Dr. Jeffrey Balser: How Great Leaders Handle Hard Things

As an accomplished doctor and the CEO of one of the best medical institutions in the world, where did that spark start for you? You know, I think it partly happened through tragedy. Mmm. Say more about that. Almost anything in life you can learn to do better, including grief. Regardless of our profession, we have a tendency to bring life home. Coming home at night is part of the job. One of the things you learn in critical care medicine emotionally is how to deal with failure and then go to the next room and function at 100%. I can't imagine with the number of people that you help with terminal illness, you've probably been close to a lot of loss. Yeah, and maybe having my own losses has helped me be more present for the people that I'm trying to help when they're going through it. I don't think we navigate adversity successfully without some level of hope. And I'm not sure hope can really exist without some level of optimism. And optimism really requires lived experience. There's something about the human spirit. There's this instinctive optimism around survival. It's amazing what the human experience can survive and learn to thrive in. I think that captures my form of hope. We've been taught everything except how to be human. I'm Miles Adcox and this podcast turns a raw experience into practical wisdom. So if you're ready to stop performing your life and start participating in it, you're in the right place. This is human school. Today's guest is someone who has spent his career building systems of care so that when a patient walks in, they feel more human, not less. He's a hospital executive, a physician and a scientist at heart. From doing research on cardiac rhythms and pharmacogenomics, to stepping into the role of CEO over a vast medical center. He's one of the few who still speaks in both the language of data and the language of people. He's considered the architect of change at Vanderbilt, restructuring the medical center, expanding footprint, bringing genomics and informatics into daily practice. And yet he often reminds us that culture and relationships are what hold everything together. I'm excited to sit with someone whose task is enormous, to lead medicine's future, but whose compass remains grounded in empathy, science and purpose. Please welcome physician, leader, innovator and my friend, Dr. Jeffrey Balser. It's great to be here. Welcome my friend, it's glad to have you. Yeah. Well, I've been looking forward to this. I put you on a list when we were dreaming about this show, because I want to talk to people from all different walks of life, but especially people who I've paid attention to, who have influenced me in some kind of way. And I've had the privilege of sitting with you and we've had coffee a few times, and you were kind of having me to your office a few years ago when I was at a pivotal point in my entrepreneurship and in my leadership, especially in behavioral health. And you gave me some great leadership wisdom that day. And I thought if I ever get a chance to hear more from you, I'd love to do that, both from your science perspective and your leadership perspective. But I want to start because I'm just curious what sparks people to get into what they love to do. And especially with you choosing medicine, where did that spark start for you? Well, I don't think it was what I put in my essay when I applied to medical school. Because we all tend to write those things thinking about what they want to hear. I actually sort of backed my way into medicine. What I really liked was math. And so I went to engineering school at Tulane. And yet I sort of had this inkling that the softer side of life, the more human side was something I didn't want to let go of. And so I did biomedical engineering so I could hedge my bets. And if I wanted to go to medical school, I could still go to medical school because you satisfy those pre-med requirements doing that engineering major. And that ended up being what was that. That was what happened. And I kind of went all through medical school trying to figure out how to reconcile those two sides of my brain. Because I really love process and engineering thinking around how to fix problems. But there's this part of me that tugs at me and wants me also to stay with the people at some level and not become a guy that sits in a back room and just thinks. And I think that's sort of how I ended up in anesthesiology yet also being an ICU doctor. So I trained in both. And anesthesiology is, patients never argue with you while they're asleep. It never happens. What is it you were saying, ma'am? I'm squeezing this around. That's motivation. And yet then I ended up doing extra training so I could work in the ICU. And that's like a big family. And I kind of needed both. Well, backing up either further than that because I think about this profession becoming a doctor is one, it seems like it's a staple foundation profession that as a kid, you can go to the toy store, you can find the kid. And you can pretend and play. I think at some point every kid tries that hat on. Did that start really early for you? Did you know when you were little or when did it happen along the journey that you're like, I think I want to pursue this? I think it partly happened because actually through tragedy, my mother died when I was 16. And her family doctor, our family doctor, but he was her doctor, sort of got more involved with me personally at that time and showed a lot of interest in me and would invite me on rounds and to come with him to the hospital on Saturday mornings. And I'd ground with him. Is he a family friend or he became a family friend when he was caring for your mom? Yeah. And he was friends with my dad too. And he just got me interested in medicine because I don't think I was instinctively drawn toward medicine. I mean, there is always this push, if you're a kid who's good in science and math, why don't you be a doctor? I mean, every parent has said that to a child who's good at science and math, but I had to experiment with it more. But I think that kind of exposure was really important in my shaping my thinking around medicine. I knew I didn't want to do exactly what he did because seeing patients in clinic wasn't really what it spoke to me. It was more the blend of being able to do the really kind of analytical process things and then having some people stuff blended in with that. So you start even knew then that it needed to be a little more well-rounded. And I can't imagine 16 what that must have been like. Was that a tragedy happened all at once or was that a long build up? Was she sick for a while? She was sick for a while. It started actually when I was in the sixth grade. We were all sitting in the living room watching the TV show and I was an only child. We heard a noise back in the bedroom because mom had gotten up to do something with the laundry and we went in there and she was now I understand she was seizing. She was having a grand mal seizure and from that point on she wasn't right. And for a while they were calling it MS. They were doing all kinds of diagnostic tests and then eventually it became clear she had cancer. But she survived with for a while but eventually it took her. It was hard, especially as an only child. And that's definitely shaped my personality. Where was that? Where'd you grow up? Evansville, Indiana. Okay. It was a five high school town. And your mom's name? Cindy. Cindy. Okay. So Cindy that would left a pretty big mark on a young man I'm sure at that age. Did you end up growing up with your dad from there? My dad and my dad's mother, my grandmother kind of stepped in. She lived in Evansville and sweet dinner at her house every night after my mom died and she was kind of a surrogate parent for me too. And my dad went through hard times after that happened. And so there were times as a older teenager that I kind of felt like I was on my own. Because you know what happens when something like that happens to a parent they go through their own crisis. Yeah. So I know it can take, you know, my business and I'll talk soon about how we've kind of overlapped in the community a little bit with me being in behavioral health in a much smaller way than you guys are with what you do at Vanderbilt. But you've been kind to anybody that's in your neighborhood that does similar things. You care about people and care about you. You aren't enough of this period. So we want that tent to keep getting bigger. For sure. I hope so as well. But I think back to a certain a couple of times in my timeline when I was a young man where I remember things that I did, activities that I did that began to imprint me on who I would ultimately become. And it sounds like making those rounds with what was it, Dr. Nicholson? With Dr. Nicholson. It was a pretty impactful experience back then. Yeah, I got to come full circle a little because about 10 years ago his family reached out to me because he needed healthcare that he couldn't get in Evansville. And so I had the whole family down to Vanderbilt and wow, got to be with him in the hospital while he was getting treated. And that was pretty fulfilling. I would say, yeah, full circle. And he talked about how your mom passing at that age kind of helped shape your personality, dealing with that adversity. So young, how would you describe what way? How did that help shape you? Yeah, it actually, oddly, people always think, well, he went into medicine because his mom died of cancer. That's probably not true. I think it actually shaped how I think about dealing with hard stuff, dealing with personal tragedy. Because as we go through life, we have these things, right? And it helped me getting through that and actually not doing it well at times, putting things away and not dealing with them. Sometimes you got to clean out the garage, you know? And I learned from dealing with that. You know, I'm in my mid 60s, so it's easier to talk about that stuff now, having been through those sorts of things. And I can look back on it and see how having not dealt with some of the grief and anger around all of that in a constructive way helped me realize I needed to handle it a little differently as I encountered those sorts of experiences. Later, like for example, my wife and I lost a full term child in a full term stillbirth when I was a senior medical student, which was just an awful thing to go through. But I found myself thinking a lot about what I'd been through with my mom when we were going through that. Almost anything in life you can learn to do better, including grief. It doesn't make it easier, but it maybe helps the outcome when you come out the other side. I'm curious about that. I think that's really well said. And when I started out in my profession, in substance use care, and we were more on the primary side of that, so we were working with people when they were a little bit more critical and needed to come into residential programming. And I had a mentor at the time tell me if you're going to spend a career in this business, you need to get some dark suits because you're going to lose some people. And they were, he was right. You know, I've been to more than my fair share of funerals and working with my space. And I can't imagine with the number of people that you help with terminal illness and Vanderbilt and probably along the way as a physician, you've probably been close to a lot of loss. Yeah, I have. Yeah. And maybe having my own losses has helped me manage that emotionally and maybe be more present for the people that I'm trying to help when they're going through it. It's a heck of a way to get good at something. Well, I think we have to live life, right? Honestly, it's compelling. And that's what this whole show is all about is I do think that there are really, I've been fortunate that my career has put me around a lot of interesting people, yours as well. I mean, we share a lot of the similar circles and because of the influence that we both have with what we do vocationally, we end up overlapping with the entertainment community and the sports community and all these people that as another other professions when we're kids, we kind of look up to and we and then you realize when you're around people that they're just as human as the rest of us. We build this thing in our head and of what we think they are, but we're very human. But I do think that people who have high pressure professions and do a lot of things that are pretty important and meaningful in the world have been able to hopefully to extract some things out of their profession and out of their life and weave it into how to become a better human in the process. Because that's what's made my profession sustainable. I am a better human for it, but it wasn't always that way. Like what you said, there was times when it came at a cost because I work in the emotional health profession and all the things that I teach, often I didn't have access to them early as an entrepreneur when I was losing sleep and feeling this financial stress and I would come home and wasn't the same guy that all of my clients might have gotten, I have a patient somebody I got. And I had to really learn how to get congruent in those two lanes. And it's still the process. I'm still working on it. You can never get good enough at that. It's coming home at night is part of the job. Tell me more about that. I hadn't thought about it in that frame. Well, you know, I had, I was raising kids and had a family and I found that if I came home at night and I always, Melindo, I used to say, I can just feel your intensity. It's almost like I want to go in the other room because it's hard to be around you when you're, it's like there's an aura of intensity around you when you come home. And I had to get to learn how to not bring that home with me. And you don't succeed 100% at that ever. But at least you become more conscious of it. And you don't have to share everything that happened at work, right? Sure, big things that I'm dealing with at work. Melinda and I talk about period and the story, we talk about it. But how I broach it and when I choose to raise it and how I, how I do that has changed remarkably over the last 40 years. I'd love to hear more about that. Because as a young man, I just came home and dumped it. Do you know what I was dealing with at work? Can you believe me, idiot? I don't know. And that actually turns out not to be very helpful to a spouse because the spouse is sitting there all day long not knowing any of the context and they just think you're miserable. And Melinda's an impact. So I was doing that to her without any thought about how she was going to experience that. Right? So it took me a long time to kind of realize that I wanted her partnership, but I needed to be more thoughtful so that she could help me more. I think the intensity is a good way to think about that because I might have called it like I will bring stress home or I will bring whatever. But intensity, if you're a problem solver, which if you're in a leadership role, you're a problem solver, then the problem solving doesn't start, doesn't stop. And so sometimes you walk out the door, there's still, there's never not a to do this. You're never going to complete that. Never. And so, and balance feels like such a myth, you know, at times. So I handed in my phone and I keep wanting to grab your detox and off your technology right now. Pockets are still vibrating, there's no phone in there. But I do think we all, regardless of our profession, we have a tendency to bring life home and bring work home and home should be a sanctuary in some ways. And I certainly, I think spouse, you know, partners can be good places for us to vent. But I do think it's so important to step back and recognize that they've also had a day. Yeah. And how can I meet them where they are without having to offload everything on top of this really wise. If you were, and that's kind of what I want to do is we tell your story is cherry pick certain things that I think we might underestimate because we've figured out a life hack to make that better. And but there's a lot of people coming along behind us that are still coming home and don't know how to take that hat off. Yeah. But if you were advising somebody younger that was just getting into new new position or something and they're like, Oh, just bring in my stress home every night and it's not helping my marriage. I guess what you use the term take my head off. I don't think that taking it off completely works. I actually think you need to wear it. Turn it sideways. Okay. So if I take about my own relationship, one of the reasons my marriage works is because we are not exactly alike. I'm an analytical type A and Melinda is an empathic care care person. She would if she were a physician, she wouldn't be a critical care doctor. She'd be, you know, a pediatrician, a family doctor. She's she wants to take care of people. So if I come in the house and I'm like raging, it's really hard to take care of somebody like that. Right. So what I found is it's more effective for both of us if I come home and I don't get into that right away. But then I do share it. But I try to take some of the emotion out of I try to calm myself down first. And then I start to introduce to her what I'm dealing with because I deeply value her partnership and thinking through it. And I know I do my job a lot better because she helps me. In fact, I tell people when I step down from my job someday, the first person I have to thank is her. There's nothing important that's ever happened to Vanderbilt that she hasn't been talking to me about. And I make different decisions sometimes. I tell you my favorite one, please. So did you notice that during COVID-19, the parks in Nashville stayed open? Don't know that cities didn't have their parks open. So it was a Saturday morning. And the mayor called me and said, Jeff, I think we need to shut the city down. Will you help me? And I'm like, sure, I agree. We need to do something here. And he said, could you write a shutdown order for me? So I sat on my couch. And on a Saturday morning and drafted the city's shutdown order. And I was reading it to Melinda and some of the cities I was borrowing content from out west that had already shut down had shut all public spaces, parks. She said, if you shut the parks down, we will all lose our minds. We need to be outside. How dangerous is it really? And the answer was, we didn't think it was that dangerous. And I kept the parks open. Now, when I sent that back to the mayor's office, I was assuming 15 people would edit it and it would look like nothing like what I had written. And when it came out of the newspaper four or five days later, it was actually verbatim what I had sent him. Wow. So what I always tell people is Melinda Balls are kept the parks open. And I wouldn't have thought to do it. So instinctual. And I happened to know Melinda, she's an angel. So I get that. But I can see why she would think about that. It's very difficult to heal in the same environment that broke you. That's why OnSight created six day immersive workshops where you can step away from the noise and give yourself the time and space to finally listen to what's underneath. So whether you come to Tennessee or California, we're here to welcome you with healing hospitality. Learn more at experienceonsight.com. Well, I do want to talk about that period because it's such an interesting period for all of us. But I want you to take me back to medical school now. And you had decided to how do I get my left in my right brain to work together and you pivoted into what field again? Well, look, I got it wrong actually. I was trying to follow my mentor at the time who was a cardiologist who I just so looked up to. And to be a cardiologist, you have to be an internal medicine doc, right? And so you do that first and you do internal medicine, you have patients in clinic, it's like you're a family doctor. And then you do cardiology. Well, I got onto that pathway and I went to Johns Hopkins to do my training and I hated it. I was miserable. And I realized I just had to make a change. It was so hard because I had so much positive reinforcement around what I was doing because I'd already written papers and published on the area that I was going into. And actually one of the people at Johns Hopkins who I was dealing with at the time actually thought I needed a psychiatry referral for getting out of the program. Wow. We said there has to be something wrong with you that you don't want to do this. So is it just very unusual for somebody, it's hard to probably get there. And when somebody is awfully hard to get there and so to change in the middle was unthinkable. And and yet I realized when I was in that internship, the thing I liked the most was the ICU. I loved the ICU. And it's not surprising that a left hemisphere dominant only child that likes analytics would like to be able to press buttons and read monitors and inject drugs and have the blood pressure go up and down like within 10 seconds, not three days later if somebody actually took the prescription you wrote. So that's the track I ended up in. And one of the ways you could do that is do anesthesiology where you learn to do that in the operating room and then you do a fellowship and you can then do it in an ICU setting. And so I did it and I did it. I focused on patients with heart disease. So I was what they call a cardiac anesthesiologist. So all of my cases were open heart cases. And then I took care of patients in a in an ICU that was just for cardiac surgery patients. I would go between those two activities. I do a week in the ICU where I was the doctor in charge and then I would do days in the OR where I do heart transplants and bypass surgeries and what about that did you love? It was exciting. It was intellectually very challenging. It had just enough people stuff. You know, I was the last person people spoke to and talked with before they went into that surgery and some of them wouldn't survive. So that was pretty meaningful. Wow. You know, I had to hold babies that moms were saying goodbye to. So I sort of held on to that people connection. But yet when I was in the operating room, it was like it felt like flying a spaceship. With everything you had to know and retain and deal with in real time. Livers, giving drugs, doing procedures, sticking the lines in people's jugular veins, floating catheters into the heart. I mean, you're kind of doing all that at once and you have a team of people actually. That is so intense. It was very intense and time would go by just like that. I'd look up and it was three in the morning. I felt like it was new. Wow. So it's a young person sport. Because the hours are long and it's very intense, but I really loved it. When you say it's a young person sport, is it really do you really try to put younger positions in those roles because the energy consumption or I think it's more that after you've done it for a while, you start to get tired and folks tend to start to blend it with other things kind of like I did. I started to move more and more into administration. That's how I ended up a CEO. It wasn't the first administrative job I had in healthcare. I also had this research program that I would spend a week with my laboratory guiding those efforts and then I'd come back and I'd be in the clinical environment for a week and I was back and forth. So I had a way to mitigate that but eventually I became a full-time administrator. When you got into the administrative role, do you miss practicing? Ever? People ask me that all the time and I really didn't. I would caveat that with there were times when I would have loved being able to jam a seven gauge into tracheal tube down somebody's throat but that's sort of a different issue. In fact, there was one time after I was already done taking care of patients where I was in a conference room at Vanderbilt and I heard a code blue down the hall and I assumed somebody had come and put the breathing tube in the patient and it was all fine and then I heard the code blue again. So no one had come and so I kind of got up and walked down the hall and people were in there and I just put the breathing tube in the patient and they really didn't know who I was and I just said, oh I'm a member of the anesthesia department. I can help you here and when the anesthesia team showed up they actually knew who I was because I had been the chair of the department there. Dr. Pauls, what are you doing here? You're not supposed to be. That was kind of fun but you never lose those reflexes. I'll never forget how to do those things because you just get to the point where it's like riding a bicycle. You get so practiced at it that it never leaves you. But I find to your question and administrative life, the complexity is greater greater than in any of the things I was doing clinically. The difference is the rewards take a lot longer to see and that's what is often hard for physicians as they move from clinical care to administration. Clinical care you get to see in real time, especially in critical care, I just saved that patient's life. Boom. Real time results. Real time results, real time gratification. How often do you feel that in administration? Rare. Really rare. I had a meeting today and we didn't yell at each other. That's a successful day. The transition for me moving into administration was the learning that the pace of reward and success, even though I would argue the rewards are even greater, they're just longer term. You kind of have to, for me that was my emotional learn. But the complexity and challenge, the intellectual challenges, every bit is great if not greater, I think. Do you recall, and I want to get into that administrative side because we're almost there, and I want to get that story about how you got back to Vanderbilt, but do you recall a story? You struck me when you said how many conversations you've had, bedside with people, and sometimes it was the last conversation they had when I went under. Do you recall one that just sticks with you? Is it really meaningful? Anything somebody said or didn't say? Or did you pick up any trends of like this is kind of what people were talking about as I think about, and a lot of times I guess they didn't know it was end of life. They were going into maybe a hopefully a life-saving surgery, and maybe it didn't pan out, but did you pick up on where people, what kind of state people were in then? You know, when it was the person, and I was talking to them before I started putting in the IVs and getting them ready for surgery, I found almost universally people were hopeful. They weren't looking at me like, you know, I might die in there, you know. That almost is never where people were. They were nervous about what they were about to experience, but my learn from that is almost everybody instinctively feels that they are going to make it. Interesting. It must have been really rare that I had somebody looking at me. I know I'm not going to wake up. Even though the chances in some of the surgeries I was participating in were 50-50, they didn't feel that. Maybe that's why they were there. Maybe you couldn't even agree to the procedure if you were that pessimistic, but there's something about the human spirit. There's this instinctive optimism around survival. It was different when I was doing baby hearts because those parents were just dying inside to hand me that child. The anesthesiologist is a person that carries the baby into the operating room before the surgeons start to do their thing. I just, the things to have to hear moms and dads say goodbye to their children. Then were you a parent when you were doing this? I became a parent while I was doing that. I found it to be, it was emotionally difficult to begin with, but when I had my own children, it was, I found it actually impossible to deal with it. I stopped actually when I was finished with my training, I stopped doing neonates and just focused on adult care, which you could do, you could bifurcate. I've always had this enormous respect for the people that do what I did and still do it, but six month old. Because A, it's even harder because can you imagine putting a big IV into a vein you can't even see? I mean, the skills these people have, they're literally savants, but the emotional side is also just super powerful. Did they give you any training like when you're in medical and say, here's how to deal with the emotions of this? It was never explicit. It was just practiced. I was thinking the last night about that because I knew what this conversation was going to be about and I thought you might ask me about that. One of the things you learn in critical care medicine emotionally is how to deal with failure and then go to the next room and function at 100% even though you just failed in the room prior to that. So you're in a patient's room taking care of them, they're having cardiac arrest, you make a bunch of decisions and it goes poorly. Patients either in a coma or is going to die and you feel partly responsible because you can look at that and go, you know, you should have picked up on that, maybe should have done that sooner and you have to learn to then walk to the next room where there's another cardiac arrest and completely put that away. Is it compartmentalized at box? Yeah, I call it putting it in the parking lot. That's my imaginary. You just have to completely leave it because otherwise you can't do everything you need to do for the next patient. And honestly, Miles, that just takes time. You just have to go through that a lot before you get the teacher there. And when people talk about medical training is too long and the hours are too long, some of that's true, but that part of it is very real and it is one of the most important things we learn and you don't want a physician taking care of you when you're critically ill who isn't capable of that. I haven't thought about it in that frame. So it's not because those of us that haven't been to medical school and you know it's one of the longest education periods of any profession, you just assume you're picking up knowledge. It's all academic, but I guess a lot of it's conditioning. There's this much emotional learning going on, especially in residency training, because that's when you're really more responsible for the care of the patients. That's actually one of the biggest learns. Do you find that I'm sure they've done research on this, that if there is ever medical error on the side of the practitioner, do you think it's tied into the conditioning, the emotional conditioning of making clear decisions? And I'm sure all of its important, sleep, everything. It'll be hard to pull out in a study, which is which, but I know it all matters. You can be too tired to make bad decisions, but you can also be emotionally distraught from what's going on. What just happened. What just happened and not be at peak performance. We all know what that feels like in everyday life. And I would actually say now as a CEO, I use that all the time. That skill. I feel it. I'm like in a situation where there's a big problem, maybe with the congressional delegation, Bill, we're trying to get and I need to be deeply involved in something that's high stakes. And at the same time, I get a call that one of my board members is in the emergency room and there's a terrible problem. So it's kind of, it feels like the ICU. I'm kind of having to deal with this thing and this thing. And there's no separation between two things where I have to be not just intellectually capable, but emotionally right where people need me. They can't know that I'm dealing with this messy thing over here. And that's why I'm a little off. It's interesting that because I think about the parallels of I support and manage a lot of mental health practitioners, clinicians, therapists. I know you've got a lot of them under your network too, but well, they do, but the training is not near as long. You can get a two year degree and do your practicum hours and then you're off and running. And then there's, I always feel for that first five years of somebody, especially if they're working in trauma or grief, because you're the vicarious and secondary nature of what you're going to consume. No doubt. There's no way to prepare your body for it. You haven't done the conditioning yet. You haven't had enough hours in the room. And it's really nice to hear that that's part of the process is because I would want a physician to not just be to know what to do, to have it intellectually and to also be emotionally present and conditioned and attuned in that environment. And you can tell when you've got that with a physician by bedside manner. If somebody's present in the room, there, if they're, it's how they look at you. So yeah, yeah, I'm sure you've trained that before. But it's interesting. We, no one ever sat me down and said, okay, this is how you need to do this. It doesn't happen that way. We model, we role model it for our trainees and people watch us and pick it up and I watched it and picked it up and I said, I want to do it like that person. Right? That's that's how it happens. And then you practice and then you do it and then you try to do it and you do it miserably. And that's it. And then you figure it out. Yeah. Yeah. Do you, do you ever have an opportunity to circle up and we call this staffing at our place where it's, we'll send people out into the field or in the rooms and they're helping people process and using whatever clinical tool we have to offload or unlock. Ideally, their resilience and help them overcome whatever they're working on, you know, mitigate stress. And then we circle up a couple of times a day in our environment and the clinicians get to download and offload what they've experienced, which is we is a really a lot of times people think we're in there talking about just the case to figure out how we can better treat it. And that's part of it. But a big part of it is a way offload verbally some of what you've consumed. Do you guys have some form of that? Yeah. I'm sure we do. I would suspect that it exists in localized environments. It wouldn't surprise me if some of our ICU groups do that. And yet at the same time, I'm absolutely sure that there are single individuals who are are living that and there's no support. Yep. Because nobody really knows. I mean, a lot of the times when I was in that situation, you know, I didn't, I had to go to the next room. I didn't have time to circle up. No time. No, I mean, I could have circled up the next day, maybe. But for physicians, especially if you're kind of in a lead situation, that would be a gift to be able to do that. And sometimes that could be really helpful. But I know there are going to be situations where that's just not feasible. Like surgeons often are doing one case after the other all day long, and they just have to go from the one room to the next room to the next patient. And there really isn't time. And certainly in ICU medicine in areas like that, that's... I think for the whole team in the ICU, having something programmed like that would be really neat though. It would be if you could figure the timing out. I understand the dilemma. But what we're talking about if you're listening to this is kind of emotional regulation. It's being able to, and we use this all the time in the room, where we'll, because people often assume if you're going to come do work around your adversity or historic stress, your grief, your trauma, that that means we're going to turn over every rock of every instance that you've experienced. And that's not actually the case. That's what keeps people from ever coming to a place like on-site or into counseling in general. They're like, I'm good. I don't need to go back. I want that rock turned over. And you don't, you don't always, it's not always called for. There are certain parts of our historic narrative. I think that it's important sometimes to explore or maybe relook at and rewrite certain narratives that don't belong to us. But it's not about going back and looking at all our baggage. As a matter of fact, when we're in the room with people, sometimes that comes up. And one of the tools we'll use is kind of what you're talking about with parking in the garage. You say, can we bookmark that? Let's bookmark that. And let's stay here and talk about this. Because sometimes we don't, we perceive that that's not the right door to walk through, or that somebody may not be regulated enough emotionally that that wouldn't cause more trauma or re-traumatized to go back and experience something that happened. And you have to be very selective. And that's part of the part of the training. But it's a great skill to be able to extract, I think, of, of living a more meaningful, sustainable life is figuring out how to put certain things in the parking lot, emotionally regulate in real time, bookmark certain instances so that you don't feel all your stress all the time. Now, we're all humans. So you're going to have moments like that. If you're listening, a lot of grace, you're gonna have, we've had moments, both of us run things that are high pressure, and we've had moments. But it is a skill that with experience over time, we can do really hard things, look at adversity in the face, and learn how to navigate it so that it doesn't consume us in real time, and then find proper outlets to be able to offload it. Like you talked about Melinda being one of those for you, and Vanessa certainly one of those for me. Yeah. The key for me is I do have to remember to go clean out the parking lot. How's clean out the parking lot look like for you? How do you clean it out? So what I do take time off, I've had a been very fortunate to have an executive coach since I was 39 years old. Wow. Because I became a department chair really young, and the prior department chair in anesthesiology for my Christmas present gave me a year's worth of coaching sessions with this executive coach that he'd used, and he turned out to be a life turned into a lifetime friend, and he still coaches me. How long has it been? How long is age 39 to age 64? That's a long time. And actually now he doesn't just coach me. When he retired from his full-time gig, he spends half of his time coaching people on my executive team. Wow. You have about 40 people at Vanderbilt Medical Center that he coaches. So I'm a big believer in coaching, but one of the things he really forced on me early was the need to take time off, and he and my wife have conspired. Intervened or conspired, which one? Whatever you want to think about it. To make me do that, and even for long weekends, and walk on the beach, and stare at the water, and think, and that's how I think that's how you decompress. I decompress, and I think that's when I go back to things, because I have the time to go back to them and process them. I think that's when I do it. And would you say that you described your personality earlier, part of it was type A, you're driven, you're passionate, you love what you do? Would you say some of those factors are why you needed outside of yours, and eyes to say, hey, or else you'd just keep going? I would, yeah, I'd keep going. I think I'm better now, but especially when I was in my 40s, I would have just worked all the time, and that would have been bad. So we call it liminal space, or putting your brain in idle, which is so counter cultural in the world we live in today, because we're in such a hustle culture, and I'm a driven guy, I work hard, but giving yourself permission to do nothing. Because even on vacation, sometimes vacations aren't vacations or trips, because we just plan, it ends up being a work, it's a work, every hour. It's over scheduled. I couldn't encourage it more, especially if you're wired, like I can relate a little bit like wired, like we were wired, but there's just a lot of capacity. I'm never not thinking, and I'm always thinking about producing, and how do we do this, and how do we do that? But given myself time, it has become probably my go to. And I love our space too, I couldn't recommend more a trusted ear, whether it be an executive coach, a counselor, there's some kind of trusted ear is, I think, I know it's a privilege for a lot of people, because a lot of people, they don't have the means to do that, but it may not be in a professional setting. It may mean that if you don't have the resources, you just find a trusted ear that is going to give you more empathy and grace than they are advice, and can just listen and let you process is a game changer. And then given your mind time to do nothing is key. They're both, I think, have saved me, frankly. I mean, I've been in my role now 17 years, I don't think that would have happened without both of the things that we just talked about, without really, really effective coaching, and without people looking after me to make sure I have time. So in the biggest benefit, I think, a lot of times for people, you just reminded me of it, the way you said that it saved me is empathy is kind of a two way street. And I just talked about this actually last week on one of my social feeds, I did a post on what I call toxic empathy, which is a whole nother topic, but empathy is a two way street. I can empathize with you and have compassion for you, which I hope I can for the people that I lead. That's a tool for a leader to have to the level that I can have it for myself. And that's much harder proposition. That's much harder proposition. When you figure that out, would you get it? But I will say having a mirror, if you get a good, I call a good coach or a good counselor, a therapist is a good mirror. They're mirroring into your soul, they're learning things about yourself. And I like to say you can't see your own golf swing. I'm not a golfer really, but it feels right to me. What are you? What do you like to do recreation when besides walk on the beach and spend time more than part of it? Yeah. So I work out on an elliptical trainer and I work out. You got one of the fancy ones with the big screen. No, I watch stupid TV shows while I'm pumping on the elliptical. Maybe your way of putting your mind in it. Yeah, yeah, it probably is. What kind of TV show does Dr. Jeff Bowser watch on the elliptical machine? I'm curious about this. Sometimes I just watch the boring news channels, but I like mysteries and the who done it type stuff that's on NPR or national public television, NPT. Kick on, do you soothe or scratch your problem solving? Yeah, yeah. I think so. And it takes me there and I completely forget about what I'm thinking about. So I like the old ones that yeah, I think I was born in our generation, but I like the old ones that were easy. Not a lot of drama, so I didn't have to activate the stress part, but I could solve like the Matlocks and the Andy Griffith shows. And yeah, well, let's talk about this role that you've been in for as long as you have. It's remarkable that you've been CEO of such a large institution for so long. And that's one of the reasons I knocked on your door. Of course, we got connected through overlapping circles. Our good friend Ronald Richardson came to work with me for a little while and you guys had a great vision, which is a lot is right about the same time we were seeing that as we both had become a trusted resource for a lot of people who are very public in what they do, whether the executives or entertainers or artists. And we saw an opportunity there to be able to build relationships and help these people feel better about who they are from the health and wellness perspective. And then hopefully that just catapults their influence and that they go put more good into the world. And I think you saw that angle and we're like, I want to create a division that creates better relationships with these people. And that was one of the ways I remember we first started getting engaged with Ronald when they started that department, he had me over to talk to some of your staff a time or two and we met around then. But I was thinking about it even then. And I don't even know the numbers now you'll have to update me. But I remember then it was the second largest employer in the state behind the state, maybe, or is it the first? I think that's about still probably true. We're the largest private employer in the state in middle Tennessee. I think if FedEx and Memphis probably employs more people than we do, but nobody else is. We're now up to about 45,000 people. So yeah, it's a city in a city. I mean, I'm at 150 and that feels like a mountain sometimes. Well, once it's more than two, it might as well be 45,000. Okay, say more about that. How does that work? How do you manage scale like that? It's all about the team you can delegate to. It's all about that because nothing else scales. Right? If I always tell people if I'm spending too much time on any one thing, I'm failing. So the success of the medical center is only is completely dependent upon how effective the sort of architecture of leaders are. It's not just me, it can never just be me. Super important that leaders get that. And the time I put into recruiting leaders and the resources that go into recruiting leaders, probably the most important time I think I have spent because it's the only thing that's sustainable. Anything I managed to get done myself got that one thing done. That's not, that doesn't scale. You still recruit and interview yourself, part of that process with your executive team? For the executive team. And my direct reports are probably larger than most companies because I have the typical C-suite executives, the general counsel, the CFO, but I also have all the clinical division heads, the chiefs of medicine, the chief of surgery, the chief of dermatology, the chief of, and I keep a direct reporting relationship to all of those service line chiefs. We call them department chairs. And there are 20 of those. And I lead the process of recruiting their successors. And there's always, because we're large and people are, people age and retire, there's only, there's always somewhere between two and four a year. So that's a fair amount of my activity is recruiting leaders for the medical center. When people over the years have asked me what's the most important thing you do, I think I've landed on that. I didn't see that initially, but I definitely see it now. What do you feel like you're, and there's a lot of accolades. I'm proud as a middle Tennessee and a Vanderbilt. I mean, it's just awfully nice to see you. It's nice. I mean, the brand is just special. I mean, you know it anywhere in the country that you go. You know we're one of the best medical institutions in the world, frankly. But what are you, what are you most proud of that you've been a part of building over the years about Vanderbilt? When you talk about it, if you're telling a stranger, let me tell you about what we're good at and tell you about what we're proud of. Well, I would say in that if we, if you talk about, I actually believe culture is everything. And I think what distinguishes us from places that may look like us around the country on paper, but are very different from us is our culture. And the human qualities of the leaders are what determine that. And we've got a lot of leaders. So when I meet with my leadership, my whole leadership team, it's like 40 people. So I have this rule I call the weekend rule when I'm recruiting and people are sick of hearing it because they've been hearing it for a long time. But we have this tradition in academic medicine that we recruit people through search committees. And so I meet with the search committee and I task the search committee and say, here's the, here's the kind of person I want. Here's a skill set. And you get to pick three finalists. And then it's mine. You're done. Two rules. Don't pick somebody you're not particularly fond of because I might pick them to be a finalist. And the other rule is don't pick somebody that's qualified on paper and that you're okay having dinner with. If you're not willing to take them home and have them live in your house for an entire weekend, don't give them to me. I'm stuck with them for years. And people chuckle. But I've told that story, I don't know, a hundred times. And people talk about it, the weekend rule. And it has transformed the nature of the professional and personal interactions between leaders at the medical center. And it takes time to see that. You know, I've been fortunate to be there so long that I can compare what it was like when I started to what it's like today. And they all kind of like each other. Which was not what I inherited. And it's amazing what people can accomplish when they really like each other. When you want to be with the people. Yeah. I went, that's part of what I talked to you about. I think I went through this when I was building my, we went from a management team to an executive team. I was trying, I was, remember I was asking these questions, okay, trying to think about how we put this together. Because I had a consultant come through years ago that did some testing. I forget what testing they did. It might have been Myers-Briggs or something, but they're testing our executive team. And we've been through that. Done all those, yeah. And the report wasn't that great. He was like, you basically heard a bunch of people think just like you. And you all are all the same. There's nobody on this executive team that is going to be doing anything. And so I was like, oh shoot, well, I better start changing that. And I'm sure you've done this before. It was one of those that I went into it and probably over corrected. Because I was like, I've got to shake this up and get different thinkers and different people. And I didn't think enough about what do we all like each other? That we all want to be here? Yeah. That we all care about the same things or are aligned with the mission? Because that was what made it so fun. Yeah. Come to work for so many years. Absolutely. And then when I started to tinker with it and started following that, I went away from my gut a little bit and I went through like five really hard years. Yeah. Now those years were important. I learned that they were essential because there were processes and different things inside the organization that we were 20 people we couldn't do now at 50 people. We definitely couldn't do with under people. I can't even think about your metrics of 45,000 yet. But just us trying to implement processes that helped communication and all of those things, those came in those hard years. Yeah. But what started to suffer a little bit was culture. Yeah. And I've learned that scale and culture are so tough to try to figure out how to do them together. It's the hardest piece. Yeah. Why do you feel like that's so hard? So there was a time, actually COVID actually sort of taught us some things about how to do that and that we never would have done. I think that as the leader you struggle and even with 100 people to be in front of all the people at some regular interval so they understand you and where you're coming from. And so we used to do these, we call them leadership assemblies in Langford Auditorium, which we'd get a couple of thousand people in there and I would give sort of a TED talk on what we're doing and those are well received and then COVID hit. Couldn't do that anymore. And we all were realizing already we were starting to have, we were starting to get so much bigger. Now in 200 locations, but before COVID we were probably in 100 and a lot of those people couldn't get to a leadership assembly and frankly it was only the leaders that could come anyway and I realized everybody was scared and I had to figure out how to scale my communication. And so we did two things. One is I flipped the leadership assemblies to being a movie. And John Sighenthaler, you probably know from DBL Sighenthaler helped me. Literally we went to a studio and we do a two hour movie production. At that time we were doing it once a quarter where it was, the championship wrestling ring was like right over here and we were over in the other studio. It was like there were cameras and they put makeup on us. I'd never done anything like this and we spent a lot of time preparing for it and it was really high quality and it was a way for us to really talk to and show what the leadership was thinking and doing. And then in crisis periods I started to do these things I call CEO videos where I found that, you know, when leaders actually think they can write something and people read it, it's part of the self delusional thing about leaders that they think people read what they write. They never read what you write. I mean few people do and they'll send you nice notes but the other 95,000 people aren't paying any attention. So you have to get in the shoes of the people you're trying to communicate with and communicate with them the way they want to be communicated with, right? Which requires a certain level of humility and keeping it really short and sweet. So I do a no more than five minute CEO video and at times when things are really intense, I might be doing them twice a month. At other times I space them out a lot more so people don't get video fatigue and I still have the transcript because there are people that have brains that would rather read it and there are people that want to see me and hear me talk and I learned how to read into a teleprompter which is another skill that most people just don't have and John Sigmund Fowler taught me how to do that as well. I've not become a one take wonder but I'm better at it than when we start. What was the big tip on how to do that? I'm not great at that. Well, I turned into my third grade class when I was reading out loud and the teacher started saying, you're not very good at reading and I want to hide under the desk. Every time I read a prompt, especially if there's people in the room, I get to like lying through and I freeze. Part of its practice, part of it is I take what people often they'll send me a draft of what they think I should talk about and I completely rewrite it to be the way I speak and I say it as I'm editing it so that it's how I want to talk. That feels way more congruent. It feels really comfortable then when I'm reading it because I say things the way I would say them, not the way I would write them if I was writing to someone and I had to learn how to do that and then John, Sigmund Fowler literally sits next to the camera and bugs me. You're not smiling. You're too fast, too slow. Don't you want to put more emphasis on that? We do several takes because he forces me out of the reading mode and into the I'm presenting mode. I find if I'm just reading into a teleprompter by myself, it's not nearly as good as when I have a professional helping me. It's like anything. He used to be on the evening news, so he knows how to do this. He's helped me tremendously. It sounds like communication is key with culture. In the nuance of communication that I want to highlight that I think you highlighted, and this doesn't matter if you're leading a company or you're leading your home, usually decisions that create conflict aren't necessarily disagreed with or missing context. People don't know the why behind what you're doing and why you're doing it. That's gotten me in more trouble as a CEO or a company owner at this stage of, I mean, it happened to me this morning. I was working with, has a big dream and it ended up in the news cycle and my name was part of it. My CEO calls me and she's like, oh, hey, we don't know about this one. Again, a little stuff that I didn't think needed context. I thought that's probably not going to live in here. It actually did. And then you're in the repair space, which is another big part of the communication. When you get it wrong, you said humility is what you use, but be willing to say, yeah, we tripped on this one. And here's how I'd like to make it right. Actually, you get tons of credit for admitting that with people and especially if you're willing to admit it to the organization. I actually found that the context was huge. So for example, I remember during COVID, a lot of places were laying people off and I got on camera and told the whole medical center, we are not doing playoffs. Period. And they needed to hear me. I couldn't have written it the way I said it. I said it in a way that there could be no doubt in your mind that I meant what I was saying. And then here we are last spring. I had to do 650 layoffs, which I hate. I don't think there's anything I hate more than that in my professional life than having to do that. And I spent a lot of time in those CEO videos at that time trying to have people understand why we really had to do it. And what the forces were and what the people were doing. And I think that's what I'm trying to do. What the stakes were if we didn't because people will give you, not everybody, but most people will give you grace if they understand the context. There are always people though that don't want to hear the context. Context doesn't matter in some case if you're emotionally charged. Those are big things. So you made that promise in COVID. Were you able to sustain COVID without that? And so the layoffs just happened. We said this spring mean recently. Yeah, for totally different reasons. I want to talk about COVID for a minute because we've referenced it a time or two. And I'm sure you talk about this a lot, but it was such an unusual time and for to be a human and to be a leader and to be everything. But it disrupted all of us. It wasn't in my contract. I don't recall that being anywhere in there. Evidence to your earlier story, which I loved about you guys going to bat and Melinda's idea with keeping the parks open is like, how do we think about how this downstream impact is going to affect humanity? And what can we do now to be somewhat preventative in the way we navigate this? But I want to just personally and from a leadership perspective, I felt like I was dealing with insurmountable circumstances. Right in my little business. I thought, how? I know what to do. There's no good answers. Most days, it was not a good answer. And you were basically, but for you, it's seems like there was so much more responsibility. I'm sure you were getting tapped on a national scale, on how to manage it on a local scale and everything. What was that like? I mean, when did you first start for you? I'd say around the time that I described with the mayor calling me and saying, I think we need to shut down the city. Do you agree with that? I think that was the, that's when it really amped up because that's when it was pretty clear we were, we were losing people in Nashville. And it was so funny because Vanderbilt Medical Center, because we actually study coronavirus and we're one of the very small number of places that was already doing research on coronavirus when all this happened. We had a test up and running in days where we could test people for COVID in Vanderbilt Health Clinics in the walk-ins. We were the only place in Tennessee that could do that. So at first, remember when people were saying that it must be all the international traffic in and out in Nashville that's causing Nashville to have COVID and nobody else in Tennessee had COVID? That was just because nobody else could test. Oh, you were there testing so that got reported out. There were just as many people sick with COVID in Memphis as there were in Nashville. No testing. There were no testing. So did you get, did you get like count or were you on calls with Fauci, the White House? I'm sure, I mean up front when they were like, Hey, this is coming or no, actually, it was much more locally managed. Okay. We, I found my interactions at a national level were much more as we were getting beyond the initial stages where we were all kind of coming together talking about different kinds of vaccine solutions. But in the crisis, we, it felt very local. You know, I was talking to the governor and talking to the mayor and those things were happening, but it, it, it was much more and honestly, miles what it felt to me like was what I just described in the ICU. I felt like I had patients in four or five rooms all in cardiac arrest at the same time. And that's kind of what a day felt like for a while. I used to tell people my calendar is like a suggestion, sort of like stoplights in Tennessee, they're just a suggestion because I would come in and we'd figure out we didn't know what to do about masking or we didn't know whether people could be together in conference rooms or we didn't know whether people, whether visitors could be in the hospital. Just stuff like that was mind bending. We'd never dealt with any of that stuff before. And I, I found it to be extremely intense. I actually, I actually was pretty proud of the way we managed it and it never, there wasn't, there was never a time when I felt like we weren't going to be okay. You had that optimism. You had that optimism. I just knew. We were going to be okay. I mean, I knew that we couldn't stop the fact that some people were going to die from this illness, but I didn't. You, you, I'd you say we, you're talking about like humanity at large or you're talking about Vanderbilt or talking about the medical center. I was completely focused on the medical center. I didn't, it was almost like when you asked me about Fauci and the people in Washington, I'm like, I'm not sure I have time for that phone call. I, I'm taking care of what's in front of you, what's in front of me and the people at Vanderbilt knew so much about what we needed to do and we're so creative and resilient and powerful in that moment that I just knew we were going to be okay. Bring stairs to my, think about it. It was a really crowd moment. What kind of, I mean, was it around the clock? It must have been at that time because I remember you had temp room set up in the parking garage and we did. We had a mash unit set up in the parking garage. Yeah. And it worked remarkably well. Yeah. I was, it was such a confusing time, you know, looking back and I know you had to be careful on this in your position because you're a lot of eyes and ears on what you're doing, but do you, there's been so much criticism and support for how it was managed. And I, you know, I have a lot of myth because like what you said, it's, if you're managing it in a small way, like if you have a company and people you're in charge of and taken care of, there was no playbook. I remember we called you guys a lot. You know, we'd call you and your team and say, because you're considered the fault leader with health and wellness and staying, it's like, what's Vanderbilt doing? I appreciate that. Should we do this? How do we do this? How do we do this? But you look back on the whole thing and now years later, and I'm sure this will be studied for a century on, did, how'd we do managing this pandemic? Did we do okay? Did we not do okay? There's a lot of, I know there were a lot of mistakes made. I'd be unsure how I feel about it because you, I've just been, I don't know enough to really be informed, but I've been reading a lot in the past few years as stuff comes down the pipe and they're starting to study certain things about what we got, what we did well, what we got wrong. And I know some of it, it's hard when you're dealing with something this for some, not to be politicized, but how do you, looking back, I know you seem to be really proud of Vanderbilt and how you guys showed up, but how do you feel like we dealt with it as a, as a country and I guess beyond our country in the world? I think we, the one area I wish we had handled better as a country and probably globally is communication. I don't think we, and I think one of the reasons there's some lasting distrust that has developed around medicine and kind of what the government says about health and is related to the fact that we weren't clear in our communication. We weren't, we were so worried about having, you know, the footnotes correct that we weren't simple, simple messages were not broadcast loudly and clearly and could have been. And I think that I give the government some grace because, you know, it's not like we'd all practice this, right? And you can always look back on something with a retrospective soap and say, hey, we could have done that better. But I actually think that what we're now living with after COVID in terms of some of the distrust of healthcare relates to the fact not that we didn't handle it well mechanically because my goodness, we had a, we had a vaccine that worked in an unbelievably short period of time. We saved, I don't know how many millions of people we saved because we got that vaccine done so fast. And Vanderbilt was really proud to be part of that. How are you guys part of that? You helping? I'll never forget it. There were two ways we were part of it. One was that one of the, one of our laboratories run by a guy named Mark Denison was, he was like one of the coronavirus researchers that couldn't get funding from anybody because who cares about coronavirus, right? And then suddenly he was a rock star. And he was running the tests, you know, people in his lab in spacesuits where they were growing coronavirus. And the pharma companies were like Pfizer and Moderna were vaccinating patients who didn't have COVID. And then after a week or two retrieving their serum to see if they were generating antibodies that would then come to our lab and kill the virus. Wow. And we were doing those tests at Vanderbilt. And there was an, I think it was a Saturday afternoon, Mark sent me an email with a photograph of a titration curve that said, we got it. I mean, I just, I could see it. It worked. I mean, that was the vaccine. So you knew before any of that the technology that anything was announced, Pfizer's and Moderna's and all the companies working on, you guys were part of the research arm that helped develop that technology. Yeah. And, and I said, I remember calling and I said, it'll just be a matter of weeks now. This works. I'm always delighted to get that call. I mean, it's like one of those unforgettable moments in life. I'll never, I'll never kind of get over what that, what that was and what that, what that looked like on my computer screen. It's like, oh my God. So, and in your experience, it happened a lot faster. That was what you were saying. It was, it was unthinkably fast. How, how the, how that happened. And it was the whole country. I mean, it was the pharma companies. It was the money the government was putting in. Project Warp Speed worked, right? The resources being allocated. So from that perspective, it was a massive success. The one area we just didn't get quite right was the way we communicated with the public. Well, listen, what's an example of that? How do you think we, what did we miss? What should the public have known? For example, the messaging around masking was all over the place. We should have just, what, what I find leaders sometimes do is they over caveat things. They over subscript their messages. If it's true most of the time, just say it. Ah, say it like that. Yeah. Not. Here's what you should do. And you know, if you want to see the exceptions, here's a file, but this is what you should do. And I think especially regulated entities worry about not caveatting everything. And I think we, I felt like the lot of the messaging was getting twisted around so that we covered all the potential. You know, is it 10 feet? Is it 14 feet? Is it, you know, I just think we got lost in the details and we didn't really focus on conveying to the public super simple, sensible messages. So it got confusing instead of just clear. Here's, And when people are confused, they lose trust. It wasn't so much that the messages were wrong. It's just that they were so muddied with complexity that people didn't trust us. And, and looking back, were there any of the messages that you feel like, ah, that one might not have, I mean, because you hear so many things now about the, and I know right now we've got an all time kind of low trust, you know, so much polarity in the country right now, and which creates mistrust, which creates confusion, which creates this downstream impact. And, and in some ways it's interesting that people are caring enough to try to think about their health a little bit more. But in other ways, it's, I'm sure it's really tough to be an institution like what you run. And I know we're treading into those waters a little bit, but how do you feel about that? The, I don't want to get into the political side of it because that's just, we leave that for another conversation. But the, the fact that people are now saying, well, I think there's a bigger picture to health and wellness than maybe what we thought there was to. Yeah, I think, I think it's healthy that people are focusing on the whole picture of health. I mean, when we, when you look at the pie chart for longevity, your medical care is a pretty small piece of that pie that determines how long you'll live. It actually, all the social circumstance stuff and the things that would determine how healthy your foods are and, you know, how much education you can have and what your economic circles, those things actually are much bigger predictors of your longevity than your actual healthcare. That's been known for years. Those studies were published in the New England Journal of Medicine 20 years ago. So the fact that the population and people and everybody is more focused on those things and nutrition being an important one is a good thing. There's no, that's indisputable. There is also no question that rigorous science is the basis for progress in taking care of people and that should apply to everything, including what nutrition is good or bad for us and what components of, so I'm okay as long as we're willing to study everything objectively and compare in a scientific way what's right and what's not right. The minute we reduce it to anecdote, we're going to get into trouble. And what I try to tell people is everything should be considered but before we make a decision, let's do the right study. Right? If somebody thinks this might be effective or not effective or dangerous or not dangerous, let's do the right study. And then let's be convinced if we do the right study. But we shouldn't reject something that somebody's proposing just because we don't like it, right? So I'm kind of letting everybody be a little bit right here. And it's a little bit like what I was saying earlier. If you don't communicate these things the right way, if you just reject things out of hand because it flies against what you believe, then you turn people off and they don't trust you. We ought to be willing to test anything, but we also ought to subject it to what we know works and that is scientific methods and principles. And you've been so involved in the scientific methods and principles and research. You're pretty confident in the measures we have to test things scientifically to see if they're going to be effective. And do you think is there something you'd like to clear up that you feel like maybe Western medicine in general is getting a bad rap for that people probably don't understand? Or... You know, I think that all forms of healthcare is just like anything else, Miles. It's like people start to believe strongly in certain aspects. Think of healthcare and religion aren't that much... You know? People start to treat the way they think about healthcare as a religion, right? We always start to get into trouble when we lose our open mind about what might be possible. And we should never do that. On the other hand, we have to anchor what we then decide to do in reality and in what we know works in terms of testing A versus B. You know, we actually are really good at that. And so what I find that frustrates the public is they have trouble understanding whether the problem... whether the reason something's not being recommended is because we just weren't willing to listen and do the right studies or because the right studies were done and they failed. The general public is not sure. And so they just say they're not willing to listen, right? And I think if we... it's again, it's just... it's a communication issue. If we were... If we were more willing to be in dialogue with all the points of view and then propose good ways to test what people believe might be true, sometimes we're going to find things we didn't expect. But I don't think we should ever separate ourselves from what we know about science and what we know about biology and what we know about how to develop evidence. That's credible because we actually have a responsibility to people not to hurt them. That's like the number one. And what I've seen in my career is anytime you deviate from that, you can really hurt people. When I was a graduate student, there was a study that was done called CAST, cardiac arrhythmia suppression trial. Have you heard of it? No. It was all over the media back in the late 1980s. There was a drug... two drugs called incanide and flecanide. And they were actually being studied at Vanderbilt because we had a big arrhythmia service that I was doing my PhD with. And the drugs, if you look at people that have had heart attacks, people that have had heart attacks have funny heart rhythms afterwards. They have extra beats. They call them PVCs. And we presume that those PVCs were the reason sometimes people six months or a year after a heart attack die because they have a terrible movement because they're having these little funny beats. Well, in small pilot studies, these drugs wiped out the funny beats. Unbelievable. It's like we've cured this. Millions of people are going to live. Well, did you really do a large controlled study in thousands of patients over a period of two to three years to really see if more people survive? We did that study. More people died on incanide and flecanide because it just turns out that wiping out those little funny rhythms wasn't the key there was something totally different going on and those drugs were causing more people to die. And it was highly significant. So if we don't apply the standards of science, we would have been out there killing people for years with those drugs. And it's my favorite example of how when you think you're doing right, if you really don't stick to the true scientific methods that we all have learned over centuries work, we can get into trouble. Do you feel like the innovation and technology, that's a whole other conversation, I'd say for another time, but I would like to hear you comment on AI and where you think we're going in healthcare. That's the one area of AI I'm kind of excited about. Yeah, naively. I worry about some other things, but I'm like, what can we learn that we don't know now with machine powered learning? But do you think, are you kind of having been a healthcare provider executive for as long as you have? You look at the trajectory and then, man, we've made a lot of progress. It's remarkable. And AI is going to be part of that. I'll tell you just one example, one story. We've implemented something and so we're big. We're really big into IT and informatics. And actually, Vanderbilt was the first medical center to have a fully implemented electronic health record in the 1990s, like 15 years before most hospitals had it. And the Bush administration came to Vanderbilt to announce the nation's health IT initiative, because we were so into this. So we've also then been, because we were focused on this, been kind of at the front end of using AI in diagnostic medicine. And one of the areas we're using it is in radiology. So we're not letting the AI read CT scans instead of us. But if you think about what a radiologist does, we do, I don't know, 800 CT scans at Vanderbilt every 24 hours. And every CT scan doesn't need to be read that day, right? I mean, two or three days is fine for lots and lots of those scans, except the ones where it's not. And we have now modules in that are AI that read the scans themselves. And if they're worried about critical findings like a cerebral brain bleed, or a blood clot in the lung, things that can kill you, especially if you were, we were going to take you to surgery and anticoagulate you not knowing, those are now getting prioritized for the radiologist to read right away. And the radiologist may determine that it's wrong. And I tell you something, we implemented that module, like on a Wednesday at seven o'clock in the morning. And the head of health IT called me and said, you're not going to believe this. At 11 o'clock that day, we identified a cerebral bleed in a patient that nobody knew about that was going to go to the operating room that afternoon. Wow. You know, it's like drop the mic. So I, you know, when I'm with you, as long as we use it smartly and we continue to be, as long as humans are guiding the process, it's going to make us better in healthcare. Do you see big automation that I know every other, there's a lot of other professions that think they're going to go away. And I mean, do you see some of that with robotics and AI and all that? Do you think they'll be taking some, some roles or? I do because if you think about the machine that we call healthcare, a lot of that is still slow and frustrating. I mean, you know, the things you have to go to to get appointments, to get your insurance squared away, to think about all that, you know, it frustrates people. A lot of that can be automated. You can completely leave alone the direct interaction between doctors and patients. I don't think we should. I think there's ways AI can help us there too. But, but if you just focused on all the administrative bureaucracy behind the healthcare enterprise, it's a substantial, it's probably a trillion of the cost of healthcare. All kinds of that stuff can be automated and made much smoother. And honestly, healthcare grows so fast that I don't think people are going to lose their jobs. We just may not have to hire as many people over time because we just get better and better at growing the processes without needing more as many more people. I actually think that's how this plays out because it takes time. And does it accelerate, I think all of us out there that have lost family members to terminal illness, the ones that I know you guys have been after trying to solve for years, but does it accelerate that? I mean, some people make the big promise of like, Hey, maybe get the cancer, cure for cancer, cure for Alzheimer's, maybe that's coming sooner. It will accelerate it because it accelerates the processes of being able to analyze large data sets. So if it would take us a week to get through all the data we need to analyze to understand whether a certain experimental therapy is doing X, Y or Z, these automation techniques could speed that up to an hour. So when we say it's going to speed up the cure to cancer to this or that, what we really mean is because we can apply these advanced technologies, we can understand what's happening across huge data sets, like 400,000 patients who all have cancer and we have their DNA sequence of their tumor and we're looking at all of that at once. Can you imagine how long it would take to analyze all that? Well, now it can get now can be done quickly. That's, that's what we mean by speeding it up. So it's the process of discovery that's being sped up. We're still discovering the same thing and we're still thinking the same stuff, but it's the whole process. It's almost like you can do 10 things at once instead of in series. That's the way to think about it. This whole, this whole segment we just spent time on with around COVID and we're getting ready to land the plane and you've been super generous with your times. A couple more questions I want to ask, but I'm thoroughly enjoying myself. Good. I'm loving that. I'm really curious about all these conversations. Conversations, we don't get to get underneath the hood that you live, the car you live in and drive in. We don't get to get underneath the hood a lot and hear about it, but I also want to take away the practical wisdom that comes from these high level lessons like navigating COVID at a health care institution. One of those I'll share that I've taken away is, as you've heard me say this before, is we don't, we don't connect dots until we collect dots. And so it's really important whether you're trying to do research and analysis on that would inform you on how to make certain moves. It's important we do that in our interpersonal relationships in our families too. A lot of times what hangs us up in living, loving, leading is when we assume we know the rest of the story. That happens with me and my marriage all the time where my spouse comes in and she's short and there's something going on and I don't know what's going on, but I just go right into defense and feel like I'm being criticized when ultimately there's a lot more data points behind her that sometimes can go back two years of a pattern that I haven't disrupted or identified, but it's really important, I think, to connect those dots. And then I don't think we navigate adversity successfully without some level of hope. And I'm not sure hope can really exist without some level of optimism. And then it's important to have that, but boy, it's really important to communicate that in real time. And it sounds like you did that really well through that season. So not only I'm sure does the hospital deserve a lot of accolades for saving a lot of lives and how they navigated it, but I think you do too for leading the charge there in our city and with all your team. Well, thank you. I think that part of communication as a leader involves transparency and helping people understand. But I also think we have a responsibility at some level to give people what they need. Because if people are... Oh, if people are just scared, they can't function. COVID was a time where I really wanted, and I really believed it was going to be okay. And I wanted people... I thought one of the most important things I could do for people was to help them feel that, to feel some security. And I tried to back that up with information and data, but I could have been doom and gloom too, because there was a lot of doom and gloom going on. So I think that's part of leadership communication is figuring out what the audience needs and how everybody can move forward. But you still have to be credible, right? You still have to... And that's all very nuanced. Well, the last part of that formula that I feel like is kind of part of your formula, your playbook, where we talked about adversity requires hope, which requires optimism. I should have ended it with optimism, really requires lived experience. It does. You've got to have survived and gone through enough adversity and challenges to be able to show up in those with some sense of knowing, deep knowing, faith, trust, belief that things are going to be okay. We're going to navigate this. We've been through enough, which it seems like that's such a through-lines through your story, starting from when your mom passed and you were really young and you learned how to deal with adversity. You're going to grow up fast in a way. And we've talked too about the humility of getting it wrong because I think lived experience only becomes a teacher when we see it or where to look at it, learn from our mistakes, be humble enough to hold it, build our self-awareness over time. And then I think you can walk out into the world with a deep sense of belief or faith that things are going to be okay. It's amazing what the human experience can survive and learn to thrive in. And I think that captures my form of hope. I think it captures it very well. When I say I have faith, that's probably what I mean. There's some kind of, you know, one of the themes of your podcast is resilience and there's something about humanity and resilience that's just remarkable. It goes back to the experience I've had taken back when I was taking patients into the operating room to have procedures that they may not survive. There was, they almost all, even if the chances were low, believed they were going to survive. And all I was going to do was reinforce that. I wasn't going to say, well, you know. Well, it's, I think talking to end-of-life practitioners is fascinating to extract some of the conversations in this calmness, this confidence that comes over people as if they, and I'm a spiritual guy, I have beliefs of something greater than me. And, but I, it feels like there's, that's when often that there's so much presence that that you can't deny it. It ushers in this level of knowing and faith. And because you'd say that, okay, well, if I'm so optimistic that I'm going to live here when I know it's 50-50, then maybe I might have an inclination that there's life beyond this experience. I don't, you know, I don't know, but maybe there's a belief that I'm going to be okay the way and I hope I'm okay in this world. I think we all hope there will be, right? That's right. I mean, how could you not hope that? And another thing I want to ask you about is, as a leader, especially someone who's very, it's pre-public in what you do, that comes with a significant amount of pressure. And one of those pressures is just you cannot be popular in every circle. And I watched that happen to where if you've got a little charisma, if you care about communicating and connecting to the people in front of you, you got some good DNA to be a leader. And then you can attract people. And then the more that grows, some decisions are not going to be popular. You're going to make mistakes that people are going to personalize. And before you know it, you look up and there's people that don't like you anymore. And for a lot of leaders, including me, that was tough. It still is to this day when I get that criticism. And I want you to speak into that, what that's like for you, because I know you're not immune to it. And I think everybody now has a little bit of a public platform because social media is so relevant. So we're all attuned to what it's like to be criticized for what we might represent or how we might be misunderstood. What's that been like for you? Well, I'm a bit of a pleaser. So I find it painful when I know people are angry at me. I think that one of the ways I build confidence to make decisions that I know will be unpopular with some folks is I go pretty deep with members of my team on what they really think and what would they do if they were me. And I really try to raise my awareness of all the angles so that I'm really sure. Not that people won't be mad at me, but that I'm doing the thing that's best. And for me, best is often we're going to help more people if we do this and harm fewer people if we do that. It's not everybody will benefit or everybody won't have a downside because the reality of these roles is that there's always some downside that's inescapable. And so we find ourselves in these kind of decision making periods where you just have to say, okay, if I go this way, the downside's somewhat lower and we're just going to manage as best we can. That somewhat lower downside is terrible as it is. That's just not fun. No. And so that's emotionally challenging. I think that what I try to tell CEOs is that I'm trying to counsel or support. And really it is CEOs that have to make those kinds of decisions because all that stuff bubbles to the top and probably should is that when you're trying to manage the workforce's mentality and kind of how people feel about things, what you really want to do is convince what I call the middle third. There are always people in a there's a third that is just going to be with you because they just deeply trust you and they will accept it. And then there are some folks that just don't want to hear it and they don't particularly like you or trust you and they're not going to be they're not going to be with you. This middle third is the key group because they're trying to decide. And that's where you're that's where you're really trying to aim all that effort around communication and context. And I try to tell CEOs don't don't get bogged down by the folks that are just never going to believe you and don't actually be persuaded by the people that are going to follow you anyway. Ignore both of those groups and focus on the middle third who's not sure because if you can bring those people along a you'll carry the day with the workforce or the people or the faculty or whatever group you're trying to bring along but be you'll feel a whole lot better about the decision if you can bring them along because you will have figured out you will learn more about what you're trying to decide in the process of convincing them. Well said. Now I think that's important for people to hear too in that it's I have struggled with my like I asked you a question which was how do you deal with not being popular not liked in your role. And you immediately went to a strategy that you use to be thought fully effective. And so I would say that to anybody that's other thing about because my my first go to is you get in survival and you're like well I got to figure out how to deal with being popular. How do I be more liked by the people that don't like me. And I think every leader has let that go. It's so hard. I think every leader's price been a little energy or in relationships you're trying to please the people that maybe you won't be able to. But instead of worrying about being popular spend your energy trying to be effective. Yeah. And if we're effective I think it helps us depersonalize it because you're thinking about a lot of the way you broke it up in thirds and if you can because you didn't it would have been easy to be like well let me go be with my people who love me and trust me no matter what blindly and that will make me feel good. And I think that's a good thing maybe give me an ego stroke or let me go convince these people who are outliers and do not like anything I'm going to say or do. No it's always look to use your influence for good and to be effective. Yeah. It's really well said. Thank you. I have a colleague at the Medical Center and he'll know who he is which I envy because he he he actually he didn't like COVID but he did like the fact that no one hugged him because he didn't like people to hug him. And I went I know some print buddies like that. In times like that I wish I could be more like him where it just didn't bother me because it just doesn't bother him that much but it bothers me but I try to I guess that's one of those other things I put in the parking lot. Let's talk about let's let's we'll lay on the plane here gosh I could talk to you for days because there's so much I hadn't even gotten asked about leadership and health care and all that stuff but mate we'll continue the conversation. I'd love to have you back in a year or something like that but let's talk about your most important roles because I know you're a guy that has a pretty strong integral compass you want to do right and live right and we've had some of those great conversations and integrity marks high on how you want to operate as a leader but you're a father husband. If you could leave us with any wisdom that you might have been able to learn on your life path but also on this significant responsibility of leading this massive operation and the complexity and then not just that I mean you've got the mind for science too you understand science and medicine but you also understand leadership at a pass ago. How has that helped you prioritize and realize what's most important and hmm yeah it's an interesting way to ask the question because I think for most folks that have jobs like us the the professional role hurts more than it helps but I do think there's some pearls that you pick up managing people and leading people that if you really think about it that's stuff your family needs too so I guess we wouldn't think twice about trying to spend extra time with a direct report who is struggling with a hard problem and trying to really be supportive of them and help them but do we really do that at home? Do we do that with a kid who's struggling with some aspect of their life and do we really put that kind of time and mental energy into them? I think one of the biggest challenges I've had over my career is time and it's not just physical being at home but it was mentally being at home and being there at the right moments and you know one of the things that lasts when you have children who are now in adulthood is you know the relationship. It's got to be one of the most rewarding things in my life is my adult relationship with my kids means probably more to me than anything except my relationship to Melinda and I think there are so many executives who didn't get that right and regret it and I'm just so grateful that I didn't make that mistake and if I regret anything it wasn't putting even more into it than I did and I can see times when I look back that I was too caught up in what was happening at work and not caught up enough in what was happening at home and I was very fortunate that I had a spouse who was home and was totally focused on the needs of our kids. I was lucky because when I wasn't there she was always there but if I could change anything I might have slowed myself down a little bit professionally and spent more time at that because that's what actually I think that's the core of what creates the adult relationship is whether you were there at the times they needed you emotionally when they were younger. You can't like suddenly show up when they're 30 and establish that. You don't get to do that so if you weren't there at all it's really hard to build it later and I don't think there's I can't think of very many things now that give me more joy than being with them. Yeah well I think any new parents out there that I'm excited for you to hear that message because I feel like I got a late start and I got a front row seat on how to do it and how not to do it because I've worked with thousands of people that come and experience on site having been highly successful vocationally and then struggling at home. It's one of the more common things that people come to us for sure and I got to watch that years before I started a family and I've got a six and an eight year old at home and already I've made some of the classic mistakes that I've supported people and I probably will make more but like we talked about that lived experience that is a catalyst for optimism which is a catalyst for hope which helps you navigate adversity. I'm so thankful to have that. I'm so thankful I'm paying attention and listening to people like you that have said like man I wish I about to spend a little more time because you're right and I want to encourage the fathers and mothers and parents out there that that maybe didn't get that time. Yeah it's it is never too late. It can be hard but like my dad right now and my mom are doing some of the best parenting they've ever done. Yeah and that great. It's beautiful and I've got a relationship with them now that I just I wouldn't trade for anything and they were they didn't do it perfectly on the way and and I won't do it perfectly on the way but there's never I don't believe a more important time to recognize how much it matters and then at the end of our time we're probably not going to be talking about our resumes. We tell them about our loved ones and our kids. You know if they build a statue of you all that's going to happen is the birds are going to fly over and poop on it. So it's it's it's just not what really matters. Yeah what matters most and that's that's who I've known you to be. So I this was an encouraging conversation. I knew it would be and that's what I hope it is. I think sometimes when people do stuff at a high level or a high scale in a way it has this funny way of dehumanizing them. You just kind of think they're this robot that runs this big thing but there's actually good people behind and you're one of those people always found to just be nice to say that class act super kind. You care about people. You give people time. You give people presence and and I'm glad it makes me thankful that you're the head of organization that I rely on for my health care and something that it's cool about Vanderbilt too is a lot of people think such an astute medical institution that's on all the lists and I'm there's some crown jewels that if you've never been in Vanderbilt Children's Hospital. Amazing place to take a step in that place. You talk about good for your soul. I just spent 41 days there with my new granddaughter because she was in the NICU. She did great but boy I just I can't say enough about what they do. Yeah there's so many special things there. She's okay. She's great. Yeah but I don't mean it. There's nothing like being in it. Right. And seeing you know day after day after day the amazing people that take care of those kids. Yeah. I just I'll never get over it. Yeah it's literally angels on earth. We brought you know I've brought a lot of programming in there off and on with entertainers and different people and it's just it's there's no better place. I've been to jails, jubies, institutions, hospitals, rehabs, health care all over the country but there is something really special about what you and your team continue to build and we're thankful for you. Thank you. There's there's some pretty special things happening because of you guys two miles. We appreciate you. It's been fun to partner over the years and do a few things together and I'll say that a lot of people know that's where I was going with that. You know when you're on all those lists you don't realize that you're also a place that offers I mean you're an on-profit. You're running a billion dollar multi-billion dollar budget with a non-profit and taking people that don't have any resources at all. Our community benefit you know when we're not not for profit charitable organization like we are you know what you have to fill out this income tax return that's called a 990 and if you look at ours the community benefit number is when you consider uninsured care and Medicaid related financial costs and all of that stuff research training of residents it all adds up to about a billion dollars a year and I always want people to know that because sometimes people associate the word Vanderbilt with wealth because I think the guy was a pretty wealthy guy right but we put every dollar we make back into the mission and we we we put everything we can into making sure the people in this region stay healthy. Well done. Anything you want to leave us with? Just thank you for giving me and all the other folks you're going to interview a chance to tell maybe a dimension of their story that they don't normally get to tell. It was an honor to be with you. Thank you for your time. Thanks for being here. If this conversation meant something to you do me a favor and send it to one person who you think deserves to hear it. Just one person. That's how we build a community of people who are done performing and ready to actually live. I'm Miles Ed Cox and I'll see you next time at Human School.