Intro

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Welcome to the Five Codes Podcast, where we discuss evidence-based methods to elevate yourself to the next level through optimizing the way you look, move, perform, feel, and connect. In this week's OR Diaries, I want to put a social lens on the people who support my patients as they come in to see me. I have this very interesting and unique practice where all of my patients are traveling in from all over the world to see me. We have that process very dialed, very frictionless. We have retreat homes our patients stay in, but one of the fun aspects of that is that somebody comes with them. My staff tends to go home with them after surgeries, in those first few days where things are really needed, but that care person, that support person is with them the whole time they're here. I usually tell my patients to have that be a spouse-level person, somebody that you don't have to entertain, somebody that you can just be yourself around. But there are exceptions that happen to this rule. And sometimes those exceptions are very, very memorable. In my head, just off the top, I can think of everything from somebody coming with their current girlfriend and their ex-girlfriend, both as sort of overlapping and semi-simultaneous support people, which is a whole story in and of itself. I can think of people, this is a fun one, who met online, and one of the people knew a lot about me and the other one did not. And they sort of like, you know, chatted about me. And the one who didn't know much ended up coming for surgery after kind of learning and diving in, and the support person ended up being the person they'd met online. So the first time they ever met was here, right next to where I'm sitting. Um, and a whole story around that, their first encounter in a very vulnerable situation when one person's post-operative. Um, but the one that I want to focus on today uh is sort of unfolding this week for me right now, as I'm out of the operating room for the week and kind of reflecting back.

Today’s Patient

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I have a patient who's here right now, lovely patient, super awesome, great relationship with her. Um, and her best friend came with her to support her. So her best friend is also lovely and had a recent procedure with one of her local surgeons. Her friend knew about me, knew who I was, but uh ended up having surgery at home for you know a multitude of reasons. We all understand why that happens. Um but now she's here with her friends supporting her. And it when I first met them, it was a really fun interaction. Uh, but as the week has unfolded, even in that very first meeting, I started picking up on these little uh, you know, your spidey sense goes off. Your little social and emotional intelligence starts clicking in, and you're like, there's some funny things happening here, just like little comments and actions from the support person, from the care person at literally every stage of the interaction throughout the week. You know, we see people a lot uh in the time that they're here from before surgery. Oftentimes that pre-surgical meeting for me on the day of the procedure can be three hours long sometimes. It's a it's you know, it's not a high-five go-to-the-operating room situation. It's a very in-depth going over things, nuances, details, bonding. It's kind of like a first date. Uh, but in this case, it's a first date with somebody else there who had surgery with somebody else, uh, which becomes important because I was picking up on these things that I'm like, this feels like this, like almost like little internal like jabbing. And, you know, I sort of sort of realizing over time this is like care person sabotage happening here in this funny way where um she, the support person with her friend who's having surgery is creating on purpose all of these little, I don't want to say on purpose, it's subconscious probably, all of these little uh areas of doubt um and all of this little negativity that's going into it. So I took that interaction and you know, went through my surgery and my flow state, got everything done. But then throughout the week I've been reflecting on a little bit and become honestly quite curious about like what's happening here, what's going on? I love, love, love thinking about cognitive biases, how humans make decisions, why that we do the things that we do, which has so many uh aspects to it, but cognitive biases are a key part of this. So um there's a few particular sources and books that I love, and I start kind of digging into this a little bit. And this turned into a fun journaling exercise for me this week is like, what is happening here? And doing a little research on it and you know, kind of fueling my own curiosity uh and growth anyway with it. But I wanted to share some of those with you. I actually took notes on this to share with you. And as I kind of dug into it, I thought I found six key cognitive biases that are probably at play in this sort of unique situation where, again, somebody had surgery with somebody else, and now they're with their friend who is very excited in a very important moment in her life, creating a very key relationship with me. And they're on the sidelines managing that basically. Like, what does that look like for them? And so here are the six. Some of these you'll have heard of probably, and some I were even a little bit new digging into me. Um, and the first

Reducing Cognitive Dissonance

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one is this idea that I talk about this often, just a reduction of cognitive dissonance, friction. And this is when that person is exposed to a different approach or a strong outcome, it creates an internal tension inside of them. And our brain tends to resolve this by finding flaws or reframing what they're seeing in front of them. So she sees, she made a different decision, she sees this happening, it creates an internal friction. And so her initial reaction is to find flaws, basically. And I will mind you, just to interject here, I when I say that process is frictionless, this is a very next level experience when you're here. There's, you know, I'm not saying everything is perfect, and but finding flaws takes effort to do, really, right? So this is as subconscious as it is, it's it's a force

Choice-Supportive Bias

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to do that, right? Uh then there's this idea of this choice supportive bias. This one really hits. After someone makes a high-stakes decision, especially around their face or their identity, we know how key those are tied to one another. The brain starts reinforcing that choice. The alternatives to the choice that were already made are not viewed neutrally, they are downgraded. So there's protecting, quite literally, uh identity here. Uh that I you she's connected to the identity of what she did before. Um, so I thought that was really uh that one really tied on to it.

Social Comparison Threat

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There's this idea, you know, and it'd be interesting to see how much this really plays into it, but this idea of a social comparison threat. When you see somebody else with a great result or having a great experience, it can feel like a quiet threat to the outcome and the experience that you had with the decision that you made. And one way that the brain restores balance is by minimizing or criticizing the comparative alternative, the other decision. That seems to hit here for sure, um, you know, whether consciously or subconsciously on that social level.

Projection

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Here's one we've all heard of uh projection, simply um any uncertainty or dissatisfaction that the caretaker is carrying uh doesn't stay internal inside of her. This is the projecting out. It shows up of criticism, as criticism of um her friend, actually. I've seen that. The process, um the results, anything, any aspect of it helps to helps to relieve that internal uncertainty or dissatisfaction.

Confirmation Bias

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Uh this one we've heard of, or a lot of us may have heard of this. This is a simple confirmation bias. Um everything that she's seeing is not being uh processed evenly because she's screening for details that support her previous decision. This she wants to feel like she made the right choice. Um, and so she'll find things that support the previous choice, and she will overlook things that conflict with that, whether that is an incredible result and an incredible experience, she'll that will get overlooked and said to be focusing on anything that supports

The Sour Grapes Effect

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her previous choice. And then this one I thought was really fun and unique and new, and I had not heard of this one, admittedly, this idea of a sour grapes effect. If you cannot go back and choose differently, the brain protects itself and your identity by lowering the value of the alternative. It's sort of a built-in way to reduce regret for the decision that you made when you know that the other one may be superior. And I'm not saying that's what's happening here,

Outro

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but um all of those sort of go into uh this, you know, they all kind of play on these little interesting aspects I've seen of this caretaker towards her friend as she's having this, you know, big event. Um and it just kind of fit into this fun and interesting. When I say fun, it's like from a curiosity standpoint, this fun and interesting spectrum of caretaker or care person experiences that I've had in my career. This is a very new one. I've never felt this sort of internal sabotage before in the same way. And again, usually it's uh a spouse level, a best friend, a sister, uh, who maybe doesn't have that other competing decision that was recently made where there is internal friction or identity challenge or social comparison, whatever it may be. So I'm just sharing my uh curious exploration with you with some fun stories around what it looks like. But I think the take-home message here is um it's a beautifully uh oiled process of coming here and bringing your caretaker. My team helps with the parts of it that are very medical, um the parts that are that take that deep knowledge that they have. They've seen this hundreds or thousands of times, depending on who it is, and they've been through this, they know what to expect with you when you come. Uh, the interesting part is who you're bringing with you and how they're supporting you. They're really just a support person. They're doing no medical care, they're not changing dressings, that we're doing all of that. You're with us a lot of the day in our in my optimized recovery protocol. We're talking like five hours a day, you're with us. So you may come in in the morning and start your recovery protocol and knock at home until the late afternoon. But from that point on, you're with your care person, your loved one. And that is a really important uh aspect of support into what goes into it. Interestingly, the most common phenomenon, honestly, is most of the caretakers. This is probably should have mentioned this earlier, most of those caretakers end up becoming patients down the road. Uh so this situation is very flipped for me where this person already had a very recent procedure. So obviously not going to become a patient, but um, you know, normally it's the other way around for me where the somebody who gets so immersed in the process ends up coming back and doing it themselves, which I think is sort of the ultimate complement in all of this for me. But this was a a fun um sort of alternative to that and really turned my brain on. So uh thanks for listening and for your interest in it. And I hope you learned something about uh thought models and cognitive biases within that as well. If you have any questions or topics you would like me to explore further, please leave them in the comments. I read them all and they often help shape the future conversations here. If you would like to learn more about my surgical practice, you can visit clinic5c.com where you will find additional information on my approach to surgery, recovery, and performance focused care. But I also want to be clear that the views shared on this podcast are my own and are not associated with or representative of my clinical teaching affiliation with the University of Washington School of Medicine, nor should this be taken as individual medical advice. Thank you for spending your time with me. I appreciate you being here, and I will see you on the next episode.