Thought Leadership in 2025

Chuck and Chris had fun with this episode as we discuss listener comments, highlight an interesting elbow case, and take a deep dive on thought leadership based on a great piece written by Benjamin Schwartz.

https://resources.nejmcareercenter.org/article/thought-leadership-101-getting-started/

Also, Chris and Macy's book is available: https://www.amazon.com/Rehabilitation-Nerve-Transfers-Upper-Extremity/dp/3031920074

We are in need of a podcast intern!  We would appreciate any referrals!

See www.practicelink.com/theupperhand for more information from our partner on job search and career opportunities.

The Upper Hand Podcast is sponsored by Checkpoint Surgical, a provider of innovative solutions for peripheral serve surgery. To learn more, visit https://checkpointsurgical.com/.

As always, thanks to @iampetermartin for the amazing introduction and concluding music.

For additional links, the catalog.  Please see https://www.ortho.wustl.edu/content/Podcast-Listings/8280/The-Upper-Hand-Podcast.aspx

Transcript

Summary

Podcast Planning and Personal Updates

Charles and Christopher discussed their upcoming podcast episode, which will cover several topics including a listener response about Vandemark, a case study, and thought leadership. 

Clinic-Based Surgery Financial Incentives

The group discussed Bob Vandemark's experience with wide-awake in-office surgeries, noting his practice has performed 6,000 cases since 2014, including over 2,000 last year. Chuck mentioned upcoming CMS changes effective January 1, 2026, which will provide financial incentives for procedures performed in clinic settings rather than hospitals or ASCs, potentially making clinic-based hand surgeries more financially viable. The discussion highlighted the positive impact of these changes for patients, surgeons, and medical costs, coinciding with the opening of a new center.

Nursing Monitoring Requirements in OR

Charles and Christopher discussed the onerous requirements for nursing monitoring in U.S. operating rooms, expressing frustration with AORN's policies, such as the mandatory presence of three people in the OR for local anesthetic cases. They agreed that documenting instances where nurse monitoring led to interventions could help challenge these requirements. Charles also mentioned Bob's comments on using Phentolamine as a reversal agent for epinephrine and the facility fee applied in different practice environments, noting that clinic settings cannot apply such fees due to insurance contracts.

Balancing Tasks and Deep Work

Charles and Christopher discussed the challenges of balancing small tasks with larger, more important projects, particularly in academic settings. Christopher shared his experience with procrastinating on a grant due Tuesday by focusing on smaller tasks, while Charles acknowledged the tendency to prioritize easier tasks over more significant work. They emphasized the importance of protecting time for deep work and intellectual tasks, with Christopher suggesting the concept of "genius time" and Charles advising individuals to identify their most productive times of day. Both agreed on the necessity of setting aside distractions and focusing on significant work during optimal hours.

The discussion then shifted to a complex elbow reconstruction case involving a patient with a history of childhood fracture and increasing elbow pain, which Charles and his partner had recently completed.

Charles and Christopher discussed clinical collaboration with surgical partners, focusing on how to allocate cases between surgeons and manage billing. They shared experiences working with different partners, including a complex syndactyly case and medial elbow surgeries. Charles described a unique case involving both varus deformity and postero-lateral rotatory instability, which led to a dome osteotomy procedure with two plates for correction.

Charles discussed a complex surgical case involving a pediatric patient who underwent a three-part procedure: ulnar nerve transposition, posterolateral plate fixation, and LUCL reconstruction. The surgery addressed varus to valgus instability, with the patient experiencing clinical complaints of instability during activities like getting up from a chair. Post-operative plans included two weeks of immobilization followed by six weeks of protected motion in pronation to allow soft tissue healing. Christopher and Charles also discussed the use of Checkpoint Surgical's bipolar nerve stimulator, Gemini, which provides finely controlled stimulation and is particularly useful for selective neurectomy in spasticity cases.

Nerve Transfer Techniques and Results

Charles and Christopher discussed nerve transfers, particularly the ADM to the motor branch of the median nerve, which Christopher found effective for high-median nerve injuries and severe thenar atrophy in carpal tunnel syndrome patients. Christopher shared promising early results of a reverse end-to-side transfer technique, showing improved nerve responses in some patients. They briefly touched on LinkedIn's role in professional development, with Charles using it primarily for content aggregation and learning, while Christopher preferred other platforms for networking and thought leadership.

Thought Leadership in Healthcare

Christopher and Charles discussed an article by Benjamin Schwartz on thought leadership in healthcare. They explored the concept of being a "lunch pail doctor" and the challenges of transitioning to leadership roles. The discussion highlighted the importance of storytelling in thought leadership, with examples of how personal stories can be more impactful than data in influencing others. They agreed that while data and facts are important, compelling narratives can often resonate more with audiences.

Authentic Leadership in Healthcare Podcast

Charles and Christopher discussed the importance of authenticity and staying within one's lane when pursuing thought leadership, particularly in the context of their podcast. They highlighted the podcast's success in reaching young surgeons and therapists, while acknowledging their willingness to admit uncertainties and share experiences. Christopher mentioned his evolution in becoming more comfortable with admitting ignorance and seeking help, a lesson he has shared with junior colleagues. They also touched on the potential risks of sharing patient cases on social media and the importance of maintaining professionalism. Finally, Christopher announced the release of a book on nerve transfers and rehabilitation protocols for the upper extremity, which he hopes will be useful for hand therapists.