The Upper Hand: Chuck & Chris Talk Hand Surgery
The Upper Hand: Chuck & Chris Talk Hand Surgery
Executive Presence- What does it mean and why is it important in 2024?
Chuck and Chris discuss patients with dupuytrens disease (in office and in the OR) including our protocols for care after formal surgery. We also discuss some challenges with needle procedures in the office. We touch on our trial of AI for clinic note generation and look forward to listener comments. And finally, we touch on leadership with a deep dive on the HBR article: The New Rules of Executive Presence by Sylvia Ann Hewlett. This article compares leadership criteria from 2012 to 2022 and the differences in priorities are great discussion points.
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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 rating that helps us get the word out. You can email us at Handpodcast@gmail.com. So let's get to the episode.
Charles Goldfarb:Oh hey, Chris.
Chris Dy:Hey, Chuck, how are you?
Charles Goldfarb:I'm good. I'm kicking back at home.
Chris Dy:Yeah, why are you at home?
Charles Goldfarb:Yes, the middle of the day. It's what is what is today? I don't
Chris Dy:don't know what so Wednesdays usually your to room our day. So a little staycation action? What's going on there?
Charles Goldfarb:Oh, that pains me that you had to bring that up. I'm in I'm in the throes of recovery. I had my unique knee replacement eight days ago. And let's just say it's more than a carpal tunnel.
Chris Dy:Ah, okay. partial knee replacement. So young man surgery so to say. Good for you. But yes, well, it's more than a carpal tunnel. I usually I mean, this is probably a gross over estimate. But when patients asked me how much things are going to hurt, I kind of use drilling in bone as a as a as a threshold for you know how much pain you're going to be in and you certainly had some bone work done.
Charles Goldfarb:Yeah it I haven't taken much in the way of narcotics I took Tramadol is it is super interesting. The whole process was interesting. It was the computer navigated blah, blah, blah, outpatient, I was home by 12:30. All that was fantastic. The block last 48 hours. And so you feel like wow, this is nothing but they did warn me that the block would wear off as we we all know in upper extremity surgery. And it was tough on the block or off. I took Tramadol and hated that feeling. It took like two pills. And then I took a couple of oxys at night and then just haven't just been taking Tylenol and anti inflammatory. And interestingly, I've been taking pregabalin, they do that for two weeks twice a day. And I don't have any nerve symptoms. Thank God and I guess this is preventative.
Chris Dy:Great way to stay ahead of it, I guess multimodal pain management, as they say, as long acting, you know, all the different types of medications. So I'm glad you're you're filling up for at least recording a podcast. I know you've been on some meetings. super interesting. We're all waiting to hear if you're going to say something crazy because you're hopped up on something.
Charles Goldfarb:Well, I'm a little worried because I was yelling at me not to email. But this is the last day because tomorrow be school. And then I go back on Monday in my light reentry half day is now up to 39 patients and why that is not a half day. Oh my god.
Chris Dy:Yeah, that's so just out of curiosity. Did you just kind of let that happen by saying yes to things or just kind of, you know, your nurse kind of knew that you wouldn't say no
Charles Goldfarb:I think it was one of those creep things where it started too high. And then you had to add a few people on. My mistake was I should have said I will see 20 patients or whatever the whatever the number was job a light day. And I didn't do that. I just said haptic
Chris Dy:so yes, he didn't put the appropriate guardrails around it. Yeah,
Charles Goldfarb:we I do. So, you know, I usually I don't know about you, I usually see a patient, I dictate the resonance bells don't dictate. I used to do it almost after every patient, or maybe after every three or four patients because I like to stay ahead, stay on time and get meditations done. I don't think that can happen on Monday with me hobbling around. But I did mention the faculty meeting this morning, that this new AI generated note option is super interesting. And there's probably listeners who are ahead of us on this. But essentially the one we're trying now, use your phone is sort of a quarter of the conversation turns your conversation and you have to be a little you know, funny about how you talk and to share what you're doing when you do stuff. But it does a great HPI physical exam is plus minus and the assessment plan is plus or minus. But if I just do that for every patient, then at the end of the day, I'll remember the patients and can populate the note.
Chris Dy:Do you see this as a replacement to the human scribe
Charles Goldfarb:100% It is definitely not there yet. But it is 100% of replacement. And it's fast like from the time that you leave the room. And then I go back to the main computer in the hallway. It's done the notes there.
Chris Dy:That's impressive. I mean, I'm still striving I like to leave myself room to grow and improve. So I'm still striving for Chuck Goldfarb levels of efficiency. I do ask our residents and fellows to start the notes for the patients that they see. And I still you know, I entered my clinic a little bit earlier in terms of patient slots because I didn't know how long it takes me to dictate and be out of there by the time that I want to be out of there. So perhaps as I you know, turn the corner and become wiser in my practice. I will lot eventually do all the notes by myself, but I'm not there yet.
Charles Goldfarb:Well I would just ask, if there are any listeners who have this down or have been using AI, we would love to hear from you.
Chris Dy:Right And I know there are a lot of people that have experienced with, with scribes, I was talking with our hand travel club, you know, they're basically convinced me that I need a scribe, and I've actually even had it on my to do list to talk to you about getting a scribe. So we'll see, you know, supposedly, the numbers that they were talking about, it pays for itself, it pays for itself after a certain number of patients. So obviously, AI could be an even more cost efficient solution. And once it gets there.
Charles Goldfarb:Yeah, I think scribes do quickly pay for themselves. If you add on two patients a day or something like that. The problem, of course, is that scribes are, you know, come and go, and you spent a lot of time training someone and then they go, and it's, you know, develop relationships. It's hard.
Chris Dy:Yep, absolutely. All the better if your scribe is, you know, Siri or whatever, whatever artificial intelligence thing, we're using that bar Exactly. Right. So we have a couple of things to go through today. Right, we've got, we've got a fantastic HBR article that I think is pretty relevant. We don't need to go into the details of the article, but really talk about the broad strokes, and we've got a few cases. But first, we probably should thank our friends over a practice link.
Charles Goldfarb:Absolutely. The upper hand is sponsored by Practicelink.com, the most widely used physician job search and career advancement resource,
Chris Dy:Becoming a physician is hard, it's really hard to get into medical school, finding the right job doesn't have to be joined practice link for free today at www.practicing.com/the. upper hand.
Charles Goldfarb:So I sent an email around to our hand crew, and said for those of you who perform in office needle apponeurotomy, which, you know, most of us do it, and we do it in office, because that's the point I shared that one insurance company has in their infinite wisdom not been paying, so we're not going to do it anymore. How stunned Are you by that?
Chris Dy:You know, I guess well never stunned by what insurance companies do, because it's in their best interest to to maximize profits and minimize patient care, to be honest with you. But is the needle app and or autonomy or a similar procedure, something that typically require a prior authorization? Because it makes little sense to do if you're trying to take care of the patient in an expeditious manner? I just don't know what's something analogous that might require a prior off burnin office procedure?
Charles Goldfarb:So when I started doing these, back when you were in grade school in 2008, I think it was, we did try to get immediate prior off in the office and then slowly, but surely, all the insurance companies said you don't need prior authorization. So this is just a blank note, you cannot do this procedure in the office, which is just stunning to me.
Chris Dy:Well, I mean it because if you think about it, the easy, the easier thing for them to do is to say no, so that you don't do it or that you do it, and they don't have to pay for it. But if you think about the ramifications of them saying you can't do this in the office, you're then doing it in the operating room with or without an anesthetist involved. Which is crazy, because it's so much more expensive. It makes absolutely no sense from a long term perspective. But again, if they're looking for the easy wins, then yeah, but I mean, it's not like there isn't an evidence base for this procedure. It's clearly evidence based, it's clearly cost effective for certain dupa trans contractors relative to something like a collagenases injection.
Charles Goldfarb:Yeah, it's exactly right. I spoke to the medical director for our region. He was great. I said all the right things, and nothing's happened. So we're not gonna do it anymore. I feel for the patients. Yeah,
Chris Dy:that's tough. I mean, honestly, I had to every time that I want to come out and do a needle, I used to not even think about kind of, you know, what insurance they have, et cetera. And I'm still not absolutely sure where to check in epic for the insurance thing. I think I know but when it's not there, I'm like I'm stuck. If it's not on like the the first part of the screen that I look at I'm like I'm though I ask the nurses help me. But I don't think about that stuff. And sadly, now, you know, the realities of American health care. You have to think about it, which thinks because you know, you don't, it's hard because you you don't want to go into a room as you taught me when I was your trainee, the Goldfarb rules to go into the room once. So if you have to go in and out of a room any more time, you know, like, so if you I don't like having to go into room checking insurance beforehand. So I don't know. It's just kind of ruins the whole thing for me.
Charles Goldfarb:Oh, totally agree. The other interesting pre auth discussion was for my knee replacement. It was computer navigated, and I had done some reading on it. And while I will say that it's not crystal clear that the computer navigation provides long term benefits, it's pretty clear that it's beneficial, especially for a uni and I had an argument with the person on the phone as the patient saying how can you not approve this? And it was a standard well, you You know, the literature doesn't support it. I'm like, here's the literature that supports it. But I think I got nowhere. Right.
Chris Dy:So that's it's really interesting, because, you know, I used to know a little bit about that world actually written some papers on peer navigation back when I was a resident. And it it certainly improves the technical aspects of the shirt surgery, the timezero kind of implant positioning, etc. But I haven't kept up on literature to know, you know, how much of a long term clinical improvement it has been things like revision rates, because I think it's probably what an insurance company is more concerned about. Yeah,
Charles Goldfarb:I think I think you're exactly right. Um, I do. I do have a case. I'd love to get your thoughts on.
Chris Dy:Yeah, absolutely. Can I ask you one quick question before we move on from Dupuytrens disease? What's your postdoc protocol for somebody who's got you know, somebody who goes to the operating room for you know, selective fasciectomy to treat it substantial cord for both the MP and the PIP joints for a couple of fingers? And how do you manage that post op? And what does that look like? Just so I think we've had some discussions about it. But I was thinking about because I was explaining to our fellow Andrews Strewsuski, who was with me in the OR yesterday, just kind of saying how I approach things. And this is what I've fallen into. And it's worked for me. But you know, what's your take on that?
Charles Goldfarb:Yeah, well, maybe this is better than the case I was going to share. So I've evolved for sure. So let's say we're talking about a 35 degree MP contracture, and maybe a 60 degree pap contracture. I'm a fan of zigzag incisions, I do not like a single straight down the middle incision with subsequent Z classes. I identify obviously, the duper trends proximately with the bundle, I also identify the duper trends distally, wherever that may be with the bundles, and then I work back and forth to excise ideally, sharply, but you know, scissor dissection as necessary. And then I really work hard not to have to do a volar plate release. And I've found it increasingly uncommon that I have to touch the volar plate. And that includes both a complete excision of the due patrons and a gentle manipulation of the PAP joint. I'll stop there because I didn't answer your question at all. But where does your approach differ from what I've just stated?
Chris Dy:Yea, no, same thing pre op pre planned the incisions burners exact incision, it's just like having to think about a too much clearly if we need to, we can rearrange things. But that's my gross understanding is that most orthopedic surgeons create these kinds of Z's ahead of time and the plastic surgeons are fancy enough to just kind of create a straight line and go for it at the end. I don't want to think that hard to be honest with you. And I have to I'm pretty big on finding the neurovascular bundles before I start to cut out any tissue. Just because I was telling our fellow Andrew, I was like this is this disease is a formidable foe. Every time you think you understand it, it humbles you. And you know, I'd rather just know where everything is. And it's interesting I was one of the things I was thinking by yesterday is that I was trying to dissect out these bundles before, you know, removing any tissue, but sometimes you got to give your Yeah, to remove a little bit of the tissue, just to give yourself some room to maneuver. So you've got those central cords that kind of spread and fan out across and you're just proximal to the Palmer digital crease. And I don't like to cut anything out until I know that see the bundles, but sometimes you got to cut a little bit out at least to see the bundles. And then once you kind of get your depth in your plane and make sure they're not doing any kind of you know, there's not a nice spiral funny business, then you can start to be a little bit more aggressive. But the for me the stress and the tension is high until I've seen bundles proximal and distal to where the maximum amount of contracture is.
Charles Goldfarb:Totally agree. I totally agree. And it's it's, it's so helpful for fellows to do some open dupes given how, you know, less common go into the OR is. And so there's nothing that replaces that experience. I think from a technical standpoint, it's one of those surgeries that technically is really important for education and technique development. So love that we still go the or at least some
Chris Dy:Yeah, absolutely. Yeah. One question I want to ask you is that, I don't know if I'm describing this properly, how it's actually been described in the literature, you know, you've got some duper trends that are like a kind of a tightly defined central corridor, a tightly defined spiral cord, ATM cord, etc. Sometimes you just kind of have this nodular deposition of SuperTrend tissue that, for me, at least sits kind of between the Palmer digital crease and the PIP crease. And that's the one that I certainly think is not going to be readily treated in my hands, at least with a needle because it's so broad and so dense that it's not like you can break up a chord and you're going to get rid of that. For me that goes to the operating room. I don't know how you feel about that. And then you know, the it's the case that we were doing a super interesting because it had that nodular kind of component over the small finger. And I thought the ring finger was going to do the same thing but the ring finger actually had a pretty classically defined spiral cord. So do you think you know Andrew and I were talking about this do you think the fingers behave similar? In the same hand, or do you think it's just going to do whatever it wants to do?
Charles Goldfarb:Yeah, it's a great question. And it's actually something we should know the answer to we being the medical community, I think they can behave quite differently. Although certainly there are some patterns that will repeat finger to finger. But yeah, I think they can, they can behave differently. And I, you know, I have had some success with the needle procedure with that large nodule over the proximal phalanx. But you're right, my expectations are diminished when that nodule is there, rather than a clean chord. So I think that's, that's really important. Here's two things I don't do anymore. Number one, I do not pin the PAP joint at all ever, in this procedure, three things I don't do. Of course, three, I don't pin the PIP joint, I don't splint postoperatively. And I'll explain that. And the last thing I'll do is I don't close with nylon alone, I only use nylon as corner stitches, and I add chromatic or whatever, in between, it just it provides the strength of the nylon, and the lack of having to take out a million sutures with the absorbable. So I really liked that combination.
Chris Dy:Yeah, it's super interesting. So to comment on your three things. I think the not pitting the joints, a good idea to, you know, clearly, I think it is, and I try to tell the patients at a time, especially the ones with more severe contractures, we're gonna get what we're gonna get. And it's not going to be perfect, there's always a chance of this coming back. And a lot of times, if they're severe enough, where you're thinking about pitting the PAP joint, after you've done it, they're probably gonna be pretty happy with a pretty substantial partial correction, to be honest with you. Because most of those folks haven't used their hand fully in a long time and really just want to get their hand in their pocket, get their hand and gloves, being able to release things. That's been my experience. I've obviously been doing it much shorter time than you. And then for postop actually, I'm curious, I don't I do splint people but I actually send them to therapy within a day or two after surgery to change out of my placer splint into a custom therapy splint and encourage motion once the block is worn off if they have a block. And then the third thing is that I still use nylons for these. I hate having to take all the amount I feel like when I have patients that are going to see their wounds sooner because they're going to therapy, the corners really freaked him out if you don't get the corners perfect. So you gotta get the corners. Perfect. I've stopped doing a corner stitch as you're taught. I actually just do simples on each side of the corner, because I feel like that's a more reproducible thing when you have multiple people that are suturing. And I don't have to keep watching people flail on the corner stitch and I don't want to kill the corner, to be honest with you. So you know, I've got shifted to that probably six or seven years ago, I probably should use more chromics. I've worked with surgeons in the past who have used chromics to kind of work in between areas of simples and mattresses, just to kind of really nicely get the skin together, pucker it exactly how you want it. But haven't used a ton of chromics, I have switched my carpal tunnel trigger closure, thanks to Sam Moghtederi, over in DC, but we could talk about that separately. But yeah, I don't know if you have any thoughts based on the things that I just said.
Charles Goldfarb:So my my I like everything you say I do use corner stitches with nylon, I agree the corners gotta get right and you got to do them right. And you got to, it can be painful sometimes. And then it's sort of maybe one nylon on each limb with you know, then maybe another stitch or two, that's absorbable. My thing with pinning, aside from the vascular concerns, if you really had a big contraction, then you pin it straight, which you don't worry about the vascularity. Assuming you you know, technically do your surgery, well, if you don't pin it, if you pin it, you have to worry about it. The real reason I don't pin it is I don't know why I would. Because if I've done the complete release, then I've done a complete release and I get the finger straight. If I haven't done a complete release, then I don't know what the pin does for me. And you can say it gives you a stretch. I think that's total BS. And then the reason I do is I do a soft dressing because it lets patients move while the blokes working. I think there's probably a little bit of benefit. And then like you I send him to therapy, usually two days post op, and they'll get a night splint for extension. And then during the day they just work on flexion
Chris Dy:How long do you night splint for?
Charles Goldfarb:I asked for six weeks but if patients are doing well they don't they don't want to do it that long. So I see the patients had 12 days and I encouraged them to keep splinting and I usually see them back at six weeks and most of discontinue this one.
Chris Dy:Yeah, so I'll do typically we'll do you know full time splinting, but coming out full time meaning day and night but coming out to work on active flexion and extension. Starting you know within a day or two after surgery, continue that after post op check one which is usually at the 10 to 14 day mark and have them do that for about two weeks like a full month of that and then just nightime splinting after that for another two weeks, yeah, I like it. I like different ways to do it.
Charles Goldfarb:I mean, dupuytrens is the one exception Yeah, on my scheduling criteria for patients over 40. Now, I don't know how but I think we've talked about before plenty of patients over 40 sneak into my clinic, but the ones true exception is due Patronus patients of all ages can come in and and I just think it's so educational, like it's really important for residents and fellows to see.
Chris Dy:Right, it pains me not to think that I could not get into your clinic.
Charles Goldfarb:You're too old. You're not old, but you're too old.
Chris Dy:Too old for the Goldfarb clinic. Well, let's thank our next sponsor at checkpoint. So our sponsor checkpoint is checkpoint surgical, supporting the WashU peripheral nerve course April 5, and 6th here in St. Louis. Faculty of this course will include myself, Dr. Mitchel Pet, Dr. Wilson, Zachary, Ray and keynote speaker, Dr. Susan MacKinnon.
Charles Goldfarb:You can register at the link in the podcast description, or on nervemaster.com. Hope to see you there. It's going to be awesome. I know there's not many slots left as I understand it, maybe you can squeeze a few more people in.
Chris Dy:Yeah so the whole economy is scarcity. Thanks. So you better sign up. I think we're still in early registration. Technically, it's gonna be great program. And we got folks coming back from other institutions that have lost you. Nerve ties, it's gonna be great. You know, the lectures on Friday the you get to do anatomy labs with all these people, including Dr. MacKinnon on Saturday, I think it's gonna be super fun. And this is a original here. I will This is an exclusive. Dr. MacKinnon has offered on the Sunday morning after the course, to do like a fireside chat about cases and give some of her lectures to the people that have come to the course the two days before. So that's a new exclusive that that's just dropping. Now it's going to be publicized eventually. But if you come to the course you also get to hang out with Dr. MacKinnon a little more, which would be super fun.
Charles Goldfarb:Wow, that's a lot of learning. And two and a half, two and a quarter days.
Chris Dy:Yeah, it's bonus, you're getting an extra like a half half day for free? Yes,
Charles Goldfarb:I love it. What do you think? Should we briefly talked about this other case? Or should we move on to our HDR to the
Chris Dy:Let's go to the article. I think it's an interesting one. And we can certainly save the case for next time. You know, one of the things that I've noticed is that leadership styles change over time. And we talked about before the people that have been incredibly successful leaders, you know, in the orthopedic world and medicine in general, generationally that shifts, and I don't know, if somebody who was an amazing leader, you know, 2030 years ago would still be the same today, like, could Michael Jordan Play in Today's MBA to the same effect, for example. So this was an article out of HBR, from the January February 2024. Print issue by Sylvia Ann Hewlett called The New Rules of Executive Presence. So for those of you that like to download at home, or at least will look it up online, let me get the reprint here for you. That is our 2401 l. But I enjoyed reading this. Chuck, what were your thoughts in terms of you know, if you wanted to introduce the article or get some high level thoughts?
Charles Goldfarb:Yeah, so it's, this is super interesting, because I've been lazy post pandemic, with my attire, we've talked about that I use any excuse to wear whatever into the office and change into scrubs. And that doesn't, you know, those kind of appearance, you know, dress for the role you want. Those things haven't changed. And this article, I think, is really, really interesting. So I guess I'll start by saying, let's talk about executive presence. I mean, as orthopedic surgeons, as therapists, especially in a leadership position, as you know, senior residents and fellows, you want to have it, and it is something as the article says that you can learn. Certainly, some people are born with this Gravatar. So there's a lot of words they use throughout others are not but it's it's incredibly important to be an effective leader. Right?
Chris Dy:Absolutely. I mean, they kind of summarize the three big groups of traits to help people with executive presence being the gravitas, strong communication skills and having the quote, right, appearance. That obviously all feels very kind of squishy in terms of, you know, you know what that means, and clearly that can change over time. So, I mean, you know, when I talk about the gravitas, you know, one of the things they talked about how when they survey people or executives in 2012 versus when they surveyed people and 10 years later, in 2022. Something that came up was this, the importance of inclusiveness? Now, I know that, you know, we've had a lot of diversity, equity and inclusion, you know, content and lectures brought to us In the last four or five years, and rightfully so, and but they're also acknowledging there's been a bit of a backlash in terms of, you know, these programs, how appropriate they are, or how effective they are, and truly how inclusive they are in some ways. But I think that the inclusiveness aspect has kind of resonated in terms of how you can be an effective leader and really, you know, get the best productivity and get the esprit de corps up in terms of morale.
Charles Goldfarb:Yeah, I think it's it is super important. And it's not and I don't want to you correct me if you see it differently, it's not just quote unquote, d&i is just making everyone in your organization feel welcome, and feel like they have a home, because then you get the best out of everyone. And, yes, that may be people that look different than you and me, and, and that's fine. But it's about that environment that you can create consciously, where everyone is performing at their highest level. That's the sort of way I think about which I assume is similarly to how you think about it.
Chris Dy:Yeah, I think so. I mean, if you really want to think about it purely from a capitalist kind of perspective, I'm totally with Mark Cuban on this one, I mean, you're gonna get the best business results, if you have a more, you know, inclusive environment, and you have more different voices in the room and different perspectives, just dollars and cents. Now, moving beyond the capitalist part of it, I think you're gonna get a better product to whatever your product is, whether you're making widgets, or doing orthopedic surgery, or plastic surgery or hand therapy, you're going to get a better result out of the entire team, if you not only get a bunch of different voices in the room, different backgrounds, but then also make them feel like they can be themselves.
Charles Goldfarb:Yeah, that's exactly right. So what's interesting is both what's changed from a gravatar standpoint and what hasn't changed. So the top two traits in 2012, and 2022 are confidence and decisiveness. And that is not overconfidence. And that's not a feeling that I'm always right. But it's that projection of confidence and being decisive when it's required.
Chris Dy:Right, absolutely. And so for those of you that have been wondering, what is gravitas? I actually quickly Google that just to make sure I can give an accurate description because I didn't want to say something that wasn't appropriate. But it is it according to the Oxford Dictionary, dignity, seriousness or solemnity of matter of man, or excuse me. So, you know, I think that Neo competence and decisiveness matches that but it is a balance right? You What is a common quote about surgeons? Always confidence sometimes, right?
Charles Goldfarb:Yeah, never in doubt. Yes, something like that is exactly right. The other things on the list for 2022 are inclusiveness as you started with respect for others vision, which was on the list in 2012, but seems much more important in 2022. And integrity, which dropped a little and it's relative priority. But I do think vision and being able to articulate your vision in a way that, again, resonates with the entire organization is super important.
Chris Dy:Yeah, I think that's mission critical. I mean, especially as we're coming out of the pandemic now. And during that time, I think there were a lot of people that were, I think loss is not the right word, but that we're looking for meaning and looking to be led, and have that vision articulated. And I think that it is you can have a vision, but if you don't articulate it, well, like you stated, nobody's going to notice or be inspired. And I think that, you know, no matter what line of work that we're in, like, even like, for example, even if you're not in an academic department, but you've got a hand surgery practice, or you've got a hand therapy practice, and you're thinking about your team, how do you allocute To them, you know, what it is that you want to do that is beyond kind of the day to day of taking care of X number of patients, you know, what, what is the bigger vision, because I think that with that in mind, you can use that as your compass, to, you know, get through the tougher times, you know, when it does feel like a bit of a slog. And it also takes stock of what you've accomplished. So not only think about what you can do next, but what have you already done?
Charles Goldfarb:Yeah, and you're right, and the buy in that you gain with that shared vision goes a really long way, as you said, when things are not so easy and not so smooth. So I really liked that. The second area was communication and again, I love this part because the top two, both in 2012 and 2022. The number one is superior speaking skills. But the second one has a twist, which is in 2012. It was command of a room which we can all recognize as important in 2022 is command of a room slash zoom. And it is so important that you can communicate and project over zoom and I see it done poorly all the time.
Chris Dy:Right, right. And I think that, you know, I think we know the everybody knows when it's been done poorly. But can you think of some time when it's been done? Well, can you think of people that have truly have command of a virtual meeting room? And can get everybody locked in getting the most out of them without somebody checking their phone or doing emails or literally anything else? Well,
Charles Goldfarb:it's hard. And I don't think you can accomplish all of the goals, meaning people come to zoom meetings with different agenda. You know, obviously, the person who organized the meeting has one agenda chucko Farms agenda for certain meetings might be to catch up on email. And, you know, that may not be changeable. But it starts with, you know, the visual appearance, the lighting, the kind of the voice and the ability to project over zoom. But then it gets back to the basic stuff, which is, you know, do you have an agenda hasn't been shared? Are you going to work through your agenda, engage with everyone, that's the other thing, I think, in 2020, that is so important. There shouldn't be silent members of a Zoom meeting, occasionally have a huge meeting. And maybe there are but engaging with everyone, whether it's in person or on Zoom is so important. It
Chris Dy:comes down to the basic meeting principles, right? You don't want a meeting that's too large. I don't know who this is originally attributed to. But I've heard Kevin Bozek, say, and on a few different occasions, Chair Surgery at UT Austin, and fittingly for you and joint replacement surgeon. But you know, there's a two pizza rule for a meeting, you shouldn't have a meeting if two pizzas can't feed the entire room. So clearly, there are some exceptions to that. But I do think that when you have those larger meetings, you're not going to get the level of engagement that that you're looking for. But I love how this this article talks a little bit about somebody who proactively manages virtual meetings. So there's a CEO CFO at an Icelandic real estate firm, that has a few simple rules. And she At first, she does a brief tech check to make sure there aren't any snack foods for us, I guess that'd be cameras on let's see where you are. And you make sure that you're not driving between sites or whatever. Second, she distributes an agenda and relevant pre reads at least six hours in advance. Now, clearly, for surgeons, you may want to do a little bit more than that for most people. But I mean, saying I expect you to have read this in advance to get maybe get some of the informational things out of the way and maybe stir up some, you know, food for thought. And then starts meetings by introducing anyone new to the group, but taking care to highlight skill sets or experience that somebody might bring to a topic. And then fourth shield, solicits participants participation from everyone in attendance, and specifically calling out people that have been quiet. And then I love this one, which I had not thought about. But asking a colleague to distribute to right and quickly distributed to summary of decisions made and next steps, which oftentimes will fall on the person who's typically would follow the person who's running the meeting and organizing meeting and honestly can't take as many good notes, because they're running the meeting. And then she rotates that role among different different members of the team. So everybody gets a turn. I love that. I mean, I think that's gold right there.
Charles Goldfarb:I think that's gold as well. And it also, I don't want to say forces engagement from everyone, but but make sure that everyone's engaged, because if I, you know, asked, Hey, Chris, great meeting, and do you mind jotting down a few notes. And I don't know, if you do that the beginning of meeting or the end of the meeting, I think either way works, making the beginning of the meetings a little safer. But in of course, AI can do that for us as we continue our AI conversation. But I love all of those points. What do you think about and you can be honest, our department and and Regis and I both have really been pushing to it that it is imperative that we have our cameras on during meetings, what what's your take on that? And some people believe that it's, you know, we're forcing or pushing too much. What's your take?
Chris Dy:You know, I think that I understand the intention entirely. I think that it, it is, but one solution to something that requires probably a multi pronged approach. You know, I think that forcing people to have their cameras on feels a little bit, you know, paternalistic in a sense. I get it, that's gonna get people at least to understand that we're paying attention to you. But forcing people to have their cameras on without actively soliciting engagement. Seems like a half step. You know, I think that for example, like for our hand Service Research meeting, which is a much smaller group, I'll be it. We have cameras on but the person who's running the meeting actively solicits engagement from people that are involved. And I think that feels different to me, like just to look at it, like that's a camera or meeting worth having my camera on for, because somebody's actually paying attention to me and wants my input. So I think, you know, comes down to basic human kind of behavior. I mean, we all we don't mind showing up for people, but if I'm going to show up, I want to be part of something. So I don't know if I directly answered your question. You know, and I also don't honestly don't want to get in trouble.
Charles Goldfarb:I think I think you Did I mean I don't think I see it as a panacea. I think it's one step in trying to create that engaged environment and look with a huge department is so hard on many levels, which is why all of these factors for leadership matter. Why don't we, if it's okay, briefly closed with appearance, I thought appearance, the conversation appearance is both interesting and tricky. The takeaway for me is, be authentic, but look like a leader.
Chris Dy:Right. And I think it gets tricky, because you certainly don't want to overly honestly, think about other people's appearances especially gets tricky when you think of more women as leaders. You know, I'm not here to judge anybody, they can dress how they would like, but there are certainly looks that exude more leadership in the classical traditional sense. I think it's important, I wouldn't put too much stock in it, because I think, you know, things have shifted, but you know, somebody shows up to an interview in a suit, you're gonna you're not going to question anything. But if somebody shows up to an interview, and athleisure, then you're gonna say, All right, well, maybe that's the new norm. But maybe that's not the position that you know that that's not look, I personally would shoot for. I was looking for a job or position. Yes. And I think the you know, they talk a little bit about online presence here. And I think that's probably a discussion for another time. But I do think there, you know, appearance extends far beyond the physical and extends into kind of making sure if you're not actively cultivating your online experience to make sure it's nothing, not anything crazy on there, because the first thing most of us are going to do is we're going to Google somebody if we're seriously considering them for a position and you don't want your first second or third patient have anything that would raise an eyebrow.
Charles Goldfarb:Totally agree. I agree with all of it. All right. Well, it is the middle of the day. And despite the fact that I'm sitting at home icing and elevating I do have another meeting. I love this conversation. I love hitting the HBr articles because it's great discussion.
Chris Dy:Yeah, absolutely. It's fun. Especially you know, with you being in business school, this is basically like you doing your homework, right? So,
Charles Goldfarb:my my homework, my homework for tomorrow is managerial economics and micro economics. I'm like, oh my god, what am I done?
Chris Dy:Wow. Enjoy. Enjoy that. Enjoy your next meeting and your icing and elevating and let me know if you need your ice pack refreshed. I'm happy to come over.
Charles Goldfarb:All right. Thank you so much. See you later. Bye. Hey, Chris. That was fun. Let's do it again real soon.
Chris Dy:Sounds good. Well, be sure to email us with topic suggestions and feedback, you can reach us at 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.
Chris Dy:And remember, keep the upper hand come back next time