#002 - Dr. Rune Toms - Norwegian neonatologist and cardiologist

This week Ben and Daphna sit down with Norwegian neonatologist and cardiologist, Dr. Rune Toms.
Dr. Toms is the former medical director of the NICU at the University of Alabama in Birmingham and is now working for Envision Physician Services. 
At Envision, he is the regional director for neonatology in South Florida, the national director of pediatric cardiology, and the national director of quality and safety.

In this episode Rune Toms discusses his upbringing, his path that led him to become a neonatologist and eventually a cardiologist. He also shares with us his passion for art, mindfulness, and his definition of the Scandinavian approach to neonatology.

https://www.linkedin.com/in/rune-toms-824018134/

As always, feel free to send us questions, comments or suggestions to our email: nicupodcast@gmail.com. You can also contact the show through instagram or twitter, @nicupodcast. Or contact Ben and Daphna directly via their twitter profiles: @drnicu and @doctordaphnamd.

enjoy!

As always, feel free to send us questions, comments, or suggestions to our email: nicupodcast@gmail.com. You can also contact the show through Instagram or Twitter, @nicupodcast. Or contact Ben and Daphna directly via their Twitter profiles: @drnicu and @doctordaphnamd. The papers discussed in today's episode are listed and timestamped on the webpage linked below.

Enjoy!

Transcript

Ben: 0:44

Hello, everyone and welcome to this episode of the incubator. This week we have the pleasure of having with us in the studio, Dr. Rooney, Tom's, Rooney works for Envision physician services where he wears many different hats. He is the Regional Medical Director for South Florida and neonatology. He's also the National Director of Quality and Safety, and finally, the National Director for pediatric cardiology. Ronnie, welcome on the show.

Rune: 1:11

Well, thank you so much, Ben. I really appreciate it.

Ben: 1:15

We're happy to have you. We definitely are very excited about doing this interview with you. You have such a fascinating life. You have such a busy schedule. So we were very eager to pick your brain and ask you a lot of questions.

Rune: 1:28

Thank you. Yeah, I look forward to it. So for

Ben: 1:31

the people who don't know your background, you were born and raised in Norway?

Rune: 1:36

That's correct. Yes. I was born in 1969 in Oslo, Norway, and lived in Norway until I was 10 years old.

Ben: 1:47

And then you pursued your medical education in Germany? Is that correct?

Rune: 1:50

Yes. after that. So when I was 10, we moved to Switzerland. And I lived there for another eight plus years. And then I moved back to Norway for a couple of years. And then ultimately, I went to medical school in Munich, Germany.

Ben: 2:05

Very nice. And you are now a board certified neonatologist and also board certified in pediatric cardiology, you are the former Medical Director of the University of Alabama, neonatal, neonatal ICU. Yes. And currently, you work for Envision healthcare, and provide neonatal and cardiology services down here in South Florida.

Rune: 2:27

That's right. Yes,

Ben: 2:29

Daphna, do you have any any questions you want to get started with?

Daphna: 2:33

Yeah, well, I'm, I'm initially just struck by how many healthcare systems you have been a part of. And I imagine that that impacts the way you care for patients. So I was actually hoping that might start there. About how your background, especially in different countries, overseas packs, how you practice that?

Rune: 3:01

Yeah, that's, that's a good question. Definitely. Sometimes, honestly, I, I kind of reflect on that myself. You know, what, what do I want to take with? Every single day when I see patients and when I when I kind of plan to project or work on optimizing flow in a unit and how can I take with my experiences from the different countries and you're right, I mean, the, the places I worked certainly the in the Scandinavian healthcare system. And also the Swiss healthcare system and the German is certainly something that I reflect over. So let me tell you, kind of how that has shaped my path. And I do think the way it has shaped my path is that I've really embarked on an on a journey of ongoing learning, trying to self reflect and be humble along the way because realizing that healthcare delivery is certainly a very complex industry, and no one gets it right. And in the sense that we do discuss kind of the different national healthcare systems just realize that that it is difficult, and I've I've experienced hiccups and problems and certainly very positive things in each one of them. And that's kind of what I tried to define the path that I want to take when it comes to providing health care.

Daphna: 4:40

Yeah, I love that I, you know, we get so caught up about doing things just one way. And I think that you bring so much you know, when we together to the table, and in terms of of your experience, I'm also you know, interested in hearing about how just traveled being, you know, new so many times has impacted your life?

Rune: 5:08

Yeah, that's that's a good question. Definitely, I do think it does matter. Like I said, when I was 10 years old, we moved from Norway to Switzerland. And I think that kind of really set the stage for how I was going to almost live my life. Living in Norway in a in in and just suburban also community. The focus on education and schooling there is unique in the sense that kids are really allowed to be kids in Norway. So they focus on on you spending a lot of time outside, just playing and running around in nature. And being physical in that sense. And I would say up until fifth grade, there's less time, really at the at the school bench and studying and less focus on academics in that sense. But I was taken out of that world and put into a an international school in Switzerland, where of course, it was much more focused on kind of performance from different, different areas. So that was really my first experience when it comes to being out of my element and being out of my comfort zone. And I guess, almost that's something that I've continued to almost seek periods where I can be out of my comfort zone, because I do realize and feel as though the rewards of actually succeeding in an area that's outside your comfort zone is very rewarding.

Ben: 6:43

So since since we're talking about schooling, I wanted to start off maybe by asking you as well, when you were in school, what would you answer to the question? What do you want to be when you grew up?

Rune: 6:54

That's a good question. You know, I would say it evolved over time. Yeah. So up until I would say maybe early, kind of middle school, eighth grade, ninth grade, I was wide open, I wanted to do something maybe a little bit more artistic. And then, in middle school and beyond. The concept of of serving people was something that I liked. And I thought I understood. And as part of that, I feel as though medicine was the obvious answer. Even though I guess at that time, I didn't realize that medicine is so much more than just serving the people. And it is a form of art as well. It is the most definitely a form of art, so and a form of philosophy, you name it, it's everything. So ultimately, of course, that's the path that I took. And I think but it started with really working with people as wishes to work with people.

Ben: 7:55

And so following up on that, as you you went through your schooling and you went through high school and university, what after being in medical school for a few years made you lean towards a career in I guess initially neonatology.

Rune: 8:10

Yeah. And that, again, was not a straight path for me. I actually, I actually wanted to become a neurologist, believe it or not, yeah. And that was fast. I was fascinated by the kind of the Early French neurologists and, and the kind of the shortcodes and shakos. And also some of the psychiatrists and he's kind of Southern Germany and such and, and but then just happened that the hospital I was doing my internship in internal medicine at the time. I am my rotations in in urology, were just not what I thought they would be.

Ben: 8:54

I think it's always the disappointing aspect of neurology. I think myself included, I've was very interested in neurology, and from the physiology standpoint, there's so many interesting things to learn and to discover. But in practice, it becomes such a restricted field, that you have this sense of letdown, like, Oh, I wish I could do more for these patients. And somehow it's like, the brain remains this impenetrable box where

Rune: 9:18

I was so excited, showed up with my reflex hammer ready to go. But no, it's just once the CT scan was done, there was no more physical exam.

Ben: 9:26

Right? Right. That's, that's true.

Daphna: 9:30

That's so funny. I felt the opposite. I wanted nothing to do with my neurology rotations that it's not until I landed firmly in neonatology and that I really kind of developed a passion for what's going on in the in the, in the baby breathing. So that's so funny how, you know, our experiences shape us. I hope and we might be able to go back and talk about that artistic side. So we know that you're an excellent clinician, and we know that you love poetry. But I think kind of your artistic side is probably even deeper than that.

Rune: 10:13

I would know definitely, if it's if it's really all that deep, but it's certainly deep when it comes to admiration for art and the arts. And I will say, and you everyone knows this, and anyone who works clinically in ontology, the all the hours you spend in the hospital, sometimes at the bedside, but often just walking hospital halls and eating by yourself in the call room, and that kind of stuff. And I have found during that period, a lot of inspiration art, there's something so tangible and something so living, when it comes to art, that it feels I feel as though I kind of rekindles this life within me that I can bring kind of as a thread throughout my both personal life and, and professional life. And I feel as though it makes me a better clinician,

Ben: 11:14

it's very interesting that you say that, because there's so much data and literature on the effects of art on the mind and the soul for patients. But we sometimes fail to recognize that clinicians may benefit from the uplifting aspect of being exposed to art and overall, it's beneficial properties. Yeah. I know that one thing that that struck me after knowing you for for now, a few years is your your passion for poetry specifically. And I'm wondering, what do you find in poetry specifically, that that brings you this sort of emotional relief that you may not be getting from another art form?

Rune: 11:49

Yeah, yeah, it's, you know, first of all, I'm, I'm not a poet, myself, I wish I was I've and there's no doubt I have tried, but um, you know, I am humbled when it comes to that, and I realize how difficult it is to use the right words and actually use the language and but what really strikes me is that reading a piece of poetry from say something, you know, written a couple of years ago to something that was written 100 years ago, it's this again, thread of humanity, right. And the fact that there is someone sat down 50 plus years ago and wrote these pieces and the words and put them together so beautiful on a piece of paper, that it touches me when I read it. To me, that is very powerful, because it's almost as if you can share something emotional, with a person that you don't even know, that actually wrote this 50 years ago,

Ben: 12:49

and I find my I'm a big lover of the arts, and as well, and I like ballet and I like paintings and and sometimes I find the art and, and, and choreography within the NICU to be very reminiscent of different art forms. I feel like it is a bit like a ballet babies coming in babies coming out. And I was wondering if if poetry was maybe like the rhyming aspect of it, the symmetry sometimes between different bed spaces, different rooms, and you're seeing the connection points. I think that's that always struck me as after after seeing your passion for poetry, it sort of made me wonder if there was not true literal poetry within the NICU as well.

Rune: 13:30

Well, it's probably true. And you know, there is also some order to it, right. And when you work in our field, you kind of you focus on order, because you're you need that order every single day. And I feel as though the longer I do this, the more order I feel. So I need and, and I respect and kind of admire the order that's found in poetry, even though sometimes the poetry is written by something very, sometimes organic, like you know, life and death and love and all those things that we live and breathe every day. So the water is part of that. It's also fascinating.

Ben: 14:09

So going back to your training, I'm wondering after you have Where did you did you train in pediatric cardiology? Was that still in Europe? Or did you do that in the US?

Rune: 14:20

Well, in in Norway, when you train as a pediatrician, and then ultimately a specialist, it's generally that you train for five years. You start off as a as a pediatrician and do general pediatric calls and then you do a subspecialty training as part of the neonatologist, subspecialty training. Many neonatologist then do some degree of neonatal echoes in the unit and that's where I was fortunate to have a boss at the place where I did train, who was a pediatric cardiologist and an ecologist and he taught me echoes. So Though early on in my natal ology career, Echo was actually part of it.

Ben: 15:06

And so just to clarify, so that so is that standard in at least Scandinavia to have this this training in point of care ultrasonography as a pediatric resident,

Rune: 15:15

I would say it's almost close to standard, but there was some who spent a lot more time doing it. Most of them ultimately do not become pediatric cardiologists. But ultimately do some degree of of targeted echo at the bedside.

Ben: 15:33

That's, that's such an avant garde type of practice that we're just getting around to in the US trying to implement this as a standard and to see that it's already sort of pretty widespread in Scandinavia as chemical, you were gonna say something definite.

Daphna: 15:47

Yeah, no, I just am feeling just kind of, you know, at the beginning, in the states of really using point of care, ultrasound, and it is so much more prevalent over overseas. I think that's really, really interesting.

Ben: 16:06

But for the listeners, I mean, it's not because you got some training in point of care ultrasound that you are, we call your cardiologist, you actually did train in cardiology. Yes. I don't want people to think you're a fraud in any way. So so how, where did the training actually then? So that led you to pursue formal training in cardiology, I suppose.

Rune: 16:27

Yeah. So ultimately, so what happened was this that and again, it's not a straight path. I, my wife is from the US. And we lived in Norway, during my initial part of training, she did some training there both are our girls were born in Norway. But our plan was really to move to the States at some point, right. So then, as part of the move was in finding a place where I could continue my training on train. Ultimately, I ended up taking a fellow position in in ontology at the University of Alabama, Birmingham, and worked with Wally Carlo, they're great mentor, great friend, and amazing role model. So then training there, in neonatology and then ultimately, pediatric residency at the same place. Once I was done, I was started working as a neonatologist in the unit there, right, and then they were expanding the cardiac program. And they needed more cardiac intensivist. And I became somewhat of an obvious target, to send on to train, do some extra training in cardiac ICU. So therefore, I went to Boston Children's and did extra training in cardiac ICU. Again, trained under Peter Lawson, who was an amazing mentor, a great friend, and I just think the world of him too. And it went back to Birmingham, UAB, and build up, together with others, cardiac ICU, their pediatric cardiac ICU, and then also neonatal cardiac ICU in the NICU.

Ben: 18:13

And I think it's, I think it's a very modern issue. As I recently completed fellowship myself a few years back, and there's always this this question that lingers for any new fellow graduating, should I pursue additional training? And it's, it's feel silly to say this to you. But there's always that question, my God, this is extra years extra financial strain. And so I guess, you seem to be a very indifferent person. But what I'm wondering is, how did your family take this additional training at the end of such a long road that you were coming to the end of?

Rune: 18:48

Yeah, I mean, I've been lucky, who have a very forgiving wife, of course, throughout this time period, but you know, we're, we are a strong entity, we're good friends, and we share a common kind of vision and interests. And the way she actually took the trip to Boston was really an exciting time with the kids. And every time that I, you know, came home from POST call or whatever, you know, we'd be ready to either go on on the freedom walk or do some kind of historical trip or go up into nature in New Hampshire, or Maine or whatever. So we just, we kind of agreed to make it something special for the kids and for ourselves. I'm not saying was easy. But we managed to do. So now that we think back. It is it was a very good time for us.

Daphna: 19:45

And really, she's a professional so and it sounds like you've been equally supportive of kind of her endeavors as well.

Rune: 19:56

Yeah, I mean, we've been we've been working as a team again, and it Of course, there's always some, you know, difficult to do to always give kind of a full clear pass on both ends. But I would say, you know, she has probably made more sacrifices than I have when it comes to career. So, you know, again, I'm grateful to her for having made those sacrifices. But we have worked as a team throughout this and made decisions together, there's no doubt. Let me ask you something.

Ben: 20:31

I wanted to ask you about what your perspective is for the future of neonatology. Do you think that this, your path is going to become eventually the norm, where neonatologist will need an extra training in either cardiology, there's there's pediatric, there's neonatal fellowship in urology as well. Do you think that this will remain sort of the outlier, or this will eventually become the norm?

Rune: 20:54

I think it's becoming more and more of a norm. And let me just finish my path because I don't think completed so the listeners understand exactly where it ends, because it really didn't end with cardiac ICU, because and I and I'll kind of come back to your question. But, you know, once I built up the neonatal cardiac ICU aspects of the of the NICU, I was at times, because I could do some of that because myself, but they weren't official, right? I wanted to, you know, even though I worked very well with pediatric cardiologists, and we collaborated talked all the time, but every now and then, when you follow the babies every single day, for months, say nav canal, trisomy 21, that's kind of stuck on CPAP with 35%, oxygen, and then you follow the echoes and follow them clinically. And if something starts deviating clinically, and that just doesn't fit the path, you want to put that echo probe on yourself, and trying to understand exactly what's going on. Is this, you know, over circulation, or is this over circulation with pulmonary hypertension? Or is it pulmonary hypertension? Or is it some kind of function issue? And that those situations really led me to wanting to become a, you know, a Board Certified cardiologist so I could do those echos myself, right. And that's when I ultimately did cardiology fellowship. And just for everyone, once you've done one fellowship, the next fellowship is only two years. Yeah.

Ben: 22:38

It still doesn't make it. Yeah, I'm not sure.

Rune: 22:42

Anyway, so. But, so back to your questions, Ben. Yes. When it comes to cardiac ICU, most larger centers now have double boarded people in either pediatric cardiology or in critical care, pediatric critical care or critical care and, and other stuff. Yeah,

Ben: 23:05

I've seen I've seen neurology, infectious disease. And I think it's very, it's very nice and honest of you to say that because it will help young graduates decide what to do, if they understand that this is the path that the field is taking. And hopefully, I'm just saying this, hopefully, maybe, neonatology fellowship programs who can offer sub fellowships will start integrating them maybe already within the third year of fellowship, that the time constraint cannot be too significant.

Rune: 23:30

Absolutely. And I will say, do your research. Many people ask me exactly what path they should take. And I think if you're going to take a path, take a path that ends up with true credentialing and find maybe ways in which you can use an institution to support you, so that you're not always on your own so that you are not necessarily, you know, taking the burden of, of the financial burden, and also the family and physical burden, no, maybe say traveling and that kind of stuff. So

Ben: 24:11

yeah, if there's an institution can support you through a partial attending position in fields, you're already board certified. It might might not take away the time commitment, but it might relieve some of the financial strain that it can place on people, especially in this day and age where people have loans to repay this might actually make this advice is it's a strong one, I think, yes, it might make it easier. Absolutely.

Rune: 24:32

And there are some early positions as a assistant professor, for example, where you can actually negotiate is kind of a strong word, but you can make an agreement that you can do some training towards a fellowship completion, but also were partially as attending so that you will have that salary, and then you can also fulfill some fellows Ship time.

Ben: 25:00

That's yeah, that's exactly right.

Daphna: 25:03

And bringing something you've had some good mentors as well, a long way. Can you speak to kind of any of those special relationships?

Rune: 25:13

Oh, yeah, absolutely. That for I do think mentorships are very powerful, and also friendships along the way. So I will say, you know, it started early. And I think that's, that's part of being open to being mentored. So it started in Norway, there's no doubt with Dr. Halls, who was my first boss, who taught me kind of the, or taught me the echos and introduced me to the world of pediatric cardiology. And then, of course, Dr. Carlo in Birmingham, and it's really his influence on me was such that anything was possible, you know, you could you can do anything, regardless of you know, and then, and it's, it's so freeing to work for someone who has that mentality. And, you know, may also add, you know, it's coming from Norway, and then having a mental result, uh, you know, came from Puerto Rico. Culturally, it's, of course, we're, you know, some somewhat pretty far apart when it comes to both rhythm and emotions, but, but it's been wonderful. So in that sense, I feel as though he, you know, our relationship has kind of helped me kind of expand on so many levels. No doubt. So,

Ben: 26:39

since since you mentioned this contrast and cultures and origins, I think we've all heard the aura of Scandinavian medicine. And without going into a broad topic like Scandinavian medicine, at least for the purpose of neonatology what I know you're this is a subject you're passionate about as well. But well, how would you define what are the main driving lines of Scandinavian neonatology? How does that differ from from the American way of doing things?

Rune: 27:10

And it's a good question, because, honestly, I've been been working with some of my colleagues in, in Scandinavia to actually try to define and define the Scandinavian way of practicing and, and Itachi. And I don't think we actually have a, it hasn't been defined. But what you will experience is a much flatter hierarchy structure, a kind of a more cohesive team, when it comes to the nursing staff and the physicians. If you not sell them, if you walk into a unit, you won't tell the difference between a physician and a nurse because they kind of wear the same type of Scrubs. And we all know that that kind of hierarchy when it comes to Central Europe is very strong sometimes and also in the US. You kind of have that hierarchy. But I think the the most important part of it is really the focus on the family. And it's really the concept that it child or neonates, it's to the point of it being seen as a as a individual or human right, for them to have the family in the unit 24/7. And it's because it's in their best interest to be held to be loved by their parents and their families. So that is something that really drives the Scandinavian model. And as part of that, it follows a lot of other stuff when it comes to you know, of course, the use of breast milk. I mean, you barely when I worked in in a community hospital, it didn't Birmingham, you walked in an error. There was a whole room with formula. I'd never seen that much formula in my life before. So yeah, that's, that's something you don't even consider really so much in in Scandinavia and neonatology. Right? So that just comes as a natural addition to including the family in the unit.

Daphna: 29:15

And I certainly feel that when I watch how you interact with families, and how much you care for them, and they they care for you. So how do you think we can you know, disrupt our way of practicing to include some of those values?

Rune: 29:34

Well, I feel very strongly that everything we do every single day as as neonatologist matters, every time we open our mouths, every nonverbal communication matters, our presence in the unit matters. And of course, how we talk to our colleagues, our nurses and families. And I feel so humility is very empowering. Orton as part of it, and just inclusion, inclusion, regardless who the parents are, regardless of what their past kind of background might be finding some degree of common ground when it comes to say, maybe being parents are being being humans in that sense. So always presenting and showing that we're equal, and we're here to care for them. And we're here to guide them through the whole process of of the NICU stay and their experience in the NICU.

Ben: 30:34

Let me ask you something about this, this idea of having the whole family at the bedside and so on. Because I feel like in the US, we are rather good at having mothers and fathers at the bedside. But one thing that had to me has been a huge hurdle to overcome is having siblings, and I am wondering if from your experience in Scandinavia? Did us? Did you find that NICUs were able to bring in siblings to the bedside of a NICU?

Rune: 30:59

Baby? Yes, yes, we certain units are very good at doing that. And, you know, you'll have brother or sister kind of spending time in the unit. And when I say unit, it really depends on the architecture. But I'm not saying that you can't do family centered or family inclusive care if you don't have a single room unit where you can actually roll in a full kind of adult bed for the mom or dad to actually lie in. But not seldom would we actually have two beds in the in the room, both mom and dad would spend time with the baby. And we would also then also have siblings come in and sometimes do skin to skin with with a baby.

Ben: 31:47

That's amazing. Yeah, that's really amazing. I think, I think that's a big, that's a big jump because of if we want to truly perform family centered care, we need to include the siblings that may be feeling left out at the auntie or at the uncle or at the grandparents when when really the the mind the parents mind is being occupied by the critical yo,

Rune: 32:08

exactly. And I think, you know, the concept of physician centric kind of day processes when it comes to hospital care versus patient centric. And I mean, there are numerous examples of of physician centric care where of course, you know, you draw labs in at four or five in the morning so that we will have lab values for four rounds, right? I mean, that's, that's

Ben: 32:37

physician centered, and it's not really thinking of the baby first exam. It's very true.

Rune: 32:41

Exactly. And then, and then, you know, rounding on Well, baby, like we talked about the other day, you know, to have them walk into the unit. See the baby at five, six in the morning. So you can leave pose call, for example, I mean, again, physician centric, not family centric. So always ask those, those questions, what's best for the family, and what's best for the family when it comes to the whole coordination of being present in the NICU.

Ben: 33:09

And I really appreciate you actually defining the term. Calling it physician centric makes it so much worse. Because we do talk about getting better at family centered care, but we ignore the fact that what we're currently performing has is an entity in and of itself, we think that family centered care is going to come out of this, of this chaos that doesn't that has this this sort of vacuum, but it really isn't. It's coming at the expense of physician centered care, as you call it. And I think that's a very good way of defining it, where we put our needs before sometimes the ones of the families of the patient. Yeah,

Rune: 33:41

I agree. And I think I will tell you unit, some of the longer I do this, some of the most rewarding times and some experiences are really sharing time with families. And so actually taking the time taking that extra kind of extra time to focus on the family and communicating with them. That gives you so much back. That's true.

Daphna: 34:08

It occurred to me as as we're talking and now that we've both known you, and a number of years that the way you treat families, with with such respect is is the same way you communicate with with your colleagues. It seems like it's almost a passion of yours to help people find their passion. Where did that come about?

Rune: 34:35

Yeah, I guess. I guess definitely kind of goes back. As I said in the beginning, when I moved from Norway to Switzerland, and go into an international school there where I spoke English and when when I was out out of school, I would live in a world where people around me spoke Swiss, German or German. So I lived in three different worlds. roles that I kind of went in and out of, and I went home to a very Norwegian household, and a Norwegian culture, again, falls into being somewhat of an outsider. But I'd say that in a positive way, because I've kind of been an observer my whole life, observed the Swiss culture when I sat on the train and observed friends at school from, you know, from England, or France, or Scotland, or from the US, Australia, which is also fascinating, as part of that kind of learning to observe learning to see people for who they truly are, and where they come from. And then kind of through my own path, realizing that you can really pursue kind of pursue anything you want. And then finding and seeing that in others is also something that I find very rewarding. And I have been so grateful for people who've seen something positive in me, helped me bring that forth. And that's something I want to share and then do to others also. That's, that's great.

Daphna: 36:12

Yeah, as they say, it takes a village right and raising babies, but and raising physicians as well, I guess.

Ben: 36:18

That's right. That's absolutely true. Since I mean, I am fascinated by not only your path, but your ability to juggle so many different things. As we said at the opening of the podcast, you have you wear so many different hats, and you wear them well. I mean, you're extremely competent and efficient. And so I guess I've never asked you this, but this is the right opportunity. What does the first 90 minutes of your day look like?

Rune: 36:44

Well, honestly, I take it pretty easy.

Ben: 36:49

Yeah. But that's your definition of taking it pretty easy, right? About the same as ours.

Rune: 36:55

Exactly. It was it was, it was funny, because at some, when I took a Masters class, at some point that everyone were to write down exactly what their first couple of minutes were of the day. And I will tell you my pretty much for 20 plus years, every morning consists of having a cup of coffee in bed with my wife. And that is sometimes that goes on for for 10 minutes, 20 minutes, even 30 minutes. So I do think there's a lot of value to, to actually taking a breather, and, and reflecting and actually doing, you know, having some just random talk and, and bonding. And that's, that means a lot to both of us. So yes, that's those are my first, at least 20 to 30 minutes.

Ben: 37:51

That's good. And, I mean, you're you're one of the few physicians and and, and mentors, I guess, who really has put the emphasis on me on mindfulness and work life balance. And so I guess what I'm wondering is, what are your tricks and your tools that you use to enforce this separation between work and home? And because I think this is something that we all struggle with. And I think it's even more pervasive as a young graduate. Because as a as a trainee, there's sometimes no way around preventing work from intruding on personal life, but you're hoping that as you become an attending, you're going to be able to have more control over that. But sometimes the bad habits of fellowship carry on. And so it is something that I found myself struggling with deeply. And and considering your your wealth of experience. I'm wondering what what have you found to be efficient and useful?

Rune: 38:45

Yeah, so I guess, first of all, I'm not sure I'm perfect at doing the things that I do. But I'll tell you the things that I've tried to do, both from, from a kind of family life standpoint and professional when it comes to I try to be a positive influence or on both areas. So say, for example, family, when you come home, I parked the car in the garage, take a deep breath, and I say okay, when the kids were smaller, I was going to be the not the one who brought the burden from work and not the one who complained and not the one who brought in problem problems. I was going to be the greeter positive greeter positive presence from the second I walked in. And I would plan projects. So I would say maybe if I was on call on on a Saturday for the next Sunday, I will plan say to build an obstacle course. Or I would plan to maybe do say, Japanese flower if Our arrangement in the afternoon and and learn about it and discuss it and kind of try to create moments that would also create memories and make a picnic and go out in the forest sit by a waterfall or something like that. And, and make it unique. And actually take the effort to do that and plan it. So that's and then also realize that I have two girls and realize that I don't necessarily always have to solve their problems. But I sometimes use listening. And sometimes being a good father is sometimes just being there. And when I've when I haven't acted the way I wish I had acted, if I lose my temper at the wrong time or something like that. I apologize. I tried to apologize, when would I do something that I shouldn't have done. So that I tried to be consistent in those manners. And I tried to be aware of those things. And again, I tried to put away my work put my phone away. And even if I had a patient duties and kind of backup stuff, I would put it someplace else, I would go and check it every 10 minutes or something like that,

Ben: 41:22

I've started doing that as well. I mean, if I take my daughter to the park, I try to leave the phone in the car, and try to be 100% with her because it's just not something that's under my control. If the phone is with us, it's gonna interfere. Yeah, so I completely echo your sentiment there.

Rune: 41:37

And then for for professionally. I said, I mean, obviously, I've been doing this for a long time. But again, when I pull up in the garage for call, I still take a deep breath and say any kind of you know, any kind of problems from the outside world, I'm not going to bring into the NICU, I'm going to be 100% present for the patients. And almost the longer I do this, the more aware I am of the fact that I can miss things, Miss trends, you know, Miss A baby getting sicker or miss not following up with a parent, for example. So I tell myself, heighten your awareness when you're in the NICU. Because ultimately, when you come come out on the other end, you've done the job that you want to do.

Ben: 42:28

That's that's very good advice. And so, on these trips to home to work, what do you listen to in the car? Yeah.

Rune: 42:36

It's very broad. Ben, it really is very broad. And and it depends, you know that and it depends on my mood and what I need, but I it's you know, I mean, I love classical music. I listen to everything from you know, I love operas. I like to Verdi operas, and I like but I like Mozart operas, too. And I like Chopin. Listen, listening to show PIAA on i 95 is like being in two different worlds. So true. Yeah. And then, and, and Schubert's Vinter eyes is also something beautiful and just kind of sets the stage I like, again, it kind of a thread of kind of humanity that goes through those, but I also love, you know, the Rolling Stones and anything else. Yeah, that's so absolutely. This is very, very broad.

Ben: 43:32

Looking back at your path, you are like we said, you're an accomplished physician, an accomplished father and accomplished mentor, and you have excelled everywhere you've gone. I was wondering, what was your most memorable rejection?

Rune: 43:47

That's a good question. Yeah. I mean, I will say, the path sitting here where I am now on having this, this talk, and you telling me that I'm successful and everything, you know, the whole path has been basically a lot of rejections along the way. Okay. And I will say, I mean, there's so many men there's so and that hard to believe. But sure, yeah. And I would say you know, it's it started maybe let's start with you know, I applied for for 2020 medical schools, right, I was admitted to one okay, I applied for 21 jobs after my after medical school, and I was lucky to almost get one I got like, a half time job when I got it because it's different than normal. You don't go through like a match and everything so and I got half a year contracts at a time. So it's been a lot of stop and go a lot of stop and go so

Ben: 44:52

that has built your resilience. Yes,

Rune: 44:55

yes. It's, it has built my resilience almost to it. To the point where I Oh, yes, it certainly has, I was gonna say, always build it to a point of where I see that kind of I expected, you know, I just I don't expect success. And I realized along the way that you never reached that moment of success where you say, I have arrived, right, but and then you reflect over the fact that it's a journey. So now obviously, you know, I'm thinking back my whole life has been this journey with ups and downs. And I'm still on that same journey, right? So therefore, rejections are part of of the successes along the way,

Ben: 45:42

it brings me back to this book by Ryan Holiday called the obstacle is the way and how each obstacle is should not be seen as a deterrent, but should seen as as the path, and these obstacles sort of remind you have what success feels like, and make you sort of allow you to grow along the way. So I completely I completely understand what you're what you're talking about. Definitely. So, go ahead. Definitely.

Daphna: 46:08

No, I'm I'm cognizant of our time. Questions that been like, everybody has been interfacing with us. And so I just wanted to make sure we got the some of those.

Ben: 46:22

Yeah, so I wanted to sort of wrap this up with a discussion on the contrast and the differences between academic and private practice neonatology, I think your path is very interesting, I think you you succeeded in the academic world. And you recently decided to leave that world to join, envision, envision healthcare, which provides neonatology services all around the country. And so I am wondering, what was your mindset and your thought process when you made that decision?

Rune: 47:00

Yeah, so I would say, you know, what academics teaches you, at least me was that creativity, and innovation is something that you need to have as part of your everyday professional life. And that is something that I have brought with me, and when I did apply for this job at Envision, which was more a larger administrative position to part of that was really building something. And to build something, I think you need creativity. And you need innovation and openness in the sense that you need to give people the benefit of the doubt you need to inspire them. You need to create an environment where people can grow and thrive. And I think that is, that is definitely something I brought with me from academics, because your days may be slightly less structured in academia. And, and you constantly seek inspiration, from visiting speakers, to discussions, to other things at the university that inspires you. So all those things is basically like a driving force. And I think that's something or I know, that's something that I brought with me as part of this position now.

Ben: 48:29

So in doing some research for this podcast, I was able to talk to some of your fellows who said that you had this this pattern of taking fellows out of the NICU to Starbucks, in the within the walls of the hospital to discuss whether it was complicated cases to discuss research. And so the people I spoke to said, this was really a trend, this was something you enjoy doing. And I am wondering, what do you feel are the benefits of breaking away from the NICU to have these sort of sessions with Mentees and students and learners?

Rune: 49:03

Well, I do think again, it's it's, it's so easy to in the NICU to kind of see everyone as a as a workhorse and someone who's needs to finish a task or go and go and check an x ray or follow up on so and so on pull the line or whatever it might be. But to actually see the fellow in this case as as an equal human being, and, and share experiences, I think going out of that environment, often to me, helped help them kind of to some degree, maybe open up and feel more comfortable just talking generally, about life and kind of what we've been talking about today.

Ben: 49:42

It sort of melts that structure that you were talking about earlier. I

Rune: 49:45

think that's very hierarchy. Yeah, exactly.

Ben: 49:51

It also, I mean, definitely I are aware of the fact that you've been very involved also with the Neo Heart Conference. And I think you've recently been named The chair of that conference, do you want to tell us a little bit about the what your heart is about? And and for the folks listening who might not be so familiar with that?

Rune: 50:08

Yes, No, exactly. So the new Heart Conference is actually the conference that's put on by the new heart society. So your heart society was started, I don't know. 2012 or something like that, and really started with a mirror out in at Children's Hospital, Orange County. And we had to be he had a vision. And, and Victor's who kind of helped build that up together with Ganga up at Columbia. And, and I joined and it's been been fun. And really what this is about is joining the concepts of NICU philosophy and management with pediatric cardiology, and pediatric cardiac intensive care. It kind of crystallizes out to some of our kind of softer aspects of NICU care, family involvement, all that kind of stuff, is a breast milk feeding strategies of babies with congenital heart disease. That also event management and, and overall kind of how we manage the babies throughout their entire complex hospital stay.

Ben: 51:23

That's very, that's very interesting. Yeah, yeah. And so how does how does? What is the forum for these types of discussions is there is their publications, websites, conferences?

Rune: 51:33

Yeah, so so we have the New York Conference, which, which has been on once a year, this 2021 is we're not going to have a conference. But last year, we had a virtual conference. And, and then we also have some white papers coming out, that's going to be published through the American Academy of Pediatrics soon. So so we are working on influencing mostly, I would say the cardiac ICU, pediatric cardiac surgery world and having more of a neonatology voice within that

Ben: 52:08

forum. And creating that bridge, I think is essential. There's been a very, very wide gap between the specialties. And so the more communication and partnerships that can be built, I think, the better off we will all be in the patient's world, I think benefit from it. Yeah.

Rune: 52:21

In collaboration through and through everywhere from prenatal aspects of management, to consultations to the real perinatal management to and again through the hospital stay.

Ben: 52:36

Definitely, did you have anything you wanted to ask?

Daphna: 52:39

Well, I you have so much education and expertise and experience really to pull from and you have kind of a different perspective there neonatologist that, that will have gone. And I'm just wondering, kind of what is maybe the biggest change or most influential papers that's come out in your, your career so far, that has been the way you practice? I think that may come from cards or or no,

Ben: 53:10

you're breaking up. So for the people who couldn't really make what you were saying you were asking Rooney if which practice both in the field of neonatology or cardiology has been the most influential during his career.

Rune: 53:22

Yeah, so I think, you know, I, there's a, I would say, more mindset than anything. So when when we work in the unit, or to kind of establish the presence of care, I would say, meta analysis and evidence based care is certainly one aspect of practice that has changed, which is a easy platform to always go back to, you have evidence that you can use and build up protocols and, and aspects of the care that you provide every single day in the NICU. And I guess really, the focus on this type of evidence care happened during the kind of the time that I was growing up as a neonatologist. And I will say that the second thing to add to that will be the focus on health care, quality and safety. Again, as you know, before there was a lot of variation in management of in the NICU, and this still is, but really to focus on this, the quality aspects of things, again, being compliant with the evidence and tracking your compliance with evidence. Knowing that you when you taking care of baby, you are doing the right thing. And knowing that when when it's middle of the night and you're not there and someone else is taking care of the baby, they're doing the same thing. And it's based on evidence. So I would say rather than picking out one kind of article or one one specific practice, I think it's a big umbrella of evidence based care. That platform wetted with quality and safety that has really changed medicine practice of medicine over the last 1015 years.

Ben: 55:11

That's, that's fascinating. I guess, because it's feels like this is almost like an unachievable goal. I feel like every time we have sat for journal club or for critical care sort of meetings and discussions, there always seems to be so much disagreement. And the evidence is so scrutinized and the papers are dismissed, not dismissed, that it feels like we're never reaching truly a consensus and that things are always evolving. And there's this, this, this, this, sometimes this trend, and this need for people to feel like they're on the cutting edge and to try new things and really be avant garde about certain things. And that, again, goes at the expense of consistency of care. And I found that it's a it's a worthy goal, because I think it's extremely difficult to reach. And so I guess, what would be your taken it? Would you favor consistency? Over the most up to date? Sometimes we're a bit too crazy about really doing the thing that the last paper mentioned? Would you favor consistency over implementing the latest? Sometimes maybe not as well proven evidence?

Rune: 56:26

Most definitely. But I would, I would add consistency, and presence of the person who are the clinician who knows what that consistency consists of. Right, if that makes sense. So imagine, for example, I feel as though if I put the right clinician with a 24, weaker, and an old ventilator, and another clinician, with the fanciest ventilator, I know if I put the right clinician with old ventilator. If that person is 100%, aware of the practice, that reduces the risk of complications and BPD, they can use that old ventilator to optimize the care and the fancy new automatic ventilator will not do the same thing. So I do feel very strongly that that awareness of what you do every single day, in addition to two protocols and reducing variation, that is is optimal care.

Daphna: 57:30

And I think that's really knowing the tools,

Ben: 57:33

and knowing the tools and also understanding why you're doing the things you're doing with the tools that are at your disposal to then use new equipment, new technology and new evidence to improve on those goals. And on these tools. Yeah, exactly. Definitely. Any last, any last words last questions for Rooney? Before we conclude the second episode?

Daphna: 57:54

No, I just want to thank you for your time with us today, but also for really your mentorship these last few years. And it's it's nice hearing a little bit more about your life.

Ben: 58:08

Yeah, I will second those those sentiments, I think I think it's been awesome knowing you. And it's been awesome working with you. And finding out a little bit more about you throughout this episode was definitely enlightening and makes and explains a lot of other aspects of who you are and your viewer personality

Rune: 58:24

has. Great. Thank you guys. I appreciate it.

Ben: 58:27

Well, thank you, Ronnie. Thank you Daphna for joining us by phone. We wish that you were here with us in person.

Daphna: 58:32

Pleasure. As always.

Ben: 58:36

Thank you for listening to this week's episode of the incubator. If you liked this episode, please leave us a review on Apple podcast or the Apple podcast website. You can find other episodes of the show on Apple podcasts, Spotify, Google podcasts, or the podcast app of your choice. We would love to hear from you. So feel free to send us questions, comments or suggestions to our email address the queue podcast@gmail.com. You can also message the show on Instagram or Twitter at NICU podcast. Personally, I am on Twitter at Dr. Nikhil spelled Dr. NICU. And Daphna is at Dr. Duffner MD. Thanks again for listening and see you next time. This podcast is intended to be purely for entertainment and informational purposes and should not be construed as medical advice. If you have any medical concerns, please see your primary care practitioner. Thank you