Natalie Freels, a trailblazing Physician Assistant, illuminates the pathways of hospital internal medicine with a unique blend of passion and expertise. From her beginnings as an EMT to shaping innovations in healthcare, Natalie captivates with stories of problem-solving and systems-based thinking that are reshaping medical landscapes. We promise you'll gain a deeper appreciation for the transformative potential of clinician-led initiatives as Natalie shares her significant contributions to disaster preparedness and electronic health record optimization.
How do clinicians enact meaningful change in the complex world of medicine? Natalie dives into the heart of this question, shedding light on the crucial need for advocacy, collaboration, and feedback within healthcare settings. By emphasizing the role of diverse perspectives and the integration of simple, effective solutions, she outlines a roadmap for achieving sustainable progress. Moreover, Natalie highlights the importance of understanding the everyday challenges faced by healthcare professionals, advocating for leadership that bridges the gap between administrative decisions and clinical realities.
Ever wondered what a day in the life of a hospital internal medicine PA looks like? Natalie takes us on a journey through her routine, balancing patient care, teaching, and professional development. Her dedication extends beyond the hospital, as she delves into healthcare technology and emergency management, advocating for robust electronic health record resiliency planning. From memorable interview questions to insights on patient-centered care, this episode promises a comprehensive look into the rewarding and multifaceted world of medicine through the eyes of an inspiring healthcare leader.
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:00):
Hello and welcome to Shadow Me Next, a podcast where
I take you into and behind thescenes of the medical world to
provide you with a deeperunderstanding of the human side
of medicine.
I'm Ashley, a physicianassistant, medical editor,
clinical preceptor and thecreator of Shadow Me Next.
It is my pleasure to introduceyou to incredible members of the
(00:22):
healthcare field and uncovertheir unique stories, the joys
and challenges they face andwhat drives them in their
careers.
It's access you want andstories you need, whether you're
a pre-health student or simplycurious about the healthcare
field.
I invite you to join me as wetake a conversational and
personal look into the lives andminds of leaders in medicine.
(00:43):
I don't want you to miss asingle one of these
conversations, so make sure thatyou subscribe to this podcast,
which will automatically notifyyou when new episodes are
dropped, and follow us onInstagram and Facebook at Shadow
Me Next, where we will reviewhighlights from this
conversation and where I'll giveyou sneak previews of our
upcoming guests.
(01:04):
Today, I have the pleasure ofintroducing Natalie Friels, a
distinguished PA in hospitalinternal medicine at the Mayo
Clinic in Florida and arecognized leader in healthcare
innovation.
Natalie's expertise extendsbeyond direct patient care.
She is deeply involved inresearch, technology integration
(01:24):
and healthcare systemsimprovement.
She plays a pivotal role inoptimizing electronic health
records, integrating wearablemedical technology and enhancing
disaster preparednessstrategies.
In addition to her clinicalresponsibilities, natalie is a
trusted advisor in health techinnovation, helping companies
(01:45):
refine their strategies andbridge the gap between clinical
practice and transformativehealthcare solutions.
She is also a subject matterexpert for multiple committees
at Mayo Clinic, where she worksto improve practice efficiency
and patient outcomes.
In today's conversation,natalie shares how her early
(02:06):
experiences as an EMT shaped herpassion for problem-solving and
systems-based thinking.
She discusses her transitionfrom aspiring to work in the ICU
to discovering a fulfillingcareer in hospital internal
medicine, where she balancescomplex patient care with
leadership in healthcareinnovation.
A particularly compellingdiscussion centers around her
(02:29):
work in disaster preparedness,where she has developed
resiliency plans for electronichealth record downtime, an often
overlooked but essential aspectof hospital operations.
She also offers valuableinsights into how clinicians,
regardless of their role, candrive meaningful change in
medicine through advocacy,innovation and collaboration.
(02:53):
Natalie's perspective isinsightful and inspiring, and I
am excited to share herexpertise with you today.
Please keep in mind that thecontent of this podcast is
intended for informational andentertainment purposes only and
should not be considered asprofessional medical advice.
The views and opinionsexpressed in this podcast are
(03:14):
those of the host and guests anddo not necessarily reflect the
official policy or position ofany other agency, organization,
employer or company.
This is Shadow Me Next withNatalie Friels.
Hey, natalie, thank you so muchfor joining me on Shadow Me
Next.
This is going to be such a funconversation.
I can already feel it.
I appreciate you taking thetime to spend with us today.
(03:36):
Thanks, ashley, so happy to behere.
So let's start.
Natalie, tell us a little bit,generally speaking, about what
you do.
What is your title and whatdoes that mean?
Speaker 2 (03:49):
Sure, absolutely.
So I am a physician assistantworking in hospital internal
medicine.
So I'm a PA, which means I havea master's in physician
assistant studies.
I got that degree from theawesome University of Florida in
Gainesville.
Then I went on to work with theMayo Clinic.
I work at our Florida campusand I work in the Division of
(04:09):
Hospital Internal Medicine,which is part of our Department
of Medicine.
So what that means is me and myteam.
I have a fantastic team ofalmost 80 physicians and almost
30 advanced practice providers,which means nurse practitioners
and PAs.
We work together, typically inteams of two, and we carry
almost one-third of the hospitalload at any given time.
(04:31):
So we see all kinds of patients.
We see new admissions from theED, we see preoperative and
postoperative patients, we seepatients who are downgraded from
the ICU.
We cover a wide variety ofpathologies and we work really
closely with our subspecialtyteams neurology,
gastroenterology, cardiology,pulmonology basically to manage
(04:54):
a very wide variety, wide arrayof different clinical symptoms
and different diseases thatwould bring someone into the
hospital, so we admit.
And different diseases thatwould bring someone into the
hospital, so we admit, wetransfer, we optimize and then
we discharge them.
A big part of my job also ismaking sure that people have set
in place the resources, or atleast information on resources
(05:16):
that will facilitate a safedischarge.
So this means good follow-upwith their primary care or being
seen by a subspecialty teamafter discharge, making sure we
really can use theirhospitalization to really impact
their health in a positive way.
Speaker 1 (05:31):
That is an absolute amazing amount of work that you
do.
I can't imagine that many,first of all, working in a team
that large 80 physicians and 30APPs, and then all of the I mean
the patients.
The numbers game here is justhuge.
When you were in PA school, didyou ever think that you would
(05:52):
be a part of a team like thisand seeing this many patients in
this capacity?
Speaker 2 (05:57):
I know it's really incredible to imagine.
No, honestly, when I went to PAschool, I really thought that I
would find myself, I find myway into the ICU.
That was pretty much my planfrom day one.
I was really interested in anICU fellowship, and that was my
plan.
I knew, though, whatever I wasgoing to do, I really wanted to
stay more broad, right.
(06:19):
So the ICU treats a wide varietyof different types of things
that can make you, you know socritically ill, and I think that
just the more I had experiencewith internal medicine and then
intensive care, I think Idecided I wanted to do the
switch to something a little bitless acute, but still stay
really broad.
That's really what I wanted todo after school was, you know,
(06:41):
develop a skill set looking at awide variety of things, and
then it was just kind of easy tomake that switch from something
a little bit less acute tosomething a bit more walkie
talkie.
You know, as we say at thehospital, are they walking, are
they talking?
And I've enjoyed that for awide variety of reasons.
One is definitely the work lifebalance.
(07:02):
I have two little kids at home,so when I was looking into
getting into intensive care.
Some aspects of the scheduleweren't as appealing and I think
the other part is I like toform a bit more of a
relationship with people.
I hopefully don't only see themonce, maybe twice, if they're
admitted a few times over thecourse of the year, but I really
(07:24):
like that aspect of being ableto coordinate care for them and
with them, talk to their primarycare, if I'm able to, and then
a lot of that you really areable to do as an internist in
the hospital.
Speaker 1 (07:35):
That's very cool.
I'm glad to hear that thequality of life, even when you
are so involved in hospitalmedicine, that the quality of
life is still there, and I'dreally love to touch on that in
a little bit.
But let's go back, natalie,because you know you mentioned
that you you've always reallybeen interested in the ICU, in
in, obviously, what you're doingright now in hospital internal
(07:57):
medicine.
It's all very complex, which Ithink a lot of medicine is
complex, but at a certain pointthere are certain things that
have more wheels spinning thanothers.
Right, tell me a little bitabout your life, maybe before PA
school.
Have you always been interestedin, you know, problems with
this level of complexity?
Or is this something that youdiscovered when you were in in
(08:17):
PA school, maybe a little bitbeyond?
Speaker 2 (08:20):
Yeah, I you know, asha, I know I knew I wanted to
go into medicine, since you knowI was.
I was really little and I thinkmy high school and college
career was really set on findingexactly what that path would be
.
But I knew I wanted to go intomedicine.
I knew I liked a little bit ofexcitement.
That's probably why I was moreinterested in the ICU.
(08:41):
So when I was in college I wentand I got my certificate to be
an EMT and for two years I waswith a private EMT company that
serviced Fulton excuse me,dekalb County, which is one of
the largest counties in Georgia,in the metro area that covers a
good part of parts very, veryclose to the city of Atlanta.
So I that was really my firsttaste for medicine as far as
(09:04):
like a professional career wasas an EMT and I I love that so
much.
I learned so much from thatexperience.
I think one of the biggestthings was I got to see where
the patients come from, right.
So whether we're in the clinicor in the ED or in the hospital,
that's such a sterileenvironment, right.
(09:25):
You know they're coming intoour turf, so to speak, and with
emergency medicine in the field,you know you're on the
patient's turf, you're in theirhome, you're in their car,
you're in their place of work,and I learned so much about
patients, about patient care,from that experience, because
it's such a raw picture of whatit means to be a patient and of
(09:47):
that person Like you just get somuch information.
So you know I, what I lovedabout emergency medicine in the
field also is that all thoseproblems that we talked about
you know, all those illnessesthat you're managing, even for a
short time, you're on your own,you know it's you and your
partner, and not only do youreally have to know your stuff,
but you have to be able totriage, you have to be able to
(10:09):
think quick on your feet andmake sure that you're delivering
, you know, the best patientcare, while also keeping
yourself, your partner and yourpatients safe is a huge part of
that.
So I really learned so muchfrom that experience and I think
that level of complex problemsolving has always been a real
love of mine.
I'm someone who, when I see aproblem or an inefficiency and
(10:34):
this is more like taking a stepback systems based not so much
direct patient care, but when Isee an inefficiency or a problem
, I really can't look away LikeI really really can't, I can't
not solve it and that's justsomething that's always, you
know, carried with me in so manyaspects of my life.
I was just talking about thiswith somebody, but my very first
(10:56):
pitch right, my very firstpitch deck.
I gave a presentation to myguidance school counselor in
elementary school on why weshould switch from styrofoam
plates to plastic trays.
And I did.
I did market research.
I knew that we had a, I knewthat we had a dishwasher, I knew
that we actually had alreadypurchased the plastic trays
(11:17):
there upstairs in like a storageunit, and and I just saw this
problem I was like we'rethrowing away all these trays
and we don't need to.
And here's a solution and hereis the research on why we should
do it differently.
And here's the presentation.
So all that to say is whether itwas as an E, through my EMT
company, working with FEMA, Iresponded to several different
(11:39):
national disasters, mainlyhurricanes, from where we were
located.
So, being able to work on alarge team problem solving
things that came up with thatyou know event to transitioning,
you know, out of EMS and intoPA school, into hospital,
internal medicine, problemsolving not only on a daily
basis for patients, but also ona systems level.
(11:59):
You know, where are theinefficiencies, where are the
gaps in care, where can we makethis process better?
That kind of thinking, that wayof thinking has been, you know,
so important to me and reallyhas carried me through so many
different aspects of my career.
Speaker 1 (12:14):
I'm so glad to hear that, because right now there's
this buzz about all of theseproblems in healthcare right,
and I just was speaking toanother guest about whether our
healthcare system is broken, andI'm sure that there are some
people who think it is and then,if they have your mentality,
(12:36):
they're looking at thishealthcare system just feeling
overwhelmed because all they'reseeing are so many broken pieces
.
But, natalie, and we're goingto get to this you are so
involved in finding these areasthat need improvement and
improving them, and I think thatis such a breath of fresh air
in medicine, and not justmedicine, but specifically in
(12:58):
being a PA fresh air in medicine, and not just medicine, but
specifically in being a PA.
Have you found that this issomething that is largely
possible to identify solutionsand work with other members of
the healthcare field to fix them, or are you really just having
to forge your way through to tryand make some of these things
happen?
Speaker 2 (13:16):
A little bit of both, to be honest.
A little bit of both, I think.
For the most part, you know,any clinician, any person in
healthcare can make a change,and I really do believe that the
best innovations come frompeople who are in the trenches
and I know.
Later, you know we can talkabout my work with some startups
(13:37):
, but that's really what I foundwith startups and with working
at my institution, as the bestideas for process change, for
systems change, come from thepeople who have to deal with
that problem every dayhealthcare.
(13:59):
To start where you're at, whatis the problem that I'm facing
today, my patients are facingtoday, and what is something
within my control that I can doto change that?
And I totally resonate withwhat you mentioned.
A prior guest said.
It can definitely feel sooverwhelming, and I think if we
can focus on the small littlespheres of influence that we all
have, the small little spheresof influence that we all have
and, you know, optimize one ortwo things, start with that it
(14:28):
really starts to be a snowballeffect.
At the same time, though, youknow it has been difficult
because there aren't as manynon-physician clinicians in
these kinds of higher rolesdealing with optimization.
I'll say non-physician ornon-administrative, so someone
with maybe a master's inhealthcare administration and I
wouldn't say that's a barrier,though I really don't believe
(14:48):
that.
I really don't view it as that.
I just view it as a place thatwe haven't yet made a name for
ourselves.
I think what we're seeing ismore nursing staff step into
that role as well, and I thinkthat more and more PAs and
people of various educationalbackgrounds will step into roles
.
Because I think what we've beenfinding, honestly, is that we
(15:13):
are pushing forward with changethat's not necessarily
clinically informed, right.
We're pushing forward for theseideas, for these possible
changes, and maybe we're notengaging at the source as much
as we should.
And that's just my opinion.
That's just kind of some of thethings I've seen through my
(15:34):
work and through working withsome companies.
Is that really, when we engageclinicians and talk about their
pain points, that is when we getthe most bang for our buck as
far as change and progress.
Speaker 1 (15:47):
I agree a hundred percent and I love what you said
about starting where you're at,because that is where you're
going to make a differenceperiod, and then it gives you an
opportunity to really practiceleadership in a place where
you're really comfortable, whichis perhaps your own clinic or,
if you're not in medicine,wherever you're working,
(16:08):
wherever you're spending themost time right now.
Practice your leadership rolethere, practice your ability to
make a change there, see how itfeels, see what works and then
start to expand that.
I love the idea of having moreclinically driven people in
leadership.
Not that we need to flood thatarea, right.
(16:28):
We just need to make sure thatthere are voices there as well,
because we need ouradministration, we need all the
many different voices inmedicine, which, of course, on
the shadow me next podcast,we're hearing from all of these
voices and it is just amazingthe, the innate value in each
specialty, in each field ofmedicine, and the different ways
(16:49):
everybody thinks.
I mean it would be incredibleto have all of those voices
coming together to address aproblem and then, you know,
reach a solution that is justreally eloquent and really
complex but still well thoughtout, you know.
So I think, I think that'sincredible, that's great.
Thank you for doing that workthat you're doing.
That's just, it can't be easy.
Speaker 2 (17:12):
No.
And I, and I think sometimes,like the, the best solutions are
so simple, you know, and itjust kind of hits you, hits you
hard when you're realizing, oh,you know this problem we've been
having, you know it's simple,yet difficult to achieve.
And so how do we bridge thatgap of a need and a possible
solution?
And I think also, you knowyou're going to try a lot of
(17:32):
things that don't work, you know, or you're going to try a lot
of things and people aren'tgoing to understand the value of
what you're trying to getacross.
And I think, if anyone isinterested in systems innovation
or process change, you reallyhave to be willing to hear the
word no and to know when to pushon, so to speak, and when to
(17:55):
not take no for an answer andwhen to say okay.
You know what?
There's just not a lot ofbuy-in for this.
You really need buy-in from allsides of the equation in order
for a change to really take hold.
And I think that it'sdefinitely a fine line of
knowing when to push on and whento say you know what?
I don't have buy-in, and sothis really isn't going to work
(18:17):
right now.
This is the season for thischange, and that's hard.
As an innovator, that's reallyhard to hear.
You really want everyone to seethe problem the way you see it,
and I think that there's a lotof humility in that too, feeling
able to say you know, I may nothave the right answer today,
and I actually probably won'thave the right answer today, and
(18:37):
that's okay, that's fine, we'regoing to keep trying and keep
trying things that work.
I think the place that clinicsand companies really get into a
pickle is when they don't wantto hear from the doctor in the
clinic or the nurse doing labdraws.
They don't want to hear aboutthe day-to-day issues, and I
(19:01):
think that you know any and alladministrators should really be
in the trenches, at least insome respect, with their staff
to hear what the pain points are.
And that's really somethingthat I've been happy to do, and
I think that that's one of thethings that really informs.
You know, both my clinical workand my additional, more
administrative work is that Ifeel those pain points every day
(19:24):
and I love talking about itwith people.
I love stopping people in thehallway and saying like, let me
pick your brain about this ortell me about how this is going
or what do you think about this?
And a lot of my ideas don't goanywhere, but they're ideas and
maybe they'll go somewhere later.
But I think it's really alsojust about having that mind of
(19:45):
progress.
How can we make this better foreverybody?
Not only how can I make thisbetter for the doctor, not only
how can I make this better forpatients, not only how can I
make this better for revenue.
It has to be all of it.
It really does have to be allof it to be something that's
truly impactful and sustainablefor sure.
Speaker 1 (20:05):
Natalie, you mentioned your focus on whole
person care and you're reallytaking that concept that should
just apply to medicine andyou're expanding it to the
actual capital M medicine, right?
It's not just like you said.
It's not actual capital Mmedicine, right?
It's not just like you said.
It's not just the physician,it's not just the people in
leadership, but we need to becommunicating and taking care of
(20:28):
and listening to everybody inmedicine.
That is the teamwork model.
I think that is so great and Ijust applaud you so much because
I think that that takes a levelof humility to approach
somebody and ask that questionhow are you doing?
What are your pain points?
What are you really enjoyingright now?
(20:50):
Because so many times, I'm sureyou're going to get some
feedback.
That is not ideal, right, andpeople are gonna open up to you
about their issues and theirconcerns and their problems and
as clinicians, we're used todealing with that.
But we're used to dealing withthat when we can say oh, I think
I know your diagnosis, let mego ahead and give you this
(21:11):
treatment, right.
But when people are presentingthese complex issues that are
related to their place of work,it takes a person with a lot of
humility, to stand there, listenand say you know what, I hear
you.
We can work through thistogether.
Let's find a solution.
So thank you for doing that.
I think that's probably it's alot more complicated than people
(21:32):
realize.
It's not just giving people eartime.
Speaker 2 (21:35):
No, exactly, and I think it absolutely is, and I
all I can say is I wish I hadmore time for that, because that
really is fulfilling, likedeeply, deeply fulfilling for me
, both inside my institution andoutside.
Hearing what are those painpoints and how can we
troubleshoot together issomething that I really, really
feel energized by, and I thinkthat, even taking it a step
(21:59):
further, what I love about it isthat it is completely a highway
for relationship, right?
I can't tell you how manypeople I've really come to know
well at my hospital just becausewe stopped in the hallway and
started chatting about somethingyou know.
I really do believe in thepower of relationship and the
power of connection, oftentimesover you know, shared issues or
(22:23):
shared problems, and to be ableto say you know, what is it that
you're dealing with here, howcan we optimize it, how can I
help?
And I'll be completely honest,you know, a lot of times I can't
, a lot of times there's reallynothing I can do.
It's way outside of my verysmall sphere or my very small
scope, but I think three things.
Number one you sat and listenedto that person's like validated
(22:47):
, heard, right, it probably wasan exercise and thought for them
to even brainstorm some thingsthat they that could be
different, right.
Number two you're formingrelationship, which is arguably
the most important.
And then number three, like ifthere's any connection or
handing off to different teamsthat I can do.
I absolutely facilitate thatand I that's really what I'd
(23:09):
like to see more of before beinghonest is is you know more
people talking about the thingsin healthcare that are going
well, the things that aren'tgoing well, and you know how do
we work together, how do we handoff to somebody who can maybe
help us solve a problem?
I love seeing the new thingsthat are coming out, new systems
(23:30):
change that are coming out andexcited for really a return back
to the basics.
I am excited about the next intech return back to the basics.
I am excited about the next intech, right, of course, but I'm
also just excited to see us as amedicine, like you said,
capital M really return toreally what the basics of
patient care should be andreally is.
I think a lot of that is, likeyou said, whole person care.
(23:52):
What does that mean?
We're taking care of the wholeperson and all the aspects that.
That includes stress management, sleep, adequate nutrition, a
social connection, you know,staying away from harmful
substances, those are, you know,that really is the basis of
(24:13):
health.
And so getting back to thiswhole person version of health,
and I think a lot of people say,oh, you know well, you're just
in hospital medicine or hospitalmedicine is just for dealing
with that pneumonia or thaturosepsis or that ICU downgrade,
and it's not.
You know, that's a reallypoignant time in a person's life
(24:36):
.
They hopefully may only behospitalized once or twice or a
handful of times.
And if I can say something tothat person that helps them take
care of the whole self or setsthem up in a way that they can
get better whole person care,then you know that's a success,
that's a huge success.
And I think that's really beenedifying for me, especially with
(25:00):
how difficult the landscape ofhealthcare has been in the last
few years.
Being able to really go back tobasics with patients and have
the time to be able to do that,that's been really incredible
(25:21):
those hospital stays.
Speaker 1 (25:21):
A lot of times, for a lot of people they're
springboards to a whole newoutlook on life and a whole new
outlook on their own health,right.
So the more people that we have, the more clinicians that we
have pouring into this wholeperson idea of medicine, the
better off this patient is goingto be.
I think about you know, indermatology, which is where I'm
currently working, I love that.
I have the time to celebratebig health wins with patients,
(25:44):
right, and a lot of times mournmajor health losses with them
too.
I was just today.
I had a patient tell me thatthey just hit losing 100 pounds
with diet and exercise and theywere they were so proud of
themselves and we got tocelebrate that and they were
able to tell me these thingsbecause they knew I've asked
(26:04):
about them in the past.
We've talked about exercise,we've talked about diet, we've
talked about how hard it is tomake healthy eating choices
sometimes and all of the burdensthat go into that, and arguably
that doesn't have a directrelation to dermatology, right,
we're talking about these thingswhile I'm performing a skin
exam, but it's really more.
It's just talking to the personabout their health you know,
(26:27):
and making time for that is isso important.
Natalie, I've been so excited totalk to you because, as a PA,
you have stepped into so many ofthese really neat roles, roles
that are right now, as youmentioned, a little unique.
So let's talk a little bitabout a day in your life as a
hospital internal medicine PAand then let's talk about how
(26:51):
that kind of bridges over tothis healthcare innovation and
systems work that you are alsodoing.
Speaker 2 (26:58):
So the day in the life of a hospital medicine PA
is very really can go either way.
Actually, you would never knowwhat you're going to get, but
this is typically how it goesfor me.
So typically I get up anywherebetween five and 6 AM, depending
, completely honest, on how thenight before went with my small
children if we were up a lot ornot.
(27:20):
But I definitely like to startmy morning with exercise and
with some reflection time.
I have my breakfast and drinkmy coffee here at my house and
then I head into work.
So by seven o'clock I am at mydesk.
We have a really wonderfulshared workspace with all of our
clinicians who are on servicefor that period of time and,
(27:41):
like I said, if I'm on a servicewhich means a list of patients
that I'm taking care of with aphysician usually we sit down,
we talk the list over and wedivvy up patients.
I will take anywhere betweenfive to eight patients in a day.
Usually our lists are anywherebetween 10 to 18.
(28:02):
So it really just depends onhow full the hospital is
anywhere between 10 to 18.
So it really just depends onhow full the hospital is.
So after you know, we chat fora few minutes about who's going
to be.
We call primary contact foreach of the patients.
Then we go on our computers andwe do what we call chart review
.
I have a whole system.
It's one of my absolutefavorite things to teach when I
have students come to precept.
(28:22):
I have a whole way of doing itand, and what's really less
important about how you do itand more important, that you do
it the same or very similarlyevery time that you have a
method where you're not going tomiss.
You're not going to miss things.
So I love teaching that whenstudents come to visit.
It's really, it's really a lotof fun for me.
So I try to give myself an hour, maybe a little bit more, to
(28:45):
look over the patients.
What happened the night before?
What has my night team, youknow, signed out to me either in
person or via the health record?
I look at labs for the morningand kind of in my mind,
formulate a plan how close arewe to discharge?
Do I need to call anyadditional teams today?
What other optimization frommaybe a case management
(29:06):
perspective, do we need?
Is this person discharging home?
Are they going to a facilityafter?
So I kind of write myself alittle to-do list.
As I click through the chart,like I said, I have my whole
method.
Then typically I meet back upwith the physician I'm working
with and maybe give kind ofbroad brushstrokes of what were
the updates of the night,anything exciting, and what's
(29:28):
the plan for today.
And then we do.
My favorite part is we gorounding.
Whether or not we round as ateam we call it dyad rounding or
co-rounding or roundindividually really is a
combination of things Complexityof the patient has that patient
been seen by that physicianbefore and what is the overall
load of the patient?
Has that patient been seen bythat physician before and what
is the overall load of thepatients right?
(29:49):
So if we have a lower number oftotal patients, I am the
biggest fan of co-rounding.
I work with some of thesmartest people I've ever met in
my life, so any opportunity Iget to be able to co-round with
them, think things throughclinically with them, hear about
their patients, I jump at thatopportunity and I just like
hanging out with them.
You know, if it's a little bitof a heavier day or if it's a
(30:11):
patient they've already seen,you know a lot of times we will
run independently so they'll seetheir set of patients.
I'll see my set of patients.
I hope to be done by rounding,usually by 1030.
I'm a bit of a slower rounder.
I really do like to sit andtalk with people it's the best
part of my job and I also liketo touch base with all of my
nursing staff in person and kindof give them my plan for today.
(30:34):
In between patients I will putin orders and make notes, either
on a little checklist that Ibring around or log into the
computer.
So the morning is spent withlooking everything over in the
chart, forming a plan for theday, talking to patients,
checking in with them, adjustingorders as needed, and then
typically by 10, 30 or 11, I'mback at my desk.
(30:57):
If there's been any big changein the plan, any big change in
presentation, you know I'll callmy colleague up that I'm
working with to update them.
But if not, then I just getstarted on notes and orders for
the day.
I like to have everything donebefore 1pm is my goal always.
If I can get it done easierearlier then that's even better.
(31:17):
After that, really, it is tyingup loose ends and afternoon
rounding.
So especially patients that aresicker, I'll see them multiple
times over the day callingspecialty teams getting their
opinion on the case, callingfamily members working with case
management to make sure we havea safe discharge, working on
documentation, like I said, andthen seeing new admissions and
(31:40):
new transfer patients as theycome in the afternoon.
So that pretty much brings usto about five o'clock and if I
have a clock I'm off service, Iget in my car, I head home for a
lovely night with my family,but that's that's the day in the
life.
In the afternoon we also haveeducational opportunities.
We, about twice a month, areable to have a case review where
(32:04):
we review different cases andtalk about, you know, best
practice updates.
We have journal club where we,one of our clinicians will
present on a recent, a recentwriting or recent change in
practice.
And we have a really fantasticeducational departments within
my division that's run by aphysician and a nurse
practitioner and they actuallyget in specialty teams from
(32:27):
around the hospital to come andtalk with all of us about what
they do and about how we canbetter work together.
So I really look forward tothose meetings.
You know, palliative care,neurology, pulmonology we'll
have different nursing staffcome in as well, so I love that
aspect and those thingstypically do happen in the
(32:48):
afternoon.
Speaker 1 (32:49):
And then any additional meetings for
committees I'm on, those are alltypically afternoon based and I
think one thing that hospitalmedicine does so well that
clinic medicine really just wejust don't do it as well is the
continued education andeverybody who works in a
hospital.
I get to hear about the journalclubs that they're members of
(33:11):
and these meetings that they getto sit in and these lectures
that they get to attend and thatmust be really refreshing to
you just to be able to use yourbrain so much for what you know
and then to also allow somebodyelse to kind of pour into you
and you get to assume thatstudent role again and really
just learn.
That's got to feel.
It's just got to feel good.
Speaker 2 (33:31):
One of the things that really drew me to the
institution I'm at right now isI wanted that opportunity.
I wanted to be at a place thatreally valued continued learning
and that was, you know, notnecessarily built in the day to
day, because there areabsolutely days where there's
just no time for that.
You know, when you're takingcare of 18 patients and 10 of
them are really really sick,there may be no time for those
(33:54):
additional opportunities.
But I wanted to be at a placewhere that cadence was valued
and, I think, even more so.
I wanted to be at a place wherethat cadence was valued for
people of all educationbackgrounds, right?
So, from you know, the top andmost experienced physician in my
practice and the newest AVP,new grad, who's just joined,
(34:17):
we're all in that meetingtogether.
Right, we're all learningsomething new from that
subspecialist who's there toeducate us and, you know, even
taking that a step further,we're teaching each other, right
so?
Journal club, or talking aboutsomething that we're really
passionate about, or we've goneout and gotten more education on
(34:38):
.
You know, I know, for me, I'mpursuing a board certification
in lifestyle medicine.
I have some talks coming up onthat with my department and
that's not only been wellreceived, but people are excited
to learn from others, and Ithink you know, creating that
culture is not easy, but it'ssomething that we can do in any
(35:00):
discipline, though it may bemore difficult in the clinic
just because of the cadence.
I think it's something that youcan build into the day, you
build into the schedule.
For us, it becomes part of ourcalendar, like I said, the
caveat being there are alwaysdays where patient care always
comes first, and so there willbe days that that's just not
available.
But I do think it's definitelya culture switch.
Speaker 1 (35:23):
I love that and thank you for the hopeful, the
hopeful thought to there.
I do think it can be built in.
It's just intention, right?
It's a matter of of taking thatintention and starting really
putting it to work.
Natalie, let's talk about thefantastic things that you have
been able to do outside ofhospital medicine because you
(35:45):
are a PA.
So this is the cool stuff.
This is the stuff to me that isjust mind blowing, because I
love what you do working withyour patients in the hospital,
but this is some of like nextlevel stuff that you are getting
after.
So tell us a little bit aboutsome of these things that you do
and just open my eyes to this,because this is so neat, yeah
(36:07):
absolutely Also I'll start withwithin my institution.
Speaker 2 (36:10):
So, like I said earlier, I got my first taste
for FEMA.
So FEMA being the, you know,federal organization that
addresses emergency, emergencysituations like on a grander
scale, so like the fires thatare going on right now and, of
course, hurricanes, there's awhole, you know, group of people
who respond to these events.
(36:30):
So that was really my firstexposure to this kind of stuff
and that really got meinterested.
It's not as bad as likedoomsday prepper, but I cut my
friends at work kind of call me,like, refer to me as this
electronic health recorddoomsday prepper.
That's kind of this role thatI've started to fill and I
actually love it.
You know, some people I thinkit's very boring, or they think
(36:53):
you know, you know, or they hatetheir, their, their charting
system.
I think it's a necessary eviland I think that you know we
need to master it, be masters ofit.
So I kind of stepped into tworoles in that within my
department.
One has been our electronichealth record super user.
So I've gone and been able toget special training to be able
(37:14):
to learn a bit more about therecord itself, about how to be
able to optimize it and takethose skills and put them at use
in my department itself.
Those skills and put them atuse in my department itself.
Any kind of questions or issuesupdates.
I keep my team, you know, up todate on those things that are
coming down the pipeline and ifanyone has interests or ideas,
(37:40):
then I can, kind of the oppositeway, bring those forward to the
team to see if we can optimizeor do some of those additions.
I think a big thing that I foundabout the EHR is this kind of
like personalization is reallybig people want to personalize.
Something that I found is issometimes that personalization
is not as helpful as we think.
(38:00):
Like I think there is there isan art of having to be simple
too.
So really working with my teamto say, okay, you know, what is
it that we need to bedocumenting, how can we document
it the most effectively, themost correct, right, and how can
I set everyone up for success?
So that's been fun and I I'mlooking forward to more
opportunities to be able to dothat from a charting perspective
(38:23):
Again, some people think it'syou know's horrible, the bane of
their existence.
It's just a necessary evil,that's just the world that we
live in.
So let's just make it as goodas we can, both to protect
patients, to legally protectourselves as well.
So, with the downtime, that'sbeen really fun.
So for anyone who doesn't know,downtime sometimes it's called
business continuity basicallymeans what is your plan if any
(38:48):
of your electronic system thatyou use for patient care were to
be inaccessible?
So the electronic health record, how you check patients in and
out, how you take their vitals,how you look at their imaging,
how you communicate withpatients if you're on your front
desk staff, how do you schedule?
So all of that kind of goesinto this big umbrella of under
(39:11):
disaster preparedness.
That means downtime.
So that has been reallyinteresting for me to get
involved in.
Where I have found myself is Iwas handed this role I like to
say voluntold but basically thisidea of, like you know, hey, we
need to be, we need to, we needto work through some issues
(39:32):
that we've had with this, andwhat I did was, you know,
instead of just okay, you know,I'm going to go to the meetings,
I'm going to say that we didthe education.
Nope, we're going to take it astep further.
We're going to develop a wholeplan based on clear methodology
of step-by-step, what we woulddo if there were to be a
downtime event that would affectour department, and so I built
(39:53):
an entire plan based on myorganization's larger plan, but
one that was specificallytailored to our department and
that has been a year and a halfin the making, and every time
there's an event we go back, welook at it, I interview people
who were on service that day,kind of get their feedback when
are the gaps?
How do we?
How do we get better?
(40:14):
Because you know, healthcare,health systems, are at a huge
disadvantage and it's a it's ahuge liability.
We are more sought after,actually in number of attacks
than banks.
We have a more expensive and alonger recovery time than any
other sector, including banking,financial, anything like that,
(40:35):
social media, of course.
So health systems and providers, clinic offices, really are a
large target.
So being able to be working ona system like that has been
super fulfilling, because I'mable to work with my team and
really say, okay, if there wasan event, how do we respond, how
do we bounce back?
(40:56):
So I love this idea ofcontinuing to build cyber
resiliency.
I have a paper that just wassubmitted really, man, maybe two
weeks ago to the society ofhospital medicine about how
other hospital services canbuild their own resiliency plan.
So I am really excited.
I'm not, I'm.
I hope that more comes fromthat and that I can teach other
(41:16):
people yeah, how they can buildtheir own plan out.
And I have a talk coming up atmy own hospital to speak about
to other PAs and nursepractitioners on how they can do
the same with their owndepartment inpatient and
outpatient.
So how does the outpatientclinic respond to this?
You know, how are they able tocontinue to deliver high quality
patient care when we don't haveaccess to what we usually have
(41:37):
access to?
And I think it's a huge, a hugeplace where other PAs and nurse
practitioners can step into abit more of an administrative
role.
Right, and I think one of thereasons is because it's not sexy
, it's not exciting, but this isthe truth, ashley, it's not a
(41:57):
matter of if this will happen tomy clinic or hospital, it's a
matter of when, and I don't meanto be negative, but that's just
the reality of it.
Speaker 1 (42:03):
I love that you're getting a peek into kind of the
backend of those things and andall of the work really that goes
into maintaining these and makesure, making sure that they're
healthy, and part of making surethat that our systems are
healthy is planning for whathappens when they become
unhealthy.
Natalie, this is a segment onour show called quality
questions, and it's basicallywhere we discuss questions that
(42:25):
have just as medical cliniciansthat have really stood out in
our past whether it wasinterviewing for school or maybe
interviewing for a job, ormaybe when we were interviewing
somebody else for a job Do youhave one of these quality
questions that's just extremelymemorable.
Before we hear what Natalie'squality question is, keep in
mind that there's more interviewprep, such as mock interviews
(42:48):
and personal statement reviewover on shadowmenextcom.
There you'll find amazingresources to help you as you
prepare to answer your ownquality questions.
Speaker 2 (42:57):
I do, yeah, I.
One of the questions that I wasasked in one of my interviews
that stood out the most was theyasked me for a time in my
specifically in my health careerwhere I saw or heard about a
mistake being made and how Iresponded to that, and I think
(43:20):
that that was really impactfulfor a few reasons.
Number one I think inhealthcare we are really
hesitant to ever admit thatsomething went wrong.
Right, and I think, possibly inan attempt to, you know, not
startle someone, not scaresomeone we don't want people to
(43:40):
lose faith.
But the fact of the matter islike to err is human right.
The mistakes happen, errors aremade and the worst thing we can
do is not be upfront about itand not, you know, fix it in a
way that brings it to the lightand shares the information.
So that was a really kind ofout of left field question, at
least, one that I was notexpecting, and I was able to
(44:03):
draw on my time as a student,something that I experienced as
a student actually to be able toanswer it.
But I was not expecting and Iwas able to draw on my time as a
student something that Iexperienced as a student
actually to be able to answer it, but I was not prepared for
that one.
So I think that's a really goodone for people to be thinking
about and really even like forthose of us that aren't
interviewing, that just takecare of patients every day, it's
an interesting thought, right.
What would I do?
What should I do when mistakesare made from any degree?
(44:26):
Right, they don't have to becatastrophic, they can be small
things, but how do we addressthem, how do we restore patient
trust and how do we move forward?
So I think that was a questionthat really stood out to me.
Speaker 1 (44:37):
Natalie, I'm just, I'm so grateful for the time
that you spent with us andthere's just, there's so much
more here.
I mean, you just have such adepth to you and your career and
what you have alreadyaccomplished in the years since
you graduated from PA school.
So thank you for sharing ataste of this with us before we
go.
What is something that you wishto tell to the person who might
(45:01):
be considering a career inmedicine and is just looking at
all this going?
You know, do I belong here?
Is this, is this for me?
What would you tell them?
Speaker 2 (45:09):
I would tell that person.
You know, if you're reallyconsidering a career in medicine
, never stop asking questions.
Right, Get it from straightfrom the source.
Talk to people who are activelydoing the job.
You're interested in the good,the bad, the ugly actively doing
the job.
You're interested in the good,the bad, the ugly.
You want to hear it all.
I think that if I could give anyadvice, it would be not to go
(45:30):
into medicine with rosy coloredglasses.
Right, Really understand thebusiness and the industry as a
whole as much as you really can,and I think you can only do
that by asking a lot of peoplewhat they think, and not only
people who are just started out,but people who have been in the
business for a long time,people of all different degree,
(45:51):
backgrounds in various sectors,Because I think, at the end of
the day, you know we all getinto this because we want to
make a difference, and the truthof the matter is, is that that
actually looks different forevery person, and there's
nothing wrong with that.
You know.
That's actually the beautifulpart about medicine is that it
can be so versatile and theskills that you use and that you
(46:13):
learn and you use to take careof patients can be used outside
of direct patient care too, andthat's wonderful too.
We need people in everydiscipline, every level to be
able to drive progress and drivechange that truly is
patient-centered andvalues-based.
I think that there's a lot ofemphasis on value-based care.
(46:36):
Well, I push back on that and Isay that care should be
values-based.
Are we giving care based onwhat the patient themselves
value?
Speaker 1 (46:46):
I think that's great and your skills are needed what
makes you unique and yourexperiences.
That is needed in medicine.
Natalie, thank you so much.
I so appreciate your time andall of the insight you've
provided and the amazing,amazing stories.
I feel so motivated aboutmedicine and the direction that
it's going thanks to you andthanks to your role in
(47:08):
leadership, so I appreciate it.
Speaker 2 (47:11):
Thank you so much, Ashley.
I really appreciate you havingme today.
Speaker 1 (47:14):
Thank you so very much for listening to this
episode of shadow me next.
If you liked this episode or ifyou think it could be useful
for a friend, please subscribeand invite them to join us next
Monday, as always.
If you have any questions, letme know on Facebook or Instagram
Access.
(47:34):
You want stories you need?
You're always invited to shadowme next.
Hello and welcome to Shadow Me Next, a podcast where
I take you into and behind thescenes of the medical world to
provide you with a deeperunderstanding of the human side
of medicine.
I'm Ashley, a physicianassistant, medical editor,
clinical preceptor and thecreator of Shadow Me Next.
It is my pleasure to introduceyou to incredible members of the
(00:22):
healthcare field and uncovertheir unique stories, the joys
and challenges they face andwhat drives them in their
careers.
It's access you want andstories you need, whether you're
a pre-health student or simplycurious about the healthcare
field.
I invite you to join me as wetake a conversational and
personal look into the lives andminds of leaders in medicine.
(00:43):
I don't want you to miss asingle one of these
conversations, so make sure thatyou subscribe to this podcast,
which will automatically notifyyou when new episodes are
dropped, and follow us onInstagram and Facebook at Shadow
Me Next, where we will reviewhighlights from this
conversation and where I'll giveyou sneak previews of our
upcoming guests.
(01:04):
Today, I have the pleasure ofintroducing Natalie Friels, a
distinguished PA in hospitalinternal medicine at the Mayo
Clinic in Florida and arecognized leader in healthcare
innovation.
Natalie's expertise extendsbeyond direct patient care.
She is deeply involved inresearch, technology integration
(01:24):
and healthcare systemsimprovement.
She plays a pivotal role inoptimizing electronic health
records, integrating wearablemedical technology and enhancing
disaster preparednessstrategies.
In addition to her clinicalresponsibilities, natalie is a
trusted advisor in health techinnovation, helping companies
(01:45):
refine their strategies andbridge the gap between clinical
practice and transformativehealthcare solutions.
She is also a subject matterexpert for multiple committees
at Mayo Clinic, where she worksto improve practice efficiency
and patient outcomes.
In today's conversation,natalie shares how her early
(02:06):
experiences as an EMT shaped herpassion for problem-solving and
systems-based thinking.
She discusses her transitionfrom aspiring to work in the ICU
to discovering a fulfillingcareer in hospital internal
medicine, where she balancescomplex patient care with
leadership in healthcareinnovation.
A particularly compellingdiscussion centers around her
(02:29):
work in disaster preparedness,where she has developed
resiliency plans for electronichealth record downtime, an often
overlooked but essential aspectof hospital operations.
She also offers valuableinsights into how clinicians,
regardless of their role, candrive meaningful change in
medicine through advocacy,innovation and collaboration.
(02:53):
Natalie's perspective isinsightful and inspiring, and I
am excited to share herexpertise with you today.
Please keep in mind that thecontent of this podcast is
intended for informational andentertainment purposes only and
should not be considered asprofessional medical advice.
The views and opinionsexpressed in this podcast are
(03:14):
those of the host and guests anddo not necessarily reflect the
official policy or position ofany other agency, organization,
employer or company.
This is Shadow Me Next withNatalie Friels.
Hey, natalie, thank you so muchfor joining me on Shadow Me
Next.
This is going to be such a funconversation.
I can already feel it.
I appreciate you taking thetime to spend with us today.
(03:36):
Thanks, ashley, so happy to behere.
So let's start.
Natalie, tell us a little bit,generally speaking, about what
you do.
What is your title and whatdoes that mean?
Speaker 2 (03:49):
Sure, absolutely.
So I am a physician assistantworking in hospital internal
medicine.
So I'm a PA, which means I havea master's in physician
assistant studies.
I got that degree from theawesome University of Florida in
Gainesville.
Then I went on to work with theMayo Clinic.
I work at our Florida campusand I work in the Division of
(04:09):
Hospital Internal Medicine,which is part of our Department
of Medicine.
So what that means is me and myteam.
I have a fantastic team ofalmost 80 physicians and almost
30 advanced practice providers,which means nurse practitioners
and PAs.
We work together, typically inteams of two, and we carry
almost one-third of the hospitalload at any given time.
(04:31):
So we see all kinds of patients.
We see new admissions from theED, we see preoperative and
postoperative patients, we seepatients who are downgraded from
the ICU.
We cover a wide variety ofpathologies and we work really
closely with our subspecialtyteams neurology,
gastroenterology, cardiology,pulmonology basically to manage
(04:54):
a very wide variety, wide arrayof different clinical symptoms
and different diseases thatwould bring someone into the
hospital, so we admit.
And different diseases thatwould bring someone into the
hospital, so we admit, wetransfer, we optimize and then
we discharge them.
A big part of my job also ismaking sure that people have set
in place the resources, or atleast information on resources
(05:16):
that will facilitate a safedischarge.
So this means good follow-upwith their primary care or being
seen by a subspecialty teamafter discharge, making sure we
really can use theirhospitalization to really impact
their health in a positive way.
Speaker 1 (05:31):
That is an absolute amazing amount of work that you
do.
I can't imagine that many,first of all, working in a team
that large 80 physicians and 30APPs, and then all of the I mean
the patients.
The numbers game here is justhuge.
When you were in PA school, didyou ever think that you would
(05:52):
be a part of a team like thisand seeing this many patients in
this capacity?
Speaker 2 (05:57):
I know it's really incredible to imagine.
No, honestly, when I went to PAschool, I really thought that I
would find myself, I find myway into the ICU.
That was pretty much my planfrom day one.
I was really interested in anICU fellowship, and that was my
plan.
I knew, though, whatever I wasgoing to do, I really wanted to
stay more broad, right.
(06:19):
So the ICU treats a wide varietyof different types of things
that can make you, you know socritically ill, and I think that
just the more I had experiencewith internal medicine and then
intensive care, I think Idecided I wanted to do the
switch to something a little bitless acute, but still stay
really broad.
That's really what I wanted todo after school was, you know,
(06:41):
develop a skill set looking at awide variety of things, and
then it was just kind of easy tomake that switch from something
a little bit less acute tosomething a bit more walkie
talkie.
You know, as we say at thehospital, are they walking, are
they talking?
And I've enjoyed that for awide variety of reasons.
One is definitely the work lifebalance.
(07:02):
I have two little kids at home,so when I was looking into
getting into intensive care.
Some aspects of the scheduleweren't as appealing and I think
the other part is I like toform a bit more of a
relationship with people.
I hopefully don't only see themonce, maybe twice, if they're
admitted a few times over thecourse of the year, but I really
(07:24):
like that aspect of being ableto coordinate care for them and
with them, talk to their primarycare, if I'm able to, and then
a lot of that you really areable to do as an internist in
the hospital.
Speaker 1 (07:35):
That's very cool.
I'm glad to hear that thequality of life, even when you
are so involved in hospitalmedicine, that the quality of
life is still there, and I'dreally love to touch on that in
a little bit.
But let's go back, natalie,because you know you mentioned
that you you've always reallybeen interested in the ICU, in
in, obviously, what you're doingright now in hospital internal
(07:57):
medicine.
It's all very complex, which Ithink a lot of medicine is
complex, but at a certain pointthere are certain things that
have more wheels spinning thanothers.
Right, tell me a little bitabout your life, maybe before PA
school.
Have you always been interestedin, you know, problems with
this level of complexity?
Or is this something that youdiscovered when you were in in
(08:17):
PA school, maybe a little bitbeyond?
Speaker 2 (08:20):
Yeah, I you know, asha, I know I knew I wanted to
go into medicine, since you knowI was.
I was really little and I thinkmy high school and college
career was really set on findingexactly what that path would be
.
But I knew I wanted to go intomedicine.
I knew I liked a little bit ofexcitement.
That's probably why I was moreinterested in the ICU.
(08:41):
So when I was in college I wentand I got my certificate to be
an EMT and for two years I waswith a private EMT company that
serviced Fulton excuse me,dekalb County, which is one of
the largest counties in Georgia,in the metro area that covers a
good part of parts very, veryclose to the city of Atlanta.
So I that was really my firsttaste for medicine as far as
(09:04):
like a professional career wasas an EMT and I I love that so
much.
I learned so much from thatexperience.
I think one of the biggestthings was I got to see where
the patients come from, right.
So whether we're in the clinicor in the ED or in the hospital,
that's such a sterileenvironment, right.
(09:25):
You know they're coming intoour turf, so to speak, and with
emergency medicine in the field,you know you're on the
patient's turf, you're in theirhome, you're in their car,
you're in their place of work,and I learned so much about
patients, about patient care,from that experience, because
it's such a raw picture of whatit means to be a patient and of
(09:47):
that person Like you just get somuch information.
So you know I, what I lovedabout emergency medicine in the
field also is that all thoseproblems that we talked about
you know, all those illnessesthat you're managing, even for a
short time, you're on your own,you know it's you and your
partner, and not only do youreally have to know your stuff,
but you have to be able totriage, you have to be able to
(10:09):
think quick on your feet andmake sure that you're delivering
, you know, the best patientcare, while also keeping
yourself, your partner and yourpatients safe is a huge part of
that.
So I really learned so muchfrom that experience and I think
that level of complex problemsolving has always been a real
love of mine.
I'm someone who, when I see aproblem or an inefficiency and
(10:34):
this is more like taking a stepback systems based not so much
direct patient care, but when Isee an inefficiency or a problem
, I really can't look away LikeI really really can't, I can't
not solve it and that's justsomething that's always, you
know, carried with me in so manyaspects of my life.
I was just talking about thiswith somebody, but my very first
(10:56):
pitch right, my very firstpitch deck.
I gave a presentation to myguidance school counselor in
elementary school on why weshould switch from styrofoam
plates to plastic trays.
And I did.
I did market research.
I knew that we had a, I knewthat we had a dishwasher, I knew
that we actually had alreadypurchased the plastic trays
(11:17):
there upstairs in like a storageunit, and and I just saw this
problem I was like we'rethrowing away all these trays
and we don't need to.
And here's a solution and hereis the research on why we should
do it differently.
And here's the presentation.
So all that to say is whether itwas as an E, through my EMT
company, working with FEMA, Iresponded to several different
(11:39):
national disasters, mainlyhurricanes, from where we were
located.
So, being able to work on alarge team problem solving
things that came up with thatyou know event to transitioning,
you know, out of EMS and intoPA school, into hospital,
internal medicine, problemsolving not only on a daily
basis for patients, but also ona systems level.
(11:59):
You know, where are theinefficiencies, where are the
gaps in care, where can we makethis process better?
That kind of thinking, that wayof thinking has been, you know,
so important to me and reallyhas carried me through so many
different aspects of my career.
Speaker 1 (12:14):
I'm so glad to hear that, because right now there's
this buzz about all of theseproblems in healthcare right,
and I just was speaking toanother guest about whether our
healthcare system is broken, andI'm sure that there are some
people who think it is and then,if they have your mentality,
(12:36):
they're looking at thishealthcare system just feeling
overwhelmed because all they'reseeing are so many broken pieces
.
But, natalie, and we're goingto get to this you are so
involved in finding these areasthat need improvement and
improving them, and I think thatis such a breath of fresh air
in medicine, and not justmedicine, but specifically in
(12:58):
being a PA fresh air in medicine, and not just medicine, but
specifically in being a PA.
Have you found that this issomething that is largely
possible to identify solutionsand work with other members of
the healthcare field to fix them, or are you really just having
to forge your way through to tryand make some of these things
happen?
Speaker 2 (13:16):
A little bit of both, to be honest.
A little bit of both, I think.
For the most part, you know,any clinician, any person in
healthcare can make a change,and I really do believe that the
best innovations come frompeople who are in the trenches
and I know.
Later, you know we can talkabout my work with some startups
(13:37):
, but that's really what I foundwith startups and with working
at my institution, as the bestideas for process change, for
systems change, come from thepeople who have to deal with
that problem every dayhealthcare.
(13:59):
To start where you're at, whatis the problem that I'm facing
today, my patients are facingtoday, and what is something
within my control that I can doto change that?
And I totally resonate withwhat you mentioned.
A prior guest said.
It can definitely feel sooverwhelming, and I think if we
can focus on the small littlespheres of influence that we all
have, the small little spheresof influence that we all have
and, you know, optimize one ortwo things, start with that it
(14:28):
really starts to be a snowballeffect.
At the same time, though, youknow it has been difficult
because there aren't as manynon-physician clinicians in
these kinds of higher rolesdealing with optimization.
I'll say non-physician ornon-administrative, so someone
with maybe a master's inhealthcare administration and I
wouldn't say that's a barrier,though I really don't believe
(14:48):
that.
I really don't view it as that.
I just view it as a place thatwe haven't yet made a name for
ourselves.
I think what we're seeing ismore nursing staff step into
that role as well, and I thinkthat more and more PAs and
people of various educationalbackgrounds will step into roles
.
Because I think what we've beenfinding, honestly, is that we
(15:13):
are pushing forward with changethat's not necessarily
clinically informed, right.
We're pushing forward for theseideas, for these possible
changes, and maybe we're notengaging at the source as much
as we should.
And that's just my opinion.
That's just kind of some of thethings I've seen through my
(15:34):
work and through working withsome companies.
Is that really, when we engageclinicians and talk about their
pain points, that is when we getthe most bang for our buck as
far as change and progress.
Speaker 1 (15:47):
I agree a hundred percent and I love what you said
about starting where you're at,because that is where you're
going to make a differenceperiod, and then it gives you an
opportunity to really practiceleadership in a place where
you're really comfortable, whichis perhaps your own clinic or,
if you're not in medicine,wherever you're working,
(16:08):
wherever you're spending themost time right now.
Practice your leadership rolethere, practice your ability to
make a change there, see how itfeels, see what works and then
start to expand that.
I love the idea of having moreclinically driven people in
leadership.
Not that we need to flood thatarea, right.
(16:28):
We just need to make sure thatthere are voices there as well,
because we need ouradministration, we need all the
many different voices inmedicine, which, of course, on
the shadow me next podcast,we're hearing from all of these
voices and it is just amazingthe, the innate value in each
specialty, in each field ofmedicine, and the different ways
(16:49):
everybody thinks.
I mean it would be incredibleto have all of those voices
coming together to address aproblem and then, you know,
reach a solution that is justreally eloquent and really
complex but still well thoughtout, you know.
So I think, I think that'sincredible, that's great.
Thank you for doing that workthat you're doing.
That's just, it can't be easy.
Speaker 2 (17:12):
No.
And I, and I think sometimes,like the, the best solutions are
so simple, you know, and itjust kind of hits you, hits you
hard when you're realizing, oh,you know this problem we've been
having, you know it's simple,yet difficult to achieve.
And so how do we bridge thatgap of a need and a possible
solution?
And I think also, you knowyou're going to try a lot of
(17:32):
things that don't work, you know, or you're going to try a lot
of things and people aren'tgoing to understand the value of
what you're trying to getacross.
And I think, if anyone isinterested in systems innovation
or process change, you reallyhave to be willing to hear the
word no and to know when to pushon, so to speak, and when to
(17:55):
not take no for an answer andwhen to say okay.
You know what?
There's just not a lot ofbuy-in for this.
You really need buy-in from allsides of the equation in order
for a change to really take hold.
And I think that it'sdefinitely a fine line of
knowing when to push on and whento say you know what?
I don't have buy-in, and sothis really isn't going to work
(18:17):
right now.
This is the season for thischange, and that's hard.
As an innovator, that's reallyhard to hear.
You really want everyone to seethe problem the way you see it,
and I think that there's a lotof humility in that too, feeling
able to say you know, I may nothave the right answer today,
and I actually probably won'thave the right answer today, and
(18:37):
that's okay, that's fine, we'regoing to keep trying and keep
trying things that work.
I think the place that clinicsand companies really get into a
pickle is when they don't wantto hear from the doctor in the
clinic or the nurse doing labdraws.
They don't want to hear aboutthe day-to-day issues, and I
(19:01):
think that you know any and alladministrators should really be
in the trenches, at least insome respect, with their staff
to hear what the pain points are.
And that's really somethingthat I've been happy to do, and
I think that that's one of thethings that really informs.
You know, both my clinical workand my additional, more
administrative work is that Ifeel those pain points every day
(19:24):
and I love talking about itwith people.
I love stopping people in thehallway and saying like, let me
pick your brain about this ortell me about how this is going
or what do you think about this?
And a lot of my ideas don't goanywhere, but they're ideas and
maybe they'll go somewhere later.
But I think it's really alsojust about having that mind of
(19:45):
progress.
How can we make this better foreverybody?
Not only how can I make thisbetter for the doctor, not only
how can I make this better forpatients, not only how can I
make this better for revenue.
It has to be all of it.
It really does have to be allof it to be something that's
truly impactful and sustainablefor sure.
Speaker 1 (20:05):
Natalie, you mentioned your focus on whole
person care and you're reallytaking that concept that should
just apply to medicine andyou're expanding it to the
actual capital M medicine, right?
It's not just like you said.
It's not actual capital Mmedicine, right?
It's not just like you said.
It's not just the physician,it's not just the people in
leadership, but we need to becommunicating and taking care of
(20:28):
and listening to everybody inmedicine.
That is the teamwork model.
I think that is so great and Ijust applaud you so much because
I think that that takes a levelof humility to approach
somebody and ask that questionhow are you doing?
What are your pain points?
What are you really enjoyingright now?
(20:50):
Because so many times, I'm sureyou're going to get some
feedback.
That is not ideal, right, andpeople are gonna open up to you
about their issues and theirconcerns and their problems and
as clinicians, we're used todealing with that.
But we're used to dealing withthat when we can say oh, I think
I know your diagnosis, let mego ahead and give you this
(21:11):
treatment, right.
But when people are presentingthese complex issues that are
related to their place of work,it takes a person with a lot of
humility, to stand there, listenand say you know what, I hear
you.
We can work through thistogether.
Let's find a solution.
So thank you for doing that.
I think that's probably it's alot more complicated than people
(21:32):
realize.
It's not just giving people eartime.
Speaker 2 (21:35):
No, exactly, and I think it absolutely is, and I
all I can say is I wish I hadmore time for that, because that
really is fulfilling, likedeeply, deeply fulfilling for me
, both inside my institution andoutside.
Hearing what are those painpoints and how can we
troubleshoot together issomething that I really, really
feel energized by, and I thinkthat, even taking it a step
(21:59):
further, what I love about it isthat it is completely a highway
for relationship, right?
I can't tell you how manypeople I've really come to know
well at my hospital just becausewe stopped in the hallway and
started chatting about somethingyou know.
I really do believe in thepower of relationship and the
power of connection, oftentimesover you know, shared issues or
(22:23):
shared problems, and to be ableto say you know, what is it that
you're dealing with here, howcan we optimize it, how can I
help?
And I'll be completely honest,you know, a lot of times I can't
, a lot of times there's reallynothing I can do.
It's way outside of my verysmall sphere or my very small
scope, but I think three things.
Number one you sat and listenedto that person's like validated
(22:47):
, heard, right, it probably wasan exercise and thought for them
to even brainstorm some thingsthat they that could be
different, right.
Number two you're formingrelationship, which is arguably
the most important.
And then number three, like ifthere's any connection or
handing off to different teamsthat I can do.
I absolutely facilitate thatand I that's really what I'd
(23:09):
like to see more of before beinghonest is is you know more
people talking about the thingsin healthcare that are going
well, the things that aren'tgoing well, and you know how do
we work together, how do we handoff to somebody who can maybe
help us solve a problem?
I love seeing the new thingsthat are coming out, new systems
(23:30):
change that are coming out andexcited for really a return back
to the basics.
I am excited about the next intech return back to the basics.
I am excited about the next intech, right, of course, but I'm
also just excited to see us as amedicine, like you said,
capital M really return toreally what the basics of
patient care should be andreally is.
I think a lot of that is, likeyou said, whole person care.
(23:52):
What does that mean?
We're taking care of the wholeperson and all the aspects that.
That includes stress management, sleep, adequate nutrition, a
social connection, you know,staying away from harmful
substances, those are, you know,that really is the basis of
(24:13):
health.
And so getting back to thiswhole person version of health,
and I think a lot of people say,oh, you know well, you're just
in hospital medicine or hospitalmedicine is just for dealing
with that pneumonia or thaturosepsis or that ICU downgrade,
and it's not.
You know, that's a reallypoignant time in a person's life
(24:36):
.
They hopefully may only behospitalized once or twice or a
handful of times.
And if I can say something tothat person that helps them take
care of the whole self or setsthem up in a way that they can
get better whole person care,then you know that's a success,
that's a huge success.
And I think that's really beenedifying for me, especially with
(25:00):
how difficult the landscape ofhealthcare has been in the last
few years.
Being able to really go back tobasics with patients and have
the time to be able to do that,that's been really incredible
(25:21):
those hospital stays.
Speaker 1 (25:21):
A lot of times, for a lot of people they're
springboards to a whole newoutlook on life and a whole new
outlook on their own health,right.
So the more people that we have, the more clinicians that we
have pouring into this wholeperson idea of medicine, the
better off this patient is goingto be.
I think about you know, indermatology, which is where I'm
currently working, I love that.
I have the time to celebratebig health wins with patients,
(25:44):
right, and a lot of times mournmajor health losses with them
too.
I was just today.
I had a patient tell me thatthey just hit losing 100 pounds
with diet and exercise and theywere they were so proud of
themselves and we got tocelebrate that and they were
able to tell me these thingsbecause they knew I've asked
(26:04):
about them in the past.
We've talked about exercise,we've talked about diet, we've
talked about how hard it is tomake healthy eating choices
sometimes and all of the burdensthat go into that, and arguably
that doesn't have a directrelation to dermatology, right,
we're talking about these thingswhile I'm performing a skin
exam, but it's really more.
It's just talking to the personabout their health you know,
(26:27):
and making time for that is isso important.
Natalie, I've been so excited totalk to you because, as a PA,
you have stepped into so many ofthese really neat roles, roles
that are right now, as youmentioned, a little unique.
So let's talk a little bitabout a day in your life as a
hospital internal medicine PAand then let's talk about how
(26:51):
that kind of bridges over tothis healthcare innovation and
systems work that you are alsodoing.
Speaker 2 (26:58):
So the day in the life of a hospital medicine PA
is very really can go either way.
Actually, you would never knowwhat you're going to get, but
this is typically how it goesfor me.
So typically I get up anywherebetween five and 6 AM, depending
, completely honest, on how thenight before went with my small
children if we were up a lot ornot.
(27:20):
But I definitely like to startmy morning with exercise and
with some reflection time.
I have my breakfast and drinkmy coffee here at my house and
then I head into work.
So by seven o'clock I am at mydesk.
We have a really wonderfulshared workspace with all of our
clinicians who are on servicefor that period of time and,
(27:41):
like I said, if I'm on a servicewhich means a list of patients
that I'm taking care of with aphysician usually we sit down,
we talk the list over and wedivvy up patients.
I will take anywhere betweenfive to eight patients in a day.
Usually our lists are anywherebetween 10 to 18.
(28:02):
So it really just depends onhow full the hospital is
anywhere between 10 to 18.
So it really just depends onhow full the hospital is.
So after you know, we chat fora few minutes about who's going
to be.
We call primary contact foreach of the patients.
Then we go on our computers andwe do what we call chart review
.
I have a whole system.
It's one of my absolutefavorite things to teach when I
have students come to precept.
(28:22):
I have a whole way of doing itand, and what's really less
important about how you do itand more important, that you do
it the same or very similarlyevery time that you have a
method where you're not going tomiss.
You're not going to miss things.
So I love teaching that whenstudents come to visit.
It's really, it's really a lotof fun for me.
So I try to give myself an hour, maybe a little bit more, to
(28:45):
look over the patients.
What happened the night before?
What has my night team, youknow, signed out to me either in
person or via the health record?
I look at labs for the morningand kind of in my mind,
formulate a plan how close arewe to discharge?
Do I need to call anyadditional teams today?
What other optimization frommaybe a case management
(29:06):
perspective, do we need?
Is this person discharging home?
Are they going to a facilityafter?
So I kind of write myself alittle to-do list.
As I click through the chart,like I said, I have my whole
method.
Then typically I meet back upwith the physician I'm working
with and maybe give kind ofbroad brushstrokes of what were
the updates of the night,anything exciting, and what's
(29:28):
the plan for today.
And then we do.
My favorite part is we gorounding.
Whether or not we round as ateam we call it dyad rounding or
co-rounding or roundindividually really is a
combination of things Complexityof the patient has that patient
been seen by that physicianbefore and what is the overall
load of the patient?
Has that patient been seen bythat physician before and what
is the overall load of thepatients right?
(29:49):
So if we have a lower number oftotal patients, I am the
biggest fan of co-rounding.
I work with some of thesmartest people I've ever met in
my life, so any opportunity Iget to be able to co-round with
them, think things throughclinically with them, hear about
their patients, I jump at thatopportunity and I just like
hanging out with them.
You know, if it's a little bitof a heavier day or if it's a
(30:11):
patient they've already seen,you know a lot of times we will
run independently so they'll seetheir set of patients.
I'll see my set of patients.
I hope to be done by rounding,usually by 1030.
I'm a bit of a slower rounder.
I really do like to sit andtalk with people it's the best
part of my job and I also liketo touch base with all of my
nursing staff in person and kindof give them my plan for today.
(30:34):
In between patients I will putin orders and make notes, either
on a little checklist that Ibring around or log into the
computer.
So the morning is spent withlooking everything over in the
chart, forming a plan for theday, talking to patients,
checking in with them, adjustingorders as needed, and then
typically by 10, 30 or 11, I'mback at my desk.
(30:57):
If there's been any big changein the plan, any big change in
presentation, you know I'll callmy colleague up that I'm
working with to update them.
But if not, then I just getstarted on notes and orders for
the day.
I like to have everything donebefore 1pm is my goal always.
If I can get it done easierearlier then that's even better.
(31:17):
After that, really, it is tyingup loose ends and afternoon
rounding.
So especially patients that aresicker, I'll see them multiple
times over the day callingspecialty teams getting their
opinion on the case, callingfamily members working with case
management to make sure we havea safe discharge, working on
documentation, like I said, andthen seeing new admissions and
(31:40):
new transfer patients as theycome in the afternoon.
So that pretty much brings usto about five o'clock and if I
have a clock I'm off service, Iget in my car, I head home for a
lovely night with my family,but that's that's the day in the
life.
In the afternoon we also haveeducational opportunities.
We, about twice a month, areable to have a case review where
(32:04):
we review different cases andtalk about, you know, best
practice updates.
We have journal club where we,one of our clinicians will
present on a recent, a recentwriting or recent change in
practice.
And we have a really fantasticeducational departments within
my division that's run by aphysician and a nurse
practitioner and they actuallyget in specialty teams from
(32:27):
around the hospital to come andtalk with all of us about what
they do and about how we canbetter work together.
So I really look forward tothose meetings.
You know, palliative care,neurology, pulmonology we'll
have different nursing staffcome in as well, so I love that
aspect and those thingstypically do happen in the
(32:48):
afternoon.
Speaker 1 (32:49):
And then any additional meetings for
committees I'm on, those are alltypically afternoon based and I
think one thing that hospitalmedicine does so well that
clinic medicine really just wejust don't do it as well is the
continued education andeverybody who works in a
hospital.
I get to hear about the journalclubs that they're members of
(33:11):
and these meetings that they getto sit in and these lectures
that they get to attend and thatmust be really refreshing to
you just to be able to use yourbrain so much for what you know
and then to also allow somebodyelse to kind of pour into you
and you get to assume thatstudent role again and really
just learn.
That's got to feel.
It's just got to feel good.
Speaker 2 (33:31):
One of the things that really drew me to the
institution I'm at right now isI wanted that opportunity.
I wanted to be at a place thatreally valued continued learning
and that was, you know, notnecessarily built in the day to
day, because there areabsolutely days where there's
just no time for that.
You know, when you're takingcare of 18 patients and 10 of
them are really really sick,there may be no time for those
(33:54):
additional opportunities.
But I wanted to be at a placewhere that cadence was valued
and, I think, even more so.
I wanted to be at a place wherethat cadence was valued for
people of all educationbackgrounds, right?
So, from you know, the top andmost experienced physician in my
practice and the newest AVP,new grad, who's just joined,
(34:17):
we're all in that meetingtogether.
Right, we're all learningsomething new from that
subspecialist who's there toeducate us and, you know, even
taking that a step further,we're teaching each other, right
so?
Journal club, or talking aboutsomething that we're really
passionate about, or we've goneout and gotten more education on
(34:38):
.
You know, I know, for me, I'mpursuing a board certification
in lifestyle medicine.
I have some talks coming up onthat with my department and
that's not only been wellreceived, but people are excited
to learn from others, and Ithink you know, creating that
culture is not easy, but it'ssomething that we can do in any
(35:00):
discipline, though it may bemore difficult in the clinic
just because of the cadence.
I think it's something that youcan build into the day, you
build into the schedule.
For us, it becomes part of ourcalendar, like I said, the
caveat being there are alwaysdays where patient care always
comes first, and so there willbe days that that's just not
available.
But I do think it's definitelya culture switch.
Speaker 1 (35:23):
I love that and thank you for the hopeful, the
hopeful thought to there.
I do think it can be built in.
It's just intention, right?
It's a matter of of taking thatintention and starting really
putting it to work.
Natalie, let's talk about thefantastic things that you have
been able to do outside ofhospital medicine because you
(35:45):
are a PA.
So this is the cool stuff.
This is the stuff to me that isjust mind blowing, because I
love what you do working withyour patients in the hospital,
but this is some of like nextlevel stuff that you are getting
after.
So tell us a little bit aboutsome of these things that you do
and just open my eyes to this,because this is so neat, yeah
(36:07):
absolutely Also I'll start withwithin my institution.
Speaker 2 (36:10):
So, like I said earlier, I got my first taste
for FEMA.
So FEMA being the, you know,federal organization that
addresses emergency, emergencysituations like on a grander
scale, so like the fires thatare going on right now and, of
course, hurricanes, there's awhole, you know, group of people
who respond to these events.
(36:30):
So that was really my firstexposure to this kind of stuff
and that really got meinterested.
It's not as bad as likedoomsday prepper, but I cut my
friends at work kind of call me,like, refer to me as this
electronic health recorddoomsday prepper.
That's kind of this role thatI've started to fill and I
actually love it.
You know, some people I thinkit's very boring, or they think
(36:53):
you know, you know, or they hatetheir, their, their charting
system.
I think it's a necessary eviland I think that you know we
need to master it, be masters ofit.
So I kind of stepped into tworoles in that within my
department.
One has been our electronichealth record super user.
So I've gone and been able toget special training to be able
(37:14):
to learn a bit more about therecord itself, about how to be
able to optimize it and takethose skills and put them at use
in my department itself.
Those skills and put them atuse in my department itself.
Any kind of questions or issuesupdates.
I keep my team, you know, up todate on those things that are
coming down the pipeline and ifanyone has interests or ideas,
(37:40):
then I can, kind of the oppositeway, bring those forward to the
team to see if we can optimizeor do some of those additions.
I think a big thing that I foundabout the EHR is this kind of
like personalization is reallybig people want to personalize.
Something that I found is issometimes that personalization
is not as helpful as we think.
(38:00):
Like I think there is there isan art of having to be simple
too.
So really working with my teamto say, okay, you know, what is
it that we need to bedocumenting, how can we document
it the most effectively, themost correct, right, and how can
I set everyone up for success?
So that's been fun and I I'mlooking forward to more
opportunities to be able to dothat from a charting perspective
(38:23):
Again, some people think it'syou know's horrible, the bane of
their existence.
It's just a necessary evil,that's just the world that we
live in.
So let's just make it as goodas we can, both to protect
patients, to legally protectourselves as well.
So, with the downtime, that'sbeen really fun.
So for anyone who doesn't know,downtime sometimes it's called
business continuity basicallymeans what is your plan if any
(38:48):
of your electronic system thatyou use for patient care were to
be inaccessible?
So the electronic health record, how you check patients in and
out, how you take their vitals,how you look at their imaging,
how you communicate withpatients if you're on your front
desk staff, how do you schedule?
So all of that kind of goesinto this big umbrella of under
(39:11):
disaster preparedness.
That means downtime.
So that has been reallyinteresting for me to get
involved in.
Where I have found myself is Iwas handed this role I like to
say voluntold but basically thisidea of, like you know, hey, we
need to be, we need to, we needto work through some issues
(39:32):
that we've had with this, andwhat I did was, you know,
instead of just okay, you know,I'm going to go to the meetings,
I'm going to say that we didthe education.
Nope, we're going to take it astep further.
We're going to develop a wholeplan based on clear methodology
of step-by-step, what we woulddo if there were to be a
downtime event that would affectour department, and so I built
(39:53):
an entire plan based on myorganization's larger plan, but
one that was specificallytailored to our department and
that has been a year and a halfin the making, and every time
there's an event we go back, welook at it, I interview people
who were on service that day,kind of get their feedback when
are the gaps?
How do we?
How do we get better?
(40:14):
Because you know, healthcare,health systems, are at a huge
disadvantage and it's a it's ahuge liability.
We are more sought after,actually in number of attacks
than banks.
We have a more expensive and alonger recovery time than any
other sector, including banking,financial, anything like that,
(40:35):
social media, of course.
So health systems and providers, clinic offices, really are a
large target.
So being able to be working ona system like that has been
super fulfilling, because I'mable to work with my team and
really say, okay, if there wasan event, how do we respond, how
do we bounce back?
(40:56):
So I love this idea ofcontinuing to build cyber
resiliency.
I have a paper that just wassubmitted really, man, maybe two
weeks ago to the society ofhospital medicine about how
other hospital services canbuild their own resiliency plan.
So I am really excited.
I'm not, I'm.
I hope that more comes fromthat and that I can teach other
(41:16):
people yeah, how they can buildtheir own plan out.
And I have a talk coming up atmy own hospital to speak about
to other PAs and nursepractitioners on how they can do
the same with their owndepartment inpatient and
outpatient.
So how does the outpatientclinic respond to this?
You know, how are they able tocontinue to deliver high quality
patient care when we don't haveaccess to what we usually have
(41:37):
access to?
And I think it's a huge, a hugeplace where other PAs and nurse
practitioners can step into abit more of an administrative
role.
Right, and I think one of thereasons is because it's not sexy
, it's not exciting, but this isthe truth, ashley, it's not a
(41:57):
matter of if this will happen tomy clinic or hospital, it's a
matter of when, and I don't meanto be negative, but that's just
the reality of it.
Speaker 1 (42:03):
I love that you're getting a peek into kind of the
backend of those things and andall of the work really that goes
into maintaining these and makesure, making sure that they're
healthy, and part of making surethat that our systems are
healthy is planning for whathappens when they become
unhealthy.
Natalie, this is a segment onour show called quality
questions, and it's basicallywhere we discuss questions that
(42:25):
have just as medical cliniciansthat have really stood out in
our past whether it wasinterviewing for school or maybe
interviewing for a job, ormaybe when we were interviewing
somebody else for a job Do youhave one of these quality
questions that's just extremelymemorable.
Before we hear what Natalie'squality question is, keep in
mind that there's more interviewprep, such as mock interviews
(42:48):
and personal statement reviewover on shadowmenextcom.
There you'll find amazingresources to help you as you
prepare to answer your ownquality questions.
Speaker 2 (42:57):
I do, yeah, I.
One of the questions that I wasasked in one of my interviews
that stood out the most was theyasked me for a time in my
specifically in my health careerwhere I saw or heard about a
mistake being made and how Iresponded to that, and I think
(43:20):
that that was really impactfulfor a few reasons.
Number one I think inhealthcare we are really
hesitant to ever admit thatsomething went wrong.
Right, and I think, possibly inan attempt to, you know, not
startle someone, not scaresomeone we don't want people to
(43:40):
lose faith.
But the fact of the matter islike to err is human right.
The mistakes happen, errors aremade and the worst thing we can
do is not be upfront about itand not, you know, fix it in a
way that brings it to the lightand shares the information.
So that was a really kind ofout of left field question, at
least, one that I was notexpecting, and I was able to
(44:03):
draw on my time as a student,something that I experienced as
a student actually to be able toanswer it.
But I was not expecting and Iwas able to draw on my time as a
student something that Iexperienced as a student
actually to be able to answer it, but I was not prepared for
that one.
So I think that's a really goodone for people to be thinking
about and really even like forthose of us that aren't
interviewing, that just takecare of patients every day, it's
an interesting thought, right.
What would I do?
What should I do when mistakesare made from any degree?
(44:26):
Right, they don't have to becatastrophic, they can be small
things, but how do we addressthem, how do we restore patient
trust and how do we move forward?
So I think that was a questionthat really stood out to me.
Speaker 1 (44:37):
Natalie, I'm just, I'm so grateful for the time
that you spent with us andthere's just, there's so much
more here.
I mean, you just have such adepth to you and your career and
what you have alreadyaccomplished in the years since
you graduated from PA school.
So thank you for sharing ataste of this with us before we
go.
What is something that you wishto tell to the person who might
(45:01):
be considering a career inmedicine and is just looking at
all this going?
You know, do I belong here?
Is this, is this for me?
What would you tell them?
Speaker 2 (45:09):
I would tell that person.
You know, if you're reallyconsidering a career in medicine
, never stop asking questions.
Right, Get it from straightfrom the source.
Talk to people who are activelydoing the job.
You're interested in the good,the bad, the ugly actively doing
the job.
You're interested in the good,the bad, the ugly.
You want to hear it all.
I think that if I could give anyadvice, it would be not to go
(45:30):
into medicine with rosy coloredglasses.
Right, Really understand thebusiness and the industry as a
whole as much as you really can,and I think you can only do
that by asking a lot of peoplewhat they think, and not only
people who are just started out,but people who have been in the
business for a long time,people of all different degree,
(45:51):
backgrounds in various sectors,Because I think, at the end of
the day, you know we all getinto this because we want to
make a difference, and the truthof the matter is, is that that
actually looks different forevery person, and there's
nothing wrong with that.
You know.
That's actually the beautifulpart about medicine is that it
can be so versatile and theskills that you use and that you
(46:13):
learn and you use to take careof patients can be used outside
of direct patient care too, andthat's wonderful too.
We need people in everydiscipline, every level to be
able to drive progress and drivechange that truly is
patient-centered andvalues-based.
I think that there's a lot ofemphasis on value-based care.
(46:36):
Well, I push back on that and Isay that care should be
values-based.
Are we giving care based onwhat the patient themselves
value?
Speaker 1 (46:46):
I think that's great and your skills are needed what
makes you unique and yourexperiences.
That is needed in medicine.
Natalie, thank you so much.
I so appreciate your time andall of the insight you've
provided and the amazing,amazing stories.
I feel so motivated aboutmedicine and the direction that
it's going thanks to you andthanks to your role in
(47:08):
leadership, so I appreciate it.
Speaker 2 (47:11):
Thank you so much, Ashley.
I really appreciate you havingme today.
Speaker 1 (47:14):
Thank you so very much for listening to this
episode of shadow me next.
If you liked this episode or ifyou think it could be useful
for a friend, please subscribeand invite them to join us next
Monday, as always.
If you have any questions, letme know on Facebook or Instagram
Access.
(47:34):
You want stories you need?
You're always invited to shadowme next.
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