It's an Inside Job

Beyond Medicine: The Power of Teamwork & Empathy with Dr. Brian Goldman

April 08, 2024 Jason Birkevold Liem Season 5 Episode 15
Beyond Medicine: The Power of Teamwork & Empathy with Dr. Brian Goldman
It's an Inside Job
More Info
It's an Inside Job
Beyond Medicine: The Power of Teamwork & Empathy with Dr. Brian Goldman
Apr 08, 2024 Season 5 Episode 15
Jason Birkevold Liem

In this podcast episode, I spoke with Dr. Brian Goldman, an esteemed emergency physician and prominent figure in Canadian medical broadcasting. Dr. Goldman, known for shows like White Coat Black Art and authoring books on medicine, including "The Power of Teamwork," discussed the vital role of teamwork, kindness, and empathy in healthcare.

He emphasized the significance of fostering collaboration, using checklists, and enhancing communication within medical teams, drawing from his experiences in emergency medicine. Dr. Goldman linked these practices to reducing errors and improving patient outcomes.

Our conversation centered on the inspiration behind his book, which stemmed from aviation's checklist introduction to medicine. He highlighted their impact on patient safety and team dynamics, sharing a poignant story that underscored the dire consequences of poor teamwork and communication in healthcare settings.

Addressing challenges in collaboration and communication among healthcare professionals, he shared insights and research highlighting the importance of teamwork in reducing burnout. We discussed cultural barriers to effective communication and his commitment to prioritising collaboration.

In the latter part, we delved into empathy in leadership, with Dr. Goldman stressing its role in understanding team members' challenges. He outlined actions he takes to foster a healthy team dynamic, including encouraging open communication, normalizing mistakes, and recognising individual contributions.

Dr. Brian Goldman's Contact Info:

teamwork, kindness, empathy, healthcare, checklists, effective communication, cultural shift, collaboration, empathy in leadership, healthy team dynamic, "The Power of Teamwork" book

Support the Show.

Sign up for the weekly IT'S AN INSIDE JOB NEWSLETTER

  • takes 5 seconds to fill out
  • receive a fresh update every Wednesday
It's an Inside Job +
Help us continue making great content for listeners everywhere.
Starting at $3/month
Show Notes Transcript Chapter Markers

In this podcast episode, I spoke with Dr. Brian Goldman, an esteemed emergency physician and prominent figure in Canadian medical broadcasting. Dr. Goldman, known for shows like White Coat Black Art and authoring books on medicine, including "The Power of Teamwork," discussed the vital role of teamwork, kindness, and empathy in healthcare.

He emphasized the significance of fostering collaboration, using checklists, and enhancing communication within medical teams, drawing from his experiences in emergency medicine. Dr. Goldman linked these practices to reducing errors and improving patient outcomes.

Our conversation centered on the inspiration behind his book, which stemmed from aviation's checklist introduction to medicine. He highlighted their impact on patient safety and team dynamics, sharing a poignant story that underscored the dire consequences of poor teamwork and communication in healthcare settings.

Addressing challenges in collaboration and communication among healthcare professionals, he shared insights and research highlighting the importance of teamwork in reducing burnout. We discussed cultural barriers to effective communication and his commitment to prioritising collaboration.

In the latter part, we delved into empathy in leadership, with Dr. Goldman stressing its role in understanding team members' challenges. He outlined actions he takes to foster a healthy team dynamic, including encouraging open communication, normalizing mistakes, and recognising individual contributions.

Dr. Brian Goldman's Contact Info:

teamwork, kindness, empathy, healthcare, checklists, effective communication, cultural shift, collaboration, empathy in leadership, healthy team dynamic, "The Power of Teamwork" book

Support the Show.

Sign up for the weekly IT'S AN INSIDE JOB NEWSLETTER

  • takes 5 seconds to fill out
  • receive a fresh update every Wednesday


[0:00] Music. 

Introducing "It's an Inside Job" podcast

[0:09] Back to It's an Inside Job podcast. I'm your host, Jason Liem.
Now, this podcast is dedicated to helping you to help yourself and others to become more mentally and emotionallyresilient so you can be better at bouncing back from life's inevitable setbacks.
Now, on It's an Inside Job, we decode the science and stories of resilience into practical advice, skills, and strategies thatyou can use to impact your life and those around you.
Now, with that said, let's slip into to the stream.

[0:37] Music. 

Introduction to Dr. Brian Goldman and his accomplishments

[0:45] Well, welcome back to a new week and welcome back to It's an Inside Job.
I'm your host, Jason Lim.
This week, I'm joined by Dr. Brian Goldman, a prominent emergency physician and a revered figure in Canadian medicalbroadcasting.
Now, Dr. Goldman has been the guiding voice behind the award-winning show, White Coat Black Art, revealing thehuman stories within modern medical culture.
In addition to hosting The Dose, a podcast offering smart medical advice, he's also a best-selling author with his latestbook, The Power of Teamwork, How We Can All Work Better Together.
As a veteran ER physician and acclaimed medical reporter for CBC's televisions The Health Show and The National, Dr.
Goldman brings unparalleled insight into the medical world.
His ability to demystify medical jargon and reveal the reality of hospitals and clinics and has earned him the title of CBCRadio 1's House Doctor.
In today's episode, we will delve into the heart of teamwork, kindness, and the empathy in healthcare.
Dr. Goldman will shed light on why teamwork is pivotal, not just in healthcare, but in our daily lives.
So in our discussion today, we'll uncover what led Dr.
Goldman to write his latest book on collaboration, to find the key elements of successful teamwork, and to explore howfostering a collaborative environment The environment benefits us all.
So without further ado, let's slip into the stream.

[2:07] Music. 

[2:22] Start the conversation by you introducing who you are and what you're about.
You know, that's a great question because I don't always know what I'm about.
I tend to be about a lot of things.
But basically, broadly speaking, I'm born and bred in Toronto.
I'm an emergency physician. I went to the University of Toronto's Faculty of Medicine.
I am a staff emergency physician at what used to be called Mount Sinai Hospital, now called Sinai Health System.
Health health care institutions tend to want to keep renaming themselves for whatever reason anyway so they callthemselves sinai health system it's one of the downtown university avenue uh.

[3:02] Hospitals and i've been practicing emergency medicine for decades uh practicing emergency medicine enabled meto write and uh i am a book author i've written a couple of books which you you've already mentioned, Power ofKindness, Power of Teamwork, to name two of them. Those are my two latest books.
And these are all basically, all the books I write tend to be nonfiction, creative nonfiction books that explore aspects ofmedicine, the culture of medicine.
You know, I'm endlessly fascinated with how doctors think.
And I never tell, I never try I try to explain to nurses how they think because they would just say that I'm attacking them.

[3:46] And so I stay in my little niche. So I get inside the heads of physicians because I am one.
In addition to that, I host a couple of radio shows. Well, one's a radio show and the other is a podcast.
The radio show is called White Coat Black Art, which is a strange name.
It is a show about the experience of being a patient or a family member of a patient or a frontline health care professionalin the culture of modern medicine, in modern medicine itself.
And so the kinds of topics we explore are, you know, how do you get cancer care if you don't have a family doctor?
Like, where are you supposed to go if you're an unattached patient?
And why are so many emergency departments in Canada closing for hours or days at a time?
Or, you know, what can nurse practitioners offer? What can physician assistants offer that physicians, you know, if youdon't have enough physicians, those are the kinds of topics that we do and other very deep topics.
You know, we're not a superficial show about health care. If you listen to our show carefully, they're deep dives andthey're really great conversations.
The other show, our sister show is the podcast is called The Dose.
And it's not about sexually transmitted infections, as some of my colleagues say. That's a dose.

[5:05] The dose is basically a quick conversation that gives you a smart take on a practical health problem like how muchsleep do I really need and how do I get more sleep or, What can what can psychedelic drugs offer me that can help mymental health or expand my horizons?

[5:29] And and, you know, they're not doing pap tests anymore.
So so how can somebody at risk of cervical cancer get screened and and all meant to give you information in about 20minutes?
I thought longer take what you might have expected. But there I am.
No, I mean, it sounds like you're a renaissance man, author, doctor.
Radio host, podcast host. So you got a lot going on.
And I think that's why, you know, our mutual friend Jim Gifford connected us and he thought you would be a great guestfor this podcast.
Because as we've spoken earlier, that this podcast focuses on the different stories of resilience, equanimity, how we faceadversity, and the general sense of well-being and how to encourage that.
And, you know, I looked into your book, The Power of Teamwork.

[6:13] And I think that That's that one resonates to me because it's from sort of an ER perspective or a doctor's perspective.
And I read one story in there about a young, young woman who was a mother.
I think this was a couple of decades ago. I can't remember exactly.
But she had lost her life due to it was just going in for I think it was some sort of normal surgery.
But there was a number of professionals in the room. And when I read the story, it kind of really hit home.
You have these people with deep knowledge, deep experience, these doctors.
But something, the ball fell through the cracks there.
And when you talk about teamwork, I mean, we can talk about corporate teamwork.
That's just as important.
But when you're talking about teamwork on the ER floor or on the operations floor, I mean, for me, it even becomes evenmore of a significant topic to explore and to discuss. us.
So I was, maybe we could start, maybe I've jumped ahead a little, but if we could rewind, what is the reason you felt thatyou needed to write the book about teamwork?

The Reason Behind Writing about Teamwork in Healthcare

[7:18] So it's interesting. There's always, Jason, there's always the superficial reason, the pitch.
The pitch came from an editor who was fascinated with something, a relatively new development in health care.
I'm not going to call it an innovation because it was an innovation from aviation.
And that was the checklist in the operating room.
So the idea, you know, the pre-flight checklist, which was borrowed from aviation or given from aviation.

[7:48] Um is is it's basically a list of things that you do you check off and you make sure you've done them before you takeoff because because if you don't then um if you miss a step then uh the plane could be in jeopardy and maybe maybe thethe lives of the of the cabin crew and the passengers and the cockpit crew are all in danger at the same time and and uh thethe whole checklist Checklist, which was kind of promoted by Dr.
Atul Gawande, who wrote The Checklist Manifesto, and he also wrote the bestseller, probably best known for this book,Being Mortal, basically about dying, basically that, you know, we all die and our society tends to want to kind of deny itand run away from it, not look at it.
But anyway, so Atul Gawande brought The the checklist, was one of the people who brought the aviation checklist tomedicine, to the operating room.
The whole idea is that you do exactly the same thing.
You gather everybody with skin in the game, everybody who's going to be operating on a patient, whether it's theanesthetist, the surgeons, the scrub nurses, the circulating nurses, everybody else, all the support staff, and stop, take apause and say, who are we?

[9:03] Let's introduce each other, ourselves to to one another, who's the patient, what's the, you know, what, what, what'sthe, what's wrong with the patient, what's the operation today, what side of the body, because sometimes we get the wrongside, you know, imagine taking off the wrong leg, or taking out the wrong lung, the one that doesn't have the cancer in it,and my editor said, what, can you, can you write a book about teamwork, work?
Can you write a book that kind of reverse engineers that checklist and maybe gives an idea of what the culture that createsthat checklist could offer the rest of the world?
And that was the pitch and not much more than that.
And then I went out and did some research and I realized two things.
First of all, that healthcare does not play nicely on teams, that we tend on In health care, we tend to have a group ofindividuals, not a team.

[10:04] And we all talk teamwork. You know, we all have the phrases, teamwork makes the dream work.
And, you know, we all know that we're supposed to espouse teamwork like we espouse motherhood. But we really don'tunderstand what teams are all about.
And so, if anything, health care has been the late adopter of teamwork.
You know, you said we're not talking about the corporate world.
And, you know, somehow that's less important.
In fact, you know, we are hardwired to want to work in teams, provided our basic needs are met. It's a higher orderfunction.
It's not quite instinctive as it is for a pack of wolves.

[10:46] And yet in healthcare, as you correctly pointed out, the stakes couldn't be higher in healthcare, and yet we don'toperate on teams.

Elaine Bromley's Tragic Case Highlights Lack of Healthcare Teamwork

[10:56] And the reason why I began with that story of Elaine Bromley, who went into hospital for routine sinus surgery andended up with irreversible brain damage in 20 minutes flat, is that three, as you said, there was an anesthetist who wassupposed to be supervising the airway, had trouble establishing an airway, and the oxygen saturation started to drop evenbefore the procedure was begun. done, it was never done actually.
A second anesthetist came in and tried to assist the first one and then the senior ENT, ear, nose and throat surgeon came inand also because they have some airway expertise and the three of them in sequence one at a time was trying to secure theairway and meanwhile the oxygen was at dangerous levels.
This woman had a recognized.

The Importance of Teamwork in Emergency Situations

[11:46] Operative emergency called can't intubate, can't ventilate, or can't intubate, can't oxygenate.
You know, we love our acronyms. That's KECO.
And for which there is an established protocol, and that is to establish a surgical airway, a tracheostomy.
And it could have saved her life, certainly could have saved her brain.
I'm sure at some point, it might have briefly occurred to anesthetists who thought, there's no way this patient's going towake up with a hole in her her throat on my watch when instead she had brain damage.
And what I wanted to do in this book was discuss how teamwork might have saved her life.
And it might have, because it was clear that a lot of the other members of this erstwhile team knew what was going on.
One nurse came in and said, we've secured a bed in the ICU.
This was a patient who was going to have routine surgery and go home in an hour.
Why would I need an ICU for this patient?
So if the surgeon or if one of the anesthetists had said, why did you say that?
What did you see that makes you say that?
Then maybe the nurse would have said, well, I'm looking at the oxygen saturation monitor and it's been dangerously lowfor the last 15 minutes.
And then the anesthetist with that narrow focus that occurs when you're under stress might have widened out and said, oh,well what should we do.

[13:13] Um, and then another nurse says, I brought the surgical airway tray in, you know, all the equipment to do it.
Again, that was another opportunity for the anesthetist to say, or the surgeon to say, what did you see that makes you saythat?
And I talk about how to use, how to, how to bring everybody into the conversation. conversation.
If they were on a team, there would have been a leader.
If there was a team, then there would have been followers and they would have developed situational awareness.
And the team leader would have known who was on the team and would have introduced themselves.

[13:50] And everybody who was a participant on the team would have felt safe to say what they saw to the the bettermentof the patient.
All of those things and others conspired to cost this woman her life, which was the reason why I wanted to tell this storyin the book.
You know, I just, as you said, you know, the healthcare was the last of the sort of branches to adopt the idea of teamwork.
And it seems completely counterintuitive to me. You know, you'd think it'd be the other way around.
But I guess almost a checklist in this case, Because I know you were referring to the KLM flight in Tenerife in the 70swhere it crashed and they created this.
And I understand the checklist is very important.
But in this case, it also sounds like there was obviously power dynamics in the room because doctors tend to be top of thefood chain in this case.
There seems to be, you know, where we can tend to bow to authority or to those more experienced to us sort of as almosta cognitive bias.
And then obviously there's the rank, the role and responsibilities of all those professionals in the room. Yes, the nurses andsuch were hinting towards that.
But I guess the power dynamics in the room sounded like they weren't able to address each other. There wasn't that...

[15:06] The overused term psychological safety, to address each other because of some sort of hierarchy.

Hierarchies and Silos as Barriers to Effective Communication and Teamwork

[15:11] Is this kind of what you were speaking to? Yes.
There's two cultural pieces that I want to say here because there's two things that are interrelated, but they're not quite thesame and they're worth distinguishing for a second.
So the first one is definitely there's hierarchies. And the surprising thing about medical hierarchies is that they are almostas tight as law enforcement and military hierarchies. They're very similar.

[15:40] In fact, we use a lot of the same military kind of slang terminology.
I wrote a book called The Secret Language of Doctors.
Not a particularly successful book because it barely became a Canadian bestseller because early sales were good.
But it was not loved by the medical profession because they felt it was a betrayal of the culture, the culture that perhapsthey're ashamed of and wanted to get rid of.
But the idea of take this up the chain of command, chastising a physician who talks to a nurse, who pulls a nurse aside, orthe nurse who talks to a physician.

[16:20] Instead of going up the chain of command, go up to your nursing department leader and then have them talk to thephysicians.
Positions, as if to say, if you do it the wrong way, you're going to piss them off.
The problem with that is that it doesn't encourage communication.
It discourages communication because it creates the impression that if you did say something and you ran it up the chainof command, it's going to turn into what we in Yiddish call or in Hebrew call a ball of gun, a mess.
It's going to create a mess. So I best not do that.
That's the purpose. Or, you know, If you're going to take this up the chain of command, you must really – you shouldreally mean it.
You should really understand what the repercussions are going to be because the entire nursing – if you make a complaintabout the nurses, they're all going to hate you.
Or if a nurse makes a complaint about the doctors, they're all going to dislike you. They're going to be worried aboutworking with you in the future.
All of that discourages communication. communication.
Also, you know, the idea that the leader in a military hierarchy, now a wise leader accepts feedback, you know, createpsychological safety, as you called it, for everybody to say what they see.
But not every hierarchical leader is wise, they might be into command and control.

[17:39] They might like it as a fetish or they might be so insecure that they think that any kind of chatter coming from themasses, coming from the rank and file, is inherently disruptive.
That somehow it's going to disrupt the orderly progression of the team, even though that's not a team by definition.
It's not a team if everybody's afraid to say what they see.
And, of course, what you mentioned, you mentioned Tenerife, you mentioned KLM, and I have a whole chapter on that,the whole idea that back in the 60s, 70s, and 80s, airplanes were going down not because the technology was so complexbut because of human factors, the most important of which was that everybody with skin in the game didn't feel safe tosay what they saw.
If they did say what they saw, they got their head chopped off.
Sometimes they were fired or they were transferred.

[18:36] But certainly, the commander-in-chief, the captain, didn't listen to them.
And sometimes planes went down because the captain thought they were 1,500 feet above ground.
But the navigator said, no, actually, we're 150 feet above the ground.
And they paid for it because the captain didn't listen to the navigator or the co-pilot.
So, you know, in the case of the airline industry, it was either we change our ways or we give up this, you know, thisaviation industry that we have and, you know, passenger travel and we won't have it.
So they changed it. Now, that also required, Jason, a culture change.
And part of that culture change is that the old style pilots who came from the Second World War had to retire and moveon and give way to a new cohort that was more used to sharing power.
The captain is still in charge, but the hierarchy is a little flatter and a little looser than it used to be.

[19:34] So that is one thing that I want to talk about. The other thing, though, is silos. And I've already hinted at silos.
The idea that nurses don't talk to doctors, doctors don't talk to nurses, that emergency physicians don't communicate withthe internists who see most of our patients.
The internists don't communicate with the surgeons. Nobody communicates with the psychiatrists.
And the idea is that there's a self-reinforcing benefit to creating a silo where we say, these are the characteristics of anemerged physician.
We suffer. We are infinitely resilient. We have a go-to attitude.

[20:14] We know a little bit about everything. We're very insecure that a specialist is going to tell us we don't knowanything, and nobody understands us like we do.
And we have to deal in blood and guts.
We have to tell the family of a patient that they just died and then move on and see the next patient, and that somehow wesuck it up, buttercup.
I've just described some cultural factors which are part of the bonding ritual for emergency physicians.
Physicians internists have theirs radiologists have theirs you know nobody understands this they think we just look atpretty pictures and that and that we sit in our offices nobody understands the pressures that we're under and and all of thishas a self-reinforcing effect but one of the negative effects is that it closes off communication between the differentspecialty groups again to the detriment of the team and the detriment of the patient so let me ask you then you've you'vedefined what a team isn't if we look to the flip side of the coin how would you define what a team.

[21:16] So a team has several characteristics. It starts with individuals who have superpowers that are acknowledged by theleader.

Characteristics of a Successful Team

[21:29] They have defined roles and roles that everybody understands, that they've probably been put into positions tosucceed rather than to fail.
Help um it's it is an environment in which um everybody knows what the goals are because they've had a hand indeveloping the goals the goals are both logical and they are logical not only to the leader or to the elite members of theteam but to each and every member of the team there is safety to say what you see so suggestions are are you knowobservations are accepted they They aren't pushed back, rejected, because that's not what we're supposed to believe here.
You know, we have a great plan here. We're not supposed to believe that the plan could have flaws in it or that it needs tobe adjusted.
They're usually led by someone who knows the overall goals, knows how everybody fits in the overall functioning of theteam, moves people around, knows enough about the team members to know when they are tired, what their likes anddislikes are, what their sensitivities are, when they're having a bad day, when they need a pick-me-up, when they need aday off.
And, you know, this is one of the emotional or aspirational goals of a team.

[22:52] That when they need help, help is offered readily.

[22:58] And when they see that somebody needs help, they offer help readily.
And so, you know, part of that is shaking off your view that if somebody asks you, you know, offers to help you, thatthey're not telling you they think you're a weak member of the team, but they're offering you help.
That's all. Whereas in our culture of medicine, we tend to see an offer of help as a, as an indication that somebody thinks Ican't do my job which which is a very counterproductive attitude the final thing that i want to say about what makes ateam is there's a certain joie de vivre there is a joy there's an ecstasy at times about doing what they do there is a sense ofof team accomplishment we did it and if you never see that then uh you probably don't have a team you know you'reprobably going to have more burnout out, more anger, seething, kind of quiet rage, quiet frustration with how things aregoing, because nothing ever changes.
Nobody ever makes a difference. I don't even know why I bother.
So I'm now sounding, I'm now giving you the patois of a burned out person who doesn't feel as if they're part of a team.
And I will tell you, this is one of the things that I found, I'm not surprised, but I was delighted to see it.
You can look at the literature on the burgeoning levels of burnout amongst frontline healthcare professionals, whetherthey are physicians.

[24:23] Nurses, respiratory therapists, pharmacists, social workers, you name it, the more they perceive that they functionon a true team, the less likely they are to be burned out, which I think is a wonderful observation.
It's something that I teach in all of my classes, and I give lots of workshops on teamwork.
For me, that's such a salient, astute point, because I started this podcast just in sort of as we were coming out of COVID.And...
Some of them I was talking to were frontline workers, you know, paramedics, ambulances, what have you.
And just listening to their stories of how they weren't always appreciated, how they were clocking the hours and notsleeping, the stress and the anxiety, not seeing their families and such.
And I think that was a very intense moment after you wrote the book on communication.

[25:16] Sorry, not on communication, on teamwork, but it's communication is one of those pillars to good teamwork.
How have you found communication has changed? Has it changed sort of at Mount Sinai in itself or when it comes tothose, that teamwork?

Communication Challenges in Stressful Healthcare Environments

[25:32] You know, it's not so much like, you know, one of the things that I, you know, one of the constants of my entirecareer, my entire exploration, ad hoc exploration of the culture of medicine over the last 25 years or so is just howimpervious it is to change.
It's hard to change.
And people need to say in these conversations, oh, it's changing.
Our approach to errors is changing. And it is to some extent.
You know, I had I had an error recently in a hospital and in the hospital, and I was gratified to find that, you know, the thethe hospital was conducting an inquiry and they assured me that it was not a blame exercise.

[26:19] It's not a blame storming exercise. It's it's it's the intent is to is to see if there are lessons that can be learned. Sothere are certainly changes.
As far as communication is concerned, part of this may be that I'm a product of my training.
I'm a product of when I trained.
I am inherently a communicator.
You don't write books and and host radio shows and you are a communicator too you're all about being understood andunderstanding others and trying to understand people on a very very deep level i have very deep and meaningfulconversations with my colleagues one-on-one in the emergency department and you know yes we do communicate youknow i have actually explained you know there are are moments when I've explained my rationale for a decision that I'mmaking to a, to, to a nurse.

[27:16] And see their eyes start to roll. Like they're getting bored.
Why are you telling me you're giving me too much information?
Just tell me what I need to do.
And, and, and, and it's almost as if people don't want communication.
They just want the bottom line. And I, I, you know, Jason, I, there are many reasons for that, but I think one of the reasonsfor that is that we're under this this constant stress and time pressure that kind of makes –.

[27:44] The communication part of teamwork, which is essential, seem as if it is a higher order function that we're onlygoing to get to when we get past this incredible period of stress.
And you haven't been to my emergency department. Certainly a lot of emergency departments in Canada are verystressful these days.
They're stressful environments because of COVID, because 6.5 million Canadians don't have a family doctor.
So if they don't have access to primary care, they either go to a walk-in clinic, an urgent care center, or they go to theemergency department.
And by definition, that means we're seeing more and more unattached patients in the emergency department.

[28:24] We don't have great places for people who have mental health crises.
We don't have great places for people who are homeless and probably need social supports more than they needemergency care.
But the emergency department is the one place that's that's open.
So they go there, particularly on cold, on extremely cold nights.
And, you know, we are dealing with a lack of emergency physicians and to a much greater extent, nurses who are leavingthe profession in droves.
They're retiring, they're quitting at a young age and we are short-staffed in terms of nurses.
So instead of having the usual 20 nurses on, we may have 12 nurses on, which sounds like it's sort of okay, but it's kind ofsubsistence.
It means that nurses are rushing from patient to patient and they barely have time to take breaks.

[29:19] And it's an exhausting kind of shift for them, which reinforces the idea that it's not a pleasant place to work.
So in that context, it is often, you know, communication, you know, kind of, And because we're all feeling this timepressure, you have people in a hurry. Cut to the chase.
Get to the bottom line. Just tell me what you want. I don't have time to listen to this full explanation right now. And I'lltell you something, too.
A part of that, when I'm in that mode where it's all, I'm in a rush and I see that there's nine other patients to see, I'm thephysician in the part of the department where I'm expected to see three or four patients an hour and there's 10 patients tosee.
So that means there's two and a half to three hours of work.
And by, you know, as I move along, I'm going to, in the shift, I'm going to slow down.
I'm going to start having to reassess certain patients. That's going to slow me down further.
And I feel this constant time pressure. And in the middle of that, I might hear two colleagues talk about a hockey gamethey went to or talking about their weekend plans.
And I'm thinking can you have that conversation someplace else because I'm trying to focus on my work I'm under stressand I'm not enjoying the fact that they're feeling relaxed and happy, Imagine that. I'm not happy because they're happy.I'm actually angry because they're happy because I got my work to do and nobody's assisting.

[30:45] And, you know, and we have, you know, we have we have the the internal politics that goes with, for instance,having an excellent trainee who's practically your colleague assigned to certain colleagues and not me.
And, you know, I remember there was a night doctor who shall be nameless.
His nickname was Dr. Grumpy.
They called him Dr. Grumpy because he was always, and he would say, I never get the best residents to work with me.
And, you know, a learner who's in their third year of medical school is going to tax you because they're going to take timefrom you.

Theoretical vs Practical Challenges in Hospital Settings

[31:25] And when you're under stress, they might exacerbate that. But, you know, a resident who's functioning at the levelof a practically an attending physician takes work off of your load and makes and and allows you to experience thatteamwork, that that, you know, that that easing of your cognitive load.
You know, there's no.
No, I find it interesting what you're saying, because, I mean, your book is filled with practical advice, but it can still beconsidered theoretical.
Theoretical because in the theater of the hospital, what you're talking about, the inherent pressure, the inherent stress, Idon't know, maybe even life and death decisions you have to make, or you have to meet so many patients in an hour andsuch.
You can understand that putting a lot of the theory into practice is not practical in a lot of cases, because it sounds like justto get through the day or that particular pressured shift, you need to be transactional.
You need You need to get your point across as clear and concisely as possible.
And there's not really a lot of room for a lot of.

[32:26] Bluff. You know, is that what I'm understanding?
Because, I mean, obviously, you're very salient and articulate in your book, but it sounds like even from your experiencein the hospital under those pressures, it's maybe even a luxury to be able to consider a lot of these elements.
Or have I sort of missed the target here? No, you haven't missed the target.
As I said, the culture is, you know, I'm not going to say it's completely impervious, but it does have a lot of inertia.

[32:57] And changing that culture, you know, there's no question there have been changes.
I believe that there is far too much work, which means far too many opportunities for teamwork for us to pass up.
You know and in the you know i remember when i started working in the emergency department when it was i alone itwas me working a night shift working 12 night shifts a month in a community hospital just north of toronto it's it's calledmckenzie health used to be called york central hospital and and i was the only doctor on duty and and now we have uhyou know now we certainly there are times in the day when we have nurse practitioners when we have physicianassistants assistants, and we have learners.
And when you add it all up, that's a team. And you add to that the nurses who are looking after the patients, theoccupational therapists, the physiotherapists, speech and language pathologists, the specialists that we work with.
And you see you've got the ingredients of a team.

[33:55] And they are more team-oriented, team-spirited than they used to be.
There's no question about that.
There were cultural barriers. The idea that I should be able able to answer every question by myself.
I should know every drug, every drug dosage. I should know every algorithm of every treatment. And, you know, itsounds absurd.
It's certainly absurd today, but it was felt at one point to be doable.
And the idea, like the flip side of that is if I didn't know the answer to those questions, somebody might get sanctimoniouswith me and say, you know, Brian, if you can't read that x-ray, you shouldn't be a doctor.
Or if you can't read that EKG, you shouldn't be a doctor.

[34:34] Well, you know, it's, it's a little more complicated than that.
Um, it may be that you're showing me that EKG when I've got five other things on my mind and I can't fully engage andyou're looking at my eyes, you can see I'm not engaged, but you still flashed it in front of me because that was theexpectation that, that, that I can take on just one more multitask.
So, so, so what we have learned from experience, what I've certainly learned is that functioning in a true team eases mycognitive load and makes me a much, much better physician.
For instance, I have found that when I'm working with a nurse practitioner who is good at collecting findings, at eliciting agood history and getting good clinical findings, that what's available in my brain.

[35:26] In terms of correct diagnoses and potential treatments and how to get out of this situation, who to consult, is thissomebody at risk of dying or do we have time?
Do we have time to kind of slowly figure out what's going on?
All of that is much more available in my brain when I function in a team.
Why wouldn't we want that? Isn't that to the betterment of the patient?
And yet we still get people saying sanctimoniously that, you know, if you can't figure that out by yourself, you shouldn'tbe in that room.
No, no, no. That's not quite especially when we're all sleep deprived.
When, you know, when we when we've got all kinds of pressures, when we may have just had a micro aggression, youknow, we might have received a put down from from from a consultant or from the resident from a consultant resident.
Resident, and now we're supposed to just put that aside and just go see the.

[36:20] Music. 

[36:24] Next patient. You know, it's a little bit more complicated.
In the first part of our conversation, Dr. Goldman highlighted the importance of teamwork in complex endeavors,particularly in healthcare where patient care is intricate.
Encouraging an environment where every team member feels safe to voice observations and concerns is crucial. crucial.
He emphasized the need to embrace uncertainty and to create spaces where diverse opinions are welcomed, which isessential for risk management and continuous quality improvement.
He stressed the crucial need for teams to communicate situational awareness and to recognize team members' strengths,vulnerabilities, and the importance of empathy in leadership roles.
He also emphasized the challenges that hinder effective communication within healthcare settings, citing hierarchicalstructures that discourage open communication. Dr.
Goldman advocated for a cultural shift towards flatter hierarchies to promote better power sharing and improvedcommunication between the different health care professionals.
And this addresses the silos that limit communication between nurses and doctors.
Moreover, the conversation acknowledged the health care industry's need for increased support and appreciation for theseprofessionals.
He also candidly discussed the challenging work environment, highlighting the necessity for better care and respect forthose working in healthcare.

[37:49] And in summary, while Dr. Goldman reiterated the vital role of teamwork in modern medicine due to itscomplexity, he also urged healthcare professionals to value collaboration, illustrating how shared observation andeffective teamwork significantly impact patient outcomes.
Outcomes he also stressed the importance of fostering a culture that encourages dialogue and collective problem solvingwithin the health care settings so now let's slip back into the stream.

[38:16] Music. 

Learning from Mistakes and Overcoming Shame

[38:26] So let me ask you, writing this book, based on your experience, based on your deep knowledge and years ordecades of working as a doctor, what did you learn about yourself when you wrote Teamwork?
What did it highlight about your own strengths and your own blackings or your own areas of improvement?
I learned that now I've had an evolution through my entire career, so I'm not who I was. I had to I had to get past theshame of the errors that I make because I'm human.
And and, you know, I I think that a lot of health professionals harbor some exaggerated feelings of shame.
You know what Brene Brown would refer to as toxic shame. You know, that's the extreme example.
Somebody who who is so shame focused that they almost can't focus on the patient, can't focus on the feelings of thepatient.
They are terrified that their next mistake will prove to their colleagues that they have no business being in medicine andthat they must leave immediately, that that that they that they be that they would be shunned and shown the door.
Door, and in fact they wouldn't even be shown the door, they'd have to find the door themselves because everybody wouldturn their backs on the patient, sorry, on the physician, not on the patient.
That is not interesting, that's a bit of a Freudian slip, but I had to overcome that.

[39:53] And, you know, even today, I recognize my own shame proneness.
But when that happened, and that happened about 15, starting about 15, 20 years ago, it became easier for me to confrontmy own mistakes, to admit them, to model that kind of behavior with my colleagues, and to become a source ofinspiration for my colleagues when they make mistakes.
Mistakes because because we do and and and in spite of the fact that we all harbor this kind of fantasy that we can cleanseourselves of our last mistake and never make another mistake again it's going to happen once that once i was able toverbalize that cut it down to size talk about my mistakes which is the which is one of the fastest ways of getting past yourshame because once you talk about it, you have robbed the shame of its ability to kind of entrap you by, by making youafraid of having your mistakes discovered.
Once you talk about your mistakes, they've been discovered because you've outed them yourself.

[40:56] And when you do that, you know, then, then, then people tend to relate to you, you know, they're, they're, and, andyou're able to function within yourself better.
Once I was able to do that, um, I found that being in a team, it was easier.
It flowed because i was no longer worried about somebody thinking of something that i where i was going to say tomyself brian you should have been able to think about that without having the nurse practitioner tell you about thatdiagnosis so and and and then i saw the advantages of teamwork once i got past the idea that offers of help or suggestionswere a good thing you know and that you know here here's a rule for life if someone throws you a a line you know life ifIf you're in the water drowning and someone throws you a water raft or a life preserver or a rope, take it.
Don't reject it. Good advice, yeah. Good advice. Then breast float.
And certainly I was always a communicator.

[41:59] As I said, I think I provided too much information. And you know what? You find your spots.
You pull people aside. You make sure you use empathy to make sure that you're not, that you have a reasonably goodunderstanding of how you're being perceived.
Because sometimes you may say things that sound like admonishments when you don't intend them to be. They're offersof support, but they sound like you're criticizing.
So you have to be aware of that because in healthcare, I don't know if you know this, we are ultra sensitive to criticism.
That's one of the manifestations of shame.

[42:37] That we think that – and there's nobody – I would put this – I would lay – I would pay a lot of money.
I would make a very sizable bet on this that there are almost no professions more than physicians who are sensitive, ultra-sensitive to criticism.
Criticism that they take criticism personally that this is a personal attack on me on my being on my philosophy of life onon my right to be a colleague on my right to to exist to breathe the same air as you uh and they take it on this on this onthis irrational level irrationally deep level it just it makes no sense but but you know you i i know as a as a broadcaster uhas somebody who has an active account on Twitter, on X, on that cesspool called X these days, how easy it is to offendpeople when you didn't intend to do so.

[43:36] Because what I hear about you, yourself, you said you've evolved.
You're an iterative process, and through experience, you've learned to understand that you've made mistakes, and mistakesare natural, that you felt shame, but by articulating your thoughts and emotions out loud, it allowed you to deal with theshame or to to neutralize the sting of the shame so that would speak to you've learned the ability to show self-compassionfor yourself to show vulnerability but also show the sense that you you're humble enough to as you said from a nursepractitioner in a hierarchy where she she or he may point out something but you don't take offense to that and And thatallows the team to flow.

[44:18] But, you know, this show, the major thing is equanimity and resilience.
And the way you describe the doctors, some of the doctors, or let's just say the culture, let's say the culture itself, youknow, if they're ultra sensitive to criticism and they take it as a personal attack and not about the problem, that wouldsuggest to me a sense of brittleness or fragility in this kind of culture.
Culture. And so you spoke to empathy.
And so maybe this is a good segue into your first book, The Power of Empathy.

The Power of Empathy in Shifting Medical Culture

[44:51] You know, what is the power of empathy and how important is it within teamwork?
I mean, how can we infuse it? As you said, you know, if there's to try to make some sort of mark or try to make some sortof headway in such a, I don't know, in such a strong culture, which is hard to shift, such as the medical, what is the role ofempathy?
Empathy, so first of all, empathy is an essential human characteristic.
It's certainly a higher function.

[45:24] It's essential to teamwork. It's a given for teamwork.
If you can't, it's certainly, it is essential for wise leadership.
I don't think a wise leader can be a wise leader without empathy for team members and self-compassion as well becausethey can't be – otherwise, they're going to have that brittleness.
And in fact, there are lots of people who are leaders who are lousy at teamwork in healthcare.
Care and and uh but but empathy is an essential characteristic and the characteristic i'm talking about is the ability to toimagine what it's like to be someone else to be standing in there where they stand looking at you as they're looking at youand uh and have that inform their actions it may not govern their actions but certainly it should inform their actionsbecause maybe they got to do what they got to do because they're leaders or you know because they have to make makesome tough decisions.
But if they, if they do it, um, without any awareness of what it's like to be you, then they're othering you.
They're othering you. They're treating you as the other, you know, you're, you know, you're, you're not important to me.
You're just, you're just somebody who, who, you know, and, and I can, I can do to you whatever I have to do in whateverway, uh, comes to my mind.
I don't have to work hard at trying to figure out a way to do it.
That would would be more congruent with, with how you might like to receive it.

[46:45] Um, because I, because I got a terrible job to do and you have no idea how tough it is to be a leader.
And if you knew you, you would know that, well, you're gone guy, goodbye, goodbye.
You're fired. Or, you know, I don't, you know, your attitude, you're not your attitude, your, your idea wasn't a very goodidea.
So, so, you know, that, you know, if you, if you have that kind of attitude, then you're going to be inspiring a team thatdoesn't function very well as a team so so it's the it's the glue it is the oxygen of good relationships empathy um it's whatallows you to communicate better it allows you to build strong relationships that endure that endure the human mistakesthat are going to occur because there will be faux pas you know there There will be times when you transgress, when youtransgress a boundary and you didn't know, and I'm not talking about it in terms of the sexual boundary.
Those are verboten, but what we're talking about is saying something that unintentionally offends somebody and then notbeing able to recover from that.

Lack of empathy in high-stress environments

[47:55] Instead of being able to easily apologize and say, you know, I wasn't thinking from your point of view when I saidthat.
You know, that you worked hard on this. I can see that you worked hard on this program and I can imagine you workedhard on this proposal and I shot it down in five seconds.
Like, like, well, we did that before and it didn't work.
And instead of instead of maybe taking the germ of what you said and maybe asking a question of the rest of the group,like the rest of the team, like, what more can we find?
How can we build on this instead of kicking it to the curb, which is what a lot of lousy leaders do, you know, in healthcare?
You know, the way we do it in a meeting is, you know, we say we tried it last year or here's this paper that if you'd onlyread this paper, you would realize what a stupid idea that that was.

[48:41] And and, you know, the problem is that we tend to assume that physicians are noble. noble, they're wonderful andwise, so they must be full of empathy, because empathy is the bedrock of the doctor-patient relationship.
See, I know the patois, I know the language, I know what I'm supposed to be saying, like teamwork makes the dreamwork, but there's a big difference between talking it and actually doing it.
Fortunately, Jason, we are all hardwired, unless we're sociopaths or narcissists or Machiavellians, we are hardwired to bekind and to be empathic, And so things work out, except when we're under stress.
When we're under stress, our primitive instincts, our tendency to other people, you know, because that comes from a veryprimitive reflex that we have, you know, that gave us great survival value a million years ago.
Or 140,000 years ago, if we stepped out of our caves, there was a good chance that we could get killed right away by aneighboring tribe. So it was a good idea to know whether they were, you know, to be able to quickly decide, are you myfriend or my foe?
Do you talk the same way? Do you use the same kind of symbolic language? Do you look the same?
Is your tone of voice threatening?

[49:57] And to make a decision within nanoseconds, friend or foe, that was useful.
Useful, not so useful today because, because, you know, and, and, you know, especially with the, with the politics that aregoing on, you know, the, the, the, the international crises that are going on right now, you're seeing the manifestation ofstress in places far removed from the theater of war.
You're seeing demonstrations with lots of anger, lots of other and going on right now.
And that is a symptom of, of, of a society that's under tremendous stress, you know, Emotional stress, physical stress,security stress, economic stress, housing stress, drugs causing stress.
And as a result, we don't have as much empathy as we should.
We tend to be othering people because we're resorting to our primitive reflexes.
And I have no idea where that's going to go, except I do know that if we could turn the temperature down on the stress….

[50:52] And, you know, I'm going to be showing my true colors. I'm not a populist.

[50:56] I'm a little left of center when it comes to this. I think we need to distribute wealth in a way that gives everybodyopportunity and gives everybody a secure blanket in case they're sick, in case they need a pension, in case they're havingtrouble finding work.
And if we don't, we're just contributing to a stressful world.
Yeah, you know, you made a number of salient points.
I'd just like to backtrack a little and kind of open them up.
I think the latter where you said where there's a lack of empathy, for me, my training is in clinical psychology, clinical andcognitive psychology.
Psychology and i think it's sometimes when there's such overwhelming stress so much overwhelming threats and and thepain we see in others it's a survival mechanism for us to shut things down and just deal in the here and now with ourfamily and friends because globally it's just too much to absorb as a single human being and i i know we need to try to dothat but that's what i see and i'm sure you see that a lot of times also you know before i started working in corporate 20years ago I used to work with trauma.
It wasn't always capital T trauma, but it was trauma.
And we were talking about empathy and the empathy we were taught about was to avoid emotional empathy because wecould drown in that and that could just completely overwhelm us.
But it was more about cold empathy or cognitive empathy, listening to person, understanding their opinion. So they feltlistened, understood and respected.

[52:23] But you had to create a little bit of an emotional distance distance otherwise because emotions for me have alwaysbeen very infectious and you can you walk into a room you see people are sad you're not going to start laughing you're onyou don't know what they're sad about but you pick up the signals and you kind of quiet down right and so I canunderstand because what you're saying is that empathy is so important and you work in a very stressful environment lifeand death in some cases and that a lot of the transactions between between yourself and the other professionals in theoperating room or in the ER, has to sometimes become transactional.
And maybe empathy right then and there is not, there's not room for it.
But I guess part of it is, for me, working with so many teams, I haven't worked with medical teams, but forgive me, butI'm just kind of stretching my experience here, is that maybe it's to set some expectations, some rules of engagement,saying, guys, when we're in there, it's going to be transactional, but please your opinions count speak up if I've missedsomething or other but there's not going to be a lot of empathy we're going to move forward but afterwards we can debriefor whatever but I mean is this some way to embed a culture of empathy by creating expectations before you go intowhatever theater you're going into even though you may not be able to show so much empathy in that that the heat of themoment.

Creating expectations and reducing stress for empathy in healthcare

[53:50] Well, I think there's two ways to answer that, Jason. I think one way is yes.
You know, you certainly creating expectations will be helpful because I think creating expectations or setting expectationsis actually an act of empathy.

[54:06] Because what you're doing is what you're doing. You're a wise leader and you're doing that is that is that you'reimagining what they might be feeling in the next 20 minutes in that stressful environment.
So that's that's that that's an act of empathy. You're putting yourself in their place and saying, be prepared. This is going tohappen.
You're going to find that it's going to be more transactional now.
I think that's actually an act of empathy.
That's one thing. The other thing is you can't eliminate stress in our environment, but you can reduce it.
The system certainly has an obligation, I think, to provide adequate numbers of people.
People um what we're seeing though is is you know the the uh you know when you when you when you when you seethat a rural emergency department is one nurse calling in sick from having to close down that they're on a knife's edge andand that kind of stress you know is is you know if they're already down a nurse and they're and they're working as hard asthey can and now uh the you know the paramedics bring in somebody you know bring in four people from a car accidentthat That might be very quickly more than they can handle. That might be overwhelming.
So we are dealing with overwhelmingly stressful circumstances right now.
And, you know, I think that, you know, your whole thing is talking or having a podcast about personal resilience.

[55:29] I think that what we're seeing in health care is a system-wide lack of resilience.

[55:37] There's not enough tolerance to absenteeism. And when I say tolerance, I don't mean verbal tolerance.
I mean that the system itself is imperiled with each absence.
And as that process accelerates, it's getting worse and worse.
And there are many reasons for that.
I think one of the most important reasons we must face is that I don't think we're paying enough taxes.
At least maybe you are in Norway, but in Canada we aren't. You know, we're talking, you know, we're influenced bywhat's going on in the United States.
And in the United States, the chatter in classes are constantly talking about how they pay too much in taxes. They don't.
You know, they could they could solve their deficit like that with a one percent sales tax and they won't do it.

[56:23] The rich have to be able to accumulate wealth. That's somehow that's the only American dream worth pursuingthese days. That's hierarchically the highest American dream.
The highest marker of success is the freedom to pursue as much wealth as you like, never mind how everybody else isdoing.
And to be earning money at a far greater rate and to have your increase in salary and bonuses be at a rate far greater thanwhat employees have.
Astronomical, yeah. Yeah.
Yeah. So so, you know, it's it's it's so so really it's both setting expectations is important, but reduce the stress and theneverybody's going to actually be more empathic.

The Role of Kindness in Wellbeing and Empathy

[57:11] Yeah, I think that's a very good point you've made because in Norway, we do pay high taxes.
I mean, it's far from a perfect medical system, but I only have the highest respect for the medical system here and howthey take care and the people and such.
And, you know, I think Canada was at the point somewhere like there, but somewhere along the line, something kind ofwas a little off skewed, right?
But that's a different podcast. podcast.
One other, I know I'm just for various respective of your time in your book on empathy, you also talked about kindness.
You know, if we come to back to leadership, back to leading oneself, you yourself said you learned over time to deal withshame, to address the shame and to show more self-compassion.
What is the role of kindness in wellbeing? being you know kindness it's there there are many definitions of kindnessthere's the more banal to kind of be chummy to be you know to uh to offer somebody uh you know uh um a bit ofcomfort.

[58:16] And and you know i think then there's the deeper definition of kindness kindness is is um you know It comes fromthe same word as kinship, my kind versus your kind.
And it's a coming together of two people, self and other, where you begin to recognize parts of yourself and the other.
You could be them and they could be you, but for maybe some different circumstances.
And an act of kindness is more than just empathy.
Empathy is an awareness of somebody else's perspective.

[59:01] An act of kindness is a much more laser-like, brilliant gesture where the person responds with a look ofastonishment. Maybe they even start to cry.

[59:14] And it's almost like you were crawling around inside my head.
How could you have possibly known that that's what I needed at that moment?

[59:25] And it is not – it's a two-hander.
It is it is a gesture it is an extension of something from somebody so it is partly about them feeling the the the need toextend it but it is not simply on their own terms where they're giving you something that they think is terrific because it'salways terrific this is what i give i give a cookie in this moment or i give a gift certificate in this moment and And this iswhat works.
It's not generic. It's personalized at its best.

The Power of Kindness and Personalized Acts of Kindness

[1:00:03] And and it comes almost from telepathy between between the giver and the receiver.
So so, you know, I've used many words to explain it because, you know, I wrote a book I called The Power of Kindness.
And yet I think I don't think there's a really astute definition of it, maybe, you know, but but I've given you some ideas.
Is, but I think what really makes kindness something more than just a generic gift, it's like the difference between, uh,between, um, you know, what you give when you deeply understand somebody and, and, uh, you know, a kind of a, uh,generic expression of sympathy, sorry for your loss, uh, you know, rather than attempting to truly understand what thatloss means for that individual moment person in that, in that time of their lives.

[1:00:53] I think you spoke about a very important triad. I'll just call it a triad, you know, where it's empathy, kindness andteamwork.
And you've talked about an environment that is stressful, that is, it can be brittle, it can be fragile.
And there's, you know, a lot of pressure on people. people and also you mentioned that it's very hard to move such amountain of culture but sometimes what I find is that you can start somewhere and that could be with your team or histeam or her team based on the triad of teamwork and empathy and and kindness and all these other salient points you'vemade what are some specific things that you do I don't know if it's a specific team But what do you do as a doctor on thefloor in the operating room in an intense emergency to create bonding?
Just to, you know, as we come to the conclusion here, what practically and pragmatically do you do to try to break theculture or instill a healthier culture when you're on the floor with your people?

[1:01:59] Uh, I do a few things. Um, one thing I do is I try to model that kind of behavior, um, how I would want to betreated.
Um, I, so I, I, I, I try to take shame out of the game. And one way that I do that is to talk about my own mistakes.
I'm open with them. And I don't just talk about mistakes that I made in my first five years of practice, which I think is atrope that we use to kind of make like we're doing it, pretend we're doing it without actually doing it.
I'm talking about giving of myself by talking about a mistake I made last week.
Um, so that they understand that I'm an organic human being and that, and that even, even with all the collected wisdomthat I have, I, I, you know, I still make mistakes.
Um, and, and I'm prepared to talk about them to give them cover so that they can talk about, about their own mistakes.
So that's one thing that I do. The other thing that I do is, um, I pull them aside.
I look for opportunities to, to talk, and create not only a safe space, but a space where there's time.

[1:03:03] And so that having that conversation with somebody in the midst of a time when I'm winding down from myshift, but they're gearing up, I have to acknowledge that's not a good time to be having that conversation.
So I picked the right time and I try to create the sense that, that, um, you know, an environment where they, they realizeI'm listening to them on a deep level and that they're the only ones I care about at that moment.
And, and I don't care about anybody else at that moment. I care about you.
So, so, you know, I, I, I'm trying to, at the very least, give them space to say what's on their minds. And if they don't wantto, that's okay.
But just to let you know I'm thinking about you. Those are some of the things that I do.
And, you know, sometimes a gesture like a coffee can be helpful.
Or, you know, like we're in the line together at the coffee stand, and I say, I'm buying today, if you don't mind. I'd like tobuy.

Emphasizing Teamwork in the Discussion

[1:04:10] But the other thing, you know, to bring it into the teamwork rubric.

The Pressure to Achieve in Healthcare

[1:04:18] Everybody has at least one superpower something that they do really well that they are dying for which they aredying to be acknowledged and and unfortunately in health care we often tend to use praise to reinforce the idea that youshould aspire to be the smartest to publish the most papers to have the most successes that we recognize as successes andand if you you know I'm sorry, you're going to have to work a little harder if you want to get to that level.
You're not at that level. You're not a gold medalist here in our little group.
And people, as a result, can spend their entire careers never being acknowledged.
Part of my own thing is that I am seldom acknowledged.
I am more often than not, I work on good teams.
I've worked with a number of producers who have produced great successes.

[1:05:19] Um, with me alongside them and they get the award and I didn't get the award.
You know, they get, they get, they get the accolades. You know, I've, I had, I worked with a senior producer on my radioshow who now she said to me, I don't think I would have gotten this better job if it hadn't been for my experience ofworking with you.
So that, that's the reward in and of itself. But I, you know, as I've evolved into more of a mentor, but, uh, but you know,the point is is that everybody has a superpower and, and a wise leader.
What I try to do is acknowledge the superpower that somebody has.

[1:05:52] And, and it's not always kind of the baubles, you know, the, the, the, the trinkets of success, you know, mostpapers published, it might be that this is the person who, uh, comes up with the most obscure has, has more diagnosesavailable in their heads, which means they're more likely to come up with that roulette on that roulette wheel of diagnosesare more likely to come up with an original diagnosis that's more accurate than just the same three diagnoses that wealways make. That's one thing.
There might be another person in the team on the team who is superb at getting along with the most difficult patient or themost difficult family member.
They have this way of being able to disarm them with charm.
Maybe it's by empathizing with them. There's another member of the team who is really good at diffusing minor conflictsbetween consulting services, you know, between the emergency physicians and the internists or the surgeons.

[1:06:50] There is yet another person who is the person that everybody talks to when two people aren't getting along on theteam.
And we are all starving for acknowledgement of what we we do really well.
And I think it's really important to acknowledge that wise leaders do that and they keep everybody engaged in the gamebecause they know.
And when it comes time to say, we did it, we succeeded, they don't just acknowledge the two or three superstars.
They acknowledge everybody and what they did.

Encouraging Critical Thinking and Active Listening

[1:07:24] You know, that's part of the critical thinking. It's not just I like this idea or I hate this idea.
But what do you see in the idea that makes you say that?
And so that you actually have to stop and think and listen.

The Power of Listening and Understanding

[1:07:42] Another superpower is a good listener, somebody who's really, really good at listening and actually hears whatpeople say.
Not only the verbal output, but the nonverbal communication and the emotional tone that went in with it as well. Thoseare some of the things that I try to do.
I don't always succeed because I'm like everybody else. I'm a creature of stress.
If I'm under stress, it gets a little harder.
Well, Brian, thank you very much for your time, sharing your experience, your knowledge and all the practical tips that Ithink go a long way.
Because from the experience of being on the emergency floor, when you're dealing with life and death situations andpressures and stresses that most of us would never face.
I think a lot of the tips and the knowledge you shared today can go a long way for other spheres of life that, you know,whether in the corporate or the education or what have you.

[1:08:32] Music. 

Empathy: Crucial for Effective Leadership and Teamwork

[1:08:42] In the second part of my conversation with Dr. Goleman, empathy emerged as a crucial aspect of effectiveleadership and teamwork.
He stressed the significance of comprehending how leadership choices impact individual team members, highlightingempathy as vital for thriving teamwork, especially in stressful situations, which is inherent on the ER floor.
He also highlighted the close relationship between empathy and kindness, emphasizing how acts of kindness reveal ourshared humanity and our potential connections.

[1:09:14] Reflecting on his role as an ER team leader, Dr. Goldman outlines several actions he takes.
First, openly discussing personal mistakes to normalize errors, creating a secure environment for open communicationand feedback, engaging in small gestures like morning greetings or buying coffee to foster team cohesion that connectionand importantly acknowledging each team member's unique contributions and values he emphasized the importance ofrecognizing their strengths or their superpower and the immense value they bring to the team well folks i hope you pulleda lot from that conversation as much as i did So if any part of this conversation has kindled that curiosity, that intriguewithin your minds, maybe you are a team leader, maybe you are part of a team.
I would highly recommend picking up Dr.
Brian Goldman's book, The Power of Teamwork, How We Can All Work Better Together.
I will be sure to leave the links in the show notes.
And i'd like just to take a moment to thank you personally brian for taking the time to share your thoughts yourexperience your wisdom on the topics of teamwork empathy and kindness for me they are super relevant and i've learnedso much from you so thank you well folks that brings us to a tail end of another show another episode and thank you forallowing me to be part of your week and until the next time we continue this conversation in seven days keep.

[1:10:39] Music. 

Introducing "It's an Inside Job" podcast
Introduction to Dr. Brian Goldman and his accomplishments
The Reason Behind Writing about Teamwork in Healthcare
Elaine Bromley's Tragic Case Highlights Lack of Healthcare Teamwork
The Importance of Teamwork in Emergency Situations
Hierarchies and Silos as Barriers to Effective Communication and Teamwork
Characteristics of a Successful Team
Communication Challenges in Stressful Healthcare Environments
Theoretical vs Practical Challenges in Hospital Settings
Learning from Mistakes and Overcoming Shame
The Power of Empathy in Shifting Medical Culture
Lack of empathy in high-stress environments
Creating expectations and reducing stress for empathy in healthcare
The Role of Kindness in Wellbeing and Empathy
The Power of Kindness and Personalized Acts of Kindness
Emphasizing Teamwork in the Discussion
The Pressure to Achieve in Healthcare
Encouraging Critical Thinking and Active Listening
The Power of Listening and Understanding
Empathy: Crucial for Effective Leadership and Teamwork