riverside_danny_04_the_whole physician
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[00:00:00]
Amanda Dinsmore, MD: Hey, friends. Welcome back to the podcast. I'm Amanda. I'm Laura. And I'm Kendra. And today we have a special treat. Dr. Danny Eiferman is joining us. He is a tenured professor of surgery at the Ohio State University, and a Castle Connolly Top Doctor since 2018. A trauma and acute care surgeon known for his candid teaching style, he helps clinicians build resilience, lead teams, and navigate the emotional side of high-stakes medicine.
He has also written a book, Cut Open: A Surgeon's Stories of Loss, Resilience, and Growth, but is most proud of his marriage to his beautiful wife, Elisa.
Did I say that correctly? Alyssa. Alyssa. Alyssa. Okay, and his relationship with his three wonderful children, Julia, Jeffrey, and Abby.
Danny Eiferman, MD: Thank you guys for having me. It's a pleasure to be here.
Kendra Morrison, DO: Yeah, we're- Thanks ... so happy you're here. Yeah, we're excited to, to hear about your story, and you talk about the [00:01:00] unwritten expectations in medicine.
What are those, and how do they shape how physicians respond to failure?
Danny Eiferman, MD: So I think it varies a little bit by, by specialty. I don't think it's one size fits all, , in medicine. But it is my opinion that a lot of the things that make for a great clinician are not in our formal education.
And what I mean by that is I love to tell the story, and I made a, a funny little video about it for a, a leadership class that I teach. I, I talk about the very first, and I am not kidding you, the very first patient that was ever presented to me on my first day of being an attending surgeon, and it was a patient that was being non-compliant with their therapy.
There was friction between the nursing staff and the resident house staff. There was friction between the house staff and the patient, and they presented it to me and they said, "Great. What do we [00:02:00] do?" And I said... I remember, first day, and I said I know the five types of peptic ulcers. I, I know all the stages of diverticulitis and what the inter..."
And on that very first day, I realized that I, I now say it's about 50%, 50% of what I need to be successful in my job I actually wasn't trained for And I went on to write this lecture called Everything I Needed to Know to Be an Assistant Professor of Surgery I Was Never Taught. And the first slide is because I have competency to take your colon out or take your gallbladder out, and your specific question is what are like the unwritten expectations?
I must also be a great communicator, team leader great in conflict resolution healthcare finance, and it's like, I, I'll just tell you, after 11 years of training, that is not what I was trained to do. But a lot of times physicians get what's known as halo effect [00:03:00] because I know how to take your appendix out, therefore he must be also great at leading a team.
Mm-hmm.
Kendra Morrison, DO: Yeah.
Danny Eiferman, MD: Hmm. Different. So that's, that's what I mean by that.
Kendra Morrison, DO: Yeah, that's interesting that you say that because we feel the same way walking in the emergency department. Yesterday we were a resident, today we're an attending, and all of a sudden we n- we're an advanced airway provider, right? And all the other things that come with it.
But then the first time you walk into a room and the patient's like cussing at you up one side and down the other, calling you everything , like, "Oh, whoops, wait, did I sleep through that class in med school residency?" Not exactly. Yeah, that's, that's im- a very good salient point and I think that also builds upon what erodes your sense of person over time because you're like, "Man, I know all the medicine part but I keep failing at the, these other unwritten expectations," or you feel the, the sense [00:04:00] of failure.
So there's often this belief, if I were better, this wouldn't have happened, as I was just saying. Yeah. How do you help physicians challenge this narrative?
Danny Eiferman, MD: So that's, that's a great question and the first thing that I tell people is we actually need to answer the question of is that true? And, , the answer is it may be.
And I tell people, a lot of people are like, "You know, what's your advice for somebody who's first starting out?" And I say, "You gotta be the three A's." Have you guys heard of the three A's? You know, you gotta be able. Can you do the job? Number two, are you available? You know, when somebody calls you for help and every time I tell you, "No, I'm not available," you're going to stop calling for help.
And then lastly, you have to be affable. Do people like working with you? You could be a fantastic, but if nobody likes working with you because you're difficult, you know the odds of you being successful. So you gotta go three for three. But in, in my opinion, at least in [00:05:00] medicine and surgery, the number one is the most important.
Can you do the job? Are you able? So, , I think the first question is, if I were better, like, do you need to have a better fund of knowledge, better technique, more experience? And the way to answer that is I write a lot about this in one of the chapters in my book, is you have to have an inner circle.
Those are the people that trust you, that you trust, who are willing to hurt your feelings if necessary to make you better. They're not yes men and yes women, okay? To go and debrief, , an airway case, as you mentioned earlier, , and talk to you. "Should I have, , gone to an LMA earlier?
Was para- paralysis not there?" Any of those things, and then take a look at it and say, " You know, Kendra, I, I do think that there probably was an opportunity there." Now, if there isn't, then my favorite thing to say to people is something I got from one of my accounting professors when I was doing my MBA.
This is after I had a complication. And he [00:06:00] said to me, "Think about this." He said, "Right in front of you, here's a bucket, okay? And in that bucket there's gonna be 10 ribbons. Nine of them will be red, one of them will be green. One time you're gonna put your hand in the bucket and you're gonna pull out one ribbon."
And he turned to me, he said, "Danny, what color would you predict that you would pick out?" Red. There was a 90% chance of that. He said, "Good. If you picked out the green one, was your thought process wrong or did you just have a bad result?" And that really resonated with me because there are times that we can do things right, , in medicine.
I'll give you a great example. DVT prophylaxis. Can you ambulate a patient, have them wear SCDs, give them chemoprophylaxis? Can you still get a DVT PE? You absolutely can, right? I did all the right steps. The result wasn't what I wanted, but the process was good. If I have a bad outcome and my process was good, I can go look at myself in the mirror and hold my head high, and I can throw [00:07:00] away the, "Am I good enough to do this job?"
If it wasn't, if I would've been better, then I gotta dig deep and do some soul-searching. I gotta get better. How am I gonna get better? Who's gonna help me , get better at that? But what you can't do, and this is very important You can't spiral out of control and say, "Because I didn't do well on this case, I can't do these other cases.
, I'm not intelligent. I'm not a good doctor." I call this learning to talk to yourself nicely.
Laura Cazier, MD: Preach. Dani? Yeah. Yes.
Danny Eiferman, MD: This case didn't go the way that I wanted it to, okay? I accept that. It's gonna hurt. That's not saying the pain is not gonna go away. However, I believe in you, in this case talking to myself, me, that you have the tools to get better and help the next person, just like you have people before this, and that's how we move on af- if I really wasn't good enough on that particular case.
Laura Cazier, MD: I wanted to add something there too that you highlighted that I think is so, so important, is [00:08:00] having people not being afraid of getting answers that will hurt our feelings.
Because that was also not trained into us during our training. Like, being wrong felt like we were gonna die, felt like we were gonna be kicked out or humiliated or shamed, and we don't grow that way. We have to be able to have accurate feedback from other people who show us our blind spots, otherwise we won't grow.
So I just thank you for mentioning that.
Danny Eiferman, MD: Is... I'll, I'll take that even further. Feedback is necessary because we are awful judges of ourself. Mm-hmm. And when I say awful, awful, and so let me give you some examples that I've used in some lectures that I've taught. Go and ask people, " Am I an above average driver?"
Okay? Do you know how many people will say... It's like s- 80% of the classroom will say they're an above average driver. There was a great study done on geriatric [00:09:00] patients who were taken out for a driving test to see if they were still safe to drive. Of the people who had almost fatal accidents, where the instructor had to take over to prevent the bad thing from happening, rated themselves just as safe as every other driver.
Laura Cazier, MD: Okay, that's terrifying.
Danny Eiferman, MD: Math
Laura Cazier, MD: ain't math
Danny Eiferman, MD: in there. Right. You know, you could do the same thing with, "I'm an above average manager." And people... But in general, when we judge ourselves, we judge ourselves on our intentions. I meant my goal was to help this patient or to help that person. , When others judge us, , they tend to judge on the outcomes.
So, we need feedback to give us a realistic view of the world, and you need those people in your life who you trust, who will give that to you, and you know that it's coming from a good place. Big caveat there.
Kendra Morrison, DO: Yeah. That's, that is a big that's a big deal because I think because there's [00:10:00] lack of vulnerability in medicine, it's extremely difficult.
I think it sets us up for like, "I don't know who to trust," you know? So you don't form those relationships. You're, you're not sure who you can talk to. You've been, you know, maybe taken out at the knees from somebody else that was more into, like, competing and correcting, and it doesn't feel good. So I, I think we all have an experience maybe in residency or even med school that you're just like, "Oh no, these people are out for blood.
I trust no one." So I think that's difficult for physicians to, to really maybe buy into that, but also to even try maybe, or even to reach out and find that community or , your ones that you start even to build a relationship, therefore then build trust with.
Danny Eiferman, MD: So you brought up and you used the word, , that I love, and it's in the...
I teach a little [00:11:00] high-performing teams class for healthcare professionals, and the first one is what are the tenets of a per- high-performing team? And the number one thing that makes a team not function well is absence of trust. Mm-hmm. And I think most people know that, right? It doesn't have to just be a team.
That could be in your personal relationships, whatever. So then I ask, how do you build trust? It's not enough just to say, "Hey, you need to have trust." How do you build trust? And my answer is you have to show your own vulnerability upfront. And when you do that, , most people will drop their guard. They will see you as another human being.
So I always give the example, like when somebody's doing a case that they've never done before, I'll be like, "Listen, you can't screw this up worse than I have before in the past." All of a sudden, I don't expect perfection. I'm a human Okay? I'm a human who makes mistakes. I understand what mistakes are like.
The caveat to that is if you drop your guard and show your vulnerability, there is a [00:12:00] very small subset of people out there who will burn you. Mm-hmm. And I'm not sure what language I'm allowed to use on your podcast. You can edit this out if not, but this is what I say. Those people are assholes. Yeah.
Okay? And you should avoid them. Fact. Okay? Now, how you... You can't always know that upfront, and that stops us sometimes from showing our vulnerability, and we're not good at this in medicine. We're definitely not good at it in surgery. But my advice is show your vulnerability first. That's when people will follow you.
, But it's hard, especially if you've had a negative experience.
Kendra Morrison, DO: That's a really good point. And for someone listening right now who may be in the middle of a bad outcome or complication, or maybe they did just get their trust violated, what would you want them to hear first?
Danny Eiferman, MD: So middle of a bad complication, trying to rebound, , be resilient, get back to your level of functioning that you were before the bad thing happens.
[00:13:00] Overwhelming evidence, this is not just my opinion, this is, evidence-based. Finding comfort from somebody who does what you do. So I always tell people when I've had a complication or what I start my book with, my worst complication, my wife, we were married 16 years at the time, she's not in healthcare,
she didn't understand the nuances. I mean, she listened to me. She knew I was sad, but it wasn't until I talked to another surgeon, who was actually my former chairman, that's when I finally began to heal and feel better. You have to... Somebody who does what you do specifically makes the biggest difference.
Find those people. That is the number, that's the overwhelmingly the number one thing that helps you back on your road to recovery.
Laura Cazier, MD: Your, so your book emphasizes that this isn't about avoiding mistakes, it's about learning how to recover from them.
What does effective recovery actually look like?
Danny Eiferman, MD: Yeah. So there's a great graph that I show when I give , a talk about this, and there are a couple of [00:14:00] words that I think that everybody should have their own personal definition of. One is value, , one is resilience, Another one is culture,
everybody should be able to define those three things for themselves. Resilience is if you are functioning at this level right here, and then bad thing X happens, name whatever it is, and you go from functioning here to functioning there right now. That is obviously a decrease in your level of function.
If you get back to the level of functioning that you were at before that bad thing happened, we use the word resilience there, okay? If you don't get all the way back up there, we use the term PTSD, you know, post-traumatic stress disorder, and in the worst case, we see that manifest as mental health problems, substance abuse, and in the absolute worst case, suicide.
However, my goal, I always tell people when I go out , and give the talk on how to be resilient, I actually think the goal should be something we don't talk [00:15:00] about enough, and that is what's called PTG, and that's post-traumatic growth. And so resilience is getting back to the level I was at before the bad thing happened.
My goal and what I think we should, how do I get better? How do I grow from this? And again, that's where when you find meaning in it, , I don't believe everything that happens for a reason, but I will find some reason in it. That, to me, what it is, is I was functioning here, I went down, and now I'm better.
Laura Cazier, MD: Love that. I love that statement. I, I'm, I love the concept of post-traumatic growth, but This was new to me in what you just said. " I don't believe that everything happens for a reason, but I can find a reason in it." That, that's really powerful. I appreciate you sharing
Danny Eiferman, MD: that. Thanks. I think that, , a lot of...
A couple of the chapters in the book tell my, Alyssa and I's story of going through, infertility while I was, when I was a resident. That quote was given to me during that time. Yeah. , And that helped- Yeah ... me, and so I try to, I [00:16:00] try to pass that along.
Laura Cazier, MD: I love that. Yeah, because- The idea that the universe is sending me, or God or however people believe, is sending me horrible things on purpose does not, believe it or not, doesn't always make me feel better.
But the idea that I can find something in each experience to help me grow, I love that.
Danny Eiferman, MD: Just so you know- Wonderful ... some- sometimes it takes a little bit of time to find that thing.
Laura Cazier, MD: Yes, absolutely. It is,
Danny Eiferman, MD: it is not instantaneous. No. No ... and we live in a world right now where, , we want the fast dopamine.
This is not fast. And there's no instant fix. If you have a bad outcome, there's zero things that I could say right now that's gonna make you instantaneously feel better.
Zero. So makes it a challenge because we want the quick fix. Yeah.
Laura Cazier, MD: Yep. One of your concepts is the your loss mindset. What is that, and how can physicians use it in a healthy and not defensive way?
Danny Eiferman, MD: Yeah. So that one that [00:17:00] came out of the your loss mindset actually came out of my parents' divorce which went on for nine years.
- Oh, my word ... yeah. And at one time there was a document that said, "My parents' divorce," comma, "one of the worst in state history," and then went on. So it was, it was a long time. And I shared in the book that I actually haven't spoken to my own father in, this is '26, it'll be the 33rd anniversary of not talking to my dad in the next, in the next, , next month, May 25th, 1993.
And , when I was younger, and he would say a lot of mean things to me even though I thought I was a pretty good kid, somebody finally pointed out to me that , not being a part of my life, was my dad's loss. Not getting to be my dad and revel in, you know, getting into a good college, being on a sports team, doing well, getting good grades, all that stuff.
And I adopted that years later and that really helped me to say, "You know what? This [00:18:00] is your loss," ? I think I'm a good person, treat people well, act with integrity, things like that, and if you don't wanna be a part of that, well, then that's your loss. And I've carried that over into my adult life where if, you know- I bring up, you know, you don't wanna work with me on a committee or on a position because I've expressed some views that are counter to what you think or believe, or we can't have healthy dialogue between each other, or we can't disagree politely and have healthy conflict with each other, then it's probably the best that we not work together, and that's okay.
But instead of feeling bad about that, in my mind, I just say, "You know what? That's your loss. I think I have a lot to offer in this arena." However, caveat, I feel like it's about the fourth time I used the word caveat . in this podcast together, is you can't just go and claim your moral superiority.
You have to go do something with yourself [00:19:00] and do something with your time and say, "Okay, I'm not gonna dedicate my time to X, Y, or whatever, but I am gonna go dedicate it and try to do something positive with it over here." Mm-hmm. But that's how I use the your loss mentality so that I don't get into a negative thought spiral- Mm-hmm
of, "God, what did I, what did I do wrong? What do I need to change?" , All that stuff.
You need an inner circle, by the way, to make sure that you're, that you are accurately assessing the situation. If you're being, if you're the jerk, you know- Right ... or you're out of line, you need someone to say, "Actually, you know what?
The other person, had some really valid points, and you blew them off. Maybe you need to revisit how you handled that." Y- you need those people in your life. After the analysis from the people that you trust and give you feedback, and it's best that maybe we go a different... That's when you can use your loss.
Laura Cazier, MD: Yes. I love that. So going back to team building, what- Yeah ... what would you say are some simple ways to start creating psychological [00:20:00] safety on a team?
Danny Eiferman, MD: Yeah. One of my favorite topics, it's the one... It's in the first when I give my class on tenets of high-performing teams. I spend the last third of it talking about psychological safety because I think it's a word that's used, or a phrase I should say, that's used a lot, but people don't talk about how you actually build it.
They say things like, "We have to have a psychologically safe environment so that people feel comfortable sharing, you know, different ideas." One of the best things that I've read and learned about and that I teach, You guys ever heard of Project Aristotle? Mm-mm. Project Aristotle was a study on what makes high-performing teams, and they came down to, , creating psychological safety.
They found two things that equal or lead to psychological safety the most, and I don't think you'll be surprised when you hear them, but probably wouldn't have thought of them yourselves. And I've done this multiple times with [00:21:00] classes. Very few people, , actually get this correct. But I will tell you that all of us being physicians, this will make sense.
Number one, learn to be a great listener, and the word that's used in Project Aristotle is ostentatious listening. And being podcast hosts, you guys are really good at it. Like, so you say back to me sometimes the last couple things that I said. You give me head nods even though we're on Zoom or whatever.
You're making eye contact with me. You are signaling to me that what I have to share, you value, versus looking off in the distance, turning , your videos off, acting like, you know, something else is more important. Listening is a skill that most of us suck at.
Most of us listen to respond. " I am listening to you because I wanna come back with my comeback so that I get my point, my meaning through, and I discredit [00:22:00] whatever it is that you have to say." You have to listen to hear what is it that you're trying to... 'Cause then- When you get the sense that I value your input, I value what it is that you have to say, you're gonna invest and you're gonna engage in the team.
So number one, learn to be a great listener. Learn how to put aside listening to respond. The other thing they found, and this is quite true for a podcast with three other people where you each sent me questions in advance that you are each gonna take part one, two, and three, is what they call equality and conversational turn-taking.
That if everybody speaks roughly at about the same amount, although probably not great 'cause I'm doing most of the talking right now, so maybe I'm not building the safety as much , as I need to. - You're
Laura Cazier, MD: okay. We're safe.
Danny Eiferman, MD: All right, I appreciate that. When you do that, that also signals it. I want, even though I'm quiet right now, I want everybody to...
Your input is valuable to the team. So those are the two things, especially in teams where I've just met them. This is very true [00:23:00] in the operating room, where sometimes I'll walk in and I don't know who my anesthesiologist is gonna be, I don't know who my scrub tech's gonna be, I don't know who my circulator is gonna be.
How can I do that quickly? I usually show some vulnerability upfront, you know, so they see me , as a human being, and then I listen, and then I make sure that I have a conversation with everybody so that I have equality and conversational turn-taking, and I'm an ostentatious listener. Those two things lead to psychological safety more than anything else, and I think you can do that in any situation that you're in.
And, and I think that goes for outside of healthcare as well.
Laura Cazier, MD: Oh, absolutely. I love those answers. I've often thought of all the things that we learn in elementary, middle, high school, college, medical school, training, where was the course on listening? The listening, learning how to listen is a s- it's a skill that does not come naturally to almost any of us, like to deeply listen.
And it, it's so, [00:24:00] so important, so I'm, I'm so glad that you highlighted that ostentatious listening. , I love that.
Danny Eiferman, MD: If I could, if I could even take it one step further, why it matters so much.
Laura Cazier, MD: Yeah.
Danny Eiferman, MD: So stick with me here. Make sure I don't get , off the rails. Our, human beings' most core thing that we want is to feel valued.
Okay? That is our core belief. That's what we need. Secondly, I believe, and it is the, it's the opening, it's the title of chapter two in my book, it says, "What's the most important thing that you have?" And I've asked this many times in different lectures and on rounds, and I say the answer is time. Time is the most important thing that you have.
You can't buy more time. You can't get it back. Now part three, what has been the one trait that has been associated with being a great healthcare worker more than any other? And that is curiosity. Now, what are you doing when you're being curious? If you wanna do it in a [00:25:00] clinical situation, you say, "Tell me more about that.
When did the pain start?" Or if you are doing interpersonal relationship, , "Tell me what your background is. How did you get interested in this?" I'm displaying my curiosity, and what I'm de facto saying is, " Whatever it is that you have to say is worthy of the most precious thing that I have.
I am giving you my time." When I give you my time, the most precious thing that I have, now you feel valued. So if you can learn to be a great listener, you will do that by demonstrating your curiosity. When you demonstrate that curiosity and then you give the time, the most important thing that I have, the most precious thing that I have, now you feel heard.
And because you feel heard, you feel valued. And that will lead to things like psychological safety, going above and beyond, things like that.
Laura Cazier, MD: Yeah. Oh, that's so good. For those of us who are spouses or parents, this all applies there. So, so important, and again, not intuitive. So shifting [00:26:00] over to responding to bad outcomes.
When, when someone is stuck in rumination after they have a bad outcome-
Danny Eiferman, MD: Yeah ...
Laura Cazier, MD: what's one practical step that we could offer them to help them move forward?
Danny Eiferman, MD: Okay. I got a couple, but if you want the first one, first thing I'm gonna tell you what not to do, okay?
Because it's important, and when I give this in like a live lecture, I have it up as a poll and I say, " Who here feels like it is helpful to say, ' How can I help?'" That the person who is going through, that you feel like that's a helpful statement. And most people, or I us- no, I think I usually ask it, when something bad happens to you, you appreciate when somebody says, "How can I help?"
And most people don't put their hands up, and I would be one of those people as well. And the reason for that is, okay, something bad just happened to Danny. Okay? Laura, Kendra, Amanda want to help Danny out. When you ask, "How can I help you?" or, "What can I do?" You just [00:27:00] shifted the obligation. Now I have one more thing that I have to come up with so that you could feel good about yourself for asking how you can help me.
And I'm gonna beg you, don't do that. But I'm gonna replace that with, what can you do? Actively do something for them. So things like you know, "What type of coffee do you like? 'Cause we're having coffee, you might as well drink something that you like." Write them a handwritten letter. Stop by, you know, unexpectedly and tell them that you're taking them out for dinner.
You have to actively do something for them. I would say that that's the one thing that you can do for a colleague. Number two that I have in my list of things that you can do for-- I really encourage people to have what I call a nice book. And that is save texts, thank you cards, you know, messages to remind yourself of things that you actively did to make somebody else's life better.
And then play that [00:28:00] out even more. I made this person's life better. They may have a spouse, and I positively affected their spouse's life. They might have kids, and I positively affected their children's lives. They may be a teacher, and I made their students' life better. They could be a coach, and I made the team's life better.
And then you see this virtuous web that you're gonna-- And you can overcome those negative feelings of, you know, "I hurt people. I'm not good at this," and all that stuff. So those would be the two things that I-- One don't do, and two to-dos.
Amanda Dinsmore, MD: Love it. That's so great. We're hitting all of the things that we really don't get trained in- Correct
just studying 10,000 hours.
Danny Eiferman, MD: Yes.
Amanda Dinsmore, MD: And yet this is so important, how to live within this work- very high intensity work. And then let's finish talking about leadership. You kind of alluded-- I feel like you kind of alluded to this at the beginning, but you have talked about leadership as being something physicians aren't trained in very often.
What are we getting wrong about leadership in medicine?
Danny Eiferman, MD: [00:29:00] I think that what we're getting wrong is-- I, I can't remember if I mentioned this earlier, I think I did, of halo effect of- The person who is the smartest or the technical whiz must also be great at building team learning about a spreadsheet, having difficult conversations.
Those are different skill sets. And yes, our four years of medical school and however long your residency and fellowship is, I do think that the overwhelming majority of that does have to be on the first A, that able. You've gotta-- Like, we have to know the material, right? That's what the patients are there are trusting us to do.
And there is only X number of hours in the day. But I do think that there is a role for getting these type of topics in there of, you know, listening, navigating difficult conversations, how to build a high -performing team, how to be an effective feedback receiver, how to [00:30:00] be an effective feedback giver, things like that.
Those are classes that I never had. You know, I was always just told, "Make sure that you get an evaluation at the end of your thing so that you can pass neurology or OBGYN or whatever it was in the, you know, or this rotation when I was a surgical resident." I do think that there's a role for this stuff because, , again, it is my belief it's roughly 50% of what we do after you've mastered the, the clinical piece.
Amanda Dinsmore, MD: Yeah. So you have taught leadership to many physicians. What are some of the recurring , blind spots that you see?
Danny Eiferman, MD: I don't know if I'll use the word blind spot. I will tell you that the thing that I get most often asked about, dealing with difficult personalities- Mm-hmm ... conflict management, conflict management when there's a difference in power.
That is what most people, when I give my like feedback, "Please give me feed- how can I make this course better? What would you like to, to learn more about?" [00:31:00] Overwhelmingly that's what comes through, is those particular skills. And I I'm sure as ER physicians, you guys have had many a disagreement with a consultant over whether somebody needs to be admitted or doesn't need to be admitted or needs more imaging or doesn't need more imaging.
W- whatever it may be. , How do we have healthy debate and con- so that, "Hey, you're pretty smart. What do you think we should do?" "Hey, I'm decently intelligent." Let's put those two things together. That to me is healthy conflict Which when you have healthy conflict is actually the second pillar of having a high-performing team.
That, to me, to specifically answer your question, that's more of what people want. I think that's-
Amanda Dinsmore, MD: Oh ...
Danny Eiferman, MD: a blind spot.
Amanda Dinsmore, MD: I have never once had this any sort of difficult exchange when I woke somebody up in the middle of the-
Danny Eiferman, MD: Yeah. Yeah, and I'm sure surgeons are the most affable people that, that you talk to all the time.
I'm sure we're the best.
Amanda Dinsmore, MD: What are, like, [00:32:00] a couple of your go-tos that you tell people that help them in this area?
Danny Eiferman, MD: Yeah. So my go-to, , when it comes to that is, , have you ever heard of Rapaport's rules?
Amanda Dinsmore, MD: I have not.
Danny Eiferman, MD: All right. This is one of my favorite things, and , I have this in the session that I do on navigating difficult conversations. So first of all, the overlying thing, whenever you're having something, a disagreement, anything like that, always open-ended questions.
Okay? So never, "Do you think this guy needs to be admitted," or, "Do you think this guy needs a..." Yes, no. Always open-ended questions. But if you're having a difficult conversation with somebody, there's four rules. Rule number one is be able to state back to the other person clearly and fairly what it is the issue that's on the table.
Let's say in this fake scenario for you guys as ER, this patient needs to be admitted , or not be admitted. You don't think that they need to be admitted because their blood pressure can be managed as an outpatient. You know, [00:33:00] I'm concerned Okay. Number two. Number two and three are by far the hardest.
List everything that we agree on. In healthcare, usually number one is the easiest. We both want what's best for the patient. Okay? So that's usually an easy one. Okay? Then the other facts of the case that you can get in there. Number three, and this is hard. What did I learn from you? So saying back to them, "You know, I was unaware that there's a new article in the Journal of blah, blah, blah and blah, blah, blah that, that says this is how we're doing it," or that, "Surgery isn't helpful in this," or, , "I do need an MRI."
Whatever it may be. So now when I've said that, what I learned from them, I just proved that I was an active listener, right? I made your input feel valued. After you do one, two, and three, I've earned the right to ask my first question And that first question should be an open -ended question. ,
So that's my every day what I try to do when, I'm having a disagreement with [00:34:00] somebody about what's best for the patient. State it clearly. What do we agree on? What did I learn from you? I've now earned the right to ask my first question.
Amanda Dinsmore, MD: I love that. So it has been- I didn't come up with it.
Well, you taught it to me, so. Oh, good. All
Danny Eiferman, MD: right, then, then that counts.
Amanda Dinsmore, MD: Yeah, it totally counts to me. It, it's helped my life. So I really appreciate your insights. You're such a great teacher. I love I also love that you're authentic and appreciate your vulnerability. , In the very beginning of your book, Cut Open, you just start with your worst complication ever and go from there, and I feel like so many of us in medicine are afraid.
We're just trying so hard to be perfect, and sometimes that's unrealistic, and it's just such a great way to connect with like I also have experienced something like you have. Mm-hmm. So where would people go if they were interested in reading your book, and how do they learn more about what you do and what you're involved in?
Danny Eiferman, MD: Thank you , for my, for my free publicity, marketing pitch. My, my book's on all, is on all the places that you [00:35:00] would expect it to be. Most people are getting it off of Amazon, but it's on Audible with yours truly own voice. Just, you know, recording your own audiobook, , listening to yourself is, is quite the experience.
I'm like, "God, do I really sound that stupid?" But, , although you guys could probably listen to your own podcast, so you know what that experience is like.
Laura Cazier, MD: Mm-hmm.
Danny Eiferman, MD: , I do have a website out there. It's integritysurgery.org, , where you can ... And my email's on there if you ... I am not on social media 'cause I think it's the devil, but the people that I published with said they would only help me if I promised to do LinkedIn, so I actually am on LinkedIn.
, But there's a way through the website if you have a question for me or wanna talk more, anything like that. But the book is, , you can order the book all... The website also has a link to order the book. But in general, most people will just be going to Amazon and getting it.
Laura Cazier, MD: Love it.
Kendra Morrison, DO: Well, thank you so much, Danny, for joining us today. I really think that your story, just like Amanda said, and [00:36:00] the platform from which you now, train up the next generation of clinically competent and empathetic surgeons and physicians is definitely making a ripple effect that you probably don't totally know the magnitude of.
But may it continue, and may your legacy be one that continues on maybe even after you're gone from teaching and surgery. Who knows?
Danny Eiferman, MD: Well, thank you for having me. I always find it a compliment you use the word authentic, and it is what I try , to bring to the table, so thank you for saying that.
That means a lot to me. Thank you for doing this. This is not these aren't easy thi- we were not trained to talk about things like this and, and having a forum like this. I remember being... You guys can tell me if you had this in medical school. I had a professor say to me Out of 20 patients you take care of, how many of them do you think you're gonna have a profound impact on their life?"
And this is back when I wanted to be a primary care physician, and I was one idealistic medical student. Yep. And I said, "19." And he [00:37:00] said, "Good. You got the answer correct, but in reverse." And he said, "It's probably gonna be about one in 20 or so." And so my goal with the book and a podcast like yours, , if I can make a small difference, for somebody that helps them gain their resilience back and all that stuff, then, then I think we did a good thing.
Laura Cazier, MD: Yeah. Your ratio is a lot better than
Kendra Morrison, DO: that. Well, yeah. Thank you for communicating that. And that's it for today's episode, friends. If you found this conversation helpful, the best way to support us is to subscribe, so click that button now. And leave us a rating and review because it helps other physicians find the podcast, and it moves us up on the list.
And we'd love to hear from you, or if you have any questions for Dr. Eiferman just send us an email, [email protected]. And don't forget to follow us on the socials. We are @thewholephysician. We love connecting with you there. And thank you for spending time with us today. Until next time, you are whole, you are a gift to medicine, and the work you do [00:38:00] matters.
