JOSH: HI ALEX! BEFORE WE GET TO THE REALLY FUN STUFF, COULD YOU GIVE ME AN OVERVIEW OF YOUR CAREER IN MEDICINE?
Alex: I am an Emergency Physician. If you go to the ER, I’m the one you see to determine if you’re having an emergency and if so, how to deal with it — and if not, what needs to be done immediately and what can wait. I finished residency a year-and-a-half ago, and I’m now in the last 6 months of a Quality Improvement and Patient Safety fellowship. I’m the kind of person who, if something isn’t working well and is preventing people from best doing their jobs, it drives me crazy. I want to do the work outside of the clinical setting to make the clinical setting work more efficiently. Everybody wins. Not a lot of people like that kind of stuff, but I do!
JOSH: WHAT KIND OF INEFFICIENCIES DO YOU SEE IN THE CLINICAL SETTING THAT YOU’D LIKE TO IMPROVE UPON?
Alex: It comes down to how much medicine has expanded. There used to not be specialties, because the knowledge needed to be learned could fit into one person’s head. With the advances in technology and medicine, it means it’s too much for anyone to handle on their own.
For example, with sepsis, which is the body’s dysregulated response to infection, the Centers for Medicare and Medicaid Services have a lot of measures they keep track of. There are a lot of opportunities to improve compliance with government regulations meant to help patients receive the best care. Another example might be knowing which antibiotic should be for a specific infection with these local resistance patterns, or how to streamline the process when someone has a stroke so they can get care as quickly as they need when time matters.
JOSH: I SUSPECT THAT BECAUSE IT’S NOT GLAMOROUS, THAT KIND OF WORK IS OFTEN LOOKED OVER.
Alex: It usually ends up being done by people who have no desire to do it. It puts someone like me, who likes to do it, in demand, but it means there’s also not always a lot of support for it. There haven’t been a lot of people coming forward to lead the industry until relatively recently.
JOSH: BUT IT’LL CERTAINLY SAVE LIVES. IN MY OWN IGNORANCE, THOUGH, I HAVE TO ASK – DO YOU EVER HAVE ANY DRAMATIC SITUATIONS LIKE YOU MIGHT SEE ON GREY’S ANATOMY?
Alex: Well, we don’t get as many bomb threats as on Grey’s Anatomy. There are situations where someone is being wheeled in by an ambulance receiving chest compressions, but most of the day is pretty mundane – things like reassuring patients and helping connect them to resources, such as a primary care doctor.
A lot of patients come into the emergency room because they can’t afford a primary care doctor. Legally, we cannot refuse someone treatment because they can’t pay.
JOSH: AND BEYOND MEDICAL KNOWLEDGE, I SUPPOSE IT’S IN THOSE SITUATIONS WHERE INTERPERSONAL SKILLS COME INTO PLAY.
Alex: Oh yes. It’s kind of the art side of medicine. Especially in Emergency Medicine, where you have no previous relationship with this person – to know what their thinking is and how forthcoming they are on certain things. A lot of times, it’s guessing, based on similar types of patients. In St. Croix Falls if an 80-year old Norwegian man is there and he says he’s fine, he’s not fine and his wife dragged him in.
JOSH: HA! THAT SOUNDS LIKE MY DAD. BUT WHAT HAPPENS WHEN YOU GUESS WRONG?
Alex: It can end up being an overnight stay in the hospital, or increased cost, or decreased productivity. Sometimes if you send someone home, they can come back the next day in worse condition. The worst phrase in Emergency Medicine is, “Hey, do you remember that patient you saw the other day?” Sometimes, it would’ve been a bad outcome either way. Any bad outcome is reviewed by other people, who determine if it could’ve been done better and if there’s an opportunity provide education for the future.
JOSH: THIS IS A VERY TOUGH QUESTION, AND YOU DON’T HAVE TO ANSWER. ALEX, HAVE YOU EVER MADE A DECISION THAT LED TO SOMEONE’S DEATH?
Alex: I’m not aware of a mistake I made that led to someone’s death. However, sometimes making decisions that lead to death is the right thing to do for the patient’s wishes.
If someone’s been receiving CPR for 45 minutes, and the chance of getting the heart started again with permanent brain damage is higher than a good outcome, most people would rather be allowed to die peacefully. Even if you go into cardiac arrest in the ER, with someone there with the right equipment, the survival chances are still not great. I’ve seen people survive and go to the ICU and suffer for a week, before passing away. Everyone wants to do what the patient would want, but sometimes, if there’s no DNR, you have to make a best guess as to what they would want, hopefully with the help of family who can better speak to their wishes.
JOSH: THANK YOU. THAT WAS OBVIOUSLY VERY HEAVY. LET’S FLIP THINGS AROUND, NOW. WORKING WITH PEOPLE ON A DAILY BASIS, YOU MUST HAVE PLENTY OF STORIES ABOUT FUN OR SILLY THINGS YOU’VE SEEN.
Alex: I had a patient last year who had survived 5 completely different cancers in his lifetime. He was the most pleasant, positive person you could imagine. He was like, “I hug every doctor and nurse I see because they take care of me and I’m so happy to be alive.” Those are so rewarding.
Other times, there are the people who come in after doing something they know was stupid, and you can reassure them, and by the end, they’re laughing about it. For example, they drink quite a lot and then try to be very acrobatic. It’s questionable if they could’ve done it even if sober. So they end up falling on something and hurting themselves in some way.
Emergency Medicine has, by the way, — and I’m not biased at all — the most fun people! It’s largely because it’s the newest major specialty. It used to have much lower volumes, and it was covered by inexperienced surgeons and internal medicine doctors. It’s only been a proper specialty for 50 years. The first people to train in Emergency Medicine are still around! We don’t have the same hierarchy that the older specialties have. For example, as doctors and nurses, we typically call each other by our first names and approach patient care as a team.
At this point, Josh proceeds to ask a series of sophomoric questions, inspired by unrealistic medical scenarios he saw on Grey’s Anatomy. For the purpose of this interview, he has chosen to defer the answers to an in-person conversation that you, the reader, should have with the marvelous Dr. himself.
JOSH: THANK YOU, ALEX! I FEEL LIKE I’VE LEARNED SO MUCH TODAY!
Alex: About what?
JOSH: EVERYTHING YOU JUST SAID.
Alex: Was it anything worth learning?
JOSH: I DON’T ASK QUESTIONS I DON’T WANT THE ANSWERS TO, ALEX .THIS IS HUMANS.