April 7, 2025 • 34 mins
Learn more about Dr. Otten or to support his documentary, please visit Medicine Forward.
His book, Ripples of Change is available at a bookstore near you!
Dr. Todd Otten pulls back the curtain on healthcare's darkest challenges while offering a vision of hope for its future. A board-certified family physician with over two decades of experience, Dr. Otten speaks candidly about his own battle with severe burnout that nearly ended his career and the devastating loss of four colleagues to suicide.
What makes this conversation particularly powerful is Dr. Otten's refusal to simply critique the system while remaining on the sidelines. As co-founder of Our Quadruple Aim and lead catalyst of Medicine Forward, he's actively building solutions to strengthen the patient-physician relationship that lies at the heart of effective healthcare. His book "Ripple of Change," co-authored with his patient Joshua Judy, offers a rare dual perspective of the healthcare journey from both sides of the stethoscope.
Dr. Otten shares the story of his "office utopia," where he mentored nurse practitioners through an open-door policy that prioritized collaborative learning and patient care. This approach stands in stark contrast to today's high-pressure, metrics-driven healthcare environment that too often values data collection over meaningful human connection. "Does data make the dying feel better?" he asks, challenging us to reconsider what truly matters in medicine.
The conversation takes a powerful turn as Dr. Otten discusses his upcoming documentary project, which aims to educate Americans about healthcare's systemic problems – from corporate greed to insurance obstacles – while activating a movement for genuine transformation. Despite these weighty topics, his message remains hopeful. For those considering healthcare careers, he emphasizes the beauty of medicine while advocating for mentorship, boundary-setting, and self-care as essential safeguards against burnout.
Through stories that range from heartbreaking to inspiring, Dr. Otten reminds us that at its core, medicine is about those profound human connections that transcend algorithms and metrics – like his poignant interaction with a 90-year-old cancer patient that created ripples of gratitude lasting decades. Subscribe to Shadow Me Next for more conversations that explore the human side of medicine with leaders who are shaping its future.
Virtual shadowing is an important tool to use when planning your medical career. At Shadow Me Next! we want to provide you with the resources you need to find your role in healthcare and secure your place in medicine.
Check out our pre-health resources. Great for pre-med, pre-PA, pre-nursing, pre-therapy students or anyone else with an upcoming interview!
Mock Interviews: shadowmenext.com/mock-interviews
Personal Statement Review: shadowmenext.com/personal-statement
Free Downloads: shadowmenext.com/free-downloads
Want to request a guest? Shoot me an email: ashley@shadowmenext.com
Mark as Played
Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Ashley (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):
In today's episode, we welcomeDr Todd Otten, a board-certified
family physician with over 20years of experience in
healthcare.
Dr Otten is the co-founder ofOur Quadruple Aim, a movement
focused on improving patientexperience, quality care,
lowering costs and enhancingprovider wellness.
He's also the lead catalyst andboard chair of Medicine Forward
(01:28):
, where he works to strengthenthe patient-physician
relationship and catalyzepositive change in healthcare.
Dr Otten's journey intomedicine was shaped both by his
passion for human connection anda desire to help others.
His personal story is atestament to the challenges of
burnout, having navigated hisown struggles with it in 2019,
(01:50):
and sadly losing severalcolleagues to suicide.
But it's his drive to makelasting change in the healthcare
system that fuels his missiontoday.
In this episode, we'll diveinto Dr Auten's experience
training young clinicians, hisheartfelt approach to patient
care and the inspiration behindhis very powerful book Ripple of
(02:12):
Change.
We'll also hear about hisgroundbreaking documentary aimed
at exposing the realities ofburnout, corporate greed and
mental health struggles inhealthcare.
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
(02:36):
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 with DrTodd Otten.
Hi, dr Otten, thank you so muchfor joining us today on Shadow
Me Next.
This is going to be a veryunique conversation, one that I
(02:56):
have been excited about since wechatted on LinkedIn.
So thanks for being here,thanks for dedicating your time.
Dr. Otten (03:02):
Oh, absolutely A little bit of pressure to start,
huh.
Ashley (03:06):
Pressure's always good.
We like it we like it.
Dr Otten is the co-author of abook called Ripple of Change
that I have really been enjoying.
I expected to finish before westarted chatting and then you
know it's a book that you justread one page and you go, wow, I
want to read that page again.
So it really hooks you and itkeeps you in there.
It's a fantastic book and we'lltalk a little bit more about it
, but let's start.
If you don't mind, let's startat the beginning.
(03:27):
Let's go back all the way backto when you were considering
your career choices, your careeroptions.
What drew you to medicine?
Dr. Otten (03:37):
Oh, thank you.
A handful of things I would sayI did well in school, which
think is is probably aprerequisite to getting into
medical school, I suppose, andso I was gravitating towards
more challenging things.
Um, and I think there was twocomponents to one of them I
think I was conscious of and Ithink one of them, in retrospect
maybe, was subconscious, to behonest with you.
(03:58):
The first part of it I was asupervisor at parks and rec and
I was supervising kids andplaying games with them and
crafts, and I just love thathuman interaction, those
relationships that developed,and so that was definitely a
driver.
And it was probably a sophomore, junior year of high school.
I really thought maybe I want tobe a doctor and kind of just
(04:19):
got on that path and stayed onit, to be honest with you, but
subconsciously, prior to that Ihad had some traumatic things
happen in my life, you know, asa kid, predominantly around some
bullying, and I think thatreally shaped me in wanting to
help others, you know, and itwasn't honestly until recently
that I really realized that.
But yeah, straight into collegeand did some track and field
(04:43):
and then was straight intomedical school.
So it was kind of right on thatroad.
And you know, a couple ofdecades later, a few more gray
hairs, handful of kids, here weare.
Ashley (04:54):
So often our experience in childhood shapes our career,
and sometimes those experiencesare really positive and I love
talking to people about howtheir life was positively
changed by, you know, a mentorin the medical field and that's
what what compelled them.
But you know, those those lessfortunate stories are are
present as well.
So thank you for sharing that,and it does seem like just
(05:14):
speaking with you and readingyour book that is one of kind of
your pillars of wanting to bein medicine is to address some
of the mental health issues thatare prevalent right now amongst
physicians.
Dr. Otten (05:27):
Oh, oh, yes, without a doubt, that is, I would say
usually when people ask me likeyou know what drives you or why
are you doing what you're doingnow?
And I think there's threecomponents to it, and it's not
all sunshine, rainbows andlollipops, as they say.
But you know, I don't want todiscourage individuals either.
Medicine is an amazingprofession.
(05:48):
I love it, you know.
I loved seeing patients, butthe reality is in our landscape
now.
It's not easy, you know.
It is difficult in thisfee-for-service world, and
that's really one of the thingsthat we need to work on, I
suppose.
But I digress.
So the three drivers is I wentthrough really pretty bad
classic burnout in 2019, um, tothe point where I was ready to
(06:10):
just quit and walk away.
Um, you know, I, I remembersitting in my backyard in tears,
hating the job that I had lovedfor over a decade at that point
, just hating it, you know.
And it speaks to the difficultyand how hard medicine is.
But again, it's a beautiful,beautiful profession, but
(06:32):
unfortunately, over my career,with all those pressures and
drivers and so on and so forth,I've also had four of my
colleagues die by suicide.
It just has to change, and howthose things negatively impact
patients is extremelyunfortunate, and so we've got a
ways to go, and so that's what'sdriving me now, and I think on
the flip side there are amazingpeople who wanted to turn this
(06:55):
ship around, so to speak, andthe corollary to that is is we
need the next generation or thegeneration behind us.
As I said, you know a lot ofgray hairs and time's marching
on.
We need the next generation orthe generation behind us.
As I said, you know a lot ofgray hairs and time's marching
on.
We need the next generation ofyoung, amazing leaders to find
good mentors, go forward, grabyour opportunity and thrive, and
(07:17):
it can be done, but you have toset boundaries and all those
other kinds of things as well.
So, long-winded answer tosaying yes, I am extremely
passionate about improving themental health, not only for
clinicians but also for patients.
We need improvements in both ofthose buckets.
Ashley (07:32):
I agree it's a complex field with complex problems, and
patients are complex andphysicians are complex and the
problems can be so great, butthe benefit to working in
medicine every single day Istill feel it and so many people
I've talked to have remarked onit.
The benefits of it are are feltso strongly and and what we do
makes such a difference in thelives of our patients and it's,
(07:52):
it's important and I love it somuch.
Tell me about when you wereworking in family medicine, tell
me about what a day in yourlife looks like and perhaps,
perhaps, how that's changedsince you've taken on a new role
.
Dr. Otten (08:05):
For sure I, you know I think back my former employer.
I had been there for 13 yearsand, honestly, the vast majority
of it was completely amazing.
You know you'd start the dayand you'd be busy and it was,
you could say, maybe organizedchaos at times in a family
medicine office.
You know lots of messages andcoming faxes and what have you.
But you know it'd be eight ornine hours later and you'd be
(08:29):
having a blast and the day wouldbe done and it was like, oh my
gosh, wow, you can tell you'reloving it when you don't even
know that time is just elapsinglike that.
Right, and honestly, if you getgood and get efficient, it can
be done where you're not doingpajama time.
That's a different topic for adifferent day and I'll let the
listeners look it up if youdon't know, perhaps.
(08:53):
But I think some of my favoritememories were when I was
working in what we called theoffice utopia.
I think it's chapter 13 in thebook.
I was supervising three nursepractitioners all right out of
school and they were incredible.
We had an open door policy.
There was teaching.
I distinctly remember there wasthree chairs in my office.
At times all four of us wouldbe crammed in there.
One of them would be sitting onthe floor, indian style, just
(09:13):
because we wanted to go overcases and soak it all in.
It was such a magical time to behonest with you.
There was a rainbow unicornabove my desk that was put there
when I had gone away onvacation and it was like we were
in a flea market.
You know, there's all theseLego figures that patients had
given me and notes on the walland so on and so forth, but it
was just an absolute blast andyou knew you were making a
(09:37):
difference.
You know the peoples whoselives you touched, whether it
was young kids who they weregetting vaccines or doing
wellness checks, or an adultwith a complex health history or
somebody who was at the tailend of their life.
They needed that emotionalsupport and maybe their family
needed the courage to do theright thing and put them in
hospice or stop doing unneededtreatments and causing patients
(10:00):
to suffer.
You know those are some of thebest moments, and so certainly
highs and lows, but I would saythe highs by far outweighed the
lows in terms of direct patientcare, for sure.
Ashley (10:11):
You mentioned that you were training three nurse
practitioners right out ofschool and I would love to talk
just a little bit about that.
First of all, thank you fordoing that.
I've talked to so manycolleagues of mine who are APPs
that's what we call advancedpractice providers PAs, nps, et
cetera who have just kind ofbeen thrust into medicine and we
don't get that physiciansupervisor, that physician
(10:36):
mentor that we were reallyhopeful for in school and coming
out of school.
It's kind of why we chose thisprofession, for that
collaboration.
Why is that so important to youto work with PAs and NPs and
perhaps other young colleagues?
Dr. Otten (10:47):
Well, probably a few reasons.
I think, inherently I enjoyteaching.
I think it's part of it.
I enjoy that interaction of youknow, maybe challenging
somebody a little bit with aquestion and trying to get them
to take their thinking to thenext level.
I think that ultimately Irealized, like you know, as an
individual, if you're onlyfocused on that circle around
(11:08):
you, you only really have somuch impact.
But if you're teaching othersor empowering others or
impacting others, your sphere ofinfluence is tending to grow
and I think, subconsciously,that was probably part of it as
well.
I think for those that arecoming out of school or
considering it, you know the jobmarket for clinicians is, I
(11:29):
would say, very much in ourfavor for the most part maybe
not everywhere, but I wouldinclude that in.
You know, when you'reinterviewing, how's the
mentorship?
Do you spend time learning?
Do you spend time teaching?
How's the backup?
Are you there to answerquestions when I'm unsure of
myself?
Honestly, I think the bestclinicians, if they heard stuff
(11:50):
like that, would be incrediblyimpressed with an interviewee if
they heard that.
Ashley (11:52):
I love that sphere of influence idea.
That's exactly what we'retrying to do here on Shadow Me
Next too, in a little bit of adifferent way.
I was only impacting so manypre-health students, allowing
them to shadow in person, and Irealized that, while I love
talking about what I do and Ifeel so passionate about being a
PA in dermatology and you knowmy work, my, my pajama work as a
(12:13):
, as a medical editor there isso much more out there and you
know this.
This podcast really does allowpeople to kind of expand and
search out more and and justreally widens their ability to
learn about medicine, which isso perfect.
Before we hear what Dr Otten'squality question is, keep in
(12:33):
mind that there's more interviewprep, such as mock interviews
and personal statement reviewover on shadowmenextcom.
There you'll find amazingresources to help you as you
prepare to answer your ownquality questions.
Dr. Otten (12:46):
When we interviewed for those nurse practitioner
positions, I had a set of, Ithink, three or four canned
questions and a couple of themwere clinical.
But one of them was very muchintended to throw the candidates
off and to see how they couldthink on their feet and what
type of answer they would comeup with.
And when I was a kid, I used toread comic books and I won't go
down the rabbit hole of comicbooks right now, but I used to
ask the candidates tell me yourfavorite superhero, what's your
(13:09):
favorite superhero and why?
And you just get some wonderfulanswers.
You know a lot of creativity, alot of thinking outside of the
box.
You'd also get people thatwould just stare at you and and
and that was always concerningto me Like they couldn't come up
with anything at that moment.
I'm like well, what are yougoing to do if someone's like
having a heart attack right here?
You know, like I don't want youjust staring at them.
Ashley (13:29):
Oh no, that's a really good point.
I think in interview questionsat this point we should be used
to getting those that are justcoming out of left field right,
and sometimes the questions outof left field are really just
meant to be just that a questionout of left field and catch you
off your feet and really seehow you think and see if you
have, you know, resilience andtenacity, that sort of thing.
Dr. Otten (13:48):
My personal one is Spider-Man.
You know I can relate to thekid who was bullied, you know,
and so I think that's why italways resonated with me.
And then the other quote thatcame from that was with great
power comes great responsibility, and as a clinician you have a
lot power and and therefore alot of responsibility.
(14:09):
I mean literally, at times youhave other people's lives in
your hands, you know, you can'tforget that.
Um, so yeah, I always went withspider-man, but I heard by
wonder woman and batgirl and allkinds of fun things.
So it was great and there waslayers to the answers, sure, you
know the best answers wouldgive you layers, and that was
really kind of what I waslooking for.
Ashley (14:25):
And you would certainly learn a lot about people in a
question.
That's a fun question.
It's enjoyable to think about,you know, reading comics and
watching superhero movies andthings like that.
So I'm sure it's a little.
It's a question that should alsobe disarming, I would think a
little bit too, let's talk aboutchanges in healthcare always
(14:46):
the case, and I think that iswhen you were describing it.
I just thought about howwonderful it would be to just
sit and just talk about patientsall the time and not feel the
pressure and the rush of clinic,but just be able to digest some
of the things that we've seenand dealt with in clinic.
How, in your opinion, youmentioned burnout earlier how
has provider burnout impactedpatient care?
(15:08):
I mean, this is a huge issueright now and, in your opinion,
what is it doing to our patients, aside from what it's doing to
us?
How are patients suffering?
Dr. Otten (15:18):
Oh, big time.
I mean, we have proven in thiscountry we can spend a lot of
money and not have the bestoutcomes compared to other
developed countries around theworld when it comes to our
healthcare delivery system.
And, frankly, in my opinion, abig part of that is burnout, and
all the studies prove it right.
When you've got a clinicianthat's not at their best, you're
(15:38):
not getting the highest qualitycare, mistakes are made,
lawsuits go up, costs go up, soon and so forth, and so this RVU
driven fee for service modelthat we are all struggling to
navigate at times is superproblematic.
Honestly, I think we need toslow down and really take a step
back and say what are we reallydoing here?
(16:00):
Are we trying to generateprofits or are we trying to care
for human beings, which is ourpurpose?
I have a friend, dyke Drummond,who talks about polarity a lot,
you know, and balancing thosepolarities profits and purpose,
or people and profits, howeveryou want to describe it.
You know so the downstreameffects of burnout are
(16:21):
horrendous.
And if we think about just, youknow I'm a physician, so I'm
obviously biased to physicians,but the statistics are going to
be similar whether you're an APPor you're a nurse or whatever,
burnout's through the roof as apatient, do you want to be
talking to somebody who'sworried about how their marriage
is or their bills, or they'vegot substance abuse issues, I
mean, and that's part of burnout, or all these things?
(16:43):
I mean that's 50% of ourworkforce.
Think about that.
Is that what you want?
Do you want that from yourclinician, or do do you want
them well rested and thinking attheir best and at the top of
their game?
Of course, we all want thelatter and and as a, as a system
, we need to strive for that.
Ashley (17:01):
So you're right.
It's interesting.
Recently, and I'm gonna say inthe last year, um I I have a
practice where I see the samepatients over and over much like
yours, and develop thesefantastic relationships with
them.
I've noticed recently that someof my patients have started
asking how I'm doing, and theydon't just mean what are you
(17:22):
doing this weekend with yourgirls?
Are you guys going to thestrawberry festival?
They mean how are you doing?
As a clinician, I've noticedthat a lot of my other doctors
are looking really tired, arefeeling very stressed and are
getting a little snappy with me.
How are you doing?
And hearing that question frommy patients that I do care about
, but I'm, you know, I'm justI'm offering a very small
(17:45):
element of their healthcare.
It's concerning and I'm sograteful that they asked me and,
of course, I'm doing fine rightnow because I have an excellent
outlet in speaking with otherpeople about this exact problem.
But they're picking up on itobviously.
Dr. Otten (17:59):
Well, and as you say that, I have a bit of a almost
bittersweet response to that.
I think it speaks to the realityof where we're at and some of
the things that have occurredand the unfortunate events in
Manhattan a few months back, ifyou will.
But on the flip side, it alsowarms my heart that the patients
are thinking about theclinicians and concern for them.
(18:23):
You know there is a sacred bondin that relationship that has
been eroded over the years andtrust has been lost and those
little moments, those littletouch points, can help restore
that.
And when I first published thebook I mean that was one of the
simple things we talked aboutwas thank your physician, ask
how they're doing, and so when Ihear that these are going on,
(18:46):
it warms my heart that it'shappening, because I think it's
critical and, honestly, I thinkit speaks to how I think we're
going to make massive changeswithin the health care landscape
.
It's not going to come from oneorganization or one state or
whatever.
Masses in a unified direction.
(19:10):
If you will speaking together,clamoring or shouting for change
, you know the reality isthere's 300 million plus people
in this country who are notsatisfied with what is going on
in healthcare.
I would make the case thatthere's a small percentage that
are satisfied with the statusquo and the primary driver for
(19:30):
that, I think, is money,unfortunately.
Ashley (19:34):
No, you're absolutely right, and that sacred
relationship in medicine islikely what drives a lot of us
to continue doing what we'redoing, and for patients, it's
what brings them back to theoffice time and time and time
again your relationship withyour patients.
One of them you developed areally great relationship with,
so much so that you guys decidedto coauthor a book, Ripple of
(19:54):
Change, and it has been.
Honestly, one of my favoritethings is getting to hear both
perspectives.
It's such a unique approach todiscussing medicine to hear from
you, who is a medical doctor,and then also to hear from your
patient.
So your patient, Joshua Judy,and you co-authored the Ripple
of Change.
This book is incredible.
It achieved the number one newrelease on Amazon in its
(20:16):
category.
Why do you think this book isresonating with readers so much?
Dr. Otten (20:21):
Oh, there's lots of directions I could take this.
Well, let me give you a littlebit of backstory, how it
developed, I suppose, first, andthen maybe I can explain why.
I think it resonates with a lotof people, which was ultimately
our hope, right?
Everybody aspires, when they dosomething like this, that it
touches many, many individuals.
So I started writing Ripple ofChange probably two years about
two years after going throughburnout, and for me it was the
(20:43):
starting point, was a little bitcatharsis.
I wrote a poem called Medicineis a World of Gray, which is
kind of a dark look at whenprimary care is a struggle and
what's really going on.
And then I wrote a chaptercalled Anatomy of Burnout, which
is really my journey throughburnout and how it affected not
just me but my family, myfriends, my colleagues, least of
which my patients.
And so I was in this writingprocess and Joshua had been my
(21:06):
patient for oh my goodness, atleast a decade at that point and
he was having his own healthstruggles with cervical
radiculopathy which is a pinchednerve in his neck.
No HIPAA violations, it's allin the book, so it's all out
there already.
But we were struggling and hewas getting to a dark place
because of pain.
You know, when you're inchronic pain it is very
(21:26):
difficult to be positive whenyou're always hurting like that.
And so we had a conversationand I brought up what I was
doing and he's a bright,articulate guy and so I gave him
a little more information, toldhim about the quadruple aim,
and he's like, what's thequadruple aim?
And I'm like, don't worry,you'll learn about it as we go.
But anyways, my prescriptionfor him that day was really to
(21:48):
just write.
That's really the onlyinstructions I gave him.
And he wrote a beautiful piece.
We got together, talked about itand then he had the idea for
the yin and the yang.
On the spine there's a yin anda yang symbol.
It's in the form of a pillcapsule, and the reason for that
is is I wrote him for amedication with devastating side
effects.
Just, they were horrible.
And it's it's the exact samedrug that I still take to this
(22:11):
day to help curb mypost-concussive headaches from
playing sports.
And so you think about this,this beautiful world of medicine
where you can have these justdrastically different responses
to the exact same drug.
And so as we weave our twostories back and forth together,
you know it starts in this kindof dark place for both of us
and then morphs into reallyhealing and opportunity and
(22:34):
ideas and things that you can doto navigate the healthcare
system better.
We tried to fill it with alittle bit of something for
everyone, which is why it's alonger book, so don't be
intimidated.
It's a big font and I thinkpart of it too is there's lots
of stories, there's lots ofhumor, and we try to just fill
(22:54):
it with actionable items and Ithink it's people that really
get through it really appreciatethat and they're like no, this
isn't just Dr Otten complaining,this isn't just Joshua Judy
relaying his struggles.
These two guys are trying toinspire people and empower
people so that they can have abetter journey through the
healthcare system or play just alittle bit of a part to make it
(23:16):
better, and I think that reallyis landing with a lot of people
and I'm thrilled about it.
That was the you know, if I hada dream, that was.
The hope is that it would touchsome lives and make a
difference.
Ashley (23:28):
Absolutely.
I have really enjoyed readingit and it's funny I started
reading it as I was coming off aconversation that I had
recently with two PAs actually,about data and data collection
and how AI is being employedwith data collection and
medicine to really kind ofchange the face of medicine, so
(23:50):
to speak, and it felt veryexciting to me but at the same
time it felt so foreign.
It's so foreign.
Data collection is not my thing, but that's probably where it's
going to benefit is AI is goingto do all the data collection
for me.
But there was a line in yourbook that says does data make
the dying feel better?
And it was just.
It's such a stark contrast towhat I was just talking about
(24:13):
and really brings you back toyeah, we can get so wrapped up
in all of these big excitingchanges in medicine but at the
same time, we have to bring itall back to the point of taking
care of people, forming thoserelationships, gaining and
earning their trust andcontinuing to gain and earn
their trust throughout theirentire relationship, with us not
focusing on the data, which Ithink is what is fueling so much
(24:34):
of our burnout right now istrying to stay ahead of the game
.
Collect all of this information, check all the boxes, but it's
about the patients ultimately,right.
Dr. Otten (24:42):
A hundred percent.
You know, I think data isimportant, but it should not be
the primary driver.
You know, there are so manyother things that we should be
focusing on as opposed tochecking all these boxes.
And you know, honestly,sometimes the right answer is
not what the textbook tells you,you know, and it's not what the
(25:06):
data tells you to be.
I mean, and that's the beautyof medicine, being a physician,
that's why it's an art, right?
You know, I'll tell you a storyand I think there's some,
there's some power behind this.
I had been at my previous jobfor, oh geez, probably all of a
month out of residency.
Fortunately, I had a lot ofexperience prior to that in the
Navy, and so me being out ofresidency for a month was
(25:27):
probably not the same as youraverage person out of residency
for a month.
I mean, I'd have been out ofschool for almost 10 years at
that point.
But there was a patient who wasin his nineties and, um,
beautiful man, just wonderfulman, but he had nuance of
diabetes and he was thin and itwas just.
It didn't make sense.
When I saw this guy for thefirst time, like I'm, like
(25:47):
something is wrong, like redflags were going up in my mind.
And so I examined him andliterally I could feel a mass in
his abdomen, you know, aroundhis stomach or his pancreas a
little hard to tell at the time.
So we ordered some blood workand we ordered a scan, you know,
and I saw him back in a veryshort period and, sure enough,
he had metastatic pancreaticcancer, you know.
(26:08):
And the reality is there was nota whole lot of great options
out there, but his daughter camein and we talked through it and
we went through the choices andforgive me if I get a little
bit choked up here he looked atme in the eye and said you know,
dr Rotten, if this is you, whatwould you do?
Right, and you know, I'm like,second time I'm meeting this man
(26:31):
, you know, and he's 90 someyears old, and I'm weighing all
this in my mind Do I send him toan oncologist?
Do I?
You know, all thesechemotherapy, radiation, big
surgery, or it's all swirling atthis point?
And I looked at him and I saidI would spend time with your
family.
And you know, is that thetextbook?
(26:55):
You know, no, Was that theright answer at that time for
that man and his family?
Yes, do I regret it?
No, he stayed at home,exercised still for a few more
weeks and died peacefully inhospice about three months later
.
(27:16):
And no unneeded treatments, nounneeded costs.
You know, I think about that.
That's such a, for me, was abeautiful poignant moment and
fast forward.
You know whatever, how manyyears, 15 years I was doing a
book signing and his daughtercame up to me and said do you
remember me?
And I said oh yeah, I knowexactly who you are.
(27:39):
She gave me a big hug.
That's, that's what medicine'sabout right there.
That's what it's all about.
Ashley (27:45):
Thank you for sharing that story.
It's bringing me back episodetwo of this podcast.
We have a PA student, audraCotter, who is on bringing me
back Episode two of this podcast.
We have a PA student, audraCotter, who is on, and she
remarked on one of the mosteye-opening things that she has
experienced in medicine is thatin second year, her clinical
year, pancreatic cancer was herexample.
Actually, she said pancreaticcancer was a page in a textbook
(28:08):
and I read all about it and thesymptoms and the treatment
options, which, of course, weremedical, surgical treatment
options.
And she said and then, onclinical rotation, all of a
sudden pancreatic cancer becamea 64-year-old woman who has
children at home and bills topay.
And she said that was the powerof clinic.
I understood this disease, butnow in clinic I understand the
(28:33):
consequences of this disease andhow these people are
experiencing this disease.
And it was pancreatic cancerwas the example.
Dr. Otten (28:40):
That's the beauty of medicine.
It's not just all science,there's that human component to
it.
Those relationships, thosebonds, those love, those fears,
those good days, bad days allroll into one.
I mean again, I've said itearlier in the podcast and I'll
say it again it is a magicalprofession, which is why I am so
motivated to try and fix it asmuch as we can, because as it
(29:07):
stands it's largely broken andwe can't have that.
Ashley (29:12):
You're right.
In the book.
I believe it was Joshua Judywho provided this quote, but he
said I only knew the field ofmedicine to heal, not destroy,
and certainly not destroy thehealers themselves.
It's such a poignant quote tome and it really ties into what
you just said about looking tofix these elements of medicine.
I it really ties into what youjust said about looking to fix
(29:32):
these elements of medicine.
I think one of the ways you'redoing this is developing this
incredible documentary.
So tell us a little bit aboutthis, tell us how that quote
perhaps ties into thisdocumentary, what it's all about
and how you hope it changesthings.
Dr. Otten (29:47):
Absolutely.
When you were saying that quote, it had me thinking of my
career.
I've had the unfortunateexperience of losing four of my
colleagues to suicide.
You know a friend from medicalschool who is probably the
smartest person I ever knew, oneof my partners who was a mentor
to me and you know I I don'tthink I ever actually asked him
(30:07):
how he was doing, and I regretthat them how he was doing, and
I regret that.
And so I am super motivated withthis documentary, where the
goal is is is multifold and and,and we're still early on in the
process of this.
You know gathering informationand interviews, and, and so I
joke that we're building theairplane as we're flying it, and
there's some truth to that,right Cause you don't know how
(30:27):
it's all going to play out tillyou interview people Like you
don't know what they're going tosay and how many gold nuggets
are going to be laid out for you, and so on and so forth.
And so it's this fun windingpath, but ultimately what we're
really wanting to do is pullback the curtain for the
American people as to what isgoing on in healthcare, not just
from mental health and suicide,but corporate greed,
(30:52):
profiteering, insurance issues.
The list goes on and on and on,and the average American
healthcare consumer is not fullyaware of a good percentage of
these things, and they deserveto be and need to be, and we
need the American public tounderstand how bad things have
(31:15):
truly gotten for to the pointwhere you know we've got
somebody who goes and shoots aCEO in Manhattan, for goodness
sake.
So we want to really openpeople's eyes and I think by
educating the American public wecan then activate, and
hopefully we'll have an.
The plan is to have an evergreencall to action so that we can
(31:35):
really transform things.
So think, educate, activate,transform, with a whole bunch of
fun, emotional, hopefully, somehumor, you know, built in there
, et cetera.
So, yeah, ironically, one ofthe quotes that's stuck already
which kind of makes me laugh iswhen I said, yeah, I was taught
to just suck it up buttercup,and we decided the name of our
(31:57):
production company is ButtercupProductions.
So a little bit of levity inthere too, despite the heavy
topics.
Ashley (32:04):
Has to be.
That's life right.
If you're just approachingevery single thing in life and
not really feeling the weight ofthe issues, are you really
truly experiencing life?
Thank you for creating thisdocumentary.
I am so excited to watch it.
I think it's going to befantastic.
(32:24):
What would you say to encouragethose who might be interested
in a career in healthcare?
Or perhaps, what hopes?
What hopes do you have for thefuture of medicine?
Dr. Otten (32:42):
You know, you hear a lot of doom and gloom, and we're
on the verge of the systemimploding and you hear a lot of
the negativity.
I think the reality is, though,it's an absolutely beautiful
profession.
I wouldn't trade a thing.
I don't think I would tradeanything in my journey for the
world at this point, to be quitehonest with you, so I would
(33:04):
encourage you to follow yourdreams.
Having said that, I thinkgetting a mentor early on would
be an amazing thing.
Having said that, I thinkgetting a mentor early on would
be an amazing thing.
I think learning to setboundaries is critical, the
capacity to say no, but,ultimately, self-care is
paramount.
You have got to take care ofyourself as you go through the
(33:26):
journey.
If you're not doing well, youare not nearly giving your best
to other human beings.
So, yeah, I think there's hopeand we need the generation that
follows behind myself to help usmove forward.
Ashley (33:43):
Thank you so much, and thank you, dr Otten, for
spending so much time andsharing so many incredible
stories with us today.
I really appreciate it.
Dr. Otten (33:55):
Oh, it was an absolute pleasure.
I hope everyone that had anopportunity to listen learned
something, and feel free toreach out to me.
I'm on LinkedIn, I'm veryresponsive there and
medicineforwardorg is thenonprofit organization where I'm
the lead catalyst, and I'llleave it with this.
Our mission statement iscatalyzing positive change so
(34:15):
physician-patient relationshipscan flourish.
Ashley (34:19):
That's incredible.
Thank you so much.
Dr. Otten (34:21):
Thanks for having me.
Ashley (34:23):
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 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.
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):
In today's episode, we welcomeDr Todd Otten, a board-certified
family physician with over 20years of experience in
healthcare.
Dr Otten is the co-founder ofOur Quadruple Aim, a movement
focused on improving patientexperience, quality care,
lowering costs and enhancingprovider wellness.
He's also the lead catalyst andboard chair of Medicine Forward
(01:28):
, where he works to strengthenthe patient-physician
relationship and catalyzepositive change in healthcare.
Dr Otten's journey intomedicine was shaped both by his
passion for human connection anda desire to help others.
His personal story is atestament to the challenges of
burnout, having navigated hisown struggles with it in 2019,
(01:50):
and sadly losing severalcolleagues to suicide.
But it's his drive to makelasting change in the healthcare
system that fuels his missiontoday.
In this episode, we'll diveinto Dr Auten's experience
training young clinicians, hisheartfelt approach to patient
care and the inspiration behindhis very powerful book Ripple of
(02:12):
Change.
We'll also hear about hisgroundbreaking documentary aimed
at exposing the realities ofburnout, corporate greed and
mental health struggles inhealthcare.
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
(02:36):
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 with DrTodd Otten.
Hi, dr Otten, thank you so muchfor joining us today on Shadow
Me Next.
This is going to be a veryunique conversation, one that I
(02:56):
have been excited about since wechatted on LinkedIn.
So thanks for being here,thanks for dedicating your time.
Dr. Otten (03:02):
Oh, absolutely A little bit of pressure to start,
huh.
Ashley (03:06):
Pressure's always good.
We like it we like it.
Dr Otten is the co-author of abook called Ripple of Change
that I have really been enjoying.
I expected to finish before westarted chatting and then you
know it's a book that you justread one page and you go, wow, I
want to read that page again.
So it really hooks you and itkeeps you in there.
It's a fantastic book and we'lltalk a little bit more about it
, but let's start.
If you don't mind, let's startat the beginning.
(03:27):
Let's go back all the way backto when you were considering
your career choices, your careeroptions.
What drew you to medicine?
Dr. Otten (03:37):
Oh, thank you.
A handful of things I would sayI did well in school, which
think is is probably aprerequisite to getting into
medical school, I suppose, andso I was gravitating towards
more challenging things.
Um, and I think there was twocomponents to one of them I
think I was conscious of and Ithink one of them, in retrospect
maybe, was subconscious, to behonest with you.
(03:58):
The first part of it I was asupervisor at parks and rec and
I was supervising kids andplaying games with them and
crafts, and I just love thathuman interaction, those
relationships that developed,and so that was definitely a
driver.
And it was probably a sophomore, junior year of high school.
I really thought maybe I want tobe a doctor and kind of just
(04:19):
got on that path and stayed onit, to be honest with you, but
subconsciously, prior to that Ihad had some traumatic things
happen in my life, you know, asa kid, predominantly around some
bullying, and I think thatreally shaped me in wanting to
help others, you know, and itwasn't honestly until recently
that I really realized that.
But yeah, straight into collegeand did some track and field
(04:43):
and then was straight intomedical school.
So it was kind of right on thatroad.
And you know, a couple ofdecades later, a few more gray
hairs, handful of kids, here weare.
Ashley (04:54):
So often our experience in childhood shapes our career,
and sometimes those experiencesare really positive and I love
talking to people about howtheir life was positively
changed by, you know, a mentorin the medical field and that's
what what compelled them.
But you know, those those lessfortunate stories are are
present as well.
So thank you for sharing that,and it does seem like just
(05:14):
speaking with you and readingyour book that is one of kind of
your pillars of wanting to bein medicine is to address some
of the mental health issues thatare prevalent right now amongst
physicians.
Dr. Otten (05:27):
Oh, oh, yes, without a doubt, that is, I would say
usually when people ask me likeyou know what drives you or why
are you doing what you're doingnow?
And I think there's threecomponents to it, and it's not
all sunshine, rainbows andlollipops, as they say.
But you know, I don't want todiscourage individuals either.
Medicine is an amazingprofession.
(05:48):
I love it, you know.
I loved seeing patients, butthe reality is in our landscape
now.
It's not easy, you know.
It is difficult in thisfee-for-service world, and
that's really one of the thingsthat we need to work on, I
suppose.
But I digress.
So the three drivers is I wentthrough really pretty bad
classic burnout in 2019, um, tothe point where I was ready to
(06:10):
just quit and walk away.
Um, you know, I, I remembersitting in my backyard in tears,
hating the job that I had lovedfor over a decade at that point
, just hating it, you know.
And it speaks to the difficultyand how hard medicine is.
But again, it's a beautiful,beautiful profession, but
(06:32):
unfortunately, over my career,with all those pressures and
drivers and so on and so forth,I've also had four of my
colleagues die by suicide.
It just has to change, and howthose things negatively impact
patients is extremelyunfortunate, and so we've got a
ways to go, and so that's what'sdriving me now, and I think on
the flip side there are amazingpeople who wanted to turn this
(06:55):
ship around, so to speak, andthe corollary to that is is we
need the next generation or thegeneration behind us.
As I said, you know a lot ofgray hairs and time's marching
on.
We need the next generation orthe generation behind us.
As I said, you know a lot ofgray hairs and time's marching
on.
We need the next generation ofyoung, amazing leaders to find
good mentors, go forward, grabyour opportunity and thrive, and
(07:17):
it can be done, but you have toset boundaries and all those
other kinds of things as well.
So, long-winded answer tosaying yes, I am extremely
passionate about improving themental health, not only for
clinicians but also for patients.
We need improvements in both ofthose buckets.
Ashley (07:32):
I agree it's a complex field with complex problems, and
patients are complex andphysicians are complex and the
problems can be so great, butthe benefit to working in
medicine every single day Istill feel it and so many people
I've talked to have remarked onit.
The benefits of it are are feltso strongly and and what we do
makes such a difference in thelives of our patients and it's,
(07:52):
it's important and I love it somuch.
Tell me about when you wereworking in family medicine, tell
me about what a day in yourlife looks like and perhaps,
perhaps, how that's changedsince you've taken on a new role
.
Dr. Otten (08:05):
For sure I, you know I think back my former employer.
I had been there for 13 yearsand, honestly, the vast majority
of it was completely amazing.
You know you'd start the dayand you'd be busy and it was,
you could say, maybe organizedchaos at times in a family
medicine office.
You know lots of messages andcoming faxes and what have you.
But you know it'd be eight ornine hours later and you'd be
(08:29):
having a blast and the day wouldbe done and it was like, oh my
gosh, wow, you can tell you'reloving it when you don't even
know that time is just elapsinglike that.
Right, and honestly, if you getgood and get efficient, it can
be done where you're not doingpajama time.
That's a different topic for adifferent day and I'll let the
listeners look it up if youdon't know, perhaps.
(08:53):
But I think some of my favoritememories were when I was
working in what we called theoffice utopia.
I think it's chapter 13 in thebook.
I was supervising three nursepractitioners all right out of
school and they were incredible.
We had an open door policy.
There was teaching.
I distinctly remember there wasthree chairs in my office.
At times all four of us wouldbe crammed in there.
One of them would be sitting onthe floor, indian style, just
(09:13):
because we wanted to go overcases and soak it all in.
It was such a magical time to behonest with you.
There was a rainbow unicornabove my desk that was put there
when I had gone away onvacation and it was like we were
in a flea market.
You know, there's all theseLego figures that patients had
given me and notes on the walland so on and so forth, but it
was just an absolute blast andyou knew you were making a
(09:37):
difference.
You know the peoples whoselives you touched, whether it
was young kids who they weregetting vaccines or doing
wellness checks, or an adultwith a complex health history or
somebody who was at the tailend of their life.
They needed that emotionalsupport and maybe their family
needed the courage to do theright thing and put them in
hospice or stop doing unneededtreatments and causing patients
(10:00):
to suffer.
You know those are some of thebest moments, and so certainly
highs and lows, but I would saythe highs by far outweighed the
lows in terms of direct patientcare, for sure.
Ashley (10:11):
You mentioned that you were training three nurse
practitioners right out ofschool and I would love to talk
just a little bit about that.
First of all, thank you fordoing that.
I've talked to so manycolleagues of mine who are APPs
that's what we call advancedpractice providers PAs, nps, et
cetera who have just kind ofbeen thrust into medicine and we
don't get that physiciansupervisor, that physician
(10:36):
mentor that we were reallyhopeful for in school and coming
out of school.
It's kind of why we chose thisprofession, for that
collaboration.
Why is that so important to youto work with PAs and NPs and
perhaps other young colleagues?
Dr. Otten (10:47):
Well, probably a few reasons.
I think, inherently I enjoyteaching.
I think it's part of it.
I enjoy that interaction of youknow, maybe challenging
somebody a little bit with aquestion and trying to get them
to take their thinking to thenext level.
I think that ultimately Irealized, like you know, as an
individual, if you're onlyfocused on that circle around
(11:08):
you, you only really have somuch impact.
But if you're teaching othersor empowering others or
impacting others, your sphere ofinfluence is tending to grow
and I think, subconsciously,that was probably part of it as
well.
I think for those that arecoming out of school or
considering it, you know the jobmarket for clinicians is, I
(11:29):
would say, very much in ourfavor for the most part maybe
not everywhere, but I wouldinclude that in.
You know, when you'reinterviewing, how's the
mentorship?
Do you spend time learning?
Do you spend time teaching?
How's the backup?
Are you there to answerquestions when I'm unsure of
myself?
Honestly, I think the bestclinicians, if they heard stuff
(11:50):
like that, would be incrediblyimpressed with an interviewee if
they heard that.
Ashley (11:52):
I love that sphere of influence idea.
That's exactly what we'retrying to do here on Shadow Me
Next too, in a little bit of adifferent way.
I was only impacting so manypre-health students, allowing
them to shadow in person, and Irealized that, while I love
talking about what I do and Ifeel so passionate about being a
PA in dermatology and you knowmy work, my, my pajama work as a
(12:13):
, as a medical editor there isso much more out there and you
know this.
This podcast really does allowpeople to kind of expand and
search out more and and justreally widens their ability to
learn about medicine, which isso perfect.
Before we hear what Dr Otten'squality question is, keep in
(12:33):
mind that there's more interviewprep, such as mock interviews
and personal statement reviewover on shadowmenextcom.
There you'll find amazingresources to help you as you
prepare to answer your ownquality questions.
Dr. Otten (12:46):
When we interviewed for those nurse practitioner
positions, I had a set of, Ithink, three or four canned
questions and a couple of themwere clinical.
But one of them was very muchintended to throw the candidates
off and to see how they couldthink on their feet and what
type of answer they would comeup with.
And when I was a kid, I used toread comic books and I won't go
down the rabbit hole of comicbooks right now, but I used to
ask the candidates tell me yourfavorite superhero, what's your
(13:09):
favorite superhero and why?
And you just get some wonderfulanswers.
You know a lot of creativity, alot of thinking outside of the
box.
You'd also get people thatwould just stare at you and and
and that was always concerningto me Like they couldn't come up
with anything at that moment.
I'm like well, what are yougoing to do if someone's like
having a heart attack right here?
You know, like I don't want youjust staring at them.
Ashley (13:29):
Oh no, that's a really good point.
I think in interview questionsat this point we should be used
to getting those that are justcoming out of left field right,
and sometimes the questions outof left field are really just
meant to be just that a questionout of left field and catch you
off your feet and really seehow you think and see if you
have, you know, resilience andtenacity, that sort of thing.
Dr. Otten (13:48):
My personal one is Spider-Man.
You know I can relate to thekid who was bullied, you know,
and so I think that's why italways resonated with me.
And then the other quote thatcame from that was with great
power comes great responsibility, and as a clinician you have a
lot power and and therefore alot of responsibility.
(14:09):
I mean literally, at times youhave other people's lives in
your hands, you know, you can'tforget that.
Um, so yeah, I always went withspider-man, but I heard by
wonder woman and batgirl and allkinds of fun things.
So it was great and there waslayers to the answers, sure, you
know the best answers wouldgive you layers, and that was
really kind of what I waslooking for.
Ashley (14:25):
And you would certainly learn a lot about people in a
question.
That's a fun question.
It's enjoyable to think about,you know, reading comics and
watching superhero movies andthings like that.
So I'm sure it's a little.
It's a question that should alsobe disarming, I would think a
little bit too, let's talk aboutchanges in healthcare always
(14:46):
the case, and I think that iswhen you were describing it.
I just thought about howwonderful it would be to just
sit and just talk about patientsall the time and not feel the
pressure and the rush of clinic,but just be able to digest some
of the things that we've seenand dealt with in clinic.
How, in your opinion, youmentioned burnout earlier how
has provider burnout impactedpatient care?
(15:08):
I mean, this is a huge issueright now and, in your opinion,
what is it doing to our patients, aside from what it's doing to
us?
How are patients suffering?
Dr. Otten (15:18):
Oh, big time.
I mean, we have proven in thiscountry we can spend a lot of
money and not have the bestoutcomes compared to other
developed countries around theworld when it comes to our
healthcare delivery system.
And, frankly, in my opinion, abig part of that is burnout, and
all the studies prove it right.
When you've got a clinicianthat's not at their best, you're
(15:38):
not getting the highest qualitycare, mistakes are made,
lawsuits go up, costs go up, soon and so forth, and so this RVU
driven fee for service modelthat we are all struggling to
navigate at times is superproblematic.
Honestly, I think we need toslow down and really take a step
back and say what are we reallydoing here?
(16:00):
Are we trying to generateprofits or are we trying to care
for human beings, which is ourpurpose?
I have a friend, dyke Drummond,who talks about polarity a lot,
you know, and balancing thosepolarities profits and purpose,
or people and profits, howeveryou want to describe it.
You know so the downstreameffects of burnout are
(16:21):
horrendous.
And if we think about just, youknow I'm a physician, so I'm
obviously biased to physicians,but the statistics are going to
be similar whether you're an APPor you're a nurse or whatever,
burnout's through the roof as apatient, do you want to be
talking to somebody who'sworried about how their marriage
is or their bills, or they'vegot substance abuse issues, I
mean, and that's part of burnout, or all these things?
(16:43):
I mean that's 50% of ourworkforce.
Think about that.
Is that what you want?
Do you want that from yourclinician, or do do you want
them well rested and thinking attheir best and at the top of
their game?
Of course, we all want thelatter and and as a, as a system
, we need to strive for that.
Ashley (17:01):
So you're right.
It's interesting.
Recently, and I'm gonna say inthe last year, um I I have a
practice where I see the samepatients over and over much like
yours, and develop thesefantastic relationships with
them.
I've noticed recently that someof my patients have started
asking how I'm doing, and theydon't just mean what are you
(17:22):
doing this weekend with yourgirls?
Are you guys going to thestrawberry festival?
They mean how are you doing?
As a clinician, I've noticedthat a lot of my other doctors
are looking really tired, arefeeling very stressed and are
getting a little snappy with me.
How are you doing?
And hearing that question frommy patients that I do care about
, but I'm, you know, I'm justI'm offering a very small
(17:45):
element of their healthcare.
It's concerning and I'm sograteful that they asked me and,
of course, I'm doing fine rightnow because I have an excellent
outlet in speaking with otherpeople about this exact problem.
But they're picking up on itobviously.
Dr. Otten (17:59):
Well, and as you say that, I have a bit of a almost
bittersweet response to that.
I think it speaks to the realityof where we're at and some of
the things that have occurredand the unfortunate events in
Manhattan a few months back, ifyou will.
But on the flip side, it alsowarms my heart that the patients
are thinking about theclinicians and concern for them.
(18:23):
You know there is a sacred bondin that relationship that has
been eroded over the years andtrust has been lost and those
little moments, those littletouch points, can help restore
that.
And when I first published thebook I mean that was one of the
simple things we talked aboutwas thank your physician, ask
how they're doing, and so when Ihear that these are going on,
(18:46):
it warms my heart that it'shappening, because I think it's
critical and, honestly, I thinkit speaks to how I think we're
going to make massive changeswithin the health care landscape
.
It's not going to come from oneorganization or one state or
whatever.
Masses in a unified direction.
(19:10):
If you will speaking together,clamoring or shouting for change
, you know the reality isthere's 300 million plus people
in this country who are notsatisfied with what is going on
in healthcare.
I would make the case thatthere's a small percentage that
are satisfied with the statusquo and the primary driver for
(19:30):
that, I think, is money,unfortunately.
Ashley (19:34):
No, you're absolutely right, and that sacred
relationship in medicine islikely what drives a lot of us
to continue doing what we'redoing, and for patients, it's
what brings them back to theoffice time and time and time
again your relationship withyour patients.
One of them you developed areally great relationship with,
so much so that you guys decidedto coauthor a book, Ripple of
(19:54):
Change, and it has been.
Honestly, one of my favoritethings is getting to hear both
perspectives.
It's such a unique approach todiscussing medicine to hear from
you, who is a medical doctor,and then also to hear from your
patient.
So your patient, Joshua Judy,and you co-authored the Ripple
of Change.
This book is incredible.
It achieved the number one newrelease on Amazon in its
(20:16):
category.
Why do you think this book isresonating with readers so much?
Dr. Otten (20:21):
Oh, there's lots of directions I could take this.
Well, let me give you a littlebit of backstory, how it
developed, I suppose, first, andthen maybe I can explain why.
I think it resonates with a lotof people, which was ultimately
our hope, right?
Everybody aspires, when they dosomething like this, that it
touches many, many individuals.
So I started writing Ripple ofChange probably two years about
two years after going throughburnout, and for me it was the
(20:43):
starting point, was a little bitcatharsis.
I wrote a poem called Medicineis a World of Gray, which is
kind of a dark look at whenprimary care is a struggle and
what's really going on.
And then I wrote a chaptercalled Anatomy of Burnout, which
is really my journey throughburnout and how it affected not
just me but my family, myfriends, my colleagues, least of
which my patients.
And so I was in this writingprocess and Joshua had been my
(21:06):
patient for oh my goodness, atleast a decade at that point and
he was having his own healthstruggles with cervical
radiculopathy which is a pinchednerve in his neck.
No HIPAA violations, it's allin the book, so it's all out
there already.
But we were struggling and hewas getting to a dark place
because of pain.
You know, when you're inchronic pain it is very
(21:26):
difficult to be positive whenyou're always hurting like that.
And so we had a conversationand I brought up what I was
doing and he's a bright,articulate guy and so I gave him
a little more information, toldhim about the quadruple aim,
and he's like, what's thequadruple aim?
And I'm like, don't worry,you'll learn about it as we go.
But anyways, my prescriptionfor him that day was really to
(21:48):
just write.
That's really the onlyinstructions I gave him.
And he wrote a beautiful piece.
We got together, talked about itand then he had the idea for
the yin and the yang.
On the spine there's a yin anda yang symbol.
It's in the form of a pillcapsule, and the reason for that
is is I wrote him for amedication with devastating side
effects.
Just, they were horrible.
And it's it's the exact samedrug that I still take to this
(22:11):
day to help curb mypost-concussive headaches from
playing sports.
And so you think about this,this beautiful world of medicine
where you can have these justdrastically different responses
to the exact same drug.
And so as we weave our twostories back and forth together,
you know it starts in this kindof dark place for both of us
and then morphs into reallyhealing and opportunity and
(22:34):
ideas and things that you can doto navigate the healthcare
system better.
We tried to fill it with alittle bit of something for
everyone, which is why it's alonger book, so don't be
intimidated.
It's a big font and I thinkpart of it too is there's lots
of stories, there's lots ofhumor, and we try to just fill
(22:54):
it with actionable items and Ithink it's people that really
get through it really appreciatethat and they're like no, this
isn't just Dr Otten complaining,this isn't just Joshua Judy
relaying his struggles.
These two guys are trying toinspire people and empower
people so that they can have abetter journey through the
healthcare system or play just alittle bit of a part to make it
(23:16):
better, and I think that reallyis landing with a lot of people
and I'm thrilled about it.
That was the you know, if I hada dream, that was.
The hope is that it would touchsome lives and make a
difference.
Ashley (23:28):
Absolutely.
I have really enjoyed readingit and it's funny I started
reading it as I was coming off aconversation that I had
recently with two PAs actually,about data and data collection
and how AI is being employedwith data collection and
medicine to really kind ofchange the face of medicine, so
(23:50):
to speak, and it felt veryexciting to me but at the same
time it felt so foreign.
It's so foreign.
Data collection is not my thing, but that's probably where it's
going to benefit is AI is goingto do all the data collection
for me.
But there was a line in yourbook that says does data make
the dying feel better?
And it was just.
It's such a stark contrast towhat I was just talking about
(24:13):
and really brings you back toyeah, we can get so wrapped up
in all of these big excitingchanges in medicine but at the
same time, we have to bring itall back to the point of taking
care of people, forming thoserelationships, gaining and
earning their trust andcontinuing to gain and earn
their trust throughout theirentire relationship, with us not
focusing on the data, which Ithink is what is fueling so much
(24:34):
of our burnout right now istrying to stay ahead of the game
.
Collect all of this information, check all the boxes, but it's
about the patients ultimately,right.
Dr. Otten (24:42):
A hundred percent.
You know, I think data isimportant, but it should not be
the primary driver.
You know, there are so manyother things that we should be
focusing on as opposed tochecking all these boxes.
And you know, honestly,sometimes the right answer is
not what the textbook tells you,you know, and it's not what the
(25:06):
data tells you to be.
I mean, and that's the beautyof medicine, being a physician,
that's why it's an art, right?
You know, I'll tell you a storyand I think there's some,
there's some power behind this.
I had been at my previous jobfor, oh geez, probably all of a
month out of residency.
Fortunately, I had a lot ofexperience prior to that in the
Navy, and so me being out ofresidency for a month was
(25:27):
probably not the same as youraverage person out of residency
for a month.
I mean, I'd have been out ofschool for almost 10 years at
that point.
But there was a patient who wasin his nineties and, um,
beautiful man, just wonderfulman, but he had nuance of
diabetes and he was thin and itwas just.
It didn't make sense.
When I saw this guy for thefirst time, like I'm, like
(25:47):
something is wrong, like redflags were going up in my mind.
And so I examined him andliterally I could feel a mass in
his abdomen, you know, aroundhis stomach or his pancreas a
little hard to tell at the time.
So we ordered some blood workand we ordered a scan, you know,
and I saw him back in a veryshort period and, sure enough,
he had metastatic pancreaticcancer, you know.
(26:08):
And the reality is there was nota whole lot of great options
out there, but his daughter camein and we talked through it and
we went through the choices andforgive me if I get a little
bit choked up here he looked atme in the eye and said you know,
dr Rotten, if this is you, whatwould you do?
Right, and you know, I'm like,second time I'm meeting this man
(26:31):
, you know, and he's 90 someyears old, and I'm weighing all
this in my mind Do I send him toan oncologist?
Do I?
You know, all thesechemotherapy, radiation, big
surgery, or it's all swirling atthis point?
And I looked at him and I saidI would spend time with your
family.
And you know, is that thetextbook?
(26:55):
You know, no, Was that theright answer at that time for
that man and his family?
Yes, do I regret it?
No, he stayed at home,exercised still for a few more
weeks and died peacefully inhospice about three months later
.
(27:16):
And no unneeded treatments, nounneeded costs.
You know, I think about that.
That's such a, for me, was abeautiful poignant moment and
fast forward.
You know whatever, how manyyears, 15 years I was doing a
book signing and his daughtercame up to me and said do you
remember me?
And I said oh yeah, I knowexactly who you are.
(27:39):
She gave me a big hug.
That's, that's what medicine'sabout right there.
That's what it's all about.
Ashley (27:45):
Thank you for sharing that story.
It's bringing me back episodetwo of this podcast.
We have a PA student, audraCotter, who is on bringing me
back Episode two of this podcast.
We have a PA student, audraCotter, who is on, and she
remarked on one of the mosteye-opening things that she has
experienced in medicine is thatin second year, her clinical
year, pancreatic cancer was herexample.
Actually, she said pancreaticcancer was a page in a textbook
(28:08):
and I read all about it and thesymptoms and the treatment
options, which, of course, weremedical, surgical treatment
options.
And she said and then, onclinical rotation, all of a
sudden pancreatic cancer becamea 64-year-old woman who has
children at home and bills topay.
And she said that was the powerof clinic.
I understood this disease, butnow in clinic I understand the
(28:33):
consequences of this disease andhow these people are
experiencing this disease.
And it was pancreatic cancerwas the example.
Dr. Otten (28:40):
That's the beauty of medicine.
It's not just all science,there's that human component to
it.
Those relationships, thosebonds, those love, those fears,
those good days, bad days allroll into one.
I mean again, I've said itearlier in the podcast and I'll
say it again it is a magicalprofession, which is why I am so
motivated to try and fix it asmuch as we can, because as it
(29:07):
stands it's largely broken andwe can't have that.
Ashley (29:12):
You're right.
In the book.
I believe it was Joshua Judywho provided this quote, but he
said I only knew the field ofmedicine to heal, not destroy,
and certainly not destroy thehealers themselves.
It's such a poignant quote tome and it really ties into what
you just said about looking tofix these elements of medicine.
I it really ties into what youjust said about looking to fix
(29:32):
these elements of medicine.
I think one of the ways you'redoing this is developing this
incredible documentary.
So tell us a little bit aboutthis, tell us how that quote
perhaps ties into thisdocumentary, what it's all about
and how you hope it changesthings.
Dr. Otten (29:47):
Absolutely.
When you were saying that quote, it had me thinking of my
career.
I've had the unfortunateexperience of losing four of my
colleagues to suicide.
You know a friend from medicalschool who is probably the
smartest person I ever knew, oneof my partners who was a mentor
to me and you know I I don'tthink I ever actually asked him
(30:07):
how he was doing, and I regretthat them how he was doing, and
I regret that.
And so I am super motivated withthis documentary, where the
goal is is is multifold and and,and we're still early on in the
process of this.
You know gathering informationand interviews, and, and so I
joke that we're building theairplane as we're flying it, and
there's some truth to that,right Cause you don't know how
(30:27):
it's all going to play out tillyou interview people Like you
don't know what they're going tosay and how many gold nuggets
are going to be laid out for you, and so on and so forth.
And so it's this fun windingpath, but ultimately what we're
really wanting to do is pullback the curtain for the
American people as to what isgoing on in healthcare, not just
from mental health and suicide,but corporate greed,
(30:52):
profiteering, insurance issues.
The list goes on and on and on,and the average American
healthcare consumer is not fullyaware of a good percentage of
these things, and they deserveto be and need to be, and we
need the American public tounderstand how bad things have
(31:15):
truly gotten for to the pointwhere you know we've got
somebody who goes and shoots aCEO in Manhattan, for goodness
sake.
So we want to really openpeople's eyes and I think by
educating the American public wecan then activate, and
hopefully we'll have an.
The plan is to have an evergreencall to action so that we can
(31:35):
really transform things.
So think, educate, activate,transform, with a whole bunch of
fun, emotional, hopefully, somehumor, you know, built in there
, et cetera.
So, yeah, ironically, one ofthe quotes that's stuck already
which kind of makes me laugh iswhen I said, yeah, I was taught
to just suck it up buttercup,and we decided the name of our
(31:57):
production company is ButtercupProductions.
So a little bit of levity inthere too, despite the heavy
topics.
Ashley (32:04):
Has to be.
That's life right.
If you're just approachingevery single thing in life and
not really feeling the weight ofthe issues, are you really
truly experiencing life?
Thank you for creating thisdocumentary.
I am so excited to watch it.
I think it's going to befantastic.
(32:24):
What would you say to encouragethose who might be interested
in a career in healthcare?
Or perhaps, what hopes?
What hopes do you have for thefuture of medicine?
Dr. Otten (32:42):
You know, you hear a lot of doom and gloom, and we're
on the verge of the systemimploding and you hear a lot of
the negativity.
I think the reality is, though,it's an absolutely beautiful
profession.
I wouldn't trade a thing.
I don't think I would tradeanything in my journey for the
world at this point, to be quitehonest with you, so I would
(33:04):
encourage you to follow yourdreams.
Having said that, I thinkgetting a mentor early on would
be an amazing thing.
Having said that, I thinkgetting a mentor early on would
be an amazing thing.
I think learning to setboundaries is critical, the
capacity to say no, but,ultimately, self-care is
paramount.
You have got to take care ofyourself as you go through the
(33:26):
journey.
If you're not doing well, youare not nearly giving your best
to other human beings.
So, yeah, I think there's hopeand we need the generation that
follows behind myself to help usmove forward.
Ashley (33:43):
Thank you so much, and thank you, dr Otten, for
spending so much time andsharing so many incredible
stories with us today.
I really appreciate it.
Dr. Otten (33:55):
Oh, it was an absolute pleasure.
I hope everyone that had anopportunity to listen learned
something, and feel free toreach out to me.
I'm on LinkedIn, I'm veryresponsive there and
medicineforwardorg is thenonprofit organization where I'm
the lead catalyst, and I'llleave it with this.
Our mission statement iscatalyzing positive change so
(34:15):
physician-patient relationshipscan flourish.
Ashley (34:19):
That's incredible.
Thank you so much.
Dr. Otten (34:21):
Thanks for having me.
Ashley (34:23):
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 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.
You want stories you need?
You're always invited to shadowme next.
Popular Podcasts
Stuff You Should Know
If you've ever wanted to know about champagne, satanism, the Stonewall Uprising, chaos theory, LSD, El Nino, true crime and Rosa Parks, then look no further. Josh and Chuck have you covered.
Dateline NBC
Current and classic episodes, featuring compelling true-crime mysteries, powerful documentaries and in-depth investigations. Follow now to get the latest episodes of Dateline NBC completely free, or subscribe to Dateline Premium for ad-free listening and exclusive bonus content: DatelinePremium.com
24/7 News: The Latest
The latest news in 4 minutes updated every hour, every day.