December 6, 2024 • 35 mins
In this episode of “Lab Medicine Rounds,” Justin Kreuter, M.D., speaks with medical students on the importance of understanding healthcare systems, their experiences from a global surgery hackathon, and how maintaining curiosity and continuous learning can enhance their medical practice.
Timestamps:
0:00 Introductions
0:49 Importance of Understanding Healthcare Systems
1:33 Fundamentals of Healthcare Systems
3:03 Complexity of Healthcare Systems
5:13 Selective vs Curriculum
6:08 Systems and Inequalities
7:18 Billing and Economics in Healthcare
8:17 Balancing Medical Training and System Knowledge
9:01 Curiosity and Continuous Learning
10:02 Learning Opportunities
13:02 Slowing Down in Critical Phases
16:41 Revising Healthcare Systems
18:02 Capturing Learning
22:03 Maintaining Curiosity
24:01 Advice for Developing Skills in Healthcare Systems
Mark as Played
Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Justin Kreuter, M.D. (00:07):
This is Lab Medicine Rounds, a curated
podcast for physicians,laboratory professionals, and
students. I'm your host, JustinKreuter, a transfusion medicine
pathologist and assistantprofessor of laboratory medicine
and pathology at Mayo Clinic.Recently, I participated in a
hackathon with a group ofmedical students from Mayo
(00:28):
Clinic's Alix School of Medicinehere in Rochester, Minnesota,
focused on global surgery. Andit gave me a really kind of
interesting insight intothinking about how we're
teaching our learners to thinkabout healthcare systems. And so
today, we actually have 4medical students with us to talk
about this topic.
(00:49):
So I'll introduce them insequence for all of our audio
listeners to kinda hear theirvoice. So we'll start off with
Matt Gish, who's a 2nd yearmedical student here at Mayo
Clinic.
Matt Gish (00:58):
Hey, everybody. Thanks for having me, doctor
Kreuter.
Justin Kreuter, M.D.: Absolutely. And Audrey Bankes is (01:01):
undefined
a 1st year medical student hereat Mayo Clinic.
Audrey Bankes (01:06):
Hello, everybody. Happy to be here.
Justin Kreuter, M.D. (01:09):
We've got Yousuf Khalil, is a 2nd year
medical student here at Mayo.
Yousuf Khalil (01:14):
Hi, everyone. Thanks for having me.
Justin Kreuter, M.D. (01:16):
And finally, we've got Richard
Betancourt here as a 2nd yearmedical student at Mayo.
Richard Betancourt (01:21):
Hi, everyone. Happy to be here.
Justin Kreuter, M.D. (01:23):
Alright. So let's kinda kick this off.
Maybe to start off, Matt, why isit important for a physician to
think about health care systems?
Matt Gish (01:34):
Yeah. This is a question that I think we need to
continuously wrestle with inmedical school, And it comes up
in the curriculum over and overagain in terms of content, you
know, who who's paying, what areour insurance companies like,
those kind of things. But Ithink engaging with it in a in a
deeper level and trying tounderstand what motivates not
(01:58):
only our health care system, butalso systems around the world
that we could, at any point,either see our system change
into or go perform in systemslike that themselves. It's just
so important to understand howthe greater structure of health
care influences the decisionsthat we'll make every day.
Justin Kreuter, M.D. (02:19):
Right. I like how you're highlighting
there's a system that we'reworking in. Something's like I
think about it as, like, thefish that's in the water. It
doesn't know what water isnecessarily or for us walking
through the air that we breathe.And maybe some of us don't think
about that as much, but I reallylike the way you talk about
continuously reexamine that.
(02:40):
And so I'm curious, maybe we canall kind of put a tack in that,
and we can kind of come back toexplore that a little bit
further as we go through.Audrey, I could start off with
you. And and I know you're a 1styear medical student, so you're
just kinda getting started withthis Global Surgery Selective.
Are there some of thefundamentals of health care
(03:00):
systems that so far to you havedeclared themselves in your
mind?
Audrey Bankes (03:06):
Yeah. That's an interesting question. Like you
said, I'm 1st year, and so we'vejust started to scratch the
surface of the very complex andlarge topic of health care
systems. But for me, I thinkabout it in the case of how is
it affecting the patients. Andso I know it's a big system, and
I know it's a lot of movingpieces.
But as doctors, I do think thatwe have some small role, and we
(03:27):
can, in some ways, influence howthe system is gonna affect the
patients and the people thatwe're interacting with. And so
that's kind of the biggest thingI started to hone in on so far
is, yes, it's a big system andit's very complicated, but it
does affect real people in realways. And it's important that we
try to make it as best that wepossibly can with what power we
do have in the system.
Justin Kreuter, M.D. (03:48):
Yousuf, I wonder if you could build on
Audrey there, kind of thinkingabout this patience, and I like
the way she's highlighting. Youhave this complexity. And in
order to kinda get our armsaround it, sometimes we have to
simplify something. But there isthis kind of tension, this back
and forth. You're a 2nd year.
You've kind of been with thislongitudinal selective for a
(04:09):
year. How have you seen some ofthese fundamentals come forward?
Yousuf Khalil (04:14):
Yeah. I think, like Audrey was saying, the the
system the system is very, verycomplex, and we've learned a lot
about it in through theselective, through our
curriculum. But even then, Ithink I'm not fully I don't
fully understand it yet, and Idon't think I will until I'm
practicing and and dealing withit every day. I can already see,
you know, in the patients thatwe do see how the system affects
(04:35):
them. And I think even as apatient myself, how the system
is super complicated with withinsurance companies and
everything that, you know, asthat patient has to deal with.
I think as future physicianslearning about the system as
best as we can and trying toincorporate that into our
practice, if the patients haveto deal with them on a daily
basis, we should also learn howto how to, you know, work within
(04:55):
the system to make their livesas easy as possible. And I think
this is particularly importantwith patients who kind of are
more underrepresented and withsome patients who have a more
difficult time with the healthcare system. I think it's
obviously a much bigger systemthan all of us, but I think,
like Andre was saying, to workwithin our means to make it
easier for them specificallytoo.
Justin Kreuter, M.D. (05:14):
Richard, can I ask you you know, so
Yousuf brought up this idea ofwhat we're learning in the
curriculum versus the, selectivethat you guys have elected? How
do you contrast those 2? How hasthe selective enabled you to
explore how you think abouthealth care systems further?
Richard Betancourt (05:34):
Yeah. I think it is important also when
considering a perspective ofwhat a system is and what it's
designed for. And I mean,systems really guide, like, the
conversation of both macro andmicro levels. I think that's
becoming increasingly more trueas we're connected more
globally, as well as, with thefurther division of labor. In
(05:54):
the past, you know, a lot of thepractice was, sort of, you know,
family, a physician oriented,but specialization wallet allows
us to expand ourselves more inexpand what's possible in
healthcare.
We are also missing a lot of theinsights that we're able to
really gain on a systems level.And I think it's really
important when considering thisin the context of inequalities
(06:16):
in the healthcare system and howthe division of labor sort of
upholds a lot of thoseinequalities. For example, in
many healthcare systems, theexperience of billing a patient
is separated from the practice,which acts sort of to shield or,
as a barrier separation fromhaving that person to person
interaction, of what is, youknow, in many cases, for
(06:38):
example, like life changingbills.
Justin Kreuter, M.D. (06:40):
That makes me wonder, Audrey, if I can ask
you, and I realize it may putyou a little bit on the spot,
but does it surprise you as amedical student that, you know,
this kind of Rick's pointingout, thinking about all these
different levels and thinkingabout how billing works. I don't
know if you were an economicsmajor, before coming to medical
school or worked in those ways,but I imagine a lot of people
(07:03):
maybe come to medical schoolkind of focused on learning the
medicine and science. And areyou surprised about this focus
on thinking about how doesbilling work these other
components of the health caresystem?
Audrey Bankes (07:17):
Yeah. I was not an economics major, but that's a
super good question. Like yousaid, I come into medical
school, and I think a lot ofpeople come into medical school
thinking about science andresearch and the lab, and it's
very removed from the billingand the real world impacts on
people. And as Rick said, thatcan be a bad thing in a sense
(07:38):
that people forget that that'shappening, and they can just
start racking up the bills andthe tests and the lab orders
without considering what it'sactually gonna cost the patient
at the end of the day. So Idon't think I'm necessarily
surprised, but it is somethingthat we don't talk about very
often in school.
At least my understanding as a1st year, we haven't talked
about it yet. And so it's it'snot surprising, but it's a
(08:00):
little bit disappointing or alittle bit disheartening, I
should say, that this issomething that's a reality, and
we have to deal with it. Andit's very hard to learn. It's
very hard to understand, andit's something that's bigger
than most of us, so it'ssomething also that's difficult
to deal with and difficult torealize that's the the case for
a lot of patients.
Justin Kreuter, M.D. (08:17):
Yeah. I like the way you put that. I
think there is something aboutan element of how much do we
have to know so that we canfunction in our health care
systems or we can optimize ourhealth care systems. But like
you're, I think, highlighting,there are other colleagues that
are playing these roles as theirprimary. What do people think
about how we strike that balanceof how much do we focus on this
(08:41):
in medical school?
How do we get each other to beable to kind of talk the
financial language withcolleagues or, you brought up
other elements of the healthcaredelivery. How do we work to
interact with colleagues who aremaybe not physicians, maybe
nursing colleagues, alliedhealth, the c suite?
Audrey Bankes (09:04):
I'll start on it just because I left off, but
Yeah. It's tough because medicalschool and medical training is a
finite period of time. Andalthough training is very long,
it still has to be completedwithin an x amount of years, and
you still have to have a finishline. And so it's hard to cram
more and more skills andknowledge and information into
(09:25):
that period of time. So I thinkthat's a tough question.
I think there's more emphasisand more learning that could
definitely be done in medicalschools or on your own free time
as that's something that'simportant for you to learn as a
human being, But I'd beinterested to see what other
people had to say about that.
Matt Gish (09:41):
I've found similarly that maintaining curiosity is
something that has driven me toexplore these complicated areas
of the medical field and kind oflearning humbly from the amazing
people here at Mayo whospecialize in all sorts of
things from patient advocacy tobilling to insurance coverage.
(10:06):
They play such a crucial roleand, I think, are really
underrecognized in our system.And the experiences that I've
had, either working with them ina clinical setting, sitting down
and hearing them speak atevents, conferences, or even
listening in on podcasts likethis one. They've opened my eyes
to the work that they do andgiven me just a little bit of
(10:28):
taste of how I can fit into whatthey're doing as a physician and
try to make this kind of jankyhealth care system that we've
created run a little bit moresmoothly.
Justin Kreuter, M.D. (10:40):
Yeah. I really like the way you put that
back. I wanna put a pin in thatabout curiosity and come back to
that in a little bit. And Iwanna highlight what Audrey was
saying about this curriculum andmedical school being a finite
time, because that hits me rightin the medical educators part
of, right, we're trying to builda curriculum and set of
(11:00):
experiences to build competency,hopefully excellence, in our
physicians. But I think it doesacknowledge the reality that
there are limitations, whichfosters some creativity.
But maybe if I can bend over andask Youssef, how are you finding
opportunities to think aboutexploring healthcare systems so
(11:23):
far in medical school?
Yousuf Khalil (11:25):
Kind of like what Matt was saying. I think
exploring other options as wellin addition to the curriculum,
like podcasts, books, stuff likethat, I think helps to kinda
give a more comprehensive viewof things. And I think even
within the curriculum, you know,the things that are well
established, the things thateveryone has to go to and and is
really important to go to arethose kind of health care system
(11:45):
science classes. But then, youknow, you can add on additional
electives like what we did withthe global surgery selective.
And I think the more you realizehow important it is to learn
these things, I think it justgives you that added motivation
to actually in your free time,even if you're tired from
learning about all the medicineand science all day and it's
(12:06):
it's exhausting and it can hurtyour brain sometimes.
I think it's important to, likeMatt was saying, maintain that
curiosity and that drive tolearn the stuff outside of the
science to kind of give yourselfa more comprehensive worldview.
Justin Kreuter, M.D. (12:19):
Right on. Are there other opportunities
that people have kinda comeacross in medical school so far?
Matt Gish (12:26):
I think this can be a situation where our patients are
some of our best educators.Maybe more than, especially a
lot of us who are just youngerin medical school. They've had
experiences navigating thehealth care system with
different insurance companies,different providers at different
institutions. And hearing outtheir stories is something that
(12:46):
can give us a lot of reallyvaluable perspective. I also
think working through patientcases can be really helpful.
Rick and I were on a teamrecently at a free clinic here
in Rochester, and we had apatient come in feeling
generally unwell. And it turnsout he was a young man, and he
had an ejection fraction of 26due to unknown cardiomyopathy.
(13:11):
And the textbook answer is tocheck some labs, get them on
appropriate heart failuremedications, but our options
were in this setting. We're at afree clinic. We have an
uninsured patient.
And now we're working to try andunderstand how can we best work
within the constraints of thefree clinic in our limited
(13:32):
resources to help this patientand ensure their safety while
also not just sending them tothe ER and causing catastrophic
financial loss. So learning fromthis patient's case and their
experience is something that canreally help heighten our own
knowledge of the world thatwe're operating in.
Justin Kreuter, M.D. (13:51):
I love that example. Right? 1, because
it's specific. But then 2,because I think this gets at
something for all of ourlisteners who probably a
minority of them are going to bemedical students, but hopefully
we got a couple, but who can bethinking about this podcast and
and what might I take away fromthis? And one one of the things
is sometimes we will send apodcast with people in the ivory
(14:14):
towers and such like this, butwhat we're talking about today
about thinking about health caresystems is really thinking about
how we what we can make the mostwith what we have.
And, Matt, can I ask you toelaborate a little bit about how
did you approach that? Because Iimagine there's a temptation of,
well, if we had other resources,I would do this. But how did you
(14:35):
approach doing the best withwhat you had?
Matt Gish (14:39):
Yeah. I mean, it was a complicated situation with
something that kind of took allof the brains of the team that
was there thinking about how wecould work through this
patient's case. We're digging upformer labs. People were calling
previous health care providerstrying to figure out what kind
of myopathy we're looking athere. We're considering, is this
(15:03):
patient clinically too sick tonot go to the ER?
Do we need to send him? We'recalling other resources through
Mayo Clinic Charity Care lookingat, can we get him an urgent
cardiology visit? But also justrecognizing that we can't just
give him the medication off ofour little limited formulary
(15:24):
sheet and hope that it works andtell him to either come back in
or go to the ER if he's feelingsick. Like, these options that
may be available to some peoplewho are better resourced were
kind of off the table for us.And it really just required a
lot of collaboration and phonecalls and trying to figure out
(15:45):
how could this patient's needsbest be served with what we had
to offer in the setting?
Justin Kreuter, M.D. (15:52):
I think you said Richard was with you
with on this case. Right? Andmaybe I can ask Richard. Can you
maybe elaborate of seeing theteam come together? And were
there elements that you saw thatwere kind of, this worked well,
and or are there elements thatyou saw with the team coming
together, that was maybecounterproductive?
(16:13):
I just wanna kind of callhighlight to those elements.
Richard Betancourt (16:16):
Yeah. So I was a little less involved in
this case. There's actuallyanother instance that same day
where a patient was coming infor just a medication refill
and, on exam, we found a,murmur. And then looking back
multiple years, we found thatthey were found to have severe
aortic stenosis that was neverthen followed up on. So that was
(16:37):
basically a similar situation.
So I can speak on, my experiencewith that.
Justin Kreuter, M.D. (16:42):
That'd be fantastic. Yeah.
Richard Betancourt (16:43):
I think one of the major things that we,
identified was, you know, whydidn't they follow-up as well
as, following the impact thatcommunication really has like
on, medical care, especiallywith like say immigrant
populations, because, thepatient was a non native English
speaker and they really did not,seem to understand what the
(17:05):
pathology was as well as likethe needs for it to be followed
up on. And after we were ableto, explain really, and make
sure that they understood whatwas going on, then they were,
I'd say amiable to justfollowing up with the issue to
make sure that nothing badhappens down the line,
hopefully. So I think, in a lotof instances, especially again
(17:27):
with the sub specialization,where we're all kind of confined
to our little boxes, and we'rehyper focusing on efficiency and
getting things done quickly. Wedon't take a step back and, make
sure that say, does the patientunderstand what's going on? I
think that taking a pause and astep back, and the system's
really helped, everybodyinvolved, even though this is a
(17:49):
time consuming process, likeMatt said, you know, it took a
lot of everyone's brains to cometogether for, you know, one
individual.
And I think in a system that,really prioritizes efficiency
and getting things done quickly.I don't know if that is, as able
to be done. So I think that is apretty big impact.
Speaker 6 (18:10):
For more laboratory education, including a listing
of conferences, webinars, and ondemand content, visit Mayo
Clinic Labs dot com forwardslash education.
Justin Kreuter, M.D. (18:26):
I'm really glad you highlighted the pausing
or slowing down deliberately.That's something that
particularly I've read aboutthis in the surgery literature
when it comes to confidenceabout experts realizing here's a
critical point, and so as aresult, like, I need to slow
down. I need to focus instead ofjust this is going along, and
(18:48):
I'm I'm finishing out theprocedure. Maybe I can ask
Audrey, since we were talkingabout this element of building
expertise, is that somethingthat you've started, that you've
been exposed to, this slowingdown to during a critical phase?
Is that something that you'veseen in your 1st year already,
or is that something that youhaven't come across yet?
Audrey Bankes (19:10):
I'll say I haven't come across it in
technical practice too too much,but it's interesting that you
say that because they tell us atleast they've told us several
times that as medical students,we actually have more time than
the attendings and theconsultants and everybody else.
And so for us, it's veryimportant to slow down and maybe
be that one person that sits inthe room, talks to the patient,
(19:31):
listens to their story, hearswhat they have to say. And if
something comes up, we can bringthat back to the consultant and
say, hey. They probably nevertold you this, but I just had a
conversation, and they broughtup a really interesting side
point that I think is importanthere. I think the doctors I've
been around and worked with,they understand the importance
of slowing down, and they doabsolutely try their best to
(19:52):
slow down.
But like Rick said, there'sthere's pressures, there's
outside factors that contributeto that, and sometimes it's just
hard or it's just a little bittoo overwhelming. There's too
much going on, and it justdoesn't cross somebody's mind.
But as a medical student, theyhave harped on us. It's
important to learn that. And,hopefully, if we do take the
time to learn to slow down, thatcan carry forward to when we're
the consultants and we're theattendings, and we can really
(20:14):
put that into practice,hopefully, in the future.
Justin Kreuter, M.D. (20:17):
It makes my medical educator heart go
pitter patter that you'rehearing this already in the 1st
year, and this is beingencouraged. Yousuf, can I ask
you, you're a 2nd year? Have youseen this play out? And I'm
wondering if you can kindaspecifically highlight some of
that tension between getting thework done but slowing down. How
have you seen this navigated?
Yousuf Khalil (20:39):
Yeah. I think in terms of taking that pause and
taking a time out, I think I'vemainly seen it a more explicit
time out in the surgery in thesurgical setting like you were
mentioning. But just in terms ofpatient care in the positions
that I've been in so far, it'smainly just been coming in,
getting a quick history andphysical, and going back and
speaking to the consultant. ButI think I started off very
(21:01):
anxious about that and wantingto make sure that I got it done
in a timely manner. But I foundthat when I was doing that, I
was not doing it well.
And so I think when I startedhaving first of all, a checklist
when I go in, a checklist ofthings that I wanna ask about,
and making sure that I take mytime with the patient and listen
(21:22):
more than I hammering outquestions at them. I've noticed
that I end up getting a muchbetter history from them. So I
think kind of keeping thateither checklist in your mind or
checklist with you in front ofyou when you go in to speak to
them, I think is superimportant. And I think that's
something that I reallyappreciate about being at Mayo
is they teach us the importanceof being present with your
(21:44):
patient. Because those thingsthat I told you that ended up
helping, those aren't thingsthat I came up with.
Those are things that myconsultants told me that I need
to get better at. And when I didincorporate those, I found,
first of all, a much morecoherent a much more cohesive
relationship between me and mypatients.
Justin Kreuter, M.D. (21:59):
I wanna go back to this idea that was said
earlier in our recording hereabout this idea of continuously
revisiting how we think abouthealth care systems. I know
we've been really focusing in onspecific examples. I wonder if
we can kinda pull back, and I'mgonna ask us to maybe go a
little bit metacognitive andthink about how we're learning
(22:22):
stuff. But, you know, this isreally kind of an open, maybe a
junk ball question. I'm gonnaput it up there and set it out.
How do you approach continuouslyrevisiting something? If we
think about medical school asthis spiraling curriculum where
we're getting exposed to thingsand regetting exposed to things,
(22:42):
but because of our trainingwe've had in the interim, we can
go deeper. How do you guysapproach capturing that learning
so that you are meaningfullyrevisiting this each time?
Richard Betancourt (22:57):
I personally, we have I'd say a
class that's called senior sageswhere we meet with a a retired
medical doctor. And in general,they helped give us like life
advice for what they foundhelpful during their experience
as a physician. And my Sage,recommended me to keep a
notebook and write down justlike things that I've done
(23:18):
throughout the day, things tohelp with like memory. And I
think that it's very helpful tohelp write down important
learning points just to, youknow, have it down. And then
maybe once in a while, I like togo back and read through my
notebook.
And it also helps with just likeremembering funny moments that I
might have forgotten about.
Justin Kreuter, M.D. (23:35):
Well, spot on. I think that's an a
wonderful technique. Do othershave other ways that they're
capturing their learning?
Yousuf Khalil (23:42):
I think for me, I think being in medical school,
I've realized that learning thescience and the medicine and
everything is very important,but I think something that's
even more important potentiallythat they're teaching us is how
to think about things and how toresearch things that we get
interested in. So I think havingthat context and learning if if
I find something that I feel isparticularly important, how to
(24:03):
how to do a deep dive and figureout everything about it and
figure out what is importantabout it. I think just kind of
that high level thinking, Ithink, is something that I
really appreciate that I'm I Ifeel that I'm gaining from
medical school. Yeah. I think Ithink that's something that I
would I would say I use to tolearn more.
Audrey Bankes (24:21):
A little bit different, and, of course, I
haven't had as much experienceas the other people here. But
when someone gives me feedbackor maybe something I didn't feel
great about, I usually rememberthat or jot it down or
something. And then I really tryto find as many opportunities to
practice and relearn and usethat skill as I can. So every
free clinic, I go and volunteer.Every opportunity to work with
(24:42):
my family on something, I usethat.
Every opportunity to go to afree suture clinic at the
school, I use that. So I justreally try to repractice that
skill over and over and overagain and just utilize
opportunities that are alreadyright in front of me to really
exploit those skills and makesure I'm learning it over and
over again even if I feel okayabout it.
Matt Gish (25:02):
Yeah. And I think our patients can be our best
reminders to take those deepdives, like Youssef was saying,
and just remain curious. Andwhen they have a a barrier to
taking a medication or they'retrying to figure out what
insurance plan is gonna maybework better with their new
diagnosis, taking those casesand instead of just letting it
(25:24):
be a, oh, that's interesting or,oh, I wonder. Taking the time to
resist the urge to only studytestable material and really
letting curiosity drive you intothat deep dive. Hey.
I'm gonna go back to theworkroom and do some research on
what kind of plans would be bestfor you and your situation right
(25:47):
now. Or, hey. I don't know a lotabout how we can get that
medication covered, but I thinkthis would be a great
opportunity for me to learn.It's those moments and those
interactions that I think aremost frequently brought about by
our own patients that we canreally use as a platform to dive
(26:07):
deep and learn well.
Justin Kreuter, M.D. (26:09):
Okay. It's official. I think I wanna
recruit all 4 of you to becomepathologists. You know? This I
the idea, the way you guys aregoing about capturing your
learning, the way you're talkingabout it sounds like you guys
are all internally motivated.
You've got the curiosity, thefire, and you're looking to just
get the repetitions and practicevariations on a theme. So these
(26:31):
are all elements that ourlisteners can really take away
from this podcast. Right? Ifyou're a physician in practice,
you know, that listening tothese medical students might be
sparking in your mind to thinkabout some of these adjacent
areas of your practice that youmay not be taking a deep dive
into, but certainly is the waterthat we're swimming in, the the
(26:52):
health care system that you workin. If you're a laboratory
professional, you could bethinking about how am I
interacting with physicians andhelping them understand how they
can optimally use the lab inwhatever kind of resource and
situation that you findyourself.
And students, if you'relistening to this, I think
there's some great tactics andstrategies that these medical
(27:14):
students are really articulatingthat I just wanna call your
attention to, this idea ofwriting things down, reflecting
on things, and practicing theheck out of it are all fantastic
strategies. Can I ask you,medical school is a challenge? I
imagine sometimes you're tired.I don't know. Maybe you guys
have, like, some battery insideyou that is just, like, amazing.
(27:37):
But how do you maintain thatcuriosity when it's tough?
Audrey Bankes (27:42):
For me, it is hard sometimes, and the
motivation dwindles. But similarmuch to the previous question,
circle back to things that Ireally enjoy and I really like.
And I was like, you know, thisis tough. This is maybe not my
favorite thing at the moment,but can I apply that to an area
that I really love and I'mreally passionate about? For me,
that's really serving underunderinsured, underserved
(28:05):
patients.
So if I'm learning aboutpharmacology and I'm judging
along, learning about a 100drugs a week, and it's, you
know, it's tough. It's not thefunniest thing for me
personally. But can I apply thatto my patients that I'm gonna
see in the free clinic? And thisis really important medication
for them. I need to understandthis.
I need to know this, so it'simportant for me to learn. And
kind of remembering that in theback of my head does help
(28:26):
motivate me even when I'm tired,even when I'm late at night and
just wanting to go to bed.
Justin Kreuter, M.D.: Reconnecting with your why is (28:31):
undefined
what I'm hearing. That that'svery powerful. Youssef, were you
gonna hop hop in?
Yousuf Khalil (28:37):
Yeah. I hate to be repetitive, but I think
that's exactly my answer. Acouple of things I think being
in the preclinical phase of yourstudies is it can be
particularly demoralizingsometimes just because you're
constantly your head's in in Iwas gonna say your head's in the
books, but I haven't opened atextbook this entire time. But I
had more in the laptop, I willsay. But you're just learning
(29:00):
the science behind things andthe medicine behind things, and
it's hard to see how it appliesto real life sometimes.
And I think having littleexposures here and there as to
how we can help patients andparticularly patients who need
it the most, I think, is very,very helpful. And for me
personally, my family isEgyptian so, you know, they
immigrated here a while ago andI go back to Egypt constantly
(29:21):
and so I see I have exposure towhat's available there and the
stark difference in what somepeople have access to. And so I
think having that kind of driveto help people back home or
people even in America who havesimilar experiences, I think
that's a big thing that can keepme going when the going gets
(29:43):
tough, honestly.
Justin Kreuter, M.D. (29:44):
I really like the way I think your
response, Yousef, actually,yeah, it does build on Audrey's.
Right? I mean, it's well, it isboth both of you are saying
you're connecting to your why. Ithink you're, like, highlighting
the floristy of just how diversethat why may be. And I think
that's something that I'm gonnabe taking away from this
(30:04):
conversation with you guystoday.
I know for myself, sometimeswhen I'm on service and at the
end of the day, I would justwanna go crash on my couch. But
I know I still need to crackopen and, you know, the latest
publication that came out. Ineed to be aware of what those
papers are. Okay. I wanna do thething that I I said at the
(30:24):
outset that I wasn't gonna do.
That's to ask a question, justgo down the line, but I just
wanna take our listeners out byhaving each of you share, what
advice do you have for ourlisteners who would like to
further develop their abilities,their skills to think about
(30:44):
health care systems? Becausesome of our listeners may not
have really deliberately thoughtabout this in a while. Some of
our listeners may notnecessarily be thinking in in
these terms or or just bestarting to. So what advice do
you have for them? And I guessI'll I'll thank you as we're
kinda going out and and startwith Matt Gish.
Matt Gish (31:05):
Yeah. Thanks again for having me, doctor Kreuter.
This has been a ton of fun. Ithink my biggest piece of
advice, and something that I'mstill working on daily, is to
continue to chase curiosity.When a patient presents with a
socioeconomic challenge oryou're having trouble navigating
the system that you're providinghealth care within, taking a
(31:28):
step back in trying to identifywhere that confusion's coming
from.
And even if you have a testcoming up on the radar or you've
just got other emails andresearch projects to focus on,
being able to chase down thatcuriosity and listen to a
podcast, flag a couple articles,pick up a book, maybe that
(31:50):
challenges the way you currentlythink about the health care
system. Those are the thingsthat, coming back to our why, I
truly believe will help make methe best provider I can be
someday. At times, it's reallyhard to understand the value of
chasing down curiosity asopposed to doing more flashcards
and more practice questions. Buttaking a step back and
(32:14):
understanding who do I wannabecome and how do I get there, I
think taking those learningopportunities is always the way
that will help me push forwardand become the best that I can
be.
Justin Kreuter, M.D. (32:25):
Thanks so much for sharing, Matt. Audrey
Bankes.
Audrey Bankes (32:28):
Yeah. I think probably everything I'm about to
say has been said in one way oranother, but for me, asking
questions is a huge one. If youdon't know something, you don't
understand something, just askthe question. Usually, people
have a lot of information andbackground knowledge that you
don't have, and it's reallyvaluable just to let them share
that with you. The second one,for me, I really like to engage
(32:50):
with people who aren't typicallydoctors or maybe not, you know,
in the same realm as us.
So if you can reach out topeople who know a heck of a lot
more about health systemsciences than you do yourself,
that is gonna be so hugelyhelpful. It just gets you
outside of your bubble, helpsyou see things from a different
perspective, which I reallyvalue it when I'm learning
anything. And then the third oneis if you have the time and the
(33:11):
energy, use your own personaltime to do some googling, look
up a cool video, look up a coolarticle. It doesn't have to be a
lot, but, you know, if you justkinda get the itch to learn
something, just read a quickpaper. And I think that if you
do that every once in a while,you'll still learn a lot, and I
think that's really powerful todo.
Justin Kreuter, M.D. (33:28):
Thank you, Audrey. Yousuf Khalil.
Yousuf Khalil (33:31):
Yeah. Thank you so much for having me again,
doctor Porter. I think I thinkfor me, my big takeaway would be
to think about the context thatyour patient presents in or
comes from. I think we in themedical field have a lot to
learn from people in the fieldof public health and
epidemiology and health systemscience, and I'm biased because
(33:51):
my wife does study publichealth, but I think we do have a
lot to learn from it. And Ithink learning about social
determinants of health andlearning about the conditions
that lead to conditions thatpatients present with.
And so I think we have a lot tolearn from the field of public
health and to incorporate thatinto a more holistic, worldview
of the field of medicine.
Justin Kreuter, M.D. (34:12):
Thank you, Yousuf. And Richard Betancourt.
Richard Betancourt (34:15):
I think for me, there's a lot of talk about
examining or taking out bias orin the context of global health,
taking out western perspectiveswhen can when it comes to health
care. And I think this followsthe same issue, when it comes to
the idea of say likecolorblindness when looking at
racism, where it ignores thefact that we live in systems
where these biases areubiquitous to a certain extent,
(34:35):
whether consciously orunconsciously. And one teaching
point that I remember from classis there's this idea where
physicians are meant to be thestoic beings that are objective
and operate in the only theconfines of science. But I mean,
physicians are humans. Sowhenever you have, say a gut
reaction towards something in aclinic or have an emotional
(34:56):
response, I think it's reallyimportant to just examine that
and explore why.
And just like Matt said, beingcurious.
Justin Kreuter, M.D. (35:04):
Those are awesome responses. Thank you all
for sharing, your advice andtalking with us today. I think
this has been really impactfulfor me to to think about. I
haven't been deliberate aboutthinking about our health care
system for some time. And thankyou to our listeners for joining
us today.
We invite you to share yourthoughts and suggestions via
(35:26):
email to mcleducation@mayo.edu.If you've enjoyed this podcast,
please subscribe. And until ournext rounds together, we
encourage you to continue toconnect lab medicine and the
clinical practice througheducational conversations.
This is Lab Medicine Rounds, a curated
podcast for physicians,laboratory professionals, and
students. I'm your host, JustinKreuter, a transfusion medicine
pathologist and assistantprofessor of laboratory medicine
and pathology at Mayo Clinic.Recently, I participated in a
hackathon with a group ofmedical students from Mayo
(00:28):
Clinic's Alix School of Medicinehere in Rochester, Minnesota,
focused on global surgery. Andit gave me a really kind of
interesting insight intothinking about how we're
teaching our learners to thinkabout healthcare systems. And so
today, we actually have 4medical students with us to talk
about this topic.
(00:49):
So I'll introduce them insequence for all of our audio
listeners to kinda hear theirvoice. So we'll start off with
Matt Gish, who's a 2nd yearmedical student here at Mayo
Clinic.
Matt Gish (00:58):
Hey, everybody. Thanks for having me, doctor
Kreuter.
Justin Kreuter, M.D.: Absolutely. And Audrey Bankes is (01:01):
undefined
a 1st year medical student hereat Mayo Clinic.
Audrey Bankes (01:06):
Hello, everybody. Happy to be here.
Justin Kreuter, M.D. (01:09):
We've got Yousuf Khalil, is a 2nd year
medical student here at Mayo.
Yousuf Khalil (01:14):
Hi, everyone. Thanks for having me.
Justin Kreuter, M.D. (01:16):
And finally, we've got Richard
Betancourt here as a 2nd yearmedical student at Mayo.
Richard Betancourt (01:21):
Hi, everyone. Happy to be here.
Justin Kreuter, M.D. (01:23):
Alright. So let's kinda kick this off.
Maybe to start off, Matt, why isit important for a physician to
think about health care systems?
Matt Gish (01:34):
Yeah. This is a question that I think we need to
continuously wrestle with inmedical school, And it comes up
in the curriculum over and overagain in terms of content, you
know, who who's paying, what areour insurance companies like,
those kind of things. But Ithink engaging with it in a in a
deeper level and trying tounderstand what motivates not
(01:58):
only our health care system, butalso systems around the world
that we could, at any point,either see our system change
into or go perform in systemslike that themselves. It's just
so important to understand howthe greater structure of health
care influences the decisionsthat we'll make every day.
Justin Kreuter, M.D. (02:19):
Right. I like how you're highlighting
there's a system that we'reworking in. Something's like I
think about it as, like, thefish that's in the water. It
doesn't know what water isnecessarily or for us walking
through the air that we breathe.And maybe some of us don't think
about that as much, but I reallylike the way you talk about
continuously reexamine that.
(02:40):
And so I'm curious, maybe we canall kind of put a tack in that,
and we can kind of come back toexplore that a little bit
further as we go through.Audrey, I could start off with
you. And and I know you're a 1styear medical student, so you're
just kinda getting started withthis Global Surgery Selective.
Are there some of thefundamentals of health care
(03:00):
systems that so far to you havedeclared themselves in your
mind?
Audrey Bankes (03:06):
Yeah. That's an interesting question. Like you
said, I'm 1st year, and so we'vejust started to scratch the
surface of the very complex andlarge topic of health care
systems. But for me, I thinkabout it in the case of how is
it affecting the patients. Andso I know it's a big system, and
I know it's a lot of movingpieces.
But as doctors, I do think thatwe have some small role, and we
(03:27):
can, in some ways, influence howthe system is gonna affect the
patients and the people thatwe're interacting with. And so
that's kind of the biggest thingI started to hone in on so far
is, yes, it's a big system andit's very complicated, but it
does affect real people in realways. And it's important that we
try to make it as best that wepossibly can with what power we
do have in the system.
Justin Kreuter, M.D. (03:48):
Yousuf, I wonder if you could build on
Audrey there, kind of thinkingabout this patience, and I like
the way she's highlighting. Youhave this complexity. And in
order to kinda get our armsaround it, sometimes we have to
simplify something. But there isthis kind of tension, this back
and forth. You're a 2nd year.
You've kind of been with thislongitudinal selective for a
(04:09):
year. How have you seen some ofthese fundamentals come forward?
Yousuf Khalil (04:14):
Yeah. I think, like Audrey was saying, the the
system the system is very, verycomplex, and we've learned a lot
about it in through theselective, through our
curriculum. But even then, Ithink I'm not fully I don't
fully understand it yet, and Idon't think I will until I'm
practicing and and dealing withit every day. I can already see,
you know, in the patients thatwe do see how the system affects
(04:35):
them. And I think even as apatient myself, how the system
is super complicated with withinsurance companies and
everything that, you know, asthat patient has to deal with.
I think as future physicianslearning about the system as
best as we can and trying toincorporate that into our
practice, if the patients haveto deal with them on a daily
basis, we should also learn howto how to, you know, work within
(04:55):
the system to make their livesas easy as possible. And I think
this is particularly importantwith patients who kind of are
more underrepresented and withsome patients who have a more
difficult time with the healthcare system. I think it's
obviously a much bigger systemthan all of us, but I think,
like Andre was saying, to workwithin our means to make it
easier for them specificallytoo.
Justin Kreuter, M.D. (05:14):
Richard, can I ask you you know, so
Yousuf brought up this idea ofwhat we're learning in the
curriculum versus the, selectivethat you guys have elected? How
do you contrast those 2? How hasthe selective enabled you to
explore how you think abouthealth care systems further?
Richard Betancourt (05:34):
Yeah. I think it is important also when
considering a perspective ofwhat a system is and what it's
designed for. And I mean,systems really guide, like, the
conversation of both macro andmicro levels. I think that's
becoming increasingly more trueas we're connected more
globally, as well as, with thefurther division of labor. In
(05:54):
the past, you know, a lot of thepractice was, sort of, you know,
family, a physician oriented,but specialization wallet allows
us to expand ourselves more inexpand what's possible in
healthcare.
We are also missing a lot of theinsights that we're able to
really gain on a systems level.And I think it's really
important when considering thisin the context of inequalities
(06:16):
in the healthcare system and howthe division of labor sort of
upholds a lot of thoseinequalities. For example, in
many healthcare systems, theexperience of billing a patient
is separated from the practice,which acts sort of to shield or,
as a barrier separation fromhaving that person to person
interaction, of what is, youknow, in many cases, for
(06:38):
example, like life changingbills.
Justin Kreuter, M.D. (06:40):
That makes me wonder, Audrey, if I can ask
you, and I realize it may putyou a little bit on the spot,
but does it surprise you as amedical student that, you know,
this kind of Rick's pointingout, thinking about all these
different levels and thinkingabout how billing works. I don't
know if you were an economicsmajor, before coming to medical
school or worked in those ways,but I imagine a lot of people
(07:03):
maybe come to medical schoolkind of focused on learning the
medicine and science. And areyou surprised about this focus
on thinking about how doesbilling work these other
components of the health caresystem?
Audrey Bankes (07:17):
Yeah. I was not an economics major, but that's a
super good question. Like yousaid, I come into medical
school, and I think a lot ofpeople come into medical school
thinking about science andresearch and the lab, and it's
very removed from the billingand the real world impacts on
people. And as Rick said, thatcan be a bad thing in a sense
(07:38):
that people forget that that'shappening, and they can just
start racking up the bills andthe tests and the lab orders
without considering what it'sactually gonna cost the patient
at the end of the day. So Idon't think I'm necessarily
surprised, but it is somethingthat we don't talk about very
often in school.
At least my understanding as a1st year, we haven't talked
about it yet. And so it's it'snot surprising, but it's a
(08:00):
little bit disappointing or alittle bit disheartening, I
should say, that this issomething that's a reality, and
we have to deal with it. Andit's very hard to learn. It's
very hard to understand, andit's something that's bigger
than most of us, so it'ssomething also that's difficult
to deal with and difficult torealize that's the the case for
a lot of patients.
Justin Kreuter, M.D. (08:17):
Yeah. I like the way you put that. I
think there is something aboutan element of how much do we
have to know so that we canfunction in our health care
systems or we can optimize ourhealth care systems. But like
you're, I think, highlighting,there are other colleagues that
are playing these roles as theirprimary. What do people think
about how we strike that balanceof how much do we focus on this
(08:41):
in medical school?
How do we get each other to beable to kind of talk the
financial language withcolleagues or, you brought up
other elements of the healthcaredelivery. How do we work to
interact with colleagues who aremaybe not physicians, maybe
nursing colleagues, alliedhealth, the c suite?
Audrey Bankes (09:04):
I'll start on it just because I left off, but
Yeah. It's tough because medicalschool and medical training is a
finite period of time. Andalthough training is very long,
it still has to be completedwithin an x amount of years, and
you still have to have a finishline. And so it's hard to cram
more and more skills andknowledge and information into
(09:25):
that period of time. So I thinkthat's a tough question.
I think there's more emphasisand more learning that could
definitely be done in medicalschools or on your own free time
as that's something that'simportant for you to learn as a
human being, But I'd beinterested to see what other
people had to say about that.
Matt Gish (09:41):
I've found similarly that maintaining curiosity is
something that has driven me toexplore these complicated areas
of the medical field and kind oflearning humbly from the amazing
people here at Mayo whospecialize in all sorts of
things from patient advocacy tobilling to insurance coverage.
(10:06):
They play such a crucial roleand, I think, are really
underrecognized in our system.And the experiences that I've
had, either working with them ina clinical setting, sitting down
and hearing them speak atevents, conferences, or even
listening in on podcasts likethis one. They've opened my eyes
to the work that they do andgiven me just a little bit of
(10:28):
taste of how I can fit into whatthey're doing as a physician and
try to make this kind of jankyhealth care system that we've
created run a little bit moresmoothly.
Justin Kreuter, M.D. (10:40):
Yeah. I really like the way you put that
back. I wanna put a pin in thatabout curiosity and come back to
that in a little bit. And Iwanna highlight what Audrey was
saying about this curriculum andmedical school being a finite
time, because that hits me rightin the medical educators part
of, right, we're trying to builda curriculum and set of
(11:00):
experiences to build competency,hopefully excellence, in our
physicians. But I think it doesacknowledge the reality that
there are limitations, whichfosters some creativity.
But maybe if I can bend over andask Youssef, how are you finding
opportunities to think aboutexploring healthcare systems so
(11:23):
far in medical school?
Yousuf Khalil (11:25):
Kind of like what Matt was saying. I think
exploring other options as wellin addition to the curriculum,
like podcasts, books, stuff likethat, I think helps to kinda
give a more comprehensive viewof things. And I think even
within the curriculum, you know,the things that are well
established, the things thateveryone has to go to and and is
really important to go to arethose kind of health care system
(11:45):
science classes. But then, youknow, you can add on additional
electives like what we did withthe global surgery selective.
And I think the more you realizehow important it is to learn
these things, I think it justgives you that added motivation
to actually in your free time,even if you're tired from
learning about all the medicineand science all day and it's
(12:06):
it's exhausting and it can hurtyour brain sometimes.
I think it's important to, likeMatt was saying, maintain that
curiosity and that drive tolearn the stuff outside of the
science to kind of give yourselfa more comprehensive worldview.
Justin Kreuter, M.D. (12:19):
Right on. Are there other opportunities
that people have kinda comeacross in medical school so far?
Matt Gish (12:26):
I think this can be a situation where our patients are
some of our best educators.Maybe more than, especially a
lot of us who are just youngerin medical school. They've had
experiences navigating thehealth care system with
different insurance companies,different providers at different
institutions. And hearing outtheir stories is something that
(12:46):
can give us a lot of reallyvaluable perspective. I also
think working through patientcases can be really helpful.
Rick and I were on a teamrecently at a free clinic here
in Rochester, and we had apatient come in feeling
generally unwell. And it turnsout he was a young man, and he
had an ejection fraction of 26due to unknown cardiomyopathy.
(13:11):
And the textbook answer is tocheck some labs, get them on
appropriate heart failuremedications, but our options
were in this setting. We're at afree clinic. We have an
uninsured patient.
And now we're working to try andunderstand how can we best work
within the constraints of thefree clinic in our limited
(13:32):
resources to help this patientand ensure their safety while
also not just sending them tothe ER and causing catastrophic
financial loss. So learning fromthis patient's case and their
experience is something that canreally help heighten our own
knowledge of the world thatwe're operating in.
Justin Kreuter, M.D. (13:51):
I love that example. Right? 1, because
it's specific. But then 2,because I think this gets at
something for all of ourlisteners who probably a
minority of them are going to bemedical students, but hopefully
we got a couple, but who can bethinking about this podcast and
and what might I take away fromthis? And one one of the things
is sometimes we will send apodcast with people in the ivory
(14:14):
towers and such like this, butwhat we're talking about today
about thinking about health caresystems is really thinking about
how we what we can make the mostwith what we have.
And, Matt, can I ask you toelaborate a little bit about how
did you approach that? Because Iimagine there's a temptation of,
well, if we had other resources,I would do this. But how did you
(14:35):
approach doing the best withwhat you had?
Matt Gish (14:39):
Yeah. I mean, it was a complicated situation with
something that kind of took allof the brains of the team that
was there thinking about how wecould work through this
patient's case. We're digging upformer labs. People were calling
previous health care providerstrying to figure out what kind
of myopathy we're looking athere. We're considering, is this
(15:03):
patient clinically too sick tonot go to the ER?
Do we need to send him? We'recalling other resources through
Mayo Clinic Charity Care lookingat, can we get him an urgent
cardiology visit? But also justrecognizing that we can't just
give him the medication off ofour little limited formulary
(15:24):
sheet and hope that it works andtell him to either come back in
or go to the ER if he's feelingsick. Like, these options that
may be available to some peoplewho are better resourced were
kind of off the table for us.And it really just required a
lot of collaboration and phonecalls and trying to figure out
(15:45):
how could this patient's needsbest be served with what we had
to offer in the setting?
Justin Kreuter, M.D. (15:52):
I think you said Richard was with you
with on this case. Right? Andmaybe I can ask Richard. Can you
maybe elaborate of seeing theteam come together? And were
there elements that you saw thatwere kind of, this worked well,
and or are there elements thatyou saw with the team coming
together, that was maybecounterproductive?
(16:13):
I just wanna kind of callhighlight to those elements.
Richard Betancourt (16:16):
Yeah. So I was a little less involved in
this case. There's actuallyanother instance that same day
where a patient was coming infor just a medication refill
and, on exam, we found a,murmur. And then looking back
multiple years, we found thatthey were found to have severe
aortic stenosis that was neverthen followed up on. So that was
(16:37):
basically a similar situation.
So I can speak on, my experiencewith that.
Justin Kreuter, M.D. (16:42):
That'd be fantastic. Yeah.
Richard Betancourt (16:43):
I think one of the major things that we,
identified was, you know, whydidn't they follow-up as well
as, following the impact thatcommunication really has like
on, medical care, especiallywith like say immigrant
populations, because, thepatient was a non native English
speaker and they really did not,seem to understand what the
(17:05):
pathology was as well as likethe needs for it to be followed
up on. And after we were ableto, explain really, and make
sure that they understood whatwas going on, then they were,
I'd say amiable to justfollowing up with the issue to
make sure that nothing badhappens down the line,
hopefully. So I think, in a lotof instances, especially again
(17:27):
with the sub specialization,where we're all kind of confined
to our little boxes, and we'rehyper focusing on efficiency and
getting things done quickly. Wedon't take a step back and, make
sure that say, does the patientunderstand what's going on? I
think that taking a pause and astep back, and the system's
really helped, everybodyinvolved, even though this is a
(17:49):
time consuming process, likeMatt said, you know, it took a
lot of everyone's brains to cometogether for, you know, one
individual.
And I think in a system that,really prioritizes efficiency
and getting things done quickly.I don't know if that is, as able
to be done. So I think that is apretty big impact.
Speaker 6 (18:10):
For more laboratory education, including a listing
of conferences, webinars, and ondemand content, visit Mayo
Clinic Labs dot com forwardslash education.
Justin Kreuter, M.D. (18:26):
I'm really glad you highlighted the pausing
or slowing down deliberately.That's something that
particularly I've read aboutthis in the surgery literature
when it comes to confidenceabout experts realizing here's a
critical point, and so as aresult, like, I need to slow
down. I need to focus instead ofjust this is going along, and
(18:48):
I'm I'm finishing out theprocedure. Maybe I can ask
Audrey, since we were talkingabout this element of building
expertise, is that somethingthat you've started, that you've
been exposed to, this slowingdown to during a critical phase?
Is that something that you'veseen in your 1st year already,
or is that something that youhaven't come across yet?
Audrey Bankes (19:10):
I'll say I haven't come across it in
technical practice too too much,but it's interesting that you
say that because they tell us atleast they've told us several
times that as medical students,we actually have more time than
the attendings and theconsultants and everybody else.
And so for us, it's veryimportant to slow down and maybe
be that one person that sits inthe room, talks to the patient,
(19:31):
listens to their story, hearswhat they have to say. And if
something comes up, we can bringthat back to the consultant and
say, hey. They probably nevertold you this, but I just had a
conversation, and they broughtup a really interesting side
point that I think is importanthere. I think the doctors I've
been around and worked with,they understand the importance
of slowing down, and they doabsolutely try their best to
(19:52):
slow down.
But like Rick said, there'sthere's pressures, there's
outside factors that contributeto that, and sometimes it's just
hard or it's just a little bittoo overwhelming. There's too
much going on, and it justdoesn't cross somebody's mind.
But as a medical student, theyhave harped on us. It's
important to learn that. And,hopefully, if we do take the
time to learn to slow down, thatcan carry forward to when we're
the consultants and we're theattendings, and we can really
(20:14):
put that into practice,hopefully, in the future.
Justin Kreuter, M.D. (20:17):
It makes my medical educator heart go
pitter patter that you'rehearing this already in the 1st
year, and this is beingencouraged. Yousuf, can I ask
you, you're a 2nd year? Have youseen this play out? And I'm
wondering if you can kindaspecifically highlight some of
that tension between getting thework done but slowing down. How
have you seen this navigated?
Yousuf Khalil (20:39):
Yeah. I think in terms of taking that pause and
taking a time out, I think I'vemainly seen it a more explicit
time out in the surgery in thesurgical setting like you were
mentioning. But just in terms ofpatient care in the positions
that I've been in so far, it'smainly just been coming in,
getting a quick history andphysical, and going back and
speaking to the consultant. ButI think I started off very
(21:01):
anxious about that and wantingto make sure that I got it done
in a timely manner. But I foundthat when I was doing that, I
was not doing it well.
And so I think when I startedhaving first of all, a checklist
when I go in, a checklist ofthings that I wanna ask about,
and making sure that I take mytime with the patient and listen
(21:22):
more than I hammering outquestions at them. I've noticed
that I end up getting a muchbetter history from them. So I
think kind of keeping thateither checklist in your mind or
checklist with you in front ofyou when you go in to speak to
them, I think is superimportant. And I think that's
something that I reallyappreciate about being at Mayo
is they teach us the importanceof being present with your
(21:44):
patient. Because those thingsthat I told you that ended up
helping, those aren't thingsthat I came up with.
Those are things that myconsultants told me that I need
to get better at. And when I didincorporate those, I found,
first of all, a much morecoherent a much more cohesive
relationship between me and mypatients.
Justin Kreuter, M.D. (21:59):
I wanna go back to this idea that was said
earlier in our recording hereabout this idea of continuously
revisiting how we think abouthealth care systems. I know
we've been really focusing in onspecific examples. I wonder if
we can kinda pull back, and I'mgonna ask us to maybe go a
little bit metacognitive andthink about how we're learning
(22:22):
stuff. But, you know, this isreally kind of an open, maybe a
junk ball question. I'm gonnaput it up there and set it out.
How do you approach continuouslyrevisiting something? If we
think about medical school asthis spiraling curriculum where
we're getting exposed to thingsand regetting exposed to things,
(22:42):
but because of our trainingwe've had in the interim, we can
go deeper. How do you guysapproach capturing that learning
so that you are meaningfullyrevisiting this each time?
Richard Betancourt (22:57):
I personally, we have I'd say a
class that's called senior sageswhere we meet with a a retired
medical doctor. And in general,they helped give us like life
advice for what they foundhelpful during their experience
as a physician. And my Sage,recommended me to keep a
notebook and write down justlike things that I've done
(23:18):
throughout the day, things tohelp with like memory. And I
think that it's very helpful tohelp write down important
learning points just to, youknow, have it down. And then
maybe once in a while, I like togo back and read through my
notebook.
And it also helps with just likeremembering funny moments that I
might have forgotten about.
Justin Kreuter, M.D. (23:35):
Well, spot on. I think that's an a
wonderful technique. Do othershave other ways that they're
capturing their learning?
Yousuf Khalil (23:42):
I think for me, I think being in medical school,
I've realized that learning thescience and the medicine and
everything is very important,but I think something that's
even more important potentiallythat they're teaching us is how
to think about things and how toresearch things that we get
interested in. So I think havingthat context and learning if if
I find something that I feel isparticularly important, how to
(24:03):
how to do a deep dive and figureout everything about it and
figure out what is importantabout it. I think just kind of
that high level thinking, Ithink, is something that I
really appreciate that I'm I Ifeel that I'm gaining from
medical school. Yeah. I think Ithink that's something that I
would I would say I use to tolearn more.
Audrey Bankes (24:21):
A little bit different, and, of course, I
haven't had as much experienceas the other people here. But
when someone gives me feedbackor maybe something I didn't feel
great about, I usually rememberthat or jot it down or
something. And then I really tryto find as many opportunities to
practice and relearn and usethat skill as I can. So every
free clinic, I go and volunteer.Every opportunity to work with
(24:42):
my family on something, I usethat.
Every opportunity to go to afree suture clinic at the
school, I use that. So I justreally try to repractice that
skill over and over and overagain and just utilize
opportunities that are alreadyright in front of me to really
exploit those skills and makesure I'm learning it over and
over again even if I feel okayabout it.
Matt Gish (25:02):
Yeah. And I think our patients can be our best
reminders to take those deepdives, like Youssef was saying,
and just remain curious. Andwhen they have a a barrier to
taking a medication or they'retrying to figure out what
insurance plan is gonna maybework better with their new
diagnosis, taking those casesand instead of just letting it
(25:24):
be a, oh, that's interesting or,oh, I wonder. Taking the time to
resist the urge to only studytestable material and really
letting curiosity drive you intothat deep dive. Hey.
I'm gonna go back to theworkroom and do some research on
what kind of plans would be bestfor you and your situation right
(25:47):
now. Or, hey. I don't know a lotabout how we can get that
medication covered, but I thinkthis would be a great
opportunity for me to learn.It's those moments and those
interactions that I think aremost frequently brought about by
our own patients that we canreally use as a platform to dive
(26:07):
deep and learn well.
Justin Kreuter, M.D. (26:09):
Okay. It's official. I think I wanna
recruit all 4 of you to becomepathologists. You know? This I
the idea, the way you guys aregoing about capturing your
learning, the way you're talkingabout it sounds like you guys
are all internally motivated.
You've got the curiosity, thefire, and you're looking to just
get the repetitions and practicevariations on a theme. So these
(26:31):
are all elements that ourlisteners can really take away
from this podcast. Right? Ifyou're a physician in practice,
you know, that listening tothese medical students might be
sparking in your mind to thinkabout some of these adjacent
areas of your practice that youmay not be taking a deep dive
into, but certainly is the waterthat we're swimming in, the the
(26:52):
health care system that you workin. If you're a laboratory
professional, you could bethinking about how am I
interacting with physicians andhelping them understand how they
can optimally use the lab inwhatever kind of resource and
situation that you findyourself.
And students, if you'relistening to this, I think
there's some great tactics andstrategies that these medical
(27:14):
students are really articulatingthat I just wanna call your
attention to, this idea ofwriting things down, reflecting
on things, and practicing theheck out of it are all fantastic
strategies. Can I ask you,medical school is a challenge? I
imagine sometimes you're tired.I don't know. Maybe you guys
have, like, some battery insideyou that is just, like, amazing.
(27:37):
But how do you maintain thatcuriosity when it's tough?
Audrey Bankes (27:42):
For me, it is hard sometimes, and the
motivation dwindles. But similarmuch to the previous question,
circle back to things that Ireally enjoy and I really like.
And I was like, you know, thisis tough. This is maybe not my
favorite thing at the moment,but can I apply that to an area
that I really love and I'mreally passionate about? For me,
that's really serving underunderinsured, underserved
(28:05):
patients.
So if I'm learning aboutpharmacology and I'm judging
along, learning about a 100drugs a week, and it's, you
know, it's tough. It's not thefunniest thing for me
personally. But can I apply thatto my patients that I'm gonna
see in the free clinic? And thisis really important medication
for them. I need to understandthis.
I need to know this, so it'simportant for me to learn. And
kind of remembering that in theback of my head does help
(28:26):
motivate me even when I'm tired,even when I'm late at night and
just wanting to go to bed.
Justin Kreuter, M.D.: Reconnecting with your why is (28:31):
undefined
what I'm hearing. That that'svery powerful. Youssef, were you
gonna hop hop in?
Yousuf Khalil (28:37):
Yeah. I hate to be repetitive, but I think
that's exactly my answer. Acouple of things I think being
in the preclinical phase of yourstudies is it can be
particularly demoralizingsometimes just because you're
constantly your head's in in Iwas gonna say your head's in the
books, but I haven't opened atextbook this entire time. But I
had more in the laptop, I willsay. But you're just learning
(29:00):
the science behind things andthe medicine behind things, and
it's hard to see how it appliesto real life sometimes.
And I think having littleexposures here and there as to
how we can help patients andparticularly patients who need
it the most, I think, is very,very helpful. And for me
personally, my family isEgyptian so, you know, they
immigrated here a while ago andI go back to Egypt constantly
(29:21):
and so I see I have exposure towhat's available there and the
stark difference in what somepeople have access to. And so I
think having that kind of driveto help people back home or
people even in America who havesimilar experiences, I think
that's a big thing that can keepme going when the going gets
(29:43):
tough, honestly.
Justin Kreuter, M.D. (29:44):
I really like the way I think your
response, Yousef, actually,yeah, it does build on Audrey's.
Right? I mean, it's well, it isboth both of you are saying
you're connecting to your why. Ithink you're, like, highlighting
the floristy of just how diversethat why may be. And I think
that's something that I'm gonnabe taking away from this
(30:04):
conversation with you guystoday.
I know for myself, sometimeswhen I'm on service and at the
end of the day, I would justwanna go crash on my couch. But
I know I still need to crackopen and, you know, the latest
publication that came out. Ineed to be aware of what those
papers are. Okay. I wanna do thething that I I said at the
(30:24):
outset that I wasn't gonna do.
That's to ask a question, justgo down the line, but I just
wanna take our listeners out byhaving each of you share, what
advice do you have for ourlisteners who would like to
further develop their abilities,their skills to think about
(30:44):
health care systems? Becausesome of our listeners may not
have really deliberately thoughtabout this in a while. Some of
our listeners may notnecessarily be thinking in in
these terms or or just bestarting to. So what advice do
you have for them? And I guessI'll I'll thank you as we're
kinda going out and and startwith Matt Gish.
Matt Gish (31:05):
Yeah. Thanks again for having me, doctor Kreuter.
This has been a ton of fun. Ithink my biggest piece of
advice, and something that I'mstill working on daily, is to
continue to chase curiosity.When a patient presents with a
socioeconomic challenge oryou're having trouble navigating
the system that you're providinghealth care within, taking a
(31:28):
step back in trying to identifywhere that confusion's coming
from.
And even if you have a testcoming up on the radar or you've
just got other emails andresearch projects to focus on,
being able to chase down thatcuriosity and listen to a
podcast, flag a couple articles,pick up a book, maybe that
(31:50):
challenges the way you currentlythink about the health care
system. Those are the thingsthat, coming back to our why, I
truly believe will help make methe best provider I can be
someday. At times, it's reallyhard to understand the value of
chasing down curiosity asopposed to doing more flashcards
and more practice questions. Buttaking a step back and
(32:14):
understanding who do I wannabecome and how do I get there, I
think taking those learningopportunities is always the way
that will help me push forwardand become the best that I can
be.
Justin Kreuter, M.D. (32:25):
Thanks so much for sharing, Matt. Audrey
Bankes.
Audrey Bankes (32:28):
Yeah. I think probably everything I'm about to
say has been said in one way oranother, but for me, asking
questions is a huge one. If youdon't know something, you don't
understand something, just askthe question. Usually, people
have a lot of information andbackground knowledge that you
don't have, and it's reallyvaluable just to let them share
that with you. The second one,for me, I really like to engage
(32:50):
with people who aren't typicallydoctors or maybe not, you know,
in the same realm as us.
So if you can reach out topeople who know a heck of a lot
more about health systemsciences than you do yourself,
that is gonna be so hugelyhelpful. It just gets you
outside of your bubble, helpsyou see things from a different
perspective, which I reallyvalue it when I'm learning
anything. And then the third oneis if you have the time and the
(33:11):
energy, use your own personaltime to do some googling, look
up a cool video, look up a coolarticle. It doesn't have to be a
lot, but, you know, if you justkinda get the itch to learn
something, just read a quickpaper. And I think that if you
do that every once in a while,you'll still learn a lot, and I
think that's really powerful todo.
Justin Kreuter, M.D. (33:28):
Thank you, Audrey. Yousuf Khalil.
Yousuf Khalil (33:31):
Yeah. Thank you so much for having me again,
doctor Porter. I think I thinkfor me, my big takeaway would be
to think about the context thatyour patient presents in or
comes from. I think we in themedical field have a lot to
learn from people in the fieldof public health and
epidemiology and health systemscience, and I'm biased because
(33:51):
my wife does study publichealth, but I think we do have a
lot to learn from it. And Ithink learning about social
determinants of health andlearning about the conditions
that lead to conditions thatpatients present with.
And so I think we have a lot tolearn from the field of public
health and to incorporate thatinto a more holistic, worldview
of the field of medicine.
Justin Kreuter, M.D. (34:12):
Thank you, Yousuf. And Richard Betancourt.
Richard Betancourt (34:15):
I think for me, there's a lot of talk about
examining or taking out bias orin the context of global health,
taking out western perspectiveswhen can when it comes to health
care. And I think this followsthe same issue, when it comes to
the idea of say likecolorblindness when looking at
racism, where it ignores thefact that we live in systems
where these biases areubiquitous to a certain extent,
(34:35):
whether consciously orunconsciously. And one teaching
point that I remember from classis there's this idea where
physicians are meant to be thestoic beings that are objective
and operate in the only theconfines of science. But I mean,
physicians are humans. Sowhenever you have, say a gut
reaction towards something in aclinic or have an emotional
(34:56):
response, I think it's reallyimportant to just examine that
and explore why.
And just like Matt said, beingcurious.
Justin Kreuter, M.D. (35:04):
Those are awesome responses. Thank you all
for sharing, your advice andtalking with us today. I think
this has been really impactfulfor me to to think about. I
haven't been deliberate aboutthinking about our health care
system for some time. And thankyou to our listeners for joining
us today.
We invite you to share yourthoughts and suggestions via
(35:26):
email to mcleducation@mayo.edu.If you've enjoyed this podcast,
please subscribe. And until ournext rounds together, we
encourage you to continue toconnect lab medicine and the
clinical practice througheducational conversations.
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