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Join Tyler Jorgensen, an emergency medicine and palliative care physician, and discover the profound insights he shares on the value of home visits in patient care. Explore the complexities of handling challenging situations, such as encountering conflicting beliefs, and learn strategies for providing compassionate care. Don’t miss this enlightening discussion on palliative medicine and the role of health care professionals in today’s society.

Tyler Jorgensen is an emergency medicine and palliative care physician.

He discusses his KevinMD article, “Embracing compassion: a physician’s journey in overcoming prejudice.”

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Transcript

Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast. Get CME for this episode by clicking on the CME link in the show notes. Today we welcome Tyler Jorgensen. He’s an emergency medicine and palliative care physician. His KevinMD article is titled “Embracing compassion: a physician’s journey in overcoming prejudice.” Tyler, welcome to the show.

Tyler Jorgensen: Thanks, Kevin. It’s great to be here. Thanks so much for having me.

Kevin Pho: We’ll get into the article in a little bit. First off, just briefly share your story and journey to where you are today.

Tyler Jorgensen: Great, thanks. Well, I’ve been an emergency medicine doctor for about 13 years, and a couple of years ago I was at a point of burnout, like a lot of us reach at times. I took some time off, stepped back, and re-examined my role in medicine and my career in medicine. Honestly, I was at a point where I considered walking away from medicine. But ultimately, that patient care, that patient connection that originally drove me to medicine, is not something I wanted to give up.

I felt like I was at a point in emergency medicine where I wasn’t able to connect with patients, and I had this evolving interest in connecting with patients in a new way. I looked around and found an opportunity to do a palliative medicine fellowship. I just finished that up six or seven days ago, and I’m now stepping into a role doing inpatient palliative medicine at Dell Medical School here in Austin, Texas.

Kevin Pho: All right, that’s a wonderful story. You’ve had perspectives, of course, from both sides, in the emergency department as well as in palliative medicine. So tell us how those two fields intersect.

Tyler Jorgensen: Well, I wish they intersected more. There have been some amazing studies, some great work done, showing that having a palliative medicine presence in the ER can greatly reduce the unwanted and ultimately unsuccessful intensive treatments that a lot of patients get. So where it’s possible to have an embedded presence of palliative medicine in the ER, that’s great.

But beyond that, what I’ve observed at the med school this year is that there is really a huge blossoming of interest among emergency medicine practitioners and emergency medicine trainees in bringing palliative medicine skills to the bedside, to be used by emergency medicine doctors. So I think it’s a real opportunity for growth: working on communication skills, having a better understanding of goals of care and prognostication, and just learning how to really work with patients to figure out whether they want all of this intervention at the end of life, or whether it would be better to focus on comfort, on presence, on being with family, and things like that. There’s a great intersectionality between the two fields, and I look forward to seeing it continue to grow in the coming years.

Kevin Pho: Was there any change in your mindset? You were an emergency physician for years, and then you just finished a palliative medicine residency. Tell us about the contrast between those mindsets.

Tyler Jorgensen: You know, it’s really funny. One of my inpatient hospice attendings who was training me this year, I would be looking at a patient and have thoughts like, “Hey, if we put a central line here or did a little mass transfusion,” and every now and then he’d have to say, “Stop it. Just stop it. That is not the goal of care here.”

So I’d say it’s been a gradual shift in my focus. I’m very, very grateful for all of the emergency medicine experience. I think it helps inform my understanding of what’s happening with patients, what might happen with intervention, and what might happen without therapeutic or curative interventions. So I’m very thankful for it, but it’s definitely a different mindset, and it was a gradual change over the course of the year.

Kevin Pho: All right, let’s talk about the KevinMD article that you wrote. It’s titled “Embracing compassion: a physician’s journey in overcoming prejudice.” How did your article come together?

Tyler Jorgensen: Well, first of all, thank you so much for the opportunity to speak about it. I found something new this year in doing palliative medicine that I’d never experienced, and that was the wonder and mystery of home visits. I found myself on hospice visits and on outpatient palliative visits in patients’ homes, and I discovered that you learn more in about one minute of stepping into a patient’s home, or lack thereof, than you could in a hundred clinic visits. So it was really eye-opening. I loved being in that setting because that’s where patients are most comfortable, and we are truly coming to them to bring them care. Sometimes we had to escalate care, but most of what I found in patients’ homes was charming, endearing stuff that gave you a warm, fuzzy feeling: quilts, family photos, and things of that nature.

But what inspired me to write this article was one particular encounter that I had with a patient who lived way out in the country. We’d been in his shack, for lack of a better term, for a few minutes before I realized that there was a big swastika flag hanging over his bed, in primacy of place in his room. There were also some old Confederate flags. We encounter those; that’s part of the heritage down here, and it may mean different things to different people. Certainly it’s something that’s talked about a lot in the news, but it’s something we’re accustomed to encountering. Finding ourselves in this tight space with what honestly looked like a new, freshly purchased Nazi flag just gave me this rotten feeling in my gut. Processing that experience and figuring out how to continue to provide compassionate care for this patient is what led me to write that article.

Kevin Pho: So when you saw that swastika, what was going through your mind at that moment?

Tyler Jorgensen: You know, this patient was very ill, and honestly, I was initially transfixed on him and his condition, thinking about what we needed to do for this patient. If this were my ER patient, what would I do, versus if this were my hospice or palliative patient, what would I do? So it was as I was almost in a reverie, pondering what the best next step was, that my eyes drifted up and I saw this thing. It snapped me out of it. Initially, it snapped me out of all thoughts of this patient, really, and it was just this sickening thing.

There’s no misinterpretation of a Nazi flag like that. You don’t want to presume, I guess. You don’t want to bring in your own prejudices. But this is a symbol of hate, a symbol of the eradication of segments of the population, a symbol of white supremacy. I think what went through my mind was, “Geez, this really is a real problem in our society today.” It’s really out there.

Kevin Pho: Now, did you have to take a step back, take a moment, just to assess and analyze your own thoughts about the situation?

Tyler Jorgensen: I was able to do it without physically removing myself from that situation, because it was a very slow-paced encounter. It wasn’t super conversational. We were allowing the moment to breathe, and so I was able to do it within that context. I think if it had happened mid-conversation or mid-intervention, I might have really had to pause the scene and regroup a little bit.

Kevin Pho: Now, how were you able to manage those conflicting feelings?

Tyler Jorgensen: As I wrote in the story, society is complex, and our role can change from time to time. My job as that man’s physician is to provide him the best clinical care that I can, end of story. My role as a physician in society, trying to combat ills or educating tomorrow’s leaders in medicine, could look different. At the med school, we’re working to root out the systemic problems that make health care inequitable. We’re always combating racism and hate in this country, and all these sorts of legacies that we have.

So, I don’t know if this is the right answer, but it’s almost like you can put it in boxes in a way. My job right now is to care for this patient, and that is all, and to provide compassionate care. One thing I find is my starting point is that I try to think of myself as no better than anybody else. I don’t know how he arrived at this point. I like to think that there’s good inside this guy. He’s probably got some really mixed ideology, some really bad stuff, but my job is to try to see the human inside of him and to care for that human. It may be my job later in the day to speak out against racism in another way, if that makes sense.

Kevin Pho: So what happened next in this story? Did you discuss the case with some of your colleagues?

Tyler Jorgensen: I did. I absolutely discussed it with some of my colleagues. It was one where I felt like I had to, and it was really interesting. I was able to share the story with some colleagues locally as well, and most people agreed that their starting point was, “You’re right. None of us is perfect. We need to show compassion.” And then I actually had some colleagues who said, “Where’s the limit?” Maybe that’s the interesting question: Where is the limit? Is there a line a patient can cross where you no longer show them compassion? I think that’s a very interesting philosophical question, maybe a moral question, a spiritual question.

But I think the story just raised it, and most people had had a similar encounter. A lot of people in training suddenly realize that the person they’re trying to resuscitate in the ER is the person who tried to murder the other patient there. Humans are messy, humans are complicated, and our job is to take care of messy humans. So it’s inevitable that you encounter things like this that challenge you, but it was very helpful to share the story with people.

Kevin Pho: As you mentioned, physicians in training especially are going to encounter situations like this, especially since we live in such a polarized society. After reflecting on your story, what kind of advice can you give to these younger physicians?

Tyler Jorgensen: I think one piece of advice would be to talk about it after the moment, to really talk about it and really decompress about it. I think our trainees today are coming up in a medical culture where, while I was trained to see the humanity in our patients, today’s providers are trained to do that but also to recognize their own humanity, and I’m thankful for that. I’m thankful that we’ve progressed.

So I would say you first need to acknowledge and give voice to what that did to you and how that felt, either through journaling or, I think, by sharing with somebody else as well. If it’s really immediate, then you need to do a little mini debrief then, and then put it away and be able to move on and take care of other people. But don’t bury it. Do whatever you need to do to be able to continue to care for the people who are your charge.

And then, in the moment, I think we just have to always be very careful to check our own biases at the door. When we walk in to see that patient, we are a minor character in their lives. We are intersecting with them at this moment in time. They’ve had a life to live to get to this moment, and we don’t know what led them to be how they are. We don’t know exactly what led them to act the way they do. So I think that whatever your own personal deep well of compassion is, always tapping back into it and always re-centering on it allows you to remain compassionate when you encounter the unexpected and something that you might find dreadful.

Kevin Pho: We’re talking to Tyler Jorgensen. He’s an emergency medicine and palliative care physician. His KevinMD article is titled “Embracing compassion: a physician’s journey in overcoming prejudice.” Tyler, tell us some of the take-home messages that you want to leave with the KevinMD audience.

Tyler Jorgensen: Well, a couple of things. One, I think it’s really important to remember that the patient in front of you is a human being who has lived a life that brought them up to this point. I tell all my learners to find the human inside of each patient. It’s a pretty simple concept, but try not to think of them just as a patient.

The other thing is to do your best to check your own biases at the door when you’re caring for the patient in front of you. You may disagree with them. They may disagree with you, and even stand against you in some way. And yet our calling is to do our best to provide compassionate care.

My third thing would be to absolutely talk about this. If you as a provider are in a situation where you are uncomfortable and feel unsafe, you absolutely have a right to step out and make sure that the situation is safe. And also just talk about these experiences with others, because it’s really important that we don’t bottle them up and pretend they didn’t happen.

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

Tyler Jorgensen: Thank you so much, Kevin. It’s a pleasure.