EP39 - Collaboration and Teamwork Caring for Patients with Functional Decline -Dr. Kenneth Lam

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 beyond modern medicine. Let's trade burnout for boundaries and learn the art of healing with precision and power.

Hello, my peaceful warriors, and welcome to the Scalpel and Sword podcast. I am your host, Dr. Lee Sharma, physician and conflict analyst, and I am so excited to have on the podcast today, Dr. Kenneth Lam. Dr. Lam has an undergraduate degree at Stanford University. He did graduate school at the University of California in San Francisco. He did his medical school at the University of Western Ontario, and he did his residency and fellowship in internal medicine and geriatric medicine at the University of Toronto. And he's currently on faculty at the University of Colorado. Say that— I'm not going to say it right.

Anschutz. Anschutz.

Thank you. I'm glad you said it because I didn't want to slaughter it. Dr. Lam, welcome to the show.

Thanks so much for having me.

So the reason I reached out to you, and this is one of the things I have loved about doing the podcast, is I will cold reach out to people who do not know who I am after reading something really cool that they've written. And it's like, hi, I have a podcast. Would you like to be on the show? And Dr. Lam, you were so gracious and generous, and I know your schedule is incredibly busy. And when I read this article that you, and it's actually an editorial along with the article that was published in the Journal of the American Medical Association. And the editorial is entitled, What Role Do Medical Professionals Have Supporting Caregivers? What was the impetus for you to write this?

I've been thinking about this idea for some time now. I'm personally very interested in how people get caregiving of all sorts, whether it's paid or unpaid. And I think that it's very much related to whether or not older adults are able to stay healthy or not. Just credit to all the work that caregivers are doing. And at the same time, I think my interest in the field has also made me really aware that as a medical profession, it's not really clear that we understand very much about caregiving overall. And it's been a long or a relatively short career. Hopefully it will be a long career exploring some of this discrepancy and trying to understand why we have this strange paradox where family members come to us asking, well, what am I supposed to do? And how do I help my loved one? Or is it me who should be helping my loved one? And then a healthcare profession, especially the doctors who basically say, I don't know, darned if I know, right? That's not really what I went to med school for. So, you know, I say that as a stereotype. There are obviously people who are very interested in it, such as myself, and have strong opinions and thoughts and would love to do more research on caregiving overall. But when I read this article, I felt like this was an opportune time. to bring this up because the article was specifically hypothesizing that better teamwork between medical professionals and caregivers, and by medical professionals, we specifically mean doctors, physical therapists, and nurses in the study that, yeah, do we actually need teamwork? And I realize there's probably a couple of different perspectives that are out there that aren't being addressed in this article at all.

I love the fact, and we talked about this a little bit before we went on the mic about the fact that this is a question that you are actively exploring. And the reason why I was so delighted to read this is because I think on some level there's sort of this, of course teamwork improves caregiving. Of course this is going to help us. I mean, it seems like this would be sort of a slam dunk question, right? And yet there's so many specific ways we can measure teamwork. This is not something we can actually just sort of look. It's like, oh, this is a good team. There's actually ways we can quantify it. And this is one of the things that you brought up in your editorial is the idea of these studies using something called like a relational coordination index. What about that concept, this idea of having something that might actually measure teamwork, was interesting to you?

Yeah, it intrigued me because I hadn't heard of the relational coordination index, and my suspicion is that it's not really mainstream in medicine. This was one of the first applications of it. More popular, I think when it is used in medicine, it's usually in very clear teams, something like an operating room or air pilots and air crew, where they're clearly supposed to be working together on a shared task. And as I started to dive deeper into what this RCI was, I went to try and figure out what the questions were exactly in the RCI. And if I could summarize it just briefly, the RCI was asking questions largely around whether or not people were available, they felt like they could communicate freely with one another, and the extent to which they felt like they were collaborating on. the same project. And once I read those measures, I began to ask this question. I'm not sure whether or not all physicians agree that they should be on a caregiving team. I can understand, and I've sensed it, part of the reason why I'm interested in the topic, that caregivers want their physicians to do more. But when I've brought that up to my colleagues, many of them just say like, that's not my job. That's someone else's job. That's the case manager's job. Or, you know, I don't do caregiving. And so that discrepancy I knew was out there. And so I felt like. To understand this paper, we needed to put it in the context, especially since it's published in JAMA Network Open, which is for physicians and the clinical space. We needed to put it in the context of what the current debate was and a broader question as to whether or not teamwork matters or it doesn't matter. And also teamwork for what?

What is the focus and what is the purpose? Yeah. Why do we even care?

An airline crew is trying to fly the plane together and they're all hired to fly said plane together. And so it makes sense that you need a high RCI amongst the So that they know and they have a sitrep, they have an understanding of everything going on in the plane. I don't know if caregivers and healthcare professionals feel that way about the caregiving for an older person, right? It's a very different experience. And I know this, you know, when I switch between being a caregiver for my family members and also to being a physician. That like, as a physician, I have a record, I'm keeping track of the medical issues, and I'm trying to get a sense and a gestalt as to how things have been going, and I'm trying to be supportive. But my overall view of it is that I'm a drop in the bucket. Like main bulk of the caregiving is happening by the caregiver hours of a week. You know, several, it's a part-time, if not a full-time or more job. And then you switch gears and you're like, yeah, I saw 20 patients today. And that's why part of me was like, is this really a team? And is the goal higher teamwork? I think that's still an open question. And I framed it as such in the editorial. We can find out because if there was a relationship between higher levels of teamwork and outcomes, then that would suggest that it does matter. But right now the paper was just describing it and I wanted to put it in context of this broader question of, I don't know whether or not everyone agrees that we should be on the same team.

Yeah, absolutely. I love how you talked about, this is a question, is being a better team necessarily going to be associated with a better outcome or a better perception of the caregiver feeling like that we are more involved? in this patient's progress. The author, the originator of the Relational Coordination Index is Dr. Jodi Goodell, and she is on faculty at Brandeis University in their Heller School of Social Policy. And Brandeis and Heller have a program called the Physician Foundation Leadership Institute, PFLI. Their first cohort started in September of 2025, and I'm actually one of the 26 physicians in this cohort. And so we actually got a lecture and about a 3-hour program with Dr. Goodell back in December.

Mm-hmm.

So this was really exciting for me when I read this because I was like, oh snap. Okay. Let's look at this. Because one of the things that Dr. Gaddell talks about in some of her early research is that they actually published that the relational coordination index, when it is high, does seem to have a correlation with improved clinical outcomes. But when you read this, what's fascinating is this was done on 9 patients. This was 9 patients postoperatively after having knee replacements.

Yeah.

So this was a very small group. But one of the things I think that was interesting is that she encouraged the people who were kind of measuring this RCI to actually map out the different relationships of all the people involved in the patient's care. And it's not just the surgeon. It's not just the nurse. You know, there's 10 different people involved in this. It's the social worker. It's the medical tech. It's the person at the front desk who's answering the phone calls. When you look at the concept of this team in RCI, this is a very large group of people. And when you start mapping out these relationships, you start to see, okay, well, this is a much bigger clinical picture than what I realized. Is this really going to improve care? If we look at objective measures like length of stay, decreased infections, less postoperative pain, are all of these things going to be improved by improving teamwork? But I also come back to this, and this is one of the questions I want to get into. We are brought up in our educational system as doctors to be in silos. We are very autonomous. You know, when we're coming through the educational process, teamwork is not taught. It's not really something we're encouraged to do. You know, you're talking about making grades and doing well on your boards and getting into the best medical school and getting into the best fellowship or residency that you can get into. And then all of a sudden we're talking about this concept of teamwork as possibly influencing caregiver perception or even quality of care. Is the concept of teamwork, was that something that you had ever encountered previously, or was this something that you just encountered when you were reading these articles?

Well, if you're asking me, at least personally, I've been interested in it for some time. I think my med school project was around leadership, which you can't separate from teamwork either. I'd surveyed my classmates actually to ask them how they define leadership. If I remember, this is off the cuff, but this is now probably 10 years ago, more than 10 years. I don't remember what the result was. If I recall correctly, some people saw it as taking charge and making the decision, and other people saw it as bringing people together. And then others saw it as not taking charge, but having expertise. It was mostly framed as medical expertise. So a very, very different vision of leadership than the business world. Which is probably a little bit more like what you attended at the Brandeis setting. I think if, and you correct me if I'm wrong, because you were at the session with the person who created the RCI, but my understanding of the RCI is that it's trying to quantify that sense that you get when people are working together really, really well, right? People have a shared mental model of what it is that we are working towards and what we are working on. And they have an understanding of what each person does and how it all fits together.

Yeah.

And it's a great experience. I mean, like you get that in these high-functioning ORs, high-functioning inpatient medical teams, et cetera, et cetera, high-functioning outpatient clinics. And it just struck me that you also need to have the people who are on the team, they all have a role in making certain things happen. And it wasn't clear to me that's something that exists for caregiving. The reason why I titled the article the way that I did was it wasn't clear to me that the medical professionals actually knew. What the caregivers were looking for. I do follow this literature quite closely because it's one of these things that I'm very interested in. And you'll see this discrepancy in literature spanning probably 10 or 20 years. It's very, very clear that caregivers want medical professionals to help them out with these things. And I tried to explain why. It's obvious, right? For example, I'm a geriatrician. I might diagnose something like dementia. So people are like, well, you see people with dementia, surely you must know about A little bit, even by proxy, what it's like to provide care for these people. And the flip side is, well, no, there's plenty of people who diagnose dementia and think about dementia and try and treat dementia or manage dementia. And all they know about is like, well, what medication do you give for it? And these other aspects that, you know, the geriatricians, we do really care about of function, of what makes for quality of life in this setting, that that's something that we explore, but that is optional to explore. In which case, if as a professional class, it's not clear that we are the experts on caregiving, do we even belong on the team? And again, that's why I tried to highlight that is what is so confusing to people. We're talking across one another where patients are coming to you and they're saying, well, I didn't even know what dementia was. Can't you educate me? Can't you explain what it's like? Then you come up with all these terms. You're like, well, there's amyloid plaque and there's like neurofibrillary tangles, but like, that's not what they want. That's, that's not what they mean when they said, I want help with this. And then they have this very strange experience where then they go, they say, well, you know, the doctor says, sorry, I can't help. And then they go and they start looking at assisted living facilities with family. They do it on their own accord. And then they go to the facility and they say, actually, I need a doctor's note. And that's also very puzzling because now all of a sudden you go see this facility and they're coming back to you and they're saying, no, we'll tell them, ask the doctor. And the doctor's like, well, actually, I don't actually know how to fill out this form. So you get this very strange situation where I understand desire, and I actually believe that it's important that doctors do get involved in this and understand this role that we play in society. Yet that's not part of our education, and it's not clear to me that an uninformed team member, which is kind of where it all gets to, an uninformed team member is really gonna lead to a better outcome at all, right? Like they might be very much in line, communicate often, make themselves available, but if they don't know what they're doing.

Yeah.

Then, you know, where are we going with this? That's the reason why I wanted to highlight, I think there's a broadness around who has this expertise in American society now. And write this editorial also to humbly recognize that there are probably other people who know this very, very, very well, right? There are occupational therapists who specialize very specifically in like dementia behavior management, right? And like, of course you would want to be on team with that person. But does that mean that all occupational therapists, just by virtue of being an occupational therapist, knows it? Probably not. And so, you know, if you were to frame that all the way back into how you'd construct this research, you ask whether or not that variable of healthcare professional is really the way you want to be defining who you would want to be on that team. Because, you know, suppose the outcome is negative. Believe that if you have good teamwork between a team of caregivers, it does lead to a better outcome. I just don't know whether or not I would classify a nurse, a physical therapist, or a doctor as categorically being able to help with caregiving.

Oh, there's so much I wanna talk to you about this, 'cause I, I love this discussion. 'Cause you bring up a really important point. It's not so much the fact that if the physician is on the team, it's the identity of the physician on the team. What are they really acting as? When they're standing in that role on the team.

Right.

They are acting, I mean, by trade, by training, we are doctors. We are trained in medicine. We are trained to understand pathophysiology and pathology and how we approach treatment of these medical issues. But in terms of being a caregiver educator, that's not necessarily part of our identity. So as such, is this measure of teamwork, is this RCI really applicable to putting this person in this role? Because we're not talking about length of stay with arthroscopy. We're literally talking about providing an educational basis for a family that needs to understand how to take care of their loved one with dementia. So this is a completely different question. And this is one of the interesting things I think about what you wrote and why I was so fascinated by it, because you asked that question and in terms of professionally, you know, one of the things that you talked about in your Article is that as professionals, as a natural part of our identity, there's a certain amount of detachment when we're wondering whether or not this would be, or the RCI adequately defines how effective we will be with our caregivers. The fact that we are taught to have some of that detachment and that's part of our professional identity plays into that. So some of that is actually measured by the RCI.

It is because they ask the caregivers, is the physician available? And, you know, once you've gone into medical practice and you realize like, oh wow, you get, you're like, you can recognize simultaneously it's a lot to care for an older person. And you might also be caring for your own older person, you know, in your own life. And then you're dealing with that across several patients and you're like, I, by design, make myself not that available. I structured my life in a way where I do inpatient practice and I actually make myself very available to patients when I'm on service. But then I let the system handle the rest where I say, when I am no longer on service, I don't fill that role. And so I can't be available. And so, you know, you kind of wonder this question. And I was very mindful cuz they're colleagues, the researchers who did the study. I use their survey for other research, so I respect them greatly.

Right.

But I dawned on they are not physicians. And so some of the stuff that's part of our hidden curriculum really might not be apparent to them because it doesn't exist very clearly in writing. Or, you know, if you're a PhD trying to study caregiving, Where would you get this perspective from the physicians of how we encounter this regularly and we are challenged by it? I remember very clearly when I was a med student, I was staying late talking to a patient till like 8:00 PM trying to learn about their life and figure out what it was. And you know, your attendings are like, go home, you know, move on with your own life. And that makes so much sense to me now. We all go through this process where you ask like, if I just gave it a little bit more, could I help the situation more?

Yeah.

And then also it's when you ask yourself, well, how can I make that process of helping people efficient? So this is where all of that comes up. Whereas, you know, you ask this question, it's like, is the RCI the right tool if you're trying to improve the experience of caregivers? I believe absolutely we want people to get education. I feel very passionately, actually, as a geriatrician, I know lots of these tricks of like, how do you communicate with people with dementia? How do you deal with behaviors? What tools can you buy? So, you know, general disability is a topic that I'm very passionate about. I don't know if I expect all physicians to be good at it. And so when you then put this in a national survey, I just had to ask, what is the goal of this study? And if there's a negative result, how would you understand that while also preserving the thing that I think is really at the core of this is that caregivers and patients are going through this phase of life. They look at doctors as experts. I think we have a role to fill. But I think that the training that we would need, it will take years for us to fill that role. And I think we still don't fully understand what it is that we're dealing with because I don't think anyone understands it. I think historically families just did it, whatever it was. And only now as the aging population grows, we're realizing, no, there's a scale to this that we actually are not well equipped. to turn into a science or a profession that we're still figuring it out and we're still figuring out who the experts are. And I actually, I wrote it with a colleague who's a PhD, who's also a caregiver, Dr. Channing Tate, who was a caregiver for her own mother with dementia. And I specifically brought her on because I wanted to talk with her to ask, do you agree with this? That like, you've also had these confusing stares when you went to the doctors to ask for help with this dementia stuff. They're just like, I don't know. I'm not available. I'll try to fill out the form. I'll get back to you. And she was like, yeah, that was my experience. So that's why I wanted to bring it up because again, I very much commend the authors and I appreciate their work. And also it's a really nuanced topic. I wouldn't say it's like entirely complex. It's a highly nuanced topic that when you put numbers to it, you gotta be careful about what those numbers mean and what they signify and that they're interpreted fairly.

Yes.

Yeah. I love that you brought on your co-author, Dr. Tate, intentionally. Because she has experience as a caregiver. So if you look at Dr. Goodell's work, one of the things that she talks about, of course, is once you identify the relational coordination index for a given entity, a given team in a given location, that of course, the next thing that happens in teams that have low relational coordination indices that she talks about ways of increasing that. How do you raise that team's functionality? And one of the things that she mentions is the concept of a boundary spanner. And a boundary spanner is somebody who sits in 2 different roles at the same time. So if we're talking about the RCI of a team and we're wondering about the effectiveness of a caregiver, if you have somebody on that team, like you intentionally asked Dr. Tatum to co-author this with you, who is writing about articles trying to assess caregiving and teamwork, but this person who's writing with you is actually herself a caregiver. You have introduced somebody who has 2 roles. They have a foot in 2 systems. They're assessing this data, but they personally know what it's like to actually be a caregiver. And if you have a team where you have somebody on that team who not only is a physician, but also had to care for an aging parent, that would be a very different effect on that relational coordination index for that team. Because by definition, you've already raised that RCI because you've got somebody on that team. Now, if you have somebody else on the team who's asking, We really don't know how to fill out these papers. We don't know where this goes. And this person who's filling a dual role says, I did this with my mom and I know how to do it. This is what we gotta do.

Well, I would say you're probably just suggest— sounds like you're standing for geriatricians insofar as like, yeah, obviously this is the area that we consider ourselves experts in because that's the area that we've chosen to learn quite a lot about this. And also As we all have a chip on our shoulders because it's not something that is well recognized as a clear medical specialization, so to speak. It's not seen as special knowledge fully or not recognized as such. But, you know, this was very apparent to me. You know, I'd been the physician of record for someone who was fairly high up at one of the universities that I worked in. And, and she came in and her father was sick and she needed help navigating the system. She was like, She's a surgeon. She was like, I've operated on so many people and I had no idea that all of this goes on in the background in the recovery process. This is a patient I was working in a post-acute SNF. And so, you know, situation, I was just like, this is how insurance works for this. This is how timelines work for this. This is probably what I would recommend if you're looking for home caregivers and you want someone paid, like this is where I would start. Like knowing how that works is pretty convoluted and it's convoluted by design because we don't really have a system around it. It's as crude a system as the healthcare system, but it has its own world to it to navigate. And so that's why I was thinking I care about it immensely. I think that's why I'm able to write about it. And also as a physician, when I think about what that entails, I don't think it's because I'm a physician. That I know about this. I think it's because I've taken it upon myself to care about it. And I hope society cares about it more. I hope we start to recognize that it's worthwhile knowing how some of this works. Like, what is the expertise needed to then function on a team around this? But it is also the reason why geriatricians, we all emphasize interdisciplinary teamwork so heavily that we recognize that it's like, no, usually you need to bring on a couple of people. Who cover each other's bases because the decision space is so large that navigating it is challenging. But it is even, and you know, it's not other people's fault entirely. As geriatricians, I think we have a hard time explaining what our expertise is as well. But it's a topic that, yeah, all I can say is I'm glad that you're thinking that way because I agree that spanning it is hard, especially for caregiving, which tends to diffuse itself through many different systems and many different providers.

So, oh my gosh. And it's really cool because that perspective from a conflict resolution perspective, it's such a powerful stance, you know, recognizing that you can have feet in different worlds and that actually enhances the goals and the accomplishment of the goals by a team. So I love it that you have actual lived experience that you've seen that and also encourage people on your team to have that kind of knowledge base, because as you said, that's just going to be so much more beneficial, not only for your team in terms of sharing that sense of success and gratitude seeing patients do well, but also in terms of just the caregivers and the patients feeling that the team is invested in a very different way. I think that's part of it. I think that's one of the things that in Dr. Goodell's research that she talks about with the RCI is that there's also an increased perception on the part of the patient and the caregiver when the team seems to be functioning well, that there is an increased sense of confidence in the team. That they actually feel that in terms of a patient experience. And the fact that you are actively encouraging that, I think is really cool. One of the things you also talk about in your article that I think is important to bring up as a sense of the culture that's around caring for these patients is the idea that this has become very medicalized. You used that term and I thought that was really interesting. What did you mean and what is your feeling about the sense that this process of aging, especially caring for our elders, has become medicalized?

I mean, they aren't my words. It's the words of this anthropologist, Sharon Kaufman, Dr. Kaufman, who unfortunately passed away, but she was at UCSF. I only encountered her work sort of posthumously, but she had done some observations around some of the thorny issues that happen in medicine. She has some work on decision-making around dialysis. And then this other work examining what happens in a geriatrics clinic. And I included her quote just because I felt like it really explained at a broad level what has happened in American society. Basically, she says historically the extended family, your family was responsible for your caregiving. And I don't put rose-tinted glasses on that. There was probably good caregiving and there was probably bad caregiving as there has been over all time. And. As American society has evolved over time, and also as people's lifespans have extended and the healthcare system has become the one responsible for keeping people autonomous and healthy and independent, we have become the de facto group that is responsible for knowing what to do when people are no longer independent. And that was a sociologic observation, just that she was like, so weird that you go to these geriatric clinics and then they, so this is a critique now on my field, right? Where they go and we itemize every last thing. Like, you know, how did you go to the bathroom? And also like, what are medications that you are taking and who is in your caregiving sphere? And so, you know, we itemize every last thing and we collect all this detail as if that will scientifically get us to the conclusion of better care.

Yeah.

And so that was her observation that we, as a field, give this impression that we are the knowledgeable ones, that if you listen to us, you will get back to the state that you need to be in. That's the language that we use to describe it. And then we've applied that now to how we care for older adults in a geriatrics clinic. And so then, yeah, you gotta listen to the geriatrician, but the paradox is that how do you become independent if you are dependent now on this geriatrician to tell you every last thing that you're supposed to do? So this is our observation of this quandary that we're stuck in. Medicine. And that's what I brought, was invoking her words around the medicalization of the death. In some ways, American medicalization is the idea that put yourself in our hands and we will make you independent again, which is just a total paradox. And that we are doing this with also how we care for older adults and that that is creating a problem. So yeah, that was what I think I was invoking there, that I was concerned that the paper Was falling victim to that same socialized way of thinking. And that also may be a trap. And I bring up why it might be a trap, and it's because this doctor that you're talking to as a class of people might not know very much about caregiving. I, I always use the example, like, experienced caregivers know about double gloving.

Mm-hmm.

And I don't know if you know what that is, but it's like if you clean someone, You need to double glove when you change a diaper because if the first layer gets soiled, then you have to take it off in order to then put the clean stuff on. But you can't just abandon all your gloves, then walk away. So like, that is a skill that is a caregiver mastery skill that the doctor, physical therapist, or, you know, IV med nurse that knows, not necessarily, it could be the CNA, it could be the caregiver at bedside who's just learned through experience. But that's not part of our medical education at all. Right. And I only know it because I would just volunteer to help. Like when I saw people get changed, I was like, I thought that was my job too. I learned later I had to be socialized out that that was in fact not my job as a doctor, but I was just like, oh, and I, I just wanted to learn cuz I felt like that was all part of it. I always saw it as like my job is to care for this patient and that is both medication, but also like steering them through this very difficult time.

Yeah.

So, you know, I come at it from this perspective where I just thought it was something that we were supposed to do. And so I share the sort of disbelief, I think sometimes of caregivers who are like, why is it that we don't know this? But I'm also socialized enough in my profession to know that's not how we talk about it. That's not dominant, for better or for worse.

I think just with your writing and then with what you just said, I think you are honestly a consummate boundary spanner because you are willingly putting yourself in both of those roles. But not only are you doing that, you are also considering other people's physician personas and how they think about this process, as well as how the caregiver is approaching this process, which makes me think that as you're continuing to study this, I think your work is going to be really fruitful and speak to a lot of people because you are willingly putting yourself in those roles and you have awareness to do that. Not everybody always has the awareness to actually constantly put themselves in these different roles and think about how other people in those roles might perceive this information. And I think as you continue to do this research, it's going to speak to a lot of people.

I hope so, cuz I do think that it leads to better care. I think if people know what they're doing, I think there's true expertise in this. I think people want that expertise. I don't think we know exactly what it is, but I am hopeful. I, I always think it's baffling. I'm like, we've learned to crack cancer. You know, we have made huge strides about cancer and cancer is also very complex and There's a lot of aging out there and it goes pretty badly. Like, why can't we think about what excellence means in this sphere? Yeah, I'll put it another way. I think my rejoinder to Sharon Kaufman's work is that, and sociologists, you read enough of them, you realize they always punch up at the biomedical profession.

It's their weird favorite.

Well, you know, we have a privileged position in society.

I get it.

I get why they're punching up. And at the same time, part of me also thinks the way out of this If there is one, is that I think we have a role to play in society that has been handed to us for better or for worse. And I think that if we are going to do better in this area, this historic challenge of how we provide excellent care for older adults, we will need to create work in the language of our field, which is science. And, you know, since evidence-based medicine came out, at least it's around science, around measurement. around figuring some of these things out. Even if it's communication, you need sort of like the science of communication. But we will need science in this area in order to bring our field back into this space to, you know, like deserve the mantle that we've been given. Do you know what I mean?

Yeah.

And that's the challenge of it all, that it's like, we don't know. It's not part of our teaching. I mean, I write papers to try and turn some of these questions into Evidence. But the soul of it all is that I believe we have this mantle. How do you then figure out what is better or worse in this sphere? And again, that's why I like BRCI. I think it's an interesting idea. I didn't want to bash it at all. I said like, the real question now is to turn it into an outcome, is to connect it with the outcome measures for which, you know, we're all paid for and the whole system is built up around. I think that's the next sort of kicker, but I did want to contextualize that work. Because I think that it's an important contribution that way.

Yeah. Absolutely. Dr. Lam, thank you so much for being on the show. If people have questions or wanna reach out to you, what's the easiest way for them to do that?

Yeah, just email me. I feel very fortunate and privileged, and as much as possible, I like to get feedback. I really am trying to bring people together because I think we do care quite a lot about our older generation, but somehow all of that caring, and we also have very strong feelings We have very strong feelings about our older generation, but somehow that all gets kind of muddy. And I see the role as like, how do we channel this in the direction that leads to the thing that the older generation does in fact want? Just, it's like good customer service. I don't mean that there's a little bit of respect for elders, but I know that's kind of patronizing to them as well. I just see it as like good customer service. But what is it? How do you deliver that? And it's a tough crack and it gets swamped in a lot of like MRIs and medical jargon and like, you know, surgical procedures and like risk-benefit analysis. And it's like, there's still something a little inefficacious. Reach out to me by email. I'm always happy to chat.

Absolutely. Thank you so much for being here. This has been a fantastic conversation. And for all of your peaceful warriors, all of you who've joined us on the Scalpel and Sword podcast today, thank you so much. And until next time. Be at peace.

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. 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.