Dirty White Coat
Mel Herbert, MD, and the creators of EM:RAP, UCMAX, CorePendium, and the collaborators on "The Pitt" and many of the most influential medical education series present a new free podcast: “Dirty White Coat.” Join us twice a month as we dive into all things medicine—from AI to venture capital, long COVID to ketamine, RFK Jr. to Ozempic, and so much more. Created by doctors for clinicians of all levels and anyone interested in medicine, this show delivers expert insights, engaging discussions, and the humor we all desperately need more of!
Dirty White Coat
Healthcare's Frontline Heroes Need Help Too
This is a reproduction of the Caring Greatly Podcast. The 100th episode and the interviewer Liz Boehm.
Dr. Mel Herbert, emergency physician, educator and medical consultant for the hit TV drama "The Pit," shares how the show portrays the realities of emergency medicine and healthcare's biggest challenges. The conversation reveals how healthcare professionals are pushing for system-wide change, especially in addressing clinician mental health needs.
• Emergency departments serve as society's 24/7 safety net but are facing unprecedented staffing and capacity challenges
• Wait times at prestigious hospitals now routinely reach 12-24 hours due to system-wide issues and patient boarding
• "The Pit" accurately portrays healthcare challenges including workplace violence, administrative pressures, and resource constraints
• Clinicians carry an "emotional backpack" of trauma from witnessing death and suffering without adequate mental health support
• Dr. Herbert advocates for mandatory mental health support for all healthcare workers to eliminate stigma
• Emergency medicine consistently ranks highest in burnout and suicide rates among medical specialties
• The profit-driven healthcare system contributes to systemic problems that harm both patients and providers
• The show helps patients and families understand what really happens in emergency departments
• Media portrayal of healthcare challenges can drive public understanding and potentially influence policy change
Watch "The Pit" to support continued storytelling about healthcare's frontline workers and the challenges they face.
Hey party people. I'm not getting these out as often as I'd like because things are really busy at the MRAP universe and at the PIT universe, but I was very fortunate to be interviewed by Liz Baum, who is part of the Karen Greatly podcast. It was their 100th episode. They really focus on healthcare, health, and they really wanted to get Joe Sax and I to talk about the PIT, but unfortunately Joe is so busy at this time of year just so incredibly busy he couldn't do it. So I took the reins on this one and I hope you enjoy it. I think it's a really important message and I really really thank them for having me come on the show. This is what I would call a mildly edited version of that show and there are links to it in the show notes.
Speaker 2:Welcome to the Caring Greatly podcast. Welcome to the Caring Greatly podcast podcast for leaders who seek to transform healthcare with humanity. Welcome to a very special milestone for the Caring Greatly podcast it's our 100th episode. We started Caring Greatly in 2019, before everything we knew in healthcare and beyond was turned upside down. Our mission, then and now, is to be a destination where healthcare leaders, advocates and other listeners can be inspired to innovate and drive industry transformation. The Caring Greatly podcast is a safe space for people to share their perspectives about healthcare and connect to human-centered stories that spark big ideas, reveal potential solutions and provide hope for a safer and brighter future of caring. Our North Star and the foundational belief for the podcast is that all care team members deserve to feel safe and be safe at work. Healthcare worker safety must be a top priority. The resilience of our healthcare system depends on it. Patients and their loved ones depend on it and, most of all, the people who dedicate their lives to healing others deserve nothing less. All 100 episodes of the Caring Greatly podcast are carefully created to bring more visibility to the importance of care team safety and well-being At the Heart of Safety Coalition. Our research shows that care team safety rests on three pillars psychological and emotional safety, dignity and inclusion, and physical safety. The three pillars of care team safety are essential to advancing better healing and working environments in healthcare. So for our special 100th episode of Caring Greatly, we invited Dr Mel Herbert, an emergency physician, educator and medical consultant and writer for the hit TV drama the Pit. Why? Because the Pit's human-centered stories and heart-hitting visuals are shining the spotlight on the hard truths and the very real challenges that care team members face hour by hour, whether that's resource constraints, moral dilemmas, unimaginable losses or workplace violence, and it showcases the incredible humanity they bring to each other and to their patients. It also shows the weight of the responsibilities care team members carry and the toll it takes on them psychologically, emotionally and physically. Dr Mel Herbert is an internationally recognized entrepreneurial pioneer, philanthropist, speaker and an award-winning educator in emergency medicine. Australia-born and trained in the United States and Australia, mel founded MRAP Emergency Medicine Reviews and Perspectives, providing quality and engaging educational content for emergency care providers for the past more than 20 years. Mel's initiatives are founded on beliefs that emergency care and emergency medicine education should be accessible to all. This paved the way for the establishment of his nonprofit initiative called MRAPGO, which helps bring emergency medical education to underserved communities around the globe. He currently resides in Santa Barbara and is a professor of emergency medicine at the UCLA School of Medicine. Dr Mel Herbert is a leader who cares greatly, and all of those things.
Speaker 2:You've had a storied career, but today we're going to focus in on the show the Pit, which depicts a single shift in a fictional Pittsburgh emergency department, with each episode of the show representing an hour in the ED. Now the story is told largely through the perspective of the show's physicians, who span levels of training and experience from med student to senior attending. It's just an incredible cast and while there's plenty of medical action, there's also a strong focus on what the clinicians experience as they go about their work. Now you're a consultant and writer for the show. As I understand it, you're now in the writing room for season two. What's it like to work on a project that is centering the very real challenges faced by healthcare professionals, and particularly ED professionals?
Speaker 1:It's an honor it's at this part of my career to be able to do this work with the impact that it has is really stunning. I never would have thought that I could be doing this and I have to shout out to Joe Sachs, who is the lead medical writer. He was on EIA. He was my attending back in the day at UCLA 30 plus years ago and he brought me onto the show as a consultant last year where we were just sort of run by cases and talk about stuff. And then this year he said like can you help me come into the writer's room? But this show has been so impactful. You know it became Max's number one show. It's one of the most popular shows throughout the world.
Speaker 1:It's got rave reviews both from the medical community and the lay community and we've had so many docs and nurses and people who work in healthcare saying I feel seen.
Speaker 1:For the first time I can sit with my husband and say this is what I do on shift and this is real, and they're having conversations about that and kids are talking to their moms and dads and like I had no idea what you did at work and that's why it's so impactful, that's why it's so important to me. It's not just the docs and nurses, but it's the family members and it's also just sort of people in general understanding what goes on in an emergency department and why you might have to be delayed because there's a lot of stuff going on back there and hopefully it will raise people's awareness about workplace violence. And you can't do that to these docs and nurses. They're on the edge and they're the safety net. So all of these stories coming together and talking about all these things, it's just. It's so important and I'm just so proud to be part of it out in the trauma wing of the ED.
Speaker 2:It's just incredible, but you're mentioning this importance of clinicians being seen and importance of lay people understanding. What does that bring? What is it you're hoping will come from that understanding?
Speaker 1:I hope that people first of all will come to understand that the Immunization Department really is the last line of defense against accidents and injuries and illness and it's there 24-7, 365. And I think we take it for granted that if I get sick, if my kid gets sick or if I get hit by a car, that there'll be somebody there to look after me. That is absolutely not true in most of the world that there'll be somebody there to look after me. That is absolutely not true in most of the world. In most of the world you're on your own. You're hoping for a stranger to pick you up and throw you in the back of a car if they have one and to be dropped off at a hospital where there may or may not be emergency medicine probably not emergency medicine and we in the West just take it so for granted that this safety net will always be there. But it might not always be there.
Speaker 1:It really is under stress for a lot of financial reasons, for a lot of psych reasons, because we had about 20% of the nurses leave the profession during COVID or after COVID. That's put huge stresses on the hospitals. The wait times are enormous. We have to find solutions to this because the emergency departments, while they're still there, many of them have become so dysfunctional that people have to wait for 12, 14, 24 hours. When I was training at UCI as a resident, if we had a patient wait for an hour or two, that was a big deal at some of these big centers.
Speaker 1:12 to 24 hours is routine at the most prestigious hospital Not the county hospitals, but the most prestigious hospitals because all of the patients are waiting downstairs and there's simply nowhere to put them. And you see some of that in the pit. You see these overcrowded waiting rooms and you see that people are getting agitated, which I understand. But if people can understand, the system is broken, not the docs, the nurses. They're not back there. You know smoking cigarettes and pounding beers. They're going as fast as they can.
Speaker 2:Yeah, as fast as they can.
Speaker 2:And one of the things that struck me is I suppose I should potentially give a spoiler alert here and this is a season one spoiler alert for those who are listening you know there is a moment where the charge nurse, dana who's just incredible and managing, you know it makes it.
Speaker 2:The show makes it clear that her ability to manage what is otherwise chaotic in the ED is just is extraordinary.
Speaker 2:She does take a moment to step outside and have a cigarette and gets attacked in that moment in an example of workplace violence which is just horrific. And the agitated patient who has been waiting a long time with a what appears we don't know fully what his condition is, but it appears to be not life threateningreatening he seems to be angry that she's pausing to take a break, a momentary break, to just not be right in that chaotic moment and finds that unacceptable, which one of the things I love on the show is it does allow. Even as the actors are working through scenarios in which the level of intensity is huge, they also have very human moments, and the idea that a patient would be angry that a nurse in a 12-hour shift takes a momentary break, I think is appalling and I really appreciate the show's portrayal of the human side of these characters and I really appreciate the show's portrayal of the human side of these characters yeah, that idea that these are superheroes.
Speaker 1:But they are not superhuman. They are human. They need to take breaks. Imagine if you're flying in a 747 across the Atlantic and the captain is really tired because she's been doing this shift for 12 hours, but there's still another four hours to go. There's a reason why in professions like that, it's like there's mandatory breaks. No, you go away now. You have a break. You have the co-pilot takeover because the stakes are so high. You can't be so tired that you'll make a mistake.
Speaker 1:We don't have that in emergency medicine and yet it's even more stressful. It's a constant flow of stress and tasks switching. And look at this EKG, look at this x-ray, look at this new patient over here. We've got a trauma coming. It's really a huge cognitive burden and we need to have these docs and nurses have a safe place and time to go and take a break or you'll make mistakes. Because this is this huge cognitive burden and it should be sort of a mandatory part of emergency medicine. But that means that you need to have people who are able to cover and right now we just don't have enough people. There's not enough nurses, there's not enough docs, there's not enough support, so it's really quite a dangerous thing, but certainly people need to understand. If you see a doctor or nurse in the parking lot taking a break, leave them alone. They need a moment. You have no idea what just went on inside.
Speaker 2:Yes, yes and and yeah, and that idea that you alluded to earlier that the anger that they're experiencing or frustration with the wait times, while understandable given the circumstances, is misdirected when it's directed at the clinicians, right. I think the show also does a nice job with the chief medical officer coming down with her administrative priorities, which are also in many ways understandable, and I know a lot of leaders in healthcare systems who are trying to do amazing things with a lot of compassion. But there can be a disconnect, place right either to treatment and out, or treatment or stabilization and up into the system are staying there for days and days and that adds to the burden. And that's part of where that shortage you talked about really plays in and plays out more strongly in the ED than perhaps in other areas in and plays out more strongly in the ED than perhaps in other areas.
Speaker 1:Yeah, it becomes the dumping ground for a system that's broken. So the ERs are always asked to just deal with it. So we've got 60 patients that have beds upstairs. You just look after them downstairs. In most hospitals, in most states, there's nursing ratios. You can't have 12 patients when you're on the med-surg floor as a nurse, but you can in the emergency department. So the default is just leave them in the emergency department where they're already overwhelmed, where they've got new patients coming, and that is not good care. That is actually terrible care.
Speaker 1:And I should say something about Gloria, who is the medical administrator in the show. I know lots of medical administrators and everybody's trying to help. Everybody's trying to do their part. People always ask what's one of the most unrealistic things about the show. I'm like. Well, one of my top three unrealistic things is that the medical administrators very rarely come down. Only the cream of the crop come down. Only those that are very confident come to the emergency department and see what's going on. I wish administrators would come down more often and see what's going on, like she does in the show. I wish the people that ran the healthcare systems would come and volunteer and hang out for a few days.
Speaker 1:In other industries the C-suite are made to go and work the front desk, I think it's Enterprise Rent-A-Car is one of those where the C-suite is like you need to come and see what it looks like interfacing with the public, listen to their complaints so that when you go back to your ivory tower you'll have some actual experience. I'd like to see more of that. I'd like to see people in power, and again, not just the hospital administrators, but the people that are buying hospital systems and trying to flip them for profit. It's like come down and see what that looks like, see what that really means. I do not believe that healthcare should be a for-profit industry.
Speaker 1:I'm a bit of a socialist who grew up in Australia in a nationalised healthcare system. I just think that there are some things that should not be for profit. That profit should be put back into the system so that we can give better care. But that's going to be a hard thing to convince people of until they go down and they see what it looks like. What does it look like when you have an understaffed, overwhelmed system? And that's what the show is allowing us to show the general public. This is what it looks like, and it could get worse if we don't fix it.
Speaker 2:And it could get worse if we don't fix it. Yeah, I want to pull up a little bit, because one of the reasons I was so struck by the show is that at the Heart of Safety Coalition, we look exclusively at care team member safety and we think of it as being comprised of three pillars psychological and emotional safety. You've already talked about cognitive load, dignity and inclusion, which is about, you know, just treatment and fairness. Physical safety, which includesle with workplace violence. We see substance use disorder, we see bullying, under-resourcing, that administrative pressure you talked about from Gloria, and we also see the very real impact on healthcare team members of social issues, including the fentanyl crisis, social determinants of health, gun violence, situations where family members' choices don't align with evidence-based practice, and those ones are particularly painful, that moral injury potential, and it's a lot. So you are an emergency medicine physician. How well is this representing what it feels like to be a healthcare professional right now?
Speaker 1:So I'm going to hand it to Joe again, the lead medical writer. There's actually, I think, seven ER docs on the show now, but Joe is the lead writer and he has worked in emergency departments, trauma centers in LA for over 35 years and he brought all of that knowledge and that experience to the show. And then we talk a lot about it and I talk to our subscribers across the country about the stresses that they're having and everybody's feeling the same thing, all of the things that you just outlined. Everybody is feeling to a greater or lesser degree. Some it's overwhelming, some to a little lesser degree, but those stresses they're all there the workplace violence, the moral injury, the just sort of feeling completely overwhelmed and the amount of psychological damage and substance abuse.
Speaker 1:And unfortunately, every time there's a study of who is the most burnt out in the house of medicine and all of medicine is under stress. But every single time there's a study, emergency medicine is on top and if we look at self-injury, emergency physicians die by their own hand at astounding rates compared to the rest of the population. So I think the show just does a good job of showing like this is real, this isn't made up for Hollywood. This is a Hollywood representation of what's actually happening in the real world, to real people.
Speaker 2:And I know the show focuses on the ED and you are an ED physician, and I presume many of the consulting if not all of the consulting physicians are ED focused. I'm curious if you have a perspective, though, about the degree to which these are universal challenges for healthcare professionals.
Speaker 1:Yeah, I talked to a lot of docs in a lot of different fields and it is not unique to emergency medicine. It is throughout the house of medicine. A lot of the pressures financial time, moral injury occur through all the specialties. And one of the things that is stunning and when you look at those studies that look at burnout is that every single profession in medicine has some degree of burnout. Emergency medicine might be number one, but even people like family medicine, where you think like that should be a much less stressful job, no, they're suffering.
Speaker 1:And I talked to my family practice doc, left medicine and started a totally different type of medicine because she's like I spend half of my time, at least half of my time fighting with insurance companies to just go and give my patients care and after 15 years I can't take it anymore. So this is throughout the House of Medicine. We have a broken system. We have a system that is broken on so many levels, but a big part of it is that we don't understand that this should be a right and we should be taking the profit motive out of medicine.
Speaker 2:I think it starts there. Let's dig into that right, because I want to talk about a slightly different right. I know recently on your podcast Dirty White Coat, you had Dr Stephanie Simmons, the Chief Medical Officer of the Dr Lorna Breen Heroes Foundation, and that is a group that is focused on and making just incredible strides in trying to remove the cultural and systemic barriers to access to mental health care for clinicians. Not with the idea that we don't need to fix these structural things that you're talking about. We absolutely do, and both in the meantime and even in a more functional system, there's a challenge with clinicians getting the help that they need, and we see Dr Rabi have, during a just horrific experience on the show, have a mental breakdown, which is completely understandable, and then you see him distressed, feeling not like he needs help but like he has failed. Can you talk a little bit about that mental health concern and what it means for clinicians?
Speaker 1:Yeah, I think we talked about this idea that when you're an ER doc, you have this backpack and you go in and you try to resuscitate a child and they die and you take that terrible emotion and that feeling of just failure and you throw all that into your backpack. And then you go into the next room and there's a young woman who's dying of cancer and it's just not fair and she's got two kids and she ends up dying and you take all that emotion and you've got to go see the next patient. So you throw it in your backpack and over time the backpack is so full of all of these undealt with moral injuries that you tip over. And that happens to so many clinicians. It happened to me After 25 years. My backpack filled up and I tipped over. I was having flashbacks of all of the dead patients that I'd looked after the little kids, the elderly and I'd never dealt with it and I hadn't dealt with it with my career, because we're sort of told that's weakness.
Speaker 1:You shouldn't get help for your depression, for your PTSD, for your anxiety. We're doctors. We should be able to just suck it up and go, and it's such a terrible message that we've had. We also have a system that says you have to disclose all that, like you did something wrong. Oh, you got help for your mental health. It should be the other way. You didn't.
Speaker 1:That's a problem and we need to de-stigmatize that because everybody has it. Every single doc I talk to and I talk to a lot of clinicians every single one has a backpack that is full of stuff that they need to deal with. And I've talked a lot recently about the fact that I think every doc and nurse that works in these settings should have mandated mental health care. And if you're doing well, fine, it's a shorter episode, it's a little less counseling, whatever it is, but everybody should get it so the stigma goes away.
Speaker 1:We should be just destroying the stigma. This is not normal. You cannot go to war and watch people die or kill people and come out of that without PTSD. You just can't, because you're a human. Only robots can do that. But that's what we're asking emergency clinicians and clinicians in many specialties to do here go to war for us, but we're not actually going to look after you. You're just going to have to deal with it yourself, and I just think that's wrong. It should be part of medical practice, nursing practices that every single person has routine mental health care because they need it.
Speaker 2:Well, and the good news is so.
Speaker 2:We're doing some research in collaboration with the Dr Lorna Brin-Harris Foundation, asking clinicians about their barriers to mental health access, and I've been reading through the open-ended responses to what solutions might be, and I was surprised at the number of people who said make this mandatory, right.
Speaker 2:Like I've not heard a lot of people say I want one more mandated thing on my, my plate.
Speaker 2:This is clearly a fundamentally different kind of thing because, as the show depicts and as you say, in in real life, the kinds of things that emergency clinicians and clinicians in other parts of medicine are facing with the death, the loss, the dying Clinicians and clinicians in other parts of medicine are facing with the death, the loss, the dying, the inequities, the lack of fairness, the overburdening is not something First of all, it's something we should strive to eliminate as much as possible for what's structurally there. But support with absolutely no questions, with absolutely no questions and, as you said, almost a question of why wouldn't? As a patient, I would certainly prefer that my clinicians are getting the mental health care that they need, and I think one of the things I love about the show is the possibility that people will watch it and say of course, and be part of rallying with the Dr Lauren Breen Heroes Foundation and others rallying to say clinical access to mental health care for health care professionals is essential.
Speaker 1:Yeah, there can't be any spoilers for season two, but this is some of the stuff that we want to continue telling that story, and I'm a little disappointed that other people have decided that getting mental health care for everybody is a good idea. I thought it was mine, I thought it was all mine, I thought it was the only one, and it turns out I'm not the only one, and that makes me so heartened to hear that there are clinicians who understand yeah, this is the way to go and it shouldn't be on your own time, your expense. This should just be part of the job. It should be paid for for the clinician and for the therapist or whoever it is, and there should be time set aside for that. So it should be a real thing, not like an unfunded mandate, which we are so fond of here when it comes to healthcare. There should be a funded mandate that everybody can be involved.
Speaker 2:In terms of both finance and time, as you said, and fortunately, again, that's what we see in the comments and hopefully elevating those voices will help make that a reality. So I sort of put the words in your mouth around that being an outcome. But what else do you hope either lay audiences or leadership audiences or professional audiences will take away from watching the show? What kind of change are you hoping to inspire?
Speaker 1:Well, the most important thing is to show the humanism of the docs and nurses. I think this show has given people a window into what that actually looks like for the first time. To hear docs say my family really had no idea what I do. And now they sit with me as we watch the show and we pause and they're like is that true, is that thing, does that happen? And you're saying yes, and it's like dad, do you do this for eight hours, 12 hours at a time, like, yes, that's what I do. So I think that's the most important thing, because from that comes compassion and from that comes to action. Compassion and from that comes to action.
Speaker 1:I just heard Jon Stewart talking about his show, about how, as a comedian, your job is to make people laugh, but it's also to make them think. But don't think, as a comedian, that just making people laugh about really difficult things in the world actually fixes those things. And this is the same thing. You actually have to go out and now do something about it. So I think what this show allows is people this window into here's what's going on. These are humans. Now let's do something about it. Just watching the show doesn't fix anything except educate you. But now what are we going to do with that education? So I'm I'm hoping that there are people in power and that will help make change People who are hospital administrators, people who are family members of the docs and the nurses that are working in these situations to start putting pressure on their congressmen and to change the way things are done. If this show can do a little bit of that, then it is absolutely worthwhile.
Speaker 2:Well, I think it is incredibly worthwhile and I do think that storytelling and perspective taking and all of those things that create that connection and compassion are the foundation of change. So thank you for being part of that. I know you're surrounded by also an extraordinary team of other people that are bringing this to life, but thank you for bringing medical realism but, more importantly, for bringing human realism to a medium that allows people an inside look at what it's really like and what we need to change in healthcare.
Speaker 1:And thank you for the work that you're doing. It's so important. We, hopefully, are on the precipice of helping fix one area of mental health, but mental health is a thing that we all need to be talking about in all of our jobs, in all of our lives. There's been a stigma around this for a few thousand years. It's time to get rid of this. We need to be able to talk about this in the open, all of us and maybe this can start that conversation, because here are the people who are supposed to be like the superheroes. They're not coping. You know why? Because we're human. Let's have the discussions about what it means to be human.
Speaker 2:Yeah, being human is central to all of this. Well, and any last thoughts you want to share before we wrap up.
Speaker 1:No, I just just thank you for the work you're doing, and there's so many groups here that are doing this. It's just such a pleasure to be able to be part of the show. I hope it goes for many seasons. We have so many stories to tell, so make sure you watch the show, because that's the way it'll stay up, watch the show, tell your friends to watch the show and hopefully we can have at least a number of more seasons where we can tell this, because it's very complicated. We've only just scratched the surface.
Speaker 2:Yes, and I hope it continues as well. I personally am a big fan and I think storytelling is such an important part, as I said, of driving change. So thank you, mel, for joining us today and thank you for the work you're doing.
Speaker 1:Thank you.
Speaker 2:If you enjoyed this episode of the Caring Greatly podcast, please subscribe and rate us on Apple or Thank you and do not necessarily reflect those of Stryker. Participants have not been compensated and are selected solely based on their expertise, regardless of whether they have any relationship with Stryker. I am your host, Liz Bohm, Executive Strategist of the Heart of Safety Coalition, brought to you by Stryker. Thank you for caring greatly.
