E20 Mohit Bhandari On Surgical Trials, Productivity And Presentations

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Chad Ball  00:15

Welcome to Cold Steel, the Canadian Journal of Surgery podcast with your hosts Ameer Farooq and Chad Ball. The goal of the CJS podcast is threefold. The first is to highlight the best research currently being completed by Canadian surgeons. Second is to offer educational topics for both surgeons and trainees alike. And most importantly, the third goal is to inspire discussion, thoughts, creativity and career development in all Canadian surgeons. We hope you enjoy it.

Ameer Farooq  00:50

Dr. Mohit Bhandari is an orthopedic surgeon at McMaster University in Hamilton, Ontario. He is a prolific researcher and is the recipient of the Order of Canada. It’s kind of hard to even articulate what this conversation was about, because it touches on so many different aspects of his life, from productivity, to social media, to even how to give effective presentations. He even plays some of his favorite songs for us on the episode. Check out the show notes below for links to his Instagram, and his papers in the Canadian Journal of Surgery. We hope you enjoy. Dr. Bhandari, thank you so much for joining us on Cold Steel, we really appreciate you taking out the time from your incredibly busy life. A lot of our listeners, obviously are gonna know you quite well from all the work that you’ve done. But for those listeners who may not know you, can you tell us a little bit about your training and career pathway?

Mohit Bhandari  01:46

Yeah, well, first of all, both Chad and Ameer, thanks for having me. And, you know, as [inaudible] quotes I wouldn’t…I changed the world to be on this. So I’m really, really excited to chat with both of you. Um, you know what, I’ll give you like a precis. But I tell you like a lot of contextual things I’ll talk about that we may get into, I really starts back really, really early for me, which is about grade three, or four. And it’ll explain to you why this all matters. Mid 1970s, you know, maybe grade three, grade four. I learned, I painted a lot. And this has come back to me like the last weeks and months, right. I’ve been thinking a lot of that. But I back then I really, really, really loved painting. Now I went to my parents, my parents are first generation immigrants from from India, and they’re working hard, they’re working 12 hour shifts. And I said, Mom, I sat them down and I said, Listen, I think I have a dream, now. I want to be an artist. They looked at each other. They smiled. My mom said something that I’ll never forget. Son, you need to find another dream. And we never spoke of art again. And that moment for me was really particularly important. Because at that place, I know they’re killing my future, like this is what I want to be, this is what I want to be. And little did I know that that decision for them to say, focus on, it’ll come back to you one day, it’ll come back to you. And I had no idea. But then let me fast forward. So 1980s comes around, right. 1980s is that’s the year of Van Halen, I mean that is when everything is going crazy. I’m a skinny Indian kid, right, I’m rumored to be doing pretty well in school. And what I needed is I needed a very serious very serious protection. So I said I you know I’m going to do I’m going to find a way to use my art and I’m going to protect myself with finding individuals who could be part of my defensive team and if you’re back in the days in the 1980s in high school in sort of a hammer town a steel town which was East Hamilton, there was basically one genre of music that you had to live with and that was Van Halen it was it was AC/DC it was Iron Maiden and luckily I had the ability to paint jean jackets back in those days so I would paint jean jackets for every one of these would be called the metal heads. So I became pretty good at that and also I had fairly good encyclopedic knowledge relatively speaking of rock and heavy metal so this particular group became very close to me and they became this group people said you know what, you keep doing your studying, don’t let anyone bug you. We’re going to protect you and we had this protocol, I jokingly look back and call the safe protocol, guys. So S A F E. First thing sit in the back of the class. Always keep your hair shoulder length and wavy. I had like a mullet like so it was like sure very business like on top but long at the bottom. And I friendship built with all of these, you know, really, really folks, who sat in the back and they were strong, strong influences on metal. And all I said was the way I’m going to survive and they said to me, hey, Mo Listen, you’re getting in trouble, just name drop us. I said alright. So if I ended up in some part of the, you know, I was a young kid, I ended up in some part of the school, and you just name drop these individuals and you survived. And through art and through knowledge of music, those two things were particularly really, really important to me. And that got me through it. We’re flying away, life’s going on and guess what happens, you know, I get, by something, you know, fast forward to 1990, I enter into medical school. But 1990 for me, was, you know, University of Toronto medical school. And that summer was this summer, right? This was the summer where this song came out. And this song came out was a classic, if you’re into, you know, this sort of genre of music. So it’s the first you know, it’s exciting. I’m in medical school, you know, and they had the whole motto was just do it right, get out there and do it. So I was extremely excited at that point, thinking, Hey, I’m going into, you know, school, I’m going to be great, but I had no idea where I’m gonna end up actually, no idea. And because I had no idea where I was gonna go, I was pretty open to everything, right? So around 1991 have my first ortho elective, right. And when that happens, it was very, very different. Because it was the first time where I thought, you know what, I think this is the type of person and this type of group I can get I can get used to and why. Because they were playing the type of music I had grown up with. So it was a very different time. And so this was the riff, I’m not joking that soon as this happened, I fell in love. That was it. You know, when I heard this, I said, Okay, this is the people I’m going to be part of this group. And so we kept going, right? So we kept going and what happened for me was is orthopaedics became the thing so I didn’t have any other options. I said, you know, for myself, I’m not gonna give myself other options. I’m gonna go full bore on orthopedics. So I keep remembering and I remember as a medical student, that first elective and that first elective is very important. And I remember now when I have a medical student or a student even pre-med, who comes. Every single thing that people did I remember that moment where I had the first time with someone actually called pronounce my name correctly. So took the time to say, you know, Mohit. Mohit. That’s how you pronounce it? Yeah. They pronounce it okay and then and then or with tons of people they said you know where’s where’s Mohit? And I was like this fellows Toronto was followed up right lots of fellows lots of residents and they’re looking around saying oh, this guy is and I’m in the back to standing there like terrified basically behind a mask of my hands kind of really high up right you know, all the things you would do as a medical student and this is coming from my point it is a parting of this wave of residence he says you see the screw here you know simple thing right? Take the screwdriver and take it up but um, you know, it was the fact that he you know, allowed me to do it but more importantly this particular surgeon for me became the focus of the type of individual I want it to be so that for me it was kind of like okay, you know, this is it love at first sight I’m going to go and I’m and I remember how it made me feel. So don’t remember all the things he said. But I felt something when I was with him. So I said, you know what, this is it. I’m committed. So kept going, got through, I got through medical school. I went into orthopedics at McMaster University around 1994-5. Around 1994 I graduated, got into med, into orthopedics at McMaster. And around 96, same thing happened, right. I, it was another flip. And it was a flip for me was okay, well, what are we going to do next? For me personally, and we were at a time that’s weird, right? You end up at the place, you’re supposed to be, I guess, and McMaster was just starting this program called Design, Measurement and Evaluation. You know, fast forward now, it’s one of the most recognized programs in the world, but they called health research methodology. But also remember that Gordon Guyatt, who was this in Canada certainly is, you know, one of the forefathers of evidence based practice actually coined the term evidence based practice. And literally just a short three four years before that, had been starting this movement at Mac, truly had been starting. Around 1990, he became the program director of Internal Medicine. So he’d been starting this, I showed up right around the time where he had been doing it for about five years, and was probably thinking we have to expand this into surgery. So you know, you need a vehicle, you need somebody who’s willing to put in energy and time and understands the value of this potentially. Now I knew I had energy, and I had a little time but I did not understand the value at that time, ’96. But fast forward again, we push for, 1998, and we get our first CIHR funded pilot study, which is about $88,000. It was called the SPRINT study. The study to prospectively evaluate reamed nails in tibia. That question is almost boring, if not mundane right now. But at that time, it was the biggest thing that I could have ever thought of in my head. That was the greatest thing ever. I’m going to change the world didn’t change the world, but we thought it was going to change the world. And it did something very interesting. It didn’t change the world. It changed orthopedics in a way that I think it got people working together that hadn’t done it before and it got us over that glass ceiling of orthopedics, trials and studies. They’re all small neural k series and this is the first one that beat the 1000 mark. So we had the first, it had over 1000 patients, and was collaborative between Canada and in, you know, and the National Institutes of Health. So that was a fairly big deal for us. And I can talk about at length about how many times that trial never happened like I, there’s multiple times, right, gut wrenching pain, thinking, Oh, God, this is it, my future is over, it is not going to happen. We had multiple events like that, multiple things that, like crisis that I thought were going to end the trial in my career, but you know, obviously, let’s look what happened, you keep plugging forward. And that’s exactly what happened. So we kept plugging forward. And around 2003, graduate, you can see is a bit of more than five years of orthopedics training because I took time away to do a Master’s at that time, I took a few years for research at that time, as well. And ultimately ended up around 2003, doing the Trump fellowship, in Minneapolis and Los Angeles. And I came back to McMaster as an assistant professor, but they had offered me a junior tier Canada Research Chair, which was very, very exciting for me, because that was something new, like that was something that was, you know, for me a really big measure that they said, you know, we we support you, we want you to do well here. Fast forward again, to 2014. You know, I get this call saying you’ve been inducted into the order of Ontario. Like completely, you know, a little bit sidelined it, and we can discuss how that happened. But for for shortness, four years after that, I get inducted into the Order of Canada. And so you look back quickly, you know, in that period of 2018, backwards, and you just can’t imagine that things didn’t happen the way they did for a particular reason. And here we are now in 2020. And in 2020, everything is different, like we’re in what I would call, you know, this product here, productivity paradox. And I mean it that way, because for most of us, right, we’ve been stuck in a situation where you want to do something, and you’re doing due to physical distancing policies, but we have to be at home. And it’s been very interesting talking to colleagues and friends, I suspect you’re both having your own experiences around this. But there’s a sense of saying, either some people are super productive right now or others are feeling completely the opposite, feel non productive. And I feel like I’ve lost something that that that that’s a part of me.

Chad Ball  12:16

Let me touch on a couple things. You said there Mo, I mean, I love that line “you end up the place you’re supposed to be.” That is such a deep and prophetic and potentially powerful line depending on I guess if you live it or not. You and I have had lots of conversations about that exact concept. Like, you know, you’re such a star from the very beginning, as as you’ve outlined, and so well respected. How is it that you end up in Hamilton? How is it you make that choice? And and why not go to Boston? Why not go to LA? Why not stay in LA?

Mohit Bhandari  12:54

Yeah, yeah. Well, it was interesting, because at that time, I thought, you know, yeah, remember, like, you know, we have we have this trial going on. So I’ve got CIHR funding, and all and quite frankly, are being recruited a lot of places in the US, Toronto is heavily heavily invested in having me come to Toronto. And obviously, McMaster is invested in having me stay at McMaster. And, and the biggest thing is, like, I’ve had a huge amount of difficulty in saying no to anyone. So I was just trying, attending all these things, smiling and giving, I’m sure giving people all kinds of mixed messages like Oh, did you want to be here, like these things are always happening. He’s always talking about greater this year. And it was really, really, really tough. But the thing that I think, is, I’ll never forget these words, Gordon Guyatt said to me, he goes, Well, you know, just remember one thing, you can go to the greatest bricks and mortar places around the world, they’re going to show you the best, best best, you know, facilities and the most high tech things that are going to tell you the world is yours. And that is true. But without people, none of that’s going to happen. So he goes, yes, stay loyal to people, people will move. And maybe you will, too. But your loyalty should always say where are the people around me, that are going to allow me and share the same culture vision and roadmap for my life that I hope to have. And if you have that, it became a very, very, very easy decision. There were…Mac was always going to be home. I just needed to, you know, I just needed to realize that. And you get caught up in the fanfare of the possibility of someone wanting you, that you forget that.

Ameer Farooq  14:32

You know, I think it’s so important for all of us, including me day to hear that. You know, you can make so much out of where you are, the people around you, the content in terms of publishing around you. The opportunities are so broad, particularly in a connected world that you really can do so much from so many places now. No doubt.

Mohit Bhandari  14:52

Oh, absolutely. Absolutely. And, and for me, and I suspect it is for both of you. You realize very quickly that you can write papers, if you’re academically inclined, you can conduct major major studies, you know, virtually and if no other time have we realized the value of some of these tools, I think we’re feeling it now. And this is probably no better time. Now, whether this is a bubble, or a boom, I have a perception. I think this is more of a bubble. I think once we actually get back to human contact, people are going to feel that that is a much better alternative than video conferencing. But when there’s no other option, video conferencing is a very, very useful tool.

Ameer Farooq  15:29

Yeah, it’s been a remarkable shift. There’s, there’s no doubt about it. I want to go back and just touch on, you know, your receipt of the Order of Canada.

Mohit Bhandari  15:35

Yeah.

Chad Ball  15:36

Well, of course, you being the humble guy. I didn’t know that. And I sort of walked into it a little bit randomly and absolutely blew my mind not because you didn’t deserve it. But because of the the the impressive nature of that honor. I mean, that’s really the the pinnacle that a lot of us could ever strive to. What was that like, getting that getting that notification? What was that whole process like?

Mohit Bhandari  16:01

Yeah, yeah, so like, it was very interesting. So I remember exactly, again, you know, you’re sitting there, I was sitting at the office, and I got a call and it said, you know, says GC Canada, ah it’s some tax thing. I don’t know what this is. So I just didn’t answer it. I said I’m not picking this up. And then the next time it rang, I said, I better pick it up and then pick up to say, Hello, and there was a French, definitely a French speaking individual. And she was lovely woman, and she was talking and I kept thinking, she goes, you know, we’re having a big event in Ottawa, we’d love to have you down. Congratulations. And she just was talking. And I kept thinking, Oh, this must be around, I said, ah this must be some induction. And because I’m the order of Ontario, they’re asking me to come to this event. That’s what I completely thought that’s what it was. I said, oh, okay. So I blew it off. Okay. Yeah, sure. And I was very like, well, okay, and I’m thinking I’m not going to this, I won’t have time for this but hung up. And then you know, you have a moment you just pause you think, hey, I wonder what, hold on here. She said, Ottawa, why would I go to Ottawa. This would be an Ontario, it should be Queen’s Park. So then obviously, I’m now I’m thinking, what have I done? Like, I just somehow denied myself from getting this. And so I called them back immediately. I couldn’t get back through her. So um, you know, that period of waiting anyways. She calls back eventually, and I say, I go, I may, I think I’ve made a grave mistake. And the gentleman says, okay, yes, he goes, can you let me I think, I’m not sure if I was just told I’ve been receiving the Order of Canada, or if they’re that, whether that was a mistake. And he says oh, one second. And it’s like an airline man. It’s like he’s clicking away. I’m thinking what? What are you typing? Just type my name and tell me like God, it’s this process of going and he says, yes, I do see your name on this. I said, okay. So I saw I received it. And he goes, yes, it would appear that way. And I said, okay, okay. So what do I do? He goes, we will be in touch. And he hung up. I said okay. And that was it. And it was this weird moment of like, Holy smokes. This has happened.

Ameer Farooq  17:55

Went from the worst phone call ever to the best.

Mohit Bhandari  17:57

Yeah, it was very, very different. And you know, the funny thing is, so you’re there. It’s surreal. I’m there with my wife, Sonya. And my daughter would have been well, she would have been 10. And so we’re just so so and because she was young, she was very young, and there weren’t a lot of kids there, right? They got, she got put right to the front row with Sonya, right. And so they’re on TV a lot of the time. And the interesting thing is, I’m standing with this lovely woman who’s maybe 85 on one end of me, and there’s another lovely, lovely woman on the other side of me, who’s probably in her 70s. And, you know, we’re standing there, and I realized, she whispered to me at the time, she said, I just want to get back to what I do. Like, it was almost like nobody here ever, like, tried to get this, they, it’s almost like they, they were trying to solve a problem. And whatever that problem was, and they just, and they fell in love with the problem, not the solution. So you know, you get caught up in I’m going to solve it. And this is the way I’m going to do it. It’s like no, whatever the problem is, I’m gonna solve it. And, and they just looked like that. They just all wanted to be back doing their thing. This was almost an interruption of their day, a very lovely interruption. But this was a very unique group of people.

Ameer Farooq  19:06

Let me go back a little bit and just touch on your particular group in McMaster, and you’ve mentioned Dr. Guyatt a couple of times, but that research group, obviously is so much more than than just Gordon Guyatt.

Chad Ball  19:22

Tell us how that group works together and how you leverage each other. And, and I’m curious even about the physical environment, I know what’s changed over time. But how do you guys work in such an amazing collective?

Mohit Bhandari  19:22

Yeah, 100%.  Yeah. So I mean, a big part of it is is, you know, as much as Gordon doesn’t, or didn’t ever think of himself as the proverbial leader of this of this group. We all thought of him that way. Because so many of us have been influenced by him. But really what it was to me was, it’s all the things you care about, right? If you if you think about what makes a team successful, successful, it can’t be too big, right? So you need we were okay, here’s the magic number of about five people and was pretty cool. The other thing that was really interesting about this was each individual was different. So it wasn’t that they were a homogeneous group of, let’s say, surgeons or a homogeneous group of internist, it was this think tank of individuals came from every angle. So when you would go and propose an idea, you would receive so much insight that was tangential, you think is tangential, but it’s actually critically important to your area. So you would, you wouldn’t have thought those things you wouldn’t have thought to things from the perspective of a leading intensivist in Deborah Cook or an absolutely brilliant, you know, epidemiologist in Brian Haynes. And by the way, Brian Haynes was the individual when, when people say, you know, when I go on PubMed, and I want to find the, you know, the RCT and use a search filter, he he designed the search filter for it. Alright, so these are the types of thoughtful individuals. Now, obviously, there’s, you know, Gordon Guyatt, the, you know, the, the quintessential professor. But there were younger, the younger but earlier career individuals. I was very early career all throughout that time. We came back around, you know, around 2003-2004. And his other fellow PJ Devereaux, who’s just, you know, become a giant in the field of perioperative medicine. I mean, fundamentally created a field. He’s created it. And people didn’t talk about perioperative cardiac events, as a field or as a service until he said, you know, I’m going to see if we can solve immediate 30-day outcomes after surgery. And by the way, a lot of patients are dying from things they shouldn’t die of, right. And it’s our job, if you can fix them in a way, we’ve got to keep them alive for those 30 days. And he spends his life doing so far. And so these individuals are particularly, you know, just it’s impressive being around them. And the reason that part of it is and I’ll get to the last point is, it’s just when you’re around individuals who just set the bar so differently and so high that you always felt and I must say I, you know, it’s a cliche, but they say never want to be the person who’s overachieving or the most achieving in the group you want to be the underachiever. I have uniquely felt that for my whole career in this group, uniquely, when I received, and I’ll just use a simple example, when I came in, and I was about to talk about, hey, we’re about to do this really big study of 1000 patients, PJ, that they said, you know, we’ve just launched a 40,000 patient study, wow, I was gonna, you know, someone’s out, you know, got the order of Ontario at that point, you know, all three of those individuals that have the Order of Canada, so it was always like, you know, this is just, this is the, this is the environment you’re in, and you’re and no one can, let me say it again, nobody chases these accolades. It was just that’s who they were. And they live, they eat, and they breathe collaboration, and this sort of energy. And when you have research meetings, you feel it every single time.

Ameer Farooq  22:54

Oh, that’s, that’s remarkable.

Mohit Bhandari  22:56

Yeah. But you know, what happens is we chat as a group we tend to congregate with like, like, like minded people, and the biggest thing you can do, you know, if you look at every single startup entrepreneurial thing on any, any pick any website about how to be successful in life in business, every every statement they make is, you know, surround yourself with a diverse group of people who think differently than yourselves. We have to do that. That’s about it.

Ameer Farooq  23:23

Yeah, it’s so true. You know, there’s no question I think it’s safe to say across all specialties within surgery, you’re really the triallist of our of our contemporary generation, there’s no doubt I mean, we even if the content of your of your massive trials doesn’t apply to what we do, we we pay attention to methodology, we pay attention to structure we pay attention to some of the things you’re talking about networking and how you’ve done it. I was wondering for our listeners, if you could go through that because your trials are 1000s and 1000s of people they typically are often involved China or India or they asked very fundamentally important wholemeal almost population level applicable questions. How do you view that and superficially, how do you do it?

Mohit Bhandari  24:07

Yeah, so okay, so I made a calculated decision and this is always because okay, so I’ll take it to the, the real influencers, so Gordon obviously influenced the clarity group. This, I’ve already mentioned to you was, you know, working in the real big influencers. But Salim Yusuf is another really very important figure in McMaster’s history and continues to be there, but he many, many years ago with Richard Peto, and he’s a cardiologist who’s, does these mega trials. So when you think of aspirin and heart attack, that’s Salim Yusuf, right? When you think of, you know, ACE inhibitors, and congestive heart failure, all this sort of stuff. And, you know, it’s him. You think of all the big, he’s he branded them all. He said something simple in one of our classes a long time ago, he said, if you go big enough, you don’t have to get fussed about all these different strategies that people use to correct for the reason they’re not going big enough which is stratification. You’re making sure you’re you’re you’ve got, you know, you stratify but all these millions of tons of variables, because you’re afraid you’re going to be imbalanced. When you get big enough, you just get balance and keep your outcome simple, don’t get caught up on complex outcomes. Are they alive? Are they dead? Did they have an infection? Or did they not? And if it’s a small amount, did it just get bigger? And that was the psychology of it. The question was, well, how do you do that? It doesn’t work to send emails out, even in this modern environment to send emails out to a bunch of people you’ve never met, unless you’ve actually physically invested time in those countries. And so in 2003, for better for worse, I got there, I’m probably, no, I mean, I got my million monitor status very early with Air Canada, because I was traveling all the time. And people said, you know, most like, the guys on a plane all the time, he’s just, you know, it’s vacation time, research is vacation time. And, you know, I wish I would have had time to sit with every one of them and explain to them the strategy because it was a pure, it was a guess, right. But I’ve seen other people do it. And the simple idea was, if you want to be able to run big programs, big programs come back to the very fundamental thing, relationships, you people rely on you and you rely on them. And the only way to get to know someone is to physically, you know, sit with them, chat with them, have a meal with them, learn about them, understand their family, and have them do the same with you. And so it was a period of travel. I must have spent several years traveling to India, on my own dime, not never asking for anything, and never was expecting anything except to simply go around that country and say, you know, I was born in this country, and I want to figure out a way to work with you and does that concept that we do that, then you go to, you know, all over Asia, and you do the same thing in Europe. Eventually, you get on the phone, and you can say, we have a study. And you know, we’d like you to get involved. And there’s a different level of connection. And the truth was, I didn’t want to be reliant on the United States, I didn’t want to have to go because the cost of running research in the United States was so expensive. That we can we can now run, Chad. And I’ll give you a simple example, which is just happening right now as we speak, we’re about to submit a grant for the CIHR rapid response to COVID. The call came out about five days ago, six days ago, it was a rapid thing. And we decided, we mobilized a study for 5000 patients in 11 countries with 20 investigators, the majority of whom are from low middle income countries, and they are signing up and wanting to do this and they mobilized in a way I’ve never seen them. This would never have been able to have happened had I had not invested all the years before, build these relationships. And I say that there’s no shortcut, and that you’ve got to get out there and meet people because, you know, humans interact with humans, no matter what we think that’s that’s the fundamental core is get out and interact with people and just dive in.

Chad Ball  27:42

I think sometimes hard for folks, maybe at the front end of their career, or at the beginning of that process to understand that, you know, the money that you personally put in and the investment of time, which of course is even more important than the money probably will pay off down down the road and is worth at least the the endeavor to try you know well.

Mohit Bhandari  28:03

I’ll give you a quote that I use. I don’t know why it pops into my head. I’m sure it happens. You’re driving. I know you were an encyclopedic knowledge of music, Chad. But, you know, people always say, you know, why are you still doing this? Like, why do you do it? And there’s a whole line from of all things, an Ice Cube song that’s for the love of money, and it starts off something like, they asked me why I’m still in the game, is it for the love or for the money?

Chad Ball  28:26

Yes.

Mohit Bhandari  28:27

And if everyone’s getting paid in love, I’m in it for the love. But if everyone getting paid in money, and he goes on and on and on. And the funny thing is, when you start working, and surrounding yourself with people who really, really love it, that’s all you want. You get paid in love, you love what you do. You don’t chase the dollars, you don’t chase anything. And because what happens is, you know, and people say, Well, you know, let’s and this happens a lot, right? So and I’m assuming, Ameer, you will back me up on this one, which is, when you’re early in your career, you say there’s a good opportunity, let’s see if we can find some way to get that research grant. Because it’s a very specific grant, I think we can, we can change our ideas a little bit just to fit the grant to get the money. We do it all the time. But I can tell you, when you fall in love with a question or a problem, you don’t think about the money, the money will come. You just start falling in love. And you start developing the problem in a way because you’re, when you write, people say well, when you speak you know, people can tell if you’re genuine or not. When you write, people can tell if you’re genuine, you’re right, your heart goes into how you write. And so if you I can tell very quickly in reading someone’s paper or grant, whether this is just some right off thing that they’re looking for another checkmark for a paper or they’re truly invested in us. And that’s what I think you can expound when you get really, really engaged in the work you do.

Ameer Farooq  29:45

Absolutely. 100% agree although it’s very, I think, hard to figure that out early in your career, what those fundamental questions are that that you want to solve because I know that I have enjoyed everything that I’ve done and I’m interested in lots of different things. So is that, like, did you figure out very quickly? Or is that something that kind of evolved over time?

Mohit Bhandari  30:08

No, it took me a decade, it took me over a decade. So you know, you start off with what is, okay, what can we do, right? What’s doable, and then you can get good. So you can teach, virtually, all of us can learn how to write a grant, I mean, a really good grant, like the mechanics of a grant. I would say 99% of people cannot articulate a powerful story. And you know, and so I would say to anybody, find good storytellers, if you can find a good storyteller, learn from them. And you know, you may not find them in our field, you might you might look to literature, you might look to art, you might look to music, you might look to comedy. I mean, some of the greatest storytellers are comedians, right. And you’re watching you see how they weave a story. One of the greatest storytellers, at least in movies, to me is Quentin Tarantino, right? So he tells the story, but he tells it in ways in which you unravels the truth in multiple different ways. So that storyline has to become important. And this is a no longer about a study or a question. This is about answering a very fundamental question in a very long and important story that we’re going to tell over the next 10 years. And the more people you want to engage, the simpler the story must be, by necessity. Big ideas are simple. And I know I’ve said this probably for a decade because I am but I say stuff not because I’m trying to preach it. I say it because I’m trying to remember it for myself. So the more I talk about it, the more I remember it. And the more I say how do we keep this simple? How do I make sure the results of this study apply to the person in mainland China, to the person in South Africa to the person sitting at the Mayo Clinic? How do we make that happen? And that becomes the big test. And that becomes a question. That is the question that we all try to ask.

Ameer Farooq  31:53

You know, this is a perfect segue, you talking about Quentin Tarantino and storytelling, because a few years ago, now you came to Calgary to give a talk and to judge our resident research day. And it was it was honestly, eye opening for me, because I’ve never seen anyone give a presentation like that. And this isn’t, you know, from looking at other stuff that you’ve done. That’s not a one off wonder that you did for us, that, you clearly have a sense of how to tell a story in presentations that I think frankly, surgeons just don’t get. Can you talk about how you think about giving presentations. And particularly, if you could talk a little bit about how you use the visuals on your PowerPoints? Because I think that this is very powerful.

Mohit Bhandari  32:48

Yeah, so you know, so no, so here’s the point, right? Take me back to grade three, to his parents who said, son, this is not your career. And the funny thing is, is that I’ve always, it’s just, you know, something that I’ve always felt I wanted to explore. And while I wasn’t going to become a formal, let’s say, artist, or painter, I’ve always thought, you know, how do I find the things and this goes to all of us. I mean, you have Chad, you know, I mean, you’ve got it, you all have things you do that give you joy outside that would not be considered, quote, work for you, there’d be an extracurricular activity of sorts, or something that gives you peace. For me, it was art, and it was to some degree music. And so I’ve tried to say, Well, how do I continue to advance myself? You know, with that sort of interest. And so I, and I’ve also gotten away from the idea, and this happens with just time, no, if I look back at my first presentations, and actually have some from 15 years ago, they are virtual, basically, you know, 12 point, documents were 12 point font of writing every slide. And I said, well, that’s probably what I did. And I probably read the slide, because I was so uncomfortable with knowledge that I just didn’t know what to do. I think what happened is, and this is where I think you can switch is, you can get into more, as you tell stories, stories are often really illustrated more with pictures than with words. And I think the minute you know that you can go off script, but you’re comfortable going off script is when you feel that you can, you know, transition to that approach, Chad. So for me, it’s a lot of it is just make sure that whatever I’m going to say I can actually feel authentic about it. So when you feel authentic in what you’re saying, you don’t feel at all uncomfortable about what you’ll say and how you’ll say it.

Ameer Farooq  34:36

You know, in a former life prior to starting medical school, I used to actually like I did the whole Royal College but for speech arts and drama, and used to spend a lot of time kind of analyzing the best speakers and public speaking and, and, you know, they talk about extemporaneous versus like a written speech and like 99% of talks that you listen to are someone reading from a prepared thing or basically reading off their slide. I’m curious how much time you have to actually put into rehearsing these talks that you give prior to prior to giving them or is it something that you just know the content so well, that it just comes off the top naturally?

Mohit Bhandari  35:20

Here’s the point. And I’ll take another example. So 2012, [inaudible], you know, a very, very close friend. And, you know, I would consider equally a mentor has been really, really an important figure in my life, academically, and it’s just been super. He said, well, I’d like you to give the presidential guest lecture when I’m president. And, and he said, I want you to do it on that thing you do, right, which is he said, jokingly think big. I said, okay, all right. You know, it’s that’s, I had about a year. So that was the year around that 2012, I can’t remember, 2012–2013 where I did what I you know, what others would probably do is I started with a slide deck, and I started giving it a grand rounds, I started giving it at every place I could give it. And I would know very intuitively what slides are working and and or I’d rearrange them. And so I, I must have given Think Big on a very small venue to maybe 15–20 people about 40 times. And so when it got to the CIA for 200 people and on a very important day for, I mean, so I have two things, I never wanted to let him, I didn’t want everyone, anyone to ever think that [inaudible] made the wrong choice and asked me to be the presidential guest speaker. So I was I was so interested in this being his day, not mine, that I just wanted him to feel proud as being the president, I just, I was just all in it for him. And so I just, but then the anxiety was, I gotta make sure that this, you know that I don’t do something that, you know, doesn’t reflect on him as a president. So I had chosen pretty well after those, I had, I had my 40 slides, I had a very as you would call it a tight set, so to speak, because I’d given so many of these small little club performances. And I don’t mean small, meaning they’re unimportant. They were probably the most important thing you can ever do. I think standing in front of a mirror practicing isn’t, I won’t say it’s useless, but near useless. You need to have feedback, and you need to get better at something, we can only get better at something sooner with feedback, right, it’s deliberate practice. I can swing a golf club as long as I want. And I’ll still have that horrible hook. Unless someone sits with me and watches me do it and gives me feedback. That’s deliberate practice.

Ameer Farooq  37:24

I think it’s also maybe ties in a little bit with your use of social media. I mean, your Instagram is, is just awesome to look at, and photographs.

Mohit Bhandari  37:36

I spent a lot of time with pictures, man.

Ameer Farooq  37:39

Yeah, no, you can tell because they’re, they’re beautiful. They’re beautiful pictures.

Mohit Bhandari  37:47

Before you jump into that, so there’s a guy, so I posted a picture yesterday I was at I was just riding a bike, and I said, I’m gonna add this like, you know, speed effect and make it black and white. And someone said, can I ride with you and paint with you? I’m available tomorrow. All right. Let’s do this. Anyway, sorry.

Ameer Farooq  38:06

No, well, I was just gonna ask, like, why did you kind of get into social media? It’s kind of unusual, I would say, maybe, maybe less so now, but certainly, it’s definitely not, you know, typical for a surgeon to be really engaged in something like Instagram or social media and, and why why do you think that’s so important?

Mohit Bhandari  38:25

Yeah. So I mean, it was actually what it’s for. It’s for a couple of reasons. The first and foremost was, you know, I have a 12 year old and I, I’ve always said that, you know, you have to understand that you can sit there and say, well, that’s not how we do it, right. I feel myself saying that all the time. Oh, you know, when we were this, and we didn’t do this, and so that I just want to stop. So I’m learning things. And I want to get good at something to understand what it is that attracts a group of people that in some ways I would like to hopefully have meaningful communications with the other big part of social media that got got me into it was less about, you know, flexing or the hating that goes on. It’s a technique to really look at Instagram as a tool for someone of my age. It’s not, it’s not doing anything, particularly to improve my academic career, anything like this. But what I do think it’s done for me, is it’s allowed me to connect on a different level with the numerous I mean, hundreds of graduate students or residents and trainees that probably I wouldn’t have gotten to know that way because I don’t get to travel to all the places I want to get. And more importantly, I think it’s a way for others to get to know you beyond the facade of what they think you are. I mean, there, you’ve been there Chad, right? You know, where you you build up an individual and they almost become impossible to relate to because they think well, there’s nothing I can relate to this person. So I don’t really want to interact with them, I don’t even want to email them. I don’t want to talk to them because there’s nothing to do. Suddenly, oh, I like riding bikes. Oh, this guy likes to sketch here and there. Well this person likes to go that place you know it, it makes it very, very unique. The one thing that I have been very careful for, so I’ve made a lot of mistakes early on, is early on, I started putting things that I started yanking off later because I said, basically, if someone in five minutes should be able to look at my photographic pictures and say, I think I understand what drives him from a non work point of view, like what are the things that he enjoys doing. And so I’ve been very careful not to curate a bit more than I used to. And now I’m just kind of used to doing it, I quite, you know, enjoy just the art side of it, more than anything else. And quite frankly, some of the storytelling. The other thing though I do use is LinkedIn, which I do find actually a reasonable tool. Most people use LinkedIn, think they can’t find any reason to why to use it. It’s just like a CV and online CV. But there are some really meaningful connections, I’ll probably get one or two really meaningful new connections a year from that. But those connections, I would have never had, like I would have never met them. And it would have never led to any sort of meaningful interaction. So because of that, I continue on both of those channels.

Chad Ball  41:06

Geez, now I feel bad Mo. I keep deleting that link every time the invite comes on LinkedIn. I guess I should pay attention.

Mohit Bhandari  41:12

I know, I tell you, I’ll tell you, like my, my LinkedIn network is much greater, that much bigger. It’s bigger than my Instagram network. And like, for example, it just it just, you know, like, and you tell stories, right? Like, so I might be at 29. I’m coming up to 30,000 on LinkedIn. And it is a very interesting group, because it’s a group with a slightly different mindset, right? It’s not about what you ate last night, although people tend to post that, but it’s not really about that, right? It’s not about some random, comic, little, you know, meme, it’s really they’re trying to provide insights on areas and they’re looking to share knowledge. And, and so it’s kind of neat, because LinkedIn has this one thing that you know, if you join it, you would get it is you can say I’m willing to interact with people who were earlier in their career who might have questions. So what happens is, every week, they’ll get like 10, people say, hey, you’ve been identified as a virtual mentor to somebody, and you check their profile, you realize, oh, you know, I’ve been there, and you just, 10 seconds to respond. And I think it makes a difference for them. And then they hopefully can give me insight as to how it worked. If they tried it.

Chad Ball  41:14

Wow, I’m on it. That’s fantastic.

Mohit Bhandari  42:24

I’ll be your first connection.

Chad Ball  42:27

I’ll take you up on that. Mo, I wanted to swing back to one of the concepts you briefly touched on in the unit I’ve talked about before. And that’s the concept of the hyper performer within a given environment. And you weave that so beautifully into a number of the talks I’ve seen you give. I was wondering for our listeners, if you could tell us what a hyper performer is, and how that person interacts and potentially impacts their immediate environment, and maybe even some of the struggles that the hyper performers encounter.

Mohit Bhandari  42:54

Right. So let me let me let me tell you what, you know, the, the graphic I use, but but we’re, I’ve actually evolved to that whole statement. So you know, there’s this, we have to live with the bell curve, and the bell curve is, you know, there’s going to be, most people are going to kind of in the in the middle of the curve, there’s going to be some group of people at one end, at the other. But there’s this other curve called the power law, or the power or the log tail, which is there’s gonna be a very, very, very few number of hyper performers. And these individuals can be researchers, they can be surgeons, they’re going to be technical people, they can be pilots, they can be in any area, right and think of any area where there’s going to be a super small super number of high performers. And then there’s this very long, gradual tail that goes up for a long, long, long, long way, in which, you know, people kind of are hopefully drawn up by this group of people like they’re kind of, you know, they’re drawn up in a way that these high performers can change it. So go back to the statement, and I just use this argument all the time. There probably isn’t a university department in Canada, let alone the world where if you took less than three or four critical hyper performance, I would even say probably three hyper performers, leaving Harvard or leaving Mayo or leaving a top university in Canada, anybody in any of our universities in Canada, as a department would leave would render that culture very, very different. And you probably know those individuals, right? And you know, very well how that culture would shift. That, to me is the essence of what what that term means. Now, you can take a step back and say, well, and this is what I’ve tried to do a long time, and I think COVID-19. In many ways, it’s forced people to really reevaluate what performance means. And there’s a quote in a small little blog. So I’ve been blogging a lot recently, and one of the blogs is on the productivity paradox. And, and I kind of started with this, started a podcast talking about this productivity paradox, but there’s a quote actually, by this group of business, you know, insight, folks, this guy by the name of Hegel, if I recall, was one of the people. But they said something along the lines of like when it comes to accelerating performance, there’s a paradox. And if we want to have a greater impact faster, we have to slow down, we have to slow down enough to reflect on what we’ve done, where we’re going to go. And that, for me has been probably the whole mindset chat about restructuring, and so on. So when you and I chatted last, or when we talk, you know, I was talking about well, you know, you’ve got to be more creative. And I think it’s really important to find those things that you know, that give you pause, what, however you find it. And I’ve been using this as one of my like, last slides for probably the last two years. And I’ve done it because I actually wrote it down. And aptly, it has this acronym THINK, which is kind of exactly what we should all take some time to do. And it reminds me to do it. In the T, in think, and I think hyper performers in general, embody these characteristics, I really do. Because I’ve watched enough of people, and most of mine is from observation, I observe other people. And I spent a lot of time looking at them, as I think you have. And you try to make these people who are the high performers, they think, and I think the T, they try new things, you never see them to sticking to one thing, they’re actually very comfortable jumping into other things. You know, there’s a paper about a number of Nobel laureates, they followed 40, up 40 high performance scientists, which eight became Nobel laureates over a 40 year period. And imagine that experiment that they did, right? So they did. But check this out. So the eight individuals that got a Nobel Prize, remember, every one of them they thought were capable of getting it but what made it different. Why were those eight people different? Well, you distill down this beautiful paper, that is an eloquent paper, the thing that isn’t eloquent about it, unfortunately, that it’s just all men back in the you know, those days that they didn’t have any real opportunities for anyone but men to excel. But if you extrapolate that to all people, the real power and that was that these individuals tried new things, they were almost like childlike play, right. So they would go to, you know, the this, there’s this one who was no astrophysicists, but he would hang out in the labs of the economists, and through that was able to build all kinds of theories that helped, you know, change the way of, you know, dynamics and electrodynamics, for example. So, all these sorts of things. So try new things. They all look like they’re having fun, actually. They’re not unhappy. So the H for me was have fun, just find ways to have fun. And if it’s not fun, you and I are a little bit different, I’m sure Ameer probably doesn’t have quite the privilege to be able to control how his day goes. We have a little bit more power to control it. So I try to instill it as grits, if I’m not really enjoying something, I will do everything in my power to get rid of it out of my daily life, in the extent that you can, so don’t take on responsibilities if they’re not enjoyable, and just do things that give you some degree of personal satisfaction. For me, the number one thing though, is the not the I invest in your 20%. Now, I’m gonna ask you, both of you guys, this list 20% of the things and one or two or three, that give you 80% of your joy. And for me, around 2012, no sorry, this is this was like 2018, sorry, not 2012. I was in Nepal, with a colleague of mine, Brad Petrisor, we were actually, you know, standing on this hillside staring out at, you know, this beautiful, you know, array of mountains in the, in the back of, are the Himalayas, you know, you stand there and you’re at 10,000 feet or sell something above sea level, and you’re going I can’t, this is life, this isn’t and you’re just, you’re alone. And I kept thinking, what are we doing? What are we doing? Why? Why am I not doing more of this and getting this feeling? Why do I, why do I not feel this feeling more in my day? And that got me to write down the stuff. What gives me 20%? What gives, what 20% of things give me 80% of my joy. So that I’ve made it a goal of saying doing more of the same isn’t going to get you better, and these hyper performers that I’ve watched, tend to be very, very good at not just saying, well, you know, if I’ve written 100 papers, I write 100 more, I’m going to be better at it, not really. If you’ve written 100 papers and you want to get to a high impact paper, you’ve got to get away, you’ve got to do something else. You’ve got to figure out a different strategy to get there or you’re going to fail. So the N of it is just don’t feel failing. In fact, seek it out. So I have done things, it’s hard for us in surgery to say okay, we’re gonna go and start failing routinely. We’re not going to do that, right? So you’ve got to have a low risk opportunity. And so while it’s hard for me, right now to say I’m just gonna go up and try to fail in the work, I do. That’s day to day, I can easily have that feeling of failing when I try something else. So I took up randomly, I, you know, I presume you guys are probably snowboarders or you probably, you ski or something, but I don’t. So I said I’m gonna pick it up and it was brutal. Like it was brutal to try to learn this.

Chad Ball  50:17

Those are very sore knees.

Mohit Bhandari  50:18

Oh boy, I got I got the bell ringer, like I literally felt hell’s bells AC/DC and it’s like that ring. That’s it, okay, yeah, this is this, that’s why people don’t do this at my age anyways. So, but what I did there was I took a number of the, like, you know they were like year one residents or early faculty or graduate student who in many ways when we’re talking feel okay, you know, Mo’s always, Mo can’t be wrong in this. And so I’m just gonna go to him for advice. And you know, I always think I’m wrong, but they don’t ever think I’m wrong for some reason. Or it’s, it’s really because they can’t see it that way. So I flipped it around. I said, okay, they saw me as this ridiculously terrified student going down a bunny hill and you know they’re all like these black diamond skiers. So it was an opportunity for them to be reverse mentoring me and say, okay, now, I, he, he’s feeling what I feel when I’m around him. Now he’s feeling it because I know what I’m doing. And he doesn’t. So it’s this back and forth. And it was really, really powerful. And my relationships with every one of them got really strong. And I think it got strong, because they saw me as a human being. And that’s the power of part of doing that. And the final part of the K is it’s okay to start again, you can you can reinvent yourself. This concept of like, we can’t reinvent ourselves, Chad, perplexes me. It’s like, you know, the concept is and you’ve heard this. And maybe you’ve been the recipient of it, Ameer right, which is, oh, you know what, this generation is gonna do it, you know, I’m gonna, you know, I’m, I’m passing it on to you, right? I’m gonna let this generation do it. And I always remind people of this series of pictures, and I show pictures of Picasso’s, four or five decades of Picasso’s life. But when you look at them, the last decade of his life was when Picasso’s art really looked like Picasso’s art. If you saw his art early on, you’d be convinced he’s a realist, you think he’s like a renaissance artist, right? You wouldn’t have known that was Picasso. And the argument I say is most of us aren’t going to find who we are, you know, until we’re really really, you know, figured it out. We’ve gone through many, many cycles, failed many times. But he wouldn’t call it a failure, he would call it learning, right? And, and the same argument, I think we have to take that time, to just take every bit of knowledge in our life and assume that it’s happening for a reason. And those who succeed the hyper performance, understand it’s happening for a reason. Rather than thinking it’s just happening to me. Oh, boohoo, right. And my life sucks. The opposite is, this is a lesson and something has happened to me. And we’re going to go for it and I’m with it right now, Chad, there’s a really, really, really motivated resident, who, you know, just hasn’t had things turn out his way. And I said, just look back and five years from now, it’ll be the best thing. You’ll look back at this, if you handle this period right. So the best thing that ever happened to you, and it’s hard, what’s happening to you, but I think when you look back, these type of high performers do those things, they try new things, they have fun, they invest in their 20%, they never feel failure. And they always know it’s okay to start again.

Chad Ball  53:18

All those points are so insightful and so critical. One of the ones that like in particular, though, you’re exactly right is the intention and taking the time and creating the environments to show vulnerability. I mean, that creates safety in teams, whether you’re Navy SEALs, whether you’re the All Blacks, whether you’re two people in a research lab, it becomes essential not only to getting to know each other, but in terms of creating that platform to allow people to move forward and really, really give that, give them the best of themselves to you, you know?

Mohit Bhandari  53:52

I fully agree with you. I mean, I think, I would have loved it, like, you know, think about our training, you know, I never really got to know a lot of my mentors in a way that I wish I would have, like I only found out, like I found out recently, some really important issues, personal issues around individuals, the way they functioned, that only now make everything 10 years ago makes sense. At that time, I just didn’t understand it. But now under context to understand it, and I think, to your point, it gets back right to when you  curate, let’s say social media, and you curate and you interact with residents at a what I call the virtual office where we almost have all our meetings or on a bike or a walk almost all of them, I rarely have a meeting in an office and they get to know you because you’re chatting, right, you’re having this moment like we’re just chatting, right? You have this moment where you get to know the person. And that’s been probably one of the greatest tactics that have helped me connect with people in a way that I wish I could have done it when I was younger.

Chad Ball  54:54

I love it. That’s amazing. One of the other big sort of concepts, Mo, that you’ve talked about in multiple talks, and it was a title of one of your, one of your grand rounds that you gave in Calgary for us, was thinking outside the box. I just wondered if you could for the listeners, sort of define that, define what you meant and what it means to being productive and happy.

Mohit Bhandari  55:15

Yeah. So I mean, it really like now that I’ve kind of looked back at everything. What I was doing is I was every year I was basically creating a talk. So the Think Big talk happened. And I did that talk pretty well, everywhere. So one strategy I used was that talk is the talk I will give. So if someone says, hey, can you talk about hip fractures? I’d say yes, I can. But I’d also like to talk about this because I was really trying to build that narrative the year after, I kept thinking, well, you know, yes, you could think bigger, I guess. But really, it wasn’t about that, because I was reading around that time, from a book by one of these billionaire investors in Silicon Valley, Peter Thiel, he was the one of the guys of PayPal, he became a PayPal billionaire. But he wrote something and it wasn’t really about that, that I was interested in. I was pretty interested in this concept, a book, he called zero to one, which he says it’s very, very, very rare. To have to go from nothing to something like, you know, imagine a world without the internet and suddenly the internet or world without a car, and car, like, those are called generational style innovations. 99.9% of us are not going to have a zero to one moment. However, our education system, the academic system, everything says, you know, you got to have that study wheel, once you’re out of the box study, what is that out of the box. And I think what happens is it creates so much anxiety, it did for me, around, I gotta have this thing. So I become paralyzed, because I don’t really want to take on anything, that isn’t the big thing. And you become actually quite unproductive with that model. So the think inside the boxes, just really the psychology, and it’s a simple one, which is, you’re much better off to do things that lead to incremental benefit, which over a period of time will have a major impact and impact because those are all doable things. So it’s the concept of, you know, slowly improving, and the reality is this, and this is the you know, where most of our bubbles get burst. Most of us don’t think out of the box, the box is really, really, really big. So we’re all inside the box thinkers. And we’re, it’s rare to have someone like a Peter Higgs, for example, right, who won the Nobel Prize for the Higgs boson, for example. He was an individual who sat for weeks on end by himself, and basically formulated an equation with never having proof for it. Waited 40 years for the world to actually have the technology to even measure what he had done in the Hadron Collider. And, you know, some years later, they say, yeah, the guy was right. Like, that’s genius, like he had, he had nothing to go on. And we didn’t have the way to test it. Now we can test it, he was right. That is genius, very, very hard for us to think about anything we’re doing in relation to that. So the box is big, Chad. And I just simply say I’m an in the box thinker. And everything we do is simple and incremental. And if you think big, they’re often simpler questions, but you can get a lot of people engaged. And so that’s kind of the that’s kind of gist.

Ameer Farooq  58:14

I have to pick up on one thing that you just sort of said in passing, which is the whole virtual office. That’s awesome. I don’t I don’t know that of many surgeons. I certainly hear about that in sort of more corporate settings, but but not as much in our are very ivory tower research settings.

Mohit Bhandari  58:36

Well, I’ll tell you, I’ll tell you, so everyone else, everyone’s talking virtual, you know, under COVID. Y’all, were virtual. Man, I’ve been doing this for four years, I’ve been doing this. So there’s nothing, there’s nothing exciting about what’s happening now. For me, it’s like, in fact, what we’re doing is regressing for what I think the real reality is the concept of saying we’re doing virtual meetings on Skype, or this or whatever, you know, or Zoom or whatever it is, is not really the full intent of what a virtual office to me means. To me, it means get out of the confines of four walls. And you can argue that there’s value in it, you know, a lot of people did walking meetings, you know, a lot of people got out did this thing and, you know, which is totally reasonable. But for me, it was one thing my office has, all these artifacts and had anyways. I’ll tell you what happened. So and, you know, sort of your, your, the wall of degrees, etc. It is a very, it’s not a, it’s a place where you walk in and immediately the person is on guard because they’re immediately thinking, okay, the decision makers, this person, it’s not me and so you have this unfair advantage over the people around you because you’re just at your, at the desk, and it’s very, it’s just not it’s just, it’s not conducive to getting people to open up and give real meaningful ideas. And they have them. So got rid of it. And as of two years ago, I just gave up my office like I do not have an office at McMaster University as crazy as it sounds. They wanted to bring in a new recruit. I said, you know what, fine, bring this person and take my office and he even has my furniture, actually. I said ah, just keep it it’s fine. So I just took all my other stuff out. And I’ve never looked back. And so now every single person has to meet with me, whether it’s the associate chair, whether it’s the chair, whether it’s the director of, you know, of the Department of science, any of them, we’re meeting for coffees, we’re going for a walk, I had had, you know, I’ve had meetings with the current chair of department of ecology, and we said, oh, and he tells us, hey, do you want to do a virtual office and, and he picks a place. I said okay. So we go meet, and it’s just we’re out and about, and we’re talking at a different level. And it’s particularly good, Chad, when you’re interacting with students, I find with students and trainees, it’s really, really great because they are, are, they just they feel, I feel the same way they’ve been, they’ve reflected back to me that they feel more energized, and they have better ideas, they feel they can share them more, because I’m not in a suit and tie. Usually we’re just, you know, t-shirt, shorts, jeans, whatever it may be. And we, two regular people, just trying to have a good conversation about something meaningful, often leads to a lot of good things.

Ameer Farooq  1:01:08

I want to shift gears a little bit. And I think we’ve talked about this in a variety of different ways over this, this amazing conversation. And that’s to talk about a little bit about a paper that you published in CJS, which talked about the characteristics of highly successful orthopedic surgeon. Was there anything surprising about that study that you weren’t really expecting? Or was it, you know, that the typical things that we kind of think and have talked about?

Mohit Bhandari  1:01:39

Yeah, so I mean, that was, do you remember the date? Is it early 2000? Maybe 2012–13, something like that. And it was in Canadian Journal of Surgery. I remember that very clearly. It was, well, the thing that surprised me the most. So you know, let me just give a precis for everyone. You know, we, we had this hypothesis, right or wrong, right? And probably it’s now we look back and they look at we’re doing a lot better. But we looked at individuals we felt would be at least for most considered to be successful individuals. We have presidents of major organizations, department chairs, you know, leaders, chiefs of surgery at various programs. And we were really targeting to say, okay, well, what is it that makes these individuals tick? So they had a fairly long questionnaire. And we asked a bunch of questions, and we’re gonna say, okay, well, how do we figure out more about these people? And as you would expect, right, lots of grants, they brought in lots of money, they seem to be doing everything, right. It’s that classic, you know, wow, like, okay, so these are these superstars that just do everything. They’re, they’re what we would potentially call the hyper performers, but you dig deeper, they’re not all hyper performance, there’s probably only a third of them that were hyper performers. And the thing that I remember the most from that particular paper, and I’ve used that, I still continue to use it. In fact, I just, I think I just used it in Mexico, not even less than four weeks ago, on the virtual conference, virtual lecture thing. 33%, like, when we ask people, you know, all these hyper performers, in theory, right, all these individuals that we would have thought would have been these, you know, highly, highly successful people. Is this the happiest time in your life? 1/3 of them actually said it was. 2/3 says it wasn’t right. And so when we regressed against that, and we said, okay, well, what are the factors predictive of a surgeon saying, you know, I’m fully content with what’s happened to me, because all of them are all, they all have all the accolades, right. So they’re all doing very well. The thing I remember as well, happy, you got to be happy, right? So this, all this is informed by own way of think about stuff, right? So they’re generally happy people. They are happy with the choice they made in their career. And it is amazing to me, how many colleagues I have had, where I’ve asked a very simple hey, how are things, you happy? And that word is seems like it’s nothing but it is a knife edge to somebody who is struggling with it. And what will happen is, and I do it as a as a division head, I, you know, as people that say, oh, you know, they start rambling on about all of their rambling, but they go on about all of their, you know, what they’ve done this year, and they go on about their papers and stuff. I say great, great. And then there’ll be a group of people that would say yep, fine, they would ignored it, and they just forget about it. There’ll be a couple people would come back and say, you know, when you said happy, did you mean like in my life? Or did you mean just at work? What do you mean by that? And at that moment, that person has really reflected. And the people like this were really successful, reflect a lot on what it is that makes them happy. These are people also that I think I recall being intrinsically motivated, right? These are people that were like for you, if you’re about to go through an exam process, right? That’s an extrinsic motivator, you have to get through that exam, right? The exam has to be passed, what’s going to really define you is what happens after the exam where there is no more exam. And now it’s just about you getting up and deciding what you’re going to do and how you’re going to make the most of your day because you don’t have to worry about studying, etc, etc. So, that motivator is a really important one in this particular group of people, generally. These people had some degree of, you know, mind health balance over, you know, they were finding ways to keep themselves either physically or mentally healthy. That was another characteristics I really picked up. And this balance, right, they figured out a way to balance all those things. And so while it seems that they were hyper productive, you think, well, you know, kind of like, like, there’s this narrative chat that I’m sure happens definitely in trauma. And I’ve heard a ton say, you know, you can’t sleep, can’t sleep, you know. Classic, you know, from the classic album Nas, you know, the Illmatic, where he says, you know, sleep is the cousin of death. Like, no, you can sleep, you got to get some sleep, you got to sleep, you got to get good sleep, so you can actually move forward. And for me, I think some of these folks, actually by taking a step back, you know, being really thoughtful about all the other things, have been able to propel above the other so that 1/3 of them, were doing some pretty amazing things and I think that 1/3 could be classified as high performer group.

Ameer Farooq  1:06:11

You’ve been listening to Cold Steel, the official podcast of the Canadian Journal of surgery. If you’ve liked what you’ve been listening to, please leave us a review on iTunes. We’d love to hear your comments and feedback. So, feel free to email us at podcast.cjs@gmail.com, or connect with us on Twitter @CanJSurg. Thanks again.