Welcome to the show Sean and Cheyenne, EKG tech experience and scribe experience

Sean talks about certifications and expectations that go beyond merely obtaining an EKG as well as the stress testing role

Cheyenne talks about the role that scribes play in the ED

Scribing for providers is often used as a role to gain patient experience for medical school or PA school

They talk about how they got into scribing and EKG technician work and Sean talks about how it is also a role that is used as a steppingstone

12 leads are complicated to interpret and require a lot of training and experience to get good at. They are even harder to interpret when the patient is not in front of you

STEMI’s are the key EKG’s to recognize because they are so time sensitive, but we don’t see these frequently – it can be very helpful when the tech recognizes this and can recognize the urgency

Knowing early signs of impending problems on the 12 lead can be helpful for patient prioritization as well

Being an EKG tech requires good resource utilization, sometimes there are not a ton of EKG techs available in the hospital, so they need to prioritize – communication is key

Communication between roles is so important when we are trying to get quickly get imaging, labs, assessments and EKG simultaneously 

At the end of the day, the patient is the top priority

Scribes do deal with a lot of stress, they must finish notes, write new notes and keep up with high volume, they like active communication with the provider

Sean talks about how a typical day can vary quite a bit

Support the show

Full show notes can be found here: Episodes - Practical EMS - Content for EMTs, PAs, Paramedics

Most efficient online EKG course here: Practical EKG Interpretation - Practical EMS earn 4 CME and learn the fundamentals through advanced EKG interpretation in under 4 hours.

If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you.

1st Phorm | The Foundation of High Performance Nutrition

Everything you hear today from myself and my guests is opinion only and doesn’t represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for educational and entertainment purposes only and should not be taken as medical advice nor used to diagnose any medical or healthcare conditions.

I’d like to welcome to the show Dr. David M. Berry, MD, he is a growing voice in the recovery and addiction space, an area that we deal with a ton across EMS and the emergency departments. He is an Emergency Medicine physician with over two decades of experience.

 You can reach him at [email protected]

Burnout and moral injury – how do we avoid these in dealing with the addicted and psychiatric patients? We can’t control most factors involving their long term care but David says: “give these folks the best care I know how to give them.” We can control what WE do

We talk about the best way to communicate between providers when passing on patients to the next shift

Dr. Berry talks about a patient he advocated for that he felt needed in-patient psychiatric admission but had been initially turned down

He talks about the importance of working patients up appropriately and not ignoring patient complaints, getting the emotion out of it

What would you do objectively if the patient was not a frequent flyer?

Dr. Berry talks about a substance use clinic he helped open in Western Colorado

He talks about meth addiction and how recovery works in his clinic

He tells a story about the devastating effects of meth on a young patient

The danger of meth is not in the withdrawal but the effects of it on your body

Dr. Berry talks about the limbic system, the reptilian part of our brain. People who struggle with addiction have a missed connection. Normally, when the average person drinks, a message gets relayed back from the brain saying slow down, you have responsibilities, you have work, you have a family. The addict’s brain doesn’t send this message back, they just get the message to drink more cause it feels good. This applies to any addiction

Their decider is broken, that’s why they need a sponsor, and their brain can eventually rewire and make the needed connections

The anatomy problem of missed or failing brain neurons is what is going wrong in the addict’s brain

This helps us understand where the blame truly needs to be placed, not on the addict for poor moral character or poor self-control but on a brain that isn’t wired correctly

Winston Churchill said everyone has an addiction, the key is finding one that is socially acceptable

Dr. Berry talks about Recovered on Purpose, an organization in Denver, CO that is working on new treatments for addictions and help market treatment centers and help get peopl

Support the show

Full show notes can be found here: Episodes - Practical EMS - Content for EMTs, PAs, Paramedics

Most efficient online EKG course here: Practical EKG Interpretation - Practical EMS earn 4 CME and learn the fundamentals through advanced EKG interpretation in under 4 hours.

If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you.

1st Phorm | The Foundation of High Performance Nutrition

Everything you hear today from myself and my guests is opinion only and doesn’t represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for educational and entertainment purposes only and should not be taken as medical advice nor used to diagnose any medical or healthcare conditions.

I’d like to welcome to the show Dr. David M. Berry, MD, he is a growing voice in the recovery and addiction space, an area that we deal with a ton across EMS and the emergency departments. He is an Emergency Medicine physician with over two decades of experience.

 You can reach him at [email protected]

We must remember, when working up these patients with addiction, they can have poor health baseline anyway, so they are at higher risk for something emergent to be going on

Dr. Berry talks about this approach to opiate OD

We have a small window between the ED and definitive care to help addicted patients move forward with treatment – a warm handoff to a treatment center or primary care that can monitor recovery is key

We have specific rules for most emergencies but often psychiatry is not on a set system

Holds may not always accomplish what we hope they will, it will not force someone to change

But there is certainly a role for the patient who is genuinely suicidal 

We talk about good structure of evaluation and treatment of the psychiatric emergencies 

David talks about some patients he has been able to help with addiction recovery from his experience

Don’t underestimate the difference we can and do make with patients just because we don’t always see the result

Dr. Berry talks about the message he has for clinicians:

We deal with a lot of emergencies, people actively dying, so when we hear a psych complaint or substance abuse complaint, we tend to mentally shuffle them into a lower priority. We need to remember to have empathy and take their complaints seriously, slow down with these patients

We talk about the balance between empathy and detachment and burnout

David talks about some methods of humanizing the experience for your patients and getting them to open up more

We talk about anchor bias and how to protect from it

David talks about conformation bias and how it relates in piloting an aircraft and emergency medicine

A key question to ask before you leave a patient room is “Do you have any questions?” – This can be hard to ask because we often want to move on but it’s so important to the patient

Support the show

Full show notes can be found here: Episodes - Practical EMS - Content for EMTs, PAs, Paramedics

Most efficient online EKG course here: Practical EKG Interpretation - Practical EMS earn 4 CME and learn the fundamentals through advanced EKG interpretation in under 4 hours.

If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you.

1st Phorm | The Foundation of High Performance Nutrition

Everything you hear today from myself and my guests is opinion only and doesn’t represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for educational and entertainment purposes only and should not be taken as medical advice nor used to diagnose any medical or healthcare conditions.

I’d like to welcome to the show Dr. David M. Berry, MD, he is a growing voice in the recovery and addiction space, an area that we deal with a ton across EMS and the emergency departments. He is an Emergency Medicine physician with over two decades of experience.

 You can reach him at [email protected]

He has an incredible story. He was conceived following a one-night stand and was almost aborted before being put up for adoption to a loving family. 

He had his first child and felt the gift of knowing his first genetically related family member for the first time.

Tragically, his first daughter was diagnosed with spinal muscular atrophy, a diagnosis not compatible with life and she later died around 9 months of age.

This led David to turn to alcohol to help deal with the pain. His family took notice of this, so he transitioned to opiates instead of alcohol, something that he could hide more easily. 

He was eventually found out and spent some time in jail and tried some treatment centers. He lost his medical license, his family left him and he became homeless.

His rock bottom was when he found himself homeless living under a bridge with no ID and realized that no one would even realize if he had died.

With the help of another doctor, David started taking Suboxone, which helped him to overcome opiate addiction.

This opened a path to Dr. Berry getting his medical license back and eventually led to a role as chief of staff of his hospital as well as opening up a rehab clinic in Colorado.

Hearing David’s story helps put in perspective the fact that none of us are that far removed from the homeless, drug addicted patient we care for in the ER.

He talks about his new appreciation for his life and his family

We talk about techniques to get patients to open up to us despite our short time with them:

“Do you mind if I examine you?” gives the patient some control in the situation

Some of our biggest misconceptions about these addicted patients is “They are trying to game the system,” maybe they are, but maybe they are totally out of options or are having a real emergency.

“What can I do to help you?” may open up a conversation about what they feel they need

Small, short conversations can make a big difference over time

We often don’t have enough time with patients to label them with anxiety disorder or opiate use disorder, so avoiding labels is probably best in the ED

Have a way to work up patients that avoids your bias

Support the show

Full show notes can be found here: Episodes - Practical EMS - Content for EMTs, PAs, Paramedics

Most efficient online EKG course here: Practical EKG Interpretation - Practical EMS earn 4 CME and learn the fundamentals through advanced EKG interpretation in under 4 hours.

If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you.

1st Phorm | The Foundation of High Performance Nutrition

Everything you hear today from myself and my guests is opinion only and doesn’t represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for educational and entertainment purposes only and should not be taken as medical advice nor used to diagnose any medical or healthcare conditions.

Creator of the philosophy The Art of Bending Time

You can find her work at Michelleniemeyer.com, LinkedIn and can text CLARITY to 33777 to get support

Michelle talks about what moved her away from law to helping others improve their lives

Finding fulfillment outside of work hours to pursue something that is important to you can have beneficial effects on your work hours

Work life balance is bullshit 

Sometimes building community and social interactions while at work is an important step to building a strong team. Telling your family and friends outside of work about your work life can be equally important. They don’t have to be totally separate parts of you

In the end, we are whole people

Personally, it is easy for me to isolate at work, but I feel better when I make the intentional time to get to know my coworkers

Remember your spouse is a partner in life with you, invite them into your work struggles

Take care of your body and your mind to avoid burnout

Be clear who you are

TEXT CLARITY to 33777 to get access to a free community page with Michelle’s guided meditation program to help you get clarity on life and remember what bring you passion and fulfilment in life

Creating a roadmap in life is crucial to making the life you want happen

Sometimes very difficult things are obtainable, but you have to take one step at a time

Michelle speaks to some healthy habits she has daily to start her day the right way, like taking her dog for a walk

Habits of unwinding at the end of the day are key as well, put down the phone well before bed

Leave for work with some extra time built in so you don’t get frustrated by traffic, start your day on a positive note

Support the show

Full show notes can be found here: Episodes - Practical EMS - Content for EMTs, PAs, Paramedics

Most efficient online EKG course here: Practical EKG Interpretation - Practical EMS earn 4 CME and learn the fundamentals through advanced EKG interpretation in under 4 hours.

If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you.

1st Phorm | The Foundation of High Performance Nutrition

Everything you hear today from myself and my guests is opinion only and doesn’t represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for educational and entertainment purposes only and should not be taken as medical advice nor used to diagnose any medical or healthcare conditions.

Creator of the philosophy The Art of Bending Time

You can find her work at Michelleniemeyer.com, LinkedIn and can text CLARITY to 33777 to get support

Michelle talks about a turning point in her life where she ended up in the ER and how this changed her perspective on health and nutrition after she was later diagnosed with PBC

Is burnout in our control?

Michelle says that the things that cause burnout are not in our control, but you can impact how you respond and how you look at the world

She recommends focusing on the things that you enjoy in your day, meditating on them

Michelle talks about some of the struggles she had as a lawyer and how it was difficult to not see the benefit of her work for 8 months to a year sometimes

Learn to be in the moment, if you are thinking about the future all the time you will suffer anxiety and if you are thinking about the past, you will be depressed

Setting goals is important, you need to be working towards something in life and figure out an action plan to accomplish them

Make sure they are goals that YOU want, as opposed to something that someone else wants for you

Delegate certain tasks, ask for help, don’t always micromanage

Step back and allow others to learn and grow

Michelle talks about how shifting from running all the time to enjoying walks outside improved her health and prevented injury

She talks about the importance of getting enough sleep and movement

Nutrition can be medicine

Michelle talks about a big case she was working on and how some dedicated, focused time, away from distractions, with adequate rest and movement, helped her through

Take care of yourself before you take care of patients 

To get focused work done, you need to set up your environment correctly and remove distractions

One distraction can make you lose precious focus one a given task

Multitasking is a myth

Burnout happens when people don’t feel any meaning in what they’re doing

Sometimes switching jobs or careers will not solve burnout, but establishing some good habits can recreate the fulfillment in your current job again

You don’t see the light when you stay doing the same stuff

Support the show

Full show notes can be found here: Episodes - Practical EMS - Content for EMTs, PAs, Paramedics

Most efficient online EKG course here: Practical EKG Interpretation - Practical EMS earn 4 CME and learn the fundamentals through advanced EKG interpretation in under 4 hours.

If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you.

1st Phorm | The Foundation of High Performance Nutrition

Everything you hear today from myself and my guests is opinion only and doesn’t represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for educational and entertainment purposes only and should not be taken as medical advice nor used to diagnose any medical or healthcare conditions.

Dr. Emma Jones is a hospice and palliative care physician, also worked as a pediatric oncologist and pediatrician. She’s been in the field for over 10 years and is active in helping healthcare professionals with burnout in the modern medical system. She is the author of The Phoenix Blueprint, Emerging Stronger from the Blaze of Healthcare

https://www.emmajonesmd.com

Boundaries are important to set up in your work. Proper emotional boundaries with your patients are important to maintain your separation from another person

You can see another person’s emotions, recognize them and understand that they are not your emotions 

True empathy does not improve your ability to provide patient care

Recognize when you do take on another person’s burden so you can do the work to set it down

We have to always remember to be patient centered. When you express empathy or share a personal experience with someone it should be serving a clinical purpose. It should never be done to help you process something

Is the patient benefiting from you relating to their experience?

Would you be better off to discuss your experience with a therapist or family member?

Spending more time to reassure and answer patient questions will save time in the long run and allows you to fully address the chief concern over the chief complaint

Rapport is developed not with time but can be done instantly by simply being a human being

Unconditional positive regard is viewing the patient or coworker or whoever you are interacting with in a positive light

This allows you to interact better with the patients you see, viewing the problem as the enemy and not each other

Positive attitudes, smiling and friendly behavior can be culturally discouraged in medicine and this needs to change, of course some situations call for a reserved attitude, but many do not

Giving away happiness and positivity does not take something away from you, it actually gives you more joy

We talk about mentoring and teaching the next generation of medical professionals

Advocacy for policy change is one of the last chapters of the book because you really have to overcome burnout in order to have the energy and motivation to take those steps

You must restore yourself to help make changes to the system

We talk about the pit fall of perfectionism. Perfectionism is different than excellence 

Perfectionism is a habit that does not serve

Perfectionism is when you try to bring things from the circle of concern into your circle of control - it doesn’t work

Support the show

Full show notes can be found here: Episodes - Practical EMS - Content for EMTs, PAs, Paramedics

Most efficient online EKG course here: Practical EKG Interpretation - Practical EMS earn 4 CME and learn the fundamentals through advanced EKG interpretation in under 4 hours.

If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you.

1st Phorm | The Foundation of High Performance Nutrition

Everything you hear today from myself and my guests is opinion only and doesn’t represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for educational and entertainment purposes only and should not be taken as medical advice nor used to diagnose any medical or healthcare conditions.

Dr. Emma Jones is a hospice and palliative care physician, also worked as a pediatric oncologist and pediatrician. She’s been in the field for over 10 years and is active in helping healthcare professionals with burnout in the modern medical system. She is the author of The Phoenix Blueprint, Emerging Stronger from the Blaze of Healthcare

https://www.emmajonesmd.com

Sometimes you need to realize you may be part of someone else’s plan and get onto your own plan

Dr. Jones talks about the difficulties with working with pediatrics but also the amazing resiliency of kids and their parents

We are told that medicine is a calling and a privilege, and we should sacrifice everything in service of the patient – this is an unrealistic expectation 

We talk about burnout and moral injury

Burnout a helpful term because it’s something we can all feel and understand and use to seek help

Moral distress or injury is something that occurs regularly - when there is discordance between what you want to do and what you are able to do - whereas burnout is more at the end of a line of moral injuries

Burnout triad: emotional exhaustion, cynicism, lack of fulfillment

If we can get the frontline healthcare workers out of burnout and the day-to-day strife, we can help them be part of the solutions to the problems we face

Dr. Jones talks about the philosophy of yoga and how it can help us flourish

Sleep is vital to healing from burnout. It allows the brain to clean itself; you are smarter after getting adequate sleep

A lot of us are not even giving ourselves the opportunity to get enough sleep

Lack of sleep makes it difficult to put things in their proper context and map solutions

We talk about core values and the importance of knowing what yours are and how they correspond to your actions

Emma shows the actions she takes to correspond with her core values

Joy and humor are a huge part of our humanity 

Questioning your thoughts is key. All thoughts are lies. We recreate memories. Our memories are fallible and tend to degenerate the more we recall an event

Learn to let go of thoughts that do not serve you. Choose the ones that are helpful. You get to control them. You cannot believe every thought that comes into your head

Steven Covey describes 3 types of circles in our lives in The Seven Habits of Highly Effective People. You have the circle of control you have direct control over but the circle of influence and circle of concern you have less control over. The point is to recognize what is worth focusing on and what is not worth your focus. For exampl

Support the show

Full show notes can be found here: Episodes - Practical EMS - Content for EMTs, PAs, Paramedics

Most efficient online EKG course here: Practical EKG Interpretation - Practical EMS earn 4 CME and learn the fundamentals through advanced EKG interpretation in under 4 hours.

If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you.

1st Phorm | The Foundation of High Performance Nutrition

Everything you hear today from myself and my guests is opinion only and doesn’t represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for educational and entertainment purposes only and should not be taken as medical advice nor used to diagnose any medical or healthcare conditions.

Bryan Jepson MD and CFP, author of The Physician's Path to True Wealth: 12 steps to gaining control over your money and your time – you can find it on Amazon and at this website for free Bryan Jepson MD, CFP® | physician finance

Disclaimers:

This is not specific financial advice, this is general education. Talk with your own advisor or schedule with Bryan to get specific advice 

The easiest, most straightforward way to start creating assets is to invest in your 401k

Debt to fund a liability is bad debt, it takes money out of your pocket

Debt that leads to more money in your pocket is good debt, but this requires wisdom in choosing your degree and education path

There are a couple of methodologies to pay off debt, the snowball method vs the avalanche method. Snowball goes smallest debt to largest. Avalanche goes from highest interest to lowest interest. Use the one that will actually work for YOU and will make you be consistent

The 4% rule: generally, when you can live off 4% of your investments per year, you have enough for retirement

So, if you need 100K to live off in retirement, you need 2.5 million in investments

Why does everyone need a will? If you have kids, it allows you to designate a guardian should you die. It also allows you to allocate where your assets go

What is the importance of giving away money?

Giving can be looked at through a couple different lenes. When you give, you are blessed in return. Or maybe you can view it as good karma

Bryan talks about how relationships are an important aspect of life and giving allows for meaningful relationships with something you value. Donate money but also your time

When you are rich, you don’t have the cushion to give. When you are wealthy, you have the ability to give to others

Finance is simple but not easy because you need discipline. You don’t have to get far into the weeds to be successful

Bryans book has the foundation you need to understand finance

Bryan talks about the difference between a financial advisor and a certified financial planner

 Bryan gives his opinion on whole life insurance vs term insurance

Support the show

Full show notes can be found here: Episodes - Practical EMS - Content for EMTs, PAs, Paramedics

Most efficient online EKG course here: Practical EKG Interpretation - Practical EMS earn 4 CME and learn the fundamentals through advanced EKG interpretation in under 4 hours.

If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you.

1st Phorm | The Foundation of High Performance Nutrition

Everything you hear today from myself and my guests is opinion only and doesn’t represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for educational and entertainment purposes only and should not be taken as medical advice nor used to diagnose any medical or healthcare conditions.

Bryan Jepson MD and CFP, author of The Physician's Path to True Wealth: 12 steps to gaining control over your money and your time – you can find it on Amazon and at this website for free Bryan Jepson MD, CFP® | physician finance

Disclaimers:

This is not specific financial advice, this is general education. Talk with your own advisor or schedule with Bryan to get specific advice 

The earlier you can get financially literate and work on a plan the better

Bryan is an emergency medicine physician, along his journey in medicine he also spent 5 years working in Autism before coming back to EM full time

The covid pandemic and a feeling of stagnation and desire to keep learning prompted Bryan to pursue a master’s degree in finance 

Bryan finds familiarity in his role as a physician to his role as a financial planner. You listen to the client and come up with a plan that fits their needs

Bryan talks about the difference between riches and wealth; discretionary income is the income above your mandatory expenses – and what you do with that extra income is how you become wealthy or rich

Riches are the material things you may spend that money on, car, house, toys

Wealth is the money you could spend but instead save or invest instead

The goal is to create assets so that your income is no longer needed. Buying back your time

When you have true wealth, you can make decisions with your time

Working towards being financially independent prevents burnout

Choosing to work vs working because you have to is easier, and makes you a better provider

Key attributes to develop to be financially successful: Be patient – assets grow slowly. Be consistent in investing. It is boring. Be honest with what you know and what you don’t know so you can spend some time educating yourself. Courage, because it does take some risk taking to invest instead of just saving

If you keep all your money in cash, you are guaranteed to lose purchasing power

The longer your time frame the better the stock market will perform for you

Creating discretionary income is difficult at lower incomes levels. But I do still believe you can retire from EMS. One way that I was able to save and invest as a paramedic was working overtime

Having higher incomes does speed things along but it is not the cure for financial problems because we all have a tendency to spend what we make – fundamentally it’s the same problem

We talk about the vehicles we drive and how we have utilized them to save more money

But spend money on

Support the show

Full show notes can be found here: Episodes - Practical EMS - Content for EMTs, PAs, Paramedics

Most efficient online EKG course here: Practical EKG Interpretation - Practical EMS earn 4 CME and learn the fundamentals through advanced EKG interpretation in under 4 hours.

If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you.

1st Phorm | The Foundation of High Performance Nutrition

Everything you hear today from myself and my guests is opinion only and doesn’t represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for educational and entertainment purposes only and should not be taken as medical advice nor used to diagnose any medical or healthcare conditions.