In his work as an emergency room physician, Dr. Haselhorst saw many patients with dementia, some from accidents and others in elderly patients. He and observed families struggling with how to handle end of life decisions. I found a need to help families hone in on what the choices were in end of life decisions. He has written Wishes to Die For about how to make advanced directives very specific and aligned with a patient’s personal wishes.
A transcript of the podcast is available.
Dr. Jessie Lindemann has recently moved from a corporate medicine environment to a community healthcare clinic where she can provide care for uninsured and underinsured patients at Community Health Service, Inc. in Moorhead, MN. She talks about how she decided to become a doctor after her recovery from Hodgkin’s lymphoma. So many things, Dr. Lindemann says, come up when it comes to cancer survivorship, but the medical profession hasn’t done a good job of managing these after effects. One of her goals is to create recognition of this gap in care and provide needed services which currently are lacking for many cancer survivors.
A transcript of the interview is available.
Paulette Efimenko is a midwife who works with women who gave made the choice to have home births. She is a midwife working in an obstetrical desert, allowing her mothers to avoid having to travel 100 miles to a hospital.
And that is so important for moms to be able to relax in labor and know that they’re going to have just the people that they want there with them. It’s not going to be any strangers or any interventions that they don’t want. They don’t have to argue about whether they’re going to be in this position or that position. They have the freedom to make the choices that is their right to make in labor and birth.
For a low-risk pregnancy, the outcomes for hospital births and home births are about the same.
Transcript of the interview with Paulette Efimenko is available.
Dr. Fleegler is a pediatric emergency physician who works exclusively with children. One of his areas of research is children and firearms deaths.
I do a lot of my research is in firearm injury violence and trying to understand it. In the United States, there are about 3,000 women a year who will die from firearm homicide. Fifty percent of those firearm homicides are intimate partner violence related from current or previous partners.
Dr. Fleegler says he’s drawn to emergency room care for a number of reasons. Many people wind up in the emergency room because they lack access to health care and many associated services. Working in an emergency room, you have a chance to work with patients through their crises and help get them connected to needed services.
A transcript of Dr. Fleegler’s interview is available.
I have written about the problems families have when it comes to making decisions about the care of family members who are very sick. As Dr. Mirarchi says, there are copies of various end of life documents here and there in electronic medical records, but doctor responsible for a patient’s care in the hospital likely doesn’t know the patient, much less what the patient has discussed with a primary care physician about what they want.
So you have a stranger who’s seeing you, taking care of you as an ER doctor, you have a stranger who’s admitting you to a hospital, you have a stranger surgeon who’s taking care of you. So all of a sudden, nobody has established relationships with people, so no one really knows what the patient’s wishes are.
Dr. Mirarchi’s MIDEO cell phone application allows you to clearly specify what you want in a readily available format that can be watched by the physicians. Your wishes in your own words, not the legalese of the paper documents.
A transcript of Dr. Mirarchi’s interview is available.
Dr. Edwin Leap was the first physician I interviewed for Doctales. As an emergency room physician, I don’t know how he finds the time to write as much as he does and as well as he does. He suggests the best place to find his current writing is on his Substack site, Life and Limb.
In this interview, I talk with Dr. Leap about the problems with small hospitals in rural communities.
One of the problems is with large corporations buying small hospitals, they’ll buy them and then maintain them for a couple of years and divest themselves of them. But they don’t really have a vested interest in them.
Those genuinely interested in solving rural healthcare problems need to listen to the doctors who work in rural communities.
Please see the transcript of Dr. Leap’s interview if you prefer reading to listening.
When I wrote the article on the confusion between Do Not Resuscitate (DNR) and Do Not Treat (DNT) that was eventually published on KevinMD, I had no idea this problem would resonate with so many physicians. Dr. Edwin Leap, an emergency room physician, who also found himself struggling to deal with this distinction with his patients contacted me that he had the same concerns with his emergency room patients. What’s more, Dr. Leap has a long history of writing engaging, thoughtful, well-written articles about life in what he calls Emergistan.
Since I was already doing regular podcasts about safe pregnancy with Neil Haley for Rural Doc Alan, interviewing physicians and healthcare workers about the changes we face as medical decisions was a Eureka moment for me.
The public clearly shows a lot of disdain for physicians in the media. Talking with other physicians and healthcare workers seemed like a great way to try to undo some of the media prejudices against physicians. Plus it provides an arena for physicians to talk about their concerns with other physicians.
Neil arranged for a Zoom launch party for Doctales.
I have now interviewed six physicians and a midwife and will be posting these interviews here on Doctales.
You may be wondering what story has to do with healthcare. When most people had a primary care doctor, the doctor knew their “story.” Chances are the doctor knew your parents and possibly even their grandparents. Your doctor didn’t have to laboriously review your family history every time you went to the clinic because your doctor knew it without having to read an electronic medical record.
Roger Schank in Tell Me A Story taught us a lot about how we rely upon story to remember our past and apply what we learned to new situations. We often “think” in story format.
Too many doctors don’t take the time to listen to your story, your concerns, or thoroughly answer your questions.
The stories you will find here may fill some of the story space between you and your doctor.