacy’s book, and it’s a great book. It provides a focus on the constellation of readily attainable full-time positions for all types of physicians. It is a must-read for those trying to answer their personal question of whether to seek an alternative career beyond bedside care.
Listen now:
www.soundpracticepodcast.com/e/100th-episode-of-soundpractice