Our guest today is Dr. Jane Fogg, a physician leader and executive with broad experience leading health care delivery, focusing on primary care, systems redesign, and value-based delivery models and a Senior Physician Advisor for the division of Professional Satisfaction & Practice Sustainability at the American Medical Association. Prior to this, she was the Executive Chair of Internal Medicine Family Medicine at Atrius Health, an innovative value-based healthcare leader in Massachusetts, and a member of Optum, responsible for the care delivery and outcomes of a practice with 350 physicians and advanced practice clinicians caring for 400,000 patients. She implemented advanced primary care redesign for reliable systems that are team-based, patient-centered, innovative, and return joy to the practice of medicine. Dr. Fogg is a Lecturer at Harvard Medical School, Affiliate Faculty at the Center for Primary Care, and speaks internationally and locally on value-based care delivery, innovation in health care, physician wellbeing, and in basket reduction.

During this conversation, Dr. Fogg recounts her interest in a medical career that was spurred by experiences as a medical assistant in oncology, where she experienced the pivotal role of relationships in healthcare. Reflecting on her over three-decade career hence, she has grown increasingly aware of systemic deficiencies in the organization of healthcare, especially in primary care, which have fueled her commitment to addressing these issues in her many leadership roles. While grappling with physician burnout and systemic challenges, Dr. Fogg advocates for fundamental changes in healthcare deliver, in particular promoting and implementing value-based care which aligns financial incentives with quality patient care. She emphasizes quite persuasively that the transition to value-based care and data-driven decision-making while optimizing clinical operations can enhance physician wellbeing as well as practice efficiency. She shares actionable strategies such as in-basket workload reduction while championing honesty, gratitude, and joy in healthcare practice and leadership.

Guest: Jane Fogg, MD, MPH, Lecturer on Global Health and Social Medicine, Harvard Medical School, Affiliate Faculty, Center for Primary Care, Harvard Medical School

LinkedIn Page: https://www.linkedin.com/in/jane-f-fogg-md-mph-52a61349/

Resources/References:

AMA STEPS Forward® practice innovation strategies offer real-world solutions to the challenges that your practice is confronting today. Gain the tools you need to overcome barriers and restore the joy in your practice of medicine: https://www.ama-assn.org/practice-management/ama-steps-forward

Jane Fogg, MD, MPH, and Christine Sinsky, MD: In-Basket Reduction: A Multiyear Pragmatic Approach to Lessen the Work Burden of Primary Care Physicians Published April 19, 2023, NEJM Catal Innov Care Deliv 2023;4(5)

DOI: 10.1056/CAT.22.0438 https://catalyst.nejm.org/doi/pdf/10.1056/CAT.22.0438?download=true

“Participant joyfully in the world…” a quote by Campbell from the book This guidance occurred in the 1991 book Reflections on the Art of Living: A Joseph Campbell Companion which consisted of material selected and edited by Diane K. Osbon.

Anthropologist Angeles Arrien re the four questions a healer would ask (YouTube video of Dr. Arrien): https://www.youtube.com/watch?v=HUJQlVeGZzY&t=34s

The guest today is Pat Croskerry, MD, PhD, is a professor in emergency medicine at Dalhousie University in Halifax, Nova Scotia, Canada. Trained as an experimental psychologist, Dr. Croskerry went on to become an emergency medicine physician and found himself surprised by the relatively scant amount of attention given to cognitive errors. He has become one of the world's foremost experts in safety in emergency medicine and diagnostic errors. Dr. Croskerry is currently Director of the Critical Thinking Program within the Division of Medical Education, Dalhousie University. His interests lie primarily in clinical decision making, diagnostic failure, and the role of cognitive and affective bias in decision making. Recent work is aimed at cognitive bias mitigation.

During this fascinating conversation, Pat shares his unique path to medicine, stemming from a background in psychology that instilled a focus on critical thinking and cognitive biases, and the discipline to study medicine, informed by his brief rowing career during which, as a member of the Canadian National Team he competed in the Olympic Games. He delves into specific biases affecting medical decision-making, such as emotional affective, anchoring, and search satisficing biases, stressing the need to mitigate these biases for accurate diagnoses. Furthermore, he explores the impact of cognitive load and decision fatigue on physician well-being, advocating for a reconsideration of critical thinking's role in modern medical practice to ensure optimal performance and professional satisfaction.

Guest: Pat Croskerry, MD, PhD, FRCP

LinkedIn Page: https://www.linkedin.com/in/pat-croskerry-199a8132/

Wikipedia page: https://en.wikipedia.org/wiki/Patrick_Croskerry

NEJM Interview: https://www.nejm.org/action/showMediaPlayer?doi=10.1056%2FNEJMdo002218&aid=10.1056%2FNEJMp1303712&area=

Other references:

Croskerry P, Clancy M. Advancing diagnostic excellence: the cognitive challenge for medicine. BMJ. 2022 Mar 29;376:o799. doi: 10.1136/bmj.o799. PMID: 35351777.

Olson A, Rencic J, Cosby K, Rusz D, Papa F, Croskerry P, Zierler B, Harkless G, Giuliano MA, Schoenbaum S, Colford C, Cahill M, Gerstner L, Grice GR, Graber ML. Competencies for improving diagnosis: an interprofessional framework for education and training in health care. Diagnosis (Berl). 2019 Nov 26;6(4):335-341. doi: 10.1515/dx-2018-0107. PMID: 31271549.

Croskerry P. From mindless to mindful practice--cognitive bias and clinical decision making. N Engl J Med. 2013 Jun 27;368(26):2445-8. doi: 10.1056/NEJMp1303712. PMID: 23802513.

The guest today is Justin Klamerus, MD, MMM, Executive Vice-President and Chief Clinical Officer for McLaren Health, a fully integrated, nonprofit health care delivery system committed to quality, evidence-based patient care and cost efficiency. The McLaren system includes 14 hospitals in Michigan, ambulatory surgery centers, imaging centers, a 490-member employed primary and specialty care physician network, commercial and Medicaid HMOs covering approximately 700,000 lives in Michigan and Indiana. McLaren operates Michigan’s largest network of cancer centers and providers, anchored by the Karmanos Cancer Institute, one of only 51 National Cancer Institute-designated comprehensive cancer centers in the U.S. McLaren maintains academic affiliations with medical schools at Wayne State University, Michigan State University and Central Michigan University. McLaren’s GME campuses offer residencies and fellowship programs that train over 650 future physicians annually.

A medical oncologist by training who joined McLaren in 2009, he went on to hold numerous positions at McLaren including president of McLaren Cancer Institute and principal investigator of the McLaren Center for Research and Innovation. Following the acquisition of Karmanos Cancer Institute by McLaren in 2014, Klamerus served as chief quality officer and later president of the Karmanos Cancer Hospital and Network. in 2020, he was appointed to the Public Health Advisory Commission by Michigan Governor Gretchen Whitmer, and in 2022 he became Chief Clinical Officer for all of McLaren Health.

During this conversation, Dr. Klamerus discusses his leadership in McLaren Health, highlighting the organization's dedication to its medical staff as well as to many diverse communities, while navigating financial constraints and significant public challenges such as the Flint Michigan water crisis, gun violence, and maternal health delivery issues. He shares a vision for how large and complex healthcare systems can improve workforce stability and community engagement through fostering an environment where staff receive the support needed to excel in complex patient care delivery and to address social issues. He underscores the importance of transparent, authentic, and engaged leadership, mindfulness, and personal connections, alongside emerging technologies, in driving positive changes in healthcare delivery, community health outcomes, and physician and health professional well-being. I found his candor, humor, genuineness and warmth to be comforting, helping me to better understand the connection we can all have with true leaders.

Guest: Justin F. Klamerus, MD, MMM

Executive Vice President and Chief Clinical Officer, McLaren Healthcare

Faculty Profile: about Dr. Klamerus- https://www.mclaren.org/main/news/mclaren-health-care-appoints-justin-f-klamerus-md-3906

LinkedIn Page: https://www.linkedin.com/in/justin-klamerus-md-mmm-a42b293b/

About McLaren Health: https://www.mclaren.org/

3 Minute Meditation Session with Dr. Mick Krasner