Transcription of Podcast

Julie Soukup 0:01  
All right. Hi, my name is Julie Yorumez. And I'm back with another exciting episode of take one patient at podcast. The reason that we're doing these communication conversations is medical memory who sponsors this podcast, we have recorded over 157,000 patient visits. And we want to be able to equip doctors and nurses with the tools to not only effectively communicate with patients, but feel comfortable recording this content that they can continue to share with with people that are really, really needing to better understand their care. I'm very excited today to be talking with my very good friend, Dr. Roy. He's here from the University of Texas pediatric surgeon, why don't you kind of introduce yourself and your experience a little bit first, and we'll kind of dive in there.

Dr. Soham Roy  0:54  
Absolutely. Well, good morning, Julie. Thank you for having me on this podcast. I'm honored to be here, thank you to all who are joining. And to tune in, I hope I can provide some useful information. So my name is Shawn Roy, I am a pediatric ear, nose and throat surgeon. I'm the Chief of Pediatric ear, nose and throat surgery here at the University of Texas at Houston, and the service line director for pediatric ear nose and throat services for Memorial Hermann health care systems, which is one of the largest health care systems in the South. I also hold a number of other leadership and administrative roles. Happy to discuss those further at some point, but here I am. Thanks for having me. It's good to be here.

Julie Soukup 1:26  
Yes, absolutely. So I think one of the really interesting things that I'm excited to talk about with you today is how the dynamics of the patient, Doctor relationship changes and shifts when your patient is a child. And then whether there's also a third element of the parents, of course, or grandparents involved in that communication strategy. So why don't you tell me originally kind of like what what made you first dive more into pediatrics versus an adult population? As far as choosing who you were going to be serving?

Dr. Soham Roy  2:00  
You know, it's a great question. So when I look back at my own history, for example, I think I knew early on that I wanted to work with children, as it turns out that there are certain types of people who are sort of drawn to helping kids frequently as in my case, it's because you just don't blame children for the things that happened to them were sometimes the things that happened to adults, kind of brought upon themselves, sorry, I enjoyed working with the families and the family dynamic. And so I spent a lot of my early medical school career trying to figure out what I wanted to do. And everything that I got involved in came back to some sort of pediatric care via heart surgery in children, ear, nose, and throat surgery in children and things like that. Ultimately, I settled on ear, nose and throat surgery because it was the best fit for me, it was been a great career choice for me. But I knew even going into my training relatively early on that I thought I would ultimately pursue a career in pediatric ear, nose and throat surgery. And that's exactly what I've done. And it's a it's a great experience, it is a completely different dynamic than dealing with adults who can make their own decisions when you're helping to assist a family in their decision making process. And I say family, because as you alluded to, in this era, in particular, pediatric care is not just about a child, it's sometimes not just about a child and their biological parents. But there are often other influences involved, including grandparents, foster parents, other family members, it's a very different dynamic. And so you learn how to communicate not only with the child, but with their guardians and caregivers as well.

Julie Soukup  3:24  
Right. So how does that impact like the way that you're communicating in that capacity? I mean, when you're really looking at, okay, we're talking to everybody in a group, or even talking around a child about something that's more serious and using different language? I mean, how do you think your communication changes based on a that dynamic and be when the child's present in the room?

Dr. Soham Roy  3:47  
Yeah, great, great questions, and great subject for discussion. So there are a lot of different ways to approach this. I don't know that my approach is any better than anybody else's. I think everybody has their own sort of unique way of communicating in the family dynamic. For me, I've made it a policy early on that children should be involved. Now, many kids are too young, of course, to be able to rationally be able to describe their own health care concerns or be involved in the decision making. But I still believe that they should have an opportunity to at least be a part of the conversation. So I always make sure for example, in the course of an office visit, when at the end of the visit, I say I have a stock line that I say to every family, are there any other questions that you'd like to discuss today? Or is there anything that we haven't talked about today that you'd like to discuss? And when we're done with that, I turn to the child and I say, Do you have any questions about anything that we've talked about today? Are there any things that you'd like to talk about today, too, and sometimes, the kids may have questions other times that kids may just want to point out that they see an airplane outside the window. Sometimes they just say, do you have candy or stickers, but whatever it is, I want them to have some input into that conversation. I want them to feel engaged in that process. Now, again, often they're not going to be able to actually make rational healthcare decisions for themselves. But I want them to feel that this is a part of their process and that things are not just happening to them, they are involved in the process of what goes on to take care of them. And so that's kind of always been my approach to doing these things is have the children involved and engaged. You know, sometimes in very difficult conversations when we're talking about cancer, or potentially life threatening illnesses. If the child is old enough to understand, I will ask the parents and the child if they'd like to be in the room for that conversation. Frequently, the parents will say no, if you don't mind, I'm going to have them step outside and watch a movie, we have movies playing in our sub waiting area so that kids can watch films. So have the child sit and watch a movie while we have a conversation just with the parents. So with each circumstance, you have to kind of be attuned to what exactly is going on in the room. What's the dynamic, you know, me working in an urban tertiary care center, I can tell you stories for hours about patients I've had where there's a patient, there's a foster mother who's trying to adopt, there's a biological parent who's there who doesn't want the child adopted out, there's a social worker there, there's somebody from CPS there, and you're negotiating amongst four or five people over the same child who have different interests and different sort of a little bit of a different take on what's going on. And so you have to be very attuned to that dynamic for each individual circumstance. You know, it starts with with simple things, one of the things I've learned since I've been here is that when I walk in the room, I don't assume that the person who's in the room is mom or dad, I will say, Hey, I'm sure Holroyd, nice to meet you, and you are and they'll say Oh, I'm mom, or dad, or grandma, or I'm a foster parent or on this, that or the other thing. And so give them a chance to say here's who I am. And here's how I fit into this role. And I think that helps sort of establish our communication early on into how we want that to look.

Julie Soukup  6:46  
Sure. Sure. Well, I think you hit on a couple interesting thing is one of which is like really meeting like a child where they're at and saying, okay, like, are you bought into the process? Are you like, at least feeling like you have control? I mean, even my kids, I have twin girls that are two and a half that they're still, even though they wouldn't understand anything, being a part of that piece of like, okay, like, Are you good with this? Are we okay, like even giving shots and stuff is super, super important. And the more that's engaging with them, versus just, you know, talking over them? Um, I think that's interesting even to when you're talking that why, with much, much older geriatric patients, I would think that would sometimes be the same dynamic shift, almost where the kids are still the ones that are taking care of the parent. And you're also wanting to like, okay, am I speaking to your level, even though someone else is making that decision? Um, so that's interesting, kind of, you know, just always being aware that they, even though they're not the ones that making final decision, they have to be bought on at every piece of it. Yeah. This question, because you mentioned something interesting is, how do you kind of work to manage or communicate when, you know, if it's a typical adult patient, they make the final decision on their care? What about when there's multiple people making the decision? And they are not seeing eye to eye you referenced that, like, how do you go about kind of mediating and communicating the importance of what's happening, to make help them make almost a decision?

Dr. Soham Roy  8:15  
Well, you know, is it too early in the morning to start drinking, because I feel like I need a drink. When we talk about subjects like this. I have horror stories. From situations like this, I did want to just go back to one thing you said real quick, you mentioned, even though your daughters are two and a half, and you feel like they don't fully understand, believe me that they do understand some things, they understand the things that are happening to them, they understand pain, they understand fear, they understand trepidation. And so as a father of a daughter, who up until about three weeks ago, had a paralyzing phobia of shots, one of the things that I think you're doing very well is by having that communication early on with children, you're setting them up in the future to understand, hey, these things aren't just happening to me, I'm a part of this decision. I'm a part of how this goes. And I think you're preparing them well, by empowering them in the future, even at a young age to say, hey, I want you to be a part of this conversation. Right? So I think that that's very sound thinking because even if you feel like they're not getting a lot out of it now, you really are setting up a good foundation for them when they're their older children when they're seven or eight. Yeah, that, hey, you are a part of this decision making process.

Julie Soukup 9:20  
Right? And well, and you're an active participant in your own health, like throughout this whole part, too. You know, you get to decide you get to help figure it out. Yeah, I mean, it doesn't really set that set that tone even for them to make better decisions, ie how they're being made.

Dr. Soham Roy  9:34  
And so I've always said I think that's very wise decision making now as as for your other question, yeah. Parents in conflict and in this era, and particularly living in a large urban environment. I frequently have parents in conflict and every electronic medical record note I have has a red flag at the top if there's a social situation to be aware of. For example, mom says do not give dad information. Dad says do not allow me In the office visit, I have frequently I will redact some information. But there is a child that I saw, who I know the father from outside the work arena. And I also know the mother from outside the work arena, they are not together anymore. Mom brought the child in to see me for a problem that I was able to fix relatively quickly. Father has a background in healthcare, he called me up on my cell phone and started screaming at me an hour later threatening to report me to the medical board because I didn't have his permission. And I said, Man, I'm really sorry, I certainly don't mean to violate your parental rights. But, you know, their mother brought them in, and she has the legal right for signature for treatment. Yeah. And when I explained all this to her, this is what she wanted to do. And I proceeded. So your problem here isn't really with me. It's with her. Yeah. And, you know, that's an ugly dynamic. And it's unfortunately, one that we encounter more and more often, which is why the presence of people to help negotiate those sorts of things, has been very helpful in our environment, with social workers and things like that, to help really create a better construct, because as physicians, you know, I don't want to negotiate difficult family circumstances, that's not what I'm here to do. I'm here to direct my resources, and my knowledge base towards making the best medical decisions that you can as a family, for your child, not for me to negotiate arguments between mom and dad, which they frequently asked me to do.

Julie Soukup 11:23  
Yeah, absolutely. Well, and I think also, as you know, COVID has hit and, um, you know, access to guess is restricted. And potentially not everybody is able to come to the visit, I don't know if you have like one parent that's allowed or whatever it is. Even if they're wanting to both participate in that conversation, oftentimes, probably not more, especially, they can't. So how do you kind of manage even that communication when you're playing a little bit of game of telephone with that other person?

Dr. Soham Roy  11:55  
Yeah, terrific, terrific conversation. So first thing is, you know, the advent of modern technology has been fantastic. So telemedicine has allowed us new opportunities that we didn't have blessing of telemedicine. Oh, if only I knew a good surgeon to help you with you're absolutely right. So frequently, we will use telemedicine technology to engage a parent who's not there. Or frequently, Mom, if mom's there and says, Well, Dad's at work. And I'll say what would you like to call him and he can listen in on this conversation. And we'll make sure we get his questions as well, frequently, and this may just be my own bias. But if it's dad at the office visit, we're discussing surgery, I will usually recommend to them, Hey, before you commit to anything, how about we talk to mom, so you don't have to, you know, say something and then deal with this when you get home? So yeah, Mom's gonna have a lot of questions. I'm like, great, well, why don't we get her on the phone? And let's talk it through with mom so that her questions are answered. Yeah. And so I try to make sure that parents have an opportunity to engage anybody else who might be involved in the decision making process frequently, for example, grandparents will come in if both parents are working. And while they have the authority to bring the child and they do not have the authority to make medical decisions, for example, for surgery. So I'll give them and I'll say, Would you like to discuss this with your family? Or would you like me to call them now to discuss it with them? So there are a lot of different ways to do that. Certainly, there are some new technology platforms, I know that medical memory is a sponsor of this, this podcast, medical memory has a great platform for things like that, where you can record some of your things, information, and patient visits, and so that others can review it and replay it at their convenience so that they better understand what the nature of the context or conversation was.

Julie Soukup  13:39  
Yeah, well, I think that's an that's one of the things that we've really started to see evolve. As the technology has evolved. Again, it's with an older population is who we've mostly been partnering with, and seeing as access to guest has been restricted and mom's in the hospital and power of attorney is making some of these decisions for somebody that isn't able to be there, you know, having the ability of these doctors to be able to record straight from their mouth. Information about hey, here's what we're suggesting, here's what we think here's what our concerns are, you know, risks, benefits, alternatives, so on and so forth. I'm allowing like right even in front of that patient so they can give their feedback or ask their questions there. It does provide a really solid tool for shared decision making. When it comes to everyone else deciding you know, what's going to happen. I definitely think especially pediatrics, this becomes a really impactful resource to be able to utilize to where Yeah, mom can't come grandma's at work or dad separated whatever it might be of saying, hey, let's get people off the phone calling back calling back calling back and recording it. So again, straight it straight from from the doctor's mouth, and I think I think as tech as access to guest has been restricted, not just medical memory, but a lot more people are aware of the technology that's available starting to lean into, you know, company calls, Zoom calls, to keep families connected and up, provide them the ability, you know, for shared decision making, you know, especially even I think, with a kid as much as on the other side, which we see a lot more often.

Dr. Soham Roy  15:12  
Yeah, I mean, I think that's very true. You know, we talk about shared decision making, it's a critical part of what we do in pediatric care. You know, the old days of paternalism are gone, long gone, and thankfully gone because paternalism and medicine, in my opinion has no place in the modern era. And instead, we want to really rely on shared decision making with parents. You know, in the EMT world, there's been a real well established person who's considered to be the thought leader, in shared decision making for pediatric EMT care. Her name is Emily boss at Johns Hopkins, she's written a lot about the shared decision making models for parents. And you know, like you mentioned, the geriatric world where sometimes you'll have power of attorney or the parents or the the children or taking care of the parents in the pediatric world until that child turns 18, or is otherwise legally emancipated by law, your parents make that decision. So if you're 17 years old, and 360 days and your parents say, you're going to have this procedure done, well, even if you don't really want to, ultimately your parents get to make that decision. Yeah, your legal guardians. So shared decision making is critical, both with parents and involving the children as well. But every patient we see in the pediatric arena, has that same element of proxy care, it's not just care approved by the patient by their proxy caregiver. Right. Right. And that's true for all of our patients, whereas in geriatrics, it's only some, depending on their ability to make autonomous decision, for sure.

Julie Soukup  16:34  
And I think that's where it becomes even that much more important that not only are you communicating about all the pieces that are necessary to make that decision, but educating everyone, that's that's really involved, too, you know,

Dr. Soham Roy  16:50  
yeah, and you know, we nothing frustrates me more to be honest, then I will see a child in the office with a parent, or maybe both parents and we'll have a lengthy discussion about intervention or surgery or something like that. And then we get to the day of the surgery, and I come to the hospital, I say hi and one parents there, but she's there with someone else, for example, a grandparent and I say, you know, I review everything again. And I say, Do you have any questions, and also, the grandparent has 10 questions. And I'm like you weren't at the office visit. That's why you have 10 questions, because clearly, your child didn't explain this to you about your grandchild. And so then I basically have to repeat an office visit in the holding area in surgery, and that gets exhausting having to, you know, Triplicane your work because one person wasn't there at the office visit and they didn't communicate it effectively.

Julie Soukup 17:40  
You know, it's so interesting that you even say that, because our surgeons at Barrow Neurological Institute is one is where our medical memory was incubated. And they actually have started implementing that they rewatch the consultation where they talked about surgery. So a lot of their doctors have been recording visits for five years, where they will do the visit. Okay, here, I'm explaining everything they record it. And so there is this pre op appointment, where they go over all their informed consent videos, pre op videos, but also while they're in there, they're saying, hey, rewatch this consultation, make sure that there wasn't any questions that you now are thinking of really popping up. And then again, the family members have access to that and can share it. But it's interesting, because that's that whole journey is what they're starting to really look at of, especially in a spine surgery where someone like my dad had spine surgery, it took him about two years to finally commit to it. After he had his original consultation. Yeah, sure. I don't even know.

Dr. Soham Roy  18:34  
I don't remember anything.

Julie Soukup 18:36  
Those things where it's, you need to have it done, but doesn't have to be done like in ER situation. And that that lapse of like, okay, well, what did i What did they say four months ago, six months ago? About what what's needed, you know, so outside of recording, how do you kind of end sitting with them, you know, in a visit, how do you, you know, educators are, how do you battle, that kind of challenge, to make sure that they're really understanding everything walking into

Dr. Soham Roy  19:01  
it is a challenge. And, you know, this gets into the larger issue of informed consent. And we could talk about this as a separate issue. You know, we always talk about informed consent, but the reality is, when you look at the data behind it, there is no real such thing as informed consent. Most patients don't have the background medical knowledge to really make an informed decision, no matter how much you really discuss it with them. Now, when you're in pediatric care, and particularly working in a large urban environment, we frequently have language barriers, educational barriers, a lot of my parents are teenagers who are still in junior high or high school. So and they're now making decisions for their baby. So, you know, a lot of times we have other barriers, rather than just the basics of remembering what was said four or five months ago. Yeah. So essentially, you're frequently repeating the same information on multiple occasions, hoping that, you know, by the third time parents heard this speech, it's going to register with them. I'll give you an example. One of the most common surgeries we do is Ear, Nose and Throat surgeons taking out some of these tonsils and Before you know, in the pre op visit, we go over some rules with them about not eating anything super sharp or crunchy, limiting their activity to no strenuous activity, what they can do for pain management, what to expect afterwards, we then have that same speech again in the consultation room before we go into surgery at the hospital. So we have that conversation in the pre op area. And then when I come and see the family, again, after surgery, 20 minutes later, I again, remind them Hey, remember soft diet, no strenuous activity, go over it again. So they've heard it three times. Yeah. And you can only pray that by the third time it may have registered to some degree. But, you know, as we discussed, you may have given that speech to one person in the office to two people, or one of the same one different person in the pre op holding area, and then to a totally different set of people in the post op area. And so you don't really know how much of it sticks. And that does become a concern. Yeah.

Julie Soukup 20:50  
So what would you if you were gonna say, okay, like, I'm good, you know that the three things that I make sure to make, make sure every single time I'm having one of these conversations in hopes that they're really going to understand are the three things that I try to be very, very most aware of, as I'm communicating, not necessarily with just a parent, but also with with the patient themselves? Let's say it's someone that would understand like a teenager, what would you say are some of those like things that you're like, every time without question, I always make sure that I do this, and to assure that they're not only understanding, but they're really like listening and communicating well, with

Dr. Soham Roy  21:26  
the you know, the first thing is, I think active listening is very helpful. So you know, active listening is not just sitting there and listening. It's saying, Do you have any questions about this? Do you understand this? Or even asking questions saying, saying, what kind of diet do you think your child should have after surgery so that they can mirror back what you've already told them? So active listening, is key reinforcement, I think is critical, and making sure the parents are engaged. So, you know, I think like many surgeons tends to sometimes kind of get into a word salad or a word vomit, where, for 10 minutes, you're giving them the speech about the potential risks, benefits, complications and alternatives, procedure. And then you're done. And you're like, Do you have any questions, and they're just looking at you, like, you know, because you just overwhelm them with a 10 minute monologue using some dialogue, they don't necessarily understand. That's not fair to the parents, it's not on them, to have to understand what you're saying, it's on us to make sure that they understand what we're saying. And to putting it into language that makes sense and the terminology that makes sense. So, you know, that's something that I think I strive to really try to do a better job. And I know, I still have a lot of work to do on that as well. And so there are those things. And then again, as I mentioned, every patient needs to have an understanding of the reasoning behind the decision making, not just here's what we're going to do, but here's why this is what we recommend. And here are your options. Here are your varying alternatives, the pros and cons of each alternative. And finally, most importantly, what questions can we answer for you today? Yeah, we are here to guide you in your healthcare journey. I'm not here parents often say, Well, what should we do, doctor and I will tell them every time I'm not here to tell you what to do. I am here to give you information, I am here to guide you and to answer questions. You are here to make your best decisions for your child's health care. But ultimately, I am here to be your guide to be your advocate and to be your source of information. I'm not here to tell you what to do. I'm not here to make decisions for you. I'm just here to guide you, and to provide you with information. And so I think it's important to remember what our role is, as surgeons in these situations. Yeah,

Julie Soukup 23:31  
that's interesting. Well, and I think and so I guess even to is, you know, when I'm thinking about that type of conversation, or, I mean, luckily, well, I take that back, I there was a spine scare with one of my babies, they were fine. Um, but dealing with my child having a health issue, versus me having a health issue. Tell you what I got to do, like, listen, like I'm taking notes. I'm like, right in there. And I think when I first heard that there might be a surgery that my child needed. I, it who tends to be a very calm, logical, rational person just got really, really emotional and really scared. And I just couldn't even see straight, let alone, you know, understand what was saying? How do you? How do you deal in battle with that or those conversations? Or do you pause the conversation when you're recognizing they this is it good news, this parent is now potentially emotional, or, you know, it's more so than themselves? You know, how does your communication shift there to make sure that we're getting that piece out of it that comes I think, only with a parent and a child. Well, it's interesting with adults, you know,

Dr. Soham Roy  24:48  
it's interesting that you would say, how do you change that because what I would offer is you shouldn't change it. Your interaction should all be cognizant of the fact that parents are going to be very emotional about their decisions you mentioned, you know, with your own daughter and her concerns The first time my daughter was in the emergency room, I, I cannot begin to tell you I wept openly when I found that she was going to be okay. I mean, I just lost my mind when I found out she's gonna be okay. Even remembering it is difficult for me because even as a parent, and as a physician, it is totally different when it's your child, because I'm no longer the physician. I'm the parent. And so I understand the complexity of emotions, people go through, and I am always in awe of the resilience of the parents, I take care of a lot of chronically sick children who are tracheostomy dependent, ventilator dependent, have serious neurological concerns and things like that. My daughter has been entirely healthy, thank God most of her life. But even I lost my mind the first time that she had to go to the emergency room, I was an emotional wreck. And so these parents have such incredible resilience. But yeah, you have to be cognizant of that. I just saw a patient this morning. It's a colleague of mine, their newborn daughter, she's five days old. And I saw her for a consultation this morning. And I, you know, immediately want to be attuned to the fact that, you know, the first couple of weeks of a baby's life is a very emotional time for parents, they're exhausted, they haven't slept, they just got to the hospital. And so as we talked to the baby needed a procedure, I just said to both mom and dad, dad's a colleague of mine, and Mom, I've known for many years, and I said, Look, this can be very trying for new parents, and your baby's going to cry, I promise, they're going to be okay. But they are going to cry. And that can be hard for parents, do you want to be in the room while we do this? Would you like to sit outside? What can we do to make this more comfortable for you and dad said, I want to be here with the baby, I'll hold her. And mom said I want to go sit outside, I said, Okay, we're gonna walk you outside and you can watch a movie, I'll come get you in a few minutes. So it's important to always be cognizant that, you know, with parents, it's your child, I mean, there's no greater resource that you have a greater gift that you have. And now you're entrusting them to the care of somebody you maybe met 10 minutes ago, that is a tremendous leap of faith. And I always have to remember that, you know, parents have have literally given me the greatest gift of all, is their faith, even in a brief interaction, that I will do everything in my power to take great care of their child. So, you know, I would say that rather than retuning your conversation, if you think the parents are going to get emotional, instead, assuming like, Hey, this is their kid, you know, this is their most vulnerable time, you have to treat everybody like this is their most vulnerable time period. And I think a lot of that just revolves around emotional intelligence. Now, I say that and I grant that many people listening to this podcast will say that surgeons are not exactly known for their emotional intelligence. But I would say that that is something that we learn and something that we can acquire. And some people may have inherently more of, but it's an important thing to us in interacting with people in the medical arena. I think that's incumbent on us to be aware of what parents are going through. I will say that, you know, I was a lot more detached about it till I had my own child, my first Gnasher been in practice 19 years now. And my first 12 years before I had a child, I was pretty clinically detached. Here's the science, here's the data, here's your options, and your pros and cons. But now it's like, all of those things. Plus, gosh, I know what it feels like to have a sick child. I know what it's like to be under this kind of stress. How can I help you feel okay about making a decision? What do you need from me? That's going to help you and so I try to bring that into every interaction. Yeah, that empathy

Julie Soukup  28:31  
of i Yeah. Like, I've been there, like what I know feels that walked a mile, like, how do we make sure that you feel comfortable, but

Dr. Soham Roy  28:39  
even for people who haven't yet had children, I think, you know, we do need to be aware that this is an emotionally charged time for parents. And to treat every parent like that I love the simplest thing. And this is stupid. But the simplest thing is, in every one of my clinic visits, we have a box of Kleenex sitting next to the parent chairs, just there, it's there. And frequently, if I see a parent getting a little teary eyed, I just grabbed the box, and I kind of gently hand it to them so they can grab it and keep talking. And you know, they don't interrupt what they're saying. It's just we understand we're here.

Julie Soukup 29:13  
Yeah, and then also there, it's even that physical action is so empathetic, like it's such a solid, like I care about you without actually saying it. And it also says that there's a reason this is here, most people are feeling really, really upset like this is this is what we do. This is where this is how it goes.

Dr. Soham Roy  29:31  
You know, over the years, I've learned a few other important things parents really prefer and patients prefer in general if you sit down when you talk to them. So if you sit down, instead of standing up while you're talking to them, they feel like hey, you're a partner in this. The other thing is frequently the way my rooms arranged rather than sitting facing somebody. So we're going like this, I will sit next to them European style, so we're facing the same way. And so I will pull up a chair next to them and I will turn them look at them and I might put my hand on their arm, or we'll sit close to one another and talk. So they understand like, Hey, we're aligned. In our vision here, we're working together, we're not confronting one another, we're looking the same way looking forward. So we're working together and that, and I use that technique a lot with my long term chronic care patients who I know are going to be seen for the rest of their lives. Because I want them to understand like, Look, you have a partner here in this. Yeah. And sometimes when all that fails, I will tell you that I'm very direct about it. And I tell. So for example, we do a lot of tracheotomy for long term ventilator management and babies because we have a very high level, neonatal ICU population here. Well, eventually, thank God, most of those babies do get discharged from the NICU, and then they come back and follow up with us for their trades. And if they're still on the ventilator, and they're going to have a trade for a long time, I always pull up a chair, I sit down next to the parents and I say, Look, when we were in the hospital and had this conversation around a tracheotomy, it was hectic, you had 100 Different people talking to you every day, you were being forced to make decisions, and answer questions. And I said, this is our time to take a deep breath and really establish our relationship. And I said, because, and I say, because look, you and I are going to become great friends, we're going to be spending a lot of quality time together over the years. And we're going to become great friends, I'm going to be there every step of the way. For you, this is our chance to sit down in a calm, not time pressured environment, and let you ask questions and and give you an opportunity to discuss whatever's on your mind. And so I think that gives them a chance to realize like, wait a minute, I have an ally here, this is somebody, there's, there's an old statement we used to use at my last institution where we would look at parents and we would sometimes hold their hands and say, I just want you to understand, I'm the best friend you have here. Because I'm here to advocate for you, I am literally your best friend in this place. And that's what I want to be. That's the role that I want to serve for you. And as, as long as you know, sometimes saying that overtly parents will understand like, Hey, this is a partner in health care, not just some guy who's going to come and do a procedure. This is somebody who's in the long haul for

Julie Soukup  31:59  
rise off, that's so beautiful. Especially good. I mean, not only just your physical explanation of like what you're doing with your body, we're sitting next to each other, we're looking in the same direction, we're looking very aligned, I, we're we're gonna go but even just taking that breath of saying, hey, let's calm, we're gonna be here for a long time. Let's look at our, this is a partnership. It's not You're the doctor, I'm the picture on the doctor, you're the patient. It's none of that. It's, it's, it's, you know, we're gonna, we're gonna be here together and I'm gonna be here with you. And it changes that dynamic of, okay, I'm a really a trusted advisor and mentor here. I'm not, I'm not just you know, that white coat syndrome of just taking care of what I need to, you know, I will

Dr. Soham Roy  32:41  
put together the greatest part of pediatric care. This is gonna sound ridiculous. But you are often invited to kids graduations from things. elementary school, junior high high school, you get invited to their birthday parties, you get invited to their recitals. One of the coolest things I ever did as I have a child, he's not a child. Sure, God, he's like a grown man now. But I have a patient I've been taking care of since he was probably nine or 10. And he started playing the violin at his school symphony, and I was a professional violinist before I went into medicine. And so for his senior Concerto in high school, I played the Bach Double Concerto in D with him. And he and I played the two violin parts together. I've been with him for like nine years, and he's just the coolest guy. He's in college now. But just to be invited to do that, like that's the coolest part about pediatric here is getting invited to watching your kids graduations, and to you know, your parents, inviting you say, hey, you know, our daughter's nine, we'd really like you to be there because she wasn't supposed to live this long. Like, that's cool. And that's a good feeling. It makes my job worth it.

Julie Soukup  33:46  
Oh, man. Well, I can I believe that you I mean, and I think that really shows, you know how much you care for your patients how much you're an advocate for their care, communicating with them educating with them. I love some of the nuggets that you mentioned about not only the physical place of it, making the child be a part of the conversation. I mean, Dr. Roy, you are a wealth of knowledge and intellect and I so appreciate the time that you took to join us today. Um, I can

Dr. Soham Roy  34:15  
safely say or imply this, I can safely say nobody in the history of mankind has ever referred to me as a wealth of knowledge and intellect. So I'm very flattered.

Julie Soukup 34:25  
Well, you know, you deserve it. Well, I so appreciate your time today. I think you gave us so many awesome, awesome nuggets that we can really think about that not only will apply to pediatrics, but even start thinking outside of even just that scope. So thank you.

Dr. Soham Roy  34:39  
So I hope so. Thanks so much for having me. All right. Bye. Happy Thanksgiving.

Julie Soukup  34:43  
You too.