See, Hear, Feel

EP51: Dr. Misha Rosenbach on emotional intelligence and life lessons

March 01, 2023 Professor Christine J Ko, MD Season 1 Episode 51
See, Hear, Feel
EP51: Dr. Misha Rosenbach on emotional intelligence and life lessons
Show Notes Transcript

Join me in a casual conversation with Dr. Misha Rosenbach, where we cover games, emotional intelligence, diagnosis, doing your best, and mention some great books (Think Again; Thinking, Fast and Slow; Children of Time; Stolen Focus). Dr. Misha Rosenbach, MD is Vice Chair of Education, Director of the Cutaneous Sarcoidosis and Granulomatous Disease Clinic, Dermatology Residency Program Director, and Associate Professor of Dermatology at the Hospital of the University of Pennsylvania and in Medicine. He attended Cornell for medical school and completed dermatology residency at the Hospital of the University of Pennsylvania. His passions include complex medical and inpatient dermatology, and he has published over 100 peer-reviewed articles. You can find him on Twitter @MishaRosenbach.

[00:00:00] Christine Ko: Welcome back toSEE HEAR FEEL. Today, I'm happy and excited to be speaking with Dr. Misha Rosenbach. Dr. Misha Rosenbach is Vice Chair of Education, Director of the Cutaneous Sarcoidosis and Granulomatous Disease Clinic, Dermatology Residency Program Director, and Associate Professor of Dermatology at the Hospital of the University of Pennsylvania. He attended Cornell for medical school and completed dermatology residency at the Hospital of the University of Pennsylvania. His passions include complex medical and inpatient dermatology, and he has published over 100 peer-reviewed articles. You can find him on Twitter @MishaRosenbach, and I'll put a link to that in the show notes. I'm just so pleased that he was willing to join me. Welcome to Misha. 

[00:00:42] Misha Rosenbach: Thanks so much for inviting me. I'm really delighted to get to chat with you. You do great work. And that was a really kind introduction. And for the listeners, I will say Christine sent some questions in advance and it freaked me out at how complicated they were and how hard they're to answer. So I'm really looking forward to see how our conversation evolves here. 

[00:00:59] Christine Ko: I will say that you answer difficult questions all the time, it seems, at the ends of lectures and in the papers that you write. So I think you're gonna wow us all.

[00:01:10] Misha Rosenbach: I'll give away one of my secrets. When people ask you hard questions, you just answer the question that you wish they asked, and try to make them forget the question they actually asked. So we'll see how that goes on your podcast. 

[00:01:19] Christine Ko: That's awesome. Yeah. You can answer the question you think I'm asking. All right, first off, can you share a little personal anecdote about yourself?

[00:01:27] Misha Rosenbach: I saw that question, and I was hoping that you'd forget it. I'm pretty boring. I'm a nerd. I like what I do, and I spend a lot of time doing what I do. Hobbies evolve over time, and I have kids, and my hobbies evolve based on their hobbies. I will say that this is the golden age of board games. And if I'm saying this to podcast listeners and they're like, wait, he likes Monopoly, that means you don't know what we're talking about. The gateway drug to interesting board games for most people is Settlers of Katan. There's this whole bunch of Euro games and strategy games; things that make you think and allow you to engage different parts of your mind are always worthwhile. And I read a lot, Derm and not derm.

[00:02:01] Christine Ko: Can you also mention one or several books that you really like? 

[00:02:07] Misha Rosenbach: Oh gosh. Children of Time, which is a vaguely realistic sci-fi, with a bunch of crazy elements, by Adrian Tchaikovsky. It's very cool. It's about future humanity and evolution and time and space and, I don't know, there's like intelligent spiders and stuff. It's very interesting. 

[00:02:23] Christine Ko: Cool. And then non-fiction, you like as well? 

[00:02:25] Misha Rosenbach: Oh, Think Again by Adam Grant. That's relevant to this podcast. Stolen Focus by Johann Hari about how the internet is taking us away from stuff and traps us into things. Reading's important. 

[00:02:35] Christine Ko: Yes, I'm with you. What is a lesson or lessons that you wish you had learned earlier? 

[00:02:41] Misha Rosenbach: I think I've mellowed quite a bit and gotten better at emotional intelligence. I used to get frustrated very easily and be very quick to anger. I demand a lot of myself, and I demand a lot of those around me. Sometimes it's easy to get frustrated with folks. It's important to know that generally everyone's probably trying their best, and if someone's not doing their best, maybe it's not because they don't care or they're not trying, but maybe they have something else going on, or they're having a bad day, or they're stressed about something else or distracted about something else.

[00:03:06] Basically everyone warrants your best effort. The patient in front of you, they need your help, and you should give them your full effort. And I think about that a lot for, on inpatient consult, where other teams are calling us for help. The truth is there's a patient, and your colleagues don't know what to do, and they're asking for your help. This is basically trying to think positively about everyone and assume everyone's acting with good intentions and doing their best. 

[00:03:30] Christine Ko: I'm like you in that I was very much quick to frustration and anger when I was younger... can still happen, especially at home where I have less control than at work. One of the major things I've become more aware of with thinking about emotional intelligence and thinking about my thinking is just as you just said, to try to have the habitual, the instant, fast thinking part of me think, okay, let me give this person the benefit of the doubt, rather than whatever other story that I've made up that reflects badly in some way. [Yeah.] Like, they didn't try, or they don't respect me, or they're not even willing to listen to me. Like, why should I listen to them? Yeah. That's great. I'm with you on that.

[00:04:16] How do you define and use emotional intelligence? 

[00:04:21] Misha Rosenbach: Okay. You know what I will say that I get asked, how do you define this? The truth is I don't always think about the actual textbook definitions of things. I think it's more practical. I think about emotional intelligence as the ability to interact with different people in different settings and to have an innate ability to build rapport or understand non-verbal cues and subtle shifts. 

[00:04:38] As a physician, you're often catching people in a vulnerable time or at their worst, or when they're scared. And they might not be comfortable opening up and admitting all that. And you have to have the cues to pick up on that. We also work in a team environment. And if you're not getting that someone's stressed or someone's sad or someone's down or someone needs help or when someone has an issue and you maybe get pulled in to cover them. If you don't have emotional intelligence, you might not be able to build rapport with your patients or interact with different types of staff or staff from different backgrounds or with colleagues, in different settings.

[00:05:11] To be really great, you look at people who are able to pick up on cues and handle the social emotional aspects of interpersonal interactions and not just the pattern recognition and algorithmic approach to medicine, both of which are important. I think you have to be able to do both, to be really great. 

[00:05:28] Christine Ko: I'm still definitely working on it because I grew up without ever having heard of the concept of emotional intelligence. I really wanted to be a doctor. I was very narrowly focused. The clerkships was when things really, in some ways, fell apart for me because I just couldn't understand the colleague to colleague interactions and interactions with residents who are above me and like, why did she just do that? I was just really confused and lost. 

[00:05:55] Misha Rosenbach: I always think that we pay a lot of attention to, like, studying and learning; we do unknowns and kodachromes, right? And we always joke that when you get one wrong, you remember that one really well. But we don't necessarily say, when you get one emotional interaction wrong, do you remember that and grow from it? I bet you do. If you like look back and think about it. If you have a really great social interaction where you pick up on something or you get some patient to come out of their shell or you clearly make someone comfortable where they weren't in the past. I think that should get the same type of praise and feeling good about it that you get for acing your test.

[00:06:24] Christine Ko: Yes. You are so wise. Your answer touches on the reason that I'm doing this, because I think if we just take the time to think about even just one of our interactions and think about how we could have done it better, whether it's a patient one, or one with a colleague, we'll learn from it. It really works. Like even me, I can learn this stuff. Awesome. 

[00:06:47] Misha Rosenbach: It's so interesting to talk about these things cuz I think a lot of these things just happen, and you don't necessarily stop and process. It's interesting cuz people study for knowledge, right? You'll cram for a test or you'll work hard at memorizing the algorithm or the second line treatments. Or people exercise physically, right? You'll go to get in better shape or whatever your motivation is. But I don't know that people necessarily devote conscious time and effort to emotional intelligence improvements or thinking about metacognition or thought processes. 

[00:07:13] Christine Ko: When you were saying, when we get things wrong, like when the teacher asked us something and we got it wrong, we're like, oh my gosh, I got it wrong. I remember I would feel shame or ashamed or embarrassed or whatever, but I would quickly turn away from the shame part, but I would be like, okay, the right answer was this. I wouldn't really think about the emotional part, but I would be triggered enough to be like, okay, well, I want to know the right answer, and then I wouldn't forget that right answer again. Through this podcast, when I've been speaking to people about shame in medicine, specifically, I realized there's so much shame in medicine. Say, when I fail at a patient interaction, when it doesn't go as well as I could have done, if I would reflect on it, like you just said, I could think, well, what went wrong? and what was the problem? There's not really a "right answer" in such a situation. So I turn away from it. So how do you hone your visual perceptive skills and related to that, how much do you think for yourself, is it talent versus hard work? 

[00:08:12] Misha Rosenbach: Some people learn better by reading or hearing. I do think that's important for people to realize what works well for them. Some people can sit and look at a textbook and absorb it. Or some people can hear a lecture and really learn a lot. I used to have one of my clinics where I had residents and one where I didn't. And where I had residents, sometimes they'd see a patient and write most of the note and then present. And sometimes in my own clinic, I see a patient, write the note, and I knew my patients where I wrote the note a lot better than if the resident had written the note, and I co-signed it. I realized part of it's that I had to process what my patients were saying and put it into my own words and put it into writing. The act of listening to a lecture or reading a book, it's different if you take notes and write things down. It's important for people to know how they learn best. I think most dermatologists tend to be visual learners or have a good visual memory. A lot of things can be learned, but I think we all encounter a student or a resident who struggles. Trying to help people bridge that shows different processes that people think through or different ways that people learn things. 

[00:09:06] Christine Ko: Related to what you said, do you have a diagnostic process? 

[00:09:10] Misha Rosenbach: That's a complicated question to answer because I also think it evolves over time. As you get more senior and experienced and you've seen things, sometimes you can just make a diagnosis. But I do think as you listen to residents or students present, it starts to form a picture in your mind, right? A good presentation should have relevant pertinent positives and pertinent negatives. And it should show your thought process, right? It's like a math problem. You should show your work. Even if you don't get the right diagnosis, you show that you thought through it correctly, right? In terms of diagnostic process, I think in dermatology, we build a visual library, and sometimes that is very helpful. But we always talk about, be careful of underdiagnosis or overdiagnosis. And there's Bayesian probability, right? What's your pre-test probability? What's your post-test probability? And that ties into never do a test unless you're willing to act on the results, right? Being willing to go back over time to reconsider what you came up with originally, I think is very important. 

[00:09:58] Christine Ko: I love it. The last thing you said about being willing to reconsider touches on my next question which is how you minimize diagnostic error?

[00:10:09] Misha Rosenbach: Really good clinicians are part of a team and know who they're working with. If I have a really hard case, I might send it to a specific dermatopathologist. There is a difference between some pathologists, and there's a difference between some labs. Knowing who you're working with on a case or which consultant you're partnering with. I'm fortunate cuz I work in the academic medical center where we have really smart residents and medical students and colleagues. If there's a case and it responds, great. If there's a case and it doesn't respond, I'm very quick to rethink it or present at conference. There's always some derm resident who's helping me. Sometimes they'll ask a question that unlocks the answer. You have to be relatively pride free. You can't fall in love with a diagnosis. A very wise dermatologist, Warren Heymann, said, The worst thing you can give a patient is a diagnosis because then you stop thinking. The mistake that a lot of people make early on in their career is you get really attached to the cool diagnosis, and you ignore the things that don't fit with that or really hone in on the one or two things that do fit with that. In the moment, you're going fast, and you're only human, and you're not gonna remember everything for every patient. Rethinking things, being pride free, reassessing things if they're not getting better, and not being afraid to ask for help. 

[00:11:16] Christine Ko: I love it. Rethink, reassess, ask for help, and be part of a team. Really great. Do you have any final thoughts?

[00:11:25] Misha Rosenbach: You touched on books and reading and there's actually like a bunch that are great about thinking or about emotional intelligence or about leadership or about education. There's that one by Daniel Kahnemann. Should there be more focus on how people think and how people learn and how you can improve yourself over time? I don't know that anyone's really talked about it. So your podcast is great. Everyone should listen to it. 

[00:11:43] Christine Ko: One of the central problems is there's not enough time in a medical school curriculum or a residency curriculum for all the things that they need to learn, that I need to learn, that we need to learn. People will say you can't devote time to X, whatever X is, because we don't even have enough time to address these crucial things like the heart and the lungs. 

[00:12:07] Misha Rosenbach: The heart and lungs are important cuz they provide blood and oxygen to the skin. Just to clarify, right? 

[00:12:11] Christine Ko: Yeah, that's right. The lesson that I think I've been learning continuously and why I keep doing this podcast is that this stuff does deserve my time. It just resets me a little bit to put priority on this stuff. Probably more than 75% of my life, I was much more focused on just like the hard knowledge and not thinking about how I think. And the fact that when I make a diagnostic error, of course, I don't know that I'm making it, otherwise I wouldn't do it. Oh, that's an error. I'm not gonna do it. By improving the way I think, just like the way we know that we can improve the way we see and observe, because we see residents. They're vastly different in the way that they can observe and make diagnoses on what they see on the skin from when they're a first year to a third year. 

[00:13:03] I'm a slow learner, but I realized, oh, it's practice. It's creation of habit, it's creation of Daniel Kahneman System 1 versus System 2, and really making things become "expert". I can make the inner workings of my mind better by talking to people like you, figuring out how you do it, and maybe I can take at least some of what you say and incorporate into the way that I do it. It's been such a pleasure to talk to you. I appreciate all of your deep thinking and consideration of these questions. 

[00:13:37] Misha Rosenbach: Thank you for inviting me and thank you for being such a great peer and colleague and role model and co-mentor. I'm glad that you have this podcast, and I'm glad you invited me on. It's been a real pleasure to get to chat with you. 

[00:13:49] Christine Ko: Yes, thank you.