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.com. Welcome to the Behind the Shield podcast.
As always, my name is James Geering, and this
week it is my absolute honor to welcome on the
show physician and author Dr. Todd Otten. Now,
in this conversation, we discuss a host of topics,
from his journey into the medical profession,
the training our physicians receive, the unknown
story behind the woefully long residency program,
the obesity epidemic, mental health in our medical
professionals, his book, Ripple of Change, and
so much more. Now, before we get to this incredible
conversation, as I say every week, please just
take a moment. Go to whichever app you listen
to this on, subscribe to the show, leave feedback,
and leave a rating. Every single five -star rating
truly does elevate this podcast, therefore making
it easier for others to find. And this is a free
library of well over 1 ,100 episodes now. So
all I ask in return is that you help share these
incredible men and women's stories so I can get
them to every single person on planet Earth who
needs to hear them. Dr. Todd Otten. Enjoy. Well,
Todd, I want to start by saying thank you so
much for taking the time and coming on the Behind
the Shield podcast today. Absolutely. Thanks
for having me. I'm excited to see where this
goes today. Absolutely. So first question, where
on planet Earth are we finding you this afternoon?
Great question. This is not my normal backdrop,
if you will. Currently, I'm in Natick, Massachusetts,
literally sitting outside of the office of Amy
Schraub and Scott Pressler, who are two of the
core. producers of the documentary Suck It Up
Buttercup. And Scott has a vintage camera museum,
if you will, that is strewn about outside the
office. So that's where I'm at currently. Beautiful.
Well, I would love to start the very beginning
of your story. So tell me where you were born
and tell me a little bit about your family dynamic,
what your parents did, how many siblings. Oh,
wow. So I was born in Lafayette, Indiana. My
dad was at Purdue University actually getting
his PhD in chemistry. um and i was born and within
i want to say a month or two we moved from there
to um southeastern michigan just south of detroit
um one of four siblings i'm the oldest um three
two wonderful sisters and a wonderful brother
all of whom are accomplished in their own right
you know most of the family dynamic was you know
pretty good i would say pretty supportive uh
for all intents and purposes i think it was Some
of it was probably a sign of the times, maybe
a little bit lacking in the mental health awareness
and support. You know, and I think I was bullied
pretty bad when I was in grade school. And I
think there was a handful of things that led
into that. We don't need to get into the specifics
per se, but I think the lack of attunement that
existed and lack of mental health resources back
then. really propelled me to where I'm at today.
And it took a long time to figure that out, James.
I mean, it wasn't until within the last year
that I realized I was basically running from
one accomplishment to the next accomplishment,
to the next accomplishment, to the next accomplishment,
in part not wanting to address those traumas
that had occurred from years gone by. And in
retrospect, it surely was a big part of why I
wanted to go into healthcare. wanting to help
others and so on and so forth. But yeah, hopefully
that answers the question. I didn't detour too
much there. Yeah, well, firstly, you mentioned
that your dad was studying. What did both of
your parents end up doing as a profession? Yeah,
sure. So my dad was a research chemist for the
chemical company BASF, which his parent is in
Germany. He was there for essentially his whole
career, retired from there. So from the mid -70s
to... Gosh, 10 years or so ago. And then my mom
was a teacher, and she taught regularly until
somewhere in the midst of myself and my siblings,
she stepped away from teaching and became a full
-time mom, which obviously is a calling and a
profession and a passion in and of itself, right?
When we all grew up and were kind of out of the
house, more or less, she actually went back to
teaching, which was really cool. So after a couple
of decades, a hiatus of rearing children, she
wanted to help other kids. So I always thought
that was an amazing thing. Well, staying with
your mom, what is her perspective if you've had
these conversations on the evolution or devolution
of education in this country? Oh, wow. I wouldn't
say that we've discussed that at length, to be
honest with you. I think the way I might answer
that is perhaps in parallel with. some of the
things that we talked about in Ripple of Change
and trying to make comparisons with the quadruple
aim in healthcare versus how that might apply
to other areas. And for the listener who has
no idea, like, Todd, what are you talking about?
What is the quadruple aim? Well, I'm happy to
tell you. So the quadruple aim was really an
evolution of the triple aim. Triple aim is a
way to deliver care in the context of population
health. And I like to simplify it to... patient
experience, quality care, and lower costs, right?
Nobody would argue that those things are not
critical, valuable, use whatever adjective you
want. The issue with the triple aim is it really
didn't address those delivering the care. And
as a result of it, it unintentionally created
a fair amount of clerical burdens, administrative
burdens, whoever you want to describe it. that
have perpetuated some of the mental health crises
and so on and so forth. I know this is a long
-winded answer. I'm going back to education.
Take your time. So, you know, in 2014, Dr. Sinsky
and Dr. Bodenheimer suggested that there should
be a fourth component, and that should be clinician
or provider or physician well -being, essentially
wellness of those that are providing the care.
There's even an evolution of that. Like in the
book, we talk about our quadruple aim because
we want ownership to be ubiquitous. You know,
it's not mine. It's not yours, James. Use it.
Take it. Run with it. And it was that notion
where we made comparisons to health care delivery
using the quadruple aim. Or how might that apply
in a school setting? How might that apply in
a restaurant setting? You know, because you're
not valuing the people working for you. and delivering
the care or delivering the education or teaching
our children, are we getting the best out of
those people? I don't know that we are. And I
think there are a lot of problems related to
that. When it comes down to it, any industry
requires some level of human input, right? And
human capital is so incredibly valuable. And
if we just take the time to celebrate that. and
honor that and care for those human beings the
positive ripples if you will the coin of phrase
are infinite um and you know i could see it you
know thinking back on it talking to my mom about
her time and in teaching you could see where
there was moments where her work and her effort
were valued and how it lit her up in such a good
and positive way And on the converse, I can think
of times where her work wasn't valued and the
negative impact that that had on her. You know,
and I don't have a ton of friends that are in
the teaching space, but I do have a buddy that
was a professor at a university. And I'm not
going to name names or say universities or point
fingers or that kind of thing. But some of the
political stuff and the bureaucracy and the lack
of respect that occurred for him while he was
there, it was deplorable. And ultimately, he
left. And the guy's freaking brilliant. and like
is that what you want you know like treat your
people like crap and then they leave and like
this is nuts i'm out of here um so yeah i mean
that was kind of a circuitous answer which is
i suppose what happens when you talk to a family
physician well staying on the parents just for
a moment um working for a chemical company and
obviously circling around the pfas is a big conversation
in our profession at the moment and you know
with the film dark waters shows the The corrupt
element of hiding the damage that that chemical
was doing and now it's literally poisoned all
but the entire world has this chemical in the
body now. Did you ever have any conversations
with your father as far as that industry and
some of the downstream ill effects that we're
seeing from some of these products? To be perfectly
honest with you, no. For probably a couple reasons.
One, my dad was more on the surfactant side of
things. And so I wouldn't say that that was where
his specialty was. And as time has gone by, my
father has gotten more involved in political
discussions. And for those of us who are trying
to get bipartisan agreement towards things, I
tend to steer clear or sidestep some of these
conversations. And so, yeah, we never really
talked about it. I will give you some fun stories,
though, if you want, of my time living with a
father who is a chemist. I distinctly recall
him bringing... home dry ice more than once and
so you can imagine having some you know dry ice
and throw it in some water and all of a sudden
you got this smoke and these cool things uh i
believe some magnesium came home more than once
um which if you add water to a magnesium fire
it's quite uh quite interesting and he had some
amazing story of his from his youth of um making
a vat of rocket fuel and inadvertently lighting
it on fire in the backyard and essentially having
a a cauldron of rocket fuel going up into the
sky um but he also you know he i always had an
interest in science too and so as you know as
a young kid when you do these science experiments
you know we made soap at home you know which
is relatively simple process but he walked me
through it and that was my that was my science
project and i have a lot of fond memories of
things of that nature so um in terms of p fast
yeah i wouldn't say that i'm a p fast expert
and nor have i had a a conversation with my father
on it yes is it an issue but i think it speaks
to you know to a certain extent one of the central
themes you know some of the work that i'm doing
you know where it should be people over profits
and not the converse you know and unfortunately
in many industries it's profits over people and
we sacrifice all kinds of things for that and
it's it's it's sad it really sad You mentioned
about the bullying. When you were young, what
was it that you were being made fun of, or was
it just simply a purely predatory thing? Oh,
gosh. Probably the answer is all of it. Everything,
all of it, whatever. You know, I don't know that
there were certain things that were the target.
I think part of the thing that was consistent
is... the way i responded and i would push back
and they would get that response they would evoke
that emotion and so then they would push harder
and you know and it became this sort of vicious
cycle of things and it's interesting how much
of it actually repressed you know and and don't
remember i mean i can even through going through
trauma from therapy and coaching and stuff i
only remember certain things and certain events
and you know but i'll say this i mean i one of
the most painful memories i had is um and i probably
should give a trigger warning here at least for
the audience a little bit people listening to
this show and already know better i promise you
all right fair enough okay yeah you never know
and i'm like oh lord i started to say stuff and
then i'm like maybe i shouldn't have said that
um maybe i should also give the disclaimer that
i was in the u .s navy so occasionally expletives
come flying out of my mouth also you can do that
just to let you know so Fair enough. This is
a profane yet safe space. I love it. Love it.
So, yeah. So, I mean, one of the most painful
memories I had, or at least historically most
painful memories, was, you know, imagine being
a 12 -year -old little boy and being at school.
And, you know, I don't even know what led up
to that, but standing in the bathroom, looking
at the mirror, deciding whether to kill myself
or not. I mean, it took a lot of work to unwind
that memory or at least be at peace with it a
little bit. But, you know, bullying is pervasive.
It's pervasive in the school systems. It's pervasive
in coaching. It's pervasive in health care. It's
pervasive in medical training. You know, I go
to kids' sporting events, and the way some of
these parents are acting over a... grade school
or high school game it's like what are we doing
like you were shouting obscenities at a 16 or
17 year old ref who i mean that's a form of bullying
and and for what so you win a game that you're
not gonna remember the result of in five years
from now i mean it's sick it's it's sick i and
yeah so i mean i've i've endured bullying and
many periods of my life, that being the most
painful, but even medical education, you know,
there's forms of bullying and intergenerational
trauma that exists that, you know, they need
to change. You know, we can't always be sacrificing
for the non -human elements, particularly profit,
if you will. But yeah, that was a tough memory.
I mean, my goodness, I couldn't even think about
it without crying for the longest time. Well,
this is an important conversation. I just saw,
I don't know the backstory, but there's a social
media account that came across my feed that is
the parent of a 10 -year -old boy who took his
own life. And this is the issue. The book that
I wrote literally hits on generational trauma.
But if we're not identifying some of these compounding
elements that lead to our children feeling...
that they are capable of doing that thing. And
I've had a 17 year at the time, 17 year old high
school student, Emma Benoit on the show who shot
herself and she survived her attempt. And now
she's this beautiful, you know, voice of mental
health, especially in the younger ages. But you
take a step back, like you said, the professional
sports or, you know, the, you know, school sports,
and then look at politically the bullying there.
And it's just this pervasive nastiness. And the
answer is the opposite. The school shootings
that we have, all these things come from this
lack of community and this unaddressed trauma
that some people stay kind of in that victim
state and some people shift into the predator
state. And I've asked a lot of people in the
mental health field about political figures,
about CEOs of cigarette companies and drug companies
who literally have killed millions of people
on this planet and still sleep safely at night.
There's that unaddressed trauma there that really
has created a sociopath in this very, very powerful
position. And one would probably argue there's
a similar kind of mental state in the CEOs of
some of the people that we're going to be talking
about today. But this all comes down from these
children. Some were bullies, some were bullied.
But if you look at the most healthiest systems.
And nations that we have, Scandinavia and Japan
and some of these other areas that are always
at the top of many, many of these physical and
mental health kind of poles, if you like. You
know, community is the most profound thing. But
if you splinter and you divide and you allow
this nastiness to be pervasive or even celebrated,
as we see in 2025, you know. Cause and effect.
This is what we're going to see. Childhood suicide
and shootings and, you know, the extreme element
or, you know, a complete deliberate fracturing
of a nation and the casting aside of the most
important people, doctors and nurses and firefighters
and paramedics and dispatchers and the true backbone
of the community. Holy smokes. We're going to
start with that. I just vomited out. Sorry. No,
no. But James is brilliant, right? I mean, I
guess, you know, as a physician, we were taught
or brainwashed or whatever to compartmentalize
very well. I mean, and same with first responders.
You're taught to compartmentalize. And that's
amazing. That's an amazing skill to have and
incredibly important and critical when you were
trying to save someone's life. like when you
were doing cpr or trying to put in a chest tube
or operating on somebody you don't want your
mind flying all over the place you want to be
focused on the task at hand the downside or at
least for me the downside was i was never taught
to process any of it it was just stuff it into
the box and just keep stuffing it in there and
it's like well wait a minute that's only good
if your box is infinite, right? If your box is
not infinite, which none of ours is, that at
some point is going to become a problem. And
that problem developed for me a little over a
year ago. And I wasn't even clear what was going
on because I had gotten so proficient at compartmentalizing
that when that Pandora's box opened, it created
a mess for me. And through therapy and counseling
and writing about it and all these other things,
I... Finally, it was like, oh, my God, this is
related to all this unprocessed trauma. And who
does somebody take it out on that's traumatized?
Often those that are closest to them, those that
they love. And so the phrase that trauma begets
trauma or trauma perpetuates trauma or pick an
adjective in there or a verb in there or whatever,
it's true. And we're doing it as a society at
large at this point. To give you maybe another
example is I think. A lot of things that go on
in the media is sensationalized and frankly,
a form of secondary or vicarious trauma to the
point where I've gotten away from watching the
news because I find it depressing, you know,
and it's triggering, triggering to me at times
even. And so I rely on my friends. If there's
some big news story that I need to be aware of,
they'll typically get a whole, Hey Todd, you
need to be aware of this. So check this out.
But it's pervasive and I'm actually writing about
it. Like you had, you know, the trauma is everywhere
and we need to. not run from it, but rather embrace
it, explore it, and then subsequently ideally
heal from it. This is what I'd like to see on
a much, much larger scale than is currently happening.
Absolutely. Well, going back to your early life,
what about sport and exercise? What were you
playing and doing back then? Oh, wow. I've been
thinking about this recently. Like, you know,
the Bessel van der Koek's book, The Body Keeps
the Score, was my... propensity to want to run
what propelled me to be a um sprinter and you
know a division one track and field athlete um
I was like I wonder how that connects I don't
know if it does or not but to answer your question
um played soccer growing up um kind of an early
adopter I suppose in the United States and perhaps
that was related to you know some of the bullying
and maybe trying to get me into a little bit
different path where You know, there wasn't that
intergenerational trauma that exists, like, in
a sport like football, you know, where kids have
been encouraged not to hydrate and have dropped
dead on the field. Like, you talk about the ultimate
bullying. Holy smokes. So I played soccer. I
was fortunate. When I was in high school, we
won the state championship. So, you know, some
30 years ago or what have you now, that was a
highlight. um like i said i was a sprinter and
a long jumper um you know which was not the norm
for the the short white kid to be the sprinter
and the long jumper but i did all right at it
so did that uh three years in college too and
it was a lot of fun a lot of fun what about career
um oh my god why is that that word falling out
my head i use it literally every interview um
career aspirations there we go When you were
in school still, what were you dreaming of becoming?
Yeah, so interestingly enough, I thought I wanted
to be a doctor very early on. I think I was probably
about a sophomore in high school. And I don't
know that there was sort of one pivotal moment.
I think at that point, it was clear that I had
the academic acumen to go down that path. I enjoyed
interacting with other people. I was a Parks
and Rec supervisor. And so, you know, 60 to 80
kids would show up every day and you do games
and crafts and all these other things. And I
liked interacting with other people. And I was
always enjoyed science and, you know, always
wanted a challenge. And, you know, so I guess
it all added up to, well, let's pick one of the
hardest things to get into and one of the hardest
things to, you know, excel at. And I guess that's
what I went for. And, you know, part of it, retrospect
to James is, you know, chasing external validation.
You know, when you feel like you weren't heard
as a child, you know, and it wasn't my parents'
fault. I mean, I think it was a sign of the times.
And when you feel like you're not heard, you're
always chasing that next dopamine hit of validation.
I mean, like, if you look at my CV, it's just
ridiculous. And a lot of the things that are
on there were kind of meaningless to me, you
know, because I was always chasing the next.
the next dopamine high, if you will, that sensation
that you've succeeded and someone else noticed
it. So yeah, but I love it. I mean, I love being
a doctor. Most of my time as a physician was
amazing. And I'm still doing a little bit of
direct care currently. You know, I think the
problem with medicine is the detractors that
exist can be so devastating and the landscape
has become so difficult. You know, we talk about
the emphasis on profit making that it's really
drawn or how do I say this? It's well, it'll
be repetitive, but it's detracted from the true
calling. You know, most people that go into medicine
or nursing or first responders or EMTs or teaching,
they go into it to help other people. They don't
go into it to become rich. You know, most medical
students walk out with like. North of $200 ,000
in debt. That's on top of whatever undergraduate
debt they have. You know, and yeah, so that was
sort of a circuitous answer as to how I got into
it. And maybe a little bit of insight is to where
I'm at now. Would I do it again? Yeah, sure.
I'd do it again. 100%. My wife just graduated
optometry school with over $400 ,000 worth of
debt because it was a private school. Optometry,
they only have, I think it's like 30 schools
in the whole of the US. And so the only one in
Florida was that one. And it was good education.
It really was. But I mean, you talk about crippling
someone who... leaves an occupational educational
track, you know, you really want to destroy their
ability to start doing the job. Just, you know,
give them a medical debt that's twice the amount
of the mortgage when they walk out the back door.
It's insane. Totally, James. And, you know, one
of the things that it's definitely contributed
in terms of, at least for physicians, you know,
and I'll speak because that's what I am, right?
It creates this golden handcuff, which has been
really weaponized against people. um because
institutions administrations they know you have
enough debt where they know you need to keep
working which prevents you from pushing back
and challenging the status quo um in that regard
i was a little unique because i had the blessing
of getting through undergrad debt free as a result
of a lot of hard work and a little bit of scholarship
and you know being a paper boy from 12 to 18.
and saving all that money up despite getting
bit by dogs five times you know having that trauma
related to it um but not everyone's that blessed
and then you know being a navy physician you
get medical school paid for and so when i got
out of residency i wasn't shackled with this
massive amount of debt like a lot of my colleagues
which i think has been a blessing because it
allowed me to be much more vocal when things
were going on that were not right and i was like
you know what i i'm in a position to not take
this Like, you can't hold my paycheck above me.
In fact, I remember, I'll tell you a story, James.
So I was, we were doing, we had a clinic going
and it was amazing. And they wanted to, the administration
wanted to figure out how they could potentially
scale it for the rest of the system. And I was
like, okay, great. We'll have this meeting. But,
you know, me being me, just talking about that
wasn't going to be enough. I, of course, had
to take it to another level. I came armed with
all my stats and all my numbers and all these
other things. And so we talked about the clinic,
but then I pushed into the topic of recruitment,
retention, well -being, you know, things that
are critical for a healthy system and a healthy
culture. And the three administrators there,
as I was going through this, James, it was like
deer in the headlights. To the point where, I
won't get into the specifics per se, I write
about it a little bit in Ripple of Change. But
I feigned that I possibly shredded some value
based reimbursement forms when I wasn't having
a good day. And I think the president of the
medical group was about ready to jump out of
his chair. He was so pissed. And then he proceeded
to threaten me with my paycheck. After I had
told them, like, I didn't necessarily need income.
I'm like, dude, you don't even listen to anything
I was just saying. You got pissed and then you
threaten a guy with his paycheck who literally
just told you he didn't need the paycheck per
se. Like, what the hell? and this this is the
kind of garbage that goes on all the time and
this was over me advocating for taking care of
people i wasn't looking for a race i wasn't even
looking for anything for me i was looking for
my colleagues to stop being treated like and
that's the response i got it's like wow you know
fast forward a year later it kind of imploded
and that's when i ultimately took a stand but
um so We can talk about that. I can tell you
the story of that story, too, if you want more
stories. I've always got stories. Let's do it.
Let's do it. All right. So fast forward about
a year. You know, I had been very vocal about
the things I was mentioning that really had nothing
to do with me. I was really advocating for my
colleagues who felt like they didn't have a voice,
you know, in part because of the golden handcuffs.
They felt like if they spoke up, they could be.
Well, basically cast aside might be the simplest
way to put it. And there's all kinds of nefarious
things that are going on in that regard. So I
came into a meeting at the time I was writing
the book, Ripple of Change, and my wife had gotten
me a coffee cup. And on the coffee cup, it said,
be careful or you will end up in my novel. And
so I walked into this meeting and I said that
on the table in front of me. And the VP's like,
Todd, is that a warning? And I said, well. I
guess it depends on how this meeting goes, because
it's about logistics. And I had an idea where
it was going. You know, ultimately, there was
a decision that had been made to save money on
rent regarding the clinic. And they were going
to move this bustling clinic that was doing very
well back to the town where I'd gotten burned
out without telling me and with very little warning.
You know, when you talk about. You talk about
setting someone up to be re -traumatized on a
daily basis. You know, in retrospect, I was being
put in a position where every day I went into
work, I was going to have to relive some very
painful memories. And I guess subconsciously,
I wanted nothing to do with that. And so I went
home and I told my wife what had happened. She
started crying. I started crying. I said a lot
of prayers. The next morning, James, I resigned.
I had been there almost 13 years at that point.
I had poured my heart and soul into that institution.
I gave so much of myself, probably too much at
times. But they crossed the line. I was in a
position to stand up for myself. And in Ripple
of Change, I call that section the day the music
died. Because the clinic that I had worked in,
it was magical. It really was magical. For the
sake of saving a little bit of money, they really
cast aside multiple people and a beautiful thing.
I'm going to have a shot in the dark while guests
and I'm using my experience in the first responder
profession and what I've seen, you know, this
last nine plus years since I've been doing this
podcast, seven of which the last seven I'd stepped
out of my profession because I realized to really
speak freely. I needed to not wear a uniform
anymore. The decisions that were being made to
make changes, did they save money possibly short
term, but actually would have a ripple effect
of costing a lot more money long term? Oh, you
know it, my friend. And I actually dug into that
a little bit. Interestingly enough, I sent the
email that I was resigning to like 20 administrators
within the health system. You know, when I made,
when I made noise, I made a bit of noise at times.
And so one of the administrators who I'm actually
still friends with to this day, she was just
put in a bad spot in retrospect and was kind
of the messenger. She came over very frustrated,
upset that I was, that I had sent that email.
And I'm like, you know, look, like I'm not a
chess piece. Like you can't just move me without
telling me. And I'm just going to sit here and
take it like everybody else. I think you should
have known that leading into this. And I told
her, I said, you know, this decision to save
X amount of dollars on rent, I'm pretty sure
I just cost you four to five times that amount
of money next year as a result of that decision.
Because when you lose a very highly productive
physician like that, the negative financial impacts
are massive. And that goes beyond just the amount
of money to recruit another one. I mean, when
you lose somebody who's seen thousands of visits
a year. You lose all that ancillary income, all
those referrals. I mean, you're talking millions
and millions of dollars were attached to that
decision, which far outstripped the amount of
money they were going to save on rent. The other,
I think, to me, even more powerful statistic
related to that, James, we didn't have a lot
of turnover in my office when I was there. And
there's reasons for that. We had a good culture.
We cared for one another. We looked out for one
another. It was like a family at times. You know,
as an example, my medical assistant was with
me for nine years. For a medical assistant to
be with a primary care physician for nearly a
decade is a testament to the culture that existed
there, right? So there were 15 people when that
meeting happened that worked there. There were
three nurse practitioners, one physician being
me, and then 11 medical assistants. We had a
nurse office manager, receptionist, what have
you. Four months later. Nine of the 15 left the
health system. They lost two nurse practitioners,
one physician and six other staff as a result
of decision to save money on rent. So you think
about all the trickle down effects of that. Let's
say it was a half a million dollar decision.
I bet all said and done. Between five and ten
million dollars of negative expenditures as a
result of that. That's an educated guess. I can't
give any hard data to that. But I mean, if I
worked it on paper, I think that's where I am.
Well, that's what we're seeing in the fire service
at the moment. Fire slash EMS is, you know, you've
got these departments and, you know, basically
our profession is circling the drain. It really
is. People are being completely honest. Unless
you're in an anomaly department that you have
all these things already in place. a majority
of the country is working 56 hour weeks and as
you know the generations have become more and
more educated young people are looking at that
and going well that's not very good and then
they learn about the mandatory overtime so now
you're in 80 you know and then unlimited like
a friend of mine just worked 120 hours in a row
you know non -stop in a busy city that he probably
was getting no or poor quality sleep every single
one of those nights And so, you know, we're having
less and less and less people in recruitment.
And then the retention is getting worse and worse
and worse. And the conversation is, well, we
don't have enough people to hire another shift,
which would give us a 42 hour work week, which
in Florida now this revolution has started. But
I am by no means a mathematical genius. In fact,
the reason that even though I wanted to be a
doctor when I was young. I didn't. It's because
of mathematics. I just wasn't smart enough to
navigate those hurdles. But when you look at
the downstream cost of what happens when you
overwork a profession, it far outweighs the money
that would be needed to simply invest in enough
doctors, nurses, paramedics, firefighters, corrections
officers, dispatchers, whatever is needed to
create an environment of health, to drive recruitment,
to drive retention. And it blows me away. That
someone with a mathematical ability of an ape
like myself can figure the shit out. But these
financial gurus in these cities and counties
and corporations can't see that proactive creates
so much savings and value versus reactive. And
it blows my mind. Well, I think a lot of that
has to do with, I mean, look at our capitalist
society that focuses on the short -term ROI,
right? When you've got a myopic view of things
where that's the only thing you're looking at
and you're not factoring all these other things
in, yeah, it's going to look like, oh, this is
a genius decision. We need to do this because
the ROI in three months is going to be X, Y,
and Z. Well, that's all well and good until you
realize you've got 10 other problems you just
created that are going to cost 30 times as much.
You know, I mean, an ounce of prevention is worth
a pound of cure is a genius statement. And in
your world and many other worlds, we need to
go back to that. But ultimately, I mean, if you
think about it, it's how are we treating our
fellow human beings? You know, and the way we're
doing it at times is leading to a whole. Man,
a whole bunch of deleterious downstream effects.
We could go down so many, so many rabbit holes.
But, you know, again, I'm not a politician per
se, but yeah, I mean. That's why with what we're
trying to accomplish with the documentary, Suck
It Up Buttercup, is to really get back to valuing
people over profits. And by doing that, again,
to stay in the world of health care, your total
cost of care goes down. Your burnout levels go
down. Your adverse events go down. I mean, let's
just focus in on the burnout rates of physicians
right now. And we could quote statistics and
all that other kind of stuff. They're not good,
okay? You know, when you've got a 50 -50 chance
of the physician in front of you experiencing
some level of burnout, do you think you're getting
their best? Is that a risk you want to take when
your life's on the line? I don't. I want someone
who's well and in the moment and so on and so
forth. I don't want someone who's contemplating
quitting their job, you know. potentially offering
some life -saving treatment or operating on me
uh those are scary scary statistics and and expensive
i mean expensive too when you start to factor
in all the downstream effects of that absolutely
well i want to go to on your kind of med school
journey so you mentioned the military what was
it that made you choose the navy for this path
a random phone call literally a random phone
call i was Oh, so I graduated college a semester
early for a couple of reasons that were kind
of cool and were all lined up. And so I was working
at BASF, actually, where my father worked. So
probably some nepotism getting me in there as
an intern and all those kinds of things. But,
you know, I showed my value and they kept me
on. And they actually hired me when I finished
school. I was a biochemistry major, full well
knowing that I was trying to get into medical
school. But I already knew the job. I already
knew how to do it. They wouldn't have to train
me. It was kind of like a plug and play kind
of thing. And so I was running a quality assurance
lab for a vitamins department. I think I was
on midnights when I got the call. So I was at
home sleeping, you know, and the old rotary phone
rings at the house. And so I answer it, you know,
and fate had it it was a Navy recruiter on the
phone. You know, I had no intention of going
into the service at that point. And so, of course,
they're all excited that I answered the phone
and start telling me all these things. Oh, we
can pay for college. And I'm like, well, I just
graduated from college. And they're like, oh,
what are you thinking about doing? I'm thinking
about going to medical school. Oh, and then suddenly,
you know, I'm half awake while this is going
on, James. And so then they start. I'm like,
you know what? Send me some stuff in the mail.
I'll look at it. And if I'm interested, you know,
I'll get back with you. You know, sure enough,
they sent it out and I looked into it and it
was intriguing from the debt perspective. you
know, to get through medical school without being,
you know, shackled in debt. You know, there's
a trade -off, right? Yeah, I traded off, you
know, a handful of years of my life serving our
country. But ultimately, it was amazing on so
many levels. You know, I got to travel. I got
to go around the world. I got to be a flight
surgeon. I mean, literally, as a flight surgeon,
you kind of learn how to fly a plane, which is
fun. You know, being like a doctor in a fraternity
at times, which has also had its level of fun.
But ultimately it pulled me to my true calling
in medicine. You know, when you get out of medical
school, a lot of individuals, they go straight
into residency and like, that's it. You're in
that residency and you're kind of locked in.
And for many people, there isn't a way out because
of those financial handcuffs. For me, I had four
to five years to sort of think about, okay, you
know, where do I want to be in medicine? What
do I want to do? Like, what's my true calling?
And it was primary care. You know, had I not
been in the Navy, I don't think that would have
happened. You know, had I not gotten that random
phone call, would you and I be talking right
now? I don't know that we would be. It's all
those little touch points that lead us down these
amazing journeys. And, you know, so to answer
the question, it was never sort of my dream to
be in the service. It was it truly was happenstance
that it all occurred. But I'm glad that it did.
What years were? Did your medical school kind
of spam? Was it pre -9 -11 or did it actually,
I mean, not circumnavigate, but spam either side
of it? Yeah, smack dab in the middle. So I was
in medical school in 1998, graduated 2002. I
still can remember, I mean, like we all can remember
9 -11, right? I mean, that's kind of a silly
thing to say. Yeah, I remember where I was on
9 -11. Well, no kidding. So does everybody else.
So, but I was in a... a fourth year fourth year
medical student um and i was on an elective and
i was following around a radiation oncologist
and we were rounding and doing stuff and of course
you know like many physicians you never stop
to eat lunch you never take a break you never
do any things to actually take care of yourself
you just keep pushing through the day so i kind
of knew what was going on like we'd be in a patient
room and there'd be like like some video clips
and then we would just keep going so i get home
my wife's like oh my god did you see i'm like
I don't fully know what happened. Give me 20
minutes to watch the news to sort of catch up
with the day. And then my phone started blowing
off the hook because, you know, at the point
I was in the service. And so my family was like,
are you going to get called up and all these
other things? And I'm like, I don't even know
how to answer these questions. Like I'm in medical
school. Do I think they're just going to pluck
somebody out of their last year of medical school?
No, probably not. They're probably going to let
me finish, you know, and then get into residency
or have you, but it was, it was definitely quite
surreal. You know, having been in the military
at that point and knowing that I could just get
taken and sent off somewhere. So after you graduate,
did you find yourself deployed in the Middle
East at all? I wasn't in the Middle East. I mean,
no, we had when I was deployed, I was actually
deployed to Sicily in Italy. So, I mean, if you
had to pick a place to be deployed with good
food and, you know, beautiful scenery, I mean,
I. probably was in about as good a spot as you
could be but the reason for that is i was the
flight surgeon for a p3 squadron which historically
they're sub hunters but their mission had evolved
over the years into surveillance and a handful
of other things and so when i was deployed to
italy we had uh we had people in el salvador
italy uh and then cutter and i was responsible
for all 500 individuals medical dental whatever
care they needed you know and and they were spread
all over the world which you know it was fun
but it has challenges too i i distinctly remember
one of our guys um ruptured his um quadriceps
tendon and he's in el salvador my boss is in
italy and at the time i was in france i had been
assigned to do a diplomatic mission and so i'm
like on the satellite phone talking to people
in three or four different countries trying to
coordinate his orthopedic care But yeah, I was
never in the Middle East. I didn't experience
any combat firsthand or anything like that. It
was more secondhand stuff and secondary trauma
type things. So going on to the doctor or the
medical education route, you have this background
as a high -level athlete. So you're obviously
very familiar with the concept of strength and
conditioning and then nutrition and hydration.
From an academic lens, as you enter this profession,
How much of the preventative lifestyle elements
are you taught in the education side itself?
Oh, Lord. It was probably the opposite of what
should have been taught. I mean, essentially,
you were taught to put the patient first, which
I agree with to a certain extent. But if that's
at the detriment of the person providing care.
Not going to go on forever. I mean, you know,
James, when I was an intern and it was before
the 80 hour work week was instituted, I lost
like 15 pounds in like two months because of
the number of meals I missed, the lack of sleep.
You know, I was at times a tired, angry little
man for a whole host of reasons. But, you know,
and I wasn't I'm not a huge guy now, but back
then. you know it's like 165 pounds so when you
lose 15 pounds that's a pretty decent percentage
of your body weight and so you know to answer
the question was the emphasis on taking care
of yourself probably quite the opposite actually
well even the patient so what about you know
as far as Treating the patient with nutrition,
exercise, sleep in a prescriptive side. How much
education will you get as far as that factoring
into the health of the men, women and children
that you're going to be treating? Yeah, some.
I mean, it was it was it was definitely a part
of it. I don't think it was as much as it should
have been. I think the you know, I'm an allopathic
physician and I think the osteopathic. uh training
is is more aligned with that if you will um so
we got some not nearly as much though as we should
have and i think those soft skills if you will
and how those contribute to uh caring for a patient
i mean i think i was taught it a little bit thinking
back on a bit on it you know to a certain extent
but not nearly as much as as i could have been
or should have been i mean those are skills that
i learned over time the value of them and how
much those could contribute to a person's healing.
You know, I mean, I distinctly remember times
where, you know, I wouldn't have the answer for
somebody, but I would be encouraging or I would
give them a hug or talk to them or share a tear
with them. And that human connection, I mean,
often would help them get them to a better place.
And it's incredibly important. And I think it's
happening more now, for sure. I mean, I'm not
in an academic setting on a regular basis, so
I can't speak to it firsthand. But it was not
valued as much as it should have been in retrospect
when I was going through school. I came across
a story a long time ago, and I talk about, as
I mentioned a little bit earlier, sleep deprivation
and the work week is such an important conversation
in FIRE and EMS, especially as we're woefully
understaffed at the moment. But I stumbled across
the story of William Halstead. And when you look
into the world of surgical residencies or residencies
in general, you know, it was always like, well,
why are these doctors, as you said before, whose,
you know, literally lives are in their hands?
Why are they required to do these crazy weeks?
And it comes from him, you know, back a long,
long time ago. I think it was the 1800s if I
got that right. He was up for days at a time.
And so obviously there was a precedent then for
the students to do the same thing. I don't know
how soon after, but it was revealed that he was
addicted to cocaine and heroin. Now, I would
probably be pretty good at sleep endurance myself
if I was high as a kite for several days. But
does that mean it's healthy? Absolutely not.
What have you seen as far as the kind of unpacking
of that and the drive to make these residencies
and work weeks in the hospitals actually healthy
rather than these insane, well, it's the way
we've always done it mentality weeks that you
saw before? Well, yeah, you know, there's a lot
to unpack there. And it's interesting you bring
up William Hosta because I recently wrote about
him. And book number two, which is titled Unraveled,
which speaks to my unraveling of not processing
40 years of trauma. And you're right. I mean,
I think when you're modeling something on a cocaine
-fueled physician, like, what could go wrong,
right? You know, we did that for like 100 years.
You know, so I think there's been efforts over
the years to unwind that. You know, the 80 -hour
work week was, you know, a step in the right
direction, you know. but there's so much more
work to be done and i think part of it is you
know at times it would be seen like a badge of
honor you know like these you don't need to sleep
and you don't need to eat and all these other
crazy things and it's like really like that doesn't
quite make sense like we're supposed to be the
ones healing other people and we're doing a shitty
job of taking care of ourselves like no wonder
why there's rampant substance abuse and physician
suicide rates are high and all these other negative
things that result from it. I mean, look at who
modeled the behavior, right? Having said that,
though, it is getting talked about a lot. And
I know there are efforts to reverse course on
this and really put the correct things at the
forefront and develop, you know, clinicians and
physicians and nurses that are healthier. But,
you know, when you've got a century of a mess
to unwind it ain't gonna it actually ain't that's
terrible it's not gonna happen overnight you
know it's gonna take some time which is why these
conversations are so important i mean it's why
you know the number of my colleagues who have
written books on these issues whether it's mental
health or exposure to suicide or substance abuse
or trauma i mean there's the number of physicians
who have written a book and i'm obviously talking
about my own inner circle here it's inordinate
and i think it speaks to the importance of continuing
to talk about it to create awareness to subsequently
lead to action to get us to a better place so
as you came through this and obviously you have
this desire to serve and make the world a little
better walk me through the the intersection between
the the healer themselves and now this corporate
element this money -making element um that you
know as we've obviously kind of suggested earlier
in this conversation is partly at the root of
why we're seeing the demise of health care at
the moment yeah so i think the interesting part
of uh corporate health care or putting profits
ahead of people is You're essentially turning
our industry into an assembly line to a certain
extent. And you are incentivizing individuals
to create more widgets, work faster, do more
procedures, et cetera. I mean, you're incentivizing
sick care or illness care as opposed to preventative
care. And I'm being overly simplistic to a certain
extent. But when you do that and you incentivize.
working harder, faster, doing more, interactions
get compressed and compressed and compressed.
And that erodes the trust of the physician -patient
relationship. It creates errors. It leads to
adverse outcomes. Honest to God, at times, we
kill people for the sake of profit. You know,
medical errors, they're rampant. You know, depending
on the estimates, at a minimum, it's estimated
that a few hundred thousand people die annually
in the United States related to medical errors.
You know, that's like, I got a buddy who equates
it to about 10 jumbo jet airliners crashing per
week of people killed by medical errors per week.
Like if we lose a commercial airliner in this
country, it makes national news typically. Yet.
10 times a week in health care that happens it's
it's it's sick and that doesn't even count the
toll of physicians clinicians nurses ems firefighters
who are taking their own lives because they're
trying to deal with so much pain they don't see
another way out you know breaks my heart to talk
about that stuff so yeah i mean corporate medicine
and greed is destroying or has destroyed our
healthcare delivery system. We're going to that
false economy. And sadly, we've all heard these
examples where companies have said, well, we're
going to have to pay X amount in lawsuits, but
our profit was double that. So it's still worth
doing. We can kill people and we'll still make
a profit. And that's been spoken of. I mean,
look at the Sackler family. Perfect example.
They had complete knowledge of what they were
doing with their painkillers. And I remember
when I first moved to the States, my ex -wife
and I lived in Broward County, which is where
all the pill mills were. And she actually found
herself working for a physician innocently because,
you know, if you weren't behind the curtain,
you had no idea what was going on. And she was
like, it's so weird. Like we write prescriptions
and these people fly from other states and they
come and get these prescriptions. And after a
while, we had an aha moment and she left. And
I think shortly after that, some agency kicked
in the door of that clinic. hold the doctor off.
But, you know, that truly predatory action, you
know, what is the ripple effect? You know, you
have all these people that are just doing it
for the right reason. But when you're putting
profit over the well -being of the nation, you
know, even from a fiscal point of view, like
you said, all these jetliners full of people,
I'm assuming there's a lot of lawsuits attached
to that. So again, you know, if we're actually
front -loading the money and giving an environment
where we have enough physicians and they can
take time with the people. And give them drugs
if they need it, give them lifestyle information
if they need it. That is going to save money
hand over fist compared to, well, we'll just
do it this way. And then if people die, then
we'll just pay a settlement. I think probably
the simplest way to potentially articulate this
to the average American is, you know, we're rapidly
approaching spending 20 % of our GDP on health
care in the United States. OK, so there's a massive
economy related to this. Compared to other developed
nations, we're spending at a minimum twice the
amount of money that they are, if not closer
to three to four times other developed nations.
And our outcomes compared to them suck. Like
we're not spending twice as much money and getting
like twice the, you know, a better car or a better
house or spending twice as much money and getting.
garbage at times you know in our life expectancy
we've we've successfully bent the needle in the
wrong direction like you look at every other
developed nation this continues to gradually
tick up and and we're now going the other way
and so we're spending an inordinate amount of
money and and for what i think that's the simplest
way to look at it and it's all these downstream
effects whether it's deaths related to narcotics
overdose lawsuits medical errors these expenditures
just grow and grow and grow and grow and we are
all paying for it rest assured we are all paying
for this um people talk about and i don't want
to get into the weeds too much on insurance because
i don't think that's necessarily where we want
to take this so i've got insurance so i'm good
are you are you good how much of a premium are
you paying what's your deductible like when if
you really start to look into it are you okay
with 20 of your paycheck going to healthcare
are you i'm not you know and not at all so sorry
i got on a soapbox or a little bit sometimes
it's hard not to yeah no this is i welcome soapboxes
here it's interesting obviously when you've when
you've worn a lot of hats lived in different
countries you know you just get this different
perspective on things and i grew up with the
nhs you know and i was kind of pseudo -rural
And so we had this amazing, you know, two doctors
my whole life. We had this elderly doctor who
retired and then this next doctor was our physician
the whole time, took care of all the generations
of earrings and tonkuses. And, you know, for
example, I've said this on here a few times,
my grandparents actually paid for Bupa, which
is the private insurance that you could get at
the time. And as they got older and older, the
premiums got so immense that they were basically...
forced to not have it anymore. Just when they
finally were maybe able to start using it for
some things, they were priced out. And my grandfather
at 99 years old got cancer and he was so healthy
physiologically that it went through him like
it would a younger person. And I watched on the
NHS him get the most incredible care from doctor's
home visits, you know, hospice care set up in
his home. After he passed away, they visit my
grandmother for literally another couple of weeks.
It was amazing. Absolutely. And that was on the
NHS. But what breaks my heart is I would argue
that is the best health care system on the planet
when it's done properly at its core. You know,
we are going to take care of the elderly, the
infirm, you know, and what that does is then
if it's a tax based system, in theory, it forces
you then to make the country healthy. And we
were a very healthy country, I would argue, for
a long time. However, when I've gone home recently.
I watch my British men and women getting fatter
and fatter and sicker and sicker and obesity
is getting worse and worse. And you couple that
with the privatization of the NHS, they've ripped
it apart. And so this is what breaks my heart
is the American model has been forced onto other
countries and the people of those countries don't
realize the damage is happening. But, you know,
a tax based health care system that you use when
you need it. that everyone chips in, that encourages
the country to be as healthy as possible so we
don't use as much tax, is an extremely fiscally
sound model as well, as long as your country
is, you know, the proactive health care is being
pushed. But what I've seen in the UK is that
with the change in nutrition and lack of exercise
and all these other things coupled with privatization.
They've taken arguably the best healthcare system
on the planet and they've fucking destroyed it.
It's interesting. I've heard this from a handful
of individuals talking about the NHS in particular.
And, you know, I can't say that I've experienced
utilizing the system firsthand, but I think,
how do I say this? I think at its core or at
its simplest, perhaps, I do think universal healthcare.
It is the way to go. You know, we've talked about
health care being a human right. And, you know,
I'm in that camp. You know, I don't like where
we're marginalizing people and not giving them
an opportunity to get the treatment and care
that I believe that deserve. I think that kind
of goes against being a human being, to be quite
honest with you. It breaks my heart a little
bit to see that. Let me back up a little bit.
I think there's some amazing things in healthcare
in the United States. I think in terms of technology
and advanced care and some of these other things
that are out there, they're hard to beat. The
problem is, do you have access to it? Can you
afford it? And if the answer to either one of
those things is no, then you're screwed, depending
on what the circumstances are. And to then take
that type of a model where... Some people can
get care and some people get nothing to other
places around the world. It's scary. And I'm
a physician in the U .S. I want the health care
system here to be as good as it can be. I don't
think we're the model at large to be extrapolating
that and implementing it around the world. I
think there's bits and pieces, sure, just like
everywhere else. Yeah, it's scary. And the downstream
effect of those decisions is, how does it then
affect the caregivers when they're not getting
the resources or the tools or the mental health
support or whatever they might need to provide
the best? And then it becomes a bit of a vicious
cycle. And then that's hard to unwind. And that's
quite a bit of where we're at now in the U .S.
that focuses on the almighty dollar. Things are
sacrificed as a result of that. And it negatively
impacts patients and caregivers at pretty much
every level. Well, speaking of obesity in this
country, I think we're well over 70 % of the
country is overweight and over 40 % of the country
is obese, like significantly overweight. And
again, that in itself, we're talking about leadership.
And I've spoken about this before on social media
and in other areas. I think it was Winston Churchill,
and I'm paraphrasing, said, you can mark the
greatness of a country by the health of their
people. And so again, greatest country in the
world. I've heard it all the time, the American
flag, but we're not. We have amazing people in
this country, but we're not taken care of. We're
not the greatest. We're not the greatest in education.
We're not the greatest in healthcare. We have
murders in our schools on a weekly basis. There's
a lot of areas that we have to be humble enough
to say, you know what? We're not the greatest
in these areas, and we have to address that.
When you talk about healthcare, the same way
as no one talks about why are our streets so
dangerous when we're talking about law enforcement,
you don't hear people talking about the obesity
crisis and the opioid epidemic when we're looking
at first responder and doctor and nurse burnout.
So talk to me about that lens. What are the frustrations
in healthcare for Americans getting fatter and
sicker and the impact of that on our hospitals
and our clinics? Oh, boy. How long is this podcast,
James? We've got all the time in the world. I
mean, the impacts are tremendous. You know, you
just take one of those cans of worms, if you
will, obesity. It makes pretty much everything
in healthcare delivery more difficult. You know,
whether we're talking about hypertension management
or diabetes management, heart disease, congestive
heart failure. Simply performing a surgery on
somebody who's in one of those camps, it becomes
more difficult. The complication rates go up,
the mortality rates go up, et cetera. So the
costs go up, right? And so the downstream effect
of that particular problem is tremendous. The
opiate crisis, oh boy. Maybe I'll talk about
this in a little bit of the context of a documentary.
I don't know if you've seen the documentary Dope
Sick. Oh, my goodness. Yeah, I mean, it was kind
of docudrama, wasn't it? Yeah, docudrama, yeah.
With Michael Keaton? Yes. And, you know, being
a primary care physician and thinking about the
individuals that died from overdose or who were
addicted to opiates. You know, the costs related
to, you know, really greed and profiteering from
Purdue Pharmaceuticals and how it negatively
impacted the health care landscape in the United
States is disgusting. I actually I know Rick
Mountcastle, great guy. And Rick's all about
justice. He's one of the lawyers that was highlighted
in Dope Sick. Great guy. Rick is a great guy.
Having witnessed some of these adverse effects
and or deaths related to the opiate crisis, it's
heartbreaking. It's absolutely heartbreaking.
And it's a huge toll on our livelihood, our interactions,
our relationship, our life expectancy, the amount
of money we spend on health care. I mean, look
at how much money we spend on getting Narcan
put all over the place in this country. Not that
I think that's a bad idea. I think it's a good
idea to have Narcan available. But why the hell
do we have to have Narcan available? You know,
like again, reactive again. Totally. Like, let's
push. Let's go further upstream and deal with
some of this stuff. You know, I distinctly remember
when the pain scale came out, you know, like
is the fifth vital sign. I was like, don't get
me started on this. I was like, what? What the
hell are we doing? This person is telling me
they're a 10 out of 10 sitting there smiling
like they're not in a 10 out of 10 pain. I used
to have to describe to people like a 10 out of
10 is like, I just cut your leg off. I'm pouring
salt and alcohol in it and lighting it on fire.
That is a 10. Is it the pot that's attached or
the nub? Because those two are different stimulus.
Touche, touche. Oh, it was like, oh, my God.
And it just created this mountain of extra work
for us, too. You know, and again, it's at the
expense of people because. of profit and money
and greed you know and those are tend to be common
themes with a lot of these things where you know
what's the right thing to do versus what's going
to make us money and we're you know where's the
balance in there you know and how do you manage
that polarity if you will well this was what
was so maddening during covid the most and this
is i would argue this is still the case to this
day the most censored voice is the one in the
middle Hands down, I've witnessed it. I've had
my Instagram account shut down for simply just
trying to push kindness, community, compassion,
empathy. And what I mean by that is during COVID,
no matter what your stance was on, let's just
say vaccines, there was one truth. The healthier
the human being, the better the outcome. If you
choose not to have a vaccine. then you need the
healthiest immune system to have the right response
to the COVID virus. If you choose to have a vaccine,
you need a healthy immune system to have the
healthy response to the vaccine to create the
immunity for the virus. But that was heresy,
absolute heresy, supposedly, that you dare suggest
that obesity and pre -existing medical conditions
had anything to do with a COVID death. And this
is the thing that just... you know, angers me
so much. Opioids, over 100 ,000 Americans die
every year from the opioid crisis. We're at the
millions with all the kind of related elements
of obesity. So when COVID hit and there was that
ticker on CNN and Fox News and, you know, whatever
their World War I trench version of this pandemic
was, but the moment that we were done with it,
they were like, all right, well, let's just move
on now. We don't want to talk about it. We don't
want to reflect and learn lessons. We just, we
don't want to pretend, you know, pretend it never
happened and let's go. Meanwhile, Americans are
getting fatter and sicker. So every year, a million
plus Americans are dying. Where is that news
coverage? So this is what's so disgusting. This
is Republican and this is Democrat. For the last
few decades, we've got sicker and sicker and
sicker. And COVID, you know, showed really, showed
this country just how sick we are. Because healthy
countries like Scandinavia, they did not have
even close to the amount of per capita deaths
than we had. And yet we come out the other end
and people still turn their head to the most
obvious thing, which is we are a very sick nation
and we have to do something about it. And that
in turn is killing our doctors, nurses, paramedics,
EMTs, etc. I don't disagree with you. I'm actually
probably so much aligned with you that I'm borderline
speechless at this point. But I think it speaks
to, you know, where where's the energy? Where's
the focus? You know, how are people communicating
with one another? And if we're just arguing about
everything in two camps, like, how do we get
to that middle ground where actually, as you
say, the truth probably is. I'm, you know, James,
I'm probably more with you in terms of political.
And I think the answers are in the middle. And
that's managing those polarities. You know, we
could even talk about the polarity of politics.
Not that I want to talk about that, because that
is not my forte at all, unless we're talking
like sports or. maybe crypto or medicine i'm
probably not the expert on it um but i think
you know it's about balance and we need to do
a better job at large in this country about finding
the balance and i think if we can do that it
will allow us to push further upstream to make
better decisions so that we do have a healthier
um population at large but but we're not there
i mean we are not there and we are very far from
there in many many places and you know i just
think about how many people are marginalized
and not even included in the discussions you
know that's a completely different topic um yeah
we got a long ways to go but i think you know
i don't want to just beat debbie downer either
though james i think i think we're getting to
a point particularly within the healthcare space
where the level of frustration not only from
clinicians and physicians but also patients it's
at a boiling point and If we are intelligent
about how we use that energy and that collective
frustration and turn it into collaboration and
opportunity and ways forward, I think that's
where the magic is with this. And to talk about,
you know, the documentary Suck It Up Buttercup
a little bit. I mean, ultimately, that's where
we want to go with this. You know, we want there's
a there's a couple evergreen calls to action.
One of it's unlearning, learn helplessness, which.
You know, that feeling like, well, I'm only one
person. What can I do? Well, you can do something.
You know, I often talk about like time, talent,
treasure. You know, do you have the time to contribute
to something that's creating positive change?
Do you have the talent to do it? Like you do
in this podcast. Clearly you have the talent
for trying to facilitate positive change. Do
you have the treasure? Skip a latte in the morning.
Donate five bucks to your favorite nonprofit
that's trying to do something positive. Everyone
can contribute to making a difference. But I
think to do it on a bigger scale, we've got to
get out of our siloed approach. I mean, healthcare
delivery in and of itself is pretty siloed. And
we don't necessarily get into that rabbit hole.
But I think at times the efforts to make positive
change are also siloed. And that's problematic
in and of itself. You know, like we need scale.
We need to be pushing way further upstream. on
this curve, if you will, to facilitate the changes
that you're talking about. And to do that, you
need numbers and you need collaboration. We need
legislative change related to this. There's a
lot of entities that are very happy with how
things are going and making a lot of money. I'll
stop. I'll stop short there. But I think this
is it. The whole point of this is obviously we
got to have these. conversations about what's
broken but like you said then the next breath
needs to be well then what can we do about it
and this is what's amazing about the documentary
and the book that you've written so let's just
kind of underline the issues in your profession
specifically and then let's then we'll go to
you know king for a day what needs to change
so what are you seeing as far as recruitment
retention burnout etc in the physician space
through your eyes oh lord um It's a, it's, it's
kind of a mess depending on where you're at.
I mean, I think there's pockets of amazing things.
Like I work, the group I work for has an amazing
culture, emergency care specialists in Michigan.
You know, they, they value their people, you
know, and it's the return over is minimal, but
that's not the norm. I think that's very much
an outlier. I think in many instances, you know,
it's, it's what's the ROI. And it's all these
deleterious effects that result from that that
are impacting clinicians, physicians, mental
health. But I think the burnout and the mental
health issues and the suicides and the substance
abuse are, they're emblematic of a much bigger
problem. You know, Wendy Dean writes about moral
injury, that feeling that you want to do the
right thing for somebody. And I'm paraphrasing
big time here. I need to just memorize this at
one point. But that's not me. And so I'll probably
keep doing what I'm doing. Anyways, that you
want to do the right thing for somebody, but
there's all these obstacles in your way of trying
to achieve that. And then you have this ethical
dilemma of like, well, I know this is the right
thing, but I can't do it because of all these
things. And that's emblematic of a sick system
that has its priorities in the wrong places.
Wendy writes about physicians being canaries
in the coal mine. You know, you took a canary
down in the coal mine so that if oxygen was deprived,
the canary drops dead and everybody needs to
leave. Well, physicians are dropping dead at
a rate of one per day on average in the United
States of America. There are about a million
of us, and the fact that we lose a physician
a day to suicide is insane. And that number really
hasn't slowed down to my knowledge. and speaks
to the level of dysfunction that's further upstream
so that was a long -winded answer to you know
what does burnout mean what does mental well
-being mean all these issues are signs warning
signs of a system that in many instances is on
the verge of collapsing you think about medical
deserts you think about obstetrical deserts you
think about the number of rural hospitals getting
shut down you think about the number of primary
care physicians walking away from their career
at the prime. You know, James, I quote -unquote
retired, if you will. I didn't really obviously
retire. I'm doing all kinds of stuff now. But
at 46, 46 years old, you know, I spent four years
of undergrad, four years of medical school, three
years of residency, 11 years in the prime of
my life to dedicate it to becoming a physician.
I can't tell you how many funerals, weddings,
birthdays, etc. I missed. Because I wanted to
be a doctor. And to give that all up because
you're so fed up. I just it's hard to even imagine,
you know, it really is. You mentioned about the
health care deserts, and I've had a few people
on the show that have alluded to this. I think
this is something that Americans don't realize.
Talk to me about the. the infant mortality rate
one would think that it would be lowest in you
know lesser developed countries but where is
america as far as you know pregnant healthy pregnancies
and infant mortality in the the range of all
the developed nations um probably the best way
to describe this is not good um again i'm not
the best according statistics and i probably
need to get better at this One of my colleagues,
Dyke Drummond, he talks about the fact that in
certain areas in the United States, infant and
maternal mortality is equivalent to sub -Saharan
areas in Africa. You know, and supposedly for,
you know, a developed country who's got the quote
-unquote best health care in the world, our infant
mortality rates and maternal mortality rates
in certain areas of this country are abysmal.
Abysmal. You know, deplorable. You know, we pull
a couple of statistics in some cases like triple
other countries. I think it speaks to what we're
valuing. Like, you know, where's the value? Think
about it. If you're a you know, you're a black
woman in an underserved area where there's no
gynecologist for obstetrician or gynecologist
for three or four hours and you have a. complication
you're screwed and it's disgusting that that's
what we're doing you know um yeah we we it almost
you know i talk about these things and i won't
lie it gives me it gives me a headache a little
bit like a tension headache to think about You
know, we value some people and some things and
some areas and others. We don't. We walk right
past our fellow man, fellow human, whatever,
and somehow that's okay. I'm not okay with that.
It was probably, I guess, more of a philosophical
answer to your question, I suppose. But back
to the, yeah, we got a lot of work to do. A lot
of work to do. Well, it circles around as well
to a comment I've made. You know, there's a lot
of different religions out there. But arguably,
all the ones that I've come across at the core
is kindness, compassion, community. There's not
a class system. Jesus didn't say, well, the rich
should get health care. I'm pretty sure, if I
remember rightly from my Bible, that he was out
there amongst them healing and lifting up the
fallen. So the way that we, again, beat our chest
doesn't even align with a lot of these faiths
that are so prominent in this country. And don't
get me wrong. beautiful human beings from all
those religions. But, you know, some of our actions
don't align. A number of people I've heard say
that are supposedly Christian, you know, Narcan
is wasted on addicts and we need to get these
bums out of our city. And like, really, that's
what your prophet would have said? I don't think
so. I think there's a disconnection there. And
I think you might need to revisit this book that
you hold so sacred and read it properly. The
other thing that I think is very, you know, under
discussed is the impact of for example drug commercials
the kind of programming that a lot of these patients
have when they walk into a doctor's office with
expectations of being prescribed x y or zed um
talk to me about that because i know that america
is only one of two countries if i'm not mistaken
new zealand being the other one that's even allowed
to have commercials on television for pharmaceuticals
so what does that do through a doctor's eyes
to the patient themselves as they walk through?
Well, the first thing that comes to my mind when
you say that, if I never saw another drug commercial
on TV when I was watching a show, I can't say
that I would be disappointed. So hopefully that
speaks to that to a certain extent. I think the
way I'll answer the question or try and tackle
the question as a family physician, it would
be... Once in a blue moon, it would be helpful.
I mean, I think once in a blue moon, a patient
would bring up a pharmaceutical that I thought
they would benefit from. But the vast majority
of times, there would be a cheaper alternative
that was almost as effective or nearly as effective,
or it wasn't indicated, it didn't make sense,
or it was prohibitively expensive for that person
that even if they wanted it, they couldn't have
access to it. And so when people historically,
and this is anecdotal evidence, obviously I'm
talking like family physician, Dr. Otten, this
is his opinion. He's remembering patients who
had come in telling me about all these great
commercials they saw, blah, blah, blah, blah,
blah. And then I would spend 20 to 30 minutes
going, oh my God, there's like 37 other options
that are way cheaper for you that we could utilize
aside from this one particular drug. So maybe
that was a tangential nebulous way of answering
your question. Like they're frustrating to me.
And I think they're emblematic of what we're
valuing again. Like, you know, I think about,
I'm not going to give specific examples because
I don't necessarily need a specific pharmaceutical
company coming after me and blah, blah, blah,
blah, blah. But the problems it created as a
family physician far exceeded the benefit that
I ever saw from a patient coming in telling me,
hey, I saw a commercial for this drug, you know.
Hopefully that answers it in a way that doesn't
put a bigger target on me than probably already
is on me. Well, what I'm getting from it, and
it's so weird because more often than not, you
see these drug commercials for issues that you
would think would be very rare. How many people
have psoriasis, for example? You see that over
and over and over and over again. Are there that
many people that you're going to spend millions
and millions of dollars? But it's that quick
fix element. So you walk in, you know, you've
got a doctor that's only been given five minutes
per patient. Then you've got a patient coming
in going, this pill is going to fix this thing
that I have. Rather than the conversation of,
well, look, it took you 20 years to get this
disease because of your lifestyle, because of
your nutrition. Let's take some time and start
walking towards. Getting you back there. And
I've always said this medicine has a place like,
you know, if you've got hypertension and it's
dangerous and yeah, we need to bring that down.
But it needs to be an exit strategy from nearly
all meds. All right. Now we've got to start talking
about, you know, your BMI or all these other
things and get you back to the point where we
don't need to take these drugs anymore. But that's
never the message. Mental health drugs, you know,
obesity drugs, all these things. There's this
kind of. facade that there's this irreversible
where you've got diabetes now there's nothing
you can do about it you're going to be on this
forever well if you caught it early enough absolutely
there's something you can do about it you can
change it with lifestyle changes you know you
can make your cardiovascular system healthier
with exercise and nutrition and sleep but I feel
like the average person is so brainwashed that
they just need that pill and it's a quick fix.
And it goes against the lifestyle changes that
are needed to actually reverse most of the diseases
that people are suffering with. I think there's
a lot of validity in what you just said. I think
there's another thing, too, is, I mean, you look
at the pharmaceuticals that are in the commercials.
I mean, what are the profit margins of those
particular drugs? You know, do you see commercials
for aspirin? Really? You know, no, not so much.
You know, an aspirin has saved how many lives
over the course of the years, you know, from
a cardiovascular perspective in particular. You
know, I'll speak to it. There is a lot of magic
in what you just said, James, talking about being
using these other elements to get off medications,
eating healthier, losing weight, exercising.
you know being in healthy relationships all these
other things there's value to this stuff and
one of my favorite things to do as a physician
was to take people off of medications like i
loved doing that particularly like the older
patients who would come in and be on like a dozen
drugs and i'm be like what the hell are you on
all this stuff or well so and so put me on it
a bazillion years ago i don't even know why i
take it or what i think of where i'm like okay
let's let's take a few minutes here and talk
about polypharmacy and what that is and how can
we address it and honestly some of my most um
i used to love dealing with polypharmacy because
if you found that one drug that was causing problems
and eliminated it oh my gosh it was so satisfying
as the clinician and the patients would love
it because it was like you gave them their life
back i can think of a i'll give you a story about
this you know um And I'm not going to give specifics
because I don't want to violate HIPAA rules and
blah, blah, blah. But I had a younger patient
who I was basically seeing as a consultant. And
her story had gotten so complex and so convoluted
that I was like, man, this doesn't, in reviewing
your chart, I'm like, this doesn't make a lot
of sense. Like, all these things that are being
considered don't seem to fit the mold or the
path. And I was like, I think this is all related
to a side effect. from a drug. And so I started
looking at her med list and trying to figure
out timelines. And then I saw the patient. I
took her through the history. I was like, just
walk me through this. Let's start at the beginning.
Let's go through when you were a kid and tell
me all about it. And of course, I had the luxury
of time because I'm kind of in a unique role
now. But long or the short, it all amounted to
one drug had created a nightmare of a cascading
evolution of medical issues that had resulted
from that one drug. And when we eliminated that
medication, a whole host of positive things occurred
as a result of it. To the point where when I
saw this person back for a follow -up, their
spouse had accompanied them to the visit. And
that usually means one of two things. Either
it's going really well or it's going really poorly.
And I was like, oh, please, God, tell me it's
going really well, Cam. and sure enough it was
and so it was so and i tell that story because
you know you spoke to the fact that like everyone's
looking for a quick fix you know the reality
is life is hard life throws challenges roadblocks
at us and you know our our quick fix and instant
gratification culture i think has perpetuated
some of the things that you've alluded to um
and we need to think twice about that we really
do i mean when i was seeing patients, you know,
yeah, sure, there was opportunity for blood pressure
medications and all these other things, but there
are many other things that needed to be entertained.
You know, in particular, blood pressure, are
you sleeping okay? Do you snore? How much alcohol
are you exercising? All these other things, how
much salt do you take in? All these other things
have potential to contribute, not universally,
but the potential, right? And that's the beauty
of medicine. It's not black and white. We'll
go into reactive versus proactive. If you think
about time. like you were able to have that conversation
because you had more time with that young lady,
how many unneeded doctor visits were avoided
because you had the time and figured out what
was going on, got her off the meds. Obviously
the other meds are probably trying to treat the
side effects. And now she's, you know, probably
coming for an annual checkup instead of constant
doctor's visits. So again, taking that, you know,
Oh, we've only got five minutes for these patient.
Well, what if you didn't, what if you actually,
you know, kind of changed the philosophy where
you said, all right, no, we're going to do 30
minutes or whatever is needed for each patient.
It'd be interesting to see as you extrapolate
out that extra time that was able so that a doctor
can truly critically think, how much time would
that save long -term? Oh my goodness. Like, you
know, as a primary care physician, if I routinely
could spend an appropriate amount of time with
a patient, the downstream cost savings would
be tremendous. Absolutely tremendous. And I think
that's why you're seeing, I'll shift a little
bit, why you're seeing an uptake in things like
direct primary care. I don't know if you're familiar
with DPC at all, but for whoever's not familiar,
it's basically a direct contract between a clinician
and a patient. You pay a monthly subscription,
50 bucks, 75 bucks, maybe it's 100 bucks, I don't
know, somewhere in that range. and your access
and the amount of time you can spend with the
physician is, it's not unlimited, but it's a
factor of X more than you would get to spend
with your run -of -the -mill fee -for -service
clinician. And by doing that, you can dig into
these things. Is there housing insecurity? Is
there food insecurity? What are some of these
other factors that may be leading to this medical
issue that truly aren't being addressed? You
know, like if I is an example, if I told diabetic,
hey, you need to take this drug and they say,
OK, but they go home and don't do it. What the
hell did I accomplish? Nothing. You know, and
maybe they're not taking it because they can't
afford it. You know, maybe it's the diabetic
who has is having to make a decision between
buying their insulin versus paying their mortgage.
You know, those are real problems that exist.
And when the decision is made to have. A place
to live and. the insulin isn't taken and then
they end up in the emergency room because of
a complication the total cost of care goes through
the roof and we're all on the hook for that whether
we think it or not but we are all on the hook
for that stuff you know um so yeah i'm totally
taught out in soapbox tangent but you said soapboxes
are okay so i figured why not i'll stop when
it goes back to you know universal healthcare
which i believe wholeheartedly is the solution.
Because again, if it's encouraging making a nation
healthy, where is the downside? But as you mentioned,
20 % of our GDP, it's not asking the nation for
even more tax money. It's, as I've quoted so
many times, because I absolutely adore this quote
now, Desmond Tutu, we spend so much time pulling
people out of the river, we forget to go upstream
and find out why they're falling in in the first
place. Yes, that's such a good one. The money
is already there. Same with the fire service.
The money is wasted in my profession on overtime
filling all these vacant spots, training people
who then turn around and leave one, two, five
years later, workman's comp payments for all
the claims, medical disabilities, line of duty
deaths, lawsuits from mistakes. There's millions.
LAFD, Los Angeles Fire Department, in four years,
they're overtime, not operating their overtime
budget. was $1 .2 billion with a B. One fire
department. So this is the thing. It's not a
we need more money conversation. It's just simply
we need to reappropriate funds proactively, which
I would argue would save so much money. I know
it will in the fire service. I know it will in
the health care system too. But imagine if we
were then motivated to make this country healthier
because people understood truly it was going
to save so much money that we could put back
into healthy food in our schools. Supporting
PE programs, pedestrianizing downtowns, bolstering
local farmers, creating, you know, organic food.
You would, you know, the savings would be incredible.
But the way that we're doing, you know, it's
finite. We're going to get to a point where we're
going to break in my profession nationally. So
this is what makes these conversations so incredible.
So I promised that we would go to solutions.
So now if you were king for a day, king doctor
for a day. What do we need to change, whether
it's within the actual medical setting and the
clinics and the hospitals that you worked in
or nationally, so that we can truly reverse this,
make patient outcomes better, and then create
the kind of environment for our medical professionals
so they can thrive rather than die every single
day? You know, James, I wish there was just one
switch I could flip. I think you've alluded to
and we've talked about many things that I think
will be instrumental in getting us to a better
place in terms of health care delivery. I think
universal health care is one. I think seeing
health care as a human right is another, to be
quite honest with you. Simply put, valuing people
over profits is a great mantra. We could talk
about the quadruple aim. We could talk about
the quintuple aim. We could talk about all these
things. I think there's multiple paths to get
us there. I think it'll be complicated. It'll
be difficult. It's going to take a tremendous
amount of work. One of the things, and I'll come
back to the documentary because obviously it's
top of mind, and maybe this is a good time to
show my shirt. Love it. Possibly. I'm actually
Scott who created it. It's in the other room
editing. You know, one of the things that we're
trying to do with the documentary, aside from
unlearning learned helplessness, is to facilitate
the concept of an impact network. And an impact,
you know, an impact network is this. Think of
all these disparate groups that are doing amazing
things, but they're not necessarily collaborating
or interconnected and working together. It's
happening. It's beginning in health care. They're
out there. If we can accelerate that, not only
with clinicians, but also getting the patient
voice involved, I think. I think truly that's
going to be where the magic is to get further
upstream in the river where the problems are
occurring, as we discussed. But we're not there.
We've got a ways to go. Definitely got a ways
to go. It's almost, you know, when you think
about it, it's such a wicked problem that I get
why people just say, you know what, I'm just
going to do my job and get through my day. But
the problem with that is if everybody does that,
it'll never get any better. You know, we've got
to think differently about how we not only take
care of ourselves and our own individual health,
but we got to think differently about our fellow
human beings and how we care for one another.
You talked about love, compassion and kindness.
I agree. I did a podcast with Diana Londano.
Gosh, I'm going to totally forget the cardiologist
who was on it too. And forgive me, it'll come
to me as soon as I'm off the show. Anyways, it
doesn't matter. The title of the podcast was
Love is Always the Answer. And, you know, if
you think about it, it kind of is. If you attack
things from an angle of love, most people do
okay. Absolutely. It's funny, I just saw a quote
today. Actually, what I'm saying, just saw a
quote. It was in your book, Ripple of Change.
Steve Jobs. The people who believe they can change
the world are the people who will change the
world. Have I got that right? That was in your
book, wasn't it? Close, close. Oh, this is, I
love that one. The people who are crazy enough
to think that they can change the world are the
ones that actually do. There you go. Much more
articulate. No, no, no. I mean, I love that.
I love that quote. And, you know, I got a buddy
who, you know, we published the book and I would
talk about what my aspirations were related to
it. And clearly I was thinking like big picture,
like down the road. And he would say to me, Sean
Nason's his name. Great guy. Brilliant guy. He's
like, Todd, you know, you can't boil the ocean.
And I would routinely respond, well, yeah, I
know that. But what if I had like a few million
of us and we all just did a little bit? Maybe
the temperature would come up a little bit. You
know, and I think that's the opportunity that
I see in particular with health care. But in
many, in many places, if we all do a little bit
and we all start talking about it, after a while,
it gets hard to ignore. And then you start to
see changes happen. And I think I kind of think
that's where we're at now. Yeah, I had the same
exact mentality with with kinder. I'm turning
it into a show now. And it's the same thing.
What if what if millions of people watched a
show that really made them believe that they
could heal, that they could be better, you know,
not waiting for a government or, you know, a
company or an organization to fix it for you.
But what if you actually one day looked in the
mirror and go, you know what, I'm going to take
that first step. I mean, you literally would
change the world. So I'm right there with you.
And it goes, what's the option? What's the alternative?
You just don't do anything and things just get
worse. And that's unacceptable to me. So I agree
a thousand percent. Let's start with Ripple of
Change then. What made you write that book? And
tell me about the unique dynamic that is a doctor
and patient within those pages. Oh, so what started
me writing Ripple of Change was. really at the
tail end of healing from my burnout as a physician.
I wrote a poem called Medicine is a World of
Gray, and it was kind of a dark look at what
really goes on in primary care. That was the
starting point. And then I wrote a chapter called
Anatomy of Burnout, which was really my journey
as a physician through burnout and not only how
it affected me, but how it affected my friends
and my family and all these concentric circles
around me in a very negative way. Right. The
trajectory of verbal change changed dramatically
when my co -author got involved. And honestly,
he was having his own health care struggles and
I was running out of ideas for him, like literally
running out of ideas because I knew I couldn't
fix it. It was a problem that was significantly
more complex than I had the capacity to manage.
But I didn't want to give up on him. You know,
and there was a couple of key moments there.
One. I told him about the project and asked him
if he would be interested in talking about it
or maybe writing a little piece. And he said,
well, what should I write? And I said, well,
just write. That's the only instructions I gave
him. And he wrote something really good. And
it led to a magical conversation that led us
on the journey. But one of the other things that
I think was critical for his healing was he was
struggling so much and was in such a dark place.
Finally, I told him, I'm like, Joshua, I believe
that you're going to get better. But you have
to believe it, too. And that was a bit of a turning
point for him that someone else believed that
he would come out of it, even though I didn't
have the answers for him. And by weaving our
two stories together, it created this, of course,
I'm biased, James, because I'm one of the co
-authors, but it created a very unique back and
forth yin and yang perspective of not only the
dark sides of health care. but potentially ways
forward and ideas for improvement. But in the
ultimate theme of the goal, aside from revolving
around the quadruple aim or our quadruple aim,
if you will, was really to inspire everybody
to play their part. I had no idea how to do marketing
or distribution and all these other things, I
think. But it became a key that opened doors
for me much quicker than I ever dreamed of. And
as a result of it, it's taken me down this path
of now creating a documentary around, frankly,
similar concepts and hopefully giving stuff for
the average American to ingest, digest, whatever
word you want to use to play their part to get
us out of this mess. Yeah, it was fun. It was
cathartic. A lot of healing occurred. I'm still
healing, still working on my processing of all
my trauma. And, you know, that'll be a lifelong
process. What are some of the tools that you
found have helped you on the mental health side
and the physical health side? Mental health.
Writing was very cathartic for me. Reading about
things, educating myself on things. Ultimately,
I think the things that have been the most beneficial
for me. From a mental health perspective was
getting involved with a trauma informed therapist
and teaching me like, you know, you're not supposed
to like throw your pain out the window, but rather
you're supposed to grab that like a pillow and
embrace it and learn from it and try and grow
from it. That was critical. I did some EMDR to
help process some of those very early painful
memories that I talked about earlier. Eye movement.
desensitization and reprocessing that was incredible
to take what was in just that a bitter memory
and turn it into something tolerable i would
say you know and i think finally more recently
even realizing like no one's coming to save me
there isn't some one person that's riding in
on a white horse saying dr hotten i'm going to
pull you out of all this trauma you've experienced
and taking a nirvana it's it's on you and you
have to have the courage to put one foot in front
of the other dig into those things and process
them and learn from them so it was a for me it
was an amalgamation of lots of support lots of
amazing people a lot of courage facing fears
that i hadn't faced in 30 years um you know and
bit by bit day by day um the light and the hope
started to appear for me personally. Um, but
I think there's an analogy here for, um, what
you're trying to do within the, uh, first responder
EMS, you know, um, uh, I'm saying the wrong word
fire. What's the word I'm looking for? Firefighter
world. Fire service. Fire service. I feel like
I'm screwing this up anyways, but you know, it's
again, one, one foot at a time, one person at
a time, one voice at a time. It all matters.
You know, so, yeah, I mean, it was I'm not gonna
lie, James, at times it's been a shit show. You
know, to be in a place that is so dark. And you
don't even know why. It's hard to describe. It
is hard to describe. So the whole mantra from
William Halstead of shoving everything into a
box and never processing it is bullshit, in my
opinion. So you mentioned about, you know, some
of the traumas maybe even haven't been discovered
yet. And I think that's the case with a lot of
people. Where I'm seeing a lot of success with
that is the psychedelics, you know, ayahuasca,
ibogaine, and then you've got ketamine, you've
got MDMA. What is that conversation in the doctor
slash nurse world? Probably polarizing, if you
will. I can't say that I'm knowledgeable about
it enough to sit here and say that I'm in this
camp or this camp. I think the way I would talk
about it is I'm intrigued enough and heard enough
positive stories that I think there's something
there. But I can't sit here and start spouting
off statistics and all these other things. It's
more anecdotal evidence. So I think it's worth
exploring. I've heard multiple stories of people
really having some benefits. but like everything
and else you know everything else in life i mean
there's pros and cons to just about everything
and again where's the balance where's the right
answer for those modalities um i'm not trying
to dodge your question per se i i think there's
something there i'm just not an expert on it
so hopefully that helps yeah i think that the
way you're looking at it is just acknowledging
that those are tools in the toolbox too because
i've always said it's also whether you want to
do it or not If it's something that, you know,
you're just like, I don't even want to try that.
Well, it's not going to work then because you've
got to obviously be bought in, especially on
the plant medicine side. You've got to trust
the medicine, as they say. And then, you know,
if you go to ayahuasca, Ibogaine, there's this
big purging element to which is needed. You know,
if you're struggling with alcoholism, Ibogaine
could save your life. You know, if you're just
looking for a slight nudge in your mental health,
maybe that's not the route for you. I think where
it's so powerful is say you have done a bunch
of, you know, talk therapy sessions and you've
done EMDR and you're like, I still feel fucking
awful. This isn't working. That I think is where
it's a really powerful conversation stuff, but
you haven't tried these yet because MDMA. was
a prescribed relationship drug initially you
know it works it's the reason why a lot of people
dance and hug each other at raves because it's
a love drug you know so getting that that fear
response to some of these memories because it's
not prescribed you do a session with a counselor
and then you go home without any drugs you know
and it's three times and the efficacy has been
amazing And ayahuasca, if you do it on your own
in a forest, is going to be very different than
if you do it again with, you know, a counselor,
shaman, whoever someone is that's very well trained
and surrounded by medical support staff, where
again, you can unpack and have these experiences.
But I think just simply knowing that they are
out there as an option for you, you don't need
to be completely for or completely against, just
need to acknowledge that it's another tool. We
know the efficacy of psych meds is pretty terrible
if you look at the stats. So why not have other
options that are available to people and give
them hope? Maybe I can actually heal and maybe
this is the tool I need to open the door that
then will allow me to have success with counseling.
Well, yeah, I totally agree. I mean, I think
there are so many things out there that have
been historically, I don't know if marginalized
is the right word. Demonized, basically. What's
that? Demonized, pretty much. Well, yeah. Yeah.
In Western medicine, for sure. I mean, I think
just another simple example is tapping and the
validity of tapping and how it works. I mean,
I've done it myself at this point and it helps,
you know, and it's not overly complicated. You
know, and if you had asked me that 20 years ago,
I'd have been like, what? What do you want me
to do? Acupuncture? What? There's a reason some
of these modalities have been around for thousands
of years. I agree with you. I think, again, I
often talk about Eastern medicine meeting Western
medicine. I think the right answer is somewhere
in the middle. But you've got to have the courage
to challenge the existing norms to get there,
which that's a whole other topic, challenging
the status quo, which clearly you and I both
do in our different worlds. But it's important.
You know, we need individuals that are willing
to speak up and take a bit of a calculated risk
to say, the existing landscape is not okay in
this particular realm. We can do better. How
do we get there? What do we try? And I'm all
about that. I'm all about blowing up silos, or
trying to blow up silos anyways, positively disrupting
things, you know, things of that nature. But
there's a way to do it too without... completely
tearing things down at the same time, right?
You know, like asking intelligent questions and
being thought -provoking and doing it in a loving,
compassionate, kind manner is, there shouldn't
be anything wrong with that. It's okay to disagree.
Screaming and yelling at people and, you know,
poking them in the eye or doing other things
that are creating some sort of additional trauma
or pain, maybe not so much. It's been interesting
kind of unpacking the last 22 years since I entered
the fire service, because obviously, you know,
for 14 years I was wearing the uniform and, you
know, if you use the word courage, it's like,
yeah, well, you know, I made entry on fires and
hung off the side of buildings on a rope and,
you know, did all the things. But then fast forward
the last few years, I realized, A, I'm totally
unimpressed by what firefighters do because I
did it and it wasn't superhero shit. It was something
that took diligence and sacrifice. It certainly
doesn't give you a Superman uniform, but that
is far less impressive than moral courage. If
you're morally courageous and you stand up because
you know it's right, even if everyone around
you is pushing against you, that to me is real
courage. And you don't need to wear a firefighter's
uniform for that. And those are the humans that
I really, really connect with because that's
why things have changed. That's why children
don't work in factories anymore. That's why women
can vote. You know, all the things is because
someone stood up when everyone said, shut up,
sit down, shut up. You're making us look bad,
whatever the thing is. And they were the ones
that were kicking in the doors. So I think that
a courageous profession is different than a courageous
person. And this is who I'm really kind of, you
know, impressed with now, whoever it is, whatever
the walk of life, age, gender. whatever is the
person that has the guts to stand up and say,
I don't care about how we used to do it. This
is wrong and we need to change it. I, well, yeah,
I agree with you. It's been, I look at my, my
friends and my colleagues who are doing exactly
what you just said, James. And I think about
how many amazing people I've gotten to meet and,
and interact with and so on and so forth. And,
You're right. It's those that are willing to
take that level of personal risk to have impact
for the greater good that just amaze me. They
just amaze me. I think of, I'll give you just
one example. A friend of mine, Tina Shaw, is
running for Congress in New Jersey. And, you
know, she's a pulmonary care, critical care intensivist
who is taking a big risk by getting into the
political scene because she wants to have a bigger
impact you know to me she's a hero i told her
that i'm like tina you're a hero to me like i
i don't think i could do that probably because
i would tell somebody to f off that i didn't
like but that's a different story um but there's
all kinds of examples like that and people don't
need to run for office you know it can be you
can be a hero in your own little space checking
in on a colleague asking them if they're okay
standing up for a colleague those are heroes
too it's a hero at a different scale but a hero
nonetheless in my mind absolutely well i just
want to make sure that we go over the the documentary
so at what stage are you at now and then tell
people listening what is going to be the kind
of over lying through line of this documentary
suck it up buttercup sure so uh suck it up buttercup
trust and betrayal healthcare in america is close.
I would say we've got about 80 to 90 % of our
filming done, give or take. And as we're doing
this interview, it's October of 2025. We're well
into editing. You know, we've got a ways to go
and creating a documentary is kind of like building
an airplane after you've already taken off. You're
like, oh my God, we need to add a wing on this
side and we need this over here. And did we put
on wheels and all these other things? The through
line for it, again, is going to be how greed
has created a tremendous negative impact on health
care delivery in the United States, which can
be extrapolated, obviously, to other parts of
the world. But it's through eyes of just a multitude
of stakeholders. It's not just physicians bitching.
The voice of nurses, the voice of patients, the
voice of health care executives, insurance administrators,
celebrities. But it's not just an airing of grievances.
The latter third of the film is ways forward
and not just a one and done ways forward. But
how can this how can this project be applicable
tomorrow, next week, five years from now, 10
years from now? Shit, hopefully 100 years from
now. You know, instead of, you know, the William
Stuart Halstead's William Stuart Halstead negative
impact on health care, hopefully it's the opposite.
In terms of distribution, there will be ideally
multiple ways that this will get distributed.
Local viewings like at universities and academic
centers and so on and so forth. We're planning
to hit the film festival circuit to a certain
extent. But ultimately, we feel the biggest impact
is going to be to get this onto a streaming service,
which we think is going to happen for a multitude
of reasons. And when is, if everything lines
up, when are you hoping to release it? So the
timeline tends to shift a little bit to the right.
When do I think and hope realistically we could
get this onto a streaming service? I think Q2
of next year is very realistic, Q2 of 2026. I
think there will be some opportunities for some
viewings prior to that. But for a massive distribution,
I think that timeline is very much in the cards.
Beautiful. Well, I want to throw some quick closing
questions at you before I let you go, if that's
okay. Absolutely. All right. The first one I'd
love to ask, we talked about your book, Ripple
of Change. Are there any other books written
by other people that you love to recommend? It
can be related to our discussion today or completely
unrelated. Ooh. Yes, I will throw a handful out
there. I don't want to screw up all the authors
per se. So I'm just going to give mostly titles
and a couple of times I'll maybe throw in the
author's names. I love the Starfish and the Spider.
I don't remember the author, but it is an incredible
book about leadership and decentralized ways
of organizing. I think that's a fascinating book.
I think Cascades by Greg Sattel is an amazing
book looking at successful movements historically.
Now you can kind of start to see where my brain
has gotten morphed by some of these books. Emily
Peters has a great book. And I don't want to
butcher the title. I think it's artists reimagining
health care is, I think, the exact title that
you have to double check me on that one. So those
are three that come to top of mind. Brilliant.
What about films and documentaries? Oh, man,
I'm not going to lie, James, I am not the greatest
guy when it comes to pop culture, which probably
is not a big surprise at this point. Having talked
to me, I found the social dilemma was fascinating.
Recently, I watched two films, historical films,
because I'm not necessarily a movie buff, really
trying to dig into the space of trauma and better
understand it. Apocalypse Now was fascinating
to me. But I also recently rewatched A Clockwork
Orange. And I watched it because a good friend
of mine who is a physician. who died by suicide
that was his favorite movie and i was hoping
to get some clues as to what led to that final
decision for him and having watched it it was
fascinating and definitely gave me some insight
for sure again trying to lean into the pain and
the discomfort to understand a little better
trigger warning for a clockwork orange there
that's like trauma wrapped in trauma if you've
never seen it so you need to be in the right
place to watch that movie Something I always
talk about because I think it just needs to be
heard over and over again. As I started going
through all these interviews, and we're up to
over 1 ,100 now, there kept being this common
denominator. When we do so many conversations,
the Venn diagram overlaps really strongly. And
if you think about how we were taught to think
about suicide, it was selfish. It's cowardly.
How could they think of their family? But then
you listen to the people that were there. Like
I said, Emma, Emma Benoit, you know, Kevin Hines,
who jumped off the Golden Gate Bridge and survived.
And then all these people have had that that
almost pulled that trigger, almost, you know,
jumped over and over and over again. Aside from
obviously wanting the pain to end was I truly
believe like I was a burden to my family or burden
to my friends. I was a reason for their pain.
And what I realize as you really unpack this
perfect storm of contributing factors from unaddressed
childhood trauma to sleep deprivation, to organizational
betrayal, the side effects of alcohol and meds
and all the other things that compound, that
the brain literally becomes miswired. So these
men and women and children that we've lost, especially
men and women, their reality. Their voice in
their mind is telling them, if you just remove
yourself, your wife, your husband, your children
will be happier. And from the first responder
professions, we've signed a blank check basically
saying we will die for a complete stranger. Well,
now this voice is telling you this. It really,
at that moment, even though one would argue it's
psychosis, at that moment, that becomes a courageous
and selfless act because they truly believe that
they are making it better. And you do not hear
that conversation. And so these people that are
left behind, they're full of shame and guilt
because they're like, I missed it. But if we
can put that as a massive red flag front and
center, if you are starting to have these thoughts
that you're a burden, that is a sign to pick
up the phone. Because we all know that that's
wrong. Unless you're Adolf Hitler or a few other
people that are truly going to be hugely detrimental
to the world. Everyone else, you're going to
be... missed so much by the people that actually
love you. You just can't see it because there's
miswiring. But if we can pull you from that proverbial
ledge and get you some sleep and get you some
counseling, that healthy mind is going to kick
back in again, which is why I think you hear,
like Kevin, the moment that his foot left the
bridge, immediately he snapped back to, I don't
want to die. And he's already falling by that
point. And you hear this with a lot of suicide
survivors. So I think... And understanding that
this is what these people that we lost were probably
going through and thinking, it takes away the
shame and the guilt on that person. And it also
you hear about that kind of submission when people
have decided they're going to do it. Sometimes
they seem happier than they've been for a long
time prior to they do it. So this I should have
seen it coming. No, you shouldn't have. A lot
of times I have no way of you seeing it. But
I think it's important to underline that, that
when we lose these people, it's because. We have
this innate desire to survive, to live, to reproduce,
to protect our children. So the brain is so miswired
that it's overriding all of those and lying to
the individual. And if we could understand that,
I think it would put a lot more compassion and
empathy in this whole mental health conversation
and allow the people that are hurting to feel
more able to reach out. And then the people around
them, if they start hearing these kind of burden
statements, for them to be able to intervene
before it's too late. I'm not sure I can add
anything intelligent after that. This is so brilliant.
I think the one thing I would say, and I'll speak
to my situation in terms of unpacking stuff personally.
I mean, it was a godsend. My family and friends
who reached out to me, regardless of what was
going on, to just say, hey, man, I love you.
I can't tell you how many of my guy friends.
you know would say that you know Todd hey I love
you man you know you're important like we want
you here and for somebody who struggled for the
better part of a year trying to process all this
stuff those words those encouragement those connections
that the act of kindness and compassion were
critically important for me so beneficial so
yeah I mean it's um it is Man, thinking back
on my friends and colleagues that have died by
suicide, historically I would think about what
did I miss, as you said, and feel guilty or ashamed
that I had missed something. But now I realize
their level of pain had gotten to a point where
they didn't know how to deal with it in any other
way. I understand that. I appreciate it. Does
it make it easier to deal with? No, not necessarily,
but at least I can see how someone could get
there. I mean, I can totally appreciate that.
And I think, as you said, the more we talk about
it and lean into these discomforts, hopefully
we can make a difference so that we're not seeing
10 -year -olds, et cetera, dying by suicide.
Exactly. Well, speaking of beautiful people,
is there a person that you would recommend to
come on this podcast as a guest to speak to the
first responders, military, and medical professionals
of the world? Oh, boy. James, I got a huge list
of people I can potentially pass along. All right.
I'm going to throw maybe a little bit of a challenge
back to you. Narrow down the focus for me. Give
me a topic or a genre or what have you, and then
I'll throw a name at you. How's that? Well, I'll
throw a name back at you. You mentioned Rick
Moncastle. That's someone I need to speak to
for a start. Oh, Rick's great. That would be
an amazing conversation. Yeah, absolutely. I
can definitely do an intro. Just remind me and
I'll do an intro to Rick. He's an amazing guy.
Truly. I mean, to stand up to a pharmaceutical
behemoth. In the name of justice, Rick is your
man. Absolutely. All right. Brilliant. Well,
then the very last question before we make sure
everyone knows where to find the book and the
documentary, what do you do to decompress? You
know, for a while, I don't even know that I would
have been able to give you a straight answer
to that question. I think the thing that I love
the most actually is. um connection whether it's
with family or friends or even just in this couple
of hours i spent with you james these moments
fly by to me and they're just magical and i get
such a joy out of connecting with other human
beings i and i think that's what's gravitated
me towards doing this bigger project and doing
all this networking is i really enjoy interacting
with others but I also like to golf and play
poker and watch my kids play sports and all those
kinds of standard things. But, you know, from
any typical perspective, this kind of stuff to
me is absolutely magic. It reminds me, I've quoted
this one here so many times. Johan Hari said,
the opposite of addiction isn't sobriety. The
opposite of addiction is connection. And I couldn't
agree more. That's awesome. I love that quote.
That is so cool. And I'll tell you, so if you're
interested in connecting with me or learning
more, I am very active on LinkedIn. If you send
me a message, there's a good chance I'll get
back to you pretty quick. Regarding the book,
the website is rippleofchange .us. Regarding
the documentary, it's suckitupbuttercupfilm .com.
And then if you're interested in the nonprofit
work I do, it's medicineforward .org. So those
are probably the main ways to get a hold of me.
Brilliant. Well, I want to thank you so much.
It's been such an amazing conversation, yet another
unique perspective. And you've put so many things
out into the world as far as trying to push that
change and bring solutions between the book and
the documentary. So I want to thank you so much
for being so generous with your time and coming
on the Behind the Shield podcast today. It was
an absolute pleasure, James. Thanks for having
me.