Podcast Episode 23 | HEART-ificial Intelligence and Physician-Patient Relationships

With Dr. Brian Lima

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The Prosperous Doc™ podcast by Spaugh Dameron Tenny highlights real-life stories from doctors and dentist to encourage and inspire listeners through discussions of professional successes and failures in addition to personal stories and financial wellness advice.

Shane Tenny, CFP® is our podcast host and Partner at SDT. He has lectured numerous times for hospitals and physician groups and, most importantly, helped hundreds of clients develop strategies to navigate through turbulent times toward their financial goals.

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Brian Lima:                   00:00                My happiness as a human being was completely wrapped up in my identity as Brian Lima, the heart surgeon. Who Brian Lima, the normal person, the guy, I had no idea who that was.

Intro:                            00:12                From Spaugh Dameron Tenny, it's the Prosperous Doc podcast. Real stories, real inspiration, real growth, a show for doctors who are ready to improve their overall wellness in every aspect of life. Now, here's your host, Shane Tenny.

Shane Tenny:                00:31                Welcome back to another episode of the Prosperous Doc podcast. I'm Shane Tenny. Glad to have you with us today. And we're here today to talk about a range of topics from physician/patient relationships to heart-ificial intelligence. Yeah, that's heart-ificial, H-E-A-R-T. We'll come to that in a minute, but I'm joined today with Dr. Brian Lima on the show. Dr. Lima is currently associate professor, cardiovascular and thoracic surgery serves as the director of cardiac transplantation at the Sandra Atlas Bass Heart Hospital in Long Island, New York. And, as of this year is the acclaimed author of, Heart to Beat; A Cardiac Surgeon's Inspiring Story of Success and Overcoming Adversity.

Shane Tenny:                01:15                So, Brian, thanks so much for being with us today.

Brian Lima:                   01:17                Thank you. Thank you for having me.

Shane Tenny:                01:19                Now, just help us make sure that we understand the current view from your chair. You're currently Director of Cardiac Transplantation. Is your work now at Sandra Atlas Bass, patient-focused? Are you more in management overseeing physicians? What's the current lay of the land for you? And then we'll get into the backstory.

Brian Lima:                   01:37                Sure. It's very much patient focused. There are some administrative responsibilities that go along with it, but by and large, it's in the trenches moment to moment now everyday.

Shane Tenny:                01:48                Dealing with real cases and real COVID and real stress.

Brian Lima:                   01:51                Yes.

Shane Tenny:                01:52                Yeah, yeah.

Brian Lima:                   01:52                Absolutely. For sure.

Shane Tenny:                01:54                But of course that's not what the basis of your book is all about. And I think that your story is what has really intrigued a lot of the folks that have been able to read your book, Heart to Beat. Rewind whatever 40 years and start with the beginning. What's your personal story growing up and what's the story that everyone needs to understand here?

Brian Lima:                   02:13                I grew up in New Jersey. I was the son of Cuban immigrants. So we were working a class family. My parents came over, my two older siblings, barely squeaking by. My dad worked in a factory. We only spoke Spanish at home. And so really the idea of becoming a doctor, going to medical school, things like that, those were fantasies, really. One thing I did have is the insight that my dad helped instill and that is that work ethic, hard work can really make up for any limitations that you have, any shortcomings. So he kind of stoked that fire. He made me believe in myself that as long as I put in the work, that really nothing was out of reach. So it was with that mindset that then I was able come out a valedictorian in high school, nearly got a full ride to an Ivy League school and then from there, get a full ride to Duke for medical school and then train for 10 years after medical school to become a heart surgeon that specializes in advanced heart failure, transplanting hearts, mechanical heart pumps. And I've been out now nearly 10 years training and it's been a blast. It's been a lot of fun, stressful, but exhilarating at the same time and somewhere in there decided to write a book about my life.

Shane Tenny:                03:32                Yeah. Yeah. Well, just to add a little something to the schedule, to fill the quiet moments, right?

Brian Lima:                   03:37                Sure. Yeah. Yeah.

Shane Tenny:                03:39                Your father was really instrumental in your growing up lives, your outlook, your work ethic. I know you talk, in the book, you quote him as saying that some people have a leg up, but victory is not bestowed, it's earned, I think is the quote.

Brian Lima:                   03:56                Yeah.

Shane Tenny:                03:56                How old were you when you remember that actually meaning something to you and giving you the inspiration?

Brian Lima:                   04:03                He had this way, I mean, we would have these kitchen table chats and he worked odd hours because he worked at a pigment factory. And so he would work overtime shifts and sometimes, so it was random times of the day and it wasn't consistent, but whenever he had a chance, he just kind of felt like he needed to lay this on me. You know, just kind of school me on what life was about. And it seemed very intense, but gradually as these discussions kept occurring, it's sort of building up this confidence. It hit home when finally at our eighth grade graduation ceremony, my closest buddy, who's also from an immigrant family, won all the awards. He got called the stage a bunch of times. And I remember thinking, Oh, this is terrible. I really blew it. I knew at that moment that I hadn't worked hard.

Brian Lima:                   04:48                I kind of was skating by, just never was cognizant of, oh yeah, we're going to actually be recognized for how little we do or how much we do. And it hit me at that moment, like a ton of bricks. And I felt so ashamed because of all those lessons he had imparted. And so that there was like a switch that went off at that moment in time where I said, okay from now on, I'm going to always give my best effort. So that was a key turning point.

Shane Tenny:                05:17                And somewhere 30 years later, it began to crystallize, I think, in this acronym, you call heart-ificial intelligence. Tell us a little bit about it. What's the phrase mean?

Brian Lima:                   05:26                So the book itself has many puns in it where I splice it in the word heart in place of heart or things like that. And one of the areas that really defined my life and defined my path to get here was figuring out a way to make up for the fact that I was rarely, if ever, the smartest person in the room. I mean, I was outgunned big time, every step of the way. The only way I figured out to make up for that was to just outwork everybody, just put in more time and stick with it. And so that's sort of my heart-ificial intelligence, kind of heart over matter. You can make up for what you lack in natural God-given talent with just pure work ethic. And many people won't do that. And even people that are much more talented than you will give up long before, so that was key. And that's what heart-ificial intelligence is. It's making up, it's not fake, but it's making up for what you lack in your mind with just heart hard work.

Shane Tenny:                06:22                And the heart stands for something in here.

Brian Lima:                   06:24                Right. So the acronym, so H obviously is hard work. So that's where it all begins. E goes by different things, entrepreneurship, having an entrepreneurial spirit, positive outlook, always try and make the most of the things. A is aligned, aligned with your moral compass, with your purpose, always figuring, knowing on a daily basis, what are you doing, why are you doing it, how does this mesh with the bigger goal. The bigger vision. R is being relentless, never giving up. And T is thoughtfulness, being mindful, being grateful, empathetic, always being aware of your emotions. It's that emotional intelligence, that factors very importantly, and also it's spoken a lot about in the entrepreneurial literature.

Brian Lima:                   07:09                So that's how heart fits together. And as a heart surgeon, I thought it was a neat concept and parallel that also with the fact that the heart just beats, no matter what. As long as you take care of your heart and you have a healthy heart, it's going to just keep going. It's going to be your ride or die. And I thought it was another interesting twist on this whole idea that no matter what happens, no matter what failure you come across, disappointment, as long as you just keep moving, get back on and just like your heart does, it just keeps moving. You know, that's it, that's half the battle right there.

Shane Tenny:                07:44                Yeah. You remind me, as you described that here in Charlotte, North Carolina, of course we've got the Carolina Panthers and one of our all star receivers for years was Steve Smith, the beast of a receiver about five nine. And he would tell folks, I may not be the biggest guy on the field, but nobody is going to outwork Steve Smith. And he always referred to himself in third person too, which added to the punch. So yeah, that's good.

Shane Tenny:                08:05                You were sharing at the beginning that your role in the cardiac transplant group is patient focused and you're in the OR and you're doing work. Doctor-patient times together are increasingly a precious commodity just given the demands of all that needs to be done, more and more that needs to be jammed in the schedule. I'm curious, do you have things that you do or things that you're aware of you do that help you to connect with really critical patients in a crisis time in limited time? Or did you have things that you suggest to other colleagues? "Hey man, you know, I know you only got 15 minutes, but ask this or think about this or whatever, to help you as you connect with people." Because I know just the patient interaction is real key to your focus and what you try to do.

Brian Lima:                   08:56                Sure. I do everything possible to, number one, break things down into simple language that anybody can understand and try to limit the amount of jargon that I use just to make it simple. Because often I'm talking about some pretty heavy duty stuff, life and death stuff. By the time they get to me, that means by and large, we've exhausted all conventional medicine, conventional heart surgery. We're talking now about, okay, we might have to replace your heart in some way. That's a huge consideration, shock many times for them, for family. So I also do everything I can to make sure I involve family into the discussion because sometimes I may be talking, but not much of it may be registering. And so having a family member there who can also help keep a tally of the magnitude of what I'm talking about. So I make sure family's around. I give my cell phone out, it's on my business card.

Brian Lima:                   09:58                Some people criticize me for that. I just feel like, Hey, this is when I connect and commit to a patient and their family, it's for life, literally. I feel like if I can help them believe that I'm really invested, they're not just another patient. This is, I become part of their life. They become part of mine. And I think that goes a long way. I think those were the key things that you have to give them the time. Also, some of it is you're going to have to reinforce things later. It's not all, when you're talking this high level stuff of life and death, sometimes it just doesn't register. So, you know you're going to have to go back and answer more questions and be prepared for that.

Shane Tenny:                10:38                Yeah. I mean, undergirding that as I listened to you, it's, you have to actually care.

Brian Lima:                   10:43                Yeah.

Shane Tenny:                10:44                And that's just what I hear in your, your tone. I mean, that's why you give out your cell phone number. It's not a gimmick it's because I actually care about the outcome here.

Brian Lima:                   10:51                Yeah.

Shane Tenny:                10:51                That'll communicate through any words.

Brian Lima:                   10:54                It's kind of a, how would you want, if it was you or your family member, how would you want that exchange to go? And if you could get the sense that this physician is just detached, you're just another number, this is too big of a deal to have it be that way it's got to matter and you can't fake it. So what I counsel other medical students and other trainees is you can't convince yourself into doing this as a career. It has to be one of those things where, gee, I can't really see myself doing anything else. It's a calling. It's not a job.

Shane Tenny:                11:31                Well, and in a really complicated technical profession, I mean, there are some who want people to know how smart they are, but as the saying goes, nobody cares how much you know, if they don't know how much you care.

Brian Lima:                   11:45                Yeah.

Shane Tenny:                11:45                Which really speaks volumes, I think. So we're going to take a quick break here. And then when we come back, I actually want to ask you about failure and complacency. So we'll be right back after this quick break.

Will Koster:                   12:01                With this episodes of financial wellness tip I'm Will Koster. Estate planning is often seen as a complex legal process that's only really necessary for the wealthiest of families and this is simply not true and a misconception that could be disastrous for a family and especially for the heirs left behind. If you haven't heard my personal story of my father dying when I was in high school, take it from me, estate planning is an extremely important part of your overall financial plan. And like I said earlier, not having documents in place can leave your children or your loved ones left behind exposed to an array of unintended consequences from things like heavy tax bills to legal battles between family members. This financial wellness tip is simply a public service announcement to stop delaying and call a certified attorney to help you map out your estate plan. With this episode's financial wellness tip, I'm Will Koster.

Shane Tenny:                13:09                So Dr. Brian Lima, we're talking about your journey as son of immigrants from Cuba, your acronym around heart-ificial intelligence and just the value of hard work and really being genuine in what you do. I find that people are attracted to advanced professions, medicine, dentistry, they're high achievers. You've got big aspirations, but it also means with big aspirations comes adversity. And so I'm wondering, can you just lay it out there? Where have you faced the adversity? Where have you faced failure? And then how do you keep that from just emotionally swamping you or holding you back?

Brian Lima:                   13:54                It's by the very nature of this field, it's an unavoidable statistical, saying that you're going to have to figure out how you're going to get around and persevere through. As a trainee, as you get graduated levels of responsibility and so you go as far as you can. Inevitably, what that means is you make mistakes and so mistakes are unavoidable. And then beyond that as a full fledged surgeon, even when you do everything absolutely perfectly, it's just by the book, it's just everything just went just great, something else happens. Things that are completely out of your hands, a random stroke, things that just, there was no way that you could have controlled for that and having to face the family, break the news to them. And again, because of the deep connections I often develop with these families, with these patients, it is very, very hard. It takes a lot out of you. And it's just one of those things that, over time, you try not to dwell on your mistakes. These can be very horrifically, tragic things.

Brian Lima:                   15:05                You have to have and build that mindset that it's a growth mindset, really. This one adverse occurrence is not going to define who you are. It's a one-time thing. And the only way to move forward is to try to glean whatever lesson you can, not dwell on it. Have what I like to call selective amnesia in that you're not going to let it simmer there in the back of your head and negatively impact you moving forward. You can't live in fear. You can't work in fear. So that takes years. I'm still, I'm in my forties, mid-forties, it's still something that I wrestle with. It doesn't get easier, but you develop almost like an automatic protocol. You know, it's a knee jerk thing when you start to feel your mind start to veer that way. You're like, whoa, let's focus now. Let's get back to the task at hand. So it's a work in progress.

Shane Tenny:                16:00                Was there a time that you look back on whether it was, I don't know, high school, college, undergrad, training where you just felt like a failure, you got your legs knocked out from under you and you look back and see that as a pivotal point where you focused on what was going on between your own two ears and got back up.

Brian Lima:                   16:18                Sure. I mean, honestly, it's countless times, whether it's as a brand new doctor, day one of a 10-year training program and you have the 10th year residents. Imagine to where you are as a first grader and where you are as a sophomore in high school. And then now extrapolate that to your first year resident, you're one of 10 and you have your 10th year resident reminding you of how little you know. And you're managing patients, you're treading water. You have a long list of patients. Things are going to be missed. You're going to make mistakes. You can't suture like the wind the first time someone gives you a stitch and you go, you're going to be slow. You're going to make mistakes. You're going to break sutures. You're going to fumble around and you're going to get yelled at. you're going to get reminded of, hey, you're far from where you need to be.

Brian Lima:                   17:08                And people either crumble under that pressure and say, that's it, I'm throwing in the towel or they just hunker down and say, okay, more reps. It's all about the reps. You got to get those reps. You got to be at that level of discomfort and then push forward. It's only at that border of where your capacity meets what you can accomplish at that current moment is where you get better. And it's humbling to say the least.

Shane Tenny:                17:36                But then you do get to the 10th year and you're the one that's finished training and you've accomplished what you set out to do. You're at the top of the mountain and sometimes exhausted at the top of the mountain. How do you, there's a temptation to coast. I think you wrote in the ... complacency is dangerous.

Brian Lima:                   17:54                Complacency is the ultimate enemy. It's the heart of war. That's the heart of war chapter. Because just when you think you've got it all figured out and you're on autopilot, so to speak, something's going to happen that's going to remind you that, hold up a minute now, you don't have this all figured out just yet. You're not in complete control. There's always room for improvement. You're kidding yourself if you think, oh yeah, this is it. I'm hot stuff. I've got this locked down. There's always technology is evolving. And in my field, incisions get smaller, approaches get better. I have to constantly be surveying the literature, the studies, what's new. What's out there. What's the next therapy. What's the new device, what's the new technique, and continue upping my game. I owe it to my patients. And so you can't kick your feet up and that applies not only to medicine, but any field. Right?

Shane Tenny:                18:50                What do you see as one of the biggest symptoms of complacency for somebody who's listening and saying, oh yeah, well, I'm not really complacent. Yeah. Wait, wait, hold on a second. Have you ...

Brian Lima:                   19:00                Denial. Denial is a big one. Regardless of what field you're in, you should be reading, not only what's going on in your field, but in general. I went through this phase where I was like, you know what, I've read enough. I had the read so much for school and this, that. I don't ... People say, "Oh, do you read for fun?" No, I've done enough reading for a couple of lifetimes, but that was wrong, actually. That was a wrong attitude. It started to materialize in my head when I started to understand that medicine, like everything else, is also a business. And I didn't know how that end of things worked at all. How hospital keeps the lights on, all that stuff that goes behind the scenes. I didn't know any of it. As I started reading my whole, all my horizons opened up.

Brian Lima:                   19:43                I started to understand, Hey, there's a lot to this. I started understanding that an entrepreneur is not necessarily some guy in an expensive suit in some Wall Street office brokering some deal. It's what I do. It's having ... being innovative, being passionate, having gravitas, being able to lead people. That's what an entrepreneur is. And so when it dawned on me that I'm an entrepreneur also in my own way, that's when things clicked and I started reading just all the time. If you're not doing that, if you're just kind of on autopilot nine to five, just watching TV, that's definitely complacency.

Shane Tenny:                20:23                Yeah. Now my experience in talking with physicians, surgeons, dentists over the years is that certainly the early career, the training is exhausting, difficult. And then there's years where you're getting your legs under you and building the success and things like that. But there often seems to be some inflection point, sometimes in the forties, sometimes in the fifties, but where the values or the aspirations shift from success to significance. Have you experienced something like that, does that connect with you and what you've either felt or observed or through your story, kind of a success versus significance type?

Brian Lima:                   21:07                Absolutely. Because I think it takes, it's such a grueling process to persevere through and make it that it's hard to turn that switch off where you can lead a normal civilian life, I like to call it, where you're not constantly in game mode and just ready for the battle. That's something I continue to struggle with. It's hard to get stressed about, oh boy, you know, you still need to take the garbage out. And it's like, oh, well this isn't a life or death issue. Like, why am I going to stress that type of thing. And then as we chatted about before the broadcast, not having your happiness as a human being tied up into your career hundred percent. And that's also an easy thing to do, particularly for these very challenging, all the years I had to invest in my twenties, my thirties, it was hard to not fall in that trap.

Brian Lima:                   22:00                And I sort of did for a little bit there, where my happiness as a human being was completely wrapped up in my identity as Brian Lima, the heart surgeon. Who Brian Lima, the normal person, the guy, I had no idea who that was. And I had to rediscover that. And so when you talk about significance versus success, if you define significance by how successful you are in your career, well, then that's going to probably mean you're not going to have a well-balanced home life, family life. And that's really not the way to be. You can't, that's, to a point you need that, I would say, killer instinct to get you to a certain point. It's a lot to be able to balance that and know when to turn that off and how to channel things that are above and beyond just who you are in that career mode.

Shane Tenny:                22:48                And what's, I mean, you're in a super demanding subspecialty with a lot of administrative responsibility, patient responsibility, family. How do you find balance? What's that look like?

Brian Lima:                   23:00                It's a work in progress. I think I've come a long way, but still not close to where I'd like to be, but I no longer rely on my career to be my sole source of fulfillment and happiness as a human being. That was number one. That did not used to be the case. And I think that's where a major turning point occurred. Now, I'm never going to be a regular nine to five, Joe. That's not possible with what I do. I'm kind of an extreme example with what, I can't sign my patient who I just did heart surgery on today to somebody else. And if they're bleeding, not be the guy that comes back in to take care of the problem. that's how I take care of my patients and I'm connected to them. But so it also a lot to do with who you surround yourself with, who you have as a foundation, who your spouse is, who your close ... can they understand that part of you?

Brian Lima:                   23:55                So it's a give and take, it's a compromise. It's not for everybody. It really isn't. Some people, it gets a little old after a while having a play second fiddle to your career. And so having the judgment to make the decision and be well informed. I failed my first marriage because of that very reason, because I didn't have that balance. I was totally 100% committed to training in heart surgery and there was no room in my life for anything else. And so that's not me anymore. And some days are better than others. Some weeks are better than others. So you try to compensate for the ebb and flow of this job.

Shane Tenny:                24:37                As you talk, I think one of the things that I've shared with folks over the years is that when you say yes to something, you're saying no to something else. And so when I say yes to doing another five guests or taking a meeting, or when you're asked, especially as someone in your situation where you're high achieving, you're successful. And so if you want something done, go ask Dr. Lima, he'll take care of ... and there's a stage where you're like, oh, sure, absolutely. Yeah, I'll be on that committee. I'll be on that board. Sure. I love having everybody ask me for my opinion. And when I'm doing that, I'm saying no to something else, which is time with spouse or time with kids or time for yourself to think.

Brian Lima:                   25:17                I've been there. Been there, done that. It's hard to broker that balance. It's very, very challenging. Like I said, I think it varies. Sometimes I'm really, really good at it and sometimes just by the nature, sometimes it's feast or famine. All of a sudden I'm up for three days operating so just go with the flow.

Shane Tenny:                25:38                Yeah, yeah, that's right. Well, that's why you're a gift to the profession because if people like me that could never stay up for three days in a row. Thanks for staying up and staying sharp for three days.

Shane Tenny:                25:49                Brian, for listeners who'd like to just connect with you more, find your book, that sort of thing, how can they track you down?

Brian Lima:                   25:55                So my website is www.BrianLimamd.com. And my book is available on Amazon, Barnes and Noble and really anywhere where books are sold.

Shane Tenny:                26:05                Sounds great. And again, the book is, Heart to Beat. Dr. Brian Lima, L-I-M-A his last name. Brian, thanks so much for being with us today. I appreciate your passion and your story.

Brian Lima:                   26:14                Appreciate it. Thank you for having me.

Shane Tenny:                26:14                Absolutely. And thank you for being with us today. We got more great episodes of The Prosperous Doc podcasts queued up, ready to roll in the coming weeks. Remember they come out every Monday. We'd love to have your review on whatever listening platform you get your podcast from. And if you have any suggestions or ideas or comments, you're welcome to just reach out and email me directly. It's Shane, S-H-A-N-E, @whitecoatwell.com. Thanks so much. We'll see you back here next time.

Outro:                          26:41                This episode of The Prosperous Doc podcast is over, but you're not alone on your journey. Spaugh Dameron Tenny has been helping physicians and dentists prosper through financial planning for over 60 years. To connect with us, visit SDTplanning.com today and take your financial wellness to new levels. Join us on the next episode of The Prosperous Doc podcast.