Interview with Dr. Eleanor Tanno

In today's interview, Dr. Eleanor Tanno explains how her consulting business grew directly from the needs of some of her patients.

She received her medical degree from the U. of Maryland School of Medicine. Then she completed her residency in Family Medicine at Virginia Commonwealth University. She works as a full-time primary care family physician as a partner in a multispecialty medical practice. She founded Advance Directive MD as a side project to assist people in creating meaningful advance directives.

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Dr. Eleanor Tanno's Journey on Side Business

The concept for this firm occurred to her very early in residency, while she was at the hospital working in the Intensive Care Unit. She observed that many families were unprepared to handle queries concerning end-of-life care. And most did not have an advance directive in place.

And those that did have advance directives had been prepared with the help of an estate attorney. They were frequently outdated and didn't contain the information to make end-of-life decisions in the hospital setting.

That's when Dr. Tanno started to envision a part-time business devoted to addressing this issue. Towards the end of the COVID pandemic, she started educating patients and helping them complete their advance directives 

How Her Consulting Business Grew

She began listening to podcasts regarding nonclinical careers. And took online courses to learn how to start a small business. She learned how to create a website, create a business plan, and market her business.

She marketed her services through word-of-mouth, presenting to groups, writing articles for the public, and holding workshops to teach patients and their families about advance directives. And she collaborated with attorneys to help their clients complete the medical portion of their advance directives. She was very pleased by how quickly her consulting business grew.

Dr. Eleanor Tannor's Advice

We're so locked into this idea that we're in clinical medicine and that's all we are doing. But the more people I talk to about this, the more physicians I meet doing things that are out of the box. 


You can get a look at what Dr. Tanno has built by visiting There you will find articles and workshops, webinars, speaking events, corporate events, and lectures for medical professionals.

NOTE: Look below for a transcript of today's episode. 

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Transcription PNC Podcast Episode 289

How This Consulting Business Grew Directly From a Patient Need

- Interview with Dr. Eleanor Tanno

John: I connected with today's guest several months back on LinkedIn, and I found her side venture so interesting that I thought I had to have her join me on the show. So, Dr. Eleanor Tanno, welcome to the show.

Dr. Eleanor Tanno: Thank you. Thank you for having me. It's such an honor.

John: Well, it's going to be fun because I find myself interviewing physicians who are practicing and they're happy in their practice. Not everyone that comes on this show is seeking the exit. But it seems like physicians are curious and when they find a problem, they want to solve it. And so, many physicians do something on the side like you're doing. And I thought it'd be very interesting to hear your story and walk through how you got involved with this and how things are going.

Dr. Eleanor Tanno: Thank you.

John: With that, first, tell us about your educational background and clinically what you've done since finishing your residency.

Dr. Eleanor Tanno: Sure. Since finishing my residency, which is in family medicine, I joined a large multi-specialty private practice in Rockville, Maryland. I practiced with about 20 internists, mostly a few family physicians are sprinkled in there and then some subspecialists. So, we have, I think three or four other subspecialists that work all under our roof. And so, that's mostly what I've been doing essentially full-time.

And then I've had this idea since the beginning of my residency, but really sort of hit the road about a year and a half ago at the tail end of the pandemic when we all had a little more time and some of us had some breathing room. I started this side venture in helping people put together their advanced directives.

John: That's very interesting. What happened that prompted you to do that? Apparently there's a problem that was needed to be solved. And in that, tell me, did you have some special relationship with that whole concept? Do you work for a hospice or any of those kinds of things? Explain that in more detail.

Dr. Eleanor Tanno: Yeah. The idea came really early in residency when I was in the hospital and doing time in the ICU. I'm sure as many physicians have seen end-of-life care in this country, the pendulum has swung. And so, we do a lot of aggressive end-of-life care and find ourselves asking, "Is it worth it for this patient? Are they getting anything out of it? Are we actually solving a problem?" And also I found that a lot of families are completely unprepared to answer the questions about end of life care and next steps.

And if they did ever talk about it with their family members, which most of the time they hadn't, it was in the form of an advanced director that had made with an estate attorney that was often extremely dated by even honestly, decades. And it didn't actually have any practical information for physicians. If I'm in a persistent vegetative state, pull the plug or something. They wouldn't actually say that term, but no heroic measures.

And I just found myself asking why are people making these documents with an attorney and not with a physician? And how can I potentially be the physician who makes that document with them and has these conversations? This idea sort of mulled around in my head for years. And I thought, "Well, one day I would love to help people put their advanced directives together from a clinical perspective."

And then when I got into practice, I just realized during a primary care session, you could briefly go over these things, but there just isn't time to really get into this information. And there's so many misconceptions out there about end of life care that I decided to really dive into this more and create a more robust system.

And I did at one point investigate doing a palliative care fellowship, maybe two years into practice. I thought maybe I should go down that road. But what I found, and I did go as far as actually to shadow a palliative care fellowship program and really see what they do all day. I found a lot of it was symptom management, which was not really a piece I needed.

And a lot of what people need is they just really need the clinical perspective and just really basic misconceptions to be corrected. A lot of people, they think that withdrawing care at the end of life is the same thing as say do not resuscitate. There's a lot of just really basic stuff that really any physician who's been in a hospital could help people with. And so, I thought, "Well, I think I can do what I want to do without the fellowship, and if I need to, I can always go back for it."

I started doing this and getting into it more, and the more I got into it, the more really of a need I realized that there is, and people are thirsty to know about this stuff. It's a little bit of a black box, which as physicians, that's our fault too, but there's just so much light to be shed in this area.

John: No, absolutely. And you mentioned the attorneys. My wife and I did the same thing. We went and did this plan. It was kind of a life plan. It was really more for the financial side. And one of the things that was in there were the documents for advanced directive. And so, we filled out what we did. Luckily, she's a respiratory therapist, I'm a physician. At least I understood pretty well what I was doing.

The other thing that it makes me think about too, when you said about being trained in palliative. The reality is even most of the physicians doing hospice care are not palliative care doctors. There's very few of those. Mostly, it is internists and family physicians like you that are doing it anyway. And you're taking care of patients that are seniors and are older. So, it's something that they all need. So yeah, it makes perfect sense. And I think you're right. The MD, DO, whatever, is plenty to understand how to make something that's a lot more specific and useful. So, that's interesting. What happened? There was a point where you said, "Okay, I'm going to do something about this." Take us down that path. What did you start doing?

Dr. Eleanor Tanno: Well, I started listening to a lot of podcasts, actually. Nonclinical career podcasts. There are so many out there, but a number that really sort of resonated with me. And one of the ones that I found was Marjorie Stiegler's podcast. And she's very practical.

My background is in engineering, and I just felt like she was speaking to me, actually like nuts and bolts how to do it. So, she talked about how to make a website. She even had a whole episode on how to create a podcast down to what kind of a camera and what kind of a mic to get. These little really, really useful nuggets.

And so, at some point I just listened enough and enough and then I felt like I was ready to launch. And I did that and I started writing and I thought, "Well, while I'm getting all my prep work, at least I can be writing down my ideas and creating, so that when I'm ready to hit go, I can." And then I created my website, which I did from scratch myself, which was a whole lesson in everything you can learn on YouTube, which I thought was fantastic.

John: Yeah, YouTube is great.

Dr. Eleanor Tanno: I know. Really, I mean, it's amazing. And that was really great because now I know how to change it and edit it and do things. And just all these little things along the way. When you get into practice after a number of years, I'm sure you hear this a lot from your people, you plateau a little bit, right? I answered the same 100 questions a day, right?

John: Right.

Dr. Eleanor Tanno: And I see the same 50 clinical diagnoses and 10 of those I see, I don't even know, 15 times a day. And so, it was really fun to start to learn something and get out there, and it's almost like you put these breadcrumbs. You leave something and you forget about it, and then a couple weeks later you get an email, "Hey, your article was accepted into wherever." And so, that's what I was doing and reaching out and making connections with senior communities, which is sort of my target audience. Most people who are thinking about advanced directives are generally in their sixties and seventies, but some of them are younger.

John: Now I'm sure that with your individual patients, of course, this was something you were doing all along in terms of trying to get that done. Although, like you said, there's not enough time in a normal visit. But the other thing that occurs to me is there's probably opportunities just to do lectures. Were you doing that before this became an idea to be a business? Or are you doing more of that now?

Dr. Eleanor Tanno: That was sort of like the building. I reached out, I thought who would be interested in this? I live outside of DC. People are very highly educated and then they retire and then they're looking for something to do with their brains. And so, there's a lot of these senior lecturers in communities. And so, I reached out to them, and honestly, they were delighted to have a physician. There aren't that many physicians who have the time or energy or interest in doing something like this or anything in terms of the lectures.

And so, I reached out and I said, "Hey, are you interested?" And I think as I did them, I got more comfortable, I realized what questions people had. I refined things. I get great feedback from my students, and I think it's just nice to have something practical. The lectures were born out of that. And as I go one day I hope to make probably an online course that people can individually take online and just purchase basically like an hour, two hours, whatever ends up being.

John: Yeah, it seems like the progression is okay, do some live events and keep doing them forever if you like. And those are usually in person, then you have the online events, and then eventually you do that so many times you're like, "Okay, well, I could definitely turn this. I can just record the darn thing because I've done it 20, 50 times." And then that's just there for people to purchase or have access to for free or what have you. So, that sounds like the process that you're following.

Dr. Eleanor Tanno: Yeah. And then the other client base that I hadn't considered when I first started was actually working with attorneys. So, I reached out to a local estate attorney, and I had asked her basically if she could see a place where we could essentially partner where she could do the legal part of the advanced directive, and I could help people with the medical part.

And she owns her own practice and she was like, "To heck with meeting one-on-one, I would love for you to come and train my estate attorneys on how to do advanced directives." Because apparently this is their least favorite part of doing the estate planning is the medical part. Because they don't feel comfortable. They don't have the training and any questions they get, they basically say, "Go ask your doctor." And so, that would be a really interesting thing is to go and train attorneys on advanced directives.

John: That's interesting how you can find a new niche that you didn't know existed, but you just get out there and network and reach out to someone that you might know or maybe that somebody refers to you and these things can develop.

One of the things I've noticed in the past is that at first it didn't make sense to me that somebody who was working full-time, who is maybe a little burnt out, just as we all are, or bored. Like you said, you're seeing the same diagnosis so many times a day. Well, let's just add another 10 or 12 hours of work a week to my plate. But it seems like people that do that, either they somehow know how to balance it but they feel they enjoy it so much and actually life seems more fulfilling and really not so much of burnout. So, is that what you've experienced in this process?

Dr. Eleanor Tanno: Yeah. I find this whole process extremely creative. Like I said, creating a website, reaching out to people, creating lectures, trying to find materials that make something that can be extremely complicated, much more user-friendly. For me, it's a lot of fun. And sometimes it's a small thing, like you're sending an email to somebody or something, and so, you might do 10, 15 minutes on that day. And other days I'm sitting down, I'm like, okay, I'm about to give a talk. Next week I have a talk for a hundred people in an advanced directive workshop. I really need to put aside a number of hours to get that done." So, it ebbs and flows, but in terms of how I find the time, it's something I enjoy. Anything you enjoy, you find time for. And I guess part of it also, I have a two and a half year old.

John: That doesn't take any time, does it?

Dr. Eleanor Tanno: No, but when she started going to bed about the same time, I felt like I could breathe. And suddenly it was eight o'clock at night and I thought, "I think she's sleeping for the night." Rather than maybe watch TV for an hour, I was like, "Well, let me write for an hour." And I enjoyed it. So, it didn't seem like that. It doesn't feel like work and it's so creative.

And I think the other thing is, and I tell this a lot of times to my medical students from Georgetown. You get into this job and there's kind of like a limit on what physicians can do in clinical practice, right? Unless you're in a hospital and you move up. Once you're in private practice, and I'm a partner at my office, there's not a whole lot of growth from an employment statement point that could happen there.

But with this side venture, it feels like the sky is the limit. I was listening to this one podcast where they said "You don't need to think outside of the box, just the box is bigger than you think it is." Something to the effect of that. And it just feels like there's so much out there and you just stumble into interesting people and ideas and fields and training the attorneys on the estate planning aspect of it. It's like you almost stumble into these new worlds and you're like, "Wow, there's something here for me to work on." I don't know, it's very open and creative.

John: Well, you said it earlier about how we spend so much time in our education and we're learning constantly. We're just programmed to learn and then you reach a plateau in your practice. And so, okay, well, I'm going to learn something new. For me, over the years, I remember I was three or four years into my practice and we didn't have a retirement plan. And I knew nothing about investing. So I spent the next year learning about investing. It was interesting, it was something different from medicine. I never became a stockbroker or anything, but it was just like, "Yeah, I can just take my attitude towards learning and apply it to this, and then it'll be something else after that."

Now this has been fine though, right? It's meshing with your practice, you're still covering and practicing full-time and doing this. Are there certain aspects of this where you can actually earn income from it that are, I don't know, maybe with this recent conversation with the attorney that opens up a whole different venue? But what part of it do you think it is really? Because we all want to diversify our income, right?

Dr. Eleanor Tanno: Yeah.

John: So, what part does it seem like has the most potential for that for you right now?

Dr. Eleanor Tanno: Right. I think there's a lot of potential. If somebody's going to sit down with a state attorney and pay them, I've heard, easily $5,000, $10,000 to put together their estate documents, why wouldn't they as part of that package or on top of that package, meet with a physician to do their advanced directive? So, that's one place that for sure income can be earned.

A lot of these lectures I give, they are at paid venues. So, assisted livings will pay for speakers. Recently, I have one that a hospital gave a grant to a local senior community to get more advanced directives in the community. And then if I did an online course, which I do want to do hopefully in the nearest future, I imagine people would be very happy to pay a nominal fee for that. As opposed to what it would cost to sit down one-on-one to then to pay for a two hour course or something. And then if I did more speaking, especially at the attorney level, that for sure could be another paid speaking audience essentially.

John: It sounds good. Sounds like a plan. I failed to mention your website or the URL for that. It's called Correct?

Dr. Eleanor Tanno: Yes.

John: Yes. And so, if our listeners go to your site, because I think it's good to look at what someone has created in this process of doing a side venture, side gig, whatever. What will they find on the website? Because you created it yourself, and it is a very good website. I definitely looked it over and it's awesome really. It's better than mine. And I'm paying somebody.

Dr. Eleanor Tanno: Well, I did get professional photos, which I think was something that was highly recommended. I took a course through Marjorie Stiegler's online class. And so, that was one thing that she had talked about.

John: I'm going to ring the bell again to hers.

Dr. Eleanor Tanno: I know, I know. She's a common name at my dinner table. My husband asked me if I was secretly sending her money or something. I was like no. In terms of the website, the homepage is basically make an advance directive with a physician. I put out there what I am.

And then really there's articles that I've written that I think are really helpful. And I often when I teach classes say "I can't cover everything in this lecture, read more." And so, I have an entire article on dedicated to do not resuscitate orders. And then I have something in Maryland. I'm in Maryland. And we have the MOLST form.

John: Right.

Dr. Eleanor Tanno: And so, people have a lot of questions about that form because it's confusing. I have stuff on the pitfalls of choosing your medical power of attorney, specifically focused around adult children who are arguing over their parents' advance directives.

John: That's a good article. I got to read that one.

Dr. Eleanor Tanno: I think that was something I saw a lot in the hospital. Maybe they talked to their spouse about their advance directive, but they never talked to their kids about it. I've tried to make the most basic questions people ask, the most user friendly things. And then that's pretty much what my website is there for. And then I have obviously the ways to connect with me and then some of the things I do with speaking.

John: Yeah, I think you list workshops, webinars, speaking events. Not that those are all active at any given day, but I think it's good. It's a good mix. And then from what I'm hearing, \it seems like you're a resource for patients and for physicians and now for attorneys.

Dr. Eleanor Tanno: Well, my target client is patients, people, not physicians. I don't think that there's much I say that most physicians haven't encountered in their lifetime or their training. But really the step-by-step guide of how to make an advanced directive for patients and like I said, the power of attorney. These are questions that I get a lot.

What's interesting is when you start teaching and seeing questions people have, you learn things that you didn't even realize were pain points for other people. I was teaching this course and about a third of my students did not have an obvious medical power of attorney. They were single, they were widows. Their kids had complicated medical problems, whatever the story was. And that for them was the reason they hadn't made an advance directive because they didn't know who they would have as their power of attorney, and therefore they were paralyzed over this. And I found out later that apparently 20% of people are in this case.

So, now when I talk about naming a medical power of attorney, I make sure to say, if you don't have an obvious person, 20% of the population don't feel alone in that. And then I talk about some things that people might do to mitigate that. And so, that's the kind of stuff, that really working with people and patients that I learned along the way that I thought was surprising and interesting.

John: Very nice. Well, we're getting near the end here. We wish you all the best for sure. Another question that I typically ask my guests before they leave is, if you were talking to a physician who's in the middle of their practice, they're kind of burnt out maybe or just frustrated, bored, all the above, what advice would you have for them?

Dr. Eleanor Tanno: Really, the sky is the limit. We're so locked into this idea that we're in clinical medicine and that's all we are doing, but the more people I talk to about this, the more physicians I meet doing things that are out of the box. And so, you just have to find what interests you. I feel in some ways that I'm sort of reinventing the wheel with what I'm doing, but a lot of times there's tons of things outside of clinical medicine that are not as starting from scratch. And so, you just have to find something that excites you. And that's the community that you can then just build.

John: Well, I do surveys of my listeners every once in a while and one question that keeps coming up is "Well, how do I start a side business?" Obviously, listening to our conversation, Eleanor, would be helpful just to see "Okay, how you walk through that?"

I think it's good to look at your website and say, "Okay, this is a website of someone who started something new. It's not rocket science. Here's what you put out there as part of your marketing plan." And so, I would definitely advise people to check out

Now, if they happen to be a patient that needs it, also go there for sure. But I think we can learn a lot. And even looking at your LinkedIn profile, which I'll put in our show notes as well. So I appreciate you taking the time and explaining all this to us today. It's been fun.

Dr. Eleanor Tanno: Thank you so much for having me. It's very exciting.

John: We're going to have to swing back in about a year or so and see what's going on. I think it will be very interesting. Again, thanks for being here. And with that, I'll say goodbye.

Dr. Eleanor Tanno: All right, thanks so much. It was great talking to you.


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