The Upper Hand: Chuck & Chris Talk Hand Surgery

Chuck and Chris continue the discussion on coaching and burnout

September 18, 2022 Chuck and Chris Season 3 Episode 36
The Upper Hand: Chuck & Chris Talk Hand Surgery
Chuck and Chris continue the discussion on coaching and burnout
Show Notes Transcript

Season 3, Episode 36.  Chuck and Chris follow- up last week's discussion with Jen Barna from the DocWorking Podcast with more talk about coaching and why it makes sense for many of us.   We also talk more about our personal solutions to resisting burnout.

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Charles Goldfarb:

Welcome to the upper hand podcast 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 things hand surgery related from technical to personal.

Charles Goldfarb:

Please subscribe, wherever you get your podcasts.

Chris Dy:

And thank you in advance for leaving a review and leaving a rating wherever you get your podcasts.

Charles Goldfarb:

Oh, hey, Chris.

Chris Dy:

Hey, Chuck, how are you?

Charles Goldfarb:

I am well how are you?

Chris Dy:

I'm good. You're busy. Man. You got your alerts going? Notifications are going off right when you're about to start recording the pod.

Charles Goldfarb:

I know. I feel like I'm insulting you with that. I silenced it.

Chris Dy:

That that's that's okay. We all know you're in demand.

Charles Goldfarb:

Yeah, I'll good i, the week feels you know, I'm gonna regret saying this. Because it's so interesting. Like, I will feel on top of things. And then 24 hours later, I feel like I'm drowning. It's really interesting. I don't know how it's changing that fast.

Chris Dy:

You've mentioned that before. And I feel like I've had the longest two days a week ever. Of course. I mean, you know what, I'm sure everybody who is in some kind of practice, whether surgical or therapy knows that when you're out, you tend to pay for it right before you leave and pay for it right when you get back unless you're very kind to yourself and play defense against it. In this, you know, coming back. This wasn't my first week back, but I got slammed in clinic yesterday. And it's just a lot of a lot of people and a lot of people with like really cool and interesting stuff that I totally dug. I enjoyed the process of seeing them. But you know, obviously makes for slightly longer visits and more of a stack of dictations to do at the end of the day. So I came home wiped yesterday. And then I had a an our day today and it was to room day and things were humming along. I was actually ahead of schedule, I was cutting dry, congratulating myself for being ahead of schedule. To the point I was like, oh, we should call some people in early. Oh, yeah. But I've learned here's what I've learned, okay. I've learned about six months ago that I cannot be in charge of the schedule, like last minute adjustments as scheduled. Because not only do I exaggerate in my mind how good I am at getting things kind of perfectly threading the needle like you do. I don't like disturbing patients on the day of surgery with changing something about their arrival, because it's already a stressful thing to have surgery and to have to arrive at a certain time and etc. So I told myself that I would not make those decisions. And I would have whoever was the charge nurse and the or that day make the decisions. So whenever anybody's like you want me to call them in early, I'm like, nope, I've learned not to make that decision. You need to go as so. And so. So I had them go so and so and she said no, we'll be fine. We'll be fine. Like if they arrive right when they're supposed to. They did but then they got delayed at registration by 30 minutes. And it just the whole thing fell apart. Chuck, on a two room day, I had an hour between my cases. I was like, no matter what I do, I'm gonna end at the same time even though I was really efficient.

Charles Goldfarb:

I haven't had that experience. Where does that

Chris Dy:

because you're because you're better because you're better than I have

Charles Goldfarb:

the same issues like occasionally you get enough ahead or a case cancels or whatever. And you're like, Should I call him in and I like you try to stay out of it. And just let them call patience. And my problem is, if they do call someone in early and disrupt their day, like you said, it's a stressful day, they may have stuff going on before the case. But then if we're slow or we're not ready when we're supposed to be ready, it adds a layer of stress to me because I really prioritize in clinic in the or being on time. And and that's that's not a it's a it's about my perception of other people's sensitivities. But it's just important to me, it's really important to me, and it's makes me stressed when I can't accomplish that goal.

Chris Dy:

Yeah, and I think that people that are in private practice are going to scoff at this because clearly in big systems in academics, we don't really have the the nimbleness that that smaller places do. But we still for patients who are having general anesthesia or any kind of anesthesia, aside from local they arrive hour and a half to two hours before their surgery time. And because we we were following that even for locals, but because we had so many people that were like why am I here just waiting for nothing, not even seeing an anesthesiologist or getting an IV or whatever, we change our local arrival time to one hour beforehand, which usually is more than enough, but it still still bites me sometimes because I like to just kind of have things ready and teed up and knock it all out and get done early if possible. But that's that's not that is not always in line with the patient experience agenda.

Charles Goldfarb:

Yeah, that's right. It is a it is a lot to balance and figure out and I'm sorry, your day went to hell.

Chris Dy:

You know what, it was fine. I got a lot of stuff done. I mean, I've tried to just embrace the downtime and it's not like I ran over. I actually probably looks like my utilization was great today. So I hope they don't dock me for the hour where I wasn't doing a case, but it happens. So I mean, that's the trials and tribulations of being in practice.

Charles Goldfarb:

That's exactly right. So any cool cases or clinical quandaries? Well,

Chris Dy:

I often wonder, what is your worst experience that you can remember and talk about removing hardware,

Charles Goldfarb:

we've said on this show, and everyone knows the old adage, no one looks good taking on hardware. And I certainly have had my share of challenging experiences, the one I can remember, most is taking out a volere distal radius plate, and an elderly, frail woman. And I was taking out for a very specific reason, I don't recall what it was, whether it was a tenant issue or whatever. And it was not a plate I'd put in, and several of the screws were stripped. And sometimes I get impatient, and I did what I could, I had all the right equipment there and was still failing, and ended up taking an Ostia tome. And you're using ice jam to try to break the screws off flush. And that was going okay until I labored. And there was a kind of fracture the volar cortex. Now, the dorsal cortex remained intact, it wasn't that big a deal. But, you know, dealing with bony overgrowth, dealing with stripped screws, and dealing with again, precise schedule, can put the heat on you.

Chris Dy:

Yeah, it's interesting, because I had a case that on the list recently, that I thought was going to be a bear to remove the hardware. So I overbooked the case that I didn't have to enter that. I didn't have the wherewithal to put it absolutely at the end of the day, for whatever reason. So then I ended up with a bunch of extra time, but I was just worried because it was a plate that again, I had not put in screws were fractured. It's not my favorite material. It's titanium, which I know is more prone to stripping screw heads. But it all came out really nicely. But I was just mad at myself for not getting the booking time. Right. But again, like you said, it could be so much worse. Do you ever endeavor to take out screw shafts that are stuck in bone after you've already taken out the fractured head,

Charles Goldfarb:

have no problem leaving and there's two issues one, you have to let the patient know, obviously. And they need to be aware if they get an MRI or something like that. And to some of them have what I would consider a reaction that is magnified compared to what it should be. And they just really disliked the concept of having that broken screw in their bone. And as long as you can do about it, and you I tend to try to explain I could have gotten it out but I would have destroyed your bone in doing so. But that's happened to me on more than one occasion for sure.

Chris Dy:

Do you are you believer in the the anecdote that some surgeons say that everybody feels better when the plates out?

Charles Goldfarb:

No, I don't think so. Obviously, I'm biased because I only take the plates out if there's a reason to you know- when I was in training Chris many, many decades ago. You know, in pediatrics, we were taken out plates, just as a matter of course, you put a plate in you take a plate out, and maybe early on and our metals, we needed to do that. But we don't, to my knowledge in 2022. And there is never a plan to take a plate out unless it is required based on positioning and concern of complications. Is that your approach?

Chris Dy:

Yeah, it's my approach. I mean, you know, I worked with a trauma surgeon and residency that, you know, I think one of the things they would do is like start the second room of the day with an elective hardware removal just to kind of allow clearances. You know, patients get cleared and stuff for traumas. And I don't know the how loose the or tight the indications were to remove the hardware, but we were taken out a lot of hardware. That was that was the chief's room. Was not. It's not always fun, but you got it done. So

Charles Goldfarb:

yeah, there's lots of reasons to your hardware, I guess.

Chris Dy:

There's some there's some countries in which the it's routine to put a plate in, take a plate out like you're saying so I think it's different. I'd love to hear from listeners around the world. You know, what their thoughts are about whether you take a plate out if you automatically take one out if you put it in? Because everybody's a little bit different.

Charles Goldfarb:

Yeah, totally agree. Yeah, and you're exactly right distal radius plates are a great example of sometimes they automatically come out to decrease the risk of complications. I get that. Awesome. Well, do you like this? Should I send you my hardware removals?

Chris Dy:

You know what I'm okay. You know, I'm good on my current frequency of hardware removal. Although I am a team player and if you want to send me those, I will send you all of the sportsy vague ulnar sided wrist pain I don't particularly enjoy taking care of so we got to deal

Charles Goldfarb:

one plate two ulnar nerves, we'll figure it out, we'll figure out a good referral system.

Chris Dy:

So we had a, we had an interesting recent episode with, with Jen Barna from, from DocWorking, always nice to talk to a fellow podcaster. And if you're a podcast or listening, and he wants to talk with us about, you know, potentially, you know, collaborating and stuff, please feel free to reach out, you know, she's doing some really important work with her partners. But I wanted to see if maybe you could bring this a little closer to home in terms of understanding this concept of coaching, because, you know, I remember I was at, I was lecturing at the clinician scientist development program for the RAF, and a fellow panelist who is now a chair at a program in California, mentioned to me, you know, why don't you have a coach? I was like, I don't know, like, she was like, Don't you want to get better? I was like, Yeah, I do. But it's just so not part of the normal. Like you mentioned in the episode, it's not part of the normal track. And it's a concept that feels a little, a little foreign to most practicing surgeons. Some of its persona of how you become a surgeon. For most people, others, it's like, well, why why would I take the time to do this? Why would I pay for summer? Why would have my IT department pay for somebody? Like what's the point?

Charles Goldfarb:

Yeah, so I think it's a really interesting question. And Jen and DocWorking, is really offering a really interesting service. I mean, the podcasts, I think, is their way of sharing some of their work, but also promoting the opportunity to work with them for coaching. Here's how I think about coaching, I'd love to briefly talk about burnout as well. And obviously, the two issues are linked. It used to be first of all that coaches were were just not something you talked about. Because if you had a coach, it was not for a good reason. I think today, in a very simplistic way, coaching falls into two categories. One is coaching, because of an a demonstrated need to improve. And whatever that means, whether it's interpersonal, whether it's you know, causing disruptions in the operating room, not you know, just whatever the challenge is, a coach could hopefully help you get through it. And that's the one that might kill still carry a stigma. But I would argue, it really doesn't in 2022, because coaching is also as you just said, just to make it better. And so as I said in the previous podcast, there is a requirement for department chairs to have coaches at Washington University. And many, many others have coaches as well. I've considered a coach and I'm, I am fortunate I may I say this very seriously, not tongue in cheek, my wife is trained as a therapist, and, you know, is great to talk to, and helps me talk through things. But it's not always perfect to use your spouse in this role. So I think there's so much benefit. And I think about a coach to help me talk through career path opportunities, what do I really want, but when you've considered coaching, what what, what would be the most important priorities for you, if you were to work with a coach,

Chris Dy:

I think that if you were to ask me a couple years ago would be the same kind of, you know, career planning career trajectory, at least talking through what you think you want, and confirming that that truly is compatible with your, you know, your value compass. I think that to be very honest with you since taking on the role of fellowship director, although about 18 months ago, I've learned that my one of the things I need to work on is, is interpersonal, you know, and I see that all the time now that I'm focused more on how I interact with others, how I, how I perceive their reactions, how they're really reacting and trying to understand, you know, how I can be a more effective communicator and leader. And, you know, taking over the fellowship role, to be honest with you a little bit earlier than I had thought I would have wanted to kind of thrust that upon me, and it's something I'm trying to actively work on. And I think that's something I'd probably would want to work on with the coach. You know, on top of the kind of the career trajectory stuff that that you mentioned.

Charles Goldfarb:

Yeah, look, I mean, anyone who says they can't be better and do better is deceiving themselves. But not everyone, you know, has a pressing need for a coach, but I think someone who is honest with you about things, and someone you can bounce ideas off of and someone who can pull, you know, information out of you. I just think it's really important. And I there should be no stigma. I mean, that just shouldn't be.

Chris Dy:

Yeah, and you know, I feel like there were probably some people that were seeking that we're getting what you should get from a coach. Other ways. You know, I remember early on, I think the first four or five years of my practice, I met monthly with either Richard Gelberman and Ken Yamaguchi. And that was some of that, yes, was largely research focused in terms of mentoring for career development award. But there were times where it was mainly about, you know, Dr. Gelberman telling me specifically what nobody else would tell me. I remember him saying that he was going to be my mirror. For better or worse, and he told me stuff that I think I needed to hear. Now whether you're gonna get that same kind of candor from a lot of people in this day and age is different. But I think that that, at that point in my career was an important, important thing for me to have. And I think that that's something that I would probably move on to have now. I guess, I the question you asked, you know, in the last episode was, what kind of background? does this person need to have to truly be a great coach? I mean, because I honestly think somebody like Dr. Gelberman would be a really good coach for the right person in the right mindset, because of his just deep familiarity with or the context of academic medicine.

Charles Goldfarb:

Yeah, it's, it's a good point. And I, what I've hesitated on is I really, I guess, I need sort of a sounding board or someone who can push me to be honest with myself about things. And, and also understand the landscape. That's my concern right now. Right. And I think that coaches are obviously every coach is different, brings different backgrounds. And, and so I think that it would not be unlikely to be the first coach, I would talk to you that I would choose. But you're right, someone like Dr. Gelberman could be a good coach, I don't think it'd be a multi dimensional, you know, Coach, but certainly in one day one, or one or two domains can be really effective.

Chris Dy:

So now we're going from having a coach to having a staff of coaches, you've got the GM, you've got the offensive coordinator. Exactly. But special teams?

Charles Goldfarb:

Yeah. Well, we've talked about I mean, other ways to improve ourselves. I mean, if someone had the time to spend with me and the or and critique, how I teach and how I operate and what I can be more efficient in, there's no doubt that would be valuable. There's zero doubt that I could learn from that. But our system in the United States is just not set up that way.

Chris Dy:

Yeah, I remember reading a New Yorker article. I don't remember the specifics, but I'm reading it in residency, Atul Gawande wrote about himself having a technical coach and er, and I think about that all the time, actually almost ended up embarking on a, on a research project with one of our former residents, on the technical aspects of coaching because I think it'd be fascinating and Please, somebody take this idea because it's not mine, but to you know, watch tape of residents operating and fellows operating and surgeons, you know, attending surgeons operating, and just go through the tape, we have the technology now, it's not that much, you know, that difficult to get. Because I know even there are studies in the general surgery literature and what you would send in your your laparoscopic cholecystectomy video, and as part of board certification, you know, you would get judged for efficiency for safety. I think that'd be great. Because as somebody who I, personally am always trying to hone my craft and the skill that comes with it, I think it'd be fantastic. I, I hope that I would be good at receiving the feedback, although I sometimes maybe I wouldn't be. But you know, I think that's that's, you know, that's that's part of it. And I think that the technical aspects of coaching, and then the coaching about teaching, you know, because that's one thing that I still constantly have to work on is meeting the learner where they are, because, you know, we see such a variety of trainees, you know, not only Junior residents, senior resident fellow, but then also medical students, how do you make sure that they have the experience that's appropriate for their level, and not only their level, but their personality? Because they're not going to change? We're the variable that needs to change to meet them.

Charles Goldfarb:

Yeah. And I agree with everything you said, as you were talking, I was thinking about our therapy colleagues. And, you know, a lot of times the setup, and I can really only speak to the setups that I've seen, obviously, are conducive to interactions and perhaps, collaboration. You know, the way our therapist work is, there's multiple therapists in a room, working with different patients, and I know they get up and interact with one another. And I wonder maybe if their culture might be more conducive to not necessarily coaching as we're talking about it, but at least support and discussion and optimization of their technical process perhaps better than us.

Chris Dy:

Agree. And, you know, we talked in that episode about things that bring us that fulfill us at work and you know, you talked about you know, collaborating with Lindley Wall at the Shriners and I know you guys do clinic together and you operate together and you know, when David Brogan and I do complex nerve planning together, when it works out I love watching him examine somebody or counseling somebody together and just kind of learning from each other and being collegial in that way. And that's that's the best system that work and I think especially for somebody has come something as complex as what you see at the Shriners and perhaps what we're doing in the nerve clinic.

Charles Goldfarb:

Yeah, totally agree. Totally agree. I, I think we should I want to talk a little bit more about what you and I do to combat burnout. I don't want to beat a dead horse. So we talked a little about it the last, but it feels like we should come up with at least seven, seven ways we fight burnout is that I think we get way more than seven. But what do you think?

Chris Dy:

We can try? I mean, yeah, it's, at this point in my life with the podcast and all the other various venues and my, I guess, becoming more comfortable with self, I feel like I'm an open book, there are a lot of things that people know about me on the podcast that they probably wouldn't or shouldn't another in other contexts. You know, and this is no secret for me, I think starting the day, if possible with with exercise is important to me, that fulfills me and you know, I wake up early to do it, it's the only time I truly get to myself, which is important. And I remember trying to do the workout at the end of the day thing, and once you know, you know, the kids came, that was impossible, because I would try to go to the gym at the end of clinic or at the end of the or, and I would feel guilty. I wasn't spending time with my kids. You know, so that's one thing for me that that is important. So everybody's going to have their own routine and how they do it when they do and how frequently they do what they do. But you know, some kind of physical activity that you know, gives you the time you need for yourself and the endorphins and the actual health benefits too.

Charles Goldfarb:

So I totally agree. And I second that I my my story is interesting, at least for me. It used to be basketball, and I had some some early games and I had some weekend games. And what I loved about basketball, and I know I've talked about this is when you play basketball, you can't think of anything other than basketball. When you jog or bike. Sometimes your mind wanders back to work, which is counterproductive. I don't, I'm not playing ball anymore, because I'm old. But what I am doing is I'm riding my bike to work about five miles. And I have to say it's early. I'm running in the dark most days and I come home. It's fantastic. And five miles you know, you could argue guys not very far it's not. But it's far enough. I get a little you know, heavy breathing and then coming home. It's more uphill, which is convenient. Because that's what more and I love it. I really love it. So that's filling that same void for me.

Chris Dy:

What do you do in the winter? Still do it? Well,

Charles Goldfarb:

last year I when it gets ridiculously cold now now, but pretty flexible. I'll do it down into the third high 30s. Low 40s. And the heat never bothered me. So as hot as it was, you know it can be but yeah, if it gets too cold.

Chris Dy:

No. And then what about the Chesterfield days or the I mean, so the Shrine, you can do the test field days? Probably not.

Charles Goldfarb:

I can do three days a week, if you know. And then like Thursday, I have a 6am meeting. So that requires putting an earlier start than normal getting on the bike a little earlier than I would probably prefer, but I think I'm still going to do it.

Chris Dy:

And when you travel for meetings or travel for fun, or you still wake up, you know, do something in the morning guy are you kind of let that routine slide

Charles Goldfarb:

the routine slides I find a way to work out but not not in that typical routine. It may be you know, doing whether it's walking on the beach or finding another time to bike or run or something. Yeah, the get up early to exercise is not required. Why do you still have to get up early to exercise?

Chris Dy:

I do. Because if I guess I kind of like I don't. I'm a knight as my favorite instructor says we're nicer people after we exercise and I truly am. So it's almost like coffee to me, they kind of go hand in hand. Let's say I tend to still get up early, because then I know it's done. And I'm not worried about it. Because I've never tably I won't worry about it. That's just my personality.

Charles Goldfarb:

So what does cooking do for you?

Chris Dy:

I have found so much joy in that it's not only the it's the process of cooking, it's more of the sharing. And it's however I think it makes me feel about you know, taking care of friends and family. Like, for example like weekend's that's kind of the bigger deal of like, you know, okay, we can like actually get together and let's do something bigger. And I enjoy the process of like, in the kitchen planning everything out. And you know, it's all stressful at times. But you know, it's fun. And, you know, the having everybody enjoy it. If it's good, it's all the better. For some reason I'm really fanatical about the Week, the weekly menu planning, we haven't gone the route that some families do of like completely prepping everything out at the beginning of the week. We you know, I love on the weekend, and I actually look forward to this. So sitting down and making a menu and making a plan like looking at like, Okay, here's what's going on these nights of the week I can do this tip is doing that, you know, the kids have this going on. And I was like let's come up with something that's going to work and whether it's something simple or a little less simple. The week that stuff tends to be pretty straightforward, but I still like that and it makes me feel better. At least I think that my kids see the process of like, something being made and that you know, whatever they are eating is not just out of you know, automatically gets You know, appears out of nowhere. And I'm not judging those that do that. Because I think that that's a reality in a lot of ways. But I personally find joy in that process of being able to thread the needle of getting home making something that is reasonably healthy and delicious and enjoying it together.

Charles Goldfarb:

Yeah, I hear you, and I realize how important it is to you, I have to say, I'm starting to understand it a little bit in the sense that there are times when I partake, and but food is just different for me. And so it's not, it'll never be my priority, I guess I would say, my replacement or, you know, something important to me is reading. I read every day, not as much as I would like, I usually am reading multiple different books I attend at the end of the day, to read some type of either historically based fiction, or just stupid fiction. And it just puts me in a good place. On the weekends, I try to read nonfiction, whatever my brain may may tolerate it. My dad used to say, when I was growing up, I used to ask why he didn't read serious books. And he goes, Well, you know, my job is serious. And, you know, I need to escape not not dive deep. And I get that, I totally get that.

Chris Dy:

I wish I could, I wish I could read more. My problem is that you're in a lab, but like, as soon as I start to read something, I usually fall asleep.

Charles Goldfarb:

But that's fine. That's fine. I do too. Sometimes.

Chris Dy:

I don't want to say it's chronic fatigue. But you know, I, I know that I know, my body. I know, my energy levels. As soon as you know something. As soon as I start to do something where I'm completely sedentary, and the room gets darker, I know what's going to happen. I've managed to learn kind of how much sleep I need, you know, how much sleep is ideal, how much sleep is tolerable? And just the sleeping is something that, you know, to the point where there was a moment where I had multiple books on my on my bedside table, and Tiff would just tell me which one of your sleeping books are you going to read tonight? She knows. Yeah, so yeah, yeah, I don't I wish I could. I wish I could read more, though, I think that's, that's super important. So I think that'd be great. If you know, anybody wants to share how they have addressed, you know, you know, their strategies for, I won't, I don't want to say just for burnout, addressing burnout, I want to say fulfillment, because you know, making sure that you're you are getting the most out of you know, what she wants to, you know, to see on a daily basis. And I think that probably, there are some things that we could talk about in a future episode about just strategies to make your life more either more efficient, or more pleasurable at work.

Charles Goldfarb:

Yeah, I think we should talk we've touched on those topics, certainly. But I think it's always worth revisiting. Because, you know, we're evolving, obviously. And what I said two years ago might not be what I say today. And I love that I love the topic. Efficiency is something I take pride in and but can always can always be better. So this was this was fun. I think we're both evolving in this in this area and how we consider coaching. We certainly consider burnout and and really pertinent topic, and in August of 2022, I guess this will drop in September of 2022. But it'll still be pertinent.

Chris Dy:

Well, let's see who has a coach in the year. Exactly.

Charles Goldfarb:

Right. All right. Thank you very much.

Chris Dy:

All right. Have a good evening.

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 at Han podcast. Hey, Chuck, what's your Twitter handle?

Charles Goldfarb:

Mine is@congenitalhand. What about you?

Chris Dy:

Mine is @ChrisDyMD spelled d-y. And if you'd like to email us, you can reach us @handpodcast@gmail.com.

Charles Goldfarb:

And remember, please subscribe wherever you get your podcast

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