Episode 11: Debra Williams, MD

Enjoy this story and the shared words of wisdom from a trailblazing physician leader. She broke barriers for female physicians. She was a full-service family physician, trained with James Andrews, MD, in sports medicine, and ultimately pursued a career as the director of a very hectic ER. 

Transcript

SPEAKER_00 0:14

Well, hello and welcome again to the Medical Mastery, the podcast of the Emerald Coast Medical Association. I am your Amaranthine host, Don Davis, MD, and very happy to be here today with one of my colleagues, one of my friends, one of my fellow board members, and one of my heroes, Dr. Deborah Williams. Deborah, thank you for being here today with us on Medical Mastery.

SPEAKER_02 0:35

My pleasure. This is going to be fun.

SPEAKER_00 0:37

Now, some of our more astute viewers may notice that you are not here with us live in studio. Is that right?

SPEAKER_02 0:45

Correct.

SPEAKER_00 0:46

Okay, so where are you right now?

SPEAKER_02 0:49

I am at our second home at the top of the mountain in western North Carolina.

SPEAKER_00 0:54

How about that? No, I want the exact address. I'm just kidding. So, so uh, well, thank you so much for um joining us here. Uh, thank you for um utilizing technology here. Um, and you know, this is our first remote interview, so you know it's you always remember your first. So we're gonna have some good times here doing this. Um now, um, before we get going here, why don't you start off by telling us um where are you from, Deb Williams?

SPEAKER_02 1:21

I grew up in a small town of the Oklahoma Panhandle, farm girl.

SPEAKER_00 1:25

Okay, all right. What is the small town, by the way? Just so we know.

SPEAKER_02 1:30

Population was 1500. My graduating class was 49.

SPEAKER_00 1:35

Many of those was just your family of the 1500, is that right?

SPEAKER_02 1:39

Um half of them, no.

SPEAKER_00 1:42

Okay. And so uh so take me from there. Where did you matriculate on from there after you went to high school?

SPEAKER_02 1:51

Interestingly enough, this is a great story. I went to Oklahoma State University.

SPEAKER_00 1:56

Oh, okay.

SPEAKER_02 1:57

With the plans of being a veterinarian.

SPEAKER_00 2:01

It's as as the old joke goes, I want to be a veterinarian because I love working with kids. Okay, so okay, great. Still water.

SPEAKER_02 2:10

Typical pathway for a farm girl who, etc. Um, made the first and only see I have ever made in my life, my first semester of college. Okay. And my 70-year-old male advisor, who really thought women should be nurses or teachers, told me that I would never get into medical school and I or into veterinary school, and I needed to change my major. And I did. My parents were both smart and supportive, but they hadn't been to college, they didn't know.

unknown 2:43

Yes.

SPEAKER_02 2:44

So I changed my major to medical technology, which was mostly pre-med courses. Um, graduated with that degree, went to the Oklahoma University Health Science Center to work. Saw all these people that I had been sitting in class with that I had done just as well or better than. And it was like, I can go to medical school. That would be great. Because, you know, being a medical technologist was kind of a dead-end street. There wasn't a lot of advancement possible, et cetera.

SPEAKER_00 3:17

Um, so well, uh let this testify to we may have some technical difficulties here or there, and we will just have to power through it. Um, we're here. Now, um, okay, so now that's an interesting way to go. Now I'm gonna take you back to a little bit of an uncomfortable place there. What was the C that you got? What class was it? It was chemistry. Chemistry, okay. So um now, you know, those of us that have gone through medical training know that there's a fair amount of at least biochemistry by the time you get through medical school. So getting through that process kind of at a later point had to have been some kind of uh a good retrospective look back to say, like, yeah, uh I can do this.

SPEAKER_02 4:10

Absolutely. It was, you know, it just shook my confidence when my advisor told me that. And, you know, had I had the right mentors or people to connect with, I probab I might not have changed at that point.

SPEAKER_00 4:25

Well, now, Deb, I at no point in this interview do I want to date you or anything like that in terms of how long ago this was. But in general, as you're applying for medical school, um, how many, what was the ratio of men to women at the time?

SPEAKER_02 4:47

Probably one female to every 10 males or higher.

SPEAKER_00 4:52

Yeah, that that sounds about right. So um, you know, in those kind of situations, I'm sure even then there may have been a perception about this of maybe you just got in just because you're female. Did you feel that?

SPEAKER_02 5:12

I I didn't really feel that initially. I guess it became noticeable sometimes when you were the only female on the team, only female at the table, etc. And I was that person, particularly at the leadership table, for many, many years.

SPEAKER_00 5:32

Yeah, and we're gonna get into your stalwart leadership uh quite a bit because um you've you've got uh quite a few examples of that along the way. But um, so take me through medical school a little bit here. So um now along the way, um, what do you find yourself interested in as you're going through that training?

SPEAKER_02 5:54

I really thought that I wanted to be a family practitioner. Um, you know, my best girlfriend growing up, her dad was the small town family doctor, et cetera, et cetera. And I just thought that was the right thing for me to do. Um I loved surgery.

SPEAKER_01 6:13

Yeah.

SPEAKER_02 6:14

Would have loved to have been a plastic surgeon, I thought. But here's an here's an example of the story. And again, this was a long time ago, and it could definitely not happen now. Um but some of the my senior residents and the surgical team said, well, you know, if you really want to think you want to do that, go talk to the director of the department. So me who has no fear, I marched myself in. To talk to him and stuff, and I will never forget. He listened to me, didn't say much, looked over his glasses that were on the end of his nose and said, as long as I'm the director, there will never be a female in my program. I was like, well, okie dokie.

SPEAKER_00 7:12

Yeah, and I think I think that should really sit on people for a little bit. I mean, just imagine having somebody that's young and go-getting and really wanted to get out there and help and do something in this field and hitting a pretty tremendous roadblock.

SPEAKER_02 7:30

And, you know, so I talked to the senior residents who had sent me to talk to him, and they said, honestly, they hadn't set me up. They weren't really surprised. That was his comment. They said, apply other places. But that this was so long ago, Don, that it's when there was a pyramid.

unknown 7:48

Yes.

SPEAKER_02 7:48

And so, you know, after a couple of years, half of the surgical residents were turned loose. So in and they were very honest with me, and they said, doesn't matter what your in-service scores are, you will be a direct shot to be let go out of any program you're in because it's still so male dominated.

SPEAKER_00 8:07

Yeah, it's it was an old boys' club for a long time.

SPEAKER_02 8:11

And um very, very different now, but you know, it it has changed.

SPEAKER_00 8:15

I think, I think uh the ratio that I've seen recently is either 55 or 60 percent of medical school um acceptance are uh females. Um so things things have certainly changed. But I mean a lot of that is thanks to folks like yourself that have really blazed that trail and said, you know what, I'll take the slings and arrows and kind of step forward. Um, you go back to, you know, the first half of medical school, at least in our iteration of it, was uh lecture-driven. Um, you know, we were we were in class, we were taking a lot of tests, at least for the first two years. And then the the last two years, the last half, um, becomes more practically. You're on the wards, you're actually learning on the fly. Was that the same experience that you had throughout your medical training?

SPEAKER_04 9:04

Yes.

SPEAKER_00 9:04

Yeah, it's and it's pretty abrupt, honestly. It goes from you're really classroom focused to all of a sudden now you're gonna be out there uh doing things that you can hopefully uh kind of extrapolate from the classroom to it. Now, as you as you were doing that, um you you said um you liked surgery. Did you find other um sources of inspiration or other things that you enjoyed as well?

SPEAKER_02 9:31

I liked it. I liked cardiology.

SPEAKER_04 9:34

Why?

SPEAKER_02 9:35

I just no, I just thought it was really interesting, the pathophysiology behind it and everything. I just I liked cardiology. Um, the crazy thing for me, and you just have a bias sometimes, is I didn't want to have to do the internal medicine residency to get to cardiology.

SPEAKER_00 9:51

I can understand. Um yeah. Uh so so again, you know, and it's kind of like that similarly with plastic surgery. Like, I mean, plastic surgeons typically have to go through a surgery residency if you're gonna get there. There's some other pathways for sure. Um, but there's some upfront stuff that you've got to do that's not as palatable to get to the end goal of what you'd like to do. Correct. Yeah. Now, um, eventually, when it came time for you to do residency, why don't you tell everybody watching and uh listening what you chose to do?

SPEAKER_02 10:25

I did family practice residency initially.

SPEAKER_00 10:28

Okay. And then uh so tell me about that. Where'd you go?

SPEAKER_02 10:32

Uh I was in York, Pennsylvania.

SPEAKER_00 10:34

Okay, all right. So now I I you'll have to pardon me being from the south here. Tell me about York, Pennsylvania. What is that like?

SPEAKER_02 10:41

Um, you know, it was a great hospital. The leaders of the family practice program were great. They they they really were concerned about the residents and interns having a life, being happy, the whole nine-garde. It was it was such a difference. I had done my internship at Prince George's Hospital outside of Washington, D.C.

SPEAKER_00 11:05

Okay, yes.

SPEAKER_02 11:06

Where you flew by the seat of your pants because there weren't enough people for supervision, etc., etc. And I was like, well, I can't keep doing this. So one of my friends was in the program in York. Um, they had someone who was moving away and and they were gonna have an opening. So I was fortunate to know that and be moved into that in my second year, and it was night and day difference.

SPEAKER_00 11:34

So night and day, in that now you're getting a little bit more guidance than just being thrown to the wolves.

SPEAKER_02 11:39

Oh, absolutely. I I mean the senior residents who were supervising the attendings, there was lots of supervision, not you know, micromanaging, but actually teaching and being concerned and that sort of thing. So it was it was just a much better learning environment.

SPEAKER_00 11:56

Yeah. For me. And I think this testifies to something that commonly, you know, uh, at least perhaps from the lay population, you think, well, you finished four years in medical school. You're actually a doctor at that point, you're an MD. And then um, well, so you've got to be ready to practice, right? No. There's a very steep learning curve that is going to be left ahead of you. And those that actually did come out do an intern year and come out practicing, boy, did they have to learn under the gun.

unknown 12:24

Woo!

SPEAKER_02 12:25

On the job.

SPEAKER_00 12:26

So, so tell me about the family practice environment there in York, Pennsylvania. Are you so you've got some good advisorship, some teaching that's going on there? Are they kind of the old school family practice that does absolutely everything? Birthing babies, doing appendectomies, the whole thing?

SPEAKER_02 12:44

Yes. We didn't do surgery. Um, you know, so that there now we didn't do surgery on our own, but we did do um obstetric care and delivered babies and et cetera. So, you know, we say we saw them from birth to death.

SPEAKER_00 13:01

Yes, yeah. And uh, you know, I had a mentor of mine that kind of um guided me to go into medical school who was a family practice physician, and uh that's what I thought I wanted to do too. And he said there's no better thing than you could ever um be in life than to see somebody at their birth and then see somebody at their death. And I thought that was really poignant. Um, but I always admired the old school family practice doctors. Do you did you guys do home calls or anything like that?

SPEAKER_02 13:29

Um yes, and we did community health and you know, all of those kind of things.

SPEAKER_00 13:36

Yeah, and I mean, talk about it. You have no idea what's going to walk in through that door, kind of thing. I mean, that can happen in these situations, and also you're kind of preparing yourself for being a small town doctor, which is taking care of this community.

SPEAKER_02 13:52

And at one point I had thought I would go back to the small town where I grew up. Um and then I just ended up switching gears. I my personality, I realized, wasn't the best fit for family practice.

SPEAKER_04 14:10

Yeah.

SPEAKER_02 14:10

Um I'm kind of that type A personality who needs constant challenge and can't sit still and can't, you know, uh deal with the chronic things. And so, and I loved my ER rotation during family practice. Yes. I absolutely loved my ER rotation, and that was when I knew I needed to make a switch.

SPEAKER_00 14:39

Yeah, so uh spoiler alert, you eventually ended up going into emergency medicine. Um, you know, for anybody that's done inpatient intense training for a while, the two categories I say to my medical students that you can put patients are sick versus non-sick, okay? And the vast majority of the non-sick is what you're gonna see as an outpatient. They're just, you know, sure they're not feeling great, sure they've got some issues, but you can take care of them. The sick are the things, these people can die on you. And when you start to realize a lot of the things that you see are non-sick, you hearken back to your sick patients and you say, What are you even complaining about? I mean, this isn't even that bad. And so that perhaps that led you to this emergency medicine kind of um crusade. So tell me about emergency medicine and how you went to that.

SPEAKER_02 15:32

Well, I think it was just the challenge of you really never know what's coming through the door. You're you're dealing with different entities at the same time for and not that family practice isn't, but it was more of a putting the pieces of the puzzle together right here and now and looking for those missing pieces so you could come up with an answer and really help people when they're at their worst. You know, I wanted to believe most people didn't want to be in the ER. It was something was wrong.

SPEAKER_00 16:11

Deb, I I I love that perspective because I say to it all the time, we are in a privileged position because patients come to us and they need help and they want help. So, just from all humanity, the way that we interact and we get to see people, we get to see them at a relatively low point. So, in other words, they don't usually come at us with acrimony, they come to us looking for help. And what a great place to be where we can provide that. So, so it's sage words there.

SPEAKER_02 16:40

Absolutely, and I suppose selfishly, part of the ER was it a lot of immediate gratification.

SPEAKER_03 16:47

Yes.

SPEAKER_02 16:47

You know, somebody comes in coding whatever it is, and you can have a huge impact on their outcome. So selfishly, there was some immediate gratification that went along with it.

SPEAKER_00 17:01

Now, um, take me back a little bit in the history of medicine, right? So is emergency medicine even a specialty at that point? Because for the most part, as I understood, it was local doctors that were covering ERs. Is that right?

SPEAKER_02 17:14

It was a specialty. Um still had ERs with many family practitioners or internists staffing them, particularly rural areas. Um I should know this, but I I want to say it was the mid-70s or 80.

SPEAKER_03 17:33

Yeah.

SPEAKER_02 17:34

That you know, the residencies and and the and the board certification and et cetera, came about.

SPEAKER_00 17:40

Yeah. Um, so so in terms of your particular training at this point, you said I want to do emergency medicine. This is this is where I want to go. I want to kind of do because effectively most emergency medicine is shift work. Is that correct?

SPEAKER_02 17:57

Correct.

SPEAKER_00 17:57

Yeah. So so you're gonna do shift work, you're gonna to run an ER. Now, where is the first emergency medicine department that you went to from there?

SPEAKER_02 18:08

Tyndall Air Force Base, when they had a full service hospital.

SPEAKER_00 18:14

So um, now again, I'm not gonna ask you what year this was. Um so so you moved down to Florida. Now, um, you know, Oklahoma is not the same as Florida. Um, so this had to have been a little bit of a new place for you to, especially coming from Pennsylvania. Is that fair to say?

SPEAKER_02 18:32

Correct.

SPEAKER_00 18:33

Okay. So tell me what it was like being here in Florida.

SPEAKER_02 18:38

I love the outdoors. I've always loved the beach. Not that we had the, you know, it was South Texas beaches that we had growing up, we ever went. Yes. Um, but I always just, you know, just the sunshine, the being able to be outdoors most of the time. And I had had plenty of cold weather and snow shoveling growing up in the Oklahoma panhandle and in Pennsylvania, sub for and moving to Washington, DC and Pennsylvania area. So that was a big decision.

SPEAKER_00 19:11

Yeah, it is a big decision, and so you're gonna come down here now. Um, are you signing your first contract to do this? Um, do you remember how long you signed that contract for it was very interesting.

SPEAKER_02 19:25

Um I had signed it for a year. Fortunately, the person who held that contract and hired me was very understanding because I got notification that I had applied for a sports medicine fellowship at that point because I'm big, I was an athlete, I was a big sports fan, etc. Um, had done a rotation there, my senior year of residency. And um the the director there called me and said they've added a position that's open in January, and I started this other job in July. Are you interested? I was very interested.

SPEAKER_00 20:13

So just ask your job if you can take a year-long vacation. I mean, it's easy as that.

SPEAKER_02 20:18

So um so anyway, he graciously let me out of that contract. I continued to work up until the the day I moved to Birmingham to do my sports medicine fellowship.

SPEAKER_00 20:30

Okay, so tell me about the sports medicine fellowship. So you moved from Tyndall Air Force Base six months later, you're going to Birmingham. Is it UAB?

SPEAKER_02 20:39

Um, no.

SPEAKER_00 20:40

Okay.

SPEAKER_02 20:40

It was the Andrews Institute.

SPEAKER_00 20:43

Uh yes.

SPEAKER_02 20:44

Um, Jimmy Andrews is world-renowned orthopedic surgeon. Um, started out at Houston Clinic in Columbus, Georgia, and then opened his own sports medicine institute in Birmingham. Um, had both orthopaedic surgery fellows and um primary care fellows. So I worked every day training side by side with the surgical orthopaedic docs as well. Um, so it was just it was an unbelievable learning experience working with someone of that caliber and knowledge and research and cutting edge, et cetera, et cetera. So it was it was really a great year.

SPEAKER_00 21:26

Now, um, I think this um really gives evidence to something else that we learned through time, which is that you know, a team symbiotic approach can really get sometimes multiplicative benefits. In other words, then the sports medicine doctor and the orthopedic surgeon seeing you in separate silos, when you come together and put your brains together, you can really make a significant difference in in we would say patients' lives, but in your case, you're talking about a finer tuned athletes' lives.

SPEAKER_02 22:00

Very much so. And each one of us was assigned a university, and we were a team. There was an orthopedic surgeon and a primary care physician. Um so I did that at Troy State.

SPEAKER_00 22:13

Okay. All right, very cool.

SPEAKER_02 22:15

I was their their team doc. So, you know, I learned from the orthopedic surgeon that I rotated with, I learned from the trainer, I learned from the coach. I mean, I just the resources were amazing.

SPEAKER_00 22:28

So um now let's let's plant a flag here for a second. Um, you know, many of us, myself included, will not know entirely what sports medicine entails. Can you kind of give us uh a padded bio about what exactly sports medicine means?

SPEAKER_02 22:45

You know, we took care of everybody, Don, from your weekend warrior to professional athletes, right? I mean, we took care of a lot of professional athletes. And so it's the simple person that hurts themselves or has a problem when they're working out at their gym or at home to the professional athlete that's injured, that you know, needs surgery, needs rehab, needs something done. So it's it's musculoskeletal.

SPEAKER_00 23:18

Yeah. Now, did you did you find yourself uh is the explicit stated goal, I want to get you back to the level you were performing at prior to this?

SPEAKER_02 23:29

You hope to be able to do that.

SPEAKER_00 23:31

Yeah.

SPEAKER_02 23:33

Um, we also did a lot of preventive work in younger kids. Um, that was one thing I really, really respected Dr. Andrews about was he wasn't somebody who was just immediately gonna slap somebody on the operating room table. And particularly kids, it it would, you know, he would have tough conversations with parents who, you know, thought their kids were gonna be the next MLB players or whatever, and say, no, at 10 years old, this is all the pitches they can throw without doing harm to their elbow for later. Or he would shut them down. Um now, most of the time people listen, but sometimes they didn't. And he would laugh and say, Then I'll see you back for surgery in about two years.

SPEAKER_00 24:21

You know, I I really like this point because um I want to take this little brief aside here and talk about, you know, modern day uh travel baseball, which is really popular around here. I'm sure you might have a few thoughts about this, but effectively these kiddos, and they're pretty young, are playing baseball maybe 11 months out of the year straight. Um, and you know, that's not something that used to be done in the 80s and maybe even 90s. There was a little bit of separation. You were doing different athletic ventures along the way. You were playing basketball and soccer and football and then baseball. And so um, you know, and there's also kind of a more competitive push, it seems like kids are doing baseball camps at younger ages, and we're probably also seeing some more sports-related injuries now that has increased in frequency. Do you have any thoughts about any of those things?

SPEAKER_02 25:18

I think sports are great for kids to participate in because they teach them so much more than playing a sport, you know, teamwork, mental agility, the whole nine yards. So we were always 100% behind kids participating in sports, but doing it smartly. And you can't have a kid whose growth plates are still open, throwing 200 pitches three times a week and not expect to have some consequences of that. So, you know, that's where we came from is yes, participate, but do it in moderation so that you don't hurt yourself. And then once your growth plates are closed, you still have to use some sense. You know, why do you think they rotate pitchers like they do on the national level, on the pro level?

SPEAKER_00 26:14

They're not interested in having their pitchers injured, those are investments. And so, yeah, and you know, it's it's crazy for somebody like myself to hear about these things of kids that are 15, 16 years old having Tommy John surgery and stuff that is like, I mean, in my mind, I think of that as a that's a pro-player injury or a pro-player surgery to have. So to hear about this happening early in high school is uh I think it tells us there's some warning signs there that maybe some of the ways that we're approaching it are not right. And we should perhaps listen to our sports medicine doctors.

SPEAKER_02 26:52

Well, I think that's the key takeaway is um, you know, most sports medicine doctors I know, whether they trained where I did or elsewhere, have that same philosophy. They want to protect the kids to be able to continue playing and doing what they want to, and great if they end up on a college level or professional level. Um but let's just do it smart.

SPEAKER_00 27:15

Yeah, yeah. Now, um, during your sports medicine fellowship, uh, I'm assuming you talked a lot about stretching, both pre and post, and how important that is. Uh, I mean, I think there's some intuition to guide us that that stretching is important, but there's kind of different types of stretching, whether or not you do dynamic versus static and other things like that. Was that something that you felt like you got a lot of training in um in teaching people?

SPEAKER_02 27:41

We did get quite a bit of training, but quite honestly, where I got it was from the trainer and voice.

SPEAKER_00 27:48

Yes, yes.

SPEAKER_02 27:49

Um, you know, so them and the the physical therapist that was in charge of the physical therapy program at the institute also was incredibly knowledgeable, did research, and so we learned a lot about that aspect of sports medicine from him as well.

SPEAKER_00 28:10

Yeah, one would also imagine that you're doing this a little bit more sports-specific. So, so you would you would alluded to earlier, you know, you're also interacting with the coaches. I mean, the coaches are gonna tell you, hey, you know, this outside linebacker is gonna need some more twist and lateral movement or something along those lines. And kind of you can start to to to think about exactly where this player is gonna get more prone to injury, and therefore how you can kind of prevent that.

SPEAKER_02 28:37

Well, and you see different injuries more commonly with different sports. You know, you've got your tennis elbow, you've got shoulder problems with basketball and tennis. So, so not that they can't have other injuries as well, but yeah, you really had more common types of injuries or complaints, depending on what sport you were taking to.

SPEAKER_00 29:04

It's gonna be different than a 55-year-old marathon runner and how they're gonna come to your office. So um, all right. So um you do your um, I should ask, um, what sport were you mainly involved with, or was it every single one?

SPEAKER_02 29:19

Not every single one, but a lot of every single one, but you know, football took up a lot of time at Troy State because you were we we went to every game and we had training room evaluations every Monday after the games. So, you know, it seemed like football took up a lot more time or we were more involved simply because we couldn't go to every basketball game, every softball game. We went to some of them, but football took up the crux of most of our time.

SPEAKER_00 29:53

Can you tell me about any athletes that you had to tell them that they shouldn't participate anymore?

SPEAKER_02 30:08

Yeah, it was hard. I mean, even in the moment, you know, your quarterback tears his ulnar collateral ligament. He wants to go ahead and play. Well, you can wrap it up and you can do this and you can do that, and I can keep playing. No, you can't. You know, it's hard. Physically you cannot.

SPEAKER_00 30:28

Yes. Yeah, and you know, um we love sports, we love kids participating in sports, we love adults participating in sports. That's fantastic. But once you put that into your mind, especially this happens with kind of, you know, our our teenage athletes, that's their raison d'etre. That's what they're there to do. And so all of a sudden, if you take away this future that they have and they're gonna have to divert, it's gotta be a very troubling time and and very scary.

SPEAKER_02 30:59

They lose their identity.

SPEAKER_00 31:02

That was much more succinctly and better stated than how I did. So thank you for that.

SPEAKER_02 31:06

Um so that's why there's a big psychologic component to sports medicine as well.

SPEAKER_00 31:13

Yeah, tell us about that. That's a really interesting point. I mean, are are you trying to get into the patient slash athlete's heads?

SPEAKER_02 31:24

And honestly, there's sports psychiatrists and sports psychologists that that's really their realm.

SPEAKER_04 31:31

Yeah, their gym.

SPEAKER_02 31:32

We we probably touched the tip of the iceberg in you know, what was going on with them, what was what were they thinking, why was this so important? Those kind of things. So we did the tip of the iceberg, but we also knew when it was time to have the professional in behavioral health intervene.

SPEAKER_00 31:54

You know, one of the things that I talk to about my medical students is that you are an amateur psychiatrist. You can walk into a room and you can feel within about five seconds what this patient is feeling, if they're anxious, if they're upset, if they're depressed, if they're happy, you can feel that. And you need to use that superpower to your advantage because that's going to change the way that you might approach things. Doesn't necessarily change the things that you do, but it will change the way that you approach it. So yeah. All right, so you finished sports medicine fellowship after one year, and then tell me what you did.

SPEAKER_02 32:29

I went to St. Petersburg and ran a sports medicine clinic with one of the orthopedic fellows that had bid training at the same time I did. A hospital down there wanted to start a sports medicine program. So I moved to St. Petersburg to run that clinic for a year.

SPEAKER_00 32:51

Now, is this your first chance at starting a program, de novo?

SPEAKER_04 32:57

Yes.

SPEAKER_00 32:58

Okay. Tell me what that experience was like.

SPEAKER_02 33:04

There was a lot of education that had to be done for the hospital who wanted to open this. Um, I was very fortunate to have the orthopedic surgeon with me who did a lot of cases and was financially supportive of the hospital.

SPEAKER_00 33:18

Absolutely. The hospital tends to see that as good.

SPEAKER_02 33:22

And the fact that the two of us trained together, we had a very similar philosophy. So instilling that into the clinic from the ground up, teaching the physical therapists who were there that were going to be working with us, um, the athletic trainers that were going to the schools to take care of these kids, you know, so the whole building the whole program, we just had such a great template from where we trained.

SPEAKER_00 33:51

You know, uh, one of the things that I've seen in my career, and I've said before on this podcast, is that, you know, at some point the cardiology became the easy part. It's not that it's easy, it just that came a little bit more naturally. And I would imagine at this point in your career, you've uh the sports medicine is kind of coming a little bit easier, but building a program and interacting with hospital administration and getting budgets and looking at all that's brand new muscles to flex.

SPEAKER_02 34:19

It it was a really good learning experience for me.

SPEAKER_00 34:22

Yes.

SPEAKER_02 34:22

Um, you know, because also we were providing athletic training to the high schools in the area, but those negotiations had to happen. I had to help set, okay, this is when they'll be there, here's what their responsibilities are, all of those kinds of things. So it it entailed a lot, but it was a really great learning experience.

SPEAKER_00 34:42

Yeah. Um, now my father-in-law will is known to say, experience is what you get when you don't get what you wanted. So, yes, it's an experience. That's great. So um now, so after a year of doing that, tell me where you went.

SPEAKER_02 34:57

I came back to Panama City.

SPEAKER_00 34:58

Okay, I've heard of it.

SPEAKER_02 35:00

Um pardon?

SPEAKER_00 35:02

I've heard of it. So yeah. So tell me about Panama City.

SPEAKER_02 35:08

So when I moved back, um, and it was a personal decision. We were at a point where I had been able to keep my beach house when I was gone for fellowship, and when I was in St. Petersburg, my uh Harry and I had been dating for like four years. So at that point, we either had to decide to for him to move to St. Petersburg, start a new business, sell the real estate in Panama City, et cetera, et cetera, and kind of start over in St. Petersburg, or I came back to Panama City, we kept our property, he kept his business, etc. And so when we really sat down with pen and paper, it just made far more sense for me to come back to Panama City. Wasn't really an opportunity for me to do primary care sports medicine at that point. Um there also wasn't an opening in the ER. So I hospital-based family practice clinic in Seagrove Beach off 38.

SPEAKER_00 36:19

Okay.

SPEAKER_02 36:22

I did that for a couple of years. During those couple of years, a part-time position opened in the ER at Gulf Coast. So I did both. Um my heart was in the ER. So as soon as there was a full-time opening there, I discontinued doing family practice and went full-time ER at Gulf Coast.

SPEAKER_00 36:46

So um, am I to translate that that you were bored doing the family practice?

SPEAKER_02 36:50

Is that it just wasn't my heart. Yeah.

unknown 36:56

Yeah.

SPEAKER_02 36:57

I mean, I I was good at it. I took good care of people, I cared about them, but it just wasn't my heart.

SPEAKER_00 37:04

This is another uh crucial point in talking to trainees coming in is do the thing that you can't not do. If you can't not do surgery, well then do surgery. If you're gonna do surgery because, well, they get paid well, let me disabuse you of some notions right now, okay? So it shouldn't be about the pay, it should be about the thing that this drives me. You should be really happy coming to work, you should be really happy going home as well. So so now you start to do full-time emergency room uh work. And this is since you've been at Tyndall, this is kind of the first time that you're really doing full-time like that. Tell me how that was.

SPEAKER_02 37:46

Um you know, I was back in my element. I loved it. The team that we had there, because we had an independent group that contracted with the hospital. Um so we had a great team put together. I enjoyed the work, I enjoyed the people I worked with, etc.

SPEAKER_00 38:07

So now, how long until you crept up to the leadership in that group?

SPEAKER_02 38:17

Five years maybe.

SPEAKER_00 38:18

Yeah.

SPEAKER_02 38:19

The leader of our group at that time was um getting a little bit older, so he brought me on as assistant director to kind of teach me the ropes and the finances of it and everything because you know, we did our own building, we did our own everything as an independent group. Um, so he brought me on to kind of take that over and spent a good two or three years learning the ropes. Um, and then he started diminishing the amount of time he spent, and I moved into the directorship.

SPEAKER_00 38:54

Did you feel like you were ready for the directorship when you got there?

SPEAKER_02 38:59

Do you ever feel like you're ready for the head?

SPEAKER_00 39:01

I don't. I never feel ready. I never you just get in kind of like having kids. I don't know if you're ready. You just you just get in head first. Yeah, yeah.

SPEAKER_02 39:10

I think I felt like I was as ready as I was gonna be that I had to just learn. And I had had the opportunity as assistant director because you know it's so important, Dawn, when you have a contract like that, you have to have a working relationship with administration.

SPEAKER_04 39:28

Yes, you do.

SPEAKER_02 39:29

You have to have you have to have credibility in a working relationship with all of the physicians on staff because at some point you interact with all of them. Um, you have to make sure your finances are in order.

SPEAKER_00 39:45

This is so this is such a big picture moment here of you kind of realizing all these things and this meta-analysis of how you're really um you're kind of spinning a lot of different plates at the same time. Oh, by the way, you're still working shift work in the emergency department, you're still doing your job. But all these things are crucially important. And I mean, uh you're also managing and motivating uh a herd of cats as well.

SPEAKER_02 40:14

I had a great herd of cats, though. I I just you know, we we no judgment. We recruited very intentionally and tried to make sure that people were a good fit.

SPEAKER_03 40:25

Yes.

SPEAKER_02 40:26

We had a couple of misses that didn't work out.

SPEAKER_03 40:28

Sure.

SPEAKER_02 40:29

Um, but in general, the team, and that's that includes the advanced practice providers, the majority of them were military trained, so they were very, very strong in what they did, and they knew their limits, which made our jobs much easier.

SPEAKER_04 40:50

So important.

SPEAKER_02 40:50

Um, so just that team that we were able to put together, we we were like a family, we had each other's back all the time. And I what else can I say? It was just I was so fortunate to have that type of team together to lead.

SPEAKER_00 41:08

You know, when you hear really excellent leaders um throughout history, they usually give a lot of credit to their team uh first and foremost. And so I think that it speaks a lot to your character to do that here and now. Now, how long were you uh director working uh or head of this group?

SPEAKER_02 41:30

15 years.

SPEAKER_00 41:31

Okay. It's a lot of time to be to put into that. And you've probably gone through a few different hospital administrators. Is that fair to say?

SPEAKER_02 41:40

Like five or six, I think. Several.

SPEAKER_00 41:44

And they're different every time they come around.

SPEAKER_02 41:46

So very different personalities, different philosophies, different thoughts.

SPEAKER_00 41:51

Yeah, different priorities, too. And then you have to kind of reconcile how your group is gonna mesh with that conceptualization about how the hospital should be run. And that's that's always a very interesting time to kind of um flesh that out.

SPEAKER_02 42:08

Well, very interesting. And as we moved through it, what like the last four years, um, because they decided to discontinue our independent contract, and so we had two contract management groups, first one, and then two years later, a different one. And it was very interesting how the priorities changed from our group to their. And you know, I'm probably not telling you anything, but it was metrics and the bottom line. I respect metrics, I respect finances, but our premise was you let us take care of the patient properly first, and everything else falls into place.

SPEAKER_00 42:56

I want every man, woman, child, medical student, layperson, my family, to listen to those words because that is exactly the point. The rest follows distally from that. That should be your prime focus. And this is exactly, you know, I've said before, our product is not iPhones, okay? We don't have this way to metricize this. You have no idea. Look, if if you have back-to-back patients and one comes in with an upper respiratory tract infection, and the next one comes in with a ruptured AAA, those are different patients. This is not just, hey, you know what, Deb, your metrics are that you should only be spending 30 minutes per patient. I mean, those can be worlds apart, and they can you also suffer in the emergency department where you don't know what you're gonna get, and there could be something hidden that is just a rope adopt that's about to hit you hard.

SPEAKER_02 43:56

Well, that's what I said is it's finding the missing pieces of the puzzle that. Aren't always obvious.

SPEAKER_00 44:01

Yes, yeah. What are you not complaining about? That's that's going to come to show itself in just a little bit. Yeah. So um uh well now, so at this point, so you have you've been doing this career where you're actually performing emergency medicine on shift work. You're also leading and directing this group. Um, tell me about some of the other things that you're doing at the same time because I know that's not just it that you've been doing. Could you talk maybe um about some of your other leadership positions that you were taking?

SPEAKER_02 44:33

Well, I was fortunate that um leaders, physician leaders who were there saw potential in me and you know, actually gave me the opportunity to be chief of medicine and mentored me and taught me. To this day, I still ask myself, what would Mike Walker say or do? He had such an impact on me. So he gave me that opportunity, and then from there I was chief of staff. Um, I was involved in the medical association, so I was able to serve on the board and and be president, etc. Um, so I just opportunities just unfolded for me. Um, and I will always be grateful to Mike Walker for giving me that opportunity.

SPEAKER_00 45:25

Well, I can certainly see where there was um some inspiration there in seeing you and just having seen you work. I can certainly see your leadership skills writ large. Um, but let's also talk about that for a second because you know, not too many emergency departments um or emergency medicine specialists end up becoming the chief of medicine and chief of staff. That's not something I've seen a lot of in my um career. Is that um were you blazing a relatively new trail there?

SPEAKER_02 45:55

Yes.

SPEAKER_00 45:57

Um it's very humble.

SPEAKER_02 46:00

And it was tough because some of the people in the Department of Medicine didn't feel like an emergency medicine physician had the right credentials um to lead that department. Part of it had to do with us not being inpatient upstairs on a daily basis. Um so there were some biases.

SPEAKER_03 46:24

Yeah.

SPEAKER_02 46:24

Um I feel like I was able to overcome them and represent the department as a whole about what was important in the emergency department, but also what's important is the inpatient.

SPEAKER_00 46:39

And that is an incredibly difficult thing to do because when you are in your zone of the emergency department, you've got your finger on the pulse of what's going on there to extrapolate that out to the hospital. Because, you know, uh some cynical amongst us would say that, you know, the emergency department is a triage department. You're there to take, you're you're you're a triage and dispo. Hey, I found out this person's sick, they're going to the hospital wards, then my job is done. I've done all the things that I need to do. This patient's got a hot appy, I'm gonna get them out of here, they're going to surgery. Good, my job here is done. Now, I know that you and your colleagues don't think that, most of your colleagues don't think that way. So you all of a sudden have to take a broader approach to what's going on in the hospital, too. You're you're following these patients throughout their hospitalization at that point.

SPEAKER_02 47:30

But it started inpatient, all the things that you're saying, Don, but it started when we started having to ward patients in the ER.

SPEAKER_01 47:38

Yes.

SPEAKER_02 47:39

So you saw a component of inpatient, but it was in my back hallway.

SPEAKER_01 47:43

Yes.

SPEAKER_02 47:45

Did it probably open my eyes to some things and see some cracks in the system? Absolutely. Yes. But I think it probably helped me have a better broad view to help my inpatient colleagues.

SPEAKER_00 47:58

That perspective is key. When you do emergency department rotations from internal medicine, you realize all of a sudden, yeah, this is you may know, I I can quote you some of the renal tubular acidoses, um, but that's not necessarily going to help you when you've got a hip fracture that comes in. And so you need to be thinking about some different stuff and and maybe give a little uh little leeway, a little grace to our ER colleagues that are um frankly saving lives.

SPEAKER_02 48:29

Our biggest job is to prioritize what comes through the door. You know, it is triage, but it's who needs me at the bedside right now and who can wait for 30 minutes.

SPEAKER_00 48:40

Look, if there's ever an emergency on a plane, I can tell you right now, you want an ER doctor there before you want me, okay? Um, all right.

SPEAKER_02 48:49

I've done that a couple of times as well.

SPEAKER_00 48:53

I have a different story about that. I'm sure you have, okay. You've been out there uh first responding uh really on the front lines. Um can we can we pivot a little bit and talk a little bit about um um the emergency department in really hard times? So let's take um a massive trauma event or um, you know, uh a major car crash where you've got 10 car crashes coming. Um could you maybe talk about the energy, especially as directing the emergency or the emergency department and kind of um, you know, how y'all band together in order to take care of situations like that.

SPEAKER_02 49:36

Honestly, early in the morning we huddled. We had a code team. You know, so so we I won't say that we always practice mass casualties, but we we had a plan. So every morning, if we if codes came in, the code team knew who was doing what. You know, you're starting the IV, you're putting the paddles on. So so it really involves uh having a plan. And we reviewed mass casualties because that's when you really have to decide who can you save and who can you not, because you have limited resources and you have to put your efforts into the people that you can save. And that is not an easy decision to make at all.

SPEAKER_00 50:24

It's absolutely not. And the other thing is, you know, I I've I've said this before to trainees. Um, it's not about the decision that you make if you have infinite time and infinite resources. It's you've got minutes and sometimes seconds on the line. What kind of decision are you gonna make at three in the morning when you're woken up from a dead sleep? That's where the rubber meets the road. So that kind of quick assessment triage. I mean, yes, when you take some retrospects hours later, that can weigh on you heavily. But at the time, it's training kicking in.

SPEAKER_02 51:01

I term it you just go on autopilot. Um you just start shouting out orders and you know what needs to be done, and you're just on autopilot. Doesn't mean that you don't reflect and like really whoo afterwards.

SPEAKER_01 51:16

Yes.

SPEAKER_02 51:17

We're human and debrief, but in the moment, you better be able to function like that.

SPEAKER_00 51:26

Because you're gonna have to save the next one that's coming by too. Um, yeah, this is this is the old adage of uh what do you do uh in a code situation? What's the first thing you do? Check your own pulse. Now I'm just gonna go. Now the training kicks in. And and that's one of the things that you um you get really happy that you did get good training inculcated into you because now I know what to do here. This is what I'm gonna do. You can be direct and calm about it. There's no reason to jump up and yell and do it. You can just, here's how we're gonna do it. And those are really the impressive uh performers whenever I see that happening.

SPEAKER_02 52:06

And you know, it's such a difference, Dawn, between the larger hospitals and the rural hospitals because they're often single coverage. Yes, less resources, so it it's more difficult in a rural hospital. I always said to my colleagues who work in a in a rural hospital, single coverage, which I did some moonlighting during residency and everything, but it's it's a much harder job because it is all on you.

SPEAKER_00 52:31

Yes. And you can't bounce around as many ideas to the neurosurgeon for somebody that comes in with a brain bleed. Like that's you're you're you're the guy. You gotta do it. And so, yeah. So um, well, I I really do um, I wouldn't say envy my emergency department colleagues, but I respect my emergency department colleagues for for uh, you know, I mean, honestly, the many lives that that you guys save, but also it's a very, very difficult job. And I'm really glad that somebody likes to do that kind of stuff.

SPEAKER_02 53:03

I, you know, just like the different specialties, different specialties have different basic personalities, I think, Donald.

SPEAKER_00 53:10

That's true, that's true.

SPEAKER_02 53:12

ER docs just kind of have that go, go, go.

SPEAKER_00 53:17

They they do personality. They do. All right. So um, so now tell me about uh after 15 years, where'd you go after that?

SPEAKER_02 53:26

So I had I had to have significant four-level lumbar surgery um in 2016. That wasn't exactly conducive to me keeping the pace in the emergency center. Um, you know, our volume had grown significantly and that, and certain procedures that we don't have to do every day, but when we do, it's necessary. And um, you know, my surgeon looked at me, he was funny and said, I'm not gonna tell you you can't go back to work. But you've made it clear to me you don't ever want to be back on my OR table.

SPEAKER_00 54:13

So there's some choices you might want to make here.

SPEAKER_02 54:16

And he said, and what I'm gonna tell you is the first 300-pound hip that's out of place that you throw over your shoulder and start pulling and wiggling and twisting on, I'll see you back in a couple of years. I was like, well, thank you for not telling me I can't go back to work, but telling me I can't go back to work in the ER.

SPEAKER_00 54:38

Because you know you're going to do that. Of course I'm you know you're going to do that. You're you can't stop yourself from doing that. That's that's going to happen if it's there. Yeah, yeah.

SPEAKER_02 54:48

Yeah. So at that point, I wasn't, it was the decision for me, Dawn, was just so important that I chose something that I still had an impact in people's lives. And so that's how I landed in consulting and doing physician coaching. Um, very different impact than at the bedside, no doubt. Um but navigating the healthcare system and all the demands that continually increase on physicians, many of which are administrative or secretarial or whatever, being able to help my colleagues navigate that system and figure out a way to still have a life has allowed me to still have an impact in people's lives.

SPEAKER_00 55:44

Well, it's also a force multiplier. If you can get physicians to continue to practice and do good quality medicine, that's going to spread out from there. So it truly is. That's you're not just having an impact on them, you're having an impact on all their patients too. So uh wow, uh what a what a powerful way to go about it. And you know, something else that that we should point out, and and again, not trying to date you, just gonna say that um, you know, you started off your career pure paper charting from top to bottom. Um as this has gone on, we've gone more electronic all the way to where now that is solely what we're doing. You're putting your orders in through the electronic, you're not even writing orders anymore. Um, nurses are having to go through the electronic device, the computers in a lot of different ways in order to get their medications out. So what I've seen this, and again, again, this could be cynical of me, is that this seems to put more and more distance from the physician to the patient, puts more and more distance between us laying hands on the patient. That's ultimately what we're there to do, is to treat the patient. And all these other things that kind of get thrown in the way along the way, that that's disheartening to us. You know, the I think the term that has been bandied about is moral injury. The more times that you have to, you know, jump through some sort of training hoops for the administration, or the more classes that you have to take. It's taking you away from that thing that you really want to do, which is take care of patients.

SPEAKER_02 57:22

No doubt. Almost every client that I work with, one of the reasons they come to coaching is charting. Charting and inbox and whatever portal is for patient messaging. They can't keep up. So, you know, it's a matter of helping them navigate, helping them set boundaries with patients, with staff. Still a good doctor, still a kind, compassionate doctor, but having to set boundaries because otherwise they're the ones paying the price with an extra hour, two hours a day, half their weekend spent finishing charts, going through inboxes, etc. So it's a common threat. It is just a common threat.

SPEAKER_00 58:11

And that's time that you're not spending with your daughters or with your wife, or you're playing sports or seeing concerts or anything. And um, it's a little overwhelming. I I try and tell everyone the same thing that I try and do. I try and finish all my work at work, even if I've got to stay later in order to get that. So my home life is my home life, and I don't have to bring that home. But many physicians aren't afforded that that luxury.

SPEAKER_02 58:39

Not they aren't. And the other common thread, um, we call it ESOR, and it's exaggerated sense of responsibility.

SPEAKER_01 58:50

Yes, yes.

SPEAKER_02 58:51

So the physician just can't let go of needing to be responsible for all of it for letting the patient bring a list of 10 things they need to talk about when it's a 15-minute appointment. You know, so I I do a lot of work with that common thread as well.

SPEAKER_00 59:09

Are you talking directly to me right now? Because you realize we're on a podcast and we're recording, right? Okay. So just so you know.

SPEAKER_02 59:16

Um it was I just threw it out as a thought.

SPEAKER_00 59:18

Yeah, well, it felt directed, okay? Um no, and this is something, you know. Um, so for example, if you have mid-levels, we have three wonderful mid-levels. We've had a series of mid-levels that have been really, really great. You know, as you delegate responsibility, you have to recognize that it may not always be done exactly the way that you would have it done. But realizing that it's probably good enough and you can relinquish that kind of fear and that that constant worry is um, I mean, that's what they're there to do, right?

SPEAKER_02 59:58

And it fits into the other common thread is letting go of perfectionism.

SPEAKER_00 1:00:06

Again, we're recording this. You cannot be talking to me like this, okay? This is this is not my, I'm not paying you for this yet, okay?

SPEAKER_02 1:00:13

No, I mean, the interesting thing about a lot of these common threads, Don, is they those patterns, those characteristics, they served us very well to get us where we are today and successful. We don't have anything to prove anymore once we get to a certain place. And so they become maladaptive instead of helpful.

SPEAKER_00 1:00:38

I think that is so well said because you kind of have to have that to get through training. And then now all of a sudden, on the other side, you realize that this could be um perhaps deleterious to your health.

SPEAKER_02 1:00:52

Right. And so I do a lot of work in that realm as well.

SPEAKER_00 1:00:56

So is a lot of this saying that you are um you're breaking down physicians, psychiatry, you're going back to the mental game.

SPEAKER_02 1:01:04

That's it's a mindset. It truly is a mindset and being able to let go of some limiting beliefs that aren't serving you anymore. You're paying the price for it.

SPEAKER_00 1:01:16

Um, so so this is a different business model for you in terms of doing this kind of coaching. Um, you know, as you think through your career and how it's gone on, um, do you find this more rewarding? Is it just as rewarding? How does this fit into your mindset of how you you recognize what you've done?

SPEAKER_02 1:01:39

It's very different. The rewards were just different. You know, in being in the emergency center and doing what I'm doing now. They're both very rewarding, but just in a different way. And, you know, I loved taking care of people. And I still miss being at the bedside taking care of people, but I don't miss all the rest of it that took part of the fun away.

SPEAKER_00 1:02:06

Absolutely. It takes a little piece of you, and there's that that moral injury that comes along with that. Um, so now are you doing this consultation full-time now?

SPEAKER_02 1:02:16

Yes.

SPEAKER_00 1:02:17

Okay.

SPEAKER_02 1:02:18

I um I actually have interestingly enough, um, a woman I had worked with back when I was on the board of the American College of Emergency Physicians, blah, blah, blah. She happens to be a Harvard physician, but she transitioned about 10 or 12 years ago to coaching full-time. So she had reached out to me because she had gotten busy enough, she was looking for associate coaches. So I actually do most of my work with her in conjunction with her um company. And she just matches her coaches with um physicians or advanced practice providers that come for assistance with um with issues. And she so they kind of do a matching game, and that's how I end up with so many of the people I'm working with now.

SPEAKER_00 1:03:09

What's um what's a day in your life now at work? What does that look like?

SPEAKER_02 1:03:16

It really varies. Um it's funny, like right now, I will tell you. Mondays and Thursdays are packed from eight in the morning until five in the afternoon. Why? Because right now, the client list that I have, their admin day is Monday or Thursday. So those are the days they have available to work with me. Otherwise, they're in clinic, they're in the hospital, they're on service, they're on consult, whatever. So, but it but it varies, you know, depending on who my clients are.

SPEAKER_00 1:03:58

Are you usually talking with them for an hour at a time? Are you going to their workplace and saying, here's some things that we can do? Um, how does that work?

SPEAKER_02 1:04:07

Well, most of my work right now is on Zoom. Um, and so a longer session is 45 to 50 minutes. And then the following week or two weeks later, if we've come up with an action plan, is a 15-minute laser session. And what that really is, Dawn, is accountability. Here's what worked in the action plan, here's what I'm still struggling with. And so we look at it in that shorter time frame about what was working and what wasn't. Or every once in a while, a certain situation will have popped up that's very important for us to collaborate on, even if it's a short session.

SPEAKER_00 1:04:49

Yeah, you know, a part I think of your training in the emergency department is that um you can kind of cut through some of the BS pretty quickly. And you can say, look, we're gonna be we're gonna be real honest about things here because that's ultimately what's gonna gather the most fruit. We could, you know, step around and light foot and do other things like that. Let's get straight to the meat and potatoes here so we can make you better.

SPEAKER_02 1:05:15

I get permission from everyone I work with to do that. Like, I know the story is important to you, but sometimes I don't need the whole story and all the details to help you move forward on something. So I get permission to interrupt and redirect if I feel like what they're telling me is a waste of their time because I want them to maximize our collaborative thinking together so that they can make progress.

SPEAKER_00 1:05:45

When um Chris uh produces this episode, I'm probably going to listen to that little tidbit about 70 times again and again because I might get that printed up and put in my clinic office. So uh so that's great. Um now um I'm I'm gonna switch gears a little bit here. Um so um what is the biggest issue that you think faces the emergency department right now in emergency medicine?

SPEAKER_02 1:06:16

Overcrowding and being used inappropriately. Um and part of what plays into that, and I I I don't want to talk politics, but like but just the bottom line is funding, like for Medicaid expansion for uninsured people to have some mode of insurance. Because when they don't think that's a continuing concern that overloads the ER for the people who really 100% need to be there.

SPEAKER_00 1:06:57

Yeah, um part of my quest here um in life is to fix medicine, and that's one of the big bugaboos that we really have to think about. Um, you know, how do we how do we keep the patients that really need to go to the emergency department go into the emergency department and those that don't, not, but still getting the care that they so desperately need so we can kind of keep people moving on in the future. I really I love that answer because the emergency department has always been a catch-all. It's always been a when in doubt, they'll sort it out. And the more that we depend on that, the more we lean on that. I think perhaps the worst medicine's coming.

SPEAKER_02 1:07:36

We're mandated to see everyone that walks through the door or at least do a medical screening. The other problem that goes along with that is then we can see them and we could get them ready for discharge, but where do I send them? Yes, because all the resources in the community, not just ours, but across the board, the community resources are limited as to where these people can follow up. So it just ends up being a hamster wheel.

SPEAKER_00 1:08:03

Yes, and you know, uh so uh I just so every lay person can hear this for a second. How many people do you discriminate against in the emergency department?

SPEAKER_02 1:08:14

Oh, absolutely not.

SPEAKER_00 1:08:16

So it's all comers, I don't know, it's been here uh legally, illegally, whatever it is, if you are in need, you come to the emergency department, you're going to get seen. Okay, it's gonna be triage, you're gonna get seen across the board. Well, we're here to take care of you. That's exactly what what our emergency departments do. Now, we have one run into a um, you know, you'll hear me beat this drum. I think medicine and healthcare should be a customer service business. The customer service in terms of the emergency department experience is getting worse. A lot of that is due to overcrowding. A lot of that is due to prolonged waits in the emergency department. And trust me, my emergency department colleagues do not want to have patients waiting in the emergency departments.

SPEAKER_02 1:09:06

I mean, you're exactly right about everything you just said. It's like, how do we resolve it? What when there's just the volume is just too large to realistically take care of safely.

SPEAKER_00 1:09:22

That's right. So we want to do things safe, and you start to have to cut corners. So that's why it becomes a quicker triage to my internal medicine colleagues, where you say, look, this person's septic. I need to get them out of here as quickly as possible, as safely as possible, so I can move on to the next thing that could be a hot appy or a triple A or you know, um a hip fracture, something else that that is going to need my help. There's also kind of a tendency to think, I think perhaps from the lay side, that what are the doctors even doing? Are they seeing anybody? Why is it taking me forever to be seen whenever I'm waiting here? I've been waiting for four hours here, and I'm I've got all these things that are going on here. Why can't anybody see me? Uh, I assure you, the emergency department doctors are not resting on their feet. They are up and around doing things at all times.

SPEAKER_02 1:10:16

Well, and that's the hard part because when you're sitting in the waiting room or whatever else, or even in a room in the air with the door mostly closed or whatever, you really don't see what else is going on. You don't see the five ambulances that just unloaded in the last 30 minutes. Um, you know, you you don't realize that someone's having a heart attack and we've got to get them, you know, quickly somewhere or a stroke. So it's hard for them to grasp that because they don't see the whole picture.

SPEAKER_00 1:10:46

Yeah, and when you're directing the emergency department, you have to be able to grasp that picture and realize oh, uh, you know, triaging patients, but also utilizing your resources as best as possible. ER doctors can't work 48 hours straight. So you have to be able to use your pieces at the right time based on where you think uh patients are going to be busy. Um because the ER doctors, they want to work, they want to help people. That's that's their job.

SPEAKER_02 1:11:13

And the funny thing is that you mentioned, Don, about even even the specialists, like if we call them too early, like our group, again in the early days, we prided ourselves on having everyone for admission packaged with the nice red bow on them. The central line was in, the intubation was done, that you know, all of those things were done and packaged. We prided ourselves on that, and so our medical staff got used to that.

SPEAKER_00 1:11:44

Spoiled down the road.

SPEAKER_02 1:11:47

You real there just isn't time to always have them, you know what needs to be done, but you just don't have time, especially if it's a difficult central line or if it's uh something else. So you have to make choices, and sometimes the specialist gets called earlier than they would like to.

SPEAKER_00 1:12:10

Yes, and again, we're all a team that includes all the nurses, triage staff, LPNs, everybody that's in the emergency department and in the hospital in general. It's a team, and we have to try and take care of patients as best we can. Um, but there's also a significant time that I see my colleagues in the emergency department having to do dictation notations, other things, putting in orders that just seems clumsy and time consuming. Um, where it's it's again, it's not traditional bedside medicine, it's it's something else. And I I don't have all the solutions to that particular issue, but it it's something that I think is clearly an issue.

SPEAKER_02 1:12:51

It's very clumsy. If I have to take time to put things into the computer or do administrative type of things, then it takes me away from a patient who's been waiting for a while, who needs my care. I don't have the answers to it either, Don. You know, but I would always remember whoever was taking notes during a code, I said, you have to be incredibly thorough because there is no way I can remember all of this at the end of the day when I need to document it very well.

SPEAKER_00 1:13:23

My job is something different right now.

SPEAKER_02 1:13:25

So that's a perfect example of what you're talking about. Um and I I don't know the answers.

SPEAKER_00 1:13:33

Yeah. Um, well, either way, uh, we're gonna keep getting through this together because we want to help people, and so uh we'll find some solutions, and maybe something is um coming around the bin that can help us a lot. And that that is kind of triage or it blends into my next question here about how is AI gonna integrate into your field as far as you imagine it.

SPEAKER_02 1:14:00

I think it has a place everywhere in medicine if it's used appropriately. And AI is only as good as what is being fed when it's set up, is my thought. So you have to have that person setting it up correctly. And then it can do a lot of the paperwork and administrative thing. If I can speak to it, it should be able to summarize and do a significant amount of the paperwork that needs to be done for documentation. I see that as the first step. Um, you know, big picture 10 years from now, are there going to be AI robots examining people, this and that? Maybe.

SPEAKER_01 1:14:43

Maybe.

SPEAKER_02 1:14:44

Um, but for right now, I think just acting as a scribe to try and help unload some of the administrative duties.

SPEAKER_00 1:14:55

I totally agree with that. I think the um, you know, the the scribing, the the notations, that's not really your work product. Your work product is bedside, is you saying these are the medications we need to give to patient. The dictation and the notations and everything, that's for billing purposes. And it's really um, so if you could just do what you do and then something else scribes it down, that would be great. I've I've said for some time, if I say, hey, this patient should be on lysinopril 20 milligrams, the computer should just send off that prescription without me having to put that in the computer. That'd be really nice.

SPEAKER_02 1:15:27

Yeah, to be able to streamline some things like that instead of you know having to go to five different screens before you can get to be able to put the order in or put the prescription, whatever it is. Um, I think the intentions for EHRs were good. The actual utilization of them I don't think has turned out as to what the original intent was.

SPEAKER_00 1:15:51

Completely agree. And just spitball me on average, how many computer systems, how many computer programs do you have up per time whenever you work in it when you're working a shift in the ER now?

unknown 1:16:02

Yeah.

SPEAKER_02 1:16:07

I don't know that I know exactly what you're asking, but you know, it's tough because you have to get out of one screen to get into another one. So instead of being able to have dual monitors or be able to work on two charts at once, depending on whatever, that wasn't possible.

SPEAKER_00 1:16:23

Yeah. Well, there's typically a pack system for your review of radiology. There is your own um emergency department computer system, there's the inpatient computer system. All these are separate and it seems like they should be fully integrated.

SPEAKER_02 1:16:37

Radiology, this one, that one, yes.

SPEAKER_00 1:16:40

It seems like you would think, oh, these are fully integrated. They're not. Um, so that's another thing where maybe um technology could help.

SPEAKER_02 1:16:48

Correct.

SPEAKER_00 1:16:49

Um, and go ahead.

SPEAKER_02 1:16:51

I was gonna say, I think that was part of the original intent. Yes, but it just hasn't seemed to mesh together and integrate to make that intent come true.

SPEAKER_00 1:17:05

Yeah. Are you saying we were sold a bill of goods on that? I don't know. Okay, I can't, I don't believe you on that.

SPEAKER_02 1:17:10

Um are you putting words in my mouth?

SPEAKER_00 1:17:13

It was all that therapy you did earlier on me. Okay, so that's what you get. Um, now um, young folks that are coming out of medical school, medical training right now, that are going into the emergency department. Um, tell me what recommended recommendations you would have for those that think uh emergency medicine is their future vocation.

SPEAKER_02 1:17:36

I always go back, Don. They just, in spite of the pressure for metrics and paperwork and everything else, they just have to put the patient first and take care of the sickest patients first. So it's it's prioritizing the patient first and taking care of them according to the training you have to triage.

SPEAKER_00 1:18:02

Perfectly stated sage advice. Um tell me, what do you do for fun?

SPEAKER_02 1:18:11

I'm a big outdoor person, so I love the beach, I love swimming, I love hiking in the mountains. Um anything outdoors makes me smile.

SPEAKER_00 1:18:23

Now, um, since your surgery that you had getting close to 10 years, um, has that limited you and your ability to be able to go climbing, rucking, um, doing all the things, hiking that you would like to do?

SPEAKER_02 1:18:38

A little. Um, the interesting thing is the one motion that continues to be painful post-surgery has been um inclines. So I have to be careful or take it very slowly if I'm doing any kind of significant incline.

SPEAKER_00 1:18:57

So, well, one would imagine out in the mountains you run into those uh occasionally. Um you know, um I I love hearing this because it's part of the things that I preach to my patients all the time, which is stay active, be out there doing stuff. Not only is it great for you, but it's great for your brain too to kind of be out in sunshine, be out in life.

SPEAKER_02 1:19:20

Oh, without question. I like with the weather we've had and that sort of thing, I've been inside way more than I'm accustomed to. And I feel the effects of that. I'm just like, oh, I I need fresh air, I need to be outside. Um not that you can't when it's cold weather out, but that's just not my cup of tea.

SPEAKER_00 1:19:39

Yeah, yeah. I I generally like my air conditioned, so uh and my drinks brought to me, but uh I still do uh recognize that being outside a little vitamin D is probably helpful to us. Um now, um one more thing that I just want to kind of allude to before we kind of wrap up here is that um so um you have been uh in charge of and planning of our academic CME retreat uh for some time now. Um and I wanted you to talk about that a little bit because it's it's um it's simultaneously a lot of logistics, it is leadership, and it's also having kind of your finger on the pulse of where you think not only our physicians should be trained of our membership, but also where they might want to have interest. And I was wondering, how do you spin all those plates whenever you're planning something like our annual CME Beach retreat, uh, which has been absolutely phenomenal ever since you've had your hands on it, and I highly recommend it to all professionals.

SPEAKER_02 1:20:44

So, first of all, I have to hand it to Michelle because she does so much of the legwork that that really the presentations and the physicians requires more input from the physician leader of the conference. The toughest thing, as you can imagine, Don, is when we have so many different specialties there, what is going to be interesting to everyone, what will apply to multiple different specialties? So I think we've learned that we try to incorporate some component of the business of medicine because that applies to everyone. And then we just change topics uh every year. Like one year, maybe we concentrate on cardiology, another year GI, another year some pediatric things. So again, the information is good even if it's not uh completely applicable to your specialty. So we really do try to rotate things and we try to come up with information that is cutting edge that's new, that everyone would be interested in hearing whether it absolutely applies to their um practice or not. So those are kind of the things that we look at when we try to put it together and just make it at least something for everyone who's there throughout the weekend.

SPEAKER_00 1:22:08

Well, I think again, you've done a tremendous job of doing that um through the years because I've I've I've hit on some topics that I would never have even thought that I didn't know anything about, whether that be um outdoors sports medicine, whether that be ear, nose, and throat common complaints and kind of advanced feels, also dynamic speakers that we've gotten. So uh I just I can't thank you enough for making my career broader in some sense and kind of thinking on different levels. And that has a lot to do with some of the education that I've gotten at at the CME retreat.

SPEAKER_02 1:22:40

Well, it's been a lot of fun, um, you know, working with Michelle and the different co-chairs that I've had uh through the years with CME. It's been a lot of fun putting this together, maybe because I'm just like most physicians, a continuous learner. So it's fun to figure out what would be a great topic this year.

SPEAKER_00 1:22:57

Yeah, I'm not sure I always like being reminded how dumb I am, but still it's you know, it's it's still refreshing to kind of get those kind of things and those awe moments of, oh wow, I never even thought of this thing like that. So so uh kudos to you. And I I should also, I would be remiss if I didn't take this opportunity to say thank you for all that you've done with regards to that, because Deb Williams unfortunately has decided that she is going to retire from the academic chair. Um now um you we are leaving it in the semi-capable hands of Zach Wilson, which is okay as far as I'm concerned. I'm just kidding, he's great. He's gonna do fantastic. Um, so you've left a very nice legacy there.

SPEAKER_02 1:23:37

Well, thank you. And you know, both Zach and Michelle and everyone that's on the board knows that I'm still around. So if there's anything I can ever bring the history back or help with, I'm always available.

SPEAKER_00 1:23:49

Yeah, I don't know if you think you're getting out of work because that's not how this game goes. Okay. So uh just buckle up, all right, sister. We're doing things. Um, all right. So um here's some rapid fire questions for you, okay? You ready for it? You should be sitting down for this, all right? Okay, who's the smartest person in history?

SPEAKER_02 1:24:12

Don Davis.

SPEAKER_00 1:24:13

Oh wow, you have not learned a lot of history, okay. Let me just disabuse you of that right now. Um, okay, so if we can live to be a thousand years old, should we do it?

SPEAKER_02 1:24:27

There's too many variables to answer that because living to be a certain age doesn't always mean that there's quality to it.

SPEAKER_00 1:24:37

That is the right answer. It's uh, and this is why I say um to my patients, we want you to be alive and active and doing things, not just alive as a head in a glass jar. Okay, so um at night, would you rather have it too cold or too hot?

unknown 1:24:57

Too cold.

SPEAKER_00 1:24:58

Good, that's the right answer. Now, um, what is one thing you would tell yourself if you could go right back and talk to yourself as you started your uh med school career?

SPEAKER_02 1:25:12

Incorporate more fun.

SPEAKER_00 1:25:15

Well stated. Um what is one current medical therapy or treatment that we do that we are gonna shudder that we did in uh 15 years I would say just broad spectrum.

SPEAKER_02 1:25:33

Anything that is significantly invasive, because I think technology is going to help us minimize the invasiveness of surgery, of procedures, of a lot of other things as we move forward.

SPEAKER_00 1:25:48

Perfectly stated. What is the best song of all time? Happy great and then are there any books that you're reading right now?

SPEAKER_02 1:26:05

You know, I'm actually reading When God Winks At You. And it's a very it's an old book, but it's a very interesting perspective.

SPEAKER_00 1:26:14

I had not heard of that, so maybe I will have to check that out. Um, Deb Williams, tell us how we can get in touch with you. Tell us how um any of our membership, if they needed some consulting services and maybe some leadership guidance, how they could get in contact with you.

SPEAKER_02 1:26:28

Um, you know, my email is golfemergency at yahoo.com. Certainly touch base with Michelle. She has my phone number, she has all my contact info. So I would encourage anyone, even if you just want to talk and bounce something off of me, please reach out.

SPEAKER_00 1:26:45

Well, we will also yell at Chris Joseon and his crew to make sure that we get some of those links in our uh in the description here so we can make sure that that the folks can get in touch with you if they need to and to reach out. Um, Deb, I can't thank you enough for being here, for being a mentor in terms of things academically, but also just being a fantastic person for helping oodles of people and now helping oodles of doctors in terms of making everybody's life better. So thank you for being here. Thank you for all the things that you've done for the Emerald Coast Medical Association in our community. And thank you to our audience here for helping us make medicine better together.

SPEAKER_02 1:27:24

Absolutely. Thank you for the opportunity.

SPEAKER_00 1:27:27

Thanks, Deb.