Turn 2020 into an opportunity by changing your mindset [PODCAST]

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“A few months ago, I signed up for a virtual conference for women in medicine. It’s a group of women, over 10,000 of us, who have watched me and supported me through the past two years of my career. Two years of struggle. Two years of personal and professional pain. Two years of opportunity for growth, and two years of numerous setbacks that were only overcome with all of their assistance. At the close of each interview with women leaders in various industries, the organizer asks them what 2020 has taught them. A friend of mine from the group reached out to a few of us and asked us what 2020 had taught us. In my response, I referenced so much of what we have touched on in this class and things that have been brought to the surface by the turmoil of this year. The only way to save medicine, save our country, and to save ourselves is to pivot.”

Nicole M. King is an anesthesiologist.

She shares her story and discusses her KevinMD article, “The only way to save medicine, save our country, and to save ourselves is to pivot.”

This episode is sponsored by Elsevier Health. Looking to update your personal or professional medical library? Shop Elsevier Health’s Holiday Sale and save up to 35% on your purchase of medical books! Plus, you can take an extra 5% off your order with code KEVINMD at checkout. Take advantage of the biggest sale of the year from Elsevier, the world-leading provider of medical books and reference materials. Shop us.elsevierhealth.com now through December 31.

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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 Nicole King. She is a critical care physician, and she wrote the KevinMD article “The only way to save medicine, save our country, and to save ourselves is to pivot.” Nicole, welcome to the show.

Nicole M. King: Thank you. I’m very happy to be here.

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

Nicole M. King: My name is Nicole King. I originally went to school in St. Louis and then joined the Navy. As you can see with my stuff behind me, I was a naval officer for 10 years, so I did all of my training in the Navy. I then did three years as an actual anesthesia attending. I left the Navy after 10 years, went back to fellowship at Vanderbilt, and now I am a critical care anesthesiologist.

Kevin Pho: We’re now speaking the week before Thanksgiving, and we are obviously in the midst of another wave of the pandemic. So tell me what you’re seeing in the critical care unit in your hospital.

Nicole M. King: The biggest thing that we’re seeing is that, you know, we know this time of year people are usually trying to get their surgeries done for insurance purposes. So you already have a big surge coming into the operating rooms and the ICUs, which is normal. We additionally are getting to cold and flu season, and then we’re also getting the COVID surge. What’s happening is, I think all of us kind of figured that the COVID surge would come through the emergency rooms, much as it did up in New York City, and maybe on the West Coast, when this first started.

But instead, what we’re actually seeing is our capacities being hit more at the ICU level, because we already have our standard sick patients who are already here in the fall and winter months, plus we’re having COVID patients come in from outside hospitals who need a higher level of care. So we’re really starting to see a crunch, not just from the bottom up, where patients are coming in from the ER, but we’re really seeing a crunch at the ICU, and then we can’t get patients out of the ICU. So overall, just how consistently we’re full is overwhelming for physicians, nurses, and, for me, because I do ECMO, perfusionists and respiratory therapists.

Kevin Pho: So what does that mean for elective surgeries going forward?

Nicole M. King: At my institution, as with most institutions, I think we’re trying really hard not to cancel all elective procedures like was done back in the spring. I think that’s for multiple reasons, for both the patients and the physicians and nurses in the hospitals, because a lot of times that then entails people getting laid off or taking pay cuts, and getting laid off and taking pay cuts during a pandemic, there’s nothing more demoralizing. So I think we are really trying hard not to go to that extent, but we are now having discussions daily, trying to figure out if we can do a surgery without taking up a hospital bed, and how long that person is going to be in that bed. So now it’s more of a day-to-day calculation of what surgeries we can do and what surgeries we cannot do.

Kevin Pho: All right, let’s transition into your KevinMD article, “The only way to save medicine, save our country, and to save ourselves is to pivot.” Now, for those who haven’t read your article, can you just walk my audience through it and share the story of why you decided to write it?

Nicole M. King: Sure. I have gone through a big transition in the last year. My initial academic job outside of fellowship ended very abruptly. I actually was going to leave that job because I was unhappy, and I quit that job the day before I flew to New York for the surge. So I flew to New York in April, and I was there for three and a half weeks. I came home, and I already had a new job, but during the time period when I was home, I really started to dig down and dig deep into how I was going to make 2020 count. How am I going to make it a pivot point instead of something that drags me down and that I’m angry about? I wanted to move forward.

I actually was asked to do quite a few speaking engagements, including at MD Anderson. I started writing. I decided to get an executive master’s in quality, safety, and leadership through Georgetown University. With all these things together, I decided to put onto paper that none of the things that are happening in 2020 have anything to do with 2020. They have everything to do with how we got to 2020. So if we want to move past 2020 in a positive way, we’re going to have to move away from the way we’ve always done things. In academic medicine, that is everybody’s favorite term: “Well, that’s not how we do things here,” or, “That’s not how it’s acceptable in the academic sphere of medicine.”

So my whole thing was: Let’s stop looking back to the past, and let’s look to the future and think, what can we do differently to make 2020 a launching pad, instead of bringing us all down and crushing us and crushing our soul as this pandemic comes back around?

Kevin Pho: So you’re talking essentially about a change in mindset, a change in how we frame what’s going on in 2020, and you talked about your story and what you did specifically. Now, what are some specific examples of what doctors can do to change that mindset and look forward, instead of looking at what’s been going on in 2020?

Nicole M. King: I think a lot of what happens in medicine, in academic medicine specifically, and then also in private practice sometimes, is that we just get very bogged down in, “Well, we just need to get back to the golden age of medicine, where doctors and nurses had more control.” We’ve given up that control to administrators and to insurance companies, and though I agree with that to a certain extent, I also think we have to own that. We have to own the fact that in the ’80s and ’90s, we let a lot of that control go because we were too busy, and now we’re kind of suffering from that.

But I also think that we tend to think it’s an us-versus-them game. It’s kind of like the whole concept of MDs versus NPs or PAs, or CRNAs versus anesthesiologists. My thing is, medicine is so complex and so broad right now that we really need all of us. So a way for us to move forward is to break down the barriers and flatten that hierarchy, which is something that they teach very well in the military. People always think the military is very hierarchy-driven, but the interesting thing is, I’ve never felt more empowered to speak my opinion or question the status quo than I did when I was in the military, and I’ve been trying to bring that into the civilian and more academic land.

I want all of us to be able to reach across the aisle, knowing that when we reach across the aisle, we are going to be reaching across to people who don’t look like us, don’t talk like us, and don’t think like us. But that’s OK, because what 2020 is introducing is this opportunity for us to really reach across the aisle and find commonalities, instead of pitting each other against each other, which is, I think, what we’ve always kind of done in medicine: doctor, nurse, this, that. Why don’t we all try to figure out what our common ground is and build on that?

Kevin Pho: So as you know, medicine inherently is hierarchical, and large academic medical institutions especially are hierarchical as well. What are some specific things that you’ve done to reach across the aisle and try to break down that hierarchy?

Nicole M. King: The big thing for me, and I learned this in the Navy, is that I worked very closely with the nursing staff on rapid response teams and MEWS programs, modified early warning dashboard systems. I don’t mean that I just went and asked them how things were going. When I wrote the policy, I wrote the policy with the nursing staff. I made myself get into the weeds on policy writing, which a lot of physicians say they don’t have time to do, and you’re right, it’s very time-consuming. At the same time, if you don’t have buy-in to the policy, then it’s very hard for people to respect your opinion on the policy.

A lot of physicians have always said, “I don’t like that policy. That policy doesn’t fit with my agenda.” Well, that’s not where we’re at anymore. So now, if you want to change the policy and make it more physician-friendly, then you need to be involved. I found so much support and respect by going to the bedside with the nurses and saying, “What is working for you? What is not? What can we do within the policy? What can we do within the chain of command to help you feel safer when you’re taking care of patients, especially when they’re in an acute rapid response setting? What would make this better for you?”

I carried that with me into fellowship and into my place as an attending. I really try to present myself as a nurse and resident advocate. If I advocate for them, then inevitably the respect and advocacy that comes back to me is twofold.

Kevin Pho: You mentioned earlier that tension between administrators and clinicians, and that is a theme that recurs on my site a lot. One of the reasons why physicians are a little bit suspicious of administration is because, obviously, administrators don’t see patients themselves, and they may not be involved in direct patient care. Now, what are some tips that you can share where clinicians can work more closely with administrators?

Nicole M. King: I think part of this, and there was actually a recent article that came out about clinicians such as myself, who are the people who do both sides, who are both clinicians but also have more of an administrative role. What I would really push forward into the future is that there’s got to be a part of the academic leadership that allows people like me, younger physicians who are still clinically active but want to get into the administrative side of things, to do both. What does that mean? That’s going to mean augmenting our FTE. That’s going to mean giving time for meetings and presentations and policy writing. It doesn’t necessarily mean that you are not capable of advancing in the academic track the way your normal, research-based person would, but it allows you to be more flexible within the academic setting.

I think it’s flexibility, but I do firmly agree that once an administrator stops practicing clinically, you lose that ability to relate to the people on the ground very quickly. We’re seeing that in the pandemic structure: Administrators have this idea, and all of us at the bedside are thinking, “You’re crazy. That’s not going to work. That would never work in a million years.” But I do think that there is a way to marry the two, and I think the only way you’re going to be able to do that is if you hire physicians who are willing to do both and want to do both, and you do not punish them for it.

Kevin Pho: If I’m a physician, how would I know that I’m interested in leadership? What are some of the characteristics that would define that?

Nicole M. King: I think that’s an interesting question. I think it’s something that we’re just taught in the military. We’re given so much responsibility so early, and we are forced into these administrative roles, that we almost come out of it not understanding that other people are not taught this stuff in the more civilian medicine world. I think, in how I’ve framed this whole year, I have been saying: If you like to innovate, if you like to advocate, and if you like to listen, then those are the things that can push you into meaningful administrative roles. I feel like advocacy, listening, and innovation will get us to the future. So if you’re somebody who hears those things and thinks, “I want to be a part of those words and what those words represent,” I think in that way you definitely would have a role in leadership or administration.

Kevin Pho: And from your experience, from an administration standpoint, do you feel that a lot of them would be more receptive to more clinical physician input?

Nicole M. King: Yes, because even just last week, I had administrators come and find me in the cardiac ICU and say, “What are you seeing? What are you feeling here at the bedside? Tell us what we can do to help you.” I do think if you have more of those people who are willing to be in both spheres, you will be able to bring those spheres together in a more cohesive and constructive manner moving forward.

Kevin Pho: We’re talking to Nicole King. She is a critical care physician, and she wrote the KevinMD article “The only way to save medicine, save our country, and to save ourselves is to pivot.” Nicole, for those clinicians who want to take up your advice and use 2020 more as a launching point, whether it is to get better relations with administration or to reduce that hierarchy, what would you say are the number one and two tips that they should do right now?

Nicole M. King: I think the biggest thing is just to get out there on the ground. Go talk to the people who are closest to the bedside and ask them what it is that is bothering them the most, and ask them, “If I could do anything to help you, what could I do?” I think the biggest thing is to reach out to other people and ask how you can help them, instead of focusing on yourself. I know that that seems very cheesy, or kind of a biased opinion based on my service and stuff like that, but I really do feel like if you’re willing to put yourself out there and ask the people below you, and even above you, “What can I do to make your life easier?” you will be shocked by how much response you will get, how much support, and how much more motivated you will be to come back to work the next day.

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

Nicole M. King: Don’t leave medicine. I don’t think you have to leave medicine to find your passion. I understand the concept of side gigs. I understand leaving medicine to go do other things. I understand why. But I think you also can make medicine something that is good and wholesome for you. You just have to find it. Easier said than done, but don’t leave medicine.

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

Nicole M. King: Of course. Thank you again.

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