Luis Garcia, MD - Sanford Health News

Virtual care becomes everyday practice

Alan Helgeson:

Hello, and welcome to the “Reimagining Rural Health” podcast series, brought to you by Sanford Health. In this series, we explore the challenges facing health care systems across the country from improving access to equitable care, building a sustainable workforce, and discovering innovative ways to deliver high quality, low-cost services in rural and underserved populations. Each episode examines how Sanford Health and other health systems are advancing care for the unique communities they serve.

Today’s topic is a conversation on virtual care and how Sanford Health clinicians are connecting with patients and making a difference. Our guests are Dr. Matthew Eggers and Bonnie Petersen, certified nurse practitioner. Our moderator is Dr. Luis Garcia, president of Sanford Clinic.

Dr. Luis Garcia (host):

Well, Matt and Bonnie, welcome. Thank you for agreeing to do this with me. This is an exciting topic. Sanford recently announced that we’re putting a significant investment in virtual care that has certainly elevated the visibility of many of the things that we were already doing in Sanford, and certainly there’s a lot of questions on what are we going to do with this into the future? So thank you for joining me in this conversation.

Matt, I’ll start with you. Virtual care is quote unquote “new” for some patients and perhaps some clinicians. But in Sanford, we have been doing it for a long time. Can you speak to us about what virtual care means?

Dr. Matthew Eggers (guest):

Sure. Thanks for having me. Virtual care, as it pertains to the service I’ve been involved with, reaching out to patients in rural locations using technology to improve access to high quality health care. This could mean seeing a provider over the computer at your local clinic, or visits at home through another device, a phone or a tablet.

As a psychiatrist, I evaluate mental health needs of patients and collaborate with primary care providers at these sites. It involves medication management and follow up, making referrals to outpatient therapy or locating community mental health resources, referrals to other specialties, collaborating with other clinic staff. The nice part about the system we’re using is we have access to several remote sites, and the messaging is instant. You can see who needs what. If a patient has a question about their medication or treatment, it’s instant access to that as well as collaborating with pharmacies.

Dr. Luis Garcia (host):

Thanks for that perspective, Matt. And it just elevates options for the patient in a non-face-to-face fashion so they can get their needs satisfied. And also, I think you mentioned the interaction between clinicians, right? And it’s not only about patient to clinician interaction, but also learning from each other and providing support to other clinicians. I mean, in your case, mental health is such a hot topic right now, and not everybody has the level of expertise that you have. And how do we help other clinicians to treat patients by utilizing this technology? So thank you for sharing those thoughts with us.

And Bonnie, I’ll ask you a question here about how has virtual care impacted your practice? You know, why did you choose to do it? We talked about how this is not new to Sanford. We’ve been doing it for a long time, but how do you take that leap of faith of this is the way I want to interact with my patients and it will be OK?

Bonnie Petersen (guest):

I think that really what interested me most about it was being able to provide another choice for our patients who maybe in a rural area to access the care at Sanford leap of faith for sure, because we didn’t know for sure what we were getting into, I don’t think. And how great of a service it could be for people.

Dr. Luis Garcia (host):

Yeah. So you do primary care, urgent care, correct? Urgent care in the rural setting?

Bonnie Petersen:

We do urgent care, and we cover the enterprise. It’s acute care providers from Sioux Falls that do the visits. Your patient might be someone in northern North Dakota or could also, really, you could be doing a virtual visit with a mom with a little one here in Sioux Falls too. It doesn’t necessarily always have to be rural, but that was really our main goal, is to reach those patients that don’t have that access. They often have a pharmacy in their town, but don’t have a provider so that we can bridge that gap for them.

Dr. Luis Garcia (host):

It’s interesting that you say that because in Sanford, we have said that we are the premier rural health care system in the nation, right? And 90% of the care that we provide is in the true rural setting. And being able to bring that best care possible to the doorstep is certainly one of the ways that we can achieve that. So thanks for everything that you do.

This is intriguing for me because we always think about how we as clinicians will adapt to the use of new technology. But Matt, talk to me a little bit about how patients actually have embraced the technology. You know, we talk a lot about the importance of the face-to-face interaction, and now we’re putting all these tools and gadgets between the clinician and a patient. How are patients embracing this?

Dr. Matthew Eggers:

We’ve had a lot of positive feedback from patients and their families as well as clinic staff. Not every patient is going to prefer seeing a provider over the computer or some other device at home, but for the most part, the feedback has been very positive and they appreciate having this service being available to them locally.

Dr. Luis Garcia (host):

Matt, and this question to you, again. A lot of people say, well, virtual care should not exist because a lot of the patients that we take care of are in their 60s, 70s, 80s, and they don’t have internet, or they don’t know how to use all these virtual modalities. Have you seen that? Or are patients really engaging regardless of their background and age and all that?

Dr. Matthew Eggers:

I think patients are very engaging. I think as long as you’re showing them that you’re listening to them and their needs and they feel that their needs are being met during a visit, they’re very engaging no matter the age. And also response time – if they need something in a timely fashion. The local clinics have been great to work with as far as that goes.

Dr. Luis Garcia (host):

You know, it’s interesting that you mentioned that. I just recently read some data from our own marketing department and in our own internal surveys, 80% of our patients actually prefer to have a virtual option when possible. So I think that data validates what you just said, Matt. But let me ask you, so we put, once again, a lot of emphasis on a productive relationship between a clinician and a patient to be face to face, and perhaps the use of these virtual care modalities would prevent us from having a good rapport or a good relationship with our patients. Can you talk to me about how do you engage your patients? How do you foster that relationship so the technology doesn’t get on the way and is as meaningful as a face-to-face interaction?

Bonnie Petersen:

I think that we engage with that patient through a virtual visit the same way that we do with that urgent care visit. We maybe don’t have that long-term primary provider relationship with them, but we tailor that visit to what are they looking for and how can we help them with that? And to have it be personal, we actually message them back through their MyChart to give them the opportunity to add anything to that. Or the video visits are especially easy to do that. You can still see that patient and they might be bouncing their little one on their knee or the cat might walk by or whatever, but it’s just engaging their whole family, I guess.

Dr. Luis Garcia (host):

So in your case are patients that you perhaps have not seen before and they request a last minute visit because they have something that is an urgent type of need. So I’m going to put you on the spot: as a surgeon, you know abdominal pain and we have to see the patient and we have to put our hands in the patient’s abdomen. How do you navigate those things virtually?

Bonnie Petersen:

Our nurses screen all of the requests that come in e-visit or video visit or Tyto Care for that matter. And if a request comes in for a visit for abdominal pain, our nurses will call that patient, get a little information from them, knowing full well that the final answers will be to them that you’ll need to be seen in person. Virtual care isn’t for everything and there’s no shame in saying, no, you need to be seen in person. You aren’t trying to handle their problem just because they’ve asked to do it this way. Sometimes they just want to know, should I go in for this or can it wait? But definitely it’s a certain group of chief complaints that you would treat virtually.

Dr. Luis Garcia (host):

Yeah, that’s, that’s really a good point, and I love your comment about there’s no shame on still asking the patient to take the next step if necessary. I think that as clinicians, we always want to do the right thing with the best of the knowledge that we have, and sometimes we just need to take the next step. So I appreciate that.

Matt, as clinicians, some have been really forthcoming with this and really want to do it, want to offer it. Our patients want it, and some others are a little bit hesitant for one reason or the other. What would you tell your colleagues as they try to embrace this model? Go for it, or pay attention to this, or what has worked for you or not? Help me a little bit about that.

Dr. Matthew Eggers:

Yeah, I would say go for it. It’s about reaching out and helping people in areas that otherwise wouldn’t normally have access to certain specialties. And I think as far as embracing these models, yeah, there will be some things out of your control. And working with as many sites as we do, not every site has the same capabilities. There are different staff availability, technology advantages or limitations. But I think it helps if you can be laid back and just work with staff and to troubleshoot any areas.

And the other thing I would say, doing what I do, is it’s a little bit different because I don’t have any direct interaction with staff colleagues or face-to-face with patients. When I was in med school in the late ‘90s, they had us complete the Myers-Briggs personality inventory, which I really gives you kind of a nice snapshot of your genetic personality, extroverts versus introverts. And I think if you are somebody who’s probably more extroverted and likes that interaction with staff and colleagues and gets energized by that, I think that’s probably going to be a little more difficult to do something like I am, just where everything is virtual. But all in all, I think it’s a really good service and a great way to reach out to patients in remote sites.

Dr. Luis Garcia (host):

Thank you to both of you. And I think you both highlighted the differences on the provider end, right? Sometimes you need to rely on your team to assess certain things before you even talk to the patient. In your case, Matt, a lot of that, you do it at on your own without need of staff. Some are patients that have a long-standing relationship with you, and the urgent care is quite the opposite. And on the back end, we are providing all that support for the visit, and that’s our responsibility as Sanford, right? But on the patient, we want to make it as simple and as fast as possible so the patient has a good experience.

So Bonnie, talk to me a little about that. I’m a patient, I want to see you, what do I need to do? Do I get on my phone and my computer?

Bonnie Petersen:

From the patient’s standpoint that visit is requested through their MyChart. So first of all, they have to have a MyChart account, but say you don’t, but you really are interested in still doing this visit, our nurses will walk you through that. And if you’re having trouble, they’ll say, see, you know, go down to the bottom there, see, push that, and whatever we can do to help them, because the IT side of it is the most frustrating for patients, being able to figure out how to make that connection.

And then you can only do so much if they’re in rural South Dakota and their internet access isn’t so great to begin with. That’ll be a struggle for both sides. But just to help that patient know that we can troubleshoot that with them. We’re not in a hurry. We can figure that out. Otherwise, it can be very frustrating if they feel like they’re having connection problems. I can hear you, can you hear me? And things like that. It’s not a satisfying experience for the patient at all. So I would think those are the main things really.

Related: Sanford Virtual Care opens first satellite clinic

Dr. Luis Garcia (host):

I tell you, I’ve never done a virtual visit myself, but I can see myself doing it in certain instances. And it’s just really nice that we offer those options for our patients. Speaking a little bit about the complexity, that even though this is advanced technological approaches to a human to human interaction, it does require a whole lot of infrastructure kind of behind the scenes. And Sanford has been committed now to provide that support for our clinicians of and our patients. And we recently announced this virtual care center that is going to coordinate a lot of the activities that are already happening.

But Matt, give me a sense of how many visits, do you know what Sanford has done? How do we transition from the last year into this new virtual center? A little bit of the philosophy behind that.

Dr. Matthew Eggers:

Virtual care is nothing new to Sanford. They’ve been at it since 2011. And I was kind of amazed when I looked at all the stats. We’re talking about 270,000-plus video visits, close to 80,000 verbal visits and 77 originating sites receiving telemed services. And I think they estimate that it’s saved 20 million miles of traveling. And as far as purpose and vision of the virtual care initiative, obviously to make high quality health care accessible through the use of technology and Sanford’s vision is to become known and nationally recognized for the virtual care services.

Dr. Luis Garcia (host):

You know, Matt, you mentioned the amount of miles, that we have saved our patients 20 million miles in the last year just on virtual visits. But I think a little bit more to the story, is that what that means for our patients. And I heard about a story where a lady for her standard routine prenatal care had to travel two, three hundred miles. And what it meant for her, where her husband was working, she needed to take not only days off of work to come to a visit, but find day care for her children, and the cost of having to travel those miles, and between gas and expenses and food and all that.

So what for us might be a simple 15, 20 minute visit for a patient could be a day changing activity. And this type of support certainly facilitates still that productive and quality interaction with our patients and taking a lot of burden off of our patients. So any of you share stories that you have heard where the patients are really appreciative or the clinicians are really appreciative of that interaction with other colleagues virtually?

Bonnie Petersen:

I think the first one that comes to mind for me, the toddler with conjunctivitis, they have pink eye. They can’t go back to day care. Mom’s got to load them up, go to the clinic however far away that is, sit in a waiting room and the child is exposed to germs that he didn’t have when he came in there just to get the eyedrops. We can talk to that patient over that (virtual) visit and handle something simple like that, tell them what to watch for, and screen the symptoms, make sure that is all it is. The patient has that visit done before they even go to work.

Dr. Luis Garcia:

One of the things that is pretty evident and clear for us nowadays is the lack of access to mental health clinicians. And in your case you’re in high demand right now and your patients absolutely need your services. So how has this virtual care facilitated improvement in access? Can you speak to that a little bit?

Dr. Matthew Eggers:

I started in late 2018 under a, I believe it was a HRSA grant. And the goal was obviously to grow the service and make it sustainable. First six months were a little slow and there were, there’s a lot of virtual meetings with providers to kind of let them know that, hey, this is available. Mental health services are here. A lot of the primary care providers, a lot of providers are comfortable in managing mental health medications to a certain degree. And basically just to get the word out there that this is available. It works. The technology is good, and we can meet patient needs. Feedback has been positive.

Dr. Luis Garcia (host):

We’ve been talking about the patient, right, and what it means for them and make it better for them. But one of the topics that continues to serve as for clinicians is the work-life balance and the burnout. Has the virtual strategy supported your work-life balance and your adaptability to work to have a better life? Can you give me some perspective of around that? And maybe I’ll start with you, Matt.

Dr. Matthew Eggers:

For one thing, less road time. I used to travel a lot to remote clinics in South Dakota and Iowa. So less road time means more time with family. And I would say also it’s important to take care of ourselves as providers. The first year I did this, I learned the hard way that you should get up and move around, take breaks, get your heart rate up. I ended up developing piriformis syndrome and was sort of limping around all summer, but I’ve recovered from that and I have a treadmill and an exercise bike at my office now, so I get up and take breaks. And also just nice to take a break from screen time, also give your eyes a rest.

Dr. Luis Garcia (host):

Unquestionably. Often we forget about taking care of ourselves as caregivers, right? Bonnie, what are your thoughts about that?

Bonnie Petersen:

I think early on it was quite a commitment from our providers. We weren’t quite busy enough to have a dedicated virtual care provider, so you were mixing that in with your regular patients going from just daytime hours to 24/7. And now we have enough virtual care appointments that we have an acute care provider, staff 24/7 just for that most days. And what it’s helped for me in my work-life balance is the opportunity to do a different type of patient care. Maybe I could do an overnight shift from home rather than in clinic it’s worked well. We’ve had young mothers who have been able to, I think, work longer through their pregnancy, because they were able to do a more sedentary virtual care than the in-clinic part of it. There’s many ways we can creatively now help give us that work-life balance.

Dr. Luis Garcia (host):

Well, Bonnie and Matt, you guys are pioneers in all this and you have really helped to shape up Sanford’s path into this future of health care and into providing the same quality of care through different methodologies to our patients. I just would like to ask you for any closing thoughts. This has been a phenomenal conversation and I think it highlights the importance of meeting our patients where they need to be met and facilitate in any way possible that interaction with their clinicians, but Bonnie, I’ll ask you first if you have any closing thoughts about this conversation on virtual care.

Bonnie Petersen:

In order to help our Sanford providers embrace the virtual world, we need to get them comfortable with it early on. That was probably one of our biggest frustrations was the technical side of it. It takes too long to do this, it’s just quicker to make them come in or whatever. If that provider’s comfortable with doing that kind of visit technically as well as through their health care, then it will be easier for them to adapt it into their practice. And we don’t see just everybody. That’s I think what providers worry about is that we’re out there telling people how to take their appendix out or something like that. We screen our patients carefully.

Dr. Luis Garcia (host):

Certainly the technological advances have allowed us to overcome some of the initial hesitancies. And of course now we’re dealing with our other things like reimbursement and policy around this. But in Sanford, we’re just committed to do it right. We’ll figure that out later. We need to provide a service to our patients. We’re committed to that. And then on the back end we work on whatever policy influence we might have to facilitate and solve that. But Matt, any closing thoughts?

Dr. Matthew Eggers:

I just want to say thanks to all the remote sites we’ve been working with. Everybody’s been working hard to make this service what it is, and I think it’s a great service and I’m excited to be part of this moving forward. And would also like to thank Casey Westphal, who has continued in a nursing role working with me, but she’s also had a virtual behavioral health strategy. Patients can reach out to her to schedule her if they have questions. And also like to thank Susan Berry for being part of this. She’s the vice president of operations of virtual care.

Dr. Luis Garcia (host):

Sanford, for very valid reasons, continues to be the most trusted health care system in our regions. And we have the commitment that we’re going to provide the best care for every patient that we touch. And it is because of people like you, Matt and Bonnie, that we are the most trusted system. Not only you bring your heart and your talent to work, but you’re always looking at how can you do it in different ways to meet patients where they need us to meet them. So thank you very much for everything you do. This has been a great conversation. I appreciate everything you do every day. Thank you.

Alan Helgeson:

You’ve been listening to “Reimagining Rural Health,” a podcast series brought to you by Sanford Health. Hear more episodes in this series or other Sanford Health series on Apple, Spotify, and news.sanfordhealth.org. For Sanford Health News, I’m Alan Helgeson, and thank you for listening.

Learn more about this topic

• Ep. 19: Start a mindfulness routine for mental health
• Ep. 16: Virtual clinic shortens distance to health care
• Sanford launches virtual behavioral health appointments

Get more episodes in this series

Sanford’s journey to zero preventable harm

Alan Helgeson (moderator):

Hello, and welcome to the “Reimagining Rural Health” podcast series, brought to you by Sanford Health. In this series, we explore the challenges facing health care systems across the country, from improving access to equitable care, building a sustainable workforce, and discovering innovative ways to deliver high quality, low-cost services in rural and underserved populations.

Each episode examines how Sanford Health and other health systems are advancing care for unique communities they serve.

Today’s topic is a conversation on safety and quality measures – at the core, providing patient care. Our guest is Dr. Jeremy Cauwels, Sanford Health chief physician. Our host is Dr. Luis Garcia, president, Sanford Clinic.

Dr. Luis Garcia (host):

Well, safe and quality as a foundation principle in our everyday activities. Jeremy welcome to this podcast. It’s great to have time to speak to you about such an important topic. How are you doing today?

Dr. Jeremy Cauwels (guest):

I’m wonderful. Thanks for having me.

Dr. Luis Garcia:

Well, thank you, Jeremy. I’m just going to get right into the purpose of this topic. We all talk about quality, and we all talk about being a highly reliable organization, but I got to admit that not everybody gets there and it’s always a work in progress. But tell me a little bit about a physician that just joined the organization, sees everywhere, “safe, safe, safe,” and those that have been here for a long time have seen the transition into this safe thing. What is safe?

Dr. Jeremy Cauwels:

Sure. So SAFE is our acronym. It stands for Sanford’s Accountability For Excellence. If you’re looking for a framework for it outside of Sanford, you would look up words like high reliability organizations. What it really means is that SAFE for us is our individual accountability as people for the things that go on in your work every day that you have direct influence over, and that you can allow or encourage to make better depending on your actions.

And so, as we work on SAFE, the basic principles are as basic as tying your shoes. They’re things like making sure you check your work to make sure you did it right. Making sure you’re engaging people appropriately and making sure that as you’re going through, you’re encouraging the people around you to maintain that same level of culture and ability. The goal really is to say, we’re going to treat other people like we want to be treated.

We’re going to do the things that we promise we’re going to do. And what I mean by that is surgeries and treatments, diseases, and that sort of thing. And we’re not going to do those things which would be unexpected. So our goal is to make sure that every person on the teams are actively engaged in preventing things like negative outcomes or bad experiences. And we can do those things in large part due to the diligence and the intelligence of all of the people that we work with on a day-to-day basis.

And so, using those teams, using a few of those simple skills – one of them we use is called STAR. So we stop, think about what we’re doing, make the action we need to, and then review it. So we actually look back at the things we just did to say, what does it take to check up on this and make sure I did the right thing?

Now the good news is that when we do that, I’m inaccurate probably to the order of 1 out of a thousand times or between 1 out of 1,000, 1 out of a hundred. If you put two of us together and we’re checking each other, we get to 1 out of 10,000 times and our error rate drops down to vanishingly low, which is really our goal every time we work together anyway, is that you and I want to complement each other on a way that makes us better.

Dr. Luis Garcia:

Yeah, and thank you for that last comment, Jeremy. Because I was going to ask you why this work? Because if you think about it, we get into health care and whether you’re a physician or a nurse or a health care provider in any sense, you always want the best outcomes. You always want to be that kind person to the people in need to our patients, to our colleagues. And we always try to work in that environment of collegiality, right?

So what was happening that you felt or Sanford felt that we needed to take a look deeper into it? Because inherently you would assume that everybody’s doing a great job in health care, right? Well, was that not happening?

Dr. Jeremy Cauwels:

I think it’s important to recognize the difference between everybody wanting to do a great job and the systems you can put in place to ensure that everybody is doing a great job.

What I can tell you is that at Sanford, every day we do deliver top-notch medical care. And we do a wonderful job of making sure that the people that we see and that we take care of really appreciate the work that we do.

But that being said, I think we all know the old phrase “two heads are better than one.” And what that means is that if I’m actively engaged in making sure that I deliver for the patient that I’m taking care of, and you’re actively engaged for delivering on the patient that you’re taking care of, we can do the job together and magnify that level of intentionality, that level of thoughtful scrutiny that allows us to do a better job with each patient every day because we’re part of a team.

Because every member of the team knows that not only can they intervene, but they should intervene. And that intervention helps all of us deliver care in a way that is less prone to error and more meaningful to the patient because all of us are actively engaged.

Dr. Luis Garcia:

Yeah, thanks Jeremy. And I agree with you. I think that we all should be very proud here in Sanford of the top-notch work that we do. I mean, we’re leading across the nation and it’s all because of all our physicians, nurses, front-line providers. And so our gratitude to them, particularly in the last couple of years that have been very difficult for them.

But you mentioned a team, right? And I want to ask you this question. You have 50,000 employees in Sanford, you know – 8,000 nurses, 3,000 clinicians. How do you go about engaging that amount of people in this kind of work to obtain better outcomes?

Dr. Jeremy Cauwels:

I think first and foremost, it’s about reminding people that they got into health care to make a difference. Whether you’re the one of our folks that cleans our floors, or whether you’re the person that’s actually going to be doing surgery on somebody’s brain. We all got into health care when we could have went and worked somewhere else because we thought that we could truly make a difference in people’s lives.

And I think the most important part about SAFE is that it reminds people of the possibility that when you go to work today, you’re going to intervene in a way that makes somebody’s life either better or longer, or both. And so as we do that, I think it’s extremely important for us to deliver on that promise. And the most important way to deliver on that promise is to make sure that each member of the Sanford family, all 50,000 of them, are empowered to, if they see something, say something. If they need to reach out and say, I have a concern, that we’ve built the culture all around them to address that concern before we move on.

Dr. Luis Garcia:

Thank you for that thought, Jeremy. So you talk about the importance of anybody, regardless of your ranking, regardless of your title, to speak for safety and to speak for preventing potential errors. And I think we all have seen the last five years and the journey that Sanford has undertaken with this SAFE approach, and it’s ingrained in our hearts and it’s part of our culture and we’re so proud of it.

Can you share of some of those results? Because there’s that example of, there was a neurosurgeon in the operating room that perhaps listened to a nurse that raised the concern, and because of that we had a great patient outcome. But can you share some of those results that you have seen, “Wow, this is truly making a difference.”

Dr. Jeremy Cauwels:

So what we call those in our world is SAFE stories. They are the stories that tell us just a little bit about what making a difference or what intervening really matters and how it really matters. One of my favorite stories was one of our brain and spine surgeons who was getting ready to do a case. And while he was going through the timeout, talked to the rest of the team in the room, and one of the team members actually raised their hand and said, you know, I’m not sure if this was the spot that we were supposed to be doing this surgery, and I’d like to review it before we move further.

What we call that in Sanford is having a concern and raising a concern. I am happy to say that that concern turned into a short deviation in the timeout where the surgeon and that person in the operating room reviewed the case, realized that they had indeed marked the wrong spot for where they were going to go and proceeded to correct that and do it in a very real way.

Obviously it prevented an error with the patient, prevented something potentially devastating if you’re involved in it from a health care standpoint, because like all of us, nobody wants to be engaged or involved in a mistake. And so if you can find it on the front end and raise that concern beforehand, you can turn the story in a completely different direction.

One of my other favorite stories is actually involving our AirMed pilots and mechanic teams. One of our mechanics recently was working on one of our helicopters and in that helicopter, he was inspecting the very back of the of the helicopter in the tail and found a really small crack in the paint. Now normally a crack in the paint is something you go get it painted over and you don’t worry about it. But this person wanted to look a little closer.

And so, using the skill we call attention to detail, managed to take apart that back portion of the plane, realized that that wasn’t just a crack in the paint, but that crack extended all the way from the tail all the way forward through that entire long tail piece of a helicopter. And we actually had to take the helicopter out of commission and drive that part to the repair facility in Texas and drive it all the way back just to repair it. But that crack wouldn’t have been found had it not been for the attention to detail of that airplane and helicopter mechanic in our air ambulance crew.

Dr. Luis Garcia:

Talking about preventing errors and saving lives in a different way. Right?

Dr. Jeremy Cauwels:

Absolutely.

Dr. Luis Garcia:

I mean, whether you’re in the operating suite or in the front-line or you’re flying helicopters, you are creating a safer place to work and saving lives, right? So that’s a great story.

And you know many other stories, Jeremy. I remember that one story where somebody called in to get an appointment to see their physician and the registrar asked some questions and noted something different with the patient, gave him the appointment. The appointment was for the following week. And further inquiring from the registrar she continued to notice something different. This turns out to be a patient that was actually thinking about committing suicide and needed immediate help. Had it not been for her attention to detail and listening with the intent to help, that patient would not be with us today.

So, once again, it just speaks to the fact that no matter what your ranking is in this organization, no matter what your title is, we all are important, right?

From the environmental services people that help us to all the way to whichever direction you want to take it. We are all important. So thank you for that.

So Jeremy, these are safety stories and I’m sure there’s a plethora of them that you can talk and we could spend here hours. But how do these individual safety stories start translating into trends, cultural trends and outcome trends? And once again, we’ve been five, six years in this journey. Can you speak about some of those trends, those bigger picture findings that you can share with us?

Dr. Jeremy Cauwels:

Certainly. I think one of the things that we talk about on a regular basis is what we call power distance. And power distance really is that space that exists in your head between me as a worker and the person that I have to report something or raise that concern to. And one of the things that’s important about telling these stories and about being receptive when people have a concern, is that that distance can get lowered. And whether that’s because, you know, you’re brand new in the operating room and you’re talking to an orthopedic surgeon who’s been around for 40 years, or whether it’s because you are a new nurse and you’re talking to a nurse that’s been around the floors for 30 years, that power distance isn’t necessarily a physical distance. It doesn’t even have to be a difference in career or degree.

It’s just that ability to make sure that everybody is engaged and everybody is encouraged to speak up when they find something that’s concerning. And so for us, as we talk about that, what we get into is we can actually monitor those safety events. We can monitor and put numbers to how many times out of 10,000 patient days we actually have a serious safety event. And I am very happy to say, as we’ve went down through this journey, we have reduced our number of serious safety events so far by over 50%. And that turns out to be a number that ranks up there in the hundreds of people. And our goal, of course, is to reduce it more than 80%.

Dr. Luis Garcia:

And also that’s in the middle of a pandemic where we were dealing with workforce shortages, where we were dealing with supply chain issues, where there was a lot of instability in the clinical field. And yet our teams, despite all those challenges, happened to reduce that number by a significant amount. Isn’t that impressive?

Dr. Jeremy Cauwels:

It is remarkable. If you look around the country in the same set of circumstances that we were in, what you would find is that many, many hospitals unfortunately didn’t have that same encouragement, didn’t have that same timing to be rolling out high reliability during the pandemic. And they did actually see an increase in hospital acquired conditions and infections while we saw a 60% decrease. So for us, it very much was changing the culture at a time when culture would be the most difficult thing to maintain and the most difficult thing to keep going in a good direction.

Because as you all know, the difficulty with keeping our patients safe while the pandemic was going on, while we were having nursing shortages, while we were all trying to figure out how to wear masks and when to wear masks and when to get our vaccine and all of those things, were the exact things that we leaned into and said, this is how we keep our patients safe and this is how we keep our coworkers safe and we want to make sure we continue to do that.

Dr. Luis Garcia:

And of course, Jeremy, you’re too humble. You always are, and you’re not going to be bragging about the tremendous work that you lead. But I really want you to brag in this conversation about the tremendous work that you do. And I hear that one of our markets right now has gone six months without a surgical site infection and another of our markets had over two years without a CLABSI (central line-associated bloodstream infection). And then you see our hospital start rating continuously go up. I want you to talk about that and what it means for the teams in each one of the markets and your team that is leading all these efforts. These are times where just watching these outcomes is just something to celebrate.

Dr. Jeremy Cauwels:

When we started SAFE, we estimated that our error rate would put us at somewhere around an adverse event more often than every single day in Sanford Health. If you looked at us for a system, I am happy to say that so far we’re pushing to towards two days between an event anywhere in the system. And our goal is obviously to push towards zero. I’ve often said somewhat with a smile that I believe that the best day in Sanford Health is when we can deliver on a day where nobody had a medical error occur at any point during their care.

My honest goal is that we can go a month, that we can go a year, that at some point we get good enough at this, reliable enough at this and that we trust each other enough while we do this, that we can prevent all the errors in health care.

Now you may tell me that’s a pipe dream and I’m OK with that, but it has to be the aspiration of every member of Sanford that only in the paint pool that they took care of that day, they did everything they could to be as close to perfect as a human can and that the person that worked on their left and their right was helping them achieve that level of perfection that allows us to walk home and say, you know what? We did the best we could for every patient we had all day today. And that is truly the goal each time we step in.

Dr. Luis Garcia:

Hey, I’ll buy into that aspiration any day, Jeremy, and kudos once again to you and your team for what you’ve been able to achieve in these last five, six years since SAFE started. So, so let me just ask you something. Why does this continue to be important for us? We onboard 150 clinicians every year and we employ many hundreds more nurses every year. Why does this continue to be important? What would you tell a new clinician that is just joining our forces?

Dr. Jeremy Cauwels:

What I would tell a new clinician is something they already know, even on their best day, they’re not quite perfect. And if they’re not quite perfect, what a better way to come to work than to know the person on your left and the person on your right are there to help you be as close to perfect as you can and that you all have the same goal. And when everybody aligns on that goal that we’re going to deliver absolutely exemplary care, then we can honestly say that if somebody stops me from doing something, they were stopping me from doing something because they had a concern. And that concern was not only for the patient in the bed, but it was for me as a doctor as well. Because I think we all know that we beat ourselves up when we find out something didn’t go as well as it could have.

And it helps prevent those days as well. It helps prevent burnout in our health care teams because we have friends around us that are helping us out. It obviously prevents adverse actions and reactions in our patients, which help us feel better about all the people that are able to leave the hospital under their own power and own care. And it helps our patients directly with the fact that they know they are walking into a transparent organization that’s there to treat them as well as they possibly can and to do it as honestly as we possibly can every single day.

Dr. Luis Garcia:

So, so you mentioned the word burnout in your statements and that is something that directly or indirectly we’ve been feeling in the last couple of years more pronounced than before. Do you feel that this work in any way impacts the level of burnout for our employees?

Dr Jeremy Cauwels:

I think this work impacts the level of burnout directly. I think one of the leading causes of burnout is the feeling that you don’t make a difference. That I don’t need to go to work today or I don’t want to go to work today because my opinion doesn’t matter. And I think the more you can engage people in saying, you know what? Your opinion does matter and every action that you have while you’re inside of our walls is going to help us deliver that perfect patient care. Those people keep coming back to work because they have a mission, they have a longing to keep doing that work well. And I think it gives us the opportunity to do a perfect or nearly perfect job of caring for each patient as we go through. But in order to do that, you have to have people that are engaged and you have to have people that are in it for the right reasons. And the good news is that automatically breeds engaged people who aren’t going to burn out because they knew when they went into work that day, they could make a difference.

Dr. Luis Garcia:

Well, Jeremy, you talk about mission. Our mission is to improve the human condition, right? And we have made it your vision to once again elevate quality and safety as a foundation of our culture. And I think that you have been extremely successful at that. And kudos to you and your team. Aristotle said that quality is not an act; it’s a habit. And I think that you have described throughout this podcast how the excellent outcomes that you have achieved with your leadership have been a matter of habit and a matter of creating a new culture for our organization that would allow us to deliver on that promise, which is excellent self-care. So Jeremy, thank you very much for being here today. Thank you very much for what you do every day and the impact that you have not only in our culture, but in our employees and in turn in our patients. Any closing thoughts Jeremy?

Dr. Jeremy Cauwels:

I would just like to thank you for the time today. Thank you for the ability to get in front of this microphone and talk just a little bit about the care that we deliver every day. And I would like to encourage anybody who’s listening to make sure they understand that this is the way we do things here at Sanford. That our goal is to make sure that every single person has the ability to make an impact on our patients, our residents, and our teams every time they walk in the door.

Dr. Luis Garcia:

Thank you Jeremy. My gratitude. Thank you for being here.

Alan Helgeson:

You’ve been listening to “Reimagining Rural Health,” a podcast series brought to you by Sanford Health. Hear more episodes in this series or other Sanford Health series on Apple, Spotify, and news.sanfordhealth.org. For Sanford Health News, I’m Alan Helgeson, and thank you for listening.

Learn more

• Ep. 9: The evolving customer experience in health care
• Sanford USD Medical Center given ‘A’ Leapfrog Safety Grade
• Where to start mental health care? Your doctor’s office
• Ep. 7: Flexible work and well-being in rural health care

Get more episodes in this series

Caring for patients while making health systems better

Alan Helgeson:

Hello, and welcome to the “Reimagining Rural Health” podcast series, brought to you by Sanford Health. In this series, we explore the challenges facing health care systems across the country from improving access to equitable care, building a sustainable workforce, and discovering innovative ways to deliver high quality, low cost services in rural and underserved populations. Each episode examines how Sanford Health and other health systems are advancing care for the unique communities they serve.

Today’s topic is a conversation on health care’s digital revolution. Our guest is Dr. Robert Wachter, professor and chair of the Department of Medicine at the University of California, San Francisco. Dr. Wachter has authored 300 articles and six books, including the New York Times Science Bestseller, “The Digital Doctor: Hope, Hype and Harm at the Dawn of Medicine’s Computer Age.” In 2020 through 2022, his tweets on COVID-19 were viewed more than 400 million times by 260,000 followers, and served as a trusted source of information on the clinical, public health and policy issues surrounding the pandemic. Our host is Dr. Luis Garcia, president, Sanford Clinic.

Dr. Luis Garcia (host):

I don’t think that there’s any type of introduction that would really give the proper credit to what you have achieved. I think that we could spend three hours just in the introduction of this podcast to maybe get to what would be proper credit. First of all, our gratitude for being such an influential leader in health care, and what you have done benefits all of us, and your work has been so prolific that it has impacted all of us.

So, to that point, you know, I was watching a video the other day where you were interviewing Andy Slavitt. He used to be the administrator for CMS, and then he also is a senior advisor for COVID-19 for President Biden, and he described you as a health care citizen. And that’s a huge honor to be described that way. What are your thoughts about that, the nomination?

Dr. Robert Wachter (guest):

I like that. That’s very sweet. Yeah. I’ve always seen my career as being a combination of trying to be a really good physician and taking that part of my life very seriously, but also trying to make the system that we work in work better. And I think that’s the citizens part, citizenship part of it. You know, when I grew up in medicine, probably you too, the idea that the role of physicians, at least at the time, was you were gonna, you need to be a really good doctor. And what being a good doctor meant was being really good one-on-one with patients. If you did a technical thing as you do Luis, that’d be really good at having the skills to do it. And I was very lucky to have mentors who really taught me that. That’s all really important, but it’s also important to figure out how do you make the system work better?

And I, that came a little bit naturally to me because I was a political science major in college. I was someone who always thought about systems and people and organizations and money and structure and all that. And it’s been one of the great joys of my career to find out that even though I always felt I was a little bit of an oddball, having this interest in policy and politics and medicine, that actually there’s this Venn diagram and it’s really important that physicians are good at that. And so it feels – it’s sort of a nice thing to look back on my career and feel like I’ve made a contribution, both as taking care of individual patients, but also trying to make the system work better.

Dr. Luis Garcia (host):

Yeah. That’s very profound. And, and I know you joke often about being a political science (major) in college and then getting into medicine, and of course that surface in your tweets around the pandemic. But I read a statistic that is just so impressive that at the height of the pandemic, your social tweets were viewed over 400 million times.

Dr. Robert Wachter:

Yeah.

Dr. Luis Garcia (host):

How does it feel to have that kind of an audience?

Dr. Robert Wachter:

It feels like a fair amount of responsibility, and particularly during COVID. I mean, it was important to recognize, I’ve been on Twitter for about 10 years, and going into COVID, I had about 15,000 followers. And within a year, year and a half in COVID, I had 300,000. And that wasn’t because I got any smarter, more interesting (laugh) or from, you know, between 2019 and 2020. It was, I was choosing to weigh in on what was the most important issue of the in the world. And people were desperate for trusted sources. So when COVID hit, it struck me that I have this Twitter presence, and I like communicating that way. I also ran grand rounds at my, at UCSF, at my institution, and that was another platform. And I felt like one of my opportunities-slash-obligations is, can I use my voice and my platforms to help people navigate through this pandemic?

And there was a little bit of time where I had some imposter syndrome, as I often do as a generalist, because I’m sometimes weighing into areas where there are specialists who know a lot more about any part of it. But one of the things I’ve learned in my career is that there is a role for generalists and a role for specialists. And the system works best when you have partnerships between the two of them. And so that’s been true for me in patient safety, where I decided to get interested in patient safety, I realized I needed to find people who really understood cognitive psychology or how the aviation industry kept itself safe, or how nuclear power plant designers do their work. Same thing with when COVID hit, it struck me that there are going to be people who know everything you need to know, or you should know about virology or vaccinology or aerosol science.

But what I could do as a generalist is synthesize that to try to pull it together in a way that made sense to me, and then try to communicate it to others. So it was really very gratifying because it’s, it became very clear that there was an audience for that, both personal, regular people and professionals who said, this is the most important issue in the world. It’s confusing as can be. There’s new information coming out every five minutes. Some of it conflicts with what I thought I knew 10 minutes ago. Can I find somebody out there who’s pulling it all together and putting it out there in a way that I find accessible and interesting? So it felt like a lot of responsibility an obligation to get it right. And I guess the other thing I’d say about Twitter and social media in general is it’s an incredible soapbox.

You can reach a lot of people. There are a lot of crazy people out there who will say things that are just incredibly nasty. And you kind of have to decide whether it’s worth it, whether it’s worth it to be, you know, in that arena. I felt like it was. I felt like the value that I had and others who were doing similar things to communicating in communicating to people about what’s going on, what the new research means, in communicating a way that I hope would be trustworthy, where they would say, this is a person who seems to know what he’s talking about, is not too partisan, is not, you know, trafficking in conspiracy theories, is really using the literature, but also feeling comfortable that I would say to people, you know, my son has COVID and I’m really scared. Or, today I, my lunch, I remember I did this in April or May, 2020, I showed people a picture of my lunch. It was SpaghettiOs and double stuffed Oreos. And I said, this is just what I felt like eating today. (Laugh) You know, the world is so scary. So being comfortable not only tweeting out facts and analysis, but a little bit of your personal story, people seem to be looking for trusted sources that way. So it’s an, it’s a responsibility, but it actually was quite a gratifying number of years.

Dr. Luis Garcia (host):

So, you know, Bob, I love the willingness and the courage to be a public trusted source, and at the same time recognizing the responsibility that that meant for you at the time. Oftentimes, I discuss with our clinicians that COVID started as a clinical challenge. We had a new virus that we didn’t know how it was going to behave. We didn’t know the short and long-term impact of it. And we were trying to figure out every day what was the next step.

But very fast, it became a leadership challenge because you mentioned the different reactions that people had, whether it was politically driven or fear driven, it became a people challenge, a leadership challenge. Talk to me a little bit about how you navigated that as a leader in this nation.

Dr. Robert Wachter:

Well, I think somewhat holistically, I mean, one of the things that I’ve recognized in my career is that medicine is always partly political, partly ethical, partly sociological, partly economic. You know, you’re talking about a system that deeply affects people that is intensely personal. There’s probably nothing more, any more personal that is 18 or 19% of the gross domestic product is that is the major employer in many regions that is going to have to traffic in issues that are, have for many people religious overtones or deeply political overtones. And so, I don’t know how you completely can communicate effectively in medicine without at least appreciating all of the kind of sociological and political context.

And obviously in COVID, it became, those became particularly germane, partly because of the nature of COVID and the nature of public health, where there’s an immediate tension between experts saying things where people may be skeptical of the source of their expertise between authorities, whether they are institutional, like from a health system or governmental is telling people what they should be doing, in part because it’s an infectious disease.

So it’s not all about you as an individual, as it might be when we’re trying to figure out how to treat your blood pressure, your diabetes. In an infectious disease, what you do affects other people. And therefore there’s a communal interest in potentially saying to people, you know, I’m gonna restrict your freedom to walk around without a mask or to not get vaccinated, which of course is in the United States going invariably lead to some libertarian backlash, just the nature of our politic. It’s some ways, the core political question in America really, if you think about the parties, is what is the role of government? What is the role of central authorities? And good people on both sides have very passionate feelings about that. And it became very clear to me COVID was going to bring those out. So to me, I guess one of the things that I bring to the table and pretty unapologetically is taking a political lens and being comfortable with taking up having a political lens through which we see this.

One of the reasons I think that’s so important is, you know, I wrote a book about technology in health care six or seven years ago, and I think we’ve all been somewhat disappointed by how bumpy the road to digital Nirvana has been in health care. And the more I looked at that, the more I came to understand that we treated digitization in health care as a technical problem. We’re gonna put in these big things called electronic health records, and we’re gonna turn them on and they’re gonna make everything better. And it turns out everything is more complicated than that. Everything is socio-technical. Everything has an aspect of behavior and people’s willingness to follow guidelines and the relationship between people and their tools. So COVID brought those out to a greater degree than I think we’re used to.

But I think it is a failing in medical education that we often treat medicine as a technical enterprise where if we can just get the facts out and just tell people, take this vaccine or treat your diabetes, or get more exercise or drink more or drink less, or whatever, that we’re done. And I think we’ve come to recognize, no, we’re not, you know, the technical scientific knowledge is only the starting point of a much harder, and to me, actually more interesting challenge of, OK, that sounds, that’s important, but so is people’s attitudes, behaviors, the money, the politics, the policy. And I think COVID just brought that out in an incredibly interesting and obviously very challenging way.

Dr. Luis Garcia (host):

The book that you’re learning to was published in 2015. And I have it here in front of me, “The Digital Doctor.” And, and by the way, it’s a fascinating read. You talk in 2015 about many of the things that we’re dealing with right now as when, as it relates to the relationship of technology and physicians and patients. So, I mean, you are a visionary. You’re not only a leader, but you’re a visionary.

Dr. Robert Wachter:

You know what? Who is a visionary, I think is someone who has their eyes open (laugh) and asks good questions. And the only thing that was that if that book is visionary at all, it was my recognition that electronic health records were going in, health care was experiencing finally its digital moment. And when I looked around, all I saw was unhappiness. All I saw with doctors complaining about their electronic health records in ways that they did not complain about their iPhone or their, or their desktop computer that in many other, or, or complain about Netflix or complain about Amazon in other walks of life. It struck me that digital came in and yeah, there were a few bumpy years. I just noted yesterday, and Netflix just announced that they’ve mailed out their last red envelope after mailing out billions of red.

So, you know, that’s how they started before they became the Netflix we know today. So it’s not like on day one they figured it out. But in other industries, I saw digital come in, and really within a relatively short period of time, people said, this makes things better in this part of my life. And in health care, digital came in, and in many ways it made it worse. And in funny and unanticipated ways. So my epiphany was when I asked people, why is that the answers I got from doctors or tech executives were wildly unsatisfying? They made no sense to me at all. And I just said one day, particularly after we committed a really terrible error at UCSF, that could have only happened because of a digital system and it’s interfaced with people, I just said, I need to understand this better.

So that’s a long way of saying, I think what was visionary was my recognition that I didn’t understand why digital was so hard and why people were so unhappy with their digital tools and that I needed to, and ultimately found the time and energy to go out and just understand it better. And to do that, I had to talk to a hundred different people from every walk of life that I thought was relevant and try to synthesize it into a story. And that’s nice to hear. I haven’t gone back and read that for the last few years, but it’s nice to hear that some of it is held up pretty well. But it was only because I had the privilege of talking to a lot of very smart people who helped me understand why this path was so bumpy.

Dr. Luis Garcia (host):

One of the really smart people that you talked to is Dr. Relman. And Dr. Relman shares in your book, not his perspective as a physician, but his perspective as a patient. Yeah. Of how he fell. He had several fractures and he ended up in a very lengthy recovery. And he speaks about how it feels to be a patient in the era where we perhaps are being too concentrated on paying attention to a computer. So it’s not only about the physician, right? It’s about the patient.

Dr. Robert Wachter:

Yeah, of all of the unanticipated consequences that may be the most interesting and important one. The way I came to know that particular consequence, first of all, I remember reading an article that my friend Abraham Verghese who’s at Stanford wrote in the New England Journal around the time my book came out, maybe a little earlier, where he coined the term the iPatient. And he said, I won’t get the quote exactly right, but he basically said, the patient only exists to keep their digital medical record alive. You know, that they basically are a representative of the physical person. This person with their life and a family and all of the things that make us human is basically sitting in a bed as an avatar for what we are paying all of our attention to, which is the digital representation of the patient.

And of course, that only gets worse over time as we get more and more data and as we’ll talk about tomorrow as AI gets more sophisticated and better. And one of the seminal moments for me was the first article in the popular press about scribes. I don’t know if you use scribes at all here at Sanford, but

Dr. Luis Garcia (host):

We do. Yeah.

Dr. Robert Wachter:

We use a ton at UCSF. The first article that brought scribes to national attention was in the New York Times in about 2015 or ‘16. It was written by my wife who writes for the New York Times. And it happened because I came home one day and I said, Katie, you know how – and she’s covered technology for the Times for a decade before that – I said, Katie, you know how in every industry they computerize and immediately start laying off people? Only in health care could we figure out a way of computerizing, and now we’ve gotta add another person into the room so the doctor and the patient can look each other in the eye.

And she said, wow, that’s interesting. And so she wrote the first big article about scribes in the New York Times. Scribes are an epiphenomenon. Scribes are a manifestation of, OK, you take the patient’s data and you put it in this computer system and you create pretty clunky computer systems where even the process of just doing a regular search is not that easy and you markedly increase the documentation requirements for the doctor. People always blame that on the electronic health record. It’s not really the EHR’s fault. The EHR became an enabler for Medicare to ask you to document these things. For, to, for billing or for someone measuring quality for all I know you are asking people to document certain things because that’s associated with higher quality medicine or demonstrates how sick the patient is. But the consequences of that is the doctor who’s sitting there who you want to have, be making eye contact with the patient is now spending mu much of his or her time looking down at the computer screen.

And the patient notices that very quickly and says, it looks like the doctor’s actually not paying attention to me. What’s happened here? And so what’s the cure for that? Interestingly enough, this cure will probably be better technology. The cure will be digital scribes, will be that you and the systems now are getting good enough that they’re pretty much ready for prime time. That you’ll be having a conversation with the patient. You’ll be able to make eye contact with the patient. That conversation will not only be transcribed, which is easy to do, but that doesn’t help but turned into a doctor’s note. And as the AI gets better, you can actually turn it into a doctor’s note and say, make it in the form of a surgeon’s note, which might be different from an internist’s note. You can even say, make it in the form of Bob Wachter’s notes.

And it can go and look back and look at my last 3,000 notes and put it in that form. Which is, so the technology in some ways creates the problems. And then ultimately, we have to have the technology bail us out. But while we do that, we also have to take a step back and ask some fundamental questions. If the patient is perceiving that I’m not paying attention to them because I’m busy paying attention to this computer screen, that is immediately going to lose trust. And when we lose trust, we’ve lost everything. But the patient doesn’t trust that you’re there because you care about them deeply and you’re listening to them with all of your energy. You, we’re all screwed. I mean, it really is very hard to have the right kind of doctor-patient encounter that we need. So that was just one of many unanticipated consequences that I saw that had nothing to do really with the quality of the digital interface, with the quality of the computer.

They all had to do with what happens when you change the nature of the work, digitize it. None of it’s anticipated.

Another one I went into in the book, which a lot of people have commented on, is in the old days, geezers like me, went down to radiology every day to look at their films. When I talk to the residents now and I tell them that story, they say, what’s a film? (Laugh) They’ve never seen a film. What’s a view box? There was a view box. They have no idea what I’m even talking about. So periodically when I’m on the wards, I’ll say to my team, let’s go down to radiology. And they’ll look at me like I have three heads. Like, why do we need to do that? Don’t you know you can see the image on the computer? I say, yes. Don’t you know you can read the radiologist’s report? I say yes.

And then I take them down and they’re invariably awed because you go down there and the radiologists now welcome us down there, in part cuz they recognize that if they don’t, the younger people will never go down there. And you have this absolutely wonderful, really important conversation, give and take between the front-line doc and the radiologist and the radiologist reports said so and so and so and so. But then you say to them, well let me give you a little bit of clinical context. This is the story. Oh, the radiologist says, well then I would really worry about this and this. So in that exchange, you’re providing better patient care. You’re getting smarter cuz you’re learning from the radiologist. The radiologist is getting smarter cuz they’re learning from you. I’ve gone back and spoken to the people that were at the leading edge of digital radiology and asked them, did they have any clue, any inkling that digital radiology would change the nature of the front-line clinician-radiologist interface?

And none of them said it even crossed their mind. And of course, in retrospect it’s obvious, why did we go to radiology every day? Why did we have radiology rounds? It’s designated time for radiology rounds every day because it was only one place where you could see the film. It lived in only one place and it was in the radiology department. Once it became digital, you no longer had that forcing function. And the same thing is true when I go to the wards. I’ll go to the wards and there are nurses all over the place. There are no doctors cuz the doctors went and see the, saw the patient, and then they went off into their room, their digital room often where they’re hanging out with each other to do their charting. In the old days, you spent your entire day on the floor because there was only one physical copy of the chart. There was only one place where the lab test came to.

So that’s just, those are examples of these unanticipated consequences that happen that are really not about the technology itself. They are the kind of sociological community relationship things that were built around the lack of technology. And we’re just not smart enough and creative enough to understand what’s gonna happen when the technology comes in until we see it. And it’s like, hmm. And then if you don’t have geezers like me around anymore, the young people never knew there was such a thing as radiology rounds. So they don’t miss it.

Dr. Luis Garcia (host):

It’s just amazing to see that despite the tools and technology and what are advancements we have, it really comes down to basic human interactions. Right? You cannot take away the value of that. And whether you call yourself a geezer leader or whatever title you wanna give yourself, I gotta tell you, I’m gonna call you a mentor because that to me is mentorship.

Dr. Robert Wachter:

Thank you.

Dr. Luis Garcia (host):

And I’d like to ask you a question. Nobody gets to the caliber of who you are by randomness or you know, by luck. Had a lot of work, a lot of mentorship. Do you recognize one mentor in your life that you go like, yep, that person changed my life because of whatever?

Dr. Robert Wachter:

Probably the most influential mentor I’ve had is a guy named Lee Goldman who was chair of medicine at UCSF in the mid-‘90s to the early 2000s, ultimately became the dean at the School of Medicine at Columbia. Lee’s this – and so it’s always shocking to me when I’m now the chair of medicine at UCSF. So the fact that I have that job when I think about how incredibly smart and strategic he is, so I have a little bit of imposter syndrome every day. But when Lee came, Lee had been a resident at our institution, went off and spent most of his career at Harvard and then came back to be chair of medicine. And he asked me to take on this new job. I had been residency director at the time.

He said, I want you to be my right-hand person running clinical work. And I said, I love running the residency. And he said, yeah, but basically stick with me. We’re gonna do big things. I want you to be my person and your level of growth in that job will be greater than what you would’ve experienced in the residency. And I, that turned out to be right. The things I learned from Lee, one is he hated the status quo. He just said, and that’s how the hospitalist field happened. So Lee and I wrote the first article that coined the term hospitalist together. And that happened because Lee said to me, you’re in charge of the inpatient medical service. I look at the medical service and it looks exactly the same as it did when I was a resident here 20 years ago. That can’t be right.

So the instinct that he had when a system that had not changed in a decade had to now be wrong because the forces of status quo and inertia are so strong, and I’m lazier than that, it was like, that’s not, would not have been my instinct. It is now when I see a system that hasn’t changed, whether it’s the way we pay people or the way we organize something, my instinct is always that can’t be right. How do we make that better? And that’s where the hospitalist thing came from. We sort of thought about how do you change inpatient medicine? Came up with this concept that actually it probably needs a separate specialist, but not a subspecialist. Someone who’s a generalist who is in charge of this general hospital care but lives there all the time. And the model for that was really what had happened in emergency medicine and what had happened in critical care medicine 30 years earlier.

So that’s kind of how the whole hospitalists field happened. But the one moment that encapsulated Lee to me, and I think I’ve tried very hard to pay this forward, is a very early meeting I had in his office. He invited me in, I’m sitting on his couch, he’s behind the desk, he’s on the phone, he’s editing the Cecil textbook, the big textbook of medicine. He’s the editor, he’s editing it while he is on the phone while having this meeting. He’s one of these remarkable multitasking people. And it was clear he was having a meeting about some leadership thing on the phone. He had the person on speaker so I could hear, and it had something to do with money and space and parking and the usual stuff. And he says to the person, Joe, can I put you on hold for a second?

And he puts the person on hold and he turns to me and he said, this person wants this and this and this. This other person wants this and this and this. Here’s the big picture, like what we’re trying to do as a department. He said, what would you do? And I said, my God, he’s pimping me on leadership the way, you know, in the old days we used to do about clinical medicine presenting a tough case. What would you do? And he is investing in, he believes in me as a potential leader and is going to basically teach me how to do this and is gonna challenge me. So I babbled something about what I would do. And he said, not exactly (laugh). And then he put the person back on speaker and told me what he did. And I said, this is a good decision to work with this guy because he takes one of the things that he wants to do. I now recognize what he was doing was succession planning. Really what he, what he recognized in me, something I didn’t recognize in myself was that I had some leadership potential and that he was going to mentor me and that I was gonna be watching everything he did. And periodically he was going to stop and ask me a question or stop and contextualize what he was doing. So I would learn that. And so a huge amount of what I think I do in leadership, I’ve learned from him.

Dr. Luis Garcia (host):

I agree with you that teachers see on us things that at times, oftentimes, we don’t see on ourselves. And a good teacher mentor is one that allows you to exploit that in a productive way. So, I love that story. I think that you describe also a situation in your life where you found a fork on the road and you had to make a decision of this or that you had a promising career going to the right, but perhaps a promising career going to the left or vice versa. And you chose – so talk to me about risk in your life and other times in which you went like, oh, what would I do? And what helps you make those decisions?

Dr. Robert Wachter:

Yeah, I, the one that comes to mind the most, and I tell young faculty this at our place, there are very few successful, whether it’s faculty members or people who’ve had other career paths, but very few. I find that when you say to them, you know, was it completely linear that from the time you were in diapers to where you are now, you had this view of what you were gonna do and everything just happened at lockstep and you got the right skills and the right qualifications? There’s almost no one who tells that story. The story is always a bump in the road. Something went wrong or an opportunity arose that they couldn’t have anticipated. And a lot of it is, you know, have you positioned yourself to be open to that? Are you asking questions? Are you taking in, are you sort of looking for new knowledge, new people, new relationships?

Because a lot of it is shots on goal. A lot of it is, you know, creating enough opportunities for those things to happen and then recognizing them when they happen. I think my interaction with Lee was one of them. When Lee asked me to take on this different job than the one I had, and I loved the one I had, but he convincing me and ultimately the making the right call that changing jobs to work with him in a larger leadership or a different leadership role was a good call. Probably the biggest one for me was I finished my residency in chief residency. I did a fellowship that was largely focused on research, epidemiology, outcomes policy at Stanford. And then I came and joined the faculty at UCSF and I got the job you’re supposed to want to have in academia, which is quote “protected time,” meaning I had about 70 or 80% of my time was funded by the system for me to do research with an expectation that in two or three years I’m gonna bring in enough grants to pay for that portion of my time.

So I was about 20 or 25% clinician, about 75% researcher. And I had written a number of papers up to that point. And I, people saw me as having a lot of research potential. I put together a big multicenter grant for what I was working on at the time, which was how AIDS patients did when they went to the ICU. Just to show you how long ago that was. You know, there were almost no AIDS patients that go to the ICU anymore. But back then there were. There were a ton. I spent a lot of time on this grant, put it out there, sent it off to the funder and got turned down. You know, it wasn’t even close. And I looked at it and there was a little bit of thumb sucking about, you know, oh, you know, it hurts to get rejected.

But for me it was a moment of introspection, which is, do I want this as a career? Do I want my incentive to be, I’m always trying to publish the next paper? Write the next grant? To me, I recognize that I did. I thought I’d maybe be successful at it, but I didn’t think I’d be that happy. I didn’t think I had the fire in the belly to be that person. And I have hundreds of people like that who now work for me. I admire them deeply. I think it’s an amazing thing that they do. And they’re incredibly impressive. I just think I’d be great at it. And I didn’t. And I thought I was too social. Cuz I think the incentive in that system is you’ve really gotta close the door and write the next grant. And I like talking to people and learning things more than that.

And so decided that that was not gonna be my career path. And I actually did not know what my career path was going to be because I liked being in academia. So it was like, all right, I don’t think I wanna be a full-time a hundred percent clinician. I’m not gonna be a researcher who’s 70 or 80% research and research funded. What do I do? And it was sort of through that period of reflection that I said, I kind of like leadership. I never saw myself as a leader. I wasn’t the president of my high school class. I always thought I was a little bit too goofy. But I was lucky enough to become a leader at an age where people, goofiness became authenticity, (laugh) that the characteristic of someone who’s reasonably accessible is a good listener, became leadership skills that were, became increasingly valued from an, in a prior era where the leader had the most gravitas was really scary, was someone who was very hierarchical.

The idea of a leader being someone who might be accessible, be someone who, you know, people can call by their first name was, became acceptable. And it was like, oh, OK, maybe I can be decent at that. And then it became one leadership role after another and became something that I over time recognized that I liked, was good at and gave me a platform. Even though I didn’t want to be a full-time researcher, I liked writing, I liked thinking, I liked being a thought leader. And through my leadership roles, I recognized that not only could I carve out enough time to do some of that writing and leadership work, but also it gave me an altitude in my health care organization where I would be seeing things that would give me insights into technology or insights into patient safety or insights into how we organize hospital care that I wouldn’t have had if I didn’t have a leadership perch. So it all, you know, I mean, I can describe it now and it sounds like it all was planned and intentional. It mostly was happenstance and just getting into the right place, the right time.

Dr. Luis Garcia (host):

But I love that story, Bob, because I think that by nature we always incentivize our younger generations to look at their strengths, right? But I don’t think we pay attention enough to what, recognizing what your weaknesses are and not engage in a journey where your weaknesses were surfaced, you know. So I, and I think you perfectly describe an instance where you identified, this is not for me, this is not where my strengths are, so I need to pivot and do something different. And, I think that’s the – you talk about the holistic human being and recognizing where you’re good at. What are you not good at? And how do you allow that to drive into your life? So let me ask you a question. Have you ever made a mistake? Have you ever disappointed somebody?

Dr. Robert Wachter:

(Laugh) I had a failed first marriage. So I, I’d say that would be the biggest mistake I’ve made in my life and didn’t seem that way at the time, obviously. But that was hard cuz I’d been successful in most of the things that I had done and professionally successful. And, you know, arguably your marriage becomes, is one of the most important decisions you make in your life. And I remember holding onto the marriage for a number of additional years cuz my kids were in high school, and I kind of had decided that my ex-wife and I almost collaboratively decided we would stay together until they finished high school. I remember talking to an old college friend one day and struggling with this in part because I really felt like it was a failure and I wasn’t used to failing in many things.

And I said, you know, partly we’re staying together for the kids. And he said, the most important lesson you can give your kids is there’s no problem that’s so bad that you can’t figure out a way of making it better. I thought that was really profoundly important. And it turns out that we ended up splitting and it was amicable and been married now for the last 15 years to the most spectacular person in the universe and we’re incredibly happy. And, but that, as I think about mistakes I’ve made, that’s probably the biggest one. But I think it also taught me some incredibly important lessons.

Dr. Luis Garcia (host):

And how do you rebound from, from when you hit bottom right? And I – to the point that you dedicated this last book to your current wife Katie.

Dr. Robert Wachter:

Well, partly because she’s wonderful and partly because I came home the day I decided to write the book was this day, I was chairing our patient safety committee and we gave a kid 40 Septra tablets. Forty. Forty antibiotic pills when the correct dose was one. It was just a breathtaking error. And it only happened because of digital systems interacting with humans, but all the usual stories of alerts firing, but people ignoring them because they got a hundred alerts a day that were all false positives and several other things. I came home at the end of the day and I said, Katie, I think I need to wanna write a book about this. I said, you know, we’re at this incredible moment of digital transformation. I thought it was gonna be so great and it’s not great. And she said she said, I think that’s a great idea.

You should write a book about it, but you need to do it journalistically. As I said, she’s been a journalist for 40 years. She’s quite good. She says, you have to do it journalistically. And I said, what does that mean? And she said, it means you’re gonna have to go out and talk to people. And I said, I hate people. And she said (laugh) she said, you know, I was joking. She said you know, you’re actually gonna love doing this. I’d never done anything like it. And so I took a year partly on sabbatical and interviewed everybody I could think of who had any insights. So everything from the CEO of Epic to cognitive psychologists to interviewing Captain Sullenberger, the pilot who landed on the Hudson, who said, you have to go to Boeing to see, to talk to the cockpit engineers there.

Next thing I know, I’m on a flight to Seattle and I’m flying a triple 77 simulator in Boeing headquarters. So one of the most interesting, rich experiences, but it was really only through Katie sort of seeing that the only way to get this story right was to go out and learn everything I could about it from a lot of different vantage points. So dedicating it to her was partly that, and partly we have, one of the metrics of a marriage is we actually are one of the few couples I know who can edit each other and not kill each other (laugh), which is a hard thing to do, but she’s a wonderful writer and I’ve learned a lot from her.

Dr. Luis Garcia (host):

Well, thanks for sharing that story. I didn’t know that what prompted you to write that book was that medical error with a child.

Dr. Robert Wachter:

Absolutely. When it happened, I went to the head of risk management and I said, this story is so rich, there’s so much in it that are general lessons about digital human interfaces that I think we have to disseminate this. And I said that to the head of risk management and she said, oh, that’s a great idea. Let’s have some, you know, let’s do grand rounds. And I said, well, I’m actually talking about writing a book about it. And I think her hair went on fire (laugh).

It’s like, what? You’re a risk manager. It’s like, this is not a great idea.

Dr. Luis Garcia (host):

You’re gonna make public what? (laugh)

Dr. Robert Wachter:

Ultimately the CEO of our health system, I felt it was important enough for him to, that he needed to greenlight it. And he thought about it for about a week and then then said, you know, one day he said, you know, this story’s so important that I want you to write about it. So I thought that was really a brave and courageous thing to do, but I think the right decision.

Dr. Luis Garcia (host):

I agree. And it was the right decision on, on his behalf as well. And so somebody would argue that you have done so much and you have reached levels that not every human reaches. Do you think you have reached your potential? What’s next for Bob Wachter?

Dr. Robert Wachter:

I’m really proud of the things that I have done, and I’m never good at saying what’s next. Because when I look back at my career, what I see is a thread of leadership roles that have felt important and interesting where I felt like I could make a difference pretty much all at UCSF. So in a big academic institution and one I like very much and respect and like the culture, and like living in San Francisco, but my career has been a succession of every five to seven years. An issue that seems really interesting to me, that fits into my sweet spot, it’s gotta be pretty clinical. It’s got, it can’t be insurance policy, it has to feel very close to the ground. So very clinical often has a training aspect to it, but all has money, policy, politics, ethics, sort of rich sociologically complicated.

And that has led me to studying the politics of AIDS and activism to studying the organization of hospital care, to studying patient safety, to studying the digital transformation of medicine to studying COVID. COVID is drying up now, thankfully. So I suspect I have one or two more of these in me, but I’m never good at predicting them. And it’s not like I say, all right, it’s seven years, it’s time for me to do the next thing. It usually is at seven years or so, the last thing is feeling a tiny bit stale and I’ve kind of done what I can do, and a new thing emerges. And I just say, that is so unbelievably interesting and I think the way I think about the world, maybe I can make a contribution. So it sort of feels like AI is sort of the next step of the technology thing I’ve been paying attention to. It feels like the new advances in AI are that, but what that means in terms of, I don’t know, writing a book or just being an interested observer, I’m not sure. We’ll have to see.

Dr. Luis Garcia (host):

Well, I can’t wait for the next five to seven years cycle. And I definitely wish that for you, it’s not two or three more, but many more seven year cycles because your contributions have been just phenomenal. Bob, this has been a pleasure, an honor for me to sit here and share some thoughts. Any closing thoughts that you want to share with the new generations, with the new leaders?

Dr. Robert Wachter:

I’ll tell you a quick story to end this. At my institution several years ago, we were talking about all the changes in medicine, technology, payment change, regulatory change, everything else. And one of the very senior, highly respected clinical cardiologists got up at the end of this meeting. He usually didn’t speak much at these meetings and he said something I’ll never forget. He said, you know, this could be worse. And I was very surprised cause he was definitely old school. I was very surprised. But then he went on and he said, I could be younger. And I like that story. First of all, I found it very amusing, but I actually think he’s wrong. I actually think that the world we’re entering in health care is one in which the capacity to take care of patients in a way that is better and higher quality and safer and more satisfying, more equitable and less expensive.

I think we haven’t done very well in any of those regards. I think we have the capacity to do that in part through digital systems. But digital systems married with people who never forget about the human aspects to it. So I think it’s gonna be up to great systems and you happen to be in one of the great systems in the United States to think about how we leverage the technology to make care better, safer, cheaper. And I don’t think he’s right. I don’t think medicine has had its golden age. I think we will over the next 10 or 20 years, and I look forward to doing what I can to help. But I think I’m a little bit jealous of, you know, my daughter is an intern in medicine now, so I’m a little jealous of people of that generation cuz I think they’re gonna see some spectacular changes that are gonna be for the better.

Dr. Luis Garcia (host):

Well Bob, thank you for those closing thoughts. And I agree with you. I think that the next two decades in medicine are gonna be positive and energizing. And, and I don’t think we have reached our maximum potential. So thank you, Bob. Whether somebody sees you as a mentor or as a teacher, or as a leader, or as a clinician or as a generalist or as somebody that coined the term hospitalist, it doesn’t matter to me. You are the definition of a great human being, and it is an honor to spend some time with you today. And to our listeners, I wish you could be here to shake Bob’s hands because he’s just a phenomenal leader and influential person in our health care. So Bob, thank you very much for spending time with us.

Dr. Robert Wachter:

Thank you, Luis. It’s really been my honor and it’s just a great pleasure to visit you and get to know your system better.

Alan Helgeson:

You’ve been listening to “Reimagining Rural Health,” a podcast series brought to you by Sanford Health. Hear more episodes in this series or other Sanford Health series on Apple, Spotify, and news.sanfordhealth.org, or Sanford Health News. I’m Alan Helgeson, and thank you for listening.

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Servant leaders make a difference in daily practice

Alan Helgeson (Host): Hello, and welcome to the “Reimagining Rural Health” podcast series, brought to you by Sanford Health. In this series, we explore the challenges facing health care systems across the country from improving access to equitable care, building a sustainable workforce, and discovering innovative ways to deliver high quality, low-cost services in rural and underserved populations. Each episode examines how Sanford Health and other health systems are advancing care for the unique communities they serve.

Today’s topic is a conversation around servant leadership and the difference it makes in the daily practice. For clinicians, our guest is Dr. Craig Uthe, family medicine physician, and Sanford Health enterprise director of clinician professionalism. Our moderator is Dr. Luis Garcia, president of Sanford Clinic.

Dr. Luis Garcia (Moderator): Thanks for joining us today, Dr. Craig Uthe, with an exciting topic, which is servant leadership. And I was just prior to starting this recording, I was having a conversation with Craig about how the last couple of years have been interesting to say the least for clinicians and how we just feel beaten down and devalued, and yet we have the most honorable profession, right? Where we get to use our talents and our gifts to help people in their greatest needs. And we need to continue to show up unlike restaurants and malls that they can close shops or cut down tables. You know, we have a commitment to our patients and we need to continue to show up. And I think our clinicians have done that and have excelled at doing that despite the circumstances. And a lot of that during the pandemic and the post-pandemic era has been leadership. Craig, you and I have had conversations numerous times about one thing is to have a title, and another thing is to have is to be a leader, right? Well, and to be a servant leader.

Dr. Craig Uthe (Guest): Yes. Being a medical doctor, MD, DO, nurse practitioner, PA, that is a title, that’s a formal leadership title. We are looked to as leaders whether we want to or not, and there’s responsibility that goes, goes with that. And when I ask people, why did you decide to become a health care professional? Always in that answer somewhere is, well, I want to help people. Seems like a, you know, very simple answer, but it is, gets to the core of why we go into medicine. And sometimes it’s not easy to remember that if you get beat down through a pandemic or if you’re up all night or through the rigors of being a physician, it’s not always easy to be in that job and to have that title.

Dr. Luis Garcia: You ask people a question, why do you become a physician? That’s a great introductory question for a great conversation. Let me ask you the same question. Why do you choose to become a physician?

Dr. Craig Uthe: Thanks for asking me. Again, it’s that proverbial, I really wanted to help people. I grew up in Sioux Falls, South Dakota. I went to Augustana College at the time, now Augustana University. I was a camp counselor in high school, in college. I worked at a YMCA camp in high school. And I remember they had the triangle of the body, mind and spirit. And I loved that analogy of the human. And so I wanted to go into profession that would take care of the body, mind, and the spirit.

I grew up in a Christian background. I’m a faith-based person, so the spirit is important to me in a person’s health. And I got to the last two years of college Augustana, but it’s called a four-one-four curriculum. So you have two semesters, and in the middle of that you take one course.

And so in my junior year of college, I shadowed a second-year family practice resident doing community medicine in Sioux Falls in the area. Went down to Keystone Addiction Treatment Center, saw my first delivery of a baby, worked in the clinic, loved it. Senior year I shadowed the three hospital chaplains at the time, Sioux Valley Hospital, now Sanford. And I loved them both.

And I said, you know what? I’m gonna apply to med school once, if I get in, I’m meant to be a physician, and if I don’t, I’m probably gonna go into some kind of a ministry. And my father, my uncle both said, well, Craig, and we think you could probably practice, you could probably minister to people as a physician easier than you could practice medicine as a clergyman. I thought, OK, I agree with that. And I got into med school and the rest is history.

Dr. Luis Garcia: Well, the rest is history. But that history is I think, full of successes and full of achievements, and more importantly, Craig, full of influence. I think that if I were to count the many, many people that you have touched and that you have helped get in a better place, I don’t know that I could. There’s so many of them. And in the medical community, you are recognized and respected.

Talk to me a little bit about that transition. You get into medical school, you become a family doctor, but yet you discover that you have other gifts that some of us wish we could have, you know, which is, once again, of leading, influencing, helping people outside of the clinical work.

Dr. Craig Uthe: Well, I like to remind each other as physicians that it’s a privilege to be a physician. Did I earn the right, I achieved things by getting into med school. You’ve achieved something. I talked to first year medical students, they say, congratulations on getting here. You have achieved something. But never forget what a privilege it is to have the opportunity to have the influence. I love that word influence. I’ve heard that term used as the definition of leadership. There’s a leadership guru named John Maxwell, and he says, leadership is measured by influence, nothing more, nothing less. And it’s that influence that’s the key to being a physician, having that influence.

Dr. Luis Garcia: So sometime in your development, your own individual personal development, you figure out that you’re being influential. Talk to me about that. Young Craig Uthe graduating from medical school and discovering, wow, not only can I be a great clinician and take care of however many patients, but I’m actually, I have other skills that I’m discovering and that I really would love to continue executing.

Dr. Craig Uthe: I realized early on in my career, I’m not sure where it was that intellect is not the only thing that’s needed in medicine. I remember for some reason I was probably about, I was a fourth-year med student and a female OB/GYN physician at Sanford, I looked at her and I thought, how does she know all that stuff? She was probably 40 years old at the time. Everything – how does she know that? Am I ever gonna get to that point and go 10, 15 years later? There was a moment I just caught myself speaking to someone. I can’t remember it was a patient, or if it was like the colleague. I thought to myself, oh my goodness, I have this knowledge base now. We all get that just through the learning.

We’re all forever learners. As physicians, we have altruism, we care about people, we all possess that intellectual curiosity. We love science, we love learning. We’re forever learners. And I remember just thinking, oh my goodness, that intellect is so important. It’s not optional, it’s required, but there’s so much more required. I had Dr. Mary Nettleman, dean of the medical school recently, she asked me one time, Craig, we’d love to bring you on board on our team, and we wanna graduate great physicians at the University of South Dakota. And I said, Mary, I love that. I just have one question. What’s your definition of great physician? And her response to me was, why don’t you go out and find out?

And I’m still looking when I ask groups, and I’ve asked people having breakfast that are retired at Hy-Vee, I’ve asked middle school classrooms, I’ve asked medical people, I’ve asked non-medical people what makes a great physician? And there’s some very similar patterns to the answers. And it’s, well, I want somebody that listens. Compassion, caring, have integrity, good listener, honest, forthright, you know, it goes on and on. And then finally somebody says, knowledge, competency, technical skills. Rarely is competency in the top three statements that people respond.

Dr. Luis Garcia: Isn’t that interesting? But yet you ask our medical professionals, how do we define ourselves? And most of the times it’ll be about achievement. Yes, it’ll be about title, it’ll be about letters behind your name. It’ll be about competencies. Right? But yet, regardless of the specialty, regardless of the condition, patients say, what I love about my physician is that he or she listens to me.

Dr. Craig Uthe: Yes.

Dr. Luis Garcia: That he or she looks at me in the eye. It just humanizes our profession doesn’t it?

Dr. Craig Uthe: There’s the saying, nobody cares what you know until they know that you care. And that’s so true. Even to the point of medical litigation. Evidence shows that physicians, that they get sued. No physician’s perfect; there’s always gonna be the chance of making a mistake. People are forgiving. If their physician cares for them and they’re doing the best they can do, it’s unlikely they will be sued by the patient. The physicians that get sued are those that are seen to be uncaring, detached, and not showing interest in the patient.

Dr. Luis Garcia: You know, it’s interesting you say that. When I teach surgical residents, I always tell them, you know, when you have a complication is not the time to look the other way. It is time to get the closest to your patient, not because of fear of getting sued or not, it’s just the right thing to do. Right?

I mean, absolutely it’s our responsibility, but to that point, the clinicians that are sued are the ones that turn their head out their head away. Right? You know, Craig, you’re talking a little bit about influence and about being a leader and about creating a difference for patients and what matters and what doesn’t matter to patient or a member of the community as we define the great physician. But what about a great colleague and a great role model? Do you think you can apply those same concepts?

Dr. Craig Uthe: Oh, absolutely. You know, servant leadership – I, for me, the definition of servant leadership is, first servant is we’re in a service industry, medicine, my job is to serve others. So it’s not about me. I don’t care what job you’re in. I don’t care what line of work a person does. We are self, each people, I mean, we’re very concerned about ourselves and we should be. But when it comes to being a physician, the privilege we have is people put their lives in our hands and we have a responsibility and an obligation in that then to do what’s best for them. My job is not to be liked, although I want patients to like me. My job is to develop the respect, the trust that’s involved in that type of work. And that just takes time and it takes giving. How do you give of yourself in that situation?

And from a very pragmatic standpoint, in the patient room, I developed a very, very simple internal guide that helped me. And I’d say, OK, does this person need an invitation from me? Do they need to be encouraged or do I need to challenge them in their health right now? If I’m telling them what to do, I’m losing. Because nobody likes to be told what to do. They like to discover what they want to do and then own it and do it. And that’s the leadership part of the definition. It’s again, it’s having influence. That’s how you measure it. Well, how do I influence someone? Well, I do it by showing that I care about them and I want them to be successful. I want them to achieve the things that they want in their life. Sounds so simple. Yet, it is so difficult to carry out.

Dr. Luis Garcia: That’s one of the reasons why you were such a respected, or you are such a respected family doctor. Right. But now leadership inside the medical community. Right? We as physicians don’t like to accept that we need help. We don’t like to accept that we can be vulnerable, that we can be human beings. So as a leader, colleague of other younger partners or even older partners that could be struggling, tell me about that. How do you navigate a relationship where there might be egos involved, where inherently we don’t accept weakness as physicians? We don’t like to get help because we’re used to help people not to be helped. So navigate me through those.

Dr. Craig Uthe: Let’s start with our strengths. Again, I’ll meet with medical students, I’ll meet with physicians, and I’ll say, I know a few things about you. Number one is you’re intelligent. Well, be, again, be thankful for that. Be grateful. Not everybody has the mental capacity to be a physician. You do. And, accept that for what that is. OK?

I also know that you’re probably very competitive. Perseverance is probably required as much as intelligence to be able to get to med school and then get through med school. So I love, love your perseverance.

Also, there’s a good chance you’re quite perfectionistic and you’re quite competitive. And the problem with perfectionism and competition is the person who might be the one you’re the hardest on is the person that looks at you in the mirror in the morning. So what makes you really good is also what could make you very vulnerable.

And so that’s where self-care trumps everything. If you can’t take care of yourself, you’re not gonna be able to sustain care for others. And so the irony and the twist of servant leadership is you can only serve others if you take care of yourself first. So some people get into the servant line and end up getting trampled over, become a doormat. That’s very unhealthy. And again, when we deal with individuals, we will find that that does happen. And it’s because of the perfectionistic, it’s the competition. But again, it’s that person that sees them in the mirror in the morning, and I say, that person that’s talking to you in the morning, when you look in them in the mirror, you need to kick them out of the house. You wouldn’t let anybody do that to you or to anybody you love. So why does it happen to yourself?

Why do you let that happen? And I find that is very helpful for people. It’s kind of sometimes I’ll even see somebody relax their shoulders in a sense of, oh my goodness, I never thought of that before. I’m harder on myself than anybody else. And just that realization – I’m not perfect, I don’t need to be perfect – is a huge awareness that can be very helpful for, well, not just for physicians. That’s what patients too would find, that patients would have that same type of experience and trying to help them to understand that, do the best you can. That’s all you can do is to give your best.

Dr. Luis Garcia: Yeah. And, God, did the last couple of years showed us that, right? That we come with a high level of intellect and a high degree of commitment. And yet there’s a day that comes where we don’t know what are we facing, right? And we don’t have all the answers. And I always say that what initially came as a clinical dilemma became very fast a people’s problem. A people’s challenge, yes. Of how you navigate patients, clinicians, nurses, society, politicians, you name it, through a very, very uncertain times. And how that influential servant leadership really, really served its purpose.

Servant leadership, right? Some people might look at it like, well, is the guy that does everything for me? And I can be, I can treat that person as a doormat. You mentioned the word doormat and that’s not what servant leadership is. So clarify that for me.

Dr. Craig Uthe: Well, servant leadership, first and foremost, is being grounded in who you are and knowing what you stand for, why you’re living the life you live. What do you value in your life? What are your non-negotiables? We need to know who we are first to in order to be able to take care of someone else. And so that’s that foundation. That’s the roots that everybody needs to have. And then I call the emotional part of our lives, the mid-brain, that’s kind of the pleasure centers of our brain, the dopaminergic centers of our brain. We tend to behave in ways that are more on that emotional side. And we don’t bring our thought process to the prefrontal cortex, reason it out. We often make decisions just by your emotions. And so it’s so important as physicians to know what you stand for because our job is to give, give, give, give.

And that’s not always easy to do. And so I’ll catch myself with patients at home with my family, and I have to sit down and think, OK, I have this, this knowledge base, I have this awareness of what illness is, what’s important in people’s lives, what’s really truly important. And unfortunately, the world wants to tell us you deserve this, you deserve that. And they tend to be things that are maybe not healthy for us. And so it’s, OK, I gotta bring this back. And what really is important to a person in their life? What really is that? How can I help them see that so they can live their life in a very intentional way? And do it in a way that you’re serving others, that it’s not about me.

Dr. Luis Garcia: You bring a very interesting point and is, as a leader, servant leader, you are here to help people. You’re here to who get the best out of them. You want your best people at your, at their best and, and get the best out of them. That’s a good leader, right?

But you also talk about boundaries and you also talk about moments in which perhaps the answer is not what the other party is expecting to get. Help me understand how Craig, you, with the best experience that you have in leadership, how do you navigate those instances where the other person needs to hear bad news or needs to hear not what they want to hear, but yet you need to empower them to change?

Dr. Craig Uthe: Well, that’s where our professionalism needs to come out. And our experience, I think, needs to play into this. I do a lot of work with addiction. I do a lot of work with pain, and it’s very difficult to eliminate pain and suffering in a person’s life. That’s what we wanna do. But how can I also reach out to them and help them accept that and live with that in that type of setting? That’s a very difficult walk to walk because I may be misinterpreted as the physician in that kind of setting. Yet that news needs to be heard. How can I help you live with pain that is not treatable? How can I help you get through grief when there’s a loss of something in your health, whatever it might be, or a loved one. And I find that to be sometimes a difficult conversation because I don’t want to be disliked and I don’t want to be misinterpreted.

So how do I walk that difficult journey with them? That’s not an easy one to do. I find what I’ve experienced is if you have compassion and you really care about them, the patient senses that and you hope they come to an understanding and to an agreement and will learn about that. Sometimes it’s effective, sometimes it’s not. That’s the difficult journey I find that we have in medicine and some of those uncertainties that we have. And that just happens to be the patient population I see right now working in a chronic pain clinic. And so that’s such a different setting than a family practice clinic where it’s mostly to feel good. People tell you how wonderful you are and it’s easier cuz you’re talking about diabetes, hypertension, things like that. It’s been a great experience to be involved in the addiction world because it contrasts the other practice I had so much. It gives me clarity into that, boy, this isn’t about me feeling good, it’s about the patient understanding. They’re going through a difficult journey and I wanna walk that with them being honest, saying, I don’t necessarily have an answer.

Dr. Luis Garcia: So how do you take that home, Craig? And this is very interesting. How do you take that home? Because based on our definition of success, when you do not, and this is when I saying our definition, it’s our internal definition that we always have to be perfect. That we always have to solve a problem. That we – so as a physician or as a leader, how do you cope with that circumstance where there’s only so much you can do, you cannot solve the problem and not taking it as a personal failure, as a professional failure?

Dr. Craig Uthe: I’ll answer from the personal standpoint is again, my upbringing was very faith-based. And so for me, from the perspective of Christianity, I live in this world, not of this world. I believe that there’s something much greater after we live this life than we have right now. So that’s the perspective I come in. I mean, this life is preparing me for something greater than that. So I just, I have hope. Hope is my number one core value.

Now my job is not necessarily to take my own feelings and my own beliefs and push it on someone else. That’s not what I wanna do. But I take great comfort in the hope that I have in that. And that’s, I always, I think, have had this sense of hope. I call it the Holy Spirit inside of a person, whatever religions call that spirit filled piece that I wanna portray that in the work that I do.

So even though this world is tough, I want that to be lived as full as it can be. Not meaning it’s gonna always be happy, but I want it to be fulfilling. So I want that patient to live that life as full as they can. That’s why walking that journey with patients who have a terminal diagnosis of cancer, I didn’t want to give them this sort of happy optimism that is not real. I wanted to find out where they put all their marbles, you know, what was most important to them in their world? Is it their family? Is it a faith? And then I wanted to take what they feel is most valuable to them and nurture that. And you can find hope.

Two of the great privileges I had in my 25 years of my regular family practice was getting to deliver a thousand babies. I got a chance to do that. I delivered a baby of a baby, you know, Elton John’s Circle of Life song, whatever you wanna say.

But I also had the privilege of being present in the death at the moment of death of about a dozen patients. And that is a real special experience. I will never forget those moments. Those were privileges. And I found them to be not despairing. I found them to be very intimate. And in that very rewarding both for the patient and for me to be able to experience that with families.

Dr. Luis Garcia: I think you brought topics of clinical relevance, topics of spirituality, topics of leadership, and I think that reflects how complex and positively complex your life has been. Talk to me a little bit about the work that you are doing right now inside Sanford for leadership and how are you interacting with the new generations?

And I gotta say Craig has been instrumental for us in Sanford to develop and implement the professional practice support program, which is a program that helps our clinicians at any stage of their career that need any kind of leadership help or if they’re dealing with challenges to bring really people like Craig and a team that he has developed of internal coaches. And then you have also a phenomenal program that – thank you for inviting me to participate – which is medical students that are looking into that aspect of leadership that you can develop. But a lot of that comes inherently with the individual, right? So talk to me about that.

Dr. Craig Uthe: Well, I think it comes back to that question that Mary Nettleman asked me years ago. “As you know, Craig, we wanna make great physicians, well we want great physicians at Sanford.” And when I left my family practice panel five years ago, that was a difficult thing to do. I had my kindergarten teacher, you know, some, you know, cousins, things like that, that we’re no longer gonna be under my care. And I do, I really wanna give that up to do something else.

Well, when somebody sees something in you, I always wanna listen to that. You know, maybe there’s, maybe it’s time for me to do a change again if I’m gonna be a servant leader. It’s not about Craig Uthe feeling good about patients, telling him how great he is. It’s about doing something that’s gonna make people better. And so what a great quote unquote new patient population than having physicians, med students, you know, all these talented, gifted, caring people.

What I love best about medicine, Luis, hands down is we all have that seed of altruism in our profession. There has not been one person I haven’t worked with in Sanford who doesn’t genuinely say I’m in medicine because I care about people, don’t care. And I look for that seed. I just, I look for that and I try to, if physicians are burned out, they may have lost that focus. And I try to help find that first. Cause that’s burnout. To me, the definition of burnout is when you lost your meaning of why you went into medicine. And I get that once in a while, I’ll get a, I’ll get a stare look when we go to do coach, I’m going time out, no coaching. Let’s get you some help. I don’t think you’re well. Let’s get you well. And once you’re well, then we’ll do the coaching.

And once coaching, I think coaching is going to become a very popular thing in the future. It’s already kind of a craze, I guess right now is what I would call it. But there is some definite value that can be had in that. I always think of the professional tennis players, the Williams sisters, Nadal and Federer, those guys, they all have coaches. And they’re the best in the world. So why would I not want a coach to help me along?

And we could call it a mentor, we can call an advisor, we can call it a coach, whoever it is. But to have that collegial support for each other. When you can have that psychological safety that Sanford offered a resource that, hey, this is about you and your well-being, this is confidential between you and your coach. To create that psychologically safe space is incredibly valuable because now you get colleagues one on one being able to, to really, really be authentic, vulnerable. And that’s where real growth begins in being that great physician.

Dr. Luis Garcia: You talk about an internal coaching program that our physicians, that you have developed to the point of becoming coaches. Yes. And now they’re helping other peers. Help me understand. Why does it have to be a clinician? Why not somebody from the car industry that comes in and coach?

Dr. Craig Uthe: Right. Well, there, there’s something that, there’s value in having been in the same shoes as the other person. I’ve had the same experiences. So working with medical students, working with residents, and working with physicians, when you are one of them, you have a bond. There is a bond. We have Luis, because you and I are physicians. It’s something that has value in it and it gives us an insight into that.

Again, it has to do with influence. Well, who’s gonna be, who’s gonna be one that’s gonna influence you? It’s gonna be someone that’s walked through the same doors that you have, has had the same experience as you have had maybe in different ways, but we can relate and then take it to the Sanford organization to be able to go through the same cultural experiences in the same organization. That gives you an additional insight that’s very helpful.

I believe honesty is absolutely imperative there. And I’ll say, you know, if there’s things you don’t like about the organization, let me know. If they’re the things that you like about the organization, let us know. Because we wanna take those themes that we hear from everybody to make the organization better. And so there’s internal coaching. There’s external coaching. I think they both can be valuable.

The internal coaching program we have at Sanford, I like because we have identified people who are interested in becoming coaches, people that have a skill set in being coaches. And then we’ve just found a couple of tools that we have found very valuable. One being the Hogan assessment, which is a personality assessment. It’s a tool that helps us identify our own strengths and our own challenges. And by actually being able to walk through that with a person who is certified in assessment coaching, we’ve found that has been very valuable for those who have participated in that program.

Dr. Luis Garcia: I’ve had the opportunity to talk to a couple of your coaches or the members of your coaching team, and they speak not only about the influence that they’re having on others and helping them find their best, but how that interaction fulfills them and allows them to grow as well. Not only as coaches, but as individuals.

Dr. Craig Uthe: One of the things I love about being a physician is the title of physician. One of the things I abhor about being a physician is the title of physician. At the end of the day, I’m still Craig Uthe. And taking that title off actually provides some freedoms for me. And so when you get into that coaching, you talk person to person as well as physician to physician. I have found that to be extremely valuable. Being able to say, OK, who is that person along with that physician? And that just provides another dimension that leads to building strength and stamina, I find. And so I always talk to my co-coach and say, I just hope that the person I’m coaching learns as much as I do today because I’m learning something every single time I have a coaching session.

Dr. Luis Garcia: So what’s the most difficult person to coach?

Dr. Craig Uthe: That’s a great question. The most difficult person to coach is a person who has a different value system than yours. Because it’s not my job to push my values onto someone. And so I have to be very aware if this person has a value that’s opposite of what I value. My job is not to push my values onto someone. My job is to help somebody be successful in what they’re trying to achieve. And so that’s very important. And so the most difficult person to coach then is that person where I have to be very, very self-conscious to not be bringing my own personal values into that work.

Dr. Luis Garcia: And not necessarily means that the success would be less. Is that just you as a coach need to be aware of that difference? Absolutely. You know, you mentioned a few people that have been influential in your life and in your own journey, but who is the person that has influenced Craig Uthe the most, to get Craig Uthe to be who you are right now?

Dr. Craig Uthe: Oh, I, you know, I, I probably have five, six or seven different individuals I could say. There’s a book written by the title of Soul Survivor, S-O-U-L survivor, Philip Yncey wrote it, Y-N-C-E-Y. And he took 13 people of influence in his life and they included people that he had not met, like Martin Luther King Jr. And Leo Tolstoy I believe. But then there was also people that he had met and walked alongside. So like C. Everett Koop was a surgeon general at one time. He had met him, he hung out with him. Is that book actually as a text for different programs? There is a theologian by the name of Charles Swindoll, he’s on the radio. Chuck Swindoll. I was a third-year med student and I would say I was struggling at that time, probably the nadir of my medical career was as a third-year med student.

I was single. I was out in the Black Hills in the wintertime. And I remember listening to Chuck Swindoll on the radio at night. He was a pastor and just had a radio show. And I just found that to be very comforting and inspiring for me. So I’ve actually met him. He is, he lives down in Texas since I went to service one time.

My father has been a great influence. My mother’s been a great influence. I just lost my high school basketball coach, just passed away last week. And so he, I think, gosh, what a great mentor. High school music teacher was a great influence for me. And, and just, I’m always having people influence me all the time. I’m always just watching people’s characteristics. You know, Dr. Luis Garcia, what do I love about Dr. Luis Garcia?

Dr. Luis Garcia: No, don’t, don’t say that. <Laugh> Make, I’m sure that list is short, so don’t.

Dr. Craig Uthe: But again, there are those traits, you know, again, it’s –

Dr. Luis Garcia: No, I understand.

Dr. Craig Uthe: It’s the core values that I have that I’ve seen in other people. And again, there are a number of people, and I could have named another 5, 7, 8, 10 people that have an influence on my life. Some who I’ve met and some of whom I have not met.

Dr. Luis Garcia: So, so let me flip the question. OK. Who has been a person that you go like, I do not want to be like that person and don’t gimme names. Give me characteristics of – yeah, you know, who is that person? I go like, I will never be like that person.

Dr. Craig Uthe: Yeah. And I wish I could. There were physicians in my residency that I remember thinking when I’d call him at two o’clock in the morning or I needed their assistance or I reached out, or I just would see them demonstrating either narcissistic behaviors that were very self-indulging or were derailing in an anger mode that was very destructive. And I remember finding myself saying, oh, I’m just, if they only knew how disappointed I was in them, they wouldn’t do that. Maybe <laugh>.

And so as this disappointment of somebody who I respected from a quality standpoint, but when it came to them being real people and caring for others, I was just disappointed. I thought, you don’t realize you’re actually influencing me as much as someone does from a positive way on just how not to be. I thank that person for that.

Now I’ve never, I never told them that I would be critical in some ways, in some kind of a specific faculty person. I’d be critical in, in the, in the evaluation form that I had. But seeing that kind of behavior when she was just so destructive and so harmful, I just call it being disappointed, you know, a person of that kind of authority and influence. It’s just so sad to see that have that negative influence on me at least.

Dr. Luis Garcia: So a good person, yeah, could have a bad influence or a positive influence and then develop personality traits based on that influence. So you teach medical students all the time, Craig, and I’m not talking about medicine. You teach them leadership. Yes. You teach them how to be productive citizens in this world. What do you tell young developing leaders about what you should be, what you should not be?

Dr. Craig Uthe: When it comes to medical students, residents, I always still start with what do you believe in? You know, so why did you go into medicine and what are your values? OK, know what they are, know what they are. That’s what you stand firm on. And then name ’em. Is it compassion? Is it humility? Is it kindness? Is it authenticity? Is it accountability? And then actually ask yourself, what does that literally look like? What does that look like? If you were to see it and say, you know what, that person is accountable. I love accountability, I wanna hang out with accountability. And then use that as your model. Now, the intelligence, the knowledge, the technical skills, they will come. Why are you here in med school? Yeah.

Now you’re gonna spend 80, 90% of your, 95% of your focus on the knowledge piece. I get it. It’s a requirement. It’s not an option. But always keep within your eyesight, within your vision, within your peripheral vision, all the emotional intelligence pieces, because that is the piece that will define the quality of your work as a physician. It’s all those other things, and you’ll get a chance to see it. So just know what you believe in.

And if kindness is your top core value of yours and you see kindness, look at it, study it, what does that look like? Cuz then once you see that, you will start doing that yourself. And for me, what is the epitome of well-being is when somebody comes up to you and says, wow, Dr. Garcia, you are the kindest person I know. And if that’s your number one core value, kindness, you’re going, that was just a grand slam home run I just hit. That’s what I live for. I’m not gonna tell people that, but that’s my goals. I wanna live that in a serving fashion to live those values. So I really search for that. You just have to know what your core is. And then, and everybody’s core is different. And I’ll get that, “Well, what do you think?” And I go, well, it’s not what I think. It’s what you think that makes all the difference.

Dr. Luis Garcia: And I think just in the last couple of minutes, you pretty much described what servant leadership is about and why are you so good at that? Craig, any closing thoughts? This has been a phenomenal conversation, Craig, and thank you for, you know, sharing your insight and your values. Well, thank you and your values and your knowledge and, but any closing thoughts?

Dr. Craig Uthe: Self-care is still the most important thing in being a servant leader. You have to take care of yourself in that and in that journey, maybe the most difficult thing to do, and to me define servant leadership, is when you can in your life, get to a point where you can provide forgiveness to others. We didn’t really talk about forgiveness, but it starts with self-care and it ends with being able to forgive others for things that maybe seem unforgivable.

Sometimes coaching gets to that point in a journey. And I do find that in any kind of a leadership course that I kind of evaluate, I always look for a piece on forgiveness because it is one of the more complicated, more difficult things as human beings to really address and to really walk through and in a mature fashion, be able to deal with that. So I’ll end it with that. Start with self-care and with forgiveness.

Dr. Luis Garcia: Well, Craig, once again you know, every time I sit down and have a conversation with you about life and about leadership, I always come out enriched. And it is a privilege for me to spend time with you. And you mentioned about, you mentioned something about people influencing your life that perhaps you have met or you have not met. And I gotta tell you, those that know you and have met you, agree with me, that their life automatically gets enriched. And if you are listening this podcast and you have not met Craig Uthe, I wish that you could because your life would be equally enriched. Craig. It’s a privilege and an honor. Thank you very much.

Dr. Craig Uthe: Well, thank you. You’re very kind, Luis. Thanks.

Alan Helgeson: You’ve been listening to “Reimagining Rural Health,” a podcast series brought to you by Sanford Health. Hear more episodes in this series or other Sanford Health series on Apple, Spotify, and news.sanfordhealth.org. For Sanford Health News, I’m Alan Helgeson and thank you for listening.

Learn more

• Ep. 3: Well-being at work: What doctors do for self-care
• Ep. 1: Virtual care options help reach more rural patients
• Trustee, physician prioritizes quality across organization

Get more episodes in this series

Well-being at work: What doctors do for self-care

Alan Helgeson (host):

Hello, and welcome to the “Reimagining Rural Health” podcast series, brought to you by Sanford Health. In this series, we explore the challenges facing health care systems across the country from improving access to equitable care, building sustainable workforce, and discovering innovative ways to deliver high quality, low cost services in rural and underserved populations. Each episode examines how Sanford Health and other health systems are advancing care for the unique communities they serve.

Today’s topic focuses on caregivers in the medical community and the importance of well-being in order to provide the best care to those in need. Our guests are Dr. Brian Gatheridge, psychologist with Sanford Health Detroit Lakes Clinic, and Dr. Heather Spies, OB/GYN, and physician director of clinician experience and well-being. Our moderator is Dr. Luis Garcia, president of Sanford Clinics.

Dr. Luis Garcia (moderator):

I’m very grateful to be joined today by Dr. Heather Spies and Dr. Brian Gatheridge. Heather, Brian, thank you for being here today. And, you both are champions of this kind of work and you both are leaders in these type of topics. And I have a question to both of you. Tell us a little bit about yourself, your personal background, your journey, and how did you get involved and passionate about clinician well-being?

Dr. Heather Spies (guest):

Well, thank you for having us here, and I have the privilege of working with both of you in this work, and so I know that we all care a lot about it, so I think this will be a fun conversation to have today together. I started in OB/GYN 20 years ago now, actually, if you think about residency, and then have been 16 years at Sanford practicing OB/GYN. And, most recently in the physician director role for the enterprise for clinician experience and well-being.

Just really feel fortunate to have this opportunity to serve in this role. It’s a new role and it’s been identified as a need because, just to really make sure that as clinicians we’re looking out for each other and making sure as an organization that we’re providing resources and that sort of thing, which we’re gonna talk more about today.

Um, but as far as my journey, I think I’ve always had a passion for well-being, although I think part of the reason I love talking about it and focusing on it is because I never practiced what I preached for a very, very long time. Still probably don’t do it as well as I should, but I think that’s where we all kind of fall somewhere on a spectrum of our well-being, our intentions of looking out for ourselves or looking out for well-being, and it needing to be more of a priority for all of us. So I think just continuing on that journey throughout my whole life is fun to be a part of this work.

Dr. Luis Garcia:

Well, thank you, Heather, and we appreciate what you’re doing and your new role. And you’re right. I mean, as clinicians, we often forget about our own well-being, so thank you for sharing that with us. What about you Brian?

Dr. Brian Gatheridge (guest):

Yeah, I would just say thanks again for the opportunity to participate in what is a very important conversation. So myself I guess I could say I’ve always had a bit of an interest in human behavior, you know, as well as emotional and cognitive processes, you know, how people interact in their environment and with others. In school, I was primarily interested in sports and hanging out, but for whatever reason, psychology was always something that was interesting to me. I also grew up in a really rural area, and I saw how you know, people struggled with mental health and how folks didn’t really understand mental health problems people were experiencing. There certainly was not an encouragement to discuss those problems or acknowledge them, and there really was not help available. And so I always felt like there was a bit of a calling for me that I felt to get into that field, to serve in so far as, you know, clinician wellness.

Like many of us who serve, I’m a clinician who cares about the people that I work with. And as I entered into the field of health care, I began to learn more about, you know, the unique pressures that, you know, clinicians face and the impact that our work has on our health. And sadly, again, that stigma that often prevents people from seeking care. And so, I guess over time, you could say I became increasingly motivated to serve in a way that could hopefully improve the health and welfare of my fellow health care providers. And again, really work to reduce that stigma that still keeps people from acknowledging that there is a concern and seeking care. So again, it’s a privilege to be here and to serve.

Dr. Luis Garcia:

Well, Brian, thank you. And I want to thank you personally for answering to that calling because you do phenomenal work and you’re a great asset to our organization. And, you know, you’re talking about the stigma. And Heather, I’d like to ask you a question about that. As a clinician, why do you feel that’s so important to talk about that stigma about well-being? And what’s your perspective on that?

Dr. Heather Spies:

This is really important for us as clinicians to focus on because we’re all working and living in very stressful environments. Medicine’s always been stressful, but even more recently, I think we’re all acknowledging that not only at work, but just everywhere in our communities and our culture and politics, everything is a little bit more intense and stressful lately. So no matter your specialty or your location, many of us are feeling more and more a sense of feeling devalued – maybe the culture, the public perception of health care has had so many changes lately.

I think all clinicians have invested so much time, energy, really sacrificed relationships sometimes just to be clinicians and to be that person that people trust. You know, traditionally we are the people that everyone looked to and trusted and valued, and the way that that’s happening now is being challenged more and more recently.

So as we dedicate ourselves to knowing the latest clinical information and trying to do the best we can for patients. The media sometimes challenges what a clinician says, and that makes it really hard for us to keep going, I think harder lately than it was in the past where we could always just say that we were the experts in things. And so I think it’s important that we talk about this because we’re all feeling fatigued and we’re all feeling burnt out at times, and what can we do to help with that?

Dr. Luis Garcia:

Thank you, Heather. And it’s just one more challenge for clinicians, right? As if medicine was not difficult enough right? Now, deal with all that devalue part that you’re talking about. Brian, you know, Heather touched a little bit into concepts like burnout, compassion fatigue, but maybe folks, maybe do not know exactly what those term terms mean. From your standpoint, can you define for us, the meaning of these terms? And maybe describe how can we recognize signs of burnout and fatigue on either in ourselves or others?

Dr. Brian Gatheridge:

Yeah, that’s a really important question Dr. Garcia. You know, we hear those terms a lot, but I’m always surprised by the folks who really don’t understand what those terms mean and whether or not they may be experiencing those concerns themselves.

So, you know, compassion fatigue and burnout are two types of stresses that can bring about, you know, psychological, physical, and emotional impacts. If we think about burnout, you know, specifically, it’s important to recognize that it’s not necessarily a psychological disorder. You know, I think the World Health Organization designates it as a syndrome which is a measure of chronic distress that we might feel at times if we’re talking about burnout specifically. Christine Maslow, Dr. Christine Maslow is a psychologist, researcher who’s really studied burnout for decades. And her research has concluded that burnout is characterized by three factors.

So one is emotional exhaustion. So these are folks who are just feeling depleted. They may be irritable, they might be down, and they just can’t seem to recharge. You know, a lot of us can feel pretty heavily, heavy or emotionally depleted at the end of the day, but we go home and we engage our family, or we exercise and we come back the next day and we’re ready to do our work again. And we feel like we have the emotional energy to do that. Folks who are burned out have a hard time recharging.

Depersonalization is the second component of the syndrome, and that’s this cynical or detached approach people may feel to caring for patients. This is where folks, you know, we start to see people as, you know, they’re presenting problem as opposed to, you know, the human that they are.

And then the last is a loss of personal accomplishment, and this is often the last symptom to develop where we just don’t feel like our work has any value or meaning anymore. And we know that, you know, burnout is bad for physicians and clinicians.

You know, it’s really proven, by increased rates of anxiety, depression, and chemical use rates, not to mention suicide, which is a significant problem within the field of health care burnout. It’s also bad for patients because we know that it’s associated with lower quality of care, lower patient satisfaction, higher turnover rates for clinicians, and increased chances of medical errors. Some research has shown that between 40 to 61% of physicians are burned out and additional research shows that about up to 60% of psychologists struggle with burnout. So it, it’s a very significant concern.

Those are things that people need to look for. Compassion fatigue is a little bit different in that it’s a bit more acute. Burnout is often caused by a number of work-related stressors, where compassion fatigue is pretty much directly related to exposure to the stressful and traumatic things that we’re exposed to within the field of health care. It has a much more rapid onset. It can also be a lot of the signs that you see are very consistent with what we’d see with post-traumatic stress disorder – you know, psychological distress, muscle tension, nightmares, cognitive shifts. Again, it’s much, there’s much more of a rapid onset and it really is impacted by helping others. There’s much more of a quicker recovery time than for burnout if we manage it early. So, again, there’s a lot of similarities between these two things but also some pretty profound differences as well.

Dr. Luis Garcia:

Brian, thanks for educating us on that. I mean, I’m gonna be honest. I personally didn’t know the difference, so thank you for that and those are striking statistics, right? The ones that you just shared with us. You know, Heather, Brian talked a little bit about the multifactorial etiology of this. So from your perspective, what things in medicine do you think have contributed to burnout or clinicians struggling to achieve that sense of well-being?

Dr. Heather Spies:

I think that we all know, from the very beginning of our training, we go into medicine and we’re really excited about it. You know, studies have shown that medical students actually have really low burnout. They’re energetic. They are ready to go and excited about things.

And then as we progress through training and residency, the number of us that begin to show symptoms of burnout or compassion fatigue really start to increase at an alarming rate actually. And then as we get into practice. And so I think it’s the time that we invest, the money that we invest. A lot of times, we enter our practices in quite a bit of financial debt, and we feel like we don’t have any other choice other than to do the work that we signed up to do 10, 20, 30 years into our practices.

So that’s one big factor I think that’s contributing. I think to organizational factors, I think sometimes the cultures get stuck kind of in that traditional way. And luckily we’re seeing that culture change and evolve across you know, Sanford and the country luckily to just really say, you know, we don’t have to have things the way that they’ve traditionally been.

We need to be looking out for each other as human beings and as people that need rest, and people that need to take turns and maybe not work for 36 hours straight all the time that, you know, we did in our training.

So I think too, it’s really been in our nature as clinicians to always put other people first. We always, I mean, that’s why we went into medicine. That’s just by nature what most of us are like. And so, you know, traditionally that really contributes, you know, over time, especially, you might do fine for a while, but over time, when you always put others first in every scenario, it’s going to take its toll. And so we’re seeing that definitely with our clinicians.

Dr. Luis Garcia:

Yeah. Not to count the expectations that we need to be perfect, right? And you know, a medical error can have significant consequences. Unlike any other job or industry and all that stress contributes to all that. So thank you for that answer, Heather.

You know, Brian, I think that we all are very aware of how all these stressors and all these factors have been heavily pronounced in the last couple of years. And I think the last couple of years can be easily be defined as full adversity. And from your perspective talk to us a little bit about the power of facing adversity and the relationship to personal growth.

Dr. Brian Gatheridge:

I guess what I would challenge all of our listeners to really pause and think about a time where you experienced adversity in your life. Think about an experience that you know, you didn’t enjoy or that was particularly challenging at the time that you faced it. And then I want you to reflect upon how that experience shaped your life in a positive direction.

You know, most of us are at the point in life where we can reflect upon experiences that at the time were quite challenging, or we didn’t appreciate for what it was. But looking back now, we may not change that because it did have a powerful effect on our life in a positive manner. And what we know is that, you know, for all of us adversity is an OK thing to experience in life. In fact, psychological research shows us that folks who have experienced adverse life events report higher overall levels of satisfaction in their life.

They’re more resilient, and people report fewer symptoms of trauma. They report overall levels of impairment and overall lower levels of emotional distress when compared to individuals with very little or no lifetime adversity. So again, lifetime adversity shapes us in a very positive direction. And, you know, hopefully, we’re all going to see that, through the last couple of years, certainly we’ve all experienced adversity. And on some level, even now, you may be able to look back and reflect upon how life has changed for the better as a result of the pandemic.

For some of us, we maybe haven’t seen that yet. And that observation will only materialize down the road. But this idea of, you know, growing from adverse experiences is also related to this concept of post-traumatic growth, which is another area of psychology, which describes the positive psychological changes that take place as a result of struggling with a highly challenging or stressful life circumstance.

Post-traumatic growth involves, you know, these psychological shifts in thinking and relating to the world and the self that contribute to a personal process of change that’s really deeply meaningful. This is when like the old normal is no longer an option.

And there’s five domains of psychological, post-traumatic growth that have been identified. And the first is, you know, people often experience a development of deeper relationships with others. The second domain that we often see is that people are open to new possibilities in life. This is related to identifying one’s overall purpose and meaning in life, what’s most important to them. The third domain is a greater sense of personal strength and ability. We have a greater idea of that. And the fourth is a stronger sense of spirituality, which is important in people’s life. And the fifth domain that we see as a result of post-traumatic growth are improvements in our overall appreciation for life. And so, again, we’ve all been through pretty tough times, you know, particularly over the past couple of years. But with time, hopefully we’ll see positive changes in our life as a result of this adversity that we’ve faced.

Dr. Luis Garcia:

Well, thanks for sharing that with us. That’s really profound Brian, and the appreciation of life and what we have in life, right? And I think that whether it is at home or at work, these last two years have really unified us as a workforce. And the way that we cared for each other in times of real adversity was just fascinating to watch. I’m highly appreciative for that.

Heather, I think that this conversation is showing us that it’s not a matter of if, but when you or I or anybody else could go through a difficult time, and most of the times very likely you could overcome that adversity alone, maybe without even sharing it with somebody, but there are times in which you’re gonna need help, right? And there are times where you need to accept that help. Can you talk to us a little bit about the wellness initiatives that we are putting in place in Sanford and how do we preserve that well-being at work?

Dr. Heather Spies:

Yeah, absolutely. I’d love to share. I think, you know, looking back on my personal journey that we kind of started with, you know, I think there’s always gonna be a gap in your well-being, but it’s whether you recognize it yourself or if you have the good fortune of a colleague or a friend, maybe saying something, you know, “Hey, I’ve noticed that maybe you’re not doing OK.” And so if you look at the – we have a wheel of well-being that we utilize through our Vital WorkLife resources that are available to all our clinicians at Sanford.

And the Vital WorkLife wheel of well-being has six dimensions. So it’s got your relational, your emotional, your physical, professional, spiritual, and financial well-being components. And I think at any given time, no human being can feel like or say that they’re optimally well in all those areas. It’s just not possible.

And it’s normal. I mean, we’re gonna sacrifice a little bit in one area to focus on one at different phases or seasons of our life. Like when I, when I had young kids, I would, I sacrificed some of my physical workouts some days because I would’ve rather, you know, taken the time to read a story to my kids at night because I had been at work longer that day or whatever. And so that’s OK, you know.

But I think overall we have to encourage people to pause and be just periodically checking in on those six different areas and saying, “Where, what area have I really let lag and is that affecting how I am doing overall?” And sometimes we see that. And so some of the resources that we have available to support those things are everything from counseling both internally, with our CAPS program here at Sanford, where we have counselors that we provide free of cost to all of our clinicians, that they can meet with and talk with.

So whether it’s emotional things or, you know, at work or personal relationship stressors, whatever it might be. So just to kind of get that relationship with the counselor started and see what else the needs might be that we can help provide resources for. We also have external counseling, so if somebody would prefer to have it be a little bit more external so that they don’t have, you know, a potential overlap of that colleague they can do it through our Vital WorkLife resource as well.

And just to go back a little bit, if they do want the internal coaching, we can do it across network too. So, say you do want it within Sanford, but maybe not the person that’s down the hall from you. We can connect our colleagues with people in another area of Sanford.

But everything from, you know, back to that wheel of well-being, everything from financial, you know, so say you just really need to meet with someone because you are feeling stuck and you just have this vision of, “I have no choice but to do this for 20 years. I can’t even see two less patients a day or anything because you just feel such a pressure.” We can provide you a meeting with a financial advisor to say, “OK, no, let’s pause and actually look at this.” I just had a colleague recently who, when she actually met with her financial advisor, she had no idea how much she had in her retirement fund, or how much, you know, what her long-term plan was. And it was actually really refreshing and freeing to her to just, you know, have that meeting and take a moment to look at that. So I think just awareness and knowing where you’re at is helpful to a lot of people.

And then physical, I mean, of course we can help with resources for our wellness programs, so all those kind of things.

And then if it’s relationships that we’re looking for I think that we have so many opportunities in Sanford to pair clinicians up with others. So we have a mentor program. We are now automatically pairing every new clinician with a mentor when they start but we’re also able to, if someone mid-career would really like us to help do that through our clinician experience office, we can help pair those people because really it comes down to relationships. And if you know that someone is listening to you and understands what you’re going through, because they’re also a clinician, maybe even in the same specialty or kind of in the same type of situation it just really does well for our well-being.

So those are a few of the things we have. I could probably talk for an hour on all different resources, but bottom line is, if you are looking for anything, all of our clinicians can contact their clinician experience specialist in their region, and we can lead you to hopefully what you need.

Dr. Luis Garcia:

Thank you for that, Heather, and I think that we have been very proactive at expanding those resources across the enterprise. And to your point, any need for our clinicians should be channeled through that Office of Clinician Experience. We have multiple resources available for them. Thank you for sharing some of them.

You know, Heather, you talk about that wheel of well-being and prioritizing some of these aspects of the wheel. Question for both of you, and I’ll start with you, Heather, again, what is one thing that you personally prioritize and why?

Dr. Heather Spies:

One thing that I’ve gotten much better at doing is my schedule. So I don’t know exactly which wheel that would fall into, but probably all of them, because what I do every Sunday is I intentionally, this is kind of, you know, embarrassing to admit, but I still write it out on a calendar. So I have my Outlook calendar, but I write out on paper – what does my week look like? And if I’m looking at my Outlook calendar and I see absolutely no white space on there, I go through and say, OK, can I move a meeting? Can I you know, move a kid’s appointment that isn’t, you know, urgent? Because if I don’t find time to at least go for a walk or do something like that, have 30 minutes to myself, I really can tell the difference, especially if I’m gonna be on call that week or I just have a really busy week.

It’s almost a necessity that I have some fresh air. So I write that in and then I see too, like, where can I delegate things? What can I ask my husband to do? What can I ask, you know, my 15-year-old to do and things like that. And so, that’s changed completely over the seasons in my life.

I look back to being new in practice and having two little kids, and I did this terribly. And if I could go back and maybe just do this one simple thing of spending literally 10 minutes on a Sunday mapping that out, I would realize that on Tuesday I’m going to be drowning, and I need help that day and just reach out to somebody or cross something off or cancel something but I never did that. I just kind of kept my head above water each day until I, you know, fell over. So that’s the one thing that is making me feel more well at this season in my life than I used to be.

Dr. Luis Garcia:

And it’s amazing how, if you’re not on your A game, how that impacts your family and your patience. Right? Let me share with you something. And, one time I asked my son, how do I make you feel when I’m not on my A game? And his answer was, “You make me feel scared.” And I can tell you that was not easy to hear. Right? You know, when you’re making one of your loved ones feel scared because of your actions that strikes your chord. So, thank you for sharing that Heather. What about you, Brian? How do you prioritize wellness in your life?

Dr. Brian Gatheridge:

That was a great statement that you made there Luis and I appreciate you sharing that story. You know, for me, the thing that resonates the most with me when I think about this question is at one point I learned not to confuse selfishness with healthy self-interest. And we know that many of us who work in health care feel like if we’re not there for others all the time, then we’re somehow acting in a selfish manner. And for me I’m constantly, I guess, checking in with myself to be aware of my stress signals and how I am feeling. As a parent, I guarantee you, my children have also, you know, experienced me at my worst. And, you know that’s something that we want to work to prevent as much as we can.

For me, I’m active in making sure that I participate in activities that ultimately promote wellness in my life. I can just tell you that to be healthy, I exercise quite a bit, and when I can, I am outdoors engaged in all kinds of different activities depending upon the season. And if I can do that with family and friends present, I’m all the better for it. I mean, those types of activities that are physical and outdoors are those that ultimately rejuvenate me and help provide me with the energy I need to be the best clinician and leader that I possibly can be.

Dr. Luis Garcia:

Appreciate that, Brian. And that’s so meaningful in impact of relationships, right? At all levels. So thank you for sharing that. I have one last question for both of you, and maybe Brian, I’ll start with you. What is your call to actions for those that are listening right now, our colleagues, our Sanford family members that are taking the time to listen to this podcast? What would you tell them? What’s your call to action?

Dr. Brian Gatheridge:

My ultimate call to action, and again, I just, I’m so proud of our organization and proud of the leaders within our organization who have made wellness a priority, who understand the importance of this, who understand that you can’t separate the mind and the body, and we need to take care of each other. And so I think if there’s one call to action, I would say is talk to each other. I mean, the research is pretty clear that within a culture, if we want to change the paradigm, if we want to reduce the stigma associated with acknowledging that we’re struggling and promoting people taking steps to get help, we need to acknowledge and share our struggles. We need to share our mistakes. We need to, you know, oftentimes people feel like, you know, they’re the only one feeling overwhelmed or in doubt or unsure but you’re not alone.

And it’s so empowering when we can speak up. You know, one of the wisest people that I’ve ever met shared three simple words with me, who, which will always stick with me. And it’s “never worry alone.” And so again, it’s just that message that if you’re struggling speak up. Don’t be too, don’t be afraid to acknowledge that you might be struggling. Let others know.

And if you’re not the one that’s necessarily struggling, don’t be afraid to lean in and check in with those colleagues of yours who you might observe to be struggling. Oftentimes we’re reluctant to ask because we don’t want to impose or we’re worried about the response that we may get. But if we don’t ask the question, we miss the opportunity to potentially improve the welfare of one of our close colleagues. And so those would be the things that I would encourage for now.

Dr. Luis Garcia:

Well said, Brian. Thank you. Heather?

Dr. Heather Spies:

Yeah, I think my call to action is simple as well. I love everything Brian said. I think the biggest thing is, you know, making sure we’re giving each other grace. Assume good. You know sometimes we tell ourselves a story that is not reality. You know, we assume someone is, you know, trying to make us work harder than them, this, that, whatever. And I think if we just assume good, that we’re all in this together, we all have the same intentions of caring well for our patients and doing a good job, and if we assume that it just makes the day go better and we end up treating each other so much better.

It’s OK not to be OK. We say that a lot, and I think we need to make sure to keep reminding ourselves that. So if you’re having a day where you’re not OK, like Brian said, reach out to somebody and ask for help who, you know, write down who is your one or two go-to people at work that you trust that you can just say, “Hey, I need you to you know, encourage me a little bit right now.”

And, you know, I’ll tell you, they’ll be happy to. I know if someone reaches out to say that to me, it actually lifts me up then, because I feel happy that they trusted me that they said something, and then I walk away thinking, OK, you know, now next time I need something, I might just ask them too. And I’m sure they’ll return the favor. So doing that for each other.

I think too, just taking one day at a time, be intentional about each day. Sometimes, like I said, when I look at my week, I don’t know how I’m gonna fit it all in. But then you break it down and you do one day at a time, and you just pause and make sure you’re intentional about spending some real time listening to your kids or listening to your spouse. I don’t think we talked about that much on this podcast, but spouses sometimes really get the brunt of things from their physician partner and I think we just need to make sure we are intentional each day. Just take one day at a time and focus on relationships, work, personal, all of those things.

Dr. Luis Garcia:

Well, thank you, Heather. I’ll tell you, Brian, Heather, it has been a pleasure for me to sit down with you today. Thank you very much for your time in this podcast. But more importantly, thank you very much for everything that you’re doing around this topic for our clinicians every day. And to our clinicians that are listening, I mean, what better way to conclude what we just heard? Never worry alone and always assume good. Please remember that we need you. Sanford is the greatest organization because of you. Our patients deserve your talent. And we, and you deserve our support, and we will continue to work on your behalf on this topic of well-being. So thank you for listening.

Alan Helgeson (host):

You’ve been listening to “Reimagining Rural Health,” a podcast series brought to you by Sanford Health. Hear more episodes in this series or other Sanford Health series on Apple, Spotify, and news.sanfordhealth.org. For Sanford Health News, I’m Alan Helgeson, and thank you for listening.

Learn more:

• Ep. 1: Virtual care options help reach more rural patients
• Healthy workplace for providers helps patients, too
• Journaling can improve mental health and wellness

Get more episodes in this series

‘Disruptors’ find ways to innovate in health care

Alan Helgeson (Host):

Hello, and welcome to the “Reimagining Rural Health” podcast series, brought to you by Sanford Health. In this series, we explore the challenges facing health care systems across the country, from improving access to equitable care, building a sustainable workforce, and discovering innovative ways to deliver high-quality, low-cost services in rural and underserved populations. Each episode examines how Sanford Health and other health systems are advancing care for the unique communities they serve.

Today’s topic is on health care disruptors and centered around access for rural and underserved populations. And where does big data fit into this? Our guest is Dr. David Newman, endocrinologist with Sanford Southpointe Clinic in Fargo. Our moderator is Dr. Luis Garcia, president of Sanford Clinics.

Dr. Luis Garcia (Moderator):

Hey, Dave, I have a question for you just to get started. You know, for those of you that don’t know, Dave and I, we actually played soccer together, and one of the things that you should know is that Dave is not only a great soccer player, but he’s actually a great coach. So Dave, what does it mean to have an influence on young children and be able to lead them and to be a role model for them?

Dr. David Newman (Guest):

Oh, it’s phenomenal. You know, I learned so much from the kids every day. It’s been a huge transformation too. So over the past, like seven to eight years I’ve been in coaching, I’ve got to see all these kids grow. I’ve got to see them have fun. I’ve got to see them get better than me. That was like a huge thing. So a couple days ago I was playing with my son in the backyard, and he’s better than I am, and it happened a lot sooner than I thought it was going to. So that probably means that I’m just not as good as I thought I was. Or maybe he’s better than I thought he was.

Dr. Luis Garcia:

Or maybe you’ll have a star in the MLS that you don’t know yet. But, hey, you know, Dave, I think that, the same growth that you have seen in your children and your teams is the same growth that Sanford as an organization has seen on you. I follow your trajectory and it’s nothing but impressive and the way that you have contributed to our organization in so many ways is so meaningful that I would like to just ask you to share some of that trajectory and what has gotten to where you’re at right now.

Dr. David Newman:

Oh, thanks for your kind words, Luis. So I’ve always been kind of a computer nerd. So before I went into to medicine, I thought that, you know, computers are the way, the future. That’s how we get better. Even before I came to Sanford, I was involved in electronic medical records when I was at Hennepin County. And it wasn’t because I liked them, but as I thought it was because I thought they could get better. I don’t think anybody really likes the EMR, to be honest, but there’s some of us that think that it’s such a pain in the butt that there’s gotta be ways to make it better. So when I came to Sanford, I was kind of thrust into a leadership role with the EMR. I’m also a practicing endocrinologist. I specialize in andrology. I do full clinic.

I do full call, so people see me around the weekends all the time. I’m actually on call right now as we’re doing this. Where I’ve really been interested though, is where efficiency and quality intersect. And I really think that comes down to how we use the EMR, how we leverage the EMR. And one of the big pet peeves I have is that technology is trying to drive health care when I really think it needs to be clinician driven, that I want to be asking ourselves every single day, “How can we fix the EMR? How can we make things better?” And it shouldn’t be the other way around that clinicians should be really be driving change at Sanford.

Dr. Luis Garcia:

Yeah, that, those are great thoughts, and I agree with you, Dave – I think that it should be the clinicians that are leading the change and not the other way around. But, you know, I think that one of the constant, or maybe the biggest constant in medicine is change. And as clinicians, we adapt fairly well to change, but then there’s disruption, right? Which, if you think about it is, could be a very positive or a very negative format of change. So in your career, you have experienced both disruption and change, but from your perspective, what is different today?

Dr. David Newman:

Oh, man. So that’s a super good question. So, I like the term innovation better than change, to be honest. So what I think of innovation is doing the same things that we’re doing now. We’re just doing them better. At some point we transition to doing new things. And then what disruption really is, is doing new things that make those old things obsolete. You know, a good example is like the Netflix Blockbuster thing. So, you know, I’m a child of the ‘80s and ‘90s and I used to love going to Blockbuster. So you’d show up and you’re like, you had all these rows of movies and you would just impulse rent something, and it was awesome. You, I mean, I should have invested at that point. I thought it was gonna be great. And then all of a sudden Netflix comes along and people are like, Oh, I mean, you can get DVDs through the mail.

It takes a while. It’s kind of cool, but I don’t know, we’ll see. I’m gonna keep going to Blockbuster. All of a sudden it’s like, Oh man, this is pretty cool. Like, they allow you to stream what’s streaming. I can watch something on-demand at my house, and then at some point, everybody was able to stream. It wasn’t just for the people that had money to do it, it wasn’t for just people that had a high internet broadband access. At some point everybody could stream and it disrupted everything. So now everything is streaming.

And that’s really what I think disruption is gonna be. And in health care it’s the same way. At some point we stopped using prescription pads; at some point, you know, we stopped writing notes on paper. These are things that we’ve gotta be ready for going forward.

Dr. Luis Garcia:

Yeah, those are great examples Dave, and, so, you know, talking about innovation or disruption, however you want to frame it, I think that if we’re totally honest in medicine, we have been slow at adapting to innovation and the pace of change lately. So one of the things that comes to mind is what are the nontraditional disruptors in medicine doing right now? And if you think about it, we always think about reimbursement, about the insurance companies, payers, quality and the traditional things that keep us awake.

But now you need to start thinking about the nontraditional aspects that are coming into our backyard, like Amazon, Microsoft, Apple, even Walgreens. We saw what happened throughout the COVID situation where, you know, the big pharma companies and the Walgreens of the world really got into the distributing and giving vaccines. So are they a true threat or do you think it’s just a factor of this technology development that we have had in the last decade?

Dr. David Newman:

Man, I think it depends on who you think they’re a threat to. Like, are they a threat to the way that we’ve been doing things? Absolutely. And should they be a threat? Yeah. I think the way that we get better is by some of these nontraditional disruptors on their competition because they’ve got good ideas. Like we should be looking at them, watching them to see what works the same way that they should be watching us. You know, some of those companies are amazing. So Amazon, if you haven’t been following Amazon, so like Alexa, Alexa’s HIPAA compliant, so you can say, Hey, Alexa, schedule me a, you know, a appointment with cardiology and Alexa can do that. You know, they’ve got pill pack. They’re kind of redefining how patients get their medications. They’re doing some really cool stuff, man.

Yeah, you brought up Amazon or Google and Apple too. So Google, they’re doing things a little differently. So they are looking at health care algorithms. So we have all this data, we’ve got structured data, which is in, you know, Epic in the fields that we type in. We’ve got unstructured data, we’ve got all these progress notes that, man, nobody probably reads them except for Google. What they’re trying to do is figure out how to leverage all this data to make things better, to develop algorithms to make our lives better and our patients’ lives better.

Dr. Luis Garcia:

Yeah. Those are great perspectives, Dave, and I gotta tell you, I’ve heard people saying, Oh, you know, we don’t have to worry about them because they’ll never have a hospital where they can see patients. So they will never have a clinic where Dave Newman and has to interact with Amazon to see a patient. But from your perspective, what do you think they’re truly, really trying to achieve by knocking on our backyard?

Dr. David Newman:

I, I mean, so the optimist in me wants to think that they’re trying to make things better. They’re trying to, you know, mimic retail. A lot of these companies started in retail to try to make health care access easier to patients, less confusing and less costly. They’re hopefully, hopefully gonna be decreasing costs for their insurance plans. So, like CVS partner with Aetna, one of their big things was to try to decrease patients going to the ER. Cuz we all know that patients go to ER for stupid reasons. Instead of doing that, go to their minute clinics and take care of the things they can there. I think they really wanna stay relevant too, that I think if you look at a lot of the biggest companies over the past 25 years, they’ve seen how big of a deal health care is. They’ve seen how big of a mess it is.

And for them to stay financially relevant and just relevant with the times health care is a big target for them. It’s also super exciting, right? So, you know, medicine has typically been like an altruistic thing to go into, like you’re actually helping people. And for them, some of them think that, you know what? Like, this is us, this can be my legacy that, I can, like, for example, Apple, some of their executives have said they want their legacy to be a health care company. So they’ve developed their apps, they’ve got their Apple Watch that can kind of function like an EKG machine. There’s a lot of things that can be very exciting in health care.

Dr. Luis Garcia:

But to those points, Dave, because I think we touched on a lot of interesting things, but to those points, what do you think is their port of entry? Are they gonna target our patients? Are they going to target our physicians, health care systems? What, what do you think is their strategy?

Dr. David Newman:

Oh, boy. So, I mean, I don’t think that they know their strategy at this point, exactly. So I think that the patient is the easiest thing to target. There are a lot of disruptors out there now that all they wanna do is get to the patients online to do telemedicine, that they feel like that is going to be the next big wave of the future because so much time and money is wasted by clinic space. I don’t see a lot of them directing their efforts towards providers at this point, mainly because it’s so hard because of the geographical limitations for that. I really think their port of entry is gonna be patients for now.

Dr. Luis Garcia:

You know, that’s quite interesting, Dave, because as physicians we’ve always said that the most important and the, and the strongest interaction is between a physician or an APP or a clinician and a patient, right? So are you saying that they’re starting to get the upper hand – if so, how and why?

Dr. David Newman:

Oh man. So I definitely think they have the upper hand with their marketing approach, mainly because they’ve got, you know, years and years of data and they know how to do this. So if you walk into a Target, if you walk into a Walgreens, they know exactly how to market their shelves and their product to you. As health care systems, we’ve mainly focused in on health care, on keeping people healthy, on, you know, operations, on prescribing medications. We haven’t been super great at marketing.

You know, health care is super complicated. Do we need to do everything that we are doing in the office? Does all the health care maintenance need to be done face-to-face? Do patients care about that? Or do they really wanna talk about what’s on their agenda? So a good example of this is, you know, health care maintenance. Would we be able to have a, you know, an army of providers, whether that’s MDs or nurse practitioners or PA’s manage a list of people that need their colonoscopy, and would it be more satisfying for a patient to come in and talk about their congestive heart failure or their fatigue as opposed to talking about when they need their colonoscopy?

Dr. Luis Garcia:

Yeah, no question. Those are great points. Given the thoughts that you just shared, what do you feel should be our position, our approach? Should we ignore these disruptors? Do we, should we engage with them? Should we compete with them? What do you think that as an organization like Sanford, we should be doing in relation to these nontraditional disruptors?

Dr. David Newman:

So I think my thoughts are very much mirrored by lots of the CEOs of health care organizations. I was at some sort of meeting at one point, and the Mayo Clinic CEO, his quote was something like, retreating from innovation is not an option at this point, really, we have to be innovative or we will die as a health care organization, that there’s so many things that are moving towards big data. I think the really interesting point that you brought up is the engage and compete. And those are definitely not exclusive. So the big question that we’ve gotta answer is, when we engage and when we compete, we are big enough at Sanford that there are certain things that we can do ourselves. I think a good example of that is like our quality dashboard. We’ve got a lot of really good work that we’re doing for quality that we don’t need someone else to build for us.

We’ve got this great donation for a virtual hospital, and we’re gonna be able to build our own protocols and really help a lot of people through that, where we’re not gonna need a lot of help from the outside as far as competing. Those are the things that we can do with engaging. There are certain things that we are still not big enough with, so we need to cooperate with the outside.

It’s, you know, health care is a global game, and we are not going to say that we can do everything ourselves. A good example of that is like with Epic. So, we have a good relationship with Epic where we can help make the EMR as dynamic as possible, but we’re not gonna kid ourselves and say that we can do it better than them because that’s all they do, right? So that’s a good example of how we just utilize their software.

We’ve partnered with Livongo, which is like a diabetes technology firm that can do things that we can’t do. So they can contact patients, they can coach patients, and they’ve got a team of, you know, educators that we just don’t have. And we’re being very innovative in that to try to make things better.

Dr. Luis Garcia:

You know, I think those are very strong points and great examples of what engaging could bring, not only just the benefits to us as an organization, but to our patients. So, you know, what would be, what do you think would be the consequences of not taking this route of engagement? What would happen if we choose to isolate ourselves?

Dr. David Newman:

Boy, I don’t think that it’s a really good option. I think it’s actually a super bad option, not keeping up with technology. I think that one of the things that needs to happen is we just need, as providers, we need to realize that we’re not as good as we think we are unless we leverage the available technology. You know, I think of, for me, this was very, very close to my heart as a couple years ago. They started having things like the artificial pancreas, which is a like a box that you wear, an insulin pump on your belt that has a sensor that monitors your glucose levels. And at first I was like, I don’t know about this. Like, is it really better than I’m gonna be changing insulin levels and monitoring glucose levels, and the algorithms are a lot better than I am?

There’s been patients that I’ve been following for like 10 years that I’ve never been able to control, that the computer’s better than I am. And that was really a wake-up call that really for me and my patients to get better. We have to leverage that technology. We have to engage with the companies. We have to say what’s out there and we have to present it to our patients.

One thing that in the Dakotas and in our footprint, we have really, really good relationship with patients and they want to talk to somebody about this technology before they go through with it. They wanna talk to someone trusted about this. It’s like the COVID vaccine. Our rates of vaccination are a lot better after they’ve talked with somebody that they trust. And we can be that intermediary between our patients and technology by, you know, standing behind it to improve our patients’ and our lives.

Dr. Luis Garcia:

I’ll tell you Dave, this is just fascinating. I remember when I was in medical school, it was either type one or type two diabetes, and now I don’t even know, I can memorize the many types of diabetes that you have. And now you’re talking about an artificial pancreas. So talking about evolution and technology, this is just fascinating. Hey, Dave, it’s been an honor to do this. And let me just ask you one last question. I know that you’re busy and you’re on call, but I appreciate your time. What keeps Dave Newman awake at night?

Dr. David Newman:

You know, my kids are old enough, they don’t. But from like a health care standpoint, it is my own ego and like how comfortable I am at this stage of life, standing in the way of improving my patients, or I think the whole health care system in general, like the whole condition. So is there something that I could be doing better than I’m not? I think that there’s gonna be a ton of stuff where us as providers, we get scared.

You know, we like having our jobs. We like being the one in charge. And, for example, like is there a piece of software that can read a chest CT better than the radiologist? Is there a piece of software that can be a better endocrinologist than me? These are things that we need to be aware of and that we need to be partnering with just to improve things. And in the long run, they improve not only our lives, but our patient’s life.

Are these nontraditional health care disruptors doing things better than us? You know, I think that we do things pretty well, but we could do things better. That is, are there people out there that we should be learning from that we’re not learning from?

Dr. Luis Garcia:

You know Dave, I can only think about the years in which you and I were in medical school and in residency and the tremendous amount of progress and the tremendous amount of technology that we’ve been able to witness and change. And it’s just, I can’t imagine how fascinating it is for the new generations to think about what the next 20 and 25 years will bring. And definitely it is an honor to belong to an organization that would allow us to witness that progress. And Dave, I could not have thought of anybody better to talk about this topic than you, a well respected individual and professional. It’s an honor for me to be here. Thank you. And thank you to all the listeners for your time in sharing this podcast with us.

Dr. David Newman:

Yeah, pleasure’s mine, Luis.

Alan Helgeson (Host):

You’ve been listening to “Reimagining Rural Health,” a podcast series brought to you by Sanford Health. Hear more episodes in this series or other Sanford Health series on Apple, Spotify, and news.sanfordhealth.org. For Sanford Health News, I’m Alan Helgeson, and thank you for listening.

Learn more

• Ep. 1: Virtual care options help reach more rural patients
• Ep. 20: Renowned thought leader visits Sanford Health
• Sanford CIO joins national conversations on digital health
• Ep. 4: Digital health literacy for patients and providers

Get more episodes in this series

Virtual care options help reach more rural patients

Alan Helgeson (Host): Hello and welcome to the Reimagining Rural Health podcast series, brought to you by Sanford Health. In this series, we explore the challenges facing health care systems across the country. From improving access to equitable care, building a sustainable workforce, and discovering innovative ways to deliver high-quality, low-cost services in rural and underserved populations. Each episode examines how Sanford Health and other health systems are advancing care for the unique communities they serve. Today’s topic is on virtual care. Our guest is Brad Schipper, Sanford Health President of Virtual Care. Our moderator is Dr. Luis Garcia, President of Sanford Clinics.

Dr. Luis Garcia (Moderator): Well, Brad, how are you doing today? Great to have you here.

Brad Schipper (Guest): Well, thanks for inviting me. I’m doing well.

Dr. Luis Garcia: And thanks for joining us for this podcast. I’m excited to discuss this topic. And I, if it’s OK with you, I’ll just get to the meat of the questions. Brad, Sanford Health recently announced a $350 million virtual care initiative, and that included breaking ground of a virtual care center. So can you tell me a little bit about this virtual initiative and what does it mean for Sanford and, and why a building for a virtual initiative?

Brad Schipper: Yeah, you bet. Well, first of all, we’re so very fortunate for the generosity of Denny Sanford. And $350 million will absolutely help us reimagine how we deliver care for rural and underserved areas. And also areas in inner cities or more on reservations or everywhere. Frankly, the reason for the building is really multifaceted.

We need some sort of flagship command center to help drive all the activities that we do within virtual health care. And that doesn’t imply that all virtual care will only be done from this building. We’re doing it across our entire footprint. We’re doing it across the U.S. We’re doing it across internationally as well, as you’re aware. But the building helps to house a lot of the technological advancements in that backbone and infrastructure for the future of what we’ll be doing.

It also, importantly, houses our educational institute where we’ll train our future caregivers and our innovation center, where we’ll be able to vet out some of the new technologies. So no surprise to you as a practicing provider yourself, some of this still has to be done in person face-to-face. So we’ll have physicians and clinicians going there in person to provide care. Some will do it from their home, but we still do need that building for the backbone and for the education, the infrastructure. And, and frankly, we’ve been very successful in most of our markets that we’re out of space. So we do need additional space for that reason as well.

Dr. Luis Garcia: Yeah, thank you for that. I, I think for that clarification, Brad, and I think you used the word reimagine. How do we do this? And clearly these are not new activities for our clinicians and for our patients. We have been using some of these technologies in Sanford for, for quite a bit of time. But what do you feel are the greatest opportunities with this new reimagining or this new injection of resources to these strategies?

Brad Schipper: Well, there are multiple opportunities, but I do appreciate you pointing out the fact that we’ve been in virtual health care for a long time. We’ve already saved patients 20 million miles of travel, and we’ve had dedicated clinicians and physicians and administration folks, and information technology professionals that have just been extraordinary in doing this work. So first I want to point out that we’ve done incredible work, and it isn’t that we’re just starting.

There’s been people that have been very dedicated to this, the teams of individuals and what we really owe the ability to do this initiative to is those folks who have been doing all this work because they have proven that we have what it takes to be able to really transform health care as it relates to the greatest opportunities.

There are so many – a couple I’d point out is in the inpatient world, for example, if you’re in a small outlying facility and you have a stroke and you need to connect with some additional specialists, you’re able to do that virtually so that if you are a provider in one of those areas, or if you are a patient, going to those ERs distance is still a factor, but it’s a lot less of a factor because you’re connecting virtually with specialists that can help some of your treatment in your care.

If you can stay locally, where 40-some percent of our transfers do stay locally now because of virtual care, which is pretty great for the community and for the person and the care providers and the families. And if you do have to be transferred, then we have a better line of sight to what’s going on and what you need for care when you get to the new facility.

On the outpatient setting, there’s numerous examples, whether it be respiratory therapists out of Aberdeen helping the entire health system, or if it’s Dr. Jim Wallace and his team that’s helping with pediatric asthma around the whole enterprise. Fargo has people that are helping right now with gastroenterology. We have people in Bismarck which are helping with nephrology. So we have providers across our entire footprint that are providing services and allowing a patient to stay at home or to not have to take off work or to travel so many distances.

Or imagine if you’re a nursing home resident and you’re getting bundled up in the cold weather and a nursing home van to go see a physician, you can do that now virtually, and we make sure that it’s the right care at the right place at the right time. So there’s just so many opportunities now and, and it’s endless as it relates to the future. I think we’re just touching on things that can be done as it relates to the technology and the care processes that we have.

Dr. Luis Garcia: Brad, first of all, thank you for giving credit to those that have been pioneers in the use of these technologies. And, and just like the examples that you outlined, I mean, I heard about an example where a lady had to drive three hours for a routine prenatal care, and I think what we don’t take into account is what does it mean for a mother of two or three to have to pay day care and pay for gas and lose a whole day and not go to work just for a prenatal visit. You know, that can be done virtually. So I think those are some of those little things that sometimes we lose sight of.

But you know, to that point, these things have made Sanford the most-trusted health care system in our regions, in all the region regions that we served, said by our populations, by our communities, and a lot of that trust comes from the relationships between patients and physicians or clinicians, nurses, caregivers. Some believe that that relationship cannot be developed unless you are in a face to face or an in-person setting. What will it mean for our patients to have these options and still be able to develop these relationships?

Brad Schipper: Well, that’s the key, right? There’s nothing more sacred than somebody who entrusts their most important asset, which is their health or their life, or the life or the health of a loved one with us. So the key thing that we’re trying to do with virtual health care is making sure that we keep that important bond between the patient and the caregiver.

And that’s through education of how the technology works, through research to make sure that what we’re doing is safe and it’s effective. Because ultimately, as you know, what caregivers want to do is they want to satisfy a need. They want to try to heal and provide comfort and help for an individual. And what an individual wants is they want to be able to trust in that recommended plan of care or an ability to try to get to a state of health of whatever that may be.

So we do work with all of our providers, we work with our patients, and we try to educate on both sides what makes sense. Some things will not make sense for virtual care, but many things will. And there are multiple ways that we can build relationships like we used to do face to face via the use of our technology. But the one thing we’re not gonna take away is the personal nature of that interaction. We need to make sure that that’s still front and center for what we’re trying to accomplish.

Dr. Luis Garcia: Yeah, I appreciate that. And, and I think you highlight the importance that it, that this has for patients, but also for our clinicians, right? And the importance of that relationship. So what do you think this means for our physicians, nurses, and what kind of satisfaction does interacting with patients in this way brings to them?

Brad Schipper: Yeah. What we hope it means, and what we’re hearing that it does mean is it allows our providers of the care the same benefits, frankly, as the consumers of the care. Meaning it’s not overly efficient and it can be cumbersome and challenging for a provider to be on the road for three to four hours to see some patients or to be away from their family or to experience some burnout from the challenges of our geography.

So hopefully through the use of some of our intelligence built into some of our platforms that we have here and our technologies, it allows them to work smarter and not harder. It allows them to maybe stay off the road so that rather than driving in a car three to four to five hours or in a plane, they have an opportunity to do some other work or to see additional patients that are in need.

So we’re really trying to set this up in a way that can benefit our caregivers, just like it benefits those who receive our care. And those are just a couple of the examples of where this can really help for that type of care.

Dr. Luis Garcia: Thank you once again for recognizing that, Brad, because I think that it’s very clear that we’re clinicians continuing to be fully committed to our patients, and at times our own clinicians are also driving or transporting themselves long distances to provide that care. And this would certainly be an accommodating factor for them. So thanks, thanks for recognizing and pointing that out.

Brad Schipper: The other thing I’d point out, like I had done earlier, and like you’ve, so, like you’ve pointed out, is the providers have done so much as well. So I would hate for anybody to misinterpret to think, Wow, now we’re gonna try to be really convenient and patient-centric. We have been convenient, we have been patient-centric, but we’re trying to do it different, right?

We’re reimagining that, but there’s nothing more patient-centric than a provider who works a long day, gets in a plane, works even a longer day, drives in a car, gets back, does their charts, tries to have a professional and a personal life at the same time. So, you know, I would hate for anybody to lose sight of that. We use words like we want to be more patient centric, or resident centric, and by no means would I ever want somebody to misinterpret that people haven’t done what’s right. It’s just a way to do that maybe a little bit differently.

Dr. Luis Garcia: I appreciate that thought, Brad. You know, Brad, if we look at some statistics, national statistics we know that about 20% of Americans live in rural areas and pretty much all our footprint is rural by definition, but yet fewer than 10% of physicians practice in rural communities. So how do you feel that these virtual strategies and this virtual care center will support our own strategy to develop our own? You know, we rely a lot on developing our own workforce and our own physicians to satisfy that shortage and that need. So how do you feel this center will support that educational piece?

Brad Schipper: No different than in our personal lives, right? We want a sense of community, we want a sense of belonging, we want support. What I think the virtual initiative can help do for our caregivers and our physicians and other providers, is they don’t have to feel like they’re on an island of one anymore. They’re connected to a huge network of other caregivers and providers within our footprint in a real time way and in a meaningful way.

It can get very lonely if you’re a subspecialty of one or a family medicine physician, for example, of one or a nurse practitioner of one. This can take away some of that feeling. But, as importantly, it can provide some of that depth and breadth that can help them to feel comfortable and to be able to go to a site where they can have partners maybe a little bit differently, maybe their virtual partners, but it’s different than it was even five, 10 years ago when how that may feel.

So I think that can help us to recruit to some of these areas. I think by investing in the education and training to make people comfortable with the technology and to help our people and allow them to innovate some of this new technology and software and hardware and wearables and everything else, I think it’s super exciting for people to be part of something so different and so special. I know it was for me, that’s why I came back. Really, this is a once in a lifetime, a once in a career opportunity to really do something differently.

And I think that’s why we had such a successful summit, to be honest. We had people that came here that it wasn’t just out of self-interest, our self-promotion, it was truly because they saw that we have the potential to do something very different.

Dr. Luis Garcia: You know, Brad, you talk about moments of loneliness and moments of uncertainty, and I think the pandemic in the last couple of years brought enough of those moments to all of us, and it was just fascinating to see to the point that you’re making how our clinicians market to market or location to location collaborated virtually to really define the treatment of a disease that we had very little knowledge about. And, we all became students and teachers and researchers in a heartbeat. And the use of technology certainly facilitated all of that. So the pandemic accelerated a lot of this and the conversations have been elevated. How is Sanford right now training our existing providers to interact more with our patients virtually?

Brad Schipper: Sure. We’re doing that today as it relates to some of our medical residencies, our fellowships, or working with our medical schools and our universities. So, that’s occurring today as it relates to the things we’re doing in the future. That’s what we’re going to do a lot more of with the virtual care center.

And it can be done virtually as well as in that center, but we will be training the future generations on, on how to utilize our technology and the best practices of that so that people are comfortable, you know, we call it website manner, and it seems intuitive, but it’s not always intuitive.

How you experience that care on the other end of the video is different than face to face. So how you’re talking to somebody, if you’re multitasking, how you’re using the monitors, et cetera, are important to that, that sacred relationship that we can have. So that’s things we continue to work on, and it’s what we learned through the pandemic that, you know, you have some, some lessons learned and, and we did an extraordinarily good job, and most things were, were a great success. The silver lining was, it really pushed forward virtual health care. But one thing we did learn is you can’t just assume everybody’s comfortable using all this technology, whether they’re receiving the care or providing the care.

Dr. Luis Garcia: So to that point, you know, I mean, I talk to my 14 year old about technology and they embrace it like that, right? <Laugh> But you get an old fart like me <laugh>, and … they say, eh, I don’t know if I believe what you’re saying. So, you know, what do you tell those providers, clinicians, nurses who are hesitant about this virtual care?

Brad Schipper: Yeah, so I think the main thing, and it’s not a sell and it’s not a tell, the main thing is we are going to research and make sure that we are driven by outcomes of what’s best for the patient or the resident. And when that happens, people buy in really fast.

This isn’t about a quick return on investment or this isn’t about the new gimmick or the flashy thing. This is truly about impacting the lives of the people that we serve. And when you do that, people get a lot of buy in and they understand. And then when you parlay that with innovation and with education and with data and research it just makes it a lot easier. And, the reality of it is, although like you, my two daughters are much more advanced in the comfort level with all the new technologies, our market research is suggesting that people, regardless of age group, are starting to embrace technology in ways different than they ever did, somewhat facilitated by the pandemic.

And my bad joke I used just today in a meeting frankly, was normally I want to know the confidence intervals and what’s the margin of error. But the reality of it is, I had a sample size one, and it’s my father, he now has a smartphone and he asked about virtual care. So the world has changed.

Dr. Luis Garcia: <Laugh>. That’s, I agree with you. I communicate with my 82-year-old mother through WhatsApp. So that’s really cool. We talk a little bit about the processes and about the strategy, but let’s talk a little bit about the structure of this virtual care initiative and clinics. I heard that that we’re gonna have a concept of satellite clinics in, in very rural areas to provide care using virtual technology. Can you speak a little bit about what’s the purpose of that?

Brad Schipper: Yeah, this is super exciting. We’re trying to figure out is there a way to provide care in a community that otherwise does not have it, or a community that may lose it? We have a lot of interest in that.

So we’re trying to look around our entire footprint to see if there are places without a hospital, without a clinic, without a lab, without a pharmacy that somebody now has to travel for care. And if there is, are we able to provide a clinic staffed with maybe an RN or a nurse practitioner that can do some lab work in the clinic, some imaging work, maybe some pharmacy work, and connect virtually with multiple care providers to try to keep that care as close to home as possible?

So supplementing maybe just off your smartphone, this is yet another way to keep that care close. So we’re actively right now working with certain communities and economic development areas and other things to see where we could pilot these to see what ultimately may make sense.

And, we have right now interest across our entire footprint. I don’t have anything to share today of where the first one may or may not be, but we are excited about this concept to see what that means, what it looks like and what it could ultimately look like down the road.

But just imagine again, if you’re a person in a small community, there’s no health care, you work late, you can’t access anything. Maybe you do it via your smartphone. Maybe now you can go to one of these virtual clinics and you don’t have to take a couple days off work and drive into the city. And I think we underestimate, right, the stress of even just driving into some of our bigger cities if you’re not used to that from some of our rural environments. So that’s what we’re trying to work on and ultimately help the outcomes of the folks in those communities, because sometimes they do at a greater rate, bypass some of the preventative screenings and services because it’s just not convenient for ’em.

So maybe there’s an opportunity to do some of that as well. And, and we’re excited about trying to pilot some of these concepts and we just haven’t quite identified where it’s going to be yet. But, it’s gonna be fun. We got the right system to do it. We’re a provider with physicians. We have bricks and mortar of hospitals, clinics and nursing homes. We have a health plan that provides insurance. We have a research arm that looks at how we’re doing. And I think partnering all that integrated system, the integrated system pieces we have with, with some of these satellite clinics could truly prove to be revolutionary in what happens in some of our underserved areas down the road.

Dr. Luis Garcia: You know, and I appreciate the thoughtful concept of those satellite clinics, but, you know, Brad, I hear that as of 2021, an estimated 135,000 people, it’s equivalent to one in six South Dakotans, for example, and similar, you know, similar ratio in North Dakota, do not have adequate broadband access. So how do you navigate those challenges when you’re trying to bring services, much needed services to very rural communities, but there are external factors that do not depend specifically on Sanford?

Brad Schipper: Yeah, it, it is absolutely a challenge, and that’s why we’re trying to look at some public and private partnerships to be able to bring some of those solutions to those communities. We do believe as we invest in those communities, it will spur other investments in those communities, which can help with broadband. But without a public private partnership and, and working with multiple stakeholders, it will be difficult. At worst case, maybe we can put it in one of these satellite clinics, for example, that has greater connectivity than otherwise people would have within their homes. But ultimately we want to try to deliver it so that they have the, the connectivity that, that we, we all appreciate in more urban areas.

Dr. Luis Garcia: That makes sense. And I think that it’s also a reflection of what Sanford has been historically, right? It’s about relationships, it’s about partnerships and the tide rises for everybody. So I appreciate that comment.

You talk a little bit about your relationship with research, with our health plan, with innovation, and it is my understanding that the virtual care center will also house some research on innovation projects. Can you talk to me a little bit about that?

Brad Schipper: Our vision for the innovation center is really a place where people can think about what needs to be done. They can create what needs to be done, they can pilot and test in a safe environment. Does that ultimately achieve what we are trying to accomplish?

So we have those spaces within this facility that are designed. In addition to that, we will have different vendors or different startups that can have space within the facility to try to come in and try to provide solutions for what we’re struggling to accomplish. And some of these startups, as you know, may be in their garage, so they really don’t have space. Other ones don’t need the space, but, but we’re truly trying to have a space where we can look at software, hardware, and other technological advancements to make sure that we can do absolutely what’s the most convenient and world class for all of our patients.

So that’s part of this. And then it’s partnered with our education center and it’s partnered with our care delivery side. And that’s really the differentiator here. There’s a lot of people getting into this space, but very few are as intentional as we are with combining innovation and research with our education and with our care delivery and doing it as broadly as we are from birth to death. We’re not just gonna pick out one specialty or our one item. We’re trying to do it across all of our service lines and all of our age groups. And it does help that we can do that one because of, we’re an integrated health system and two because of Denny’s generosity, but we’re gonna do it anyway cuz it’s the right thing to do, and we’re gonna be here for life. We’re not gonna jump into this and jump out of this. This is what we do.

Dr. Luis Garcia: Yeah. I appreciate your thoughts very much. Brad and I tell you that, that reflects a lot of the nature of Sanford too. Sanford has been my only employer. And sometimes somebody asks me, How, how would you define Sanford? And I just say, We just hate this status quo, <laugh>, we just don’t like it. Correct. You know, and I think that that defines part of our nature.

And tapping a little bit on that, you know, even though we’re talking about these virtual initiatives, we have done more than 600,000 virtual care consults and visits over the last few years. And as innovators and as leaders in an industry, you know, there’s things that go bad and there’s things that go well. Can you share with us some of those things that have been learning opportunities for us where something just didn’t go as well as we expected, or that we could have done it differently?

Brad Schipper: Sure. I think one of the bigger learnings, and it’s part of having the educational institute in such a laser focus on that is, is we probably at times have underestimated the amount of ramp up or training or education it takes to provide some of these services virtually, whether it be for the patient to try to access these services or whether it be for the care providers to deliver these services. So I can’t say that there’s any one service that we went, Wow, we really shouldn’t have done that. But there were some services where I think if we just spent a little more time on the front end, and had the luxury of that, now the pandemic didn’t afford us all that luxury as we know. But everything we provided, fortunately, we feel was safe and effective, but we think we could even make it a better experience for the consumer of the service or the provider of the service with additional education.

The other thing that gets a little tricky in this, and one of the things that we learned is that, you know, payers and others, insurers treat virtual differently. And it’s really kind of tricky to figure out, well, who’s gonna cover this? Well, only if it’s in your home. Nope. Only if it’s in the clinic. Nope. Only if it’s for this level of service. Only if you’re this age. And those things get really, really kind of complicated to figure out. So we’re doing a lot of advocacy there with data and research to see what makes sense.

And again, we’re really fortunate that we have a health plan, so we sit side by side with a health insurer, us, that we can talk and say what makes sense. And ultimately what we’re going to do is what makes sense. This is, again, not gonna just be driven on all those payer provider discussions that I just said, but we’ll need to be cognizant of them so that we’re aware of how that all works. But if it makes sense at Sanford, we have a history of just doing it.

Dr. Luis Garcia: That speaks loudly about the commitment that we have with our communities, right? And the purpose of our mission where we’re gonna give you or provide care to you, and we’ll just figure out how do we get reimbursed or all those collaterals. So I think that speaks loudly about our commitment.

What does success look like for this center Brad? And this is gonna be my last question, I promise you.

Brad Schipper: <laugh> All right. I think a lot of people would say success is that we open the building on time and we get that built. And a lot of people would say, we maybe have an advancement in a technology that nobody has. And a lot of people may say that, you know, we have great patient or resident satisfaction, or we help some of our recruitment. Those are all incredible measures of success that we would want to celebrate and recognize. For me, it’s more simplistic than that. Did we ultimately improve the health and well-being in the human condition of those that we’re interacting with? We have an amazing privilege and amazing obligation and a challenge to care for those who are in need. So ultimately, if that doesn’t change or we don’t move the needle on that, I will not say that we have been successful in this arena despite the other things.

It’s the ultimate way that we’ll know if we’re successful, but we’re gonna have micro successes along the way. But I think you and I would both agree that those are exciting to celebrate, but if we can really improve the human condition, that’s a game changer.

Dr. Luis Garcia: That’s well said, Brad, and I said it was gonna be my last question, but I lied. This is my last question, <laugh>. OK. You’re a very accomplished professional. You’ve seen a lot of things in your life. What excites you personally about this opportunity?

Brad Schipper: Well, personally, I think it’s rare that you can have an opportunity to have such a global impact on health care that we have. And personally, I believe in it. Professionally, I believe in it. Health care is ripe for change and we need to change. And I just couldn’t be more excited to help be part of a team that has done so much work already and will do so much more work and have the opportunity to, to truly shape health care. And I, I, I just can’t overstate that enough. I mean, that gets me up and gets me excited every single morning that, like I said earlier, I do believe it’s a once in a lifetime and a once in a career opportunity. And I’m just fired up for it. It’s incredible.

Dr. Luis Garcia: I agree with you, Brad, and thank you. It is incredible. And let me just offer, if you allow me my gratitude to the leaders in Sanford that had this vision, and certainly to have the vision to include you in this project because you are the right person for that. So thank you, thank you for joining us on that journey.

My deep gratitude to our benefactors specifically Denny Sanford, who is making this possible, my most sincere gratitude to our clinicians. We have been talking about the tremendous amount of work that they execute every day. And this is just one more way in which they will satisfy that commitment.

And certainly the deepest of the gratitudes to our patients for considering us the most trusted system and continue to come back to us in their times of greatest need. And you’ve said it, you said it, it is a privilege, but at the same time, it’s an obligation and we love the privilege and we embrace that obligation. And this is just one more example in which Sanford will succeed. So thank you very much for joining me today.

Brad Schipper: Thank you so much for your time your kind words and your questions.

Alan Helgeson (Host): You’ve been listening to Reimagining Rural Health, a podcast series brought to you by Sanford Health. Hear more episodes in this series or other Sanford Health series on Apple, Spotify, and news.sanfordhealth.org. For Sanford Health News, I’m Alan Helgeson, and thank you for listening.

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Renowned thought leader visits Sanford Health

Courtney Collen, Sanford Health News:

Welcome to this episode of our Innovations podcast series by Sanford Health. Dr. Eric Topol is a renowned American cardiologist, scientist and author. He is the founder, director and professor of molecular medicine at Scripps Research, and he is senior consultant at the division of cardiovascular diseases at Scripps Clinic in Southern California. Dr. Topol oversees a multimillion dollar grant on precision medicine, and he’s the principal investigator for an NIH grant, focusing on innovation and career training in medicine. Our moderator for this episode is Dr. Luis Garcia.

Dr. Luis Garcia (Host):

Thank you, Dr. Topol. I’m going to tell you, there are people that wait all their lives to have an opportunity like the one I’m having right now and they never get it. So I’m blessed and honored to be here today.

You know, you have been one of the most influential physicians in our industry, excellent clinician involving drug development, device development, molecular medicine research, one of the top 10 cited scientists in the world, three books. You advise the UK government on their national health system and all those accolades that I could take the hour that we have here to talk on that.

But I want, because we want to hear from you, but one of the things that I want to tell you is that what I have learned from you today is that besides all that you are a great human, you have great character and you have a great integrity. That’s what I learned today. So that leads me to my first question. Who is Eric Topol?

Dr. Eric Topol:

Well, first, let me say, how kind are you to say these things and I’m very appreciative and humbled. I try to reckon with this question, I’ve never had it before. Who am I, you know. But basically, you know, I as you might expect I have a wife now, 43 years as of yesterday. I have two great kids and three grandchildren, and then there’s what I do at work, which tends to get overemphasized. But as you say, I identify as a physician and as a person who’s trying to improve medicine. I’ve been working out for a long time. And sometimes many days I feel like I haven’t gotten very far, but I won’t keep, I won’t stop. I’ll just keep working until I can’t anymore.

Dr. Luis Garcia (Host):

Well, thank you. And I think the product of your efforts are, it is very tangible for us. I mean, it’s very notable and we appreciate that. You know, you, you mentioned family as a first description of you, and I know you’re a family man. Who was Eric Topol as a child, you know, as you’re growing up? Tell us about your family and your dreams about becoming somebody influential.

Dr. Eric Topol:

Yeah, well I didn’t come from medical family. My mother was a schoolteacher, my father, an accountant. And I really didn’t know that medicine was going to be in the cards until actually in college at University of Virginia. I worked at night shift just trying to make ends meet.

And I happened to be in the night shift as a respiratory technician. And those were the days where, you know, these were very primitive ventilators compared to what we had now, but I saw people in the intensive care unit, almost like a Lazarus, you know, resurrection, I thought they were to die and then they were, they would make it. And I said, “Wow, this is – this medicine thing is amazing.”

So that basically pushed me from what I was planning to do in life to become a physician. But I never really had aspired to be, you know, a leading-edge type force. It was more as a natural pushing hard on things that I believed in or worked hard to try to advocate.

Dr. Luis Garcia (Host):

And you know, a lot of young physicians-to-be, or a lot of children perhaps find themselves or will find themselves in a situation like yours, where you get the opportunities to seize an opportunity and you do it, and then you become really influential.

What would you tell those children right now that are the future of our country and of our world? What message would you tell them of encouragement of why is it important to get an education? Why is it important to take advantage of those opportunities and capitalize on them?

Dr. Eric Topol:

Well, I think the idea that is a limitless, what you can do, if you are really driven to what you’re passionate about that, you know, everyone has the talent and it’s the real matter of applying it, too. It doesn’t have to be kinds of things that I’ve worked on, or you’ve worked on, Luis, but many other people don’t ever find their niche in life. They don’t find the matchup of where they have something to offer. And that’s, I think unfortunate. That alignment of what you can do, that’s special and help people and make a difference.

You know, we’re lucky when we find those, but there’s too many people that have that latent or not-so-latent capability, that’s extraordinary, but they don’t really come to that realization or sometimes they do, but it’s, you know, much later in their life. So the sooner you can find what you are excited about, what you think may be a talent to nurture a particular quality that is burning inside you, go for it.

Of course, it doesn’t happen by accident. It’s not something that’s a natural gift. It means work. You have to really work at it, as well. So it’s a pairing of finding that kind inclination quality and then really going after it.

Dr. Luis Garcia (Host):

I appreciate that that insight, Dr. Topol. Yes, I’ve got to tell you, I feel so lucky that I’m in the medical field and that I love what I do. Right. Oftentimes we find somebody doing a job just because it is a job and not because it is a passion, right? So, realizing what your passion is and executing on it with hard work … I appreciate those comments.

When I talk to great leaders in this world, oftentimes they can identify a moment of uncertainty on their lives in which they had to make a decision. And that decision put you in a much different spot than you would have been if you would’ve taken the other side of the road. Did that ever happen to you?

Dr. Eric Topol:

Oh, actually several times. I live in uncertainties really. But the one I can recall, particularly since we’re talking about a kind of career path, I was at UC-San Francisco in my medical training. And I actually was planning to be a diabetologist because my father had type 1 diabetes and had gone blind by age 49 and I wanted to dedicate my life towards that. And in fact that was one of the reasons I picked UC-San Francisco. They had a first-rate diabetes division.

Anyway, my wife said when I was doing rotations and intersecting with cardiology said, “That’s what you’re really excited about. Can’t you tell?” And so she was the first one to note that I wasn’t at all excited about what I had purported to be. She helped sway me towards cardiology and that was a big, important decision where I was certain, but I was basically realigned with her support and insight.

Dr. Luis Garcia (Host):

Let me change up a little bit, the topic here, Dr. Topol. Sanford Health, we say that we aspire to be the premier rural health care system in the nation. We’re driven by the values that I’ve heard you reinforce and talk so much like restoring humanity in medicine, being about the patient, not being about compensation or reimbursement and really finding again the value and the art of being a physician and taking care of people in need. You articulate that very eloquently in your books. Do you want to share your thoughts about that?

Dr. Eric Topol:

Well, because I’m older, I’ve seen medicine change over the many decades and unfortunately it’s mostly for the bad. That is the emphasis on the patient-doctor relationship has been lost in most respects and the business of medicine has become the center so that term patient-centric is really useless compared to what is the reality.

Especially, as I got older, and naturally I became more frequently a patient and realized even from firsthand experience how this attrition has become so extraordinary. And that is, I think, ignited me to try to get us back and find all the other people that are willing to work together towards getting medicine back to where it was, which was that precious relationship that you had with your doctor, which was the person who had your back, the person who you should trust and whenever you talk, there was an attentiveness, there was just a real presence and you could relate your deepest concerns. Whereas now, of course, that is a rarity.

So I hope that in the future, that’s our biggest deficit right now that I think accounts for why there’s a global crisis of burnout and such severe depression among clinicians. And we can do this, we can get it back. I’m confident of that, but it isn’t going to be without a lot of effort and without solidarity in the medical community.

Dr. Luis Garcia (Host):

Well, one of the things Dr. Topol that I got out of your books was obviously the physician and clinician perspective is very important in patient care. But what about the patient perspective? And to your point that somehow, that art of medicine has been lost for the wrong incentives and oftentimes as physicians will say, “Well, my patients love me and I provide the best care in the world.” And interestingly, in one of your books, you bring the “word cloud” concept. Can you talk to us a little bit about that?

Dr. Eric Topol:

Yeah. I think the perception that our patients, “my patients love me” may be a little off because while there may be some physicians who truly have that, most don’t, and we saw that the word cloud you mentioned is from one leading medical center.

What are the two words that you think of from right coming out from your visit? And the words were not pretty you know, hurried and rushed and unconcerned and just devoid of the humanistic qualities that we need to exude. And that I think is the real problem.

That used to be the case that there was a love. It was bilateral. I mean, there were a lot of patients I just adore. I mean, no question about it. But the time that we have is so compromised that we don’t even have time to listen to a patient no less to do a proper exam and cultivate a relationship.

What I’m excited about with Sanford is that you could be the leader and pioneer reestablishing the care of the patient is about caring for the patient because there isn’t a health system in the United States that exudes that, or is the exemplar. And you can do that here.

Dr. Luis Garcia (Host):

Dr. Topol, thanks for pointing that out to us. And let me be honest with you. As I mentioned earlier in the podcast we’re driven by values. And during the pandemic, we took a special interest on learning how what our patients thinking of us as a health care system, and turns out that we are the most trusted health care system in our regions. And people understand by default that we have the greatest talent, but it is about that trust and it is about that relationship that that really makes the difference.

And the last couple of years have been so difficult for clinicians and health care providers. Right now, they feel that they’re devalued and the sense of being devalued comes precisely from what you’re seeing from their patients, perhaps not trusting their opinion, not trusting their insight because of all the myriad and amount of information that we get from untrusted sources. What are your thoughts about that?

Dr. Eric Topol:

Well, the bigger picture is there is more blurring of truth and lies and, you know, facts and fabrications than ever before and we have done as a country, little to ante up with the forces that are making this, that are consciously trying to blur and, you know, all the fake stuff.

And we have to work hard to get that trust back. And it’s across the board. I mean, all the revered institutions, including medicine has suffered from this. But we have a very strong anti-science faction in this country, more so than most other industrialized parts of the world. And we haven’t done anything really to cope with it, to counter it and take control and unfortunately it’s just gotten worse through the pandemic.

In this time of crisis, this would’ve been ideal time to really work against it. And in fact, knowing it was going to be an issue you could tell early on. But you know, it’s never too late. And I think that because there’s so much unreliable source of information for people because people get their punitive facts and news that often is questionable through so many varied sources. We have to have a central source that is known to be trusted that everyone can rely upon and that’s going to take effort. And we have no such thing, no such force at this point.

Dr. Luis Garcia (Host):

And I don’t want to miss the opportunity to speak about two instances in which your determination in which your adherence to science really have made a difference. And I have to ask you about your participation in COVID, that’s one thing and your participation with the UK government, with the United Kingdom government. But let me just ask you, how does it feel to get called on your personal phone by somebody telling you we want you to come and redefine the national health care system for the United Kingdom? That must be a super honor. How does that feel?

Dr. Eric Topol:

Well, yeah, it was kinda interesting that it happens, you know, from another country, rather than in your own country at the time. I was actually, I was thrilled to get that call and invitation. I didn’t know exactly what I was getting myself into, that I would go and have these, you know, 50 different people assigned to this for this review to help me. And it was obviously a big part, not just planning the national health service, but how well it would be received by the public, how would it be seen as a political, you know, football sort of thing? And so, it was a fascinating learning experience for me and made a lot of, you know, new friends from it.

But, you know, these days in the pandemic, it’s been gratifying because now there are people in our own government that are making contact and, you know, asking for input and it’s great to have a voice to have a chance to weigh in. I think that when you have at least a way, a channel, what you, you know, sometimes in the bubble that our government sits, they don’t really have enough insight about what is the problem out there. I think right now you know, the chance has increased throughout the pandemic of being able to give some, at least thoughts. Sometimes you could consider it advice and it’s fun for me.

Dr. Luis Garcia (Host):

And it’s just amazing. You shared a story with us earlier of how once again, your determination and your input really influenced the release of the vaccine and all the research that what’s going on behind the COVID vaccine. Do you want to share some thoughts about that?

Dr. Eric Topol:

Well, it’s interesting. I never realized the power of social media for me, at least, until I exercised it during the course of the pandemic. It started with the vaccine trials were, we knew they were ongoing, but the companies Pfizer, Moderna, J and J, AstraZeneca, and none of them would release their protocols, like they had something to hide.

So I basically started tweeting at these companies, “When are you going to release your protocol?” And finally, I got them, or whatever that happened, and one did it, you know, and then they all did it because they were all basically you know, undressed about this issue. And once you saw the protocols, then you started to see, “Oh my gosh, there’s a chance that these trials could be stopped early, really early before we knew the truth.”

And then of course there was a concern that the FDA was being subverted. And then the company’s interest was to get the vaccine. So you basically had alignment of the current administration that subverted the FDA and the companies all wanted to get the vaccines approved and get hundreds of millions of doses out there sold as quickly as possible but they didn’t have a plan to do it right.

So by social media, basically exposing the protocols and making them public and also for the research community to see, that was basically the ticket to, we cannot let this happen. If these trials stop after 30 patient events, and we are going to start giving vaccines to billions of people, something is going to be off here.

I think the extraordinary part of this knowing the protocols, being able to have precise readout that if this were to happen as the companies wanted, and as the administration wanted, we could be looking at premature dissemination of vaccines that were not proven, and this could be not knowing the results, but this could be a real setting for mistrust and also a backfire. I mean, we could have really good vaccines, but without validation, we could really see trouble. So, fortunately this got all fixed in the nick of time in October of 2020.

And we were very lucky. We had vaccines that had 95% efficacy, at least against the original strain. And we had it done right. The trials were finished and in just a mid-November, you know, we started to see the results. The companies acted properly and everything kind of fell into place. And we’re lucky about that. It could have gone a whole different route and whatever accusations people have made about “it was rushed.” They don’t have any idea about what rushed could have meant.

Dr. Luis Garcia (Host):

You know, on behalf of so many patients that needed, there’s so many patients that needed that. And there’s so many people that needed your leadership. Thank you for standing up for the right thing. So we appreciate that.

You know, Dr. Topol, in your books, you talk a lot about the future of medicine and how will augmented intelligence, machine learning and all that would influence medical care in the future? Where do you see medicine in 5, 10, 15 years down the road?

Dr. Eric Topol:

Well, one thing I’ll preface that by is that, every time I try to think where it’s going to be an X number of years, it’s multiplied by about three or four times – if not more. It doesn’t move like it should. And this is another flagrant example is that if we were to embrace AI (artificial intelligence) and go after it, in terms of doing the proper vital validation work, we could get there faster. But we’re not. We’re more – the medical community, more afraid of it than they are seeing the extraordinary potential.

But over time, we will see keyboard liberation. We will see reestablishment of really good communication during encounters between patients and clinicians. We will ultimately see remote patient care with much less use of hospitals than we do today. That will take longer, of course, because we have all sorts of reasons in this country to rely on hospitals that we shouldn’t be as much.

At any rate, there will be more changes ahead or at least opportunities for change. Whether we in the United States will adopt them as compared to other countries that are better poised because of their health systems –  that remains to be seen. But this is the most exciting time for medicine rather than certainly the last couple decades where we’ve seen degradation. This is the potential for an extraordinary turning point if we work at it.

Dr. Luis Garcia (Host):

Yeah. I love that last sentence, Dr. Topol. At Sanford, this is reassuring because we are investing a lot on the virtual aspect and the digital aspect for patient care for the right reasons. I’m going back to your comment of “this is exciting, and medicine is still beautiful, medicine is still good.”

We have so many people that have left the workforce and they might decide to come back or not, or so many people that are considering getting into the workforce of health care, but they’re hesitating because of what the last two years had done.

This is my last question: what would you tell those kids that are considering getting into medicine? Why should they get into our field and what is so precious about it that it should be their calling?

Dr. Eric Topol:

Well, there isn’t any question that the best is yet to come. I mean, we’ve hit a bottom that will only can get better now. But moreover there’s no profession that is more exciting, more rewarding than medicine.

The fact that you can truly care for another person for the most important part of their existence, their health, and you can help promote that. And you can have the trust of that person for a lifetime. I mean, there’s nothing like this. There’s no other profession like this. We are privileged to be part of it.

I think once we start to get this turning point established where the humanity is brought back in, it won’t happen. Like a light switch it’ll happen in phases. There will be a surge of interest to be part of this like never before.

Dr. Luis Garcia (Host):

I started my conversation with you highlighting what a great human being and leader you are and to all our listeners, I think they will agree with me that after the thoughts that you shared with us, that is exactly who you are. Thank you for everything you have done until now. I hope that you live until you are 200 years old, so we can continue to have your leadership and if not somehow, with the future of polygenics, and everything that we can clone you. So, but thank you for being here with us.

Dr. Eric Topol:

Thank you. You’re much too kind, but I really appreciate the chance to speak with you today.

Courtney Collen:

And our thanks to Dr. Eric Topol for his time. Find and hear more Sanford Health podcast series and episodes by clicking the link in the show notes, Sanford Health podcasts are also available on Apple, Spotify, or wherever you listen. For Sanford Health News, I’m Courtney Collen. Thanks for being here.