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Meet again Joe Sherman. Joe grew up in a family being the youngest of seven siblings. His parents who had not gone to college wanted their children to do better than they in part by getting a college education. Joe pretty much always wanted to go into medicine, but first obtained a bachelor’s degree in engineering. As he said, in case what he really wanted to do didn’t pan out he had something to fall back on. Joe, however, did go on and obtain his MD and chose Pediatrics. He has been in the field for 35 years. This time with Joe we talk a lot about the state of the medical industry. One of Joe’s main efforts is to educate the medical profession and, in fact the rest of us, about burnout among medical personnel. Joe tells us why burnout is so high and we discuss what to do about it. Joe talks about how the medical profession needs to change to keep up with the many challenges faced by doctors and staff and he offers interesting and thought-provoking ideas. Again, I hope you will find my discussion with Joe Sherman beneficial, productive and helpful to you, especially if you are a doctor. About the Guest: Dr. Joe Sherman helps health professionals transform their relationship with the unrelenting demands of their jobs and discover a path toward meaning, professional fulfillment, and career longevity. He believes the key to personal and professional success lies in bringing “soul to role” in your medical practice. Dr. Sherman is a pediatrician, coach and consultant to physicians and healthcare organizations in the areas of cross-cultural medicine, leadership, and provider well-being. He is a facilitator with the Center for Courage & Renewal and a Master Certified Physician Development Coach with the Physician Coaching Institute. Dr. Sherman has been in pediatric practice for over 35 years concentrating on healthcare delivery to underserved and medically complex children in the District of Columbia, Tacoma, Seattle, Uganda, and Bolivia. He has held numerous faculty positions and is currently Clinical Associate Professor of Pediatrics at the University of Washington. Ways to connect with Dr.Joe: My website is: https://joeshermanmd.com/ LinkedIn: www.linkedin.com/in/joeshermanmd Direct email connection: joe@joeshermanmd.com About the Host: Michael Hingson is a New York Times best-selling author, international lecturer, and Chief Vision Officer for accessiBe. Michael, blind since birth, survived the 9/11 attacks with the help of his guide dog Roselle. This story is the subject of his best-selling book, Thunder Dog. Michael gives over 100 presentations around the world each year speaking to influential groups such as Exxon Mobile, AT&T, Federal Express, Scripps College, Rutgers University, Children’s Hospital, and the American Red Cross just to name a few. He is Ambassador for the National Braille Literacy Campaign for the National Federation of the Blind and also serves as Ambassador for the American Humane Association’s 2012 Hero Dog Awards. https://michaelhingson.com https://www.facebook.com/michael.hingson.author.speaker/ https://twitter.com/mhingson https://www.youtube.com/user/mhingson https://www.linkedin.com/in/michaelhingson/ accessiBe Links https://accessibe.com/ https://www.youtube.com/c/accessiBe https://www.linkedin.com/company/accessibe/mycompany/ https://www.facebook.com/accessibe/ Thanks for listening! Thanks so much for listening to our podcast! If you enjoyed this episode and think that others could benefit from listening, please share it using the social media buttons on this page. Do you have some feedback or questions about this episode? Leave a comment in the section below! Subscribe to the podcast If you would like to get automatic updates of new podcast episodes, you can subscribe to the podcast on Apple Podcasts or Stitcher. You can subscribe in your favorite podcast app. You can also support our podcast through our tip jar https://tips.pinecast.com/jar/unstoppable-mindset . Leave us an Apple Podcasts review Ratings and reviews from our listeners are extremely valuable to us and greatly appreciated. They help our podcast rank higher on Apple Podcasts, which exposes our show to more awesome listeners like you. If you have a minute, please leave an honest review on Apple Podcasts. Transcription Notes: Michael Hingson ** 00:00 Access Cast and accessiBe Initiative presents Unstoppable Mindset. The podcast where inclusion, diversity and the unexpected meet. Hi, I'm Michael Hingson, Chief Vision Officer for accessiBe and the author of the number one New York Times bestselling book, Thunder dog, the story of a blind man, his guide dog and the triumph of trust. Thanks for joining me on my podcast as we explore our own blinding fears of inclusion unacceptance and our resistance to change. We will discover the idea that no matter the situation, or the people we encounter, our own fears, and prejudices often are our strongest barriers to moving forward. The unstoppable mindset podcast is sponsored by accessiBe, that's a c c e s s i capital B e. Visit www.accessibe.com to learn how you can make your website accessible for persons with disabilities. And to help make the internet fully inclusive by the year 2025. Glad you dropped by we're happy to meet you and to have you here with us. Michael Hingson ** 01:21 Well, hi all. This is your host, Mike hingson, and welcome to another episode of unstoppable mindset. And today we are meeting once again with Dr Joe Sherman. And if you remember our last show, Dr Sherman is a board certified pediatrician and master certified physician development coach, and I won't give any more away, because it's more fun to talk to him about all of that. But we had such an interesting discussion, it just seemed like what we ought to do is to have a continued discussion, because we didn't get to cover everything that he provided to us last time, and and I know we've probably got lots more that we can add to the discussion. So, Joe, welcome to unstoppable mindset. We're glad you're here Dr. Joe Sherman ** 02:10 again. Thanks so much for having me. Michael, it's good to be back. Michael Hingson ** 02:13 Well, glad you're here and all that. Do you want to start by kind of, maybe refreshing people about you a little bit life and all that, any anything that you want to give us just to start the process? Sure, Dr. Joe Sherman ** 02:25 I currently live in Seattle, Washington with my wife. We have a few grown children that are in their early 20s, and I am a pediatrician, and now am a physician professional development coach, and I facilitate retreats for health professionals, medical teams, and most of my focus is on trying to bring who we are to what we do kind of being more authentically who we are in our workplace, trying to come to our work with a more balanced mindset, and trying to work A little bit more collegially as medical teams in today's ever changing health care environment. So now, I have practiced for about 35 years in pediatrics, and am now devoting all of my time to coaching and facilitation. You Michael Hingson ** 03:37 know, gosh, there's so many, so many things that would be interesting to discuss, and I do want to stay away from the whole idea of politics, but at the same time, what do you think about the whole way the medical profession, you know, of course, one of the things that comes to mind is just everything that happened during COVID. But what do you think about the way the medical profession and some of the things that the profession is trying to do is being treated by politicians, and a lot of times it seems like people don't take it seriously, or it just doesn't fit into their agenda. Does that make sense? Dr. Joe Sherman ** 04:15 You mean, as far as so as a pandemic was concerned? Well, the Michael Hingson ** 04:20 pandemic, or, you know, there were some discussions about end of life or life discussions, and some people poo pooed, having that kind of thing and saying that isn't something that doctors should be doing. Oh, Dr. Joe Sherman ** 04:33 I think, right now, I think that politics and healthcare are intricately entwined. Especially after the pandemic, and I think right now, the idea of the politics getting in the way of a kind of. The doctor patient relationship is, is challenging. It's challenging for healthcare workers. I think where we desperately need political courage is in trying to develop a healthcare system that works for everybody in the country. So I think that that's where the focus should be. Michael Hingson ** 05:21 What do you think about? And I've had a number of people tell me, single pay healthcare system wouldn't be a good thing. It's too socialistic, and we'll leave that out of it just wouldn't be a good thing. It seems to me that it has been very successful in a number of places, but the kinds of arguments that people give are well, but by having competition, we have been a lot better at producing new and innovative technologies that wouldn't be produced or wouldn't be provided if we had just a single pay kind of system. I don't know whether that makes sense or I'm expressing it the best way, but it just seems like there's an interesting debate there. I Dr. Joe Sherman ** 06:03 think there is debate because I do think there is some truth in the statement that our health care system has enabled development of technology and research in ways, perhaps that other countries have not. On the other hand, our health outcomes and our health access for people who live in this country is not very good, especially given the degree of wealth that our country has. So I used to joke, although it's not that funny, but one clinic where I worked that was a low income clinic, I used to joke that if one of our patients were to come out of their apartment To cross the street to come to the clinic. They may be turned away at the door because they don't have any insurance, or they don't have the proper insurance, or they can't pay but if they happen to be get run over by a car in the street on their way across the street, there would be no questions asked. The ambulance come pick them up. They'd be taken to the emergency room, given the best treatment to try to save their lives, admitted to the ICU and incur a huge medical bill with the greatest of technology, but they would not have been able to have gotten that primary care appointment to be in with. Yeah. So we are very kind of high tech, high intensity, high specialized in our approach to health care, whereas other countries focus much more on primary care. Michael Hingson ** 07:54 I know in 2014 in January, my wife became ill. Started out as bronchitis, and it kept getting worse, and she didn't want to go to the hospital, but, and she was always in a wheelchair, so she she found that they didn't really know how to deal with can Well, she was congenital or always paralyzed from basically t3 from the breast down, and she so she didn't like to go, but finally, we compelled her to go to the hospital. And was on a Saturday, and the next day, the bronchitis morphed into double pneumonia and ARDS, and her lungs ended up being 90% occluded, so she had to even to get air into her lungs, they had to use a ventilator, and she had a peeps level of 39 just to get air into her lungs. Yeah, you know what that that means. And it was, it was pretty amazing. People came from all over the hospital just to watch the gages, but she had literally, just about turned 65 and we were very blessed that we didn't get any bill because Medicare, I Guess, absorbed the entire thing, and we we, we didn't know whether, whether we would get anything or not, and we didn't. And she did recover from that, although she felt that she had coded a couple times, and then her brain wasn't quite as good as it had been, but, but she did well, and so we got incredible care from Kaiser Terra Linda up in the San Rafael area, and it all went well. Of course, I we had gotten the pneumonia shots, and I complained to our physician to talk about joking. I complained to our primary care physician. I. Well, you say that these shots are supposed to keep it from happening, but we both had the shots and and, and she got double pneumonia anyway. Of course, the unfortunate thing was that that the doctor had an answer. She said, Yeah, but it would have been worse if he hadn't gotten the shot. Darn. She shot me down, but it was fun to joke. Dr. Joe Sherman ** 10:18 Well, I'm sorry that that happened to you that that's, that's a unfortunate situation, it Michael Hingson ** 10:26 was, but you know, things, things do happen and and we did get over it. And out of that, we ended up moving down to Southern California to be closer to to family. So it worked out okay. But we we love the and really support the medical system in any way that we can. We see both of us did, and I still, you know, and wherever she is, she must see the value of of what's done. And it just is so frustrating anytime people say doctors are crazy people. They don't, they don't really look out for people's interest, and just so many different things. It, it's unfortunate, because, you know, I can tell you from personal experiences. I just said what we saw, Dr. Joe Sherman ** 11:16 yeah, I think that what is happening in our healthcare system now is this epidemic of burnout amongst professionals, especially amongst physicians and nurses, but and a lot of that has to do with the amount of administrative tasks and the amount of pressure that's put on physicians and other health care providers in trying to see as many patients as they can in the shortest amount of time as possible, and this is because of our system of fee for service reimbursement for medical care, the way that that health systems stay afloat is by trying to see as many patients as possible, and this unfortunately, combined with the amount of administrative work that needs to be done for each of those visits, plus the amount of communication that comes in from patients, as well as referral sources and requests for prescription refills, all of that comes in constantly through the computer of any physician that's trying to work as an outpatient or inpatient doctor, and it just becomes overwhelming, Michael Hingson ** 12:43 yeah, how do we fix that? That's a good loaded, general question, isn't Dr. Joe Sherman ** 12:50 it? It is it is a good question. And I I think it's a multi pronged approach. I do think that one thing that has happened is that the technology of healthcare and the business of healthcare has changed dramatically during the time that I've been a physician, a pediatrician, and the culture of healthcare, kind of, the way we do things, really hasn't changed. So that means that the business and the technology has placed more demands on us, and at the same time, we're kind of doing things pretty much the same way we've always done them, because of these extra demands that are placed on physicians and other health professionals, what's needed are experts that are in those areas of billing, administrative, administration, technology, it all of those things that now all feed into seeing patients in the office or in the hospital. So you need all of those professionals working together side by side along with the physician, allow the physician to do the work that she's been taught to do, which is actually deal with the patient and take care of the patient, and then let other people do the data entry, do the billing, take care of all of the messages and other things that are coming in around that that that provider. Do Michael Hingson ** 14:23 you think that the same level of burnout exists in other countries that exists here? Dr. Joe Sherman ** 14:29 You know it does. I do think that burnout exists everywhere in healthcare. I do think that it is less in low income countries, which seems kind of strange, but I've worked for many years in my life in low income countries in Africa as well as South America. And it's a different culture. It's a different culture. Culture of health care there is, there are different expectations of doctors, I think, in other countries, especially countries that are used to seeing a lot of disease and mortality, the pressure on saving lives and the pressure on having to be perfect and always get it right and knowing everything to do it each time that a patient comes in is not quite as intense as it is here. So I do think that it is different in other places. However, I will say that I have spoken to physicians in definitely in the more developed, higher income world, parts of the world that this epidemic of burnout is pretty universal Michael Hingson ** 15:57 now, It seems to me that I've been seeing in recent years more what they're called physician assistants. Is that a growing population, or is it always been there, and I just haven't noticed it? And does that help? Dr. Joe Sherman ** 16:14 I do think that in our country, here in the US, the future, will see many more physicians assistants and nurse practitioners, what we call Advanced Practice clinicians, or advanced practice practitioners, providers. We're going to see many more of them doing primary care, and a model that I think would would probably work very well is a team based model where the MD, who is kind of trained at a much higher level for many more years, leads a team of other providers made up of physicians assistants and nurse practitioners to do primary care, to take care of a group of patients, and perhaps that MD is there to consult, to be back up and to care for the more complex patients, while the nurse practitioners and PAs Are are getting the primary care, delivering the primary care. Michael Hingson ** 17:23 Well, I know that the PAs that I have dealt with through the years, it seems to me, have, especially in the last 10 years, but have been very, very competent, very qualified. And I I don't, I don't know that, where I would say that they're less rushed, but I've had the opportunity to have some good conversations with them sometimes when, when the doctor just doesn't have the time. So it that's one of the reasons that prompted the question. It just seems to me that the more of that that we can do, and as you said, the more that that takes off. Perhaps some of the load from the physician itself may, over time, help the burnout issue. Dr. Joe Sherman ** 18:10 I do think so. But I also feel like there's tremendous pressure right now on those pas and nurse practitioners, because they're under a lot of pressure too, too, and there aren't enough of them. Reduce and yes, so actually, right now, there's a movement within the the federal government to expand the number of positions in training programs for nurse practitioners and PAs. We have far too few, especially Physician Assistant schools. We don't have nearly as many as we need in this country. And if you look at the numbers, I think it's more competitive to get into PA school than it is to medical school, 18:54 really. Yeah, Dr. Joe Sherman ** 18:58 I, you know, I that's been my experience of what I've seen from people just, you know, the number of applicants toward compared to the number of accepted, hey, Michael Hingson ** 19:09 they wouldn't let you into a PA school, huh? 19:11 Exactly? Yeah. Michael Hingson ** 19:15 No, I know. Well, it's, it is interesting. I know we read a few years ago that University of California Riverside actually started a program specifically, I'm trying to remember whether it was for training doctors. It was something that was supposed to be an accelerated program. Oh, some of the hospitals sponsored it. And the agreement would be, if you went to the school, you'd get the education, you wouldn't pay and at the end, and you would go to work for those hospitals like, I think Kaiser was one of the major sponsors of it. And again, it was all about trying to bring more people into the profession. Which certainly is admirable by any standard. Dr. Joe Sherman ** 20:04 Yes, I think there are. Now, there are a few medical schools, and they're expanding the numbers that have free tuition, and they some of those schools, such as NYU Medical School has a generous donor who is given a tremendous amount of money as a donation and as an endowment. It pays for all the education of the students that go there. And there are some other schools that have the same arrangement. I think, I think if I were to be boss of the country, I would make all medical education free in in return, people would have to work in an underserved area for a certain number of years, maybe a few years, and then after that, they would be free to practice debt free, in any specialty and anywhere they would like. Michael Hingson ** 21:10 Well, we need to do something to deal with the issue, because more and more people are going to urgent cares and other places with with different issues. I have someone who helps me a little bit. She's our housekeeper, and she also comes over once a week for dinner, and she has some sort of allergy. She just her face and her neck swelled up yesterday and had all sorts of red spots and everything. It's the second time she took not Benadryl, but something else that made it go away the first time, but it was back, and several of us insisted that she go to urgent care, and she went, and while she was there, she heard somebody say that they had been waiting four hours. So she left, you know, and which doesn't help at all. So I don't know actually whether she went back, because I talked with her later and said, Go back. So I don't know whether she did, but the waiting time is oftentimes very long, which is unfortunate. And I don't know whether more people are getting sick, or they think they're getting sick, or they're just taking ailments that are less too urgent care, but there are definitely long waiting times. Dr. Joe Sherman ** 22:25 Yes, people, the people do not have a medical home. Many, many people don't have a medical home, a true medical home, that early in my practice pediatrician, as a general pediatrician, if there was a child that was in our practice and at night time or over a weekend, somebody would be on call. If that parent was concerned about a child in any way, they call the emergency line for the practice, the on call line, and that operator would page whoever the doctor was on call, and I would, as the doctor covering call that parent and talk directly at home, give advice over the phone, say what to do, make a decision of whether that child needed to go to the emergency room or not, or in the vast majority of cases, could give advice over the phone about what to do and then follow up when the office was open the next day or on the next week. Yeah, but nowadays, people aren't connected to offices like that. Yeah. We have call centers nurse advice lines of people that don't have access to medical records or have very strict protocols about what type of advice to give and the bottom line and the safest thing is go to the emergency room or go to urgent care. So that's unfortunately why some of the highest burnout rates are in emergency room doctors, and some of the biggest problems with understaffing are in emergency rooms right now. And Michael Hingson ** 24:16 I can understand that, and makes perfect sense to hear that, and it's unfortunate but true. So yeah, but yeah, you're right. So many people don't really have a home. We've been blessed Karen, my now late wife, of course, was always a patient of Kaiser, and was a strong advocate for the way they did most of all of what they did. And so I eventually, when we got married and we were in a Kaiser area, then I did the same thing. And mostly I think it worked out well. I think. Kaiser is a little bit more conservative than some when it comes to perhaps some of the the newer procedures or newer sorts of things like they, you know, we see ads on TV now for the Inspire way of dealing with sleep apnea, as opposed to CPAP machines. And I don't know whether Kaiser has finally embraced that, but they didn't for the longest time. At least our doctor said that it wasn't really great to have to undergo surgery to deal with it, and the CPAP machines work fine, but I think overall it to to use your your words, definitely, if you're in that kind of an environment, it is a little bit more of a home, and you have definite places to go, which I think is valuable. And I think that more people really ought to try to figure out a way to find a home if they can. Dr. Joe Sherman ** 26:00 Yeah, I do think that it is in the amount just society has advanced so so rapidly and so much in in how communication is instantaneous these days, through texting and through internet and through instant messaging, all these different ways that everything is sped up so people are looking for answers right away. Yeah, and it's, it's that's often puts too much pressure on the people that are trying to manage all of the patients that and all of their inquiries that they have. So I think, I think we need to make some serious changes in the way that we, that we staff hospitals, the way we staff clinics, and look and see what are the specific duties that need to be done, the specific activities and responsibilities in attending to a patient and specifically target personnel that are skilled in that activity, instead of having a physician who you know, is not the greatest typist, or is not the greatest at trying to figure out a code of billing for insurance or how to look at 100 messages that came in while she was attending to, you know, 25 patients in A clinic. It's just too much. It's overwhelming. And I mean, I now facilitate a group. It's a support group for physicians through physicians anonymous, where physicians are suffering from anxiety, depression, addiction. Suicide, ideation, and it's it's really at at scary levels right now, and I do think that the healthcare systems are starting to be aware of it. Think patients need to be aware of it, and the reason why, when you call, you're on hold forever or you never do get to speak to a real person, where it takes months to get in to see a doctor, it's because nobody's home. Yeah, everybody is many, many people have, have quit. Michael Hingson ** 28:39 Yeah, there's such a shortage. I know at least we see ads oftentimes for nurses and encouraging people to go into the field, because there's such a shortage of nurses, just like there's a shortage of teachers. But we don't do as much with the conversation of, there's an incredible shortage of physicians. I think it's probably done in some ways, but not as publicly as like nurses and some other types of physicians. Dr. Joe Sherman ** 29:13 Yes, I think right now, the I always feel like, I mean, this has been always true that on hospital floors, because the profit margin for hospitals is very narrow, there are only certain services that hospitals truly make profit on. So usually the staffing levels are kept to the very bare minimum, and now that just puts too much pressure on those that are remaining. And so now we're seeing many more hospitals have nurses that go out on strike or or decide to slow down, or. Or do other measures to try to get the attention of how dangerous it is to have understaffing in the hospital. Michael Hingson ** 30:08 Have we learned anything, because of all the stuff that happened with COVID Now that we're in this somewhat post COVID world, have we have we learned a lot or any or anything, or is anything changing, and is there really ever going to be a true post COVID world? For that matter? That's a fair question. Dr. Joe Sherman ** 30:29 That is a fair question. And I do think recent changes in policy by the CDC of of treating COVID As if it were influenza, or RSV or other type of respiratory viruses is there are many physicians that disagree with that policy, because COVID, this COVID, 19 that We've been dealing with, causes many more complications for those that have complex medical conditions, and this long COVID situation is something that we really don't have a grasp on at this point, but I believe one innovation I would see or expansion that has come about is the whole telehealth movement, now that there are many, many more video visits, I do think that's a good thing. I also believe that it can provide more flexibility for healthcare providers, which will help to decrease burnout, if providers are able to perhaps do their telehealth visits from home, or be able to spend time doing telehealth visits as opposed to having to see patients in person. I think what happens now is we need to get better organized as far as which types of visits are should be telehealth, and which types should be seen in person, so that one provider is not going back and forth from, you know, computer screen to seeing somebody in person, back and and so that gets too disorganized. Yeah, I think at times, other things, I think we learned a lot about infectious disease. I think that the general public learned a lot more about infections and infection control. I think that's all good. I think one thing that we did not learn, unfortunately, is how desperately we desperately we need to do something to try to stem the tide of burnout, because it just accelerated during COVID and then has continued to accelerate because of the economic crunch that healthcare systems find themselves in now. Michael Hingson ** 33:10 Well, and what is, to me, a little bit scary, is all it takes is one COVID mutation that we don't expect or encounter, and we're almost in back where we were, at least for a while. And I hope the day will come when, rather than using the the mRNA type vaccine that we use now that we truly will have a vaccine like an influenza vaccine, that can really kill the virus and that we can then take, even if it's yearly, but that will truly build up the immune system in the same sort of way. Although I have no problem with the current vaccine, in fact, I'm going in for my next vaccine vaccination a week from tomorrow. And what cracks me up is I've been there a number of times, and some people talk about the conspiracies of all they're doing is injecting you with all these little things that are going to track you wherever you go. And I'm sitting there going, Fine, let them. Then if there's a problem, they're going to know about it, and they'll come and get me, you know, but what I really love to do is a nurse will come over, she'll give me the the vaccination, and she pulls the needle away, and then I reach over with my one hand and slap my hand right over where she did the shot. And I said, Wait a minute. One just got out. I had to get it, you know. And, and she says, you know, there aren't really any trackers. I said, No, I'm just messing with you, but, but you know, it will be nice when that kind of a vaccination comes, and I'm sure. Or someday it will. Dr. Joe Sherman ** 35:02 Well, I think the vaccines it this specific, these types of respiratory viruses do mutate quite a bit. There's all kinds of variants, and they change every year. So I think no matter what kind of vaccine we get, we're still with with infections such as influenza or COVID, we're still going to end up needing to get annual vaccines, most likely, yeah, Michael Hingson ** 35:34 and that is the issue, that even with influenza, we do get lots of variants, and I know a couple of years, as I understand it, they kind of predict what strains to immunize for based on like, when Australia gets in our middle of the year and things like that. But sometimes it doesn't work. That is they they guessed wrong when it gets to us, or it's mutated again, and it's unfortunate, but it is, it is what we have to deal with. So for me, as far as I'm concerned, anything that we can do is going to help. And I really have found the current vaccines that we do get for COVID, at least, whether it will totally keep you from getting it or not, which I gather it won't necessarily, at least it will mitigate to a large degree what could happen if you didn't take the vaccination. Dr. Joe Sherman ** 36:34 Yes, yes, that's correct. We We are. We're seeing much less deaths as a result of COVID infection. However, in the peak of the winter time in the clients that I was that I've been coaching, who work in in hospitals and in ICUs, they were seeing still a large number of patients that were there. It's just that we've now developed better treatment and management for it and so, so then less people are dying of it. But it is, you know, we have, again, the amount of research, medical research and development that has developed these vaccines has prevented so much infection that what doctors are called on to do now and what they're called on to treat and manage has shifted much more into areas of behavioral health and lifestyle change than it is treating infections. That's dramatically different experience through my pediatric training than what type of training that a pediatrician these days gets Michael Hingson ** 38:01 and there again, that means that the physicians have to spend the time learning a lot of that that they didn't learn before, which also takes a toll, because they can't be in front of patients while they're learning or while They're studying. Dr. Joe Sherman ** 38:18 Yes, yeah, it's what the medical students and residents now are being called on to manage in the hospital are very, very complex, specialized conditions and very serious conditions. My experience as a resident was much more. The vast majority of people I took care of as a pediatric resident were normal, healthy children who happen to get sick, mostly with infection and sometimes very seriously sick, come in the hospital, receive treatment, and walk out as a child, a normal, healthy child again, we don't see that as often as pediatric residents, just speaking from pediatricians point of view, and I think that that has a an emotional toll on the resident physicians. I got a tremendous amount of reward from caring for patients with serious infections that received antibiotics and got completely better than patients who already have complex chronic conditions that just get worse or a complication, and they come In and the resident helps to manage them a little bit, and then sends them on their way. But really doesn't feel like they cured them contributed in the same way and that that was they don't have that same type of reward, that rewarding feeling, I think, are Michael Hingson ** 39:59 we seeing? More of that kind of patient, significantly more than we used to in the hospital. Absolutely. Why is that? Is there really are more or Dr. Joe Sherman ** 40:11 or what? Well, there aren't. We've taken care of most of the serious bacterial infections that used to be treated in the hospital with antibiotics, we've taken care of them with vaccines, and then we've also advanced the the quality and and variety of conditions that we can treat as an outpatient now, so that people that used to come into the hospital all the time for conditions, simple, basic things, are now treated as outpatients. And that's a good because you don't want to be in the hospital any longer than you absolutely have to. No, Michael Hingson ** 40:58 I had, well, my father, I don't remember how old I was. It must have been in the we 1960 sometime he had to have a his gallbladder out. So it was a pretty significant operation at the time, because they he was in the hospital a couple days, and came home with a nice scar and all that. And then my brother later had the same thing. And then in 2015 suddenly I had this, really on a Thursday night, horrible stomachache. And I figured there is something going on. I hadn't had my appendix out, but this wasn't right where my appendix was, but we went to the local hospital. We called Kaiser, and they there isn't a hospital, a Kaiser hospital up here, so they sent us to another place, and they took x rays, and then we ended up going down. They they took me by ambulance on down to Kaiser, and it was a gallbladder issue. So I guess all the men in my family had it. But what happened was that when they did the surgery, and by the time we got down to Kaiser, the there was a gallstone and it passed. So I didn't want to do the surgery immediately, only because I had the following Sunday an engagement. So we did it, like a week later, the doctor thought I was crazy, waiting. And then later he said, Well, you were right. But anyway, when I had the operation, there were three little band aids, and it was almost, I guess you call it outpatient, because I went home two hours later. Wow, I was I was blessed. So they it was almost like, and I've had colonoscopies before. I didn't spend any more time doing the gallbladder operation than I did, really, with all that I spent in the hospital doing a colonoscopy, it was pretty good, Dr. Joe Sherman ** 42:58 right? I do think that there's been again, major advances in endoscopic surgeries and robotic surgeries and minimally invasive procedures to be able to to treat patients. I mean, again, I have to say that our ability now to treat stroke and and heart attacks, myocardial infarction, our abilities to our ability to treat those acutely, do something to try to improve the outcome, has improved dramatically just recently, I would say, especially stroke management. So what we have is amazing, dramatic changes in in reducing the morbidity and mortality from stroke now, and I think that it's remarkable. Even as a physician, I didn't even realize until a recent trip I took to Bolivia with a group of neurosurgeons how stroke is treated now, and it's, it's, it's phenomenal that before you have a stroke, and it's just kind of like, well, you hope for the best. You support hope that some blood flow returns to that part of the brain. Now, if you have a stroke, and people are taught to recognize it and immediately get to the hospital, they can give a medication to melt the clot, or actually go in there with the catheter and extract the clot out of the vessel and restore you back to full function and Michael Hingson ** 44:56 remarkable, and have a glass of red wine while you're at it. Yeah. Uh, or, or, do we still say that TPA helps some of those things a little bit? You Dr. Joe Sherman ** 45:07 know, it's interesting. It's, you know, as far as as I think I've never seen so many articles written about the consumption of alcohol coffee, going back and forth and back and forth. You know what's helpful? What's not? Everything in moderation, I would say this point, Michael Hingson ** 45:28 yeah, I I would not be a good poster child for the alcohol industry. I have tea every morning for well, with breakfast. And the reason I do is that I decided that that would be my hot drink of choice. I've never been a coffee drinker. The caffeine doesn't do anything for me, so it's more the tea and then a little milk in it. It is a hot drink. Ever since being in the World Trade Center, I do tend to clear my throat and cough more, so the tea helps that, and that's the reason that I drink tea. But I remember seeing old commercials about red wine. Can can help you. So if I have a choice in wine, I'll oftentimes get red just because I've heard that those commercials, and I don't know how how true it is anymore, but hey, it's as good a reason as any to have a glass of wine every other week. And that's about what it usually is. Dr. Joe Sherman ** 46:26 Yeah, sounds like. Sounds like a good, a good plan. Yeah, Michael Hingson ** 46:31 works. Well, it's, it's now kept me around for a while, and we'll keep doing it. It works. So what is it that healthcare workers and physicians do to kind of restore their love for what they do and work toward burnout? What can individuals do? Dr. Joe Sherman ** 46:54 I think we're at a point now where in in approaching the issue of burnout and approaching the issue of overwhelm with the amount of work that physicians are called on to do these days is a combination of personal Changes to mindset and approach to our work, as well as structural and organizational changes to facilitate our work. And I think that the organizational structural changes, again, have to do with trying to improve specific staffing to match the activities and responsibilities that are that are called on in the medical setting, and being able to do more in the in the formation of medical teams and in teamwork And in people having a common mission, working together, appreciating what each other does, and hospital administrations and and those folks that run the business of the hospital truly value and enlist The engagement of frontline workers in policy and procedures. So those are kind of structural changes right on the personal side, yeah, I was that's I just a lot of it has to do with being more realistic. And I'm speaking to myself too. We can't do everything for everyone all the time we are human. We often have been taught that we are super human, but we're not. And if, if we try to do too much and try to do it perfectly, then our bodies will rebel and we'll get sick. So I think we need to set boundaries for ourselves. We need to be able to say, these are the hours that I'm working. I can't work any more than that. We need to say that you can't reach me three different ways, 24 hours a day, all the time, and have me respond to all of those inquiries, we have to set limits, and we have to really look at what it is that we love about medicine, what it is we love to do within medicine, and really try the best we can, I Think, with the help of coaches and other types of mentors and folks that can help us to create the types of jobs and the types of positions that help us maximize that experience of fulfillment, that experience of of. Feeling like we truly are contributing to the health and well being of our patients. Do Michael Hingson ** 50:07 you think overall that the kind of work you do, and then others are doing to address the issue of burnout is is really helping? Are we are we making more progress, or are we still losing more than we gain. Dr. Joe Sherman ** 50:23 I think we're making progress on an individual basis, on people that do seek help. But we need also to change the mindset of ourselves as physicians, to be willing to seek help. We need to seek help and be admit that we need that type of support, but until we get organizational commitment to trying to change the structures and the systems that we work under, then we will continue to have more physicians lost to burnout, depression and suicide. Michael Hingson ** 51:05 Are healthcare institutions recognizing more the whole issue of burnout, and are they? Are they really starting to do more about it? Dr. Joe Sherman ** 51:17 Some, I think some are. I think organizations are recognizing it. Associations of physicians are recognizing it. But when it comes to surviving as a health organization, healthcare institution, the bottom line is, what runs a show, and the way you make income is through billing, and the billing occurs as a result of a health care provider providing and billing for what they Do. So if there's an economic crunch, the first thing to go is anything that doesn't generate income and supports for the well being of staff does not generate direct income. What it does, though, is that it retains staff. It it results in a happier staff, a more higher professional satisfaction, and in the long run, is going to save you money, Michael Hingson ** 52:33 yeah, which, which is another way of making some more money. Dr. Joe Sherman ** 52:39 Yeah. I mean the total cost, the average cost for replacing a physician who has decided to quit is anywhere from about 600,000 to $2 million depending on the specialty of the physician. Yeah, Michael Hingson ** 52:57 and then getting people to necessarily see that is, of course, a challenge, but it still is what what needs to happen, because it would seem to me that those costs are just so high, and that has to account for something that is still a fair chunk of money. Yeah, it Dr. Joe Sherman ** 53:16 is. It's a great deal of money. And, you know, our again, our system of health care, we were headed in the right direction. And I think eventually we have to get there to population based health in looking at health outcomes and trying to look at overall health of of our our citizens and and those who live here in our country in trying to, instead of having a fee for service model, have a model that looks at reimbursement for health care based on the total health of The patient, and that is contributed to by nurses, doctors, technicians, receptionists, community health workers, all those types of health professionals. Michael Hingson ** 54:12 What can we do to get the wider society to become more aware of all of these issues and maybe to advocate for change. Dr. Joe Sherman ** 54:25 I think, I think avenues like this, these Michael Hingson ** 54:29 podcasts, this podcast is one. Dr. Joe Sherman ** 54:32 I also believe that look at your real life, lived experience of trying to access healthcare today compared to how it was 20 years ago, and are you having more trouble? Are you having is it more expensive? Are you having more challenges? This is direct result of a. System that's not functioning well. Michael Hingson ** 55:02 Did the whole process of what we now call Obamacare, did that help in the medical process in any way? I Dr. Joe Sherman ** 55:11 think what happened with Obamacare was well, and the bottom line answer is yes, it has helped. And the way it has helped is that more people have access to health insurance, less people are completely uninsured than ever before. So I think from that perspective, that's been helpful, but there were so many compromises, oh yeah, to insurance companies and two different lobbyists that were all looking out for their interests, that what ended up happening was a much more watered down version of what was initially proposed, but step in the right direction, And if we continue to work toward that, and we have some contribution of government sponsored health insurance, then we're going to be better off as a nation, Michael Hingson ** 56:14 yeah, well, and anytime we can make a step forward, it does help, which is, of course, a good thing. So if there's one thing you want listeners to take away or watchers, because we are on YouTube, if there's one thing you want people to take away from this, what would it be? Dr. Joe Sherman ** 56:33 It would be, pay attention to your own personal experience with healthcare. Pay attention to your own health and observe what's going on in the clinics, in the offices and in the hospitals where you receive your medical care. If somebody is treating you well with respect and compassion, point it out. Make it known. Thank them. Yeah, make it known that you know that they're under tremendous stress and pressure, and that anytime that they can be kind, then that means that they are very dedicated to to treating you, treating patients. And if you're finding that where you're going to receive your health care seems to be understaffed, and say something about it. If you have a health care provider who is a bit snappy, is not patient with you, doesn't seem to be listening to you, it's not because they don't want to. Yeah, they desperately want to. It's just that the conditions are such that they're not able to Michael Hingson ** 57:44 and and it would probably be good to at least engage them in a little dialog and say, hey, hey, I'm not trying to yank your chain here and kind of try to help warm them up. I've been a firm believer that in a lot of places where I go, like in the in the airline world, the TSA people and so on, I love to do my best to make them laugh. So like when I go up to the kiosk and the TSA agent says, I need to see your ID, especially when I'm wearing a mask, I'll say, Well, what do you want to see it for? You can't tell who it is behind this mask, right? And I've had a couple people who didn't expect anything like that, but they usually laugh at it. Then the other one I love to use is they ask for my idea. I say, Well, what's wrong with yours? Did you lose yours? And I just love to try to make them laugh where I can, because I know it's a thankless job, and I know that what doctors and medical people deal with is a pretty thankless job, too. So it's fun to try to make them laugh whenever I can and get them to smile. Dr. Joe Sherman ** 58:47 Yep, they all could use a little bit more humor. Yeah, there's always that. So Michael Hingson ** 58:51 if people want to learn more about you and reach out and learn about your work and so on, how do they do that? Where do they find you, online or any of those things? Sure, Dr. Joe Sherman ** 59:00 I have a website that you can go to. It's Joe Sherman md.com and you can reach me by email. Joe at Joe Sherman md.com also on LinkedIn, so you can find me there. Too Cool. Well, Michael Hingson ** 59:20 once again, I want to thank you for being here. This has been a lot of fun and very enjoyable and in a lot of ways, but certainly educational, and I've learned a lot, and we got through all the questions this time that we didn't get through last time, which is always a good thing. So see, it was worth doing it twice. Dr. Joe Sherman ** 59:39 Great. Thank you so much. Well, it was Michael Hingson ** 59:42 fun, and of course, for you listening out there, reach out to Joe, and I want to hear from you. I want to hear what you think of today. So please email me. Michael, h i at accessibe, A, C, C, E, S, S, I, B, e.com, or go to our podcast page, www, dot. Michael hingson.com/podcast and Michael Hinkson is m, I, C, H, A, E, L, H, I N, G, s, O n.com/podcast, would really appreciate a five star review from you, wherever you are listening to us. We like those reviews if you can, if you know anyone that you think ought to be a good guest on unstoppable mindset. And Joe you as well. We'd love to hear from you or provide us introductions. Always looking for more folks to to meet and to chat with, and love the incredible diversity and subjects that we get to talk about. So that makes it a lot of fun, but I do want to just once more. Joe, thank you for being here. This has been enjoyable, and I really appreciate it. Thanks Dr. Joe Sherman ** 1:00:40 so much, Michael, I enjoyed the conversation. Michael Hingson ** 1:00:48 You have been listening to the Unstoppable Mindset podcast. Thanks for dropping by. I hope that you'll join us again next week, and in future weeks for upcoming episodes. To subscribe to our podcast and to learn about upcoming episodes, please visit www dot Michael hingson.com slash podcast. Michael Hingson is spelled m i c h a e l h i n g s o n. While you're on the site., please use the form there to recommend people who we ought to interview in upcoming editions of the show. And also, we ask you and urge you to invite your friends to join us in the future. If you know of any one or any organization needing a speaker for an event, please email me at speaker at Michael hingson.com. I appreciate it very much. To learn more about the concept of blinded by fear, please visit www dot Michael hingson.com forward slash blinded by fear and while you're there, feel free to pick up a copy of my free eBook entitled blinded by fear. The unstoppable mindset podcast is provided by access cast an initiative of accessiBe and is sponsored by accessiBe. Please visit www.accessibe.com . AccessiBe is spelled a c c e s s i b e. There you can learn all about how you can make your website inclusive for all persons with disabilities and how you can help make the internet fully inclusive by 2025. Thanks again for Listening. Please come back and visit us again next week.
