D (1:56)

My story is an odd one, but I don't think it's actually that far off the bell curve for a lot of clinical doctors who. They started out, you know, with this very idealistic seeking a path kind of approach, and then everything fell apart into despair and commodification and assembly line mechanics and Then hopefully there's a rebirth and a reawakening. And I think a lot of clinicians are struggling for that path to rebirth. So mine kind of all started. I'm born to two immigrant physician parents and from India. So it's like, I'm not going to be an artist. I'm not, you know, I'm not going to. I'm not going to be a chef. It's like, you're going to do medicine and that's it, that's the end of it. So there was no. No real choice, except that there was, because both of my parents said, you know, things are changing and, you know, the way we used to do medicine is not the same way. So if you can find something you'd rather do, we'll support you. So I tried really hard. I tried to be a musician. Turns out you need something called, you know, talent and drive and ambition. And in music, I didn't really have that. So in the end, I actually found that I was passionate about medicine. I love connecting with people. I love the science. I love the humanity aspect of it and the way it combined that with the sort of hard science. So I ended up going to medical school. UCSF did my training at Stanford. Kind of was disillusioned after training, actually, because I saw this, like, wow. Most of what we do in medicine is this reactive, patching people up. We're sending them back out.

B (3:22)

We're.

D (3:23)

We're spending a lot of time documenting and on paperwork, but not a lot of time really connecting with patients in the way that it's clear they want. If we could actually spend time with them, there's this thing called the placebo effect that studies seem to suggest works better. When people think there's a therapeutic alliance, when they think the doctor cares about them and spends time with them, makes eye contact with them, puts a hand on their hand. And it all seems to be kind of subverted to. We got to generate a lot of RVUs and we got to make sure we don't get sued, and we have to make sure we document everything. We're not going to get paid. So when I got this opportunity to come work as a hospitalist back at my hospital at Stanford, I kind of jumped at it, thinking, it'll last a year or so. And it ended up lasting almost 10. And for the first five years, it was this interesting thing because when you're unplugged from the Matrix for a minute and you see reality as it is, when you go back to the Matrix, you can't accept it anymore. Well, for the first three to five years of my job there, we had this beautiful thing that was like we had unplugged from this typical matrix. We were a partnership. We spent lots of time with our patients. The EHR hadn't gone live yet, so we were sort of paper based, which was a struggle, but also we were familiar with it. And we got to take care of our patients the way we thought we needed to. And we had this collegiality with our colleagues. So we would talk to them, we would see them. I knew all the primary care physicians who admitted to me as a hospitalist. So I felt responsible to them, I felt responsible to the patients. And it was that sort of reciprocity and collegiality and relationship based sort of foundation of it all that made it have meaning. And I remember I had a little diary I used to keep, which I stopped doing because it's dumb, but at the time I was like, I'm gonna keep a diary because I've never been so happy in my life. And I want to document this. And I'm glad I did because it got miserable after that. Pretty soon we started to see all the general pressures that lead to what I call Health 2.0. This sort of over reliance on documentation EHR going live means that now that we can document it, we have to. And that there was so much data, but it wasn't modulated in any way that we felt was useful. See, physicians want to be consumers of targeted data. They do not want to be data entry clerks. They don't want to be providers of data. They want to be consumers of data. But the 1.0 generations of our EHRs force us to be, you know, providers of data. And trying to consume it is like looking at a space shuttle dashboard. It's all this information that we just don't need. We need to see what's important so that we can go back to being doctors.

B (6:07)

You said something that really struck me, and you and I have had a chance to talk in the past about some of the research that we've done around this idea of capability, this idea that physicians and providers of healthcare who have the tools and the resources that they need to take care of their patients and the latitude to make the decisions that they feel are right on behalf of their patients, that they are in a better place in a lot of different ways, you see less burnout, you see higher degrees of engagement, you see that their organizations just tend to perform better. One of the things that we're learning and we have new research that's coming out, so we're doing capability 2.0. If you're talking about healthcare 3.0. But we have done another round of survey work, and one of the things that we're learning is that isolation is a very strong driver of burnout. In fact, it dwarfs a lot of the other survey components that we were testing. And the way you were describing sort of the before and after state of the practice that you were just telling the story of is that you had a world in which you did not feel isolated. You had collegiality with other physicians, you had the ability to spend time with patients, but then you felt that going away. I'd love to hear your reaction to this observation that isolation is a key driver of the burnout challenge that we're seeing in the industry today. And if you agree with that, what should we do about it? What are some of the things that you've seen in your conversations with people at the front line that you think is working? There was a lot in that question.

D (7:43)

No, no, no, no. That's. Actually, I'm fascinated by this because I'd never thought specifically about isolation as a driver. And now it doesn't surprise me at all that you're seeing this in the data on capability, on this idea that what makes us feel capable as physicians and prevents burnout. So, for me, part of the reason I decided to become a hospitalist and specialize in inpatient hospital care is that I felt like, for me, the outpatient world was too isolating. So I'm in this sort of bastion in my office, and I'm not connected to other caregivers. And it wasn't for me. Whereas in the hospital, I knew, okay, here's my social worker, here's the nurses, here's the team. It's always. I'm always bumping into people and being very collegial. So what ended up starting to change for me is that, first of all, I think the electronic health record encouraged this kind of electronic siloing. So we're messaging each other instead of talking. And, boy, so much can be done from talking that with a colleague, whether it's the cardiologist that I called, the consultant or the gastroenterologist, I'm concerned about this person having maybe a psychosomatic reaction with abdominal pain. Is this GI bleed something I need to take seriously right now? Is there something instead? Now we're just sending these little staff messages that fill up a very overloaded inbox. We're not seeing each other and in the process, we're separating from our own colleagues. So that that feeling of accountability, you know, we evolved as a species to be cooperative. In tribes, when you break the tribe up into little silos and everybody's isolated, we fall apart because we haven't had the chance to evolve that kind of apparatus to deal with that world. Maybe it's okay if we actually had the tools for it, but we don't. So for me, that was the biggest thing, is feeling so alone, even in a sea of people. You know, the patient is supposed to be the center of this. We always talk about that. But you cannot take care of the patient properly without having the tools and the resources. And a lot of that is a team and collegiality and colleagues. One of the big things they did at Stanford that made it better before I left was creating a true physician lounge. So having us then have a place where we could sit and decompress and connect with each other, ask each other questions. But it needs to even go beyond that because you want to connect with the nurses, you want to connect with the pharmacists, you want to connect with everybody, not just the doctors who are walling themselves off from everybody else in their lounge.

B (10:03)

Well, and I think you want to connect as well with providers and physicians and nurses, et cetera, who are not in the hospital in the first place. Right. I mean, we know that care is moving out of the hospital. Do you have any thoughts on how you create collegiality in a world that is increasingly characterized by healthcare that is provided in outpatient clinics and urgent care centers and this dispersed distributed healthcare ecosystem, as opposed to one that is where you can have a physical physician's lounge where everyone comes together.

D (10:35)

And this is a very interesting and tough question, because what I found, one of the things they made us do at our organization was even though we were hospital docs, they made us come do two half days of clinic a week. And that wasn't to punish us, because they knew hospital docs hated outpatient clinic. They did it because they wanted us to know who our colleagues were that were admitting patients to us. So that then after we'd met them in the flesh and we had a little relationship with them, then we could connect electronically, whether it is through phone voicemail messages or in, you know, on phone conversations or tele sort of presence, or even more enlightened epic or whatever our EHR was, staff messages that we were using, so that I knew the face behind that. So, yes, you want to be able to connect in A distributed way, especially since no physician can exists now in a vacuum. So you're going to need to know who's in urgent care, who's in the er, who's in the outpatient world, who's admitting to you, who's in the oncology department in the outpatient building several miles away that's going to admit this patient to the hospital with neutropenia to you. And again, you can have technology help to create that, but it's got to also be wrapped around physical understanding of each other. Meaning, do we go to the same parties, do we meet in a lounge, do we go to events together where we actually know each other? Because when that started to fall apart, then it became very tough, at least for me.

B (11:56)

As you know and as we know, healthcare is increasingly being delivered by larger organizations. And one of the things that's come out really strongly in our research, we've been seeing this for a couple of years now, but we got sort of definitive evidence of it. I would say, in this most recent round, is the importance that leadership and communication from the top of the organization play in. In those individual physicians sense that they have what they need to do their jobs and to take care of their patients. So you've kind of played both roles. You've been the individual physician face to face with a patient. You've been the leader of a larger organization. Talk a little bit about how you see those two roles playing with one another. If you see one as being, or maybe how you see them being different from one another.

D (12:49)

As an individual doctor working in a large organization, it's always fun to bag on the administrators and the leadership, and that's just what you do.

B (12:57)

I've seen the enemy and he's us.

D (12:58)

Yeah, he is us. He's us. Well, this is the thing. He is us when he is us. But when he's not us, when it's somebody who doesn't have a medical background per se, it becomes tremendously difficult for them to credibly lead clinicians. So you need at least someone in leadership who has an MD or an RN or a PharmD after their name, somebody who's touched patients in order to have credible leadership. You can manage people, but you need to. We're looking for leadership, and this is especially true of physicians, who tend to be very autonomous, but also hierarchically minded, because we were trained that way and very highly conditioned creatures. So having one of us in leadership helps a lot. But what I noticed at the time is it's easy to be us and Them, when you're them, the tables turn. So when I became an administrator as the CEO of Turntable Boy, now I just feel really bad for clinical leaders because their struggle is very, very hard. They have to serve multiple masters, they have to serve the bottom line, they have to serve shareholders, they have to serve their own personal interests, and they have to serve this tribe of clinicians and patients and everybody. And it's very hard. So they have to do the best they can. And the struggle is difficult. So they need tools and resources and latitude to be able to do what they do, actually as much as the people that they're, quote, unquote, leading or managing. But what I noticed is that, and I'm pretty sure the data bears this out, clinical leaders who I think the team felt they were engaged, they helped listen and give their teams the sort of latitude to make decisions as well as the resources and tools, but provided firm leadership when necessary. I bet you those organizations have less turnover, they have better retention, and I bet better productivity and outcomes. So leadership is a key thing. And clinical leadership, we're not good at grooming, we don't do a good job of that. We're very bad at mentoring leaders. You know, when I was threatening to leave, you know, and go and work for tech, you know, what the program should have done is said. You know, maybe you're just frustrated because you don't agree with how medicine is done in the leadership. Because that's. If they had looked in, they would have seen that that's what it was. Maybe we should start helping you groom to be a clinical leader or an executive, but that's not typically how it's done. So we could do a lot better with that.

B (15:16)

Yeah, I think that recognizing what you're good at and what you're not good at is one of the most important leadership moments that an individual can have. Because I think we are raised to believe that we have to be good at everything. And if we're not good at something, that's a kill for cause. I would imagine that is particularly true for those who have been trained as physicians and who literally have lives in their hands. Is that something that you've had to wrestle with as you have taken on different roles in the healthcare world?

D (15:43)

You know, everybody demands humility from leaders and from physicians, but physicians themselves don't broker it because we're trained very hierarchically that death is failure, there's no room for error, lives are on the line, and you just suck it up and fake it till you make it. And the Truth is, what you actually need in your leaders and in your doctors is humility to understand when we don't know what's going on and what we're going to actually do about that, and knowing what you don't know and being honest about your strengths and weaknesses. I have been the victim of self deception for a long time in terms of, oh, I can do this and I can do this and I can do this and I can do this and I can do it all at once. No, you can't. And as soon as you recognize that, you ask for help. And actually, the act of asking for help creates networks and support that give you the tools and autonomy and latitude to actually be a better leader. So you have to have that insight at some point and on an ongoing basis.

B (16:40)

Actually, here's something I'm curious about, and I'm jumping around a little bit here, but I think you'll forgive me. So you grew up with physicians as parents, you probably went to med school, assuming that you were going to have a fairly traditional trajectory as a physician. You would go through residency, maybe stay in a hospital setting, maybe do something else. At some point that changed, and you somehow figured out a way to become what I like to think of as a constructive disruptor in the industry. This is something, I think, that every practicing physician, every. Not even every practicing physician, anyone who is involved in healthcare today, recognizes that things need to be disrupted, and yet it is extraordinarily difficult to do that. So what advice would you have to people who are sort of inside the system and thinking this really needs to change, but everything seems to be stacked against it actually changing? How would you recommend that they kind of go about figuring out the right way to tackle what they see as the major dysfunctions?

D (17:46)

I mean, this is the million dollar question, by the way. I much prefer constructive disruptor to what my dad calls me, which is a professional jackass, which I, you know, I

B (17:56)

really don't want to get into the family dynamics here. Zubin. Yeah, yeah, yeah.

D (18:01)

Let's just say he has a very traditional view of medic. I think there's a lot of forces that keep people in the box. And I talk about this when I do live shows. Actually. There's this conditioning where we go through medical school, and we're actually really highly conditioned to obey authority, to obey hierarchy, that the system is the system, and you, through your own personal resilience and mindfulness, adapt to the system. And not only that, but you listen to your superiors, you listen to your attending, and you kiss the ring until you're the ring that's kissed. That's the bargain you make in the third and fourth year of medical school. Then when we come out into a world where the system's even worse than we thought, like, you know, everyone's warning us about it, and we're like, no, we're better than that. We'll do fine. We get into it and we realize, no, this is really unconscionable. But we were all, we're still conditioned. So we try to adapt ourselves to this broken system. The truth is, if we all stood up in our own way with our own gifts, and believe me, these are gifted people in healthcare across the board, from administration down to the person serving the food in the hospital, they all have gifts to bring to the table. If we woke up and said, you know what? No, in my own little way, I'm going to do something revolutionary. When I walk in the room, I'm going to turn the EHR screen around so my patient can see what I'm typing as I'm typing it and can help me build his chart. That little act is transformative, and it doesn't require you losing your job and taking a bunch of risk, but it is a little risk right there. Like, whoa, what if the patient sees something someone wrote about them? You know, that's the whole idea, is we're trying to be radically transparent in these little bits. So people just reconnecting. For me, it was reconnecting with who it is. Who am I? You know, I'm somebody who's not likely to repeat the party line and likes to connect with people, and I don't like things that get in the way. And I have oppositional defiant disorder, and I'm always trying to go against what people tell me to do. And so, well, how can I harness that in a way that doesn't destroy everything that I'm trying to save? And for me, it was just make these little videos kind of secretly under an alter ego, ZDoggMD. Put them online and just hope that something happens. And this is the thing, when you start going with who you are, and it could be, you know, everybody, every clinician has this aspect of their personality. They can find the thing they do and just do it on a small scale. Maybe it's. Maybe it's something radical, like, I'm not going to work for this big entity anymore, and I'm going to go form a direct primary care practice and run that. So some people do that. Others are like, no, within my big organization because like you said, healthcare's increasingly delivered by big organizations. And personally, I have a soft spot for big organizations because that's where I worked and I saw the function that came out of that as well as the dysfunction. But the function is you're supported, you have resources, you have a team. It's kind of like a tribe of people that are all on your side. And so maybe it's making little disruptive changes within the confines of your organization that then ripple out. So there's lots of ways to do this, but there is no excuse anymore, I think, for saying I can't change the system, nothing will change the payment model. Is this fine? Well, if you're that bummed, go seek a different payment model. If you want to make incremental change, then let's start working together and lobbying for what we think is right, whether it's pay for actual quality, whatever the models are that you want to promote. And everybody has their own. So let's start working on that. We can't be politically silent anymore either. Whatever your politics are, go out and agitate for it. But the problem is that's not how we're conditioned. We're conditioned to believe we're powerless in the face of a big broken situation. And the big companies that run healthcare and so on and so forth, each of these companies, if you get under their skin, they feel as powerless as everybody else because it's just a self fulfilling prophecy.

B (21:45)

You mentioned the little videos that you make, and I'm going to beg to differ here because one of the things that I find so fascinating about the way in which you are tackling some of the challenges that manifest in this industry is that you've taken those little videos and you've turned them into a very powerful platform. You've got almost 2 million followers across different social media platforms. And it's physicians and nurses and CRNAs and techs and it crosses the spectrum of healthcare delivery. Talk a little bit about the way you see that platform as a force or a catalyst for change in the industry,

D (22:29)

the way I like to see that. And I think a lot of that came out of actually the failure of Turntable Health. So when we closed after three years in downtown Las Vegas, I mean, I made a ton of mistakes. One of my biggest mistakes was trying to be everything to everyone. We served a lot of different populations with a capitated model and, and some populations are really good for that. But if you try to optimize, you can really only optimize for maybe one or two populations trying to do everything for everyone is hard. And we were too ahead of the curve. So there was no big partners either on the insurance side or on the business side that were willing to take the risk so early in the evolution of what we're calling Health 3.0. So when we closed, I went full time into doing, starting with a live show on Facebook and growing a tribe of people, because I said, you know, part of the reason we closed is that the soil wasn't yet fertilized for this kind of model to grow. So how can we do that if we can reach frontline healthcare professionals, along with the leaders of organizations, administrators, government officials, and patients, all together using new media, which is social media, in a viral way that takes back, say, Facebook from the Russian bots and the people who would manipulate it for evil. Let's use it for good. Let's take the narrative back from the press, which has mishandled the narrative about healthcare. Let's take it back from politicians who've mishandled the narrative about healthcare. Let's put it in the hands of people who actually do this stuff for a living. And if we do that, we can show bright spots to the world of healthcare professionals. And by altering one physician's thoughts and practice, you affect thousands of patients, colleagues, et cetera. And so with this platform that we call the Z Pack, this group of people that are passionate about change, if we do a show, we can reach maybe a million people that minute with the show that night in a way that it would have taken a decade of going to medical conferences to spread whatever message we were trying to promote. And so what started as these silly little videos with using comedy as a Trojan horse to get people's guard down is now this platform where people are kind of tripping over themselves to be like, can I be on your show? Because I want to talk about this new treatment for opioid addiction that I have, or whatever it is. So. So again, this was something that anybody could do. It just so happens you have to be willing to go and take the risk and put in the sweat equity, too, because if I hadn't practiced full time for 10 years in the trenches, no one is going to trust a thing I say. As far as other doctors and CRNAs and techs, they're going to be like, what does he know? Right? Because people want to hear from people who have had their pain and experience. So that's kind of what we see our platform as. Now is a catalyst to show people bright spots and try to catalyze change.

B (25:13)

What Sort of changes are you hearing in the conversation? You've been doing this for a few years now. Are you sensing any differences in the sort of, in the things that you're hearing? Because I know that you it's a very active dialogue between you and the rest of the Z pac. What are you hearing now that you weren't hearing a couple of years ago?

D (25:31)

I'm hearing hope, which is interesting. I'm seeing that there's a tipping point. And actually I think the political upheaval we've had, I think the fact that we're reaching a critical mass where people are like, you know what, either going to go single payer now or it's going to fall apart or something else is going to happen. So people are in a sense of crisis which from crisis, with the right leadership you can get tremendous positive change. And so what I'm sensing now is people's hunger for change. People are coming out who are otherwise feeling powerless and saying, you know what, even in my own organization I'm seeing these changes starting to happen. There are a number of people who are miserable and are full of danger, despair, but through the channel they go, you know what, maybe what I need to do is walk away from this organization because I can't do anything here and walk to an organization where I can have an impact. And so that idea that we can actually, actually have power and have change, that is brand new. And in the setting of that seeing companies starting to embrace these ideas, companies that you would normally have said, you know what? No, they would never have a, here they are. You know, even big insurance companies like Aetna are making noises now about hey, maybe we should focus on prevention, maybe we should focus on team based care collaborating with healthcare professionals instead of being antagonistic EHR companies like Athena that are like, you know what, maybe we should give doctors actual tools that help them take care of patients instead of just, you know, purely glorified cash register. These kind of things are very helpful and I'm seeing it now starting to accelerate. The other thing I'm noticing is that the mainstream media, which used to only listen to the wonks and the academics and the business leaders, is now listening to us. If we break a story or talk about something, they will run a story with a screenshot of something we've said or something someone on our show has said. And that to me means that we can finally have a voice. Which means by having a voice nationally we can raise the profile of these issues and actually affect real meaningful change. So that's what's very exciting. And that's changed exponentially in the last few years.

B (27:33)

It's amazing. Using imagine social media as a force for good. Who would have thunk it?

D (27:38)

Heaven forbid.

B (27:40)

Let me do this. Let me just throw a couple of the statistics that we have taken from the most recent round of the research and maybe do a little bit of free association with you and get your reaction to them. So one thing that we've seen is that 37% of physicians are spending 10 hours or more outside of the office per week on documentation work.

D (28:05)

37% of docs are working around the clock. I think it's a fricking crock, because, you know, I got a crock pot to cook for my family. You know what I'm saying? No, the truth is, this is what happens when you ask me to free associate. I will free rap associate. So this doesn't surprise me at all, because I think this is one of the biggest complaints and especially relating to burnout. But, yo, I click, click, click at work, and then I want to spend time with my patients. So that means I got to do the click, click, clicking at home when, you know, little Sally's like, read me a story, and I'm like, shut it. I got to click this box, this box, copy paste this. Make sure I follow up these labs, because I didn't have time to do it at work. And I think that is demoralizing to most of us because we didn't sign up for that. We're not data entry clerks. We want to be consumers of data, and instead we're, you know, were the victims of too much data access.

B (28:57)

All right, here's another one. So 25% of the physicians that we surveyed feel that their practices or the organizations that they are associated with are not actively working to combat burnout. And close to half of them feel more burned out now than they did last year.

D (29:17)

So it sounds like physicians, like a quarter think that their organizations really oughta do more to help offset the slaughter of our mindset and our mental status so we can spend time with our daughters. You know what I'm saying? I have no idea what I'm saying. Word this word. Jsp word. This is the thing with that. It is no surprise that frontline clinicians feel like their leadership has let them down when it comes to this. Because what happens is we hear these key phrases like, you guys should be more resilient and maybe work on mindfulness and maybe work smarter, not harder, and we want to storm the Bastille and Murder everybody. Because we are already very resilient. We've already done these hacks, we've done a lot of stuff to make this work. What we need is leadership to go in and go, you know, what. What is the source of the moral injury that is at the root of burnout? And by moral injury, and this has been looked at, moral injury means we feel like we're serving two masters or more. We're serving our patients, which we went into this to do. We're serving ourselves from a financial standpoint and a work life balance standpoint. We're serving our administrators because they're telling us we need more RVUs. And we didn't click the smoking Cessation Council, even though we counseled smoking cessation. And by not documenting it, it didn't happen. So we don't get minus $3 after taxes. So when you combine all those masters that you're trying to serve, moral injury is very similar to what happens in war. Good people are forced to do terrible things and make terrible compromises, and it hurts so much that they manifest it in very malproductive ways, whether it's substance abuse, suicide, depression, burnout. And this is what's happening to us in healthcare. And then we see our leaders as having the gall to say, you know, we're gonna do a mindfulness retreat for you. And it's like, shut up. You need to address the root cause of why we're so upset. And it is not because we're not mindful enough. We're incredibly mindful of how terrible this broken system is and how it's making us do things we did not go into this to do. And that actually feel wrong to us. So that's the perception. I'm not saying it's correct. I'm saying this is how people feel. So, of course, when 25% say, you know what, they're not doing enough, I mean, I think that's an underestimation. I think people are scared to say what they really think.

B (31:37)

Yeah, no. And I do think that one of the things that has been really interesting for me as I've been talking to folks about this topic, is the degree to which the conversation sort of splits into two pieces. There is the exactly what you just described. It's a wellness problem. It's a resilience problem. And we need to do a bunch of stuff that, frankly, is probably good. Make mental health resources more available, reduce the stigma to using them, create opportunities for reflection. None of that is bad, but it doesn't get at the systemic and structural problems that are arguably the bigger drivers behind this epidemic that we're seeing. And that is something. And I'm just going to reiterate what you just said, that is something that only the leadership of an organization can prioritize and fix because it's beyond the level of any individual caregiver, physician, nurse, et cetera.

D (32:30)

And I'm glad you said that. The things that they are doing, like resiliency, mindfulness tools about destigmatizing mental illness, those are absolutely crucial. So when I talk about it again, I think those things are great. They're just not a substitute for the root cause.

B (32:44)

It's just not enough.

D (32:45)

It's not enough. It's not enough. And that's why we created this character Doc Vader, who is this burned out doctor who's more dark side now, because he's been just transformed by this system. And he is, within like a year, he has half as many followers, 530, you know, thousand followers that it took me eight years to build on my regular platform. And the reason is he taps into the pure angst, the pure misery and despair, and he speaks truth to power by just telling them what they're doing. And it's interesting because administrators and leadership like Doc Vader as much as frontline providers, because they see in him the kind of chains that are around their own wrists, that they're forced to kind of go through these motions because of the masters they are serving. So we really need to start to look at who are these masters and how can we change the fundamental premise of this to get back to being

B (33:39)

healers, I want to put one more number out there and get your reaction to it. So we not only looked at burnout and this idea of capability of measuring the degree to which people believe they have the tools and the resources and the latitude that they need to do their jobs in the way that they think is right. But we also asked a couple of questions about the degree to which physicians find fulfillment in their day to day work. And one of the most interesting things, and I don't know exactly what this means yet, and I'd love to get your thoughts on it. So 50% of physicians who report symptoms of burnout are also saying that they find deep fulfillment in their day to day work. So burnout does not seem to preclude a sense of deep fulfillment in day to day work. And I'm wondering if that resonates with you and what that makes you think.

D (34:32)

Ooh, I mean, this is fascinating. First of all, thank you for doing that work. Because companies aren't asking these questions, right? It's these little mini surveys and stuff that you guys have this big network that you can draw from to answer some of these questions. Because it seems counterintuitive that burnout and fulfillment coexist. But of course they coexist. The reason the physicians still come to work, despite feeling emotionally detached and low senses of accomplishment and, you know, stress and all the things that go with burnout is because at the heart of this, they get to do at some level in the day, they get to do what they went into this to do, which is to be with other people when they're vulnerable and to provide help to those people. And every now and again, every 20th patient, they'll get a thank you, or they'll get some gesture where they feel like, wow, this is why I got out of bed. This is why I suffer through paying my loans back. This is why, you know, I didn't make my daughter's violin recital because of this. So it doesn't surprise me at all. And in fact, if anything, it might make the burnout worse to the extent that you see what the good is and then you see all the barriers to it, and it makes it that much more painful. Whereas it's kind of hard to get burned out if from the beginning your job is meaningless and you're just going through the motions. Well, you're already burned out before you start. It's that poignancy of seeing what could be and the barriers to it that make the burnout worse. That's my speculation. Again, I have no evidence for this.

B (36:03)

It's endlessly fascinating, and I am deeply grateful for the opportunity to think about things like this and to get the response of folks like you. And I've just decided that I want to come up with a new that I'm thinking of tentatively as the Doc Vader Index, which is we will know that we are making progress against the burnout epidemic when we start to see his social media following tapering off a little bit because people just don't identify with it anymore. Are you with me?

D (36:31)

That is brilliant. Oh, My gosh, the DVI today we had a 20 point drop in the DVI because entire insurance companies went out of business. There you go. That is absolutely incredible.

B (36:47)

You can use that if you want.

D (36:48)

I'm gonna absolutely steal that jsp, because the Doc Vader. Because I'll tell you secretly, Doc Vader wants to turn to the light side. He wants to go out of business. And I'M gonna be honest. Like, this is something that I've never really said publicly. Doc Vader's success hurts me deeply, even though it's me, right? And some people don't even realize it's me because they're just out to lunch. But even though it's me, it hurts me. When Doc Vader is successful, when he. When he does a live show and gets, you know, a hundred thousand people to watch him, it makes me think, you know, how is it that people are so willing to hear the negative and celebrate the negative and not so easily hear the positive? So the day that that switch trips now, I'm gonna keep doing it because I think it's an important message, but plus, it's Fun to get 100,000 views in a mask. It's like playing Darth Vader when you're Darth Vader when you're a kid and actually having people watch you and point and stare. But. But the day he goes out of business is the day we have really won the battle. So I think the DVI is something I'm gonna celebrate and try to influence if I can.

B (37:49)

All right, we're gonna make this happen.

D (37:50)

I love it. The metrics that matter. Okay, these are the quality measures. These are the quality measures that actually measure quality dvi.

B (37:58)

We're gonna change the industry, my friend.

D (38:02)

Oh, this is great. This is the beginning of something tragic or wonderful or both.

A (38:08)

Decoding Healthcare is a production of Athena Health.

B (38:11)

Our producer is John Fox.

A (38:13)

Our engineer, composer, and all around Mike of all trades is Mike Moschetto.

B (38:17)

You can rate and review us on Apple Podcasts, Stitcher, or wherever you get your podcasts.

A (38:23)

And you can follow us on Twitter thenahealth. I'm Kevin Bam.

B (38:27)

And I'm Jessica Sweeney. Plaid.