First thing I want to do is ask you a question. I'm from Lynchburg, Virginia. I always ask people, what is Lynchburg, Virginia famous for? Three things. Does anybody know what one of them is? We're the home of what? Something related to GI. Fleet Entenmas are made in Lynchburg, Virginia. C.B. Fleet Company. They also made Chapstick, but they sold that off to somebody else. All the Fleet Entenmas and phospho soda, when they had the problem, when they withdrew it from renal failure and preps, I think the company took it on the chin a little bit, but they kept on making it for overseas, so they still survived. Second thing we're famous for is Liberty University and Jerry Falwell and the religious right. We are the home of the evangelical religious right. If you're a Republican who's going to run for president, you're going to be in Lynchburg. There would always be a buzz about that. The third thing is we're the home of the nuclear navy. All the nuclear reactors and fuel for the naval propulsion ships is made in Lynchburg. Nobody ever knew that, so that's just some of the things that we do. I want to talk about this box of chocolates. I don't know if you've watched Forrest Gump, but life is like a box of chocolates. You never know what you're going to get. That's sort of what you have been trying to figure out today. You have heard lecture after lecture after lecture trying to analyze the decisions you're going to make in what's going to happen. They've given a lot of parameters, a lot of things to consider, framework, but you never really know what you're going to get until you bite into it and you eat it. You're never going to know what your situation is like until you get there. I want to go through a few of mine so that you kind of know who I am by the different pieces of chocolate that I picked up. Hopefully, you can learn something about ... I'm sort of here to talk about the glue, sort of the interpersonal relationships we've got to have and be successful with to be successful in your practice. I've learned this, and I'll explain in a minute how I came up with my top points I want to make. When you ... Does this thing have a pointer? Yeah, there we go. The first piece of chocolate you may take is you decide to go into gastroenterology, and you pick your fellowship. Then the next piece you're going to pull up is your practice that you go into. You analyze it. You try to figure it all out, but you never quite know about it until you ... As you've heard me say, three years in, maybe you kind of figure it out a little bit better. For me, I did that, and then I was in practice for 10 years in a multi-specialty group, and I said, I'm going to go into leadership. I'd had enough discomfort with my group, and I had these opportunities to think. I started to read books about dimming and total quality management and the red beet experiment. John Berwick at the time was talking about using quality improvement in healthcare to improve it. My values are ... I'm very frugal right here. I believe in computers, and I believe in relationships. I thought I could make a difference, so I went to the hospital and said, hire me. This is what I want to do. I left my group completely. They didn't want me to keep practicing with them. They thought I might join the enemy, as far as they were concerned, and so I formed the first VPMA position, Vice President of Medical Affairs, in that area. This was in North Carolina, Rocky Mountain, North Carolina. I tried to find anybody else in the state that was doing what I was doing. I only found about three people, so it was very early in physicians getting into careers. At that time, hospitals had the management and the capital to be able to afford to pay me, whereas groups did not. Groups did not value leadership and didn't pay for it at the time. I took a 40% pay cut and went to the hospital and started work, and that was the second. That's my next piece of shock. Then you find out people start recruiting you, and you just have to go change and go somewhere else. I moved to Virginia. I became the Chief Medical Officer there. Then the next thing that happens is I thought about being CEO, so I applied to be the CEO when the CEO retired at the health system. After one round of interviews, I decided I didn't want to do it because it would take too much out of my life. I wanted to play some golf. I wanted to have time with the family, so I backed away from that really big leadership position. Then when the new CEO came in, he was so horrible, I lasted about six months. I went to the GI group and became the CEO of the GI group and ran that. That's how I got back with Klaus and everybody else and got back into the GI world. The final bitter piece of chocolate that I did is I was forced into retirement. I did 16 endoscopies one day. I came in there with a nurse. I said, I can't go another step. Something's wrong with me. I had a knee replacement six months before that. I thought I just had to recover from my knee replacement. I took two months off and been getting better. Two months later, I had to go out on disability. Three years later, I was diagnosed with Parkinson's disease. Didn't know I had it. I've learned a lot about Parkinson's and neurology that I never knew as a gastroenterologist, but I had to stop practicing because I couldn't practice. What that piece of chocolate had in it, it has some sweet insides. The outside's bitter. I can't move as good as I used to and I have to take a lot of medication, but I was able to spend time in Vermont with my family. We've got a place up there. I play more golf. The most important thing is I was able to develop an executive coaching career where I work with physicians and as a coach. I call myself a doctor whisperer. When there's physicians that are having behavior problems, I work with them. When there's two doctors having problems together, I'll work with them. We have physician leaders emerging, I'll work with them. I have medical groups in town that have governance issues, I'll work with them, help them work through it. They have CEO issues, I'll help them find new CEOs. I do individual coaching and group consulting. It's been the best thing I've ever done. I've enjoyed it more than anything. I think there's a silver lining to what's happened to me. That's why I sort of have this other value, I don't think anything's possible. No matter what's going on with you or what you're thinking, anything is possible. That's sort of how I got to this point and why I'm here today to talk to you about it. What I have learned in my coaching is I've found a certain pattern of deficiencies we as physicians typically have when we go out and have to interact in groups and teams and all that kind of stuff. I want to leave you some pearls of wisdom that hopefully you can use some of them so that you're more successful in doing all this stuff. It'll help you keep you from being sued, it'll help you be successful in your work. These are the pearls. The first thing is this quote from Theodore Roosevelt. Have you heard this quote before? That the man in the arena, this was written in 1900 so it's very male-oriented, but it says, It's not the critic who counts, not the man who points out how the strong man stumbles or where the doer of deeds could have done them better. The credit belongs to the man who is actually in the arena, whose face is marred by dust and sweat and blood, who strives valiantly, who errs, who comes short again and again because there's no effort without error and shortcoming. Who does actually strive to do the deeds and who knows great enthusiasms, the great devotions and who spends himself in a worthy cause, who at best knows in the end the triumph of high achievement and who at the worst, if he fails, at least fails while daring greatly so that all his plays shall never be with those cold and timid souls who neither know victory nor defeat. So the first thing is you need to jump in and be a leader. If you listen to Muhammad talking about first starting in practice, you're a leader wherever you go. They're going to turn to you. You're the boss. So you've got to have those leadership skills. So you've got to know how do I step into that leadership role and be effective and not be counterproductive. I see a lot of physicians very patriarchal, ordering, they don't understand the teamwork that's involved. So how do you do that? And you have to think about how to be different as a clinician and different as a physician leader. And here's some examples of how I think about it. You as a physician are a doer, whereas as a physician leader you sort of plan and design. You don't actually do the work, you do a lot of delegation. So I have on there you are a decider, but mostly when you're a leader you have to delegate. You have one-on-one interactions as a physician, whereas as a leader you have meetings. And all my friends say I hate meetings, I can't stand them. But you need to spend time in meetings because you need more people to get the job done than just you. You've got to be proactive rather than reactive. You've got to think how am I going to change this, how am I going to make this better. It's delayed gratification. If I look back at my career in management, I would see results of my work six to twelve months later, maybe two years later before I really see the fruits of putting in a whole new IT system in a hospital, for example. It takes you years to do that, negotiating and putting it in. And then once you get it in and it's working well, the software is out of date, you've got to do a new one. So it takes years to delay gratification. As a physician, you like autonomy, whereas you need to value collaboration. You need to be an organizational advocate. You know, the patient comes first, then the organization, and you come later as far as the hierarchy of how you should think. And you identify with your organization rather than identify with your profession. So as you take on leadership roles, you've got to think, I've got to shift who I am, how I think, and how I work to have more of these characteristics rather than these. And another way of looking at this is that you've got, right down here is where you're seeing the patient or doing the procedure, and there's an outcome that you want. But leading up to that, there's a whole bunch of stuff in the blunt end of work processes, culture, all that stuff that you've heard today that will make you successful or not at the sharp end. So you've got to learn how to move from here, the thinking there, to how do I influence work up here. So my first pearl is, don't complain and say what you don't like and stand on the side. Jump in, get involved, but get involved with the kind of approach that I've outlined. Second is communication. You know, you always hear the biggest problem is communication. Watch the movie where what we have here is a failure to communicate. Words, what percent of communication, if we're talking about 100% here, we've got three different categories. We've got words, we've got tone, and we've got body language. What percent of communication is words? Somebody give me a number. What percent? 20? 7%? What percent is tone? 38. Body language? 55. So when you're communicating, you've got to be very aware of your body language and your tone. And you can, I just love that talk. You know, that comes across, you heard me scream rather than you heard me say I love that talk. So you have to be very careful with this. And we do some, when I teach some of the position executives, we do some interview taping and things like that to make sure people are, you know, don't have their arms crossed. If you have your arms crossed, that typically means I'm not very receptive to what you're trying to tell me. You know, or you can sit in a chair and you kind of lay back, cross your legs, put your arms up, I don't care either. So you've got to, these little subtle clues make a big difference. So I think that we aren't aware of our body language or our tone quite often as far as the way we're communicating. That's the way people hear us rather than the words we use. Let me give you an example of that. Here is a situation that happened in my hospital, and this is an email tone example. So you know, there's, we have three LUCOMs, LUCOMs are Liberty University College of Osteopathic Medicine in Lynchburg, who will be coming this month for Block 9. Is there anyone who does not want a student? I will be gone for two weeks, I will not be taking a student. Please let me know if you have any preferences. Just a reminder, if you're away and have a student, please arrange coverage before your departure and send an email to myself and Amanda so we'll know who will be responsible for your student. I will take assignments on Friday. Thanks. This is the Psychiatry Dr. A. Do you see anything wrong with that email? It seemed pretty reasonable. If there was anything wrong with it, what would it be? Say that again? All of it. All of it? There's just one thing, and that's this right here. This doctor underlined that word, and that's the tone, because this is the response that came from the next doctor, Psychiatry Dr. B. You know, he goes through, it's a new thing to cover, etc., and then they underline an entire sentence, collegial relationship of outpatient providers with each other. So these two had had bad blood, and they underlined their emphasis, so it's the tone that was the problem. And then, this is the Medical Director who has to get involved, and he does a good job of talking about how nice we need to be and coordinating schedules, and wants to meet in person and talk about this and things like that. And one of the complaints with this physician was that he's a little too wordy sometimes. And a little bit of this, that was a pretty short email for him. But then this was the final email from Psychiatry Dr. A, after seeing those three emails. Just wanted your feedback, thoughts, and communication, but I don't think I can function in this department anymore. I'm so frustrated and emotionally exhausted, I'm not willing to walk on eggshells the rest of my career. My leadership continues to perpetuate this narrative of me being mean, angry, and difficult. Past few weeks have been so upsetting and unpleasant for me, leaving seems like the only option at this point. This Psychiatry Dr. A eventually was fired, and this physician did have a lot of problems, and I would work with, as a female physician, on changing and how she could change her tone, not being so self-righteous, not trying to tell everybody they're wrong all the time, not being as aggressive. I told her, if you get upset, call me first, and run it by me, and maybe you'll be a little calmer in the way you go about it. So I told her, it's like, she couldn't do it, because if you cross, I ask you to cross your hands like this, all right, then switch and put the other thumb on top. Feels a little uncomfortable, doesn't it? Cross your arms. Now cross your arms the other way. Doesn't feel natural. Or take your watch and put it on the other arm. So what's happening to her is that I'm trying to get her to change, and she's so uncomfortable, she just can't do it. So it takes a lot of persistence to do that. So that's an example of communication with tone, and it's just an underlying word in an email. So be careful about what you underline and what you send. Also an accomplice was showing the use of too many words. We need an economy of words, and Jason was talking about that earlier, about grants and how you need to have very few words and how to be efficient with them. And I think we're all guilty of saying way more words than we should, but that's the other thing that we need to do in communication. So be efficient in how you communicate, less is more. So we've got jumping the arena and communication, body language, tone, words. I want to show you, to me, the most important skill I think you should have, and we're taught this by taking histories at home, but I just want you to watch this video, and we'll talk about it afterwards. Some of you may have seen it. It's just, there's all this pressure, you know? And sometimes it feels like it's right up on me, and I can just feel it, like literally feel it in my head, and it's relentless. And I don't know if it's going to stop. I mean, that's the thing that scares me the most, is that I don't know if it's ever going to stop. Yeah. Well, you do have a nail in your head. It is not about the nail. Are you sure? Because, I mean, I'll bet if we got that out of there- Stop trying to fix it. No, I'm not trying to fix it, I'm just pointing out that maybe the nail is causing- You always do this. You always try to fix things when what I really need is for you to just listen. See? I don't think that is what you need. I think what you need is to get the nail out- See? You're not even listening now. Okay, fine. I will listen. Fine. It's just, sometimes it's like there's this achy, I don't know what it is, and I'm not sleeping very well at all, and all my sweaters are snagged. I mean, all of them. Yeah, that sounds really hard. It is. Thank you. Ow! Come on! If you would just- Don't! Try to see things my way. Do I have to keep on talking till I can't go on? We can work it out. We can work it out. So, the third skill is to listen. We do a terrible job of this. I know we're supposed to take a history and listen to the patient, but often we're jumping in and our mind's running ahead. We're trying to fix the nail and pull the nail out. They just really want to be heard. And you think of your spouse. Think of your friends. Think about all that listening. I'm terrible. I always want to jump to what I need to fix, but if you can develop the true listening skill, you will do so much better in your teams. The less you say, an economy of words, and listening. And what I mean by listening is you need to actively listen. And what I mean by actively listening is when you're conversing with someone, you paraphrase and repeat back to them what you're hearing. Rather than you, they may be talking about, I did this, such and such, you say, oh, I did this, you go on, you keep one up in each person with your conversation. You need to sort of repeat back to them what you heard. And when I do coaching, that's one of the things I've learned is when I do coaching, I don't really tell people what to do or coach them what to do. I help pull out of them what they think they should do. And help them feel comfortable about it. And so you learn how to paraphrase. And paraphrasing is not saying everything back to them. It's just acknowledging I've heard something that you've told me. And maybe with a question or a follow-up that shows that I've heard who you were and where you're from and what you want to talk about. So being actively listening is a big one. And you paraphrase with emotion, you get, and that's empathy. And that's sort of what you saw the guy do in the video toward the end. And that's kind of, I think, some of the things that we need with all of our conflict today. My second talk will be a little bit about conflict. We need to figure out how to listen to each other and paraphrase and repeat back with emotions that shows some empathy and understanding of people. So listening. Who's this? This is pearl number four. Who is this person? You're all too young to know, but I'll see who can guess. Pink Cadillac. Who's this? Mary Kay. Mary Kay Cosmetics. If you ever look up her quotes on the internet, she's got some of the best quotes around. And she says this. Everyone has a sign on the front of them that says, make me feel important. So where I find leaders having problems is that they don't make the people they work with feel like they're important. And you've got to find ways to make the folks you're working with feel like you're very important to them. And you do this by being a creep. You're constantly ready to encourage each and every person. So you need to do things, say, I like what I saw you did today, or I appreciate. So if you say I like and I appreciate and be a creep, pretend that that person's got a sign in front of them that says, make me feel important, your leadership would be much more effective. And I've been working with an executive director of our local theater, historic theater. And his employees were having a lot of problems with him because he did not do this. They felt taken for granted. And so you need to figure out how to do it. A trick I tell people is that put in your pocket something, a paperclip or a coin, in one pocket, say five of them. And then by the end of the day, you've got to move five over to your other pocket. And you can only move one when you say, I like or I appreciate to somebody. So when you put one coin and put it over here, I've said something, then by the end of the day, you want all five coins moved over to the other pocket. So if you do something like that, you'll learn how to say I like and I appreciate. That'll get you a long way. The other thing, and I don't like busy slides like this, but I kind of want to talk about this a little bit. Has anybody ever read Dale Carnegie's How to Win Friends and Influence People? Probably the best book you'll ever read. It was written in early 1900s. So all the examples are like the old Ford Motor Company and different companies that aren't in existence anymore. But if you want to be an effective leader and get along with people and do well with your patients and do well with your colleagues who are going to be referring you, business, these are the things that you need to do. And I'm going to touch on a number of them and sort of explain them. But the book is very short. It's not very long. And it's called His Golden Rules. So as you know, don't criticize, condemn, or complain. We do this all the time. But it gets just nowhere. It's okay to give constructive criticism and feedback, but don't criticize, condemn, or complain, and give honest and sincere appreciation like I just said. That was I like and I appreciate, but be sincere and honest about it. Don't fake it, because people can tell if you're faking it. You don't want to arouse the other person's ego. One, you want to make it be like their idea, but become genuinely interested in other people. People like to talk about themselves. So if you can drag that out of them, not just a patient but a colleague, that goes a long way. Smile, don't be grumpy, and remember that person's name is the most important sound in any language. People like to hear their name called. So try your best to say Klaus or Chow or whoever. You know, people like that. Makes a difference. Good listener, okay? Some of the stuff I just talked about. Talk in terms of the other person's interest and make the other person feel important, like we just talked about. There are other things. I like the one at the top. The only way to get the best of an argument is to avoid it. And the reason I put this up here, I use this all the time, is if you think of the arguments you've been in, perhaps with your spouse, even though you may be right, do you feel like you've won? Or if you get in an argument, I had a patient I was arguing with about, they weren't allergic, they had an intolerance to this medicine, you know, it was not allergy. I could not talk her out of that, so I just avoided it. I just said, okay, it's your allergy. But you know, have respect for the other person's opinion. Never say you're wrong. If you were wrong, admit it quickly. Begin in a friendly way. Let it be their idea. And then the other thing is let the other person do a great deal of the talking. And here's another, some of his golden rules, and call attention to people's mistakes indirectly. So I often have to give pretty tough feedback to people, and I try to draw the problem indirectly. And I was mediating a problem in this place where I live in Vermont in the summer, and these people weren't getting along, and there was one particular person that had a problem, and he was acting out, so I drew the attention to his mistakes indirectly by saying, I do this, I'm guilty of this, I do that, you've been plowing ahead without including anybody else, and they've all been left behind. Said, but I'm guilty of it more than you are, so you are a lot, a lot alike. So I tried to call attention to his mistake indirectly, and that's what we did there. So anyway, these are just, if you ever want a book to read, it's really good, it'll help you with this, I'd read this one. The other thing you gotta remember is that when you're a leader, and there's this dynamic between a support, and you have a conversation with somebody who reports to you, no matter how good you feel like the conversation is, they never feel like it's good. So you gotta always realize that the nurse, or the employee who's reporting up to you, or you're over, the conversation's never like this. It's always like this, so always keep that in mind. Be it, there you are, leader, not here I am, leader. So that's when you walk in the room, you don't wanna make everybody know, oh, I'm here, the big leader. You're there to help. Number five, you need to network, as you've heard everybody say. And, because most of innovation comes by looking over in the future, and the search behavior is more important than brilliance. And, you know, when I went into leadership, there was nobody doing what I did, and I didn't know how to do it exactly. I mean, how do I put in computers in hospitals? How do I improve relationships? How do I, you know, lower cost of care? How do I put in guidelines and order sets and stuff like that? So I formed my own networking group called the North Carolina Council of Physician Executives, and eventually got about 50, 60 doctors in leadership, and we would meet. In my local community, I served on the school board, I was on the chamber board, and right now I'm doing a podcast at home interviewing leaders. So stretch out in your community, stretch out in your group, and form your own network. And you learn so many things, you get exposed to things. You know, Basin was talking about his travels and the networking he's done all over the world. I mean, it's just invaluable, the contacts that you'll make. Let's see. Number six, seek feedback and have the hard conversation about it and change based on that feedback. And I'm gonna show you an example to finish up here of a hard conversation I had to have with a cardiologist, two cardiologists. I was called in to a problem where a new cardiologist that does TAVR, but that's the place they already valve through the catheter, was coming in to start the program, but it was a guy that already doing some of it, he had not been trained in it, and they weren't getting along. So the cardiologist called me in to see how can I get these two folks to get along a little bit better. I'm just gonna show you the feedback that I got. So what I do when I do a 360 feedback is I ask each doctor to give me 10 names of people to tell me what do they do good, I wanna keep doing, what do they do bad, they should stop doing. And it's brutal sometimes what I had to do. But here's Dr. A, the positives. This is what you want to be said about you, right? Good with patients, program builder, nice person. Well-trained, smart, funny, approachable, great cardiologist. But I also heard this. arrogant, hierarchical, is this physician would treat the nurses and the nurse practitioners and the techs horribly, but would treat his peers very nicely. And he came across, you know, the head of body language, seemed like he was entitled, and lacks humility, so I had to work with him on that. But the doctor he's having conflict with was this one, Dr. B. Similar kind of words, but this doctor is volume oriented at the expense of others, appears to have issues with truth and honesty. What he would do is he goes up on the floors from the cath lab and picks out the patients he wants to do cath on that would be the best reimbursement at the expense of his other cardiologists in the cath lab who were getting the bad cases. So his colleagues didn't trust him, but he was very good with the staff. And so I had to sit down and work with these doctors, and believe it, the one, this first one that I had to work with, he ended up doing a procedure on my sister, and he called me about three weeks ago at nine o'clock at night, told me, telling my sister how great I was with him and how I helped him a lot. So even with that feedback, I had to give him somehow or another, I was able to gain his confidence. And so anyway, I won't go into this leadership weaknesses, but problems with interpersonal relationships is the biggest thing that you've got to think about. And in summary, jump in the arena, communicate economically, listen, be a positive leader, network, seek feedback, and you want to be perceived like this and not like that. Here I've got some books, you know, bibliography here, some of the stuff I've read that may help you just with that. So that's the first talk I was going to give about leadership. Let's see if we have either virtual or in-person questions about that topic. Well, thank you. That was great. Thank you. So you like? You appreciate it? I like. I appreciate it. You can take that coin and put it in your other pocket. I appreciate it. Additionally, I think I'm OK saying that I've heard that talk several times. And Kjell was the one who disclosed his Parkinson's. It's especially impressive to see how you're delivering it, despite the challenges. That's seven years of it now. Thank you. Yeah. Medicine works. Pramopexol, levodopa, sagilene. It works. I tell people I'm either too greased or not greased enough. I'm either wiggling like Michael J. Fox, or I'm like this and can't move. I can still play golf. You had mentioned earlier that you were amongst the only one or of the three that were around the area that were taking up just as a profession, like coaching and conflict management. But have you seen that being adapted by other institutions now? Or has it become because I think in our institution or other institutions, we don't see that very readily available, if you would say. You're talking about the kind of work that I'm doing now with coaching and stuff like that? Yeah. You're right. Most health systems don't invest in it. And I'm doing it with my local health system because my friends that I mentored and brought along as physician leaders are now in leadership roles. So they were using me because they knew me and trusted me to come back and help them take care of these problems. Most people just kind of ignore them or sweep them under the rug or don't handle it very well. They just tell them you've got to stop. They don't take the time to talk to everybody and to really sit down and give them the hard feedback and then work on that. So I would say most don't do it because coaching is pretty expensive. But I'm cheap. I do it because I enjoy doing it. And I like to make the health system better. So I charge $150 an hour. So an engagement with me for somebody for about six months is about $3,000. And most coaches would be $20,000 to $30,000 kind of price range. So I come really cheap. I'm not looking for business either. Fergal, you had a hand? Yeah. Really insightful for me. Can I ask, do you feel that coaching or executive coaching is a necessity or a nicety? I think it's a necessity. And can I ask you, at what stage in someone's life or career do you think it should start? That's a good question. I think when you're in training, you're always getting feedback. When you get out on your own and you get a little isolated, you probably need to get some feedback every so often or seek it out in some way. If it's not official, some friends or whatever, accountability partners, I've heard them called, somebody that's good listening. So every coach is different about how they do it. But I would certainly say most of these folks I've been dealing with about 10 years in their career when they need the coaching. And can I ask you from a frequency perspective, do you think a once a year interaction is good? Or should it be something perhaps once a quarter? What I typically do is I'll meet with someone initially to find out what's going on. They've been referred to me either for a problem or to help evolve them as a leader. And I will spend two or three hours initially. And then I'll get the names. And I spend 10 hours calling and talking to people on the phone. And I'm able to get these people to really tell me the truth. Somehow or another, you're usually afraid to talk about somebody. But I'm able to drag it out of people. Because what I find when I call those 10 people is I find the same theme with all 10. It's not there's a friend, and there's somebody that doesn't like me. I hear the same story from everybody. So I will do that. And then I will sit down with the person I'm coaching. And I've typed all that up. And some of the words are really harsh. And actually, what you saw there was watered down language from what I heard. And so I will typically type up a little gentler version. And then I sit down with the doctor. And I read it to them. And at the end, I have the summary of the points. I feed back every word, what everybody says about it, blinded. So they hear every word. And I hear the summary. And then I have interventions of what we need to do to make this better. So usually, it takes me, I spend about six months with somebody. And then I kind of try to launch them. I'm around. Call me if you need me, if you have a major problem. And the psychiatry doctor that I was working with, they told me that when I was working with her, she was OK. But then when I did the six-month leave, she deteriorated. And HR fired her. So that's actually just going to be my follow-up question. When you get involved in scenarios such as that, what percentage do you deem are successful? That's a good question. I think that it depends on what you define as success. Does not repeat offend anymore. Yeah. What I typically find, and that's sort of like, another way to ask that question is, do people change? Do you change anybody? And I would say that if I can get somebody from being unconsciously incompetent to consciously incompetent, where they know they've got a problem, I've made progress. To get them consciously competent, that's tougher. And your real success is when they're unconsciously competent. So I've got a few that I've worked with in anesthesia that have become unconsciously competent. They're very good. But this person, she was consciously incompetent, but she couldn't help herself. She really couldn't. She just could not hold back. I know there's more questions in the room, but we're running a little bit late. I want to at least have the virtual audience give us one question. And then we'll go ahead, and maybe we can cut a couple of minutes from the second talk and from the breaks. So the question from the virtual audience is, can anyone try to become a leader, or is it something they're born with? I think anyone can become a leader, not necessarily born with it. I think there's certain characteristics people have that maybe make them a little easier to be a leader, but I think everybody can be a leader by reading and experience and doing these kind of things, be a better listener, do Dale Carnegie kind of stuff. That's the way you lead. I mean, everybody leads a little differently. Extroverts can lead, introverts can lead, lead by example, lead by being outspoken. There's a lot of ways to do it. The way I would have answered that question is to ask, can everybody become a colonoscopist? Because having done some of that coaching, I think of some of these techniques the same way I think about techniques we learn when we're doing procedures. There are certain things that you can train yourself to do. So that's how I think about leadership.

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