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Meet a Gastroenterologist · Workplace Confessions: Behind Closed Doors

• 0:02
  SPEAKER_02: Welcome to Workplace Confession behind closed doors.
• 0:05
  SPEAKER_02: I'm Elisa Barbie.
• 0:06
  SPEAKER_02: And I'm telling you and truth.
• 0:08
  SPEAKER_02: We have been friends since sixth grade.
• 0:10
  SPEAKER_02: Somewhere between a question, a few questionable boy choices, and 40 years of friendship.
• 0:16
  SPEAKER_02: We became the kind of people who always want to know what's really going on, including work.
• 0:21
  SPEAKER_03: Del spent 25 years as an employment lawyer digging into workplace children from the inside out.
• 0:27
  SPEAKER_03: I built a long career in the beauty industry as a breakfast educator with beauty became a sprinkle in their function.
• 0:33
  SPEAKER_02: We came up in very different industries.
• 0:36
  SPEAKER_02: We have the same meeting new people and asking having a fair job.
• 0:40
  SPEAKER_02: What they love, what they can't stand, and what happens behind closed doors.
• 0:51
  SPEAKER_02: They can fill the truth with the choices they make the tiny cruelty, tiny city, and some of the moments that never make it into human resources reports.
• 1:03
  SPEAKER_03: Equal parts informative and title-leading.
• 1:06
  SPEAKER_03: This show serves up all the tea while honoring the incredible, complicated, often messy work people are doing across the industries and across the map.
• 1:14
  SPEAKER_03: Welcome to Workplace Confessions Behind Closed Doors.
• 1:16
  SPEAKER_03: Let's get into it.
• 1:48
  SPEAKER_02: Tell us, walk us through how you went from referring soccer to what you do now.
• 1:55
  SPEAKER_01: So I'm a gastroenterologist.
• 1:57
  SPEAKER_01: I've been in practice for 14 years.
• 1:59
  SPEAKER_01: Uh and it's something I've uh you know, I really enjoy doing.
• 2:05
  SPEAKER_01: But it's it's a great field.
• 2:06
  SPEAKER_01: Um, how I got here is is kind of a long story, but you know, when you go into college and you start doing your sciences, and then you start identifying what type of science you like, and then trying to get into medical school, which is a big step and a challenge in and of itself, and then going into medical school and then trying to figure out during your clinical rotations what you really are what you could envision yourself doing every single day, started becoming more and more real.
• 2:36
  SPEAKER_01: And that's during the third and fourth years of med school.
• 2:39
  SPEAKER_01: And uh that's when you put on the white coat, it's a short white coat, so you kind of get ostracized.
• 2:44
  SPEAKER_01: You're not really a doctor yet, you're you're just a short lab coat kid.
• 2:48
  SPEAKER_01: Uh, you know, you everyone knows that you're not a true doctor.
• 2:52
  SPEAKER_01: Um, but then you kind of, you know, you have a stethoscope, you got a little bit of responsibility, there's a hierarchy in the hospital.
• 2:59
  SPEAKER_01: Uh, there's the attending physician, there's a resident, there's a fellow, so everyone, you know, above you kind of oversees you.
• 3:05
  SPEAKER_01: And then, you know, during my clinical rotations, I really enjoyed the cerebral aspect of internal medicine.
• 3:13
  SPEAKER_01: Uh, it was pretty cool to be able to look at labs and be able to make some sort of sense out of, oh, you have this problem.
• 3:19
  SPEAKER_01: It's you know, and you can look at things that others it's that others may look at as hieroglyphics.
• 3:26
  SPEAKER_01: So it's been it was it was uh it that was the part that I knew I was doing internal medicine was the the field I wanted to go into.
• 3:32
  SPEAKER_01: But then I loved surgery and working with my hands and being in the in the room doing a procedure.
• 3:40
  SPEAKER_01: Um you know uh I had dexterity, I played video games as a kid, so that all helped.
• 3:47
  SPEAKER_01: Um, and then when I was in my surgical rotation, I was I remember one day that I was on call the eve of my birthday, and I got in at five o'clock in the morning at the hospital, and I left 9 p.m.
• 4:03
  SPEAKER_01: the day the following day with no sleep.
• 4:07
  SPEAKER_01: And I was doing and I uh it was just it was a non-stop mayhem, and after that day, I'm like, there's no way I'm doing surgery, there's no way, this is not for me.
• 4:18
  SPEAKER_01: Uh, and then I ended up uh doing internal medicine and segued over to the procedural side of internal medicine, which is gastroenterology, and 75%, 80% of my practice is procedure-based, and I love it.
• 4:32
  SPEAKER_01: That's the fun part of doing gastroenterology work.
• 4:36
  SPEAKER_02: For those who don't understand what that is, what what do gastroenterologists do?
• 4:42
  SPEAKER_01: Great question.
• 4:43
  SPEAKER_01: As a matter of fact, we have a cycling team for our GI group of friends.
• 4:46
  SPEAKER_01: Uh, our our motto on the back of our jersey says for butts, guts, and glory.
• 4:51
  SPEAKER_01: And that's what it's for.
• 4:52
  SPEAKER_01: No.
• 4:54
  SPEAKER_01: Uh we we uh we our main our main practice is uh preventative care.
• 5:01
  SPEAKER_01: And uh we do colorectal cancer screening on the regular, that probably encompasses the majority of our practice.
• 5:07
  SPEAKER_01: Um we spend day to day doing about 15 to 20 colonoscopies a day.
• 5:14
  SPEAKER_01: Um we get really good at it and do about 11, 1200 per physician uh annually.
• 5:21
  SPEAKER_01: Um so we spend a lot of our time doing that, and then the other aspect of our care is hospital-based.
• 5:27
  SPEAKER_01: So when I'm in the hospital and patients come in for whatever GI disorder it may be, maybe for autoimmune problems like Crohn's, ulcer of colitis, um, they may have liver conditions, autoimmune hepatitis, uh cirrhosis, uh, or gastrointestinal bleeding.
• 5:44
  SPEAKER_01: So we go in there and we're we're the ones that go in and identify sources of bleeding and and make the bleeding stop.
• 5:51
  SPEAKER_01: And these are most often caused by medications that patients are taking, or sometimes just uh inflammatory condition.
• 5:58
  SPEAKER_03: Was there ever a moment when you doubted your profession, your profession uh choice?
• 6:03
  SPEAKER_01: The thing that's interesting, and I doubt about medicine, I still doubt about medicine, is that we are physicians that are incentivized based on disease and the presence of disease.
• 6:15
  SPEAKER_01: Which is a weird way of looking at it, but medicine is not profitable without disease.
• 6:22
  SPEAKER_01: And when we talk about doctors, we should be talking about preventative care.
• 6:26
  SPEAKER_01: And I do preventative care, and that's my practice.
• 6:28
  SPEAKER_01: I do colonoscopies and prevention of colon cancer, but preventative care in a in a global aspect of what we what we should be doing as physicians and taking more time doing in the day-to-day clinic visits before the disease becomes apparent, which is something that is very absent in our day-to-day practice as well as our medical training, to be honest.
• 6:50
  SPEAKER_03: Would you believe, would you think our country is a lot different than other countries in the way we practice?
• 6:59
  SPEAKER_00: Oh yeah.
• 7:00
  SPEAKER_00: The loaded question.
• 7:01
  SPEAKER_00: You're digging.
• 7:03
  SPEAKER_01: Uh you know, I think we're we're we are the most advanced uh, you know, internationally as as a as a field.
• 7:12
  SPEAKER_01: Uh we are also the worst when it comes to efficiency.
• 7:17
  SPEAKER_01: There is a big challenge in medicine to be able to fight against the world of of our nutritional state.
• 7:24
  SPEAKER_01: Um so it does make it challenging for medicine to have to overcome that.
• 7:29
  SPEAKER_01: Um, but also physicians ha in the United States have this constant desire to protect themselves as physicians against lawyers that may want to come at us for whatever it may be.
• 7:46
  SPEAKER_01: So there are a lot of times we overdo things, we over-treat, and we over-test.
• 7:52
  SPEAKER_01: Um, you know, that's it's extremely common in my world that when I see patients with chronic abdominal pain, that they'll have 10, 15 CAT scans in the computer system and they're in their 40s.
• 8:02
  SPEAKER_01: And they've been radiated multiple times and they've had antibiotics for various reasons.
• 8:06
  SPEAKER_01: And, you know, then we have to try to step back and say, are we harming them or helping them?
• 8:10
  SPEAKER_01: And I think that's the that's the biggest problem that we need to overcome in in medicine in the United States is um looking at the patient as a whole and figuring out if the testing is is helpful or harmful to the patient.
• 8:26
  SPEAKER_01: I'll give you another example.
• 8:27
  SPEAKER_01: You know, it we use colonoscopy as our primary source of colorectal cancer screening in the United States.
• 8:34
  SPEAKER_01: We're the only country that does that actually.
• 8:37
  SPEAKER_01: The other countries use a stool card test as their main form of colon cancer screening for the patients who don't have any symptoms.
• 8:45
  SPEAKER_01: And when I mean screening, that means they have no symptoms at all or family history.
• 8:49
  SPEAKER_01: Um we choose the most expensive route to screen.
• 8:53
  SPEAKER_01: And the data has shown that if you want to put stool card tests against colonoscopies, the prevention of cancer and the mortality benefits are equal between the two.
• 9:04
  SPEAKER_01: Because if your test ever turns positive on a stool card, you get a colonoscopy anyways.
• 9:09
  SPEAKER_01: And our our detection of polyps is higher, obviously, but our incidence of colon cancer is no better.
• 9:20
  SPEAKER_02: Why do you think we're jumping to the most expensive solution?
• 9:24
  SPEAKER_01: There are there is a benefit for doing colonoscopies.
• 9:27
  SPEAKER_01: We remove polyps and polyps, just to kind of make an analogy simple to understand, is like a seedling and cancers the tree, and we we pluck the the seeds out of the colon so the tree never grows.
• 9:40
  SPEAKER_01: Um so for that reason, colonoscopies are well established as a good form of preventative care.
• 9:49
  SPEAKER_01: Um, so yes, it is used for that purpose.
• 9:52
  SPEAKER_01: And there is personal bias.
• 9:55
  SPEAKER_01: I do believe that colonoscopies do have a better profile over screening with stool car tests because the stool car tests are looking for microscopic blood.
• 10:06
  SPEAKER_01: And when you have microscopic blood, it can come from various different conditions.
• 10:10
  SPEAKER_01: It can come from hemorrhoids, it can come from polyps, it can come from a strained vowel movement that day.
• 10:16
  SPEAKER_01: Um, you know, there are a lot of different things that that could turn a stool car test positive.
• 10:22
  SPEAKER_01: Um and sometimes the stool car tests have missed colon cancers, and I've seen it.
• 10:26
  SPEAKER_01: Uh, but that that is few and far between.
• 10:29
  SPEAKER_01: That's not the norm.
• 10:30
  SPEAKER_01: Um but we choose colonoscopy in the US because it has been proven to prevent colon cancer.
• 10:37
  SPEAKER_01: Uh, it's also profitable.
• 10:42
  SPEAKER_01: It's a lot more expensive.
• 10:43
  SPEAKER_01: Yeah, it's very expensive.
• 10:45
  SPEAKER_01: It's a procedure, so any procedure-based medical thing is a lot more expensive.
• 10:49
  SPEAKER_03: What would you say is the best part about what you do on the daily?
• 10:53
  SPEAKER_01: I'm in the room.
• 10:54
  SPEAKER_01: I got music in the room, patients walk in, they get wheeled in, and I got two nurses in the room.
• 11:01
  SPEAKER_01: And it's always fun to be in a social interaction of patients are kind of out of it, they say things that are strange, I say things funny back at them, and they'll they'll repeat themselves and they'll be like, Hey, do you remember?
• 11:15
  SPEAKER_01: Did I tell you about it?
• 11:16
  SPEAKER_01: I'm like, Yeah, you did actually.
• 11:17
  SPEAKER_01: And so we it's it's fun to be able to have these patients that are kind of with it but not not quite there.
• 11:23
  SPEAKER_01: You have your nurses around you that you get to know their personal lives, they talk about their kids and their families.
• 11:29
  SPEAKER_01: I do the same.
• 11:30
  SPEAKER_01: Um, and it's kind of like social hour.
• 11:33
  SPEAKER_01: Uh, I'm the the there's there's a cocktail, it's versette and fentanyl.
• 11:37
  SPEAKER_01: We give them medications to get them nice and comfy.
• 11:40
  SPEAKER_01: Uh and from that point on it becomes fun.
• 11:43
  SPEAKER_01: No, I have fun watching the patients say the crazy things they say.
• 11:47
  SPEAKER_02: Okay, we need to know what some of those are.
• 11:50
  SPEAKER_01: I'll tell you the most annoying thing that patients tell me.
• 11:53
  SPEAKER_01: They they turn it into an experience of a different sort that I don't like to equate it to.
• 11:57
  SPEAKER_01: They're like, oh, are you gonna buy me drinks after this, or do I get dinner after I'm like, come on.
• 12:02
  SPEAKER_01: That's the most common things patients say.
• 12:05
  SPEAKER_01: Like, grow up, don't say that.
• 12:06
  SPEAKER_01: It's it's a procedure, let's be professional here.
• 12:09
  SPEAKER_01: I've dealt with teeth, I've dealt with dentures, I've dealt with swallowed objects, I've had people who have swallowed razor blades, uh pencils.
• 12:18
  SPEAKER_01: These are psychiatric patients that are trying to hurt themselves, and you get called in the middle of the night to go and you know withdraw the foreign body out of their stomach and sedate them, do an upper endoscope and try to remove it from them.
• 12:30
  SPEAKER_01: Um, those are the those are the interesting things.
• 12:34
  SPEAKER_01: Um the rewarding things are fighting the uh I'm a specialist that does small bowel disease also, so I do this special type of procedure called a double balloon ineroscopy.
• 12:45
  SPEAKER_01: So I kind of go into my little spacesuit and go into the deeper parts of the bowels that no one else goes into with a special camera and special scope.
• 12:53
  SPEAKER_01: And uh I found these rare cancers in gastric bypass patients who've had excluded stomachs out of the way, and I get to the excluded stomach and I found a cancer there, which is you know crazy to find.
• 13:06
  SPEAKER_01: Uh, I found found incidental uh cancer in the deep small bowel and someone who came in for a denture that or a dental implant that they swallowed, and it wasn't I was looking for the dental implant and I found a cancer by chance and it was just luck.
• 13:21
  SPEAKER_01: Um, so there's some there's some interesting things.
• 13:23
  SPEAKER_01: I mean, when you're practicing medicine, the experiences come by volume, and the more volume you do, the more things you see.
• 13:30
  SPEAKER_02: Do you ever go in for the colonoscopy and find there's something in there that shouldn't be in there?
• 13:37
  SPEAKER_01: I found worms in patients.
• 13:40
  SPEAKER_01: Like from outside?
• 13:41
  SPEAKER_01: Yeah, yeah.
• 13:43
  SPEAKER_02: Wow.
• 13:44
  SPEAKER_01: Yeah.
• 13:45
  SPEAKER_01: Um, you know, these are patients who are working in the environments of farming most often.
• 13:51
  SPEAKER_01: Oh other than that, that's I mean, the foreign objects are the most most common.
• 14:02
  SPEAKER_01: I had one patient that was interesting.
• 14:05
  SPEAKER_01: This guy, uh, he was a Persian patient, and watermelon seeds are, you know, not sunflower seeds, but watermelon seeds are consumed as like a you know a snack.
• 14:14
  SPEAKER_01: And apparently he was out in the middle of nowhere and he had like a bag of watermelon seeds, and he decided to just eat them whole and not take the shell out.
• 14:24
  SPEAKER_01: He had two pounds of it.
• 14:27
  SPEAKER_01: And every time he went to the bathroom, uh the seeds would uh act as razor blades.
• 14:33
  SPEAKER_01: Oh, so we had to figure out how to get this out of him without hurting him.
• 14:38
  SPEAKER_01: Your GI tract is just an extension of the outside world, it's it's not a sterile environment, and whatever you eat gets its way out somehow.
• 14:46
  SPEAKER_02: Like related question though.
• 14:48
  SPEAKER_02: So when you're a kid and you swallow your gum, they tell you it will be inside you forever.
• 14:54
  SPEAKER_02: Seven years.
• 14:55
  SPEAKER_02: Seven years?
• 14:56
  SPEAKER_02: That's that's what I always heard.
• 14:57
  SPEAKER_02: That's what I heard.
• 14:58
  SPEAKER_02: So what's the truth on that?
• 15:00
  SPEAKER_01: No, I've actually that's funny you say that.
• 15:02
  SPEAKER_01: I've actually seen people who have swallowed gum the day before their colonoscopy, and I find it in their colon.
• 15:09
  SPEAKER_02: Okay, so it's not staying in your stomach like that.
• 15:12
  SPEAKER_02: No, it comes out.
• 15:13
  SPEAKER_01: No, it comes out.
• 15:15
  SPEAKER_01: Well, anything the size, anything the size that's smaller than your pinky nail will come out.
• 15:21
  SPEAKER_02: So, what about coins?
• 15:24
  SPEAKER_01: Great question.
• 15:25
  SPEAKER_03: We are not going to give them a whole entire list of everything you've ever swallowed in your life.
• 15:30
  SPEAKER_01: Can I can I can I give one dangerous thing that you should always keep kids away from?
• 15:34
  SPEAKER_01: Batteries and magnets and magnets.
• 15:38
  SPEAKER_01: Magnets and batteries are the worst things.
• 15:41
  SPEAKER_01: Uh, the caustic injury from the batteries and the magnets are the worst because if you have multiple magnets, especially these little toys that these kids have that are like these little balls of magnets that then morph into like different shapes.
• 15:53
  SPEAKER_01: If you're to swallow those, if kids swallow those, you could take one piece of bowel and another piece of bowel and magnetically attach them, and all of a sudden you become uh attached in that space, and you end up having to do some major repair surgery in order to get those out.
• 16:07
  SPEAKER_01: And that falls in the hands of a surgeon, not me.
• 16:09
  SPEAKER_01: But those are the dangerous things to swallow.
• 16:11
  SPEAKER_03: What would be something?
• 16:13
  SPEAKER_03: What is the hardest part about doing your job?
• 16:18
  SPEAKER_01: You know, we have physicians all have egos.
• 16:22
  SPEAKER_01: Some have bigger egos, some think they walk on water.
• 16:27
  SPEAKER_01: Um, and I think the hardest part of medicine is not the patient.
• 16:33
  SPEAKER_01: For me, it's not the patient.
• 16:34
  SPEAKER_01: Sometimes it's the personalities of the doctors that are around us, the demands that they try to impose on us.
• 16:40
  SPEAKER_01: You know, sometimes um various departments will demand something gets done from a procedural standpoint, and it's not the safest option, then you have to kind of uh posture against them and say, hey, no.
• 16:54
  SPEAKER_02: What are some myths about your profession that kind of make you crazy?
• 17:02
  SPEAKER_01: Well, one is they think that we're dealing with poop all day long.
• 17:04
  SPEAKER_01: We don't.
• 17:05
  SPEAKER_01: Uh that's that's the that is not that's we we deal with clean colon.
• 17:10
  SPEAKER_01: So if you have if patients come with dirty vowels, we send them back and prep them and come back again.
• 17:16
  SPEAKER_01: Um uh the biggest myth is that we're dealing with butts all day.
• 17:20
  SPEAKER_01: Uh we we we are uh I always just explain it as we're doing video games.
• 17:27
  SPEAKER_01: Um uh the controller is in my hands, the screen is the screen, and your your butt is the Nintendo.
• 17:35
  SPEAKER_01: The myth, I I gotta probably tell you one myth is that we know nutrition well.
• 17:41
  SPEAKER_01: I think people come in, they're like, hey doc, you're tell me about diet and nutrition, and tell me about what's the right food to eat.
• 17:49
  SPEAKER_01: And they believe that gastrologists know that the answer to that question.
• 17:54
  SPEAKER_01: And we do to some degree, but it's mostly based on personal lifestyle that we carry, not as physicians, because we're we've given we're given zero classes in medical school on nutrition, and you know, we don't have the understanding of all the details of our diet and in our in our country like we should as gastroenterologists should.
• 18:20
  SPEAKER_03: If you could wave a magic wand and change one thing about your industry, what would it be?
• 18:29
  SPEAKER_01: So I work in the very large corporate healthcare system.
• 18:35
  SPEAKER_01: The thing I'd love to make go away is the red tape.
• 18:40
  SPEAKER_01: Uh I have a role in education in in the system.
• 18:45
  SPEAKER_01: Um, I also have an administrative role in the healthcare system regionally.
• 18:51
  SPEAKER_01: And, you know, um, when we want to make a change, the command uh that I have to go through in order to make the change happen for something that is practical and necessary is very difficult.
• 19:07
  SPEAKER_01: And it's it's to the point where at some point, and I did in this situation give up.
• 19:14
  SPEAKER_01: A good example is you know, we're we're the doctors that you go to if you're losing blood, if you're anemic.
• 19:20
  SPEAKER_01: Okay.
• 19:21
  SPEAKER_01: Anemia comes in different flavors though.
• 19:24
  SPEAKER_01: Anemia doesn't mean you're losing blood.
• 19:25
  SPEAKER_01: Anemia could be that your kidneys aren't functioning properly, or your bone marrow is not producing well, or you're destroying your red blood cells.
• 19:32
  SPEAKER_01: Anemia comes from different things.
• 19:35
  SPEAKER_01: But primary care doctors send us patients who have anemia in our healthcare system, and they have this this whole um uh they're trying to siphon all the patients with anemia to our our department.
• 19:48
  SPEAKER_01: And I sit at and look at the labs and I'm like, well, this patient is not an iron deficiency anemia.
• 19:53
  SPEAKER_01: This is a patient who has chronic kidney disease, or this is a heavily menstruating female, and she doesn't need to come to us.
• 20:00
  SPEAKER_01: And I put in this request to add this one extra lab, which is called a ferritin.
• 20:06
  SPEAKER_01: So I'm you please, before you send this to gastroenterology, I'm trying to avoid the extra work in our department and the unnecessary need of doing endoscopies and colonoscopies on 25-year-old patients that don't need these procedures.
• 20:20
  SPEAKER_01: Add a ferritin to all the patients who have anemia because that's the workup you're supposed to do in order to get the right answer of whether or not this is an iron deficiency anemia.
• 20:29
  SPEAKER_01: And if this iron deficiency anemia is not related to menstruation, then send them to us.
• 20:39
  SPEAKER_01: I got the rebuttal that it's too much work to have a ferritin checked.
• 20:43
  SPEAKER_01: I said, well, tell me what the numbers are.
• 20:46
  SPEAKER_01: The numbers came out to one in 300 physicians would have to look at a lab, an extra lab per month.
• 20:53
  SPEAKER_01: One in 300.
• 20:55
  SPEAKER_01: And at that point, I realized how ridiculous it is to negotiate with a corporate healthcare system, uh, because you know they'll find their best interest in mind as far as extra work for them.
• 21:10
  SPEAKER_01: And uh, I'm trying to do what's right.
• 21:13
  SPEAKER_01: And sometimes the two don't quite go hand in hand.
• 21:17
  SPEAKER_03: What is the wildest, weirdest, or most unforgettable thing that you've actually witnessed at work?
• 21:23
  SPEAKER_01: I think this is probably going to be the same for a lot of doctors.
• 21:26
  SPEAKER_01: It was the pandemic.
• 21:29
  SPEAKER_01: The pandemic was weird.
• 21:31
  SPEAKER_01: It's unforgettable when COVID hit, they were looking for a person in San Diego to be the leader of a triage system that would help guide the whole San Diego COVID patients from getting overloaded into the emergency room, overloaded into the ICU, and figuring out how to triage these patients.
• 21:55
  SPEAKER_01: So then I was put in charge of the COVID operations of San Diego in 2020.
• 22:02
  SPEAKER_01: And I stepped away from my role as a gastroenterologist for three months.
• 22:06
  SPEAKER_01: I was not a GI doctor.
• 22:07
  SPEAKER_01: I was the guru of COVID and I wasn't treating the COVID, but I was the frontline person that would uh all the tests would come to me.
• 22:16
  SPEAKER_01: I would call the patients, and then we had to assess them over the phone about how sick they were.
• 22:23
  SPEAKER_01: And and we had to figure out their social situation.
• 22:26
  SPEAKER_01: And it was fascinating.
• 22:28
  SPEAKER_01: I was listening to the patients on the phone in the infancy of COVID in March, February, March of 2020, when people are starting to get scared, the vaccine wasn't out, the the news was hitting, the the scare was going out.
• 22:47
  SPEAKER_01: Um it hit it had hit Europe, it's making its way over here, the stories were coming out and it was actually happening.
• 22:54
  SPEAKER_01: And I realized that the patients with the lower socioeconomic conditions, multi-generational households, six, eight people living in a house, one had COVID.
• 23:06
  SPEAKER_01: How am I gonna isolate them?
• 23:08
  SPEAKER_01: So then I had to figure out how to put these patients into a form of isolation.
• 23:12
  SPEAKER_01: They didn't have an extra room.
• 23:14
  SPEAKER_01: So then I had to talk to uh Department of Public Health.
• 23:18
  SPEAKER_01: Then I had to figure out the hotels that were available in San Diego.
• 23:23
  SPEAKER_01: I linked up with hotels in San Diego that were willing to give away free rooms to our patients.
• 23:28
  SPEAKER_01: I would put patients, so I became a social worker on top of a physician.
• 23:32
  SPEAKER_01: I would assess their severity of illness, I would have to identify if they're sick enough to go to the hospital, make them walk up their stairs, I'd have them come back and I'm gonna listen to them and they're winded while they're talking.
• 23:44
  SPEAKER_01: Do go to the emergency room now.
• 23:46
  SPEAKER_01: Had patients that were pregnant.
• 23:48
  SPEAKER_01: Had one kid, I remember distinctly, he was a it was an 18-year-old kid, and he told me that he has COVID or he had COVID.
• 23:57
  SPEAKER_01: I obviously called him for that, and he told me I asked him if he has anyone else in the house that has COVID.
• 24:01
  SPEAKER_01: He said, Yeah, my roommate, but he had to go to Palm Springs because there was a hotel that they were willing to put him up over there.
• 24:09
  SPEAKER_01: It wasn't through me, and he died, and he was 20 years old.
• 24:16
  SPEAKER_01: And I opened up the newspaper the next day in the San Diego Unit Tribune, and it shows 20-year-old found dead in his hotel in Palm Desert.
• 24:23
  SPEAKER_01: I'm like, that's my patient's roommate, and everything was real.
• 24:27
  SPEAKER_01: It's the the magnitude of the disease was real at the beginning.
• 24:32
  SPEAKER_01: People were, oh, you're overdoing it.
• 24:34
  SPEAKER_01: No, it was killing people, it was hurting the patients because this was a virus that we've never experienced.
• 24:42
  SPEAKER_01: It's not like we had herd immunity, we couldn't soften the blow.
• 24:45
  SPEAKER_01: It was impacting our healthcare system, and there was no prior virus that was similar to it to the level that we had the immune system to be able to fight against it.
• 24:55
  SPEAKER_01: It was it was fascinating, it was probably the most rewarding phase of my career, and it had nothing to do with gastroenterology, it had it just me being a physician helping patients, and I loved it, it was cool, it was exhausting.
• 25:09
  SPEAKER_01: I was spending about 15 hours a day on the computer trying to put algorithms and thoughts and looking at the CDC guidelines and redoing it and trying to figure out how to make the system not buckle.
• 25:22
  SPEAKER_01: Uh, but that was, I don't think we'll ever, uh I don't think any provide healthcare provider will ever experience what we did in pandemic ever again.
• 25:30
  SPEAKER_01: That was that was gnarly.
• 25:32
  SPEAKER_02: I wonder what steps you take to um demonstrate care and concern to your patients, considering all the other strains you're under, time you know, time limitations with patient, etc.
• 25:46
  SPEAKER_01: Yeah.
• 25:46
  SPEAKER_01: Um that's that's I always have sympathy when patients I should say I've sympathy towards the physicians when patients come up to me like I have this doctor, and he was just so rude.
• 25:57
  SPEAKER_01: And we're human, we have strains in our day-to-day life.
• 26:02
  SPEAKER_01: It's hard to be able to balance the hours of work, the this sometimes being on call and and having the mood to be able to explain things to patients in a clear, calm manner.
• 26:14
  SPEAKER_01: Um but sometimes just you know, when I step into a room and I know it's the next patient, I take a deep breath before I walk in the room because I know it's every patient is different.
• 26:25
  SPEAKER_01: I don't want to carry the I don't want to carry the brunt of last patient if there was a bad interaction into the next room.
• 26:31
  SPEAKER_01: Um it's you always have to kind of have uh you have to have amnesia as a physician.
• 26:37
  SPEAKER_01: You have to walk into the room and have like 15 seconds, everything from the last, you know, prior to that is gone.
• 26:44
  SPEAKER_01: Because otherwise your entire day could be completely wrecked.
• 26:49
  SPEAKER_01: And when you walk into the next patient room, it's not fair to them for you to for them to hear the burden of your last patient.
• 26:56
  SPEAKER_02: But I am curious if you've seen signs of how artificial intelligence might impact your work going forward.
• 27:03
  SPEAKER_01: I think it's gonna be great.
• 27:05
  SPEAKER_01: If we integrate, and it's not that they're taking over, if we integrate AI into the healthcare system and we incorporate it into the electronic health record system and we assist in diagnostics, I think the physician will only be better.
• 27:22
  SPEAKER_01: It's amazing how open AI has helped in medicine.
• 27:29
  SPEAKER_01: You know, things that I would have to go to PubMed, which are kind of our reference, you know, uh website for us and all of our journals that we look at to identify specific scenarios in medicine and how to answer those questions.
• 27:43
  SPEAKER_01: And you would have to read an article or read its summary and have to interpret it.
• 27:48
  SPEAKER_01: Open AI, just open it up and you'll be like, oh, you know, this scenario with this condition and this medication, and what's the potential that this could be causing it?
• 27:57
  SPEAKER_01: And it's like data just like boom, boom, boom, boom, quick comes at you.
• 28:02
  SPEAKER_01: Um I think that it's it's gonna be very helpful to the primary care world specifically because they're not specialists and you know, bless their hearts, they have a lot to cover, they have to deal with all the disciplines of medicine, and you know, they're not the experts of everything.
• 28:17
  SPEAKER_01: I think it's in the in the in the future, what we're gonna find is AI, and I already read some stuff about how AI is being integrated into radio radiology, how they're being integrated into pathology, and how looking at slides with biopsies can identify things through AI because radiologists and pathologists are doctors of pattern recognition.
• 28:43
  SPEAKER_01: AI is the ultimate pattern recognition.
• 28:47
  SPEAKER_01: And you have that aside alongside you as a radiologist or pathologist, it's gonna make you like super, super amazing.
• 28:57
  SPEAKER_01: I think there's gonna be some drugs that will end up being created as a result of AI modeling systems, um, you know, because a lot of these are these treatments have to do with receptors on the cellular level and trying to find the the connections between the drug and the the receiving end of the cellular level.
• 29:16
  SPEAKER_01: And if we can identify how they fit together on a cellular level, we can create new new medications, and that's what's happening right now.
• 29:24
  SPEAKER_03: If someone's thinking about entering your field, what should they know?
• 29:28
  SPEAKER_01: You know, first of all, it's very academically challenging to go through the whole rigors of medicine.
• 29:33
  SPEAKER_01: I mean, you have your undergraduate years, you have your medical school years, you have your residency years, and then you have your fellowship years.
• 29:39
  SPEAKER_01: In totality, that was 14 years after high school.
• 29:43
  SPEAKER_01: And, you know, we are we are so blindsided or we're so focused on just academia, academia, and being really smart and identifying diseases and and and being able to find the zebras that no one else can know that oh, I found that diagnosis, no one else did.
• 30:02
  SPEAKER_01: That we sometimes become deficient in our confidence in speaking against the culture of patient first dogma.
• 30:10
  SPEAKER_01: You know, when you go on a plane and oxygen levels, you know, drop, and what are you supposed to put the mask on first?
• 30:16
  SPEAKER_01: Yourself for yourself.
• 30:20
  SPEAKER_01: And the the concept of sacrifice for the well-being of others doesn't mean that we need to sacrifice our own well-being, you know.
• 30:28
  SPEAKER_01: Um and I think that at times I've seen a lot of providers around me that are friends of mine that work excessively, and you know, there are sacrifices being made to their families, to their children, uh, to their health.
• 30:47
  SPEAKER_01: Um and uh if I could tell a young, budding pre-med student is do all the things you need to do to get to where you want for your career, but don't forget to take care of yourself the entire way.
• 31:01
  SPEAKER_01: And that's in your undergraduate years, in your medical school years, in your residency years, in your fellowship years, and most importantly, when you're in your career, because you will always have more put on your plate with little to be given in return, especially in a big industry.
• 31:19
  SPEAKER_01: Uh, be willing to say no, be willing to speak up, be willing to understand that your your well-being is very important from a financial standpoint, which we're not allowed to talk about in medicine, and also from your uh your ability to have your well-being of time and being able to tend to yourself.
• 31:38
  SPEAKER_01: Uh so you know, look out for your well-being.
• 31:42
  SPEAKER_01: Don't be afraid to ask the questions of how much I'm getting paid, because it really does come down to it.
• 31:47
  SPEAKER_01: It's money's a stressor in in society.
• 31:50
  SPEAKER_01: And if you don't know what you're getting, then what you think you deserve may not be what they think you deserve.
• 31:58
  SPEAKER_03: Well, with that being said, you touched on it a little bit.
• 32:01
  SPEAKER_03: And as we start closing out, I am very curious as to your personal time.
• 32:06
  SPEAKER_03: What do you do to recharge?
• 32:09
  SPEAKER_01: My my family.
• 32:11
  SPEAKER_01: Uh I I I spend a I spent a good time with my family.
• 32:14
  SPEAKER_01: My I have two kids and a wonderful wife, and uh, you know, I hope to be traveling more in the near future, but um spending time with them is is my decompression and coming home and being able to go to their sporting events, uh, go to you know, sporting events with them, watching different uh shows and going to their, you know, traveling to local places with my parents, my my their cousins.
• 32:40
  SPEAKER_01: It's it it that's what brings me happiness.
• 32:43
  SPEAKER_01: I think that uh having the calm at home is the thing that uh lets me go through the tougher days at work.
• 32:51
  SPEAKER_02: So thank you so much for your time.
• 32:53
  SPEAKER_02: Uh you have officially joined the ranks of the brave and the bold, and we are so glad to have you on the pod.
• 33:00
  SPEAKER_03: And thank you so much for your time.
• 33:02
  SPEAKER_03: So great.
• 33:03
  SPEAKER_03: Thank you so much.
• 33:06
  SPEAKER_02: That's it for this week's confession.
• 33:09
  SPEAKER_02: We've laughed, cringed, and maybe questioned our own career choices.
• 33:13
  SPEAKER_03: Big thanks to our anonymous guests for keeping it real and reminding us that behind every jump tunnel is a story worth telling.
• 33:19
  SPEAKER_03: If you've got a workplace confession of your own for all ears, hit us up at our email address.
• 33:25
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• 33:28
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• 33:30
  SPEAKER_02: Until next time, keep your bags cleaned, your coffee's true, and your stories file.
• 33:35
  SPEAKER_02: This is Workplace Confession behind the stories.