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Today’s episode features John Chase, an orthopedic surgeon and author of You What?!: Humorous Stories, Cautionary Tales, and Unexpected Insights About A Career in Medicine.

John shares some of his most memorable moments interacting with patients throughout his career. He shares some of the humorous and witty responses he’s received from his patients, which have given him a different perspective on how people cope with pain and aging.

John highlights how important it is to keep a sense of humor and find the positive side of things, despite the seriousness of his work. He believes that humor can help both patients and medical professionals alleviate some of the stress and anxiety that come with dealing with medical issues.

Join us in this entertaining and insightful conversation with Dr. Chase as he shares his experiences and the lessons he’s learned from his years as an orthopedic surgeon.

John Chase is an orthopedic surgeon.

He shares his story and discusses his book, You What?!: Humorous Stories, Cautionary Tales, and Unexpected Insights About A Career in Medicine.

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Transcript

Kevin Pho: Hi, and welcome to the show. Rate and review at KevinMD.com/rate. Subscribe at KevinMD.com/podcast. Today on the show, we have John Chase. He’s an orthopedic surgeon. He’s the author of the book “You What?!: Humorous Stories, Cautionary Tales, and Unexpected Insights About A Career in Medicine.” John, welcome to the show.

John Chase: Thank you. Glad to be here.

Kevin Pho: So we’ll get into your book in a little bit, but first off, just briefly share your story and journey to where you are today.

John Chase: Sure. Well, I graduated from medical school at the University of Iowa in 1980 and did my orthopedic residency in Gainesville at the University of Florida for six years, and then I moved to Orlando and practiced orthopedic surgery, specializing in knee and ankle work, and retired in March of 2020. That sounds coincident. It is. It’s exactly when COVID started, so I never had to practice in the world of COVID.

Kevin Pho: All right, so as you reflect on your decades-long orthopedic career, just tell us some of the biggest changes over the years that you’ve seen in orthopedic surgery.

John Chase: Yes, well, there’s been a tremendous amount of advances technologically, but one of the things that I kind of focused on in my book, and I wanted to continue on, is that even despite the technological advantages, patients still want to be talked to. They still want to be listened to. They still want to be touched. And that was one of the things I tried to focus on in the book, and I think those things are never going to go away. It’s very hard to practice them now, but I think they’re still really important.

Kevin Pho: So especially in orthopedic surgery, when you’re dealing with a lot of devices and obviously you spend a lot of time in the operating room, how do you maintain that connection with patients, and how do you maintain those ideals?

John Chase: Well, one of the things I tried to do is make sure I left enough time to be able to actually do those things, to listen and to actually explain things. Sometimes I think we allow ourselves to get so overwhelmed. I think one of the things I said was that the best way to build your practice is a single word, and that’s “yes.” But if you keep saying yes, you get inundated and quickly overwhelmed. So I tried to leave some time for those things. I thought they were important. I actually enjoyed it too, so I probably wasn’t as productive as some of the other orthopedic surgeons, but I think, hopefully, I gave better care, and I certainly enjoyed it more.

Kevin Pho: Now, before we get into your book, let me ask, for those medical students considering orthopedic surgery as a career, and even for those newly graduated orthopedic surgeons, what’s one piece of advice that you could share from all the wisdom that you have?

John Chase: Yeah, I think I would probably suggest that you focus on maintaining enough time for yourself and your patients. Particularly if you have a family, it’s pretty easy to have that fall into the background, and I think you really need to spend some time making sure that you give enough time for that.

Actually, when I was doing my book, I found myself initially starting out trying to tell stories, of which there are plenty, hopefully funny stories, but I found myself talking more to my medical students and saying, “Do this, don’t do that. Be like this, don’t be like that guy.” And so that was one of the things I wound up doing more that I hadn’t planned on when I started the book.

Kevin Pho: Now, when you were practicing orthopedic surgery, how did you maintain that balance? How did you carve out time specifically, either for yourself or for your family?

John Chase: Yeah, I specifically kept my schedule to what I thought was reasonable. I tried not to let myself get overwhelmed. I tried not to keep taking on new and larger projects that would take me away from the family. So I think I maintained a fairly good balance, but it depends on who you talk to. You talk to my family, and I’m pretty sure my daughters had no idea I was an orthopedic surgeon, because I was at their sporting events all the time. They probably didn’t want me there with all the advice I was giving them, but I tried to be there as much as I could.

Kevin Pho: All right, that really resonates with me as well. My older daughter is a high school varsity soccer player, and I did make it a point to make it to all her games. And like you said, maybe she didn’t want me to share all my advice, but I do think it’s tremendously important to share those moments with your children.

John Chase: And you don’t get them back. You can’t say, “Well, I’m going to make it up. We’ll go to the zoo this weekend.” One of the things I thought was really important is getting home for dinner and being there for dinner. Maybe you had to go back, maybe you had to go do some charts, but being there for dinner I thought was really important.

Kevin Pho: All right, let’s turn toward your book. It’s titled “You What?!: Humorous Stories, Cautionary Tales, and Unexpected Insights About A Career in Medicine.” Now, John, what were the events that led you to write this book?

John Chase: Yeah, I had no deep, underlying desire to write a book, but my X-ray tech, and I love telling stories, said, “Dr. Chase, with these stories, you should write a book.” And this kind of light went off in my head that said, maybe I will. So I took these little cards that we had, and I would write things down. And then when I got done and retired, I sat down and took all these cards and just laid them out on the table and tried to organize them. I got some help making an outline, and I wrote the book just because I wanted to tell the stories.

And as I said, I wound up adding quite a bit of advice for young people in medicine. So as I got done, I felt my goal was to try to get it out to as many young people in medicine as I could, and hopefully the humor would entice them to read it. And it’s also available now on audiobook, so for people that like to listen to podcasts such as yours or do a lot of listening, it’s available on that too, which I was really thrilled with.

Kevin Pho: All right, tell us one of those stories that you think is most representative of the book.

John Chase: Well, there are some of the things that patients would say, and that actually was in the article, that were just hilarious, and I really couldn’t stop laughing. One of them was, I said, “Is the pain bad?” And she said, “No. Well, the pain is bad, but not so bad that it’s decapitating.”

And I also asked another patient about her medicines, “What medicines are you on?” And she says, “Well, I’m on,” and I didn’t recognize that medicine, and I said, “What’s that medicine?” She says, “Well, I’m not really sure. I’m in a study, and I don’t know whether I’m on the real medicine or the placenta.”

So things like that were just where I thoroughly enjoyed it, and it made it fun. And if you don’t have enough time to listen now, you won’t get those things.

Kevin Pho: Now, by focusing on the positivity and the humor of the interactions that you have with patients, does that impact the care that you give to them?

John Chase: I think so. There’s some interesting information that’s been published on, particularly, surgeons and why they get sued, and one of those reasons they get sued is patients don’t feel like they listen to them. And they’ve said that, you know, you take just a single minute, probably even 45 seconds, and just listen and don’t interrupt, and surgeons particularly are notorious for interrupting, just listen, and they’re going to think you’re the most caring, kind physician they’ve ever met, and all you did was listen for 45 seconds or a minute. So that’s one of the things that I learned along the way and tried to incorporate into what I did.

Kevin Pho: So take us into one of your patient interactions, into either the exam room or, if you’re doing a consult in a hospital, give us an example of how you would include one of those minutes where you allow patients to share their story. Because doctors today, and I talk to a lot of physicians on the podcast, are really inundated when it comes to what they have to do, and they feel always rushed. They have to see more patients, they have to do documentation, the electronic medical records. How do you carve out a little bit of time where patients can share their story or you can share a little laugh together?

John Chase: Yeah, first of all, I try not to overschedule, and then I really tried to stay on time. I mean, if I don’t start on time, I’m never going to catch up. So I was very conscious of it. In fact, I was called pathologically punctual by some people.

Kevin Pho: How do you do that? How do you stay on time? Because that is something that is not taken for granted by a lot of physicians.

John Chase: Yeah, I always tried to leave time at the beginning of the day to do all my paperwork and get all my stuff done, and then if something happened, it came out of that time, and I wasn’t a half an hour late for the office. So I’d start in the office, I’d try to be on time for surgery. It just was, I thought, respectful for the people who worked in the operating room and the doctors that were behind me. There are other ways you get behind, but it wasn’t going to be me that started it behind, and I thought that was really important.

Kevin Pho: All right, so tell us, what are some of the other main messages that you want readers to come away with from your book?

John Chase: There are three main messages that I wanted to get across. The first is to be kind to people, just be decent to people. I had a number of the operating room nurses who, when I retired, said, “You know, we just really appreciated that you treated us with respect.” And so I thought that was really important.

And the second thing is, and for you, I don’t think you have to be brilliant to be a physician. You need to be conscientious and responsible. You need to dot the i’s, you need to check that culture, you need to make sure you checked on this thing. You don’t have to be Einstein. You just have to make sure you do all the right things, and if you get stuck, then that’s what the Mayo Clinic’s there for, to refer somebody on. And I never pretended to be the smartest guy, but you just do the right things. And we call that, you know, the John Wayne surgery, which is get in there and do the right thing.

And then the third thing, I thought, was just take some time for yourself, and particularly your family. You just need to enjoy yourself along the way, because if you’re miserable, I don’t care how much money you make, if you go to work every day and you’re miserable, it is not going to be enjoyable. It’s hard to get through a whole career.

Kevin Pho: Now, you said that you’ve been practicing for about 30 years before you retired. How have you changed as a physician during those decades?

John Chase: I think I became a lot more cynical, particularly in dealing with the business of medicine, dealing with attorneys, dealing with electronic medical records, all the things that you know. And I had a cardiologist tell me, “I like what I’m doing when I’m inside the room with the patient. I just walk out of the room, and then it’s all this other crap that’s waiting for me that I don’t like.” And so that’s what I was surprised at. I thought that it was hard to practice the kind of medicine that I wanted to with all these other things that are pounding upon you all the time.

Kevin Pho: So specific to orthopedic surgery, tell us a story. Give us an example of some of those impediments.

John Chase: Well, the attorneys, that was the one that I had. First of all, we had to try to keep ourselves from being sued, so you have to make sure that you document everything, and there’s that. But I was kind of expecting that. What I wasn’t expecting is the “Have you been injured?” people, you know, the people in the car accidents and workman’s comp who have an attorney, and somebody trying to get something, and we are the vehicle that has to fill out the papers, do the depositions, and go to trial. I felt like that was one of the things I really disliked about it.

Kevin Pho: How much time did you spend doing that, going to depositions and dealing with attorneys?

John Chase: I actually purposely stopped taking referrals from people that had attorneys, because I figured if they had an attorney before they were coming to see me, then their medical care wasn’t their first priority. So I stopped taking those referrals, and then the word got out with the personal injury attorneys in town that Chase wasn’t the guy to see, because he wasn’t going to give a very high impairment rating. But there were still the ones that you had to do, and so I did that, but I didn’t try to add that to my practice.

Kevin Pho: Now, despite all that cynicism, the business of medicine, the bureaucracy of medicine, how did you maintain your ideals? How did you pull through that?

John Chase: Well, what I thought was, this is a really cool profession to be in, because I can do things. I can come out every day and say I made an influence on somebody’s life. Now, hopefully it was good. Maybe it wasn’t. Maybe I didn’t help them, or maybe I hurt them. I don’t know. But I always felt like what I was doing was significant.

And then the other thing is, I told my kid this, you know, one of the things you can do is you can help your friends. They call you and they say, “What should I do? Should I go to the emergency room?” You know, “My mother is going to have hip surgery,” “My grandfather just went into a nursing home,” and they can ask you. And very few people tried to hit me up for free medical care. They just wanted some guidance, and that’s a really cool thing to be able to do for your friends, to help guide them in the right direction. I really enjoyed that and still do. I still get those calls all the time, even though I’ve been retired now for three years.

Kevin Pho: So tell us about what you think about the future of medicine. Is there anything that you’re worried about?

John Chase: I am. I am worried about the focus on clicking boxes, electronic medical records. I have a quote that electronic medical records are like a nude beach; the idea sounds appealing, but when you actually see it, it can be really ugly. And just the focus not on the patient but on the boxes to click, the numbers, the ICD codes, the surgical codes, all of that. It’s really hard to do that. My son-in-law has been in practice for five years now, and so I hear all the stuff he’s having to do, and in a way, I’m glad I’ve got a lot of gray hair.

Kevin Pho: One of the things you said earlier is that you made a point to carve out time for your family and carve out time for yourself. You never overbook. Would you say that was pretty typical among your colleagues, either in orthopedic surgery or outside of your specialty?

John Chase: No, not at all. It’s very hard to do. I was ostracized for doing it.

Kevin Pho: Really? How so?

John Chase: Yeah, because I wasn’t productive enough. I was not a highly productive orthopedic surgeon in terms of the figures on the sheet at the end of the month when we went to the meetings, and it was really hard to sit there and be ostracized because of that, and punished, in a way. But I thought it was important. I said, “Listen, I’m fine.”

The other thing is, whenever I got worried, “OK, I’m not making enough money,” or “I’m not being paid enough for this,” or “They don’t think I’m making enough money,” I said, I compare myself to my high school classmates and some of the people that are still farming in Iowa. And I go, if I told those people that I was not making enough money or I was not productive enough, they would absolutely laugh in my face at how ridiculous that is. And that kept me, I think, grounded.

I think the problem for physicians is you’re around a lot of people who have stuff, and I promise you, you get into the comparison. You know, these people have a beach condo, those people went to Paris, this guy has a really nice car, and if you start comparing yourself to them, that’s where you get in trouble. I thought, OK, I compared myself to my high school classmates that were farming, and then I wasn’t worried about it.

Kevin Pho: So when you say that you were ostracized, who was doing that? Was it the administrators? Was it your physician colleagues? Did they just put RVU productivity on some type of PowerPoint, and you were shamed? Like, what exactly did they do?

John Chase: Oh, absolutely. It was my practice partners, and they said I wasn’t practicing enough, I wasn’t productive enough, I was raising their overhead. And things changed, and there are a lot of ugly details, but toward the end of my practice, I was basically working for nothing. Fortunately, I had been wise in my decisions, so I was able to maintain it, but I was basically working for nothing. So, you know, the overhead went up, and I was supposedly the cause of it.

Kevin Pho: So how do you feel about that?

John Chase: Oh, shoot. I was angry. I had a hard time sleeping at night. I thought I was trying to do the right thing, and so I just needed to get away from it as soon as I could.

Kevin Pho: A lot of physicians may find themselves in a similar position. You stayed resolute, certainly, during all that pressure. Any advice that you could share with these physicians who are also under productivity pressures?

John Chase: Yeah, that’s really hard, because you’re getting hammered about it. Mine was in my practice, but if you’re working for a hospital or you’re working for a venture capital group, you know that they can fire you. I don’t have a good answer. You just have to find a happy medium between doing the right thing and, you know, meeting the demands of your profession.

Kevin Pho: We’re talking to John Chase. He’s an orthopedic surgeon. He’s the author of the book “You What?!: Humorous Stories, Cautionary Tales, and Unexpected Insights About A Career in Medicine.” John, tell us some of your take-home messages that you want to leave with the KevinMD audience.

John Chase: If you’re dealing with your patients, you just need to be conscientious and responsible. Dealing with the people you work with, just treat them decently. And then take some time for yourself, to enjoy yourself along the way.

I would also say something I learned about in writing a book is that writing a book is a contact sport. I have been amazed. Most of the reviews and the feedback have been good, but there are some people that have, I mean, one review started with “another doctor with a God complex” and ended by calling me a condescending jerk. So I began to realize that their problem, hopefully because they’ve only read two chapters, their problem wasn’t with me; it was with all the physicians in general. So I realized that you have to have a thick skin. You’ve probably figured that out too. You have to have a thick skin because there’s lots of criticism, and you just have to let it run off your back like a duck.

Kevin Pho: All right, tell us where readers can find your book.

John Chase: It’s available on Amazon. That’s the only place you can get it in print. The audiobook’s available both through Downpour, which was the company that published it, and then also through Audible on Amazon as well, if you have Audible and if you like listening to stuff. I was thrilled with the reader I got. His name is Bronson Pinchot. He’s my favorite reader of all the books I listened to, and he did such a great job with that. He made the audiobook better than the written book, I think.

Kevin Pho: Thank you so much for sharing your story, time, and insight, and thanks again for coming on the show.

John Chase: Thank you, Kevin. I appreciate it.