Global Surgery Hackathon: Lessons in Healthcare Systems - podcast episode cover

Global Surgery Hackathon: Lessons in Healthcare Systems

Dec 06, 202436 minEp. 122
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Episode description

In this episode of “Lab Medicine Rounds,” Justin Kreuter, M.D., speaks with medical students on the importance of understanding healthcare systems, their experiences from a global surgery hackathon, and how maintaining curiosity and continuous learning can enhance their medical practice.

Timestamps:
0:00 Introductions
0:49 Importance of Understanding Healthcare Systems
1:33 Fundamentals of Healthcare Systems
3:03 Complexity of Healthcare Systems
5:13 Selective vs Curriculum
6:08 Systems and Inequalities
7:18 Billing and Economics in Healthcare
8:17 Balancing Medical Training and System Knowledge
9:01 Curiosity and Continuous Learning
10:02 Learning Opportunities
13:02 Slowing Down in Critical Phases
16:41 Revising Healthcare Systems
18:02 Capturing Learning
22:03 Maintaining Curiosity
24:01 Advice for Developing Skills in Healthcare Systems

Transcript

Introductions

Justin Kreuter, M.D.

This is Lab Medicine Rounds, a curated podcast for physicians, laboratory professionals, and students. I'm your host, Justin Kreuter, a transfusion medicine pathologist and assistant professor of laboratory medicine and pathology at Mayo Clinic. Recently, I participated in a hackathon with a group of medical students from Mayo Clinic's Alix School of Medicine here in Rochester, Minnesota, focused on global surgery. And it gave me a really kind of interesting insight into thinking about how we're teaching our learners to think about healthcare systems. And so today, we actually have 4 medical students with us to talk about this topic.

Importance of Understanding Healthcare Systems

So I'll introduce them in sequence for all of our audio listeners to kinda hear their voice. So we'll start off with Matt Gish, who's a 2nd year medical student here at Mayo Clinic.

Matt Gish

Hey, everybody. Thanks for having me, doctor Kreuter.

Justin Kreuter, M.D.

Absolutely. And Audrey Bankes is a 1st year medical student here at Mayo Clinic.

Audrey Bankes

Hello, everybody. Happy to be here.

Justin Kreuter, M.D.

We've got Yousuf Khalil, is a 2nd year medical student here at Mayo.

Yousuf Khalil

Hi, everyone. Thanks for having me.

Justin Kreuter, M.D.

And finally, we've got Richard Betancourt here as a 2nd year medical student at Mayo.

Richard Betancourt

Hi, everyone. Happy to be here.

Justin Kreuter, M.D.

Alright. So let's kinda kick this off. Maybe to start off, Matt, why is it important for a physician to think about health care systems?

Fundamentals of Healthcare Systems

Matt Gish

Yeah. This is a question that I think we need to continuously wrestle with in medical school, And it comes up in the curriculum over and over again in terms of content, you know, who who's paying, what are our insurance companies like, those kind of things. But I think engaging with it in a in a deeper level and trying to understand what motivates not only our health care system, but also systems around the world that we could, at any point, either see our system change into or go perform in systems like that themselves. It's just so important to understand how the greater structure of health care influences the decisions that we'll make every day.

Justin Kreuter, M.D.

Right. I like how you're highlighting there's a system that we're working in. Something's like I think about it as, like, the fish that's in the water. It doesn't know what water is necessarily or for us walking through the air that we breathe. And maybe some of us don't think about that as much, but I really like the way you talk about continuously reexamine that.

And so I'm curious, maybe we can all kind of put a tack in that, and we can kind of come back to explore that a little bit further as we go through. Audrey, I could start off with you. And and I know you're a 1st year medical student, so you're just kinda getting started with this Global Surgery Selective. Are there some of the fundamentals of health care systems that so far to you have declared themselves in your mind?

Complexity of Healthcare Systems

Audrey Bankes

Yeah. That's an interesting question. Like you said, I'm 1st year, and so we've just started to scratch the surface of the very complex and large topic of health care systems. But for me, I think about it in the case of how is it affecting the patients. And so I know it's a big system, and I know it's a lot of moving pieces.

But as doctors, I do think that we have some small role, and we can, in some ways, influence how the system is gonna affect the patients and the people that we're interacting with. And so that's kind of the biggest thing I started to hone in on so far is, yes, it's a big system and it's very complicated, but it does affect real people in real ways. And it's important that we try to make it as best that we possibly can with what power we do have in the system.

Justin Kreuter, M.D.

Yousuf, I wonder if you could build on Audrey there, kind of thinking about this patience, and I like the way she's highlighting. You have this complexity. And in order to kinda get our arms around it, sometimes we have to simplify something. But there is this kind of tension, this back and forth. You're a 2nd year. You've kind of been with this longitudinal selective for a year. How have you seen some of these fundamentals come forward?

Yousuf Khalil

Yeah. I think, like Audrey was saying, the the system the system is very, very complex, and we've learned a lot about it in through the selective, through our curriculum. But even then, I think I'm not fully I don't fully understand it yet, and I don't think I will until I'm practicing and and dealing with it every day. I can already see, you know, in the patients that we do see how the system affects them. And I think even as a patient myself, how the system is super complicated with with insurance companies and everything that, you know, as that patient has to deal with.

I think as future physicians learning about the system as best as we can and trying to incorporate that into our practice, if the patients have to deal with them on a daily basis, we should also learn how to how to, you know, work within the system to make their lives as easy as possible. And I think this is particularly important with patients who kind of are more underrepresented and with some patients who have a more difficult time with the health care system. I think it's obviously a much bigger system than all of us, but I think, like Andre was saying, to work within our means to make it easier for them specifically too.

Selective vs Curriculum

Justin Kreuter, M.D.

Richard, can I ask you you know, so Yousuf brought up this idea of what we're learning in the curriculum versus the, selective that you guys have elected? How do you contrast those 2? How has the selective enabled you to explore how you think about health care systems further?

Richard Betancourt

Yeah. I think it is important also when considering a perspective of what a system is and what it's designed for. And I mean, systems really guide, like, the conversation of both macro and micro levels. I think that's becoming increasingly more true as we're connected more globally, as well as, with the further division of labor. In the past, you know, a lot of the practice was, sort of, you know, family, a physician oriented, but specialization wallet allows us to expand ourselves more in expand what's possible in healthcare.

Systems and Inequalities

We are also missing a lot of the insights that we're able to really gain on a systems level. And I think it's really important when considering this in the context of inequalities in the healthcare system and how the division of labor sort of upholds a lot of those inequalities. For example, in many healthcare systems, the experience of billing a patient is separated from the practice, which acts sort of to shield or, as a barrier separation from having that person to person interaction, of what is, you know, in many cases, for example, like life changing bills.

Justin Kreuter, M.D.

That makes me wonder, Audrey, if I can ask you, and I realize it may put you a little bit on the spot, but does it surprise you as a medical student that, you know, this kind of Rick's pointing out, thinking about all these different levels and thinking about how billing works. I don't know if you were an economics major, before coming to medical school or worked in those ways, but I imagine a lot of people maybe come to medical school kind of focused on learning the medicine and science. And are you surprised about this focus on thinking about how does billing work these other components of the health care system?

Audrey Bankes

Yeah. I was not an economics major, but that's a super good question. Like you said, I come into medical school, and I think a lot of people come into medical school thinking about science and research and the lab, and it's very removed from the billing and the real world impacts on people. And as Rick said, that can be a bad thing in a sense that people forget that that's happening, and they can just start racking up the bills and the tests and the lab orders without considering what it's actually gonna cost the patient at the end of the day. So I don't think I'm necessarily surprised, but it is something that we don't talk about very often in school.

Billing and Economics in Healthcare

At least my understanding as a 1st year, we haven't talked about it yet. And so it's it's not surprising, but it's a little bit disappointing or a little bit disheartening, I should say, that this is something that's a reality, and we have to deal with it. And it's very hard to learn. It's very hard to understand, and it's something that's bigger than most of us, so it's something also that's difficult to deal with and difficult to realize that's the the case for a lot of patients.

Balancing Medical Training and System Knowledge

Justin Kreuter, M.D.

Yeah. I like the way you put that. I think there is something about an element of how much do we have to know so that we can function in our health care systems or we can optimize our health care systems. But like you're, I think, highlighting, there are other colleagues that are playing these roles as their primary. What do people think about how we strike that balance of how much do we focus on this in medical school?

How do we get each other to be able to kind of talk the financial language with colleagues or, you brought up other elements of the healthcare delivery. How do we work to interact with colleagues who are maybe not physicians, maybe nursing colleagues, allied health, the c suite?

Curiosity and Continuous Learning

Audrey Bankes

I'll start on it just because I left off, but Yeah. It's tough because medical school and medical training is a finite period of time. And although training is very long, it still has to be completed within an x amount of years, and you still have to have a finish line. And so it's hard to cram more and more skills and knowledge and information into that period of time. So I think that's a tough question.

I think there's more emphasis and more learning that could definitely be done in medical schools or on your own free time as that's something that's important for you to learn as a human being, But I'd be interested to see what other people had to say about that.

Matt Gish

I've found similarly that maintaining curiosity is something that has driven me to explore these complicated areas of the medical field and kind of learning humbly from the amazing people here at Mayo who specialize in all sorts of things from patient advocacy to billing to insurance coverage. They play such a crucial role and, I think, are really underrecognized in our system. And the experiences that I've had, either working with them in a clinical setting, sitting down and hearing them speak at events, conferences, or even listening in on podcasts like this one. They've opened my eyes to the work that they do and given me just a little bit of taste of how I can fit into what they're doing as a physician and try to make this kind of janky health care system that we've created run a little bit more smoothly.

Learning Opportunities

Justin Kreuter, M.D.

Yeah. I really like the way you put that back. I wanna put a pin in that about curiosity and come back to that in a little bit. And I wanna highlight what Audrey was saying about this curriculum and medical school being a finite time, because that hits me right in the medical educators part of, right, we're trying to build a curriculum and set of experiences to build competency, hopefully excellence, in our physicians. But I think it does acknowledge the reality that there are limitations, which fosters some creativity.

But maybe if I can bend over and ask Youssef, how are you finding opportunities to think about exploring healthcare systems so far in medical school?

Yousuf Khalil

Kind of like what Matt was saying. I think exploring other options as well in addition to the curriculum, like podcasts, books, stuff like that, I think helps to kinda give a more comprehensive view of things. And I think even within the curriculum, you know, the things that are well established, the things that everyone has to go to and and is really important to go to are those kind of health care system science classes. But then, you know, you can add on additional electives like what we did with the global surgery selective. And I think the more you realize how important it is to learn these things, I think it just gives you that added motivation to actually in your free time, even if you're tired from learning about all the medicine and science all day and it's it's exhausting and it can hurt your brain sometimes.

I think it's important to, like Matt was saying, maintain that curiosity and that drive to learn the stuff outside of the science to kind of give yourself a more comprehensive worldview.

Justin Kreuter, M.D.

Right on. Are there other opportunities that people have kinda come across in medical school so far?

Matt Gish

I think this can be a situation where our patients are some of our best educators. Maybe more than, especially a lot of us who are just younger in medical school. They've had experiences navigating the health care system with different insurance companies, different providers at different institutions. And hearing out their stories is something that can give us a lot of really valuable perspective. I also think working through patient cases can be really helpful.

Rick and I were on a team recently at a free clinic here in Rochester, and we had a patient come in feeling generally unwell. And it turns out he was a young man, and he had an ejection fraction of 26 due to unknown cardiomyopathy. And the textbook answer is to check some labs, get them on appropriate heart failure medications, but our options were in this setting. We're at a free clinic. We have an uninsured patient.

Slowing Down in Critical Phases

And now we're working to try and understand how can we best work within the constraints of the free clinic in our limited resources to help this patient and ensure their safety while also not just sending them to the ER and causing catastrophic financial loss. So learning from this patient's case and their experience is something that can really help heighten our own knowledge of the world that we're operating in.

Justin Kreuter, M.D.

I love that example. Right? 1, because it's specific. But then 2, because I think this gets at something for all of our listeners who probably a minority of them are going to be medical students, but hopefully we got a couple, but who can be thinking about this podcast and and what might I take away from this? And one one of the things is sometimes we will send a podcast with people in the ivory towers and such like this, but what we're talking about today about thinking about health care systems is really thinking about how we what we can make the most with what we have.

And, Matt, can I ask you to elaborate a little bit about how did you approach that? Because I imagine there's a temptation of, well, if we had other resources, I would do this. But how did you approach doing the best with what you had?

Matt Gish

Yeah. I mean, it was a complicated situation with something that kind of took all of the brains of the team that was there thinking about how we could work through this patient's case. We're digging up former labs. People were calling previous health care providers trying to figure out what kind of myopathy we're looking at here. We're considering, is this patient clinically too sick to not go to the ER?

Do we need to send him? We're calling other resources through Mayo Clinic Charity Care looking at, can we get him an urgent cardiology visit? But also just recognizing that we can't just give him the medication off of our little limited formulary sheet and hope that it works and tell him to either come back in or go to the ER if he's feeling sick. Like, these options that may be available to some people who are better resourced were kind of off the table for us. And it really just required a lot of collaboration and phone calls and trying to figure out how could this patient's needs best be served with what we had to offer in the setting?

Justin Kreuter, M.D.

I think you said Richard was with you with on this case. Right? And maybe I can ask Richard. Can you maybe elaborate of seeing the team come together? And were there elements that you saw that were kind of, this worked well, and or are there elements that you saw with the team coming together, that was maybe counterproductive? I just wanna kind of call highlight to those elements.

Richard Betancourt

Yeah. So I was a little less involved in this case. There's actually another instance that same day where a patient was coming in for just a medication refill and, on exam, we found a, murmur. And then looking back multiple years, we found that they were found to have severe aortic stenosis that was never then followed up on. So that was basically a similar situation. So I can speak on, my experience with that.

Revising Healthcare Systems

Justin Kreuter, M.D.

That'd be fantastic. Yeah.

Richard Betancourt

I think one of the major things that we, identified was, you know, why didn't they follow-up as well as, following the impact that communication really has like on, medical care, especially with like say immigrant populations, because, the patient was a non native English speaker and they really did not, seem to understand what the pathology was as well as like the needs for it to be followed up on. And after we were able to, explain really, and make sure that they understood what was going on, then they were, I'd say amiable to just following up with the issue to make sure that nothing bad happens down the line, hopefully. So I think, in a lot of instances, especially again with the sub specialization, where we're all kind of confined to our little boxes, and we're hyper focusing on efficiency and getting things done quickly. We don't take a step back and, make sure that say, does the patient understand what's going on? I think that taking a pause and a step back, and the system's really helped, everybody involved, even though this is a time consuming process, like Matt said, you know, it took a lot of everyone's brains to come together for, you know, one individual.

And I think in a system that, really prioritizes efficiency and getting things done quickly. I don't know if that is, as able to be done. So I think that is a pretty big impact.

Capturing Learning

Speaker 6

For more laboratory education, including a listing of conferences, webinars, and on demand content, visit Mayo Clinic Labs dot com forward slash education.

Justin Kreuter, M.D.

I'm really glad you highlighted the pausing or slowing down deliberately. That's something that particularly I've read about this in the surgery literature when it comes to confidence about experts realizing here's a critical point, and so as a result, like, I need to slow down. I need to focus instead of just this is going along, and I'm I'm finishing out the procedure. Maybe I can ask Audrey, since we were talking about this element of building expertise, is that something that you've started, that you've been exposed to, this slowing down to during a critical phase? Is that something that you've seen in your 1st year already, or is that something that you haven't come across yet?

Audrey Bankes

I'll say I haven't come across it in technical practice too too much, but it's interesting that you say that because they tell us at least they've told us several times that as medical students, we actually have more time than the attendings and the consultants and everybody else. And so for us, it's very important to slow down and maybe be that one person that sits in the room, talks to the patient, listens to their story, hears what they have to say. And if something comes up, we can bring that back to the consultant and say, hey. They probably never told you this, but I just had a conversation, and they brought up a really interesting side point that I think is important here. I think the doctors I've been around and worked with, they understand the importance of slowing down, and they do absolutely try their best to slow down.

But like Rick said, there's there's pressures, there's outside factors that contribute to that, and sometimes it's just hard or it's just a little bit too overwhelming. There's too much going on, and it just doesn't cross somebody's mind. But as a medical student, they have harped on us. It's important to learn that. And, hopefully, if we do take the time to learn to slow down, that can carry forward to when we're the consultants and we're the attendings, and we can really put that into practice, hopefully, in the future.

Justin Kreuter, M.D.

It makes my medical educator heart go pitter patter that you're hearing this already in the 1st year, and this is being encouraged. Yousuf, can I ask you, you're a 2nd year? Have you seen this play out? And I'm wondering if you can kinda specifically highlight some of that tension between getting the work done but slowing down. How have you seen this navigated?

Yousuf Khalil

Yeah. I think in terms of taking that pause and taking a time out, I think I've mainly seen it a more explicit time out in the surgery in the surgical setting like you were mentioning. But just in terms of patient care in the positions that I've been in so far, it's mainly just been coming in, getting a quick history and physical, and going back and speaking to the consultant. But I think I started off very anxious about that and wanting to make sure that I got it done in a timely manner. But I found that when I was doing that, I was not doing it well.

And so I think when I started having first of all, a checklist when I go in, a checklist of things that I wanna ask about, and making sure that I take my time with the patient and listen more than I hammering out questions at them. I've noticed that I end up getting a much better history from them. So I think kind of keeping that either checklist in your mind or checklist with you in front of you when you go in to speak to them, I think is super important. And I think that's something that I really appreciate about being at Mayo is they teach us the importance of being present with your patient. Because those things that I told you that ended up helping, those aren't things that I came up with.

Those are things that my consultants told me that I need to get better at. And when I did incorporate those, I found, first of all, a much more coherent a much more cohesive relationship between me and my patients.

Justin Kreuter, M.D.

I wanna go back to this idea that was said earlier in our recording here about this idea of continuously revisiting how we think about health care systems. I know we've been really focusing in on specific examples. I wonder if we can kinda pull back, and I'm gonna ask us to maybe go a little bit metacognitive and think about how we're learning stuff. But, you know, this is really kind of an open, maybe a junk ball question. I'm gonna put it up there and set it out.

Maintaining Curiosity

How do you approach continuously revisiting something? If we think about medical school as this spiraling curriculum where we're getting exposed to things and regetting exposed to things, but because of our training we've had in the interim, we can go deeper. How do you guys approach capturing that learning so that you are meaningfully revisiting this each time?

Richard Betancourt

I personally, we have I'd say a class that's called senior sages where we meet with a a retired medical doctor. And in general, they helped give us like life advice for what they found helpful during their experience as a physician. And my Sage, recommended me to keep a notebook and write down just like things that I've done throughout the day, things to help with like memory. And I think that it's very helpful to help write down important learning points just to, you know, have it down. And then maybe once in a while, I like to go back and read through my notebook.

And it also helps with just like remembering funny moments that I might have forgotten about.

Justin Kreuter, M.D.

Well, spot on. I think that's an a wonderful technique. Do others have other ways that they're capturing their learning?

Yousuf Khalil

I think for me, I think being in medical school, I've realized that learning the science and the medicine and everything is very important, but I think something that's even more important potentially that they're teaching us is how to think about things and how to research things that we get interested in. So I think having that context and learning if if I find something that I feel is particularly important, how to how to do a deep dive and figure out everything about it and figure out what is important about it. I think just kind of that high level thinking, I think, is something that I really appreciate that I'm I I feel that I'm gaining from medical school. Yeah. I think I think that's something that I would I would say I use to to learn more.

Advice for Developing Skills in Healthcare Systems

Audrey Bankes

A little bit different, and, of course, I haven't had as much experience as the other people here. But when someone gives me feedback or maybe something I didn't feel great about, I usually remember that or jot it down or something. And then I really try to find as many opportunities to practice and relearn and use that skill as I can. So every free clinic, I go and volunteer. Every opportunity to work with my family on something, I use that.

Every opportunity to go to a free suture clinic at the school, I use that. So I just really try to repractice that skill over and over and over again and just utilize opportunities that are already right in front of me to really exploit those skills and make sure I'm learning it over and over again even if I feel okay about it.

Matt Gish

Yeah. And I think our patients can be our best reminders to take those deep dives, like Youssef was saying, and just remain curious. And when they have a a barrier to taking a medication or they're trying to figure out what insurance plan is gonna maybe work better with their new diagnosis, taking those cases and instead of just letting it be a, oh, that's interesting or, oh, I wonder. Taking the time to resist the urge to only study testable material and really letting curiosity drive you into that deep dive. Hey.

I'm gonna go back to the workroom and do some research on what kind of plans would be best for you and your situation right now. Or, hey. I don't know a lot about how we can get that medication covered, but I think this would be a great opportunity for me to learn. It's those moments and those interactions that I think are most frequently brought about by our own patients that we can really use as a platform to dive deep and learn well.

Justin Kreuter, M.D.

Okay. It's official. I think I wanna recruit all 4 of you to become pathologists. You know? This I the idea, the way you guys are going about capturing your learning, the way you're talking about it sounds like you guys are all internally motivated.

You've got the curiosity, the fire, and you're looking to just get the repetitions and practice variations on a theme. So these are all elements that our listeners can really take away from this podcast. Right? If you're a physician in practice, you know, that listening to these medical students might be sparking in your mind to think about some of these adjacent areas of your practice that you may not be taking a deep dive into, but certainly is the water that we're swimming in, the the health care system that you work in. If you're a laboratory professional, you could be thinking about how am I interacting with physicians and helping them understand how they can optimally use the lab in whatever kind of resource and situation that you find yourself.

And students, if you're listening to this, I think there's some great tactics and strategies that these medical students are really articulating that I just wanna call your attention to, this idea of writing things down, reflecting on things, and practicing the heck out of it are all fantastic strategies. Can I ask you, medical school is a challenge? I imagine sometimes you're tired. I don't know. Maybe you guys have, like, some battery inside you that is just, like, amazing.

But how do you maintain that curiosity when it's tough?

Audrey Bankes

For me, it is hard sometimes, and the motivation dwindles. But similar much to the previous question, circle back to things that I really enjoy and I really like. And I was like, you know, this is tough. This is maybe not my favorite thing at the moment, but can I apply that to an area that I really love and I'm really passionate about? For me, that's really serving under underinsured, underserved patients.

So if I'm learning about pharmacology and I'm judging along, learning about a 100 drugs a week, and it's, you know, it's tough. It's not the funniest thing for me personally. But can I apply that to my patients that I'm gonna see in the free clinic? And this is really important medication for them. I need to understand this.

I need to know this, so it's important for me to learn. And kind of remembering that in the back of my head does help motivate me even when I'm tired, even when I'm late at night and just wanting to go to bed.

Justin Kreuter, M.D.

Reconnecting with your why is what I'm hearing. That that's very powerful. Youssef, were you gonna hop hop in?

Yousuf Khalil

Yeah. I hate to be repetitive, but I think that's exactly my answer. A couple of things I think being in the preclinical phase of your studies is it can be particularly demoralizing sometimes just because you're constantly your head's in in I was gonna say your head's in the books, but I haven't opened a textbook this entire time. But I had more in the laptop, I will say. But you're just learning the science behind things and the medicine behind things, and it's hard to see how it applies to real life sometimes.

And I think having little exposures here and there as to how we can help patients and particularly patients who need it the most, I think, is very, very helpful. And for me personally, my family is Egyptian so, you know, they immigrated here a while ago and I go back to Egypt constantly and so I see I have exposure to what's available there and the stark difference in what some people have access to. And so I think having that kind of drive to help people back home or people even in America who have similar experiences, I think that's a big thing that can keep me going when the going gets tough, honestly.

Justin Kreuter, M.D.

I really like the way I think your response, Yousef, actually, yeah, it does build on Audrey's. Right? I mean, it's well, it is both both of you are saying you're connecting to your why. I think you're, like, highlighting the floristy of just how diverse that why may be. And I think that's something that I'm gonna be taking away from this conversation with you guys today.

I know for myself, sometimes when I'm on service and at the end of the day, I would just wanna go crash on my couch. But I know I still need to crack open and, you know, the latest publication that came out. I need to be aware of what those papers are. Okay. I wanna do the thing that I I said at the outset that I wasn't gonna do.

That's to ask a question, just go down the line, but I just wanna take our listeners out by having each of you share, what advice do you have for our listeners who would like to further develop their abilities, their skills to think about health care systems? Because some of our listeners may not have really deliberately thought about this in a while. Some of our listeners may not necessarily be thinking in in these terms or or just be starting to. So what advice do you have for them? And I guess I'll I'll thank you as we're kinda going out and and start with Matt Gish.

Matt Gish

Yeah. Thanks again for having me, doctor Kreuter. This has been a ton of fun. I think my biggest piece of advice, and something that I'm still working on daily, is to continue to chase curiosity. When a patient presents with a socioeconomic challenge or you're having trouble navigating the system that you're providing health care within, taking a step back in trying to identify where that confusion's coming from.

And even if you have a test coming up on the radar or you've just got other emails and research projects to focus on, being able to chase down that curiosity and listen to a podcast, flag a couple articles, pick up a book, maybe that challenges the way you currently think about the health care system. Those are the things that, coming back to our why, I truly believe will help make me the best provider I can be someday. At times, it's really hard to understand the value of chasing down curiosity as opposed to doing more flashcards and more practice questions. But taking a step back and understanding who do I wanna become and how do I get there, I think taking those learning opportunities is always the way that will help me push forward and become the best that I can be.

Justin Kreuter, M.D.

Thanks so much for sharing, Matt. Audrey Bankes.

Audrey Bankes

Yeah. I think probably everything I'm about to say has been said in one way or another, but for me, asking questions is a huge one. If you don't know something, you don't understand something, just ask the question. Usually, people have a lot of information and background knowledge that you don't have, and it's really valuable just to let them share that with you. The second one, for me, I really like to engage with people who aren't typically doctors or maybe not, you know, in the same realm as us.

So if you can reach out to people who know a heck of a lot more about health system sciences than you do yourself, that is gonna be so hugely helpful. It just gets you outside of your bubble, helps you see things from a different perspective, which I really value it when I'm learning anything. And then the third one is if you have the time and the energy, use your own personal time to do some googling, look up a cool video, look up a cool article. It doesn't have to be a lot, but, you know, if you just kinda get the itch to learn something, just read a quick paper. And I think that if you do that every once in a while, you'll still learn a lot, and I think that's really powerful to do.

Justin Kreuter, M.D.

Thank you, Audrey. Yousuf Khalil.

Yousuf Khalil

Yeah. Thank you so much for having me again, doctor Porter. I think I think for me, my big takeaway would be to think about the context that your patient presents in or comes from. I think we in the medical field have a lot to learn from people in the field of public health and epidemiology and health system science, and I'm biased because my wife does study public health, but I think we do have a lot to learn from it. And I think learning about social determinants of health and learning about the conditions that lead to conditions that patients present with.

And so I think we have a lot to learn from the field of public health and to incorporate that into a more holistic, worldview of the field of medicine.

Justin Kreuter, M.D.

Thank you, Yousuf. And Richard Betancourt.

Richard Betancourt

I think for me, there's a lot of talk about examining or taking out bias or in the context of global health, taking out western perspectives when can when it comes to health care. And I think this follows the same issue, when it comes to the idea of say like colorblindness when looking at racism, where it ignores the fact that we live in systems where these biases are ubiquitous to a certain extent, whether consciously or unconsciously. And one teaching point that I remember from class is there's this idea where physicians are meant to be the stoic beings that are objective and operate in the only the confines of science. But I mean, physicians are humans. So whenever you have, say a gut reaction towards something in a clinic or have an emotional response, I think it's really important to just examine that and explore why.

And just like Matt said, being curious.

Justin Kreuter, M.D.

Those are awesome responses. Thank you all for sharing, your advice and talking with us today. I think this has been really impactful for me to to think about. I haven't been deliberate about thinking about our health care system for some time. And thank you to our listeners for joining us today.

We invite you to share your thoughts and suggestions via email to [email protected]. If you've enjoyed this podcast, please subscribe. And until our next rounds together, we encourage you to continue to connect lab medicine and the clinical practice through educational conversations.

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