Latest / Cut & Tell / Coaching, panic, and the arrival fallacy: a surgery chat with Mel Thacker, MD

Transcript

Coaching, panic, and the arrival fallacy: a surgery chat with Mel Thacker, MD · Cut & Tell

• 0:00
  Hi there and welcome to Cut and Tell.
• 0:02
  I'm Liz Malfress.
• 0:03
  I'm a newly minted plastic surgeon in Philadelphia.
• 0:05
  And this season is all about arming you with the health policy knowledge that you need to be an advocate for your patients and just as importantly, for yourself in this crazy healthcare system.
• 0:30
  So today, I'm very excited about today's podcast, y'.
• 0:32
  All.
• 0:32
  This is a very special episode because I have my first ever guest on the pod, and I think she's exactly the right person to break up some of these intense policy conversations we've been having and give us, like,
• 0:45
  a little bit of sunshine, a little bit of real world insight, a little bit of perspective to shake things up a little bit in particular.
• 0:51
  I think this is going to be a great conversation for anyone who is early in their career or any of you residents and med students who are kind of looking ahead to early practice practice.
• 1:01
  It's.
• 1:01
  Drumroll, please.
• 1:03
  Dr.
• 1:03
  Mel Thacker.
• 1:04
  Hi, Mel.
• 1:04
  Hi, Liz.
• 1:05
  Thank you for having me.
• 1:07
  Thank you so much for joining.
• 1:08
  I'm really excited.
• 1:09
  You're the perfect first guest.
• 1:10
  I'm so glad that you could come on the podcast.
• 1:12
  So I'm going to give a little.
• 1:13
  Give you a little introduction first, just in case people don't know who you are.
• 1:16
  So, Mel, Dr.
• 1:17
  Mel Thacker is an ENT.
• 1:19
  She specializes in rhinology.
• 1:21
  I've heard her refer to as the sinus queen.
• 1:23
  Is that correct?
• 1:24
  Yes.
• 1:25
  Okay.
• 1:25
  I am the sinus queen.
• 1:28
  She also is a surgeon coach.
• 1:30
  She's very active on Instagram.
• 1:32
  You may know her from there.
• 1:33
  And then she also.
• 1:34
  She's a part of the Hippocratic Collective, like I am.
• 1:36
  And so you may know her as well as the host of Surgeons With Purpose, a really fantastic podcast that if you haven't checked it out, I totally think you should.
• 1:45
  So part of what brings her here today is that I just read, I just read Mel Thacker's book.
• 1:50
  It's called Scrubbing In.
• 1:52
  It's coming out first week of October.
• 1:55
  The Scrubbing In A Surgeon's Journey From Self Doubt to Wholeness.
• 1:58
  I so enjoyed reading this that I decided to wear my matching green outfit so we would be all coordinated.
• 2:04
  A really fascinating memoir about a surgeon who has come so far from where she started.
• 2:11
  Like, really a super interesting personal story that was just fascinating.
• 2:15
  I would have.
• 2:16
  I just had no idea what all that you've been through.
• 2:19
  And then I think a really interesting story about, you know, how, like, ultimately maybe it's our past coming for us or at least like our we can only repress our feelings and our problems for so long until they
• 2:34
  come to find us.
• 2:35
  And not only did your.
• 2:36
  Your problems found you, but you really overcame them in a fascinating way.
• 2:39
  So anyway, thank you so much for being here.
• 2:42
  And I think to start, I would just love to hear a little bit about, like, I don't know, I.
• 2:46
  I'm fascinated by people who write books because writing a book seems like a huge deal to me.
• 2:50
  Will you just talk a little bit about sort of why you decided to write the book in the first place and how you tackled like writing a book while being a sur.
• 2:57
  Like, it seems like a lot to take on.
• 2:59
  Absolutely.
• 3:00
  I started kind of documenting my childhood because I have a very interesting background.
• 3:06
  I come from intense neglect.
• 3:08
  For example, there's a scene in Scrubbing in where my mother accidentally throws a lit cigarette and it flies out her window into the back of back seat of the car while I'm in it, and almost sets the whole
• 3:20
  car on fire.
• 3:21
  It does set the car on fire with me inside it.
• 3:24
  And that's just one example of neglect that I experienced.
• 3:27
  I was cycling in out of being unhoused.
• 3:30
  These are all unique things.
• 3:32
  And now that I have children, I've wanted my kids to kind of know where they came from because they don't have a relationship with my parents.
• 3:38
  And so it's like very interesting that, oh, I have a relationship, Gammy and taps on dada's side, but we don't have relationship with mama's parents.
• 3:45
  What's happening here?
• 3:46
  So I was documenting my childhood in bits and pieces.
• 3:50
  And then when I saw that Frances May wrote her memoir and I joined the Hippocratic collective and she went through this year long stewardship or like this class with Neil Strauss, I was like, oh, then I'm gonna work
• 4:06
  with her and then she can help me book develop.
• 4:08
  And so I pitched the idea.
• 4:09
  And actually when I first pitched the idea to her, it was like this story of how everything always works out for me.
• 4:14
  And she was like, that's not a good story.
• 4:17
  I was like, everything works out for me.
• 4:18
  I need to hear that, Mel.
• 4:19
  Okay.
• 4:21
  Must be nice.
• 4:22
  Yeah.
• 4:23
  So, so.
• 4:23
  But that I think was my way of coping is like, that's, that's again coaching.
• 4:28
  Right?
• 4:28
  It's like how you see the world.
• 4:29
  That was how I was able to survive intense neglect.
• 4:34
  And so then we started kind of workshopping a book.
• 4:37
  And it turned into the chaos of my early life, which is mostly for my children.
• 4:43
  And then it all culminates when I kind of beat the video game.
• 4:47
  And I, you know, get all of.
• 4:49
  All my dreams come true.
• 4:50
  I become the surgeon.
• 4:51
  I have the house, I have the.
• 4:52
  The husband, the kids, and I pay off my loans.
• 4:55
  And it's the arrival fallacy hitting me really, really hard.
• 4:58
  I don't feel any better.
• 4:59
  There is no celebration.
• 5:00
  There's no parade to celebrate me, and I am just filled with emptiness.
• 5:05
  And then that combined with the pandemic threatening my private practice and me being the sole breadwinner for my family, it was kind of like the perfect storm of everything that led to an identity crisis.
• 5:18
  And I ended up having panic attacks in the operating room.
• 5:20
  And that was when I couldn't ignore kind of my.
• 5:23
  My past or my nervous system any longer.
• 5:26
  And then the second half of the book is written to describe what I did next and how I kind of came through that and pieced myself back together through coaching.
• 5:35
  And that is wr for any surgeon who is trying to fit inside surgery culture.
• 5:40
  And they feel like maybe they're an outsider.
• 5:42
  And I don't think that anybody should have to shape themselves to fit into the round hole of surgery.
• 5:46
  I think we should be able to design life as a surgeon on our terms.
• 5:50
  And so that's what the ultimate book is.
• 5:52
  The message is.
• 5:53
  Yeah, it's really.
• 5:54
  It's really a great story and very vulnerable and very brave.
• 5:57
  Like, you.
• 5:58
  You say things that I.
• 6:00
  Some of the things, like a lot of your early.
• 6:02
  The early part of the book is like this unimaginable things that I like.
• 6:05
  I'm sure it was painful to write, but it is like, very power to be able to read.
• 6:09
  But I think the later half of it, some of that stuff is like, stuff that.
• 6:12
  That I think a lot of us know but aren't willing to say and aren't willing to acknowledge.
• 6:17
  And so I think that's part of why the book is really powerful.
• 6:20
  So I did want to talk a little bit about.
• 6:21
  The arrival fallacy, I think, is such a powerful part of, like, I think everyone's experience in healthcare.
• 6:27
  Like, you literally spend decade, decade, a decade or more like, grinding toward this goal.
• 6:33
  And I worry that a lot of people get to the end and it's not what they thought.
• 6:36
  You know, like, even in.
• 6:37
  I think there's.
• 6:38
  It's not.
• 6:39
  I guess it's maybe not necessarily the arrival fallacy, but it's like the.
• 6:42
  The dream you get sold or the dream that you kind of cling to when you're.
• 6:45
  Especially before med school, I think healthcare looks really different than what people dream About.
• 6:51
  Yeah, I mean, we don't have much autonomy.
• 6:53
  And I think when we go into residency or training, we trade our autonomy for a brief period of time for the container of residency where we get in return mastery and competence.
• 7:02
  And then we expect to get our autonomy back.
• 7:04
  And we don't.
• 7:05
  We never get it back.
• 7:06
  Yeah, exactly.
• 7:07
  They don't give it back to you, but then, but then by then you're like, you're not used to having it.
• 7:10
  And so I think you're just like, oh, I guess this is, this is just like how it is.
• 7:14
  Yeah.
• 7:14
  And we are trained to become people pleasers, which is just trauma response.
• 7:18
  It's fawning, it's overriding your internal truth to appease or acquiesce the truth of somebody else.
• 7:24
  It's essentially lying is what people pleasing is.
• 7:26
  So it's like you're lying in order to conform to culture.
• 7:29
  You learn to do that really, really, really well.
• 7:31
  You get used to not having autonomy.
• 7:33
  So no wonder we are in this, like, shit show of, of the US healthcare system that we have currently.
• 7:39
  Yeah, I totally agree.
• 7:39
  I wrote a piece about being a people pleaser because it's like, it's sad to me in that it's sort of.
• 7:44
  I think early on in medicine I viewed it as a superpower of like, I can literally, I can get along with anybody.
• 7:50
  I can make anything work.
• 7:51
  Like, I can.
• 7:52
  I'm a chameleon.
• 7:53
  Like, I can do whatever.
• 7:54
  I'm like, totally changeable.
• 7:57
  But then basically my experience is that, like, at some point I, like, senior enough that I felt like I'd earned my right to be able to, like, be myself and, and like, people would respect me because of my
• 8:09
  years of service and like, dedication and everything I've ever shown people about myself.
• 8:13
  And it turns out it doesn't work that way.
• 8:15
  Like, it turns out the conformity was the point.
• 8:18
  Like, it turns out I wasn't.
• 8:19
  I think that I thought that I was earning something that I could then, like, you know, whatever, like, pay off later or, like, you know, be able to cash in later and get some kind of, like, respect in
• 8:31
  return or, like a little bit of extra leash to, like, do what I wanted to.
• 8:34
  And it's just not true.
• 8:36
  And all I was doing was like, was like, just saying stuff on the Internet that everyone agreed with, but, like, it was just like a little bit too.
• 8:41
  Except a little bit too out of line.
• 8:43
  So I worry that's a big problem with like, a lot of.
• 8:45
  A lot of how we all approach this is that You.
• 8:48
  You think it's all gonna pay off, and then I just don't know that it always does.
• 8:51
  No, I agree with that.
• 8:52
  And I think we get that black or white thinking where we think we either have to.
• 8:56
  People, please.
• 8:57
  So override ourselves to go along with what everyone else wants from us or what somebody else is requesting of us, or we go to war with them.
• 9:05
  But there's like, this middle path where you can just be honest and be kind and not ruin the relationship.
• 9:10
  You can just speak your truth and also still keep the relationship intact.
• 9:15
  So.
• 9:15
  Yeah, exactly.
• 9:16
  Everything.
• 9:16
  Everything gets so, like, heightened in healthcare because the stakes are so high, I think is part of it.
• 9:21
  But also just like, we're so accustomed.
• 9:23
  To, like, such a.
• 9:25
  Such a high level of just, like, putting your head down and grinding it out and just, like, suffering as.
• 9:30
  As like a value almost that any deviation from that just feels huge.
• 9:35
  So, speaking of.
• 9:36
  Speaking of kind of hospital stuff I did ask you about, there's an another.
• 9:39
  Love.
• 9:40
  Your.
• 9:40
  Your book's amazing.
• 9:41
  We'll come back to your book.
• 9:42
  I did want to talk about another piece that you wrote that I thought was, like, pretty spicy.
• 9:46
  It's on the Hippocratic Collective in the Business of Medicine section, and it's called When Incentives Become Instinct.
• 9:53
  So this piece, I think everyone should read it.
• 9:55
  This is fascinating.
• 9:56
  You're.
• 9:57
  This is definitely something that I don't think a lot of people are willing to say out loud, but incentives in healthcare are real.
• 10:04
  They affect our behavior and, like, something that I don't know, that we do a good job of preparing especially young, like.
• 10:11
  Like, residents and physicians to be able to take on.
• 10:13
  Would you just tell us briefly, like, kind of about this experience you had where you realized that you were, like, being incentivized and maybe not being the doctor that you wanted to be, if that's fair.
• 10:24
  Yes, in my experience.
• 10:25
  So I'm an ENT surgeon, and I primarily do rhinology.
• 10:28
  And in private practice, I offered something called balloon sinuplasty, which is a procedure that I do in the office under local anesthesia.
• 10:37
  And it.
• 10:37
  It is a valid procedure.
• 10:39
  It helps people.
• 10:39
  And I was doing it in service to patients to help them.
• 10:42
  But what happens is when you have somebody who has a sinus issue and they come to see you and you're able to see the revenue cycle, I know how much their insurance is going to reimburse me so I
• 10:51
  can look at their insurance, and I'm not insurance naive, and I see that they have a specific insurance based on what I've been paid in the past.
• 10:57
  I know how much an office based procedure that takes me an hour, a balloon procedure will reimburse, and maybe it's $13,000 for a one hour procedure.
• 11:06
  I also know that if I do it in the surgery center under general anesthesia, it'll reimburse me $3,000.
• 11:12
  So my brain started doing those calculations and I found myself like directing people into the office based, higher incentivized procedures.
• 11:21
  And I was doing that subconsciously or unconsciously until I became aware of it and I was like, oh my God.
• 11:26
  And I became really disgusted with myself.
• 11:29
  And that was when I made a very intentional decision to stop.
• 11:33
  And this happens in other specialties as well.
• 11:36
  So in spine surgery, we already know that the US Is operating on way more spines than other developed countries because we're incentivized to do multiple levels.
• 11:44
  There is also the knowledge that there are joint surgeons who will kind of play the gray area and replace joints maybe more than they need to, just to kind of churn and burn and make as much money as
• 11:55
  you can.
• 11:56
  And it's a response to a system that is improperly squeezing the people inside of it.
• 12:02
  And so what these people do, especially people in private practice who are trying to pay overhead and pay bills that keep getting higher and higher because of inflation, they're like, well, I'm going to squeeze you right back.
• 12:10
  And so it's like an unethical eye for, like an unethical eye.
• 12:13
  And I just don't.
• 12:14
  It's just not something.
• 12:15
  It's not a game I'm willing to play because, like, the people who are ethical and who want to just do the right thing for patients are the ones who are in the middle of it.
• 12:22
  And they're the ones who are most morally injured because now the insurance, they're.
• 12:25
  The ones who lose out.
• 12:26
  Like, they're also like, not going to be able to make this, like, make the math.
• 12:29
  Math to be able to make the math work.
• 12:31
  No.
• 12:32
  Yeah, because it's just a race to the bottom.
• 12:34
  And the insurance companies keep coming up with more rules.
• 12:38
  They have all the power.
• 12:39
  And so they're trying to proceduralize everything.
• 12:41
  And it's like, why do we even need a doctor?
• 12:43
  Because you're going to make us jump through all of the hoo in order to arrive at the treatment that I'm recommending.
• 12:49
  So why, you know, what is the point of, of me even giving my professional recommendation if it doesn't even matter?
• 12:54
  You have to go through like, the cookbook of the insurance.
• 12:56
  Exactly.
• 12:57
  And that's the problem.
• 12:57
  That's the moral injury.
• 12:59
  Yeah, it's really.
• 13:00
  It's.
• 13:00
  It's.
• 13:01
  I.
• 13:01
  I think that what being a doctor is.
• 13:03
  Is not what I.
• 13:04
  I, like our earliest doctorly forefathers, fathers kind of planned.
• 13:07
  Like, it's very.
• 13:08
  It's very different.
• 13:09
  Like, you are.
• 13:09
  You were very constrained.
• 13:10
  You do not have nearly the level of autonomy that I think.
• 13:13
  Like, I think a lot of us choose.
• 13:15
  Like, you choose medicine, like, well, you ch a doctor and not a PA or not a nurse or not something else in this field.
• 13:21
  You choose that because you want to be the person making the decision, like, potentially.
• 13:25
  Like, for me, it's like, I know I need to be that person.
• 13:27
  Like, I.
• 13:28
  I'm like, I'm not good at following.
• 13:29
  Like, I.
• 13:30
  I need to be able to do what I want, what I think is right.
• 13:33
  Or like, to me, that was.
• 13:35
  That was what I didn't like about my past career is like, I want to be somewhere where I can be making decisions.
• 13:39
  And so it's just so sad to me that this.
• 13:41
  I think this profession used to be that.
• 13:43
  And I think we've just kind of lost it.
• 13:45
  And I think, too, to your point about, like, it be being sort of morally complex on both sides.
• 13:50
  Like, I certainly have found my.
• 13:53
  Myself and like, seen this in residency of, like, the incentives are so fucked up that you end up doing things.
• 13:59
  Like, you end up like.
• 14:01
  Like, you end up lying sometimes when you know that you shouldn't, but, like, you're lying in service of the patient.
• 14:06
  So, like, the example that I've definitely seen before is like, like, say, you know, a patient needs a mammogram, but, like, it's been like, only 11 months, not 12 months or whatever.
• 14:15
  And like, so you just say the patient had breast pain because, like, if you don't say they had breast pain, they're gonna charge the patient, like, you know, thousands of dollars.
• 14:22
  And like, it just like, things like that where it's like, you're basically.
• 14:25
  You're manipulating the system back.
• 14:26
  Like, the system manipulating you.
• 14:28
  You're doing it back.
• 14:29
  And like, you feel like you're doing it for a good reason.
• 14:31
  But I worry that all of that kind of erodes the, like, the.
• 14:35
  The bright line between what is clinical judgment and what is like, manipulated manipulation and.
• 14:42
  And like, economics that is like, not really what we're trying to do and not what I think patients think that we're doing, either.
• 14:49
  Yeah, no, you're exactly right.
• 14:50
  And it's something called ethical fading that Simon Sinek Talks about in the book the Infinite Game.
• 14:55
  It happened at Wells Fargo and they were incentivized to do something and it ended up into like this huge scandal that was very well publicized.
• 15:03
  But yeah, our brain starts to get used to thinking in a certain way and we're always thinking in a way, how do I work the insurance?
• 15:10
  Then how are we going to know if we're working the insurance for the patient or for us?
• 15:13
  That line starts to blur.
• 15:15
  And like, I think it's dangerous to ever think that way to like build that muscle of working an insurance company so that we can get them to cover what we think, you know, what we're recommending, whether it's 100%
• 15:26
  for the patient or if it's for our pocketbook.
• 15:27
  You know, like, my way to get through this was to leave my private practice at the end of 2024.
• 15:32
  I just wasn't willing to work for insurance companies.
• 15:35
  And then I now work very part time and I am completely insurance naive.
• 15:42
  So I'm not thinking about overhead, I'm not looking at people's insurances.
• 15:46
  I have no knowledge of it and I prefer it that way.
• 15:49
  And I'm not saying that it's bad.
• 15:50
  I want to double click and not say that people should all leave private practice.
• 15:54
  I think we need more private practice.
• 15:56
  But the way that the model is currently, the way it's incentivized and how we outsource our value to a third party, essentially, I just don't think it's sustainable if our reimbursement keeps going down and down and down and
• 16:07
  our bills keep going up and up and up.
• 16:09
  I think this problem is going to be more glaringly obvious because of that.
• 16:13
  Yeah, I totally agree.
• 16:14
  Like, I've certainly, like, I, I know that people who are like a lot of people advocate for incremental change and like incremental change.
• 16:21
  I get it.
• 16:22
  Like I, I did a public policy degree.
• 16:23
  Like that is the main reason that way, the main way that things happen is through incremental change.
• 16:27
  But I worry that the incremental changes has been happening for 30 years and in the wrong direction.
• 16:32
  And all of our, like, nice friendly tactics, like through our professional organizations, like, like nothing has worked.
• 16:39
  Like reimbursements have, like been going down steadily for 30 years just for inflation.
• 16:43
  Like this is kind of a disaster.
• 16:45
  And so I'm sort of with you.
• 16:46
  Like, I think that's why there, there is evidence more and more people are leaving, like insurance or like, like choosing to be concierge.
• 16:54
  And I know people some People view that as a negative thing.
• 16:57
  But I, to me it's like we, something's got to give, you know, like something's incremental changes is not going to get us there anymore because the other side isn't fighting fair.
• 17:05
  And so I think it's going to take something like something big, like we need a big change.
• 17:10
  Yeah, I agree.
• 17:11
  And I mean it kind of speaks to like my whole three part engine that I kind of teach everybody, which is protect the asset.
• 17:17
  We're the asset.
• 17:18
  We can't keep just letting a third or fourth party determine how we practice medicine and how much we are worth and then serve the patient.
• 17:26
  Just always, always, always make sure our first intention is to serve the patient.
• 17:30
  Not to say that we should be compensated, but it should always be second.
• 17:34
  And then third, diversify your professional identity so that when you are not willing to put up with this bullshit anymore, you can leave.
• 17:40
  Yeah, I really like that.
• 17:41
  And I think, I think that's like the, I, the, the diversifying part of it has something that I've kind of come to just organically I think because I did a lot of other stuff before I went to, went
• 17:51
  into healthcare.
• 17:52
  But like, I think especially for surgeons you are, it is tenuous your ability to like this is a very high level of performance.
• 17:58
  It requires a lot from you and your body.
• 18:01
  And like, like, you know, I like, I think all of us are like one bad car crash away from not being able to do our jobs.
• 18:07
  And that's, it's true like to a certain extent for every profession.
• 18:10
  But I think it's just especially true because like I need every single one of my fingers to work.
• 18:14
  Like I need my back to be pain free.
• 18:16
  Like I need both of my eyes to be correctable vision.
• 18:18
  You know, like there's a lot of stuff that you.
• 18:20
  Absolutely, it's like there's no compromise on any of this stuff.
• 18:23
  And so for me, even as like a young healthy person, like I've just, I, I just kind of need a backup plan for like if this doesn't, if something happens, like what am I going to do?
• 18:33
  But I worry that the way that a lot of us are trained and brought up in this profession is that it has to be single minded.
• 18:38
  Like you have to be, this is your whole identity and you can't have anything else.
• 18:42
  And for sure residency trains us to be that way.
• 18:46
  Yeah.
• 18:46
  And it's not healthy.
• 18:47
  And I think we start to watch our older colleagues.
• 18:50
  I mean I started watching colleagues who were 10 or 20 years older than I was.
• 18:54
  And they were not happy.
• 18:55
  And their.
• 18:56
  Their physical health was failing them.
• 18:57
  And then people who are in their 80s who retire and then come back, and it's like you're ripping the scalpel out of their hand because they don't know what to do with themselves because they don't know who they
• 19:06
  are underneath.
• 19:06
  Surgeon.
• 19:07
  And that's helpful either?
• 19:09
  No.
• 19:09
  For anybody.
• 19:10
  None of that is good.
• 19:11
  No.
• 19:11
  It's really kind of crazy.
• 19:12
  Yeah.
• 19:13
  Yeah.
• 19:13
  I think that that's.
• 19:14
  This.
• 19:14
  The coaching work you do is really interesting.
• 19:16
  And coaching is something that I've thought a fair amount about.
• 19:19
  And actually it's like, related to a project I did while I was in residency.
• 19:22
  So I was really interested in particular, like.
• 19:24
  Like, the idea of coaching is.
• 19:26
  Is missing from residency training.
• 19:28
  And I don't know why, because we talk all the time about, like, oh, like, we, we like the sports stars.
• 19:34
  Like, we like the really high performance people from other professions.
• 19:36
  Like, we like that experience.
• 19:37
  We think that is good for surgery because it's a high performance profession.
• 19:41
  But then we don't give residents any of the tool or we don't.
• 19:44
  We don't approach it the same way.
• 19:46
  Like, it's sort of like if you were like, hey, you should be a baseball star.
• 19:49
  I'm just gonna throw you on the field and not tell you the rules and, like, see if you figure it out or not.
• 19:53
  Like, that's actually probably not a great way to train players.
• 19:57
  I don't know.
• 19:57
  But I don't think it would be.
• 19:58
  And I feel like that's kind of what's happening in surgery.
• 20:00
  So I wanted to hear what you.
• 20:02
  What?
• 20:02
  Like, I think that we should have coaching in residency.
• 20:05
  So if.
• 20:06
  And I'm guessing you do too, could you just talk a little bit about what you think the benefits of coaching are or could be and what you would say if a residency wanted to start a coaching program.
• 20:16
  Like, how would you go about doing that?
• 20:17
  Yeah, I absolutely agree.
• 20:19
  And I think it's coaching is just how to do life.
• 20:22
  Like, how to be a human in the world and like, how to manage your brain, because we're not taught that.
• 20:26
  And we're all walking around with all of these attachment wounds from childhood, this desire to prove ourselves, and we attach our sense of self to the outcome.
• 20:35
  That's why we, a lot of us go into this profession.
• 20:38
  I mean, I think I ran into the profession because I came from chaos, and it felt very comfortable and familiar.
• 20:43
  And so that's why I did it,.
• 20:45
  Because it's chaotic here too.
• 20:46
  Yeah, exactly, because it was chaotic.
• 20:48
  But I didn't know that I was doing that in response to my childhood wounding.
• 20:52
  And then you see surgeons who act like toddlers in the or, or they hit people with instruments or throw instruments.
• 21:00
  And I've seen so many people who have like, lost it.
• 21:02
  I was a child, an emotional child until I was 41.
• 21:05
  Like, we do not, we don't have good emotional regulation.
• 21:08
  You know, we lose it on ER doctors calling us in the middle of the night.
• 21:12
  So I think, like, just for the emotional regulation, I think it's really important to repair past wounds and past traumas.
• 21:19
  However that looks.
• 21:20
  It could be therapy, it could be emdr, it could be internal family systems, it could be coaching.
• 21:25
  But then once you repair all of those wounds that you're carrying with you that keep getting triggered, that keep getting poked with circumstances that life is going to throw at you because everything's fine.
• 21:34
  When patients are happy and surgery's going well and you have all your equipment, 99% of the time it's fine, maybe 90%, but it's that 10% that things are not going well.
• 21:43
  And because we're in such a high stakes environment, we have to be on top of our brain.
• 21:47
  And that's what coaching is, is triaging the, the thought that you're having the sentence in your mind before it creates a charge in your body.
• 21:54
  So, like now I'm very good at doing that.
• 21:57
  And I, when I feel emotions, I'm intentional about what is the thought behind that and do I really want to believe it?
• 22:03
  Like, I felt shame recently and I interrogated my brain.
• 22:07
  I was like, what is the thought?
• 22:08
  I was like, oh, that's not true.
• 22:09
  And I just immediately got rid of it.
• 22:11
  So I'm.
• 22:12
  I have a muscle now.
• 22:13
  I have a strong muscle of being able to look at what is the thought that's causing the charge and do I really want to believe it?
• 22:19
  If I don't, I can, can direct myself to something else.
• 22:22
  And I will say that like, it's one of the most powerful muscles I have now in, in surgery and now that I've gotten through kind of my own coaching journey, even though it peaked at panic attacks, which is
• 22:33
  like the worst thing you can possibly have in the operating room.
• 22:35
  Now that I'm on the other side of it and I have all these tools, I'm the safest, most efficient, like best surgeon I ever have been in my career.
• 22:41
  I use these tools all of the time.
• 22:43
  I used it to do an emergency airway case recently and I was like, wow.
• 22:46
  Like.
• 22:46
  Like, that was awesome.
• 22:47
  Like, that went as good as it possibly could have gone.
• 22:49
  Like, it's good for patients and it's good for us.
• 22:51
  And I walked away from that not exhausted and feeling like an asshole because I wasn't proud of how I showed up.
• 22:57
  Like, I want every surgeon to go to bed at night and, like, think about their day and be like, wow, I killed it today.
• 23:03
  Like, I was awesome.
• 23:04
  Life threw all this shit at me and I just like, pew, pew, pew.
• 23:06
  It's like dodgeball, you know, or like you're like, deflecting it and you just manage it and you go.
• 23:11
  You put your head on the pillow and you're just really proud of yourself.
• 23:14
  I think that's what coaching does for you.
• 23:15
  And the patient gets the benefit of having their surgeon at, like, the highest version of themselves at capacity, not lashing out or reacting.
• 23:22
  Yeah, well, I think that's like, the weird irony of it all is that, like, coaching is about control.
• 23:26
  But I think because we as surgeons are supposed to think that, like, we don't.
• 23:31
  We're like, we're already perfect.
• 23:33
  We're totally in control all the time.
• 23:35
  Like, that sort of is like, I think it's not drilled into us because I don't think anyone teaches it to you, but it's just like, that's the example you get shown and that's how you're supposed to behave outwardly
• 23:44
  at least.
• 23:45
  And I just, it's like, to me, ironic that, like, this actually, what you're describing sounds like what you.
• 23:50
  Actually.
• 23:50
  How you would want to train a surgeon is like, train a surgeon to be mentally strong and to know how to deal with difficult, like, mental emotional situations.
• 24:00
  Because the OR is such a charged place.
• 24:03
  And like, this is the whole point is, like, you want someone who's going to be able to handle a high pressure situation.
• 24:07
  That's who.
• 24:07
  That's.
• 24:08
  That's the surgeon you want.
• 24:09
  And, like, that's why, you know, we.
• 24:11
  This tra.
• 24:12
  This kind of, like, coaching mentality applies to every other high performance profession.
• 24:16
  I don't know why.
• 24:16
  We just have decided that, like, surgeons are different or separate or something.
• 24:20
  It's really kind of bizarre to me.
• 24:21
  Yeah.
• 24:22
  And I think one of, like, the fear pieces is letting your truth be known.
• 24:26
  You know, like telling people with radical transparency in the operating room that I'm having a panic attack is not comfortable.
• 24:33
  Like, you don't want.
• 24:34
  I love that part of the book, though.
• 24:35
  That was really, to me, that was like, that was that the most extreme vulnerability I think I've ever, like, read and.
• 24:41
  But such a powerful story, too, of just like.
• 24:44
  And also just like that if you.
• 24:45
  If you show people who you are, they're not gonna, like, they react in a positive way.
• 24:49
  Yeah.
• 24:49
  They're not.
• 24:50
  Like, they're actually gonna be okay.
• 24:52
  Yes.
• 24:52
  No.
• 24:53
  But I think our nervous system thinks, like, people are gonna kill us.
• 24:55
  Yeah.
• 24:56
  They're gonna kill you.
• 24:56
  Yeah.
• 24:58
  But it's funny to say out loud, I guess, is part of the point.
• 25:00
  Yeah.
• 25:01
  And like, one of my clients was telling me how she, you know, she used these tools in the operating room.
• 25:05
  And she's like, all right, everybody, I'm freaking the fuck out, just so you know.
• 25:08
  And she's just like, you know, tamponading the bleeding.
• 25:11
  And then.
• 25:12
  And then she's like, quick, you know, gets herself.
• 25:14
  She's like, just gimme 90 seconds.
• 25:16
  Breathe through it.
• 25:16
  As we talk about, like, letting everything flush through.
• 25:19
  And then she generates curiosity and then creatively solved the problem.
• 25:22
  And she's like, it went amazing.
• 25:24
  And everybody was on board.
• 25:25
  They're like, okay.
• 25:26
  Like, it's okay.
• 25:27
  And then when she talked to her colleague, who comes from a very militaristic background, and he's 10 or 20 years older than her, and he's a guy, he was like, don't ever do that.
• 25:35
  He's like, you cannot.
• 25:36
  You can never say that to them in the or.
• 25:38
  You have to acknowledge weakness.
• 25:39
  Yeah.
• 25:39
  He's like, I have knowledge too, but I would never say them.
• 25:42
  Oh, my God.
• 25:43
  She's like, well, I am.
• 25:44
  Watch me.
• 25:45
  Yes.
• 25:45
  And I.
• 25:46
  And like, I'm sure.
• 25:47
  Yeah.
• 25:47
  Like, I don't know.
• 25:48
  Every time I've done something like that, I've just, like, said something that you're not supposed to say, but that everyone's thinking, like, the reaction tends to be pretty positive.
• 25:54
  Like, overall, people are like, yes, I know.
• 25:56
  I too, have noticed that.
• 25:58
  And this, like, we could just be humans together and talk about stuff.
• 26:01
  Like, it's okay even in the or.
• 26:03
  Yeah.
• 26:03
  No secrets.
• 26:04
  And I mean, that's what integrity is like.
• 26:05
  Integrity is not about moral or ethical being good or anything.
• 26:10
  It's just from the word integer, which is means whole and undivided.
• 26:15
  So it means, like, if a plane is not in integrity, the fuselage is, like, coming off the thing, then it's not going to fly.
• 26:21
  Just like the human being will not show up as good as they could as well as they could if they are not in integrity of body, heart, mind and spirit.
• 26:28
  If you're pretending to be one thing, but internally, you Believe something else we can tell.
• 26:33
  Like, we are highly attuned social creatures.
• 26:35
  We can sense bullshit.
• 26:37
  And, and it's, it's like all of surgery culture is like, no, just bullshit your way through it.
• 26:41
  Yes, exactly.
• 26:42
  Yeah.
• 26:43
  Say, yeah, what is it?
• 26:44
  Never sometimes wrong, but never in doubt.
• 26:46
  Yeah.
• 26:46
  No.
• 26:47
  Yeah.
• 26:47
  And I worry that's a little bit become a feature of just healthcare in general.
• 26:50
  And it's not necessarily all surgeon's fault or doctor's fault because I think a lot of like, the way, the way that you have to contort yourself to conduct yourself in the healthcare system today, it's just wild.
• 27:01
  Like the, the hoops you have to jump through to be able to just like, you can know you don't just get to look at a patient and say, like, like, I have diagnosed your problem.
• 27:07
  This is the treatment.
• 27:08
  Here you go.
• 27:09
  Like, all of that other stuff you have to do, I think is in a lot of ways a challenge to that integrity you're talking about.
• 27:15
  Of, like, it's forcing you, like, out of that state of being able to like, be the advocate for patients that you want to be.
• 27:22
  And like, I think it's like, it's because it's death by a thousand cuts.
• 27:27
  Like, it's all these little things.
• 27:28
  It's like prior.
• 27:28
  It's like, you know, like one more prior auth.
• 27:30
  It's like, like one more thing where, like insurance times, you have to do this.
• 27:34
  It's like all of these little things add up in a way that I think, think we haven't been able to acknowledge, partly because our culture is that you just always take more shit.
• 27:42
  Like, you just, you just, you just say, sure, may I have another?
• 27:45
  And I just, I think we have to do better for our healthcare system.
• 27:48
  And I think, I think the ideas you're talking about are a big part of how we can, like, get that mindset shift, you know?
• 27:53
  Yeah.
• 27:54
  And in every other profession, when you add more things to the plate, you're.
• 27:57
  Like, okay, what would I.
• 27:58
  What shall I deprioritize?
• 28:00
  Yes.
• 28:00
  If I have to.
• 28:01
  What would you like me to do?
• 28:02
  Yeah, what would you like me to not do if I'm going to do this?
• 28:04
  Like, what's your plan for that?
• 28:06
  No, but I think Danielle Offrey in her New York Times article calls it this wondrous elasticity where we just keep taking on more work and we make it happen because we tell ourselves, well, we have to because people's
• 28:17
  lives are.
• 28:18
  Are at stake.
• 28:19
  It's.
• 28:19
  It's like exploiting our altruism.
• 28:22
  And I think we have to stop, like, stop taking it.
• 28:24
  I think we do, too.
• 28:25
  Yeah.
• 28:26
  Yeah.
• 28:26
  And I think that's part of what's happening with.
• 28:28
  With so many people leaving.
• 28:29
  But honestly, part of what I worry about is, like, it's amazing how people, like, like, I think we see a lot of problems in healthcare.
• 28:36
  Like, there's obviously a lot of problems, and I think we've been fortunate to be able to, like, find a niche that works.
• 28:42
  But I worry about people who come into this profession expecting one thing and, like, finding something totally different.
• 28:46
  And I just wonder at what point people stop.
• 28:49
  Stop coming into this, into this space.
• 28:51
  Because I don't know, I just, I'm.
• 28:53
  I'm glad that there are people who want to be part of this profession, and I, like, still have a lot of confidence in it, but I just worry that if we don't do.
• 28:59
  If we don't do something to make it better, like, we almost.
• 29:02
  The reason to do it is for the med students now, like, to be like, we just, like, this can still work.
• 29:07
  Like, I know that we can rescue this, but.
• 29:08
  Yeah.
• 29:09
  I mean, humans need autonomy.
• 29:11
  So I think we have to do something to restore physician autonomy and, you know, reduce the salaries of CEOs and all of those things, like capping those.
• 29:19
  Totally agree.
• 29:20
  Yeah.
• 29:20
  Leaving health insurance completely, letting all of the health insurers fall.
• 29:24
  Everybody just stopped signing the contracts.
• 29:27
  Something has to happen.
• 29:28
  I love that idea.
• 29:29
  Yeah.
• 29:29
  I think.
• 29:29
  I think part of it is it's like we're not going to fix it by little changes.
• 29:32
  We need big changes.
• 29:33
  And I think health insurance.
• 29:35
  Yeah, health insurance, the.
• 29:36
  The whole industry does not need to exist like that, that, that.
• 29:39
  That industry is massive.
• 29:41
  It's like UnitedHealthcare is like the third, like, like, highest.
• 29:44
  I don't know, it's like one of the third, like the third biggest company in America and like, it doesn't need to exist.
• 29:50
  And like, all of that money that it has is money that we could be using to pay for healthcare and, like, making healthcare less expensive.
• 29:56
  And like, we're just.
• 29:57
  I don't know why we just, like, kind of aren't targeting the right things, because I think partly because all of us doctors have our heads down and are trying to.
• 30:04
  Trying to just get shit done.
• 30:06
  Yeah.
• 30:06
  And in scrubbing in, I mean, I talk about a specific incident where I'm talking to.
• 30:12
  I won't even say the name of the insurance company, but it is the one you just mentioned, and I'm sure.
• 30:15
  It's the one we're all thinking of, everyone knows.
• 30:17
  Yeah.
• 30:18
  And.
• 30:18
  And I have a patient who, who could use sinus surgery.
• 30:21
  You know, she's had five plus years of sympt.
• 30:24
  Her sinuses are full of pus, and she, you know, she needs surgery.
• 30:29
  And that is my professional opinion, that she should have surgery.
• 30:31
  But I do give her medicine, but she decides not to take it.
• 30:34
  And I call her and she's like, well, it gave me diarrhea.
• 30:36
  And I was so, like, crazy when I was on prednisone, I don't want to take it again.
• 30:40
  And I was like, I think you just need surgery.
• 30:42
  We need to just take care of this.
• 30:43
  And her insurance company denied it.
• 30:46
  And I talked to an otolaryngologist and I'm telling him the story.
• 30:49
  And I'm like, this is her story.
• 30:50
  This is what I think she needs.
• 30:51
  I sent you pictures of her CAT scan.
• 30:54
  Clearly OMC obstruction, frothy secretions, opacification, all the things.
• 30:59
  And he said no.
• 31:00
  He was like, no, we can see that she didn't pick up her meds.
• 31:02
  And no, I'm not, I'm not following it.
• 31:04
  And I was like, the call's coming.
• 31:05
  From inside the house.
• 31:07
  Yes.
• 31:07
  How did they get in?
• 31:08
  So that was the moment where I was like, oh, gosh, they've gotten to ENT doctors.
• 31:12
  They've gotten to ent.
• 31:13
  Yeah, yeah.
• 31:15
  It's really, it's a turning point.
• 31:16
  It's a crazy situation.
• 31:17
  But anyway, this, this book, I like, highly recommend this book to anyone, I think, especially, like, one last question before I.
• 31:24
  Before we get towards the answering my cat is being crazy.
• 31:27
  You have a really interesting job that's like, different than, I think, a typical surgeon job.
• 31:33
  And it's important to me that people know that these things exist.
• 31:35
  So can you tell us just briefly, like, you're a part time surgeon, which isn't even really a thing.
• 31:39
  So tell us about that.
• 31:40
  Yes.
• 31:41
  So, yeah, I totally believe that there are more paths than just the 3 of perpetual employment, academia and private practice.
• 31:47
  Well, now we have direct care, so I guess there's four.
• 31:49
  But I do this like very part time locums thing.
• 31:53
  So when I left my private practice in 2024, I was a partner for eight years.
• 31:57
  I was there for 10.
• 31:58
  I didn't have a plan.
• 31:59
  I just knew that I wasn't willing to work for insurance companies.
• 32:02
  And I could see the writing on the wall with the reimbursement going down and overhead going up.
• 32:07
  So I was getting out.
• 32:09
  And then I had also built this other ecosystem of thought leadership and Coaching and building a coaching practice.
• 32:15
  I was like, okay, I'm building.
• 32:16
  I'm planting these seeds, and I'm willing to risk entrepreneurship.
• 32:21
  So I went that route.
• 32:22
  My husband doesn't.
• 32:22
  Wasn't bringing any money.
• 32:24
  I'm the sole breadwinner of our family of four.
• 32:26
  He was on board.
• 32:27
  And then I had six months where I was just trying to just figure out, what am I gonna.
• 32:31
  What am I gonna do?
• 32:31
  But there are many excuses in the way, like, what are we gonna do for health insurance?
• 32:34
  We had to get on the health connector.
• 32:36
  Fine.
• 32:36
  We can figure it out.
• 32:37
  We figure out everything.
• 32:39
  It was fine.
• 32:40
  And then I reached out to a Locums company, and I found a job that is two hours west of where I live, in my same state where they.
• 32:48
  They have a big need for ent and so they had me go out there, and I only wanted to work five days a week.
• 32:55
  So I was working Monday through Friday, taking call, operating, seeing patients in clinic, and then I've been doing that since last August.
• 33:02
  They offered me a contract to do seven days per week or per month.
• 33:06
  And I decided ultimately, I don't want to sign a contract where I'm committed to two years.
• 33:11
  So I'm staying with Locums.
• 33:13
  But I've been doing that because they have the need for over a year now.
• 33:17
  Yeah, no, it sounds great.
• 33:18
  And it, like, works well for you.
• 33:20
  And, like, that's.
• 33:20
  Yeah, like, to me, that's.
• 33:22
  I just feel like.
• 33:22
  I don't think people realize that there are, like, you can find these ways to carve out a position that works for you that, like, meets your parameters.
• 33:28
  Like, you don't have, like, for you.
• 33:29
  You're like, if, like, you also can just tell them, you'd be like, I'm not gonna do weekends.
• 33:33
  And, like, people will.
• 33:34
  People will make that work for you.
• 33:35
  So, anyway, I just think it's really cool because I.
• 33:37
  I agree.
• 33:37
  Like, a lot of us get told that, like, you can do academics, and then if you really, like, decide that you don't care about anything, then you can do something else.
• 33:45
  Like, there's this, like, such.
• 33:46
  This mental from training about, like, what's an acceptable job for a surgeon?
• 33:50
  And, like, we.
• 33:52
  You know, it doesn't have to be that way.
• 33:53
  There's, like, a lot of ways to be a surgeon and to show up for your patients.
• 33:55
  Yeah.
• 33:56
  So thank you so much, Mel.
• 33:57
  This has been an amazing conversation.
• 33:59
  Thank you so much for coming on the podcast.
• 34:01
  And for all of you listeners out there, scrubbing in is an amazing book.
• 34:06
  A memoir of a courageous and very authentic surgeon.
• 34:09
  The kind of, the kind of like book that I think we need to be reading now if we want to read about surgery.
• 34:14
  Like forget all those old ones we used to.
• 34:17
  This is, we have like a great new gener generation of books about surgeons who are real.
• 34:21
  And so anyway, thank you so much, Mel for being here and good luck with your, with your book tour.
• 34:27
  Yeah.
• 34:27
  When are you starting?
• 34:28
  Yeah, October 6th.
• 34:29
  October 6th.
• 34:31
  Okay.
• 34:31
  And where can we get the book?
• 34:32
  We can get at Amazon and it'll be on my website too.
• 34:35
  Melthackercoaching.com Amazing.
• 34:37
  All right, well, thank you so much, Mel.
• 34:38
  Thank you, Liz.
• 34:40
  Thank you for listening to Cut and Tell.
• 34:42
  If you enjoyed this episode, please subscribe, rate us five stars and check out all of our other amazing shows and podcasts including Dr.
• 34:50
  Thacker's Surgeons with Purpose@Hippocratic Collective.com.