Revitalizing Healthcare

Dr. River: The Beauty in the Multifaceted, Wholehearted Life

February 21, 2023 Season 2 Episode 12
Dr. River: The Beauty in the Multifaceted, Wholehearted Life
Revitalizing Healthcare
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Revitalizing Healthcare
Dr. River: The Beauty in the Multifaceted, Wholehearted Life
Feb 21, 2023 Season 2 Episode 12

In this podcast episode, Dr. Amanda River, uses her unique perspective to challenge the medical industrial complex and describes her journey to provide better care and value for patients.

Dr. River works in a critical access hospital in her hometown in rural Iowa. She also does locums emergency medicine at a community hospital in Oregon and practices emergency medicine at a public government hospital in Guam. She has previously been the owner and medical director of a private cannabis medicine clinic and is currently working toward creatively integrating Lifestyle Medicine into her practice. 

Andrea mentions a podcast with Dr. Vinny Arora on The Emergency Mind in which they discuss many myths and limiting beliefs around sleep deprivation in medicine. It's episode 51 available. Here's the link on Apple or Spotify.

River mentions how much the previous episodes on this podcast with Drs. Paasch and Barrett (Season 2, episode 5 and 6 from Dec 13 and 20, 2022) resonated with her, specifically the term "medical, industrial complex." Which is the term they used to describe big healthcare and how it dehumanizes patients and providers.

Andrea discusses the book It Takes 5 to Tango, which discusses how to align the interests of patients, providers, pharma, policy, and payors. Andrea and River discuss that there are many opportunities to make working conditions better for doctors and ultimately take better care of patients.

Are you a healthcare professional looking to empower yourself and advance in your field? Then, you won’t want to miss the transformational Women in Medicine Summit, September 13-14 at the Drake Hotel in Chicago. This event is a powerhouse of inspiration designed to elevate and celebrate women in medicine.

Dr. Austin, host of this podcast will be there and hopes you will be too!


MicroSkills is built on one core, easy-to-learn principle: every big goal, complicated task, healthy habit, and, yes, even what we think of as character traits, can be broken down into small, learnable, skills that can be practiced, and incorporated real-time. Pre-order wherever you buy your books or on Amazon; launches Apr 16.

Support the Show.

  • Connect with Andrea on Instagram (@revitalizingdoc) or LinkedIn about the show and more, or visit her website www.andreaaustinmd.com.
  • Sign up for her newsletter, “Revitalizing Healthcare.” It is your go-to source for insightful content on transforming the healthcare landscape and staying well while changemaking.
  • Join this list to keep up to date on the launch of her forthcoming book, Revitalized: A guidebook to rediscovering your heartline. This book provides a beacon for channeling emotional intelligence not only to survive but thrive in medicine.
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Show Notes Transcript

In this podcast episode, Dr. Amanda River, uses her unique perspective to challenge the medical industrial complex and describes her journey to provide better care and value for patients.

Dr. River works in a critical access hospital in her hometown in rural Iowa. She also does locums emergency medicine at a community hospital in Oregon and practices emergency medicine at a public government hospital in Guam. She has previously been the owner and medical director of a private cannabis medicine clinic and is currently working toward creatively integrating Lifestyle Medicine into her practice. 

Andrea mentions a podcast with Dr. Vinny Arora on The Emergency Mind in which they discuss many myths and limiting beliefs around sleep deprivation in medicine. It's episode 51 available. Here's the link on Apple or Spotify.

River mentions how much the previous episodes on this podcast with Drs. Paasch and Barrett (Season 2, episode 5 and 6 from Dec 13 and 20, 2022) resonated with her, specifically the term "medical, industrial complex." Which is the term they used to describe big healthcare and how it dehumanizes patients and providers.

Andrea discusses the book It Takes 5 to Tango, which discusses how to align the interests of patients, providers, pharma, policy, and payors. Andrea and River discuss that there are many opportunities to make working conditions better for doctors and ultimately take better care of patients.

Are you a healthcare professional looking to empower yourself and advance in your field? Then, you won’t want to miss the transformational Women in Medicine Summit, September 13-14 at the Drake Hotel in Chicago. This event is a powerhouse of inspiration designed to elevate and celebrate women in medicine.

Dr. Austin, host of this podcast will be there and hopes you will be too!


MicroSkills is built on one core, easy-to-learn principle: every big goal, complicated task, healthy habit, and, yes, even what we think of as character traits, can be broken down into small, learnable, skills that can be practiced, and incorporated real-time. Pre-order wherever you buy your books or on Amazon; launches Apr 16.

Support the Show.

  • Connect with Andrea on Instagram (@revitalizingdoc) or LinkedIn about the show and more, or visit her website www.andreaaustinmd.com.
  • Sign up for her newsletter, “Revitalizing Healthcare.” It is your go-to source for insightful content on transforming the healthcare landscape and staying well while changemaking.
  • Join this list to keep up to date on the launch of her forthcoming book, Revitalized: A guidebook to rediscovering your heartline. This book provides a beacon for channeling emotional intelligence not only to survive but thrive in medicine.

Dr. Andrea  Austin     00 :00 :00

Welcome to The Revitalizing Doctor Podcast . We explore with our guests how you can move from surviving to thriving . As a physician , we know that when you connect with your values and authenticity , you can live a life that is fulfilling and not only good for you, but drives the necessary transformation in healthcare to take better care of our physicians , which means better care for our patients .

 

 

Dr. Amanda    River  00 :00 :31

I think in medicine and medical school , but the entire medical education curriculum does a really poor job of telling us to be there for people all the time , but then not teaching us to be there for ourselves or be there for our people . It seems sort of backhanded in a way.

 

 

Dr. Andrea  Austin     00 :00 :50

Hi friends , I want to tell you about a couple of things happening over at Revitalize . The first one is our upcoming coffee chat that's going to be February 28 at 09 :00 A.m. Pacific 12:00 p.m.. Noon. This will be a casual conversation about the future of revitalize , and you're invited . We want to share the revitalized mission and vision and also get your feedback and understand how we can better serve you moving forward . So you can go to our website , which is https://www.peoplealwayshcc.com/revitalize , or you can just go to the Show Notes , which is available in your podcast app, and click the link there to register . And then I want to tell you about a couple of programs that we're offering this spring . The first one is our women leadership mastermind . This is a program specifically designed for women physician leaders . We provide resources , support and accountability to break through barriers , increase your influence , and achieve your goals . This is a mastermind format that will help you see challenges in a new light and offer many perspectives so you can overcome the toughest challenges with success and gain more leadership presence . If you'd be interested in joining this group , just go to the Show Notes , click the link , and that will take you to schedule a consultation with either me or Linda and we'll tell you more about the program . Last but not least , I want to tell you about our military transition mini mastermind . This course is specifically designed for women physicians that are leaving the military in the next one to two years. We provide accountability and expertise to help you explore new possibilities and redesign your career to really align with your values. Linda and I are both veterans , and we understand that this is quite likely the first time that you have a completely blank slate . You get to design your own life to do whatever you want , and that can be freeing and also overwhelming . This is our most successful program and we would love to help you create the life that you deserve . So reach out to us. The link will be in the Show Notes , and Linda and I would love to talk to you more to see if you're a good fit for that program as well. The house is now kept . We will jump into this week's episode with my dear friend and colleague , Dr. River.

 

Dr. Andrea  Austin     00 :03 :11

I am so excited today to have my friend and colleague , Dr. Amanda river. She is an emergency medicine physician that's currently credentialing to work at a critical care access hospital in rural Iowa. She also does locums work in a community hospital in Oregon and also has worked at a public hospital in Guam. She's the previous owner and medical director of a private cannabis medicine clinic , which I believe this is our first physician that's worked in the cannabis business on the podcast . That's pretty cool . And she's also board certified in lifestyle medicine and looking at integrating that into her overall practice as well. So, Amanda River, let me start off by saying you now go by river, which is hard for me sometimes , and I'll probably make a few mistakes during the podcast . It's great to have you on the podcast .


Dr. Amanda    River  00 :04 :07

It's great to be on. Thanks for having me. I'm looking forward to getting the chat .

 

Dr. Andrea  Austin     00 :04 :12

So I've had the benefit of knowing you for many years. We first became friends in medical school , and I always think of you as somebody with a really big heart , varied interest , and endlessly curious . In a way, I kind of find medical school an interesting choice for somebody like you, because when you reflect back on medical school , or at least when I reflect back on it , it's in some ways very narrowing . In order to learn all that we have to know as doctors , you really have to forego other interests , other things , and go down this extremely narrow pathway of learning everything you can about the human body. And it's for good reason. Humans are complicated , and having someone's lives in our hands , we really do need to be proficient in everything that we do as doctors . So how did you decide to go to medical school ?

 

Dr. Amanda    River  00 :05 :18

You make an interesting observation that I don't know that I've ever heard anybody actually put into words , but probably one I've had subconsciously myself . I don't know that medicine was exactly the right fit for me. I kind of fell into it a little bit . It's funny, I found my fifth grade graduation form the other day, and on it it said I wanted to be a part time artist and a part time veterinarian . And I think that's truthfully probably more where my actual ethos is that I kind of stumbled into it . So when I was 14 and my sister was ten, she was diagnosed with ewing sarcoma , and we spent a good part of a year, my family and I, driving back and forth to the university hospital that was about 75 minutes away. And so my parents were both working two jobs at the time . And so I learned how to drive on the interstates in Iowa and spent a whole lot of time in the hospital with my sister and kind of taking care of a lot of family stuff during that time . And I remember just being in awe of how we didn't know what was going to happen with my sister . This was something we didn't really know anything about . And her doctors were, I felt

like, very honest and very caring . And I thought it was just the neatest thing in the world that somebody had a profession where they had the ability to help somebody come through something that they might not have made it otherwise , that they could give somebody their life back , they could give somebody their health back and give a person's family that too . And so I thought it was just the coolest thing that you could offer humanity . So there I went , and I was actually fortunate at my sister's orthopedist I was a really well known orthopedist at the university hospital , and he allowed me to shadow him kind of through college and was a bit of a mentor to me during that time . I grew up as a mechanic on a farm . I grew up on a farm in Iowa. And I thought the fact that you could have a toolbox in the operating room was just the neatest thing ever. I have always really been interested in physiology . Growing up on the farm , I always helped with the animals and help with procedures , and I'm not surprised that I ended up doing , like, doing procedural stuff with my hands and working with physiology . But, yeah, medicine isn't probably something I would have come to had that circumstance not happened in my life . Long winded answer to the question of how I got to medical school .


Dr. Andrea  Austin     00 :08 :01

I think it's so fascinating , and I kind of feel like a crappy friend because I actually never knew what had happened to your sister that had never come up in all the years that we've known each other .

 

Dr. Amanda    River  00 :08 :15

Yeah, no, it doesn't make you a crappy friend . I mean, it was something my sister is doing fantastically . She's actually a health coach now, and she's doing great . She had some struggles through that time that is doing fantastically . And I guess part of it is that that was my initial motivation for doing it . But the more that I got into medicine , I find the human body fantastically interesting . And medical school is

interesting , though , because I feel like the reason that I was appealing to the medical school was because I had such a varied background and varied interests and was an interesting person . And then I got to medical school , and I feel like they kind of try to beat that out of you a little bit . Or maybe that's just my own subjective opinion . But, you know that there's all this you know, I was involved in so many things , and I was the leader of all these different groups , and I kind of felt like coming into medicine , one of the things that I could bring was I didn't come from a medical background . And so I felt like I had kind of open eyes to what the process was. And I feel like med school kind of puts you in a little bit of a weird funnel where , at least for me, I wasn't able to enjoy kind of that multifaceted nature of my personality or do a lot of other stuff while in medicine . And I found that really challenging when you apply.

 

Dr. Andrea  Austin     00 :09 :46

That's great , that's cool , that's interesting . But like you said, once you get into it , it's so all encompassing that you really have to give up a lot of stuff . And I think you and I are both on this journey now, many years after residency , of trying to reclaim different parts of our lives. And I look back on things that happened during medical school . My grandmother died , and I remember I failed my biochemist that day, but we found out that she died and I went to the funeral , and then I was just right back into studying and just had to move on. And I couldn't be like a very good family member because I

just needed to get through medical school . And there are many things like that that happened , whether it was a family member that died or when my dad had a stroke or friends , that things would come up and you just didn't have time to really slow down and be present for a lot of those life moments .


Dr. Amanda    River  00 :10:55

I'm sorry to hear that you had that happen . And I had a very similar feeling that you're trying to hold on so much that you don't have the latitude to be there as a human, which I think in medicine and medical school , but the entire medical education . Curriculum does a really poor job of telling us to be there for people all the time , but then not teaching us to be there for ourselves or be there for our people . It seems sort of backhanded in a way.

 

Dr. Andrea  Austin     00 :11:28

Yeah. I mean, looking back on it , and I know as I'm involved in medical education now, that there's movements to change it . But when I look back to deciding to go into medicine and then kind of the culture that you get sucked into is it in a lot of ways feel similar to the priesthood or going into serving the Church . Because they kind of teach you to forsake everything else and that you're doing this very sacred thing which , on one hand, I do think it's sacred . It is sacred being at somebody's bedside in their moment of need. But at this point , can't we have those sacred moments and not destroy ourselves ?


Dr. Amanda    River  00 :12:17

We can is the answer. We can. But I think when you come up to there's a certain amount of I don't know if you got this , but when I was in med school and residency , you know, you're taught to not complain , right , about the hours or about the work because the people that came before you had it harder. Right. And so, you know, even though you're working 90 hours a week, and even though , I don't know, for me, I developed migraines . I had viral meningitis , and I developed migraines in med school . And they're like, you know, whatever , get through it or figure it out . There's no time to stop or to slow down or to deal with anything . And if you want to complain about 90 hours weeks, well, at least it wasn't the 120 that people were doing beforehand . And I really maybe I'm wrong about this . I haven't seen any data about it , but I don't think that , you know, me carrying a code pager as a first year resident for 36 hours is any kind of a badge of honor. I think it's stupid . I don't want my loved one being taken care of by a first year resident in their 35th hour work . Nobody works well at their 35th hour work . But I feel like that's what there's this pride system that keeps going , and I suspect it's probably monetarily driven , but ultimately but it's pathologic . I don't know. A lot of medicine is unfortunately . I feel like this is why we're here, right . It's to try to help kind of upend some of that pathology .

 

Dr. Andrea  Austin     00 :13:52

Absolutely . And I think a lot of us have been told that it's the only way that the system can work . And part of what we do at revitalize is coaching . And a big part of coaching is challenging limiting beliefs . And I think that's a huge limiting belief that's been placed on physicians and people that want to be physicians , that the system can only work if we work you 80 hours a week. No, that's how the system is currently designed . And there's all sorts of innovations that we could do that wouldn't require people to work 80 hours a week. And just like you said, who wants their family member taking care? I think about all the trauma surgeons and their 24 hours call. And do you really want to be going up to the or. With somebody that's on their 23 hours of being awake? We went on an airplane pilot , and frankly , you can't they have laws that prevent pilots from flying because they know it's unsafe . So this is where I really

hope conversations like this , this podcast is mainly for doctors , but this is an episode that maybe , I hope , some patients are listening to. And I really do think it's going to take patients and doctors aligning , saying , like, hey, how long have you been up? Patients shouldn't have to ask that question , but I think patients should , and I think we need to start pushing back on that this is normal or okay to have somebody that's been awake for that long taking care of people .

 

Dr. Amanda    River  00 :15:34

And I think there's so many things in medicine that the public isn't privy to or doesn't know. Right. And I think that's a lot of what creates the disconnect between the medical system and physicians and patients . Right? I mean, I'm in the medical system and it's confusing . I have a master of public health background , and so I did a lot of healthcare economics classes and a lot of healthcare design classes , and in some ways they came out more confused than I went in. So I don't expect the general public to be able to understand the deep inner workings of how the healthcare system works . But I think there's some basic things they should be able to expect , and I think ultimately , that's probably a big part of what's going to drive change in health care. Is the public feeling like they have more of a voice in what they're able to choose , and in the important stuff , too . Not , does the lobby have a fountain ? And do I have a swanky private room , but what are my physicians outcomes ? How long have they been on shift ? Things that are important to their actual health care that I don't think we're addressing right now.

 Dr. Andrea  Austin     00 :16:47

Yeah. And I would just encourage the listeners to listen to the episode I did with Vinny Arora on The Emergency Mind . And we debunk a lot of the myths around safety and medicine . And the one I really want to just put in a bug in all of our listeners ear is when I think back to residency , in those 80 hours , weeks, if you really had somebody recording what you were doing , during those 80 hours weeks, how much of it was actually required work by a physician versus how much of it was what we call scut , which is menial labor that does not require a physician . How much of it was making phone calls for follow up appointments or writing an arduous note because there wasn't a functioning dictation system or scribe ? You look at doctors if you went straight through , maybe you're 26 years old. If you didn't go straight through , it doesn't matter what your age is, you have a freaking doctorate . Why do we expect somebody with a doctorate to do all these tasks that could be done by other people and expand the team and then people wouldn't have to be awake for 80 hours ? You could probably easily shave off . I think if I look back to most of my ic rotations , you could have probably shaved off 20 hours in just pure scut . That could have been done by a clerk or a scribe .

 

Dr. Amanda    River  00 :18:27

Yeah, agreed . And also, why do we have to make the process miserable for patients , right ? I can't imagine being a post operative patient , you feel terrible , right ? So say you have appendicitis , right ? 20 % of us at some point are going to get appendicitis . So you felt like crap for a couple of days. You haven't eaten anything , you had surgery yesterday , your belly hurts . There's some medical student that comes poking around at 05 :00 in the morning because that's what we do, right ? Because the medical student has to go, and then the resident has to go, and then the attending has to go, and then they have to write notes , and then they come around again. Why don't we just as a team, see the patient once after they've been up for a little bit and save everybody ? It's just like you said. I think there's this system that is perpetuated because we think that's how it has to happen . But a lot of it , I think , makes it confusing for patients too . Right. Because they ask the medical students a question , and then they ask the residents question , and they ask, why don't we collectively make this a better experience for patients ? And I think the training in that would create some room for better physicians as well, and probably better rested physicians and patients , too . I don't know. There's so many we could talk for hours about this .

 

Dr. Andrea  Austin     00 :19:42

Yeah, I think it's a great conversation to have. And I'm reading It Takes Five to tango right now, which is a book that looks at aligning patients , physicians , payers, policy , and pharma . Those are the five things .

And I think there's tons of opportunities for us to build a better system that aligns our interests . Absolutely . Well, let's pivot and talk a little bit about what you've been up to since medical school .


Dr. Amanda    River        :20 :16

I have been figuring out how to find my place in this medical how did one of your podcasts get the medical industrial complex or what have you? So I trained in emergency medicine , so I went to the University of Arizona for emergency medicine and was a chief resident there , went to a community health system in central Oregon . After that , it wasn't a particularly sick population , which great for central Oregon , but not great for me right out of training , as you know, in emergency medicine , your procedural skills and things , you have to see a certain volume of rather ill patients . So I went to a big level. One trauma center , got my butt kicked for about a year. It was an interesting experience . It was an academic center and taught me so, so much . It kind of got taken over by a large management company while I was there that we could talk about if you want to or not . So I ultimately left there because I felt like the large management company and my values were not in line. And then I went to guam. So I've been practicing in guam for six years, on and off at a private facility there , as well as a public government run hospital there , which has been fun and lovely. And last year, well, in there I had a

cannabis clinic . I happened to be in a state that legalized medicinal cannabis while I was in the state and tried my hand at that for a few years, which was a phenomenal experience . Having my own clinic and getting to see patients that were really looking for something different in the health care system and being able to speak with them in an educated manner about something that traditional medicine doesn't educate physicians very well about , was a really neat and rewarding experience . I last year worked in a COVID icu for six months in the Dutch West Indies. So that was also a very interesting experience . And more recently , I've been doing some logan's work and then I'm kind of circling back to my roots a little bit and doing some emergency work in my hometown and then trying to figure out I got my certification , lifestyle medicine , right before COVID kind of came on board . And so that went to the back burner for a little bit in favor of doing emergency medicine . And then I'm kind of coming out from that a little bit and looking to rekindle the interest in lifestyle medicine .

Dr. Andrea  Austin     00 :23 :02

Wow, that's a lot of stuff .

Dr. Amanda    River  00 :23 :07

Yes, I've been doing a lot of stuff . It's kind of as we talk about health care and how we integrate into healthcare and how we lead healthcare , I get conflicted because I see the potential for us as physicians and patients to really change the system . And then in some ways I also feel like we're trying to hit control alt delete on a typewriter . Like there's this like we're trying to insert a function into a contraption that is just not built to accommodate what the current space needs . And so I'm trying to figure out how do I lend myself to that in the best way possible . And I've tried community and private and government and academics and I really enjoyed having my own private clinic and I don't know if that is the best way to do it or not for me. And I'm kind of trying to sit and listen for a minute and figure out where I go next .

Dr. Andrea  Austin     00 :24 :12

So you and I are both emergency medicine physicians and we've talked a little bit about this offline . Certainly I've had my moments not moments , periods of burnout with emergency medicine , which statistically 70% of emergency physicians experience burnout . What has that experience been like for you? And what are the factors that make emergency medicine so prone to causing burnout in positions ?


Dr. Amanda    River  00 :24 :48

I think a couple of your guests on a podcast , I want to say they were on in January, pair of sisters , I believe , Dr. Paasch and Dr Barrett , I believe , had a really good way of putting it , and I think they hit the nail on the head for what my experience has been. I think . Well, first , when I went into emergency medicine , I heard people got burnout , and I thought it was probably due to the volume of traumatic stuff that you deal with , because we do deal with a very high volume of traumatic stuff , and there's not a lot of way to get around that in the profession that we have. So we have to learn how to deal with that . I thought that's what it was going to be going in. And then as I kind of have gone through my profession , I thought maybe it was that I hate the volume of notes that we have to do, or it's the shift work and all the little kind of detailed stuff that are everyday work that grinds away at you. And I think to some extent that's hard. I think it's hard to work overnight and I think it's hard to do all these notes when you have all these patients to see and things . But I think for me it really has come down to a value misalignment . I feel like the system I value my time with the patients , I value my quality of care, I value the experience that they have. I value how I'm making their life better for some people is going to be the worst day of their life or the worst day of their month or we have such a privileged and challenging position to get to be the person that helps people through that . And the feedback that I get as an emergency physician is how accurate is my billing ? How many check boxes have I checked for cms? How can I move more patients through ? How can I put orders in on a patient even if it's really uncomfortable for them to have a partial exam done in the waiting room ? Because we are trying to meet our metrics and there's just this system that the things that I care about and want to get better at and do better at is not what the system seems to want to get better at or do better at. And I feel like our patients suffer so much from that and that's hard to come to work every day in a system that doesn't really care about what you care about or it doesn't feel like they do. I have a pen in my hand that says patients are partners , right ? And I've worked for so many systems that integrity is us, but it's not . Those are words . And that for me has been the biggest part of burnout is not having the whether it's the perception of or the latitude to be the kind of physician that I want to be within the system .

 

Dr. Andrea  Austin     00 :28 :05

No, that was a really articulate way of describing something that's so confusing and messy. I totally identify with a lot of the points that you made. I think an example is the obsession with the door to dock time . And for people that aren't familiar with that , essentially , I don't know who's decided somebody has decided that patients should be seen by an emergency physician within 30 minutes of arrival to an emergency department . And it's with a good intention behind it that it's good to be seen rather quickly because sometimes people are more sick than maybe somebody else would have realized . So it's with a good intention . But during COVID when we were getting essentially overrun and frankly overrun by a lot of people that didn't need to be in the emergency department by people with minor COVID symptoms of runny nose, fever, body aches. It really was doing at some point , everyone a disservice . How many times did somebody come up to me and said, hey, you need to go see this person . They're about to leave, and we don't want to get an lwbs left without being seen. And I'm actually in the middle of doing something important for somebody else. And it's just like those constant things that , well, no, you got to meet this metric instead of doing what you know in the moment is the right thing , like concentrating on this ekg that you're trying to figure out , is this potentially a stem ? But now I'm interrupted because somebody wants to be seen immediately .


Dr. Amanda    River  00 :29 :54

Yeah, and I think that's hard. This is a whole , I guess , different tangent too , but my capacity to being a caring individual when you're constantly faced with those kind of things is, I feel like, reduced . Right. I mean, you get to sort of a spot where people are demanding your attention for things that are not high up on your priority list . And so eventually I get really annoyed . I get annoyed at having to go see this patient because they want to leave or whatever . Patients don't know that , right ? But there's not a barrier there that keeps you from that door to dock time or that left without being seen or whatever . It's like it's constantly okay to interrupt you in the middle of whatever important thing you are doing because of whatever other important thing that somebody else thinks is important . And when I say somebody else, I kind of mean these metrics that have been put in place . You're right with good intention , but don't appreciate that . I am just got sterile for a central wine. I am in the midst of having a conversation with a patient's family. I worked at this place that I laugh about it . It was terrible , actually , that made us carry the transfer phone . So it was a big academic facility , and we across the board accepted all transfers . We never said no to a transfer , but they made us carry the transfer phone . And so every time there was a transfer , which was, I don't know, anywhere from two to ten times an hour, that phone would ring and I would have to take the details of the transfer , and occasionally we would provide recommendations or whatever . But we kept trying to get a system in place , because , as you know, as an emergency physician , when you're working at a busy place to have a phone call eight to ten times an hour about some other random thing that wasn't on your plate beforehand , that you just have to say yes to get somebody to answer the phone . If they have a medical question , I'll take it . But it's not that I'm opposed to taking it , but I have other things I need to be doing , and I don't know, I don't feel like the system respects that a whole lot .

Dr. Andrea  Austin     00 :32 :12

Yeah. And it's interesting now what I've been trying to do when I get this really annoying interruption that's something small. I've made some decisions that actually , I'm in the middle of something . I'm having a conversation with a consultant , or I'm in a patient room having a moment with them , they're going to have to wait . And I found that by regulating myself a little bit more of like, no, I'm not going to go do this other thing until I'm ready, I can show up a lot better . Because when you yank me out of something that was important and then you tell me to do something to meet a metric , I'm not really honestly probably my best self. When I go do that other thing where if I had a few minutes to tie things up, then I can go into that room calm and more compassionate that somebody has a runny nose.

Dr. Amanda    River  00 :33 :17

Well, and the metrics aren't always the best thing for the patient , I think . Again, sweeping things are with good intention . But I can't tell you how many times when I worked at a super busy facility that I would walk into a room and a patient had vancomycin running . And I'm like, Why does the patient have vancomycin running ? Or I would walk into a room and the nurse is giving five milligrams of morphine for somebody that smashed their finger in a door. I'm like, Why are we giving five milligrams of morphine ? Well, because we have to meet our long bone fracture time to narcotic by whatever , and I was intubating somebody , so I couldn't meet our long bone fracture . It's just like so many of these things when I'm like, well, now my patient just got a narcotic they didn't need, or they just got an antibiotic they didn't need. And a lot of these aren't being driven by thoughtful physician decision making . It's being driven by some metric that we have to meet . And it's just I don't know. I feel like part of the reason, at least in my case, the places that I've worked , is we're just understaffed . And that's a whole , I guess , other thing , too , right , is nurses have ratios doctors don't . And so I have worked at several facilities that have very poor staffing , and that , for me, has been a source of burnout . Also, it's just the expectation that you can see unlimited numbers of patients and that you can see them very quickly , and it's hard to process for complicated patients an hour for 10 hours .

Dr. Andrea  Austin     00 :34 :51

Yeah, that's such a great point that you bring up. And it's something that I've said many times , what is my ratio ? And we don't even actually have data on what is a safe ratio for physicians . And it's time that we do that research . And we know I've had times where I've had 50 patients that are under my name. Now, maybe I've had some advanced practice apps working with me or residents , but at the end of the day, it was my name. I was responsible for all of those patients . I personally just don't think that's a safe way to do things or write designing a system that would not be the way you would design it .

Dr. Amanda    River  00 :35 :38

It's not . I mean, it's so hard. Even when we have the time with our patients and stuff . People are complicated , right ? The human body is complicated . There's a reason we went to school for twelve years to do what we do. The human body is complicated . If your expectation is to be able to pick up 50 complicated things on patients at once , nobody can do that . And yet I feel like we're asked to do that not infrequently . And I think that is really challenging and frankly , very unacceptable and dangerous . And I've been in that position myself and it's so uncomfortable to know that you don't have the capacity to do the best you can for every patient because you just don't physically have I mean, you can't do the best thing you can for 50 patients at one time . You just can't .

Dr. Andrea  Austin     00 :36 :31

So we're going to leave it there for this week. It's not lost on me that we got a little negative towards the end and some parts taken out of context could be misunderstood . I know river really well and we're both proud emergency physicians and we take pride in being there for patients . 365 24 /7. We are the only doctors that are we are the only people that are there for everybody , regardless of their ability to pay.

And that's why we chose to go into emergency medicine . But the safety net is frayed and we need everyone to be focused on ways to better support us and provide us the resources , staffing , physical supplies , workflows , working as a team in the hospital , recognizing that we can never close our front door, patients continue to come in. And the only way things work is if patients , when they need to be admitted , move upstairs . And when patients need to be transferred , that ambulances are available to pick them up and safely take them to where they need to go. So you did hear some frustration , you did hear some questions of how can we be the wealthiest country in the world and still have these issues and be burning out our physicians . So coming back full circle to why Linda and I founded revitalized is we are tired of being tired . We are tired of hearing these stories over and over again. We'll keep listening because part of this is that we want to be alongside you. And I'm still complaining as well. But there gets to be a point where it's like we can't continue down this road. There has to be a new way, and we hope that revitalize is part of that solution . We believe that more of us coming together and getting clear on our values. You heard river say that several times during the pod that I was working in a place that wasn't aligned with my values. So recognizing your values, recognizing boundaries , and then lastly, becoming leader, that when you are in a system that is not toxic , we're always going to recommend that if you're in a toxic system , that you leave. But if you're in a system that's just not working well, but it's not malignant , it's not pathological , there's some good people that need help. We hope that the tools that we have at revitalize empower you to be able to make the changes , because we need you. Your patients need you. Your communities need you. The level of expertise that all of you have is enormous and not replaceable . A lot of people are trying to tell you that you are replaceable . You are not . So I know we got a little dark in this episode , and that's okay, because we don't believe in toxic positivity . We want you to show up and tell us what you're feeling . And after we get that out , we're going to pick ourselves back up. We're going to support each other , and I believe we're going to make healthcare better , because we've got to we've got to do it for ourselves , and we got to do it for our patients . So I'm sending you an air hug, and I'll see you back on the pod next week.

Dr. Andrea  Austin     00 :40 :18

Thanks for listening to The Revitalizing Doctor podcast . This podcast is brought to you by Revitalize Women Physician Circle , founded by Dr. Linda Lawrence and Dr. Andrea Austin , your host . You can connect with us on our website at https://www.peoplealwayshcc.com/revitalize . You can tweet at us at RevitalizeWomen and please connect with us on LinkedIn at Revitalize Women Physician Circle . We look forward to helping you go from surviving to thriving . 

This podcast represents our opinion and the opinions of our guests . It does not represent any entity that we work for or with , including the military , the government, or any other institution . Thanks for listening , and we'll see you again soon.