Difficult Conversations -Lessons I learned as an ICU Physician

It’s All In The Delivery: Improving Healthcare Starting With A Single Conversation by Dr. Anthony Orsini

The Orsini Way X

drorsini@theorsiniway.com

Shawn Gibbs LinkedIn

GIV Gowns

Buying for a Facility (email link)

The Weight of Your Words Jan 14, 2026

Show notes

Host: Liz Poret-Christ

Guests:

Tracey Piparo

Jennifer O’Brien

In this special episode of Difficult Conversations, Liz Poret-Christ hosts in memory of her husband Ken, whose voice you hear in the show’s intro/outro and who passed away about a year ago from glioblastoma. Liz shares how that loss and the painful reality that palliative care and hospice are often introduced far too late sparked the conversation. She welcomes two guests, Tracey Piparo, a longtime physician associate who transitioned from emergency medicine to palliative care because she realized patients and families weren’t being truly heard, and Jennifer O’Brien, a healthcare leader and author of The Hospice Doctor’s Widow, who became an advocate for “death literacy” after caregiving for her late husband through a 22 month cancer illness. Together, they lay the groundwork for why these services matter: palliative care can support quality of life alongside curative treatment, while hospice focuses on comfort and support at end of life.

The heart of the episode tackles why clinicians “dance around” these conversations: fear of failure, discomfort with mortality, a high-achiever culture that equates death with losing, and confusion about palliative versus hospice. Liz shares her personal story of repeatedly asking when to involve palliative care, only to be told “not yet,” until a hospice physician finally stated plainly that Ken was actively dying, leaving little time to prepare family and say goodbye. Tracey explains how avoiding clarity can rob patients of informed choices and argues communication should be treated like a clinical procedure, trained, practiced, and supported by specialists when needed. Jennifer adds a compassionate framework her late husband used “precious time” to help families understand when it’s time for the most important conversations (“I love you,” “I’m sorry,” “I forgive you,” “thank you”), and emphasizes that preparing for end of life doesn’t destroy hope, it reshapes it. The episode closes with a strong call for both clinicians and families be clear, ask early, bring in palliative support sooner, and replace “but and or” with “and” so care can hold “hope” and preparation at the same time.

For More Information:

It’s All In The Delivery: Improving Healthcare Starting With A Single Conversation by Dr. Anthony Orsini

Tracey Piparo LinkedIn

Jennifer O’Brien Website

Precious Time Implementation Guide (free download) by Jennifer O’Brien

A Guide to Palliative Care & Hospice (free download) by Jennifer O’Brien

Free Resources (free downloads) by Jennifer O’Brien

The Hospice Doctor’s Widow: A Journal by Jennifer O’Brien

Anchored in Hope with Dr. Jessica Daigle Dec 22, 2025

Show notes

This episode of Difficult Conversations features Dr. Jessica Daigle, a board-certified pediatrician, NICU and pediatric hospitalist, and founder and CEO of Mom & Me, MD, joining Dr. Anthony Orsini and Liz Poret-Christ for a conversation about what families remember most in healthcare, not perfect outcomes, but how clinicians show up in the hardest moments. Jess opens with a core theme, medicine’s discomfort with silence, uncertainty, and pain, and how the pressure to “fix” everything can unintentionally deepen trauma. The discussion repeatedly returns to the idea that there are multiple patients in the NICU experience (baby, mother, father/partner), and that compassionate presence, transparency, and patient-centered communication can change how families carry grief, fear, and uncertainty.

Jess shares her personal path into NICU work, first through early fascination with neonatology, then through a personal experience, a traumatic miscarriage where she delivered her baby herself, and later a prolonged hospitalization and preterm birth of her son Liam. Those experiences reshaped her focus from “the baby only” to the whole family system, and helped inspire her work through Mom & Me, MD. She also highlights her devotional book Anchored in Hope for NICU parents, designed to support the emotional and spiritual toll alongside the medical journey. The episode closes with Jess reflecting on her first time delivering serious news as an attending, how hard it is to balance urgency, honesty, and empathy, and the lasting truth that even when outcomes are heartbreaking, families often remember and value the clinician who stayed present and helped them navigate with humanity. Please hit the subscribe button now! For More Information:

It’s All In The Delivery: Improving Healthcare Starting With A Single Conversation by Dr. Anthony Orsini

drorsini@theorsiniway.com

Jess Daigle, MD FAAP LinkedIn

Dr. Jess Daigle Instagram

Mom & Me MD

Anchored In Hope: A NICU Parent’s Devotional: 30 Days of Strength, Peace, and Hope by Jessica Daigle, MD

The Long Dying of Baby Andrew by Robert & Peggy Stinson

Difficult Conversations with Dr. Anthony Orsini Podcast- Episode 91: Not What I Had In Mind with guest Laura Diaz-Freeland

A Friend in the Business - Navigating the Complex Healthcare System Nov 25, 2025

Show notes

Difficult Conversations with Dr. Anthony Orsini- Episode 93

Difficult Conversations is back with one of its most personal, emotional episodes yet. Dr. Anthony Orsini and Liz Poret-Christ return to talk with guest Dr. Stephanie Tan, a physician and clinical trial specialist whose career has spanned surgery, dermatology, pharma, academia, and regulation across Asia and Australia. Stephanie shares how her own health redirected her from surgery into research, giving her a rare 360-degree view of medicine and clinical trials. That perspective and her personal journey ultimately led her to co-found AbbeMed, a doctor-led concierge service that helps patients and families cut through red tape and connect with the right specialists, clinical trials, and cutting-edge therapies around the world.

The heart of the episode is Stephanie’s deeply moving story as both doctor and mother. She recounts the long, frustrating process of noticing her young daughter’s developmental delays, fighting through months-long waitlists, and finally receiving an ultra-rare genetic diagnosis, only to be met with silence from the pediatric neurologist who didn’t know what to say. Dr. Orsini and Liz unpack what compassionate communication could have looked like in that moment and why “I don’t know, but we’ll figure it out together” can be so powerful. From there, they explore how AbbeMed aims to be that “friend in the business” for families facing complex or rare conditions, and Dr. Tan offers advice to new doctors: stay curious, think beyond rigid training, be honest when you don’t know, and always validate your patients’ emotions. She closes with a message of hope for patients and caregivers: Keep an open mind, don’t give up, if there’s a will, there’s a way, and services like AbbeMed exist to walk that path with you acting like you have a friend in the business. Download this episode now to hear more!

Top of Form

Hosts:

Liz Poret-Christ

Dr. Anthony Orsini

Guest:

Dr. Stephanie Tan

For More Information:

It’s All In The Delivery: Improving Healthcare Starting With A Single Conversation by Dr. Anthony Orsini

The Orsini Way-X/Twitter

drorsini@theorsiniway.com

AbbeMed

Artificial Intelligence and The Future of Medicine with Dr. Robert Pearl Sep 16, 2024

Show notes

In this podcast episode, Dr. Anthony Orsini discusses the value of difficult conversations in the medical field, reflecting on how his podcast has allowed him to connect with incredible people over the years. He reintroduces Dr. Robert Pearl, a former CEO of Kaiser Permanente, who first appeared on the podcast in 2021. Dr. Orsini highlights Dr. Pearl’s work and his new book, "ChatGPTMD: How AI-Empowered Patients & Doctors Can Take Back Control of American Medicine," which explores the role of AI in healthcare. Dr. Pearl emphasizes the broken state of the healthcare system, particularly the inefficiencies and challenges surrounding chronic disease management. He advocates for the integration of AI in medicine, arguing that it can enhance patient care, reduce costs, and ultimately save lives if clinicians are willing to embrace the technology.

Dr. Pearl discusses how generative AI, like ChatGPT, can revolutionize the way healthcare is delivered by providing tools that make the practice more efficient and effective. However, both he and Dr. Orsini acknowledge the importance of maintaining the human element in medicine. They stress that while AI can assist with diagnoses and administrative tasks, the physician's role in building relationships and providing compassionate care remains irreplaceable. The conversation ends with a call for healthcare professionals to actively engage with AI to harness its potential while preserving the critical human touch that defines quality patient care. Please hit the subscribe button now!

Host:

Dr. Anthony Orsini

Guest:

Robert Pearl, M.D.

For More Information:

It’s All In The Delivery: Improving Healthcare Starting With A Single Conversation by Dr. Anthony Orsini

The Orsini Way-X/Twitter

drorsini@theorsiniway.com

Robert Pearl, MD Website

Robert Pearl, MD X/Twitter

Robert Pearl, M.D. LinkedIn

ChatGPT, MD: How AI-Empowered Patients & Doctors Can Take Back Control of American Medicine by Robert Pearl, MD

Difficult Conversations Podcast-Episode 153: Uncaring Conversations about Physician Culture with guest Robert Pearl, M.D.

Not What I Had In Mind Feb 12, 2024

Show notes

On this episode, Dr. Anthony Orsini and Liz Poret-Christ introduce guest, Laura Diaz-Freeland, whose twin daughters were born at the very limits of viability at just 23 weeks gestation. Laura’s memoir, “Not What I Had in Mind,” is discussed, highlighting the emotional journey and the deep empathy found in motherhood that she experienced following the birth of her extremely premature daughters. Dr. Orsini was part of the team who cared for her twins and they discuss the bond that Laura forged with the medical staff. Laura discusses at length the emotional rollercoaster, exhaustion and helplessness that she and her family experienced. The episode covers the profound advancements in neonatal care and the ethical dilemmas faced by parents and medical professionals in the treatment of such young infants. As a seasoned professional in marketing and creative writing, Laura’s poignant reflections highlight the importance of informed choices in the face of life’s most fragile beginnings, giving voice to the silent struggles and triumphs of preterm birth.

Laura advocates for parental choice and informed decision-making in cases of extreme prematurity, sharing insights from her 224-day hospital experience with her twins. She stresses the need for compassion from healthcare providers and the importance of informed consent. Dr. Orsini and Laura delve into the delicate conversations that occur in neonatal care, emphasizing the need for a supportive team approach to patient care. Laura recounts how, despite feeling alone during the initial decision-making process, she later felt part of a team at the Hospital that was committed to her twins’ survival. Laura also mentions the unique nicknames she has for the medical staff, like ‘The Godfather’ for Dr. Orsini, and ‘Behemoth Hands’ for the surgeon, reflecting their impactful roles in her and her daughters’ lives. For parents navigating this journey, we end with Laura sharing advice to parents to educate themselves, be gracious with themselves, and to not yell at the medical staff. Please hit the subscribe button now!

Top of Form

Hosts:

Dr. Anthony Orsini

Liz Poret-Christ

Guest:

Laura Diaz Freeland

For More Information:

It’s All In The Delivery: Improving Healthcare Starting With A Single Conversation by Dr. Anthony Orsini

The Orsini Way-X/Twitter

drorsini@theorsiniway.com

Laura Diaz Freeland Website

Laura Diaz Freeland Instagram

Not What I Had in Mind: A Motherhood Origin Story by Laura Diaz Freeland

COFFEE + CRUMBS-“Delusional Hope” by Laura Diaz Freeland

Hope For The Best. Plan for the Rest Jan 02, 2024

Show notes

In this episode, Dr. Orsini and Liz Poret-Christ are joined by guest, Dr. Samantha Winemaker, an associate clinical professor in the Department of Family Medicine, Division of Palliative Care at McMaster University in Ontario, and co-author of the book, Hope for the Best, Plan for the Rest: 7 keys for navigating a life changing diagnosis. Dr. Winemaker, an advocate for open communication, emphasizes the importance of patients expressing their need for honesty in their healthcare interactions, even when it involves tough conversations. Her work in palliative care, recognized by numerous awards and her co-hosting of “The Waiting Room Revolution” podcast, reflects her dedication to improving the healthcare journey for patients. She shares her personal path into palliative care, shaped by her medical interests and her desire to move away from internal medicine. Frustrated by the healthcare system’s delayed engagement with palliative care, she calls for a change, pushing for better public mortality awareness and suggesting that providers integrate palliative skills without necessarily labeling them as such to combat societal discomfort with death.

Dr. Winemaker’s critique of the healthcare system extends to the misconceptions surrounding palliative care and the need for rebranding to reflect its comprehensive role. She argues for mandatory training in communication and palliative care skills in medical and nursing schools to ensure providers are well-equipped to support patients effectively. She shares a story about a patient with lung cancer, to highlight the importance of informed decision-making and understanding the progression of illness. This episode also features insights into the book, Hope for the Best, Plan for the Rest, which offers 7 keys for navigating life-changing diagnoses, aiming to empower patients in managing their health. Dr. Winemaker aligns with Liz’s experiences with chronic illness, agreeing that patients should feel free to request full disclosure from their physicians to mitigate the fear of the unknown. She expresses her view on dying, considering it a natural chapter of life, and hopes to live her best life until the end without fear. Dr. Winemaker also shares her goal for the podcast and book, which is to educate patients worldwide, empowering them to navigate the healthcare system effectively and to manage their illnesses with confidence and knowledge.

Hosts:

Dr. Anthony Orsini

Liz Poret-Christ

Guest:

Dr. Samantha Winemaker

For More Information:

It’s All In The Delivery: Improving Healthcare Starting With A Single Conversation by Dr. Anthony Orsini

drorsini@theorsiniway.com

Dr. Samantha Winemaker Website

Hope for the Best, Plan for the Rest: 7 Keys for Navigating a Life-Changing Diagnosis by Dr. Sammy Winemaker and Dr. Hsien Seow

The Waiting Room Revolution Podcast

Entrepreneurship with a Purpose Dec 11, 2023

Show notes

Welcome to another episode of Difficult Conversations-Lessons I Learned as an ICU Physician. In this episode, get ready to explore the journey of Jon Brandt, a remarkable entrepreneur whose journey is not just about business, but about purpose and change, especially in the realm of mental health in educational settings. Liz Poret-Christ and Dr. Anthony Orsini dive into Jon’s recent sale of the Thrive Alliance Group, and his vision for integrating mental wellness into the fabric of our school systems. As we explore Jon’s journey, from the founding of Sage Day Schools to his innovative approach with Thrive Alliance, we’ll uncover the layers of a mission-driven life that has touched many.

Today, we trace Jon’s path from the loss that ignited his passion for mental health advocacy to the innovative ideas that propelled him into healthcare industry, revolutionizing patient care and worker standards. Dr. Orsini uncovers the milestones in Jon’s career, highlighting the value of an outsider’s perspective in healthcare innovation.

The discussion also touches on lessons learned from failures, the power of facing difficult conversations, and how his ventures have had a clear social impact. He also hints at his new venture, an educational program for entrepreneurs incorporating stoic wisdom, which is still in the early stages. Join us as Jon shares his insights on mental health, driving change, and leaving a positive mark on the world. Please hit the subscribe button now!

Hosts:

Liz Poret-Christ

Dr. Anthony Orsini

Guest:

Jon Brandt

For More Information:

It’s All In The Delivery: Improving Healthcare Starting With A Single Conversation by Dr. Anthony Orsini

The Orsini Way-Twitter

drorsini@theorsiniway.com

Resources Mentioned:

Jon S. Brandt LinkedIn

Jon S. Brandt X/Twitter

Thrive Alliance Group

Difficult Conversations Podcast-Episode 191: Fighting for our Heroes with Corey Feist

National Healthcareer Association

The Road Less Traveled by M. Scott Peck

Fighting for our Heroes Nov 13, 2023

Show notes

Welcome to Difficult Conversations. You may have heard the story of Dr. Lorna Breen, who was an accomplished physician that tragically took her own life during the spring of 2020. Today, Dr. Orsini and Liz Poret-Christ are honored to introduce guest, Corey Feist, who is the co-founder, and President of the Dr. Lorna Breen Heroes’ Foundation. Corey dives into his personal journey, driven by the tragic suicide of his sister-in-law, Dr. Lorna Breen, and his mission to transform the healthcare system to support the well-being of healthcare professionals. The Dr. Lorna Breen Heroes’ Foundation’s work includes awareness efforts to break the stigma surrounding mental health issues, advocating for changes in licensing laws and credentialing questions to protect healthcare workers’ rights, and advancing solutions that aim to improve the overall well-being of the healthcare workforce.

Corey shares insights into the challenges within healthcare, such as electronic medical records and burnout, which prompted him to take action. He discusses the “All in Wellbeing First for Healthcare” initiative, that includes grants to fund well-being solutions, a starter kit for healthcare systems to kickstart well-being initiatives, and a focus on removing barriers to mental health access. We’ll also hear the significant progress the foundation has made, including the passing of the Dr. Lorna Breen Healthcare Provider Protection Act and the creation of the All In Champions Challenge Badge program,. Corey emphasizes the importance of healthcare professionals reaching out for help and clarifies that the most reliable source for information on the status of physician licensing and mental health concerns is their website because the foundation regularly updates this information. He also discusses the need to remove questions about past mental health issues from peer reference forms, stressing the importance of creating a supportive environment and ensuring confidentiality for healthcare workers seeking help. If you enjoyed this podcast, please hit the subscribe button on your favorite podcast platform and download this episode to hear more!

Hosts:

Dr. Anthony Orsini

Liz Poret-Christ

Guest:

Corey Feist

For More Information:

It’s All In The Delivery: Improving Healthcare Starting With A Single Conversation by Dr. Anthony Orsini

drorsini@theorsiniway.com

Resources

J. Corey Feist LinkedIn

Dr. Lorna Breen Heroes’ Foundation

Dr. Lorna Breen Heroes’ Foundation YouTube

National Physician Suicide Awareness Day

Dr. Lorna Breen Heroes’ Foundation Toolkit

All In: Caring For Caregivers

988 Suicide & Crisis Lifeline

Support Changes Outcomes Oct 30, 2023

Show notes

Difficult Conversations with Dr. Anthony Orsini- Episode 88

In this episode, host Liz Poret-Christ along with Dr. Orsini, welcome guest Gina Jacobson, who discusses the Working with Cancer initiative. The initiative, born out of a heartfelt response to the need for better workplace support for employees facing cancer and chronic illnesses, aims to create a safe and positive environment for disclosing health conditions at the workplace. Gina, a survivor of stage four colon cancer, shares her passion for the initiative and her belief in the power of workplace support. The initiative has garnered support from major companies, including Yahoo, Disney, Walmart, SAP, Adobe, as well as The Orsini Way, all dedicated to fostering more inclusive and supportive workplaces, regardless of the company's size. Gina’s own experience surviving Stage 4 colon cancer and her belief in the power of workplace support have driven her commitment to this initiative.

Gina explains how companies can become involved in the initiative, emphasizing flexibility, and providing a framework with five commitment pillars. The conversation underscores the significance of teaching people how to support colleagues facing cancer and the need for a safe space for difficult conversations at work. The discussion also explores the challenges of sustaining the Working with Cancer initiative and ensuring continuous training. Gina discusses the importance of ongoing training, teaching people how to speak to and support their colleagues facing cancer. She emphasizes the need to provide a safe space for individuals and caregivers to have difficult conversations at work, how personal experiences and emotions play a role in advocating for the initiative’s global change, and its integration into inclusive manager training. Cohort sessions for managers are introduced as a way to offer intensive, real-time support. Gina highlights the initiative as a catalyst for promoting empathetic and compassionate communication in various challenging situations, extending beyond cancer. For more information, check out the Working with Cancer Pledge website and connect with Gina for more information. Hit the subscribe button now!

Hosts:

Liz Poret-Christ

Dr. Anthony Orsini

Guest:

Gina Jacobson
For More Information: