Zeina Nahleh, MD

Podcast Transcript

Cara King:

We are so excited to have Dr. Zeina Nahleh on our show today. She's coming to us all the way down from Florida, so welcome. Thanks for joining us today, Zeina.

Zeina Nahleh:

Thank you, Cara. Great to be with you.

Cara King:

Yes, it's going to be a great morning with you. I want to start with talking a little bit about your journey into medicine and your upbringing. You grew up in Lebanon, is that right?

Zeina Nahleh:

Yes. I was born and grew up in Beirut, Lebanon, and I did my medical school and initial medical training in the American University of Beirut.

Cara King:

Wow. And when did you move over to the States?

Zeina Nahleh:

I moved over to the States in 1998. I was very young at that time. And I stayed here and continued my training and my practice, and this is my home now.

Cara King:

Absolutely. And I was listening to your bio video on the Cleveland Clinic website. I hope you don't mind, but just in preparation for our talk today. And I was listening to you talk about your actual childhood in Lebanon and just what a hostile environment that you grew up in. Do you feel comfortable talking about that?

Zeina Nahleh:

Sure. Well, actually my childhood, the first few years were great. I have loving parents and two brothers. And my father is a schoolteacher, and my mother is a housewife. So, we had a happy childhood, but when I was a teenager and growing up as a young adult, we of course, lived the civil war in Lebanon for 15 years. That was a time of a lot of hardship, and we were constantly, my parents were taking us from one place to another to be safe. So now looking back, I believe some of those experiences have shaped my character and have given me some of the strength I have. It was hard, it was not easy for a young adolescent and for my parents and my brothers to grow in that environment, to grow up in that kind of hostile, like you said.

But again, now looking backward, I believe we learned through this. We learned the power of hope, the power of optimism, and staying focused. And during all this we continued to train. As I said, my father was a teacher, so he focused on our education, and he tried to protect us from all the distraction that's happening. So, we would have a test or an exam or something to do and we would have no electricity one day, but we would use candles or one of these small gas lanterns and sure enough, we go to do the test. And that's how we continued through college, actually. So, like I said, now looking backward, it gives me, I remember it not in a bitter way. On the contrary, I remember that we survived. Through the power of hope and hard work and resilience, things usually get better, not worse in life.

Cara King:

That is just such a powerful story, and I just can't imagine, like you said, growing up in that type of environment and having your parents just so optimistic and hopeful during that. And if they're making you take a test in candlelight, there was no getting out of anything, right?

Zeina Nahleh:

No, at the time, you wouldn't know any different because that's the best we have. So, I guess, it will show you that you can be creative and use the resources you have to be successful. And that, I think, applies to a lot of things in life.

Cara King:

I love that. I mean, I think that is just the truest definition of grit and resilience and all the things that you just mentioned. You said that your father was a teacher. Do you have any physicians in your family?

Zeina Nahleh:

I was the first physician in my family to go to medical school. Thanks to my high grades in high school, I got into the best college in the country, in the area for medical school in Lebanon, the American University of Beirut. And I got a scholarship because of that to study. And I was fortunate to continue my medical school and my initial training and then be able to come to the US and fulfill my dreams to become an oncologist and study in the US.

Cara King:

I also heard you say that oncology for you was a really easy decision. You knew that's where you were supposed to be. How did you know? What made that decision easy for you?

Zeina Nahleh:

Oh, of course, we had people with cancer around us and for me, that part of growing up in Lebanon and seeing the hardship and I also volunteered with the Red Cross, and we used to go to places where people have no medicine and no access to healthcare. So, during my rotations in medical school, I wanted to really work with the people who are the most vulnerable. And to me, I wanted to help patients with cancer because cancer is a life-changing experience and I believe, like many diseases, patients are patients, but patients with cancer require another level of attention. And my personality, I really, truly, genuinely care for people and I wanted to be as helpful as possible for patients who are suffering and facing the most scary diagnosis, that is cancer.

Cara King:

That's so interesting. Your level of empathy is at an entirely other level, I think, from a lot of other people. And I'm thinking about the way that your childhood looked like, and I think a lot of people maybe could have a different lens of that childhood and maybe feel less empathetic. I don't know. But you really embraced the opposite and became more empathetic and understanding of suffering and hardship. So, you're just truly amazing.

Zeina Nahleh:

Thank you. I think with time, I believe, yes, that childhood and my experiences growing up during the hardship of the war in Lebanon and probably trying also to help my parents so they can feel less scared, all of this, I believe, shaped my personality. And I became more sensitive to others, more in tune to the moods and feelings of others. And my desire to succeed and maybe make my parents proud and seeing how hard they're trying to help us. I believe all of it makes us more sensitive to the needs of others.

Cara King:

Such great advice. And we have quite a few medical students who listen to our show. And I'm just curious, do you have any advice for medical students who may be listening about how to find the right specialty fit for them during their rotations?

Zeina Nahleh:

Medical students have a great opportunity. It's a privilege to become a physician because people will trust you with their life. And we take that very seriously and we carry it throughout our careers as physicians. So, we have to really earn that trust and raise the bar and we are always trying to work for the greater good. That would be my best advice, is to take that into consideration. Always try to consider that you're here to make a difference and improve patients' lives. And sometimes it is not easy.

Sometimes it is hard. It requires some sacrifices or some efforts to try to get to what you need to do.

In terms of choosing the right career or the right specialty, I believe it's good to explore all the options and give yourself a chance to rotate throughout all of these disciplines during your medical studying. And don't make a rush decision. For oncologists, it requires a whole other layer of empathy and compassion and patience. I would say you have to be very patient with patients because patients are suffering. They're not always the easiest to deal with. They are scared and sometimes that shows up in their interaction and they have a lot of complaints and a lot of worries. So, oncology, I would say requires someone who's very compassionate or who very patient, who's willing to be a good listener, who's willing to provide time for these patients.

If that's not your forte, that's okay. Some people are more technical. Some people prefer to work with their hands, and they prefer to do procedures. That's always great. Now with the technology and innovation, it's amazing to be a surgeon or an interventional radiologist or pathologist. You have all kinds of options. Pediatrics is another field, you also need to be very patient and willing to give the time and attention to the little kids, and their parents, by the way. So, all of that I think you will explore during your rotations. Enjoy it and embrace it and give it the best you can so you can come up with the right decision. Of course, primary care is at the highest need, every family practice, someone who's knowledgeable and willing to be a general physician who can encompass the whole person. I mean, all of these. I don't want to forget any specialty. They're all amazing and needed for the health of people.

Cara King:

Such great advice, to go into your rotations with an open mind, though. I see sometimes people go in and think they know exactly what they want, and I think having that open mind can really enlighten you in areas that you didn't even know exist. I'm just amazed at how many specialties and subspecialties there are within medicine that there will be a perfect fit, truly. Right?

Zeina Nahleh:

That's true. And they all complement each other. You can't have one without the other.

Cara King:

Exactly right. All right, I want to move into this area of feedback next because I find this topic really interesting. Feedback, I would say, is critically important to help you identify your blind spots and really take you to the next level. And whether that be with technical skill or leadership development or all the different areas that we're in, but I think knowing how to provide that feedback and when to provide that feedback can be really complex. And I think this is proven by the thousands of books that are currently on Amazon right now about how to give feedback.

And I saw on your Twitter feed recently that you posted a really great excerpt from Adam Grant who I'm also obsessed with. And it said something along the lines of, when people ask for your feedback, it's a mark of respect. And when they don't hesitate to give you feedback, it's a sign of trust. And that really resonated with me. So, I'm curious, what techniques have you found that work well from providing feedback and how do you work to establish this critical trust in that relationship?

Zeina Nahleh:

That's a great question. Thank you, Cara. I believe feedback is essential for growth. So, at any level of your career, whether you're a leader or you're an employee or a staff member, it's valuable to receive feedback because that will give you the chance to try to improve. We are not perfect, no one is perfect, and we all are students of learning, of knowledge. And as leaders more than others, that's a constant learning experience. You always learn and you always grow every day. So, from that perspective, feedback is valuable. Not many people like feedback, that's human nature. They prefer praise over feedback.

Cara King: 

Yes.

Zeina Nahleh:

Because they sometimes perceive feedback as more on a critical end, which is not at all the case because she was giving you feedback should trust you enough to not withhold feedback because it's much easier to withhold feedback, to avoid conflict and to avoid a reaction. But when someone is giving you honest and genuine feedback, that requires an effort. And as leaders, we always give feedback, but that's not easy sometimes because we don't know the reaction or how it is going to be perceived.

But we understand that feedback is essential for the growth of the other person who may not be aware of their weaknesses and who would otherwise not have a chance to improve if they do not receive the feedback. So, I feel feedback can be very constructive, but it is much easier, of course, to give feedback for to someone who you have a trusting relationship with.

So before starting to give feedback, you start with building a relationship, building trust, and then feedback will definitely fall into the right place. So that's one thing because again, like I said, people don't like to have their weaknesses exposed. You start with giving them a psychologically safe relationship, and then you can definitely give the feedback and it'll resonate better. The other thing is to receive feedback, it gets easier. I believe with time, I used to have difficulty when I was of course, a young physician or a young leader, and now I feel I am more secure in receiving feedback.

So, people who have security don't necessarily need to be winning all the time. So, this is how they take the feedback more and as a growth opportunity. So, they don't have to always feel they have to win, and they will feel approachable. But also, if someone gives them feedback, they take it as an opportunity for growth, just like the Adam Grant. And also, probably, you need to thank the person who was giving you feedback because they trusted you enough to give you that feedback. So, I think as leaders, to give feedback, you have to be some kind of a relationship before, a trusting relationship with your team. You have to be approachable, you have so that you can put yourself at ease and others at ease when you give them feedback.

Cara King:

Such important words. And it's so complex, and I like the way you kind of scaffolded this, in that we all naturally want positive feedback. That's where we want to be, but that's not where we have true growth oftentimes. And within this space of vulnerability is where true growth happens. But we all have egos to some extent, and I think we all probably have a level of imposter syndrome at some extent, at least I do. And so having this space of critical feedback can be really hard. So, I appreciate your words. My question next is do you have any tips on how to give feedback that may be difficult to hear? You know what I mean? When you sit down with someone as a leader and have to deliver news that may not be positive and you have that psychologically safe space, which I agree is very important. Do you have any tips on how to actually deliver that feedback, so it resonates well?

Zeina Nahleh:

Yes, and it may not be very easy and not every situation is the same. So, I think it's very important to genuinely try to care about the person who you are giving feedback. Because that will resonate, and people know when you care versus when you are trying to win or score a point. And that should not be the goal of any feedback. It should be focused on improving or helping the other person improve and grow, and it's an opportunity for growth. So also, I personally don't think you should always sandwich the feedback, say a positive thing and a negative thing and a positive thing. I feel you should be honest about the situation. You should not talk about the character of the person. That feedback should not define the person, it's just a situation. I think it is more important to save the relationship than the situation.

So don't sacrifice the whole relationship because of one situation. So, when you give feedback, again, be sensitive to the other person's motivation and where they're coming from and make it two-way feedback. Try to listen and give them a space to present their point of view versus just you are one way and you are giving them all what you think is happening. So that should be two-way, should be with empathy and with sensitivity to the needs of the other person and should be done in a caring way. Not so much in a way that, oh, you're just criticizing and don't make it about the whole person. Just make it about that exact fact or that circumstance that doesn't define the person, it doesn't negate and remove all the good things that they have done. Just make it in a way to fix the situation and improve the situation and help the person see that as an opportunity to improve.

Cara King:

Brilliant. I could not agree more with the things that you just mentioned. The thing that I'm hearing you say is number one, care personally. It's easier to not give feedback honestly, oftentimes. So, the fact that you're sitting down with someone giving feedback that you're being present and doing that one-on-one, I think that's showing that you care personally. So, keep that at the crux of the relationship. And I also love how you said a two-way dialogue. Allow the space for reflection and help process the feedback with that person I think will resonate better than just having it be one way, tell them how you feel and then out of your office. So, I think those are really important points. And I don't know if you read this book, Radical Candor by Kim Scott. So, she has a TED Talk, which I watched recently, and she talks about this kind of space of feedback. She talks a lot about caring personally and challenging directly, and she has this two-by-two graph. I'll link it to our show notes so you guys can look at it, but it's very much in line with what you're stating.

So next, I want to move to another really interesting article that you posted on your feed recently, and it was talking about different types of rest that every person needs. And this sounds a little superficial, but I really love this article and when I read this, my fatigue made so much more sense. I'm going to summarize it real quick and then I want to ask your thoughts about this. So when we often think about resting, right, I think about physical rest, get more sleep, and I'm always like, I know, get more sleep. I get it and I try, but still, it doesn't always work. And this article justifies that we also need to rest around these other areas like mental rest and sensory rest, creative rest, emotional, social and spiritual rest. And especially with, I think most recently with all this decision fatigue, all these decisions that we have to make all of the time, it makes sense why I feel tired, it justified it. So, I'm just curious, where were you mentally when you posted this article and what areas of this article stuck out to you?

Zeina Nahleh: 

So let me tell you, I am a big proponent of wellbeing at work and people who in my team know me, they always hear me say that you have to take care of yourself, in other words, you have to take care of yourself so you can take care of others because that's where I'm coming from. If you are not well rested and present and focused with less distraction, internal or external distraction can be internal too, then you'll be able to provide the best care possible, especially in the field of medicine. And that applies not only to physicians, but also to front desk people, office coordinators, schedulers, nurses, lab technicians, anyone who deals with patients or with people, they need to be mentally and psychologically and physically well rested. So, as you know, this is not a small problem. It affects burnout, impacts medicine, impacts our field, but not only for medicine.

You can apply this to any other discipline, any other industry. If a waitress and a restaurant is looking exhausted and looking stressed, you will not have a great experience as a customer. So, I imagine in healthcare where if you're dealing with people who are burned out and who are stressed all the time, what kind of patient experience, let alone quality and safety. So, I'm a very big advocate for mental health at work for physicians and for healthcare workers. So that's not a small topic and it is unfortunately in general, we focus so much on being physically strong and we learn to overcome fatigue and we want to be heroes all the time. And that takes a toll on you. And that's why I think physical and mental rest are critical so we can continue to fulfill our mission.

Cara King:

Such important words. I'm curious, what do you do in your life to recharge? How do you notice when you're feeling mentally or physically tired? And what do you do to reverse that?

Zeina Nahleh:

It's a good question and it's not an easy answer. So, it's easier said than done. Sometimes you take your baggage with you home, it's not easy to disconnect. So, I would say I do two things. For my personal rest, I have a routine where I pay attention to my body, and I always try to use healthy habits to recharge and to unplug. For example, I always try to exercise at least three times a week and I don't exercise in a gym or in a closed space. I don't feel like I connect with nature that way. And I'm fortunate, I live in Florida, so we have good weather. So, I take advantage of that and at least three or four times a week I'm outside by myself sometimes, or sometime with my dog and my husband, we walk around the neighborhood.

So, I feel that that's important to be and to have fresh air and change the scenery and be disconnected from electronics. So that's how I will look at it. But I also engage very closely with friends and family, I don't have a lot of time from my friends. But we have a group from medical school that sometimes, occasionally we post jokes and things like that on an app called WhatsApp. So, I feel connected with them from a long time ago. And we support each other. We have a group for our small family, my two brothers, their family and my mom and dad back in Lebanon. So, I try to connect with them that way.

And I also try to get involved very closely with my daughter. And that's not easy because she's 15 years old and she doesn't want to be anywhere near me.

But I try to insert myself and all her homework and try to be in contact with what she's doing at school and talk about her friends and the things that interest her. So, we try to have this close and warming connection with my family outside work, at work. And I think it's important because we live at work more than we live at home. I try to always encourage an environment of collegiality. We try to encourage people to give positive feedback. We have the caregiver celebration, and we encourage people to always recognize others. But we also have intentionally a structured program here in our center where we have a monthly newsletter where we recognize the great things that people are doing and it's constant, not just once off. We always try to give encouragement and recognition to others. And always when you do that, you feel good yourself.

When you try to give praise or to give positive comments and encouragement, it's an amazing feeling because it reflects on you. You feel great even sometimes more than the person who's receiving those positive recognitions. So, we try to promote that environment as much as possible. And before the pandemic, we used to create some social defense. Now we're doing it again, hopefully slowly just to build teamwork. So, all of this together, I believe outside and at work helps shape your personality and your character and decrease the stress of work. And anyone can do it because it doesn't cost much. It is something cheap and it is a great feeling to be able to connect with others, practice gratitude, be close to your family, but also take care of yourself. And we as physicians are guilty of not taking good care of ourselves and leaving it as the last thing on the agenda while it should be the first. Because mental health and psychological wellbeing impact everything else we do.

Cara King:

I love these tips because like you mentioned, it's not one big thing like going to the gym for two hours a day. It's like all these little things that you can really just integrate on a daily basis that can just change your entire mindset. I love these. And I'm hearing you say nature, I'm hearing you say social interaction, walking with your dog and teenagers terrify me. My kids are young enough, they still like me. They're two, four and six, but I'm so scared when they're teenagers, is it wild? It's wild.

Zeina Nahleh:

Yes, it is. But it's interesting. Teenagers, like anything, I would say as a person you have to be approachable. As a leader, I learned, and I always try to improve my leadership skills to be an approachable leader. And same thing with your kids. If they feel that you're approachable, if they feel they're safe to come to you and that you are not going to be judging and you are going to be providing them with trusting, connection and build this kind of relationship, whether a leader or a parent, I think at the end of the day, yes, teenager may not express. I'm telling you from now, don't expect a lot of thank-yous and love yous and please. But at the end of the day, I noticed when it's like, for example, Mother's Day or my birthday, she would send me a card that's complete like, oh, this is from my daughter. Yeah, thank you for being my best friend, thank you for always being there for me, and how did this happen? So yes, you can definitely see that.

Cara King:

So, it's deep in there. It will come back in her '20s, but it's deep in there.

Zeina Nahleh:

I'm waiting for that, yes.

Cara King:

Oh my gosh, you make me laugh. All right, with our last couple of minutes, I just have just some final questions and it's about leadership, exactly what you're talking about with this idea of approachable leadership. And as the chair of the Department of Hem Onc Hematology and Oncology and the Director of the Maroone Cancer Center Cleveland Clinic Weston Hospital, you've obviously excelled in this area at an exponential level. So, I'm just curious, in your experience, what are the most important attributes of a leader?

Zeina Nahleh:

I wouldn't say I excelled; I'm still learning. And like I said, leadership is a lifelong learning experience. You have to continue to be willing to learn and you learn from everything and everyone, not just from mentors. I do though, I often ask for feedback, but feedback is about the past. I also ask the council about the future. So, I'm lucky and fortunate to have amazing mentors and leaders at Cleveland Clinic and elsewhere who have supported me. So, I always seek feedback, but also counsel. Now, I think an important attribute for leadership is something we discussed to be approachable, to be empathetic and compassionate, and also to look for the greater good. Not only focus on yourself but focus on the greater good of your team and of the organization.

But in terms of personal interaction, a leader should be fair, should really treat people with empathy and should give credit where credit is due. But I also look at myself in terms of developing those qualities, I feel that I'm also motivated, and that's an important characteristic of a leader, is to be sometimes self-motivated. Because you have so many challenges and that can drain you as a leader unless you develop self-motivation and always focus and try to minimize distraction, like I said, internal or external. So, you have to be focused, motivated, and fair, but also looking at the greater good as a servant leader.

Cara King:

I love these thoughts. And then idea of internal motivation, like internally motivate yourself. That comes from true passion, and you can tell that you just truly enjoy your job and your role and the personal connection that you have with your colleagues and the way you've spoken over the past half hour too. It's not just your colleagues, meaning other physicians, but it's everybody on your team. It's the front desk people, the people who help clean our office space. It's the entire team that raises everybody else up. And I can just tell that you just make this culture throughout your department. So, thank you so much for your really wise words.

Zeina Nahleh:

Thank you, Cara, that's great to hear from you. And thank you for this opportunity. I feel we have a great opportunity, also a chance and a privilege to make a difference. It's our team or our patients, and I think we take this very seriously, but I think also my last step is probably you should not take yourself too seriously. You should laugh at yourself sometimes and bring that humor into your life. Maybe I should add this to the lifestyle tip. I think this is important, it is to look at life and take yourself too seriously and laugh at yourself sometime and help others relax and be comfortable and try not to always be too stiff about things and make people feel at ease. I think that helps you and that helps people around you.

Cara King:

Like that state of true vulnerability. When you're vulnerable enough to look at yourself and laugh and know that we're human, it makes other people feel comfortable that they can do the same. I have to agree. Well, Zeina, thank you so much for your time today. It's been an absolute pleasure talking with you this afternoon, and we hope to have you back sometime soon. Thank you so much.

Zeina Nahleh:

Thank you so much.