Month: April 2019

Truth Prescriptions for a Better QOL with Dr. Errin Weisman

Dr. Errin Weisman is a family physician in rural, southwest Indiana, and a life coach, speaker, blogger, and a podcaster.  We talk about three ideas she wishes she could teach her younger self and each has its own actionable step to help us all live more fulfilling lives.  We also flipped the script on an old formula. On previous episodes, we’ve had specialists discuss what they think all physicians should know about the specialty, but this time, she told us what she wants all specialists to know about being a rural family medicine physician.

Dr. Weisman faced professional burnout early in her career and speaks openly about her story in order to help others, particularly female physicians and working moms, know they are not alone. She wholeheartedly believes that to be a healer, you must first fill your own cup. She is also a farmer’s wife, athlete and mother of three. You can find out more about Dr. Weisman on her podcast “Doctor Me First,” her website truthrxs.com or hang out with her on social media @truthrxs. 

This and all episodes have been expertly produced by voice-over artist @caringilfry 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!!!

#truthrxs #burnout #moralinjury #qualityoflife #familymedicine #somedocs #podcast #medtwitter #healthcare #medical #medicine #physician #doctor

Truth Prescriptions for a Better QOL with Dr. Errin Weisman

Dr. Errin Weisman is a family physician in rural, southwest Indiana, and a life coach, speaker, blogger, and a podcaster.  We talk about three ideas she wishes she could teach her younger self and each has its own actionable step to help us all live more fulfilling lives.  We also flipped the script on an old formula. On previous episodes, we’ve had specialists discuss what they think all physicians should know about the specialty, but this time, she told us what she wants all specialists to know about being a rural family medicine physician.

Dr. Weisman faced professional burnout early in her career and speaks openly about her story in order to help others, particularly female physicians and working moms, know they are not alone. She wholeheartedly believes that to be a healer, you must first fill your own cup. She is also a farmer’s wife, athlete and mother of three. You can find out more about Dr. Weisman on her podcast “Doctor Me First,” her website truthrxs.com or hang out with her on social media @truthrxs.

This and all episodes have been expertly produced by voice-over artist @caringilfry 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!!!

#truthrxs #burnout #moralinjury #qualityoflife #familymedicine #somedocs #podcast #medtwitter #healthcare #medical #medicine #physician #doctor

 

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  0:00
Dr. Aaron Wiseman is a family physician in rural Southwest Indiana, and a physician coach, speaker, blogger and a podcaster. We talk about three ideas she wishes she could teach her younger self, and each has its own actionable step to help us all live more fulfilling lives. We also flip the script on an old formula here at the podcast. on previous episodes, we’ve had specialists discuss what they think all physician should know about their specialty, but this time, she’s told us what she wants all specialists to know about being a rural family medicine physician.
Unknown Speaker  0:33
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 Krebs cycle. The ideas expressed on this podcast are those of the interviewer and interviewee and do not represent those of their respective employers. Those on this podcast except no liability for the outcomes of the medical decisions based on this information as the radiologist like to say clinical correlation is required. This is not medical advice. And 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  1:15
Welcome back to the physicians guide to doctoring. On today’s episode, we have family physician and life coach Aaron Wiseman. She’s a family medicine physician in rural Indiana. And she also hosts her own podcast, helps physicians as a life coach and has an active blog at truth RX is calm, truth prescriptions, but the abbreviation our exes.com. So, Dr. Aaron, thank you so much for being on the show today.
Unknown Speaker  1:45
Absolutely. It’s my pleasure to join you.
Unknown Speaker  1:48
So first, just tell us a little bit about your training where you went to medical school and did residency and what you’re up to now.
Unknown Speaker  1:55
Yeah, so I am a do from Kansas City University out in Kansas City, Missouri. I’m originally from Southern Indiana. And when I was looking around at medical schools, I have to say we are a boilermaker Purdue University faithful so I my family, not that they were against IU School of Medicine, but they were like maybe you can look at some other things because that rivalry runs deep here in Indiana. And so I went out to Kansas City, I love the osteopathic mindset. And so it was one of the first places I interviewed and that’s where I decided to stay. After finishing medical school, I went to deaconess family medicine residency in Evansville, Indiana, kind of down in the toe of Indiana and got my training there and didn’t do any kind of fellowship or specialty afterwards, just got busy and jumped into practice.
Unknown Speaker  2:48
So where is it you’re practicing now?
Unknown Speaker  2:50
Well, it has been a journey my friend, let me tell you so a few weeks after I got out of residency, I realized things were not good. hindsight is always 2020 I was probably already burned out in residency, and having only taken Labor Day weekend off and start into my new practice. I was really pedal to the metal. I got out into practice, and it wasn’t different than residency is actually harder. And that’s when I started looking around and being like what I want to do with the rest of my life, because at that point in that place, I knew I couldn’t do that for the next 30 some odd years of my career. So I ended up practicing in the office for about three years and then transitioned away from traditional outpatient family medicine. I had a real nasty non compete that I had to get away from so for about 1215 months, I practiced emergency medicine here in rural Indiana. And right now clinically, I’m doing a lot of fun stuff with telehealth and telemedicine.
Unknown Speaker  3:46
Well, that must give you a whole lot more freedom.
Unknown Speaker  3:48
Absolutely. It does. And it’s fine. I’ll be honest, I am definitely a millennial and I love what we are doing with technology right now and marrying that with the clinical skills of healthcare
Unknown Speaker  4:00
So, one of the things that I think is very helpful for for burnout is having a creative outlet. So one of your creative outlets is is your podcast. So tell us a little about your podcast.
Unknown Speaker  4:12
Yeah, absolutely. So it was around the turn of the year 2018. I had a business coach at that time and she had a really amazing podcast I’d really got into podcasting with all the foam the free open education that emergency medicine was doing, you know, having jumped into that really want home.
Unknown Speaker  4:33
I’ve actually seen that hashtag quite a bit and yeah, know what’s what’s foam. Aside from this thing that pretentious restaurants will put on your food?
Unknown Speaker  4:43
Yeah, free open access information. So I think the M is medicine or anything, but it’s pretty much everything that’s been locked down before we either had to like join an association or like be a part of particular hospital. Now the thought process is we need to disseminate this information faster. And we need to make it more available to the masses. And actually, emergency medicine is one of the fields that has really taken to this. There’s a lot of great podcasts out there right now, bringing up to date, journal information, new techniques from different hospitals on a variety of topics. And so, family medicine is starting to get a little bit into it. There’s a few podcasts that are popping up. But essentially, the thought processes behind it is if we’re doing something great, or we learned something great. We need to share this with our colleagues and an unencumbered way, you know, not through a journal that you’re not going to have time to read, not through a members only access online, but actually making it available through a podcast.
Unknown Speaker  5:53
I love it. That’s, I think what we’re both trying to do here, so So what’s your podcast? What’s it called and what do you talk about?
Unknown Speaker  6:00
Sure my podcast is called Dr. Me first. And it’s all about authentic conversations between female physicians. I am the only female doctor in my county here in Southern Indiana. And I was really lonely. And you know, that’s another thing that goes along with burnout is isolation. And so kind of in my own selfish way, I was like, You know what, I’m gonna start talking to other female colleagues, and I’m going to start recording them. And when I did, there were just some amazing conversations that happened. Recording wise, I’m up to like episode number 50. I’ve launched about 25 of those. But we talk about everything life and medicine and practice and motherhood and being a woman in medicine, and just really putting that dialogue out into the world. I recently had a comment on my Apple iTunes where it was a non physician, but she had commented that was so great to hear that doctors have problems too. So I mean, it’s particularly for physicians, but I’m loving That non clinical people are listening to it too, because the things that we struggle with, perhaps they’re a little bit more magnified, but everybody else is struggling with it you.
Unknown Speaker  7:11
We’re not as special as we think we are.
Unknown Speaker  7:12
No, no. Sometimes we’re a little bit more pathologic than what we think we are.
Unknown Speaker  7:19
What Why do you call it Dr. Me first?
Unknown Speaker  7:22
Well, it goes back to
Unknown Speaker  7:25
in
Unknown Speaker  7:26
2017, I really sat down and I wanted to write a book. I wanted to write the book that I needed when I was in the middle of burnout, that would have helped me. And so in 2015, I started doing life coaches training, and some of it jives with my clinical science type a brain and some of it didn’t. So what I did is I sat down and I wrote a workbook taking those things that I learned and life coaching training and marrying it with my science brain, and the project was named Dr. Me first so it is a special self guided workbook. For anyone who knows that there’s more to life. We just don’t know where that is. Or for that person who’s just feeling super crispy and just totally in the middle of burnout, you know, no empathy for patients depersonalization, not even knowing what they’re calling is, it’s something they can pick up, put pen to paper and work through it. And my hopes at the end as you come out a better person and a better doctor. Wow.
Unknown Speaker  8:29
Yeah, so from that I just kept the theme and I thought well, might as well name this doctor me first too.
Unknown Speaker  8:34
And I think it’s important, right? We all make that analogy, or rather, I’ve heard this analogy before to to affixing your oxygen mask on before you help someone else right in the airplane. That’s because it loses pressure so quickly that if you don’t get it on really fast, you know you’ll I think it’s from like the partial pressure of oxygen it’ll it’ll leave your bloodstream and you fall unconscious. You don’t happen if it doesn’t happen fast enough. So if you don’t get the mask on fast enough, so You always have to put your own mask on first before because you’re not you’re not as effective. A physician, caretaker family member, community member, if you don’t look out for yourself.
Unknown Speaker  9:09
Yeah, I definitely look at it this way. I mean, 95% of us the stats, say went into medicine because we wanted to help and care for other people. So we really are very percent say, I think it’s money and personally.
Unknown Speaker  9:23
Those are the honest ones.
Unknown Speaker  9:24
Hey, maybe. But so I would say majority of us went into it for good reasons.
Unknown Speaker  9:30
And so at times, I feel like that kind of gets used against us when we’re in training. And then by the time we come out, we’re super self sacrificing. Like we will take care of other people, whatever the cost it is to us. So I really emphasize people that it really is about filling your own cup and your healing art should come from the overflow rather than you turning your cup over and shaking every last drop out of it. So yeah, I the oxygen mask has been used. I like the cup analogy. I love the one that Dr. Dre, Dr. Almond uses to with the canary in the coal mine about how we all need to put our own gas mask on and in the environment of, you know, toxicity that we work in at times. So yeah, any of those I think are great analogy.
Unknown Speaker  10:18
So before the show we had talked about
Unknown Speaker  10:23
and I think some of these probably come from your your workbook as well. Three lessons that you wish you had before you went through your your recovery, burnout, and recovery, three life lessons, and then three action steps that you recommend people take, whether it’s a physician that you’re coaching, or really anyone else, simple action steps that they can take in order to address that lesson that you learned. So the first one you mentioned was life is a journey. There’s no arriving. So what do you mean by that and what The action step that you take in order to, to manage that.
Unknown Speaker  11:04
Well, I think for me, this goes all the way back to getting into medical school, that it was like, Okay, I get into school and and then it’s going to, you know, it’s going to get better then we’ll get through first year and then second year and then third year. And like it was like always pushing towards that, like next mile marker. And then like when I got through all those years and got out my training, like that’s when I was going to like, summit the top of that mountain after climbing and climbing and climbing up. But little did I know that that was just one mountain in the pathway of the journey of my life. And so I think I put so much expectation on finishing, finishing, finishing pushing through hammering through that. I didn’t enjoy the steps along the way at all. I mean, I barely remember the first year of my first child’s life. I was an intern at the time. You know, not that my program was malignant. It was just, it was it was rough. It was rough being a new intern, being a mother, just figuring it all out. And I look back at baby pictures. Now I’m like, I don’t even recall that I only remember that holiday and a lot of the pictures, I wasn’t even there. And so I just tell people, you know that making sure when you’re walking your path that you’re actually like looking around and engaging instead of getting to the point like I did when I summited the top of the mountain and I was like, Holy hell, I’ve climbed the wrong mountain. I really thought after I got a residency that I had made a huge mistake. By going into medicine, I was ready to hang up the white coat, throw the stuff stethoscope in the trash can and like go find something else. Because I was I had just turned 30 at the time and I was like, I, I can do something else I can change. But I think it’s that delayed gratification that we’re really really good at as physicians that we really need to pump the brakes on as well. So my action step with that is life is happening now. And for a few minutes, we gotta stop thinking about the delayed gratification and do something that brings richness into our life today, not waiting for when the rotations over not waiting for the next time we go on vacation. But we we need to know how we can more fully experience life today. Because we all see that death is around us illnesses around us. And we’re not going to evade it either.
Unknown Speaker  13:34
If I if I may make a suggestion to supplement that. If you’re looking for something specific within that action step, you know, human connection is is so hugely important. And sometimes in medicine, even though we’re seeing patients all the time. We’re not really, you know, there were there to help them. You know, they’re not we’re not really talking about ourselves or Connecting about ourselves. So in terms of the delayed gratification and doing something now, for that for a couple minutes a day, reach out to someone that you haven’t spoken to in a while, just send an email to someone that maybe you haven’t spoken to a year or two or three and just tell them how you’re doing and ask them how how they’re doing. And even something as simple in that can add some richness that some of that richness that you’re talking about and some of that depth to your life.
Unknown Speaker  14:31
Yeah, are absolutely like one thing that I had a client she decided to do to bring the riches into her life. She brought like really expensive coffee, like the stuff that’s you like, you don’t want to spill it’s so expensive. And each morning, she would make her really expensive coffee and sit with it, smell it, drink it just take five minutes to really like taste this coffee and and and just be with it. She felt like that was a really centering, a really great experience for her to say, you know, I’m sitting in my home, that, you know, I’ve worked really hard for in my kitchen that I love drinking this really expensive coffee.
Unknown Speaker  15:15
And that also gets back to gratitude. Because if it’s that level of conscientiousness, when you’re drinking the coffee, you’re enjoying the coffee, you’re grateful for the cup, you’re appreciating the coffee. So that’s, that’s another thing that can kind of tie into this action stuff.
Unknown Speaker  15:31
And there’s a huge lot, a lot of work about gratitude. But you know, the sad thing is, a lot of times when people get to me as a life and burnout coach, they can’t even they can’t even comprehend gratitude, because they’ve just been so hammered down. Just almost like I said, just beat down to the ground. That that’s one of the first things that I work with people about is like, finding something in the midst of the stuff of the suck. That they can they can be gracious for.
Unknown Speaker  16:03
And I have a personal story about the delay gratification as well. My 28th birthday, I think I was a second year end resident, and one of my co residents husband’s was there. And he said, Man, he was a year older than us. Man 20 it was a great year, it’s a shame, you’re gonna miss it. Because we just spend so much time in the hospital. And then our free time is spent studying, preparing a presentation, right? We give up that, that that life. And so that might have been the time that I realized that you know what, I have to have two years left in my 20s I have to find time to be able to enjoy it and not just write another paper and do more research and you know, all the rest of the pressure that we put on ourselves. So the next thing that you mentioned was You are not alone.
Unknown Speaker  16:55
What did you mean by that?
Unknown Speaker  16:57
Well, going back to that isolationism
Unknown Speaker  17:02
So many times, I know that when I talk with other physicians, even in a crowded room, they feel like nobody understands. Nobody’s kind of knows their journey. And also because as a physician leader, it’s not like we can relay those struggles to those that we work with, and definitely not unloading those on our patients. And so that’s a huge one, that when I work with people, I think that’s one of the main reasons they reach out to a coach because they don’t want to be alone anymore. They want to have somebody to tell their story and to understand them again. And it’s one of those things too, that we know with suicide research, that when a person becomes totally isolated and hopeless, that’s the moment at which suicide seems like a really good idea. And as physicians, we don’t get second chances on suicide. Typically, a first attempt of a physician is usually always fatal. So that’s where I, I really want to reach out to people who are maybe in that hopeless state, or who are feeling very isolated and just tell them that they’re not alone. And that, you know, they, we all want to be perceived as competent and strong and capable. But it really, it can lead to some huge amount of isolationism. You know, the, for instance, that I shared with you when we were talking beforehand, is what I felt like was lip service that was given to us in residency, like we were told if we needed help, and that there were services, but in my experience was the same attending would then criticize a resident or student who did seek that help or who maybe came to them and said, Hey, I’m really struggling. And I felt like that was a huge double standard that can no longer be tolerated and that we shouldn’t tolerate and that’s why I think it’s great having other physician calls Who are life coaches, because we can be a totally unbiased, unattached resource for physicians and trainees who feel stuck in their situation. And that’s one, for instance, why I formed my own business. I didn’t want to be part of a hospital group. I consult with groups now. But I wanted to kind of have that autonomy of my own. So people can feel safe to unload their burdens when they do feel so isolated and alone. And so my action step for that was reach out to one person who is safe to you, and have an open, open and honest conversation about how you’re really doing not about you know, how when you put the smile on the white coat on and you walk into the room, like take all that off, and be like, really, how are you doing?
Unknown Speaker  19:51
Wow, that’s,
Unknown Speaker  19:54
yeah, I even though we’re surrounded by our colleagues, we can Very often feel feel isolated. And you know, you know being vulnerable. I think it’s Bernie Brown, who gave the TED talk and does the social psychologist that talks about the benefit of being vulnerable. So yeah, I think there’s there’s a lot to allowing yourself to be vulnerable and how it’s actually a show of strength. Yeah, it’s not, it’s not weakness and strength. One
Unknown Speaker  20:24
thing that I’ve started doing around this because you know, we’re all busy, and we don’t want to go to yet another meeting or anything like that is I’ve started having like, online groups that meet via zoom. That’s the the online meeting that I use, and it does, it provides a safe space, it’s only physicians. And the two questions that you have to answer every meeting is what has been your greatest victories since the last time we talked, and what has been your low point. And so that helps like open up that dialogue. One, because then you can kind of show your wounds to people. But then also you can be a witness to those wounds, and it helps with your own healing. Because here’s the thing most doctors walking around today are wounded warriors. I mean, think about that patient who still comes into your mind and dreams from years ago that you haven’t told anybody about. But you know, it still bothers you. So this is the way that I’ve really helped. My colleagues have that safe space have that place to be vulnerable, and it’s coaching involved, but sometimes I turned into a little bit of a support group. here locally, I have got one live group going and Vincent and Deanna that call women in medicine and it’s along the same lines, it builds community, but then it gives a place to be open. And because when we carry so many burdens around, at some point, you’ve got to unload them or they’re going to crush you. So I think it’s just with the amount that everyone is carrying these days, we’ve got to start relying on each other groups and hospital systems have got to see that they’ve got to provide the safe space for physicians, because otherwise we’re all just going to break under the load, or we’re just going to drop it and be like, wow, and leave.
Unknown Speaker  22:20
Yeah, excellent, powerful points. The last thing that that I think that really dovetails well into what you were just saying, is it’s important to listen to yourself. So if you’re having some inner turmoil, right, it’s important to recognize that that’s there. So, when you’re gonna, you’re gonna have an open and honest conversation with someone. I think first you need to listen to yourself. So is that is that what you meant? Well,
Unknown Speaker  22:48
I think so. Yeah, you do have to first. I mean, that’s one thing that we are, we have gotten so good about not doing is self awareness. I do a talk residents and I like so tell me what your body feels like when you need to pee. And you know, a lot of people will be like, Oh, you know, like, I get super crew blood pressure and like that and I’m like, No, really, like tune into that. What does it feel like when you need to pee? And then I’m like, Okay, everybody go take a break, because I know you all need to pee right now. And then come back and tell me what it feels like after you’ve emptied your bladder. Because for so long we have denied ourselves that we we don’t even have self awareness when it comes to our own body urges, let alone our feelings and emotions. It’s a huge one. You know, so many times we’re like, oh, we’re grouchy cuz we’re tired or Oh, we’re angry that but really when you start looking at it and kind of getting a little bit deeper doing that in your head kind of work that nobody really wants to do. You’re like, oh, maybe I’m angry because x y&z maybe something else is going on? Maybe I’m having like some perpetual thoughts. So really learning exactly to like, Listen to yourself. That like squirmy feeling that you have inside of you when something is just not right. Or somebody said something and you’re like, I just doesn’t feel good. I don’t know about you, but so many times, I would just be like, illogical push it to the side. But now I’m starting to learn. I’m like, No, that’s a body cue, like, I need to tune into that what is this telling me? It could be something good, bad, neutral, whatever it is, at least pick up on the cues now. And and like I said, that’s been that’s been intriguing as I’ve been working with physicians, you know, we think we know the body really well. And we know other people’s bodies pretty well. We have no clue on our own. So then, I think that leads further into burnout because then when we can’t even pick up on our own cues, be it thought cues or body cues. We just spiral downward until we like get to the bottom of the pit and then we feel so stuck and desperate and alone and isolated and broken. We don’t even know where to start. Because we don’t even know how to sit with our feelings and our thoughts to kind of Wade all through that. So that’s why I encourage people to like, stop and start examining that. I mean, how many of us can sit with ourself in silence? I know it took me a long time and I still struggle with that. Like, it’s always like, you’ve got to be busy, you got to be doing something. For me, it’s because I always feel like my worth was always kind of based on what I’m doing, what I had accomplished, what I’ve got going on, which, you know, paper, am I working on presentation and we pay patients on my scene, what am I going to do tomorrow, when in fact, we need to take that time to be like, what’s going on with me? You know, a lot of people there’s a lot of like mindset work or mindfulness going on, you know, meditation, yoga, it doesn’t matter, whatever term you want to call it. But pretty much all those are about centering back into yourself, and really getting real with who you are and the body that you live in.
Unknown Speaker  26:00
So is there a specific way that you recommend I you just said, whether it’s meditation or yoga, but there’s meditation, there’s journaling, go for a walk, is there a
Unknown Speaker  26:13
frequency? There’s
Unknown Speaker  26:15
coloring?
Unknown Speaker  26:16
coloring is one. There’s like listening to like ambient music. There’s, there’s so there’s many different ways as there are people. And so there’s no right answer to that. Is there a frequency?
Unknown Speaker  26:33
Like, like five minutes a day, five minutes every other day? 10 minutes, you know, is there is there some some type of structure that you think is is necessary to have, let’s say a minimum effective dose?
Unknown Speaker  26:49
We all want that. Don’t wait because we’re the number
Unknown Speaker  26:50
three.
Unknown Speaker  26:52
Okay, we’re good for the day. We
Unknown Speaker  26:54
got my five and a half minutes.
Unknown Speaker  26:57
The life coaching me says no, the Because one day, you may need five minutes and the next day you need to may need to do five minute boluses every hour. So it really comes down to who you are and what really helps you. So like me personally, I I struggle with meditation. I’ve tried it, I’ve done the podcast, you know, I’ve got that like headspace app, like I really tried it. But for me, really tuning into my body and really listening. I need movement, I need motion with it, I need to be like burn off that like top 10% of energy. So that then I can like really get focused in on what’s going on. So I’m an outdoors person. So I do a lot of trail hiking and trail running. And that’s my, like, checking in with myself time. Like I said, other people have other things that they do. So I think you have to know first, who you are and what your personality type is. When you’re thinking About activities and thinking about things, when you almost get like lost in the flow of it. I mean, journaling, that’s a really good one for some people that that helps them kind of check back in. When they’re doing that, like free thought on paper. There’s a lot of research to about journaling, like connecting thoughts brain and actually writing it down the tactical side, we can get into that later. But I don’t think there’s a perfect recipe for this. And I think you’re always perpetually figuring out and then tweaking and figuring something out and then tweaking
Unknown Speaker  28:35
around, I need my assignment. I need my very specific time period and tasks so I can take it off my list
Unknown Speaker  28:42
number one.
Unknown Speaker  28:46
Because you know, here’s the thing too, when I work with our colleagues, they want the solution. You know, they want the piece of paper that they do XYZ, so many minutes a day for so many weeks, and they will get it done and then they will be healthy. I’m like, it doesn’t work like that. I’m sorry. And if anybody is selling that to you and calling themself a coach, you need to turn around and go the other way. Because that is not how it works. I have people who are like, Well, how do I sign up and work with you? And I’m like, Well, you know, I have a lot of different options. Because for everybody, it’s a little bit different. Some people come to me, and they’re all gung ho, and they’re ready to go. And then I start asking the hard questions, and they’re like back off, because either they need some more time to think about it, or they’re just not ready. And so like I said, there’s no like, if you do this, you will be fixed, because you first have to realize you’re not broken. There’s just things that are off that need to be set back online.
Unknown Speaker  29:44
So just to circle back around the three points that you made. One, life is a journey, there’s no arriving. So wherever you are with your training, or you’re in the thick of residency, or your new attending, you have to record dies, that there’s always going to be that next step. So make sure you’re doing something to enjoy your life. Now, make it more enjoyable, make it more fulfilling. Number recommend recommendation was number two was, you’re not alone. So be sure to reach out to someone on a regular basis to have an open and honest conversation about what’s really going on in your life because your patients are going to be constantly bombarding you with their issues. This is what we do. But you need to be able to have an open and honest conversation with with someone else. And then the last one is you need to have an open and honest conversation with yourself. So you have to schedule in some alone, quiet, uninterrupted time, whether it’s some type of physical activity or journaling or meditation, where there’s no distraction from your thoughts, and you’re really stuck with them so you can reflect on on how you’re feeling and how you’re doing
Unknown Speaker  31:00
That’s great.
Unknown Speaker  31:01
So there is one more thing that I wanted to talk to you about because you’re you’re a family medicine physician and, and we’ve had orthopedic surgeons and ophthalmologists, and I’m an otolaryngologist, we had an anesthesiologist, and every, every one of them wanted to talk about what they think every physician should know about their specialty. So as a family medicine physician, you’re a generalist, right? You’re responsible for everything. So what is it that you would like us specialists to know about a family medicine physician either? what it is that you you struggle with when you’re seeing your patients, or what it is that you feel is the strength of the specialty? what it’s like being anything that you think it would benefit us to know about what it is about something about family medicine?
Unknown Speaker  31:54
Sure. So I can only talk from my own perspective when it comes to family medicine and family Medicine is so diverse, and what people choose to do within their practice. What they don’t do within their practice. So like I said, I’m going to come from the perspective of me. But I think the first thing I would want a specialist to know as a family medicine doctor is there is so much psychosocial that we take care of, and that we know about in our patient in their lives, in their family, those nuances that don’t always make it in to the the EMR, that maybe we did something a little bit quirky, with a medicine or the referral or something like that. But But I know for myself, there’s usually a rhyme or reason.
Unknown Speaker  32:49
And it usually comes off the psycho social on what’s going on with them, for instance, like
Unknown Speaker  32:55
so I’m in the rural part of the state. We don’t even have Uber here that which is totally Sad but transportation is. And so there’s been times that I have had taken care of family members who needed to go to like a similar specialist. And though one is probably sicker than the other, like, I’ve had to request my nurse or even myself call this specialist and be like, I have to have you see both of them because they’re coming in the same, you know, Van together, you know, their their pastor from their churches driving them down, you know, and, and so I think that’s the biggest one and I think the other thing too, coming from the family medicines perspective is that we are a generalist, we we do have to take care. I mean, I took care of cradle to grave and still do and so we know a lot, but not evidently a lot about your specialty. And I know sometimes with some of my friends who are some specialist, you know, they get frustrated with some of the referrals that they get. But sometimes you’ve tried a lot and you just don’t know where else to go. And I think that goes back to maybe as a system we need to get better at colleague colleague calls and just bouncing things off. I’m so I’m, I’m really excited. I always try to get him on the phone when I have the time and also the mental energy to get a hold of a colleague, but it’s like chasing cats sometimes for us to get together, but having those conversations to do what’s best for our patients. I mean, there’s so much pressure right now with formulary changes with what insurances are doing, that the management at the primary care level of these patients is, it’s insane. It’s absolutely insane. And so many times it’s like, if a specialist orders and medicine or particular test and they can get ahold of or Something’s going on. A lot of time that gets kicked back to me. Like I’m the pitch runner that just got thrown into the game. And I got to figure it out. I’m one of those stories I can think of when I first got over residency is being the new doctor in town of course, I was like picking up all the new patients. And I was working at our I had started working at the local one of the local nursing homes, and it was a real young gal. She was like 43 got admitted to the nursing home in stage. CHF. Little did I know that she was like on a 24 hour like infusion with all of these cardiac meds like they were sending her to the nursing home for hospice because they thought that she was just going to die. And so now I’m back to like the inpatient rounds. Taking care of these like, super toxic meds were like drawing troughs every couple hours from the nursing home and in like, also having the hospice talk with this family and like preparing them for what that looks like. And lo and behold, like she started Getting better. And so it was like one of those that just the juggling of that is, oh, it’s astronomical sometimes. And here I’m sitting, like an hour away from any major hospital if something should happen, or, you know, I’m calling up my good buddies from medical school and trying to get the best information that I can from them getting stressed out, just thinking about
Unknown Speaker  36:22
that.
Unknown Speaker  36:22
Ah, it’s amazing. So I, you know, there’s times where I’m at that, you know, people just walk into the office and they’re like, hey, I need to see the doctor and we’re not walking clinic or we weren’t a walking clinic, I should say, since I’m not there anymore. But we had one guy, he came in, he had cut his hand in his workshop, he was retired, and he opens up his towel that he brought in, and I mean, I’m clearly looking at all the tendons in the palm of his.
Unknown Speaker  36:54
And I’m like, a now this is bigger, and I had to literally
Unknown Speaker  37:00
It’s so terrible but I so I know our local Ms. So I get on the phone. I’m like Chris, you got to come to the office. I got a guy here. He’s going to try to drive himself to the hospital. I was like, he’s got a really significant hand laceration. And like, I made him get in the ambulance to go because otherwise he was just going to go home. his dog.
Unknown Speaker  37:19
Yeah. No hope that it secondary intention.
Unknown Speaker  37:22
Yes. Yeah. Yeah, exactly. He was going to probably put some duct tape on it. And it’s like, No, no, we can’t. So I think that’s something to to remember, like, in the middle of a busy clinic day or you’re in the O r, and you get these calls, and you’re just like, what in the f are they doing? Like just remembering on the other side, like they’re probably struggling with something big too.
Unknown Speaker  37:49
Yeah, and as especially as sometimes that’s when I when I walk the patients through why they’re seeing me, sometimes, you know, and I even need to clap What the what the question is? Because that, you know, that happens sometimes just oh yeah, listen, you just know the patients. They’re super sick. They’re super complicated. You’re just guys, I just, I just need a little help. That’s all I’m asking for right now. Like, you know, and so I think it’s important that we, we also communicate with our, with our colleagues, you know, a couple episodes ago I had a radiologist sanj Cottrell, who wrote a book on positive psychology. And one of the things that he said as a radiologist was, he makes it a point to call the referring doctor at some regular interval, just so he can connect with with the referring physician. So he’s not just stuck in a dark room and, you know, reading film after film completely divorced from the patient that he’s somehow helping, you know, three steps away by by reading the film that those those physician connections are really important. It really gets back to what You’re you were talking about earlier, you’re you’re not alone, you know, the connections are important. So even reaching out and speaking to the referring doctor or as a family physician, reaching out and speaking to the, the, the specialist, this is what the patients got going on. This is what I’m worried about, you know, and I think it’s a learning opportunity for everybody. So I think that’s
Unknown Speaker  39:20
really clear because we’ve all gotten lazy about like reason for referral and putting like, chronic sinusitis, you know what I mean? Like, really getting like putting some more information with that, like, you know, failed treatments, how many times you know, what did their CT show, like, really like helping that next guy out down the road? Just taking the few extra minutes to put in
Unknown Speaker  39:48
all the work that you did? Yeah, work that you did all the work that you did as as the primary care provider. This is what I’ve done so far. This is all the work that I’ve put into this patient and they’re still not getting better. You know, where do we where do we go from here? Yeah, I think that’s that’s an excellent way.
Unknown Speaker  40:04
And I think we’re all going to have to work on capturing that time back. Like, we really need to push back and say, you know, having that time to be like, even if it’s carved out your schedule being like, no, I need to have that so I can talk to, you know, my referring physician or my primary care. Because, I mean, I think that’s part of where we went wrong in the culture of medicine. When we start digitalizing everything we just assume that our message would get across through that EMR and an absolutely doesn’t. And I think that’s the important of having the connectedness within your medical community. So that like, you know, I remember as a student like going into still when doctors lounges were still a thing, and and knowing the people in there and and being able to know a face with a name and I feel like That’s been part of our problem is we don’t even know who’s who. We don’t even know how to talk to each other because we’re not sure the roles that everybody’s playing or the patient type or even, you know, maybe there’s something that you’re really good at, but because we don’t have that personal connection anymore.
Unknown Speaker  41:20
That’s happening and that’s a detriment to us, and it’s a detriment to our patients.
Unknown Speaker  41:25
And I definitely need to get a lot better about that I need to get a lot better about contacting my referring physicians. And for those who are just starting out in practice, hugely important for building your practice. Whenever referring doctor says even if they didn’t send the patient to you, even if they ended up in your office, because you’re available because you’re the new doctor in town, you’re the one with the open schedule, contact that referring provider and let them know what’s going on with their patient. it’ll it’ll help you enjoy your job more. It’ll be better care for the patient. And That’ll end up building your business. So
Unknown Speaker  42:02
well the other thing to them like as the family practice, then I’m like, Hey, I know I can get ahold of Dr. Block. You know, he, he, he seemed like a nice guy. It seems like this will be a good fit for this patient. Because then you have that can congeniality between the two of you, like I can even think now of specialists that I rotated with as a family medicine resident? Yeah, I refer to them all the time, because I know them. Yeah, I know, their kid, I can attest to their character. And, and I know that if anything happens, like they have my cell phone number, if they really need to get ahold of me, and I think I think that’s where it comes back on pushing back on administration and being like, you’re protected time like, you should have protected time to be able to get to these medical staff meetings. You should have protected time. Somewhere in your schedule that if you are a specialist, like you said, being able at the end of your day, to try to contact somebody having the protected time to get A way to local CMEs to meet other physicians is so vitally important and we really need to push back on that and say no, this is important to us. We need to protect it. We need to have this in our life and in our practice.
Unknown Speaker  43:15
Excellent point. Excellent point. So Baron Wiseman, where can people find you online?
Unknown Speaker  43:21
All right, they can Google me it’s Aaron with two R’s. And Wiseman is spelled V is man. You can also type in truth prescriptions, and I will hopefully pop up at the top of that. You can hang out with me at Dr. Me first on anywhere that you listen to podcasts. And you can find me I like hanging out these days a lot on Instagram and LinkedIn. Facebook is not my friend right now. I’ll be perfectly honest. So you can find me at the handle truth or access. And, again, my name Aaron Wiseman do on LinkedIn.
Unknown Speaker  43:55
Well, this was a great conversation. I certainly learned a lot about the life of Family Medicine. physician and ways that I can improve my life. So I hope our listeners have and I’m sure they have. So thank you very much for your time. It’s been a pleasure.
Unknown Speaker  44:11
That was Dr. Bradley Block at the physicians guide to doctoring. He can be found at physicians guide to doctoring 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, please be sure to leave a five star review on your preferred podcast platform. We’ll see you next time on the physicians guide to doctoring.
Transcribed by https://otter.ai

Evidence Based Habit Development

If you’ve ever counseled a patient (or yourself!) on how to improve their diet, quit smoking, or exercise more, you are basically saying that they need to improve their habits.  Should you be telling them to go Paleo?  Keto? Crypto? CrossFit?  Yoga?  Tai Chi?   Dr. Tello gets into the evidence behind the science of habit development.  Her recommendation?  Just do one push-up a day.  Or eat one piece of kale.  That’s it!  She wrote a book about evidence based habit development called Healthy Habits for your Heart

We start by talking about the interesting way that she got the book deal before diving into the science of habits.  We discuss how to start a habit, how to discontinue one, how long the process takes, the psychology of habit development.  The second half of her book is a list of 100 heart healthy habits, so discuss a few of those. 

Monique Tello is a primary care physician at Massachusetts General Hospital in Boston, Massachusetts and instructor at Harvard Medical School. She practices part-time internal medicine at Women’s Health Associates, a small MGH-based primary care practice with all female providers that serves predominantly female patients. She is originally from the Boston area, and graduated from Brown University and the University of Vermont College of Medicine. She completed a combined internal medicine and pediatrics residency training program at Yale/New Haven Hospital. After residency, she earned a Master’s in Public Health at the Johns Hopkins Bloomberg School of Public Health and completed a clinical research fellowship in General Internal Medicine at Johns Hopkins Hospital; her research and clinical focus while at Hopkins was HIV Women’s Health. Throughout training and beyond, Monique has been active in international health, volunteering at and supporting clinics in Central and South America, as well as participating in several disaster missions. While living in Baltimore, she met her husband, local sports broadcaster Bob Socci, and they relocated to Milton, Massachusetts almost a decade ago. They have two young children, one with autism. She is half Latina, speaks Spanish, and maintains a close relationship with her extended family in Guatemala. She writes a popular blog, generallymedicine.com, about her life as a doctor and a mother and contributes to many other blogs, including Mothers in Medicine and Harvard Health Blog. Her writing focuses on work/life balance and healthy lifestyle.

Evidence Based Habit Development

If you’ve ever counseled a patient (or yourself!) on how to improve their diet, quit smoking, or exercise more, you are basically saying that they need to improve their habits.  Should you be telling them to go Paleo?  Keto? Crypto? CrossFit?  Yoga?  Tai Chi?   Dr. Tello gets into the evidence behind the science of habit development.  Her recommendation?  Just do one push-up a day.  Or eat one piece of kale.  That’s it!  She wrote a book about evidence based habit development called Healthy Habits for your Heart

We start by talking about the interesting way that she got the book deal before diving into the science of habits.  We discuss how to start a habit, how to discontinue one, how long the process takes, the psychology of habit development.  The second half of her book is a list of 100 heart healthy habits, so discuss a few of those. 

Monique Tello is a primary care physician at Massachusetts General Hospital in Boston, Massachusetts and instructor at Harvard Medical School. She practices part-time internal medicine at Women’s Health Associates, a small MGH-based primary care practice with all female providers that serves predominantly female patients. She is originally from the Boston area, and graduated from Brown University and the University of Vermont College of Medicine. She completed a combined internal medicine and pediatrics residency training program at Yale/New Haven Hospital. After residency, she earned a Master’s in Public Health at the Johns Hopkins Bloomberg School of Public Health and completed a clinical research fellowship in General Internal Medicine at Johns Hopkins Hospital; her research and clinical focus while at Hopkins was HIV Women’s Health. Throughout training and beyond, Monique has been active in international health, volunteering at and supporting clinics in Central and South America, as well as participating in several disaster missions. While living in Baltimore, she met her husband, local sports broadcaster Bob Socci, and they relocated to Milton, Massachusetts almost a decade ago. They have two young children, one with autism. She is half Latina, speaks Spanish, and maintains a close relationship with her extended family in Guatemala. She writes a popular blog, generallymedicine.com, about her life as a doctor and a mother and contributes to many other blogs, including Mothers in Medicine and Harvard Health Blog. Her writing focuses on work/life balance and healthy lifestyle.

Anesthesia Myths and Unbound Doctors

Dr. David Draghinas was an active duty anesthesiologist in the US navy before going into private practice in the Dallas area.  He made his first foray onto the world wide web with the anesthesia myths website, as a way to help patients tell fact from fiction with anesthesia.  We talk about what he wants all physicians, especially those writing surgical clearance letters, to know about anesthesia.  We also discuss his podcast, Doctors Unbound, where he interviews physicians who are doing “amazing things outside of clinical medicine.” He curates only the finest guests, which is why he had me on the show a few months ago.

anesthesiamyths.com/

doctorsunbound.com/

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!!!

Anesthesia Myths and Unbound Doctors

Dr. David Draghinas was an active duty anesthesiologist in the US navy before going into private practice in the Dallas area.  He made his first foray onto the world wide web with the anesthesia myths website, as a way to help patients tell fact from fiction with anesthesia.  We talk about what he wants all physicians, especially those writing surgical clearance letters, to know about anesthesia.  We also discuss his podcast, Doctors Unbound, where he interviews physicians who are doing “amazing things outside of clinical medicine.” He curates only the finest guests, which is why he had me on the show a few months ago.

anesthesiamyths.com/

doctorsunbound.com/

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 radiologist like to say clinical correlation is required. This is not medical advice. And even though the magic of podcasting may make it seem like we’re speaking directly in your ears, this does not constitute a physician patient relationship. If you have a medical problem, seek medical attention And now, here’s Dr. Bradley Block.
Unknown Speaker  1:05
Dr. David jumpiness is an anesthesiologist in Dallas, who made his first venture on to the World Wide Web with the anesthesia myths website as a way to help patients tell fact from fiction with regards to anesthesia, we talked about what he wants all physician, especially those writing surgical clearance letters to know about anesthesia. We also discuss his podcast the doctors unbound, where he interviews physicians who are doing interesting things aside from typical clinical responsibilities, as he curates only the finest guests. I was one of his interviewees a few months ago. Welcome back to the physicians guide to doctoring. On today’s episode, we have anesthesiologist, Dr. David droopiness. He’s in private practice in the Dallas area. And he’s actually had a presence online for a long time. He started out producing a website called anesthesia myths, which we’re going to talk about today. Originally, he produced it for his patients to help them understand anesthesia better and obviously dispel myths, but we’re going to be talking about anesthesia Miss for physicians, and currently he’s also a podcaster as well. He has doctors unbound, where he talks to different doctors who are, as you would expect, unbound by physician stereotypes, they do things that are really out of the box and unexpected for for typical physicians. So Dr. Dave, thank you so much for taking the time to be on the show today. Clearly,
Unknown Speaker  2:32
you have a lot on your plate. Hey, thank you so much for the invitation. I’m excited to be on the show, talk to you, and hopefully share some things about what I’ve been doing and anesthesia, all that kind of good stuff.
Unknown Speaker  2:44
So first, let’s just talk about your training. Where’d you go to medical school and residency?
Unknown Speaker  2:48
Yeah, sure. So I trained on the west coast. I’m kind of a USC lifer. So I was a biomedical engineer for undergrad at the University of Southern California. Go Trojans. Then I stuck around for medical school left for just one winter. I was like, Well, you know, I need to get away a little bit. So for internship went to University of Michigan so actually caught a real winter. One was enough for me and then I, I got my butt back to Southern California where I did my residency in anesthesia.
Unknown Speaker  3:23
And then what are you doing right now?
Unknown Speaker  3:25
So now I’m in private practice in the Dallas Fort Worth area. I had the Navy pay for three years of my medical training. So after I finished my residency, I went down to San Diego and I was a naval anesthesiologist for about three and a half years had a wonderful time taking care of our servicemen and women, their families. So did that for about three and a half years down at the Naval Medical Center in San Diego. And then we knew that it was time for us to kind of move on, move into private practice, start a family and so after our first That stint, I moved out here to the Dallas area and I’ve been here ever since and really enjoy it out here.
Unknown Speaker  4:06
So what does private practice mean for an anesthesiologist?
Unknown Speaker  4:10
Yeah, you know, the anesthesia itself. You know, anesthesia is the anesthesia, but you probably have, you know, different pressures, different, different processes when you’re in private practice. So, obviously, you know, the stress for the anesthesiologist that you always have to provide a safe anesthesia care. But when you are in a private practice setting versus maybe an academic setting, where there’s teaching, there’s residents, there’s things like that, then, you know, the speed of everything kind of moves up. And so you just you have to be very efficient, still take great safe care of your patient, but do it in a very efficient manner.
Unknown Speaker  4:50
And you started a website. How long ago was it that you started on a season with anesthesia? Yeah, it’s such a
Unknown Speaker  4:57
such a mouthful. Yeah. You know, started it probably like I believe it was 2012. It was right after I came out, it came to Dallas, I was here for about a year or so. And what I saw was, I had a certain subset of patients, not a large subset, but significant enough, and these patients would show up, let’s say for elective surgery, and, you know, they knew about it for a week, a couple weeks, whatever it was, and they would show up just super anxious. And so I said to myself, you know, what could I do to hopefully help alleviate some of that anxiety and I found that talking to them, explaining to them, you know, the different risks related to anesthesia? Sure, there’s some risk, but for the vast majority of people, those risks are very small. And just explaining the process would have alleviated a lot of that stress and anxiety. And so I asked some of these patients said, Hey, you know, you’ve been stressed for two weeks, what have you been doing? And they’re like, well, I’ve been googling, you know, these keywords, these topics, these anesthesia related words. And so I started doing that myself. And when I saw what was out there, you know what Was popping up on the first pages of Google was kind of scary, whether it was misinformation or you know, or forums where, you know, it was patients giving patients advice, just just a lot of misinformation. And so with a buddy of mine, you know, is also an anesthesiologist. We said, Hey, why don’t we create a site where, you know, we’re not trying to be physicians for these patients? Oh, it’s not for patients per se, but it is for lay people and so how can we provide anesthesia information in simple to understand language that was the goal, just to provide that anesthesia information for people who, you know, might be having whatever procedure and they’re just nervous about it just to give them a little bit more reassurance about the process.
Unknown Speaker  6:47
So they’re not getting their information from like a horror movie.
Unknown Speaker  6:50
Exactly. It’s it’s so difficult because, you know, in a lot of movies, you know, unfortunately the anesthesiologist is is usually like the scummy bad guy. You You know, who leaves either the villain or or, you know, just the, you know, the, the immoral person who just, you know, just leaves in the middle of the case or, you know, doesn’t care, you know, it’s just all of these bad stereotypes. And, you know, unfortunately, there’s a certain number of patients who, you know, take that to heart and I’ve got to sit there sometimes and say to them, I’m not leaving the room. You know, this is not like the movies, and just to kind of explain these different things to them.
Unknown Speaker  7:28
Well, if you’re a good anesthesiologist, you’re not memorable, right? Like, if everything goes smoothly, they don’t think about it at all, ever again. And so it’s the it’s the memorable events that end up becoming memorable, right become maybe lower or end up getting shared on Facebook or something like that.
Unknown Speaker  7:48
Yeah, sure. And that’s probably, you know, you know, what you’re getting as probably the crux of, you know, online reviews for physicians, right, because you have, you know, 100 great outcomes with patients but You know, they don’t bother to leave you a review unless you probably prompt them because, you know, they don’t think about it, but that one person who either you rubbed the wrong way or or you know, or something happened, maybe their IV infiltrated. Yeah, something like that. And then all of a sudden, that’s the person who’s going to go online and, you know, let everybody know about it. So it’s, it’s tough, you know, all physicians deal with that. It’s, it’s part of the part of the job, unfortunately.
Unknown Speaker  8:25
So we were going to talk about today is anesthesia myths and I really need to enunciate that for physicians. So the first question is, if you are with a med student, and you know, they’re going to do something non surgical, what is it that you want them to take away? Put another way, what are some of the myths that they might have about anesthesia that you’re going to need to dispel? Sure so
Unknown Speaker  8:53
so probably as far as you know, a lot of people think about going under anesthesia, rotation and probably, you know, the top thing that comes to mind is probably intubations. And Ivy’s, you know, and it’s okay to get that experience, you know, that has its place, I would say probably one of the things that’s more overlooked is how to properly ventilate a patient mask ventilation, because you don’t necessarily need to know how to intubate a patient. But if you can mask ventilator patient, you can keep that patient alive until help, you know, until help gets there. So, you know, whenever I’ve, you know, dealt with trainees who come through my or I’ve always tried to emphasize that number one to them, you know, teach them how to hold a mask properly and properly ventilate a patient. So I think that is one thing that comes up and is really important. And then you know, they want to get some IV experience sure that that can help intubations all that kind of stuff. But I would say that’s one thing that’s maybe sometimes missed by people because it’s not that interesting, right? So I got the intubation But the mask ventilation is probably more important, right? Because they’re
Unknown Speaker  10:05
the likelihood that they’re going to be called upon to intubate at some point, pretty low, right? The likelihood that they’re going to be at a code, and they need to match the patient, especially during their training is significantly higher. And as an EMT, you know, we know a bit about the airway. So I would add to that, don’t underestimate the value of an oral airway. Yeah, fine. If you’re having trouble very ventilating, get that tongue out of the way, put an oral airway and it’s likely to make it significantly easier for you.
Unknown Speaker  10:31
Absolutely.
Unknown Speaker  10:33
So I actually had surgery this morning. And so I asked my anesthesiologist what, what thoughts he would have about something like this, and he referred specifically to physicians given clearance, right, so primary care physician is giving clearance before surgery. And he said, a lot of times they’ll say things like well cleared for local anesthesia or something along those lines. He said that I think it’s a little mismatch of What’s being asked and he said, Don’t tell me what to do. Tell me about the patient. And I thought that was really appropriate, because ultimately, who’s getting cleared for surgery? It’s the anesthesiologist, right? Because you guys are the the gatekeepers, and if the lungs are clear to the primary care physician, but you guys hear some wheezing and asthmatic, you’re, you know, you’re going to take that clearance and turn it right around. So I thought that was an excellent point. Tell me about tell me the patient’s story. Well, they have a family history of cardiac disease. And the last EKG was then the lessee. Echo was then and these are their labs. And, you know, I think they’re This is there’s still some risk, but this is as good as they’re going to get. And then the anesthesiologist can make as informed decision as possible.
Unknown Speaker  11:47
Yeah, absolutely. Probably as any anesthesiologist that it really puts us in a bad spot if somebody recommends a particular type of anesthesia because it may be because it may not be the the best plan for that patient. But when another physician has suggested that especially a physician, that is not an anesthesiologist, now, you’ve already planted that seed into the patient’s head. And it becomes more difficult for me to get them to buy in to the plan that I think is best. So this is one of the things actually that that comes up a lot. And what I would say is, you know, we’re not looking for quote, unquote, clearance, what we’re looking for our consultant colleagues, is for more information that will help us take care of the patient. So what I would say, you know, let’s say, cardiology comes up as an example, quite often, right? Where you know, we send a patient to a cardiologist, well, what are we really looking for? You know, we’re looking for kind of, you know, two different things. You know, what is the significance of the disease process that the patient has, because that may impact my anesthetic it may impact the type of anesthesia induction agents that I might choose, a patient that has a poor rejection fraction might get a different type of induction agent as somebody else. And number two, what I’m looking for is, is anything that this patient has, you know, within that disease process or for that specific organ, or whatever that specialist is looking at, can anything be optimize? You know, because we’re talking if we’re talking about elective surgery, you know, we’d like to know if there’s anything that can be optimized prior to elective surgery. Now, if it’s an emergency surgery, then all bets are off, you know, we we have to take that risk, we do the best we can for that patient. But those are kind of the you know, the big things, you know, that we look at, in in when somebody recommends, you know, recommend spinal now it puts us in a bind, because now we’ve got to explain if we don’t think that spinal is the best option, why it’s not.
Unknown Speaker  13:49
And then it’s tough to manage that situation in terms of helping that referring physician to save face. Sure, because now you’re putting your you’re stuck. contradicting the physician that they’ve had a long relationship with, and you’re this new person coming in, who’s contradicting their trusted doctor. So that’s Yeah, that that always makes it for a challenging situation for all parties.
Unknown Speaker  14:14
Yeah, for sure. There’s a story. And I don’t know if this is war lore if it actually happened, but I was I think, I don’t even think I was a resident. I was a med student rotating through anesthesia and there’s, you know, one of these very, very vocal and boisterous attendings and, you know, he told a similar story of, of one of his mentors, you know, who was like, you know, chair of the department or whatnot. And one of these patients gets a recommendation from I forget what specialist and they said recommend spinal for the anesthetic. So, so the story goes, that this particular anesthesiologist brought the patient to the operating room, got the patient set up for a spinal and then said page doctor recommended the spinal it is supposedly that, you know, that physician shows up and, you know, he looked at at that person and said, you know, up Ready for their spinal, you know, sort of jaw dropping, because, obviously, you know, they weren’t well equipped to place a spinal So, so don’t make those kind of recommendations. Just you know, we really appreciate the the expertise of our of our specialists, colleagues that consult for these patients, it really helps us get the patient through the perioperative period, you know, as safely as possible. But really, those are the things that we’re looking for. We’re looking for the significant significance of the disease process. We’re looking for anything that can be optimized there so we can best take care of the patient.
Unknown Speaker  15:32
What are the risk factors? What can be mitigated and what can’t? Sure, yeah, yeah. So So let’s say you have a med student rotating with you. And now you know, they’re going into a surgical specialty. So you know, they’re going to be on the other side of the curtain from you. Is there aside from bag mask ventilation? Is there anything that you want a future surgical colleague to know about? anesthesiology?
Unknown Speaker  15:58
Well, what I would say Is that the surgeons that I’ve worked with that just impressed me the most, and if I can put it that way, are the ones that understand the anesthetic implication, you know, and what we do and how that correlates with the surgery. So, so to give you an example, I was working with the surgeon some time ago, and, you know, got a phone call from the surgeon, very experienced. Surgeons been doing this for years and years. And he says, you know, hey, Dave, we’ve got this patient and this patient has a difficult airway. Now, you know, as an anesthesiologist, you know, okay, you know, that that that makes us kind of perk up trying to you know, we got to do a little more research exactly, you know, what was difficult etc. But then the surgeon said to me, now that now the The surgery was a hernia repair, typically with a hernia repair. You know, we’re going to paralyze and intubate a patient because we’re getting in trouble nominal. And, you know, when you intubate a patient, you know, difficult airway There’s certain things there. So but this surgeon said to me, says says Dave is like, I can do this case with an LMA. And what that surgeon was telling me is he understood our anesthetic. He understood that with an LMA, I don’t need to paralyze a patient, you know, I can slip that in without having to, you know, dl and intubate the patient. So, you know, he was giving me more options on how to safely do that anesthetic, because he understood, you know, my side, my side of the drape as well. And so I appreciated that tremendously. Because, you know, it gave us another option, had all the difficult airway stuff in the car, but we were able to safely do the case with an LMA, and the patient did great. And you know, we didn’t have to take on that risk of, you know, doing either an awake intubation on a patient that could be a lot more uncomfortable, or, you know, going down the road of you know, different intubation.
Unknown Speaker  18:02
So, if the patient’s not paralyzed, they’re still breathing. Right? Is that considered general anesthesia? Like how how do you define general anesthesia versus conscious sedation versus unconscious sedation? versus, you know, I think sometimes it gets confusing for surgeons. One thing that’s confusing is, what do you how do you define surgery? Right? Like, if I’m doing your tubes and a kid, I’m doing it in the operating room. It’s technically surgery, when I’m doing it in the office, because that technically surgery is it an office procedure? If I’m doing something like that an adult, I think basically what it comes down to is it’s defined by the CPT code, and then you have some insurance companies that will put certain procedures in their surgical deductible. And so then it’s the insurance company that’s deciding what qualifies as surgery right, not any agreed upon nomenclature. So what about for me seizure were defined the different types of anesthesia
Unknown Speaker  19:02
and you know, and it’s a spectrum and it’s, you know, it can be tough and it can be confusing because you can go from, you know, a very light sedation, to a moderate sedation, to a deep sedation to general anesthesia. And, you know, you can use the same drugs to accomplish all those things, but but the dosing and the timing of it matters. So basically with general anesthesia, you got somebody that is, you know, losing consciousness, they’re losing their airway reflexes You know, that’s that’s going to indicate that they’re under general anesthesia, it does not necessarily mean that you’re using a paralytic, which you require, typically require for an intubation, not always but you know, usually for an adult, you know, you’d be using a paralytic or something like that. But with with elemis. Typically, in this country, we’re not paralyzing. We’re using something like propofol, it works very fast, you lose the reflexes, they stop breathing, right because pair because purple fog causes that respiratory depression, especially when you’re giving it a general anesthesia type dose, you know, you’re able to slip in an LMA, and within a couple minutes you know that patient is breathing on their own often. So it’s kind of hard to explain because like I said, you know, you’re using the same drugs and you can you can achieve all those different levels, but it’s all about you know, the dosage and the timing and how often are you giving it and what exactly are you trying to accomplish?
Unknown Speaker  20:30
And is there is there like a an agreed upon I was impression that general anesthesia was based on the depth of anesthesia. So if the patient isn’t arousal, to gentle stimulation, then it’s general anesthesia and it’s conscious sedation if they are browsable. So it’s a question of more of, like you said, the doses, the doses can lead to a certain amount of of arouse ability or is it more like, you know, if the patient is paralyzed?
Unknown Speaker  20:54
sure that I mean that Well, I mean, that that is going to be part of it. You know, and like I said, with general anesthesia, you’re getting to that point you’re getting past that point where their arousal where, like I said, you know, they’re losing their airway reflexes, they’re they’re losing consciousness you know, they’re not going to they’re not going to be a browsable with that. So, you know, that’s that’s part of it. But a lot of times patients and you know, other people don’t realize that, you know, the paralytic drugs are different than the drugs that induce anesthesia and wasn’t thinking about bringing it up in this way. But unfortunately, there was a bad outcome recently at a hospital where didn’t happen in the operating room, but a vial of vecchio chronium was mistaken. Or Yeah, while evaporative was mistaken for verse said, nurse, she was giving verse said, but gave vacu around them to a patient in radiology suite. And that patient ended up dying, right. And what a horrible death because that patient got paralyzed, could not move could not move a muscle. You know, basically suffocate, and they’re awake the whole time because there was no sedative given. So that patient is they’re awake, obviously, you know, till the very end there. But, you know, what a horrible, horrible way to go.
Unknown Speaker  22:17
I think that that’s the case where the nurses being she was arrested for effectively a medical error.
Unknown Speaker  22:25
Yeah, I’ve heard that. That’s the latest. I haven’t read the latest article but but I’ve heard that now you’re dealing with an arrest and and that’s
Unknown Speaker  22:34
crossing a line I know as, as, as physicians and healthcare practitioners in general that that certainly causes us all to quake a bit in our boots. If this is you know, going to be some type of a trend right if you’re,
Unknown Speaker  22:50
if you’re getting into criminality of it. Yeah, that’s that’s that’s crossing a line.
Unknown Speaker  22:56
Nothing but let’s bring it back towards Anastasia. Yeah, for sure. That’s what we’re talking Talking about. So
Unknown Speaker  23:03
if there are any med students listening, right? Is there anything about your specialty that you weren’t aware of? Until you became an attending? Sure. So
Unknown Speaker  23:13
there’s, there’s a couple of things and and one that I would stress and I see this as a, you know, as kind of a myth with a specialty in and I got this, you know, from some of my classmates when you know, it’s kinda like you go off that, you know, you go off to third year and your your rotations and you come back at the end of third year beginning of fourth year, and everybody’s like, Hey, what are you going into? What are you going into? You know, and when I told some of my friends, I was going into anesthesia, some of the responses I got, it’s like, why you actually can talk to people. So, so one of the one of the myths is that, you know, if you’re an anesthesiologist, you don’t need good communication skills. Nothing could be further from the truth, you have a very short amount of time to gain the confidence and trust of that patient. So I would say that you need excellent communication skills to be a good anesthesia. Y’all, so that’s something that some, excuse me, sometimes medical students or other people don’t realize about the field. Number two, I would say, the human body is very resilient. If you’re doing this long enough, you know, you see that you recognize that. But I would say the other thing, and it kind of goes back to the communication and the soft skills once once you’re competent, you know, as an anesthesiologist gone through your training, you’ve gone through your boards, you’re competent, the soft skills really take over on a really essential, you know, how are you able to deal with different surgeon personalities? How are you able to be a good consultant from them? You know, are you able to, you know, talk to them if there’s if you know, if there’s a cancellation? Are you able to talk to them in a manner where, you know, you make them understand that this is something that is best for the patient. So you’re not only looking out for the patient, but you’re also looking out for the surgeon because if there’s a bad outcome, now everybody is involved in that, you know, how are you able to Do that navigate with the hospital with, you know, or charge nurses are you able to are you definitely, you know, maneuver and you know, work out the or workflows, a lot of these soft skills really become important to, you know, safely take care of patients and then, you know, be efficient with that or throughput. So those are some things that probably, you know, don’t get realized, you know, by med students when you know, when they’re first looking at the field.
Unknown Speaker  25:32
If, if rapport isn’t for you, then don’t go into a specialty where you have to rapidly build rapport with someone so that they trust you with their life. Absolutely. Okay. Are there any other myths about your field that you find doctors believing that you want to discuss?
Unknown Speaker  25:51
You know, I think that covers it. Pretty good.
Unknown Speaker  25:57
Then let’s talk about doctors unbound.
Unknown Speaker  25:59
Yeah, so So doctors unbound is, is this podcast that I’ve been doing for about, oh, 16 months now. And it was, it was a little bit of scratching my own itch. You know, I, I wanted to highlight positions, like you were talking about earlier who are doing these really interesting, cool things, you know, outside of their typical clinical practice, you know, I’d met some of these physicians. You know, I’d been impressed with them, I learned from them. And I thought to myself, man, I just wish there was, you know, something out there, where, you know, we can learn from each other. We can help each other out, build this community. And you know, I just so impressive. There’s doctors doing awesome things. You know, there’s people out there, who are financial bloggers, who are really impacting, you know, the finances of physicians, there are people out there that have decided to step into the political arena, and with how divisive our politics are. These days. I’m seeing more and more physicians on both sides of the aisle doing that and I think that’s important because we need physicians who care who are knowledgeable, to be out there affecting policy on a local, state and national level. So it’s just really cool to see these physicians that have mastered you know, medicine, but then also have ventured out and are doing these really awesome thing. So I get to talk to them at doctors unbound podcast that I put out every week, every Monday you there’s a fresh new episode. And you know, an episode will last anywhere from about 20 to 45 minutes. And, you know, we we talk about whatever the expertise that position is, you know, has and then you know, we do we also do some learning points, some takeaway points for the audience as well. So, it’s been tremendous for me, I tend to pick up two or three things from from each guests that I have on. You’ve been on the podcast, so thank you very much. I really want to thank you publicly for coming on. Learned. I learned a lot from you as well and It’s been just a tremendous growth for me personally and being able to put it out there to the physician community.
Unknown Speaker  28:06
Well, clearly I highly recommend that episode. But that and and the other episodes where where can people find you online? Where can people find the podcast? And where can people find anesthesia men?
Unknown Speaker  28:15
Sure. So so the podcast is doctors unbound, and it’s just that doctors unbound.com what you’ll find there is for every episode, there is a blog post or show notes, if you will. And what that includes is the podcast player, so for you, so if you don’t listen to podcasts any other way, there’s an embedded podcast player right there where you can listen to the episode. I have highlights of the episode and then I actually include transcripts so full transcripts of every episode because some people would rather read them listen, so all of that is available there. But you can find the podcast if you if you listen to podcasts regularly, like many of your listeners, obviously do. You can find it on your favorite pod catcher, whether that’s, you know, Apple podcasts or Stitcher or something else and just search for Doctors on the bound you and b o u and D and you’ll find it there and I would appreciate it if you listen subscribe and you know if there’s there’s any topics that you like or want to give me some feedback I’m always happy to hear that
Unknown Speaker  29:15
and then anesthesia Mrs. anesthesia meds calm
Unknown Speaker  29:18
yep Anastasia mitts calm now that both sites but that site especially needs needs a redesign. And so like you said, we we started that site in in 2012. It’s now just me it’s a solo thing now. So the great thing about some of this anesthesia content is that it’s evergreen. So once you put up a blog post about anesthesia, general anesthesia side effects, there’s not a whole lot that changes so so that was the beauty of it, but it’s it’s in need of a redesign that’s in the works right now. So if you go there, it’s not going to look so pretty. It’s going to look prettier soon. But check it out. If you have any patients that have, you know, interest in learning about different Anastasia topics we covered from general anesthesia, to labor, epidurals to spinals, to regional anesthesia blocks, all that kind of stuff is covered there. So go ahead and check it out. And I would say one more thing, if you’re a physician, that is either an anesthesiologist or maybe a surgical subspecialist, or something like that, and you would like to write for it, you’d like, Hey, you know, you want to write about a specific topic, you know, that is, you know, somehow related to Anastasia, you know, contact me in any way. And, you know, you can, you know, you could put a post on there and I’d be happy to give you credit obviously, and link back to either you know, your website or your social media profile or, or wherever you would like that link back. So if somebody is looking to to contribute that way, I’d be happy to collaborate.
Unknown Speaker  30:46
Sounds fantastic. I look forward to looking at the redesign. And then maybe when you do that, you can begin to take down the articles about ether.
Unknown Speaker  30:53
Yeah, man, it’s funny. I had a patient not too long ago, and they were telling me that, you know, they had either Way back when they were a kid and I was like, man, we don’t we don’t train on that anymore. We don’t train on Halloween. We don’t train on either anymore. That’s that’s
Unknown Speaker  31:08
the thing. I think holiday might have been on one of my steps at some point, and I’m not, you know, I guess I finished medical school in 2006. So, but I think it had been, it hadn’t been used anymore yet. They hadn’t updated the exam yet.
Unknown Speaker  31:22
No, we haven’t seen it in my training. The one hell of a story I have is I was in Iraq as a naval anesthesiologist. And we were there doing a case on base and some of the guys pulled out something called a draw over vaporizer, which was the first time I saw that and looked on there it said how they you know, you’re supposed to put Halloween in there, but but we use ISO flooring which is kind of has some similar properties. And we did a case with that just because we thought we might need to be mobile in a war environment and that was one of the options that we would have so we you know, there’s like three anesthesiologists are said All right, we’re going to do a case with this with this more mobile drove or vaporizer.
Unknown Speaker  32:01
So so that’s that’s the only that’s the closest I got to help me to actually get how they
Unknown Speaker  32:06
was labeled how it was like it was labeled. Exactly. That’s That’s it.
Unknown Speaker  32:11
All right. Well, Dr. David genus, thank you so much for taking the time to talk to us. I’ve learned a lot and it’s been a fun conversation. Hey, thank
Unknown Speaker  32:18
you so much. It’s been my pleasure to be on the show.
Unknown Speaker  32:23
That was Dr. Bradley Block at the physicians guide to doctor and 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

What weighs 1 ounce and has 7 fellowships?

Dr. Rand Diab is a board-certified, comprehensive ophthalmologist in the Chicago suburbs of Northwest Indiana, practicing for over 15 years.  We discuss what she thinks all physicians should know about ophthalmology, which starts with how to spell it.  We discuss acute eye injuries and why every pink eye doesn’t get treated with antibiotics drops.  She also really deflates my balloon when she dispels the myth that an avulsed eyeball can be kept in milk until it can be reattached. 

Dr. Diab. lives in the Chicago area with her husband and 3 children. She loves family, friends, and fitness.  She shares her passion for patient education on her website and her life experiences on her blog and social media. 

You can find her at www.randdiab.com or @randdiabmd on Instagram and Twitter. 

 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!!!

What weighs 1 ounce and has 7 fellowships?

Dr. Rand Diab is a board-certified, comprehensive ophthalmologist in the Chicago suburbs of Northwest Indiana, practicing for over 15 years.  We discuss what she thinks all physicians should know about ophthalmology, which starts with how to spell it.  We discuss acute eye injuries and why every pink eye doesn’t get treated with antibiotics drops.  She also really deflates my balloon when she dispels the myth that an avulsed eyeball can be kept in milk until it can be reattached.

Dr. Diab. lives in the Chicago area with her husband and 3 children. She loves family, friends, and fitness.  She shares her passion for patient education on her website and her life experiences on her blog and social media.

You can find her at www.randdiab.com or @randdiabmd on Instagram and Twitter.

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
terrain. dapp is an ophthalmologist in the Chicago suburbs of Northwest Indiana. She went to med school at the University of Illinois in Chicago and did her residency at Case Western Reserve. We discuss what she thinks all physicians should know about ophthalmology, which starts with how to spell it. We discussed the management of acute I injuries and why every pinkeye doesn’t get treated with antibiotic drops. She also really deflates my balloon when she dispels the myth that nivola eyeball should be kept in milk until it can be reattached.
Unknown Speaker  1:34
Welcome back to the physicians guide to doctoring. On today’s episode, we have ophthalmologist rend df and she’s here to share with us everything every physician should know about ophthalmology. So Dr. Dr. Thank you so much for being on the show today.
Unknown Speaker  1:49
Thanks for having me.
Unknown Speaker  1:51
So we were going to start things off with a riddle a riddle that should have a pretty apparent answer that we talked about it beforehand to make sure is asked it probably But what has seven fellowships and weighs an ounce?
Unknown Speaker  2:05
I think I know what it is. eyeball,
Unknown Speaker  2:08
an eyeball. So an eyeball something that small for those on the metric system. If you’re not sure how big announces just think about how big an eyeball is. And that’ll give you an idea about how how heavy announces. So there are seven different fellowships for that tiny, tiny part of the body. And if you have that many fellowships, it must be pretty complicated. So Dr. Deb is here to talk to us about try to demystify some of what’s what’s out there about the eyeball. So if you had a med student rotating with you, and you didn’t know what field they were going into, what are the types of things that you’d want them to take away from a rotation.
Unknown Speaker  2:50
So the first thing I would want them to know is the name of our specialty and how it is spelled. A lot of people struggle with technology because they say ophthalmology, but it’s written off cell morphology, spelling, it seems to be challenging for a lot of people. So that would be, I think, a good place to start.
Unknown Speaker  3:07
When I was a medical student, you know, this was, I guess the the internet had been around for a while, but you know, not not that long and, or email, you know, it wasn’t it wasn’t as ubiquitous as now. So someone had inadvertently emailed the entire listserv, meaning to just email the dean saying that they were interested in ophthalmology and of course, he misspelled it. And so the dean replied back also reply all. Sweet, are you today? First better remember, your first better learn how to spell it properly. was a little embarrassing.
Unknown Speaker  3:45
So yeah, so that would be the first thing. I think it’s important and we appreciate it. And the other thing that’s related kind of to that is knowing the difference between our field and optometry and a lot of lay people that’s very confusing because a lot of We’ll just say I doctor and Lucy when they say that they mean the optometrist, but it kind of gets mixed up together. So if I had a medical student to someone who’s you know, in medical school and going to be a physician gemologist is a fellow physician, and an optometrist has a different course of training. And I found that even sometimes my fellow physicians don’t really know when they should see an optometrist versus an ophthalmologist. So that would be an important thing to learn. And one of the critical differences is obviously in our training as an ophthalmologist, we go to medical school for four years, and then we do four years of ophthalmology residency, and as you pointed out, we have been seven different fellowship paths we can choose or we can stay in comprehensive ophthalmology, which is what I did. So whereas an optometrist can go to undergrad and go to for yourself cometary school, and our training is very different, because we get the whole medical training that all other physicians get in medical School, as well as the surgical training of the eye. And we are able to consider the patient’s medical, their entire medical history into what we’re looking at which is is really oftentimes plays importantly, into what we’re doing, and an optometrist, in most cases, to be more focused on prescribing glasses and contact lenses. So anytime somebody has a more medically related problem with the I would recommend seeing it just for that.
Unknown Speaker  5:31
And I think there’s a little bit of scope of practice conflict there, because I’m sure that there they have their lobbyists pushing at the state level to increase their scope of practice to overlap more with ophthalmologists. And their argument inevitably is going to be access to care. So this is just another example of why we should be all involved in advocacy. Am I am I correct here?
Unknown Speaker  6:00
Absolutely correct. There are many states where they have gotten made progress and change the scope of practice laws. And they have a very active political lobbyists. Anyways, maybe more active than ours. And, and it is it’s actually a very important issue for us that we face this off positions in general because we’re facing these scope of practice issues on so many fronts. But definitely when it comes to surgical things, we would really like the surgical conditions to be managed by those who are trained surgically.
Unknown Speaker  6:33
One of my earliest episodes was all about high return on investment, low effort, advocacy. So this is something that affects you make sure you check out that episode. Okay, I’ll stop plugging my own podcast. But, so, how to pronounce it, how to spell it, and what makes you different from an optometrist. But what are what are some of the conditions that you want us to look out for and maybe even start a workup or Maybe patients that you should be referred that aren’t being referred. You know, we, a couple episodes ago we had Dr. A film talking about a fit been his, one of his major points was that in order to decrease the risk of recurrence, you really need early referrals. So the sooner you can send to the electrophysiologist, the better. So, let’s maybe talk about that what what are some things that you think should be sent sooner to the ophthalmologist?
Unknown Speaker  7:25
So the most common things that that other physicians send us are things like diabetic there are some standards of care in terms of when we should check them after being diabetic for somebody here is that how often we chop them, and then certain medication, which is like, well, hydroxychloroquine a lot of patients who have autoimmune diseases are on that. So they require certain types of monitoring as to other medication. So those are pretty routine. And I think I think most of the people who are prescribing those medications are dealing with those kinds of patients are familiar with how often should be examined, there may be some things that are a little bit less like there. For example, I’ll give an example gentle arthritis. That’s the tough condition, sometimes to diagnose a good simple artery biopsy, but there, there are definitely some important ocular manifestations of that and it can lead to blindness. And so I think, knowing how to really evaluate that and work it out and working down to the mall just into that can be an important an important part of that patients care. There are a lot of vascular conditions. Evaluation earlier on, so sometimes we may, any patient who has, for example, trend and alterations where there’s some template, a vision, those those kind of patients would require our evaluation earlier on. I generally find in my practice, most of my colleagues are really good about referring patients. Have any question about the AI? And I think we kind of get to the other side of the issue, which is that it seems like people don’t really want to deal with the AI. So they would actually much rather, any question about it would much rather refer it. You know, sometimes I think we feel like, it would be useful. If there was a little bit better tree, I think of what needs to be doing for us, versus what maybe could take some time and we don’t have to see it right away.
Unknown Speaker  9:28
Give us an example.
Unknown Speaker  9:30
So
Unknown Speaker  9:32
the really kind of urgent things would be somebody had sudden onset, let’s say, light flashes and floaters or maybe they have those kinds of things could be indicative of a retinal detachment, or retinal tear, and we want to see that right away because we could get that under control before it needs surgery. Something like anything would that involves loss of vision, even if it’s temporary? Some of the things I think that kind of come to get manage outside of our office are like red eye type condition. And sometimes those are hard to know what we should see and what we shouldn’t see. I would generally say, if you can a patient for something that involves red eye or pain in their eye, and you giving your first line which I’ve noticed in most cases and antibiotic I dropped on it that people tend to give and they’re not improving within a few days, then you should probably have them evaluated by an ophthalmologist because you’ll get a lot of patients who have gone back and forth three times. They’ve been in primary care they’ve been maybe even in an emergency. So they’re getting different people giving them different things. And they’re not they’re obviously not getting better and those people would have done better if they had seen us early because sometimes they may have something like herpes simplex hasn’t gone course of treatment. And most patients don’t. Most adults don’t have bacterial conjunctivitis, the treating antibiotic has really limited benefit in most of these cases.
Unknown Speaker  10:59
So So how would you treat it then? Like if you if you just imagine the pain, there’s there’s likely, I mean, obviously dread may be accompanied with some pain but no discharge, is that correct?
Unknown Speaker  11:12
That’s one of the common presentations. Yeah, so a lot of those patients who just have like a red eye that’s kind of painful. They don’t they actually they don’t have a bacterial infection. Sometimes it can be viral without using a little bit different presentation. But a lot of those are actually maybe a dry eye or some type of their eyes is inflamed or irritated, sort of, for some unknown cause it’s not infectious. A lot of those times we actually treat them with lubricating drops. You know, which is so simple, but we wouldn’t know that if we can do a full exam and make sure that there’s something else going on. And then you know, sometimes there’s allergy and sometimes there’s inflammation of some sort, but generally, there’s no discharge and there’s no there’s no injury then You know, if especially if they’ve already been on a course of antibiotic drugs better than they get.
Unknown Speaker  12:06
So it was an adult, then you would say, if the if the physician isn’t sure, and they want to try something before they send, you would say, rather than antibiotics start with a lubricating drop, and if there’s no significant improvement, then send them on.
Unknown Speaker  12:18
That’s a good sign. If there’s no discharge in the eyes, not only read, they’re irritated. There’s no significant visual loss. That’s an important thing. And it was really helpful if you can look at the eye. And I think that goes back to maybe one of the main things I would want a medical student to learn on a rotation with me and and I do have some medical students and I spend a lot of time making sure they know this is just the basic anatomy of the eye. It’s, it seems simple, and it’s a small structure, but it makes a big difference. If people can kind of imagine what they’re looking at, you know, they kind of have a sense of what the anatomy is. And that’s really important. So I think getting being able to look at the eye even just with a pen light, doesn’t have to be under scopic exam because most of these things like red eyes and stuff. They’re not necessarily Something that’s gonna affect the fundus. So just making sure there’s no obvious capacity on the cornea, let’s say that could be a corneal ulcer, that would be pretty serious. If it’s something as simple as just a subcontract title hemorrhage, then that usually doesn’t, you know, they look really dramatic, and they look really scary. And I get so many of those sent to my office urgently. And they’re never anything to worry about. So, you know, so looking at that I can make a big difference in terms of what you decide to do with the patient.
Unknown Speaker  13:29
So you think because we learned the fundus scopic exam in medical school, and it’s it can be challenging. And then if we can’t do it, then we’re just going to write off the eyeball together and say, I don’t know what to do with that. Some of the ophthalmologists it might be the case. Yeah. Some cases and I you know,
Unknown Speaker  13:45
the other thing is that
Unknown Speaker  13:48
the things that we consider important when we’re, when someone’s referring a patient does would be would be to know what their vision is, for example, so that you know, kind of like the vital signs of an eye pressure pupils, at least vision Useful cause like is there is there a change in their vision, what is their vision has it dropped because they will definitely change the urgency of the situation if there’s been a drop in vision and also when, when checking a patient division, make sure that they have whatever their corrective lenses or contacts or glasses or reading glasses or whatever, that they’re using them, you know, so they were just they just were reading glasses that they can put them on and maybe look at something read something up close, but they have to do each eye separately. So are you won’t find the problem. But if they don’t wear glasses, or they were glasses for distance, you know, you might not have an eye chart in your office. So just having them read something cover one I compared to the other I can be useful. So just to get you know, some idea where they’re at with that, that’s important.
Unknown Speaker  14:43
Okay, so change in vision is going to change our acuity. So look at the eye with a pen light. identify all the structures, you can try a fun to skubick exam if it’s something you’re comfortable with, and then check the vision and if there’s a change in Division, then it’s going to lead to a more acute referral top ology,
Unknown Speaker  15:01
definitely. So are there any other
Unknown Speaker  15:03
conditions that you want to review? That maybe we, you know, that that most physicians should be familiar with.
Unknown Speaker  15:14
If a patient has had surgery on the eye, especially if it’s a glaucoma surgery, but if it’s even if it’s a cataract surgery, it was, let’s say recent, and they have redness or change in their vision, then in that case, we will worry about end up behind this idea and that can be very serious and devastating. I caught early. So in terms of really serious things, asking about a surgical history, that would be and asking, Hey, I know another thing that I think gets very confusing for for other doctors is when do you have to worry about medication use and glaucoma because a lot of medications say they’re contraindicated in a patient with glaucoma. Most of those are for people with narrow angle glaucoma, which is really the minority of what we treat we usually are treating people For opening Oklahoma, so, the patient might not even open angle glaucoma. So it may be a little bit confusing but generally most medications that are labeled contraindicated for glaucoma for arrow angle
Unknown Speaker  16:13
is not treated surgically.
Unknown Speaker  16:15
Yeah, narrow angle glaucoma, we treat by doing a laser treatment on the eye. So hopefully, if they do have it, they won’t have it for long and then you can treat them with whatever you are planning to treat them with. Right and so it’s usually not super relevant in terms of the medication that the task in terms of open angle glaucoma what is relevant is that scary medications elevate the eye pressure, so that can worsen some as well call or even caused glaucoma. And somebody who doesn’t have it or causes cataracts as well. So anybody who is on steroids, like for example, especially if they’re on a prolonged course, but even a short course, federal those tax patients who are on inhalers, patients who are on Sarah face cream, things like that. Definitely the increased risk of elevated I pressure which way to go call that and also they have an increased risk of cataracts. So those patients have they’re going to be on those medications for any extended period of time, especially long term should get evaluated. And I’ve had an unfortunate a lot of patients over the years younger patients have had cataracts, and can only recall the answer is one time, like one of those back or you know, something like that. So that’s a significant effect.
Unknown Speaker  17:27
So if someone has say mild, persistent asthma and needs to remain on an inhaler, indefinitely, these patients should be seen by an ophthalmologist at a regular rate.
Unknown Speaker  17:38
They should at least get one evaluation and then let the ophthalmologist decide how often they would want to see them. I think that would be beneficial for them. Interesting.
Unknown Speaker  17:48
Yeah, as an EMT, we use a lot of steroids either for sinus infections or polyps are actually a multitude of of things. We see a lot of pain syndromes for the TMJ Sometimes those get treated with with steroids. So that’s definitely good for for me to be aware of. Although sometimes I do have a disagreement with the ophthalmologist on call when there’s a sinusitis that leads to an orbital cellulitis. And you know, sinusitis is treated very effectively, a lot of the time with steroids. So I want to treat the underlying problem and they want to protect the eye. And we’re both ultimately trying to protect the eye and treat the patient appropriately. But, you know, frequently but butt heads about whether or not the treatment with steroids is, you know, I’m trying to keep the patient out of the operating room. And sometimes the steroids are the way to do that. So I can lead to a little bit of conflict.
Unknown Speaker  18:40
I can see that. So
Unknown Speaker  18:44
what about I injuries? So, you know, this is part of what this podcast is all about, is that we’re physicians, and we’re also community members. So we might be a situation where we’re like orthopedic surgeon, we haven’t seen seen an eyeball since our phonology rotation is a third year medical student. But, you know, we have, we’re in a softball game and someone gets an eye injury. And they say, Hey, Doc, can you take a look at this? And, you know, we haven’t seen eyeballs except when we’re talking to people and looking at them in the eye. So how do we defend that situation? How do we differentiate an acute injury that requires immediate referral to the ER versus something subacute that can wait for an outpatient appointment with an ophthalmologist.
Unknown Speaker  19:32
So obviously, the type of injury so if it was like a missile injury, something like a ball hit die really fast, speed, the impact, those kinds of things should be taken into consideration. Generally, what I’ve found is that there’s usually one area that takes the brunt of the impact. There really is injury hits around the orbit for example, you know, you see bruising around the orbit tenderness, you may have an orbital fracture, but in most of those cases, the eye is somewhat protected because the orbit of the material The impact or the ball, that’s ideal, you know, or the nose, because then you protect the eye. And that’s why the orbit tends to protrude a little bit around the eye. It protects it. So if that’s not the case, and the eye takes the brunt of the injury, that they definitely should get an evaluation because there could be internal trauma to the eye that might not be evident externally. But again, go back to the basic things, vision, sometimes in an acute injury, they may get really blurred initially in the initial shock and trauma, and then it may clear up so just knowing how is the vision doing, and if there is a significant vision loss, even if it’s just for the first minute, I would, I would worry about you know, that I so because obviously enough of an impact to to do that. Looking at the I can’t even just get your camera on your cell phone layout. And and just look at the I just to kind of see just does the pupil look around, because in a really bad injury, you can actually get a ruptured globe interior, like you get a laceration, let’s say the cornea and then usually the iris tissue will just jump to fill that gap within the pupil is distorted. That’s a definite emergency. So then another thing you might be able to appreciate is if you can’t see the iris, then there might be a high female, which is that there’s actually blood in the anterior chamber. But most injuries are probably going to have some level of subcontract cable hemorrhage soda, the conjunctiva is going to be more red under the contract type or you know between the kanyon the sclera and then corneal abrasions are really common as well. So corneal abrasions will usually present in like a scratch type of injury. And the I will be very painful. It’ll be really hard to open the I tears a lot. People just want to keep it closed. So those are usually corneal abrasions. And those should be seen relatively soon as well because we don’t know how deep the injury might be how large and also a The risk of infection is a lot of our fingernails tend to carry a lot of bacteria. So we would want to treat those. So just kind of assessing the situation and especially if you saw the injury happened that might help you to know the potential for how bad it could be.
Unknown Speaker  22:17
But let’s say the eye comes out all together, do you treat it like a tooth and like put it in a cup of milk until you can get to the to the emergency department.
Unknown Speaker  22:26
That’s actually a really good thing to know. The thing that helps my, my son when he was six months old, we shaved his shoe. We planted it like an hour later. But you can’t do that with
Unknown Speaker  22:38
the eyeball doesn’t come out. So a lot of people ask us that.
Unknown Speaker  22:42
When we do cataract surgery that we actually
Unknown Speaker  22:48
attached to the rest of the body,
Unknown Speaker  22:50
wash it off in one of those golf ball containers before you put it back in. Before you pop it back in. Yeah. And
Unknown Speaker  22:59
yeah, you can be prolapsed a little bit outside of the eyelids, you know if it’s if there’s like some proptosis or something, and that can be pretty scary, but it can’t come all the way out loud is actually able to count really horrible injuries but then it would, there’s nothing we could do. I was gonna
Unknown Speaker  23:16
make a joke and
Unknown Speaker  23:18
kill it.
Unknown Speaker  23:23
Okay, so there are there any other injuries that we might encounter any other things to look for? So you mentioned changing the iris obscured pupil changing vision, possible corneal abrasion. And I would imagine if you think the globe is ruptured, that would probably be a reason to immediately send the patient to the ER.
Unknown Speaker  23:43
Yeah, so a lot of globe rupture happens last year, a part of the globe so you can’t see it. We can’t even see it on our exam. There are some some some as an imaging like a CT scan, I might be able to detect it if it’s changed the shape of the globe. But as I mentioned before, and here at global Could Happen along, maybe along the cornea, or if there was a puncture wound or something like that, and then you, you really should be able to tell us like there’s Iris coming to the wound. That’s critical. And we need to immediately deal with that. Because obviously, that tracks infection into the eye and that tissue necrosis and those are really serious. The other thing is foreign body. So we get a lot of foreign body injuries, they’re usually small, rust colored metallic objects that get kind of stuck into the cornea and those need to be removed. Those can be of various varying depths. So some of them are very superficial, we can just kind of remove them with a small four separate needle and some of them can be pretty deep and need a lot of work to get removed. So that’s another important thing you’d be able to see I had one recently that was pretty large. And it was a dark colored foreign body and the way he was sitting on the I, whoever evaluated the patient in the ER told me a hole in his eye. So they thought that that dark spot was like a whole, not that it was been realized as a foreign body, I guess. And so, and he saw me like a couple days later and I thought, wow, this was a hole in the eye like, immediately. So
Unknown Speaker  25:14
well, I guess that’s a ruptured globe. That’s a globe.
Unknown Speaker  25:17
I need. Yeah. Yeah, right. It’s
Unknown Speaker  25:21
serious. But yeah, so the, you know, the their people have varying that was an NP, by the way that was not not a physician, but people have varying levels of assessment that they’re able to do on the eyes. Hence the reason for this podcast and you’re educating us. Right, I hope it useful.
Unknown Speaker  25:42
So far, very much so. So before we start wrapping up, are there any other issues that say a rotating med student, or rotating NP anyone you know, who’s going to be seeing your patients before sending them to you that you’d like them to know?
Unknown Speaker  25:58
Yeah, two things that I haven’t mentioned one There was a study published somewhere in an emergency medicine journal that said that when you have a patient corneal abrasion, as I mentioned before, they’re extremely painful that you could give them ocular anesthetic drops to take home, like prescribe them or send them home with some just to reduce the discomfort and help them until they see the optimal just presumably, we are very opposed to that. I don’t that that study, there’s a lot of holes in that study and under attack. And, you know, we’re very, very opposed to anybody going home and ocular anesthetics. And the reason for that is that it inhibits epithelial healing, and it can cause Nicole the corneal melts where basically the cornea just kind of melts and it’s, you can’t just fix that you have to, eventually once it you heal it and you have to transplant it. So there because that that is such a serious condition that we take that very seriously. So we’re very careful on a call. Things that we wouldn’t want someone giving our patients without really having a good exam ocular anesthetic. never send them all with anesthetic eyedrops, because they may just keep using them and not come to us and until they have a corneal mouth and we’ve seen that. And then the second thing is we really don’t prefer for patients to be sent on steroids drops because of the risk of it being as I mentioned before herpes simplex condition or something repetitive even zoster of the cornea, which would get much worse with steroids. And those are sometimes they can masquerade as other things. So sometimes even for us, they’re hard to diagnose. And I wouldn’t expect someone without a slit lamp and about our training to be able to diagnose that. So those would be two things to watch out for. And I’ll add one last thing. As I mentioned before, one of the things important to get familiar with the pupil looking at the patient’s pupil, so if they’re good because there are some critical conditions like a third nerve palsy that involves the people that are emergencies. So if you know just again, a kind of a feel for what the norm pupil looks like how it reacts compare one people to the other, if their pupils large a nonreactive toeses or something or they have a limited extraction or motility or their complaint diplopia you know, then that could be people involving their inner policy which should be an emergency. So that would be another thing to get looking at a time
Unknown Speaker  28:20
is interesting there used to be these ear drops on the market oral Gann that were anaesthetic airdrops and they’re off the market now, and I’m not sure the reason but I know an otolaryngologist would never prescribe numbing your drops because you know, otitis externa you’re going to treat the new otitis externa. If it’s some referred pain, then you’re going to treat the referred pain, right you’re, you’re always going to treat the underlying problem you’re not going to just give an anesthetic. I mean, there there’s I had never prescribed it and then I read somewhere that it was was off the market. So they get the similar you know, it’s we always want to keep our patients comfortable, but not in of, you know, their ultimate outcome.
Unknown Speaker  29:03
Right and calibrations are really measurable, but generally they’re kind of like when you bite your tongue gets really painful at first, but 24 hours later, it’s much better. So you wouldn’t want to have something that could have healed in 24 hours become a potential ocular disaster. Yeah.
Unknown Speaker  29:19
Is there anything that you learned in med school that you found out later, either was overturned by by research, or you found out was actually misinformation to begin with? I’ll give you an example. Because in medical school, one of the things I learned was that post nasal drip is one of the most common causes of cough. Now post nasal drip is a symptom, not a diagnosis. So it kind of misses that the diagnosis that’s causing golf is either a cold or sinus infection, which I think you can hear my voice that I have one of those right now. But you know, that was that was kind of a misunderstanding of the physiology. Is there anything like that that happened to you that you when you did your residency you found Uh huh, you know, maybe maybe that’s a A little bit of misinformation.
Unknown Speaker  30:03
I actually can’t think of anything but you know, it’s been a long time. It was about I finished my residency about 16 years ago, so I can’t think of those examples.
Unknown Speaker  30:13
Well, good. That’s a good thing. You were
Unknown Speaker  30:15
Yeah. Well
Unknown Speaker  30:20
alright, well Is there anything else you again we’ve covered a lot. Is there anything else that you you you want to mention before we wrap this up?
Unknown Speaker  30:27
No, I think we got through all the big things.
Unknown Speaker  30:31
I think so too. So you know, we’re can people find you online.
Unknown Speaker  30:35
I have a website ran dry, calm, my first name, last name, calm. And I blog there and I also post educational videos about ophthalmology that are kind of geared towards my patients in some ways and just the general public other physicians could benefit them as benefit from them as well. And I’m on YouTube under my name as well Randy up empty. But all of my YouTube videos are Also on my website, that’s probably the best place to start.
Unknown Speaker  31:03
Fantastic, a lot of very useful information that would benefit physicians and the general public. Well, thank you very much. It has been a pleasure.
Unknown Speaker  31:13
Thanks for having me. It was very good.
Unknown Speaker  31:17
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