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Welcome to the “People Always, Patients Sometimes” podcast, a production of Spencer Health Solutions. Healthcare has come to a crossroads and it’s time to start listening to new ideas that challenge our “always done it that way” thinking. We hope you enjoy our conversations with the disruptors, innovators and transformers in clinical trials and healthcare.
In this episode, we have a conversation with Dr. David Zaas, president of Duke Raleigh Hospital. Shortly after he gave a keynote at a meeting of the ACRP, the Association of Clinical Research Professionals, he spoke to me about his experience as both a patient and a participant in a clinical trial when he discovered that he had Leukemia. Our conversation also includes his thoughts on compassion as a trainable skill for healthcare professionals and the need for patients to be presented with all options so they can decide what is their best care with their healthcare professional. I hope you enjoy this episode of the “People Always, Patients Sometimes” podcast.
Janet Kennedy: 01:12 At the ACRP regional meeting, we started the session with a keynote that was really a gut punch and it was about how a physician experienced a life-threatening health situation and how that impacted him as a health leader. Welcome to the podcast, Dr. David Zaas, President of the Duke Raleigh Hospital.
David Zaas: 01:36 Thank you.
Janet Kennedy: 01:37 You have been in healthcare for decades and suddenly you found yourself on the other side of the physicians’ table. What was that like?
David Zaas: 01:47 The initial was unbelievably shocking. As a physician, and I think many clinicians and healthcare, we think we’re invincible. We care so much for others, we don’t think about our own vulnerability. We don’t think about our own mortality. When I was diagnosed with leukemia, I realized all of a sudden that I was no longer invincible, I was now a patient. I was now dependent on others to really help me in this battle.
Janet Kennedy: 02:19 Was this a situation where you had been doing the proper thing as a patient, having your annual physicals, all along? Or were you thinking that you had a pretty good read on your own health and it wasn’t that necessary and this was a big surprise?
David Zaas: 02:34 So I think I’m not alone, and most physicians we’re not very good at seeing doctors. I really didn’t think I needed an annual physical. I was busy working, taking care of the family. I got my flu shots. I was otherwise healthy and didn’t take any medicines. You don’t think about yourself when you’re carrying so much for others. I knew something was wrong for weeks. I wasn’t feeling right. When you can’t breathe, when you’re trying to run right, you run harder. You try to push through it. Within four to six weeks, I knew something was really wrong. I knew that I needed help getting our physicians and friends to help with some of that testing in labs really confirmed that something was wrong and that I had leukemia. I was fortunate that I had great access to care, so it was really able to enter the system quickly. But I was in a real crisis. I realized if I didn’t get care soon I would be facing my own mortality.
Janet Kennedy: 03:40 And as a father of two young boys and a husband you mentioned something in your presentation that really stuck with me. It was that you really didn’t think as a physician anymore.
David Zaas: 03:54 You know, as a physician and as a leader, as a scientist, right? I love to question. I love to push myself and our team. As a patient. I wanted to care for my family. I needed to trust others to help guide me down that path. And I didn’t want to question and challenge. I wanted to be led. I wanted to have that trust. And I was fortunate, credit to my care team, to my wife, to the physicians and nurses. I had an amazing team, helped me along that journey. So I didn’t want to be the expert on leukemia. I wanted to be a father and a husband.
Janet Kennedy: 04:43 In listening to patient communities, I’m hearing them say you have to become your own advocate. You have to push, you have to question, you have to research and don’t necessarily trust in essence the one right answer that there could be multiple answers. So how do you balance your own personal experience and your need to trust and to let others care for you versus the patients who really feel the need to, “I have to be the manager of my own health.”
David Zaas: 05:15 Every situation is different. I think that trust in your care team is absolutely critical and if you have that trust in the relationship right, then you can safely question and challenge and really be part of that. That’s very different than if you were challenging or questioning without that trust. What we’ve tried to encourage our care teams, right? We need to have that relationship with our patients and families. We need to be that advocate and that partner with the families and not discourage. We would encourage every and family to ride be that advocate, but I really believe in addition to providing all of our patients and families with the information we talked today about the importance of how do we demonstrate character in order to have trust and we need to do both. Information alone is not enough. Information combined with the things that drive that character, including integrity and transparency and compassion and the ability to listen, I think are critical. I think science is really complicated and even as a physician, I’m not the expert, but we can drive and promote trust while we encourage patients to do and to strive for the best outcome and the most information at the same time.
Janet Kennedy: 06:50 In some ways I hear that caregivers are this unique type of individual that has this beautifully balanced set of interpersonal skills and on the other hand, I’m thinking to myself, there are curmudgeons everywhere. There are people who generally don’t have good social skills or might be a little brusque, that sort of thing, and certainly, medicine does have its share of egos. You mentioned that you think compassion is something that is a skill that can be learned. How do you balance the very compassionate caregiver on the one side with someone who may not have those traditional bedside manner techniques? How do you evolve that person or should they just be in the lab?
David Zaas: 07:41 I think it’s really important to realize we all bring a different skill set to start on this journey as part of the care teams. We can all get better. We can all build skills and competencies, right? We can. We know we build our knowledge throughout our education and training. I think we need to be as intentional to build skills around compassion and relationships and communication. The focus on those parts of equal importance to the competencies will create some of that trust. When we look at caregivers, they’re in stressful situations. If we look, a significant number of our caregivers really grow despite those challenging circumstances. What drives that growth? We know caregivers need to develop the ability to depend on others. We need others along this journey. We can’t do it ourselves. We know as caregivers that are going to need the change, their roles and they need to be able to adapt. We know as caregivers they need to be that advocates and that voice that the patient is either unwilling or to do in that part of the care journey. I truly believe that if we give our teams these skills of compassion and we partner with caregivers, that we will actually help strengthen them and help them be more successful in their vital role along this journey,
Janet Kennedy: 09:16 One of the things that really impacted me was your discussion of it isn’t really just about the patient. It’s really about their whole ecosystem. It’s their family, their friends, and their support system. Yet we do know that there are a lot of people in the United States who are for all intents and purposes alone. So what happens when a patient comes in who really doesn’t have those familial friends’ support systems? How do you compensate for that?
David Zaas: 09:44 So that is a really tough question that we’re internally debating, right? We know that patients that have that social support network and that ecosystem, as you described, are gonna have better outcomes. They’re more compliant. They have fewer complications that tend to have better survival. When that doesn’t exist and we realize it’s critical, how do we help create that? What is the surrogate? How do we create that team that I think every patient needs during some of these difficult journeys? I don’t think we know the answer to what that team, but I think the first step is recognizing that that social support and team around the individual are critical. What does that, how does that change the role of our current caregivers? What do we need to do differently with communities and family and things outside of the hospital to create it? I don’t think we know the answer, but I think the first step is recognizing that the team is important and then how we help people create their team, which is going to be unique based on each individual circumstances.
Janet Kennedy: 10:55 I do think that this is a question that isn’t the responsibility just of the hospital system, the caregiver, the physician as a, as a nation. As a larger community, this is definitely something we need to look at it. When, when you think about, for instance, seniors living at home, meals on wheels filled that so there probably need to be some more discussions around ‘how do we help those folks that are alone’? When we look at suicide, challenges, a lot of times it’s because people don’t have that support system. So I do think this is a much bigger question. I’m not gonna make you answer, but it’s one that as human beings, we need to be talking about.
David Zaas: 11:39 As we transform our delivery systems to say we are not just in the business of healthcare delivery. If we are in the business of truly improving the health of our communities, we’re going to need to figure out this answer. And I think that for us it’s critical to recognize that the outcomes we need to be striving for are not just the best healthcare delivery, it’s the best health outcomes. And we may not be the sole solution and the only responsibility, but are we uniquely positioned to help drive that conversation and to help create the dialogue to really make that impact? Because we can have the greatest technology and innovation and if we have an individual that doesn’t have that team and that support, then we’re not going to get the outcomes that we know are possible and we’re not going to be the best stewards of their health and of the resources available in our community.
David Zaas: 12:35 So I think it’s important that we take on that challenge and realize we need to partner with our communities and others to really improve health.
Janet Kennedy: 12:44 I absolutely agree. I’d like to ask you a question about what it was like being a participant in a clinical trial. You did have an advantage in that, you knew to be asking about that and finding out what was out there and you ended up in a clinical trial, not where you live. You had to travel and be a part of that. Based on your experience in being in another city with your family at home or sometimes coming to see you, what was that like and how has it informed in how you operate now as a healthcare practitioner?
David Zaas: 13:18 As a physician, I never realized the importance of clinical research to patients. I appreciated their involvement. I thought it was a critical part of our delivery system. As a patient, it was absolutely required for me to tackle this challenge. I knew the odds were against me. I knew that it had a bad disease and current treatments were limited. I was dependent on clinical research psychologically to believe that I was doing everything I could to win this battle to survive both for myself and for my kids. I think if we realize how important that was to me and translate that into how important is access to research to patients today, and that is not just patients with really bad prognoses, right? There may be research that improves the quality of life. As a patient, I just needed to know I was doing everything. I absolutely could read my individual behaviors in the choices that we made and research was absolutely critical to be able to do that back as a physician and as a leader today, how do I ensure that every patients has those same benefits of the research, even if we don’t know if it will have its intended clinical outcome, the psychological benefit to patients and families to know that they are doing everything they can in order to get the best outcome possible is what they should expect of us as members of their care team.
Janet Kennedy: 14:59 So who should have that knowledge? Should every individual physician be totally boned up on everything that’s happening in their field, regarding clinical trials? Or do you think that hospitals and or even physician practices should have someone on staff who is kind of an expert in at least researching and knowing and pulling that information?
David Zaas: 15:21 So I think as a delivery system around the country, we have lots of different models based on resources, based on rural versus urban communities and community in academic hospitals. I’m not sure there is a single solution. I think we need to adopt the principles that we have the privilege of serving patients and families. We as part of that privilege, how do we ensure they have access to any and all treatment options that may be able to improve their outcomes? In some areas and systems like ours, specialization among providers has become more common as knowledge grows and it’s become almost a requirement. I think the solution is going to be different for different disease groups in different systems. The principle thought of ensuring patients should have access to whatever meets their needs and whatever improves their outcomes, whether that’s delivered locally or whether it means traveling. What is the patient as our customer, what are their needs and how do we ensure that? I think we can do better as a community of making it transparent of what those options are and what are those discoveries and where is that research and innovation? And I think through both the engagement of our providers from our research coordinators, from technology and web-based tools, how do we ensure that we make that information available to patients who are seeking it? And that may not be all, but for those that are, how does that become part of our opportunity to even better meet their needs?
Janet Kennedy: 17:12 Thank you for downloading this episode of the “People Always, Patients Sometimes” podcast, a production of Spencer Health Solutions. We are dedicated to the idea that the patient should always be at the heart of everything we do. Thanks again for listening and please take a moment to subscribe to the podcast to make sure that you don’t miss an episode. And if you’ve got time, a rating and a review on iTunes would be greatly appreciated.