Shadow Me Next!
Shadow Me Next! is a podcast where we take you behind the scenes of the medical world. I'm Ashley Love, a Physician Assistant, and I will be sharing my journey in medicine and exploring the lives of various healthcare professionals. Each episode, I'll interview doctors, NPs, PAs, nurses, and allied health workers, uncovering their unique stories, the joys and challenges they face, and what drives them in their careers. Whether you're a pre-med student or simply curious about the healthcare field, we invite you to join us as we take a conversational and personal look into the lives and minds of leaders in Medicine. Access you want, stories you need. You're always invited to Shadow Me Next!
Shadow Me Next!
14 - Advocating for Change in Clinical Settings: Inside Hospital Internal Medicine with Physician Assistant | Natalie Freels, PA-C
Natalie Freels, a trailblazing Physician Assistant, illuminates the pathways of hospital internal medicine with a unique blend of passion and expertise. From her beginnings as an EMT to shaping innovations in healthcare, Natalie captivates with stories of problem-solving and systems-based thinking that are reshaping medical landscapes. We promise you'll gain a deeper appreciation for the transformative potential of clinician-led initiatives as Natalie shares her significant contributions to disaster preparedness and electronic health record optimization.
How do clinicians enact meaningful change in the complex world of medicine? Natalie dives into the heart of this question, shedding light on the crucial need for advocacy, collaboration, and feedback within healthcare settings. By emphasizing the role of diverse perspectives and the integration of simple, effective solutions, she outlines a roadmap for achieving sustainable progress. Moreover, Natalie highlights the importance of understanding the everyday challenges faced by healthcare professionals, advocating for leadership that bridges the gap between administrative decisions and clinical realities.
Ever wondered what a day in the life of a hospital internal medicine PA looks like? Natalie takes us on a journey through her routine, balancing patient care, teaching, and professional development. Her dedication extends beyond the hospital, as she delves into healthcare technology and emergency management, advocating for robust electronic health record resiliency planning. From memorable interview questions to insights on patient-centered care, this episode promises a comprehensive look into the rewarding and multifaceted world of medicine through the eyes of an inspiring healthcare leader.
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Hello and welcome to Shadow Me Next, a podcast where I take you into and behind the scenes of the medical world to provide you with a deeper understanding of the human side of medicine. I'm Ashley, a physician assistant, medical editor, clinical preceptor and the creator of Shadow Me Next. It is my pleasure to introduce you to incredible members of the healthcare field and uncover their unique stories, the joys and challenges they face and what drives them in their careers. It's access you want and stories you need, whether you're a pre-health student or simply curious about the healthcare field. I invite you to join me as we take a conversational and personal look into the lives and minds of leaders in medicine. I don't want you to miss a single one of these conversations, so make sure that you subscribe to this podcast, which will automatically notify you when new episodes are dropped, and follow us on Instagram and Facebook at Shadow Me Next, where we will review highlights from this conversation and where I'll give you sneak previews of our upcoming guests.
Speaker 1:Today, I have the pleasure of introducing Natalie Friels, a distinguished PA in hospital internal medicine at the Mayo Clinic in Florida and a recognized leader in healthcare innovation. Natalie's expertise extends beyond direct patient care. She is deeply involved in research, technology integration and healthcare systems improvement. She plays a pivotal role in optimizing electronic health records, integrating wearable medical technology and enhancing disaster preparedness strategies. In addition to her clinical responsibilities, natalie is a trusted advisor in health tech innovation, helping companies refine their strategies and bridge the gap between clinical practice and transformative healthcare solutions. She is also a subject matter expert for multiple committees at Mayo Clinic, where she works to improve practice efficiency and patient outcomes. In today's conversation, natalie shares how her early experiences as an EMT shaped her passion for problem-solving and systems-based thinking. She discusses her transition from aspiring to work in the ICU to discovering a fulfilling career in hospital internal medicine, where she balances complex patient care with leadership in healthcare innovation. A particularly compelling discussion centers around her work in disaster preparedness, where she has developed resiliency plans for electronic health record downtime, an often overlooked but essential aspect of hospital operations. She also offers valuable insights into how clinicians, regardless of their role, can drive meaningful change in medicine through advocacy, innovation and collaboration. Natalie's perspective is insightful and inspiring, and I am excited to share her expertise with you today.
Speaker 1:Please keep in mind that the content of this podcast is intended for informational and entertainment purposes only and should not be considered as professional medical advice. The views and opinions expressed in this podcast are those of the host and guests and do not necessarily reflect the official policy or position of any other agency, organization, employer or company. This is Shadow Me Next with Natalie Friels. Hey, natalie, thank you so much for joining me on Shadow Me Next. This is going to be such a fun conversation. I can already feel it. I appreciate you taking the time to spend with us today. Thanks, ashley, so happy to be here. So let's start. Natalie, tell us a little bit, generally speaking, about what you do. What is your title and what does that mean?
Speaker 2:Sure, absolutely. So I am a physician assistant working in hospital internal medicine. So I'm a PA, which means I have a master's in physician assistant studies. I got that degree from the awesome University of Florida in Gainesville. Then I went on to work with the Mayo Clinic. I work at our Florida campus and I work in the Division of Hospital Internal Medicine, which is part of our Department of Medicine. So what that means is me and my team.
Speaker 2:I have a fantastic team of almost 80 physicians and almost 30 advanced practice providers, which means nurse practitioners and PAs. We work together, typically in teams of two, and we carry almost one-third of the hospital load at any given time. So we see all kinds of patients. We see new admissions from the ED, we see preoperative and postoperative patients, we see patients who are downgraded from the ICU.
Speaker 2:We cover a wide variety of pathologies and we work really closely with our subspecialty teams neurology, gastroenterology, cardiology, pulmonology basically to manage a very wide variety, wide array of different clinical symptoms and different diseases that would bring someone into the hospital, so we admit. And different diseases that would bring someone into the hospital, so we admit, we transfer, we optimize and then we discharge them. A big part of my job also is making sure that people have set in place the resources, or at least information on resources that will facilitate a safe discharge. So this means good follow-up with their primary care or being seen by a subspecialty team after discharge, making sure we really can use their hospitalization to really impact their health in a positive way.
Speaker 1:That is an absolute amazing amount of work that you do. I can't imagine that many, first of all, working in a team that large 80 physicians and 30 APPs, and then all of the I mean the patients. The numbers game here is just huge. When you were in PA school, did you ever think that you would be a part of a team like this and seeing this many patients in this capacity?
Speaker 2:I know it's really incredible to imagine. No, honestly, when I went to PA school, I really thought that I would find myself, I find my way into the ICU. That was pretty much my plan from day one. I was really interested in an ICU fellowship, and that was my plan. I knew, though, whatever I was going to do, I really wanted to stay more broad, right.
Speaker 2:So the ICU treats a wide variety of different types of things that can make you, you know so critically ill, and I think that just the more I had experience with internal medicine and then intensive care, I think I decided I wanted to do the switch to something a little bit less acute, but still stay really broad.
Speaker 2:That's really what I wanted to do after school was, you know, develop a skill set looking at a wide variety of things, and then it was just kind of easy to make that switch from something a little bit less acute to something a bit more walkie talkie. You know, as we say at the hospital, are they walking, are they talking? And I've enjoyed that for a wide variety of reasons. One is definitely the work life balance. I have two little kids at home, so when I was looking into getting into intensive care. Some aspects of the schedule weren't as appealing and I think the other part is I like to form a bit more of a relationship with people. I hopefully don't only see them once, maybe twice, if they're admitted a few times over the course of the year, but I really like that aspect of being able to coordinate care for them and with them, talk to their primary care, if I'm able to, and then a lot of that you really are able to do as an internist in the hospital.
Speaker 1:That's very cool. I'm glad to hear that the quality of life, even when you are so involved in hospital medicine, that the quality of life is still there, and I'd really love to touch on that in a little bit. But let's go back, natalie, because you know you mentioned that you you've always really been interested in the ICU, in in, obviously, what you're doing right now in hospital internal medicine. It's all very complex, which I think a lot of medicine is complex, but at a certain point there are certain things that have more wheels spinning than others. Right, tell me a little bit about your life, maybe before PA school. Have you always been interested in, you know, problems with this level of complexity? Or is this something that you discovered when you were in in PA school, maybe a little bit beyond?
Speaker 2:Yeah, I you know, asha, I know I knew I wanted to go into medicine, since you know I was. I was really little and I think my high school and college career was really set on finding exactly what that path would be. But I knew I wanted to go into medicine. I knew I liked a little bit of excitement. That's probably why I was more interested in the ICU. So when I was in college I went and I got my certificate to be an EMT and for two years I was with a private EMT company that serviced Fulton excuse me, dekalb County, which is one of the largest counties in Georgia, in the metro area that covers a good part of parts very, very close to the city of Atlanta. So I that was really my first taste for medicine as far as like a professional career was as an EMT and I I love that so much.
Speaker 2:I learned so much from that experience. I think one of the biggest things was I got to see where the patients come from, right. So whether we're in the clinic or in the ED or in the hospital, that's such a sterile environment, right. You know they're coming into our turf, so to speak, and with emergency medicine in the field, you know you're on the patient's turf, you're in their home, you're in their car, you're in their place of work, and I learned so much about patients, about patient care, from that experience, because it's such a raw picture of what it means to be a patient and of that person Like you just get so much information. So you know I, what I loved about emergency medicine in the field also is that all those problems that we talked about you know, all those illnesses that you're managing, even for a short time, you're on your own, you know it's you and your partner, and not only do you really have to know your stuff, but you have to be able to triage, you have to be able to think quick on your feet and make sure that you're delivering, you know, the best patient care, while also keeping yourself, your partner and your patients safe is a huge part of that. So I really learned so much from that experience and I think that level of complex problem solving has always been a real love of mine.
Speaker 2:I'm someone who, when I see a problem or an inefficiency and this is more like taking a step back systems based not so much direct patient care, but when I see an inefficiency or a problem, I really can't look away Like I really really can't, I can't not solve it and that's just something that's always, you know, carried with me in so many aspects of my life. I was just talking about this with somebody, but my very first pitch right, my very first pitch deck. I gave a presentation to my guidance school counselor in elementary school on why we should switch from styrofoam plates to plastic trays. And I did. I did market research. I knew that we had a, I knew that we had a dishwasher, I knew that we actually had already purchased the plastic trays there upstairs in like a storage unit, and and I just saw this problem I was like we're throwing away all these trays and we don't need to. And here's a solution and here is the research on why we should do it differently. And here's the presentation.
Speaker 2:So all that to say is whether it was as an E, through my EMT company, working with FEMA, I responded to several different national disasters, mainly hurricanes, from where we were located. So, being able to work on a large team problem solving things that came up with that you know event to transitioning, you know, out of EMS and into PA school, into hospital, internal medicine, problem solving not only on a daily basis for patients, but also on a systems level. You know, where are the inefficiencies, where are the gaps in care, where can we make this process better? That kind of thinking, that way of thinking has been, you know, so important to me and really has carried me through so many different aspects of my career.
Speaker 1:I'm so glad to hear that, because right now there's this buzz about all of these problems in healthcare right, and I just was speaking to another guest about whether our healthcare system is broken, and I'm sure that there are some people who think it is and then, if they have your mentality, they're looking at this healthcare system just feeling overwhelmed because all they're seeing are so many broken pieces. But, natalie, and we're going to get to this you are so involved in finding these areas that need improvement and improving them, and I think that is such a breath of fresh air in medicine, and not just medicine, but specifically in being a PA fresh air in medicine, and not just medicine, but specifically in being a PA. Have you found that this is something that is largely possible to identify solutions and work with other members of the healthcare field to fix them, or are you really just having to forge your way through to try and make some of these things happen?
Speaker 2:A little bit of both, to be honest. A little bit of both, I think. For the most part, you know, any clinician, any person in healthcare can make a change, and I really do believe that the best innovations come from people who are in the trenches and I know. Later, you know we can talk about my work with some startups, but that's really what I found with startups and with working at my institution, as the best ideas for process change, for systems change, come from the people who have to deal with that problem every day healthcare. To start where you're at, what is the problem that I'm facing today, my patients are facing today, and what is something within my control that I can do to change that? And I totally resonate with what you mentioned.
Speaker 2:A prior guest said. It can definitely feel so overwhelming, and I think if we can focus on the small little spheres of influence that we all have, the small little spheres of influence that we all have and, you know, optimize one or two things, start with that it really starts to be a snowball effect. At the same time, though, you know it has been difficult because there aren't as many non-physician clinicians in these kinds of higher roles dealing with optimization. I'll say non-physician or non-administrative, so someone with maybe a master's in healthcare administration and I wouldn't say that's a barrier, though I really don't believe that. I really don't view it as that. I just view it as a place that we haven't yet made a name for ourselves.
Speaker 2:I think what we're seeing is more nursing staff step into that role as well, and I think that more and more PAs and people of various educational backgrounds will step into roles. Because I think what we've been finding, honestly, is that we are pushing forward with change that's not necessarily clinically informed, right. We're pushing forward for these ideas, for these possible changes, and maybe we're not engaging at the source as much as we should. And that's just my opinion. That's just kind of some of the things I've seen through my work and through working with some companies. Is that really, when we engage clinicians and talk about their pain points, that is when we get the most bang for our buck as far as change and progress.
Speaker 1:I agree a hundred percent and I love what you said about starting where you're at, because that is where you're going to make a difference period, and then it gives you an opportunity to really practice leadership in a place where you're really comfortable, which is perhaps your own clinic or, if you're not in medicine, wherever you're working, wherever you're spending the most time right now.
Speaker 1:Practice your leadership role there, practice your ability to make a change there, see how it feels, see what works and then start to expand that. I love the idea of having more clinically driven people in leadership. Not that we need to flood that area, right. We just need to make sure that there are voices there as well, because we need our administration, we need all the many different voices in medicine, which, of course, on the shadow me next podcast, we're hearing from all of these voices and it is just amazing the, the innate value in each specialty, in each field of medicine, and the different ways everybody thinks. I mean it would be incredible to have all of those voices coming together to address a problem and then, you know, reach a solution that is just really eloquent and really complex but still well thought out, you know. So I think, I think that's incredible, that's great. Thank you for doing that work that you're doing. That's just, it can't be easy.
Speaker 2:No. And I, and I think sometimes, like the, the best solutions are so simple, you know, and it just kind of hits you, hits you hard when you're realizing, oh, you know this problem we've been having, you know it's simple, yet difficult to achieve. And so how do we bridge that gap of a need and a possible solution? And I think also, you know you're going to try a lot of things that don't work, you know, or you're going to try a lot of things and people aren't going to understand the value of what you're trying to get across. And I think, if anyone is interested in systems innovation or process change, you really have to be willing to hear the word no and to know when to push on, so to speak, and when to not take no for an answer and when to say okay. You know what? There's just not a lot of buy-in for this. You really need buy-in from all sides of the equation in order for a change to really take hold. And I think that it's definitely a fine line of knowing when to push on and when to say you know what? I don't have buy-in, and so this really isn't going to work right now. This is the season for this change, and that's hard. As an innovator, that's really hard to hear. You really want everyone to see the problem the way you see it, and I think that there's a lot of humility in that too, feeling able to say you know, I may not have the right answer today, and I actually probably won't have the right answer today, and that's okay, that's fine, we're going to keep trying and keep trying things that work.
Speaker 2:I think the place that clinics and companies really get into a pickle is when they don't want to hear from the doctor in the clinic or the nurse doing lab draws. They don't want to hear about the day-to-day issues, and I think that you know any and all administrators should really be in the trenches, at least in some respect, with their staff to hear what the pain points are. And that's really something that I've been happy to do, and I think that that's one of the things that really informs. You know, both my clinical work and my additional, more administrative work is that I feel those pain points every day and I love talking about it with people. I love stopping people in the hallway and saying like, let me pick your brain about this or tell me about how this is going or what do you think about this?
Speaker 2:And a lot of my ideas don't go anywhere, but they're ideas and maybe they'll go somewhere later. But I think it's really also just about having that mind of progress. How can we make this better for everybody? Not only how can I make this better for the doctor, not only how can I make this better for patients, not only how can I make this better for revenue. It has to be all of it. It really does have to be all of it to be something that's truly impactful and sustainable for sure.
Speaker 1:Natalie, you mentioned your focus on whole person care and you're really taking that concept that should just apply to medicine and you're expanding it to the actual capital M medicine, right? It's not just like you said. It's not actual capital M medicine, right? It's not just like you said. It's not just the physician, it's not just the people in leadership, but we need to be communicating and taking care of and listening to everybody in medicine. That is the teamwork model. I think that is so great and I just applaud you so much because I think that that takes a level of humility to approach somebody and ask that question how are you doing? What are your pain points? What are you really enjoying right now?
Speaker 1:Because so many times, I'm sure you're going to get some feedback. That is not ideal, right, and people are gonna open up to you about their issues and their concerns and their problems and as clinicians, we're used to dealing with that. But we're used to dealing with that when we can say oh, I think I know your diagnosis, let me go ahead and give you this treatment, right. But when people are presenting these complex issues that are related to their place of work, it takes a person with a lot of humility, to stand there, listen and say you know what, I hear you. We can work through this together. Let's find a solution. So thank you for doing that. I think that's probably it's a lot more complicated than people realize. It's not just giving people ear time.
Speaker 2:No, exactly, and I think it absolutely is, and I all I can say is I wish I had more time for that, because that really is fulfilling, like deeply, deeply fulfilling for me, both inside my institution and outside. Hearing what are those pain points and how can we troubleshoot together is something that I really, really feel energized by, and I think that, even taking it a step further, what I love about it is that it is completely a highway for relationship, right? I can't tell you how many people I've really come to know well at my hospital just because we stopped in the hallway and started chatting about something you know. I really do believe in the power of relationship and the power of connection, oftentimes over you know, shared issues or shared problems, and to be able to say you know, what is it that you're dealing with here, how can we optimize it, how can I help? And I'll be completely honest, you know, a lot of times I can't, a lot of times there's really nothing I can do. It's way outside of my very small sphere or my very small scope, but I think three things. Number one you sat and listened to that person's like validated, heard, right, it probably was an exercise and thought for them to even brainstorm some things that they that could be different, right. Number two you're forming relationship, which is arguably the most important. And then number three, like if there's any connection or handing off to different teams that I can do. I absolutely facilitate that and I that's really what I'd like to see more of before being honest is is you know more people talking about the things in healthcare that are going well, the things that aren't going well, and you know how do we work together, how do we hand off to somebody who can maybe help us solve a problem? I love seeing the new things that are coming out, new systems change that are coming out and excited for really a return back to the basics. I am excited about the next in tech return back to the basics. I am excited about the next in tech, right, of course, but I'm also just excited to see us as a medicine, like you said, capital M really return to really what the basics of patient care should be and really is.
Speaker 2:I think a lot of that is, like you said, whole person care. What does that mean? We're taking care of the whole person and all the aspects that. That includes stress management, sleep, adequate nutrition, a social connection, you know, staying away from harmful substances, those are, you know, that really is the basis of health.
Speaker 2:And so getting back to this whole person version of health, and I think a lot of people say, oh, you know well, you're just in hospital medicine or hospital medicine is just for dealing with that pneumonia or that urosepsis or that ICU downgrade, and it's not. You know, that's a really poignant time in a person's life. They hopefully may only be hospitalized once or twice or a handful of times. And if I can say something to that person that helps them take care of the whole self or sets them up in a way that they can get better whole person care, then you know that's a success, that's a huge success. And I think that's really been edifying for me, especially with how difficult the landscape of healthcare has been in the last few years. Being able to really go back to basics with patients and have the time to be able to do that, that's been really incredible those hospital stays.
Speaker 1:A lot of times, for a lot of people they're springboards to a whole new outlook on life and a whole new outlook on their own health, right. So the more people that we have, the more clinicians that we have pouring into this whole person idea of medicine, the better off this patient is going to be. I think about you know, in dermatology, which is where I'm currently working, I love that. I have the time to celebrate big health wins with patients, right, and a lot of times mourn major health losses with them too.
Speaker 1:I was just today. I had a patient tell me that they just hit losing 100 pounds with diet and exercise and they were they were so proud of themselves and we got to celebrate that and they were able to tell me these things because they knew I've asked about them in the past. We've talked about exercise, we've talked about diet, we've talked about how hard it is to make healthy eating choices sometimes and all of the burdens that go into that, and arguably that doesn't have a direct relation to dermatology, right, we're talking about these things while I'm performing a skin exam, but it's really more. It's just talking to the person about their health you know, and making time for that is is so important.
Speaker 1:Natalie, I've been so excited to talk to you because, as a PA, you have stepped into so many of these really neat roles, roles that are right now, as you mentioned, a little unique. So let's talk a little bit about a day in your life as a hospital internal medicine PA and then let's talk about how that kind of bridges over to this healthcare innovation and systems work that you are also doing.
Speaker 2:So the day in the life of a hospital medicine PA is very really can go either way. Actually, you would never know what you're going to get, but this is typically how it goes for me. So typically I get up anywhere between five and 6 AM, depending, completely honest, on how the night before went with my small children if we were up a lot or not. But I definitely like to start my morning with exercise and with some reflection time. I have my breakfast and drink my coffee here at my house and then I head into work. So by seven o'clock I am at my desk. We have a really wonderful shared workspace with all of our clinicians who are on service for that period of time and, like I said, if I'm on a service which means a list of patients that I'm taking care of with a physician usually we sit down, we talk the list over and we divvy up patients. I will take anywhere between five to eight patients in a day. Usually our lists are anywhere between 10 to 18. So it really just depends on how full the hospital is anywhere between 10 to 18. So it really just depends on how full the hospital is. So after you know, we chat for a few minutes about who's going to be. We call primary contact for each of the patients. Then we go on our computers and we do what we call chart review. I have a whole system. It's one of my absolute favorite things to teach when I have students come to precept. I have a whole way of doing it and, and what's really less important about how you do it and more important, that you do it the same or very similarly every time that you have a method where you're not going to miss. You're not going to miss things. So I love teaching that when students come to visit. It's really, it's really a lot of fun for me. So I try to give myself an hour, maybe a little bit more, to look over the patients. What happened the night before? What has my night team, you know, signed out to me either in person or via the health record? I look at labs for the morning and kind of in my mind, formulate a plan how close are we to discharge? Do I need to call any additional teams today? What other optimization from maybe a case management perspective, do we need? Is this person discharging home? Are they going to a facility after? So I kind of write myself a little to-do list. As I click through the chart, like I said, I have my whole method. Then typically I meet back up with the physician I'm working with and maybe give kind of broad brushstrokes of what were the updates of the night, anything exciting, and what's the plan for today. And then we do.
Speaker 2:My favorite part is we go rounding. Whether or not we round as a team we call it dyad rounding or co-rounding or round individually really is a combination of things Complexity of the patient has that patient been seen by that physician before and what is the overall load of the patient? Has that patient been seen by that physician before and what is the overall load of the patients right? So if we have a lower number of total patients, I am the biggest fan of co-rounding. I work with some of the smartest people I've ever met in my life, so any opportunity I get to be able to co-round with them, think things through clinically with them, hear about their patients, I jump at that opportunity and I just like hanging out with them. You know, if it's a little bit of a heavier day or if it's a patient they've already seen, you know a lot of times we will run independently so they'll see their set of patients. I'll see my set of patients. I hope to be done by rounding, usually by 1030.
Speaker 2:I'm a bit of a slower rounder. I really do like to sit and talk with people it's the best part of my job and I also like to touch base with all of my nursing staff in person and kind of give them my plan for today. In between patients I will put in orders and make notes, either on a little checklist that I bring around or log into the computer. So the morning is spent with looking everything over in the chart, forming a plan for the day, talking to patients, checking in with them, adjusting orders as needed, and then typically by 10, 30 or 11, I'm back at my desk. If there's been any big change in the plan, any big change in presentation, you know I'll call my colleague up that I'm working with to update them. But if not, then I just get started on notes and orders for the day.
Speaker 2:I like to have everything done before 1pm is my goal always. If I can get it done easier earlier then that's even better. After that, really, it is tying up loose ends and afternoon rounding. So especially patients that are sicker, I'll see them multiple times over the day calling specialty teams getting their opinion on the case, calling family members working with case management to make sure we have a safe discharge, working on documentation, like I said, and then seeing new admissions and new transfer patients as they come in the afternoon. So that pretty much brings us to about five o'clock and if I have a clock I'm off service, I get in my car, I head home for a lovely night with my family, but that's that's the day in the life.
Speaker 2:In the afternoon we also have educational opportunities. We, about twice a month, are able to have a case review where we review different cases and talk about, you know, best practice updates. We have journal club where we, one of our clinicians will present on a recent, a recent writing or recent change in practice. And we have a really fantastic educational departments within my division that's run by a physician and a nurse practitioner and they actually get in specialty teams from around the hospital to come and talk with all of us about what they do and about how we can better work together. So I really look forward to those meetings. You know, palliative care, neurology, pulmonology we'll have different nursing staff come in as well, so I love that aspect and those things typically do happen in the afternoon.
Speaker 1:And then any additional meetings for committees I'm on, those are all typically afternoon based and I think one thing that hospital medicine does so well that clinic medicine really just we just don't do it as well is the continued education and everybody who works in a hospital. I get to hear about the journal clubs that they're members of and these meetings that they get to sit in and these lectures that they get to attend and that must be really refreshing to you just to be able to use your brain so much for what you know and then to also allow somebody else to kind of pour into you and you get to assume that student role again and really just learn. That's got to feel. It's just got to feel good.
Speaker 2:One of the things that really drew me to the institution I'm at right now is I wanted that opportunity. I wanted to be at a place that really valued continued learning and that was, you know, not necessarily built in the day to day, because there are absolutely days where there's just no time for that. You know, when you're taking care of 18 patients and 10 of them are really really sick, there may be no time for those additional opportunities. But I wanted to be at a place where that cadence was valued and, I think, even more so. I wanted to be at a place where that cadence was valued for people of all education backgrounds, right? So, from you know, the top and most experienced physician in my practice and the newest AVP, new grad, who's just joined, we're all in that meeting together. Right, we're all learning something new from that subspecialist who's there to educate us and, you know, even taking that a step further, we're teaching each other, right so?
Speaker 2:Journal club, or talking about something that we're really passionate about, or we've gone out and gotten more education on. You know, I know, for me, I'm pursuing a board certification in lifestyle medicine. I have some talks coming up on that with my department and that's not only been well received, but people are excited to learn from others, and I think you know, creating that culture is not easy, but it's something that we can do in any discipline, though it may be more difficult in the clinic just because of the cadence. I think it's something that you can build into the day, you build into the schedule. For us, it becomes part of our calendar, like I said, the caveat being there are always days where patient care always comes first, and so there will be days that that's just not available. But I do think it's definitely a culture switch.
Speaker 1:I love that and thank you for the hopeful, the hopeful thought to there. I do think it can be built in. It's just intention, right? It's a matter of of taking that intention and starting really putting it to work. Natalie, let's talk about the fantastic things that you have been able to do outside of hospital medicine because you are a PA. So this is the cool stuff. This is the stuff to me that is just mind blowing, because I love what you do working with your patients in the hospital, but this is some of like next level stuff that you are getting after. So tell us a little bit about some of these things that you do and just open my eyes to this, because this is so neat, yeah absolutely Also I'll start with within my institution.
Speaker 2:So, like I said earlier, I got my first taste for FEMA. So FEMA being the, you know, federal organization that addresses emergency, emergency situations like on a grander scale, so like the fires that are going on right now and, of course, hurricanes, there's a whole, you know, group of people who respond to these events. So that was really my first exposure to this kind of stuff and that really got me interested. It's not as bad as like doomsday prepper, but I cut my friends at work kind of call me, like, refer to me as this electronic health record doomsday prepper. That's kind of this role that I've started to fill and I actually love it. You know, some people I think it's very boring, or they think you know, you know, or they hate their, their, their charting system. I think it's a necessary evil and I think that you know we need to master it, be masters of it. So I kind of stepped into two roles in that within my department. One has been our electronic health record super user. So I've gone and been able to get special training to be able to learn a bit more about the record itself, about how to be able to optimize it and take those skills and put them at use in my department itself. Those skills and put them at use in my department itself. Any kind of questions or issues updates. I keep my team, you know, up to date on those things that are coming down the pipeline and if anyone has interests or ideas, then I can, kind of the opposite way, bring those forward to the team to see if we can optimize or do some of those additions.
Speaker 2:I think a big thing that I found about the EHR is this kind of like personalization is really big people want to personalize. Something that I found is is sometimes that personalization is not as helpful as we think. Like I think there is there is an art of having to be simple too. So really working with my team to say, okay, you know, what is it that we need to be documenting, how can we document it the most effectively, the most correct, right, and how can I set everyone up for success? So that's been fun and I I'm looking forward to more opportunities to be able to do that from a charting perspective Again, some people think it's you know's horrible, the bane of their existence.
Speaker 2:It's just a necessary evil, that's just the world that we live in. So let's just make it as good as we can, both to protect patients, to legally protect ourselves as well. So, with the downtime, that's been really fun. So for anyone who doesn't know, downtime sometimes it's called business continuity basically means what is your plan if any of your electronic system that you use for patient care were to be inaccessible? So the electronic health record, how you check patients in and out, how you take their vitals, how you look at their imaging, how you communicate with patients if you're on your front desk staff, how do you schedule? So all of that kind of goes into this big umbrella of under disaster preparedness. That means downtime. So that has been really interesting for me to get involved in.
Speaker 2:Where I have found myself is I was handed this role I like to say voluntold but basically this idea of, like you know, hey, we need to be, we need to, we need to work through some issues that we've had with this, and what I did was, you know, instead of just okay, you know, I'm going to go to the meetings, I'm going to say that we did the education. Nope, we're going to take it a step further. We're going to develop a whole plan based on clear methodology of step-by-step, what we would do if there were to be a downtime event that would affect our department, and so I built an entire plan based on my organization's larger plan, but one that was specifically tailored to our department and that has been a year and a half in the making, and every time there's an event we go back, we look at it, I interview people who were on service that day, kind of get their feedback when are the gaps? How do we? How do we get better? Because you know, healthcare, health systems, are at a huge disadvantage and it's a it's a huge liability. We are more sought after, actually in number of attacks than banks. We have a more expensive and a longer recovery time than any other sector, including banking, financial, anything like that, social media, of course. So health systems and providers, clinic offices, really are a large target. So being able to be working on a system like that has been super fulfilling, because I'm able to work with my team and really say, okay, if there was an event, how do we respond, how do we bounce back? So I love this idea of continuing to build cyber resiliency.
Speaker 2:I have a paper that just was submitted really, man, maybe two weeks ago to the society of hospital medicine about how other hospital services can build their own resiliency plan. So I am really excited. I'm not, I'm. I hope that more comes from that and that I can teach other people yeah, how they can build their own plan out.
Speaker 2:And I have a talk coming up at my own hospital to speak about to other PAs and nurse practitioners on how they can do the same with their own department inpatient and outpatient. So how does the outpatient clinic respond to this? You know, how are they able to continue to deliver high quality patient care when we don't have access to what we usually have access to? And I think it's a huge, a huge place where other PAs and nurse practitioners can step into a bit more of an administrative role. Right, and I think one of the reasons is because it's not sexy, it's not exciting, but this is the truth, ashley, it's not a matter of if this will happen to my clinic or hospital, it's a matter of when, and I don't mean to be negative, but that's just the reality of it.
Speaker 1:I love that you're getting a peek into kind of the backend of those things and and all of the work really that goes into maintaining these and make sure, making sure that they're healthy, and part of making sure that that our systems are healthy is planning for what happens when they become unhealthy. Natalie, this is a segment on our show called quality questions, and it's basically where we discuss questions that have just as medical clinicians that have really stood out in our past whether it was interviewing for school or maybe interviewing for a job, or maybe when we were interviewing somebody else for a job Do you have one of these quality questions that's just extremely memorable. Before we hear what Natalie's quality question is, keep in mind that there's more interview prep, such as mock interviews and personal statement review over on shadowmenextcom. There you'll find amazing resources to help you as you prepare to answer your own quality questions.
Speaker 2:I do, yeah, I. One of the questions that I was asked in one of my interviews that stood out the most was they asked me for a time in my specifically in my health career where I saw or heard about a mistake being made and how I responded to that, and I think that that was really impactful for a few reasons. Number one I think in healthcare we are really hesitant to ever admit that something went wrong. Right, and I think, possibly in an attempt to, you know, not startle someone, not scare someone we don't want people to lose faith.
Speaker 2:But the fact of the matter is like to err is human right. The mistakes happen, errors are made and the worst thing we can do is not be upfront about it and not, you know, fix it in a way that brings it to the light and shares the information. So that was a really kind of out of left field question, at least, one that I was not expecting, and I was able to draw on my time as a student, something that I experienced as a student actually to be able to answer it. But I was not expecting and I was able to draw on my time as a student something that I experienced as a student actually to be able to answer it, but I was not prepared for that one. So I think that's a really good one for people to be thinking about and really even like for those of us that aren't interviewing, that just take care of patients every day, it's an interesting thought, right.
Speaker 2:What would I do? What should I do when mistakes are made from any degree? Right, they don't have to be catastrophic, they can be small things, but how do we address them, how do we restore patient trust and how do we move forward? So I think that was a question that really stood out to me.
Speaker 1:Natalie, I'm just, I'm so grateful for the time that you spent with us and there's just, there's so much more here. I mean, you just have such a depth to you and your career and what you have already accomplished in the years since you graduated from PA school. So thank you for sharing a taste of this with us before we go. What is something that you wish to tell to the person who might be considering a career in medicine and is just looking at all this going? You know, do I belong here? Is this, is this for me? What would you tell them?
Speaker 2:I would tell that person. You know, if you're really considering a career in medicine, never stop asking questions. Right, Get it from straight from the source. Talk to people who are actively doing the job. You're interested in the good, the bad, the ugly actively doing the job. You're interested in the good, the bad, the ugly. You want to hear it all.
Speaker 2:I think that if I could give any advice, it would be not to go into medicine with rosy colored glasses.
Speaker 2:Right, Really understand the business and the industry as a whole as much as you really can, and I think you can only do that by asking a lot of people what they think, and not only people who are just started out, but people who have been in the business for a long time, people of all different degree, backgrounds in various sectors, Because I think, at the end of the day, you know we all get into this because we want to make a difference, and the truth of the matter is, is that that actually looks different for every person, and there's nothing wrong with that.
Speaker 2:You know. That's actually the beautiful part about medicine is that it can be so versatile and the skills that you use and that you learn and you use to take care of patients can be used outside of direct patient care too, and that's wonderful too. We need people in every discipline, every level to be able to drive progress and drive change that truly is patient-centered and values-based. I think that there's a lot of emphasis on value-based care. Well, I push back on that and I say that care should be values-based. Are we giving care based on what the patient themselves value?
Speaker 1:I think that's great and your skills are needed what makes you unique and your experiences. That is needed in medicine. Natalie, thank you so much. I so appreciate your time and all of the insight you've provided and the amazing, amazing stories. I feel so motivated about medicine and the direction that it's going thanks to you and thanks to your role in leadership, so I appreciate it.
Speaker 2:Thank you so much, Ashley. I really appreciate you having me today.
Speaker 1:Thank you so very much for listening to this episode of shadow me next. If you liked this episode or if you think it could be useful for a friend, please subscribe and invite them to join us next Monday, as always. If you have any questions, let me know on Facebook or Instagram Access. You want stories you need? You're always invited to shadow me next.
