Month: March 2019

Breast Feeding for Trauma Surgeons

Sonal Patel is a neonatologist who recognized a gap in the transition of care from a hospital delivery to discharge to the first pediatrician visit, so she created a practice that fills that gap from the ground up.  We discuss how she went about doing that and what she thinks every physician, from pathologists to trauma surgeons, need to know about breastfeeding. 

Through residency, fellowship, practice and in personal experiences, she noticed the gaps of postpartum care. In 2017, she founded NayaCare: Newborn Speciality Clinic at Your Doorstep. This month-long evidence-based clinic is viewed as an extension of hospital care. Comprehensive care comprised of a Pediatrician, Lactation, and Counselor is delivered to your doorstep. By bringing care home, stressors are alleviated during this fragile time of maternal healing and family bonding.  She is currently pursuing her Certification of Lactation. She is also an active member of Good Business Colorado, a Strong Economy Working Group, with a focus of bringing paid family leave to Colorado.

nayacare.org

toxnet.nlm.nih.gov/help/newtoxnet/lactmedapp.htm

 This and all episodes have been expertly produced by voice-over artist Carin Gilfry at GilfryStudios.com

Find this and all episodes on your favorite podcast platform at PhysiciansGuidetoDoctoring.com

Please be sure to leave a five star review, a nice comment and SHARE!!!

Breast Feeding for Trauma Surgeons

Sonal Patel is a neonatologist who recognized a gap in the transition of care from a hospital delivery to discharge to the first pediatrician visit, so she created a practice that fills that gap from the ground up.  We discuss how she went about doing that and what she thinks every physician, from pathologists to trauma surgeons, need to know about breastfeeding.

Through residency, fellowship, practice and in personal experiences, she noticed the gaps of postpartum care. In 2017, she founded NayaCare: Newborn Speciality Clinic at Your Doorstep. This month-long evidence-based clinic is viewed as an extension of hospital care. Comprehensive care comprised of a Pediatrician, Lactation, and Counselor is delivered to your doorstep. By bringing care home, stressors are alleviated during this fragile time of maternal healing and family bonding.  She is currently pursuing her Certification of Lactation. She is also an active member of Good Business Colorado, a Strong Economy Working Group, with a focus of bringing paid family leave to Colorado.

nayacare.org

toxnet.nlm.nih.gov/help/newtoxnet/lactmedapp.htm

This and all episodes have been expertly produced by voice-over artist Carin Gilfry at GilfryStudios.com

Find this and all episodes on your favorite podcast platform at PhysiciansGuidetoDoctoring.com

Please be sure to leave a five star review, a nice comment and SHARE!!!

 

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, Dr. Bradley Block interviews experts in and out of medicine to find out everything we should have been learning 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 except no liability for the outcomes of medical decisions based on this information. As the radiologists 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  1:06
On today’s episode we speak to Dr. CINAHL Patel, a neonatologist who started her own niche practice conducting neonatal home visits. She gives us some networking pearls that she found to be critical to her success in our new practice, and then we segue into breastfeeding, and discuss how we can best support our patients and colleagues, and she gives us some great online resources. Welcome back to the physicians guide to doctoring. On today’s episode we have Dr. sonar Patel, a neonatologist who actually has her own niche practice where she visits mothers and their newborns at home. Right after they’ve left the hospital, it seems that there was this empty space where it was really challenging in that in those first few days to actually get out of the house. Pack the baby up there in such a fragile state, especially if you had a C section. Get into the dark office that she, she was witnessing this and decided to start a practice to fill that niche. So we’re going to talk about two things. We’re going to talk about how she started this practice and the lessons she’s learned, but also what she wants every doctor to know about breastfeeding and the circumstances in which she’s seen this take place and what someone like me an otolaryngologist, or seeing an orthopedic surgeon would need to know about and consider about breastfeeding. So Dr. Patel, thanks so much for being on the show today.
Unknown Speaker  2:28
Oh, thank you for having me. And thank you for giving me a platform to voice the breastfeeding issue.
Unknown Speaker  2:35
So, so first, where did you do your where’d you go to med school? Where’d you do your training?
Unknown Speaker  2:41
So um, I am from Omaha, Nebraska. And I went to med school, a university Nebraska Medical Center there after myself and my husband couples matched and we ended up down at I ended up in LSU. Children’s New Orleans and my husband is an order Peters. So he ended up down at aashna. And I started my nichy fellowship at LSU. However, my husband got a trauma fellowship at Harvard. So we moved up to Boston, where I completed my nichy fellowship at Tufts. And he actually led there after he led the job search. And my only criteria for him was my parents and my brother lives in Nebraska. And I wanted a direct flight there. That was my only thing. How many cities did he get to choose from where there are direct flights from Omaha, Nebraska? Yes, it’s actually not that bad. So Atlanta is one of them. So is Atlanta, St. Louis and Denver, where they
Unknown Speaker  3:46
find a job and one that’s like, Oh, that’s like applying for an academic job when you’re in a very small specialty. They’re like three cities to choose from and the whole country so
Unknown Speaker  3:56
well, I’m I followed him to Boston. So This was my only criteria for him and I knew he was going to be leading the job search because I knew I was going to go part time. That sounds like a nice compromise. Let’s say,
Unknown Speaker  4:08
That’s definitely reasonable confidence.
Unknown Speaker  4:11
Because the thing was at this time I already had my first child. And I, whenever I had to go home to Nebraska, there’s always a layover. And some of those layovers as time went on, got shorter and shorter, like it was 20 minutes or 30 minutes and running through I just remember reading through Chicago’s airport with a toddler is very challenging. And
Unknown Speaker  4:35
on its massive,
Unknown Speaker  4:37
yes. And it was ridiculous. So that was my only criteria is like, I just need a direct flight home. So, so we ended up in Denver, and for majority of my time here so far for seven and a half to eight years. I practiced making Nick you at Denver health and then Around actually working in the ICU, I end up having three of my own kids even more. So now I’m a mom of four beautiful boys who are challenged me every day, I would say. But it actually also inspired me to look at postpartum care in the United States. And that’s what led me to developing my own clinic. So what had happened was my when my fourth was born, at this time, he actually came due to some medical issues that I was facing with him. He came in earlier than anticipated and all my support system wasn’t available. So my mom is also a physician. So she usually would take two weeks off to come and be with me and then my mother in law would follow. But in both instances, they would take time off of work to do that. So we found herself in a position where my husband can take time off Cuz he had already, he’s a trauma ortho surgeon so you could take a couple days off. But other than that we were in between any very long story but what ended up happening is I didn’t have any help. So I found myself going to my newborn appointments. So traditionally what happens you deliver a baby, and two to three days after that you’re told after you get discharged from the hospital, you’re told to come back to the pediatricians office. And here it was snowing but in Denver, even if you get like, a foot of snow school still open so schools were still open and I found myself making sure that my boys had their lunches and drive them to school. While then I was in charge of also taking my newborn to the appointment. And mind you it’s still snowing. I get to the appointment. And did you did you shovel the driveway
Unknown Speaker  6:57
to that sounds like that should have been
Unknown Speaker  7:03
It was because at this time, like, by the time they went to school at 830, my husband had already left at six because it was a surgical day. And I’m not kidding you it, it was one of those things that I think everything aligned for me to realize this kind of sucks. And what are we doing? You know, like it’s something had to be pushed me over. So I go to this appointment. And first of all, I don’t fault the pediatricians at all because this is the system that’s been created, that you have 10 to 15 minutes with them. And in my case, this I didn’t actually have a pediatrician at a nurse practitioner. And within 10 to 15 minutes they had checked out if maybe was jaundice or not by just putting a little monitor on his head. That’s what the ability monitor that you can quickly do. And ask me how breastfeeding was going and I was like, great, and they were like, okay, we’re done. We’re good go back. And that whole ordeal just for that 15 minute appointment. It literally took me four hours because I had pumped before I had nurse before. I had to make sure all my kids were done. And then actually I spent a little time I remember in the, in my car nursing because now it’s time to nurse again before I could drive back home. And I came home exhausted. And I was like my husband and I, I looked at him I’m like, this is ridiculous. All I needed was a weight check, and someone to check jaundice. And I had to do that. And here’s the big caveat. I had just delivered a baby. Like, I had a one month baby or a two month Baby, I had just delivered a baby. Actually my contractor and obviously everything opens at once we had to get some work done in the house and he looked at Meaning goes, you just had a baby. I go, I know. So, I mean, those are the circumstances that moms do a
Unknown Speaker  9:09
little food scale in the kitchen to way I’m just emailed them the results.
Unknown Speaker  9:14
Exactly. actually an interesting side note and one of my newest, one of my patients that I recently had through my business, which we’ll talk about in a minute, she actually had her mom was there with her little puppy and she goes, do you mind if I just use the baby scale because of veterinarians just once a week and I don’t want to go out
Unknown Speaker  9:34
door.
Unknown Speaker  9:36
I mean, it was it was just really check and what I realized, like I said, I have four kids, I have four different deliveries and one of them was a C section. And I still remember going after two to three days, going with my baby after my C section, and mind you, C section is abdominal surgery. It’s not Let’s just kind of put in the context it is they cut you open and it’s abdominal surgery. If you’ve had abdominal surgery any other time in your life, they would restrict you for bed rest. And they would also restrict you for weight, right, like don’t pick up more than five pounds. But in most cases when you’re actually having a C section there, especially a term Baby, it’s because the baby’s too big. And so now I have an eight pounder that I have to pick up and nurse at the same time I have to do see all of us vigorously. What are we doing? So fast board was creating was looking at it came back home and said there has to be a better way and started exploring. What How could it just been simple. I just needed a weight check. And then within the state of Colorado, and it’s now more nationally, one of the biggest challenges in our field was when a baby went home. And the ductus closed that could potentially give the baby some hidden heart lesions that were not that were ductile dependent, and then the baby comes back and cardiac shock. So that was like one of the biggest fears. However, especially in Colorado, and in other states, there’s a state law now that you have to have a congenital heart screening done, ie a pulse ox tests before the baby goes home. So now through a lens of the Nick you what are we sending home? Well, we’re sending pretty much healthy babies who need to be breastfed. When you look at the data, the majority of readmissions in the first month are because of jaundice and feeding issues. So then you look at from the labor and delivery perspective. So now we’re sending a mom delivers vaginally, let’s say, and some of the insurances don’t even cover 48 hours. In 48 hours, the milk probably hasn’t come in Most likely cases that hasn’t come in, and now you’re sending her mom home. If it’s a new mom, they don’t know anything about breastfeeding, or they’re learning. If a second or third time mom, they actually have a higher chances of their milk coming in. But there’s this discrepancy that is occurring. Um, and so yeah. And that’s where the idea of a postpartum clinic came up. And actually, it’s not a new idea at all. A lot of European countries do this. A lot of Australia does this. Japan does this. And it is an evidence based clinic based on those research that has been done in those countries.
Unknown Speaker  12:46
So how did you get your business started today? Let’s talk about the logistics of starting from the ground up.
Unknown Speaker  12:54
Yes, so I actually started two years ago and initially because it was was such a novel idea for this area as well. It’s like, okay, I wanted to work as a lactation specialist and see. And here’s the other thing I’ve never worked. I’m coming to Denver. I’ve never trained here. So I just didn’t know the layout for the pediatric groups here. So I didn’t want to step on anybody’s toes and I still don’t. So I worked as a lactation specialist because I just wanted to see where like, just look at the market first. And I was realizing that I was hired as a lactation specialist out of pocket. It was they people were willing to pay for it. And once I added the MD part of it, it’s like, Yes, I’m a lactation specialist, but I’m an MD. People were willing to pay leave a little more because now they’re getting an expertise behind it as well. And for the first year, I just noticed that a lot. The pediatricians would keep asking the babies to come back in for a week. Come back in for a check in that first week of life. And the first week of life is very, it’s very precious because breastfeeding needs to be established. And you can’t just keep having a mom keep coming back for just a simple way check. And it was that’s all they need. That’s like, literally they can do it at home. Why can’t they do at home and not recorded? And obviously it’s a liability issue, right? So it was like, Okay, so first starting the business, I had to learn my market and I had to learn what was out there. And then I realized people are paying for lactation specialist out of pocket. So why would they not pay for me out of pocket when I can provide a little bit more and save them a trip to their pediatrician. So in September, February of last year, I actually opened officially open the clinic but I really didn’t do anything till September because I wanted a summer off
Unknown Speaker  15:00
Just like I’m tired of working, I want a summer off.
Unknown Speaker  15:04
Clearly you’re entitled you’ve you’ve paid your dues. Yes.
Unknown Speaker  15:09
So yes. And the other thing is that so you need to know your market. And the second thing is my market is the birthing world here. I’m still doing and I still do a lot of networking I do with the duelists. I do with my advice, because they actually, a lot of patients will go to them first. Or we’ll, we’ll search them and then come find me because it’s the same kind of line of thinking that they have.
Unknown Speaker  15:39
And those have been the birth birthing community really has helped me propel more of the attraction behind the clinic. This might be incorrect, but when I hear midwife when I hear doula, I think home birth, so are you now the first
Unknown Speaker  15:58
pediatrician to See these kids? And that’s it is that is that some of what you’re seeing is these home births?
Unknown Speaker  16:04
No, actually the most of Colorado. I mean, it’s a mixed but they have birthing centers here as well. And in the state of Colorado, the midwives are actually capable under their license to do the whole first week visit. And they just need a pediatrician at the one week mark. So that’s where I’m actually fitting into that realm. The ones that go through the hospital are finding me through Google ads, finding me through social media, and those are the ones that I see for their hospital discharge visit. And then the two week and then there after they see their pediatrician at one month.
Unknown Speaker  16:46
And how did that work in terms of malpractice because if you’re just getting started and you’re not taking any income yet, right, because you don’t know when you’re at a place with no patients. You have to start paying malpractice insurance without any income.
Unknown Speaker  17:04
Yes, it’s called.
Unknown Speaker  17:07
It’s also called an invest an owner’s investment from your husband.
Unknown Speaker  17:14
I think I’m very fortunate in that sense that there is I’m able to do it in that guys. And also, before I left the Nicky, we had a lot of moonlighting opportunities, which I took. So I knew I had a I actually invest I knew I was going to invest something so where’s the Where’s going to be coming from so even more so I took a lot more moonlighting opportunities just to have somewhat of a cushion before I got started. So
Unknown Speaker  17:50
credit card with zero percent for a year. Do you have to pass do
Unknown Speaker  17:57
I did I did I think I did that in my last year residency.
Unknown Speaker  18:02
which is I think what everybody tells it’s the complete opposite of all the rest of the teaching which is live like a resident for as long as you can try to start living like an attending while I was still resident accumulate a good idea. So, okay, so if you had one thing that you one piece of advice that you’d like to impart to people that are thinking of starting their own niche practice, what would it be what maybe a mistake that you made or something that came out well that you think man I think this is the type of thing that should be taught in med school.
Unknown Speaker  18:36
Know your market like my market is a know your network. So those are the two important things so I learned my market and it took me and I’m still learning it. I knew they people are paying for lactation specialist. I knew what their rates were. So I I made myself more reasonable. I didn’t say I want to be not a concierge service to be looked upon because come here, always has a notion of that’s a lot of money that I can spend. But then I know like in this market, what a lactation person costs and if I just add, you know, 30 to $50 more, then people will, people still will use me. And I’m still getting my mission to improving postpartum care out and know what community you have to network with. Because for me, the birth community is a huge and powerful resource that has been in existence before I even started this. And there are people in there they have so many more connections than you would ever imagined. Yeah, so those would be the two things
Unknown Speaker  19:45
and how did you network with them? Did you have like, you take people out for dinner, did you have a meet and greet at a like I just, I wouldn’t know where to begin aside from just like, liking people on like LinkedIn or something. You know, something like that? How do you How did you get out and meet people
Unknown Speaker  20:05
picked up the phone, call them up and said, Hey, this is what I’m doing because they like, it aligns with their values also, so you have to pick it, you have to also pick groups that align with your values. And I’ll get Alex elaborate a little more on that in just a second. But it really is picking up the phone and saying, This is what I’m doing. These are the we have a connection here. Let’s just meet and I’ve, I’ve, what happens is, you meet a lot of people you have coffees with them, you do like for the midwifery groups, I’ve actually done talks at their place with them. So then they get to start to get to know me as well and that’s where the referrals hopefully will start and have started coming in through and then the birthing community here. What they do is this two things has happened for me for one for the Colorado service. See the circusy part here. And they’re only pediatrician listed on their website. So that’s kind of really neat. So that’s a different edge. And secondly, the community here, every annually has a huge meet and greet. And I was invited to that and go and behold, I actually knew 20 to 30% of the people already there. And then they started introducing me to other people, and they’re like, Oh, you really have to meet this doctor. She’s doing something really novel that will fit your clientele. And then the other community is go beyond that, because I actually will look at Women’s Foundation and because their mission is to improve women’s care and economical and financial and health care in a spectrum, and I went to them and said, hey, how can we do this and in May they have a They there are nonprofit but they have a gala with not with donors that come out and will start supporting a cause. And so then my name will be listed on there as well. So some let’s think outside the box too, because that was something that I was like, well, a Women’s Foundation one better care for women. So I know their, their values align with mine. So sometimes sitting, sitting, thinking outside the box is really helpful to
Unknown Speaker  22:28
Yeah, very, very busy, very active. That’s That’s some fantastic advice on on marketing yourself and, and networking. But and that’s what I wanted to talk to you about. But you wanted to be on the podcast to talk about breastfeeding because you want to educate physicians in general about what we should all know about breastfeeding. Now. As an otolaryngologist. I sometimes see kids within their first couple of days of life because their difficulties breastfeeding because of a tongue tie. So it’s I’m a fairly large PDI. I’m a generally empty, but I have a fairly large pediatric practice. So I see that quite a bit. But that’s kind of the beginning and the end of what what I see. So let’s put you in a hypothetical circumstance where you have one of the University of Colorado, med students rotating with you for a week or two, and you don’t know what specialty they’re going into. They can go into anything. What is it that you would want them to take away from? breastfeeding?
Unknown Speaker  23:31
Yes. And so to step back, but all of us, I don’t want you to know the mechanism of breastfeeding. That’s not where this is going to go. That part is if you are interested in it, and it falls in your round. Like if you’re a pediatrician, family practice it will be and that’s something that you want to explore more, by all means, and we’re not even a good dive into that. But that because that’s not what I want anybody to know. For a medical students I want them to know that this is a public health issue. breastfeeding is and it ties into directly what every specialty they’re going to go into. We as physicians are affected by the cost of health care. We feed every day. We see that, you know, we we spend more time charting notes because we’re trying to get reimbursement. We see hospital care costs increasing increasing. And why when you start from the basics of preventive medicine, and we know if we do preventive medicine, it seems breastfeeding dollars. I mean, sorry, it saves healthcare dollars. And breastfeeding is a public health issue because of two reasons. One, the mom, it is shown and there’s research to back that up, that it reduces risk of type two diabetes and mothers and also, it reduces the risk of ovarian and breast cancer. Those are two huge, two huge things that you might see as an internal medicine person or a breast surgeon or a GYN gynecologist, you’re going to be somewhat affected by that. Then secondly, for the baby, and obviously there’s, we’ve all heard it, it reduces ear infections, it reduces cold in the first year, it reduces the likelihood of asthma it in. It protects them from type one diabetes, and also colitis and Crohn’s disease, and the list kind of goes on. And so in those terms, there’s actually studies been done that if you are supportive of a breastfeeding mom, and it becomes a public health issue, we can save about $13 billion and health care cost. That’s huge. And health care costs should be a priority for every position. So that’s one does that make sense?
Unknown Speaker  26:00
Yeah, absolutely.
Unknown Speaker  26:02
Okay. Secondly, you don’t need to know anything about breastfeeding. Know your resources. And the one resource is called lacked med. That’s one that’s an online it’s online and what you do is you put in a medication and see if it’s compatible with breastfeeding. So for example, and this is why I think we are talking is my husband is a trauma ortho surgeon, and he had a mom who was had a one month old This was in a car accident and ended up having some pelvic injuries that he got involved in. And that mom was for in her mind, she still has to provide milk for one year old, right me for her one month old. And obviously, during surgery and during recovery, there was so much medication pumped into her that there was no way that milk was good was going to be good for the baby. So that’s, that’s where all this thing and so what happened? It’s like he didn’t know what where to go and I was like well who is your lactation specialist in your hospital? And they’re mostly an adult hospital so they don’t have one. And then secondly, he was asking me about drugs being compatible with breastfeeding and I was like, well, Lachman is a good source. And now all his peers know that source. So they went back to her and they said, Listen, we understand that this is important to you. However, these medications are not compatible with breastfeeding. But we will get you to a point where you can pump again and nurse your baby. And that’s all you needed, right? The empathy part of it. So the other
Unknown Speaker  27:57
two points, I just want to
Unknown Speaker  28:00
Go back to one is did you really ask an orthopedic surgeon who the lactation consultant for the hospital was genuinely expect an answer?
Unknown Speaker  28:09
No, but I wanted him to think.
Unknown Speaker  28:14
Okay, and to what what is what was that website again?
Unknown Speaker  28:17
It’s laxed meded. La CT m Ed. Okay.
Unknown Speaker  28:21
Yeah, I think I think that research, which I was not aware of, right, as now, as an alarm bell, just I see lots of sinus infections. And, you know, we’re constantly putting people on antibiotics or steroids. And that is a common question that I get. And every time I get it, I have to look the medication up in, you know, on the EMR and it I was not aware that this resource was available, and I will definitely be using it starting tomorrow. So thank you for that. I lacked med calm
Unknown Speaker  28:55
or just google.com or dot, whatever, but just Google it and it’s a great Yeah, yeah. Yeah. And then, yeah, just you need to know anything about breastfeeding. Just know your resources. You know, but those that and then this idea of empathy. So why is that so important? Because breastfeeding is been for a mom, if you read a new mom, or mom, whatever type of mom, if you read it, you can see, we’ve had a pendulum shift in our culture, because we know we don’t like to stay in the middle. We always have to go either all the way to one side or all the way to the other side. And being in the middle seems very unnerving for our culture. So what happened with breastfeeding in our society was in the 50s and 60s, formula was introduced and formula was pushed. And a lot of women did not breastfeed for multiple reasons. And then when we started noticing in the 80s and 90s was That we were losing the benefits of breastfeeding. And then and we started getting lactation specialist and we started getting a big wave of now. I mean, you people do call them sometimes lactation Nazis that you have to breastfeed, you have to breastfeed. There’s no other way to do this. And now you get a mom in this day and age where there’s a generational gap of knowledge about breastfeeding, because it most likely cases her mom didn’t breastfeed her. So the knowledge has not been transferred to the mom. And then on the second, the one other arm, you’re getting a lactation specialist who’s just might be forcing their views on this mom, and on the third arm, it’s societal views. It’s like, Oh, my God, you’re not breastfeeding. Like, why are you not breastfeeding? And if you take breastfeeding the contents of human evolution, we’ve had wet nurses, we’ve had milk sharing You don’t know what kind of a breastfeeding Mom, you’re going to be until you start the process. So this whole idea that formula is bad and supplementation is bad. Is, is very outdated. I guess I have to say it, we’re just very lucky to live in a country where we can have fresh water to, you know, to mixer formula with, but milk sharing and what nurses exists in double developing countries. And a mom who’s chosen to breastfeed is her struggles might be internal, but just saying, Wow, in a really good job or just acknowledging the fact that she’s doing it is is monumental in my mom’s mind, and I think any physician who comes across, for example, a plastic surgeon who needs you know, for there’s a handful of moms who get diagnosed, unfortunately, with breast cancer, and I have a couple of friends who were dying. Nose while they were breastfeeding, to be like, you did a great job up to this point. But let us you’ve done wonderful. Your baby’s gotten exactly what it needs, but now to start taking care of you. So I think I could go on and on. So I apologize if I’m rambling. I think you’re you kind of
Unknown Speaker  32:21
you mentioned it, but but I do want to reiterate it because it relates to Allison escalon Day is a pediatrician that I interviewed. I think it was two episodes ago and she talks about the shitstorm. Right, that that we have to be aware of right because you should breastfeed you should Brett right? Like but there are some mothers who aren’t able to for a multitude of reasons or simply don’t want to and so you’re right it is in our in their best interest to try to but we also have to be wary about how Hard we really push it and try and not to shame them into doing it or make them think that they’re bad parents for not doing it. You were you were getting to that a bit in, in what you were saying. Yeah. Right. I think it’s really important to tell them and educate them and support them in any way we can. And right in as prescribing physicians, we have to make it as easy for them as possible and support them as much as possible. But at the same time, you’re right, the pendulum swings in one direction and the other before it was better living through chemistry that’s like DuPont or something like that. And so they were pushing formula now it’s in the other direction. So it’s just the onus is on us to just educate and support and educate and support.
Unknown Speaker  33:44
Right. And then the fourth point about breastfeeding and every medical student is going to see this at one point in the please support your colleagues who are working physician moms, who are climbing back to work and pumping and be supportive in the sense of, you know, not. I mean, there’s so many instances not only, I mean, nothing’s really personally happened to me, but I’ve heard is the medical community and professionals are supposed to be supporting the outside community about breastfeeding and they make they might make snarky remarks like, Oh, she’s pumping again. Or Oh, you know, oh, she’s, she’s not. She’s doing that again. And from personal experience, I’ve tell you, I’ve pump at my I pumped at my desk while doing my notes. I have pumped I have not pumped for seven hours straight because I’ve taken care of the ICU baby that needed me. And so we make the our first priority when we come back as physicians is to our job And sometimes our babies needs get on the back burner, which is totally fine by us, like those are our choices that we’re making. But please be supportive of us in those roles if we do need those 10 to 15 minutes to breastfeed instead of being and if there’s nothing going on and that’s how we have a lot of like I said, I used to do my notes, you know him a Snickers bar, can of water just remind them or just be like, Hey, good job doing that. I just had a recent incidents where in one of my position mom, blogs, on Facebook, one of the moms it’s a closed group and one of the moms mentioned that she was discreetly pumping in a meeting. And pumps have come this far that you can, you don’t need to be hooked up into an electric pump, meaning to the outlet or anything like that. They’re so discreet that you can put them underneath your shirt and nobody really knows that you’re pumping except for a small amount of noise and then noise can be muffled. I mean, it’s, it’s, you have to like, kind of listen for it. And that’s how sophisticated breast pumps have become. But she was actually told that she was being inconsiderate of everybody around her, though it was underneath the shirt, you could barely hear it. And there was no visible evidence of the fact that she was actually pumping. But they were just aware of it. And they kind of breast shamed her. And it’s kind of really disheartening that we can’t look in within our community ourselves and be supportive of our own peers
Unknown Speaker  36:35
in that way as medical professionals. Yeah, I mean, we we didn’t have our kids until after well after I was done with residency. So and it’s so hard, but I have no idea how you can have children and complete a residency program at the same time. It’s just incredible. It’s an incredible feat. And so my head my head goes off to you and yes, any support that That we can give from the medical community you make an excellent point we should get, we should be internally as supportive as we are, at least as we claim to be externally.
Unknown Speaker  37:12
Right. Right. And that’s all I those are the points I wanted to make.
Unknown Speaker  37:18
So some excellent points, excellent resources lacked bed, I’m definitely going to be using that going forward. That’ll make my life a lot a lot easier. And help me with patient care and some excellent pointers if you’re going to be starting your own business. So Dr. Sunil Patel, where can people find you online?
Unknown Speaker  37:36
I am on Instagram for Nyah care, that’s na y a CA r e on Facebook for Niagara care Colorado and a y a CA r e. Colorado, and then my website is Naya care.org and a y a CA r e.org. Nyan means renewal and sunshine. And it was always my girls name and I have
Unknown Speaker  38:02
my business as my baby.
Unknown Speaker  38:04
So I’ve heard you say that before. And I love that story. Yeah.
Unknown Speaker  38:11
Well, thank you for very much for talking to us today. It has been a pleasure.
Unknown Speaker  38:15
Thank you so much.
Unknown Speaker  38:18
That was Dr. Bradley Block at the physicians guide to doctoring. We can be found at physicians guide to doctor and calm or wherever you get your podcasts. If you have a question for a previous guest or have an idea for a future episode, send a comment on the web page. Also, be sure to leave a five star review on your preferred podcast platform. Our show is produced by guilt free Studios in New York City you can find them at guilt free studios calm our theme music was written by our show’s producer voice actor current guilt free
Transcribed by https://otter.ai

Healer, Leader, Partner with former Kaiser Federation CEO Jack Cochran, MD

As the former National Executive Director (CEO) of the Permanente Federation of Kaiser Permanente, Dr. Jack Cochran is the penultimate physician leader.  He shares his advice on why physicians need to become leaders of change in healthcare (in short, because if we won’t, who will).  He uses his experience mixed with evidence to teach us how in his new book, Healer, Leader, Partner: Optimizing Physician Leadership to Transform Healthcare, and in this podcast episode.            

He began as a pediatric plastic surgeon at St. Joseph Hospital in Denver for over 20 years where he also served as President of the Medical Staff and a member of the hospital’s Board of Directors. He then became the President of the Colorado Permanente Medical Group, leading until 2007 when he assumed the role at the Federation. The Federation’s focus on clinical improvement and innovation achieved national recognition and led to extensive collaboration with the White House and the U.S. Senate on national health policy development. Modern Healthcare named him one of The 50 Most Influential Physicians for three years. Today he works as a professional speaker, corporate consultant, and author. He speaks on Transformation of Healthcare in the Digital Age and The Power and Synergy of Strong Physician Leadership in Transformation.

Healer, Leader, Partner with former Kaiser Federation CEO Jack Cochran, MD

As the former National Executive Director (CEO) of the Permanente Federation of Kaiser Permanente, Dr. Jack Cochran is the penultimate physician leader.  He shares his advice on why physicians need to become leaders of change in healthcare (in short, because if we won’t, who will).  He uses his experience mixed with evidence to teach us how in his new book, Healer, Leader, Partner: Optimizing Physician Leadership to Transform Healthcare, and in this podcast episode.

He began as a pediatric plastic surgeon at St. Joseph Hospital in Denver for over 20 years where he also served as President of the Medical Staff and a member of the hospital’s Board of Directors. He then became the President of the Colorado Permanente Medical Group, leading until 2007 when he assumed the role at the Federation. The Federation’s focus on clinical improvement and innovation achieved national recognition and led to extensive collaboration with the White House and the U.S. Senate on national health policy development. Modern Healthcare named him one of The 50 Most Influential Physicians for three years. Today he works as a professional speaker, corporate consultant, and author. He speaks on Transformation of Healthcare in the Digital Age and The Power and Synergy of Strong Physician Leadership in Transformation.

 

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 doctor, a practical guide for practicing physicians. Dr. Bradley Block interviews experts in and out of medicine to find out everything we should have been learning 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 our respective employers. And now, here’s Dr. Bradley Block.
Unknown Speaker  0:27
On today’s episode, we interviewed Dr. JACK Cochrane, the former CEO of the permanent a federation who recently published the book healer, leader partner, optimizing physician leadership to transform healthcare is a bit of a cold number some minor issues with connectivity so please bear with us. It makes an argument for why physicians after all of our sacrifices need to work to write the ship that is the healthcare system. And it gives us some strategies for finding ways to take those leadership positions and how to be effective entrepreneur.
Unknown Speaker  0:57
He talks about finding motivation to lead by reading our med school applications. But after the interview, I brought something up to him. And this is my show, so I’m going to mention it now. One of my favorite books is Victor Frankel’s Man’s Search for Meaning. And the theme is to help cope with your grief, stagnation, depression. You find purpose, purpose in that suffering. So I would argue for those suffering from burnout, rather than turning to idealism. Use that to find the cause. This is where you make your stand. This is where you make your fight. And this is where you direct your leadership. He also gives us some recommendations for to small but powerful habits that we can use to help cultivate leadership traits within ourselves. One that fits neatly on a two by two and the other that fits neatly into three by five. And at the end, we discuss his views on mentorship and it reminded me of a Calvin and Hobbes cartoon where Calvin says there’s treasure everywhere.
Unknown Speaker  1:53
You’ll see what I mean.
Unknown Speaker  1:56
Welcome back to the physicians guide to doctoring On today’s episode, we have Dr. JACK Cochrane, he started out like me as an otolaryngologist, and then went on to become a pediatric plastic surgeon. And eventually his career led him to become the executive director of the permanent a federation. Now, Dr. Cochran wrote a book called The doctor crisis how physicians can and must lead the way to better healthcare, and recently published his second book, healer, leader partner, optimizing physician leadership to transform healthcare. So, Dr. Cochran, thank you so much for being on the podcast today.
Unknown Speaker  2:33
Thank you, Brad. It’s great to be here.
Unknown Speaker  2:35
So first, can you tell us how you went from a plastic surgeon, pediatric plastic surgeon to the executive director of the permanent a federation?
Unknown Speaker  2:45
Right. I can only tell you that because I experienced it, but it was not a thoughtful, proactive, intentional life plan. It was more a series of learning reaction acknowledgement. What I was seeing and then changing. So I started off because somewhere in medical school, I did not come from a family of doctors. I’m not a physician family. And so I didn’t know what I wanted to do. So probably general family practice or something. But I really realized I had a great interest in surgery. And I really love doing the reconstructive plastic surgery that I saw in med school, because it seemed to make such a difference to kids with facial deformities in bars, etc. So it seemed very, very impactful. So I did that practice. It went into private practice in Denver, Colorado. And while I was there was sort of encouraged you’re tapped by some of the hospital leadership along the way to, oh, why don’t you become chairman of the surgery department. I did that for a few years and then President, the medical staff so I was sort of being encouraged by my colleagues to do some leadership. I then switch my practice base from a private practice to Kaiser Permanente because another acknowledgement of the changes in healthcare, I thought, I think the future is going to belong to systems of care, and not just isolated practices. And so it might be useful to be part of a system of care. And I practice alongside Kaiser in Denver, and it was a high quality group and I thought, well, this, this could be a good match for me. And I practice there for several years, again, just a full time surgeon and change happen. The managed care era came in and lit up the skyline with all kinds of concern and a son became involved in the medical group for Kaiser as a board member. And shortly thereafter, was recruited and selected to be the president of the Regional Medical Group. So a series of things that were not not well necessarily planned but happened and I realized, I had some sense that leadership was at least a capability of mine, although I had to spend an awful lot of time developing it. And then the Colorado region, which I read for seven years, or for nine years, from nine to 99 to seven was did very well. And I was recruited to be the national leader for the permanent Federation, which is the national organization, providing support for all eight permanente Medical Group. So that was the journey, it was a bit of a take advantage of situations learn, do what, what I could try to make improvements and then, you know, getting some recognition that maybe what I was doing was, was working and helping and so I got asked to do some, some more things. And, frankly, I learned on the job as, as I’ve often said, The reason I think physician leadership is so important is that it’s just not a part of any of our intrinsic training. And so, to be a plastic surgeon, I had four years of medical school, six years of residency. Extensive certification and examination and monitoring and proctoring to ensure that I was competent. On the other hand, when I went into the leadership of the business of medicine, as the President of a regional group, my training was just in time on the job, trial and error. And that is to not be a more stark contrast between the two career paths. So lots of self learning, lots of learning on the job, and I thought, maybe what I learned should be distilled down into something that can be useful for aspiring and established doctors to make them more competent, and more confident because we don’t get trained in the skills of the human condition of leadership in our basic training.
Unknown Speaker  6:54
And in your book, it’s not just it’s not a how I did it, right. It’s a compilation I have evidence based information that can help us to become better leaders. And that’s that’s one aspect of it that I really appreciate it not just, I was a leader, this is how I did it. And this is why I was successful. But rather, these are the lessons that I learned. And these are the studies and psychologists and other leaders that I’m referencing, to show you that it wasn’t just how I did it, but how others are doing it as well.
Unknown Speaker  7:28
Right? Well, you’re very discerning the, the that book prototype that you mentioned, which is, look at me, this is what I’ve done, and this is how I did it. There’s no shortage of those. And I have read a number of them, but not finished all of them. And I think it’s because you realize after you’re into it a while it’s like, you know, it’s my own personal saga, and while it doesn’t have to be bragging and all that it really is more about a Biography and I think that this this world of leadership is a very personal journey. And I was I really thought it was fun what I learned because the the the model for for medical education and for most frankly most professions, engineering nurses is high levels of academic achievement and academic prowess, you know, the A’s in chemistry will inherit the earth. Excuse me, and while that’s not an important, it does not necessarily make it thank you capable or make it easy to relate to and deal with vulnerable, independent, seriously capable human beings. And, and because leadership is not about leading the status quo for the next several decades. Leadership is all about leading change. You will You better have some understanding of what makes your fellow man tick, and how we can either be engaged and enthused and committed or not. And I was sitting there saying commitment and compliance. And both can make people change but commitment is you actually share enough context and capability with people that they that they see a future that works for them, ideally, is the same one or similar to what you see. And therefore they will take their focus their discretionary energy, and their enthusiasm and work toward that. And that’s commitment. Compliance says, If we don’t do this, by the end of this year, we’re all screwed. That also works. But it is not the same as creating a long term culture of creativity and innovation and an enthusiastic career satisfaction. So I just learned an awful lot. I probably Lovely read 60 or 70 books and thousands of articles, listen to everybody’s lecture I could. And I found that there were themes, and that there were things that I agreed with things I didn’t agree with. I mean, people who believed in highly forceful, dogmatic leadership would sign my my book, not something that’s so I could relate to. But on the other hand, it works and it works for a variety of people. And I can only tell you the some of my greatest joys are people who originally heard me talk about one of the most important initial steps in leadership is listening. And you know, and I’m a surgeon, remember, and they would roll their eyes and go, Oh, my God, what’s this going to be about? The most important starting point is listening. And they have learned with me and from me and watch me and watch the results and they’ve come back to me. months, two years later and go, jack I got a Dahlia. My eyes were rolling. out of my head. I used to hear what you took some of the things you said and wrote about leadership. I thought, this guy’s got his head in the clouds. This is this is about getting the right decisions, giving them to people and and making them do it. So well, there is a place to that. But I said long term, you end up with somebody who’s 80% committed, and you get a pretty good result versus versus a group of people that go, this is exactly what I care about. This is exactly what I do want to do. And thank you for asking my opinion. And for listening to me. I have this little thing and I’m sorry, I’m going to record so I’m a very noxious but I’m sorry, drinking lots of water and doing all the good doctor things. But as a my book that said something to the effect of
Unknown Speaker  11:49
leadership is a continuous iterative process of sharing context, with trusted friends and individuals. hearing their response, listening do what they say acknowledging it challenging in another way. So you continue to co create solutions, co create ideas, and co create methodologies for going forward. And as you do that, you develop, talking about the whole is greater than the sum of its parts. You actually now are building context that you both agree on. Because you come to sing, you come to ideas with one point of view versus another point of view, that if you spend all your time trying to argue your point of view, you really miss the opportunity to listen. And one of the things I tell people about credibility, which, again, some of my more dogmatic leaders don’t like his credibility is based on two things. One is your ability to influence. Can you convince me Can you teach me Can you show me a way that I believe it or care about the ability to influence Ah, but that’s not full credibility, full credibility, also requires that you demonstrate a willingness to be influenced. And the nuance there is, if all you have is your ability to influence, then then your your whole guard or your ace in the hole is omniscient, right? because nobody’s ever given you feedback, and course corrections, and nuanced corrections of what you’re saying. And so that’s why I think it’s very important that people understand the power of listening, and it never goes out of my teaching never goes out of my writing. And after people have experienced it and learned that they say, Boy, that was so powerful, and I just when I first started, I thought, come on, let’s get to the meat of this jack. Let’s get to the really hard stuff. I said the hard stuff is building a coalition of people who want to go the same direction. That’s the hard stuff. You do not do that by coercion. You can now March alone ways to never build a culture. That’s going Continue to turn out great innovation and high discretionary effort people.
Unknown Speaker  14:05
Let’s take a step back. Because a lot of the discussion among physicians now is about burnout. Right? That’s a big concern among physicians. And what you’re proposing is, is a pretty big ask, right? And I’m going to take a quote directly from your book, it says, I’m a good doctor, I send up to work hard and pre med, get into a good medical school, make good grades and get into a residency. So I could work 100 hours a week, then pass my boards, go into a practice where I take calls often in the middle of the night, and deliver great care to my patients. That’s what I signed up for. So please don’t talk to me about leadership. And so what we’re, from my perspective, I’ve devoted my life to my training, and I still work really hard to take good care of my patients, to keep up with my education, and to try and better myself. But I’d also like to Spend time with my family. So, what I need you to do is tell me what I why I should take time either away from my family, or my practice or my own self care to devote myself to leadership.
Unknown Speaker  15:15
Outstanding, outstanding question. This is where the two books link. The doctor crisis was an attempt to assemble a clear view of reality and clarify and personalized patients and caregivers, the real realities of certain contracts and the contracts that are alone that career you just described. Healthcare got a lot better. We had great advances, miracles, cures, all of which were good for patients, all of which were good for doctors. But unfortunately, some other things happen. The care was also uneven. We found out the medical error was an issue we found that the patients families are Having bankruptcies from medical bills, and we found out the doctors were burning out and all around us. And what happened was, there was nothing wrong with the covenant that we believed in and that we believed was guaranteed. The flaw was it wasn’t guaranteed forever based on, you know, us just doing our work and letting the whole other ship go its own way. Dr. burnout, it was something I brought up in 1998. When I became president, the group, my number one constant focus for a turnaround was preservation enhancement of career. I would say that the enthusiasm for that was very, very limited. Most people related to it. A lot of people said, tomorrow, they’re a bunch of well paid spoiled guys. Come on, get them, get them working, or the other extreme, which was equally worthless. Oh, the poor things is just awful being a doctor. And so the reason I bring that up is I started talking about this one years ago, and nobody was was talking about today, thank goodness, it’s very pervasive and, and what we have to do is to own it like we own any other scientific challenge. What is the problem define the problem, but the computer world is yours, as well as the employer as well. It’s okay. It’s okay. Let’s define the problem. Let’s then take our best thinkers and say, how do we parse this out to grade some, some potential solutions that we can test? We can measure and then we can improve? This is not physician burnout is not more complex than cancer. We just haven’t focused our science, our energy and our intellect to it. So we were we were little. We were a little focused on our careers, which was good, but things happened around us. Things happen to us, and many of us were to Pepsi then we were victims. Was that wrong? No, it was You’re right. The rules change. And some of us on zones did now. It’s not 100% burnout. Interestingly, it’s somewhere in the 5060 70%. What are the happy ones thinking? Well, many of them have gotten into organized systems of care or other careers. They’ve done a lot of things. But But basically, the the issues that we’re talking about is when we were young, and we had the dream of being doctors, we knew we had to work our butts off. So we took hard classes and we make good grades. And then when we came to the medical school application process, we had to fill out an application, including write a couple of paragraphs about why did we want to be doctors? Well, guess what? Find that application and read those two paragraphs. They are bringing tears to your eyes. They are teeming with idealism. They’re full of hope. They are over written with humanity and compassion, and that’s exactly where it should be today. So let’s not give up and, and so, so doctors are retiring early and quitting and all that. I can’t I can’t go into full retirement salmon to work on my fly fishing. There is a covenant that I have with patients even though I’m not operating. And there is a covenant I have with my profession, which I cannot just turn my back on and say it’s that that kind of victimization, says patients, you’re on your own. You are on your own. And so things got more complex, knowledge exploded, technology exploded, everything got more complex and the old model of the doctor patient visits as the location, paper chart as the record and the physician brain as the source
Unknown Speaker  20:02
Simply inadequate in the complexity of the world of exploding knowledge and technology. And so we can’t just sit in our small practices and ponder that and make a change. We have to get into some organizational changes and some changes that I talked about in great detail in the book. But where we are doing that, we’re starting to see some very encouraging things happen. And that’s the notion of disproportionate impact positions still have, that we are the most highly respected profession for medical information. We are not the most highly respected medical profession that is nursing. We are the most highly respected for clinical information. And so that’s that’s an honorable place. And by the way, as I said before, we may have a hard day we may be having hard time but the role of patient no matter how big Our day is the role of patient is involuntary and instantaneous. And they need us to retain our evidence to the issues that are facing them in health care, because they don’t want Watson or some AI system to scare. The other hand, let me give you a real example. This seminar been in two years on two continents. And it was like, jack, I think he’s been slapped. I was at an app development conference in about 2012. At Stanford Business School, not Stanford Medical School, Stanford Business School, about two medical app developers. I was probably the only guy in the room with a tie. And I was I gave a talk about business and leadership. And then I was on a panel. And the panel was to medical app developers in their 20s and 30s. And the guy who ran the panel, he said, okay, the three of you guys developing apps, trying to get health care of six from a different place. interview them doctors. Turn to Dr. Cochran and tell him how you view doctors in your business development. And what a setup. So the first one says, we’re still trying to figure out, we can’t get doctors interested in what we’re doing. You know, every once in a while someone say, that’s interesting that I’m busy. I get to see 40 people a day. Sorry. So we can’t even get an extra cycling says, We gave up. We tried, they wouldn’t listen, they were only gonna do things their own way. They weren’t going to try anything new. So we gave up. So you can tell it the temperature the rooms growing right? The third one said screw them. They had their chance that he said not to embrace the modern world of information and technology. We completely ignore them. All we care about as patients and insurance companies. And you talk about a nice to the heart of a doctor, a person who’s trying to develop cures for problems to the test. worlds day, we cared about the next year I was in Brussels. And I was on a panel with a guy who was the president of the European medical. And I said to this medical student, I said, How do you deal with the complexity we security, the Washington manual or the airplane handbook or something with us all this time in our little white pocket pocket, as well. We still have some of those. But our professors suggested we use Wikipedia and Google and I thought I was gonna fall off my chairs. I thought, what is what is going on right this minute in the ice covered brick, endured walls of organized medical schools. Do they know this is just said this, that they talk about Wikipedia. And I was shot. But what he was saying was, he was He wants to carry around two, three journals and four books and all that. And just spraying for me that all of my assumptions were just that they were my assumptions. And these guys were dealing with a new world trying to adapt to it, try to create different solutions. And so now instead of the doctor brain and the one on one visit, very much like the old, go to the bank to cash, the checks, and then there was ATM machines. And now there’s cash in your in your cell phone. Now, we have got to do the same thing with medicine, which is to move and much more electronic and impersonally to the patient. So I think I think
Unknown Speaker  24:39
what you’re saying that the argument to put forth to the reluctant physician who’s saying, I barely have time for myself, how how am I going to have time to devote to to leadership? The answer is, well, you have to because if you don’t, someone else will and if if you’re not the one steering the ship And someone else without your best interest in mind will be doing it. So you have to find the time somewhere. Let me tell you what it’s not.
Unknown Speaker  25:08
Because I think you have probably experienced that. And this is very common in community hospitals. I’ll tell you what it’s not. It’s not a bad day a good guy, volunteer, be Chief of Surgery, you’re going to have to go to a dinner to Thursday nights a month. One is the Quality Committee. And after you’ve operated all day and made rounds, and you know, barely gotten through the day, we’re going to sit down and give you a chicken dinner and go through quality reports. And then the other Thursday night a month, we’re gonna have the executive committee, another chicken dinner, and another evening out of your life. And by the way, I hope you’re good at it. Because we’re going to give you some people who understand quality are going to help you. That is the model that created no traction around physician leadership because we weren’t prepared. We were weren’t trained, we were supported. And we were not given time. And so what what we have to do, and that’s why in my, in the final chapter when I talked about becoming, you know, or practicing either leader partner, talk about you have to first of all start in an organizational construct where there is a sense of where you’re going, what is the direction or the mission that sounds like old school thinking but you better know what you’re signing up for. And they better know what you’re signing up for. So that’s important. And then the second one I call it structure for efficacy and efficiency that’s been in place Kaiser Permanente, the CEO similan. By structuring you start to say, I’m going to have business structure, systematic approach to care that’s going to include actually spending money for doctors to not deliver care to be on finance committees to be on it. And not to do it at 10 o’clock at night after the end of the day, we’re going to invest time, money and training to give physicians the opportunity as part of their lives. Most physicians actually don’t mind a little break from semicolons times. But not if it’s on the backs of their life, their budgets, their family, etc. so organized for efficacy and efficiency, and then create a system that says, Yeah, we’re not going to just say all the doctors are volunteers and all the finance people are well paid. We’re going to have a system that says and the physician should not be positioned as victim which I talked about, they should also not be position is tiring, which says, okay, you you business people, I’m done. That that is also a it’s really a slap in the face to the profession. So yes, the place where you can become part of the solution. Sometimes it means moving or changing or changing bosses. Those things are all possible. But if you say right now I’m not happy, and I’ve got another 15 years, and I’m going to spend those 15 years treading water, I’m going to have a miserable life, a miserable life and my family deserves better, and I deserve better. So the systems that tend to have less unhappy doctors tend to be systems, group practices, organized systems, sometimes faculties. But then they have to have leadership that has, you know, the compassion, of understanding the profession. But this is where the book is so good. Is it just, it is so approachable and so easy. I say that the subtitle of the book how to be simple, not easy. I don’t I don’t throw anything in there that’s so esoteric that it’s possible, but you got to have the capability and the competence. And what I love is when bag goes a resident at Duke, who read it and he said he says, I have a Call every other 96. I read this book twice in one week. He said it’s just perfectly timed for me. He said we all of our residents need to read this business had to just say this is not some esoteric problem and give up and turn all the finances over to the CFOs. And all the it over the CIOs know, we need to be on those teams. We don’t we do not need to be domineering, and rude and all that. But we need to be on those teams. So
Unknown Speaker  29:29
in the book, you talk about traits. So let’s say we find yourself in that position, right? The the board or the executive committee of the hospital, ask you to serve in a leadership position. You accept it with the caveat that it is, instead of summing up your clinical hours, not in addition to them. You have you outlined in the book a couple of traits for leaders and how to cultivate them. So one thing that I like for this podcast to be Is instructional what’s a simple high return on investment habit that you can have to help cultivate your leadership traits? So first, what are the you know, you outline those traits in the book. So what are they in what what’s a simple thing that we can do? The first one you mentioned is respect and clinician. So I don’t think there’s really anything that you can do other than, you know, work hard and know your stuff and and treat your patients well to become a respected clinician, but but maybe with the others Unless Unless you do have something specific for that some some specific high return on investment happen we can do.
Unknown Speaker  30:38
I do have something specific. And the reason I put it in there is, is exactly this. You will find a physician who’s burned out being a doctor doesn’t like it, and by the way, isn’t all that committed or all that good at and so they decide They’re going to become an administrator. And it’s not impossible it’s happened before. That’s why that’s they give us a bad name because now they’re going to be administrators. And they’re going to turn over their shoulders where we used to be their friends and go Okay guys, you can do this this this and this so respected to your clinical craft is more than your skill as a surgeon, it’s where is the three in the morning when I need them and call them are how is the tour the nurses are dignified. So it’s really important respected for your craft. And it’s number one a or something with integrity, and integrity. It’s just that I’m a little romantic, but I’m a pretty, pretty convinced that this profession is a real high calling. And I think it’s an honorable thing for us to take really good care of. And so integrity is that unassailable trust. You know, the person is you know where they’re going to be. That’s number one respected clinician is number two things like EQ, humility, more enterprise like us, those are also important. But those first two are just the most important before I’d like to, and we can stay there. But there’s something else that I have put in the book and it’s not quite as clear. It’s sort of called the essentials of leadership. So it’s neither traits, nor is it expectations, which are the behaviors of the of the corporation. They all turned out to be seized. So I just want to mention them because the first one nobody talks about. It’s one that I said, I learned this for some reason so early, and it was it confirmed about every year in my career. So the five C’s are clarity, consistency, collaboration, compassion, and courage. And why is clarity number one, and again, Consistency is wanting clarity is number one, because we have to make hard decisions. And we have to make complex solutions out of really very complex data and information. And so when we do that, these are the situations and always real clear. But your team, your group, your organization, deserves to know how you think and how you feel. And why is this because for example, you say, I think we should stop doing robotic surgery for trusting are they which is pretty bold statement, but it’s clear. And the beauty of the clarity is that then your colleagues say, Okay, I didn’t have to guess. Here’s why you are exactly wrong. I’m going to give you data, preaching you’re wrong. Or glad you said that because the literature has Suggest You’re right. So clarity is so hard, because it’s sort of brands you will see opinion and people go well, I think we should build a hospital in the south part of the city. But on the other hand, you know, the other guys are building down there. Maybe we should look at the west side and pretty senior teams though. Okay. me to call the question. So clarity you watch it, watch it when you go to meetings, brands business, see people waffle. It was separate. And, and it’s not about being more bold, more self assured. For more, right? It’s about being clear, because clarity gives people the gift of saying I disagree and this is why I agree fully and this is what clarity is one of the things that I see people really bundle when they get stressed. They just don’t want to take in and that’s Because taking a stand implies that you’re going to be wrong. And that’s why the number to see is consistency. They wonder who’s going to show up? Oh, my God, what’s Cochran tonight, Lizzie, what’s going on? Does that make sense? I see, I’ve seen leaders who couldn’t articulate a clear point of view make people crazy. And you know, all they were trying to do was avoid a really tough dilemma because they just didn’t have the solution. And by the way, wasn’t one solution as I thought about I have no bias, you guys are going to help. And that’s why I go back to start listening. Listening is
Unknown Speaker  35:40
it’s more important than people ever understand. Because Don’t forget, you are a gifted or learn voluntas you are trained deeply in a field with multiple years of residency and training, and research and all kinds of things. You’re not deeply trained in leadership. And so listening says Going to be a leader. I’m not omniscient, I’ve done have to take the time to understand what my my friends and colleagues points to you.
Unknown Speaker  36:08
Well, I think that gets also back to, right. Because if you’re if you’re clear about what you want, but in the setting of humility, if it turns out that you’re very clear and very wrong, you still have to have the humility be able to be able to accept that.
Unknown Speaker  36:27
And I’ll just give you a lesson I provided for a guy one day and he said, he thought I was kind of full of it. And they said, he said, within three months, it was so valuable to him. And that is, the consequences of clarity. Are it’s your decision, your names on it, you made it. And so there’s no question when the outcome occurs that you had your fingerprints all over it. But I said, Here’s what’s important is it When you are wrong, and if you are not wrong enough, you are not making very large decisions. You’re making 60% decisions. Sometimes you got to make hundred percent decisions. And if you’re not wrong with the law, you’re not taking enough stretch and not staying at risk. But here’s the situation if you go through a process, you come up with a solution, and you declare it and it gets next year and it’s wrong. It is a pivotal point for you, in your personal development and your personal well being. And it’s this, if you’re wrong, how you go from there is one of the most telling realities of yourself and of your leadership. If you say, if you deflect blame, if you externalize blame, if you minimize results, if you deny the results. If you do all those things, then you really create lose out of a potential neutral win. Because now you’re spending all your time backtracking. And there is nothing no learning going. On the other hand, if you say, Well, this was my hypothesis, this was our idea. It did not work. Starting point is it did not work. Where do we go from here? Well, we better examine our assumptions. We better examine our data, we better examine our thought process around the strategy. We better examine our structure around execution, and we better examine the execution. Now, if you commit to do that, and you’re dead wrong, then you deserve the final. The final piece of the learning curve, which is personal forgiveness, personal forgiveness is what you deserve. Me make bold decisions when you’re clear about it. When you talk to people and you say, we’re going to have to do this. I’m not 1,000% Sure. But this is where we’re gone. And then you’re wrong. In order for you to ever do that again, and not next time, take a 50% less risk. You got to learn to forgive yourself. And it’s this is not the grovelling fall down. I’m not worthy forgiveness. This is, well, I really I really learned from that I was wrong kind of forgiveness.
Unknown Speaker  39:23
And I think I’ve heard that referred to is talking to yourself, as if you were one of your friends, right? If your friend was in that situation where they made a mistake on the outcome wasn’t, wasn’t what they wanted. Right? What would you tell your friend? Well, what we tell ourselves is only not the same voice that we would use to tell our friends and we’re much harsher. And if I think I’ve heard, if you split if we speak to ourselves, we speak to our friends, the way we speak to ourselves, we wouldn’t have any friends. So I think that is that is that correct?
Unknown Speaker  39:54
Yeah, that’s good.
Unknown Speaker  39:57
That’s great.
Unknown Speaker  40:00
just you know, the concept of personal forgiveness is not weaknesses, it’s a matter of recharging yourself from a position of great vulnerability. And we need to make our decisions. So
Unknown Speaker  40:14
what about habits, so I’m also a big fan of small habits, small effective habits win the day. So, if if our listeners were to put a sticky note on the bathroom mirror, and one on the fridge and one on their computer at work, to just remind them of something simple that they should be doing each day to cultivate either a leadership mindset, or one of you are one of the leadership traits integrity, humility, EQ, passion, what’s a small thing that we should be doing each day in order to cultivate that
Unknown Speaker  40:51
leadership? That is, I love it.
Unknown Speaker  40:56
I don’t think I’ve been asked exactly like that. Some of the battle here for a second while I take a minute. First of all, let me just do a tiny, tiny digression, I think we have time to take about a minute. I have a chapter of the book called The crux. And the crux is basically understanding yourself. Because if you don’t understand yourself, then you are you’re very vulnerable to living a very mythological existence of how things happen. And by that, I mean this. Do you fundamentally believe that your fellow man, your fellow colleagues, your doctors, your nurses, whatever, given the options, the information cetera, are most likely to try to do the right thing want to do the right thing and care and carry good values? But for? Do you fundamentally believe that your fellow man are out to themselves, they’re gonna do what they need to do to get their things done and get them done. And They’re very self centered. Now, as you know, from the dichotomous nature that question, there are people on both sides, we have both types of people. But the issue about the crux is, understand your own by your own eyes because it’s going to color how you respond to people. And you’re going to be fooled sometimes if you’re the trusting one, and that’s okay as long as you learn from it, but so the trusting one says, I believe in you, I’m going to share information, I’m going to, you know, carry along with this conversation, etc, etc. And I’m going to believe in you Sarah. It starts with listening. And then acknowledging their points of view, and then challenging the greater context as you build it. And it’s a it’s a slower iterative process. Then also a lot of listening very slow at the beginning, but it builds tremendous momentum between you and your colleagues, whomever they are in this process. The other side of that, which is that if you don’t believe in people that money you do it fool them, you incent them, you coerce them, you you try to either force them or fool them. And less leaders do that. That’s that’s their day. They try to coerce or force or cool people. By the way, both techniques can get you a result. But again, one creates a culture of, you know, compliance. Okay, I’ll do it. So I’ll go on, and the other creates a culture of possibility. So I say that because one, three by one sticky I might put would say manage yourself. But it could also be part of a instead of a two by two sticky a three by fives to eat, which is my leadership on a three by five cards, and that is, manage yourself. Develop great leaders in teams and learn continuously. And that’s to me the daily mantra leadership, manage yourself, develop great leaders and teams and learn continuously and manage yourself is number one because he wants people to voltage drops because they get, they get hooked, and they get angry, or they get rude or they get something because they’re not managing themselves. That’s, that’s the EQ. But then the one other one the other sticky and this is a two by two, I would put, listen, listen, because you’ve already heard what you have to say. You don’t need to hear yourself more. You’ve heard you know what you think. Listen, it’s so powerful. I said the one of the great, great opportunities for me wonderings I was by some standards successful early was I was so inexperienced, you know, on the job just in time travel there was so many expressed that I had to go out and sit down with primary care Doc’s and just listen to them. I go. Really? Yeah, that’s What that computer does to our daily practice, I said was it’s not that hard. And so, listening is is so important.
Unknown Speaker  45:10
And I would add as a caveat to listen, that when you’re listening, you really need to be fully present because we always have that running monologue in our own heads that frequently responds to people as they’re speaking, and you need to find a way to shut that off. And when you’re really present, you’re you’re shutting that off so that you really are listening, because it’s, I think it’s the kind of nod and, and, and kind of acknowledge what they’re saying. But you also have to find a way to shut off your own inner monologue while you’re doing that so you can truly be present and really, that’s, that’s an effective tool for listening.
Unknown Speaker  45:53
And that’s, that’s the listening that says, I’m just going to listen long enough to you Give me an opening to make my point. Right? That’s, that’s the listening, you’re talking about which which
Unknown Speaker  46:05
it sounds like what I just did to you. So I guess I apologize for that.
Unknown Speaker  46:11
No, not at all. Not at all. You get a very good example. Very good example. But that’s the true listening is. It’s, it’s a practice craft and you know, it’s, it’s because we’re all in a hurry. We’ve all got to get things done. But the act of listening creates a little space in the room where people who are because otherwise, you know, you go in there and you blow people away with your, your rank, your serial number, your title, and your charisma and all that and pretty soon, they just said, Okay, forget it. It just doesn’t happen. And this is just going to go on. But I think but that’s that’s the listening for. And you see that it’s just that it’s almost stunning disrupts the meeting with somebody just sitting there listening As soon as somebody says something where they get their two cents and they have it in there, and as opposed to sometimes the best example of good listening is when somebody who I never thought I, I gotta tell you that never crossed my mind. When we spend a minute on air. I think
Unknown Speaker  47:26
we have plenty of opportunities to practice it. Because we see patients every day where we listen and need to be present and need to shut off that inner monologue and actually hear, hear their story and they’re saying, so that that’s the two by two right there. Listen. Yeah, there’s one more thing that you you spoke about in the book that if you have time, I’d like to go into a little more detail before we wrap this up and that’s mentorship. So how do we find mentors, how do we keep them? How do we effectively learn from them?
Unknown Speaker  48:04
I wrote a whole chapter on it. And it is it is not a static discipline or field in my view. And that’s why I wrote the one piece called mentors everywhere.
Unknown Speaker  48:19
My daughter My grandson is you know,
Unknown Speaker  48:23
sometimes you learn from people just by being present, watching them. And then in your in your private mind saying, Oh my gosh, I never want to act like that. Oh my gosh, I don’t like what that’s
Unknown Speaker  48:39
so
Unknown Speaker  48:41
there’s mentors everywhere. And one of my favorite stories was a we had this I was doing searches except in the Philippines and we have this young Filipino general surgeon, one of three plastic surgeons in the US. Were working in Manila and this kid was So gifted he was he was just shocking us second year surgery resident, and we were doing cleft lips. And usually those guys, you know, they cut not they got the not so nice. And so one day we were having dinner this one guy that I worked with the same with you today. And he he’s amazing. He said, You know, you think he was third year plastic surgery so good. And then somebody else worked with them. And then I worked in Sector three nights were involved with us good. So the next day we go and you say, okay, Victor, we’re not gonna let you do the surgery. But how would you design and draw this is well, I’m stronger. As I recall Dr. heggs as we saw this angle and this and also is pointing to things and showing me things and I’m going this is just me. He, he has such a hand I get but we finally sat down and we said we gotta we have to learn more from this get some than we could ever teach him and what it was was He had a serenity and a reverence about him. That term is the opera. Arguably the most junior and operator. This is sort of reverence. And his mind was, it was just amazing. We were just shaking my head. And he would laugh cuz he didn’t see it. And we said, Victor, you know, just never, ever stop being Victor and Susan was teaching as you can, and as much mentoring as you can. So that’s what I mean by mentors everywhere. I go in there for teaching relationship is not mentor mentors everywhere, say, mindfulness, who can I learn from today, and sometimes it’s really positive. And sometimes it’s really not, you know, the classic mentoring this sort of structured, you have two people or that sort of thing and you get a topic and you create a paradigm from expectations in some ways. You’re going to measure it I would say this Don’t let it go forever. And don’t continue to say the gradient goes one way, especially today, those of us older physicians really need to learn a lot more from the millennials, and many to learn from us at times. So I think that this should be pretty fluid. And then we have another model called soul mentoring. And the total mentoring model was, we would take to senior leaders of eBay or to VCs, and we would match them with a couple of junior leaders. And we would pick a topic and we would meet and it was good because it one senior leader could be leaving and talking to the other could be watching and learning. And it just sort of mix things up. And then after six months, we would change groups, and then we would just then we would get together and have dinner talk about so I think keeping it fresh, keeping a dynamic in that sort of these important but the standard mentoring is no Some of the higher gradient of knowledge or information of the lower gradient and how do you transmit that and learn that? That’s important, no question, but I think that the whole learning philosophy is a lot deeper than that.
Unknown Speaker  52:12
So, where where can people find you online?
Unknown Speaker  52:17
www jack Cochrane, MD. com. Fantastic. And then the books, the first book Dr. Crisis, how physicians can and must lead the way to better health care. And the one that just came out healer, leader partner, optimizing physician leadership to transform healthcare, to fantastic books, and, you know, if we don’t, if we don’t take the reins and lead, then someone else will. So it’s, you make some excellent points, have some excellent instruction for for us physicians, on how to do it. And I really appreciate your time to talk taking the time to talk to me and the listeners on the podcast about it.
Unknown Speaker  52:54
But you my friend, who I don’t know well but hope to know better are already charting Your own pathway. And you’re finding a new and different way to deliver on the healthcare equation besides just clinical and we must all do that, be creative, be committed, and continuously learn and and run this network, you know, the coalition of courageous colleagues. We have a lot going for us we have the high ground of the morality of the profession. We have the needs of society. We have the the American dream. You know, I say one of the problems we have today is that because of the cost issues in healthcare, the average family is rationing health care at the kitchen table. They’re taking the side is activities and they’re sitting down at the kitchen table and saying, I got to get into the truck, we’re not going to be able to do the tonsillectomy this month, or I’ve got to get a new refrigerator. We’re not gonna do the MRI this month. And that is just rationing healthcare to get some tables. It’s it’s a tragedy and
Unknown Speaker  53:54
and we have the, the lead in our profession, we have the leverage and the ability to do something about it and we need to.
Unknown Speaker  54:02
And by the way, we have the credibility. Deeply people still love them believe in us. And people who say I’m going to quit, I say, don’t find another way, because the profession needs honoring Not, not abandoning.
Unknown Speaker  54:19
Thank you very much for your time and for your leadership.
Unknown Speaker  54:24
So great to talk to you.
Unknown Speaker  54:27
That was Dr. Bradley Block at the physicians guide to doctoring. We can be found at physicians guide to doctor and calm or wherever you get your podcasts. If you have a question for a previous guest or have an idea for a future episode, send a comment on the web page. Also, be sure to leave a five star review on your preferred podcast platform. Our show is produced by guilt free Studios in New York City. You can find them at guilt free studios calm our theme music was written by our show’s producer, voice actor carnivale free
Transcribed by https://otter.ai

Burnout Breakthrough with Dr. Christopher Burton

Dr. Christopher Burton is a physiatrist, speaker, and prolific author, writing about physician finance, home buying, practice marketing, and finds physician burnout to be such a critical issue, that this is his SECOND book on the topic.  In our interview, we discuss the specialties that are most commonly affected, how to recognize it and how to address it.  This is not a woo-woo talk about breathing and meditating your burnout away.  We talk about the brass tacks like outsourcing and learning to love your EMR.  Dovetailing well into the last episode about strategic quitting, he uses his “legacy ladder” to help us decide what we need to quit to achieve the Burnout Breakthough: Make the Most of Your Time, Your Family, Your Health, Your Career.

 This and all episodes have been expertly produced by voice-over artist Carin Gilfry at GilfryStudios.com

Find this and all episodes on your favorite podcast platform at PhysiciansGuidetoDoctoring.com

Please be sure to leave a five star review, a nice comment and SHARE!!!

Burnout Breakthrough with Dr. Christopher Burton

Dr. Christopher Burton is a physiatrist, speaker, and prolific author, writing about physician finance, home buying, practice marketing, and finds physician burnout to be such a critical issue, that this is his SECOND book on the topic.  In our interview, we discuss the specialties that are most commonly affected, how to recognize it and how to address it.  This is not a woo-woo talk about breathing and meditating your burnout away.  We talk about the brass tacks like outsourcing and learning to love your EMR.  Dovetailing well into the last episode about strategic quitting, he uses his “legacy ladder” to help us decide what we need to quit to achieve the Burnout Breakthough: Make the Most of Your Time, Your Family, Your Health, Your Career.

This and all episodes have been expertly produced by voice-over artist Carin Gilfry at GilfryStudios.com

Find this and all episodes on your favorite podcast platform at PhysiciansGuidetoDoctoring.com

Please be sure to leave a five star review, a nice comment and SHARE!!!

 

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 doctor, a practical guide for practicing physicians. Dr. Bradley Block interviews experts in and out of medicine to find out everything we should have been learning 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 our respective employers. And now, here’s Dr. Bradley Block.
Unknown Speaker  0:27
On today’s episode, we speak to Dr. Christopher Burton, a physiatrist, public speaker, position coach and prolific author. He just published burnout breakthrough a follow up to putting out the fire, both about physician burnout, we talked about the symptoms and consequences of burnout. Reasons for burnout, what specialties tend to be the most commonly affected. And we finished with some high yield ways to minimize burnout like learning to love your EMR and following his legacy ladder to make sure your time is being devoted to living the life you want to live.
Unknown Speaker  1:04
Welcome back to the physicians guide to doctoring. On today’s episode we have Dr. Christopher Burton, a physiatrist in Florida who is actually a prolific author and public speaker. And his latest book, burnout breakthrough was recently released. And that’s what we’re going to be talking about today. So, Dr. Christopher Burton, thank you so much for being on the show today.
Unknown Speaker  1:23
It’s a pleasure. Thanks for inviting me.
Unknown Speaker  1:26
So first, let’s just talk about your training. Where’d you go to med school and residency?
Unknown Speaker  1:31
Yeah, I was out in Southern California for both I trained in Loma Linda University. Not too far from San Bernardino and Riverside Redlands California area.
Unknown Speaker  1:44
And then, you know, what, what made you decide to write this book? What experiences have you had that led you to, to this breakthrough?
Unknown Speaker  1:57
Yeah, that’s a good question. I actually It was kind of a combination of things that led me down this road. First one I started out, I was focused on on leadership and communication for physicians. I did some coaching around the business side of medicine, you know how to market your practice, promote yourself in your specialty. But the more I talk with, with my fellow physicians, the more I realized that most of the problems we were addressing, they lead back to, to being burned out, you know, that someone would talk about, how do I know how to write a book, How do I become a speaker? How do I undergo a career change? But the problem was, they weren’t necessarily going to those things because they were passionate about it. And some of them were, the others were just tired of what they were doing already. And we’re looking for a change. And so I realized that you know, no matter what else I did, we were just kind of putting a bandaid on it if you will. Now, the The real thing we needed to address was the fact that most physicians are burned out and are ready to do something about it.
Unknown Speaker  3:08
So you kind of you mentioned it,
Unknown Speaker  3:11
that people would ask you how, because you are already a public speaker, how they can put themselves in the position that you’re already in. So I definitely think it bears mentioning at this point that you’re you’re a prolific author, you’ve written books on physician finance, purchasing a home as a physician, marketing yourself as a physician. And this isn’t even your first book on burnout. Your first book was putting out the fire, how to prevent physician burnout. So, so this is this is a topic that you’re revisiting. Why do you think if you’d already had a book on it, why do you think it was necessary to revisit the issue?
Unknown Speaker  3:49
I think, you know, as a I’m finished the first one and got it out there in the hands of more and more physicians. It really I realized that prevention was One thing, but now I mean, let’s face it, we’re already busy. How much time do we spend on prevention even with our patients or as patients? And how much do we spend on doing our own preventative maintenance, versus when things are already bad now that you’re looking for a solution. You know, very few patients come in and say, you know, I’d like to eat better exercise more lose weight, you know, they come in because you know, the hypertension that that diabetes, their joints hurt, and that they’re already feeling the pain. And that’s why kind of one of the analogies someone else told me a few years back was, you know, people, you know, that they come to for the pain medicine, they don’t come for you to for the vitamin, so that, you know, maybe I needed to explore it a little, little more depth gets specific tips for people who are already burned out and see what they could do differently. So it’s a little bit of different taking a little deeper exploration of the topic.
Unknown Speaker  5:01
So, first, let’s define burnout. How is it that you define burnout? What are the symptoms? And what are the consequences?
Unknown Speaker  5:10
Yeah, burnout is
Unknown Speaker  5:14
overall, it’s a lack of enjoyment of in what you’re doing or specifically in your profession. That’s kind of a generic term or definition we use and the symptoms, they start off pretty subtle and you might not even notice some of them at first. And that makes it hard to diagnose or quantify burnout for a lot of people. Think of things like cynicism or sarcasm, for example, like that can actually be an early defense mechanism when administrators are pushing you placing unrealistic demands on you. You don’t feel like you have any say in how your schedule is going, how your clinics run, how your whether you can hire fire staff, even when you can have Start getting that, that cynicism or sarcasm most people don’t think of that necessarily as burnout, there’s kind of the first step down that road. You know, same thing with strained relationships at home. It may seem like there’s something else that’s the problem initially. But then you realize that you know, a lot of it has to do it kind of your attitude in the way that your your judgments clouded by the stress at work, or, frankly, the depression. And we start off now we feel exhausted, we feel physically emotionally exhausted. We start doubting ourselves, that ourselves in clinic or in the operating rooms, you know, is my doing the right things? Am I making a difference anymore? You know, that, that sense of personal accomplishments, not there. You don’t feel like you’re, you’re having an impact on the world, which, you know, ideally or not, that’s kind of why most of us went into medicine was to make a difference because we wanted to help people and make an impact to to feel like Jordan Doing that it feels like you wasted 12 1314 years of your life to get to this point. And again that the strained relationships so it can lead to things like divorce, you know, being estranged from your children. Some physicians are struggling with anger management difficulties, disruptive behavior, that’s the dreaded label that you don’t want at the hospital or healthcare system. And just know that getting apathetic and not going through the motions, if you will, and that your patients notice it, you start making mistakes more frequently. You don’t have the same compassion or empathy you had when you started out. And some, some of the physicians unfortunately, slide down that slippery slope into things like substance abuse, gambling, and, and sadly, even you know, suicide is become a real problem for physicians with over 400 physician suicides a year now. That’s over one Day that physicians taking their life because they’re, they’re so burnt out. It’s really, you know, the consequences of ignoring burnout are quite serious. But despite the dire impact, you know, it’s just not receiving the attention that it needs. And when I say that, I don’t mean that people aren’t talking about burnout. I mean, that they’re not doing anything about burnout. You know, you can read all the journals about the number of and the percentages and everything. But what I’d like to see and what my book hopefully provides for physicians is concrete steps that people could take to get rid of the burnout to get out of that rut as opposed to just, you know, we’ll hear your Don’t feel bad. You’re one of you know, 50 or 60% of physicians in the US.
Unknown Speaker  8:50
So, one of the things that you mentioned in terms of ways to handle it is is your is your legacy ladder. So I definitely want to talk about my ways to manage burnout. But I want to first talk about the fact that it starts it can start as early as residency, right? It can even start it in medical school, and then residency. In residency, it’s a bit understandable, right? Like your, your schedule is not your own, your life is not your own. Your patients are not your own right, you’re seeing other people’s patients. And also there’s a steep learning curve. So you might, you know, you’re constantly being informed of what you’re doing incorrectly, in an attempt to educate yourself, but it really, you know, it can, it can take its toll on your confidence, which then takes its toll on your well being.
Unknown Speaker  9:42
And so, one of the things that was implemented
Unknown Speaker  9:47
when I became a resident was the 80 Hour Work Week, right? You know, and then I’m sure the eight hour work week is still considered obscene Lehigh but, you know, there were there were doctors that were working You know greater greater than or at least in the hospital for more than 80 hours a week. So when we limited our hours, at least his residence did that have an impact on the rate of burnout in residency? And if it was that we used to work more now we work less Why? Why didn’t burn out go away during for residence.
Unknown Speaker  12:19
So my sister in law when she was a general internal medicine Fellow at Hopkins wrote a paper on, I think she wrote it, maybe it was under her maiden name Lauren gold. Maybe it was under her married name Lauren block, but she wrote a paper that received a significant amount of publicity. Because you tracked the amount of time that internal medicine residents were spending doing different activities. And it turned out that face to face time with patients was was, I mean, I don’t want to say it incorrectly. But like somewhere between eight and 15% ring rings a bell, but whatever it was, it was something that was definitely noteworthy because of how much time they spent filling out discharge paperwork and things like that. And how much time was spent actually with
Unknown Speaker  13:05
physical? Yeah, with patients. And that’s that’s exactly it. You know, there’s no, no sense of I went into medicine to fill up big purse. No one ever said that.
Unknown Speaker  13:18
So, so if there are any med students listening not that this should dictate their decisions, but rather inform their decisions, what specialties tend to have higher burnout rates? And are there any specialties out there that would seem counterintuitive to you, given that, you know, you’re saying we need to be we need to be fulfilled. That’s that’s how we, one of the major ways that we combat burnout is by making sure that we feel we’re doing matters so. So what are the ones out there that tend to be the highest? And what are the ones that you would take you by surprise?
Unknown Speaker  13:52
Yeah, so recent survey looked at just this last week. It said urology was number one number ology was number two, and physical medicine rehab. Actually, number three is followed by, you know, what you expect, you know, your primary care your emergency room physician and general surgery. So that’s, you know, that’s kind of the top of the list. And I was I was shocked to see my specialty for dietary at number three on the walls, because now we, I would say, we’re not nothing we do are very free infrequently as anything we do life and death. So, you know, we may not get as many calls, I think it just comes back. You know, some of these specialties that, you know, you go into it expecting one thing and you realize, you know, you’re doing a lot of other things like now for us, you know, people come in and they want disability forms filled out. They want their DMV to get their handicap placard for their car filled out. A lot of this stuff that you’re doing is administrative or paperwork, and it’s not satisfying. And the same thing with radiology, I don’t think many people would expect that to be in the top half of the list of burnout specialties. I’m going to get even even then, you know that there’s a lot of radiologists that are that are burned out now to
Unknown Speaker  15:17
Yeah, actually just had a conversation with sanj cartel who wrote a book on positive psychology and, and he’s a radiologist. And it seems that even though it seems, you know, they do well, financially, they don’t get a lot of MIT in the middle of the night calls there. They’re so distanced from the patient care, that they’ve lacked that fulfillment. So he actually had some strategies to to help combat that. But I think that’s that seems to be the refrain here, that that if you’re in pmmr years filling out forms for disability and workman’s comp and you’re not kind of feel fulfilled it and it seems like compensation does very little to to mitigate that or at least a lot less than you would expect.
Unknown Speaker  16:07
And and that’s surprising a lot of the people who’ve done these studies, they were surprised to find that out it didn’t have anything to do with how much or how little you made you know if you’re if you’re filling out the same form, and I’ll you know, you mentioned the word competition to honor that was kind of my bread and butter when I first started out is because nobody else wanted to do it at the time. You know, you, you put everything in your note you dictate your assessment, your plan, work camp, least in Florida at the time you had a separate one that you filled out where you put down again, everything you found on your physical exam, your assessment, and then your diagnosis, and then your plan, what you would ordered, and then you wrote on your prescription, the medication you ordered against the writing the same thing three times just to meet different people’s requirements. And then headset doesn’t take a medical degree to be able to basically photocopy something down. You know, it just gives you stress and carpal tunnel. And that was about the gist of it.
Unknown Speaker  17:14
Which being in PMR, you’re able to diagnose, treat. Yes.
Unknown Speaker  17:20
So what are some of your higher yield recommendations from the book let’s, let’s, let’s try and find some action items for our listeners that take like a least a month just to kind of dip their toe in the water and give them a taste for what you you provide in the book. So least time and effort that are going to have the biggest impact so they get to get them started.
Unknown Speaker  17:41
Yeah, and I think most of the things I’ve wrote about really aren’t not time intensive to do or they don’t require big change is it’s little things you know if you can save 30 seconds each patient and counter and you have 20 patients you see in a day or you save 10 minutes that day, over the course of a week, that’s an hour, which, you know, you add that up, you say you work 50 hours a week, take two off, or 50 or 50 weeks out of the year, you know, that’s you substantially increase the amount of free time or time to got to do other things. Even just making that you know, 30 minutes a day difference. Now, if you can add that to your to your day. And so, you know, the top thing that most physicians complain about is, is electronic medical record. The we, the number one cause of burnout everywhere you look has to do with charting and bureaucratic tasks. So if you can find ways to make your EMR your, your EMR your ally and not your enemy, that’s going to go a long way to reducing burnout. So another thing to realize is there’s no question It’s EMR system out there, because I’ve gone through this with tons of physicians. And they’re like, Well, you know, maybe I need to switch to this one or that one. Well, no matter what you do, you’re going to run into the same problem. And that is that someone who has no medical education, not a clue about what it takes to interact with a patient in the room, writing the software that you’re now using and being forced to squeeze into how we practice. So find ways to work around it within the system as much as you can. And so, for me, templates are a lifesaver, everything that I do, if possible is templated to the nth degree. In that can be not just your patient knows not just your reports, they can be letters to referring physicians, they can be letters to patients, they can be my special two letters, the case managers or attorneys, just to anything that you want. More than once a day, you really must have that template, it’s somewhere. If you write it more than even once a week, I still do a template for it just because it saves you so much time to do it that way, you may not think that it’s a lot of work to dictate another 60 seconds each time. But again, those little minutes here and there add up to use technology as your friend, the others, there’s ways that you can combine the standard template along with voice recognition. So one of the things I did early in my practice and I combine the two, it actually sped things up so much because you’re a lot of people know you can’t template, every single possible thing there is, you know, so being able to say, dictate a history. point and click for the physical exam point, click for a diagnosis, point and click for your assessment and plan and then Maybe you know, predicted a sentence or two that specific to that patient and makes it go much faster than than typing we all we talk faster than we can type I mean voice recognition when I was writing my book even just because I have a thought in my head if I don’t get it fast enough the chances are it may leave before I before I get it written out by hand or even typed out. So using that to your advantage make technology in your electronic medical record your friend don’t don’t look at as as an as an enemy as something to struggle against.
Unknown Speaker  21:37
Yeah, I use I use dragon and I’m certainly not but I really you know, it helps me one it helps me connect with my patients a little more because they’ll tell me their their story and then I will dictate it in a more succinct way which really helps them understand what they’re experiencing, you know, particularly when patients come in with sinus problems. Me up beside it, sinus infections or dizziness, which is always very complicated to wade through, you know, bring it back themselves with in a succinct way can help them understand their symptoms a bit more. And then I dictate the plan, I dictate, I dictate the whole plan for most situations because then they get to hear the plan at the end. So rather than me telling them what the plan is, I dictate the plan. They hear me doing it, so I don’t do it in such a rapid fire away. And then I get an opportunity to ask questions. So I’ve saved myself a step there. I do have some templated plans, but but I definitely what I need to do based on what you’re saying is, I need to take a day off, I need to take it off. And I need to sit down with someone who knows my EMR really well. And I need to find as many ways as possible to maximize the macros and the templates. The caveat being though, you know things like carry forward, there is a huge legal liability there. You always need to watch out for things like that if there are contradictions, your review systems and your history present illness, now your documentation can’t be trusted as much and, and so those are those are always things that you need to be cognizant of but I definitely need to take a day off because it will make a huge not a day off a day to maximize my EMR or a half a day because you’re right it is going to make a huge impact as much as you may not like the EMR don’t hate the player hate the game. You know, you got
Unknown Speaker  23:34
to you have
Unknown Speaker  23:35
to find your your you’re in it. You can’t you can scribble your notes on a on a note card and days are passed yet you
Unknown Speaker  23:42
have to find a way to embrace it. And really, most especially if you work for a hospital system, or they have people who would that’s their job is they’ll come sit down next to you walk through a patient encounter with you and just see where it is that they can help you maximize your efficiency and and you’re right taking the time it may seem like a burden at this moment, but you take the time and invest in getting to know your system front work backwards, you’re going to make up all that time in the in the end because you’re going to be so much more efficient. There is so much less stress. You don’t if you’re taking two or three steps to do something that one of the Mr. champions at your facility can can show you how to do in one step is going to make a make your life so much easier. And really, you know that that’s what we’re trying to do with this book is just find ways to make the most of your time so you can get back some of that. You know, we talked about delegating outsourcing. Now whether you use your nurses and aides to fill out forms or fields phone calls us a scribe in the in the room with you outsourcing at home, you know, if you want to spend more time with your spouse, connect with your kids, you know, find someone else to do the yard work or clean house, you know, you don’t have to do all those things. You just have to find someone else who can do it. And, you know, let’s face it, they probably are better at it than you are.
Unknown Speaker  25:15
Well, especially, you know, you have to consider your income versus how much you’re paying out. Right? If you if you can dry while you’re your own house, then. But the amount that you make as a physician, that being said, post tax, right, and then, absolutely, and how efficiently they do it and how much they cost and how well they don’t relative to you. And, you know, it’s it’s basically an economic decision, you know, how much do I make an hour? How much do I pay this person an hour? And how well do they do it relative to how well I can do it? Or you know, unless you enjoy it? Some people enjoy the spackling I guess,
Unknown Speaker  25:50
yes, yes. I can’t say that. That’s one of my favorite things. But there’s, that’s kind of one of things I touched on the book is and I actually break it down by if you Make, say 200,000 a year and you work 80 hours a week. What’s your hourly rate? And if it comes out $200 an hour just for a round number. And you can get the kid down the street to mow your lawn for 20 bucks and he gets done in an hour. Why are you doing that? Unless you just really love it. Is there not something better you can do with your time, I would never have time enough to catch up on our paperwork and things he had she get caught up on your billing, you’re actually making money during that time. He’s out there mowing the lawn for you. Now you’ve got it, those things are where you going to are going to make the most of it financially is not going to be doing those minimum wage type tasks around the house.
Unknown Speaker  26:45
Yeah, being being frugal is important and not spending money buying stuff that isn’t going to make you any happier, which we’ve talked about in previous episodes. But outsourcing is going to free up time which is your most valuable resource. So paying someone to Do something that you would be doing is very different. Because you’ve just bought time. You have to think think of these things in two different baskets. One is stuff. And the other one is time and time is much more valuable than stuff
Unknown Speaker  27:14
that time is the most valuable thing we have. There’s no resource greater. You can look gold, silver, Bitcoin, whatever you want. There’s nothing more valuable than time. When I work with people or coach them, I always tell them, I can find ways to make you more money. I cannot find ways to make you more time once if you’re not willing to do some of these things that we’re talking about. Your limited, I cannot create time. Now we can find ways to make your practice more efficient. You can see more patients you can sell braces in front of front end of your office. You can invest in stocks or real estate. You can make more money. You can never ever create more time though. And so that’s what The things I focused more on in the book was how to get your time back as well as your healthy I things like eating well exercising right? Every day. Those are kind of important things that I was to me anyway you got your your health and your time there’s, there’s nothing else more important than that. Because you can don’t have those two things you can’t give to anyone else in your life.
Unknown Speaker  28:24
There’s one last thing from your book that I want to talk about and that’s the legacy ladder. Can you just talk briefly about the legacy ladder?
Unknown Speaker  28:32
Oh, certainly. The the legacy letter was something I created to help my coaching clients reconnect with with their dreams to get clear on their goals. What What is it that you want to get from your career? Because let’s face it, when you’re burned out, when you’re stressed when you’re, you don’t get a sense of purpose in your life. It’s kind of hard to get out of that rut and that’s where you know, whether it’s using the book or an actual coach. One on One, to to get you out of that. That’s where having an outside source helps. And that’s really what the legacy ladder is. It’s, it’s some, it’s a ladder to help you get out of that rut, if you will. It looks at what is starts off the big picture, what’s the legacy you want to leave with your life? If we look at the big picture, what do we want to accomplish, how it’s much easier to narrow down to the specific things that we need to change. We can get more clear on things that are really important to us and what are not important. Because let’s face it, you know, we always get asked to, to sit in on some meeting or be a part of the committee or even outside of the hospital to be a warden for Warner for charitable foundation or, or school or your alma mater that really are those things help you reach your goals in kind of next step is that you know, so you have that big picture and What roles Do you need to be successful in in order to make that legacy a reality? I mean, you’ve got your role as a physician, which is important to you, and you work so hard to get there. But you’ve also got your role as, as a spouse, as a parent, as a as a friend, as a leader in your community. And sometimes those roles compete so you’ve got to be able to, to weigh know the value of those, you know, and do. Am I living out my life according to what I say value in if my values and beliefs aren’t lined up with the roles I’m taking on or the way I’m spending my time and you’re just going to get frustrated and you’re not going to feel fulfilled with that. And then the other kind of the next couple rungs down from that is you know, if I’m if I need to fulfill this need to be in this role, what skills do I need to succeed within that? Roll. So if your goal is to, you know, become Chief Medical Officer at your hospital, the president needs to learn some leadership skills. You know, if you want to give presentations on your area of expertise to, to further your academic career to attract more patients, now, the developing your public speaking skills is important. You know, for me, you know, I’ve written a number of books and, and I’ve been a speaker, and I’ve done coaching, you know, the really, writing was only one that came naturally to me, that was kind of one of my innate strengths that I had speaking took more time and more effort, you know, to master the techniques to to be able to communicate effectively in either a 10 minute time block, a half hour time block or an hour time block, depending on where I was at. So, you know, do you have the skills to succeed and D are the habits to be successful. This is kind of what we talked about in the book too, is Managing your your EMR managing the your to do list by delegating or outsourcing.
Unknown Speaker  32:07
Are you taking care of your yourself sleeping, right eating right exercising? Do you have the right habits in order to be successful? I think further kind of at the bottom of that list is really you know, you’re in the right environment to grow. If you’re, you know, unfortunately, a lot of doctors think that this is the place they want to start and, and that’s, it’s good to consider your environment but it’s really kind of the lowest level you can succeed no matter where you’re at, if you have the right habits, right skills. And you know, you’re putting yourself in the right positions. But if you’re, if you’re not addressing any of those things, and just looking at, you know, I’m going to change my environment, that new job is what I need. Unfortunately, you’re going to take a lot of those same attitudes and skills or lack thereof with you to your next job or Your next institution or your next unfortunately, for some physicians relationship, your next marriage, you know, you gotta fix those things. And you can’t do that without kind of going through the steps this legacy ladder to see where you want to end up at the end of your career, then if you’re alive, what do you want to do? Where do you want to be? And I think that doing it this way with the legacy ladder really is a much more efficient way of, of doing that. And it’s worked for a lot of other physicians and I highly recommend it to anyone who’s kind of feeling stuck and feeling like what they’re doing isn’t isn’t leaving them satisfied or fulfilled.
Unknown Speaker  33:42
I think that ties in well to the last question that I that I wanted to ask you, it was the the thing in your book that I I found that the hardest to believe. And so what position were you in that you know, two people who play the French horn That
Unknown Speaker  34:00
that was just
Unknown Speaker  34:02
a coincidence of being in a very interesting medical school class. I had a couple of classmates who are music majors one of them played French horn in college for scholarship, I believe. And she was quite talented. And another one of my classmates he, he actually played the French horn as well. We had we had a class choir, we had a class band, we had class flight football team, we were we did most of us anyway, past we sent some very eclectic people in our, in our group and it was definitely fun to get to see all the different traits and and learn about what, what other people do to relax and unwind. Because, you know, there’s some things we may not think about illiterates listening to a good podcast on your way to work, reading a book or or playing music to find things even outside of medicine that you enjoy, and hope you feel fulfilled in life.
Unknown Speaker  35:06
Yeah, I think that’s, that’s, you know, we need we need fulfillment in life in and we think we need fulfillment in our careers, but also outside of the office outside of the operating room outside of the hospital. So it’s important to have that, that type of balance. So some type of creative outlet I think is really important too. That’s an excellent point. So Dr. Christopher burden, it has been a very interesting and very helpful conversation to me and I’m sure to the listeners as well. So where else can people find you?
Unknown Speaker  35:35
The easiest places just Christopher Burton, MD. com. Please do the MD otherwise you get to a luxury home builder in South Florida. Won’t be helpful at all. unless you’d like luxury homes but yeah, Christopher Burton MD. com. You can email me info at Christopher Burton MD. com. I’m also on LinkedIn. For slash Christopher Britain, MD So those are probably the best ways to reach out to me the book is on Amazon available. If you get a chance to go check it out. I would greatly appreciate it if you can leave a review as well, just to, you know, spread the word. let other people know there are solutions out there. Now, we talked about the consequences of burnout in and we don’t have to go through that, that slippery slope, we don’t have to go through it alone, either. Whether it’s whether it’s a book or attending a lecture or or having one on one coaching there’s there’s solutions out there. Don’t think that you have to face burnout alone.
Unknown Speaker  36:40
Christopher burden MD burnout breakthrough is the book. Thank you very much for your time. It has been a pleasure.
Unknown Speaker  36:46
Thank you look forward to talking soon.
Unknown Speaker  36:50
That was Dr. Bradley Block at the physicians guide to doctoring. We can be found at physicians guide to doctor and calm or wherever you get your podcast. If you haven’t Question for a previous guest or have an idea for a future episode, send a comment on the web page. Also, be sure to leave a five star review on your preferred podcast platform. Our show is produced by guilt free Studios in New York City. You can find them at guilt free studios calm. Our theme music was written by our show’s producer voice actor current guilt free
Transcribed by https://otter.ai

Strategic Quitting – What Every Doctor Needs to Quit NOW

Lynn Marie Morski, MD, has played every instrument, every sport, run for every office and she quit them all to lie on the beach.  OK, none of that is true except the lie on the beach part since she lives in San Diego, but she is a quitting evangelist.  We discuss when to quit and more importantly, when NOT to quit, the psychology of quitting and what prevents us from following through.  She has a five point plan for strategic quitting, so we go through all five steps.  Even though her platform is quitting for EVERYONE, she is a physician, so she understands the struggles we face and specifically tailors her quitting strategy to our profession. 

She helps people quit anything that’s no longer serving them, like jobs, relationships, or mindsets, through her book, Quitting by Design, and her podcast, Quit Happens, along with speaking and coaching. She is also a board-certified physician in family medicine and sports medicine, currently working at the Veterans Administration, and she serves as Chief Medical Editor for PRIME, the largest peak performance, optimization, and longevity marketplace in the country. In addition, she is an attorney and former adjunct law professor.

When not doctoring, lawyering, or preaching the gospel of strategic quitting, Lynn Marie can be found doing yoga, playing multiple musical instruments and dancing like everyone’s watching.

quittingbydesign.com

Strategic Quitting – What Every Doctor Needs to Quit NOW

Lynn Marie Morski, MD, has played every instrument, every sport, run for every office and she quit them all to lie on the beach.  OK, none of that is true except the lie on the beach part since she lives in San Diego, but she is a quitting evangelist.  We discuss when to quit and more importantly, when NOT to quit, the psychology of quitting and what prevents us from following through.  She has a five point plan for strategic quitting, so we go through all five steps.  Even though her platform is quitting for EVERYONE, she is a physician, so she understands the struggles we face and specifically tailors her quitting strategy to our profession.

She helps people quit anything that’s no longer serving them, like jobs, relationships, or mindsets, through her book, Quitting by Design, and her podcast, Quit Happens, along with speaking and coaching. She is also a board-certified physician in family medicine and sports medicine, currently working at the Veterans Administration, and she serves as Chief Medical Editor for PRIME, the largest peak performance, optimization, and longevity marketplace in the country. In addition, she is an attorney and former adjunct law professor.

When not doctoring, lawyering, or preaching the gospel of strategic quitting, Lynn Marie can be found doing yoga, playing multiple musical instruments and dancing like everyone’s watching.

quittingbydesign.com

 

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 doctor, a practical guide for practicing physicians. Dr. Bradley Block interviews experts in and out of medicine to find out everything we should have been learning 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 our respective employers. And now, here’s Dr. Bradley Block.
Unknown Speaker  0:28
On today’s episode, we speak to Dr. Lynn Marie morskie, Esquire, a sports medicine family physician, lawyer, yoga instructor, bassist and quitting evangelist. She has a successful coaching program on quitting podcast and book all about strategic quitting. We talked about when to quit, when not to quit psychological barriers to quitting and her five steps to quit strategically.
Unknown Speaker  0:57
Welcome to the podcast Lynn Marie morskie Thanks for having me. Thank you for being here. You are a very busy woman wearing many hats. So I really appreciate you taking the time out of your day and time away from your own podcast, which we’ll talk about in a bit to to discuss quitting with physicians guide to doctoring. So before we get to the quitting, let’s just talk about your training and how you ended up becoming a quitting expert. So what’s your educational background?
Unknown Speaker  1:28
my undergrad was in Media Communications, not pre med. And then I went to grad school for interactive multimedia design and got about halfway through and that’s when I made my first quit and decided multimedia was not my jam. And so then I went to St. Louis University School of Medicine, and then to Mayo Clinic, Scottsdale for family medicine residency and the University of Arizona for sports medicine fellowship. And then I went to Thomas Jefferson School of Law for my law degree.
Unknown Speaker  1:56
Is that in Philadelphia, is that the same TJ that then became the Jimmy Kimmel or Sidney Kimmel, medical school.
Unknown Speaker  2:03
No, it’s in San Diego.
Unknown Speaker  2:05
San Diego. Okay. Different Oh, which is where you are. Yeah. Now I can see once you get to San Diego not not wanting to leave San Diego?
Unknown Speaker  2:12
No, no, it was the fact that when I moved to San Diego, the condo I moved into happened to be next to a law school they were building I never planned to go to law school. I just looked over and just kept feeling really envious of the people who are going to get to go there. And I decided, well, envy isn’t a fun feeling. Let’s just go there.
Unknown Speaker  2:27
See, I hung out with some law students. And while I was in med school, I was jealous of the of the law students because they seem to be having a lot more fun. But I never thought after I’m done with medical school and residency, wait a second, let’s go back to law school. Let’s be a student again. Well
Unknown Speaker  2:48
happen.
Unknown Speaker  2:49
I’m like, didn’t end this is you know, like, foreshadowing for whatever’s gonna come later in our story, but I didn’t love medicine after I spent 10 years doing because, you know, I was a media major. So I had Do pre med completely from scratch, and then med school, and then residency and then fellowship. And I got to fellowship and the entire time I was just like, okay, I don’t like any of this. When you get to sports medicine, it’ll be amazing, which was just a totally flawed train of thought. But, you know, that’s why I’m partially why I’m passionate about teaching people went to look at signs now, because I had sign after sign, but I put my head down, like gonna make it sports medicine, didn’t love it. And so by the time I get to San Diego, I have the job I have now which we’ll talk about that. I don’t work a ton. I have like 10 hours a week, there’s a salary cap, and that’s why I only work that much at government job. And lo and behold, I live next to this law school and I just had this feeling of like, Oh my gosh, because I had studied on how to take the L sat when I was in seventh grade because my dad just had this book laying around. he’d gotten a bunch of book donation books to the house, and we had the seventh grade Pizza Hut book it program. Like if you read a book this summer, you’ll get a personal pan pizza, and that’s the book I chose was how to take the L sat So really, that book was like engaging enough. You’re you should be reading I don’t know. I?
Unknown Speaker  4:07
Yeah, like seven in one day. Oh, yeah, exactly.
Unknown Speaker  4:11
Yeah, I was a nerd. and still am. And yeah, I was like, Oh, the L SAT. And so I learned how to take the L sat in seventh grade. And then I tutored my brother on how to take bail said I’d never taken it. And I tutor my day is also dance partner How to say feels that they both got into law school. And I would like have so much fun tutoring them and like doing the practice problems that I was like, I just want to take the whole set really badly. And I think that’s part of why I thought like, Okay, if the outside is this, that must be what law school is kind of like even though partially, but I just was so envious by this point. And I’m like, Well, I worked two days a week and I live next to this law school. It’s I said, Okay, if I can get in for free because at this point, I’m a quarter million in the hole from med school, I was not going to take out another loan. I thought, if I can do this part time and get in for free, I want to do this. And I made that decision in August. And I was I was Law School by January. So when the universe lines up things, it really does a good job.
Unknown Speaker  5:04
So let’s talk about what you’re doing. So what you’re doing now full time, full time for your for your income will say yes. Is that what you were doing through law school as well? Yes. Okay. So I think this would be a good time to talk about what it is you do.
Unknown Speaker  5:21
Great. I work in the end, if you’re on one of the Facebook groups like you and I are these doctors groups, the fabled VA Compensation and Pension Exam, person contract position. And if you haven’t seen this talked about, it’s where when vets get out of the service, they need to have exams done. And all I do is fill in these forms and like occasionally make a decision. I don’t treat anything, there’s nothing there’s no call I make my own schedule. I don’t have anything that resembles a benefit. And if the patients don’t show up, I don’t get paid. So it’s not like okay, I show up for a day of work. I’m guaranteed this much pay. It depends on who shows up for the day. But I could you know, work two days a week I could work none there’s a salary Kept, like I mentioned, but that’s all there is to it. There’s no pager, there’s no call, and no prescribing medicines of any kind, you were just reporting on what they like what injuries they got. And occasionally you’re making a decision whether or not that injury did start in the service. And that’s what I do two days a week, five hours a day,
Unknown Speaker  6:18
but you’re not working up the injury, you’re just reporting what they’re telling you and what you’re finding on exam. You’re not making decisions about further workups. Like, okay, let’s get a CAT scan or an MRI or, exactly,
Unknown Speaker  6:30
it’s kind of like one of the least medical things you could do. It’s still be quasi clinical. Like, I think I draw the clinical line like do I have to touch a patient or not? And since I’m still touching patients, I believe it’s still clinical ish. Not very,
Unknown Speaker  6:44
and you do well enough to then fund your passion project. Indeed,
Unknown Speaker  6:49
yes. And not to fund it like rolling in a mother it in case anybody’s wondering, just to live in Southern California, and still have a little leftover for the bedroom project.
Unknown Speaker  6:59
Right. And you You live in San Diego, which isn’t some place that has a low, you know, you need to do fairly well in order to live a reasonable life and in San Diego, you know, when, when all of these other physician oriented and financial independence, you know, they’re they’re not exactly they’re not talking about, it’s much harder to do when you live in a place like I do on Long Island, or where you do in San Diego, where the cost of living is so high, so, but you’re able to live in a place with a high cost of living. And still, and I think actually, I apologize, calling it your passion project. I feel like take something away from from what you’re doing and the intensity to which you’re doing it. So so let’s get into that. So you are a quitting expert. You help people to quit and you have a podcast about quitting. You wrote a book about quitting and you coach people through quitting. So how did you decide to become that that was your niche that was your thing.
Unknown Speaker  7:58
I had tried so many Other things at the point where I made the decision I had been right multimedia designer, a sports medicine doc than a regular via doc and then I went to law school. Then after law school, I was in a startup where I was co founder, Chief Medical Officer an in house legal counsel. And then after that didn’t work, I taught law for a few semesters and then I was a delegate for Bernie Sanders, and did politics for a year and after all that, I was like, okay, none of these light me up. Like they’re some of them are fun ish. And some of them are terrible, but like, none of them are reason I would want to wake up and like jump out of bed in the morning, they give me like that. I’m too excited to sleep feeling the night before, like kids going to Disneyland. Like, that’s what I wanted for my life. I had spent so much time in training and schooling and I thought I this point in time, I should figure out what I really want to do. I owe this to myself for all the time I’ve put in. And I was listening to Tim Ferriss podcast, and he had Seth Godin on and they’re talking about finding your calling, and they said maybe you should ask people around you if you don’t know what you’re calling us. Ask you what you’re good at what they think of you as their go to person for. And so I made a Facebook post Hey guys, what do you think I should be doing? And then one of my friends responded, hey, let’s meet up and talk about this. And when I’m waiting for him in the parking lot of Starbucks, I put two sheets of paper out of my little journal. And so I’m just just sitting there and I thought like me for this thing. And on one piece of paper, I wrote things I’m good at. And the other piece of paper I wrote things I like to do. And on the things I like to do side, there is public speaking and there’s giving advice. And on the things I’m good at side, when I put pen to paper, what came out was quitting, like, number one on the list things I’m good at. And I think this is kind of forefront ish in my mind, because when I had done this speech at my law school graduation, I had done it on the power of strategic quitting. And it was really well received and then somebody heard it and wanted me on this this career podcast. And so after I was on that podcast, I realized, oh, like this quitting could be a thing but I never did anything with it after that, but I still had that nugget in my head of like, Whenever somebody wants to come to me for advice, like I, like I said, when it was like law school graduation, speech time, I was like, What am I gonna say to these people that can be useful? What are the graduates like? What What would they benefit from hearing? How did you end up giving a speech at your law school graduation? You just be valedictorian.
Unknown Speaker  10:17
Okay, so I just, you know, we’re trying to establish your street.
Unknown Speaker  10:21
I thought it’d be worth mentioning that working at the VA as a physician and going putting yourself through law school and managed to graduate valedictorian, so I, you know, I think that’s a have some significance, because, you know, there are things that you’re good at and things you like doing, and then there are things you’re qualified to do. Right. So I think I think all three of those things should line up because they’re, they’re Yeah, they’re these things. I like doing their things that I want to do. And I like yesterday.
Unknown Speaker  10:52
One of those lists was not one list is what I like to do in a second. This is what I’m good at. Like, yeah, I had two boys and the girl is very good.
Unknown Speaker  10:58
Okay, I guess you’re good at it. That is qualified to do. But I just, I think it’s bears mentioning that you were valedictorian of your, your, your law school class, which is, you know, hard to say yourself, I can appreciate that it’s easier when someone else pulls it out of you just in establishing, you know, what makes you an authority on something. And so I think, you know, if you’re, if you’ve graduated, valedictorian, it opens a lot of doors. And you chose not to go through some of those doors or you chose to, and, and then and then quit. So you didn’t have options available to you and then and then decided to quit, you’re like, you had a lot available to you and then decided, I’m not doing this stuff. I’m doing this.
Unknown Speaker  11:41
Yeah. Well, basically, law school is unfortunately, they don’t have any built in residency and so you can graduate from law school, like I did, having really no idea what to do outside of the classroom, because I didn’t do any internships or anything. Because I didn’t ever want to practice law. I knew that much going in. I just thought the last three would be fun to have. And since I was already working at the VA, I was like, I’m not going to do an internship on top of this, like I kind of looked into it and applied for like a summer one or something. But I never end up doing anything. So I was not super qualified to do any intricate law practice when I got out. But I figured I was qualified enough to do what I got hired for. Well, hired is a funny word when you’re doing a startup. I didn’t get paid. But like when I was asked to be in house legal counsel for a startup, I was like, Okay, I can review contracts and do kind of basic stuff. But yes, I mean, I did well in law school, but I was not good at med school, which is just another thing that like, when when there’s the What are you good at list medicine was not on it. Like it was. It was a whole different ballgame from medical to law school, which I think part of why I wanted to go to law school because I just suffered through 10 years of fighting against medicine, feeling like this was just never right for me. And law was I knew that, like if I was good at the outset in seventh grade, clearly my brain works in a certain way. That medicine just somehow didn’t jive with But anyway, yes, that’s how you end up doing a speech at your graduation. And then I sat there and I had those two lists, and one said, you know, okay, public speaking, giving advice, the other side quitting, I said, this is I’m going to make this into a thing. I didn’t have have had no idea how or what that was going to look like. But that’s what you know, my friend and I talked about it. And he’s like, well, I’ll put up a website for you. And then we’ll just kind of go from there. Maybe you do a webinar, and then I just end up writing a book. And then once I got a publisher for the book, and I had time, I was like, well, I’ll just do a podcast like, I like nothing was very well planned out. But now it seems like geniusly constructed but it was just a lot of trial and error. all facets of social media covered, right. I have all the channels.
Unknown Speaker  13:35
So you mentioned Seth Godin. And I think that’s a good segue into the first question about quitting because he wrote a book called the dip, right where we it’s basically the struggle through, you know, something like residency, but residency, we know when we’re going to be done. So if you’re really just slugging through residency and going through the motions, you can’t wait for it to be done. You know, when there’s a finite end, but if you’re sitting entrepreneur and things aren’t going well. And you’re, you know, you’re taking on more debt, you’re putting tons of time and you’re, you’re it’s not doesn’t seem to be working. The dip is you keep pushing through, because eventually the dip will be over and your product will be successful. You may need to pivot here or there. But you know, the people that find success are the ones that can work through the dip because there there is almost always going to be a dip. And Angela Duckworth is a psychologist who talks about grit, right? There’s value to resilience and just sucking it up and pushing it through. Because you know, what, if you’re trying to learn guitar at the beginning, it sucks because you can’t play anything and it sounds terrible and your fingers are sore and right all the rest of it. But you need grit in order to push through that in order to become Joe Satriani. So let’s first talk about not quitting. So when would you say someone shouldn’t quit?
Unknown Speaker  15:00
Okay, can I back up to both of those examples real quickly? Yes,
Unknown Speaker  15:03
I can’t. I can’t imagine you saying no. So forgive me for having to phrase it in such a stupid way. But I’m going to back up to those two examples for a second. The first one, okay. You said the entrepreneur you’re supposed to get through the dip and then push through it. Not all the time. Really, like I was in a startup. We were in I was in a dip. I could have kept pushing through that started eventually went under what I’ve been somehow, somehow a success of I just waited longer until it went under. No, I did the whole cul de sac thing that he talks about in the dip is when you see this isn’t going anywhere. You turn around and just sticking through a thing and gritting your teeth. Allah Angela Duckworth, you know, okay, I’m going to get through this thing is not always the way to go. Even if it’s residency, so I had at least one friend, she was in an OB residency, ob residency is really brutal, and she was having massive health problems. And, yeah, there’s an obvious okay. If you make This if you live through the five years or four years of this residency, I think it’s four years, then yeah, you’ll be done with it. There’s a light at the end the tunnel, you know where it comes. That still doesn’t mean you should keep going. she switched to a different residency is so much happier. I think so many people have this erroneous thought of like, okay, Angela Duckworth, yes, if I want to sit down and become Joe Satriani, interesting choice, I’ll go with Tom Morello. But if I want to be that person, and I know it, and I love the guitar, and I still admire this person. Yes, I’m gonna have to sit through how terrible This is. I’m a bass player. I would love to be many other bass players. And I have to fight through it because I’m not great. And I’m getting better. But if I and I did this before, like, I tried to play softball, I am not a ball sports person. The first day of softball, I got whacked in the shoulder, and I got knocked over. And everybody was like cheering me they’re like, Oh my gosh, you stopped the ball. You’re amazing. And I was like, You didn’t ask how I was. I’m clearly super injured over here. This is not My jam, like, I could just tell with every fiber of my being, like, I could have gritted through a year of softball, I wasn’t going to be great at it. And I really didn’t like it. Like you shouldn’t be. What Seth specifically says in that book many times is are you going to be the best in the world? And I mean, that’s a little exaggeration. But are you going to be great at this thing? Great. Stick through it, keep doing it. If not, turn around, refocus your energy. So back to your actual question is when you should not quit. That’s when your head is telling you, you should quit. So there are two signs you should quit. One could be your head telling you things. And one is when your body is telling you things. And in your body. I mean, I’m encompassing your physical and mental health. And I am making a distinction between that and then the voice in your head. That just is annoying. It says like, Oh, I feel like doing this today. Or Oh, man, it’s nice to stay in bed. I don’t want to get up and train for this marathon. That’s just like self talk. Oh, you’re not very good. You shouldn’t do this. Don’t quit when it’s just that little voice in your head. But you really want to do a thing like, oh, you’re really bad at the guitar, you sound terrible, but you really want to do it, like, fight through that guy. But say if you’re training for your residency, and it’s not the voice in your head, it’s the fact that now you can’t sleep because you have insomnia because you’re so stressed out about your cases, or you’re you’re getting adrenal problems or your thyroids all out of whack, because you haven’t slept and you haven’t eaten and you can’t get the right nutrition because your hours are crazy. Or just like maybe you’re doing something that really makes you anxious all the time. And so your nerves are fried. Like, if that’s happening, you should definitely consider quitting because you can’t be a great physician when your own health is terrible. So that’s where I make the distinction is like, if this is something you really should be doing, and you feel very called to do and you’re very passionate about it. But just a little voice in your head is is making you second guessed, then, probably best to keep it to increase your grit. Keep trying. But if you’re going down the wrong path completely, there’s no heroism in staying with the wrong thing. Unless it’s like another person is involved, and you need to work it out for that other person, but most of these decisions generally just affect you. Unless like this, of course, you got a family or somebody you’re supporting. But if the decision only affects you and your health is suffering, please consider quitting. Strategically, we will talk maybe about that reducing quitting and giving up but please strategic thinking about strategically quitting whatever it is.
Unknown Speaker  19:23
I think you bring up an excellent point there. There’s also accountability, right? Like your, for a lot of the things that we do, we’re accountable to other people. And so if your quit is going to affect other people that you’re accountable to it doesn’t mean you shouldn’t do it. But it means you need to take those things into consideration and how it affects those people and maybe what they’ve done or sacrifice to get you in that position. Before you before you quit, doesn’t mean you shouldn’t just mean those are those are things that need to be considered as well.
Unknown Speaker  19:52
Right. I definitely quit the startup in a funding round. And for anybody who’s done a startup that is like the worst time essentially like Hey, guys, These give us money for our startup. Try Pay no attention, the fact that the co founder just up and quit. But this was a strategic quit in the fact that like, I was miserable for a long time, but I thought, Okay, I’m going to stick it out, I’m going to stick it out. And then when I started to be unable to sleep, and I started having anxiety and panic attacks, I was like, nope, my health is paramount here. Yes, I realize is affecting other people. But I cannot sacrifice my health, just so that their their numbers on a on a portfolio look good or whatever, like I have to put myself first, my health cannot go.
Unknown Speaker  20:31
So I think you’re making the distinction between being lazy. And actually, you know, whatever it is that you’re doing is, is taking a toll on you physically and psychologically. So the sacrifices that you’re making in order to to accomplish x, if those sacrifices are now greater than the value of x, then that’s time to quit. That’s time to consider a quick Yes, very left brain. Yeah, I like it. That’s exactly that Sir, it’s that’s how I think about everything my, we were just talking about that my It’s a family trait the blocks are nothing is not methodical. So um okay, so So when is it? So that’s that’s when it’s time to quit so what about the psychology of quitting right that you talked about self talk so sometimes it’s the self talk that’s telling you that you shouldn’t run the marathon that you’re not worth it that you’re you can’t do it you can’t accomplish this thing, which is different than like, this is thing is just making me so miserable that I’m having health issues. But what so what are the other some of the what are the some of the other psychological issues like the cognitive biases that go into quitting? I know you talked about some cost fallacy. So let’s start with that.
Unknown Speaker  21:49
We’ll start with that. And by the way, if you are laying in bed and not wanting to get up to practice for the marathon, and that’s the self talk then guess what you do have to quit the self talk. Like they’re all kinds of quits the be useful. Like in that instance, if you want to run a marathon, you have to make a quit. And it’s not quit training, it’s quit the self talk that’s keeping you in bed. So often free, you know, we don’t think about things in terms of quitting very often. But if you don’t, then it’s kind of just hard to say like, get over it, tell that voice to stop, like, no, acknowledge that it’s there and make a strategic plan to quit that voice so that you can get on to doing what you want to do. But getting back to the sunk cost fallacy, one of my favorite things and so applicable to doctors, because we have often put many thousands, hundreds of thousands of dollars into our training and up to or plus a decade of time, right. And you can either view it as I did when I had started. So I thought, okay, I’m a multimedia designer, I want to become a sports medicine doctor. That’s the dream. So I am going to spend a quarter million of somebody else’s money and 10 years getting to that job. And when I got to that job, it was not a dream job, at which point I realized I wasn’t spending that money to get to be a doctor. I was investing that money in a career that I would like. And those are two very different things. Because if you said, Okay, I spent all this time and money to become a sports med doctor, I guess I better stick with it like that, that gives you this one kind of ball and chain feeling like I’ve done this thing. I gotta stick with it. But if you realize that the reason I was going to become a sports medicine doctor is because I thought it would be a career I would love not just to become a sports medicine doctor and sports medicine doctor as my fabled awesome career. And when it wasn’t that since I had already and let’s change the verbiage here. I had already invested a quarter million dollars, somebody else’s money and 10 years of my life into getting a career I liked and when sports medicine wasn’t it, I owed it to myself because of how much I had invested to keep going and trying to find a career that I would love. And and the sunk cost fallacy is essentially like if you Stop and try to left brain like, let’s go with the left brain. If you try to left brain why staying in a thing is logical just because you spent a lot of time and a thing, you’re going to come across a wall really quickly. Let’s just look at relationships. You know, sometimes they like, Oh, I don’t want to break up with the person I spent three years with them to stop and logically think why that would mean you should spend some more with yours with them. Like, you’re just a Apparently, the thought is, but I those years will be a waste. They didn’t get me any closer to being in a marriage that you know, or let’s just say the goal was marriage, just hypothetically, it they won’t have gotten any closer to a marriage. Well, guess what, if this person is wrong for you, after three years and you’re wanting to leave, that’s not going to get you here, not any closer to a marriage, you’re in closer to divorce, if you stay with that person, right? Like that person is not for you. So why don’t you cut your losses those that those years have already been sunk that is a sunk cost. You cannot get it back by staying. You cannot get the time and money you’ve spent back in medicine by staying It’s already gone. Let cut your cut your losses and then go because there’s an opportunity cost that you’re missing out, you can’t generally be with two people at once, you can’t generally be in two full time careers at once. So think of what you’ve spent as an investment. And you haven’t wasted it you have used that time learning what you do and do not like in in work environments, in jobs. And you’ve learned a ton of skills along the way. And if we’re talking relationships, you’ve used that time to know what you do and do what not wanting to partner so that time was not wasted time was an investment, but you owe it to yourself to cut your losses, and then go out and find the next opportunity that was better for you.
Unknown Speaker  25:38
If the market is down, and you invest more, the thought is you while you’re buying it when it’s low in order to sell it when it’s high, but if you’re having the same experience in your career, you’re if you’re at a low it’s not likely to come back up to to a high that you know In the same vein, write it low, you’re likely to it by just going to continue to get worse. That being said, this needs to be done strategically. So we will get to your your very methodical, five steps to quitting. But are there any other psychological barriers that people, specifically doctors, yes, because that’s the audience here. Either the self talk or you know, other things that we tell ourselves that talk us out of making decisions, because, and I think one of them is probably risk or risk aversion because doctors, you know, one of the reasons we come doctors, with a lot of people become doctors because we’re guaranteed a job right there. They’re always there’s always going to be a need. We’re not being replaced by AI, despite what the social media talk is. We’re not being replaced by AI anytime soon. So we’re not big risk takers. So So let’s talk about that. Let’s look at the risk associated with it and how we might be risk averse or any other psychological barriers. That you encounter for doctors who want to who want to quit,
Unknown Speaker  27:03
I would say the two two of the biggest. Because yes, it’s risky to quit. But again, when we get to the steps, I’m going to point out that I’m not saying hang up your white coat all together. I’m saying like you had done. We talked about a little before you start recording, you stop doing certain procedures, that’s a quit. That is a something you stopped doing. And if those are the procedures that were giving you the most friction or the most like, I don’t want to do this today. And then all of a sudden you get to go to work and not have to do them. Hasn’t your work, satisfaction increased? And the friction decrease? And there’s so many I mean, the practice of medicine is so broad, that we’re actually very fortunate. We can make all kinds of changes and still be within medicine. Like I said, my job is so barely clinical, I have cut out I quit all those things I talked about I quit call, I quit writing prescriptions like for a doctor to get to quit. That sounds a little crazy, but these things exist. So I’m not saying all of a sudden become like a carpenter. If medicine isn’t working for you, I’m saying there’s plenty ways to try to still carve out The degree where you can manage that risk, because then it’s not going to seem so risky. But what I think is a bigger psychological hurdle for doctors, especially if they do want to transition, at least from even clinical to non clinical. So you’re still maybe you’re like a medical director. Or maybe you want to transition completely out. So in any scenario where you’re going from patient care to not patient care, I think there’s the societal pressure of, don’t you want to still help people. And it’s a gross misconception, but very widespread that every doctor has gone into medicine because they want to help people. And that’s what people want to think because that’s what you want to think about. Your doctor is a person who’s here because he or she wants to help me, right. But like you just pointed out, man, there are other reasons. We knew this was going to be a pretty secure job, right? There may have been parental pressures on people to come become doctors, like, I’m pretty sure most people didn’t go into medicine because they didn’t want to help people. But helping people may not be the first primary reason and You’ve already done so much damage to yourself that helping people is barely even possible anymore, then that’s no longer your driving force, but society still thinks it should be. Or we think society thinks it should be whether or not we quit medicine and anybody actually ever says anything to our face. I think a lot of doctors fear or they have people say that if they’re like, I really want to quit medicine, will you want to help people? If a banker wants to quit banking, does anybody ever say but don’t you want to move money around anymore? like nobody else has the same pressure like not nobody, but probably very few professions have the same pressure. And so doctors have to be secure in themselves in knowing that what the rest of society thinks about you will not affect you. The only person’s thoughts who could ever possibly probably affect you are either if they’re under your same roof or if maybe like it’s a parent who’s going to write you out of their will if you’ve done something they don’t approve of, but it like 99% of situations. What Joe Blow down the street thinks of you. Putting medicine First off, he’s gonna think about it for like 30 seconds because everybody is living in their own, like distraction Laden, social media crazy world. So they’re thinking about themselves. And they’re spending most their time wondering if other people are thinking about that, like, that’s the kind of comical thing of our world, like, everybody’s worried about what everybody else is thinking. And the funny joke is that nobody’s really thinking about anybody else. So you’re really worried about that. Think about the fact that that guy might think about your decision to leave medicine for three seconds, but you have to stay in medicine for you know, 40 hours a week or all year long or however much.
Unknown Speaker  30:32
You’re just because you’re not treating patients doesn’t mean you’re not helping people, right? Like, absolutely are plenty of other careers where you can help people and maybe use your medical knowledge, maybe not use your medical knowledge, right, you’re you but you don’t you don’t know it. I think something is like I owe it to somebody in order to continue doing that. And really, you I think you want your family you might owe it to some people that helped you to get into the position that you’re in, but mostly you owe it to yourself to Do the thing. That’s, that’s, that’s right for you. But I think, you know, in terms of quitting medicine, that’s like a completely quitting medicine. That’s a pretty dramatic change. So let’s focus it down a little bit on just quitting a responsibility, right? Like, let’s say, you work in a hospital, you’re being asked to do something administrative. And then you’re being asked to like, I don’t know, go to the next ama meeting or beyond this committee, right? Let’s talk about that type of quit the type where, you know what, and, and I really like this saying that every time you say yes to set to something, you’re saying no to something else, right. When you’re maybe an undergrad or in your early 20s you have a lot of free time, so you can take on more responsibility. Maybe, you know, if you’re saying yes to another responsibility, you’re saying no to another show on Netflix, right? But, but you know, when when you’re our age Every time you say yes to something, you’re saying notice something in your life that’s of significance, right? Like every time I get another responsibility, it either means I have less time to take care of myself less time to be with my family, or less time to see patients. So do I have you know, I had to say no to a number of things. So let’s let’s talk about quitting something like that or even just saying no to something like that. What are the psychological barriers? How can you give doctors permission to start saying no, tell them it’s okay. Right? We’re not okay. Right. What are your What are your thoughts on that on the smaller quits
Unknown Speaker  32:35
on the small quit? Generally it requires asking right because somebody is asking you to a thing. And so for you to quit that thing. It requires asking if you can quit it like if somebody is expecting you to go to the AMA meeting. Essentially you have to ask somebody can I not go right? And the biggest thing that would be stopping them would obviously be fear. Oh, this person is going to say no, or this person is going to think I’m not a team player. Anything along Those lines, right? Oh, I might not get a promotion because I said no. And I have been there. And this is the thing that a lot of physician entrepreneurs get to is that we get tired of answering to another person. And if you’re not at the point where you’re willing to totally step out on your own, and you’re still in this situation where you have to answer to other person, then the onus is on you to make the best of it by the following means, which is you have to ask because you’ll never know if you don’t ask like for example, you might think, Oh my gosh, they need me to go to ama I gotta go to ama maybe there’s somebody like a little bit further down the line who really does want to go to ama but they can’t because you’re going because you’re higher up and you say, Okay, I really don’t want to go to me and you tell them why and you generally as much as you can make it about you and not the thing not like oh I am is really boring. It’s a lot of time, etc, etc. Say hey, I’ve got some important things with my family that week. I don’t want to miss this T ball game. It’s my wife’s birthday. Make it about you, or just say like, I have a Any reason that’s logical that you would not want to do it? give them that. And if they still say, No, you have to go, well, then First off, you tried. But secondly, the goal in everybody’s work situation who is working for another person. And by the way, these are all ideals and aspirational things. It’s not like we can go from zero to 60 and have this right now. But keep in mind that, you know, we do have medical degrees, which gives us a ton of flexibility compared to some other people. There are always needs of doctors, maybe not exactly the positions you’d want. But because of that, we should be working for people who have our best interest in mind. And so if you go to your boss with a very logical reason, you don’t want to go to this thing or you don’t want this extra responsibility. Okay, they asked you to do a bunch of extra admin. Well, I’m already having a hard time getting to pick you know, pick my kids up from school as it is or, or my spouse never sees me and that’s really causing some friction relationship. I think one more thing on my plate would really like be the end of us. If They don’t understand that, then you need to start looking for a place that does. Because if you keep being asked to do things, and you keep speaking up with your truth, because if you don’t want to go the AMA, you’re going to go and spend an entire weekend miserable. And that’s not great for your health, doing something that’s totally out of alignment with your values and your desires is going to at some point in time, at the least annoy you and at the worst affect your health. And none of those are good for preventing burnout. And they should not want a burnt out physician in their practice or in their hospital. They should want to promote physician well being and physician standing up and saying what, what they want to do and what they would rather not, if at all possible. Like if there’s a really great reason that you have to go to a thing, Fine, whatever. But if it’s something that’s not absolutely necessary, and they don’t understand, and that’s what I’d suggest starting to look around because you have to be able to speak up your mind to speak your mind. For those notes.
Unknown Speaker  35:52
humanize you’re saying to humanize the situation like you You need to rather than just saying no, no. Brad, would you mind Going to this meeting, know, and walk away. So that’s not the approach to take. No, of course that would be would be, you know, give them a specific reason that really humanizes it rather than Listen, I’m really so busy already or I’ve got a lot on my plate. You know, that’s just too vague. It should be something very specific,
Unknown Speaker  36:20
very specific because this is I
Unknown Speaker  36:23
will be responsible for my impending divorce. Bingo.
Unknown Speaker  36:30
But yeah, like, essentially, we’ve gone from this model where the boss is somebody up at the top, and everybody else is like a little minion and nobody ever shares their struggles. That’s the old paradigm in this new paradigm. Like what we’re talking about burnout and those kinds of things. We have to express our feelings and we have to do granted there’s always going to be that fear. When you’re going to your boss and you’re showing them you’re human. But at the point if they can’t accept your humaneness and they judge you for it or you get a demotion or whatever for it. Then find a boss who is okay with your humaneness because Guess what, that boss is also human. And at some point in time, that person might need some help. And you shouldn’t be in a situation where like one side gets to be human and the other has to pretend to be this perfect little carbon copy, you know, find people to work with who are supportive of you. It’s super important.
Unknown Speaker  37:16
And I think this dovetails really well with the an episode that I just recorded with Allison Escalante who talks about the shitstorm where, you know, we we go through high school, you know, being in all the clubs and all the honors classes and all the sports so in order to get the best college and then try to get the best grades and beyond all the clubs, we can get into med school and then we have to be active in med school, to get into the best residency and residency have to do all the research in order to get into the fellowship and then get the best job and then, you know, you gotta gunning for chairmanship and doing more research and getting grants. And, you know, it seems like we’re always saying yes to everything in order because that’s just the culture that That we have grown up in right in order to get into medical school and get into residency. This is what we’re being bred to think. And so it’s going to take a change in mindset to start saying, not only, no, I’m not going to do this thing, but even take a step further and say, you know, this thing that I’m already doing, this is detracting from my quality of life. And it’s not, you know, it’s not where I want to be at this time. So I think I’m going to quit this responsibility. I think that that takes a shift in mindset because we’ve been groomed to and, you know, and selected for, right because the people that weren’t saying yes to everything didn’t necessarily get into medical school, they didn’t necessarily get into residency so that the our peers or were ourselves in our peers are always people that have said yes to everything. And it’s going to take a mindset shift to not only say no, but quit some of those responsibilities.
Unknown Speaker  38:56
Yeah, it’s gonna take a mindset quit my friend.
Unknown Speaker  39:00
Yes to the mindset of we have to say, No, we have to do all the things. Everybody’s expecting us to do all the things and we are less than if we don’t do all the things. No, no, you are more than already, just by virtue of where you’ve gotten, you’re already good enough. You don’t have to prove anything to anybody else anymore. Take that mindset out, quit that entire mindset, you will feel so much freer. Like whenever I start to feel a should coming on, that’s when I know I and it’s outside of the job that I have to be up because something has to pay the bills, but like if it’s in a hobby or in a relationship or anything else that I feel like I’m doing something only because somebody else expects me to or that I those this should there that isn’t from the from a good place of like, actually came to think of a good place to show to come from Otherwise, I would just be enjoying to do it. Like, I mean, maybe I should practice the base a little more. But that’s just because I really want to be good at the base. If the show is coming from anywhere else. That’s what I’m like, oh, visit incoherency we’ve got to look at quitting whatever this is. But yes, quit that mindset that there’s anything that you need to be doing anymore. You’re enough. You’re good
Unknown Speaker  40:00
So what are the what are your five steps of quitting?
Unknown Speaker  40:03
Step one, decide whether or not there’s something that needs to go. And this is strategic quitting is a framework. So you just need to develop it, learn it and have it in place. Because you might be thinking right now, No, there’s nothing I need to quit. But then some new opportunity may present itself or some thing in your life may change to where you need to quit. And it’s good to have this in place so that you don’t start struggling and struggling and why do I have anxiety and reflux, and now I’ve got irritable bowel and all these things. Well, because you didn’t listen to your intuition telling you you needed to quit a thing. And then you got into a situation now you feel stuck in your settling. So step one to developing this framework is being able to tune into your intuition, which mostly manifest and we were all doctors here as health symptoms. So again, it’s the difference between that voice talking to you or the fact that every time for me in the startup, for example, every time I email will go off, that had a little little noise that I knew it from the startup, my stomach would sink. Every time I would see patients in a clinic and my sports medicine fellowship, my heart rate would start going through the roof. Little things like that your is your body kind of whispering like, Hey, this is not our jam. We do not like doing this, this is not for you, then it becomes insomnia. It could become panic attacks become chronic pain headaches, we’re doctors, we have the means to just go start treating them, which is where we need to stop. That’s what I did. I’m like, I’ll take propranolol, my heart is racing panel. Know, your heart is racing because you have an anxiety problem because you don’t like to be in clinic, not because you have a heart problem. And so we have to as doctors stop and realize where’s this coming from? And by the way, apply to see your patients do because most of your patients who are coming in with stress based symptoms need to quit somewhere. There’s something that’s causing those symptoms besides just the bad food or whatever. Like there’s probably an underlying stress causing a ton of things they may need to quit to. Anyway, that’s step one.
Unknown Speaker  41:45
That’s actually that that is interesting for what I see because I see a lot of people with your pain. Why? TMJ they grind their teeth, why they grind into something stressing them out. So that’s, that’s something Explore with them also very commonly causes grinding your teeth, temporal pain, and maxillary pain. So people come in thinking that they have sinus infections. But really, they’ve just got a lot of facial pain because they’re pushing their mandible up into the maxilla. And in creating that pressure, so those are those are people that might need to quit something,
Unknown Speaker  42:19
right? I mean, it’s very hard to think back in any situation where somebody’s got some stress based, you know, and of course, it’s a cascade of things like maybe they have this because they got this person that leads to that, but there’s probably somewhere in one of those conditions. That’s something I mean, even if it’s like, okay, they’re obese. Well, generally overeating is is self treatment of a stressful problem. Very, I mean, granted, there’s many other things, but there’s just so many times when quitting is the answer to many, many things. So that’s step one. Step two is like I was talking about earlier, drill down on exactly what it is that isn’t working for you and quit only that. Like if you’re unhappy in your medical practice, but it’s only because you don’t like the EMR. And you You see if you can get a different EMR like, instead of, I’m going to quit medicine altogether. Like that’s throwing the baby out with the bathwater, figure out exactly what it is. If you just don’t like the commute, switch to telemedicine, there are all kinds of options, little things you can quit just do one type of surgery or maybe you don’t like procedures will then quit doing procedures instead of having to quit all of medicine. Same thing goes with relationships or cities you live in, like, I didn’t love where I live in San Diego, do I up and move to New York? No, I’m probably gonna try another neighborhood in San Diego First, it might just be like the immediate vicinity. Like don’t make quitting harder than you need to. Don’t cut out more than you need to. And then step three is overcoming the more esoteric fears, which are the sunk cost, fallacy fears, fears of what people would think sometimes the pressure of like, Oh, you have a dream job. Should you just stay in the dream job, those kinds of esoteric fears. Step four is addressing the logistics. And this is a big one for doctors like I’ve got these quarter million alone. That’s not going anywhere. Ever. Now even after I die, I mean, I don’t know what happens then I have nobody to pass it on to but we have to prepare our finances, we have to prepare our own health, especially if we’re doing a lot of Doc’s are doing the whole got a day job and I’ve got a side hustle. Well, that takes a lot of energy, you better have your sleep in order, you better have your diet tuned in. And if you did, like what I did was I went from where I had actual health insurance to now I’m a contractor, we don’t have health insurance. So I had to buy my own and everything costs an arm and a leg, you better get every last exam you can while you have your health insurance before you make that transition. And the third thing to prepare in the logistics department is your relationships because if you’re in a marriage or some other close relationship or you live with your parents or whatever is going on, that will affect other people and they can either be your biggest supporters or your biggest detriment. So best to get them on their side get their buy into the quit before you dive in. And Step five is making the quit in the way that burns of you is bridges and preserves relationship as best as possible, which is essentially just doing what we talked about with the telling the know thing If you’re going to go and quit your job, or some part of the job, same thing, make it about you do the whole it’s not you it’s me thing and just be human about it. Like, don’t say, I don’t want to work at this hospital anymore hate everything about this hospital say, I’m feeling really called to try a different type of practice right now something that they can’t argue with. And they can’t feel heard about, like, Oh, it’s not us. It’s just that really he’s being called to go to like a rural practice. Well, good for him. Now, go try that. That way. If your rural practice doesn’t work, you can probably come back. Don’t leave in like office space, burn the place down. Tell them everything that’s wrong with it. That’s why you’re leaving. Leave in the way that keeps the relationships in case you need to go back. Same thing with religion. Did you take my stapler? I did get red stapler.
Unknown Speaker  45:46
Exactly. So when you left the startup, how did you if they were in the middle of what would you call they were looking for funding?
Unknown Speaker  45:54
Yeah. funding round
Unknown Speaker  45:56
funding round. If you left that, how did you manage do that? But in the nicest way possible.
Unknown Speaker  46:02
I mean, I did exactly what I said is I said, Look, I told him, I said, I have been trying to hang on for a very long time. I’m not sleeping. I am now having to see a therapist. I don’t eat. I’m super anxious. I cannot function and be the. And by the way, if you’re at that point, how great of an employee Are you like, I was a terrible co founder. At that point. I didn’t want to work. I was like not wanting to ever drive up to LA where the startup was, I moved back to San Diego I had lived in LA initially, and I was like, not there for it because it was making me miserable. Like, you deserve a good co founder. You deserve a good chief medical officer. it every time that it seems like what you’re doing is selfish. There’s the flip side where it would also be selfish for you to stay and be really subpar at that job. Specially in medicine, because patients can suffer. And so I that’s exactly what I did. I said Look, I tried to hang on. But you know, the co founder who I’m quitting on, or the founder had plenty of role to play and me being super stressed. And so it was, you know, and I didn’t say like, hey, you’re making me super stressed. But there was also like, yeah, I’m gonna be as nice as I can. But if this bridge has to be burnt, he’s clearly not somebody I’m ever going to work with probably again, because of the way he was treating me then. So I but I still went out at about like, I don’t need an enemy. And we’ll cross paths plenty of times, we both practice the same martial art. And so that’s what I said. I
Unknown Speaker  47:25
said, like, getting kicked in the face. And so, you know,
Unknown Speaker  47:29
small price to pay. But yeah, I just had to say like, I mean, because the stress was just 24 seven, like, I could not get this weight off of me. I was just eating like being eaten alive from the inside. And I said, I’m sorry. I tried to wait till the funding round was over, but it kept getting pushed back and I can’t wait anymore. My health is suffering. That’s what I you know, and if at that point at me, yeah, he’s mad. But like, if he cares about me as a person, then he’s going to know she has to do which is best for you. And if he does not care about me for a person, I do not care that he’s mad. He doesn’t get to be in My circle of five people
Unknown Speaker  48:01
very well put very well put So
Unknown Speaker  48:05
Dr. Lynn Marie You are the master of social media people can find you in all sorts of places to learn more about your five steps of quitting the psychological barriers when to quit when not to quit. So tell us where can people find you?
Unknown Speaker  48:18
You can find my podcast quit happens on all the places they have podcasts and my book quitting by design is on Amazon but you can go to quitting by design calm and find all the above there you can also find my coaching packages I have either an online coaching program or I have one on one so go to quitting by design calm for either of those. And on Facebook and Instagram I’m quitting by design. On Twitter, I’m quit happens because they have a character limit. And if you want to be all jazzed about quitting all the time, you can come to quit topia, which is the Facebook group I have for strategic quitters to hang out and support each other through our quits.
Unknown Speaker  48:56
Do you have a problem with people then quitting the group because they get so excited about quitting the join the group now I’m quitting this group
Unknown Speaker  49:02
hasn’t happened yet. Because this is the thing like, yeah, the second that they, you know, I would tell them and I’ve told people like, Hey, you can quit reading the book midway, but only strategically like, don’t give
Unknown Speaker  49:13
up on the book. But yeah, I mean, there’s always this is the thing is there’s always I mean, still even my day to day life, I’ll probably make a quit every one to two months, it may be a small quit maybe a big quit, but there’s always those to have that reminder, you know, to be always reminded about like, Hey, you can always quit, hey, these are the symptoms of maybe you need to quit some people who are not they don’t spend their entire day and night talking about quitting like I do. It’s good to have that continual reminder so that when friction comes up, you’re like, Oh, that’s right. I don’t have to have friction in my life. Is there a way I can quit something about this, that’ll make it smoother?
Unknown Speaker  49:43
It also sounds like it’d be a good idea to just maybe quarterly or annually to just take stock of your responsibilities and see what you can quit, see if there’s anything in there that you can shed so you can have more free time to do the things that you want to do and spend time with the people you want to spend time with.
Unknown Speaker  50:02
Yeah, just for everybody listening let me give you just to get your your juices quit juices flowing. These are some of the quotes that have made biggest differences in my life. I quit cooking. I have quit yoga memberships and moved to like a class card because I’m stressing out about getting to yoga enough times to make the membership worth it. stressing about going to yoga is counterproductive. So quit that gonna class card. My mom read the book her quit. She came out she’s like, I think I want to quit cleaning your dad’s bathroom. Amazing. Great like he can clean his own bathroom. Like just little things that were not
Unknown Speaker  50:37
or not
Unknown Speaker  50:39
live his own filth doesn’t matter. It is not her job to clean the bathroom that she never uses. And it’s just little quits like that. You might want to quit doing fitness competitions, quit the ketogenic diet. You may want to quit some type of workout hobby that you’re in because it’s taking up way too much time and energy and you’re not getting that much out of it anymore. They’re all of your wits are so San Diego
Unknown Speaker  51:01
Okay, what is the Long Island?
Unknown Speaker  51:07
I’m quitting going to the beach. I’m gonna quit surfing yoga class and cooking and Yeah.
Unknown Speaker  51:14
Like, I quit cooking for, like, doesn’t everybody have to put food in their mouth, right? So like, most people, the food gets there because they cooked it. I’m pretty sure no matter if you’re in San Diego or the rest of the world, people cook to put
Unknown Speaker  51:27
food in their mouth. Interestingly, in a couple of episodes, we’re going to have chef Collins zoo, a family medicine physician and Chef on the show and we’re going to be talking about cooking. Amazing. I know. He’s Oh, yeah.
Unknown Speaker  51:46
But that’s the thing like I quit it all together. Like that may sound crazy, but I have food delivery. I do not cook like somebody’s like, are you gonna bring anything to the potluck? Yeah, ice like I’m not going to cook I do not turn on the oven. And I am so much happier for it. And you can make these ridiculous Somebody quits in your life. Be creative. There are ways to get through it. Cookie was giving me anxiety and strife to cut it out much happier. Take that inventory, figure out what annoys you, what’s the like, low point in your day and see if you can bring that up a little bit by quitting. I’m going to take stock
Unknown Speaker  52:15
of all my responsibilities, and see if there’s anything out there that I want to quit right now. And I think all of our listeners should. And please, please check out Dr. Lynn Marie more skis book and her podcast and her website and her coaching. She has a lot to discuss beyond what we just we’re just scratching the surface with the podcast. So Dr. morskie, thank you very much for your time. It has been
Unknown Speaker  52:38
a pleasure. Thank you very much for having me.
Unknown Speaker  52:43
That was Dr. Bradley Block at the physicians guide to doctoring. And speaking of quitting, don’t quit the podcast, subscribe wherever you get your podcasts. We can also be found at physicians guide to doctoring calm. If you have a question for a previous guest or have an idea for a future episode. Send a comment on the web page. Also, please be sure to leave a five star review on your preferred podcast platform. Our show is produced by guilt free studios in NYC, you can find them at guilt free studios calm. Our theme music was written by our show’s producer voice actor Karen Gallifrey.
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England’s National Health System with Dr. Hussain Gandhi

Given the recent push from the progressive arm of the Democratic party for Medicare for all, it is useful to look at nations that already have that model.  Dr Hussain Gandhi is a General Practitioner (GP) in Nottingham, England.  We discuss the UK health system and the pros and cons of universal state-funded healthcare for populations and individuals.    Aside from his practice, he is the representative to the Royal College of General Practitioners (RCGP) council, treasurer of GP Survival, local LMC representative and owner of eGPlearning – which aims to support clinicians with technology-enhanced primary care and learning. Use the following link to find your platform of choice – linktr.ee/drgandalf52 and find out more about health tech, med tech, social media use as a clinician and more, or better yet subscribe to his weekly updates at bit.ly/eGPleariningYouTube He also co-hosts the eGPlearning Podblast – the UK’s leading primary care focused health tech podcast on various platforms here: linktr.ee/egplearning.

England’s National Health System with Dr. Hussain Gandhi

Given the recent push from the progressive arm of the Democratic party for Medicare for all, it is useful to look at nations that already have that model.  Dr Hussain Gandhi is a General Practitioner (GP) in Nottingham, England.  We discuss the UK health system and the pros and cons of universal state-funded healthcare for populations and individuals.    Aside from his practice, he is the representative to the Royal College of General Practitioners (RCGP) council, treasurer of GP Survival, local LMC representative and owner of eGPlearning – which aims to support clinicians with technology-enhanced primary care and learning. Use the following link to find your platform of choice – linktr.ee/drgandalf52 and find out more about health tech, med tech, social media use as a clinician and more, or better yet subscribe to his weekly updates at bit.ly/eGPleariningYouTube He also co-hosts the eGPlearning Podblast – the UK’s leading primary care focused health tech podcast on various platforms here: linktr.ee/egplearning.

 

EPISODE TRANSCRIPT

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Welcome to the physicians guide to doctoring A Practical Guide for practicing physicians where 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.
On today’s episode, we speak with Dr. Hussain Gandhi, a general practitioner and Nottingham, UK. He’s the host of the EGP learning podcast, where they discuss healthcare technology and its applications for GPS. He’s on the show today discuss the National Health System, England socialized healthcare system. There’s a push among progressive Democrats for Medicare for all a more socialized system for the US. So we discussed the strengths and weaknesses of the socialized English system from his perspective as a GP and the differences and even some similarity between his systems and ours.
Welcome back to the physicians guide to doctoring. On today’s episode, we’ve had Dr. Hussain Gandhi who’s joining us from England. He’s a general practitioner there now also hosts his own podcast. So Dr. Gandhi, thank you so much for being with us today. I think we did do an doing great doing great recording today from my mother in law’s closet in Zurich, Switzerland.
Wow. So truly international podcast with you in Switzerland in the UK.
Indeed, indeed. So first, let’s just talk a little bit about your podcast.
Yeah, so I co host what’s called the EGP learning pod blast. And so it’s a podcast that me and my colleagues set up about just over a year ago, partly because we’re both a bit tech geeks and stuff and we also GPS. So I guess for the benefit of your audience, as a general practitioner, or a GP, is probably the equivalent of a family physician that you guys would have in America, but based in our slightly different country, The structure of healthcare systems. So we do majority of the patient contacts in the UK when it comes to health services. And, you know, I’ve got a huge interest in tech, huge entities and health and provision of health and stuff. So we started up this pocket, that’s just talking about all the various different forms of health technology, and how you can use it either as clinician or as a patient and the impact that it can have. So we’ve covered various different things like simple stuff, like apps that people may use, all the way up to things like genomics, artificial intelligence, video consultations, all this kind of stuff. So yeah, it’s a topic we love to talk we enjoy. And we’ve had some really interesting stuff come out in the past few months. And we’ve got some really cool things coming in the next few months as well. So yeah,
and I think my audience is mostly, if not all in the United States, but it sounds like this is not a UK centric podcast. While it’s you know, it’s based there. I think all health tech is international. So it seems like it would be useful for Anyone?
Definitely, I mean, a lot of the stuff we may cover does relate to the kind of the structure of the NHS and the provision of health care in the UK, but particularly things like the apps themselves and the various different types of tech that we review and cover. Yeah, that’s applicable internationally and stuff. So, and one of my favorite one that we covered quite recently as part of that was something called headspace. So it’s an app that people may have heard of in America as well. And it’s designed to try and help you with mindfulness and meditation and a new mental health really, and it’s definitely applicable anywhere, whether your base really.
Yeah, my wife and I actually just downloaded that app and we started, we started meditating together before bed to help us just, you know, after you put the kids to bed and all unwind helps us get those rambling thoughts out of our head and get to sleep a little faster.
Yeah, I mean, like I said, there’s lots of different reasons for using applications and stuff. And headspace is one of my favorites at the moment. Partly in because of The way the healthcare system is at the moment, it’s one of the options I have to recommend to my patients because I may not have full access to the kind of resources at the same time. So if you’re trying to look for the positives and in terms of what you can get hold of really.
And that sounds like an excellent segue into what we were planning to discuss today, which is the United Kingdom’s National Health System, which actually I think I’m incorrect in calling it the UK National Health System, right. It’s it’s, it’s separate for Scotland, Wales, Northern Ireland and England, right. They’re each an independent system.
Yeah, so so they’re, they’re all called the NHS, the National Health System, but there are regional variations of it that are controlled regionally as well. So although the idea in the original setup was a UK initiative, particularly with evolution in terms of Scotland and that castle, that we’ve now got our own various different portions obviously with NHS England we’ve got NHS Scotland, NHS, Wales, and NHS Northern Ireland and stuff, and they have local control over how they determine their health service delivery compared to various different areas. NHS England is the largest of the lot with the biggest population and, and definitely does seem to do things differently because in the past year or so we’ve actually seen a change in the way that they managed, particularly the primary care aspect of their health care delivery. And with Scotland kind of creating its own kind of contract particularly for the general practice in primary care.
So tell us about the overall structure of the NHS, how does how does this work?
So the NHS is a government funded health care system originally came back around I think, was 1944. Potentially it was set up on the years and sorry, is proposed in 1944. That was a and then it was effectively the father NHS as somebody called nightbot and you’re in Bevin or nicknamed 911 Who was basically came up with this idea of having health care as a socialist kind of delivery mechanism that was accessible for all. So the idea being that no matter who you are, no matter where you were, and within the country, you would be able to access and use healthcare for free, and that money shouldn’t be a deterrent for you being healthy. And eventually went through all the various processes and things went through to become law, and it came into effect. And as a result of that, in 1948, we had the national health care system, they changed from what used to be a private health care system in the UK. And you can argue that it was very much needed at that time, because we were post World War Two, where, you know, health had changed significantly with, you know, half the population. You know, effectively not being round fighting off in the wars coming back and obviously the impact that may have had over that time, that has Been adjustments to the original Constitution and it’s no longer that everything is completely free for health care access. So shortly after as they did introduce charges for prescriptions, which is based on particular criteria, and that’s changed as time has gone on opticians access and dental access has changed as well. So now you most likely will have to pay for some part of that access. So for example, your glasses frames and your glasses lenses, you probably won’t get free anymore whereas, you know, if you went back to the original time you would have done and, and it continues to change and adapt. And one of the more recent changes that we had was something called pension health and care social act in 2012, which made radical changes to the the political structure within the NHS to take away some of the responsibility from the government and also change the the amount of private investment that could occur. Within the NHS, as well as a lot of the structural aspects of how it’s delivered, both from a provider and from a commissioning perspective as well. And that’s led us to kind of where we are now really.
So a way for more private money to enter the system. I think I read that a, for the first time a hospital was bought by a publicly traded company in England.
Yes, I think so. I think it was back in again. 2012, there was a company called circle that took over the Hinchingbrooke Hospital in terms of their running and delivery and everything. Interestingly, I think a short while after about a year or so later, they had to hand it back because they couldn’t manage it financially. And they were just not making enough I guess profit or whatever. But that was handed back in terms of the contract and stuff. And I think that’s where a lot of the potential friction comes into play when it comes to health care system in the UK, in terms of the psychotic features. between private and public health care, funding and delivery. And you know, if you ask the run of the mill person, generally a lot of people seem to have originally a lot of hesitation about private health care. And in the UK, I think that that shit that is shifting, and there’s a couple of reasons why they’re shifting. And, you know, in terms of what we’re going to see, I think we are going to see more private healthcare delivery in the UK is the next few years go on at the very least.
So as a patient, is there an option for private insurance on top of your or, or even instead of your NHS insurance, if you can even call it that?
Yes. So private healthcare still continued. It’s not that with the creation of NHS, it kind of went away. No one’s ever considered it. And so there’s a variety of smaller private hospitals dotted around the area, so even where I live, which is in Nottingham, which I think is 10th largest city in England, and we have about five private hospitals in our city area. And that’s purely because, you know, some people still want the benefit going private because it has different options. And some consultants, physicians and surgeons and stuff still do private work. And they have their own lists and stuff that’s either through companies or more often not, it’s it’s a business book more than anything else, company perks. So if you’re with a company, they’ll provide you with private health insurance, either free or a discounted rate is one of your employee benefits. And then you can access that. And the key benefit has his time, more than anything, because if you’re trying to provide a healthcare system for a population that’s free. And then effectively, the main thing you potentially might have to do is wait because you go into a waiting queue and it’s the healthcare is delivered, effectively, baby On need, not based on convenience. And that’s a key part of the NHS kind of mantra such that, you know, as with anything, you know, people are triage into the category of most need first rather than, you know, what you may have specifically. And I think because of that, obviously, people want to use private healthcare system to speed up things or to make it more convenient. So maybe that, you know, if you’re sitting on the NHS, you’ll be seeing in a couple months down the line. And you know, if you want to be seen, for example, next week, but most likely would not be possible to say for example, you know, you’ve injured your knee and you wanted to have consultant opinion about that, well, you potentially are going to have to wait to have that done. So that that’s where the key differences.
So you mentioned that there are private hospitals in the United States. There are I mean, there are a few publicly like county hospitals. But most hospitals I think are are privately owned. But you get your insurance. That hospital is then paid by your insurance company, which may be a Medicare or Medicaid, which is a publicly funded insurance or it may be paid by your private insurance. So the hospital itself is seeing both private and public patients. But you mentioned that they’re freestanding private hospitals. How does that work? Is it you need to have it and how do they end up getting paid?
And so they end up getting paid by the government directly. So one of the key differences about the UK health system and for example, many other countries like American stuff, is that I think it’s something like 80% of healthcare is paid directly by the government. And the government receives that money through taxation and you know through other sources So we have something called National Insurance is paid by every working person, and how much you pay varies based on your income and that kind of thing. And then that predominately that chunk of money goes to fund the NHS. So the current NHS bill, I think for this year is something like 120 billion, I think it is pounds. And but don’t quote me on the exact number, it has just recently changed. But that’s how much it costs to run NHS England. And as a result of that, it’s like because that that money comes from taxation, that money then goes directly to the providers, and then that’s what they have in order to fund their services. And the difference between hospital care and primary care is different. So majority of hospital care is payment by results. So they get paid for based on the work that they do, compared to primary care, which is a capitation based So effectively, so I’m a GP, I run a general practice, I get paid a certain amount per head per patient. per year, and I have to deliver all the health care that that person may need from that amount, but I get. So as an example, my practice is approximately 10,000 patients. And I receive something like 130 pounds in total. And when you include all the minor tops and that kind of stuff that we get per patient. So that’s what
the 1000 Sorry, I’m a little bit off this morning, and no 1.3 million
pounds to deliver the healthcare for 10,000 patients. And that’s regardless of how many times they come to see us what they may need, you know, all those kind of things. We have to deliver the entire health care for that population for that sum of money.
So if you happen to work in an area where patients happen to be more ill let’s say it’s a lower associate I’m an area where they tend to have more medical problems, you’re going to be working a lot harder, because you have the same number of patients, but those patients are going to have a lot more vision visits. But if you’re in a more affluent area where people tend to be less ill, then then you’re going to have fewer visits or your life is going to be a whole lot easier.
That would say, yeah, that’s definitely the case. And there is meant to be some form of modification around that. So we have something called the car Hill formula, which is basically a calculation is made based on the average age of population, the location of your population, that kind of stuff that just the amount that you get, so I, I work in it in a city Nottingham area, and so quite a deprived population, very complex health needs and stuff. And as a result of that, we get slightly more than say, for example, another area of Nottingham where it’s more suburban, you know, middle class kind of stuff. So the hundred and 38 pounds, We get per patient is slightly higher than other areas to try and counteract whether it meets those demands is one of the key challenges of the NHS. And particularly at the moment, because we are having some challenges to significantly with the NHS and particularly as winter hits, and this year we’re anticipating it’s going to be quite challenging to say the least.
But it sounds like you’re financially rewarded for taking care of a more challenging population, whereas in the United States, a lot of the sicker patients have Medicaid, which doesn’t pay as well as private insurance, where people tend to be healthier. No, you actually get paid more for taking care of healthier patients.
In principle, maybe I would say that the the, the modification factor doesn’t allow for the increased use and and need so although it’s it is an increase, it’s not a significant An increase, I would argue that allows you to deliver the difference in healthcare needs. So although I get more than say, for example, a middle class area, and they would probably get about 120 pounds per patient. So it’s not a huge increase in comparison. And the other thing is, it’s the change of the providing low income. So as I said, we still have private practice and stuff in the UK. And one of the rules within primary care is that you cannot offer a direct private care service to patients on your own list. So if I have a patient living in St. John’s where I work, and I can’t turn around to them say, Well, we’ve got private service where you can be seen this, you know, quicker, or for this particular reason, I can’t offer that directly to my own patients, I have to refund another service. But can you see patients from someone else’s
list like could you do? I mean, it sounds like you’d be extremely busy with all the patients that you need to take care of. But guess if you found a way, like evenings or something to take care of private patients, you could offer them from someone else’s list.
Your services? Yeah, so definitely potentially the challenge there is obviously like I said, I work in an area which is more deprived and doesn’t have the attraction, shall we say, to a more leafy suburban, you know, kind of putting partly is aesthetics, partly its character, that kind of stuff, you know, trying to attract people that would want to pay for their healthcare service is not as easy and, and part of that could be down to services. But actually, the biggest challenge we have right now is just dealing with the day to day workload in order to have the headspace and the capacity to offer extra services to other patients. And so, it is possible and it is done in some places. But it’s not a simple kind of process to go through.
No, you can’t You can’t decrease the hours that you’re treating your other patients in order to make time for those those private patients. This is yes. Like, like I said, You’re extraordinarily busy to begin with, and you know, having a podcast and an active Twitter account. Yeah, definitely. To the business, so, um, so what are some of the issues that you’re seeing now with with NHS because we’re in America, there’s been a push on the progressive wing of the Democratic Party for Medicare for All right, the more socialized system, and we actually have a socialized system in America. It’s the Veterans Health System. And the problem one of the problems that we see in the Veterans Health System is, is there, there’s no incentive. So you’re salaried. So it doesn’t matter how many patients you see per day. At least this is the experience that I had as a resident working at the Veterans Hospital. Is that you see some people that really see as many patients as they can. And you have some people that just they work so slowly that they they’re very inefficient. And that inefficiency leads to longer wait times for for the veterans. So we have this socialized system and and they’re, that that’s just the tip of the iceberg in terms of problems with with that system. So in theory, it seems nice. Everyone has, has a right to health care, everyone should get health care, and it should be an egalitarian system where everybody gets the same care. Great, nice in theory, but in practice, there are all sorts of problems, like you said, triage, someone’s responsible for triage, seeing all these patients and determining who has more more severe problem and should be seen first. And so, that leads to long wait times, unless, of course, you want to increase taxation, in order to increase the amount of money in the system so that you can have more people taking care of more taking care of those patients increasingly investments in technology. And nobody likes higher taxes. So, you know, you have this, everyone has a right to care. Nobody wants to pay for it. So, so what are some of the problems that you guys are seeing right now with with NHS?
So I think that’s probably one of the key aspects. So at the moment, the NHS system, like I said, is predominantly funded by government funds. And in the UK, I think we’re just above the OECD average in terms of how much we fund per head per person, per per area kind of thing. Sorry, what was that OECD? How easy is that the organisation for economics and I will the CD stands for I’m afraid. But basically, it’s the comparison of how much each country puts into its national, you know, its healthcare systems and stuff. So they analyze all the data and stuff and the UK is just above the average in comparison to some other countries and And interestingly, America is the one that spends the most on its healthcare. So money isn’t like 16,000 per head. And I think the UK something like 9000 per head. Again, the figures do change. And I think that’s based off 2014 or 2016 figures, I can’t quite remember. So fairly recent. And, and what’s interesting is that they’ve looked at various different metrics in terms of how much funding you’ve put in, and the type of funding you put in sort of split between private government or self funded. And, and then they’ve also looked at things like outcomes or like life expectancy and that kind of stuff. If you look at the data, and one of the things it shows is that the UK kind of does, okay. And in terms of, you know, the amount that it spent, spends on health care versus the life expectancy of a patient. And if you think if I remember rightly, that the most cost effective country I think was Japan with a life expectancy, something like eight to one average for the amount that they put in. And the Scandinavian countries do very well. So their healthcare system seems to be fairly effective in terms of financing and delivery. And interestingly, in American one, which is probably the most funded one, and like I said about 16,000, and has not so good life, expanding the average life expectancy with some nice 61. And so there is a stark difference in terms of, you know, how much it’s being funded and the outcomes, if you’re just looking at life expectancy as an outcome. I think that the America was equivalent to Turkey.
That does that number seems, seems a bit low. 61 doesn’t. But But I’m, I’m not sure. I know some of the metrics that we do use are not equitable in other countries, for instance, infant mortality, I think one of the metrics we consider any birth of viable birth or any birth past No, no, it’s I think any birth past 25 weeks we considered a viable birth. Whereas in other countries, they they use a different number. So, you know, is is it possible for anyone past 25 weeks to be available birth? Yes. And so that’s why that number is used. But, you know, sometimes you’re comparing apples and oranges. And it becomes harder to compare from one health system to another. But But your point being, there are countries that spend that are more efficient with their spending, right, they spend a certain amount of money to get a certain amount of life expectancy. And while it may mean that you’re stuck waiting for your knee replacement for maybe a couple months more, in the end, you know that that convenience of being able to get that surgery soon carries with it a high economic cost. And so you have to decide where you’re going to spend this money in order to get the best value and in America, we’re terrible at that. Right because the if you have money, you can get care quickly. And if you don’t have money, it can take very long time where you don’t may not have access to certain specialties at all in your in your region, and then that leads to poor outcomes. So yeah, there’s a there’s, there’s a balance here is what you’re getting at between the two and the Japanese have them.
And I think when when you healthcare services provided exclusively by the government, there are also restrictions that come on that. So for example, cosmetic care, and very little cosmetic is funded on the NHS. So, you know, for example, if you had something that was causing an obstruction, like a mole or something like that, it was not, for example, catching on your belt line or catching on your bra strap or something like that. And you may be able to have that removed on the NHS, but you have to show that that is the that there is a medical reason for wanting to do it, not just purely a cosmetic reason. So you know, that would not be covered. And, you know, other things would be so for example, burns patients, that kind of stuff that they would still get some form of cosmetic treatment, and, and no, in terms of how that impacts patient workload, but that’s quite significant at times and patient reasons for attending the practice as well. So as I said, I work in primary care. And we see approximately 90% of the workload that comes through the healthcare system, because to see any kind of specialists, you would need to go through your GP first before you could access them. So my understanding the American healthcare system is if I wanted to go see a guy, an ecologist, well, I guess I wouldn’t want to see a gynecologist, you know, and you know, if as a patient I want to go see a dermatologist more gender appropriate one surely. And then I can just get corporate dermatology provision says center and just you know, go see a dermatologist, as long as I’m able to pay for it or have it covered by like you said the Medicare or whatever like that.
It actually depends. It depends on your so so I think it was like in the 80s Maybe the 90s HMOs were very popular, which sounds like what the what the health maintenance organization. So you signed up for a health maintenance organization, and then you were given a certain panel of patients. So this is this is the number of patients that you need to take care of. But within that panel, I’m not sorry, not within the panel. Within that HMO, there were a number of specialists. So you could have all of your specialists within that panel. And yes, you’d need to go through the GP. And there are some insurances that also make you go through but I think most of those are the the Medicaid and the managed Medicaid, where you actually need to have a referral from your primary care physician in order to see a specialist. And then the wait time really depends on where you are, right? Like if you’re, if you’re in a city, that saturated with practitioners that take your insurance, then they’re probably not going to be a very long wait time. Whereas if you’re in a rural area where there are very few specialists, it’s going to take much longer to be able to see that that that specialist is So your region then affects your outcome, which is unfortunate consequence of our system.
And I think that that would actually describe the way that the NHS service currently runs. So I was working in in city area, and we have actually really good access to things like physiotherapy. And so patients can self refer themselves as long as they register patient within the city area to a physiotherapy service. And they once they’re seen, there will be seen until their problem has a reasonable resolution. And whereas if you go to where I live in Nottingham, which is only, you know, two miles away, we’re not talking you know, massive distance at all. And if I was to injure myself, I have to go see my GP first to get referral to the physiotherapy service. And I will only get two sessions no matter what the problem is. And so even if it’s resolved or not, that’s all I’m allowed. And then I have to go back and get another referral or I have to pay for it if I want to top up kind of thing.
Wow. Yeah, I would I would imagine that most injuries warrant significantly more visits than two visits with a physiotherapist. Or here’s a here’s a squeezy ball for you. Good luck.
Yeah, exactly. So there is massive difference. And I think comes down to this simple principle, there’s a certain amount of money in the pot, everybody kind of wants or needs a piece of it. And and what do you do in the pot runs out? Because that’s the current challenge we’re having to deal with the NHS at the moment. And healthcare is increasingly becoming more and more expensive, because of technology because of medications because of, you know, the the governance as well, you know, increasingly more and more people are becoming more medical, legally aware. And therefore, you know, you can argue that clinicians are over requesting at times to cover themselves. So that’s
happening in your system too.
easily. I think any healthcare system is starting to happen because it’s a natural creep, isn’t it? And part of that, I think is in guideline driven and so is more and more guidelines. Come out. You look at the complexity and the level of depth of care that we have now for simple health conditions compared to what was done 20 years ago, you know, the number of potential tests and recommendations and what kinds of you may have to do is completely different. And compared to that kind of time, and you know, and that has an impact in the workload in the process, you know, that kind of stuff. So, I now have patients who we focus a lot on prevention and prevention of ill health. And that can mean either screen programs and that consult, which are now becoming more prolific. And, you know, I’m a 40 year old medic, 40 year old patients who are taking anti blood pressure medications and statins because of cardiovascular risk scores to try and prevent them having the problem in the future. And that comes with the workload that it comes with. So you know, we would need to see them at least probably once a year, just to check that they’re okay. Check their blood pressure, check their bloods to make sure the medications aren’t causing damage to the liver. And possibly to the cholesterol again, and that kind of stuff. And that all comes with workload that all comes with cost, which is not borne directly by that person. They don’t pay for that. But they do through taxation. So it’s, you know, pay through various different costs. And that creates challenges in terms of, like I said, the provision of health care, because what do you do when the pot is so bursting, that at times you want to provide things and you can’t. So one of the more recent changes we’ve started to have is that actually, they’re now starting to restrict a lot of the potential kinds of treatments that we may be able to offer. So one of the more controversial ones that we’ve had recently is patients with celiac disease, and you have things like the flowers and the, you know, the food items available on prescription, and if you didn’t pay for your prescriptions, effects we got for free. And so therefore, and you know, there were patients that had access to that and became As changes in the way that they’re looking at things, they’ve now basically said that all those prescriptions are no longer appliable. So we can’t offer things like the, you know, the the gluten free products and stuff on prescription anymore. And if you don’t pay your prescription, then you don’t get them at all. So you now have to bear that cost yourself.
It seems though, that that would add some efficiency to the system, right that you have a central body that looks at the cost versus the benefit and is able to make those decisions while as an individual patient, you might say, Wow, this, I have this, this problem. And now it’s not being I’m not getting the assistance of the assistance of the government anymore in terms of being able to have eyes on the entire system and the way the financial cost versus the actual benefit. That would seem to be beneficial, although I’m sure they’re going to be comfortable. decisions where a lot of people don’t agree, you know, sacrifices need to be made.
Definitely. And I agree it would be useful if it was a central kind of group that made those decisions, and they make some of them. And part of the challenge as a clinician comes in the way that those decisions come down in terms of wording. And so a lot of the changes that come into play. So, more commonly used ones are a lot of the medications are available over the counter. So for example, paracetamol, which I could leave you guys call acetaminophen, and, you know, the fevers and pain for kids, antifungal creams that you can easily use to treat self limiting conditions, that kind of stuff. A lot of those are now not recommended to be prescribed for use by patients for you know, a minor illness or or self limiting condition. But interesting, the wording they’ve used is not that you can’t prescribe them, it’s that you should not prescribe them and that slide semantic aspect is actually a real challenge for particularly, you know, GPS in my situation. Because the, the overriding tenants of descriptions when it comes to the NHS system is that if the clinician is recommending that you have the treatment, you should offer it on a prescription. And therefore, if I’m seeing a patient and I say, Yeah, you’ve got a fungal infection, you should have an antifungal to treat that then I’m telling you that I’m now being told I can’t prescribe you them because you should buy it yourself. But then I’ve got another tenant that says I should prescribe it if I’m recommending it. You know, there’s nothing to stop that patient from then complaining and potentially taking you through the legal process, not issuing them a prescription that they wouldn’t have free.
Are there any repercussions for over prescribing to you?
directly, no, apart from I guess, reputational issues and stuff, and obviously, the cost of that comes into it overriding lead to the health care providers. So for example, the money that my practice gets that doesn’t include the drug costs for our patients that’s borne by the higher organizations, the CCGs and the area teams and that kind of stuff. So, MCC g stands for clinical commissioning group which there’s about 50 I believe over the country that basically they get the money to deliver the health care provision, both primary care, secondary care, opticians, dental, that kind of stuff. Sounds like
it sounds like that’s the HMO the CCM an HMO? Yeah, that’s description.
And so they bear the cost of the drugs. And we get monthly reports of how much in terms of our previous year comparison we’re spending, whether we’re overspending under spending that kind of stuff to give us a marker so and you know that they will make those figures and publicly evident. We’ve actually got a really interesting website created by a guy that got challenged to basically Look at prescribing, he created a website called over prescribing dotnet and looks at the individual prescribing habits of every general practice in England and compares them. So it tells you how many practices are prescribing antibiotics. And it tells you how many practices are prescribing, you know, other kind of medications. And sometimes just having that information out there in public can be quite a stark and contrasting kind of tool to make you think about your prescribing habits.
So you’d be they’re using shame as a tool to get you to prescribe
fewer things. And I’d see it more as a learning tool. But yeah, I guess you could look at it as you know, a positive and a negative. And so, you know, there are definitely medications that I think needs to be controlled a lot better. I mean, America is in the grips of an opiate crisis and the UK is falling you quite closely in fact, we’re not far behind you guys in terms of the impact that opiates are having on the general public. We are having huge issues with patients taking significant levels of opiates for, you know, potentially inappropriate reasons and, you know, being able to see where you are sometimes can be a good marker giving you an idea of what you may need to change within practice and the way that you approach things and stuff. And in that sense, I think it can be quite a powerful motivator to see where you are and how you need to change and the impact that will have both on system care but also patient care as well. Because no,
yeah, that’s that’s that would be an interesting thing for for us to do as well. I think in some regards. It could be used as a marketing tool, because you have patients that say, I definitely need an antibiotic right now. I want to give I want to go to the person that prescribes everybody antibiotics. But in the same regard, we also have this public information tool that I think many people are interested in seeing that tell us how much money you get from the drug companies and from the equipment company. So if you have someone that comes to your office and brings you a lunch once a month to tell you about their medication that goes into system, and that is then made public, and I don’t really think anybody’s looking at it, but if you had something that was prescription based, that showed how much people how much people are prescribing, I think that would be a useful tool, like you said, a metric for yourself to see where you fall and help you reflect and improve, but also system system wide. To help us manage trends and manage our prescription medication use, I’m going to be having someone on the show in a bit to talk about the importance of antibiotic stewardship, because that’s that’s just such a huge problem.
It is, I mean, that’s one of the massive things that’s being pushed at the moment in terms of you know, making sure that patients get the right treatments for the right cause and actually is making a difference. You know, I am now actually having many patients say to me, Well, I don’t need them to politics, but what they want is Then check to make sure that they’re still healthy. So the reason why that’s quite interesting is so I talked about the fact that our healthcare system is based on the capitation had, so you know, I get 130 pounds per patient. I’ve seen that patient no matter what their healthcare needs may be, and say, for example, they’re worried that they may have a cold, and they can book in see me to talk about the cold. And I would have to see them. And that could be once a year, and that could be once a week, potentially could even be once a day. And I can’t really turn around and say to them, we’re not going to see you. unless I’ve got a system in place to try and triage them out in some way, shape or form, particularly, they’re coming to me every single day. And that’s obviously how how do you balance that cost in terms of provision of service, and versus what you’ve got in the pot to pay for it kind of thing. And so I do actually have some patients that will come and see our practice on a weekly The basis is, you know, 50 odd appointments in the year, and not a lot. And I imagine spending that much time at your doctor’s office. And, and some of that is appropriate. And some of that you could argue is not appropriate. But the impact that has is that that’s a resource they’re using. And then you still need to provide resources outside of that, unless you can change their health behavior, which is where a lot of the things like antibiotic stewardship has come into play. You know, I think it’s getting people to recognize you don’t need antibiotics to solve every kind of cough or cold all that kind of thing, because the reality is you don’t. But what it has shifted people to is that they’re now asking the question, I just want to make a check to make sure I’m okay. Yeah. And that is having quite a significant impact and the way I try and describe it to particularly nowadays, we are seeing a shift in the fact that people the NHS system was always designed to tell you if you’re unwell but nowadays, people are wanting To know if they’re healthy, which is not really what the NHS is actually designed to cope with, is purely there to tell if you’re unwell and deal with you if you’re unwell. It’s not really a public health tool. And I think a lot of people try to use it as a public health tool. And that’s having a significant impact on the way in delivery the workload is having to deal with.
But that would also be the advantage of having a central system, right is that if you have this paradigm shift, then the central system is able to pivot whereas if there’s no central system, to be able to respond to something like that, then that’s not possible to have that paradigm shift. Because I think this that paradigm shift is happening in many places, right, where you’re, you’re trying to optimize your wellness, not just treat the treat the illness.
Yeah, I guess the difference is that we’ve got a separate organization is meant to be doing that. So we have a public health department across the entire country. This job is to try and deal with, you know, and keeping people healthy. And you could argue quite clearly that public health has better impact on population based healthcare than any individual doctor will ever have in their time. Apart from probably Edward Jenner thing is probably going to have a better outcome. But, you know, it’s a massive shift. And you know, I see people for social reasons, I see people because that lonely, I see people because, you know, there’s no other route for them to go to. And they end up coming to see me to try and sort out things that realistically, I would love to help them. But I don’t have the bandwidth, I don’t have the capacity and I don’t have the routes to give them the help that they need. Because all those services all those things they may need, and either don’t exist or have been chained, used to prioritize for other kind of health options, and therefore the only way for them to access it would be to pay for it themselves. But we live in an area where in an age where the NHS is seen as the main healthcare provider, and people don’t want to pay for it unless they’ve got the funds to do so. And that may not always be the case, particularly working in a in a city deprived area. And someone that is changing. And so I mentioned earlier that we’ve got, you know, new players in the market, we’ve got the proliferation I think, probably in America, you’ve got the same video consultation services for health care, and, and that’s providing a new avenue for people to access health care services in a way and a method that they would want to and there’s both positive and negative and you know, one of the providers, you pay 20 pounds a month and for that you can have as many consultations as you want through a video interface with a GP and if you back Missy privately and or you can See them through in certain areas on NHS basis as well. And you’ll get your health care delivered by that method, which obviously has some benefits in the sense that you don’t have to take time off work to go necessarily you don’t have to go sit around in a waiting area. And you know, with other people, that’s one of your challenges that you have from a mental health perspective, for example, or from infection control. Yes. If you’ve got chickenpox and things, and and you get health care that what kind of way that you want it. And then the other question is, does that also drive a different method of delivery? So are you therefore more likely to get prescribed, like you said, things like antibiotics or medications or, you know, even complaints is one of the things I’ve seen people have increased because then mental Actually, we do need to see face to face. No one don’t want to come down and you know, vexatious complaints as a challenge at times.
Well, I think that’s a great segue back into your podcast, the technology in, in primary care, so it’s Why don’t you just tell us about that podcast one more time before we wrap up?
Yep. So it’s the EGP learning pod blast. And so we’re on all various platforms like iTunes, pod bean, and that kind of stuff. So if you search for it, it will come up quite easily. And it’s mainly hosted on on our pod bean site and pod bean comm slash EGP learning. And we provide a monthly podcast where we cover a variety of different things like app reviews, healthcare, tech, reviews and deep dives. And so one of our more recent and popular episodes is one that looks at video consultations. So if you want to hear more about how that impacts healthcare delivery and stuff, that’s a good one to have a listen to. And and yeah, so every month we do that as well as an in between we interview people who’ve done and created health tech as well to see the journey and share that with our listeners.
Is there anywhere else people can find you?
Yes, as I’m on Twitter, at EGP learning but my personal one which more than happy pupils contact me on is at Dr. Gandalf. 52. And just to be clear, I’m not 52 years old, which is one of the common questions I get.
Now there were just 51 other doctor handoffs before you, I guess.
No, there weren’t. But it was just a way to just unfortunate ganged up was taken by a dead account, which really annoyed me. I’ve been complaining Twitter for many years, because it hasn’t posted for about seven years now. That it’s probably a dead account, can we please close it? So I can take it but Twitter don’t seem to want to listen, which is fair enough. They’re an international company that don’t really have to listen to me, but it’d be nice if it did.
Right. So Dr. Gandalf 50 to EGP learning, fantastic podcast. I’ve really learned a lot about the National Health System and maybe some trials that we’re going to end up with in the United States as we may end up moving towards more socialized system. So I really appreciate you taking the time to discuss this with me and our listeners and been a pleasure. Thank you.
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