E26 Tim Pawlik On Surgical Regret, Leadership, And Academic Success

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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

The relationship between a surgeon and patient is unique. Although our conversation with Dr. Tim Pawlik was wide in scope and interest, discussion of this topic was a real treat. Tim Pawlik is a surgical oncologist and the surgeon in chief of the Ohio State University Wexner Medical Center. He was kind enough to chat with us about academic productivity, leadership, passion, and even his research on shared decision-making and surgical regret. Check out the links below for all the papers we discuss.

Chad Ball  01:21

Thank you so very much for taking time out of your busy schedule to join us on Cold Steel. It’s a it’s a real honor. And we certainly understand how how the the breadth and depth of all the things that you that you do in a day, so thank you so much. I, most of us, I think it’s fair to say, in North America and probably the world know exactly who you are with regard to, you know, some of your papers and your and your, your professional side. But I was curious for maybe those who don’t know you as well, if you could talk about where you grew up, and you know, why medicine and in particular, at the end of the day why HPB?

Tim Pawlik  01:58

Yeah, absolutely. Well, first of all, Chad and Ameer, thank you so much for having me on Cold Steel, I really appreciate it. You know, I always say one of the very best things about academic medicine and academic surgery, other people that you meet. And, you know, I’ve been really lucky to get to know you, Chad, in particular, over the years through different associations and have a lot of respect for you. So this is a real honor for me today to be able to chat with the both of you. So thank you very, very much. Yeah, so I mean, a little bit about me. I mean, I grew up in Massachusetts, and you know, I know obviously, you’re Canadian Chad and big hockey fan, I’m a Bruins fan. I grew up in the just outside the Boston area. And, you know, a town about 30 miles north of Boston. You know, both of my parents, you know, didn’t go to high school. You know, my dad and my brother are now used car salesmen still, in Massachusetts. I think that instilled in me, as young person, really strong work ethic, seeing my dad owned his own business and going to work every day, coming home every night, late hours, and no really having your own business. Just this work ethic that you know how hard you work, what you put into it is what you get out of it. And I think from very early on, both he and my mother instilled me a very strong work ethic. And then, you know, was lucky enough to do my undergrad in Georgetown where actually was a theology major, which comes up later on because some of my research interests have delved into ethics and now in religion and spirituality in the cancer journey. And then did med school up at Tufts in Boston, residency at Michigan, and then spent some time at the Massachusetts General Hospital with Ken Tanabe in his lab, and then did my fellowship at MD Anderson with Nick Vauthey. And that kind of segues into your question, like, you know, why medicine and why HPB. I would say why medicine was just really kind of, you know, the obviously the ability to kind of interface with people in a very special way. You know, to be part of people’s lives in a unique way to be part of their health care journey. And to be part of potentially trying to heal them, both physically and you know, frankly, spiritually and emotionally. And then I would say HPB was largely because of my mentors, you know, working with Ken Tanabe at MGH, who’s an HPB surgeon. And being at an impressionable point in my life as a resident and seeing Ken and the type of person he was the type of surgeon he was, and is, and then really, Nick Vauthey, who has been my mentor and my friend for you know, well over a decade now. You know, just kind of pointed me in the direction of HPB. And I’d like HPB, probably like most surgeons, because it’s tough, you know, we never take the easy road out road out of places, you know, it’s challenging surgery. Every surgery is different. You know, obviously, I kind of favorite liver a little bit more than the pancreas. But there’s no two liver cases that are the same. And just the intellectual and technical challenges that HPB brings with it. I think it’s just so exciting every day to tackle tackle those types of cases.

Ameer Farooq  05:42

Dr. Pawlik, as I said, kind of before we started the show, I’ve been a huge fan. And I know there’s there’s a lot of us north of the border, that have been a huge fan of your academic work. And really your voice for science and and the impact that you’ve had on the field? How do you think about academic surgery? And in how do you remain and how have you been so productive over your career?

Tim Pawlik  06:10

Well, you know, I feel passionately about academic surgery for so many different reasons. And now in currently, my role is as a chair and trying to, you know, build a department that reflects a solid foundation and grounding and excellent clinical care. And also, you know, reflects strong academic credentials. You know, I always say that, you know, we’re clinicians first, you know, not a researcher who does surgery. I’m a surgeon who does research. And, and that’s the image that, hopefully, you know, the department that we have here at Ohio State reflects that is that we’re surgeons, yet surgeons need to be scientists. We know what questions are important, because we are at the interface of science in medicine, and day in and day out, we care for patients, we know what the clinical problems are, we know the questions that have not been answered yet on the clinical front lines, and who better to identify the difficult questions that need to be tackled in the laboratory setting the clinical trial setting, the population health setting, the big data setting, than surgeons. So I feel very passionately that we can be excellent surgeons, and we also need to be excellent scientists. And I think just like the intellectual curiosity that we bring to our clinical, you know, setting, you know, that we love, you know, hard clinical questions and, and making great diagnoses and thinking through a case. I think that same intellectual stimulation can come through academics. And also, just as I want to help the patient before me in the clinic and the patient that’s before me on the operating room table. I think there’s a real opportunity for surgeons to help 100s and 1000s of people through the discovery and innovation of new therapies, new clinical trials, and also through a better understanding of health care delivery systems, and how we can risk stratify patients relative to their perioperative risks and perioperative outcomes. So, you know, as you can tell, hopefully, you know, I feel passionately about this, I feel strongly about this. And you know, we’re incredibly lucky to be in a rich intellectual and academic environment within the HPB community as there’s many great surgeon scientists in our field.

Chad Ball  08:47

You know, it’s it’s interesting, Tim, one of the best talks I ever really saw you give quite honestly, and that’s, I think, high praise because your your talks are always so so superb, was your presidential address two or three years ago in Las Vegas at the AAAS SUS meeting, and you talked about a lot of things, as I’m sure you recall. Some of them were sort of based on productivity and a positive outlook. And to be honest, in in watching the Last Dance story about Michael Jordan and the Chicago Bulls, there’s elements you know, sitting there quietly, watching that great series that that take my brain back to your talk. And I was wondering if you could just summarize for us, sort of what your intent was in that talk and what your overall message was, cause I think it’s really valuable?

Tim Pawlik  09:36

Yeah, so yeah, thanks, Chad. You know, one of the things I want to emphasize in my as presidential talk again, with this whole idea of having impact in really challenging folks and challenging myself to really think big, no to spend a lot of time thinking about know what are the real challenges, problems, issues that need to be tackled. And again, getting back to this idea that surgeons are very well positioned to identify those problems and issues and questions and to answer them. And I think that to do that, though, it takes hard work. And I’ve been watching the Last Dance also. And I think one of the take home messages from I get is that if you want to achieve excellence, that you need to be dedicated, you need to work hard. And I think there is no kind of avoiding the 10,000 hours and hard work. And one of the things that I highlighted during my presidential talk was this idea of, you know, what are, you know, kind of the tips for success. And I highlighted four things, which I think I still think about, to this day, and one of them is know that you have to work harder. And if you want to get things done, that there’s no real elevator to success, you know, you have to take the stairs. And, you know, there is a lot to be said about inspiration. But there’s similarly a lot to be said about perspiration. And one needs to be willing to put in the work like Michael Jordan did, or Tom Brady, since I’m a Patriots fan, even though he’s no longer with our team. There’s just no beating around the bush. I think the other thing is that one needs to learn to prioritize. You know, we are constantly pulled in multiple different directions all day long with our clinical responsibilities, research, administrative, educational, personal, family, everything. And so it’s impossible to accomplish everything. So I would challenge myself and others to try to prioritize what are the things that are most important to you in your career? What are perhaps those things that are low priority but high impact? That, you know, if you spent time working on that, that actually would make a difference to patients, and to the care that we deliver. And then the other thing is to build the team? And Ameer asked me, you know, well, you know, how have you been successful and been so prolific? It’s because, you know, it’s always about team. And to quote Michael Jordan, again, you know, individuals win games. But, you know, teams win championships. And you need to build a team around yourself and empower that team to operate at the top of their license. And then I think you will be able to collectively accomplish great things. And then finally, you know, you have to hold yourself accountable. No one can do this for you. You know, people talk about having protected time. But I always say, you know, there’s no such thing as protected time, you have to protect your own time. You know, no, no one sets your alarm clock except for you. And no one decides how hard you’re going to work except for you. So I think you have to hold yourself accountable. And focus on what you are passionate about, and what’s your priority in life. Try to identify what you are very passionate about, and then you’ll be willing to put in that discretionary effort, and really work hard to make a difference.

Chad Ball  13:37

Yeah, I couldn’t agree more. You know, it’s it’s interesting watching that documentary. It’s so topical. I think the whole world’s watching it, quite frankly. But, you know, I I do wonder what some of the earlier influences were with Jordan, you know, because when you mentioned Nick Vauthey, you mentioned, you know, Ken. Yeah, really, really hard working great role model, HPB surgeons, for sure, who clearly have that passion and follow a lot of those things that you that you talk about. So you know, some of its nature, some of its nurture, there’s no doubt, but the mix is also interesting.

Tim Pawlik  14:13

Yeah, I think clearly. And I mean, again, going back to my own parents, I mean, I think in the Last Dance, I mean, Jordan spoke extensively about his father James and the influence that he had on him and the documentary clearly highlights some specific moments in Jordan’s youth were his father kind of said to him, you know, you’ve been kind of screwing up here. And if you do this, you’re not gonna be able to play sports. And if you remember that.

Chad Ball  14:39

Yeah, exactly.

Tim Pawlik  14:40

And Jordan said, he turned on a dime, and then just really got his act together. So I think, you know, it’s family influences, its friend influences, its mentor influences. And then, you know, but ultimately you have to internalize all that yourself, right? And you have to own it. And you have to leverage everything that people provide for you, in their advice and in their mentorship, and turn it into something, and only you can do that.

Chad Ball  15:10

Yeah, totally. It’s it’s really no surprise, Tim, that you’re an associate editor or an editor in chief for a number of different journals, Annals of Surgical Oncology, JOGS, JAMA surgery and so on. How do you view that those jobs or that category of job for you within the greater day or the greater week of, of your of your time?

Tim Pawlik  15:32

Yeah, well, I mean, I love the activity that I’m lucky and blessed to have through these different journals. You know, I think that part of our job is as researchers, researchers, is to innovate, to discover, and to do great science and discover new things. At the same time, you have to disseminate it. And so, unless you’re able to write and get your work out there, so others can peer review it and adopt it, then we are doing a disservice to the research that we’re doing. So I viewed as kind of the final step in a robust research process. And in my role, as editor, Associate Editor for a number of different journals, I feel very privileged to be able to review the latest science, the latest, greatest research that’s coming out from our surgeons and are researchers, and to really see how people put their work together to have impact. So it’s really a wonderful opportunity.

Chad Ball  16:42

Yeah, there’s no doubt it really is a privilege to both review and edit. It’s it’s a remarkable experience. I’m just curious, in all disclosure, to be honest, I, I asked Keith Lillemoe the same question. How do you handle this scenario where your reviewers provide a rejection and you get relatively intense or terse letter back from the authors that maybe is difficult to handle? How do you view that scenario?

Tim Pawlik  17:12

As an editor?

Chad Ball  17:13

Yeah, for sure.

Tim Pawlik  17:15

Yeah. So obviously, you know, always do our absolute best to be fair, just, transparent. And, you know, come to find out everyone feels very passionately about their work, you know, everyone thinks that their work is fantastic. And most of the time it is. Sometimes it’s not. And I also think that different pieces of research and writing may just not be a good fit with a certain journal. So the first thing I would say to authors is, you know, don’t take it personal. It’s not personal. And it may be that it’s good science, and it was even well written, it’s just not a right fit for a particular journal. Or it’s not the right time, because other papers in this area have similarly been published recently, and things like that. I think if the author’s bring up salient points that go to that there was some type of misinterpretation or erroneous interpretation of their data that would speak to why the paper was rejected, then we take that into consideration, and occasionally would have it re-reviewed by separate reviewers. However, in general, my response to authors and trust me I’ve been on the other side of this many, many times, is to look at the comments from the reviewers, to put that in the top of your desk draw or on a folder on your computer, to walk away for a few days, and then come back to it and read it again. And I would surmise that in most instances, if you are honest with yourself, the reviewers generally have good points. You should incorporate those good points, move on and tried to revise the work in submitted to a different journal that may be a better fit.

Chad Ball  19:14

Yeah, I couldn’t agree more. I think in Calgary, they call it the one-week rule because that’s exactly what I say to the residents. When that negative review comes back, your initial interpretation is is often like not only am I a bad scientist, I’m a bad person. So put it away for a week. Again, read it with fresh eyes, you know,

Tim Pawlik  19:33

Right. And then don’t again, don’t take a personally. Trust me, I know it’s hard for me not to do that too sometimes. But really try to look at it based on the scientific merit and something that’s trying to help you improve your scientific work.

Chad Ball  19:46

For for trainees or early faculty is there any absolute dos or don’t dos that you would advise in terms of submitting their their work to a journal like like any of yours?

Tim Pawlik  20:00

Well, I think a couple things. One is just try to work on your writing. You know, the people say, you know, that, you know, you know, bad writing can make good science look bad. So, you know, even if your science is, is good and solid, if things are sloppy and poorly written, I am amazed at some folks command of the written word. And so I would just spend time on the presentation. Because if the presentation is poor and sloppy, sometimes you won’t even get to the science. So that would be the first thing I would say. I think the second thing is, you know, avoid focusing on issues of this is the biggest cohort or this is the first cohort, you know, size and primacy are less important than impact. So I think, trying to frame the scientific question, relative to some gap in knowledge is important. Frequently, what I am seeing is actually pretty good papers from pretty good science, just bad novelty. Lots of me toos that are in the literature. And I think that is something when you’re shooting for a higher impact journal, you really have to identify what is the gap in knowledge that you are trying to address through this scientific endeavor.

Ameer Farooq  21:34

Dr. Pawlik, speaking about gaps, I think, one of my favorite sort of areas of your research that that made me a huge fan of yours is your work on regret. And you kind of talked about this a little bit or alluded to this a little bit in in your background as in theology. But can you tell us a little bit about your paper? Actually, I guess you have several papers on this topic. But can you tell us in particular about your 2017 paper in the World Journal of Surgery, where you systematically reviewed regret in surgical decision-making? Can you can you tell our listeners firstly, why did you become interested in this topic? And then secondly, what did you find?

Tim Pawlik  22:16

Yeah, so it’s a great question, Ameer. So I think for me personally, most good questions or relevant questions come out of real experiences, clinical experiences. And, you know, it was interesting, as someone who does HPB surgery, you know, do a Whipple on a patient, and then only a month or two months later, you know, they have a liver met. There’s a lot of regret that may go on there. You know, there’s regret amongst the patient. I regret having that operation. And then I would experience regret. And I’d be like, Oh, man, I’m I regret doing that operation, you know, should I’ve done something different? And so, you know, in diseases that have poor prognoses, I think that decisional regret is, is a real thing. And decisional regret, as we and others have shown, can adversely impact patient outcomes with increased anxiety, depression, and worse quality of life. And there’s nothing worse in my mind than having done an operation on a patient and then there is a suboptimal outcome because they recur early. And then on top of that, they also have the mental anguish of having regretted the decision that they made two or three months previously. I think similarly, when we think of provider self care, there is a regret that we experience as surgeons, not only around prognosis or recurrence, but, you know, every week when we have our M&M mortality and morbidity conference, I see how surgeons can have regrets around decisions that they have made. So this whole idea of decision or regret, is this feeling that, you know, if you had had made another choice, that it would have been better. And, you know, I kind of conceive of decisional regret as an omission in commission. No omission is I regret not having done that. I wish I had done that. And then commission is our Oh, man, I, I regret that I did do that. And I think that a lot of this goes on in our minds implicitly. And sometimes we don’t explicitly draw to the front of our mind, either as a patient or provider, and, you know, and discuss it. And I think one of the things that is interesting, to me at least, is this whole concept of like shopping for a surgeon, and we kind of have this idea that if you shop long enough, you’ll find a surgeon to do whatever operation you’re looking for. And I think part of that is because different surgeons have different levels of decision or regret. And we did one study when we presented surgeons different stylized scenarios of clinical situations with the exact same patient and tumor specific factors. But we showed that it was really like, you know, buckshot, you know, all over the map whether a surgeon would offer a patient this operation, or not offer a patient an operation. And we looked at that relative to the amount of regret a surgeon would have, whether they did or did not do the surgery. And, you know, based on different thresholds of regret, one surgeon will do operation X and one search won’t operation X. And I think it’s a very interesting phenomena to think about surgical decision-making that is not just based on the X’s and O’s of patient and tumor characteristics, but also our own implicit subjective thresholds for how much regret we might have whether we do or do not do a specific operation.

Ameer Farooq  25:58

Yeah, and I think I wanted to pick up on one specific part of your systematic review. And that’s this whole idea about shared decision-making in your papers talk about, in fact, the idea of shared decision-making and how that can be important. But not all patients want the same level of input or the, you know, the same amount of information or the same amount of control. You know, we always talk about patient-centered care or patient autonomy. But from from looking at your work, it seems very clear that not all patients want that level of power or choice. And can you talk a little bit about that?

Tim Pawlik  26:43

Absolutely. We’ve been doing a lot of research in this area now. And, you know, one of my team members, Liz Palmer is a clinical psychologist, and has been doing a lot of qualitative and quantitative research in this area. And, you know, what we’ve been looking at is that, you know, we kind of think of shared decision-making as a good thing, and it is a good thing. I think the danger though, as you alluded to, is if we think of it as in some monolithic fashion that shared decision-making is one size fits all. So when I walk into that clinic room, this is the way that Tim Pawlik does shared decision-making. And it doesn’t matter if Mr. Jones or Mrs. Smith or Mr. Matthews, or whoever else is in that room, this is how Pawlik does share decision-making. I do not think that that is the appropriate way necessarily to do shared decision-making. What we have found back to decision or regret, is that patients have the least amount of risk for decision or regret, not necessarily when you do share decision-making whatever that means. It’s when you arrive at a decision with the patient that aligns with the way that they like to make decisions. So what we have been trying to do is to better understand how different patients like to make different decisions. And one thing that we’ve been interested in, is if we can better understand how, perhaps you Ameer makes big decisions in your life. Like how do you make a decision about who to choose as your partner in life or how to buy a house? Or where you’re going to do your residency? There’s probably certain ways that you go about making decisions in your life, and how you involve other people in those types of decisions. And if we had some insight into that, could we use could we use that to inform how physicians should be interacting with different patients in different ways. So we can apply a more personalized, we talked about personalized medicine, how about personalized decision-making. So that we can flex as providers in truly provide the context and approach to shared decision-making, that the patient is actually looking for not some preconceived notion of what I have is shared decision-making when I walk into that room.

Ameer Farooq  29:09

And I have to make a comment on this. I think one of my favorite things about this is that this research really isn’t just about surgeons, but it’s really actually looking at human nature and and who we are as people, I think that’s one of the hallmarks of really cool and really impactful research, as you say, is that it has spillover to not just surgery, but you know, too many aspects of let’s say psychology, or it teaches us something about how we as human beings make decisions. And and I just to follow up with that as well. What do you think that surgeons can do better in trying to understand how they themselves make decisions and how patients make decisions? Because, you know, it’s one of the one of the things that always shocked me is that patients come into your office and you say, yeah, you need an operation. Then they say, Yeah, okay, sign me up. But it’s amazing that you can get their trust so quickly. But, I mean, clearly, that’s not always the case. What advice would you have for surgeons for themselves and for their patients?

Tim Pawlik  30:13

Yeah, I mean, that’s a great question. And that’s a big focus of our research right now, because I completely agree with you. I mean, that the best thing is really to get to know someone. However, as surgeons, we frequently don’t have that opportunity. It’s not like family medicine or internal medicine, where you spend years getting to know a patient, and getting to know the nuances of their life, their family, and kind of really get to know them and understand how they like to approach things. To your point, it’s not uncommon where I meet a patient or you meet a patient, or Chad meets a patient. And within within an hour, they’re agreeing to some crazy big operation, wherein we take a third of their pancreas out part of their intestine and part of their stomach, and they’re like, sounds good, and we just met. And so, you know, that’s why I think that all the more reason for surgeons, we have to be very attuned to how patients like to make decisions. And we have to, I think, spend the time to understand. You know, I always lead with what, you know, what is your understanding of this disease? What is your understanding of this operation? You know, how would you like us to make this decision today, who would you like to be involved in this decision. And I think it involves not only the surgeon, but it has to involve the whole team from the moment the patient shows up and interfaces with the resident. So we have to be modeling this behavior to our residents, and also other providers on our team like the EPPs, and such. And we are currently trying to identify different tools that perhaps the patient could interface with before they show up, again, to kind of help frame the context for surgeons. So before even they need a patient, they can have some idea about the decision-making style that this patient may prefer. And we’ve recently some published some papers looking at different personality traits amongst patients, and how personality traits amongst patients contract with how they like make, how they, how they like to make decisions. And so if we could do some work in the pre kind of clinical setting to identify those factors, it may help me better understand when I walked through that door, that in general, this is how Ameer likes to approach big decisions.

Chad Ball  32:37

What excites me about this particular program that you’re moving forward with is is the reality. I think this is probably a teachable skill. It’s a learnable skill. And we all know, as we’re training and maybe with our fellowship, and maybe then as even as partners, some folks are so elegant, elegant and nuanced with with patients and achieve that endpoint so quickly. And for others, it’s a struggle. But you’re right, I think if you if you pay attention, and you have insight, and you’re willing to learn a better way, I think everything you talked about can can be taught and you guys are doing an incredible job of communicating that as time goes on.

Tim Pawlik  33:14

Yeah, I agree, Chad, I mean, I think these are teachable skills. And it’s incumbent upon us as more senior surgeons, again, to be modeling these behaviors for the medical students and the residents. This is an important skill, just like learning how to do a PJ or an HJ is an important skill. These are challenging diseases that our patients face. And we need to be holistic in our approach to the care of our patients.

Chad Ball  33:43

There’s no doubt. Tim, you’ve been at The Ohio State now for a little bit as the chair and I wanted to ask you a three part question. When did you first know that that would be your your goal in terms of that that level of leadership and what pulled into that? Second question, then is, what are some of your biggest challenges day to day? And then I’m also thirdly, curious how COVID more recently has impacted those things for you?

Tim Pawlik  34:13

Yeah, those are great questions. Well, I mean, Chad, I can honestly say that I never aspired to be a chair. I may have aspired to do the things that a chair does. But I never sat around thinking that one day I want to be a chair. Right. And I think that’s an important lesson for me. And perhaps others is you know live in the moment. All of us are leaders now. And if one does a good job in your current role, it will get recognized and subsequent opportunities will open up. And I think that if one is looking for future  leadership opportunities all the time, then people can sense that you’re not looking them in the eye, you’re looking over their shoulder at the next opportunity. And I think that, hopefully is something that I’ve never done. I think, you know, just I, you know, I wanted to stretch myself both personally and professionally. And that is why I chose to come here to Ohio State. This was an incredible opportunity. And the institution here had a number of elements that were incredibly appealing to me, both with regards to the largest of the medical center in the clinical operation being a hospital, that’s about 1400 beds, in a large busy clinical platform. And also real dedication to academics as we had previously highlighted. And then also the robust training programs, with our residency and fellowship programs. I thought it was just an opportunity where I wanted to have impact going back to the IAS presidential talk, and to really pivot from a focus on me and my career, to focus on having impact, building a department, building a team, and elevating other people. And having my success be measured in the reflection of other people’s success in the department. Because as all of us are growing older, I think you learn less more and more that your own success matters less than less. And really what all of our legacy will be, is those that we have lifted up and promoted. I think some of the biggest challenges is just, you know, no, you know, it’s just, there’s a lot going on, it’s a big place, and servicing all of the missions, and maintaining a focus on clinics, academics, education, the administrative role, can be challenging at times. And then also, just balancing being a surgeon, you know, I still am a surgeon and operate and I want to make sure that I always remain a surgeon, and then keeping time for my family and myself so I’m grounded and centered. That has proven to be additionally challenging during this time of COVID-19 as you allude to, in your last question. It has been, you know, a challenging time, you know, during this pandemic, to integrate all of the different moving pieces to a halt elective surgery, and now beginning to align this. And it reminds me of, you know, somewhat of Apollo 13, the movie one of my favorite movies, when they realize that there was that, you know, fatal kind of important flaw in the, you know, Apollo 13 mission. And I, someone said, No, this is a disaster. And then one of the Apollo astronauts said, No, this is going to be our finest moment. This is going to be our finest moment. And through all of the trials and tribulations of COVID-19 in some ways, I think this is collectively have been our finest moment, not only here at Ohio State, but also health care workers nationwide. We have really come together, to rise up to face this head on, to really show that folks can work together the teamwork, the flexibility, the innovation, the heroism, the courageousness, the compassionate nature of people, I think it truly has been a shining moment for surgeons and health care professionals, not only here at Ohio State, but nationwide, and that uplifts me every day.

Ameer Farooq  38:58

One of the things Dr. Pawlik that I’ve really enjoyed watching through Twitter, is how you’ve really kind of engaged with residents and the people that you you are in charge of in a really unique way. Like, for example, I really enjoyed that little Peloton challenge that you had against some of the other department chairs and surgeons. And I think that requires a certain amount of vulnerability to put yourself out there. How have you approached that sort of specifically around social media but also more generally, in terms of reaching out to your constituents and the people you serve?

Tim Pawlik  39:38

Yeah, definitely was some vulnerability there. Given that I came in absolutely dead last in the Peloton balance on the bike and kind of by a longshot, I was dead last. So, you know, I think it’s important, you know, you know, people are people and, you know, it sounds corny, but, you know, I think, you know, people aren’t surgeons, people are people. And you know, we have to meet people where they’re at. Everyone has a life story. And, you know, showing that, that I’m human, right? And that I want to, I want to meet you as a person, and understand what’s going on, not on your professional life, but your personal life, I think is important all the time. And even more now during COVID-19, where we’re separated. And there can be this potential for isolation. So we’ve worked very hard to come up with different wellness activities, whether it be the biking Peloton challenge, trivia nights, we had the Newlywed Game the other night, and now we’re gonna have some UNO face off next week. But really trying to build camaraderie and morale. Because, you know, people, you know, will thrive, if you engage them and are interested in them from a genuine humanism point of view. And I genuinely am I mean, at the end of the day, I want people to feel fulfilled, I want people to feel happy. And it’s all about like a life well lived, right? And being surgeons is a huge part of that. Yet there are other parts of our lives that are equally as important that, as leaders, we need to make sure that we are attending to, for those people who are working with us as our colleagues.

Ameer Farooq  41:35

I think that’s fantastic. And certainly to an outside observer, I really appreciate that that level of commitment to really making sure that the well-being of all the members of your of your department in your division are are taken care of. I wanted to ask something a bit selfish in that what advice do you have for any early career surgeons who are interested in in leadership? Are there any recommended societies or activities?

Tim Pawlik  42:04

Yeah, I guess, a couple things. One is spend a lot of time initially thinking about what you’re passionate about. You know, know thyself, I cannot help you get to where you want to be as a leader, as a chair, as a mentor, if you do not know where you want to go. So this is your life, this is not my life. So I think I would strongly encourage folks take time to really think about what makes you happy? What makes you fulfilled? What are you passionate about? Where can you have impact? For the young people out there, you have a whole career in front of you. 20-30 plus years to make a difference. What is going to be your trajectory? So before you jump into the deep end, you know, really spend some time thinking about what road you want to get on. You know, obviously, you can change paths, change roads, but really spend some time getting to know yourself and what your passions are, I would say that is the first thing. The second thing is find great mentors, you know, and don’t be afraid to move on if your mentors aren’t working out. I always say you know, don’t fire your mentors, just let them fade away. But if people aren’t working out for you find new mentors. All of us need teams of mentors, the people that can kind of invigorates us, motivate us, act as you know, that light that draws us forward. So I think that is super important. The third thing I would say is, you know, lean into it, and work hard. And realize that, you know, depending on you know, what you want to achieve, you’re gonna have to alter your efforts. And, you know, if you want to be the Michael Jordan or the Tom Brady, then there’s going to be a lot of practice and a lot of burn in the steps and a lot of, you know, free throws you’re going to have to put up in order to accomplish what you’re wanting to accomplish. And then I would always say, you know, don’t take yourself seriously. You know, enjoy yourself, have a balance in your life. I think that if you’re happy, you will succeed in the long term, much more likely than if you’re not. And then as far as societies are concerned, you know, I’m kind of, you know, I don’t want to be too much of a self serving here, but I would have to say, you know, one would be the Association for Academic Surgery, especially for young people. That society is specifically focused on young surgeons and there’s lots of opportunity for young surgeons to get involved and to quickly move into leadership positions in the AAS. And one of the other benefits of the AAS is it is discipline agnostic or very ecumenical. So, it is a great way to get to know people in other disciplines. And then as your career matures, and their career matures, you have a wide network of individuals in surgery writ large beyond HPB. I would also recommend that you get involved in the AHPBA. The AHPBA is the premier HPB surgical Association in Canada, North America, Central America and South America, and has a number of rich opportunities with regards to mentorship, leadership, and the ability to present your work, get to know people create collaborations, and really advance your career. So those are the two associations that I would focus on.

Chad Ball  46:04

It’s perfect that you bring that up. Tim, as listeners know, for the most part, I think it’s safe to say you’re the current president of the AHPBA. What is that experience been like so far this year? And you know, I would from the outside, it certainly looks like the honor of a subspecialty career, the combination of it in many ways. How do you frame that experience so far?

Tim Pawlik  46:27

You know what, I’m incredibly lucky, Chad to be the president of the AHPBA this year and have a wonderful group of, you know, executive officers with me, you know, Mike, Majella, and Sean. And we’ve been working hard to continue the success of our association, much of our efforts, recently has done a COVID-19. We’ve had two very successful webinars, one with the executive officers as the pandemic began to help our membership, understand the implications of the pandemic and how to deal with, you know, canceling or postponing nonessential surgeries. And then just yesterday an additional webinar with past presidents of the AHPBA, many of whom are leaders at their local hospitals, discussing how we are now going to have to adopt to a new normal, and begin a slow road to recovery. And in addition, there have been a number of other logistical issues with regards the AHPBA that we have been dealing with even beginning to think about what our meeting will look like in March, as this pandemic may last for a number of months.

Chad Ball  47:47

It wouldn’t be fair if we didn’t end the podcast without asking you a couple of sports questions. So since you brought up TB 12 a couple of times, you know, as you said, you’re a Boston guy and I have a particular love of Boston as we’ve talked about before given our family history. But I’m curious how do you think TB 12 will do in Tampa and how you think your boy Beli and and the Patriot crew will do without him?

Tim Pawlik  48:12

Yeah, so I’ve been saying no, Brady, no problem. In Belichick, we, in Belichick we trust. Yeah, so. So Gronk and Brady are dead to me at the moment. And I trust trust Belichick, and I think we’re gonna I think we’re gonna be fine.

Ameer Farooq  48:38

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.