A shout out to small hospitals [PODCAST]

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“I’m a small-time doc in a small town, and I work at a small hospital in the Midwest, and I’m proud of it. The huge university hospitals (like Cleveland Clinic) get all the glory (especially in society and in the press), but small hospitals like mine drive this country.

It has been really weird working at a small hospital, where it seems like the emotions are more magnified than in the big city. A year ago, it seems like there was a local community group every day bringing food or treats for the hospital workers. Nationally, there was this outcry to recognize those in the medical field.

And, then, something changed. Now, for some reason, both nationally and locally, medical workers are seen as “the problem,” and there is a lot of negative emotion directed at us. And, it seems locally, like that negative emotion is magnified. Why did that happen, and how did we get here?”

Mike Sevilla is a family physician who blogs at his self-titled site, Dr. Mike Sevilla.

He shares his story and discusses his KevinMD article, “A shout out to small hospitals.”

Reflect and earn 1.0 AMA PRA Category 1 CME for this episode.

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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, 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 Mike Sevilla. He’s a family physician, and he wrote the KevinMD article “A shout out to small hospitals.” I was talking to Mike shortly before this podcast, and I was saying that the last time we talked to each other online, I was on his podcast about 15 years ago, and we were just reminiscing about how much time has passed since then. Right, Mike?

Mike Sevilla: Yeah, yeah. Good to be with you, and it’s just great catching up with you again. Thanks so much for sharing my article on KevinMD.

Kevin Pho: Now, we’ll get into that article in a little bit, but for those who don’t know who you are, can you just briefly share your story and journey to where you are today?

Mike Sevilla: Yeah, so my name is Mike Sevilla, and I was born and raised in northeastern Ohio. I’m a family physician, and I’ve been here 20 years. I’m in a group practice, physician-owned, not hospital-owned or owned by any kind of organization. So we’re a traditional practice. We still go to the hospital, we still go to nursing homes, and we do a lot of longitudinal care, which is what I went to medical school for. I still love what I do, and I still have students in, just to tell them this is still what you can do in primary care. And still a lot of students have their eyes opened on what primary care or family medicine is all about.

I’m fascinated with sharing my story and making observations. Kevin talked a little bit about my origins in social media, and I can’t believe it’s been 15 years. We started before Twitter and Facebook, with the traditional blog and long-form writing, and that’s where I really find my joy, in that type of format.

Through the pandemic, like everyone else, I had a very tough time just dealing with things personally and professionally. One of the things that I’ve really tried to do to get myself back to some kind of normalcy is to really get back to writing again. That’s where I found my joy. I wrote this piece because it really, really spoke to me. It really kind of spoke to what was going on in my community, and it was a joy to kind of write that, post that, and share that. It’s been fun trying to get back to things I really enjoy and love to do.

Kevin Pho: So whenever you read my site on KevinMD, or you read mainstream media, there are always articles pronouncing the death of primary care. We talk about all the things that are wrong in primary care and how there’s going to be a huge shortage of primary care. But you’re living the primary care life. You’ve done this for decades now, and you have a traditionally run primary care practice, which is actually in the minority. So tell us, what keeps you going in primary care despite all the obstacles and challenges that face the field?

Mike Sevilla: You know, I get that question a lot, especially from medical students: “What’s the deal with primary care, and why would I as a student want to do that? It’s underpaid, it’s underappreciated, and there’s not really any kind of appeal or sex appeal to it at all.” I went to medical school, like everyone else, just to try to help people. Through my medical school experience, I learned the way to take care of patients in a longitudinal fashion. And what family medicine is, is taking care of patients, taking care of families, taking care of patients and families in small communities like where I’m at right now and what I’ve been doing, and there’s a real joy with that.

Of course, with any kind of job, especially in medicine, there are headaches. There are a lot of rules and regulations and regulatory factors and all that type of thing, and it’s going to be there with any kind of job. But where I really get my gratification, and why I still kind of keep going to work every day, is that relationship with your patient, that relationship with your patient’s family, that relationship with your community.

There are a lot of students that say, “Hey, I don’t want to be a small-town doc, because patients are just going to be too invasive of your privacy whenever you’re at the store or at church or something like that.” That’s a myth for the most part. When I first got here, sure, I didn’t know anybody in this community, and like everyone else, I just had to find my own way. But when students come and see me, when I talk to people about it, it’s really that relationship with that patient, that long-term relationship with that patient.

There’s a lot of talk now about the rise of things like urgent care, and is that primary care? That’s really kind of a transactional relationship. You go there, you’re sick, you get treatment, and then you keep going. When you make that relationship with that family physician, you know that you’re going to get to know that physician, and that physician is going to get to know you, get to know your family, get to know your medical problems, get to know your allergies and medicines, and get to know that you’re not supposed to get that medicine. You’re not going to get that in an urgent care setting. You’re not going to get that in other settings. And that’s why I really try to convey to medical students and the community why I still love family medicine, and I’m going to still love family medicine. So I hope that answers your question.

Kevin Pho: So there’s a lot of talk about physician burnout. We talk a lot about that on KevinMD and on this podcast, and you talk a lot about primary care clinicians who are backing out of clinical medicine for more of that proverbial work-life balance. Now, how do you maintain that relationship with a patient through the outpatient setting, the inpatient setting, and nursing homes? You still round and see patients in all three of those settings. How do you balance maintaining that close relationship with patients with the work-life balance that a lot of doctors crave?

Mike Sevilla: Yeah, I admit I don’t have really great answers for that. I can share what I do. People have to really kind of make boundaries: make professional boundaries and make emotional boundaries, certainly with this type of job, with the demand that comes from society. I can work 24/7, even in the age of electronic medical records and telehealth visits; that opportunity is there. But that balance is something that you have to try to carve out for yourself, and certainly each person is different. During this pandemic, I’ve been trying to just get back to things, or to do things, to really find that work-life balance, whether it’s for my mental health or for my physical health.

I think we as physicians really want to try to do everything for all our patients all the time, at the expense of ourselves, and sometimes at the expense of our families. One of the things during this pandemic is that there is a certain point where that cost is just too much for that physician, and not just physicians but other medical providers. We’re seeing that a lot of medical providers are walking away from medicine completely. Is that the answer? Maybe that’s the answer for them. But for me, it’s still trying, even though there are all these headaches and frustrations. When it comes to what medicine really is, what family medicine is, it is that personal relationship with that person, with that family. I’m given permission to ask questions that other people aren’t, and that is an honor, and that is a gift. I think that is something that physicians really need to recognize, and just to say to themselves, “Hey, this is our value,” even in this kind of economic world where we’re not really recognized in that fashion as primary care and family physicians.

Kevin Pho: All right, let’s transition into the KevinMD article that you recently wrote. It’s titled “A shout out to small hospitals.” Now, for those who didn’t get a chance to read that article, can you just briefly walk my audience through it and share the story of why you decided to write it?

Mike Sevilla: Yeah, so that article was kind of a venting-type episode, which is kind of part of the beginning of a lot of my writing. We live here in a small town in northeastern Ohio, and when you look at the media, they give a lot of glory to the big university hospitals, Cleveland Clinic and those types of things. And what I’ve seen in my experience here in this small city is that the things that are happening in the big cities, the very emotional things, I think are really magnified in a small city, in a small community, because everybody knows everybody else.

The observations that I made in this piece are that when this pandemic started, especially in our small little hospital, every day there would be some member of the community or some organization who would drop off food or would recognize the medical professionals in that community. Sometime in the last year, that all kind of turned on a dime, for whatever reason, whether it’s politics or whether it’s anything else. Especially when it comes to masks and vaccines and all of that, there were really a lot of people directing a lot of that frustration to physicians, to medical professionals. And I’m like, “That’s not really right. We’re trying to help the community get through this.” And that’s where that writing came through. We were heralded as heroes in 2020, and then that quickly turned around to being the problem.

I just wanted to give a shout-out to a lot of people, especially my community here, who really reflected on that and said, “Hey, we feel that too.” I just wanted to give them recognition in my little way, to let them know, “Hey, whether you’re in a big city, whether you’re in a small city, whether you’re a physician, whether you work anywhere in health care, you are appreciated, especially through this pandemic.” I got a lot of response from that. There are people who really reflected on the piece, and that really brought me a lot of joy, that it’s not just me that’s feeling this, going through this.

Kevin Pho: Can you give an example or share a story where a member or members of your community turned against some of the health care professionals that were working in your hospital? What’s an example of that?

Mike Sevilla: Well, every day, especially when the vaccine started coming out and there were things like mask mandates, a lot of people pushed back on that. I was kind of like the little Dr. Fauci of my community, and whatever that meant politically for them, they were really reflecting that on me, and not just on me but on people everywhere in the community, especially in the emergency department of our community hospital. That would be something that I would go through every day. I would be trying to find out information: “Are you vaccinated? Do you have questions about vaccinations? Do you have questions about masking?” And that really turned very quickly, getting that patient after patient after patient every day.

And not just me, but the staff in my office, the people that answer the phones, non-medical people: They were getting this very negative energy from a lot of the people that come to our practice. In addition to that, there was the pandemic itself, and people in our office who would get COVID, or they had family who got COVID, and all that stress. So all of that kind of really came together, and I wrote this piece when the negativity was really at a high level. That’s where a lot of the origin of this piece came from.

Kevin Pho: Now, you mentioned that you were like the Dr. Fauci of your community, and I know that you appear regularly on your local television stations talking about health education and trying to educate the public. Did you get any specific pushback when people recognized you on the street? Did they say, “Dr. Sevilla, I saw you on the news,” and would they give you any pushback after your public appearances?

Mike Sevilla: Oh, yeah, I got both. I had some people say, “Hey, thank you for saying that. We need people locally to really speak out. It’s not really a Washington, D.C., issue.” And of course, yes, I would get negative feedback as well. But that’s just part of what I think being a medical educator in your community is. If you want to speak out about it, if you want to speak your heart about it, if you want to speak the science about it, you really have to take the good with the bad. For the most part, it has been positive, but there’s always that one or two people or one or two experiences that really bother you. But yeah, there’s some negativity, but I don’t reflect on that.

Kevin Pho: Now, do you have any success stories? Because one of the things that we certainly talk about, about being physicians who are prominent on social media, is that we want to change a few minds, certainly not change every mind, but just change a few minds. Now, are there any success stories that you can share from being a public physician, any minds that you may have changed through your public or social media appearances?

Mike Sevilla: Oh, yeah. I have a few, and they all have to do with the vaccine and with being a family physician and having that longitudinal relationship with patients. People are always talking about younger people and vaccines, and them not getting a vaccine. But having those regular conversations with them for six months, for nine months, for 12 months, I would get a little notification from the pharmacy that they got their vaccination. That is part of what drives me being a primary care physician, a family physician: We do have that longitudinal relationship. I’m not going to convince anybody with a 90-second interview on the news, but if my patients see that, and then that opens a conversation in the exam room, we can dive deep into it further, or I can refer them to my website or to my social media pages, where they can explore it more.

That is part of what I do, not only having a medical license, but being that voice on social media, which, as you know, can be very negative. But we do need physicians out there, as you’ve been saying for a long time, to really tell the right story, tell the science, and battle back all this negative and incorrect misinformation that’s out there.

Kevin Pho: We’re talking to Mike Sevilla. He’s a family physician. He wrote the KevinMD article “A shout out to small hospitals.” Mike, are there any misconceptions about working at or going to a small hospital that you want to clear up for the KevinMD audience?

Mike Sevilla: Yeah, there are all these kinds of characterizations out there that it’s kind of like an old boys’ club, or it’s not very welcoming to people outside of the community, or it’s very cliquey. None of that is true. Of course, when I started there, I didn’t know anybody, and you just have to start putting yourself out there and talking to people.

I guess another misconception about small hospitals is that we’re just the feeder hospitals for the university centers, for the Cleveland Clinics and things. We’ve learned to take care of a lot of medical conditions in a community hospital, because there have been many, many times where we’ve been told that there are zero beds in Cleveland, there are zero beds in other tertiary centers, and we do take care of sometimes complex medical cases. We do have the specialist coverage, we have the hospice coverage, we have the primary care coverage there, and we have all the facilities, like radiology and imaging and all of that.

So I hope that especially the general public still has faith in the small community hospital. I think one of the slogans around here is that we deliver kind of world-class care in a small community. And I really feel that the public, and especially the public here in the small community, really appreciates the hospital. They know that they may have to go to the big university setting on certain occasions, but for the most part, small communities support their small hospital, they support their churches, and they support their local organizations. That’s why I work in a small community.

Kevin Pho: And my final question: What are some of your take-home messages that you want to leave with the KevinMD audience?

Mike Sevilla: You know, I thought about this for a long time, especially for physicians who were going through this pandemic. Some of us really went to a dark place, or maybe are still in a dark place. For me, it’s just trying to get out of the negativity, just really trying to find some kind of joy, to try to get back to where we were before the pandemic, whether it’s doing things that you didn’t have time to do before or connecting with people that you haven’t been able to before.

But also, there are some of my colleagues who are just so negative now that I just had to cut them out of my life. So in addition to finding the joy, sometimes, for some people and some activities and some places, you just have to cut that out. We really have to try to be together for each other to get through this, and everybody has to find their own way. Everybody’s self-care journey is different. I’m just happy to kind of share mine with everybody, and I hope to have that resonate with people, especially in my small community.

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

Mike Sevilla: Good to be here. Thank you.

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