Life Changing Moments: Walking in Other’s Shoes, with Dr. Scott Abramson

Transcript

[0:00] How can I make things easier for you? That’s her last question.
Now, so she said that to this, so she’s telling me she said that to this woman and there was a long silence on the phone, seemed like a long silence.
And the woman answered back, she said, how can I make things easier for you?
Woman answered back, you just did.
There are times in our lives that change the way we see the world.
Navigating these challenges can take insight, trusted confidants, or even a coach.
Let’s explore those moments.
In this companion podcast to Rx for Success, we will discover ways to learn and write our own success stories together.
I’m Dr. Dale Waxman, a physician coach with MD Coaches, and this is Life Changing Moments.
Physicians spend many years in medical education settings learning knowledge and skills to refine our craft.
Occasionally we learn something outside of the halls of medicine that absolutely transforms how we practice.
Well, this is what happened to my guest today.

[1:09] Dr. Scott Abramson is a retired neurologist who spent his entire 40 year career at Northern California Kaiser Permanente.

[1:18] For the past 20 years, he has been passionately involved in communication and physician wellness projects at Kaiser and has transformed much of his wisdom into brief videos on his website and in the recently published book, Bedside Manners.
Scott was the guest for Rx for Success podcast episode number 61.
His story is inspiring and if you haven’t heard it, I invite you to access it through the Rx for Success website or your favorite podcast app.
Scott, welcome to Life-Changing Moments.
Thank you, Dale. It’s so good to be here. Thank you for having me.
I really appreciate it. Oh, it’s great to have you back to the MD Coaches family of a podcast.
So great to have you. You know, you’ve had a long and rewarding career as we heard some about in the podcast with Randy.
You know, I’d just be curious, you know, as you think about your career, what were some of the highlights that come to mind right now?

[2:19] I think the real highlight was getting involved with the communication aspect, the real communication aspect, the doctor-patient communication aspect.
And Dale, you said, you mentioned I was for 40 years at Kaiser, and I can tell you this, the first 20 years I was doing the usual kind of find it, fix it stuff, explain it, give a medicine for it type stuff.
And I was competent, but that was, And that was a job.

[2:51] And maybe it was a career, maybe. But when I got into the communication business, then the next 20 years became a calling, as they say, a calling. And I can tell you this, if I hadn’t have done this, I can tell you I would have retired a lot earlier than 40 years because learning these skills and practicing these skills and teaching the other really just enriched my life and just made my practice so much more rewarding.

[3:18] Well, that’s fascinating. We’re going to get into, you know, kind of your pathway to that particular second half of your career, if you will. So let’s get right into it. You mentioned when you were talking with Randy that one of your pathways to that was Toastmasters.
So say a little bit about, you know, what is Toastmasters and what was happening there for you?
Yeah. This was a life-changing moment for me, joining Toastmasters. And I didn’t know anything about it. A relative of mine had to give a speech at a wedding or something like that, and he was going and he mentioned it. I went and it’s a group of people that get together in these clubs. And I thought, oh gosh, you’re going to learn to give a toast or something. I think that’s what a lot of people think when they hear it. But no, it’s about learning public speaking.
But that’s just one pillar of that, learning public speaking.

[4:10] And what the way a meeting works just real briefly, you’ll have about three or four people and they’ll give you a prepared speech five to seven minutes, then you have an evaluator.
Each person is assigned an evaluator that will evaluate that speech.
And then there’s another part called tabletop is where you just speak extemporaneously for off any topic.
So those are the three pillars. And but most people concentrate on the public speaking part.
But there’s also it’s also about public listening.
And that’s what it was for me. Because you have to listen to someone’s talk, five to seven minutes, and then you’re given two or three minutes to evaluate that talk and give them advice. What worked? What didn’t work? What could have been done better?
Yeah. So just the process of Toastmasters itself got you more oriented around, I’d really need to listen carefully so that I can give feedback to the people that are giving speeches. Is that, did I read that right? That’s absolutely right. You really have to listen.
Yeah. So, which is the theme for you with respect to how you kind of got into communication.
But can you just say, when did you first start noticing that your involvement with Toastmasters made a difference in what you were doing professionally as a neurologist?

[5:26] It turns out it was just a very, very fortunate happenstance for me. But just about the time I was doing Toastmasters, Kaiser Permanente came out with a mission to teach their doctors communication. So I went through the course and I said, wow, this is so great because it’s teaching people, it’s teaching doctors how to listen. And so those two things came together and that’s how I really got involved with the Kaiser mission. So Toastmasters, if you will, oriented you towards the power of listening and then simultaneously the way the universe works, there’s this opportunity to really expand on communication skills in the clinical setting.
Yeah, yeah, thank God the universe works that way. That’s right.

[6:12] So it’s very compelling what you said. I want to go back to this that you said, I would have retired a lot earlier had I not done this. So how did, that make a difference in your experience of being a physician?
One of the communications we learn and we teach is getting patient perspective.
So I remember, I can remember this so clearly. When I first started this thing, I may be a little skeptical, so I tried it out.
This woman comes in to see me, she’s got a headache and referred to me as a neurologist for a headache, but it seemed like very vague, you know, I could have, and I thought to myself, you know, I can spend the next five minutes, I can spend the next five minutes trying to get every detail about this headache and then try to figure it out.
And then I said, well, let me try this skill called patient perspective.
And one of the questions we ask is, what do you think is causing the problem?
And so I asked this woman, I said, well, what do you think is causing the problem?
And here’s what she says, she says, you know, maybe it’s, the exact words, I remember, maybe it’s technological, maybe it’s energy force, maybe it’s cosmic.
Now it’s not angelic or spiritual, but I feel like I’m connecting to someone out there.
But why am I connecting? Why isn’t anybody else connecting? So here’s the thing, I could have spent five minutes getting nowhere.
And with that one question, I mean, I knew I couldn’t help her, but at least I knew who her next consultant would be. Right.

[7:41] But it’s, I mean, it’s, but it’s so much more serious than that.
It’s like, you know, someone comes in and, you know, I’ll get a few preliminaries.
And the first thing I’ll say is, what do you think, what’s your biggest fear about this?
You’ve got to, you know, you say you’ve got some dizziness, you got to have, What’s your biggest fear?
Doctor, I think I might have cancer. And then I realized the focus of my whole visit, I don’t have to get this, you know, does it hurt on Tuesday, Thursday feeling that just my focus is, is to reassure them that they don’t have cancer. And that makes for a great visit. It saves a lot of time and it really addresses what they need. Yeah, there’s a quality Scott and what you’re saying that, you know, there’s the communication skill, but there’s also this quality of relationship.
Yes.

[8:35] And say some more about that, you know, just as I’m bringing that forward to you.
There’s a quality of relationship that, I don’t know, you know, was there something different about relationship with patients?
Absolutely, Dale, you know, because when you can make that connection, you know, You know, let’s say in that situation, you’re not just telling someone, well, the dizziness is benign, but you know what?
You don’t have cancer. And when someone gets that, that’s all they wanna hear.
And just asking the question is so important. You know, here’s another story that I tell.
There was a nurse practitioner that we work with, and she calls people that come in for surgery, that are coming in for surgery, and it’s kind of scary and frightening.
So she calls them up and she tells them, all the things you have to do, get the blood test, get the EKG, here’s where you go to, blah, blah, blah, blah.
And her last question to people is, she says, and she knowing that it’s difficult surgery type thing, she says, how can I make things easier for you?
That’s her last question. Now, so she said that to this, so she telling me she said that to this woman and there was a long silence on the phone, seemed like a long silence.
And the woman answered back, she said, How can I make things easier for you?
Woman answered back, you just did.
You just did. Just by asking the question, just by honoring her to get her perspective, You’ve created that connection and trust.

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[11:20] Music.

[11:30] Hi, I’m Rhonda Crowe, founder and CEO for MDCoaches. Here on Rx for Success, we interview a lot of great medical professionals on how they grew their careers, how they overcame challenges, and how they handle day-to-day work.
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I’m hearing just to kind of recap, I’m hearing the benefits to you as a practitioner, toast masters into communication training. The benefits were not only efficiency, you know, you’re When you are getting the patient’s perspective, you get at what’s most important to them, and that can save you a whole lot of time. Sometimes it doesn’t. Sometimes patients don’t really, you know, I don’t know. You’re the doctor, you tell me what’s going on. But a lot of times, so there’s the efficiency piece, but there’s also, I’m hearing this piece of.

[14:16] Boy, I’m really going to focus in on what they’re most concerned about.

[14:19] You know, we’ll talk about what I’m concerned about too, but when they’re most concerned about, And there’s this relational aspect to it also that sounds like was very gratifying for you.
Dr. John Ligato It is. It was very gratifying. And, you know, and because of that connection, you know, that you’re making now with patients, that deeper connection, being able to tell someone that they don’t have cancer, you know, not only is a great thing for them, but having done that, you can bring joy and meaning into your own life. And that’s how it got me into the, you know, physician wellness thing, because that’s the key to wellness. I’m seeing this woman, she’s about 37 years old, she’s got a few kids, and she was referred to me for this funny thing on her MRI, it was just a serendipitous thing. It was an incidental oma, it was a benign thing, it was what we call you know a nothing oma.

[15:13] So I’m seeing her and I’m going over these things and I just show the x-ray talking to her and I say and finally I just explain, you know, so I said, Joanne, it’s just nothing to worry about. It’s just an incidental finding, blah, blah, blah, and take care. Have a good life. And as I’m leaving, and I’m just getting ready to leave and it would have just been a routine appointment, you know, blah, blah, you know, kind of nothingoma. As I’m leaving, she grabs my hand and she says, Dr. Abramson, thank you so much. God bless you. I was so worried about this. I have two children.
God bless you, doctor. Thank you, doctor. And I say to him, I say, well, Joanne, it was nothing. It was nothing. And I walk out of the room. And then I start thinking to myself, wait a minute. To Joanne, this was not nothing. This was something. And to me, here’s what’s more important. To me, it should have been something. You know, I saw a license plate.
It said, and there’s a lot of wisdom in license plates, by the way, and it said, it’s amazing the impact you can have on people’s lives and never even appreciate it.
It’s amazing the impact you can have on people and never see.
And I would have been in that never appreciated category for the first 20 years of my life.
But now, having gone through that and realize that I’m saying, man, this made my day.

[16:34] This was great for me.
I’m feeling terrific. this nothing OMA, which I’d have written off as a, you know, just a kind of a waste of a consult really, now became a very, very important thing to me. It brought me joy and brought me meaning in what I do every day. And so that’s the connection between the communication part and the physician wellness part. Yeah, there’s a piece in there, Scott. This is really important, I think, for for the clinicians out there that are listening to this.
We’re trained to do things, we’re trained to do things reflexively.
Even our communication training, if we do really excellent at that, we evoke things, but we don’t always drop into what’s this like for the patient?
What must this be like? How are they experiencing this?
What impact does this have on them?
And we tend to minimize it by saying, well, you know, I’m just doing my job.
You know, my job is to diagnose and to treat.
And we actually forget about the impact that it has on people.
It’s not an ego thing, right? It’s not about I’m so great. It’s about really dropping into this human condition of people feeling relieved by being healed.

[17:52] Yeah, yeah, yeah. And if we are ever, you know, if you’re ever on the other side of that, you know, as a patient, or your family members a patient, boy, it’s, it’s so important to understand what you can help understand what it’s like on their side, what it’s like, you know, to, to wait for three hours for a doctor that’s gonna gonna supposed to call you that morning, right?
You’re so, you know, you’re sitting in your office and you got a ton of stuff and you know, somebody called and you said, okay, I’ll call him back. But that person is waiting at home, and they don’t, they’re afraid to go to the bathroom, they’re afraid to go out to get groceries, because the doctor might call. And if you can put yourself into their place, what it must be like when you make that phone call, it can be a joyous thing, because you know what it was like to wait for that doctor to call. Putting yourself in their shoes, that is the, that’s just the key to, I think, to well-being, to finding joy and meaning in medicine.
And it’s tough sometimes, you know, Dale, I’ll admit to you, I mean, when sometimes I’ve been on the other side of that thing and man, I come off when I say, man, I am going to be so much better because I know what it’s like. I’m going to really change the way I do things. And it works for about a week. And then you get your inbox full and you get all these work-ins and, you know, And you kind of lose it again.

[19:16] It’s a struggle. It’s a struggle. Yeah. It’s a struggle. It’s tough when there is all of the things, the business side of what we do.
And.

[19:31] To be able to savor these moments that are meaningful. We know, I think you know this too from your work and well-being, increasingly we are seeing that lack of meaning is directly related to burnout. There’s a lot of other things that are too, but meaning is hard to measure.
It’s hard to measure. But as we’re hearing from some narratives and qualitative research that that meaning may be at the core of all of it, because I’m not doing what’s meaningful, there’s things getting in the way of me doing meaningful work and so I think you’re really onto something there.

[20:09] When you cultivate it in the way that you have. And Dale, you mentioned that, I think you used the term moments of meaning, to try to cultivate those moments of meaning, and the point is that every moment is a moment of meaning, every nothing Ola, every person that comes in with a with an itch or something, you know.

[20:31] You can give them reassurance. You may not be able to cure them. But you can certainly make an empathic statement that may be important. So every every moment is a meaningful moment.
Yeah. And if you have that perspective, boy, and there are some people, I mean, there’s some people that that have it naturally. I mean, you probably have met some of those doctors out there, they are just saintly people and just beautiful people. For people like me, you know, it didn’t come natural. I have to work on it. I have to work on it every day. It’s a struggle. So that kind of is a segue to my next question. So you’re involved in bringing this work to your colleagues at Kaiser. And I’m curious what that was like to be a teacher of this and how receptive were your learners and what were some of the challenges, what were some of the the joys of that.

[21:21] Yeah education. Oh gosh i mean it really like i said this was what kept me going during the last twenty years is is teaching this and continuing to learn this and one of the things is we would, you know we had to go through the training ourselves part of the training is We have actors that pretend to be patients and we interview them and then we have people that watch us, people that watch how we do.
So when i was going to the training they brought up this, so this actor was having this problem and i’m not gonna go into all the details but i did all my skills you know i was practicing all my skills of communication i thought i was doing fantastic.
And so then I got back out and we replayed the tape of me and we replayed the tape of the, and the facilitators were there watching me.
And man, I thought these guys are gonna just pat me on back and say, God, you’re just a natural tissue, great.

[22:17] Thing is, is that I didn’t shut up. I kept talking, I kept explaining.
I kept giving explanations and teachings and education.
And I thought that was great.
That was not what this guy needed. You know, they needed someone to listen.
And so I realized first, you know, the great, there’s a, I think George Bernard Shaw said, he said, the problem with communication, is the illusion that it’s taken place.
And if you were to interview a bunch of doctors and you were to say, okay, you just had this interview, how’d you think things went? They go, it was great. You know, I got the symptoms, I did the exam good, I gave education, I was doing great.
And then you interview the patient, the patient say, I don’t know what he was talking about.
I don’t know what a lesion is. What’s a lesion?

[23:04] So it was really, and that’s part of the training that we do.
We would do videotapes, we would do actors, we’d have people look at the videotapes.
And it really was great to see people, because the best learning comes when you can make the corrections yourself, not being told, but you can make the corrections. You can be guided, but just to make those corrections.
Yeah, and video is an incredibly powerful teacher and very anxiety provoking. So how did you prepare your learners for that?

[23:37] Well, this is a special program we have. It’s like a, we call it the communication intensive offsite. And we have, it’s a four day program from morning till night. You do these videotapes, you’re facilitated. And we do it in groups of three or four. So it’s a small group. We developed the small group.
You know bonding and trust and it’s a it is it can be very difficult and you know with the camera with the actors people watching you but it works it really it really does.
Sounds like the bonding in this small group create some safety and allow some vulnerability for that kind of learning that’s awesome.
We tell people, look, we want you to screw up. That’s the only way you’re going to get better is if you see your mistakes. It’s important to screw up. Please, if you didn’t screw up, there’s no point being here.
So I’m just curious, people go through this training, you’ve taught a lot of folks over the years through this. What are some of the success stories you’ve heard as a result of you and others being involved in teaching this and creating that culture at Kaiser?

[24:53] You know, the, of course, one thing is we have, we get these grades on our, you know, patients are sent surveys and how did your doctor do and so forth. And so we, we, it’s always gratifying when the people that we, that we teach have, you know, increased and done really well on those patient scores. So, I mean, that’s, that’s one thing, but But you know, a lot of times it’s the personal testimonies that people will tell us.
One thing we really try to emphasize is making an empathic statement, you know, with every patient.
Just make one empathic statement. And the problem with making an empathic statement, doctors do that.
But here’s what they do.
Let’s say someone’s coming to see me and they come for some medical problem or neurological problem and they mentioned that they’re grieving over their husband’s death three months ago or something, you know?

[25:50] And you can see that’s kind of relating to their issues, maybe. And so the typical doctor will say, you know, making empathy, say, wow, that’s really tough to hear about your husband.
Now, and then what, here’s how, but here’s how it will come out. You’ll say, wow, really tough to hear about your husband. Now, you know what? I think maybe all a lot of these dizziness and headaches may be related to that thing. So how about we consider a support group, but grief support group, or perhaps you’d like some antidepressants or whatever it is.
It’s what it is, is you make this empathic statement and then you fix it. You say the words and then you fix it. And what we try to teach is just shut up, just shut up. Wow.

[26:34] It must be tough. It must be tough, your husband, your beloved husband dying, and you just shut up.
Yeah, just leave him. So much will come. And a lot of times, so much will come from that in that moment. And if nothing comes, you know that there’s a connection going. I’ve heard from a lot of people when we teach that one skill, just make the empathic statement, make it, it’s important to make it, but shut up.

[26:57] There’s some space. CB. We have such a, our tradition in medical education is so, you know, from day one, it’s diagnose and treat. And so there’s that urge to fix, you know, so you’re really helping people people fight off that urge, just be there.
You know, I mean, you still need to do the fixing when fixing is appropriate.
We’re not saying that, but after empathy, you don’t have to fix that.
Something else I wanted to ask you about some people who are listening to this, who have not gone through communication skills training.
I imagine where their minds are going right now is, oh my gosh, what he is, what Dr. Abramson is talking about, that’s got to take me more time.
Yeah, yeah. And the fact is, it actually, it actually saves time. I know it may seem like that on the surface. Let’s say you’re, you know, here’s a typical situation I imagine for a lot of doctors. Somebody comes in, a guy comes in and says, you know, my kid is up all night with a cough, you know, you doctor, you need to give him antibiotics. So the doctor then says, you know, no, I’m not going to, you know, this is, let me show you the Mayo Clinic studies, let me show you this, here’s all the data, you know, it’s bad news to get anybody. And you can go back and forth like that. But consider this, if a doctor, if a doc, why can’t you get my son, I’m up all night with with my kid, I gotta go to work next week.
It goes something like, wow.

[28:19] It must be tough having to be up all night with your kid. Guy says, yeah, you know, it is. It’s tough. And then when you make, if you can, you can make that connection and you can build trust with that connection. And if you build trust, you can build adherence. And then that conversation doesn’t become this argument with the Mayo Clinic data and this data and that data, but it says, look, trust me, this is not a good thing for your son. And that’s safe. That’s going to save you a whole lot of time. If you can build connection and trust with the communication, with asking perspective questions, it’s in the long run. And I can tell you, like I said, that was just.

[29:01] One of the mechanical ways that it made my career so much better, not just in the cognitive ways, but I was connecting and the visits didn’t go as long.
Yeah. So this kind of recapping Toastmasters, I need to listen more, I need to listen better.
And then communication skills training where you really not just are listening, but also making sure that you’re listening for what to be empathic about without fixing, eliciting their perspective. And then the rewards from that were people feeling really heard, people feeling appreciated, people feeling trust, more likely to actually then listen to suggestions that you have. And then we’ve talked about touched on meaning.

[29:52] Yeah. Is there anything else you haven’t mentioned that all of this enhanced your career to that point where you said, boy, that you did not retire 10 years earlier? Is there anything that you haven’t mentioned yet that made a difference in your professional life or your, personal life?
It has, Dale, because what I’ve tried to incorporate and tried to learn is.

[30:19] The concept of self gratitude you know and that’s what really has made it so rewarding so like i told you about that woman that came in with the nothing on my so forth in the old days it would have been just ok that was a good that’s a good point that was really quick it only took me to you know what i can catch up on some other stuff that great but.

[30:39] If i use self gratitude if i can graduate myself.
On change on impacting this person’s life.
Man, she I gave her something. I gave her something that was so meaningful.
The reassurance that what she was worried about, she didn’t need to worry about.
Man, I’m feeling good now.
I feel wonderful after that. That’s the connection. That concept of self-gratitude, being joyous in just the minuscule, the minor stuff that we do.
Awesome. Well, Scott, I really appreciate your willingness to spend a little extra time talking about the, you know, expanding on this quality that really created quite a change for you in your professional trajectory. And I’m just as a sort of a last question for for you, for our listeners.
Is there anything that you want?
Other listeners to hear, other people to hear about from you in terms of advice or being open to things. Anything you’d like to pass along that was a learning for you?

[31:53] Yeah. You know, medicine is so tough these days with all the pressures that we have on it. And I I just want to emphasize just the self-gratitude part of this.
And as we talked about before, Dale, is trying to…
You can reach that. I think one of the ways, the pathways, as you mentioned, to reach that is to put yourself, to walk a mile in someone else’s shoes.
What’s it like to be this woman who’s worried about something on her MRI?
What’s it like to wait three hours for a doctor’s phone call?
If you can start out and just put yourself in their shoes, even the minuscule, even the little things you do can bring joy and meaning into your daily practice.
Well, Dr. Scott Abramson, thank you so much for being with us on Life-Changing Moments.
Some great advice indeed for the people who are listening to this and really awesome, awesome work that you’re bringing to your colleagues at Kaiser and now through your website and also through your book, also bringing that to the masses as well.
And so, thank you for all you’re doing to, you know, as you said, improve the lives, you know, of the practitioners, not, you know, the patients and the practitioners at the same time.

[33:14] So, thank you so much. Thank you, Dale. I so appreciate you talking with me today.
Here are my takeaways from this conversation.
With the challenges of contemporary medicine, it is easy to get mired down with the parts of practice that we have no control over, like numerous regulations or prior approval or the electronic health record.

[33:40] When we do get mired down in those things, we lose sight of the things that we can do that bring joy and meaning back to our work.
Through enhancing his communication skills, Scott Abramson reconnected with his purpose of being a physician and reclaimed the joy and meaning that this profession can offer.
So let me recap some of those skills that he practices and teaches and that has changed his life and can change yours too.
Number one, find out the patient’s perspective. Ask them what they think is going on or what they’re worried about.
Number two, drop into what it must be like to walk in your patient’s shoes, and then make at least one empathic statement.
Then…
Shut up. Don’t try to fix it. 3. Practice self-gratitude.

[34:32] In a non-egocentric way, focus on what you do that makes an impact on people’s lives and be joyous in even the miniscule things, always remembering that a miniscule thing to you may be monumental for your patient.
Finally, I really appreciated Scott’s embodiment of the concept that engaging in meaningful work is an antidote to burnout.
It certainly was and is for him.
So I invite you to bring some of the practices that Scott brought forward in the conversation today.
If, however, doing so isn’t enough to restore meaning and joy in your work, consider a conversation with one of the coaches at MD Coaches.
You can find us at MyMDCoaches.com.
Thank you for listening and be well. Thank you for tuning in to Life Changing Moments.
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