Episode 194 - Mental Health Matters In EMS With Dr. Joe Gill

[Music] [Music] Hello everyone, welcome again to another edition of the MCHD Paramedic Podcast. This is Dr. Casey Patrick and today on our show we have a couple of special guests. I'm going to introduce first Spencer Lance, he is our EMS software systems administrator here at MCHD. He's been a paramedic here at MCHD around almost as long as I have. And he has been gracious enough to join us to talk to Dr. Joe Gill, who is a medical director at Fort Bend County EMS. And so what do these folks on the podcast have in common? Well, they have a passion and an appreciation and a drive to really spread the word and open the conversation, push the conversation forward about why mental health matters in EMS. So I'll pass it to you first Dr. Gill, Joe, tell the listeners about yourself, your role, and how you became interested in EMS first responder mental health. All right, yeah, my role, well, thank you first of all for having me on your podcast. This is a great podcast. I've loved listening to it. I like to joke with my wife that Dr. Patrick always says, I'll say Casey, Casey always says, you know, your gels are far symposium, but in the reverse, I've always gels have his podcast. It's been long standing, I like listening to it, it's good quality content. So I appreciate being on today. Yeah, so how did I get passionate about this in the first place? To keep it brief, I started out as a tech in the yard during nursing school and then was at ER nurse for three years. Went to med school in Orlando at UCF, then residency in emergency medicine in South Carolina. And that's when I got my taste for pre hospital medicine. I did the usual track. I went to an EMS fellowship in Houston, did that and did the local EMS start it. And then if I'll be completely honest, I worked my bones until my body could take no more. And I burnt out in a lot of different ways. And most recently I spent almost three months in the hospital. For a diagnosis of videopathic pegrity, that was a year ago. And part of my own journey in healing was just for myself. You know, a lot of people asked me, what did I learn in the hospital? And we could talk about my story as we continue, but what I really saw was really good healthcare workers from the EMTs that transfer me from the paramedics that transfer me back and forth from the rehab. The people that resuscitated me when I was being intubated and had ARDS to the nurses and the text, the CT text when my belly was just and I saw really good people. And I was awake even when you know, you're sedated at times, but sometimes you take sedation holidays. And I had nothing to do. I had no energy. And so I saw a system that's not supporting and I'm talking about that hospital. That's a great hospital is that, but a whole system of healthcare and really frontline workers that are becoming burnout and from being completely honest, I was a victim of that myself. And I wanted to give back. And part of my healing process was, hey, I want to start a nonprofit. And then I want to eventually do this is my pipe dream. I want to do legal action, legislative action, at least on a state level to protect people like us. The too long didn't read version as I was a nurse to turn ER doctor, turn EMS doctor patient. And I got tired of seeing our frontline workers burn out. I get tired of seeing my friends commit suicide, get divorces, lose their jobs. I think we can do better and my little funny slogan I come up with is it's time to heal the healers. I was the year where I'm going to start back and it's going to become as I told my closest friends, I thought I was going crazy a little bit at first. I'm not going crazy. It's a it's the year of returning to the healers for me. And this is going to be my closest passion, you know, moving forward. You know, honesty and getting it all out there in our world is not the norm. Right. We keep it bottled up. We have to put on a good face. We have to see the next patient jump the next call. We have to see the next patient room and you know, we're in some repeat and that's not always healthy and not always the best way to go. Spencer, you're in this world too. Before we sort of roll into our questions here, I think it'd be good for the listeners. How did you end up here? Where, where, where, where did your passion come from? How, what, what drove you into this space? Absolutely. And Dr. Gillis, honestly, not not too terribly far off from yours. I think once we experienced those mental health struggles aren't around, we start to realize how much it matters. I had a very brief interest in kind of mental health and peer support, but really it came once I actually had a mental health crisis, my own very open about it within the agency and Instagram, but I had a suicide attempt. And after that really realized that, you know, hey, this was the result of one like Dr. Gillis at a system where it's not prioritized in general. And that's not to say MCHD, you know, it's taking care of very well here, but just healthcare, EMS fire, law enforcement as a whole. But also myself, right, taking accountability and that I didn't pay attention to the signs. I didn't know what they were. I didn't know where to seek help or support and let it get to that point. So I've been able to see through the social media space, kind of the impact that simple things like posting and providing kind of that education can have on people. And also that vulnerability bringing that forward so that we can show that it's okay to talk about this stuff. People aren't going to mock you, they're not going to hate you for it more than anything people appreciate being able to be open about it and understanding that other people have gone through the same things they have. So that's kind of what led me to the same spot, reaching that burnout point and having those mental health issues myself and really being able to, you know, provide that perspective from the same seat that those people are sitting in. So you got to see the biggest needs where the needs right now. So so Joe, you're going to you're going to tackle it anytime you decide to tackle, especially when you get into the legislative world, you got to have a, you're going to have a point of contact, a place that you feel like this is the, this is a spot that I really want to drill down and drill into. Where do you see the biggest needs right now and I would say, you know, my simple answer that question would be we're still in the stage of recognizing the scope of the problem, but that doesn't get to real action. Where do you see the action? I guess I'll do some shameless brand plug in right now. So my social media handle and the play on between two firms and so we chose between two IVs. But really, the, it'll be the nonprofit will be between two and that means between two healthcare workers and what I'm talking about healthcare workers. So who is between two IVs we started with who I am. I'm a nurse, turn ER doc, turn street doc, turn patient who's fed up with a system that's not treating their frontline workers the way it should. And so the who it's not it's not a, I look at it as not a social media platform for me. I'd rather I say this all the time not to make light of dying, but I'd rather die than be an influencer. This is very uncomfortable for me as I'm sure you guys can appreciate I see you guys nodding. This is not my forte. So I'm, you know, not chasing likes followers anything else. I'm trying to one do awareness, to answer your question directly. The first stage of my project will be awareness. And that's, you know, silly post that I'm doing interviewing people. It's really an interview based platform. Because I'm tired of hearing news stories of whatever is relevant in the news and we're not asking the frontline workers what's going on specifically when it relates to the mental health. Then there comes advocacy. I like to think that my next step personally for me is in part of my journey here is advocacy through this platform. And so I personally plan on being an advocate much like Spencer has become. And then it becomes into action, right. It's great to talk about it to your point. We recognize there's a problem. We can talk about all the literature, the science. I can we can nerd out a nerd out on it all day. But we have a problem. And so awareness is the first step. We have to advocate for ourselves is the second step. And to jump ahead of it, the solution to me is action. And for me, that looks going to look like legislative action. Part of the barriers to care and the stigma to care. Have to do with access to mental health in our line of work. As you both know, there's tons of stigmas. I know in my own practice and my own personal life. You have to report any mental health condition to the Texas medical board. At most hospitals, they have to ask. I'm of the belief that they shouldn't be allowed to create such a stigma for help. And I'm speaking as an ER doctor. And I've seen it through my colleagues, not getting help because of things like that. That lack of access to care. And then it goes past that legislative action to protect our people. I'm tired of seeing nurses, empties, medics, firefighters, police officers getting beaten up, just trying to do their job. Right. And we're starting to see that in some states. But I like it to be even more so where there's actual legal repercussions and protection to our health care workers upfront. Kudos and Godspeed and all those things like that's. It's inspiring to say the least. Spencer taking one of our questions around the list that. That you know through your experience. I know that you have thoughts here. And I'll let you and Joe sort of back and forth this one. What tips do you give medics when trying to navigate mental health issues with all of those potholes and all of those pieces to dodge that Joe just mentioned. What have you learned there and you know, maybe toss it to Joe after you give your answer as to, you know, having been in that situation is a patient. And physician and someone with emergency medicine and EMS knowledge. You know what answer do you give. your medics at Fort Bend County when they come to you with those questions. So how do you navigate it? How can you do it in today's world? Hopefully in five years, you know, you both have made your impact and this is an easier path to walk down, but today it's pretty difficult. So let's take it from today. How do you do that? So with that, I've always started people at recognition of the problem within themselves because that is the pitfall of a lot of the folks that go through mental health struggles is by the time they realize they are at the cliff, they don't know they've been walking toward it for a mile. And so what I stress first of all is recognizing that that things are different, right? That maybe your patterns of behavior at home are not the same they used to be, maybe you're interacting with people in your life differently. It really is specific to the person because we're not all the same human being, but at the end of the day, somebody would be able to notice when you start to really get introspective about that and notice that those things are changing. And that's where you can pull in things like your support network. So, you know, if you have wife, husband, kids, extended family, friends, start to check in with them if you start to feel a little bit off because they've often noticed that stuff way longer than you have. Maybe it just hasn't gotten to the point that they've noticed. So that first step is recognition. Once it gets beyond that, I really stress routine. Streat, routine, even if you're in the middle of a crisis is I think some of the best things you can do just to make sure that you stay on track with these things. And integrating exercise, journaling, eating well, connecting with people and friends, therapy, I'm a massive therapy advocate. I feel like everybody should just do maintenance therapy all the time because it just helps so much to have, you know, that professional be able to provide input and hear you out and what you're going through. So, so recognizing the problem, keeping patterns and routines, reaching out is, I would argue the best thing you can do, especially if you know someone who's been through it. One of the biggest surprises I had when I was open about it here was how many providers we had that reached out to me afterward were like, "Hey, I'm going through the same thing. What do I do?" I also tell you right now, I think I could speak for probably 90% of the people who have experienced mental health struggles. If you reach out to us and ask for advice on that stuff, we are more than happy to share our stories because we don't want people to go through the same thing we have. So, that's kind of my perspective as far as, you know, recognizing the problem, hitting it with routine, reaching out for help. I think those are the big kind of triad as far as, as far as that goes. But Dr. Gilm, I'm really curious about your answer to that because like Dr. Patrick said, I think that you, I think you bring a really special perspective there and that you've started at that nursing level, at the grant level, so to speak, right? Then moving up to a physician level, but you are also an EMS leader now. So, I would really love to see your perspective on that. Two answer. That was probably the hardest question. You guys sent me short list of questions and, you know, I'm doing this off the cuff as to be as vulnerable as you have been. People have grown to respect in this space that are advocates like yourself, Spencer. I have a lot of vulnerability, and I'll pause for a moment and just one of the things I like to tell my medics, my incharge is going for the test, et cetera. Dr. Patrick, you'll appreciate this. I tell them I was trained very early. I don't hire and fire paramedics. I stay out of that. I credential and decredential. And there's certain things that impress me. But one of them is vulnerability and why? I don't pay you, right? Dr. Patrick, do you pay anybody? No. No. Yeah. No. I wish I could head ultimate control over the budget, the taxpayer's money, et cetera. That's not how life works. So, what's our form of currency? What's my form when I talk to Dr. Patrick or do you Spencer? I say, hey, look, Casey, like, this is going on. It's trust. My only form of currency is trust. And so as a medical director, I look for people that I can trust. Now, how do you demonstrate trust? And one of that ways is being vulnerable. And for me, circling back, Spencer, that's why I appreciate your your mando medic page so much. I looked through it, and I was shocked, you know, to be honest, I was like, wow, he's really opened up. I mean, you talked about suicide on there. That takes effort. And so I don't know the exact right answer. And we could talk about it more. But I think it's exactly that it's building trust. Like, if you're going to be an advocate in this space, like you are Spencer. And for me, that's my personal answer. I want to be an advocate for my medics. So long answer short, as an e-mess medical director, you start with advocacy. And a great way to do that is to be vulnerable. So I'll I shared this recently in Fort Ben, and I'll return the vulnerability because it's a form of trust. Spencer, I said this at the symposium at Fort Ben. I've I've dealt with obsessive compulsive disorder or OCD since, well, if you ask, my mom probably since the fifth grade, I saw a psychiatrist when I was 17. And there's been plenty of other trauma. I can trauma dump all day. But that I held that to my chest since I was like, like my closest secret. I remember when I told my wife for the first time, I was like, I have to tell you something. Come here. And she's like, what's wrong? She thought I was going to tell her I had cancer, some terminal diagnosis. Because that's the way I thought I thought it was a terminal diagnosis. I was like, I'm not sure if you want to be with me. And it was emotional, but I'm at the place finally in my career where honestly, I don't give a crap. It's the least of my worries. I've been through enough in life. I'll be fine. You know, if you have to put it on some forms, which I think is ridiculous for hospitals, et cetera, I shouldn't have to report that. It's done nothing but make me a better physician in many ways. And it's been controlled by Zoloft. Surprise. That's the first time I've ever said that out loud. But it's freeing for me, but it's important. And the reason I'm doing it again is not for likes or follows. But for the simple reason of Dr. Gil, the medical director can say, oh crap, he has this chronic condition and he got help. That's okay. I, uh, I'm not too gimmicky of a guy, but I did bring one thing. But I brought my Zoloft. I've taken it since I was 17. You guys can see that the viewers can't. I'm gonna take it while on camera, but at least with you guys in front of me to prove to everyone that I'm not full of crap. But Zoloft saved my life. I've taken it every day, same dose for over 20 years. And cheers. I'm gonna take mine now. It's time. You guys can't see this as it's a podcast. We probably will have to leave the four letter word. I'm, I think balls is gender neutral that, you know, internal external. We want people around that have them. I definitely think Spencer does. But we are a, uh, safe for work podcast here. And we love our G rating. So we've done some editing before we've had, uh, we've had Jeff Jarvis on it. You know, he can't go longer than five minutes without spring. Some exploatives. So, uh, I can tell the people that can't see that, uh, that that was indeed pills that you heard rattling. And Joe really did just, uh, you know, put his money where his mouth is, so to speak. Um, you know, I didn't have an answer for that question when I wrote it. What's the role of medical, the medical director in, in mental health advocacy? And honestly, I don't know that I've even thought about it from my standpoint. I love the idea of, of trust and vulnerability. I probably lean more towards it from the standpoint of acknowledging clinical deficiencies. I think we, uh, don't do a good job there from this, from, from a medical director standpoint, or, you know, when we think about taking feedback and, and looking at ourselves in the mirror and looking at ourselves to mirror, and we don't do well, probably does lead to some mental health issues long term. Um, we're not perfect. We train ourselves to be perfect. We expect, we expect to be perfect and sitting down and looking at a clinical case that doesn't go our way. That's, we say you should do that and there's value there and you're going to get a lot out of it, but it's hard. It sucks. And, uh, being able to say, Hey, listen, I've been there. I've, I've, I've mismanaged patients. I've had patients, uh, walk in talking and die because of, uh, poor clinical pathway like that happens to have that to be able to have that big conversation with medics. I'm, I've put a lot more thought into that space and I don't know that it's that far away, maybe in the same, same zip code. Uh, number one, the medics have to trust us. And number two, I can't sit there and be holier than now, uh, because I've been there and I've done that. Uh, I, I, you can only build that with involvement and with repeated conversations and, um, you know, it's a two way street. You can't just walk into a room and expect folks to trust you. You have to build that over time. I believe that's where being at a service and involved in a place and involved in a culture, you know, it can't happen in six months. Like it's, it's, you know, especially when our services are the size that ours are that we're associated with. Uh, it's tough for me. It's probably one of my biggest wish list items. I just wish I knew everybody a little bit better, uh, because that vulnerability and trust is not a, you know, you can't just flip a switch in it and it be there. It takes relationship building, I believe. And that's what's, if you can figure out an answer to that one with a service that's growing like ours is. And I know, I know Fort Bend County is, is no different than Montgomery County. There's a new housing development and a new strip mall and a new building every time I go around any corner that's undeveloped, which eventually amounts to a new truck and more medics and more MTs and more folks for us to try to know. So that's honestly, you said I'd rather, uh, I don't know, I'm not being influencer in the end. If that was my last option, but it would be really low on the list for me. But the whole point of the podcast way back when was to try to make some asynchronous contact with our folks from an educational medical director standpoint. So it's not as good as an in person conversation in the room, you know, slap on the back, whatever it may be. But it's the best that we've had over time and hopefully it works in some in some sense Man, I just you know, I think the other piece of it that you guys both did that's ways you're said and done is and When you look at all the pieces that Spencer had in his recognition and routine and check-ins A lot of those involved conversations with other people and talk about it talking about this is something that's not segmentized and I believe over the last 10 to 15 years we've Recognized that that stigma exists. I don't know how much we really sanded it off though. I think the stigma is still there It's a little more accepted, but it's surely not a 190 degrees So and those those points were all excellent and you know y'all are no shortage of vulnerability here and man It's just you know, I to your point Spencer. It's one of those issues where once someone knows that you're in that same boat Everybody's willing to usually start helping you paddle. It's just crossing that line of letting someone else know It's way easier said than done thoughts there anything I said that you guys would agree with or push back on fire away Yeah, no, I completely agree and I think the Be the last point to about that we're willing to help each other paddle I think the hardest part for a lot of us is having a bad interaction early on with that I know me personally that was so I came up in a fire department south of Seattle and I had an old salty fire captain and an old Sarge salty ladder crew and that was you know I ran I ran six pretty gnarly pediatric arrest my first five months in EMS and fire and so After every one of them. I remember the captain, you know like I had to express something at one point that was anywhere near This didn't really sit well with me It was very much of a you know be quiet. Let's go back to work kind of a deal And so that stuck for years Even when I got here and people were pretty open about that stuff and happy to talk about it It turns into this layer of concrete that you start to build up around any chance of being vulnerable so I think that I think if we can ship away at one thing It's that it's okay to talk about the stuff and just start to introduce it to people But we also on the flip side need to be willing to have those conversations from a receiving end whether you've had mental health problems or not And I think that's something that you know, maybe as you come into fire EMS law enforcement Whatever it may be that you start to prepare yourself that you might you might come into contact with that yourself Or you may just end up being a sounding board for someone else But how critical it is that you're able to receive that information from them without you know patronizing or putting it down I agree with that Casey to your point. I think you guys are walking the walk to already if I had any EMS medical directors out there listening first of all Jarvis if you're you are listening Anything I say about data. You know how how slow I am with data. That's not my strong suit For those about there don't know dr. Jarvis is a data wizard and an EMS legend to your point case you guys walk the walk You have this space right here the fact that we're having this conversation right now It's fact that you guys care enough to break down stigmas and berries and have the conversation and hold a space for your cruise That's what every medical director can walk away answer questions directly for any Miss medical director listening out there What can you do for your cruise mental health right now? That is a hot topic conversation that is hard hard hard hard to answer I don't have all the solutions But I would want to do just like dr. Patrick's doing hold a space for your cruise to engage in those conversations You don't even have to lead it but just be willing to address it. Hey, there are some stigmas There's some bears and there are potentially some things we don't even know we're doing yet that we could be doing So let's talk about talk about its number one and then two it's it's all on to us in the action what we do I think we have a real opportunity to Unify as healthcare workers and when I say frontline healthcare workers I really lump a lot of people together. I joke I like to say like if you had a healthcare hero sign up Front of your place of work during COVID then you count so that's long-forcoming officers. Yeah, they're healthcare too. They put on AEDs They shock people all the time and so as a medical director I'm thinking about my workforce. They're not my workforce, but they are healthcare providers in my county, right? And so I have multiple officers out there that have had multiple shock one shock saves, right? And so they're healthcare workers. They had the COVID sign heroes. ER doctors. Yep. That's me my nurses Yep, the techs there. Yep. Any frontline worker firefighters police EMS even the med directors the the four-letter word ambulance driver of our service I like to joke that I'm a Double board certified and emergency medicine and I'm an ambulance driver doctor Myself depreciation or deprecation I guess for the for the day, but yeah, we have to do action So I would I would tell any emiss medical trigger open a space and do action. So the next question is what great great Joe what's what's action look like? Well, I think Casey has the nail in the head again. What about QA Casey? How many times do we we see and I've been guilty of it If I'm being honest in the past we beat our medics over the head. We money morning quarterback. Yeah, we say we don't do it We do it and we really have ourselves. It's That's a simple take home stop doing it stop doing it medical directors Because you don't like it when you work in the ER most of us work shifts and think about it when you go to that intensivist that surgeon that just Dreams you doesn't listen to you and says why don't you do that then you get that QA call when you had all those borders in the wall time and you're in the Amestok right you're an e-mess doc You know the wall time suck and that you need to do something about it, but you can even do it that day And that's I'm guessing I'm just talking about love myself now, right? Like I need to pause and we all do the QA can't be punitive. It can't be what are your thoughts on that? Well, it's a tough line to walk and I've probably spent more time in the past decade thinking about the right answer to that question Maybe than any other. I don't know. I mean, it's up there with airway safety and sedation safety and ketamine safety for me as far as How do you take a situation where our job is oh, I mean? I feel like the primary role of a medical director from my standpoint is education and oversight How do you take a situation where your job is to give feedback both positive and negative and make it as non punitive as possible To make it as non-threatening as possible when not infrequently you have to sit down with someone and say hey You didn't do a good job on this call and here's where we need to redirect next time and it doesn't mean that you're not good It means that you didn't do good in this situation Because the perspective of the person in the other chair sitting across from you know, it's a delegated practice state There's a power gradient. It's huge. I recognize that we recognize that but I don't know if there's an easy way to always make those Conversations well received I I'm we try we talk about it. We think about it. We've moved to a lot of virtual Case reviews to try to take the the spotlight nature away from it We've tried to provide as much information as to the why behind run reviews and what the The asks are for the next case so you don't walk out and say well, I just got beat up for no reason It's hey, we had to talk about this and here's where you go next time so that the next patient can be better Off, which is the goal. It's not the conversation itself. It's not really about me or the medic. It's about the next patient To try to really focus on Spotlighting the good and Spencer's played played a role with we've we've really made an effort over the past year When we're doing quality reviews, which is in a bubble as you know like the whole service doesn't see quality reviews And they don't see all the good and the fist pumping we do in that room was six or eight people like man That was that was great what an intubation and then we move on to the next case and no one hears about it. We've got You know TVs at all our stations. We use a product called Yodeck no Conflict of interest, but it's the thing that flips the screen automatically in stores or in lobbies or whatever and Spencer's been really integral in helping us create a visually attractive Version of case spotlights. So if you're out at station, you know, whatever 16 and you've got You're walking through to get your you know your morning snack or you're hitting the couch or whatever it is. You're going to your next call Going forward and I don't know if we have if we have case one up yet or not, but they're coming We're gonna rotate a spotlight case every couple weeks So it's not always you know clinical quality the medical director the you know the office of clinical bringing down some Hammer like we do really really good work, and I I think that Where we are today is it if the only time that I talk to you or that we talked to you from a clinical standpoint is A negative situation then we're not we're not doing a good enough job and of course people are gonna be resisted to that I think trust and vulnerability coming to play there too, but we've really worked on trying to balance the the good that Happens out there because there's a ton more good than there is clinical negative we have to deal in both as medical directors But I think if we only Focus on the negative didn't no wonder people are resistant. That's that's what I got right now. The spot on That's 100% true when you focus. I like to joke when I walk in if I if I get myself spun up and I come in with a bunch of what I perceive to be negative cases. I come in like a monocene of law and order like fun-bang Like you know what you know, it's a crime scene. Yeah, we're murdering everybody. We're not murdering everybody. We're doing really great care And what I perceive as murder by the way is not murder at all. It's minor hiccups and things that don't even affect the patient That just irritate me and when I calm down it helps me quite a bit but No really moving into that culture QA and I that could probably be a whole separate talk right But I think you know one I like to start with you're the man or the woman in the arena You tell me what went on I can Monday morning quarterback that screws me up all the time and I try to chart defensively as much as I can when I can there's been ships that I've had where I man I wish I'd have you know said that in the record because I'll be honest with you half the time And if any of my medics are listening if you just document a little bit more I'd probably never even pinged your email Because that makes total sense. It's like in the ER you go and this is one of my biggest pet peeves. I'll do one anecdotal little story here. One time I'm working at the mothership and I hear, "Man, I can't believe this agency gave 15 of us out of this trauma patient." I was like, "Yeah, man, that sounds a lot. It's like 15 milligrams." I said, "Man, everybody agrees 15 of it. What's that? What are they doing in slugging 15?" I was like, "All it wants? Does anybody ask them?" No. And of course we do the thing ER doctors do and other doctors do. We do the passive aggressive. They talk about the crew, but they're right around them. And so anybody in the hospital stop doing that. They hear, "You don't have to be passive aggressive with the crew. If you have questions, these are professionals you're dealing with. Engage them like a professional. If you were dealing with a colleague, another surgeon, another doctor in the hospital, would you would you talk passively aggressive around them? Hard stop? No. These are professionals. We're not dealing just with 21s. You're one year olds anymore. People are staying in the game. We're fine. This is the whole point in this podcast, by the way, right? Mental, how do we keep our people in the game? We have great people. They're professionals. So if you just engage them as professionals, yeah, that's a, that's half the QA calls though. That's the pro tip from Dr. Gilfer and Amy Mymedics. Write a good chart and then expect professionalism because I sure expect it as a medical director. I won't have my crews. I'm Casey, I know you're the exact same way. You're ferociously protective over your crews. And that's one of the things I'm not to blow smoke, but I might about you as a, no, you protect them. You protect your crews every day. And what I tell our crews is just like when the hospital complains, then I tell our crews, our job is to shield you from some of the, the stuff that maybe you don't need to hear because you don't need to be pummeled with QA left and right. Sometimes you, we need to filter some of that. And just like I won't like when the hospital has, a Dr. Patrick, what did you do with Spencer? He messed up. You know what I say? Well, I'm going to decredential him so I know. And likewise, most of our medics out there, I don't get to tell them. And I'm sure Dr. Patrick is the same way. He doesn't get to say, well, I took that CMO aside and I dressed him up and down the wall. No, he doesn't get to say that, but I can guarantee you medics out there at MCHD. He 100% does it. He is ferociously protective of you guys. So that'll be my one compliment of the year. I'll take it. I will say that you would be surprised how passively aggressively folks can handle each other in the hospital from a medic standpoint. It drives me bad. We are professionals, y'all are professionals. You deserve to be treated like adults. If I went into a bank or my CPA's office or HEB and I talked to the professionals who work in those spaces like some of our hospital colleagues can talk to each other, you get like management called on you. It's amazing the way and how much just acid on communication and communication styles that we tolerate in the healthcare space. I wish magic wand waving. Just talk to me like I'm adult. Talk to me like the fourth grade teacher at your kids parent teacher conference. And if you can't talk to the medic that way is the yard doc or the medical director, then you need to really step back and figure out where you're at. This idea that you can ring people out and that's ever really appropriate is is absurd. I think that's just a really, really solid point. And so many times with those 15 milligrams of verse ed charts that you hear about and those runs you're like, oh my god what happened. And I've definitely learned lessons here is that you know your blood does start to boil as a medical director and that steam starts to come out of your ears and and your mad and almost always there's an explanation. People get up in the morning, medics get up, EMTs get up, AMTs get up and they want to go to work and they want to do a good job and they want to take care of patients and they want to go home and be with their families. People aren't getting up to go out and do evil. It's just not the general nature of humans, especially humans that are doing these jobs that are often thankless. And so as a chart reviewer and a QI person and you know you're reading the black and white trying to paint the picture of the story so much of it is just the attitude you take from the start. And that is and I tell all of our quality folks this and this is not a lesson that I learned immediately but just to assume good in folks like from the beginning and I think that bleeds over into the hospital whether it's nursing or ED staff or our consultants when I call up a surgeon or a cardiologist and I just get that immediate pushback, argumentative interruption it's like hey I'm trying here and I'm actually calling you for help and there's really no difference in that interaction than the interaction between a medic walking into the hospital speaking to a nurse or any art physician and we have to be good stewards of that interaction and that communication environment and understand that those medics even if they gave 15 of a dazzling right they were trying to do the right thing here and out and maybe it's somebody that's got chronic issues that needs remediation and maybe the medical director needs to know about that so they can help to educate them and provide a platform and a framework but there's never never need to bring anybody out. I just I'm over that and honestly when consultants do it to me today I just stop the conversation and explain to them that there's a couple folks on earth that can talk to me that way one of them's my father and you're not him so let's restart I'm your colleague and we're professionals here's what I'm asking you for can I get an answer but you know from a mental health standpoint those those are jabs you know they're not knockout punches but they're jabs and they're hitting in the you know in the gut and you're in the fifth round you're in the sixth round if you're like me you're in the twelfth round maybe those jabs add up and to Spencer's point of you know making this a conversation that starts early is that you can you learn some defense early because you're going to get jabbed in this job you're going to get uppercuts there's going to be really rough days I mean how many pd arrests in six months Spencer that's a that's a baptism by fire it's part of the job so if it's going to be there we have to anticipate it so I've rambled enough on that and honestly y'all this has been super eye-opening conversation from my standpoint I've loved it I think the listeners are going to love it I also know that we've got more avenues that we can take here so I see this in real time as a multi-part discussion because we're already pushing our our mchd paramedic podcast link but I'll toss it back to each of you if you have any closing thoughts feel free we're going to have Dr. Gil back on because this is great Spencer it's great um closes up guys and I will take us to the finish line let's go ahead all right yeah so one last little thing because Dr. Patrick brought up the jabs keep an eye out for that because that that build up over time is usually what I ended up getting folks so I think a lot of people from mental health expect to be one big event it's usually not it's over time and it builds up so just take care of yourself keep an eye out and don't be afraid to reach out to anybody you can if you need help all right you heard it from the man doh medic in the between two IVs front I guess if anybody out there has a story I have a place for you you don't have to be as vulnerable as I am you don't even have if it's vaguely related to the mission of mental health for frontline healthcare workers it could be five second clip anybody out there I've got a spot for you with my middle micro following and come reach out to me and if you don't want to be on camera can reach up to me can reach up to Spencer come reach out to Dr. Patrick um brawl like mind of people and we might not know the answer but we can get you to the people who do we're always open podcast at mchd-x.org for new episode ideas comments feedback I would say in this episode though podcast at mchd-x.org is going to get some folks who care about you and if you're ever in need you can you can fire off to that email as well that's not the normal closing here but in today's episode I think it fits so Spencer the man doh medic on instagram the responder toolkit app search those go there Dr. Joe Gil medical director for Fort Bend County EMS between two IVs he's on instagram the stuff looks great I don't know how you get it to look that great I I deal in just audio here I don't like really to have my face up our P.O. here at mchd-mystie-willingham puts us on Instagram or on youtube sometimes and it does definitely weird me out but no thank you guys both for what you're doing in this space it's much needed and this is a conversation that will absolutely continue so thank you all for your time today as always thank you all out there for listening we appreciate your listening please send us feedback like subscribe review all of those things we'll be back again with another episode this podcast was brought to you by the Montgomery County Hospital District Texas production and editing by Andrew Adams questions or comments which are always welcome can be sent to podcast at mchd-tx.org make sure to subscribe above to keep updated to all our future castes music copyright heaven mclout and compotec.com licensed under creative comments by adromation 3.0