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The Clinical Excellent Podcast, sponsored by the Bucksbaum Institute for Clinical Excellence is a biweekly podcast hosted by Drs. Adam Cifu and Matthew Sorrentino. The podcast has three formats: discussions between doctors and patients, discussions with authors of research pertinent to improving clinical care and the doctor-patient relationship and discussions with physicians about challenges in the doctor-patient relationship or in the life of a physician.
[00:00:00] Dr. Cifu: On today's episode of The Clinical Excellence Podcast, we have Diane Rogers of Contagious Change talking about physician coaching.
[00:00:12] Ms. Rogers: The biggest challenge for me is to be fully present, to be respectful, to be curious, and to be thoughtful in how I present what I'm objectively seeing, feeling, hearing, and sensing back to you for you to be able to decide what you want to do with that.
[00:00:40] Dr. Cifu: We're back with another episode of The Clinical Excellence Podcast, sponsored by the Bucksbaum Institute. On this podcast, we speak to patients and doctors about all aspects of excellence in clinical medicine. I'm Adam Cifu, and today I'm joined by Diane Rogers. Diane is a healthcare experience and engagement consultant, a leadership coach, and the president of Contagious Change. She is the author of Leading Heartfully. Diane, thank you so much for taking the time to join me this morning.
[00:01:10] Ms. Rogers: No, it's my pleasure to be here, and it's great to see you again.
[00:01:14] Dr. Cifu: So, Diane, I know you've had sort of an, I don't know, we'll call it an interesting and diverse career path to end up where you are. Can you take me through kind of your journey to physician coaching? Kind of, how did you end up doing this?
[00:01:29] Ms. Rogers: Absolutely. And you're right, Adam, it is rather diverse. I have a math degree. It took me years to really appreciate what that did, but it actually allowed me to think. I'm a good critical thinker. And so for most of my career, I have been problem-solving, uncovering root causes, hard-drying solutions, and implementing changes. And I started in nuclear power a long, long time ago, and then went into aerospace, and then semiconductors.
[00:02:01] Dr. Cifu: Wow.
[00:02:02] Ms. Rogers: And that work was really productive and very impactful, but for me, I was missing a connection to purpose.
[00:02:10] Dr. Cifu: Yeah.
[00:02:10] Ms. Rogers: And that purpose led me to healthcare.
[00:02:13] Dr. Cifu: This is sort of off-topic. I often think this, talking to trainees and even talking to physicians sort of early in their career, but I guess it really applies to everybody. Career change always seems like a very courageous move. And it sounds like you've had multiple pivots over your time, I guess, A, were those hard things to do? And do you think that plays a role in kind of what you're able to achieve in your coaching practice?
[00:02:48] Ms. Rogers: Boy, that's a great question. I mean, it really is because when I think about the points at which I changed careers, there were some defining moments. I would agree with you, Adam, that they are courageous moves. But as I think about it, kind of out loud here, right? You know, change occurs when it's connected to something very meaningful. And when I left nuclear power and moved into aerospace, there was a personal reason for that change in my life. And when I went into healthcare, there was a very long personal searching. I really wanted something purposeful and meaningful. I moved to Arizona, Dial Corporation used to be headquartered in Phoenix. And I always wanted to work for Dial Corporation because they dealt with people, right? They had made soap and that was people. And I really had this desire. I wanted a bunch of kids, that didn't happen. And I just needed to find a way to really connect to personal relationships and all of that. That's a great question. And so, you know, I guess to tie a bow around that is, yeah, right? What I do is create conversations, create the space for people to dive into the depth of what is meaningful in what it is they want in their lives.
[00:04:27] Dr. Cifu: So, I guess that's probably, like, the perfect transition. What I've seen you do, and where we've been involved together, is when you join physicians, you know, in their practice. My question is, when you're preparing for that, you know when you're sitting down with a physician, whether it be in the office, in the operating room, whatever, and think about how you're going to give helpful advice to this person, what are kind of the biggest challenges that you face? I guess either preparing for it or in the actual, you know, experience of being there with them.
[00:05:07] Ms. Rogers: I really am appreciating the question because it brings into our conversation today, what coaching really is and isn't, so... And coaching, the word is used over and over again, particularly in healthcare now in so many ways, but coaches and in particular, me, we do not give advice. And in fact, when this morning I was listening to one of the experts in our field, Marcia Reynolds, and she said that when we give advice, we are actually making a judgment about that person. And coaching is all about creating the space that is free of judgment, free of assumption, filled with compassion, and caring, and curiosity, so that the individual that you're coaching can find their way forward toward what it is that they want, right? So the biggest challenge I have in preparing for any physician coaching session, any coaching session in general, it's me. It is for me to get out of my own way. Right?
[00:06:34] Dr. Cifu: Right.
[00:06:34] Ms. Rogers: In order for the client to find their way forward. So I have to practice being present. And it's interesting, Adam, because there's a whole lot of components of being present, right?
One is, particularly in the exam room, wherever we're at, there are a lot of external distractions, whether it's the team dynamics, the physician dynamics, right? The clinical medicine that you guys talk about with your patients, that's distracting for my head, right? The other thing is the internal distractions. When you say something, it is not for me to take it in and process it, but rather to hear it and then to reflect it back to you. For you to hear and appreciate what the meaning of that statement might be for you and it's in those reflective statements that allow you to challenge or to see more clearly what it is that you want. And we always start with what is it that you want. Right? I'm not the expert in how you should connect with your patients. I'm not the expert in how you should show up. I'm not there to tell you, I'm not there to point out what you should or shouldn't have done, and yet, sometimes those creep into your head, right? And so the biggest challenge for me is to be fully present, to be respectful, to be curious, and to be thoughtful in how I present what I'm objectively seeing, feeling, hearing, and sensing back to you for you to be able to decide what you want to do with that.
[00:08:35] Dr. Cifu: Sure. I think it's so neat listening to you talk because, you know, my experience of you as a coach, which I found both an amazing experience and a very sort of helpful, productive experience, was having another set of eyes in the room to be able to, you know, in a somewhat detached way, see like, you know, what's going well here, what's not going well here, how can you use the things that are going well, either more frequently or in different settings, things like that. And that was just hugely helpful. When I listen to you talk, it's neat because so much of the challenges that it sounds like you deal with are the same kind of challenges that I feel like I deal with as a doctor, right? It's clearing the head. It's ignoring a lot of the things in the room. It's trying to be mindful about how people are responding. And only now, listening to you talk, it's funny because so much of what you do, at least on the observation side of coaching, is very much what physicians do, right? On the physician's side of doctoring in a way.
[00:09:49] Ms. Rogers: It is so wonderful to talk to you, right? As I think about that, though, oftentimes what I witness in the room is where you, you being a physician, right, are the coach in the relationship with the patient.
Now, there are some physicians who aren't coach-like at all. There are some people, right, who just want to tell other people what they should do. But we know that when we can create a conversation with our patients that is unconditional, non-judgmental, kind, and caring, when we can invite into the conversation what they want... Might not always be what you think is clinically best or what you would actually advise but you also know that if you can create a conversation where they can thoughtfully determine what's the best pathway for them, then they're more likely to do that.
In coaching, we don't use the word comply. In healthcare, we do, right? But what we really want for our patients is for them to be able to move forward in a healthy, fulfilling, thoughtful, and meaningful way for them.
And so, you know, Adam, your insight into the similarities between the physician relationship and the coach-client relationship is really enlightening. And were we to be better coaches as physicians, as leaders, the same thing applies with... Right? Just imagine what would be possible.
[00:11:46] Dr. Cifu: Right, right. Your discussion about, you know, that we try these days to not say, "Listen, I'm going to tell you what you should do. You know, I'm going to spend time giving you the information so you can make the appropriate decision for yourself." And maybe that's, you know, for me, counseling people on, you know, risk of harms, chance of benefits, cost of medication, side effects, whatever, you know, so you, patient, can make a decision.
It is what you strive to do. It's to say, you know, let me outline for you everything that's going on here so you can recognize in your own practice, you know, what works best for you. It is a great way to think of it.
Let me ask you, this is one of the things that actually after we sort of parted ways when we were working together that I was so struck by. I feel like I've been in medical education, you know since I was a trainee and man, I've observed, you know, hundreds and hundreds of people doctoring but they're pretty much all people early in training, whether it be medical students or residents, you know, the occasional junior faculty member. I think your experiences are very special because you've actually had a career where you've observed you know, many, many senior people, I know from the people you've worked with here, you know, you've worked with the Bucksbaum Institute, you've worked with these people who, you know, have been admitted to the Institute as kind of master clinicians, right? And you're there with them. And so I sort of wonder, you know, are there like lasting impressions or commonalities that you take away from these experiences? Obviously, everybody's kind of different. Everybody's a different person and they interact with other human beings differently, but I don't know. Are there things that you've seen that you're like, "Wow, this is how it works," you know?
[00:13:56] Ms. Rogers: Certainly, I learn from my observations with each of you. And while I can't, at the top of my head, think of, oh my God, everybody should do it this way kind of thing, there are a couple of common things that do come up.
One is, through the experience, perhaps the most common response I always get is, "Wow, I never knew I did that." Right? And that is very enlightening for many. I kind of think about it that how... I can't imagine having worked for so many years to be this physician that you wanted to grow up and be, right? And never having any information as to whether or not you are actually achieving that. Right? And so this idea that they get to kind of see who they are, I'm holding up the mirror for them to see themselves, right? Kind of leads to the second thing I actually see the most and that is that it's very validating. I think you even shared that with me, you know, that what it is that you wanted to accomplish in our interactions was present. Now, are all the interactions perfect? No. Were there and are there things that we can do more of and concentrate further on? Of course, there are, right? But the coaching, or I should say, and the coaching conversation actually enables individuals to step into that space to explore that more freely.
What I do take away the most is, Adam, I am in awe, really. I am in awe of what healthcare professionals do, what physicians do. There is kindness. There is so much unselfishness. There is so much expertise. All in service of what I refer to as strangers. And to me, that is profound. And at the same time, I don't really understand why that's not what we are continuing to talk about, leverage, and use.
There's a lot of evidence that were we to connect more fully to the meaningful work that we do, to have a sense of accomplishment, to develop quality relationships, to leverage our strengths, and to be engaged, right? All of that evidence that promotes and fosters well-being. And coaching and these conversations and believing that each individual has the capacity to do and be their best fosters well-being. And yet, we still today focus on what we're not doing, why we haven't hit the targets, all of that, right? And so, you know, working with the Bucksbaum in particular and Adam, with your leadership and Matt's leadership to be able to bring this to your environment is a pathway forward to reducing burnout. It's a pathway forward for us to be well. Right? And I am privileged to be invited into that very sacred space where I get to witness the awe of what you all do ever so routinely, ever so magnificently, but every day.
[00:17:51] Dr. Cifu: Yeah. It's interesting listening to you kind of link this to burnout because as you were talking, I think that one thing that we've... I wouldn't say we've lost, but I don't think we do enough of in medical education is this sort of, you know, one-on-one apprenticeship model. You know, student watching physician practice, physician watching student practice, maybe even student watching themselves practice, you know, just on video. And I often feel that what we're losing there is we're losing the modeling, we're using this sort of master-apprentice relationship, but I like the way you talk about it is that something else we lose is kind of recognition of the privilege of the experience almost. And that is something that no matter what you do in the field is so important. It's what makes what we do not only valuable but enjoyable, you know. And it may be one other reason to kind of recommit to having that as part of medical education, maybe writ large, you know, throughout an entire career.
[00:19:06] Ms. Rogers: You know, the other thing that came to mind when you said it is that it is also or could be also perceived as that thread that unites all of you, right? Because I get to play in the sandbox of surgeons, of internists, of infectious disease specialists, of neurology, right? All of, and I don't... I mean, I appreciate the medicine clearly, right? But what's present in all of them is connection, is caring, is expertise, is conversation, is the desire to help another human being, is wanting to develop your residents, and your... All of that is common within all of you, right? So, you know, we are more alike than we are unalike, my friend Maya Angelou says. Wonder what would happen were you all to come together and actually change health care a little bit, right?
[00:20:10] Dr. Cifu: Good. Diane, thank you so much both for the work you've done and absolutely today for joining me. I think this is a really nice taste on sort of what you do, what the potential is, and hopefully part of, you know, what we're trying to do to make this more available to physicians everywhere, really.
So thanks for joining us for this episode of The Clinical Excellence Podcast. We're sponsored by the Bucksbaum Institute for Clinical Excellence at the University of Chicago. Please feel free to reach out to us with your thoughts and ideas via the Bucksbaum Institute webpage or on Twitter.
The music for The Clinical Excellence Podcast is courtesy of Dr. Maylyn Martinez.