May 3, 2022

Ep 4 Doctors As Patients

Ep 4 Doctors As Patients

What happens when the doctor has to take off the stethoscope and lie down in the hospital bed? You’ll hear 3 stories today: A pediatrician hospitalist whose own child is in the hospital, a provider that does telehealth with her clients all the time but stumbles through her own telehealth appointment, and me talking about what exactly is so hard about being a doctor-patient.


Date: 5/3/22
Name of podcast: Dr. Patient
Episode title and number: 4 Doctors As Patients

Episode summary:
What happens when the doctor has to take off the stethoscope and lie down in the hospital bed? You’ll hear 3 stories today: A pediatrician hospitalist whose own child is in the hospital, a provider that does telehealth with her clients all the time but stumbles through her own telehealth appointment, and me talking about what exactly is so hard about being a doctor-patient.

Guests:
Dr. Barrett Fromme, University of Chicago
Sharon Dornberg-Lee, LCSW

Key Terms:
Hospitalist [00:41] - a physician who works exclusively in the hospital caring for inpatients
Jon Snow [14.58] -  reference to the character from Game of Thrones who is often told, "you know nothing, Jon Snow"

Transcript

Heather Johnston:

When doctors have to be patients, it's an incredibly strange and uncomfortable feeling. My husband likes to use the phrase "seeing too much of the chicken". And I often think that that's applicable to being a doctor-patient, as I call us. I know a bit too much for my own good about certain things. But then there's also a lot that I don't know anything about at all. Oftentimes, when a doctor becomes a patient or has a family member who's a patient, it heightens their ability to be empathetic to their own patients later on, because they now understand a bit better what the experience is like on the other side. My first guest today is Dr. Barrett Fromme, a pediatric Hospitalist and Professor of Pediatrics at the University of Chicago. A while back, her child was in the hospital where she worked. And here's her story about how she managed to be a mom and a doctor at the same time.

Barrett Fromme MD:

Yeah, so Emerson was in the hospital, which is really specific to what I do, right? I'm not a pediatrician. I'm a pediatrician who takes care of kids in the hospital. So it was my it was literally my house, right? She was on the floor where I work, I joke, it was my shortest commute that I've ever had. Because I literally woke up with her in the room and went saw a patient next door, it was good stuff. But I should have taken time off. I combined my work and my family life.

Heather Johnston:

Care for yourself.

Barrett Fromme MD:

Exactly.

Heather Johnston:

It's interesting that you said that about not taking work off. And I wonder if it's because when you are a doctor, and then you become a patient, you feel like you're at work. It doesn't seem like it's your personal time. I mean, did it occur to you to take time off? Or were you like, well, I'm just here, it's just happening.

Barrett Fromme MD:

There was one day where she went for a procedure. And I got coverage for that. Because it was at the time of rounds. So I didn't want to conflict. I, it actually in some ways, I was able to convince myself, Well, look, it's even easier. I don't have the commute. So I'm just going to duck out for a minute. And then you know, I can sit in the room where I normally would be roving around. My team can call me if they need me because I'm they can stop by if they want. So it just I don't know it it. I can't even say if I rationally thought. I made a decision. I mean, that I'll tell you that's kind of the my was my whole approach to the whole thing is to take control, right? For me having a daughter who was a patient in my own hospital in a mystery case, right? Well, you don't have control. You don't know what it is. It's not like she came in with asthma. And we all know what to do with asthma. And I knew what to expect she came in. We'd been going at it for a couple of weeks. We you know, had a an MRI, the MRI said a lesion - lesion is never a good word as we all know in medicine. And so at that point, it was like let's control what I can control, right? and I can't control the diagnosis. I can control. You know what I do? If I can get my husband caught in the house. That was my big who no one gets cards. You have the futon and a chair, but I got VIP to get a cut for us while in. But I control the things I asked the nurses. I don't want overnight vitals like nobody nowadays, we understand that. And we're trying to do that more. But at the time, no one stopped vitals at night. And it's like, no, I'm going to control this tool. I think working was also that control piece.

Heather Johnston:

Did you ever consider yourself part of her medical team?

Barrett Fromme MD:

I don't think I ever did. I certainly funny. I don't think I ever. I mean, listen, I tried to see if I could add to what I was giving but I didn't. I didn't research it. Once the by the time we got into the hospital, I didn't do any lit searches, I didn't do any reviews. I said I have orthopedics, infectious disease, rheumatology and the hospital medicine team. I'm gonna let them think. I considered myself the coordinator. I as an outpatient like I kind of I just famously my bad but I thought they might we were still not hospitalized. I thought they might want an MRI within a few days. And I knew who I wanted to do the sedation for that MRI. So I scheduled the MRI and had the orthopedist call me and say Barrett, I saw you scheduled an MRI. I thought I had been clever. And I was like well no just in case you want it. And he was like, I don't know what you're doing. So mine was more functional. Like I was like I'm a coordinator I'm gonna get I'm gonna get the test done when you want to get the test and I'm going to be prepared, but it was also very selfish. I wanted to make sure I had the right sedation person and the right anesthesiologist when we went to procedure. That was, but I never tried to be part of the physician team. I sat back and just let I said, they're smarter than me at this moment. I'm probably too close. I'll let them run the show here. When they all came back with different opinions, I've had more knowledge to challenge them with questions like do I need to stay for another night of antibiotics? Yes. Or what do you think of that? But no, I actually don't recall, I'm pretty confident about this. I did not try to manage the medicine. I tried to manage the systems efficiencies.

Heather Johnston:

So would you say that you fully trusted the doctors that were taking care of her? 100%?

Barrett Fromme MD:

That's rude to throw 100% at me. I would say from a medical diagnosis standpoint, I was 100% trustworthy that they were coming up with the best ideas from their experience. And I know that sounds like a really cautious way of saying it. But I thought the orthopedist, I 100% trusted that he was giving me his best. I 100% trusted that infectious disease was giving me their best rheumatology. I didn't 100% And this is gonna sound weird. I didn't 100% trust all the people who might have put brain altering chemicals into my daughter's body, when it came to sedation and anesthesia. That's where I was like, I don't I don't need and I don't know, I've never thought about that. But like, I trusted the individuals I work with those individuals a lot that right? The people I work with the the medical teams, I worked with tons. So I knew their schedules, and I knew who they were,

Heather Johnston:

What if she was at a different hospital and you didn't know them? Would you feel trustworthy?

Barrett Fromme MD:

My trust would have gone down some. I still would like to think I was at 60 to 70%. You have to try and trust your physician. You have to know at some point, but I think if I was at another, I'm pretty confident if I was at another institution where I did not know them. I would have been doing more of my own searches, I would have been coming to rounds with my own ideas. When it's me, it's me, right? I'm just dealing for me. When it's my daughter, I need to be a parent for her and not try to be the doctor at the same time. I need to cleave those personalities. Versus when it's just me, I could be the doctor. I'm also a pediatrician. So like trying to say what to do for 48 year old woman is stupid. I don't know.

Heather Johnston:

But we always feel like we know a lot anyway. At least you can you know, you can read in good sources and understand the articles that you're reading.

Barrett Fromme MD:

Exactly.

Heather Johnston:

I remember when my son Ellis was in the hospital, and you were our doctor. And I had a similar feeling. I knew everybody, and I felt very trusting of the people that were taking care of him. And I knew that I was a total emotional hormonal train wreck. Because I think it was only a week after he was born.

Barrett Fromme MD:

I remember the emotional train wreck it was; you were.

Heather Johnston:

There was a lot of crying going out. But no, but I think it comes down to knowing people. Because I can tell you now that if he wasn't there at that hospital with you who I had known for years, taking care of him, I would have been checking up on things. So it comes down to knowing people, and therein lies the issue that I have with the medical system as it is today. Because the health insurance industry makes it so difficult for people to keep doctors for the long term. It makes it hard for doctors to stay in practice. It makes it hard for them to see patients they want the way they want to see them with enough time. And so you and I are sitting here saying we're doctors, and we trust people that we know. But if we don't, we don't really trust everybody. But we're asking our patients to come in and trust us even though they don't know us very well.

Barrett Fromme MD:

I always say picking a pediatrician, like your doctor, your primary care doctor of some kind. It's like picking a spouse, right? You have to find the one that fits you. Do you want the paternalistic one who's just like trust me, it's fine. Do you want the one that explains it to you, right? And so there's not just the element of trust, but it's finding a doctor that fits your style. And I think part of that ease of me to trust the doctors in my own hospital is even if they weren't like I wasn't gonna say, hey, ID Doc, you get off get me the one I like their style, but I knew I knew them enough to even if our styles differed. I knew how to get around that because I knew them on a personal level. So it wasn't I wasn't struggling with a communication style or a style of doctoring that differed with me and they were all I'd say all three specialists were very different in how they, but I knew them well enough to like it didn't matter as much, right?

Heather Johnston:

Do you find that when you are being a patient and you're doing patient things like waiting in a waiting room, changing being given the gown and instructions, getting on the scanner table or whatever the thing is, are, are you just registering every detail and thinking about how that normally happens?

Barrett Fromme MD:

Yeah, I remember I had a colonoscopy, and they were like, so the nurse anesthetist said, Hello, and I so I was like "so what meds are we using today?" Like, that was my like, cool line, like I needed to know what meds we were using, but like I was, you know, we were waiting for the GI doc. And I was like, analyzing all the equipment like I was not where I normally go. So it was like, oh, look at the camera. They've got this, what's that? I'm asking what meds they're using, I'm analyzing. I think it's partly at partly out of curiosity, because I don't live in that zone. Right? I might send people for MRIs. And I know what an MRI does. And I've been down in MRI, but scopes and all these different kinds of things. It's, it's a little so I tend to always be

Heather Johnston:

like, maybe you haven't seen one since medical school, right? I mean, and it's changed a lot.

Barrett Fromme MD:

Let's be honest, it's been awhile for us. And you know, we we just could use like spy glasses. That's the only thing we had back in the day. I didn't have kids yet. And I remember you coming out. And we went around the corner to offstage, if you remember, because I think you were like 568 or 668, you're at the end of the hall, and you are on the call. And you okay, we went on stage around the corner where patients don't go and you broke down. And you said, I just need you to tell me what to do. Because I kept being very patient-centered with you, because you're you're a doctor. And so I want to make sure you know, like and be there for Matt, but really you understand? And I think that was like

Heather Johnston:

I remember that now, I had totally forgotten about that.

Barrett Fromme MD:

Yeah, it was it was hugely impactful for me because as a physician, it was that idea that I thought I knew what you wanted or needed, because you were a doctor. But you had to tell me what that was. And I've taken to now and I have physicians' kids saying, how do you want this? Like, how do you want me to play this with you, right. And a lot of times, it's people I trained, whose kids are coming in, which is even weirder. And it also taught me that now that I've had my own daughter be a patient, and I've gone through your own patient-hood. And now my own patient-hood. It's just thinking about, like, kind of being able to verbalize that let people know kind of what you need, in a sense.

Heather Johnston:

That's so interesting, I actually hadn't really thought of that angle of being a doctor to a doctor, I was thinking of it more as being on the patient end as a doctor. It's getting confusing with the language. But that's interesting. I remember in practice, when I had when I was taking care of children of doctors, like my partners or other people there at the medical center, I did make a point, I think more after I had children than before, because you really don't fully understand it till you have your own. But I would make the point to say, I want you to know in this first visit, I'm not going to treat you as a doctor. Oh, that's great. I'm just letting you know that I'm going to treat you as a mom. If you have some other medical level question, feel free to ask it, but I'm not going to treat you that way. I'm going to say it all in the way that I would say it normally. And you can ask if you need more information,

Barrett Fromme MD:

Because I think that's the thing, right? When you are the patient, you are a doctor and a patient. We didn't really talk about this, you are treated differently.

Heather Johnston:

Yeah, you really are.

Barrett Fromme MD:

And even though you said that I bet in a little way, you treated them a different way a little bit differently. It's hard. It's hard not to,

Heather Johnston:

I'm sure I did, yes

Barrett Fromme MD:

treat them differently, especially if you know them, right? Especially like, like, definitely if somebody says, Oh, so and so's a doctor, but I don't know who the heck they are. It's not that I it's, I still treat him a little bit differently because in my head, right? I'm thinking, Oh, they're a doctor, but I think you totally get as a patient who's a physician, I think sometimes they run over things too quickly. You know, I'm like, don't assume I know, like, I've had that happen with you know, my health recently. People assume I know. And I'm like,

Heather Johnston:

Well, I've had that happen too, well you know about blah, blah. I don't know that.

Barrett Fromme MD:

Like, I haven't lived in this world. Right. And so I think and I think that maybe why then doctors end up reading more, because they're like, Oh, they're assuming my medical school training from 20 years ago I still remember from the test. I'm like, I did not pay attention in internal medicine. Like I knew I was gonna be at attrition. Stop talking to me. So I think I think to some point, right, are we reading because that's just who we are as doctors probably a little bit but are we reading because there's an assumption about us like, oh, you know, this I know nothing. Like I'm Jon Snow of Medicine when I'm a patient right? So it's a I think that's a little bit of something that I don't think we touched on but I think how quite how our treatment by others and again, in no way meant to be a negative. I think everyone's trying to be like, oh, you know something. I don't want to make I don't want to dumb this down. I don't want to, you know, great but I've even had like patients, parents who are pediatricians, but neonatologists or something that no longer deals with, like 10 year olds with pulmonary disease, and you're great, and you're just like, No, right? You know, nothing, because you've been 20 years as a neonatologist. And, you know, my best friend's a neonatologist and we saw each other, we were talking about something and she looked like a little glazed over and I was like, oh, right, you don't, you don't do that. And then but she'll talk about neonatology. I'm like, what, what are you doing? Yeah, so I think it's like I went to medical school sometime in the last 100 years. So you must, so I can I can shortcut this. And I think the best experiences of a head when somebody just says, let me just say how I would say this to anyone else, I might be able to drop a medical term. Because you you understand the language a little bit if you don't understand the content, you know, you don't have a background on the content. But yeah, yeah, I mean, I when I got diagnosed with with celiac, the nutritionist was phenomenal, even though she knew I was a physician, because she wrote "Dr. Fromme". Like she clearly, she has a way she does it. I don't care who you are, like she's delivering her message. And I was like, she was like, and then as once or twice, she say, I hope this isn't too simple. I'm like, Girl, keep it coming, keep it coming. Like I'm, I'm taking notes, I'm memorizing everything you say because, yeah, I know the word gluten. But like, I she was like gluten comes from Latin, meaning sticky. And I'm like, well, thank you. I did take Latin. But I don't know. I felt like she treated me completely like anybody else she was sent to talk to Yeah, but I think physicians, sometimes you have to be like, Whoa, Timeout, timeout, what is going on?

Heather Johnston:

That also makes me think a little bit about the whole concept of VIP treatment, which I've generally now deemed in my life is a bad idea. It's just bad to get. Because nobody is doing the things the way that they normally do them, which is really what you want. And so I know, over my years of many weird little health problems, there have been times where people have said, Oh, we're gonna do this specially or do it differently. And in the beginning, I thought, oh, yeah, great. Great. And now I would say absolutely not. Put me in a normal room, treat me normally. I don't want any of that. I'm just a patient.

Barrett Fromme MD:

My only rules are, and I think you've probably had the same. At my own institution, do not send medical students in. Like, I have to grade them. So the VIP treatment I need is to not have like, I'll take a res like an OB resident or anesthesia resident in my epidural. Like, I got no problem with that. I don't grade her.

Heather Johnston:

Yeah, me too.

Barrett Fromme MD:

But like, a peds resident, like when I delivered and I knew I was having a C section. For their sake and mine, I made sure my birthing plan, right, which everybody else has accomplished. Mine was the NICU fellow and the nurse practitioner come, not a resident. Not because I don't trust him, but because that's an awkward situation for everybody to be

Heather Johnston:

Yeah, like, you know, you're standing in front of my vagina, and I have to grade you tomorrow and it's weird. It's weird. My second guest today is Sharon Dornberg-Lee, a licensed clinical social worker in Chicago. She had a surprising experience when the table's turned and she had a telehealth appointment with a doctor.

Sharon Dornberg-Lee:

So my name is Sharon Dornburg-Lee, and I'm a clinical supervisor at CJE Senior Life in Chicago. I am a licensed clinical social worker. And I have a variety of roles there at CJE, but my primary one is as a therapist to older adults, and also providing training and supervision for some of our staff and a variety of programs. So we're a multi-service senior center that has a counseling program for older adults. I have been there for 24 years, which is shocking when I say it out loud, I can never believe it's been that long. I have been providing telehealth now to older adults for psychotherapy. For two years since the outset of the pandemic, we quickly pivoted and had to get everybody online to continue to work with our folks. So because I am a supervisor, I have a smaller caseload. So I have about 12 or 15 folks that I'm working with at any given time, and my colleagues and my team may have twice that money. And so we were all sent home well, you know, as everybody was, was that late March 2020, and then sort of said, grab a laptop, we're all going to work from home. I had never provided any telehealth. And so for the first week or so we provided phone sessions with our clients. And then we very quickly pivoted to zoom sessions. So there was a lot of trying to educate all of our clients at once about this new way that we could connect with them. And then a lot of coaching with folks like this is what zoom is, this is how it works. You can, you're gonna have video, if you have a video camera, do you have a video camera? Do you have a computer? Do you have a smartphone? Have you ever used them? Have you ever done a FaceTime call? Have you ever use Skype, so there was a lot of just fishing around to figure out if they had ever done any of this. For those who have done nothing, we were on the phone with them for quite a while, some of them are still on the phone. Sometimes there'll be horrible audio problems we were trying to problem solve, couldn't hear each other. Remember when there was all that lag because everybody's Wi Fi was bad? Yep, I was trying to improve my Wi Fi at home with different systems. But there were folks who you know, had a data package on their phone, but no Wi Fi. So there was just a patchwork of trying to figure out a way to see and hear each other. And some people said, you know, this is too much for me. I don't know how to do this. I'd say now go to your email. Do you know how to email? Because there's going to be a link there for the session, I just emailed it to you. And they'd say, I don't know how to get to my email. Or I got to my email but there's this other email open and I don't know how to get rid of that. So some of it was very basic computer skills, and some of it was people with technical issues, people with no Wi Fi people with no devices. So I had two years into this my first appointment as a telehealth patient. I suffer from chronic migraines. And so this was a follow up appointment with a neurologist that I had seen once in person before. And I thought, well, no big deal telehealth. I'm an expert. I've been doing this for two years. So this telehealth appointment was long awaited, because I had finally, I don't know if it's a victory or failure, failed on my three oral medications and knew I could potentially be getting this injectable that I've heard rave reviews about from him and from a friend who also suffers. So the stakes felt high for this appointment. I didn't want to miss it. And you know, I'm sure that the demand for appointments is so great right now during the pandemic. So people are waiting months to get in to see a specialist. And this was no exception. So I was really looking forward to having this conversation with him with the hope of getting some relief, and kind of just put it on my calendar didn't think twice about it. Until about an hour before the appointment that day, I suddenly thought I don't know what I'm doing. I don't know how to get out of this appointment. I know it's scheduled. I don't know if it's a video or a phone call. I don't know what to expect as the patient. I don't know how he'll reach me. So I started frantically, you know, trying to get on the patient portal, trying to look and see was this phone video message his staff. And finally, it seems that there were some instruction that you would receive a text, and that it would be a phone call for his office, not a video telehealth session. And you could convert it from your phone to your computer when the text arrived. Well, I didn't know how to do that. I thought I'm gonna get this text on my phone. What do I do to get it to the computer. So I quickly gave up on that. The really hilarious part was that in my office at work where I was that there are some background noise from the HVAC system, and I usually kind of ignore it, I'm on zoom all day. But I suddenly thought like, I need to be able to hear him this is really important. He needs to be able to hear me. So I raced across the office to try to find another office that doesn't have that bad sound interference. And by this point, it was like two minutes to the hour when he was supposed to call. And I was really going into a panic, which is so uncharacteristic of me. I never get nervous before medical appointments, you know, it's not that big of a deal. But somehow this virtual platform on the other end as the patient felt completely different than what I've been doing for two years as a provider. So I get into this other office, and then I start to sweat which I'm sure was an anxiety symptom. And I have to say it was I've never had that anxiety symptom in my life. I don't sweat what I get anxious, but somehow I'm bursting out into this sweat. And then my feet start to itch. So I'm kicking off my shoes because my feet are perspiring, throwing them across the room. I'm looking at my phone for this text, and then the text comes, like two minutes late. And so I click on the text. And there he is on video, even though I was told he would be on the phone. So surprised a little, you know, happily surprised to see him and to be able to talk face to face, that immediately felt much better. And the visit actually went off just fine once the connection was made. He was, you know, as as personable and supportive via video as he was in the office previously. There was a point where I think I received an incoming call, and it disrupted the video. And so then I got completely flummoxed about that, and didn't know how to how to get him back, went back to the original link which didn't work. Somehow, a minute later, we reconnected and there he was waiting for me, I thought it would have perhaps moved on to the next patient.

Heather Johnston:

Are you still doing telehealth appointments?

Sharon Dornberg-Lee:

Yes, almost exclusively.

Heather Johnston:

Right. Okay. So after that experience, did it change anything for you as the provider.

Sharon Dornberg-Lee:

So I think I had more empathy than ever for how anxiety provoking this can be. And just a realization that it feels really different on the other end, when you're the one sending the link and saying just click on it, versus the one trying to figure out where the heck it is.

Heather Johnston:

It sounds amazing. I mean, also, what strikes me is that your patient group is lucky to have somebody like you, and like your coworkers who can and are able to and willing to do all of that coaching. Because I think you know, for other places that are maybe people who are seen at a big hospital or a clinic that's more impersonal, they don't have any of that. They're just kind of left to figure it out.

Sharon Dornberg-Lee:

Yes, such a good point. And so badly needed. And I think because it's all about the relationship, it's mental health services, that was our commitment to them. But and they probably were perhaps more open to learning from us because of that trust in that patience of we're gonna figure this out. I know, we just wasted 15 minutes, but we're gonna figure this out. And maybe we can even go a little late today, because I don't have anybody right after you. So people don't feel cheated out of their session when we could or when we could do that. So yeah, thanks for saying that. And I think that was part of our commitment to them. And not everybody has that it's so needed.

Heather Johnston:

Getting back to the seeing too much of the chicken concept, I'd like to talk a little bit more about that. When I'm a patient or someone in my family is, I sprang into action, and I have a few doctor-related skills and tricks that I put to use. Number one, I know the right words to say. If I feel sick, and I think I need an urgent care visit, I would know to explain my symptoms using certain words that would guarantee that they would squeeze me in. Number two, I know how things are supposed to work, so I'm well aware when they're not working that way. For example, I know that my mother, who has a pacemaker and is having heart palpitations and shortness of breath should not and cannot wait for an appointment in three months to check that out. Nor should she be given a telehealth appointment so someone can watch her breathe in and out on a screen. Number three, like Dr.Fromme mentioned earlier, I think ahead about what will be needed. I brought my teenager to her doctor to get a prescription for migraine medication before things could get worse. Number four, I know exactly who each person is who comes into my hospital room - student, intern, resident, fellow, attending, doctor, nurse. So I know whom to ask for different things. Stay tuned for a short take later in the season coming up on who's who in the hospital system. Number five, I know when something isn't being done the way that it should be. For example, when my kids pediatrician does not do a complete cardiovascular exam for their sports physical. I ask them to do so because I know that it's a required part of the visit that's been missed. I also know when medicine has been practiced beautifully, as an art, as with one of my breast cancer surgeons in 2020. She's incredibly busy, but she took the time with me. Each time we met to answer all of my questions patiently. She sat down, got close, spoke clearly and warmly and frankly, which I prefer in my doctors.