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Baylor College of Medicine

What is Medical Professionalism?

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iTunes | Google Play | Spotify | Stitcher | Length: 37 minutes | Published: May 6, 2020

Resonance is a student-run podcast aimed at showcasing the science at Baylor through the eyes of young professionals. Each episode is written and recorded by students who have a passion for research and the medical community. Guests on the show include both clinical and basic science research faculty who are experts in their fields.

Dr. Ellen Friedman discusses what it is like to be an otolaryngologist and the director of Baylor's center for professionalism as well as some projects that the center has created, like the "Threads Among Us."

What is Medical Professionalism? | Transcript

Roundtable Discussion

Erik: Here we are.

Karl: We are here.

Erik: This is the Baylor College of Medicine Resonance podcast. I am one of your hosts, Erik Anderson.

Juan Carlos: I'm another host Juan Carlos Ramirez.

Karl: And I am Karl Lundin, I am the writer for this episode.

Erik: Before we get into today's episode on professionalism with Dr. Friedman I just figured we should introduce Mr. Juan, umm, who will be, you'll be hearing a lot more from him in the second season as we kind of rotate through the leadership position, because so the podcast as you guys all know is a student-run podcast and so basically every year we're gonna have new people cycling in and so Juan's starting to, umm, kind of getting more involved and will be on most of the episodes in the second season as I will fade out in a way.

Karl: What Erik is trying to say is he's being pushed out.

All: (Laughing out loud).

Erik: Yeah.

Karl: Juan has seized the reins of power. With iron fists.

Erik: Yes.

Karl: Yeah, I support, I support you.

Erik: Yeah, no. It’s true. Well, we all know that Karl.

Karl: So there’s gonna be some changes around here.

Erik: Yeah. So yeah. So anyways, without further ado though, Karl if you want to tell us about professionalism.

Karl: Yeah and I know professionalism is one of those topics where we probably have heard a lot about it in med school more like “Oh, professionalism. Yeah, I know what that is,” and to certain extent you do but today we're gonna kind of get into I think a very different perspective on Professionalism, more as like a state of mind or an outlook than a specific set of rules but before we do that let's go ahead and get into the specific definition of professionalism officially so according to the American Board of Medical Specialties medical professionalism is and I quote “a belief system in which group members declare to each other and the public the shared competency standards and ethical values they promise to uphold in their work and what the public and individual patients can and should expect for medical professionals…,” it's a lot!

Juan Carlos: I think I caught according to the American Board of Medical Specialties.

Karl: Yeah, you know I think that's good enough for our purposes today. I mean, it is important to have this official definition of professionalism, right? But today we're gonna really get into more like, what does professionalism look like? How do we bring professionalism into our interactions with others? And it's gonna be a lot less about like “do this, don't do that, do this don't do that!” and more about how you treat people what your attitude towards people is, like the example we get into Dr. Friedman, I remember for example is, let's say you're in the OR and this nurse is being really, surgeon is, excuse me, being really snippy with you or like, just kind of grumpy you could be like “Oh, this guy's just a jerk. Surgeons are just jerks. I hate surgeons.” Right? Or you could think “Oh, I don't know what's going on in this guy's day.” Maybe, or he had something rough happen, you know? And so, we need to have like, that understanding compassion and kind of bring that to the workplace, and that's kind of what we get into. You were gonna say?

Erik: I was gonna say empathy, right?

Karl: Yeah, empathy. Empathy. Exactly.

Erik: Yeah, no it's true and I think as we were outlining this episode as we do with all of them, before we do the interview, I certainly focus more on writing this roundtable about sort of the cut-and-dry of here's the definition of professionalism, here's what each ethical standard of, uhh, that the specialties hold themselves to, and then as we interviewed her I was like, oh wow! Well, this is a lot more relatable and makes a lot more sense. It's just the golden rule, right? Treat others as you want to be treated and Juan I believe you have, uhh, some experience with professionalism in a different vein – is that correct?

Juan Carlos: Yes, certainly. So, umm, I spent a nearly a decade in the military and uhh, whether you're in the Regular Army or in Special Operations, professionalism goes way beyond, you know, showing up in the right uniform at the right time in the right place, but the professionalism is really how you treat others and how you present yourself to others through your actions. It's good to, to build cohesion this way, right? Umm, most people want to be treated in the same professional manner, so I think it's kind of a really good initiative that Baylor is kind of spearheading this effort to, to you know? Grow, not just in the medical field in medical knowledge but how you, how do you become a real professional? How do you treat people right? Right? And so, this is amazing. I look forward to the, to the actual episode and uhh, how to become better physicians by being better professionals.

Erik: Yeah, and well, and I think actually the definition of a professional, as we were told on like the first few days of medical school, is that you have just a core set of values, so like, you take the Hippocratic oath and you have the beneficence, and non-malefeasance and all that stuff that everybody in the profession holds and abides by. It makes sense, and you would want that in your physician or your lawyer or any other profession that you can think of or you know, your military.

Karl: Well, like Juan was pointing out, is kind of like, umm, anytime you're working with other people, you all want to be treated with a certain amount of respect, right? And the more people feel respected, the more people feel appreciated, the more they feel part of a cohesive team, and the better you can do in general, right? And so, in healthcare, umm, that means the attitude you have towards the patient, the attitude you have towards the other doctors, the nurses, the person who, umm, cleans the floors, right? You have that certain attitude towards them of respect, of empathy – that's gonna make everybody cohesive as a team and make everybody do a better job, which is ultimately improving people's health and improving their lives, right?

Erik: Mm-hmm.

Karl: And Dr. Friedman has actually taken over for Baylor's new center of professionalism. She's the director. It's actually a new initiative here at Baylor. Very few medical schools are doing this right now, so we're kind of cutting edge and their real like, whole plan, is to, kind of, show us how to be professionals like, help demonstrate how to be professionals. So, we're gonna talk to her today about a number of projects they have going on. We're gonna talk about a project they have called the “Threads Among Us,” which really focuses on how we can take these concepts and kind of, incorporate them, not just in our interactions with patients or interactions with you know fellow doctors, but with everybody here and we're also gonna talk about some other projects they have going on like the, uhh, pop Awards which is a kind of positive thing that we can use to highlight people. So it's gonna be a great conversation and I think it's gonna give people really new kind of outlook and a different kind of take on what professionalism is and it, for me, it makes it very clear like, what this should look like in my daily practice, umm, not just in medicine but in every area of life. So, it's gonna be great, I think.

Erik: Yeah, no. Definitely, so I guess without further ado we'll get into the interview. Dr. Friedman, who is an Otolaryngologist, got her Bachelor of Science from Boston University, her MD from Albert Einstein College of Medicine, and completed advanced training at Montefiore Hospital and Medical Center, George Washington University affiliate hospitals, and Harvard Medical School affiliate hospitals.

Karl: Yeah, so let's talk to Dr. Friedman.

Juan Carlos: Right on.

Interview

Karl: Well thank you very much for joining us today Dr. Friedman. Umm, to start off I was wondering if you could just tell us a little bit about yourself, your career, what's your day like as an otolaryngologist.

Dr. Friedman: Well, thank you so much for inviting me I'm really excited that you've started this podcast and I wish you great luck and I hope it's quite popular. So, I have been an otolaryngologist for a very long time and I enjoy it thoroughly. It's a field that I'd love to recommend to the students to investigate because it's a beautiful balance of medical and surgical options: you can treat males, females, adults, children – there's a lot of variety within the field and it, I've been doing it for many, many years and I continue to love it. I think most of the people who go into Otolaryngology are kind and very lovely colleagues, so it's made a beautiful career. Okay, that's great. Do you spend a lot of your time in practice still? I know you have some administrative duties - so what's the division there I guess.

Dr. Friedman: Right. For many years, I was the chairman of the division of pediatric otolaryngology at Texas Children's Hospital over 20 years and about six years ago I stepped down to take the position of being the director of the Center for professionalism here at Baylor. Now I do a very limited amount of clinical work. I work clinically one day a week. Uhh, in a month, I have three operating days and two clinic days when there are five, five weeks in a month, and it's a great balance and it's been a really exciting and positive mood because it's been invigorating to think about new topics in our, or maybe even old topics but in a new way.

Karl: Oh, okay. That's very interesting. Thank you. So, you mentioned you are the director for the center of professionalism here at Baylor. I was wondering if you could tell us a little bit about the center, of what you guys do, and what you're all about.

Dr. Friedman: Yes. the Center for professionalism was actually the dot idea of Dr. Klottman and when he was recruited here it was one of the top priorities in his recruitment package because he had created one at Mount Sinai and felt it was one of his most proud accomplishments there. So, he was highly motivated to start one here and I am the first director of that Center. The center has two major missions one is to elevate and support professionalism throughout the campus from students to the highest faculty within the clinical sciences as well as the basic scientists and that's the, the wonderful role and the other role is to identify and remediate lapses in professionalism in a clear, consistent, and predictable and fair manner. So, those are the two missions and it's been a very exciting and challenging position.

Karl: What was the formal process like before the Center for Professionalism for dealing for professionalism issues and that sort of thing?

Dr. Friedman: Yes. That's a great question. I think it was done in a very, umm, inconsistent way, and even today, I wouldn't say we've totally harnessed the topic but I think it was very inconsistent and frequently not transparent, and so, this has been a very positive move towards trying to change the culture and to improve the culture towards a culture of greater patient safety and greater collegiality among community.

Karl: Okay, so it sounds like may use a bit more of an ‘ad hoc’ system before. We're trying to just make things standardized – uniform.

Dr. Friedman: Right. And, and to make sure that it's fair to everybody involved. That, that's really my personal goal – that I want it to be consistent, you know? I think there has been a suspicion that higher up people don't have, get treated the same way that either students or assistant professors would be treated and I really pride myself on having a very consistent approach and it may be a little bit more awkward when you're talking to someone higher up but everyone gets the exact same approach and I'm confident of that.

Karl: So, I guess along that line, what does professionalism mean in a medical context? What would that look like?

Dr. Friedman: Yes. Actually, almost every talk I give I start with that because I think there's a wide perception of what professionalism means and the type of definition that I like to use is that professionalism in medicine is a collection of behaviors such as altruism, compassion, integrity, striving for excellence. That builds trust for relationships between patients and physicians, and physicians and their colleagues.

Karl: Okay, so it's kind of really about a framework we use to make sure that we can trust each other and we can work well together to accomplish things.

Dr. Friedman: Exactly. I think, for patients, when you have a trustful relationship, there will be compliance with your recommendations, there'll be an open real conversation, you'll, everyone benefits. Patient safety benefits. Patient outcomes benefit, and when you work well with your colleagues you'll also maximize your efficiencies, your effectiveness, and it's just a much more pleasant work environment. So, there, there's a lot to be saying for professionalism.

Karl: Yeah, I mean, it's a lot harder to get burnt out if you have that kind of trust in the good relationships.

Dr. Friedman: Absolutely. Not, not only with burnout, which is a whole separate podcast I'm sure, but in terms of, of communication skills and professionalism there are numerous very large and significant studies that show that the vast majority of medical errors as well as malpractice litigation are not due to lack of expertise, lack of medical knowledge, or lack a poor technique but it's due to poor communication and poor professionalism by far. So, it's really, professionalism has really risen in terms of national interests because it is linked to so many downstream problems.

Karl: Okay. That's very interesting and that, kind of, does remind me of the project you guys did recently called ‘The Threads Among Us,’ and how it kind of helped highlight how professionalism, at least to me when I saw it, was maybe not always all the things we think of when we think of professionalism but it's a much, kind of, broader sort of thing. So, I wonder if you could tell us a bit about that project and everything.

Dr. Friedman: Yes. My – my collaborator with that was Dr. Jordan Shapiro. He is currently a fellow in adult medicine GI but he also has training in pediatrics and before he even came to Baylor he had contacted me with an interest in professionalism and, a personal peeve of mine is a lot of the inter-professional disrespect and in civilities and I really wanted to do a project that would work towards increasing empathy among our co-workers and as a surgeon myself, I have frequently heard the pediatricians who think that surgeons are idiots with knives, and surgeons think that pediatricians can't make a decision, and the OBGYN people don't like the urologist, and – I mean, you could stack it up, but there's nobody who's immune from it and it's so counterproductive, and the truth is that medicine is so complicated today, no one can do it on their own. I mean, we all have to rely on each other and when you badmouth a colleague, the likelihood that you're going to have a wonderful outcome is significantly diminished. In fact, that was one of the issues that would came up in the student survey – that they actually felt moral distress when they would hear people on a service bad-mouthing other people on other services or consultants, and it's something that I have seen many, many times for many, many years, and for example, in the doctor’s lounge, where groups of residents or attendings – believe me, the attendings are just as guilty – will sit and make fun of someone else who's had a complication or someone else who didn't seem to understand the underlying clinical issue, and I find that very distressing because the truth is, we all have areas of expertise and you know being able to rely on each other and have confidence in each other is really critical, and one of the things that I really love about Baylor is we have so many great people here and to undermine each other is really, umm, distressing.

Karl: Yeah. I mean, kind of what struck me about it when I saw the project is, seems like professionalism is almost, uh, we're talking about a mindset, right? – Having a certain kind of gratitude for the situation, for the people you have to work with, for the opportunities you've been given, having a certain kind of graciousness in the way you approach others, and thinking like “Well, you know, so-and-so is taking a little time to call me back, but maybe they're busy.” Maybe, you know, giving people the benefit of the doubt – that sort of thing. It's very important.

Dr. Friedman: Wow. You really got it. Yes! That's exactly the message. The idea is that, I also would use the term empathy for each other, you know, because, you know, I think if we could all give each other a little bit of a break, I think that sometimes, um, you just, either from a past experience or from, or even just a rumor about someone else's behavior or someone else's experience with someone, you prejudge them and you jump off and are already annoyed before you've even given them a chance, and I guess another point that I hope that, that we discuss in the workshop following that video, is that, you know, everybody has their own back life and they may have personal issues on it, and everybody can't be a hundred percent their best self every single day because there are issues that come up, and in the video I'm happy that you've seen it, you know. It shows that when people are driving in they sometimes they – they have traffic for an hour and a half before they get here! Then they have to park their car, and these things kind of stack up, and you can start your day already frustrated and annoyed. So, I think it's really a great reminder to try to step back, you know, take some breaths and really be gracious. I think you really described exactly – exactly what we were hoping a participant in the workshop would feel.

Erik: …and you briefly mentioned a student survey. Um, we know what you're talking about but for those of us that are listening that might not know, would you be able to explain that?

Dr. Friedman: Well, every year Baylor College of Medicine, as well as every medical school around the country, gives students – graduating students, as well as students in each of the years – a survey to get their impression of their education, the learning environment, basically, I think it's called a learning environment climate study, and we look at that information and take it very seriously. I – I guess, I'm glad you asked me that because I think the students think we just collected and gave it a toss or something, but the truth is, we actually pour over it because we want you to be the best physicians and the best end product as possible, and we want to make you have a very positive experience while you're at Baylor. So, we take all of that information, which is giving totally confidentially, and we analyze it, and we look for steps, specific tangible steps, that we can do to address the concerns.

Karl: Just delving into some of the theory or the concepts that kind of underlie the threads among us and then just kind of the work you guys do in the professionalism Center: Is there any, if we could talk about a few concepts, so could you tell us a little bit about social contagion theory? I guess, we already talked about but the importance of gratitude, and then also on the ‘Ladder of Inference,’ kind of what these things are and what they mean.

Dr. Friedman: Sure. So, um, the way the workshop work goes with the threads among us is that there is a seven-minute video and then we have a discussion with a workshop, and it's a – It's available online both the video as well as the workshop, and in the workshop, we speak about three different principles that we hope are illustrated well in the video. The first is the social contagion theory, and that is how we basically show how there are social networks and every part of our lives – things that we don't, we're not even aware of. For example, there are studies that show if a friend of a friend of a friend of yours smoked cigarettes it's more likely, statistically, that you'll smoke cigarettes, and there are a number of different behaviors where there is this interwoven network that shows connectivity, basically, among large social groups, and we use that example to show how someone who has, is in a bad mood affects everyone that they come in contact with, and I think the thing that I like about the way we use the social contagion factor is in the discussion aspect, is that we always think about people who affect us but the idea is to remember that your attitude affects others, so you are a vector also. So, we talked about example, if we first asked people in small groups to think about individuals who can suck the energy out of a room, and I think everybody can think about a work situation where you see that you're partnered with someone, you're assigned to work with someone, and you know, it's going to be an unpleasant situation, it's going to be aggravating because they just are so negative, they’re so, maybe depressed but basically the negativity – it just can suck the life out of you and then there are also individuals where, you know, you're part paired up with them – not really even your personal friend – but they always lighten the day and they roll with whatever happens, they're flexible and they're positive, and you know you're going to have a good day, and so we get those – those individuals in our mind and then we go to realize that we also have the ability to either suck the life out of a room or to elevate it, and I think it's a very powerful exercise when you do it because some people honestly get this “aha, like, yeah, you know, I – I probably am doing that too,” and it might be even the first time they think about themselves sending out the vibes. They only have thought about receiving the vibe so, that's the social contagion theory. The ‘Ladder of Inference’ is a little bit more complicated to think about but, the Ladder of Influence is sort of the explanation behind a knee-jerk reaction, where instantaneously, you – you flip in your brain from a very neutral occurrence that you observe to maybe a negative interpretation, and it is a way how you can make instantaneous bad decisions and bad judgments. So, it's a little bit like when you're driving – driving, and a person in a fancy Lexus cuts you off and you say “Ugh, those guys are jerks!” You know? And the next time you see someone in a Lexus, you're already ready for the, to honk at them, and I think that happens to all of us, and I think that's one of the ways with stereotyping that even whole fields medicine gets stereotypes where you, when you already are talking to a surgeon you think they're going to be jerks or you when you're talking to the pathologist you think they can't decide or whatever group, and the idea of the activity that we do with the Ladder of Inference is to first of all make you aware of it because it's so quick you're not even aware of it when it's happening, and trying to get, let you get in touch with how this happens and to remind you that when you get a gut feeling that is kind of, maybe out of proportion to the actual occurrence, that you can step back, take a deep breath – literally, take a deep breath and say to yourself “Is this out of proportion to what's actually happening here?” and give your brain a chance to, sort of, recalibrate because, um, it's not that easy to do but, the truth is, that when you make these – these gut reactions with the knee-jerk reaction, it can be based on a perception that's completely out of whack with reality and so, I think that – that's a very helpful approach, and in the workshop we try to discuss the tools to get off of the ladder before you jump to a decision that will move you towards a bad action or bad decision.

Karl: Yeah. So, I guess, to me, that kind of reminds me about – you use the traffic example – sometimes, when somebody will cut me off or something in traffic, I'll feel that anger coming up, then I'll say to myself “Well, I don't know what's going on in their day. Maybe something happened. Maybe they are rushing off because they've got somebody sick in the hospital, the loved one or something. No, I don't know.”

Dr. Friedman: It's so hard to do that but you're so right, and I, and the thing is, especially when you're driving in the medical area I think there are a lot of people who are distraught, you know. They're – they're going to see a very ill family member or maybe they have someone in the car. I mean, I'm not mother Teresa and I'm not able to think that at every moment of every day but, the truth is, there are a lot of distraught people driving around here and I really do try to give everybody a little bit of a break. I wanted to say that the last concept in the ‘Threads Among Us,’ is the idea about gratitude, and I know we touched on it a little bit but, the truth is, that I think that we could all benefit with a little bit more appreciation. I know that when you do something wrong you usually get the feedback, right? But, when you do something right, people act sometimes like it's expected or it wasn't even enough or one thing or another, and I think, um, that the truth is, that, in fact, has even been studied by sociologists – that the impact of gratitude is very profound, not only on the recipient who recieves the gratitude but on the person who gives the gratitude, and we try to demonstrate that and give an interactive activity involved with that in the workshop because there's so many people in the chain that we work with and the threads that connect us, actually, and in a patient encounter, and during our day, who get very little positive feedback, you know? I always think about the unit Secretaries, you know? And I'll come into my clinic and I'll see a family yelling at the unit secretary about their having a long wait and they go on, and on, and on, and on, and then when I see them in the room they say “Oh, Dr. Friedman, how are you? Tell me how, what's new with your son, and they're so charming because, I guess, they feel that they're entitled to take it out on the unit secretary and so, I think it's really helpful to express appreciation for everyone who helps you during the day, and it makes a big difference and it makes you have a better day.

Erik: Well, on that note, um, because that sounds like a technique to, kind of, like help combat maybe the social contagion theory.

Dr. Friedman: Yeah. Very much.

Erik: So, when you were talking about it, it was making me wonder at the workshops. I think you had said you – you'll offer up some techniques, um, and like, mindfulness kind of comes to mind to, I don't know – do you ever talk about that with people or really, just any technique to like just kind of come back into yourself and, and, and foster that empathy that you're talking about.

Dr. Friedman: Well, that's the goal of the entire workshop: is to foster empathy. In fact, we try to. We talked about incivilities but, in terms of, that's a negative term, and so we try to frame it in terms of developing empathy for others with mindfulness and kindness, basically, and uh so, those are exactly the goals of this project.

Karl: That's good, and I think it is good for us to point out, like, this topic of professionalism, we often think of it in the context of what you shouldn't do, right? But, equally, and even maybe more important component, is what you should do. Like, the attitude you should have, the minds that you should have, um, and I think it's very good that we have initiatives we're trying to do that. Um, we were talking before the podcast about a new initiative you guys are doing to, kind of, provide some positive incentive for people to demonstrate excellent behavior, so…

Dr. Friedman: Yes. We're really proud of the P.O.P Award, and I hope that you've heard of it. It stands for the ‘Power of Professionalism’ and it's an award that is unique in terms of awards within the Baylor system. We already have professionalism awards for, sort of, lifetime achievements – let's senior people, very senior faculty people win once a year but, the P.O.P Award is totally different because it can be peer-nominated and it can be, it's given on a rolling basis. We can give multiple awards on the same day, and all you have to do is see someone and it can be given to, for anyone, from a medical student to a senior person, to support staff, who you think has done something special. So, the idea is, it shouldn't be really just baseline kindness but something unusual something – something that, you, really impresses you, and then you have to write one to two paragraphs describing the action and submit it to the Center for professionalism. We have a committee that reads them and – and then you can win the award, and the great thing about, there, so, I think there are a lot of great things about it but, one is that it shows appreciation and for positive behavior so, it draws your attention away from the lists of people who have delayed charts or have, or come late to clinic, or start the O.R. late, and it focuses on positive behavior. Plus, we have a little ceremony where we give the award and we usually do it at Grand Rounds so, there's a large audience and I think it inspires the audience because it makes you feel like “Hmph, that's attainable.” Sometimes you think about professionalism as, as you mentioned, that there's so many different ideas of what constitutes professionalism and you think of it as some kind of a unreachable goal but during the ceremony you see you and one of your peers gets it and you also hear the specific actions because we read the actual nomination at the ceremony and then you get a very valuable prize you get this P.O.P lapel pin as well as a box of microwave popcorn, and two tickets to the movie theater, and I have to tell you that as, as simple as this approach has been, some of the recipients have cried when at the ceremony. Many of the students get standing ovations. I mean, it has really been a very powerful, in my opinion, and a powerful innovation and actually, just yesterday, a colleague from UT came because she wants to copy the P.O.P Award there, which I was – I was gratified that she wants to do it but I, I, I think it's another example of appreciative appreciation in the role of appreciation and I think having a more positive work climate, it was better for everyone and – and, you know? We actually surveyed the recipients of the P.O.P Award, and one of the comments I thought was so telling, it said “It shows that the things that some people aren't counting actually matter,” and you know, I think Einstein has a quote about that, that you know, you can think sometimes the things that – um...

Karl: “Not everything that matters can be counted, and not everything that can be counted – ”

Dr. Friedman:  “ – matters!”

Erik: He’s a physicist.

Dr. Friedman: Oh. Well, there you go!

(All laugh.)

Dr. Friedman: Well, I'm certainly not a physicist.

Erik: Me neither.

(Dr. Friedman laughs.)

Karl: I am not either, so…

Dr. Friedman: No, but isn't that a great quote? Because it seems to be, in fact, that's exactly what – what professionalism is about: it's not so easy to measure, it's not so easy to, you know, make little check marks, you know, to – to get points or anything but it's this general culture and it's your behavior, it's your mind, I think you use the term mindset, and it really is a mindset it's – it's recognizing that you want to be kind and, I mean, I believe that everyone got into this because they want to help people, I mean, as corny as that sounds ,and as a cliché that everyone used during their medical school interviews. I actually think everybody means it, and I think that our, my goal, is to make it easier to the best of my limited ability to let people continue to keep that goal in their heart because there are a lot of discouraging distractors in our environment and so, I think keeping professionalism foremost in your mind is extremely helpful.

Karl: That sounds very good. So, I guess to close, I figure we take a, kind of, broader scope view and just ask you over your career. How have you, kind of, seen attitudes and ideas, and even awareness, towards professionalism change?

Dr. Friedman: Hmm. Well, I've actually have always really cared about professionalism and I think that you know there have always been examples of people with poor professionalism and so I don't think this new, this new focus on professionalism is actually new, I mean, I, I, I think, as a beginning medical student, I remember seeing things that I would say “I am never gonna do that,” you know? You know what I mean? So, I'm not sure that, that so much has changed I, I, also I guess, I'd like to say a word about millennial learners, you know, that's what people talk about a lot and I am, and I think there are differences in the mental outlook and the approach to life between the old days which weren't, aren't really the good old days but the old days, and the current millennial mindset but, something that kind of annoys me is when people say “Oh, the Millennials are like precious little snowflakes,” you know? “They have to have everything perfect” but, you know, the truth is, I think we're all precious little snowflakes. I'm not kidding. I think that the faculty, when they get negative feedback or what we call constructive input, they take, they take it very personally and they take it very seriously so, I, I guess, I, that's something that I – I'm not that fond of the this characterization of the Millennials as being perfect little precious little snowflakes that can't handle any adversity because I, I don't think it's true and I definitely don't think that the Millennials don't care or aren't hard-working or any of those things that you sometimes hear or see written about Millennials because actually I've been quite impressed. That, that's not the case.

Karl: Okay.

Erik: Well, I was going to ask. So, do you feel like, uh, well there's any, any mentality that we have is obviously thanks to the quote as you said older generation, the Boomers, the Gen-X, so we are who we are because of great teachers, um, and…

Dr. Friedman: That's it. That's a really good point. Then, I have read some of the things about Millennials. They say, you know, they're your children, so you know, so I mean, I think we own it, so I mean, where we should own it so, I'm agreeing with you completely.

Erik: But I was, I was going to ask, uh, do you feel, I mean it's hard to quantify, and you can't quantify it but, you feel like, what is a change maybe that you've seen between just now and as you said the old days? If you can just think of one example.

Dr. Friedman: I'm I have a very vivid – well, I don't know if this is the kind of type of category you're thinking about but for me the biggest thing is the commercialization of medicine. You know, my entire career I, and maybe I am a little, little wacky but, honestly, I never thought about the financial aspect. I mean, I knew you had to earn money. I knew you had to pay rent, you have to pay for utilities, you have to pay for your staff, I mean, I wasn't lying to all of that but it was a very insignificant consideration in my part and I was always proud that I tried to make the best decision for every patient every single day, and I believe that we are still doing that but there is so much emphasis on rvu production and those elements and efficiency but not just efficiencies to make patient care faster, or more but, merely to increase output these things are, I find personally discouraging and so I, I wish that there would be a way to mitigate some of that. I mean, I certainly recognize that the reality is, you know, whatever they say no margin no mission but I want to make sure that we don't have a profit above people, you know? So, to use two clichés.

Erik: And you feel like that is more acute now than it was maybe when you were training or?

Dr. Friedman: Oh, absolutely. Absolutely, and I mean, you know when I don't feel, I'm not a scholar on medical economics or medical policy so maybe I don't understand all of the ramifications but, I can say, as a practicing clinician, for a long time, I was oblivious to it. Now, probably being totally oblivious isn't the right approach, you know, you're, because you can't manage resources effectively and thoughtfully so, I mean, I think that there have been benefits to having more of an awakening about the economic impact of the practice of medicine but I think that it has shifted perhaps overboard and that I think that the majority of people in the workforce honestly are caring, compassionate, empathetic, professional people, and I feel that talking about the technical money aspects is sort of a disappointment.

Karl: I can see that, and I guess, um, kind of, to tie it all back together: the thing that kind of protects you from that is keeping this attitude of what am I as a professional, right? What's a medical professional? What's the profession about? It's about people. It's about taking care of the patient, right? And so, hopefully if you kind of keep that in mind and you keep your professionalism, that will always be your first priority.

Dr. Friedman: And that is exactly it. You know, what I say is that professionalism is really our life raft because if you hold on to that, you know, you won't get off track because, you know, especially if you surround yourself – which I strongly against – that surround yourself with negative, cynical people, um, you're going to be discouraged but the truth is, this is a very beautiful career and, um, when you don't, you think back at night you say, you don't say to yourself “Oh, I made 10 more RV use today.” No, you've said yourself wow that kid is reading more books because I talked to him about a certain author and during my clinic visit or you know any of the incredible and interchanges we have with colleagues or with patients and families and that's what really does bring you joy and I, I mean I'm sure listening to this it sounds perhaps too flowery or something but the truth is, I didn't get joy out of that and I, I do hold on to that and, and, and I have plenty of bad days or unfortunate interactions but the idea is to hang on to your professionalism. I think you've capsulized it very well.

Karl: Thank you. That was a very beautiful way to end it. Thank you for your time Dr. Friedman.

Erik: Yeah, thank you so much.

Dr. Friedman: Thank you so much and thanks again for this, um, creating this podcast. I think it's going to be a very impactful opportunity.

Outro

Jennifer: Alright. That's it for now. We'd like to thank everyone out there who took the time to listen to this episode of the podcast. Special thanks to Eric and Carl for writing that episode. Thank you to our faculty advisor Dr. Poythress for helping us put everything together. Thank you to the Baylor Communications department for helping with the production and the website and thank you again to Dr. Freedman for taking the time to be interviewed by us. We hope everyone enjoyed it and we hope you tune in again soon. Goodbye for now. [Music]