S04E84 Neurosurgery, Leadership, and Innovation with Dr. Phil Stieg

In this episode of 'Botox and Burpees: The Surgical Series,' we sit down with Dr. Phil Stieg @drphilstieg, esteemed Neurosurgeon in Chief at Weill Cornell Medical Center in New York. Dr. Stieg shares insights into his extensive background, his leadership style, and his philosophies on patient care and surgery. The conversation covers a range of topics, including Dr. Stieg's unique approach to maintaining a world-class neurosurgical team, his methods for dealing with surgical stress, and his thoughts on the future of brain health.

Dr. Stieg also discusses his popular podcast 'This Is Your Brain,' providing a deep dive into fascinating subjects like nonverbal communication, the neurology of menopause, and near-death experiences. Additionally, they explore his involvement in Metaflix, a medical streaming app aimed at improving doctor-patient communication and education.

Dr. Stieg's story is not just about professional achievements but also about the humanity and ethical approach he brings to his work. His blend of technical expertise, emotional intelligence, and innovative thinking makes for a captivating and informative episode. Whether you're an aspiring neurosurgeon or someone fascinated by brain health, this episode offers invaluable insights and inspiration.

#NeurosurgeryInnovation #MedicalMentorship #SurgicalJourney #ColumbiaNeurosurgery #BotoxandBurpeesPodcast #LifeInMedicine #MedicalInspirations #FutureSurgeons #ResidencyLife #DoctorsOfInstagram #SurgeryEducation #podcast #plasticsurgery

00:00 The Stereotype of Physicians' Egos

00:58 Introducing Dr. Philip Stieg

01:54 A Unique Leader in Medicine

04:21 Dr. Stieg's Background and Achievements

07:18 Memorable Moments in Surgery

13:14 The Importance of Preparation and Visualization

16:10 Challenges and Rewards of Neurosurgery

19:10 Dr. Stieg's Podcast and Broader Impact

22:49 Leadership and Maintaining Excellence

27:40 Emphasizing Teamwork and Creating Lanes

28:24 Learning Leadership Qualities

32:17 Maintaining Brain Health

37:46 Future Goals and Metaflix

43:19 Advice for Aspiring Neurosurgeons

48:53 Concluding Thoughts and Gratitude

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S04E84 Neurosurgery, Leadership, and Innovation with Dr. Phil Stieg

TRANSCRIPT

[00:00:04] Dr. Sam Rhee: tThere is a stereotype out here that physicians have big egos. And as much as I'd like to say that that isn't true, it is absolutely true. Some of the biggest egos I have ever found were hanging off of physicians. And out of these physicians, you would be correct in assuming it is almost always the surgeons who are the most arrogant of the bunch.

I mean, for who do you think the phrase God Complex was invented? Alright, so take a surgeon in one of the most immodest specialties such as um, for example let's say brain surgery, and put them in charge of one of the biggest departments at one of the top academic centers at one of the biggest cities in the world, say, Manhattan, New York City.

And what kind of personality would you expect for that person to have? I mean, seriously, just imagine the ego that this person must have. And yes, that's exactly what I imagined when I had to meet this person, the neurosurgeon in chief at New York, Weill Cornell, Presbyterian Medical Center, the guest of today's podcast episode, Dr.

Philip Stieg.

I was a brand new craniofacial surgery attending a couple of years out of fellowship. I had no riz as the cool kids say these days. I was just trying to survive in the Byzantine politics that are endemic to big city academic New York medical centers. And yet Dr. Stieg was the exact antithesis of so many of the big shot academic department chairs I had encountered time and time again.

In med school, as a resident, as a fellow, and now as an attending. These great and powerful Oz'es were everywhere, all masters of their domains. And if you wanted to have a successful academic career, you had better pay your respects and kiss the ring. But Dr. Stieg was and is stunningly different.

You could call him a unicorn of academic chairs. And as I mentioned later, I actually witnessed him one day cleaning an operating room floor in between cases just to help out, not as a PR stunt. I had to look around for cameras to make sure I can only guess that it must be the true mid-Westerner in him coming from Wisconsin.

But speaking of rizz before, Dr. Stieg has it in spades. He speaks with an easy grace and confidence. He can connect as easily to the 5th Avenue robber barons that patronize the wings of his Upper East Side Hospital, as well as the interns and medical students rotating on a service. And Dr. Stieg has continued to maintain one of the top neurosurgical services in the world, bringing together a group of faculty who were for the most part when I met them, extremely collegial, which is something I had to know how he manages.

And you'll hear me ask about it in the podcast. And speaking of podcasts, Dr. Stieg does have his own podcast called This Is Your Brain. Which is an amazingly deep dive into neurosciences and the brain. And what makes us behave and do the things we do. So whether it's hearing Dr. Steak talk about his podcast and the upcoming phone app that it spawned.

Or how he talks to patients, what he does to prepare for his inordinately complex surgery, why he is so fascinated by intracranial arteriovenous malformations or AVMs, or even what interview questions the faculty ask the medical students applying to become brain surgeons. And they really are challenging questions.

Dr. Stieg is a captivating listen. He is one of the few and maybe the only chair that I know that I would actually want to sit down and have a hamburger with. Plus, while I hope I would never need it, he might be the only surgeon I would let allow to operate on my own intracranial AVM, but I would much rather just eat a hamburger with him, though. I enjoyed his company and I hope that you do too. Thank you very much.

All right, welcome again to another episode of Botox and Burpees, the Surgical Series. I have the most distinguished guest I've ever had to date, maybe ever so far.

This is Dr. Phil Stieg. Uh, Dr. Stieg? is the only person I know who has his own Wikipedia entry, which I've actually, that I know personally. Uh, he is the Neurosurgeon in Chief at New York Presbyterian Wild Cornell Medical Center, and he has been since the year 2000.

Dr. Stieg is a Milwaukee native, was born there, got his zoology degree at University of Wisconsin Madison, and then got a Ph. D. in Neuroanatomy and Neuroscience at Albany Medical College. And then he went back and got his medical school degree at Medical College of Wisconsin and subsequently was a neurosurgery resident at University of Texas Southwestern Medical Center and Parkland Memorial Hospital.

Uh, Dr. Sieg also did a fellowship in Cell Transplantation for Restorative Neurological Function at the Karolinska Institute in Stockholm. Uh, and, uh, And since, like I said, 2000, he has been the neurosurgeon in chief at Weill Cornell Medical Center, uh, at New York Presbyterian, which is currently ranked the number one hospital for neurosurgery in the country by Newsweek, uh, which is very impressive.

I was fortunate to work with Dr. Stieg when I was a brand new, pretty freshly minted attending, uh, for a couple years at Cornell. And I will have to say my memories of you, uh, were of kindness. For someone who was as distinguished as you are, I have a couple of very formative memories, uh, like core memories, if you will, uh, being a new attending.

And one was, I actually did witness you cleaning the floors in between a case. Before the next case. And I, it blew my mind that someone would just do that. Like it wasn't for sure. You just wanted to help get the case going for the next one. And that blew my mind because I've never seen that, especially someone, uh, that was such a big shot.

And the second core memory I had was you were willing to work with me on some of your, um, bigger, uh, range, uh, cranial trauma patients, and you didn't have to. You had a ton of other people that you could have worked with, brought from And I was raw. I knew I was raw and inexperienced and yet you, you guided me, you helped me.

And, uh, and that was a formative experience for me in terms of learning how people in, um, great positions can, can help others. So it's really a pleasure to welcome you, Dr. Steig. Thank you so much for agreeing to guest today.

[00:06:49] Dr. Philip Stieg: Sam, I can't tell you how delightful it is to see you again, be with you again. And, uh, uh, I hope that you're paying it forward just like this. Certainly with things like this podcast, you are, uh, uh, you know, we get more out of life by giving than taking. So it's, uh, um, you know, just a great pleasure to be with you again today.

[00:07:10] Dr. Sam Rhee: That's very nice. Thank you. And I also want to mention, and I would like to get into it later, you are, uh, one of the few physicians I know who has a successful podcast. This is your fifth season of This is Your Brain with Dr. Phil Stieg, uh, which is among the top, uh, Life Sciences podcast on Apple podcast and has been ranked as such for quite some time And I would love to pick your brain a little bit about that as well, but let me ask you first Go back to when you were training and you first decided well, this is something that I want to do I want to do neurosurgery surgery is something that really interests me Are there any memories that really stuck out, that stick out to you now, that sort of helped guide you along the way to that path early?

[00:07:58] Dr. Philip Stieg: In the process of making the decision or during my training,

[00:08:02] Dr. Sam Rhee: Uh, both! Let's, let's, let's go for both.

[00:08:05] Dr. Philip Stieg: Well, uh, you know, I got my PhD in neuroscience, but I did it with a PhD who was working in the Department of Neurological Surgery at, uh, at Albany. So I got to know a lot of the neurosurgeons and then my research involved both tissue culture, but also micro dissection in animals.

And it was at that time that I realized that I actually Had some three dimensional facility in terms of surgical skills. So when I, uh, finished my PhD, I'm a baby boomer. So at that time, everybody was doing two to three postdocs, which means that you go do an apprenticeship. For two to three years, and then what I was seeing is that people from every great institution, you know, including Harvard, Stanford, Wash U, uh, MIT, even after doing those postdocs, they were having a hard time finding jobs just because there was such a glut PhDs at that time.

So I, uh, I didn't have that in me. So I said, okay, I'm going to go back to medical school to become a neurosurgeon. So that was because of my experiences. And, and, and I, I realized that I liked neuroanatomy and I loved understanding the brain and quite frankly, psychology that I wanted to go back to medical school. then the, um, uh, telling times in terms of my residency. You know, I think there, there are dark moments in residency and there are positive moments as I'm sure you're well aware. And so one of the, one of the dark moments, I remember I had been up for 48 hours and I was doing a micro discectomy, which is taking a disc out of the lumbar spine with the chairman of the department, Duke Sampson.

And I went underneath the, the, the, The nerve root, and I pulled out the disc, but all of a sudden got a quick gush of CSF. And I, you know, it's called a leak. All right. And, you know, it's a terrible sinking feeling is, you know, fortunately no neurologic deficit, but when the chairman says, gosh, I've never had that happen to me before.

[00:10:17] Dr. Sam Rhee: ahead

[00:10:19] Dr. Philip Stieg: know, you're going to, Oh God, but you know, that sinking feeling of then owning it, working through the process of recovery, the patient made a complete recovery, but working through the delayed process of recovery because of that mishap was an incredible learning experience in regard to owning your mistakes.

And then, you know, Positing it to the patient in the most positive way you can, and reassuring them that you're going to get them through this, you know, you're with them for the whole ride.

[00:10:52] Dr. Sam Rhee: Does that ever get easier though? I mean,

[00:10:56] Dr. Philip Stieg: pardon me?

[00:10:56] Dr. Sam Rhee: does it ever get easier that responsibility for that patient? Like, that is a terrible and great responsibility as a surgeon, which when I was younger, I kind of took for granted because I was so eager to operate.

But now I also realize as I get older, this is a really big responsibility. The consequences are enormous, especially as a neurosurgeon, even more than, than what I do.

[00:11:17] Dr. Philip Stieg: Yeah, I mean, listen, the day that I take that lightly is the day I should retire. Right? You know, I mean, I, I, uh, a good portion of the time that I spend meeting a patient in the office is spent trying to sort out who they are, what their value system is, what their goals are, how they spend their time so that I can then try to tailor the treatment.

options that I have and every, every problem has more than one option and we try to tailor that treatment to fit their needs. You know, what I do get tired of is so many patients that come to me that have seen other physicians and they just, they offer them one option and I go, well, you know, you actually have more than one and let's go through what sounds most attractive to you.

There's pros and cons to every option. And work with the patient to help them select that.

[00:12:11] Dr. Sam Rhee: have you become better as a surgeon over all of these years? Of course, experience matters. You've had a lot of experiences. As you, as you mentioned, all surgeons have both good and bad ones and they help guide us to become better. But is there any guiding principle or particular way of thinking that makes you say, this is what is going to help me become better as I keep

[00:12:34] Dr. Philip Stieg: Yeah. Well, uh, uh, I think that, you know, the expression do no harm is something that has to go off in your head. Every time. I do think that there, there is the concept of pushing the envelope, trying to develop new techniques and new ways of approaching things. And they don't necessarily always turn out the first time you do it, but with, with work and modification, it does get better.

Fortunately, now we can do a lot of that in the laboratory. Like you with plastic surgery, you can do a lot of things on, you know, on, on animals and models to, to work it out. And so can we, uh, uh, I do think that what is extremely important for a surgeon is

[00:13:24] Dr. Sam Rhee: closing the case.

[00:13:25] Dr. Philip Stieg: when you're starting your career, I always would tell my residents that I go through the case from the time the patient gets wheeled into the room and they get wheeled out to the recovery room.

I go through that case 15 times and it involves every aspect of the case in terms of getting them from the chair onto the operating table. I mean, I didn't leave an aspect. not reviewed. And in addition to that, like anything else, you have to have contingency planning. So I'm doing an aneurysm, and I envision the aneurysm explodes while I'm dissecting.

What am I going to do? What are the moves? So that I was always prepared. It doesn't do the patient any good if I freeze. It does the patient a lot of good if I, if I react expeditiously. So I, I think it's that, and I'm sure you do this, is you just have to go through it multiple times so there's just no opportunity.

And then you go through that with your operating room staff. You know, the scrub nurse, the circulator, you make sure you got every bit of equipment in the room so they're not running down the hallway in the

It's attention to detail.

[00:14:34] Dr. Sam Rhee: You know, pre visualization is something that a lot of surgeons, including, like, that is amazing that that is such a common theme that I see so many surgeons, uh, cite as their means for success is thinking about the operations multiple times, going through it in their head before they operate. Uh, as you are more experienced, does that Get more efficient, like, do you tell the residents, you need to break it down into these many parts, but I, at this point, I'm going to be breaking it out, out this way.

[00:15:05] Dr. Philip Stieg: Well, yeah, certainly for me, it becomes more, much more expeditious. You know, I can rock and roll through. Uh, uh, uh, I, uh, I think that I can anticipate the problems more. I think there are fewer problems. Uh, you know, I mean, for me in my early career, the, the, the most troublesome problem was premature rupture of an aneurysm.

The, uh, the unfortunate part for me now is that more aneurysms are being, Treated with endovascular techniques, so I don't have to prepare for that problem as much anymore, which I miss, but I think it's in the patient's best interest. But that being said, I think that what I do do now is I sit down with the resident in the room before the case, and I say to them, okay, take me through the case, and I want to see how they're thinking. And I'm somewhat surprised that some of them go, Oh gosh, I haven't thought of that. I mean, wait a minute, you're coming into the operating room and you're not prepared, excuse me.

[00:16:04] Dr. Sam Rhee: Yeah, that, uh,

[00:16:06] Dr. Philip Stieg: that's why it's a learning process.

[00:16:08] Dr. Sam Rhee: that is exactly right. Uh, what, what is one of your favorite surgical procedures that you really still enjoy doing at this time?

[00:16:16] Dr. Philip Stieg: Probably what I'm most known for, and I just came out with a new book, it's about intracranial arteriovenous malformations. Uh, they're incredibly complex anatomically. They're complex surgically. They're, they're, I mean, they're easy ones, but then the majority of them are very challenging because the blood vessels, as you know, themselves, I'm sure you've done ABMs in the skin.

They don't, they don't, They don't behave normally. I mean, in surgery, we do something called cautery and, uh, with a bipolar and normal blood vessels will clot off, but AVM vessels won't. So it's really important to understand the three dimensional anatomy of the AVM, uh, how to avoid vessels that aren't going into it so you don't hurt other brain.

Uh, uh, it's a marvelous. Teaching venue for residents, you know, I can really guide them and teach them how to do micro surgery, how to use their hands, how to move their body, the microscope, and all that. It's, um, you know, it's, it's just I mean, it's stressful as can be, you know, particularly if you're dealing with a deep one.

But, but on the flip side of it, there's no greater satisfaction than when you're successful in getting it out.

[00:17:37] Dr. Sam Rhee: What do you listen to in the OR these days when you're operating?

[00:17:42] Dr. Philip Stieg: You know, I've never been a music guy, you know, I mean, uh, uh, I, I really like it peaceful and quiet. I want everybody kind of calm. I don't want a lot of chatter in the background either, you know, people are going yucking it up. I tell them, please be quiet because I want my scrub nurse and my circulating nurse to always be attentive.

I want the concentration to be on the case. I mean, if somebody's enjoying rock and roll music, I've gone into operating rooms where they've had the music so loud that I couldn't even think, you know, in my mind, that's disruptive. It's, uh, your mind, you know, your mind needs to be completely focused on the task at hand.

Now, I, I, the one thing that I find interesting is, uh, in my podcast, I, I was talking with people about concentration. In 2000, Concentration and the impact of social media on your concentration. In the year 2000, the average person had a concentration span of two minutes and 40 seconds. In 2024, the average person's concentration is now 40 seconds. You know, as you well know, doing surgery takes more than 40 seconds of concentration. So I don't think, number one, we need anything to distract us, but then you also have to understand when you are losing your concentration, take a brief break, which fortunately we can in surgery, and then come back focused.

[00:19:03] Dr. Sam Rhee: Mm. Let's, uh, let's talk about your non surgical endeavors. Now, you know, mentioning your podcast. In addition, you have been neurosurgeon in chief at Cornell for now 24 years. Uh, Yeah. A lot of surgeons don't want all of the non surgical responsibilities. They don't want the administrative stuff, they don't want to deal with politics, they don't want to deal with stuff outside surgery.

What made you decide, listen, I need to also do more, not in the OR, but out of the OR?

[00:19:38] Dr. Philip Stieg: Yeah. Well, let me break it into, we can take it into pieces. In regard to my podcast, the way I look at it is, you know, as a neurosurgeon, I can maybe affect 10, 000 peoples in my life. Right? From a surgical perspective, and then maybe another 20, 000 people that I don't operate on and tell them you don't need surgery.

With the podcast, I'm hopeful that over my lifetime I can affect millions of people. I mean, somebody can just flip it on on their iPhone, and they can learn something important about maintaining brain health. So it's just a, another way of trying to pay back, uh, and use my knowledge and the knowledge of other people in the books that I read, translating it.

I mean, one thing I am good at is, is dumbing down material, uh, so that it's really understandable for people. So I, I just find that enjoyable and I, you know, based on the success of the podcast, I guess other people like it. Uh, and I think it's useful.

[00:20:37] Dr. Sam Rhee: Let me ask you this about the podcast. Um, I just looked at, I read, I listened to a couple episodes and your topics are amazing. Like your last four or so, you talked about nonverbal communication with an expert like hand gestures. You talked about the change, like the neurologic changes that are associated with menopause.

Uh, you mentioned the incredible shrinking attention span and the deluge of You know, digital social media and how that's affecting our brains and then near death experiences and how the out of body phenomena and that light in the tunnel and what that experience is like, these are incredible, incredible topics, really fascinating for a lot of people.

What, how do you choose them? And how do you even have the time to read the books, do the research and, and, and talk to these people? Because I know like podcasting takes an incredible amount of time. Uh, not just that, you know, brief recording session that you're doing.

[00:21:35] Dr. Philip Stieg: Yeah. Well, number one, I enjoy reading the books because let's face it. I, I think a lot of people think about these issues, you know, I mean, how many, how many times have you read about these out of body experiences, near death experiences? Um, you know, I, I interviewed Temple Grandin who was, you know, had, uh, severe, uh, not, not severe, but she had autism and, and, and, and again, how she saw the world through visions and then, you know, communicating through hand gestures and that, these are all important aspects of our human life, you know?

Uh, uh, I, I wish I could make. the neurosurgical diseases that we deal with more relevant, but it's, it's not. So I, you know, I choose to focus on, you know, brain function. And the reality of also is that functional MRI has enhanced our ability to understand the way the brain works and the neural networks.

So I, it's, it's the PhD side of me. It's still, you know, always asking those kinds of questions and it's, um, uh, I hope that it's meaningful to people.

[00:22:44] Dr. Sam Rhee: You've done a ton of research. You, you, you, as you said, you published multiple texts. Um, so what made you decide to seek leadership positions both inside your institution and outside your institution, which you've held so many? I mean, to me, that's, that seems like a huge burden more than anything else, honestly.

What, what is it that, uh, drives you to, to do that?

[00:23:08] Dr. Philip Stieg: Yeah, I don't find it burdensome. I mean, the only thing that's really burdensome in my job is the human resource issues. You know, it never ceases to amaze me, the stupid things people can do to each other. Uh, verbally, uh, I mean, all you have to do is open up the newspaper and you read it every day. Let's face it, that happens in our daily life.

So I find that burdensome, but and again, um, uh, I, I love the human interaction component of it. I love the fact that I'm working with junior faculty and help them, helping them mold their careers. I love working with residents and helping them mold their careers, nurse practitioners, PAs. Uh, uh, in this day and age where People aren't able to communicate effectively.

It's, it's really become problematic. Uh, you know, society in my mind has become very marginalized. You know, the Democrats can't talk to the Republicans and the woke can't talk to the anti woke, you know, the day is gone where we can just have a meaningful dialogue. And, uh, I find that authentic. Very fulfilling in my job, trying to work with my faculty and entire staff to create an environment that's rational.

Um, I, uh, I, I feel society wise, we were becoming a bit irrational and that's worrisome to me.

[00:24:35] Dr. Sam Rhee: How do you maintain that number one ranking? Cause you've been amongst the top neurosurgical, uh, departments as well as hospitals in the, in the world, actually for, for quite some time. So what is, what is your secret sauce? What is it that you're doing to, to do that?

[00:24:50] Dr. Philip Stieg: Well, the good news is that things don't change fast, you know? So I, I was very fortunate when I first got here to recruit and now retain a world class faculty, really good people. And then, you know, When I, when I started, um, you know, uh, I, I created some fundamental principles that I applied to not only myself, but also to the entire department.

And those principles were integrity, collegiality, collaboration, compassion, perseverance, leadership, surgical excellence, and scientific curiosity. And I said, these are the things that we're going to focus on as a group. If we have integrity, if we're collegial, we're going to like each other and we're going to like our patients and we're going to try to do the right thing for our patients.

And I think that, that mantra, uh, I've been very sensitive to maintaining that. People have swallowed the Kool Aid and said, yeah, I, you know. We aspire to do those same things, and I think it has, um, allowed us, you know, look at, you know, Bill Belichick with the Patriots, you know, he had it going for, what, 14 years.

Vince Lombardi with the Green Bay Packers had it going. You know, these, these dynasties get going, you have a, a, a nucleus of people that believe the same thing you do, and you, uh, then I just get out of their way and let, let them do their job.

[00:26:18] Dr. Sam Rhee: Yeah, but Bill Belichick had to get Tom Brady to huge contract, uh, reductions, sacrifice quite a bit, and, uh, you know, not that, Uh, neurosurgeons, I wouldn't, you know, they're not the most humble, modest, not like I, I love neurosurgeons. I know so many of them, obviously, but they're known for themselves. Like, you know, big egos, how do you, how do you manage that in a department where you have world class faculty, people want more for them, for themselves, for their practice, for their, you know, for their patients, how do you negotiate and manage that?

Because. You're in New York City. Space is limited. Uh, you're competing against other institutions. How do you, how do you figure that out as, as, as the chief?

[00:27:07] Dr. Philip Stieg: Um, well, I guess, I don't know that I would say that I've figured it out. That being said, I mean, there are people that have left because they, they didn't, they didn't accept the principles that we had, you know, and certainly, Neurosurgeons have always been known to be iconoclasts and eccentric. They don't play team sports.

They mountain climb, they hang glide, paraglide, right? You know, they do extreme kind of stuff. Um, which is fine with me. I, you know, uh, but in order to be in an academic environment, you are in a team sport. And I, uh, all I can say is that I really emphasized Being on a team. But also the other important thing that I did was I created lanes for everybody.

You know, when I hired somebody, I said, this is going to be your lane. This is what you're going to become world famous in. Right? And, you know, I will help you do that. And we've had a number of people that are, you know, internationally known for what they do. And, you know, beyond that, I, you know, if somebody's looking for more than that, then they're not here.

You know, it's, uh, uh, something else that they want to do.

[00:28:23] Dr. Sam Rhee: Hmm. How did you learn these leadership qualities or these principles? Because they don't teach them in school. In your PhD, as you're, you know, working in the lab, they're, they're not being taught in residency per se, you're teaching them, uh, surgical, uh, skills and, and how to manage patients. So most surgeons have to pick this stuff up somewhere.

Where did you pick up how to man, you know, your management style, your leadership techniques, you know, how to manage people.

[00:28:51] Dr. Philip Stieg: I remember when I was thinking about applying for neurosurgery and I, you know, I had a neurosurgical mentor and he said to me, you're not a typical neurosurgical type. I think you'll be good for the field, but you're not the type. I have always had an abiding interest in humans and interpersonal interaction, and that's kind of like my fundamental core.

Um, I, I feel by and large, I have a, uh, good moral compass. I mean, we all fail, but, uh, uh, uh, and I felt that I could communicate that moral compass without inflicting my views on life on other people around me. That's right. By having that. And then as a kid growing up, uh, I grew up in Wisconsin and Vince Lombardi was the coach of the Green Bay Packers and Vince Lombardi at that time was bigger than life, you know, as you know, Richard Nixon wanted to run as his vice president.

He became the coach of the Redskins. I mean, he was, he wrote books, he was articulate and, uh, he made an indelible impression on my life that you could be. You could be focused, but you had to have, you had to have a vision and you had to be able to communicate with people. And I, you know, I've, over time, and then I've, I've read hundreds of leadership books, which all kind of say the same thing with, Just in different paragraph form, you know, and I, uh, I, I valued that as a skillset.

So I, I worked at it and you know, I'm sure you'll, if you ask my faculty, um, uh, am I a better leader now than I was 20 years ago? They'll, they'll say absolutely yes. And, you know, they'll say that you curse

[00:30:38] Dr. Sam Rhee: Yes,

[00:30:41] Dr. Philip Stieg: So, you know, it's, uh, you know, when you're young, you're impetuous. You, you want to get things done now. So, uh, I, I, I. I think I've learned how to convince people to do the right thing, uh, through the concept of enlightened self interest. So

[00:30:58] Dr. Sam Rhee: yeah, I think a lot of surgeons have that perspective of, yeah, being a, you know, like you said, emotional or tempestuous, uh, aggressive, as you said, and then, uh, you, you gain some perspective with that as you go. Um, how long do you foresee yourself operating or, or continuing to become a surgeon? Because we all know surgeons that will literally, they're like old draft horses, they will die in the harness.

Like holding a scalpel in their hand and then others who sort of have different exit plans and, and, and what they want to do.

[00:31:29] Dr. Philip Stieg: we've all seen people that have hung around too long,

[00:31:32] Dr. Sam Rhee: Hmm.

[00:31:32] Dr. Philip Stieg: right? And I, you know, I'm very sensitive to that. I, I, you know, I, I'm not long for the chairman's world. I'll probably step down as chairman over the next couple of years. Uh, stick around because I, I, Another role model of mine is Hank Greenberg, who still goes into the office at 97 years old, you know, uh, I, I think that if you retire, And just go sit in a chair, your, your brain goes stale.

So I, I want to maintain intellectual stimulation is the reason why I, I do the podcast. I would hope that I can continue with that. Uh, you know, and another thing is if all of a sudden I developed a terrible tremor in my hands, I would say, you know, it's time to hang up the cleats.

[00:32:16] Dr. Sam Rhee: Mm hmm. Uh, what do you do now that, let me pick your brain since you've had five seasons of brain health podcasting. What do you do to maintain your brain health or, you know, to main, make sure that you're neurologically as, as healthy as you can be at this point in your life?

[00:32:33] Dr. Philip Stieg: So let me say, you know, I mean, I try to do, I try to practice what I preach. So let's start with how you spend one third of your day. I try to get restful sleep. You know, it's, uh, it's exceedingly important. Uh, if, if you find that you're waking up, you know, you gotta, you know, have you had too much to drink?

Are you eating too late at night? You know, those things. So you, you really work on great sleep hygiene. When I get up in the morning, I, you know, I, I pray, Meditate and and try to just clear my mind and then focus on what the tasks are at hand You know And then I've learned the art of deep breathing, you know Before I used to curse now I take a deep breath

[00:33:16] Dr. Sam Rhee: Much

[00:33:17] Dr. Philip Stieg: diet with breakfast in the morning, you know, I'm, I'm, I'm trying to do the things, no sugars, uh, or natural sugars in fruits.

Basically a Mediterranean diet with not a lot of red meat, uh, nuts and things like that. I try to get regular exercise as much as I can given my busy lifestyle. Uh. Two glasses of red wine a day don't hurt me. And I, I really try to maintain friendships and relationships, uh, but also challenge my, my, my brain with lots of reading for the podcast and looking at new, new adventures so that you're always stimulating some new nerve cells in your hippocampus to remember something.

[00:34:02] Dr. Sam Rhee: I read, uh, several theories and some research where your You know, in terms of staving off dementia or other, you know, failing brain function, there are two major factors. One is where you start at the beginning of your life, i. e. how much education you've received, how much, you know, brain stimulation or, or activity you've done early.

But then as that decline occurs, what you are doing to modulate that decline, as you said, there are a lot of, Studies that show after retirement, when people are no longer engaging their brains very much, their, um, their brain, uh, function, uh, tends to precipitously drop. Is that something you believe in?

And is that why you keep doing all these, these things for yourself?

[00:34:48] Dr. Philip Stieg: Yes. When I first, when I was doing my PhD, there was the malarian hypothesis that one nerve, one function, and when that nerve died, you lost the function. Well, we know that not to be true now. We have ongoing stem cells in your brain. Uh, but the other thing that I used to hate was people that would refer to the brain as a muscle.

The more I thought about it, it actually is a little bit like a muscle in the sense that, and this is where social media plays a role, you know, people don't write in prose anymore. That part of their brain is a little bit less well developed versus the visual portion of your brain because you're always looking at your iPad and typing in very short sentences.

So, Thinking about the brain and the neural networks, the more you do different functions, visual spatial functions, coordination functions, writing functions, cognitive functions, thinking about the relationships between objects, that's going to challenge your brain to maintain those neural connections and preserve function.

So you got it. It's like any other, any other sport or exercise. You've got to use it, you know, use it or lose it.

[00:36:08] Dr. Sam Rhee: Do you think AI is going to make that worse? Because I'm already sort of using it to help me write some of my notes or some of my podcast blurbs and other things where I would have to force myself to actually, you know, compose more of it myself, for example.

[00:36:24] Dr. Philip Stieg: Yeah. I think it, it will make writing skills worse. I guess the question is, have you filled the time that you would have taken to write something out? Are you filling that time with something useful or are you sitting in a chair staring at a TV? You know, if you're doing that, it's not so good. Uh, so again, I think that it's. What people have to realize, you know, you and I as, as surgeons, you know, you as a plastic surgeon actually have to deal with this a lot. You know, somebody wants to eat a bunch of crap food and they come into you and say, make me look good with liposuction. Right? I think that we as physicians need to remind people that that's not the best way to go about a healthy life.

You know, it is not my job as a physician to allow you to go on with your debauched life and then come, I fix you, and then you go back to it. It's about making good choices in terms of your lifestyle, and that's what we have to convince people that of that healthy living is, is productive. It helps you lead a more fulfilled and a longer life.

[00:37:39] Dr. Sam Rhee: Absolutely. Yeah, that story of my life, especially with liposuction candidates, big one. Uh, so at some point, uh, what are your future goals? So probably you said in the next couple years you will, uh, No longer be surgeon in chief or neurosurgeon in chief. You, uh, have, uh, at some point, um, potentially not operate, uh, whenever you so choose, hopefully.

What else do you see in your horizon in terms of your future? What you would like to do?

[00:38:12] Dr. Philip Stieg: Well, I've gotten involved with a startup company that's called Metaflix. And what it is, is it's a medical streaming app that currently we've, we've put on your iPhone or your iPad. And it, as I said, it's a streaming app. And. What I've realized is, number one, patients don't have access to doctors. Try to get an appointment with a neurologist, you're talking months.

An internist, you're talking months, right?

[00:38:41] Dr. Sam Rhee: Yep.

[00:38:42] Dr. Philip Stieg: Psychiatrists, equally long, unless you're willing to pay cash. So, number one, patients don't have access to doctors. And then, because of the reimbursement schemes set up now, since Obamacare, doctors. basically allot you 15 minutes. So the patient goes in, has their 15 minutes and they come out frustrated, confused and unhappy with the information they've gotten.

So what do they do? They go to the internet and they get very discombobulated information that's not digested. And it's not put in my mind, you know, a language skill set that's appropriate for their age or for their education. And it's. presented in a very confusing format. So at Metaflix, we put together to start 200 doctors, and we are going to click through each disease.

The first disease that we picked is the most complex, obesity, because it affects everything, right? Heart, lungs, kidneys, joints, body image, psychiatry, all of that. And, uh, uh, you, you get onto the site, And we have guides and the physician will be your guides and we explain the fundamental questions. You know, what do you have?

What does it mean to have it? What can you do about it? And what are the risks associated with those choices? Then we use AI to find out what are the other 100 most asked questions and our physicians answer those. We video it on a little iPhone. It's a very inexpensive way to do it. And then during the time that you're on Metaflix, you can type in a question.

And say, I have a question about this. Boom. And so what we're doing is we're creating an engagement between you and the physicians on Medaflix. We are not treating, we're providing advice, and we're also going to teach patients how to be patients. You know, instead of going to the doctor and saying everything that they've got and thinking that it's related to their problem, we're going to say, all right, how do you describe pain?

There are specific ways to describe pain, right? So, uh, we're working with the patients and the goal is that we will be an aid to the patient. But in addition to that, physicians will say, go to MediFlix and look at this and it'll help you, it'll educate you on what we're, what we're about to go through.

[00:40:59] Dr. Sam Rhee: Hmm. That sounds amazing. I think some of that is going to have to be marketing the, the app because, uh, a lot of people are going to have to see the utility of it through, say, social media. You demonstrating it, like making sure people understand it. Uh, it's gonna be driving those patients into that app, and then once you reach some sort of critical mass, just like YouTube or any other sort of, you know, major entity, then people know about it, but, but it's, it's driving that critical mass part of it where you get enough people.

[00:41:35] Dr. Philip Stieg: Yeah, I mean, that's if you're a business to customer model. We're more of a, we thought about that, and what we're thinking, what we're approaching it as, is more a business to business. So we want this to start off being a demarcation for an insurance company. We're providing this as a benefit to you.

Or a company saying, you know, we want to help. Walmart has how many employees, you know, it's in their best interest to keep the employee showing up for work, right? So we, we would like them to provide it to their employees as a benefit. Well,

[00:42:10] Dr. Sam Rhee: Uh, wow. That's, uh, that's pretty ambitious for someone who's already accomplished so much in their life. Did you come up with this idea or did someone else present it to you? And you're like, I want to, I want to help take this idea to fruition.

[00:42:23] Dr. Philip Stieg: the funny thing is, is, you know, it was a spinoff of my podcast. I was, you know, I'm doing my podcast and I, I said, you know, I need to get, I wish I was an influencer. So I had millions of people following it. And so a friend of mine said, you need to meet this guy. And his name is Steve Lieber, and he used to be the manager for the Rolling Stones, Aerosmith, put on Beatlemania, and he was a promoter, right?

And his wife had died of multiple myeloma, and after she died, he found out that there were treatments that he wasn't made aware of. And he, you know, he said, my gosh, you know, here I am connected up the wazoo. I know everybody. And I still couldn't deliver for my wife what I wanted to deliver. This isn't right.

He said, we're going to start a company to do this. And that's hence Metaflix.

[00:43:16] Dr. Sam Rhee: that's awesome. Wow. So, if I'm someone who is a young college student, medical student, someone interested in going into neurosurgery, you, you deal, you work with a lot of residents, medical students, uh, other, um, healthcare personnel who are training. What is, I mean, I've neurosurgery residency training, and it is impossible Literally almost impossible to become a neurosurgeon these days.

Like the, the qualities that these, these candidates are presenting are insanely, uh, high. Like these are elite of the elite out there doing, you know, accomplishing great things even before they apply. So, um, how does some, like, what kind of advice are you going to give these, these people are hoping to become the next Dr.

Stieg or, or, you know, following the footsteps of someone like you? to do this.

[00:44:11] Dr. Philip Stieg: I think that they have to accept the fact that it is competitive. And part of the competition is, is a selection device, you know. Uh, one of my residents is, is somebody that started with me in high school. And she would come in and she would see patients with me. And then she went off to Johns Hopkins for undergrad, went up to Harvard to medical school, and I finally got her back, uh, in the residency.

And during that time period, she was always committed to neurosurgery. I don't think it takes that kind of laser focus from high school on, but you know, what are the characteristics that we look for in somebody that's interested in being a neurosurgeon? Again, for us, we're probably the only department that has an emotional IQ component as part of our interview process.

[00:45:01] Dr. Sam Rhee: Really?

[00:45:01] Dr. Philip Stieg: Yeah, yeah, we take people through and we, we challenge them with emotional, emotional types of questions. Um, yeah, we're unusual in that.

[00:45:11] Dr. Sam Rhee: Okay, give me an example of an emotional IQ type question that you would ask me.

[00:45:14] Dr. Philip Stieg: oh, well, um, you know, we'll take, um, uh, scenarios. We'll go through. So you're a, you're a chief resident and one of your junior residents isn't progressing as rapidly as possible. Give me the scenario. How are you going to work through that? Okay, and then, and then as they answer it, you start spinning off of that.

Okay? As a medical student, I mean, these are experiences that I have. I've had, not me, but, you know, I've, uh, your, your, your roommate in medical school is having an inappropriate relationship with one of the professors. Right? How are you going to handle that? And you, you, you, you, you, there isn't a right answer necessarily, but you see how the person thinks through things or do they choke and get nervous?

You know, unfortunately a neurosurgeon can't choke and get nervous. They got to. You know,

[00:46:06] Dr. Sam Rhee: Right.

[00:46:07] Dr. Philip Stieg: ready.

[00:46:08] Dr. Sam Rhee: Wow. No, go ahead. That's amazing. So, that's unusual. They never asked those questions when I was, uh, on my residency interviews at all. They just wanted to know how, like, figure out how tough I was, basically, I think was, was what it was. Like, could I stand the heat? More or less.

[00:46:26] Dr. Philip Stieg: Yeah. I remember when I was up at Harvard, uh, there was one professor that used to put the medical student applicants in his office, close all the windows, bolt them shut and turn the heat up to a hundred degrees watch how they would respond. I mean, Thank God times have changed, right? You know, we're not like that.

You know, we want to create real world experiences. By the time somebody gets to us for an interview process, you know, on paper, they've, you know, they've worked with Mother Teresa. They played the violin at Carnegie Hall. They all have incredibly high board scores and straight A's in medical school. So, you know, I mean, there is curriculum vitae inflation.

We got that, you know. And so the, the interview process is to find out what kind of person they are, you know. You know, when a nurse calls them at three in the morning with a mundane question, are they going to be rude or are they going to be polite? Right? When somebody asks me what, you know, what am I looking for in a resident?

I'm saying I'm looking for somebody that is bright as a whip, hard working, has great eye hand coordination, and at 3 in the morning they're nicest to nurses, and at 7 at night when we're all done with work, I'd love to have a beer with them because I want to find out what their worldview is. A well rounded person, you know? That's what people should shoot for.

[00:47:48] Dr. Sam Rhee: Absolutely. I guess, uh, that's, uh, that would help make the institution what you are, what it is, just from finding quality people like that. That's not easy, though. Let's just put it that way. After all that, because, uh, you know, you're screening for very, very few people, and to find that high EQ type of person amongst those, uh, that, those candidates, I don't know if it's that easy, really.

So.

[00:48:15] Dr. Philip Stieg: No, no, no, it hasn't been, you know. And again, um, but that's the evolving process, you know. Again, as you said earlier, most neurosurgeons, and there are still neurosurgeons out there like this, that are very egocentric. Very self absorbed and, uh, don't necessarily have the broader view of what's, quote, right and, uh, in my mind, the appropriate moral view.

Uh, we don't want to be that. You know, we want to be that different sort of somebody that creates doctors that are compassionate and caring, but also extremely skillful and intelligent.

[00:48:53] Dr. Sam Rhee: Well, Dr. Stieg, I have to say, when I've seen a lot of different surgeons, surgeons in leadership positions, there are very few that I would say are the good guys that do it the right way and still maintain the most elite programs in the country. And you've been one of them. And I would have to say, it's been such a pleasure to have known you, to see what you've accomplished and are continuing to accomplish on so many levels.

Uh, so I really appreciate everything you've done. That you've done so far and that what you will, uh, continue to do. I look forward to all of your accomplishments and I will be listening to This Is Your Brain. Uh, I'm working through your latest season, season five, and I'm going to be working my way backwards through the rest of the episodes, so I really appreciate it and thank you for taking the time today to speak with me.

[00:49:42] Dr. Philip Stieg: Sam, it's been a delight. Thank you for reaching out and, uh, let's continue the dialogue.

[00:49:47] Dr. Sam Rhee: Absolutely. Thank you again.

[00:49:49] Dr. Philip Stieg: All right. Take care.