Lessons learned from a combat doctor in Iraq [PODCAST]

Listen and followApple PodcastsSpotifyYouTubeMore apps · Browse all episodes

“My own dream-induced pain started at the same time this child was mowed down. Then and there is when and where my faith in God died because God, the higher power, had allowed this unspeakable nightmare to happen. My hope for the future evaporated, all while helplessness chewed through my guts From Left to Right.

This was the same moment I realized that humanity is connected in a definitive, tangible, and spiritual way. A trigger-happy and scared Marine was likewise connected. He made an understandable mistake in the heat of the moment and accidentally destroyed this innocent little girl. His solitary action grew into horror, altering all of our lives. We are all intrinsically connected, and yet, we point weapons at each other, pulling triggers, and then we deal with a fragmented, amputated existence. War eviscerates us all.”

Reagan Anderson is a dermatologist and author of Universal Death Care.

He shares his story and discusses his KevinMD article, “The trauma of a combat doctor in Iraq.”

Did you enjoy today’s episode?

Please click here to leave a review for The Podcast by KevinMD. Subscribe on your favorite podcast app to get notified when a new episode comes out!

Do you know someone who might enjoy this episode? Share this episode to anyone who wants to hear health care stories filled with information, insight, and inspiration.

Hosted by Kevin Pho, MD, The Podcast by KevinMD shares the stories of the many who intersect with our health care system but are rarely heard from.

Transcript

Kevin Pho: Hi, welcome to the show, where we share the stories of the many who intersect with our health care system but are rarely heard from. My name is Kevin Pho, founder and editor of KevinMD. Today on the show we have Reagan Anderson. He’s a dermatologist, and he’s the author of the book Universal Death Care: A Solution for Health Care in the Age of Entitlement. He contributed an excerpt from that book to KevinMD, and that was titled “The trauma of a combat doctor in Iraq.” Reagan, welcome to the show.

Reagan Anderson: Thanks for having me. It’s great to be here.

Kevin Pho: So we’ll get into your article and book in a little bit, but first off, can you share your story and your journey to where you are today?

Reagan Anderson: Sure. So I went to medical school off of a Navy scholarship, and then I owed the military time. The time that I owed them, I spent being the 1st Reconnaissance Battalion surgeon, which is a very specialized battalion of Marines, and I did two combat tours to Fallujah, Iraq. During that time, I lost my faith in God. I was ready to quit medicine, become a chef, and just get rid of the whole profession. I decided to try to go into dermatology, thinking I never would be accepted. They actually did accept me, and here I am. I am a dermatologist now in Colorado Springs, which is a far cry from what I did in the military. I’m a Mohs surgeon, and I’m the president of the American Osteopathic College of Dermatology right now.

Kevin Pho: We are speaking in the beginning of January, and of course in the midst of the latest wave of the pandemic. What kind of cases are you seeing from a dermatological standpoint?

Reagan Anderson: Sure. So a lot of stuff in dermatology is inflammatory-based, especially the rashes. So anything that is inflammatory-based, we’re seeing an uptick in, and things that were traditionally ascribed to regular old viruses, we’re also seeing those with COVID. So it’s not surprising that cases of pernio could be COVID-related, not surprising that a viral exanthem covering your whole body or parts of your body could be related to COVID, and not surprising that you can get increases in atopic dermatitis or other things that have some sort of immune-mediated response. So basically any rash that’s red on the body, well, that’s inflammation. That could be COVID-related, or it could be due to the normal things that are normally happening.

Kevin Pho: And with your background as a combat doctor in Iraq, what are the similarities between that and our fight with COVID today?

Reagan Anderson: Oh, there are so many similarities. I mean, in war you have to have a singular mindset. You have to have a singular mission. You have to have a singular set of directives. You have to have the logistics down. You have to have your mindset ready for mass casualties. I’ve been in more mass casualties than I can literally even remember right now. Unfortunately, those come out in my dreams at night, but I’ve been in so, so many, Kevin. And I think for many, many physicians in America, this is the first time in our professional careers that we’ve ever dealt with something that is far above our means of taking care of it.

I think it’s also very important to take lessons from war about having a singular purpose, and logistics and everything locked down from top to bottom, and consistent messaging, in order to be able to defeat the enemy. In America, we don’t have any of that right now. We don’t have a cohesive plan from federal to state to local government. We don’t have cohesiveness even in the house of medicine. We don’t have a plan for getting this vaccine to some of the zip codes that are not as well-off as others. I mean, if we continue right now with our current plan of distribution, the logistical plan of distribution, it’s going to take nine years to vaccinate every American in this country. And it’s because we don’t have any cohesive thought, and we don’t have any systemic plan that will span from coast to coast.

Kevin Pho: I’m a primary care doctor myself, and we have a lot of primary care clinicians who listen to this podcast. Now, what kind of lessons can you take from your experience as a combat doctor? What kind of actionable tips can you give us to help us going forward?

Reagan Anderson: Plan, plan, and plan. So have at least six months’ worth of supplies in your office. Have a plan for an active shooter drill in your clinic. Have a plan for local catastrophes, whether that is COVID or whether that’s nature-induced. You need to have a plan.

But I’d say the most important thing, especially given the mental health crisis that is facing our providers, is to realize that you’re human. Yes, you might be an MD or DO or an NP or PA, or whatever your training is, but that has a very limited power and authority in another person’s life. When a mass casualty situation hits, you have to be able to do the best you can with the knowledge that you have currently, and then you have to leave that at the door. It is not fair to go and play Monday morning quarterback with knowledge that we will gain six months from now. That’s a losing battle. And I fear that so many of our primary care providers, so many of our ER physicians and hospitalists, are assuming more responsibility than the human form can take on. And so we have to have a little bit of grace with ourselves.

You know, after my second tour I had PTSD. I literally didn’t sleep for a decade. I mean, I was a wreck. I was still able to function medically, and I was still able to hold on to my practice and take care of my patients, but I couldn’t let that extra responsibility go, because I thought I had too much control over it. So Kevin, if there’s anybody out there who’s listening to this, your job is to do your best, and then it is over. Then you become Kevin again. Then you become a father or a husband, or whatever it is that you define yourself as outside of medicine. But you have to let go of that.

Kevin Pho: Great. So let’s transition now into the excerpt from your book on KevinMD. That excerpt’s titled “The trauma of a combat doctor in Iraq,” and that’s from your book Universal Death Care: A Solution for Health Care in the Age of Entitlement. Now, for those who didn’t read that excerpt, can you just walk my audience through it and share the story of why you decided to share that particular one?

Reagan Anderson: Sure. So it is a story about me getting to Fallujah and waking up in the middle of the night feeling like my intestines had exploded. I walked to the command center and asked them, “What’s going on?” You know, I just got there. I was 24 hours in country, if I remember correctly. They said everything was fine, so I tried to go back to sleep. But there’s no sleeping in Iraq, so I went to the surgical facility, Fallujah Surgical, and a little girl, a 14-year-old girl, had been eviscerated by a Marine’s machine gunfire. When that happened, that was the same time I woke up in the middle of the night with that pain in my stomach.

I bring that story into the book because it’s such a heart-wrenching story, and I think, especially during COVID, people can relate to horrendous, horrendous stories and eventualities that we have to live through and do our best through. And I think that if the house of medicine can wrap its arms around our original mission of education and taking care of each other and our patients, then we’re going to get there. You know, there are great companies out there, like Doximity or like Dr. Pedia, where they’re trying to actually get back to our roots of educating, providing prevention, and providing help, not only for the patient but also for the provider. And this book is trying to get us to realize that the current system in America is perhaps the worst rationing of care of any developed nation on this planet, and until we actually stop rationing care and have equal medicine for all in an accountable way, it’ll never be sustainable.

Kevin Pho: Tell me some of the steps, or what did it take for you to overcome that particular trauma in Iraq from the story that you just told? And share some of the lessons that you’ve learned since then.

Reagan Anderson: I had to face it. You know, I think a lot of times when we have difficulties in our lives and they come to our mind, we just shake our head and we move past it, and that never allows our cognition to function properly. We can’t put it in the right category. So what I had to do, when I was hallucinating bombs under cars and when I was overreacting and being hypervigilant, was stop, and I had to say, “Look, what is actually happening? Am I back in Fallujah? Am I being shot at right now, or am I in America?” And I had to actually go back to Iraq mentally, and I had to experience it, and I had to have the palpitations and the sweating and all of that stuff, and I had to just stare it down. The first couple of times, it took me an hour of basically having a panic attack in the middle of the street, and then after that, it went shorter and shorter and shorter. And once I was able to grab hold of Iraq and look at it for what it was, and then grab hold of where I currently am, and then in the middle of all of that say, “I’m human, and I did the best I could.”

Kevin, in two combat tours to Iraq, in Fallujah, I never lost a single person who came to me alive. I mean, I was so fortunate, so blessed, if you want to use that word, and still I held on to this guilt that I couldn’t stop war. I couldn’t stop the tragedy. And all those people listening to this right now, you can’t stop COVID. You can’t stop the surge that’s going to happen. But what you can do is have grace with yourself. You can go back to the original situation to learn from it, but not to beat yourself up over it. And then you need to go into the beautiful situation you’re in at home, with your family, with your loved ones, a hike in nature. You need to meld those two together and actually own what you’re truly responsible for, and own what needs to be put on somebody else’s shoulders.

Kevin Pho: You also mentioned earlier that there are some broader lessons for the American health care system from your experience back as a combat doctor. Go into more detail. What are some of those broader lessons that can be applied to the American health care system as a whole?

Reagan Anderson: Well, number one, I think we need a universal set of rules. So rules of what we are supposed to document, rules of what is allowed for our patients, none of this prior authorization stuff that costs over $60,000 per provider to play the game of the insurance company so they can make more money. If we had one set of rules and one set of payments, that would save 20 billion dollars a year, just that alone. That would reduce everybody’s co-pays and deductibles to zero.

But we also need to hold people accountable. It’s not sustainable to have a health care system where people just destroy their bodies their whole lives, and then when they get to Medicare age at 65, and now they’re on the government dime, they’re going through multi-system organ failure, and that needs to be put on the government dime. People need to pay their fair share in an appropriate way and have access to medicine that is focused on prevention, not treatment. And I think that’s where we start.

And again, I think these companies out there that are trying to educate patients appropriately, from physicians, not from insurance, not, like, Dr. Pedia, like from these places that are really trying to educate, I think that’s the focus of it. Because if we can educate the populace and our providers on the business of medicine, if you will, and the prevention of needing that business, then I think that’s where we need to go. But we can’t have a system where there are literally thousands of different rules based on what insurance you have. No physician, no database can keep up with that, and it’s fracturing the system.

Kevin Pho: Now, what does your ideal health care system look like? For instance, are you advocating for more government, like a single-payer health care system, or are you advocating for more regulation of private insurers so perhaps we can get a unified set of rules? So in your mind, in your ideal health care system, what is the role of government versus private insurers?

Reagan Anderson: So I think that there’s a reason that France has the number one rated health care system in the world, and we’re 37th. By the way, Kevin, 37. And it’s not because we have bad doctors. We have the best doctors in the country, or on the planet. It’s not because we have bad medicine or bad equipment. We have the best of all of it, but we’re 37th, and that does not rest on the shoulders of the providers. It just doesn’t. It rests on when insurance companies can buy the laws. Then they get what they get.

You know, in the last fiscal year, 2019, the lobbyists for insurance companies spent millions and millions of dollars in the last quarter so that we did not have to have prescription drugs be commiserate with all the other developed nations out there. Right now, we pay between two and two and a half times the amount of money for the exact same pill that Canada, Britain, and all these other places pay. And the lobbyists were successful. They bought the laws, and they said, “No, you don’t. We don’t need to actually price negotiate. We don’t need to do all these things.” You know, the Medicare Modernization Act of 2003 said that government shouldn’t price negotiate, and so the pharmaceutical industry considers a 10 percent increase a year a reasonable fee, 10 percent a year. Now, if I got a 10 percent return on my stocks every year, I would be over the moon, ecstatic, because my money would be doubling, you know, less than every seven years. Well, we have a situation in America where democracy can be bought.

And so I think if we go back to someplace like France, where there’s a universal set of rules but private insurance to distribute it, and they have to compete with themselves, we can get rid of the corporate greed. We can hold our citizens accountable for their own health. We can change how medicine is taught, from medical schools on, and we can have something that is sustainable. Right now, the only person in health care who is accountable to anybody is the physician, and you know this better than anybody. We’re held accountable even if our patients don’t take their blood pressure medication. Are you serious? And yet that’s the solution of government. We need to have something that represents everybody and is fair. Right now, it’s no wonder that our house is fracturing, that Medicare is set to completely run out of money by 2026, probably earlier because of COVID, and something has to be done. We need a standard.

Kevin Pho: We’re talking to Reagan Anderson. He’s a dermatologist, and he’s the author of the book Universal Death Care: A Solution for Health Care in the Age of Entitlement. Reagan, with the incoming Biden administration, President-elect Biden is advocating for the continued existence of private health insurers but with more regulation. Are you happy with that approach? Because it sounds similar to what you’re suggesting, and that you want better regulations of the private insurers. And if not, what more would you like to see from the incoming Biden administration?

Reagan Anderson: Yeah, I do support most of the Biden plan. I think it’s measured, I think it’s prudent, and I think it’s needed. I do not support any one-sided deals like they did in 1986, where anybody who was injured had to go to the emergency room and you had to take care of them and you’ll never get paid. Like, that’s ridiculous. You know, emergency room physicians do the most amount of pro bono work of any specialty, and it’s about 60 percent.

So my callout to President Biden is: Listen, we need better regulation. We need accountability of not just the provider but also the patients and the insurance companies. But we also need to be measured and thoughtful in this, and there needs to be an equal number of doctors and bean counters at the table. We can make this work, but we have to stop looking at it from one-sided solutions, where only industry wins or only government wins.

We’ve been beaten down for years. Do you know that in 1992 we got paid more per RVU than we would have if Congress didn’t just pass the legislation last week to avoid the budget neutrality? It was about $32, and it was going to be about $32 if they didn’t fix it at the last moment, but that’s just a temporary fix. If you just keep up with inflation, that’s $58 that we should be getting paid, to keep up with 1992. They made this budget neutrality thing, and they said, “Oh, well, it doesn’t matter what happens with inflation or anything else. We’ve got to balance this.” And who cares if providers are going to be providing medicine and they can’t even keep the lights on, like a lot of primary care doctors are doing right now. It’s absolutely absurd.

So President Biden, if you’re listening to this, you have a copy of my book. I’ve sent it to you. I’ve dedicated my life to this. If you want somebody on your team who’s a physician, call me. I’ll do anything possible. But I think, Kevin, more than President Biden listening to this, providers, everybody listening to this podcast right now, you need to get educated. We got out of medicine, and then we practice medicine, and then we’ve left it to the politicians to give us our laws, and look where that’s gotten us. Guys, we have to start getting involved. You have to start talking to your congressmen and senators, doing what you can, because if we aren’t the voice, who’s going to represent anything for ourselves or for our patients?

Kevin Pho: And my final question, Reagan: What is your take-home message that you want to leave with the KevinMD audience?

Reagan Anderson: Do the best you can, and then live your life. You’re not responsible for COVID. You’re not responsible when somebody dies. There are forces at play that you have no control over, not just from patient compliance or industry or anything like that. But guys, do the best you can, find the joy in the little things, and move on with everything else that makes you you.

Kevin Pho: Well said, Reagan. Thank you so much for your time and insight, and thanks again for being on the show.

Reagan Anderson: Thank you, sir.

Listen and followApple PodcastsSpotifyYouTubeMore apps · Browse all episodes