How to heal and revitalize our beloved profession [PODCAST]

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“We have to heal ourselves first. That begins with caring for our own minds and bodies, and souls. It means not avoiding (as I did) caring for our own physical and especially our mental health. It means we must be a part of the lives of our families and loved ones as well.

Once that is accomplished, then and only then can we move on effectively to heal and revitalize our beloved profession. And likewise, that is not a battle that can be shouldered alone. We must join with and support each other. We must arm ourselves with knowledge and motivation by taking advantage of mentors and coaches. And perhaps most importantly, we must be aware of when we need to be the mentor and when to be the protégé. Only then will we heal ourselves.

Randy Cook is a surgeon and physician coach.

He shares his story and discusses his KevinMD article, “How to heal and revitalize our beloved profession.”

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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, and 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 Randy Cook. He is a retired surgeon and physician coach. He wrote the KevinMD article “How to heal and revitalize our beloved profession.” Randy, welcome to the show.

Randy Cook: Thank you very much. It’s a real honor to be here, Kevin. I’m a big fan.

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

Randy Cook: It’s rather lengthy. I practiced for 44 years, but the capsulized version is I always wanted to be a physician. I had a fairly normal educational route through the liberal arts undergraduate arena and then medical school. I went on to the Medical College of Georgia, where I did my surgery residency, and after that I had a really diverse number of clinical experiences.

My first practice was in a huge multispecialty group in the Tampa Bay area, which was really fascinating. We had more surgery than we could comfortably do, there was a lot of pathology, and it was a great way to start my practice. But at some point I decided that I should move back home to Alabama. A lot of things went into that decision; certainly you don’t leave a successful practice like that on a whim. But I came back home to Alabama, and I had the experience of starting over where nobody knew me and I had to prove myself, the sorts of things that I had not really experienced in my previous practice.

A few years after that, that group dissolved, and I had to make a decision about what to do next. Against everybody’s advice, I decided to go into solo practice, which I did, and that was very successful. And then finally, I closed out my clinical years by taking over the management of the chronic wound care and hyperbaric medicine center in my hospital. As a result of that, I had the great opportunity to work on the teaching faculty with a big wound care management company, got to know some great people, and had some great experiences as a teacher.

And then, as I indicated, a couple of years ago I decided it was time to retire. Just simultaneously with that, I heard from a nice lady named Rhonda Crowe, who was starting a company called MD Coaches for the purpose of coaching and mentoring physicians. She drew me in by asking me if I’d be willing to do a podcast to help publicize the coaching service. She knew that I had a background in radio, and, man, that sounds pretty good. And then there was, “Oh, by the way, I want you to be a coach as well.” That’s turned out to be good as well. So that’s the elevator pitch, the elevator summary of my career.

Kevin Pho: As you reflect on your decades-long surgical career, what would you say are some of the biggest changes in surgery over the last few decades?

Randy Cook: I think easily that would have to be the shift from more of a meticulous, hands-inside-the-body approach to a more remote approach. A lot of, I don’t know if I would say most, but many operations nowadays are done while the surgeon watches it on a television screen.

In addition to that, many of the things that we did a lot of early in my career, such as staging laparotomies for cancers, particularly lymphomas, have absolutely disappeared with the advent of much improved imaging technology. So the need to hunt around inside the abdomen and inside the chest to look and see where pathology might be hiding was completely taken over by a different technology. In four and a half decades, it seems to me that we hardly do anything now like we did back then. So there have been a lot of changes.

Kevin Pho: Let’s talk now about your KevinMD article titled “How to heal and revitalize our beloved profession.” For those who didn’t get a chance to read your article, can you just walk my audience through it and share the story of why you decided to write it?

Randy Cook: I was trying to get my blood pressure medication refilled and had sent an email to my good friend and my internist to let him know that I needed a refill. The response that I got back was, “No more medicines from me, buddy, until you come see your doctor.” And I realized that it had been between four and five years since I had actually been in for an examination. So that was a little bit of a shocker, but he made a good point, and I didn’t put up any fight.

So I went for my examination, and I had my blood drawn beforehand and all the things that you do. When he walked in the room, he sat down at his EMR screen, and he said, “Wow, your vitamin D is almost nonexistent.” We went on to talk about other things. My lipid profile was a little elevated, although at least at that point I didn’t think my symptomatology had changed at all. But he said, “Well, with all this going on, the lipids up and so forth and so on, do you want to get a CT calcium score?” He added, “Your insurance won’t pay for it, but it might be a way to find out if we’ve got anything to worry about.”

So I said, “Sure,” signed up for the calcium score, went in, and got on the table. After the first pass of the machine, the technician stepped out from behind the screen and said, “Dr. Cook, have you got a stent in your heart?” Well, no. And of course, I began to wonder what opacity had caused that reaction. So she scanned me again. We were done, and she invited me to go back and see my good friend the radiologist, who was going to do the reading. When I walked into the room, he looked as though he had seen a ghost, and he said to me, “This is one of the highest calcium scores I’ve ever seen.”

So this was a bit of a surprise. It led to a consultation with another good friend of mine who is a cardiologist. After talking to me, well, not actually that long, he was under the impression that I was having angina, which I almost certainly am. We scheduled an exercise test, which I did very well on, but it led to a big change in my medication and a significant change in my attitude about just how healthy I was or was not.

So with that in mind, I wrote this article to simply point out that we walk around as physicians, we think we know what we’re doing, we think we know when to suspect that we are sick or that we have problems, but the truth is that we don’t. And we really should reflect on just how fragile we are, how we are just as human as anybody else, and we ought to really make it a point to take care of ourselves.

To expand that a little further, I simply pointed out that this is a time where the practice of medicine has changed dramatically. Many, many practitioners are finding themselves disappointed and burned out, and I think that it’s clear that the direction the practice of medicine has been moved without physician input is going to lead to that. It’s to be expected that we should see that kind of satisfaction, and nobody is going to change that for us. The physicians really need to step up and be a part of the conversation and make sure that we make the kind of changes that need to be made to, number one, take better care of our patients, and number two, give us an opportunity to feel the sense of reward that I think most of us expect when we go into medicine.

So that includes not only taking care of your physical health, but it means carefully exploring the things that are weighing on your mind. There are all kinds of ways to do that. You can talk to your minister, you can talk to a professional counselor, you can involve yourself in yoga and things of that nature, which I think is a really superb way to improve your mindfulness and give you a chance to learn some introspection about just how healthy you may or may not be.

I think that is absolutely key to being able to make that pivot to where you can go to the people who are now in charge of running medicine and make sure that they understand what the goals should be. That’s where coaching comes in. And I have to say that the opportunity to have these kinds of discussions, to talk to people about the things that bother them and help them explore ways to make things better in the medical profession, has been every bit as rewarding for me as the practice of medicine itself.

Kevin Pho: Can you give us an example story or a case study of how these dramatic changes in medicine have affected a particular physician such that his or her own health was harmed?

Randy Cook: You asked for an example; I’ll give you two. Just a couple of weeks ago, we buried a very close friend of mine, a family practitioner. Unbeknownst to me, he had some severe mitral valve disease and did not survive the attempt to replace that valve as well as bypassing four coronary arteries. It’s difficult for me to say, and he’s not here to speak for himself, but it’s difficult for me to say that he neglected himself because of these particular changes in the way that we practice medicine. But he certainly did, and he was very busy. He worked very hard, he put in a lot of hours, and I have to think that to a certain degree the demands on his time and the pressures that he felt probably contributed to him neglecting his own health, much more than I did.

And then the second example would simply be myself. As I mentioned, I closed out my career as the medical director of the wound care and hyperbaric medicine center, and it was one of the most enjoyable parts of my career. I got a great deal of satisfaction taking care of these people with wounds that nobody else wanted to be around. But as time went on, the intrusiveness of administrators and practice managers and electronic medical records and things of that nature became so pressing that it was making it very difficult for me to keep my mind on what I needed to do.

And the result was I more or less lost my job. The hospital administrator came to me and said, “Hey, we don’t need a medical director here anymore. We’re going to let the management company handle all that. You can stay here and see patients if you want to, but we don’t need your help anymore.” And that came about for two reasons. One was simply my frustration that I couldn’t get the attention of the people who were in a position to help me run my wound care center better, and that inability to communicate for myself effectively just led to my downfall.

So with that announcement that they no longer had any confidence in me to oversee my wound center, I felt that the smart thing for me to do would be to get out of the way, and that’s when I retired. I decided that I didn’t need to see patients, that I shouldn’t see patients anymore, because I didn’t have the skills to stand up for them.

Kevin Pho: When you say that physicians need to be involved with the changes, what are some of the ways doctors can do that?

Randy Cook: It means being involved in the committee structure of your hospital and having some input in policy. That probably becomes more difficult nowadays, with more physicians employed by hospitals as opposed to being independent practitioners. But being present in the space where decisions are being made that ultimately will affect clinical outcomes is something that a physician should take an interest in and should do.

And then the other thing is to become as involved as you possibly can with physician organizations that are trying to amplify the voice. For the 44 years of my practice, the perceived voice of the physician community was the American Medical Association, but I can tell you that during the entire length of my practice, I knew very few people that really thought that the American Medical Association was speaking for physicians at all.

But today there are quite a number of groups. I should be able to name a half a dozen of them, but they don’t pop into my head immediately. But there are any number of physician groups that are actively taking on that role. They are taking the conversation to the government, they’re taking the conversation to the health care management organizations, they’re taking it to the people who are currently in charge of the way we practice medicine, and there simply has to be more of that. Otherwise, we will simply not be listened to.

I mean, probably the most alarming thing that we’ve seen is the recent phenomenon that physicians are no longer looked upon as physicians. They’re looked upon as providers, and so-called mid-level providers like physician assistants and nurse practitioners are equally as effective as physicians. It’s a dangerous thing, and unless physicians decide to step up and address that issue, I only expect it to become more severe, because after all, a mid-level provider is a much lower level of overhead than a physician. And I think part of where the burnout comes from is that physicians begin to feel like they are looked upon as nothing more than overhead. Why wouldn’t they be burned out?

Kevin Pho: We’re talking to Randy Cook. He is a retired surgeon and a physician coach. He wrote the KevinMD article “How to heal and revitalize our beloved profession.” Randy, what are some of your biggest pieces of advice, and perhaps you can end with some take-home messages to my clinician audience?

Randy Cook: I’m going to get philosophical on you. In Greek mythology, there was a famous horse; his name was Pegasus. Mythologically speaking, you could mount Pegasus, but he wouldn’t go anywhere unless you were thinking noble thoughts. And I think it’s time for us to begin to think noble thoughts; otherwise, we won’t go anywhere.

The other thing that was remarkable about Pegasus was his most famous rider, a fellow named Bellerophon. Bellerophon one day decided that he deserved a place right alongside the gods, so he mounted Pegasus and directed him to go straight to Olympus because he wanted to be among the gods. But the ride became so bumpy and so furious that he fell off and fell into the sea and was drowned.

The message there is that you’re no good with just your noble thoughts alone. You need to surround yourself with like-minded people and stick together, listen to each other, counsel each other, and take encouragement from each other, so that you can really advance on a noble cause. You can’t do it alone.

Kevin Pho: Randy, thank you so much for sharing your time and insight, and thanks again for being on the show.

Randy Cook: Thanks for having me. It’s been a lot of fun.

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