EP154: Navigating Soft Skills: Insights from Dr. Maxwell Fung

The Intersection of Dermatopathology and Emotional Intelligence with Dr. Maxwell Fung

In this episode, Christine welcomes Dr. Maxwell Fung, a seasoned dermatologist and dermatopathologist, who shares his insights from over 25 years of experience. Dr. Fung discusses pivotal 'soft skills', such as communication and active listening, that have shaped his career. He also delves into the challenges of error and lifelong learning in the medical field, and addresses issues of burnout and thriving within a demanding profession. The conversation explores mindfulness, perspective, and emotional intelligence as essential tools for maintaining professional and personal well-being.

00:00 Introduction to Dr. Maxwell Fung

00:05 Dr. Fung's Career and Achievements

01:27 Soft Skills in Medicine

01:48 The Importance of Communication

03:46 Learning from Mistakes

06:02 Dealing with Burnout

08:10 Mindfulness and Perspective

09:59 Final Thoughts and Reflections

Transcript

Christine Ko: [00:00:00] Welcome back to today's episode. I have the honor of speaking with Dr. Maxwell Fung. Dr. Fung is a dermatologist and dermatopathologist and has been practicing for over 25 years. He was junior faculty at the University of Connecticut before becoming the Founding and current Director of the UC Davis Dermatopathology Service in 2003 and Professor of Clinical Dermatology and Pathology at UC Davis. He served as the first Executive Vice Chair VC Academic Affairs in the dermatology department at UC Davis and has served many local and national organizations, including the Test Development and Advisory Committee, abbreviated TDAC, for dermatopathology which serves both the American Board of Dermatology and the American Board of Pathology. He's also served the International Society of Dermatopathology and the American Society of Dermatopathology. He currently serves as President Elect of the American Society of Dermatopathology. He is [00:01:00] a prolific author and has published over 140 original manuscripts and chapters. He's given over 140 invited lectures at national and international meetings, and he enjoys spending time with his wife and three children; playing tennis, guitar, piano, dabbling in photography, and recently golf.

Welcome to Max.

Maxwell Fung: Thank you, Christine. It's a real privilege and honor to be here. 

Christine Ko: I'm glad that we could do this together. I cover emotional intelligence and other things sometimes in this podcast. I include emotional intelligence as a soft skill. What "soft skills" have helped you in your career? 

Maxwell Fung: I'll confess. I had to look up "soft skills" on the internet just to make sure that I was in the right range. There are a variety of soft skills. Some of them have been more helpful for me than others. The first one is very basic: communication skills, both written communication but also, in person verbal communication. I probably came [00:02:00] to value the importance of written communication first. Email is a primary means of communication, which of course is a type of written communication. I feel like perhaps I'm slower and spend more time on my emails, but that also is good for communicating effectively. Some of it's just the art of using the system, paying attention to who's getting the email, who's getting CC'd, conveying information to the people who need to respond, but also keeping other people in the loop, that type of thing.

Perhaps another soft skill is just being able to listen. I'm definitely not always the best listener for sure. But at times when I've been able to listen, I've been appreciative of rare, but perhaps very valuable, points of feedback that I've received from people. And this is typically unsolicited feedback. If you get unsolicited feedback from someone that has no special interest in boosting you up in any way, that's something that's probably worth paying attention. 

Christine Ko: Well, listening to you say that, it's interesting. I throw that term around, [00:03:00] "soft skills", but I've never actually looked it up. I just assumed that I know what it is. I guess I think of soft skills as not traditionally offered in high school as a class.

Maxwell Fung: At least for me, writing and then speaking were things that I didn't really have a lot of confidence in early on. Really only after becoming an attending and working for decades have I started to feel like I've reached that comfort zone. 

Christine Ko: I like it that you chose communication. A lot of my job is about communication, communicating a diagnosis, talking to patients, talking to colleagues, talking to people at meetings. I'm going to move on to another question. What do you wish you had known earlier?

Maxwell Fung: One of the first things I thought about was more related to work. So I wish that nevoid melanoma that saw me before I recognized it for what it was... I wish I had seen that, I wish I had known that [00:04:00] earlier. But very, very literal.

Christine Ko: I am always wishing that I knew stuff already. Why couldn't I have known that a second ago or five seconds ago or a minute ago or an hour ago, a day; for me, it has to do with error or mistakes. Not knowing something. It has to do with the medical culture of we're supposed to know everything, but we don't.

Maxwell Fung: Errors and things you wished you had known earlier are just individual examples of anecdotes that speak to the general principle that you can never know everything. You're going to have to continue that lifelong learning, but some junctures are more painful than others.

Christine Ko: There's so much medical knowledge exploding around me all the time. It is a little bit disconcerting. How am I going to keep up with all of this stuff? 

Maxwell Fung: I agree, Christine. The explosion in knowledge is definitely a moving target. It's much more efficient when you're at the bedside, when you actually have cases, but it's the [00:05:00] same principles. Repetition is what's going to make it intuitive. There definitely are those small number of inspirational moments that you'll never forget at a meeting or a certain interaction, but tends to be the exception rather than the rule. 

Your comments reminded me of another anecdote. You're asking me about error. There was another case that was also at the ASDP meeting. I was on the faculty for the Evening Slide Symposium, and I presented a wrong diagnosis. I didn't realize it until afterwards. A couple of people that were friendly to me came up to me afterwards and told me, No, Max, it's not that. It's this. It was embarrassing, but I was also very gratified that people felt comfortable enough to say that to me. When I went back to learn more about that entity, it was in my file. I had a hard copy file. I had a copy of the original paper on the entity. I just had forgotten that I had seen it. There's so much information, and you can only retain a subset of that. 

Christine Ko: Yes. You gave that one example of error and friendly people coming up to you [00:06:00] and, in a nice way, letting you know. My next two questions are related. One is about burnout which is, as I've talked about before on this podcast, a system problem. It's really not an individual problem, but in order to address it, often the individual has to do stuff; and thriving, which is the opposite of feeling burnout. Can you talk about burnout, if you've ever encountered it? And if you haven't, how have you thrived in your career?

Maxwell Fung: There probably have been moments in earlier junctures in my career, I probably felt brief moments of burnout, but overall, I think I've been quite lucky. I've been fortunate that I've been pretty much in a good place all of my career to date. Nothing's guaranteed, but I've been pretty lucky. So in terms of avoiding burnout, just in terms of basic things that I take for granted now, I would say that just doing your best to make a good career choice is probably a big thing. I'm just thankful that 30 years later, I [00:07:00] feel like it still is the best choice I could imagine for myself. People tend to be happy in our subspecialty for a variety of reasons. 

In terms of just day to day, by adulthood, if not earlier, you realize that you really have to look out for yourself, and your parents aren't going to be making decisions for you anymore. If you don't make the decision, most likely, no one else is going to be making those decisions. I do my best to take it upon myself to be mindful about burnout. I can still count on two hands the number of times I've said no to professional invitations, but I don't regret any of them. In the end, only I could decide for myself whether I already had too much on my plate, how much I was going to enjoy doing this commitment versus an alternative commitment. You just have to do that for yourself. There's so much out there online saying, don't worry about what other people think, just do your best to be at peace with yourself. I think that's made it easier, at least for me, to stay afloat. 

[00:08:00] And definitely health. So just being careful, getting enough sleep, trying to exercise, eat well. Little things add up in the long run.

Christine Ko: You said to be mindful. How did you become mindful? Were you always that way? 

Maxwell Fung: I've actually never consciously thought of myself as being mindful. Perhaps it's taking more of a long view. I put a lot of value on having perspective about things, having a perspective on life. You've got to be mindful to hold on to that perspective. 

Christine Ko: For most of my life, I would say, I don't think that I was mindful. I would be organized, and I was task oriented, and I still am. I'm driven to finish the tasks that I set up for myself, and I enjoy it. But to really be mindful of time, and perspective, and the future, and the present in relation to all of that.... 

Maxwell Fung: I was talking before about being mindful more at the [00:09:00] macro lifespan level. But on a day to day basis, I do have a little bit of an obsessiveness with time. 

The other thing is, because of dermatology, I became interested in photography. Early on when I was a resident, I invested in a nice camera that I paid for by hard earned resident salary. I took really good care of that camera. I started using it on weekends and for vacations and things like that. When you're a photographer, you step outside the moment, out of the moment. When you're with family and friends and things, as a photographer, you jump in and out. So you're in the moment, but then you jump out of the moment to try to get a good shot. I've spent enough time taking pictures that I intuitively can jump in and out of the moment. There's probably times in social gatherings where my wife would say, come on, get involved again, stop taking so many pictures, but it goes back and forth. 

Christine Ko: Art in general, whether it's music even, or, visual arts like photography; it changes our thinking pattern in our brain a little bit to be more mindful or present or whatever we mean that to be. Do you have any [00:10:00] final thoughts?

Maxwell Fung: It's generally true of people, and it's true of husband wife partnerships, and also, relationships at work as well, that when you're under stress, when you're overwhelmed, the stress tends to lower down your guard of professionalism and civility. I think that's natural. I think I was impressed most by that phenomenon as a medical student, actually. When people are under duress, sometimes, you sometimes see their true colors more. Sometimes that's good, but sometimes it's not. In the heat of the moment, that's where problems can escalate, but if you keep in mind that this is what's happening, then I think it's easier to deal with and not let it upset you so much.

Christine Ko: Yeah, you're absolutely right, when we're stressed, we just have less resources right to behave like a ideal person. Maybe ideally part of medical training is trying actually to learn how to still put your [00:11:00] best self forward, even when you are stressed; although unfortunately, sometimes the models that we have, like what we see, actually often is the opposite, right?

Where under stress people aren't putting their best foot forward. The modeling of really how to react in the best way possible when things are not going well in critical situations.... It's not easy to come by really great models and examples of that.

Maxwell Fung: And there can be generational differences sometimes in what would be appropriate or effective in terms of handling difficult situations.

There could be a situation where you became an imperfect human for one moment. And you said something. That's a learning opportunity.

Christine Ko: There have definitely been times where I have not been "good" in front of patients. Like you said, I'm only human. I've been more accepting of my shortcomings. I remember an [00:12:00] interaction of mine with a patient was not going well. And I remember I said, let's just restart. Let's just start over. And then it went better than it had been going. I can't remember if I was tired, hungry, stressed, maybe all three. But it was like, wait a second, neither of us are probably getting what we want. Me, to be able to help the patient with what they need, and the patient to get an answer for why they're there. I remember at first, I wasn't sure what would happen after, but it actually ended up making things better. Before I really started thinking about being mindful, I don't think I would have ever said that. 

Maxwell Fung: We're all human. The example you shared is a testimony to the magnitude of your emotional intelligence. Because when you're in the heat of it, and things are escalating, and you're in that positive feedback cycle, it takes experience to actually hit pause and say, hold on, let's try this again. And that's true not only at the bedside, but in all of life.

Christine Ko: Thanks for the the compliment. I'm big fan of [00:13:00] yours. I'm glad we got to spend this time together. 

Maxwell Fung: Thank you, Christine, for allowing me to be a guest. It's been a real treat and a new experience.

Christine Ko: Thank you.