Season 3, Episode 19. Chuck and Chris discuss a listener submitted question on the difficult patient. How to best handle a challenging patient in the clinic. We share our tips and pearls together with the reality of modern medicine.
We plan a newsletter launch soon. Subscribe here: https://wustl.us6.list-manage.com/subscribe?u=c6fe13919f69cbe248767c4e8&id=10e0c1dd85
Survey Link:
Help Chuck and Chris understand better what you like and what we can improve. And be entered for drawing to win a mug! https://bit.ly/349aUvz
As always, thanks to @iampetermartin for the amazing introduction and conclusion music.
theupperhandpodcast.wustl.edu. And thanks to Eric Zhu, aspiring physician and podcast intern.
Season 3, Episode 19. Chuck and Chris discuss a listener submitted question on the difficult patient. How to best handle a challenging patient in the clinic. We share our tips and pearls together with the reality of modern medicine.
We plan a newsletter launch soon. Subscribe here: https://wustl.us6.list-manage.com/subscribe?u=c6fe13919f69cbe248767c4e8&id=10e0c1dd85
Survey Link:
Help Chuck and Chris understand better what you like and what we can improve. And be entered for drawing to win a mug! https://bit.ly/349aUvz
As always, thanks to @iampetermartin for the amazing introduction and conclusion music.
theupperhandpodcast.wustl.edu. And thanks to Eric Zhu, aspiring physician and podcast intern.
Welcome to the upper hand, where Chuck and Chris talk hand surgery.
Chris Dy:We are two hand surgeons at Washington University in St. Louis here to talk about all aspects of hand surgery from technical to personal.
Charles Goldfarb:Thank you for subscribing wherever you get your podcasts.
Chris Dy:And be sure to leave a review that helps us get the word out.
Charles Goldfarb:Oh, hey, Chris.
Chris Dy:Hey, Chuck, how are you?
Charles Goldfarb:I'm really well, how are you today?
Chris Dy:I'm doing really well. Too excited. It's a nice, it's gonna be a nice day here in St. Louis. Got the Pool Heater going this morning. So the kids are going to be excited. I still haven't really paid too much attention to my to my bill. But it was oh, man, the kids have loved the kids loved the pool.
Charles Goldfarb:And you know, we've talked about this a pool is a great investment if you can afford it as a parent, because it makes your house a congregating point. And there's such value in that.
Chris Dy:Yes, absolutely. We're actually my daughter is turning. Well, by the time this has aired, my daughter will have turned four. And we're having a pool party. And actually one of our partner's kids is going to be the lifeguard which is going to be fun. But a lot of people coming over for the pool party. So we're trying to figure out how to use our space appropriately in terms of, you know, setting up all the stuff.
Charles Goldfarb:That will be fantastic. That will be fantastic. Yeah, those those days are long gone for me. We had my daughter's 17th birthday party, my youngest had her 17th a week ago and she went out to dinner, we it's interesting. We went out to dinner. And 10 of her friends joined us, Talia and I sat in a different area at a table for two, which was fun. And the girls had a great time at their table.
Chris Dy:And they picked up your bill, right?
Charles Goldfarb:Yeah, it was funny. I was like, you want to take out how many people? Can't you narrow the group down? And she's like, Dad, just pay for dinner.
Chris Dy:Well, so it's interesting. So when, when I was when we were in high school, we would like go out to like dinners for people's birthday, kind of like that parents wouldn't come. But then we would argue over who would pay because like it was like well, is are you paying for the birthday person? Or is the birthday person taking everybody out? Because you know, my parents grew up in the Philippines. And the tradition in the Philippines was that the birthday person took everybody out. But then it seemed over. You know, when I was growing up, I was like, oh, no, you got to pay for the birthday person.
Charles Goldfarb:Yeah, I think it's a great question. And obviously, in this setting, it was clear and my sister actually gave me grief for going but we wanted to kind of see what was going on. And you know, it was good. A few weeks back, I mentioned a webinar that I really enjoyed and it was done. recently. It was put on by the Academy, the orthopedic Academy and the hand society really run by the Academy. It was organized by Jeff Yao and Sanj Kakar, Glen Gaston and myself. Were the speakers along with Jeff and we talked about the black box of the ulnar wrist and I know you love the ulnar wrist and the arthroscopy often utilized to assess it. It was a really good webinar and it's available for free if as long as you have an AAOS login. So super fun. And, you know, yes, webinars are getting a little old. But the format's just too easy not to continue to make use of it.
Chris Dy:Right, right. Absolutely. Well, what was some what was your favorite thing that either you taught or you learned in, you know, because those are some great, very bright people and thinkers. So you know, I'm sure that you've imparted a lot of knowledge, but maybe picks them up to two.
Charles Goldfarb:I would say this, and I've become really, really sensitized to this. It's all about anatomy, which sounds like a stupid thing for a hand surgeon to say because, of course, it's all about anatomy. But to me, it's about recognizing pathologic anatomy, in the wrist, and especially on wrist arthroscopy, and I do not believe there's consensus. And so that's going to drive some of my research in this space moving forward. But each of the speakers had had really interesting things to say and you know, Sanj Kakar talks a lot about the split tears between the ulnar carpal ligaments that is the ulnar lunate and ulnar triquetral ligaments. Many of us don't see that as regularly as he does, although it may see us anyways, good.
Chris Dy:Are you buying it? Are you buying it? Come on.
Charles Goldfarb:No, not to the level that Sanj buys it.
Chris Dy:All right, so it's a you Mayo trainees that listen, I know some of you do. Chuck just called out Sanj. Maybe we should have Sanj on to defend himself. Come on.
Charles Goldfarb:Yeah, we probably should he'll be calm.
Chris Dy:I cannot think of a topic I would like to talk about less. To be very honest with you.
Charles Goldfarb:Well, speaking of topics you'd like to talk about, I believe we have a case submission.
Chris Dy:Well, well, I will I will get to the case. But I will say multiple people have commented about how helpful that ECU episode was that we did a couple of weeks ago. So a couple of trainees, and actually I cited it and I was like, we're talking about ECU stuff and in clinic and I was like, just go listen to that podcast. Chuck, Chuck Todd, a lot of stuff. Just listen to that. But uh, you know, one of our mica Sinclair is actually coming to visit our team. And she talked about how much he liked and she's like, this is perfectly time because I needed to hear about this somehow you guys know that we? We'd like to that I needed to hear about that. So yes, kudos to you for really driving that one. That episode. It was great.
Charles Goldfarb:Well, you know, it's all fun. And you know, it does bear repeating this is self evident. But Chris, and I share our opinions. It doesn't make it fact, and we have our own set of biases, and our own set of passions, but glad to hear it's helpful.
Chris Dy:I disagree, actually listened to a different podcast that has a segment called My opinion is fact. But when the when the host contradicts their prior opinions, it's called My opinion is fluid.
Charles Goldfarb:I like that, I like that.
Chris Dy:Andy Nelson is a hand surgeon in practice in Connecticut. And he has been kind enough to share about our podcasts on the hand society listserv. So thank you, Andy, for that. I know you're listening. We talked about this case that you had emailed me about and you said it was okay to share it. So Chuck, I'm gonna throw you a case here before we get to our main segment. A, an elderly woman who fell in the bathroom and had a hand versus glass fixture and was seen in an ER, and sent out and is at the surgeon's office three days later, after having the skin closed. The assessment is that the FCU the radial artery, the ulnar nerve in the FDP ring and small, have been lacerated. So-
Charles Goldfarb:Repeat that one more time.
Chris Dy:So you got FCU and radial artery or out hand is perfused. But the FCU and the radial artery out the ulnar nerve is completely lacerated. And the ring and small finger are, are also lacerated. And for the purposes of this injury, actually, he didn't tell me exactly where it was, but let's just say it's at the wrist crease, or just proximal the wrist crease.
Charles Goldfarb:Yes. What's your question?
Chris Dy:Timing. So what's what's, what's the timing of this? Is this something like, you know, do it, say it walks into the office, the patient walks into the office, you do this ASAP? Like, Hey, let's go to the OR when we're done with clinic, or is this let's book it for your next elective day?
Charles Goldfarb:Yeah, I think it's a great question. I think that's what you know, that's part of the struggle of transition to your own practice is how to prioritize it is one of the things we don't you know, trainees don't necessarily think about other than get frustrated with attendings who push things. And I think this is one given this already been three days, it is not emergent. I think it's urgent in the sense of within five days.
Chris Dy:Five days and when it comes to you? Or five days from the injury.
Charles Goldfarb:Yeah, if it comes to me, if I see the patient on a Monday, I want to get it done that week. If it comes in on a Friday, I probably wouldn't do it over the weekend, what we're trying to do it early the next week.
Chris Dy:Is it. So the question was does the the ultimate result changed by waiting a few extra days? Like, you know, because the practical aspect is you canceled clinic or do you cancel other cases, even if you're trying to get it done within, you know, save the next day or so?
Charles Goldfarb:Yeah. And that's why it's so great having a big group like ours, where we can leverage each other to try to avoid impacting other patients. And then that's one thing I hate, I hate canceling. And it's not about me, it's about other people, other patients. I don't want to cancel anything. And occasionally that's required, but not often. So I would try to avoid canceling get it done. And within a few days, but not today, necessarily, or tomorrow necessarily.
Chris Dy:And I agree with you, it is about the patient logistically for your team. It is really, really a nightmare to cancel a clinic. Actually canceling surgeries is a little bit easier. It's less people, but people plan their lives around surgery. So you know, as much as you can avoid canceling I agree with you entirely. I mean, I'm actually scrolling down in Andy's email and looking at the laceration. It is just proximal maybe like three centimeters approximately wrist crease. And I think he meant to write on their artery, not radial artery, just you know, because it'd be really hard to Knock. Knock the radial artery out without getting everything in between the ulnar nerve, ulnar artery. Are you going to fix the ulnar artery? Hand is perfused Yeah, I guess you're probably about a week out now from the injury.
Charles Goldfarb:I'm not against fixing the ulnar artery but typically No, not in this situation, some would argue for MRB maximum resident benefit? I don't know, I don't. There there is an argument to be made to doing it. But I probably would not, would you?
Chris Dy:I think MRB is huge. I mean, this is a great vessel to work on as a resident and as a fellow. I mean, you're getting almost not elective, but you're getting daytime micro, and you're doing a huge artery. I mean, I think that then the clinical benefit, I think, is potentially for things like, you know, avoiding cold ischemia, things like that. I think it's worth doing, personally, but I don't think it's required as you state. How do you counsel the 71 year old say, you get nice tendon repairs plus minus on the artery? Are you going to tell her I can repair your nerve? Are you putting in a graft? Are there other things you would do?
Charles Goldfarb:So I think we can expect a reasonable outcome from the tendon repairs at that level, there should be a really good outcome, honestly, the nerve is the trick. And I would tell the patient that I hope that she regains protective sensation plus meaning much better than protective sensation, but not normal viewpoint. By any stretch, I would be really satisfied if and I'm talking a little out of my area of expertise. But I would say if she got eight millimeter two point discrimination, I would be happy. And I would plan a primary repair with an appropriate resection given that this is a sharp laceration.
Chris Dy:What would you expect in terms of intrinsics? Because you're in the area where the ulnar motor and sensory, they run together as part of the ulnar nerve, but they are easily separable and identifiable at this level.
Charles Goldfarb:Yeah, thanks for pointing that out. I, you know, I think this is a group acicular repair, whereas, or at least a darn per perfect alignment of the epithelium, as you know, using the microscope, probably for that reason, not because you need a microscope to repair this nerve, because you do not in my opinion, but trying to get the alignment perfect is an important goal. And I would be really, I don't think she's gonna get her first di back at all, I would hope that perhaps she can get a little bit of the intrinsics otherwise, I don't know what's what's your prediction?
Chris Dy:No, I I wonder whether you can get this primarily repaired. You know, after trimming back, that is one argument potentially to go sooner is that the more days you wait, potentially, if things are retracting, you know, maybe that's consideration. Would you flex the wrist to get a repair?
Charles Goldfarb:I don't mind. I don't mind flexing the wrist as long as when I flex the wrist is still not under the repairs do not under undue tension. That's the difference between some tension versus no tension. Sure. Flex at 20 degrees. No problem.
Chris Dy:Yeah, no, I like flexing the wrist here. I've actually used ultrasound to monitor some of the repairs I've done in this particular setting. Ultrasound I think is good to tell you that it is not ruptured. It's not good to tell you that you know anything beyond that, at least in my limited experience with it. I think if you have to use a graft I think for me, this is an autographed this is probably sural mainly for the motor component. You know, there was some way that the motor was preserved but the sensory was out then I think on all our graph will be fine. I agree with you. I don't think she's gonna get back her FDI especially at that age, you know, being an older patient. I am intrigued by brutalities description of using a transfer from the opponents and transferring it to the branch to the FDI. I have not used it a ton because I'm kind of waiting more for the right patients. But you know, the limited experience I've had I've really liked it. But we've talked about this for on the pod like it's a challenging surgery. That's one that you get in the lab to do just because it is a small small nerve.
Charles Goldfarb:Yeah, love that and I it's one that I have encountered with some of the congenital work I do and and recently encountered it. You would love this case and excision of an arteriovenous malformation and a 10 year old that involve all the thenar muscles was massive and we tried to preserve muscle and dissecting this AVM tricky case exposed all those damn nerves and saved all of them I think.
Chris Dy:Beautiful. Now the last question before we get to our other topic for today is ease and this is from Andy what kind of would you wrap this nerve after you've repaired it or grafted it?
Charles Goldfarb:I would not I would not my goal would be primary repair no wrap secondary option would be graft no rap. What about you?
Chris Dy:I would not rap it. I mean my bias is been made very clear on against the wraps both in literature and on the podcast.
Charles Goldfarb:But to be clear, your repair technique is a combination of this would probably be 8-0 nylon. And tisseel?
Chris Dy:Probably I probably use 9-0 nylon and augment it with fibrin glue. I would not wrap this nerve. I think the wraps. I will say the I think the wraps do not do what they're reported to do. They may actually be bad. And we've talked about that before. I think a lot of people are going to ask me on this one, but I don't like the wraps.
Charles Goldfarb:Point taken. I've never used them. I don't think I ever will. But at least that's one thing we agree on. All right. I'm excited about our non hand surgery topic today.
Chris Dy:Okay, so this is this is about generational differences in work. And interesting. We pick this HBR article. It's called How Gen Y and boomers will reshape your agenda. The first author is Hewlett, I didn't realize it's a great article was from 2009. So it's even before everybody started hating on the millennials, Gen Y millennials. So I think it's really interesting that this came out 14 years ago.
Charles Goldfarb:And I would just I'll defer, everyone's always been hating on the millennials. So a couple of premises number one, I may have mentioned this on the pod before my first the first discussion of generations that I remember, is Peter Stern's presidential lecture for the hand side. And in case I didn't mention it, I will never forget when he basically sided when he discussed with his his grandfather. And when he discussed with his daughter, the meaning of the term mailbox. And that was early in the days of AOL, etc. The term mailbox meant different things to different people. And I thought that was just that's a great example. generations are important. They're important to us in our clinic conversations, they're important to understanding what the patient wants, this article gets to employees, and how can we create an ideal work environment, something I deal with every day? We all do. But from management level, I deal with it every day. And I think it's fascinating. I think it's fascinating.
Chris Dy:So yeah, so I mean, I agree, I think we should talk about this through the lens of, you know, workplace and teams as opposed to relating to patients. So I am technically a millennial. I am a Gen Y.
Charles Goldfarb:Let's define them all. Let's define them all.
Chris Dy:So they say here that, let's see, Gen Y millennial is 1979 through 1994, in terms of birth year, Gen X being 1965 through 78, and the boomers 1946 through 1964. So I know that we have a broad range of listeners. I'm not I know that we've got boomers listening, I know we've got Gen Xers I know we've got millennials. So I'm Gen Y, although I don't classically identify, I think with how the millennials are portrayed in the popular media.
Charles Goldfarb:Right. So I, I agree, and I'm definitely Gen X. What I did in preparation for this is I pulled I did a search, just a Google search on essentially stereotypes around our generation. So let me let me share some of those with you if you're okay with that. Change that plan so, so baby boomers, the quote me generation born hippies, they don't embrace technology. They're too old to have fun. And they caused a lot of problems that have impacted generations that followed. I will say remember.
Chris Dy:You are the gener- boomers, you are the generation that raised millennials. Okay.
Charles Goldfarb:That's right.
Chris Dy:Just keep that in mind.
Charles Goldfarb:That's exactly right. I would say my perception has always been the boomers work pretty hard. And that certainly in medicine, that's what you and I have seen is that generation was raised in a medical system that expected and rewarded head down hard work.
Chris Dy:Yeah, that that was, you know, era of still a pyramidal residencies in terms of you know, if you didn't cut it you were out. There was no coddling of the medical professionals. There was no talk about wellness or burnout. It was about doing the work and shut up and don't complain.
Charles Goldfarb:Yep. Gen X, in which I fall squarely in the middle. Maybe perceived as slackers, mediocre parents, focused on self and money. Spoiled.
Chris Dy:Interesting. I can I will say, I don't think you fall into any of that.
Charles Goldfarb:Thank you.
Chris Dy:I guess I have to be polite and saying that right.
Charles Goldfarb:Yeah. And then millennials, we are not hard working when everything handed to us entitled and overpraised. We don't care about relationships. We love electronics. We can't figure out how to be adults. We can't we're behind in life because we focus on ourselves for so long that we delayed the important stuff. I can't see me that you either.
Chris Dy:No, no, that's me. That's me. That's definitely me. I think that I'm identify, I think more isn't what I've seen, the term is x ideal in terms of, you know, kind of being close to the transition that people talk about, you know, the tail ends of five years, you know, I feel less like a millennial. But I know that I'm going to be attributed as a millennial anyway. So I think that the article is really interesting, because it talks about how the boomers and the millennials are not that different in terms of their values and what they want. Although the generations are kind of pitted against each other. It's kind of like people fighting against their, with their parents. But they're not that different.
Charles Goldfarb:This is a fascinating article. And it for anyone who thinks about these kinds of things, it really is almost, it's an impassioned plea to figure out how to make this work, because the generations are synergistic in so many different ways. And one can help the other, and the other can help. The first it's really an interesting, interesting article. Let's dive in.
Chris Dy:So do you feel like one of the concepts they talk about here is mentoring in both directions? Do you feel like you're learning a lot from your like, so you're not a boomer. But you know, do you learn a lot? Or do you see boomers learning a lot from people that are in Gen Y?
Charles Goldfarb:I hope that's the case. I think it used to be that knowledge flowed one direction, right? That that's sort of me is the boomer ism of this all is that I am going to teach you, you have nothing to teach me and that was my residency. Let's be honest, if I chimed in with a thought I was quickly told you don't have enough experience or aren't smart enough to have a thought just learn from me. I think today, that theory doesn't hold in is just wrong. And I think one of the joys I get out of mentoring is that two way flow of information and perspective.
Chris Dy:Yeah, great. I mean, I was listening to you, when we did that podcast a few weeks ago, the grab bag episode hearing you talk about, you know, the first rule of your rotation was that, you know, people have to speak up. If something either, you know, is not, if you don't think it's the right thing, or if you're just you have a question, right? Like, why are we doing it this way? And that was definitely not embraced in prior years of training. I think it's kind of the way we have to be known. It's the way we should be.
Charles Goldfarb:Yeah, yeah, I think so in it, it's just so it's so much more impactful and meaningful. And if I go into a relationship thinking that, that it's only me giving, and I have nothing to receive, in that I'm not interested, that relationship can't succeed in this day and age, I don't think.
Chris Dy:Right, right. I agree with you entirely. You know, they talk in this article about different characteristics. So like you said, you know, the, the stereotypes, but they actually did some research here. And they, they did a survey of four large employers, let's see who they surveyed here. It was Booz Allen Hamilton, Ernst and Young, Time Warner and UBS. So looks like 4000, almost 4000 employed college graduates. So a pretty big sample, and they looked at the portrait of Gen Y. And then they looked at a portrait of the boomers. And this was interesting to me loyalty versus quest. So 45% of Gen wires expect to work for their current employer for their entire career. So are you going to be somebody like a, you know, a Kobe or an MJ who plays for the same team, your whole career? Are you gonna be LeBron just kind of hopping around?
Charles Goldfarb:It's a fascinating question. And, you know, I think the stereotype of academia up to now has been moved to advance your career. The challenge with that is that many of us, and I might say most of us today, don't want to do that. We don't want to uproot our family to advance our personal career, because I think they, it's just not something that's a priority for most and I'm not being judgmental for those who choose to do that. But I hear that over and over and over again, if I can continue to be engaged with my only employer which has been watched you. Absolutely. I'll stay here forever. But the risk is that you start bumping into ceilings of what you can accomplish and what you need from work. And maybe that sounds self indulgent. But I think that's the risk.
Chris Dy:You sound like a millennial. But I mean, I think that plays into, you know, I think that my generation likes to feel valued. And that's the, you know, like you're the stereotype you talked about, like constantly being praised and positive feedback, etc. But I think that that's reality that employers have to understand is that people want to feel valued, they're not going to as much just kind of take it on the chin for the for the team. And I think that while there is some interest in kind of the Wanderlust, etc, many of us like you're saying, like, we'd like to stay in the same place as long as we feel valued. And I will correct myself, I have blacked out the period where MJ played for the wizards. But I'm pretty sure Kobe played for only one team.
Charles Goldfarb:Haven't we all. Yeah, and I love there's, there's this example, which I thought was really impactful, of an employee that was had an employment offer from UBS. And ultimately, the UBS gave him an opportunity to defer the start of employment with some salary support, and went off and, you know, participated in under basically spending a gap year in India with a nonprofit, and came back better interested and able to start work. And I guess part of me, is what this article calls, a hard nosed manager might say, It smacks of self indulgent behavior, paying people to find themselves Sun themselves and surf the net. I get that perspective. But I don't think that perspective holds in 2020 to 2009, when this article is written, must not have held either medicines different, though, you know, I think it has to be about giving people the chance to engage however they want to engage, as well as getting the work done. That's the tricky part for me.
Chris Dy:Well, I mean, I think that, you know, they talk about here, the importance of, you know, taking time for pursuing opportunities and passions, and they say, 53% of Gen Y's and 49% of boomers would like to temporarily step away from work. Now, you talked about it in your example of on the front end, but we have a visiting professor coming from Stanford, where they have sabbaticals for their medical faculty. So I mean, I think that's great. If you can pull it off, clearly, there's going to be a, I would think that there would be opportunity costs in terms of how you're compensated. And then making sure that you have enough people on the team to provide patient care. But what are your thoughts about a sabbatical?
Charles Goldfarb:I've always envied that. You know, there's two issues to the sabbatical. One, there is no doubt it would recharge me, you all of us, there's no doubt it would have to. The second thing, though, is, you know, pursuing something during that, I think six months is what Stanford gets. That makes you a better person, more qualified researcher, whatever. What are you going to do during that six months? That's a big question. But wow, what an opportunity. But I have no concept of how that works practically.
Chris Dy:Well, I know that we do have some listeners from Stanford, our buddy, Jeff. Yeah, I was listening. So maybe, Jeff, you can enlighten us on how that works. At your wonderful institution? What was something that you picked up about the boomers, they talked about, you know, you know, how long people want to work for, and that boomers are still a big presence in the workforce?
Charles Goldfarb:Yeah, that's one of the criticisms, you know, they're still hanging around. They 42% say they're gonna keep working past 65. We've seen that in medicine, haven't we, I mean, my gosh. And the, they also want to do more than just work and they want to work. But they want to do work outside of their official job capacity. And they need work flexibility to do that. I think about that, in our practice, I think about how we can engage, you know, instead of, you know, we recently had a senior faculty member retire, who really brought a lot to the department and there were conversations of how to continue an engagement, and ultimately, it didn't work out. I think that's a that's a loss. That's a missed opportunity to figure out how we can keep people engaged.
Chris Dy:Right, right. I mean, I think that, you know, there are definitely places where they do it better in terms of keeping, you know, faculty who have a ton to share that may not want to be as clinically active. I think there's a way to do it. And we talked earlier about you know, How you're valued. I brought it up earlier. And one of the things they talked about in this article is that it seems like for both Gen Y and Millennials and Boomers, it's not just about compensation financially. It is about being valued in different ways. So they talk about a great team challenging assignments, a range of new experiences and explicit performance evaluation and recognition. As women in particular, both generations place high importance on receiving recognition for a job well done. How do you think about that, as your greedy money grubbing Gen X personality? Is Gen X more more consumed with compensation financially?
Charles Goldfarb:I would say yes. But I don't think that Gen Y is compensation agnostic by any stretch. In fact, there's some signs in what I see on a regular basis that that it's actually the opposite, that some Gen Y really does focus on compensation, but totally agree it's about recognition for a job well done. And Gen Y needs it more than Gen X stood out to me, that is a fundamental difference that impacts my leadership daily.
Chris Dy:I mean, as a non enough being part of the leadership for, you know, for the department or anything like that, I think that it seems like Gen Y wants compensation enough to feel like they're valued. And then once they start questioning value, then maybe it becomes paying more attention to compensation. But I think people I mean, my understanding is that people want to be compensated enough where they don't have to worry about things and that they feel valued. And then maybe they're not going to question the rest of it.
Charles Goldfarb:I think that's well said. I hope that's accurate. I hope it's accurate. Let you want to go through the, what they call the new workplace initiatives. I like these, these are towards the end.
Chris Dy:Yeah. So the first one they talk about is modularity. So chunking of work that allows Boomers to scale back their hours and their breath and control but still tackle these sophisticated tasks and their years of experience that their years of experience equip them to handle? I don't know. But I mean, I don't know that I don't know how that applies to medicine, to be perfectly honest with you, unless you're at a say, alright. So you are teaching faculty, we are going to expect that you spend more time with residents, fellows, and you're going to we understand you're going to do less cases, but you're really going to maximize their education.
Charles Goldfarb:Yeah, and we have a couple of examples of that in our department. It's tricky in medicine. It's not easy in medicine, because of malpractice and just practical stuff. It's doable, and but not in a way that other traditional businesses think about it. flexibilities number two, you know, how can we consider alternative work arrangements?
Chris Dy:Again, I think the pandemic really kind of put that into full view, but much harder to do when you're, you know, patient facing.
Charles Goldfarb:Right. And so we we've continued to embrace that as we can exactly as you said, if you're patient facing is much harder, but you know, business side, people in our department and even research support people can can, you know, really have a hybrid arrangement, which is great. It's just harder. I mean, yes, telehealth does open some doors, I don't think any of us are sold that telehealth and orthopedics are a perfect match.
Chris Dy:So opportunities to give back because of next one. Do you feel like that is something of importance as that an employer should be sponsoring because I feel like most of us, in patient care settings, our hand therapists or surgeons, we give a lot to our patients. We feel like we give a lot to our communities already. And I think that the person my personal feeling is that the choice to give back should be of an individual choice if you want to spend your weekends doing something. But do you think an employer should have more of a role in that?
Charles Goldfarb:It's a really tough question. I do think the general philosophy is that we as physicians do a lot of work for our community. But are we doing enough? That's ultimately the question and what's the employers role in helping that? I don't know very mixed feelings. I think it's personal. I don't think we should push people to do this. I think if people have interest, then we should help them to foster Here's one. Here's an example that I don't know the easiest solution. So in a couple weeks, I'm doing a mini mission trip where it's just a couple of clinics, no surgery, so flying down to southern Caribbean to a underserved area. Hopefully I'll see 40 or 50 kids and then fly back. So it's a long weekend. That's vacation time. The way our department rules are, is that right? I don't know. I don't know. But it's an example of the how tricky this can be.
Chris Dy:Right? Right. Exactly. And you Be very clear, like we talked about, you know how we give a lot and we're compensated well, for that amount of time that we're giving. But you know, in terms of the emotional, you know, the time and then the emotional capacity to keep giving, I think some of us try to draw a line somewhere. But I think your point about, you know, whether that should be vacation time, or whether that should not count as vacation time. Let's be honest, Chuck, you're not taking all your vacation time anyways. That's true. And then the next one is progressive policies. So for example, you know, should employers be more engaged on things that are of greater importance to society? Like, I don't know, climate change or something?
Charles Goldfarb:I think there's a role for that in medicine. And again, it's also about personal choices. But I think you and I both thought about this, I was involved in in opening our outpatient center voc. We started work that opened in 2007. But it's a green building. And that's largely because we pushed hard for that, that feels good. That was the right thing to do. And you and I've talked about the environmental impact on surgical supplies and, and the local only kit you built that matters. So there are little things like that, that add up. There's bigger things, which might be trickier, but I think it's important.
Chris Dy:Yeah, there's a lot of really good grassroots movements and ermine, a few articles and JHS, you know, greening the OR? I mean, whatever we can do, I think that that's appropriate. You know, I think that it as long as it clearly feels relevant to your day to day life, you know, so green buildings. Fantastic. You know, I think that that is that is a huge thing. And I know that we try to be as environmentally conscious as we can. I think that we could do much better too.
Charles Goldfarb:Yeah, of course we can. And, again, in medicine, there's so many challenges that I don't know, that's not always number one. Their fifth point is sort of the easiest one intergenerational mentoring, which we've already discussed in the back and forth, the generations can provide to one another incredibly valuable. And, you know, mentoring is something that every new hire once more of, and they're right. You know, there, we have not done a good job with mentoring even though we've given it lip service. So I think this is vital.
Chris Dy:When When do you feel like a mentoring relationship should be assigned versus organic?
Charles Goldfarb:I think it has to be both. Because the organic processes take time. And time, I don't want to say it's our enemy here. But But giving this too much time is can be counterproductive. So an organic mentorship relationship will absolutely develop for almost all of us. But there's more to it than that.
Chris Dy:Do you think Boomers and Gen Xers wants to be mentored as much as millennials feel the need to be mentored?
Charles Goldfarb:I think everyone wants to be mentored, even if they don't call it that, either. They don't see it that way. And if you don't ask that the shame on you.
Chris Dy:But I mean, you talked about it. It's subtle. But you talked about how this is what the current generation of people that you're hiring, this is what they want, they explicitly asked for mentor me, as opposed to that was something where I was more active in seeking that relationship out and making that arrangement. I think the people that we're hiring now are saying no, you have to do that, for me.
Charles Goldfarb:Totally fair, totally true. Totally a point of generations.
Chris Dy:Well, because I remember I started mentoring, Ken Yamaguchi was my mentor and still as a mentor, but we had no actual, like monthly meetings when I started, and I remember seeing him in the hallway one day, and it was literally my first month and he had met me when I was a fellow and everything. And he's like Chris, who are your mentors? And I was like, oh, you know, no, he's been assigned to me. He's like, Chris, nobody assigns you a mentor, you go find your mentors. So then I was on a schedule for a monthly meeting next month. But that struck me and I think that's the difference. You know, I now I've been much more active because I have that kind of a wake up call from Ken, like, Hey, you got to do this. But you know, I think that it's different. Maybe I was falling into the millennial trap of wanting to be coddled and waiting for somebody to assign me a mentor.
Charles Goldfarb:I think that's a great example. It is a difference. I think a lot of the generational differences are overplayed. But there are real differences. And a you know, more than ever, we've talked about workplace environment, workplace culture, engaging this is not only obviously physicians, this is every employee, and we want to engage employees, we want people to stay we want people to spend their career here, because that makes our operations better.
Chris Dy:I mean, you know, I think that it's, there are some that would be tempted to just kind of put their head down and do it the way that they've always done it but you're not going to recruit and retain the best talent if you don't at least adapt to the ways of the you know, the current generation or understand the current generation.
Charles Goldfarb:Totally agree. Exactly right. All right, that was fun.
Chris Dy:Well, I think that you have plenty to, to apply in your job as our Executive Vice Chair.
Charles Goldfarb:There is no doubt.
Chris Dy:Aside from your whole hand surgery thing that you do, too.
Charles Goldfarb:All right. Thank you.
Chris Dy:Thank you have a wonderful day.
Charles Goldfarb:You too. Hey, Chris. That was fun. Let's do it again real soon.
Chris Dy:Sounds good. Well, be sure to check us out on Twitter@handpodcast. Hey, Chuck, what's your Twitter handle?
Charles Goldfarb:Mine is@congenitalhand. What about you?
Chris Dy:Mine is @ChrisDyMD spelled dy. And if you'd like to email us, you can reach us at handpodcast@gmail.com.
Charles Goldfarb:And remember, please subscribe wherever you get your podcasts.
Chris Dy:And be sure to leave a review that helps us get the word out.
Charles Goldfarb:Special thanks to Peter Martin for the amazing music. And remember, keep the upper hand. Come back next time.