Transcript

[0:00] You know I think that are visible leaders sort of set the tone.
For you know who we are and who we want to be and where we want to go but I wholeheartedly agree with you that many of the most influential leaders who make a difference on a day-to-day basis have no titles at all.

[0:25] Paging dr. cook paging dr. cook dr. Kirk you’re wanted in the OR dr. KO.

[0:33] Music.

[0:56] Hello everyone and welcome to prescription for Success I’m dr. Randy cook your host for the podcast which is a production of MD coaches.

[1:07] Providing leadership and Executive coaching for Physicians by physicians to overcome burnout.
Transition your career develop as a leader or whatever your goal might be visit MD coaches on the web at my MD coaches.com because you’re not in this alone.

[1:27] My guest today is a recently retired family physician who has released a new book based on the accumulated wisdom he acquired during his 30 plus years in practice.
So let’s hear my conversation with dr. John Chuck.

[1:43] Music.

[1:49] Great pleasure it is for me today to have dr. John Chuck,
on the show a recently retired family physician out in California John thanks so much for being here oh it’s my pleasure thanks for having me.

[2:05] There is so much that we can talk about and I hardly know where to begin.
But what we typically do in this show is begin at the beginning so with that,
let’s talk about the fact that you are a California native born in San Francisco is that right that’s correct and basically of the lived your
entire life in California did you ever have the urge to be any place else or have you just been deliriously happy all that time you know I’m just a product of my environment I was born and raised there I got spoiled by good weather
and good food and a lot of cultural diversity so while I enjoy visiting other parts of the country and the world I always.
Look forward to coming back to California and Northern or Southern I’ll admit you do it is a wonderful place I quite agree but let’s talk some more about your beginnings.

[3:06] Do you recall when you first began to think that you might become a physician well it’s interesting so I grew up in a family where my father was a minister and San Francisco’s Chinatown for over 40 years same church
and my mom was partly a stay-at-home mom but then also sometimes a burn unit nurse at st. Francis Hospital
but I didn’t want to be a minister or a healthcare professional I wanted to be a sports writer.
For the San Francisco Chronicle because no kid and what a great ambition oh well well let’s see this the sports sporting session the chronicle
was called the Sporting Green and the paper was white but the sporting section was literally mint green color.

[3:47] And I wasn’t a great athlete growing up but I love to follow the Giants and the 49ers in the Warriors and when I was a senior in high school I thought I was a pretty good writer.
But one day I had this,
realization that I wasn’t even the best Rider in my class of 30 pimply High School seniors and I thought if I’m not the best writer in this little group.
I’m pretty sure that nobody will pay me to write I made the right decision not to go into writing and I said to myself well I I love people,
and I love science so maybe I’ll head off to Cal
and try and be a pre-med student and as you know having been a pre-med you just kind of take it year by year and you know if you keep passing classes think well you know maybe I have a chance and stuff so it worked out.
Did you get encouragement from your mom know it’s so funny you ask that that is a great question so my mom and dad are both have both passed but after my mom passed I was talking to my dad and he said you know.

[4:51] Your mom never wanted to tell you this but when you expressed an interest in medicine.
She was very sad because she thought that it was too difficult of a career but she didn’t want to discourage you so she never told you that.

[5:06] That’s very interesting do you do you think it’s possible that your mom might have.
Seen in the faces of the Physicians that she worked with the very sort of thing that we struggle with today and namely burnout which probably hadn’t been named at that time but do you think that that was on her mind at all.

[5:27] You know I think that was exactly that you know she is somebody who she went to Stanford nursing school on the GI Bill and then she she was in charge of a big pediatric unit at the old Stanford Hospital in San Francisco
which is where I was born and I just think that she what she observed and the physician is was that.
They worked very hard and didn’t have much of a personal life but it’s interesting because a couple of my role models in medicine and what we’re uncles who were Physicians.

[5:57] And I saw that they were very busy and they really enjoyed their work.
And they didn’t have a whole lot of time for family but but I thought that might kind of work out for me if I tried a little harder than they did to spend time with my family what you have done,
well I was blessed with a very good wife who was very straightforward about the need for us to,
apparent as a team and I thank her for that I know early on in my career you know you may have experienced the same was difficult was working very hard we had young kids.
You’re trying to balance you know being on it all overnight in the hospital with changing diapers and helping out with the midnight speeds right so.
And we’re going to get into some more of that shortly but
in any case to get back to your story it sounds like you weren’t particularly fascinated with your undergraduate level of study but you realize that it was going to lead to something bigger.
But once you got into medical school at UCLA did what was the initial feeling did you think man I’m in the right place now or did that,
evolve oh so I was super happy to be at UCLA I actually went through all my Premier dearest thinking that.

[7:13] That I wanted to go to the UC San Diego School of Medicine cuz I grew up in San Francisco and Berkeley they’re both kind of urban and I knew that UC San Diego the school of medicine was based in La Jolla and I thought this is my dream School.

[7:25] And I was accepted there not a bad place to be not a bad place to be so as accepted there in December of my senior year and I said I am done.

[7:33] This is perfect I’m just going to play intramural sports and barely pass my classes but then my two uncles one of whom had gone to UCLA the other gun in Northwest from they said well you know UC San Diego’s an excellent medical school and it is.
And they said we would encourage you to go to UCLA because we feel like the clinical opportunities in your clerkship years will be will be better
and so but my initial thought was I hate the Dodgers I hate the Rams I hate the Lakers you are a sports fan is no way in hell I would ever go to UCLA.
But anyway I understand their encouragement I flew down I interviewed and I fell in love with the place it’s like wow this is amazing Medical
the medical school is on the undergraduate campus I can come to school here get a great education and go to Pauley Pavilion see John when the whole thing so anyway I went there I loved it from start to finish this one of the things I would do over and over again given the same opportunity.
And our Dean was Sherman melon cough who they called the dean of American teens Not only was he a really nice.
Why is man but he was very old so that’s probably why he is the dean of Dean’s but anyway on the very first day of class dr. Marilyn Cobb came in and said.
Well welcome to UCLA it’s really great to have you here I know that many of you might be a little anxious and concerned about whether or not you’re going to survive the rigors medical school let me reassure you that you will all graduate and be doctors.

[8:55] Wow I thought wow,
that’s a different message only thing to say I said I think I’m good to go and so from that point on I pretty much did not have any of the pre-med stress that I had at Cal I pretty much just thought I’m just going to do my best and I’m going to
graduate and be a doctor and so it was a very very,
enjoy books was great camaraderie wonderful classmates and my attendings and staff in the nurses there which is wonderful.
That’s a great start and Andy even in the basic science years you were satisfied that everything was well.

[9:30] Yeah it was well and you know in those days you know I teach medical students now nobody comes to class anymore right but of course in those days everybody goes to class it’s this great corporate thing there’s a lot of camaraderie.
You know you’re telling jokes between class and all that it was in fact there was one class I had Jared Diamond as a physiology professor and he won a MacArthur.
Surprising that he was a brilliant man and a very forward thinker and one day he brought two gigantic platters of asparagus into the classroom and he said I want everybody eat a spear of asparagus,
and then during the break I want you to go pee and then we’ll talk about your experience when you come back right
it was all about you know genetics and some of us are predisposed to have this Gene that makes you know you’re in smell funny after asparagus and others not those of you were urine smelled fine please right you know it was just a lot of fun and just a whole bunch of experiences like that this is wonderful that’s really remarkable
and I think those kind of experiences are rare.

[10:23] In relation to others I got lucky then you really did and then from that point once you were in your,
clinical rotations again was the experience yeah this is what I wear I want to be or was it terribly intimidating what was on your mind at that point,
I would say overall it was wonderful but thank you for asking about intimidating,
so my uncle who had attended you tell Cal and you sell in the school of medicine did his Medicine Residency at the VA wodsworth.
Which is a wonderful VA right off Wilshire Boulevard so I signed up for 20 weeks.
Clerkship work at the VA wodsworth it was probably an overshoot but talk about intimidating I did surgery on Doctor Pizarro’s service at the VA was a vascular surgery.
And we would have morning rounds in this gigantic Circle and Doctor Pizarro looked like George C Scott’s.

[11:21] And he was an excellent surgeon and great teacher but super intimidating.
And it was the ultimate pimp rounds and stuff and you know you practically pee in your pants and stuff even the chief residents but that being said that was balanced by dr. Bruce stabile who is another attending there and I think later on he went on
did you see San Diego but dr. stabile and contrasted dr. Zara he had me in his office and he sat down he said John.
You know let’s talk about you know you know muscular Lumen and like like what happens when one of them gets obstructed.
You know and and it was just a lovely casual conversation which for the rest of my life help me explain the colicky you know renal colic and you know intestinal obstruction and.
And so anyway that was really fun and then and then the thing I did love about you soul and turn on my uncle’s where right.
The breadth of clinical experience at the VA versus Cedar Sinai versus Harbor UCLA,
you know all of you and then ultimately I did a one month rotation,
on the Family Medicine service at Kai’s at the Kaiser Sunset hospital that kind of was a big pivot point in my life because coming to medical school I wasn’t sure what I was going to do and I knew nothing about Kaiser Permanente.

[12:33] But dr. Jimmy how is my attending and he was just a wonderful human being all the patients loved him and I saw Joe,
this is what a family physician could do in a large integrated Healthcare System,
and at that moment I thought hmm I think I’m going to head towards family medicine and I definitely want to find out more about Kaiser Permanente and my residency so.
So yeah I actually have to yeah yeah it worked out well you know I think it’s fair to say that the,
Kaiser Permanente system is profoundly unique and people don’t have an opportunity to see anything like it in other parts.

[13:16] Of the US and I know it’s difficult for you to imagine what it might have been like but suppose
you didn’t have that proximity to KP back in those years but what if you were the Wilderness of Southern Louisiana or something of that nature yes it is it possible,
that you might have bypassed the possibility of family practice at that point I know that’s a really Oddball question but I’m just interested to know what you think
well you know it’s really that is actually a great question because and we’ll get to it later on in this conversation but
in the last 15 years of my career at Kaiser Permanente I was very involved in leadership working physician Health and Wellness.

[14:04] And I ended up working not just within Kaiser Permanente but
with many groups outside of Kaiser Permanente throughout the country and I learned a lot about the experience outside of a large integrated Healthcare System
and I had envisioned in my pre-med years and maybe my early medical school years I envisioned I was going to have a practice like my uncle Arthur.
He was a solo practice General internists in Fresno California which is like a Central Valley Ag down here in California and so I did have many thoughts about what life like that would be like.

[14:38] And when I was a third-year resident I did a one-month elective with a family physician group of three and Vacaville California which is a.
Small Northern California and it would have approximated,
Uncle Arthur’s career and they offered me a job and they gave me a $500 Brunner’s Furniture gift certificate and it was very wow you were brightly
yeah it was a surprise but it was a Family Practice Group that took care you know they were the team doctors vacuole High smoothing took care of the mayor it was just wonderful,
but I sort of saw the writing on the wall in the late 80s and and you know a lot of the smaller groups were being consumed by large group
and sure enough a few years after I declined that job offer there are lovely little three-man group was consumed by a much larger than it lost all of.
Much of its character and but I still I mean I know that to this day you know many Physicians you know in America and throughout the world.
Are in traditional practice like Uncle Arthur was in decades ago but that it’s very challenging right I mean you’ve been in so many ways.

[15:44] And I’m very you know sympathetic and I hope that one day I can do things or maybe say some some things during this
podcast that would help those people and I want to get back to enlarge on that question a bit you made the decision to go into family practice and once you were in the postgraduate Arena
I gather from everything that I’ve read about you that you must have felt I am really headed in the.

[16:14] Right direction am I correct about that well yes you are correct about that when I was in medical school at turned out.
That I liked every rotation I was on literally every rotation because I went to medical school thinking maybe I’ll be a geriatrician or a gastroenterologist.

[16:29] My wife’s uncle is a gastroenterologist in Fresno any when I was in a pre-med he took me into his
office and he showed me all these esophageal dialer tears and this could be pretty fun and I’m pretty good with my hands and I love to do procedures so you thought it would be fun to shove an esophageal dilator down somebody’s throat all right.
Well if it would relieve their dysphasia yes you’re not sounding like Marcus will be here but do go ahead with your story by the way I love Marcus Welby and dr. Kelly and all that but in any event,
so I liked everything and then I met dr. hajra and I thought wow I could be a family physician and be many things to many people.
I could be the person that answers 95% of the healthcare related questions at a cocktail party.
And I really wanted to be that person for my family and my community and and then I went to residency where you know I experienced a lot of things and a lot of Health Care Systems and.
It’s sort of confirmed the fact that yes I really like comprehensive long-term care and then I also I rotate it extensively through two kinds of permanent to hospitals when I was a resident UC Davis and.
I really admired that the type of Physicians who join that group and there,
a lot of them were just do-gooders like social Mission people who happen to be doctors in fact I went from residency straight to Kaiser Fairfield Vallejo.

[17:49] And vallejos you know it’s a challenged Urban setting low socio-economic population.
And I was working side-by-side with some outstanding interns and family doctors and if people like Sandy broken Howard’s wire and I’d say why did you guys join Kaiser Permanente when it was very unpopular and.
You know it was shunned by the medical societies and everything and they said we just believed and outstanding care for all human beings regardless of their ability to pay and I’m thinking oh my God you people are so much more benevolent than I am I said.
I joined because it seemed like a really good job and the seller and benefits were solid right and so anyway I was just immersed I was in this simmer sauce of really smart good people
on a mission to transform you know the face of American Healthcare and I knew right away I was in the right place in fact the gentleman that recruited me Steve Friedman.
It was from Pottstown Pennsylvania really funny energetic Jewish guy he went to Princeton and Stanford medical school and he trained in Family Medicine at a UC Davis Affiliated program.

[18:53] And when I met him and I interviewed and I met his colleagues during my interview Fred Klein Zinger.
Who had gone to Harvard and came out west and was living Oakland he taught me how to do a toenail Excision.
And Mark Van Heusen was from Syracuse and he was he loves sports and I love sports and then you know Steve had so much energy and passion I said I have to join this group like I said and the nice thing about Kaiser Permanente was,
had I joined and I didn’t like it you could just leave after a year no strings attached where.
We’re if I joined a small practice I would have been buying into an office building sure that was run by one of the Physicians spouses it was just,
a little Messier so it was kind of a
my wife and I just step back and we thought what are the pros and cons of the different opportunities and you know in retrospect who made a great life changing decision for ourselves
hi I’m Rhonda Crowe founder and CEO Forum D coaches
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.

[20:01] I really hope you’re getting a lot of great information but if you’re looking for an answer to a specific problem management or Administration challenge.
Or if you’re feeling just a bit burnt out like maybe you chose the wrong career.
Well then there’s a faster way to get the help you need now it’s not counseling it’s coaching.
RX for success is produced by MD coaches a team of Physicians who have been where you are I know you’re used to going it alone.
But you don’t have to get the support you need today visit us at my MD coaches.com to schedule your complimentary consultation.

[20:39] Again that’s my MD coaches.com because you’re not in this alone.

[20:47] We’ll get back to our interview in just a moment but right now I want to tell you a little bit about physician Outlook.

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[21:51] And now let’s get back to today’s interview do you think that that dedication to the ideal
and the level of satisfaction in their practice is really highly
prevalent all across the system or am I just talking to the ones who.
Are more successful and understood how to do it right from the beginning what your thought what I saw in Permanente Physicians and medical school and residency was
as a group almost without exclusion the people really smart they’re committed and they’re team players and when I was recruited by Steve Friedman he said.

[22:36] You know we are a large integrated evidence base physician-led group where the Physicians make the decisions based on what’s best for the patient.
And that was very appealing to me and the people really walk the walk I mean I observe that at the Kaiser Sunset Hospital.
As a medical student at Kaiser Sacramento Morse Avenue in South Sacramento has a.
And then you know fast forward to joining the group and my first few years yeah yeah it was the real deal like people walk the walk.
And then later in my career I became a physician recruiter for Permanente medicine I hired 250.
Possibly this family doctors outpatient doctors and I was very clear about about our mission and what we’re trying to do in the world and I said you know.

[23:22] We’re a good fit for some people and not for others,
and I only want you to choose us if this is a good fit for you if what we do is consistent with your values in life and your mission in life.
Then we’d love to sign you up and then we’d like you to contribute to this Mission so I would say that that belief is held by almost all the people in the group and it’s not just the Physicians I mean we’re looking for nurses you want to be part of a team.
We want people to achieve as individuals but for the team and like I said I think Kaiser Permanente Works in communities.
Where there’s a critical mass of healthcare professionals
and patients who want to buy into that model you know obviously it’s not going to work everywhere in the country and of course if there’s no economy of scale,
and you don’t have a dense enough population it doesn’t work but in certain parts of the country with certain demographics it’s just one of the greatest experiments.
In healthcare in the issue of the world in my mind I have very biased view well as I say the people that I’ve talked to to a person have been very enthusiastic about it
but that brings up another interesting thing that I mentioned in snooping around in your life from the very outset of your association with Kaiser Permanente you thought it could be improved and you want about organising a mentoring plan you want to tell us about that
yes so when I joined Kaiser Permanente I just wanted to be a great clinician.

[24:46] But as you know from your career you’re just trying to mind your own business being a clinician but.

[24:52] You’re frequently be invited to accept leadership position so when I transferred from Fairfield to Davis which I wanted to do because,
I missed my residency mates and and I was teaching on a regular basis and if I move back to Davis he would just be easier so when I transfer back to The Davis Clinic they said well.
I will accept you as a transfer on one term and that’s that you’re the chief of the department I said I don’t really want to be the chief I just want to be a doctor they said well then you can’t come I said well okay I’ll be the chief
so as Chief I had to recruit some Physicians our population was growing and I just I had some good success in that so.
The chief of adult medicine the entire Sacramento Valley said oh is there any chance you can be the assistant chief for the whole department and do all of our hiring and so
you know in the Sacramento Valley you know we have about 1300 of Kaiser permanente’s 10,000 physicians in Northern California is a big department right so yeah when I took on the recruiting job,
it was a big job it took a lot of my time and then we were having some issues with,
not just recruiting people to the Sacramento area but retaining them because you know Northern California all the sexy cities are like you know San francisco-oakland Palo Alto all that one way we thought that we could retain
and professionally develop our new hires was to Mentor them,
so I was paired with Susan hell Vic who was an assistant Medical Group administrator of a wonderful nurse leader manager.

[26:20] And we sat down and did a survey of you know the different mentoring programs that existed in Northern California Kaiser and then did a literature search on.
Mentoring programs and then we designed one for our department.
For our rapidly growing department and the fundamentals of it were a one-on-one pairing of every new hire with an experienced member of the department,
and then we also had a little ancillary Mentor from a different department so that every new hire could have have at least one person no bridge to whatever head and neck surgery Orthopedics pathology whatever and then
we said well this is pretty good and we set some very modest goals and I said you know my only goal.
Is it if we serve any new hires one year end of their employment we’re going to ask them two questions number one did you have a mentor so that’s low-lying fruit they’ll say yes and number two did this Mentor help improve your onboarding experience at Kaiser Permanente
so you know pretty modest goals but solid goals and so we achieve that but then we said we should we should add something else,
that makes the program unique or better and I thought you know,
I said historically when you educate primary care physicians you bring in Specialists from the University.

[27:31] But I said you know what my observation as a medical student and Resident is that the some specialist at Kaiser Permanente are outstanding and forty percent of them hold clinical positions.
At the local medical schools anyway at Stanford and UCSF and Davis I said why don’t we create a new hire lecture series do it quarterly for four hours.
You know on a weekday morning and bring in all of our sub Specialists to teach our primary care doctors about the subspecialty medicine and how to interface with our doctors that way they’ll also get face time,
with the Specialists they’ll be working with for 30 years so they’re really really of that and I picked all of my favorite urologist and pulmonologist and infectious disease doctor.

[28:10] And it was just wonderful it was a wonderful experience for the new hires who are working at multiple satellite clinics and things to come together as a cohort every quarter.
And to not only socialize but learn from the people they’d be interacting with for the next 30 Years I want to ask you a little bit of an off-the-wall question if you will.
And I think it’s really brilliant that you were able to get some of the most visible practitioners in the Kaiser Permanente group too.
To to be available as influencers for your colleagues when I look back on my my education and my career,
I noticed that quite a number of probably most of the big influencers for me were people who didn’t really have a lot of titles.

[28:59] You know the people who were at the top of the Heap were sort of busy making big decisions and steering the ship and that sort of thing but the people that that I had
so much respect for the they were not in those positions they were the day-to-day people that I had conversations with over coffee and that sort of thing and now I’m wondering if you think if it’s is it possible
that are most visible leaders are not necessarily our best examples are best mentors what do you think you know I think that are visible leaders,
sort of set the tone.
For you know who we are and who we want to be and where we want to go but I wholeheartedly agree with you that many of the most influential leaders.

[29:48] Who make a difference on a day-to-day basis have no titles at all so
actually one of my favorite leaders who I admired the most during you know my career at Kaiser was Carlos who was our head custodian at the Kaiser Davis Clinic she said well what is Carlos do,
well first of all he kept the place spic and span and you know we do all these number patient satisfaction surveys and I guarantee you that if our Clinic
is not super clean and tidy and smelling wonderful there’s no way that I could do a service recovery despite my best efforts
and Carlos not only kept our place looking great.
But when we had a patient with lice or there was vomit and everybody is so afraid and wigs out.
Carlo shows up like the professional he is and does his job with a smile but he did more than that actually Carlos was also the guy.
That inspired us to exercise more so at lunch.
Despite his busy days he would go on a walk and invite the rest of us to go on a walking and Davis you know it’s sometimes a hundred and seven degrees at lunchtime you know but he was very consistent and he said hey and I said Carlos I’m busy goes hey.

[31:01] Know if you walk with me you’ll feel better when you come back you’ll be a better doctor this afternoon sure enough if whenever I joined them that I was I was sort of infected by his enthusiasm.
And yeah it is true if you work straight through lunch and then try and grind out the afternoon you’re just a you know a skeleton of what you could be so,
yeah I would say he was a leader professionally
but also culturally and sort of like service was as well I thought if Carlos can clean up vomit with a smile and a professional attitude
I can deal with a narcotic seeking to Patient or borderline personality or somebody you know filing a formal complaint against me I mean so
so yeah I absolutely I think some of my favorite role models are people who don’t have official leadership titles
well thank you for affirming my faith in the unsung heroes I actor really really important so.

[31:58] Really successful career at k p but fairly recently you made the decision that it was time to retire or at least
semi-retire from clinical practice and it sounds to me like you were really having a ball practicing medicine and I wonder what it was that
made you say what made when you woke up one morning that it maybe it’s time to close the door on that chapter wonderful question and I think a lot of people including people who knew me well and with whom I work closely were surprised when I retired,
at age 60 last year or so in our Medical Group it’s known that,
you can retire at 60 and I had planned on doing that for at least.
10 years and I think maybe the the role model for me and that was my father.

[32:49] Who was a minister at the same church in San Francisco’s Chinatown for about 40 years but he
I had always planned to do a really good job as the head pastor at the same place for a long time and then when he retired he did an intentional pivot shift and he started teaching at a seminary
in Berkeley on a regular basis and any supplement of that by pretty extensive intentional mentoring.
Of Seminary students and and young ministers and things.
And so I thought wow isn’t that wonderful how my dad had a whole second chapter career.

[33:31] That was just kind of Life Stage appropriate and played to his strengths at that age so I always thought that especially in the last 15 years of my career
at Kaiser where I was working extensively in Burnout and wellness issues I thought yeah I think when I want to do is just give Kaiser Permanente my all for the 31 years
and then I want to do a pivot shift and get more involved in Wellness work and teaching so when I retired I spent about four months
cleaning out our garage and start to put a dent in our yard which I had literally,
ignored entire perimeter sides of my house for 26 years as I did that for a while and then I.

[34:14] In my years of leadership work and wellness I had talked about a lot of topics developed a lot of programs and I was afraid that I was going to forget those things that I thought were helpful to people.
So I kept this little private blog called.
Pearls from the practice of life and I just listed all the things that I had learned in all the things that I was teaching people and I said when I retire,
I’m just going to leisurely write a book where I do a chapter on every one of these topics and so I kind of did that in bits and pieces over six months after I remove my retirement and
one day I looked up and my wife and I said I think I’m done I think it’s ready to go and I found a layout editor on upwork.com and she designed the jacket cover and I.
Published it on Amazon and launched it in June of this year has just been wonderful it’s yeah and one thing I told my wife was.
Now that I’ve written down all these things I want to pass on to the world I you know if I have an untimely accident I’m okay with it because everything I want to share with my children in the world is in this book
so I wrote the book I you know I started a wellness Consulting business for healthcare professionals and then
also serendipitously when I retired and I sent out my retirement letter to my patients.

[35:26] One of my patients who’s the founder of California North State University when he got the letter he said hey can you call me tonight he texts me said can we talk tonight he said I would love for you to come teach at California North State and I had taught at UC Davis Medical School,
20 30 years instead of but I was sort of intrigued by the idea of teaching in another place is kind of a little upstart place right led by this Dynamo who doesn’t know that he shouldn’t be able to do these things on this timeline.
Right so because you know I love the University California I love Kaiser Permanente but we kind of move at a more.
Methodical Pace right because you know they’re not so it’s been a wild ride and some teaching students couple days a week and that’s fine and then and then I’ve also
squeezed in Gulf one day a week because I was horrible golf with tears and,
now I’m just barely a semi-decent call form anyway yeah so the whole pivot shift thing and having a second group that was very intentional.

[36:24] And you know I was raised in the church to you know to love God and love people and to have a purpose and a mission that you know Midway through my professional career like in yours a lot of opportunities to come at the same time,
so I want to ask my pastor Glenn Schneider I said you know Glen you know how do I discern God’s Will and all these different things and.
I forgot it was going to somebody else recommended I read this book called God’s Voice Within by Mark Thibodaux and.
And basically it’s a book about you know when different opportunities present themselves to you in life how do you discern discern God’s will for you and all that so anyway I just do my best and I pray about it I talked to our pastors I’m in a home group in our church and we talk about these things and
I’m just trying to do my best I told my wife I think I’m going to be cremated but if I had a tombstone of any sort it
we just say you know John Chuck not MD cuz you know I wasn’t born a doctor and John Chuck he love God love people and I think that
what’s important is not that everybody has that same Mission but that everybody in life
has thoughtfully considered their values and their beliefs based on that developed a personal mission statement and then you spend your life.
Just trying to live that mission right and so this is one of the things that you know I know that you are very successful coach.
And you know this is a type of thing you coach people on right because especially Physicians we spend so much of our careers learning about how to help others.

[37:47] But not a whole lot about prioritizing arm own Wellness right and of course Aurora mental first step in that I’ll talk about later is
defining your values you know we taught a resilience course in my medical group and one of the first modules was yeah you know it’s taken values inventory and then develop a mission statement and then I would come and somebody else taught that unit but I would come in and talk about.
You know relationships and things like that.

[38:11] And I would ask okay how many of you have done a values inventory and written a mission statement before and oh it was like I was shocked like you know the audience of 30 to 65 year-old Physicians nephrologist surgeons Obstetricians like.
At most 25 percent of the people would raise their hands and the and most and I taught this course like 60 70 times groups of 20 to 30 and stuff it’s like
my God how to Physicians get this far in their lives without Dennis and and then I figured out I said you know what I said while in college everybody else was.

[38:43] Packing in Europe smoking dope and figuring out the meaning of life you are all studying for the MCAT and you never stopped and did this work that all your fellow non health professional human beings did,
it’s interesting to me that you had the foresight to plan that transition and clearly there were some really important influencers that perhaps.

[39:04] Not everyone has but your parents ministers that you’ve known and other Physicians around you clearly had an influence and,
you know obviously very fortunate for you that you had that available to you but to have that Vision before you before you had to make that decision you know there are I’m sure you’ve seen it
there are Physicians that go into retirement Kicking and Screaming because they just can’t imagine
say that they don’t sit down in front of a patient and come up with a differential and make a plan but
the fact that you were able to go to it peacefully and realize that you had much to offer beyond that is a really powerful statement and I
I congratulate you for that and I want to talk some more about the book pearls from the practice of Life a family physicians guide to struggle less and Thrive more
here’s the title and the subtitle that’s been available since June and you mentioned that it
it was available on Amazon from the beginning
and is also available in print now and it also fascinates me that apparently you had the book written
you just kind of had to wrap it up and present it you’ve been making notes all this time that’s that’s smart yeah I would say that pretty much.

[40:29] You know there are 69 chapters in the book every chapter in there and you know the chapters run anywhere from
like a half page to four and a half pages are all very short chapters but every chapter in there I’ve either LED at least an hour long lecture or maybe for our seminar
on those but I tried to keep it brief because I’m actually a non-reader I don’t
I read a lot but but the books I do like to read our brief and to the point and can be sort of red in small little increments so I’ve had people say that they’ve read like my daughter read the book from start to finish on a flight from Hawaii to the mainland
but most people have said you know John I see this more as a reference book.
You know I pick it up I read a couple chapters I think about it for a couple of days because they’re short but end their Story Farm which is friendly but they’re very dense it really makes me think about something big in my life
and in fact one of my editors is a journalist he said yeah John you got it goes that,
that’s how most people read this book and they’re going to have it on their shelf they may not have been read it soon after they buy but they’re going to go back to it over and over again in their lives,
but it’s such a valuable piece of writing I think and and as you say as best as I can determine I have not downloaded and read it it might read it myself but
I will but I can tell from the discussions that I’ve read in the reviews that I’ve read that it is exactly that you don’t necessarily have to begin.

[41:53] Page one you can sort of dive in anywhere and find some advice that’s very valuable and I think we could all use something like that
one of the former will actually the photo the first chairman of the Department of Medicine at the University of South Alabama which opened while I was still in medical school was a guy named Clifton met or
and he wrote in coffee table book called a little book of doctor rules but it sounds like that you’re exactly in that,
territory except much more expository and I’m and I’m really looking forward to it I have scanned the.

[42:32] The chapter list and I if I’m not mistaken there’s one in there called how not to waste time if I got that right well you know that that’s actually in the introduction.
Where I talk about when my father was officiating my Uncle Arthur The General.
His interment ceremony in Fresno you know it was actually not a solemn ceremony because Uncle Arthur would is the late 80s had a great career and stuff but what my father said at the ceremony was.
You know the sad thing about life is not that Uncle Arthur died because we all must die.

[43:05] He said the sad thing would have been if Uncle Arthur had wasted,
the time he had how he was right now and so one of the reasons I wrote the book is because you know in my 31-year career in Primary Care.
I was blessed by so many intimate stories of my patients you know
one of the things that dr. Melanie cost said was you know he said there’s a lot of Technology coming down the road like like for example they were teaching us anatomy in resin cross-sections and I said.
I asked dr. Clemente I said Doctor and it what why are we learning anatomy and cross-section is it oh they’re coming up with something called a CAT scan anyway but anyway but dr. Emily cop said you know there’s a lot of Technology come around because he said one thing will never change and that is the fact.
That when you put on your white coat and you go in there done when you close your door behind you there’s a lot of transference going on and patience will just share with you these
unfiltered high-octane stories that will bring you to your knees
yeah and I found that that was one of the greatest blessings of my life but one of the things I learned in these stories is that a lot of people were.
Not adapting to the circumstances of in their life that were favorable and in ways that were favorable to them having joy and meaning.

[44:25] That they weren’t emerging from their struggles you know stronger or better but but in other patients I discovered ways that they were Marvis marvelously adapting.
To the challenges in their life and the purpose of this book is for me to share all those.
First of all it’s to let people know that I hear them in their suffering and I know that suffering is an essential element of The Human Condition.
But I want to share with those people some Pearls of Wisdom that will help them to.
Not to struggle with but maybe to suffer less and to have more join meaning and in the book I talk about you know what is Joy what is meaning what our struggles.

[45:05] What might be some ways that people have dealt with struggles so it’s it’s honestly.
Everything I know based on my work about how to help people lead their best life.

[45:16] And it’s and you clearly have been unusually observant about.
The lives that are going on around you in addition to your own life one of the most,
powerful mentors in my life was a guy named Tinsley Harrison he was the original editor of Harrison’s internal medicine
oh my God I had that book that was a big book one of the things that always stuck with me was this thing that you said that when you go into the room with the patient and take your history,
unless you have put
the what will it be the eventual diagnosis in to your list of differentials within 15 minutes of listening to the patient
then you’ll probably never make a diagnosis he felt that the key was always in the history Now understand that this was before
the CT scanner was available in any of the miraculous things that we have today but it always stuck with me and and to the to a larger degree
it was not so much nailing the diagnosis as it was understanding why that patient was in front of you another mentor of mine was Gail Stevens a great family,
petitioner who said you’ve got to learn to hear what.
Is beneath what they say and extract things from them and it sounds like your practice was.

[46:43] Very much based on that capacity to listen,
well I am deeply I mean I’m melting into my chair right now I’m deeply resonating with what you’re saying dr. melon cough also told us that.

[46:57] If you just ask a few open-ended questions and demonstrate a little bit of empathy the patient will tell you their diagnosis,
in our story right is it very similar to what the dr. Harrison said and then something that I used to teach residents 25 years ago that I thought was sort of insightful but now it’s a regular part of our teaching is I said you know
patients are going to come to you with a chief complaint.
And I said that’s important to tease that out and find out more but I said what you really want to uncover is their Chief concern.
Like right what about the chief complaint.

[47:34] You know LED them to make this visit what are they really worried about and then as you know because you’re obviously loving kind experience condition you know it’s sort of like asking them like.
I’m the doctor you’re the patient but but what do you think might be going on here.

[47:51] You know if you had to venture a guess what do you think is causing your headache or your floppy left leg or whatever to tell me more about that and I think to engage the patient as a partner.
In the relationship it’s sort of like tapping in the hint of the humanity of medicine right.
You bet that would that was actually at the heart of what dr. Stevens was getting at in fact he used to say that every person who comes to you for medical care
his made a decision to be sick that there because they’re sick he said they made a decision to be sick and he went on to talk about the fact that a lot of people go around with the same symptoms for months if not years
before they seek medical care but something makes them come to the physician and unless,
you understand that your capacity to really help them is going to be severely hampered,
I thought there was a lot of wisdom in that so I’m doing way more talking here than I should and I want to get on but but I am a I’m loving this it’s like you know Manna From Heaven I mean I I feel like.

[48:57] You know when you read the book you’ll find that I didn’t make up much of anything but I feel like I’m a Clearinghouse.
For just these nuggets and Pearls of Wisdom that have moved me and changed my life.
And I feel like I just want to make sure that these are shared in some way shape or form but none of the wisdom comes from me
and you know as I got older I always felt like I have a certain spine of knowledge and wisdom and stuff but but then as I got older like if I heard something new that I thought was really good I would just add that.
To list and that’s why I created the whole blog for myself so that when I retired I would remember all these things because each one of them moved me so much.

[49:41] When I first heard it and I incorporated into my practice and my being I thought this stuff is too good to just keep on a private blog right like.
Like this needs to see the light of day and so I actually think that it’s a wonderful tool during the pandemic which is.

[49:59] You know I mean there have been a lot of challenges to individuals and societies throughout history mankind but yeah this is a significant one I mean it’s it’s up there right.

[50:08] But I think that a lot of the messages in the book would help people.

[50:12] Have some sort of framework or perspective from which they can navigate this and and survive it and maybe even find some good in it so
I bet they will and I’m looking forward to to getting the whole thing in front of me having scanned the chapter list I’m truly fascinated I’ve taken up almost an hour of your time already but one thing I want to ask you about,
before we get into your personal prescriptions for success.

[50:40] You are behind an idea called serotonin surge charities
could you tell us about that I would love to tell you about that oh I think 25 30 years ago in my career I was a CME chief
and in those days you know it was thought to be okay to partner with pharmaceutical companies and to put on salmon says but it was also thought to be okay to do things like have
pharmaceutical companies take out the golf so I knew a rap and he said hey he said hey you know can you get 50 guys together and I’ll host golf I said yeah I’ll do that sounds fun.

[51:12] So I got 50 guys together and we set a date and then.
Maybe about a month before the event he called and said oh you know my Western area manager he nixed the idea I can’t do that for any more I said well.
I got 50 guys took the day off we think we’re playing golf so anyway I got a Little Dutch but I called some other drug rep you know people I knew and I said hey what am I India they said hey.
Yeah this is horrible it’s horrible be said once try to make something good of it why don’t you just like
try and turn it into a charity event I said charity events anyway I didn’t know much about that but I said yeah okay maybe I’ll try maybe we’ll still have the event but will turn into charity golf tournament and try and raise some money for a local AIDS clinics oh okay.
So I kind of cobbled it together and somehow you know God had his hand in there and we had a great time maybe raise several thousand dollars and we thought.
I think we’re onto something here so anyway I did it again the following year and then I think we raised I don’t know maybe 10 20 thousand dollars.
And one of the guys who came was a banker and he was the husband of one of our ophthalmologist and he said John you know.

[52:15] You should form a 501 c 3 because if you do then corporations that sponsor you they can write that whatever whatever I said pie and I didn’t know nothing about they said hey.

[52:25] Novo books rights this $20 paperback it’ll teach you how to do a 501 c 3 so I literally went to Barnes & Noble I bought this book,
and I just plowed through the pages and add some help from my friend click knock who is an attorney with and up the Attorney General’s office and I said clay
can you kind of helped me on a few of these Pages because I want to go to prison so Clay did some things and sure enough it soon thereafter we had formed a 501 c 3 and in terms of the name serotonin search literally one morning.
It must have been a God thing I woke up yeah they sure do miss George did yeah and you know I was treating a lot of time Family diet read a lot of depression and stuff so I said hey.
We should call this thing serotonin surge Charities because I really don’t like you know charitable things where you feel like oh it’s a burden I have to we should make it fun.
To raise money for good causes right so anyway we filed a serotonin sir and I love the alliteration the S and the S you so we launched it and from its Inception like 22 years ago it’s always been all volunteer.
We don’t have a single paid person on staff there’s no building there’s no nothing and long story short by putting on wonder to event-based fundraising events for year over 22 years we’ve given away.
Over five million dollars wow and it’s just been you know I told my wife I said the best thing about serotonin serves Charities and running an all volunteer organization is that.

[53:50] It puts you in touch with a nicest people on the planet.
Because bad people don’t help you with volunteer things to raise money for things like free clinics breast cancer research and college scholarship they just don’t so we’ve met that nicest people from.
Kaiser Sutter UC Davis Dignity Health epic secure they’re just they’re just I say we’re just a celebration of all the people who said yes and then.
I feel very comfortable you know being a development officer my wife is a tremendous event planner like and we have friends do that so we’ve put on like
for 500 people food wine fashion show and we’ve done five 10K races and a lot of golf terms
it’s just one and then last year but it was pandemic no one to get together so.
We put together a one-hour online program it featured things like a patient of mine has a hit with head women’s tennis coach at UC Davis and he did like a hilarious eight minutes,
video about how to hit a tennis ball and stuff my friend Dave Costco’s on our board he’s a sports medicine doctor from his new home in Ketchum Idaho he sang a song,
beautiful he’s a great musician and then after he did it week later his he and his wife Sue sent us a gigantic check I said Dave you already performed it goes no we just really believe in the cause so anyway last year one our virtue of it we raised over $200,000,
for safe on medical care online in an hour and we had more.

[55:18] Personal donations than ever in the history of our organization is so I said hey you know the pandemic sucks it’s horrible but you know even in a pandemic some people are still hustling.

[55:31] To make progress in the midst of chaos right like.
You know doctors we spend our lives fighting maximum entropy and chaos and disorganization that and I just love doing that with other people it’s all about the relationships and,
finding a handful of people and like you you know you’re just trying to save careers and lives right.

[55:53] And you’re talking all the time on your own to get online do these interviews you have to edit the whole damn thing but you’re passionate about it because you think it makes a difference.

[56:04] So that’s what serotonin surges all the in fact I just emailed some people about.
Hey you know I know it’s a pandemic are we still going to fund this scholarship thing we’ve been doing try and they said of course we’re going to do it so now I’m gonna get the ball rolling on that again I thought they were going to say we have no more money but they said no this is good let’s let’s sponsor the kids going to college again so
you know you just kind of you kind of move forward with the people that want to move forward with you.

[56:28] Well there seems to be a good bit of magic about you you’ve you’ve touched a lot of things that blossomed into something really good and I’ve enjoyed hearing about that,
I appreciate you taking the time to speak with me and at this point what I’m going to do is.
Be quiet for a bit close my Mike and we will have the great honor of hearing dr. John Chuck deliver his personal prescriptions for success.
All right there are three things I’d like to share with people three things that I think might help you enjoy personal success the first is early on in your life you should sit down create some time and space
to sit down and do what’s called a values inventory or you basically Define for yourself what you really value in life
and based on the results of that that self inventory you should begin working on your personal mission statement like who do you want to be in this world what do you want to get done before you die
you know what do you want your Epitaph to be and then work backwards from that and you know this is a very weighty task.

[57:41] And I think that for many people they do this sort of exercise and like some sort of enrichment course or whatever but if you don’t have access to those I highly recommend,
engaging with a life coach.
Or a therapist to do a values inventory I think that it’s time and money well spent.
And I know that dr. cook and his organization they offer those services but you know either use them or somebody else that you know and trust and engage in that really important work because what we know
intuitively and through evidence-based research is that people who have defined their values and who have crafted a personal mission statement.
And then go on to lead a values congruent life.

[58:27] For what you do and what you think reflects your values and what you’re trying to get done with your one brief time in this earth those people have more joy meaning and wellness in their lives.
My second recommendation is struggles and suffering it’s an essential part of the human condition,
so I recommend that you adapt to change and suffering by adopting best practices
so my source of wisdom for this is the great chip Heath is a business school professor at Stanford and in wrote this wonderful book called switch how to change when change is hard and Professor he says.
You know individuals and societies and groups have always faced great challenges and if you look around in the wake of those challenges you will see that some,
individuals or organizations are adapting to the stress better and he calls those people and organizations bright spots.
And he said that your responsibilities in life is to either be a bright spot.

[59:25] Or to identify the bright spots and it just copy their habits and behaviors so once again.

[59:32] We’re all going to face challenges they’re inevitable if you if you aren’t challenge or struggling now you will be in the near future so when that happens to you,
once again adapt to the change by adopting a best practice and that would be very helpful.

[59:48] The last recommendation I have is to invest deeply in the relationships that bring your life join meaning,
so I would recommend you read this book by Richard Swenson a family doctor titled restoring margin to overloaded lives and what dr. Swanson says in the book is that in his clinical practice so many people came to him,
disengage burned-out depressed and he found that.
One of the reasons is because they were looking for wellness join meaning in things and he said Wellness join meaning never come from things they come from relationships.
And he said you have three types of relationships you have relationships with other people and that is called your social life which can include your professional life and your work.
He said you have a relationship with yourself.
Any calls that your emotional life and I’ve run that by many counselors and they say yeah that’s a lovely way to describe your emotional life.
Is your relationship with yourself and the story you tell yourself about yourself.

[1:00:50] And lastly dr. Swanson says that your relationship with God is your spiritual life and for many people the spiritual life.
Is a very strong source of their join meaning I would add to dr. Swanson’s,
recommendations that there’s a fourth type of relationship that brings many of us join meaning and that would be our relationship with nature,
and you might relate to that if you’ve ever been snorkeling in Hawaii or.

[1:01:22] Hiking on the Pacific Crest Trail or whatever sometimes that connection with nature.
Is a supernatural experience that definitely helps you resonate with your own joy and meaning.
And then I’m going to add one bonus recommendation as part of my prescription for success and that is that.

[1:01:42] Your sustainable best effort is by definition.
The best you can do and I think that many of us especially those of us in healthcare who are all the most obsessive compulsive people from the third grade.
Which by the way is abnormal like when we were on the third grade and the teacher offered extra credit we all did that that is not normal.
But that’s kind of who we are the problem is when we carry that Mo past our training years into our long professional careers.
That exact same approach to life which was very adaptive to get you into your profession.
It’s the exact same thing that will destroy you in a long career or Perfection is not really attainable or possible.

[1:02:34] So I think for many of us deep into our careers to reasons were so,
burned out emotionally exhausted or depersonalizing the care or feeling like we haven’t accomplished much.
It’s because we’re hanging on to this obsessive compulsive Behavior.
And belief that you know the only thing that’s good is that which is perfect the great Rachel remin who who has taught generations of Physicians and nurses about joy and meaning she said you know.
As soon as she leaves people in this breathing exercise where she says you know as you take a breath in.
Be grateful you know for for fresh air and the oxygen that it brings you the life-sustaining oxygen but she says as you exhale let go of those habits that no longer serve you well and I think for many of us
one of those habits that no longer serves us well is this belief that were only good enough and we’re only worthy of belonging if we’re perfect.

[1:03:33] And that’s not true your sustainable best effort is by definition the best you can do and it’s really what,
your family and your patience and your community one from you your sustainable best effort.

[1:03:46] So that’s it those that’s my prescription for Success best wishes dr. John Chuck I have to say you’re one of those rare individuals who,
I have a lot to say and it’s all worth listening to and I thank you for sharing with us today before we leave I want to give you an opportunity to tell our audience.

[1:04:07] Anything that you would like to tell us about how to find you and where to find your book so if it’s Twitter handles or email addresses or whatever what would you like to share with us,
what the best place to find out more about the book pearls from the practices of Life a family physicians guide to help you struggle less and Thrive more is to go to John Chuck pearls.
Dot blog spot.com I’m a huge fan of Google’s free blogs which is Blogspot and so John Chuck pearls dot blog spot.com it’ll tell you everything about the book and how to buy it through Amazon
and if you’d like to find out more about the wellness work I’m doing in the world you can go to John Chuck Wellness dot blog spot.com.
And last but not least I would love to hear from you by email and you can reach me at John Chuck one.
The number one at gmail.com John it’s been a great pleasure speaking with you today and I can’t thank you enough for being with us and maybe we have you back sometime it’s been a great conversation.

[1:05:14] Dr. cook my life has been blessed by our time together thank you for doing the important work.
You’re doing in the world I’ve really enjoyed our time together this morning thanks again John.

[1:05:29] Thank you so much for listening with us today.

[1:05:35] Remember you can always get more information about our guests as well as hear them face my rapid fire questions at our patreon site.
And while you’re there you can also subscribe to the podcast give us a rating and hopefully offer suggestions on what you’d like to hear in future episodes.

[1:05:53] Thanks very much to Ryan Jones who composed and performs our theme music for us.
That’s all we have for today so please be sure and fill your prescription for success with my next episode.

[1:06:06] Music.