The Interview with Dr. John Crosby
"The Kindly Country Quack"
to contact Dr. Crosby email him at email@example.com
On a Personal Note:
Meeting John again was a real breath of fresh air. He is a kind person and you sense that immediately. When we were done the interview, my camera and podcast friend (Cameron) and I were leaving and he said to us "you boys are probably hungry let me get some food for you" we didn't have time but he truly meant it. That same level of concern is why his patients love him so much- he cares about people.
As individuals, we always have a choice of being kind to other professionals we meet, but for whatever reason, whether that is because of our personal ego, hate, fatigue, frustration, scarcity thinking, many may choose to behave unkindly and sometimes just downright obstructive and abusive. I've certainly dealt and saw many professionals behave badly with doctors, nurses and patients. He's a role model who reminds us to be better and that it's never too late to become better. He's an example of the spirit of how we can provide care for others.
Dr. Crosby could easily work quietly in his office and enjoy his peaceful life, but he feels a calling to help others in the medical profession become healthier. That takes energy and a big heart; the world needs more doctors like him.
I hope you enjoy this conversation with Dr. John Crosby as much as I did.
Dr. John Crosby is a regular contributor to the Medical Post (a newspaper for healthcare professionals). His CV is extensive including being a peer reviewer for The College of Physicians & Surgeons of Ontario. He is a consultant to organizations, he is an author, blogger and a mentor to many physicians. He is remarkable at 72 years old as he is still practising family medicine with full energy and insightful contributions for the medical community.
“We’ve got to figure out tricks to fool ourselves”
In this interview, we cover a wide range of topics from:
- dealing with mean doctors
- how an introverted doctor/person should deal with a bully doctor, especially if you’re
a person who avoids conflict like him and I do.
- How he is inherently conflict averse but has had to step in to deal with tough situations.
- He shares very specific language to use in conflict situations. His language is interesting and insightful, somethings he says in the interview may shock you.
- He shares tips on how doctors should deal with and AVOID college complaints.
- How to deal with paperwork and why he loves it so much.
- He talks about marriage, his the fun fund, and how to plan a vacation.
- How to complain properly.
- How he gained empathy when he never had it.
- Why doctors are not wonderful.
- How he failed a peer review and learned from it
He’s quite candid about his personal challenges and tribulations as a doctor. He shares how he hated family medicine but then learned to love it. He talks about why laziness is good and how it helped him.
Lalit : John, welcome to the show. I am very excited to have you here today. I've read many of your articles in the Medical Post. So this is a real honour to have you here. I always wanted to ask you, you call yourself the kindly country quack. So tell me, how did that name come about?
Dr. Crosby: That was from my brother in law, Peter Loughead, who is a Toronto teacher and I'm out here in Cambridge. So whenever we went into Toronto he'd say, “how's the kindly country quack doing? Just making fun of me, so when I needed a blog handle, I thought that was brilliant to use that. So it's been like that ever since.
Lalit : That's funny. Now you're 72 years old, you've been practicing for 46 years as a doctor. That is a long time to be doing anything and some of my listeners probably aren't even that old, but that is great because you'll be a master at what you do. Now in your recent Medical Post article that you wrote, you said you grew up in Sarnia, you had a very great life, almost a like a privileged life, an idyllic life and you never really experienced any difficulty; and then used somewhere along the way you developed empathy. Was there a particular point or a story that you can share that, that allowed you to change?
John with his 98 yr. old Mother-in-law Clara
Lalit: I guess that's not a fair question.
Dr. Crosby: No, it is. I was young and I didn't have any complaints. I enjoyed it. Then I was actually bored by it. I thought, oh, how sick can you be if you can see me at Tuesday at three in the afternoon.
So, so then I went into emergency medicine, which was really exciting. So that was really fun. And I did that for 20 years and that was great.
Lalit: Then what made you decide to go back into family medicine?
Dr. Crosby: It was just the lifestyle. I was 45 years old. I had three kids when I was 42 and my wife was 38, so was late. And the whole world is nine to five. And when you're an emerge doctor, you're working on sociable hours, nights, holidays, weekends. I wanted to be with my family. So, with great trepidation, I came back here to be a family doctor-27 years ago and I was really nervous about it. I thought, “Geez, what if I screw it up again?” But luckily I changed. I really had changed myself and I changed the processes.
Dr. Crosby: Not, one specific thing. It was a whole, it was really life. I sort of grew up, I matured. I think most doctors are like me, we're really lucky. It’s lucky to be a doctor and it's hard to empathize with patients that smoke and eat too much and have bad marriages and things like that.
So, once I've lived life and had kids and been married and had parents die and friends die, I had a lot more empathy for people.
Lalit: So how would you describe yourself as a doctor initially until you ran into those tough times?
Dr. Crosby: Well, I just couldn't understand people like they, they made me angry - why can't you stop smoking? Why can't you stop eating? Like why don't you leave your abusive husband? Why do you work at a crappy job now?
I know the answer- because you have too. I mean, it's hard to do all that stuff. And I've never had to do anything. So I had no empathy for them. So now I have empathy and that makes me a lot better family doctor because I don't judge them.
I think that's the biggest, and I think we are all bad -especially smoking, very few doctors smoke and we, I, used to listen (with the stethoscope) over where their cigarette pack and say “I think I know where the the problem is” and just my body language and stuff.
So now I don't judge them, now I go, “I know how hard it is and I'll try to help you.”
John with his Wife Jill
Lalit: So, what would be some key processes that you changed that you think that some doctors are making a mistake doing currently? What do you think are things that, you see that many doctors are making?
Dr. Crosby: I don't think doctors are making mistakes. They, they just fall into it. I mean, you come out, you're tired, you're in debt. You just start working really hard to pay back your debt. You just, work faster and faster, harder and harder and you start missing breakfast and breaks. You start working through your lunch. You’re grabbing a sandwich between patients and typing and stuff. And you'd show up home at seven at night exhausted. You didn't start your life like that. It just kind of happened to you. So, when I came back, I was really aware of that.
I was older, I had mentors. I think the most important thing you can do as a doctor is get a mentor. Get an older doctor that's been successful and just listen to what they tell you and, and try to emulate what they say.
Lalit: My dad always said, “People learn from their mistakes. Wise people learn from the mistakes of others. “ So I hear you.
Dr. Crosby: That is a great saying and that's what I'm trying to do really with this podcast and my articles and I offer free mentorships. I've made tons of mistakes so new young doctors don't have to. And that's how we educate ourselves as humans. I mean, when we were cave men and women, if you burned yourself on the fire, you told your kids not to touch the fire so they didn't have to burn their hands.
And that's what education is totally like- don't kill the patient. Here's, how to do it. And here's the tricks of the trade. And when we go to medical school and residency, often our professors don't tell us that because they're so way up there in their ivory towers. They don't know, how do I be on time in my busy general practice? How, do I make sure I have an empty, in basket (no paper work) every day? Things nobody teaches you at medical school. So, my role is to try to get the practical tricks of the trade.
Lalit: So, what did you do? What were some couple of processes that you've made?
Dr. Crosby: Okay. So I first got a mentor and my mentors said to me, one was Jim Kavanaugh who invented the Telus computer system that a lot of us use across Canada, and he's my next door neighbor. So, I was lucky there. And he said “you don't have to marry the patients. You don't have to own them. They're not your best friends. You're their doctor. You don't have to fix all their problems. Sometimes you just have to listen to them. Sometimes you just have to reassure them.”
That was a huge thing. I really had boundary issues before, and trying to fix everything. And I think as a family doctor, we rarely diagnose things. We rarely fix things. It's often just chronic disease management. You don't get better from high blood pressure; you don't get better from diabetes or cholesterol. But we can help in depression and anxiety. So, we're sort of chronic disease managers.
Lalit: Well we certainly do manage; making sure their blood pressure and diagnosing the diabetes and hypertension to make sure they don't have the negative sequelae from that. So, I certainly agree with that and I certainly agree that sometimes people may not be ready for the change that you would like to see. And sometimes we have to be patient, we have to be patient with their timing. Because sometimes our timing is just, it's just not what it's meant to be.
Dr. Crosby: And that's what I had to learn because I was so impatient, because why can't everybody be as fast? Like my mom, was fast, my sister's fast. I'm just a fast person. So it was great in emerge. I mean, I could juggle 20 patients.
That was one of the medical students said to me, “this is like air traffic control. I mean you've got like 20 planes in the air.” And I said, “yeah, I hope none of them crash.”
So, coming to be a GP and you're talking to a 100-year-old lady-uh it just, you have to be very patient. Or like smokers, like I've had six smokers where I nagged them for 22 years and they finally quit after 22 years. So 22 years is a lot different than a two minute cardiac arrest. So, I've really had to slow myself down and just keep, gnawing away at people and not being frustrated by it and not getting angry about it.
I used to be angry and judge them and it's your fault and you're a bad patient and nobody's bad. I mean, you're just a human and we need to get that, have to teach them tricks of the trade as well.
So, a lot of the stuff I teach to students, medical students, residents and interns, nurse practitioners and physician assistants and graduate doctors. I teach them to my secretary and nurses and patients as well. Everybody needs to be educated about all this stuff all the time. And plus me being educated, back by them.
Lalit: Talking about saying the patient is bad. Correct me if I'm wrong, but I've certainly had the experience where I've seen other doctors in the emergency room or just sometimes in a clinical setting where they're just not nice and they're just frankly, sometimes they're just mean, at times.
Why do they behave that way? Because I don't think people go into any helping profession, certainly not for the money. Right. If you really think about the hours that the average doctor, nurse, physical therapist, that the amount of time they put in and you count all that it and spread it out the financial aspect of it. Why do you think some doctors are crabby and sometimes abusive?
John with his son Steve at a Raptors Game
Dr. Crosby: I think you're right. And I've run into those doctors too. I've been lucky and I've got a pretty nice disposition and I'm always happy and even when I feel bad and I'm in a lousy mood, and I'm grumpy or I got a cold or something, I try to suck it up and be nice to patients just for the simple reason.
It's much easier to be nice than it is to be nasty. And a great way to get sued or get a college complaint if you're nasty. Patients tend to not sue their doctors if they like them. I have an example; I was chief of staff at a hospital years ago and we had an emergency doctor who had 37 complaints about them in one year. I used to run an emerge in Ontario where we used to get one complaint a year for the whole emerge, that was 50,000 visits. It was just wonderful because we had wonderful nurses and really good doctors and we were on time. People weren't crabby because they'd waited 12 hours.
So, we had to call this guy into the office to say, why do you have 37 complaints about you? And, and he started crying in front of me and yeah, he was a 40-year-old guy, he just said, “I'm, I'm broke, I owe money. I'm working double shifts, I'm exhausted. I'm just so crabby. I'm so depressed, I can't sleep.”
So he had a real mental health problem and he was taking it out on the patients. You have to sort of say, what's behind this behaviour? Is the person clinically depressed? Are they burned out? Are they working too hard? Too many hours? Especially with doctors, you're on call too much. So, we fixed, this guy actually was great.
I acted like his realtor. I said, why don't you sell your house and rent, pay off all your debts because the house is the only thing they don't tax us for-it's tax free. In those days, a house would be worth $500,000, which would buy you a dog house now in Toronto. So, I said sell your house, get out of debt, and then he did and it worked. And he had like four complaints the next year. He’s never going to go down to zero complaints. Like he was kind of a grumpy guy and felt people were abusing the emergency department all the time. He was very judgmental, but we took him from 37 complaints to four complaints just as his financial advisor and not his medical advisor. Well, that is huge.
Lalit: So you may be really good at dealing with that, but how would somebody, say who's more introverted or shy or conflict of averse? Because I know sometimes that tends to be my behaviour- to avoid the situation altogether. How do you approach that? How would you, or what kind of advice would you give?
Dr. Crosby: Well, and I'm like that too. I hate getting in battles with people. I'm terrible at it and I try to avoid it at all costs. And, that's tough as a doctor because you've got to say no to narcotics. You've got to say no to time off work. So, we're in conflict constantly and people are mad at us and we're in the middle with a lot of stuff.
So, number one, I call it rent a spine. My secretary has got a really good spine and she's great and she can say no to people and they don't even know they're being said no to. Like one of my multimillionaire patients said, I would love to have your secretary as my secretary because she can blow people off and they don't even know they're being blown off. So she's great.
And I've had one complaint about her in 27 years, from a crack addict that wanted to see me immediately. So, I lucked into her. I mean she was here when I took over the practice, but I treat her well and I give her lots of money and lots of time off work and praise her. We have a great working relationship between us. So, she's my rent a spine-like.
So people, for example, will call up and say, “I hate my job, I hate my boss and my coworkers. tell Dr. Crosby I need two months for stress leave. “And she's just great. She starts right away. She says, “well, Dr. Crosby doesn’t believe in a lot of time off for stress because you're just running away from your problem.” And she's already starting my spiel on the phone because she knows how I work.
“He might give you two weeks off, and try a holiday, but just get counselling, get help, talk to human resources, if it's an abuse situation, get a new job, things like that.”
So then when they come into me, she's already taken them from two months to two weeks. So, her spine has replaced my lack of spine, so I'm not arguing with them and they're not mad. They don’t go out mad at me and I'm a horrible person and I feel bad and they slam the door and stuff. They come in already thinking like I do.
Lalit: But how do you deal with it when you can't rent a spine? When you're in the hospital and you have to deal with a particular doctor or a colleague or somebody you're working with. And frankly, their agenda doesn't line up with the greater purpose or there are bullying behaviour tactics. How do you deal with that?
Dr. Crosby: The way you treat a bully is with a bigger bully. That's the secret to treating bullies. So you've got to get a bigger bully. I've had that situation, as chief of staff and as head of the nursing home and, and just as a colleague.
First of all, if there's trouble you don't want to deal with it on the ward or in front of other people. You want to take that person away to another room where you are private together; turn off your iPhone so you're not going to be interrupted. And I try to decompress the situation. You don't want to have a fight in front of the nurses and staff and then you always want to hear their side first instead.
Dr. Crosby: And I'm really honest with people. I go, “You seem really upset. You seem really angry.”
And I do that with patients too. Patients that are angry, I will say, “You seem really angry. Like, what is upsetting you? “
Because it may be something totally you don't (know about) - my dog just died, or I just got a diagnosis of cancer. So, you don't know what's going on in their life. If they're just a nasty person that's bullying a nurse or something, then, and I have done this- I will stand up to people and I'll say,
“that's unacceptable behaviour and that's not helping the patient. It's not helping you. It's not helping the nurse. It's a lose, lose, lose and it's a great way to get sued or get a college complaint.”
So I always put things in their best interest- the doctor, the nurse, the patient, always people care about themselves.
So you always want to do that with what's best for you.
“being a bully is not good for you and I'm sure you're not happy doing it either.”
Lalit: That is a good language. So would you ever say that to a bully- being a bully is not good for you?
Dr. Crosby: Yeah, I do. I'm really honest with people. You know, one of my pet peeves is people who use euphemisms and stuff like that, you know- pass away and passed over and your dad passed. And I always went “what a kidney stone or passed out” or like use the word die. Like, you know, there's nothing wrong with dying. We all die. We got a hundred percent failure rate as doctors. All our patients die. I mean, I always joke, how would you imagine if you worked at a Ford Motor Company and you had a hundred percent failure rate?
Well, we as doctors have 100% failure rate. All our patients die. So, I hate that euphemism- use real words with people. You know, your dad is going to die, and people appreciate that. They don't like all these fuzzy words that doctors use. That’s a pet peeve I have with medical people - speak plain English or French.
Lalit: That is good advice. That's good advice because I do think we do, …
Dr. Crosby: obfuscate. There's a big word, there's a big word.
Lalit: I'll have to look that up. Note to self.
Dr. Crosby: obfuscate is using big words to say when we should use little words.
Lalit: So, yes we do to use euphemisms. And one thing I know I have to be mindful of is, especially when talking to patients is the use of language, things like benign, malignant… you know; Basal Cell Carcinoma versus Squamous cell carcinoma, you know they don't necessarily know that. They don't know the difference. And we, ourselves get so wrapped up in it, because it's inherent to us. We know it they don't necessarily know it.
Dr. Crosby: So I have a funny story about that? There was this old GP in Oakville when I was a head of the Emergency Dept. and he said, “you know, you always write ‘f u f p’ on all the bottoms of your charts. (And that was follow up family physician). And he said, for like five years, I thought you were swearing at me!”
Lalit: Oh that's funny.
Dr. Crosby: So then I started really, you know, you have to use the real words with people. Like SOB - is shortness of breath. It means different things to other people. So, and that's a pet peeve with any presentation. I, whenever I teach, I never use short forms on PowerPoint because you don't know your audience.
You know ED could be emergency department, erectile dysfunction, executive director. So, use the full word there. You've got lots of room on a PowerPoint slide. Never use short forms because you don't know who's going to read your stuff or be at your talk or what patient it is.
One trick too, so patients don't feel they're being talked down to - l use two words. So, I'll say you have a fractured broken arm cause some people think fracture's different than a break. Or any trouble going to the bathroom- you know, pooping or peeing or having a bowel movement. So, I'll use them all in a sentence and they can pick out the one that they're comfortable with, especially people with English as a second language; because they'll just sit there and nod, - or say, I don't have trouble with it all the while they are thinking ‘what the hell is a bowel movement?’ You know, you got to talk the lingo to them.
Lalit: I talk about that in a previous episode about how important it is to give proper discharge instructions, This is a true story, I don't know if you know about this, but this child came in and he was having a lot of diarrhea and vomiting and not, this was a really good conscious emergency room physician. I heard this from the CMPA. The Canadian Medical Protective Association. They gave this workshop and the ER doctor told the parents, “if nothing changes, then bring him back.” And nothing changed, inn their mind because the child was still sick, he hadn’t changed for the better. (I’m sure the doctor meant “if the child didn’t change for the better) well, nothing had changed because the child continued to have vomiting, diarrhea and the child died.
Dr. Crosby: Oh my, that’s so sad isn’t it? And that, and everyone's innocent there. And then the kids dead.
Lalit: Well that was a good lesson for me to hear because when I give discharge instructions, I'm very clear, so I’ll say “if the child continues to have vomiting, diarrhea, blah blah blah, bring him back. If you're concerned, bring him back at this time. You know, he should be improving in 24 to 48 hours or less. These are signs and things to look out for.” I don't want to scare them, but I tell them this is so “for your education so that you're aware, I’m not saying that it's going to happen, but if that chest pain escalates and it becomes deeper, whatever you need to go to the emergency room.”
Dr. Crosby: That's great advice. And, and also I always give them written instructions and, and I learned this tip in Cambridge emerge actually on ever door they had all the instructions on one piece of paper. So you weren't running around trying to get 10 different pieces of paper, and it was on every door just outside the door and in a slot. Because you can't find anything in an ER.
And so I did this in my family practice, so it's now in the computer now. I can just print my handout and I've got a handout for kids that covers head injury and fever and things like that. Vomiting, diarrhea, when to call the doctor, when to go back to emerge, what to look for, you know, fever, stuff like that. I do that with most of the stuff I do in medicine. It's nice having a computer. I just print out my instructions and hand it to them and my secretary makes fun of me.
She says, I find half of them in the garbage. They throw them out, they ignore you. Except for the teachers and librarians. And I said, well teachers and the librarians are worthwhile. So even if half of them throw them out, half of them didn't throw them out
Lalit: and you don't know which half is keeping them, keeping them. And it's probably not half is my guess.
Dr. Crosby: another trick I do on the computer too is I'll go through things like advice for sleep or weight loss or anything. Like any of the big problems we have -smoking - I'll actually go through on the computer with the patient, here's all the tips for weight loss, here's all the tips for sleep. And then I'll print it out for them. And then I will say, I want you to read this and bring it back in a week and we're going to go over it again, like homework.
So they can't throw it out this time but at least they know in a week from now...And I’ll say let's go through the list again. And that's when it's great. I think that's the best thing I've ever learned really as a GP because a lot of the times they don't do the things you asked.
So they have insomnia and I'll say, well, did you give up all caffeine?
Well, no I can't. You know, I have to have my triple - triple every morning.
And so then we talk about that and l’ll say “you know, people with insomnia should have zero caffeine? You can't even look at a cup of coffee, you know? And that's hard to get off. So, we're going to have to wean you down your half coffee for a week and you're going to have withdrawal symptoms. So things like that.
They'll argue with you or napping is a big thing is napping. I say no naps ever. If you feel like a nap you gotta go for one. If you have a nap, you're not going to sleep tonight. And they'll say, “I just couldn't give up my nap. I was exhausted.”
So, it may take three or four visits to finally work them through this because this behaviour modification and habits and stuff. And that's really rewarding because they actually get better and thanked me for that- instead of me throwing them a handout and then throwing it in the garbage and going out.
So that's our job as family doctors and specialists to are trying to change human behaviour. Well, you know, it is the hardest thing in the world to do.
Lalit: And it's really, I call it like the low hanging fruit because if they sleep better, they stop watching TV and iPads an hour before bed. You know, hydrate better, eating food better. And those are things that I don't know if every physician talks to them about. I hear nurses, they do.
Dr. Crosby: You talk about that in your podcast too. And that's good that you're getting the message out there and that's where …we call them ‘screenagers’ for teenagers because they are always on the screen, not a great line. And everybody loves their screens. I mean, we're all addicted, including me and I just love it.
You say to them two hours before bedtime, you've got to read a book. Like you can't watch the news. It's all bad. It's always Trump doing this or that. And you've got to turn off all your screens cause your brain thinks it's still daytime. So cavemen and women didn't have that problem, you know?
So, I'm always taught, and I use cavemen and women a lot saying, you know, there's things we do because this is what we've inherited from our, our forebears. So, we've got to figure out tricks to fool ourselves and to do… When I think about my life, is teaching people tricks. Like you are an illusionist.
You you use tricks cause I can't change them. I mean I'm not gonna change a patient or a doctor or a nurse, but I can show them tricks of the trade. Like, “I always go, you know, everybody hates paperwork and computer work. I mean it's the number one burnout cause of all doctors. And I love it. I'm the only doctor in the entire world that loves paper. I will come to your office and do your paper for you.”
I love it so much because I have learned the tricks to loving paperwork.
Lalit: So what are they?
Dr. Crosby: Okay. Number one is you have to have it in your schedule. Like most doctors do it at lunch or at supper on the weekend, which ruins your weekend and your supper. So, it's in my schedule, it's right in my iPhone. It says eight till nine every weekday paperwork. It's right there. Just like saying, seeing Mr. Jones at nine o'clock in the office, I have an appointment to do paperwork because it's part of our job. Like stop whining about it. It's our job. Yeah, you can't get rid of, everybody has paperwork and computer work too. And I use paperwork for computer work now because I'm down to about 1% paper and 99% computer, but I mean lab x-ray specialists, all that stuff that pours over us.
And if you see 30 people a day, you're going to get 60 of those a day because lab x-ray specialist for almost everybody. So, I do it every morning, eight until nine when I'm fresh and then I reward myself. I have a reward. I have a coffee - DECAF. I get to read the paper. So, I'm rewarding myself and, and it's done. I'm done for the day instead of letting it’ll just grow and grow and grow in your in-basket until, and then you don't want to go near it. If someone has a huge chart that you have to summarize for a lawyer, a, it's going to take you two hours. I charge 300 bucks an hour. So that's $600. It makes me a very happy man. Makes me love it, money can buy you happiness because, and I give that money to my wife to buy shoes (laughing).
No, no. I uh, have two pairs of shoes. She has 200 pairs of shoes and she still needs more, but we have a fun fund. So she puts all this money from paperwork in the fun fund and then we go to a Broadway play or a play in Toronto or we go to a Blue Jays game (and not her, I get to go to that) or raptors game. You can take out a mortgage on a raptors ticket from the scalpers.
SoI'm rewarding myself instead of saying this is horrible. I hate it. I hate paperwork, I love paperwork. Bring me your paperwork because I'm getting paid for it for this is private stuff - make lawyers pay, they're going to charge 1000 bucks to the client, t things like that. So tricks of the trade.
Lalit: do you ever complain and I mean you seem so positive.
Dr. Crosby: Like uh, all the time. Ask My wife, I'd come home -and she’s good for me too because I come home at five o'clock at night on time and I just sit there and bitch for 10 minutes; then she goes okay that's it. You're allowed to complain for 10 minutes and then move on.
So I don't ruminate about it. But everyone needs to complain and complaining is a good thing. I know when I was an emergency doctor, we used to call it stitch and bitch. The nurses would be at four in the morning. They would be stitching away and making quilts. And I'd be back sleeping and they'd be complaining about their kids and their husband and their job and stuff, but it was like group therapy. They were getting it out and lancing the boil.
Lalit: You brought up a very good point in that there is a technique where you actually schedule time to complain. You’ve done that with your wife and she puts a time limit on it and that's it.
Dr. Crosby: So I should put it in my iPhone complain time 5:00-5:10 pm
Lalit: It’s actually a technique. It's like focusing you and you say “I'm too busy. I'm not going to be focusing on this negative moment. I’ll complain at 5:00 to 5:30 for five to 15 minutes, I'm going to complain. And that's it.
Well, that's what I love about this and my blog. I get feedback and when I give speeches around the world;I feedback from the audience of fabulous site. And then I spread those great ideas to everyone. I feel like a little bumblebee pollinating all the different flowers and stuff. So, I collect all these great tips and then send them out to everybody. And you've got to do it simply. If you give too much information to people, their head just explodes. Yeah-so that was a good tip.
I always remember the pharmacists were always whining at the nursing home, how we were using all these stupid short forms in writing like ‘od’ for every day. And that means actually your right eye- I ocular dextra, so they put a whole list of all the things doctors did wrong on their prescriptions. And I said, “you're making mistake because doctors hate all this stuff and they just going to toss this. They're not going to look at it. So once a week send one email saying this week's tip from the pharmacy is don't use ‘od’ write once daily, so they will learn that and write ‘please acknowledge you got this email’ they have to get back to you by email.
So little things and I think you're doing that with your podcast. And I tried to do that with my blogs. And I know the College of Physicians and Surgeons is doing this now. I interviewed the president and she said she's an obstetrician from St Thomas, Nancy Whitmore and she said we're going to send out just one little tip from the college a month instead of 10 pages, which you're going to just explode over because you've got so much paperwork. We're just going to give a quick little paragraph on how to avoid, this kind of problem that gets doctors into trouble with the college. So we, because we are in information, paper overload, email overload and everything, it's hard to keep up, just kills you.
Oh, one last thing about paperwork is I always do it in front of the patient. So, if they come in with workers' comp form, we do it together because they know. Can you bend, how long have you been off? So, I do it when they are there. If you put that in your in-basket it will grow and have babies. And I tell that and people think that's a joke. But it has babies. Because you'll get more paper coming saying what happened to the first paper. So, and then they're mad at you because they don't get paid. And so everyone's mad. Your secretary is mad at you because she's drowning in all your paper. So this is a win, win, win. You're happy, you have no paperwork, they're happy, they get paid, secretaries happy instead of lose, lose, you get win-win win. And that's a trick of the trade.
Doing it right there in front of them and, and staying ahead, because I know if I've ever in the past, let it pile up. It's very daunting and it's actually depressing too to look at the pile and you don't do it well, but you're forced to do it at some point.
Yeah. So thank God. But I have a routine. My routine is usually on Saturday mornings. I would, I'd wake up early and have a coffee and then I do it. And then anything that I need patients to come into, they'll, I'll need to do an assessment or whatever. I'll talk to them. Well, that's good. So yeah, and if my patient gives me a big fat chart, I'll just write in on it. So then the patient has to come in and then I can't procrastinate. They're sitting in front of me so I can't blow it off.
Dr. Crosby: And one last tip too is when I'm on vacation, I always come back a day early, right to this very desk. So, and it's actually the best, this is how sick I am. This is the happiest day of my vacation. I would rather be here than at Disney world, dying of the heat and buying $10 waters for my five year old grandson. So, I come back a day early and I turn off everything. No phones, no iPhones, no secretary, no patients, no nurses, no family, no buddy, just me alone. And I spent eight hours here in absolute heaven getting caught up on all my computers, so I start the next day ahead of myself.
But you have to put that in your schedule. You have to fly in a day early instead of flying in at night and being exhausted and crabby, and then you've blown your whole vacation- you need a vacation to for your vacation.
Lalit: That is actually a great tip. I've done that a few times and when I've done it, I'm like, “why don't I do this all the time?” Because that extra day, even if it's if you're six or eight hours ahead it changes the level of energy and it's actually an investment on your vacation. That's a good point.
Dr. Crosby: Another trick is when you're coming home from vacation, put in your iPhone, the next vacations right in there, I do that before I get home. So you're always thinking ahead of yourself. Like this year my wife and I were just overloaded. The 1st of July we had a like a million things happening and we were just exhausted and angry and crabby and complaining and, and we said, we never want to do that again, but we'll forget and do it next July 1st because we're so stupid.
We can't remember. So I put it in my iPhone, it says May 20, don't schedule anything for July 1st. Because I'll go, oh yeah, I remember last summer we, we ruined it; instead of having a fun on July 1st, We had a crummy July 1st because we over programmed ourselves. So you can use this time management stuff for your private life as well. You need to prioritize stuff. And, with doctor vacations, I always say plan your vacations a year in advance and send an email to everybody in your life-the hospital, your call group, your spouse, your friends, your family, everyone that is that you are involved in your entire life, the nursing home; then it's there. So, they know you're going to be off July 1st to July 14th. Because if you try to do that in June, you're in big trouble. But if you always said, I've already got my schedule fixed for the next year.
Lalit: So, I actually at home I have a, I take a 12 month calendar, open it up and I have it on the wall. So I scheduled life 12 months ahead of time. Because I need to, I'm a visual person. I need to visually see it.
So, I know where I'm at. And then as that, and then as the months pass on, I will extend more, more time. Just keep going. So anywhere, if you look on my wall, there's about 12 months to 18 months. But then also at the end of the year, I will also look back, I do a recap of the year. My daughter kind of saw the recap one time for 2017 and She said, what are you doing here? - I actually recap all the things, the highlights of the year, what I've done, the conferences, where we went on vacation etc.
So if I, if I look back, I'll tell you 2014 was like for the year of this thing… and 2015 -so it's kind of a fun thing to do.
Dr. Crosby: That's a great idea
Lalit: It makes you feel good. You, look at, it's kind of like progress. Okay. This year I actually did something.
Dr. Crosby: That's a great idea.
I totally agree with you about booking a vacation ahead of time. When I was in residency, my mentor, Dr Greg Archibald, I remember him saying to me, he said, I think he said “ when you have your first vacation planned, always have another one scheduled two or three months ahead of time. You should have a week off every three months. You should always schedule it because otherwise you will burn out. You need something to look forward to it and to look back on.
Dr. Crosby: That's a wonderful idea. Thank you for reminding me. And we call it the Tarzan method because Tarzan was going through the jungle on a vine and he's always looking for his next vine to swing to. So, we're always, my wife and I are always planning a vacation on our vacation. And, and I'm glad you brought that up because, uh, we, we had three boys. And a secret to a good medical marriage is you have to go away alone, just you and your spouse. Because a lot of people, when they get kids and this all marriages, you get kids and you focus in on the kids and you forget about the spouse and all of a sudden the kids are all gone in 20 years and you're strangers and you see these late divorces, because they're just strangers because the kids are gone. So, we always, for our 44 years of our marriage, we always do a week with the kids and then a week alone.
Dr. Crosby: We’ll do February alone in the Caribbean on March break with the kids, skiing in New York state or just drive to Callingwood or something near here in Cambridge. And then kids are at Camp in the summer, we're alone at the cottage.
So our marriage, we always have alone time together. And I say that with my patients too. I'll say, ‘when's the last time you went away alone with your spouse?’ And it's like five years ago. And, and that's a great way to get divorced.
Lalit: That is a good point. Now, did you have somebody to take care of the kids when they were younger?
Dr. Crosby: We have a nanny and I recommend to all doctors out there, and I can say this without being sexist because a woman surgeon told me, she said “what women doctors need is a wife.” before you write in and say, I'm sexist pig. That's a woman surgeon saying that and she said her husband was an anaesthetist and she said, “we spend $40,000 a year. On a nanny and it's wonderful. We come home, the kids are well looked after dinner on the table, the laundry is done, the house is clean. We have a glass of wine together instead of fighting with each other and trying to cook dinner. And so it saves marriages.”
And that's how male doctors have survived for thousands of years. They always had a wife looking after everybody at home. And when you hear how hard they worked, well, because they didn't do anything at home.
So now that us younger, a more liberated people- like my dad never changed a diaper and I help out about probably 40% so I'm as good as most men and new young men are much better than we were.
So we always had a nanny to look after our kids when we went away alone. And you can get family too, although, yeah, I mean our moms were so old by that time, they were worn out by my sisters.
Lalit: I never even thought about- getting a nanny just for that week. But that's a good suggestion.
Dr. Crosby: We had a nanny all the time, because my wife was a flight attendant. I was an emergency doctor, so we had a crazy schedules. Like she'd be in Germany, I'd be an Oakville. So we all over- we didn’t work long hours. Like emerge docs only work 28 hours a week. Nobody knows that. Don't tell anybody. And flight attendants work 35 hours a month, but they're weird hours. So we would have a nanny for one or two days a week just to make sure we weren't, so if she got stuck in Germany and I had to do a night shift...
That's when you have stress and burnout. But that's how we worked then. But I mean you could, even, if you don't have the money for a nanny, you can swap. So you can get another couple to look after your kids for a week and then you can do their kids for a week and when your kids get older, like nine or 10. But even when we had infants- we had one year olds, we would go away for a week and that's really been good for our marriage. And you always have to put your marriage first. Your marriage is more important than your kids because your kids will be gone. And if you have a good marriage, then you will be able to raise good children. You want to have a solid team because it's a tag team match. ,, it takes two of you.
Lalit: Well my wife, she's a professional and she works and I can tell you I have a lot of women friends who are nurses, physiotherapists, doctors. And I think women work twice as hard as men because they not only do the work outside of the home, but they're also running all the things at home. And it really, in most cases, so it's very challenging.
Dr. Crosby: They have way more burnout than men.
Dr. Crosby: Because men dump everything on women, including me and every man. Show me a man that's a 50 /50 with a woman. And I'm pretty close. Like I scrubbed toilets. I really do. Like I do, I really try to help my wife. But we have a cleaning lady too.
I mean, so we make good money. So I try to pay- to buy happiness, I call it and it's worth it. So these are once again, trick of the trade. Here's a trick, go away alone with your spouse.
Here's the trick-get a nanny, get a cleaning lady, you're making good money. Rich people support the- you think Harry and Megan are up at three in the morning with Archie. I mean they have nannies and cleaning ladies and the rich have always done that since time began. And the poor don't have a lot of stressors because they're in one room and that with their kid, it's the middle class, upper middle class doctors that are doing all the work at their jobs and all the work at home and cutting the grass and they're just exhausted by it. And that's why they're burnt out. You know the rich and poor have figured it out. It's us in the middle that have-it's all about your support systems. And I'm saying that like, my secretary is my support system. The nurses at the nursing home are my support. I delegate to them, they do all the work and I come in and consult and make sure it's done right. That's the whole essence of time management, which leads to stress management, which helps you avoid burnout.
Lalit: We’ve never done that , the one week vacation.
Dr. Crosby: Doctors orders
Lalit: it's good advice.
Dr. Crosby: Jokingly -what's your OHIP number?
Lalit: But what we do do is we have date night that's generally once a week and at the end My wife and I will go watch a movie, Go have dinner and just spend that quality time. There was a billboard that that really captures, I think an important message. It said “a babysitter is much cheaper than a marriage counselor or a divorce lawyer.”
Dr. Crosby: that is awesome, a great line. You have to mail the mean these ideas, I forget stuff
Lalit: It will be on the podcast, you can listen back and it will be in the notes
Dr. Crosby: Yeah, great idea. And it's true. I had a date night yesterday with my wife. We went to see the live production of Greece and then went to a ritzy restaurant. So still in love after 44 years, 54 with the wind chill factor. But I urge you to take a week alone with your wife because the secret to a vacation is when you don't know what day it is. You're sitting on the beach going “is it a Tuesday or Thursday.”
That's your secret. You've turned off your iPhone. It's just the two of you, the way you used to be. You need to get a week away where you can just do nothing to it and just say nothing. Just be alone-with no kids, no relatives, no friends, no family. And doctors are the worst because we have an excuse to be on our iPhones.
We can say, ‘oh, we're delivering babies and we're talking to patients.’ So doctors get more burnout than anybody else in the world because we can say ‘aren’t I a wonderful guy. I'm working till 10 saving lives and stamping out diseases.’
If you're a banker saying that you're just, a greedy banker. But if you're a doctor saying that, aren't you a wonderful person? No, you're not a wonderful person. You're disorganized, you're divorced, you don't know your kids. You're an alcoholic, you're taking drugs, there's something wrong with you. You don't need to work till 10 o'clock every night. Get your job done by five and then sign out to a call group. And that's another thing I did here in Cambridge because I'm lazy and I hate being on call. I designed a call system and it's been running for 25 years where you're only on call one night a month, which is talk about a burnout cure.
And once again, turning it around and turning i a negative to a positive. So when you're on call, you take the next day off. So you're rewarding. Everybody goes, I hate being on call, I'm up all night. I'm exhausted. I'm crabby, burnout, terrible patient care, yelling at the nurses, crabby.
This is great. I only do it once a month. I'm taking the day off afterwards. I'm going to spoil myself, I'm going to drive to Toronto alone and go to the art gallery and go to a nice restaurant and just be alone with myself for the whole day and do exactly what I want to do. And so I'm rewarding myself instead of punishing myself.
I love paperwork. I love being on call. I love annoying patients because I'm going to turn them around, turn everything around that pisses, can I say piss you off?
Lalit: No, that's fine.
Dr. Crosby: So always say, why am I being annoyed by this and how can I flip it up? Say what's Dr Crosby's trip trick to flip this. I'll we read his ebook and he's got a trick for everything. It’s taken me 46 years to get these tricks. So I will give them to you in 46 minutes.
Lalit: I'll share that ...I'll put that into show notes and we'll, we'll come back to that.
Dr. Crosby: Thanks, And I have an audio book too, because a lot of doctors don't have time to read my ebook. They're so far behind so you can just listen to it while you're driving hands free in the car.
Lalit: I’d kind of like to change the subject a bit. I've noticed in the last two or three years and, and other doctors have said this to me, - I had a couple doctors, they wanted me to ask you this question: Do you feel that doctor have felt that in the public that they've been a bit more vilified or they, in some ways, and in some ways actually, have been taken off their pedestal. And there's some doctors feel that they're there is resentment towards them because they feel they make a lot of money. The public doesn’t know about the overhead and how much we pay and the hours you work. What is your perspective? Because you've seen certainly seen that from the beginning ..for a long time, How have things have changed, doctors were on top and in many good ways
Dr. Crosby: For sure. I mean 46 years and I've seen a massive change. Like I literally was at the very end of what doctors were like for thousands of years. Like when I started in 73, even in a Cambridge is,a middle sized town, it's bigger than Chatham. Of course everything is. But it's like there's 150,000 people here. So that's a good mid sized town in Canada. And we did everything. I mean, there was no emergency doctors used to get up at three in the morning to go up to the, you had to drive up to emerge to see someone with a heart attack. I was just crazy, deliver all our own babies, look after the hospital house calls, office, like we did every, we did everything that a small town doctor does today in a large city. So I've seen the entire change in going from being a full service doctor to now being just nine to five Monday to Friday in my office.
I'm not even on call anymore because my wonderful call system that I invented, let me go off call at age 65, seven years ago. So I was even thinking of the future back when I was young and foolish. So I've seen it all and I'm still lucky I have an elderly practice and they really treat me with respect. I mean, they stand up when I come in the door, the Portuguese patients call me Mr doctor and the little old ladies cook me stuff and the Russians bring me vodka and the Jamaicans bring me rum, and everybody; they must all think I'm an alcoholic. Like everybody brings me booze and they're wonderful. LCBO and baking. And so I'm living the old Marcus Welby family doctor that we used to be. So I'm not good at commenting on that. I've always had respect and I like my patients and the guy who sold me this practice, I paid for it, when you didn't have to, he said to me, “these are my friends then that that's always been like that”
Lalit: That’s great. If you weren't a doctor, what do you do? Have you ever thought what you would do?
Dr. Crosby: I would be a teacher. I was going to be a teacher because I didn't get into medical school. I was dumb. I had 73 %-I would never be in today. I had a 73% average in grade 13. 56% average in first year of university, because I partied my brains out. Then I got religion and got scared and pulled up my socks and got an 80 average getting into med school. Now you have to have a 90 average. So I would have been a teacher and I would have liked being a teacher and I love to teach. I teach medical students and graduates and stuff. And I would have been retired, seven years ago on an index pension.17 years ago.
Lalit: Are you gonna Retire?
Dr.Crosby: Never. When I die, my wife couldn't stand me at home. Like Iorganize her at home. So she says keep going to work and bringing home money. So what I'm doing is I'm cutting back slowly. So I share with the nurse practitioner and she's wonderful and a lot of people don't realize nurse practitioners are the ultimate locums. Locums are usually pretty tough, because they're poorly trained and they don't show up and they're annoying. They take your patients off work and give them narcotics and you have to come and reverse everything. But she's been with me for four years and I pay her a hundred dollars an hour, which everyone thinks I'm crazy, but it's tax deductible. So it's $50 an hour locums, 200 bucks an hour and she's wonderful and they can do everything I can do.
She can write for narcotics, she can take away your license, she can certify you for insane, she looks after my nursing homes, my office 100%. She doesn't have to report to anyone else. I just pay her, So it's fabulous. So she's doing more and more and I'm doing less and less so. So I go to Florida for March and complain about the,the government full time down there. And, then I take six weeks off in the summer at our cottage on Georgian Bay and, and she does Wednesday afternoons and Fridays. So, so she's doing more and more all the time. Like next summer she's going to do, like seven weeks and she's going to take over Thursdays for me in December. So I'm sort of having a slow retirement where she's doing more and more and I'm doing less and less. So eventually they have a better union than us, so I still have to do the on call.
So, that's a very pleasant way to go out, and a lot of doctors, and I urge you out there in podcast land, don't retire. Retirement is hard. Why would you retire? I mean, I love my job. I make lots of money. Like my retired friends are boring, you get old, your brain starts to fail. There's one doctor in town who's 87 here who assists at surgery and loves it, he's wonderful. The surgeon say he's the best assistant there is. So, and if you're doing a good job, like don't do anything crazy. I mean, if you're just a GP and you can refer stuff to people, you don't want to be doing surgery or eye surgery when you're 75 or that, but, it takes a lot of pressure off doctors because especially nowadays with huge debt, they go, ‘I got to pay this debt off in the next few years.’
No you don't. I wasn't out at a debt till I was 60, you can work until you're 70 quite easily and enjoy it. So you don't have to pay off your mortgage and pay off your school debt. You can amortize it over 40 or 50 years.
Lalit: I remember one advice one doctor gave me was that, he actually gave the whole class that advice, and he said when you get out,you'll move to a different earning bracket and then you'll think you have all this money and you start and you have a huge debt, ...the average debt 150 to $200,000 after medical school, Then you think you got all this money , you're getting this bigger paycheck, you're forgetting the government's going to take half of it.
And then you buy a yacht, you buy a BMW, and then you have what he called the golden shackles. You're working just to pay off all of that. And so you don't have to.
I know many doctors are still in debt at age 60 because I think their finances are not handled properly, but it is also quite expensive. It cost at least like $120-150,000 to run a practice.
Dr.Crosby: Oh, I know. And yeah, and people spend, spend their gross instead of their net. I urge doctors to put away for your taxes every month. Like don't put it away quarterly, put it monthly, you should never even see that money. It doesn't exist for you because you just love... I love to spend, I mean if you give me a dollar, I'll spend it. So I have to be protected from myself.
So I only have this little bit that I can deal with here. The rest goes to pay for insurance and everybody but me there, there's a lot. That's another stressor that we didn't have. When I went to school with $700 tuition, I just had a medical student in from Western last week, 29,000 bucks. And it's even more if you go, offshore. I mean, it's $100,000. So it's, so we're talking about burnout with doctors. There's another thing of burnout that I never had as an older doctors never had, was those huge debt. And just look at house prices these days. $1 million for a dog house in Toronto. So I feel sorry for young doctors today, but you don't have to be burned out, but everything has a solution. Everything has a trick. So the trick is to work longer. It's not a bad thing.
It's a wonderful thing. And make sure you pay everything off every month and you don't need that BMW. You can buy a Chevy and I drive my cars for 10 years, 300,000 km like as soon as you, if you turn your car over every four years, you're just paying the car company and the car dealerships. These new cars are so wonderful. You can drive them safely for 300,000km in most cases... there's a trick right there. You don't have to do what the advertisers are telling you to do. They're trying to sell you those cars. They're at all great. I mean, my 10 year old cars just as nice as the one I got today.
Lalit: I don't see myself retiring either. It's like, and I think you know why I think people think about retirement is because they're justnot happy now and they're just working at such a pace that they're not playing the long game.
They're not realizing that, I need to schedule the way I work so that I, I can work longer, but work at a level that is enjoyable and still competent.
Dr. Crosby: I've always done that. I've always enjoyed my job and I've always made good money. I mean, I make way more than the average GP, but I've always thought how to do it. And I've always paid attention- I only have a secretary. I don't have a nurse. I saved $1 million not having a nurse, I do the nursing job, I weigh them, I do their blood pressure. I give the babies needles as I'm talking to mom and Dad, I'm multitasking. You don't need a nurse, or, I hate to say nurses don't beat me up. My mom was a nurse. My sister was a nurse.
You don't need a nurse in your family practice office. Hate to tell everybody that. But I've written blogs about that. I do it, just me and my secretary run this place. My wife does the billing, so I cut my overhead. Look, it's not the Taj Mahal. Patients don't care. I'm not a dentist that has to get business. So if you read my book or listen to my audio book, it'll tell you how to run your practice. So you get an hour and a half for lunch and you're home at five and you get a half an hour, half a day off, a week and eight weeks off a year and you can still make good money doing that. There is a way to do that. Yet you were never taught to do that by the professors, taught you medical school, never had to run a practice.
They had you to do their job for them. You did their paperwork, they saw three people in a day. You come out here and you have to see 30 people in today. So guess what you do, you just work longer and you don't take lunch and you get home at seven and you're exhausted and you hate your job. So I teach you how to work smarter. How do you do that?
Lalit: I like having a nurse. I think it's, they're invaluable. They sometimes connect with patients in a very special way, but I hear your point.
Dr. Crosby: I loved mine and it broke my heart to fire her and she's still my patient. Even when I see her 20 years later I still feel horrible, but that million dollars saving was nice.
Lalit: the kind of the last serious question because I think we've really been talking for an hour.what about college complaints? That's a thing that you are really an expert. You've consulted with the CPSO, the College of Physicians and Surgeons you've involved in,I can't remember how many thousands of cases, you've been involved in
Dr. Crosby: I've done over a hundred malpractice cases as an expert witness. So what will be about 30 college complaints?
Lalit: So what, you didn't have 30 colleges plans yet as an expert?
Dr. Crosby: Yeah, on the right side of it. Yeah. I always say that to people. I've been sued, I've had a college complaint, which makes me more empathetic too, I like I ain't perfect. I've made my share of mistakes and it's horrible to go through them.
Lalit: So what advice would you give to young, middle, old in terms of dealing with doctors handling a college complaint.
Dr. Crosby: Once again I have, it's in my book, and malpractice suits - I've gone through them so they're horrible. Please, if you can do anything to avoid them, they go on forever. Like a malpractice suit. It'll go on for 10 years. I'm telling you, because the lawyers are making money by the hour, so there's no interest in them ever to quit. I hope there's my CMPA lawyers aren't hearing that. They're wonderful. By the way. CMPA lawyers they are fabulous. They know more medicine than we do. They're just so brilliant because that's what they do. So we're lucky to have them, but it's a horrible thing to go through. A college complaint will take two years sometimes. Now, they're speeding it up and they're, they're really doing a good job and they're trying to make it quick because they know that it's a huge because of burnout.
Just waiting. just torturing us with waiting. So the best way to avoid complaints and malpractice is being nice to your patients. Like patients don't sue and complain about people they like. You can cut off the wrong leg and they won't sue you if they like you, if you have a good bedside manner. I know that sounds horrible. I'm glad I'm old because I can say these truths. If I was young, I couldn't say that. But it's true. I mean I, I do these cases and they'll say they sue everybody, but they'll say, don't sue my family doctor because I like him and the lawyer will say, you got to sue everybody because they'll just work each other and get you. You've got a blanket, sue every, they even do a John Do sue, whoever was in the operating room.
So the lawyer doesn't get sued because he left someone out. So if they like you, so be nice to people. Don't come to work tired and crabby. Don't come to work if you have a cold or the flu, - take the day off like the rest of the world does. Because that doesn't count. You can't say to the judge, Oh, ‘I felt lousy.’ It's just like a pilot says, ‘I'm sorry I had diarrhea today and we crashed the plane.I sorry about that folks.’Well, just don't show up for your flight. So,so be nice to people.
Charting is 99% of complaints and malpractice. If you didn't chart it, you didn't do it. And I'm a terrible charter, so I can speak like you're- I'm a reformed hooker talking here. I'm a whore. I used to chart in emerge like a happy face with like, hree stitches on a scar here.
So I've had to learn how to chart and I use templates and stamps and once again, they're in my book -how to do that , and the college endorses that. As long as they're not checklists, you have to fill them in and it's like the Rourke baby for everything.
So, be nice to people, chart a for sexual stuff, always have a chaperone and I can do that as a solo GP with one secretary. So my secretary, if I have an intimate exam, breast or pap smear, I'll just say to the woman, okay, put on these gowns and drapes. And then I leave and I bring my secretary back in and she's got her Madonna phone on, so she's still on the phone and she's up there helping a woman and handing me stuff in that and still running the office. So you can do it with one secretary.
You can't say, Oh, I'm a solo GP, I have nobody to come in and chaperone me. And so that's the kind of stuff you've got your secretary,for, a female in there with female patients and, and if you're a male or if you're a female doctor and you're doing with male, I don't know what they do. You'd have to ask a female doctor, I guess you'd have to get a chaperone of the same sex. So, when you read that Dialog, (the magazine of complaints against doctors) as we all do. All the poor people that got nailed in the college. A lot of the people I work with that got get into trouble with the college as they get spread too thin. They're running three clinics and they're exhausted and they're running around in their charting badly and it looks bad. So, stay focused, just run one clinic and do a good job there.
Don't get spread thin, that's the one thing I'm seeing. And once again I was like that. So I'm good at this because I was like that. So I've been bad. And then I've had to teach myself how to be good. I'm not some guy on high crapping on you saying I'm the wonderful professor, I've always been perfect. I have been you. I've had four jobs at once. Trying to get two kids through university, pay off a mortgage, and got in trouble.
I flunked a peer review at my nursing home and I had to get religion, I thought I could lose my license here. Like talk about scaring the hell out of you. And I did, I changed. I quit my job at the hospital. I quit my job at the retirement home. I focused on the nursing home, did better charting, had more time for it.
I brought my tricks to play. I was rushing, I was running around not charting and they just look at the chart. So you could be the greatest doctor in the history of the world. If you don't chart it, it's just your word against theirs.
Lalit: Those are all really valuable and good, good common sense. And common sense is often very uncommon.
Dr. Crosby: So to reassure doctors in your audience, they're not looking. The college and judges and juries and malpractice and CMPA are not looking for some star. They want an average competent doctor and that's it. They bring in another family doctor to critique you or to support you. It's your peer. It's not, what would an internist do with a heart attack or what would a neurologist do with a headache? What would a good family doctor do? Not a brilliant family doctor.
Not a genius to, so we don't have to live up to some….you just do the best you can. They know we have 10 minutes per patient. You can't, you can't pick up every zebra that runs down the hallway, but you want to say, if I don't know what the Zebra is- I will refer it to an internist who will tell me. You don't just say, I don't know what your zebra is - Take a hike! I don't know why you're losing weight- Beat it, I can't find out why you're losing weight. You say-I've done a CAT scan of your abdomen. I've done labs- I'm going to send you to an internist, like cover your rear end. I don't know why you have fatigue. I'm going to send you to an internist. It may just be stress or depression.
I don't know why I have night sweats, it’s good for the patient. Good for you, good for the CMPA. Win, win, win, win, win. It's the doctors that go,- ‘I don't know why you have night sweats- take a hike. That's when they find out they got lymphoma or sarcoidosis or something or typhoid fever or malaria. They're the guys that are in trouble and they get sued and they get successfully sued because a peer like me comes and says, I would have referred that patient. Right?
That doesn't cost me any money. Or any time I can refer with one keystroke, what does that cost me?
Lalit: I've had patients who should have been referred and I've seen them in the emergency room and, and patients have said, I've asked my family doctor to refer and they haven't (or won’t).And I said, well, we'll send a referral over.
Dr. Crosby: I don't understand the thinking behind that, even when patients say, could you refer me to..., because it doesn't cost you anything. I'm, I'm very supportive of doctors. I think doctors are number one. If we have good doctors, it's good for patient care. Like I'm the most pro doctor in the world. They're my friends. They're me. I rarely criticize them, but that's one thing I criticize when a patient asks for a consult, even it's a stupid idea. Why would you fight it? First of all, it's easy. Like, bye bye. You're done. And second, why would you antagonize them if something goes wrong, they're mad at you and they're going to sue and complain about you. Like please somebody out there, tell me why you're, you're not saving the taxpayer any money.
Because they're going to go anyway and they're going to go to an emerge for 300 bucks and the lawsuits and everything are going to cost millions of dollars. So really, somebody please in your audience, tell me. I had one case where I had a guy asked for for a consult, He was a, a rock and roll singer, smoker and everything. He had a hoarse voice. And I said, it's because you're singing and smoking. And he went to an ENT, said the same thing. So he wanted a second ENT and then a 3rd and So I finally stood up and said, “this is a ridiculous abusive”. He’ still my patient still still horse, still singing. So, so that's once in my entire life where I stopped a stupid consult.
Lalit: I really do think that the one thing I always keep in mind is “what would I do if that was me, my family member, my child, my wife, my sister could, I mean, I don't have a sister, but you get the idea. That's a great way to live your life, then I take the appropriate steps and I think that has always served me well.
Dr. Crosby: That's a great idea.
Lalit: I want to ask you a few fun questions. - do you have any pet peeves?
Dr. Crosby: Yeah. Wait Times in Canada, that's the worst thing. And I did a blog about medicare for all because the Americans now are all the Democrats are running on Medicare for all. And I always say, pack a lunch because when you have a free system, you're going to have wait times. You have a free a restaurant, guess what? It's going to line up out the doors. And the wait times are worse now than they've ever been in 46 years. We have a 14 month wait for gastroenterologists and Cambridge, which is an hour from three huge teaching centers, Toronto, Kitchener and Hamilton and London so that's ridiculous and disgusting and as a Canadian shameful. And I don't know the answer to that. And it's not throwing more of my tax dollars at it, maybe getting more efficient, but that's my only beef with the Canadian healthcare system. I think it's a pretty good system otherwise, but it's horrible. I'm sure it's worse than Chatham.
Lalit: Well, yeah, every city, every town has that issue, I'm sure. So here's a fun question... what do you have a motto or a message that you would put on a billboard
Dr. Crosby: I wrote it here? Because I wanted to get it right. Yeah. Doctor burnout is, preventable and treatable. And the reason I say that is like most doctors just give up. Like half of doctors are burned out in the entire world. It’s worse in the United States because they have to work for companies and they have more malpractice. So American docs and they have a lousier computers. So American doctors are even worse off than us, but we're pretty bad. And Europe is terrible in England and Japan. It's a horrible problem everywhere, in the entire world. And, and doctors just accept it, they, they just go, ‘I'm just gonna plot away and then retire.’ And what a horrible way to live your life. Like I love, I can't wait to go to work tomorrow. When I'm on vacation, I can't wait to get back to, I love this job.
It's never boring because I have practiced what I preached. I used to be burnt out and I fixed my burnout. So you can prevent it if you're a medical student or a resident or a new young doctor. Even if you're a middle aged or old doctor. I've had 65 year old doctors come up to me, I had one come up to me on a cruise ship in the Caribbean. He was from Sarnia, he was a pediatrician from Sarnia and he had been on call for five years, 24/7 365 every single second for five years he'd been on call. Wow. Like that's torture. I mean that is torture. How good can you be as a doctor? His wife had to march into the CEOs office and say, what does it take to get another pediatrician in this city? And all of a sudden they found some money to hire fellows from Western to come out from London to help.
But if they hadn't complained, they would have killed that guy. So you have to stick up for yourself. No one's going to look after you. You, you will get no help even from your spouse. And friends. The only people you have is you. That's the only person. And people like me and you, we're happy to help out your fellow doctors, but no one else. Everyone else thinks you're rich and you're not going to get any sympathy from anybody. Why should you? Do you sympathize with teachers who make $100,000 and get July and August off? Nobody does. So that's the way they think about us. They all think we make a million bucks and we're idiots. So, you have to look after yourself and put yourself. So it is, burnout is preventable. And it's true. Once you get it, you can treat it. It's a fixable disease.
It's not a terminal diagnosis.
Lalit Chawla: , one final question. What book other than your own, have you gifted to other people or I really liked
Dr. Crosby: Books by Atul Gawande, He's a surgeon from New York City. A wonderful writer and writes for the New Yorker, New York Times and he's written a whole bunch of books. I urge you to Google him buy all his books. He really can talk like a doctor, but he's a good writer too. And that's hard. You have very few people are skilled at being both. He really gets the feeling out there of everything we do. And so I've gifted that to a surgeon. I have one buddy that's a surgeon and he never reads ever.
He's, he just doesn't read, which I can't believe. I mean I, I read everything from Mad magazine to the New Yorker and everything in between. I read the Sun and the New York Times to get the whole spectrum And The economist, The economist is a wonderful magazine, is very broad. It's not just about money and it's not just American, it's worldview and Atul Gawande is fabulous and I urge you, and I gave all his books to this surgeon buddy of mine. So that's the only time I've ever gifted a book Being Mortal, but he's written a whole bunch. And read them all. They're absolute already very agreeable doctor books.
Lalit: Nice. Well John, this has been fantastic. I thank you. How can the audience get ahold of you?
Dr. Crosby: You're welcome to use my private email firstname.lastname@example.org and just email me. I'll send you my ebook for free. I will send you links to my audio books for free. It's on time and stress and risk management. ,, how to avoid burnout, how to be a good time manager, how to avoid stress, how to avoid malpractice and college complaints. And there's a new book just came out called ‘TheKindly Country Quack’ and it's all a best of my blogs and lots of Nice pictures in it too.
I also offer free mentorships too, which I've done with 63 doctors from across Canada and no matter where you are in the world, what we do is we just talk on the phone at time that's convenient for both of us. So, 8-9 am in the morning because none of you have any time to do this. That's the big problem. No one has time to be on time. So they'll say, I love your ideas but I don't have time to read your book so you can listen to it while you're driving and you can, while you're munching your sandwich at lunch between patients.
We do sort of a personalized mentorship. I just had a doctor write to me last week saying she was tired, and went to her accountant and wants to quit and when can she quit? She's been in 20 years and he said, you have to work another 10 years to afford it financially. What a sad way to be. I mean, you don't have to be like that. I said to her, you have a treatable disease. Let's treat it, but it's going to require change is hard and it takes a while to change things.
Lalit: Dr. Crosby, I want to thank you and I look forward to your future articles are in the Medical Post and this has been a true delight so thank you.