Month: January 2019

Nothing to Fear, Just a Dislocation Here

We discuss what every physician should know about the management of acute orthopaedic injuries that any of us may encounter in our lives and when to worry and when to reassure.  And how to reduce a dislocated shoulder.  We also discuss what sports she wouldn’t let her son play and the answer certainly surprised me.  

Dr. Nancy Yen Shipley is a board-certified orthopaedic surgeon, with additional fellowship training in sports medicine and arthroscopy. Her professional interests include sports medicine, arthroscopic surgery, injuries and conditions of the shoulder and knee, fracture care and general orthopaedic surgery.

Dr. Yen Shipley received her B.A. degree in Psychology at the University of California, Los Angeles. She spent time after her undergraduate training working in the snowboarding industry and event planning, before finding her true passion, medicine. She attended Drexel University College of Medicine, in Philadelphia, where she discovered her love for Orthopaedics. Dr. Yen Shipley completed internship and residency in orthopaedic surgery at Virginia Commonwealth University in

Richmond, Virginia, then completed additional fellowship training in arthroscopy and sports medicine at Orthopaedic Research of Virginia.

Dr. Yen Shipley is a partner at Multnomah Orthopedic Clinic. In addition to her her clinical practice, Dr. Yen Shipley enjoys caring for athletes of all levels, as a team physician for  U.S. Ski and Snowboard Team, Multnomah University and Portland Interscholastic League. She has also been involved as a part of the medical team for track and field’s IAAF World Indoor Championships, the University of Richmond and the Virginia Special Olympics.

Dr. Yen Shipley is passionate about sharing her path to medicine with others, in particular our next generation of future physicians. She is a mentor and champion for women and diversity in surgical specialties, and brings awareness to this through speaking engagements and an active online presence. She has been a featured contributor on KevinMD.com, called “a must-read blog” by Rebecca Ruiz of Forbes, among multiple other online sources of medical news.

In her free time, Dr. Yen Shipley enjoys spending time with her family, snowboarding, stand up paddleboarding, playing (i.e. learning) tennis, and enjoying the great outdoors and the great food in her adopted hometown of Portland. 

She can be found at 

www.NancyMD.com

www.instagram.com/_nancymd

https://www.youtube.com/channel/UCRHOG_6gCyGJd0bQerfFPOw 

www.facebook.com/nancymdpdx 

www.linkedin.com/in/nancyyenshipleymd 

Nothing to Fear, Just a Dislocation Here

We discuss what every physician should know about the management of acute orthopaedic injuries that any of us may encounter in our lives and when to worry and when to reassure.  And how to reduce a dislocated shoulder.  We also discuss what sports she wouldn’t let her son play and the answer certainly surprised me.

Dr. Nancy Yen Shipley is a board-certified orthopaedic surgeon, with additional fellowship training in sports medicine and arthroscopy. Her professional interests include sports medicine, arthroscopic surgery, injuries and conditions of the shoulder and knee, fracture care and general orthopaedic surgery.

Dr. Yen Shipley received her B.A. degree in Psychology at the University of California, Los Angeles. She spent time after her undergraduate training working in the snowboarding industry and event planning, before finding her true passion, medicine. She attended Drexel University College of Medicine, in Philadelphia, where she discovered her love for Orthopaedics. Dr. Yen Shipley completed internship and residency in orthopaedic surgery at Virginia Commonwealth University in

Richmond, Virginia, then completed additional fellowship training in arthroscopy and sports medicine at Orthopaedic Research of Virginia.

Dr. Yen Shipley is a partner at Multnomah Orthopedic Clinic. In addition to her her clinical practice, Dr. Yen Shipley enjoys caring for athletes of all levels, as a team physician for  U.S. Ski and Snowboard Team, Multnomah University and Portland Interscholastic League. She has also been involved as a part of the medical team for track and field’s IAAF World Indoor Championships, the University of Richmond and the Virginia Special Olympics.

Dr. Yen Shipley is passionate about sharing her path to medicine with others, in particular our next generation of future physicians. She is a mentor and champion for women and diversity in surgical specialties, and brings awareness to this through speaking engagements and an active online presence. She has been a featured contributor on KevinMD.com, called “a must-read blog” by Rebecca Ruiz of Forbes, among multiple other online sources of medical news.

In her free time, Dr. Yen Shipley enjoys spending time with her family, snowboarding, stand up paddleboarding, playing (i.e. learning) tennis, and enjoying the great outdoors and the great food in her adopted hometown of Portland.

She can be found at

www.NancyMD.com

www.instagram.com/_nancymd

https://www.youtube.com/channel/UCRHOG_6gCyGJd0bQerfFPOw

www.facebook.com/nancymdpdx

www.linkedin.com/in/nancyyenshipleymd

 

EPISODE TRANSCRIPT

Disclaimer: This is the transcript to the episode. This transcript was created by a talk to text application and the function of having this here is to improve the page search engine optimization. This transcript has not been proofread, so please listen to the episode and don’t read this. The information contained herein will inevitably contain inaccuracies that affect that quality of the information conveyed and the creator of this content will not be held liable for consequences of the use of the information herein.

Unknown Speaker  0:03
Welcome to the physicians guide to doctoring A Practical Guide for practicing physicians were Dr. Bradley Block interviews experts in and out of medicine to find out everything that we should have learned while we were memorizing Krebs cycle. The ideas expressed on this podcast are those of the interviewer and interviewee and do not represent those of their respective employers. This podcast is intended for medical professionals. The information is to be used in the context of your own clinical judgment. And those on this podcast accept no liability for the outcomes of medical decisions based on this information. As the radiologist like to say clinical correlation is required. This is not medical advice. And even though the magic of podcasting may make it seem like we’re speaking directly in your ears, this does not constitute a physician patient relationship. If you have a medical problem, seek medical attention. And now, Dr. Bradley Block
Unknown Speaker  0:58
Welcome back to the physicians guide to die On today’s episode, we talked to Dr. Nancy yen Shipley in arthroscopy and sports fellowship trained orthopedic surgeon in Portland, Oregon. She tells us about the common acute injuries that she sees when sports side and how a non orthopedic surgeon can actually help to work those up and decide what needs to go to the ER, and what can wait for follow up. And what specifically we need to look for to help us make those decisions. She talks about some of the common concepts that she sees in the office. Now we shouldn’t just get everyone in MRI as it usually isn’t necessary and frequently can be misleading. We also talked about an inflammatory article from the New England Journal of Medicine in 2008. That said, arthroscopy doesn’t work. So how does someone who doesn’t have fellowship in arthroscopy respond to that? It was very enlightening what she had to say about that. We also talked about the truth behind glucose. I mean, does it work or is it just Cebu effect and then some exercise recommendations that she gives to our patients that all of us could benefit from. This and all episodes are produced by car and Gill free professional voiceover artist and she can be found at car i n g i ll fry.com. And now, Dr. Nancy n Shipley, welcome back to the physicians guide to doctoring. On today’s episode we have Dr. Nancy and Shipley, a fellowship trained sports orthopedic surgeon who is also an active blogger. You can find her at Nancy and Shipley MD calm. And she’s here to talk to us about things that all physicians should know about orthopedic surgery specifically related to what she is fellowship trained in. So Dr. Jenn Shipley, thank you so much for being on the show today.
Unknown Speaker  2:48
Thank you. Thanks so much for having me.
Unknown Speaker  2:50
First, can you just give us a quick summary bio of your training?
Unknown Speaker  2:55
Absolutely. So as you said, I am a fellowship trained or orthopedic surgeon. My fellowship training was in sports medicine and arthroscopy. I had been in practicing here in Portland for seven years and I went to medical school at Drexel in Philadelphia, followed by residency and orthopedic surgery at Virginia Commonwealth University. And that was down in Richmond, Virginia. I stayed an extra year in Richmond, Virginia and went to orthopedic research of Virginia for my fellowship training in sports medicine and arthroscopy.
Unknown Speaker  3:34
So you spend some time on the East Coast before going back to the west coast.
Unknown Speaker  3:39
That’s right. Yep. And there were a whole bunch of Californians out there because there are just too many Californians and and you know, a whole bunch of us go out to the east coast, and then we kind of bitch about the weather and about how California It’s wonderful. And everybody wants to go back. So there’s a little bit sometimes Some of the East coasters were a little annoyed with us and oddly I I did come back West but I didn’t end up going back to California.
Unknown Speaker  4:07
And Philly, I’m, I live in New York, but I’m a big fan of Philly. I went to college there and yeah, I think Philly is very underrated and underappreciated city.
Unknown Speaker  4:18
Oh, I absolutely agree. I really, really loved living. There was a culture shock in the beginning coming from Southern California and a weather shock, but, but it really grew on me and I have a lot of fun feelings for the city.
Unknown Speaker  4:33
Oh, yeah, Philly. Philly sports fans famous for booing Santa Claus, and now
Unknown Speaker  4:40
obscene mascot gritty.
Unknown Speaker  4:44
Someone’s meth addled nightmare. Okay.
Unknown Speaker  4:50
So, hockey mascot sports injuries. There’s the segue. Well, one of the things that I like to talk about on the podcast are Things that every physician should know. So when we go through medical school, we learn a lot of the basics. They know the steps of the Krebs cycle, but I never rotated through orthopedic surgery. So yeah, I know very little about it. But as a physician, I may be putting situations where I’ll need to know something about it. So for instance, if if one of my kids were in a soccer game, and someone got hurt, I’m they’re going to turn to me and say, hey, you’re a doctor, what, what do we do? And unless they’re having a nosebleed, or broke their nose, or need their tonsils out, I’m really going to be sure what to do if it’s anything orthopedic related, other than not or no rest, ice and elevated. So let’s talk about acute injuries that that you see and that we might encounter in those situations. So what are the most common acute Well, actually, First, let’s talk about what a as a as a in sports in our thrive could be one of the joints that you treat.
Unknown Speaker  6:03
So, I personally work quite a bit on the shoulders and the knees. That’s probably my bread and butter. I have of those two joints, I’m probably like 6040, a little more heavily weighted in the shoulder. But I also do some bread and butter fracture care. I take call at my hospital and in private practice, and I take a couple calls a month. And so I also treat fractures of the wrist, the elbow, the ankle, the patella, and hip fractures. So my elective practice is mostly shoulders than knees, but my, my general, orthopedic practice kind of encompasses a number of different areas. So let’s let’s start with the shoulder then. So
Unknown Speaker  6:51
if someone has an acute injury of the shoulder, how, as the physician should we help to tree can we help to triage the patient Right, how do we determine? Well, this is something that needs to go to the emergency room right now versus something that can you can follow up with an orthopedic surgeon as an outpatient. How do I help aside from bone sticking out of the skin?
Unknown Speaker  7:17
So you know, the most common injuries that you’re going to see like say, let’s take football, for example, right, you know, on, say you’re at a game or you you happen to be field side kids playing football. And most commonly, you’re going to see sprains and strains. And I know you asked me on the shoulder, but I’ll kind of maybe also load into more generalities as well.
Unknown Speaker  7:40
But absolutely will make it simpler to remember. So some.
Unknown Speaker  7:45
Sure. I think that
Unknown Speaker  7:48
you know, one of the things is, is to go back to basics, right, you know, so there may be a sprain or strain. Maybe they’ve had a if there’s a dislocation, there may be obvious deformity right? They may have a fracture but the for many I think obviously should go to the ER right and I’ll talk a little bit about you know some some quick and easy things that might be that you know any physician may be able to do field side or on on the scene that could help that. But with with fractures for example, if an individual cannot bear weight on that extremity so like lower extremity, their ankle hurts so much they cannot take three steps then that probably deserves an X ray. They may not need to if it doesn’t look obviously the form they may not need to go the ER right then but if the pain remains the same, then you might want to tell them hey, you should probably go the ER the urgent care tomorrow let’s get some x rays. If there is an obvious deformity there are certain injuries that dislocations for example, that you know depending on the physician, they may or may not be comfortable attempting a reduction But let’s use shoulder dislocations as an example. So, so these high school kids, we often see shoulder dislocations in football. Most of the time, this is going to be an anterior dislocation. So, so humeral head is anterior relative to the glenoid, right? With these freshness locations, you can actually get an anterior shoulder dislocation reduced in a really kind of easy non traumatic way and then and then this football player wants to hug you afterwards because it feels so much better. This with a good arm, yes, but maybe even with a bad arm if it feels good. So you know if if somebody is out the front and and they’re dislocated, a gentle external rotation of the arm, with their arm at the side can sometimes just pop it in. The reason that works is as you’re externally rotating your your forearm You know, to the hands moving further away from body, keeping the elbow at the side, you’re increasing tension across the subscapularis in the front of the shoulder. So as you increase that tension that almost acts like, you know, it’s kind of like making a rubber band really taught. And that will push that humeral head back into the shoulder. So and I’ve done this field side, when I first was learning about this reduction maneuver, reading about I was like No way. And one of the times I was I forget was a fellow and I was out at the field and somebody had an obvious shoulder dislocation, I’m like, I’m going to try this because it seems way less traumatic than the usual you know, what we see in the ER yankin on the arm. And it’s, it’s fantastic because when they first have dislocated, they haven’t gone into spasm yet. And that’s when you can get that shoulder in real quick. So that’s a great, great trick to know
Unknown Speaker  10:54
and external rotation real quick. So that is your elbow, the the arms are out there. side, the elbow it is against the body. And the the hand is at a 90 degree angle, like you’re going to shake someone’s hand that and then turn it out to the side so that the arm, the forearm is then parallel to the body instead of perpendicular to it. So that’s exactly what you’re referring to.
Unknown Speaker  11:21
Yeah, yeah. And then you can even put your, you know, you put your other hand kind of right in front of their shoulder where that you know, there’s going to be a humeral head kind of bulging out a little bit there. And a little bit of gentle pressure, along with that external rotation will oftentimes get a really fresh shoulder dislocation back in. I think elbow dislocations are a little bit harder to finger dislocations happening a lot in in football and in basketball. And I think I think any physician can reduce the finger dislocation at field side or courtside as well. It’ll be obvious looking at that joint, you know which which direction that the phalanx right your your finger is dislocated and it’s sometimes it’s just as easy as pulling you know axial traction is kind of pulling it straight back out. But I often teach people to do kind of an up and over so it’s almost like you exaggerate the deformity just a tiny bit before you pull that axial traction, a lot of times that’ll pop that right back in. But But I would caution you know, the physician if they are trying this and you know, applying some gentle yet from pressure and it’s just not going and don’t force it. If it if it doesn’t pop right in, then you know, then that’s then that warrants a trip to the ER.
Unknown Speaker  12:50
And as a disclaimer, this is
Unknown Speaker  12:55
as a disclaimer, and there’s the disclaimer at the beginning of the episode, but I’m just going to reiterate this This is all in the context of your own education. And we are not advocating that you, you do this on your patients with it unless it’s within your training and your comfort level. And yeah, we’re dealing with the finger. That’s a little bit far from the nose. But, you know, certainly these are not unreasonable things to try. But this is for physicians within the context of their education and training. So
Unknown Speaker  13:30
absolutely no.
Unknown Speaker  13:32
For any untoward
Unknown Speaker  13:35
yanking on your and then I don’t know it comes off something like that. So
Unknown Speaker  13:40
Exactly. Yeah.
Unknown Speaker  13:41
Yeah. Okay. Sorry. Continue. I just had to I felt compelled to throw that in there.
Unknown Speaker  13:46
Yeah, no, I think that’s definitely warranted. But you know, I think if if it’s, if it’s totally outside of your, your comfort zone, or even if you’re even if you’re a full fledged position, but you’re in a different specialty and These things are outside your comfort zone. It’s always better to err on the side of safety and send the person if there is any question whatsoever you know and sometimes dislocations we’re still talking about dislocations will pop out and pop back in one area that is really concerning is the need because you know, lots of important vasculature back there that can get injured and and it’s always nice to go back to basics. Like is there a pulse is there some station can they wiggle their toes, you know, and so if they’re near vascular exam is is no good or different from the other side, you can always just see I can’t quite feel the pulse Well, I can feel it on either side. And then you know, it’s a good idea to send that person down to the ER. So, gross deformity or potential damage to the neurovascular bundle. So loss of function
Unknown Speaker  14:57
or loss of blood supply. So if it’s cold lows, the sensation loses motor function. Loss of pulses any of that stuff immediately.
Unknown Speaker  15:09
Yeah, absolutely. For sure.
Unknown Speaker  15:12
You know, you mentioned the weight bearing. A couple of weeks ago, I was carrying my than 11 month old son down the stairs and slipped out a toy fell out, boy, mostly he was fine, but I did. my elbow had ended a little bit on his ankle. Yeah. Ended up on the phone with two of my orthopedic surgery friends. And both of us the same thing. But can you wait, bear?
Unknown Speaker  15:42
Walk? he crawls? He doesn’t wait.
Unknown Speaker  15:48
Am I supposed to find out if he’s able to wait bear when he’s not capable of weight bearing? Like Well, yeah, X ray but sometimes the X ray doesn’t. I mean, as it turns out, we just put him on his we stood him up, because he’s able to. So he stood among held up, he wasn’t guarding, he was standing. He was comfortable. It was fine. And every time we touch it, it would hurt that eventually went away. So, yeah, I’m totally fine. But he never. Yeah. Well, you know, I’m not expecting him to be able to wait bear for another couple of months because he’s not gonna. Right, exactly. But you mentioned that in the beginning so with they can’t wait there. That’s another thing that tells us so but it wasn’t clear. If they can’t wait, bear. Does that mean go to the ER or does that mean they need to see an orthopedic surgeon in the next couple of days?
Unknown Speaker  16:39
I think if there’s no deformity and but the neurovascular exam is fine. And they’re they’re having like an ankle sprain. You don’t know if it’s a sprain or is it a hairline fracture, then if they can’t wait there, they may not need to go to the emergency room like that night like it’s 10 o’clock football games ending do they need to go wait in the ER for hours and hours not necessarily you know I think if there’s you tell that person you know just wait barriers tolerate if it’s not tolerable then don’t do it elevate isolate, you know the whole rice stuff. And if tomorrow morning it’s still this painful then yeah that maybe you should go there urgent care right or the ER or if your primary offices open go in and they have an X ray take an X ray. So it’s I think as long as there’s no significant deformity there and then your vascular exams Okay, then then it’s okay to wait and kind of go in semi electively.
Unknown Speaker  17:39
So it sounds like the algorithm would be x ray. If the X ray doesn’t show a fracture, then continue rest eyes elevate. And then if you continue not to be able to wait bear, then it might be something more soft tissue related for which you would then need the help of an orthopedic surgeon.
Unknown Speaker  17:56
That’s that’s a good way to put it. Yep.
Unknown Speaker  17:58
Okay. Great. Okay, well, are there any other acute injuries that you think might happen? field side that they might call on an unwitting pathologist or radiation on someone else that hasn’t seen orthopedics since their third year rotation?
Unknown Speaker  18:18
You know, I think those are those are your most common, right you’re going to see the sprains and strains and the things that you know, people start, you know, running around hair on fire in circles or bone sticking out, like you said, and things that are deformed and loss of function, loss of ability to White Bear.
Unknown Speaker  18:37
Those are some excellent, excellent comprehensive rules feel like that should be in a class in medical school, but
Unknown Speaker  18:44
it should be on a poster, maybe. Yeah.
Unknown Speaker  18:47
And that’s the point of this podcast because we all have these things that we say over and over, that really every every physician should know it would be beneficial for every physician to know rather than memorizing the steps of the Krebs cycle. All right, yeah, now common console. So So let’s talk about some of the more common concepts that you see and how you like to start your work up. So sure, so let’s say you’re, you’re a family physician or an internal medicine or someone who doesn’t have ready access to orthopedic surgeons. So what were what are some what some advice that you would give to practitioners in those situations that do see some of the issues that you see?
Unknown Speaker  19:30
Well, um, I, I can definitely go into some of the more common things that the the primary care the family physician is going to see but maybe I’ll start with something specific to the shoulder because this is something I see a lot of, I’m considered a shoulder specialist. And so it’s definitely This is something that’s like in my wheelhouse and at the forefront of my mind. shoulder pain, super common and as we get older, and get in into the late 30s 40s and 50s. And beyond rotator cuff often becomes a concern. So some of the conditions that we see in it around the shoulder having to do with the cuff bursitis and rotator cuff tendonitis go hand in hand. People are always worried like, hey, do I have a rotator cuff tear? So shoulder pain is super common. And I think what sometimes the the primary care doctors don’t realize and and not by any fault of theirs, it’s just exposure to care, the rotator cuff, you know, is that not everybody needs an MRI. I think that and Same goes for the knees. I see a lot of you know, knee pain, arthritic knees where they you know, they come in, they’ve already gotten the MRI, and it’ll say there’s a meniscus tear or the shoulder MRI will say, oh, there’s some partial tearing or there might be a rotator cuff tear. And people come in freaked out, thinking oh my god, I need to have surgery. Um, when it comes to the shoulder, for example, you look at you look at increasing age by decade and the percentage of people who have completely asymptomatic shoulders that have a rotator cuff tear goes up. And you know, when you get into like your 70s 80s it’s like it’s something like half of these people with no shoulder pain are walking around with with a rotator cuff tear and and they have no symptoms. And so it’s not, you know, getting an MRI is appropriate when indicated but sometimes if if somebody presents with shoulder pain and that’s the first thing that they they go to, it can produce some unnecessary panic and the patient thinking, Oh gosh, this is torn, I need to have it fixed. Because not all rotator cuffs need to be fixed. And kind of along the similar lines, knee arthritis people Knee Pain, they get an X ray, maybe it’s arthritic. And the next go to a lot of times before they come to see the orthopedic surgeon is an MRI. What I think a lot of people don’t realize is that when you develop arthritis in a joint, especially the in the knee, you normally have, if you have pristine cartilage, it is smooth, there’s a very low amount of friction, and your joints are meant to glide on each other like I saw nice. But once that arthritic process starts and you start getting flaking and praying and divots in that surface of the cartilage, they’re going to rough each opposite end up. And this this little innocent bystander meniscus that’s stuck in the middle, that’s the softer consistency, it is going to get beat up. And so if someone’s arthritic enough 100% of the time there is going to be some kind of meniscus tearing in there. And so you get Mariah and says, Oh my god, the meniscus is start, I gotta have it fixed. I need a nice job but a minister to me, and that is just not necessarily the case, the Arthritis kind of Trumps the meniscus tear. And so if someone comes in to see me, for example, they haven’t had that MRI, but they’re thinking, gosh, do I need one, and I get some standing films where we’re seeing what gravity is doing to the knees. And I see that that joint space is almost completely gone because they’ve worn away their articular cartilage. I’m not getting an MRI. I’m going to treat that arthritis, we’re going to treat that arthritis symptomatically.
Unknown Speaker  23:38
How do you do that?
Unknown Speaker  23:40
So um, we look at their range of motion, I look and see how much swelling there is in the knee. Maybe they need to have some of the fluid aspirated or drawn off and then they may be a candidate for a cortisone injection. If they’re having an acute flare up, and they’re painful and they’re swollen. They may need anti inflammatories, physical therapy, maybe control certain you know glucosamine chondroitin could help some of these people.
Unknown Speaker  24:13
Wait a second. We were speaking about glucosamine beforehand.
Unknown Speaker  24:17
We were
Unknown Speaker  24:19
so yeah, so dropping that
Unknown Speaker  24:24
in its You’re welcome for the transition.
Unknown Speaker  24:27
very smoothly done. We’re talking about just to because I like to bring everything back to otolaryngology because this is my podcast and it’s all about me.
Unknown Speaker  24:37
And you’re allowed to Yeah,
Unknown Speaker  24:38
that it seems like glucosamine is like the lipid flavonoid of tinnitus. And so you know that the tinnitus is the hearing a sound that’s not an organized sound like a hallucination, but you’re hearing a sound that nobody else can hear and it can be very distracting. And so there are lots of there are a lot of snake oil there. A lot of snake oil. And one of these things that that a lot of people advocate is labeled flavonoids. And the placebo controlled trials just aren’t there. But something like tinnitus is very just like pain. Very, very susceptible to the placebo effect. So yeah, should I be recommending this benign? entity, this benign substance, I guess to, to my patients, when I know that if they’re going to feel better, that’s because the placebo or do I not recommend it because the science isn’t there, and it’s, um, just almost do like fooling them into thinking that they’re getting better when they’re not, but really, it doesn’t matter because so it’s a subjective sensation. So and I gotta jump on, on on on the description because what we had talked about beforehand is you were saying was the data just isn’t there for the glucose I mean, and I see it on the counter. In my parents house, so then
Unknown Speaker  26:03
I tell them stop taking it because it just doesn’t help.
Unknown Speaker  26:08
Well, you know, it’s it’s not that there is no evidence for it. It’s the evidence is not super solid, strong watertight right there. There have been studies and there may be a subset of patients who have moderate arthritic pain, and they take glucosamine chondroitin Codrington glucose mean, and they may have reportable pain relief. But you know, study sizes are not quite big enough. The data isn’t quite there, however, that this is how I approach it in my practice, because I get asked that question a lot. Do you think I should take this supplement? Well, I will say that glucosamine in particular is fairly benign, right? If you bought a bottle of it, you’re probably not going to have any significant side effects. You’re not going to die. I think it’s sick. It’s it’s fairly benign. And I will tell my patients, you know, it’s worth a try. If you want to give it a try, keep a journal, take it consistently, don’t add in something else that might be helping your joint pain. And maybe do it for a week, maybe do it for two weeks or even a month, and then stop it and see if you can feel a difference, right? And so this person tries it for a month and they stop and I’m like, Oh, my gosh, that came came right back. I didn’t do anything else different. It wasn’t a change in the weather or whatnot, then I’ll say, you know, it’s probably not doing any harm. And if you are subjectively feeling better than go ahead, and, and there is some data, it’s just not, it’s not super strong, right?
Unknown Speaker  27:46
And so no money in these subs in these in these substances, that I think the research may be there, but they don’t want to publish it because it’s not in their self interest. So the Public anecdotal stuff. I mean, I’m not a big conspiracy theorist, but I think if you follow the money, you get the answer. And these, there’s so much money in these supplements that, that I’m sure these companies have done some studies that compare them to placebo, and they just found out that they’re not there and because they funded the study, they don’t have to publish it.
Unknown Speaker  28:24
Yeah, yeah. It’s, I’m sure it exists. But, you know, I’m sorry. Sorry. But um, you know, and then the other thing that you and I talked about earlier as well is, is that because these are over the counter, they are not regulated right by? Yeah. So you don’t know the quality of what you’re getting. Like, you can go into a GNC or go to Costco or whatnot. And it there’s there’s not really a governing body that’s going to say Hey, everyone, Goes must contain exactly how much of this glucose me and control. So there is some inconsistency out there and you see that with a ton of other supplements over the counter remedies and patients asking me about turmeric right Turmeric is thought to have some anti inflammatory properties. But um, how do you make sure you’re getting a consistent dose? How do you make sure you’re not getting too much? And I tell them that I’m like, that’s the challenge, you know. And and sometimes when they asked me about the benefits of supplements, I don’t have a lot of solid research. You know, I think it’s, this is another kind of a little veering off topic a little bit, but I think it’s okay for physicians to say I don’t know, you know, I don’t know how this how well this is going to work for you.
Unknown Speaker  29:45
Oh, yeah. And that’s how much you just making something up. Yeah, generally not good to make.
Unknown Speaker  29:53
Yeah, there are studies tumeric is better if you sprinkle it on french toast and regular toast because the The
Unknown Speaker  30:01
help it to distribute into the body.
Unknown Speaker  30:06
I find my partners
Unknown Speaker  30:10
say that the best way to build a practice is to make stuff up. Now, none of us do. Really 100% none of us do it. We just were but, you know, we hear the things that other physicians sometimes tell patients, and they just seem so outlandish, but so convincing, like they see these things, such great conviction, and people just eat that up. And, and, and it’s, you know, it’s much better than my answer, which is, well, you know, I’m not sure. Like, it could be this, and it could be that but like, you know, I just the way that I think, because that’s just the way that I think in the way that I talk right like I we don’t know for sure we’re not positive, we’ll see what happens, right. Like, that’s just a lot of the time how we have to speak as physicians, it’s much easier, you know, people You’re much more receptive as you speak with great conviction. We’re just in this position where we can’t because Yeah, because we can’t Yeah, but I liked what you did with the glucose I mean you you made you made it like you make sure that the patient cuts out as many variables as they can when they try it. Don’t do anything differently. Don’t do Don’t cheat routine don’t do it. Just make sure it’s this one thing. So at least you have as few variables as possible when you’re trying to figure out if this thing works for you.
Unknown Speaker  31:29
Yeah, like like don’t don’t start it with Celebrex.
Unknown Speaker  31:33
Right. Don’t start it with the prescription anti inflammatory because then how do you know is it the prescription? Is it? No, no, it’s definitely it’s not you know,
Unknown Speaker  31:44
out to get me and the
Unknown Speaker  31:47
salesman there’s no money to be made in tumor x. So he is definitely not interested in definitely has the tumor cells man definitely has my interest in mind and is okay that my bowel movements are now bright orange because of all the two
Unknown Speaker  32:01
so colorful.
Unknown Speaker  32:04
So are there any other concepts that you want to bring up that you think would be worthwhile to discuss?
Unknown Speaker  32:12
Like just
Unknown Speaker  32:13
the major right, I see,
Unknown Speaker  32:15
just reflexively get the MRI.
Unknown Speaker  32:18
Yeah, I think that’s that those are among some of the most common common referrals that that I, I get just by the nature of my sub specialty. And that’s something I commonly see.
Unknown Speaker  32:32
So I remember a few years ago, there was an article in a major journal. I don’t remember if it was the New England Journal of Medicine or whether it was Jama. But it was very inflammatory about arthroscopy. Mm hmm. Right. Yeah. No.
Unknown Speaker  32:50
Yeah, yeah. That was New England Journal.
Unknown Speaker  32:53
So, the, the takeaway, I thought was, arthroscopy doesn’t work, right. I think that that That’s why it caused a lot of controversy. But mean that just can’t be true, or it might be true. So we don’t do any arthroscopy. So I really, you know, I didn’t Delve any deeper into that, being out of my specialty but, but I think a lot of people came away from that saying, thinking that So, right, you tell us about that article and what the, the orthopedic surgeons who did a fellowship in arthroscopy, what is her perspective?
Unknown Speaker  33:30
So, um, you know, this is kind of an extension of what we were just talking about with, like when when people with knee arthritis get that MRI and they’re like, Oh, my God, I’ve got a meniscus tear. I gotta have arthroscopy and fix that meniscus tear or shame it on the real problem. There is the Arthritis and that’s you know, and that’s exactly why I say you know what, we got a treat your arthritis, not true meniscus meniscus is an innocent bystander. I got kind of beat up your symptoms. Due to arthritis and, and so, you know, I think that there there had been a lot of cases where a lot of these folks were getting scoped and and then they don’t necessarily get better if the if the root problem is that they are arthritic, then going in there and cleaning up the the frayed meniscus that got beat up because there’s arthritis around it isn’t going to do a whole lot. And, and I actually find myself talking patients out of surgery quite a bit for that reason. And so, you know, this this particular study is from from the New England journals in 2008. And they, they looked at patients with arthritis of the knee and that and basically they said that, you know, arthroscopic, like widespread arthroscopic treatment for arthritis in the knee is not warranted. You know, And some physicians will, will say, okay, but you know, they may have arthritis, they may have this beat up degenerative type of meniscus tear, but there is a component of that tear that is flipping around and it’s causing the need to have a mechanical symptom. So it’s like the knees getting stuck or the knee is getting locked up. And if if that particular kind of tear is what we call a big bucket handle tear, then that may be a case where you would scope an arthritic knee, you know, it’s a big huge giant chunk of the meniscus slipped into a whole nother zip code of the knee, then yeah, we can go in and we can scope them we can resolve some of those mechanical symptoms. Now, this person may no longer have mechanical symptoms from that giant piece of innocence that’s that’s in the wrong place. But it doesn’t mean that they won’t have popping and catching because they’re still arthritic, they still have these uneven surfaces. And, you know, you kind of walk around those, those rigid surfaces, rough surfaces may kind of jump the track on each other. And that’s going to give you a mechanical sensation and pain and that you can’t take away with arthroscopy. And so, you know, I think this study that that’s kind of the takeaway point is that an arthritic knee does not need does not absolutely need to have a scope and in most cases should probably kind of stay away from a scope with few exceptions. You know, and I think for the casual observer, people who have kind of maybe heard about the article in passing, it kind of comes across as like me scopes are bad, don’t get me scope, but it’s, you know, there are a couple of more nuances there that more attention and, and I talked to my patients about that all the time.
Unknown Speaker  36:57
Yeah, that sounds like where I would have gotten my medical in. formation which would have been like CBS, their, their their tagline would be doctors do millions of scope a year and this article says these scopes don’t work. But yeah, the fact of the matter is, if you take a large group of people with arthritis of the knee, and you perform a sham scope on some and a real scope on the other than you won’t find a benefit, because most of those patients with arthritis, you’re kind of missing the point. But there are some select patients in there for which it’s appropriate. But in a large group like this, there, the statistical significance of those are going to get washed out by the no pun intended, but washed out by the the large cohort for whom you’re saying, Yeah, it is inappropriate for those patients to be scope. Right? That’s exactly right. Interesting, interesting. Okay. So, the next question, I’m completely stealing from another podcast. That I heard on and I thought it led to an interesting interesting discussion especially since you have you have a son. I have two sons. They’re mine are not quite old enough for sports, but my older one climbs everything so we’re definitely going to get him to gymnastics soon. What are your sports that you would steer your children away from ha ha of injury from the injuries that you see because I heard from an orthopedic surgeon at my hospital, he doesn’t happen to mention in passing he thinks people who ski should get separate health insurance because he sees so many ski injuries. So what sports like that,
Unknown Speaker  38:47
you know,
Unknown Speaker  38:49
I and you may have heard on the other podcast I kind of like jumped to, to an answer really quickly, but, and admittedly I backtracked a little bit because And, you know, I’ll tell you what that answer was, but I, you know, I immediately said, Well, I don’t think I’d let my son play football. But then as I was talking I actually thought about it a little bit more and by Central I six so he’s not playing tackle football and I’ll be he’ll end up playing tackle football but he like we all we ski, I snowboard. He skied, he started when he was three and a half and in like, last year, he did his first black diamond. Right. And so I think at some point, if he keeps progressing, he’s going to be one of those kids out there that are going to be good and going down some, some steep things. And you know, if he’s like most boys, he’ll be jumping off of things. And
Unknown Speaker  39:44
it’s good to hear you’re gonna have to have them. Right.
Unknown Speaker  39:48
But, you know, and so I think maybe it was a little bit unfair of me to just say, Hey, I don’t think you should ever played football, but I let the kids ski you know, and you can get some pretty devastating injuries skiing and he also plays soccer I take care of a ton of ACL injuries from soccer my and maybe it’s just my patient population but I do more a sales from soccer than I do from football. And so you know, he’s he’s an avid little soccer player and and there’s also a decent concussion risk in soccer. So, you know, all of these sports are going to carry certain inherent risks with them. And and I don’t think even as an orthopedic surgeon, and a parent, I can say your kid should not play football or
Unknown Speaker  40:41
say what other people should do. I’m just wondering what is going to happen in your house and I think my wife and I will see what the boys ultimately are interested in. But my wife and I are the same page because of because of the CTE that Yep, chronic traumatic encephalopathy that football and and you do see concussions in soccer you do see concussions in other sports. And you know there was there was this famous racecar driver that had. I think he ultimately died of a head injury while wearing his helmet while skiing off piste. Yeah, years ago. So there are but but just the incidence of chronic traumatic encephalopathy you know, yeah. And football and I played rugby poorly for two years in college. And so I’d be concerned about you know, any anything where you’re running headlong at the Yep. Other person? Yeah, but But yeah, just like from a neurosurgeon or a neurologist, you know, what you’re saying is from an orthopedic surgeons perspective, where you see, you know, broken bones and dislocations there really isn’t a specific or that you would say no, I wouldn’t let my son do this because of the earth because The risk. That being said, you were also you were, was it you worked in a snowboard store or you were a snowboard instructor? What was this? So part of your life? You know, so you’re an athletic individual to begin with.
Unknown Speaker  42:13
Yeah, I my first job out of college I worked for a small snowboarding company and this was in this would have been in the mid to late 90s. When no mid Who are we kidding? It was the mid 90s. So I was fresh out of college and I sort of didn’t didn’t really know what I wanted to do, but I knew that I like to snowboard a lot. And so I worked for a small snowboard company and I did marketing and sales there were only a couple employees there so we kind of all did everything and so I basically you know, worked in the office and and I was kind of that that sales internal sales person and then was liaison to the shops that carried our boards but part of what I did for I got to travel around and go to contest and hand out stickers because that was marketing so that was that was a little detour that was definitely a whole lot of fun but um you know, um yeah, I have been a long time snowboarders and in there are definitely injuries that go along with that for sure. One example is a personal one. I was, for lack of better terminology hucking myself off of a ginormous jump, and I’m in my early 20s so I think I’m still invincible. I would absolutely never do that. Now I’m my skills are declining every year. But you know, I kind of didn’t quite make the transition to to land at the appropriate place on the landing. So the next time I went up, I’m like, I am going to bomb this job. And in a misaligning because now I overshot it and I remember being up in the air thinking, am I allowed to curse on the show or not?
Unknown Speaker  44:11
I said, Yeah.
Unknown Speaker  44:15
I said, oh snap. But it wasn’t really that as I was up in the air, I started to fall backwards and I landed squarely on my tailbone and sat on had to go down on a sled toxics fracture. I couldn’t stand up straight and then I sat on a doughnut pillow for six months. So you know, as kind of a brief aside Yeah, there are some pretty significant things that can happen in story to especially when you are landing from 20 feet in the air.
Unknown Speaker  44:46
Did you get an MRI?
Unknown Speaker  44:48
I didn’t get an MRI they say they got an X ray you know and I was your bathroom
Unknown Speaker  44:56
you know, and and basically came down. Good luck. toxic fracture that eventually went on to heal but I went everywhere with my donut. So
Unknown Speaker  45:07
last question is, what exercise recommendations would you have physicians give to their patients, either common exercises that they’re doing that maybe are more prone to injury or some important exercises for injury prevention. For instance, Seth Grossman’s an orthopedic spine surgeon, he was on the show a few episodes ago, and he said that everybody should be doing the Superman before they go to bed. Why? Because we’re all that you know, in in, you know, sitting at our computer desks and hunched over and our phones and getting texts neck and all the rest of it. That in order to the exercise, I think it’s called the posterior chain. We should all be doing the Superman before better. So what Yeah, what type of exercises do you recommend stretches or anything that you recommend for us to recommend to our patients. injury prevention.
Unknown Speaker  46:01
You know, I, I talked to my patients a lot about what I call the four pillars of a well balanced exercise program. Sometimes people when they want to go get into shape, you know, the first thing that pops in their mind is like, I better go out for a run, you know, they haven’t worked out in ages, they go out for a run. But you know, what, the lifts the cleaning? or? Yeah, exactly. And so, you know, I, I like to tell people, you got to have these four things in a well balanced fashion so that you don’t get hurt, right? And it should be a combination of strength, cardio, flexibility, and mind body, you know, and people might poopoo the mind body, but I think it’s an important part of the, what I call the four pillars of a good, well balanced exercise program. And so, you know, having those four components is one thing that’s important. Having good prep, like giving yourself extra time to warm up stretch cooldown. Before and After playing sports or or doing your exercises is is another good way to avoid injury. And certainly if we’re talking about body parts I think the core is is often neglected. And there is a misconception I think out there in the public that having a good strong core means doing 5 million setups, you know, and everyone always concentrates on the ads. But yeah, there is that old poster side. That is is a crucial component component of the core and so yeah, I think doing the Superman every night, at bedtime, maybe doing a plank is is a nice foundational thing that you can do to avoid extremity and back injuries or injuries but also extremity injuries, having a good strong core having good Hip, hip stability, but they’re not putting
Unknown Speaker  47:55
pictures of anybody’s posterior chain on the covers of magazines. Now Is the ABS I’m sorry. Right. But what about stress? So you mentioned stretching and warming up? Do you recommend stretching before exercise?
Unknown Speaker  48:12
You know, I think that there is some evidence that more dynamic stretching that incorporates movement, it’s a little bit better in that scenario, we’re kind of combining your warm up and stretch. You don’t want to stretch cold muscles, you don’t want to stretch cold tendons on. And so you know, like when you’re like a walking squat or a walking lunge, right? So you’re doing a little bit of stretch, but you’re also moving the joints at the same time. You know, maybe walking and kind of doing the hamstring, a sentence where you’re kind of kicking, kicking in front of you as you’re taking steps, side lunges, things like that.
Unknown Speaker  48:54
tend to be a little bit more effective. Great.
Unknown Speaker  48:57
Well, is there anything else that you’d like to do? Is that we haven’t brought up today. I think this was a pretty comprehensive conversation.
Unknown Speaker  49:04
Yeah. Now Um, I think we covered it.
Unknown Speaker  49:09
So you have a very interesting blog where you cover lots of different subject matter. And so where can people find you?
Unknown Speaker  49:18
So my blog is at WWW dot Nancy in Shipley md.com. And that is the world’s longest URL. And so, so actually Nancy MD com also goes the same place bonus. And my blog is on there I focus on musculoskeletal wellness. It is a wide range of topics that I generally will speak to injury prevention and and other muscle joint bone topics of interest. I am also on Facebook as Nancy MD I’m on Instagram and Twitter as underscore Nancy MD say You can find me on any of those platforms I talked about not just the orthopedic aspect of things on some of these other platforms, but just kind of life as a female mom, orthopedic surgeon, aging along with everybody else. talk a lot about just just what life is like as an as an arthropod as well.
Unknown Speaker  50:23
Well, thank you very much for taking the time to talk to us today. It has been a pleasure.
Unknown Speaker  50:28
Thank you so much for having me.
Unknown Speaker  50:32
That was Dr. Bradley Block at the physicians guide to doctoring. Find all previous episodes on iTunes, Stitcher, Google podcasts or wherever you get your podcasts and write us a review. You can also visit us on facebook@facebook.com slash physicians guide to doctoring. If you are interested in being a guest or have a question for a prior guest send a message or post a comment.
Transcribed by https://otter.ai

Doctor Identities on the Blockchain

Leah Houston, MD had her physician identity used for billing after her employment concluded.  This led to the epiphany that caused her to start HPEC.IO, an organization that is trying to give physician’s back control of their identities using blockchain technology.  This could be useful for doctors that want to switch jobs or states without having to have every bit of information independently verified.  We first discuss what blockchain is and then get into how she plans to implement it to not just help us keep our identities under our control, but to create bureaucracy-free virtual physician communities.

She is a board-certified Emergency Physician, founded Houston Health in 2013, and has a personalized private practice in Manhattan. While practicing medicine across the US for nearly 10 years she recognized a common problem: uncompensated administrative burdens related to physician employment and credentialing are a leading cause of administrative waste and physician burn out.

She began HPEC in 2018 when she realized that Blockchain could solve the obstructive regulatory problems with its distributed ledger technology. HPEC is building a platform that will give every physician a self-sovereign digital identity attached to their credentials in order to create the Decentralized Autonomous Organization of physicians and surgeons.  This will streamline the current antiquated and laborious process of hospital credentialing, save on administrative costs, improve access to care, and give physicians sovereign ownership of their data, professional brand and employment rights. HPEC will also create an opportunity for physicians to communicate more efficiently about policy and practice and in turn improve patient care. 

She can be found on her Social Media Handles (linkedin, twitter, Facebook, Instagram)

@LeahHoustonMD         

@HPECDAO        

Doctor Identities on the Blockchain

Leah Houston, MD had her physician identity used for billing after her employment concluded.  This led to the epiphany that caused her to start HPEC.IO, an organization that is trying to give physician’s back control of their identities using blockchain technology.  This could be useful for doctors that want to switch jobs or states without having to have every bit of information independently verified.  We first discuss what blockchain is and then get into how she plans to implement it to not just help us keep our identities under our control, but to create bureaucracy-free virtual physician communities.

She is a board-certified Emergency Physician, founded Houston Health in 2013, and has a personalized private practice in Manhattan. While practicing medicine across the US for nearly 10 years she recognized a common problem: uncompensated administrative burdens related to physician employment and credentialing are a leading cause of administrative waste and physician burn out.

She began HPEC in 2018 when she realized that Blockchain could solve the obstructive regulatory problems with its distributed ledger technology. HPEC is building a platform that will give every physician a self-sovereign digital identity attached to their credentials in order to create the Decentralized Autonomous Organization of physicians and surgeons.  This will streamline the current antiquated and laborious process of hospital credentialing, save on administrative costs, improve access to care, and give physicians sovereign ownership of their data, professional brand and employment rights. HPEC will also create an opportunity for physicians to communicate more efficiently about policy and practice and in turn improve patient care.

She can be found on her Social Media Handles (linkedin, twitter, Facebook, Instagram)

@LeahHoustonMD

@HPECDAO

EPISODE TRANSCRIPT

Disclaimer: This is the transcript to the episode. This transcript was created by a talk to text application and the function of having this here is to improve the page search engine optimization. This transcript has not been proofread, so please listen to the episode and don’t read this. The information contained herein will inevitably contain inaccuracies that affect that quality of the information conveyed and the creator of this content will not be held liable for consequences of the use of the information herein.

Unknown Speaker  0:03
Welcome to the physicians guide to doctoring A Practical Guide for practicing physicians were Dr. Bradley Block interviews experts in and out of medicine to find out everything we should have learned while we were memorizing Krebs cycle. The ideas expressed on this podcast are those of the interviewer and interviewee and do not represent those of their respective employers.
Unknown Speaker  0:27
Today’s episode was triggered Dr. Leah Houston, an emergency medicine physician and the founder of the humanitarian physicians empowerment community, a startup that is seeking to help physicians to keep their credentials in blockchain format, so that we can not only own our credentials, but the data we generate. It will help us to more easily move between institutions prevent physician identity theft, and use that proof of identity to create a physician ecosystem where we can communicate with each other free of the barriers of bureaucracy. We started discussing just what blockchain is, and then Discuss how she sees that ecosystem evolving. They’re still looking for early investors and she wants to keep this physician owned. So if you’re interested, be sure to check her out at HP ec.io this and all of my episodes are produced by car and Gill free, professional voiceover artist and she can be found at ca ri n. gl f ROI calm. And now Dr. Leah Houston. Welcome back to the physicians guide to doctoring. On today’s episode, we have Dr. Leah Houston. She’s an emergency medicine physician who actually has temporarily left the practice of medicine to focus on the blockchain. So we’re going to talk about how that happened, why it happened, why it’s necessary for physicians to enter into this. Thank you, Dr. Houston for for being on the podcast.
Unknown Speaker  1:51
Thank you for having me. It’s great to be here.
Unknown Speaker  1:53
So first, let’s just talk about what blockchain is because in preparation for this podcast, caste, I did some reading. And by doing some reading, I mean, I listened to a bunch of podcasts about what blockchain is. And so before we even get into how it can be used for physicians and our patients, let’s just talk about what the heck it is because I feel like when you talk to someone who, who’s not familiar with it, it’s like saying the cloud, right? It’s just this big, nebulous place. And it’s really hard to define, but in essence, it’s not. It’s not really that hard to define. So, whereas something like the cloud, if you have a bit of information that is saved on one computer somewhere, and the word that they use in the field is that information is siloed, meaning it’s all in one place. Whereas with the blockchain, and correct me, if I’m wrong, Leah, the blockchain rather than information being siloed in one place, it’s spread out Among them bunch of different places. And each one of those places is password protected. And, and there’s some redundancy in it. So it’s almost like you have a couple of pieces of a puzzle in each different silo. And some of those pieces are repeated in different silos. And you really need to open all of them in order to put the puzzle together. But if you lose maybe one or two, you can still put it together. And so, so this is a way of keeping things secure, because even if you break into one, you really need to break into all of them in order to have access. And in addition, it’s referred to as the ledger and the ledger is just the history of the data. And so the ledger data is kept in these multiple silos and my anywhere near
Unknown Speaker  3:54
you are very, very, very close, I would say almost perfect. Thank you.
Unknown Speaker  4:00
Yeah, I mean that that’s a, that’s a really good explanation.
Unknown Speaker  4:04
And to like make it a little bit less obscure, you know, blockchain solves the, the problems that the internet can’t solve related to trust. So if you have all of your data in one place, um, you know, there’s there’s risk for security breaches, but also means that you need that one place for your data. And without them, you’re not able to store it and you’re not able to use it. So, when you’re able to distribute your data, and you have you, you, as an individual are the one that has the copy of your data. You no longer need a trusted third party because all the information is distributed. It’s not trapped in this one space.
Unknown Speaker  4:50
So yes, because I’ve been trapped in that one space, it can be corrupted and you no longer trust it, right? Like it’s like in a bank account, right. So it’s If someone gets my password and logs into my bank account, then they can just spend it and and whoever’s receiving that money can’t necessarily trust that it’s coming from me because my account can be so easily hacked. Whereas if you really need to put all of these pieces together, it leads to more trust for more security, whereas there’s something more to it than just the security.
Unknown Speaker  5:27
Um, well, it comes from security, but also, you know, if it prevents censorship, you know, so right now, we also have social media platforms that are centralizing our data as well. So it’s secure, it creates more security on both ends. And could you explain just what the ledger when people are using the term ledger,
Unknown Speaker  5:51
right? That that’s what blockchain technology is it? It’s a ledger
Unknown Speaker  5:57
legendary
Unknown Speaker  5:58
hyzer and good writer and the calculator and he’s keeping a ledger like a old school account. Right? Like, what is the ledger that they’re referring to?
Unknown Speaker  6:09
Right? I mean, so the term ledger is not really wasn’t really commonly used phrase outside of the accounting world until fairly recently. But essentially, you know, we need to document everything. And we need to make sure that that documented documentation is correct. And that nobody’s going to alter it, especially if we’re basing a lot of important things on that documentation. So you’re basing whether or not you’re getting a mortgage on your home on your credit, which is a documentation of your ability to pay, you know, your bills, then you want to know that that is a secure, verifiable document that’s immutable, meaning that it’s not able to be changed. And so they say the ledger, you know, but it’s really just a form of documenting the truth.
Unknown Speaker  6:54
Okay. And so how are you proposing That physicians use this technology to their advantage. How is it? What is it that? What is it that you’re doing?
Unknown Speaker  7:09
There’s a lot of blockchain technology out there that’s being built in order to fix a lot of problems. You know, there’s problems with transactions. There’s problems with supply chain management, and the healthcare industry. You know, they’re trying to solve some problems with research and development and documenting what’s happening in research. They’re trying to solve problems of patient records and giving patients access to their records and making themselves sovereign. And so there’s a lot of people trying to fix the user experience for enterprise and for patients. From what I can tell h Peck is one of the few blockchain applications that aims to fix the user experience for physicians. And as we all know, our user experience has been pretty crappy. A lot of us are leaving medicine. Some people are committing suicide. It’s so bad Trying to pivot into entrepreneurial endeavors, cutting back on hours retiring early, etc. And I think that for the most part, in my opinion, from what I’ve gathered from my physician colleagues, the majority of people were having these experiences of what’s called burnout really is a result of systematic abuse. They’re having these these feelings, but it doesn’t necessarily mean that they want to leave medicine. They just don’t like the way they’re experiencing it now. So how does blockchain step in? If we are able to create a decentralized physician database of physicians, everybody that practices medicine, and we’re allowed to give every physician and identity where it’s attached to their credentials. Then we essentially created a physicians Guild, a digital Guild of doctors, where we’re all in One space yet because it’s on the blockchain decentralized ledger. We’re free to do whatever we want. yet we’re also able to easily and quickly come together and form a consensus around policies and practices when we need to,
Unknown Speaker  9:16
should be a way for us to communicate with each other.
Unknown Speaker  9:19
That’s correct.
Unknown Speaker  9:21
Well, let’s let’s take a step back because I know with h pack first, what what was it that each pack stands for? Again, it stands for humanitarian physician empowerment community. Okay. And what we were discussing when we were offline was that inish or at least the first stage of this would be credentialing. Correct? Correct for physicians,
Unknown Speaker  9:44
right. So in order to make sure that a physician is a physician, and that we’re not making a distributed database of non physicians, we need to first check the credentials. So in order to create a physicians identity, we need to first check their credentials and then Once their credentials are checked, they then become part of their identity, that’s part of your data as a physician, that’s part of your immutable data, you became a doctor once, it’s not going to change, it can’t they can’t take your medical degree away. So your credentials can become part of your identity that are now portable owned by you. And so that is the first step to this process.
Unknown Speaker  10:22
So I think even before we get to the physicians guild aspect of it, there are a lot of inefficiencies in the credentialing system. When I first went into practice. Even before I finished residency, I was filling out tons of forms, including information that was clearly redundant because if I was finishing residency and and clearly I must have finished medical school, I must have passed step one and step two. And yet, I’m filling out all these forms and have to get all this evidence that I that I did all these things. And so there’s there’s a lot of redundancy there. And now each time I apply to be on an Insurance panel, I’m filling out the same forms and giving up the same information. And that redundancy is time and time is money. And so, so there’s a lot of waste in the system. And we’re talking about trying to make the house of medicine and the delivery of medicine more efficient, and more fiscally responsible. So it stops being the the GDP of a, of a large country. And it sounds like if we were to keep our data in the way that you’re describing in this immutable way, we’d be able to get a lot of rid of a lot of this redundancy and save a lot of money.
Unknown Speaker  11:40
Absolutely. And that’s, you know, that’s part of, you know, that’s one of the biggest parts of this, you know, having your credentials that are yours that are immutable, that are valid, already validated and authenticated once and they don’t need to be validated and authenticated again, and having you as the individual physician in control of those credentials. Not some legacy system, not you know, your hospital, not the insurance company that will allow physicians to move freely, and, you know, move to different health systems and, you know, get, you know, get on to the roster of insurance companies if they choose to do that much easier and much quicker because it’s validated authenticated on this cryptographically secure ledger.
Unknown Speaker  12:24
So why wouldn’t we just have this? Like, what’s the importance of having this on the on the blockchain and in the possession of the physician? Why can’t I just submit when I pass my boards when I when I finish residency, submit this to some siloed possibly government organization that just keeps all of our information in some central location that way, if a hospital or insurance wants to know, they know that they can trust the government and in theory can trust the government and just get that information there from this silo location with Is there an occurrence or something that that happened with that we talked about online that offline rather, that that gave you the idea that we couldn’t do that, that that would be a bad idea?
Unknown Speaker  13:12
Right. I mean, so we already are kind of in the system where we’re giving our information during credentialing to health system. And where, you know, we have our MPI, we have the federal state medical licensing board, we have the, you know, the state licensing boards. And, you know, unfortunately, because these centralized areas of our data are controlled by one entity, somebody on the inside could make a mistake, and improperly use our data. They could sell our data without our permission, which is a very common occurrence that people don’t realize. They call it de identified data. But oftentimes, you know, if you really look at who’s who especially, you know, physicians is only a million of us are so you can figure out Who’s Who if you look at where they weren’t, you know, some of the IDI supposedly de identified information. And, you know, something did happen to me that, you know, as this was occurring, I realized that this is a potential solution. And what actually happened, we you know, people don’t even realize that we have something called the medicare medicaid p 10. Number, PTA and and that number is a necessary in order the bill for Medicare and Medicaid. And so most of us have billing people that deal with this stuff. And so the billing person has, you know, everybody who works in the hospital and a file cabinet or in some on some floppy disk somewhere. And if they put your number Joe Smith’s p 10. Number In, instead of Jim Smith on accident, then all of a sudden that’s Medicare fraud. And because you’re the one with the license, you’re the one committing the fraud, not the billing person because they just made an honest mistake. And this actually happened to me I was You know, working in a different state, and in a hospital that I used to work for was continuing to build with my P 10. Number. You know, they they claim that they were doing it on accident, but because my license lapsed in that state during the period, it made the Center for Medicaid care and Medicaid, think that I was working without a license. And you know, chugging along, and all of a sudden they get a note from Medicare Medicaid, saying that my privileges to bill for Medicare and Medicaid are revoked. And I’m like, for what, and you know, it was a bureaucratic nightmare took almost two months just to find out that they thought I was working without a license. Now, I’m very grateful that I was actually actively working in another hospital because I was able to very easily prove, hey, I was working in this hospital in this other state on those days. There’s no way I was working in both places. And they of course, rapidly reversed it. But that was after almost four months of you know, litigation and Back and forth, and me trying to just figure out what’s going on. Because, you know, this government, you know, government systems are extremely slow and bureaucratic. So that’s, you know, one example of identity theft that happened to me. And when that happened to me, I kind of started going online and, you know, talking to other physicians that have had similar things happen. And, you know, I’m definitely not alone. That, you know, that was a different kind of issue that’s happened to others, but our identity, you know, is is not well kept, and it’s not protected with these with these health systems and insurance companies, and it’s often also being commoditized on, you know, we we control, eight, you know, 80% of healthcare spending, you know, with the physicians decisions were the ones that decide who gets CAT scans who gets admitted who get surgery and who doesn’t. And so that’s, you know, 80% of the spending is controlled by us. So our data and how we spend that money, and what we’re doing and how many clicks and how long it takes between clicks. When we’re submitting things, and when we’re not submitting things, filing claims, that data is extremely valuable to industry. And so we’re kind of giving all that data away. You know, we’re spending our, you know, our time on these EHR, that’s all also data, you know, it’s our patients, but it’s also ours. And so this type of solution allows us to reclaim ownership of ourselves essentially, in a digital space, and to not allow our data and our livelihood and our abilities and our hard work and our intellectual property to be coached any longer.
Unknown Speaker  17:37
That I don’t quite understand how, That, to me, that’s a little bit of a leap. So I just need some clarification there because because on the one hand, you’re, you’re talking about our identity, right, like all all of everything that we’ve accomplished in order to have the right to practice our exams, completing residency and fellowship and any credentials that we might have. Having licenses and in different states, there’s there’s that having that on the blockchain so that we have access to it, and then it’s immutable and verifiable. And that way with a click of a button, we can just let this hospital know that we’re legit, and we can work there. How does that doesn’t translate to control of our data?
Unknown Speaker  18:21
Well, because, you know, our identity is our data nowadays. You know, people don’t realize that it’s, it’s becoming one of the same, right? our identity in a digital space is our data. Our date of birth is part of our data, our you know, when we’re doing what, and when we’re clicking what that’s data that we’re generating. And that can be that can be collected in our own digital wallet for our data that’s attached to our identity that we control.
Unknown Speaker  18:55
So like, Facebook has my data because I log in, they know what my behaviors are, they know what I click on? They know on, they know how long I spend on each screen, how long I spend scrolling, how often I log in, they have that data. So you’re saying that once we have that I identity and becomes ours, then all of that data is logged under that identity. And so because it’s under that identity that belongs to us, that the data associated with it also belongs to us.
Unknown Speaker  19:26
Yes. If it’s if it’s properly designed from a cryptographic standpoint, yes.
Unknown Speaker  19:31
Okay. Okay, that that, that makes more sense.
Unknown Speaker  19:36
Thank you for clarifying. So. So it seems that this could also be used
Unknown Speaker  19:43
for patient data. Right. Is that is that something that’s happening right now?
Unknown Speaker  19:48
Absolutely. And you know, it’s it’s very interesting, because there’s a lot of people that are talking about patient data. And so there’s lots of patient data, there’s, you know, how many steps you’re taking, and you’re actually exercising, sometimes you can get that data off Fitbit and other wearable devices and the internet, medical things can capture this data. There’s your lab studies that you know, you when you get your lab draws, that’s part of your medical health data. There’s your electronic health records, which are created by people that are caring for you. So you know, we as physicians create a large portion of those those medical records. So, in this scenario, for example, if if you really want to be a patient who has freedom to go to the hospital that you want, and to see the doctor that you want to see, the only true way for you to have a self sovereign health record is for you to have a physician on the other end is also self sovereign and how they practice medicine and where they practice medicine, and how they get paid for their time and how much time they’re alive. To spend with you needs to be a decision between you and that physician, not a decision that the healthcare system or an insurance company is imposing on the relationship.
Unknown Speaker  21:10
So, if more what I was getting at was, you know, with with em ours, right, we figured they would just all be able to talk to each other. And the reality is that they can’t write. One has next gen one has epic one has all scripts, and they can’t communicate with each other. So it was mandated by the government that by a certain I don’t remember the date, but that you had to be on on EMR. And one of the benefits that was sold to us was these EMRs would be able to communicate with each other. And that way, if you got a CAT scan on one place, your doctor would be able to have access to that CAT scan another place. And the reality of the situation is, at least when I was in residency, if you had a CAT scan at a community hospital, and unless they put it on a CD and physically sent it with you, we might have to repeat that CAT scan when Got to our hospital because we have no idea what the heck is going on, get you someone else’s report, we need to be able to see it ourselves. So because there’s no cross talk, you can’t have that. But if you had patient information that was on the blockchain one, it’s not siloed. So you would be extraordinarily difficult to, to hack it to get access to it. But then, as long as you gave your physician the key to your ledger, then they would have access to all of your patient information, whatever we determined that to be right. You wouldn’t need all of their nursing notes from the time they spent in the hospital four years ago, but we could determine what was really high yield information like their labs, their imaging, their operative notes, their medication lists, things like that. So now suddenly, using blockchain technology, we can the patient what you were saying before can go to any doctor they want, because they no longer have to stay within their health system, just so everyone has, oh, I’m a this hospital patient. So I have to go to this hospital doctor so that everyone has access to my information, they can really go anywhere.
Unknown Speaker  23:15
Right? Absolutely. Now you’re talking about the high tech act of 2009, where they essentially were like, HR for everybody. And they started imposing this on everybody, but they didn’t creating standards for interoperability. So, you know, we now have all these electronic health records that don’t communicate with each other, and are in some ways, purposefully, not communicating because if a health system has to repeat a CAT scan, it’s money in their pocket. So you know, they’re they’re not really incentivized with the fee for service model to create interoperable records. I mean, now, you know, people are starting to wake up to this idea. You know, there’s a lot of really smart people working on identity and working on Mash master patient indexes where they’re trying to get all patients into one space so that they can, you know, have identities and access their records. And it’s really interesting. You also mentioned, you know, the nursing notes from four years ago might not be important. I think that that’s part of why I think this type of solution with physician identity is important, because the physicians notes number one are usually more important. And the physicians are usually the ones that help communicate to the patient’s, hey, this is what we’re going to be doing. This is actually what’s going to be happening. And those are the important the important parts of the records that need to be easily accessed.
Unknown Speaker  24:38
Right, because not that that nursing nose wasn’t important at the time. But if that note was a significant event, it would make its way into the physician note that would then go into the patient’s chart and then ultimately influence their, their care and be part of their ledger later on. NGO Yeah. So sounds like you’ve solved the problem for physician identity, you’ve solved the problem for patients being able to take their care wherever they see fit. With this with his technology is just a question of implementing it, which is clearly the larger problem. But I actually want to take a step back to to the physician identity. Let’s say you, you’re already in the process of creating this platform. So first, just just tell us where you are with that.
Unknown Speaker  25:30
Well, um, you know, there’s a lot of really smart people working on identity. And there’s also people working on governance, and they’re still figuring it out, for the most part, you know, they have the the world identity conference, and they they all get together, and I actually was speaking with some of them today. And you know, they’re really working hard to make this an interoperable system to try to not duplicate the mistakes of the past. So you know, at this point, you know, we are crowdfunding From physicians to try to build this, I’m really trying to keep it integrity base by keeping it physician owned. And you know, I have a technical team that’s ready to start moving on this process and start building on these platforms that, you know, we’re not reinventing the wheel, these technologies already exist. And so that’s where we’re at now, you know, I’ve been traveling all over the country this past month. So you know, Washington DC, where, you know, other leaders, physician leaders gather to, to kind of try to get a game plan and you know, you know, practicing physicians of America, physicians for patient protection, physicians against drug shortages, you know, the American Association of physicians and surgeons, and a lot of other groups. I was in LA speaking with some of the, you know, the leaders in the blockchain healthcare industry, and I was sitting on some panels with some really, really bright people. You’re also coming up with really great blockchain solutions. I was just also in Orlando with the DPC conference talk, you know, talking with leaders of the DPC movement, including the docs for patient care Foundation and the you know, DPC Alliance and dBc frontier
Unknown Speaker  27:21
dBc being direct primary care, correct. That’s correct.
Unknown Speaker  27:23
And their model is very interesting. And they’re they’re actually
Unknown Speaker  27:28
decentralizing already, their decentralizing power back towards the, the old way of doing things where there was just the doctor and the patient and that’s it. And, you know, that was part of why it was important for me to be at that conference because, you know, these physicians are really the revolutionary it eaters and they’re really trying to, I don’t even want to say they’re trying to they are, they’re creating a new healthcare system. They’re showing the world that this can be done. more efficiently if you get the government and the insurance companies and the third parties out of the doctor patient, you know relationship and let the doctor practice medicine. And their model is really, really revolutionary. And it’s, it’s, it’s really picking up speed. I’m like so impressed. It was one of the best conferences ever been to.
Unknown Speaker  28:22
And I think that makes sense. But But that being said, limited to a primary care
Unknown Speaker  28:29
arena, because when you get into the specialties, right, like you can’t have a radiation oncologist who is doing direct patient fee direct patient fee for service, because the overhead required for something like that is going to be so astronomical that it would need to be paid by insurance, which is pooled resources from a number of people who are all paying for that. Right.
Unknown Speaker  28:54
Right. Well, I don’t necessarily think that it has to be paid for by insurance. But it does need to be paid for in a risk pool type model. And you know, I don’t really love the word insurance because from what I’ve learned, after kind of spending some time on this issue and my time doing some, you know, doing public policy, the cost of insurance is artificially inflated. And that creates artificially inflated cost of medical care. The real cost of medical care is completely hidden. And that’s another blockchain application for, you know, for the payment of healthcare. You know, price transparency is something that can be achieved with this technology as well. So, yes, I mean, I don’t want to say that, you know, in what the what the public is led to believe is that you need insurance to get health care. But I do you think you need to have risk pools, but I don’t necessarily think the current model for insurance is the way I actually think it’s artificially driving up the cloud.
Unknown Speaker  30:02
Absolutely. I think you’d find it hard to disagree with that, because of all the bureaucracy that gets involved with the administration of that. I mean, there are just so many third parties involved in getting from the patient’s pocket to the physicians and the overhead in the care that Yeah, they’re they’re clearly a lot of inefficiencies in the system that that that could be done better. But we’re, we’re getting a little little circle back to blockchain. And I appreciate that. But But we should talk about h h pack just a little bit more. So you sounds like you’ve been speaking to a lot of advocacy groups for physicians and for patients. Because let’s say you do get a number of physicians and actually you didn’t want to toot your own horn. Sharon, I’m going to I’m going to do it. Because I’ve heard you say before that you’ve been approached venture capital to fund your idea. But you have declined because you want to keep this position own. So I think you’re to be really, really applauded for that. Because you’re trying to create a physician ecosystem here where we can we can control our our destinies. And if it gets sold to venture capital, it’s kind of right now, what you what you want to
Unknown Speaker  31:25
be, it’ll become more of the same because, you know, the whole consolidation of health systems and buying up a doctors practices and things like that is what this is trying to fix. It’s trying to reverse that trend. You know, so allowing a mouse aligned incentives back into the system that we’re trying to build wouldn’t be helpful. You know, I’m, I’m really trying not to be myopic on that because if if this is going to fail, unless I take some, some venture capital money, I would prefer not to fail. But I also you know, just, this is a very, very big idea. And if it’s implemented in the way that I’ve conceived it, and how, and how, you know, after speaking with other physician leaders that have decided to come on board, and how, you know, they, you know, they really agree that if this is built this way, this has the potential to, you know, decrease dramatically decrease the cost of health care for patients, and improve compensation to physicians for their time, which previously, you know, we hadn’t been being compensated for. There’s a lot of, you know, uncompensated, administrative burdens that would fall away. And that time would now be able to be for the care of patients, which is what it’s supposed to be for.
Unknown Speaker  32:41
So instead of filling out tons of paperwork, you’re actually seeing patients which is better for the physicians, because they’re earning more income and it’s better for the patients because then they’re being seen more, more more efficiently. So let’s say you do get a number of physicians to to keep their information on the blockchain, who are the gatekeepers? that needs to be addressed so that a hospital can get you can give the hospital access to your information. So they’re able to verify that you are who you say you are and have the credentials that you say you have. Right? Who’s Who are the gatekeepers there? Because right now, what’s the stop? Why would Why would a hospital say? Sure? h pack? I’ve heard of that we can just get your data from there rather than using the same inefficient system that they’re using.
Unknown Speaker  33:31
Well, you know, what they’re doing right now is they’re calling hospitals. And they’re making sure that your, your medical degree is real. And they’re making sure that you weren’t had don’t have any recent lawsuits. You know, so, if you if your hospital or if your health system that you used to work for is, you know, has permission to access to your identity, and they can put on the chain that you’re in the middle of a lawsuit. You know, Number one, is this going to completely eliminate the need for them to do anything other than just connect with you and your identity? Probably not, they’re probably going to want to do their due diligence on their end. But this is creating as a system for physicians to not have to do any more burdensome paperwork around this for the physicians part to be done on this end, if that makes sense.
Unknown Speaker  34:21
So you would then say to the hospital, here’s my key, here’s all my information. But what might actually happen is the physician the hospital says, great. Here’s this stack of paper, you still need to fill that out.
Unknown Speaker  34:34
Well, so my so the way it’s this is built the way that I can see that that won’t happen. And the reason it won’t happen is because there’ll be so many people on the platform, they won’t be able to do that.
Unknown Speaker  34:47
Okay, so you get enough positions that just say, if you want me to work for you, with you, this is how you get my information. And because we have so many physicians in the ecosystem, if everybody’s saying that, so that’s where the leverage is the leverage isn’t convincing the government or convincing the hospital systems that this is okay. You get enough physicians on the ecosystem that then say, this is how you get my information. And if you don’t want to do it this way, then you’re not going to have any anyone working there because this is how you get all of our information. Okay, that’s quite a few physicians that you need to get in order to have that type of leverage. Yeah,
Unknown Speaker  35:36
my goal is to have 200,000 by 2021.
Unknown Speaker  35:37
Fifth of physician, I think that’s, what is it one quarter right there 800,000 practicing physician so that’s, you’re saying one quarter of us physicians would need to be on this platform.
Unknown Speaker  35:50
I don’t think that they need to. I think that if we reached 50 to 70,000, it would still be powerful. But my goal is bigger than that.
Unknown Speaker  35:57
I think maybe regional Right, you’re in, you’re in New York, I’m on Long Island. We’ve already got two physicians in the ecosystem. We just build from there.
Unknown Speaker  36:09
I totally agree. And the thing is, is, you know, I’m not, I’m not suggesting that we’re strong on the industry into doing it our way at all. You know, I’m suggesting that we create a system and a front facing application that’s so you know, user friendly, that’s so trusted because it’s on this, this cryptographically encoded and secure ledger, that they’re happy to use it because they’re, you know, that these systems spend a lot of time and money on this on this credentialing problem. There’s a lot of redundancies, there’s a lot of mistakes and there’s a lot of waste. If we create something that’s easy for them, that makes their life you know, that makes their life easier than you know the only Why wouldn’t they want to utilize this this platform. You would probably just need some bold early adopters that then show how simple it is, and cost effective it is. And then it it snowballs from there. Absolutely.
Unknown Speaker  37:07
So there was something that you discussed earlier that I want to circle back to just because because we’re running low on time, you know, I keep on referring to it. And I don’t know whether I did or I got this from you as the physician as the ecosystem where physicians can communicate with each other because that’s the other end of this that you started to talk about. And then kind of went to went to a different place. So, you know, physicians are a guild, right? We know that because who decides how many physicians there are? Well, physicians who decides how you get your license, and this is all decided by us and that makes us a guild. So So how would you use this technology for us to be able to more effectively communicate with each other and thereby make some collective decisions?
Unknown Speaker  37:57
Yeah, any anybody who’s been a member of any national regional level Association knows that, you know, as the group’s grow, they begin to kind of collapse and implode on each other when it comes to decision making. And you know, a lot of times you put in layers of regulations, you put a board of directors, you put coat committees, co committees, and as this happens, efficiencies start building in efficiency, sorry, not efficiencies. So, you know, as groups grow, and as people kind of aggregate around a shared idea, in the movement towards actionable outcomes towards that idea starts becoming slow and sluggish, because it’s just, it’s not an efficient way of or there’s no, there’s no efficient way of organizing. So blockchain governance platforms allows the individual to, you know, tag their identity to different ideas. Yeah, you can create micro communities around shared ideas. You can collaborate and convene. What appears to be honest, a front facing app like a social media platform or like slack or Facebook, where you can kind of come up to come to a consensus with groups and not have hierarchy not have a need for a board of directors not have a need for committees? Because you can, I know have a cryptographic code that allows people to organize through through the blockchain.
Unknown Speaker  39:26
And you said, there are some inefficiencies, but some might argue that we we have this system through our specialty societies or the American Medical Association, but those also sometimes have some conflict of interest, right, where, where the people running the organizations have have an agenda and do their best to work with their their members, but there are some inherent conflicts of interest there. And so it seems like decentralizing that you get rid of those those underlying contract flicks of interest that are in the organizations
Unknown Speaker  40:08
where you get rid of the conflicts of interest. And then you also get rid of the the temptation for conflicts of interest because there’s nobody on the top.
Unknown Speaker  40:16
But without the bureaucracy, how do you then affect your will? Right? Like, let’s say, all of the laryngologist in the Mid Atlantic states decide to vote on someone proposes a vote on something and we all unanimously vote to, I don’t know, do something and what what then happens to that that sounds like that might just go into the right how do we then use that to affect change?
Unknown Speaker  40:45
Well, let’s take the no balance billing law in New York state right now. That’s something that’s that’s actually happening. And subspecialists are refusing to cover the emergency departments because they’re not being guaranteed payment anymore. And They’re not being paid. They’re not even if they don’t get payment, they’re not allowed to build a patience. So they’re disincentivize to cover emergency departments. So, you know, a lot of physicians were against this legislation, but it was put, you know, it was created anyway. And a lot of it had to do with, you know, people didn’t even know what’s happening. The people that didn’t know it was happening, we’re too busy to do anything sometimes. And the ones who did try to do something they were out and money’s not numbered by special interests. So um, you know, imagine if you could very quickly and easily be made aware of things like this on a monthly or weekly basis. You know, delegate and physician champions be incentivized to do research around these issues. And then, you know, to be able to vote and say, Hey, okay, of all the alerting colleges, how many of you would stop covering emergency departments and then we’ve helped That data to the public. Hey guys, did you know that if you know this bill is passed, and you have, you know, a car accident, then you might have to maxillofacial plastic surgeon to fix your face? You know, and that kind of thing would have the potential to change the votes of the people and to make people aware of what’s actually happening. And if we can do it in an efficient way, where, you know, physicians aren’t spending so much of their time, you know, trying to figure things out, and where, you know, if something’s affecting more than one specialty, those specialties can collaborate together. We’re right now, if you’re only a member of the, you know, I don’t know what the specialty society is for Ottolenghi ology, but you’re only a member of your specialty society and then the GI doctors are only a member of theirs and the plastic surgeons are only a member of theirs. There might be legislation that, you know, affects everybody but because, you know, they’re all kind of stuff Right out there, not potentially not communicating. And they could be, you know, collaborating on these types of things. So you know, and the way the way the H pack platform aims to do this is by incentivizing every physician on the network to generate income on the network. So if you get paid through the network, you’ll be incentivized to do so. And when it when it happens, a small transactional fee 2% will be taken and put into a pot. And that pot will then be delegated to different services, whether it be direct payment, malpractice, you know, legal aid for physicians who have had, you know, a run in with, you know, the system that in an unfair running with the system, you could delegate a certain amount of money to lobbying efforts and you could do that with your individual vote. So right now, a lot of people don’t like to give money to these legacy systems. Partially because of the potential collusion and the corruption, but also because they don’t know that their money is going directly towards something they care about. But in this type of technology, you can delegate your financial contribution directly to what you as an individual are voting for. And so I, you know, I think it solves a lot of the problems that we as a physician community have around us, you know, kind of having different opinions, being fragmented, not really wanting to work together, you know, feeling very patient, you know, connected to your specialty and things like that it, it encourages community and it encourages, encourages a more tribal mentality around the practice of medicine as a whole. You know, we all went into this to take care of people, and how are we going to fix the system so that we can take care of people again, how are we going to do that together while also preserving our own sovereign rights.
Unknown Speaker  45:01
I think that is an excellent way to, to finish up the talk and excellent summary of, of what you’re trying to do. Where can people find you?
Unknown Speaker  45:11
h pack.io? So www.hpec.io that’s our website.
Unknown Speaker  45:21
Any Anything else? This is quite a comprehensive talk. Was there anything else that you want to mention? Before we wrap things up that you think we may have missed?
Unknown Speaker  45:28
No. I mean, I think I just I want people to have hope. I want people to realize that you are still the person that you you were when you entered medical school, you’re still that person. You still can make a difference. It’s not you know, I know that there’s been a lot going on that makes people feel helpless lately. And, and it’s, it’s, it’s not a hopeless situation. We do have the power, we have a new technology that can help amplify that power. We just need to agree to use it. That’s it.
Unknown Speaker  45:59
Well, if you can bounce back from having your identity stolen and someone built under you and then not be able to work for a while. Well, if you can bounce back from that, then I think we can we can all bounce back. So thank you very much for taking the time to talk to me tonight. I’ve really learned a lot and it’s Thank you for everything that you’re doing for the physician community and for patients.
Unknown Speaker  46:19
Thank you. Thanks for having me, and thanks for listening.
Unknown Speaker  46:25
That was Dr. Bradley Block at the physicians guide to doctoring. Find all previous episodes on iTunes, Stitcher, Google podcasts, or wherever you get your podcasts and write us a review. You can also visit us on facebook@facebook.com slash physicians guide to doctoring. If you are interested in being a guest or have a question for a prior guest send a message or post a comment.
Transcribed by https://otter.ai

No Fibs about A Fib with Doctor A Fib

Dr. Percy Francisco Morales is a fellowship-trained electrophysiologic cardiologist who felt that he could help more people by developing an alter ego and creating online content.  As physicians, we tend to answer the same questions again and again, so he thought it would be helpful for patients if he made an atrial fibrillation FAQ and thus Dr. A Fib was born.  We discuss the risks associated with a fib, management options, why coumadin is becoming a thing of the past, and new procedures.  

www.drafib.com

No Fibs about A Fib with Doctor A Fib

Dr. Percy Francisco Morales is a fellowship-trained electrophysiologic cardiologist who felt that he could help more people by developing an alter ego and creating online content.  As physicians, we tend to answer the same questions again and again, so he thought it would be helpful for patients if he made an atrial fibrillation FAQ and thus Dr. A Fib was born.  We discuss the risks associated with a fib, management options, why coumadin is becoming a thing of the past, and new procedures.

www.drafib.com

 

EPISODE TRANSCRIPT

Unknown Speaker  0:03
Welcome to the physicians guide to doctoring A Practical Guide for practicing physicians or Dr. Bradley Block interviews experts in and out of medicine to find out everything we should have learned that while we were memorizing the Krebs cycle, the ideas expressed on this podcast are those of the interviewer and interviewee and do not represent those of their respective employers. This podcast is intended for medical professionals. The information is to be used in the context of your own clinical judgment. And those on this podcast accept no liability for the outcomes of medical decisions based on this information. As the radiologist like to say clinical correlation is required. This is not medical advice. And even though the magic of podcasting may make it seem like we’re speaking directly in your ears, this does not constitute a physician patient relationship. If you have a medical problem, seek medical attention. And now here’s Dr. Bradley Block.
Unknown Speaker  0:56
Welcome back to the physicians guide to doctoring On today’s episode. We speak to Dr. Percy Francisco rallis, a cardiac electrophysiologist in Houston, who’s also known as Dr. A fib. Because of all the online content he’s created under that moniker. We talked about the main tenets of managing a fib. Why getting your patient to an electrophysiologist sooner rather than later hopes, their long term prognosis in new onset a fib. Why we expect most people to be off Coumadin soon, and some of the procedures he uses to get patients out of a fib, or off of anticoagulation. Welcome back to the physicians guide to doctoring. On today’s episode, we have Dr. Percy Francisco Morales, a fellowship trained cardiac electrophysiologist, who is sometimes known by his alter ego, Dr. A fib. He’s created a lot of online content to help his patients and other patients understand atrial fibrillation. And so he’s on the show today to help the physician community better understand this pathology. So Francisco, thank you so much for being on the show today.
Unknown Speaker  2:00
Thank you, Brad. Thank you for having me on the show. I enjoy listening to your podcast.
Unknown Speaker  2:04
Thanks as always, always nice to meet a fan. So
Unknown Speaker  2:09
So first of all, just introduce our introduce yourself to establish some street cred with the audience. Where was your training? What was your training in and then we’ll, we’ll start off talking about that alter ego of yours.
Unknown Speaker  2:21
Okay, well I’m originally from Chicago, born born and raised and went to college at the University of Illinois, but then I eventually went over to Washington University for medical school, which is great medical school there a lot of great teachers over there. However, when I was there at school, I actually ended up doing my general surgery rotations through the month of December, January and February and there was a lot of brutal cold at that those times years and scrape the ice off of my car. And that’s when I officially said that I am done with the cold weather and so I pretty much when it came time for my intro Turn year and applying for residency, I was only looking at stuff in the in the southern hemisphere of the south of the country for the most part, and that ended up matching Baylor College of Medicine for my internship and residency, and they ended up staying there ever since. For the next several years for training, I did my general medicine residency there. I did my cardiology fellowship there, as well as my electrophysiology training. They’re all in the Baylor College of Medicine in Houston. And then once the my training finished about six years ago now, I ended up joining a private practice group over in the northeast Houston suburbs.
Unknown Speaker  3:37
I can completely empathize with your cold situation. I went to medical school in Buffalo and I just remember leaving the library and my eyeballs freezing open because it was so cold. The one benefit though was, of course is as medical students, we were the last ones to leave the library we were close it out. So an empty Park. Lot full of snow was was great to learn how to do spin outs in your car.
Unknown Speaker  4:05
Well, I will say in the past 13 years I’ve been in Houston, I’ve probably only seen snow, maybe two or three times it doesn’t stay on the ground and I don’t really miss it.
Unknown Speaker  4:15
You don’t miss it. Yeah, you can always. You can always travel somewhere if you want to go skiing. But
Unknown Speaker  4:21
yeah, I mean, growing up in Chicago, I feel like I’ve had enough snow to last in my lifetime. I’m pretty good with that.
Unknown Speaker  4:27
So how does your Alter Ego feel about the snow?
Unknown Speaker  4:30
Well, my alter ego is Dr. A fib and which is an online educational platform that I started about a year ago now actually, just recently just hit my one year mark of starting my online platform. And I recently I really started this because you know me, I’m sure you see this an EMT, but you just get a lot of the same questions, you know, and people ask a lot of the same questions about their diseases. And for me doing electrophysiology, I mean, atrial fibrillation was probably over 90% of the patients that I take care of. And so about a year ago I started thinking, you know, is I was really kind of reaching for a way to kind of extend my reach in a way to be able to education, educate patients better, and just to create something that you know, belongs to me that I could create and control and kind of control the content and control the direction of where it would go. And so I created Dr. A fib, bought a year ago now and you know, started off with a few small videos on Facebook and soon realized that this is something that people were genuinely interested in. There’s somewhere around 5 million people in the United States with a fib and over 30 million across the globe that have a fib and it’s still a disease that a lot of people don’t really understand. And it can be pretty complicated to really understand some of the features of disease and that’s why I started doing Dr. phibes. A year ago and you know, wanted to give it a catchy name to and it seemed
Unknown Speaker  6:04
like the name as well. So how does
Unknown Speaker  6:07
the dynamic work in your office? I was wondering about that because if I were to create some content about say tonsillectomy, right, if I were to tell parents Well, I think your child would benefit from an ad no tonsillectomy here, watch this video that I made. I’ll be back in 10 minutes while I go see my next station. You know, I can’t see that dynamic working that well because you know, that they need to trust you the rapport I feel like there’d be an issue with the reporter. Is that how you use this content?
Unknown Speaker  6:42
Oh, no, no, not at all. I mean, this doctor a fib is completely like a side gig, educational content, educational platform, you know, my day job of you know, being electrophysiologists and seeing patients you know, the report has never been No different, you know, I still answer the same questions all day, you know, to the patients and in person, you know, this online platform was to kind of extend my reach and to reach patients and and educate people far more than what I could do just by seeing people in person. So the kind of separate things factory fed there’s a little bit separate from Dr. Morales even though there’s a lot of intertwined between the two I kind of, like far as how I manage patients is, you know, really hasn’t really changed at all.
Unknown Speaker  7:29
Okay, so you don’t, you don’t use it during the office visit as a way to educate the patients you direct. You might tell them about it. after they leave the office. Hey, if you if you want to learn more about your condition, I have this platform here where you can find more information. But as your answer you’re still answering the questions. It doesn’t change that physician patient.
Unknown Speaker  7:52
No not at all my office visits are still exactly the same but like you said at the end I do have I have made some doctor a business cards which I kind of say, Hey, if you’re interested in more educational content, if you’re interested in completely optional, take a look at this site, you know, but the actual encount patient visit, you know, really hasn’t changed.
Unknown Speaker  8:11
So most of it is is tailored, we’re all of it is tailored for the patient population. But the reason you’re on the show today is actually to talk to the physician and clinician population. So if you had a medical student rotating with you, and you didn’t know what specialty they were going into, what would be some of the things you would want them to take away from atrial fibrillation, or you can even talk about elect other electrophilic physiologic issue. Although given that you said 90% of what you do is a fib. We should probably focus most of it on on atrial fibrillation,
Unknown Speaker  8:46
especially if someone was a medical student. there be a couple of points for me to point out I mean, first thing I’ll try to tell people is, don’t be intimidated by this disease. I think people get kind of like, they just look at an EKG or they see a person’s heart rate. Going 130 minutes, just throw their hands up in there and they say, I don’t know what to do with this, you know, or, or, you know, fix it, you know, like it’s not, it’s okay, just settle down, you know, it’s a control the heart rate understand their risk of stroke, you know, and it’s this is very manageable condition. And then I will try to tell try to encourage people about how interesting it can be to manage people who have atrial fibrillation or doing electrophysiology because I’m not really as aware of other fields and medicine, they have so much of a mesh between health as, you know, healthcare and medicine, but as well as technology. I mean, there’s so much technology in the world of electrophysiology as well as with taking care of a fit patients when it comes to the equipment and the ablations and all the monitoring devices. I mean, it’s, we get called the electrician for a reason, but it’s kind of a nickname that a lot of electrophysiologist get because there’s a lot of mess between technology And and the diseases as well as health as well as managing them.
Unknown Speaker  10:05
So what are some of the cooler gadgets that you end up using? Because I, I finished medical school. You know, we talked before the show, we’re about the same age I finished medical school in 2006. And so I would imagine there’s a lot that’s changed technology wise since then. So what’s some of the newer cooler stuff out there that people might find interesting?
Unknown Speaker  10:28
Well, the newest stuff has been all the kind of home monitoring and wearable technology mean they’re really getting like even apples getting into the world of atrial fibrillation. You know, the Lewis generation Apple Watch is going to can automatically tell you if you’re in a fit or not. And there’s several other like I said, a basic I’m sure they haven’t didn’t say that specifically I fit but that’s probably a name that they’ll probably come up with as well. But at the Apple Watch can do it as every other wearable home technology as Well, big company called the cardia is the name of the product that they do also the same thing. And you can kind of just put your, your fingers on a sensor, and it’ll tell you on an app on your phone if you’re in a fit or not. They’re pretty accurate. They have an FDA clearance and so they’re pretty accurate device. And so this whole world of at home map monitoring and at home technology is just rapidly growing.
Unknown Speaker  11:24
So are you with this new technology? Are you catching more patients that otherwise might not have been diagnosed?
Unknown Speaker  11:32
I wouldn’t say that I’m catching more patient being diagnosed just yet. I’m sure that that will change. I mean, the latest generation Apple Watch was just announced like in September, so I can’t really say I haven’t been seen it much change things in practice, but probably the biggest use of it now for me and my patients is that, you know, I have plenty of patients and you may have some to that they live far away from your practice, you know, and sometimes it’s hard for the patient feeling to know that In a film, or they just say, hey, my Harvey’s calling fast today, from a Caribbean a ship. And instead of coming down to the office, you can send this trip from home and send, send it through email over to our practice, and then I can tell you what’s going on. And so this kind of helping to manage things for people, especially who are further away from the from the office has been a pretty useful thing about these at home monitors.
Unknown Speaker  12:22
So how do those monitors work used to the patient puts the leads on themselves.
Unknown Speaker  12:26
So that now there’s a couple of different options. And so there’s probably one of the more popular ones is a little device called the cardia. And it’s, it’s about three or four centimeters long, it’s got these two little electrodes that you put your fingers on, and think you put it back, you put it on a table, and you put your fingers on there. And then that little gadget transmits to an app on your phone, which has, like, you know, its own kind of algorithm that will tell you if you’re in a fit or not, and it’s like the skinniness single lead EKG, so they’re pretty cool.
Unknown Speaker  12:56
Wow. Yeah, that is that is pretty interesting. So you mentioned Before, if there is a rate of 130, don’t let it intimidate you. The two things are rate control and stroke risk.
Unknown Speaker  13:09
I mean, those those are treatments one into for any patients that have atrial fibrillation and, and I frequently describe these to patients. And there’s like two hands in a sense, like you have to treat the symptoms and one side and then treat the risk of stroke on the other side. And they’re very separate things that people like, people think that they’re both kind of together, you know, but you have to kind of manage them kind of separately, you know, there’s either controlling the rate or controlling the symptoms or minimizing symptoms, which can involve a variety of different medications and whether it’s something simple like beta blockers or more complicated medications, like anti-arrhythmic medications, and then there’s risk of stroke and that’s what typically involves your blood thinning medications like your war friends or your newer medications like xarelto analysis. Those are the types of blood thinners.
Unknown Speaker  14:02
Speaking of which, so as an EMT, I encounter this a lot in my practice the atrial patient with atrial fibrillation and an active nosebleed on blood thinners, whether they’re on one or multiple blood thinners, and sometimes it’s not such a bad nosebleed, it’s fine Stan your blood thinners but then sometimes it’s pretty challenging to control. And so sometimes I try and figure out for the patient, what their stroke risk is going to be if they go off of their blood thinners for just a little bit, so correct me if I’m wrong, and clearly there’s going to be a range because some people have proxies. Molina some people are always in a fib. But the main risk is like 5% per year, not on a anticoagulation, but I think it’s 2% per year on anticoagulation.
Unknown Speaker  14:53
So in general, when people are on anticoagulation, and most of the studies the risk of stroke was somewhere around 2% but in the big antic regulation reduces risk of stroke usually somewhere around 65 to 70%. As far as the risk of stroke, not being on a blood thinners is based off of their risk factors, and that’s what we’re the Chad’s vast risk score comes in when you’ve taken account people’s age, and whether they have high blood pressure, diabetes, and we’ve had a stroke. And that kind of factors in what their risk of stroke is, which can range from zero for people who have very low risk of stroke always around 18% if they have all the risk factors for risk of stroke, but going back to your question about being off of blood thinners when somebody has, you know, may significant bleeding, and you know, when I’m managing my patients is the fact the matter is you have to go with what the clinical scenario is, you know, I mean, those risks of strokes are based on an annual risk stroke, you know, so there’s no really way to calculate the say if a patient is often blood For two days, the risk of stroke is going to be x or y, you know that number that the risk scoring system that we have is based off of a annual risk of stroke, you know, so there so happens all the time where my patients are on blood thinners. And they either have a clinical bleeding issue or they have a procedure that they’re coming up that we have to stop the blood thinners and just go with the clinical scenario. And, you know, there’s very, very few people that in my practice, that I actually will say like, either No, you can’t, or you have to use short term blood thinners like Lovenox. But for the most part, it’s perfectly fine to stop the blood thinner for a day or two, especially these newer blood thinners. I mean, they’re halflife is somewhere between 12 to 18 hours and so the usual recommendation for like eliquis or xarelto, that since they’re very popular, newer medications, is that, you know, one day off for minor procedures and two days off for more major procedures.
Unknown Speaker  17:01
So I just did a little quick math. And if it’s the highest risk, highest risk patient, which is 18% per year, and you take them off for a week, so let’s say, you know, 52 weeks a year, so 18% divided by 52 looks like it’s around a point 3%. And that math might be wrong. I think there was like an negative number and maybe an imaginary number in there when I tried to do that. But I think it’s like, point 3% per year. So if I asked my my patient who is actively bleeding, to just stop their xarelto even if they’re the highest risk patient, it looks like they have a point 3% so I can tell them that you know, your risk of stroke in this one week is extremely low. And given that you’re actively bleeding, but in the end, probably I should just call up their cardiologist and have that conversation with them. Anyway to to let them help me mitigate that risk.
Unknown Speaker  17:57
Yeah, that’s always the safer But in general, I mean, it happens all the time. You just have to go to clinical scenario. And I mean, I wish I could say I haven’t seen any patients that had a stroke after just being off of blood thinners for, you know, very short amount of time, because it has happened just but it’s pretty rare. And it my overall kind of practice is that, you know, the clinical need for you go ahead and stop the bulletins.
Unknown Speaker  18:23
Well, you know, if you see enough patients, you’re going to see some of those outcomes. So, yeah, I volume practice. So, let’s say you have, say a rural physician who doesn’t have easy access to interests and electrophysiologist. And they are in a community hospital, they encounter a patient who just had a stroke there because their stroke, they’re diagnosed with a fib. How do you begin your workup?
Unknown Speaker  18:55
Well, when they’re first diagnosed with a stroke, Of course, first important thing is, you know, we have from the stroke and you know, kind of getting better from whatever their initial hospitalization is. And as far as the initial treatment versus somebody who’s a, either primary care really doesn’t take care of a lot of a few patients, you know, probably one of the most important, most common treatment strategies geez that are given are probably just re controlling medications like beta blockers or calcium channel blockers. Many physicians, whether you’re a cardiologist or not are very comfortable with using beta blocker medications. And then pretty most people are very comfortable with starting them on entik regulation, you know, if they’re there for stroke, I always kind of make sure that a neurologist kind of is saying it’s okay to start them on anticoagulation but sometimes if it’s a big stroke, you know, they may say Okay, wait 2448 hours makes you don’t have to memorize your conversion or something like that, you know, but once they say it’s okay to start blood thinners, you know, you go ahead and start the blood blood thinners immediately. I tend to Like these normal blood thinning medications like xarelto, Alec was better just because they pretty stable, consistent blood thinning option. And you know, the level of the levels of the anticoagulation effects are pretty steady with those medications.
Unknown Speaker  20:14
So are we going to see everybody off of Coumadin? Now? Is that is that what’s going to happen with these newer medications?
Unknown Speaker  20:21
I’m probably, you know, I honestly, rarely ever start medication people on Coumadin nowadays. Really the main 100% these days is still mechanical, heart valves, you know, you there’s really none of those medications have been tested in that scenario, but when it comes to a fib or other things that need you know, DVT or PS like these medications are becoming a standard usage now, and honestly, probably the only reason why I use criminalities tends to be because of cost related reasons I’m and there’s a lot of patients that these newer medications, the CO pays are just too expensive for them and you know, and they may try painful for a little while, but then especially patients who are on Medicare, this is too expensive for them. And in those cases, you know, the probably the one of the main ones that I put them on Coumadin.
Unknown Speaker  21:11
Because they’re the labs that go into Coumadin. I guess, just the way the coverage works, maybe a bit more of the labs are covered rather than the medication, because I’m sure that in the total cost plays into it, because you don’t need to monitor these medications with serum or like you do with Coumadin.
Unknown Speaker  21:28
Yeah, it’s true. I guess that the out of pocket amounts of the patients and the pain that ends up being more with these
Unknown Speaker  21:34
medications.
Unknown Speaker  21:36
Yeah, which is just a product of our system rather than the genuine difference in costs, although I’m sure there’s a genuine difference in cost there to even with the labs just because Coumadin it’s so it’s so cheap.
Unknown Speaker  21:47
Yeah. Yeah. And obviously, I’d have to think about the actual costs the labs and everything together, but I’m sure that the cost of the newer blood thinner is probably still more expensive at this time, but You’re the first ones to come out, which I believe was Pradaxa. I think it’s somewhere around seven years old now. I mean, so it’s probably not still several years away before any of these medications and become generic, but it’s not super far time from now.
Unknown Speaker  22:15
Well, but and then and then
Unknown Speaker  22:18
everybody’s off coming in. Probably unless you have, like I said, a mechanical hard mechanical hard up clear indication that you have to take take for for mechanical valve.
Unknown Speaker  22:28
So let’s let’s talk about some of those other gadgets that you have maybe not gadgets, but procedures. ablation ablations versus cardioversion when when you use one, when do you use the other and what are the indications for either of those?
Unknown Speaker  22:44
Um, well, I think this brings up a pretty good point that I kind of wanted to emphasize to your audience is about the whole area of rhythm control procedures where there is lesions or cardioversion, you know, I think for a lot of doctors out there, especially people who maybe have a little bit of experience, or a little bit who have managed someone a little bit patients where they fit, there’s some people out there that have impressions that, you know, ablations or party versions don’t work, or the aphid comes back, you know, and some of that is true, you know, I mean, there’s certainly no 100% cure for a fifth meaning, there’s no one shopping and you get it done, and you never, ever, the rest of the patients like have to worry about the fib anymore. But but the patients can be dramatically improved, and they are the hospital, certainly a lot of benefit from it. Now, what I wanted to point out was that a fib is a disease of progression. And the more that people have a fib, the more the heart inherently changes. And, you know, even on a molecular level, the heart changes now We’re not going all the way back to the Krebs cycle. But you know, we’re talking about like, action potentials. I thank you for the sodium calcium channels. Yeah. I don’t remember too much about the Krebs cycle, but I know, potential, you know. And, you know, they inherently changed. The longer people have a fib, the heart from a molecular standpoint changes, they get more dilation, they get more scarring in their heart, and the heart inherently changes and people to be able to have higher success rates and have better outcomes in the treatment. They’re a fit, the earlier that they get treatments like a cardioversion or an ablation, the less long term damage has been done to the heart and so that success rate will be better and I think that’s something that a lot of lot of other doctors don’t really know or understand. You know, a lot of times I’ll get a patient sent to me who’s, you know, their previous doctor or you know, they’ve had a fit for year or two, they’ve been trying around different medications that is not working. And I say, Well, I wish I would have met you a year or two ago, you know, when it was just kind of in this early starting out process and we could have had a higher success for trying to really have a really good handle of your atrial fibrillation. So I just kind of wanted to emphasize that it is a disease that progresses and the sooner that people get expert consultation, the sooner they get put on either whether the medication of their car diversions or ablation procedures, you know, the, the better that success rate is
Unknown Speaker  25:33
so that that stroke patient in the rural hospital, in all likelihood probably just statistically had that atrial fibrillation for a while until they developed a stroke. So that’s not the patient that you’re referring to. And plus they’re right, clearly in the stroke or to the hospital. They’re not gonna, you’re not going to be in your office anytime soon. But if, say that same rural physician in their outpatient practice sees a picture that maybe has a couple of days of fluttering in their chest, get that patient to get that patient to get in the car or however the safest mode of transportation is, but get that person to an electrophysiologist as soon as possible, because then you’re going to have the highest likelihood of controlling that patient long term.
Unknown Speaker  26:21
Yeah. And and obviously, there’s been changes and all of this, you know, doesn’t mean they have one episode of a fear that they have to go get in an ablation done or, you know, have a procedure done or have to see an electrophysiology. But there’s certainly a progression. I mean, when I meet patients where they said, though, going to tell me a common story, they had an episode of a fib and then maybe they didn’t have anything again, for a year or two, they started getting them more frequent and lasting longer. And it’s just, it’s a disease of progression. And you know, and the further along along that progression that the patient is, the less the success rate of any type of procedures for a fit.
Unknown Speaker  26:54
So then when are you using those procedures to tell me the indications for an ablation versus the indications For cardioversion,
Unknown Speaker  27:01
so, cardioversion, I tell people is sort of a simple quick fix, you know, it’s trying to get, you know, basically, it’s like, you know, I tell my patients, you have your phone and TV doesn’t work and you turn it off, you turn it back on again, but it doesn’t fix the, what is the whatever the inherent problem is inside of the heart and so, but it’s a very simple thing to do. And so a lot of times cardioversion, that I’ll do them because maybe the first time the patients have a fib and you just put them in back into normal rhythm and they may have normal rhythm for a long time, or some people are a little bit too sick to really undergoing an ablation procedure, which is certainly more aggressive and so a cardioversion may be a better option. And another way I kind of do a use Akari virgins a little bit of a test run and I guess I say to see if their heart has advanced too far to where, you know, more aggressive options I can ablations are really not going to be so festival, you know, to see if there are at the point of no return where no matter what I do, it’s just not going to be successful to try to keep a personality out of a, a fair. But when it comes to ablations, you know, the actual indications are pretty variable based on the stage of a fear. You know, when people have a fear that comes and goes, you know, and you’ve been on at least one medication and you’re still symptomatic from it, that’s a class one indication for doing an ablation. Now, if you’ve been more advanced stages of a fit, you know, it becomes more of us, I believe it’s a to a indication to do it, and a place and because the success rate is is not as good but it’s certainly it’s still can be a better option than medication for a lot of people.
Unknown Speaker  28:50
And do you have a favorite procedure was one that you enjoy doing more than the others, because cardioversion. It makes you feel like you’re You’re one of the doctors on er.
Unknown Speaker  29:04
You know what, when it when it comes to cardioversion, you know what I, I wish, you know, they make it seem on TV like people have the paddles that the shock of people, they don’t have those anymore so it’s never as exciting anymore to shock somebody just pressing buttons on the machine now, you know, like I always wanted to have those kind of little paddles in the gel
Unknown Speaker  29:25
the way they do on TV, but you know, they don’t really have those kinds anymore.
Unknown Speaker  29:28
You’re like, you’re like swiping right instead of shocking the face and
Unknown Speaker  29:32
yeah, pretty much already swipe. Okay.
Unknown Speaker  29:37
But when it comes to ablation, there’s all different types of equipment that I use now and some of it just again, it depends on where the patient is in their stage of a fit. You know, people who had earlier stages of a fit, you know, the ablation procedure is a little bit simpler. And there’s all sorts of kind of one shot balloon technologies to help with the ablation procedure, which kind of makes the procedure little more faster and more efficient, which I started to like to use a little bit better. Who are more? Yeah, so there’s a freezing balloon called the cryo balloon, and basically you put a, you put a balloon and where the pulmonary veins are in the left atrium, that’s where the most of the ship comes from. And so the balloon kind of inflates in each one of the pull of pulmonary veins and it freezes the antrum. And it’s kind of like a one shot of area of bleeding area that can triggers most a fib. And so you can do these procedures in probably about an hour, hour and a half to the last shorter than a lot of more traditional ablation procedures. Obviously, as people advanced more into a fib, but you know, you kind of need to change the equipment and do more of a traditional kind of burning catheter to kind of get a better control of their duration. But all this is always in flux. I mean, there’s always constantly new research coming out with new equipment and new techniques to do it.
Unknown Speaker  31:01
I feel like there’s a balloon manufacturer out there that just visits every single sub specialist and say, Hey, hey, where can we use this balloon in your patients? Because there’s the sinuses there’s a balloon for tracheal dilation there. There’s a balloon for electrophysiology. I feel like there’s a blend for everything you’re not sure what I’ve done probably alone. choosable balloon just use it for something and then a laser because there’s, you know, everything I have a laser to do you have a laser. I’m
Unknown Speaker  31:32
really a laser there. Now, practical laser and I’ve seen some stuff in like, trials and describe but nothing that’s really commonly used for laser
Unknown Speaker  31:43
device looking for a home. Yeah.
Unknown Speaker  31:47
The patients ever asked you that. Do you? Do you use a laser for that?
Unknown Speaker  31:51
Um, no, but like I said, I at least when I was in fellowship people were one of my my mentors was doing some clinical trial that involved balloon that use the laser, you know, and I
Unknown Speaker  32:02
got them both. He’s got balloons and lasers.
Unknown Speaker  32:05
And the patient, I remember seeing one, but he was very excited like, I want the laser and, and I don’t think that that technology has been has panned out because I haven’t really seen it being used, you know,
Unknown Speaker  32:17
I totally just completed my balloon. Yeah.
Unknown Speaker  32:22
Okay, so is there anything else that we haven’t touched upon that you think every physician, whether it’s someone who treats a fib or someone who doesn’t treat a fib should know about atrial fibrillation,
Unknown Speaker  32:33
that there’s actually one more thing that I think that’s a
Unknown Speaker  32:36
key thing that I think is important for, you know, people who see people bleed a lot on blood thinners, whether it’s an EMT or gi doctor or or urologist was keep seeing people bleeding over and over on blood thinners and that’s there are other options. Now, you know, the main risk of stroke for people who have a Fed come from formula thrombus, no left atrial appendage, which is a simple Little kind of pocket pouch does it on the side of the left Hmm, I kind of tell my patients it’s like the appendix of the heart, it doesn’t really contribute much to the heart function, but it’s kind of like this little blind pouch that that’s where most of the thrombus forms and then where that’s where the main risk of stroke comes from. And there’s actually an emergence of procedures and particularly one called a watchman, where you basically put a plug in the seal that area off and the watchman has been approved about three years now. Basically, it just goes through a catheter through the groin up to the heart and basically deployed is plugged into the left atrial appendage, and they thought this day on blood thinners only for about six weeks after about six weeks, we checked with an ultrasound which everything looks nice and sealed off and then they don’t need it anymore. And it’s that watching plug was not inferior or equivalent to being on warfarin in terms of risk of stroke. And so there’s a lot of patients out there to have these ever going cycles of okay put you back on blood thinners because you have a high risk of stroke. You’re bleeding now you stop the bleeding for a little bit. Okay, let’s put you back on. Let’s take it off. And they just keep going through these cycles over and over and over again. And there are better options for them now, and this is this Washington procedure has been a very good option for those types of patients.
Unknown Speaker  34:14
How long has that been around
Unknown Speaker  34:17
for about three years now?
Unknown Speaker  34:19
Okay, so I mean, it sounds if it’s if it’s equivalent, that sounds like that might be a new trend for patients who are at high risk for the procedure itself, right? Because if I’m a patient, you know, you can either be on blood thinners or you could potentially get this procedure. Some patients are very fearful of procedures, especially something new like that. But some patients have great concerns about being on the blood thinners so especially with an active lifestyle.
Unknown Speaker  34:44
And one thing that I’ve always why I’m a big, wide been a big proponent of this watch and procedures that if it was studied for a long time, and actually went to two clinical trials in the US. I was approved in Europe A long time ago. So there’s many years of data behind it to show how Well, an effective they can be, you know, compared to just, you know, like the being compared to being on a blood thinner it’s equivalent, but compared to not being on a blood thinner for people who have legitimate bleeding, history or bleeding issues, I mean, this is an excellent option for a lot of patients.
Unknown Speaker  35:17
Wow, that’s, that is exciting. So,
Unknown Speaker  35:22
again about your website, where can people find you? So my main website is Dr. A fit calm. That’s where all my content is there on my blog posts, you know, my videos, links to my social media as well. I’m also pretty active on Facebook, as well as Twitter. Dr. Ha bondo kind of uniform, brand new platform through our doctor a fit, especially Bernie that other doctors may want to reach out to me You can always find me on there, Francisco merliss, my personal Facebook page as well.
Unknown Speaker  35:55
Well, thank you so much for creating all that content to help not just your own patient, but A lot of patients out there and thank you for taking the time to educate us about atrial fibrillation. Dr. Percy Francisco Morales.
Unknown Speaker  36:08
Thank you, Bradley. Thank you for Thank you for having me here. Appreciate it.
Unknown Speaker  36:12
That was Dr. Bradley Block at the physicians guide to doctoring. Find all previous episodes on iTunes, Stitcher, Google podcasts, or wherever you get your podcasts and write us a review. You can also visit us on facebook@facebook.com slash physicians guide to doctoring. If you are interested in being a guest or have a question for a prior guest send a message or post a comment.
Transcribed by https://otter.ai

Disclaimer: This is the transcript to the episode. This transcript was created by a talk to text application and the function of having this here is to improve the page search engine optimization. This transcript has not been proofread, so please listen to the episode and don’t read this. The information contained herein will inevitably contain inaccuracies that affect that quality of the information conveyed and the creator of this content will not be held liable for consequences of the use of the information herein.

 

Helping Doctors Heal the World Through Coaching

Dr. Dianne Ansari-Winn had her own battles with burnout until she turned to a physician coach, then became a coach and now teaches coaches.  There are executive coaches, sales coaches, tennis coaches, but until recently, not many physician coaches.  With the increase in physicians dissatisfied and unfulfilled by their careers, the “physician coach” is responding.  Dr. Dianne and I discuss why our field has been slow to realize the importance of coaching, her five-step physician vitality recovery system, some of the most common issues she encounters as a coach and I even get a free mini-coaching session!

http://www.dianneansari-winn.com

Please see the above link to learn more about her coaching and be sure to check out her podcast, The Doctor’s Life.

Helping Doctors Heal the World Through Coaching

Dr. Dianne Ansari-Winn had her own battles with burnout until she turned to a physician coach, then became a coach and now teaches coaches.  There are executive coaches, sales coaches, tennis coaches, but until recently, not many physician coaches.  With the increase in physicians dissatisfied and unfulfilled by their careers, the “physician coach” is responding.  Dr. Dianne and I discuss why our field has been slow to realize the importance of coaching, her five-step physician vitality recovery system, some of the most common issues she encounters as a coach and I even get a free mini-coaching session!

http://www.dianneansari-winn.com

Please see the above link to learn more about her coaching and be sure to check out her podcast, The Doctor’s Life.

 

EPISODE TRANSCRIPT

Disclaimer: This is the transcript to the episode. This transcript was created by a talk to text application and the function of having this here is to improve the page search engine optimization. This transcript has not been proofread, so please listen to the episode and don’t read this. The information contained herein will inevitably contain inaccuracies that affect that quality of the information conveyed and the creator of this content will not be held liable for consequences of the use of the information herein.

Unknown Speaker  0:03
Welcome to the physicians guide to doctoring A Practical Guide for practicing physicians were Dr. Bradley Block interviews experts in and out of medicine to find out everything we should have learned while we were memorizing Krebs cycle. The ideas expressed on this podcast are those of the interviewer and interviewee and do not represent those of their respective employers.
Unknown Speaker  0:25
Today’s episode we speak with Dr. Diane and sorry, when an anesthesiologist who suffered from burnout and managed to find her way out. She took that experience and turned it into a passion. Now she not only coaches physicians that are suffering from burnout, but she coaches physicians who want to coach other physicians. We discuss the importance of having a coach and why this is common in many other high performing fields. But not in medicine, at least not yet. The function of a coach and tips for physicians who may be suffering from burnout or know someone who is and I even got a bit of coaching myself during that interview. She even followed up with me the following day about what we discussed. This in all of my episodes are produced by car and Gill free professional voiceover artist. And she can be found at ca ri n g i ll fry calm. And now, Dr. Diane and sorry when Welcome back to the physicians guide to doctoring. On today’s episode we have Dr. Diane and sorry when, who’s a very accomplished anesthesiologist who, after 15 years in practice, pivoted and is now a full time physician coach. She not only coaches other physicians who may be experiencing the also common physician burnout, but now she’s actually teaching coaches teaching other physicians how to coach other physicians and extending herself in that way. So Dr. On sorry when did her undergrad and medical school and mph at the University of Michigan dinner anesthesia residency at Illinois State Sonic, and then a fellowship at the University of Chicago in both cardiac and pain, and was then an anesthesiologist for 15 years in Denver, Colorado, before pivoting into coaching. She received her certificate in CO active coaching from the coaches Training Institute, and is a graduate of the CTAs year long leadership incubator, the CO active Leadership Program. She is a physician development coach, and currently started and is managing the physician vitality Institute in order to coach physicians through difficult times, or even not so difficult times because kind of like therapy, it helps people that are living well, to live even better. She’s also the host of one of my favorite podcasts, the doctors life podcast, which serves our physician community in a similar way to this one, and that we’re both trying to help physicians to live their best lives. So Dr. I’m sorry when Thank you So much for for taking the time out of your extremely busy schedule to come to talk to me today about about coaching, the importance of coaching, how you got into coaching, and and what we can all learn from someone who’s studying, coaching as much as you have.
Unknown Speaker  3:16
Well, thanks Jackie read is great to be here this evening. Thanks so much for the invitation. And the that very warm introduction. I just wanted to make a slight correction just so that so the folks in the audience kind of know what I’m doing. I left corporate pivoted as you said, I left clinical practice six years ago and I actually started working in industry. So I, my I actually have two jobs. My day job is a medical director in industry, and then my passion project and the work that I do around That work so read evenings and weekends is, is the coaching the physician vitality Institute, the podcast. So, just like all of you guys, you know, sometimes transitioning from non clinical or clinical and non clinical doesn’t mean that you’re less busy because we have our interests and the things that we love to do. And, you know, we’re doctors, so we don’t want to miss out
Unknown Speaker  4:30
at all. Wow. Yeah, I’m sorry. I’m sorry about that. That that mistake, because as you are, it seems like that is not a side gig. It’s
Unknown Speaker  4:41
a full time job. Wow.
Unknown Speaker  4:42
Well, you know, it’s a it’s a doctors part time job, which is anybody else’s full time job.
Unknown Speaker  4:49
Yeah, definitely. That’s how we were all so so. coaching, how did you get into coaching? How did that become something that was even because a lot of us, we don’t even know Realize that a physician coaches is a thing you hear about executive coaches and, but but I know it’s something that’s that most of us could probably, if not all of us could benefit from so how did you discover that this was even a thing and then and then get into it?
Unknown Speaker  5:14
Yeah. Well, you know, interestingly, physician coaching has become a lot more prevalent, which I’m so excited about. now. I’ll talk about that specifically a little bit more later. My role and in creating more physician coaches, but how I got into physician coaching was probably about nine years ago when I really started to feel like I was burning out like I was not enjoying what I was doing. I was really feeling like it was you know, it’s really tough because I had been super high achievers you you know, you’re so kind introduction it’s you know, I went straight from a graduated from high school. It 16 I went to college at 16 straight into med school you know right into the very you know competitive residency I was chief resident married someone that was in my medical school class was also you know super high priorities pulmonary critical care you know went to Denver private practice had two kids and you know in the fight first five years did my practice and became partner bought the house the starter house so that one got the VIP Dr. House you know, so just plugging along being super high achiever and then I just started feeling really tired I started feeling fatigued. I started feeling trust not trusting myself in my work, even though I was still doing very good work. You know, I was the kind of doc that I was. would get requests, you know, from the nurses and from other docs if they wanted a family member to be cared for. Or if they had a patient that needed TLC, they would look for me. I did a lot of ob because I loved being with the patient’s ob anesthesia meeting. I love being with awake patients. I you know, and I was really good at my work, but I started to feel like I was sliding and even though I wasn’t, you know, on the outside, but on the inside, I could definitely feel the science of burnout coming on. And so I was looking for help. I was looking to talk to other another doctor about it, you know, I didn’t really feel honestly, you know, I didn’t feel so I could talk to my friends. My colleagues, most of my friends were surgeons, no offense, Dr. Brad, but you know, like, you don’t want to talk to other docs that are in your circle because the concern is that they’re going to think that you are Nothing just you think you’re sliding. But if you you know, if you say that you might be feeling like you’re not enjoying your work or you’re, you’re really tired or you know, it just doesn’t sound like just, you know, the regular doctor, doctors lounge complaining that we do all the time. But
Unknown Speaker  8:16
you have an episode a little while ago
Unknown Speaker  8:21
that were you were discussing that with someone. And they talked about just how frequent that is that so many of us are experiencing those symptoms, right? And if you were to, you know, reach across the drape as it were, and try to discuss something like that with someone. It sounds like you’d be surprised how often we’re feeling like that. That being said, if you’re anesthetizing one of my patients, and you said, Listen, Brad, I’m really not feeling so into this right now. Probably wouldn’t get the best reaction
Unknown Speaker  8:55
on it. Yeah. And then you know, Yes, exactly. And then you have to keep in mind, you know, you’re talking now I’m talking nine years ago, this is before Facebook. They’ve before LinkedIn before Twitter, before this sort of movement around physician burnout that starting to come out before all the research came out on physician burnout. So basically, you know, we we learned in med school and residency, like, never show your weakness, never, never. And so for me to even say anything like that, I felt that was, would be. It was scary to do. And so I was looking for a safe place to land a safe person to talk to you.
Unknown Speaker  9:44
And so in the dream, you had the house, you had the family, you had the job you had the career, you had everything that we aspire to have, how dare you be unhappy? That’s what that comes down to.
Unknown Speaker  10:00
Well, it is that and then also like, is she gonna crack in the middle of a case and like, just leave that or like, you know, like, Could she be dangerous? Could she be you know, Could she be dangerous to me my patients, you know, so that was the fear. And it’s still a fear, actually, if I you know, when I talk to physicians, that I coach is still a fear. But anyway, I was looking for someone to speak with, I found one physician coach, he left clinical medicine and she had learned coaching, and I found her and then as far as like other coaching, I actually started seeing a psychiatrist because I just thought there was something wrong with me, you know, I’m, but I learned I was burned out. There wasn’t anything wrong with me specifically except those for now. So, so I got into coaching because I was inspired by the coach that I was working with and I thought this is really cool. Like You know, night, I don’t want to go back to residency and study psych. So it’s like, well, coaching sounds really great and it’s such a great community of supportive people, not just docs, but non physicians. They are an amazing group of people and some of my best friends are our coaches. I just love the coaching community so but I got into it because of my own need search and my own needs at that time.
Unknown Speaker  11:31
So we do have that movement that is now prevalent where we’re all becoming more aware of physician burnout and but the the coaching, I still think is something that is very undervalued and underutilized in our industry. You know, executive, like I said, executive coaches, sales people have coaches. It’s very prevalent in in so many industries, but we’re all taught to be so self sufficient, right? don’t show any signs of weakness because like we’re, you know, you’re at the top of your class. This is this is who we are, this is what we do. You can’t show any cracks in the armor. All right. Well, why do you? Why do you think clearly you think coaching is important in it? you’d be hard pressed to find someone that disagrees with it. But But why do you think we were so late to catch on? Do you think it’s just this? It’s in our culture?
Unknown Speaker  12:33
Yeah, I think I think that’s the primary driver. And as you are, you already pointed out a lot of the reasons you know, we self select into medicine. We’re very driven group of people were very resilient group of people self sufficient. And that is reinforced in how we learn medicine, how we communicate. to each other as colleagues in medicine, and I think also that we’ve kind of can confuse the compartmentalization that that sort of is required of us to be professionals. And we confuse that and just put put all of like the emotions and everything that we have when we’re working, we put them away. And then sometimes forget that we need to like take them back out and process some, you know, if you if you and I were together in the ER, we had a difficult case. You know, where you’re, you’re at, and at one point, you’re kind of, you know, like, oh, holy crap that was going on. But then you switch into your doctor boat and so you just, you know, and that’s, that’s the thing to do, you know, so that your emotions don’t confound your actions. So we do what we need to do. But then, you know, at least we know when I was in practice, like we might have gone like who that was tough one and thank God, you know, just tuck them away and the unit or wherever. And then what will we do? Though we’re late rego go do next case like we’re not, you know, like, how did you feel wasn’t that scary or like we’re not doing any of that
Unknown Speaker  14:22
we’re just there’s no decompression.
Unknown Speaker  14:24
No, no, we’re just it’s going on to the thing. And then and I think that’s where we kind of take that for granted. And then maybe so we wouldn’t take that time one. We may we may be running late. So maybe if it’s lunchtime, and we’re running late for the next case, do we go eat? No, we’re not going to eat. We go and start the next one. So like we’re neglecting ourselves on multiple fronts in order to get the work done, and and that’s that’s laudable and it’s way but it takes it to
Unknown Speaker  15:00
And ultimately, right you get those signs of burnout and it can lead to apathy, which then ultimately affects patient care. And the reason that you’re, you’re skipping lunch is because you’re trying to look out for the patients and the schedule and the other doctors and you’re trying to take care of other people. So ultimately what you’re trying to do is ends up being self destructive. So, so if you
Unknown Speaker  15:20
said Well said, Thank you.
Unknown Speaker  15:22
So so if you if you have someone like a, let’s say, you meet another doctor at a cocktail party, right, okay. And you tell them that you’re a physician coach, and they give you the incredulous look right? Like, what is that? Who would? Who would need a coach? What? What’s your what’s your spiel? to use my East Coast? what’s the what’s the spiel? Why, you know, how do you convince someone who,
Unknown Speaker  15:57
I guess, I guess we can start with the How do you convince someone who comes to you feeling like they have a problem? That the coach that the physician coach relationship is a valuable one and what a coach can do for them? And then I guess from there, we’ll move on to Well, what about those skeptics that feel like, Oh, we don’t need to this is ridiculous. This is, too whoo, whoo. So but let’s start with someone that recognizes that they have a problem, and they’re looking to you for help. How do you explain to them the role of a coach? Yeah, thank you. Well, I think the primary role of a physician coach least appear physician coach, first and foremost is to give just like I was describing what I was looking for when I was burning out, is to give a doc a safe place to land and a safe place to talk about what’s happening in their lives because and most of the time, they don’t have that they can’t speak to their colleagues. They not in a in a way that they might that they can completely safe and confidential all the time.
Unknown Speaker  17:06
And then also, you know, a coach is trained to listen and to give feedback in a constructive way. And then we also if you think about it, you know, we have goals that are around our careers. Well, interestingly, like a lot of Doc’s don’t necessarily have goals around their careers, like they go into practice. And then their goal is to practice long as they can, unless you’re in academics or something. But you know, when you look at it, like when I asked people like stocks, like do you have goals around your career, like how do you want your career to fit into your life? How What do you see yourself doing in 1015 years and that’s, you know, then there’s look kind of changed from like in credulousness to like, Oh, I never thought of that.
Unknown Speaker  17:55
Yeah, I had that moment when I started. When I started in practice, because You know, I went through the motions college medical school residency, and then got my job, you know, and then eventually would, I made partner, but like, this is my office forever, let’s say, unless I move move jobs in, I love my practice. I’m a big believer in it. But I saw the chair, I saw the exam rooms, and then I saw the next 40 years, like, this is what this is it this is and then like, just it just because, you know, every we work in, in our through our stages, like spend four years here and four years here in five years here and then and now. 40. Like, so. Yeah, that’s an excellent, I think it’s an excellent point, right? Like is this this is and and for many people, that’s totally fine. I mean, and for me, I have no intention of leaving, right this but I Have a creative outlet. This is why I’m doing the podcast.
Unknown Speaker  19:04
Right? Well, that’s the deal. It’s it, in addition to looking at, like, Where do you want your career? What do you want your career to look like? Right? So it can look like yours, where you’re practicing full time, you know, we just have more options now. And then docs are also interested in talking to me because I have transitioned from non from clinical to non clinical medicine. And I do have a lot of interests and pursuits. So they want they want to know, like, how, you know, how did you do that? How can you do that? And then look, so that’s another category people that speak to me and then and then there’s people who are, they’re kind of soul searching, they’re looking for their next step, what they’d like to do next, or they’re feeling tired and burned out and they know that I’ve recovered from burnout so they want to learn how they can either recover from burnout or
Unknown Speaker  20:01
Or, you know, prevent burnout from occurring.
Unknown Speaker  20:05
So And just to be clear, you recovered from burnout while you were still practicing medicine and continue to to practice clinical medicine right? Because you said it was nine years into practice.
Unknown Speaker  20:17
Well, I started burning out nine years into practice but i i left clinical medicine because of physician burnout. Yo, okay. I did Yes, I didn’t recover from burnout and then leave like I I, you know, when people ask, like, how when did you burn out it’s like, well, when I hit like, probably started to really get kind of crispy about three years before I actually left. And you know, I don’t want to go into all the details, but I actually did a podcast episode on on this not too long ago, but there’s also another one called What do we call it? Going to the dark side I did about a year ago with one of the Well another doc that went, he’s the he was a thoracic, cardiothoracic surgeon and NIH fellow. And he went in into doing clinical trials and industry. So he’s doing research so but for industry and yeah, we call it going to the dark side.
Unknown Speaker  21:18
Oh, but so many people would would salivate. Just, you know, the opportunity to do something like that.
Unknown Speaker  21:26
Right? Right. When you know, again, like we’re talking contextually so this, you know, when we made that transition, I was six years ago, and I think he was like, eight years ago, like, even when I was thinking of leaving medicine and going to industry, that’s what I got, you know, like, Oh, so you’re gonna go to the dark side, huh? Yeah, I think I am. So, so about three years before I actually left is when I started realizing that I probably should consider an exit strategy, but I wasn’t really sure. And that’s when I started putting things in In the place slowly but I started looking at and I just like I said, we did a whole episode on how to do it but you know, you start need to start looking at your finances, your you know, you need to start looking at Would you be willing to take a pay cut, looking at your overhead your debts, your kids in private school, your nanny, you know, like, all that stuff. You know, it’s if you’re smart and you can do it, it’s good to look at all of those things so that if you decide to leave clinical medicine, that it’s not such a big leap or a big impact because leaving medicine alone is a huge impact. It’s a loss, you’re going to feel grief around it. Even if you wanted to do it. I swear my medicine was in my bones and I think it still is, but it’s so it was one of the toughest things that I ever did, but it was definitely necessary for me to do My own well being, just taking too much again, there’s a cost right there. So what you love to do, and then there’s the cost that it takes to do it. So for some people that becomes out of balance, and they, you know, it makes sense to cut back or transition and for others, you can recover that it is possible to recover from burnout stay in practice. And I think maybe what were you’re referring to is that I haven’t had a single client of my life.
Unknown Speaker  23:37
Clearly not a great, great example.
Unknown Speaker  23:40
she recovered and practice medicine for another six years. No, that is incorrect. But But you do coach people who then go on to stay in medicine. Yeah, they do. Okay.
Unknown Speaker  23:53
I’m super happy about that work. Yeah. Because I want to see docs. I want to see docs. Do that. work that they love to do, I want to see them happy. I want to see them fulfilled and on purpose and on track. And so whatever that looks like for them is what they should be doing.
Unknown Speaker  24:12
So that the so we started this part of the conversation with how would you discuss what a coach does with a someone who recognizes the benefits of coaching. Now, how would you respond to a coach skeptic? And that that answer might be well, I wouldn’t, and that’s totally fine. But, but how would you start convincing someone who’s skeptical about the benefits of a physician coach, or even the role of a physician coach, right knowing knowing what physicians are like,
Unknown Speaker  24:46
right? Well, you know, I think, and it’s not that it’s like the skeptic at the cocktail party. This is an ongoing discussion in our physician community. We know when you start looking at the reasons for Why docs burnout, right? Because there’s there’s three components to it. There’s an individual component, organizational component, and the cultural component. They all contribute to a physician burnout. So some people say that, you know, Docs, docs don’t burn out because themselves, they burn out because the system sucks. And it’s like, yes, the system does. And what I do is to help dogs that are still, you know, working within the system to do what they can for themselves, including advocating for themselves, so that they can, you know, have the best career that they want to within the system. So I think what I you know, for a skeptic, that’s like, because I’ve had skeptics come and talk to me, they’re like, well, what’s the difference between you and a friend or you and a therapist, and I will just say that the difference between a coach and a friend is that a coach is completely and totally invested in your agenda and your goals. They don’t have a You know the gender of a friend and they don’t and they whatever wacky crazy goals you think you might have, the coach is going to help you achieve them. And then and coaching is not therapy, although there is a lot of process in coaching, you know, if you come in you talk about your feelings, and you talk about your fears, and you talk about your big dreams, that’s process work. And so that but that is not therapy. The nice thing though, about a physician coach is that they can, they can kind of see a little maybe a little more readily than someone that’s just like a plain old life coach, that you might need therapy now or that you might be depressed, and then in refer you, you know, to the proper person, you know, it might be and I you know, I talked about this when I talk to docs about recovery, and one of those pieces is to make sure that you’re in good physical health. So if you come Me and you, you told me that you’re tired all the time. You know, I’m like, when’s the last time your family doc? Have you seen him in the last year? You know, you might have a medical condition that has gone undiagnosed, you know, because you haven’t been caring for yourself as well. And, you know, with a lot of docs, don’t go see a physician regularly for checkups. I’m, you know, I’m in that number. You know, I went not long ago, but it’s been a couple of years. Before that, I must admit so. So that I think in that way, as physician coaches a little bit more adept and making sure that you we still keep the eye on the ball in terms of looking at your, your health, but but coaches look at your entire life. They look at not just your career and your goals, but we help you look at what’s happening in your family, what’s happening with your finances, what’s happening. You know, your mindset and terms of, you know,
Unknown Speaker  28:03
do you feel like you
Unknown Speaker  28:05
can’t leave medicine because you don’t deserve to leave medicine or you know, there’s just a lot of factors involved. But I would say that the thing about a coach, position coaches, they get it, they have been through it. So they’re unlike any other kind of coach in that respect. You know, when you when you use acronyms when you refer to your medical education, when you talk about getting pimp drive, when you talk about staying up for 36 hours, you know, we get it, we get it, whereas you just so you don’t have to explain that safety. that camaraderie, it’s right there for you. So and so I’m like, Well, if somebody doesn’t want that, then that’s that’s all good.
Unknown Speaker  28:59
That was An excellent sales pitch
Unknown Speaker  29:04
not liking pizza.
Unknown Speaker  29:09
We could have a debate about Chicago versus New York.
Unknown Speaker  29:13
And I just tire on the deal. I love Chicago. New York pizza. I love holding it.
Unknown Speaker  29:21
Right now with a knife and fork right you gotta
Unknown Speaker  29:24
like I love the big slice and folding it now. Yeah, I love New York.
Unknown Speaker  29:31
We week. We were
Unknown Speaker  29:35
my husband ex husband’s family’s from from New York. And so we call Chicago pizza. Cheese pie. Yeah, a
Unknown Speaker  29:44
lot of Dan.
Unknown Speaker  29:47
Yeah, a lot of cheese. It’s dough filled with cheese.
Unknown Speaker  29:53
So, so you you started the physician vitality Institute. Correct. That’s yours. That’s yours. Yes. And your five step system that you go through with people when you’re coaching them. So can we go through those? Those five steps? Yeah, we’ll just talk about some of the common issues that you see, and how you help people to address those issues. Yeah. Oh,
Unknown Speaker  30:20
yeah. I’ll be happy to go through them briefly. And I’ll also say to that, I’m excited to announce I think this is the first time I’ve announced it on a podcast that I’m actually wrote up my system and so as a book, and that is going to be the talk about a busy for like, want something done, ask a busy person. So that’s going to be released on January 2. And yeah, it’s called doctor heal that myself physicians guide to health and wellness. So that’ll be released. Yeah, thank you. So, so just briefly, what I talked to Doc’s about is this first principle is energy management. So looking at things in terms, looking at your life and your actions and the things that you do in terms of energy, meaning things that energize you and things that deplete you, not just in terms of tasks, right? So like you say, have surgery, right? And if you know it’s going to be a long surgery, but it’s like you geek out, it’s like your favorite surgery. You love it, you know, so when you come out of that six hour case, in some ways, you’re tired just because of the time that you spent, but like because it was so fulfilling to you. How do you feel at the end? you actually feel energized, like or imagine like having to spend like six hours studying for boards. Six hours, right? How do you feel after that? Probably depleted his mic. That’s, that’s how I would feel Yeah, you can spend the same amount of time doing a task that like energizes your depletes do. So just keep that in mind as you’re, you know, you know, if you did learn take nothing else from this, start thinking about energy management as opposed to like your task management.
Unknown Speaker  32:21
Because it may be things that you think you enjoy, because you should enjoy them. So you’ve convinced yourself that you enjoy them, but in fact, you don’t. So they’re, yeah, they’re depleting you without you recognizing it, because they’re the things that you’re supposed to like,
Unknown Speaker  32:36
right? And it kind of hinges ideas like between work and play, like some people go to work and they’re like, well, I can’t wait until I finish work so that I can go like play with my family, whatever. And then, you know, you can feel kind of guilty because like childcare and housework and stuff like that, you know, may may have some may feel good in some ways, but in some ways, it’s hard work and it can be depleting. So it just takes away those labels of like what is work in play? It’s okay to, it’s okay, if your work energizes you, it’s okay if you know, housework depletes you, and kind of knowing those things will help you when you’re trying to figure out where you need help. Because you’re looking for more of the activities that are going to energize you, or at least put them in a sequence, where you’re not like doing all the depleting tasks together on the energizing tasks together. So, you know, in some ways, that’s why like, if you schedule things and you’re like, I can’t wait, so I go on vacation, and then you do a vacation. That is, it’s fun, but it’s also can be like, you know, taxing, like, you know, like, we I live in Colorado for 15 years, right? So, you know, people would come from Texas, they go skiing, and they would have a great time. But you know, it’s like, sometimes it’s not as relaxing as it would have been to choose something else like so you kind of look at the you know, what was the purpose of the vacation. It was like to relax, would you renew rejuvenate? So you have to learn, you know, it’s like Dr. Hill myself needs to learn, you know, who you are. And you know what, what does energize you What does deplete you, and it’s different for different people. So that’s the first thing just to keep in mind. So that’s what I started to teach docs. And another thing is, I want to really emphasize is that it’s really important to care for yourself and to make yourself a priority in your life. And I know particularly for doc set have work and kids and family responsibilities that that can really fall by the wayside. But it is so true that like, you can not have the capacity to do everything that you need to do especially at such a high level if you don’t take good care of yourself. And so it’s not selfish, and it’s not rude and Not me, like it’s just something that you need to do so that you can be at your best sell. So those are the two things I kind of want people to be thinking about. And then I teach more specific strategies about how to renew your energy in different ways. So, and the whole system is called the physician vitality system, like based on the physician vitality Institute. So things that energize us connecting with others. So there’s a, you know, a module on that there’s a chapter on that in the book. So not so friends, family colleagues, you know, maybe it just taught and I teach ways to do that, how to make better connections. And then inspiration. So connecting with things that inspire you, it doesn’t matter like you know, whether it’s doesn’t have to be like traditional spiritual practices. But even like walking outside in nature, meditation, looking at a picture of your kids, like the things that get to your heart, what makes your heart feel glad, that’s inspiration. Then the other thing that I teach docs are calming techniques. So things that you can rake and help you to calm your mind. So that you have relaxed and focused thought like during your day and then how to recover from your your day. So, simple practices that will help you give you more energy during your work day and then also help to energize to, you know, before the end of your workday. Then I also teach about caring for your body. So again, you know, like, getting that checkup getting the exercise, eating meals, I mean, these are like simple things sometimes but dogs we just, we are just, you know,
Unknown Speaker  36:57
we just our
Unknown Speaker  36:59
schedule was packed. I didn’t eat dinner.
Unknown Speaker  37:01
Did you eat lunch today, doctor?
Unknown Speaker  37:05
Actually, my wife was not gonna appreciate this because she gets mad when I skip meals But no, not lunch and then by the time I finished seeing all my patients and made all my phone calls, it was time for this interview. So know your dinner. Yes,
Unknown Speaker  37:18
you are.
Unknown Speaker  37:20
And that’s the thing is there’s this is there’s this chest thumping mentality in medicine that like I got two hours of sleep last night, and I’m just gonna power through because I’m the toughest guy and I you know what, I just sucked it up. And I didn’t need anything today because I just took care of patients because I’m this martyr. Right? Like, yeah, I could have made my schedule a little lighter and Yeah, actually, actually lunch or really would have served my patients better had I stopped for lunch and taken a walk around the block outside. Right cleared my head room. Reset me a little bit. Right? That sounds like what you’re saying, right? walk off a couple spots, take a walk around the block, and then my afternoon patients will be better served by me having having done that.
Unknown Speaker  38:14
Absolutely. Absolutely. So yep, and last but not least, emotional fitness. So being aware of our thoughts, particularly our negative thoughts, and how to recognize them and how to turn them around as best we can. And that’s, it’s just simple, simple. You know, it’s old, good old fashioned, offering. conditioning, basically recognize the thought, you know, let it, identify it, recognize it, and see like, how it’s how it shows up in your body, or how it showing up and then ways to to switch those Let those negative thoughts go away because those in themselves, not only are they obviously their negative thoughts, who wants to feel negative, but you know, those get passed on to family, friends, colleagues, patients, and turn on yourself. So being emotionally fit is the last of the five, like major components of the system. But I think if you’re, you know, take the one thing away, like you’re saying, you know, just ask yourself, Is it like, is what will really happen if I take 10 minutes to eat? And, you know, go to the restroom, like, like, what really happened? You know, what, like, how much better could it be? If I know like, I’m going to be late seeing patients, and I take two minutes, and I send a text to my wife or call my wife or husband. Just say, Hey, I was thinking about you. can be late. Whatever. Like that’s the connection to others.
Unknown Speaker  40:05
Oh yeah. But in it when you’re when you’re seeing patients in the office, what happens is that that snowballs right you start seeing patients late, and then that puts you further behind and then then the next patient you have to apologize and that takes a minute and then that adds to your and then by the end of the day, you’re running like an hour behind and nothing’s few things stress me out more than seeing a whole bunch of patients that are waiting for me. So yeah, that’s how I keep my stress level to a minimum is by actually skipping, like taking my time with my patients using my lunchtime to catch up and then putting on time so but I should just make well that’s
Unknown Speaker  40:44
it you’re going to turn this into a coaching session, but you could find a way you know, to eat the meal still because you didn’t like you didn’t have to. You’re like how can I get a meal because the whole purpose is just to get food in so yeah, can I get the meal and and like, does it have to be all or nothing. So, does it have to be the whole 20 minutes? Or could it be five minutes? Can I take, you know, in order to like get my stress level down? Could I, before I go into the next patient’s room? Take five deep breaths and just center myself. Yeah. And and get rid myself of the negative thoughts of that somehow being a being late equates with your value as a physician or as a husband or whatever. And, you know, like, I’m always like, back it up to the present moment. Just back it up. So take those couple of deep breaths and walk in and like, you know, I’m Dr. rad. I’m so glad you’re here. Let’s look at what can I do for you be present for them. They won’t care like that. You’re we’re five minutes late. You’re there. For them, not like rest. They won’t care. Believe me, I’ve been on both sides of it.
Unknown Speaker  42:06
These were two lessons that you said were actually in previous episodes episode for the where I had a patient experience representative. One of his big tips was before each visit, stop, take a breath, and then open the door and see the next patient that was. And then a show that hasn’t been published at the time that we’re recording. This was with Dr. Stephanie SOG is a PhD in psychology. And she works at the Harvard weight management center. And we talked about how to talk to people about that are having issues with their weight about that issue. And what she was one of the things she talked about was there negative self talk, catch people having these. Oh, I’m so stupid. Oh, I’m so right. Make them recognize that they’re saying it and point out how destructive it can be. So the same thing applies to us you have these negative thoughts. If you I think the saying is, if you if if you talk to your friends the way the thoughts in your head talk to you, you wouldn’t have any friends. So recognizing that you have these thoughts that are devaluing you and and helping to turn those around.
Unknown Speaker  43:24
Absolutely. You guys can’t see that Dr. Bad Niren zoom and I am just like nodding my head like a bobblehead and all the things that he’s saying you’re trying not to interrupt but I have the hugest grin on my face and just smiling and nodding and acknowledgement. You are on the money. Dr. Brad I so appreciate
Unknown Speaker  43:44
applying it is a different.
Unknown Speaker  43:46
Yes.
Unknown Speaker  43:48
Now that I’m hearing it again, it’ll hopefully it’ll help me to then you know, this is obviously I’m not recording this just for me. It’s for the listeners as well. I think we’re running short short on time. But I’m I’m really enjoying this, I’m hoping you can stay on just a little longer. And just mentioned if you have some some of the issues that you see that have relatively simple ways to correct them. So when your code of your coaching clients, you probably see some common threads. So if you could just mention one or two things that have relatively simple solutions. What would those be?
Unknown Speaker  44:34
Well, I would say that, you know, one of the things is that we’ve already talked about it, so I’m not going to like go into like a whole nother, you know, discussion. But I think that that a lot of Doc’s come in, and they feel as though they aren’t valued. They are they are working hard and they’re doing their work, and they’re feeling bit undervalued and misunderstood. And so So I think one of the things to help to ameliorate that is to do just a simple practice. When you get home at night or before you leave, just write down three wins for the day, three things that you did good related to your work or some the way you communicated with someone or whatever it is three wins, just so that’s one thing you can do. You know, just the simplicity is real simple. They’ll just give you simple structures. The other thing is that doctors often feel like disconnected and they feel lonely. You know, interestingly, in part, I think because we do have to assume the role of superhero, superhuman, even though we’re just simply human and we have a special skill set. We always have a very special skill set and we are truly People not going to deny it. Like we’re, like I said before, I think doctors are awesome, we’re resilient, we’re bright, we’re motivated, we want to give to the world. And you know, and, you know, I, so I’ve, I’ve given you four wins right there, like just who you are. So just keep keep that in mind that that you are doing the superhuman special work, but that you are, you know, simply human and it’s okay to have needs, wants desires, hunger, thirst.
Unknown Speaker  46:42
It’s all it’s okay. And I think that as slowly but surely, we’re going to change the culture, you know, medicine as we go through and, and will be more supportive of each other. You know, it’s like you said executives have coaches. therapists have groups that big Why? Because They know that their work is hard. So they talk to each other about their work. Why so that they continue to continue to do their work at a high level. So, you know, take a page out of their playbook. It’s it’s not an admission of weakness, to just admit that you have needs human needs.
Unknown Speaker  47:21
So if someone wants to take a deeper dive into this, where there are a multitude of places where people can find you, where can people find you?
Unknown Speaker  47:28
Yeah, thanks. Well, you can find me on all social media at Dr. Diane MD. So you know, I’m not going to run through all this social media but you can find me there. You can find me on my website www.dr. Diane, calm, and that will tell you more about me and also gives you links over to the physician vitality Institute. You can listen to the Dr. Side podcast, through that website. And then you can also Find out about the spirit more interested in helping other docs and becoming a physician coach. And I actually launched a training program for doctors. It’s running its first session now the spa and we are we’re already enrolling for a second session that starting on October 15. So it’s called the physicians Coaching Academy. And in three months, you can learn how to become have coaching conversations with other physicians. And so I have a few docs in that group that want to be coaches. I have docs in that group. I have one doc that’s for example, she’s a residency program director. She has doctors coming to her already for advice. She wants to know how to have coaching conversations with them. So So come one come all. ww www.dr diane.com. Find out more about that. So Send me a note through that website, check things out and just feared or, and, and how and, and grow this wonderful community just to try and help docs heal the world. It’s my mission. So join me
Unknown Speaker  49:20
put that book one more time
Unknown Speaker  49:25
that the book is entitled, Doctor heal thyself. So that’s easy to remember. And that will be released on January 2. So well you have a you know some more information about that as it comes closer to launch.
Unknown Speaker  49:44
Fantastic Well, I appreciate you with all these different things that you’re juggling taking the time to have this conversation with me and, and to be on the podcast and for all the great you’re doing all the great work that you’re doing with and for the Physician community and the house of medicine it’s, it is it is it is desperately needed and much appreciate it. So thank you very much.
Unknown Speaker  50:07
Well, thank you. It is it really has been my pleasure to speak with you this evening and I can’t wait to let you go. So you can go.
Unknown Speaker  50:22
Halloween candy.
Unknown Speaker  50:24
There you go.
Unknown Speaker  50:26
I thought that was the breakfast of champions.
Unknown Speaker  50:30
bookending bookending.
Unknown Speaker  50:32
Right. Yeah. started the day off with
Unknown Speaker  50:34
graham crackers in juice.
Unknown Speaker  50:37
Exactly. The doctor says
Unknown Speaker  50:40
that’s something only only doctors will understand. graham crackers, cranberry apple and ginger ale.
Unknown Speaker  50:56
Thank you so much.
Unknown Speaker  50:58
That was Dr. Bradley. Lock at the physicians guide to doctoring. Find all previous episodes on iTunes, Stitcher, Google podcasts or wherever you get your podcasts and write us a review. You can also visit us on facebook@facebook.com slash physicians guide to doctoring. If you are interested in being a guest or have a question for a prior guest, send a message or post a comment.
Transcribed by https://otter.ai