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What Patient Advocacy Looks Like · The Short Coat (Audio): An Inside Look at Getting Into and Getting Through Medical School

• 467 === [00:00:00] Faith Anton: I know your face. This is so weird. And I've seen you in the halls before. Okay. And like, I know this role, but I don't remember why I feel like I, I'm theology [00:00:17] Riley Behan-Bush: major. I was not, but my sister was. So I think you're getting us confused. We don't look that similar. No. Do you know Amaris? I'm just like exposing my sister on the podcast. What was your major? My major was in engineering. [00:00:28] Faith Anton: Maybe that's why I know you had roommates in engineering. I don't know. This is very odd. It's lovely to meet you. Hi. Yes or no? [00:00:36] Riley Behan-Bush: I feel like I am now becoming that like, obscure person that like was roaming the halls of medical school once, but is now just like doing research and like her PhD world where I'm pretty detached from like all other people. So, I'm starting to realize that about myself. I'm, as I go get [00:00:54] Dave Etler: higher, I think you should start dressing strangely. Should I like many other lab people that I've seen. Not strangely, but just like unique, super ultra casual. [00:01:05] Riley Behan-Bush: Yeah. I do feel like being able to just wear jeans every day is pretty casual. [00:01:10] Dave Etler: And if you're not wearing EarPods at all times. [00:01:14] Riley Behan-Bush: Oh no. I have headphones on, like at all times. Yeah. It's absurd. I have friends that'll come and be like, what are you gaming? I was like, I don't know. Like, [00:01:22] Happy Kumar: I'm just You have the [00:01:23] Riley Behan-Bush: big ones. Yeah. Because I like to remind myself that I am youthful by being on B real. So Dave, you were at once. [00:01:31] Happy Kumar: I'm no longer on [00:01:32] Dave Etler: Facebook though. Am I? I did delete my Facebook act. We're gonna [00:01:36] Riley Behan-Bush: find out how this is of I know. [00:01:39] Faith Anton: At some point, yes. I need to, it's been bugging me. Sorry, but I'll let it go for now. I just have a [00:01:44] Happy Kumar: mystery before we started. [00:01:46] Dave Etler: Welcome back to the Short Coat Podcast. It's the show that gives you an inside look at medical school from the students drinking from that fire hose. It's production of the University of Iowa Carver College of Medicine. I'm Dave Etler with me today in the s e p studio and on the internet, some students who are already making their mark in medicine spin your way to youth and health with her old age Rejuvenator centrifuge. It's PA one Faith Anton. [00:02:33] Faith Anton: Bless up my old age. I'm almost 25 [00:02:36] Dave Etler: centrifuge. not you're not old age. It's your people who you're spinning in your centrifuge to rejuvenate. Oh, yes, yes, yes. Wisdom. Remember? Yes. Faith, the thing that you invented. Yeah. Yeah. Her portable antico vapor bath will allow you to sit in a cloud of sweat and humidity in the comfort of your home. It's MD/PhD student Riley bean bush. Wow. That sounds [00:02:56] Riley Behan-Bush: really delightful. It's like a sauna, but wars. [00:03:00] Dave Etler: Protect your fetus from cell phone radiation with his copper infused fabric dress. It's M three Happy Kumar. hello, and cure your hiccups with his specially designed straw. It's M two Jeff Goddard joining us all the way from South Africa. Woo. [00:03:16] Happy Kumar: Hello. [00:03:16] Jeff Goddard: Hello. [00:03:18] Dave Etler: yeah, these are all actual inventions. You guys didn't make these? No, I'm not. Don't sue us, us makers of these things. Actually, some of them are dead. these are actual things though. Yeah. All of them are actual dubious inventions. [00:03:31] Jeff Goddard: Inventions. I would [00:03:32] Riley Behan-Bush: love to just go down the list of like patents in the world. Yeah, I bet there are some absolutely unhinged patents. Yeah. Yeah. From someone just getting crazy with some ideas and saying, what's the worst that can happen? I might as well get the patent. Yeah. That's [00:03:46] Happy Kumar: just how we advance. Yeah. I figured that'll be like really good for trivia because you'll figure out someone who made like one invention and you figure out that they also own a patent for some completely unrelated invention in another field, and you'll be like, Hey. Did you know that the person who made like X also happened to make like, I don't know, a portable toilet or something and you're like, [00:04:06] Riley Behan-Bush: damn, this would be a great trivia question. Or like the true two truths and a lie. Like which of these, [00:04:10] Faith Anton: inventions is not, that could be a theme of the show sometimes. Yeah, that would be fun. [00:04:14] Happy Kumar: Yeah. [00:04:14] Dave Etler: Okay. We could [00:04:15] Faith Anton: just do it right now. [00:04:17] Dave Etler: I don't know if I'm prepared to be that spontaneous. Spontaneous [00:04:20] Faith Anton: faith spontaneity. Isn't spontaneity on like one of those laptop stickers you have or I don't [00:04:26] Dave Etler: think that's one of them. [00:04:27] Faith Anton: No, I don't have my laptop with me. [00:04:30] Dave Etler: Anyway, thank you guys for joining me on the show today. we do have a listener question, we haven't gotten a lot of listener questions lately, and I'm so glad that Savannah phoned in with her question to, the Short Coat Podcast hotline 3 47 short ct. you can also email us at, the short coats gmail.com. Let's hear Savannah's question. [00:05:58] Dave Etler: What do you guys learn about patient advocacy [00:06:04] Happy Kumar: in terms of just kind of our [00:06:07] Dave Etler: curriculum here or in general? Yeah. what do you learn? and then I mean, you're, out in the clinics these days. Yeah. so you could maybe tell us a little bit about that part of it. Sure. [00:06:17] Happy Kumar: yeah, so first off, Savannah, thank you for the question. I think it's a really important question. simply just because like our, we are here to help out our patients and help out our patients is to listen to them, advocate for them, figure out what their needs are, and then just ways to help them and the in their needs. but just kind of, this might be a bit of a long answer, but I have three ch answers for you, essentially. So the first one is talking about not getting burnt out and taking emotional burdens. and number one for that would essentially just be like, remember to take care of yourself. Oftentimes when I find myself kind of lacking empathy and not being able to be at my game a hundred percent whenever I myself am tired, I'm just kind of thinking about like, if I'm working like an overnight shift and if it's 2:00 AM and I'm not really running on sleep, and if I haven't eaten anything and I'm just looking forward to getting home, then the next time I see a patient coming in, I'm just gonna wanna get that encounter done and over with. and just kinda like being aware of that where it's like, oh, hey, like I myself am hurting and this might be a good time for me to like, take a step back a little bit, go out, get a snap to snack, to eat, take a power nap, just like take care of myself a little bit more. Just so I can then be focused and take care of my patients. so that's like the first thing that I do in order to avoid burnout a little bit simply just because like, I find that like if my needs aren't being met, then I'm not really gonna care about anyone else, unfortunately. that's one. number two is just kind of, and this will help out on the adv advocacy side, is just to kind of be aware of your own personal biases. especially in healthcare, you're gonna, you're gonna see patients from all walks of life, from all sorts of backgrounds. The first patient you see, you might be like, oh, this is really serious. I want to help you out and everything. and then you might, and it might just be a bread and butter case, but then the next case you see just might be, really sad, really terrible. and you might even just walk in and already have preconceived notions about these patients. and just kinda like being aware of like, you know, just kinda like the mental box that you put them in and the fact that they're not gonna be in that box and you shouldn't necessarily always treat them as if they're in that box. Does that make sense? I think so, yes. Yeah. So we all have biases in everything and just like being aware of them is the first part of the, it is just the first [00:08:51] Dave Etler: part because I think even if, I think what you're saying is even if you are aware that somebody needs help, right? And you're coming to it from that perspective, right? You've already, but you haven't actually met them or talked to them yet, you've already made some judgment about them that may or may not be warranted. That might, right. That might color your perception of that right. [00:09:14] Happy Kumar: Encounter. Right. Because no matter what, most of the time before you see a patient, you're either gonna be reading in their chart and reading their previous notes. And in a sense, like getting to know them and seeing these preconceived notions before we even sit. Like before you even see them. Right. [00:09:28] Dave Etler: And those notes that you read. Yeah. As much as you might want them to be or as much as you expect them to be. Right. They may not tell, they don't, they won't tell that person's whole story. [00:09:36] Riley Behan-Bush: Oh, a hundred percent. Yeah. Like an example would be you read in the notes that this person come, like is frequently coming back to the emergency department. You might go in and be like, oh, well I'm already have this bias that this person may be here for a reason that they don't need to be. And then you go in and you're not actually going to be able to like listen to that patient Yep. And kind of understand and hear what they actually have to say. Yeah. So, it's kind of like the boy who cried wolf. Like Yep. There could be experiences in which the, boy crying wolf is the doctors who have had preconceived notions in the past that you're reading about or actual true stories about patients. But regardless, those are the biases. [00:10:13] Happy Kumar: Yeah. Yeah. and then one last thing. and this is just. So because like I'm coming off of my OB rotation, and especially like as a guy being on an OB rotation, there's a lot of like privacy concerns and just it's easy for me to make a patient uncomfortable. So before, like walking into like a patient's room might always just be like, okay, just like, like be the doctor that you want your, that I want my mom to see, right? And it's just kind of, just making things a little bit more personal talk, talking someone through it, listening to them a lot more, and just be the, be and just like be that patient advocate. I, I don't know necessarily like if that'll help out, but that's just kind of something that like I told myself on like, Hey, like remember like these are actual people that you're dealing with and like make sure, like you figure out what all, what they're, what they're telling you and why they're telling it to you and how it relates to their health. [00:11:06] Dave Etler: Man. Jeff, What do you, what have you, what in the didactic curriculum. ha. What have they taught you about patient advocacy so far? You just finished year one. [00:11:19] Jeff Goddard: Yeah. So, I was actually thinking of the hidden curriculum that we've gotten a little bit. So we've had some small groups where we will practice with these, hypothetical situations of what would you do if a patient is a insulting a fellow staff member, or what would you do if a fellow medical student has made some racist comment toward a patient or an attending has made some, I don't know, inappropriate comment about a patient that you're about to see? And I. I have a very strong sense of justice. It gets me into trouble a little bit sometimes. I have a hard time like, you know, waiting for the proper moment. And, several times I've been like, well, probably the best thing to do would've been to like, anonymously report instead of confronting the individual. And I keep thinking like, no, the patient needs an advocate right now. and so I think that, I mean, obviously there's a balance between trying to do what's best for your career, and not like always fighting these battles. But also I'm somewhat concerned that the implicit or sometimes explicit instruction is, don't make a fuss, don't make waves, and then if you need to silent, like silently, anonymously report what happened. yeah, so I don't know. That's,I'm normally the happy-go-lucky, optimistic one, but in this situation, I think I'm not as optimistic. [00:12:48] Dave Etler: Yeah, I was, I was thinking about ways, you know, one of the things that she mentioned in her question, which kind of derailed me when I was first thinking about this, was the thing that she said was about abuse of patients by coworkers. And that's fucking tragic. I, [00:13:06] Faith Anton: kind of test, well, I mean, I worked in a nursing home too, like Savannah did, and it does happen. And I worked in one that was for more affluent people. And the fact of the matter is that in our country, like, I mean okay, tangent, but the book, being Mortal by UL Gawande I think is how I say his name. Or how we say it, he did it. Um, recommend that to anyone here, anyone listening, excellent author. But we have like in America and probably around the world, like a really awful problem with how we treat. Our wiser population when our bodies begin to fail, you know, and America is all about independence and we're go-getters and we're taking care of ourselves. And then, you know, people who need people get left behind. People who need us get left behind. And I'm so not saying that is right, but I'm just saying that it's a reality of medicine and healthcare workers and it really stinks. So the fact that Savannah, that you actually were able to report those things that you observed, that it's incredibly brave and honestly not something that a lot of people do. I don't think because of, you know, just like about everything in life medicine is about power hierarchy and we're afraid of repercussions that might fall on us. Right. If we decide to go against [00:14:23] Dave Etler: that. So, and it requires that you, like every place puts systems. I think probably a lot of places put systems in place That you're supposed to use in order to report. Such things, right? But doing so requires that you trust the system. And that's a big ask. I want to acknowledge that. You know, that's a really big ask. because [00:14:46] Faith Anton: it's easy for us to sit here on our righteous seats and be like, oh, yeah, if I saw this happening to a patient, no doubt in my mind would I go to the higher ups and report it. But the fact of the matter is, it's hard. It's a hard thing to do, but we do it because it's Right. [00:15:02] Dave Etler: I think there can be a way to do it. And Jeff sort of touched on this when he sort of was talking about himself as a crusader a little bit. Or a, I can't remember the exact words. You used a bulldog maybe. yeah. but I think the thing to do is, especially if you're not in a position of power, like as a medical student I think the thing probably to consider is, Talk about the facts that you see in front of you. So if you're a medical, for instance, if you're a medical student, you go into a patient's room and you see a new bruise, the thing to do is to talk about that bruise. And to go to your resident or your attending or whatever and say, Hey, I noticed this. just wanna let you know. Cause number one, it could be clinically significant in some other way, right? but it's also sort of an indication that something isn't right here. Now, I'm sort of approaching this as if, you know, you're first on the scene to, to notice this, but you may not be the first on the scene to notice it. This may be something that's sort of piling up. you know, something that's sort of piling up among the reports that your residents or your attendings are getting and maybe starting to make them. Suspicious. [00:16:15] Riley Behan-Bush: Well, I think one of the key things too is as a medical student, are any trainee in the medical establishment, you are more likely to spend more time with that patient Yes. Than like anyone else that's coming through the rooms. Aside from maybe some of the like other care providers, but especially compared to like your residents and your doctors, you are likely to be the one that's gonna like, have a conversation with them, ask 'em about their grandkids, ask them about what they do for work, like et cetera, et cetera. So you're gonna have more time with them and you are going to be able, like you might think, well, maybe they all saw it. Yeah. Odds are they probably didn't, maybe they didn't. If you're really the one that has spent the most time likely, [00:16:54] Dave Etler: uh, that you should bring that up. I, posed this question to, a couple of faculty member members. the first is, Dave Asprey. He's, one of the deans, the Student Affairs and Curriculum Deans. and he's also the head of the PA program and he's in charge of the preclinical phase of our curriculum. and I asked him, you know, his thoughts about your question, Savannah. So let's hear from, Dean Asprey. So, [00:17:17] Dave Asprey: yeah, during the didactic phase, we certainly help our students recognize that as a critical member of the healthcare team, they are going to have those situations where they're interacting with patients and may have information from the patient that, other members of the healthcare team who may be. Had less opportunity to interact with a patient or maybe just have not had that same information shared with them, might have a very differing perspective on what a desired treatment might be. labs, lab tests, procedures that might otherwise be ordered. And so certainly our students can bring those issues to the attention of either the residents or the attending physicians that they're working with. Oftentimes patients might be a little more willing to share information with a medical student or a PA student simply because they maybe feel like they're not quite as, Powerful or as busy on the team. And so rather than taking some of that information to an attending, I think a lot of times they're willing to share that with a student who then in turn can be their advocate, [00:18:15] Dave Etler: I actually, I had an [00:18:15] Riley Behan-Bush: experience Oh, did you like, in this realm, and I'll try to like make sure it is well, kind of under the veil of anonymity. De-identified, de-identified. so I had gone in and seen a patient and they had expressed to me that they had previous experiences with eating disorder, disordered eating. And it was going to be a topic of conversation at that experience with the doctor, it was in an area of medicine in which. Talking about diet and weight was likely going to come up. And so this person really expressed to me that they've really worked through this a lot. It was going to be really difficult to work through that they were, well aware that it was going to be a topic of conversation. And if it didn't need to be, then it would be really appreciated by the patient. And ultimately, like from my perspective as a medical student, I could see that this person really understood and I wanted to make sure that the doctor knew that and knew to like tread lightly into that conversation and to come at it from a very empathetic perspective. And I talked to this patient and I said, well, likely it's going to come up. What do you need to make sure that it is like an open and honest conversation if it has to come up? And we had a really good conversation and ultimately when the doctor came in and I was in the room as well, This patient ended up starting to cry and I was like a little worried. I was like, oh no. Like we messed it up. Like I told the doctor to do the wrong thing, but she looked at us and she was like, I was, I've never felt so heard by a medical provider ever. And it was all because that provider had the information from the measly little medical student who got to go in and spend 20 minutes and just talk with this person. And so the doctor knew tread lightly and it amazing. It was awesome and like it really did work and it, I so easily could have gone to that doctor and been like, eh, I don't really wanna like add more to this person's plate. Like it's not a big deal. Like whatever this person get over it. But it was so important and you could tell so much that it was so, it's not even just like patients that are like those kind of big things where it's like, oh, you know when it's happening that someone got hit or some abuse is happening. But really it's just like, Listening to them and make, like taking that little extra effort to make sure that they are heard, seen and treated. And this [00:20:42] Dave Etler: is how it's supposed to work. Right? Yeah. I mean, you're supposed to be, as the, you know, you're on a team of people who are providing for patients, right? You should be sharing the information that you have so that everybody knows what's going on, has all the information, and can do the best they can for the patient. That's brilliant. Yeah. what a great sort of formative experience [00:21:07] Riley Behan-Bush: for you. It was so formative, and I think the other thing that's been so formative that we learned during our didactics is just always ask the patient what they're thinking. Like, what are, what do you think it is? What are you thinking? Like patient advocacy can range, it's anything from, you know, reporting when something wrong is happening, but it's also really important to just hear them when they say, I think my appendix is bursting. Maybe you should check on the appendix. Or maybe they say, well, I really think I have cancer. And in the back of your brain you're probably like, well, no. but remember they're telling you that because they're anxious, they're worried about something really tragic happening in their life. Yeah. Don't just be like, nah, you don't have cancer. You have to like, walk them through that, make them feel heard, seen, acknowledged. Like that's the whole [00:21:56] Dave Etler: point. Yeah. specifically thinking about Savannah's question, what do they tell you about mandatory reporting as medical students? when I looked at what mandatory reporters were in Iowa, and I assume it's gonna vary from state to state. it wasn't clear to me that medical students were in included in that. I think in a [00:22:34] Faith Anton: way we are. I mean, you have to be right. No, we definitely are. at least like in terms of children Yeah. Pediatrics and dependent older adults. Like we signed up for this profession and we have a duty to our profession and like primarily our patients to look out in their best interests. [00:22:55] Happy Kumar: Yeah. If we're in a situation where we might have to like report like suspected abuse, With a patient, then typically, we will be [00:23:04] Faith Anton: with someone else. Yeah. We're being supervised as [00:23:07] Happy Kumar: students. Yeah, I will. Yeah. So I may go in there alone on my own. Mm-hmm.But the resident will definitely follow up. Also follow up. And the attending will also definitely follow up. so like, it might not be us specifically who are the mandated reporters, but like someone who is a mandated reporter will be in that chain of command and they will like, like lay eyes and talk to the patient. Yeah. [00:23:32] Dave Etler: I wanna talk, I wanna hear from, Katie Harris. She's, our, McOwen learning community, faculty. Director one of the two and, I sent her the question so that she could weigh in. Let's hear from her. [00:23:45] Katie Harris: Hi, this is Dr. Katie Harris and I am an internal medicine physician and I work primarily in the hospital, but also do some outpatient work. And I think that this is a really great question about how to care for patients who have suffered, abuse You know, in my work as primarily an inpatient internal medicine physician, I have seen patients, who have been abused, usually patients with intellectual disabilities, or dementia and or are suffering from elder abuse. I think that for me, the. Best way to help these patients is to involve others. So having our multidisciplinary team, including the nurses, nursing assistants, and social workers are really the key to helping these patients, move forward and to prevent abuse from happening in the future. I know that she mentioned in the question, how do we prevent abuse from occurring? And for me, unfortunately, when I'm seeing the patients, it's usually after the abuse has occurred and we're more looking toward preventing abuse in the future. to be honest with you, medical school doesn't train me,to know all of the resources within the community and also all of the legal aspects that come into play. And that is where the social workers are really invaluable to me. So having that multidisciplinary team and support is what's most important. secondly, I think the question asked about how to not let this lead to burnout. And for me, I think, you know, I feel very empowered to be the patient advocate, so that's my time to speak up on their behalf, to get the right people involved. and honestly, that makes me feel as though, you know, I'm really helping them and helping them to stay safe in the future. So I guess that aspect of it has not burned me out in the past because I focus on the advocacy work that I'm doing on each patient's behalf. [00:25:50] Dave Etler: Awesome response. And gets to exactly what you were saying, Riley, about your success in that particular example that you gave, you did something good that day. Ain't nothing, ain't no reason to burn out over that. And, you know, you go back and listen to a recent episode that, we did with Wendy Dean, where she talked about burnout being more a moral injury. and I think the point,the salient point there is that, you know, yes, you're gonna be, you're gonna work real hard. Yes, you're gonna work long hours. Yes, it's gonna be a demanding profession. but really when people burn out, it may be more about not being able to do the right thing for your patient because the system won't let you. and in this case, and then in the situation that Katie is talking about and the case that you brought up, that's not what's happening. You are able to make a profound difference in somebody's life because you noticed and you acted upon the information that you had, hard to get burnt out over that sort of thing. Now I would love to know more about Savannah's experience reporting. Abuse because it may not have worked out the same way in her situation, at a mental health facility. I don't, you know, I don't know. But I think at a teaching hospital especially, you're gonna find a very different dynamic. it's unfortunate that, you know, people who are so dependent on, on caregivers can't, may not be able to trust them. That's horrible. [00:27:28] Happy Kumar: Yeah. [00:27:28] Faith Anton: And I don't know, like, I think happy you said earlier that you're an optimist or no. That was Jeff that said that chooses to view the world like in a positive light. Right. And. I don't know, like, I don't wanna be cynical when I say this, but I think that humans, whether they're in a, in the medical profession and like, you know, we're gonna do good work, but at the same time, like we're still human and we have the propensity to be bad, you know, like no matter how we try, but we can also try to be good despite like, being tired. And I think it's important to like realize that because like in my personal life, if I'm tired, if I'm fed up with stuff like happy alluded to when he needs a snack, like we snap at people, we don't be behave through like in a way that we be proud, not me, pleasant [00:28:18] Dave Etler: at all times. Oh, [00:28:20] Faith Anton: oh, I could totally see that. Just like sunshine, rainbows all the time. Absolutely. So, and again, like you talked about biases, right? Someone did. But like, just being aware of that and being aware that other people also suffer in the same way and maybe some people want to be mean. In which case they need help. In my opinion. We all need help, but like, just be aware that does happen. And then be willing to have conversations with your coworkers or anyone. That is struggling with [00:28:51] Happy Kumar: that. Yeah. brief story time. so I was on a rotation where, we had a patient come in with a very horrific injury. and the prognosis like was not good. and just kind of the circumstances for the injury were also like really sad. one of my friends was there whenever this patient came to, their department first, and then they had to take time and they were told to take time off and talk with their team a little bit. Then they just cried for 30 minutes. and when they came up to my team, I just kinda remember seeing this patient, for the first day. but like a couple of the residents like sat me down. They're like, yeah, what you saw was horrific. and just remember to like, take time for yourself and talk about this with yourself, other people, your therapists and everything, because you're still gonna be seeing stuff like this in the future. But like, don't be ashamed to like, reach out and get help and talk about this and go through your emotions and don't just keep it all in. and then later on I talked to my attending about it and it's something that, they said that stuck out to me was, Behind every great surgeon is a graveyard of sorrows and regrets. and to me, that just kind of hammered in the point that like, yeah, you're gonna be seeing stuff that isn't great and it's gonna have an impact on you, and that might, you know, stay in your mind for years and decades on end, but you should still learn how to take care of yourself and learn how to like, just figure out these coping strategies, which, I mean, we're still kind of in like our training phase, so we're still figuring all that out. [00:30:31] Dave Etler: and I You're gonna be figuring this out for years to [00:30:33] Happy Kumar: come. Yeah. [00:30:34] Riley Behan-Bush: Just when you think [00:30:35] Jeff Goddard: you've figured it out. Boom. Yeah. [00:30:36] Happy Kumar: And so like, it's like, this is like a really hard concept, for, and like people have their own ways of just kind like dealing with all this stuff. But like, again, like that, that might change for years. I ju like, I remember like I was upset, at one point since, just kinda like any patient who's like older and who's an immigrant, since I, I see my parents in them, that like gets me upset and like there have been attendings who like, have gotten upset whenever like something happens to a patient and that patient is like the same age as their kid. Yeah. You know, so there are still [00:31:08] Riley Behan-Bush: patients like two years removed from clinicals where I'm like, in my brain I'm like, I wonder where they are. Yeah, [00:31:16] Happy Kumar: yeah. Because they just stick [00:31:18] Dave Etler: with you. Stories stick. Yeah. [00:31:20] Jeff Goddard: I'm trying, sitting over here thinking about why these things happened. Like a lot of pre-med students, I worked, as a CNA for a while. specifically I worked in memory care overnight while I was doing a full course load during the day. I was not my best on those shifts. a lot of my coworkers were also not their best and, we probably didn't treat,the patients as well as they deserved. Like, I wasn't, you know, running around pushing them downstairs or anything, but,they deserve a lot more than what we are able to give them a lot of the times as caregivers. And the difference in like an academic institution like the University of Iowa is there's a larger team. the problem I think that I've noticed, is when something is a for-profit venture not to get on my. anti-capitalism ramp, which I'm certainly not. I'm all for capitalism. But when healthcare becomes for profit and profit is the most important part of the endeavor for the owners, we start working on the margins. And all of a sudden, six people are taking care of 30 people. Six people are taking care of 40 people. And,it goes back to this idea that like, I like what faith said, like if somebody's hurting somebody else, it's probably because they need help. one would hope that person would rise above it and do the noble thing. And it's a beautiful thing when somebody does. But at the same time, like maybe stop, setting up a system where you either have to be essentially a paragon of virtue or fail and cause harm. Like maybe just make a system where it's easier to do good and harder to do harm, by. Hiring more people, you know? Yeah. If you wanna fight burnout, if you want to give people more autonomy, if you want to prevent these types of, callous acts against more, especially our elderly population, but we need more caregivers. and we need hours that are more conducive to them being humane. yeah, that's it. I think that's, [00:33:18] Riley Behan-Bush: think that's fair point too, which is that like idea of the paragon of virtue and say you're a medical student leaving for the day after 12 hours. What [00:33:26] Faith Anton: does paragon mean? I think [00:33:29] Riley Behan-Bush: it's just like exemplar. You are like exemplar the vision of virtue. You are the ideal, the [00:33:36] Faith Anton: ideal. I love this. Okay. Okay. Sorry. [00:33:38] Riley Behan-Bush: Carry on. Yeah, no, I was just thinking cuz I think you could very much, if you're anything like me and you have even a dabble of anxiety where you would leave the day and you would think to yourself, Geez, I really should have advocated for this patient or I really should have done this. And like, you could leave your day just wallowing in the, I should have helped more than I did. And I think like Jeff brings up a great point, which is there is a lot we can do as patient advocates. I think it's really important that we do. There is also some times where we will miss Yeah. And be compassionate with yourself and to recognize you might have missed it because you've worked 3 24 hour shifts this week. Or you're, you were on your 27th hour of call and you just got a last another patient right before the day team was coming in and you're trying to scramble like you're gonna miss some. The goal is not to get every single thing right. It is not a, it is not kind of like a points game. if you lose out on an opportunity to help and be an advocate, you are not. Immediately back to zero. Like it is just incremental changes over time and recognizing that like little tweaks and putting yourself outside the box and saying to a doctor, Hey, I think this patient doesn't wanna talk about this. Or saying to your team, Hey, I think this patient is being abused. Like, those little things are gonna make a massive difference, but if you miss them, it, it'll be okay. It's not okay also, but like, I'm just trying to like, I guess also recognize what you, but we are also human and [00:35:16] Dave Etler: we'll some stuff. but I also wanna point out that, you know, you know, I don't wanna take your example of like going home and saying, I, I fucked up. That damage is done and I've, I'm a terrible [00:35:28] Faith Anton: person. Do realize I don't take Your audience is right. We are type A. Everything is but perfect all the time. I don't wanna take this, which like, it does not have to be, you do not have to be perfect. K, anyone? I don't wanna take that [00:35:36] Dave Etler: super literally. But I do wanna point out that it's rarely the case. So that's all or nothing thinking. I, it's rarely the case that you can't go back and fix it. True, true. You know, you could go the next day and say to your team members, I couldn't let go of this situation that happened yesterday. Can we talk about it? and you should do that. Yeah. Absolutely. [00:36:00] Faith Anton: And even if you don't do that, like if, sorry Jeff, if there's one patient that you can't help, then at least you'll have in your mind, I miss this. That is really upsetting. That is really bad. And I am not ever going to do that again. You very hard. Yeah. So, I don't know. It's the suffering of what? Oh, Cal. What is the suffering of few for the many? What is that? Is it the, [00:36:27] Happy Kumar: justice utilitarianism? There we go. [00:36:29] Faith Anton: Utilitarianism. Thank you, Jeff. Yes. Tip of my tongue. Yeah. [00:36:31] Riley Behan-Bush: Yeah. Jeff, what were you [00:36:32] Jeff Goddard: gonna say? I was gonna say that, so I have a lot of friends that, get onto me because I'm a bit of a perfectionist, but I am the most type B personality ever. Like, it's a false dichotomy anyway, but like, I'm big chilling, like my whole life is big chilling. And it's because of that idea that Riley brought up this self-compassion, this idea that like, I want to be perfect. Like, I literally want to be perfect, but also at the end of the day, I can say, I could have done better today. I can forgive myself and I'll do better tomorrow. it's just, it's, especially with something like medicine where you'll spend an entire lifetime trying to improve. So that you can better help people. I think that's like probably one of the most important lessons that you can learn. That you just, you have to be able to forgive yourself and move on. And, Riley opened that with like, maybe you're a little bit like me. I think, you know what, Riley, if we were all a little bit more like you, we'd probably be a lot better off. So [00:37:28] Riley Behan-Bush: yeah. I mean, you might just like be in your head a little bit more, but yes, I do believe, like, to believe that the worry that people have is only driving them to be better. Do I think that you should go outwardly worry about everything? No, that's wrong, but just it's a little hard to realize therapy, 10% better the next day or whatever. Like the like buzz [00:37:48] Happy Kumar: words that we've got. Yeah. Yeah. shout out Therapy. shout out therapy. Throw it out there. [00:37:52] Riley Behan-Bush: Better help. Can we get 'em as a sponsor? They're on every other podcast. [00:37:55] Happy Kumar: Yeah. A friend of mine, told me like, just go to therapy. It's like a nice mental oil change and it's kind of how I like to describe it. but medicine's kind of a weird field in the sense that like, whenever you're applying to it, you have to like be a perfectionist. You have to take all these standardized tests, you have to have like the perfect application, write the perfect essays and everything. And then whenever you're a doctor, all that kind of just like goes out through, or even when you're a student. Yeah. Like, yeah, like how do you sign point values to like talking to a patient, like you can't mm-hmm. You know, and medicine's like one of the fields where even if you do everything 100% right, things can still go wrong and it's not on you if that happens. So like, I'm definitely all for like, be easier on yourself and on the compassion train too. all you can do [00:38:45] Dave Etler: is all you. I mean, it sounds, it's very trite. All you can do is your best. And. Keep doing that [00:38:51] Riley Behan-Bush: hot tip. If anyone wants to like get rid of their academic validation, Do a PhD. You'll get no feedback. No thank you. You'll get no feedback, but love that. You'll write a paper once a year, then you'll get copious amounts of feedback that you don't want but are useful. It'll just Danish, it would recommend. Okay. 10 out of 10 Riley's would recommend. [00:39:11] Faith Anton: Okay. Jeff had alluded to like, policy and politics being the overarching influence on how we are able to deliver care. Money being at the root of all evil. so I just, this is my soapbox. This is what I'm passionate about. So like we have immense power as individuals if we go on our own as a group to our legislators. If we go to, in Iowa, if we go to Des Moines, if we go to. See the people that are actually stakeholders in policy. I mean, hell, if you even go to Washington dc I don't know, write letters, do what you can because like I have become really involved with that this year. And in that I think I have found immense purpose. So in previously in my life, I was interested, I didn't really believe that I could have an impact. But I think that if it's something that's truly important to you and at the, like the foundation of it is that our patients, we just, we want better healthcare for them. And if we want that, then we need to initiate change and policy that enables us to deliver that care. So that's kind of my message is that like, yes, you are one person. Yes, you may be, I don't know how old with however much experience in politics, but like that doesn't really matter. Like at, I would like to believe that politicians haven't. They would give an ear to anyone. Chuck Grassley even wrote me back when I emailed him about some issue wrote. their secretary will write you [00:40:58] Riley Behan-Bush: back. You can get a response. [00:40:59] Faith Anton: Yeah. Like it's, and it's fun just to be like, new experience. It's scary, but like goddamn, grow up, be involved in our country. I don't [00:41:08] Happy Kumar: know. Brief plug to the H D S M P, healthcare delivery systems management and policy distinction. Track at the [00:41:15] Faith Anton: University Iowa. How held the back come outta your [00:41:16] Happy Kumar: mouth. Agriculture medicine. We need rebranding. [00:41:20] Faith Anton: I'm acronyms. Speaking in acronyms, man. I'm just kidding. Sorry. [00:41:23] Happy Kumar: Go on. go on. Yeah. if anyone's interested in that, there's a management track over here where our distinction track where you can actually like, you know, meet up with legislators and everything. And actually go on like a policy elective. Yeah. we had, like, like someone come speak like a couple months ago, it was one of the,it was one of the local senators. I forgot his name. It's a really bad look for me. but, he like mentioned that like a lot of people who are like making like the state legislator, well, legislature laws actually like, have never been to college, which talking with us were, they're business [00:41:52] Faith Anton: like I've met them in February. Did they own businesses? They don't. Yeah. Or they're farmers. They just do politics as a side job because they feel a duty to serve. Right. Like [00:42:03] Happy Kumar: and Right, and props for them. Right? Yeah. And like they have their area of expertise. But we have our area of expertise and that doesn't overlap with their area of expertise. So that's why we need to go and talk to them and show them our perspective and everything. Right? Because if we're physicians, if we're as is, yeah. [00:42:20] Jeff Goddard: Continue. As a student who has gone to Des Moines, and to Washington DC to meet with legislators, they are very receptive. Especially if somebody is in a field of interest like medicine where it's like you're the ones that see the patients. You're the ones that know what these policies are actually going to do, talk to us, and they are very receptive, either through letters or through advocacy groups or go on your own, I guess. But, certainly one of the nice things about medicine is there are always going to be groups that you can join. So I'm. Personally, this may or may not help my case, but, I'm a member of the American Medical Association, the Iowa Medical Society, the, Iowa Public Health Association and a couple of other, advocacy groups that spend their time trying to get legislators to do things. And I've seen legislators change their minds on several issues. They voted differently because of meetings that they've had with either me or somebody that's just like me, another medical student who is trying to help them make better decisions. So, yeah, you can, if you want to be a good advocate for your patients, there's, they're not really a lot of places where you can have more of an impact than with the legislators. [00:43:31] Riley Behan-Bush: I am very, inspired now by all three of you. I will give my own personal biases in that I see politics and I think to myself, I'm ewm sick of it. I'm sick of it. I feel like nothing's gonna change, and if it's gonna change, it's not gonna change for the better. Yeah. Like, so I do think you guys have all encouraged me to like get a little more involved. Well, not that this is about me, but I just want to let you know, for all those people out there that are like, Ew, politics, this is [00:43:58] Faith Anton: important. It's ew politics because we've spent how long of society thinking ew politics. Yeah. When really we're blessed to have a democracy. We can like, speak to the people that make the decisions that affect everyone. So, [00:44:13] Dave Etler: yeah. Jeff, do you know the, us house member who Congressman Johnson. Is he the guy who, does the Really the one [00:44:22] Jeff Goddard: in North Carolina who's on the, the US Armed Services Committee? I think that's him. [00:44:27] Dave Etler: Yeah. [00:44:28] Jeff Goddard: yeah, I, he's one of my favorite humans. [00:44:30] Dave Etler: his message is that politicians are actually kind of reasonable people. where they appear to be unreasonable. they're trying to get the attention of, the media by being sort of outlandish. this is, you know, this is how they get attention, how they keep their jobs. Is that cool? no. You wish if [00:44:56] Riley Behan-Bush: doctors did that, I, right. I mean maybe it is the, maybe that's what we gotta do. Maybe it's the equivalent of driving into Chicago and you just see like personal entry, lawyers and doctors having billboards left and right, but like this is on a new scale. Yeah, I know. [00:45:09] Dave Etler: And I'm sure there are individual legislators that we could think of that probably are not normal and reasonable people when the cameras are off. But, you know, that's it's part of this game that they play, especially on the national level. I mean, that I think makes us go ill [00:45:26] Jeff Goddard: politics and, I'm sorry, his name is actually Jeff Jackson. That's what it is. [00:45:31] Dave Etler: Yes. Thank you. Yeah. go follow him on this. Go follow him on the [00:45:34] Happy Kumar: socials. I love [00:45:36] Riley Behan-Bush: a Hank Green reference. [00:45:37] Happy Kumar: Go ahead. Yes. [00:45:39] Jeff Goddard: Oh boy. Howdy. Do I love that man. and he made a comment about media in general that I thought was very apt. This idea that. the problem with all media is that, bombastic comments, divisive language, gets likes. it draws you in, right? And that's true if you're writing in the newspaper. That's true. If you're on cnn, that's true. If you're on TikTok or Twitter or Facebook, it doesn't matter. The things that are going to get people emotionally riled up are the things that get the most interaction. And so media kind of pushes us further and further into those things, which is why I like people, like, Congressman Jackson, who can say, remember guys, it's an act. We're all doing the act. We all know that we're doing the act. Because when you sit down with these people, think like your crazy aunt on Facebook, that's just spouting the most ridiculous nonsense. But then when you sit down with her for Thanksgiving dinner, she's actually somewhat reasonable. You can actually have a conversation with her. At least that's my experience with my family. The everything they put on the internet is nuts. And then I sit down with them and they're like, actually, yeah, I see that you have a point. Like, it's the same thing with legislators. It's the same thing with everybody that's on the other side of every issue. That, that is important to us. if you can get face-to-face interaction, turns out we're all human. Yeah. And there's a human side to us. [00:47:01] Faith Anton: Thank you for that, Jeff. I like that. Yeah. Yeah. Sending this to my family. [00:47:05] Happy Kumar: Yeah. [00:47:07] Dave Etler: Am I gonna have to remove that this week? No, I'll remove what I said. [00:47:13] Happy Kumar: it's okay. [00:47:14] Faith Anton: You can actually keep that. That's funny. Leave, [00:47:17] Happy Kumar: leave him. Yeah. I remember there was a quote with like, one of the former presidents, I know he's unpopular, but I think it might have been Reagan or whatever, but like, it was like, him and like the speaker of the house would just constantly butt heads and everything and like, The quote was like, from eight to five, they are like the worst bitter enemies ever. And then like after 5:00 PM till 8:00 AM they're like best friends and they like go out to [00:47:40] Dave Etler: dinners. It must be a strange existence being a politician. [00:47:43] Happy Kumar: Oh yeah. [00:47:43] Riley Behan-Bush: Yeah. That's what I, this is part of what I can't get, like some of the media persona is like also kind of, I have a hard time getting behind it. Never like [00:47:51] Faith Anton: did it, has it always been like that? It's really hard because I think the media's [00:47:56] Riley Behan-Bush: become political, become very disingenuous. [00:47:58] Faith Anton: Oh, I, okay. I go to bars and I talk about politics, religion, and Yeah, politics and religion. This is what I do. This is like, I love this. I love doing it. Sorry, [00:48:09] Dave Etler: I, I, yeah, I mean I think it's just, it's just, I think it's always, I think it's always been this way. I think it's in, it's always been this way. [00:48:17] Riley Behan-Bush: It's our [00:48:18] Faith Anton: new media, to be honest. People used to trust in the media to give them. The truth, and then now we don't even know what to [00:48:25] Riley Behan-Bush: believe. I think it's because of the YouTubes, the TikTok Instagram. Yeah. Like if we're gonna go like an anthology of why we have this, it's likely because of the short form medias that we've now like garnered I'm no [00:48:36] Dave Etler: anthropologist. Yeah. You when you've got like three minutes, in a video to like put your position forward. Yeah. [00:48:43] Happy Kumar: Also, like there's a lot of complicated issues that I don't think you could boil down to in just three minutes. No, you really can't. [00:48:49] Dave Etler: Yeah. You know, this is why my friend Jeff Godard's, TikTok is so I don't have TikTok, Jeff Godard's. It's so refreshing because it's a calm and measured discussion of actual things. [00:49:02] Faith Anton: Wait, Jeff, do you have Instagram? Because I don't have TikTok, but I religiously watched, eels on [00:49:07] Jeff Goddard: Instagram. I do have Instagram, I use it. You know what, so I've been in South Africa for well over a month now, I guess. I've posted exactly one picture and it's of me sitting on a bench petting a cat. Oh, respectable. I'm not really an Instagram guy. I'm sorry. Like I've licked an elephant. I've, you know, like seen a giraffe. I've done all of these things and I'm like, well, here's a cat. And that's what you guys are getting. Sorry, can we, so Instagram's not the place to follow me. Sorry. [00:49:35] Dave Etler: can we go back? did you say you licked an elephant? [00:49:38] Faith Anton: I definitely heard licked also, and I wanted to return to that. Al too [00:49:44] Happy Kumar: said also [00:49:44] Jeff Goddard: twice. okay. So there's a bit of a story here. When I was a child, I was licked by a giraffe and I swore vengeance, but the giraffe that's in our backyard here will [00:49:53] Happy Kumar: not hold, still our resident giraffe to [00:49:55] Jeff Goddard: stay still long enough. So the elephant I could get to, so I licked the elephant and I called it good. What did it taste like? it was very dusty. It was, covered with dirt obviously, because that's how they cool off [00:50:09] Happy Kumar: elephants. Are you immune to a lot of things now about elephants? Somehow with context, I'm even more confused. Yeah, that's fair. And elephant's not [00:50:17] Faith Anton: a giraffe. That's fair. I've [00:50:18] Riley Behan-Bush: learned so much about you that you had a vent. I respect though, from this Jura flicking you respect. This [00:50:23] Dave Etler: is hilarious. Is this me? Okay, so, so, I once in a pet store got peed upon by a cockatoo peed pond. [00:50:30] Faith Anton: A pawn. It's like, well British right now. We got peed [00:50:33] Dave Etler: upon peed pun by, by a cockatiel. Ew. Or something. Some big birds pee. I thought they [00:50:38] Faith Anton: peed and POed simultaneously. [00:50:39] Dave Etler: I don't know. This bird released, it came like car windshield. Yeah. This bird released a stream of [00:50:45] Faith Anton: nitrogen containing surface [00:50:47] Dave Etler: urine. I, well, back then, I didn't know that. I don't know the answer to your question. This was a long time ago, but in my memory, a stream about the width of a pencil came out of this bird and landed on my leg. Which by Jess's logic means that I'd should shit on a, [00:51:06] Riley Behan-Bush: also should pee on a dog [00:51:07] Dave Etler: too. But I'm gonna pee on a different animal. [00:51:12] Riley Behan-Bush: Pick your animal. What is our least favorite [00:51:15] Happy Kumar: animal? [00:51:15] Jeff Goddard: Animal? What you can get to, I guess a snake. [00:51:17] Riley Behan-Bush: What's every Yes. [00:51:18] Dave Etler: In your backyard. I do have two cats. Sorry. Cats. [00:51:21] Faith Anton: No, we like cats. They don't deserve that. They would probably hit you forever. That's all I got. I think. I feel like if any animal's gonna hold a grudge, it's a cat. Okay. [00:51:28] Happy Kumar: Yeah, that's true. [00:51:29] Dave Etler: Yeah. My cat shit on the floor last night. So rabbit. A rabbit. I [00:51:32] Happy Kumar: heard. I heard rabbits can like be petty uhhuh. I love that. Okay. [00:51:37] Jeff Goddard: All right. wait. There's only one person in that room that's old enough to remember when a president of the United States was attacked by a rabbit. Dave, do [00:51:47] Dave Etler: you know what president that was? I dunno. This story, I'm gonna guess that it was, oh boy. I'm gonna guess that it was Jimmy Carter. [00:51:56] Jeff Goddard: Dead on. [00:52:00] Dave Etler: Oh, so couldn't happen to a nicer guy. Oh, I [00:52:01] Happy Kumar: think I remember seeing like that documentary on it. Why was seeing like, what was it, Monty Python, the Holy Grail. [00:52:07] Faith Anton: Wait. Yeah. The best documentary. Like totally factual, hilarious. [00:52:11] Happy Kumar: It didn't, like everyone should watch it. It didn't like Jimmy Carter. Like, throw a hand grenade at that rabbit. No. Jimmy Carter was in my Python. No, that's the joke, because that was long time ago. Not dead yet. [00:52:22] Dave Etler: Jeff, why did he get attacked by a rabbit? [00:52:25] Jeff Goddard: I don't know the story. I wasn't alive yet. But, I do know that there are images of him trying to swim away from this rabbit, and it is chasing him through the water. So, [00:52:34] Dave Etler: something to do this evening while I'm lying on the couch scrolling. I'm gonna look up this video slowly, dude. A little American History for the kids. Amazing. [00:52:42] Happy Kumar: Amazing. It Girls be Bugs Bunny, maybe. I don't know. Yeah, I feel like that could be outta the Loony Tune skit. Yeah, it does seem like a [00:52:49] Riley Behan-Bush: Loony Tunes episode. That'd be so funny if Jeff was just messing with us all and it was just a Loony Tunes. I, [00:52:54] Faith Anton: I vote that Dave ends this episode by saying like, Dave, that's all folks [00:52:59] Jeff Goddard: except [00:53:01] Dave Etler: Well, I should, I should end the show. dang. Happy Riley Faith. Jeff, thanks for hanging out with me today. Appreciate it. Always a pleasure. what kind of doting old fool would I be if I didn't think you short coats for making it's part of your week. If you're new and you like what you heard today, follow the sh If you're new here, not like new. In general, if you're new here and you like what you heard today, follow the show. Wherever find podcasts are available, like Spotify, apple Podcast, Google Podcast, and YouTube. today's show is produced by Dave Etler. The show is made possible by a generous donation by Carver College of Medicine, student government, and ongoing support from the writing and humanities program. Our music is by Dr. Vox in Sphe. I'm Dave Etler saying, don't let the bastards get you down. Talk to you in one week. [00:53:41] Happy Kumar: And that's all folks. Hey, but [00:53:43] Faith Anton: hey, that's all folks. [00:53:44] Riley Behan-Bush: Listen on a code. Yeah, he didn't do it. [00:53:48] Faith Anton: Hopefully we'll keep that clip in.