The Good Doctor Read online

  Praise for

  THE GOOD DOCTOR

  Case studies of grit paragons like these doctors are a great starting point for understanding the path forward—and fun to read!

  —ANGELA L. DUCKWORTH, PHD, Christopher H. Browne Distinguished Professor of Psychology at the University of Pennsylvania and New York Times bestselling author of Grit

  The Good Doctor is a great read, especially at a moment where cynicism about our institutions and individual motivations prevail. With humanity and warmth, Tom Lee reminds us why the best physicians still view medicine as a calling. These seven profiles are each exhilarating and inspiring for all prospective and practicing clinicians, as well as those seeking reassurance about the humanity of healthcare.

  —JON PERLIN, MD, PHD, President of Clinical Services and Chief Medical Officer at HCA Healthcare

  In The Good Doctor, Tom Lee gets to the heart of the most pressing crisis facing physicians today: burnout. Telling the stories of seven physicians, he shows how each creates deeper meaning in their work and in their lives by bringing the care of their patients to a different level, one which resonates deeply and insulates them from our profession’s stressors. Dr. Lee’s message is elegant in its simplicity.

  —LARRY H. HOLLIER JR., MD, Surgeon-in-Chief of Texas Children’s Hospital

  Dr. Lee shares the stories of extraordinary doctors and identifies the core qualities they all display, including empathy, resilience, strong sense of purpose, and the ability to create communities where they work. Healthcare organizations should study these stories to understand what motivates clinicians and what undermines those motivations, so we can support them in doing the noble work of patient care.

  —JESSICA DUDLEY, MD, Chief Medical Officer of the Brigham and Women’s Physicians Organization

  For years we have known that burnout is largely related to dysfunctional systems and processes, not a defect in the people who dedicate their lives to heal others. Tom has beautifully tipped the scales back in the right direction via intimate storytelling about the human spirit—a spirit that rises from trauma, that heals when no cure is possible, and that loves despite all odds.

  —ADRIENNE BOISSY, MD, Chief Experience Officer of Cleveland Clinic Health System

  Tom Lee uses these inspirational stories to teach a powerful lesson. They show us what grit looks like and how a few individuals who find meaning in their work are having remarkable impacts.

  —FREDERICK P. CERISE, MD, CEO of Parkland Health & Hospital System, Dallas

  You won’t be able to put this down as you get into the profiles of these seven good doctors. Tom Lee provides insights into resilience, grit, and passion, providing a framework for doctors to focus their careers to avoid burnout and to serve their patients in a meaningful manner.

  —LEE SACKS, MD, retired Chief Medical Officer of Advocate Aurora Health

  Good doctors like the physicians in this book inspire through their perseverance, resilience, and recognition of the need for mentoring throughout life.

  —PHILIP E. STIEG, MD, PHD, Chairman and Neurosurgeon-in-Chief at Weill Cornell Brain and Spine Center

  The stories of Joe Sakran and others in The Good Doctor show that determination and excellence have not gone out of style in medicine and are being reinvented by a new generation of physicians.

  —ALLEN KACHALIA, SVP of Patient Safety and Quality and Director of the Armstrong Institute for Patient Safety and Quality of Johns Hopkins Medicine

  Copyright © 2020 by Press Ganey Associates, Inc. All rights reserved. Except as permitted under the United States Copyright Act of 1976, no part of this publication may be reproduced or distributed in any form or by any means, or stored in a database or retrieval system, without the prior written permission of the publisher.

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  To my late father-in-law, Ali Gharib, MD,

  who showed so many

  what it means to be good

  Contents

  THE GOOD DOCTOR

  Acknowledgments

  Introduction

  CHAPTER

  1 The Good Physician

  CHAPTER

  2 Embracing “The Hard Thing”

  CHAPTER

  3 Keeping Promises

  CHAPTER

  4 Minimizing Fear

  CHAPTER

  5 Fighting the Root Cause

  CHAPTER

  6 Treating the Whole Person

  CHAPTER

  7 Delivering Care to Those in the Greatest Need

  CHAPTER

  8 Never Giving Up

  CHAPTER

  9 Being and Becoming a Good Doctor

  Notes

  Index

  Acknowledgments

  THE GOOD DOCTOR

  FIRST AND FOREMOST, I would like to thank the seven doctors profiled in this book—Mike Englesbe, Michigan Medicine; Merit Cudkowicz, Massachusetts General Hospital; Emily Sedgwick, HCA Houston Healthcare West; Joe Sakran, Johns Hopkins Medicine; Laura Monson, Texas Children’s Hospit
al; Lara Johnson, Parkland Health and Hospital System; and Babacar Cisse, New York–Presbyterian Hospital. They trusted me to capture their stories accurately and convey them in a way that is consistent with their values. None are self-promoters, but all could see that there were noble reasons to share the stories of their noble work.

  I also want to thank my colleagues in healthcare who appreciated the idea behind this book and then pointed me toward physicians whom I really had to meet. For example, Laura Forese, executive vice president at New York Presbyterian, introduced me to Babacar Cisse; Fred Cerise, CEO of Parkland Health and Hospital System, introduced me to Lara Johnson; and Larry Hollier of Texas Children’s Hospital introduced me to Laura Monson.

  I’d like to thank friends and colleagues who have created and shared their insights about the nature of resilience and grit, two of whom deserve special mention. Deirdre Mylod, who works with me at Press Ganey, is the real thinker behind our framework for thinking about burnout, engagement, and activation. Angela Duckworth, the University of Pennsylvania psychologist (and my cousin), has created a body of work around grit that has deep and obvious influences throughout this book.

  I want to thank Pat Ryan and my other colleagues at Press Ganey for encouraging and supporting the writing of this book. They are good people with good values—and they all love a good story. As each chapter was concluded, I would send the draft to about 10 of them during the next weekend, because, well, this is the kind of stuff they like to read on a Sunday morning—a way of getting ready for the week ahead.

  I am grateful again to Beverly Merz for doing what she has done with all my books—serving as a trusted editor, someone who makes the manuscript better without making the author mad! I’d also like to thank Casey Ebro and her team at McGraw-Hill, for their confidence that what we thought might be a good idea actually was one, and then for their effectiveness in moving the book through the publication process so quickly.

  Finally, my deepest gratitude goes to Soheyla Gharib, my wife, who has been so supportive of all aspects of my work for decades now—but who gives her greatest respect on those occasions when I prove to be a good doctor myself. She’s a wonderful physician and the daughter of a wonderful physician (to whom this book is dedicated). Forty years after meeting Soheyla on the first day of our internship, I remain endlessly interested in impressing her. Nothing impresses her more than going the extra mile for a patient.

  Introduction

  THE GOOD DOCTOR

  I WISH I COULD SAY that this book began with a full-blown vision of what it means to be a good doctor in the modern era and how to become one. The reality is that it began with nothing more than the pleasure of telling a good story. And then another. And another.

  The conversation that led to this book occurred in the late spring of 2018, right after Pat Ryan, the CEO of Press Ganey, learned that one of his closest friends, Sean Healey, had just been diagnosed with amyotrophic lateral sclerosis (ALS). I told Pat that I knew a wonderful ALS specialist who worked with a really excellent team—Merit Cudkowicz, MD, at Massachusetts General Hospital.

  It turned out that Pat’s friend had already made his way to Merit—no surprise, since in the ALS world, everyone knows who she is. She is famous among neurologists for leading clinical research trials on some of the most promising agents for this disease. She is famous among patients because she and her team offer wonderful care—and even hope—for a condition that so many others label “hopeless.”

  Our conversation shifted from admiration for what Merit and her team do, to amazement that they have been able to keep it up for decades for patients who are sure to have a downhill course. Merit and her colleagues remain deeply empathic with these patients and their families, even though one might expect them to have developed defense mechanisms to protect themselves from emotional involvement.

  “She should be the most burned-out physician on the planet,” her colleagues say. “But somehow, she is the least.”

  “Merit is incredible,” Pat said.

  “She is,” I agreed. “But let me tell you about Emily Sedgwick.” And then I told him how I had recently met a young breast radiologist at Baylor College of Medicine in Houston. A decade ago, when she was just in her early thirties, she re-engineered breast imaging at her institution with the goal of reducing fear. She knew that, even when women whose mammograms reveal suspicious abnormalities got their core needle biopsies the next day, it could be a very long and difficult night. So in her program 95 percent of the biopsies are done the same day. Women don’t leave the mammography room right away after their initial images are taken because Emily and her colleagues know that when women get the message that more images are needed, their hearts stop. Instead, women stay in the room with the imaging equipment until a radiologist has looked at the mammograms and decided whether any other shots should be taken before the patient leaves.

  “That’s a great story,” Pat said. I told him that there were plenty more out there. We agreed that it would be interesting to collect several of them. In an era in which so many doctors and nurses feel burned-out from their work—overwhelmed, ineffective, and depersonalized—maybe there were patterns in the stories of those who avoided burnout and lessons to be learned from them.

  As soon as I began to mention that I was working on such a collection, I started getting suggestions for other remarkable physicians to interview. “You have to talk to Lara Johnson.” She is the primary care physician who leads the healthcare program for homeless patients at Dallas’s Parkland Health and Hospitals System. Or Joseph Sakran, who survived a serious gunshot wound to his throat when he was 17 and went on to become a trauma surgeon at Johns Hopkins. In the fall of 2018, he became nationally known after he reacted with anger to a tweet from the National Rifle Association (NRA) that physicians advocating for gun control should “stay in their lane” and started the “@ThisIsOurLane” hashtag on Twitter. But his story was already remarkable even before he tweeted, “Where are you when I’m having to tell all those families their loved one has died?” and struck a chord with so many physicians and others alarmed by gun violence.

  And so on, and so on. The names poured in—and they are still pouring in. I did podcast interviews with the physicians profiled in this book and have continued doing so after I finished writing about the seven in this book. I’m not one bit concerned about this well running dry.

  The reason to collect these stories is not to suggest to clinicians experiencing burnout that there is something wrong with them, but to offer some examples of how physicians handle the stresses that lead to burnout.

  As a practicing doctor (and the spouse and father of practicing doctors), I am tuned in to the stresses and frustrations that are driving a burnout epidemic among clinicians. I hear doctors whom I really respect say that they no longer find pleasure in their work and are retiring sooner than they otherwise would have. And these are people whose sense of self is based at least in part upon the belief that they are doctors—and good ones at that.

  But the fact is that I also meet physicians whose passion for their work endures. The physicians I profiled in this book take care of patients with the same empathy and the same high standards as the best physicians of any era. They live in the real world and are every bit as exasperated by bureaucratic hassles and information technology dysfunction as the rest of us. They don’t describe themselves as “great,” but they are finding greatness in their work.

  These physicians are younger than I am and older than my oldest daughter (a 31-year-old cardiology fellow), and they have something to teach both of us. They are defining how to be a good doctor in our times—and showing that being a good doctor remains something pretty great. Figuring out what they have figured out and reverse-engineering their grit have yielded some insights that could help healthcare organizations shape their cultures—and might help some individuals find their way.

  The individual stories were an inspiration, and the physicians behind them a delight. They ar
e all self-aware, self-effacing, and funny. They were all amused that doing what they considered logical led them into activities that others find remarkable. The common theme to their stories is that they empathize with their patients and really want to take good care of them. And by adhering to their values, they found themselves—like Laura Monson, the craniofacial surgeon who started a summer camp for children with cleft palates—doing things that fell outside their job descriptions. None of them seem motivated by a desire for promotions, more money, or fame. What makes them remarkable are the accomplishments that have logically followed from their efforts to be a good doctor.

  I realized that their collective stories were a story in themselves—with the three basic elements of that story being conflict, crisis, and resolution. For physicians and other clinicians today, the conflict is the tension between the desire to do good for their patients and the barriers, hassles, and dysfunction that slow them down and make it hard to do so. There is the gap between the life they imagined when they decided to go into medicine and the life they currently live. This conflict will be explored at greater length in Chapter 1.

  The crisis is the burnout epidemic—the well-documented increase in feelings of ineffectiveness, being overwhelmed, and depersonalization that are associated with compromised quality of care and increasing rates of suicide among physicians. That, too, will be explored in greater detail in Chapter 1.

  The physicians profiled in this book are not superhuman and not immune to the stresses that drive burnout. But they have found resolution by changing how they experience those stresses, which has made them more resilient. They began with the same passions that draw most people to healthcare (most notably, easing the suffering of patients), and something happened to make these passions unusually intense. As a result, these physicians have been able to persevere in their pursuit of improvement over years and decades, often doing work that falls outside of traditional patient care.