with whatever supplies you might have on hand — or without what you don’t have. I still think of those days when physicians get indignant about their preferences. In my opinion, a physician’s skills are intrinsic. I always told hospitals that I can use any product to get the same outcome — most of the time — because what if some- day I moved to another hospital or another country where those products were unavail- able? Being stuck on one brand makes you a less capable surgeon, again in my humble opinion. LYDEN: The fact that we have always put patients first and outcomes first, and the fact that the industry continues to be very prof- itable despite hospitals running on a much lower margin. At the end of the day, industry is still profitable, but hospitals have become the greatest risk of this over time. As long as patients are first, I think there is plenty of fat in the system to be caught.

LYDEN UNPLUGGED Unlikely source of inspira- tion: My wife. She actually has a PhD in Business, and I used to laugh at all the organizational behavior and human resources things she did. Little did I know that I would actually need all of these things, and she has really been great at helping me understand all of the business model issues that I did not understand before. Most creative thing you’ve ever done: I built a zip-line in my backyard that was 25 feet high just last year. What makes you laugh: Some of the silly mis- takes I make and get away with on a daily basis. Best and worst advice someone ever gave you: My father’s best advice was your word is your honor — don’t give it away because no one can give it back to you. The worse advice is that life should be fair — it is not. Must-have accessory: My dictaphone because I type so slow. Favorite thing to do on a day off: It is a tie between golf and watching my daughters do competitive cheerleading. Surprising fact about you: That I spend a lot of my days going to competitive cheerleading competitions. Describe yourself with three words: Account- ability, fairness and respect. Favorite object you keep in your office: A picture of my four daughters walking in front of the golden dome at Notre Dame. What you would tell yourself if you traveled back in time to when you just started in healthcare: That I arrived 10 years too late — the good days are gone. Now it is a lot of hard work and hard effort.

REITER: Evidence that others have been able to achieve equally good patient out- comes. Most of us can work with a variety of similar products and will do so as long as we know that quality of care will not change.

Why do you believe physicians are so reluc- tant to change product brands? CHEN: It boils down to physician comfort and patient risk. Physician comfort includes an understanding and predictability of the indications for using the product, how the product will behave, how it will act in the patient, and how to rescue the situation if something goes awry. For these reasons, switching to a new product can take a physi- cian out of their comfort zone and may have the capacity to put a patient at risk. Neither of these is desirable to the physician. CHUNG: Mostly it’s the “N=1” factor. You have one bad experience with a brand, and you never go back. Perception beats any statistical evidence. You see that with nearly every product out there. Some people believe physicians stick to one brand because of their relationship with the rep, and that may be the case for some specialties, but in general, that is a very rare situation. LYDEN: Because we have become very comfortable, and unfortunately live by an- ecdote, and we are uncomfortable with new technology and are unhappy to give up what we are comfortable in using. We are likely to try new products and new innovations because we do not want to be left behind. REITER: Many are truly concerned that they won’t be able to maintain quality out- comes. Some have physical characteristics like larger, stronger hands that make one device more comfortable for them to use than another. Some are brand-loyal for the same reasons that car buyers and chees- esteak lovers are brand-loyal — something about the chosen maker or supplier simply pleases them more than the others do. And a few receive nonclinical benefits from as- sociation with their brands of choice, e.g., free marketing through “preferred doc” lists, consulting fees, etc.

When you hear the excuse used to justify physician preference items, “because that’s what I was trained on in med school or residency” or “if I don’t get this I’ll take my patients somewhere else,” what goes through your mind? CHEN: We really need a culture shift toward nimbleness. The current economic and market forces have mandated a critical look at cost and constant reassessment of value. CHUNG: First, most surgeons trained in multiple facilities during med school or residency, so in reality they have had expo- sure to multiple items. Usually they follow


a favorite professor’s choice. In most other professions, people have to be prepared to use various different brands of products, so medicine shouldn’t be any different, as long as there is no difference in quality. If a physician threatens to go to another hospital because of a particular device, there is something else going on that they are un- happy about. Surveys show that physicians leave hospitals mostly because they are dis- satisfied with OR efficiency and operations, quality of the nursing care, how they are treated, etc. The device is just the last straw, if they leave. Most surgeons don’t want to leave a hospital that they are used to, since that is inconvenient for their patients and logistically hard to do. LYDEN: When physicians have this reac- tion it really is that they have not had to make this hard choice before. It is almost 95 percent of the time after the time after they have actually made a switch that they say it was not so hard and my outcomes did not change and that it was actually pretty simple.

REITER UNPLUGGED Unlikely source of inspira- tion: Miles Davis: “If you don’t have anything to say, don’t say anything.”


play what’s there, play what’s not there.” “If you under- stood everything I say, you’d be me!”

Most creative thing you’ve ever done: Facial plastic surgery can be cosmetic, reconstructive or both. I hope I was sufficiently creative to help each patient achieve what he or she wanted and needed rather than what I would have wanted if I were the patient. What makes you laugh: Irony. Best and worst advice someone ever gave you: Best — Don’t waste energy on things you can’t change. Worst — Don’t bother learning a modern language. You need to study Latin to be a doctor. Must-have accessory: A guitar. Favorite thing to do on a day off: Plan, prepare and enjoy a long, leisurely meal with my wife with good wine and good music. Surprising fact about you: I’ve been a working musician for almost six decades and still play jazz and blues in dive bars. Describe yourself with three words: In the pocket. Thank you, Wilson Pickett! Favorite object you keep in your office: The photo gallery on my walls — each picture brings a great moment from my life back to me. What you would tell yourself if you traveled back in time to when you just started in healthcare: You made the right decision. Just stay flexible and roll with the punches — we never promised you a rose garden.

Page 1  |  Page 2  |  Page 3  |  Page 4  |  Page 5  |  Page 6  |  Page 7  |  Page 8  |  Page 9  |  Page 10  |  Page 11  |  Page 12  |  Page 13  |  Page 14  |  Page 15  |  Page 16  |  Page 17  |  Page 18  |  Page 19  |  Page 20  |  Page 21  |  Page 22  |  Page 23  |  Page 24  |  Page 25  |  Page 26  |  Page 27  |  Page 28  |  Page 29  |  Page 30  |  Page 31  |  Page 32  |  Page 33  |  Page 34  |  Page 35  |  Page 36  |  Page 37  |  Page 38  |  Page 39  |  Page 40  |  Page 41  |  Page 42  |  Page 43  |  Page 44  |  Page 45  |  Page 46  |  Page 47  |  Page 48  |  Page 49  |  Page 50  |  Page 51  |  Page 52  |  Page 53  |  Page 54  |  Page 55  |  Page 56  |  Page 57  |  Page 58  |  Page 59  |  Page 60  |  Page 61  |  Page 62  |  Page 63  |  Page 64