WEBVTT 00:00:00.000 --> 00:00:02.640 This episode is sponsored by Transcend, a veteran 00:00:02.640 --> 00:00:04.960 -owned and operated performance optimization 00:00:04.960 --> 00:00:08.039 company that I introduced recently as a sponsor 00:00:08.039 --> 00:00:10.820 on this show. Well, since then I have actually 00:00:10.820 --> 00:00:13.080 been using my products and I have had incredible 00:00:13.080 --> 00:00:15.939 success. There was initial blood work that was 00:00:15.939 --> 00:00:19.039 extremely detailed and based on that they offered 00:00:19.039 --> 00:00:23.559 supplementation. So I began taking DHEA. bpc 00:00:23.559 --> 00:00:26.539 157 for inflammation based on the fact that i've 00:00:26.539 --> 00:00:28.859 been a stuntman a martial artist and a firefighter 00:00:28.859 --> 00:00:31.980 my whole life lots of aches and pains dihexa 00:00:31.980 --> 00:00:34.759 to help cognition after multiple punches to the 00:00:34.759 --> 00:00:37.820 head and shift work and peptides four months 00:00:37.820 --> 00:00:40.119 later they did a detailed blood work again and 00:00:40.119 --> 00:00:43.119 i was actually able to taper off two of the peptides 00:00:43.119 --> 00:00:45.640 because my body had responded so well to just 00:00:45.640 --> 00:00:48.079 one of them that it was optimized at that point 00:00:48.570 --> 00:00:51.869 So I cannot speak highly enough of the immense 00:00:51.869 --> 00:00:54.390 range of supplementation that they offer, whether 00:00:54.390 --> 00:00:57.409 it's male health, female health, peptides to 00:00:57.409 --> 00:00:59.429 boost your own testosterone, which I would argue 00:00:59.429 --> 00:01:02.429 is needed by a lot of the fire service, or whether 00:01:02.429 --> 00:01:04.569 it's exogenous testosterone needed, especially 00:01:04.569 --> 00:01:08.019 after TBIs or advanced age. Now, as I mentioned 00:01:08.019 --> 00:01:10.379 before, the other side of this company is an 00:01:10.379 --> 00:01:12.900 altruistic arm called the Transcend Foundation, 00:01:13.420 --> 00:01:15.980 which is putting veterans and first responders 00:01:15.980 --> 00:01:19.120 through some of their protocols free of charge. 00:01:19.340 --> 00:01:22.079 Now, Transcend are also offering you, the audience, 00:01:22.239 --> 00:01:25.299 10 % off their protocols. And you can find that 00:01:25.299 --> 00:01:28.040 on jamesgearing .com under the Products tab. 00:01:28.379 --> 00:01:30.840 And if you want to hear more about Transcend 00:01:30.840 --> 00:01:34.560 and their story, listen to episode 808 with the 00:01:34.560 --> 00:01:38.950 founder, Ernie Colling. or go to transcendcompany 00:01:38.950 --> 00:01:42.750 .com. Welcome to the Behind the Shield podcast. 00:01:42.909 --> 00:01:44.810 As always, my name is James Geering, and this 00:01:44.810 --> 00:01:46.849 week it is my absolute honor to welcome on the 00:01:46.849 --> 00:01:53.049 show physician and author Dr. Todd Otten. Now, 00:01:53.049 --> 00:01:55.950 in this conversation, we discuss a host of topics, 00:01:56.030 --> 00:01:58.870 from his journey into the medical profession, 00:01:59.209 --> 00:02:03.650 the training our physicians receive, the unknown 00:02:03.650 --> 00:02:06.849 story behind the woefully long residency program, 00:02:07.150 --> 00:02:11.789 the obesity epidemic, mental health in our medical 00:02:11.789 --> 00:02:15.750 professionals, his book, Ripple of Change, and 00:02:15.750 --> 00:02:19.110 so much more. Now, before we get to this incredible 00:02:19.110 --> 00:02:21.990 conversation, as I say every week, please just 00:02:21.990 --> 00:02:24.990 take a moment. Go to whichever app you listen 00:02:24.990 --> 00:02:28.710 to this on, subscribe to the show, leave feedback, 00:02:28.789 --> 00:02:32.900 and leave a rating. Every single five -star rating 00:02:32.900 --> 00:02:36.080 truly does elevate this podcast, therefore making 00:02:36.080 --> 00:02:39.979 it easier for others to find. And this is a free 00:02:39.979 --> 00:02:45.219 library of well over 1 ,100 episodes now. So 00:02:45.219 --> 00:02:48.860 all I ask in return is that you help share these 00:02:48.860 --> 00:02:52.020 incredible men and women's stories so I can get 00:02:52.020 --> 00:02:55.360 them to every single person on planet Earth who 00:02:55.360 --> 00:03:23.259 needs to hear them. Dr. Todd Otten. Enjoy. Well, 00:03:23.340 --> 00:03:25.599 Todd, I want to start by saying thank you so 00:03:25.599 --> 00:03:28.199 much for taking the time and coming on the Behind 00:03:28.199 --> 00:03:31.099 the Shield podcast today. Absolutely. Thanks 00:03:31.099 --> 00:03:34.400 for having me. I'm excited to see where this 00:03:34.400 --> 00:03:37.520 goes today. Absolutely. So first question, where 00:03:37.520 --> 00:03:39.680 on planet Earth are we finding you this afternoon? 00:03:42.000 --> 00:03:45.039 Great question. This is not my normal backdrop, 00:03:45.340 --> 00:03:47.939 if you will. Currently, I'm in Natick, Massachusetts, 00:03:48.340 --> 00:03:52.860 literally sitting outside of the office of Amy 00:03:52.860 --> 00:03:55.020 Schraub and Scott Pressler, who are two of the 00:03:55.020 --> 00:03:58.729 core. producers of the documentary Suck It Up 00:03:58.729 --> 00:04:02.229 Buttercup. And Scott has a vintage camera museum, 00:04:02.389 --> 00:04:05.270 if you will, that is strewn about outside the 00:04:05.270 --> 00:04:08.110 office. So that's where I'm at currently. Beautiful. 00:04:08.370 --> 00:04:10.110 Well, I would love to start the very beginning 00:04:10.110 --> 00:04:13.030 of your story. So tell me where you were born 00:04:13.030 --> 00:04:14.969 and tell me a little bit about your family dynamic, 00:04:15.229 --> 00:04:18.089 what your parents did, how many siblings. Oh, 00:04:18.110 --> 00:04:21.410 wow. So I was born in Lafayette, Indiana. My 00:04:21.410 --> 00:04:23.870 dad was at Purdue University actually getting 00:04:23.870 --> 00:04:27.910 his PhD in chemistry. um and i was born and within 00:04:27.910 --> 00:04:30.490 i want to say a month or two we moved from there 00:04:30.490 --> 00:04:34.370 to um southeastern michigan just south of detroit 00:04:34.370 --> 00:04:39.209 um one of four siblings i'm the oldest um three 00:04:39.209 --> 00:04:41.629 two wonderful sisters and a wonderful brother 00:04:41.629 --> 00:04:44.250 all of whom are accomplished in their own right 00:04:44.250 --> 00:04:48.050 you know most of the family dynamic was you know 00:04:48.050 --> 00:04:50.310 pretty good i would say pretty supportive uh 00:04:50.310 --> 00:04:53.819 for all intents and purposes i think it was Some 00:04:53.819 --> 00:04:55.660 of it was probably a sign of the times, maybe 00:04:55.660 --> 00:04:58.980 a little bit lacking in the mental health awareness 00:04:58.980 --> 00:05:06.459 and support. You know, and I think I was bullied 00:05:06.459 --> 00:05:10.300 pretty bad when I was in grade school. And I 00:05:10.300 --> 00:05:12.360 think there was a handful of things that led 00:05:12.360 --> 00:05:15.740 into that. We don't need to get into the specifics 00:05:15.740 --> 00:05:19.199 per se, but I think the lack of attunement that 00:05:19.199 --> 00:05:21.579 existed and lack of mental health resources back 00:05:21.579 --> 00:05:24.810 then. really propelled me to where I'm at today. 00:05:25.050 --> 00:05:27.310 And it took a long time to figure that out, James. 00:05:27.430 --> 00:05:30.110 I mean, it wasn't until within the last year 00:05:30.110 --> 00:05:32.410 that I realized I was basically running from 00:05:32.410 --> 00:05:34.529 one accomplishment to the next accomplishment, 00:05:34.750 --> 00:05:37.410 to the next accomplishment, to the next accomplishment, 00:05:37.449 --> 00:05:41.529 in part not wanting to address those traumas 00:05:41.529 --> 00:05:44.170 that had occurred from years gone by. And in 00:05:44.170 --> 00:05:48.170 retrospect, it surely was a big part of why I 00:05:48.170 --> 00:05:50.459 wanted to go into healthcare. wanting to help 00:05:50.459 --> 00:05:54.079 others and so on and so forth. But yeah, hopefully 00:05:54.079 --> 00:05:56.259 that answers the question. I didn't detour too 00:05:56.259 --> 00:05:58.459 much there. Yeah, well, firstly, you mentioned 00:05:58.459 --> 00:06:02.139 that your dad was studying. What did both of 00:06:02.139 --> 00:06:04.339 your parents end up doing as a profession? Yeah, 00:06:04.360 --> 00:06:06.620 sure. So my dad was a research chemist for the 00:06:06.620 --> 00:06:10.339 chemical company BASF, which his parent is in 00:06:10.339 --> 00:06:13.819 Germany. He was there for essentially his whole 00:06:13.819 --> 00:06:17.160 career, retired from there. So from the mid -70s 00:06:17.160 --> 00:06:20.990 to... Gosh, 10 years or so ago. And then my mom 00:06:20.990 --> 00:06:24.949 was a teacher, and she taught regularly until 00:06:24.949 --> 00:06:29.430 somewhere in the midst of myself and my siblings, 00:06:29.470 --> 00:06:31.889 she stepped away from teaching and became a full 00:06:31.889 --> 00:06:35.709 -time mom, which obviously is a calling and a 00:06:35.709 --> 00:06:38.009 profession and a passion in and of itself, right? 00:06:39.430 --> 00:06:42.529 When we all grew up and were kind of out of the 00:06:42.529 --> 00:06:44.410 house, more or less, she actually went back to 00:06:44.410 --> 00:06:47.620 teaching, which was really cool. So after a couple 00:06:47.620 --> 00:06:50.500 of decades, a hiatus of rearing children, she 00:06:50.500 --> 00:06:52.720 wanted to help other kids. So I always thought 00:06:52.720 --> 00:06:55.819 that was an amazing thing. Well, staying with 00:06:55.819 --> 00:06:58.540 your mom, what is her perspective if you've had 00:06:58.540 --> 00:07:02.339 these conversations on the evolution or devolution 00:07:02.339 --> 00:07:07.600 of education in this country? Oh, wow. I wouldn't 00:07:07.600 --> 00:07:09.920 say that we've discussed that at length, to be 00:07:09.920 --> 00:07:12.939 honest with you. I think the way I might answer 00:07:12.939 --> 00:07:16.069 that is perhaps in parallel with. some of the 00:07:16.069 --> 00:07:18.990 things that we talked about in Ripple of Change 00:07:18.990 --> 00:07:22.389 and trying to make comparisons with the quadruple 00:07:22.389 --> 00:07:24.310 aim in healthcare versus how that might apply 00:07:24.310 --> 00:07:27.029 to other areas. And for the listener who has 00:07:27.029 --> 00:07:29.209 no idea, like, Todd, what are you talking about? 00:07:29.269 --> 00:07:31.470 What is the quadruple aim? Well, I'm happy to 00:07:31.470 --> 00:07:35.410 tell you. So the quadruple aim was really an 00:07:35.410 --> 00:07:37.889 evolution of the triple aim. Triple aim is a 00:07:37.889 --> 00:07:40.889 way to deliver care in the context of population 00:07:40.889 --> 00:07:43.980 health. And I like to simplify it to... patient 00:07:43.980 --> 00:07:46.800 experience, quality care, and lower costs, right? 00:07:47.240 --> 00:07:49.399 Nobody would argue that those things are not 00:07:49.399 --> 00:07:53.279 critical, valuable, use whatever adjective you 00:07:53.279 --> 00:07:57.439 want. The issue with the triple aim is it really 00:07:57.439 --> 00:08:01.480 didn't address those delivering the care. And 00:08:01.480 --> 00:08:04.740 as a result of it, it unintentionally created 00:08:04.740 --> 00:08:08.160 a fair amount of clerical burdens, administrative 00:08:08.160 --> 00:08:10.569 burdens, whoever you want to describe it. that 00:08:10.569 --> 00:08:12.509 have perpetuated some of the mental health crises 00:08:12.509 --> 00:08:14.509 and so on and so forth. I know this is a long 00:08:14.509 --> 00:08:16.430 -winded answer. I'm going back to education. 00:08:16.509 --> 00:08:22.149 Take your time. So, you know, in 2014, Dr. Sinsky 00:08:22.149 --> 00:08:25.670 and Dr. Bodenheimer suggested that there should 00:08:25.670 --> 00:08:29.050 be a fourth component, and that should be clinician 00:08:29.050 --> 00:08:31.629 or provider or physician well -being, essentially 00:08:31.629 --> 00:08:33.570 wellness of those that are providing the care. 00:08:34.250 --> 00:08:36.509 There's even an evolution of that. Like in the 00:08:36.509 --> 00:08:38.389 book, we talk about our quadruple aim because 00:08:38.389 --> 00:08:40.850 we want ownership to be ubiquitous. You know, 00:08:40.850 --> 00:08:43.429 it's not mine. It's not yours, James. Use it. 00:08:43.450 --> 00:08:46.990 Take it. Run with it. And it was that notion 00:08:46.990 --> 00:08:50.090 where we made comparisons to health care delivery 00:08:50.090 --> 00:08:52.830 using the quadruple aim. Or how might that apply 00:08:52.830 --> 00:08:55.149 in a school setting? How might that apply in 00:08:55.149 --> 00:08:56.970 a restaurant setting? You know, because you're 00:08:56.970 --> 00:09:00.899 not valuing the people working for you. and delivering 00:09:00.899 --> 00:09:03.460 the care or delivering the education or teaching 00:09:03.460 --> 00:09:06.820 our children, are we getting the best out of 00:09:06.820 --> 00:09:10.779 those people? I don't know that we are. And I 00:09:10.779 --> 00:09:12.960 think there are a lot of problems related to 00:09:12.960 --> 00:09:16.220 that. When it comes down to it, any industry 00:09:16.220 --> 00:09:20.259 requires some level of human input, right? And 00:09:20.259 --> 00:09:25.820 human capital is so incredibly valuable. And 00:09:25.820 --> 00:09:30.039 if we just take the time to celebrate that. and 00:09:30.039 --> 00:09:34.159 honor that and care for those human beings the 00:09:34.159 --> 00:09:37.720 positive ripples if you will the coin of phrase 00:09:37.720 --> 00:09:42.720 are infinite um and you know i could see it you 00:09:42.720 --> 00:09:44.480 know thinking back on it talking to my mom about 00:09:44.480 --> 00:09:47.039 her time and in teaching you could see where 00:09:47.039 --> 00:09:50.299 there was moments where her work and her effort 00:09:50.299 --> 00:09:55.259 were valued and how it lit her up in such a good 00:09:55.259 --> 00:09:58.460 and positive way And on the converse, I can think 00:09:58.460 --> 00:10:01.519 of times where her work wasn't valued and the 00:10:01.519 --> 00:10:05.139 negative impact that that had on her. You know, 00:10:05.159 --> 00:10:06.980 and I don't have a ton of friends that are in 00:10:06.980 --> 00:10:08.980 the teaching space, but I do have a buddy that 00:10:08.980 --> 00:10:10.940 was a professor at a university. And I'm not 00:10:10.940 --> 00:10:13.879 going to name names or say universities or point 00:10:13.879 --> 00:10:16.179 fingers or that kind of thing. But some of the 00:10:16.179 --> 00:10:18.539 political stuff and the bureaucracy and the lack 00:10:18.539 --> 00:10:21.080 of respect that occurred for him while he was 00:10:21.080 --> 00:10:24.720 there, it was deplorable. And ultimately, he 00:10:24.720 --> 00:10:26.840 left. And the guy's freaking brilliant. and like 00:10:26.840 --> 00:10:28.259 is that what you want you know like treat your 00:10:28.259 --> 00:10:29.820 people like crap and then they leave and like 00:10:29.820 --> 00:10:32.860 this is nuts i'm out of here um so yeah i mean 00:10:32.860 --> 00:10:35.759 that was kind of a circuitous answer which is 00:10:35.759 --> 00:10:37.919 i suppose what happens when you talk to a family 00:10:37.919 --> 00:10:42.419 physician well staying on the parents just for 00:10:42.419 --> 00:10:45.419 a moment um working for a chemical company and 00:10:45.419 --> 00:10:48.379 obviously circling around the pfas is a big conversation 00:10:48.379 --> 00:10:50.879 in our profession at the moment and you know 00:10:50.879 --> 00:10:55.620 with the film dark waters shows the The corrupt 00:10:55.620 --> 00:10:58.360 element of hiding the damage that that chemical 00:10:58.360 --> 00:11:00.700 was doing and now it's literally poisoned all 00:11:00.700 --> 00:11:03.399 but the entire world has this chemical in the 00:11:03.399 --> 00:11:05.700 body now. Did you ever have any conversations 00:11:05.700 --> 00:11:09.139 with your father as far as that industry and 00:11:09.139 --> 00:11:11.539 some of the downstream ill effects that we're 00:11:11.539 --> 00:11:15.500 seeing from some of these products? To be perfectly 00:11:15.500 --> 00:11:18.399 honest with you, no. For probably a couple reasons. 00:11:18.539 --> 00:11:21.919 One, my dad was more on the surfactant side of 00:11:21.919 --> 00:11:26.429 things. And so I wouldn't say that that was where 00:11:26.429 --> 00:11:30.110 his specialty was. And as time has gone by, my 00:11:30.110 --> 00:11:32.289 father has gotten more involved in political 00:11:32.289 --> 00:11:35.830 discussions. And for those of us who are trying 00:11:35.830 --> 00:11:39.230 to get bipartisan agreement towards things, I 00:11:39.230 --> 00:11:41.809 tend to steer clear or sidestep some of these 00:11:41.809 --> 00:11:44.409 conversations. And so, yeah, we never really 00:11:44.409 --> 00:11:46.990 talked about it. I will give you some fun stories, 00:11:47.009 --> 00:11:49.509 though, if you want, of my time living with a 00:11:49.509 --> 00:11:51.509 father who is a chemist. I distinctly recall 00:11:51.509 --> 00:11:55.500 him bringing... home dry ice more than once and 00:11:55.500 --> 00:11:57.919 so you can imagine having some you know dry ice 00:11:57.919 --> 00:11:59.240 and throw it in some water and all of a sudden 00:11:59.240 --> 00:12:02.399 you got this smoke and these cool things uh i 00:12:02.399 --> 00:12:05.179 believe some magnesium came home more than once 00:12:05.179 --> 00:12:09.220 um which if you add water to a magnesium fire 00:12:09.220 --> 00:12:12.000 it's quite uh quite interesting and he had some 00:12:12.000 --> 00:12:15.700 amazing story of his from his youth of um making 00:12:15.700 --> 00:12:19.440 a vat of rocket fuel and inadvertently lighting 00:12:19.440 --> 00:12:21.759 it on fire in the backyard and essentially having 00:12:21.759 --> 00:12:25.090 a a cauldron of rocket fuel going up into the 00:12:25.090 --> 00:12:29.110 sky um but he also you know he i always had an 00:12:29.110 --> 00:12:31.230 interest in science too and so as you know as 00:12:31.230 --> 00:12:33.769 a young kid when you do these science experiments 00:12:33.769 --> 00:12:37.090 you know we made soap at home you know which 00:12:37.090 --> 00:12:39.389 is relatively simple process but he walked me 00:12:39.389 --> 00:12:41.549 through it and that was my that was my science 00:12:41.549 --> 00:12:43.309 project and i have a lot of fond memories of 00:12:43.309 --> 00:12:46.769 things of that nature so um in terms of p fast 00:12:46.769 --> 00:12:48.850 yeah i wouldn't say that i'm a p fast expert 00:12:48.850 --> 00:12:51.799 and nor have i had a a conversation with my father 00:12:51.799 --> 00:12:54.539 on it yes is it an issue but i think it speaks 00:12:54.539 --> 00:12:57.480 to you know to a certain extent one of the central 00:12:57.480 --> 00:13:00.320 themes you know some of the work that i'm doing 00:13:00.320 --> 00:13:03.519 you know where it should be people over profits 00:13:03.519 --> 00:13:07.399 and not the converse you know and unfortunately 00:13:07.399 --> 00:13:12.440 in many industries it's profits over people and 00:13:12.440 --> 00:13:16.600 we sacrifice all kinds of things for that and 00:13:16.600 --> 00:13:21.210 it's it's it's sad it really sad You mentioned 00:13:21.210 --> 00:13:23.669 about the bullying. When you were young, what 00:13:23.669 --> 00:13:26.490 was it that you were being made fun of, or was 00:13:26.490 --> 00:13:31.970 it just simply a purely predatory thing? Oh, 00:13:31.970 --> 00:13:38.649 gosh. Probably the answer is all of it. Everything, 00:13:38.809 --> 00:13:42.009 all of it, whatever. You know, I don't know that 00:13:42.009 --> 00:13:45.769 there were certain things that were the target. 00:13:46.190 --> 00:13:48.850 I think part of the thing that was consistent 00:13:48.850 --> 00:13:52.610 is... the way i responded and i would push back 00:13:52.610 --> 00:13:54.789 and they would get that response they would evoke 00:13:54.789 --> 00:13:57.129 that emotion and so then they would push harder 00:13:57.129 --> 00:14:00.309 and you know and it became this sort of vicious 00:14:00.309 --> 00:14:02.649 cycle of things and it's interesting how much 00:14:02.649 --> 00:14:06.710 of it actually repressed you know and and don't 00:14:06.710 --> 00:14:09.549 remember i mean i can even through going through 00:14:09.549 --> 00:14:11.450 trauma from therapy and coaching and stuff i 00:14:11.450 --> 00:14:14.330 only remember certain things and certain events 00:14:14.330 --> 00:14:19.580 and you know but i'll say this i mean i one of 00:14:19.580 --> 00:14:24.200 the most painful memories i had is um and i probably 00:14:24.200 --> 00:14:26.019 should give a trigger warning here at least for 00:14:26.019 --> 00:14:28.419 the audience a little bit people listening to 00:14:28.419 --> 00:14:30.460 this show and already know better i promise you 00:14:30.460 --> 00:14:33.379 all right fair enough okay yeah you never know 00:14:33.379 --> 00:14:35.200 and i'm like oh lord i started to say stuff and 00:14:35.200 --> 00:14:36.679 then i'm like maybe i shouldn't have said that 00:14:36.679 --> 00:14:39.179 um maybe i should also give the disclaimer that 00:14:39.179 --> 00:14:41.299 i was in the u .s navy so occasionally expletives 00:14:41.299 --> 00:14:44.100 come flying out of my mouth also you can do that 00:14:44.100 --> 00:14:46.649 just to let you know so Fair enough. This is 00:14:46.649 --> 00:14:51.389 a profane yet safe space. I love it. Love it. 00:14:51.870 --> 00:14:54.830 So, yeah. So, I mean, one of the most painful 00:14:54.830 --> 00:14:57.029 memories I had, or at least historically most 00:14:57.029 --> 00:14:59.870 painful memories, was, you know, imagine being 00:14:59.870 --> 00:15:03.309 a 12 -year -old little boy and being at school. 00:15:03.610 --> 00:15:05.049 And, you know, I don't even know what led up 00:15:05.049 --> 00:15:08.070 to that, but standing in the bathroom, looking 00:15:08.070 --> 00:15:11.769 at the mirror, deciding whether to kill myself 00:15:11.769 --> 00:15:18.440 or not. I mean, it took a lot of work to unwind 00:15:18.440 --> 00:15:22.799 that memory or at least be at peace with it a 00:15:22.799 --> 00:15:27.299 little bit. But, you know, bullying is pervasive. 00:15:27.379 --> 00:15:30.679 It's pervasive in the school systems. It's pervasive 00:15:30.679 --> 00:15:33.720 in coaching. It's pervasive in health care. It's 00:15:33.720 --> 00:15:36.480 pervasive in medical training. You know, I go 00:15:36.480 --> 00:15:40.960 to kids' sporting events, and the way some of 00:15:40.960 --> 00:15:44.820 these parents are acting over a... grade school 00:15:44.820 --> 00:15:48.419 or high school game it's like what are we doing 00:15:48.419 --> 00:15:52.340 like you were shouting obscenities at a 16 or 00:15:52.340 --> 00:15:56.139 17 year old ref who i mean that's a form of bullying 00:15:56.139 --> 00:15:59.120 and and for what so you win a game that you're 00:15:59.120 --> 00:16:00.759 not gonna remember the result of in five years 00:16:00.759 --> 00:16:05.120 from now i mean it's sick it's it's sick i and 00:16:05.120 --> 00:16:08.460 yeah so i mean i've i've endured bullying and 00:16:08.460 --> 00:16:12.559 many periods of my life, that being the most 00:16:12.559 --> 00:16:15.200 painful, but even medical education, you know, 00:16:15.200 --> 00:16:17.159 there's forms of bullying and intergenerational 00:16:17.159 --> 00:16:19.639 trauma that exists that, you know, they need 00:16:19.639 --> 00:16:22.399 to change. You know, we can't always be sacrificing 00:16:22.399 --> 00:16:26.200 for the non -human elements, particularly profit, 00:16:26.299 --> 00:16:29.919 if you will. But yeah, that was a tough memory. 00:16:30.039 --> 00:16:31.820 I mean, my goodness, I couldn't even think about 00:16:31.820 --> 00:16:35.830 it without crying for the longest time. Well, 00:16:35.909 --> 00:16:37.649 this is an important conversation. I just saw, 00:16:37.730 --> 00:16:41.070 I don't know the backstory, but there's a social 00:16:41.070 --> 00:16:43.389 media account that came across my feed that is 00:16:43.389 --> 00:16:46.389 the parent of a 10 -year -old boy who took his 00:16:46.389 --> 00:16:50.450 own life. And this is the issue. The book that 00:16:50.450 --> 00:16:52.870 I wrote literally hits on generational trauma. 00:16:52.929 --> 00:16:55.409 But if we're not identifying some of these compounding 00:16:55.409 --> 00:16:58.470 elements that lead to our children feeling... 00:16:59.200 --> 00:17:01.320 that they are capable of doing that thing. And 00:17:01.320 --> 00:17:04.680 I've had a 17 year at the time, 17 year old high 00:17:04.680 --> 00:17:06.900 school student, Emma Benoit on the show who shot 00:17:06.900 --> 00:17:09.119 herself and she survived her attempt. And now 00:17:09.119 --> 00:17:11.779 she's this beautiful, you know, voice of mental 00:17:11.779 --> 00:17:15.400 health, especially in the younger ages. But you 00:17:15.400 --> 00:17:17.440 take a step back, like you said, the professional 00:17:17.440 --> 00:17:20.500 sports or, you know, the, you know, school sports, 00:17:20.500 --> 00:17:22.599 and then look at politically the bullying there. 00:17:22.700 --> 00:17:26.480 And it's just this pervasive nastiness. And the 00:17:26.480 --> 00:17:29.299 answer is the opposite. The school shootings 00:17:29.299 --> 00:17:31.539 that we have, all these things come from this 00:17:31.539 --> 00:17:34.599 lack of community and this unaddressed trauma 00:17:34.599 --> 00:17:37.240 that some people stay kind of in that victim 00:17:37.240 --> 00:17:39.380 state and some people shift into the predator 00:17:39.380 --> 00:17:41.480 state. And I've asked a lot of people in the 00:17:41.480 --> 00:17:44.240 mental health field about political figures, 00:17:44.339 --> 00:17:49.519 about CEOs of cigarette companies and drug companies 00:17:49.519 --> 00:17:52.400 who literally have killed millions of people 00:17:52.400 --> 00:17:55.400 on this planet and still sleep safely at night. 00:17:56.119 --> 00:17:58.900 There's that unaddressed trauma there that really 00:17:58.900 --> 00:18:02.160 has created a sociopath in this very, very powerful 00:18:02.160 --> 00:18:04.359 position. And one would probably argue there's 00:18:04.359 --> 00:18:07.799 a similar kind of mental state in the CEOs of 00:18:07.799 --> 00:18:09.039 some of the people that we're going to be talking 00:18:09.039 --> 00:18:12.279 about today. But this all comes down from these 00:18:12.279 --> 00:18:14.700 children. Some were bullies, some were bullied. 00:18:15.000 --> 00:18:17.960 But if you look at the most healthiest systems. 00:18:18.720 --> 00:18:21.440 And nations that we have, Scandinavia and Japan 00:18:21.440 --> 00:18:23.839 and some of these other areas that are always 00:18:23.839 --> 00:18:26.319 at the top of many, many of these physical and 00:18:26.319 --> 00:18:30.119 mental health kind of poles, if you like. You 00:18:30.119 --> 00:18:33.299 know, community is the most profound thing. But 00:18:33.299 --> 00:18:36.279 if you splinter and you divide and you allow 00:18:36.279 --> 00:18:40.039 this nastiness to be pervasive or even celebrated, 00:18:40.140 --> 00:18:44.109 as we see in 2025, you know. Cause and effect. 00:18:44.349 --> 00:18:46.349 This is what we're going to see. Childhood suicide 00:18:46.349 --> 00:18:49.130 and shootings and, you know, the extreme element 00:18:49.130 --> 00:18:52.589 or, you know, a complete deliberate fracturing 00:18:52.589 --> 00:18:56.170 of a nation and the casting aside of the most 00:18:56.170 --> 00:18:58.309 important people, doctors and nurses and firefighters 00:18:58.309 --> 00:19:02.190 and paramedics and dispatchers and the true backbone 00:19:02.190 --> 00:19:07.730 of the community. Holy smokes. We're going to 00:19:07.730 --> 00:19:12.900 start with that. I just vomited out. Sorry. No, 00:19:12.920 --> 00:19:15.019 no. But James is brilliant, right? I mean, I 00:19:15.019 --> 00:19:21.660 guess, you know, as a physician, we were taught 00:19:21.660 --> 00:19:24.519 or brainwashed or whatever to compartmentalize 00:19:24.519 --> 00:19:29.019 very well. I mean, and same with first responders. 00:19:29.160 --> 00:19:31.819 You're taught to compartmentalize. And that's 00:19:31.819 --> 00:19:34.259 amazing. That's an amazing skill to have and 00:19:34.259 --> 00:19:37.759 incredibly important and critical when you were 00:19:37.759 --> 00:19:39.950 trying to save someone's life. like when you 00:19:39.950 --> 00:19:42.349 were doing cpr or trying to put in a chest tube 00:19:42.349 --> 00:19:44.769 or operating on somebody you don't want your 00:19:44.769 --> 00:19:46.509 mind flying all over the place you want to be 00:19:46.509 --> 00:19:50.390 focused on the task at hand the downside or at 00:19:50.390 --> 00:19:53.089 least for me the downside was i was never taught 00:19:53.089 --> 00:19:58.089 to process any of it it was just stuff it into 00:19:58.089 --> 00:20:00.849 the box and just keep stuffing it in there and 00:20:00.849 --> 00:20:05.039 it's like well wait a minute that's only good 00:20:05.039 --> 00:20:07.380 if your box is infinite, right? If your box is 00:20:07.380 --> 00:20:10.920 not infinite, which none of ours is, that at 00:20:10.920 --> 00:20:13.519 some point is going to become a problem. And 00:20:13.519 --> 00:20:16.660 that problem developed for me a little over a 00:20:16.660 --> 00:20:18.940 year ago. And I wasn't even clear what was going 00:20:18.940 --> 00:20:22.480 on because I had gotten so proficient at compartmentalizing 00:20:22.480 --> 00:20:25.000 that when that Pandora's box opened, it created 00:20:25.000 --> 00:20:28.720 a mess for me. And through therapy and counseling 00:20:28.720 --> 00:20:30.539 and writing about it and all these other things, 00:20:30.619 --> 00:20:32.329 I... Finally, it was like, oh, my God, this is 00:20:32.329 --> 00:20:35.569 related to all this unprocessed trauma. And who 00:20:35.569 --> 00:20:38.890 does somebody take it out on that's traumatized? 00:20:39.549 --> 00:20:41.829 Often those that are closest to them, those that 00:20:41.829 --> 00:20:45.650 they love. And so the phrase that trauma begets 00:20:45.650 --> 00:20:48.450 trauma or trauma perpetuates trauma or pick an 00:20:48.450 --> 00:20:50.470 adjective in there or a verb in there or whatever, 00:20:50.630 --> 00:20:54.789 it's true. And we're doing it as a society at 00:20:54.789 --> 00:20:57.930 large at this point. To give you maybe another 00:20:57.930 --> 00:21:00.700 example is I think. A lot of things that go on 00:21:00.700 --> 00:21:03.539 in the media is sensationalized and frankly, 00:21:03.599 --> 00:21:06.180 a form of secondary or vicarious trauma to the 00:21:06.180 --> 00:21:08.819 point where I've gotten away from watching the 00:21:08.819 --> 00:21:11.099 news because I find it depressing, you know, 00:21:11.099 --> 00:21:13.519 and it's triggering, triggering to me at times 00:21:13.519 --> 00:21:16.019 even. And so I rely on my friends. If there's 00:21:16.019 --> 00:21:17.900 some big news story that I need to be aware of, 00:21:17.900 --> 00:21:19.700 they'll typically get a whole, Hey Todd, you 00:21:19.700 --> 00:21:21.319 need to be aware of this. So check this out. 00:21:21.799 --> 00:21:24.259 But it's pervasive and I'm actually writing about 00:21:24.259 --> 00:21:26.660 it. Like you had, you know, the trauma is everywhere 00:21:26.660 --> 00:21:29.400 and we need to. not run from it, but rather embrace 00:21:29.400 --> 00:21:32.700 it, explore it, and then subsequently ideally 00:21:32.700 --> 00:21:34.819 heal from it. This is what I'd like to see on 00:21:34.819 --> 00:21:38.019 a much, much larger scale than is currently happening. 00:21:39.460 --> 00:21:42.140 Absolutely. Well, going back to your early life, 00:21:42.279 --> 00:21:44.240 what about sport and exercise? What were you 00:21:44.240 --> 00:21:48.619 playing and doing back then? Oh, wow. I've been 00:21:48.619 --> 00:21:51.119 thinking about this recently. Like, you know, 00:21:51.140 --> 00:21:53.599 the Bessel van der Koek's book, The Body Keeps 00:21:53.599 --> 00:21:57.930 the Score, was my... propensity to want to run 00:21:57.930 --> 00:22:02.190 what propelled me to be a um sprinter and you 00:22:02.190 --> 00:22:04.890 know a division one track and field athlete um 00:22:04.890 --> 00:22:06.730 I was like I wonder how that connects I don't 00:22:06.730 --> 00:22:08.150 know if it does or not but to answer your question 00:22:08.150 --> 00:22:12.509 um played soccer growing up um kind of an early 00:22:12.509 --> 00:22:14.829 adopter I suppose in the United States and perhaps 00:22:14.829 --> 00:22:17.650 that was related to you know some of the bullying 00:22:17.650 --> 00:22:19.269 and maybe trying to get me into a little bit 00:22:19.269 --> 00:22:21.769 different path where You know, there wasn't that 00:22:21.769 --> 00:22:24.910 intergenerational trauma that exists, like, in 00:22:24.910 --> 00:22:28.369 a sport like football, you know, where kids have 00:22:28.369 --> 00:22:31.569 been encouraged not to hydrate and have dropped 00:22:31.569 --> 00:22:34.650 dead on the field. Like, you talk about the ultimate 00:22:34.650 --> 00:22:38.029 bullying. Holy smokes. So I played soccer. I 00:22:38.029 --> 00:22:39.990 was fortunate. When I was in high school, we 00:22:39.990 --> 00:22:43.130 won the state championship. So, you know, some 00:22:43.130 --> 00:22:46.009 30 years ago or what have you now, that was a 00:22:46.009 --> 00:22:48.990 highlight. um like i said i was a sprinter and 00:22:48.990 --> 00:22:52.950 a long jumper um you know which was not the norm 00:22:52.950 --> 00:22:55.630 for the the short white kid to be the sprinter 00:22:55.630 --> 00:22:58.410 and the long jumper but i did all right at it 00:22:58.410 --> 00:23:01.869 so did that uh three years in college too and 00:23:01.869 --> 00:23:06.069 it was a lot of fun a lot of fun what about career 00:23:06.069 --> 00:23:10.349 um oh my god why is that that word falling out 00:23:10.349 --> 00:23:12.309 my head i use it literally every interview um 00:23:12.309 --> 00:23:15.180 career aspirations there we go When you were 00:23:15.180 --> 00:23:17.140 in school still, what were you dreaming of becoming? 00:23:19.500 --> 00:23:22.059 Yeah, so interestingly enough, I thought I wanted 00:23:22.059 --> 00:23:24.440 to be a doctor very early on. I think I was probably 00:23:24.440 --> 00:23:28.619 about a sophomore in high school. And I don't 00:23:28.619 --> 00:23:30.880 know that there was sort of one pivotal moment. 00:23:31.039 --> 00:23:33.980 I think at that point, it was clear that I had 00:23:33.980 --> 00:23:38.680 the academic acumen to go down that path. I enjoyed 00:23:38.680 --> 00:23:40.759 interacting with other people. I was a Parks 00:23:40.759 --> 00:23:45.150 and Rec supervisor. And so, you know, 60 to 80 00:23:45.150 --> 00:23:47.130 kids would show up every day and you do games 00:23:47.130 --> 00:23:49.630 and crafts and all these other things. And I 00:23:49.630 --> 00:23:52.369 liked interacting with other people. And I was 00:23:52.369 --> 00:23:55.150 always enjoyed science and, you know, always 00:23:55.150 --> 00:23:58.009 wanted a challenge. And, you know, so I guess 00:23:58.009 --> 00:23:59.789 it all added up to, well, let's pick one of the 00:23:59.789 --> 00:24:01.789 hardest things to get into and one of the hardest 00:24:01.789 --> 00:24:05.430 things to, you know, excel at. And I guess that's 00:24:05.430 --> 00:24:07.309 what I went for. And, you know, part of it, retrospect 00:24:07.309 --> 00:24:11.809 to James is, you know, chasing external validation. 00:24:12.480 --> 00:24:15.480 You know, when you feel like you weren't heard 00:24:15.480 --> 00:24:18.859 as a child, you know, and it wasn't my parents' 00:24:18.960 --> 00:24:20.740 fault. I mean, I think it was a sign of the times. 00:24:20.779 --> 00:24:23.160 And when you feel like you're not heard, you're 00:24:23.160 --> 00:24:26.079 always chasing that next dopamine hit of validation. 00:24:26.299 --> 00:24:28.980 I mean, like, if you look at my CV, it's just 00:24:28.980 --> 00:24:31.779 ridiculous. And a lot of the things that are 00:24:31.779 --> 00:24:34.619 on there were kind of meaningless to me, you 00:24:34.619 --> 00:24:37.160 know, because I was always chasing the next. 00:24:37.900 --> 00:24:40.720 the next dopamine high, if you will, that sensation 00:24:40.720 --> 00:24:42.960 that you've succeeded and someone else noticed 00:24:42.960 --> 00:24:47.539 it. So yeah, but I love it. I mean, I love being 00:24:47.539 --> 00:24:49.599 a doctor. Most of my time as a physician was 00:24:49.599 --> 00:24:52.460 amazing. And I'm still doing a little bit of 00:24:52.460 --> 00:24:56.160 direct care currently. You know, I think the 00:24:56.160 --> 00:24:59.740 problem with medicine is the detractors that 00:24:59.740 --> 00:25:03.420 exist can be so devastating and the landscape 00:25:03.420 --> 00:25:06.809 has become so difficult. You know, we talk about 00:25:06.809 --> 00:25:10.549 the emphasis on profit making that it's really 00:25:10.549 --> 00:25:15.430 drawn or how do I say this? It's well, it'll 00:25:15.430 --> 00:25:17.410 be repetitive, but it's detracted from the true 00:25:17.410 --> 00:25:20.049 calling. You know, most people that go into medicine 00:25:20.049 --> 00:25:23.710 or nursing or first responders or EMTs or teaching, 00:25:23.829 --> 00:25:27.289 they go into it to help other people. They don't 00:25:27.289 --> 00:25:31.650 go into it to become rich. You know, most medical 00:25:31.650 --> 00:25:34.799 students walk out with like. North of $200 ,000 00:25:34.799 --> 00:25:38.079 in debt. That's on top of whatever undergraduate 00:25:38.079 --> 00:25:43.440 debt they have. You know, and yeah, so that was 00:25:43.440 --> 00:25:45.779 sort of a circuitous answer as to how I got into 00:25:45.779 --> 00:25:48.460 it. And maybe a little bit of insight is to where 00:25:48.460 --> 00:25:50.180 I'm at now. Would I do it again? Yeah, sure. 00:25:50.319 --> 00:25:54.559 I'd do it again. 100%. My wife just graduated 00:25:54.559 --> 00:25:57.599 optometry school with over $400 ,000 worth of 00:25:57.599 --> 00:25:59.660 debt because it was a private school. Optometry, 00:25:59.720 --> 00:26:02.099 they only have, I think it's like 30 schools 00:26:02.099 --> 00:26:04.720 in the whole of the US. And so the only one in 00:26:04.720 --> 00:26:07.200 Florida was that one. And it was good education. 00:26:07.400 --> 00:26:10.519 It really was. But I mean, you talk about crippling 00:26:10.519 --> 00:26:14.460 someone who... leaves an occupational educational 00:26:14.460 --> 00:26:17.279 track, you know, you really want to destroy their 00:26:17.279 --> 00:26:19.640 ability to start doing the job. Just, you know, 00:26:19.680 --> 00:26:21.940 give them a medical debt that's twice the amount 00:26:21.940 --> 00:26:24.779 of the mortgage when they walk out the back door. 00:26:24.900 --> 00:26:27.400 It's insane. Totally, James. And, you know, one 00:26:27.400 --> 00:26:28.960 of the things that it's definitely contributed 00:26:28.960 --> 00:26:31.359 in terms of, at least for physicians, you know, 00:26:31.380 --> 00:26:32.920 and I'll speak because that's what I am, right? 00:26:33.119 --> 00:26:35.720 It creates this golden handcuff, which has been 00:26:35.720 --> 00:26:39.140 really weaponized against people. um because 00:26:39.140 --> 00:26:42.819 institutions administrations they know you have 00:26:42.819 --> 00:26:44.539 enough debt where they know you need to keep 00:26:44.539 --> 00:26:47.279 working which prevents you from pushing back 00:26:47.279 --> 00:26:51.559 and challenging the status quo um in that regard 00:26:51.559 --> 00:26:53.759 i was a little unique because i had the blessing 00:26:53.759 --> 00:26:56.880 of getting through undergrad debt free as a result 00:26:56.880 --> 00:26:59.200 of a lot of hard work and a little bit of scholarship 00:26:59.200 --> 00:27:01.720 and you know being a paper boy from 12 to 18. 00:27:02.380 --> 00:27:04.039 and saving all that money up despite getting 00:27:04.039 --> 00:27:07.200 bit by dogs five times you know having that trauma 00:27:07.200 --> 00:27:10.480 related to it um but not everyone's that blessed 00:27:10.480 --> 00:27:12.680 and then you know being a navy physician you 00:27:12.680 --> 00:27:16.240 get medical school paid for and so when i got 00:27:16.240 --> 00:27:18.500 out of residency i wasn't shackled with this 00:27:18.500 --> 00:27:20.579 massive amount of debt like a lot of my colleagues 00:27:20.579 --> 00:27:22.980 which i think has been a blessing because it 00:27:22.980 --> 00:27:25.539 allowed me to be much more vocal when things 00:27:25.539 --> 00:27:28.640 were going on that were not right and i was like 00:27:28.640 --> 00:27:30.640 you know what i i'm in a position to not take 00:27:30.640 --> 00:27:34.319 this Like, you can't hold my paycheck above me. 00:27:34.319 --> 00:27:36.400 In fact, I remember, I'll tell you a story, James. 00:27:36.480 --> 00:27:39.599 So I was, we were doing, we had a clinic going 00:27:39.599 --> 00:27:44.420 and it was amazing. And they wanted to, the administration 00:27:44.420 --> 00:27:46.740 wanted to figure out how they could potentially 00:27:46.740 --> 00:27:49.900 scale it for the rest of the system. And I was 00:27:49.900 --> 00:27:51.200 like, okay, great. We'll have this meeting. But, 00:27:51.200 --> 00:27:53.119 you know, me being me, just talking about that 00:27:53.119 --> 00:27:55.059 wasn't going to be enough. I, of course, had 00:27:55.059 --> 00:27:58.299 to take it to another level. I came armed with 00:27:58.299 --> 00:28:00.200 all my stats and all my numbers and all these 00:28:00.200 --> 00:28:02.480 other things. And so we talked about the clinic, 00:28:02.519 --> 00:28:05.420 but then I pushed into the topic of recruitment, 00:28:05.579 --> 00:28:08.460 retention, well -being, you know, things that 00:28:08.460 --> 00:28:10.380 are critical for a healthy system and a healthy 00:28:10.380 --> 00:28:14.319 culture. And the three administrators there, 00:28:14.380 --> 00:28:16.500 as I was going through this, James, it was like 00:28:16.500 --> 00:28:21.819 deer in the headlights. To the point where, I 00:28:21.819 --> 00:28:23.579 won't get into the specifics per se, I write 00:28:23.579 --> 00:28:26.170 about it a little bit in Ripple of Change. But 00:28:26.170 --> 00:28:28.930 I feigned that I possibly shredded some value 00:28:28.930 --> 00:28:30.970 based reimbursement forms when I wasn't having 00:28:30.970 --> 00:28:33.630 a good day. And I think the president of the 00:28:33.630 --> 00:28:35.470 medical group was about ready to jump out of 00:28:35.470 --> 00:28:39.089 his chair. He was so pissed. And then he proceeded 00:28:39.089 --> 00:28:42.130 to threaten me with my paycheck. After I had 00:28:42.130 --> 00:28:45.789 told them, like, I didn't necessarily need income. 00:28:45.990 --> 00:28:47.309 I'm like, dude, you don't even listen to anything 00:28:47.309 --> 00:28:49.670 I was just saying. You got pissed and then you 00:28:49.670 --> 00:28:52.069 threaten a guy with his paycheck who literally 00:28:52.069 --> 00:28:53.589 just told you he didn't need the paycheck per 00:28:53.589 --> 00:28:56.579 se. Like, what the hell? and this this is the 00:28:56.579 --> 00:28:58.460 kind of garbage that goes on all the time and 00:28:58.460 --> 00:29:01.660 this was over me advocating for taking care of 00:29:01.660 --> 00:29:04.400 people i wasn't looking for a race i wasn't even 00:29:04.400 --> 00:29:07.019 looking for anything for me i was looking for 00:29:07.019 --> 00:29:09.259 my colleagues to stop being treated like and 00:29:09.259 --> 00:29:14.180 that's the response i got it's like wow you know 00:29:14.180 --> 00:29:16.279 fast forward a year later it kind of imploded 00:29:16.279 --> 00:29:18.839 and that's when i ultimately took a stand but 00:29:18.839 --> 00:29:23.049 um so We can talk about that. I can tell you 00:29:23.049 --> 00:29:24.190 the story of that story, too, if you want more 00:29:24.190 --> 00:29:27.750 stories. I've always got stories. Let's do it. 00:29:27.930 --> 00:29:33.470 Let's do it. All right. So fast forward about 00:29:33.470 --> 00:29:36.009 a year. You know, I had been very vocal about 00:29:36.009 --> 00:29:39.809 the things I was mentioning that really had nothing 00:29:39.809 --> 00:29:42.089 to do with me. I was really advocating for my 00:29:42.089 --> 00:29:43.809 colleagues who felt like they didn't have a voice, 00:29:43.990 --> 00:29:46.049 you know, in part because of the golden handcuffs. 00:29:46.150 --> 00:29:48.349 They felt like if they spoke up, they could be. 00:29:49.680 --> 00:29:51.920 Well, basically cast aside might be the simplest 00:29:51.920 --> 00:29:53.640 way to put it. And there's all kinds of nefarious 00:29:53.640 --> 00:29:58.059 things that are going on in that regard. So I 00:29:58.059 --> 00:30:00.880 came into a meeting at the time I was writing 00:30:00.880 --> 00:30:04.500 the book, Ripple of Change, and my wife had gotten 00:30:04.500 --> 00:30:06.880 me a coffee cup. And on the coffee cup, it said, 00:30:06.920 --> 00:30:10.240 be careful or you will end up in my novel. And 00:30:10.240 --> 00:30:11.960 so I walked into this meeting and I said that 00:30:11.960 --> 00:30:14.819 on the table in front of me. And the VP's like, 00:30:14.980 --> 00:30:19.720 Todd, is that a warning? And I said, well. I 00:30:19.720 --> 00:30:23.220 guess it depends on how this meeting goes, because 00:30:23.220 --> 00:30:25.380 it's about logistics. And I had an idea where 00:30:25.380 --> 00:30:27.960 it was going. You know, ultimately, there was 00:30:27.960 --> 00:30:30.299 a decision that had been made to save money on 00:30:30.299 --> 00:30:32.819 rent regarding the clinic. And they were going 00:30:32.819 --> 00:30:36.599 to move this bustling clinic that was doing very 00:30:36.599 --> 00:30:39.119 well back to the town where I'd gotten burned 00:30:39.119 --> 00:30:42.960 out without telling me and with very little warning. 00:30:43.859 --> 00:30:46.789 You know, when you talk about. You talk about 00:30:46.789 --> 00:30:48.990 setting someone up to be re -traumatized on a 00:30:48.990 --> 00:30:52.730 daily basis. You know, in retrospect, I was being 00:30:52.730 --> 00:30:55.730 put in a position where every day I went into 00:30:55.730 --> 00:30:57.589 work, I was going to have to relive some very 00:30:57.589 --> 00:31:00.769 painful memories. And I guess subconsciously, 00:31:00.769 --> 00:31:03.690 I wanted nothing to do with that. And so I went 00:31:03.690 --> 00:31:06.529 home and I told my wife what had happened. She 00:31:06.529 --> 00:31:11.150 started crying. I started crying. I said a lot 00:31:11.150 --> 00:31:13.349 of prayers. The next morning, James, I resigned. 00:31:14.569 --> 00:31:16.849 I had been there almost 13 years at that point. 00:31:16.930 --> 00:31:20.390 I had poured my heart and soul into that institution. 00:31:20.430 --> 00:31:24.829 I gave so much of myself, probably too much at 00:31:24.829 --> 00:31:29.450 times. But they crossed the line. I was in a 00:31:29.450 --> 00:31:32.109 position to stand up for myself. And in Ripple 00:31:32.109 --> 00:31:35.890 of Change, I call that section the day the music 00:31:35.890 --> 00:31:39.970 died. Because the clinic that I had worked in, 00:31:40.009 --> 00:31:45.380 it was magical. It really was magical. For the 00:31:45.380 --> 00:31:48.880 sake of saving a little bit of money, they really 00:31:48.880 --> 00:31:52.720 cast aside multiple people and a beautiful thing. 00:31:54.539 --> 00:31:57.819 I'm going to have a shot in the dark while guests 00:31:57.819 --> 00:32:00.339 and I'm using my experience in the first responder 00:32:00.339 --> 00:32:02.640 profession and what I've seen, you know, this 00:32:02.640 --> 00:32:05.160 last nine plus years since I've been doing this 00:32:05.160 --> 00:32:07.839 podcast, seven of which the last seven I'd stepped 00:32:07.839 --> 00:32:11.319 out of my profession because I realized to really 00:32:11.319 --> 00:32:13.890 speak freely. I needed to not wear a uniform 00:32:13.890 --> 00:32:16.950 anymore. The decisions that were being made to 00:32:16.950 --> 00:32:20.569 make changes, did they save money possibly short 00:32:20.569 --> 00:32:22.690 term, but actually would have a ripple effect 00:32:22.690 --> 00:32:27.670 of costing a lot more money long term? Oh, you 00:32:27.670 --> 00:32:30.490 know it, my friend. And I actually dug into that 00:32:30.490 --> 00:32:36.650 a little bit. Interestingly enough, I sent the 00:32:36.650 --> 00:32:39.450 email that I was resigning to like 20 administrators 00:32:39.450 --> 00:32:42.539 within the health system. You know, when I made, 00:32:42.539 --> 00:32:45.140 when I made noise, I made a bit of noise at times. 00:32:45.519 --> 00:32:50.940 And so one of the administrators who I'm actually 00:32:50.940 --> 00:32:53.599 still friends with to this day, she was just 00:32:53.599 --> 00:32:56.380 put in a bad spot in retrospect and was kind 00:32:56.380 --> 00:32:58.819 of the messenger. She came over very frustrated, 00:32:58.940 --> 00:33:01.059 upset that I was, that I had sent that email. 00:33:01.140 --> 00:33:04.900 And I'm like, you know, look, like I'm not a 00:33:04.900 --> 00:33:07.960 chess piece. Like you can't just move me without 00:33:07.960 --> 00:33:09.539 telling me. And I'm just going to sit here and 00:33:09.539 --> 00:33:11.660 take it like everybody else. I think you should 00:33:11.660 --> 00:33:15.400 have known that leading into this. And I told 00:33:15.400 --> 00:33:17.119 her, I said, you know, this decision to save 00:33:17.119 --> 00:33:20.180 X amount of dollars on rent, I'm pretty sure 00:33:20.180 --> 00:33:22.559 I just cost you four to five times that amount 00:33:22.559 --> 00:33:25.380 of money next year as a result of that decision. 00:33:25.680 --> 00:33:28.539 Because when you lose a very highly productive 00:33:28.539 --> 00:33:31.380 physician like that, the negative financial impacts 00:33:31.380 --> 00:33:34.220 are massive. And that goes beyond just the amount 00:33:34.220 --> 00:33:36.900 of money to recruit another one. I mean, when 00:33:36.900 --> 00:33:38.839 you lose somebody who's seen thousands of visits 00:33:38.839 --> 00:33:41.940 a year. You lose all that ancillary income, all 00:33:41.940 --> 00:33:44.339 those referrals. I mean, you're talking millions 00:33:44.339 --> 00:33:46.380 and millions of dollars were attached to that 00:33:46.380 --> 00:33:49.440 decision, which far outstripped the amount of 00:33:49.440 --> 00:33:51.339 money they were going to save on rent. The other, 00:33:51.380 --> 00:33:54.440 I think, to me, even more powerful statistic 00:33:54.440 --> 00:33:57.180 related to that, James, we didn't have a lot 00:33:57.180 --> 00:33:59.940 of turnover in my office when I was there. And 00:33:59.940 --> 00:34:01.599 there's reasons for that. We had a good culture. 00:34:01.880 --> 00:34:04.160 We cared for one another. We looked out for one 00:34:04.160 --> 00:34:09.289 another. It was like a family at times. You know, 00:34:09.289 --> 00:34:10.969 as an example, my medical assistant was with 00:34:10.969 --> 00:34:14.050 me for nine years. For a medical assistant to 00:34:14.050 --> 00:34:16.150 be with a primary care physician for nearly a 00:34:16.150 --> 00:34:19.429 decade is a testament to the culture that existed 00:34:19.429 --> 00:34:23.630 there, right? So there were 15 people when that 00:34:23.630 --> 00:34:25.849 meeting happened that worked there. There were 00:34:25.849 --> 00:34:28.050 three nurse practitioners, one physician being 00:34:28.050 --> 00:34:32.010 me, and then 11 medical assistants. We had a 00:34:32.010 --> 00:34:34.230 nurse office manager, receptionist, what have 00:34:34.230 --> 00:34:38.730 you. Four months later. Nine of the 15 left the 00:34:38.730 --> 00:34:42.130 health system. They lost two nurse practitioners, 00:34:42.570 --> 00:34:45.929 one physician and six other staff as a result 00:34:45.929 --> 00:34:49.090 of decision to save money on rent. So you think 00:34:49.090 --> 00:34:51.849 about all the trickle down effects of that. Let's 00:34:51.849 --> 00:34:53.250 say it was a half a million dollar decision. 00:34:54.610 --> 00:34:59.809 I bet all said and done. Between five and ten 00:34:59.809 --> 00:35:02.949 million dollars of negative expenditures as a 00:35:02.949 --> 00:35:08.489 result of that. That's an educated guess. I can't 00:35:08.489 --> 00:35:10.510 give any hard data to that. But I mean, if I 00:35:10.510 --> 00:35:12.530 worked it on paper, I think that's where I am. 00:35:13.510 --> 00:35:16.230 Well, that's what we're seeing in the fire service 00:35:16.230 --> 00:35:18.969 at the moment. Fire slash EMS is, you know, you've 00:35:18.969 --> 00:35:21.389 got these departments and, you know, basically 00:35:21.389 --> 00:35:24.409 our profession is circling the drain. It really 00:35:24.409 --> 00:35:26.369 is. People are being completely honest. Unless 00:35:26.369 --> 00:35:29.110 you're in an anomaly department that you have 00:35:29.110 --> 00:35:31.800 all these things already in place. a majority 00:35:31.800 --> 00:35:35.699 of the country is working 56 hour weeks and as 00:35:35.699 --> 00:35:38.500 you know the generations have become more and 00:35:38.500 --> 00:35:40.519 more educated young people are looking at that 00:35:40.519 --> 00:35:42.739 and going well that's not very good and then 00:35:42.739 --> 00:35:44.900 they learn about the mandatory overtime so now 00:35:44.900 --> 00:35:48.480 you're in 80 you know and then unlimited like 00:35:48.480 --> 00:35:50.880 a friend of mine just worked 120 hours in a row 00:35:50.880 --> 00:35:53.840 you know non -stop in a busy city that he probably 00:35:53.840 --> 00:35:57.159 was getting no or poor quality sleep every single 00:35:57.159 --> 00:36:00.380 one of those nights And so, you know, we're having 00:36:00.380 --> 00:36:02.659 less and less and less people in recruitment. 00:36:02.719 --> 00:36:04.679 And then the retention is getting worse and worse 00:36:04.679 --> 00:36:07.980 and worse. And the conversation is, well, we 00:36:07.980 --> 00:36:10.179 don't have enough people to hire another shift, 00:36:10.260 --> 00:36:12.239 which would give us a 42 hour work week, which 00:36:12.239 --> 00:36:15.559 in Florida now this revolution has started. But 00:36:15.559 --> 00:36:19.380 I am by no means a mathematical genius. In fact, 00:36:19.420 --> 00:36:20.880 the reason that even though I wanted to be a 00:36:20.880 --> 00:36:23.380 doctor when I was young. I didn't. It's because 00:36:23.380 --> 00:36:25.619 of mathematics. I just wasn't smart enough to 00:36:25.619 --> 00:36:29.619 navigate those hurdles. But when you look at 00:36:29.619 --> 00:36:31.920 the downstream cost of what happens when you 00:36:31.920 --> 00:36:35.960 overwork a profession, it far outweighs the money 00:36:35.960 --> 00:36:38.400 that would be needed to simply invest in enough 00:36:38.400 --> 00:36:40.860 doctors, nurses, paramedics, firefighters, corrections 00:36:40.860 --> 00:36:43.440 officers, dispatchers, whatever is needed to 00:36:43.440 --> 00:36:46.239 create an environment of health, to drive recruitment, 00:36:46.440 --> 00:36:50.460 to drive retention. And it blows me away. That 00:36:50.460 --> 00:36:53.320 someone with a mathematical ability of an ape 00:36:53.320 --> 00:36:56.559 like myself can figure the shit out. But these 00:36:56.559 --> 00:36:59.739 financial gurus in these cities and counties 00:36:59.739 --> 00:37:05.880 and corporations can't see that proactive creates 00:37:05.880 --> 00:37:09.340 so much savings and value versus reactive. And 00:37:09.340 --> 00:37:13.039 it blows my mind. Well, I think a lot of that 00:37:13.039 --> 00:37:15.340 has to do with, I mean, look at our capitalist 00:37:15.340 --> 00:37:17.539 society that focuses on the short -term ROI, 00:37:17.900 --> 00:37:22.539 right? When you've got a myopic view of things 00:37:22.539 --> 00:37:24.460 where that's the only thing you're looking at 00:37:24.460 --> 00:37:26.239 and you're not factoring all these other things 00:37:26.239 --> 00:37:29.119 in, yeah, it's going to look like, oh, this is 00:37:29.119 --> 00:37:30.880 a genius decision. We need to do this because 00:37:30.880 --> 00:37:32.679 the ROI in three months is going to be X, Y, 00:37:32.679 --> 00:37:35.039 and Z. Well, that's all well and good until you 00:37:35.039 --> 00:37:37.460 realize you've got 10 other problems you just 00:37:37.460 --> 00:37:40.599 created that are going to cost 30 times as much. 00:37:41.119 --> 00:37:44.920 You know, I mean, an ounce of prevention is worth 00:37:44.920 --> 00:37:49.840 a pound of cure is a genius statement. And in 00:37:49.840 --> 00:37:51.559 your world and many other worlds, we need to 00:37:51.559 --> 00:37:54.679 go back to that. But ultimately, I mean, if you 00:37:54.679 --> 00:37:57.360 think about it, it's how are we treating our 00:37:57.360 --> 00:38:01.699 fellow human beings? You know, and the way we're 00:38:01.699 --> 00:38:05.539 doing it at times is leading to a whole. Man, 00:38:05.699 --> 00:38:08.400 a whole bunch of deleterious downstream effects. 00:38:10.460 --> 00:38:12.460 We could go down so many, so many rabbit holes. 00:38:12.539 --> 00:38:15.099 But, you know, again, I'm not a politician per 00:38:15.099 --> 00:38:18.909 se, but yeah, I mean. That's why with what we're 00:38:18.909 --> 00:38:23.090 trying to accomplish with the documentary, Suck 00:38:23.090 --> 00:38:26.929 It Up Buttercup, is to really get back to valuing 00:38:26.929 --> 00:38:31.530 people over profits. And by doing that, again, 00:38:32.369 --> 00:38:34.670 to stay in the world of health care, your total 00:38:34.670 --> 00:38:39.010 cost of care goes down. Your burnout levels go 00:38:39.010 --> 00:38:43.090 down. Your adverse events go down. I mean, let's 00:38:43.090 --> 00:38:45.750 just focus in on the burnout rates of physicians 00:38:45.750 --> 00:38:49.039 right now. And we could quote statistics and 00:38:49.039 --> 00:38:51.239 all that other kind of stuff. They're not good, 00:38:51.420 --> 00:38:54.460 okay? You know, when you've got a 50 -50 chance 00:38:54.460 --> 00:38:57.139 of the physician in front of you experiencing 00:38:57.139 --> 00:39:00.699 some level of burnout, do you think you're getting 00:39:00.699 --> 00:39:04.079 their best? Is that a risk you want to take when 00:39:04.079 --> 00:39:08.539 your life's on the line? I don't. I want someone 00:39:08.539 --> 00:39:11.659 who's well and in the moment and so on and so 00:39:11.659 --> 00:39:13.599 forth. I don't want someone who's contemplating 00:39:13.599 --> 00:39:16.869 quitting their job, you know. potentially offering 00:39:16.869 --> 00:39:20.329 some life -saving treatment or operating on me 00:39:20.329 --> 00:39:23.869 uh those are scary scary statistics and and expensive 00:39:23.869 --> 00:39:27.170 i mean expensive too when you start to factor 00:39:27.170 --> 00:39:30.489 in all the downstream effects of that absolutely 00:39:30.489 --> 00:39:32.789 well i want to go to on your kind of med school 00:39:32.789 --> 00:39:34.710 journey so you mentioned the military what was 00:39:34.710 --> 00:39:36.869 it that made you choose the navy for this path 00:39:36.869 --> 00:39:42.750 a random phone call literally a random phone 00:39:42.750 --> 00:39:47.980 call i was Oh, so I graduated college a semester 00:39:47.980 --> 00:39:50.579 early for a couple of reasons that were kind 00:39:50.579 --> 00:39:54.139 of cool and were all lined up. And so I was working 00:39:54.139 --> 00:39:59.519 at BASF, actually, where my father worked. So 00:39:59.519 --> 00:40:01.320 probably some nepotism getting me in there as 00:40:01.320 --> 00:40:03.280 an intern and all those kinds of things. But, 00:40:03.300 --> 00:40:05.119 you know, I showed my value and they kept me 00:40:05.119 --> 00:40:07.219 on. And they actually hired me when I finished 00:40:07.219 --> 00:40:10.760 school. I was a biochemistry major, full well 00:40:10.760 --> 00:40:12.239 knowing that I was trying to get into medical 00:40:12.239 --> 00:40:14.530 school. But I already knew the job. I already 00:40:14.530 --> 00:40:15.730 knew how to do it. They wouldn't have to train 00:40:15.730 --> 00:40:17.090 me. It was kind of like a plug and play kind 00:40:17.090 --> 00:40:20.090 of thing. And so I was running a quality assurance 00:40:20.090 --> 00:40:23.750 lab for a vitamins department. I think I was 00:40:23.750 --> 00:40:26.090 on midnights when I got the call. So I was at 00:40:26.090 --> 00:40:29.949 home sleeping, you know, and the old rotary phone 00:40:29.949 --> 00:40:33.369 rings at the house. And so I answer it, you know, 00:40:33.369 --> 00:40:37.010 and fate had it it was a Navy recruiter on the 00:40:37.010 --> 00:40:39.090 phone. You know, I had no intention of going 00:40:39.090 --> 00:40:41.699 into the service at that point. And so, of course, 00:40:41.719 --> 00:40:43.159 they're all excited that I answered the phone 00:40:43.159 --> 00:40:45.099 and start telling me all these things. Oh, we 00:40:45.099 --> 00:40:46.940 can pay for college. And I'm like, well, I just 00:40:46.940 --> 00:40:49.099 graduated from college. And they're like, oh, 00:40:49.199 --> 00:40:50.659 what are you thinking about doing? I'm thinking 00:40:50.659 --> 00:40:52.400 about going to medical school. Oh, and then suddenly, 00:40:52.480 --> 00:40:54.239 you know, I'm half awake while this is going 00:40:54.239 --> 00:40:56.920 on, James. And so then they start. I'm like, 00:40:57.000 --> 00:40:58.480 you know what? Send me some stuff in the mail. 00:40:59.780 --> 00:41:02.980 I'll look at it. And if I'm interested, you know, 00:41:03.039 --> 00:41:04.780 I'll get back with you. You know, sure enough, 00:41:04.800 --> 00:41:06.340 they sent it out and I looked into it and it 00:41:06.340 --> 00:41:10.510 was intriguing from the debt perspective. you 00:41:10.510 --> 00:41:12.269 know, to get through medical school without being, 00:41:12.349 --> 00:41:14.550 you know, shackled in debt. You know, there's 00:41:14.550 --> 00:41:16.409 a trade -off, right? Yeah, I traded off, you 00:41:16.409 --> 00:41:18.269 know, a handful of years of my life serving our 00:41:18.269 --> 00:41:22.670 country. But ultimately, it was amazing on so 00:41:22.670 --> 00:41:25.530 many levels. You know, I got to travel. I got 00:41:25.530 --> 00:41:27.250 to go around the world. I got to be a flight 00:41:27.250 --> 00:41:29.530 surgeon. I mean, literally, as a flight surgeon, 00:41:29.590 --> 00:41:32.750 you kind of learn how to fly a plane, which is 00:41:32.750 --> 00:41:35.730 fun. You know, being like a doctor in a fraternity 00:41:35.730 --> 00:41:38.269 at times, which has also had its level of fun. 00:41:38.760 --> 00:41:41.139 But ultimately it pulled me to my true calling 00:41:41.139 --> 00:41:43.699 in medicine. You know, when you get out of medical 00:41:43.699 --> 00:41:45.159 school, a lot of individuals, they go straight 00:41:45.159 --> 00:41:47.800 into residency and like, that's it. You're in 00:41:47.800 --> 00:41:49.980 that residency and you're kind of locked in. 00:41:50.019 --> 00:41:52.360 And for many people, there isn't a way out because 00:41:52.360 --> 00:41:55.539 of those financial handcuffs. For me, I had four 00:41:55.539 --> 00:41:58.739 to five years to sort of think about, okay, you 00:41:58.739 --> 00:42:00.519 know, where do I want to be in medicine? What 00:42:00.519 --> 00:42:02.519 do I want to do? Like, what's my true calling? 00:42:03.179 --> 00:42:08.789 And it was primary care. You know, had I not 00:42:08.789 --> 00:42:11.809 been in the Navy, I don't think that would have 00:42:11.809 --> 00:42:13.730 happened. You know, had I not gotten that random 00:42:13.730 --> 00:42:16.690 phone call, would you and I be talking right 00:42:16.690 --> 00:42:20.590 now? I don't know that we would be. It's all 00:42:20.590 --> 00:42:23.530 those little touch points that lead us down these 00:42:23.530 --> 00:42:25.469 amazing journeys. And, you know, so to answer 00:42:25.469 --> 00:42:27.590 the question, it was never sort of my dream to 00:42:27.590 --> 00:42:31.050 be in the service. It was it truly was happenstance 00:42:31.050 --> 00:42:33.590 that it all occurred. But I'm glad that it did. 00:42:34.489 --> 00:42:38.380 What years were? Did your medical school kind 00:42:38.380 --> 00:42:41.139 of spam? Was it pre -9 -11 or did it actually, 00:42:41.280 --> 00:42:44.820 I mean, not circumnavigate, but spam either side 00:42:44.820 --> 00:42:49.800 of it? Yeah, smack dab in the middle. So I was 00:42:49.800 --> 00:42:53.059 in medical school in 1998, graduated 2002. I 00:42:53.059 --> 00:42:55.639 still can remember, I mean, like we all can remember 00:42:55.639 --> 00:42:57.360 9 -11, right? I mean, that's kind of a silly 00:42:57.360 --> 00:42:59.320 thing to say. Yeah, I remember where I was on 00:42:59.320 --> 00:43:00.920 9 -11. Well, no kidding. So does everybody else. 00:43:01.639 --> 00:43:07.000 So, but I was in a... a fourth year fourth year 00:43:07.000 --> 00:43:10.639 medical student um and i was on an elective and 00:43:10.639 --> 00:43:12.840 i was following around a radiation oncologist 00:43:12.840 --> 00:43:15.500 and we were rounding and doing stuff and of course 00:43:15.500 --> 00:43:17.340 you know like many physicians you never stop 00:43:17.340 --> 00:43:19.539 to eat lunch you never take a break you never 00:43:19.539 --> 00:43:21.199 do any things to actually take care of yourself 00:43:21.199 --> 00:43:23.579 you just keep pushing through the day so i kind 00:43:23.579 --> 00:43:26.079 of knew what was going on like we'd be in a patient 00:43:26.079 --> 00:43:29.239 room and there'd be like like some video clips 00:43:29.239 --> 00:43:30.820 and then we would just keep going so i get home 00:43:30.820 --> 00:43:33.179 my wife's like oh my god did you see i'm like 00:43:33.630 --> 00:43:36.210 I don't fully know what happened. Give me 20 00:43:36.210 --> 00:43:38.829 minutes to watch the news to sort of catch up 00:43:38.829 --> 00:43:41.369 with the day. And then my phone started blowing 00:43:41.369 --> 00:43:43.550 off the hook because, you know, at the point 00:43:43.550 --> 00:43:45.590 I was in the service. And so my family was like, 00:43:45.650 --> 00:43:47.010 are you going to get called up and all these 00:43:47.010 --> 00:43:49.190 other things? And I'm like, I don't even know 00:43:49.190 --> 00:43:50.849 how to answer these questions. Like I'm in medical 00:43:50.849 --> 00:43:52.849 school. Do I think they're just going to pluck 00:43:52.849 --> 00:43:54.730 somebody out of their last year of medical school? 00:43:55.250 --> 00:43:57.090 No, probably not. They're probably going to let 00:43:57.090 --> 00:43:59.329 me finish, you know, and then get into residency 00:43:59.329 --> 00:44:02.130 or have you, but it was, it was definitely quite 00:44:02.130 --> 00:44:05.440 surreal. You know, having been in the military 00:44:05.440 --> 00:44:08.280 at that point and knowing that I could just get 00:44:08.280 --> 00:44:12.139 taken and sent off somewhere. So after you graduate, 00:44:12.239 --> 00:44:14.340 did you find yourself deployed in the Middle 00:44:14.340 --> 00:44:17.840 East at all? I wasn't in the Middle East. I mean, 00:44:17.940 --> 00:44:21.960 no, we had when I was deployed, I was actually 00:44:21.960 --> 00:44:25.900 deployed to Sicily in Italy. So, I mean, if you 00:44:25.900 --> 00:44:29.519 had to pick a place to be deployed with good 00:44:29.519 --> 00:44:32.800 food and, you know, beautiful scenery, I mean, 00:44:32.840 --> 00:44:35.199 I. probably was in about as good a spot as you 00:44:35.199 --> 00:44:37.940 could be but the reason for that is i was the 00:44:37.940 --> 00:44:41.940 flight surgeon for a p3 squadron which historically 00:44:41.940 --> 00:44:44.760 they're sub hunters but their mission had evolved 00:44:44.760 --> 00:44:46.679 over the years into surveillance and a handful 00:44:46.679 --> 00:44:48.920 of other things and so when i was deployed to 00:44:48.920 --> 00:44:52.699 italy we had uh we had people in el salvador 00:44:52.699 --> 00:44:56.780 italy uh and then cutter and i was responsible 00:44:56.780 --> 00:44:59.800 for all 500 individuals medical dental whatever 00:45:00.409 --> 00:45:02.809 care they needed you know and and they were spread 00:45:02.809 --> 00:45:05.289 all over the world which you know it was fun 00:45:05.289 --> 00:45:07.809 but it has challenges too i i distinctly remember 00:45:07.809 --> 00:45:11.409 one of our guys um ruptured his um quadriceps 00:45:11.409 --> 00:45:15.989 tendon and he's in el salvador my boss is in 00:45:15.989 --> 00:45:19.050 italy and at the time i was in france i had been 00:45:19.050 --> 00:45:21.849 assigned to do a diplomatic mission and so i'm 00:45:21.849 --> 00:45:23.829 like on the satellite phone talking to people 00:45:23.829 --> 00:45:25.989 in three or four different countries trying to 00:45:25.989 --> 00:45:30.260 coordinate his orthopedic care But yeah, I was 00:45:30.260 --> 00:45:32.260 never in the Middle East. I didn't experience 00:45:32.260 --> 00:45:35.480 any combat firsthand or anything like that. It 00:45:35.480 --> 00:45:38.019 was more secondhand stuff and secondary trauma 00:45:38.019 --> 00:45:43.760 type things. So going on to the doctor or the 00:45:43.760 --> 00:45:47.059 medical education route, you have this background 00:45:47.059 --> 00:45:49.760 as a high -level athlete. So you're obviously 00:45:49.760 --> 00:45:51.980 very familiar with the concept of strength and 00:45:51.980 --> 00:45:53.940 conditioning and then nutrition and hydration. 00:45:54.739 --> 00:45:58.099 From an academic lens, as you enter this profession, 00:45:58.750 --> 00:46:01.889 How much of the preventative lifestyle elements 00:46:01.889 --> 00:46:05.630 are you taught in the education side itself? 00:46:06.010 --> 00:46:12.610 Oh, Lord. It was probably the opposite of what 00:46:12.610 --> 00:46:15.889 should have been taught. I mean, essentially, 00:46:15.969 --> 00:46:18.530 you were taught to put the patient first, which 00:46:18.530 --> 00:46:21.690 I agree with to a certain extent. But if that's 00:46:21.690 --> 00:46:24.329 at the detriment of the person providing care. 00:46:25.989 --> 00:46:30.570 Not going to go on forever. I mean, you know, 00:46:30.570 --> 00:46:33.650 James, when I was an intern and it was before 00:46:33.650 --> 00:46:38.929 the 80 hour work week was instituted, I lost 00:46:38.929 --> 00:46:42.289 like 15 pounds in like two months because of 00:46:42.289 --> 00:46:44.969 the number of meals I missed, the lack of sleep. 00:46:45.570 --> 00:46:48.809 You know, I was at times a tired, angry little 00:46:48.809 --> 00:46:52.610 man for a whole host of reasons. But, you know, 00:46:52.630 --> 00:46:54.969 and I wasn't I'm not a huge guy now, but back 00:46:54.969 --> 00:46:58.260 then. you know it's like 165 pounds so when you 00:46:58.260 --> 00:47:02.380 lose 15 pounds that's a pretty decent percentage 00:47:02.380 --> 00:47:05.699 of your body weight and so you know to answer 00:47:05.699 --> 00:47:07.639 the question was the emphasis on taking care 00:47:07.639 --> 00:47:11.400 of yourself probably quite the opposite actually 00:47:11.400 --> 00:47:14.320 well even the patient so what about you know 00:47:14.320 --> 00:47:17.030 as far as Treating the patient with nutrition, 00:47:17.269 --> 00:47:21.110 exercise, sleep in a prescriptive side. How much 00:47:21.110 --> 00:47:24.489 education will you get as far as that factoring 00:47:24.489 --> 00:47:26.530 into the health of the men, women and children 00:47:26.530 --> 00:47:28.469 that you're going to be treating? Yeah, some. 00:47:28.670 --> 00:47:30.550 I mean, it was it was it was definitely a part 00:47:30.550 --> 00:47:33.230 of it. I don't think it was as much as it should 00:47:33.230 --> 00:47:36.250 have been. I think the you know, I'm an allopathic 00:47:36.250 --> 00:47:41.530 physician and I think the osteopathic. uh training 00:47:41.530 --> 00:47:45.590 is is more aligned with that if you will um so 00:47:45.590 --> 00:47:48.150 we got some not nearly as much though as we should 00:47:48.150 --> 00:47:51.829 have and i think those soft skills if you will 00:47:51.829 --> 00:47:55.190 and how those contribute to uh caring for a patient 00:47:55.190 --> 00:47:58.090 i mean i think i was taught it a little bit thinking 00:47:58.090 --> 00:48:00.849 back on a bit on it you know to a certain extent 00:48:00.849 --> 00:48:03.530 but not nearly as much as as i could have been 00:48:03.530 --> 00:48:04.989 or should have been i mean those are skills that 00:48:04.989 --> 00:48:08.679 i learned over time the value of them and how 00:48:08.679 --> 00:48:12.199 much those could contribute to a person's healing. 00:48:12.619 --> 00:48:14.800 You know, I mean, I distinctly remember times 00:48:14.800 --> 00:48:17.159 where, you know, I wouldn't have the answer for 00:48:17.159 --> 00:48:20.059 somebody, but I would be encouraging or I would 00:48:20.059 --> 00:48:23.539 give them a hug or talk to them or share a tear 00:48:23.539 --> 00:48:28.239 with them. And that human connection, I mean, 00:48:28.239 --> 00:48:30.400 often would help them get them to a better place. 00:48:30.539 --> 00:48:34.659 And it's incredibly important. And I think it's 00:48:34.659 --> 00:48:36.480 happening more now, for sure. I mean, I'm not 00:48:36.480 --> 00:48:38.880 in an academic setting on a regular basis, so 00:48:38.880 --> 00:48:42.820 I can't speak to it firsthand. But it was not 00:48:42.820 --> 00:48:45.900 valued as much as it should have been in retrospect 00:48:45.900 --> 00:48:50.460 when I was going through school. I came across 00:48:50.460 --> 00:48:53.159 a story a long time ago, and I talk about, as 00:48:53.159 --> 00:48:55.400 I mentioned a little bit earlier, sleep deprivation 00:48:55.400 --> 00:48:58.300 and the work week is such an important conversation 00:48:58.300 --> 00:49:00.719 in FIRE and EMS, especially as we're woefully 00:49:00.719 --> 00:49:03.690 understaffed at the moment. But I stumbled across 00:49:03.690 --> 00:49:07.389 the story of William Halstead. And when you look 00:49:07.389 --> 00:49:10.369 into the world of surgical residencies or residencies 00:49:10.369 --> 00:49:12.710 in general, you know, it was always like, well, 00:49:12.730 --> 00:49:15.110 why are these doctors, as you said before, whose, 00:49:15.190 --> 00:49:17.110 you know, literally lives are in their hands? 00:49:17.130 --> 00:49:19.809 Why are they required to do these crazy weeks? 00:49:20.250 --> 00:49:23.070 And it comes from him, you know, back a long, 00:49:23.130 --> 00:49:25.349 long time ago. I think it was the 1800s if I 00:49:25.349 --> 00:49:29.300 got that right. He was up for days at a time. 00:49:29.380 --> 00:49:31.300 And so obviously there was a precedent then for 00:49:31.300 --> 00:49:33.780 the students to do the same thing. I don't know 00:49:33.780 --> 00:49:36.320 how soon after, but it was revealed that he was 00:49:36.320 --> 00:49:38.760 addicted to cocaine and heroin. Now, I would 00:49:38.760 --> 00:49:40.840 probably be pretty good at sleep endurance myself 00:49:40.840 --> 00:49:43.519 if I was high as a kite for several days. But 00:49:43.519 --> 00:49:45.659 does that mean it's healthy? Absolutely not. 00:49:46.679 --> 00:49:49.659 What have you seen as far as the kind of unpacking 00:49:49.659 --> 00:49:53.760 of that and the drive to make these residencies 00:49:53.760 --> 00:49:57.340 and work weeks in the hospitals actually healthy 00:49:57.340 --> 00:49:59.800 rather than these insane, well, it's the way 00:49:59.800 --> 00:50:02.119 we've always done it mentality weeks that you 00:50:02.119 --> 00:50:05.179 saw before? Well, yeah, you know, there's a lot 00:50:05.179 --> 00:50:07.159 to unpack there. And it's interesting you bring 00:50:07.159 --> 00:50:10.579 up William Hosta because I recently wrote about 00:50:10.579 --> 00:50:14.960 him. And book number two, which is titled Unraveled, 00:50:14.960 --> 00:50:17.980 which speaks to my unraveling of not processing 00:50:17.980 --> 00:50:21.340 40 years of trauma. And you're right. I mean, 00:50:21.340 --> 00:50:23.639 I think when you're modeling something on a cocaine 00:50:23.639 --> 00:50:30.139 -fueled physician, like, what could go wrong, 00:50:30.159 --> 00:50:32.480 right? You know, we did that for like 100 years. 00:50:32.719 --> 00:50:35.000 You know, so I think there's been efforts over 00:50:35.000 --> 00:50:37.619 the years to unwind that. You know, the 80 -hour 00:50:37.619 --> 00:50:39.900 work week was, you know, a step in the right 00:50:39.900 --> 00:50:42.820 direction, you know. but there's so much more 00:50:42.820 --> 00:50:45.780 work to be done and i think part of it is you 00:50:45.780 --> 00:50:47.599 know at times it would be seen like a badge of 00:50:47.599 --> 00:50:50.840 honor you know like these you don't need to sleep 00:50:50.840 --> 00:50:52.860 and you don't need to eat and all these other 00:50:52.860 --> 00:50:57.099 crazy things and it's like really like that doesn't 00:50:57.099 --> 00:50:59.739 quite make sense like we're supposed to be the 00:50:59.739 --> 00:51:03.019 ones healing other people and we're doing a shitty 00:51:03.019 --> 00:51:05.579 job of taking care of ourselves like no wonder 00:51:05.579 --> 00:51:08.369 why there's rampant substance abuse and physician 00:51:08.369 --> 00:51:10.510 suicide rates are high and all these other negative 00:51:10.510 --> 00:51:12.889 things that result from it. I mean, look at who 00:51:12.889 --> 00:51:16.070 modeled the behavior, right? Having said that, 00:51:16.110 --> 00:51:19.530 though, it is getting talked about a lot. And 00:51:19.530 --> 00:51:22.889 I know there are efforts to reverse course on 00:51:22.889 --> 00:51:24.730 this and really put the correct things at the 00:51:24.730 --> 00:51:28.070 forefront and develop, you know, clinicians and 00:51:28.070 --> 00:51:30.449 physicians and nurses that are healthier. But, 00:51:30.510 --> 00:51:34.639 you know, when you've got a century of a mess 00:51:34.639 --> 00:51:37.320 to unwind it ain't gonna it actually ain't that's 00:51:37.320 --> 00:51:39.800 terrible it's not gonna happen overnight you 00:51:39.800 --> 00:51:41.340 know it's gonna take some time which is why these 00:51:41.340 --> 00:51:43.559 conversations are so important i mean it's why 00:51:43.559 --> 00:51:46.179 you know the number of my colleagues who have 00:51:46.179 --> 00:51:47.960 written books on these issues whether it's mental 00:51:47.960 --> 00:51:51.840 health or exposure to suicide or substance abuse 00:51:51.840 --> 00:51:55.199 or trauma i mean there's the number of physicians 00:51:55.199 --> 00:51:57.219 who have written a book and i'm obviously talking 00:51:57.219 --> 00:52:00.960 about my own inner circle here it's inordinate 00:52:00.960 --> 00:52:04.599 and i think it speaks to the importance of continuing 00:52:04.599 --> 00:52:07.860 to talk about it to create awareness to subsequently 00:52:07.860 --> 00:52:12.019 lead to action to get us to a better place so 00:52:12.019 --> 00:52:13.960 as you came through this and obviously you have 00:52:13.960 --> 00:52:16.099 this desire to serve and make the world a little 00:52:16.099 --> 00:52:21.460 better walk me through the the intersection between 00:52:22.599 --> 00:52:25.880 the the healer themselves and now this corporate 00:52:25.880 --> 00:52:29.059 element this money -making element um that you 00:52:29.059 --> 00:52:31.460 know as we've obviously kind of suggested earlier 00:52:31.460 --> 00:52:34.699 in this conversation is partly at the root of 00:52:34.699 --> 00:52:36.900 why we're seeing the demise of health care at 00:52:36.900 --> 00:52:43.099 the moment yeah so i think the interesting part 00:52:43.099 --> 00:52:48.659 of uh corporate health care or putting profits 00:52:48.659 --> 00:52:55.119 ahead of people is You're essentially turning 00:52:55.119 --> 00:52:59.880 our industry into an assembly line to a certain 00:52:59.880 --> 00:53:02.639 extent. And you are incentivizing individuals 00:53:02.639 --> 00:53:08.880 to create more widgets, work faster, do more 00:53:08.880 --> 00:53:12.000 procedures, et cetera. I mean, you're incentivizing 00:53:12.000 --> 00:53:15.639 sick care or illness care as opposed to preventative 00:53:15.639 --> 00:53:20.380 care. And I'm being overly simplistic to a certain 00:53:20.380 --> 00:53:23.019 extent. But when you do that and you incentivize. 00:53:23.469 --> 00:53:27.070 working harder, faster, doing more, interactions 00:53:27.070 --> 00:53:31.030 get compressed and compressed and compressed. 00:53:33.030 --> 00:53:39.210 And that erodes the trust of the physician -patient 00:53:39.210 --> 00:53:44.690 relationship. It creates errors. It leads to 00:53:44.690 --> 00:53:49.949 adverse outcomes. Honest to God, at times, we 00:53:49.949 --> 00:53:54.489 kill people for the sake of profit. You know, 00:53:54.510 --> 00:53:59.929 medical errors, they're rampant. You know, depending 00:53:59.929 --> 00:54:02.369 on the estimates, at a minimum, it's estimated 00:54:02.369 --> 00:54:05.670 that a few hundred thousand people die annually 00:54:05.670 --> 00:54:08.110 in the United States related to medical errors. 00:54:08.349 --> 00:54:10.769 You know, that's like, I got a buddy who equates 00:54:10.769 --> 00:54:13.530 it to about 10 jumbo jet airliners crashing per 00:54:13.530 --> 00:54:16.710 week of people killed by medical errors per week. 00:54:17.110 --> 00:54:19.510 Like if we lose a commercial airliner in this 00:54:19.510 --> 00:54:22.630 country, it makes national news typically. Yet. 00:54:22.920 --> 00:54:27.719 10 times a week in health care that happens it's 00:54:27.719 --> 00:54:30.920 it's it's sick and that doesn't even count the 00:54:30.920 --> 00:54:34.760 toll of physicians clinicians nurses ems firefighters 00:54:34.760 --> 00:54:37.000 who are taking their own lives because they're 00:54:37.000 --> 00:54:40.159 trying to deal with so much pain they don't see 00:54:40.159 --> 00:54:43.460 another way out you know breaks my heart to talk 00:54:43.460 --> 00:54:47.579 about that stuff so yeah i mean corporate medicine 00:54:47.579 --> 00:54:54.599 and greed is destroying or has destroyed our 00:54:54.599 --> 00:54:57.639 healthcare delivery system. We're going to that 00:54:57.639 --> 00:55:00.260 false economy. And sadly, we've all heard these 00:55:00.260 --> 00:55:03.019 examples where companies have said, well, we're 00:55:03.019 --> 00:55:05.960 going to have to pay X amount in lawsuits, but 00:55:05.960 --> 00:55:08.019 our profit was double that. So it's still worth 00:55:08.019 --> 00:55:10.019 doing. We can kill people and we'll still make 00:55:10.019 --> 00:55:11.960 a profit. And that's been spoken of. I mean, 00:55:11.980 --> 00:55:14.260 look at the Sackler family. Perfect example. 00:55:14.559 --> 00:55:17.280 They had complete knowledge of what they were 00:55:17.280 --> 00:55:19.539 doing with their painkillers. And I remember 00:55:19.539 --> 00:55:22.179 when I first moved to the States, my ex -wife 00:55:22.179 --> 00:55:24.679 and I lived in Broward County, which is where 00:55:24.679 --> 00:55:27.079 all the pill mills were. And she actually found 00:55:27.079 --> 00:55:30.019 herself working for a physician innocently because, 00:55:30.079 --> 00:55:31.679 you know, if you weren't behind the curtain, 00:55:31.719 --> 00:55:33.840 you had no idea what was going on. And she was 00:55:33.840 --> 00:55:35.699 like, it's so weird. Like we write prescriptions 00:55:35.699 --> 00:55:37.619 and these people fly from other states and they 00:55:37.619 --> 00:55:40.239 come and get these prescriptions. And after a 00:55:40.239 --> 00:55:43.579 while, we had an aha moment and she left. And 00:55:43.579 --> 00:55:46.199 I think shortly after that, some agency kicked 00:55:46.199 --> 00:55:48.869 in the door of that clinic. hold the doctor off. 00:55:49.369 --> 00:55:53.250 But, you know, that truly predatory action, you 00:55:53.250 --> 00:55:55.309 know, what is the ripple effect? You know, you 00:55:55.309 --> 00:55:56.730 have all these people that are just doing it 00:55:56.730 --> 00:55:59.130 for the right reason. But when you're putting 00:55:59.130 --> 00:56:01.969 profit over the well -being of the nation, you 00:56:01.969 --> 00:56:04.050 know, even from a fiscal point of view, like 00:56:04.050 --> 00:56:06.550 you said, all these jetliners full of people, 00:56:06.690 --> 00:56:08.650 I'm assuming there's a lot of lawsuits attached 00:56:08.650 --> 00:56:11.570 to that. So again, you know, if we're actually 00:56:11.570 --> 00:56:13.849 front -loading the money and giving an environment 00:56:13.849 --> 00:56:15.510 where we have enough physicians and they can 00:56:15.510 --> 00:56:18.210 take time with the people. And give them drugs 00:56:18.210 --> 00:56:20.010 if they need it, give them lifestyle information 00:56:20.010 --> 00:56:22.630 if they need it. That is going to save money 00:56:22.630 --> 00:56:24.849 hand over fist compared to, well, we'll just 00:56:24.849 --> 00:56:26.630 do it this way. And then if people die, then 00:56:26.630 --> 00:56:30.730 we'll just pay a settlement. I think probably 00:56:30.730 --> 00:56:34.489 the simplest way to potentially articulate this 00:56:34.489 --> 00:56:39.130 to the average American is, you know, we're rapidly 00:56:39.130 --> 00:56:42.130 approaching spending 20 % of our GDP on health 00:56:42.130 --> 00:56:44.530 care in the United States. OK, so there's a massive 00:56:44.530 --> 00:56:47.750 economy related to this. Compared to other developed 00:56:47.750 --> 00:56:51.389 nations, we're spending at a minimum twice the 00:56:51.389 --> 00:56:53.389 amount of money that they are, if not closer 00:56:53.389 --> 00:56:55.510 to three to four times other developed nations. 00:56:56.030 --> 00:57:00.929 And our outcomes compared to them suck. Like 00:57:00.929 --> 00:57:03.389 we're not spending twice as much money and getting 00:57:03.389 --> 00:57:06.889 like twice the, you know, a better car or a better 00:57:06.889 --> 00:57:09.389 house or spending twice as much money and getting. 00:57:10.639 --> 00:57:13.280 garbage at times you know in our life expectancy 00:57:13.280 --> 00:57:16.280 we've we've successfully bent the needle in the 00:57:16.280 --> 00:57:18.500 wrong direction like you look at every other 00:57:18.500 --> 00:57:20.380 developed nation this continues to gradually 00:57:20.380 --> 00:57:22.619 tick up and and we're now going the other way 00:57:22.619 --> 00:57:24.639 and so we're spending an inordinate amount of 00:57:24.639 --> 00:57:27.599 money and and for what i think that's the simplest 00:57:27.599 --> 00:57:29.219 way to look at it and it's all these downstream 00:57:29.219 --> 00:57:34.440 effects whether it's deaths related to narcotics 00:57:34.440 --> 00:57:38.670 overdose lawsuits medical errors these expenditures 00:57:38.670 --> 00:57:41.750 just grow and grow and grow and grow and we are 00:57:41.750 --> 00:57:46.789 all paying for it rest assured we are all paying 00:57:46.789 --> 00:57:49.670 for this um people talk about and i don't want 00:57:49.670 --> 00:57:51.510 to get into the weeds too much on insurance because 00:57:51.510 --> 00:57:53.510 i don't think that's necessarily where we want 00:57:53.510 --> 00:57:55.110 to take this so i've got insurance so i'm good 00:57:55.110 --> 00:57:58.630 are you are you good how much of a premium are 00:57:58.630 --> 00:58:01.530 you paying what's your deductible like when if 00:58:01.530 --> 00:58:03.190 you really start to look into it are you okay 00:58:03.190 --> 00:58:05.210 with 20 of your paycheck going to healthcare 00:58:05.210 --> 00:58:12.860 are you i'm not you know and not at all so sorry 00:58:12.860 --> 00:58:14.460 i got on a soapbox or a little bit sometimes 00:58:14.460 --> 00:58:19.320 it's hard not to yeah no this is i welcome soapboxes 00:58:19.320 --> 00:58:22.920 here it's interesting obviously when you've when 00:58:22.920 --> 00:58:25.900 you've worn a lot of hats lived in different 00:58:25.900 --> 00:58:28.559 countries you know you just get this different 00:58:28.559 --> 00:58:31.659 perspective on things and i grew up with the 00:58:31.659 --> 00:58:35.280 nhs you know and i was kind of pseudo -rural 00:58:35.900 --> 00:58:37.880 And so we had this amazing, you know, two doctors 00:58:37.880 --> 00:58:40.039 my whole life. We had this elderly doctor who 00:58:40.039 --> 00:58:43.019 retired and then this next doctor was our physician 00:58:43.019 --> 00:58:44.940 the whole time, took care of all the generations 00:58:44.940 --> 00:58:48.579 of earrings and tonkuses. And, you know, for 00:58:48.579 --> 00:58:50.300 example, I've said this on here a few times, 00:58:50.380 --> 00:58:53.199 my grandparents actually paid for Bupa, which 00:58:53.199 --> 00:58:55.460 is the private insurance that you could get at 00:58:55.460 --> 00:58:59.260 the time. And as they got older and older, the 00:58:59.260 --> 00:59:02.840 premiums got so immense that they were basically... 00:59:03.150 --> 00:59:05.150 forced to not have it anymore. Just when they 00:59:05.150 --> 00:59:07.309 finally were maybe able to start using it for 00:59:07.309 --> 00:59:10.150 some things, they were priced out. And my grandfather 00:59:10.150 --> 00:59:14.110 at 99 years old got cancer and he was so healthy 00:59:14.110 --> 00:59:15.989 physiologically that it went through him like 00:59:15.989 --> 00:59:19.369 it would a younger person. And I watched on the 00:59:19.369 --> 00:59:23.889 NHS him get the most incredible care from doctor's 00:59:23.889 --> 00:59:26.630 home visits, you know, hospice care set up in 00:59:26.630 --> 00:59:29.269 his home. After he passed away, they visit my 00:59:29.269 --> 00:59:31.170 grandmother for literally another couple of weeks. 00:59:31.289 --> 00:59:33.619 It was amazing. Absolutely. And that was on the 00:59:33.619 --> 00:59:37.059 NHS. But what breaks my heart is I would argue 00:59:37.059 --> 00:59:39.099 that is the best health care system on the planet 00:59:39.099 --> 00:59:41.539 when it's done properly at its core. You know, 00:59:41.559 --> 00:59:43.500 we are going to take care of the elderly, the 00:59:43.500 --> 00:59:47.000 infirm, you know, and what that does is then 00:59:47.000 --> 00:59:49.860 if it's a tax based system, in theory, it forces 00:59:49.860 --> 00:59:51.900 you then to make the country healthy. And we 00:59:51.900 --> 00:59:53.699 were a very healthy country, I would argue, for 00:59:53.699 --> 00:59:57.639 a long time. However, when I've gone home recently. 00:59:58.570 --> 01:00:02.070 I watch my British men and women getting fatter 01:00:02.070 --> 01:00:03.869 and fatter and sicker and sicker and obesity 01:00:03.869 --> 01:00:06.670 is getting worse and worse. And you couple that 01:00:06.670 --> 01:00:09.530 with the privatization of the NHS, they've ripped 01:00:09.530 --> 01:00:12.510 it apart. And so this is what breaks my heart 01:00:12.510 --> 01:00:15.389 is the American model has been forced onto other 01:00:15.389 --> 01:00:17.409 countries and the people of those countries don't 01:00:17.409 --> 01:00:19.949 realize the damage is happening. But, you know, 01:00:19.949 --> 01:00:25.250 a tax based health care system that you use when 01:00:25.250 --> 01:00:29.500 you need it. that everyone chips in, that encourages 01:00:29.500 --> 01:00:33.559 the country to be as healthy as possible so we 01:00:33.559 --> 01:00:37.019 don't use as much tax, is an extremely fiscally 01:00:37.019 --> 01:00:39.420 sound model as well, as long as your country 01:00:39.420 --> 01:00:42.360 is, you know, the proactive health care is being 01:00:42.360 --> 01:00:45.500 pushed. But what I've seen in the UK is that 01:00:45.500 --> 01:00:49.139 with the change in nutrition and lack of exercise 01:00:49.139 --> 01:00:51.480 and all these other things coupled with privatization. 01:00:52.320 --> 01:00:54.679 They've taken arguably the best healthcare system 01:00:54.679 --> 01:00:57.519 on the planet and they've fucking destroyed it. 01:00:58.820 --> 01:01:01.500 It's interesting. I've heard this from a handful 01:01:01.500 --> 01:01:04.480 of individuals talking about the NHS in particular. 01:01:06.800 --> 01:01:09.159 And, you know, I can't say that I've experienced 01:01:09.159 --> 01:01:12.019 utilizing the system firsthand, but I think, 01:01:12.079 --> 01:01:15.840 how do I say this? I think at its core or at 01:01:15.840 --> 01:01:21.400 its simplest, perhaps, I do think universal healthcare. 01:01:22.159 --> 01:01:25.000 It is the way to go. You know, we've talked about 01:01:25.000 --> 01:01:28.219 health care being a human right. And, you know, 01:01:28.219 --> 01:01:31.900 I'm in that camp. You know, I don't like where 01:01:31.900 --> 01:01:34.579 we're marginalizing people and not giving them 01:01:34.579 --> 01:01:36.320 an opportunity to get the treatment and care 01:01:36.320 --> 01:01:39.559 that I believe that deserve. I think that kind 01:01:39.559 --> 01:01:43.159 of goes against being a human being, to be quite 01:01:43.159 --> 01:01:45.820 honest with you. It breaks my heart a little 01:01:45.820 --> 01:01:49.340 bit to see that. Let me back up a little bit. 01:01:49.420 --> 01:01:51.940 I think there's some amazing things in healthcare 01:01:51.940 --> 01:01:54.840 in the United States. I think in terms of technology 01:01:54.840 --> 01:01:57.440 and advanced care and some of these other things 01:01:57.440 --> 01:02:00.079 that are out there, they're hard to beat. The 01:02:00.079 --> 01:02:03.500 problem is, do you have access to it? Can you 01:02:03.500 --> 01:02:05.699 afford it? And if the answer to either one of 01:02:05.699 --> 01:02:09.340 those things is no, then you're screwed, depending 01:02:09.340 --> 01:02:12.340 on what the circumstances are. And to then take 01:02:12.340 --> 01:02:14.869 that type of a model where... Some people can 01:02:14.869 --> 01:02:17.070 get care and some people get nothing to other 01:02:17.070 --> 01:02:24.250 places around the world. It's scary. And I'm 01:02:24.250 --> 01:02:27.070 a physician in the U .S. I want the health care 01:02:27.070 --> 01:02:30.630 system here to be as good as it can be. I don't 01:02:30.630 --> 01:02:33.909 think we're the model at large to be extrapolating 01:02:33.909 --> 01:02:36.349 that and implementing it around the world. I 01:02:36.349 --> 01:02:38.110 think there's bits and pieces, sure, just like 01:02:38.110 --> 01:02:43.960 everywhere else. Yeah, it's scary. And the downstream 01:02:43.960 --> 01:02:47.699 effect of those decisions is, how does it then 01:02:47.699 --> 01:02:50.639 affect the caregivers when they're not getting 01:02:50.639 --> 01:02:52.780 the resources or the tools or the mental health 01:02:52.780 --> 01:02:55.360 support or whatever they might need to provide 01:02:55.360 --> 01:02:57.360 the best? And then it becomes a bit of a vicious 01:02:57.360 --> 01:03:00.219 cycle. And then that's hard to unwind. And that's 01:03:00.219 --> 01:03:03.800 quite a bit of where we're at now in the U .S. 01:03:03.820 --> 01:03:07.000 that focuses on the almighty dollar. Things are 01:03:07.000 --> 01:03:10.969 sacrificed as a result of that. And it negatively 01:03:10.969 --> 01:03:14.130 impacts patients and caregivers at pretty much 01:03:14.130 --> 01:03:17.510 every level. Well, speaking of obesity in this 01:03:17.510 --> 01:03:21.610 country, I think we're well over 70 % of the 01:03:21.610 --> 01:03:25.090 country is overweight and over 40 % of the country 01:03:25.090 --> 01:03:29.889 is obese, like significantly overweight. And 01:03:29.889 --> 01:03:32.889 again, that in itself, we're talking about leadership. 01:03:32.909 --> 01:03:35.730 And I've spoken about this before on social media 01:03:35.730 --> 01:03:39.349 and in other areas. I think it was Winston Churchill, 01:03:39.550 --> 01:03:41.630 and I'm paraphrasing, said, you can mark the 01:03:41.630 --> 01:03:44.110 greatness of a country by the health of their 01:03:44.110 --> 01:03:47.110 people. And so again, greatest country in the 01:03:47.110 --> 01:03:48.889 world. I've heard it all the time, the American 01:03:48.889 --> 01:03:52.869 flag, but we're not. We have amazing people in 01:03:52.869 --> 01:03:54.730 this country, but we're not taken care of. We're 01:03:54.730 --> 01:03:56.590 not the greatest. We're not the greatest in education. 01:03:56.829 --> 01:03:58.650 We're not the greatest in healthcare. We have 01:03:58.650 --> 01:04:01.250 murders in our schools on a weekly basis. There's 01:04:01.250 --> 01:04:03.110 a lot of areas that we have to be humble enough 01:04:03.110 --> 01:04:05.110 to say, you know what? We're not the greatest 01:04:05.110 --> 01:04:07.070 in these areas, and we have to address that. 01:04:07.840 --> 01:04:11.159 When you talk about healthcare, the same way 01:04:11.159 --> 01:04:13.079 as no one talks about why are our streets so 01:04:13.079 --> 01:04:15.099 dangerous when we're talking about law enforcement, 01:04:15.340 --> 01:04:18.699 you don't hear people talking about the obesity 01:04:18.699 --> 01:04:22.159 crisis and the opioid epidemic when we're looking 01:04:22.159 --> 01:04:24.880 at first responder and doctor and nurse burnout. 01:04:25.199 --> 01:04:29.000 So talk to me about that lens. What are the frustrations 01:04:29.000 --> 01:04:32.900 in healthcare for Americans getting fatter and 01:04:32.900 --> 01:04:35.619 sicker and the impact of that on our hospitals 01:04:35.619 --> 01:04:42.750 and our clinics? Oh, boy. How long is this podcast, 01:04:42.969 --> 01:04:46.710 James? We've got all the time in the world. I 01:04:46.710 --> 01:04:51.289 mean, the impacts are tremendous. You know, you 01:04:51.289 --> 01:04:53.550 just take one of those cans of worms, if you 01:04:53.550 --> 01:04:58.349 will, obesity. It makes pretty much everything 01:04:58.349 --> 01:05:00.769 in healthcare delivery more difficult. You know, 01:05:00.809 --> 01:05:02.909 whether we're talking about hypertension management 01:05:02.909 --> 01:05:06.230 or diabetes management, heart disease, congestive 01:05:06.230 --> 01:05:09.070 heart failure. Simply performing a surgery on 01:05:09.070 --> 01:05:12.190 somebody who's in one of those camps, it becomes 01:05:12.190 --> 01:05:14.610 more difficult. The complication rates go up, 01:05:14.630 --> 01:05:16.750 the mortality rates go up, et cetera. So the 01:05:16.750 --> 01:05:19.329 costs go up, right? And so the downstream effect 01:05:19.329 --> 01:05:22.869 of that particular problem is tremendous. The 01:05:22.869 --> 01:05:27.750 opiate crisis, oh boy. Maybe I'll talk about 01:05:27.750 --> 01:05:31.510 this in a little bit of the context of a documentary. 01:05:31.550 --> 01:05:33.269 I don't know if you've seen the documentary Dope 01:05:33.269 --> 01:05:36.489 Sick. Oh, my goodness. Yeah, I mean, it was kind 01:05:36.489 --> 01:05:40.769 of docudrama, wasn't it? Yeah, docudrama, yeah. 01:05:40.909 --> 01:05:51.449 With Michael Keaton? Yes. And, you know, being 01:05:51.449 --> 01:05:54.909 a primary care physician and thinking about the 01:05:54.909 --> 01:05:57.909 individuals that died from overdose or who were 01:05:57.909 --> 01:06:02.460 addicted to opiates. You know, the costs related 01:06:02.460 --> 01:06:06.440 to, you know, really greed and profiteering from 01:06:06.440 --> 01:06:09.440 Purdue Pharmaceuticals and how it negatively 01:06:09.440 --> 01:06:12.159 impacted the health care landscape in the United 01:06:12.159 --> 01:06:17.179 States is disgusting. I actually I know Rick 01:06:17.179 --> 01:06:20.460 Mountcastle, great guy. And Rick's all about 01:06:20.460 --> 01:06:22.559 justice. He's one of the lawyers that was highlighted 01:06:22.559 --> 01:06:27.480 in Dope Sick. Great guy. Rick is a great guy. 01:06:32.569 --> 01:06:35.190 Having witnessed some of these adverse effects 01:06:35.190 --> 01:06:38.489 and or deaths related to the opiate crisis, it's 01:06:38.489 --> 01:06:41.070 heartbreaking. It's absolutely heartbreaking. 01:06:41.250 --> 01:06:46.510 And it's a huge toll on our livelihood, our interactions, 01:06:46.670 --> 01:06:49.309 our relationship, our life expectancy, the amount 01:06:49.309 --> 01:06:50.789 of money we spend on health care. I mean, look 01:06:50.789 --> 01:06:52.909 at how much money we spend on getting Narcan 01:06:52.909 --> 01:06:55.510 put all over the place in this country. Not that 01:06:55.510 --> 01:06:57.409 I think that's a bad idea. I think it's a good 01:06:57.409 --> 01:07:01.059 idea to have Narcan available. But why the hell 01:07:01.059 --> 01:07:03.099 do we have to have Narcan available? You know, 01:07:03.119 --> 01:07:06.260 like again, reactive again. Totally. Like, let's 01:07:06.260 --> 01:07:08.739 push. Let's go further upstream and deal with 01:07:08.739 --> 01:07:13.480 some of this stuff. You know, I distinctly remember 01:07:13.480 --> 01:07:16.119 when the pain scale came out, you know, like 01:07:16.119 --> 01:07:19.880 is the fifth vital sign. I was like, don't get 01:07:19.880 --> 01:07:22.380 me started on this. I was like, what? What the 01:07:22.380 --> 01:07:24.340 hell are we doing? This person is telling me 01:07:24.340 --> 01:07:26.500 they're a 10 out of 10 sitting there smiling 01:07:26.500 --> 01:07:29.630 like they're not in a 10 out of 10 pain. I used 01:07:29.630 --> 01:07:31.369 to have to describe to people like a 10 out of 01:07:31.369 --> 01:07:34.329 10 is like, I just cut your leg off. I'm pouring 01:07:34.329 --> 01:07:37.510 salt and alcohol in it and lighting it on fire. 01:07:37.829 --> 01:07:40.929 That is a 10. Is it the pot that's attached or 01:07:40.929 --> 01:07:43.070 the nub? Because those two are different stimulus. 01:07:44.690 --> 01:07:48.929 Touche, touche. Oh, it was like, oh, my God. 01:07:48.949 --> 01:07:51.489 And it just created this mountain of extra work 01:07:51.489 --> 01:07:55.349 for us, too. You know, and again, it's at the 01:07:55.349 --> 01:07:59.980 expense of people because. of profit and money 01:07:59.980 --> 01:08:02.880 and greed you know and those are tend to be common 01:08:02.880 --> 01:08:05.699 themes with a lot of these things where you know 01:08:05.699 --> 01:08:07.400 what's the right thing to do versus what's going 01:08:07.400 --> 01:08:08.920 to make us money and we're you know where's the 01:08:08.920 --> 01:08:11.380 balance in there you know and how do you manage 01:08:11.380 --> 01:08:14.239 that polarity if you will well this was what 01:08:14.239 --> 01:08:17.420 was so maddening during covid the most and this 01:08:17.420 --> 01:08:19.600 is i would argue this is still the case to this 01:08:19.600 --> 01:08:22.880 day the most censored voice is the one in the 01:08:22.880 --> 01:08:25.600 middle Hands down, I've witnessed it. I've had 01:08:25.600 --> 01:08:27.699 my Instagram account shut down for simply just 01:08:27.699 --> 01:08:29.600 trying to push kindness, community, compassion, 01:08:29.840 --> 01:08:34.140 empathy. And what I mean by that is during COVID, 01:08:34.399 --> 01:08:37.119 no matter what your stance was on, let's just 01:08:37.119 --> 01:08:40.899 say vaccines, there was one truth. The healthier 01:08:40.899 --> 01:08:43.859 the human being, the better the outcome. If you 01:08:43.859 --> 01:08:46.579 choose not to have a vaccine. then you need the 01:08:46.579 --> 01:08:49.020 healthiest immune system to have the right response 01:08:49.020 --> 01:08:52.359 to the COVID virus. If you choose to have a vaccine, 01:08:52.479 --> 01:08:54.560 you need a healthy immune system to have the 01:08:54.560 --> 01:08:57.260 healthy response to the vaccine to create the 01:08:57.260 --> 01:09:00.380 immunity for the virus. But that was heresy, 01:09:00.460 --> 01:09:03.920 absolute heresy, supposedly, that you dare suggest 01:09:03.920 --> 01:09:06.600 that obesity and pre -existing medical conditions 01:09:06.600 --> 01:09:10.720 had anything to do with a COVID death. And this 01:09:10.720 --> 01:09:13.449 is the thing that just... you know, angers me 01:09:13.449 --> 01:09:16.829 so much. Opioids, over 100 ,000 Americans die 01:09:16.829 --> 01:09:19.609 every year from the opioid crisis. We're at the 01:09:19.609 --> 01:09:22.409 millions with all the kind of related elements 01:09:22.409 --> 01:09:25.810 of obesity. So when COVID hit and there was that 01:09:25.810 --> 01:09:29.010 ticker on CNN and Fox News and, you know, whatever 01:09:29.010 --> 01:09:31.989 their World War I trench version of this pandemic 01:09:31.989 --> 01:09:34.850 was, but the moment that we were done with it, 01:09:34.970 --> 01:09:36.489 they were like, all right, well, let's just move 01:09:36.489 --> 01:09:38.050 on now. We don't want to talk about it. We don't 01:09:38.050 --> 01:09:39.789 want to reflect and learn lessons. We just, we 01:09:39.789 --> 01:09:40.970 don't want to pretend, you know, pretend it never 01:09:40.970 --> 01:09:44.060 happened and let's go. Meanwhile, Americans are 01:09:44.060 --> 01:09:47.140 getting fatter and sicker. So every year, a million 01:09:47.140 --> 01:09:49.539 plus Americans are dying. Where is that news 01:09:49.539 --> 01:09:52.439 coverage? So this is what's so disgusting. This 01:09:52.439 --> 01:09:55.920 is Republican and this is Democrat. For the last 01:09:55.920 --> 01:09:58.460 few decades, we've got sicker and sicker and 01:09:58.460 --> 01:10:01.979 sicker. And COVID, you know, showed really, showed 01:10:01.979 --> 01:10:04.939 this country just how sick we are. Because healthy 01:10:04.939 --> 01:10:07.460 countries like Scandinavia, they did not have 01:10:07.460 --> 01:10:10.279 even close to the amount of per capita deaths 01:10:10.279 --> 01:10:12.970 than we had. And yet we come out the other end 01:10:12.970 --> 01:10:15.149 and people still turn their head to the most 01:10:15.149 --> 01:10:17.949 obvious thing, which is we are a very sick nation 01:10:17.949 --> 01:10:20.529 and we have to do something about it. And that 01:10:20.529 --> 01:10:24.289 in turn is killing our doctors, nurses, paramedics, 01:10:24.289 --> 01:10:30.350 EMTs, etc. I don't disagree with you. I'm actually 01:10:30.350 --> 01:10:32.930 probably so much aligned with you that I'm borderline 01:10:32.930 --> 01:10:36.350 speechless at this point. But I think it speaks 01:10:36.350 --> 01:10:38.930 to, you know, where where's the energy? Where's 01:10:38.930 --> 01:10:41.989 the focus? You know, how are people communicating 01:10:41.989 --> 01:10:44.170 with one another? And if we're just arguing about 01:10:44.170 --> 01:10:46.670 everything in two camps, like, how do we get 01:10:46.670 --> 01:10:48.350 to that middle ground where actually, as you 01:10:48.350 --> 01:10:51.470 say, the truth probably is. I'm, you know, James, 01:10:51.529 --> 01:10:54.189 I'm probably more with you in terms of political. 01:10:54.609 --> 01:10:57.510 And I think the answers are in the middle. And 01:10:57.510 --> 01:11:00.710 that's managing those polarities. You know, we 01:11:00.710 --> 01:11:02.069 could even talk about the polarity of politics. 01:11:02.130 --> 01:11:03.630 Not that I want to talk about that, because that 01:11:03.630 --> 01:11:05.970 is not my forte at all, unless we're talking 01:11:05.970 --> 01:11:08.939 like sports or. maybe crypto or medicine i'm 01:11:08.939 --> 01:11:12.060 probably not the expert on it um but i think 01:11:12.060 --> 01:11:16.760 you know it's about balance and we need to do 01:11:16.760 --> 01:11:18.979 a better job at large in this country about finding 01:11:18.979 --> 01:11:22.659 the balance and i think if we can do that it 01:11:22.659 --> 01:11:25.039 will allow us to push further upstream to make 01:11:25.039 --> 01:11:27.720 better decisions so that we do have a healthier 01:11:27.720 --> 01:11:32.779 um population at large but but we're not there 01:11:32.779 --> 01:11:36.000 i mean we are not there and we are very far from 01:11:36.000 --> 01:11:39.359 there in many many places and you know i just 01:11:39.359 --> 01:11:40.920 think about how many people are marginalized 01:11:40.920 --> 01:11:43.439 and not even included in the discussions you 01:11:43.439 --> 01:11:47.720 know that's a completely different topic um yeah 01:11:47.720 --> 01:11:49.220 we got a long ways to go but i think you know 01:11:49.220 --> 01:11:51.819 i don't want to just beat debbie downer either 01:11:51.819 --> 01:11:54.420 though james i think i think we're getting to 01:11:54.420 --> 01:11:56.859 a point particularly within the healthcare space 01:11:56.859 --> 01:12:00.859 where the level of frustration not only from 01:12:00.859 --> 01:12:03.680 clinicians and physicians but also patients it's 01:12:03.680 --> 01:12:08.479 at a boiling point and If we are intelligent 01:12:08.479 --> 01:12:11.359 about how we use that energy and that collective 01:12:11.359 --> 01:12:14.140 frustration and turn it into collaboration and 01:12:14.140 --> 01:12:17.380 opportunity and ways forward, I think that's 01:12:17.380 --> 01:12:21.479 where the magic is with this. And to talk about, 01:12:21.500 --> 01:12:23.500 you know, the documentary Suck It Up Buttercup 01:12:23.500 --> 01:12:26.340 a little bit. I mean, ultimately, that's where 01:12:26.340 --> 01:12:29.760 we want to go with this. You know, we want there's 01:12:29.760 --> 01:12:32.619 a there's a couple evergreen calls to action. 01:12:32.720 --> 01:12:35.479 One of it's unlearning, learn helplessness, which. 01:12:36.060 --> 01:12:38.859 You know, that feeling like, well, I'm only one 01:12:38.859 --> 01:12:42.039 person. What can I do? Well, you can do something. 01:12:42.180 --> 01:12:44.119 You know, I often talk about like time, talent, 01:12:44.180 --> 01:12:47.880 treasure. You know, do you have the time to contribute 01:12:47.880 --> 01:12:50.939 to something that's creating positive change? 01:12:51.199 --> 01:12:53.319 Do you have the talent to do it? Like you do 01:12:53.319 --> 01:12:54.979 in this podcast. Clearly you have the talent 01:12:54.979 --> 01:12:57.640 for trying to facilitate positive change. Do 01:12:57.640 --> 01:13:00.500 you have the treasure? Skip a latte in the morning. 01:13:00.960 --> 01:13:02.840 Donate five bucks to your favorite nonprofit 01:13:02.840 --> 01:13:05.680 that's trying to do something positive. Everyone 01:13:05.680 --> 01:13:08.439 can contribute to making a difference. But I 01:13:08.439 --> 01:13:10.380 think to do it on a bigger scale, we've got to 01:13:10.380 --> 01:13:14.079 get out of our siloed approach. I mean, healthcare 01:13:14.079 --> 01:13:16.560 delivery in and of itself is pretty siloed. And 01:13:16.560 --> 01:13:18.539 we don't necessarily get into that rabbit hole. 01:13:18.600 --> 01:13:21.760 But I think at times the efforts to make positive 01:13:21.760 --> 01:13:24.939 change are also siloed. And that's problematic 01:13:24.939 --> 01:13:27.539 in and of itself. You know, like we need scale. 01:13:28.260 --> 01:13:32.159 We need to be pushing way further upstream. on 01:13:32.159 --> 01:13:34.779 this curve, if you will, to facilitate the changes 01:13:34.779 --> 01:13:37.000 that you're talking about. And to do that, you 01:13:37.000 --> 01:13:40.420 need numbers and you need collaboration. We need 01:13:40.420 --> 01:13:43.279 legislative change related to this. There's a 01:13:43.279 --> 01:13:45.319 lot of entities that are very happy with how 01:13:45.319 --> 01:13:48.739 things are going and making a lot of money. I'll 01:13:48.739 --> 01:13:51.859 stop. I'll stop short there. But I think this 01:13:51.859 --> 01:13:53.939 is it. The whole point of this is obviously we 01:13:53.939 --> 01:13:56.399 got to have these. conversations about what's 01:13:56.399 --> 01:13:59.239 broken but like you said then the next breath 01:13:59.239 --> 01:14:01.359 needs to be well then what can we do about it 01:14:01.359 --> 01:14:03.039 and this is what's amazing about the documentary 01:14:03.039 --> 01:14:06.039 and the book that you've written so let's just 01:14:06.039 --> 01:14:08.119 kind of underline the issues in your profession 01:14:08.119 --> 01:14:10.359 specifically and then let's then we'll go to 01:14:10.359 --> 01:14:12.560 you know king for a day what needs to change 01:14:12.560 --> 01:14:15.560 so what are you seeing as far as recruitment 01:14:15.560 --> 01:14:19.340 retention burnout etc in the physician space 01:14:19.340 --> 01:14:26.409 through your eyes oh lord um It's a, it's, it's 01:14:26.409 --> 01:14:28.770 kind of a mess depending on where you're at. 01:14:28.850 --> 01:14:30.770 I mean, I think there's pockets of amazing things. 01:14:31.069 --> 01:14:33.590 Like I work, the group I work for has an amazing 01:14:33.590 --> 01:14:36.149 culture, emergency care specialists in Michigan. 01:14:37.510 --> 01:14:42.090 You know, they, they value their people, you 01:14:42.090 --> 01:14:45.869 know, and it's the return over is minimal, but 01:14:45.869 --> 01:14:49.069 that's not the norm. I think that's very much 01:14:49.069 --> 01:14:51.569 an outlier. I think in many instances, you know, 01:14:51.569 --> 01:14:54.100 it's, it's what's the ROI. And it's all these 01:14:54.100 --> 01:14:56.760 deleterious effects that result from that that 01:14:56.760 --> 01:15:00.420 are impacting clinicians, physicians, mental 01:15:00.420 --> 01:15:05.100 health. But I think the burnout and the mental 01:15:05.100 --> 01:15:07.239 health issues and the suicides and the substance 01:15:07.239 --> 01:15:11.239 abuse are, they're emblematic of a much bigger 01:15:11.239 --> 01:15:15.560 problem. You know, Wendy Dean writes about moral 01:15:15.560 --> 01:15:18.579 injury, that feeling that you want to do the 01:15:18.579 --> 01:15:20.340 right thing for somebody. And I'm paraphrasing 01:15:20.340 --> 01:15:22.699 big time here. I need to just memorize this at 01:15:22.699 --> 01:15:25.500 one point. But that's not me. And so I'll probably 01:15:25.500 --> 01:15:27.760 keep doing what I'm doing. Anyways, that you 01:15:27.760 --> 01:15:29.420 want to do the right thing for somebody, but 01:15:29.420 --> 01:15:31.760 there's all these obstacles in your way of trying 01:15:31.760 --> 01:15:34.680 to achieve that. And then you have this ethical 01:15:34.680 --> 01:15:36.319 dilemma of like, well, I know this is the right 01:15:36.319 --> 01:15:39.079 thing, but I can't do it because of all these 01:15:39.079 --> 01:15:43.779 things. And that's emblematic of a sick system 01:15:43.779 --> 01:15:46.279 that has its priorities in the wrong places. 01:15:47.869 --> 01:15:50.489 Wendy writes about physicians being canaries 01:15:50.489 --> 01:15:52.829 in the coal mine. You know, you took a canary 01:15:52.829 --> 01:15:55.289 down in the coal mine so that if oxygen was deprived, 01:15:55.710 --> 01:15:57.890 the canary drops dead and everybody needs to 01:15:57.890 --> 01:16:02.050 leave. Well, physicians are dropping dead at 01:16:02.050 --> 01:16:04.289 a rate of one per day on average in the United 01:16:04.289 --> 01:16:06.789 States of America. There are about a million 01:16:06.789 --> 01:16:08.649 of us, and the fact that we lose a physician 01:16:08.649 --> 01:16:13.510 a day to suicide is insane. And that number really 01:16:13.510 --> 01:16:16.300 hasn't slowed down to my knowledge. and speaks 01:16:16.300 --> 01:16:18.600 to the level of dysfunction that's further upstream 01:16:18.600 --> 01:16:23.159 so that was a long -winded answer to you know 01:16:23.159 --> 01:16:25.600 what does burnout mean what does mental well 01:16:25.600 --> 01:16:29.960 -being mean all these issues are signs warning 01:16:29.960 --> 01:16:33.680 signs of a system that in many instances is on 01:16:33.680 --> 01:16:37.340 the verge of collapsing you think about medical 01:16:37.340 --> 01:16:40.399 deserts you think about obstetrical deserts you 01:16:40.399 --> 01:16:42.640 think about the number of rural hospitals getting 01:16:42.640 --> 01:16:44.920 shut down you think about the number of primary 01:16:44.920 --> 01:16:47.220 care physicians walking away from their career 01:16:47.220 --> 01:16:50.199 at the prime. You know, James, I quote -unquote 01:16:50.199 --> 01:16:52.260 retired, if you will. I didn't really obviously 01:16:52.260 --> 01:16:54.640 retire. I'm doing all kinds of stuff now. But 01:16:54.640 --> 01:16:59.279 at 46, 46 years old, you know, I spent four years 01:16:59.279 --> 01:17:01.520 of undergrad, four years of medical school, three 01:17:01.520 --> 01:17:04.920 years of residency, 11 years in the prime of 01:17:04.920 --> 01:17:08.539 my life to dedicate it to becoming a physician. 01:17:09.100 --> 01:17:11.039 I can't tell you how many funerals, weddings, 01:17:11.260 --> 01:17:14.390 birthdays, etc. I missed. Because I wanted to 01:17:14.390 --> 01:17:18.510 be a doctor. And to give that all up because 01:17:18.510 --> 01:17:26.010 you're so fed up. I just it's hard to even imagine, 01:17:26.170 --> 01:17:31.989 you know, it really is. You mentioned about the 01:17:31.989 --> 01:17:34.550 health care deserts, and I've had a few people 01:17:34.550 --> 01:17:36.350 on the show that have alluded to this. I think 01:17:36.350 --> 01:17:38.210 this is something that Americans don't realize. 01:17:38.630 --> 01:17:43.000 Talk to me about the. the infant mortality rate 01:17:43.000 --> 01:17:44.920 one would think that it would be lowest in you 01:17:44.920 --> 01:17:47.399 know lesser developed countries but where is 01:17:47.399 --> 01:17:49.960 america as far as you know pregnant healthy pregnancies 01:17:49.960 --> 01:17:52.520 and infant mortality in the the range of all 01:17:52.520 --> 01:17:57.720 the developed nations um probably the best way 01:17:57.720 --> 01:18:04.140 to describe this is not good um again i'm not 01:18:04.140 --> 01:18:05.899 the best according statistics and i probably 01:18:05.899 --> 01:18:08.869 need to get better at this One of my colleagues, 01:18:08.949 --> 01:18:11.449 Dyke Drummond, he talks about the fact that in 01:18:11.449 --> 01:18:14.710 certain areas in the United States, infant and 01:18:14.710 --> 01:18:19.149 maternal mortality is equivalent to sub -Saharan 01:18:19.149 --> 01:18:23.350 areas in Africa. You know, and supposedly for, 01:18:23.449 --> 01:18:26.250 you know, a developed country who's got the quote 01:18:26.250 --> 01:18:28.710 -unquote best health care in the world, our infant 01:18:28.710 --> 01:18:31.369 mortality rates and maternal mortality rates 01:18:31.369 --> 01:18:34.310 in certain areas of this country are abysmal. 01:18:35.270 --> 01:18:40.470 Abysmal. You know, deplorable. You know, we pull 01:18:40.470 --> 01:18:43.050 a couple of statistics in some cases like triple 01:18:43.050 --> 01:18:48.189 other countries. I think it speaks to what we're 01:18:48.189 --> 01:18:51.829 valuing. Like, you know, where's the value? Think 01:18:51.829 --> 01:18:54.529 about it. If you're a you know, you're a black 01:18:54.529 --> 01:18:59.189 woman in an underserved area where there's no 01:18:59.189 --> 01:19:02.689 gynecologist for obstetrician or gynecologist 01:19:02.689 --> 01:19:08.469 for three or four hours and you have a. complication 01:19:08.469 --> 01:19:14.010 you're screwed and it's disgusting that that's 01:19:14.010 --> 01:19:23.609 what we're doing you know um yeah we we it almost 01:19:23.609 --> 01:19:26.189 you know i talk about these things and i won't 01:19:26.189 --> 01:19:27.949 lie it gives me it gives me a headache a little 01:19:27.949 --> 01:19:33.050 bit like a tension headache to think about You 01:19:33.050 --> 01:19:35.550 know, we value some people and some things and 01:19:35.550 --> 01:19:40.270 some areas and others. We don't. We walk right 01:19:40.270 --> 01:19:43.329 past our fellow man, fellow human, whatever, 01:19:43.449 --> 01:19:47.130 and somehow that's okay. I'm not okay with that. 01:19:47.890 --> 01:19:50.949 It was probably, I guess, more of a philosophical 01:19:50.949 --> 01:19:53.590 answer to your question, I suppose. But back 01:19:53.590 --> 01:19:56.170 to the, yeah, we got a lot of work to do. A lot 01:19:56.170 --> 01:19:58.210 of work to do. Well, it circles around as well 01:19:58.210 --> 01:20:00.289 to a comment I've made. You know, there's a lot 01:20:00.289 --> 01:20:03.069 of different religions out there. But arguably, 01:20:03.189 --> 01:20:05.529 all the ones that I've come across at the core 01:20:05.529 --> 01:20:08.510 is kindness, compassion, community. There's not 01:20:08.510 --> 01:20:12.210 a class system. Jesus didn't say, well, the rich 01:20:12.210 --> 01:20:16.050 should get health care. I'm pretty sure, if I 01:20:16.050 --> 01:20:18.630 remember rightly from my Bible, that he was out 01:20:18.630 --> 01:20:21.689 there amongst them healing and lifting up the 01:20:21.689 --> 01:20:25.449 fallen. So the way that we, again, beat our chest 01:20:25.449 --> 01:20:27.510 doesn't even align with a lot of these faiths 01:20:27.510 --> 01:20:29.470 that are so prominent in this country. And don't 01:20:29.470 --> 01:20:32.670 get me wrong. beautiful human beings from all 01:20:32.670 --> 01:20:36.090 those religions. But, you know, some of our actions 01:20:36.090 --> 01:20:38.390 don't align. A number of people I've heard say 01:20:38.390 --> 01:20:40.789 that are supposedly Christian, you know, Narcan 01:20:40.789 --> 01:20:43.109 is wasted on addicts and we need to get these 01:20:43.109 --> 01:20:46.310 bums out of our city. And like, really, that's 01:20:46.310 --> 01:20:48.210 what your prophet would have said? I don't think 01:20:48.210 --> 01:20:50.670 so. I think there's a disconnection there. And 01:20:50.670 --> 01:20:52.930 I think you might need to revisit this book that 01:20:52.930 --> 01:20:57.489 you hold so sacred and read it properly. The 01:20:57.489 --> 01:21:00.810 other thing that I think is very, you know, under 01:21:00.810 --> 01:21:05.390 discussed is the impact of for example drug commercials 01:21:05.390 --> 01:21:09.289 the kind of programming that a lot of these patients 01:21:09.289 --> 01:21:11.949 have when they walk into a doctor's office with 01:21:11.949 --> 01:21:15.909 expectations of being prescribed x y or zed um 01:21:15.909 --> 01:21:18.470 talk to me about that because i know that america 01:21:18.470 --> 01:21:20.670 is only one of two countries if i'm not mistaken 01:21:20.670 --> 01:21:22.770 new zealand being the other one that's even allowed 01:21:22.770 --> 01:21:26.189 to have commercials on television for pharmaceuticals 01:21:26.189 --> 01:21:29.590 so what does that do through a doctor's eyes 01:21:29.590 --> 01:21:32.010 to the patient themselves as they walk through? 01:21:34.109 --> 01:21:36.189 Well, the first thing that comes to my mind when 01:21:36.189 --> 01:21:39.350 you say that, if I never saw another drug commercial 01:21:39.350 --> 01:21:42.829 on TV when I was watching a show, I can't say 01:21:42.829 --> 01:21:46.710 that I would be disappointed. So hopefully that 01:21:46.710 --> 01:21:48.569 speaks to that to a certain extent. I think the 01:21:48.569 --> 01:21:50.250 way I'll answer the question or try and tackle 01:21:50.250 --> 01:21:54.069 the question as a family physician, it would 01:21:54.069 --> 01:21:58.310 be... Once in a blue moon, it would be helpful. 01:21:58.529 --> 01:22:00.670 I mean, I think once in a blue moon, a patient 01:22:00.670 --> 01:22:03.649 would bring up a pharmaceutical that I thought 01:22:03.649 --> 01:22:06.689 they would benefit from. But the vast majority 01:22:06.689 --> 01:22:09.850 of times, there would be a cheaper alternative 01:22:09.850 --> 01:22:12.670 that was almost as effective or nearly as effective, 01:22:12.930 --> 01:22:16.710 or it wasn't indicated, it didn't make sense, 01:22:16.909 --> 01:22:20.930 or it was prohibitively expensive for that person 01:22:20.930 --> 01:22:23.470 that even if they wanted it, they couldn't have 01:22:23.470 --> 01:22:27.260 access to it. And so when people historically, 01:22:27.399 --> 01:22:29.279 and this is anecdotal evidence, obviously I'm 01:22:29.279 --> 01:22:32.220 talking like family physician, Dr. Otten, this 01:22:32.220 --> 01:22:34.699 is his opinion. He's remembering patients who 01:22:34.699 --> 01:22:36.140 had come in telling me about all these great 01:22:36.140 --> 01:22:37.619 commercials they saw, blah, blah, blah, blah, 01:22:37.640 --> 01:22:39.640 blah. And then I would spend 20 to 30 minutes 01:22:39.640 --> 01:22:43.079 going, oh my God, there's like 37 other options 01:22:43.079 --> 01:22:45.380 that are way cheaper for you that we could utilize 01:22:45.380 --> 01:22:49.380 aside from this one particular drug. So maybe 01:22:49.380 --> 01:22:51.279 that was a tangential nebulous way of answering 01:22:51.279 --> 01:22:53.880 your question. Like they're frustrating to me. 01:22:54.159 --> 01:22:56.979 And I think they're emblematic of what we're 01:22:56.979 --> 01:23:00.659 valuing again. Like, you know, I think about, 01:23:00.699 --> 01:23:02.600 I'm not going to give specific examples because 01:23:02.600 --> 01:23:04.420 I don't necessarily need a specific pharmaceutical 01:23:04.420 --> 01:23:06.760 company coming after me and blah, blah, blah, 01:23:06.800 --> 01:23:09.579 blah, blah. But the problems it created as a 01:23:09.579 --> 01:23:13.720 family physician far exceeded the benefit that 01:23:13.720 --> 01:23:17.100 I ever saw from a patient coming in telling me, 01:23:17.159 --> 01:23:20.300 hey, I saw a commercial for this drug, you know. 01:23:21.430 --> 01:23:23.829 Hopefully that answers it in a way that doesn't 01:23:23.829 --> 01:23:27.229 put a bigger target on me than probably already 01:23:27.229 --> 01:23:29.890 is on me. Well, what I'm getting from it, and 01:23:29.890 --> 01:23:32.369 it's so weird because more often than not, you 01:23:32.369 --> 01:23:35.930 see these drug commercials for issues that you 01:23:35.930 --> 01:23:38.729 would think would be very rare. How many people 01:23:38.729 --> 01:23:42.109 have psoriasis, for example? You see that over 01:23:42.109 --> 01:23:43.810 and over and over and over again. Are there that 01:23:43.810 --> 01:23:45.789 many people that you're going to spend millions 01:23:45.789 --> 01:23:49.479 and millions of dollars? But it's that quick 01:23:49.479 --> 01:23:51.979 fix element. So you walk in, you know, you've 01:23:51.979 --> 01:23:54.300 got a doctor that's only been given five minutes 01:23:54.300 --> 01:23:56.380 per patient. Then you've got a patient coming 01:23:56.380 --> 01:23:58.479 in going, this pill is going to fix this thing 01:23:58.479 --> 01:24:01.060 that I have. Rather than the conversation of, 01:24:01.079 --> 01:24:03.560 well, look, it took you 20 years to get this 01:24:03.560 --> 01:24:06.100 disease because of your lifestyle, because of 01:24:06.100 --> 01:24:08.779 your nutrition. Let's take some time and start 01:24:08.779 --> 01:24:11.500 walking towards. Getting you back there. And 01:24:11.500 --> 01:24:13.960 I've always said this medicine has a place like, 01:24:14.000 --> 01:24:15.840 you know, if you've got hypertension and it's 01:24:15.840 --> 01:24:17.640 dangerous and yeah, we need to bring that down. 01:24:18.100 --> 01:24:20.640 But it needs to be an exit strategy from nearly 01:24:20.640 --> 01:24:22.960 all meds. All right. Now we've got to start talking 01:24:22.960 --> 01:24:25.239 about, you know, your BMI or all these other 01:24:25.239 --> 01:24:27.000 things and get you back to the point where we 01:24:27.000 --> 01:24:29.359 don't need to take these drugs anymore. But that's 01:24:29.359 --> 01:24:32.340 never the message. Mental health drugs, you know, 01:24:32.359 --> 01:24:34.720 obesity drugs, all these things. There's this 01:24:34.720 --> 01:24:38.380 kind of. facade that there's this irreversible 01:24:38.380 --> 01:24:40.079 where you've got diabetes now there's nothing 01:24:40.079 --> 01:24:41.479 you can do about it you're going to be on this 01:24:41.479 --> 01:24:43.560 forever well if you caught it early enough absolutely 01:24:43.560 --> 01:24:45.399 there's something you can do about it you can 01:24:45.399 --> 01:24:47.260 change it with lifestyle changes you know you 01:24:47.260 --> 01:24:49.960 can make your cardiovascular system healthier 01:24:49.960 --> 01:24:54.409 with exercise and nutrition and sleep but I feel 01:24:54.409 --> 01:24:56.670 like the average person is so brainwashed that 01:24:56.670 --> 01:24:58.810 they just need that pill and it's a quick fix. 01:24:58.869 --> 01:25:01.710 And it goes against the lifestyle changes that 01:25:01.710 --> 01:25:04.329 are needed to actually reverse most of the diseases 01:25:04.329 --> 01:25:07.069 that people are suffering with. I think there's 01:25:07.069 --> 01:25:08.810 a lot of validity in what you just said. I think 01:25:08.810 --> 01:25:11.010 there's another thing, too, is, I mean, you look 01:25:11.010 --> 01:25:13.829 at the pharmaceuticals that are in the commercials. 01:25:13.949 --> 01:25:15.550 I mean, what are the profit margins of those 01:25:15.550 --> 01:25:20.569 particular drugs? You know, do you see commercials 01:25:20.569 --> 01:25:26.439 for aspirin? Really? You know, no, not so much. 01:25:27.539 --> 01:25:30.619 You know, an aspirin has saved how many lives 01:25:30.619 --> 01:25:32.039 over the course of the years, you know, from 01:25:32.039 --> 01:25:34.779 a cardiovascular perspective in particular. You 01:25:34.779 --> 01:25:39.479 know, I'll speak to it. There is a lot of magic 01:25:39.479 --> 01:25:43.159 in what you just said, James, talking about being 01:25:43.159 --> 01:25:46.539 using these other elements to get off medications, 01:25:46.960 --> 01:25:52.039 eating healthier, losing weight, exercising. 01:25:52.890 --> 01:25:55.369 you know being in healthy relationships all these 01:25:55.369 --> 01:25:57.970 other things there's value to this stuff and 01:25:57.970 --> 01:26:00.609 one of my favorite things to do as a physician 01:26:00.609 --> 01:26:03.989 was to take people off of medications like i 01:26:03.989 --> 01:26:07.189 loved doing that particularly like the older 01:26:07.189 --> 01:26:09.970 patients who would come in and be on like a dozen 01:26:09.970 --> 01:26:13.109 drugs and i'm be like what the hell are you on 01:26:13.109 --> 01:26:15.449 all this stuff or well so and so put me on it 01:26:15.449 --> 01:26:17.470 a bazillion years ago i don't even know why i 01:26:17.470 --> 01:26:18.869 take it or what i think of where i'm like okay 01:26:18.869 --> 01:26:22.399 let's let's take a few minutes here and talk 01:26:22.399 --> 01:26:26.000 about polypharmacy and what that is and how can 01:26:26.000 --> 01:26:28.819 we address it and honestly some of my most um 01:26:28.819 --> 01:26:33.279 i used to love dealing with polypharmacy because 01:26:33.279 --> 01:26:35.979 if you found that one drug that was causing problems 01:26:35.979 --> 01:26:42.020 and eliminated it oh my gosh it was so satisfying 01:26:42.020 --> 01:26:44.859 as the clinician and the patients would love 01:26:44.859 --> 01:26:46.619 it because it was like you gave them their life 01:26:46.619 --> 01:26:49.579 back i can think of a i'll give you a story about 01:26:49.579 --> 01:26:52.819 this you know um And I'm not going to give specifics 01:26:52.819 --> 01:26:54.399 because I don't want to violate HIPAA rules and 01:26:54.399 --> 01:26:56.619 blah, blah, blah. But I had a younger patient 01:26:56.619 --> 01:27:01.239 who I was basically seeing as a consultant. And 01:27:01.239 --> 01:27:06.100 her story had gotten so complex and so convoluted 01:27:06.100 --> 01:27:08.079 that I was like, man, this doesn't, in reviewing 01:27:08.079 --> 01:27:09.420 your chart, I'm like, this doesn't make a lot 01:27:09.420 --> 01:27:12.220 of sense. Like, all these things that are being 01:27:12.220 --> 01:27:16.420 considered don't seem to fit the mold or the 01:27:16.420 --> 01:27:19.319 path. And I was like, I think this is all related 01:27:19.319 --> 01:27:23.439 to a side effect. from a drug. And so I started 01:27:23.439 --> 01:27:25.079 looking at her med list and trying to figure 01:27:25.079 --> 01:27:27.699 out timelines. And then I saw the patient. I 01:27:27.699 --> 01:27:28.920 took her through the history. I was like, just 01:27:28.920 --> 01:27:31.159 walk me through this. Let's start at the beginning. 01:27:31.380 --> 01:27:33.220 Let's go through when you were a kid and tell 01:27:33.220 --> 01:27:35.140 me all about it. And of course, I had the luxury 01:27:35.140 --> 01:27:36.880 of time because I'm kind of in a unique role 01:27:36.880 --> 01:27:40.979 now. But long or the short, it all amounted to 01:27:40.979 --> 01:27:48.479 one drug had created a nightmare of a cascading 01:27:49.589 --> 01:27:51.789 evolution of medical issues that had resulted 01:27:51.789 --> 01:27:55.909 from that one drug. And when we eliminated that 01:27:55.909 --> 01:28:00.729 medication, a whole host of positive things occurred 01:28:00.729 --> 01:28:03.770 as a result of it. To the point where when I 01:28:03.770 --> 01:28:05.630 saw this person back for a follow -up, their 01:28:05.630 --> 01:28:09.430 spouse had accompanied them to the visit. And 01:28:09.430 --> 01:28:11.770 that usually means one of two things. Either 01:28:11.770 --> 01:28:14.850 it's going really well or it's going really poorly. 01:28:14.930 --> 01:28:17.050 And I was like, oh, please, God, tell me it's 01:28:17.050 --> 01:28:20.039 going really well, Cam. and sure enough it was 01:28:20.039 --> 01:28:22.819 and so it was so and i tell that story because 01:28:22.819 --> 01:28:24.699 you know you spoke to the fact that like everyone's 01:28:24.699 --> 01:28:26.399 looking for a quick fix you know the reality 01:28:26.399 --> 01:28:31.600 is life is hard life throws challenges roadblocks 01:28:31.600 --> 01:28:35.680 at us and you know our our quick fix and instant 01:28:35.680 --> 01:28:38.960 gratification culture i think has perpetuated 01:28:38.960 --> 01:28:41.359 some of the things that you've alluded to um 01:28:41.359 --> 01:28:44.039 and we need to think twice about that we really 01:28:44.039 --> 01:28:46.930 do i mean when i was seeing patients, you know, 01:28:46.930 --> 01:28:50.729 yeah, sure, there was opportunity for blood pressure 01:28:50.729 --> 01:28:52.569 medications and all these other things, but there 01:28:52.569 --> 01:28:54.289 are many other things that needed to be entertained. 01:28:54.850 --> 01:28:56.510 You know, in particular, blood pressure, are 01:28:56.510 --> 01:28:58.489 you sleeping okay? Do you snore? How much alcohol 01:28:58.489 --> 01:29:00.810 are you exercising? All these other things, how 01:29:00.810 --> 01:29:02.510 much salt do you take in? All these other things 01:29:02.510 --> 01:29:05.090 have potential to contribute, not universally, 01:29:05.229 --> 01:29:07.210 but the potential, right? And that's the beauty 01:29:07.210 --> 01:29:10.850 of medicine. It's not black and white. We'll 01:29:10.850 --> 01:29:13.449 go into reactive versus proactive. If you think 01:29:13.449 --> 01:29:16.430 about time. like you were able to have that conversation 01:29:16.430 --> 01:29:19.050 because you had more time with that young lady, 01:29:19.189 --> 01:29:23.229 how many unneeded doctor visits were avoided 01:29:23.229 --> 01:29:26.369 because you had the time and figured out what 01:29:26.369 --> 01:29:28.270 was going on, got her off the meds. Obviously 01:29:28.270 --> 01:29:30.010 the other meds are probably trying to treat the 01:29:30.010 --> 01:29:32.310 side effects. And now she's, you know, probably 01:29:32.310 --> 01:29:34.750 coming for an annual checkup instead of constant 01:29:34.750 --> 01:29:38.149 doctor's visits. So again, taking that, you know, 01:29:38.149 --> 01:29:39.949 Oh, we've only got five minutes for these patient. 01:29:40.069 --> 01:29:42.289 Well, what if you didn't, what if you actually, 01:29:42.390 --> 01:29:44.710 you know, kind of changed the philosophy where 01:29:44.710 --> 01:29:46.289 you said, all right, no, we're going to do 30 01:29:46.289 --> 01:29:48.109 minutes or whatever is needed for each patient. 01:29:49.029 --> 01:29:51.430 It'd be interesting to see as you extrapolate 01:29:51.430 --> 01:29:54.350 out that extra time that was able so that a doctor 01:29:54.350 --> 01:29:57.470 can truly critically think, how much time would 01:29:57.470 --> 01:30:05.010 that save long -term? Oh my goodness. Like, you 01:30:05.010 --> 01:30:08.789 know, as a primary care physician, if I routinely 01:30:08.789 --> 01:30:11.090 could spend an appropriate amount of time with 01:30:11.090 --> 01:30:14.260 a patient, the downstream cost savings would 01:30:14.260 --> 01:30:17.720 be tremendous. Absolutely tremendous. And I think 01:30:17.720 --> 01:30:19.600 that's why you're seeing, I'll shift a little 01:30:19.600 --> 01:30:22.359 bit, why you're seeing an uptake in things like 01:30:22.359 --> 01:30:25.680 direct primary care. I don't know if you're familiar 01:30:25.680 --> 01:30:29.199 with DPC at all, but for whoever's not familiar, 01:30:29.380 --> 01:30:32.060 it's basically a direct contract between a clinician 01:30:32.060 --> 01:30:35.380 and a patient. You pay a monthly subscription, 01:30:35.640 --> 01:30:37.680 50 bucks, 75 bucks, maybe it's 100 bucks, I don't 01:30:37.680 --> 01:30:39.939 know, somewhere in that range. and your access 01:30:39.939 --> 01:30:41.579 and the amount of time you can spend with the 01:30:41.579 --> 01:30:45.140 physician is, it's not unlimited, but it's a 01:30:45.140 --> 01:30:47.520 factor of X more than you would get to spend 01:30:47.520 --> 01:30:51.020 with your run -of -the -mill fee -for -service 01:30:51.020 --> 01:30:54.979 clinician. And by doing that, you can dig into 01:30:54.979 --> 01:30:57.939 these things. Is there housing insecurity? Is 01:30:57.939 --> 01:31:00.479 there food insecurity? What are some of these 01:31:00.479 --> 01:31:02.939 other factors that may be leading to this medical 01:31:02.939 --> 01:31:05.369 issue that truly aren't being addressed? You 01:31:05.369 --> 01:31:07.529 know, like if I is an example, if I told diabetic, 01:31:07.609 --> 01:31:09.149 hey, you need to take this drug and they say, 01:31:09.189 --> 01:31:12.350 OK, but they go home and don't do it. What the 01:31:12.350 --> 01:31:15.170 hell did I accomplish? Nothing. You know, and 01:31:15.170 --> 01:31:16.689 maybe they're not taking it because they can't 01:31:16.689 --> 01:31:18.909 afford it. You know, maybe it's the diabetic 01:31:18.909 --> 01:31:20.890 who has is having to make a decision between 01:31:20.890 --> 01:31:24.029 buying their insulin versus paying their mortgage. 01:31:24.909 --> 01:31:27.470 You know, those are real problems that exist. 01:31:27.609 --> 01:31:33.050 And when the decision is made to have. A place 01:31:33.050 --> 01:31:36.779 to live and. the insulin isn't taken and then 01:31:36.779 --> 01:31:38.500 they end up in the emergency room because of 01:31:38.500 --> 01:31:41.199 a complication the total cost of care goes through 01:31:41.199 --> 01:31:43.560 the roof and we're all on the hook for that whether 01:31:43.560 --> 01:31:45.380 we think it or not but we are all on the hook 01:31:45.380 --> 01:31:48.439 for that stuff you know um so yeah i'm totally 01:31:48.439 --> 01:31:52.260 taught out in soapbox tangent but you said soapboxes 01:31:52.260 --> 01:31:53.880 are okay so i figured why not i'll stop when 01:31:53.880 --> 01:31:57.739 it goes back to you know universal healthcare 01:31:57.739 --> 01:32:00.899 which i believe wholeheartedly is the solution. 01:32:01.079 --> 01:32:04.399 Because again, if it's encouraging making a nation 01:32:04.399 --> 01:32:07.380 healthy, where is the downside? But as you mentioned, 01:32:07.539 --> 01:32:11.979 20 % of our GDP, it's not asking the nation for 01:32:11.979 --> 01:32:15.000 even more tax money. It's, as I've quoted so 01:32:15.000 --> 01:32:16.859 many times, because I absolutely adore this quote 01:32:16.859 --> 01:32:20.020 now, Desmond Tutu, we spend so much time pulling 01:32:20.020 --> 01:32:22.140 people out of the river, we forget to go upstream 01:32:22.140 --> 01:32:24.180 and find out why they're falling in in the first 01:32:24.180 --> 01:32:27.729 place. Yes, that's such a good one. The money 01:32:27.729 --> 01:32:30.470 is already there. Same with the fire service. 01:32:30.510 --> 01:32:34.069 The money is wasted in my profession on overtime 01:32:34.069 --> 01:32:37.010 filling all these vacant spots, training people 01:32:37.010 --> 01:32:39.189 who then turn around and leave one, two, five 01:32:39.189 --> 01:32:42.529 years later, workman's comp payments for all 01:32:42.529 --> 01:32:44.909 the claims, medical disabilities, line of duty 01:32:44.909 --> 01:32:48.050 deaths, lawsuits from mistakes. There's millions. 01:32:48.689 --> 01:32:51.609 LAFD, Los Angeles Fire Department, in four years, 01:32:51.689 --> 01:32:54.329 they're overtime, not operating their overtime 01:32:54.329 --> 01:33:00.680 budget. was $1 .2 billion with a B. One fire 01:33:00.680 --> 01:33:03.439 department. So this is the thing. It's not a 01:33:03.439 --> 01:33:06.539 we need more money conversation. It's just simply 01:33:06.539 --> 01:33:09.899 we need to reappropriate funds proactively, which 01:33:09.899 --> 01:33:12.800 I would argue would save so much money. I know 01:33:12.800 --> 01:33:15.399 it will in the fire service. I know it will in 01:33:15.399 --> 01:33:18.659 the health care system too. But imagine if we 01:33:18.659 --> 01:33:21.899 were then motivated to make this country healthier 01:33:21.899 --> 01:33:24.079 because people understood truly it was going 01:33:24.079 --> 01:33:26.279 to save so much money that we could put back 01:33:26.279 --> 01:33:29.630 into healthy food in our schools. Supporting 01:33:29.630 --> 01:33:33.289 PE programs, pedestrianizing downtowns, bolstering 01:33:33.289 --> 01:33:36.069 local farmers, creating, you know, organic food. 01:33:36.590 --> 01:33:38.670 You would, you know, the savings would be incredible. 01:33:39.130 --> 01:33:41.550 But the way that we're doing, you know, it's 01:33:41.550 --> 01:33:44.750 finite. We're going to get to a point where we're 01:33:44.750 --> 01:33:47.569 going to break in my profession nationally. So 01:33:47.569 --> 01:33:49.729 this is what makes these conversations so incredible. 01:33:50.189 --> 01:33:51.970 So I promised that we would go to solutions. 01:33:52.329 --> 01:33:56.109 So now if you were king for a day, king doctor 01:33:56.109 --> 01:33:59.600 for a day. What do we need to change, whether 01:33:59.600 --> 01:34:02.840 it's within the actual medical setting and the 01:34:02.840 --> 01:34:04.619 clinics and the hospitals that you worked in 01:34:04.619 --> 01:34:08.079 or nationally, so that we can truly reverse this, 01:34:08.220 --> 01:34:11.060 make patient outcomes better, and then create 01:34:11.060 --> 01:34:13.760 the kind of environment for our medical professionals 01:34:13.760 --> 01:34:17.159 so they can thrive rather than die every single 01:34:17.159 --> 01:34:22.039 day? You know, James, I wish there was just one 01:34:22.039 --> 01:34:26.439 switch I could flip. I think you've alluded to 01:34:26.439 --> 01:34:28.340 and we've talked about many things that I think 01:34:28.340 --> 01:34:30.300 will be instrumental in getting us to a better 01:34:30.300 --> 01:34:32.859 place in terms of health care delivery. I think 01:34:32.859 --> 01:34:35.819 universal health care is one. I think seeing 01:34:35.819 --> 01:34:39.680 health care as a human right is another, to be 01:34:39.680 --> 01:34:43.159 quite honest with you. Simply put, valuing people 01:34:43.159 --> 01:34:46.500 over profits is a great mantra. We could talk 01:34:46.500 --> 01:34:48.039 about the quadruple aim. We could talk about 01:34:48.039 --> 01:34:49.779 the quintuple aim. We could talk about all these 01:34:49.779 --> 01:34:53.600 things. I think there's multiple paths to get 01:34:53.600 --> 01:34:59.220 us there. I think it'll be complicated. It'll 01:34:59.220 --> 01:35:01.460 be difficult. It's going to take a tremendous 01:35:01.460 --> 01:35:05.500 amount of work. One of the things, and I'll come 01:35:05.500 --> 01:35:07.260 back to the documentary because obviously it's 01:35:07.260 --> 01:35:09.579 top of mind, and maybe this is a good time to 01:35:09.579 --> 01:35:15.380 show my shirt. Love it. Possibly. I'm actually 01:35:15.380 --> 01:35:17.100 Scott who created it. It's in the other room 01:35:17.100 --> 01:35:19.960 editing. You know, one of the things that we're 01:35:19.960 --> 01:35:22.619 trying to do with the documentary, aside from 01:35:22.619 --> 01:35:24.939 unlearning learned helplessness, is to facilitate 01:35:24.939 --> 01:35:28.579 the concept of an impact network. And an impact, 01:35:28.619 --> 01:35:31.060 you know, an impact network is this. Think of 01:35:31.060 --> 01:35:32.619 all these disparate groups that are doing amazing 01:35:32.619 --> 01:35:34.520 things, but they're not necessarily collaborating 01:35:34.520 --> 01:35:37.600 or interconnected and working together. It's 01:35:37.600 --> 01:35:40.100 happening. It's beginning in health care. They're 01:35:40.100 --> 01:35:43.579 out there. If we can accelerate that, not only 01:35:43.579 --> 01:35:45.300 with clinicians, but also getting the patient 01:35:45.300 --> 01:35:48.079 voice involved, I think. I think truly that's 01:35:48.079 --> 01:35:49.840 going to be where the magic is to get further 01:35:49.840 --> 01:35:52.619 upstream in the river where the problems are 01:35:52.619 --> 01:35:58.399 occurring, as we discussed. But we're not there. 01:35:58.500 --> 01:36:01.939 We've got a ways to go. Definitely got a ways 01:36:01.939 --> 01:36:04.859 to go. It's almost, you know, when you think 01:36:04.859 --> 01:36:10.920 about it, it's such a wicked problem that I get 01:36:10.920 --> 01:36:12.920 why people just say, you know what, I'm just 01:36:12.920 --> 01:36:15.770 going to do my job and get through my day. But 01:36:15.770 --> 01:36:19.670 the problem with that is if everybody does that, 01:36:19.729 --> 01:36:22.750 it'll never get any better. You know, we've got 01:36:22.750 --> 01:36:25.270 to think differently about how we not only take 01:36:25.270 --> 01:36:27.409 care of ourselves and our own individual health, 01:36:27.510 --> 01:36:29.970 but we got to think differently about our fellow 01:36:29.970 --> 01:36:32.850 human beings and how we care for one another. 01:36:32.909 --> 01:36:35.210 You talked about love, compassion and kindness. 01:36:35.310 --> 01:36:39.329 I agree. I did a podcast with Diana Londano. 01:36:42.000 --> 01:36:43.560 Gosh, I'm going to totally forget the cardiologist 01:36:43.560 --> 01:36:45.720 who was on it too. And forgive me, it'll come 01:36:45.720 --> 01:36:47.539 to me as soon as I'm off the show. Anyways, it 01:36:47.539 --> 01:36:50.060 doesn't matter. The title of the podcast was 01:36:50.060 --> 01:36:55.159 Love is Always the Answer. And, you know, if 01:36:55.159 --> 01:36:58.560 you think about it, it kind of is. If you attack 01:36:58.560 --> 01:37:02.279 things from an angle of love, most people do 01:37:02.279 --> 01:37:07.800 okay. Absolutely. It's funny, I just saw a quote 01:37:07.800 --> 01:37:10.579 today. Actually, what I'm saying, just saw a 01:37:10.579 --> 01:37:12.460 quote. It was in your book, Ripple of Change. 01:37:13.079 --> 01:37:19.859 Steve Jobs. The people who believe they can change 01:37:19.859 --> 01:37:21.840 the world are the people who will change the 01:37:21.840 --> 01:37:24.079 world. Have I got that right? That was in your 01:37:24.079 --> 01:37:27.939 book, wasn't it? Close, close. Oh, this is, I 01:37:27.939 --> 01:37:29.939 love that one. The people who are crazy enough 01:37:29.939 --> 01:37:32.300 to think that they can change the world are the 01:37:32.300 --> 01:37:35.109 ones that actually do. There you go. Much more 01:37:35.109 --> 01:37:38.329 articulate. No, no, no. I mean, I love that. 01:37:38.390 --> 01:37:40.869 I love that quote. And, you know, I got a buddy 01:37:40.869 --> 01:37:43.989 who, you know, we published the book and I would 01:37:43.989 --> 01:37:46.409 talk about what my aspirations were related to 01:37:46.409 --> 01:37:49.090 it. And clearly I was thinking like big picture, 01:37:49.130 --> 01:37:52.449 like down the road. And he would say to me, Sean 01:37:52.449 --> 01:37:55.430 Nason's his name. Great guy. Brilliant guy. He's 01:37:55.430 --> 01:37:58.010 like, Todd, you know, you can't boil the ocean. 01:37:59.230 --> 01:38:01.449 And I would routinely respond, well, yeah, I 01:38:01.449 --> 01:38:03.090 know that. But what if I had like a few million 01:38:03.090 --> 01:38:06.350 of us and we all just did a little bit? Maybe 01:38:06.350 --> 01:38:08.949 the temperature would come up a little bit. You 01:38:08.949 --> 01:38:10.890 know, and I think that's the opportunity that 01:38:10.890 --> 01:38:14.550 I see in particular with health care. But in 01:38:14.550 --> 01:38:18.789 many, in many places, if we all do a little bit 01:38:18.789 --> 01:38:21.789 and we all start talking about it, after a while, 01:38:21.850 --> 01:38:24.430 it gets hard to ignore. And then you start to 01:38:24.430 --> 01:38:27.329 see changes happen. And I think I kind of think 01:38:27.329 --> 01:38:30.369 that's where we're at now. Yeah, I had the same 01:38:30.369 --> 01:38:32.689 exact mentality with with kinder. I'm turning 01:38:32.689 --> 01:38:34.729 it into a show now. And it's the same thing. 01:38:34.890 --> 01:38:38.329 What if what if millions of people watched a 01:38:38.329 --> 01:38:41.569 show that really made them believe that they 01:38:41.569 --> 01:38:44.949 could heal, that they could be better, you know, 01:38:44.949 --> 01:38:47.890 not waiting for a government or, you know, a 01:38:47.890 --> 01:38:50.109 company or an organization to fix it for you. 01:38:50.130 --> 01:38:52.930 But what if you actually one day looked in the 01:38:52.930 --> 01:38:54.529 mirror and go, you know what, I'm going to take 01:38:54.529 --> 01:38:56.979 that first step. I mean, you literally would 01:38:56.979 --> 01:38:59.260 change the world. So I'm right there with you. 01:38:59.560 --> 01:39:01.420 And it goes, what's the option? What's the alternative? 01:39:01.699 --> 01:39:03.960 You just don't do anything and things just get 01:39:03.960 --> 01:39:07.520 worse. And that's unacceptable to me. So I agree 01:39:07.520 --> 01:39:09.880 a thousand percent. Let's start with Ripple of 01:39:09.880 --> 01:39:11.840 Change then. What made you write that book? And 01:39:11.840 --> 01:39:15.479 tell me about the unique dynamic that is a doctor 01:39:15.479 --> 01:39:20.699 and patient within those pages. Oh, so what started 01:39:20.699 --> 01:39:25.989 me writing Ripple of Change was. really at the 01:39:25.989 --> 01:39:28.630 tail end of healing from my burnout as a physician. 01:39:28.829 --> 01:39:30.670 I wrote a poem called Medicine is a World of 01:39:30.670 --> 01:39:34.250 Gray, and it was kind of a dark look at what 01:39:34.250 --> 01:39:38.229 really goes on in primary care. That was the 01:39:38.229 --> 01:39:41.229 starting point. And then I wrote a chapter called 01:39:41.229 --> 01:39:44.329 Anatomy of Burnout, which was really my journey 01:39:44.329 --> 01:39:46.630 as a physician through burnout and not only how 01:39:46.630 --> 01:39:49.109 it affected me, but how it affected my friends 01:39:49.109 --> 01:39:52.350 and my family and all these concentric circles 01:39:52.350 --> 01:39:56.319 around me in a very negative way. Right. The 01:39:56.319 --> 01:39:59.579 trajectory of verbal change changed dramatically 01:39:59.579 --> 01:40:02.739 when my co -author got involved. And honestly, 01:40:02.960 --> 01:40:05.699 he was having his own health care struggles and 01:40:05.699 --> 01:40:08.739 I was running out of ideas for him, like literally 01:40:08.739 --> 01:40:10.840 running out of ideas because I knew I couldn't 01:40:10.840 --> 01:40:13.180 fix it. It was a problem that was significantly 01:40:13.180 --> 01:40:15.560 more complex than I had the capacity to manage. 01:40:15.899 --> 01:40:18.699 But I didn't want to give up on him. You know, 01:40:18.720 --> 01:40:20.020 and there was a couple of key moments there. 01:40:20.100 --> 01:40:23.720 One. I told him about the project and asked him 01:40:23.720 --> 01:40:25.380 if he would be interested in talking about it 01:40:25.380 --> 01:40:27.600 or maybe writing a little piece. And he said, 01:40:27.640 --> 01:40:28.760 well, what should I write? And I said, well, 01:40:28.760 --> 01:40:30.720 just write. That's the only instructions I gave 01:40:30.720 --> 01:40:32.619 him. And he wrote something really good. And 01:40:32.619 --> 01:40:34.779 it led to a magical conversation that led us 01:40:34.779 --> 01:40:37.039 on the journey. But one of the other things that 01:40:37.039 --> 01:40:43.100 I think was critical for his healing was he was 01:40:43.100 --> 01:40:45.800 struggling so much and was in such a dark place. 01:40:45.939 --> 01:40:49.079 Finally, I told him, I'm like, Joshua, I believe 01:40:49.079 --> 01:40:51.939 that you're going to get better. But you have 01:40:51.939 --> 01:40:56.119 to believe it, too. And that was a bit of a turning 01:40:56.119 --> 01:40:58.399 point for him that someone else believed that 01:40:58.399 --> 01:41:00.819 he would come out of it, even though I didn't 01:41:00.819 --> 01:41:04.000 have the answers for him. And by weaving our 01:41:04.000 --> 01:41:07.079 two stories together, it created this, of course, 01:41:07.079 --> 01:41:09.100 I'm biased, James, because I'm one of the co 01:41:09.100 --> 01:41:13.760 -authors, but it created a very unique back and 01:41:13.760 --> 01:41:17.199 forth yin and yang perspective of not only the 01:41:17.199 --> 01:41:20.140 dark sides of health care. but potentially ways 01:41:20.140 --> 01:41:23.420 forward and ideas for improvement. But in the 01:41:23.420 --> 01:41:26.840 ultimate theme of the goal, aside from revolving 01:41:26.840 --> 01:41:28.840 around the quadruple aim or our quadruple aim, 01:41:28.859 --> 01:41:31.319 if you will, was really to inspire everybody 01:41:31.319 --> 01:41:36.680 to play their part. I had no idea how to do marketing 01:41:36.680 --> 01:41:39.739 or distribution and all these other things, I 01:41:39.739 --> 01:41:42.699 think. But it became a key that opened doors 01:41:42.699 --> 01:41:46.619 for me much quicker than I ever dreamed of. And 01:41:46.619 --> 01:41:48.899 as a result of it, it's taken me down this path 01:41:48.899 --> 01:41:51.960 of now creating a documentary around, frankly, 01:41:51.960 --> 01:41:57.020 similar concepts and hopefully giving stuff for 01:41:57.020 --> 01:42:01.039 the average American to ingest, digest, whatever 01:42:01.039 --> 01:42:03.359 word you want to use to play their part to get 01:42:03.359 --> 01:42:06.920 us out of this mess. Yeah, it was fun. It was 01:42:06.920 --> 01:42:09.020 cathartic. A lot of healing occurred. I'm still 01:42:09.020 --> 01:42:11.779 healing, still working on my processing of all 01:42:11.779 --> 01:42:13.760 my trauma. And, you know, that'll be a lifelong 01:42:13.760 --> 01:42:16.600 process. What are some of the tools that you 01:42:16.600 --> 01:42:18.739 found have helped you on the mental health side 01:42:18.739 --> 01:42:25.380 and the physical health side? Mental health. 01:42:27.979 --> 01:42:31.920 Writing was very cathartic for me. Reading about 01:42:31.920 --> 01:42:34.819 things, educating myself on things. Ultimately, 01:42:34.819 --> 01:42:38.000 I think the things that have been the most beneficial 01:42:38.000 --> 01:42:42.840 for me. From a mental health perspective was 01:42:42.840 --> 01:42:44.720 getting involved with a trauma informed therapist 01:42:44.720 --> 01:42:48.399 and teaching me like, you know, you're not supposed 01:42:48.399 --> 01:42:50.840 to like throw your pain out the window, but rather 01:42:50.840 --> 01:42:53.439 you're supposed to grab that like a pillow and 01:42:53.439 --> 01:42:56.600 embrace it and learn from it and try and grow 01:42:56.600 --> 01:43:00.659 from it. That was critical. I did some EMDR to 01:43:00.659 --> 01:43:02.779 help process some of those very early painful 01:43:02.779 --> 01:43:05.819 memories that I talked about earlier. Eye movement. 01:43:07.360 --> 01:43:09.579 desensitization and reprocessing that was incredible 01:43:09.579 --> 01:43:12.100 to take what was in just that a bitter memory 01:43:12.100 --> 01:43:15.319 and turn it into something tolerable i would 01:43:15.319 --> 01:43:18.500 say you know and i think finally more recently 01:43:18.500 --> 01:43:23.000 even realizing like no one's coming to save me 01:43:23.000 --> 01:43:26.960 there isn't some one person that's riding in 01:43:26.960 --> 01:43:29.680 on a white horse saying dr hotten i'm going to 01:43:29.680 --> 01:43:31.680 pull you out of all this trauma you've experienced 01:43:31.680 --> 01:43:36.199 and taking a nirvana it's it's on you and you 01:43:36.199 --> 01:43:38.260 have to have the courage to put one foot in front 01:43:38.260 --> 01:43:41.520 of the other dig into those things and process 01:43:41.520 --> 01:43:44.260 them and learn from them so it was a for me it 01:43:44.260 --> 01:43:47.960 was an amalgamation of lots of support lots of 01:43:47.960 --> 01:43:51.579 amazing people a lot of courage facing fears 01:43:51.579 --> 01:43:56.960 that i hadn't faced in 30 years um you know and 01:43:56.960 --> 01:44:01.279 bit by bit day by day um the light and the hope 01:44:01.279 --> 01:44:05.770 started to appear for me personally. Um, but 01:44:05.770 --> 01:44:09.210 I think there's an analogy here for, um, what 01:44:09.210 --> 01:44:11.489 you're trying to do within the, uh, first responder 01:44:11.489 --> 01:44:16.710 EMS, you know, um, uh, I'm saying the wrong word 01:44:16.710 --> 01:44:19.569 fire. What's the word I'm looking for? Firefighter 01:44:19.569 --> 01:44:23.270 world. Fire service. Fire service. I feel like 01:44:23.270 --> 01:44:25.909 I'm screwing this up anyways, but you know, it's 01:44:25.909 --> 01:44:28.489 again, one, one foot at a time, one person at 01:44:28.489 --> 01:44:31.350 a time, one voice at a time. It all matters. 01:44:32.140 --> 01:44:34.760 You know, so, yeah, I mean, it was I'm not gonna 01:44:34.760 --> 01:44:37.659 lie, James, at times it's been a shit show. You 01:44:37.659 --> 01:44:43.279 know, to be in a place that is so dark. And you 01:44:43.279 --> 01:44:48.479 don't even know why. It's hard to describe. It 01:44:48.479 --> 01:44:51.760 is hard to describe. So the whole mantra from 01:44:51.760 --> 01:44:55.380 William Halstead of shoving everything into a 01:44:55.380 --> 01:45:00.260 box and never processing it is bullshit, in my 01:45:00.260 --> 01:45:04.979 opinion. So you mentioned about, you know, some 01:45:04.979 --> 01:45:08.140 of the traumas maybe even haven't been discovered 01:45:08.140 --> 01:45:09.819 yet. And I think that's the case with a lot of 01:45:09.819 --> 01:45:13.279 people. Where I'm seeing a lot of success with 01:45:13.279 --> 01:45:16.180 that is the psychedelics, you know, ayahuasca, 01:45:16.220 --> 01:45:17.960 ibogaine, and then you've got ketamine, you've 01:45:17.960 --> 01:45:21.800 got MDMA. What is that conversation in the doctor 01:45:21.800 --> 01:45:27.800 slash nurse world? Probably polarizing, if you 01:45:27.800 --> 01:45:32.319 will. I can't say that I'm knowledgeable about 01:45:32.319 --> 01:45:35.399 it enough to sit here and say that I'm in this 01:45:35.399 --> 01:45:38.100 camp or this camp. I think the way I would talk 01:45:38.100 --> 01:45:42.260 about it is I'm intrigued enough and heard enough 01:45:42.260 --> 01:45:44.979 positive stories that I think there's something 01:45:44.979 --> 01:45:48.060 there. But I can't sit here and start spouting 01:45:48.060 --> 01:45:50.159 off statistics and all these other things. It's 01:45:50.159 --> 01:45:52.920 more anecdotal evidence. So I think it's worth 01:45:52.920 --> 01:45:57.279 exploring. I've heard multiple stories of people 01:45:57.279 --> 01:45:59.869 really having some benefits. but like everything 01:45:59.869 --> 01:46:01.770 and else you know everything else in life i mean 01:46:01.770 --> 01:46:03.550 there's pros and cons to just about everything 01:46:03.550 --> 01:46:06.289 and again where's the balance where's the right 01:46:06.289 --> 01:46:10.170 answer for those modalities um i'm not trying 01:46:10.170 --> 01:46:12.729 to dodge your question per se i i think there's 01:46:12.729 --> 01:46:16.250 something there i'm just not an expert on it 01:46:16.250 --> 01:46:18.729 so hopefully that helps yeah i think that the 01:46:18.729 --> 01:46:20.810 way you're looking at it is just acknowledging 01:46:20.810 --> 01:46:23.350 that those are tools in the toolbox too because 01:46:23.350 --> 01:46:25.229 i've always said it's also whether you want to 01:46:25.229 --> 01:46:27.250 do it or not If it's something that, you know, 01:46:27.270 --> 01:46:28.670 you're just like, I don't even want to try that. 01:46:28.710 --> 01:46:30.489 Well, it's not going to work then because you've 01:46:30.489 --> 01:46:31.949 got to obviously be bought in, especially on 01:46:31.949 --> 01:46:34.130 the plant medicine side. You've got to trust 01:46:34.130 --> 01:46:36.210 the medicine, as they say. And then, you know, 01:46:36.229 --> 01:46:38.029 if you go to ayahuasca, Ibogaine, there's this 01:46:38.029 --> 01:46:40.729 big purging element to which is needed. You know, 01:46:40.729 --> 01:46:42.989 if you're struggling with alcoholism, Ibogaine 01:46:42.989 --> 01:46:45.029 could save your life. You know, if you're just 01:46:45.029 --> 01:46:47.069 looking for a slight nudge in your mental health, 01:46:47.210 --> 01:46:50.029 maybe that's not the route for you. I think where 01:46:50.029 --> 01:46:52.189 it's so powerful is say you have done a bunch 01:46:52.189 --> 01:46:53.970 of, you know, talk therapy sessions and you've 01:46:53.970 --> 01:46:56.329 done EMDR and you're like, I still feel fucking 01:46:56.329 --> 01:46:59.909 awful. This isn't working. That I think is where 01:46:59.909 --> 01:47:01.909 it's a really powerful conversation stuff, but 01:47:01.909 --> 01:47:05.659 you haven't tried these yet because MDMA. was 01:47:05.659 --> 01:47:07.859 a prescribed relationship drug initially you 01:47:07.859 --> 01:47:10.579 know it works it's the reason why a lot of people 01:47:10.579 --> 01:47:12.640 dance and hug each other at raves because it's 01:47:12.640 --> 01:47:15.399 a love drug you know so getting that that fear 01:47:15.399 --> 01:47:17.340 response to some of these memories because it's 01:47:17.340 --> 01:47:19.239 not prescribed you do a session with a counselor 01:47:19.239 --> 01:47:22.539 and then you go home without any drugs you know 01:47:22.539 --> 01:47:24.920 and it's three times and the efficacy has been 01:47:24.920 --> 01:47:27.489 amazing And ayahuasca, if you do it on your own 01:47:27.489 --> 01:47:29.109 in a forest, is going to be very different than 01:47:29.109 --> 01:47:31.630 if you do it again with, you know, a counselor, 01:47:31.750 --> 01:47:34.670 shaman, whoever someone is that's very well trained 01:47:34.670 --> 01:47:37.609 and surrounded by medical support staff, where 01:47:37.609 --> 01:47:39.670 again, you can unpack and have these experiences. 01:47:40.550 --> 01:47:42.810 But I think just simply knowing that they are 01:47:42.810 --> 01:47:45.649 out there as an option for you, you don't need 01:47:45.649 --> 01:47:48.130 to be completely for or completely against, just 01:47:48.130 --> 01:47:50.399 need to acknowledge that it's another tool. We 01:47:50.399 --> 01:47:52.779 know the efficacy of psych meds is pretty terrible 01:47:52.779 --> 01:47:55.739 if you look at the stats. So why not have other 01:47:55.739 --> 01:47:57.539 options that are available to people and give 01:47:57.539 --> 01:48:00.500 them hope? Maybe I can actually heal and maybe 01:48:00.500 --> 01:48:03.100 this is the tool I need to open the door that 01:48:03.100 --> 01:48:04.960 then will allow me to have success with counseling. 01:48:06.119 --> 01:48:09.239 Well, yeah, I totally agree. I mean, I think 01:48:09.239 --> 01:48:11.640 there are so many things out there that have 01:48:11.640 --> 01:48:15.579 been historically, I don't know if marginalized 01:48:15.579 --> 01:48:19.369 is the right word. Demonized, basically. What's 01:48:19.369 --> 01:48:22.010 that? Demonized, pretty much. Well, yeah. Yeah. 01:48:22.109 --> 01:48:23.989 In Western medicine, for sure. I mean, I think 01:48:23.989 --> 01:48:27.310 just another simple example is tapping and the 01:48:27.310 --> 01:48:29.270 validity of tapping and how it works. I mean, 01:48:29.289 --> 01:48:31.750 I've done it myself at this point and it helps, 01:48:31.930 --> 01:48:36.689 you know, and it's not overly complicated. You 01:48:36.689 --> 01:48:39.470 know, and if you had asked me that 20 years ago, 01:48:39.470 --> 01:48:41.710 I'd have been like, what? What do you want me 01:48:41.710 --> 01:48:45.470 to do? Acupuncture? What? There's a reason some 01:48:45.470 --> 01:48:47.430 of these modalities have been around for thousands 01:48:47.430 --> 01:48:52.229 of years. I agree with you. I think, again, I 01:48:52.229 --> 01:48:54.930 often talk about Eastern medicine meeting Western 01:48:54.930 --> 01:48:57.489 medicine. I think the right answer is somewhere 01:48:57.489 --> 01:48:59.409 in the middle. But you've got to have the courage 01:48:59.409 --> 01:49:02.590 to challenge the existing norms to get there, 01:49:02.770 --> 01:49:07.250 which that's a whole other topic, challenging 01:49:07.250 --> 01:49:09.369 the status quo, which clearly you and I both 01:49:09.369 --> 01:49:13.010 do in our different worlds. But it's important. 01:49:13.630 --> 01:49:16.189 You know, we need individuals that are willing 01:49:16.189 --> 01:49:18.529 to speak up and take a bit of a calculated risk 01:49:18.529 --> 01:49:23.970 to say, the existing landscape is not okay in 01:49:23.970 --> 01:49:28.390 this particular realm. We can do better. How 01:49:28.390 --> 01:49:31.630 do we get there? What do we try? And I'm all 01:49:31.630 --> 01:49:35.430 about that. I'm all about blowing up silos, or 01:49:35.430 --> 01:49:38.270 trying to blow up silos anyways, positively disrupting 01:49:38.270 --> 01:49:40.270 things, you know, things of that nature. But 01:49:40.270 --> 01:49:43.109 there's a way to do it too without... completely 01:49:43.109 --> 01:49:45.250 tearing things down at the same time, right? 01:49:45.489 --> 01:49:48.869 You know, like asking intelligent questions and 01:49:48.869 --> 01:49:51.590 being thought -provoking and doing it in a loving, 01:49:51.649 --> 01:49:54.489 compassionate, kind manner is, there shouldn't 01:49:54.489 --> 01:49:56.409 be anything wrong with that. It's okay to disagree. 01:49:57.390 --> 01:49:59.489 Screaming and yelling at people and, you know, 01:49:59.510 --> 01:50:01.850 poking them in the eye or doing other things 01:50:01.850 --> 01:50:05.609 that are creating some sort of additional trauma 01:50:05.609 --> 01:50:10.409 or pain, maybe not so much. It's been interesting 01:50:10.409 --> 01:50:14.189 kind of unpacking the last 22 years since I entered 01:50:14.189 --> 01:50:15.850 the fire service, because obviously, you know, 01:50:15.869 --> 01:50:18.569 for 14 years I was wearing the uniform and, you 01:50:18.569 --> 01:50:19.890 know, if you use the word courage, it's like, 01:50:19.970 --> 01:50:21.649 yeah, well, you know, I made entry on fires and 01:50:21.649 --> 01:50:23.470 hung off the side of buildings on a rope and, 01:50:23.489 --> 01:50:27.069 you know, did all the things. But then fast forward 01:50:27.069 --> 01:50:30.369 the last few years, I realized, A, I'm totally 01:50:30.369 --> 01:50:32.989 unimpressed by what firefighters do because I 01:50:32.989 --> 01:50:36.010 did it and it wasn't superhero shit. It was something 01:50:36.010 --> 01:50:39.920 that took diligence and sacrifice. It certainly 01:50:39.920 --> 01:50:43.039 doesn't give you a Superman uniform, but that 01:50:43.039 --> 01:50:47.619 is far less impressive than moral courage. If 01:50:47.619 --> 01:50:50.180 you're morally courageous and you stand up because 01:50:50.180 --> 01:50:52.159 you know it's right, even if everyone around 01:50:52.159 --> 01:50:55.020 you is pushing against you, that to me is real 01:50:55.020 --> 01:50:56.880 courage. And you don't need to wear a firefighter's 01:50:56.880 --> 01:50:59.220 uniform for that. And those are the humans that 01:50:59.220 --> 01:51:02.340 I really, really connect with because that's 01:51:02.340 --> 01:51:04.739 why things have changed. That's why children 01:51:04.739 --> 01:51:07.039 don't work in factories anymore. That's why women 01:51:07.039 --> 01:51:09.479 can vote. You know, all the things is because 01:51:09.479 --> 01:51:11.439 someone stood up when everyone said, shut up, 01:51:11.439 --> 01:51:13.380 sit down, shut up. You're making us look bad, 01:51:13.479 --> 01:51:15.760 whatever the thing is. And they were the ones 01:51:15.760 --> 01:51:18.359 that were kicking in the doors. So I think that 01:51:18.359 --> 01:51:22.920 a courageous profession is different than a courageous 01:51:22.920 --> 01:51:26.140 person. And this is who I'm really kind of, you 01:51:26.140 --> 01:51:29.239 know, impressed with now, whoever it is, whatever 01:51:29.239 --> 01:51:32.489 the walk of life, age, gender. whatever is the 01:51:32.489 --> 01:51:34.630 person that has the guts to stand up and say, 01:51:34.670 --> 01:51:37.449 I don't care about how we used to do it. This 01:51:37.449 --> 01:51:43.750 is wrong and we need to change it. I, well, yeah, 01:51:43.850 --> 01:51:47.430 I agree with you. It's been, I look at my, my 01:51:47.430 --> 01:51:50.409 friends and my colleagues who are doing exactly 01:51:50.409 --> 01:51:53.470 what you just said, James. And I think about 01:51:53.470 --> 01:51:56.029 how many amazing people I've gotten to meet and, 01:51:56.029 --> 01:52:00.449 and interact with and so on and so forth. And, 01:52:01.930 --> 01:52:04.189 You're right. It's those that are willing to 01:52:04.189 --> 01:52:08.489 take that level of personal risk to have impact 01:52:08.489 --> 01:52:11.810 for the greater good that just amaze me. They 01:52:11.810 --> 01:52:13.909 just amaze me. I think of, I'll give you just 01:52:13.909 --> 01:52:18.010 one example. A friend of mine, Tina Shaw, is 01:52:18.010 --> 01:52:23.069 running for Congress in New Jersey. And, you 01:52:23.069 --> 01:52:27.409 know, she's a pulmonary care, critical care intensivist 01:52:27.409 --> 01:52:32.920 who is taking a big risk by getting into the 01:52:32.920 --> 01:52:34.819 political scene because she wants to have a bigger 01:52:34.819 --> 01:52:40.579 impact you know to me she's a hero i told her 01:52:40.579 --> 01:52:42.859 that i'm like tina you're a hero to me like i 01:52:42.859 --> 01:52:44.659 i don't think i could do that probably because 01:52:44.659 --> 01:52:46.619 i would tell somebody to f off that i didn't 01:52:46.619 --> 01:52:50.560 like but that's a different story um but there's 01:52:50.560 --> 01:52:52.159 all kinds of examples like that and people don't 01:52:52.159 --> 01:52:53.960 need to run for office you know it can be you 01:52:53.960 --> 01:52:57.300 can be a hero in your own little space checking 01:52:57.300 --> 01:52:59.600 in on a colleague asking them if they're okay 01:53:00.220 --> 01:53:02.859 standing up for a colleague those are heroes 01:53:02.859 --> 01:53:06.960 too it's a hero at a different scale but a hero 01:53:06.960 --> 01:53:10.760 nonetheless in my mind absolutely well i just 01:53:10.760 --> 01:53:13.039 want to make sure that we go over the the documentary 01:53:13.039 --> 01:53:16.640 so at what stage are you at now and then tell 01:53:16.640 --> 01:53:18.640 people listening what is going to be the kind 01:53:18.640 --> 01:53:21.560 of over lying through line of this documentary 01:53:21.560 --> 01:53:26.279 suck it up buttercup sure so uh suck it up buttercup 01:53:26.279 --> 01:53:31.930 trust and betrayal healthcare in america is close. 01:53:32.890 --> 01:53:36.770 I would say we've got about 80 to 90 % of our 01:53:36.770 --> 01:53:38.989 filming done, give or take. And as we're doing 01:53:38.989 --> 01:53:42.750 this interview, it's October of 2025. We're well 01:53:42.750 --> 01:53:45.029 into editing. You know, we've got a ways to go 01:53:45.029 --> 01:53:47.069 and creating a documentary is kind of like building 01:53:47.069 --> 01:53:49.569 an airplane after you've already taken off. You're 01:53:49.569 --> 01:53:51.130 like, oh my God, we need to add a wing on this 01:53:51.130 --> 01:53:53.390 side and we need this over here. And did we put 01:53:53.390 --> 01:53:57.439 on wheels and all these other things? The through 01:53:57.439 --> 01:54:00.420 line for it, again, is going to be how greed 01:54:00.420 --> 01:54:06.020 has created a tremendous negative impact on health 01:54:06.020 --> 01:54:07.720 care delivery in the United States, which can 01:54:07.720 --> 01:54:10.319 be extrapolated, obviously, to other parts of 01:54:10.319 --> 01:54:13.579 the world. But it's through eyes of just a multitude 01:54:13.579 --> 01:54:16.579 of stakeholders. It's not just physicians bitching. 01:54:17.760 --> 01:54:21.159 The voice of nurses, the voice of patients, the 01:54:21.159 --> 01:54:23.699 voice of health care executives, insurance administrators, 01:54:24.060 --> 01:54:28.319 celebrities. But it's not just an airing of grievances. 01:54:28.359 --> 01:54:31.760 The latter third of the film is ways forward 01:54:31.760 --> 01:54:35.600 and not just a one and done ways forward. But 01:54:35.600 --> 01:54:39.260 how can this how can this project be applicable 01:54:39.260 --> 01:54:43.060 tomorrow, next week, five years from now, 10 01:54:43.060 --> 01:54:45.420 years from now? Shit, hopefully 100 years from 01:54:45.420 --> 01:54:47.899 now. You know, instead of, you know, the William 01:54:47.899 --> 01:54:51.399 Stuart Halstead's William Stuart Halstead negative 01:54:51.399 --> 01:54:54.520 impact on health care, hopefully it's the opposite. 01:54:55.119 --> 01:54:57.340 In terms of distribution, there will be ideally 01:54:57.340 --> 01:54:59.319 multiple ways that this will get distributed. 01:55:00.880 --> 01:55:03.340 Local viewings like at universities and academic 01:55:03.340 --> 01:55:06.100 centers and so on and so forth. We're planning 01:55:06.100 --> 01:55:08.399 to hit the film festival circuit to a certain 01:55:08.399 --> 01:55:11.800 extent. But ultimately, we feel the biggest impact 01:55:11.800 --> 01:55:13.979 is going to be to get this onto a streaming service, 01:55:14.340 --> 01:55:17.560 which we think is going to happen for a multitude 01:55:17.560 --> 01:55:20.760 of reasons. And when is, if everything lines 01:55:20.760 --> 01:55:27.359 up, when are you hoping to release it? So the 01:55:27.359 --> 01:55:30.460 timeline tends to shift a little bit to the right. 01:55:31.960 --> 01:55:35.399 When do I think and hope realistically we could 01:55:35.399 --> 01:55:37.579 get this onto a streaming service? I think Q2 01:55:37.579 --> 01:55:41.020 of next year is very realistic, Q2 of 2026. I 01:55:41.020 --> 01:55:43.220 think there will be some opportunities for some 01:55:43.220 --> 01:55:46.560 viewings prior to that. But for a massive distribution, 01:55:46.779 --> 01:55:49.260 I think that timeline is very much in the cards. 01:55:50.079 --> 01:55:52.659 Beautiful. Well, I want to throw some quick closing 01:55:52.659 --> 01:55:54.460 questions at you before I let you go, if that's 01:55:54.460 --> 01:55:57.319 okay. Absolutely. All right. The first one I'd 01:55:57.319 --> 01:55:59.300 love to ask, we talked about your book, Ripple 01:55:59.300 --> 01:56:01.239 of Change. Are there any other books written 01:56:01.239 --> 01:56:03.579 by other people that you love to recommend? It 01:56:03.579 --> 01:56:06.060 can be related to our discussion today or completely 01:56:06.060 --> 01:56:13.300 unrelated. Ooh. Yes, I will throw a handful out 01:56:13.300 --> 01:56:15.640 there. I don't want to screw up all the authors 01:56:15.640 --> 01:56:17.800 per se. So I'm just going to give mostly titles 01:56:17.800 --> 01:56:19.300 and a couple of times I'll maybe throw in the 01:56:19.300 --> 01:56:23.199 author's names. I love the Starfish and the Spider. 01:56:24.139 --> 01:56:26.600 I don't remember the author, but it is an incredible 01:56:26.600 --> 01:56:30.560 book about leadership and decentralized ways 01:56:30.560 --> 01:56:32.880 of organizing. I think that's a fascinating book. 01:56:34.159 --> 01:56:37.300 I think Cascades by Greg Sattel is an amazing 01:56:37.300 --> 01:56:40.359 book looking at successful movements historically. 01:56:40.779 --> 01:56:43.600 Now you can kind of start to see where my brain 01:56:43.600 --> 01:56:47.380 has gotten morphed by some of these books. Emily 01:56:47.380 --> 01:56:52.739 Peters has a great book. And I don't want to 01:56:52.739 --> 01:56:55.420 butcher the title. I think it's artists reimagining 01:56:55.420 --> 01:56:58.659 health care is, I think, the exact title that 01:56:58.659 --> 01:57:00.399 you have to double check me on that one. So those 01:57:00.399 --> 01:57:03.359 are three that come to top of mind. Brilliant. 01:57:03.399 --> 01:57:08.640 What about films and documentaries? Oh, man, 01:57:08.840 --> 01:57:12.159 I'm not going to lie, James, I am not the greatest 01:57:12.159 --> 01:57:14.939 guy when it comes to pop culture, which probably 01:57:14.939 --> 01:57:17.899 is not a big surprise at this point. Having talked 01:57:17.899 --> 01:57:20.960 to me, I found the social dilemma was fascinating. 01:57:22.779 --> 01:57:25.880 Recently, I watched two films, historical films, 01:57:26.039 --> 01:57:28.560 because I'm not necessarily a movie buff, really 01:57:28.560 --> 01:57:31.579 trying to dig into the space of trauma and better 01:57:31.579 --> 01:57:34.880 understand it. Apocalypse Now was fascinating 01:57:34.880 --> 01:57:41.060 to me. But I also recently rewatched A Clockwork 01:57:41.060 --> 01:57:46.760 Orange. And I watched it because a good friend 01:57:46.760 --> 01:57:49.750 of mine who is a physician. who died by suicide 01:57:49.750 --> 01:57:53.130 that was his favorite movie and i was hoping 01:57:53.130 --> 01:57:57.510 to get some clues as to what led to that final 01:57:57.510 --> 01:58:01.409 decision for him and having watched it it was 01:58:01.409 --> 01:58:03.310 fascinating and definitely gave me some insight 01:58:03.310 --> 01:58:06.149 for sure again trying to lean into the pain and 01:58:06.149 --> 01:58:07.609 the discomfort to understand a little better 01:58:07.609 --> 01:58:10.930 trigger warning for a clockwork orange there 01:58:10.930 --> 01:58:13.289 that's like trauma wrapped in trauma if you've 01:58:13.289 --> 01:58:15.090 never seen it so you need to be in the right 01:58:15.090 --> 01:58:18.170 place to watch that movie Something I always 01:58:18.170 --> 01:58:20.090 talk about because I think it just needs to be 01:58:20.090 --> 01:58:22.750 heard over and over again. As I started going 01:58:22.750 --> 01:58:25.430 through all these interviews, and we're up to 01:58:25.430 --> 01:58:29.529 over 1 ,100 now, there kept being this common 01:58:29.529 --> 01:58:32.189 denominator. When we do so many conversations, 01:58:32.409 --> 01:58:35.890 the Venn diagram overlaps really strongly. And 01:58:35.890 --> 01:58:38.350 if you think about how we were taught to think 01:58:38.350 --> 01:58:41.550 about suicide, it was selfish. It's cowardly. 01:58:41.569 --> 01:58:44.560 How could they think of their family? But then 01:58:44.560 --> 01:58:46.380 you listen to the people that were there. Like 01:58:46.380 --> 01:58:48.859 I said, Emma, Emma Benoit, you know, Kevin Hines, 01:58:48.859 --> 01:58:50.720 who jumped off the Golden Gate Bridge and survived. 01:58:50.939 --> 01:58:52.760 And then all these people have had that that 01:58:52.760 --> 01:58:55.199 almost pulled that trigger, almost, you know, 01:58:55.199 --> 01:58:59.439 jumped over and over and over again. Aside from 01:58:59.439 --> 01:59:03.739 obviously wanting the pain to end was I truly 01:59:03.739 --> 01:59:06.819 believe like I was a burden to my family or burden 01:59:06.819 --> 01:59:09.180 to my friends. I was a reason for their pain. 01:59:09.529 --> 01:59:13.329 And what I realize as you really unpack this 01:59:13.329 --> 01:59:17.569 perfect storm of contributing factors from unaddressed 01:59:17.569 --> 01:59:20.829 childhood trauma to sleep deprivation, to organizational 01:59:20.829 --> 01:59:23.729 betrayal, the side effects of alcohol and meds 01:59:23.729 --> 01:59:26.989 and all the other things that compound, that 01:59:26.989 --> 01:59:30.710 the brain literally becomes miswired. So these 01:59:30.710 --> 01:59:33.270 men and women and children that we've lost, especially 01:59:33.270 --> 01:59:38.479 men and women, their reality. Their voice in 01:59:38.479 --> 01:59:41.619 their mind is telling them, if you just remove 01:59:41.619 --> 01:59:44.979 yourself, your wife, your husband, your children 01:59:44.979 --> 01:59:47.960 will be happier. And from the first responder 01:59:47.960 --> 01:59:50.060 professions, we've signed a blank check basically 01:59:50.060 --> 01:59:52.180 saying we will die for a complete stranger. Well, 01:59:52.239 --> 01:59:55.199 now this voice is telling you this. It really, 01:59:55.260 --> 01:59:57.720 at that moment, even though one would argue it's 01:59:57.720 --> 02:00:01.939 psychosis, at that moment, that becomes a courageous 02:00:01.939 --> 02:00:05.079 and selfless act because they truly believe that 02:00:05.079 --> 02:00:08.140 they are making it better. And you do not hear 02:00:08.140 --> 02:00:10.840 that conversation. And so these people that are 02:00:10.840 --> 02:00:14.060 left behind, they're full of shame and guilt 02:00:14.060 --> 02:00:17.020 because they're like, I missed it. But if we 02:00:17.020 --> 02:00:19.640 can put that as a massive red flag front and 02:00:19.640 --> 02:00:21.779 center, if you are starting to have these thoughts 02:00:21.779 --> 02:00:23.819 that you're a burden, that is a sign to pick 02:00:23.819 --> 02:00:25.899 up the phone. Because we all know that that's 02:00:25.899 --> 02:00:29.119 wrong. Unless you're Adolf Hitler or a few other 02:00:29.119 --> 02:00:33.119 people that are truly going to be hugely detrimental 02:00:33.119 --> 02:00:35.640 to the world. Everyone else, you're going to 02:00:35.640 --> 02:00:39.060 be... missed so much by the people that actually 02:00:39.060 --> 02:00:40.960 love you. You just can't see it because there's 02:00:40.960 --> 02:00:44.100 miswiring. But if we can pull you from that proverbial 02:00:44.100 --> 02:00:47.079 ledge and get you some sleep and get you some 02:00:47.079 --> 02:00:51.000 counseling, that healthy mind is going to kick 02:00:51.000 --> 02:00:53.560 back in again, which is why I think you hear, 02:00:53.619 --> 02:00:56.159 like Kevin, the moment that his foot left the 02:00:56.159 --> 02:00:59.180 bridge, immediately he snapped back to, I don't 02:00:59.180 --> 02:01:00.979 want to die. And he's already falling by that 02:01:00.979 --> 02:01:02.640 point. And you hear this with a lot of suicide 02:01:02.640 --> 02:01:06.460 survivors. So I think... And understanding that 02:01:06.460 --> 02:01:08.720 this is what these people that we lost were probably 02:01:08.720 --> 02:01:11.840 going through and thinking, it takes away the 02:01:11.840 --> 02:01:14.720 shame and the guilt on that person. And it also 02:01:14.720 --> 02:01:18.579 you hear about that kind of submission when people 02:01:18.579 --> 02:01:20.279 have decided they're going to do it. Sometimes 02:01:20.279 --> 02:01:22.319 they seem happier than they've been for a long 02:01:22.319 --> 02:01:24.479 time prior to they do it. So this I should have 02:01:24.479 --> 02:01:26.579 seen it coming. No, you shouldn't have. A lot 02:01:26.579 --> 02:01:28.640 of times I have no way of you seeing it. But 02:01:28.640 --> 02:01:30.880 I think it's important to underline that, that 02:01:30.880 --> 02:01:34.640 when we lose these people, it's because. We have 02:01:34.640 --> 02:01:38.220 this innate desire to survive, to live, to reproduce, 02:01:38.439 --> 02:01:41.779 to protect our children. So the brain is so miswired 02:01:41.779 --> 02:01:44.539 that it's overriding all of those and lying to 02:01:44.539 --> 02:01:47.100 the individual. And if we could understand that, 02:01:47.180 --> 02:01:49.239 I think it would put a lot more compassion and 02:01:49.239 --> 02:01:51.560 empathy in this whole mental health conversation 02:01:51.560 --> 02:01:54.720 and allow the people that are hurting to feel 02:01:54.720 --> 02:01:57.760 more able to reach out. And then the people around 02:01:57.760 --> 02:01:59.699 them, if they start hearing these kind of burden 02:01:59.699 --> 02:02:02.119 statements, for them to be able to intervene 02:02:02.119 --> 02:02:08.989 before it's too late. I'm not sure I can add 02:02:08.989 --> 02:02:11.970 anything intelligent after that. This is so brilliant. 02:02:12.029 --> 02:02:15.729 I think the one thing I would say, and I'll speak 02:02:15.729 --> 02:02:21.390 to my situation in terms of unpacking stuff personally. 02:02:21.670 --> 02:02:25.710 I mean, it was a godsend. My family and friends 02:02:25.710 --> 02:02:29.470 who reached out to me, regardless of what was 02:02:29.470 --> 02:02:31.449 going on, to just say, hey, man, I love you. 02:02:32.010 --> 02:02:34.270 I can't tell you how many of my guy friends. 02:02:35.149 --> 02:02:37.569 you know would say that you know Todd hey I love 02:02:37.569 --> 02:02:40.329 you man you know you're important like we want 02:02:40.329 --> 02:02:44.930 you here and for somebody who struggled for the 02:02:44.930 --> 02:02:46.850 better part of a year trying to process all this 02:02:46.850 --> 02:02:50.890 stuff those words those encouragement those connections 02:02:50.890 --> 02:02:54.590 that the act of kindness and compassion were 02:02:54.590 --> 02:02:58.869 critically important for me so beneficial so 02:02:58.869 --> 02:03:07.350 yeah I mean it's um it is Man, thinking back 02:03:07.350 --> 02:03:13.109 on my friends and colleagues that have died by 02:03:13.109 --> 02:03:16.869 suicide, historically I would think about what 02:03:16.869 --> 02:03:20.529 did I miss, as you said, and feel guilty or ashamed 02:03:20.529 --> 02:03:26.449 that I had missed something. But now I realize 02:03:26.449 --> 02:03:29.850 their level of pain had gotten to a point where 02:03:29.850 --> 02:03:31.630 they didn't know how to deal with it in any other 02:03:31.630 --> 02:03:37.770 way. I understand that. I appreciate it. Does 02:03:37.770 --> 02:03:41.710 it make it easier to deal with? No, not necessarily, 02:03:41.949 --> 02:03:46.189 but at least I can see how someone could get 02:03:46.189 --> 02:03:48.390 there. I mean, I can totally appreciate that. 02:03:48.590 --> 02:03:51.289 And I think, as you said, the more we talk about 02:03:51.289 --> 02:03:53.449 it and lean into these discomforts, hopefully 02:03:53.449 --> 02:03:56.930 we can make a difference so that we're not seeing 02:03:56.930 --> 02:04:00.369 10 -year -olds, et cetera, dying by suicide. 02:04:01.609 --> 02:04:06.880 Exactly. Well, speaking of beautiful people, 02:04:07.119 --> 02:04:10.239 is there a person that you would recommend to 02:04:10.239 --> 02:04:13.439 come on this podcast as a guest to speak to the 02:04:13.439 --> 02:04:16.000 first responders, military, and medical professionals 02:04:16.000 --> 02:04:23.319 of the world? Oh, boy. James, I got a huge list 02:04:23.319 --> 02:04:26.079 of people I can potentially pass along. All right. 02:04:26.840 --> 02:04:30.159 I'm going to throw maybe a little bit of a challenge 02:04:30.159 --> 02:04:34.409 back to you. Narrow down the focus for me. Give 02:04:34.409 --> 02:04:38.470 me a topic or a genre or what have you, and then 02:04:38.470 --> 02:04:40.390 I'll throw a name at you. How's that? Well, I'll 02:04:40.390 --> 02:04:42.350 throw a name back at you. You mentioned Rick 02:04:42.350 --> 02:04:45.189 Moncastle. That's someone I need to speak to 02:04:45.189 --> 02:04:47.949 for a start. Oh, Rick's great. That would be 02:04:47.949 --> 02:04:51.250 an amazing conversation. Yeah, absolutely. I 02:04:51.250 --> 02:04:54.170 can definitely do an intro. Just remind me and 02:04:54.170 --> 02:04:55.909 I'll do an intro to Rick. He's an amazing guy. 02:04:56.609 --> 02:04:59.569 Truly. I mean, to stand up to a pharmaceutical 02:04:59.569 --> 02:05:04.510 behemoth. In the name of justice, Rick is your 02:05:04.510 --> 02:05:07.489 man. Absolutely. All right. Brilliant. Well, 02:05:07.529 --> 02:05:09.449 then the very last question before we make sure 02:05:09.449 --> 02:05:11.090 everyone knows where to find the book and the 02:05:11.090 --> 02:05:19.090 documentary, what do you do to decompress? You 02:05:19.090 --> 02:05:21.949 know, for a while, I don't even know that I would 02:05:21.949 --> 02:05:23.250 have been able to give you a straight answer 02:05:23.250 --> 02:05:26.189 to that question. I think the thing that I love 02:05:26.189 --> 02:05:32.829 the most actually is. um connection whether it's 02:05:32.829 --> 02:05:36.550 with family or friends or even just in this couple 02:05:36.550 --> 02:05:39.189 of hours i spent with you james these moments 02:05:39.189 --> 02:05:42.590 fly by to me and they're just magical and i get 02:05:42.590 --> 02:05:46.170 such a joy out of connecting with other human 02:05:46.170 --> 02:05:50.010 beings i and i think that's what's gravitated 02:05:50.010 --> 02:05:53.289 me towards doing this bigger project and doing 02:05:53.289 --> 02:05:55.550 all this networking is i really enjoy interacting 02:05:55.550 --> 02:05:58.060 with others but I also like to golf and play 02:05:58.060 --> 02:06:01.199 poker and watch my kids play sports and all those 02:06:01.199 --> 02:06:03.779 kinds of standard things. But, you know, from 02:06:03.779 --> 02:06:06.020 any typical perspective, this kind of stuff to 02:06:06.020 --> 02:06:09.800 me is absolutely magic. It reminds me, I've quoted 02:06:09.800 --> 02:06:12.239 this one here so many times. Johan Hari said, 02:06:12.399 --> 02:06:15.180 the opposite of addiction isn't sobriety. The 02:06:15.180 --> 02:06:17.819 opposite of addiction is connection. And I couldn't 02:06:17.819 --> 02:06:21.600 agree more. That's awesome. I love that quote. 02:06:21.659 --> 02:06:25.170 That is so cool. And I'll tell you, so if you're 02:06:25.170 --> 02:06:26.989 interested in connecting with me or learning 02:06:26.989 --> 02:06:30.109 more, I am very active on LinkedIn. If you send 02:06:30.109 --> 02:06:31.510 me a message, there's a good chance I'll get 02:06:31.510 --> 02:06:33.710 back to you pretty quick. Regarding the book, 02:06:33.890 --> 02:06:38.470 the website is rippleofchange .us. Regarding 02:06:38.470 --> 02:06:42.590 the documentary, it's suckitupbuttercupfilm .com. 02:06:43.130 --> 02:06:44.930 And then if you're interested in the nonprofit 02:06:44.930 --> 02:06:48.550 work I do, it's medicineforward .org. So those 02:06:48.550 --> 02:06:49.930 are probably the main ways to get a hold of me. 02:06:50.329 --> 02:06:52.560 Brilliant. Well, I want to thank you so much. 02:06:52.579 --> 02:06:54.739 It's been such an amazing conversation, yet another 02:06:54.739 --> 02:06:57.399 unique perspective. And you've put so many things 02:06:57.399 --> 02:06:59.760 out into the world as far as trying to push that 02:06:59.760 --> 02:07:01.880 change and bring solutions between the book and 02:07:01.880 --> 02:07:04.779 the documentary. So I want to thank you so much 02:07:04.779 --> 02:07:06.899 for being so generous with your time and coming 02:07:06.899 --> 02:07:09.939 on the Behind the Shield podcast today. It was 02:07:09.939 --> 02:07:11.899 an absolute pleasure, James. Thanks for having 02:07:11.899 --> 02:07:12.100 me.