November 10, 2024 • 28 mins
11/10/24
The Healthy Matters Podcast
S04_E02 - Dr. Thomas Wyatt and the Hospital's Front Door (Open 24/7/365)
It can be said that the emergency department is the front door between a community and healthcare - that never closes. Within it, there's an immense team of providers working together to attend to anyone and everyone who comes in through the door - every hour of every day. Safe to say, it's an intensely busy place with no two days ever being the same.
Hennepin County Medical Center is a Level I Adult and Pediatric Trauma Center and safety net hospital, which means it's equipped to tackle the full gamma of healthcare issues in our community - from earaches to heart attacks. It's an intricate organization with a lot of moving pieces and a new, unique leader at the top, Dr. Thomas Wyatt (MD, FACEP). Dr. Wyatt is one of the first tribally enrolled American Indians (Shawnee/Quapaw) to chair an academic emergency department in the United States and in Episode 2 he'll discuss the importance of this role, what life is like inside and outside of the emergency department, and the many challenges facing these departments across the country. This is an excellent chance to get an inside view of an essential piece of the healthcare puzzle and to get to know a great figure in medicine. We hope you'll join us.
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:01):
Welcome to the Healthy Matters podcast with
Dr. David Hilden , primary carephysician and acute care
hospitalist at HennepinHealthcare in downtown
Minneapolis, where we cover thelatest in health, healthcare
and what matters to you. Andnow here's our host, Dr. David
Hilden.
Speaker 2 (00:18):
Hey everybody, it's Dr. David Hilden, your host,
and welcome to the podcast.
Today we are gonna talk aboutthe emergency department.
You've all likely heard aboutit or you've been to your local
emergency department, but doyou really know how an
emergency department operatestoday? I am joined by my friend
and colleague, Dr. Tom Wyatt .
He is the chair of theDepartment of Emergency
(00:39):
Medicine at HennepinHealthcare, and somebody I've
known for a good 20 years ormore. Tom, welcome to the show.
Thank you, Dave . So you're thechairperson, you're the chair
of the Department of EmergencyMedicine. You're a unique chair
of emergency medicine. We're anacademic medical center. We're
a large level one trauma centerin downtown Minneapolis. And
you're a Native American man.
That's true. You , you're oneof the very few people who I
(01:00):
could say that about. So Iwanna talk to you, if you
could, about first of all, ouremergency department, second of
all, about your path to it, andthen after the break a little
bit later, we're gonna talkabout some of the challenges
and what people can expect inan emergency environment. So
you and I did our internshiptogether right here at Hennepin
Healthcare. It was HCMC,Hennepin County Medical Center
some 20 years ago. Tell meabout your career path, if you
(01:21):
could .
Speaker 3 (01:21):
Yeah, so I remember back in those days, Dave,
you're a lot smarter than me ,that's for sure. Um,
Speaker 2 (01:26):
Oh, that is not a true statement. .
Speaker 3 (01:29):
Um, yeah, I , I remember those , uh, training
days very fondly. And I , Ifeel like I was trained at the
best , uh, emergency departmentin the world, if I may say so.
And then, you know, after mythree years of training, I went
out into the community. Um , Ileft Hennepin for 13 years, and
I worked for , uh, Allina at ,at Mercy Medical Center up in
Rapids in Minnesota, and had a, a really great time there. Uh
(01:51):
, really trying to learn from ,uh, some of my mentors at that,
at that shop, and kind of triedto hone my skills as an
emergency physician , um, as aclinician, and really enjoyed
that work.
Speaker 2 (01:59):
And now you came back to us, you even met your
wife in tra did you, can I evensay that?
Speaker 3 (02:04):
You can, yeah. Yeah.
My wife Karen, she's anemergency physician as well.
She was in my residency class,and she's been at North
Memorial now for 21 plus years.
Speaker 2 (02:11):
So you're back in Hennepin now, and you're
running what I still considerto be the nation's Premier
Emergency Department. Tell usabout your department. Yeah,
Speaker 3 (02:19):
I would agree , agree with your assessment
there. I think that , um, HCMChas a very long kind of storied
history in terms of emergencymedicine. If you look at our
training program, we'reaccredited as , as being the
second oldest in the , in thecountry. There's only one
that's older than us only bysix months. And since 1972,
we've been training the, thebest emergency medicine
residents in the world, in myopinion. And it's really been o
(02:42):
obviously the people that camebefore me, but a lot of those
people that have kind of pavedthat path for us in emergency
medicine started , uh, righthere at Hennepin. If you think
about emergency ultrasound, ifyou think about the management
of emergent airways, those arejust two examples. A lot of the
research that we've done as adepartment, it's just an
incredible training program.
And , uh, it's an asset to theorganization. And the
(03:03):
organization. He , andhealthcare is definitely an
asset to our community.
Speaker 2 (03:07):
I was one time visiting a friend of mine who's
an emergency doctor at Brighamand Women's in Boston, one of
the nation's premier hospitals,a big hospital, everybody knows
about Brigham and Women's. Andshe was a friend of mine, and I
was getting a tour of theplace, and she took me into
their emergency department,which is not ours, but she took
me in there. And all she had tosay to her emergency colleagues
(03:27):
in Boston was, well, this is myfriend David. He's from
Hennepin in Minneapolis, andthat's all they had to know
about me. It was because of ouremergency department. They say
, oh, we know all about you outthere in the Midwest. Emergency
doctors around the country knowabout this place. So you run a
level one trauma center. Whatis that? Yeah,
Speaker 3 (03:46):
A level one trauma center is a emergency
department, a hospital systemthat can handle any traumatic
injury. And that takes a reallyt tremendous amount of
resources , uh, that are, youknow, put toward that. And
basically you get verified bythe American College of
Surgeons who verifies traumacenters, and then you get
designated by your state tobecome a level one trauma
center. And so we're thebiggest , um, busiest emergency
(04:08):
department and level one traumacenter in , in the state. And
we've been that way for, formany years now. I
Speaker 2 (04:12):
Would imagine we're the biggest one from Chicago to
Seattle across the wholenorthern Yes. Uh , part of the
country. I believe
Speaker 3 (04:18):
You're true. One , we're definitely one of the
biggest in the , in the upperMidwest. And I think we are the
biggest between Chicago and
Speaker 2 (04:23):
Seattle. And that means that 24 7, 365 days a
year, it's your team ofdoctors, advanced practice
providers, nurses, everybody inthe emergency department. And
then you have a whole othersupport team of surgeons and
other consultants that are atthe ready, doesn't it? Yeah.
Speaker 3 (04:38):
I mean, that , that level of readiness , uh, does
come with , with a cost, youknow, with all those resources.
But I think you can also attestto this, Dave , and that it is
very much a team effortwhenever somebody that comes in
acutely injured or ill, and yougo into our resuscitation area,
which we call the stabilizationroom or the state room, and to
people who aren't reallyfamiliar with that room, if
(04:59):
they open the , the doors andthey look inside, you know,
when we have all four bays fullof patients, it can look pretty
chaotic in there. You know,there , there could be 75
people in that room, buteveryone knows their role.
Everybody is, is so welltrained , and the communication
in there is so tight that itjust works.
Speaker 2 (05:14):
I wish the public could see that in action.
'cause I have, and you mightsay it looks chaotic, but it
doesn't look like the old shower, where there's like shrapnel
flying across the room andpeople yelling and screaming at
each other. I do see everybodyhas their role, and I look at
the doctors and the nurses, andthey're, they're on alert.
They're obviously very focusedand engaged at a high level of
(05:38):
reactivity, but they're calm atthe same time. Your team kind
of knows what they're doing.
Speaker 3 (05:41):
I agree. And I think that collaboration is the key
word there. Yeah.
Speaker 2 (05:44):
So I'm gonna shift a little bit and talk about you.
If, if we could, I said at thetop of the hour that you're an
American Indian man, you are inan academic medical center and
you run one of the largest andmost premier emergency
departments in the country. Howdid you get to this place? And
how does your role as a memberof an enrolled tribe in this
state, how does that informyour work?
Speaker 3 (06:06):
Yeah, I think , um, it's a great question. I could
really take you on a, a longkind of winding answer, but I
think in, in general, for me,it's , uh, having people that
supported me. Um, even early onin my career, I was the first
person in my family to go tocollege. So I didn't really
have people that actually knewhow to navigate that world. And
I grew up in , in Oklahoma, Igrew up kind of , uh, with my ,
(06:27):
a foot in both worlds, both thetraditional world, while my
mother's full blood AmericanIndian, she's a tribal enrolled
member of the Oppa and theShawnee Tribes, as am I. And
then my father was white. Hewas the first white man that
actually ever married into mymom's family. And so I was kind
of in , in both those worlds.
And learning how to navigateboth those worlds was pretty
important for me. I went tocollege, university of
Oklahoma, and then I took abouta year and a half off, and I ,
(06:49):
it was that time that I worked,started working as a first in
EMT and then a full paramedic,and really got to love taking
care of patients in thatpre-hospital setting. And then
from there, I got accepted intothe University of North Dakota
School of Medicine into aprogram called Inmed or Indians
into Medicine. And that programstill has , uh, the highest
number of American Indianmedical students of any medical
(07:12):
school in the country. Shout
Speaker 2 (07:13):
Out to UND for that.
Yeah,
Speaker 3 (07:15):
UND is great in that , in , uh, I'll , I'll also add
that the University ofMinnesota and Duluth, the
Center for American IndianMinority Health is very close
to , to UND. They're doing somegreat work and in , in Duluth.
But UND was great for me. Youknow, I , I was a little bit of
a non-traditional student, andit took me a little while for
my first two years to really,you know, learn how to study
again in Excel. Um , but thenit was something when I was
(07:37):
there and , you know, I , Ithought about emergency
medicine and given my career asa paramedic, and there were two
emergency physicians inBismarck, North Dakota that had
trained at Hennepin. And I, Istarted talking to them about,
you know, going into emergencymedicine, and they, they said,
have you ever heard about HCMC?
And I , I hadn't. So theyhelped me set up a rotation and
the rest is history.
Speaker 2 (07:57):
And now you're running the department
Speaker 3 (07:59):
. Yeah, now
I'm running the
Speaker 2 (08:00):
Department, yes .
Yeah. Yeah . I bet you probablydidn't consider that when you
were grown up in Oklahoma.
Speaker 3 (08:04):
Did not. Absolutely
Speaker 2 (08:05):
Not many of our patients are , uh, largely of
the Dakota, Lakota , uh,Anishinaabe , um, Ojibwe tribes
and , and other tribes in thisstate. And I'm gonna be laying
my cards right out on thetable. We haven't always, as a
medical system done right bythose communities. What are
your thoughts about how we cancare for all of our
(08:27):
communities, but evenparticularly for Native
American populations?
Speaker 3 (08:31):
Yeah, I mean, I think both as a , not just as a
, as a medical institution,have we not done right by
American Indians as , as asociety, right? And that just
goes all the way back tohistory. And we , again, we
could talk
Speaker 2 (08:41):
Hundreds of years,
Speaker 3 (08:42):
Hundreds of years, we're talking about centuries,
and we could talk about thatall day. I think, you know,
Hennepin Healthcare is veryunique in that we serve a very
large proportion of AmericanIndians. Um , you know, as our
patient population , uh, we seeabout 4% of our overall patient
population as American Indian.
When you compare that to the ,the population of Hennepin
County for American Indian,it's only about one to 2%. But
(09:04):
I think that, you know, havingprogramming as, as Hennepin
Healthcare has committed to,like having American Indian
cultural navigators that arepresent and that can help do
exactly what it says, helpAmerican Indian patients
navigate the system, which are, you know, medical, our
medical system is verycomplicated even for people who
are, are used to it and knowabout , uh, how to navigate it.
So having those people presentin our institution, very, very
(09:26):
important. If you look atprogramming like the Talent
garden and our health equitydepartment is really, what's
that? Uh , the Talent Garden is, uh, a program that was
developed by our health equitydepartment, and one, and one
individual in particular thatI'll , um, call out is Jim
Peters to really engageunderrepresented minorities who
have not had a lot of the opsame opportunities that white
(09:46):
people have had, to be blunt,and to bring them into Hennepin
Healthcare for a day and allowthem to experience what it's
like to interact withhealthcare professionals,
physicians, nurses, pharmacistsacross the gamut of healthcare
providers, of people who looklike them, that are maybe even
from their same communities andfrom the same culture and from
the same ethnicity and race.
(10:07):
And so it's been a really anamazing program. And American
Indians, and we've had twoAmerican Indian youth with
stethoscopes events where webring these young, you know,
kids in teenagers, right ?
Teenagers, yeah. Um, that comein with their, sometimes their
family members, sometimes theirschool counselors, and they get
to spend a day with us. We havepanel interviews, we actually
have them go through stations,you know, they're in the sim
center, they're doing all thesereally cool things and just,
(10:29):
you know, seeing people thatlook like them , uh, giving
them that , uh, inspiration,you know, in many cases is
something that's reallyimportant. And really it's, for
us, it's really just showingthem that we, we care about
them and that we believe inthem. And they can certainly
accomplish a career inhealthcare if they , they
choose.
Speaker 2 (10:42):
I've heard somebody , um, say to me, who's a lot
smarter than I am? You can't beit if you can't see it. And so
to have all of these AmericanIndian kids see a doctor, not
only a doctor, but the leaderof this cool department, you
know, where you're making adifference and you're doing all
these things at an academiccenter and being the one in
charge that's an AmericanIndian guy who's in charge. And
(11:04):
you could be that too. I thinkthat is really, really
exciting. That being said, youtold me earlier that Aaron
Robinson , another doctor thatI happen to know is another
American Indian man in yourdepartment, and that you two
represent not how it iseverywhere else.
Speaker 3 (11:20):
Yeah, it's true. If , um, from our knowledge , um,
when we inquired last year tothe national database, there's
only two academic emergencymedicine physicians who
identify as American Indian,and it's Dr. Robinson and
myself. And we're both atHennepin. You're
Speaker 2 (11:34):
Both here. Both here in downtown Minneapolis.
Speaker 3 (11:36):
Yeah. And so I think obviously that's not
necessarily , um, a way to patourselves on the back, Dr.
Robinson and I, but it's almostlike an indictment on the
system, right?
Speaker 2 (11:45):
That's what it is .
It is . It's like, where iseverybody else? And we need to
correct that.
Speaker 3 (11:49):
Yeah, agree. But I think if you look at some of
the efforts that HennepinHealthcare has put into really
recruiting American Indians,you know, I just heard a number
that , um, is a little over ayear and a half ago. We were
around 26 American Indianemployees out of the 7,000
here. And now we've more thandoubled that from my, from my
understanding. So that's,that's pretty good progress. If
you look at our emergencymedicine , uh, residency,
(12:09):
we've, we have our firstAmerican Indian resident that
we recruited, and we had anumber of American Indian , uh,
medical students rotating inthe emergency department , um,
this past
Speaker 2 (12:18):
Summer. That needs to be a goal of all of us. Um,
we need to have our medicalstaff, our doctors, our nurses,
our everybodys represent thecommunities, not just that look
like me. And historicallythat's what medicine has been.
So you're an American Indianman, but our patients are from
all kinds of cultures. How canwe increase representation on
(12:42):
our medical staffs , um, ingeneral , um, whether it be in
native communities orelsewhere?
Speaker 3 (12:47):
Yeah, I think that's the , uh, the really important
question a lot of people aretrying to answer. And I think a
lot of it is , uh, people haveto recognize that there aren't
just these huge pools of peopleto, to, you know, draw from
that this is gonna take, it's along game. And so a lot of the
work, you know, you hear termslike a middle school to medical
school starting early, as earlyas you can in the schooling of,
(13:08):
you know, young children comingup. And this really introducing
them to , uh, healthcare isreally important. And I think,
again, just, you know,practicing cultural humility.
Obviously, you know, hand up inhealthcare has the Compass
program , um, which is beingrolled out to all of our
employees, which is reallyimportant. Um , could
Speaker 2 (13:22):
You explain that to our listeners? Yeah.
Speaker 3 (13:23):
It's really a, a program that initially was
targeted , um, kind of ofleadership and now it's kind of
been rolled out to everyemployee in the organization to
really teach this idea ofcultural humility and learn
about , uh, different cultures,especially the, the , the
patients, you know , um, thatwe see coming to us for help
for their healthcare. It's afirst step. It's been rolled
(13:45):
out, and I think it's been ,uh, well received by, by our ,
our organization. It definitelyis something that takes a lot
of work and a lot of , uh,thoughtful reflection , uh, for
everyone.
Speaker 2 (13:53):
I like the term cultural humility, which is one
I wasn't all that familiar withuntil recently through some of
the stuff we've been doing inthe Compass program here at
Hennepin. We used to use thisword cultural competence.
That's a joke. I agree. I can'tbe competent in in the
culture that you grow up in, inOklahoma. I can never be
competent in anything aboutthat, but I can be humble and
(14:14):
learn about other cultures. Sobefore I get to the break, what
do you like to do outside ofthis work?
Speaker 3 (14:20):
Try to stay healthy.
You know, I'm a a trail runner,so I try to do that just to ,
it kind of clears my mind, butI also know you
Speaker 2 (14:26):
Gotta twist your ankle
Speaker 3 (14:27):
. Yeah, yeah
. I've had my , i , I have my
list of injuries. Yes., um, you know , I have , uh,
three , um, high school , uh,children, my wife and I, and so
they keep us really busy withother activities too. So it's
really good to be a family manor try to be, and kind of stick
grounded.
Speaker 2 (14:40):
So do you still stay in touch with your old friends
in Oklahoma? Of course. Yeah .
Absolutely . Do you have familydown
Speaker 3 (14:45):
There still? Yeah, my mother still is there. She's
89 years old. She's , uh, oneof the tribal elders. Uh , and
I have a sister and her familythere too.
Speaker 2 (14:51):
Oh, that's cool.
Yeah. Big respect to her. Yeah, that's , that's lovely. Thank
you. We're talking with TomWhite . He's the chair of the
Department of EmergencyMedicine at Hennepin Healthcare
here in downtown Minneapolis.
And a long time colleague ofmine. When we come back, we're
gonna talk more specificallyabout running a big, huge
emergency department. Stay withus. We'll be right back
Speaker 4 (15:14):
When Hennepin Healthcare says, we are here
for life. They mean here foryou, your life and all that it
brings. Hennepin Healthcare hasa hospital, HCMC and a network
of clinics both downtown andacross the West Metro. They
provide all the primary careand specialty care you would
expect to find, but did youknow they also have services
like acupuncture andchiropractic care available at
(15:37):
many of their primary careclinics and at their
integrative health clinic indowntown Minneapolis. Learn
more@hennepinhealthcare.org.
Hennepin Healthcare is here foryou and here for life.
Speaker 2 (15:51):
So it's no surprise to anyone, Tom, that , that
this job can be hard. Start usoff by talking about just kind
of the range of things youmight see in a given day. It's
not all people who arecritically ill. That's
Speaker 3 (16:03):
True. No , that's true. And I think that's part
of the, the stress of it isthat, you know, as an emergency
physician, you're never gonnahave the same day , uh, ever at
Speaker 2 (16:10):
Work. Did that draw you to it? Did you like that?
Did
Speaker 3 (16:13):
You like that part of it? It did . Yeah, it did. I
think it draws most of us , uh,to it because there's a lot of
people that, that don't likethat. Like a lot of people like
to, you know, expectations andkind of routine things. And
that's definitely not theemergency department. That
feeling of pressure and stressthat you don't know what's
gonna be coming through thedoor is something that you can
get used to. But sometimes itdoes catch you all off guard.
Speaker 2 (16:31):
It does, I bet.
'cause So we're gonna get alittle bit more into some of
the really serious things yousee, but you might in one day
see a kid with an earache and ababy that's swallowed a tablet
and a with a terrified parent,and then a gunshot wound and
then somebody having a heartattack.
Speaker 3 (16:46):
No, that's true . I think not , it's not just major
trauma, but we see a lot of thetime sensitive conditions, you
know, heart attack and strokeare the two that come to mind
along with trauma. But we seeprimary care complaints as
well. We see urgent carecomplaints, we see some
complaints that aren'tnecessarily even medical,
sometimes they're socialrelated . So there is a , a
wide range of things that ,that we have to
Speaker 2 (17:06):
Deal with. Mental health issues, substance use
issues. Could you comment onthose? Yeah,
Speaker 3 (17:09):
Unfortunately, too many. In fact, if you look at
the trajectory over the lastdecade or so, I mean both
substance use disorders, opiateuse disorder in particular as
well as, you know, mentalillness, those, those visits
have gone way
Speaker 2 (17:21):
Higher. Any idea why that is? So you're, you've got
patients in the emergencydepartment, I will just tell
listeners, every singlesolitary day with a mental
health , uh, crisis of somekind or not a crisis, just a
mental health issue that needsaddressing or a substance issue
that needs addressing either acrisis or just they don't know
where else to turn. Why do youthink that is? Is there , is
(17:41):
our community mental health andsubstance use system broken?
Yeah,
Speaker 3 (17:46):
I don't know that it was ever , um, to be honest,
really robust enough to bebroken. I think it's just been
underdeveloped, you know,that's part of the problem. Um,
I think that our county isdoing the best that it can do.
I think that it could do moreprobably, but I think that
that's not exclusive to ourcounty. It's definitely not
exclusive to our state or, orour healthcare organization.
But I think that if you look atan true emergency department,
(18:07):
you know, in a , in a perfectworld, would see emergencies
and we see more non-emergenciesthan we do emergencies. Then if
you add on the substance abuseand the mental illness and
those types of patients thatcome in and a lot of the social
problems, seeing patients thatare unsheltered and that have
food insecurity, those are allpretty common complaints in the
, in the emergency department.
And, you know , we don't havethe resources all the time to
(18:30):
take care of all those things.
So we would count on externalresources, you know , from the
county, et cetera, and othercommunity partners. And
sometimes those resources justaren't there.
Speaker 2 (18:38):
Yeah, I would second that. We don't really have a
system that is robust in thecommunity that meets
communities where they are andwith what they need. And so
they get great care in youremergency department, but
sometimes that's the only placethey know where to go. And the
needs are not being met by ahealthcare system that is not
functioning as well as itshould be. I think that's what
I would say on that. That'sright.
Speaker 3 (18:58):
That's right.
Speaker 2 (18:58):
So we talked about this breadth of things you see,
how do you get through thatday? How do you support your
staff and what's it like tobounce around on that
rollercoaster?
Speaker 3 (19:10):
Yeah, sometimes it can be tough. I think , um,
learning to handle thetransitions is the hardest
part. And that's something thatwe, we try to focus on in
training. How do you go from areally high stress, emotional
case many times, say forinstance, a , a child is
involved to where you're doinginvasive procedures and making
some very quick decisions abouttrying to stabilize someone or
(19:31):
save their life
Speaker 2 (19:32):
When you only have seconds or minutes Exactly . At
most , right ? Yeah .
Speaker 3 (19:35):
And you're working together as a team and it's,
it's a very high stakes andhigh stress environment. How do
you go from that to walking toa different area of the
emergency department, which youdo , um, and seeing an earache
or a sore throat or somethingof that nature. So you have to
be able to manage thosetransitions. And for me, over
the years, I guess the bestadvice I would give and I try
to give to our residents is youhave to really only focus on
(19:57):
the things you could control.
'cause if you let those otherthings you can't control kind
of creep in during a shift,then that's when it can really
catch you off guard and kind of, uh, uh, cause you to lose
focus. You , you can sit thereand pause and think about why
do I have so many guns in thiscountry? Or how come there's so
much domestic violence and howcome there's so much substance
abuse? But you can't controlany of that. All you can
control is what's in front ofyou. And so if you can do that
(20:20):
and you still connect to thatpurpose and how you're making a
difference, then I think that'sthe way to get get through it.
Speaker 2 (20:26):
There's probably very, very few other
professions in the world where, where you come home at the
end of the day and you maybehad your hands inside
somebody's body , and then youhad about two minutes to deal
with that and process thatbecause there's another person,
always another person waitingfor your care next. I don't
(20:47):
know if there's any other joblike that where that would
actually happen. And, and so Iimagine that when you're
leading a very largedepartment, and it's not just
doctors,
Speaker 3 (20:56):
I wouldn't be able to forgive myself if I didn't
say how amazing our nurses arein our emergency department.
I'm in continuous awe of themat times when I see the
multitasking, especially withthe critical patients that we
see and the duties they performand they're really the backbone
of our emergency department.
Speaker 2 (21:11):
There are a team of incredible nurses. Some of the
best nurses I've ever seen inmy life are the emergency
nurses at Hennepin. There'snurses, there's physician
assistants, nursepractitioners, there's
chaplains, there's the peoplethat clean the department.
There are environmental serviceworkers who come and make sure
that that place is ready forthe next person. So I can't
imagine what it's like tosupport all those people who
(21:33):
see this every hour of theirday and then have to move on.
And I like that about what youcan control. But in the end,
how do you, when you go home atthe end of the day, do you
leave it at work? How do you,how do you separate and how do
you care for your ownwellbeing?
Speaker 3 (21:48):
Yeah, it's sometimes it's not easy. Um, I think that
just really trying to connectback to the purpose and that
you are doing good. You are ina position to help people is
really important. So reallyconnecting back to that
purpose, I think that's why alot of us work at , uh,
Hennepin Healthcare, justbecause that there is so much,
it's such a mission-drivenorganization and there is so
(22:08):
much purpose in what we do. SoI really think that's the key.
Speaker 2 (22:11):
So you might self-select kind of people who
run on adrenaline a little bit.
Speaker 3 (22:14):
Yeah. I think you have to people that maybe run
on adrenaline, but also peoplethat are comfortable making
decisions without a lot ofinformation. Mm-Hmm .
because thathappens to us sometimes when
people come through the doorand , and they're unidentified
and we have no idea, you know,what their medical history
might be. They're on anymedications, for instance, you
know, it's all done. And sothat can be stressful as well.
So again, we have to train totake in the information we're
(22:36):
getting diagnostically and alsofrom, you know, people that
might know what happenedpre-Hospital when those
patients came in to really makesome quick decisions. And
sometimes the decisions aren'talways the correct ones, but we
have to be able to really , uh,adapt and pivot right away. And
once we figure that out,
Speaker 2 (22:52):
I wanna dig into that a little bit more. 'cause
you do hear people say, I wentto the emergency department.
The doctors got it all wrong.
You know, they, they did this,they didn't do that. I left
there, I still had my problemand they didn't get it. Right.
Right. You and I both know thatyou are making decisions on
very limited information in avery short period of time and
(23:13):
you have the best diagnosticsin the world, which you have
access to. What are yourthoughts on that when you hear
that? Yeah, the doctors didn'tknow what they were doing. The
ed, they got it wrong.
Speaker 3 (23:20):
Yeah. Sometimes I , I do hear that and I can
understand the frustration ofpeople maybe, you know ,
there's long waits these days.
Mm-Hmm . becausethe system is really clogged
up. And we can certainly talkmore about that, but I think
you , you have to listen topeople because a lot of times
you can learn from whatthey're, they're saying with
their frustrations. But Ialways like to approach a
patient when they come in. Ialways like to ask 'em right up
front , you know, what are yourexpectations from this visit?
(23:42):
'cause we're an emergencydepartment. I'm not a primary
care physician. I'll likelynever see you again as a
physician. Tell me what you'rehere for, what brought you in?
And I'll tell you that, youknow, my job is to rule out
life-threatening conditions,emergent conditions, and to try
to identify what the cause ofyour symptoms are and then try
to devote resources to eitherhelping you during that visit
or if you can be followed upsafely as an outpatient, how do
(24:04):
I get you connected with thatcare?
Speaker 2 (24:06):
Yeah. 'cause sometimes you're dealing with
like a lifetime of medicalproblems or a year's worth of
medical problems in that hourthat you have with them and you
know, maybe haven't been in ahealthcare system and like you
have an hour , you know? I like that expectation
setting. In our last section, Iwanna talk to you about your
administrative role a littlebit. Um, 'cause you run this
big department, it's more thanjust caring for the patient in
(24:28):
front of you. Do you haveresources to deal with? You
have to keep your people safe ,um, you have to deal with space
and overcrowding and fundingand all that. What things are
most on your mind when you goto sleep at night on an
administrative level? What arethe challenges that you are ,
that you're thinking about?
Speaker 3 (24:45):
Yeah, there, there's a lot of 'em . And coming into
this role, just this recently,I'm , I'm, you know, every day
there's, there seems like a newone that kind of takes the
priority, but for me it's thewellness of our providers and
our, our nurses and the supportstaff. Everyone that works in
the emergency department is, istop of mind for me and their
safety while they're working.
Are they staying mentallyhealthy? You know, all those
(25:06):
things and all the differentsupports that we have in place
to, to help people that aremaybe struggling. That's really
important to me. I think also ,um, the flow, I touched on that
a little bit earlier. We needmore space to see more
patients. If I had a , a magicwand to wave , um, it would be
to create more space in thehospital so we could get our
patients flowing. You know, theanalogy is the, the faucet, you
(25:27):
know, the inflow is completelyon all the time. And we don't
have control over that becausewe're an emergency department.
We have to see everyone thatwalks through the door. It's
Speaker 2 (25:34):
Not like , can close the doors and turn off the
lights Yeah . And say close seeyou tomorrow.
Speaker 3 (25:38):
No , it's a, it's , it's a government mandate,
which we kind of look at thatas a badge of honor. Yeah .
We're happy to see anyone thatwalks through the door at any
time . Doesn't matter who youare. But the outflow is the
thing that's really kind ofbacking up. Now we're not able
to get patients moved throughand into the hospital. 'cause
the hospital has strugglesdischarging people out into the
community to those resources.
So it's a big problem. Again,it's not unique to our hospital
(26:00):
or to Minnesota. It's a , it'sa national problem.
Speaker 2 (26:03):
It is, I think something that listeners ought
to know about the things thatyou might see when you go to
your doctor or your emergencydepartment are due to a system
that, that is got a lot ofbacklog right now. It's hard to
get somebody out of thehospital because there's not
enough community resources tosupport them. And if the
hospital's full, the people aresitting in your emergency
(26:24):
department waiting for a bed,and if they're waiting for a
bed, they're taking up a spotin your emergency room. That
means the waiting room'sgetting really crowded. So it's
not for lack of wanting to getyou through quickly. It's that
there are some realities thatare really challenging in our
healthcare system. That's
Speaker 3 (26:39):
A hundred percent correct. And I think that
because of that, differenthospitals systems are looking
at how do you try to move careout to triage out in
Speaker 2 (26:46):
The waiting even
Speaker 3 (26:47):
Practically.
Seriously . Yeah. Yeah. How doyou do that? Um, so we've
obviously been looking , uh,and trying to adjust and adapt
in that regard, but it's hardto do when you, you have, you
know, the space isn't there andso that's another issue. So
Speaker 2 (26:58):
You're, you're in the first year of your job
running this. What would youleave us with? What brings you
hope about your job?
Speaker 3 (27:05):
Well, I'm really excited about coming into this
new role because again, I workwith a fantastic , uh, number
of emergency medicine faculty.
We have 52 of us now, whichwe've grown tremendously in the
last decade. And theopportunities are very
plentiful for us to , uh, notonly to maintain some of our
excellence as a department, butalso to improve upon things and
(27:26):
innovate and conduct moreresearch and to continue to
train the best emergencymedicine residents in the world
while we serve our community.
Speaker 2 (27:33):
I, for one, am glad you're in this role because I,
I'm proud of our hospital andour front door to the world is
indeed the department you run.
And thank you for taking onthis job as leading that
department and thank you toyour whole department. Thank
you. We've been talking withDr. Tom White about what it's
like to lead a large level oneemergency department and his
(27:53):
unique role as one of the onlyAmerican Indian healthcare
leaders in the country inemergency medicine listeners,
thanks for tuning in and I hopeyou'll join us for our next
episode in two weeks time. Inthe meantime, be healthy and be
well.
Speaker 1 (28:09):
Thanks for listening to the Healthy Matters podcast
with Dr. David Hilden. To findout more about the Healthy
Matters podcast or browse thearchive, visit healthy
matters.org. Got a question ora comment for the show, email
us at Healthy matters@hcme.orgor call 6 1 2 8 7 3 talk.
There's also a link in the shownotes. The Healthy Matters
(28:30):
Podcast is made possible byHennepin Healthcare in
Minneapolis, Minnesota, andengineered and produced by John
Lucas At highball Executiveproducers are Jonathan , CTO
and Christine Hill . Pleaseremember, we can only give
general medical advice duringthis program, and every case is
unique. We urge you to consultwith your physician if you have
a more serious or pressinghealth concern. Until next
(28:52):
time, be healthy and be well.
Welcome to the Healthy Matters podcast with
Dr. David Hilden , primary carephysician and acute care
hospitalist at HennepinHealthcare in downtown
Minneapolis, where we cover thelatest in health, healthcare
and what matters to you. Andnow here's our host, Dr. David
Hilden.
Speaker 2 (00:18):
Hey everybody, it's Dr. David Hilden, your host,
and welcome to the podcast.
Today we are gonna talk aboutthe emergency department.
You've all likely heard aboutit or you've been to your local
emergency department, but doyou really know how an
emergency department operatestoday? I am joined by my friend
and colleague, Dr. Tom Wyatt .
He is the chair of theDepartment of Emergency
(00:39):
Medicine at HennepinHealthcare, and somebody I've
known for a good 20 years ormore. Tom, welcome to the show.
Thank you, Dave . So you're thechairperson, you're the chair
of the Department of EmergencyMedicine. You're a unique chair
of emergency medicine. We're anacademic medical center. We're
a large level one trauma centerin downtown Minneapolis. And
you're a Native American man.
That's true. You , you're oneof the very few people who I
(01:00):
could say that about. So Iwanna talk to you, if you
could, about first of all, ouremergency department, second of
all, about your path to it, andthen after the break a little
bit later, we're gonna talkabout some of the challenges
and what people can expect inan emergency environment. So
you and I did our internshiptogether right here at Hennepin
Healthcare. It was HCMC,Hennepin County Medical Center
some 20 years ago. Tell meabout your career path, if you
(01:21):
could .
Speaker 3 (01:21):
Yeah, so I remember back in those days, Dave,
you're a lot smarter than me ,that's for sure. Um,
Speaker 2 (01:26):
Oh, that is not a true statement.
Speaker 3 (01:29):
Um, yeah, I , I remember those , uh, training
days very fondly. And I , Ifeel like I was trained at the
best , uh, emergency departmentin the world, if I may say so.
And then, you know, after mythree years of training, I went
out into the community. Um , Ileft Hennepin for 13 years, and
I worked for , uh, Allina at ,at Mercy Medical Center up in
Rapids in Minnesota, and had a, a really great time there. Uh
(01:51):
, really trying to learn from ,uh, some of my mentors at that,
at that shop, and kind of triedto hone my skills as an
emergency physician , um, as aclinician, and really enjoyed
that work.
Speaker 2 (01:59):
And now you came back to us, you even met your
wife in tra did you, can I evensay that?
Speaker 3 (02:04):
You can, yeah. Yeah.
My wife Karen, she's anemergency physician as well.
She was in my residency class,and she's been at North
Memorial now for 21 plus years.
Speaker 2 (02:11):
So you're back in Hennepin now, and you're
running what I still considerto be the nation's Premier
Emergency Department. Tell usabout your department. Yeah,
Speaker 3 (02:19):
I would agree , agree with your assessment
there. I think that , um, HCMChas a very long kind of storied
history in terms of emergencymedicine. If you look at our
training program, we'reaccredited as , as being the
second oldest in the , in thecountry. There's only one
that's older than us only bysix months. And since 1972,
we've been training the, thebest emergency medicine
residents in the world, in myopinion. And it's really been o
(02:42):
obviously the people that camebefore me, but a lot of those
people that have kind of pavedthat path for us in emergency
medicine started , uh, righthere at Hennepin. If you think
about emergency ultrasound, ifyou think about the management
of emergent airways, those arejust two examples. A lot of the
research that we've done as adepartment, it's just an
incredible training program.
And , uh, it's an asset to theorganization. And the
(03:03):
organization. He , andhealthcare is definitely an
asset to our community.
Speaker 2 (03:07):
I was one time visiting a friend of mine who's
an emergency doctor at Brighamand Women's in Boston, one of
the nation's premier hospitals,a big hospital, everybody knows
about Brigham and Women's. Andshe was a friend of mine, and I
was getting a tour of theplace, and she took me into
their emergency department,which is not ours, but she took
me in there. And all she had tosay to her emergency colleagues
(03:27):
in Boston was, well, this is myfriend David. He's from
Hennepin in Minneapolis, andthat's all they had to know
about me. It was because of ouremergency department. They say
, oh, we know all about you outthere in the Midwest. Emergency
doctors around the country knowabout this place. So you run a
level one trauma center. Whatis that? Yeah,
Speaker 3 (03:46):
A level one trauma center is a emergency
department, a hospital systemthat can handle any traumatic
injury. And that takes a reallyt tremendous amount of
resources , uh, that are, youknow, put toward that. And
basically you get verified bythe American College of
Surgeons who verifies traumacenters, and then you get
designated by your state tobecome a level one trauma
center. And so we're thebiggest , um, busiest emergency
(04:08):
department and level one traumacenter in , in the state. And
we've been that way for, formany years now. I
Speaker 2 (04:12):
Would imagine we're the biggest one from Chicago to
Seattle across the wholenorthern Yes. Uh , part of the
country. I believe
Speaker 3 (04:18):
You're true. One , we're definitely one of the
biggest in the , in the upperMidwest. And I think we are the
biggest between Chicago and
Speaker 2 (04:23):
Seattle. And that means that 24 7, 365 days a
year, it's your team ofdoctors, advanced practice
providers, nurses, everybody inthe emergency department. And
then you have a whole othersupport team of surgeons and
other consultants that are atthe ready, doesn't it? Yeah.
Speaker 3 (04:38):
I mean, that , that level of readiness , uh, does
come with , with a cost, youknow, with all those resources.
But I think you can also attestto this, Dave , and that it is
very much a team effortwhenever somebody that comes in
acutely injured or ill, and yougo into our resuscitation area,
which we call the stabilizationroom or the state room, and to
people who aren't reallyfamiliar with that room, if
(04:59):
they open the , the doors andthey look inside, you know,
when we have all four bays fullof patients, it can look pretty
chaotic in there. You know,there , there could be 75
people in that room, buteveryone knows their role.
Everybody is, is so welltrained , and the communication
in there is so tight that itjust works.
Speaker 2 (05:14):
I wish the public could see that in action.
'cause I have, and you mightsay it looks chaotic, but it
doesn't look like the old shower, where there's like shrapnel
flying across the room andpeople yelling and screaming at
each other. I do see everybodyhas their role, and I look at
the doctors and the nurses, andthey're, they're on alert.
They're obviously very focusedand engaged at a high level of
(05:38):
reactivity, but they're calm atthe same time. Your team kind
of knows what they're doing.
Speaker 3 (05:41):
I agree. And I think that collaboration is the key
word there. Yeah.
Speaker 2 (05:44):
So I'm gonna shift a little bit and talk about you.
If, if we could, I said at thetop of the hour that you're an
American Indian man, you are inan academic medical center and
you run one of the largest andmost premier emergency
departments in the country. Howdid you get to this place? And
how does your role as a memberof an enrolled tribe in this
state, how does that informyour work?
Speaker 3 (06:06):
Yeah, I think , um, it's a great question. I could
really take you on a, a longkind of winding answer, but I
think in, in general, for me,it's , uh, having people that
supported me. Um, even early onin my career, I was the first
person in my family to go tocollege. So I didn't really
have people that actually knewhow to navigate that world. And
I grew up in , in Oklahoma, Igrew up kind of , uh, with my ,
(06:27):
a foot in both worlds, both thetraditional world, while my
mother's full blood AmericanIndian, she's a tribal enrolled
member of the Oppa and theShawnee Tribes, as am I. And
then my father was white. Hewas the first white man that
actually ever married into mymom's family. And so I was kind
of in , in both those worlds.
And learning how to navigateboth those worlds was pretty
important for me. I went tocollege, university of
Oklahoma, and then I took abouta year and a half off, and I ,
(06:49):
it was that time that I worked,started working as a first in
EMT and then a full paramedic,and really got to love taking
care of patients in thatpre-hospital setting. And then
from there, I got accepted intothe University of North Dakota
School of Medicine into aprogram called Inmed or Indians
into Medicine. And that programstill has , uh, the highest
number of American Indianmedical students of any medical
(07:12):
school in the country. Shout
Speaker 2 (07:13):
Out to UND for that.
Yeah,
Speaker 3 (07:15):
UND is great in that , in , uh, I'll , I'll also add
that the University ofMinnesota and Duluth, the
Center for American IndianMinority Health is very close
to , to UND. They're doing somegreat work and in , in Duluth.
But UND was great for me. Youknow, I , I was a little bit of
a non-traditional student, andit took me a little while for
my first two years to really,you know, learn how to study
again in Excel. Um , but thenit was something when I was
(07:37):
there and , you know, I , Ithought about emergency
medicine and given my career asa paramedic, and there were two
emergency physicians inBismarck, North Dakota that had
trained at Hennepin. And I, Istarted talking to them about,
you know, going into emergencymedicine, and they, they said,
have you ever heard about HCMC?
And I , I hadn't. So theyhelped me set up a rotation and
the rest is history.
Speaker 2 (07:57):
And now you're running the department
Speaker 3 (07:59):
Speaker 2 (08:00):
Department, yes .
Yeah. Yeah . I bet you probablydidn't consider that when you
were grown up in Oklahoma.
Speaker 3 (08:04):
Did not. Absolutely
Speaker 2 (08:05):
Not many of our patients are , uh, largely of
the Dakota, Lakota , uh,Anishinaabe , um, Ojibwe tribes
and , and other tribes in thisstate. And I'm gonna be laying
my cards right out on thetable. We haven't always, as a
medical system done right bythose communities. What are
your thoughts about how we cancare for all of our
(08:27):
communities, but evenparticularly for Native
American populations?
Speaker 3 (08:31):
Yeah, I mean, I think both as a , not just as a
, as a medical institution,have we not done right by
American Indians as , as asociety, right? And that just
goes all the way back tohistory. And we , again, we
could talk
Speaker 2 (08:41):
Hundreds of years,
Speaker 3 (08:42):
Hundreds of years, we're talking about centuries,
and we could talk about thatall day. I think, you know,
Hennepin Healthcare is veryunique in that we serve a very
large proportion of AmericanIndians. Um , you know, as our
patient population , uh, we seeabout 4% of our overall patient
population as American Indian.
When you compare that to the ,the population of Hennepin
County for American Indian,it's only about one to 2%. But
(09:04):
I think that, you know, havingprogramming as, as Hennepin
Healthcare has committed to,like having American Indian
cultural navigators that arepresent and that can help do
exactly what it says, helpAmerican Indian patients
navigate the system, which are, you know, medical, our
medical system is verycomplicated even for people who
are, are used to it and knowabout , uh, how to navigate it.
So having those people presentin our institution, very, very
(09:26):
important. If you look atprogramming like the Talent
garden and our health equitydepartment is really, what's
that? Uh , the Talent Garden is, uh, a program that was
developed by our health equitydepartment, and one, and one
individual in particular thatI'll , um, call out is Jim
Peters to really engageunderrepresented minorities who
have not had a lot of the opsame opportunities that white
(09:46):
people have had, to be blunt,and to bring them into Hennepin
Healthcare for a day and allowthem to experience what it's
like to interact withhealthcare professionals,
physicians, nurses, pharmacistsacross the gamut of healthcare
providers, of people who looklike them, that are maybe even
from their same communities andfrom the same culture and from
the same ethnicity and race.
(10:07):
And so it's been a really anamazing program. And American
Indians, and we've had twoAmerican Indian youth with
stethoscopes events where webring these young, you know,
kids in teenagers, right ?
Teenagers, yeah. Um, that comein with their, sometimes their
family members, sometimes theirschool counselors, and they get
to spend a day with us. We havepanel interviews, we actually
have them go through stations,you know, they're in the sim
center, they're doing all thesereally cool things and just,
(10:29):
you know, seeing people thatlook like them , uh, giving
them that , uh, inspiration,you know, in many cases is
something that's reallyimportant. And really it's, for
us, it's really just showingthem that we, we care about
them and that we believe inthem. And they can certainly
accomplish a career inhealthcare if they , they
choose.
Speaker 2 (10:42):
I've heard somebody , um, say to me, who's a lot
smarter than I am? You can't beit if you can't see it. And so
to have all of these AmericanIndian kids see a doctor, not
only a doctor, but the leaderof this cool department, you
know, where you're making adifference and you're doing all
these things at an academiccenter and being the one in
charge that's an AmericanIndian guy who's in charge. And
(11:04):
you could be that too. I thinkthat is really, really
exciting. That being said, youtold me earlier that Aaron
Robinson , another doctor thatI happen to know is another
American Indian man in yourdepartment, and that you two
represent not how it iseverywhere else.
Speaker 3 (11:20):
Yeah, it's true. If , um, from our knowledge , um,
when we inquired last year tothe national database, there's
only two academic emergencymedicine physicians who
identify as American Indian,and it's Dr. Robinson and
myself. And we're both atHennepin. You're
Speaker 2 (11:34):
Both here. Both here in downtown Minneapolis.
Speaker 3 (11:36):
Yeah. And so I think obviously that's not
necessarily , um, a way to patourselves on the back, Dr.
Robinson and I, but it's almostlike an indictment on the
system, right?
Speaker 2 (11:45):
That's what it is .
It is . It's like, where iseverybody else? And we need to
correct that.
Speaker 3 (11:49):
Yeah, agree. But I think if you look at some of
the efforts that HennepinHealthcare has put into really
recruiting American Indians,you know, I just heard a number
that , um, is a little over ayear and a half ago. We were
around 26 American Indianemployees out of the 7,000
here. And now we've more thandoubled that from my, from my
understanding. So that's,that's pretty good progress. If
you look at our emergencymedicine , uh, residency,
(12:09):
we've, we have our firstAmerican Indian resident that
we recruited, and we had anumber of American Indian , uh,
medical students rotating inthe emergency department , um,
this past
Speaker 2 (12:18):
Summer. That needs to be a goal of all of us. Um,
we need to have our medicalstaff, our doctors, our nurses,
our everybodys represent thecommunities, not just that look
like me. And historicallythat's what medicine has been.
So you're an American Indianman, but our patients are from
all kinds of cultures. How canwe increase representation on
(12:42):
our medical staffs , um, ingeneral , um, whether it be in
native communities orelsewhere?
Speaker 3 (12:47):
Yeah, I think that's the , uh, the really important
question a lot of people aretrying to answer. And I think a
lot of it is , uh, people haveto recognize that there aren't
just these huge pools of peopleto, to, you know, draw from
that this is gonna take, it's along game. And so a lot of the
work, you know, you hear termslike a middle school to medical
school starting early, as earlyas you can in the schooling of,
(13:08):
you know, young children comingup. And this really introducing
them to , uh, healthcare isreally important. And I think,
again, just, you know,practicing cultural humility.
Obviously, you know, hand up inhealthcare has the Compass
program , um, which is beingrolled out to all of our
employees, which is reallyimportant. Um , could
Speaker 2 (13:22):
You explain that to our listeners? Yeah.
Speaker 3 (13:23):
It's really a, a program that initially was
targeted , um, kind of ofleadership and now it's kind of
been rolled out to everyemployee in the organization to
really teach this idea ofcultural humility and learn
about , uh, different cultures,especially the, the , the
patients, you know , um, thatwe see coming to us for help
for their healthcare. It's afirst step. It's been rolled
(13:45):
out, and I think it's been ,uh, well received by, by our ,
our organization. It definitelyis something that takes a lot
of work and a lot of , uh,thoughtful reflection , uh, for
everyone.
Speaker 2 (13:53):
I like the term cultural humility, which is one
I wasn't all that familiar withuntil recently through some of
the stuff we've been doing inthe Compass program here at
Hennepin. We used to use thisword cultural competence.
That's a joke. I agree. I can'tbe competent in
culture that you grow up in, inOklahoma. I can never be
competent in anything aboutthat, but I can be humble and
(14:14):
learn about other cultures. Sobefore I get to the break, what
do you like to do outside ofthis work?
Speaker 3 (14:20):
Try to stay healthy.
You know, I'm a a trail runner,so I try to do that just to ,
it kind of clears my mind, butI also know you
Speaker 2 (14:26):
Gotta twist your ankle
Speaker 3 (14:27):
list of injuries. Yes.
three , um, high school , uh,children, my wife and I, and so
they keep us really busy withother activities too. So it's
really good to be a family manor try to be, and kind of stick
grounded.
Speaker 2 (14:40):
So do you still stay in touch with your old friends
in Oklahoma? Of course. Yeah .
Absolutely . Do you have familydown
Speaker 3 (14:45):
There still? Yeah, my mother still is there. She's
89 years old. She's , uh, oneof the tribal elders. Uh , and
I have a sister and her familythere too.
Speaker 2 (14:51):
Oh, that's cool.
Yeah. Big respect to her. Yeah, that's , that's lovely. Thank
you. We're talking with TomWhite . He's the chair of the
Department of EmergencyMedicine at Hennepin Healthcare
here in downtown Minneapolis.
And a long time colleague ofmine. When we come back, we're
gonna talk more specificallyabout running a big, huge
emergency department. Stay withus. We'll be right back
Speaker 4 (15:14):
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for life. They mean here foryou, your life and all that it
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of clinics both downtown andacross the West Metro. They
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(15:37):
many of their primary careclinics and at their
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Hennepin Healthcare is here foryou and here for life.
Speaker 2 (15:51):
So it's no surprise to anyone, Tom, that , that
this job can be hard. Start usoff by talking about just kind
of the range of things youmight see in a given day. It's
not all people who arecritically ill. That's
Speaker 3 (16:03):
True. No , that's true. And I think that's part
of the, the stress of it isthat, you know, as an emergency
physician, you're never gonnahave the same day , uh, ever at
Speaker 2 (16:10):
Work. Did that draw you to it? Did you like that?
Did
Speaker 3 (16:13):
You like that part of it? It did . Yeah, it did. I
think it draws most of us , uh,to it because there's a lot of
people that, that don't likethat. Like a lot of people like
to, you know, expectations andkind of routine things. And
that's definitely not theemergency department. That
feeling of pressure and stressthat you don't know what's
gonna be coming through thedoor is something that you can
get used to. But sometimes itdoes catch you all off guard.
Speaker 2 (16:31):
It does, I bet.
'cause So we're gonna get alittle bit more into some of
the really serious things yousee, but you might in one day
see a kid with an earache and ababy that's swallowed a tablet
and a with a terrified parent,and then a gunshot wound and
then somebody having a heartattack.
Speaker 3 (16:46):
No, that's true . I think not , it's not just major
trauma, but we see a lot of thetime sensitive conditions, you
know, heart attack and strokeare the two that come to mind
along with trauma. But we seeprimary care complaints as
well. We see urgent carecomplaints, we see some
complaints that aren'tnecessarily even medical,
sometimes they're socialrelated . So there is a , a
wide range of things that ,that we have to
Speaker 2 (17:06):
Deal with. Mental health issues, substance use
issues. Could you comment onthose? Yeah,
Speaker 3 (17:09):
Unfortunately, too many. In fact, if you look at
the trajectory over the lastdecade or so, I mean both
substance use disorders, opiateuse disorder in particular as
well as, you know, mentalillness, those, those visits
have gone way
Speaker 2 (17:21):
Higher. Any idea why that is? So you're, you've got
patients in the emergencydepartment, I will just tell
listeners, every singlesolitary day with a mental
health , uh, crisis of somekind or not a crisis, just a
mental health issue that needsaddressing or a substance issue
that needs addressing either acrisis or just they don't know
where else to turn. Why do youthink that is? Is there , is
(17:41):
our community mental health andsubstance use system broken?
Yeah,
Speaker 3 (17:46):
I don't know that it was ever , um, to be honest,
really robust enough to bebroken. I think it's just been
underdeveloped, you know,that's part of the problem. Um,
I think that our county isdoing the best that it can do.
I think that it could do moreprobably, but I think that
that's not exclusive to ourcounty. It's definitely not
exclusive to our state or, orour healthcare organization.
But I think that if you look atan true emergency department,
(18:07):
you know, in a , in a perfectworld, would see emergencies
and we see more non-emergenciesthan we do emergencies. Then if
you add on the substance abuseand the mental illness and
those types of patients thatcome in and a lot of the social
problems, seeing patients thatare unsheltered and that have
food insecurity, those are allpretty common complaints in the
, in the emergency department.
And, you know , we don't havethe resources all the time to
(18:30):
take care of all those things.
So we would count on externalresources, you know , from the
county, et cetera, and othercommunity partners. And
sometimes those resources justaren't there.
Speaker 2 (18:38):
Yeah, I would second that. We don't really have a
system that is robust in thecommunity that meets
communities where they are andwith what they need. And so
they get great care in youremergency department, but
sometimes that's the only placethey know where to go. And the
needs are not being met by ahealthcare system that is not
functioning as well as itshould be. I think that's what
I would say on that. That'sright.
Speaker 3 (18:58):
That's right.
Speaker 2 (18:58):
So we talked about this breadth of things you see,
how do you get through thatday? How do you support your
staff and what's it like tobounce around on that
rollercoaster?
Speaker 3 (19:10):
Yeah, sometimes it can be tough. I think , um,
learning to handle thetransitions is the hardest
part. And that's something thatwe, we try to focus on in
training. How do you go from areally high stress, emotional
case many times, say forinstance, a , a child is
involved to where you're doinginvasive procedures and making
some very quick decisions abouttrying to stabilize someone or
(19:31):
save their life
Speaker 2 (19:32):
When you only have seconds or minutes Exactly . At
most , right ? Yeah .
Speaker 3 (19:35):
And you're working together as a team and it's,
it's a very high stakes andhigh stress environment. How do
you go from that to walking toa different area of the
emergency department, which youdo , um, and seeing an earache
or a sore throat or somethingof that nature. So you have to
be able to manage thosetransitions. And for me, over
the years, I guess the bestadvice I would give and I try
to give to our residents is youhave to really only focus on
(19:57):
the things you could control.
'cause if you let those otherthings you can't control kind
of creep in during a shift,then that's when it can really
catch you off guard and kind of, uh, uh, cause you to lose
focus. You , you can sit thereand pause and think about why
do I have so many guns in thiscountry? Or how come there's so
much domestic violence and howcome there's so much substance
abuse? But you can't controlany of that. All you can
control is what's in front ofyou. And so if you can do that
(20:20):
and you still connect to thatpurpose and how you're making a
difference, then I think that'sthe way to get get through it.
Speaker 2 (20:26):
There's probably very, very few other
professions in the world where, where you come home at the
end of the day and you maybehad your hands inside
somebody's body , and then youhad about two minutes to deal
with that and process thatbecause there's another person,
always another person waitingfor your care next. I don't
(20:47):
know if there's any other joblike that where that would
actually happen. And, and so Iimagine that when you're
leading a very largedepartment, and it's not just
doctors,
Speaker 3 (20:56):
I wouldn't be able to forgive myself if I didn't
say how amazing our nurses arein our emergency department.
I'm in continuous awe of themat times when I see the
multitasking, especially withthe critical patients that we
see and the duties they performand they're really the backbone
of our emergency department.
Speaker 2 (21:11):
There are a team of incredible nurses. Some of the
best nurses I've ever seen inmy life are the emergency
nurses at Hennepin. There'snurses, there's physician
assistants, nursepractitioners, there's
chaplains, there's the peoplethat clean the department.
There are environmental serviceworkers who come and make sure
that that place is ready forthe next person. So I can't
imagine what it's like tosupport all those people who
(21:33):
see this every hour of theirday and then have to move on.
And I like that about what youcan control. But in the end,
how do you, when you go home atthe end of the day, do you
leave it at work? How do you,how do you separate and how do
you care for your ownwellbeing?
Speaker 3 (21:48):
Yeah, it's sometimes it's not easy. Um, I think that
just really trying to connectback to the purpose and that
you are doing good. You are ina position to help people is
really important. So reallyconnecting back to that
purpose, I think that's why alot of us work at , uh,
Hennepin Healthcare, justbecause that there is so much,
it's such a mission-drivenorganization and there is so
(22:08):
much purpose in what we do. SoI really think that's the key.
Speaker 2 (22:11):
So you might self-select kind of people who
run on adrenaline a little bit.
Speaker 3 (22:14):
Yeah. I think you have to people that maybe run
on adrenaline, but also peoplethat are comfortable making
decisions without a lot ofinformation. Mm-Hmm .
people come through the doorand , and they're unidentified
and we have no idea, you know,what their medical history
might be. They're on anymedications, for instance, you
know, it's all done. And sothat can be stressful as well.
So again, we have to train totake in the information we're
(22:36):
getting diagnostically and alsofrom, you know, people that
might know what happenedpre-Hospital when those
patients came in to really makesome quick decisions. And
sometimes the decisions aren'talways the correct ones, but we
have to be able to really , uh,adapt and pivot right away. And
once we figure that out,
Speaker 2 (22:52):
I wanna dig into that a little bit more. 'cause
you do hear people say, I wentto the emergency department.
The doctors got it all wrong.
You know, they, they did this,they didn't do that. I left
there, I still had my problemand they didn't get it. Right.
Right. You and I both know thatyou are making decisions on
very limited information in avery short period of time and
(23:13):
you have the best diagnosticsin the world, which you have
access to. What are yourthoughts on that when you hear
that? Yeah, the doctors didn'tknow what they were doing. The
ed, they got it wrong.
Speaker 3 (23:20):
Yeah. Sometimes I , I do hear that and I can
understand the frustration ofpeople maybe, you know ,
there's long waits these days.
Mm-Hmm .
up. And we can certainly talkmore about that, but I think
you , you have to listen topeople because a lot of times
you can learn from whatthey're, they're saying with
their frustrations. But Ialways like to approach a
patient when they come in. Ialways like to ask 'em right up
front , you know, what are yourexpectations from this visit?
(23:42):
'cause we're an emergencydepartment. I'm not a primary
care physician. I'll likelynever see you again as a
physician. Tell me what you'rehere for, what brought you in?
And I'll tell you that, youknow, my job is to rule out
life-threatening conditions,emergent conditions, and to try
to identify what the cause ofyour symptoms are and then try
to devote resources to eitherhelping you during that visit
or if you can be followed upsafely as an outpatient, how do
(24:04):
I get you connected with thatcare?
Speaker 2 (24:06):
Yeah. 'cause sometimes you're dealing with
like a lifetime of medicalproblems or a year's worth of
medical problems in that hourthat you have with them and you
know, maybe haven't been in ahealthcare system and like you
have an hour
setting. In our last section, Iwanna talk to you about your
administrative role a littlebit. Um, 'cause you run this
big department, it's more thanjust caring for the patient in
(24:28):
front of you. Do you haveresources to deal with? You
have to keep your people safe ,um, you have to deal with space
and overcrowding and fundingand all that. What things are
most on your mind when you goto sleep at night on an
administrative level? What arethe challenges that you are ,
that you're thinking about?
Speaker 3 (24:45):
Yeah, there, there's a lot of 'em . And coming into
this role, just this recently,I'm , I'm, you know, every day
there's, there seems like a newone that kind of takes the
priority, but for me it's thewellness of our providers and
our, our nurses and the supportstaff. Everyone that works in
the emergency department is, istop of mind for me and their
safety while they're working.
Are they staying mentallyhealthy? You know, all those
(25:06):
things and all the differentsupports that we have in place
to, to help people that aremaybe struggling. That's really
important to me. I think also ,um, the flow, I touched on that
a little bit earlier. We needmore space to see more
patients. If I had a , a magicwand to wave , um, it would be
to create more space in thehospital so we could get our
patients flowing. You know, theanalogy is the, the faucet, you
(25:27):
know, the inflow is completelyon all the time. And we don't
have control over that becausewe're an emergency department.
We have to see everyone thatwalks through the door. It's
Speaker 2 (25:34):
Not like , can close the doors and turn off the
lights Yeah . And say close seeyou tomorrow.
Speaker 3 (25:38):
No , it's a, it's , it's a government mandate,
which we kind of look at thatas a badge of honor. Yeah .
We're happy to see anyone thatwalks through the door at any
time . Doesn't matter who youare. But the outflow is the
thing that's really kind ofbacking up. Now we're not able
to get patients moved throughand into the hospital. 'cause
the hospital has strugglesdischarging people out into the
community to those resources.
So it's a big problem. Again,it's not unique to our hospital
(26:00):
or to Minnesota. It's a , it'sa national problem.
Speaker 2 (26:03):
It is, I think something that listeners ought
to know about the things thatyou might see when you go to
your doctor or your emergencydepartment are due to a system
that, that is got a lot ofbacklog right now. It's hard to
get somebody out of thehospital because there's not
enough community resources tosupport them. And if the
hospital's full, the people aresitting in your emergency
(26:24):
department waiting for a bed,and if they're waiting for a
bed, they're taking up a spotin your emergency room. That
means the waiting room'sgetting really crowded. So it's
not for lack of wanting to getyou through quickly. It's that
there are some realities thatare really challenging in our
healthcare system. That's
Speaker 3 (26:39):
A hundred percent correct. And I think that
because of that, differenthospitals systems are looking
at how do you try to move careout to triage out in
Speaker 2 (26:46):
The waiting even
Speaker 3 (26:47):
Practically.
Seriously . Yeah. Yeah. How doyou do that? Um, so we've
obviously been looking , uh,and trying to adjust and adapt
in that regard, but it's hardto do when you, you have, you
know, the space isn't there andso that's another issue. So
Speaker 2 (26:58):
You're, you're in the first year of your job
running this. What would youleave us with? What brings you
hope about your job?
Speaker 3 (27:05):
Well, I'm really excited about coming into this
new role because again, I workwith a fantastic , uh, number
of emergency medicine faculty.
We have 52 of us now, whichwe've grown tremendously in the
last decade. And theopportunities are very
plentiful for us to , uh, notonly to maintain some of our
excellence as a department, butalso to improve upon things and
(27:26):
innovate and conduct moreresearch and to continue to
train the best emergencymedicine residents in the world
while we serve our community.
Speaker 2 (27:33):
I, for one, am glad you're in this role because I,
I'm proud of our hospital andour front door to the world is
indeed the department you run.
And thank you for taking onthis job as leading that
department and thank you toyour whole department. Thank
you. We've been talking withDr. Tom White about what it's
like to lead a large level oneemergency department and his
(27:53):
unique role as one of the onlyAmerican Indian healthcare
leaders in the country inemergency medicine listeners,
thanks for tuning in and I hopeyou'll join us for our next
episode in two weeks time. Inthe meantime, be healthy and be
well.
Speaker 1 (28:09):
Thanks for listening to the Healthy Matters podcast
with Dr. David Hilden. To findout more about the Healthy
Matters podcast or browse thearchive, visit healthy
matters.org. Got a question ora comment for the show, email
us at Healthy matters@hcme.orgor call 6 1 2 8 7 3 talk.
There's also a link in the shownotes. The Healthy Matters
(28:30):
Podcast is made possible byHennepin Healthcare in
Minneapolis, Minnesota, andengineered and produced by John
Lucas At highball Executiveproducers are Jonathan , CTO
and Christine Hill . Pleaseremember, we can only give
general medical advice duringthis program, and every case is
unique. We urge you to consultwith your physician if you have
a more serious or pressinghealth concern. Until next
(28:52):
time, be healthy and be well.
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