[Podcast] The Art of Human Care

By Stewart Gandolf, Chief Executive Officer

I recently had the pleasure of speaking with Dr. Hassan Tetteh, a US navy captain, associate professor of surgery of the uniformed services at the University of Health Sciences and adjunct faculty of Howard University College of Medicine. He was also a Robert Wood Johnson Health Policy Fellow from 2012 to 2013 and a visiting scholar in the Congressional Budget Office.

Dr. Tetteh is a board-certified thoracic surgeon, best-selling author and popular speaker who inspires people to focus on the heart of all that really matters in life. He currently leads a specialized thoracic adapted recovery team at MedStar Health and Walter Reid National Military Medical Center in Washington D.C. His extensive research in thoracic transplantation aims to expand heart and lung recovery and save lives.

In this podcast interview, Dr. Tetteh and I discuss the patient experience and his third book, “The Art of Human Care,” in which he emphasizes the importance of humanizing and personalizing medical care. I highly recommend anyone interested in the patient experience buy Dr. Tetteh’s book.

“The Art of Human Care”

After reading Dr. Tetteh’s book and enjoying all the illustrations created by his daughter, Ella Bleue, I was excited to speak with him about it as well as his thoughts on the patient experience—a topic near and dear to my heart and something that we cover a lot on this podcast.

Like me, Dr. Tetteh is passionate about purposeful writing. “When I got back from a very difficult and challenging deployment as part of my military work in Afghanistan supporting the marines, I found it very cathartic to put pen to paper to help reconcile much of what I experienced as a combat trauma surgeon.”

Though the book was originally inspired by a speech that he delivered to the incoming class for medical students of 2018, Dr. Tetteh says “The Art of Human Care” was written very intentionally so everyone, no matter his or her profession, could easily relate to it.

Healthcare versus human care

Dr. Tetteh knew from a young age that he wanted to become a doctor, but a life-threatening illness that left him bedbound for weeks created a paradigm shift in how he viewed his role in healthcare. It really opened his eyes to the patient experience.

“I recall my ER doctor coming to see me while I was recovering on the regular wards. He was carrying the book “Harrisons and Harrisons,” the bible of internal medicine. He came to give me more information about my illness because my friends had told him I was studying to be a doctor. I was so struck by his level of interest in me—a complete stranger. This brief but poignant interaction changed how I viewed my role in healthcare. It also embodies many of the elements of human care that I write about in my book.”

Once he began interacting with patients, he noticed a strong correlation between patient outcomes and their mental attitude. He shared anecdotal evidence that suggests patients with a positive mental attitude and/or a purpose typically did a lot better in recovery than those that did not. It was then he realized how important good communication is for helping each patient feel positive, upbeat and important.

The LEARN model

While away on deployment he learned a valuable lesson about the importance of good communication. He learned how even a small breakdown can lead to serious challenges—not just in the marines, but in healthcare as well. His LEARN model is a framework for not only giving doctors a mnemonic to remember what they should do for their patients, which is learn about them, but gives them a prompt to remember what it is that they need to do:

L: Listen to your patients

E: Empathize with your patients

A: Affinitize (understand your patient)

R: Repeat (listen more, empathize more, affinitize more and also say their words back to them)

(K): now your patient now (do not assume you know why they are seeking care)

The three pillars

Dr. Tetteh then shared his three pillars of the art of human care:

Purpose

“Finding someone's purpose and helping them connect to their purpose, I think is very foundational to The Art of Human Care, whether that's discovering it for you as an individual, or conveying that with someone you're interacting with.”

Personalization

“It is important to personalize the care you deliver to each individual because each individual has different needs, different requirements, desires, passions, dreams and frustrations.”

Partnerships

“The other element of the art of human care comes from partnerships because nothing great has ever been accomplished by one individual.”

Keeping a spotlight on human care

There have been a lot of changes this year especially in providing quality healthcare during a pandemic. Telemedicine is quickly becoming the norm and we, as human care providers, are learning to use tools that are a bit outside of our medical toolkit.

“Let's not focus on healthcare, let's focus on achieving health. One does not have to cure in order to heal. There are many of us that are walking around with conditions, sometimes terminal conditions, that will never be cured per se because we just don't have cures for them, but there's a great number of things that we can do for those individuals to help them heal and that could be sharing some art with them, taking the time to listen to them, taking the time to empathize with them, taking the time to understand what their now is, what their needs are.”

Again, I highly recommend Dr .Tetteh’s book, “The Art of Human Care,” listening to the entire podcast or reading the full transcript below.

Note: The following transcript is computer generated.

Stewart Gandolf, MBA:

Hi again everybody, this is Stewart Gandolf, happy to have you to yet another one of our podcasts. Today, I'm going to be interviewing Dr. Hassan Tetteh, who is a US navy captain, an associate professor of surgery of the uniformed services, University of Health Sciences and a adjunct faculty of Howard University College of Medicine. He was a Robert Wood Johnson Health Policy Fellow from 2012 to 2013, assigned to US congress, congressional budget office, currently Dr. Tetteh is a thoracic surgeon for MedStar Health and Walter Reid National Military Medical Center, he leads a specialized thoracic adapted recovery team in Washington D.C. and his research in thoracic transplantation aims to expand heart and lung recovery and save lives. Dr. Tetteh welcome, and thank you for joining us.

Hassan Tetteh, MD:

Thank you, thank you Stewart.

Stewart Gandolf, MBA:

We're just talking about your really unique practice offline and you're certainly as a transplant surgeon, are on the go, particularly these days during COVID and we're just talking about recoveries and some of the things that are going on, but you're also a passionate author and I know that this is your third book and I was referred to you by a trusted friend and our loyal listeners will know that we do a lot with patient experience and it's one of our things that we like to support and I often tell people, "Look, I don't want to be a clinician," I enjoy it, love what I do but if I could do anything to help people get better care and particularly for whatever reason, patient experience is a common ... and empathy is something that I feel like, something I can help endorse and help promote and this is square in your area. So I'm glad to meet you and have you on our podcast for the first time. You did a number of books, this is your third one and I'd like to start off by talking about this one, is The Art Of Human Care and talk about maybe just a couple background of your other couple books and then focus in on this one and why now and why is is different?

Hassan Tetteh, MD:

Sure, yeah. So writing has been a passion of mine, as you just said. My dad told me a long time ago, when I was probably just an adolescent, that he said one of the best ways to ensure that you could live forever is to write a book and I guess it's something I internalized and I think many people have different reasons for wanting to write a book and so I've always wanted to be an author and in fact, very early in my childhood, I actually wrote a book for Young Authors Festival that I resurrected a few years ago when I had an opportunity to do a TED talk and so that was neat to bring that book back to life, it was something I did in the 1980s, for your listeners, it was a while ago.

Hassan Tetteh, MD:

Then, when I got back from a very difficult and challenging deployment as part of my military work in Afghanistan supporting the marines, I found myself in a very tough spot dealing with many of the challenges that I faced out there and one of the outlets that I have always had is journaling and writing and I certainly did a lot of reading while I was in Afghanistan and when I came back to States, I found my outlet in writing and it was very cathartic to write about my experience and I had a unique experience to work with publisher to craft the fiction and so that was a really neat book and I got a lot of good recognition for it and I think it helped a lot of people out, but certainly helped me out writing about that experience and putting pen to paper and creating a story that helped me reconcile much of what I experienced as a combat trauma surgeon and it was a way to help me transition back into the real world, so to speak.

Hassan Tetteh, MD:

So this book, The Art Of Human Care, I will have to say has been a work in progress for many, many years actually. It is a labor of love and has been a labor of love, was a labor of love and one that I was very intentional about writing and wanted to make sure that it was going to be a book that would relate to many people, whether you were in healthcare or not. If you look at the cover of the book, it says The Art Of Human Care, it has a scalpel and it has a paintbrush, there's some meaning to that, but perhaps most importantly, besides my name, beside it, it says with Ella Bleue. So this was a project that I got to work on with my daughter. My daughter is Ella Bleue, she is an artist, at least in my eye and it was very neat to work on a project with her.

Hassan Tetteh, MD:

So I'd like to tell potential readers and folks that may be interested in picking up the book that it has pictures in it, so that makes it quite an easy read, intentionally written to be brief and something that you could finish in one sitting or two, but with the pictures, I hope to evoke a lot of emotion and hopefully, since you had a chance to read it, I hope it was something that touched you by the stories and the art and the message with it?

Stewart Gandolf, MBA:

I love it actually and it's quite a read. Like you said, it was an easy read and it was a touching read and there was some really good anecdotes we can talk about. One of the questions I have about the book, because again, as I said a moment again, it's very entertaining and it's very rich and emotional, but I really could not help but thinking, who did you write this book for? The intended audience? Because it felt like a physician to physician, colleague to colleague, or maybe it's them plus additional healthcare professionals, or the lay public. Who were you thinking about when you wrote this book?

Hassan Tetteh, MD:

Yeah, that's a good question. So I would say that the intent is really for the general public for sure and when I began to craft the framework of what The Art Of Human Care was all about, the basis for it was inspired by a speech that I delivered to the incoming class for medical students of 2018. So this was a while back, I was invited to be the white coat ceremony speaker. So for those of those in healthcare, that's a pretty, I think rich landmark, for students and the newly entered folks that are going to be indoctrinated into healthcare and what happens is they get to get their white coat and typically, they get a very seasoned, usually gray-haired professional, to speak about the world of medicine. So here I was, being invited by my alma mater to do just that.

Hassan Tetteh, MD:

Not only was I honored, I was very humbled and absolutely thrilled to be bestowed this great responsibility and I really wanted to inspire the students because I thought that this would be one moment in time that hopefully they'd reflect back on and this could be the beginning, or this was the beginning officially of their medical careers. So initially, the beginning of the book highlights that, that experience and so there is, I think some hint that that is the intended audience but you'll see that one of the things that I try to do for the students as well as for the reader, is humanize health, care and in fact, argue or propose if you will, that healthcare is quite different than human care. So again, the title was very intentional, the stories are very intentional and the goal and the objective is to write for an audience and for those that, at any time in their life, both have been human and care for others, or receive care. So in that way, it really is a large audience that the book is intended to touch and hopefully resonate with.

Stewart Gandolf, MBA:

Outstanding, so that was one of my questions I wanted to ask you, so I thought that was really interesting, the idea of human care versus healthcare, why don't you expand upon that and explain what you mean by human care?

Hassan Tetteh, MD:

Yeah, so I relate in the story, an experience that I had well before I was a physician, well before I was in medical school, in fact I was in undergrad and during that time in undergrad as a junior, aspiring to be a physician, I was biochem major, I had a unique opportunity to have an early decision interview for Johns Hopkins Medical School, as a junior. This was a huge honor because I was able to visit the school as a candidate and be potentially accepted well before my senior year even began and would not have to be burdened with a lot of the MCATS and things like that, some of the testing. This was based mainly on my academic records at that point, my desire to be a physician and the recommendation, so it was a huge honor.

Hassan Tetteh, MD:

So I flew down to Baltimore, I was going to school in upstate New York at a small arts and science college at the time and I had what I thought was the best interview and I thought they loved me and I was all prepared to receive a acceptance letter in the mail and a few days after returning to my campus. But what happened instead was I didn't quite get the letter, but instead I start to experience a lot of illness and I was sick and over the ensuing days, a week or so after I came back from this trip, I found myself with a fever, the worst headache of my life, stiff neck and fevers and not feeling well. I went to the infirmary, fortunately, even though they misdiagnosed me with what I actually had, they did give me something that potentially helped to prolong my life for a little bit until the time when I was found, hours later in my dorm room, late at night on the weekend, pretty much unresponsive.

Hassan Tetteh, MD:

Ultimately what happened, I'll fast forward, but I was taken to the hospital and I was diagnosed with bacterial meningitis. Now, if you know anything about bacterial meningitis and if your audience has never been unfortunate to experience that, whether by a loved one or themselves, it's quite a lethal condition and I was fortunate to survive that and I believe at the time, not only were the doctors and the healthcare professionals that administered care to me at the hospital there, not delivering good healthcare, but they delivered human care, what do I mean by that? Well, this one doctor that I recall being my attending physician was an ER doctor and he was the one that made the diagnosis, which wasn't really intuitive.

Hassan Tetteh, MD:

If you think about a college student coming in to a college town hospital on a weekend with his two fraternity brothers and he's unresponsive and looking a little lethargic, the default there is, "Oh, he must have been drinking," or something and they insisted that that was not the case. In fact, that was not anything I really indulged in as an undergrad. So that empathy from the doctor was one that was not lost on me, but more importantly, he must have taken time, because I was totally out of it. He must have taken time to really get a good, detailed history about what was going on with me from my friends and although I spent about two weeks in the hospital, two of those weeks actually in the ICU and a little bit more in the hospital, I recall this doctor that initially cared for me in the ER coming up to see me as I was recovering on the regular wards. I'd been transferred outside the ICU, I was just maybe a day or so from deploying the hospital and he came up to see me and was carrying this large textbook and it was called Harrisons and Harrisons is the bible of internal medicine and he came up and said, "Hey Hassan, I'm glad you're doing better and your friends told me that you wanted to be a doctor so I wanted to come here and share with you what you had."

Hassan Tetteh, MD:

That's an amazing story, and it doesn't sound like much but I don't know how many people have ever had an ER doctor come visit them a couple weeks after they've been admitted to the hospital, so the fact that he kept tabs on me and was so concerned that he wanted to come and see how I was doing and then more importantly have a conversation with me and then bring me something that he knew would be of interest to me because he learned that I was going to be a doctor. That to me embodied a lot of the elements of what I espouse here, of human care.

Hassan Tetteh, MD:

What was really neat was this, he shared with me what I had in terms of the disease and I read about it, I realized, wow, I really was fortunate to live. Then at the end, he said, "I have a little bit of a test for you." He said, "Listen, you want to be a doctor right?" I said, "Yeah, I do." He said, "All right, have a test." He said, "What's two plus two?" I said, "Well, it must be some kind of trick here," but I said, "It's four." He looked at me and he said, "You're going to make an excellent doctor." And that was something that I'll never forget. I mean, I'm relating this story to you but that happened decades ago and it was absolutely what I needed because shortly after discharge from the hospital, this was well before the age of internet and emails and things like that, I went back to my dorm to find a big, fat rejection letter from Johns Hopkins.

Stewart Gandolf, MBA:

Oh no.

Hassan Tetteh, MD:

But I was not dissuaded from still pursuing medicine because the doctor that took care of me in the hospital told me that I passed the test, that I was going to make an excellent doctor. So I persisted and I persevered and ultimately, I did go to med school and wound up doing a lot more, but that's the element of human care, where you think about all of us in this world being humans and we, in some way, and hopefully in many ways, take care of each other. Now, we certainly do that with our family and our friends, but sometimes, it can be just the care, or just the interest that you take in a fellow human, and sometimes even a stranger, that can make all the difference in the world and by doing so, you really impact the world in a very powerful way and that's what I'd like to convey in this human care. Now, there's stories throughout the book that bring to light many examples of what I'm sharing with you here, but that's just one of many.

Stewart Gandolf, MBA:

That's great and you know, it's funny, you mentioned about ... I ask you about your audience and the audience of our podcast includes a whole bunch of people, it includes people that are very interested in patient experience, mostly it's people who do work in and around healthcare, I don't know if we have too many laypeople that are completely outside of it, but we have hospital executives and marketing people and doctors and clinicians and experts in their own field and pharma and all kinds of different areas but I think that what you touched on there a moment ago, was the whole idea of empathy and being more than just a cold clinician. Again, when you're doing transplants, it's at the height of ... at least I would think, pretty close to the height of technical expertise required but you're still bringing that human experience to it every day.

Stewart Gandolf, MBA:

Most of the doctors we work with, when we're working with them, are like that. There are the classic clinician-only, "I don't care if they like me, I just want them to get better," kind of attitude, but there are certainly today, there's a tsunami of change and I think that's what makes this such an exciting part of what we do with our company our agency, is just give people, smart people, a voice to help reinforce that message and I think that story is really touching, for sure.

Stewart Gandolf, MBA:

One of the things that I noticed in your book as well, you talked about the mind body connection and particularly the part about how that helped you survive and that seems unusual, for at least some of the surgeons I know. Tell me what your thoughts are about the mind body connection?

Hassan Tetteh, MD:

Yeah, absolutely. I'll use that story again as an anchor to convey and maybe highlight and illustrate what I mean by that. So here I was, a young, invincible adolescent, just came back from the interview of a lifetime and was pretty convinced I was going to be a doctor. I just interview at Johns Hopkins for goodness sake and here I was now, with what should have been a lethal infection and something that could have quite frankly, taken me out. Now, I don't recall a lot of what happened, particularly# in the early stages of that hospitalization and that experience, I do remember a tube in every orifice of the body, I remember people trying to keep me awake and aroused while I was in and out of it, but the one thing I do remember with great, vivid recall, is the fact that I was going to be a doctor. I had this purpose, I had been working on this for years, I was, like I said, a biochem major, I just went on this interview and even though I was in this almost dreamlike state while I was in the hospital, I kept thinking there was something that I had to live for. There was something that was pulling me toward recovery and getting better.

Hassan Tetteh, MD:

Certainly when I was emerging from the illness and the serious part of that, it was the work of the doctor and the small test and the little interaction that I had with him that helped to people me out of the hospital with this enthusiasm that I was going to do well no matter what happened, including a rejection letter. But nonetheless, the whole time that I was in the hospital, I kept feeling like there was a reason why I had to stay alive and that was something that was internally ingrained in me at that stage. So when I became a medical student and then certainly started to engage and interact with patients, I recognized something that was really interesting and that was the patients that I could find that had something to live for, whether it was a family, whether it was a job, whether it was a hobby, a cause, they seemed to be able to overcome some of the most insurmountable challenges from a healthcare standpoint, and most did so irregardless of what we did to them as healthcare professionals, in terms of surgery and treatments and things like that.

Hassan Tetteh, MD:

One of the most important and powerful drivers for someone recovering was what it was that they were going to do when they recovered and I became very attuned to this and I started to ask my patients, especially when I became the attending surgeon and the one that was entrusted with the care of my surgical patients, I always tried to find what it was that was important to them, because I knew that if I could even get them to think about that, I would just notice anecdotally and I would just remember and recall my own experience that that made a big difference in the way I recovered.

Hassan Tetteh, MD:

Now consequently, there were times and fortunately not many times, when I would come upon patients and they didn't really seem to have a passion about anything, not really having a purpose for whatever reason unfortunately, they may not have family, or they were on their own or by themselves, they didn't really have a job they were passionate about, didn't really have a cause and even though their illness or sickness was something that was ... I wouldn't say relatively benign, but certainly something that was not life-threatening, their outcomes would not necessarily be so good, even though they were given just as good, if not better, care than anybody else.

Hassan Tetteh, MD:

I started to make this connection, at least in my mind, that when someone has something that they're passionate about, that they're living for, if they have a purpose, they'll ultimately do a lot better no matter what healthcare challenge that they're facing. I've just found that to be universally, consistently and powerfully true throughout my career. So that's the mind body connection that I speak of and I do believe that there is something to a positive mental attitude, even though your physical state may not be in top form. There's an old saying, I think I came across and there's been iterations of it, where it says, "A sad soul will kill you faster than a germ."

Stewart Gandolf, MBA:

You know, it's amazing because as you were talking, I had to look this up, because it's been a while but I remember vividly in high school, I don't know if you've read Man's Search For Meaning by Victor Frankl?

Hassan Tetteh, MD:

Oh absolutely, it was one of my favorite books, yes.

Stewart Gandolf, MBA:

Right, so while we were talking, I went on my phone and googled it and yeah, I remember the name Search For Meaning, but I don't remember the full name, and I do remember Victor Frankl. So for the audience that's not initiated with that, Frankl was a prisoner in a Nazi concentration camp and again, very similarly, noticed who survived and who didn't and the ones that had a sense of meaning, or sense of purpose ... I'm paraphrasing, you have to go read the book, but the ones that had sense of purpose did much better.

Stewart Gandolf, MBA:

I think this is, of all the people I've talked to and the thousands of doctors I've talked to over the years, it's the first time I remember somebody, I'm sure people have brought this up to me before, but that talked about this sort of thing with me, about that mental attitude and being more than just positive mental attitude, but really it's life and death positive mental attitude. So I just think that's really interesting and I read that in the book but the color commentary just brought that to life for me so thank you, that's really an interesting insight and tying it back to a book I read many years ago, I think is really intriguing.

Hassan Tetteh, MD:

Yeah, well yeah, making that connection is really neat because Victor Frankl is definitely one of my most favorite authors and that book is one of my all-time favorites.

Stewart Gandolf, MBA:

Yeah, for sure. All right, so let's talk about ... this wasn't' just a feelgood book, you went into a lot of practical tips and again, we work with healthcare professionals every day at all kinds of different levels and everybody feels stress, particularly now, right? So it's easy, okay, got to be nice, smile once in a while, nod, pay attention, great, got it, next patient. Well, there's more to it than that and so I liked your LEARN model and maybe you could give us a quick overview, or not quick, spend as much time as you like, but explaining LEARN and what that means and how practitioners can use that in the real world?

Hassan Tetteh, MD:

Sure, yeah. So let me give a little bit of context to the LEARN model and I definitely will highlight for the audience what that means. As I mentioned, many of my experiences in life have colored my outlook and my perspective on things, certainly my military experience has done so and I remember when I was deployed, I had one of the marine colonels share with our team something and it was very interesting. He said, "You know, the marines," because I was deployed with the marines and they are very unique and a great force to be reckoned with. He said, "You know, the marines do three things. We move, we shoot and we communicate." He said, "No one in the world, or no one on the planet does the first two things better than the United States marine, move and shoot." He said, "The communicate though, sometimes we have a little bit of a problem with that," and he said, "When you do have a problem with communication, it's the one thing, when done poorly, or not done well, can lead to the most problems." He says, "That could be true in life, it could be true in your professional relations and it can be true in our unit."

Hassan Tetteh, MD:

He was trying to highlight a point, of a communication breakdown that lead to some challenges that we had. I remember that and I thought to myself, "Wow, that has an absolutely direct correlation to healthcare." I thought to myself about how important it was to have the empathy and to give the space to patients to let them tell their story and I started to do some work with a number of my colleagues and you talk about a patient experience. You know, there's studies that are done on patient and physician, and I don't know, healthcare professionals and patient's interactions. Not surprisingly, and I certainly realize this in my own practice and even my own experience dealing with the healthcare professionals on the patient side, that most patients are interrupted by their healthcare professionals within the first 16 to 20 seconds of the conversation or the engagement.

Hassan Tetteh, MD:

Now think about that. 20 seconds. That means you never have an opportunity to share your story and to actually tell the individual that's there that's supposed to be there to help take care of your problem, or address your concerns, why you're there. Without giving that time and that space, it really leads to a lot of problems and let me highlight practically what I mean by that. Most patients when they go see their physician, they're very, very anxious, at least I am and I'm a physician, I know about things, you're concerned, you don't know what's going on, you're trying to get some answers and the healthcare professional, and they may not even be the doctor, it could just be the person that's just doing the initial assessment says, "So, what brings you in today Mr. Smith, Mr. Johnson?" "Well, I was ... " and then immediately, within 20 seconds you're going to get interrupted with a question or qualifier. Now, that takes you off your train of thought and you may start answering questions, fulfilling another person's agenda, without really conveying why you were there.

Hassan Tetteh, MD:

Then they get a preconceived notion of why you're there and start addressing things that may or may not be relevant, or of paramount concern to you. That becomes a problem. So this LEARN model is a framework for not only giving you a mnemonic to remember what you should do for your patients, which is learn about them, but gives you a prompt to remember what it is that you need to do. So when I say LEARN, and I highlight in the book this practical toolkit if you will, of how you could communicate with your patients, the first L in LEARN is to listen to your patients and listening is a very important part of communication.

Hassan Tetteh, MD:

People think that communication is all about talking and expressing yourself. I would argue that it's not. I like to tell my medical students and my colleagues and certainly my junior residents and faculty all the time, we are given two ears and one mouth. That means we should always be listening twice as much as we are talking. So listening is very important because when you listen, you start to learn about your patient. Therein goes the learn again. So that's the L for learn.

Hassan Tetteh, MD:

E is to empathize and empathizing with your patient's very important as well. Now, much easier to empathize with a patient if you yourself have been a patient. It's uncanny to me how many of my colleagues and physicians, nurses, or even any allied health professional will tell me how much more empathy they have for patients when they themselves have been a patient and I mean a real patient, with the gown and the hospitalization and nothing to eat and all the tests and things and tubes in your body. When you're in that position, that vulnerable state, you start to realize, "Wow, this is not a good place to be," so having empathy is really important.

Hassan Tetteh, MD:

The A is for affinitize, it's a bit of a word that I coined from affinity, but what I mean by that is many of my patients will come to me from all different walks of life and backgrounds and what interests one patient may not interest another patient and how you convey a therapy or a treatment, or a change in behavior, suggest a change in behavior, would be vastly different from individual to another individual, so it's only after listening to a patient, empathizing with them and understanding where they are and saw their world, that you can start to now tailor your treatment, your advice, or your therapy to meet them where they are. So that's the affinitize part.

Hassan Tetteh, MD:

The R is for repeat, because it's very important to repeat things. Repetition is the mother of success and so I think repeating things and it may be even on that same visit, or in subsequent visits, it's very important. And then the N is just simply to know the patient's now and what I mean by that is, lots of our patients come to us and they may have chronic illnesses like diabetes, or hypertension, and you may falsely assume that they're there to just address that issue. So you come in and you have a lot of preconceived thoughts about why the patient there with diabetes and hypertension is sitting in front of you and in my case, in surgery, they come to me a surgical condition and I just assume that's just why they're there.

Hassan Tetteh, MD:

But only after listening to them and empathizing with them that I recognize that their now, the reason that they're there in front of me right now could be vastly different and sometimes it has nothing to do with their condition or their illness, often it's with the behavioral or anxious, or anxiety concern that they have regarding something unrelated to their primary conditions that are documented so vividly in the chart. So I try and give the space to my patients as much as I can to understand and glean from them these things and the LEARN framework for me is one of these ways that I remember to include all of these elements in my communication with the patient, so that I do that right and so that I don't have any problems, or at least minimize the problems.

Stewart Gandolf, MBA:

You know, it's funny, I liked about the book, you did have some great anecdotes in there and again, having worked with so many doctors, a lot of times, ti's just being able to keep up with my grandkids, or I think you mentioned bowling in one of the anecdotes there and so understanding their why, why do their care, it's not the healthcare part of it, it's so they can do things they enjoy, I think is really motivating and going back to our Victor Frankl discussion a minute ago, understanding the meaning of why we're doing this might give them so more motivation which is clearly a good thing.

Stewart Gandolf, MBA:

One also that I thought was really interesting, the three Ps. Can you talk about those a little? I thought that was really intriguing as well.

Hassan Tetteh, MD:

Right, sure. So yeah, a little context to the three Ps, so what you're talking about and for those that hopefully will read the book, you'll come to see these three Ps and the three Ps are purpose, personalization and partnerships and those are the three pillars of the art of human care. So oftentimes, I'll have people say, "Well what is the art of human care? What does that mean?" Or, "How do you apply the art of human care," or, "How do you execute the art of human care, what do you mean by that?"

Hassan Tetteh, MD:

Now, as you know because you read the book, there's a lot of what I think goes into the art of human care, certainly. However, I also have had the great opportunity to ... have had a lot of schooling and as Mark Twain said famously, "I never let my schooling interfere with my education." So even though I've been to medical school, I've got three different master's from some pretty important universities, I always felt that where my education was coming from was not necessarily the institutions and the ivory towers there, but it was from the practical conversations that I had with my professors and with my colleagues and more importantly, my fellow students, that's really where I learned a lot from.

Hassan Tetteh, MD:

But one thing that did come to mind and I've seen this as a constant theme among the ages, is it's very easy to take something that's complicated, like human care, or healthcare, or medicine, and make it more complicated. Anybody can do that and I can tell you, "Oh yeah, let me tell you about this little gizmo here." And I'll start talking technical and making it more complicated than it has to be and that doesn't take any kind of genius at all, but what true genius is is taking something that's complicated and distilling it down to some elements that make it easy to remember, easy to recall, but more importantly, convey some meaning to the person and so that's why I try to do with The Art Of Human Care and distilling it down to these three principles of purpose, personalization and partnerships. I argue in the book, and I highlight and outline how these three elements of purpose, personalization and partnerships, when applied very deliberately can actually impact not only an individual life, but actually fundamentally change the world.

Hassan Tetteh, MD:

So again, we talk a lot about the purpose, I experience my purpose as I was recovering from my bacterial meningitis illness and I experienced how purpose and having a passion for life and for living for something, fundamentally impacts the outcome of the patients that I care for but I also recognize that purpose is something that's hard to articulate. So in the book, I convey and I propose, if you will, that one finds their purpose by doing something and typically by doing something for others. Just like you're doing right now, you have this platform, where people are listening and in many ways, you're helping them by connection them with information that'll be both useful and practical and something that will be inspirational, ideally, to help them change their lives and you're living your purpose by what you're doing and many people do that, whether you're a teacher, you're an architect, you're an engineer. Your doing something gives you the purpose and I think that's a really important thing.

Hassan Tetteh, MD:

So finding someone's purpose and helping them connect to their purpose, I think is very foundation to The Art Of Human Care, whether that's discovering it for you as an individual, or conveying that with someone that you're interacting with. Personalization is very important because as you know, in the book, there are many stories and I convey how important it is to personalize the care that you deliver to each individual because we're very different and each individual has different needs, different requirements, desires, passions, dreams and frustrations. So personalizing your care and the way that you engage with individuals is very important.

Hassan Tetteh, MD:

Then to round it all out, I think the other element of the art of human care comes from partnerships because nothing great has ever been accomplished by one individual. I mean, even when you think of the titans of businesses and companies, yes we like to celebrate the one individual solo person, but invariably, that success is almost always made possible by the work of many people contributing to that individual's success. So there's a collective success.

Hassan Tetteh, MD:

The same is true in healthcare. When I had my experience as an undergrad, I knew that it was more than just that doctor that rallied to make me better. It took nurses, I had to have physical therapy, I had to have an audiologist work with me because I had some partial hearing loss at one point, so there was a great number of people that rallied around me in a partnership to help me get better, not to mention my friends and family and loved ones and professors and all the folks that were concerned about me. So partnership is very important.

Hassan Tetteh, MD:

So in the same way, when you talk about how do we make care better for individuals, or for society, it's going to take way more than just doctors. I don't care if you're the best surgeon in the world, you by yourself can't evoke the kind of systems and the infrastructure and all of the things that are required to really deliver health to an individual. That's really what we, I think, are all really after. It's not sick care, it's really trying to develop and build a system and societal framework and support system that provides you will all of the tools that you can utilized to achieve and maintain and thrive in a healthy way and a state. So, long answer.

Stewart Gandolf, MBA:

But it's important and one of the things you mentioned, I'm not going to ask you to do the whole story here, but Mrs. E.V. you followed the purpose and got a benefit from that. Do you want to share that with our listeners?

Hassan Tetteh, MD:

Oh yeah. So that's a neat story. So I start off by telling about one of the first experiences I had as a young surgical intern and my purpose at that time was to be the best surgical resident that I could be and at that time, I was an intern and I would follow the example of my surgical chief, who was at the time, the chairman of surgery at the department that I was working in and I was his personal intern and he set this very high bar and standard for what surgical excellence was all about and one of the things that he conveyed and he insisted and demanded was that he took really good care of his patients and by extension, his patients became my patients.

Hassan Tetteh, MD:

So there was this one woman, who I went over and above and beyond the call of duty to ensure that she was always well taken care of. She was very sick woman, she had lots of different medical problems and what we were helping her with at that particular time when I was taking care of her and had the honor to participate in this surgery, was to help remove some masses that she had in her neck that were causing her parathyroid gland to be overacting, overreacting if you will and was leading to lots of different health problems.

Hassan Tetteh, MD:

So anyway, we did this surgery and like I said, I made it my point to be at her beck and call and make sure that she was getting everything she wanted. If she wanted a muffin, I said, "Did you want that toasted or with butter?" If she had pain, I wanted to make sure the pain would go away and it began a part to try and follow the model and the example of my surgical chief but I realized very quickly that his model and his example was how you should treat everybody that you engage with and all your patients. But in her case, she was my first one and so I really wanted to make a difference.

Hassan Tetteh, MD:

Well it turns out, she did well and she wind up eventually getting better and recovering and being discharged from the hospital and I later found out that while she was at the hospital, she had a daughter and her daughter had a very good friend who was a nurse and in conversation, she mentioned to her daughter's friend, "You know, there was this young surgeon that took really, really good care of me. He was one of the best doctors I've ever had." Now, it's fair to say that maybe if I wasn't such a good doctor and I wasn't trying my best to not only impress my patient, but my surgical chief, I may never have had this connection made, but the connection was, her daughter's friend turned out to be also a nurse and said, by recommendation of my patient, that she should seek me out.

Hassan Tetteh, MD:

So there was a little bit of matchmaking made but I'm proud to say that that woman that she connected me to and that we made that connection because of this great care, became not only my wife by my love of my lifetime and the mother to my son and my daughter. So there you go.

Stewart Gandolf, MBA:

So when you get together at dinner parties, you win that story. That's one of my favorite conversation starters, how did you guys meet? My wife and I have a good one too, but when you have a good one, it's like, "I won." So that's great. Good story, I love it.

Stewart Gandolf, MBA:

Couple more questions before we wrap up, because these are all pressing to me. One was, the connection with art, we talked about the human connection, we talked about your daughter's art. But why art? What do you feel the art is in medicine and in your book specifically? There's the right brain, left brain thing and as a funny aside, years ago, I sought out a famous art instructor because at the time, I was working with a fair number of large dental groups and plastic surgery groups and it's funny because they were clinicians and they're changing people noses or smile but they had no art sense. They didn't have that right brain and that matters a lot, right?

Hassan Tetteh, MD:

Sure, absolutely.

Stewart Gandolf, MBA:

A sense of proportion and how things all fit together. So this famous art author, I tried to get her to go on the tour with me doing talks for dentist and plastic surgeons, it didn't turn out but she was great. But I think art is a ... not just on the cosmetics, but there's art to medicine as well and so just briefly, you talked about art and the whole book is about art in some way, what connection do you see with art and medicine? Particularly as you're a transplant surgeon?

Hassan Tetteh, MD:

Sure, sure. Well, let me answer that in two ways. I'll answer it personally and then I'll answer it more generally and maybe a little bit more in the context of the book. So personally, believe it or not, before I wanted to become a doctor, I also at one point, entertained becoming an artist and in fact, I thought I was pretty good at art and I just always had an interest in art, I used to color and draw, just like any child did but I took it to the next level as I became a teenager and at the time, I grew up in a small village town in New York called Brooklyn and during my childhood, graffiti art was a big medium back then and I would hang out with these graffiti artists and I would learn the style and the technique and it was something that I was really enamored with and I actually applied to art and design high school and I got accepted. I had a portfolio and I had to take a test to do some still drawings and live drawings and it was a great honor for me, I was pretty excited and psyched.

Hassan Tetteh, MD:

I wanted to go to art and design high school because one of my best friends at the time was going there and it was a school in Manhattan, which meant I would get to take the train, which is a big deal back then. So when I brought the acceptance to this art school to my father, who at the time had to certify my acceptance by giving his consent for me to go, he promptly said ... So let me give a little context. My parents were West African immigrants and so with many immigrant parents, as you can imagine, especially first generation as I was, going to art school is not necessarily top of the list, you know?

Stewart Gandolf, MBA:

Right.

Hassan Tetteh, MD:

Many immigrant parents have the saying that your son or your daughter's either a doctor, or a lawyer, or a failure. So the seeds for medicine were definitely planted there but here I was trying to get into art school and my dad quickly said, "No, you're not going to art school because you'll never make a living as an artist." So there is that personal connection with art that I've always held steadfast to and when I recognized that my daughter had both an interest and, I think an aptitude to art, I wanted to nurture that and even if she has to be on the payroll for the rest of her life, I really want to make sure I nurture and support that interest.

Hassan Tetteh, MD:

But that's the personal part and within the book, I weave in a lot more personal anecdote about how powerful art has been in my life and why it resonates with me, even today as a surgeon, because it really does take some creativity and you said it well. You work with plastic surgeons and with cosmetic dentists and even dentists, there is a lot of creativity that's necessary to do your craft if you will and surgery for me, is one of these ways where you can mix the creative art and the energy of expression with something that is scientifically based and rooted.

Hassan Tetteh, MD:

Now, from a more generic standpoint, there is absolutely a healing effect of art, I think when it comes to health. We talk about the healing arts and if anyone's been depressed, or sad, or blue and they heard their favorite song, or they hear their favorite song, it can take them back to a place and a state of mind that brings them joy and brings a smile to their face. Conversely, you can be in the greatest mood in the world and hear something or see something that just evokes sadness and gives you melancholy because of the power of the way art can convey a message and connect with us. At its very root, if you were to look up the definition of what art is, it's really a form of an expression of communication and if you think about human's first existence, we expressed ourselves and communicated with art and through art.

Hassan Tetteh, MD:

So I think art is something that is absolutely fundamental to the human experience and so how could you not include it when you're talking about care and becoming healthy? I think it's something that's just an element that's just naturally interwoven and part of our reality of life. There's no one that can't be impacted or touched by art in its various forms, music, sculpture and expressive arts. So I think there's a very important healing attribute to art and that's what I try and convey in the book, not only through the words and through the stories, but also through the actual art that's in the book.

Stewart Gandolf, MBA:

Two more questions and then we'll be wrapped up here. The second to last is, I presume you did most of the writing, maybe all the writing for the book prior to COVID, right? So we're in a different environment if that's the case, and I'm wondering if there's any ironies, some things that, "Wow, they were important then," that you really feel like caregivers, leaders, public should know with the new context of COVID

Hassan Tetteh, MD:

Wow, well that's a great question. So absolutely, absolutely, absolutely, yes. There are many ironic parallels because I think that everything that I wrote about in the book, the message of human care, the elements and the pillars of purpose, personalization, partnerships, they're evermore important now in the time of a pandemic. In fact, if we need nothing else right now, the thing that we do need is human care, probably more than we ever did before.

Hassan Tetteh, MD:

Now, the irony is, I started out this year, 2020, like many people did with great aspirations for making this be a very big year, we're entering a new decade, I had all the goals and the objectives down and it was January and February and I was also ... had a very big plan for how I was going to get the word out about the book because the book had just been published at the end of 2019 and I was going into 2020 with all this momentum. I had many bookings for readings, I had invitations to come give lectures at medical schools and we had these plans for sharing this message with all of these graduating students and their various healthcare tracks. Then what happened was COVID and like many people, I also retreated into the recluse of isolation and hunkering down and it took a while, like I think with many people, to start realizing that we still have to live, even with a pandemic, and having been a student of many pandemics, I realized that pandemics have been around with us since the dawn of human existence and every 80 to 100 years or so, there's usually a really big one that is of great consequence and it changes society, fundamentally, politically, economically, socially and sometimes advances and sometimes pulls us back, technologically.

Hassan Tetteh, MD:

I think in this case, we certainly have seen how impactful politically COVID has been, we've recognized the impact that it's had to our economics. It socially changed the way that we live. People talk about we're going back to normal someday, well if you really think about the way pandemics have shaped humankind and societies, there is never again a going back to normal. We have and we will be resetting what we now call the social norm moving forward. It's already been reset. It's never going to be the way it was on March 10th 2020 for anyone in the world, pretty world. It's just not going to be that way, it's going to be different.

Hassan Tetteh, MD:

Technologically, I mean, what we're doing right now has been accelerated and it's being used more widespread than ever before because we're not able to socialize, at least like we did before. So I recognized that all of these things were happening but at the same time, there was still this great need, and probably more so than ever, because I've seen and taken care of COVID patients, I've had personal loss in my own family, for people that have died from COVID, that now more than ever, we need human care. Each one of us needs to find a purpose, we need to help others find their purpose, we need to personalize the care that so many are in need of right now, because so many people are suffering. Whether they're suffering physically from COVID, or as collateral damage from COVID, there's still so many challenges as society is really in need of something that could help and I believe that The Art Of Human Care is the technology that can bring a lot of relief and a lot of ease to a lot of pain and be a great benefit to many.

Stewart Gandolf, MBA:

You know, it's funny, one of the things we've talked about in the past on webinars and podcasts and different things I've done, healthcare, for all the change that happens technology and we work a lot with the pathology and things are changing daily, it's impossible for people on the ground to keep up with all the different things that are going on in oncology, but as a whole, healthcare's not famous for being a fast mover, right?

Hassan Tetteh, MD:

Right.

Stewart Gandolf, MBA:

There's a lot of interest in the status quo. One thing that COVID did in this case, is telemedicine where there was a whole bunch of ... telemedicine's been around for a while in various forms, it's not new but within weeks, hospital systems were doing telemedicine at scale when it was impossible to agree to even try it two weeks before. So it's amazing when you think about reimbursement, solved, HIPAA, solved.

Stewart Gandolf, MBA:

Then all the excuses of, "Well I don't really feel comfortable with it," or, "Patients won't like it," or, "I don't have time," just melted away and so that's been cataclysmic and that'll change the way healthcare is delivered and as a transplant surgeon, it'll be interesting to see things evolve for follow-up care, do they have to really come back in or can you do telemedicine? In most areas of healthcare, there's probably a role, so I think that's just one example that comes to mind of ... because I've talked to these people for years, right?

Hassan Tetteh, MD:

Right.

Stewart Gandolf, MBA:

Have you thought about ... just getting people to be willing to allow patients to put their calendar, schedule their own appointment, or to email securely their doctor. The patients wanted it but the doctors like, "No, no, no, I don't want to do that." Now, it's like, boom, it's just changing.

Stewart Gandolf, MBA:

Last question I guess is the ... so I think you gave me a perfect set up here. So what's your call to action? So what do you want our listeners to do? Because remember, we have people in healthcare, some people are pretty influential in healthcare, others are in the frontlines and others are just trying to do their job to support it, but how can our listeners and your broader readership, what can they do?

Hassan Tetteh, MD:

Well first of all, they should read the book.

Stewart Gandolf, MBA:

I agree and by the way, I'll have a link to buy the book in the podcast, just so you know. So I will do that.

Hassan Tetteh, MD:

Well, I don't have a agenda for that, call to action, but I believe it has the instructions and does give a blueprint and a good model for how to approach the times that we're living in right now in the midst of COVID, but more importantly, how we can work together collectively and I think especially because of the background, the nature and the experiences of your audience, how we could work collectively to bring health to many, in all it's different ways that you can do that. Again, I admonish that you don't have to be a healthcare professional to be responsible or to be actually critical in helping people achieve health. That's really what we want.

Hassan Tetteh, MD:

Let's not focus on healthcare, let's focus on achieving health. Health is a lot different than healthcare and I would also give this pearl, which I outline in a book and that is, one does not have to cure in order to heal. Let me say that again. One does not have to cure in order to heal. There are many of us that are walking around with conditions, sometimes terminal conditions, that will never be cured per se because we just don't have cures for them, but there's a great number of things that we can do for those individuals to help them heal and that could be sharing some art with them, taking the time to listen to them, taking the time to empathize with them, taking the time to understand what their now is, what their needs are.

Hassan Tetteh, MD:

Try to find out how you can help them discover purpose at a time of such great uncertainty, help them to personalize how they approach their work and partner with them, so that you can work toward restoring health, if that's possible, making health better when possible, and also impacting the world in that way, because like I said, I go back to my story of the doctor. I remember that day vividly, he didn't do much. Arguably he did more for me medically, but I don't remember any of that, but what I do remember is him taking the time to care about learning about something that was important to me, coming to share that moment with me, have that connection with me and then gave me a little bit of inspiration and didn't cost him anything to do that but it made such a difference for me and I try to hopefully repeat those little experiences with the patients that I engage with on a daily basis. Perhaps for me, because of my work in transplant where there's always stark contrast between life and death, I'm always reminded about how short life is.

Hassan Tetteh, MD:

So I'll end with this Steward, that the call to action, is don't dilly-dally, life is short. Go out and make a difference.

Stewart Gandolf, MBA:

Fantastic, that's a great ending. Well hey, I appreciate you being on our podcast, love to help you get the message out, I told you this is part of something I just do, I don't make a revenue on this sort of thing, but whenever I hear somebody that I think is interesting, that can help improve healthcare, it's my pleasure to invite them and take advantage of our little channel we've created here. So good luck with this and please keep in touch and feel free to come back any time you want to talk about this stuff again, personally or as a podcast. I've enjoyed this and it's been fun, so thank you.

Hassan Tetteh, MD:

No, thank you.