"The Pitt" vs Reality: Care, Costs, And Burnout

We unpack what "The Pitt" gets right about ER reality, where AI helps and where it fails, how cybersecurity outages ripple through care, and why insulin costs still push patients into crisis. We close with practical ways to protect purpose and fight moral injury.

Have a question for Dr. Brian Schmutzler? 
Submit them to any of the social media pages below or on his website at https://www.drbrianschmutzler.com/

Facebook: https://www.facebook.com/drbrianschmutzler
Instagram: https://www.instagram.com/drbrianschmutzler
TikTok: https://www.tiktok.com/@drbrianschmutzler?lang=en

Provider or Medical Student?? Subscribe to his Patreon Page to get exclusive content and access to Medical Blocks:
https://www.patreon.com/user?u=89356957&utm_medium=clipboard_copy&utm_source=copyLink&utm_campaign=creatorshare_creator&utm_content=join_link

Thanks to our show sponsor: Butterfly Network
https://store.butterflynetwork.com/us/en/?rsCode=BRIAN25

Get $750 off the latest iQ3 at ButterflyNetwork.com

Transcript

Sponsor: Handheld Ultrasound Transformations

SPEAKER_00 0:16

This is going under Anesthesia Answer with Dr. Brian Schmutzler. I'm Vahid Saderzade. We are brought to you by the Butterfly Network.

SPEAKER_01 0:23

Alright, I'm going to let you in on something that's completely changed the way I practice. I've been using butterfly probes for years. It's a portable ultrasound that plugs right into my compatible smartphone or tablet so I can start scanning at the bedside in seconds. If you've used the older versions, or even if you're new to handheld ultrasound, let me tell you why this new IQ3 is a game changer and really impressive. First off, having an ultrasound that literally fits in my pocket means I can move faster, whether it's vascular access, procedural guidance, or just getting real-time insights for my patients. And the tech inside this tiny device is pretty incredible. Biplane imaging lets me see short and long access simultaneously. Huge for procedural guidance and honestly a great tool for learners. The new needle out of plane preset even shifts the scan plane digitally so I can see the needle tip sooner, which makes a real difference when precision matters. And the image quality. Honestly, the IQ3 holds up against some of the high-end card systems I've used. That's impressive for something this portable. If you're looking for a device that supports your practice, I can't recommend the Butterfly IQ three enough. And right now they're running a special offer. You can get$750 off the latest IQ three. Check it out at ButterflyNetwork.com.

Setting The Agenda: The Pit

SPEAKER_00 1:28

Thank you, Butterfly, for continuing to sponsor this podcast. And on this episode, we are focusing because we had such a great reaction to our last episode. And a new season just came out. I still haven't seen it. It's great. I still haven't seen it.

SPEAKER_01 1:44

I didn't just like they're releasing episodes currently.

Realism Of The ER Format

SPEAKER_00 1:46

Scrubs is also coming out with a new season. Yeah, yeah, yeah. The pit is coming out with a new season. And we're going to talk today about what the show gets right about American healthcare, uh, what lessons we're learning from the pit, uh, specifically you, what lessons you're learning, if anything. And we're going to talk about AI and moral injury. Yes. Which you said is a pretty big deal. Yeah, it's a big deal. These days. Yeah. Well, let's talk about the pit. The premise of the show for people who didn't see our previous episode.

AI Charting: Promise And Pitfalls

SPEAKER_01 2:18

Um so the pit is um the premise is that it's uh minute for minute, hour for hour in an emergency department. And so the first hour is 7 a.m. to 8 a.m. and the episode runs, it's actually like 56. It's like 24. Yeah, basically, it's like 24. Um, but it's it's super accurate. The guys that they used on it, um, I think they took a little bit from the old ER, but they use like a lot of uh consultants and stuff, medical consultants and stuff. So it's very realistic. But that's not what I want to talk about today. So um, and also I would like to point out who for anybody who has any questions about my number of Facebook and Instagram followers, they're all real. Thank you. I can attest to that, and unpaid for. Can also attest to that. So anyway, uh no, so the pit. So um the first season we talked about a few different things, like some of the realism in it, and some of the um, you know, uh attacking healthcare workers and all that sort of stuff. So this season, and I'm about an episode and a half behind, so I don't know what the most recent um the most recent episode showed, and there may be some spoilers. So if you're watching the pit and you're not fully caught up, just don't listen. Or don't listen to this part. So one of the big things that they talk about, they bring in this new doctor from the VA, and she's big into like electronics and AI and stuff. Sure. So she's pushing them all to use an AI system when they do their they dictate, so they talk into a microphone to do their notes, and then the AI is supposed to like take what they say and convert it into a nice note. Well, um, she's pushing it and pushing it and pushing it and pushing it, and then in the last episode, or the episode before the last one, um, somebody comes down from the floor and says, Your notes were all screwed up on this patient, and so they go and talk to the the ER resident who was working on it, and she's like, No, that's not what I said, the AI changed it. So they talk about in that episode how like AI can be a tool, but it's not like the panacea, it's not the thing that's gonna fix all of our problems with charting in particular. But anyway, so so that brings up the point that you know we've talked about, oh no, AI is gonna replace doctors, and you know, um uh Elon Musk says uh, you know, in in 20 years we won't need surgeons because robots are gonna complete all the surgeries, and it's like we're nowhere near that. And AI is true generative AI is in its infancy. Like there's not a ton of true generative AI. Now, AI is very good at pattern recognition, which is a lot of what medicine is, but not you know, hype, high-paced, like fast-paced, high acuity medicine. It's fine if you're looking at an X-ray or something like that for radiology, but I think it's gonna be a b a big problem for this type of stuff, like when you're trying to do something fast-paced.

What AI Can And Cannot Do In Medicine

SPEAKER_00 5:01

AI, right now, in my estimation and my experience, is a helper. AI is not a replacer. Yep. It's a in a it's a tool. Right. Almost like if you were using Google. Right. Almost like if you were now, is it replacing some surgeries or aiding surgeries? Kinda. Not really. So I mean, I don't know. Listen, for people who are like, oh, AI's, I think we've talked about this in the past, like taking jobs or whatever. Not yet. Nope. Not yet. Now will it get to that point? Maybe, yeah. Probably. Yeah.

SPEAKER_01 5:38

Right? I mean, I I think attorneys are so pathologists, primary care docs, radiologists, and attorneys, I think, are at risk. Because those are all things that you can teach a computer to do, and it's mostly pattern recognition.

SPEAKER_00 5:53

But there's no emotion, right? Like you're at true. You're not so and and this is where where I get at this. So doc I mean, for a physician or whatever, or whatever profession you're in, I'm in the media profession. I have played around with AI, meaning, okay, AI make me a video.

SPEAKER_01 6:17

Yeah.

SPEAKER_00 6:17

You see what is it called Sorel S uh Soray or Sora? Sora is like the program that uses AI to make videos from pictures or whatever. So we see the Trump memes all the time. Um right. So in my experience with it, you can create a video. You can create a picture, you can create whatever you want. You can't replace the emotion in the video. Yeah, that's true. You can't replace the actual right, like the feeling behind it. Sure. So scratch that. Let's take medicine, for example. Yeah. You're not gonna replace the physician, you're gonna aid, right? You can aid in the processes of what it takes.

System Outage And Paper Charting

Cybersecurity Threats In Hospitals

SPEAKER_01 7:07

For the most part. I think uh again, there's a couple areas, pathology and radiology in particular. You know, it's really it's pattern recognition, right? It's it there really isn't a whole lot of art, and and again, not but surgeons, so it'd be hard to replace that. ER. Hard to replace that. Anesthesiologist, hard to replace, yeah, for sure. Um, but the other thing that's funny, and then we can move on to the next thing that the the pit's been talking about this season. But the other thing that's funny is well, it's it's two things. So number one, they get to the point where they realize the AI is making mistakes, and then they have to go back and reread and proofread all their notes after the AI is gonna be. So it's double the time. So it's double the work, right? So that's that's funny. Number two, um, and we'll get to this in the next one, is is that all the computer system goes down. And so once the computer system goes down, you have to go back to paper charting, and so the AI is gone. So that flows very nicely into the cybersecurity issue. So in one episode, and again, spoiler alert, but in one episode, the cybersecurity goes down at multiple hospitals around um the one that Pittsburgh trauma or whatever it's called, the fake hospital in the pit. And so they're getting all these patients because their computer systems are down. Well, turns out that they're about to get hacked as well. And so the the CEO comes in and says, We're shutting down the entire computer system, and you watch all these like Gen Zers like, oh, panicking, right, panicking. And I'm like, Yeah, when I when I started medical school, even the beginning of residency, like halfway through residency, we still did paper. I had paper charts, paper orders, paper everything. So I don't think anything's wrong. I still take notes. Yeah, yeah. So anyway, it's funny to listen to that. Do you take paper notes anymore? I do, yeah, yeah. Uh I don't have any on me right now, but I take paper notes. But anyway, that does bring up the point of cybersecurity, right? So you hear over and over again there's systems that get hacked, and all these Russian hackers that hold them for ransom and all that kind of stuff. So it's interesting. I think cybersecurity is one of the biggest issues in medicine right now. So there is a worry. Oh, yeah, 100%. Yeah. And and a lot of times it's not, you know, they've got these like super high-tech defensive systems, and everybody's like, you know, preventing anything from getting in. And usually it's something innocuous, like some random person clicks on a link or clicks on a video or something, and that and then the malware comes in and then they take over the whole system. So it's it's interesting that the cybersecurity, I don't think we're at a point, unless you can get everybody to not click on anything, we're not at a point where we can prevent cyber attacks.

SPEAKER_00 9:38

So what does this mean for digital storage of records? I mean, you know, I I think that's been a back and forth issue in medicine for years now. Is you know, why p the paper trail, why the paper trail, why the paper trail, when you can back it up, back it up, back it up. Yeah. Why have we figured out security online for every anything else, but we can't do it for medical records?

SPEAKER_01 10:04

Uh I mean, there is security online for medical records. I mean, they get stored, but yeah, it's not bad to have a paper copy. Um, you know, and then to to back things up not only on hard drives, but on a cloud as well, so that you can access that cloud. Like let's say you get hacked and then you've got a cloud out, you know.

SPEAKER_00 10:22

Hard okay. This is where like the this it's all it all comes together. Hard drives are expensive these days, yeah. Especially to hold as much data as you would need for that. Data centers are hoarding hard drives. So I'm experiencing it. Four terabyte, eight terabyte hard drives are double the price. Right. Yeah. Does that make it more so like do you guys as a hospital system or a surgery center, do you look at that and say, okay, the cost of storage has gone up? We in turn raise our prices. You don't do that.

Data Storage, Costs, And Tradeoffs

SPEAKER_01 11:00

No, no, no. We can't, right? Because we're based on our prices have to be based on services. Services and there's you know, fee schedules and does administration look at that? Probably not. I doubt it. Yeah. And I think we store most of ours. Like, I don't think most hospitals store their patient records unless they're paper um on site. I think most have remote, hard storage access and then cloud access. So all right. Um, but yeah, so so it's interesting. Uh that that whole thing happens in the episode, which and then everybody freaks out, and I'm like, eh, I could paper chart. So anyway, that was kind of an interesting portion of of the show, um, which I think is and and you know, we talked about before like change healthcare got hacked, which was like one of the biggest clearing houses, and um Ascension Health got hacked, which is a Catholic hospital system, so there's a lot of that going on.

SPEAKER_00 11:53

Hollywood tends to mythesize these things sometimes. What do you mean? Mythicise? I don't know, like they tend to overdramatize. I didn't seem overdramatize. No, but you you think this show in particular is pretty accurate, is very accurate. What lessons are we learning? What lessons are you learning from this show? For about cybersecurity, um, just about medicine in general.

Lessons From The Show For Clinicians

SPEAKER_01 12:17

Um, I mean, I I'm not an I'm not an ER doc, so I'm learning a little bit about how the ER works. Like we talked on the episode last season about how they they use an ultrasound for everything, right? Like, and they even had a butterfly in one of the episodes. So, I mean, that that's interesting to me because I definitely didn't do that when I was in medical school doing doing emergency medicine. Um But yeah, I mean I think it's just I think if you weren't in medicine, there's a lot of things you look at and be like, wow, I didn't know that. I think if you're in medicine, it just represents well a lot of things that could happen. So I would say the one kind of unrealistic portion of the show is that all this stuff happens all in one 12 or 14 hour shift. Like you're not gonna have all this stuff happen in one 12 to 14 hour shift. Like, no matter where you are, even if you're out in Chicago, it's just not gonna happen. But I mean, otherwise, what are they gonna do? They're gonna have three hours of the show where everybody's just sitting around doing nothing. Like, that's not gonna work.

Cost And Access: Insulin And DKA

SPEAKER_00 13:11

So uh I want to focus in on the the next two topics here. Cost and access to care.

SPEAKER_01 13:17

Oh, what about uh is that oh yeah, yeah, sorry, yeah. I thought we were going down to the social media. Yeah, yeah.

SPEAKER_00 13:21

Not yeah.

SPEAKER_01 13:22

We're we'll cover social media and your and your real followers. There's an interesting thing on on one of the episodes. But yeah, cost and access to care. So so here's the interesting um part of things. And I I'm you know, pharmaceutical companies, I I understand that they're necessary, that they are a business, they need to make money, they do a lot of good things, research and development. But um, there's a particular uh part of one of the episodes where a guy gets um what's called DKA, diabetic keto acidosis, because he can't afford his insulin. And so then he goes to the hospital because he gets DKA, and then he can't afford his hospital bills. And so I guess what I wanted to focus on is the fact that some of these medications, including insulin, was super expensive because there was so much research and development to it. But if you look at the history, so insulin's been around for a hundred years, right? That we've known about diabetes, how to treat diabetes, we've known about insulin for like a hundred years. And I think we should do a we should do an episode just on diabetes, like the natural course of diabetes, how you treat it, all that sort of thing. Next week. So so what they used to do is they used to take out the pancreases of pigs and isolate the insulin from the pancreas of the pig and then put it into a medication. Right? So that's expensive, time consuming, right? In the mid to late 80s, they figured out a way to just use a bacteria, put a gene in it, get it to replicate, and then you get that like basically secretes insulin, and you just take the insulin, right? So I get that the research research and development a hundred years ago was probably pretty expensive, but there's no reason insulin should should be so expensive. Like it's like$500,$600 a month for something that probably insulin is? Yeah, yeah. That probably cost them, you know, per dose a hundredth of that or less.

SPEAKER_00 15:10

So we are discovering in uh GLP1s, yeah, that it is not a cure-all, yeah, but it is bringing blood sugar lower.

SPEAKER_01 15:21

It is, and it was and GLP ones were designed to be um a a diabetic medication. Yeah, they're a diabetic medication, but they're not insulin, right? So so there's two types of diabetes there's insulin-dependent diabetes and non-insulin-dependent diabetes. If your body still has the ability to make insulin, what these drugs do, like GLP1s, like SGLT2s, like metformin, they help your body use the insulin you have to get the blood sugar into your muscles, into your So if you're type 1. Well, it's not as clear as type 1, type 2. So now we call it insulin-dependent diabetics, non-insulin-dependent diabetes.

SPEAKER_00 15:56

So that's where that terminology is shifted.

Diabetes Meds, GLP‑1s, And Dependence

SPEAKER_01 15:59

Correct. Yeah. So it used to be type 1, used to be kids just got insulin-dependent or uh insulin-dependent diabetes, type 1 diabetes, and then type 2 diabetes was older people who burned out their pancreas because they ate too much sugar or whatever. Now what's happening is it's so bad that people are turning from type 2 or non-insulin-dependent diabetics to insulin-dependent diabetics because at some point your pancreas has produced so much insulin that it burns itself out. And it's there's probably an autoimmune component. So anyway, we'll talk about this. Uh, that can be a whole topic in and of itself. But what I'm saying is these pharmaceutical companies that produce insulin produce it very easily, very efficiently, and very inexpensively now. But because it's such a big demand for insulin because so many people are diabetic, they charge a lot for it. So I questioned. Yeah, I I question, again, I'm not a big, you know, I'm not a big like government control guy, but I question whether there's some price gouging here. So how do we deal with that? Now that's a whole nother issue. But um, so that so that kind of brought brought up a little bit of issues. And then the other thing is, you know, just the cost of care in general and how you know, if if you don't have insurance, if you're in that middle range where you're uh you make enough money to not be at the poverty line to get Medicaid, but you also don't make enough to afford health insurance or your employer doesn't give you health insurance, you can get stuck in this area where you're you like you're you're basically the working poor that has no ability to get insurance. So they brought a lot of that stuff up. I guess my my biggest issue is we probably shouldn't be charging five hundred dollars per dose of a drug that you that you discovered a hundred years ago that costs five bucks to generate now. So anyway, that was that was my diatribe on that.

Pricing, Insurance Gaps, And Equity

SPEAKER_00 17:49

Let's talk about social media healthcare and social media. Here's my favorite thing. Here's my favorite thing and comment that people have for you. What's that? Other than oh, you have fake followers. Fake followers, yeah. Good one. Um here's here's the here's the one that really uh is interesting to me. When people are like, shouldn't you be working instead of doing social media, doc?

Physicians On Social Media

SPEAKER_01 18:19

Right. Did you say that to people who are out golfing or spending time with their kids or whatever, right? I mean let's talk about kind of maybe the building of your platform because it's been a few years now. Yeah, let me relate it back to the pit issue uh the pit episode, and then I'll talk about my own own journey. So um one of the she's actually a medical student in the show, um comes in and uh one of the patients specifically asks for her, and the resident's like, I mean, I can get her, but why? And so she comes in. She's calling herself a resident. No, no, no, no, no. Yeah, so she comes in and the patient's like, Oh, I watch all your TikTok videos. I want you to do this procedure. Um, so I mean, I have had people say, like, hey, I recognize you from TikTok. But anyway, so that's that and and they don't really get much into it except to say, like, you've got to be a little bit careful. You can't have patient stuff on there, you can't have identifying information. But um, but yeah, so my own journey, you know, we started the social media platform four or five years ago. Five years ago now, four or five years ago. Yeah. Um, mostly because coming out of COVID, it was really hard to travel. I wanted to teach blocks, and so we started the process of putting a Patreon together and doing all this stuff. And that just, I mean, it's very niche and it didn't really take off. But then had a little bit of luck. We were in New York City, did a video that was trending at the time. We are anesthesiologists, and it got, I don't know, four million views or something. And so from there, I became sort of the self-deprecating funny anesthesiologist, which is fine. I mean, we got a lot of you walked in the hallway and got 10 million views. We got a lot of viewers now. We got a lot of uh a lot of um followers and stuff, but a lot of medical students too who follow the page, right? Right. And so and we do some serious stuff. It's not all just jokey stuff, and then we have this the podcast that people can listen to as well.

SPEAKER_00 20:02

So yeah, so I mean, listen, when you're at work, you're at work. Of course, you're not doing right, you're not using the ER, uh the surgery rooms.

Boundaries, Consent, And Professionalism Online

SPEAKER_01 20:12

And we we do all this like off hours, we do it when patients aren't around, we do it when people aren't around. Like it looks you guys do a great my social media team does a great job of making it look realistic, but we do this outside of business hours. So yeah, um, I I never worry about that. You're not there with a patient, other yeah, except except when we have uh when we have in the past done that, we have gotten their consent. We don't show their face, we don't say their name, right? So we've done some of that, but all of HIPAA compliant. All compliant. Um, but yeah, so that one issue that that one comment that I got on um on one of the pages that I have now for some other things I'm doing that said that my followers were fake and purchased, they are not fake and purchased. And that that comment more than anything else ticked me off. So anyway, next person who has 900 followers, yeah. Focus on your own. Probably bought all those.

SPEAKER_00 21:02

Yeah, so focus on your own people.

Moral Injury Versus Burnout

SPEAKER_01 21:03

So so the next issue um we wanted to talk about, and this is this is kind of the the final portion um that we'll talk about. And this so there's this idea of moral injury. I I'm curious because I never heard of that before today. So so this is big in medicine, probably has been for the past five to ten years. So we used to talk about burnout, right? So that's when you're just working too hard, you're not getting kind of what you need out of your your practice or whatever, and you feel like you're working too hard and not getting anything out of it, and so you start to burn out. Moral injury is even like kind of the next step. So you're burnt out, but you keep working, and then you lose basically your core values, right? So you no longer come to work and want to help people because you felt like you've been beaten down. And so there's a lot of discussion of how do we prevent this, but one of the biggest pressures that creates that moral injury is lack of being appreciated by patients and by administrators, and then adding a Non-clinical work. Those two things cause the most moral injury. So non-clinical work means paperwork. Paperwork or meetings about meetings about meetings or being driven by the bottom line, not by patient care. Like there's there's a lot of things that come from a non-clinical administrator point of view that causes this moral injury. So like some of the things are like forcing being forced to discharge patients early or to do more, like for me, you need to do more cases to generate more money because the hospital needs more money. If you know me at all, I'm not a I'm not a fan of health insurance. Um being forced to document things more so than take care of patients, right? It's more important that you make sure the documentation is right so we can get paid than you actually take care of the patient. And then, like I said, all the administrative pressures that come of like make sure the charting's the right way, the billing's the right way, this, this, this, this, this, and this, which is not something that we we really care that much about as healthcare providers, we care about taking care of patients.

SPEAKER_00 23:11

So, how much is burnout A and B, uh depression a big part of the medical industry?

Stigma, Debt, And Career Pressure

SPEAKER_01 23:19

Yeah, so burnout's huge. I mean, some studies you you can read anywhere from like 40 to 90 percent of people experience burnout at some point during any year. And the and the longer you're in practice, the more burnout you have, the less control you have over your practice. So if you're employed by a health system, the more burnout you have as opposed to being in private practice or owning your own, um, owning your own practice. So it's huge. I mean, burnout's huge. Um, in terms of like clinical depression, I think that's a little bit harder to evaluate. Um, I think there's still a stigma, particularly in healthcare, where if you say you're depressed and you go on an antidepressant, that you're concerned that the board is gonna look at you or that sort of stuff. So it's probably underdiagnosed in in healthcare. Um, but I would say in general, it's probably about the same as the general population. Is there a stigma to talk about it? Yeah. Oh yeah. Yeah. Yeah. Yep. Especially like suicidality, there's a big stigma about that. Because if they feel like you're suicidal at any point, they take you out. Like if you if you're working in, you know, a factory putting together widgets, and somebody finds out that you had a suicide attempt, they're not gonna not put you back on the line, right? You're gonna continue to make widgets. If you're in medicine, they're gonna they're not gonna put you back in, right? So I think there's a huge stigma in that. And then and then the bigger I mean, another big issue of that though is that if you are removed from work for whatever reason, you know, that's a lot of financial pressure then, right? Especially for people in medicine who take on hundreds of thousands of dollars in debt. And so if you're early in your career and you haven't paid that back and you're trying to you know, and then you're not allowed to work anymore.

Why People Enter Medicine And The Money Shift

SPEAKER_00 24:57

So have you okay, so I'm gonna I'm gonna pose this question to you. Do you find that most doctors you're gonna laugh at this, but I I truly there is a reason I'm asking the question. Do you think a lot of the doctors that you have interactions with get into medicine because it's a passion and it's fun? Fun meaning, right? Like you're actually following a lifelong passion and a dream, and it's exciting every day when you wake up and it's like, hey, I'm I'm um or is it or is it more you know, this is what I should be doing.

Preventing Moral Injury: Purpose And Rest

SPEAKER_01 25:48

I think it's a combination. Um, I think anybody who has any knowledge about it's not getting into it to get rich, right? I mean, because there's a lot of ways you can make a lot more money. Um, I think a lot of people get into it for the right reason, but I think you get beat down pretty quickly because medicine's not about taking care of patients anymore. Medicine is about money now. That's a line. It is, but I mean it's the truth, right? Uh when when the federal government took over healthcare, which is one-sixth of our GDP, it became all about money, right? So when was that, do you think? When was the breaking point? Probably 90s, probably Great Society, the 60s. The 90s was yeah, so that's when that's when Medicare and Medicaid came about, right? So that's when a lot of the pressures came to reduce the cost of medicine. I think generating revenue in medicine probably came in, like you said, in the 90s when health insurance companies became huge and when private equity started buying into the medical field. So, you know, I I think the I think prior to Medicare and Medicaid, prior to the Great Society, physicians or healthcare professionals made the decisions in medicine. And it was more about taking care of patients. Now there was money in it, right? There was still money being generated, but not the way it not not the way that it is now, where it's basically just uh just like the military merit military industrial complex, there's the medical industrial complex now. And so it's all about extracting money out of the system to give to stakeholders, not about using the money in the system to take care of the patients. Awesome. So well, thanks for explaining that. Yeah. Um that and there, so just one other quick thing. So so the moral injury thing. Again, it's a this was not a big portion of the show, sure, but I think it they allude to it. And so there's there's probably it's probably good for anyone listening who's in healthcare to talk about the moral injury. How do you how do you address it? So re-anchor to purpose, right? So you want to make sure that when you go into work, you're not saying, oh, this is so terrible because I have to document this, blah, blah, blah. Recalling why you started, right? I want to take care of patients, or I love doing these procedures. Whatever it is that got you into it, you want to re-anchor to that. Um, you have to figure out something to do outside of work that's productive. And so it's interesting. One of the guys, one of the guys who's an ER doc in the pit actually does SWAT work. He was a he was in the army and does SWAT work as his like time off because he loves the adrenaline of it or whatever. For me, it's you know, lifting weights, working out. Yeah, you know.

SPEAKER_00 28:20

So you you have an outlet outside of the hospital.

Closing Thoughts On The Pit

SPEAKER_01 28:23

Correct, correct. And and taking some time off, right? That's the other thing. Like, you know, we've talked about a little bit now that um it's a busier time right now, but in general, for the last couple of years, I've been taking Saturdays completely off of doing work. Now I do stuff around the house and I hang out with the family, but I've been taking Saturdays off of doing any work whatsoever. So taking a Sabbath and and you know, um it's pretty clear that that's that's helpful to to kind of overcome moral injury. The other thing is faith and moral grounding. So uh um again, I'm a Christian, very openly a Christian, but really if you read the literature, having any faith or moral grounding that you can go to does help in the moral injury aspect of things. Um having peers um and then people you can talk to, not just like somebody you see in the hallway and wave at, but somebody you can actually confide in. And then finally having boundaries and saying no. So, like if the administration comes to you and says, Hey, I I need you to go from seeing 30 patients a day to 40, you say, No, I'm not gonna do that. Right. I just can't. I can't see 40 patients a day responsibly.

SPEAKER_00 29:24

I just think uh honesty in what you're doing is huge, but also knowing your limitations, right? I mean, I think it's easy for people who you, me, maybe some folks out there who are just go, go, go all the time, just to like put your head down and just be like, I I can't take one because we know our own limitations, right? But it's also after agreeing with you and having taken days off. Oh yeah, it's almost forcing yourself to what do I want to do? Come into this office every day and fix and get everything done, right? Everything done, yeah. I'm gonna be behind. I'm gonna be behind. It's always this, I'm gonna be behind stuff. But at the end of the day, it's like, yeah, I gotta just your mental health, your physical, emotional, spiritual health, all are at play and make you better at what you do.

SPEAKER_01 30:15

Absolutely. And whatever that means to you, whatever day of the week it is, even if it's like, okay, I take this afternoon off and this afternoon off. Um, I think there's an argument to be made biblically and even outside of the Bible, just just mentally and and mental health-wise, that you need to take take a Sabbath, take some time off. Um, and so you know, I think um in closing. Yeah, in closing, I would say, you know, uh The Pit, I I love it. It's a great show. It's great to watch, but it does bring up a lot of things, particularly for us of uh those of us in healthcare. And so it, you know, it shows chaos, but uh also shows courage and it gives some sort of generalized themes under they're not they're not overt, but sort of under the underpinning some of the some of the things that um there are some ways that we as healthcare professionals can can get better and overcome a lot of this stuff. So I love the show. Everybody should watch the pit. Um, I am not paid by the pit. I have no connection to the pit other other than just watching it, uh, but everybody should watch it because it's great. I me included.

SPEAKER_00 31:19

Yeah. Which you haven't done yet. Which I haven't done yet. I I will. I'm getting around to it. Let's do it. This has been going under anesthesia answered with Dr. Brian Schmutzer. I am Fahid Sadrasadi. We're brought to you by the Butterfly Network. And we'll see you next time.