Performing Under Pressure in Medicine
with Dr. Pasquale Eckert

You go to somebody for your procedure who has the most reps, just like Arnold Schwarzenegger chasing that dream of being that perfectly bodybuilt person—it’s the reps that got him there. The first thing you do when you wake up in the morning is make your bed; you’ve already accomplished something, and it adds structure and regimen to your day. I think that’s huge.

I call all my patients on post-op or on Saturday mornings to check in and make sure everyone’s doing okay. It’s not something that I’ll ever completely detach from, but I can compartmentalize stuff in my mind pretty well.

In this episode, we’ll cover a lot of great stuff with Dr. Pasquale Eckert, who is a peak performer at the highest level. You’re going to love it. This week’s charity is the Make-A-Wish Foundation. Again, that’s two guests in a row. So, please go ahead and like, subscribe, and share it with a friend. Also, leave a comment about the episode and what you liked; we really appreciate it and it helps us here at the channel.

Jock Putney: So, here in California, dude. Right? Welcome to the "Left Coast."

Dr. Pasquale Eckert: Thanks for having me. Yeah, it’s awesome. The West Coast, though—I don’t know if it’s the best coast.

Jock Putney: Yeah, that’s a debatable thing, right? I mean, the last time I saw you was on the East Coast.

Dr. Pasquale Eckert: Yeah. And that was fun. We had a good time in the town of Belmont. That was an interesting dinner, a good little sidebar.

Jock Putney: So tell me how it all starts for you. Like your career, or just as a kid—I’m sure you were super motivated from the gate.

Dr. Pasquale Eckert: As a kid, I was probably a pretty average student in high school. I had a good group of friends and a good family support system that kept me on track. As a kid, pretty much all I cared about was when I could get to the ski mountain next. I cared about skiing, hiking, and playing outside; that was my big drive.

Then when I got to college, I met my wife during my first year. We were study buddies. I think that was a big part of what kept my nose to the grindstone—having that support system and that anchor in my life throughout college, despite whatever social pulls there might have been. During my first or second year of college, I worked in my dad’s office over the summertime and I thought, "This is really cool." I knew I wanted to do something medicine or dentistry related, and oral surgery—maxillofacial surgery—blends the two.

I went from being a B/A-minus student in the first year of college to just pushing straight through. I was accepted to 13 dental schools. I chose Tufts University School of Dental Medicine because I thought it could give me the best education. I also tried to stand out as a leader, serving as class president for four years in Boston. I published three articles in the Journal of Oral and Maxillofacial Surgery. I think that helped me stand out, and then I got into my first-choice residency program—Tufts again. I grinded through residency, skied when I could, and now I’m on the Tufts alumni board. So, "Go Jumbos" for those who are watching.

Dr. Pasquale Eckert: I think my work ethic was partly from my parents instilling it into me from a young age and not getting caught up in some of the bad things circulating around society nowadays. I’m a checklist person. Whether it’s my day-to-day routine, house chores, or studying for exams, everything’s ranked. Number one has to get done before number two. If I just start ripping through the numbers, I can see that progress, and that helps me get through any given task.

Jock Putney: Talk more about that. That’s not a habit; that’s a routine. It’s something deeply ingrained in you.

Dr. Pasquale Eckert: It’s a routine. On a Saturday morning—my wife and I have a one-year-old son, Graham—there’s a lot to do. If it’s not on paper, my mind is scattered. I hit the gym early before the baby wakes up, then make breakfast while my wife feeds Graham. Nobody taught me to make checklists; it was just the only way to get everything done while balancing being class president and studying.

Jock Putney: Dental school is like boot camp, but talk about a day in the life of residency.

Dr. Pasquale Eckert: There’s "on-service" and "off-service." Off-service includes general surgery, anesthesia, and cardiology. On-service is the intensive oral surgery specific training. I’d wake up at 4:00 or 4:30 a.m., soak my cereal while showering, and be at the hospital to "pre-round" on patients before the senior residents arrived. We’d check vital signs and pain control, write a census, and round as a group by 6:30 a.m.

By 7:30 a.m., the first OR cases start, or you're in the clinic all day doing "bread and butter" implants and extractions. We didn’t have a lunch break back then. At 4:30 p.m., you’d round on the hospital patients again. Then I’d start prepping for the next day, go home, and usually get paged back into the hospital in the middle of the night. You're pretty much living at the hospital. I think my wife still has PTSD from that pager sound. We actually had to get rid of a microwave because it had the same beep as my pager.

Jock Putney: You mentioned orthognathic surgery. Many people don’t even know what that is, but the results you achieve are unbelievable.

Dr. Pasquale Eckert: Orthognathic comes from the Greek words ortho (straight) and gnathos (jaw). We make incisions inside the mouth to access and cut the bone, then move the jaws into the proper position and plate them. Think of the character "Jaws" from James Bond—he has acromegaly, which causes a big underbite. Surgery can bring the lower jaw back and the upper jaw forward to set the bite. It is life-changing from a functional and aesthetic standpoint.

Jock Putney: It’s amazing to see those cases. I’ve seen pictures where the change is dramatic.

Dr. Pasquale Eckert: The biggest movement I’ve done was a 12 mm change—over a centimeter. It changes a person’s social confidence and functionality. It balances out the facial features to make things more beautiful.

Jock Putney: We should probably talk about wisdom teeth and the misconceptions. A lot of general dentists might try to get them out, but a specialist produces a superior result.

Dr. Pasquale Eckert: We have specific training. A full set of impacted wisdom teeth takes us about 45 minutes. My wife’s younger brother went to an oral surgeon and was in and out in 15 minutes with no issues. For an oral surgeon, no tooth should take more than 20 minutes to remove. We use surgical handpieces that cut through the toughest teeth in seconds, whereas the equipment in a general dental office isn't always as equipped for cutting through bone.

Jock Putney: How do you detach from the really tough cases?

Dr. Pasquale Eckert: I don’t fully detach. I saw my dad doing it my entire life—taking calls while skiing or on family trips in Italy. I’m on call 24/7 for my office. I try to compartmentalize as much as possible and leave the business side at the door when I step into my house. But I call all my patients on Friday evenings or Saturday mornings. Medicine is never perfect; there’s never a guarantee. That’s why we’re always there for our patients.

Jock Putney: One thing I think about now is stem cell banking from wisdom teeth.

Dr. Pasquale Eckert: Tell me more about that, Jock. I know people choose to bank them, but how does the science work?

Jock Putney: For a long time, people were just freezing teeth, but the tissues weren't viable. We worked with universities to develop a GMP (Good Manufacturing Practice) protocol. We transport the teeth in a media that keeps them nourished and sterile. In the lab, we open the teeth, extract the pulp, separate the stem cells, and then expand them using PCR (Polymerase Chain Reaction) to increase the count.

Dr. Pasquale Eckert: What’s the window of time you have?

Jock Putney: We usually look at a 72-hour window. We use a proprietary media that acts like antifreeze for the cell, so it doesn't crystallize when frozen. Once it's in cryo, it stays in that state indefinitely. It’s exciting because stem cells can play a huge role in treating Alzheimer’s, Parkinson’s, and diabetes. We’re even looking at regenerating cartilage and heart tissue.

Jock Putney: For the kid thinking about being a doctor, what should they focus on?

Dr. Pasquale Eckert: Figuring out what you want to do early helps so you don't lose years stacking a resume later. Call your local oral surgeon or eye doctor and ask to shadow them. Shadow a few different ones, because one orthopedic surgeon might do finger surgeries while another does hip replacements.

Find a mentor. A good mentor is someone who wants to give you all the knowledge they have with no reservations, simply to see you grow. For me, that was my dad and a professor at Tufts. Oral surgery is the greatest career in the world because you can do anything from "teeth and titanium" to treating tumors or facial plastics. Find someone who can show you how they made it to their goal.

Jock Putney: Sage advice. Having a mentor is super important. Dr. Eckert, it’s been great to have you.

Dr. Pasquale Eckert: Thank you. Good to be here.

Jock Putney: Thanks everyone for watching. Please remember to like, comment, and subscribe. Share the video with someone who might be interested in supporting our guest's charity, Make-A-Wish. We'll see you soon.