Laning Andrews

Laning has come into share his insights in emergency medicine and discuss several issues in the medical industry.

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Intro:              00:00          Podcasting from the base of Lake Tahoe in the Eastern Sierras comes The Medicine Wheel. We are a group of progressive physicians seeking solutions and enlightenment while surfing the seas of big data and summiting mountains of research in an effort to make the practice of medicine more personal and medical knowledge more accessible and empower you, the listener and viewer to be as healthy as possible. Now The Medicine Wheel.

Dr. Devlin:         00:34          Hello everyone. Welcome back to the medicine wheel. This is Dr. Sean Devlin. Again, we've been lucky enough to capture a wonderful person to join us here today. And that's Dr. Laning Andrews. He is a board certified ER physician, works here locally up at the Lake at Incline Village. He's joined us today to talk about a few different issues and things that involve medicine today. So I'd like to welcome Dr. Andrews.

Dr. Andrews:        00:59          Thanks for having me.

Dr. Devlin:         01:00          You bet. I know we've known each other for many, many years and we've had many adventures together which I appreciate and appreciate your guidance and wisdom in the past and your, mentorship and your peer support. So thank you. I know that medicine has been a Rocky road for a lot of us and you have your own unique tale through medicine, but I want to figure out how exactly you even ended up in medicine. Can you talk a little bit about that?

Dr. Andrews:        01:28          Yeah. Well before I get into that, I just want to say thank you because watching you grow from a young resident to where you are today is really amazing and it's been really fun to help guide you on your path to where you are today.

Dr. Devlin:         01:42          Thank you.

Dr. Andrews:        01:42          Cause we've had some fun times in the past and I always knew that you were an amazing physician and I feel honored to be able to kind of participate in that and help you, I feel like help guide you in certain directions when, you know, maybe things weren't going so well or just needed a little bit of guidance. So, I'm just really proud of you. So I just wanted to say that at the start.

Dr. Devlin:         02:09          Thank you very much.

Dr. Andrews:        02:09          How I got into medicine. I grew up in Las Vegas and didn't really do that great in high school and didn't really know what I was going to do. I was really into skiing and early days of snowboarding and I became a ski patrol at the ski area. There's a ski area in Las Vegas called Lee Canyon. It's awesome as two lifts. And, and so I became ski patrol and got involved with caring for injured, you know, skiers and that kinda started the spark. And then, you know, I did, I went, I had two choices. Cause I wasn't great in high school. So it was UNR or UNLV, so UNR, I chose up here because there were two ski areas that are allowing snowboards Donner ski Ranch and Boreal. And I started school with no real major and kind of fell in. I liked biology, I like chemistry. And so the pre-med degree was kind of a combination of both. And I got into that and I got into medical ethics. I actually got a minor in medical ethics.

Dr. Devlin:         03:16          That is surprising.

Dr. Andrews:        03:16          Yeah, and so the more I looked at it, the more I liked it. And then did volunteer work and had jobs at the hospital and then I just kinda fell into it. And when I- I just said I was going to take the MCAT, I'm gonna apply once and see what happens and if I don't get in, then they must not want me, and I'll do something else. And I got in and here we are.

Dr. Devlin:         03:41          Amazing. So I know obviously from this story you shared is a little bit of serendipity, but ultimately you landed a position in medical school and you went to school here locally at UNR.

Dr. Andrews:        03:51          Yes.

Dr. Devlin:         03:51          And then after you matriculated in medical school, you chose the field of emergency medicine. Talk to me a little bit about that choice and where you ended up doing your training.

Dr. Andrews:        04:02          That was kind of the same learning process that I went through to get into medicine in the first place. As we rotated through our different rotations, I found that I liked everything. You know, I liked a little bit about OB. I liked surgery a little bit, but not enough to commit to that. You know, I liked a little bit of the psychiatry and, you know, internal medicine and I just kinda liked everything. And so I felt like emergency medicine was the best choice. And also in the back of my mind, I was seeing these, some of these other specialties really kind of suffering. And it seemed like, if I was going to manage my time, emergency medicine was a good choice, because you don't have an office and when you're off, you're off, you know? So when I was applying for residency, I, you know, again, didn't get many interviews, and the places I did get interviews were super hardcore places like, you know, downtown Atlanta, big County, LA, you know, USC, and then Martin Luther King hospital in South central LA. And I loved that program and that's where I ended up going. Yeah.

Dr. Devlin:         05:24          And what was your experience like when you were down there? I mean, what sort of things did you see that sort of maybe changed you or made you, kind of the physician you are today?

Dr. Andrews:        05:35          Well, it's, well, first of all, I was placed in a scenario where as a white guy, I'm a minority. And so it was really neat way to immerse yourself in black and Hispanic culture. The people were great, the experience was wonderful. It was a real, it was really neat experience to seejust how everybody came together to support this community. It was also at the height of kind of the gangster rap era and there was a lot of gun violence and penetrating trauma. And so, like, the army trained their surgeons at our hospital,

Dr. Devlin:         06:19          Wow.

Dr. Andrews:        06:19          Because it was so violent. And so I learned a lot from that. I saw a lot of horrific things. And you know, weirdly enough, at the end of my residency there was less trauma and it wasn't necessarily because there was any less violence. It was just that there were less people in that age range to like shoot. Right, right. Yeah. So, yeah, but it had a profound effect on me. Learning about other cultures and just, you know, being thrown right into the belly of the beast, you know, the most hardcore place you could possibly be. And I definitely grew as a physician.

Dr. Devlin:         07:03          Yeah, sounds like a, a major Rite of passage in emergency medicine. Well, on a sort of a different, maybe a happier note coming out of this story. Tell me a little bit about like a profound experience or a time in medicine that kind of left an impression on you. It could be a simple case, it could be maybe an effect you had on either a colleague or a coworker ultimately the system itself. Can you talk to me about that? You've been around doing this for 20 years now, so,

Dr. Andrews:        07:35          Right. Well, I think probably the most, like the most profound thing once I got into medicine that I'm realizing is the resiliency of the human body and then the fragility of the human body. Like you see people that you're like, how are you even alive? And then you see people get turned off like a light switch, you know, for some small thing that just went arise. So it's amazing to me how resilient we can be, but yet how fragile and that's always, and that's kinda the scary part, you know, because you know, it's the fragile ones that, that you worry, you know, and it's hard to tell the difference, you know? So that, that's always been really interesting to me.

Dr. Devlin:         08:26          Yeah, I think that's very poignant, because we, when we are in the emergency room, we see patients and we have to default to everyone's fragile. Everyone could suddenly die and we need to do, the minimum to cover all of our bases. And unfortunately, a lot of that's driven by the medical legal world that we live in. But ultimately I think if you're a compassionate and kind human being, you want to make sure that this person leaves your ER intact without negative sequella. So I think what you point out is something that we really don't talk about a lot but is absolutely true, I think in all aspects of medicine.

Dr. Andrews:        09:03          Right, and you try to use your training and go with your gut and convince yourself that this person is stable or safe, and man, you make one mistake and, you know, you're in a malpractice suit.

Dr. Devlin:         09:19          Right, right.

Dr. Andrews:        09:19          You know. So, it's kind of hard to ride that line because the added element is, Oh, well if I am wrong you know, I'm going to be getting a phone call and, you know, from one of the TV lawyers.

Dr. Devlin:         09:35          Right, right. Exactly. Yeah, and not only is a life potentially in jeopardy or somebody may have a bad outcome, but ultimately your career is in jeopardy.

Dr. Andrews:        09:44          That's right.

Dr. Devlin:         09:44          So, yeah, every single decision you make is critical. And I've been in situations where, you know, it's a scary and you want to make sure you do right. Certainly by the patient and then ultimately by yourself, you know?

Dr. Andrews:        09:55          Right.

Dr. Devlin:         09:55          So let's kind of change our track here a little bit. I know that you have a very, very rich life outside of medicine. Can you talk to me a little about some of the activities you participate in that sort of makes your life as dynamic as it is?

Dr. Andrews:        10:10          Well, just for recreational stuff, I'm all about Nevada and you know, I like to sail, I like to bow hunt, fly fish, back country ski, and just explore Nevada. And that's kind of my favorite thing to do, because, you know, growing up in Nevada, it's like the best kept secret in the world. Like everybody thinks Nevada is a drive through state, but that's cause she holds her cards close to her chest and once you start looking and digging it's uncrowded and beautiful, so I spend a lot of time doing that. But, I also dabble in kind of entrepreneurial type stuff, and I've owned a few companies and done a few things. But my biggest funnest things was I was part of Baldface Lodge. I was an investor, and the medical director there, and guide. And baldface lodge was started by some guys up in Incline that just dreamt up, like, we're going to open a snowcat operation in British Columbia. And they got the largest tenure in BC. It's like 10 Squaw Valleys put together with two snowcats, with 12 guests each and you just ride around in PistenBullies and shred pow all day. And then through that I met Justin Hostyneck at Absinthe Films and became a partner with him and started producing snowboard films and traveling all over BC and Alaska and Washington and around Tahoe filming snowboard films.

Dr. Devlin:         11:47          Wow. When did you start doing that?

Dr. Andrews:        11:49          That was about five years ago.

Dr. Devlin:         11:52          Okay.

Dr. Andrews:        11:52          We had gotten bought out from Baldface and Justin was looking for a producer and some help and I felt like I wanted to take my snowboarding too a- I wanted to challenge myself and go to Alaska and go to these other places. You know, after riding baldfaced for 10 years, it's like, it's time to, you know, step it up. I'm not getting any younger and I want to see how far I can take this. And we interestingly, Baldfaced is a place where people seem to meet their partners, and, like, I met my wife there. She was a pastry chef there. AndJustin met his wife there, she was a bartender. Kate Butt Dr Butt, she's actually a Chinese medicine doctor, she's fascinating.

Dr. Devlin:         12:43          Wow.

Dr. Andrews:        12:43          But she was working as a bartender at the time there and he, and so he got, they got married and. So my wife and his wife are good friends, so we became really good friends and then we kind of, you know, he asked me to be a producer and to start traveling around and filming and I just couldn't say no.

Dr. Devlin:         13:02          Great. Tell me a little bit about the- that first production. I mean, like how did that go? I mean, I know from doing this show that there's a lot involved and there's many layers.

Dr. Andrews:        13:13          There's so much more involved than I anticipated. That first year, I just jumped in and went on trips and was the second camera man just hand me the crappy camera and put me somewhere and I'll film. And so I did a lot of filming. And we went to Alaska and we actually just, so we went to Haines and just North of Haines, before you get to the Yukon, there's a little strip of British Columbia that comes in. And we actually got a permit to fly in British Columbia, just North of Haines. And we stayed in a cabover, you know, trailers or RV. We rented a bunch of RVs and we had a helicopter and we were going to pullout on the highway with RVs and a helicopter on the side of the road and a trailer full of jet fuel. And we were just flying in British Columbia, right North of Haines. And that was kind of my first experience with big mountains.

Dr. Devlin:         14:11          Yeah.

Dr. Andrews:        14:11          And then when the production time came Justin lived- his family lives in Lafayette, so we set up kind of a production studio in the house. And I wasn't sure how that was gonna go, but basically I would just sit behind Justin and he would edit and then I would just make little comments and we would just kind of manipulate things. And that seemed to work really well. It was just kind of first time just kind of going with what I thought needed to be done. And we ended up being a really good team. And like some of our movies, if you really watch them, like especially dopamine, which my favorite like, every little turn or like if a snowboarder hits a pillow, it's timed to the music. Like you can really, it's really amazing how detailed the editing goes with those films.

Dr. Devlin:         15:07          Yeah, I mean when you first showed it to me, I was very impressed, and I was kind of moved to say, wow. I mean this is like, you know on the level of Warren Miller, and had the same sort of dynamic capture of this sport that, you know, both you and I have participated in and many of our friends, and a lot of people have a great passion for this and watching it certainly was very exciting. I'm going to reach out here to my IT guy, Mason, Is there any way you can pull up a little snippet for us and is this one from "Dopamine"? Not sure, "Dopamine", great. Yeah. Go ahead and pull that up. And let's just take a quick look at it. And where's this at?

Dr. Andrews:        15:43          So this is in Revelstoke, British Columbia. And if you get above tree line there, it looks like Alaska, It's crazy. And that's Jason Robinson, he's from Whitefish, Montana, he's an amazing kid. Lost his brother to an avalanche in Chile.

Dr. Devlin:         16:03          And then does this?

Dr. Andrews:        16:04          Yeah! He's a great kid. I especially like this cause he gets all that sluff going and then he dives right into the sluff and rides It kind of like a big wave and then comes out the other side.

Dr. Devlin:         16:14          How many days would you guys be up there doing filming?

Dr. Andrews:        16:19          You know, a week at a time, maybe longer. It's kinda funny entering into filming. We don't really have a set agenda. We just go where the snow is. And we have film crews in Salt Lake, we have them in BC and then we have them in Europe. So we have a whole European film crew. And if things are going off in the Dolomites, they go to the Dolomites, you know, and so they do their filming and then I'm basically the BC crew with Justin. And if it's a terrible winter, then the crew might pick up and go to Japan or they'll stay in Nelson and we'll go to baldfaced cause we have a good relationship with them. Or, there's lots of, we do sled missions, there's lots of back country to do. And then there's a whole other subset that I'm not really involved with, which is 'street', like the street riding, and they do that early season. And some of these guys that do street and big mountain, it's hard because, man, street takes its' toll.

Dr. Devlin:         17:23          Yeah, now, talk to me a little bit about street riding.

Dr. Andrews:        17:26          It's insane and they're putting themselves at risk and they get really hurt and it takes a long time to get those skills. And the guys that do both, I have tremendous respect for. I mean, I have respect for all of them, but the guys that do both, it's like, you know, insane.

Dr. Devlin:         17:45          That's insane. Do you have some segments here that would show some street riding?

Dr. Andrews:        17:48          Yes. You want to go forward a little more? More and more and more and more and more. Keep going. Okay. Why don't we see what this is. There we go. I liked this one cause we use that back song Debra.

Dr. Devlin:         18:12          Yeah.

Dr. Andrews:        18:12          And that's Brandon Cocard and he does both, he's a neat guy. He has a band that we use a lot for our movies called Easy Giant.

Dr. Devlin:         18:23          Oh, wonderful.

Dr. Andrews:        18:24          Yeah.

Dr. Devlin:         18:24          Dude! And where are you guys? Are you in Oregon, at this time or?

Dr. Andrews:        18:31          That's in Europe.

Dr. Devlin:         18:34          Oh, this is in Europe.

Dr. Andrews:        18:35          Yeah, he went over to film with the Europe crew.

Dr. Devlin:         18:38          Wow.

Dr. Andrews:        18:40          So I'm not, I'm not sure what resort that is.

Dr. Devlin:         18:42          When you see these things, it looks like controlled free fall in some cases.

Dr. Andrews:        18:45          Yeah, no doubt. These guys are amazing athletes. And, you know, for me, it's kind of, it's frustrating to see these kids, I mean, they don't get paid much. They get sponsors and that's how they get their money and then they break themselves doing this stuff, and then, if they get hurt bad enough, the sponsor immediately drops them.

Dr. Devlin:         19:10          Oh.

Dr. Andrews:        19:10          You know, and then they're left with no skills to, you know.

Dr. Devlin:         19:14          And what- have you ever been on site when someone's been injured and you've rendered care?

Dr. Andrews:        19:17          Yeah, not this, but.

Dr. Devlin:         19:20          Right.

Dr. Andrews:        19:20          I mean that's insane. That's like the longest rail ever ridden. Yeah, in the back country. I've been, you know, and it's lots of, you know, some cuts and some contusions and all that and a lot of dislocated shoulders. So, and those, you know, if you catch them fresh, they're pretty easy to put back.

Dr. Devlin:         19:45          Great. Awesome. All right, well yeah, let's take a step forward here and talk about some stuff that may be personal to you. I love these clips and it'd be nice to maybe have some of those attached to the end of the podcast today so folks can see kind of the good work you guys do.

Dr. Andrews:        20:03          Yeah, we need the support. You know, it's really hard to make money in that business. And that's why I'm not all that involved. Cause you know, I mean we just, we don't have any money.

Dr. Devlin:         20:13          Right.

Dr. Andrews:        20:13          And interestingly enough, we've been kind of saved by the cannabis industry, specifically in Canada. One of our main sponsors is Aurora Cannabis.

Dr. Devlin:         20:24          Oh, wonderful.

Dr. Andrews:        20:25          So they've, you know, come onboard and really helped us out, because, you know, the other sponsors, you know, like the Kynd and you know, QuickSilver, and all of them, and the money's kind of drying up. So they've kind of saved us. But yeah, it's hard. You know, I always say snowboarders are freestylers if it's free, they're styling. So we get a lot of stuff stolen, you know, with those-what are those called? Those pirate sites that,

Dr. Devlin:         20:55          Oh, right, right. Yeah. They just do illegal downloads or whatever. Yeah.

Dr. Andrews:        20:58          Yeah, yeah. So, we lose a lot of money that way. And so, if you do like our films. Please try to support us.

Dr. Devlin:         21:04          There you go. And kind of give us some information about where some of the films could be found or bought.

Dr. Andrews:        21:10          All the media platforms like iTunes, I guess. And our website, you can download it. And, but we still make Blu-ray, you can buy and Blu-ray, like, cause you know, we've made 25 films. I mean, I've only been involved in the last five years. But, people like their library.

Dr. Devlin:         21:32          Right, absolutely.

Dr. Andrews:        21:32          I mean, they started with VHS and they have a whole library. So we still make blue Ray for people, that want their collection to be complete.

Dr. Devlin:         21:44          And what's the name of the website, where people can go to buy some of these?

Dr. Andrews:        21:47          Absinthe-Films.Com.

Dr. Devlin:         21:47          Okay, Absinthe Films. "Absinthe", Like the drink?

Dr. Andrews:        21:52          Absinthe, like the drink.

Dr. Devlin:         21:53          Okay. Great. Perfect. All right, well back to you. Give me a little idea of what you consider your best medicine. And I, I've asked this of many of my colleagues, a lot of us when we go into medicine, it's about the other, it's about the patient, it's about those who we're caring for, and then ultimately, our own healthcare and our own mental wellness takes the back burner. So what are you doing? And I hope you're not, like, you know, doing lines of cocaine and staying awake for days on end. I mean, but ultimately when I talked to colleagues, I'm like, well, they medicate or they might drink, and maybe that sort of tapers the issues for them. But ultimately most of my colleagues actually have very healthy lifestyles. They eat well, they exercise, they participate in healthy socializing. Kind of talk to me about what your go tos are for your self care.

Dr. Andrews:        22:40          Well, like I mentioned earlier, I just, I like to say, "I like to get high", meaning there's so many mountains in Nevada, I like to get to the top of the mountains and I like to be out in nature. You know, skiing, back countrybow hunting, fishing, I just need to be outside. But I've struggled with this, you know, I mean, you maybe drank a little bit more or you don't eat as good and every once in a while you have to put yourself in check on that. Because it is a difficult thing to try to decompress from the intensity of our work. And the new thing is I have Ren, my two-year-old, and just spending time with her and just allowing yourself to live in the moment as they do has really, really been an amazing thing.

Dr. Devlin:         23:39          I think having that sort of innocence around you and that pure joy of having a small child in your life is incredible. And ultimately is probably one of the most rewarding things that you can have in your life and when you can encounter that at the end of the night or a day where all you've encountered is sort of pain, hardship and struggle and basically a dump of cortisol into your system as you're trying to make it through a shift. That's amazing. I see so muchharm being done to a lot of our colleagues, especially in the more intense side of medicine where you're faced with basically a cortisol dump. You know, every time you go in on a shift, unless you've found your Zen and you can carry it with you everywhere, a lot of doctors are in a state of chronic PTSD, just from the work they do. And so having some healthy outlets and alternatives to support you in being a physician I think is critically important. Anything else that you want to chat about that you're doing, or actively engaging in to, sort of, make sure health is a priority for you?

Dr. Andrews:        24:42          Well, I think, like you mentioned, PTSD, I suffer from that if you want to call it PTSD. I mean, I don't want to disrespect. You know, the military, but. I do, I've found that I've gotten more anxious after 20 years, you know, you walk into- when you walk into a shift in the person walking out, it says, don't go in there. You already know you're defeated, right?

Dr. Devlin:         25:10          Yeah, right.

Dr. Andrews:        25:10          And so, and then, you know, I've had malpractice suits and I've seen the legal side of things and how nasty that is. So I think the biggest thing for me is to just say, yes, you've been affected. Realize that you've been affected and try to address it or at least acknowledge it and try to take steps to mitigate it or try to lessen it in some way.

Dr. Devlin:         25:38          Yeah, I think that's critical. And I think so much of our monkey minds will glom on to the insult, the injury, the accusation and hold that closer than the 99.9% of your practice, which has been stellar and all the lives you've saved and impacted positively. And that's sad. And I think a lot of folks don't learn, learn about that monkey mind aspect until it's too late and they've suffered the ravages of basically reliving these bad events or being troubled by a case you saw. And you come to find out that, Oh, the parent of the child who didn't do well is a malpractice attorney, "oh, wonderful." So at the end of the day, you can take home so many burdens that just sort of stew and,

Dr. Andrews:        26:26          Absolutely.

Dr. Devlin:         26:26          I think that's something that's gotta be dealt with in our profession globally. Cause I see too many people burned out. I see too many people dissatisfied or scared of going to work.

Dr. Andrews:        26:36          Or killing themselves.

Dr. Devlin:         26:37          Or killing themselves. Absolutely.

Dr. Andrews:        26:38          Right.

Dr. Devlin:         26:38          Absolutely. Yeah, that's a tragedy.

Dr. Andrews:        26:40          No, and you develop this anxiety and when you're driving to work and you're already freaked out and then you walk in and then you're worried about hearing the worst possible words you could hear, "you remember that patient you saw yesterday?"

Dr. Devlin:         26:57          Right, right, "It's not technically a sentinel event, yet."

Dr. Andrews:        27:01          Right, and I've had bad outcomes, terrible. And I think about them all the time and it's really hard to think about the good.

Dr. Devlin:         27:14          Yeah.

Dr. Andrews:        27:14          And so much focus is on bad.

Dr. Devlin:         27:18          It is. It is. And we have to break that paradigm. And I think you brought something up earlier, before we started recording, and that was the concept of having all these thank you notes posted in your emergency room. I mean, that's a testament to what you're providing for your community and you have a very interesting and unique community that you care for. And I think that's great because I think there's a certain caliber of person that lives in that community and they really do understand what you guys are bringing to the table, that it is sort of life or death care that you're providing and having made available to them 24/7. And when you realize that, and you honor what it takes to provide that, then you get the feedback that is appropriate, that are the thank you letters and basically saying, "Hey, listen, you saved my life. You saved my wife's life." A lot of times people who are working in areas where the community doesn't have much respect or maybe even disdain for the clinicians, they don't see any of that. And that's a shame.

Dr. Andrews:        28:11          No. Yeah, and, you know, up at Incline, it's also, you know, even just the routine things that we take care of, we do a stellar job and we call everybody back the next day, which is incredible. So I think, yeah, there's the life and death stuff that they know we're there for, but it's just knowing that we're there, you know, for their, when they eventually tear their ACL or whatever, they, you know, they really appreciate that.

Dr. Devlin:         28:39          Yeah.

Dr. Andrews:        28:39          And you know, we see a lot of tourists, from the Bay area. Like, you know, I like to say that Incline, you know, the hospital has been keeping the Bay area alive since 1979 but those people come, our wait times are, is like 45 seconds or something average, you know. And, and that's why I work there. Cause you can spend time with people, you can take a review of systems, you can learn about them. And they come from the Bay area and they get exemplary care. Cause, I mean, they could probably get sick in the Bay, drive to our hospital, be seen quicker and back home. They could still be in the waiting room than the ER over there.

Dr. Devlin:         29:21          Right.

Dr. Andrews:        29:21          So it's really a, it's really a cool place to practice.

Dr. Devlin:         29:25          No, that's awesome. Well, when we look at healthcare in general, in your opinion, where do you think we're going as far as the future goes and, what do you think some of our strengths are in medicine? I know it's kind of a twofold question.

Dr. Andrews:        29:38          Right.

Dr. Devlin:         29:39          Medicine has been in transition ever since I got into the profession of medicine and I think we do some things phenomenally well and I think we are dropping the ball in other areas. Can you talk to me a little bit about kind of what we're doing well right now?

Dr. Andrews:        29:51          Right. Well, when you first, when you were a resident, when I was your attending physician,

Dr. Devlin:         29:56          When I was a baby. Right?

Dr. Andrews:        29:57          Yeah. I mean that was kind of the start of the slippery slope where it really started going fast. You know, like medicine had been kind of like when I started, the nurses had been there 15 years and the doctors and everything was established and they were a family. And then you started to see it start to slip, and man, it's slipped. I mean, I feel like to the point of no return. And so what I see as far as where medicine is going is it's going to continue. There's going to be, you know, a, an insurgence of mid level providers, more burnout, more suicide or whatever you wanna call it. And until there's going to be a doctor shortage and then eventually they'll redo the EMRs and they'll redo the system and they'll recognize this problem, because the problem that we're facing right now is kinda like the opioid crisis. Like we all know what's going on, but until somebody in government or whatever, or the hospital administrators decide to do something about it, it's going to continue. So I think down the road it will, it's going to continue to dip and then maybe it'll start to rise up. As far as what's good in medicine right now what I think is really cool is at least for the last five years, we've been unlearning what we've learned. You know what I mean?

Dr. Devlin:         31:21          Yeah.

Dr. Andrews:        31:21          Like, you know, we used to do Swan-Ganz and all that stuff. And I think it's really cool because when I was taught, you know, emergency medicine and we were doing these things, kind of in my gut, I'm like, we're not really doing any favors to this patient and this may be even doing harm, you know, like NG tubes or intubation and now you know, we have BiPAP, and we have- and we're unlearning all these crazy things that we used to do, and we thought we were doing good. And so I'm really enjoying unlearning the stuff that in my gut I thought, "I don't know if this is exactly right." The other thing I think we're doing good is just the education, the educational opportunities like EM:RAP. Mel Herbert, and those guys, like, they have taken continuing education to a new level. It is entertaining, on-point, amazing, supportive, addressing all the issues. And you know, when I got out it was like you'd listen to these cassette tapes that were dry as can be.

Dr. Devlin:         32:24          Yes.

Dr. Andrews:        32:24          And, or reading these things. And this is like, I'm excited to learn. So I think our education is getting better. Yeah, and then just unlearning everything is, I think it's great.

Dr. Devlin:         32:38          Yeah. You bring up such a good point because medicine has changed so much in the past 20 years alone. And, like even just the past week, you know, they come back and they're saying, "no, don't take a daily aspirin. Naw, actually it's not providing a benefit. In fact, there's a downside to it." And so we have an about-face on aspirin. And now some of our normal screening tools that we would use are no longer applicable, they don't want us to do them. So I mean, it's really, it's a delicate dance that we do. And I think what we need to do as clinicians is to develop a repertoire of skills that allows us to individually evaluate patients as an N of one, and do the best we can with big data to drive decision making. And ultimately for the patient to have complete autonomy in that process and not to have that stolen way. I see so many times in my patients, have been told they need to do X, Y, and Z or they're going to die or they need to be taking all these medicines. And of course, polypharmacy is a nasty issue that we see in the emergency room a lot. And a lot of times, you know, they come in because they've had either a side effect or some meds didn't mix well for them. But you're absolutely right. We're in the process of learning and unlearning, I think probably all the time and even more so now.

Dr. Andrews:        33:48          Yeah. And on the subject of polypharmacy, I mean, it's ridiculous. You know, there's what, 'too many cooks' or whatever.

Dr. Devlin:         33:59          Yeah, right. Exactly.

Dr. Andrews:        34:00          Like, I always say, if you're on more than three medicines, you're beyond medical science. Like there's no way any data is ever going to come out to talk about the interactions of these medicines.

Dr. Devlin:         34:11          Yeah. There's, it's, it's nearly impossible. And that's why we really have tocreate either tests or ways to evaluate patients, maybe genomically or using proteomics to determine whether or not they're a good candidate for X, Y, Z chemical. And we're not there yet. I think we're getting there, but we're not there yet. And the other thing you brought up, I want to talk about, because it has been a bane of many physicians existence is EMR. Just as we were being birthed into the world of medicine EMR was slowly coming into the clinic and into the hospital and you know, we trained in paper charts and then all of a sudden within five years we have computers thrust in front of us and a lot of doctors who are older than us have, kind ofdealt with it to the best of their ability or actually even left medicine. I think that we have a wonderful opportunity with electronic health records and EMR in general to do a lot of good. However, we're not there yet. I mean we have really taken away the time, energy, and mental capacity of the physician and force them to deal with technology that isn't really conducive to the practice of medicine. I mean, they're trying but my experience has been it's more labor than it is beneficial. You know, it's harder for us to use than it is to implement. So what are your thoughts?

Dr. Andrews:        35:25          Well, it's data entry.

Dr. Devlin:         35:26          Yeah.

Dr. Andrews:        35:26          And it's not eyeballs on the patient.

Dr. Devlin:         35:29          Right.

Dr. Andrews:        35:29          And it's part of this thing that started 20 years ago. What was it? Is it Eisenhower who talked about the military industrial complex? This is the start of the medical industrial complex. And we didn't take ownership of the EMR because it was the old guys that were the leaders that didn't want anything to do with it. And then the young people get this system that was built by the hospitals and it's basically a cash register for the CEO, is what I look at it as.

Dr. Devlin:         36:00          Yeah. I see a lot of emphasis being placed on tracking what's being used or incorporated into the care of the patient. On the flip side, I have seen systems that have been great at collecting data and some of that data is Richardson information that we can use for future care. But really at the end of the day, it's a hardship. And I do, I would say productivity has dropped, I don't see how it's increased. The only thing that I've seen that's been done in the past, that I think we got an edge on productivitywas using the scribe system. And that was something that you guys used early on?

Dr. Andrews:        36:31          Yeah, we actually started the scribe system, even though we don't get credit as being the inventors. The people who, I think it was in Fort Worth, that claimed to have invented the scribes came to us to look at our program and then claimed that they invented it. And that was really good, as far as efficiency, but really bad as far as accurate documentation, because you train these kids, they take medical terminology and their premed. But sometimes, you know, and I find that now that I'm on my own and I'm doing my own entry, that, you know, I find that I am able to describe things and it's a little better chart, you know, with the history and all that. Cause, you know, if you're seeing, you know, you're working on 10 to 12 people at the same time and you're cranking them out and you got this scribe writing this history, you don't have time to look at all of that stuff. So efficiency-wise it's good. But I thinkas far as individual patients and looking them at them as an N one and making sure that the appropriate data gets into the chart, I think it doesn't quite work as good. But I will say that the EMR is the one that we're on to be able to look at old records from anywhere is really quite amazing.

Dr. Devlin:         37:44          Yes. Yeah.

Dr. Andrews:        37:45          And also, the warnings about like, "Hey, this drug isn't compatible with this." Like, in a paper chart, you know, I get these warnings and I'm like, "Well, I've done that for 20 years. I guess I got lucky."

Dr. Devlin:         37:59          Yeah.

Dr. Andrews:        37:59          You know, so it's really interesting that way. But man, just the, you know, we call it death by a thousand clicks and it's just clickety clickety click all day. And that, when the ER gets busy, it drives me a little bit insane.

Dr. Devlin:         38:15          Yeah. It can be a rate limiting step, unfortunately,

Dr. Andrews:        38:17          No doubt.

Dr. Devlin:         38:18          For care. We had discussed, I think it was earlier in the week, about some articles both you and I were familiar with, and independently so, and we talked about that. But it involves the concept of "Moral Injury" to physicians. And I had seen some videos on this and I also read an article and it really resonated with me, because of my background and culturally how I grew up, that when we enter medicine a lot of our, I think, mores, morals are challenged. Can you talk to me a little bit about what "Moral Injury" means to you and how that has affected you?

Dr. Andrews:        38:58          Well, it's Dr Z. You know.

Dr. Devlin:         39:01          Yeah, Zdogg,

Dr. Andrews:        39:01          He's a Stanford, training our doc in Vegas. He does all these amazing videos. I didn't read the article, but I, you know, I watched the video that Dr. Z put out and that hit home so hard for me because I've been looking for, I guess a label for this, because this is exactly what has happened to me. I got my dream job and, you know, a nice ER and Reno and then I watched things start slipping, and what I mentally was doing was I would draw a line in the moral sand and then they would do a little something and I, "okay, I got to move the line a little bit." Okay, they do this, you know, sell the hospital and go private, and move the line, and make you do this, and make you do that. And I kept redrawing this line in the moral stand to where I got to a point where I didn't really recognize myself anymore. And that is moral injury. Like, that's the definition is, you know, being exposed to these things that don't go along with your morals, and then you have to make adjustments to it or you have to make a decision to leave and seek something that more aligns with how you believe. And that's not an option that's readily available for a lot of people, so they're kind of stuck in this cycle. And its' basically, represents greed. Like, greed is one, and we're not greedy people. We want to give care and we're, you know, being forced to do these things much like people in battle, you know, that have a certain set of morals and are forced to do things and it's just little tiny bites that add up, you know. So, I'm really excited that that's out there because it's resonating with the masses. And when I left my job in the busy ER, I was just thinking like, " Is it just me? Like, is this me? Like, is it me that's the problem?" And why, you know, I always thought my group should stand up to administration and, but they didn't want to risk the contract. And I'm like, I'm ready to risk the contract to do what's right and these guys aren't. And I left, and I'm like, why aren't these guys following me? Like, this is something that needs, you know? And so I thought it was just me. So when this came out, I'm like, that's exactly, and I'm not alone.

Dr. Devlin:         41:38          Yeah. And I'm glad that it has shown up in the media, and it's shown up in professional dialogues, because what we're seeing is that the entry into medicine is almost a commitment to make a change in who you are. I came into medicine with some very grandiose thoughts about what I would be able to do and provide for patients, and then very quickly, reality set in. And I think for anybody who's listening or watching this, has to understand that we're all human beings trying to care for another sentient being, in the best way possible. And when influences that don't involve that intimate relationship, put pressure on that care or try to manipulate that care for some third party gain, then the system's broken.

Dr. Andrews:        42:28          Right.

Dr. Devlin:         42:28          And that's what we're facing every single day. Whether it's, "Hey, listen, I only had to see 15 patients on the wards today, to now, I saw 30 patients on the wards today, and I've got more coming in, and they want me to see more, and they're not paying me anymore. But I'm generating revenue for this machine." And which the very top and the machines being paid several million dollars, if not, you know, multiples of that. And we're making an average physician wage. And so you have to-

Dr. Andrews:        42:53          "Fair Market Value."

Dr. Devlin:         42:54          "Fair Market Value." Exactly. Yeah. And you have to really wonder people are trapped in those positions, and they don't have any outs, they, and I'll be honest with you, there's a lot of physicians who have overextended themselves financially. Unfortunately, you know, prior failures in marriage or relationships that it's been costly for them. Ultimately, they sometimes like a lot of toys or they overextend themselves. And I'll be honest, as physicians, we're not trained in the area of business or money management and we falter in those fields and a lot of times fall victim to a variety of scams.

Dr. Andrews:        43:25          Right. And we also sacrificed our twenties.

Dr. Devlin:         43:28          Absolutely. Yeah, and people don't understand that.

Dr. Andrews:        43:29          So we want to get out and play, you know.

Dr. Devlin:         43:32          Right. And that can complicate issues.

Dr. Andrews:        43:33          Right.

Dr. Devlin:         43:33          So, yeah, "Moral Injury", I think, and that's something we're going to talk about more on the show along withburnout depression in the physician population as well as suicide. Unfortunatelywe, both of us have known clinicians who have taken their own lives, and it's heartbreaking, because what these people have done to give back to society and to provide care for those in need. It's miserable to know that we are at increased risk for committing suicide as a profession. I know we're reaching our time limit here, but I wanna to wrap up with a couple other questions. One of them involves sort of some medical wisdom or pearls that you can pass on to some of the viewers who maybe aren't clinicians, who may be patients themselves, something that you can tell them that they might be able to put in their back pocket for later use?

Dr. Andrews:        44:23          Well, I mean I could talk to the physicians.

Dr. Devlin:         44:25          Okay. Talk to the physicians.

Dr. Andrews:        44:27          I mean, as far as the patients go, I would, you know, educate yourself, but be careful where you get your education. You know, every person that comes in thinks they have cancer cause they've consulted dr Google and dr Google should be sued for malpractice. So make sure you use good sources when you're trying to, you know, help yourself. But as far as the physicians go, I would say like they say on EM:RAP, what you do matters, and what you do truly matters. I would say if you feel like you have the golden handcuffs on, make changes in your life, your finances, whatever, because if you feel like you have the golden handcuffs on, then they need to come off. So make changes, and try to, you know, take those golden handcuffs off and just live your life, because that's a miserable way to live. Cause I did that for years and it's no fun.

Dr. Devlin:         45:26          No, absolutely.

Dr. Andrews:        45:26          Yeah. And then go with your gut. I mean as clinicians just, kind of, if you feel like something's wrong, it's probably wrong. I mean, it goes for patient care, it goes for personal life. It goes for dealing with administration, you know, just go with your gut. Those are kind of things I would say.

Dr. Devlin:         45:46          Wonderful. No, that sounds good. A lot of times I ask some of my clinicians that I have on the show where do you see medicine in the next 50 years? I mean, I've had a variety of answers, I don't want to share them now, but I want to hear your opinion. 50 years from now, where are we in medicine? What's happening?

Dr. Andrews:        46:01          Well, whenever I think of the future of medicine, I always think of Idiocracy and the press that button and it like probes you. But like I said earlier, I think it's going to continue this downward slide until it breaks. And then we get intuitive EMR, we get physicians, you know, med school becomes affordable and we get a resurgence of physicians, because right now, not to disrespect mid-levels, but there is a, they're vulnerable and they're being taken advantage of, and there's more and more mid levels and I think we'll see a physician shortage. But then I ultimately see it coming back up with more efficient EMRs, more efficient practice technology and so I'd like to say that, "I see it getting better", but it's just going to have to get worse before it gets better.

Dr. Devlin:         46:56          Right, right. It's a got a burn before the Phoenix can rise.

Dr. Andrews:        46:59          That's right.

Dr. Devlin:         47:00          And so, well, Laning, listen, thank you so much for coming in today. It's been an absolute pleasure. It was wonderful to see those beautiful snippets of the videos, that we looked at. And I look forward to spending some more time with you and possibly doing some future casting together.

Dr. Andrews:        47:14          Yeah, this is great.

Dr. Devlin:         47:15          Awesome. Listen, thank you to all our viewers. This is Dr. Sean Devlin, signing off for The Medicine Wheel.

Outro: 47:20
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