EP35 - Culture, conflict and mediation in medicine with Dr. Jeff Stuart

In every operating room, in every ward, in every clinic, and every team meeting, a silent battle brews. Conflict, negotiation, identity. Welcome to the Scalpel and Sword podcast, where I, Dr. Lee Sharma, physician and conflict analyst, Explore the hidden negotiations behind modern medicine. Let's trade burnout for boundaries and learn the art of healing with precision and power.

Hello, my peaceful warriors. Welcome to the Scalpel and Sword Podcast. I'm your host, Dr. Lee Sharma, physician and conflict analyst. And I am so excited to have on the podcast today Dr. Jeff Stuart. Dr. Stewart is the co-founder of RxSolve Conflict. He's an experienced physician executive. He's had leadership roles as private medical group, a medical director, and a board member of multiple surgery centers. He's also had 3 years as chief medical officer of the Washington Healthcare System in Fremont, California. He has 3 decades of leadership in medical practice, and he also has service as a hospital chief medical officer during the pandemic. He has completed mediation training at the Center for Understanding and Conflict in Marin, California, where he also participates in ongoing professional development for mediators. Through the High Conflict Institute in San Diego, California, he has also completed training aimed at managing high-conflict people who blame and disrupt. And he studied professionalism at Vanderbilt Center for Patient Professional Advocacy. We're really going to get into that too, because Dr. Bill Cooper has also been a guest on the show. Currently, he is in the process of becoming an ICF-certified coach through Surgeon Masters based out of San Diego. He's a board-certified anesthesiologist. He also has an MBA from the Wharton School. Dr. Stewart, welcome to the podcast.

Thank you, Lee. It's great to be here. I really look forward to it. I really enjoyed getting introduced to you by our mutual friend Kimberly Best, and I knew we would click with similar interests as many of us that are interested and passionate about these issues are. And so, no, it's been great. I really look forward to our chat. So do I.

And Kimberly Best, who's been just a great friend of the show and has become a personal friend, she shares this passion and belief of how valuable this training is in terms of conflict and conflict resolution. At what point in your career did you find and start to see the importance of studying conflict resolution as a physician?

Well, I think it clearly was not at the beginning, or I would've maybe had less stress over the 30 years. But I think what happened with me is my story, as far as falling into leadership is the way I describe it, which I'm guessing you may have heard that from several physician leaders. It often happens to those of us who appear interested in trying to help others or interested in our group or our setting and somehow have a level of baseline communication skills that draws these kind of jobs or needs to us. But over the, over those many roles, as I evolved to maybe having a little more responsibility and the potential for conflict or inevitable conflicted or different views of a situation arose, I mean, I started to be aware of it and notice it. At first, I was pretty reactive to it, which is what we don't want to be in conflict in general, as you, as we all know.

Right.

But it's interesting because I think I had that maybe 10, 15 years of kind of observing. And I think in retrospect, it's easy to say this, in the back of my mind, I knew there had to be kind of a way or a strategy of managing this. And I think what clicked for me was maybe 15, 20 years, as I said, into my leadership journey, before I'd had some of the larger roles system-wide. You know, I had a situation where I was dealing with a difficult physician, and I was in a medical director role over a facility. And I realized, Every time I had to deal with them was taking too much out of me. And again, it kind of spurred my interest in figuring out there's got to be a better way. First of all, kind of methodically to do this efficiently and as possible. And secondly, to kind of— this is where a lot of my drive came from— making me, the person involved with it, be able to cope better, feel better, and be ready to approach all this in a much more competent way. I'd had some exposure to difficult conversations along the way with a lot of physician leadership training, even in business school, we touched on it. But I think to me, where I really saw the potential benefit of training and bringing this to light, and all of us that are in it know this, really trying to focus talent and attention. I came around the time of the pandemic. With the pandemic, what I found was, even though I thought I had a pretty global view and was empathetic about what was going on in my world as I was thrust into this chief medical officer role. And I'd say the depth and significance of misunderstandings between people based on nothing other than, in many cases, faulty assumptions or feeling they wanted to stay true to their group. And it really— being in a role where I was trying to streamline everybody's efforts in a certain direction, it really became clear to me that most people are just not aware that this is even going on in the background. That's kind of the framework for what we're all dealing with. And, you know, that's when I really started with my colleague, Paul Netterson, who was also a CMO at the time, and we were commiserating or brainstorming, depending on the day, with each other. We kind of coalesced on this communication piece of it and how actually during the pandemic, both of our organizations were very proactive and transparent and intentional really on how we dealt with this. So it's kind of that experience. And then as I exposed myself to some additional training, I'd had some formal mediation training, as you mentioned, and then it kind of really opened this area of interest for me where I saw not just my own ability to maybe help in these situations, but just the potential for some learning for everybody in healthcare that really could move the needle because it's such an emotional conflict. I know listeners to your podcast know that. inevitably conflict laid in. I'm really happy, not that the pandemic happened, but it happened in a way where I was thinking about these things already. And it's really kind of what put me over the top of wanting to dedicate this part of my career to trying to make a difference there.

Oh my gosh, that's so amazing. There's so much I want to talk about in sort of your journey to seeing how valuable this training and how important this topic is. And the first one is that when you initially had that awareness, that there was something that you wanted to work on in this space. It was having a felt personal response to being in a conflict situation, that you actually walked away from that situation feeling, this does not feel good. I don't like this. And I think on your part, that takes such a self-awareness to be able to walk away from that interaction going, I don't like how that felt.

Right.

And that's so powerful. That was an impetus because I think as someone who works in this very, very high-level chief medical officer role, you already had a lot of emotional intelligence to know that this doesn't feel good. And I think that's such a valuable skill. And I know that's something that's helped you so much in terms of doing formal and informal mediation is being able to be your own thermometer in that sense of understanding there's something here. But there's also something else I want to talk about that you mentioned that I think is so important for people asking. why this is such an important topic to address. You kind of talked about the fact that as you were getting into this, especially during the pandemic, there was sort of this underlying hum. There was sort of this baseline level of there's something always here. There's always this potential for conflict. We're not even dealing with that. And unfortunately, we get into the pandemic and then it just blows wide open.

Right.

And so, all of a sudden, all of these things that were sort of very, not quietly in the background, but definitely existing in the background, and we sort of blow through it and we don't acknowledge it, or we have a pizza party and we say it's all going to be okay. And then all of a sudden we get to the pandemic and we can't do that anymore.

Right.

And especially you being in that situation, the fact that you were able to look at all of this and go, this needs to improve. I have the ability and the interest and the willingness to improve it. And you had somebody else that you could talk to. You had a colleague that was in a similar situation that you guys could, as you said, some days it's commiserating and some days it's brainstorming and some days it's creative. But you were literally talking to somebody else that said, I'm having a similar experience and I want to work with it. At what point did you and Paul say, this topic is so important, we need to formalize how we provide these services? And that, I'm sure, is what led you to RxSolve.

Yeah. No, I think it was pretty early into our commiserating slash brainstorming sessions. You know, we kind of coalesced around communication and difficult communication, whether it was His story or my story; it was things we were doing every day, and then kind of thinking back. Yes, we were blessed with a certain level of emotional intelligence and interest in this area, but it was not something we were actively drawing out of ourselves. And we thought about things like why were Paul and I the ones that the CEO or the chief of staff would call to to deal with the worst situations? And it's like okay, can we reverse engineer that to a degree? What was it that we learned along the way, even though it was not so formal, that we could kind of go back and create lessons or perspective or insights for other people. Everybody is going to deal with things a little bit differently, but on a very high level, what struck Paul and I as we were going through this is, again, this need that we somehow were blessed with some skills to be able to do it. We pursued more training and basically done a ton of research and saw how that kind of supercharged what we already had and that there's so much emotion in the hospital. Like one day it just kind of clicked for us that, oh, okay, 'cause this was a little bit of my journey too. Let's see if we can turn this around and make this— doctors are problem solvers. Can we create something or at least a mindset for them that this is— conflict is an inevitable problem and difficult communication in the hospital. Can we relate it to them in that way? And would that open their mind to skill building around solving a problem? Because I think a lot of times it can be a little amorphous, you know, difficult conversations. And I mean, I'm not saying that things like Crucial Conversations, all this great work makes it less amorphous, but especially with physicians, which is kind of what we were drawn to, is that kind of openness for thinking about there's so many other problems to be solved. This is not even something you're thinking of as a problem. So it was pretty early on to our commiserating, and then we kind of evolved to have our own problem-solving approach around. How we can maybe contribute.

One of the things that you talked about just now that I think is such a big part of people who are in this space, and it's a great theme that I'm seeing more and more, is a lot of what people who work in conflict resolution and medicine have to work with is this mindset that conflict is always bad. And the presence of conflict is basically like a fever in the healthcare system. It's like, if there's conflict, then there's something wrong, rather than saying This is something that's not a sign that you're doing something wrong or the system is inherently broken. This is inevitable. We are human beings. And such an important point of what you guys talk about on the website, and I think anybody who's working in this space, is really pivotal information and a very important way to approach it, is that conflict is inevitable. And because it's inevitable, we are going to learn how to work with it. And if we do that, it has the potential to be very productive. How do you help people buy into this process of sort of shifting this mindset with regard to conflict?

Well, first of all is awareness, as I said, and education, I believe, and education in a way that if you understand the overlying nature of a problem and its potential, I think you're much more likely to buy into addressing it. And I think what we tried to— I mean, through stories, right, and through experience, and everybody's lived it, and there's plenty of science and research out there. One thing I really kind of enjoyed was the Patrick Lencioni 5 Dysfunctions of a Team and how the ability to manage conflict is inherently like the base of the triangle of foundation. Here's a great example. We talked about the pandemic.

Yeah.

And there were so many difficult things already going on that weren't being addressed. Now, to some degree, and this kind of ties into your question, I believe, the fact that we had to pull these problems out to the surface and deal with them with people that may not see eye to eye Showed incredible potential for productivity and the best answers. Great example is, you know, the head of pharmacy, the head of ER, the ID doctor, and the head of the lab, and me basically get together and we're creating a testing program. All these people have their own constraints. All these people have their own biases and assumptions about the other, and they all feel very strongly and passionate. So they're gonna lay it out there in this particular situation. If you have— and that's where I feel like— the skill of kind of drawing it out and this concept of mining for conflict, but it was happening anyway because everybody felt like they were defending their entire turf or everybody that was working in their department. Once we met a few times and people learned— because we had to listen to each other because we really didn't know any better than them, and you had to give up something to the domain expert in the lab. I mean, they knew how many lab kits we had, they knew how hard it was to get the lab machine, the ID doctor, she had her expertise, the ER doctor, he was down there, you know, living it. So it was, what was fascinating to me. And again, just as an example, these are the kinds of stories I tell of the potential for it is if everybody had just been quiet and, or just kind of pissed and not said anything, then we would have not come to the conclusions that we came to. Number one, that was more creative because everybody had to go back and forth on kind of aligning. what they thought with reality. And then we had a collaborative buy-in to it. So I think by illustrating stories of success, stories of failure that a lot of physicians are aware of within their own institutions, whether it's 2 high-producing providers that can't get along, have a big divorce. I mean, everything was going so well, nobody can understand what the heck happened.

Mm-hmm.

And I think it takes leadership. And I just wanna go back to a little bit of my time in the pandemic and not just my leadership, but I was very blessed to have a CEO that trusted me and we worked together. And we had, as I said, a very intentional approach to how we were going to communicate. And we were going to enlist that approach and make sure everybody understood what it was. So very— I'd say as far as getting people on board with the concept, I think the stories which yield the potential for it or the stories that show The negative outcomes from it are really important. And ultimately, all these discussions, if we tie it back, even though there's different hierarchies in the hospital, there's different value systems, not necessarily right or wrong, doctors, nurses, techs, I mean, they're just looking at it from a different perspective. Again, going back to COVID, everybody was focused on the pandemic and taking care of the patients. hyperfocused. And I think that is another key aspect of getting people on board is bringing it all back to, we're here to take care of the patients. And if we are able to manage these difficult conversations or even encourage them is what we're— you and I are talking about, we're going to do better and we're going to be better for the patients.

Oh my gosh.

Amen.

There's so many things that you did in this process. And as you're telling these stories, you were talking about your CEO and your working relationship with this person, that you really had to not only trust each other, but your CEO had to trust you with a process. And there's so much to this underlying concept of building trust in a process that I think is so foundational for anybody who works in conflict.

Yeah.

You are not walking in there saying, we're all going to hold hands and hug each other, it's going to be okay. There's so much more to it than that. But you are walking into someone with an objective. I'm reading right now a really great book on boundary spanners that was written by a British politician who saw it in action in the British political system. It's an amazing book. And you walk away from that book kind of feeling like we're all boundary spanners. But one of the things that he talks about is this idea is people who are good at building relationships and bridges have to do that by building trust. And how do you build trust? You build trust by setting some type of objective, some type of promise. I'm going to help us all sit down and we're going to figure out what to do with the number of kits that we have during this pandemic. And you sit down and you say, I think we can, with this process, achieve this. And then you do it. And then people walk away from what may be a very uncomfortable experience. Because I think, and you talk about this on the website, and I really want to get into this, you know, people who are conflict avoiders that are not good at dealing with conflict. And you have somebody who's a conflict avoider who's sitting down in this very uncomfortable process. And you help them work through this process in a, sometimes a relatively structured way. And then they walk out of it and they go, wow. We got a really good outcome. And guess what? The next time you sit down and have a difficult conversation and that person's at the table, they are not only going to trust the process because they've seen it work, they are going to be more willing to bring other people into the process. And this is where we start to see cultural change, is people actually understand how valuable these processes are. I love the fact that on the RxSolve website, You make a differentiation between formal and informal mediation processes. What does an informal mediation process look like?

Well, to me, an informal mediation process is something that's not chronicled on a write-up or an incident report. It's something where, you know, I'll just use myself as an example, just because these are stories I've lived. You know, I may see from being anesthesiologist, medical director in the same operating rooms every day, tension or an issue, even be aware of something behind the scenes between a surgeon and a nurse or a surgeon and tech or a surgeon and another anesthesiologist. To me, informal mediation/informal conflict coaching involves getting together with these people after you're pretty sure that what you're assessing or kind of aware of is happening on the front end in a very informal way. And again, using the skills we in this all doing this kind of work have and showing empathy and respect. attention for these folks individually and then kind of drawing them into a conversation. Because what often happens, as you know, is the power for me of more informal processes. And when I say informal processes, the processes are less formal than sitting down as a mediation or an arbitration, or God forbid, as we go further along, judicial reviews and things like that. But it can still be integrated policy-wise and structure-wise into the conflict resolution system of the hospital or an organization. That's what's really interesting to me. And because you don't see that very much. And again, having a strategic approach to this, if you're able to kind of create sort of the coach model where you have kind of key people and key levels of leadership that have at least— again, they start out with awareness, they're going to have to build. I mean, you can do a lot of skill building, but they're going to have to live it and build these skills. It creates an atmosphere where these kind of informal mediations that I just described kind of happen organically, as you said. And then if somebody sees it, just going back to what you said again, the power of observation and experience is so intense, but it only works if people in the positions, whether it be medical director, CMO, CEO, et cetera, where people are watching how you deal with every interaction, You have to be aware that there's incredible potential here for you to drive how people will react. And I mean, if you're a CEO and you do some informal mediation between a couple of your VPs or director level, the odds are very high, especially the ones that you're going to want to keep in the organization, they're going to go do that with their people. So I think people can learn the skills to do informal conflict coaching, informal mediation. I mean, I think we all have that in us. I mean, it takes some commitment. But I really feel like that those informal processes are wholly underutilized because we haven't intentionally put those out there nor trained people to do it. So I hope that answered your question as far as where we're going with that.

Oh, no, no, absolutely. And that's why I'm so glad when you specifically put that on the site, that's one of the reasons I was so excited for us to talk about that, because there are a couple of things I really want to talk about with what you just said that I think are so cool. The first thing you said, which I think is probably one of the reasons why the two of you, you and Paul, are so good at what you do, is what you just said about everybody having the potential to be a conflict resolver.

Right.

Just having that, I think that one mindset is one of the most amazing things that you can have walking in this space. I believe that every person I work with Can become better at working with conflict. If you just walk through your whole day, no matter what you do in life, but especially if you're working in the sphere of conflict resolution, if you go through your whole day believing that every single person you come in contact with can get better, you're already going to make positive change. You've already set the stage for changing a culture, a healthcare system. You've already set that in motion just by that belief, which that's why makes me so happy when you said that. I love that so much.

No, that is great. One thing I would say, I didn't start out with this level of sort of confidence in dealing with conflict now. And I mean, I talked a little bit about my evolution, but I was clearly conflict avoidant at the beginning, right? So I don't want people to think this guy does this a lot and like, easy for him to say, but not so easy for me to say, because I was exactly where these people were. I think they need to know that, or anybody that's interested in developing their skills. And I've kind of responded under sort of the pressure of being in leadership, knowing I needed these skills. But, you know, the fact that I was able to go from conflict avoidant to what I'd like to think as competent in how I manage conflict, it doesn't inherently change my Thomas-Kilmann conflict assessment, but it does change my ability to manage the situation. And as we've talked about a few times, often on the air, this idea of getting people to a point where they are confident enough at a minimum to respond and not react to something. You're already slowing your brain down. You're already doing some problem solving outside the emotions of your amygdala. And it can be really powerful. I mean, I've heard from other people even that I've coached and otherwise that like sometimes clicks with them and just kind of having that mindset shift can really help, which is more evidence that we can train and improve people.

Absolutely. I'm also before, and my baseline is very conflict avoidant also. So before I started studying conflict resolution, I definitely was that person. And that definitely created in me a lot of professional fear and unhappiness. Going through the process of studying conflict definitely made me more aware, not only of myself and my own, like you said, reactions and how I would not be constructive in a conflict situation. But understanding that as a conflict avoidant person, if I can become somebody that actually can understand how to work with conflict, not only for myself, but for other people, then definitely that gives me hope. If I can do it, then anybody can do it. And I think just having that mindset is amazing. And I love that you articulated that so beautifully.

Thanks.

The other thing I do love about what you're talking about with informal processes, And I think this is a really important part of this conversation, because a lot of times when people talk about conflict resolution and mediation, what do we visualize? We visualize people sitting around in a boardroom, people sitting around at a table, actually going through a formal articulation process or actually writing down a list of shared goals. We think about something that's very structured. And when you start talking about informal processes for conflict, I think the reason why that's such a great thing that you talk about and you delineate and you obviously teach on RxSolve is—

Mm-hmm.

Because that to me is the boots on the ground, day-to-day change that's actually going to make people's lives better and benefit patient care. And I want to circle back to this because this is like the first paragraph on RxSolve is the connection of conflict management and patient safety. When you talk about this on the website, and I want to draw attention to this, this is also the reason why the Joint Commission has specifically in their regs— That there has to be processes within the organization to maintain accreditation that deal with conflict.

Why?

Because conflict and patient care are intimately connected. If you have a team of people, a department, an anesthesia team, a surgery team that is in conflict, by definition, that level of care has potential to go down.

Mm-hmm.

Is that something you're finding people are more aware of? Are you still finding that's something that you have to really educate people about? In terms of how these two are so intimately entwined?

I'd have to say it's logical to most people, but it's not top of mind for most people. But most people, what's top of mind is, you know, the protocol says to do 1, 2, 3. He only wants to do 1 and 2. And, you know, I'm just really angry about that and I'm going to call my supervisor. And that's the reacting, not responding. But I think That's why, you know, in the trainings we've done, we really kind of give some background on conflict in healthcare, sort of the why, which is this is the biggest why, you know, and then the what, as far as, you know, the different dynamics within the hospital. I mean, these are things that any doctor on a medical staff for more than a few years would be aware of if you go through them, but it's not something they're going to put up a slide in their mind and think, oh, these are the 4 or 5 things that are going to drive conflict when I'm treading on one of these. Maybe I should be a little more emotionally aware about, you know, where it's going. So I think that clearly it resonates with people because it just makes so much sense, but it's not, especially when we're feeling in the middle of a conflict, it's not where our brain wants to go immediately. That's why you need to kick it into gear to do something productive. And I think that on top of giving this background in A few trainings we've done, we've done the Thomas-Kilmann assessment, had people kind of guess where they were. And that's always really kind of interesting because it's a mismatch and that's not always, but, and then have them do some scenario-based work where they're playing out of their character within their character. One of the coolest things I ever saw was this first time we tried this and I had some background on the individuals and there's somebody wholly competitive and somebody wholly avoidant. And we made a scenario about whether to pay the GI doctor for call or something. They were playing different roles. And then we had them play opposite roles. For 5 minutes, they stayed in their roles and then they broke into their styles, which is such a cool illustrative thing when you're in that kind of grouping. We could have talked a whole day about scenario-based stuff, because I think it's just the experiential thing is just so important. But it was more that made an impact on them. You know, they kind of stepwise from awareness why this is important, what is being sacrificed here. Again, they're aware of it, but it makes them, you know, think about it, you can see them kind of the wheels moving in their brain. Like, wow, this is my responsibility to be better at this because this is affecting the care of my patients.

Wow. This is so cool. 'Cause I feel like one of the great things about role play, when you actually put people in role play situations, they sort of start to release some personal expectations. They kind of can really embrace and sort of visualize from the outside in. But it's interesting, right? How quickly people will fall back on those patterns. It is who they are. And there's, I think I'm not going to say it right, but it's in the margins of The Glass Menagerie, Tennessee Williams, where he talks about, you really find out who people are in the thundercloud of conflict. That's where you really see what people are. And it's so interesting to me when you put them in scenarios, you put them in role plays and you have them, you know, one of the things I used to do when I would teach martial arts is I would put the kids playing good instructor, bad instructor, and let them sort of play off of that. And even though they were children, they're still— their styles and their personalities would inevitably come out. And, you know, at a certain point, you just can't hide who you are when you get in that situation. And I think raising the awareness of who people naturally can be and their tendencies is so powerful. And that's why I think role play is so cool. You talk about on the website, the high conflict physician or the high conflict personality. And I know after having done the work with Vanderbilt, with the Center for Patient Professional, one of the things that I did very early on, this was long before I did my master's, you know, Vanderbilt had a program where they would actually do peer coaching that you would spend a day and they would train you and you would do interventions with high-risk physicians on staff. And all you did would be to go in and sit with them and say, these are the list of patient complaints against you. That's all you do is sit there. I was one of the first doctors in that program.

Oh wow.

And this was long before I did any of this. And so when Bill was on the show, it's like, I was one of your first doctors. And he was so excited about that. But one of the things I told him was I only did one intervention with a physician through that program, but I'm still friends with that doctor. Like he and I still work together. He is an ER doc and we still work together. But it was amazing to me to see how just raising somebody's awareness To the fact that your conflict style and the way you approach and the way you interact is having a negative effect on the people that you work with. Do you find that also rings true for you in your work with RxSolve?

Yes, I think in the vast majority, and I think going back to the Vanderbilt data, it's like, as you go up that pyramid, it's like less than 2% that really end up with ultimate kind of dismissal or whatever. And Vanderbilt does it well. It's creating awareness. Either way, I really like the Vanderbilt approach with the cup of coffee and progressive. I think their approach is very much gold standard for how you actually communicate these type of things. So that's going to work in many situations. I think it's not a total solution to the day-to-day conflicts we have, but as far as difficult physicians, it is. What we have somehow developed a little niche around is the truly disruptive physician, which takes that A step further. And again, I really don't even love using that term because I think it puts too much of the onus on the physician. I know we all know what we're talking about with respect to that. So there is going to be this, you know, while the Vanderbilt approach is excellent, will work well in the vast majority of cases, and I found that from my CMO time, there are either unique, special, very high-end conflicts or people in that realm. Digging we've done is that those people you got to treat a little bit differently because they're not going to respond to what you just described. Awareness is just not going to do it. Sometimes awareness can be counterproductive. These folks, you almost got to just focus on future behaviors, and it takes more time. Often these are people in this realm that are very important to the hospital, which is how we end up getting involved. So there is the different approach with those people, but I'd say in the vast majority of physicians, as you Awareness is a very powerful first step. They have blinders on. It's all like, "I need these ten things done for my patient. If you're not going to do it right now, I'm going to yell at you so you can do it right now." They're not consciously thinking that, but that's what the blinders are doing. I think creating awareness with them is really good. I mean, even a better path would be some opportunity to really kind of learn more about themselves. As we touched on here, I think that's been a huge part of my journey as far as. Doing this work. And I think most of us in this work have probably learned as much about themselves as they have about others in doing it. Yeah.

One of the things that we were talking about before we started the podcast, we were talking about your daughter, that you have a daughter who's in medical school. And my dad was a general surgeon and my dad grew up in the '60s. He trained at Carolina back in the day when you stood up when your chairman entered the room, you know, it was a different era. But where my dad trained, it was really kind of inculcated in them that they were surgeons, but they were also gentlemen. And as a result, when I started my residency training, when I started medical school and internship, and I started really witnessing firsthand some of the really aggressive behaviors that some people had in the operating room and would start to share some of those stories with my dad. And he told me, he said, okay, I want you to hear me. If you ever act like that in an operating room, if I ever found out that you threw something or yelled at somebody, I will yell at you. And if I have passed and if I am in heaven, I will come back and I will haunt you. You will not act that way in an operating room.

Yeah.

And so my behavior as a surgeon was very much guided by what my father said. And so I think going into being in an operating room, for me, I was my dad's always watching. I'm never going to act that way. Now, I think it's also very interesting because I don't think fundamentally that's a good way to approach because you still need to— if you need something, you still need to verbalize it in such a way that you can help to mobilize your team. You're not going to sit there and be a doormat. Your patient needs something. You are going to communicate it in such a way. And I feel like that's one of the things that having an education of conflict resolution helped me as a clinician is that it wasn't just I was afraid of embarrassing my parents.

Oh, yeah.

It was understanding that there was a way to accomplish things that did not involve throwing things and screaming at staff, that there was a way to do this in such a way that I was able to meet the needs of my patient and maintain the intactness of my team.

Mm-hmm.

How are you passing on, because you have this wealth of knowledge now, this, all the experience that you have, and now you have a daughter that's going through this process. How are you sharing your knowledge with her? Because inevitably she's going to be in these situations as well.

Yes. Well, I'm very blessed by both my daughters. My medical school daughter and I have a pretty unique relationship as far as how we communicate, I think, and the openness. And she's been observing me at work since high school, working at my facility. And so she's seen me in the operating room. She's seen how I deal with others. She's seen how others react to me. So I've been really lucky to be able to have her observe me day to day and how I manage things. And she's seen some stuff go down in the operating room.

Yeah.

And, you know, with respect to her and all the young doctors, I mean, this is really one of my driving forces because You know, the thing that we know how hard it is to be a doctor, but like doctors usually don't talk about it with each other because it's just like you're a doctor, so it's going to be hard. And this obviously relates to burnout, et cetera, as well. There's been much more awareness and ability to speak up about burnout and developing resilience, and that's all great. But the systematic view of things as far as how are we really— we can build resilience all day, as you know, but There need to be systemic changes. We can't allow people to be throwing things in the operating room. Given some level of training or emotional intelligence, or worst case, some sort of repercussions. Healthcare is so hard for all of us. So I don't want to say just physicians, but if we can embed some of this thinking day to day with everybody, we can kind of— things are so amped up generally. And then, as you know, in an operating room, sometimes they spike. Again, if we can just tamp down the baseline and, you know, it's funny, she's heard me say this a few times when I'm not going to be able to do a full like training session with somebody who's having issues. I like to just pick off like a couple of things to tell them. And I remember when I was first listening to a lot of conflict stuff a few years ago, I came across Simon Good, who's this Australian, I believe, mediator. And I just have the first podcast I heard from him had these 3 cool things that's good for anybody that I started using as well. And it's in other literature, but Don't take things personally, keep your composure, and always maintain 51%. And what, obviously the first 2 are self-explanatory. And if you focus on doing those 2 things, you'll respond to things much better. And then the 51% thing is really just about never giving up on somebody and just kind of keeping going. But I only bring that particular one up because like, she's heard me say things like this to other people. She knows how important this work is to me.

Yeah.

I don't know if I collaborate with her on this work, but we certainly talk about it a lot. And as a matter of fact, just a shameless plug, she and I are doing a little podcast about her journey through medical school where we talk about a lot of things, trying to, that she wanted to talk about that are outside. So my daughter and I, we're pretty darn connected and like-minded as far as, you know, empathetic capabilities, which for both of us have been positive and a negative. And we work together to manage. She helps me manage mine, so it's pretty cool that my first-year medical student can help take care of her dad already.

I love that. That's such a beautiful relationship that you have. And yeah, definitely. What's the name of the podcast?

It's called Dr. Stewart Squared. Dr. Stewart with a little squared.

I love it. It's so cute.

It's definitely not competition for this one, but you know, it's been very fun to do and. Really just trying to get, again, just some awareness of younger people going to med school, the kind of things they may deal with, and a venue to talk about it, which is for all of these kind of things we're really trying to help people on the ground level. Just talking about it, being aware of it, and knowing where to go to get information are really awesome things to provide.

Absolutely. Jeff, we are going to put the link to your podcast for Dr. Stewart Squared, but we're also going to put the link for Rx Solve.

I didn't mean to bring that. I wasn't even planning on bringing that up.

No, no, no, no, no, no. I'm so glad you did. I'm so glad you did. Because this is how I believe, because even like the way that you're sharing this journey with your daughter, but you also, obviously you guys are so close that, you know, she's able to share with you and through you what her journey's like. And I think about when I was in school, you know, obviously this was the '80s and early '90s and we didn't have this kind of media. If it wasn't for my parents and when I would tell them, you know, those days, I really don't know if I can keep going. I really don't know if I can keep doing this. This is really hard. And if I didn't have parents who were able to say to me, we've been through it, you'll be okay, you will be fine, this is what you're going to do to survive. And I was very blessed to have them, but there are so many people who aren't able— they don't have that kind of support system. And so in a really real way, you and your daughter providing that support system for other people. So yes, we want as many people, medical students, to know about this as possible. So I know I'm so glad you said it. Everybody check out RxSolve. We will have the link in the show notes. Jeff, if people wanted to reach out to you and if they had questions, especially about the work that you do and the services you have, what's the easiest way for them to find you?

It's probably on the website, my email, but it's jeff, just J-E-F-F at RxSolveConflict.com. And that is my email. And I Would be happy to talk to anybody. And no, this is just such a great opportunity. I want to thank you and the ability again to try to let people know that just living conflicted in the hospital is something we need to not accept as going forward. The conflict, we have no choice, it's happening. But how we manage it and support each other and the community I've met, like Lee and many others that are really spending time working on this, there's a lot of us. with a lot of perspective that really want to help. And hopefully that provides some support to younger physicians especially, but everybody working in healthcare.

Absolutely. Jeff, thank you so much for being here. This has been fantastic. I really appreciate it.

All right. Thank you so much, Lee. That's great. Good luck.

Thank you. And for all of you who have joined us today on The Scalpel and Sword, my peaceful warriors, until next time, Every episode is an invitation to speak, to negotiate, to choose.

I'm Dr. Lee Sharma. Join the dialogue by subscribing to Scalpel and Sword. Until next time, peaceful warriors, may your choices be sharp and your voice be even sharper.

Thank you, Dr. Sharma.

This podcast is a reflection of lived experience and research in conflict resolution. The Scalpel and Sword is not intended as medical or legal guidance. For personal matters, please consult a qualified professional.