John Jurica MD, MPH, CPE
John Jurica MD, MPH, CPE is a board certified family physician. He served VP of Medical Affairs and Chief Medical Officer of a regional hospital. John is a blogger, podcaster, business owner and entrepreneur. He enjoys bluegrass guitar as well as competing in Track and Field.
- John feels that despite improvements in communication delivery, interpersonal communication has not really improved over the course of his career.
- John feels that active listening is a major issue with physician communication. He also feels that clarity in communication would improve interactions globally.
- John also recommends slowing down when trying to communicate with others.
- John advises acknowledging all members of the team with specific complements on their skills/work duties.
- “For a leader, there is no trivial comment” (Fierce Conversations- Susan Scott)
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I hope you enjoyed this episode and stay tuned for Episode 003: Let’s Talk About Drugs, Baby!
Andrew Tisser 0:03
Dr. John Jurica. Welcome to the Talk2MeDoc podcast!
John Jurica 0:13
Hey, it’s great to be here. Thanks for inviting me on here, Andrew.
Andrew Tisser 0:17
Absolutely. Thank you so much for coming on. For the listeners, if you could just give us a little bit of who you are and maybe what your career trajectory has been?
John Jurica 0:30
Sure. I’m a family physician by training. I did family practice for many, many years. My former hospital cmo, I did that for basically 15 years. And now I’m a blogger, podcaster course creator and an entrepreneur. I am the medical director and part owner in two urgent care centers in the northern Illinois area, so I’m kind of still balancing several things. And I kind of made those transitions from family medicine to hospital leadership to the urgent care over a period of the last 20-30 years.
Andrew Tisser 1:07
Wow. So you certainly do a lot of things there, John. As you as you reflect on all your different roles and the different hats you’ve worn over the years, this is a communication based podcast. So could you reflect on where we are currently with communication and healthcare as a whole?
John Jurica 1:27
Oh, boy. Yeah, I think communication is kind of one of those timeless things. Although I will say that things have changed drastically over the past 30 plus years that I’ve been in practice. You know, when I started, we didn’t really use cell phones at all to communicate. We had pagers, we didn’t have texting. We didn’t use email, and then over the years, and that all came online, and then of course, we are still in paper charts.
And now that’s all changed and we’re on EMRs (electronic medical records) and and all of our meetings. If we discuss something or talk about a patient that had be over the phone or on a meeting. And now we can do web based meetings, zoom meetings, things like that. But I think, I don’t know the communication in the either the good or bad of communication is really changed that much. I mean, it’s changing the method. But I think as humans, we’ve probably keep, we keep making the same mistakes when it comes to communication. And given that it’s super important, not only in patient care, but in running a business or practice running a hospital health system. It’s just unfortunate that these, these problems sort of seem to never go away.
Andrew Tisser 2:41
Sure, what do you think some of those problems are?
John Jurica 2:45
Well, you know, communication is such a vast area. There’s a couple that stand out to me when I think about communication if I were going to boil down the big the big issues and I’ll try and even boil it down to the biggest one in my mind, but On the front end, I think, the inability or lack of attention to listening from the very front end, listening is a big problem. We’re busy physicians and clinicians, leaders, managers. And we start the whole communication process wrong when we’re interacting with almost anybody if we don’t actually stop and actively listen.
So that’s, that’s that piece that I see continually going wrong. And then on the other end, the thing that I like to talk a little bit more and focus on myself is that there’s often a lack of clarity, when we do get down to trying to have a two way conversation. So what I mean by that, and this can be, well, actually electronic methods made it worse. It used to be let’s say, I was sitting across the table from you, we can have a conversation, there’s a pretty good chance that 15-20-30% of that you’re probably not really understanding the point I’m trying to make. Part of its because we’re not listening. But part of its because we’re not being clear in what we’re trying to get across.
But at least we have the body language we can see each other is there any emotion with it, you take that kind of communication you put it on a telephone okay now the body language is gone. And you pull it over to to an EMR well on an EMR electronic format, or email or a text. And now you’re trying to get emotion and you know, and I, you’ve probably had this issue with kids if you have your spouse. Two people can look at the exact same text, exact same email and get completely different feelings from it.
My wife is more of an emotional type of communicator, she has a high emotional quotient. She’s much better at understanding people, but she reads in a lot more emotion and attacks than I do. You know, I’m a very logical so to speak very sort of numbers oriented person and when I look at Like a two sentence text, it has no emotion. It’s just basically it’s trying to tell me something. So then you’ve got everything in between. So I, when I was the CMO, clarity was a really big deal. And you know, if you if you like, I give you some examples of why that was an issue.
Andrew Tisser 5:17
Yeah, please, that’d be great.
John Jurica 5:19
So I just saw so many examples where the lack of clarity, lead to problems. So in the main problem I’m talking about is patient safety and patient quality of care. me if I was in a hospital setting. And, again, I’m going to go back to years ago, things that, you know, people of your generation don’t really think about. But we, you know, CMS (Centers for Medicare and Medicaid Services) had to put in a rule that you couldn’t use abbreviations. I can’t tell you how many patients were harmed. Because myself or another physician would write something out abbreviate an order in a chart, which would then be misconstrued. It would just get the wrong medicine. Get the wrong dose. So I mean, that was one obvious example now that has been eliminated essentially by electronic medical records and order sets and so forth.
And that the whole issue of handwriting has been solved. But that was one example. But those things continue. You’re giving a verbal order over the phone to a nurse, supposed to do a read back. Now, sometimes we do the read back, sometimes we don’t. It’s extremely easy to have a breakdown of communication and what’s going to happen, the patient is going to suffer. And this is not an uncommon cause for lawsuits. It’s not an uncommon cause of poor patient outcomes or safety problems. And even I remember an example with with my CEO and the leadership team, so kind of take it out of direct patient care. But we would have regular meetings, they were planning meetings, and it was a senior executive team or 10 of us in the room, the CEO, myself, the Senior VP, whoever was over HR, so on and so forth. And we would have You know, conversations, strategic planning, goal setting and so forth. And the CEO would have X expectations. Okay, we discuss this issue, CEO next week. Make sure you come back follow up with us on this particular problem, what action you took and what the results were.
I don’t remember the exact subject matter, but I remember coming back a week later, the CEO said, Okay, so, you know, Jim, did you follow up on this issue? I was expecting you to bring this today. Do you have a report for us? And he was like, No, because that isn’t really what I took from what we saw what you said last week now that CEO is getting totally irate, because this person didn’t deliver what they expected him to deliver. And the reality was all of us around that room. did not hear what the CEO said he was expecting. We were like, No, that isn’t what you said because nobody said that. But after the meeting, we’re like, wow.
And he got very emotional fact was very upset. seconds with something he fully expected. There’s no written, you know, version of that there was nothing in the minutes, there is no way to go back and check, but it just resulted in unnecessary, sort of anxious and emotional, you know, stress on the entire team over something which is really just a misunderstood communication that’s happened in front of the whole team. So it’s just rampant. And so I really, I really think we need to focus on clarity in you know, anytime we’re communicating. And, you know, we need to take the time to have someone explain back to us, right, that’s what we do with the teach backs with patients. We have to tell them what to do. But please Now, tell me what I just taught you or told you to do. But how many of us can really do that? You know, our visits were in the clinic or the office and we’re seeing patients every 10 minutes, 15 minutes. See if your pediatrician every six minutes, whatever it might be, how often do you have time to sit and spend four minutes to hear back what you’ve just taught the patient or the So it’s it’s very dangerous when we don’t really focus on the clarity in our communication.
Andrew Tisser 9:07
Absolutely. Thanks for the example. You really explained a lot of the points there. I see. You’re saying that read backs and having people repeat back to you is kind of one of the strategies that you think can improve clarity. But do you think there’s anything else we can work on to improve just the understanding of what’s being said and clarity of thought?
John Jurica 9:30
Well, see, I think part of it, I don’t think I really have the ultimate answer. But I think what helps me and some of the people that I work with is to slow down. And again, sometimes you can’t, but when you’re in a hurry to communicate, you’re not going to formulate your communication all that well. And so you need to slow down and take time. And then it does take a little study. I mean, it’s interesting, people will ask a very simple question. And think it makes perfect sense. Like if I say, hey, you and I going to get together next week for that meeting and follow up on this project. Does Wednesday work for you? Or is Thursday better? And then you respond yes. In your email, or your text. Because you didn’t realize I was actually asking two questions. Do you want to meet on Wednesday? Or do you want to meet on Thursday? You know, you almost have to separate it.
But we tend to run these ideas together and questions and in texts and emails. And so part of its just slowing down. And I don’t know if you’ve ever been in a court of law, or been deposed or, you know, actually have to testify. But one of the tricks an attorney does that traps you is they have very long run on sentences. And what your defense counsel will always tell you is to stop and then say, could you rephrase that, please? Could you ask it another Could you break it down because I really didn’t understand it. So we have to make sure we understand it first and break it into smaller pieces if we can any any really critical communication. The other thing that I do is when I’m communicating like we are live, or on a telephone call, I almost always say I’m going to send you an email with what we just spoke about. I’m going to follow this up with a written version of what I said and what I think you took, and what we each expect of one another. So it’s a little redundant, but I think really to get the top notch clarity, probably it’s about the only way you can do it is to just build in some redundancy.
Andrew Tisser 11:38
Yeah, that’s a really good point. I think I feel that whenever that’s done, I don’t think I do it enough. But whenever that is done, it certainly clears up some confusion and sometimes leads to follow up emails because people didn’t understand what was being said.
John Jurica 11:52
I was on a phone call the other day we were I was planning a new project and working on with a couple of other physicians. I think I had like a 15 minute conversation. But I said, you know what I’m going to put what we talked about into just basically take minutes, I’m going to put it in here. And I mean, just based on a 15 minute conversation, I mean, I had a full page of, I think 10 or 12 items that we discussed somewhat. So very brief, but it’s like if I put it on paper, I send it right back out to my partners on this thing. Then, next time we get together, I can either clarify and they’ll say, Well, I don’t I don’t remember talking about that, or whatever it might be just just another way to build in that redundancy.
Andrew Tisser 12:36
Absolutely. And now, I mean, you spoke about some of your experiences as a clinician and then as an administrator, now that you’re working on some more entrepreneurial ventures, podcasting, etc. Do you feel that some of those communication skills that you learned during those roles translated well or is it a whole new skill set
John Jurica 12:57
Everything that you do in your Career, this is kind of the way I look at it is you’re building a certain talent or skill set. And they almost always apply in other settings. And they almost always stack on one another to where they can make you better at whatever future career you may follow. If it’s, you know, you may still be in as a clinician, but you’re going to end up being a leader, most physicians ends up being a leader in some setting in medicine, that’s our nature. But I’ll give you an example. So I’m talking about like verbal and written communication. Well, as a podcaster, and a blogger, I sometimes delegate or outsource duties to other people.
So I go on, you know, a site called Upwork. And, and I’m going out and I’m trying to recruit people could be around the world, it could be in Philippines, India, wherever. And I’m trying to communicate, okay, this is what I need you to do. I need you to take this file, I need to edit it or I need to take this audio file turn into a written file or transcription, whatever It might be, but it’s exactly the same. It’s like if I don’t, if I don’t spend a few minutes really trying to be crystal clear, I guarantee it’s gonna come back and they’d be like, what do you really want me to do? I don’t understand. So, this this goes into all areas of life and even with your, you know, your family, I mean, be having clarity, and not take for granted that everybody understands what you’re getting at.
Andrew Tisser 14:24
Sure, yeah, no, that makes a lot of sense. What about the greater health care team? As in? I know, we’re talking about administration, physician relationships, we were talking about physician nursing relationships, but how about everybody else, such as facility security, etc. I’m sure clarity plays a role there. But do you think there are issues with communication among the physicians and everybody else?
John Jurica 14:55
Well, yeah, I mean, if you’re in a hospital or health system courses. So it’s such a matrix relationship that you have with everyone. Now, typically you don’t interact directly with, you know, maintenance and facilities and, you know, people sort of like bad but when you’re talking in a team, I’m thinking more at the leadership team in the hospital, you know, those are all those other components are as important to, let’s say, patient safety and quality as the clinical in some way. So I mean, even the person that comes into the room, and is turning over the room and sterilizing the room and, and and, you know, reducing contamination, so forth isn’t as important for patient care. I think the other thing is that when you’re working in any environment, where it’s a team approach, which we always do, and whether you’re like in a clinic or you’re in the hospital, I think it’s really helpful to interact with all the people and acknowledge them and that’s probably one thing that I don’t do as much as I should and that is kind of that related to our clarity, but I obviously take for granted some of the work that these people are doing.
And I think it’s good to remember to just stop and acknowledge someone. So you know, it really helps me that when I come in here in the morning, this place is so clean or this place is so organized. And you know, the stocking is done. So for talking about, you know, staff that are dealing with supplies, and just take a minute to do that, but obviously, you’re not going to, here’s another place where the communication breaks down. Yeah, I had this with the urgent care centers where I had all the rooms stocked exactly the same, theoretically, so that we can move through things quickly. And, you know, the other providers would come through medical providers, right, they were providers, but medical providers, okay, because it’s PAs and NPs but I kind of bunch us all together, you know, had made some changes or I go into a room and things are missing, but it wasn’t really that it was missing it was a lack of communication.
They, it was decided when I wasn’t there one day, that we were going to move all the scalpels out of the room. into where we keep the needles just so we didn’t have some patient go berserk and grab a scalpel and injure somebody, you know, but I was like, I’m looking, why are you people not doing your job and putting the scalpels? I need the scalpel? Well, now we sorry, we didn’t communicate to you that we move them. You know, you should have asked us, we would have told you, but yeah, I mean, it’s just communication is such a critical thing at all levels. And it’s easy to forget. And so I try to keep that in mind. But, you know, many of us physicians are introverts. By nature. We’re not necessarily proactive about talking and interacting with people, I have to kind of almost force myself to engage, you know, during downtime with the staff around me if I’m working in a patient care setting. So there’s a lot of things we can continually improve with communication.
Andrew Tisser 17:50
Absolutely. Do you think as a whole that affects patient care, do you think there’s a trickle down effect there even the people that aren’t directly clinically involved?
John Jurica 18:01
Well, yeah, I mean, the patients do interact with those people, you know, depending, you know, at each step of the process, maybe maybe not the people who come in and clean the rooms at night or something, but I mean, all the staff that are actually physically in whatever environment you’re working in, so you kind of indirectly can improve the communication of them or the, their relation to these patients by relating better to them because you’re part of it is just modeling. So, you know, this is another interesting thing about communication. I heard somebody, I read a book. I think you had asked me to think of some books I was interested in, but one of the things that I read was, that was really so true. It says that for a leader, there is no trivial comment. It’s like, okay, that’s awesome as Susan Scott that said that and, you know, basically that means that you’re always on and people take their lead from you either as a physician or physician leader or again a leader in a hospital system like I was in so it all trickles down. And you have to be careful because what you think might be something trivial or inconsequential, or even a joke or sarcasm. It can be taken really wrong by the people around you so yeah it all filters out into the whole mill you and the whole environment of the wherever it is that you’re functioning.
Andrew Tisser 19:29
Absolutely. The you know, for someone who’s a self proclaimed introvert to have over 100 podcast episodes I think you’re doing pretty well there John.
John Jurica 19:41
It’s funny of this is a man I know I can digress for a moment. No, number one I’m shy and number two I’m an introvert does two different things of course, but I don’t get energy from groups of people except like on a podcast, I guess. It’s like a virtual group. And but the thing is, as you get older, you just get over it. People look at me now. Like you’re not an introvert because you know you crack jokes or do whatever go out to dinner and, you know, get into a conversation with the waitress or something. But you know, part of its just getting older and not caring anymore.
Andrew Tisser 20:18
So your podcast is about non clinical or alternative careers for physicians. What got you interested in that?
John Jurica 20:26
Let’s see. Oh, that’s a good question. You know, here’s what happened, I think I was I was really interested in sharing my expertise about leadership, physician leadership, and trying to promote physician leadership and so forth. So I wrote the blog, I was writing the blog about becoming a medical director and working as CMO and how to work on a leadership team and so forth. And I had some interest in that. But then it occurred to me that going into hospital leadership or hospital management was just one of many non clinical careers. What I did, but looking back, I realized I did that in part because I had some of the symptoms of burnout. I was starting to almost, you know, not like my patients, I was getting fed up with the paperwork.
And so that was my natural route to go. But then I was looking around, go, wow, there’s a lot of people who feel like I did, but they can’t go into that, you know, they can’t go into hospital management. They’re in an outpatient setting, they don’t even set foot in the hospital. And I became intrigued and interested in physicians who were doing coaching for people with burnout physicians who had made a shift to other non clinical careers. And so I basically decided to do the podcast so I could learn about non clinical careers from others that were doing. It was sort of like I wanted to become the expert in a way, but I knew I wasn’t. So I thought, well, I’ll just talk to physicians that have done these other non traditional careers. And so that’s was the inception of the podcast. I’ve never really dug deeply into burnout or a lot of people that do burnout.
You know, they talked about burnout, they try to address burnout, they teach about burnout. And more or less I don’t, I’m not against physician staying in clinical medicine. In fact I encourage, and I just don’t think they should stay in a soul crushing form of clinical medicine, you know. And so if you can fix it by getting a different boss or going to a different organization, do it, but don’t just sit there mired in the pain and, and, you know, if you start to feel like you don’t care, like you’re not engaged, you know, there’s something wrong and most physicians don’t even realize that they’re burnt out, but at least initially, but anyway, that’s a driven drove me into the podcast. Now I just, there’s so many may have interviewed, I don’t know, maybe 80 physicians or so 70 or 80, do some solo episodes.
I mean, I’ve almost kind of only scratched the surface because there’s so many careers out there that I wasn’t even aware of, and then I’ve not even spoken to people about yet so I’m just trying to get new guests with different topics. That we can address and hopefully I’m just there to help the rest of the physicians out there, I want all of my colleagues. I mean, we’re in a group, you and I, other physicians were elite in some way. I don’t mean that, you know, like, we’re better than anybody else. But we’re kind of like the military, we have gone through a process. And I think our processes even a lot longer than military, unless you’re a lifetime, you know, in the military. But I mean, it takes us so long to get through it. And it’s such a similar process that we all go through that we are automatically, you know, part of this group, that we can all relate to one another at some level. And we’re all professionals, and I just, I hated that my colleagues are miserable, some of them and so that’s why I do the podcast.
Andrew Tisser 23:50
Yeah, I a little plug for John’s show. I love it. I’ve been listening for a long time now. And it’s just amazing to hear how many different things that physicians have done. Whether it be on the side or as a full time transition careers, you never would have thought were possible because they definitely don’t teach you about them in medical school. Nor they do they teach you about communication for that matter.
John Jurica 24:13
That’s right. You know, there’s only so much time, you know, and every time you want to put something into a med school curriculum, you have to pull something out. It says a lot of resistance to doing that.
Andrew Tisser 24:23
Yeah, that’s fair. I don’t know. I don’t know why. It’s always a take it or leave it kind of thing. But with with improving curriculums and changing curriculums, that’s a really long process.
John Jurica 24:37
Yeah, they should, they should be more that should be more about a lot of things, you know, non clinical careers or actually clinical careers, a build on your medical degree and so forth. But also you know, how to deal with money and how to lead people, they don’t spend that much time. I mean, as a physician, if you stay in clinical your whole life, you’re going to be leading teams. And so it’s a little bit by experience, but they don’t know always very just upfront about that.
Andrew Tisser 25:01
Absolutely Well, I think we’ve already kind of transition to the second part of the show, which is really just trying to get to know the guests a little bit better. So we talked about your podcast and some of your motivations. But let’s talk about books. I’m a bit of a nerd when it comes to reading books. So how about one current book recommendation and maybe a favorite book of all time?
John Jurica 25:24
Oh, let’s see here. You know. Okay, let me boil it down. Something that I read, not that long ago, but I think is really interesting. And it’s called Deep work by Cal Newport. And I just found it intriguing. It’s something I had never really considered before and it’s just how to get in the zone and things you can actually practically do. And it also talks about the importance of having quiet time to plan things, to write things. He is an academician. So he writes, a lot of of academic things, but I mean applies to anybody who is, you know, planning and writing a book, or planning a business or planning a new venture in the hospital or whatever it might be. So, I mean, that’s one that is recent that I think is worth looking at. Now, you asked me about favorite all time book? Yep. Okay, so now you’re going to have to tell me, whether it is going to be based on the number that I’ve given away because I thought people would like it or based on the number of times I’ve read the book myself.
Andrew Tisser 26:38
How about the number ones you’ve given away?
John Jurica 26:41
Okay, so this is one, this is going to be added. I feel foolish even saying this. I took my family on basically, to Africa for a safari type experience, you know, photographs and things. It was an awesome vacation. I came back we were in the airport and I saw a book and I grabbed it. brought it with me home. I read it on the plane. And when I look back, I thought to myself the high point of this trip was finding that book.
Andrew Tisser 27:09
John Jurica 27:12
It’s called the four hour workweek by Tim Ferriss. Now I’m sure you’re familiar with it. Yes, the guy is an icon. Of course he has the long form podcast so maybe I’m interested in that for that reason, but really, it was just an eye opener for me it was like okay, you there are possibilities and the book is not about trying to do work really work four hours a week, obviously, but it’s a compilation of a lot of different things and it just kind of basically says that you can create your own life your own lifestyle and it’s about lifestyle redesign and all kinds of different things. So the the titles kind of for those that haven’t read it, you know, he’s got the four hour shaft and there’s a lot of follow up books, but that one is like the beginning and it’s it’s one of my favorites. And so when I’ve given away the most because I found it so interesting.
EDITOR’S NOTE: I followed up with John who recommended a few more books: The Road by Cormac McCarthy, Fierce Conversations by Susan Scott, The Five Dysfunctions of a Team by Patrick Lencioni.
Andrew Tisser 28:00
Yeah, that’s a great book. I think a lot of the lessons in there about automation can really apply to busy health care professionals. And some people are just put off by No, I can’t work four hours a week. But that’s not that’s not what the books about at all.
John Jurica 28:13
Now he admits it. Like it’s sort of like a spammy or scammy type of title, kind of what you call like, clickbait type thing, but no, I mean, that’s not really what it’s about. But it is about taking control and then implementing things, these new things like you said, automating things and improving your effectiveness. And so yeah, it’s really been very popular.
Andrew Tisser 28:38
So John, what do you like to do for fun?
John Jurica 28:41
Oh, for fun. Well, I do like to do the podcast and the blog and work with people in this whole setting. That’s one thing. Other things I do I workout fairly regularly. I compete in masters track and field events and the 102 hundred meter dash and I play the Bluegrass guitar when I have time. Spend time with family.
Andrew Tisser 29:02
That’s cool bluegrass guitar. I’m a bluegrass banjo player myself.
John Jurica 29:07
Oh, no, you’re kidding me. I know. That is fantastic. You know how hard it is to find a banjo player or a mandolin player?
Andrew Tisser 29:14
You know, and we were living in Chicago it would have been perfect.
John Jurica 29:18
A small group of us. I had a banjo player, mandolin player, fiddle player and occasionally a basis and we go to the nursing home once a month and play for the seniors, you know, folk music and bluegrass. We did that for like eight years.
Andrew Tisser 29:30
That’s amazing. I’m sure sure that was a big hit. It was fun. Well, you already answered my next question about a piece of advice to physicians in regards to communication. So finally, john, if people want to reach out to learn more about what you do, where can they find you?
John Jurica 29:50
I would make two suggestions. One is the show notes or my blog is combination I have like about 100 articles on there plus, like the hundred plus podcast show notes on there, which will To the podcast on your iTunes or wherever but that’s it’s at vitalpe.net now it sounds weird but vital pe refers to vital physician executive.net which is the my original blog and this just happens at the podcast show notes are there too but vital p.net. And then the other one, it’s pretty popular is the Facebook group. For those looking at non clinical careers. It’s physician non clinical career hunters, Facebook group on Facebook, you have to apply have to be a physician, we have over 12,000 members getting close to 13,000. And they’re all physicians. So that, you know, if you’re interested in learning more, you just go there and check that out.
Andrew Tisser 30:41
Great. Well, this has really been a lot of fun, John, I learned a lot and I hope to talk to you pretty soon.
John Jurica 30:48
Hey, it’s been a blast and good luck with this young podcast. I think it’s gonna be great communication is super important. So thanks for having me on.
Andrew Tisser 30:58
Absolutely. Take care.
Transcribed by https://otter.ai