From Carpentry to Surgery: Dr. Christopher Kennel’s Unique Journey and Insights

Doctor Christopher Kennel joins us to discuss ENT practice in New Zealand

Dr. Frances Mei Hardin: Welcome to this week’s episode of Promising Young Surgeon. This week we have Doctor Christopher Kennel joining us to discuss ENT practice in New Zealand, the dynamics of the operating room in New Zealand and his teaching philosophy as an attending. There’s a lot that we want to get into today, so we’ll jump right into discussion with Doctor kennel. Doctor Chris Kennel is an ENT surgeon who completed residency followed by an otology fellowship in the US. Prior to moving to start his ENT practice in New Zealand. He enjoys a rich and varied life with his wife and children aged 13 and 15. He’s an avid gardener, growing avocados, citrus, olive stone, fruits, berries and herbs. He bikes to work daily in enjoying a mediterranean climate and seeing the sunrise over the ocean. On one commute, he’s surrounded by orchards. His hobbies include exploration of local farmers markets and orienteering. He is the creator of the company ENT and Allergy Limited. For full disclosure, Chris was one of my seniors during ENT residency and he was always so kind, eccentric and a very thorough answer of questions, whether in the operating room, clinic or outside. So thank you so much for joining me today, Chris, all the way from New Zealand.

Dr. Christopher Kennel: thanks for having me. It’s great to be on your show. I feel like I may be the, promising geriatric, surgeon, however.

Dr. Frances Mei Hardin: Oh my gosh. Well, and you know, Chris was recently on Radio New Zealand, is that right? Is that the name of the show? He’s in his media content era, media King era.

Your first life as a carpenter was prior to residency training

I’d like to really just kind of jump into things, but one of, I think the most interesting things about your career and something that, in my opinion, shaped your disposition and your approach to and your strategy for residency was your whole life, you know, first life as a carpenter prior to residency training. And so you’ve described a little bit to us when we were all residents, you talked a little bit about the apprenticeship model and things like that. But I mean, for our listeners who don’t know anything about carpentry or the apprenticeship model, what is that like?

Dr. Christopher Kennel: Yeah, so one of the unique things about carpentry is that when you’re working on the job, almost everything you do is very publicly visible. So before I went into carpentry, I did college and I did some public health. And a lot of what I did on a daily basis was meetings or computer work or writing. And it wasn’t like anybody was really seeing what I was doing to a huge extent. So I show up for my first day on the job doing carpentry the reason I did carpentry, because I wanted to switch to a more physically active, I guess a more physically active job because I got tired of working behind a desk all the time. And so I showed up and I was asked to frame a small closet, and I was given a pneumatic gun to shoot nails. And I didn’t know how to use that. I didn’t know how to use a lot of the equipment. And I built this wall that was really quite shambolic. It was, I didn’t know where the good pieces of wood were, so I was, like, cobbling together small pieces that I had found, from demolition somewhere else in the house. And at the end of the day, I had this thing that was all rickety. I told you, the guy who hired me, I was like, I can’t bill you for this. This is just really bad. And I was working for the owner, on a remodel at his own home. And he was just like, no, this was kind of a test to kind of see where you were. And, I mean, I had no skills at all, basically, but over the course of about seven years, I developed those skills. And so one of the things I learned is that in a field like carpentry, that’s very hands on. It’s frequent that you can’t do things as good as you might hope to. And everything you do is visible. Like, at the end of the day, people would look at what I did and I would see it. And so maybe the average person might not notice some of the finer details, but the other construction workers on the job site sure would. And so if something wasn’t right, I would hear about it, and I just got used to that. Yeah. Yeah. And sometimes we would make a mistake. Like, if you read the blueprints wrong and put a wall, you know, not in the right place or not the right dimensions, or, once I tore down a load bearing wall that I shouldn’t have, and so we had to go in and, rebuild it, or it ended up better because it created more of an open environment for this basement, but it cost us probably a couple days of work. And so I also learned that you have to make things right. So if you make a mistake, which we sometimes do, you, try to fix it as best you can.

Chris, your experience in carpentry closely mirrors your journey in residency

Dr. Frances Mei Hardin: Do you feel like you were always really good at receiving feedback even before that job and that chapter of your life? Or do you feel like that experience was very formative and you became like the zen master of receiving feedback?

Dr. Christopher Kennel: I don’t think I was that good at receiving feedback, but it was just humbling to fail so much and to fail so publicly. So it’s kind of like you get sort of beaten down into it and you realize that, things aren’t that good. And it was, I was used to doing pretty well in school and with academics and at my other jobs. So this was kind of a new phase for me. But in hindsight, like, after a few years, I could look back and be like, wow, I’ve gotten some great skills. I’m now able to do really hard jobs and do them effectively. So it’s kind of getting that perspective. Like, you start off not very good and then you get this feedback and you fail a lot. And from the failure you can grow.

Dr. Frances Mei Hardin: Yeah, that’s so true.

Dr. Christopher Kennel: I think a lot of people in medicine, they’re used to being really successful and may be successful in all kinds of things, hobbies and school, and they’re used to that pressure and always succeeding or usually doing pretty well or better than average. And so it can be hard if you’re doing something that’s a little out of your comfort zone or new, like a manual labor type of thing where you’re using your hands. And if you’re not so good at it, it can be probably scary to, you know, fail, especially if you’re, if you’re, if your self worth is dependent upon, or your image of yourself is one that is a successful image. Mm.

Dr. Frances Mei Hardin: Right. And it’s dependent on your performance or maybe like hinges upon feedback that you receive and things like that. And so I do see a lot of parallels, of course, because obviously what we do, you know, in ENT surgery and all surgery. And really, I think a lot in medicine is, yes, like this is public facing work. You know, our scars, our surgical scars are certainly visible that something visible to the patient, to their family members and friends, things like that. So we are very held accountable in the way that, you know, other jobs where maybe they are working behind the computer or maybe they’re, you know, they’re doing their excel spreadsheets and things like that. But that doesn’t go public. You know, that gets kind of reviewed by their boss or privately within the team before. Before it’s seen widely throughout the community. I really think that you’re hitting on something because I do feel like maybe your experience in carpentry closely mirrors more of my journey during residency, because I do feel like there’s a lot of, you know, like public facing mistakes that we make as we learn and then also, like, you know, a lot of accountability for those mistakes. And, of course, the very necessary need to become better, both clinically and surgically, like, every day. But what is difficult, like you said, is that a lot of us don’t have experience in terms of, like, learning on the fly and learning by trial and error publicly and things like that. And so it’s funny to think about if maybe we were all required to spend, like, five years doing carpentry apprenticeship prior to residency, then maybe we’d be better residents.

Dr. Christopher Kennel: It’s possible. You know, I was told all the time how to hold an instrument differently. all these little things, like, just simple things, like how to put a bipolar down on the patient’s chest where there’s a magpad, all these little things, like. And you just sort of have to let it roll off your back and realize that someone’s trying to help you learn or see it as an opportunity to try something and develop some skills. But, yeah, I totally agree. I think a lot of people go into medicine, have a, more academic background, and don’t do much physical job labor. And so it can be. It’s a different way of doing things.

Dr. Frances Mei Hardin: But I do think that what’s interesting, too, because I totally agree, like, obviously, for the record, I agree with Chris, and it is, you know, it’s a privilege to be able to learn from people, even in the style that we do in residency and things like that. Kind of like apprenticeship model. but that being said, there’s also kind of, like, the converse of that. There’s instances where that goes haywire. I will say that surgeons pretty famously, like, they’re egotistical maniacs. Like, I can say that that’s just. That’s pretty, widely agreed upon to be true. And so I will use the example of even something that I’ve talked about on a previous episode, which was basically this huge, huge explosion in the or it was over the topic of a Vikram pop off suture being popped off at the wrong angle, or the, quote, unquote, the incorrect angle. Right? Like, the technique for popping that little curved needle off of the suture. It was not suitable to the attending. But here’s what’s so interesting. I’m glad I shared that story, because since then, I’ve had surgeons reach out to me. One of my friends who’s a neurosurgeon, he reached out afterwards. He was like, we use micro pop offs every single day. I’ve been using them every day for, you know, years and years. And years now, I’ve never heard of a quote unquote correct angle. Right. So that what’s interesting. And so, of course, I’ve talked to more surgeons and things like that. There. There is a difference between, like, personal opinion and style points versus, true, safe anatomical technique. And not only that, but pretty much just one of my core arguments is that even if someone did make an error, like a learner, let’s say, junior resident makes an error in terms of, like, some surgical technique, is that something worth the whole blow up, leaving the. Or things like that over?

Dr. Christopher Kennel: Yeah. I think sometimes we can lose perspective about what’s really important and what’s just style points, I guess, and. Or how you do things. Since coming to New Zealand, I haven’t had all the same resources as I had in the US, and where I had different resources. And so I’ve been questioning, do I really need to do things? And I think one of my approaches has been to get rid of stuff, just stop doing certain things and see if I really need it. Like, if I’m doing a mastoid surgery, I don’t do a head wrap. It doesn’t prevent a hematoma. And so, like, in the operating theater, you’re spending, I don’t know, three to five minutes putting this bandage on. That falls off later on in the day where you buy this glasscock dressing that you’re not going to use. I was like, you don’t really need that. there’s so many things that I feel like if you just question, do you really need this? And to sort of simplify your practice. And, so that’s been kind of a journey that I’ve had here, and you’re right. There’s a lot of things that I think I get particular about or I might be particular about, but when I question myself, do I really need that? Or is that just something that I. I do because I’ve been doing it? When teaching people, it’s kind of like I try to focus on what’s the most important thing and not. Not the little things. And maybe I can learn from somebody else, watching them do it their way.

Dr. Frances Mei Hardin: Yeah, I think there’s a lot of power. Like, over the years, I can remember mentors and other attendings, even fellows, you know, senior residents, saying things like, they’ll preface their next sentence. They’ll just say, hey, this is how I do it. I’ve actually seen a couple of different ways to do it. You know, multiple acceptable methods. I would like to show you my preferred way, and that’s really helpful because now the learner, they receive that information and they can basically put it into their own mental framework appropriately. Cause especially, I will say, like the journey to becoming a surgeon, there’s a huge difference between, there is only one way to do this, and it’s life or death, and we’re airway surgeons versus. Okay, what I’m about to share with you, there’s a couple different ways for this, all seemingly, there’s not evidence that one’s superior. I just want to share with you mine.

Chris: I think in the US medical system, there’s more pressure

You know, there’s a big difference with even between how the learner receives that information and can categorize it for themselves.

Dr. Christopher Kennel: Yeah. Something else that I learned doing carpentry was not something that, I guess I gathered it from watching my supervisors or the couple of company owners. One of them took pride in finding people who were kind of down on their luck and might not have had many skills, especially life skills, and training them to be kind of, a carpenter or a helper. And his mantra was, let people rise to the level of their ineptitude. It was kind of like a project, right? He would find somebody who you might think, oh, this person doesn’t have much talent, but his job was like, I’m going to train this person and see how. See how good they can get. And so I think at the time, I wasn’t thinking about this in a medical context, but in the back of my mind, now that I’m on the other side. And honestly, when I was a resident, I didn’t really have this approach. I wasn’t in the same headspace that I am now. and I was sleep deprived and stuff. But now I’m like, that’s a great philosophy. Why don’t I take this registrar, that’s what they call residents here, and, like, teach them to. And see what we can do together. Maybe I can make them great or, you know, really good.

Dr. Frances Mei Hardin: Yeah.

Dr. Christopher Kennel: And it’s kind of fun. It’s like a project.

Dr. Frances Mei Hardin: I m love that so much. And I do think that that is not present uniformly in the US. You know, I do. When I connect with people, like, especially in the surgical subspecialties, things like that. We hear fairly often these stories of, you know, a program picks a resident they don’t like every year or every couple years, and that resident is going to be under increased scrutiny and not uncommonly either put on probation and invited to quit or fired and things like that. Those are stories that I’ve heard from really all parts of the country, again, across multiple surgical subspecialties. And I’ve definitely witnessed that as well, where either a senior resident is threatened by a junior resident’s excellent performance, or even the attendings like to almost pile on on somebody’s poor performance. And what’s funny, and I remember by the time I was a chief resident, I started kind of, like, muttering about this stuff, of course, on the DLC, pretty, much to myself. But I was like, man, that’s crazy. Like, you know, if my intern, who I teach, and they come see all the consults with me, and, you know, I’m, like, helping this intern, if they win, we all win. Or, like, if a resident does really well, it makes the whole department look better. But yet I’ve seen, you know, all these different things where even, like, departmental attendings or things like that don’t prioritize residential education, and that ends up showing, I think, even. Even has downstream effects.

Dr. Christopher Kennel: Yeah. it’s hard to find time if you’re under a lot of stress. Like, I think in the us medical system, there’s just more pressure. There’s more bureaucracy to deal with and more, more time to pressure. You start earlier, you work later, you work longer hours. There’s more family, probably more family emotional stress when you go home because you’re, You’re not at home as much. And it’s just hard for people to perform their best if there’s all that pressure. And then you get into these situations where folks are envious of each other or feel like somebody else’s success makes theirs less m valid or have threats that way. And I fell into that, too. I mean, that wasn’t my best when I was sleep deprived. I mean, you told a story that talked about once how I, I got curt with you when I was on a bike ride. You told that to me, when I visited you in Nashville. And that really was helpful to hear because, you know, I wasn’t that aware of how I had been less. I didn’t live up to who I probably should have or hoped to have been when I was insensitive toward you.

Dr. Frances Mei Hardin: No, I appreciate you saying that, but, you know, like, now I feel like we got to tell everybody the story. So if that’s okay, I’ll do a quick, you know, like, two minute summary of it, because it just. And, like, truly, at the end of the day, I mean, you guys can probably hear it. Like, Chris and I are really good. He’s one of my most favorite mentors and teachers I’ve had on this whole journey. To becoming a surgeon. And, like, truly, it is remarkable, because I guess in the several years we worked together, you did show up very consistently in a pleasant mood, and you had excellent emotional regulation, which I did not see everywhere. you know, so obviously that mentorship means a lot, but there was just one specific instance where it was funny, because we were reconnecting, on one of his visits to the states, like, six months ago, and we were getting ice cream, and Chris was like, you know, yeah, I know it. I know you went through it. Like, I know there were some real. There were some hairy moments, things like that. And he’s like, but I never, you know, like, made you cry. And I was like, you did make me cry once. I was like, no worries, though. Like, no worries at all. Like, let’s get ice cream. I don’t want to get into it. He was like, no, no. Now I must know. And so. But I do think that this is such a great. I actually like this story because I think it shows some nuance and it shows, just maybe some of, like, the resident experience or stressors that we, both, you and I, like, came to this situation with, which is just that, basically, when he was, a chief resident, the schedule for the following week always came out on Fridays, like, Friday afternoons, which it was like the terror dome, because you just, you know, you finally survived a week, and then you’d get hit with this schedule for next week, and it could be. It could just be, like, your nightmare lineup, and you’d have to sit with that all weekend. you know, or in my case, like, drink about it all weekend, and then you just show up Monday and you’re there for the lineup. But what actually happened is that I was on call that weekend. So, you know, Friday evening, all day Saturday, all day Sunday, I was on call. And what happened was that by Sunday, it, was a pretty busy, brutal call. So I’d had, like, a couple hours of sleep total since Friday. Now it’s Sunday. I’m preparing for the week. I’m preopping patients, and I had been assigned to surgery with, actually, that attending who, has some specific vicral pop off tendencies, preferences. So I was assigned to operate with. With that attending, and I knew I was running on almost no sleep. And Chris was the chief, and he had made the schedule. And so on Sunday, even though he was off, which, like, to your credit, 100%, you were not on the clock, you’re not on call. Like, I reached out more interpersonally, directly to say, hey, may I ask you a question? You know, I was like, calls been really bad this weekend, and I’m worried that, like, this is a little bit of a setup to fail. Like, I’ve had a couple hours of sleep. This guy, he’s not forgiving, right? Like, again, I can. I can say it generously, which is that, like, he’s not a forgiving guy. There’s several cases. These are going to be, like, more in depth, head and neck cases. Could I be reassigned somewhere else? And honestly, I love clinic. I always. I was like, oh, please, put me in clinic.

State: I asked to swap into clinic to avoid another sleep deprivation fight

I wasn’t like, put me nowhere. I was like, can I just please do clinic? Which is a place that I find, you know, just for context, I find it more relaxing than being in the OR. And so I said, please, you know, put me over there. And you were basically like, I’m riding my bike. You’re like, I’m on a bike ride. And you were like, you’re always trying to get out of stuff. And, you know, you were like, and you can never update the list. Right? Like, all our junior residents are having trouble updating the list, and then you just basically hung up, so. I did. I had. I had a small cry about that. I don’t think that you were out of pocket or anything. I mean, I was good at updating the list, so, actually, you were out of pocket, and I don’t have issues updating the list. But just in terms of, you know, I didn’t mean to bother you on your time off. What that turned into, though, is just that I continued to not feel like that I was set up to succeed with work, you know, because I do think that putting, like, a super sleep deprived resident who’s asking for, you know, just to swap into clinic to try and avoid another huge, massive blow up and fight in the oR. Like, I was trying to be proactive about that. But, you know, you can certainly talk about your experience, which I think is that you don’t remember this phone conversation at all.

Dr. Christopher Kennel: I didn’t until you brought it up, and then I was, like, vaguely remembering it, but you. It was either you or Lauren on an earlier episode, had that saying about how the axe forgets, but the tree remembers, and I’ve remembered that since hearing it. It’s a good. Good, It’s a good phrase to think about.

Dr. Frances Mei Hardin: Yeah. And we all do that. Like, I know that there are instances where I have been the axe, and I certainly. But I try to be. And especially, I think, you know, at this chapter of my life, like, I do approach a lot of my workplace interactions with kind of the sensitivity of like, I don’t want you to come find me, you know, when I’m, at an ice cream shop, like years from now, and tell me, hey, do you remember when you talked to me this way at work? Like, I really do. Just, I think that fortunately, my experiences have shaped how I do approach my modern day interactions.

Dr. Frances Mei Hardin: But anyway, we’re not trying to blow up your spot. You were a great, great senior. But yeah, that was just, it was just funny because, you know, he’s bragging in the ice cream chef. He’s like, I never, I mean, there’s no way. And I was like, oh, no. I mean, I cried for like an hour. And I think that is also sleep deprivation related, you know, which you’ve alluded to, like, none of us are at our best in residency training, which is like pretty inherently set up, in that model where we rarely are rested or very.

Dr. Christopher Kennel: Absolutely. It’s really hard when you’re in that.

Dr. Frances Mei Hardin: State to kind of piggyback off of what you mentioned about your practices in the or and things that you’ve kind of, been, able to try out. Such as, like not putting a glass cock or, you know, one of these mastoid dressings on after surgery. What he’s describing is that, Chris does a lot of otologic surgery, which is ear surgery. And afterwards there’s this like pretty dramatic, you know, full head wrap bandage that everyone does. I’ve always seen it done and it’s interesting to think about how I have heard that those glac cock, glass cocks are really expensive. Right? Like per use.

Dr. Christopher Kennel: Cause they’re all like, I’m sure they are.

Dr. Frances Mei Hardin: I’ve heard that they were pretty expensive. And I think I heard that. Cause I saw someone drop one once and they got yelled at. They were like, those are expensive, you know, don’t do that.

Tell us more about the dynamics in the operating room in New Zealand

But what I think is really interesting is just, if you could tell us more about the dynamics in the operating room, the culture of surgery in New Zealand, and any differences that jump out to you compared to the US and like north american systems.

Dr. Christopher Kennel: Yeah, I have some things that might blow your mind. They were definitely surprising to me, and then just some common things. So when we meet in the morning, we get together, or it could be, if it’s in the afternoon case. the first thing that we do is we all get together as a group. The surgeon, anesthetist, the anesthetic tech, the nurses, and we go through the list of patients that we’re going to operate on that day, and we discuss each patient. So we have a team huddle, about 15 minutes before the first case, and just talk about everything that’s going on. and the nurses have a chance to ask questions about every case so that they are prepared, and an esthetic has a chance to ask their, questions or raise issues, too. So there’s kind of a teamwork approach. And also we’ll have introductions because oftentimes there might be a learner and. Or like a. Yeah, it could be a learner or just somebody who’s new at the hospital. So it’s a good way to kind of, start the day. And we also talk about when we’re going to have our morning tea and our afternoon tea and lunch, because in New Zealand, there’s a culture where people have a break for about half an hour in the morning, maybe around ten, and then in the afternoon probably around, I don’t know, 230 or so for tea. It’s kind of a british thing, I think. As a surgeon, I usually just operate through it, but the staff kind of rotates around. Or if I’m doing short cases, I’ll, you know, we’ll have our breaks that way. So anyway, we have a huddle, and.

Dr. Frances Mei Hardin: I, mean well, and I love that too, because that’s in contrast to in the US. If people haven’t been in the operating room, what typically happens if a learner’s joining or just a new team member, or it might be like that. The surgeon and the anesthetist don’t know each other. Everyone just kind of meets in the operating room. Patients often already on the table. The learner walks in and the surgeon will give them like, you know, a backwards wave, and they’ll be like, hey, I’ll be like, stand over there, don’t touch anything. And no one else meets the Lord. Like, that’s a pretty common introduction.

Dr. Christopher Kennel: Yeah, no, here it’s all very much team oriented. like, another major thing is we don’t have a lot of people, going around making rules, just arbitrarily about what to do in the operating theater. And I’m thinking mostly about sterility. And this was a shock to me. Like, in the operating room, the surgeon, and like, the scrub tech, they’re the ones that always have a mask on, but the, like, anesthesia tech, the circulating nurse, they may or may not. The anesthesiologist often has a cup of tea or coffee. if it’s a long case, they may have a biscuit. So people can be eating and drinking in the operating theater while we’re operating. And at first, I was like, this can’t be good. This is going to cause more infections. And I had some infections on ear cases, and I was like, I raised this to my colleagues. Most of them were trained in the UK, and they’re like, it’s not them eating in the operating theater. Think about what you’re doing. And it was. It was what I was doing. I wasn’t forcing betadine down into the ear canal far enough, because in fellowship, I learned that if so, there’s a perforation, you get betadine in the middle ear. It causes mucosal weeping, and it can be a little bit of a problem. so I just changed my technique. I didn’t have problems with infections since then, and I haven’t noticed any problems with, yeah, so, like, so what, the tea? It wasn’t the tea. No. So people are some. I just, like, took a step back, because at first I was like, this is horrible. People aren’t wearing masks. And now I’m like, that’s just what they’re doing. They’re, you know, that’s incredible. Well, and again, maybe not impacting things.

Dr. Frances Mei Hardin: I love it. I’m very intrigued. Like, this legitimately stopped me in my tracks.

North American intraoperative dynamics are very hierarchical, very tense

And so that’s why I think it’s so important that we kind of share with everyone to broadly refresh everyone’s mind about the north american, what I think it’s fair for us to call the north american, intraoperative dynamics and structure. It’s very hierarchical. We talked about in a previous episode, the canadian study, that looked at hierarchy in the or, and kind of, it had all this, descriptive evidence of fear and intimidation that was probably sequela of the inherently hierarchical system. And so if there is a stressful moment in the middle of the OR, say, there’s some bleeding that somebody’s getting into, it’s terrifying. Everyone’s silent. Like, of course, yes, it’s a big deal, and the surgeon needs to control it. But the tension in the room, even with the circulator, even with anesthesia, any learners? So it’s completely silent. And if there’s an interruption of that silence, that might be met with yelling from the attending. I have seen it happen where it’s a stressful moment of the case and the phone rings in the operating room, and that is met with yelling from the attending at the resident physician, which is so funny. Like, I can’t tell you how much of my time, actually, I think over the years of training was spent just, like, willing the phone not to ring. Cause I was like, mm Shit’s gonna hit the fan. Like, no one better call in here. I can’t control that. I should have been, like, taking phones off the hook because, you know, there were all these uncontrollable factors that because of the already significant setup for tension, it would just be like lighting a match. And so, you know, Chris wrote me after the distress tolerance episode where I really. I told you guys, I was like, look, if you’re a surgical resident, you’re scrubbed in. You should have some distress tolerance skills in your pocket. Like, you don’t know what’s going to go down. It’s an inherently extraordinarily tense environment, very high stress. And if it’s okay, Chris, I wanted to read this little excerpt from the email.

Dr. Christopher Kennel: Yeah.

Dr. Frances Mei Hardin: Because, again, I want to share with everyone. I mean, stop me in my tracks. Kind of made me rethink everything. My eyes, my little eyes popped out of my head. But here’s what he wrote. You described being scrubbed in during a case and having limited options for mentally resetting when stress was high. Here in New Zealand, when surgery is tough or there’s some bleeding that takes a bit of time to settle, you can have a break and have a cup of tea. In fact, most people in the or who aren’t close to the patient don’t have to wear masks. So anesthesiologists, scrub nurse, anesthesis tech, etcetera, often have a cup of coffee or tea and a biscuit on their table in the OR. We do not seem to have a higher rate of surgical site infection. So I suspect the US may have over regulated with regard to sterility. It is totally okay to pack a neck or ear and take a break, giving time for bleeding to stop or just to relax a bit, since everyone else is doing it already. Like, m. You could have knocked me over with a feather.

Dr. Christopher Kennel: One of my, I mean, I’m here with an otologist who’s been doing ear surgery for, I don’t know, 30 years. He’s, he’s well regarded, and he’s like, yeah, if I get into some bleeding, I’ll just pack off the ear, and then I’ll go to the break room and have a. Have a cup of tea and then come back in five minutes. And, you know, it’s usually better. It helps them reset. And, you know, otologists, they can be a little bit, uptight. Sometimes in particular, you know, everything needs to go just right, and you’re working with like, micro millimeters of distance sometimes. So anyway, it’s just like, wow, this is. This is kind of interesting. I hadn’t encountered that in the US. And it’s true if you’re feeling, if you’re feeling a little bit stressed out, I mean, the best thing is to kind of unwind and step back and, do something that gives you a little bit of a break because you can be really focused really hard when you’re operating, and sometimes you just need to regroup.

Dr. Frances Mei Hardin: I think that that definitely makes perfect sense. And especially, you know, when outcomes are similar, safety is still proven with that method. Like, that’s very compelling because, you know, I remember even in training, they did give us a couple ergonomics lectures, which is just trying to remind the surgeon every 20 minutes or so, 1520 minutes, just take a, 1 second stretch break. And, you know, we have to stay in our sterile box, so we can’t even stretch our hands up above our head or anything like that. But just even the act of looking up and out of the neck wound, like, I do a lot of endocrine surgery, so if I don’t remember to take ergonomic breaks, then at the end of 2 hours, you know, I look up, and now I have a crick in my neck, and I’m in pain for like a day and a half.

Dr. Christopher Kennel: Yeah. And I think you’ll find for, people who are operating on big cases, taking a short break can actually help you be faster in the end. I, We’ve got a lot of skin cancer here, and it usually metastasizes. So I’ve had to do a lot of. Not a lot, but it seems like every month I’m doing a parotidectomy, neck dissection. And so those are long cases, and it’s nice to be able to just step out, have lunch, come back. I’m faster, more refreshed, and, I think there’s something to be said for that.

Dr. Frances Mei Hardin: I mean, and I’ve seen, I’ve seen the opposite. Right? Like, the surgeon is flustered. They get into bleeding. They are hurriedly trying to get through it. They get into more bleeding by doing that. Like, and especially, yeah, if it’s something like Venus, like, maybe this could have just been, like, held with pressure, and we all could have taken, like, a mini stretch or something like that, let alone a biscuit. Like, that’s what killed me is I like that. I like the sound of that a lot.

There are many other diverse cultures where intraoperatively, they do things differently

I’m interested in biscuits. I wish I had biscuits in the or, you know, like, I’m very intrigued by your culture. And I just think that by. By learning about this from you, though, it really starts to make us just look at our own systems and say, okay, well, does it have to be that way? You know, it sounds like there are many other, diverse cultures where intraoperatively, they do things differently.

Dr. Christopher Kennel: Yeah. And I think this isn’t just a New Zealand thing. It’s. I think that my friends who train in the UK, I think they do it there, too. So it’s, The US may be a bit of an outlier. the nurses also, they’ll go around with food. If you’re on a long case, they’ll try to give you some candy under your mask or a sip of water or something. So it’s definitely a more collaborative atmosphere. People are a little bit less stressed to get through things.

Dr. Frances Mei Hardin: I really love that. And to me, I would not be surprised if that shows in quality of life of healthcare workers. and team dynamics. And certainly the canadian study about hierarchy in the OR, it was just kind of showing as a refresher for that study I referenced, it came out a couple years ago, but they were experimenting on these anesthesia residents where they brought in a high fidelity actor, and they said, this is your new attending. And that new attending told them, give blood to this Jehovah’s Witness. Yeah, I know that they declined. And, like, this is legally, ethically, like, I don’t care. Do it, give them the blood. And so they experimented on these poor residents. But, yeah, it was very interesting to then see the analysis of all the interviews that they did with residents afterward, because they all. I mean, they had all these different tips and tricks, some of which may sound familiar to you, but all these tips and tricks on, like, how to voice concern or question what’s going on, but in a way that’s, like, extremely backwards, right? Like saying, wow, I’m surprised by that. I mean, when I was on an off service rotation, I witnessed. When I was an intern at this point, I witnessed a wrong site surgery. this was a, like, teenage girl, and it was an excisional lymph node biopsy for lymphoma, which is where we cut out a lymph node. And basically from preoperative imaging, I knew that it was higher up in the neck, level two. I mean, I didn’t know that I was an intern, so maybe I thought some things about it. I had some preconceived notions about it. And the surgeon just comes in, and this was a very hierarchical or. He came in, marked an incision. It was very low in the neck. But again, I was an intern. I was off service. We were alone in there. And he was one of those attendings who was like, don’t talk to me. Like, nobody in the. Or talked to me. He had the correct side of the neck, but again, several centimeters. I mean, inches down, because, he kind of marks, like, level four. And I said, wow, I’m surprised by that. I said, I thought it was kind of higher in the neck. And he was like. Didn’t even reply. He was like, be quiet. And just made the incision. You know, we worked for, like, 45 minutes. Couldn’t find it. Couldn’t find it. And I kept being like, wow, that’s surprising. you know, I did think on CT scan, it might have been, like, a little bit higher. And then after, like, an hour of this, he went and looked at the imaging. He came back without even a word, without even hesitation, he made another parallel several centimeter incision up, higher in level two. So this teenage girl ended up with two, you know, four centimeter parallel incisions on her neck. Found it within, like, ten minutes that way.

Dr. Christopher Kennel: That’s interesting. I I mean, when you told that story, I was wondering. I mean, there’s the topic of, how do you voice, differences in opinion. But then there’s also, why didn’t that surgeon question themselves? Like, I feel like I’m always questioning myself, and aren’t. Aren’t people who. Who strive to be their best? Like, aren’t we always second guessing ourselves? Maybe. Maybe that’s just my own thing looking onto the, like, projecting out into the world. But I feel like I’m always trying to figure out, like, how could I do this better? Could I, you know, could I be wrong?

Dr. Frances Mei Hardin: No. I think that you’re pretty unique. I don’t. I like, again.

I think that there’s so much to learn about respectful questioning in surgery

And you guys know that I’m part joshing, but, you know, I’m part not joshing when I say, I don’t know a ton of surgeons who have that level of humility and who say, could I be wrong? You know, I think that we are kindred spirits. I think that if any member of the staff in any capacity at the hospital said to me, hey, are you sure about that? I’d be like, whoa. I’d stop what I was doing 100%. It’s not even a question. But, I mean, there, you know, there’s all sorts of, other. Other practitioners out there. And so, no, like, it did not slow him down at all. I voiced question, I voiced respectful questioning, very similar to the way that this canadian study had a lot of its residents say, like, well, sometimes, so that it’s obvious that I’m not being insubordinate. I phrase it as a gentle question, and I phrase it as, wow, crazy little old me thought it was, like, somewhere else, but, like, I could be wrong. And again, I did that multiple times, and it did not slow this person down. so I just. I think that there’s so much to learn. When I was out in Norway recently, I did get the chance to speak with many locals, and they were talking about how, you know, the nurse strikes, the physician strikes were not uncommon. Pay parity was much closer. And just like, and in my reading then of the literature, like, there’s a much more even playing field. And just kind of this acceptable questioning. Like, any member of the team can question anything at any time. Time. To me, that’s a good team. I would want surgery in that type of environment. I don’t want to be operated on by one of these people who thinks that they know best and they don’t slow down. If people are kind of like, oh, hey, like, that’s weird. What do you think about this? But there are people who will steamroll through that. I don’t know if you feel like you’ve seen that before.

Dr. Christopher Kennel: I mean, I’ve probably seen it. I don’t really remember. This is my own flaw, probably. I don’t pay as much attention to what other people are doing. I’m more just go by the. Go by the. Go with the flow. And then what happens is I pay more attention to my own failures and things that I could change, but other. Yeah, I mean, I’m sure it happens. I’ve probably seen it. Don’t try to dwell on it too much.

Dr. Frances Mei Hardin: Well, I think that’s your superpower. May just like this total immunity to what other people are saying and doing.

Dr. Christopher Kennel: Yeah. When you asked me a little bit about, or sometimes you described me as having a Zen outlook on things. And, I lived in Thailand a couple years, and I read a book by thich nhat Hanh called old path white clouds. And it’s kind of his recounting of the life of Buddha. And it was mainly to understand sort of the buddhist philosophy that is in Thailand, because it’s a buddhist country. And I think that I was in my formative years, probably around the age of 20, maybe 21, 22. And, I thought that was really helpful in terms of just thinking about a different way of perceiving

00:40:00

Dr. Christopher Kennel: the world. And I’m not a Buddhist, but I think there’s a lot we can learn from, that mindset where oftentimes the things that we get trapped up in are our own preconceptions of the world and, how our will, we want things to be a certain way. And if it doesn’t match up to that, then we get into all kinds of strife and how we project onto other people, that’s kind of another topic. But I think that’s totally. That’s probably influenced me a good bit.

Dr. Frances Mei Hardin: Absolutely. And. But what’s funny, though, and, you know, I’m sure that you totally have an appreciation for, like, the different stages of life, because the reason that I call you Zen is because you have told me all this before. And, for instance, like, when I was a, in the middle of residency, some of the hairiest parts of it, and I was really having a difficult time, solely, really, due to interpersonal issues and things like that and other people’s words and actions affecting me. You know, I remember seeking advice from you, and I think that we were in the women and children’s hospitals, like, doctors lounge, and I was like, what the heck? You know, like, I’m gonna die. Like something, you know, I need to relate differently to my surroundings or I’m going to die. That was actually a conclusion I successfully came to on my own during residency training.

How do we reach people in distress with Buddhist teachings after residency

But when you talked about even, like, thich nhat Hanh, at the time, I was not familiar with his writings. I am now a superfan, but at the time, I was so, like, in the middle of it and in such a deep abyss, really, with, like, how extreme and how extremely negative my experience was in residency that I wasn’t able to learn from some of even, like, thich nhat Hanh’s incredible teachings. And what I will say, and this is kind of proof, though, about, like, maybe environment interplay with our ability to grow, is just that since residency, and even by the end of residency, reading the untethered soul, reading all of thich nhat Hanh’s writings, and, like, I really study and love his teachings, the stoic teachings, I’ve been able to really bite into those and apply them to my life and grow as a person since. But what’s tough and what I’d love to know your thoughts on are how can we reach people who are in the abyss with that? Because, like, I really do think that that would be. My question is, how do we bottle this up? Because, you know, thich nhat Hanh and his, like, gentle, beautiful, like, so incredible, so sneaky and wise teachings, like, they just will not reach a person, in my experience, who’s in acute distress.

Dr. Christopher Kennel: Yeah, I don’t have an answer for that, unfortunately. It’s one of those things where I don’t think I’ve been in that level of distress, like what you’re describing and what you went through. So it’s hard for me to have an answer for how that person can help themselves, and maybe they can’t. Really. The first thought that came to my mind was, it’s not their responsibility. It’s a responsibility of the people who are. Who are teaching them and who are kind of in control of the environment, to change the environment so that their learners can, be more successful and are not feeling so oppressed. That’s. Yeah, but that’s not something that the person who’s in residency can. Can do themselves.

Dr. Frances Mei Hardin: Yeah, it’s tough. It’s tough to get out of a hole when you’re in it. But I do think that actually, like, you know, you almost hit the nail on the head. You had been in Thailand and you had studied thich nhat Han, and, you know, it really changed your perspective prior to even entering medicine. I think that’s very interesting. And, like, I definitely believe in getting these tools to people way earlier on their pre med journey. I mean, there’s no reason that this can’t be, you know, disseminated to college students, certainly medical students, because all medical students are going to run into challenging, high stress situations. It’s the nature of the work. They’re going to see it, whether it’s their clinical rotations, their residency, their fellowship. I know many people who had a wonderful residency experience, wonderful med school and residency experience, and then when fellowship time came, they had a malignant experience. So there’s. There’s no time that, to me, is too early to teach these skills. Yeah.

Dr. Christopher Kennel: I would agree. And it’s. It’s funny. Like, I don’t really think of myself as kind of a Zen person, but in fellowship, I kind of got that reputation in the practice where I was working, too. They’re like, this guy’s kind of Zen. What’s. He’s weird. What’s. What’s going on with him?

Dr. Frances Mei Hardin: He’s impervious to, like, the outside world. Like, it’s amazing.

Dr. Christopher Kennel: yeah, I’m just, like, clueless. But anyway, it’s I think it’s good. I think. I think it is important for people to. Going into residency, I had the advantage. I didn’t mention this, but my wife was, she’s a doctor and she trained before me. And so I kind of, knew a little bit about what was coming up, both with medical school and residency. So I had that perspective, and that also helped. So people who are going into residency, if they can get some tools to make them more. More resilient. Sad. I have to say that because really, it’s an indication that the system is not as, supportive as it could be or should be. Yeah.

Dr. Frances Mei Hardin: Not as optimized, I think. And so, you know, I really feel like I could talk about that forever, but I do want to get to really one more topic before we wrap up here. And so, you know, I love that you’re involved in graduate medical education. Like, I. It’s hard to think of people who are, like, more suited to that than you. as your department’s residency supervisor, I’m sure you’re developing your own teaching philosophies and methods and everything like that.

All of the registrars are unionized in New Zealand

And so I wanted to start by asking what the dynamic is like between attendings and you said registrars or resident physicians in New Zealand?

Dr. Christopher Kennel: Yeah. So in New Zealand, all of the registrars are, unionized. And there’s a couple of unions that they’re under, and I’m not sure. I think the surgical ones are on one union, and then the non surgical tend to be in a different union. But the gist of it is, the unions have all these rules, and I don’t know what the rules are. I’ve read through them, but I don’t have them memorized. And so basically, I give the registrars a lot of autonomy. They are there to learn. I think they’re supposed to have one day out of five off during the work week. So Monday through Friday for academic pursuits and so forth. And so I kind of let them make their own schedule. they. I think they’re not supposed to start before a certain time in the morning, so they’ll often, you know, join me in the operating theater around 830 or so, or nine if they’ve got a lot of ward rounds to do. And then I think their day ends around 04:00 p.m. and so, like, if there’s consults that come in and they’re not on call in the evening, then, you know, it falls on me. So the first thing is, as far as the dynamic goes, the residents, they have a lot of, freedom, at least the way I’m doing things, because I don’t want to run afoul of the union. And they’re happy. They get. The union helps them. I mean, they get paid, a decent wage starting out. And because they don’t go through like here, as well as most of the other parts of the world other than the US. Medical school is not a doctorate degree, it’s a bachelor’s degree. So when people finish high school, they go to medical school and it’s usually about six years. And the last few years are more clinical. so they don’t have a lot of debt. They’re getting paid a decent salary. their work life balance is pretty good. So they’re generally pretty happy.

Dr. Frances Mei Hardin: And they got biscuits.

Dr. Christopher Kennel: Yeah, they got biscuits. And by the time they’ve come to us, like, we’re not a full on ENT, residency program, there’s two types of training options. There are what we call the training track, where people go in, it’s like five years. And when they come out, they can sit for boards. And that’s the, that’s what we would be, would be like in the US. But before people get to that, they rotate through different hospitals and they do different roles and they’re like a junior, registrar or a house surgeon, rotating with different departments. But they also might do a non training track, which is what we have. So we take people for a year and they might not have done any ENT before. And they’re basically, this is a stepping stone. So if they do well here, we write them letters of recommendation, they can go off and maybe get into a training track. So,

Dr. Frances Mei Hardin: Kind of like a prelim year, almost.

Dr. Christopher Kennel: Yeah, exactly. A prelim year in ENT. So, I might. I have a lot more flexibility, probably because I don’t have to adhere to like specific things that a full on training track would be. And because we only have people for one year, we don’t have like a hierarchy of residencies or residents. So, there’s not like a lot of experience once teaching the, junior ones. But our registrars do teach the house officers who are like a level below. And so there is some conversion there and sometimes the house officer moves up.

Dr. Frances Mei Hardin: Oh, great.

Anyone injured in New Zealand gets compensated by the accident compensation Corporation

Dr. Frances Mei Hardin: Well, and so what I wanted to ask about, you know, you’ve mentioned that you are very thoughtful and passionate in the area of, you know, like registrar learning, which will also include inevitably at times, medical or surgical error. And so just kind of like what it’s like when errors happen, how they’re handled and how that. That is fundamentally different in New Zealand as well.

Dr. Christopher Kennel: Yeah. So, I mean, one of the huge differences is we don’t have a medical tort system here. We don’t have any tort system. So anyone who’s injured in the country of New Zealand gets compensated by the accident compensation Corporation. So, for example, if there’s a medical malpractice thing, or if there’s a car accident, or if someone hurts themselves mountain biking, you fill out a form and they get paid for their rehab, or if they need surgery or whatever corrective things that they need gets paid by this. It’s like a national

Dr. Christopher Kennel: insurance fund. And so if I have a medical, If there’s a medical error or a complication that’s a little bit. Some complications, like a post operative infection, aren’t part of this because that’s just a standard, common complication in surgery. But if something more extreme happens, then they get, compensated that way. And there aren’t lawyers coming after you. And so that’s kind of the background. So if there’s a problem, we tell the patients because we’re filling out the paperwork to help make it right for them. We apologize, to them. And I, did have a complication with a resident recently. you know, when I think about complications, there’s things I can fix. There’s things I can’t fix, but somebody else can fix. And there’s things that maybe nobody can fix. And this is one that maybe somebody else can fix, but it’s. It’s likely that nobody can fix it. So this is, in my mind, like, a really bad complication that happened. It was an injury of an important anatomical structure doing sinus surgery. And the. When, in a registrar did it. So it’s on me because I was supervising them and maybe letting them do more than they were capable of, although he had been doing really well up into this point. So we have this injury, there’s a complication, and now I’m in the position where I feel horrible myself because I was supervising this. I have to try to make it up for the patient as best I can and help them get the care that they need to optimize their outcome. And then I also have to take this junior resident and make sure that they, aren’t crushed by this event, because this is a good resident, and all they need is, like, I want. I want them to achieve their career goals. So after this happened, we met, we sat down maybe a day or two later. I tried to, understand what they observed, and we tried to work through what had happened. And then it was important for me to stress that this won’t affect his or my opinion of him, and it’s not going to affect my recommendations, like, when he goes to apply for jobs or training, positions after us. And that I wanted him to, you know, he felt pretty bad about this, too, and I wanted to just support him through it and know that it was really my fault, because I, you know, I was the supervising doctor there. And so I think when things go wrong, it’s important to support those who are like the residents, so that they don’t have that. Is it called the second injury or something where they,

Dr. Frances Mei Hardin: The second victim effect?

Dr. Christopher Kennel: Yeah. Yeah. And so I feel a little bit, because we don’t have this tort system here with lawyers and stuff, it feels like maybe I’m a little less likely to become a victim myself because I don’t have all of that. I just have my own judgment. And then I have to present this at, the, morbidity and mortality conference with my peers. And so it’s. And I see this patient a lot, too. So that’s the other thing. I give all my patients my mobile number so they can call me or text me after surgery if there are questions. But in this particular patient, like, I, You know, you have to see these patients a lot and get them through their. Their complication when it doesn’t go well.

Dr. Frances Mei Hardin: Well, I really appreciate you sharing that. And, you know, it. It just, like, everything that. Everything that you’re saying, that’s just the kind of doctor who I would want for myself and my family members and everything. So, you know, I hugely respect that. And I want to share, you know, with the listeners. Like when Chris and I, you know, we do communicate via email, in part because he lives in New Zealand and in part because he is not, like, a millennial. He’s. What are you, a boomer? You might.

Dr. Christopher Kennel: I mean, I’m a Gen X. I.

Dr. Frances Mei Hardin: Kind of feel like you might be a boomer. So we communicate.

Dr. Christopher Kennel: I’m a boomer because I’m so uncool, but I’m actually Gen X. Gen X is a small group that is, everyone forgets about the Gen X. That’s okay.

Dr. Frances Mei Hardin: Okay, sounds good. Maybe, I just. I want to say.

Dr. Christopher Kennel: Go say it. Okay. Boomer.

Dr. Frances Mei Hardin: No. No, I wouldn’t do you like that?

You talked about patient first in your email about handling medical errors

But I just want to call out, like, this one line in the email, and you echoed it now, but when you said, you know, you talked about the first piece of handling medical error, which, absolutely. Patient comes first, making sure that they’re handled and making sure that the paperwork is all set up and that they, have everything that they need. And then I’m going to read this quote. My second goal was to help get my resident through the process. I met with the resident to let them know that this error doesn’t make me see them in a worse light than before. And, like, that’s. That’s just really beautiful. I wanted to highlight that because what a great, what an incredible model.

Dr. Frances Mei Hardin: you know, I don’t even know that in that decision, in that situation, that I’d have my wits about me enough to be thinking of that person. And, like, the extra care that you took to make sure that they were good was just very beautiful. And, like I was gonna say, I mean, when I, when I read that, like, I was almost moved to tears. And now I’m kind of like, people listening are going to think that I cry maybe too much and, like, don’t worry about me. I cry a normal amount. But that is really beautiful. I just think that that’s so representative of a different ethos for a surgeon and for somebody in medicine. And I just. I can learn a lot from it, and I think hopefully many people can learn from that example.

Dr. Christopher Kennel: Well, I mean, it occurred to me that maybe the mindset is very different here because we can’t do our job without the residents. when they go on strike, we notice and, like, they make our lives so much better. They’re doctors. They’re like, you wouldn’t treat your nurse practitioner or your physician’s, assistant that your practice has hired, rudely and, demean them. And it’s just, it’s not something that happens here that I’ve seen. You know, these are people that, help us so much, and we value them a lot. And so our goal needs to be to help them achieve their career goals. And it’s, Yeah, it’s a different. Different mindset, perhaps.

When junior doctors or residents go on strike, they pay us dollar 500 an hour

Dr. Frances Mei Hardin: Oh, and can you tell everyone how much do they have to pay an attending doctor per hour if they have to come in and cover striking residents?

Dr. Christopher Kennel: Oh, yeah, that’s dollar 500. I mean, that’s at least, that’s the current rate. So it’s, all negotiated. And they send. If you want to know what a doctor earns in this country, if at least publicly, not privately, but publicly, it’s all because it’s a union. There are tables you can anyone can google it. And we all earn the same if you’re in a specialty or whatever. working publicly. But anyway, yeah. When the junior doctors or the residents go on strike, they pay us dollar 500 an hour if we have to fill in for them. And it’s not just 1 hour, because they’re like, if you have to come into the hospital, that’s going to be 3 hours per the union. So the hospital is going to. They’re motivated to try to sort out these issues. Yeah. So as a resident, you’re worth $500 an hour.

Dr. Frances Mei Hardin: Yeah. Yeah. And that’s just not always how residents are treated here. and I do think that, like, in my personal experience, it was much more of, like, it’s an inconvenience to me to have you here. It doesn’t matter if you do all the orders, all the paperwork, all the setup, all the takedown, and all of the face to face patient and family conversations. I’m still annoyed by you. I don’t like your face. I don’t really like your vibe. And if you bother me, I will berate you. That was just kind of more personally, my experience.

Dr. Christopher Kennel: Yeah, we have it so easy here because the residents, they, take care of so much stuff behind the scenes and.

Dr. Frances Mei Hardin: But that’s true here, too.

Dr. Christopher Kennel: Yeah, absolutely. And it’s great to have that, and you need to value that. I mean. Yeah.

Dr. Frances Mei Hardin: Yes. Well said. Well, thank you so much. You know, well, again, we could. We could talk about this all day. I think that there’s so much that we can learn from kind of your practice and your experience now in practice as an expat. But thank you again for joining me today, and it’s been really life affirming to chat with you.

Do you believe in karma? Colin Royal says he doesn’t

All right, time for the big question. Do you believe in karma?

Dr. Christopher Kennel: So I was hoping you would ask me this, because I don’t believe in karma. And the reasons why I don’t believe in karma is if you spend time with a brain tumor support group, you will see people who have been struck down in their best years of life and for no fault, on their own. And you might know this, your listeners don’t, but my wife had brain cancer, and to see someone who’s a better person than me have to deal with pain and disability as a result of that, how could I believe in karma? It’s not something that, she deserved. And so that’s kind of shaped my philosophy on that. The notion of karma also seems a little judgmental in that. I’m feeling like if you believe in karma, then you’re thinking someone deserves something or I deserve something. And so because of that, and then.

Dr. Frances Mei Hardin: Things are like inherently good or bad, which, like in therapy, they frown upon.

Dr. Christopher Kennel: Yeah. but I do believe that our mental outlook helps to shape the world. So people who are generally more positive and don’t dwell on the negative often have a better experience in life. Or they might. And those who perseverate on their what’s been wrong in their life and are looking for conflict, they’ll find conflict.

Dr. Frances Mei Hardin: I see. That really makes sense. That’s very well said. Thank you for sharing. Next week we will have Colin Royal back on the podcast to discuss strategy. Follow me on Instagram at francesmae, Md. And rethinkingresidency. Visit my website, rethinkingresidency.com to learn more about resident physician stories and ways that residents can most effectively navigate the game of residency. I cannot wait to connect with you on the next episode of Promising Young Surgeon.