Positively Deviant Emergency Medicine

Latest Episodes:

Marny Benjamin Feb 17, 2020

Show notes

Marny is an emergency physician at Methodist Hospital in Saint Louis Park, Minnesota and at Hutchinson Hospital in Hutchinson, Minnesota. She has been with the large and strong EPPA group since finishing residency at Regions Hospital in 2002.

I really enjoyed interviewing Marny while attending ACEP 2019 in Denver. Marny’s always got a smile on her face and so our time together flew by. Topics we hit:

the joy of raising a family
decisions about how to spend your time outside your shift
on-shift efficiency tactics
documentation tricks with a scribe
MDM composing methods
pitfalls she sees in colleagues early in their career
in-room communication tactics
Marny’s experiences as woman physician and her tactics for success

Topher Obetz Nov 05, 2019

Show notes

Topher (Christopher) Obetz is an emergency physician in practice at Abbott Northwestern Hospital in Minneapolis, MN. He graduated a year or two after I did from the EM residency at Regions Hospital. Somehow, he found his way into the role of President of the multi-hospital democratic emergency medicine group – Emergency Care Consultants (ECC) and hasn’t looked back.

We wandered through a number of topics during this coffee shop interview, from physician engagement to efficiency, mindfulness and creative writing. Enjoy!

Laura Schrag Mar 29, 2019

Show notes

Laura, like my previous guest, also works at Hennepin Health and had lots to share. Hearing another voice describing Hennepin as a great place to work, learn and teach was fun.

Laura previously practiced at North Memorial Medical Center; a high volume urban emergency department and Level 1 trauma center. Before that, she trained as a resident at Hennepin. This career arc from through community practice and back to academic medicine gives her a perspective few others can provide.

Laura shared so many tips and rules of thumb I feel like I could write a book on emergency medicine practice right now. We cruised right through a slew of professional practice tips and perspectives for use both on and off the floor. I’m really excited to get this one to you.

Show Notes

Introductions
Settling into your first job or any new job and figuring out your right pace
Empowering those around you to make yourself more efficient
Perspective of working in different environments through your career
Aspects of prioritizing the work minute to minute like a restaurant server
Talking and examining to a patient simultaneously
End of shift push to get some patients dispositioned based on typical workup time
Self improvement via reading follow up notes
Balance between seeing patients and time spent documenting
Managing shift energy and interruptions
Wrap up

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Thomas Wyatt Jan 13, 2019

Show notes

Introduction

In this first Episode of 2019, I’ve branched beyond the walls of Regions Hospital to interview a new friend at Hennepin Health: Tom Wyatt. He trained as a resident in their residency program in the 2000s and then worked at a high volume suburban community practice for many years.
He then returned to academic medicine at Hennepin a few years ago. He’s now Medical Director of the emergency department at ‘the county’.

I was a bit nervous about interviewing Tom for the show, which wasn’t helped by our designated meeting location being closed upon arrival! But, we both rolled with it (in typical emergency medicine style, I’d say) and found ourselves really enjoying our hour long talk. I think we’ve only scratched the surface of Tom’s wisdom but it was a good start at a look into his evolving career.

Show Notes

Introductions
Tom’s move back to his training home – Hennepin County Medical Center and his transition between emergency medicine practice environments
Bringing some of the community learnings back to the academic setting
World transition to the EHR, scribes and the need for learning the details of documentation and billing understanding alongside clinical skills
Tips for wellness and career sustainability
Tom’s routines – Shift work, mornings, shift start/during shift routines
Tom’s approach to teaching and supervision in a learning environment
Teaching the aspects of documentation in emergency medicine
Tom’s experience with using the nursing staff in a efficient practice
Advocacy at the local and national levels in emergency medicine
Beginning a diversity initative
Wrap up

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Rachel Dahms Dec 01, 2018

Show notes

Rachel Dahms is 14 years into her career really having a great time. She was an assistant program director for an emergency medicine residency for 11 of those years. She now has a leading role in medical student development within our health system. She’s spent years building wisdom in some diverse areas like the resident scheduling plans, creating care plans for patients and teaching procedural skills training labs.

In this interview I we talked about how Rachel got into emergency medicine, how she approaches giving feedback and structuring improvement plans for struggling residents and how she picks the things she gets herself. She has a strong sense of self and in my opinion is a great example of someone who’s found their calling and is having fun with it.

Outline

Spoiler: Rachel enjoys her work!
Shift in roles in her career
How Rachel starts her shifts
Approach to starting a shift with different learners
Feedback in general
Challenging patient approach
Managing the surge
Moving from Novice to Expert
Hard / vague feedback
Reflective Practice
Procedural Competency
Rare Procedures
Rachel’s path to medicine
Exploring the basis of her confidence
Close out

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Snakes!

No November Guest Nov 01, 2018

Show notes

The schedule and the cancellations piled up and I’ve worked through my backlog of interviews. So, somewhat sadly I have no podcast for November.

Ahh, such is life!

I’ll be back in December!

Mary Carr Oct 01, 2018

Show notes

Mary Carr just finished her career in clinical Emergency Medicine. Most of her practice was at Regions Hospital, but she didn’t start there. She started her training as an EM resident in Michigan and completed it at Regions Hospital. Over that time she served her patients and the system in many ways. She was the key physician liaison with the trauma program for many years. She’s been a core member of the residency since the beginning. She then developed a new and highly regarded Sexual Assault Nurse Examiner program at Regions that now has multiple practice locations in the east metro area of the Twin Cities. Not satisfied there, Mary applied for and was awarded a grant through the Bush Foundation. She developed her own fellowship in Clinical Forensic Medicine and turned that into a forensic medicine consulting service for police and prosecutors in criminal law. In this role she could help the criminal system interpret findings on people who were still living, as compared to those who’ve died – often represented by medical examiners.

This interview was done in May of 2018 just prior to Mary’s retirement. I feel very fortunate to have caught Mary at the close out of her amazing and enduring career in emergency medicine. She has seen it all and she shares just a bit of her wisdom in this episode. I had way too much fun talking with her and we went beyond 90 minutes – so I expect you’ll be breaking this one up over multiple listening sessions.

Outline

Mary’s path to emergency medicine was rooted in her childhood
How many other women were in Mary’s EM residency? Can you guess?
From Henry Ford to Med College of Wisconsin to Ramsey
Early exposures to teaching in Wisconsin then in the pre-EM residency Ramsey
Keys for success. #1 is arrive a bit early.
Mary’s per-patient workflow
Mary wears a white coat for the pockets… not for nurse vs doctor recognition…
Getting the whole exam done right away
Slack time during a shift – what is the right amount?
Long term career resilience tips
The importance of staying up on current medical knowledge
Mary’s niche in sexual assault medicine and forensic medicine
Details on the clinical forensic medicine consulting service for the criminal law system
We wax on about the possibilities allowed by emergency medicine to have a rich and multifaceted life
Gender equity in medicine – extensive discussion of her experience with tips for men and women
Showing up
Listen to me ramble though the ‘awe’ of Mary as I ask ‘Why are you such a bad ass in emergency medicine?’ and her much more deft response.
Room 10 and Mary’s Trauma Liaison role
Finding escape in your life and Mary’s daily year-around running in Minnesota
The next horizon for Mary
Wrap up – would you recommend medicine to a career in medicine?

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Physicians Committee for Responsible Medicine

Sam Stellpflug Sep 01, 2018

Show notes

Sam Stellplug is currently a core faculty member, a night hawk doc at Regions and the program director for our Toxicology Fellowship. He has a diverse history that informs his style and manner of practice and I really had fun exploring what he had to say.

Outline

Introduction and Sam’s Background
Performing an Annual Family Assessment
Work fulfillment
Shift preparation
Night Hawk Thoughts
Post Night Turn Around
Sam’s Drug Cocktail for Night Shift Success
Learning from community practice – self assessment of the Event Log
Benefit of verbal communication with nurses about new orders
Test ordering and result dichotomization as the sole key to fulfillment in emergency medicine (we spent A LOT of time here)
Supervision of learners and methods to train based on learning level
Translating Brazilian Jujitsu to Emergency Medicine and personal improvement
Managing emotion during typically stress inducing events
Hey, is that John Candy?
Wait. I have a question!
Wrap up – Sam’s already got his kid managing multiple patients.

Kathy Neacy Aug 01, 2018

Show notes

Many of you subscribed at this point don’t know Kathy Neacy. Kathy trained as a medical student at the University of Illinois- Chicago and then a resident at the University of Michigan in Ann Arbor. (Before being a student, she was in the medical device field for a number of years).

She was a faculty member at Regions and staff physician at Hudson from the late 90s to the mid 2000s before heading back closer to family in Chicago. Since moving, she’s mostly practiced at Loyola University Medical Center as a Staff Physician and Assistant Professor of Emergency Medicine. However (as we get into in this podcast) she scratched an itch to try something different: she moved to a pure community ED for a period of time.

Kathy is always fun and interesting to talk with, but this experience of working in academics and community practice might provide early career physicians or current ED residents some extra perspective on the options available out there. I’m honored to call Kathy a personal friend and was excited that she agreed to be interviewed on a recent trip to the twin cities. Many older residency alumni and faculty will no doubt remember her intensity, her cut-the-crap approach, but also her compassion for the suffering and passion for helping others learn the art and science of medicine.

Enjoy!

Show Outline

Introduction
Does Kathy enjoy her job?!
Understanding and defining role as an emergency medicine provider
Methods of getting yourself and your department back on track when ‘on the ropes’ and other ramblings on managing people and yourself during stress during the ED shift
Kathy’s foray into community medicine
Structural differences observed between community and academic practice
Considerations on culture and burnout in your group
Advice for early career women in emergency medicine
Going into the room – first moments of relationship building with the patient
Teaching patients about supervising residents in the moment
Tips for connecting with patients
Closing – Would you recommend your career?

Keith Henry Jul 02, 2018

Show notes

Keith Henry is a confident and experienced academic emergency medicine physician. However, different than many academic docs, he started his post-residency career in community EM and returned to academics. He leads the Univ of Minnesota medical student emergency medicine rotation. We had a great tour of his thoughts on the role and techniques of being a emergency medicine doc in this interview. Enjoy!

Show Outline

Introduction
Keith’s Pre-game – early is on time and on time is late
During -shift workflow priorities – you can run the shift or let the shift run you
Defining your role as an emergency physician
Detailed discussion about pre-test probability use in emergency medicine
The importance of getting back on track during a shift
Documentation strategy – method, complexity
How did Keith develop his skill set?
Closing – the people keep us coming back.

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